bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P042: Association Between Family History of Cardiovascular Disease and Childhood Obesity
Authors: Umer Amna , Hamilton Candice , Britton Cris , Pyles Lee , John Collin , Neal William , Lilly Christa
Published: March 2022

Introduction:
Children with family history of cardiovascular disease (F-CVD) have a higher predisposition to develop CVD risk factors during childhood due to shared genes and/or environmental factors. The purpose of this study was to examine if there is an association between F-CVD and childhood obesity.

Methods:
The study used longitudinally linked data from two cross-sectional datasets (the West Virginia (WV) Birth Score Project and the Coronary Artery Risk Detection in Appalachian Communities Project in fifth grade) in WV children (N=22,136). The outcome variable was BMI percentile adjusted for age and gender in fifth grade children. Exposure was defined as F-CVD (having family history of one of the six variables: heart disease, coronary heart disease, heart attack, open heart surgery, angioplasty, and death from heart disease). Additional covariates included socio-demographic variables, perinatal risk factors, and child’s current CVD risk factors. An independent sample t-test was used to determine significant difference in the BMI percentile of children with and without F-CVD. Multiple regression analysis was used to assess the adjusted relationships after controlling for covariates. The change in R-square was calculated to determine the unique amount of variance shared between F-CVD and BMI percentile.

Results:
Nearly one third (33.3%) of the children had F-CVD. The mean difference of BMI percentile of children with F-CVD vs. no F-CVD was 1.25 (95% CI: 0.46 - 2.04). The change in BMI percentile was 0.97 (95% CI: 0.01 - 1.94) or 0.02 standardized units for children having F-CVD compared to no F-CVD after adjusting for covariates. The predictors accounted for 25.8% of the variance in BMI percentile, and F-CVD uniquely accounted for 0.02% of the variance.

Conclusion:
Our results show a significant but small positive association between F-CVD and childhood obesity in fifth grade WV children. Examination of this association is an important step in identifying the role of F-CVD and childhood obesity in the state of WV.
Abstract P044: Difference of Body Composition Between Urban and Rural Overweight Children in Taiwan - Reappraisals Using of BMI as the Criteria for Childhood Obesity
Authors: Chu Nain-Feng , Hsu Juy-Ting , Lin Fu-Hung
Published: March 2022

To evaluate the prevalence of overweight among school children at urban and rural area and also examine the difference of body fat compositions of normal and overweight status children in Taiwan.

We conducted school-wide survey among junior-high school children at Taipei (as urban area) and Taitung (as rural area) in 2006 and 2012. Anthropometric variables of body height and weight were measured using standard scales and BMI was calculated as kg/m2. We measured body composition using the Tanita body composition analyzer (TBF-410GS). Total body fat (TBF) and percentage of body fat (%BF) were obtained for further analyses.

There are 1263 urban and 577 rural children included for this survey. The mean (SD) of BMI for boys was 21.6 (4.2) at urban and 21.0 (4.2) at rural area and for girls was 20.5 (3.5) and 20.3 (3.4) at urban and rural area (no statistical difference). But the percentage of body fat was 22.2 (7.9) and 18.9 (6.9) for urban and rural boys (p < 0.001), and was 26.2 (7.8) and 24.5 (7.1) for urban and rural girls (p< 0.01).

The overall prevalence of overweight was 38.3% in boys and 24.6% in girls for urban children and was 30.4% and 20.5% for rural children. The prevalence of overweight was 41.7, 37.1 and 35.8 for age 13, 14 and 15 yo urban boys and was 33.3, 33.7, and 25.2% for rural boys. For girls, the prevalence of overweight was 23.5, 25.8 and 24.6 for age 13, 14 and 15 yo at urban area was 28.1, 20.9, and 17.1% at rural area.

There is no statistical difference of mean BMI between urban and rural area (26.0 vs. 26.3 for boys and 25.4 vs. 25.4 for girls). However, the percentage of body fat was higher for urban overweight children when compared with rural overweight children (28.8 vs. 26.5 for boys, p<0.05 and 36.5 vs. 32.9 for girls, p<0.001).

Using BMI as cot-off points of overweight for children at urban and rural area may be biased (or underestimate for the urban children). Body fat composition may be more appropriate criteria for children or for children comparing with different areas or countries.
Abstract P051: Heterogeneity in the Association of Low Birth Weight with Adult-onset Diabetes: The Brazilian Longitudinal Study of Adult Health
Authors: Mueller Noel T , Yarmolinsky James , Duncan Bruce B , Chor Dora , Bensenor Isabela M , Griep Rosane H , Barreto Sandhi M , Schmidt Maria Ines
Published: March 2022

Background:
Low birth weight is related to adult-onset diabetes, although this association has been sparsely investigated in developing countries. Given reports of sexual dimorphism in fetal programming, we aimed to investigate heterogeneity, by sex and maternal diabetes, in the association of low birth weight with type 2 diabetes in participants from a large Brazilian cohort.

Methods:
We used baseline (2008-2010) data of 12,066 participants aged 35-74y from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Diabetes was defined by self-reported information and laboratory measurements (OGTT or HbA
1c
). We employed multivariable-adjusted Poisson regression models with robust variance to estimate prevalence ratios (PR) and 95% confidence intervals (CI).

Results:
Nine hundred and ninety participants (~8% of the total) reported low birth weight (defined as <2.5 kg). Low birth weight was associated with higher prevalence of diabetes in a fully-adjusted model in women (PR 1.54, 95% CI: 1.32-1.80 vs. birth weight of 2.5-4kg), but not in men (PR 1.09, 95% CI 0.91-1.29;
P
heterogeneity
<0.01). Additionally, the association was stronger among participants who had mothers with diabetes (PR 1.60, 95% CI 1.33-1.93), than those who did not (PR 1.18, 95% CI 1.01-1.38;
P
heterogeneity
<0.05). When jointly stratified by sex and maternal diabetes, the low birth weight-diabetes association was observed for women with (PR 1.67, 95% CI 1.28-2.19) and without (PR 1.50, 95% CI 1.25-1.81) maternal diabetes. In contrast, in men, low birth weight was associated with diabetes in participants with maternal diabetes (PR 1.51, 95% CI 1.17-1.93), but not in those without (PR 0.93, 95% CI 0.74-1.18). High birth weight was marginally and homogenously associated with lower prevalence of diabetes.

Conclusions:
Low birth weight was variably associated with higher prevalence of diabetes in Brazilian adults. The heterogeneity observed supports complex and sex-specific intra-uterine environmental effects on adult metabolic health.
Abstract P055: Serum Calcium and Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Rooney Mary R , Pankow James S , Sibley Shalamar D , Selvin Elizabeth , Reis Jared P , Michos Erin D , Lutsey Pamela L
Published: March 2022

Introduction:
Non-skeletal calcium serves a variety of functions. Pertinent to diabetes, an influx of calcium through calcium channels into pancreatic β-cells is required for insulin secretion. Previous cohort studies exploring the association between serum calcium and diabetes have not accounted for 25-hydroxyvitamin D [25(OH)D], or parathyroid hormone (PTH), and have had limited racial/ethnic diversity.

Hypothesis:
We hypothesized that serum calcium concentration would be positively and independently associated with diabetes incidence.

Methods:
A total of 12,800 black and white ARIC study participants without diabetes at baseline (visit 1, 1987-1989) were followed for incident diabetes. Serum calcium was measured at baseline, and corrected for serum albumin. Levels of 25(OH)D and PTH were assessed at visit 2. Diabetes was identified by glucose levels, self-report or medication use at any of three follow-up exams (each approximately 3 years apart). Multivariate Cox proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals.

Results:
Mean age was 54, 23% were black and 56% female, mean serum calcium concentration was 9.87 mg/dL overall, and 9.96 mg/dL in blacks, and 9.84 in whites. During a median of 9 years of follow-up, 1516 cases of diabetes were identified. Baseline serum calcium was positively and independently associated with incident diabetes after adjustment for demographic and lifestyle characteristics (Table). This association was largely unchanged with further adjustment for biomarkers that may lie on the metabolic pathway (i.e. 25(OH)D, PTH, phosphorus). While there was not a significant race interaction (p-interaction > 0.25 in all models), the calcium-diabetes association was somewhat stronger among blacks than whites (Table).

Conclusions:
Consistent with prior studies, elevated serum calcium was associated with greater risk of type 2 diabetes. Further research is needed to understand the role calcium plays in the pathogenesis of diabetes.
Abstract P083: Modest Association Between the Number of Fast Food Restaurants in a Neighborhood with Cardiovascular Disease Incidence
Authors: Vaartjes Ilonca
Published: March 2022

Background:
In recent years, there has been an increasing interest in the association between neighbourhood environments and cardiovascular disease (CVD) outcomes. Applying advanced linkage techniques to existing databases enables new and more in-depth research in this field.

Aim:
To investigate the association between fast food restaurant (FFR) density and incident CVD.

Methods:
Through linkage with the Dutch Population Register, Hospital Discharge Register and Cause of Death Register we obtained a cohort of 35+ years adults who at 01-01-2009 had lived at the same address for 15 years and were not previously admitted for CVD during this period. We followed these persons for one year for incident CVD. Trough linkage with the Locatus database, a nationwide retail database, we obtained information about the number of FFR’s within 500m, 1000m and 3000m buffers from the exact address. Logistic regression analyses was used to investigate the association between FFR density and CVD incidence. We adjusted for age, gender, marital status, country of origin, area-level SES , comorbidity, and degree of urbanisation.

Results:
In total 3,146,469 adults (46% male), aged 59.2 ± 12 were included. After one year 72,811 (2.3%) persons suffered from an incident CVD. The association with the number of FFR and incident CVD in both 500m, 1000m and 3000m buffers were shown in table 1.

Conclusion:
There is a modest association between FFR and incident CVD. The association was stronger when FFR’s are within 500m from a person’s home address and when there is a high number of FFR’s.

Table 1: The association (OR (95% confidence interval)) with the number of FFR and incident CVD in both 500m, 1000m and 3000m buffers. Adjusted for age, gender, marital status, country of origin, area-level SES , comorbidity, and degree of urbanisation.
Abstract P089: Pre-eclampsia and Risk of Subsequent Hypertension: In an American Indian Population
Authors: Best Lyle G , Lunday Laramie , Webster Elisha , Beal James R
Published: March 2022

Background and Objectives:
Preeclampsia (PE) is a pregnancy-specific disorder that affects 2-8% of all pregnancies and as many as 60,000 annual maternal mortalities globally. A number of proposed pathophysiologic mechanisms relate to similar factors implicated in cardiovascular disease, such as endothelial dysfunction, inflammation, insulin resistance and impaired renal regulation. Pre-eclampsia has been associated with subsequent hypertension, cardiovascular disease and related mortality in later life.

Methods:
The 3 most recent blood pressures, body mass index (BMI) and use of hypertensive medications were recorded from electronic medical records of routine clinic visits for 130 cases and 289 controls previously identified and carefully characterized for a study of the etiology and complications of PE. Comparison between case and control groups was made using the student t test for continuous variables and chi-square testing for discrete variables. Linear regression analysis was used to evaluate the effects of risk factors on subsequent systolic and diastolic blood pressure (SBP and DBP respectively).

Results:
Follow-up measurements occurred a mean of 13.11 years (range 3.6 to 36.7 years) post PE pregnancy. Cases were of similar age (35.9 vs 36.1 years, p=0.82); but with significantly higher BMI (34.1 vs 31.6, p<0.002), systolic (127.2 vs 121.3 mm Hg, p<0.001 and diastolic (76.2 vs 72.6 mm Hg, p<0.001) blood pressure, and more likely to be using hypertensive medications (35/130, 27% vs 25/289, 9%, p<0.001). Linear regression showed significant and independent association between BMI (SBP β=0.47, DBP β=0.29), age (SBP β=0.19, DBP β=0.14), previous history of PE (SBP β=4.47, DBP β=2.71) and current systolic and diastolic blood pressure (all p values <0.002). Analysis of the quartile with follow-up of less than 7.19 years also shows independent association of prior PE with both SBP (β=6.54, p<0.006) and DBP (β=4.96, p<0.001).

Discussion and Conclusions:
PE appears to confer risk of subsequent hypertension on American Indian women after a period of at least 13 years. This risk is independent of additional risk factors such as increased BMI and age. The risk is apparent soon after the affected pregnancy and there are undoubtedly cases where the hypertension of PE fails to resolve post partum.
Abstract P090: Younger Age of Immigration Mitigates Allostatic Load in Africans: The Africans in America Study
Authors: Sumner Anne E , Bingham Brianna A , Duong Michelle T , Aldana Paola C , Ricks Madia , Mabundo Lilian S , Udahogora Margaret , Berrigan David , Chung Stephanie T
Published: March 2022

African immigrants living in the United States are exposed to the stress of changing continents and cultures. Therefore African immigrants are exposed to two types of environmental stress; first, stress related to navigating new social and economic realities; and second, stress due to work, education and a sedentary lifestyle in the United States. To evaluate the effect of these stressors on health, we calculated the allostatic load score in two groups of Africans: childhood immigrants who came to the United States before 18 years of age, and adulthood immigrants who came to the United States at 18 years of age or older. Allostatic load is a measure of the influence of environmental stress on physiological function. It is calculated for each individual by assigning one point for each high risk cardiovascular, inflammatory, and metabolic biomarker present. The higher the allostatic load score, the greater the impact of stress on physiologic dysregulation. As no consensus exists on which biomarkers to include in the calculation of allostatic load score, we used four different published equations to evaluate allostatic load in 213 African immigrants (age: 40±10y,(mean±SD) range 21-64y; BMI: 27.7±4.5 kg/m
2
; male: 70% (149 of 213); adulthood immigrants: 81% (181 of 213)). By multiple regression, the effect of age, age at immigration, duration of stay in the United States, income, education and exercise on allostatic load score was determined. Overall, childhood immigrants were younger than adulthood immigrants (29±7 vs. 41±9y,
P
<0.01). However, length of residence in the United States was longer for childhood immigrants than adulthood immigrants (19±8 vs. 12±9y, P<0.01). Regardless of which equation for allostatic load score was used, childhood immigrants had lower allostatic load scores than adulthood immigrants, (
P
<0.01). Among adulthood immigrants, the age range of immigration was 18 to 61y; within this group, lower age of immigration was associated with lower allostatic load scores (
P
<0.05). In addition, as length of stay in the United States increased, allostatic load score increased in adulthood immigrants (
P
<0.01) but not childhood immigrants (
P
>0.6). For both groups of immigrants, low income, lack of a college education and low levels of exercise did not increase allostatic load score (
P
>0.3). Overall, the factor which appears to have the greatest impact on the physiologic health of African immigrants is age of immigration. Africans who emigrated as children experience less physiologic stress than their counterparts who emigrated as adults.
Abstract P102: Longitudinal and Secular Decrease in Total Cholesterol Levels in All Birth Cohorts. The Tromsø Study 1979-2008
Authors: Hopstock Laila A , Bønaa Kaare H , Eggen Anne E , Grimsgaard Sameline , Jacobsen Bjarne K , Løchen Maja-Lisa , Mathiesen Ellisiv B , Njølstad Inger , Wilsgaard Tom
Published: March 2022

Introduction:
Elevated blood cholesterol is a modifiable risk factor for cardiovascular disease (CVD). Surveillance of cholesterol levels is needed to study disease burden, consider priorities for CVD prevention and intervention, and understand the effect of diet, lifestyle and medication use. Previous studies show a cholesterol level decline in recent decades, but lack data to follow individuals from different birth cohorts from early and middle adulthood to older age.

Hypothesis:
To assess secular and longitudinal trends in total cholesterol levels.

Methods:
We investigated changes in age-specific cholesterol levels by repeated measurements in 37,968 women and men born 1905-1977 examined up to five times between 1979 and 2008 in the population-based Tromsø Study.

Results:
Mean total cholesterol decreased from 1979 to 2008 in both genders in all age groups. The decrease in age group 40-49 years was 1.2 mmol/l in women and 1.0 mmol/l in men. Both the 80th percentile and the 20th percentile of the population cholesterol distribution decreased. In birth cohorts born 1940-77, mean total cholesterol levels increased with age up to 2001 and decreased thereafter to 2007. Among those born 1910-39, the cholesterol decrease was evident after 1994-95. The longitudinal trends in those born 1940-77 were not influenced by use of lipid-lowering drugs, while the decrease with age in birth cohorts born 1910-39 was slightly weaker among never users of lipid-lowering drugs compared to the total sample.

Conclusions:
A longitudinal decrease in mean cholesterol levels was observed from 1994-95 or from 2001 depending on birth cohort. A secular decrease was observed from 1979-80 in all age groups. The findings points to a mass population effect rather than a treatment effect of high-risk individuals alone.
Abstract P103: Effect of Agents Specific to Triglyceride Lowering, Statins Alone, or a Combination of Both Among Patients with Diabetes and Very High Triglycerides
Authors: Nichols Gregory A , Reynolds Kristi , Kimes Teresa M , Olufade Tope , Anzalone Deborah , Fortmann Stephen P
Published: March 2022

Background:
Severe hypertriglyceridemia is an often-neglected risk factor that is associated with increased risk of cardiovascular disease, pancreatitis and mortality, especially when other comorbidities are present. We investigated the association between triglyceride (TG)-lowering therapy and subsequent reduction in TG levels in patients with diabetes and very high triglycerides (VHTG).

Methods:
We combined data from the Southern California and Northwest regions of Kaiser Permanente to identify patients with diabetes and a TG measurement
>
500 mg/dL with a follow-up measure 6-15 months later. Patients were stratified by whether they received no treatment, pharmacotherapy specific to TG lowering (fibrates, niacin, omega-3 products) only, a statin only or a combination of both between the two TG measures. We compared the characteristics of the four groups of patients and constructed a multivariable logistic regression model to determine the probability of achieving TG <500 mg/dL following therapy, controlling for other characteristics.

Results:
Of the 3,188 diabetic patients with VHTG, 23% received no therapy, 8% received a TG-specific drug only (72% fibrates, 27% niacin, 1% omega-3), 55% received a statin only, and 14% received both. Compared with no treatment, those receiving a TG-specific agent were not significantly more likely to attain TG <500 mg/dL. However, patients receiving a statin only were more likely to do so (OR 1.79, 95% CI 1.42-2.25), as were patients receiving both a statin and TG-specific agent (1.77, 1.29-2.43). In addition to higher initial TG level, non-Hispanic blacks (1.81, 1.07-3.05), Hispanics (1.26, 1.03-1.54), and men (1.43, 1.16-1.75) were more likely to attain TG level <500 mg/dL. Lower A1C (0.91, 0.87-0.96), systolic blood pressure (0.98, 0.97-0.99), and higher HDL-C (1.02, 1.01-1.04) were also associated with attaining TG <500 mg/dL.

Conclusion:
Our results suggest that pharmacotherapy is essential for the attainment of TG levels <500 mg/dL in patients with diabetes and VHTG. Because better control of other risk factors was also associated with TG improvement, uncontrolled VHTG may represent an important marker or additional risk factor for diabetes complications that deserves consideration.
Abstract P110: Serum Uric Acid, Gout, and Venous Thromboembolism: The Atherosclerosis Risk in Communities Study
Authors: Kubota Yasuhiko , McAdams DeMarco Mara , Folsom Aaron R.
Published: March 2022

Introduction:
Some rheumatologic diseases, including rheumatoid arthritis and systemic lupus erythematosusa are associated positively with occurrence of venous thromboembolism (VTE). Chronic inflammation accompanying these rheumatologic diseases is considered to increase the risk of VTE. Gout, which is caused by hyperuricemia, is the most common rheumatologic inflammatory arthritis. In addition, hyperuricemia, itself, has proinflammatory effects on vascular cells. Hyperuricemia and gout therefore may increase the risk of VTE, but, so far there has been no study investigating these associations.

Hypothesis:
We assessed the hypothesis that hyperuricemia or gout are positively associated with the risk of VTE.

Methods:
The Atherosclerosis Risk in Communities Study measured serum uric acid (SUA) in 15,063 men or women, aged 45-64, without history of VTE or anticoagulant use and followed them for VTE from 1987 to 2011. Of these participants, 10,982 men or women provided information on gout history. Hazard ratios (HRs) of VTE were estimated using Cox proportional hazards models adjusted for age, sex, race, center, body mass index, diabetes, smoking, eGFR, vonWillebrand factor, factor VIII, and gout medication across levels of SUA [median (range) mg/dL: 4.6 (≤5.2), 5.7 (5.2-6.2), 6.7 (6.2-7.2), 7.7 (7.2-8.2), 8.5 (8.2-8.9), and 9.6 (≥8.9)] or gout history (yes or no).

Results:
We documented 688 incident VTEs [265 unprovoked and 423 provoked VTEs (232 not cancer related and 191 cancer related VTEs)]. Age, sex, and race-adjusted HRs [95% confidential interval (CI)] for total VTE were 1.00, 1.31 (1.04-1.65), 1.34 (1.05-1.70), 1.81 (1.39-2.35), 1.81 (1.25-2.60), and 2.85 (2.06-3.95) (P for trend<0.001) across levels of SUA. After adjustment for the other VTE risk factors, those in the highest vs. lowest level of SUA had HRs (95% CI; P for trend) of 1.72 (1.22-2.45; 0.006) for total VTE, 1.83 (1.08-3.09; 0.128) for unprovoked VTE, and 1.61 (1.00-2.58; 0.022) for provoked VTE. On the other hand, we observed no significant association between the gout history and the incidence of VTE.

Conclusions:
In conclusion, elevated SUA was associated with a higher risk of VTE, suggesting that elevated SUA might be a novel risk factor for VTE.
Abstract P116: Physical Fitness in Early Adulthood: A Modifiable Risk Factor for Neurological and Psychiatric Diseases
Authors: Nyberg Jenny , Åberg David , Margda Waern , Wallin Anders , Torén Kjell , Nilsson Michael , Åberg Maria A , Kuhn Georg
Published: March 2022

Low cardiovascular fitness in mid- and late life represents a risk factor for several neurological diseases. However, the respective effect of aerobic cardiovascular and muscle fitness in early adulthood is largely unknown. Therefore, we analyzed these in young men with regard to long-term risk serious depression, bipolar disorders, stroke and dementia.

We performed population-based longitudinal cohort studies of Swedish male conscripts registered in 1968-2005 for mandatory military service (approx. 1,800,000 subjects), representing about 95 % of all Swedish males at age 18 during this time period. Data on cardiovascular fitness (determined by the cycle ergometric test), muscle strength (isometric contraction) and cognitive performance (IQ tests) were subdivided into low, medium, high fitness groups. Over a 40-year follow-up, risk of serious depression, bipolar disorder, stroke and dementia were calculated with Cox proportional hazards models controlling for potential confounders. To identify cases, we used the International Classification of Diseases (ICD) 8-10 in the Hospital Discharge Register and the Cause of Death Register.

Depression. Adjusted hazard ratios (HRs) with confidence interval (CI) show significant relationships between fitness and severe depression for low compared to high fitness: HR (CI) 1.80 (1.64-1.99) for cardiovascular fitness and 1.43 (1.32-1.55) for muscle strength. Bipolar disorders exhibited a lower, yet significant association with cardiovascular fitness and muscle strength (adjusted hazard ratios (HRs) with confidence interval (CI): 1.35 (1.12-1.63) and 1.22 (1.05-1.42), respectively.

Stroke. Adjusted HRs show inverse relationships between fitness and stroke for low compared to high fitness HR (CI) 1.70 (1.50-1.93) for cardiovascular fitness and 1.39 (1.27-1.53) for muscle strength. All three stroke types (subarachnoidal hemorrhage, intracerebral hemorrhage and ischemic stroke displayed similar associations. There were stronger associations for fatal stroke.

Dementia. Low compared to high cardiovascular fitness was significantly associated with an increased risk for diagnosis of dementia before age 60: HR (CI) 2.49 (1.87-3.32). Mild cognitive impairment (MCI) showed an even greater association: HR (CI) 3.57 (2.23-5.74). The combination of low cardiovascular fitness and poor cognitive performance in early adulthood was associated with a >8-fold increase in the risk of early-onset MCI and a >7-fold increased risk of early-onset dementia.

In summary, this study sheds light on physical fitness as an early-life risk factor for psychiatric and neurological conditions, and underlines the potential for lifestyle modification to reduce the risk of late-life CNS impairments.
Abstract P118: Gender Differences in Physical Activity Levels on Cardiovascular Events in Diabetes: The Strong Heart Study
Authors: Singh Parmanand , Almarzooq Zaid , Roman Mary , Devereux Richard
Published: March 2022

Background:
It has been previously shown that physical activity lowers the risk of incident diabetes in American Indians. However, in this population at high risk for cardiovascular (CV) events, it remains to be fully explored whether physical activity reduces CV death in subjects with diabetes and whether this effect is equal between genders.

Objectives:
To determine the inter-relationship between activity, diabetes, gender and CV death, we tested the hypotheses that, (i) activity lowers CV death in diabetes, and (ii) the CV benefit of activity is similar across genders.

Methods:
We examined the association between activity (leisure-time plus occupational) and CV death among 1,896 diabetic adults (mean age 56.9 ± 8) in phase I of Strong Heart Study (1989-1991. Of these, 1,254 were female (mean age 57.4 ± 8) and 642 were male (mean age 55.9 ± 8). Activity was measured as METS-hours per week on a validated survey. Regression models were used to assess for the prespecified associations and adjust for traditional CV risk factors. Kaplan-Meir analysis was used to plot survival based on activity.

Results:
After 14 years of follow-up (1989-1999), there were 222 CV deaths. Compared to diabetic subjects with minimal activity (quartile 1), those with higher activity levels had a lower risk of CV death (p=0.001, Fig 1A). Odds ratios were 0.60 (95% CI: 0.40-0.90; p=0.014), and 0.63 (0.41-0.95; p=0.027) for increasing activity (3rd and 4th quartiles), after adjustment for age and traditional CV risk factors. Moreover, in a subgroup analysis of female subjects with diabetes, increasing physical activity levels was significantly associated with less CV death compared to male subjects with diabetes (Fig. 1B), independent of conventional CV risk factors (p=0.003).

Conclusion:
In a large population study of American Indians, physical activity lowered CV death in subjects with diabetes, a finding most pronounced in females. Additional studies are needed to further investigate the pathophysiologic basis of the disparate gender response to activity.
Abstract P129: Impact of Regular Physical Activity on Prognosis After Myocardial Infarction: The OACIS Study
Authors: Usami Masaya , Sakata Yasuhiko , Nakatani Daisaku , Mizuno Hiroya , Suna Shinichiro , Matsumoto Sen , Shimizu Masahiko , Sato Hiroshi
Published: March 2022

Introduction:
It has been demonstrated that regular physical activities improve physical capacities and prognosis in survivor patients with acute myocardial infarction (AMI), especially in well-designed, relatively small patients cohorts. However, impacts of regular physical activity on prognosis are not fully elucidated in large scale, real-world settings because of varieties of confounding factors.

Hypothesis:
We assessed the hypothesis that regular physical activity at 3-month after AMI is an independent predictor for 5-year survival in a large cohort of post-MI patients registered in the Osaka Acute Coronary Insufficiency Study (OACIS).

Methods:
The OACIS is a prospective, multicenter, observational study enrolling consecutive patients with AMI at 25 collaborating hospitals in the Osaka region of Japan. Among 8957 patients registered in the OACIS, 5218 patients who reported physical activities at 3-month after MI were enrolled and were followed for 5 years. Multivariate Cox regression was used with the following variables as covariates: age, gender, BMI, HT, DM, dyslipidemia, smoking, ST-elevation MI, NYHA at 3-month after MI, reperfusion therapy, multivessel disease, depression status by SDS score, living alone, and beta-blocker, statin, antiplatelet agent, ACEI/ARB, calcium channel blocker, and diuretics therapy.

Results:
Regular physical activity at 3-month after MI were seen 1180 patients (22.8%, total n=5170). Cumulative mortality at 5-year after MI was 3.5%, which was lower than that in the patients without regular physical activity (3990 patients, 7.9% log-rank p<0.001). However. the difference was not statistically significant in the multivariate analysis (adjusted HR 0.66, 95%CI 0.38-1.07, p=0.088). Cumulative mortality at 5-year after MI was 10.9%, which was highest (log-rank p<0.001, total n=5218) in lowest quartile of maximum physical capacity (Q1: medium 4.5 Mets, n=1911) compared to 4.7% in the Q2 (median 5.5 Mets, n=681), 3.1% in the Q3 (median 6.5 Mets, n=1261), and 2.7% in the Q4 (median 7.5 Mets, n=1365). Cumulative mortality at 5-year after MI was highest (9.9%) in the patients’ activity changed from active to inactive after MI and was lowest (3.1%) in those changed from inactive to active (log-rank p<0.001, total n=5204). Factors which related to start regular exercise after MI are male (OR 1.91), statin (1.59), and beta-blocker (1.33), whereas to give up was NYHA>2 (OR 0.36, 95%CI 0.23-0.55, p=0.001). Frequency of cardiac death was higher in the patients without regular physical activity than with regular physical activity.

Conclusion:
Regular physical activity apparently related to better prognosis after AMI, but was not an independent predictor for 5-year mortality.
Abstract P148: Median American Intake of Fructose Does Not Increase Cardiovascular Disease Risk Factors
Authors: Lowndes Joshua , Sinnett Stephanie , Rippe James M
Published: March 2022

Introduction:
Studies in animals have shown that fructose can promote weight gain and the development of associated metabolic diseases when consumed in very high doses. The applicability of these findings to human consumption is unclear because they do not represent how fructose is consumed in the human diet, which is virtually always in combination with glucose and at much lower levels.

Methods:
156 subjects were studied. All were apparently healthy and weight stable (no change in weight greater than 3% over the past three months) at enrollment (M=69, F=87, mean age 35.7 ± 11.4). Participants were randomly assigned to one of five groups - four that contained low fat milk with added sugar and one unsweetened low-fat milk control group. Milk was consumed in amounts so that the added sugar contributed a target percentage of the calories required for weight maintenance. The groups were as follows: Fructose 9% (50
th
percentile of fructose consumption in the US), Glucose 9%, High fructose corn syrup 18%, sucrose 18% and an unsweetened milk control consumed so milk contributed 18% of the weight-maintenance calories. The energy intake required for weight maintenance was estimated using the Miflin St Joer equation and using an appropriate activity factor determined by responses to a physical activity questionnaire. The intervention lasted ten weeks.

Results:
There was a small change in weight (162.0 ± 28.5 vs 163.8 ± 29.3 lbs), BMI (26.0 ± 3.5 vs 26.3 ± 3.7) and waist circumference (81.0 ± 10.1 vs 81.6 ± 10.4 cm) in the entire study population (p<0.01), but no effect of group (interaction p>0.05). In contrast there were no changes (p>0.05) in blood pressure (SBP: 106.7 ± 9.7 vs 105.5 ± 10.1, DBP: 68.7 ± 7.9 vs 68.6 ± 7.6 mmHg), cholesterol 178.3 ± 34.9 vs 179.4 ± 35.4 mg/dl), triglycerides (105.5 ± 79.9 vs 106.3 ± 76.3 mg/dl), LDL (104.4 ± 29.2 vs 105.7 ± 28.7 mg/dl), or glucose (88.9 ± 6.9 vs 90.4 ± 9.5 mg/dl). Although there was a statistically small decrease in HDL (54.2 ± 15.6 vs 52.8 ± 13.3 mg/dl, p<0.05), it was not clinically important. In all cases, the treatment group did not affect the response (p>0.05).

Conclusion:
These data suggest that the majority factors are unaffected by the consumption of the U.S. population average intake of fructose, whether consumed as fructose or as other types of sugar.
Abstract P151: Vitamin K Intake and All-cause and Cause Specific Mortality
Authors: Zwakenberg Sabine R , den Braver Nicolette , Engelen Anouk I , Feskens Edith J , Vermeer Cees , Boer Jolanda M , Verschuren W M Monique , van der Schouw Yvonne T , Beulens Joline W
Published: March 2022

Background:
Vitamin K has been associated with various health outcomes, including non-fatal cardiovascular diseases and cancer. However, little is known about the association between vitamin K intake and all-cause and cause specific mortality.

Objective:
To investigate the association between vitamin K intake and all-cause and cause specific mortality.

Methods:
This prospective cohort study included 33,289 participants, aged 21-70 years from the EPIC-NL cohort. Participants were recruited between 1993 and 1997 and the follow-up is complete until December 2012. Dietary intake was assessed at baseline with a 178-item validated food frequency questionnaire and intakes of total vitamin K intake and its sub forms, phylloquinone, menaquinones (MK), short-chain menaquinones (SMK) and long-chain menaquinones (LMK) were calculated. Information on vital status and causes of death was obtained through linkage to several registries. The association between the different forms of vitamin K intake and mortality was assessed with Cox proportional hazard regression, adjusted for risk factors for chronic diseases (gender, age, BMI, physical activity, smoking status, education level) and nutrient intake.

Results:
During a median follow-up of 16.8 years, 2,863 deaths occurred, including 625 from CVD (256 CHD specific), 1,346 from cancer and 894 from other causes. After multivariable adjustment, vitamin K intake was not associated with all-cause mortality with hazard ratios for the upper vs. the lowest quartile of phylloquinone and menaquinone intake of 1.04 (0.93-1.17) and 0.94 (0.82-1.07) respectively. Phylloquinone intake nor menaquinone intake was associated with risk of CVD mortality. Higher intake of LMK was borderline significantly associated (p
trend
= 0.06) with lower CHD mortality with a HR per 10 μg of 0.87 (0.75-1.01). None of the forms of vitamin K intake were associated with cancer mortality or mortality from other causes.

Conclusions:
Vitamin K intake was not associated with all-cause mortality, cancer mortality and mortality from other causes. A higher intake of LMK tended to be associated with a lower risk of CHD mortality.
Abstract P159: Sedentary Behavior During the Weekend, Rather Than Weekdays, Affects Body Composition in Young Adults
Authors: Drenowatz Clemens , DeMello Madison M , Shook Robin P , Hand Gregory A , Blair Steven N
Published: March 2022

Background:
High sedentary time has been considered an important chronic disease risk factor but there remains limited evidence on the differential effects of sedentary behaviors during weekdays versus the weekend on body composition. The purpose of the study was to examine the prospective association between objectively measured sedentary time and self-reported sedentary behaviors during weekdays and the weekend with body composition in young, healthy adults.

Methods:
Measurements were taken every 3 months in a sample of 430 young adults (49% male) between 20 and 35 years of age over a period of 1 year. Energy Expenditure, time spent sedentary excluding sleep (SED) was objectively assessed with a multi-sensor device over a period of 10 days at every measurement time. In addition, participants reported sitting time, TV time and non-work related time spent at the computer separately for weekdays and the weekend. Body weight was measured in a fasted state with participants wearing surgical scrubs and in bare feet. Fat mass and fat free mass were assessed via dual x-ray absorptiometry and used to calculate percent body fat (BF). Further, energy intake (EI) was calculated based on change in body composition and objectively measured energy expenditure.

Results:
A total of 332 (50% male) participants provided valid data over the 12-month observation period. At baseline SED was associated with sitting time (r=0.20), TV time (r=0.23) and non-work computer time (r=0.24) during the weekend (p<0.01) but not during weekdays. Body weight and BF at baseline were directly associated with SED during weekdays and the weekend (0.23 < r < 0.30, p<0.01). In addition, TV time during weekdays was associated with BF (r=0.16, p<0.01). Linear mixed models, adjusted for EI, did not show a significant association between change in SED during weekdays and body composition at 12 months. Change in SED during weekends, however, was directly associated body body composition at 12 months follow up (βweight=0.05, βBF=0.08; p<0.01). As for self-reported sedentary behaviors, only change in sitting time during the weekend was directly associated with BF at 12 months but not with body weight. No significant associations were observed between sedentary behaviors during weekdays and body composition at 12 months.

Conclusions:
Total sedentary time, rather than specific sedentary behaviors, appears to influence subsequent body composition, particularly during the weekend. These findings suggest that a reduction in leisure time sedentary behaviors should be emphasized in addition to strategies aiming at a reduction in occupational sedentary time when addressing weight management.
Abstract P169: Long-term Yogurt Intake is Associated with a Lower Risk of High Blood Pressure in Middle-aged Nurses and Health Professionals
Authors: Buendia Justin R , Hu Frank B , Singer Martha R , Cabral Howard J , Moore Lynn L
Published: March 2022

While dairy products have been shown to reduce the risk for high blood pressure (HBP) in at-risk adults, few long-term studies have examined independent effects of yogurt consumption, a dietary component that may have particularly beneficial effects on blood pressure. We used repeated measures of diet and lifestyle collected over 2-3 decades among participants without prevalent HBP in the two Nurses’ Health Study cohorts (NHS and NHS II) and the Health Professionals Follow-up Study (HPFS) to examine this question. After 18 to 30 years of follow-up, we documented 74,609 new cases of HBP in the three cohorts. After adjusting for age, race, family history of HBP, physical activity, energy, and intakes of total protein, fruits and vegetables, milk, and cheese, women who consumed 5 or more servings of yogurt per week (compared with those consuming 0-<1.0 serving per month) had statistically significant 23% (95% CI: 0.70-0.84) and 17% (95% CI: 0.77-0.90) reductions in risk of HBP in the NHS and NHS II respectively, while men in the HPFS cohort had essentially no reduced risk. To determine whether the effect of yogurt consumption might be explained or modified by other healthy dietary factors, the independent and combined effects of yogurt and a DASH diet score (excluding yogurt from the calculation of that score) were examined. Those in the highest tertile of the DASH score who did not consume yogurt had 15%, 29%, and 15% reductions in HBP risk, respectively, in the two NHS and the HPFS cohorts. The beneficial effects of yogurt intake were modified by a higher DASH score. In these analyses, the beneficial effects of 5 or more servings of yogurt per day on HBP risk were strongest among those in the highest tertile of DASH scores (NHS: HR=0.66; 95% CI: 0.59-0.75; NHS II: HR=0.68; 95%CI: 0.62-0.75; HPFS: HR=0.75; 95% CI: 0.64-0.88). Results were partially attenuated when controlling for BMI. These analyses from three large, longitudinal cohorts suggest that regular yogurt consumption, especially as a part of an otherwise healthy diet, is associated with a reduced risk of developing HBP during the middle adult years. These beneficial effects may be partially explained by intermediate effects on BMI.
Abstract P176: Trends in Prescription- and Payment-related Factors That Promote Adherence to Medications Used to Treat Hypertension, 2009-2014
Authors: Ritchey Matthew D , Tsipas Stavros , Loustalot Fleetwood , Wozniak Gregory
Published: March 2022

Background:
Effective hypertension management often necessitates patients’ adherence to their prescribed blood pressure (BP)-lowering medication regimen. Improving adherence is complex, but can be related to several prescription- and payment-related factors, including: reducing patient out-of-pocket burden with low copayments, increasing generic medication use, prescribing fixed-dose combination pills with more than one BP-lowering medication per pill, limiting the number of pills to take per day, increasing the days’ supply per fill—for example, 90-day vs 30-day allotments, and using mail order pharmacies. These factors are often controlled by prescribers, filling pharmacies, pharmacy benefit managers, and/or patients’ health insurance plans, but not by patients. This study describes patterns and trends in these factors that the literature reports are associated with increased adherence to BP-lowering medication.

Methods and Findings:
We use a robust source of United States prescription sales data—IMS Health’s National Prescription Audit (NPA)—to describe BP-lowering medication fill counts and spending for 2009-2014. The NPA includes outpatient prescription information from ~87% of the retail and ~70% of the mail order universe. IMS Health applies a patented projection methodology to the collected data to create the national level estimates within the NPA. We describe patterns and trends in the adherence-promoting factors described above across age groups, payment sources, and medication classes. During 2009-2014, an average of 628 million BP-lowering medication prescriptions was filled annually and encouraging trends in adherence-promoting factors included: the share of generic fills increased from 82.5% to 95.0%; average days’ supply per fill increased from 45.9 to 51.8 days; and average total (patient contribution) spending per years’ supply decreased from $359 ($54) to $311 ($37). Possibly undesirable trends included: the percentage of fills for fixed-dose combinations decreased from 17.1% to 14.2% and acquired via mail order decreased from 10.7% to 8.2%. In 2014: 653.0 million fills occurred accounting for $28.8B in spending; adults aged 45-64 years had the highest percentage of fixed-dose combinations fills (16.9%); and fills with Medicaid as the payment source had the lowest average patient spending per fill ($1.19).

Conclusions:
Annual outpatient BP-lowering medication fill counts and spending were substantial during 2009-2014. We identified both encouraging and possibly undesirable patterns and trends in prescription- and payment-related factors that have been shown to be associated with improved adherence, but are often outside of patients’ control. Continued tracking of these data can be used to identify areas that can be addressed by clinical and policy interventions to improve adherence for medications commonly used to treat hypertension.
Abstract P196: Associations of Prenatal Antibiotics with Fetal Size and Cord Blood Leptin Levels: Findings From Project Viva
Authors: Mueller Noel T , Rifas-Shiman Sheryl L , Blaser Martin J , Gillman Matthew W , Hivert Marie-France
Published: March 2022

Background:
Early postnatal antibiotic use appears to promote infant weight gain, but it is unclear how intrauterine exposure to antibiotics is associated with fetal growth and adiposity. The objective was to examine associations of antibiotic prescriptions in each trimester with fetal size and leptin levels at birth.

Methods:
In 2128 pregnant women from the pre-birth Project Viva cohort, we estimated antibiotic prescribing by timing - any during pregnancy and trimester-specific - from electronic medical records. Outcomes were sex-specific birth weight-for-gestational-age z-scores (BW/GA-z) and cord blood leptin levels. We used linear regression models adjusted for maternal age, pre-pregnancy BMI, parity, race/ethnicity, education, smoking during pregnancy, household income and child sex and gestation length.

Results:
643 (30.2%) of women were prescribed antibiotics at any point during pregnancy. Mean (SD) BW/GA-z was 0.17 (0.97) and cord blood leptin was 9.0 ng/ml (6.6). In adjusted models, having an antibiotic prescription at any point during pregnancy was associated with lower BW/GA-z in (β -0.10; 95% CI -0.19, 0.00). In trimester-specific analyses, only 2
nd
trimester antibiotic prescriptions were associated with lower BW/GA-z (adj β -0.20; 95% CI -0.35, -0.06). Antibiotic prescription at any point in pregnancy was not associated with cord blood leptin. However, in trimester-specific analyses, 3
rd
trimester antibiotic prescriptions were associated with higher cord blood leptin (β 2.28 ng/ml; 95% CI 0.38, 4.17), while1
st
and 2
nd
trimester antibiotics were not associated with cord blood leptin.

Conclusion:
Antibiotic prescriptions in mid-pregnancy were associated with lower BW/GA-z, whereas 3
rd
trimester prescriptions were associated with higher cord blood leptin.