bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P091: The Association of Socioeconomic Status and Subclinical Atherosclerosis in a Rural Bangladesh Population
Authors: Garshick Michael , Wu Fen , Ahmed Alauddin , Sarwar Golam , Chen Yu
Published: March 2022

Background:
Cardiovascular mortality has risen 30 fold in South Asia yet there is little data on how socioeconomic status (SES) contributes to the rising cardiovascular disease (CVD) burden. In Bangladesh, CVD accounts for the majority of non-communicable mortality. The purpose of this study was to determine the role of SES on subclinical atherosclerosis measured as carotid intima media thickness (cIMT) in a rural Bangladesh population.

Methods:
cIMT was measured in 1022 participants (average age 46, 40% male) randomly selected from the Health Effects of Arsenic Longitudinal Study (HEALS), a population-based prospective cohort study based in rural Bangladesh. SES was measured with survey data as occupation type, land ownership, educational attainment, and television ownership. We assessed the association between each of these SES indicators and cIMT adjusting for potential confounders.

Results:
Over half of the participants received formal education (53%) and under half owned land (48%) and a television (44%). Women were primarily homemakers (95%) and men worked as factory workers (24%), laborers (18%), or in business (55%). In univariate analysis, those owning greater than one acre of land (p = 0.03), owning a television (p =0.02), or laborers and business owners when compared to factory workers had higher levels of cIMT (p<0.01). Educational attainment was not an independent predictor of cIMT (p = 0.7). In multivariate analysis after adjustment for potential confounders, men employed in the business sector had a 26.7 μm (95% CI 6.7 - 46.9, p < 0.01) significantly greater level of cIMT when compared to factory workers. The association was strongest in older men (50.8 μm, 95% CI 9.0 - 92.6, ≥50 years old compared to younger men (19.4 μm, 95% CI -2.0 - 40.9, <50 years old). Other SES indicators were not predictors of cIMT after multivariate adjustment.

Conclusion:
Working in the business sector was positively associated with subclinical atherosclerosis after adjustment for confounders. This finding is consistent with evidence from other developing nations suggesting that certain SES factors are independent predictors of CVD.
Abstract P094: Genetic Risk, Incident Coronary Heart Disease Events, and the Benefits of a Healthy Lifestyle: Joint and Interacting Effects Across Four US Cohorts
Authors: Del Gobbo Liana C , Salfati Elias , Li Jin , Gardner Christopher D , Ioannidis John P , Assimes Themistocles L
Published: March 2022

Background:
Recent GWAS revealed single nucleotide polymorphisms (SNPs) that cumulatively increase risk of CHD in those of European ancestry. We quantified the magnitude of preventive effects of healthy lifestyle against the countervailing effects of genetic risk on incident CHD, and assessed potential interactions.

Methods:
We extracted SNPs of genome-wide significance (<5 x 10
-8
) for CHD from CARDIoGRAMplusC4 GWAS, and created a weighted 57-SNP genetic risk score (GRS). Baseline covariates, healthy lifestyle score (including diet pattern, physical activity, smoking and BMI), and incident CHD were harmonized across 4 US cohorts (WHI, ARIC, CHS, and MESA) using dbGaP data. Pooled analyses were run using one-step individual participant data multivariate regressions in Caucasians without prevalent CVD.

Results:
Among 22,412 adults, the GRS was associated with incident CHD (n = 3001 cases) across each cohort (pooled GRS quintile (Q)5 vs Q1, RR (95% CI): 1.59 (1.41-1.79)), independent of all demographic and lifestyle variables. The lifestyle score was more strongly associated with CHD (pooled Q1 vs Q5, RR: 1.94 (1.71-2.20)) than the GRS, and better discriminated those who had a CHD event (
P
=0.025 for difference in AUROC curves). When compared to population-level analysis, joint effects analysis revealed significant heterogeneity within quartiles of lifestyle score on risk of incident CHD (
Table
). Interactions between the GRS and diet pattern (
P
=0.022) and trans fats (
P
=0.046) were observed. Effects of trans fats on CHD risk appear to be concentrated in those with a higher GRS: for trans fats >2.4% of energy, RRs for increasing GRS quartiles are 0.92 (0.62-1.36), 1.13 (0.79-1.62), 1.43 (1.01-2.01), and 1.84 (1.30-2.61), compared to those in the lowest quartile of trans fat (<1.3% of energy) and lowest GRS quartile.

Conclusion:
A joint effects approach reveals significant inter-individual variability in lifestyle on CHD risk by underlying genetic risk that is obscured by a conventional population-level effects approach.
Abstract P105: Weighted Multi-marker Genetic Risk Scores for Incident CHD Among Individuals of African, Latino or East-Asian Ancestry
Authors: Iribarren Carlos , Lu Meng , Jorgenson Eric , Martinez Manuel , Lluis-Ganella Carla , Subirana Isaac , Salas Eduardo , Elosua Roberto
Published: March 2022

Background:
GWAS have identified genetic variants associated with coronary heart disease (CHD). One of the potential uses of these genetic biomarkers is to improve the predictive capacity of existing risk functions. We studied the clinical utility of 4 multi-locus genetic risk scores (GRS’s), previously validated in European subjects, among persons of African (AFR), Latino (LAT) and East-Asian (EA) ancestry.

Methods:
We used data from the GERA cohort of Kaiser Permanente in Northern California (30-74 years old, 69 to 73% female) that included 2,079 AFR, 4,329 LAT and 4,801 EA. We generated 4 GRSs based on 8, 12, 36 and 51 SNPs, respectively, associated with CHD weighted by the magnitude of the association reported by the CardiogramplusC4D Consortium. We used the Framingham Risk Score (FRS) to estimate 10-year CHD risk (< 10%=low, 10 to 20%=intermediate, > 20%=high).

Results:
After a mean (± SD) follow-up of 5.9 (± 1.5) years, 77, 109 and 101 incident CHD events (AMI, angina pectoris, revascularization procedures and/or CHD death) were documented in AFR, LAT and EA, respectively. In models adjusted for individual FRS risk factors and principal components, GRS_8 and GRS_51 were significantly associated with CHD among LAT while GRS_36 and GRS_51 were significantly associated with CHD among EA. In fixed effects meta-analysis there was no evidence of heterogeneity (all p>0.53). The inclusion of the GRS on top of the FRF did not improve the Harrel’s C-statistics in any of the ethnic subgroups nor in the meta-analysis. The bias-corrected NRI in the intermediate FRS group (c-NRI) was statistically significant for GRS_8 and GRS_12 in EA and in the meta-analyses.

Conclusions:
All 4 GRS’s were linearly and directly associated with an increased risk of CHD events among minority subjects in GERA. Reclassification was overall better for GRS_8 and GRS_12 than for GRS_39 or GRS_51. These results support the consideration of the inclusion of genetic information in classical functions for risk assessment among subjects of minority background.
Abstract P108: Genome-wide Association Study of Activated Partial Thromboplastin Time in Multi-Ethnic Populations
Authors: Seyerle Amanda A , Basu Saonli , Fuchsberger Christian , Germain Marine , Guan Weihua , Kacprowski Tim , Greinacher Andreas , Kleber Marcus E , Delgado Graciela , März Winfried , Morange Pierre-Emmanuel , Pankratz Nathan , Tregouet David-Alexandre , Pankow James S , Tang Weihong
Published: March 2022

Background:
Activated partial thromboplastin time (aPTT) is a clinical test used to measure the clotting time between the activation of factor XII and the formation of a fibrin clot. Prolonged aPTT indicates a deficiency in the coagulation pathway while shortened aPTT is associated with prothrombotic risk factors and venus thromboembolism. Despite the high heritability of aPTT (40-80%), previous genome-wide association studies (GWAS) of aPTT have been limited to European descent populations, with only a smaller candidate gene study conducted in African Americans.

Methods:
We included 13,803 participants of European ancestry (EU) and 2,724 participants of African American ancestry (AA) from the Cohorts for Heart and Aging Research in Genetic Epidemiology (CHARGE) consortium. aPTT, in seconds (s), was measured using standard protocols in plasma with the use of automated coagulometers. Genotype data were imputed to the 1000 Genomes Phase 1 reference panel, and associations were examined using linear regression assuming an additive genetic model and adjusting for global ancestry, age, sex, and study design. Study-specific results were combined using a fixed-effects, inverse variance weighted meta-analysis.

Results:
We identified seven loci associated with aPTT in EU populations (
F5, FRMD5, KNG1, F11, F12, HLA, ABO
) and three loci associated with aPTT in AA populations (
KNG1, F12, ABO
) at genome-wide significant levels (
P
< 5x10
-8
). These results are consistent with previously reported genetic studies in EU and AA populations. Effect sizes were larger in AA populations (1.08 to 1.32 s) than in EU populations (0.40 to 1.00 s).

Conclusions:
We successfully replicated associations with aPTT at seven loci in EU populations and three loci in AA populations. Our results suggest that genetic determinants of aPTT are consistent across race/ethnicity but that studies in AA populations are currently underpowered relative to EU populations. Future work in aPTT genetics should consider more diverse populations.
Abstract P111: A Genome-Wide Gene Expression Study of Blood Pressure in Twins
Authors: Huang Yisong , Ollikainen Miina , Kaprio Jaakko , Hao Guang , Su Shaoyong , Wang Xiaoling
Published: March 2022

Background:
Recently, a genome wide gene expression study identified 34 genes that were differentially expressed in relation to blood pressure (BP). However, to what extend these BP related gene expression signatures are driven by genetic factors or environmental factors have not been investigated.

Methods:
In this study of 383 twins (84 DZ pairs, 105 MZ pairs and 5 singletons; age 32-69; 40% male) recruited from the Finland Twin Cohort Study, genome-wide gene expression data in peripheral leukocytes were obtained using illumine HT12 V4 array. Systolic and diastolic BP related gene expression changes were identified using linear mixed model. Structural equation modeling was used to estimate the genetic and environmental sources of variance of BP related gene expression signatures.

Results:
Our genome wide gene expression analysis identified 1 gene (
ECT2
, FDR=0.019) with its expression level associated with SBP and 1 gene (
LMNA
, FDR=0.004) with its expression level associated with DBP at the cutoff of FDR<0.05. Out of the previously identified SBP (N=21) and DBP related genes (N=20), 5 genes (
CD97, TAGLN2, MYADM, SL31A2
and
TIPARP
) for SBP and 5 genes (
CD97, S100A10, MYADM, TIPARP
and
SLC31A)
for DBPcan be replicated in the twin cohort with same directions and p<0.05. Four genes showed association with both SBP and DBP. Structural equation modeling was conducted on the expression levels of the newly identified BP related genes as well as the ones that were previously identified but can been replicated in this study. Out of the 8 genes, genetic factors contributed significantly to the expression of 2 genes (
LMNA
and
S100A10
) and shared environmental factors contributed significantly to the expression of 1 gene (
MYADM
), while for 5 genes, both genetic and shared environmental factors have significant contributions to their gene expression levels.

Conclusion:
In this study of twins, we identified novel genes with its expression level associated with BP and replicated several previously identified signals. Our study further provides new insights into the genetic and environmental sources of BP related gene expression signatures.
Abstract P122: The Clinical Impact of TC/HDL-C Discordance With LDL-C and Non-HDL-C: 20 Year Follow-up of the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Quispe Renato , Elshazly Mohamed B , Zhao Di , Toth Peter P , Sniderman Allan D , Puri Rishi , Virani Salim S , Martin Seth S , Jones Steven R , Michos Erin D
Published: March 2022

Introduction:
TheTotal to High-Density Lipoprotein cholesterol (TC/HDL-C) ratio may carry unique prognostic information for atherosclerotic cardiovascular diseases (ASCVD) risk beyond the more commonly used measures of low-density lipoprotein (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C). Information regarding patient-level discordance between these lipid parameters may be clinically relevant in refining risk stratification.

Methods:
We studied 14,393 ARIC participants free of ASCVD at baseline who were mean age 54 years, 56% women, and 25% black. Lipids were measured at baseline (1987-1989) and at four additional visits. TC/HDL-C discordance with non-HDL-C and LDL-C (defined by categories above/below the median) was updated at each visit. Participants were followed for ASCVD events through end of 2013, with mean follow-up of 20 years. Multivariable-adjusted Cox hazard models were used to estimate for ASCVD risk for each category.

Results:
Among participants with low LDL-C <median, a discordantly high TC/HDL-C ≥median was associated with a greater ASCVD risk compared to those concordantly low for both TC/HDL-C and LDL-C. Those with low non-HDL but a discordantly high TC/HDL-C also had greater ASCVD risk than those concordantly low for both measures
(Table).

Conclusions:
In a primary prevention population,the TC/HDL-C ratio provides additional prognostic information to non-HDL-C and LDL-C. Individuals who reach low levels of LDL-C or non-HDL-C may still be at high risk of ASCVD if TC/HDL-C is discordantly high.
Abstract P141: Biological and Socioeconomic Determinants of Dysglycaemia in Canadian Youth
Authors: Feely Allison , Rodd Celia , Dart Allison , Sharma Atul , McGavock Jonathan
Published: March 2022

Background:
Population-based rates of prediabetes or dysglycaemia (i.e. elevated A1C) among low-risk youth are not well described. Moreover, the biological and socioeconomic determinants of an elevated A1C in youth remain poorly understood.

Methods:
Youth aged 6-19 years who participated in the first (2007-2009) or second (2009-2011) cycles of the Canadian Health Measures Survey (CHMS) were included in our analyses. The primary outcome, dysglycaemia was defined using A1C guidelines established by the American Diabetes Association (ADA: 5.7%-6.4%) and Canadian Diabetes Association (CDA: 6.0%-6.4%). Various biological and socioeconomic determinants were compared between healthy and dysglycaemic youth using two sample t-tests and χ
2
tests (Table 1). Multivariable logistic regression was used to calculate adjusted odds ratios for dysglycaemia. Age stratified regression was performed to adjust for physical activity. All analyses were unweighted.

Results:
Of the 3449 youth studied, 785 (22.8%) and 179 (5.2%) displayed dysglycaemia according to ADA and CDA definitions, respectively. Youth with dysglycaemia (ADA definition) were more likely to be male (55.4 v 50.6%, p=0.02), non-white (24.8 v 14.6%, p<0.001) and obese (16.2 v 10.8%, p<0.001). Dysglycaemia in youth was more common in those living in households with middle income adequacy (32.6 v 26.8%, p=0.006) and lower levels of parental education (high school or less, 15 vs 11.4%, p=0.007). Similar associations were found using CDA definition. In the adjusted logistic regression model (age ≥12y), significant predictors were age, race, income adequacy, geographic region, obesity (OR=1.60, 95% CI: 1.08-2.35) and physical activity (monthly frequency of activity longer than 15 minutes, OR=0.97, 95% CI: 0.95-0.99).

Conclusion:
Nearly 1 of every 5 youth in Canada are at risk for type 2 diabetes, based on early elevated A1C. Elevated A1C in youth is associated with social determinants of health and some lifestyle factors and both should be addressed in prevention efforts.
Abstract P142: Social Jetlag is Associated With Adiposity in 8-10 Year Old New Zealand Children
Authors: Stoner Lee
Published: March 2022

Background:
Childhood obesity has been associated with poor sleep behaviour, including sleep duration, sleep disorders and social jetlag. Social jetlag is the discrepancy between an individual’s circadian clock and social rhythms, and is measured as the difference in hours between the midpoint of sleep at work/school and free days. While social jetlag has been associated with being overweight adults, no known studies have examined whether obesity is associated with social jetlag in children. We hypothesized that poor sleep behavior, including sleep duration, sleep disorders and social jetlag, would be associated with body composition in in 8-10 year old New Zealand children.

Methods:
This cross-sectional study recruited 341 children (50% F) aged 8-10 years from three representative sample sites across New Zealand. Four dependant variables were calculated: body fat (%), fat mass index (FMI, kg/m
2
), waist to hip ratio (WHR), and body mass index (BMI, kg/m
2
). The three independent variables were: average sleep duration, social jetlag, and sleep disorders. Sleep duration was recorded using a parent-reported, single item habitual school/weekday sleep survey. Social jetlag was calculated as the absolute difference between the midpoints of sleep on weekdays versus weekend days. Sleep disorders were estimated using the Children’s Sleep Habits Questionnaire.

Results:
Following adjustment for confounders, sleep duration was only associated WHR (
β
= -0.008, 95%CI: -0.015, 0.000), and sleep disorders was only associated with FMI (
β
= -0.034, 95%CI: 0.002, 0.067 kg/m
2
), while social jetlag was associated with all four body composition variables. A one hour increase in social jetlag was associated with a 2.98 % (95%CI: 0.41, 5.55 %) increase in body fat, 0.51 kg/m
2
(95%CI: 0.11, 0.91 kg/m
2
) increase in FMI, a 0.90 kg/m
2
95%CI: 0.21, 1.58 kg/m
2
) increase in BMI, and a 0.13 (95%CI: 0.003, 0.023 increase in WHR.

Conclusions:
In conclusion, Social jetlag may be a particularly important sleep behaviour correlate of adiposity in children. Moreover, social jetlag provides an opportunity for a relatively simple and measurable public health strategy.
Abstract P144: Being Born Small for Gestational Age and Later Cardiac Structure and Function in Adolescence
Authors: Timpka Simon , Hughes Alun D , Chaturvedi Nishi , Franks Paul W , Lawlor Debbie A , Fraser Abigail
Published: March 2022

Background:
Evidence suggests that impaired fetal growth is associated with increased risks of ischemic heart disease, atrial fibrillation, and stroke. Less is known about the potential association between low birth weight (small for gestational age; SGA) and cardiac structure and function later in life.

Methods:
1,592 participants (54% females) from a UK birth cohort were examined with echocardiography at mean age 17.7 years (SD 0.3). Using regression models we investigated the association between being born SGA and adolescent cardiac structure and function; left ventricular mass indexed to height
2.7
(LVMI), relative wall thickness (RWT), left atrial size indexed to height
2.7
, ejection fraction, s’, and E/e’. Birth weight Z-score (by gestational week and sex) was defined according to an external reference based on UK data from the same time period as the births of the participants. SGA was defined as Z-score ≤5th percentile. Birth weight was also analyzed using linear splines with predefined knots at the 5
th
, 50
th
and 95
th
percentile to allow for potential non-linearity in associations. Main models were adjusted for age, sex and several maternal factors: height, pre-pregnancy BMI, gestational diabetes, gestational week at birth, hypertensive disorders of pregnancy, smoking, and education.

Results:
Adolescents born SGA had smaller LVMI (-2.12 g/m
2.7
; 95% Confidence Interval (CI) -3.69 to -0.55). SGA was also associated with greater mean ejection fraction (2.24, 95% CI 0.62 to 3.87) compared to non-SGA adolescents. In the linear spline analyses, we observed a positive increase in LVMI per one unit increase in birth weight Z-score among those born SGA (3.56 g/m
2.7
, 95% CI 0.95 to 6.17) and a negative change of slope in the next interval (birth weight between 5
th
and 50
th
percentile, p=0.02). There was no support for any associations between SGA, including the spline analyses, and the other outcomes (RWT, left atrial size indexed to height
2.7
, s’, and E/e’). The association between SGA and left ventricular mass was evident also without indexing for body size, and when indexing by body surface area or (height in m)
1.6
.

Conclusion:
Being born SGA appears to be associated with certain aspects of cardiac structure and function in adolescence, which later in life predict the development of clinical heart disease. Smaller left ventricular mass in adolescence might predispose those born SGA to be more susceptible to adverse cardiac remodeling later in life.
Abstract P146: Parental Influences on Children’s Healthy Behaviors
Authors: Marcotte Kayla , Krallman Rachel , DuRussel-Weston Jean , Kline-Rogers Eva , Jackson Elizabeth A , Eagle Kim A
Published: March 2022

Background:
The effect of parental health behaviors on children has not been well studied. This study examined how sixth-grade students’ health behaviors were influenced by perceptions of their parents’ health behaviors.

Methods:
Sixth grade students from 60 schools in Michigan participating in Project Healthy Schools were eligible for this study. Data on children’s and parents’ dietary, physical activity, and sedentary habits were collected through a validated health behavior questionnaire. Health behaviors analyzed included physical activity, screen time, sugary beverage consumption, fast/fatty food consumption, and fruit/vegetable consumption. Logistic regressions were used to determine the effect of parents’ health behaviors on their children’s health behaviors.

Results:
4065 students completed the health behavior questionnaire. Children were more likely to have healthy physical activity habits if their parents also had healthy physical activity habits. Children were more likely to have healthy screen time habits if their parents had healthy screen time, fast/fatty food, and sugary beverage habits. Children were more likely to have healthy sugary beverage habits if their parents had healthy sugary beverage, fruit/vegetable, and fast/fatty food habits. Children were more likely to have healthy fast/fatty food habits if their parents had healthy fast/fatty food, screen time, and sugary beverage habits. Children were more likely to have healthy fruit/vegetable habits if their parents had healthy fruit/vegetable, physical activity, and fast/fatty food habits.

Conclusions:
Parent behaviors were strong predictors of child behaviors in the same category (e.g. high parental physical activity predicted high child physical activity) for all health behaviors assessed. All behaviors except physical activity were influenced by a multiple parent behaviors, suggesting more complex relationships. Further investigation may provide insight into strategies to improve children’s health behaviors.
Abstract P149: Associations Between Perinatal Risk Factors and Childhood Cholesterol and Blood Pressure
Authors: Lilly Christa , Umer Amna , Hamilton Candice , Britton Cris , John Collin , Neal William
Published: March 2022

Introduction:
There is growing evidence that early-life risk factors may influence the development of cardiovascular disease (CVD) in later life. The goal of this study was to examine the associations between numerous early life exposures and subsequent childhood hypertension and dyslipidemia at 11 years of age to identify the modifiable risk factors.

Methods:
The study used longitudinally linked data from three cross-sectional datasets in West Virginia (N= 22,136). The outcome variables included pre-hypertension/hypertension defined as ≥ 90th percentile for SBP (>124mmHg) or DBP (>80mmHg) and dyslipidemia defined as LDL ≥130mg/dl and HDL <40 mg/dl. Logistic regression was used to examine the association between the two outcomes and an extensive list of perinatal predictors, including sex, race, health insurance status, family history of cholesterol and cardiovascular disease, smoking during pregnancy, maternal age at birth, breastfeeding intention at birth, and birth weight of the infant.

Results:
The results showed that approximately 21% (4482 of 21817) of the children had hypertension and one fourth had dyslipidemia (24.6%, 4481 of 18184) in fifth grade. Increased odds for childhood hypertension was associated with age of the child in fifth grade, male gender, race (other compared to white), family history of cholesterol, and no maternal intention of exclusively breastfeeding their infant. Increased odds for childhood dyslipidemia was associated with family history of cholesterol, family history of cardiovascular disease, and maternal smoking during pregnancy. Notably, two modifiable perinatal risk factors stood out: mothers who did not intend to exclusively breastfeed had children who had significantly higher odds of having hypertension in fifth grade (OR: 1.2, 95%CI: 1.1, 1.3) compared to mothers who intended to exclusively breastfeed. Additionally, mothers who smoked during pregnancy had children who had significantly higher odds of having dyslipidemia in fifth grade compared to mothers who did not smoke (OR: 1.3, 95%CI: 1.2, 1.4).

Conclusion:
Surprisingly few perinatal factors were associated with childhood hypertension and dyslipidemia. The perinatal modifiable factors for hypertension and dyslipidemia included intent to breastfeed and maternal smoking during pregnancy; thus, smoking cessation and exclusive breastfeeding should be encouraged.
Abstract P160: Weight Management Program Characteristics: Keeping Patients Engaged Through Group Activities
Authors: Graham Laura A , Richman Joshua , Levitan Emily B
Published: March 2022

Introduction:
Weight management programs must be effective at engaging patients in order to be successful. However, few studies have examined program characteristics associated with better patient engagement.

Hypothesis:
The objective of this study was to assess patient engagement on a facility-level in the nation’s largest population-based weight management program (MOVE!).

Methods:
Facility-level data were collected from the Veterans Health Administration (VHA) Support Services Center. Patient engagement was measured as the average number of MOVE! visits per patient per year (VPY). Bivariate statistics were examined and multivariate-adjusted generalized linear models were used to examine factors associated with VPY.

Results:
We identified 140 VHA hospitals enrolled in MOVE! between 2008-2013 representing a nationwide sample of 462,132 patients with over 3 million visits. The 140 hospitals were distributed across the nation and represented a population that was 15% female, 72% white, and 34% rural. In 2008, 96% of MOVE! programs offered group counseling, 53% offered weight loss medications, and 26% offered bariatric surgery. The average facility VPY was 5.3 (SD 2.9) and increased from 4.9 (SD 3.9) in 2008 to 6.3 (SD 2.8) in 2013 (p<.01). Factors associated with higher facility VPY were more administrative staff support (p<.01), group counseling (5.3 vs. 3.3, p=0.01), and higher proportions of group counseling sessions among all MOVE! visits at a facility (p<.01). In adjusted analyses, facilities offering group counseling reported 1.8 more VPY than facilities without group counseling (p=0.01, Figure). Offering weight loss medications (p=0.76) and bariatric surgery (p=0.57) had no effect on engagement.

Conclusions:
Our study demonstrates that weight loss programs offering group counseling may be more effective at engaging patients in the intervention. These findings identify potential areas for improving utilization of weight management programs.
Abstract P166: Multimorbidity and Risk of Mortality in China: Results From the Chinese Electronic Health Records Research in Yinzhou (CHERRY) Study
Authors: Lin Hongbo , Zhang Dudan , Shen Peng , Xu Zhe , Si Yaqin , Tang Xun , Gao Pei
Published: March 2022

Introduction:
The prevalence of multimorbidity is increasing in developed countries, while corresponding research in Chinese population is limited.

Methods:
A population-based cohort in Yinzhou located in an eastern coastal area of China (961,008 adults ≥18 years in 2009; latest mortality follow-up: Nov 2015; 22,637 deaths; 6.53 million person-years at risk) was assembled by linking epidemiological surveys, electronic records for chronic disease management, health administrative and medical records databases. Multimorbidity was defined as the presence of two or more following disorders: hypertension, diabetes, cardiovascular disease or cancer. History of selected diseases was extracted from the electronic records for chronic disease management. Follow-up on fatal events is achieved through records linkage to the regional system of death surveillance.

Results:
Overall age- and sex-standardized prevalence of one, two or ≥3 disorders were 16.16% (16.09% - 16.23%), 4.11% (4.07% - 4.15%) and0.36% (0.35% - 0.38%) respectively, whereas 41.73%, 14.41% and 1.67% were observed in people aged 60 years and older. The all-cause mortality rate adjusted to the age of 60 was 4.77 per 1000 person-years. Comparing to people without any selected diseases, the age- and sexadjusted HRs for all-cause mortality were 1.17 (1.14, 1.21) in those with one disorder, 1.78 (1.72, 1.86) in those with two morbidities, and 2.97 (2.76, 3.19) in those with ≥3 morbidities. The HRs in those with multimorbidites were higher in younger people and were heterogeneous among different combinations of multimorbidites. Population-attributable fractions (PAF) for all-cause mortality due to one, two or ≥3 disorders were 2.63%, 3.04% and 0.67% respectively (1.28%, 7.69% and 2.34% in people aged 60 years and older).

Conclusions:
The CHERRY study can serve as a valuable big data resource for scientific research in China. Multimorbidity is becoming acommon condition in Chinese population, especially in older population, and is associated with high mortality. A complementary strategy is required for population health interventions.
Abstract P181: Temporal Relationship Between Changes in Body Weight and Insulin Resistance and Its Impact on Blood Pressure in Response to 2-year Weight-loss Diet Interventions: the POUNDS Lost Trial
Authors: Han Liyuan , Zhang Tao , Sun Dianjianyi , Ma Wenjie , Wang Tiange , Heianza Yoriko , Chen Wei , Bray George A. , Sacks Frank M , Qi Lu
Published: March 2022

Introduction:
Changes of body weight and insulin resistance (IR) are closely correlated, and their temporal sequences in affecting blood pressure (BP) remain poorly defined. We examined the temporal sequences of weight loss and change of IR, and their relations with blood pressure in the Pounds Lost trial, a randomized weight-loss diet intervention study.

Hypothesis:
We hypothesized a one-directional temporal relation between weight loss and change of IR in affecting BP during weight-loss diet interventions.

Methods:
The present study included overweight/obese adults, who were randomized in a 2х2 factorial design to diets containing 20% or 40% fat and 15% or 25% protein (diets with 65%, 55%, 45% and 35% carbohydrate). Weight, IR, systolic and diastolic BP levels were measured at baseline, 6 and 24 months. After excluding the subjects who took antihypertensive or weight-loss drugs, cross-lagged path and mediation analysis were performed among 540 participants.

Results:
After adjusting for age, race, sex, and diets groups, the cross-lagged path coefficient from baseline weight to 24-month IR (β
1
=0.135,
P
=0.04) was significantly greater than the path coefficient (β
2
=0.022,
P
>0.05) from baseline IR to 24-month weight (
P
<0.05 for the difference in βs), indicating that weight-loss preceded change of IR. The mediation effects of 24-month IR on the 24-month systolic BP and diastolic BP were estimated at 17.03%(
P
=0.004) and 20.94% (
P
=0.034), respectively.

Conclusions:
Our dataindicate that weight loss precedes change of IR in affecting changes of BP in response to weight loss diet interventions.
Figure 1
. Covariate-adjusted path coefficients from baseline weight to 24-month IR; β
1
and β
2
are cross-lagged path coefficients; r
2
and r
3
are tracking correlations; The difference between β
1
and β
2
was tested using Fisher Z test;
*
P<0.01,
†
P<0.05 for difference between β
1
and β
1
.
Abstract P190: Hypertension, Hypertension Awareness and Depressive Symptom Severity in a Large Hispanic Population
Authors: Goldmann Emily , Roberts Eric T , Boden-Albala Bernadette
Published: March 2022

Introduction:
Limited evidence suggests that greater psychological distress among those with elevated blood pressure may be due to awareness or labeling of this condition rather than elevated blood pressure itself. However, studies have not examined this phenomenon among specific race/ethnic groups, among whom chronic disease and disease diagnoses may have varied psychological impact due to group-specific cultural, social, and health-related factors.

Hypothesis:
Hispanic adults with a lifetime hypertension (HTN) diagnosis will have elevated depression symptom severity compared to those without a diagnosis, regardless of current HTN status.

Methods:
As part of a large community survey of health and health behaviors, 3,403 Hispanic adults residing in Northern Manhattan were assessed for past month depression symptoms using the Patient Health Questionnaire (range 0-27). Systolic and diagnostic blood pressure (SBP, DBP) was calculated as the average of the last two of three sphygmomanometer readings. Using JNC 7 criteria, current HTN was defined as SBP≥140 mmHg or DBP≥90 mmHg. Participants were also asked to report whether they had ever been diagnosed with HTN by a health professional, and were categorized into four groups: (1) no diagnosis, no current HTN, (2) no diagnosis, current HTN, (3) diagnosis, no current HTN, (4) diagnosis, current HTN. Analysis of variance evaluated the overall association between HTN group and mean depression score. Multivariable linear regression further examined differences in mean depression score by HTN group adjusting for age, sex, marital status, education, and insurance status.

Results:
More than half of participants had no diagnosis and no current HTN (group 1: 56.6% [1,889 of 3,332]), while 27.4% (912 of 3,332) had HTN but no diagnosis (group 2), 5.7% (187 of 3,332) had a diagnosis but no HTN (group 3), and 10.3% (344 of 3,332) had HTN and a diagnosis (group 4). Mean depression score was higher among those with a diagnosis compared to those without (group 1=0.86, group 2=1.48, group 3=0.78, group 4=1.76, p<0.01). In the adjusted regression model, only groups with a diagnosis had significant, albeit modestly, higher mean depression scores compared to group 1, and mean depression score did not differ significantly between these groups (group 2: beta=0.43, p<0.01; group 3: beta=-0.11, p=0.66; group 4: beta=0.72, p<0.01). Sensitivity analyses that varied the definition of HTN and restricted to those with no other chronic disease yielded similar results.

Conclusions:
This study supports previous work highlighting the psychological impact of HTN diagnosis and extends this evidence to Hispanic adults. Findings from this study may have important implications for clinical practice and strategies to improve mental health among those with chronic illness.
Abstract P199: Development of an Algorithm for Identifying Fatal Cardiovascular Disease in Medicare Claims
Authors: Xie Fenglong , Colantonio Lisandro , Curtis Jeffrey , Kilgore Meredith , Levitan Emily , Monda Keri , Safford Monika , Taylor Ben , Woodward Mark , Muntner Paul
Published: March 2022

Introduction:
Administrative claims data including Medicare are often used to study cardiovascular disease (CVD). Approximately one-third of CVD events are fatal, but claims data lack information on cause of death and claims-based analyses only include non-fatal outcomes.

Objective:
To develop claims-based algorithms to discriminate fatal stroke, fatal coronary heart disease (CHD), and fatal CVD (fatal CHD or stroke) from deaths due to other causes.

Methods:
We analyzed data for REasons for Geographic and Racial Differences in Stroke (REGARDS) study participants who died between January, 1, 2003 and December, 31, 2013, and were age ≥65.5 years and had at least 182 consecutive days of fee-for service Medicare coverage prior to their death. Deaths within 28 days following an expert-adjudicated stroke, CHD, and CVD event in REGARDS were defined as the gold standard. Logistic regression was used to develop algorithms including demographic data, ICD-9-CM diagnosis and procedure codes from Medicare claims for hospitalization and outpatient visits. We chose cut-points of predicted probability to define fatal stroke, CHD and CVD using these algorithms. Cut-points were chosen such that a similar proportion of participants had a fatal stroke, fatal CHD, and fatal CVD through REGARDS adjudication and the algorithms.

Results:
We analyzed data for 2,675 deaths among REGARDS study participants; 142 fatal strokes, 479 fatal CHD events, and 608 fatal CVD events. The algorithms are described in the footnote to the Table. C-statistics for the algorithms were 0.966 (95%CI 0.948, 0.980) for fatal stroke, 0.861 (95%CI 0.843, 0.878) for fatal CHD and 0.883 (95%CI 0.868, 0.898) for fatal CVD. Sensitivity, specificity, and positive and negative predictive values using cut-points of 24%, 30%, and 34% predicted probabilities for fatal stroke, fatal CHD and fatal CVD, respectively, are provided in the Table.

Conclusion:
The algorithms we developed can be used to identify Medicare beneficiaries with fatal CVD events.
Abstract P200: Estimating the Receiver Operating Characteristics (ROC) Curve and its Associated AUC in Matched Case Control Studies
Authors: Balasubramanian Raji , Xu Hui , Whitcomb Brian W , Hankinson Susan E , Paynter Nina , Rexrode Kathryn M , Qian Jing
Published: March 2022

Background:
The matched case-control study design is frequently used in cardiovascular disease research and can result in significant gains in efficiency; however, prediction in this setting is not straightforward. We propose an inverse-probability weighting approach to estimate the predictive ability associated with a set of covariates.

Methods:
We consider AUC estimation in 1:m matched case control studies and compare its bias with logistic regression in simulations. Let
X
denote the vector of exposures,
Z
the vector of matching factors and Y the binary outcome. We assume the population logistic model: logit [Pr(Y = 1
Abstract P213: Industry and Non-Profit Partnerships as an Effective Model for Implementation of Community-Based Nutrition Interventions
Authors: Vafiadis Dorothea , McKnight Liz , Gavras Heather , Robb Karen , Denning Meg , Shay Christina
Published: March 2022

Introduction:
Consuming fruits, vegetables and whole grains is associated with lower risk of cardiovascular disease. Community-based nutrition programs are an effective approach to changing attitudes and behaviors around food and health in underserved populations. The American Heart Association and Aramark launched
Healthy for Life 20 by 20, a
five-year initiative to increase fruits, vegetables and whole grains by 20 percent. A major focus of their collaboration was the development and implementation of a 12-week community-delivered nutrition engagement pilot. The purpose of this pilot was to evaluate the effectiveness of this health program in improving healthy food purchasing behaviors, nutrition and lifestyle choices.

Methods:
A 12-week pilot intervention was designed and implemented in three cities at five community centers March-June 2016. Weekly sessions were focused on enhancement of healthy cooking and shopping skills, nutrition education, and assessment of personal cardiovascular risk factors. Participating centers had the option to choose from two delivery methods: optimal and flexible. Participant fruit and vegetable intake, whole grain intake, and number of meals prepared at home were assessed before and after completion of the intervention.

Results:
Study participants (n=119) were predominately female (79%), Hispanic (60%) and African-American (27%), had high school or lower educational attainment (67%), lower income (39% < $20K, 40% $20K-$39.9K), young and middle ages (45% <34 years old, 27% 35-44), and 52% had ≥ 2 children living in their household. Three-quarters of participants (76%) had no previous experience participating in health and wellness programs. The median consumption of fruits/vegetables among participants increased by 2 servings/day (3.0 to 5.0) and over two-thirds of participants (69%) increased their fruit/vegetable consumption by at least 1/2 a serving. The median consumption of whole grains increased by 1 serving/day (1.0 to 2.0) and half (48%) of participants increased their whole grain consumption by at least 1 serving. Forty-five percent of participants (n=87) increased their percentage of eaten meals prepared at home each week.

Conclusions:
The use of industry and non-profit partnerships in a community engagement format can be an effective way to facilitate programs focused on increasing consumer trust for shopping and cooking, to build confidence of new skills, and to empower individuals to improve their health and potentially the health of their family. These results suggest that this community engagement partnership approach can positively transform health in communities and drive the American Heart Association’s goal of improving Americans’ health by 20% by 2020.
Abstract P220: Plasma Trans-fatty Acids and Metabolic Syndrome Among US Adults: Findings From NHANES 1999-2000 and 2009-2010
Authors: Zhang Zefeng , Gillespie Cathleen , Yang Quanhe
Published: March 2022

Background:
Previous studies examined the association between trans-fatty acids (TFAs) and individual components of metabolic syndrome, not simultaneously. In addition, no study has examined if the relationship might become undetectable after significant reduction in TFA intakes.

Objective:
To examine and compare the association between plasma TFA levels and metabolic syndrome before and after the U.S. Food and Drug Administration enacted food labeling regulations for TFAs in 2006.

Methods:
We used data on 1442 and 2233 adults aged 20 years or older from NHANES 1999-2000 and 2009-2010, respectively. Multivariable logistic regression analysis was used to assess the association between plasma TFAs concentration and metabolic syndrome and each of its five individual components.

Results:
The median plasma TFAs level was reduced from 79.8 μmol/L in 1999-2000 to 36.9 μmol/L in 2009-2010. The adjusted prevalence ratios comparing the highest quartile vs. those in the lowest quartiles of plasma TFAs concentration in 1999-2000 were 3.45 (95% confidence interval, 2.42-4.92) for metabolic syndrome, 1.71 (1.37-2.13) for large waistline, 8.45(6.62-10.77) for high triglycerides level, 1.96 (1.48-2.59) for low HDL cholesterol level, 1.14 (0.85-1.52) for high blood pressure, and 1.49 (1.19-1.85) for high fasting blood sugar, respectively. The corresponding adjusted prevalence ratios in 2009-2010 were 2.92 (2.41-3.54), 1.62 (1.40-1.88), 15.10 (9.39-24.30), 3.09 (2.19-4.37), 1.27 (1.11-1.47), and 1.24 (1.06-1.46), respectively. The observed associations were consistent across age groups, sexes, race-ethnicities, education, dietary intake, physical activity, body mass index, and statin use categories.

Conclusions and Relevance:
Plasma TFAs concentration was positively associated with risk of metabolic syndrome and its individual components except for blood pressure in 1999-2000. Our findings support initiatives to remove TFAs from industrially-produced foods.
Abstract P222: Moderate Alcohol Consumption is Associated With a Lower Risk of Coronary Artery Disease: The Million Veteran Program
Authors: Song Rebecca J , Nguyen Xuan-Mai T , Quaden Rachel M , Ho Yuk-Lam , Justice Amy C , Cho Kelly , O’Donnell Christopher J , Concato John , Gaziano J. Michael , Djousse on behalf of the MVP investigators Luc
Published: March 2022

Introduction:
Moderate alcohol consumption has been shown to protect against coronary artery disease (CAD) in the general population, but this relationship has not been well studied among U.S. Veterans.

Methods:
61,587 Million Veteran Program (MVP) participants completed a baseline and lifestyle survey that included questions about frequency and volume of alcohol consumption. We combined grams of ethanol in wine, beer, and spirits to create the exposure variable for this analysis. Using the VA electronical health record, incident CAD events included myocardial infarction, angina pectoris, other forms of chronic ischemic heart disease (ICD9 codes 410-414.9) or coronary procedures (ICD9 procedure codes 36.0-36.99). Participants with prevalent CAD (n=27,844) before the baseline survey date or alcohol abuse using ICD9 codes 303.0 and 305.0 (n=16,048) were excluded from the analysis. We used a Cox Proportional Hazard model to estimate hazard ratios (HR) and 95% confidence intervals (CI) for CAD adjusting for age, sex, body mass index, and smoking status.

Results:
Among 59,288 participants analyzed, the mean age was 65y (SD=11.9), mean BMI was 28.9 kg/m
2
, 90% were men, 33% were never smokers, 86% self-reported as White, 11% Black, and 6% Hispanic. Participants were categorized into 6 alcohol consumption categories: Never, former, and current drinkers of half drink/d, >half to 1 drink/d, >1 to 2 drinks/d, >2 to 3 drinks/d, >3 to 4 drinks/d, and >4 drinks/d. During a mean follow up of 3.3 years, 3,670 CAD events were documented. Using current drinkers of ≤half a drink/d as the reference group, we found a 19% lower risk of CAD in drinkers of >1 to 2 drinks/d, a 25% lower risk of CAD with alcohol intake of >3 to 4 drinks/d, and 34% lower risk in the highest alcohol category in a multivariable adjusted model (Table 1). As expected, former drinkers had a slightly higher risk of CAD. We did not have enough data on women to conduct sex-specific analyses.

Conclusion:
Our data show a lower risk of CAD with moderate alcohol consumption among MVP participants.