bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P538: Abnormal Serum Potassium is Associated With Risk of Chronic Kidney Disease Progression and All-Cause Mortality in Patients With Chronic Kidney Disease
Authors: O'Connell Samantha , Stefanescu Andrei R , Cueto Jenilee , He Hua , Chen Jing , Grams Morgan , Anderson Amanda H , He Jiang , Mills Katherine T
Published: March 2023

Introduction:
Chronic Kidney Disease (CKD) is a major risk factor for end-stage renal disease (ESRD) and premature death. It remains unclear if abnormal serum potassium is associated with CKD progression. We assessed the prospective relationship between serum potassium with both CKD progression and all-cause mortality among participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study.

Methods:
The CRIC study is a prospective cohort study of 3,939 participants with CKD from seven locations in the United States. Serum potassium was calculated as the cumulative mean from serum samples collected at baseline and annual follow-up visits prior to developing an event. Clinical cut points were used to group serum potassium: hypokalemia (<3.5 mmol/L), normokalemia (≥3.5 and ≤5.0 mmol/L), and hyperkalemia (>5.0 mmol/L). Kidney disease progression was defined as either incident end-stage renal disease or a 50% decline in estimated glomerular filtration rate (eGFR) from baseline. Cox proportional hazards models were used to examine the associations between serum potassium and CKD progression and all-cause mortality adjusting for baseline age, sex, race/ethnicity, education, clinic site, body mass index, cigarette smoking, alcohol drinking, physical activity, history of diabetes, hypercholesterolemia, and cardiovascular disease, use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, use of diuretics, use of other antihypertensive medications, and eGFR.

Results:
CRIC patients had a mean age of 57.7 years, were 45.1% female, and 41.9% Non-Hispanic Black. The prevalence of hypokalemia and hyperkalemia was 2.5% and 7.3%, respectively. Over an average 6.5 and 11.0 years of follow-up for CKD progression and all-cause mortality, respectively, 1,784 CKD progression events and 1,621 deaths occurred. Hypokalemia had a hazard ratio (HR) of 1.65 [95% confidence interval (CI): 1.25-2.10; p=.0004] for CKD progression compared with normokalemia. Similarly, hyperkalemia had a HR of 1.76 (95% CI, 1.50-2.06, p<.0001) for CKD progression compared to normokalemia. The HR for all-cause mortality were 1.57 (95% CI, 1.13-2.18; p=.0066) for hypokalemia compared with normokalemia, and 1.43 (95% CI, 1.19-1.72, p=.0001) for hyperkalemia compared with normokalemia, after multivariable adjustment.

Conclusions:
Our study found that abnormally high and low serum potassium is associated with increased risk of CKD progression and all-cause mortality. These findings suggest that interventions that maintain serum potassium levels in the normal range may reduce the risk of CKD progression and premature death among patients with CKD.
Abstract P541: Trends in Initiation of Anticoagulation for Atrial Fibrillation in the Early Months of the COVID-19 Pandemic
Authors: Yang Lanting , Tang Shangbin , He Meiqi , Guo Jingchuan , Gabriel Nico , Swabe Gretchen , Gellad Walid , Essien Utibe R , Saba Samir , Benjamin Emelia J , Magnani Jared W , Hernandez Inmaculada
Published: March 2023

Introduction:
Oral anticoagulation (OAC) is the treatment of choice to prevent stroke in patients with atrial fibrillation (AF). We evaluated changes in OAC initiation in newly diagnosed AF after the onset of the COVID-19 pandemic.

Hypothesis:
We hypothesized that individuals newly diagnosed with AF in the early months of the COVID-19 pandemic would be less likely to initiate OAC than those with incident AF before the pandemic.

Methods:
We selected individuals with incident AF in 01/01/2016 - 09/30/2021 from Optum’s de-identified Clinformatics® Data Mart Database. AF was defined by having ICD-9 code 427.31 or ICD-10 codes I48.0, I48.1, I48.2, or I48.91 at the first or second diagnosis field. For every 30-day period. We measured the proportion of individuals newly diagnosed with AF initiated OAC within 30 or 180 days of diagnosis. As secondary outcomes, we evaluated the initiation of warfarin and of direct oral anticoagulants (DOACs) individually. We constructed interrupted time series analyses to examine changes in the level and trend of OAC initiation following the onset of the COVID-19 pandemic, defined by the date of the World Health Organization declaration (3/11/2020).

Results:
The study sample included 573,524 individuals (age 73± 11 years, 48% female sex, 85% Medicare beneficiaries). Although initiation of OAC and DOAC increased in 01/01/2016-09/30/2021 (Figure), there were no significant changes associated with the onset of pandemic (all P>0.05). Rates of warfarin initiation decreased over time, from 9.7% in year 2016 to 1.9% in year 2021.

Conclusion:
There were no significant changes in the initiation of OAC immediately after the onset of the COVID-19 pandemic among patients newly diagnosed with AF during this time.
Abstract P559: Evaluating Geographic Variation in Hypertension in Urban Haiti: Findings From the Haiti Cardiovascular Disease Cohort Study
Authors: Rasul Rehana , Rouzier Vanessa , Yan Lily D , Sufra Rodney , Sabwa Shalom , Mourra Nour , Deschamps Marie , Pape Jean , Nash Denis , Mcnairy Margaret
Published: March 2023

Introduction:
Hypertension (HTN) is the leading cardiovascular risk factor in low-income countries including Haiti. Understanding blood pressure (BP) variation at the individual, neighborhood and population levels may help target interventions for multi-level risk reduction. This study aims to identify systolic BP (SBP) and diastolic BP (DBP) variation by neighborhood census blocks in Port-au-Prince to determine if this level should be targeted for future HTN interventions.

Methods:
Using data from the Haiti Cardiovascular Disease Cohort (March 2019-August 2021), a population-based cohort of Haitians ≥ 18 years, HTN was defined as SBP ≥140 mmHg or DBP ≥80 mmHg. Census blocks were defined as geographic areas of approximately 100-200 residential buildings per the Haitian Institute of Statistics. The geographic distribution of SBP and DBP was mapped based on household location. The proportion of SBP and DBP variation in block membership was calculated using intra-class correlations (ICC) from linear mixed models.

Results:
Among 2,972 participants, median (IQR) age was 40 (28-55) years and 57.6% were female. HTN prevalence was 33.0% and median (IQR) SBP and DBP were 120 (108-140) mmHg and 73.0 (64.0-85.0) mmHg, respectively. No distinct geographic pattern was present for SBP or DBP across blocks (Figure 1). The variation of SBP was 0.7% and DBP was 1.0% across census block membership.

Conclusion:
HTN prevalence in urban Port-au-Prince is high without a significant variation in SBP and DBP by census block. This may be due to outdated census data, crossover of individuals living informally across households, and/or the need for different household-level neighborhood geographic constructs such as shared household units. Moreover, these data suggest that interventions may need to target the population level, which span neighborhoods, given the uniformity of hypertension across these communities in Port-au-Prince.
Abstract P568: Osteoporosis and Cardiovascular Disease-Related Mortality Trends in the United States, 1999 - 2020
Authors: Ibrahim Ramzi , Alabagi Abdulla , Salih Mohammed , Habib Adam , Singh Vikram , Singh Simar , Ravi Soumiya , Lee Justin Z
Published: March 2023

Background:
Cardiovascular disease (CVD) and osteoporosis share common risk factors and often co-exist. In this study, we quantify CVD-related mortality trends in individuals with osteoporosis.

Hypothesis:
Among gender, racial, and geographic subgroups, disproportionate mortality rates related to CVD and osteoporosis are observed.

Methods:
We performed cross-sectional analyses using the CDC Wide-Ranging Online Data for Epidemiologic Research database to identify mortality rates from 1999 to 2020 with CVD as the underlying cause of death and osteoporosis within the multiple causes of death. Quantified measures included age-adjusted mortality rate (AAMR), average annual percentage change (AAPC), and 95% confidence intervals. Joinpoint regression (National Cancer Institute) was used for AAPC calculation. Stata (StataCorp LLC) was used for data visualization.

Results:
There was a total of 70,930 deaths from 1999 to 2020. The AAMR decreased from 1.76 in 1999 to 0.40 in 2020 [p <0.05] with an AAPC of -6.8%. There were a higher AAMR among females (1.34) compared to males (0.27) [p <0.05], with a similar AAPC (-6.6% and -7.2%, respectively [p >0.05]). White populations had the highest AAMR, followed by Asian populations (0.63), then Black populations (0.28) [p <0.05]. AAPC was similar among the three racial subgroups (-6.9%, -6.8%, -4.7%, respectively [p >0.05]). Non-Hispanic (0.98) subgroups had higher AAMR than Hispanic subgroups (0.45) [p <0.05], with a similar AAPC (-6.8% and -6.6%, respectively [p >0.05]). Non-metro regions (1.17) had higher AAMR compared to metro regions (0.9) [p <0.05], with a similar AAPC (-5.8% and -7.2%, respectively [p >0.05]). The Midwest (1.19) had the highest AAMR, followed by the West (1.13), South (0.80), and the Northeast (0.74) [p <0.05]. AAPC was similar among all US regions (-6.4%, -6.6%, -8.3%, and -6.4%, respectively [p >0.05]).

Conclusion:
Disparities related to CVD and osteoporosis related mortality exist among gender, racial, and geographic subgroups within the United States.
Abstract P574: Does Being Multiracial Matter for Chronic Disease? An Evaluation of Differences in Obesity by Multiracial Subgroups in the U.S.
Authors: Jones-Antwi Rebecca E , Aguayo Liliana , Poveda Rey Natalia , Argeseanu Cunningham Solveig
Published: March 2023

The multiracial population is considered the fasted growing population in the United States. In 2020, the percentage of people who reported multiples races changed more than all of the single race groups, increasing from 2.9% of the population (9 million people) in 2010 to 10.2% of the population (33.8 million) in 2020. Each multiracial subgroup has unique social and political histories that may lead to distinct social perceptions, economic situations, and health outcomes. We hypothesized that there is a multiracial distinction in the prevalence of obesity. On average multiracial respondents will have better or worse than both single-race component groups. We assessed whether the patterns of obesity of adults who identify as multiracial are distinctive from that of adults who identify a single-race identity, by using a three-year (2010-2012) pooled sample of the Behavioral Risk Factor Surveillance System (BRFSS). We further investigate whether the prevalence of obesity in multiracial versus single-race individuals differ among Hispanic and non-Hispanic subgroups. Results show that categorizing all multiracial individuals into one group masks the different patterns of obesity within multiracial individuals. White-Black, White-Asian, White-Native Hawaiian/Pacific Islander (NHPI), and White-American Indian adults have a prevalence of obesity in between their single-race counterparts (Figure 1, Panel A). Among Hispanics, the prevalence of obesity in White-Black and Black-America Indian adults is lower than the same categories among non-Hispanics (Figure 1, Panel B). Whereas the prevalence of obesity in White-NHPII and Asian NHPI is higher than the same categories among non-Hispanics. This study helps us address aspects of the social construction of race and the complexity in evaluation of obesity prevalence. Findings raise further questions about the usage of a homogenous multiple race categorization in national surveys.
Abstract P589: Utilization of Pulmonary Artery Sensor (CardioMEMS Device) During the Sars-CoV-2 Pandemic
Authors: Muhyieddeen Amer
Published: March 2023

Introduction:
The implantation of wireless pressure monitoring devices has allowed remote monitoring of hemodynamic data in patients with congestive heart failure. Devices such as the (CardioMEMS HF System) achieve this by remotely monitoring changes in pulmonary artery pressure, which has been shown to be a signal of worsening heart failure. The benefits of wireless pressure monitoring devices in reducing mortality and hospitalizations have been shown in clinical trial data. However, the impact of the COVID-19 pandemic on its use has not been studied. The aim of this study was to examine if the COVID-19 pandemic led to gender and race differences in in-hospital outcomes, length of stay, and total hospital charges in pulmonary artery sensor insertion.

Methods:
Data was extracted from the National Inpatient Sample database for the calendar year 2020. Patients implanted with a wireless pressure monitoring device were identified using relevant International Classification of Disease, and Clinical Modification codes. The study sample was stratified based on gender and race. The key outcomes of length of stay, total hospitalization cost, and mortality were then accessed.

Results:
A total of 485 patients were included in the final analysis. The mean age was 66.3 years, 32% (155 of 485) were female and 70% (340 of 485) were Caucasian. The overall inpatient mortality rate was 3.09% (15 of 485), 76.2% (370 of 485) of admissions were non elective, mean length of hospitalization was 14.87 days and mean total hospital charges was 349,599 US dollars. We found no association between differences in mortality rates between both gender and race. Regarding total hospital charges, there was a significant less amount of total hospital charges for females (P<0.05) but not between races. There was no significant difference between length of hospital stay for gender or race.

Conclusion:
Analysis of this large database of patients undergoing wireless pressure monitoring device implantation suggests that in-hospital mortality and length of stay were comparable in both gender and race during the first year of COVID-19 pandemic. However, females had a significantly less amount of hospital charges. Our study suggests that further randomized data is needed to fully assess gender disparities in patients implanted with wireless pulmonary artery pressure devices.
Abstract P600: Beyond Mean Glucose: Development of Novel, Reproducible Continuous Glucose Monitoring Metrics
Authors: Sartini Joseph , Fang Michael , Rooney Mary R , Aurora Rashmi (Nisha) , Punjabi Naresh , Selvin Elizabeth , Coresh Josef , Zeger Scott
Published: March 2023

Introduction:
Continuous glucose monitoring (CGM) devices record blood glucose every few minutes over a maximum 2-week wear period. Despite the richness of these data, existing first and second moment statistics (such as mean glucose) fail to capture the “shape” of variation in the CGM time-series.

Objective:
We developed novel, reproducible CGM shape metrics using functionals of the periodogram, a decomposition of CGM signal (
Figure 1A
) variance, to comprehensively characterize glucose patterns.

Methods:
We analyzed CGM data from N = 160 HYPNOS clinical trial participants with type 2 diabetes who wore CGM sensors twice, 3 months apart. We first calculated log-transformed periodograms for each person-period. To these decompositions, we fit piece-wise linear models over 3 frequency ranges: less than 1/24 hrs
-1
(long term patterns), 1/24 to 2/5 hrs
-1
(daily diet patterns), and greater than 2/5 hrs
-1
(immediate fluctuations due to food). Slopes of fit segments, value at first frequency, and values at segment midpoints were extracted as our initial metrics (
Figure 1B
). We estimated and compared the within-person test-retest correlation for our shape measures against existing CGM and glucose metrics: mean glucose, time-in-range, and HhbA1c.

Results:
The highest raw correlation among the new shape metrics (r = 0.737) was comparable to that of the existing metrics (r = 0.798) (
Figure 1C
). Even after adjusting the shape metrics for existing metrics, there was a maximum test-retest correlation of r = 0.778. The shape metrics also carried information distinct from existing metrics. According to mixed effect models fit to data from both wear periods, the shape metrics explain less than 16% of variance in any existing metric when controlled for the other existing metrics.

Conclusion:
These new shape metrics carry reproducible information distinct from that of standard CGM metrics and HbA1c. The next step is to evaluate whether these novel shape metrics, which leverage the granularity of CGM data, can be linked to clinical endpoints.
Abstract P623: Long-Term Mortality and Causes of Death After Venous Thromboembolism: The Atherosclerosis Risk in Communities Study
Authors: Kamin Mukaz Debora , Li Aixin , Lutsey Pamela L , Zakai Neil A , Guan Weihua , Folsom Aaron R , Cushman Mary
Published: March 2023

Background:
Each year in the U.S, 60,000-100,000 people die of venous thromboembolism (VTE), but little is known about mortality and causes of death over the long-term after VTE.

Hypotheses:
VTE, especially cancer-related VTE, is associated with poor long-term survival. Cancer and circulatory diseases are the main causes of death after VTE.

Methods:
Atherosclerosis Risk in Communities (ARIC) cohort participants, free of VTE at baseline (n=15,516), were followed (1986-2019) to identify first-time VTE (classified as unprovoked, cancer-provoked, or other-provoked, e.g., after surgery) and deaths. ICD10 codes were used to define cause of death. The proportion who died for each cause of death after first VTE, by type of VTE, was tabulated. Hazard ratios (HRs) of death by type of VTE were estimated with Cox proportional hazards models adjusted for age, race, gender, and pre-baseline cancer. Survival rates were visualized by adjusted survival curves.

Results:
Over a maximum follow-up of 33 years, 1,076 participants had first-time VTE; 441 were unprovoked, 271 were cancer-provoked, 364 were other-provoked. Mean age at first VTE was 74. After unprovoked VTE, 37% died of circulatory diseases (excluding VTE) and 13% of cancer. Those values were 35% and 13% for other-provoked VTE. By contrast, for cancer-provoked VTE, 80% died of cancer and 10% of circulatory diseases (excluding VTE). In the
Figure
, those with VTE had poorer long-term survival than 14,400 participants without VTE, and cancer-provoked VTE had the highest mortality. Overall, the HR of death was 2.75 (95% CI: 2.49-3.05) for those with vs without VTE. Those with cancer-provoked VTE had the highest HR, 10.02 (95% CI 8.81-11.40), but those with unprovoked and other-provoked VTE also had higher mortality than those without VTE.

Conclusions:
In this study, long-term survival after VTE was poor. Apart from cancer-provoked VTE, circulatory diseases were the primary causes of death after VTE. Optimizing cardiovascular prevention could improve long-term survival of patients with VTE.
Abstract P626: Associations of Supervised and Home-Based Exercise With Serious Adverse Event Rates During Exercise Interventions for Peripheral Artery Disease: A Meta-Analysis of Five Randomized Clinical Trials
Authors: Thangada Neela , Xu Shujun , Tian Lu , Zhao Lihui , McDermott Mary M
Published: March 2023

Background:
Supervised or home-based walking exercise therapy (ET) are guideline recommended to improve walking performance in people with peripheral artery disease (PAD). This study compared serious adverse event (SAE) rates associated with home-based compared to supervised exercise in people randomized into clinical trials of ET for PAD.

Methods:
Data from five randomized clinical trials of ET for PAD were combined. In three trials (GOALS, HONOR, and LITE), participants were randomized to home-based ET or control. In two trials (PROPEL and TELEX), participants were randomized to supervised ET or control. The primary outcome in all trials was change in six-minute walk. SAEs consisted of hospitalization or death and were identified from participants, family members, and medical records. In post-hoc analyses, a meta-analysis compared associations of supervised ET and home-based ET on odds of a SAE or death. Control groups from the trials of supervised and home-based ET were not combined.

Results:
867 unique participants were included (mean age + SD: 69 ±10 years, 47% female, 57 % Black, mean + SD ABI 0.66 ±0.15). Results are shown in the Table.

Conclusion:
In clinical trials of home-based ET, rates of coronary revascularizations and cardiovascular events were significantly higher in participants randomized to exercise, compared to control. However, there were no significant differences in rates of coronary revascularizations or cardiovascular events between participants randomized to home-based, compared to supervised ET. Improved walking performance from home-based exercise may precipitate symptoms from underlying coronary artery disease in people with PAD.
Abstract P628: The Right Dose for the Right Patient - High Intensity Rosuvastatin Dosing in Patients With Chronic Kidney Disease
Authors: Zitelny Edan , Hickey Robert , Sanghavi Monika
Published: March 2023

Introduction:
The utilization of high intensity statins for lipid lowering therapy has revolutionized our approach to decreasing the incidence of myocardial infarction. In February 2003, rosuvastatin was approved by the FDA for use at dosages ranging from 5mg to 40mg daily, with lower doses recommended for patients with reduced glomerular filtration rates (GFRs). Prescribing patterns of rosuvastatin for patients with chronic kidney disease (CKD), notably those with a GFR < 30 mL/min/1.73m
2
, is largely unstudied.

Methods:
A single center retrospective study of all admitted patients with a chart diagnosis of chronic kidney disease (CKD) over the course of one year was performed. Data on inpatient rosuvastatin orders and overall statin selection was collected and analyzed.

Results:
Between 10/1/2021-10/1/2022, a total of 5359 patients were admitted with the diagnosis of CKD. In this cohort, 62% (n = 3325) had a prescription for a statin placed for continuation of outpatient care or new initiation of lipid lowering therapy. Most patients were on atorvastatin (69.4%, n = 2310) or rosuvastatin (20.9%, n = 695). Among inpatients with CKD, a total of 1465 inpatient rosuvastatin orders were placed. Almost 32% (n = 468) of these patients had an eGFR <30 mL/min/1.73m
2
. Of this cohort, 48% (n = 223) were prescribed doses of 20mg or 40mg rosuvastatin daily, which is above the FDA recommended dose for this population (
Figure 1
).

Conclusions:
A large percentage of patients on lipid lowering therapies have CKD, and data regarding renal outcomes associated with high doses of statins in this population are limited. In this large single center study, we found that nearly half of patients with eGFR <30 mL/min/1.73m
2
were on inappropriately high doses of rosuvastatin when considering their kidney function. Further research into long term outcomes and rosuvastatin dosing in this patient population is needed.
Abstract P629: Influenza Vaccine Uptake is Associated With Cholesterol Treatment Adherence: An Analysis of the Behavioral Risk Factor Surveillance System Survey
Authors: Slavin Samuel D , Berman Adam N , Gaba Prakriti , Hoshi Rosangela A , Mittleman Murray A
Published: March 2023

Introduction:
Misinformation, distrust, and other sociocultural factors that influence vaccine uptake may also influence adherence to cholesterol treatment.

Hypothesis:
Among American adults with hyperlipidemia, individuals who receive influenza vaccination are more likely to report use of cholesterol lowering medication.

Methods:
We pooled 2017 and 2019 survey data from the Behavioral Risk Factor Surveillance System (BRFSS). Our sample included all respondents aged 40 to 75 years with self-reported high cholesterol. We used logistic regression models adjusted for potential confounders to examine the association between influenza vaccine uptake and use of cholesterol medication. We also evaluated whether the association was different among those with and without established atherosclerotic cardiovascular disease (ASCVD). All analyses accounted for survey weighting.

Results:
Of 228,338 (weighted = 107,893,277) participants with hyperlipidemia, 51% reported influenza vaccination and 61% reported taking cholesterol medication. Vaccine uptake was associated with cholesterol medication use (OR 2.08, 95% CI 2.00-2.16, p <0.001). Although slightly attenuated, this association persisted after adjustment for socio-demographics, access to care, comorbidities, and adherence to hypertension treatment (OR 1.53, 95% CI 1.42-1.65, p-value <0.001). The association was similar in those with ASCVD (OR 1.63, 95% CI 1.32-2.03, p-value <0.001) and those without ASCVD (OR 1.52, 95% CI 1.40-1.64, p-value <0.001), p-value for interaction = 0.89.

Conclusions:
Influenza vaccine uptake is associated with cholesterol medication use among American adults with high cholesterol, including those with ASCVD. The sociocultural factors affecting vaccine avoidance, such as misinformation and distrust, merit investigation as potential targets of cardiovascular prevention efforts.
Abstract P641: Gaming the Way to Cardiovascular Health in Nepal: A Digital Approach in Adolescents
Authors: Shakya Dayana , Flodin Karin , Thapa Dip Raj , Bankler Jon Victor , Bai Hua , Wilhelmsson Ulf , Subedi Madhusudan , Ng Nawi , Oli Natalia , Vaidya Abhinav , Backlund Per , Krettek Alexandra
Published: March 2023

High prevalence of behavioral risk factors for cardiovascular disease (CVD) warrants a life course approach for efficient prevention. Our previous HARDIC trial in semi-urban Nepal shows conventional CVD educational interventions for mothers improved knowledge, attitude, and practice (KAP). Digital cardiovascular health promotion provides opportunities to efficiently reach adolescents. Our aim was therefore to develop such digital health promotion through a serious game that is educational and entertaining, as an innovative way to reach adolescents. We conducted a mixed-method study to assess adolescents’ KAP and perception regarding CVD, explored opportunities for digital cardiovascular health promotion, and developed a concept for a serious game prototype. In total, 649 adolescents grades 8-10 in two government and seven private schools in a semi-urban community of Nepal were surveyed cross-sectionally following parental consent. A self-administered questionnaire assessed KAP of CVD, mobile phone use, internet availability at home and gaming behaviors. For deeper understanding of adolescents’ perception on CVD, we conducted eight focus group discussions (FGDs) separately among boys and girls (n=76). The health belief model and the technology acceptance model guided FGD development and analysis. Eighty percent of adolescents were aged 13-15 years, 49% were girls and 40.4% studied in government schools. The median (IQR) percent scores for KAP were 70.6 (10.59), 78.5 (8.46) and 69.5 (11.59), respectively. Good KAP (median percent scores >75%) was found in 27.7%, 69% and 27.8% adolescents, respectively. Knowledge (
p
<0.001), attitude (
p
=0.025) and practice (
p
<0.001) was higher among adolescents in private than government schools. Girls had better attitude than boys (<0.001). Furthermore, 98% adolescents had smartphone access and 91.6% had internet access.Preliminary FGD analyses show that adolescents mentioned physical, nutritional, mental, environmental, and hereditary causes for CVD. Financial and work-related burdens, as well as psychological, mental and family-related issues were perceived to influence CVD severity. Temptations for junk food and physical inactivity were barriers to follow heart-healthy behavior. Adolescents perceived serious games as beneficial and easy to use for creating CVD awareness. The game should offer challenge and exhibit increased levels of difficulty to remain stimulating throughout its intended use.We conclude that the existing gaps in knowledge and practice, with good attitude and excellent mobile and internet prerequisites, provide great opportunity for serious games in Nepal.

The prototype of “Happy Heart” is being pilot-tested among adolescents, suggesting a promising way forward for digital cardiovascular health promotion.
Abstract P644: Engagement With a Weight Loss Program for Postpartum Individuals at Elevated Cardiovascular Risk: A Qualitative Study
Authors: Bediako Hilary , Allison Kelly , Leahey Tricia , Stupp Sarah , Riis Valerie , Levine Lisa , elovitz michal , Shea Judy , Lewey Jennifer
Published: March 2023

Background:
Rising rates of postpartum obesity increase risk for cardiovascular (CV) disease, especially among individuals with adverse pregnancy outcomes. Engagement in weight loss programs (WLP) have not been well studied in the postpartum period. Our objective was to understand barriers to engagement in an online behavioral WLP among a racially diverse postpartum population with CV risk factors.

Methods:
We conducted a qualitative study of participants enrolled in a clinical trial. We identified individuals who were 3-12 months postpartum, had a body mass index ≥ 27 kg/m2, and had ≥1 of the following: chronic hypertension, hypertensive disorder of pregnancy, gestational or pre-gestational diabetes. We randomized 60 subjects 1:2 to usual care or online WLP based on the Diabetes Prevention Program. We conducted semi-structured virtual interviews with participants in the WLP who completed final assessments to understand barriers to and facilitators of program engagement. Interviews were recorded and transcribed, a codebook was developed iteratively with concurrent interrater reliability assessment, and themes were identified using content analysis.

Results:
Of 26 eligible participants, 20 completed interviews (77%). Mean age was 35 years and 45% were Black. Common barriers to program engagement were a lack of time due to competing life priorities and stressors, coupled with insufficient program personalization and peer support (see Table). In terms of facilitators, participants discussed intentionality, creating a routine to complete program requirements (e.g., daily morning weights) and specific aspects of the program structure (e.g., weekly feedback) as playing important roles in maximizing program engagement.

Conclusion:
Participants identified several opportunities to improve program engagement and weight loss success among postpartum individuals in future studies. These strategies will be critical to the implementation of future lifestyle interventions using remote technology in this population.
Abstract P646: American Indian Community Stakeholders Evaluate the Cardiovascular Health Curriculum Honoring the Gift of Heart Health: The Strong Heart Study
Authors: Eisele Megan , Reese Jessica , Jones Aimee , Zhang Ying
Published: March 2023

Honoring the Gift of Heart Health
(HGHH) is a cardiovascular health education curriculum culturally tailored for American Indians (AI). It emphasizes adoption of cardiovascular health recommendations through lifestyle changes. The NHLBI has not revised HGHH components since 2006. Effectiveness of the HGHH may change overtime and updates may be required to influence community health behaviors. Therefore, we aimed to determine the cultural values and practices necessary for inspiring heart healthy behaviors and to make recommendations on including these values and practices in the curriculum. We used a qualitative research design and a narrative inquiry approach. Using snowball sampling, we recruited 11 AI community stakeholders in Oklahoma who participate in the Strong Heart Study. We conducted 3 focus groups with a semi-structured interview guide. We transcribed recordings and conducted a thematic content analysis (Figure 1). Participants viewed written materials as informative but the media as outdated, especially for younger generations, and suggested content ought to be dispersed through various social media. They theorized in-person activities would further educate and motivate community members to be heart healthy, thus adoption of HGHH recommendations more effective. Participants shared concerns about implementing HGHH dietary suggestions while attempting to control food costs, having time constraints, and perceiving food discussed in the program as not representative of what their communities eat. In conclusion, AI community stakeholders advise HGHH updates need to be applicable with current technology, focused on younger generations, coupled with in-person activities, and socio-economically and culturally sensitive to have the most effect. Collecting and evaluating community feedback can guide the development of appropriate updates to the HGHH curriculum.

Figure 1
. Theme words identified in focus groups in colored boxes and their related code words in grey boxes.
Abstract P653: Cardiac Rehabilitation Participation is Associated With Lower Risk of Major Adverse Cardiovascular Events Across Race or Ethnicity and Income
Authors: Garfein Joshua , Swabe Gretchen , Forman Daniel E , Magnani Jared W
Published: March 2023

Introduction:
Cardiac rehabilitation (CR) participation reduces the likelihood of major adverse cardiovascular events (MACE), but is limited by structural factors, including race or ethnicity and annual income. We investigated (1) associations between CR participation and MACE, and (2) how structural disadvantage modifies this association, focusing on the intersection between race or ethnicity and household income.

Hypotheses:
We hypothesized that (1) CR participation would be inversely associated with MACE, and (2) this association would attenuate differences in MACE by race or ethnicity, as well as by household income.

Methods:
We identified 212,744 individuals with a CR-qualifying event between 1/1/16 and 12/31/20 in Optum’s de-identified Clinformatics® Data Mart database. We evaluated associations between CR sessions attended (0 to 36) and MACE (cardiac arrest, heart failure, myocardial infarction, or stroke hospitalizations) using a proportional hazards model for recurrent events, and assessed the three-way interaction between CR participation, race or ethnicity, and household income.

Results:
We included 212,744 individuals (age 70.8±11.3 years; 37.8% female sex; 71.9% White race) of whom 26.0% attended ≥1 CR sessions. Overall, we observed a dose-response association between CR participation and MACE. After adjustment, those who did not attend CR were 2.9 times as likely to experience MACE as those who attended ≥36 sessions (95% CI: 2.71, 3.03,
P
<0.0001), for whom there were no significant differences by race or ethnicity (
Figure
). Associations between CR participation and MACE were similar both across race or ethnicity and by household income (
P
, interaction=0.28).

Conclusion:
Greater CR participation is associated with lower risk of MACE, regardless of (1) race or ethnicity and (2) household income. Because participation in CR remains low, particularly in socially disadvantaged populations, interventions to promote use of CR are critical to reduce disparities in cardiovascular outcomes.
Abstract P666: Prevalence and Determinants of Left Ventricular Structural Abnormalities and Diastolic Dysfunction in Asymptomatic Mexican Americans Living in South Texas
Authors: Lee Miryoung , Patnaik Soumya , Paul Neha M , Molina Emma , McPherson David D , McCormick Joseph B , Fisher-hoch Susan P , Laing Susan T
Published: March 2023

Left ventricular hypertrophy (LVH) and concentric LV remodeling (CR) are precursors to development of clinical heart failure (HF), and are associated with obesity, hypertension (HTN) and diabetes mellitus (DM), which are highly prevalent in Mexican Americans. Our study aimed to determine the prevalence of subclinical LV structural abnormalities (LVH or CR) and LV diastolic dysfunction (LVDD) in a sample of asymptomatic Mexican Americans in South Texas and determinants of these LV structural abnormalities.

Methods:
Demographic, cardiometabolic biomarkers, and body composition data were obtained in 1208 participants (66.3% females, mean age 53.0±0.4 years) without any CVD history from the community-based Cameron County Hispanic Cohort study. Echocardiography was used to determine LVH/CR (linear method) and LVDD was assessed using national guidelines. Those with LV systolic dysfunction (n=26) were excluded. Abdominal adiposity was determined by abdominal visceral fat mass (VAT) from dual-energy X-ray absorptiometry. Weighted ordinal logistic regression analyses were conducted adjusting for demographic and clinical covariates.

Results:
Weighted prevalence rates of LVH (16.6% ± 1.7%), CR (40.7% ± 2.0%) and LVDD (24.2% ± 1.8%) were high in this cohort. In men, age (p<0.01), obesity (p=0.04) and HTN (p<0.001) were positively related to LV abnormalities. In women, age (p<0.001), obesity (p<0.01), education (p=0.02), HTN (p<0.01) and DM (p<0.01) were related to LV abnormalities. VAT was associated with LV abnormalities in women (p=0.02), but not in men (p=0.08).

Conclusion:
More than half of this asymptomatic Hispanic cohort had evidence of LV structural abnormalities and almost a quarter had subclinical diastolic dysfunction. We noted a gender interaction, with diabetes and abdominal obesity seen to be significantly related to cardiac abnormalities only in women. Identifying subclinical changes in cardiac function in these high-risk patients may mitigate progression to clinical HF by early intervention.
Abstract P667: Association of Number of Calcified Coronary Arteries and Cardiovascular Outcomes Stratified by Calcification Volume: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Reyes Mikaila P , Allen Tara S , Criqui Michael H , Kermanshahchi Jonathan M , Denenberg Julie O , Bhatia Harpreet S
Published: March 2023

Background:
Coronary artery calcium (CAC) is a risk factor for atherosclerotic cardiovascular disease (ASCVD). Data suggests number of vessels with CAC independently improves risk prediction but impact by CAC volume remains unknown.

Methods:
Using data from 3256 MESA participants with CAC>0 and clinical follow-up, we evaluated the association between number of arteries with CAC and risk for coronary heart disease (CHD), myocardial infarction (MI), and CVD events stratified by CAC volume (above/below median) using multivariable-adjusted Cox proportional hazards models.

Results:
Mean age was 63.3 years (SD 9.5) with 1363 (41.9%) women. There were 1079 (33%) with single-vessel, 822 (25%) with 2-vessel, and 1355 (42%) with 3-4 vessel CAC. Median CAC volume was 84.7 [IQR 24.5, 267.2] mm
3
. CAC in 3-4 vessels was independently associated with higher CHD risk (
Figure
) compared to 1-vessel (HR 2.01, 95% CI 1.1-3.6; p=0.018) and 2-vessels (HR 1.69, 95% CI 1.0-2.8; p=0.04) for lower CAC volumes, with similar findings for MI and CVD outcomes (
Table
).

Conclusions:
Number of arteries with CAC independently increases risk for ASCVD events only for those with lower CAC volumes.
Abstract P670: Association of Left Atrial and Left Ventricular Sphericity With Left Ventricular Structure and Function
Authors: Mladenovik Viktoria , Dong Zhiyong , Long Ngo , Osypiuk Ewa , lehman birgitta , McManus David D , Benjamin Emelia J , Mitchell Gary F , Ramachandran Vasan S , Cheng Susan , Tsao Connie W
Published: March 2023

Introduction:
Spherical remodeling of atria and ventricles is associated with cardiovascular disease (CVD) and mortality. We hypothesized that volumetric left atrial (LA) and left ventricular (LV) sphericity index (SI) are associated with adverse measures of LV structure and function in older adults free of CVD.

Methods:
Framingham Heart Study 2nd generation participants without prevalent CVD with echocardiography at exam 8 were studied (n=1701). Volumetric LA SI was calculated as the ratio of biplane LA volume to the volume of a sphere [4/3*pi*(r^3)] calculated using the radius of LA length (r=½ average length of the atria in 4- and 2-chamber views in diastole). Volumetric LV SI was calculated as the ratio of LV end-diastolic volume (LVEDV) to the volume of a sphere calculated using the radius of LV length (r= ½ length of LV in 4-chamber view in diastole). LVEDV was measured by biplane area-length method. In multivariable models adjusting for CV risk factors including age, sex, BMI, hypertension, dyslipidemia, diabetes, and smoking, we evaluated the relations of LA and LV SI with echocardiographic LV structure and function: wall thickness (septal and posterior wall average), mass, global longitudinal strain, ejection fraction (EF), and log-transformed mitral Doppler E/A. β coefficients are presented as standard deviation (SD) change in outcome per SD change in predictor variable.

Results:
Descriptives are presented in the
Table
. There was no association of LA or LV SI with sex (p=0.48, p=0.61, respectively). LA SI was associated with worse (positive) LV global longitudinal strain (std β±SE: 0.08±0.03, p=0.016). LV SI was associated with LV wall thickness (std β±SE: 0.24±0.03, p<0.0001), mass (0.45±0.03, p<0.0001) and log-Doppler E/A (0.07±0.03, p=0.015) and was inversely associated with LV EF (-0.12±0.03, p<0.0001).

Conclusions:
In a large community sample without prevalent CVD, spherical remodeling of the heart was associated with unfavorable LV structure and both systolic and diastolic dysfunction.
Abstract P678: On the Relationship of Breast Arterial Calcification With Coronary Artery Calcification: A Pilot Study
Authors: Iribarren Carlos , Chandra Malini , Sam Danny L , Rana Jamal S , Wong Nathan S , Ding Huanjun , Molloi Sabee
Published: March 2023

Breast arterial calcification (BAC) detected in mammograms is an emerging risk-enhancing factor for atherosclerotic cardiovascular disease (ASCVD). The predictive value of coronary artery calcification (CAC) for risk of ASCVD above and beyond traditional risk factors is well-established in women. However, there are few studies that have simultaneously evaluated BAC and CAC. The Multiethnic study of breast arterial calcium gradation and cardiovascular disease (MINERVA) cohort, a large, racially and ethnically diverse cohort of postmenopausal women aged 60-69 (n=5,059) was recruited in 2012-15 at Kaiser Permanente of Northern California (KPNC). BAC was assessed using a densitometry method, and presence of BAC was defined as a calcium mass score>0 mg. Searching the electronic health record up to 5 years after baseline, we identified 33 women (39% non-white) who underwent cardiac computed tomography (CT) because of medical indication. BAC was present in 33% (11/33) whereas CAC (Agastston score >0) was present in 61% (20/33). Nine (27%) were BAC and CAC -; 7 (21%) were BAC and CAC+; 4 (12%) were BAC+ and CAC -; and 13 (39%) were BAC - and CAC+. The correlation between log (BAC+1) and log (CAC+1) was 0.45 (p=0.02) in the entire sample (n=33) and was 0.68 (p=0.09) in the 7 women who were BAC and CAC+. The concordance, sensitivity, specificity, PPV, NPV for BAC considering CAC as the gold standard were 0.48, 0.35, 0.69, 0.63 and 0.41, respectively. The unadjusted odds ratio for log (CAC+1)>0 as a function of Log (BAC+1) was 1.21 (95% CI, 0.27-5.38; p=0.80). Although our sample was small, the findings reflect real-world evidence and suggest that BAC and CAC are not entirely overlapping and thus may convey independent predictive information for ASCVD.
The Analysis of Research Trends and Public Awareness of Smart Farms using Text Mining
Authors: Kil Sung-Ho , Park Hye-Mi , Lee Eunseok , Kim Jin-Young , Kim Ji-Woo
Published: March 2023

Background and objective: To deal with recent issues such as climate change, rural aging, food security, and the Fourth Industrial Revolution, there is a growing interest in smart farms that can efficiently produce food with ICT. In response to the international issues, this study analyzed articles on smart farms published in international journals and KCI journals as well as Instagram hashtags through text mining and identified relevant research trends and public awareness.Methods: This study collected total 584 articles on smart farms from 2010 to 2021 and hashtags in Instagram posts uploaded in 2021. To improve the reliability of the analysis results, nouns were exclusively extracted from the abstracts and hashtags, and data preprocessing was performed by removing nouns that appear customarily and combining synonyms. After that, we analyzed frequency, degree centrality, betweenness centrality, and topic modeling.Results: The analysis results of words with high frequency and centrality by research data are as follows. KCI and international journal articles had a tendency to mainly focus on ICT system development for efficient operation of smart farms. However, KCI articles considered relevant policies to establish the technologies. On the other hand, international journal articles tended to conduct research on smart farms in a wider area of agricultural fields than KCI articles. The main topics on Instagram were diet food, rural migration, and urban agriculture. This result shows that healthy food, experiences, and education through smart farms are gaining public interest.Conclusion: Currently, there is insufficient analysis of research trends in smart farms. In this vein, this study has significance as it included academic trends and public awareness by considering both research articles and Instagram posts. We expect the results of this study to be used as useful data for decision making to set the research and policy directions required to advance smart farms in the future.
Hobbes and Leibniz on the Nature and Grounds of Slavery
Authors: Topete Iziah C
Published: March 2023

During a period when transatlantic slavery was still being racialized, Hobbes and Leibniz represent stark alternatives on the nature and justification of slavery. This article investigates Leibniz’s encounter with the Hobbesian position on slavery (servitus), drawing out the racial implications. Throughout his political works, Hobbes defended voluntary servitude by transforming a legacy of Roman jurisprudence that had come to be encapsulated in the law of nations (jus gentium). Hobbes defended the justification that a master could possess slaves as de jure property with the rights to buy or sell them. In Sur la notion commune de la justice, Leibniz argued against Hobbes that slave-owners’ rights should be limited. He also defended his own paternalistic justification of slavery, reinterpreting Aristotelian natural slavery. Leibniz claimed that some persons merit guidance as slaves by nature, yet legitimate possession of persons can only go as far as a usufruct. In contrast, Hobbes had rejected the normative logic that any person could rationally merit enslavement but maintained that masters could totally possess the body of captive slaves for as far as their power extends.
Gastrodia pushparaga (Orchidaceae, Epidendroideae, Gastrodieae), a new species from Sri Lanka
Authors: GOPALLAWA BHATHIYA , PERERA AMILA , MADOLA INDRAKHEELA , YAKANDAWALA DEEPTHI , KUMAR PANKAJ , JAYAWICKRAMA HARSHA , CHASE MARK W.
Published: March 2023

N/A
New Ocnerodrilidae genera, species and records from Brazil (Annelida: Crassiclitellata)
Authors: JAMES SAMUEL W. , BARTZ MARIE L.C. , BROWN GEORGE G.
Published: March 2023

We describe three new species of Eukerria, six of Kerriona, one of Ocnerodrilus and two of Belladrilus (Clitellata: Ocnerodrilidae) from Brazil, mostly from wet habitats including bromeliad leaf axils, plus some from forest soils in Bahia state. We also provide new morphological and distribution data on Kerriona luederwaldti Michaelsen, 1924. We describe the new genus Pauqueba and its two new species, both from bromeliad leaf axils and forest floor litter in the state of Bahia. It has two pairs of calciferous glands, the balantine reduction of the male terminalia but spermathecae in ix, and no gizzard. The new genus Parabauba found in deeper (30 cm) soil layers is distinctive for the combination of two pairs of calciferous glands, a large gizzard in v, acanthodriline male terminalia, and no typholosole. The new genus Diplomoela from a mesic soil in Bahia is meronephric, unusually large for the Ocnerodrilidae, and has two well-developed gizzards.