bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P125: Aerobic Exercise Training Reduces Postprandial Thermogenesis in Older Women
Authors: Wang Xuewen , Bowyer Kimberly , Porter Ryan , Breneman Charity , Custer Sabra
Published: July 2021

Introduction:
Thermic effect of food is a component of total daily energy expenditure (TDEE). Some literature suggests lower postprandial rise in energy expenditure predicts future weight gain. It is also known that other components of TDEE, resting metabolic rate (RMR) and free-living physical activity energy expenditure, are prone to change in response to exercise training. However, most studies estimate thermic effect of food as a proportion of TDEE and thus have not evaluated whether changes in postprandial thermogenesis occur in response to exercise training. The objective of this study was to determine whether postprandial thermogenesis changed after completing aerobic exercise training in older women.

Hypothesis:
We hypothesize that the postprandial thermogenesis decreases in sedentary older women who complete 16-week aerobic exercise training.

Methods:
Sedentary older women (n = 47; age = 65.1 ± 4.3 years) completed 16-week moderate-intensity aerobic exercise training. RMR and 5-hour postprandial thermogenesis following ingesting the same meal, before and at the end of training, was measured via indirect calorimetry. The meal consisted of approximately 40% of each woman’s RMR at baseline. Postprandial thermogenesis was calculated as area under the curve. TDEE was also measured using doubly labelled water before and at the end of training.

Results:
After exercise training, RMR and TDEE did not change (p > 0.05 for both). Total postprandial thermogenesis (from 287 ±36 to 276 ± 40 kcal for 5 hours, p = 0.008) and postprandial thermogenesis in the first hour (from 69.9±8.7 to 66.3±8.1 kcal, p = 0.05) decreased significantly. The ratios of total and first-hour postprandial thermogenesis to TDEE also decreased (p = 0.026 and 0.013, respectively).

Conclusion:
Postprandial thermogenesis following the same meal reduced after aerobic training in older women. This adaptive change may contribute to an individual’s ability to defend the body’s energy store.
Abstract P132: Cardiorespiratory Fitness Has Declined in Individuals Joining a Self-referred Exercise Program Over the Past 45 Years
Authors: Harber Matthew P , Montoye Alexander H , Whaley Mitchell H , Kaminsky Leonard A
Published: July 2021

Introduction:
Cardiorespiratory fitness (CRF) has emerged as a strong predictor of cardiovascular disease (CVD) and all-cause mortality; however, there are limited data to describe population trends in CRF over time. Thus, the purpose of this investigation was to examine changes in objectively measured CRF over the past four decades. We hypothesized that CRF would be progressively lower, by decade, from 1970 to 2015.

Methods:
We retrospectively examined 3238 individuals who were tested at enrollment into a self-referred university based exercise program. All participants underwent a CVD risk assessment (including measures of blood pressure, blood lipids, and anthropometrics) and a maximal cardiopulmonary exercise treadmill test with measured CRF (i.e., VO2max). Differences in CRF and risk factor variables were analyzed by sex (n=1467 female, n=1771 male) and group based on when testing was conducted (Group A: 1970-1984, n=872; B: 1985-1994, n=1154; C: 1995-2004, n=670; D: 2005-2015, n=542) using a 2x4 factorial analysis of variance.

Results:
Mean age of participants was higher (P<0.05) in successive cohorts after group B, regardless of sex (41.1±0.3, 41.7±0.3, 45.4±0.5, 47.1±0.6 years for A, B, C, D, respectively). CRF was lower (P<0.05) in successive cohorts after group B for both men (38.1±0.4, 38.0±0.4, 34.8±0.6, 32.8±0.7 ml/kg/min for A, B, C, D, respectively) and women (28.8±0.4, 29.1±0.4, 26.9±0.4, 25.1±0.5 ml/kg/min for A, B, C, D, respectively). Differences in CRF persisted after controlling for age, body weight, and BMI. BMI increased (P<0.05) with each successive cohort up to C for men (25.8±0.2, 27.4±0.2, 29.3±0.3, 29.3±0.3 kg/m2 for A, B, C, D, respectively) and women (24.9±30.3, 25.7±0.2, 27.9±0.3, 29.0±0.4 kg/m2 for A, B, C, D, respectively) and the increase was greater (P<0.05) in women. Resting diastolic blood pressure was lower (P<0.05) with each successive cohort after B (80.1±0.3, 79.5±0.3, 77.8±0.4, 75.6±0.4 mmHg for A, B, C, D, respectively) regardless of sex while no differences were noted for systolic blood pressure. Total cholesterol decreased (P<0.05) with each successive cohort for men (221±2, 211±2, 205±2, 185±2 mg/dl for A, B, C, D, respectively) and women (210±2, 197±2, 199±2, 196±2 mg/dl for A, B, C, D, respectively) with the decrease being greater (P<0.05) in men. Resting heart rate was higher (P<0.05) in cohort D compared to A, B, C in men only (65±1, 68±1, 67±1, 71±1 bpm for A, B, C, D, respectively).

Conclusion:
Over the past 20 years, adults making the decision to begin an exercise program are doing so at a later age and with a markedly lower CRF (>1.5 METs) than 20-45 years ago. The change in CRF is not fully explained by increasing obesity trends. These data suggest that greater emphasis be given in exercise prescriptions to aggressively improve CRF.
Abstract P167: Insulin Resistance and Cognitive Status Among Adults 50 Years and Older: Data From National Health and Nutrition Examination Survey (NHANES)
Authors: Sherzai Ayesha , Yu Jeff , Talbot Konrad , Shaheen Magda , Sherzai Dean
Published: July 2021

Introduction:
Alzheimer’s disease (AD) is a progressive neurodegenerative disease that results in cognitive impairment. As there are no treatments available so far, identification of risk factors are crucial. A link has been proposed between defective insulin signaling in the brain and the cognitive decline observed in AD. Our purpose is to determine the relationship between homeostatic model of insulin resistance (HOMA-IR) and cognitive status among population ≥50 years.

Hypothesis:
Increase in insulin resistance is associated with lower cognitive status in the population ≥50 years.

Methods:
We analyzed data from the NHANES 1999-2002 population ≥50 years. Cognitive status was measured by the digit symbol substitution exercise score. The main independent variable was HOMA-IR. We used bivariate analysis and multiple linear regression adjusting for age, gender, race, triglyceride levels, systolic and diastolic blood pressure, total cholesterol, LDL, HDL levels, and diabetes. SAS V9.3 was used to analyze the data taking into consideration the design, strata and weight.

Results:
Of the 2,975 participants ≥50 years old, 45% were male and 80% were white. The mean age was 70.5+/- 0.30 years. Their average HOMA-IR was 5.0+/- 0.54 and they had a mean of 48+/-0.99 correct score in the cognitive test. Adjusting for the confounding variables, HOMA-IR was associated with decline in cognitive status (adjusted B=-0.34, 95% confidence interval=-0.58 to - 0.09, p=0.01). Significant predictors of decline in cognitive status among population ≥50 years were older age, male gender, high systolic and low diastolic blood pressure, non-white race (p=0.01). The association between HOMA-IR and decline in cognitive status was also found among non-diabetic population ≥50 years old (adjusted B=-0.54, 95% confidence interval=-1.1 to - 0.02, p=0.04).

Conclusions:
In the national representative sample, Insulin resistance as measured by HOMA-IR was independently associated with lower cognitive status score among participants ≥50 years and also found among non-diabetic population. Prospective studies are needed to determine the causal relationship.
Abstract P217: Impact of Serum Potassium on Mortality and Kidney Outcomes in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Chen Yan , Chang Alex R , Coresh Josef , McAdams-Demarco Mara A , Inker Lesley A , Grams Morgan E
Published: July 2021

Introduction:
Little is known about whether abnormal values of serum potassium (K) are associated with mortality and adverse renal outcomes in the general population.

Hypothesis:
Abnormal K values are associated with higher risk of mortality and adverse renal outcomes, with stronger associations among persons taking medications that influence K levels.

Methods:
We studied 15,641 participants in the ARIC study. Cox proportional hazard regression was used to investigate the association of K at baseline (1987-1989), evaluated categorically (hypokalemia, <3.5 mmol/L; normokalemia, 3.5-5.4 mmol/L; hyperkalemia, ≥5.5 mmol/L) and continuously using linear spline terms (knots at 3.5 and 5.5 mmol/L), with mortality, incident chronic kidney disease (CKD), and end-stage renal disease (ESRD). We also evaluated whether kaliuretic diuretics modified the association between K and adverse outcomes.

Results:
Overall, 2.7% of the participants had hypokalemia, 2.1% had hyperkalemia and 19.1% were taking kaliuretic diuretics. In an unadjusted model, both hypo- and hyperkalemia were associated with mortality; in a fully adjusted model, hyperkalemia was significantly associated with mortality (HR: 1.24; 95% CI: 1.04-1.49) while hypokalemia was not (HR: 1.03; 95% CI: 0.89-1.20); however, hypokalemia was associated with mortality among people not taking kaliuretic diuretics (HR: 1.74; 95% CI: 1.31-2.30; p for interaction: <0.001). Neither hypo- nor hyperkalemia was associated with renal outcomes in the adjusted model; however, there was an interaction of kaliuretic diuretic use with hypokalemia, where hypokalemia was associated with significantly higher risk of CKD and ESRD in participants not using kaliuretic diuretics and lower risk in participants using kaliuretic diuretics (CKD: p for interaction: 0.001; ESRD: p for interaction: 0.002).

Conclusions:
Abnormal values of K were associated with death and adverse renal outcomes in the general population, particularly among participants not taking kaliuretic diuretics.
Abstract P261: Genome-wide Association Study of Susceptibility to Particulate Matter-associated Reduced Heart Rate Variability
Authors: Gondalia Rahul , Avery Christy L , Napier Melanie D , Giráldez Raúl Méndez , Stewart James D , Sitlani Colleen M , Li Yun , Roach Jeffrey , North Kari E , Reiner Alex P , Zhang Zhu-Ming , Tinker Lesley , Liao Duanping , Whitsel Eric A , Investigators MOPMAP
Published: July 2021

Background:
Heart rate variability (HRV) is a heritable electrocardiographic measure of cardiac autonnomic control that is consistently and inversely associated with ambient particulate matter (PM) air pollution and risk of both incident cardiovascular disease, and death. However, genetic susceptibility to PM-associated decreases in HRV has not been characterized.

Methods:
To characterize such susceptibility in a genome-wide context, we conducted cohort-, race/ethnicity-, and sex-stratified longitudinal analyses of ten Women’s Health Initiative clinical trials and Atherosclerosis Risk in Communities Study subpopulations (total n: 27,121; mean age: 64.6 yr; 81% female; 25% black; 7% Hispanic; mean visits/person: 2.5). In each subpopulation, we log-transformed three previously validated and reliable measures of HRV: RR interval duration (RR); root mean square of successive differences in normal-to-normal RR (RMSSD); and standard deviation of normal-to-normal RR (SDNN). We also estimated mean concentrations of PM < 10 μm on the day of and before HRV measurement. We then used generalized estimating equations (GEE) methods adapted for low prevalence exposure to leverage the repeated measures of HRV and PM10. The GEE models estimated interactions between approximately 2.5 million single nucleotide polymorphisms (SNPs) and PM10 concentrations dichotomized at subpopulation-specific 90th percentiles, while adjusting for age, geographic region or center, season, calendar year, and ancestry. We combined the SNP x PM10 interaction estimates in a Bayesian meta-analysis accounting for ancestral heterogeneity to identify trans-ethnic interactions exceeding genome-wide thresholds: log10 Bayes Factor (BF) > 6 and posterior probability of heterogeneity (PHet) < 0.5.

Results:
Preliminary analyses of RMSSD provided suggestive evidence of a trans-ethnically important interaction at five SNPs on one locus. The lead SNP (rs17809071; T allele frequency range: 3-16%) is located on chromosome 4, 120 kilobases downstream from SPRY1 (log10BF = 5.31; PHet = 0.14). SPRY1 encodes sprouty receptor tyrosine kinase signaling antagonist 1 which is expressed in cardiac fibroblasts, antagonizes cytokine-induced epicardial fibrosis, and inhibits adipogenesis.

Conclusions:
Findings from this genome-wide association study of SNP x PM10 interactions suggest that genetic factors may affect susceptibility to PM10-associated decreases in HRV among racially/ethnically diverse populations of men and women protected by the U.S. Environmental Protection Agency under the Clean Air Act.
Abstract P281: Comparing the Impact of Price Change and Mass Media Campaigns in Reducing Cardiovascular Disease Mortality and Disparities in the US
Authors: Pearson-Stuttard Jonathan , Bnadosz Piotr , Rehm Colin D , Afshin Ashkan , Penalvo Jose , Whitsel Laurie , Danaei Goodarz , Micha Renata , Conrad Zach , Gaziano Thomas , Bromley Helen , Lloyd-Williams Ffion , Mozaffarian Dariush , Capewell Simon , O’Flaherty Martin
Published: July 2021

Introduction:
Cardiovascular disease (CVD) mortality burdens remain large and unequal in the US, and much is attributable to poor diets. However, few data exist regarding the potential population level impact of policies aimed at improving dietary intake, such as the Supplemental Nutrition Assistance Programme (SNAP), and potential effects on disparities.

Aim:
To estimate reductions in CVD mortality and disparities achievable in the US population up to 2030 through food price changes and mass media campaign interventions targeting fruits and vegetables (F&V) and sugar sweetened beverages (SSBs).

Methods:
We developed a US IMPACT Food Policy Model to compare four contrasting food policy scenarios targeting dietary intake: A) - national F&V mass media campaign, B) F&V price reductions of 10% universally and C) 30% to SNAP participants, D) - SSB price increase of 10% universally.

Data sources included the National Vital Statistics System, SEER single year population estimates, the US Bureau 2012 National Population projections, and NHANES. We stratified the US population into SNAP participants, SNAP eligible but not participating, and SNAP ineligible.

We modelled cumulative deaths prevented or postponed (DPP) and life years gained (LYG) using best-evidence effect sizes for each policy, existing mortality rates and trends, and F&V and SSB mortality effects. We stratified by age, sex, and CVD subtype from 2015 to 2030. Sensitivity analyses were conducted with Monte Carlo simulation.

Results:
Scenario B (universal 10% price reduction) would yield the greatest national benefits, generating approximately 88,000 DPPs (95% CI: 81,000-94,000) and 1,369,000 LYGs (1,268,000-1,460-000) by 2030. This compares with between 28,000 (26,000-30,000) and 84,000 (79,000-89,000) DPPs in Scenario A, depending on duration of media campaigns; and approximately 27,000 (24,000-30,000) and 29,000 (25,000-33,000) DPPs in scenarios C and D respectively.

Scenario C (30% price reduction to SNAP participants) might reduce CVD disparities by about 18% comparing SNAP participants with the ineligible population. Scenarios A, B and D would have negligible effects on mortality disparities.

Conclusions:
All four dietary policies would be effective in reducing mortality. Reducing fruit and vegetable (F&V) price by 10% to the entire US would save most lives. Reducing F&V price by 30% to SNAP participants would reduce disparities the most, particularly if SNAP program coverage and penetration were improved. These results support population fiscal strategies targeting diet to reduce cardiovascular mortality and disparities in the US.
Abstract 28: Orthostatic Hypotension is Associated With 20-year Cognitive Decline and Incident Dementia: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Rawlings Andreea , Juraschek Stephen , Heiss Gerardo , Hughes Timothy , Meyer Michelle , Selvin Elizabeth , Sharrett A. Richey , Windham B. Gwen , Gottesman Rebecca
Published: July 2021

Background:
Orthostatic hypotension (OH) has been associated with incident cardiovascular disease and all-cause mortality, but few studies have examined long-term associations with cognitive decline and dementia

Hypothesis:
OH will be associated with greater cognitive decline and risk of incident dementia

Methods:
We prospectively analyzed 11503 participants who attended visit 1 (1987-1989) of the ARIC study and had no history of coronary heart disease or stroke. OH was defined as a drop in systolic blood pressure (BP) >=20 mmHg or a drop in diastolic BP >=10 mmHg upon standing from a supine position. Dementia was ascertained using cohort surveillance, telephone contact with the participant or their proxy, or a comprehensive cognitive and neurologic exam in 2011-2013. Cognition was measured via three neuropsychological tests administered in 1990-1992, 1996-1998, and 2011-2013 that were summarized using a Z score. We used adjusted Cox regression and linear mixed models.

Results:
At visit 1 (mean age 54 years, 57% female, 27% black) 6% of participants had OH. In adjusted models, persons with OH at baseline were 40% more likely to develop dementia than those without OH (HR: 1.40, 95%CI: 1.13, 1.73; Table). Associations were significantly larger in persons with hypertension (p-value for interaction=0.023). Persons with OH compared to those without had significantly more cognitive decline over 20 years (difference: -0.12, 95% CI: -0.23, -0.02; Table).

Conclusions:
OH assessed in midlife was independently associated with incident dementia and cognitive decline over 20 years. Although typically considered a transient mechanism, these data suggest that OH, or the underlying disease conditions manifesting as OH, persist over time. Whether OH is a marker of vulnerability beyond that of standard hypertension measures, or whether repeated transient exposure to hypotension reduces perfusion to the brain sufficiently to lead to long-term cerebral dysfunction is an important area for further research.
Abstract 47: Atrial Fibrillation is Associated With Increased Risk of Incident Venous Thromboembolism: The Atherosclerosis Risk in Communities Study
Authors: Lutsey Pamela L , Norby Faye L , Alonso Alvaro , Cushman Mary , Chen Lin Y , Michos Erin D , Folsom Aaron R
Published: July 2021

Background:
It is well-established that atrial fibrillation (AF) is associated with thrombus formation in the left atrium, which can lead to ischemic stroke. Case reports, autopsies, and transesophageal echo data have indicated that clot formation also occurs in the right atrium (i.e. right-side intracardiac thrombosis) of AF patients, which could lead to pulmonary embolism (PE). However, it is unclear whether this occurrence is common.

Objective:
Test the hypotheses that individuals with incident AF are at elevated risk of developing venous thromboembolism (VTE), and that the association will be stronger for those presenting with PE alone versus PE and deep vein thrombosis (DVT) or DVT alone.

Methods:
A total of 15,205 Atherosclerosis Risk in Communities (ARIC) study participants, aged 45-64 years, were followed from baseline (1987-1989) to 2011 for incidence of AF and VTE (median follow-up 19.8 years). Incident AF and VTE events were identified via active surveillance and defined by relevant hospital discharge ICD codes. VTE events were validated by medical record review. Multivariable-adjusted Cox proportional hazards regression models were used, with AF modeled as a time-dependent covariate. We also evaluated separately risk of PE without evidence of DVT, DVT without PE, and events presenting with both PE and DVT.

Results:
At baseline participants were on average 54 years old, 55% female and 26% black. In the absence of AF there were 678 VTE events, for an incidence rate of 2.6 per 1000 person-years. After an AF diagnosis there were 77 events, with an incidence rate of 7.1 per 1000 person-years. In multivariable-adjusted models, having AF (versus no AF) was associated with a greater risk of incident VTE; the HR (95% CI) was 2.10 (1.65-2.68) after adjustment for demographics, 1.82 (1.42-2.32) additionally accounting for numerous AF and VTE risk factors, and 1.97 (1.53-2.53) after further adjusting for time-dependent anticoagulant use. When we restricted to PE events without evidence of DVT there were 188 events in total, of which 19 occurred following a diagnosis of AF. The HR for AF (versus no AF) was 1.53 (0.92-2.56) in fully adjusted models. For DVT alone there were 384 events in total, of which 48 occurred after AF diagnosis; the HR for AF was 2.43 (1.77-3.33). Among the 116 events presenting with both DVT and PE, 10 occurred after AF diagnosis, and the HR for AF was 1.36 (0.67-2.75).

Conclusions:
Diagnosis with AF was associated with a nearly 2-fold increased risk of incident VTE. The association was not stronger when isolated to those with PE without DVT, suggesting that higher risk of VTE among AF patients may be due to either the coagulation abnormalities that accompany AF, or shared risk factors that were not fully accounted for in this analysis.
Abstract MP013: Diet High in Sweets and Sugar-sweetened Beverages But Low in Fruits and Vegetables is Associated With Pro-inflammatory Adipokine Profile in Mexican Americans at Risk For Diabetes
Authors: Koebnick Corinna , Black Mary Helen , Wu Jun , Shu Yu-Hsiang , Buchanan Thomas , Xiang Anny
Published: July 2021

Background:
High consumption of sweets and sugar-sweetened beverages is associated with obesity, insulin resistance and cardiovascular disease. Pro- and anti-inflammatory adipokines may mediate the relationship between dietary intake and poor metabolic profile. However, studies investigating the association between diet and adipokines are scant and often restricted to one or two biomarkers.

Study design and methods:
Subjects were participants of BetaGene, a study of obesity, insulin resistance and β-cell dysfunction in Mexican Americans (n=1,128, 73% female, age 34.6±8.0, BMI 29.5±5.9). Adiponectin, IL-1β, IL-6, IL-1Ra, leptin, lipocalin, MCP-1, resistin and TNF-α were assayed using Millipore multiplex kits with magnetic bead panels; apelin, CRP, DPP-IV, visfatin, SFRP4 and SFRP5 were measured with ELISA. Dietary intake was assessed by 12-mo recall (126-item Harvard-FFQ). Joint multivariate associations between levels of adipokines and food group consumed (grams/day) were analyzed using canonical correlation after adjustment for age, sex and energy intake.

Results:
Median (IQR) energy intake was 2.27 (1.75,2.85) Mcal/day. While 55% of total intake was accounted for by carbohydrates, 24% was due to sugar. A total of 37% of the shared variation between diet and adipokines was explained by the top linear association between the two. The top dietary component (
Figure 1
) was most represented by sugar-sweetened beverages (SSB, loading coefficient ρ=0.55), sweets (ρ=0.53), fruits (ρ=-0.47), fruit juices (ρ=-0.34), and vegetables (ρ=-0.30), while the adipokine component was most represented by leptin (ρ=0.63), CRP (ρ=0.56), and MCP-1 (ρ=0.47).

Conclusions:
Diets high in sweets and sugar-sweetened beverage but low in fruits and vegetables contribute to a pro-inflammatory profile characterized by high leptin, CRP and MCP-1, which in turn is associated with poor metabolic profile in Mexican Americans at risk for type 2 diabetes.
Abstract MP024: Increase in Adverse Cardiovascular Risk Profile among Hispanics/Latinos of Diverse Backgrounds Living in the United States: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Daviglus Martha L , Cai Jianwen , Pirzada Amber , Butera Nicole M , Durazo-Arvizu Ramon A , Lash James P , Aviles-Santa Larissa , Gallo Linda C , Kaplan Robert , Schneiderman Neil , Talavera Gregory A , Wassertheil-Smoller Sylvia , Stamler Jeremiah
Published: July 2021

Background:
HCHS/SOL showed that a sizeable proportion of Hispanics/Latinos (80% of men, 71% of women) had at least 1 major CVD risk factor (RF), with marked variations by ethnic background. Little is known about changes in CVD RF profiles over time in this population.

Objective:
To describe ~6-year changes in CVD RF profiles and examine associations with demographic and socioeconomic/ sociocultural factors.

Methods:
HCHS/SOL is a multi-center prospective community-based study of 16,415 Hispanic/Latino adults of Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American backgrounds, aged 18-74 at Visit 1 (2008-11). Visit 2 (2014-17) is ongoing and 8,413 persons (~60% of the cohort to be studied) attended as of Sept. 2016. Analyses included 7,789 men and women with complete data. CVD RF profiles were defined as having 0 (0RF) or any 1 or more (1+RF) of the following: hypercholesterolemia, hypertension, obesity, diabetes, and smoking (see definitions in Table). Adjusted percent increases in number of RFs were computed. Multinomial logistic regression was used to examine associations of Visit 1 characteristics with change in RFs, adjusted for sociodemographic, sociocultural, and lifestyle factors.

Results:
After 5.8 years, 29% of men and 27% of women had increases in number of RFs; changes occurred more frequently in persons with 1+ RF at Visit 1 than in those with 0RF and varied by background (
Table
). Significantly higher odds of increase in number of RFs (vs. 0RF at both visits) were seen with older age (OR=1.07, 95% CI=1.06-1.08 per 1 yr) and male sex (1.74, 1.37-2.21); lower odds with higher education (0.60; 0.44-0.83 for > vs. < high school) and income (0.56, 0.38-0.81 for >$50,000 vs. <$20,000); acculturation did not relate to RF changes.

Conclusions:
In just a few years, a large percent of US Hispanic/Latino adults had an increase in number of adverse RFs, which varied by background; age, sex, education, and income were associated with RF increases. Greater efforts are needed to prevent CVD RFs in this population.
Abstract MP040: Comparative-Effectiveness of Implementation Strategies on Blood Pressure Control among Hypertensive Patients: a Meta-Analysis
Authors: Mills Katherine T , Obst Katherine M , Shen Wei , Molina Sandra , Zhang Huijie , He Jiang
Published: July 2021

Introduction:
Globally, only 13.8% of adults with hypertension have controlled blood pressure (BP). Effective strategies are needed to overcome barriers to BP control. The overall objective is to determine the comparative-effectiveness of implementation strategies to reduce BP in adults with hypertension.

Methods:
We searched Medline and Embase (through November 2015) for randomized controlled trials of implementation strategies targeting barriers to hypertension control compared to usual care. One hundred trials with 48,070 hypertensive participants met our eligibility criteria and were included in this analysis. These trials were grouped by intervention strategy, and the effects of the intervention on BP change were combined using random effects models.

Results:
Multi-component team-based care with and without non-physician providers titrating medications had the greatest reduction in systolic and diastolic BP. Health coaching, home BP monitoring, and a combination of the two also resulted in significant reductions in BP. Few studies of BP audit and feedback and clinical decision support systems were available, and they did not result in significant reductions in systolic BP. Provider training did not significantly reduce BP.

Conclusions:
Team-based collaborative care is the most effective strategy for BP control among patients with hypertension. In addition, health coaching and home BP monitoring are useful patient-level strategies for hypertension control. These strategies should be prioritized in future BP control efforts.
Abstract MP050: Changes in Dietary Fat Intake and Long-term Weight Change in US Women and Men
Authors: Liu Xiaoran , Li Yanping , Tobias Deirdre K , Wang Dong D , Manson JoAnn E , Willett Walter C , Hu Frank B
Published: July 2021

Introduction:
The role of dietary fat intake in body weight regulation remains controversial and few studies have examined long-term changes in types of dietary fat and weight change in longitudinal studies.

Methods:
We examined the association between changes in energy from dietary fat and weight change in three large, prospective cohorts including 102, 123 U.S. women and men who were free of diabetes, cardiovascular disease and cancer at baseline. Linear mixed model was used to assess the association between changes in energy from specific dietary fat and weight changes at 4-year intervals with multivariable adjustment for age, baseline body-mass index at each period, and simultaneous changes in dietary factors (total energy, energy from protein, cereal fiber) and lifestyle factors (smoking, physical activity, television watching, sleep duration).

Results:
Increased intake of polyunsaturated fatty acid (PUFA) was inversely associated with weight gain. A 5% increment in energy from total PUFA was associated with less weight gain (-1.8 lb, 95% CI: -1.95 to -1.65, p<0.0001) and a 5% increment in energy from n-6 PUFA was associated with 0.90 lb (95% CI: -1.07 to -0.73, p <0.0001) less weight gain over 4-yr period. For marine n-3 PUFA, a 0.3% increase in intake was associated with 2.28 lb (95% CI: -2.50 to -2.10, p<0.0001) less weight gain; a 0.3% increase in intake of vegetable n-3 PUFA (ALA) was also associated with less weight gain (-0.77 lb, 95% CI: -0.86 to -0.68, p<0.0001) at a 4-year interval. The effect of monounsaturated fatty acid (MUFA) intake on weight changes varied across time as the major food contributors to MUFA shifted from animal sources since 1986 to plant sources after 1994 in these cohorts. Prior to 1994, increasing intake of MUFA was positively associated with weight gain (0.50 lb, 95% CI: 0.36 to 0.65), whereas after 1994, increasing intake of MUFA was inversely associated with weight gain (-0.56 lb, 95% CI: -0.56 to 0.07, p<0.0001 for interaction). In addition, a 5% increase in energy from SFA was associated with 1.71 lb (95% CI: 1.59 to 1.83) greater weight and a 1% increase in energy from
trans
-fat was associated with 1.97 lb (95% CI: 1.86 to 2.08) greater weight gain within each 4-year period.

Conclusion:
Different types of dietary fats have divergent associations with long-term weight change: higher intakes of PUFA (both n-6 and n-3 PUFA) and plant-based MUFA were associated with less weight gain, whereas increasing saturated and
trans
-fat intakes were associated with greater weight gain. Our results support the current dietary guidelines that recommend unsaturated fats as replacements for saturated and
trans
-fats.
Abstract MP052: Neither Insulin Secretion nor Genotype Pattern Modify 12-Month Weight Loss Effects of Healthy Low-Fat vs. Healthy Low-Carbohydrate Diets Among Adults with Obesity
Authors: Gardner Christopher D , Hauser Michelle , Del Gobbo Liana , Trepanowski John , Rigdon Joseph , Ioannidis John , King Abby , Desai Manisha
Published: July 2021

Background:
Dietary modification remains an essential component of successful weight loss strategies. No one dietary strategy has been determined to be superior to others for the general population. Studies that contrast reducing dietary fat vs. carbohydrate report consistently high within-group variability in dietary adherence and weight loss. Previous research by our group and others suggest that insulin-glucose dynamics or genotype patterns may modify diet effects.

Objective:
To determine if within-group weight loss variability on a Healthy Low-Fat (HLF) vs. a Healthy Low Carbohydrate (HLC) diet can be attributed to underlying factors such as insulin-glucose dynamics (i.e., insulin resistance and secretion) or genotype pattern. We hypothesized the above factors would be effect modifiers of HLF and HLC diets on 12-month weight loss.

Methods:
Generally healthy, non-diabetic adults, 18-50 years, BMI 28-40 kg/m
2
, were randomized to HLF or HLC with no specific prescribed energy restriction for 12 months (n=609). Health educators delivered the intervention in 22 1-hr group classes. Data were collected at 0, 3, 6, & 12 months. Dietary intake was assessed by three 24-hour recalls/time point. Clinical data includes: 75-g glucose oral glucose tolerance tests (insulin concentration at 30 minutes [Ins-30], a measure of insulin secretion), genotyping (3-SNP multilocus genotype: Low-Fat Genotype vs. Low-Carb Genotype, UK Biobank Axiom® array), body composition (DXA), resting energy expenditure (indirect calorimetry), epigenetics, proteomics, subcutaneous adipose tissue, microbiota, and standard CVD risk indicators.

Results:
At 12 months participants collectively lost 6,559 lbs. Retention was 79%, with equal dropout between arms. Range of weight change in both diet arms was ~80 lbs (-60 to +20 lbs). Macronutrient distribution at 12 months was 48% vs. 30% carbohydrate, 29% vs. 45% fat, and 21% vs. 23% protein for HLF and HLC, respectively. Both groups reported achieving and maintaining an average ~500 kcal deficit relative to baseline. Weight loss was similar for HLF vs. HLC: -12.1 ± 1.1 lbs vs. -13.8 ± 1.0 lbs, mean ± SEM. Neither Ins-30 (p for interaction = 0.84) nor genotype pattern (p for interaction = 0.20) modified the effect of diet on 12-month weight loss.

Conclusions:
Despite substantial weight loss, high within-group variability, and strong dietary differentiation between groups, neither baseline Ins-30 nor genotype pattern modified the effect of diet on 12-month weight loss. Focus on a healthy diet in both diet arms is novel in the context of many previous Low-Fat vs. Low-Carb studies and may have diminished expected effect modification. The extensive data set collected will be used to explore this and other potential explanatory factors.
Abstract MP057: Subclinical Cerebrovascular Disease is Associated with Worsening Gait and Balance in an Elderly Multi-Ethnic Population: The Northern Manhattan Study (NOMAS)
Authors: Willey Joshua Z , Park Moon Yeseon , DeRosa Janet , Kulick Erin , Cespedes Sandino , Bagci Ahmet , Alperin Noam , Cheung Ying K , Wright Clinton B , Sacco Ralph L , Elkind Mitchell S
Published: July 2021

Introduction:
Age-related decline in gait and balance is a contributor to morbidity in the elderly. Subclinical cerebrovascular disease, seen on magnetic resonance imaging (MRI) as white matter hyperintensities (WMH) and silent brain infarcts (SBI), is associated with impaired mobility. Less is known about the association of WMH in specific brain regions and mobility impairment. We hypothesized that anterior WMH volume would be associated with lower scores on the Short Physical Performance Battery (SPPB), a well-validated mobility scale associated with falls and mortality in the elderly.

Methods:
Participants in the Northern Manhattan Study MRI cohort had the SPPB measured a median of 5 years after enrollment. The SPPB has three domains with a maximum total score of 12: gait speed, chair stands, standing balance. Volumetric distributions for WMH volume across 14 brain regions (brainstem, cerebellum, and bilateral frontal, occipital, temporal, and parietal lobes, and bilateral anterior and posterior periventricular white matter) were determined separately for each hemisphere by combining bimodal image intensity distribution and atlas based methods. Multi-variable linear regression was performed to examine the association between SBI and total and regional (frontal, parietal, occipital, temporal, anterior, posterior, and brainstem) head size-corrected WMH volumes, with the total SPPB score; models were adjusted for cardiovascular disease risk factors, osteo-arthritis, and grip strength.

Results:
Among 668 stroke-free participants with the SPPB available, mean age at the time of assessment was 74 ±9 years, 37% were male and 70% Hispanic; the mean SPPB score was 8.2 ± 2.9, interquartile range 7-10. Mean total WMHV was 0.55±0.75cc, mean anterior WMH volume 0.18±0.24cc, and 12% of participants had SBI. In multi-variable models, total WMHV was associated with a lower SPPB (beta = -0.3 per SD of logWMH, p=0.004), while SBI was not (beta= -0.12, p=0.7). For regional WMH volumes, only greater anterior periventricular WMHV was associated with SPPB (beta= -0.29 per SD, p=0.009).

Conclusions:
White matter hyperintensities, especially in the anterior cerebral regions, are associated with a lower SPPB. Prevention of subclinical cerebrovascular disease is a potential target to prevent physical aging in the elderly.
Abstract MP070: Saturated Fat Intake by Food Source and Risk of Incident Coronary Heart Disease in Men: the Kuopio Ischaemic Heart Disease Risk Factor Study
Authors: Virtanen Jyrki K , Koskinen Timo T , Virtanen Heli E , Mursu Jaakko , Tuomainen Tomi-Pekka , Voutilainen Sari
Published: July 2021

Introduction:
The epidemiological evidence of the role of dietary saturated fatty acids (SFA) in the etiology of coronary heart disease (CHD) is inconsistent. However, the proportions of different SFAs in different foods vary, and food sources of SFA (such as dairy and meat products) have had distinct associations with risk of CHD and its risk factors.

Hypothesis:
We assessed the hypothesis that SFA from different food sources have distinct associations with CHD risk in men.

Methods:
A total of 1981 men from the population-based Kuopio Ischaemic Heart Disease Risk Factor Study from eastern Finland, aged 42-60 years and free of CHD at baseline, were included. The consumption of foods was assessed with instructed 4-day food recording by household measures. Dietary intakes were adjusted for total energy using the residuals method. Multivariable-adjusted Cox regression analyses included age, examination year, body mass index, diabetes, hypertension, family history of CHD, smoking, education, leisure-time physical activity, and intakes of alcohol, energy, fiber, polyunsaturated fatty acids, and fruits, berries and vegetables. Fatal and nonfatal CHD events were ascertained from national registries, with no loss to follow-up.

Results:
The mean±SD total SFA intake was 49.1±10.4 g/d (18.1 E%). SFA from dairy (16.1±7.7 g/d, excluding butter), butter (16.0±11.1 g/d), plant sources (6.7±5.0 g/d), processed red meat (4.7±4.2 g/d), and unprocessed red meat (3.6±2.7 g/d) contributed most to the total intake. During the mean follow-up of 19.6 years, 458 CHD events occurred. The extreme-quartile hazard ratios (95% CIs) were 1.08 (0.79-1.47, P-trend=0.57) for the highest vs. the lowest quartile of total SFA, 0.99 (0.75-1.32, P-trend=0.93) for total dairy SFA, 1.17 (0.84-1.63, P-trend=0.45) for butter SFA, 0.96 (95% CI 0.70-1.32, P-trend=0.62) for plant SFA, 1.09 (0.82-1.44, P-trend=0.76) for processed red meat SFA, and 1.15 (0.88-1.49, P-trend=0.29) for SFA from unprocessed red meat. Only SFA from fermented dairy (mean±SD intake 4.6±4.6 g/d) was associated with the risk (hazard ratio in the highest vs. the lowest quartile 0.69, 95% CI 0.52-0.91, P-trend=0.02). The associations were not appreciably different with a shorter, 10-y follow-up (199 cases).

Conclusions:
Our results suggest an overall non-significant role for SFA intake in the CHD risk and little difference in the associations with SFA from various food sources. Because milk is the raw material in all dairy products, the inverse association with fermented dairy likely reflects other constituents in these products than SFA.
Abstract MP076: Angiographic Coronary Artery Disease Severity and Risk of Mental and Conventional Stress Induced Myocardial Ischemia
Authors: Hammadah Muhammad , Abdelhadi Naser , Fang Shuyang , Almuwaqqat Zakaria , Alkhoder Ayman , Ghafeer Mazen , Gay Hawkins C , Ibeanu Ijeoma , O’Neal Wesley T , Sullivan Samah , Samman Tahhan Ayman , Mohamed Kelli Heval , Oleksiy Levantsevych , Obideen Malik , Pimple Pratik , Sandesara Pratik , almheid ibhar , Wilmot Kobina , Ramadan Ronnie , Shah Amit J , Bremner J. Douglas , Raggi Paolo , Sheps David , Quyyumi Arshed , Vaccarino Viola
Published: July 2021

Background:
Mental stress induced myocardial ischemia (MSIMI) is linked to increased risk of adverse cardiovascular outcomes, but its mechanisms are thought to be different from those of conventional stress-induced ischemia (CSIMI). Specifically, whether MSIMI is associated with more severe underlying obstructive coronary artery disease (CAD) is unclear. We investigated the association between angiographically-defined CAD severity and both MSIMI and CSIMI with a hypothesis that, CAD severity will be linked to CSIMI, but not MSIMI.

Methods:
A total of 273 patients with stable CAD, aged 51±7 years, 49% female, who survived a myocardial infarction (MI) within the past 8 months (median 167±52 days) were enrolled in the Myocardial Infarction and Mental Stress 2 (MIMS-2) study. The coronary angiogram performed during the index MI hospitalization was used to assess CAD severity. Coronary artery obstruction was assessed by counting the number of diseased vessels with 70% stenosis (DV70%) and using the Gensini Score (GS) after correcting for revascularized vessels. Patients underwent 99mTc sestamibi myocardial perfusion imaging during mental stress, using a public speaking task, and during conventional stress test, using exercise or pharmacological stress. MSIMI and CSIMI were defined as a new or worsening impairment in myocardial perfusion using a 17-segment model.

Results:
A total of 68 (26%) patients developed CSIMI, while 46 (17%) developed MSIMI. Median DV70% and GS were 0 (0-1), and 3 (0-12), respectively. Using logistic regression models, and after adjustment for age, gender, hypertension, hyperlipidemia and diabetes, obstructive CAD was associated with increased risk of CSIMI [OR(95%CI) of 1.54 (1.02 - 2.31) for DV70% and 1.25 (1.03-1.53), for GS], but not MSIMI [OR(95%CI) of 0.93 (0.56 - 1.53) for DV70%, and 0.94 (0.75-1.18) for GS].

Conclusion:
Although CSIMI is linked to underlying coronary obstruction, MSIMI is independent of CAD severity among post- MI patients. Other mechanisms are likely responsible for MSIMI post MI.
Abstract MP083: Autonomic Imbalance at the Level of Atrioventricular Node, but Not at the Level of Sinus Node, is Associated With Sudden Cardiac Death: The Atherosclerosis Risk in Community Study
Authors: Mukundan Srini V , Kabir Muammar M , Thomas Jason , Sedaghat Golriz , Waks Jonathan W , Sotoodehnia Nona , Post Wendy S , Henrikson Charles , Biering-Sørensen Tor , Solomon Scott S , Soliman Elsayed Z , Siscovick David S , Buxton Alfred , Josephson Mark E , Tereshchenko Larisa
Published: July 2021

Introduction:
Autonomic imbalance, quantified by decreased heart rate variability (HRV), is associated with increased cardiovascular mortality. It is unknown if autonomic influences on sinus and atrioventricular (AV) nodes are equally important for the risk of sudden cardiac death (SCD).

Hypothesis:
Autonomic influences on sinus and AV node are equally strongly associated with increased SCD, non-sudden cardiac death (non-SCD), and non-cardiac death.

Methods:
Baseline visit 10-second ECGs (n=14,250) of the Atherosclerosis Risk in Communities (ARIC) cohort were analyzed. Normalized variance of P-onset to P-onset intervals (PPVN) and QRS-onset to QRS-onset intervals (QQVN) was calculated to assess autonomic influence on sinus and AV node respectively. Normalized variance of Rpeak - Rpeak intervals was determined as HRV measure. Values were log-transformed to normalize distribution. SCD served as primary outcome. Secondary outcomes were non-SCD and non-cardiac death. Three Cox regression models were constructed for dichotomized at 20
th
percentile predictor variables.

Results:
Over median follow-up of 24.4 years, there were 497 SCDs (incidence 1.66 [95%CI 1.52-1.82], 742 non-SCDs (incidence 2.48 [95%CI 2.31-2.67], and 3,753 non-cardiac deaths (incidence 12.6 [95%CI 12.1-13.0]) per 1,000 person-years. In paired analysis, LogPPVN was significantly larger than LogQQVN (-7.28±1.06 vs. -7.72±1.24; P<0.0001). There was no difference between LogQQVN and Log RRVN (-7.72±1.24 vs -7.72±1.23; P=0.364). After full adjustment, LogRRVN and LogQQVN were significantly associated with non-SCD and SCD. Association with non-SCD was stronger. LogPPVN was independently associated with non-SCD but not SCD. No value was associated with non-cardiac death.

Conclusion:
Autonomic imbalance at the AV node, with likely summary effect at the bundle of His, is associated with SCD and non-SCD. Autonomic imbalance at the SA node is associated with non-SCD only. Autonomic input to SA and AV node should be further studied.
Abstract P013: Prevalence, Correlates and Prognosis of Healthy Vascular Aging in a Western Community-dwelling Population
Authors: Niiranen Teemu , Lyass Asya , Larson Martin , Hamburg Naomi , Benjamin Emelia , Mitchell Gary , Vasan Ramachandran
Published: July 2021

Introduction:
Although hypertension in the elderly is no longer considered harmless, increasing arterial stiffness and blood pressure (BP) are still widely seen as inevitable parts of the aging process. However, these phenomena may not be unavoidable as they are nearly absent in populations leading traditional hunter-gatherer lifestyles. Our study had 3 aims: 1) to define a new concept - healthy vascular aging (HVA); 2) to assess prevalence and correlates of HVA in a sample acculturated to a western life-style; and 3) to estimate the magnitude of cardiovascular (CVD) risk associated with HVA vs. absence of HVA.

Methods:
We studied 3197 Framingham Heart Study participants aged ≥50 years (62±9 years, 56% women) who underwent physical examination, interviews, and measurement of carotid-femoral pulse wave velocity (PWV) in 1999-2008. We defined HVA as no hypertension (BP <140/90 mmHg without antihypertensive treatment) and PWV <7.6 m/s (equivalent to +2 SD above mean of non-hypertensive reference sample aged <30 years with no CVD risk factors). We used logistic regression models that included physical activity, caloric intake, and classical CVD factors as covariates to assess the correlates of HVA. For each participant, we constructed a cardiovascular health score based on presence vs. absence of 6 modifiable risk factors (cholesterol, plasma glucose, healthy diet score, physical activity, body mass index (BMI), and smoking) defined as dichotomous variables according to the American Heart Association’s Life’s Simple 7 score (modified to exclude hypertension). We estimated odds ratios (OR) per 1-unit increase in cardiovascular health score for HVA. We used Cox regression models adjusted for classical CVD risk factors, including systolic BP, to assess the relationship between HVA and incident CVD events (CVD death, myocardial infarction, heart failure, stroke, and unstable angina).

Results:
In our sample, only 566 (17.7%) had HVA. Lower age (OR per 1-SD increase 0.18, 95% confidence interval [CI] 0.14-0.23), female sex (OR 2.03; 95% CI 1.54-2.68), lower BMI (OR per 1-SD increase 0.54; 95% CI 0.47-0.63) and no diabetes (OR 0.09; 95% CI 0.02-0.36) were significantly associated with HVA. A 1-unit increase in the cardiovascular health score conferred 1.55-fold (95% CI 1.38-1.74) odds of HVA. During follow-up (median 9.6 years), 391 participants had CVD events. HVA was associated with an age- and sex-adjusted hazard ratio (HR) of 0.36 (95% CI, 0.22-0.60) and a multivariable-adjusted HR of 0.45 (95% CI, 0.26-0.77) for CVD relative to absence of HVA.

Conclusions:
One in 6 individuals experiences HVA in our sample. Individuals with HVA are at a considerably low risk of CVD. Prevention strategies targeting modifiable factors and behaviors included in Life’s Simple 7 are important for preventing or delaying vascular aging and the associated risk of CVD.