bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P129: Risk of COVID-19 Hospitalization or Death by the AHA's Life’s Essential 8: The Collaborative Cohort of Cohorts for COVID-19 Research (C4R)
Authors: Plante Timothy B , Juraschek Stephen P , Balte Pallavi , Krishnaswamy Akshaya , Mok Yejin , Allen Norrina B , Gabriel Kelley P , Xanthakis Vanessa , Norwood Arnita , Min Yuan-I , Gonzalez Sara , Sotres-Alvarez Daniela , Talavera Gregory A , Daviglus Martha L , Talegawkar Sameer , Jin Yichen , Lloyd-Jones Donald M , Elkind Mitchell S , Rundek Tatjana , Gutierrez Jose , Levitan Emily B , Cushman Mary , Judd Suzanne E , Wang Henry E , Zakai Neil A , Howard Virginia J , Pamir Nathalie , Safford Monika M , Kamin Mukaz Debora , Fretts Amanda M , Oelsner Elizabeth
Published: May 2024

Background:
It is unknown how cardiovascular health (CVH) relates to severe Covid-19 illness in adults without clinical cardiovascular disease (CVD). We hypothesized that more optimal Life’s Essential 8 (LE8)-quantified CVH is associated with lower risk of severe Covid-19 among US adults without clinical CVD.

Methods:
C4R is ascertaining Covid-19 events in 14 NIH cohorts via questionnaires, serosurvey, and medical record adjudication. We included cohorts with pre-pandemic LE8 measures of body mass index (BMI), blood pressure (BP), lipids, diet, glucose, physical activity, smoking, and sleep in participants without clinical CVD. Covid-19 was defined as severe (hospitalization, death) or non-severe (all other events). Fine-Gray sub-distribution hazard models compared incident Covid-19 by LE8 quartiles, with non-severe and severe Covid-19 as competing risks. Models were censored at first event, stratified by cohort, and adjusted for sociodemographics and vaccinations at time of Covid-19.

Results:
Among 21,300 participants in 7 cohorts (mean [SD] age 67 years [14], 61% female, 2% American Indian, 4% Asian, 16% Black, 33% White, 43% Hispanic), mean (SD) LE8 was 65 (14). In 3/2020-9/2022, there were 3,034 non-severe and 488 severe Covid-19 cases. The best CVH quartile (Q) 4 had more non-severe and fewer severe Covid-19 events. The Q4 vs. Q1 aHR was 1.08 (95% CI 0.98, 1.20) for non-severe Covid-19 and 0.59 (0.45, 0.77) for severe Covid-19. Examining LE8 components separately, better status on 5 LE8 components (BMI, BP, glucose, physical activity, smoking) was associated with significantly lower risk of severe Covid-19, whereas 3 were not associated (cholesterol, diet, sleep; data not shown).

Conclusions:
Better LE8-quantified CVH was associated with 41% lower risk of severe Covid-19 events in adults without clinical CVD. Further research is needed to elucidate mechanisms of Covid-19 resilience and the role of CVH-directed interventions to reduce risks of severe Covid-19.
Abstract P145: Randomized Trial of an Integrated Care Intervention Among Latino Adults: Sustained Effects on Diabetes Management
Authors: Mendez-Rodriguez Heidy , Rosas Carlos E , Talavera Gregory A , Roesch Scott C , Muñoz Fatima , Castañeda Sheila F , Mendoza Paulina M , Gallo Linda
Published: May 2024

Purpose:
Adequate diabetes management is challenging to sustain. In healthcare practices serving under-resourced communities, the development of cost-efficient interventions with a sustainable impact are crucial. We examined the 12-month maintenance effects of a previously successful integrated model of diabetes care at improving glycemic management and psychological well-being among Latino adults with type 2 diabetes (T2D).

Methods:
A randomized controlled trial (2015-2019) compared an Integrated Care Intervention (ICI) with Usual Care (UC) among 456 adults with T2D. The ICI included integrated medical and behavioral care and health education over 6 months. Assessments were completed at baseline, 3-, 6-, 9-, and 12-months.

Results:
Most participants were female (63.7%), with a mean age of 55.7 years. In multi-level models, significant group x time (quadratic) interaction effects were found for HbA1c ( ß = .10, 95% CI .02,.17,
p
< .01) and anxiety ( ß = .20, 95% CI .05,.35,
p
< .009), but not depression symptoms ( ß = .15, 95% CI -.01,.31,
p
< .07). Analyses of instantaneous rate of change in the ICI group showed significant decreases at 3- and 6-months for HbAc1 ( ß = -.31 at 3-months; ß = -.12 at 6-months) and anxiety symptoms ( ß = -.92 at 3-months; ß = -.46 at 6-months), and no significant changes at 9- or 12-months, suggesting that initial improvements were largely maintained. The UC group showed a small decrease in anxiety symptoms at 6 months ( ß = -.17), but no other significant changes (all
ps
> .05). (See Figure 1).

Conclusions:
This culturally tailored integrated care model that included both medical and behavioral care and health education programs, shows potential in producing and sustaining positive effects on clinical and psychological outcomes above standard care. Findings have implications for practice and policies that facilitate implementing these models in healthcare organizations.
Abstract P152: Linguistic Acculturation is Associated With Better Cardiometabolic Health Among Bhutanese Refugees Living in the United States
Authors: Murkey Jamie , Singh Rupsha , Cohen Jeffrey , Suzuki Taku , Raut Shambika , Jackson Chandra , Montiel Ishino Francisco
Published: May 2024

Background:
United States (US) South Asians are a fast-growing immigrant group that on average, while having a higher socioeconomic status, present with an increased prevalence and faster development of cardiometabolic health (CMH) conditions. Acculturation—the process of adapting norms of a host culture—can give rise to a unique set of stressful challenges and is associated with poor CMH outcomes among immigrant groups. However, the impact of acculturation on South Asian CMH is relatively unknown due to limited studies, especially when considering the Bhutanese community; the third largest US refugee group.

Hypothesis:
We hypothesize that increased English linguistic acculturation among US Bhutanese adults would be associated with poorer CMH.

Methods:
Using 2021-2022 Bhutanese Community of Central Ohio Health Study data, we examined associations of linguistic acculturation and sociodemographic characteristics in relation to CMH conditions among Bhutanese adults living in Central Ohio (N=495). A summed score for responses of very limited (1 point); limited (2 points); fair (3 points); good (4 points); and excellent (5 points) English language proficiency in speaking, listening and understanding, reading, and writing was used to capture limited (≤8), intermediate (9-19), and excellent (20) linguistic acculturation. CMH was assessed from participant self-report of clinical diagnosed or treated hypertension, type 2 diabetes, and dyslipidemia, as well as weight and height to calculate body mass index (BMI). Adjusting for sex, age, and BMI, we used Poisson regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) of associations of linguistic acculturation and sociodemographic characteristics in relation to CMH conditions.

Results:
Most participants were aged 18 to 44 years (69.8%) and migrated to the US ≥11 years ago (60.2%). Linguistic acculturation prevalence was 34.1% for very limited/limited and 65.9% for fair to excellent. Most participants reported no CMH condition (70%), while 12.9% reported one, 10.8% reported two, and 6.3% reported three. Fair to excellent vs. very limited/limited linguistic acculturation were associated with a lower prevalence of having three CMH conditions (PR=0.17 [95% CI: 0.03-0.97]). Migrating to the US ≥11 years vs. <11 years was associated with a higher prevalence of having two CMH conditions (PR=1.67 [95% CI: 0.95-2.95]).

Conclusions:
In conclusion, more linguistic acculturation was associated with better CMH among Bhutanese adults living in the US. Given the burden of CMH disparities among minoritized racial/ethnic groups in the US, future studies should consider acculturation to further explore the role of language in shaping immigrant and refugee health across the lifecourse.
Abstract P158: Prevalence of Val122Ile Variant Transthyretin Amyloidosis Mutation Among Hispanics/Latinos: Insights From the Hispanic Community Health Study/ Study of Latinos (HCHS/SOL)
Authors: Duran Luciano Priscilla , Pandey Ambarish , Swett Katrina , Kaplan Robert , Talavera Gregory A , Daviglus Martha L , Schneiderman Neil , Hurwitz Barry E , Shah Sanjiv J , Sofer Tamar , Solomon Scott D , Cheng Susan , Aviles-Santa Larissa , Parada Humberto , Thyagarajan Bharat , Gonzalez Franklyn , Kansal Mayank M , Tauras James M , Maurer Mathew S , Rodriguez Carlos J
Published: May 2024

Background:
Val122Ile variant is the most common mutation causing hereditary transthyretin amyloidosis. The prevalence of Val122Ile among Hispanics/Latinos, a population with admixed genetic ancestry (African, European, Amerindian), is still unknown.

Methods:
We utilized genome-wide data (unweighted n=12687 adults) from the population-based HCHS/SOL to identify Val122Ile mutation. Continental proportions of African (AA), European (EA) and Amerindian (AM) ancestry were computed with an ADMIXTURE software, with thresholds set at 30%, 40%, and 50%. Complex survey analysis was employed to determine weighted frequencies of Val122Ile overall, across ancestry and across disaggregated Hispanic/Latino background groups (Cuban, Puerto Rican, Dominican, Mexican, Central American, and South American).

Results:
The prevalence of Val122Ile mutation in the cohort overall was 0.8%. Participants with (vs. without) Val122Ile were younger (37.3 vs. 41.6 years) and more commonly female (52.5% vs. 48.8%). Val122Ile prevalence was significantly higher among individuals with higher AA (<30% AA vs. >50% AA: 0.4% vs. 3.4%) and lower among individuals with higher EA (<30% EA vs. >50% EA: 1.7% vs. 0.8%) (
Figure 1A
). AA >50% was related with higher odds of Val122Ile mutations (OR= 7.9, 95% CI: 3.5 - 17.8) vs. AA <30%. An inverse relationship was seen with EA >50% and Val122Ile mutations (OR= 0.3, 95% CI: 0.1 - 0.6) vs. EA <30%. No statistically significant difference was found among Val122Ile by proportion of AM. Individuals with Val122Ile mutation were primarily of Dominican and Mexican descent, accounting for 33.7% and 31.7% of carriers, respectively (
Figure 1B)
. Dominicans have the highest Val122Ile prevalence (2.6%) when compared to other Hispanic/Latino background groups (
Figure 1C)
.

Conclusion:
Val122Ile mutation was mostly identified in Hispanics/Latinos at younger ages. African Ancestry is strongly correlated with Val122Ile mutations in Hispanics/Latinos with those of Dominican descent having the highest prevalence.
Abstract P172: Potential Contribution of Social Factors in Reducing Population Disparities in Cardioprotective Health Behavior Between Bisexual, Gay/Lesbian, and Straight Adults
Authors: Rivera Adovich , Chao Chun , Hechter Rulin
Published: May 2024

Background:
Studies have demonstrated disparities in cardioprotective behavior by sexual orientation. Social factors have been associated with individual outcomes, but their impact on population disparities is unclear. We assessed if hypothetically intervening on social factors may reduce health behavior disparities by sexual orientation.

Methods:
We analyzed the intake survey data from the 2015-2023 Kaiser Permanente Research Bank. We compared unadjusted and demographics-standardized prevalence of selected health behaviors by sexual orientation (gay/lesbian or bisexual (LGB) vs straight adults (reference)). We then assessed the potential impact of hypothetically intervening on a single social factor (neighborhood safety, discrimination, education, income) on population disparities using a gap-closing estimand approach (i.e., modified inverse propensity weighting with g-computation).

Results:
We included 166,479 adults (mean age = 59 years), with 4.5% (7,476) gay/lesbian and 3% (4,936) bisexual. A higher proportion of LGB adults had documented current smoking, binge drinking, and low fruit intake compared to straight adults. Also, a higher proportion of bisexual adults had a high fast-food diet and inadequate sleep. Standardized prevalence of smoking, binge drinking, and inadequate sleep (bi only) remained higher in LGB adults. In gap-closing analysis, no change in gay/lesbian-straight disparities were observed. Reduction in bi-straight disparities in smoking (-2.5%, 95%CI: -3.5, -1.7) and sleep (-2.4%, 95%CI: -3.6, -1.1) may occur with higher college education rates. The sleep disparity (-2.4, 95%CI: -4.0, -0.93) may also decrease by reducing discrimination rates. None of the factors reduced the binge drinking disparity. (Table)

Conclusion:
LGB adults had higher prevalence of smoking, drinking, and inadequate sleep (bi only). Addressing single factors could reduce some LGB health behavior disparities but multi-factor interventions may be necessary to attain equity across orientations.
Abstract P194: Consumption of Added Sugar and Added Sugar-Rich Foods and Beverages is Associated With Accelerated Epigenetic Aging in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Copp Katherine , Steffen Lyn , Yi So-Yun Y , Zhou Xia , Jacobs David R , Shikany James M , Rana Jamal S , Joyce Brian , Zheng Yinan , Kim Kyeezu , Hou Lifang
Published: May 2024

Background:
Added sugar (AS) and AS-rich foods and beverages have shown unfavorable associations with overall and cardiovascular health; however, their associations with epigenetic age has not been studied.

Aim:
To examine the associations of AS intake and AS-rich carbohydrate (CHO) food score with the pace of epigenetic aging in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

Methods:
There were 850 adults included in this cross-sectional study using data from Year 20 (2005-06). Trained interviewers administered a diet history, and foods were coded using Nutrition Data System for Research (NDSR), which outputs nutrients, including AS, and food groups. An AS-rich CHO food score was created including refined grain breads and rolls, quick breads, sweet bakery products, ready-to-eat cereals, candy, sugar products, and sugar-sweetened beverages. Year 20 epigenetic age measures were calculated from DNA methylation data, generating acceleration measures GrimAge acceleration (GrimAA) and PhenoAge acceleration (PhenoAA). Multivariable linear regression evaluated the associations of GrimAA and PhenoAA across quartiles of AS and AS-rich CHO food score, adjusted for demographic characteristics and lifestyle factors (see footnotes in table).

Results:
Participants who consumed more AS completed fewer years of education, were less likely to be current drinkers or smokers, and more likely to be ever smokers. They had lower intakes of total CHO, protein, total fat, and saturated fat, and fewer servings of vegetables, red and processed meat, eggs, and diet beverages. Consuming more AS was positively associated with PhenoAA (p
trend
=0.029), but not GrimAA (p
trend
=0.85). The AS-rich CHO food score was also positively associated with PhenoAA (p
trend
<0.001), but not GrimAA (p
trend
=0.14).

Conclusions:
Consuming greater amounts of AS and AS-rich CHO foods and beverages were associated with an increased risk for accelerated epigenetic aging.
Abstract P198: Developing a Practical, Evidence-Based Framework for Evaluating Community Nutrition Security Interventions
Authors: Donze-Black Jessica , Picou Kylie , Downey-Piper Mel , Toner Cheryl , Ellis Mei Ling , Zakocs Ronda , Honeycutt Sally
Published: May 2024

Introduction:
Addressing nutrition insecurity at a population level is complex and requires changing policies, systems, and environments. The American Heart Association (AHA) has identified 17 research informed systemic interventions that have the potential to increase nutrition security over time. These interventions can be leveraged individually or together based on community needs and assets. Evaluating these interventions is essential for understanding impact, improving implementation, and allocating resources to effective strategies. This project sought to establish a pragmatic yet rigorous framework for evaluating the health impact of these strategies in communities across the United States.

Hypothesis:
We assessed the hypothesis that we could evaluate community nutrition security interventions by using program records, secondary data sources, and judicious use of primary data collection.

Methods:
Researchers reviewed details from the AHA's community impact database detailing 188 research informed nutrition security projects in communities across 29 states and the District of Columbia. Impacts were assessed for reach of intervention and strength of evidence to determine relative population dose of interventions. Seven interventions were determined to be ‘high dose,’ and researchers identified community and proximal outcomes for three high-dose interventions where the AHA is typically the catalyst that is leading and influencing work with community partners. Researchers reviewed 11 national databases to identify existing community-level data aggregated at the county, city, zip code, or census track that may be associated with the three high dose impact opportunities. Researchers then reviewed the evidence-based literature associated with proximal outcomes - organizational, environmental, policy, or individual/household changes - that have been documented in research studies in association with the three high dose interventions. Using the insight from both reviews, researchers were able to develop a model evaluation framework for assessing the impact of community level interventions over time.

Results:
Researchers were able to identify 17 proximal outcomes and two community level outcomes with evidence associated with the three high dose interventions.

Conclusion:
Demonstrating the impact of community level nutrition security interventions is challenging given the complexity of the environments in which they are implemented and the limitations of evaluation resources. This approach prioritizes high dose evidence-based interventions and then leverages existing community level datasets and organizational measures to assess impact. It provides a framework for other organizations to prioritize specific systemic interventions to evaluate and further informs the evidence base for future interventions.
Abstract P199: Oral Microbiome Potentially Modifies the Cardiometabolic Benefits of Nitrate Consumption: Results From the Oral Infections Glucose Intolerance and Insulin Resistance Study (ORIGINS)
Authors: Goh Charlene E , Bohn Bruno , Genkinger Jeanine , Molinsky Rebecca L , Roy Sumith , Paster Bruce , Chen Ching-Yuan , Rosenbaum Michael , Yuzefpolskaya Melana , Colombo Paolo C , Knight Rob , Desvarieux Moise , Papapanou Panos , Jacobs David R , Demmer Ryan
Published: May 2024

Background:
Dietary nitrate consumption is associated with cardiometabolic health in many but not all studies. The enterosalivary nitrate-nitrite-nitric oxide (NO
3
- NO
2
- NO) pathway requires the oral microbiome for NO production (a signaling molecule beneficial to cardiometabolic health) following nitrate intake. We hypothesize that the oral microbiome modifies the cardiometabolic benefits of nitrate intake.

Methods:
We analyzed cross-sectional data from 657 ORGINS participants. Dietary nitrate intakes and alternative healthy eating index (AHEI) scores were calculated from food frequency questionnaire responses and a US food database. Subgingival 16S rRNA microbial genes (Illumina, MiSeq) were sequenced, and PICRUSt2 estimated metagenomic content. The Microbiome Induced Nitric oxide Enrichment Score (MINES) was calculated as a microbial gene abundance ratio representing enhanced net capacity for NO generation. Cardiometabolic biomarker (systolic and diastolic blood pressure, HbA1C, glucose, insulin, and HOMA-IR) Z-scores were averaged to form a cardiometabolic Z-score (CMZ). Adjusted multivariable linear models regressed CMZ and individual Z-scores on nitrate intake tertiles.

Results:
Participants were mean age 31±9, 72% female, 31% White, 14% Black, and 28% Hispanic. Mean nitrate intake was 189±171 mg/day. Higher nitrate intake was significantly associated with lower CMZ, glucose, insulin, and HOMA-IR. Mean CMZ(SE) across dietary nitrate tertiles were 0.53(0.30), 0.35(0.31), and -0.11(0.30), p for trend=0.04; findings were attenuated after adjustment for AHEI (p for trend=0.12). In subgroup analysis by MINES level, higher nitrate intake was only associated with lower cardiometabolic biomarker levels among participants with a <median MINES even after AHEI adjustment (Table).

Conclusion:
Higher dietary nitrate intake was associated with lower cardiometabolic risk biomarker levels only among those with reduced potential for oral microbiome-dependent NO generation.
Abstract P203: Healthy Diet Perception, Cardiovascular Disease, and Risk Factors in Americans
Authors: Jia Jenny
Published: May 2024

Introduction:
Healthy diet perception may influence cardiovascular (CV) outcomes. Misperceptions on the healthfulness of one’s diet can interfere with the precontemplative and contemplative stages of behavioral change if individuals overestimate their diet quality. Using a nationally-representative sample, we explored the prevalence of healthy diet misperception in the general population and in those with CV diseases, as well as whether misperceptions are associated with clinical CV risk factors.

Methods:
We included adults≥20 years old from the National Health and Nutrition Examination Survey 2017-2020. Using survey data on participants’ perception of their own diet and diet recall data to calculate Healthy Eating Index-2015 (HEI), we divided participants into dietary quantiles. We categorized healthy diet perception (HDP) as overestimated (perceived>HEI quantile), accurate (perceived=HEI quantile), or underestimated (perceived<HEI quantile). We categorized those who self-reported hypertension, coronary heart disease, myocardial infarction, congestive heart failure, and stroke as having CV disease. Clinical CV risk factor measures were body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin A1c, total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). We used multiple logistic regression to measure the association between CV disease and HDP and multiple linear regression for HDP and CV risk factors, stratified by presence of CV disease.

Results:
Of 7,710 adults, 4,470 (57.5 weighted %) overestimated HDP; 1,924 (25.6 weighted %) underestimated HDP; and 1,316 (16.9 weighted %) correctly estimated HDP. After adjusting for age, sex, and education level, having CV disease was not associated with incorrectly estimating HDP (adjusted OR 1.08; 95% CI 0.93, 1.26) or overestimating HDP (adjusted OR 1.21; 95% CI 1.00, 1.48), compared to correctly estimating HDP. Among those with CV disease, overestimating HDP was associated with higher BMI (adjusted difference 1.9 m/kg
2
; 95% CI 0.8, 2.9) and lower HDL (adjusted difference -2.8 mg/dL; 95% CI -5.1, -0.5). Among those without CV disease, overestimating HDP was only associated with higher BMI (adjusted difference 1.9; 95% CI 0.8, 2.9)

Conclusions:
More than half of Americans overestimate their diet quality, and adults with CV disease do not estimate diet quality more accuracy than those without CV disease. Among adults with CV disease, misperceptions in diet quality were associated with worse CV risk factor profiles, highlighting the need to assess and educate patients with CV disease on personal diet quality as part of healthy lifestyle promotion. Among those without CV disease, dietary misperceptions were associated with higher BMI, suggesting that increasing awareness of one's diet is also important in CV disease prevention.
Abstract P213: Examining Sociodemographic Disparities in Physical Activity and Diabetes: Preliminary Findings From 2007-2020 National Health and Nutrition Examination Survey
Authors: Deng Yangyang , Moniruzzaman Mohammad , Rogers Breanna , Hu Lu , Jagannathan Ram , Tamura Kosuke
Published: May 2024

Purpose:
Physical activity (PA) plays a crucial role in preventing diabetes, but few studies have examined whether sociodemographic factors were associated to PA, and PA and sociodemographic factors were related to diabetes. We aimed to 1) examine associations between sociodemographic factors and PA, and 2) investigate whether PA and sociodemographic are related to the prevalence of diabetes.

Methods:
Data came from the 2007-2020 National Health and Nutrition Examination Survey (NHANES), a series of cross-sectional cohort studies (total sample=30,788, Female: 49.1%,
mean age
=49.6). Two binary outcomes included: 1) Meeting PA guidelines (≥500 MET minutes/week) and 2) diabetes (yes/no). Sociodemographic variables included age group (20-44 [referent], 45-64, 65-79), sex, race/ethnicity (White [referent], Black, Hispanic, and other adults), and poverty income ratio (low, middle, high-income [referent]). PA guideline was also considered as exposure for diabetes analysis. By accounting for the complex survey design, two weighted generalized Poisson models were used to conduct the analyses, adjusting for covariates.

Results:
Model 1 showed that participants aged 45-64 and 65-79 had 14% and 16% lower likelihood of meeting PA guidelines than those aged 20-44. Females had an 18 % lower likelihood of meeting PA guidelines than males. Furthermore, Black, Hispanic, and other racial/ethnic adults were 7%, 8%, and 12% less likely to meet the PA guidelines than White adults. Adults with low- and middle-income had 13% and 8% lower likelihood of meeting PA guidelines than those with high income. Model 2 showed that participants from 2017-2020 were 22% more likely to have diabetes (AOR = 1.22) than those from 2007-2008. Adults aged 45-64 and 65-79 years had a 4.35- and 7.36-times higher likelihood of having diabetes than those aged 20-44. Females had a 25% lower likelihood of having diabetes than males. Black, Hispanic, and other groups were 49%, 35%, and 73% more likely to have diabetes than White adults, respectively. Adults with low- and middle-income had a 52% and 32% higher likelihood of having diabetes than those with high income. Adults meeting PA guidelines had a 28% lower likelihood of having diabetes than those not meeting the PA guidelines.

Conclusion:
The study highlights persistent disparities in PA levels and diabetes across different sociodemographic groups within the U.S. population. Future interventions targeting diabetes should prioritize addressing these disparities among vulnerable populations who do not meet PA guidelines. Emphasis should be placed on promoting PA as an integral component of diabetes prevention.
Abstract P235: Subjective Well-Being as Compared With Traditional Risk Factors in Relation to Incident Cardiovascular Diseases
Authors: Kou Minghao , Li Xiang , Ma Hao , Wang Xuan , Heianza Yoriko , Manson JoAnn E , Qi Lu
Published: May 2024

Introduction:
Emerging evidence suggests a role of subjective well-being (SWB) in modifying the risk of developing cardiovascular disease (CVD), while supportive data from prospective studies are scarce.

Hypothesis:
Low SWB is independently associated with higher incidence of CVD, comparable in magnitude to several established traditional risk factors.

Methods:
The study included a total of 154,217 women and men from the UK Biobank study, free of CVD at baseline and with measurements of SWB based on general happiness, personal health, family relationships, friendships, and financial situation, followed up until May 31, 2021. Cox proportional hazards models were used to estimate associations between SWB and incident CVD. The relative importance of SWB in terms of predicting outcomes was measured by explained R
2
values.

Results:
During a median follow-up of 11.3 years, there were 11,662 incident CVD events (8,474 coronary heart disease [CHD] cases and 1,804 ischemic strokes). Individuals with low SWB had an approximately 2-fold higher risk of CVD compared to those with high SWB (Hazard Ratio [95% Confidence Interval], 1.99 [1.75-2.27] for CVD, 1.98 [1.71-2.30] for CHD, and 1.90 [1.34-2.69] for ischemic stroke) after adjusting for traditional risk factors. Of 12 factors examined, SWB was ranked as the fourth-strongest CVD risk factor, following hypertension, smoking, and body mass index (
Figure
). SWB was ranked as the sixth- and third-strongest risk factor for CHD and ischemic stroke, respectively.

Conclusions:
Our study indicates that SWB is robustly associated with the risk of incident CVD, potentially as one of the strongest modifiable risk factors for CVD prediction.
Abstract P241: Stress-Induced Autonomic Dysfunction is Associated With Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Artery Disease
Authors: Osei Jeffery , Vaccarino Viola , Wang Maggie , Shah Anish , Lampert Rachel J , Ko Yi-An , Pearce Brad , Kutner Michael , Garcia Ernest V , Piccinelli Marina , Raggi Paolo , Bremner James , Quyyumi Arshed A , Sun Yan , Haddad George , Li Louis , Correia Luis , Roberts Tatum E , Stefanos Lewam , Ahmed Hashir , Shah Amit J
Published: May 2024

Background:
Mental stress-induced myocardial ischemia (MSIMI) is associated with adverse cardiovascular outcomes in individuals with coronary artery disease (CAD), but the mechanisms underlying this phenomenon are unknown. We examined the relationship between stress-induced autonomic dysfunction, measured by lower heart rate variability (HRV) in response to stress, and MSIMI in patients with stable CAD. We hypothesized that stress-induced autonomic dysfunction is associated with higher odds of MSIMI.

Methods:
In 735 participants with stable CAD, we measured high frequency (HF) and low frequency (LF) HRV in 5-minute intervals before and during a standardized laboratory-based speech stressor using Holter monitoring. MSIMI was evaluated with single-photon emission computed tomography myocardial perfusion imaging. HRV at rest and stress were categorized into low (lowest quartile) versus high (upper three quartiles) categories; low category was used as an indicator of autonomic dysfunction. Multivariable logistic regression models were used to examine the association of autonomic dysfunction with MSIMI.

Results:
The mean age was 58 (SD ±10) years, 35% were women, 44% were Black participants, and 16% developed MSIMI. Compared with high stress HRV, low stress HRV (both HF and LF) was associated with higher odds of MSIMI after adjusting for demographic and clinical factors. LF HRV at rest was also significantly associated with MSIMI with slightly reduced effect estimates.

Conclusions:
In individuals with CAD, mental stress-induced autonomic dysfunction may be an independent mechanism in the pathogenesis of MSIMI.
Abstract P248: Women With Migraine Had Higher Progression of 10-year Stroke Risk Than Those Without Migraine: Findings From a Nested Case-Control Study
Authors: Tian Longben , Xie Yao Jie , Deng Yunyang , Wang Harry Haoxiang , Liu Justina
Published: May 2024

Introduction:
There was limited understanding of the association between migraine status and longitudinal changes in stroke risk.

Hypothesis:
We hypothesized that migraine patients would have higher growth in 10-year stroke risk than those without migraine during a 1-year follow-up period in Hong Kong Chinese women.

Methods:
A nested case-control study was conducted using data from the Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women (MECH-HK). The MECH-HK initially enrolled 4,221 Hong Kong Chinese women aged 30-74 years between 2019 and 2021 and followed up with 3,435 participants in the second-round survey until September 2023. Diagnosis of migraine was confirmed according to the ICHD-3 criteria. Stroke risk was calculated using the 10-year China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) stroke risk model. The change in China-PAR stroke risk between the baseline and second-round survey was then computed. Cases were identified as individuals with the top 20% high growth in China-PAR stroke risk. The age-matched controls (±2 years) were randomly selected from the cohort at a 1:1 ratio. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable conditional logistic regression models. Subgroup analyses were performed based on participants' baseline age (<65 years or ≥65 years) and the presence of migraine aura (migraine with or without aura).

Results:
A total of 589 cases (aged 60.70 ± 4.31 years) and 589 controls (aged 60.57±6.05 years) were identified (p >0.05). The baseline 10-year China-PAR stroke risk was 2.80%±1.73% and 2.97%±2.01% in the cases and controls, respectively (p >0.05). A total of 48 (8.1%) and 15 (2.5%) women with migraine in the cases group and controls group were identified (p<0.01). During the 1.13-year follow-up period (Interquartile range: 1.07-1.22), migraine was associated with a 3.39-fold increase in the odds of being high growth in China-PAR stroke risk after adjustment for age, education level, drinking, and previous use of oral contraceptive (95% CI: 1.91-6.38, p<0.01). In subgroup analyses, the association was only found in women aged 65 years and older (adjusted OR: 4.12, 95% CI: 2.02-9.34, p<0.01). In addition, a stronger association was observed in women with migraine with aura (adjusted OR: 6.97, 95% CI: 2.33-30.01, p<0.01, migraine with aura vs. non-migraine) than those without aura (adjusted OR: 2.52, 95% CI: 1.29-5.21, p<0.01, migraine without aura vs. non-migraine).

Conclusion:
Migraine was associated with higher growth of 10-year stroke risk in a sample of Hong Kong Chinese women, typically in older women and the women with migraine with aura.
Abstract P249: Association Between Loneliness and Functionality in an Elderly Population
Authors: Bertoldi Karina , Baena Cristina P , Bernardelli Rafaella S , Karam Leandro Z , Haagsma Ariele B , Roig Javier J
Published: May 2024

Background:
Functionality plays a pivotal role in the well-being and autonomy of older individuals. Discovering new predictors of functional decline is a pressing concern, with loneliness emerging as an unconventional risk factor for chronic diseases. However, its role in functional limitations remains poorly understood.

Hypothesis:
Loneliness is an independent predictor of limitations in Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs) among individuals aged 80 or older.

Methods:
A cross-sectional analysis was conducted using data from Wave 8 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), spanning 28 European countries, for participants aged 80 and above, excluding residents in long-term care institutions. Loneliness was assessed using a reduced version of the R-UCLA Loneliness Scale, including measures of companionship, feeling left out, and isolation on a 3-point Likert scale ("often," "some of the time," "hardly ever or never"). Participants scoring 4 to 9 were categorized as lonely. The outcome was defined as the presence of limitations in one or more of the six ADLs and/or the nine IADLs. Logistic regression models were employed to control for potential confounding factors. Multivariate analysis included covariates with p<0.200 and no multicollinearity. Model quality was evaluated using the area under the ROC curve, and the significance level was set at 5%. The analysis was conducted using IBM SPSS, version 28.0.

Results:
The study included 7,434 individuals, with 58.2% (n=4,323) being female and a mean age of 84.4 (±3.8) for both genders. A majority of participants (52.5%, n=3,879) had low levels of education (ISCED-97 from 0 to 2). Comorbidities included cardiovascular disease (22%, n=1,634), stroke (7%, n=523), diabetes mellitus (17.2%, n=1,281), cancer (6.6%, n=494), and obesity (16.8%, n=1,180). In the univariate analysis, older adults classified as lonely exhibited an odds ratio (OR) of 2.213 (95% CI: 2.016 - 2.428) for presenting limitations in one or more ADLs/IADLs. The multiple model showed an OR of 1.472 (95% CI: 1.313 - 1.649) for having one or more ADLs/IADLs limitations in the presence of loneliness. This association remained significant even after adjusting for confounders (age, gender, education, chronic diseases, hip fracture, pain and European region). The AUC was 76,4%.

Conclusions:
Our study reveals an independent link between loneliness and limitations in ADLs and IADLs among individuals aged 80 or older from the SHARE dataset. These findings lend support to interventions aimed at preventing loneliness and preserving functionality in this age group.
Abstract P252: Baseline Cognitive and Physical Function and Subsequent Occupational Status in Chinese Adults
Authors: Howard Annie Green , Balakrishnan Ellie , Tien Hsiao , Du Shufa , Zhang Bing , Wang Huijun , Batsis John A , Spangler Hillary , Adair Linda , Gordon-Larsen Penny
Published: May 2024

Background:
Declines in cognitive and physical function in later adulthood can have an impact whether or not individuals remain in the workforce, although the relationship is complex and often bidirectional. Little is also known about how this relationship differs in rural versus urban populations. We capitalized on longitudinal data in an urbanizing population to estimate the differential impact of urbanization level with cognitive and physical function on remaining in the work force.

Methods:
We used longitudinal data from 5,228 adults in the China Health and Nutrition Survey aged 58+ to assess the association between cognitive and physical function at the 2015 survey with whether older adults remained in the work force, based on self-report of either formal or informal work, in 2018. We defined cognitive function using a global cognitive score based on a subset of the modified Telephone Interview for Cognitive Status (TICS) and physical function using limitations as measured by instrumental activities of daily living (IADLs). Given differences in demographics of working status in urban (urban areas or small towns) versus rural villages, we included an interaction term for cognitive function by urban versus rural village residence. In minimally adjusted models, we controlled for age and gender and in fully adjusted models we additionally adjusted for birth cohort, education, region, marital status, and income.

Results:
In 2018, 48% of adults lived in rural villages and 41% were currently working. In rural villages, we found individuals with any (versus no) physical limitations in 2015 in were more likely to be working in 2018: Any IADL limitations versus no limitations: (OR=0.47 [95% confidence interval (CI) of 0.34-0.65). However, in urban areas, individuals with any (versus no) physical limitations in 2015 were more likely to be working in 2018: Any IADL limitations versus no limitations: OR=2.44 (1.18,5.03). We found no evidence of differential association between cognitive function and subsequent working status in the total sample or by rural village residence in the minimally or fully adjusted models.

Conclusion:
Physical (but not cognitive) function at baseline impacts future occupational status differently for those in rural versus urban areas which could reflect differences in the types of work being done as well as differences in the availability of economic resources between rural versus urban areas.
Abstract P253: Lifetime Risk of Dementia by Midlife Vascular Risk Factor Burden: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Hu Jiaqi , Fang Michael , Gottesman Rebecca F , Lutsey Pamela L , Mosley Thomas , Selvin Elizabeth , Coresh Joe
Published: May 2024

Introduction:
Vascular risk factors play an important role in the development of dementia and death over the lifecourse. However, no absolute lifetime risk of dementia by individual and composite number of vascular risk factors have been reported.

Methods:
We conducted a prospective cohort analysis of data from the Atherosclerosis Risk in Communities (ARIC) Study. We examined the associations of vascular risk factors with incident dementia. Risk factors were measured at visit 2 (1990-1992) and included hypertension (SBP140mmHg, DBP90mmHg or medication use), diabetes status (self-reported physician diagnosis, medication use or HbA1C6.5%) and smoking status. Incident dementia was ascertained via active surveillance involving cognitive function assessments, informant reports, hospitalization codes and death records. We performed survival analysis using age as time scale and accounted for death without dementia as a competing event. We used age 60 as the origin and age on December 31
st
, 2019, as the administrative censoring endpoint.

Results:
Among 13,161 participants, 45%, 40%, and 15% had 0, 1 and 2+ risk factors. There was a dose-dependent association between number of risk factors and the cumulative incidence of dementia
(Figure A)
and death
(Figure C)
. In competing risk models (
Figure B
), the cumulative incidence of dementia (95% CI) in persons with 0, 1 and 2+ risk factors by age 80 was 7.5% (6.6-8.5%), 10.3% (9.2-11.5%) and 13.7% (11.5-15.7%). By age 90, due to higher risk of mortality among those with vascular risk factors, the dementia risk (95% CI) for 0, 1 and 2+ risk factors were 34.8 (32.3-37.3%), 31.2% (29.0-33.2%) and 26.7% (23.9-29.6%).

Conclusion:
Preventing vascular risk factors in midlife may substantially reduce the age-specific risk of dementia. However, since fewer risk factors also lead to longer survival to oldest ages where dementia risk is very high, reducing lifetime risk of dementia beyond age 90 years will require additional preventative strategies.

Figure:
Cumulative incidence of dementia using Kaplan Meier estimator (A), using cumulative incidence function with competing risk of death (B), and cumulative incidence of death (C), according to the number of vascular risk factors in mid-life.
Abstract P255: The Longitudinal Association Between Dietary Vitamin K Intake and Cognitive Function in the General Population (Tanushimaru Cohort Study)
Authors: Morikawa Nagisa , Enomoto Mika , Fukami Ako , Nohara Yume , Sato Hiromi , Yoshimura Harumi , Adachi Hisashi , Fukumoto Yoshihiro
Published: May 2024

Background:
A relationship between vitamin K intake and cognition has been shown in several studies, although most of them were cross-sectional studies. Therefore, we investigated the association vitamin K intake and cognitive change in the longitudinal cohort study.

Methods:
We recruited 976 participants who had a health check-up in 2009 and were followed in 2018 in a prospective Tanushimaru cohort study. We had a dietary interview using brief-type self-administered diet history questionnaire (BDHQ) and Mini-Mental State Examination (MMSE) in 2009 and 2018. Vitamin K intake was calculated based on BDHQ data. We defined people with ≦23, 24-27, 28≦ score of MMSE as dementia-level, mild cognitive impairment (MCI) and normal cognition (NC), respectively. Generalized additive model (GAM) was performed to examine non-linearity of the association between vitamin K intake in 2009 and cognitive change over time. Additionally, we estimated risks for progression from MCI to dementia-level for 9 years by multivariate logistic regression analysis.

Results:
The mean age was 62.6±9.0 years old and dementia-level, MCI and NC in 2009 were 1.6%, 38.7% and 59.6%, respectively. Vitamin K intake in 2009 was not associated with conversion from NC to MCI/dementia-level, but was inversely associated with progression from MCI to dementia-level. According to GAM (Fig 1), its association was linear and we defined 400 μg/day of vitamin K intake as a cut-off value. MCI participants with and low vitamin K intake (<400μg/day) in 2009 had higher risk for dementia progression compared to those with high vitamin K intake (≧400μg/day) (4.77% vs 0.67%)(Fig 2A). Additionally, regarding its concurrent relationship, MCI participants keeping high vitamin K intake from 2009 to 2018 had quite low dementia risk than those with low vitamin K intake in 2009 and 2018 (0.25% vs 5.65%) (Fig 2B).

Conclusion:
Higher dietary vitamin K intake was significantly associated with maintaining cognitive function for 9 years and may prevent cognitive decline to dementia-level.
Abstract P256: Rationale, Development, and Implementation of a Multidisciplinary Digital Lifestyle Health Education Program for Older Adults With Cardiovascular Disease and Osteoarthritis
Authors: Parmenter Belinda J
Published: May 2024

Introduction:
Cardiovascular disease (CVD) is the leading cause of death worldwide. Globally, osteoarthritis (OA) affects 654 million. In 2018, of the 1.2 million Australians who had CVD, half also had arthritis, with the most common form in Australia being OA. Ongoing pain and physical limitations from OA can affect lifestyle choices, contributing to the shared risk factor profile of CVD and OA (physical inactivity, overweight/obesity, poor diet, high medication use). This contributes further to the burden of both diseases including reduced 6-minute walk (6MW) performance, which is directly related to increased CVD mortality. This project outlines the rationale for and development of a multidisciplinary digital lifestyle health education program for the treatment and secondary prevention of CVD and its common comorbidity of OA.

Methods:
This study is a cross-sectional analysis of older adults in Sydney. Class was classified based on the Australian socioeconomic index for areas. Conditions were defined according to Australian national guidelines. Medical history, body mass index (BMI), waist measurement, muscle strength, and 6MW measurements were assessed. Differences between those with and without OA were determined via one-way analysis of variance. Simple linear regressions assessed potential relationships.

Results:
In a cohort of 532 adults; n=341 (64.1%) had diagnosed CVD; 48.4% of which had OA (mean age 66±12 years; 73.3% female). Socioeconomic index was deemed high. In the OA cohort mean BMI and waist were above healthy heart recommendations according to the World Health Organisation. There were no significant differences between those with OA and those without for cardiovascular risk factors of body weight, BMI, waist measurement, blood pressure, 6MW, or muscle strength. However, in those with CVD and OA, the relationship between age and 6MW was stronger and age accounted for more of the variance in performance (r=-0.44; r
2
=0.19; p<0.001) than those without OA (r=-0.37; r
2
=0.17; p<0.001), indicating a greater reduction in walking ability in those with OA as they get older.

Conclusion:
With 6MW performance being related to CVD mortality, interventions are needed to improve health and fitness in this cohort. International guidelines for CVD and OA recommend treatment should prioritise lifestyle changes, including a healthy diet, regular physical activity, and interventions that address all risk factors. Lifestyle LIFEMAP will assess the efficacy of a widely translatable multidisciplinary digital evidence-based 10-module lifestyle, food, exercise, medication, and park prescription education program for adults with the comorbidity of CVD and OA. We expect this program to improve knowledge, and healthy lifestyle choices, thereby improving physical activity and health outcomes in this highly vulnerable population.