bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P210: Weight and Body Image Perceptions in Young, Low Income Adult Latinas with Imprecise Body Mass Index Classification
Authors: Rinaldo Jen , Froelicher Erika , Waters Catherine , Bibbins-Domingo Kirsten , Stotts Nancy
Published: July 2021

Introduction:
Mexican American women in the US have the second highest prevalence of overweight or obesity (78.2%), 44.8% are obese, yet little research has examined the relationship between body mass index (BMI) and body satisfaction among young, low-income Latina adults.

Objective:
To examine the relationships between knowledge, attitudes, beliefs, and behaviors about weight, body image and excess weight.

Hypothesis:
We hypothesized that (1) the women would incorrectly classify BMI; (2) the majority would be obese and (3) there is no difference in body satisfaction among those with and without excess weight.

Methods:
A cross-sectional study with a convenience sample of 131 self-identified Latina women, ages 18 to 45 years was used from two Northern California clinics. An interview administered questionnaire assessed demographics, weight and body image. Statistical analysis included descriptive statistics, chi-square statistics, and logistic regression analysis.

Results:
While 31% (n=41) classified themselves as having a healthy BMI, 21% (n= 27) met the criteria. Although 58% (n=77) classified themselves as overweight, 46% (n=60) met the criteria. Although 2% (n=3) classified themselves as obese, 34% (n=44) were obese. The majority of women (67%; n=88) reported that they were not at their ideal body weight. Of those who wanted to lose weight, the mean number of pounds they would have to lose to be at their ideal body weight was 15.5 (± 16). The mean body dissatisfaction score of those with excess weight was 2.2 (± 1.1) and 0.74 (± 1.4) for those with healthy BMI.

Conclusions:
Most women underestimated their BMI category. Less than 6% (n=3) of obese women correctly classified themselves as obese. The misclassification and underreporting of excess weight was statistically significant (p≤ 0.05), pointing to a need for education about weight. Body dissatisfaction scores were higher in women with excess weight. Actual/current body silhouette sizes were statistically significantly associated with excess weight: (OR=2.78, 95% CI: 1.28, 6.04, p= 0.02).
Abstract P230: Measures of Glycaemia (Fasting and 2 hr Glucose, Glycosylated Haemoglobin) in Relation to Incident Vascular Disease in Non-diabetic Adults
Authors: Metcalf Patricia A , Kyle Campbell , Kenealy Tim , Riddell Tania , Chelimo Carol , Wells Sue , Jackson Rod
Published: July 2021

Introduction:
Glycosylated haemoglobin (HbA
1c
) has recently been accepted for diagnosing diabetes in New Zealand. A 2 hour 75g oral glucose test was used previously and remains an alternative for diagnosis.

Hypothesis:
We assessed the hypothesis that HbA
1c
would do at least as well as fasting and 2 hour glucose levels for predicting vascular events.

Methods:
Baseline data from a primary care cardiovascular disease (CVD) risk register of approximately 220,000 patients were prospectively linked to hospitalization, mortality and lab test data. There were 21,720 patients without a history of diabetes or CVD who had an HbA
1c
and oral glucose tolerance test. We compared the prognostic value of HbA
1c
and fasting and CVD or all-cause mortality using Cox proportional hazards regression.

Results:
The median follow-up time was 5 years (range 0 to 11). For HbA
1c
values of less than 5.0%, 5.0 to less than 5.5%, 5.5 to less than 6.0%, 6.0 to less than 6.5%, and 6.5% or greater, the adjusted (age, gender and ethnicity) hazard ratios (with 95% confidence intervals) for diabetic hospitalisations were respectively: 1.45 (0.81-2.45), 1.00 (reference), 1.27 (1.01-1.63), 2.34 (1.88 -2.95), and 6.31 (5.10-7.94), respectively. Baseline HbA
1c
was also related to risk of renal complications and retinopathy. For CVD, the hazard ratios (HR’s) were 0.95 (0.51-1.62), 1.00 (reference), 1.16 (0.95-1.42), 1.19 (0.98-1.46), and 1.32 (1.09-1.61), respectively. All associations remained significant after adjustment for the baseline fasting and 2 hour glucose levels. No HR’s were significant for all-cause mortality after adjusting for ethnicity. The associations between fasting glucose levels and the risk of CVD or death from any cause were not significant in models with adjustment for age, gender and ethnicity as well as HbA
1c
.

The association between the 2 hour glucose levels and the risk of diabetes was significant, but attenuated, in the model with adjustment for age, gender and ethnicity as well as HbA
1c
.

Conclusions:
In conclusion, in people with no diabetes and no CVD, baseline HbA
1c
was associated with subsequent diabetes, CVD, diabetic renal complications and retinopathy. HbA
1c
was more strongly associated with these vascular complications than were fasting glucose and 2-hour glucose.
Abstract P289: Understanding Perceived Risk of Type 2 Diabetes in Healthy Middle-aged Adults
Authors: Godino Job G , van Sluijs Esther M , Sutton Stephen S , Griffin Simon J
Published: July 2021

Introduction:
For type 2 diabetes (T2D) prevention programs to successfully reach their intended targets, high-risk individuals must first be aware that they are at high risk. Greater understanding of factors associated with perceived risk might inform the development of more effective risk communication and prevention efforts. We aimed to determine the perceived risk of T2D in a population-based sample of healthy middle-aged adults and examine its relation to modelled risk, clinical risk factors, and psychological factors theorised to be antecedents of behaviour change.

Methods:
An exploratory, cross-sectional analysis of perceived lifetime risk of T2D was conducted using baseline data collected from 569 participants in the Diabetes Risk Communication Trial (Cambridgeshire, UK). T2D risk factors were measured during a health assessment and the Framingham Offspring Diabetes Risk Score was used to model risk. Questionnaires assessed various psychological factors. Multivariable regression analyses were used to determine associations with perceived risk.

Results:
Table 1 shows that participants (mean (SD) age = 48.8 (7.3) years; n (%) male = 265 (47.5); mean (SD) BMI = 26.1 (4.23) kg/m2) with a higher lifetime perceived risk (mean (SD) = 34.8% (24.05%)) were at higher risk according to the Framingham Offspring Diabetes Risk Score (mean (SD) = 11.7% (19.0%)) (p < 0.001). Higher perceived risk was associated with higher body fat percentage, lower self-rated health, higher diabetes-related worry, and lower self-efficacy for adhering to governmental recommendations for physical activity (all p < 0.001).

Conclusions:
Overestimation of T2D risk is common. Higher perceived risk is associated with higher risk of developing the disease, and decreased likelihood of engagement in risk-reducing health behaviours. Risk communication interventions should target high-risk individuals with messages about the effectiveness of prevention strategies and address ability to engage in risk-reducing health behaviours.
Abstract P292: Adverse Childhood Events Are Linked To Cardiovascular and Lung Disease Among Women In Hawaii: The Behavioral Risk Factor Surveillance System Survey, 2010
Authors: Remigio-Baker Rosemay A , Hayes Donald K
Published: July 2021

Introduction:
Cardiovascular disease (
CVD
), which includes heart disease and stroke, account for about 30% of mortality in Hawaii and affect more women than men. In addition, lung disease (
LD
) (e.g. chronic obstructive pulmonary disease [
COPD
]) continues to rise in the state with a death rate that is also higher among women. Little is known about the association between adverse childhood events (
ACEs
) and CVD or LD among women in Hawaii. Further, although the LD-CVD association has been established, the influence of ACEs in this relationship has yet to be evaluated.

HYPOTHESES:
We assessed the hypothesis that the type of ACEs (household dysfunction and physical, verbal and sexual abuse) will be positively associated with CVD and LD, and that the LD-CVD association will vary by the presence of ACEs.

Methods:
Data on 3,477 women residing in Hawaii from the Behavioral Risk Factor Surveillance System Survey was used to examine the relationship between ACEs and CVD (coronary heart disease [
CHD
], myocardial infarction [
MI
], stroke), or LD (COPD, asthma) using multivariable logistic regression, taking into account sampling method. The LD-CVD association was also investigated, with ACE types evaluated as potential modifiers. CVD and LD were assessed as individual ailments (e.g. CHD, COPD) and combined (any CVD, any LD). Covariates included socio-demographics, health behaviors (current smoking status, binge drinking), emotional support, BMI and current depressive symptoms status.

Results:
Evaluation by ACE type revealed a significant relationship between household dysfunction and CHD (OR=2.6, CI=1.4, 5.0) and any CVD (OR=1.8, CI=1.2, 2.7). Physical abuse was also found associated with COPD (OR=2.1, CI=1.3, 3.6), while verbal abuse was found related with asthma (OR=1.6, CI=1.2, 2.2) and any LD (OR=1.6, CI=1.2, 2.1). Further, physical abuse modified the association between COPD and MI (p=0.003) or any CVD (p=0.042), with a positive association found in the absence but not the presence of physical abuse (OR=3.9 vs. 0.1 and 2.9 vs. 0.7, respectively). The same trend was found for sexual abuse in the asthma-MI relationship (OR=2.6 vs. 0.5). Noteworthy was that individuals who did not report childhood physical or sexual abuse were more likely to have diabetes than those reporting abuse (p<0.05 for both ACE).

Conclusions:
In conclusion, it might be of benefit to investigate the presence of ACEs, particularly household dysfunction and physical and verbal abuse, in treating CVD or LD among women in Hawaii. Decreasing the prevalence of ACEs might also lower CVD or LD morbidity and mortality in this population. Although the COPD-MI, or any CVD, and asthma-MI associations were significantly positive only among those who reported physical or sexual abuse, respectively, this cohort had a greater prevalence of diabetes, which might influence these relationships. These findings warrant further investigation.
Abstract P296: Age-related Differences in Risk Factors for Mortality Among Individuals with Chronic Kidney Disease: The REGARDS Study
Authors: Tanner Rikki M , Bowling Barrett , Safford Monika M , Gutiérrez Orlando , Colantonio Lisandro D , Warnock David G , Muntner Paul
Published: July 2021

At younger ages, chronic kidney disease (CKD) is a progressive disorder associated with an increased risk for end-stage renal disease (ESRD). Older individuals with CKD are 10 to 20 times more likely to die than progress to ESRD. We hypothesized that, among individuals with CKD, the association between traditional cardiovascular risk factors with mortality would be weaker and the association between psychosocial risk factors with mortality would be stronger for individuals ≥ 75 years of age compared to those < 75 years of age. We included 5,924 REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants with CKD without ESRD at baseline. CKD was defined as an albumin-to-creatinine ratio ≥ 30 mg/g or an estimated glomerular filtration rate < 60 mL/min/1.73m2. The 12-item Short Form Health Survey (SF-12) was administered and low physical and mental component scores (PCS and MCS) were defined as scores in the lowest quintile. Mortality was assessed through biannual telephone follow-up and contact with proxies provided by the study participant upon recruitment. Date of death was confirmed through death certificates, National Death Index, or Social Security Death Index. Over a median follow-up of 5.0 years, 1,255 deaths occurred. The mortality rate was 30.9 (95% CI: 28.6 - 33.4) and 74.8 (95% CI: 69.2 - 80.8) per 1,000 person-years for individuals < 75 years and ≥ 75 years of age, respectively. Diabetes, history of stroke, and systolic blood pressure were associated with an increased risk for mortality among individuals < 75 years of age but not among those ≥ 75 years of age (Table 1). Low PCS was associated with a higher risk for mortality for both younger and older adults. Symptoms of depression and low MCS were not associated with mortality in either age group. In conclusion, some cardiovascular risk factors are associated with an increased risk for mortality among younger but not older individuals with CKD. These data suggest approaches to reduce mortality risk may differ for younger and older adults with CKD.
Abstract P313: Poor Cardiovascular Health Knowledge despite the Rising Epidemic of Cardiovascular Diseases: findings from a peri-urban Nepalese community
Authors: Vaidya Abhinav , Aryal Umesh R , Krettek Alexandra
Published: July 2021

Nepal, a low-income South Asian country, is facing a growing epidemic of atherosclerotic cardiovascular diseases. Information on how well its population knows about the underlying risk factors and possible prevention and control strategies is an important determinant in tackling the epidemic. Studies indicate Nepalese people have poor knowledge regarding cardiovascular health, for example, about symptoms of heart attack or diabetes. We conducted a study on cardiovascular health literacy in a peri-urban area near Kathmandu and tested the hypothesis that better cardiovascular health knowledge is associated with superior cardiovascular health behaviour. For this cross-sectional study, we conducted face-to-face interviews with 777 consenting adults aged 25-59 years from six randomly sampled clusters of Duwakot and Jhaukhel communities between September and November 2011. We used WHO-STEPs questionnaire to gather information on demographic, behavioural and anthropometric variables. Additionally, we did a thorough literature search to construct questions on cardiovascular health knowledge and attitude. Scores were given to knowledge, attitude and behaviour/practice components which were then aggregated to calculate composite median percent scores. Five categories from highest to lowest quintiles of median percent scores were then generated. Seventy percent of the respondents were females- out of which two-thirds were housewives, and a third was without formal education. A fifth of the 229 male respondents were doing agriculture-based work. When asked to spontaneously name the risk factors, respondents showed low overall knowledge- ranging from 1% for diabetes and 29% for smoking. Sixty percent of them did not know any heart attack symptom. Chest pain as a heart attack sign was known only to 14% of the respondents. Nonetheless, 86% of them thought heart diseases could be prevented by improving lifestyles. However, 65% of men and 54% of women did not want to change their lifestyle as they did not consider themselves to be at risk. Further, among those with highest knowledge quintile score, only 14.7% had highest attitude quintile score, and only 13.4% had highest behaviour quintile score. Likewise, among those with lowest knowledge quintile score, 26% had lowest attitude quintile score, and 16.4% had lowest behaviour quintile score. In conclusion, despite the rising burden of cardiovascular epidemic in Nepal, population-level knowledge on cardiovascular health is still poor. Further, better knowledge did not necessarily translate into superior cardiovascular health behaviour. Therefore, community-based interventions that improve all the three components should be promoted rather than those which influence only the knowledge aspect.
Abstract P314: High Prevalence of Behavioural Cardiovascular Risk Factors in a Nepalese Community undergoing Socio-epidemiological Transition
Authors: Vaidya Abhinav , Oli Natalia , Aryal Umesh R , Karki Damber B , Krettek Alexandra
Published: July 2021

Behavioral risk factors, particularly the major four- tobacco consumption, harmful use of alcohol, unhealthy diet and physical inactivity- are accountable for a major proportion of cardiovascular disease burden. Driven by urbanization and globalization, these risk factors are rising in many of the low- income countries including Nepal. Population-based surveys and hospital reports indicate cardiovascular diseases are rising in Nepal. The first countrywide WHO-STEPS risk factor survey conducted in 2007-2008 showed that 23.8% are daily smokers, 28.5% are current drinkers, and 61.9% consumed less than five servings of fruits and vegetables, while 5.5% had low physical activity. Risk factors are generally more prevalent in urban areas than rural. We aimed to study the status of these behavioural risk factors in a community that is rapidly undergoing transition from a village to an urban community. We conducted the study in Duwakot and Jhaukhel, two urbanizing villages 13 kilometers from the capital Kathmandu. Six clusters were randomly selected. Altogether 777 adults aged 25-59 years consented to participate. Questions were based on the WHO-STEPS survey. Current smokers included those who affirmed to the question ‘Do you smoke?’ Current drinkers had ‘consumed alcohol in the previous one month’. Inadequate fruit and vegetable intake indicated those who were taking less than five servings of combined fruit and vegetable in a day. Physical activity was subjectively measured by asking about the respondent’s activities at work, travel and leisure. Having low physical activity meant not meeting any of the GPAQ (Global Physical Activity Questionnaire) criteria of adequate physical activity. Prevalence of the four major behavioral risk factors was high in the community. Addictive behavioural risk factors were particularly higher in the males than in the females: current smoking (33.5% vs. 14.7%), current smokeless tobacco consumption (20.2% vs. 3.3%), and current alcohol drinking (34.5 % vs. 12.6%). Only 2% of the study population fulfilled the recommended minimum five servings of fruits and vegetables. Low physical activity was present in 43.3% of the respondents, with a higher prevalence seen among the females, elderly, more educated and those on non-agro works. In conclusion, there is particularly high physical inactivity and low fruit and vegetable intake in the community indicating negative effects of urbanization such as changing dietary habit and escalating sedentary lifestyle. Because the community is still beginning to urbanize, it is important that timely population-based health promotional strategies and favourable environmental modifications are implemented to counteract the effects of urbanization.
Abstract P331: Associations Of Coronary Heart Disease With Common Carotid Artery Near And Far-wall Intima-Media Thickness (IMT): The Multi-Ethnic Study Of Atherosclerosis.
Authors: Polak Joseph F , Szklo Moyses , O'Leary Daniel H
Published: July 2021

Background:
Intima-media thickness (IMT) as measured on ultrasound images of the common carotid artery (CCA) is associated with cardiovascular events and used to measure the effects of lipid lowering interventions. Far wall CCA IMT is favored over near wall IMT based on the physics of ultrasound.

Materials and Methods:
We studied 6606 members of the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal cohort study (mean age 62.1 years; 52.7% female) who had near wall and far wall CCA IMT measurements. Multivariable linear regression models were used to estimate model goodness-of-fit of near wall IMT, far wall IMT, and mean IMT with Framingham risk factors (FRF). Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident coronary heart disease (CHD) events for each IMT variable. Change in Harrell’s C-statistic was used to compare the incremental value of each IMT variable when added to FRF.

Results:
Mean IMT had the strongest association with risk factors (R2 = 0.31), followed by the near wall (R2 = 0.26) and far wall IMT (R2 = 0.22). Far wall IMT improved the prediction of coronary artery disease events (change in C statistic: 0.009; 95% Confidence Intervals: 0.004, 0.015; p= 0.001) as did mean IMT (p=0.033) but near wall IMT did not.

Conclusion:
Far wall CCA IMT had the strongest association with incident CHD whereas combined near wall and far wall IMT had the strongest association with risk factors. Selected IMT variables may give different results in intervention trials than in outcome studies.
Abstract P347: Serum 25-hydroxy Vitamin D, Cardiovascular Risk Markers, And Incident Myocardial Infarction In A High Risk Community Population
Authors: Yang Jaeun , Naugler Christopher , de Koning Lawrence
Published: July 2021

Background:
It is unclear whether vitamin D deficiency is associated with a higher risk of cardiovascular disease, and through what biochemical pathways this could occur. We investigated the relationship between serum 25-OH vitamin D and typical cardiovascular risk markers as well as incident myocardial infarction (MI) in a large group of high-risk individuals from the community of Calgary, Alberta, Canada.

Methods:
Calgary Laboratory Services databases were queried for age, sex, body mass index (BMI), personal healthcare number (PHN) and first available serum 25-OH vitamin D measure from patients who received an electrocardiogram or urine creatinine clearance test from 2010-2013. Data was linked by PHN to first available laboratory results for total cholesterol, HDL cholesterol, triglycerides, LDL cholesterol, fasting glucose and HbA1c as well as Alberta Health Services hospital discharge data for first myocardial infarction (ICD-10: I21.1-9) occurring after 25-OH vitamin D measurement. Multiple linear and logistic regression were used to examine all associations.

Results:
There were 36 000-50 000 complete patient records for analysis of each of the risk markers, with a median follow-up of 8-11 months. A 30 mmol/L increase in serum 25-OH vitamin D was associated with significantly (p<0.001) lower total cholesterol (-0.07 mmol/L), LDL cholesterol (-0.06 mmol/L), triglycerides (-0.14 mmol/L), fasting glucose (-0.12 mmol/L), and HbA1c (-0.13% mmol/L), but higher HDL cholesterol (+0.06 mmol/L) after adjusting for age, sex, BMI, monthly hours of sun-exposure and time between measures. Among these individuals, there were 458 cases of MI occurring after 25-OH vitamin D measurement, with a median follow-up of 1 year. In a case-cohort analysis that included 2500 controls, a 30 mmol/L increase in 25-OH vitamin D was associated with a 21% (p<0.001) lower odds of MI after multivariate adjustment. This association was strongly attenuated after adjusting LDL, HDL, fasting glucose and HbA1c.

Conclusion:
In a high-risk group of community patients from Calgary, Alberta, Canada, higher serum 25-OH vitamin D was associated with a lower risk of MI, which was explained by changes in commonly measured cardiovascular risk markers. Further study is needed to determine whether changes in cardiovascular risk markers are causally related to changes in 25-OH vitamin D.
Abstract P373: A Comparison of Examination-Based and Self-Reported Cardiovascular Health Indicators Using Mississippi Delta Cardiovascular Health Examination Survey Preliminary Data and the Mississippi Behavioral Risk Factor Surveillance System
Authors: Short Vanessa L , Mendy Vincent
Published: July 2021

Background:
Cardiovascular disease (CVD) surveillance at the regional or local level is limited. The Behavioral Risk Factor Surveillance System (BRFSS) frequently provides the primary source of information on CVD and its risk factors at the population level. However, BRFSS data may be limited due to reliability of self-reported information, a lack of serologic and other objective measurements, and non-local level sampling frames. The Mississippi Delta Cardiovascular Health Examination Survey (CHES) is an ongoing CVD surveillance system in the 18-county Mississippi Delta, a predominately rural, disadvantaged region with some of the highest rates of CVD in the nation. Our objective was to compare prevalence estimates of self-reported CVD risk factors from the Mississippi BRFSS with examination-based measures of these risk factors from Delta CHES.

Methods:
Delta CHES uses an in-home data collection model to collect survey data, anthropometric measures and fasting blood specimens on a representative sample of adults ≥ 18 years of age living in the Mississippi Delta region. Preliminary examination data, collected between October 2012 and October 2013, from 484 Delta CHES participants were compared to weighted 2011 Mississippi BRFSS self-reported data from 1,187 respondents living in the Mississippi Delta region. Prevalence estimates and 95% confidence intervals (CI) were calculated for measures related to obesity, hypertension, dyslipidemia, diabetes, and smoking. In Delta CHES, dyslipidemia was defined as abnormal values for any cholesterol component or for triglycerides; hypertension was defined as systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg; obesity was defined as body mass index of ≥ 30.0 kg/m
2
; current smoking was defined as serum cotinine level > 10.0 ng/mL; and diabetes was defined as plasma glucose ≥ 126 mg/dl or hemoglobin A1c ≥ 6.5%. For prevalence estimates, non-overlapping 95% CIs indicate statistical significance (at α=0.05).

Results:
Delta CHES provided a significantly greater prevalence estimate of obesity [53.5% (95% CI 48.9-58.1%) vs. 42.9% (95% CI 39.0-46.9%)], diabetes [24.4% (95% CI 20.3-28.5%) vs. 16.3% (95% CI 13.7-18.9%)] and smoking [30.4% (95% CI 26.0-34.9%) vs. 20.2% (95% CI 16.7-23.6%)] compared to BRFSS. Conversely, the prevalence of hypertension was significantly lower in Delta CHES compared to BRFSS [14.4% (95% CI 11.2-17.6%) vs. 51.8% (95% CI 47.9-55.8%)].

Conclusion:
Objectively measured estimates from Delta CHES and self-reported measures from the Mississippi BRFSS differed for key CVD risk factors. These preliminary findings suggest self-reporting may have distorted past estimates of CVD risk factor rates in the Mississippi Delta region. Population-based CVD surveillance systems using examination-based measurements can provide perspective on routinely collected self-reports.
Abstract P385: My Unlimited Health Potential: Short term Effect of Participation in a Worksite Lifestyle Intervention Program on Significant Weight Loss and Eligibility Criteria for Bariatric Surgery Among High Risk Individuals
Authors: Roberson Lara L , Aneni Ehimen , Shaharyar Sameer , Oni Ebenezer , Rouseff Maribeth , Tran Thinh , Guzman Henry , Das Salkalp , Brown Doris , Santiago-Charles Joann , Ochoa Teresa C , Mora Joseph , Castillo Beatriz , Veladar Emir , Feldman Theodore , Agatston Arthur , Post Janisse , Nasir Khurram
Published: July 2021

Background:
Current recommendations support bariatric surgery among the morbidly obese as an option to mitigate future risk of cardiovascular disease, diabetes and hypertension. To date, there is little evidence on the effect of extensive lifestyle interventions among those high-risk individuals in reducing the need for such procedures.

Methods:
The purpose of the present study was to examine the efficacy of an intensive lifestyle workplace intervention on significant body weight and cardiovascular disease risk factors across the spectrum of obesity. Changes in BMI were measured from baseline to 12 week follow up, along with corresponding improvements in cardio-metabolic risk. In addition, the decrease in participants meeting criteria for bariatric surgery over the study period was examined. Bariatric surgery criteria were defined as BMI≥40 or BMI between 35 and 40 and at least one of the following co-morbidities: diabetes, hypertension, or high cholesterol.

Results:
The study population consisted of 169 individuals (49±10 years, 77% female) with BMI≥27 at baseline and complete data at follow-up. A total of 65 (39%) participants lost at least 5% of both their initial BMI and body weight. Additionally, 32% dropped an entire BMI category. Of note, 38%(18 of 48) who were classified as BMI>40 were in BMI 35-39 at follow-up, respectively 37%(13 of 55) of individuals in the BMI category 35-39 successfully moved to the BMI category 30-34 at 3 months follow-up. Sixty-three participants (37% of total) initially met criteria for bariatric surgery. At 12 weeks follow-up 35% (22 of 63) of these candidates no longer qualified.

Conclusions:
Worksites can be effective for achieving clinically important reductions in body weight and diminish the potential need for procedures among a small proportion of morbidly obese individuals. Further follow-up is needed to ascertain whether weight loss can be sustained long-term, and if the short term gains will translate to significant improvements in cardio-metabolic risk profile.
Abstract P394: The Prevalence of Hypertension Among Kazak Individuals of Diverse Occupational Backgrounds In Xinjiang, China
Authors: Jiang Jingmei , Zhang Mingtao , Xue Fang , Tang Yong , Hou Lei , Liang Shaohua , Han Wei , Wang Weizhi , Zhang Biao , Pang Haiyu , Wang Yanhong
Published: July 2021

Introduction:
Kazak’s hypertension ranks fifth with regard to morbidity among the 56 Chinese ethnic groups. Kazaks, are the main ethnic group in Kazakhstan, and represent a sizable ethnic minority in China and Russia. For thousands of years, China’s Kazak people are mainly active in raising livestock on the prairie grasslands in northwest China, and have developed a unique culture and lifestyle. In order to establish whether this distinct feature affects the prevalence of hypertension in this population, we undertook a population-based study which involved in three occupational backgrounds (herdsman, farmer, non-manual worker) in Xinjiang, China. We hypothesized that any variation in the effect of hypertension is based on the genetic homogeneity.

Methods:
A prospective cohort design was used, with 1670 participants (aged 30-92 years) from seven villages and town city recruited by a stratified random clustering sampling procedure in Hong-Dun town, Altay region Xinjiang from Jan to Mar 2013. All participants completed the survey and physical examination using standardized procedures. The overall response rate for completing both was 92.5%.

Results:
Compared with farmers and non-manual workers, herdsmen had the highest prevalence of hypertension and the lower rates of treatment and control (Tab). High-salt diet (air-dried beef and milky-tea) intake and low intake of fruits and vegetables were more common in the nomadic group and a dose-response relationship was observed between hypertension and occupation (Fig). Furthermore, the prevalence of hypertension within each occupational group was more common in lower socioeconomic status based on educational attainment and economic measures.

Conclusion:
Unlike the previous epidemic of hypertension in developed countries which was driven mainly by urbanization, these data highlight the need for careful monitoring and control of hypertension risk factors in rural residents, especially groups such as the Kazak nomads who have a greater degree of marginalization in modern China.
Abstract P445: A Randomized Controlled Trial Of A Cardiovascular Fixed-dose Combination Pill (polypill) Treatment Strategy Compared With Usual Care On Carotid Intima Media Thickness Progression In Individuals At High Risk Of Cardiovascular Disease
Authors: Lafeber Melvin , Stanton Alice , Thom Simon , Hughes Alun , Grobbee Diederick E , Rodgers Anthony , Bots Michiel L
Published: July 2021

Aim:
The use of fixed-dose combination (FDC) pills, frequently called polypills, containing aspirin, a statin and blood pressure (BP) lowering medication may improve medication adherence and consequently reduce cardiovascular risk. Carotid intima-media thickness (CIMT) and CIMT progression have been used as surrogate measures of cardiovascular risk. This study evaluated the effect of a polypill-based treatment strategy compared to usual care on CIMT progression.

Methods:
A study nested within the UMPIRE trial was performed to assess whether a polypill-based treatment strategy reduces CIMT progression compared to usual care. The study was a randomized, open label, blinded endpoint clinical trial in participants with established cardiovascular disease or at equivalent high risk (estimated five year cardiovascular risk of ≥15%). Two versions of the polypill were available. These contained aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg and either atenolol 50 mg or hydrochlorothiazide. The choices of polypill version and the components of usual care were made at the discretion of the physician. (http://clinicaltrials.gov/show/NCT01326676).

Results:
In total 296 participants in the polypill group and 290 participants in the usual care group had both a baseline and follow-up CIMT scan. Allocation to a polypill compared to usual care resulted in similar levels of low-density lipoprotein (LDL)-cholesterol (mean difference: 0.0 mmol/L; 95%-confidence interval (CI): -0.1 to 0.1; p=0.41) and systolic BP (mean difference -1.7 mmHg; 95%-CI:-4.5 to 1.1; p=0.23) after a median follow-up duration of 1.00 year [IQR: 0.93 to 1.04 year]. The annualized rate of change in common CIMT in the polypill-based treatment strategy group (6.56 μm/year; standard error (SE): 4.76 μm/year) did not differ significantly from the rate of change in the usual care group (10.72 μm/year; SE: 4.76 μm/year; mean difference: -4.2 μm/year; 95%-CI: -17.0 to 8.7; p=0.53).

Conclusion:
This study demonstrated that a polypill-based cardiovascular treatment strategy compared to usual care did not reduce the rate of progression of common CIMT during a one year follow-up interval in a well-treated population with cardiovascular disease. Importantly, CIMT progression was not adversely effected by the polypill-based treatment strategy.
Abstract 103: Rib and Sternum Fractures After Cardiopulmonary Resuscitation: An Autopsy Study
Authors: Friberg Niklas , Walther Charles , Englund Elisabet
Published: July 2021

Introduction:
Chest compression during cardiopulmonary resuscitation (CPR) is associated with skeletal chest injury. The aim of this study was to investigate the incidence of rib and sternum fractures after mechanical active compression-decompression CPR (aCPR) and standard manual CPR (mCPR).

Method:
This prospective study was conducted from January 1 2005 through December 31 2013. We included adult patients (age ≥18 years) who did not survive after CPR and were referred for clinical autopsy. The patients had been treated with either the aCPR device Lund University Cardiac Arrest System (LUCAS) or mCPR only. Patient and CPR data was drawn from autopsy referral documents or the patient medical records. Out of many referred cases, inclusion required examination by one of two pathologists with experience of CPR-related injuries. Autopsy was performed with special attention given to skeletal chest injuries and a standardized written protocol was used.

Results:
In the period 2005-2013 we included 362 cases treated with aCPR and 52 cases treated with mCPR. Sternum fracture was found in 291/362 cases (80 %) in the aCPR group and in 20/52 cases (38 %; p<0.001) in the mCPR group. Rib fracture was found in 349/362 cases (96 %) in the aCPR group and in 40/52 cases (77 %; p<0.001) in the mCPR group. Fracture on ≥ three ribs was present in 334/362 cases (92 %) in the aCPR group and in 36/52 cases (69 %; p<0.001) in the mCPR group. In the majority of cases there were multiple bilateral rib fractures, with a median of 10 fractures per case (interquartile range 7 to 13 fractures) in the aCPR group and 7 fractures per case (interquartile range 1 to 9.75 fractures; p<0.001) in the mCPR group. There was no fracture in 6/362 cases (1.7 %) in the aCPR group and in 10/52 cases (19 %; p<0.001) in the mCPR group.

Conclusion:
The incidence of rib and sternum fracture was significantly higher after aCPR than after mCPR, sternum fractures being twice as common and rib fractures being markedly more numerous after aCPR. These findings should be considered in the light of emerging survival data.
Abstract 10957: Association of Insulin Resistance and Dysglycemia With Components of Blood Pressure: A Study From the Hispanic Community Health Study/Study of Latinos
Authors: Bello Natalie A , Claggett Brian , Rodriguez Fatima , Cai Jianwen , Moncrieft Ashley , Garcia Karin , Del Rios Rivera Marina , Kaplan Robert C , Daviglus Martha L , Solomon Scott D , Cheng Susan
Published: July 2021

Background:
Data are conflicting regarding the extent to which insulin resistance or dysglycemia contribute to the development of elevated blood pressure (BP). Therefore, we examined whether these metabolic abnormalities are associated with distinct BP components, including measures of pulsatile versus steady state load (surrogates for large and small artery disease) in a large community-based cohort.

Methods:
We studied 10,720 non-diabetic participants from 4 U.S. sites in the Hispanic Community Health Study / Study of Latinos who were free of cardiovascular disease and not on any anti-hypertensive medications. We used linear regression for complex survey sampling and non-parametric spline models to examine the relation of insulin resistance (HOMA-IR) and dysglycemia (HbA1c) with components of BP (systolic, diastolic, pulse pressure [PP, reflecting pulsatile load], and mean arterial pressure [MAP, reflecting steady state load]) while adjusting for established clinical correlates of BP.

Results:
The target population mean age was 38 years (s.e. 0.22) and included 52% women, 38% with pre-diabetes, 35% obese, and 9% with untreated hypertension. All BP component measures were higher in pre-diabetes than non-diabetes. In multivariable analyses, HOMA-IR was significantly associated with increase in all BP components (P<0.01 for all), including both PP and MAP, in the setting of both pre-diabetes and particularly non-diabetes (Figure). By contrast, HbA1c was not significantly associated with increase in any BP component.

Conclusion:
In a large population of non-diabetic Hispanic/Latino adults, insulin resistance (rather than dysglycemia per se) is related to increase in all BP components including measures of both pulsatile load (representing large artery disease) and steady state load (representing small artery disease). These findings may have implications for interventions aimed at preventing large and small vessel disease in the community.
Abstract 10998: Estimated Surgical Risk and Anatomical Compatibility for MitraClip Intervention in Patients With Severe Mitral Regurgitation According to Valve Disease Etiology
Authors: Agmon Yoram , Gofman Itai
Published: July 2021

Background:
Percutaneous mitral valve repair using the MitraClip technology was originally introduced to treat degenerative (myxomatous) mitral regurgitation (DMR), but it is currently mostly used in patients (pts) with functional (ischemic) MR (FMR). We examined whether this approach was justified, based on surgical risk and valve anatomy.

Methods:
Consecutive pts with severe MR who were hospitalized at a tertiary care medical center were identified and their clinical records and echocardiographic studies were reviewed. Surgical risk was estimated using the Society of Thoracic Surgeons (STS) risk scores. The anatomical compatibility for MitraClip invervention was assessed using the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) echocardiographic criteria.

Results:
Of 236 pts included in the study during 3 yrs, the cause of MR was FMR in 104 pts (44.1%), DMR in 84 (35.6%), and other causes (mainly endocarditis and rheumatic disease) in 48 (20.3%). Age and gender distribution were similar in pts with FMR (age 71±14 years, 62.5% male) and DMR (age 73±14 years, 66.7% male) and severe NYHA III/IV heart failure symptoms justifying intervention were evident in 73.1% and 60.7% of pts, respectively (P=0.10). Using multiple risk scores, the estimated surgical risk (mortality and major morbidity) for mitral valve repair or replacement (with or without bypass surgery) was consistently much higher in pts with FMR than DMR. Valve anatomy was suitable for MitraClip intervention in 87 pts (83.7%) with FMR versus only 38 pts (45.2%) with DMR (P<0.001). Assuming the most common type of surgery was valve repair for DMR and annuloplasty + bypass surgery for FMR, and using an STS estimated mortality greater than 10% to define high surgical risk, only 6 pts with DMR (7.1%) had a clinical indication for intervention, high surgical risk, and valve anatomy suitable for MitraClip intervention, versus 21 pts (20.2%) with FMR (P<0.001). Using an STS estimated mortality and morbidity greater than 20% to define high surgical risk, these proportions were 20 pts (23.8%) for DMR and 60 pts (57.7%) for FMR (P<0.001).

Conclusion:
Higher surgical risk and better anatomical compatibility justify the greater use of MitraClip intervention in patients with FMR than in patients with DMR.
Abstract 11013: Resource Utilization for Non-Cardiac Hospital Admissions in Patients With Single Ventricle Congenital Heart Disease
Authors: Thomas Ian D , Seckeler Michael D
Published: July 2021

Background:
Patients with single ventricle (SV) congenital heart disease (CHD) incur high hospital costs during staged surgical palliation. However, resource utilization for non-cardiac admissions in SV patients has not been reported. This study sought to compare costs for common non-cardiac hospital admissions between SV patients and patients without CHD.

Methods:
A retrospective review of hospital discharge data from the University HealthSystem Consortium (UHC) from January 2011 through December 2013 was performed. UHC collects discharge data from 120 academic institutions and 302 affiliated hospitals. The database was queried for patients <18 years of age with ICD-9 codes for SV lesions: hypoplastic left heart syndrome (746.7), tricuspid atresia (746.1) or common ventricle (745.3). Neonates (<30 days old) were excluded to eliminate hospitalizations for Stage 1 surgical palliation. Primary diagnosis, direct cost, length of stay (LOS), ICU admission rate and mortality data were obtained. The eight most common non-cardiac admission diagnoses were compared between SV patients and non-CHD patients using t-test and Fisher’s exact test, as appropriate.

Results:
The non-cardiac admission diagnoses, with ICD-9 codes, and comparisons between SV and non-CHD patients are shown in the Table. Total direct cost, LOS and ICU admission rate were higher for SV patients for all diagnoses with the exception of LOS for failure to thrive, which was not different between groups. Notably, hospital mortality was markedly higher for SV patients admitted for RSV bronchiolitis or pneumonia.

Conclusions:
Hospital costs for common non-cardiac diagnoses are higher for patients with SV CHD. As long-term survival of SV CHD patients increase they will utilize a disproportionate amount of medical dollars, as our study shows. Further characterization of SV CHD patient costs will be important so steps can be taken to reduce or prevent hospitalization in these patients.
Abstract 11019: Incidence and Predictors for Late Acquired Stent Malapposition of Drug-Eluting-Stents With Second-Generation Permanent and Biodegradable Polymer-Coatings - A Prospective, Randomized Comparison Using Optical Coherence Tomography
Authors: Roth Christian , Gangl Clemens , Dalos Daniel , Scherzer Sabine , Krenn Lisa , Kreiner Gerhard , Delle-Karth Georg , Neunteufl Thomas , Berger Rudolf
Published: July 2021

Introduction:
The polymers releasing the drug of first-generation drug-eluting stents (DES) may induce allergic reactions and inflammation, resulting in late-acquired stent malapposition (LASM) with uncoverage of struts, and risk of stent thrombosis. The incidence and predictors of LASM in DES with different polymers designed to improve biocompatibility are unknown.

Methods:
Fifty patients with 59 lesions of interest were randomized to elective treatment with Everolimus-eluting stents (EES; n=17, 20 lesions)], Zotarolimus-eluting stents (ZES; n=15, 19 lesions), and Biolimus-eluting stents (BES; n=18, 20 lesions) and underwent optical coherence tomography after implantation and after one year.

Results:
After implantation 29 early stent malappositions (ESM) were documented in 29 lesions (49% of lesions), distributed to 11 lesions treated with EES (55%), 11 with ZES (58%), and 7 with BES (35%; n.s.). After one year 14 late stent malappositions (LSM) in 14 lesions (24%) were detected; nine ESM persisted (EPSM) after one year (1 EES, 6 ZES, 2 BES), whereas 20 ESM resolved. In addition, 9 LASM were documented (5 LASM in early well-apposed Stents, 4 LASM in Stents which also have EPSM). LASM was present in 7 hydrophilic polymer-coated ZESs (37%), in 2 fluoropolymer-coated EESs (10%), and in none of the biodegradable polymer-coated BESs (p=0.003). Independent predictors of LASM were the vessel treated (RCA as vessel with high motion; p<0.022) and type of polymer (biodegradable or permanent; p<0.035).

Conclusion:
The incidence of ESM and EPSM were similar, whereas the incidence of LASM was different in second-generation DES with different polymers. Biodegradable polymer prevented LASM, stent locations with significant vessel movement (RCA) enhanced LASM.
Abstract 11025: Cardiovascular Disease Mortality Among Black and White Women With Ductal Carcinoma in Situ of the Breast
Authors: Berkman Amy , Cole Bernard , Ades Philip A , Dickey Samantha , Higgins Stephen T , Trentham-Dietz Amy , Sprague Brian L , Lakoski Susan G
Published: July 2021

Background:
Ductal carcinoma in situ (DCIS) of the breast represents 15-20% of new breast cancer diagnoses in the United States annually and the incidence has been escalating since the 1970s. Long-term competing risks of cardiovascular disease (CVD) mortality, as well as racial differences in outcomes among US women with DCIS are unknown.

Methods:
Case data from the years 1978-2010 was abstracted using SEER*Stat software available through the National Cancer Institute from the 2010 SEER (Surveillance, Epidemiology and End Reports) registries. We evaluated CVD, breast cancer, and all-cause mortality using cumulative incidence rates and hazard ratios (HRs).

Results:
A total of 12,173 deaths were observed over a median follow up time of 9.2 years with 33% of deaths due to CVD and 8% due to breast cancer. The cumulative incidences of CVD death at 5, 10, and 20 years of follow up were 2.0% (95% CI 1.8-2.1), 5.1% (CI 4.9-5.3), and 13.2% (CI 12.8-13.7), respectively. The highest incidence of CVD mortality were found in women diagnosed with DCIS between 1978-1983 with 5, 10, and 20 year incidence of 5.0% (CI 3.9-6.1), 10.2% (CI 8.6-11.7), and 21.1% (CI 19.0-23.2), respectively. When stratifying by age at diagnosis, cumulative incidences of CVD death were highest among women diagnosed at age ≥ 70. Compared to white women, black women tended to have higher risk of death, especially among women diagnosed at young age; for those aged 40-49 at diagnosis, the HR for CVD mortality was 9.83 (95% CI 4.56-21.17).

Conclusions:
Among women diagnosed with DCIS, the risk of dying from CVD was greater than breast cancer at 20 years, with the incidence of CVD most pronounced among women diagnosed in an earlier treatment era (1978-1983) and older age. Black women had greater risks of dying from CVD compared to white women for all years, with this disparity decreasing with advanced age.