bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P070: Comparison of Heritability Estimation Using the Principal Components Calculated by Maximizing Variance and Heritability for OSA Traits
Authors: Liang Jingjing , Feng Tao , Cade Brian , Lin Xihong , Saxena Richa , Gleason Kevin , Zhu Xiaofeng , Redline Susan
Published: July 2021

RATIONALE:
Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive pauses in breathing during sleep associated with significant cardiovascular morbidity. Accumulating study results suggest that there are strong genetic contributions for this disease as defined by the apnea hypopnea index (AHI), the number of breathing pauses per hour of sleep. Using this metric, it has been shown that OSA significantly aggregates within families (1-2); heritability for the AHI is estimated to vary from about 20 to 40% (2-3). However, the AHI is only one index from several that describe OSA severity, and may not be the most relevant phenotype for genetic studies. It has not, however, been clear how to systematically assess heritability of multiple correlated and uncorrelated OSA traits.

METHODS:
To identify OSA related phenotypes that are most heritable to inform discovery of genetic risk variants for the disease, heritability analysis of multiple OSA related phenotypes were conducted using family data from Cleveland Family Study which comprises 700 African Americans from 147 families and 669 European Americans from 139 families. Principal-components analysis was performed using two approaches for combining data for six OSA traits that describe several dimensions of physiological and clinical impairment: the AHI and three other sleep study metrics (average hypopnea duration, average oxygen saturation, and percent time at oxygen saturation of < 90%) and two OSA symptoms (habitual snoring and excessive sleepiness). One method uses the traditional principal-components (PC) approach assuming all subjects are independent. The other developed by Rabinowitz and Ott (4) calculates principal components by maximizing the heritability.

RESULTS:
In European Americans, the maximum heritability for the traditional multi-trait PC was 0.513 (SE=0.1010) while it was 0.512 (SE=0.100) for the PC calculated maximizing heritability. The maximum individual trait heritability was for average oxygen saturation, which is 0.388 (SE=0.107). In African Americans, the maximum heritability of traditional multi-trait 0.50 (SE=0.094) while it was 0.616 (SE=0.091) for the PC calculated maximizing heritability. The maximum individual trait heritability was for average hypopnea duration, which is 0.570 (SE=0.096).

CONCLUSIONS:
In general, both principal components approaches (maximizing variance and heritability) of six OSA related traits result higher heritability estimates than individual trait heritability estimates. The principal components approach based on maximizing heritability has the potential to improve trait heritability and therefore can be useful in future association analysis for searching genes underlying obstructive sleep apnea.
Abstract P071: How to Get a Better Night’s Sleep: Be Active and Reduce Sedentary Behaviour
Authors: Kakinami Lisa , O'Loughlin Erin K , Brunet Jennifer , Dugas Erika N , Sabiston Catherine , O'Loughlin Jennifer L
Published: July 2021

Background:
Approximately 40% of the population reports sleep problems such as poor quality sleep and insufficient sleep duration. Physical activity (PA) can help improve sleep, but data on whether PA intensity or duration is most strongly associated with sleep are lacking. In addition, given that sedentary behaviour (e.g., TV, computer use) is distinct from physical inactivity, the association between sedentary behaviour and sleep in young adults needs to be characterized.

Objective:
To describe the relationships between sleep quality and sleep duration and (1) frequency and duration of light, moderate, and vigorous PA, and (2) different types of sedentary behaviours (TV, computer, reading) in young adults.

Methods:
Self-report data for 658 participants were from the 22nd wave of the Nicotine Dependence in Teens (NDIT) cohort study (mean age=24.0 years, 46% male [300 of 658]). PA measures assessed frequency (number of days) and minutes of light, moderate and vigorous PA in the past week. Sedentary measures assessed number of hours spent reading, watching TV, and using the computer per day. Sleep measures included (1) the Pittsburgh Sleep Quality Index (PSQI) which assessed seven dimensions of sleep (daytime dysfunction, disturbances, duration, efficiency, latency, quality, use of sleeping medications), (2) general sleep quality, and (3) sleep duration in the past month. General sleep quality and sleep duration were two separate additional measures distinct from similar PSQI items (r=0.73 between general sleep quality and PSQI score; r=0.69 between sleep duration and PSQI score). Data were analyzed using multiple linear regression. Due to evidence of non-normality the PSQI score was log-transformed.

Results:
Controlling for age, sex, and maternal education, each additional day of light or vigorous PA was associated with 3 minutes less sleep per night (p<0.05). Each additional 10 minutes of moderate PA was associated with greater general sleep quality (β=0.004, p=0.04). TV was associated with a poorer PSQI score (β=0.01, p<0.05) and each additional hour of reading was associated with 2 minutes less sleep per night (p=0.04). Computer use was associated with a poorer PSQI score (β=0.02, p=0.005) and poorer sleep quality (β=-0.02, p=0.05). Results were similar when sedentary and PA measures were included in the same model. The inclusion of body mass index, self-rated mental and general health, and stress did not affect the results and were omitted from the final models.

Conclusion:
PA and sedentary behaviours are independently associated with sleep duration and quality. Sedentary behaviours are associated with poorer sleep duration and quality. In contrast, PA frequency may decrease sleep duration while PA duration may improve sleep quality. Clinicians who treat sleep problems in young adults may need to take PA and sedentary behavior into account in treatment plans.
Abstract P160: Ankle-Brachial Index and Fracture Hospitalization in Middle-Aged Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ballew Shoshana , Sang Yingying , Schneider Andrea L , Grams Morgan , Loehr Laura R , Tanaka Hirofumi , Heiss Gerardo , Selvin Elizabeth , Coresh Josef , Matsushita Kunihiro
Published: July 2021

Background:
Several studies indicate that lower extremity peripheral artery disease (PAD), commonly defined by an ankle-brachial index (ABI) <0.9, can increase the risk of bone fracture via its impact on physical function and mobility. Because the majority of prior studies are limited to older white male populations (age ≥65 years), uncertainty remains regarding this association in non-whites, women, and younger individuals.

Methods:
We studied 15,160 ARIC participants (age 45-64 years in 1987-1989) whose ABI was measured in a randomly selected leg at baseline. Hip or lower extremity fracture-related diagnostic codes were identified through active surveillance of hospitalizations. We used Cox proportional hazards to estimate the independent association between ABI including high ABI (≥1.4), a condition shown in PAD with vascular stiffness, and incident fracture hospitalization, adjusting for potential confounders.

Results:
There were 668 hip or lower extremity fracture hospitalizations during a median follow-up of 22 years. In the crude model, there was a dose-response relationship between low ABI and fracture risk (Table). However, only ABI 0.9-1.1 remained statistically significant after demographic adjustment compared to normal ABI (1.1-1.4) and inclusion of other covariates rendered this association non-significant. The results were largely consistent among most demographic and clinical subgroups, but we observed increased risk of fracture in low ABI (<0.9) among those with history of cardiovascular disease and high ABI (≥1.4) in men, in the fully adjusted model.

Conclusion:
An independent association of ABI with increased risk of hip or lower extremity fracture hospitalization was not that evident overall in our biracial population of middle-aged adults. However, ABI may contribute to increased risk of fracture in subgroups, warranting further investigation.
Abstract P186: Quality of Total Heart Adipose Tissue May Contribute to the Presence and Extent of Coronary Artery Calcification in Women at Midlife: The Study of Women’s Health Across the Nation
Authors: Hanley Carrie L , Matthews Karen , Brooks Maria M , Janssen Imke , Budoff Matthew J , Sekikawa Akira , Mulukutla Suresh , El Khoudary Samar R
Published: July 2021

Background:
The location and quantity of specific adipose tissue depots have been shown to be independent predictors of subclinical atherosclerosis. Most recently, attention has been focused on the quality of these fat depots as a novel marker of CVD risk. Adipose tissue attenuation, measured via radiodensity in computed tomography (CT) Hounsfield units (HU), is one such marker of fat quality. Our objective was to determine the cross-sectional association between total heart adipose tissue (TAT) radiodensity and coronary artery calcification (CAC) in women at midlife, a time period marked with an increase in CVD risk.

Methods:
Participants from the Study of Women’s Health Across the Nation (SWAN) Ectopic Cardiovascular Fat Ancillary Study were evaluated. CAC and TAT were measured using electron-beam CT. CAC was evaluated as 1) presence of CAC (CAC Agatston score >10), and 2) extent of CAC (continuous Agatston score). TAT radiodensity was evaluated as tertiles of HU (lowest tertile, -91 to -81 HU; middle tertile, -80 to -78 HU; highest tertile -77 to -67 HU). Logistic (for CAC presence) and Tobit regression (for CAC extent) were used for statistical analyses.

Results:
A total of 495 women with a mean age of 51 years were examined. This sample of women was 63% white, 37% black, 54% pre-/early peri-menopausal, 35% late peri-/postmenopausal, and 11% used hormones. In unadjusted logistic and Tobit regression models (
Table 1
), the tertiles of TAT were significantly and inversely associated with the presence and extent of CAC. In fully adjusted models, the middle tertile remained significantly inversely associated with the presence and extent of CAC compared to the lowest tertile, but the adjusted estimates for the highest tertile were attenuated and non-significant (
Table 1
).

Conclusions:
There appears to be an inverse relationship between TAT radiodensity and CAC which is more pronounced for those with mid-range radiodensity values. These results merit further investigation.
Abstract P193: Infection Type and Severity are Risk Factors for Hospital-Acquired Venous Thromboembolism in Medical Inpatients
Authors: Merrill Samuel , Desarno Michael , Houghton Damon , Huston Christopher , Callas Peter , Repp Allen , Cushman Mary , Zakai Neil
Published: July 2021

Introduction:
Hospital-acquired venous thromboembolism (HAVTE) leads to increased length of stay, cost, morbidity, and is a target of government quality measures. How infection relates to HAVTE risk is unknown. We wished to identify infection-related risk factors for HAVTE to help identify at-risk patients and to guide prevention efforts.

Hypothesis:
We hypothesized that increased infection severity, affected organ system, and positive microbiology culture results were associated with HAVTE in medical inpatients.

Methods:
HAVTE between 2009-2012 were identified by ICD-9 codes with confirmatory imaging at a 500 bed teaching hospital. ICD-9 codes, microbiology results, lab and vital sign data, and medication records were used to classify infections as presented in the Table. Logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI) for HAVTE adjusting for known HAVTE risk factors in the MITH score, a previously developed HAVTE risk score for medical inpatients. Models incorporated known HAVTE risk factors and assessed each variable from the Table individually.

Results:
In 20,327 medical admissions there were 113 hospital-acquired HAVTE (incidence: 0.56%). The table presents the association between infection-related risk factors and HAVTE. Septic shock (OR 7.48), sepsis (OR 5.9), and MSSA culture isolate (OR 6.39) had the greatest point-estimates of HAVTE after adjusting for known HAVTE risk factors.

Conclusions:
Infection severity, affected organ system, and microbiologic etiology were risk factors for HAVTE after adjusting for known risk factors. The relationship between these risk factors and thrombosis is likely complex, but these risk factors are easily measureable using the electronic health record. These results may help facilitate HAVTE prevention by further identifying high risk patients.
Abstract P206: Ambulatory Blood Pressure Monitoring Phenotypes Among Individuals With and Without Diabetes: The Jackson Heart Study
Authors: Bromfield Samantha G , Shimbo Daichi , Bertoni Alain , Sims Mario , Carson April P , Muntner Paul
Published: July 2021

Several ambulatory blood pressure monitoring (ABPM) phenotypes including masked hypertension are associated with an increased risk for cardiovascular disease (CVD). Diabetes is associated with CVD risk as well as a higher prevalence of hypertension. However, little is known about whether ABPM phenotypes differ between individuals with versus without diabetes. We evaluated the association between diabetes and ABPM phenotypes including clinic hypertension, awake hypertension, sustained hypertension, nocturnal hypertension, non-dipping pattern, white coat hypertension, and masked hypertension in the Jackson Heart Study (JHS). Baseline data collection included two clinic blood pressure measurements using standardized protocols. ABPM measurements were taken in the 24 hours following the baseline visit. Diabetes was defined as fasting glucose ≥126 mg/dL, hemoglobin A1c ≥6.5%, or use of diabetes medications. Of the 1,032 JHS participants with valid ABPM data (67.7% female, mean age 59.2 years), 253 (24.5%) had diabetes. The prevalence of clinic hypertension was similar for participants with and without diabetes (Table 1). After multivariable adjustment, diabetes was associated with an increased prevalence ratio of awake, sustained, and masked hypertension and a lower prevalence ratio of white coat hypertension compared with individuals without diabetes. In summary, there was an increased prevalence of adverse blood pressure phenotypes among individuals with versus those without diabetes that was not captured in the clinic setting alone. The role of ABPM for identifying high risk individuals with diabetes should be further investigated.
Abstract P230: Antidepressant Use and Incident Heart Failure among Veterans with and without HIV Infection and Major Depressive Disorder
Authors: White Jessica R , Chang Chung-Chou H , Armah Kaku A , Stewart Jesse C , Gupta Samir K , Butt Adeel A , Gibert Cynthia L , Rimland David , Rodriguez-Barradas Maria C , Leaf David A , Bedimo Roger J , Gottdiener John S , Kop Willem J , Gottlieb Stephen S , Budoff Matthew J , Khambaty Tasneem , Tindle Hilary A , Justice Amy C , Freiberg Matthew S
Published: July 2021

Depression is associated with an increased risk of heart failure (HF) among HIV infected (HIV+) and uninfected (HIV-) veterans. Antidepressants are commonly prescribed to mitigate psychosocial symptoms related to major depressive disorder (MDD). The purpose of this study was to determine whether antidepressant use was associated with lower HF risk among a large cohort of HIV+ and HIV- veterans with MDD.
We analyzed data on 13,849 veterans (36.5% HIV+) from the Veterans Aging Cohort Study (VACS), a prospective study of HIV+ and matched HIV- veterans who had a diagnosis of MDD (ICD-9 codes 296.2x & 296.3x) and were free of cardiovascular disease (CVD) at baseline. Antidepressant use was defined as documentation of selective serotonin reuptake inhibitor (SSRIs), tricyclic antidepressant (TCAs), and non-SSRI, non-TCA antidepressant use from the VA pharmacy records during the baseline period (1998 - 2003). Incident HF was identified using ICD-9 codes and defined as first HF event on or after 4/1/2003 until 12/31/2009. We used Cox proportional hazards regression to assess the association between HIV infection, antidepressant use and incident HF, adjusting for covariates (Table). Most participants were on antidepressant therapy [90.2% (12,498 of 13,849)]. In the total sample, baseline antidepressant use was associated with a lower risk of HF, adjusting for all covariates including HIV (adjusted HR = 0.76, 95% CI = 0.58 - 0.99). The rates of incident HF were highest among HIV+ participants who did not use antidepressants (Table). Among the HIV+ participants, the association between antidepressant use and lower HF risk neared significance (p = 0.053). Antidepressant use was common among this cohort of veterans with MDD and was associated with a lower risk of incident HF. Our study lends support to further investigations to determine the importance of antidepressants as additional therapy for CVD prevention among MDD patients with and without HIV.
Abstract P246: Lean Body Mass, Percent Body Fat, and HbA1c in the U.S. Population: The National Health and Nutrition Examination Survey (NHANES 1999-2006)
Authors: Bower Julie K , Brackett Rachel , Foster Meredith C , Foraker Randi E
Published: July 2021

Introduction:
Weight loss is an important component of diabetes prevention and management because of the known effect of adiposity on insulin resistance. While both muscle (lean mass) and fat mass are known to serve important metabolic functions, most studies of obesity and diabetes use proxy measures for overall or abdominal obesity without accounting for the composition of that mass. The aim of this study was to examine the association of total and trunk lean body mass and fat mass with hemoglobin A1c (HbA1c) - an indicator of glucose control in persons with diabetes and a risk marker in non-diabetic populations - in the general U.S. population.

Methods:
We conducted a cross-sectional analysis of data from the NHANES collected in 1999-2006 in participants aged 18-69 years. Lean body mass and percent body fat were determined using dual energy x-ray absorptiometry (DXA); analyses were weighted and multiple imputation was applied to account for missing DXA data. Associations of body composition with HbA1C were evaluated using multiple linear regression.

Results:
The study sample included 1,085 participants with diagnosed diabetes (mean age 56 years, 50% male, mean HbA1c=7.6%) and 15,597 participants without diabetes (mean age 40 years, 51% women, mean HbA1c=5.3%). Trunk lean mass and total lean mass were significantly associated with lower HbA1c in adults without diabetes, independent of body mass index (BMI) and waist circumference. After adjustment for age, sex, race/ethnicity, and waist circumference, each 10 kg increase in trunk lean mass was associated with 0.07-% points lower HbA1c (95% CI: -0.09, -0.03). After adjustment for age, sex, race/ethnicity, and BMI, each 10kg increase in total lean mass was associated with 0.03-% points lower HbA1c (95% CI: -0.05, -0.0). Each 5% increase in trunk fat was associated with 0.5-% point higher HbA1c (95% CI: 0.45, 0.55) and each 5% increase in total fat was associated with 0.05-% point higher HbA1c (95% CI: 0.05, 0.06). Lean mass and percent body fat were not associated with HbA1c in participants with diagnosed diabetes (p > 0.05).

Conclusions:
Lean mass is independently associated with HbA1c in adults without diabetes. Interventions that target both weight loss where warranted and increasing lean mass via resistance training may have the most beneficial impact for diabetes prevention.
Abstract P265: Neighborhood Environments and Weight Change Among Individuals Participating in a Weight Loss Intervention
Authors: Mendez Dara D , Ewing Linda J , Zheng Yaguang , Imes Christopher C , Goode Rachel W , Mancino Juliet , Music Edvin , Burke Lora E
Published: July 2021

Introduction:
Studies have shown that neighborhood factors (e.g., socioeconomic disadvantage, food sources) have been associated with weight. However, neighborhood factors are often overlooked in weight loss interventions, and few studies examine the influence of neighborhoods on weight change. We examined the neighborhood environment and its association with weight change in a 12-mo. weight loss intervention.

Hypothesis:
Individuals who live in obesogenic neighborhood environments (e.g., low income, absence of grocery stores) would be less likely to lose weight over time compared to those who live in healthy environments.

Methods:
This analysis included data on body weight assessed at 0 and 6 mos and calculated as percent change. Residential address at baseline was geocoded using ArcGIS software and assigned the appropriate census tract. Key neighborhood measures included grocery store and restaurant density, proportion Black and low income, and an index of neighborhood socioeconomic disadvantage. We tested differences in mean weight changes across the various neighborhood factors.

Results:
The sample (N=127) was 91% female, 80% White, mean age 51 years, and mean BMI 34. The mean percentage weight loss was 8.8% ±6%. Participants tended to live in neighborhoods that were predominately White, middle to high education, and low poverty. The proportion of Black residents in the neighborhood was the only neighborhood factor significantly associated with weight change. Neighborhoods with the lowest proportion of Black residents had the highest density of grocery stores and restaurants, were the highest income and had the lowest socioeconomic disadvantage score (see table below).

Conclusion:
Our findings are preliminary; however, they suggest future interventions need to address neighborhood factors to better understand how to improve weight loss for all population groups. This study should be replicated in a larger cohort with representation of individuals from various neighborhood types.
Abstract P285: Frequency of Sexual Activity the Year before Myocardial Infarction and Risk for Subsequent Cardiovascular Adverse Events: Results of a Long-Term Follow-Up Study
Authors: Rothenbacher Dietrich , Dallmeier Dhayana , Mons Ute , Rosamond Wayne D , Koenig Wolfgang , Brenner Hermann
Published: July 2021

Introduction:
Sexual activity (SA) is an important component of quality of life and of concern for many patients with myocardial infarction (MI). Available data showed that the frequency of SA decreased one year after an MI, however, the general patterns were relatively stable overall. Although SA may be a trigger of an MI in very few cases, the association between SA before MI and the onset of a subsequent adverse cardiovascular disease event (CVD-event) has not been evaluated so far.

Hypothesis:
Frequency of SA during the 12-months prior to an MI is not associated with risk of subsequent adverse CVD-event.

Methods:
Prospective cohort study in CHD patients aged 30-70 years undergoing an in-patient rehabilitation program after an incident MI due to CHD. SA frequency (including masturbation) during the 12-months prior to the MI was evaluated by means of a standardized questionnaire. A Cox-proportional hazards model was used to determine the association of frequency of SA on subsequent adverse CVD-events (nonfatal and fatal MI, stroke, cardiovascular death) during ten-year follow-up after adjustment for age, gender, school education, rehabilitation clinic, smoking status, history of diabetes mellitus, left-ventricular function HDL-cholesterol.

Results and Conclusions:
The mean age of the included 536 patients with an incident MI was 57.1 years (SD 8.6) at baseline, 85.8% were men. Self-reported SA in the 12-months before the MI was none for n=80, less than 1 time per month for n=25 (both grouped in one category), less than 1 time per week for n=136, and one or more times per week for n=295. Sexual more active patients were on average younger, more often men, had less often diabetes and a less severe coronary vessel disease. They were also more often physical active in leisure time compared to others. During ten-year follow up (median 9.97 years) n=100 adverse CVD-events occurred (overall 23.9 events per 1000 patient years). When compared to patients with less than one time SA per week (reference group) patients with at least one SA per week had a Hazard ratio (HR) of 0.49 (95% confidence interval (CI) 0.31-0.77) in the multivariable analysis; adding leisure time physical activity practiced 12-months prior to the MI into this final model did not change the results. Additional adjustment for Nt-proBNP level at baseline did not alter the result. In conclusion, a weekly SA activity pattern in the year prior to an acute MI is not associated with a higher risk for subsequent adverse cardiovascular events.
Abstract P291: Similar Over-Reporting of Physical Activity among African Immigrant Men and Women: The Africans in America Study
Authors: Aldana Paola , Thoreson Caroline , Duong Michelle , Ricks Madia , Courville Amber , Mabundo Lilian , Sumner Anne , Chung Stephanie
Published: July 2021

Levels of physical activity (PA), an important risk factor for cardiometabolic disease, may decline in Africans after immigration and it is unknown whether PA type differs by sex. To determine PA profile and perceived activity in African immigrants, we examined PA type and intensity using the self-report Multi-Ethnic Study of Atherosclerosis (MESA) Typical Week Physical Activity Survey (TWPAS). Physical activity levels were defined as time spent in total and moderate-vigorous PA in 80 African immigrants living in the DC metro area, who self-identified as healthy (66% male; age 39.1±9.4y (mean±SD), range 22-58y; BMI 28.2±4.4 kg/m
2
, range 19.7-41.2). Total and moderate-vigorous PA were 1952.1±1759.6 and 717.6±840.3 min•wk
-1
, respectively and did not vary by sex, P=0.9 (Fig 1). Men and women reported spending equal amounts of time in each moderate-vigorous PA category (household, occupational, childcare, intentional and volunteer, P=0.7). Ninety-five percent of Africans reported meeting moderate-vigorous PA guidelines > 150 min•wk
-1
(Fig 1A). However, 10% of Africans reported more total PA than there are minutes in a week (Fig 1B) and 1/3 reported excessive weekly moderate-vigorous PA (total >5hr•dy
-1
and intentional > 2 hr•dy
-1
). In the 26 Africans with >5 hr•dy
-1
of total moderate-vigorous PA, those with an annual income of ≥$30,000 reported greater levels of moderate-vigorous PA than those with an income <$30,000, 4866.8±1646.3 vs. 3558.7±769.9, respectively (P=0.01). Moderate-vigorous PA levels did not vary in this group by African birth region, education, years in the US or percent weight gain since immigration (P>0.3). Self-reported PA profiles were similar among African immigrant men and women, but were over-reported by at least 10% of respondents. Over-reporting may be more common in Africans of higher socioeconomic status. The MESA TWPAS questionnaire provides insight into PA profiles in African immigrants, but is suboptimal for quantitative examination of PA levels.
Abstract P296: Racial Differences in Hyperglycemia: Comparative Prognostic Value of Traditional and Nontraditional Glycemic Markers
Authors: Parrinello Christina M , Maruthur Nisa M , Sharrett A. R , Klein Ronald , Bergenstal Richard , Grams Morgan E , Coresh Josef , Selvin Elizabeth
Published: July 2021

Background:
Associations of nontraditional measures of hyperglycemia with clinical outcomes in blacks and whites are unknown and could help address the debate over race-specific cut-points for hemoglobin A1c (HbA1c).

Methods:
We included 9,434 white and 2,898 black participants from the ARIC Study with measures of HbA1c, fructosamine, glycated albumin and 1,5-anhydroglucitol (1,5-AG) at visit 2 (1990-92). Diagnosed diabetes was defined by self-reported physician diagnosis of diabetes or glucose-lowering medication use. We created cut-points for the nontraditional markers corresponding to accepted HbA1c clinical cut-points. For each glycemic marker, we used Cox models to assess adjusted associations with incident coronary heart disease (CHD), ischemic stroke, heart failure and end-stage renal disease (ESRD) through 2011; and logistic regression for concurrent retinopathy. We included an interaction term for category of glycemia and race.

Results:
Median levels in blacks versus whites without diagnosed diabetes were 5.7 and 5.4% for HbA1c; 234 and 225 μmol/L for fructosamine; 13.3 and 12.5% for glycated albumin; and 17.3 and 19.0 μg/mL for 1,5-AG, respectively. Median levels in blacks versus whites with diagnosed diabetes were 8.8 and 7.4% for HbA1c; 344 and 292 μmol/L for fructosamine; 22.5 and 17.7% for glycated albumin; and 3.5 and 6.6 μg/mL for 1,5-AG, respectively. Associations of hyperglycemia, as assessed by different glycemic markers, with CHD and ESRD were similar by race (p-values for interaction >0.20,
Figure
). Results were similar for stroke, heart failure and retinopathy (p-values for interaction >0.10).

Conclusions:
Blacks had consistently higher levels of glycemia than whites as assessed by higher HbA1c, fructosamine, and glycated albumin, and lower 1,5-AG. However, associations of all glycemic markers with outcomes were similar by race. Our results support the use of similar clinical cut-points for diagnosis and management of diabetes using HbA1c in blacks and whites.
Abstract P302: Association of High-Sensitive Troponin I With Coronary Heart Disease Incidence Among Asymptomatic Older Adults: The ADVANCE Study
Authors: Iribarren Carlos , Chandra Malini , Rana Jamal S , Hlatky Mark A , Fortmann Stephen P , Quertermous Thomas , Go Alan S
Published: July 2021

Background:
The third generation of cardiac troponin-I assays (high-sensitive troponin-I, hs-TI) has a lower limit of detection one order of magnitude lower than current commercial assays. Elevated hs-TI has been associated with structural and coronary heart disease (CHD), but data remains sparse, particularly in asymptomatic subjects free of clinical cardiovascular disease (CVD).

Methods:
Among asymptomatic subjects with no known CVD in The Atherosclerotic Disease, VAscular FunctioN and GenetiC Epidemiology (ADVANCE) Study recruited in 2002-04 (mean ± SD age=62 ± 8 years, 49% women; 52% non-white), we identified the correlates of hs-TI and the independent predictive value of hs-TI for incident CHD (hospitalization or death with
ICD9
codes 410-414 or coronary revascularization procedures) over a median of 8 years of follow-up. Hs-TI was measured using stored serum with the Abbott ARCHITECT
STAT
assay, a chemiluminescent microparticle immunoassay (CMIA).

Results:
There were 153 CHD events among 1,157 subjects. The median (interquartile range, in ng/L) of hs-TI was 4.1 (3.1-5.5) in men and 3.3 (2.5-4.2) in women. The independent (positive) correlates of hs-TI were black race, body mass index, diabetes and hypertension. Age-adjusted CHD rates showed a threshold effect at the 4
th
quartile. In proportional hazards regression, there was a 2.4-fold increased risk of CHD associated with the sex-specific quartile IV (relative to quartiles I-III combined) in Model 1 adjusting for age, gender and race/ethnicity. The increased risk was only partially explained by adjustment for Framingham risk score (FRS), C-reactive protein and estimated glomerular filtration rate (Model 2). The area under the curve (AUC) improved from 0.66 to 0.69 (p=0.05) after adding hs-TI to a model with Model 2 covariates, and the net reclassification improvement (NRI) was 0.13 (p=0.01).

Conclusion:
Among asymptomatic adults without known CVD, hs-TI may be useful for helping identify patients at increased CHD risk beyond traditional risk factors.
Abstract P339: Glycemic Excursions and Cognitive Function in Older Adults With Diabetes
Authors: Rawlings Andreea , Sharrett A. Richey , Maruthur Nisa , Parrinello Christina , Rebholz Casey , Steffes Michael , Selvin Elizabeth
Published: July 2021

Introduction:
The association between glucose excursions and cognitive function in older adults with diabetes is not well described. 1,5-anhydroglucitol (1,5-AG) is a novel biomarker of hyperglycemic excursions. Low 1,5-AG levels reflect blood glucose concentrations exceeding the renal filtration threshold (~180 mg/dl) over the prior 1-2 weeks. Our aim was to test the hypothesis that glucose excursions, as measured by 1,5-AG, were associated with lower cognitive function in older adults with diabetes.

Methods:
We conducted a cross-sectional analysis of 2000 participants with diabetes from ARIC visit 5 (2011-2013). Diabetes was defined based on self-reported physician diagnosis, diabetes medication use, or HbA1c ≥6.5%. Eleven neuropsychological tests were summarized using Z scores and were grouped into three cognitive domains representing memory, executive function, and language; a global measure of cognitive function was also calculated by averaging and standardizing scores from all tests. 1,5-AG was dichotomized at 10 μg/mL, with values <10 μg/mL reflecting glycemic excursions. Participants were categorized into one of four groups based on 1,5-AG categories and glycemic control (HbA1c <7% vs ≥7%). We used linear regression and adjusted for demographic and clinical characteristics.

Results:
The mean age of participants was 75 years, 57% were female, and 78% were white. For persons with HbA1c ≥7%, the adjusted differences in cognitive scores comparing 1,5-AG <10 to 1,5-AG ≥10 ug/mL were significantly lower in all domains except memory (Figure). For persons with HbA1c <7%, there were no significant differences in cognitive scores between 1,5-AG categories.

Conclusions:
Short-term glucose excursions are independently associated with lower cognitive scores in older adults with diabetes and with poor glycemic control (HbA1c ≥7%). Prospective studies are needed to determine if targeting hyperglycemic excursions can improve cognitive function in older adults with diabetes.
Abstract P387: Length of Stay Among Medicare Beneficiaries Hospitalized with Heart Failure
Authors: Levitan Emily B , Van Dyke Melissa K , Chen Ligong , Kilgore Meredith L , Brown Todd M , Durant Raegan W , Safford Monika M
Published: July 2021

Background:
Heart failure (HF) is among the most common reasons for hospitalization in the United States. Hospital length of stay (LOS) is a driver of cost and disease burden.
Objectives:
To examine factors associated with LOS of HF hospitalizations.
Methods:
Medicare beneficiaries with fee-for-service and pharmacy coverage who had HF hospitalizations (inpatient claims with ≥1 overnight stay/2 hospital days with HF as the primary discharge diagnosis, discharged alive) between 2007 and 2011 were identified in the Medicare national 5% sample. The median and interquartile range (IQR) LOS was calculated by demographic characteristics, comorbidities, and discharge status based on Medicare claims data with the Kruskal-Wallis test to compare distributions in the overall population with HF (n = 45,584) and in the subpopulation with documented systolic dysfunction (n = 10,256).
Results:
The median LOS was 5 days (range 2-255, IQR 4-8 days) in the overall HF population and 5 days (range 2-204, IQR 4-8 days) in those with systolic dysfunction. Across most demographic characteristics and comorbidities, the median LOS was 5 days but was higher among nursing home residents and individuals with malnutrition in both groups and with chronic kidney disease in those with systolic dysfunction (
Figure
). All comorbidities were associated with a shift in the distribution toward longer LOS in the population with systolic dysfunction and all but coronary heart disease in the overall population (p < 0.001). HF patients discharged to a skilled nursing facility had longer LOS (median 7 days, IQR 5-10 days) versus other discharge statuses (median 5 days, IQR 3-7 days, p < 0.001) in both populations.
Conclusions:
In patients hospitalized for HF, the median LOS was 5 days across most comorbidities and other characteristics, but comorbidities were associated with a shift in the upper tail of the distribution toward longer LOS. Worse functional status (nursing residence or discharge to a skilled nursing facility) was associated with a higher median LOS.
Abstract 10: Effect of coincident infections in acute Kawasaki disease
Authors: Jibiki Toshiaki , Hashimoto Yuji , Kanazawa Masaki , Kato Izumi , Morita Yoshinori , Abe Katsuaki , Shikino Ayumi , Fukushima Hideaki , Koudaira Manao , Yoshida Misato , Sugita Emi , Ishiwada Fumie
Published: July 2021

We investigated prevalence of coincident infections in acute Kawasaki disease (KD) to know the possible effects of infections on diagnosis of KD, clinical course, therapy decision and coronary outcomes. Single center consecutive 344 KD patients hospitalized in our institution, between January 2009 and December 2013 were retrospectively analyzed. Patients those were positive for bacterial culture, rapid antigen tests or elevated levels of pathogen specific antibodies were counted as KD patients with infection. Pathogen unproven patients those presented with apparent respiratory or gastrointestinal symptoms regarding infections were also counted as KD patients not to underestimate number of patients with suspected infections. Overall, 125 KD patients were grouped as KD patients with infection (Group1). Group1 included 125 patients with 73 upper respiratory tract infection, 21 bronchitis, 7 pneumonia, 3 acute otitis media and 21 gastroenterocolitis, respectively. Remaining 219 KD patients were grouped as KD without infection (Group2). Appropriate antibiotic or antiviral treatments were done for each pathogen proven infection. Distribution of age and sex, day of admission, diagnosis and treatment, prevalence of initial treatment regimen and rate of additional therapy, duration of fever, laboratory findings except serum albumin value, and coronary outcomes were similar between the groups. We showed that presence of coincident infections have no effects on clinical course, treatment decision and coronary outcomes on KD.
Abstract 123: Long term Prognosis After Methylprednisolon pulse Combination Therapy For Refractory Kawasaki Disease
Authors: Ebato Takasuke , Ogihara Yoshihito , Takanashi Manabu , Honda Takashi , Kimura Sumito , Ogata Shohei , Ishii Masahiro
Published: July 2021

Background:
We previously investigated the molecular mechanism and the clinical utility of intravenous methylprednisolone-pulse(IVMP) plus intravenous immunoglobulin (IVIG) combination therapy (IVMP+IVIG) for patients with Kawasaki disease (KD) in the acute phase (Pediatr Res 2009, Pediatrics 2012). However, the long-term prognosis after IVMP+IVIG still remains unclear.

Objective:
To examine the long-term prognosis after IVIG+IVMP.

Methods:
Forty-six patients (Age: 5-70 months, male: 27) who were enrolled in this study were treated with IVMP+IVIG during the period from 2007 to 2014 at Kitasato University Hospital who were all predicted to show resistance to initial IVIG according to their Egami score (J Pediatr 2006). The IVMP therapy (30mg/kg, 1dose) was administered for 2 hours before starting the IVIG therapy. Heparin (10U/kg/h, continuous infusion) was used concomitantly from 2 hours before the start of IVMP therapy and it was thereafter continued for 24 hours. The long-term prognosis of coronary artery lesions (CALs) and adverse events between the time of diagnosis and 5 years after IVMP +IVIG were determined. The “Z-score2.5-5” and “Z–score>5” were defined as dilatation and an aneurysm, respectively, according to the AHA guidelines.

Results:
Dilatation cases based on the Z-score2.5-5, were identified in 15 of 46 patients (32.6%) at diagnosis, in 15 of 46 patients (32.6%) after 1 month, and in 3 of 36 patients (8.3%) after 1 year. All patients in whom coronary artery abnormalities were observed at 1 year later demonstrated regression.No patients showed a Z-score≧5 in all phases. Thirty-six patients (78.2%) showed prompt defervescence owing to the combination therapy. The patients had adverse event at acute phase, 16 of 46 patients (34.7%) for hypothermia, 5 patients (10.8%) for hypertension, 2 patients (4.3%) for bradycardia, and 4 patients (8.6%) for recurrent fever. No patients experienced any serious adverse events (short stature, hyperlipidemia, abnormal glucose tolerance) after IVMP +IVIG during the long-term follow-up.

Conclusions:
This study showed IVMP+IVIG combination therapy to therefore effectively prevent CALs in KD patients that are predicted to be resistant to intial IVIG according to their Egami score.
Abstract 124: Patient Condition Adaptive Path System of Kawasaki Disease
Authors: Fujiwara Masako , Kobayashi Tohru , Tsuru Satoko , Ida Hiroyuki
Published: July 2021

Background:
In Japan, 2 guidelines are published, the clinical guidelines for medical treatment of acute stage Kawasaki disease(KD)(2012) and guidelines for diagnosis and management of cardiovascular sequelae in KD(2013). Patient Condition Adaptive Path System (PCAPS) is a technique to structure clinical knowledge. It places “patient condition” as a core, to which multiple “target conditions” are linked. On the other hand, patients of KD ware focused the severity of the disease and therapeutic strategy influences the improvement.

Purpose:
The purpose is confirming the PCAPS KD contents, which complied two Japanese Guidelines and to evaluate adaption of the contents.

Methods:
PCAPS content is composed of Clinical Process Chart (CPC) and Unit Sheet (US).CPC is an overhead view of clinical path consisting of a chain of units. CPC was made according the guidelines, and coronary evaluation, CHF, cardiac catheterization and ACS unit can activate on time. CPC stratify the patient’s severity. US are composed of specific healthcare tasks in a unit.

Results:
We confirm PCAPS KD contents on the base of 2 guidelines. We can evaluate diagnostic process and severity of KD by route analysis using CPC (figure). We can visualize relationship between treatments and severity by US. US are effective to support the decision on treatment and examinations. From the analysis, there are no lack of the unit and route, and confirm the advice to decision making.

Conclusions:
PCAPS can easily analyze the severity and clinical process from CPC route analysis because PCAPS is electrical path which can automatically store the data of each hospital. From US data, there are possibilities to find new severity score.
Abstract 132: Methylprednisolone Pulse Therapy for Kawasaki Disease with Symptomatic Myocarditis
Authors: kim yeo hyang , Shin Chae Ok , Hyun Myung Chul , Lee Dong Seok
Published: July 2021

Purpose:
Kawasaki disease (KD) is an acute febrile illness of infants and young children that is characterized by a systemic vasculitis, especially involving the coronary arteries. Although, sometimes, subclinical myocarditis is combined in KD, symptomatic myocarditis is extremely uncommon. We report a 7 year old boy who developed hypotension and decreased left ventricular systolic function (EF 40%) in the acute phase of KD.

Case:
A 7 year old boy (height 115 cm, body weight 20 kg) was admitted because of 2 days of persistent fever and left cervical lymphadenopathy (white blood cell count 17,870 /mm
3
, C reactive protein 23.6 mg/dL). Conjunctiva injection and lip redness developed on the 4th day of illness, and hypotension and tachycardia (SBP 59/DBP 29 mmHg, HR 153/bpm) were combined. The echocardiography revealed a decreased ejection fraction (EF) (40%) without chamber dilatation and normal coronary artery size (LM 1.9mm, z score=-1.3, RCA 2.3mm, z score=0.4). The level of N terminal pro BNP was 28,000 pg/mL. With a diagnosis of KD with myocarditis, he was initially treated with inotropics and intravenous immunoglobulin (2 g/kg). Without clinical improvement in spite of initial treatment, A change of coronary arterial size (LM 2.9mm, z score=1.2, RCA 3.1mm, z score=2.3) was developed and decreased LV systolic function (EF 45%) and fever were persisted. Then, he was given 3 daily pulses of intravenous methylprednisolone followed by tapering doses of oral prednisolone. He showed prompt clinical recovery after pulse therapy of intravenous methylprednisolone (SBP 95/DBP 49 mmHg, HR 98/bpm). Although EF was improved (59%), coronary arterial dilatation was progressed (LM 3.4mm, z score=2.4 RCA 5.5mm, z score=7.9).

Conclusions:
The present case serves to highlight the fact that methylprednisolone should be considered as the priority in children with KD who have symptomatic myocarditis during the acute stage.
Abstract 138: Early Therapeutic Intervention With IVIG Is Effective In Infants Less Than 3months With Kawasaki Disease
Authors: Nitta Megumi , Murata Yuji , Suzuki Rikio , Kitamura Taro , Chiba Hiroo , Nishio Toshiyuki , Takayanagi Masaru , Ohura Toshihiro
Published: July 2021

Background:
Kawasaki disease (KD) in infants less than 3 months (<3M) is reported rare, but incomplete type or coronary artery lesion are more frequent than in older ages.

Purpose:
To elucidate the correlation between treatment effect and age in KD.

Methods:
A total of 367 children with KD were admitted in our hospital from 2007 to 2014. A Comparison was made among 3 age groups (<3M, 3 months to less than5 years {3M-5Y} and 5years or older {≧5Y}) from the view points of disease type (complete or incomplete depend on major symptoms are 5 or less out of 6), effect of initial intravenous immunoglobulin (IVIG) and coronary artery lesion (dilation or aneurysm formation).

Results:
Incomplete type of KD was seen in 82% of <3M (14/17), whereas 6.6% (20/300) in 3M-5Y and 4.0% (2/50) in ≧5Y. Initial IVIG was unsuccessful in 24% (4 cases) in <3M, 22% (66 cases) in 3M-5Y and 38% (19 cases) in≧5Y. Coronary artery lesion was observed in 5.8% (1 case) in <3M, 0.6% (2 cases) in 3M-5Y and 2% (1cases) in ≧5Y.

Discussion:
Since the time from the initial symptom of KD to the first visit to our department was shorter in <3m infants (1.53 days) than the older age groups (4.18 days in 3M-5Y and 4.44 days in ≧5Y), majority of <3M infants with KD showed less than 5 major symptoms; polymorphous exanthema in 88%, lip and oral cavity findins in 76%, bilateral bulbar conjunctival congestion in 59%, extremities changes in 23%, cervical lymphoadenopathy in 18%. We make a diagnosis of KD in <3M infants when labolatory data suggests vasculitis and/or echocardiography reveals abnomal findings, together with major clinical symptoms even less than 5. Based on these diagnosistic process , we started initial IVIG by 4 days and achieved satisfactory results.
Abstract 149: How Effective Is Steroid Combination Therapy For High-risk Cases Of Kawasaki Disease?
Authors: Yoshikane Yukako , Hashimoto Junichi , Hirose Shinichi
Published: July 2021

Background:
There are three scoring systems for the prediction of non-response to IVIG in Japan. Steroid combination therapy for initial treatment is recommended for high risk cases in the new guideline from the scientific committee the Japanese society of pediatric cardiology and cardiac surgery in 2012. Objective: to evaluate efficacy of steroid combination therapy for high risk cases which have high scores in more than two prediction scoring systems. Subjects and Methods: From January 2009 to 2014, a total of 54 hospitalized patients with high scores in more than two prediction scoring systems were enrolled. The patients were separated into two groups. Group S (n=21): who were administered steroid+IVIG, Group N (n=33): who were administered only IVIG. Clinical data, clinical course, and circumstances of additional therapies were compared. Results: In the patients who had high scores in two prediction scoring systems, there were fewer patients who received additional therapies in group S compared to that in group N (13% 1/8 vs. 38% 8/21). However, for patients who had high scores in all prediction scoring systems, those who received additional therapies had not decreased in group S compared to that in group N (50% 6/12 vs. 46% 6/13). Conclusions: Steroid combination therapy is beneficial for the patient who has high scores in two or less prediction scoring systems. On the other hand, in the most severe cases those who have high scores in all prediction scoring systems, Steroid combination therapy is less efficacious and other additional therapy should be considered in the early stage to improve prognosis.