bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 020: C-reactive Protein As A Moderator And Insulin Resistance As A Mediator For The Association Between Endothelin-1 And Type 2 Diabetes Progression Among African Americans In The Jackson Heart Study
Authors: Gao Xiang , Horbal Steven R , Fan Hao , Su Le , Musani Solomon K , Fox Ervin R , Kaze Arnaud D , Zoh Roger S , Echouffo-Tcheugui Justin , Bidulescu Aurelian
Published: May 2021

Objective:
Little is known about the moderation and mediation factors among the association between endothelin-1 (ET-1) level and type 2 diabetes progression in African Americans. We explored the role of high sensitivity C-reactive protein (hsCRP) as a moderator and homeostatic model assessment of insulin resistance (HOMA-IR) as a mediator for the association between ET-1 level and type 2 diabetes progression among African Americans enrolled in the Jackson Heart Study (JHS).

Methods:
We included 1,692 participants free of prediabetes and diabetes at baseline, who attended Exam 1 of the JHS in 2000-2004 and Exam 3 in 2009-2013, and with measured ET-1 level at Exam 1. Incident prediabetes and diabetes were ascertained at Exam 3. We used a sequential regression model procedure. Zou’s modified Poisson multivariable models were used to calculate risk ratios (RR) and 95% confidence intervals (CI) for prediabetes and diabetes. Effect modification was assessed in the multivariable adjusted model. Valeri and VanderWeele’s mediation analysis approach was utilized to evaluate mediation.

Results:
A higher log-transformed ET-1 level was detected when comparing non-diabetes versus prediabetes and diabetes participants (p-value for trend = 0.03). Compared to quartile 1 (<0.9 pg/mL) of ET-1, quartile 2 (0.9-1.2 pg/mL) of ET-1 was significantly associated with higher risk of prediabetes (RR=1.19 [95% CI 1.02, 1.38]) and diabetes (RR=1.19 [95% CI 1.02, 1.40]). This association only remained significant for diabetes in the multivariable adjusted model (RR=1.20 [95% CI 1.02, 1.40]) and was not attenuated after adjusted for hsCRP (RR=1.20 [95% CI 1.03, 1.40]), HOMA-IR (RR=1.20 [95% CI 1.02, 1.40]), and both hsCRP and HOMA-IR (RR=1.20 [95% CI 1.03, 1.40]) in quartile 2 of ET-1.The risk of elevated ET-1 level on diabetes was higher in participants with increased hsCRP level in the multivariable adjusted model (RR=1.06 [95% CI 1.02, 1.09]), and further adjusted for HOMA-IR (RR=1.06 [95% CI 1.02, 1.09]. The indirect effect of ET-1 on prediabetes through HOMA-IR is 0.96 (P<0.01), but not found for hsCRP (p=0.26). The total effect of ET-1 on prediabetes mediated by HOMA-IR is 47%. No such mediation effect of HOMA-IR was found among diabetes participants.

Conclusions:
African Americans with higher ET-1 levels have a higher risk of prediabetes and diabetes. Additionally, the risk of diabetes is elevated among those African Americans with increased hsCRP levels. The mediation analysis result supports that ET-1 is involved in the stage of glucose metabolism imbalances leading to diabetes progression.
Abstract 031: Age-related Homeostatic Dysregulation In Midlife And Physical Function In Late Life: The Atherosclerosis Risk In Communities (aric) Study
Authors: Lu Yifei , Pike James R , Kucharska-newton Anna , Palta Priya , Whitsel Eric A , Bey Ganga , Zannas Anthony , Windham Gwen , Walker Keenan , Griswold Michael , Heiss Gerardo M
Published: May 2021

Introduction:
Age-related homeostatic dysregulation (Dm), characterized by multi-biomarker composite measures, has shown promise as a rate-of-aging metric. We tested the association of midlife Dm and its change over ~20 years of follow-up with later life physical function.

Methods:
We studied 4617 ARIC cohort participants (mean age 54.8 years, 58% female, 20% Black) who completed in-person examinations from 1990-92 (baseline) through 2011-13. Dm quantifies the multivariate statistical deviation of 15 physiology-motivated biomarkers from the distribution in a healthy sample at baseline. Midlife Dm was grouped by quartiles (higher quartiles indicating greater homeostatic dysregulation) and temporal change in Dm was quantified continuously. Physical function was assessed in 2011-13 and included measures from the Short Physical Performance Battery (SPPB) including repeated chair stands, balance, 4-meter walk and grip strength. Associations were quantified using linear regression and ordinal logistic regression as applicable, adjusting for age, sex, race, and education.

Results:
A graded association was observed between midlife Dm and physical functional performance in late life (Table). Compared to the 1
st
quartile of midlife Dm, the odds ratio of a lower SPPB score in late life was 1.19 (95%CI 1.04, 1.35) for the 2
nd
quartile, 1.63 (1.41, 1.90) for the 3
rd
quartile, and 3.14 (2.60, 3.79) for the 4
th
quartile. Similar associations were observed for each of SPPB components and grip strength, either modeled ordinally or continuously. Each standard deviation increase in 10-year Dm change was associated with ~2-3 times the odds of having a poorer physical functional performance.

Conclusions:
Greater homeostatic dysregulation at midlife and increases in dysregulation during follow-up were associated with poorer physical function in late life. Insights into the factors that lead to progression of multisystem deterioration during midlife may highlight opportunities to preserve functional abilities in late life.
Abstract 038: Cumulative Exposure To Sleep Disordered Breathing From Childhood Through Young Adulthood Is Associated With Impaired Endothelial Function
Authors: Fernandez-Mendoza Julio , Gao Zhaohui , Qureshi Myra , Vachhani Baadal A , Liao Jiangang , Brandt Kristen , He Fan , Calhoun Susan , Vgontzas Alexandros , Liao Duanping , Bixler Edward O
Published: May 2021

Introduction:
Clinical and population-based studies in adults have shown that sleep disordered breathing (SDB) is associated with impaired endothelial function. However, there is a lack of population-based studies demonstrating an association between SDB and endothelial dysfunction in young adults using a developmental approach.

Hypothesis:
Exposure to SDB since childhood is associated with long-term impaired flow-mediated dilation (FMD) in young adulthood.

Methods:
We tested this hypothesis in a subsample of the Penn State Child Cohort, a population-based study of 700 children (median age 9y), of whom 421 were followed-up 6-13 years later during adolescence (median age 16y), and 178 have been followed-up 11-19 years later during young adulthood (median age 24y). Subjects (54.5% female, 20.8% racial/ethnic minority) underwent in-lab polysomnography to ascertain the apnea/hypopnea index (AHI) at all three time points, and ultrasounds to assess FMD in young adulthood. Based on the AHI truncated at ≥5 events/hour of sleep to include subjects already on positive airway pressure therapy, we averaged the exposure to AHI over the three time points (cAHI). The study outcomes were FMD, as a continuous measure, and endothelial dysfunction, defined as FMD<10.3% based on the median of the sample. Linear and logistic regression models simultaneously adjusted for sex, age, race/ethnicity, overweight and length of follow-up.

Results:
The mean cAHI was 1.31 (1.35) ranging from 0 to 5 and the mean FMD was 0.11 (0.04) ranging from 0.03 to 0.25. Linear models showed that cAHI was associated with significantly lower FMD in young adulthood (β = -0.006; 95% CI = -0.011, -0.0013; p = 0.014). To test the robustness of the analysis, we applied the same model with the square root of FMD as the outcome and similar results were obtained (β = -0.009; 95% CI = -0.016, -0.0017; p = 0.015). Logistic models showed that each point increase in cAHI was associated with 51% higher odds of endothelial dysfunction in young adulthood (OR = 1.51; 95% CI = 1.14, 2.06; p = 0.006).

Conclusions:
The preliminary data of this ongoing longitudinal study indicates that exposure to SDB during early stages of life is associated with increased risk for cardiovascular disease in young adults from the general population.
Abstract 042: Do Disparities In Cardiovascular Comorbidities Account For Excess Covid-19 Morbidity And Mortality In African Americans?
Authors: Dasa Osama , Cohen Scott A , Zheng Yi , sajdeya Ruba , Taha Mohamad B , Hu Hui , Pearson Thomas A
Published: May 2021

Introduction:
COVID-19 incidence, severity, and death in African Americans (AA) has been reported to markedly exceed those of White Americans (WA), but the epidemiologic basis for this is unclear.

Hypothesis:
We hypothesize that AA have an excess of comorbid conditions compared to WA accounting for the disparity in COVID-19 infection and death.

Methods:
We examined 67,094 COVID-19 cases with laboratory-confirmed COVID-19 and compared them to 135,188 controls (2:1 match by age, sex, and zip code) representing a state-wide sample of healthcare recipients from the ‘OneFlorida’ research consortium through August 3, 2020. We assessed the prevalence of preexisting comorbid conditions (e.g. cardiovascular disease, cancer), behavioral risk factors, and health outcomes in the electronic health records of COVID-19 cases compared to controls.

Results:
Cases included 25,443 (37.9%) WA, 11,709 (17.5%) AA, and 16,119 (24%) Hispanic Americans (HA). Among cases, there was a significant increase in the prevalence of several cardiovascular comorbidities in AA vs. WA, such as hypertension, diabetes, heart failure, and stroke, but not for common cancers, liver disease, and COPD (Table 1). Likewise, smoking and BMI were higher in AA. Similar disparities were also appreciated in matched controls. Compared to WA, AA and HA had higher odds of becoming infected with COVID-19 (Unadjusted OR, 1.08; CI [1.05-1.11] and OR, 1.17; [1.15-1.2]) respectively. The prevalence of severe COVID-19 outcomes (intubation and death) was higher in AA (3.6 and 2.7%) than WA (2.5% and 2.3%) or HA (1.3 and 1.4%), respectively.

Conclusions:
Excess comorbidities for cardiometabolic diseases are present in this population-based sample of COVID-19 cases and controls. Careful mediation analyses will determine whether these differences in cardiovascular comorbidities alone account for disparities in COVID-19 in AA patients. Such data would be important to identify high-risk subgroups benefitting from enhanced preventive and early therapeutic interventions.
Abstract 044: Association Of Cardiovascular Comorbidities With Sars-cov-2 Seropositivity In A Population-based Cohort.
Authors: Ivanov Alexander , Annabathula Rahul V , Hammoud Aziz , Zhao David X , Correa Adolfo , Weintraub William S , Herrington David M
Published: May 2021

Background:
Following the outbreak of SARS-COV2 > 7,750,000 Americans were diagnosed with COVID-19. Many comorbidities were found to be associated with increased risk of severe disease. Due to limited testing and high percent of asymptomatic cases the exact prevalence is unclear. Moreover, whether the presence of comorbidities is associated with an increased rate of COVID-19 remains unknown.

Methods:
COVID-19 Community Research Partnership (CCRP) is a prospective cohort designed to collect information about the community's coronavirus exposures, symptoms, and prevalence (NCT04342884). Serological substudy is a prospective case series evaluating development of IgM or IgG in randomly selected 5000 participants from the CCRP cohort. Serological test kits are shipped to the volunteers monthly. Prevalence of comorbidities was estimated using electronic health records.

Results:
There were 4902 patients included in the analysis (Figure). Of those, 2,832 (57.8%) were female, mean age±SD was 49.6±14.4. There were 3,871 (79%) Caucasians, 422 (8.6%) - African Americans and 242 (4.9%) - Hispanics (Table). From May 2020 to August 2020, 424 patients (8.7%) seroconverted (IgM or IgG positive): 327 (6.7%) were found to be IgM positive/ IgG negative, 38 (0.8%)- IgM negative/IgG positive and 59 (1.2%) - IgM positive/ IgG positive. Prevalence of comorbidities was low: 1,318 (26.9%) patients have hypertension, 1,379 (28.1%)- hyperlipidemia, 413 (8.4%)- diabetes, 217 (4.4%)- coronary artery disease, 156 (3.2%)- peripheral arterial disease, 132 (2.7%)- atrial fibrillation, 95 (1.9%)- history of deep venous thrombosis and pulmonary embolism, and 54 (1.1%)- history of heart failure (HF). Only the presence of HF was associated with an increased odds ratio of seroconversion OR 2.4, (1.21- 4.87), p<0.012. This association remained robust after controlling for age, sex and race.

Conclusion:
Prevalence of seroconversion was near 9%. Presence of heart failure was independently associated with an increased odds ratio of seroconversion.
Abstract 048: Disparities In Gestational Diabetes Mellitus Among US- Vs. Foreign-born Women: An Analysis Of 2016-2017 National Health Interview Survey
Authors: Ogunwole Michelle , Turkson-Ocran Ruth-Alma N , Boakye Ellen , Bennett Wendy L , Cooper Lisa A , Creanga Andreea A , Sharma Garima , Wang Xiaobin , Commodore-mensah Yvonne
Published: May 2021

Background:
Gestational diabetes mellitus (GDM) is a common complication of pregnancy. Although GDM is associated with increased risk of cardiovascular disease it is unclear whether the associations between GDM prevalence and cardiometabolic risk factors differ between US- and foreign-born women and whether length of US residence influences these associations.

Methods:
We analyzed cross-sectional data from the 2016-2017 National Health Interview Survey among women currently living in the US who both reported ever being pregnant and responded to the survey question about GDM. Using generalized linear models with binomial distribution and logit link, we examined the prevalence of GDM by nativity status and length of US residence adjusting for potential confounders (Table).

Results:
Of 24,466 women, 14.3% were foreign-born. The crude prevalence of GDM was higher among foreign-born (9.0%) compared to US-born women (7.1%). Foreign-born women with ≥10 years of residence in the US had the highest age-standardized GDM prevalence (8.3%) compared to US-born (7.5%) and foreign-born women with <10 years US residence (4.8%). Among women with a history of GDM, US-born women were more likely to be overweight/ obese, report a history of hypertension, be current smokers and alcohol drinkers than foreign-born women. Among foreign-born women, those with ≥10 years of US residence had higher prevalence of hypertension, smoking and alcohol use than those with <10 years in the US. In the fully adjusted regression model, only foreign-born women with ≥10 years of residence in the US had a significantly higher prevalence of GDM than US-born women (PR=1.43; 95% CI:1.22-1.67).

Conclusions:
In this sample of women with self-reported GDM, greater length of US residence contributes to nativity-related disparities in GDM. Acculturation, including changing health-related behaviors, may have a larger impact on maternal health outcomes of foreign-born women, and should be a target of interventions to reduce GDM and future cardiovascular diseases.
Abstract 051: Pre-pregnancy Cardiometabolic Risk Factors, Mediterranean Style Diet, And Risk Of Preeclampsia In The Boston Birth Cohort
Authors: Minhas Anum , Hong Xiumei , Wang Xiaobin , Mueller Noel T
Published: May 2021

Background:
Preeclampsia carries high acute and chronic maternal and fetal morbidity and mortality. It is still unclear how pre-pregnancy conditions affect preeclampsia risk, and whether diet reduces risk. We examined associations of pre-pregnancy hypertension, obesity, and diabetes with preeclampsia, and investigated if a Mediterranean-style diet associates with lower risk.

Methods:
We used data from the Boston Birth Cohort, which comprises racially/ethnically diverse, urban, low-income mothers. We obtained maternal demographic and dietary intake frequencies via interviewer-administered questionnaires within 24-72 hours after birth. We extracted additional pregnancy-related clinical information, including physician diagnosis of preexisting conditions and preeclampsia from medical records. We created tertiles of a Mediterranean-style diet score previously created by our group. We performed logistic regression to assess associations of pre-pregnancy conditions and Mediterranean style diet with odds of preeclampsia.

Results:
Of 8,507 women in the sample, 849 developed preeclampsia. 47% were black, 28% were Hispanic, and the remaining were white/other. After multivariable adjustment (see table), pre-pregnancy hypertension had the strongest association with preeclampsia (OR 7.81; 95% CI 6.25-9.76), followed by obesity (OR 1.67; 95% CI: 1.41-1.99). Pre-pregnancy diabetes was not associated with preeclampsia after adjustment for obesity and hypertension (table). A higher Mediterranean-style diet score associated with lower preeclampsia odds, but it did not attenuate associations of hypertension or obesity with preeclampsia (table).

Conclusions:
Pre-pregnancy hypertension and obesity are independently associated with higher preeclampsia odds. Self-report of adherence to Mediterranean-style diet was also associated with lower preeclampsia odds, but this did not mediate risk among obese and hypertensive women. Strategies to prevent preeclampsia among high-risk women are needed.
Abstract 053: Association Of Pre-pregnancy Cardiovascular Health With Adverse Maternal And Fetal Outcomes
Authors: Wang Michael C , Freaney Priya M , Perak Amanda M , Allen Norrina B , Greenland Philip , Grobman William A , Lloyd-Jones Donald M , Khan Sadiya S
Published: May 2021

Introduction:
Individual pre-pregnancy risk factors such as obesity, hypertension, and diabetes disproportionately affect minority women and are associated with adverse maternal and offspring outcomes. However, quantification of pre-pregnancy cardiovascular health (CVH) and association with pregnancy outcomes is lacking and can help identify at-risk women and children.

Hypothesis:
Suboptimal pre-pregnancy CVH is associated with higher risk of adverse maternal and fetal outcomes.

Methods:
We conducted a cross-sectional study using the CDC Natality files, which include all pregnancies in the US that resulted in live birth or fetal death after 20 weeks. Our study sample consisted of data from singleton live births or fetal deaths to women aged 15-44 years in 2018. Four maternal metrics (body mass index, smoking, diabetes, and hypertension) were assigned 1 point each for pre-pregnancy BMI < 25.0 kg/m
2
, non-smoking, and absence of hypertension or diabetes to construct a pre-pregnancy clinical CVH score ranging from 0-4. We examined the distribution of CVH by race/ethnicity. We then quantified associations of CVH with maternal ICU admission, preterm birth (PTB), low birthweight (LBW), and fetal death using logistic regression (CVH = 4 as the referent) adjusted for maternal age, race/ethnicity, education, prenatal care, and parity.

Results:
Of 3,582,832 pregnancies in 2018, more than half of women had a suboptimal CVH score (CVH = 3: 51.8%; CVH = 2: 6.7%; CVH = 0/1: 0.4%). Suboptimal CVH score (<4) was more prevalent in non-Hispanic Black (67.8%) and Hispanic (63.1%) than in non-Hispanic White (57.2%) and Asian (36.8%) women (
Figure)
. There were consistent and inverse graded associations between CVH score of 3, 2, and 0/1 (compared with 4 as the referent) and maternal ICU admission, PTB, LBW, and fetal death (p<0.001).

Conclusions:
Pre-pregnancy clinical CVH score has strong, graded associations with adverse maternal and fetal outcomes, with disproportionate impact of suboptimal CVH in non-Hispanic Black and Hispanic women.
Abstract 059: Pre-stroke Physical Activity Is Associated With Lower Mortality Risk After Stroke In The Atherosclerosis Risk In Communities (ARIC) Study
Authors: Mediano Mauro F , Mok Yejin , Coresh Josef , Kucharska-newton Anna , Palta Priya , Lakshminarayan Kamakshi , Rosamond Wayne D , Matsushita Kunihiro , Koton Silvia
Published: May 2021

Background:
The association between pre-stroke PA and long-term stroke outcomes is still unclear. We examined the association of pre-stroke PA with adverse health outcomes after incident stroke in the ARIC study.

Methods:
We included 881 participants with incident ischemic or hemorrhagic stroke occurring between 1993-1995 and December 31
st
, 2016. Follow-up for all-cause and cardiovascular disease (CVD) mortality, CVD or recurrent stroke occurred through December 31
st
, 2017, allowing for at least 1-year of follow-up after incident stroke. Pre-stroke total and domain-specific (work, sports and leisure) PA was assessed with the modified Baecke questionnaire at the baseline visit (1987-1989) and in 1993-1995. The total PA score was calculated by summing scores at both visits. Distribution-based tertiles of the summed score were derived. Cox proportional hazards models estimated the hazard ratios of adverse outcomes by tertiles of pre-stroke PA, adjusted for demographic and clinical characteristics.

Results:
During a median follow-up of 3.1 years after incident stroke, 77% participants developed adverse outcome. Compared to low pre-stroke PA, high pre-stroke PA was associated with a lower risk of all-cause mortality (HR=0.78; 95% CI: 0.63-0.97, Table). In the analysis by domain-specific PA, the risk of all-cause mortality was lowest among participants in the highest tertile of work PA (HR; 95% CI=0.77; 0.62-0.96) and leisure PA (HR=0.72; 95% CI: 0.58 to 0.89) compared to the lowest tertiles. The risk of CVD mortality was also lower in the highest tertile of work PA (HR=0.45; 95% CI: 0.29-0.70) compared to the lowest tertile.

Conclusions:
Higher levels of total pre-stroke PA, as well as work and leisure PA, were associated with a lower risk of mortality after incident stroke. Strategies to increase lifetime PA should be encouraged to decrease long-term mortality after stroke.
Abstract 061: Comparison Of Diagnostic Methods For Diabetes Diagnosis In Patients With Heart Failure: A National Health And Nutrition Examination Survey Analysis
Authors: Ishikawa Yuta , Laing Emma M , Anderson Alex K , Zhang Donglan , Trivedi-Kapoor Rupal , Sattler Elisabeth L
Published: May 2021

Introduction:
The use of hemoglobin A1c (HbA1c) to screen for diabetes in patients with cardiovascular disease has shown low sensitivity, and the currently recommended cutoff point may leave many patients undiagnosed. The objective of the study was to examine the degree of agreement among current diagnostic methods for diabetes, including HbA1c, fasting plasma glucose (FPG), and two-hour plasma glucose (2hPG) after oral glucose tolerance test (OGTT) among community-dwelling heart failure (HF) patients.

Methods:
We included 237 HF participants (20+ years) without history of diabetes or diabetes medication use, using data from the 2005-2016 National Health and Nutrition Examination Survey cycles. Diagnostic criteria for diabetes were based on the American Diabetes Association (ADA) guidelines: (1) HbA1c ≥ 6.5%, (2) FPG ≥ 126 mg/dL, and (3) 2hPG after OGTT ≥ 200 mg/dL. The sensitivity, specificity, and Receiver Operating Characteristic (ROC) curve for HbA1c and FPG were examined against the OGTT (FPG ≥ 126 mg/dL and/or 2hPG ≥ 200 mg/dL) as the reference method.

Results:
Included participants had a mean age of 65±1 (SE) years, 45.5% were female, and 12.5% were non-Hispanic black. Among included participants, 50 patients were newly diagnosed with diabetes based on ADA guidelines. Hemoglobin A1c alone identified only 27.0% of patients, whereas the OGTT identified 90.1% of patients. The area under the ROC curve, assessing HbA1c performance for the diagnosis of diabetes defined by OGTT, was 0.76 (95% CI, 0.67-0.84). Sensitivity and specificity using the HbA1c cutoff at ≥ 6.5% were 19.1% and 97.5%, respectively. The Youden’s J statistic for HbA1c was maximized at 5.8-5.9% (69.9-64.3% sensitivity and 63.9-70.1% specificity).

Conclusion:
Our data show that identification of diabetes among HF patients was inadequate on the basis of HbA1c screening alone. Our findings suggest diabetes screening on the basis of the OGTT or an HbA1c cutoff point of 5.8-5.9%.
Abstract 063: Racial/Ethnic Differences In Blood Pressure Around The Time Of The 2016 United States General Election
Authors: Hwang Andrew Y , Cardel Michelle I , Smith Steven M
Published: May 2021

Introduction:
Politics are a major source of stress and anxiety among U.S. adults, and the 2016 U.S. general election may have led to increased psychosocial stress among different racial/ethnic populations. Psychosocial stress can manifest physiologically in elevated blood pressure (BP). Yet, little is known regarding whether this response differs among racial/ethnic groups. We sought to characterize population-level changes in BP among non-Hispanic (NH) Whites, NH Blacks, and Mexican Americans before and after the 2016 U.S. general election.

Methods:
Using cross-sectional 2015-2018 National Health and Nutrition Examination Survey (NHANES) data, we included participants aged ≥20 years with ≥1 systolic BP (SBP) and diastolic BP (DBP) measurement during the examination periods just prior to and after the election. The pre-election period was from May 2016 to October 2016 and the post-election period was from November 2017 to April 2018. Survey-weighted data were analyzed to compare mean SBP and DBP pre- and post-election, stratified by race/ethnicity. Stratified analyses were also performed on hypertension status, defined as self-report, mean BP ≥140/90, or use of ≥1 antihypertensive drug.

Results:
We included 1,060 NH Whites, 720 NH Blacks, and 223 Mexican Americans during the pre-election period and 676 NH Whites, 564 NH Blacks, and 468 Mexican Americans during the post-election period. We observed a significant increase in SBP among Mexican Americans (mean±SEM, 118±0.5 mmHg [pre-election] vs. 121.7±0.7 mmHg [post-election], p=0.005), but not among NH Blacks (126.7±0.9 mmHg vs. 128.9±0.7 mmHg, p=0.083) nor NH Whites (123±0.6 mmHg vs. 124.8±1.4 mmHg, p=0.256). DBP increased among both Mexican Americans (69.5±0.5 mmHg vs. 72.6±1.1 mmHg, p=0.022) and NH Blacks (72.2±0.8 mmHg vs. 74.9±0.6 mmHg, p=0.012), but not among NH Whites (70.4±0.4 mmHg vs. 72.9±1.3 mmHg, p=0.075). These effects were largely attributable to BP changes among those with hypertension (pre-election: 414 NH Whites, 350 NH Blacks, 60 Mexican Americans; post-election: 330 NH Whites, 298 NH Blacks, 156 Mexican Americans), in whom there was an increase in SBP among NH Blacks (138.8±1.3 mmHg vs. 143.7±1.7 mmHg, p=0.032) and Mexican Americans (133.9±1.1 mmHg vs. 141.9±1.5 mmHg, p=0.0002); and an increase in DBP among NH Blacks (76.2±1.2 mmHg vs. 80.8±0.9 mmHg, p=0.005). No significant changes were observed in any racial/ethnic group without hypertension.

Conclusions:
At the population-level, NH Blacks and Mexican Americans had increases in BP following the 2016 U.S. general election, largely driven by BP elevations among those with hypertension. Patient-level data, especially linked with political affiliation, may provide additional insights into the psychosocial stress effect of major political events.
Abstract 064: Prevalence, Risk Factors And Cardiovascular Outcomes Associated With Persistent Blood Pressure Control: The Jackson Heart Study
Authors: Tajeu Gabriel S , Colvin Calvin , Hardy Shakia T , Gaye Bamba , Bress Adam P , Jaeger Byron , Ogedegbe Gbenga , Sakhuja Swati , Sims Mario , OBrien Emily C , Spruill Tanya M , Shimbo Daichi , Muntner Paul
Published: May 2021

Introduction:
Cross-sectional studies have reported the proportion of African-American adults with controlled blood pressure (BP) at a single time point, but few data are available on the proportion that maintains controlled BP over time and the extent to which it is associated with cardiovascular disease (CVD) risk.

Methods:
We analyzed data from 1,414 African-American Jackson Heart Study (JHS) participants taking antihypertensive medication to estimate the proportion with persistent BP control, defined by having controlled BP at the three JHS visits, conducted over a median of 8 years. At each visit, BP control was defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg. Follow-up for CVD events began after the third visit. We calculated risk ratios (RR) for factors associated with persistent BP control and hazard ratios (HR) for incident CVD events among participants with versus without persistent BP control.

Results:
At baseline, 76.5% (n=1,081) of participants had controlled BP, among which 64.4% (n=696) had persistent BP control. Overall, 49.2% (n=696) of participants had persistent BP control. After adjustment for sex, participants ≥65 compared with <65 years of age were less likely (RR; 95% CI) to have persistent BP control (0.73; 0.64 - 0.83). After age and sex adjustment, participants were more likely to have persistent BP control if they had income ≥$25,000 a year at each study visit (1.25; 1.11 - 1.40), a high school education (1.20; 1.01 - 1.41) and health insurance (1.28; 1.05 - 1.57) at Visit 1, and visited a health professional in the past year at each study visit (1.21; 1.07 - 1.37). The multivariable adjusted HR (95% CI) comparing participants with versus without persistent BP control was 0.71 (0.45 - 1.14) for CVD, 0.85 (0.41 - 1.79) for coronary heart disease, 0.68 (0.28 - 1.64) for stroke, and 0.57 (0.33 - 0.98) for heart failure (HF) (
Table
).

Conclusions:
Less than half of JHS participants taking antihypertensive medication had persistent BP control, putting them at increased risk for CVD, particularly HF.
Abstract 067: Does BP Trajectory Across Childhood Predict Adult HTN?
The International Childhood CV Cohorts Consortium
Authors: Urbina Elaine M , Khoury Philip R , Bazzano Lydia A , Burns Trudy L , Dwyer Terence , Jacobs David R , Juonala Markus , Prineas Ronald J , Raitakari Olli T , Sinaiko Alan , Steinberger Julia , Venn Alison , Woo Jessica G
Published: May 2021

The relationship between single measures of systolic blood pressure (SBP) in youth and adult levels is weak. We sought to define trajectories of SBP over childhood to determine ability to predict adult hypertension (HTN). In the International Childhood CV Cohort (i3C) Consortium, we constructed SBP trajectories in 11,482 participants (mean age 8.0 + 2.0 years at time of first measure, 47% male, 25% non-Caucasian) who had at least 3 SBPs in youth between the ages of 4 and <20 years assessed with at least 5 years between measures. To account for differences in normal BP by age, sex and height, trajectories were constructed using SBP percentile as defined by the 2017 Clinical Practice Guideline for BP management in youth. We then assessed HTN status (by survey) at mean age 46.7 years in 5,357 of the participants (mean age at first assessment 8.1 + 1.9 years, at self-assessment of HTN 46.7 + 5.7 years. 41% male, 23% non-Caucasian). SAS Proc Traj was employed to construct models with differing numbers of trajectories where all individual trajectories were significant (whether linear, quadratic or cubic). Model fit for each number of trajectories (up to 9) was assessed and trajectories were examined for clinical relevance. The final model selected included 6 trajectories. The prevalence of adult HTN was lowest in the group with low SBP across childhood and adolescence (Low-Low = 20%) and was highest in the group with persistently high SBP (High-High, 49%, chi square <0.001). At first assessment, participants in the High-High group were slightly older (8.7 vs 7.7 years), heavier (BMI 65.2 vs 45.1%), had higher BP (112/61 vs 90/48 mmHg; 27% vs 86% for SBP) and, higher Tchol, LDL, TG, Insulin, Glucose and lower HDL although means were within normal limits (all p<0.001). We conclude that trajectories of BP across childhood may identify youth at high risk for development of HTN in adulthood.
Abstract 070: Community-based, Cluster Randomized Controlled Trial Increases Physical Activity In Diverse, Low Income Older Adults Over 2-year Period
Authors: Crist Katie , Tuz Zahra Fatima , Full Kelsie M , Jankowska Marta M , Natarajan Loki
Published: May 2021

Objective:
Older adults are the least active population group in the U.S. Low income and ethnically diverse communities have fewer physical activity (PA) related resources and facilities, which contributes to lower PA levels and disparities in cardiovascular (CVD) risk factors and disease outcomes. This study assessed the hypothesis that low income and diverse older adults participating in the multilevel Peer Empowerment Program 4 Physical Activity (PEP4PA) would increase moderate-to-vigorous PA (MVPA), improve blood pressure (BP), perceived quality of life (PQoL), and depressive symptoms to a greater extent than older adults receiving usual senior center programming.

Methods:
In a cluster-randomized controlled trial (RCT) in 12 senior centers, 476 older adults (mean age 71.4 years, 76% female, 60% low income, 38% minority) were assigned to a PA intervention (n=267) or control (n=209) condition. The peer-led intervention included individual self-monitoring and counseling, group walks and social support, and community advocacy to improve walking conditions. Outcomes included minutes of MVPA per day (7-day accelerometer), systolic and diastolic BP (automatic cuff), PQoL (PQoL-20) and depressive symptoms (CES-D 10) at baseline, 6, 12, 18 and 24 months. To account for multiple measurement days and clustering of participants within senior centers, mixed effects regression models with random effects estimated the intervention effects on all outcomes between groups over time. Models were adjusted for imbalanced baseline covariates. A three-way interaction term assessed whether intervention effects differed by income status.

Results:
Compared to the control group, intervention participants significantly increased MVPA from baseline at 6, 12, 18 and 24 months by 8, 11, 9 and 9 minutes/day respectively (p<0.001), with increases remaining statistically significant across the 2-year period. The intervention group significantly increased mean PQoL scores from 7.2 at baseline to 7.6 (p<0.001), 7.8 (p=0.008) and 7.7 (p<0.001) at 12, 18 and 24 months, compared to control participants. No significant effects were observed for BP or depressive symptoms. Low income participants decreased minutes of MVPA, compared to higher income participants, at 12 and 24 months (β=-7.9, p=0.008 and β=-10.8, p=0.001).

Conclusions:
The multilevel RCT achieved sustained increases in MVPA and QoL in a diverse cohort of older adults across 2 years of follow up. The peer-led, community-based intervention provides a sustainable model to improve health behaviors related to CVD in an at-risk and often difficult to reach aging population. Further exploration is needed to understand what components of the intervention may be modified to address the differential effects by income status.
Abstract 071: Ten-year Change In Tv Viewing Is Associated With Concurrent Change In Pericardial Adipose Tissue In Middle-aged Adults: The Coronary Artery Risk Development In Young Adults (CARDIA) Study
Authors: Oh Minsuk , Gabriel Kelley Pettee , Jacobs David R , Terry James G , Ding Jingzhong , Carr John J , Robinson Jennifer G , Bao Wei , Whitaker Kara M
Published: May 2021

Introduction:
Pericardial adipose tissue (PAT), an ectopic adipose depot surrounding the coronary arteries, is a pathogenic risk factor for cardiometabolic disease; however, the association of sedentary behavior with PAT is poorly understood. We examined the longitudinal association of 10-year change in TV viewing with concurrent change in PAT.

Hypothesis:
Increased h/day of TV viewing over 10 years are associated with larger mean increases in PAT during the same 10-year period.

Methods:
Middle-aged adults (N=1659, mean age=40.4, 912 females, 733 blacks) from the Coronary Artery Risk Development in Young Adults (CARDIA) Study at the exam years 15 (2000-2001) and 25 (2010-2011) were included. Both TV viewing (h/day) and the volume of PAT (mL) were measured at Years 15 and 25 using the CARDIA physical activity questionnaire and computed tomography, respectively. Covariates measured at year 15 included PAT, sociodemographic factors, cardiovascular disease risk factors, diet quality, TV viewing, moderate-to-vigorous intensity physical activity (MVPA), inflammatory cytokines, and waist circumference. Multivariable linear regression was used to estimate 10-year change in PAT across increasing tertiles (≤ -1, > -1 to < 1, ≥ 1 h/day) of 10-year changes in TV viewing.

Results:
On average, TV viewing and PAT increased between the two exam years by 0.2 h/day (8.7% increase, mean: 2.3 → 2.5 h/day) and 11.8 mL (25.9% increase, mean: 45.6 → 57.4 mL), respectively (all p < 0.01). In the fully adjusted model including MVPA and other major confounders, the highest tertile of 10-year change in TV viewing was associated with greater change in PAT (β = 2.97 mL, p < 0.01) when compared with the lowest tertile (see
Figure 1
), while mean PAT change was intermediate in the middle tertile.

Conclusions:
A greater 10-year increase in TV viewing is associated with a greater concurrent increase in PAT, independent of MVPA and other important confounders. Reducing TV viewing time may be associated with less PAT accumulation with age.
Abstract 073: Physical Function And Subsequent Risk Of Cardiovascular Events In Older Adults: The Atherosclerosis Risk In Communities (ARIC) Study
Authors: Hu Xiao , Mok Yejin , Ding Ning , Sullivan Kevin , Lutsey Pamela L , Schrack Jennifer , Palta Priya , Matsushita Kunihiro
Published: May 2021

Background:
Reduced physical function, an exemplary phenotype of aging, has been associated with cardiovascular disease (CVD). However, few studies have comprehensively investigated the association of physical function with risk of incident and recurrent CVD in community-dwelling older adults.

Methods:
Physical function, evaluated with the Short Performance Physical Battery (SPPB), was assessed in the ARIC study at visit 5 (2011-2013) among 5548 participants (mean age 75±5 years, female 58%, black 22%). The SPPB score was categorized into low (0-6), intermediate (7-9), and high (10-12) physical function. We assessed the associations of SPPB categories with composite and individual outcomes of coronary heart disease (CHD), stroke, or heart failure (HF) using Cox proportional hazards models adjusting for potential confounders. We also evaluated improvement in c-statistics by adding SPPB to covariates.

Results:
During a median follow-up of 6.2 years, there were 821 composite events (329 CHD, 226 stroke, and 467 HF cases). Compared to high SPPB score, low and intermediate SPPB score were robustly associated with higher risk of the composite CVD outcome (hazard ratio [HR] 1.59 [95% CI 1.29-1.95] and 1.32 [1.12-1.56], respectively) (Table). These associations were largely consistent between participants with and without a history of CVD at baseline. Among individual outcomes, low SPPB score showed the highest HR for stroke, whereas intermediate SPPB score was only significantly associated with HF. The addition of SPPB significantly improved c-statistic for composite outcome (Δc-statistic 0.006 [95% CI 0.002-0.009]), and the improvement was especially evident in participants without history of CVD (Δc-statistic 0.013 [0.003-0.023]).

Conclusions:
Lower physical function was robustly associated with the risk of CVD and improved its prediction beyond established predictors in older adults. Clinicians should pay attention to physical function when managing CVD risk in older adults.
Abstract 074: Familial Dementia Versus Healthy Lifestyle On The Risk Of Dementia
Authors: Brellenthin Angelique , Lee Duck-chul , Lefferts Elizabeth , Song Bong kil , Kim Youngwon
Published: May 2021

Introduction:
Familial dementia (FD) is one of the strongest risk factors for dementia. Little is known about the independent and combined associations of having FD and following a healthy lifestyle with the risk of dementia.

Hypothesis:
We hypothesized that FD and a healthy lifestyle would be independently associated with the risk of dementia and that a healthy lifestyle would attenuate the risk of dementia among those with FD.

Methods:
Participants were 302,239 men and women aged 60±5 years who completed a baseline examination between 2006-2010 as part of the UK Biobank study. Participants with dementia at baseline were excluded. FD was defined as dementia in a first-degree relative (i.e., mother, father, or siblings). For healthy behaviors, participants were given one point for each of the following: not having obesity (body mass index <30 kg/m
2
); ≥150 min/wk of moderate-to-vigorous physical activity; sleep duration between 6-9 hr; drinking in moderation (>0 to ≤14 or 7 drinks/wk for men or women, respectively); not smoking; and following a healthy diet (e.g., more fruits and vegetables; less processed meats and refined grains). Participants were categorized on whether they had ≤2 (reference), 3, 4, 5, or 6 healthy behaviors. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) of incident dementia (according to hospital inpatient records and death registry) by FD and number of healthy behaviors. In a joint analysis, participants were categorized based on reporting FD and following ≥3 behaviors. Models were adjusted for age, sex, race, education, socioeconomic status (Townsend deprivation index), hypertension, hypercholesterolemia, diabetes, and depression, with mutual adjustment for healthy behaviors and FD.

Results:
During an average follow-up of 8 years, 1698 (0.6%) participants developed dementia. Compared to ≤2 healthy behaviors, the HRs (95% CI) were 0.70 (0.57-0.86), 0.58 (0.48-0.70), 0.58 (0.48-0.70) and 0.49 (0.39-0.60) for 3, 4, 5, or 6 behaviors, respectively, after adjusting for the confounders including FD. Compared to no FD, HR (95% CI) of dementia was 1.72 (1.53-1.93) among those with FD after adjusting for the confounders including healthy behaviors. In the joint analysis, compared to those with “FD and ≤2 healthy behaviors”, the HRs (95% CI) for dementia were 0.65 (0.42-0.99), 0.74 (0.47-1.15), and 0.37 (0.25-0.56) for those with “FD and ≥3 behaviors”, “no FD and ≤2 behaviors”, and “no FD and ≥3 behaviors”, respectively.

Conclusions:
Adopting more healthy behaviors was associated with reduced risk of dementia, independent of FD. In those with FD, adopting at least 3 healthy behaviors may help reduce the risk of developing dementia.
Abstract 075: Differences In Body Composition At Baseline And In Response To Exercise Training By Metabolic Health And Weight Status
Authors: Jones Alexis , Barber Jacob L , Skinner James S , Bouchard Claude , Sarzynski Mark A
Published: May 2021

Background:
Body composition is known to differ across metabolic health and weight phenotypes. Regular exercise improves body composition, yet little is known about differences in exercise response across metabolic health and weight phenotypes.

Methods:
Normal weight (n=376) and overweight/obese (OWOB) adults (n=456) from the HERITAGE Family Study (56% female, 38% Black) completed a 20-week endurance training program. Four groups based on baseline BMI and metabolic risk were created: metabolically healthy normal weight, MHNW; metabolically unhealthy normal weight, MUNW; metabolically healthy OWOB, MHO; and metabolically unhealthy OWOB, MUO. Unhealthy was defined as having ≥2 metabolic syndrome components. General linear models tested for differences in baseline and change in measures of body composition (fat mass [FM], fat-free mass [FFM], % body fat [%BF], visceral fat) after adjusting for age, sex, and ethnicity (and baseline value in change models).

Results:
Table 1 shows adjusted mean baseline and change in body composition values by group. Baseline body composition tended to track with weight status, with NW adults having lower FM, %BF, and visceral fat compared to obese adults (p<0.05), regardless of metabolic health. However, the MHO group had lower baseline values of these traits compared to MUO (p<0.05). Body composition measures significantly improved with exercise training in all groups, however, the magnitude of change differed between groups. For example, both NW groups had larger decreases in %BF compared to the obese groups, with MUNW showing the largest decrease. Conversely, MHNW showed the largest decrease in visceral fat, which was greater than both obese groups, but change in visceral fat was similar between MHO and MUNW.

Conclusions:
Normal weight adults tended to have better body composition profiles at baseline and larger improvements with exercise compared to obese adults, regardless of metabolic health. Within weight groups, body composition improved regardless of metabolic health status.
Abstract 076: Longitudinal Trajectories And Predictors Of County-level Cardiovascular Mortality In The United States (1980-2014)
Authors: Rao Shreya , Hughes Amy E , Ayers Colby , Das Sandeep R , Halm Ethan A , Pandey Ambarish
Published: May 2021

Introduction:
CV mortality has declined over 4 decades in the U.S. However, whether declines have been uniformly experienced across U.S. counties, and predictors of CV mortality trajectory are not known.

Methods:
County-level mortality data from 1980-2014 was obtained from the National Center for Health Statistics. We used a
ClustMix
approach to identify 3 distinct county phenogroups based on mortality trajectory. Adjusted multinomial logistic regression models were constructed to evaluate the associations between county-level characteristics (demographic, social, and health status) and CV mortality trajectory-based phenogroups.

Results:
Among 3,133 counties, there were parallel declines in CV mortality in all groups (Fig.1A). High-mortality counties were located in the South and parts of the Ohio and Mississippi River valleys (Fig. 1B). County phenogroups varied significantly in social characteristics such as non-white proportion (low vs. high mortality: 12% vs. 27%), high-school education (11% vs. 20%), and violent crime rates (.01 vs. 0.3/100 population). Disparities in health factors were also observed with higher rates of smoking, obesity, and diabetes in the high (vs. low) mortality groups. A substantial collinearity was observed between social and health factors. In adjusted analysis, social, environmental, and health characteristics explained 56% variance in the county-level CV mortality trajectory. Education status (OR [95% CI]=12.4 [9.4-16.3]), violent crime rates (OR [95% CI] =1.6 [1.3-1.9]), and smoking (OR [95% CI] = 3.9 [3.1- 4.9]) were the strongest predictors of high mortality trajectory phenogroup membership (ref: low mortality).

Conclusions:
Despite a decline in CV mortality, disparities at the county-level have persisted over the past 4 decades largely driven by differences in social characteristics and smoking prevalence. This highlights the need for multi-domain interventions focusing on safety, education and public health to improve county-level disparities in CV health.