bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9869: Validation of a Claims-Based Prediction Rule for In-Hospital Pulmonary Embolism Mortality
Authors: Kohn Christine G , Peacock W F , Fermann Gregory J , Bunz Thomas J , Crivera Concetta , Schein Jeffrey R , Coleman Craig I
Published: March 2022

Background:
Guidelines suggest that a low risk cohort of patients with pulmonary embolism (PE) may be managed as outpatients or with an abbreviated hospital stay. There is need for a claims-based prediction rule that payers and hospitals can use to efficiently risk stratify PE patients. The authors recently derived a rule found to have high sensitivity and moderate specificity for predicting in-hospital mortality.

Objective:
To validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule using admission claims data.

Methods:
This analysis was performed using Humana admission claims data from January 2007-March 2014, and included adult patients admitted for their first PE (International Classification of Diseases, ninth edition, Clinical Modification code of 415.1x in in the primary position or secondary position when accompanied by a primary code for a PE complication). The IMPACT rule, consists of age + 11 weighted comorbidities (myocardial infarction, chronic lung disease, stroke, prior major bleeding, atrial fibrillation, cognitive impairment, heart failure, renal failure, liver disease, coagulopathy, cancer), and was used to estimate patients’ risk of in-hospital mortality. Low risk was defined as in-hospital mortality ≤1.5%. IMPACT results are presented as prognostic test characteristic values and 95% confidence intervals (CIs).

Results:
A total of 23,858 patients (47% male, 77% ≥65 years of age) hospitalized for PE were included and 3.3% died in-hospital. The IMPACT prediction rule classified 2,371 (9.9%) as low-risk (0.8% died); with a sensitivity of 97.6% (95%CI=96.1-98.5), specificity of 10.2% (95%CI=9.8-10.6), and C-statistic of 0.70 (95%CI=0.0.68-0.72), for in-hospital mortality. IMPACT classified 42.7% of patients <65 years old as low-risk; with a sensitivity, specificity and C-statistic of 85.0% (95%CI=77.4-90.5), 43.3% (95%CI=42.0-44.7) and 0.74 (95%CI=0.0.69-0.78), respectively.

Conclusion:
The IMPACT prediction rule was valid when implemented in a database consisting largely of Medicare claims. The rule has high sensitivity for predicting in-hospital mortality, and may be valuable for identifying PE patients that are candidates for an abbreviated hospital admission.
Abstract 9899: Understanding the Venus and Mars Effect: Sex-Based Differences Across a Spectrum of Cardiovascular Biomarkers
Authors: Lew Jeanney , Rohatgi Anand , McGuire Darren K , Sanghavi Monika , Ayers Colby R , Gore Maria O , Berry Jarrett D , Khera Amit , de Lemos James A
Published: March 2022

It is unknown whether sex-based differences in the prevalence and pathobiology of cardiovascular disease (CVD) can be informed by cardiovascular biomarker profiles. We analyzed sex-based differences in multiple biomarkers associated with CVD that reflect unique biological pathways, adjusting for differences in CVD risk factors and body composition.

Methods:
A cross-sectional analysis was performed using data from the Dallas Heart Study, a multi-ethnic probability based cohort study. Participants with existing CVD were excluded. Associations between sex and 26 distinct biomarkers were evaluated using multivariable linear regression adjusting for age, race, traditional CVD risk factors, MRI and DEXA measures of body composition and fat distribution, renal function, insulin resistance, LV mass by MRI, and menopausal status.

Results:
The study population included 3557 individuals, mean age 43, 56% women and 52% African American. Significant sex-based differences were seen in multiple categories of biomarkers, including lipids, adipokines, and biomarkers of inflammation, endothelial dysfunction, myocyte injury and stress, and renal dysfunction. In fully adjusted models, women had higher levels of HDL-C and HDL-p, leptin, d-dimer, osteoprotegerin (OPG), and NT-proBNP, and men had higher levels of lipoprotein-associated phospholipase A2 (LP-PLA2), monocyte chemoattractant protein-1 (MCP-1), soluble endothelial cell adhesion molecule (sESAM), symmetric dimethylarginine (SDMA), hs-cTnT, and cystatin C (Table).

Conclusion:
Even after accounting for sex-based differences in traditional CVD risk factors, body composition and insulin resistance, important differences in biomarker profiles exist between women and men without CVD in the population. Future studies are needed to characterize whether pathophysiological processes delineated by these biomarkers contribute to sex-based differences in the development and complications of CVD.
Abstract 9909: Selenium Supplementation Rescues Cardiac Function in Patients With Severe Heart Failure Who are Intractable to Renin-Angiotensin System Inhibitors and β-blockers
Authors: Hiraoka Yuji , Tanabe Masato , Yamazaki Taketoshi , Kihara Yasuki
Published: March 2022

Introduction:
Increases in oxidative stress may be involved in the progression of heart diseases. Selenium (Se) is an integral part of the enzyme glutathione peroxidase (GSHPx), one of the central players of the heart’s antioxidant system. This study evaluated Se supplementation in patients with severe heart failure who were intractable to renin-angiotensin system (RAS) inhibitors and β-blockers.

Methods:
In order to confirm the activation of myocardial oxidative stress and the local deficiency of GSHPx, we examined immunohistochemical staining of endomyocardial biopsy specimens obtained from 24 dilated cardiomyopathy (DCM) patients and analyzed serum Se concentrations and GSHPx activities. We enrolled patients who had shown no functional improvements after RAS inhibitors and β -blockers (n = 11). The patients were supplied with 25 μg of Se chloride twice per day while their other medications remained unchanged.

Results:
Compared with patients with normal ventricular function (n = 30), the serum Se concentrations and GSHPx activities from the patients with DCM (n = 24) were decreased by 55% (0.167 μg/ml vs 0.076 μg/ml, p < 0.01), and by 33% (328 μmol/min/L vs 221 μmol/min/L, p < 0.01), respectively.

Myocardial biopsy from DCM patients, but not control patients, uniformly showed marked reduction of GSHPx stains (24/24 vs 0/3, respectively) that was accompanied by positive staining for both 4-hydroxy-2nonenal (20/24 vs 1/3) and 8-hydroxy-2`-deoxyguanosine (16/24 vs 0/3).

Left ventricular (LV) ejection fraction increased from 26% ± 8% to 34% ± 8%, 37% ± 12%, and 38% ± 11% at the 3-month follow-up, 6-month follow-up, and 12-month follow-up, respectively, and then maintained thereafter.

Conclusions:
Our study suggests that myocardial oxidative stress in chronic heart failure may be augmented at least in part by concomitant GSHPx deficiency, and that the administration of Se could rescue the exhaustion of this selenoprotein, resulting in improved LV function.
Abstract 9919: ST-Segment Elevation in Lead aVR is the Strongest Predictor of 30-Day Mortality in Patients With Type A Acute Aortic Dissection
Authors: Kosuge Masami , Uchida Keiji , Isoda Susumu , Ebina Toshiaki , Hibi Kiyoshi , Masuda Munetaka , Umemura Satoshi , Kimura Kazuo
Published: March 2022

Introduction:
We investigated the prognostic value of ST-segment elevation in lead aVR (ST↑aVR) at presentation ECG in type A acute aortic dissection (AAD).

Hypothesis:
In type A AAD, ischemic ST-T changes at presentation have been shown to be associated with poor outcomes. ST↑aVR, an ECG marker of severe acute myocardial ischemia, may provide important prognostic information.

Methods:
We studied the relation of ECG findings to clinical features on admission and 30-day mortality in 280 patients who were admitted within 6 h from symptom onset and underwent emergency surgery for type A AAD. Patients with bundle branch block or left ventricular hypertrophy were excluded. Patients were divided into the 3 groups according to admission ECG findings: no significant ST-T changes (n=96, G-A); the absence (n=142, G-B) or the presence (n=42, G-C) of ST↑aVR ≥0.5 mm with ST-T changes in other leads. Estimated glomerular filtration rate (eGFR) was measured on admission, and renal dysfunction was defined as an eGFR <60 ml/min per 1.73 m2.

Results:
There were no differences in age, sex or time from symptom onset to admission in the 3 groups. In G-A, G-B, and G-C, the rates of renal dysfunction were 41%, 56%, and 67% (p<0.01); shock were 2%, 22%, and 71% (p<0.01); cardiac tamponade was 3%, 18%, and 67% (p<0.01); moderate/severe aortic regurgitation was 4%, 28%, and 43% (p<0.01); coronary ostial involvement was 3%, 11%, and 32% (p<0.01); left coronary artery involvement was 2%, 1%, and 17% (p<0.01); right coronary artery involvement was 1%, 9%, and 10% (p<0.05); and both left and right coronary artery involvement was 0%, 1%, and 5% (p=0.10); coronary artery bypass surgery was 2%, 7%, and 12% (p=0.07); aortic valve repair/replacement was 1%, 6%, and 10% (p=0.06); 30-day mortality was 1%, 6%, and 33% (p<0.01), respectively. After adjusting baseline characteristics, multivariate analysis showed that ST↑aVR (OR 38.4, 95%CI 8.10-82.0, p<0.01) was the strongest predictor of 30-day death, followed by renal dysfunction (OR 5.85, 95%CI 1.70-20.1, p<0.01).

Conclusions:
In patients with type A AAD who underwent emergency surgery, ST↑aVR on admission ECG was the strongest predictor of 30-day mortality. Our findings suggest the importance of ST↑aVR in early risk stratification for type A AAD.
Abstract 9925: Mixed Aortic Valve Disease: Natural History and Predictors of Adverse Events
Authors: Egbe Alexander , Poterucha Joeseph , Warnes Carole
Published: March 2022

Objectives:
To determine freedom from symptoms and adverse events (AE) defined as aortic valve replacement (AVR) or death in patients (pt) with mixed aortic valve disease (MAVD).

Methods:
Reviewed pt with moderate/severe MAVD (moderate/severe aortic stenosis and regurgitation) at the Mayo Clinic from 1994-2013. Only asymptomatic pt with normal ejection fraction (>50%) and trileaflet aortic valves were included. Cox proportional-hazard models were used to determine predictors of AE. Event-free survival curves were generated with the Kaplan-Meier method.

Results:
We identified 213 pt (age=69±11 years, male=67%). AE occurred in 155 pt, and 71% of these AE occurred in moderate MAVD (peak velocity of 3 to 3.9 m/s). Mean follow-up was 10.1±3 years and time to AE was 2.9±2.1 years. Concomitant coronary artery bypass grafting (CABG) and/or aortic replacement during AVR was performed in 54/151 (36%). Early mortality was 0.7%. Freedom from AE was 30% and 15% at 5 and 10 years. Freedom from symptoms was 34% and 16% at 5 and 10 years. Predictors of AE were peak aortic velocity (hazard ratio [HR] 2.56 Confidence interval [CI] 2.24-2.93, p<0.0001) for every 1m/s increase in peak velocity, and having severe stenosis or regurgitation at presentation (HR 2.92; CI 2.73-3.14, p=0.001).

Conclusion:
MAVD had high rate of AE and development of symptoms, even in a subset of pt with only moderate MAVD. Peak aortic velocity and severe MAVD at presentation predict AE.

Figure Legend:
pVel: peak velocity group 1: moderate aortic stenosis and regurgitation Group ≥2: severe aortic stenosis or regurgitation
Abstract 9965: Echocardiography in Cardiac Arrest Prognosis in the Intensive Care Unit for Non-shockable Rhythms 1 Year of Follow-up
Authors: Flato Uri P , Timerman Ari , Paiva Edison
Published: March 2022

Introduction:
In-hospital cardiopulmonary arrest (CPA-IH) is a public health problem with high worldwide morbidity and mortality. Cases of non-shockable CPA rhythms, such as asystole and pulseless electrical activity (PEA), have remained unchanged over the last 30 years. Despite updates to resuscitation guidelines every five years, we have not been successful in increasing patient survival. Prognostic and diagnostic factors during CPA are necessary to increase survival among these patients and optimise available resources. Transthoracic echocardiography (TTE) provides valuable information about diagnosis and perhaps prognosis, through real-time images.

Hypothesis:
This study describes the use of TTE in patients with CPA with non-shockable rhythms in an intensive care unit (ICU), evaluating the prognostic factor of myocardial contractility in the return of spontaneous circulation (ROSC) and differential diagnoses

Methods:
This was a prospective cohort study conducted in an ICU of a university hospital with patients in CPA with asystole or PEA as their initial rhythm.

Results:
TTE performed by doctors highly trained in the method was included in the treatment protocol. In total, 49 patients were included in the study, 32 in PEA and 17 in asystole, of whom 27 patients in PEA had myocardial contractility. During the examination, the patients in PEA were subclassified into pseudo electromechanical dissociation (EMD) and true EMD. Of the 49 patients, 24 had ROSC, and two had survival > 360 days. The pseudo-EMD patients (contractility present and without central pulse) had a survival rate odds ratio of 2.99 (1.22 to 7.29; p = 0.016) compared with the other groups.

Conclusions:
Therefore, the presence of myocardial contractility may be a short- and long-term prognostic factor during CPA.
Abstract 9970: Androgen Deprivation Therapy by Surgical Castration, Gonadotropin Releasing Hormone Receptor Agonists or Antagonists and the Development of Atherosclerosis in Apoe-deficient Mice
Authors: Poulsen Christian Bo , Bødtker Mortensen Martin , Koechling Wolfgang , Brandt Sørensen Charlotte , Fog Bentzon Jacob
Published: March 2022

Introduction:
Adjuvant treatment of prostate cancer often involves androgen deprivation therapy (ADT) by orchiectomy (Orx), gonadotropin releasing hormone (GnRH) receptor agonists or GnRH receptor antagonists. Clinical studies of men with preexisting atherosclerotic disease, have indicated that cardiovascular event rates differs between different types of ADT, suggesting that not only testosterone deficiency, but also direct effects of ADT on processes in the atherosclerotic plaque may be involved. Immune cell GnRH receptors have been implicated as potential mediators. In the present study, we compared the effects of common types of ADT on de-novo atherosclerosis in mice.

Methods:
Chow-fed Apoe-deficient mice (n=121) were allocated to Orx and/or monthly injections with the GnRH receptor agonist leuprolide (0.5 mg s.c.), the GnRH receptor antagonist degarelix (0.5 mg s.c.) or saline starting from 8 weeks of age (n=19-21 in each group). At 26 weeks of age, the burden of atherosclerosis was quantified by en face analysis of the Oil red O-stained aortic arch and in histological sections of the aortic root. Bone marrow-derived macrophages and splenocytes were incubated in the presence of leuprolide (10
-6
mol/L) or degarelix (10
-6
mol/L). Data is shown as mean ± sem, *p<0.05, **p<0.01.

Results:
All types of ADT augmented hypercholesterolemia and atherosclerosis with no significant differences in the size of the effect (Figure A-B). In Orx mice, the addition of leuprolide, but not degarelix, led to further increases in plasma total cholesterol and in atherosclerosis in the aortic root (D), but not the aortic arch (C). Plaque necrosis was unaffected by ADT. No effects of the drugs on macrophage cytokine secretion or splenocyte proliferation were observed.

Conclusions:
ADT did not exert differential effects on the development of atherosclerosis in the Apoe-deficient mice. A pro-atherogenic, possibly cholesterol-mediated, effect of leuprolide was seen in Orx mice.
Abstract 9995: Emergency Percutaneous Coronary Intervention in Survivors of Out-of-hospital Cardiac Arrests is Safe and Feasible With Good Outcomes
Authors: Mohamed Mohamed O , George Sudhakar , Calvert Patrick A , Ludman Peter F , Doshi Sagar N , Townend John N , Khan Sohail Q
Published: March 2022

Purpose:
Out-of hospital cardiac arrest (OHCA) is associated with high degrees of morbidity and mortality. We aimed to evaluate the prevalence of coronary disease in survivors of OHCA in our local population, and to assess whether early angiography had an impact on survival.

Methods:
Patients with OHCA over a 3-year period were included (January 2012- December 2014). A review of patient records was performed including details of coronary angiogram and PCI findings. Univariate analysis was performed.

Results:
There were 45 patients included (71% Males, Mean Age 65.1 ± 12.7 Years). Cardiopulmonary resuscitation (CPR) was started immediately in 62% of patients, and mean time for return of spontaneous circulation was 22.9±18.7 minutes. Ventricular Fibrillation was the initial rhythm identified (80%), followed by PEA (15.5%) and Asystole (4.5%). Post arrest ECG revealed ST-Elevation in 53% (n=24). Patients were grouped into those with and without ST elevation (24 vs.21). All patients had been ventilated prior to angiography, and 46.6% (n=21) were in cardiogenic shock. Coronary angiography revealed at least one significant coronary artery lesion (≥50%) in 91% of patients (n=41), of which 63% (n=26) were due to an acute occlusion. In the STEMI group, 83.3% (n=20) of patients had a significant acute occlusion. In the non-STEMI group, 33.3% (n=7) of patients had a significant lesion, all but one due to an acute occlusion. 11.5% (n=3) of patients with an acute occlusion had no ST changes on their ECG. 41 patients underwent successful PCI.

21 patients (47%) survived to hospital discharge and were also alive at 30-days. STEMI vs. non-STEMI survival (9 vs.12, p = 0.24). The positive and negative predictive value of ST-Elevation on the ECG to determine significant coronary lesions was 83.3% and 71.4% respectively.

Conclusion:
Early angiography is feasible and significant coronary artery disease is present in the majority of survivors of OHCA. Occlusive coronary disease is commonly found despite no evidence of ST- Elevation on the ECG.
Abstract 9998: Prognosis of Low Normal Left Ventricular Ejection Fraction in an Asymptomatic Population -based Adult Cohort. MESA
Authors: Yeboah Joseph , Qureshi Waqas , Rodriguez Carlos , Liu Songtao , Carr Jeffrey J , Lima Joao A , Hundley Gregory W , Herrington David M
Published: March 2022

Introduction:
A reduced left ventricular ejection fraction (LVEF) is associated with adverse cardiovascular events; however, the optimal threshold for a “normal” LVEF is uncertain. In general a LVEF ≥ 55% is considered “normal” by guidelines, with a low normal designation for LVEF 50-55%. We assess the prognosis of participants with low normal LVEF (LN-EF) in the Multi Ethnic Study of Atherosclerosis. All participants were asymptomatic and had no known clinical CVD at baseline.

Methods:
4669 out of 5004 had LVEF of ≥ 50% assessed using cardiac MRI (SSFP), had no significant valvular disease (- VD), did not have MI during follow up (-MI), had complete data and included in analysis. 475/4669(10.2%) had LN-EF. Cox proportional hazard and cubic spline analyses were used to assess the association of low normal LVEF and 10 years of adjudicated incident congestive heart failure(CHF) and all- cause mortality adjusting for age gender and race( model 1) and model 2: model 1 + DM, smoking, SBP, BP meds, BMI, creatinine, LDL, family history and educational status. Model 3: model 2 + LV mass.

Results:
Age averaged 61± 10yrs, 46% were men, 35% had BP meds, 8% T2DM. After 10.2 years of follow up, 112 developed CHF and 425 died. 87/112 CHF events had LVEF available at diagnosis [45 had a LVEF≥ 50%-HFPEF and 42 had LVEF<50%-HFREF]. Table 1 shows our results.. Using LVEF of 55% as reference the risk of CHF in individuals with LVEF≥ 50% is non- linear (Figure 1).

Conclusion:
In asymptomatic population based adults -VD, -MI, LN-EF is prevalent(10.2%) and is an independent predictor of future clinical CHF. LN-EF is not associated with mortality. Future CHF prevention measures should also focus on individuals with LN-EF.
Abstract 08: The Impact of Food Taxation and Subsidy Policies on Cardiometabolic Disparities in the US
Authors: Penalvo Jose L , Cudhea Fred , Micha Renata , Afshin Ashkan , Rehm Colin , Wilde Parke , Shulkin Masha , Bishop Eve , Pearson-Stuttard Jonathan , O’Flaherty Martin , Gaziano Thomas , Whitsel Laurie , Capewell Simon , Mozaffarian Dariush
Published: March 2022

Background:
Food taxes and subsidies are promising strategies for improving diets and reducing cardiometabolic diseases (CMD). Both dietary habits and CMD burdens are unequally distributed in the US, with major disparities by socioeconomic status (SES). Information on impacts of national food price policies on disparities is lacking.

Aim:
To estimate the impact on CMD deaths and health disparities in US adults of price interventions (taxes, subsidies) targeting 7 key dietary factors.

Methods:
Using nationally representative data, we conducted comparative risk assessment analysis to estimate the impact of a 10% price subsidy on fruits, vegetables, whole grains, and nuts and a 10% tax on processed meat, unprocessed red meat, and sugar-sweetened beverages, on CMD deaths and disparities in SES subgroups. We evaluated 18% (based on global price elasticity data) and 50% (based on recent experience from soda taxes in Mexico) greater price responsiveness in lowest vs. highest SES groups.

Results:
Each separate price intervention would reduce CMD deaths (Figure). Jointly subsidizing and taxing these 7 dietary factors (10% price change each) and assuming 18% greater price-responsiveness in lowest vs. highest SES, this intervention would prevent 5.27% of CMD deaths in those with <high school education (<HS), 6.27% among HS graduates and those with some college (SC), and 5.11% among college graduates (COL). Effects in each group were dependent on both baseline (current) diet and price responsiveness. Applying a 50% greater price-responsiveness, the corresponding values were 5.91% (<HS), 6.27% (SC), and 4.58% (COL).

Conclusions:
Introducing modest price changes on key dietary factors could reduce CMD burdens and improve disparities in the US. Policy-based strategies targeting disparities will require considering both baseline dietary habits as well as price responsiveness in specific population subgroups.
Abstract 12: Socioeconomic Correlates of Cardiovascular Disease Risk in African Americans: The Jackson Heart Study
Authors: Min Yuan-I , Anugu Pramod , Butler Kenneth , Correa Adolfo , Hartley Tara , Mwasongwe Stanford , Norwood Arnita , Sims Mario , Wallace Valerie , Wang Wei , Winters Karen
Published: March 2022

Background:
Research has found that socioeconomic status (SES) is associated with cardiovascular disease (CVD) risk. However, few studies have reported the SES correlates of CVD risk in African Americans (AA). Since low SES is over-represented in AA, our objective is to examine the socioeconomic correlates of CVD risk in this population, which may provide new insights on racial/ethnic disparities in CVD risk.

Methods:
A cross-sectional analysis of baseline data collected in the Jackson Heart Study (JHS), an entirely AA population, was performed. Multivariable logistic regression analysis estimated the age and sex-adjusted association of SES indicators (education, household income and occupation) with prevalent CVD (myocardial infarction (MI), stroke and hypertension). Stratified analyses by age (<65 and ≥65 years) and sex were also performed. Additional analyses were performed using logistic models with a backward selection procedure that included age, sex, education, household income, occupation and burden of CVD risk factors (measured by the number of Life’s Simple 7® metrics meeting ideal health) as independent variables and prevalent CVD as dependent variables, Due to missing data, sample sizes for these analyses ranged from 3,473 to 5,301.

Results:
Baseline prevalence for MI, stroke and hypertension were 5.5%, 4.4% and 60.1%. About one-third (32.5%) of the participants had a bachelor’s degree, 35% held management or professional occupations and 30% were “affluent” (≥3.5 US Census poverty level). We observed an inverse relationship between prevalent CVD and SES indicators. The largest and most consistent SES correlate of prevalent CVD was observed with income on MI (odds ratio (OR) 3.5; 95% CI 2.3, 5.4) and stroke (OR 3.7; 95% CI 2.3, 6.0) comparing the poor (below US Census poverty level) to the affluent income categories. Stratified analyses suggested stronger SES gradients in individuals <65 years and in females for MI. In the backward logistic regression models, the significant SES indicators (p<0.05) remaining in the final model were income for MI and stroke, and occupation for hypertension. The burden of CVD risk factors was statistically significant and remained in the final model for all three CVD outcomes.

Conclusions:
Inverse SES gradients on the prevalence of MI, stroke and hypertension were observed among AA in the JHS. The most important SES correlates were income for MI and stroke, and occupation for hypertension. These findings suggest SES, and income in particular, is an important factor contributing to health disparities in CVD among AA and possibly AA-White disparities in health outcomes.
Abstract 17: Exercise Capacity and Primary Prevention of Major Adverse Cardiac Events in Veterans: The ETHOS Study
Authors: Kokkinos Peter , Faselis Charles , Myers Jonathan , Narayan Puneet
Published: March 2022

Introduction:
Increased exercise capacity is associated with better health outcomes. However, less is known about the impact of increased fitness on the primary prevention of major adverse cardiovascular events (MACE) defined as fatal or non-fatal myocardial infarction, cardiac bypass surgery, heart failure or stroke, has not been determined.

Hypothesis:
We assessed the hypothesis that increased exercise capacity decreases the risk of primary MACE.

Methods:
We identified 21,062 veterans (mean age:58.4±11.4) who completed an exercise stress test to either assess fitness status or suspected ischemia at two VA Medical Centers (Washington DC and Palo Alto, Ca). None had documented cardiovascular disease or any evidence of ischemia during the test.

We established five fitness categories based on age-stratified quintiles of peak metabolic equivalents (MET) achieved: Least-Fit (4.2±1.2 METs; n=4,035); Low-Fit (6.0±1.2; n=4,483); Moderate-Fit (7.9±1.0 METs; n=3,898); Fit (8.6±1.4 METs; n=5,115); and High-Fit (11.9±2.3 METs; n=3,531). Multivariable Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals [CI] for incidence of MACE across fitness categories. The models were adjusted for age, BMI, race, gender, cardiac risk factors, sleep apnea, alcohol dependence and medications. The Least-fit category was the referent.

Results:
During follow-up (median=11.3 yrs), 2,911 developed MACE. For every 1-MET increase in exercise capacity, the risk for MACE was 15% lower (HR=0.85, 95% CI: 0.84-0.87). When considering fitness categories, MACE risk was lower by: 28% in Low-Fit (HR=0.72; CI: 0.65-0.79); 36% in Moderate-Fit (HR=0.64; 95% CI, 0.57-0.71); 55% in Fit (HR, 0.45; 95% CI, 0.41-0.51); and 66% in High-Fit (HR, 0.34; 95% CI, 0.29-0.39) individuals. Similar trends were noted in each of the MACE components.

Conclusions:
Increased exercise capacity protects against primary MACE. The association is independent and graded.
Abstract 26: Assessing and Refining Cardiovascular Disease Risk Estimation Among Patients with Human Immunodeficiency Virus: Center for Acquired Immunodeficiency Syndrome Research Network of Integrated Clinical Systems
Authors: Feinstein Matthew J , Drozd Daniel R , Ning Hongyan , Delaney Joseph A , Nance Robin , Mathews William C , Kitahata Mari , Saag Michael , Eron Joseph , Moore Richard , Achenbach Chad J , Crane Heidi , Lloyd-Jones Donald M
Published: March 2022

Background:
Persons living with human immunodeficiency virus (HIV) have greater risks for myocardial infarction (MI) than uninfected persons. These elevated MI risks, which are associated with both traditional and HIV-specific risk factors, may limit the applicability of cardiovascular risk prediction models for HIV-infected persons.

Methods:
We evaluated the ACC/AHA atherosclerotic cardiovascular disease (ASCVD) Risk Estimator’s Pooled Cohort Equations (PCEs) and a new model incorporating HIV-specific variables using the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) multi-center U.S.-based cohort of HIV-infected adults. CNICS has rigorous central adjudication of type I and II myocardial infarction (MI), which may be distributed differently in HIV-infected versus uninfected populations. Because adjudicated stroke data were not available, ASCVD risks predicted by the PCEs were scaled to determine predicted MI rates using race-sex-specific proportions. MI rates predicted by the PCEs and the new model were compared with observed MI rates in CNICS. Harrell’s C-statistic and Hosmer-Lemeshow chi-square were used to determine discrimination and calibration of these models.

Results:
Of 11,901 HIV-infected persons in CNICS with baseline data required for the PCEs, 180 experienced MIs over a mean follow-up of 4.3 years. The PCEs were poorly calibrated for white men and black women (Hosmer-Lemeshow chi-square = 25.3 and 42.9, respectively) and had inadequate discrimination for black men (Harrell’s C statistic = 0.65). A modified, data-derived model had excellent discrimination (Harrell’s C-statistic for men = 0.81; for women = 0.83) and was well calibrated (Figure).

Conclusions:
A data-derived ASCVD risk estimator that incorporates HIV-specific coefficients had excellent discrimination and calibration in a large multi-center U.S. HIV cohort. Future studies are needed to validate this model in other HIV cohorts and evaluate the contributions of type I versus II MI to ASCVD risk.
Abstract 29: Changes in Three Diet Quality Scores and Total and Cause-specific Mortality
Authors: Sotos-Prieto Mercedes , Bhupathiraju Shilpa N , Mattei Josiemer , Fung Teresa T , Li Yanping , Pan An , Willett Walter C , Rimm Eric B , Hu Frank B
Published: March 2022

Background:
The latest 2015 Dietary Guidelines Advisory Committee Report has recommended healthy dietary patterns as an easier way for the public to understand and act upon. Despite the latest evidence supporting the association of the adherence to diet quality and lower mortality risk, few studies have evaluated changes in diet quality over time in relation to mortality risk. Therefore, we examined changes in diet quality and subsequent risk of total and cause-specific mortality in two large cohort studies.

Objective:
To evaluate the association between 12-y changes (1986-1998) in three diet quality indices assessed by the Alternative Healthy Eating Index (AHEI), the Alternate Mediterranean Diet (AMED), and the Dietary Approach to Stop Hypertension (DASH)) with total and cause-specific mortality in the Nurses’ Health Study (NHS) and Health Professionals Follow-up Study (HPFS) from 1998-2010.

Methods:
We followed 44,501 women in the NHS and 23,100 men in the HPFS, both from 1986 to 2010. The AHEI, AMED and DASH were defined from validated food frequency questionnaires and updated every 4 years. Cox proportional hazards models were used to calculate hazard ratios (HR) with adjustment for potential confounders (both at baseline and changes over time). Results across cohorts were pooled by an inverse variance-weighted, random-effect meta-analysis.

Results:
During 758,683 person-years of follow-up, we documented 9,772 deaths, including 2,292 CVD deaths and 3,314 cancer deaths. The pooled HR comparing participants with the greatest improvement in diet quality (14%-33%) vs. participants whose diet quality remained relatively stable (no change, 0-3%) in the 12-year period was 0.89 (95% confidence interval [CI], 0.83 to 0.95) for AHEI; 0.83 (95 CI%, 0.65 to 1.05) for AMED; and 0.88 (95% CI 0.83 to 0.94) for DASH. In contrast, a decrease in diet quality was significantly associated with increased total mortality. In continuous analyses, a 20th-percentile increase in the three diet quality scores was associated with a 9%-20% lower total mortality (AHEI, 20% [15% to 24%]; AMED, 9% [6% to 12%]; DASH, 13% [9% to17%]). The results were largely similar when evaluated risk of death from CVD and cancer as outcomes. Notably, maintaining a higher vs lower adherence to any of the three dietary patterns during the 12 years was significantly associated with a 23-24% lower total mortality, a 19-27% lower risk of CVD deaths, and a 13-20% lower risk of cancer death.

Conclusions:
In two large, independent cohorts of U.S. women and men we found consistent associations between increasing diet quality over 12 years and decreased total, CVD, and cancer mortality. These results underscore the importance of the strategies to promote and sustain a healthy diet in improving longevity among middle-aged and older adults.
Abstract 37: Effect of Fish Oil on Coagulation and Fibrinolysis: A Double-blind Randomized Trial in Obese Adolescents
Authors: Balagopal Babu , Lovely Rehana , Khan Mustafa , Hossain MD Jobayer , Gidding Samuel
Published: March 2022

Background:
A hypercoagulable state is reported in obese children and adolescents. Fish oil may reduce the propensity for thrombosis by favorably impacting coagulation and fibrinolysis. We hypothesized that pharmacologic fish oil supplementation would reduce the concentration of coagulation factors such as total-fibrinogen (T-Fib) and gamma prime fibrinogen (γ’-Fib) and fibrinolysis factors such as plasminogen activator inhibitor-1 (PAI-1) in obese dyslipidemic adolescents.

Methods:
Participants (n=42, age 14±2 years) with hypertriglyceridemia and low-density lipoprotein (LDL) cholesterol <160 mg/dL were enrolled in a randomized, doubleblind, crossover trial comparing 4 g of fish oil daily with placebo. Treatment interval was 8 weeks with a 4-week washout. Glucose, insulin, high-sensitivity C-reactive protein (CRP), interleukin-6 (IL-6), T-Fib, γ’-Fib and PAI-1 were measured pre- and post-intervention or placebo.

Results:
PAI-1 significantly decreased (p = 0.03) with a trend towards a decrease in T-Fib in the fish oil group. Fish oil treatment group also showed significant decrease in γ’-Fib, but not in the placebo group; mean change (95% CI): -0.11 (-0.16, -0.06) vs -0.03 (-0.08, 0.02). The difference in the mean change in γ’-Fib concentration from baseline or washout measures between fish oil treatment and placebo was significant; reg coeff (SE):0.08 (0.03); p=0.02. The change in γ’-Fib was related to the change in log transformed PAI-1 (reg coeff (SE): -0.09 (.041); p=0.03). Further, log-transformed CRP and IL-6 (reg coeff (SE): 0.064 (.030), p=0.04) and 0.10 (.04); p=0.03 respectively) showed significant correlations with baseline or washout baseline γ’ fibrinogen, but there were no such relationships for mean changes.

Conclusions:
Fish oil-induced synchronized reduction of γ’-Fib, T-Fib and PAI-1 suggests attenuation of the obesity-related alterations in coagulation and fibrinolysis in adolescents. Intriguingly, these changes are independent of changes in other inflammatory factors. The reduction in elevated concentration of γ’-Fib is remarkable as it forms clots that are more fibrinolysis resistant. Further evaluation is warranted on the specific beneficial effect of fish oil on the obesity-related hypercoagulant-/hypofibrinolytic-state and the potential for thrombosis later in life.
Abstract 40: Neighborhood Grocery Store Density is Associated with Daily Self-efficacy Among Individuals Enrolled in a Behavioral Weight Loss Intervention Study
Authors: Mendez Dara D , Rathbun Stephen L , Ma Qianheng , Goode Rachel W , Zheng Yaguang , Mattos Meghan , Imes Chris C , Danford Cynthia A , Sereika Susan M , Hu Lu , Burke Lora E
Published: March 2022

Introduction:
Neighborhood factors may play an important role in the treatment of obesity. However, it is unclear if exposures to certain neighborhood factors influence self-efficacy among individuals attempting to lose weight.

Hypothesis:
We hypothesized that individuals living in obesogenic neighborhood environments at baseline would have low self-efficacy for resisting urges to eat beyond their recommended eating plan in a 12-mo weight loss study.

Methods:
We used ecological momentary assessment (EMA) to collect daily data on self-efficacy with an EMA question: How CONFIDENT are you that, if you have an urge to go off your healthy lifestyle plan, you can resist the urge? (value 1 to 10) This EMA question was delivered randomly an average of 5 times/day on a smartphone. Residential address at baseline was geocoded using ArcGIS software and key neighborhood measures (e.g., grocery store and restaurant density, proportion of Black and low income residents, index of neighborhood socioeconomic disadvantage (NSED)) were linked at the census tract level. Data were analyzed using descriptive statistics and linear mixed modeling.

Results:
The sample (N=136) was predominately female (90%), White (80%), mean (SD) age 51.3 (10.3) years, and mean BMI 34.1 (4.6) kg/m
2
. The residential neighborhoods of participants were predominantly White, middle to high education level, and low poverty. The mean confidence score decreased from 7.3 at month 1 to 6.8 at month 12 (p <.001). A higher level of baseline neighborhood grocery store density was associated with a higher confidence score (
p
= .037) (see table). No other neighborhood factor was associated with confidence score.

Conclusion:
Neighborhood factors, specifically access to grocery stores, may affect an individuals’ ability to lose or maintain weight loss by supporting one’s confidence to maintain a healthy lifestyle. This study needs to be replicated in a larger cohort with a more diverse neighborhood representation.
Abstract 44: Association of Somatic and Affective Factors with Inflammation: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Camacho Alvaro , Gonzalez Patricia , D’Anna-Hernandez Kimberly , Nunez Alicia , Linke Sara E , Roesch Scott C , Allison Mathew A
Published: March 2022

Objective:
Proinflamatory biomarkers such as C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) have been linked to the pathophysiology of depression. Depressive states encompass affective (both negative & positive affect) and somatic symptoms. The association of affective and somatic factors of depression with inflammation has not been examined in a multi-ethnic cohort.

Methods:
Data were derived from 6,818 participants aged 45-84 years from the Multi-Ethnic Study of Atherosclerosis (MESA).Depressive symptoms, as measured by the Center for Epidemiologic Studies Depression Scale (CES-D), and inflammatory markers (i.e., CRP, IL-6 and TNF-α) were collected from visit 1 from the MESA cohort. Inflammatory markers were log-transformed to reduce skewness. A confirmatory factor analysis supported a 3-factor model of the CES-D comprised of: somatic symptoms (poor appetite, could not get going, poor sleep, excessive effort, trouble concentrating), negative affect (feeling blue, depressed, crying spells, sadness, felt like a failure, fearful and lonely), and positive affect (feeling happy, good, hopeful, enjoy life). In cross-sectional analyses, structural equation modeling (SEM) was performed to examine the associations between affective and somatic latent variables of the CES-D with the inflammatory biomarkers (CRP, IL-6 and TNF-α) after controlling for age, gender, ethnicity, BMI, lipids, systolic blood pressure, smoking, alcohol use, physical activity, diabetes, lipid-lowering medications and antihypertensives.

Results:
The mean age was 62.15 (SD=1.23) and mean CES-D score was 7.57 (SD=7.59). The 3-factor model of the CES-D exhibited good fit with root mean square-error of approximation <0.05 and standardized root mean square residual <0.07. In the fully adjusted models, the SEM showed a significant association between the somatic factor and IL-6 (β=0.18;p<0.01)and TNF-α (β=0.21;p=0.006) but not CRP (β=-0.12; p=0.16). The negative affect factor was significantly associated with IL-6 (β=0.05;p=0.006), CRP (β=0.04; p=0.03) but not with TNF-α (β=-0.02;p=0.18), while the positive factor was significantly associated with IL-6 (β=0.20;p=0.006), CRP (β=0.65;p<0.001) and TNF-α (β=-0.17;p=0.01).

Conclusion:
This cross-sectional study showed that inflammatory markers are significantly associated with somatic and both positive and affective factors of depressive symptomatology in a multi-ethnic cohort.
Abstract MP03: The AHA Life’s Simple 7 Metric is Inversely Associated with Subclinical Atherosclerosis Among South Asians: Findings From the Mediators of Atherosclerosis in South Asians Living in America Study
Authors: Jin Yichen , Kanaya Alka M , Kandula Namratha R , Talegawkar Sameera A
Published: March 2022

Objective:
To examine the prevalence of the Life’s Simple 7 (LS7) metric and its associations with measures of subclinical atherosclerosis in a community-based cohort of South Asians in the U.S.

Methods:
We conducted a cross-sectional analysis of data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study consisting of 875 South Asians (mean age 55 y, SD=9.4, 47% women). Each LS7 component was assigned a score of 0 (poor), 1 (intermediate) and 2 (ideal) and these scores were summed to derive an overall cardiovascular health score ranging from 0 (poor adherence to AHA guidelines) to 14 (perfect adherence to AHA guidelines).Carotid intima media thickness (cIMT) and coronary artery calcium (CAC) were measures of subclinical atherosclerosis. Multivariate linear and multinomial logistic regression models were used to examine associations between the overall cardiovascular health score, modeled as tertiles, and subclinical atherosclerosis. Covariates included age, sex, insurance type, length of residency in the U.S., and acculturation.

Results:
The prevalence of having 0, 1, 2, 3, 4, 5, 6, and 7 ideal metrics was 1.6%, 8.3%, 20.1%, 27.9%, 21.6%, 15.8%, 4.7%, and 0%, respectively. The overall LS7 score ranged from 3-13, with median of 9; men had a lower median score compared with women (9 vs. 10, p<0.05). In adjusted analyses, compared to those in the lowest tertile, those in upper tertiles had lower common cIMT (score:9-10: β= -0.06, 95% CI: -0.09 to -0.02; score:11-13: β= -0.07, 95% CI: -0.11 to -0.04), and internal cIMT (score:9-10: β= -0.14, 95% CI: -0.21 to -0.08; score:11-13: β= -0.14, 95% CI: -0.21 to -0.07). Higher LS7 scores were also associated with decreased odds of CAC. As compared to the lowest tertile of LS7, those in the highest tertile had 70% (OR=0.30, 95% CI: 0.19 to 0.47) lower odds of having CAC between 1 and 400, and 79% (OR=0.21, 95% CI: 0.08 to 0.54) lower odds of having CAC over 400.

Conclusion:
This is the first study to show that better cardiovascular health, as defined by the LS7 metrics, is associated with a lower burden of subclinical atherosclerosis in middle- and older-aged U.S. South Asians. Prospective follow-up of MASALA will determine whether the LS7 metric will predict incident atherosclerotic vascular disease events.
Abstract MP04: Individual Material and Social Deprivation is Associated with Poor Cardiovascular Health. The Paris Prospective Study III
Authors: Empana Jean-philippe , Gaye Bamba , Perier Marie-Cecile , Guibout Catherine , Thomas Frederique , Pannier Bruno , Boutouyrie Pierre , Jouven Xavier
Published: March 2022

Purpose:
Primordial prevention has been recognized as a public health priority, by the American Heart Association and more recently by the United Nations and World Health Organization. Reduction in social inequalities in health is a major challenge. We hypothesized that subjects in a socio-economical precarious position would be characterized by a poor cardiovascular health (CVH).

Methods:
We included 8748 men and women aged 50-75 years who enrolled the Paris Prospective Study III from June 2008 to May 2012 (Paris, France). The CVH status was defined as poor (0 or 1 ideal health metric), intermediate (2, 3 or 4 ideal health metrics) and ideal (5, 6 or 7 ideal health metrics). A validated multidimensional index (ranging from 0 to 100) of material and social deprivation including 11 questions derived from a principal component analysis (based on 42 questions) and covering employment, income, education, socio professional categories, accommodation, family composition, social networking, financial difficulties, life events and perceived health was used. The association of individual deprivation index (in quartiles) with poor and intermediate CVH as compared to ideal CVH was estimated by multivariable polytomic logistic regression analysis.

Results:
Mean age was 59.5 (standard deviation: 6.2), 61.5% were men and 40% had more than 12 years of school education. One-fourth of the study cohort was precarious (score of material deprivation>30), slightly more women than men. The prevalence of poor and ideal CVH was respectively 43.3% and 8.6% in precarious subjects compared to 39.4% and 10.7% in the non precarious (p<0.001). After adjusting for age, sex, depressive symptoms, migrant status and ethnicity, the odds of poor CVH was 1.38 (95%: 1.12-1.70), 1.55 (1.25-1.91) and 1.86 (1.48-2.32) for the second, third and fourth quartile of the individual deprivation index compared to the first quartile (p for trend<0.001). This reflected an association with the behavioural but not the biological component of CVH. In sex stratified analyses, associations were stronger in magnitude and were significant for each upper quartile of the deprivation index whereas in men only the last quartile was significant (p for interaction=0.04). Furthermore and contrary to the main analysis, a significant association between individual deprivation and the biological component of CVH was noted in women but not in men (p for interaction=0.002).

Conclusion:
Subjects from the community in precarious situation are more frequently in poor cardiovascular health and should be targeted in priority for primordial prevention. The reasons behind the gender difference deserve additional investigations.
Abstract MP24: Association of Tea Intake with Coronary Artery Calcification and Cardiovascular Events: Results From the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Miller P. Elliott , Zhao Di , Michos Erin D , Frazier-Wood Alexis , Averill Michelle , Sandfort Veit , Burke Gregory L , Polak Joseph F , Lima Joao , Post Wendy S , Blumenthal Roger S , Guallar Eliseo , Martin Seth S
Published: March 2022

Objective:
Tea is one of the most commonly consumed beverages in the world. However, the association of tea intake with coronary artery calcium (CAC) and major adverse cardiovascular events (MACE) remains uncertain. We therefore sought to investigate the association of tea consumption with CAC progression and incident MACE.

Methods:
From the Multi-Ethnic Study of Atherosclerosis (MESA), we examined 6,212 ethnically-diverse participants with available tea data. Participants were classified as never, <1 cup/day, 1 cup/day, 2-3 cups/day, and ≥4 cups/day. Our main outcomes were CAC progression (measured by cardiac CT), CAC volume progression and MACE [myocardial infarction, angina resulting in revascularization, resuscitated cardiac arrest, stroke, and cardiovascular death]. A CAC progression ratio was derived from mixed effect regression models (visits 1 through 5) using log
e
(CAC score+1) or log
e
(CAC volume+1) as the outcome. Cox proportional hazards analyses were used to evaluate the association between tea intake and incident MACE.

Results:
Over a median follow-up of 11.1 years for CVD events and 5.3 years for cardiac CT follow-up, participants who drank 1 and 2-3 cups/day of tea showed a decreased progression of CAC score and volume compared with never drinkers after multivariate adjustment (Table). This correlated with a statistically significant lower incidence of MACE for 1-cup/day tea drinkers (HR 0.65; 95% CI 0.45, 0.96). Sensitivity analyses excluding Chinese participants showed similar results for CAC progression and incident MACE.

Conclusion:
We found that being a moderate tea drinker was associated with a decreased progression of CAC and decreased incidence of MACE. Future research is needed to understand the potentially protective nature of moderate tea intake.