bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP26: Silent Small-vessel Cerebrovascular Disease In Individuals With A Family History Of Coronary Heart Disease: The Atherosclerosis Risk In Communities (ARIC) Study
Authors: Johansen Michelle C , Nyquist Paul A , Sullivan Kevin , Fornage Myriam , Gottesman Rebecca F , Becker Diane
Published: May 2021

Background:
It is established that a family history of coronary heart disease (FHCHD) is associated with coronary atherosclerosis in healthy first-degree relatives, but the extent to which FHCHD is associated with silent cerebrovascular disease (cSVD) is unknown. We hypothesized a higher prevalence of cSVD in healthy persons with FHCHD, independent of traditional risk factors, compared to those without FHCHD.

Methods:
ARIC is a community-based cohort study with self-reported family history data and brain magnetic resonance imaging (visit 5; 2011-13). The association between binary markers of cSVD (lacunar infarcts and/or cerebral microbleeds), or log-transformed white matter hyperintensity volume (WMH), and FHCHD (parent and/or sibling), or number of relatives was examined using separate adjusted multivariable logistic or linear regression models respectively. Sensitivity analysis (N=183) excluded prevalent CHD. Race interaction terms were included.

Results:
Of 1828 participants (76±5yo, 60% female, 28% black), 787 had FHCHD (699 parental, 209 sibling FHCHD). There were increased adjusted odds of lacunar infarct among those with parental FHCHD (Table). An increased odds of cerebral microbleeds were seen among those with sibling history but not parental. Effect estimates were similar when excluding those with prevalent CHD (Table). Greater number of siblings affected was associated with higher odds of lacunar infarct (OR 1.35, CI 1.04-1.74), lobar (OR 1.53, CI 1.12-2.09) and subcortical microbleeds (OR 1.30, CI 1.01-1.66). Odds of a lacunar infarct being present were higher among blacks (p-interaction 0.04) with paternal FHCHD (OR 2.20, CI 1.35-3.58) compared to whites (OR 1.17, CI 0.87-1.56). Neither FHCHD nor number of affected relatives was associated with WMH.

Conclusions:
Our results suggest that some cSVD manifestations are associated with FHCHD, potentially representing shared mechanisms in different vascular beds, and perhaps a genetic propensity for vascular disease.
Abstract MP38: Longitudinal Population-Level Changes In Resting Heart Rate During The COVID-19 Pandemic: Impact Of Changes In Sleep, Circadian, And Physical Activity Variables
Authors: Rezaei Naghmeh , Grandner Michael A
Published: May 2021

Introduction:
Population-level objective estimates of changes in health metrics over the course of the COVID-19 pandemic are sparse. This study evaluated change in resting heart rate (RHR) determined by optical plethysmography and relationships to changes in other lifestyle health behaviors (sleep and activity).

Methods:
Data were obtained from N=197,988 Fitbit users who wore their heart-rate enabled Fitbit device to sleep and had detected sleep stages at least 10 days in the month of January, the baseline period; and synced their devices at least once in the last 10 days of April. In addition, potential participants needed to reside in one of 6 target cities: Chicago, Illinois; Houston, Texas; Los Angeles, California; San Francisco, California; New York City, New York; and Miami, Florida. Users who met these criteria were randomly selected. Daily RHR, sleep duration (minutes), sleep duration variability (standard deviation), bedtime, step count, and active minutes were estimated by the device. Differences between January (before the pandemic) and April (peak of stay-at-home orders) was computed. Correlations between change in RHR and change in other variables were evaluated, stratified by age and sex.

Results:
For all age groups, in both men and women, mean RHR declined from January to April by about 1bpm, with the highest reductions in the youngest adults (all p<1x10
-100
). In general, across both genders and all age groups, reductions in RHR were correlated with greater sleep duration, delaying bedtime, reduced sleep variability, and more active minutes. Steps were also associated in younger (but not older) adults. Results for ages 18-29 and >=65 are displayed in the Table.

Discussion:
During the COVID-19 pandemic, RHR decreased robustly but very slightly. Reductions in RHR were correlated with improvements in other health behaviors (sleep and activity). Causal relationships could not be evaluated, but future studies may explore whether even small changes in health behaviors can measurably impact population RHR.
Abstract MP39: Factors Associated With Adherence To Evidence-based Recommendations For COVID-19 Prevention Among People With Cardiovascular Disease
Authors: Adeniran Esther , Ahuja Manik , Awasthi Manul , Dowling Karilynn , Maisonet Mildred , Weierbach Florence , Stewart David , Paul Timir K , Mamudu Hadii M
Published: May 2021

Introduction:
The United States Centers for Disease Control and Prevention (CDC) issued behavioral recommendations to limit the spread of the novel coronavirus disease-2019 (COVID-19). No studies have examined the influence of various factors on adherence to COVID-19 preventive measures. Among individuals with co-morbidities, such as cardiovascular disease (CVD) and residing in rural communities, adherence is essential as they are at an increased risk of COVID-19 infection and increased disease severity.

Objective:
This study aims to explore factors influencing adherence to evidence-based recommendations for preventing COVID-19 among patients/family caregivers with CVD in rural Central Appalachia.

Methods:
During March-April 2020, 102 CVD Stakeholders - patients/family caregivers, community leaders, and providers from six states across Appalachia participated in a survey administered through REDCap. This study used a subsample (n=73) that excluded providers. Adherence score was defined as the rate of compliance with health authorities’ guidelines, including handwashing, physical distancing, staying home if sick, wearing a face mask, disinfecting and cleaning daily, and cough and sneezing etiquette. Simple and multiple linear regressions were performed to examine associations between adherence scores and variables of interest.

Results:
Over half (53.42%) of participants complied with all guidelines. Gender, employment status, hypertension, smoking, no insurance, getting information about COVID-19 from Government/CDC website, and getting information about COVID-19 from worship place/club were significantly associated with adherence to CDC recommendations (p<0.05). Compared to low personal perception of threat (PPT), having no and high PPT were associated with lower and higher adherence scores, respectively (β= -2.32, 1.42; p=0.001). Compared to low perception of COVID-19 threat towards family/friends, having moderate or high perception of COVID-19 threat toward family/friends was associated with improved adherence (β= 1.3, 1.57; p<0.05 for both), whereas having no perception was negatively associated with adherence (β= -2.08, p=0.003). Moderate and high perception of COVID-19 threat toward one's community (β= 2.14, 2.06; p<0.001) were likewise associated with higher adherence. R squared for the model= 0.459.

Conclusion:
Moderate and high perceptions of COVID-19 threats are associated with higher adherence, whereas no perception was associated with lower adherence with health authority recommendations for COVID-19 prevention. These factors should be considered in order to develop effective adherence interventions for CVD stakeholders in rural communities. Results should be confirmed in a larger study.
Abstract MP41: Rates Of Acute Myocardial Infarction Around The Covid-19 Pandemic And Comparable Time Periods In 2019 In An Integrated Healthcare Delivery System
Authors: Mefford Matthew T , Liu Ran , Qian Lei , Harrison Teresa N , Jacobsen Steven J , An JaeJin , Lee Mingsum , Gupta Nigel , Price Chileshe N , Muntner Paul , Reynolds Kristi
Published: May 2021

Background:
Stay at home orders and fear of acquiring COVID-19 may have led to an avoidance of care for medical emergencies including acute myocardial infarction (AMI). We sought to examine rates of confirmed AMI cases between January 1-June 30, 2019 and 2020.

Methods:
We identified Kaiser Permanente Southern California members ≥ 18 years old with a hospitalization or emergency department visit for AMI, defined by ICD-10 primary diagnosis codes. Rates of AMI per 100,000 member-weeks were calculated for pre-pandemic and pandemic periods of January 1-March 3, 2020 and March 20-June 30, 2020, respectively, and in the same periods of 2019 overall and for ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), separately. March 4-19, 2020 was considered a washout period given the gradual rollout of stay-at-home orders. Rate ratios (RR) and 95% confidence intervals (CI) were calculated comparing pre-pandemic and pandemic periods of 2020 to 2019 using Poisson regression.

Results:
The mean age of patients presenting with AMI during the 2020 (n=3,029) and 2019 (n=3,518) periods was 69 years, and a majority of events occurred among men (62%) and whites (47%). Rates of AMI in the pre-pandemic period of 2020 and same period in 2019 were 4.23 and 4.45 per 100,000 member weeks, respectively. During the pandemic period of 2020 and the same period in 2019, rates were 3.04 and 3.85 per 100,000 member-weeks, respectively. (Figure) There was no evidence rates of AMI were different during the pre-pandemic period of 2020 compared to the same period in 2019 (RR 0.95, 95% CI 0.88, 1.03). In contrast, rates of AMI were lower during the pandemic period of 2020 compared to the same period of 2019 (RR 0.79, 95% CI 0.74, 0.85), and among NSTEMI (RR 0.80, 95% CI 0.74, 0.86) and STEMI (0.74, 95% CI 0.66, 0.84) cases.

Conclusion:
AMI rates were lower during the COVID-19 pandemic compared to the year prior. Public health messaging is important to ensure people seek care for medical emergencies.
Abstract MP43: Breast Milk-dependent Associations Of Infant Gut Microbiota With Childhood BMI Z Score
Authors: Differding Moira K , Madan Juliette , Gilbert-Diamond Diane , Baker Emily , Karagas Margaret R , Mueller Noel T
Published: May 2021

Introduction:
The prevalence of overweight and obesity in children ages 2-5 years continues to rise in the US. Experimental germ-free animal models indicate gut microbiota can cause excess weight gain. Observational human studies, mostly cross-sectional, also suggest gut microbiota is associated with obesity, but these studies have largely been conducted in older children and adults. Infants have a unique gut microbiota composition and function, under strong influence by human milk. Bifidobacteria, in particular, is hypothesized to be beneficial in the presence of human milk oligosaccharides. To our knowledge, no longitudinal studies have examined the association of the infant gut microbiota with childhood BMI, taking into account intake of human milk.

Hypothesis:
We hypothesized that infant gut microbiota composition, in particular relative abundance of Bifidobacteria, in the first year is prospectively associated with differences in child BMI from ages 2-5 years and associations are modified by duration of human milk feeding.

Methods:
We examined longitudinal data from mother-child dyads in the New Hampshire Birth Cohort, which began enrolling pregnant women from New Hampshire in 2009. We measured the infant gut microbiota using 16S rRNA sequencing at 6 weeks and 12 months of age. We estimated alpha diversity using the Shannon diversity index. Child BMI z scores (BMI-z) at 2-5 years of age were calculated using sex- and age-specific WHO growth charts. We used unadjusted and multivariable adjusted linear mixed models. We adjusted for pre-pregnancy BMI, birth weight, delivery mode, and infant BMI-z at 12 months (in 12-month microbiota models). We considered effect measure modification by breastfeeding duration.

Results:
Our analytic sample comprised 148 and 146 infants with microbiota data at 6 weeks and 12 months, respectively, and at least 1 BMI-z from ages 2-5 years. Shannon diversity at 6 weeks and 12 months of age, and top genera at 6 weeks were not significantly associated with child BMI-z. Abundance of 12-month
Bifidobacterium
was associated with lower BMI-z (-0.12; 95% CI (-0.25, 0.006)) and interacted with breastfeeding duration (p interaction <0.01); among infants consuming breast milk ≥6 months
Bifidobacterium
was associated with a 0.22 (95% CI: 0.06, 0.37)
lower
child BMI-z. Lower abundance of 12-month
Prevotella
, a bacteria linked to obesity in adults, was suggestively associated with lower child BMI-z and this association was also modified by breastfeeding duration (p interaction=0.01), such that it was only significant among infants breastfed < 6 months (0.34; 95% CI: 0.09, 0.60). Both interactions were consistent when breastfeeding duration was dichotomized at 12 months.

Conclusion:
Higher percent
Bifidobacterium
and lower
Prevotella
at 12 months was prospectively associated with lower childhood BMI-z, and both associations were modified by breastfeeding duration.
Abstract MP56: Specific Nutrients Associate Better Than Dietary Approaches To Stop Hypertension Score With Adult Cardiovascular Risk Factors Over 25 Years: The Princeton Lipid Study
Authors: Beck Leah , Woo Jessica G
Published: May 2021

Introduction:
Diet is a contributing factor to cardiovascular disease risk and is the basis for dietary guidelines such as the Dietary Approaches to Stop Hypertension (DASH) eating plan. However, little is known about how childhood dietary habits are maintained into adulthood or how child to adult, or adult to adult changes in diet may influence disease risk.

Hypothesis:
Our goal was to examine the relationship between diet quality, cardiovascular disease risk, and changes in diet quality over time. We hypothesized that diets lacking in nutrients for ideal cardiovascular health would be conserved from childhood to adulthood. This would be reflected as increased rates of hypertension, diabetes, dyslipidemia, and obesity.

Methods:
Diet data was analyzed from the Princeton Lipid Research study (24 hour recall in the 70’s; Block Food Frequency Questionnaire in 1998). Diet quality at each visit was assessed as a ranking of 15 different macro/micronutrients and by a modified DASH index based on 9 nutrient targets and adapted for children. Outcomes in both childhood and adulthood included: glucose intolerance/diabetes, high blood pressure/hypertension, dyslipidemia/hyperlipidemia, and obesity. Linear and logistic regression models were performed with adjustment for age, race, sex, BMI, occupation and education of self or head of household, and marital status.

Results:
Analysis included 221 total individuals in Generation 1 (parents at initial visit; 39% (86 of 221) male, mean age 38.9 ± 6.5 followed up at 66.6 ± 6.6 years) and 606 individuals in Generation 2 (45% (271 of 606) male, mean age 11.9 ± 3.23 at initial visit and 38.5 ± 3.6 years at follow up). Generation 1 increased in total DASH score from initial visit to follow-up (1.74 ± 0.95 → 2.11 ± 1.33) while Generation 2 decreased (1.91 ± 0.80 → 1.64 ± 1.13). Overall DASH score was not significantly associated with baseline or follow up outcomes in childhood or adulthood. However, in Generation 2 at follow-up, fiber, potassium, iron, niacin, and vitamin A were associated with hypertension; fiber and sugar with hyperlipidemia; cholesterol with obesity; and saturated fat with diabetes in Generation 1.

Conclusions:
Overall diet quality was poor in both generations and changed little over time. In conclusion, no relationship was detected between DASH diet accordance and disease outcomes, however certain nutrients are associated with higher cardiovascular disease risk.
Abstract MP59: Effects Of Sodium Reduction And Weight Loss On Lightheadedness And Falls In Older Adults: Results From TONE
Authors: Juraschek Stephen P , Cluett Jennifer , Anderson Timothy , Ishak Anthony , Sahni Shivani , Millar Courtney , Appel Lawrence J , Miller Edgar R , Lipsitz Lewis , Mukamal Kenneth J
Published: May 2021

Background:
The Trial of Nonpharmacologic Interventions in the Elderly (TONE) demonstrated the efficacy of sodium reduction and weight loss to reduce hypertension medication use in older adults. However, adverse events related to lightheadedness and falls have not been reported.

Objective:
To determine whether sodium reduction and weight loss are associated with greater risk of lightheadedness and falls among older adults.

Methods:
TONE was a randomized trial of 60-80 year-old adults with systolic BP (SBP) and diastolic BP (DBP) below 145 and 85 mm Hg, respectively, while receiving treatment with a single antihypertensive medication. Participants were randomized to behavioral interventions focused on sodium reduction, weight loss, both, or neither (usual care); 3 months after randomization, the antihypertensive medication was withdrawn and only restored later during the study if needed for uncontrolled hypertension. Total follow-up was 36 months post-randomization. Two physicians independently adjudicated adverse event logs, masked to intervention assignment. The primary outcome was a composite of the first occurrence of adverse event related to falls (total N=95): 72 involved orthostatic symptoms (lightheadedness, dizziness, vertigo), while 23 involved hard events (fall or syncope). Hazard ratios were determined via Cox proportional hazards models.

Results:
Among the 975 participants (mean age 66 yrs, 48% women, 24% black), mean SBP and DBP were 128 and 71 mm Hg. The cumulative incidence of adverse events at 30 months was 0.08, 0.13, 0.11, and 0.14 for usual care, reduced sodium, weight loss, or both, respectively (
Figure
). In adjusted multi-variable analyses, sodium reduction was associated with higher risk of an adverse event (HR 1.52; 95% CI: 1.02, 2.27), while weight loss was not associated with adverse events (HR 1.18; 0.77, 1.79).

Conclusions:
In the context of antihypertensive medication withdrawal, sodium reduction was associated with a higher risk of fall-related adverse events, predominantly symptoms.
Abstract MP62: Longitudinal Measures Of Blood Pressure And Subclinical Atrial Arrhythmias: The Multi-ethnic Study Of Atherosclerosis And The Atherosclerosis Risk In Communities Study
Authors: Harding Barbara N , Norby Faye L , Heckbert Susan R , McKnight Barbara , Psaty Bruce M , Soliman Elsayed Z , Floyd James , Chen Lin Y
Published: May 2021

Purpose:
High blood pressure (BP) is a well-known risk factor for atrial fibrillation (AF), but a single BP measurement may provide limited information about AF risk in older adults. We evaluated whether longitudinal measures of BP were associated with subclinical arrhythmias after adjustment for more conventional BP measures such as a single cross-sectional BP value.

Methods:
This study included 1,256 Multi-Ethnic Study of Atherosclerosis (MESA) and 1,948 Atherosclerosis Risk in Communities study (ARIC) participants who underwent extended ambulatory electrocardiographic monitoring and who were free of clinically-detected cardiovascular disease, including AF. Using BP measurements from six exams (2000-2018 in MESA, 1987-2017 in ARIC), we examined cross-sectional BP at the most recent exam, individual long-term mean BP from exams 1-5, BP trend during exams 1-5, and visit-to-visit variability during exams 1-5 in systolic BP (SBP) and pulse pressure (PP) for each participant. Logistic regression models were used to examine BP exposures in relation to subclinical AF and linear regression models were used to examine BP exposures in relation to frequency of supraventricular ectopy. Models adjusted for participant demographics, height, weight, diabetes, antihypertensive medication use and cross-sectional BP. Results from each study were combined with inverse variance-weighted meta-analysis.

Results:
At Exam 6, the mean age was 73 years in MESA and 79 years in ARIC, and 4% had subclinical AF. A 10 mmHg higher cross-sectional SBP and a 10 mmHg higher cross-sectional PP were associated with less AF (odds ratio [OR] SBP 0.86, 95% confidence interval [CI] 0.76, 0.96 and OR PP 0.73, 95% CI 0.63, 0.84). In contrast, a 4 mmHg higher visit-to-visit variability in SBP was associated with a greater prevalence of subclinical AF (OR 1.20, 95% CI 1.02, 1.38) and with a greater frequency of premature atrial contractions/hour (8%, 95% CI 1%, 15%). For PP as well, a 4 mmHg higher visit-to-visit variability was associated with a greater prevalence of AF (OR 1.18, 95% CI 1.00-1.37). In addition, a 10 mmHg higher long-term mean PP was associated with a greater prevalence of subclinical AF (OR 1.36, 95% CI 1.08-1.70).

Conclusion:
Our results indicate that information on BP assessed longitudinally for several years, especially visit-to-visit BP variability, is associated with a greater prevalence of subclinical atrial arrhythmias, while cross-sectional BP values alone were not associated with a greater prevalence of subclinical atrial arrhythmias. Prior longitudinal BP assessment, rather than current BP, may be more helpful in identifying older adults who are at higher risk of atrial arrhythmias.
Abstract P014: Life’S Simple 7 And Fibroblast Growth Factor 23: The Boston Puerto Rican Health Study.
Authors: Ochin Chinedu C , Bigornia Sherman , Garelnabi Mahdi O , Tucker Katherine L
Published: May 2021

Introduction:
FGF-23 is a phosphatouric hormone which also serves as a plasma biomarker that mediates pathologic cardiac remodeling, such as left ventricular hypertrophy or myocardial fibrosis, and is associated with increased cardiovascular mortality. However, limited evidence is available on lifestyle-related factors associated with circulating concentration of this emerging cardiovascular risk factor.

Objective:
Our aim was to measure the association between the American Heart Association’s Life’s Simple 7 (LS7) and circulating FGF-23 concentration among Puerto Rican adults.

Methods:
Data are from Boston Puerto Rican Health Study (BPRHS) participants (mean age 56.2 years, 77% female) at baseline and at approximately 8-y follow-up (n=410). LS7 was calculated at baseline and includes 4 physiological (BMI, total cholesterol, blood pressure, and fasting glucose) and 3 behavioral factors (smoking, physical activity, and diet). Each component was categorized using a constituent scoring system (ideal=2; intermediate=1; Poor=0) and these were summed to calculate the total LS7 score. Participants were categorized into 5 LS7 groups as follows:
1)
score 1-4 (n=105),
2)
5 (n=76),
3)
6 (n=89),
4)
7 (n=69), and
5)
8-12 (n=71). Fasting plasma FGF-23 concentration at 8-y follow-up was measured by ELISA. Associations between baseline LS7 score and 8-y FGF-23 were assessed using ANCOVA, adjusted for age and sex (model 1), and additionally for history of cardiovascular disease and poverty-income-ratio (model 2).

Results:
Relative to participants in LS7 group 1 (2.98 ± 1.09 mg/dL), those in groups 5 (1.63 ± 1.12 mg/dL, p=0.0001) had significantly lower FGF-23 concentration (model 1, P-trend=0.0001). After considering additional confounders, FGF-23 concentration among LS7 group 5 (1.69 ± 1.12 mg/dL, p=0.0007) remained significantly lower than in group 1 (2.95 ± 1.09 mg/dL). The p-trend across categories was also significant at p=0.0007. In additional analyses, LS7 components for smoking (ideal vs. poor, 2.07 ± 1.10 mg/dL vs. 2.87 ± 1.10 mg/dL, p=0.01) and fasting glucose (ideal vs. poor, 2.03 ± 1.07 mg/dL vs. 2.90 ± 1.09 mg/dL, p=0.004), but no other components, were associated with FGF-23 concentration.

Conclusions:
Optimal LS7 status was associated with lower 8-y mean plasma FGF-23 concentration. Efforts to target LS7 components, particularly smoking and glucose control, may improve FGF-23 concentration among Puerto Rican adults.
Abstract P021: Association Of Resting Heart Rate With All-cause And Cardiovascular Mortality: Sprint
Authors: Mould Steven J , Soliman Elsayed Z , Pokharel Yashashwi , Beaty Elijah , Bhave Prashant , Whalen S P , Yeboah Joseph , Singleton Matthew J
Published: May 2021

Introduction:
Elevated resting heart rate (RHR) has been shown to be associated with both all-cause and cardiovascular mortality. Prior studies have provided conflicting estimates of the strength of each association. To explore the relationship between RHR and competing mortality risks, we sought to compare the association between RHR and cardiovascular and non-cardiovascular mortality among participants in the Systolic Blood Pressure Intervention Trial (SPRINT).

Methods:
Eligible SPRINT participants had baseline RHR, longitudinal follow-up, and were not using beta blockers or non-dihydropyridine calcium channel blockers. Mortality was classified by a treatment-blinded adjudication committee as cardiovascular if secondary to coronary heart disease, stroke, sudden cardiac death, or congestive heart failure. Multivariable Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CI) for cardiovascular and non-cardiovascular mortality, separately, associated with a 10 beats per minute increase in RHR.

Results:
Among 5,571 eligible SPRINT participants (67.1 ± 9.4 years, 33.8% female, 63.8% white, mean RHR 70.4±11.8 beats per minute) over a median 3.8 years of follow-up, there were 56 cardiovascular deaths and 176 non-cardiovascular deaths. In models adjusted for age, sex, race, prior cardiovascular disease, smoking, systolic blood pressure, creatinine, total cholesterol, high-density lipoprotein cholesterol, and trial treatment assignment, higher RHR (per ten beat-per-minute increase) was associated with both cardiovascular (HR 1.17, 95% CI 1.02-1.35) and non-cardiovascular mortality (HR 1.27, 95% CI 1.13-1.43).

Conclusions:
Elevated RHR was associated with both cardiovascular and non-cardiovascular mortality, suggesting that RHR may serve as a marker of both global health rather and cardiovascular health. Higher RHR may reflect imbalance in autonomic tone and further studies are needed to explore the mechanisms of these associations.4
Abstract P024: Associations Between Carotid-femoral And Estimated Pulse Wave Velocity In Older Adults: The Atherosclerosis Risk In Communities (ARIC) Study
Authors: Pagan Lassalle Patricia , Meyer Michelle L , Heffernan Kevin S , Kiefer Adam W , Bates Lauren C , Hanson Erik D , Horiuchi Masahiro , Michos Erin , Kucharska-newton Anna , Matsushita Kunihiro , Hughes Timothy , Tanaka Hirofumi , Stoner Lee
Published: May 2021

Background:
Carotid to femoral pulse wave velocity (cfPWV), the gold-standard measure of aortic stiffness, is associated with the incidence of cardiovascular disease (CVD) events. Most cfPWV measurements depend on technical proficiency, which limit broader implementation in clinical settings. Recently, an estimated pulse wave velocity (ePWV) measure derived from age and mean arterial pressure (MAP) has been shown to be associated with the risk of CVD events and all-cause mortality and may be a simple alternative to cfPWV. However, ePWV is poorly predictive in non-White individuals, possibly because it was originally developed from European Cohorts. Consequently, our purpose was to: estimate the strength of association between cfPWV and ePWV, and determine whether agreement is consistent across race.

Hypothesis:
cfPWV and ePWV are in good agreement and association would be consistent across race.

Methods:
We included Black and White older adults (n= 4,478; 75.2 [5.0] years) from visit 5 (2011-13) of the community-based Atherosclerosis Risk in Communities Study (ARIC). cfPWV was measured using an automated cardiovascular screening device. ePWV was calculated as presented in Fig 1. Association between cfPWV and ePWV was determined using Pearson’s correlation coefficient (r) and Bland-Altman plots.

Results:
As reported in Fig 1, there was a weak (r=0.35) correlation between cfPWV and ePWV for the total population, with similar correlations when stratified by Blacks (r=0.31) and Whites (r=0.36). Bland-Altman plots indicated significant systematic differences between cfPWV and ePWV (-0.17 m/s, 95% confidence interval: -0.25 to -0.09 m/s, P <.001), which was consistent by race.

Conclusion:
In older adults, there was weak correlation between cfPWV and ePWV and systematic differences in agreement. Our results do not support ePWV as a surrogate measure of cfPWV in a sample of older White and Black adults.
Abstract P055: Diabetes, Early Heart Failures Stages (A & B), And Progression To Overt Heart Failure In Older Adults: The Atherosclerosis Risk In Communities Study
Authors: Echouffo Tcheugui Justin B , Ndumele Chiadi E , Zhang Sui , Florido Roberta , Matsushita Kunihiro , Coresh Josef , Skali Hicham , Shah Amil M , Selvin Elizabeth
Published: May 2021

Introduction:
Diabetes confers a high risk of heart failure (HF). However, the influence of diabetes in preclinical HF (stages A or B) on the progression to overt HF is not well understood.

Hypothesis:
Diabetes accelerates progression to clinically overt HF, but significantly more so in stage A than B.

Methods:
We included older adults (aged 66-90 years) without clinical HF (n= 4782) who attended ARIC study visit 5 (2011-2013). We categorized participants into stage A (n=3067) or B (n=1715) HF. Within each stage A or B, we used Cox regression to quantify the associations of diagnosed diabetes and glycemic control (HbA
1C
<7% vs. ≥ 7%) with progression to HF. We also evaluated the relative and absolute risk associations of cross-categories of HF stages (A vs. B) and diabetes and glycemic control with incident HF.

Results:
There were 401 HF events during a median 6.3 years follow-up (mean age 75, 59% female, 21% Black, 28% with diabetes). The 7.6-year cumulative HF risk among individuals with diabetes and HbA
1C
≥ 7% vs. those without diabetes was 11.9% vs. 4.5% in stage A, and 18.1% vs. 13.6% in stage B. In stages A and B, individuals with uncontrolled diabetes had significantly higher risks of HF compared to those without diabetes (all
P
<0.05;
Table
). Uncontrolled diabetes was more strongly associated with HF in stage A than stage B (
P
=0.02). In cross-categories of HF stage, diabetes, and glycemic control, individuals with stage B HF and uncontrolled diabetes had greater than 4-fold risk of HF than those with stage A HF without diabetes.

Conclusions:
Among older adults with preclinical HF stages (A and B), uncontrolled diabetes is associated with substantial short-term (~8 year) risk of HF and should be a focus of aggressive preventive therapies. Newer anti-diabetes therapies such as
SGLT2
inhibitors
are currently recommended in adults with diabetes and clinical HF, but not stages A and B. Our results suggest that among older adults, such therapies may yield clinical benefits
in early HF stages.
Abstract P056: The Role Of Socioeconomic Status In Racial/ethnic Disparities In Complications Of Diabetes: The Atherosclerosis Risk In Communities Study
Authors: Hicks Caitlin W , Wang Dan , Purnell Tanjala , Windham B Gwen , Grams Morgan , Coresh Josef , Matsushita Kunihiro , Selvin Elizabeth
Published: May 2021

Background:
Few prospective studies have evaluated the role of socioeconomic status in explaining racial/ethnic disparities across major complications among adults with diabetes. We assessed the prospective association of race/ethnicity with long-term complications and cardiovascular mortality in persons with diabetes in a community-based cohort.

Methods:
We conducted a prospective analysis of 4,460 black and white participants in the ARIC Study with prevalent or incident diabetes (and no history of cardiovascular disease) followed from time of diabetes through 2018. We calculated incidence rates of major clinical outcomes (fatal coronary heart disease or myocardial infarction, heart failure, ischemic stroke, end stage renal disease, hospitalized peripheral artery disease [PAD], lower extremity amputation) using standard definitions in the ARIC Study. We used Cox regression to assess the associations of race/ethnicity with incident complications and cardiovascular mortality before and after adjustment for cardiovascular and socioeconomic factors.

Results:
The incidence rates (per 1,000 person-years) were higher for black vs. white adults with diabetes for heart failure (22.1 vs. 17.4), ischemic stroke (8.5 vs. 5.5), end stage renal disease (5.6 vs. 1.6), PAD (4.7 vs. 3.2), lower extremity amputation (2.9 vs. 1.0) and cardiovascular mortality (7.5 vs. 6.5). These associations remained significant after adjusting for age, sex, smoking, and hypertension (HRs 1.41 to 3.27), but - with the exception of ESRD - were largely attenuated after further adjusting for health insurance and socioeconomic variables (
Table
).

Conclusions:
Among adults with diabetes, the association of race/ethnicity with complications differs depending on the outcome. Socioeconomic disparities play a major role in explaining the differences between groups. Our findings suggest that eliminating economic and healthcare system disparities is important to address health equity and prevent complications in adults with diabetes.
Abstract P057: The Association Of Diabetes Duration With Central Artery Stiffness And Its 5-year Change Among Older Adults: The Atherosclerosis Risk In Communities Study (ARIC).
Authors: Marji Meera , Heiss Gerardo M , Pike James R , Palta Priya , Meyer Michelle , Tanaka Hirofumi , Stoner Lee , Selvin Elizabeth , Nambi Vijay , Ballantyne Christie M , Kucharska-newton Anna
Published: May 2021

Background:
Central artery stiffness is a predictor of cardiovascular risk and mortality among individuals with diabetes. Few studies examined whether the duration of diabetes relates to arterial stiffening and its rate of progression.

Objective:
To examine the association of diabetes duration from midlife to older adulthood with arterial stiffness and its 5-year change.

Methods:
Diabetes (defined by fasting glycemia level >126 mg/dl or use of glucose lowering agents or self-reported) was ascertained at visit 1 (1988-1990), on repeated examinations and on telephone follow-up calls of 2,155 ARIC cohort members (58% women, 20% black, mean age 74 years), as well as time since ascertainment of diabetes. Carotid femoral pulse wave velocity (cfPWV), a measure of central artery stiffness, was obtained at cohort visits 5 (2011-13) and 6 or 7 (2016-19). Associations of duration of diabetes with visit 5 cfPWV and the 5-year cfPWV change from visit 5 to visit 6 or 7 were evaluated by multivariable linear regression adjusted for demographic factors.

Results:
Among study participants with diabetes ascertained from midlife to older adulthood (n=639 (29%)), the mean cfPWV at visit 5 was 78.6, 95%CI (52.9, 104.4) cm/s greater than those without diabetes. Over a mean of 4.9 (SD 3) years of follow-up, cfPWV increased by a median 137 cm/s. The 5-year change in cfPWV was 40.5, 95%CI (12.3, 68.8) cm/s greater among those with diabetes, as compared to those without diabetes. The mean diabetes duration was 8.1(SD 6.8) years for participants with diabetes. After adjusting for demographic factors, we observed a positive association of diabetes duration with the 5-year change in cfPWV in older adulthood (Figure).

Conclusion:
Duration of diabetes was associated with a greater rate of progression of central arterial stiffness in older adults.
Abstract P069: White Cell Gene Expression Related To Immune Function And Cumulative Blood Pressure During Young Adulthood And Middle Age: Coronary Artery Risk Development In Young Adults (CARDIA)
Authors: Gross Myron D , Thyagarajan Bharat , Vivek Sithara , Jacobs David R
Published: May 2021

Introduction:
High blood pressure (BP) is a global public health problem that is strongly associated with many aspects of cardiovascular disease. Approximately 90% of hypertension cases have unknown cause. Studies of white blood cell gene expression may help to clarify the pathobiology.

Methods:
Gene expression (25 genes) was assayed in CARDIA at the Year 25 Exam (N=3,074 black and white men and women in 4 US cities, examined in 2010-2011, age 42-56 years). Whole blood was collected in PAXgene Blood RNA tubes; mRNA was isolated using the PAXgene Blood RNA kit (Qiagen Inc., Germantown, MD). The nCounter analysis system (Nanostring Inc., Seattle, WA) was used to measure expression of 25 genes related to inflammation and oxidative stress. Gene expression levels were logarithmically (base 2) transformed to approximate a normal distribution, so 1 unit higher represents doubling of the expression. Average cumulative sitting rest BP exposure was calculated (N=2,823) as the time weighted average across ≥5 BP measurements among 9 CARDIA exams with ≥1 measurement in each of Set 1 Years 0, 2, 5, 7; Set 2 Years 10, 15; and Set 3 Years 20, 25, 30. We added 10 mmHg to the systolic BP and 5 mmHg to the diastolic BP at visits in which antihypertensive medications were used. Linear regression estimated associations between dependent variables cumulative systolic and diastolic BP and each of the 25 gene expression levels, adjusting for age, race, sex, clinic, and year 25 body mass index. Hypertension at year 25 was defined as BP >140/90 mmHg or taking antihypertensive medications and pre-hypertension at year 25 was defined as BP between 121-139/81-90 mmHg, not taking antihypertensive medications. Unconditional logistic regression models were used to estimate the cross sectional association between hypertension and gene expression after adjusting for the covariates mentioned above.

Results:
The mean ± standard deviation for cumulative systolic BP was 113±11 mm Hg and for cumulative diastolic BP was 72±8 mmHg. NADH Dehydrogenase [Ubiquinone] 1 Beta Subcomplex Subunit 3 (
NDUFB3)
, a mitochondrial gene involved in the electron transport chain was significantly associated with both cumulative systolic (β=1.549; p<0.0001) and diastolic BP measures (β=1.281 mmHg/1 log 2 unit of expression; p<0.0001), even after Bonferroni correction. Other genes had weaker signals. Consistent with these observations, hypertension (n=898) at year 25 (OR: 1.737; p<0.001) and pre-hypertension (n=1,127) at year 25 (OR:1.288; p=0.005) were also associated with increased NDUFB3 expression.

Conclusions:
Expression of the NDUFB3 gene, an element of oxidative stress, was associated with BP assessed throughout young adult and middle age and with concurrent hypertension.
Abstract P071: Metabolic Syndrome Gut Microbial Associations Are Independent Of Country Of Origin: Evidence From African-origin Populations
Authors: Adam Kaavya , Morrow Patricia , Sharma Anukriti , Choo-Kang Candice , Lambert Estelle V , Plange-Rhule Jacob , Bedu-Addo Kweku , Luke Amy , Bovet Pascal , Gilbert Jack , Layden Brian , Dugas Lara
Published: May 2021

Introduction:
Changes to the overall diversity and relative abundance of the microbiota have been shown to alter not only the functionality of the gut system, in particular with regards to the metabolic rates and levels of pro-inflammatory cytokines, but also the development of disease states such as metabolic syndrome (METS). The purpose of this study was to explore the composition of the gut microbiota diversity, and metabolic outcomes, across three populations: the United States, Ghana and South Africa.

Hypothesis:
We assessed the hypothesis that differences between the three populations, including variations in diet, would affect the diversity and composition of the microbiome of the participants; these changes would in turn be reflected in the gut-related metabolic outcomes.

Methods:
Participants(N=560) provided a fecal sample which was analyzed using the analysis of Composition of Microbiome to identify differentially abundant bacterial exact sequence variants (ESVs), and general linearized models (GLM) to test associations between selected ESVs and gut-related metabolic outcomes.

Results:
Not surprisingly, macronutrient intake was significantly different across the 3 sites (p<0.001), which resulted in differences in the overall microbial diversity (p<0.01) and composition of pro-inflammatory species such as Bacteroides (p<0.01). There were also differences in the relative abundance of ESVs associated with multiple metabolic functional pathways in participants meeting diagnostic criteria for METS. As the number of positive METs criteria increased, there were a significant decline in the proportions of microbiota associated with fatty acid degradation (p = 0.026) and lipid metabolism (p = 0.041). On the other hand, the abundance of organisms participating in the proinflammatory LPS functional pathway were higher in obese participants when compared to age and location matched non-obese participants. Finally, there the difference across countries bacterial diversity was associated with a differential pro-inflammatory LPS abundance (p<0.01).

Conclusion:
In conclusion, we found that country of origin was significantly associated with bacterial diversity. These differences were associated with alterations in the bacterial functional metabolic and proinflammatory pathways, suggesting a role in cardiovascular health and the development of the METS.
Abstract P076: Increased Burden Of Chronic Illness Among Insured Compared To Uninsured Sudden Death Victims
Authors: Houston Reaves , Keen Susan , Deitelzweig Chelsea , Jones Hannah , Laible Sarah , Sauter Catherine , Simpson Ross J
Published: May 2021

Introduction:
Lack of health insurance is associated with reduced access to medical care and increased mortality. Chronic illness is associated with sudden death, a major cause of natural death. Insurance status of sudden death victims has not been characterized.

Hypothesis:
Uninsured compared to insured sudden death victims will have more chronic illnesses.

Methods:
From 2013-2015, emergency medical services-attended out of hospital deaths among ages 18-64 in Wake County, NC were screened to adjudicate sudden deaths. Medical records were reviewed for demographic, clinical, and health insurance status data. Insurance status was characterized as private, public, or no insurance. Cases were excluded from the analysis if no information on insurance was available. Comparisons of demographic and clinical characteristics were made between the three insurance status groups using Student’s t-test and ANOVA for continuous and categorical variables, respectively.

Results:
Of 399 cases of sudden death, insurance status data was available for 130: 25 (19.2%) had no insurance, 62 (47.7%) had public insurance, 31 (23.8%) had private insurance, and 12 (9.2%) had insurance of unknown type. Uninsured victims had lower frequencies of hypertension, hyperlipidemia, and chronic respiratory disease than those with private or public insurance, and lower frequencies of diabetes mellitus, mental illness, and substance abuse than those publicly insured (Table 1). No significant differences were found in coronary artery disease, age, gender, race, marital status, or years of education.

Conclusion:
Uninsured sudden death victims have less chronic illnesses than those insured. This counterintuitive finding suggests that uninsured sudden death victims have undiagnosed chronic illnesses that are treatable and preventable and contribute to their death. Our results suggest that expanding health insurance among working age adults may reduce the incidence of sudden death.
Abstract P077: Trends In Prevalence Of Cardiometabolic Diseases By Food Security Status, 1999-2016
Authors: Liu Junxiu , Yi Stella , Russo Rienna , Zhang Donglan , Rajbhandari-Thapa Janani , Li Yan
Published: May 2021

Introduction:
Cardiometabolic diseases (CMDs), which include coronary heart disease (CHD), hypertension (HTN), type 2 diabetes (DM) and obesity, are an interrelated set of highly preventable conditions. Food insecurity, another pervasive public health issue, is associated with CMDs. We aim to characterize the prevalence of CMD by food security (FS) status over time.

Hypothesis:
Prevalence of DM and obesity increased while that of HTN and CHD decreased over time, with pervasive disparities among FS status.

Methods:
Adults ≥20 years from the 1999-2016 NHANES were included in this analysis. CMD outcomes included DM (prior diagnosed or FPG≥126 mg/dL or HbA1c ≥6.5%), CHD (prior diagnosis of myocardial infarction, angina or any other type of CHD), obesity (BMI ≥30 kg/m
2
) and HTN (≥1 of the following: systolic blood pressure (BP) ≥130 mmHg, diastolic BP ≥80, or currently taking BP medications). FS status was measured through the US Household Food Security Survey Module and recategorized into three levels (full, marginal and low). All estimates were age-standardized to the 2010 US census population. All analyses accounted for the complex survey design. Logistic regressions were conducted to calculate P-values.

Results:
Our sample included 46,879 adults (79.5% of full, 7.67% of marginal and 12.8% of low FS). HTN prevalence decreased from 50% to 44.4% among the full FS group and from 54.9% to 50.4% among the marginal group (P-trends<0.001, P-interaction=0.009). CHD prevalence decreased from 6.33% to 4.81% (P-trend<0.001) among the full group. Obesity prevalence increased from 31.0% to 38.0% among the full group and from 38.3% to 50.5% among the low group (P-trend<0.001, P-interaction=0.02). DM prevalence increased from 8.30% to 11.3% for the full group, from 14.9% to 21.8% for the marginal group and from 14.8% to 20.1% for the low group (P-trend<0.001) (
Figure
).

Conclusion:
From 1999 to 2016, the prevalence of CMDs were lowest among participants who were in full FS group and disparities by FS status persisted or worsened.
Abstract P084: The Association Of Socioeconomic Status With Ideal Cardiovascular Health In African American Males
Authors: Azap Rosevine A , Nolan Timiya , Gray Darrell , Lawson Kiwan , Gregory John , Capers Quinn , Odei James , Joseph Joshua J
Published: May 2021

Introduction:
African American (AA) men are burdened by high cardiovascular risk and have the highest age-adjusted all-cause mortality rate in the United States of America (US). Socioeconomic status (SES) is associated with improved cardiovascular risk factors in majority populations, but there is a paucity of data in AA men.

Hypothesis:
We hypothesized that higher levels of socioeconomic status would be associated with higher attainment of ideal cardiovascular health in AA men.

Methods:
We examined the association of socioeconomic status measures including education, income, occupation, and insurance status with an ideal cardiovascular health (ICH) score which included blood pressure, glucose, cholesterol, body mass index (BMI), physical activity, and smoking in African American Male Wellness Walks (AAMWW). Six metrics of ICH were categorized into a three-tiered ICH score 0-2, 3-4, 5-6. Ordinal logistic regression modeling was performed with adjustment for age.

Results:
Among 1,444 men, 108 (7%) attained 5-6 ICH metrics at baseline. After adjustment for age, none of the baseline indicators of socioeconomic status were associated with attainment of ICH.

Conclusion:
In our community-dwelling sample of AA men, the proportion of individuals with highest scores for ICH was very low, and SES was not associated with greater attainment of ICH. Strategies to increase attainment of cardiovascular health in AA men by health care professionals and policymakers need to incorporate intentional interventions beyond the scope of SES in order to advance health equity in AA men.