bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P266: Low Adherence to Antihypertensive Medications Predicts a Decline in Health-Related Quality of Life Among Older Adults
Authors: Peacock Erin , Williams LaKeisha , Joyce Cara , Muntner Paul , Morisky Donald , Krousel-Wood Marie
Published: March 2022

Purpose:
Low adherence to antihypertensive medication is associated with poor cardiovascular outcomes and increased healthcare costs. Less is known about how low adherence relates to health-related quality of life (HRQOL) over time. We tested whether low adherence to antihypertensive medications predicts a decline in HRQOL over one year using data from the Cohort Study of Medication Adherence among Older Adults (CoSMO).

Methods:
A telephone survey was administered to hypertensive older adults three times at yearly intervals. Three measures of low adherence captured at first follow-up were used: pharmacy fill (low adherence defined as proportion of days covered (PDC) <0.8), self-report using the 8-item Morisky Medication Adherence Scale (MMAS-8) (low adherence defined as a score <6), and self-report using a published 4-item scale by Krousel-Wood and colleagues (K-Wood-4) (low adherence defined as a score >0). HRQOL was measured using the RAND Medical Outcomes Study 36-item tool. Low HRQOL was defined in two ways: Mental and Physical Component Summary scores (MCS and PCS, respectively) in the lowest tertile. Decline in HRQOL was defined as a 10 point decrease from first to second follow-up. Separate multivariable logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI) for declines in MCS and PCS, after adjusting for sociodemographic and clinical factors. The analysis predicting a decline in MCS was restricted to those without low MCS at first follow-up (n=1234), while the analysis predicting a decline in PCS was restricted to those without low PCS at first follow-up (n=1225).

Results:
The sample was 58.2% female and 30.0% black with a mean age of 74.9. Among those without low MCS at first follow-up, the incidence of low MCS at second follow-up was 21.6%; the incidence of low PCS at second follow-up was 15.7% among those without low PCS at first follow-up. After adjusting for sociodemographic and clinical factors, low adherence at first follow-up as measured by the K-Wood-4 was associated with a decline in MCS over one year (OR=1.85, 95% CI 1.13, 3.05), but not with a decline in PCS (OR=0.73, 95% CI 0.47, 1.14). Neither PDC nor MMAS-8 measures predicted declines in MCS or PCS over one year.

Conclusions:
Low adherence to antihypertensive medication as measured by the K-Wood-4 predicts a decline in MCS, but not PCS, over one year among older adults with hypertension. Efforts to address low adherence may improve HRQOL for older adults.
Abstract P274: Pregnancy-induced-hypertension and the Risk of Postpartum Hypertension Among Gestational Diabetes Women
Authors: Wang Leishen , Leng Junhong , Liu Huikun , Zhang Shuang , Wang Jing , Li Weiqin , Li Wei , Li Nan , Zhang Tao , Hu Gang
Published: March 2022

Background:
Previous studies in the general people indicated that pregnancy-induced hypertension (PIH) increased the risk of subsequent hypertension after delivery. Some studies found that women with gestational diabetes mellitus (GDM) had an increased risk of PIH. However, very few studies have assessed the association between PIH and the risk of postpartum hypertension among GDM women.

Aims:
To evaluate the association between PIH and the risk of postpartum hypertension among GDM women.

Methods:
We performed a retrospective cohort study in 1261 GDM mother at 1-5 years after delivery using the baseline data from Tianjin Gestational Diabetes Mellitus Prevention Program. Cox regression models were applied to assess the single and joint associations of having a history of PIH, maternal pre-pregnancy BMI (normal weight, overweight and obesity), and weight change from pre-pregnancy to postpartum with the risk of subsequent hypertension among the GDM women.

Results:
GDM people with a history of PIH, high pre-pregnancy BMI, and weight gain more than 7 kg from pre-pregnancy to postpartum were associated with an increased risk of postpartum hypertension. Joint effects analysis revealed that the positive association between a history of PIH in the index pregnancy and the risk of postpartum hypertension was consistent in GDM women with different levels of pre-pregnancy BMI or weight gain from pre-pregnancy to postpartum.

Conclusion:
A history of PIH increases the risk of subsequent hypertension in postpartum 1-5 years among GDM women. We suggest highlight the pregnancy guide in different stages and pay more attention on this group of people.
Abstract P277: Orthostatic Hypotension Predicts Arterial Stiffness Later in Life
Authors: Crichton Georgina , Elias Merrill
Published: March 2022

Arterial stiffness is a major risk factor for myocardial infarction, stroke, end-stage renal disease and other cardiovascular diseases. It is now recognized that measures of central arterial function are better and more useful predictors of vascular health outcomes than measures of traditional blood pressure, and pulse wave velocity (PWV) is now considered the gold standard non-invasive method for measuring aortic stiffness. The aim of the present study was to test the hypothesis that orthostatic changes (hypo- or hypertension) may be related to arterial stiffness, as inferred by PWV over a five year period, with consideration given to other cardiovascular risk factors, lifestyle and PWV-related variables. Orthostatic hypotension was defined as a fall in systolic blood pressure of 20 mm Hg or more, or in diastolic blood pressure of 10 mm Hg or more, and orthostatic hypertension as a rise in systolic blood pressure or 20 mm Hg or more. The majorprospective analysis was undertaken on 503 community-dwelling participants (mean age 61 years, 60% women) from the Maine-Syracuse Longitudinal Study (MSLS). At baseline, the prevalence of orthostatic hypotension and hypertension was 3.9% and 4.9%, respectively. Orthostatic blood pressure variables were related to PWV, after adjustment for demographic, cardiovascular, lifestyle and PWV-related factors. Arterial stiffness was significantly greater in those with orthostatic hypotension (12.1 ± 0.56 m/s) than in those without (10.5± 0.11 m/s), measured up to five years later, with full multivariate adjustment. Orthostatic hypertension was not associated with arterial stiffness. In conclusion, we found that orthostatic hypotension predicts arterial stiffness later in life.
Abstract P279: Racial/Ethnic Differences in the Association Between Ready-to-eat and Ready-to-heat Meal Consumption and Obesity
Authors: Singleton Chelsea R , Odoms-Young Angela , Powell Lisa M
Published: March 2022

Introduction:
Convenience meals that are ready-to-eat (RTE) or ready-to-heat (RTH) are typically considered unhealthy choices because they are often high in saturated fat, sodium, sugar, or processed foods. Frequent RTE and RTH meal consumption is hypothesized to increase obesity risk. This research aimed to examine differences in RTE and RTH meal consumption by race/ethnicity in a large sample of US adults. Furthermore, we aimed to determine if associations between RTE and RTH meal consumption and obesity differ by race/ethnicity.

Hypothesis:
Differences in RTE and RTH meal consumption will exist between racial/ethnic groups. RTE and RTH meal consumption will be associated with increased body mass index (BMI) among all racial/ethnic groups.

Methods:
Cross-sectional data on 14,307 participants of the National Health and Nutrition Examination Survey (NHANES) years 2009-2012 were analyzed. Participants were 49.0% Non-Hispanic white, 23.2% Non-Hispanic black, and 27.8% Hispanic or Latino. Self-reported food purchasing behaviors were captured via a questionnaire. Participants were asked to record the total number of RTE meals (i.e. meals prepared away from home at a food retail outlet) they consumed in the past 7 days, and the total number of RTH meals (i.e. frozen meals) they consumed in the past 30 days. Stratified multivariable-adjusted linear regression models were used to examine associations between RTE and RTH meal consumption and BMI by racial/ethnic group. Analyses were adjusted for the NHANES sampling scheme.

Results:
Mean BMI was 28.1 (±0.1). About 39% of participants were obese. On average, Non-Hispanic white participants consumed significantly more RTE meals and RTH meals than Non-Hispanic black and Hispanic participants. Hispanic participants, on average, consumed RTE and RTH meals the least. After adjusting for covariates such as age, education level, household size, and participation in the Supplemental Nutrition Assistance Program, increased consumption of RTE meals was significantly associated with increased BMI among Non-Hispanic whites and Non-Hispanic blacks. There was no association between RTE meal consumption and BMI among Hispanics. RTH meal consumption was not associated with BMI among any racial/ethnic group.

Conclusions:
Racial/ethnic differences in the association between RTE and RTH meal consumption and obesity were observed. More research is needed to better understand the contribution of food purchasing behaviors to racial disparities in chronic disease.
Abstract P280: Greater Dietary Fiber Consumption is Associated with Lower Insulin Resistance and Blood Pressure in Adolescents
Authors: Dong Yutong , Pollock Norman , Raed Anas , Parikh Samip , Bhagatwala Jigar , Gutin Bernard , Zhu Haidong
Published: March 2022

Introduction:
Greater dietary fiber intake has shown cardiometabolic benefits in adults. Previously, we have shown that dietary fiber intake is inversely associated with adiposity and inflammation in youth. However, evidence of the relations of fiber intake to insulin resistance and blood pressure in adolescents is lacking.

Hypothesis:
We hypothesized that greater daily dietary fiber intake would be associated with lower insulin resistance and blood pressure. Additionally, insulin resistance may mediate the relationship between fiber intake and blood pressure.

Methods:
Seven hundred and sixty-six Southeastern US adolescents from age 14 to 18 were recruited (50.3% females; 49.2% African-Americans). Diet was assessed via four to seven independent 24-hour recalls. Seated systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured five times at 1 minute intervals after 10 minute rest and the last three measurements were averaged. Percent body fat (%BF) was measured by dual-energy x-ray absorptiometry. Fasting blood samples were measured for fasting glucose and fasting insulin. Homeostatic Model Assessment for insulin resistance (HOMA-IR) was then calculated.

Results:
Multiple linear regressions with bootstrapping, adjusting for age, sex, race, Tanner stage, %BF, and energy intake, revealed that dietary total fiber intake was negatively associated with HOMA-IR, SBP, and DBP (standardized β = -0.22, β = -0.09, and β = -0.12; all
p
< 0.05). Subcategorizing fiber into soluble and insoluble fiber revealed that both types were negatively associated with HOMA-IR (
p
< 0.01). However, only soluble fiber intake was negatively associated with both SBP and DBP (all
p
< 0.01). No significant race and gender interactions with fiber were identified. Furthermore, a mediation test identified HOMA-IR as a mediator between soluble fiber intake and SBP and DBP (95% CI: -0.34; -0.04; 95% CI: -0.15; -0.01 respectively).

Conclusions:
Our data suggest that greater consumption of fiber may reduce insulin resistance and blood pressure in adolescents. Furthermore, insulin resistance may mediate the relationship between soluble fiber intake and blood pressure.
Abstract P281: Longitudinal Associations of Diet, Screen Time, and Physical Activity Behaviors With Cardiometabolic Risk Factors Among Chinese Children and Their Parents
Authors: Dong Fei , Howard Annie Green , Herring Amy , Adair Linda , Thompson Amanda , Popkin Barry , Aiello Allison , Zhang Bing , Gordon-Larsen Penny
Published: March 2022

Background:
Understanding intergenerational differences in associations of urbanization-related lifestyle behaviors with cardiometabolic disease (CMD) risk factors in children and their parents is important in rapidly urbanizing China.

Objective:
We tested the intergenerational differences in longitudinal associations of away-from-home eating, snacking, screen time, and leisure-time sports with high waist-to-height ratio (WHtR), elevated blood pressure (BP), elevated hemoglobin A1c (HbA1c), and elevated C-reactive protein (CRP) among Chinese children and their parents.

Method:
We studied 5,180 children (aged 7-17y) and their parents participated in China Health and Nutrition Survey (1991-2009) with measured WHtR, BP, HbA1c, and CRP. We used three-day 24-hour dietary recall to derive away-from-home eating (non-consumer, <1meal/day, and ≥1meals/day) and consumption of fruit/vegetable snacks (any/none) and other snacks (any/none). We used a seven-day physical activity recall to collect screen time (≤1hr/day, 1-2hrs/day, and >2hrs/day) and leisure-time sports (any/none). Random-effects logistic regression was used to examine the associations of lagged behaviors with CMD risk factors.

Results:
We detected intergenerational differences in associations between lagged behaviors and risk factors (
P
interaction
<0.1). Generation-specific models showed that lagged away-from-home eating ≥1 (versus no) meals/day was negatively associated with parents’ high WHtR (OR=0.68, 95% CI=0.53, 0.89) but positively associated with children’s high WHtR (OR=1.46, 95% CI=1.01, 2.12) at follow-up. Lagged fruit/vegetable snack consumption was negatively related to parents’ high WHtR, parents’ elevated BP, and children’s high WHtR at follow-up. Lagged screen time was positively associated with parents’ high WHtR and children’s high WHtR, elevated BP, and high CRP at follow-up. The behavior-risk factor associations did not differ across years.

Conclusion:
CMD risk factors were negatively associated with fruit/vegetable snack consumption and positively associated with screen time in both generations. Away-from-home eating was associated with higher WHtR in children but lower WHtR in parents. Generation-specific intervention strategies may be needed for behavioral changes to reduce CMD risk.
Abstract P289: The Neighborhood Food Environment and Change in Body Mass Index: A Systematic Review and Meta-Analysis of Longitudinal Studies
Authors: Maleki-Yazdi Keon A , Peñalvo Jose L , Marsden Daniel , Rompay Maria V , Micha Renata , Mozaffarian Dariush
Published: March 2022

Introduction:
The neighborhood food environment - locations and density of different types of stores and restaurants - is of great interest to reduce obesity. However, prior meta-analyses have focused on cross-sectional studies, for which reverse causation is a major limitation. Meta-analyses restricted to longitudinal study designs evaluating the food environment and change in BMI have yet to be conducted.

Hypothesis:
We hypothesized that increased exposure to fast food restaurants would be associated with increased change in BMI.

Methods:
Eleven databases were searched for longitudinal studies evaluating convenience stores, fast food restaurants, grocery stores, or supermarkets and change in BMI. Inclusion criteria consisted of: (1) interventional, quasi-experimental, or cohort studies; (2) adult or children populations; (3) any country; (4) geographic density or distance of food outlets; (5) a multivariable-adjusted change in BMI over time and corresponding uncertainty. Data were extracted independently and in duplicate, and studies pooled using fixed and random-effects models. Heterogeneity was quantified using Cochrane’s Q, and publication bias using funnel plots, Egger’s test, and Begg’s test.

Results:
13 studies including 98,268 subjects were identified. In random effects models, no significant association was seen between food environments and change in BMI (
Figure
). A nonsignificant trend was seen toward lower BMI with increasing density of supermarkets; however, a similar nonsignificant trend was also observed between increasing density of fast food restaurants and lower BMI. Evidence for publication bias was not identified.

Conclusion:
In available longitudinal studies,no significant relationships were identified between food environments and change in BMI. Our novel findings support the need for further longitudinal and especially interventional studies of how the built food environment, including new measures related to cost and accessibility, may influence health and weight.
Abstract P292: Re-evaluation of the Relations of Egg Consumption to Serum Total Cholesterol, Cause-specific and All-cause Mortality
Authors: Nakamura Yasuyuki , Okamura Tomonori , Kita Yoshikuni , Miura Katsuyuki , Okayama Akira , Ueshima Hirotsugu
Published: March 2022

Background:
We previously reported that egg consumption was related to age-adjusted serum total cholesterol (TCH), and all-cause mortality in the 1-2-eggs/wk group was significantly lower than that in the 1-egg/d group in women, whereas no such relations were noted in men, using 14 year follow-up of NIPPON DATA80. Re-evaluation of these relations in a different cohort is needed.

Methods:
We analyzed the relations of egg consumption to serum total cholesterol (TCH) and cause-specific and all-cause mortality by using the NIPPON DATA90 database with a 15-year follow-up. At the baseline in 1990, a nutritional survey was performed by using the food-frequency method, and data were collected on study participants, ages 30 years and over, from randomly selected areas in Japan. We followed 4,799 female participants without history of stroke or myocardial infarction (mean age 52.8 y) for 15 years.

Results:
The participants were categorized into 5 egg consumption groups on the basis of their responses to a questionnaire (seldom, 1-2/wk, 1/2 d, 1/d, and ≥2/d). There were 218, 1507, 1622, 1409, and 43 women in each of the 5 groups, respectively. Age-adjusted TCH was not related to egg consumption (206.4, 206.3, 207.0, 207.7, and 203.8 mg/dL in the 5 egg consumption categories, respectively, P=0.737, analysis of covariance). There were 199 cardiovascular disease (CVD), 221 cancer, and 642 all-cause mortality during follow-up. Cox analysis, adjusted for confounding factors, found that all-cause and cancer mortality in the ≥2/d group were significantly higher than that in the 1-egg/d group (HR in the ≥2/d vs the 1-egg/d group: all-cause, 1.88 [95%CI: 1.12-3.16]; cancer, 2.77 [1.32-5.80]), and that cancer mortality in the 1-2-eggs/wk group was significantly lower than that in the 1-egg/d group (0.70 [0.50-0.99]). Egg consumption was not associated with CVD mortality.

Conclusions:
Loss of the relation of egg consumption to TCH might be due to that hypercholesterolemic individuals avoided eating eggs. Positive association of egg consumption with cancer and all-cause mortality needs further evaluation, and it may indicate that limiting egg consumption has some health benefits, at least in women in Japan.
Abstract P297: Intensity-specific Physical Activity Measured by Accelerometry and Mortality in Women: The OPACH Study
Authors: LaMonte Michael J , Rillamas-Sun Eileen , Evenson Kelly R , Lee I-Min , Buchner David M , Di Chongzhi , LaCroix Andrea Z
Published: March 2022

Background:
Associations for cardiovascular disease (CVD) and all-cause mortality with intensity-specific physical activity (PA) exposures assessed by questionnaire may be underestimated by exposure measurement error, especially in older adults. We examined accelerometer measured PA and CVD and all-cause mortality in 6,374 race-ethnically diverse women (White, 49.4%, Black 33.7%, Hispanic 16.9%) ages 63-91 (mean 78.7 years) followed a mean of 2.5 years as part of the Objective Physical Activity and Cardiovascular Health (OPACH) Study.

Methods:
Vector magnitude counts/15-sec epoch from hip worn Actigraph GT3X+ triaxial accelerometers (required ≥4 of 7 days with ≥10 hr/day wear time) were used to define time spent in low light (LLPA; 19-225 counts/15-sec), high light (HLPA; 226-518), and moderate-to-vigorous (MVPA; ≥519) PA based on cutpoints determined from a calibration study among similarly aged women. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for these associations.

Results:
There were 270 (4.2%) all-cause deaths and 78 (1.2%) CVD deaths during 14,205 person-years of follow-up. Adjusting for awake-time accelerometer wear-time, age, and race, HRs (CI) for CVD mortality associated with a 30-min/day increment in PA were 0.82 (0.71,0.96) for LLPA; 0.48 (0.38,0.61) for HLPA; and 0.53 (0.38, 0.74) for MVPA; and for all-cause mortality were 0.86 (0.79, 0.93), 0.61 (0.54, 0.69), and 0.57 (0.48, 0.67) respectively. These associations were similar following additional adjustments for smoking, age at menopause, and number of prevalent comorbidities (CVD HRs = 0.83, 0.49, 0.54, respectively, P≤0.01 all; all-cause HRs = 0.86, 0.62, 0.58, respectively, P<0.001 all). Similar results were observed after discarding the first 6 months of follow-up (CVD HRs = 0.84, 0.49, 0.50; all-cause HRs = 0.87, 0.63, 0.59). In a final model mutually adjusting for total light PA (LLPA and HLPA combined) and MVPA, each 30-min increment in light PA and MVPA was associated with HRs for CVD mortality of 0.84 (0.75, 0.93) and 0.67 (0.47, 0.96) respectively; and with all-cause mortality of 0.90 (0.85, 0.95) and 0.66 (0.55, 0.80), respectively.

Conclusions:
Higher levels of both light intensity PA and MVPA measured by accelerometry are associated with lower CVD and all-cause mortality in older women. Because light intensity PA accounts for the majority of daily PA energy expenditure in older women’s lives, these results could have important public health implications and should be confirmed.
Abstract P300: Associations of Sarcopenia and Low Muscular Strength With All-cause Mortality Among US Older Adults: The National Health and Nutrition Examination Surveys 1999-2002
Authors: Li Ran , Xia Jin , Zhang Xi , Guo Jianjun , Song Yiqing
Published: March 2022

Background:
Sarcopenia is defined as aging-related loss of muscle mass and knee extension strength serves as a marker of lower extremity muscular strength in populations. Sarcopenia and low muscular strength (LMS) may be important but understudied risk factors for aging-related morbidity and mortality in the older and elderly populations. However, data from prospective studies are limited.

Objective:
We aimed to prospectively examine individual or joint associations of sarcopenia and LMS with all-cause mortality in a nationally representative sample of US older adults in the National Health and Nutrition Examination Survey (NHANES).

Methods:
Data sources included the NHANES 1999-2002 with public-use 2011 linked mortality files, which comprised 4,449 participants aged 50 years and older with complete data on body composition by dual-energy x-ray absorptiometry and isokinetic knee extensor strength measurement. Sarcopenia was defined by two definitions proposed by the National Institutes of Health Sarcopenia Project according to appendicular lean mass (ALM) and ALM divided by BMI (ALM/BMI). LMS was defined as the lowest 25% of measurements of knee extensor strength. Weighted multivariable logistic regression models were used to account for multistage stratified and clustered sampling. Models were adjusted for age, sex, race, BMI, smoking, alcohol use, education, leisure time physical activity, sedentary time, and history of cardiovascular diseases, diabetes, cancer, chronic obstructive pulmonary disease, or chronic kidney disease.

Results:
Overall, the weighted prevalence of sarcopenia was 23.1% defined by ALM and 17.0% defined by ALM/BMI; the weighted prevalence of low muscular strength was 19.4%. In the multivariate-adjusted models, sarcopenia was significantly associated with increased risk of all-cause mortality for ALM/BMI definition (OR: 1.44; 95% confidence interval [CI], 1.06-1.97) but not for ALM definition (OR: 1.37; 95% CI, 0.90-2.09) while LMS was strongly associated with all-cause mortality (OR: 2.32; 95% CI, 1.70-3.18). In the joint analyses, a significantly increased all-cause mortality was observed only among participants with LMS and non-sarcopenia (OR range: 2.03-2.50) and those with LMS and sarcopenia (OR range: 2.15-2.56) while those without sarcopenia and LMS were the reference group.

Conclusions:
Low knee extensor strength indicative of low muscular strength was independently and significantly associated with an increased risk of all-cause mortality among US older adults regardless of the presence or absence of sarcopenia.
Abstract P302: Energy Expenditure Responses to Exercise Training in Older Women: The Influence of Baseline Physical Activity
Authors: Wang Xuewen , Bowyer Kimberly , Porter Ryan , Breneman Charity , Custer Sabra
Published: March 2022

Introduction:
Components of energy expenditure are not static. There is debate over whether there is a reduction in non-exercise activity thermogenesis (NEAT) that compensates for energy cost of exercise training. The purpose of this study was to determine the changes in components of energy expenditure following exercise training, and whether any of the changes differ by dose of exercise.

Methods:
Older inactive women (60-75 years, less than 20 minutes of structured exercise for 3 times/week, n=72) participated in 4 months of exercise training of lower- or higher-dose (8 and 14 kcal/kg body weight weekly, respectively). The exercise was treadmill walking, 3 to 4 times per week, at 50-55% of heart rate reserve. Total daily energy expenditure (TDEE) by the doubly labeled water method, resting metabolic rate (RMR) via indirect calorimetry, and total physical activity by ActiGraph accelerometers (counts per minute), were measured at baseline and in the last two weeks of exercise training. Exercise energy cost was determined by speed, slope, and duration of walking according to the American College of Sports Medicine guideline. NEAT was calculated as (TDEE x 0.9 – RMR – exercise energy cost).

Results:
There were no group differences in the changes in energy expenditure measures (p for time x group interaction > 0.10 for all). TDEE, RMR, NEAT and total physical activity did not change at the end of exercise training (p > 0.05 for all). However, a significant baseline physical activity x time interaction was found for several energy expenditure measures. Data were therefore stratified into tertiles based on baseline physical activity. In the highest tertile, TDEE remained unchanged but NEAT and total physical activity decreased (p < 0.05 for all). In contrast, in the mid- and lowest tertiles, NEAT remained unchanged, total physical activity increased, and TDEE was unchanged or increased (p < 0.05 for all).

Conclusions:
In this group of older women, 4 months of aerobic exercise training did not change any of the energy expenditure measures in the overall sample. However, baseline physical activity levels influenced the energy expenditure responses, indicating reductions in NEAT and total physical activity despite participation in exercise training in those who had higher physical activity level at baseline.
Abstract P305: Daily Walking Time and Pneumonia Mortality Among Elderly With/Without Medical History of Myocardial Infarction or Stroke
Authors: Ukawa Shigekazu , Zhao Wenjing , Yatsuya Hiroshi , Yamagishi Kazumasa , Iso Hiroyasu , Tamakoshi Akiko
Published: March 2022

Several studies report that daily walking reduces the risk of pneumonia. However, the elderly often experience underlying chronic diseases such as myocardial infarction (MI) or stroke which also increase the risk of pneumonia; thus, the association of walking with pneumonia may merely be a result of confounding of the underlying conditions. Therefore, we explored the links between daily walking and pneumonia mortality stratified by the presence of medical histories in 22,280 Japanese elderly (9,067 men and 13,213 women) aged 65 to 79 years from 1988-1990. The Cox proportional hazards model was used to calculate hazard ratio (HR) and 95% confidence interval (CI) for pneumonia mortality (ICD10: J9-18, J69) adjusted for age, sex, and possible confounders. P for trend was calculated across the categories of walking time. After a median of 11.9 years’ follow-up, 1,203 participants died of pneumonia. In participants without a medical history of MI or stroke, the HR of pneumonia mortality in participants who had walked at baseline for ≥1 h/day was 0.73 (95% CI, 0.62-0.85; P for trend <0.001), compared with those who had walked for 0.5 h/day. Participants with a medical history of MI who walked for ≥1 h/day also showed significantly decreased risk of pneumonia mortality (HR, 0.49; 95% CI, 0.27-0.92; P for trend = 0.01). No significant associations were found among participants with a medical history of stroke (HR, 0.82; 95% CI, 0.39-1.72), although P for trend was statistically significant (P for trend = 0.003). However, the HR of pneumonia mortality in participants who had walked at baseline for <0.5 h/day was 1.46 (95% CI, 1.19-1.78) in participants without a medical history of MI or stroke, 1.06 (95% CI, 0.46-2.25) in participants with a medical history of MI, and 2.83 (95% CI, 1.35-5.95) in participants with a medical history of stroke. Our findings suggest that longer walking time may be beneficial in reducing the risk of pneumonia mortality in elderly populations.
Abstract P306: Skeletal Muscle Mass is Related to Physical Activity and Dietary Behavior in Adolescents
Authors: Hao Guang , Pollock Norman , Harris Ryan , Gutin Bernard , Su Shaoyong , Wang Xiaoling
Published: March 2022

Background:
As the most abundant insulin-sensitive tissue, skeletal muscle plays a crucial role in systemic glucose metabolism. Physical activity and healthy diet are beneficial at preserving skeletal muscle in the elderly; however, their role on skeletal muscle mass in adolescents has not been reported.

Objective:
We hypothesized that higher physical activity and healthy diet behaviors are associated with greater skeletal muscle mass.

Design:
A cross-sectional, observational study in 640 healthy European and African American aged 14-18 years.

Measurements:
Diet was assessed by four to seven 24-h recalls, and physical activity was determined by 7-day accelerometry. Healthy diet behaviors included higher energy intake from protein, lower energy intake from fat, higher consumption of fruit, vegetable, whole grain foods and lower consumption of sweetened soft drinks. Fat-free soft tissue mass (FFM) and fat mass (FM) were measured using dual-energy X-ray absorptiometry. The residual derived from the regression of FFM on height and FM was used as an index of skeletal muscle mass. This is an index independent of the influence from height and fat mass.

Results:
Multiple linear regression, adjusting for age, sex, race, and total energy intake, revealed that skeletal muscle mass was positively correlated with both moderate (P<0.001) and vigorous physical activity (p<0.001). In addition, skeletal muscle mass was positively correlated with energy intake from polyunsaturated fatty acid (p=0.023) and consumption of whole grain foods (p=0.029) while negatively correlated with energy intake from saturated fatty acid (p=0.003) and consumption of sweetened soft drinks (p=0.003). In the final model including all of the significant predictors, physical activity, energy intake from saturated fatty acid, and consumption of sweetened soft drink are all independent contributors to skeletal muscle mass.

Conclusions:
For the first time, our adolescent data suggest that engage in physical activity increase while greater consumption of saturated fatty acid and sweetened soft drinks reduce skeletal muscle mass.
Abstract P314: Higher C-Reactive Protein Levels Among Women with a History of Hypertensive Disorders of Pregnancy
Authors: Tanz Lauren J , Stuart Jennifer J , Rimm Eric B , Vadnais Mary A , Missmer Stacey A , Hibert Eileen N , Rich-Edwards Janet W
Published: March 2022

Introduction:
Women with a history of pregnancy complications, including hypertensive disorders of pregnancy (HDP: preeclampsia and gestational hypertension) and preterm delivery (<37 weeks), have an increased risk of cardiovascular disease (CVD). There is limited knowledge of the pathway linking pregnancy outcomes and CVD, but chronic inflammation may play a role.

Methods:
We selected parous women from the Nurses’ Health Study II who had the inflammatory biomarkers C-reactive protein (CRP; n=2,987) or interleukin (IL)-6 (n=2,916) assessed in stored blood samples provided after pregnancy, between 1996 and 1999. Women were selected from previous nested case-control biomarker studies. Robust linear regression models were used to separately evaluate the mean differences in CRP and IL-6 and 95% confidence intervals (CIs) associated with a history of HDP compared to no such history and with a history of preterm delivery compared to no such history. Models were adjusted for age at blood draw, pre-pregnancy body mass index and smoking, and variables related to lab selection.

Results:
Ten percent (285 of 2,987) of women had a history of HDP, while 12% (358 of 2,987) had at least one preterm delivery prior to blood draw. Median time from first pregnancy to blood draw was 17 years (range: 1-37 years). Mean CRP levels were 2.00 mg/L and 1.57 mg/L, while mean IL-6 levels were 1.56 pg/mL and 1.42 pg/mL in women with and without a history of HDP, respectively. In women with and without preterm delivery, mean CRP levels were 1.54 mg/L and 1.62 mg/L and mean IL-6 levels were 1.39 pg/mL and 1.44 pg/mL, respectively. Plasma levels of CRP were 0.36 mg/L (95% CI: 0.12, 0.60) higher, on average, in women with a history of HDP compared to those with all normotensive pregnancies. Plasma IL-6 levels were not significantly higher among women with a history HDP (0.06 pg/mL, 95% CI: -0.16, 0.27). There were no significant differences in CRP (-0.11 mg/L, 95% CI: -0.30, 0.07) or IL-6 (-0.08 pg/mL, 95% CI: -0.25, 0.10) levels in women with a history of preterm delivery.

Conclusion:
CRP was elevated in women with a history of HDP in the decades following pregnancy, suggesting a potential inflammatory response. An altered inflammatory profile was not present in women with a history of preterm delivery. Further investigation is needed to confirm these inflammatory responses in women with a history of pregnancy complications and to evaluate the utility of CRP as a potential risk marker in CVD screening.
Abstract P328: Association of Functional and Structural Social Network Components With Medication Adherence Among Participants With Coronary Heart Disease Risk Factors: the REasons for Geographic and Racial Differences in Stroke Study
Authors: Mondesir Favel L , Carson April P , Durant Raegan W , Lewis Marquita W , Safford Monika M , Levitan Emily B
Published: March 2022

Prior research suggests that functional (e.g., practical support) social network components are more strongly associated with chronic disease health outcomes than structural (e.g., social network size, frequency of social contacts) components. Yet, it is unclear whether strong social networks help improve health outcomes by promoting medication adherence, particularly among those with coronary heart disease (CHD) risk factors. We included 17,133 black and white adults aged ≥45 years from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who had diabetes, hypertension, dyslipidemia, or prevalent CHD and used medications for these conditions. Functional (i.e., someone to care for you while sick or disabled vs no-one available) and structural (i.e., presence vs absence of adults in household, married/in a marriage-like relationship vs not partnered, number of close friends and relatives, and number of close friends and relatives seen at least monthly) social network components were self-reported and medication adherence was assessed using the Morisky scale. A weighted composite score was created using the structural components and participants were categorized as reporting high vs low structural support based on the median. Multi-variable adjusted logistic regression models adjusted for demographics, CHD risk factors and cumulative number of medications, were used to estimate the association between functional and structural social network components and medication adherence. Prevalence of high medication adherence was 68.9%. Compared to participants who reported that they had no one to care for them while sick or disabled, participants who reported that someone was available had higher prevalence of medication adherence [OR=1.15 (95% CI: 1.04, 1.26)]. Participants who reported higher structural support (composite score above median) had similar prevalence of medication adherence compared to participants who reported lower structural support [OR=1.09 (95% CI: 0.87, 1.37)]. In conclusion, interventions aimed at providing social support for people with CHD risk factors may need to consider preferentially focusing on enhancing functional aspects of individuals’ social networks as a means of potentially improving medication adherence and ultimately cardiovascular health.
Abstract P350: Lower Urinary Tract Symptoms (LUTS) Predict Incident Cardiovascular Disease (CVD) in a Cohort of Middle-aged to Elderly Men
Authors: Martin Sean A , Vincent Andrew , Taylor Anne W , Adams Robert J , O’Loughlin Peter , Wittert Gary A
Published: March 2022

Introduction:
Both lower urinary tract symptoms (LUTS) and cardiovascular disease (CVD) share multiple risk factors. Whether LUTS predict the development of CVD, independent of these factors, remains unclear.

Objectives:
To examine the cross-sectional and longitudinal relationship between LUTS (total, storage, and voiding LUTS) and first-event CVD.

Methods:
Participants were drawn from a cohort of randomly-selected, community-dwelling men aged 35-80 years at recruitment (2002-5;n = 1195;sample response rate: 67.8%). LUTS were assessed using the International Prostate Symptom Scale (IPSS). Men with an overall IPSS score >7 were classified as having total LUTS, while men with IPSS scores of >3 for items 2, 4, & 7 and >4 for items 1,3, 5 & 6 were classified with storage and voiding LUTS, respectively. CVD status was obtained by either self-reported physician diagnosis and/or data linkage with a state-wide registry of in-hospital events. The cross-sectional sample (n=1108) consisted of men who had uncomplicated LUTS and complete LUTS measures at baseline. Binomial logistic regression models were used to fit exposure (LUTS) against outcome (CVD) along with qualifying lifestyle, and health-related factors. The longitudinal sample consisted of all CVD-free men at T1 who attended follow-up visits (2007-10;n=701). Cox proportional models were used to determine to hazard ratios (HR) for first-event CVD or date of data-linkage (June 2015).

Results:
For the cross-sectional sample, 9.4% (n=104) of men examined were found to have CVD. Higher levels of CVD were observed in men with total (35.6% (n=37) vs. 18.2% (n=198) without CVD,
p
=0.009), storage (40.4% (n=42) vs. 28.3% (n=308),
p
=0.009) and voiding (31.7% (n=33) vs. 20.0% (n=218),
p
=0.005) LUTS. In unadjusted binomial models, CVD was associated with total LUTS (OR: 2.38; 95%CI: 1.23-4.31), storage LUTS (1.55;1.08-2.52), and voiding LUTS (1.55;1.08-3.33). In the multi-adjusted model, voiding (1.65; 1.06-3.89) and total (2.18; 1.17-4.11) LUTS was independently associated with CVD, with no significant associations observed for storage LUTS. In the longitudinal analysis (median follow-up duration: 67 months), n=103 CVD cases were detected (14.7% of sample; 20 MI,38 IHD,18 sudden cardiac arrests, and 27 heart failure cases). In unadjusted Cox proportional models, a significant association was detected for voiding (1.28;0.87-1.55) and total (HR: 1.22; 95%CI 1.05-1.83) LUTS, but not storage LUTS (1.18;0.78-2.01). In multi-adjusted models, total LUTS only (2.89;1.37-6.23) were associated with incident CVD.

Conclusions:
We demonstrate in a group of broadly-representative, middle aged men an independent association between total LUTS at baseline and the development of CVD, suggesting its utility as a prognostic marker for CVD.
Abstract P354: Objective Short Sleep Duration Increases the Risk of Mortality Associated with the Metabolic Syndrome
Authors: Fernandez-Mendoza Julio , He Fan , Vgontzas Alexandros N , Liao Duanping , Bixler Edward O
Published: March 2022

Background:
The metabolic syndrome (MetS), the clustering of cardiometabolic risk factors, has been associated with short sleep duration and mortality. Most studies have been limited by using self-report measures and treating sleep duration as a sole, independent predictor, thus, its role in predicting mortality is still not well-established.

Hypothesis:
We hypothesized that objective sleep duration is an effect modifier of the impact of the MetS on mortality.

Methods:
We addressed this question in the Penn State Adult Cohort, a random, general population sample of 1,741 men and women (48.7 ± 13.5 years) who were studied in the sleep laboratory and followed-up for 16.7 ± 4.6 years. MetS was defined by the presence of three or more of obesity (≥30 m
2
/kg), elevated total cholesterol (≥200 mg/dL), triglycerides (≥150 mg/dL), fasting glucose (≥100 mg/dL), and blood pressure (≥85/130 mmHg). Polysomnographic (PSG) sleep duration was classified into clinically meaningful categories. Among the 1,741participants, 23.5% (n=478) of them died during the follow-up.

Results:
We tested the interaction between MetS and PSG sleep duration on mortality using Cox proportional hazard models controlling for multiple potential confounders (p-value < .05).The hazard ratios (95%CI) of all-cause and cardiovascular / cerebrovascular mortality associated with MetS were 1.28 (0.88-1.86) and 1.49 (0.75-2.97) for individuals who slept ≥ 6 hours and 1.99 (1.53-2.59) and 2.10 (1.39-3.16) for individuals who slept < 6 hours. Interestingly, this effect modification was primarily driven by the elevated blood pressure and glucose dysregulation components of the MetS.

Conclusions:
The risk of mortality associated with the MetS increases as a function of short sleep duration. Short sleep in individuals with MetS may be linked to greater central autonomic and metabolic dysfunction. Future clinical trials should examine whether lengthening sleep improves the prognosis of individuals with MetS.
Abstract P356: Association Between Sleep Disturbances and Dyslipidaemia: Systematic Review and Meta-analysis of Prospective Studies
Authors: Kruisbrink Marlot , Robertson Wendy , Ji Chen , Miller Michelle A , Geleijnse J M , Cappuccio Francesco P
Published: March 2022

Objectives:
To assess the longitudinal evidence of the relationship between sleep disturbances (of quantity and quality) and dyslipidaemia in the general population and to quantify such relationships.

Methods:
We performed a systematic search of PubMed and EMBASE (up to July 2016), complemented with manual searches. Studies were included if they were prospective, had sleep quantity and/or quality at baseline and either incident cases of dyslipidaemia or changes in any of the lipid fractions assessed prospectively. Relative risks (95% CIs) were extracted and pooled using a random effect model. Sub-group analyses by lipid type and cumulative meta-analysis by publication date were also performed. Heterogeneity and publication bias were assessed.

Results:
13 studies were identified (4 on quality, 11 on duration). There was heterogeneity in the sleep quality aspects and types of lipids assessed. Classification of sleep duration (per hour/groups) and outcome reporting (changes, risks, differences) also varied widely. In the pooled analysis of sleep duration (6 studies, 16 cohort samples; 30,021 participants; follow-up 2.6-10 years), short sleep was associated with a risk of 1.01 (95% CI: 0.93-1.10) of developing dyslipidaemia, with moderate heterogeneity (I
2
=56%, p=0.003) andpublication bias (p=0.035). Long sleep was associated with a risk of 0.98 (95% CI: 0.87-1.10) for dyslipidaemia, with heterogeneity (I
2
=63%, p<0.001) and no publication bias (p=0.248). However, subgroup analyses suggested a trend for higher TChol in short sleepers (1.10; 0.99-1.22; p=0.07) and lower TChol in long sleepers (0.91; 0.81-1.01; p=0.087). Cumulative meta-analysis shows a general trend towards no effect for both short and long sleep duration with dyslipidaemia.

Conclusion:
The results do not support a significant relationship between sleep duration and the development of dyslipidaemia. However, heterogeneity in the reporting of both exposure and outcomes and some publication bias limit the interpretation.
Abstract P376: Risk Factors for the Progression and Incidence of Aortic Calcification in an International Multi-ethnic Cohort of Men Aged 40-49 Years: ERA JUMP Study
Authors: Shangguan Siyi , Guo Jingchuan , Mahajan Hemant , Masaki Kamal , Willcox Bradly J , Miura Katsuyuki , Ueshima Hirotsugu , Fujiyoshi Akira , Hisamatsu Takashi , Kuller Lewis H , Barinas-Mitchell Emma J , Edmundowicz Daniel , Sekikawa Akira
Published: March 2022

Background:
Aortic calcification (AC) is independently related to cardiovascular (CV) disease mortality. No previous study has examined associations of risk factors with the progression of calcification in the entire aorta.

Methods:
1033 men aged 40-49 years without overt CV diseases from the ERA-JUMP cohort were examined for AC, CV risk and other factors in 2002-07 with rigid standardization with a median follow-up of 5.9 years. AC was assessed by electron-beam CT and was quantified using the Agatston’s method. We defined annual AC progression as the absolute difference of Agatston score divided by follow-up time in years, which was further dichotomized at the 80th percentile: ≥100/year vs. <100/year. In participants free of detectable AC at baseline, AC incidence was calculated. Logistic regressions were performed to analyze the association of risk factors with both annual AC progression and AC incidence. AC progression was adjusted for baseline AC and AC incidence was adjusted for follow-up time.

Results:
After excluding missing data (n=287) and extreme outliers (n=10), our sample included: 234 Caucasian, 53 African American, 207 Japanese American and 242 Japanese in Japan. AC was present in 55.3% (407 out of 736) at baseline. Baseline mean (SD) of age, pack-years of smoking, systolic blood pressure (SBP), BMI, LDL-C and AC Agatston score were 45.3 (2.9) years, 9.1 (14.0) pack-year, 124.5 (13.4) mmHg, 26.6 (4.6) Kg/m2, 129.7 (33.9) mg/dl and 103.0 (336.8), respectively. Overall analysis showed that baseline BMI, smoking, SBP and diabetes were significant or marginally significant determinants of AC progression (table 1). Incidence analysis showed that baseline smoking, SBP and LDL-C were significant or marginally significant determinants of AC incidence. Japanese in Japan displayed significantly lower incidence as well as progression.

Conclusion:
Both AC progression and incidence were closely related to multiple traditional CV risk factors, most significant for pack-years of smoking and blood pressure.