bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P118: Scheduling Recruitment Calls Based on Participant’s Preference Increases Screening Success Among Black Adults
Authors: Ibikunle Oluwagbemisola , Turkson-Ocran Ruth-Alma N , Fitzpatrick Stephanie L , Cao Jingyi , Col Hannah , Harry Tamunotonye , Feng Yuanyuan , Choppa Nikhilsai R , Plante Timothy B , Hermosilla Manuel , Elborki Marwa , Aidoo Emily , Juraschek Stephen P
Published: May 2024

Background:
Black adults are underrepresented in cardiovascular trials. Competing priorities may limit when they are available to complete trial prescreening requirements. Examining the impact of calling potential participants during their stated preferred time of day could inform strategies to improve recruitment of Black adults in clinical research.
Objective:
To characterize when Black adults in the Boston area prefer to be called regarding enrollment in two ongoing trials and the association with the number of times a participant was called and/or completion of a phone-based prescreening visit (PSV).

Methods:
The GoFresh trials are two single-masked, parallel-arm, randomized trials, testing a home-delivered, DASH-patterned grocery intervention on BP among Black adults with and without treated hypertension, residing in Boston-area food deserts. Both trials are identical in recruitment drive, design, assessments, and incentives. Participants’ preferred call time was self-reported via a web-based Qualtrics survey. We logged each time staff called participants, whether they were successfully reached, and if a PSV was completed.

Results:
Of 2,861 inquiries, 30.1% did not specify a preferred time, 5.8% preferred a call before 9 am, 11.8% preferred a call between 12-1 pm, and 16.3% preferred a call after 4 pm; the remaining 36% fell within working hours. Of the 2,516 attempted calls between August 2022 - July 2023; 1,883 (74.8%) were reached by phone and of those, 1,467 (77.9%) completed a PSV. There was a positive association between preferred call time category and completion of a PSV (
P
< 0.0001). There was also a positive association between calling a participant at least once during their preferred call time and reaching that participant (
P
= 0.0005).

Conclusion:
Contacting participants during their preferred call time was associated with completion of a PSV. These data highlight the importance of study teams’ flexibility in outreach time to enhance recruitment of Black adults into cardiovascular clinical trials.
Abstract P124: Associations of SARS-CoV-2 Infection and Cardiorespiratory Fitness: Findings From the Cooper Center Longitudinal Study
Authors: Defina Laura F , Durstenfeld Matthew S , Leonard David , Wright Beth B , Shuval Kerem , Pavlovic Andjelka , Radford Nina , Berry Jarett D , Gabriel Kelley P
Published: May 2024

Introduction:
Prior studies suggest that SARS-CoV-2 infection may be associated with declines in cardiorespiratory fitness (CRF), especially with Long COVID. Few studies have pre-pandemic CRF measures and appropriate comparison groups to evaluate differences in CRF by infection status. Thus, we aim to address these gaps using the well-characterized Cooper Center Longitudinal Study (CCLS) cohort. We hypothesize that SARS-CoV-2 infection will result in greater CRF decline compared to no infection and that CRF declines will be greatest among those with Long COVID.

Methods:
Data are from 3532 CCLS participants (26.6% women [938 of 3532]; mean age: 51.9 years) who presented for a Cooper Clinic preventive exam during 01/17-12/22 and had CRF assessed twice, i.e., pre-infection and after the COVID questionnaire was available (01/21). Reported SARS-CoV-2 infection status was defined as never diagnosed, diagnosed with symptoms ≤3 or >3 months (Long COVID). CRF was estimated as final workload in METs via a modified Balke treadmill protocol. Linear mixed effects regression models were used to compare pre-post fitness changes among COVID groups after adjustment for age, sex, smoking, BMI and face mask use during the test.

Results:
A total of 35.4% (1250 of 3532) of the sample reported SARS-CoV-2 infection and 1.7% (61 of 3532) reported symptoms ≥3 months. All 3 groups exhibited significant but minor decreases in mean CRF (0.2 METs). When compared to those without SARS-CoV-2, there were no differences in CRF changes among those with SARS-CoV-2 related symptoms ≤3 or >3 months after full covariate adjustment.

Conclusions:
Over an average of 2.8 years follow-up, CRF did not significantly vary by SARS-CoV-2 infection status or persistence of symptoms. While potential acute changes to CRF were not captured, these findings suggest that COVID infection does not accelerate age-related declines in CRF regardless of symptom length. Future longitudinal research will clarify if differences in CRF by infection status emerge over longer follow-up.
Abstract P140: Using Group Model-Building to Understand and Address Type 2 Diabetes in Native Hawaiian Communities
Authors: Ing Claire T , Kama Ka'apuni , Kenney Meghan , Dolin Brooke , Marshall Sarah M , Hester Gregory , Zhu Yi , Kekauoha B P , Dillard Adrienne Y
Published: May 2024

Introduction:
Native Hawaiians, the indigenous people of Hawai‘i, have a prevalence of type 2 diabetes more than twice that of non-Hispanic Whites. Risk factors and social determinants of health for type 2 diabetes are multilevel and interrelated including individual-level factors, household-level, community-level, and societal-level. To address this complex issue effectively, it is crucial to understand the structure of how these factors interrelate and result in prevalence of type 2 diabetes in Native Hawaiian communities. Group Model-Building (GMB) is a participatory method rooted in systems theory, which provides a conceptual framework to understand such complex systems. It engages stakeholders in a structured process that leverages local knowledge to create contextually relevant causal loop diagrams (CLDs).Purpose: To demonstrate the value of GMB in constructing a CLD that captures the relationships and feedback mechanisms underlying type 2 diabetes in a Hawaiian homestead region and identify potential targeted interventions and policies to address type 2 diabetes prevalence, morbidity and mortality.

Methods:
Prior to the GMB workshops, we identified and engaged key homestead stakeholders, aquired necessary materials, selected a meeting location, create and train a facilitation team, and create the GMB agenda. The workshops were held over two evenings and included structured activities: Hopes and Fears, Graphs over Time, Causal Loop Diagrams, and Action Ideas.

Results:
Hopes and fears themes included: decreasing prevalence, healing, health education, community programs, decreasing quality of life, death, and the impact on the family spectrum. Graphs over time depicted increases in behavioral risk factors for type 2 diabetes, increases in type 2 diabetes-related morbidity, changing access to care, and changing quality of life. Participants developed and revised a CLD illustrating balancing and reinforcing feedback structures. Finally, participants developed 13 intervention/program ideas to address type 2 diabetes including health-related policies, community programs, and addressing social determinants of health (eg., access to care and healthy food, employment services).

Conclusion:
GMB was seen as a valuable tool for visualizing the connections and interdependencies between factors which community understands intuitively but hasn’t seen represented on paper. The process revealed the extent to which community programs impact community members, and highlighted collaborations to foster to sustain these effects. The constraints of physical space limiting the programs they can offer were identified. GMB is a promising method for collaboration, knowledge sharing, and co-creating a comprehensive understanding of diabetes-related factors in Native Hawaiian communities.
Abstract P143: Lignan Intake and Mortality Among Adults With Incident Type 2 Diabetes
Authors: Liu Binkai , Hu Yang , Wang Siyue , Wang Molin , Rimm Eric B , Sun Qi
Published: May 2024

Introduction:
Lignans are polyphenolic compounds abundant in plant-based foods such as seeds, whole grains, and certain fruits and vegetables and may lead to better metabolic health. It remains elucidated regarding the role of lignan consumption in the etiology of premature deaths among diabetes patients.

Hypothesis:
We hypothesize that a higher intake of post-diagnosis lignans is associated with lower risk of mortality among individuals with incident type 2 diabetes (T2D).

Design:
Data from two prospective U.S. cohorts were analyzed, including the Nurses' Health Study (1984-2020) and Health Professionals Follow-up Study (1986-2022). Average daily consumption of total and individual lignans were calculated, and post-diagnosis lignan intakes were cumulatively averaged. Multivariable-adjusted Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between post-diagnosis lignan intake and mortality.

Results:
Among 8,691 incident T2D cases contributing 119,065 person-years of follow-up, 4,502 deaths were documented, among which 1,379 cases were attributed to cardiovascular disease (CVD) and 777 to cancer. The pooled multivariable-adjusted HRs (95% CIs) of all-cause mortality comparing extreme quintiles of post-diagnosis lignan intake were 0.83 (0.74, 0.94) for total lignans, 0.87 (0.78, 0.96) for matairesinol (MAT), 0.77 (0.69, 0.86) for secoisolariciresinol (SECO), 0.92 (0.82, 1.03) for pinoresinol (PINO), and 0.92 (0.82, 1.03) for lariciresinol (LARIC). Higher post-diagnosis intakes of SECO were also significantly associated with lower CVD and cancer mortality. The HRs (95% CIs) of total mortality comparing extreme quintiles of changes in lignan intake from pre- to post-diagnosis were 0.84 (0.75, 0.93) for total lignans, 0.85 (0.76, 0.94) for MAT, and 0.79 (0.71, 0.89) for SECO. No significant associations were observed for PINO and LARIC. Stratified analyses showed that the associations of lignans were significantly stronger among non-white individuals.

Conclusions:
In conclusion, among individuals diagnosed with T2D, a higher intake of lignans, particularly SECO, was significantly associated with reduced overall, cardiovascular, and cancer mortality. Minority groups may particularly benefit from lignan intake, although further studies are warranted to substantiate this observation.
Abstract P147: Alcohol Consumption and Its Relation to Ectopic Adiposity in African Caribbean Men
Authors: Acevedo-Fontanez Adrianna I , Bessette Lily G , Cvejkus Ryan , Carr John Jeffrey , Terry James G , Nair Sangeeta , Kuipers Allison L , Wheeler Victor , Miljkovic Iva
Published: May 2024

Introduction:
Alcohol intake and ectopic fat are associated with cardiometabolic diseases. While previous studies primarily focused on visceral and/or liver fat, few studies to date have investigated the associations of alcohol intake with skeletal muscle fat infiltration, a fat depot which might contribute to the increased risk of diabetes and hypertension in African ancestry populations.

Methods:
Alcohol intake (drinks/day) was assessed using a 146-item semi-quantitative food frequency questionnaire in the Tobago Health Study (N=800). Ectopic fat was measured in the abdomen and thigh in a subset of this cohort (N=706, mean age=63.94 (8.66) years, mean BMI=27.72 (4.65) kg/m
2
) using computed tomography. Men were divided into current drinkers/not current drinkers, and the current drinkers were further subdivided into types of alcohol consumed (wine, beer/stout, or liquor).

Results:
A majority of men (56.1%) were not current drinkers. Of drinking men, 76.1% were light drinkers (<1 drink/day), 17.4% were moderate drinkers (1-3 drinks/day), and 6.5% were heavy drinkers (>3 drinks/day). Men who did not drink were slightly older (65.1 vs 62.5, p<0.001), with less visceral adiposity (91.4 vs. 101.9 cm
3
, p=0.002) and less psoas muscle fat (0.59 vs 0.64 cm
3
, p=0.017) than men who drank, independent of age. In fully adjusted models, drinking liquor was positively associated with BMI, waist circumference, visceral and subcutaneous adiposity, while drinking beer was positively associated with thigh muscle fat (Table).

Conclusion:
Alcohol intake was associated with greater ectopic fat accumulation in all studied compartments, except in the liver, in this cohort of African Caribbean men, who mostly had low alcohol consumption. We also report a novel finding that observed relationships differ by type of alcohol.

†
Adjusted for total energy intake, age, walking (hours/week), TV watching (≥14 hours/week), current smoking, diabetes, hypertension, and statin use status.
*
Additional adjustment for BMIHU = Houndsfield Units
Abstract P153: Disruptions to Diabetes and Hypertension Care During the COVID-19 Pandemic and Recovery Approaches in the Latin America and Caribbean Region
Authors: Ogungbe Oluwabunmi V , Jabakhanji Samira , MEHTA ROOPA , McCaffrey John , Byrne David , Hurley Sinead , Lori Rosman , Bansah Eyram , Ibukun Folahan , Quarshie Irene A , Lord Katherine , Yidan Lu , Wang Yunzhi , Rayani Asma , Liu Hairong , Joseph Ann M , Escobosa Alejandro , Nyamuame Ivy , Lee Jieun , Meng Ning , Jehanzeb Ibrahim , Akinyemi Temitope , Nohara Shoichiro , Sousa Cecília , Farhat Juliana , Bandeira de Mello Renato , Yeboah-Kordieh Yvette , Taeed Tara , Appel Lawrence J , Angell Sonia Y , Gregg Edward , Matsushita Kunihiro
Published: May 2024

Background:
The COVID-19 pandemic disrupted healthcare services in Latin America and the Caribbean (LAC). However, few studies provided comprehensive and quantitative data on the magnitude of this disruption.

Objectives:
To synthesize evidence on the extent of disruptions to diabetes and hypertension care in LAC during the COVID-19 pandemic and interventions to recover.

Methods:
We conducted a scoping review of published papers in English, Spanish, and Portuguese. We adopted the Primary Health Care Performance Initiative (PHCPI) Framework to identify healthcare services susceptible to disruptions during the COVID-19 pandemic, specific to diabetes and hypertension, including recovery approaches. We synthesized study findings narratively to represent the diversity of findings geographically and health system.

Results:
Our search yielded 33,510 abstracts after de-duplication; following title/abstract screening and full-text review, 330 articles (218 on disruptions; 112 on interventions) were included in the synthesis. Although there was high heterogeneity, similarities in landscape of disruptions to primary care services across LAC exist. Of the PHCPI Framework domains, disruptions to workforce, medications and supplies, and patient-related outcomes were most recurrent. Intervention studies focused telehealth using digital strategies for diverse care areas and counseling support for health behaviors and mental health. There were data gaps within LAC regarding health system readiness and digital health effectiveness, adoption, efficiency, reach, and sustainability (
Figure
).

Conclusions:
This scoping review identified priorities for action within LAC: 1) establish and fund high-quality research and surveillance systems for hypertension and diabetes; 2) Optimally integrate digital health into hypertension and diabetes care; 3) implement mental health promotion strategies among healthcare workers; 4) establish optimal governance, leadership, and financing of healthcare systems.
Abstract P155: Identifying Inpatient and Outpatient Factors That Reduce Heart Failure Exacerbation Readmissions
Authors: Aujla Sumeet , Tabbaa Kutiba , Affas Ziad , Dubaisi Samer , Joseph Alan , Najor Amanda , Onofrey Erin , Hussain Ali , Arnautovic Jelena
Published: May 2024

Acute heart failure 30-day readmissions are associated with increased patient morbidity and mortality. Our aim is to identify systemic factors that can reduce heart failure readmissions, including the implementation of a heart failure care coordination team. We assessed the hypothesis that individualized post-discharge education and summary from the heart failure care coordination team will reduce 30-day heart failure readmissions.This retrospective study included 213 patients, 18 years and older admitted with NYHA Class II-IV and ACC/AHA Stage B-D heart failure exacerbations from July 2021- March 2022, at a community hospital. Collected variables included demographics, medical comorbidities, labs, echocardiographic findings, inpatient orders, LACE index score, discharge follow-up, receipt of an after-visit summary, length of stay, and 30-day readmission. Descriptive data was summarized as counts and percentages for categorical data, and mean or median for continuous data. Between-group parametric data means were compared by calculating the t-test for independent variables, or medians using the Mann-Whitney U test for data that were nonparametric. Categorical variables were compared by calculating the chi-square test for association or Fisher’s exact test, as appropriate. The primary study objective was tested using Logistic regression modeling. Throughout this study, a p-value ≤0.05 (two-tail) was considered statistically significant. The medical records of all available reduced treatment plan patients were compared to preserved treatment plan patients in approximately equal numbers. Pair-wise t-tests required the greatest number of subjects. Using the conventional power level of 80%, a two-tailed alpha of 0.05, and assuming a medium effect size, it was estimated that this comparison will require at least 114 subjects.

In this study, 189 of 213 patients were reached by the heart failure care coordination team. 49/189 were readmitted in 30 days and 140/189 were not. For the readmission group, the percentage of patients who were CKD Stage 3 or 4 (39.4%, 28 of 71) was higher than those who were not (21.1%, 30 of 142) with a p-value of 0.005. The percentage of patients who had discharge BNP checked (39.1%, 18 of 46) was higher than those who were not (24.1%, 40 of 166) with a p-value of 0.043. A higher LACE index score was associated with readmission as compared to a lower score, with a p-value of < 0.001.

In conclusion, presence of CKD stage 3 or 4, discharge BNP, and a higher LACE-index score were associated with 30-day heart failure readmission. Counterintuitively, the heart failure care coordination team did not have an impact on this endpoint, contrary to our hypothesis. Future studies with a larger sample size and focus on the outpatient care team efforts may be helpful in elucidating the team's potential in preventing heart failure readmission.
Abstract P168: Life’s Simple Seven by Sexual Orientation and Sex in the CARDIA Cohort
Authors: Beach Lauren B , Slone B. R. , Avila Grace , Bhatt Ankeet , Shikany James M , Schreiner Pamela , Streed Carl , Caceres Billy A , Phillips Gregory , Poteat Tonia , Perreira Krista , Lewis Cora E , Carnethon Mercedes R , Janulis Patrick
Published: May 2024

Introduction:
Sexual minorities are impacted by broad-ranging health disparities. Few studies have investigated cardiovascular health by sexual orientation.

Objective:
We assessed Life’s Simple 7 (LS7) in 2015-16 in the Coronary Artery Risk Development in Young Adults (CARDIA) study by sexual orientation identity, including an interaction term for sex.

Methods:
CARDIA participants completed sex and sexual orientation identity items in 2020-22 and had complete LS7 data on file from 2015-2016. Poisson and linear regression were used to test for LS7 differences and generated similar results. Linear models are reported to facilitate interaction interpretations.

Results:
In 2015-16, mean participant age was 55.2 years, 59.7% of participants were female, and 44.3% were Black. Compared to heterosexual male participants, heterosexual female participants had significantly higher LS7 scores (B = 0.950, p < 0.001). No LS7 differences were found between heterosexual male participants and gay, bisexual, or something else/not sure male participants. A significant interaction was detected between sex and identifying as gay/lesbian (B = -1.177, p = 0.003), suggesting the LS7 protective effect of sex for heterosexual female participants was lower for gay/lesbian female participants (Table 1).

Conclusions:
Future studies will assess LS7 longitudinally by sexual orientation and gender identity in CARDIA.

Table 1. Differences in LS7 Score by Sex and Sexual Orientation Identity
Abstract P169: Cardiovascular Disease Incidence Among Male Veterans by Sexual Orientation and Race
Authors: Duncan Meredith S , Streed Carl , Heier Kory , O'Leary John , Skanderson Melissa , Goulet Joseph
Published: May 2024

Introduction:
Studies of cardiovascular disease (CVD) in sexual minority (SM) men (i.e., gay, bisexual) vs. heterosexual men are limited by small sample sizes and lack of objective CVD ascertainment. Small samples also hinder study at the intersection of race and sexual orientation on CVD events. We used the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender Electronic Health Record cohort to fill these knowledge gaps.

Methods:
We studied 919,404 male cisgender veterans who were free of prevalent CVD and classified as SM or non-SM by a natural language processing tool. We defined incident CVD as first instance of AMI, ischemic stroke, cardiac revascularization, or CVD death between baseline and date of death or 8/31/22. We stratified sample statistics by SM status and race. We used Cox proportional hazards regression to assess the intersection of sexual orientation and race with incident CVD; we adjusted for Hispanic ethnicity and age. Based on the minority stress model, non-SM White men were the referent.

Results:
Within races, traditional CVD risk factors were similarly distributed by SM status but SM men had greater prevalence of stress-associated characteristics like substance use, depression, and anxiety. Heterosexual, gay, and bisexual Asian men had lower CVD risk than non-SM White men, while Black/African American and Multiracial men had persistently increased CVD risk (
Table
). White and American Native gay men had increased CVD risk vs. non-SM White men. With the exception of Asians, all unclassified SM men had increased CVD incidence vs. non-SM White men. Risk was highest in among Black or Multiracial SM men.

Conclusion:
This is one of the first studies to examine the intersection of sexual orientation and race on CVD risk in male veterans. CVD risk appears increased or decreased in certain racial groups regardless of sexual orientation but this is not always true and invites further study into the mechanisms by which stress results in inequitable CVD events across groups.
Abstract P184: Association of Plasma Lipid Species With Lipoprotein Insulin Resistance Score Before and After Exercise Training
Authors: Leszczynski Eric , Dev Prasun K , Barber Jacob , Rao Prashant , Mi Michael , Ghosh Sujoy , Connelly Margery , Clish Clary , Bouchard Claude , Robbins Jeremy , Gerszten Robert E , Sarzynski Mark A
Published: May 2024

Background:
The lipoprotein insulin resistance (LP-IR) score has been shown to assess insulin resistance, predict future type 2 diabetes, and improve with regular exercise. The lipidomic profile is known to differ with insulin resistance and type 2 diabetes, but few studies have examined lipidome associations with LP-IR, particularly in response to an exercise intervention.

Methods:
Plasma lipids were measured using the C8-positive LC-MS method in 671 participants from the HERITAGE Family Study (56% Female, 35% Black, 35.2 yrs) before and after a 20-week exercise intervention. LP-IR, a weighted index of six lipoprotein parameters, was measured before and after training through nuclear magnetic resonance spectroscopy (Labcorp, NC). Linear mixed models were used to test the associations of 193 known plasma lipids with LP-IR before and after exercise training. All models were adjusted for age, sex, and race, while post-training models also adjusted for baseline lipid and baseline LP-IR.

Results:
A total of 162 lipids (84%) were associated (FDR<0.05) with LP-IR at baseline (
Figure 1
). The top positive associations were found for TG species, while cholesterol ester species showed the top inverse associations. Following training, the change in 143 (74%) lipids were associated (FDR<0.05) with change in LP-IR. There were 129 lipid species associated with both baseline and changes in LP-IR, while 33 were only associated with baseline measures and 14 only associated with changes in LP-IR following exercise (
Figure 1
).

Conclusions:
We found that most lipids were associated with LP-IR regardless of exercise training status. Importantly, we identified a subset of lipids that were only associated with changes in LP-IR, which may represent exercise responsive biomarkers of exercise induced changes in LP-IR. However, further research is needed to identify the biological mechanisms connecting the changes in these lipid species and metabolic changes following exercise training.
Abstract P185: Plasma Lipidome Signature of Visceral Fat Reveals Heterogenous Cardiometabolic Risk Profiles
Authors: Leszczynski Eric , Dev Prasun K , Barber Jacob , Rao Prashant , Mi Michael , Ghosh Sujoy , Clish Clary , Bouchard Claude , Robbins Jeremy , Gerszten Robert E , Sarzynski Mark A
Published: May 2024

Background:
Excessive visceral fat is associated with metabolic alterations and is a causal risk factor for CVD. The plasma lipidome is altered in obesity and lipidome signatures of BMI and obesity have been identified. However, few studies have examined the plasma lipidome in relation to visceral fat.

Methods:
Plasma lipids were measured using the C8-positive LC-MS method in 671 participants from the HERITAGE Family Study (56% Female, 35% Black, 35 yrs). Visceral fat was measured using CT scans. Linear mixed models were used to test the associations of 193 known plasma lipids with visceral fat adjusting for age, sex, race, and BMI. A FDR<5% was used to determine significance.

Results:
In individual models, 156 lipid species were significantly associated with visceral fat, with 109 species associated after additional adjustment for BMI (
Fig 1
). The top positively associated lipids were triglycerides, while cholesterol esters showed the strongest inverse associations with visceral fat. A LASSO regression model retained 73 lipids and explained 78.5% of the variance in visceral fat. Delta visceral fat was calculated as the difference between predicted (from LASSO) and measured visceral fat. Examining quartiles of delta visceral fat showed that discordance between predicted and actual visceral fat was associated with differing cardiometabolic profiles independent of age, sex, race, visceral fat, and BMI. Individuals with higher delta visceral fat (Q4, overpredicted) had significantly (p<1.0x10
-04
) higher levels of TG, apoB, total cholesterol, LDL-C, and fasting insulin and lower levels of large HDL particles and LPL activity compared to those with lower delta visceral fat (Q1, underpredicted).

Conclusions:
The plasma lipidome is widely associated with visceral fat levels. A lipidome-based visceral fat score may provide additional information over measured visceral fat for assessment of cardiometabolic health. Further studies are needed to test and validate the clinical utility of such lipidome-based scores.
Abstract P195: Metabolites Mediate the Association of the MIND Diet With Hypertension and Chronic Kidney Disease
Authors: Couch Catharine , Ament Zsuzsanna , Patki Amit , Kijpaisalratana Naruchorn , Bhave Varun M , Jones Alana , Armstrong Nicole D , Kimberly W. Taylor , Irvin Ryan M
Published: May 2024

The Mediterranean-DASH diet intervention for neurodegenerative delay (MIND), is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. The Mediterranean and DASH diets are associated with decreased risk of cardiometabolic disease; however, less is known regarding the association of the MIND diet with cardiometabolic disease. The objectives of this analysis were (1) to determine if the MIND diet is associated with prevalent hypertension and chronic kidney disease (CKD) and (2) to identify metabolites associated with the MIND diet and if these metabolites mediate the association of the MIND diet with hypertension and CKD.

In the REasons for Geographic and Racial Disparities in Stroke (REGARDS) cohort, we examined the association of the MIND diet with prevalent hypertension and CKD. Fully adjusted models included age, sex, race, calories, alcohol, smoking, education, exercise, income, region, BMI, lipidemia, history of coronary artery disease, and diabetes. In the REGARDS stroke case-cohort sub-study, 357 metabolites were measured in baseline plasma. Weighted linear regression models were used to test the association between MIND diet score and metabolites adjusting for age, sex, race, calories, alcohol, and smoking. Weighted logistic regression models were used to test the association between MIND-metabolites and hypertension and CKD adjusting for age, race, sex, BMI, alcohol, and smoking. Mediation analysis was conducted to examine metabolites mediating the association between MIND diet and hypertension and CKD. Sensitivity analyses were conducted in the cohort random controls.

A higher MIND diet score was associated with lower odds of hypertension (odds ratio [OR] 0.97, 95% CI 0.96-0.99; p=0.01) and CKD (OR 0.88, 95% CI 0.86-0.91; p<0.0001). Fifty-one metabolites were associated with the MIND diet (MIND-metabolites). Three MIND-metabolites were associated with greater odds of hypertension; however, these associations were attenuated in the fully adjusted models. Twelve MIND-metabolites were associated with greater odds of CKD. Mediation analyses indicated dimethylguanidino valeric acid (DMGV), guanosine, and C7 carnitine to mediate the association between MIND diet and hypertension. DMGV, guanosine, gluconic acid, S-Adenosyl-L-homocysteine, C7 carnitine, and 5 triacylglycerols mediated the association between MIND diet and CKD. Higher adherence to the MIND diet is associated with a lower likelihood of hypertension and CKD. MIND diet-related metabolites were found to be associated with hypertension and CKD and may provide insight to metabolic pathways linking diet and disease.
Abstract P197: Dietary Quality Determined by Healthy Eating Index-2015 and Endothelial Function in Healthy Adults
Authors: DeSouza Christian S , Farrell Kathleen T , Pacheco Garcia Vinicius , Greiner Jared J , Stauffer Brian L , Desouza Christopher A
Published: May 2024

The Healthy Eating Index (HEI) is a measure of diet quality based on Dietary Guidelines for Americans and developed in collaboration with the US Department of Health and Human Services and the US Department of Agriculture. Clinical interest in HEI has increased due to its association with obesity, inflammatory biomarkers and risk of coronary heart disease and stroke. Indeed, higher HEI-2015 score has been linked with reduced cardiovascular risk, morbidity, and mortality. Endothelial dysfunction, particularly impaired endothelium-dependent vasodilation, is a central etiological factor underlying cardiovascular risk and events. We and others have previously demonstrated that diets high in saturated fat and other proatherogenic diets are associated with endothelial vasodilator dysfunction. It is currently unknown whether HEI-2015 dietary score is associated with endothelial function. If so, assessing dietary quality based on HEI-2015 may provide targeted nutritional guidance for enhancing vascular health and mitigating cardiovascular risk. The aim of this study was to determine whether HEI-2015 score is associated with endothelial vasodilator function in healthy adults. Using data from 4-day dietary records, HEI-2015 scores were determined in 103 adults (65 M/38 F; age 44-68 years) free of overt cardiometabolic disease. The HEI-2015 score is based on 13 components summed to yield a total score from 0 to 100; higher score representing higher diet quality. The adults were stratified by HEI-2015 score quartiles: Q1: HEI < 52.5 (n=25; 23 M/2 F); Q2: HEI 52.6-59.1 (n=26; 14 M/12 F); Q3: HEI 59.2-66.0 (n=26; 15 M/11 F); and Q4: HEI > 66.0 (n=26; 13 M/13 F). Endothelium-dependent vasodilation was determined by forearm blood flow (FBF) (via plethysmography) responses to intra-arterial infusion of acetylcholine (ACh: 4.0, 8.0, and 16.0 μg/100 mL tissue/min) and sodium nitroprusside (NTP: 1.0, 2.0, and 4.0 μg/100 mL tissue/min). There were no significant differences in endothelium-dependent vasodilation across the HEI-2015 score quartiles. FBF blood responses to ACh were remarkably similar between Q1 (5.1±0.2 to 13.0±0.7 mL/100 mL tissue/min), Q2 (4.3±0.2 to 12.1±0.7 mL/100 mL tissue/min), Q3 (4.4±0.2 to 13.0±0.7 mL/100 mL tissue/min) and Q4 (4.5±0.2 to 14.4±0.6 mL/100 mL tissue/min). Moreover, HEI scores were not significantly associated with the vasodilator response to either ACh (r=0.15, P=0.13) or NTP (r=-0.04; P=0.72). In summary, although diet quality determined by HEI-2015 score has been shown to be associated with increased risk of cardiovascular disease and events, HEI-2015 was not associated endothelial function in mid-life and older adults. Given the established experimental and pathophysiological evidence linking between diet, endothelial vasodilator function and cardiovascular risk, HEI-2015 score is not a sensitive dietary indicator/biomarker of vascular function.
Abstract P202: The Effects of Sodium (Na) Reduction and the Dash Diet on Ambulatory Blood Pressure in Black and Non-Black Individuals: Results From the DASH-Na Trial
Authors: Hussain Tasfia , Juraschek Stephen P , Miller Edgar R , Appel Lawrence J
Published: May 2024

Background:
Black individuals compared to White individuals tend to have higher nighttime BP. It has been hypothesized that lifestyle changes will reduce and potentially eliminate this disparity.

Objectives:
To determine the effect of reduced Na and the DASH diet, alone and combined, on ambulatory blood pressure (ABP) in Blacks (B) and Non-Blacks (NB, mostly white).

Methods:
Participants (n=335, 58% B) were randomly assigned to eat a control diet or the DASH diet. On their assigned diet, each participant had three, randomly ordered, 30d feeding periods with different Na levels (low, medium, and high). ABP was measured at the end of each period.

Results:
Before feeding, mean office SBP was similar in B and NB (135.5 and 134.5 mmHg, respectively). On the reference diet (control diet with high Na), daytime and nighttime SBP were higher in B than NB adults (Table). Compared to the ref diet, reducing Na and consuming the DASH diet, alone and combined, substantially lowered daytime and nighttime systolic ABP in Black and Non-Black individuals. The DASH diet combined with low Na reduced daytime SBP in B and NB with no significant B-NB difference, i.e. no racial disparity in daytime SBP; otherwise, B-NB differences were present in daytime SBP for Na reduction alone and DASH diet alone. For nighttime SBP, there was a consistent pattern such that Na reduction alone, DASH diet alone, and the DASH diet with low Na reduced nighttime SBP in B and NB, but in each case, B had significantly higher nighttime SBP levels than NB. For DBP, Na reduction alone, DASH diet alone, and combined DASH with low Na reduced daytime and nighttime BP in B and NB, but significant B-NB differences persisted (data not shown).

Conclusions:
Reducing dietary Na and consuming the DASH diet, alone and combined, substantially lowered ABP in Black and Non-Black individuals. However, racial disparities in ABP mostly persisted. These results highlight the importance of implementing both the DASH diet and Na reduction as a means to reduce BP throughout the day, regardless of racial background.
Abstract P207: Blood Metabolomic Signatures of 24-hr Urinary Sodium and Potassium Excretion Were Associated With Cardiometabolic Diseases in the Hispanic Community Health Study/Study of Latinos
Authors: Luo Kai , Mossavar-Rahmani Yasmin , Daviglus Martha L , Burk Robert , Labovitz Daniel L , Yu Bing , Boerwinkle Eric , Hou Lifang , Kaplan Robert , Qi Qibin
Published: May 2024

Background:
24hr urinary sodium (Na) potassium (K) excretions are considered as accurate measures of sodium and potassium intake, but data are limited in large population-based studies due to the difficulties of 24hr urine sample collection.

Hypothesis:
24hr urinary Na and K excretion can be predicated by blood metabolomic signatures, which are associated with the risk of cardiometabolic diseases.

Methods:
We assessed 24hr urinary Na, K excretion and sodium/potassium ratio (Na/K) in 447 apparently healthy individuals from the SOL-Nutrition & Physical Activity Assessment Study (SOLNAS) of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We calculated urinary Na, K excretion, and Na/K metabolite scores by using the Least Absolute Shrinkage and Selection Operator regression on 199 serum metabolites in SOLNAS, and evaluated their associations with incident CVD (heart failure, stroke, myocardial infarction), type 2 diabetes (T2D), and hypertension (HTN) in up to 5738 individuals in HCHS/SOL.

Results:
There were 41, 22, and 71 metabolites selected to be predictive of urinary Na, K excretion, and Na/K, respectively. Metabolite scores were significantly correlated with measured urinary Na (r=0.35, p < 5e
-14
), K (r=0.58, p< 5e
-50
) excretion and Na/K (r=0.6, p< 5e
-50
). After multivariate adjustment, metabolite scores of urinary Na excretion and Na/K were significantly associated with incident CVD risk (hazard ratio=2.6 for Na and 1.91 for Na/K, per 1 SD increase in score), incident T2D (relative risk [RR]=1.33 for Na and 1.16 for Na/K), and incident HTN (RR=1.53 for Na and 1.35 for Na/K) over a median 7.6 years of follow-up. The metabolite score of urinary K excretion was not associated with CMD risk.

Conclusion:
In US Hispanics/Latinos, higher levels of 24hr urinary Na excretion and Na/K indicated by blood metabolomics signatures were associated with increased risk of CVD, HTN, and T2D.
Abstract P215: Activity Behaviors and Cardiometabolic Health Outcomes in People Living With HIV
Authors: Jones Raymond , Hankes Michael J , Armstrong Nicole D , Gabriel Kelley P , Buford Thomas W , Dooley Erin E
Published: May 2024

Introduction:
Physical activity (PA) and sedentary behavior (SB) are independently associated with cardiometabolic health; data on activity behaviors and cardiometabolic health among people living with HIV (PWH) are limited.

Hypothesis:
Activity behaviors would differ by age and that not meeting
PA Guidelines
would be associated with an increased risk of cardiometabolic diseases among PWH.

Methods:
Using NHANES 2007-08 through 2017-18, PWH (n=125; age 44.3 yrs) were characterized as emerging (18-29 yrs), early (30-44 yrs) and middle (45-59 yrs) adulthood. Achieving
Guidelines
(≥150 min/wk) was derived from self-reported PA across three domains. SB was reported as time spent sitting. Chronic conditions were high cholesterol, obesity, hypertension, and chronic kidney disease. Prevalence estimates of joint high SB (≥8 h/day) and inactivity (<10 min/wk) were calculated, and regression models were used to estimate differences in behaviors by age and investigate the association between achieving
Guidelines
and chronic conditions.

Results:
PWH reported 395.8 min/day of SB with 37.5% spending over 8 h/day sitting. There was no significant difference in SB across lifestage. A total of 67.2% achieved
Guidelines
although 14% were jointly inactive and highly sedentary. Compared with early adult PWH, middle adult PWH spent more time performing transport-related PA (β= 102.7 min/wk,
p
=0.009) and less time performing leisure-time PA (β= -211 min/wk,
p
=0.044) (
Figure
). Compared with PWH meeting
Guidelines
, those that did not meet
Guidelines
had higher diastolic blood pressure (β= 6.1 mmHg [CI: 2.6, 9.6]) and higher odds of obesity (OR=2.5[CI: 1.0, 6.4]).

Conclusions:
Domain-specific differences occurred in transportation and leisure time PA among PWH - a high-risk group for cardiovascular disease. Not meeting the
Guidelines
resulted in greater odds of obesity and higher diastolic blood pressure. Future research should incorporate device-based measures of movement to understand its relation to chronic disease in PWH.
Abstract P219: Moderated-Mediated Effects of Environmental Barriers and Income Level on Exercise Determinants Among Black Americans With Hypertension
Authors: Nemati Donya , Noriega de la Colina Adrian , Kaushal Navin
Published: May 2024

Introduction:
Black individuals are disproportionately affected by hypertension and due to racial disparities have fewer opportunities to engage in preventive measures such as exercise compared to their White counterparts. There is a dearth of research employing a theory-driven approach to comprehensively investigate the factors contributing to disparities in exercise participation among racial groups, both at the individual and environmental levels. The I-Change Model is a contemporary health behavior model comprising three primary pillars hypothesized to influence health behavior: Awareness, Motivation, and Action/Planning. What sets this model apart is its unique emphasis on the proximity of the barrier construct to predicting behavior execution, a feature that may contribute to disparities in exercise participation, including racial disparities. Hence, this observational study aimed to apply the ‘I-Change model’ to identify factors that contribute to exercise behaviors among Black and White individuals with Hypertension.

Methods:
We used the I-Change model, which includes mediating behavioral determinants, along with moderators that include environmental barriers (e.g., access and transportation to a supportive exercise environment), and income (low vs. moderate and above) to gain a better understanding of racial disparities in exercise participation. Individuals with hypertension (n= 370) that comprised of Black (n= 142) and White (n= 228) adults who were recruited via an online recruitment platform and completed a survey that included validated theoretical constructs. Hayes PROCESS 4.0 Macro (model #16) for SPSS was used to construct the theoretical model and analyze the data. The model included race (x), exercise time (y), behavioral determinants (mediators), environmental behaviors, and income (moderators between mediators and exercise time).

Results:
I-Change determinants (risk of heart disease, planning, exercise knowledge, exercise partner/social support) mediated the relationship between race and exercise time (β= .24, 95% CI .098, .394) in favor of White participants. Moderated-mediation effects were found on barriers that interacted between planning and exercise time (β= .03, 95% CI .0018, .0674), and income which interacted between social support and exercise time, (β= .05, 95% CI .0004, .1056).

Conclusion:
Intervention work at the community level for low-income Black individuals with hypertension supported by a theoretical framework is needed. Specifically, an exercise promotion program that supports the development of I-Change determinants, which provides an accessible and supportive environment, would be helpful in providing equitable exercise opportunities for Black individuals with hypertension.
Abstract P224: Rural Hospital Closures Are Associated With Increased Mortality From Ischemic Heart Disease: A County-Level Analysis
Authors: Kanuparthy Meghamsh , Kanuparthy Srikur , Harris Dwight , Broadwin Mark , Stone Christopher , Sellke Frank W
Published: May 2024

Objective:
Ischemic heart disease remains the leading cause of death in the United States; yet mortality from heart disease is geographically heterogeneously distributed. From 2011 - 2020, several hospitals across the US have closed. In this study we will investigate the impact of hospital closure on county level disease-specific mortality data. We hypothesize that rural hospital closures will be associated with increased risk of mortality from ischemic heart disease.

Methods:
The CDC-Wonder database, an online outcomes reporting system was queried for county level, ischemic heart disease specific mortality in Texas - the state with the largest number of hospital closures. Demographic, socioeconomic, and comorbidity information was collated from the County Health Ranking project. Hospital closure data was obtained from the Sheps Center for Health Services Research. Counties were grouped by Health Service Area (HSA) and were considered affected if any county in the HSA was affected by a hospital closure. A difference in difference analysis with unbiased staggered adoption was performed with a multivariate linear model. 4 counties with multiple hospital closures in the time frame were excluded from analysis.

Results:
Over a 10-years (2011 - 2020) 247,712 deaths were recorded as related to ischemic heart disease in Texas. Difference-in-difference analysis with all counties did not demonstrate a significant treatment effect of hospital closure (ATT = - 0.01, p = 0.71). Restricting comparisons to rural hospitals demonstrated a significant effect of rural hospital closures as compared to other rural counties (ARR = 0.119, p = 0.04). There was so significant effect in comparison of non-rural counties with hospital closures.

Conclusions:
These results demonstrate the disproportionate impact of hospital closure on rural health outcomes. As compared to patient-level analysis relying on hospital discharge data, this country level analysis captures non-hospital deaths and elucidates the true human cost of hospital closure.
Abstract P225: Heartfelt Savings: Health Savings Accounts Assist in Alleviating Financial Burdens and Prompt Timely Treatment for Patients With Cardiovascular Disease
Authors: Won Daniel , Walker James , Workman Connor , Guo James W , Zordani Elizabeth , Chorniy Anna , Malaisrie S. Christopher , Lloyd-Jones Donald M
Published: May 2024

Background:
Cardiovascular diseases (CVD) are among most costly in the U.S, with a significant portion of CVD patients unable to afford care. Use of health savings accounts (HSA) to increase financial savings for medical expenditures is controversial. While HSA have shown to not decrease medical expenditures, the financial impact of HSA on patients with CVD remains unknown.

Methods:
This cross-sectional study used data from the Medical Expenditure Panel Survey for 2014-19 and included patients aged 18-64 who reported having at least one CVD (i.e., hypertension, angina, myocardial infarction, heart failure, stroke, or all other CVD). A survey-weighted model was utilized to determine the adjusted odds ratios (OR) for associations between CVD patients with HSA and 1) demographics factors and 2) metrics associated with financial difficulty by adjusting for age, sex, race, total out of pocket (OOP) yearly premiums, total yearly medical expenditures, total OOP yearly medical expenditures, total yearly income, annual deductibles, and other demographic factors
(Figure 1)
.

Results:
CVD patients with HSA were significantly less likely to experience financial difficulties such as affording medical care (OR 0.586, 95% CI 0.344-0.998, p = 0.049) and trouble paying medical bills (OR 0.762, 95% CI 0.582-0.996, p = 0.047). Furthermore, CVD patients with HSA were significantly less likely to delay medical care (OR 0.614, 95% CI 0.389-0.970, p = 0.037) and preventive medicine (OR 0.575, 95% CI 0.336-0.983, p = 0.046) due to cost. However, CVD patients who earn lower income, self-identify as Hispanic or Black, from the South or West, or have lower years of education were significantly less likely to benefit from an HSA
(Figure 1)
.

Conclusions:
CVD patients with HSA were significantly associated with decreased financial difficulties and were less likely to delay care. Policies intended to support minority and lower-income CVD patients such as increased financial education may reduce healthcare disparities and promote access to care.