bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P136: Access To Potable Water, Sugar-Sweetened Beverages, And Central Obesity In Puerto Rico
Authors: Tamez Martha , Rodriguez-Orengo Jose , Mattei Josiemer
Published: May 2021

Introduction:
To date, no studies have shown how access to potable water is related to beverage (sugar-sweetened beverages (SSB's) and water) intake, and obesity.

Objective:
To determine associations between access to potable water, and beverage intake, with obesity among adults residing in Puerto Rico (PR).

Methods:
Participants of a cross-sectional study of adults (n=248;30-75y) living in PR responded to questions about the type of water access and preference factors for choosing such type based on availability, appearance, cost, or taste. Beverage intake was assessed with a food-frequency questionnaire. Interviewers measured waist circumference; central obesity was defined as >102cm in men and >88cm in women. We used multivariable linear regression models to evaluate the association between type of access and preference factors for potable water and beverage intake. Multivariable logistic regression models were used to evaluate the association between beverage intake and central obesity. Substitution analysis of one serving of water for one of SSB's was also performed.

Results:
Most participants (57%) reported drinking bottled water, 30.7% liked its taste, and 21% thought the water was clean/safe. Participants that reported cost and taste as factors for water selection had lower water intake than their counterparts (mean ± SE cost: 2.06 ± 0.19 vs. 2.76 ± 0.22; taste: 1.19 ± 0.15 vs. 1.85 ± 0.17 servings/d). Availability, appearance, or type of water source were not associated with beverage intake. Higher odds of central obesity were noted per serving/d of all SSB's (OR=1.23; 95%CI: 1.03, 1.47), and soda only (OR=1.51; 95%CI: 1.08, 2.13) (Table 1). Substituting one serving of water for soda was marginally associated with lower odds of central obesity (OR=0.73; 95% CI: 0.51, 1.03).

Conclusions:
Reducing soda intake and substituting it with water may be an appropriate approach to prevent central obesity in Puerto Rican adults. Measures to provide affordable and pleasantly tasting potable water may facilitate its intake.
Abstract P139: The Impact Of Inpatient Diet Orders On Patient Nutrition And Dietary Behaviors Post Discharge
Authors: Dastmalchi Lily N , Dharia Ishaan , Frame Leigh A , Solomon Allen J
Published: May 2021

Introduction:
Suboptimal nutrition is a known contributor to the development of cardiovascular disease. In the past decade, focus has been on improving the quality of hospital food with nutrition and policy science initiating programs, e.g. Healthy Food in Health Care. Little has been studied on the impact of these improvements on diet choices after discharge. To our knowledge, this is the first study to evaluate if inpatient diet orders play a role in nutrition after discharge.

Methods:
Patients ≥18 years of age admitted to the medicine service with either a regular or cardiac diet order were recruited. Exclusion criteria were the following dietary parameters—fluid restriction, low potassium, diabetic, gluten free, or vegan diets. Patients were given a baseline questionnaire using a Lickert scale to assess dietary behaviors, nutrition counseling during admission, and demographics. One month post-discharge, a follow-up questionnaire was given to reassess their dietary choices.

Results:
In this preliminary analysis, 70 subjects were enrolled: 57.1% (n= 40) regular diet and 42.0% (n=30) cardiac diet. 38.6% (n=27) believed diet orders during admission were part of the their medical treatment. At follow-up, 55 patients remained and included in the final analysis. 50 with identifiable subject IDs: 57.4% (n= 27) regular diet and 42.5% (n=20) cardiac diet. 15 were lost to follow up: 1 deceased, 2 declined to participate, 2 were readmitted to the hospital, and the remaining were not reachable. Diet was reported as always important to overall health 50.0% (n=35) at baseline vs 72.7% (n=40, p= 0.642) at follow up. 22.8% (n=16) of subjects stated never reading nutrition labels in comparison to follow-up 12.7% (n=7, p= 0.019). Never monitoring salt intake was reported among 23.6% (n=9) patients at baseline and 12.7% at follow-up (n=6, p=0.043). Subjects reported that nutrition education was never received during their inpatient or outpatient follow up period (30% (n=21) vs 76.3% (n=42), p=0.0002).

Conclusions:
To-date, our pilot study shows inpatient diet orders having the potential to influence dietary behaviors with significant changes in food label reading and monitoring salt intake after discharge. Nutrition education was significantly never given in both inpatient and outpatient settings. However, most patients believe nutrition is important to their overall health, further supporting receptivity to nutrition education during inpatient and outpatient follow-up education.
Abstract P140: Dynamic Relationships Between Body Fat And Circulating Adipokine Levels From Adolescence To Young Adulthood: The Santiago Longitudinal Study
Authors: Kim Daeeun , Howard Annie Green , Blanco Estela , Burrows Raquel , Correa Paulina , Albala Cecilia , Santos José L , Angel Bárbara , Lozoff Betsy , Justice Anne E , Gahagan Sheila , North Kari E
Published: May 2021

Introduction:
Adipose tissue secretes adipokines such as adiponectin and leptin playing important roles in energy metabolism. Adiponectin has a protective effect against cardiometabolic diseases (CMD), whereas leptin increases risk of CMD. Although associations between plasma adipokines and body fat mass have been established, most have been cross-sectional, limiting causal inferences.

Hypothesis:
We hypothesize that 1. adipokines can affect body fat accumulation via the regulation of energy homeostasis and 2. adipose tissue can affect the amount of adipokines secreted. Thus, we assessed the associations between body fat percent (BF%) and adipokines during adolescence and 6 years later.

Methods:
Measurements for plasma leptin (N=622) and adiponectin (N=565) were available at age 16 and 22 in participants from the Santiago Longitudinal Study. BF% was measured by dual X-ray absorptiometry. Structural equation models were used to estimate longitudinal associations of BF% and adipokines at baseline and with 6-year changes in these values, adjusted for sex, time to follow-up, baseline age, physical activity, nutrition quality, smoking status, and alcohol consumption.

Results:
Effect estimates are shown in
Figure 1
. We found evidence of association between baseline adipokine and BF% change and baseline BF% and adipokine change with the one notable exception a lack of association between baseline BF% and adiponectin change.

Conclusions:
Leptin and BF% were positively associated longitudinally, but the longitudinal associations between adiponectin and BF% were counterintuitive or non-significant. While there might be a close long-term relationship between leptin levels and body fat accumulation, the long-term relationship between adiponectin levels and body fat accumulation might develop after the adolescence and young adulthood transition.
Abstract P141: Association Of Obesity And Cigarette Smoking With Markers Of Inflammation And Thrombosis
Authors: Oshunbade Adebamike A , Lirette Seth T , Hamid Arsalan , Kamimura Daisuke , Kipchumba Rodney , DeFilippis Andrew , Kerut Edmund K , Butler Javed , Butler Kenneth R , Mosley Thomas , Hall Michael
Published: May 2021

Association of obesity and cigarette smoking with markers of inflammation and thrombosis

Background:
The association between obesity with inflammation and thrombosis has been understudied. The combined association of obesity and cigarette smoking with inflammation and thrombosis also has not been systematically investigated in a well characterized cohort.

Methods:
We investigated 2549 participants from the Genetic Epidemiology Network of Arteriopathy (GENOA) study (mean age 61±10 years, 64% women, 51% African American). Participants were classified by body mass index (BMI) as normal BMI (n=371), overweight (n= 864), or obese (n= 1314). Obese participants were further classified by self-reported smoking status as having never smoked (n= 747), smoked in the past (n= 454), and currently smoking (n= 113). We compared adjusted associations among these groups with 18 biomarkers of inflammation and 8 biomarkers of thrombosis using generalized estimating equations.

Results:
After adjusting for potential confounders, individuals who were obese but had never smoked had higher levels of high sensitivity CRP, serum amyloid A, TNFR1 and TNFR2, IL-6, fibrinogen, and VWF compared to participants with normal BMI that were had never smoked (all p<0.05). However, individuals with obesity currently smoking had higher levels of these biomarkers compared to those who never smokers, particularly within the domains of systemic inflammation and cytokines (Table). Compared with participants without obesity who never smoked, the odds of hsCRP >10 milligram/liter in individuals with obesity was 3.6 times for those who currently smoked, and 2.7 times for those who never smoked.

Conclusions:
In adjusted analyses, obesity is associated with several proinflammatory biomarkers; but when combined with cigarette smoking, this relationship becomes stronger. These findings underscore the need to recommend smoking cessation and weight loss in patients with both of these important risk factors.
Abstract P143: Effects Of Oral Anticoagulant Choice On Mortality In The Primary Treatment Of Non-cancer Venous Thromboembolism: Medicare, 2011-2016
Authors: Walker Rob F , Norby Faye L , Maclehose Richard F , Adam Terrence J , Alonso Alvaro , Zakai Neil A , Lutsey Pamela L
Published: May 2021

Introduction:
Oral anticoagulants (OAC) are the mainstay of venous thromboembolism (VTE) treatment, with newer direct oral anticoagulants (DOACs; rivaroxaban, apixaban, and dabigatran) approved for the treatment of VTE. Although clinical trials have evaluated DOACs versus warfarin individually, there are few direct comparisons of OAC treatment choice among VTE patients and risk of mortality.

Hypothesis:
Patients enrolled in Medicare who are prescribed DOACs for primary treatment of incident VTE will experience a lower rate of mortality compared to patients prescribed warfarin. Among different DOACs, there will be no difference in rate of mortality.

Methods:
We used the Medicare 20% sample to identify a cohort of 84,877 individuals with incident VTE from 2011-2016. We excluded VTE patients with evidence of prevalent cancer (N=27,603). Beneficiaries were then matched by OAC using patient characteristics at date of VTE diagnosis to create an analytic dataset of 35,922. All-cause mortality and date of death were ascertained from linkage with the National Death Index. We used Cox regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for the association of OAC choice with mortality. All analyses were limited to 6-months of follow-up. Multiplicative interaction by age (≥75 years), sex, race and kidney disease were explored.

Results:
In our matched sample 21,320 individuals were prescribed warfarin, 10,504 rivaroxaban and 3,681 apixaban. The average age was 77 years (SD: 8 years), 63% were female, 82.0% were white, 10.4% black and 7.6% were other/unknown. There were 2,701 deaths within 6 months of VTE diagnosis, of which 1,726 were warfarin, 604 were rivaroxaban, and 272 were apixaban. In the adjusted models, individuals prescribed rivaroxaban had 0.85 times the rate of 6-month all-cause mortality compared to those prescribed warfarin (HR: 0.85; 95% CI: 0.77, 0.93). There was no difference in mortality rates comparing apixaban to warfarin (HR: 0.98; 95% CI: 0.85, 1.13) or apixaban to rivaroxaban (HR: 1.12; 95% CI: 0.95, 1.32). For the interaction analyses among those aged under 75, apixaban users had a higher risk of mortality compared to warfarin (HR: 1.37; 95% CI: 1.06, 1.77) and rivaroxaban users (HR: 1.32; 95% CI: 0.99, 1.77). No other interactions were observed.

Conclusions:
We found differences in mortality related to anticoagulation choice for the treatment of VTE, with rivaroxaban having a lower mortality risk than warfarin and a similar risk overall with apixaban. However, apixaban had a higher risk of mortality in secondary analyses stratified by age, with a higher risk in those <75. The age-dependent association of apixaban with mortality was not hypothesized and requires further confirmation.
Abstract P144: One-year Change In Walking Performance And Mobility Loss In People With Peripheral Artery Disease: The Walking And Leg Circulation Study (walcs)
Authors: Hammond Michael M , McDermott Mary M , Tian Lu , Zhang Dongxue , Zhao Lihui
Published: May 2021

Introduction:
Peripheral artery disease (PAD) affects 10-15% of people age 65 and older, and the prevalence is expected to rise as the population ages. People with PAD have greater functional impairment and faster decline in walking performance than people without PAD.

Objectives:
To determine the association between 1-year change in walking performance and mobility loss. We hypothesized that greater declines in walking performance over one year would be associated with higher rates of mobility loss.

Methods:
Participants underwent measurement of 6-minute walk and 4-meter walking velocity at baseline, and returned yearly for repeat measurement of walking performance and assessment of mobility. Participants were categorized into tertiles based on their 1-year change in walking performance (Tertile 1: greatest decline). Mobility loss was defined as becoming newly unable to walk one-quarter mile or walk up and down 1 flight of stairs without assistance after the 1-year follow-up. We used Cox proportional hazards models to examine the association between 1-year change in walking performance and mobility loss, adjusting for potential confounders.

Results:
907 participants with PAD (mean age 71 +/- 9 years, 40% female, 23% black) were included. Median follow-up time was 38 months. Participants in Tertile 1 were older (mean 73 ± 9 years compared to 71 ± 9 in Tertile 2, and 70 ± 9 in Tertile 3; p=0.0004), had lower ABI (p=0.001), and included a higher prevalence of female (42% vs. 40% in Tertile 2, and 37% in Tertile 3; p=0.36). Participants with greater decline in 6-minute walk at 1-year follow-up had higher rates of mobility loss than participants with less decline. No significant associations of change in 4-meter walking speed and mobility loss were observed (Table).

Conclusion:
Among people with PAD, greater 1-year declines in six-minute walk distance are associated with higher rates of mobility loss. Further study is needed to determine whether interventions that prevent decline in six-minute walk can also prevent mobility loss.
Abstract P146: Comparative Effectiveness Of Direct Oral Anticoagulants Versus Warfarin Among Medicare Beneficiaries With Atrial Fibrillation
Authors: Ardeshirrouhanifard Shirin , An Huijun , Goyal Ravi , Raji Mukaila , Alexander Caleb , Mehta Hemalkumar
Published: May 2021

Objective:
Post-hoc analysis of three pivotal clinical trials suggests no difference in risk of ischemic stroke or systemic embolism among cancer patients with atrial fibrillation treated with direct oral anticoagulants (DOACs) vs. warfarin. However, these studies were underpowered and also do not reflect the context of real-world use. We compared the effectiveness of DOACs versus warfarin for the risk of stroke or systemic embolism and all-cause death in patients with NVAF.

Methods:
We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2009 to 2016 and included patients aged ≥66 years diagnosed with cancer (breast, bladder, colorectal, esophagus, lung, ovary, kidney, pancreas, prostate, stomach or uterus) and NVAF. We limited the cohort to patients who newly initiated warfarin or DOACs (from 2010 to 2016) with no history of ischemic stroke or systemic embolism. The primary outcome was hospitalization due to ischemic stroke or systemic embolism and the secondary outcome was all-cause death. We used Fine and Gray’s competing risk model, while treating death as a competing risk, to determine the association of oral anticoagulants with the incidence of stroke or systemic embolism. We also adjusted the analysis using inverse probability of treatment weighted (IPTW). Additionally, an IPTW-adjusted Cox proportional hazards regression model was constructed for all-cause death.

Results:
Of 1,028,784 patients with cancer, 158,744 (15.4%) were diagnosed with atrial fibrillation. After applying all inclusion criteria, the final study cohort included 7,334 cancer patients diagnosed with incident NVAF who newly initiated warfarin or DOACs, of which 3,194 (43.6%) used warfarin and 4,140 (56.4%) used DOACs. The unadjusted rate of stroke or systemic embolism was similar among warfarin and DOACs users (1.20 vs. 1.32 cases per 100 person-years, p=0.27). In the IPTW weighted competing risk model, the use of DOACs was not associated with an increased risk of stroke or systemic embolism compared with warfarin users (Hazard Ratio [HR] 1.41, 95% confidence intervals [CI] 0.90-2.20). However, DOACs users had a significantly lower risk of all-cause death compared with warfarin users (HR 0.82, CI 0.74-0.91).

Conclusion:
Among cancer patients diagnosed with NVAF, DOACs had a similar risk for stroke or systemic embolism compared to warfarin, although DOAC use was associated with reduced risk of all-cause mortality.
Abstract P152: Self-reported Physical Activity And Outcomes In Individuals With Chronic Kidney Disease
Authors: Bruinius Jacob , Hannan Mary , Chen Jinsong , Brown Julia , Kansal Mayank , Meza Natalie , Saunders Milda , He Jiang , Ricardo Ana , Lash James
Published: May 2021

Background:
In the general population, higher levels of physical activity are associated with lower risk for cardiovascular events and mortality. Although individuals with CKD are less physically active than individuals without CKD and at increased cardiovascular risk, the association between physical activity and outcomes has not been extensively evaluated in this population.

Hypothesis:
Lower levels of physical activity will be associated with an increased risk for cardiovascular events and mortality.

Methods:
We used data from 3935 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study, an ongoing multi-center prospective observational study of adults with CKD enrolled between 2003 and 2008. Self-reported physical activity was assessed at study entry using a self-reported survey. We evaluated two predictors: walking pace and moderate-to-vigorous physical activity (MVPA) MET-hours per week. Outcomes included physician-adjudicated myocardial infarction (MI), stroke, congestive heart failure (CHF), and cardiovascular (CV) death. Cox proportional hazards were used to assess the association of physical activity with outcomes.

Results:
At baseline, mean age was 57.7 years, 45.2% (1777 of 3935) were women, 33.4% (1314 of 3935) had self-reported cardiovascular disease, mean eGFR was 44.9 ml/min/m
2
, 11.7% (459 of 3914) were in the fastest walk pace group (>3 mph) and median MVPA was 39.0 MET-hours per week. During a median follow-up of 8.9 years, the number of events was 477 for MI, 230 stroke, 843 CHF, and 1022 CV deaths. In fully adjusted models, fastest walk pace was associated with lower risk for each outcome. Those in the highest MVPA quartile had lower risk for MI and CV death, but not stroke or CHF, compared to those who were least active (
Table 1
).

Conclusion:
In this cohort of adults with CKD, higher physical activity was protective against cardiovascular events and cardiovascular mortality, which may have important implications for clinical practice and the design of future studies.
Abstract P153: Dose-Response Associations Between Physical Activity And All-Cause Mortality Among A Multi-Ethnic Sample With Diabetes: NHANES 1999-2006
Authors: Boyer William , Brenton Madison , Milano Allison
Published: May 2021

Introduction:
Emerging evidence has suggested that those identifying as non-Hispanic white (NHW) or non-Hispanic black (NHB) have consistent and similar all-cause mortality risk reductions across dose of aerobic PA. In the same analyses, those identifying as Mexican American (MA) receive no protection from all-cause mortality across dose of aerobic PA. However, a single study has suggested that MAs meeting both the aerobic and muscular strengthening activity (MSA) recommendations have similar all-cause mortality risk reductions compared to NHW and NHB, highlighting the importance of MSA among MA. It is unknown, however, if these results translate to those who have diabetes.

Hypothesis:
NHW or NHB participants will have similar all-cause mortality risk reductions associated with aerobic PA independent of MSA participation. MA meeting both recommendations will have significant all-cause mortality risk reductions.

Methods:
The study sample (n=1,999) included adult (≥20 years of age) participants with diabetes from the 1999-2006 NHANES. Diabetes was defined as having one of the following: reported physician diagnosis, reported taking anti-hyperglycemic medication, or HbA1c ≥6.5%. PA was categorized into 6 categories based around the 2018 PA guidelines: category 1 (no aerobic PA and insufficient MSA), category 2 (insufficient aerobic PA and insufficient MSA), category 3 (active and insufficient MSA), category 4 (no aerobic PA and sufficient MSA), category 5 (insufficient aerobic PA and sufficient MSA), and category 6 (meeting both recommendations). Cox-proportional hazard models were used for all analyses.

Results:
A significant interaction (p<0.001) was found between categories of PA and race. Statistically significant risk reductions were found for categories 2,3 and 6 among NHW, and categories 2 and 3 among NHB; with a non-statistically significant risk reduction of 67% in category 6 (p=0.13) for NHB. A 45% reduction in risk was found among MA for category 6, however the estimate did not attain statistical significance (p=0.17).

Conclusions:
Similar to previous studies in those without diabetes, aerobic PA of any volume significantly reduced risk for all-cause mortality only among NHW and NHB with diabetes. While the risk reductions were clinically meaningful for both NHB and MA in category 6 compared to category 1, there was a lack of statistical significance. It is probable this may be, in part, influenced by a relatively low sample size within these two race-ethnic groups.
Abstract P154: Leisure-Time Physical Activity, Sedentary Behavior, And Carotid Atherosclerosis Morphology: The ARIC Carotid-MRI Study
Authors: Kumar Aarti , Qiao Ye , Wasserman Bruce , Gabriel Kelley P , Diaz Keith , Evenson Kelly R , Folsom Aaron R , Sharrett A Richey , Zhang Yiyi , Heiss Gerardo M , Palta Priya
Published: May 2021

Introduction:
Studies suggest that greater physical activity (PA) may be associated with favorable carotid artery characteristics, while greater time spent in sedentary behavior (SB) may be a potential risk factor for atherosclerosis development and progression. We evaluated the association between leisure-time PA and SB in midlife and their temporal patterns with carotid atherosclerotic morphology measured by MRI.

Methods:
ARIC Carotid-MRI participants (n=1582, mean age: 53 years, 43% male, 18% Black) with self-reported assessments of PA and SB at visits 1 (1987-1989) and 3 (1993-1995), who participated in the Carotid MRI substudy in 2004-2006 were included. Self-reported leisure-time PA was categorized based on the American Heart Association’s Life Simple 7 categorization of ideal, intermediate, or poor PA. SB was ascertained based on participant report of how often they watched television during leisure-time, and categorized as low [“never”/ “seldom”], medium [“sometimes”], or high [“often”/“very often”]. To measure persistent PA and SB, we examined participants who reported the same level of PA (n=849) or SB (n=954) at both visits 1 and 3. Carotid MRI using a 1.5T scanner quantified internal carotid artery wall thickness, lipid core, and calcification measures. Weighted analyses accounted for the sampling design allowing for generalizability to the visit 1 ARIC population. Multivariable linear and logistic regression were used for continuous and categorical outcomes, respectively. All models were adjusted for demographic, behavioral, and lifestyle factors.

Results:
Though no clear trends were observed for PA, higher levels of SB were associated with a greater odds of lipid core presence and lower odds of calcification (Table). Similar trends were observed for the persistence analyses, though none were statistically significant.

Conclusions:
PA and SB may influence atherosclerotic plaque characteristics. SB and lack of PA may have different measurable effects on plaque morphology.
Abstract P160: Associations Between Metabolic Syndrome Severity And Race/ethnicity, Socioeconomic, And Lifestyle Factors
Authors: Imes Christopher C , Kariuki Jacob , Chasens Eileen , Scott Paul , Yang Kyeongra
Published: May 2021

Introduction/Purpose:
Metabolic syndrome (MetS) is a disorder characterized by a cluster of cardiometabolic conditions that increase the risk of cardiovascular disease and diabetes. While MetS is treatable through lifestyle changes and medication, factors of race/ethnicity, socioeconomic, and lifestyle may influence MetS severity.

Methods:
The National Health and Nutrition Examination Survey (NHANES) 2015-2016 dataset was used for this secondary data analysis. Weighted data from individuals aged ≥ 20, not pregnant during the time of the assessment, with self-reported Non-Hispanic (NH) white, NH black, or Hispanic race/ethnicity, and with the variables needed to calculate MetS severity were included in the analysis (N=1850). Severity of MetS was determined using the formula developed by Gurika and DeBoer (2014) and expressed as a Z-score adjusted for sex and race. The severity score includes systolic blood pressure, triglycerides, HDL cholesterol, glucose, and body mass index. Socioeconomic variables included education level and the ratio between annual household income and poverty level. Lifestyle factors included sleep duration, dietary quality, sedentary time, and meeting the physical activity (PA) recommendation of 500 MET-mins/week (yes/no). Z-scores were converted to percentiles, which were categorized into quartiles. Regression analysis was used to examine the associations between MetS severity and race/ethnicity, socioeconomic, and lifestyle factors.

Results:
Based on weighted data, prevalence of MetS severity >75
th
percentile differed across age (20% for 20-40 y/o, 36.4% for 41-60 y/o, 33.0% for 61-80 y/o) and across racial/ethnic (29.4% for NH white, 29.1% for NH black, and 34.9% for Hispanic) groups. Mean MetS severity scores were significantly different between the age and race/ethnicity groups (p <. 001 and p = .014, respectively). While MetS severity scores were not significantly different among the four income to poverty-index ratio groups, the difference between the lowest (≤ 133%) and highest (≥ 500%) group was significantly different (p = .02). In the regression model, a higher quality diet (p <.001), meeting the PA recommendations (p = .008), and higher education level (p = .027) were associated with lower mean MetS severity score. After adjusting for socioeconomic and lifestyle factors, being in the Hispanic race/ethnicity group was associated with higher MetS severity scores (p = .020) compare to being in the NH white group.

Conclusions:
Diet, physical activity, and educational level were associated with MetS severity score. After adjusting for socioeconomic and lifestyle factors, being in the Hispanic group was associated with the highest MetS severity scores. Research and preventive efforts should focus on groups at increased risk for MetS and severity. Culturally appropriate education and interventions are needed to address this health inequity.
Abstract P161: Tai Chi Movements Bring On Parasympathetic Nerve Output As Indicated By Audible Bowel Sounds
Authors: Wang Desuo
Published: May 2021

Tai Chi movements are unique exercise that can improve cognition, strength somatomotor coordination, and enhance autonomic nerve regulation on internal organ function. The mild increase in heart rate and/or slight sweat during and after practicing Tai Chi indicates the activation of the sympathetic nervous system. There is lack of evidence to show that Tai Chi exercise enhances the activity of parasympathetic nervous system though it has been claimed that practicing Tai Chi could do so. The author tested the hypothesis that Tai Chi exercise brings on an increase in parasympathetic nerve outputs (PNO). The PNO is evaluated by recording the bowel sounds using an audio recorder (Sony digital voice recorder ICD-PX Series) and the data analyses were done using NCH software (WavePad audio editor). The heart rate was simultaneously recorded using a fingertip pulse oximeter (Zacurate Pro Series 500DL) during Tai Chi exercise. All the data was repeatedly collected from a Tai Chi Master in a study period of 6 months. A total of 30 recordings were used to carry out the analysis. The audible bowel sounds occurred when the performer started to do the Ready-Movement of Yang-style Tai Chi. These Tai Chi induced-bowel sounds lasted from the beginning to the end of a set of movements (3-5 min for 24-moves style). The frequency of bowel sounds was in a range of 0.2 to 3.5 Hz. The average number of bowel sounds was approximately 2.5 sounds per Tai Chi Move. The intensity and frequency of the bowel sounds are not related to the change of the performer’s heart rate. In comparison, meditation or deep squat exercise performed by the Tai Chi master did not cause any changes in the bowel sounds. According to the autonomic innervation of the GI tract, increase of bowel movements is mediated by PNO. In conclusion, Tai Chi movements can simultaneously exercise skeletal muscles, sympathetic nervous system and parasympathetic nervous system. The enhancement of parasympathetic nervous system output by Tai Chi exercise is a valuable modality of physical exercise for wellness.
Abstract P165: Hypertension, Dietary And Exercise Habits In Pregnancy - A Case Control Study
Authors: Kovell Lara C , Essa Angela , Meyerovitz Claire V , Ferreira Sarah , Panella Leslie , Moinul Sheikh , Maxner Benjamin , Juraschek Stephen P
Published: May 2021

Background:
Hypertension (HTN) in pregnancy is increasing in the United States and is implicated in nearly 40% of maternal deaths. While national guidelines recommend the Dietary Approaches to Stop Hypertension (DASH) diet for all women with HTN, adherence to DASH dietary habits in pregnant women with HTN is unknown.

Objective:
We determined the differences in diet and exercise habits in pregnant women with HTN compared to pregnant women with normal blood pressure (BP).

Methods:
Pregnant women with HTN and normal BP were recruited at 24-32 weeks gestation. HTN was defined by a provider diagnosis prior to 20 weeks gestation or BP ≥140/90 mm Hg at the time of recruitment. The normal BP group had systolic BP <120 mm Hg. Dietary intake was characterized using the Block Sodium and Fruit-Vegetable-Fiber surveys. The Pregnancy Physical Activity Questionnaire was used to determine the type, duration, and intensity of physical activity. Differences across hypertension status were compared using Chi-square Student's t-tests.

Results:
The mean age of the HTN group was 33.8 years and 31.3% were Black, while the mean age of the normal BP group was 30.4 years and 6.5% were Black. The HTN group reported lower sodium intake (HTN = 2,366 mg/day, normal BP = 3,221 mg/day; p < 0.01). However, the HTN and normal BP groups reported similar fruit, vegetable, fiber, magnesium, and potassium intake (Table). There were no significant differences in light, moderate, or vigorous activity between groups.

Conclusions:
While pregnant women with HTN reported lower sodium intake, they consumed similar amounts of fruit, vegetable, fiber, magnesium, and potassium compared to women with normal BP. Future work should identify barriers to healthy lifestyle habits to improve the implementation of evidence-based dietary strategies for BP control in pregnant women.
Abstract P168: Parity Is Associated With Higher Arterial Stiffness But Not Its 5-year Change In Older Women: The Atherosclerosis Risk In Communities - Neurocognitive Study
Authors: Bonner Alison N , Jayawickreme Shantal , Malek Angela M , Vladutiu Catherine J , Oliver-Williams Clare , Cortes Yamnia I , Tanaka Hirofumi , Meyer Michelle L
Published: May 2021

Introduction:
Although studies have demonstrated a J-shaped association of parity with cardiovascular disease, the association with vascular disease is not fully understood. We examined the association between parity and carotid-femoral pulse wave velocity (cfPWV), a measure of arterial stiffness.

Hypothesis:
Women who were never pregnant or had no live births and women with 5+ live births would have higher cfPWV and 5-year cfPWV change compared to women with 1-2 live births.

Materials and Methods:
We included 1220 women (average age 73.7; 21.9% Black) from the Atherosclerosis Risk in Communities - Neurocognitive Study, a cohort of 15,792 adults enrolled in 1987-1989 from four communities: Forsyth Co., NC; Jackson, MS; Minneapolis, MN; and Washington Co., MD. Technicians measured cfPWV at visit 5 (2011-13) and visit 6 or 7 (2016-19). At visit 2 (1990-92), women self-reported parity (number of prior live births), which we categorized as never pregnant or pregnant but no live births, 1-2 (referent), 3-4, and 5+ live births. We used linear regression models to evaluate associations of parity with visit 5 cfPWV and 5-year cfPWV change, adjusting for years between visits 5 and 6 or 7, age, race-center, education, body mass index, heart rate, mean arterial pressure, hypertension medication, and diabetes.

Results:
Participants reported having had no (7.7%), 1-2 (38.7%), 3-4 (40.0%), or 5+ (13.6%) prior live births. Women with 5+ live births had a higher visit 5 cfPWV (β=50.6 cm/s, 95% confidence interval (CI): 3.6-97.7 cm/s; Table) as compared to those with 1-2 live births. No statistically significant associations were observed for other parity groups and visit 5 cfPWV or cfPWV change.

Conclusions:
In later life, women with 5+ live births had higher arterial stiffness than those with 1-2 live births, but the rate of cfPWV change did not differ by parity. Longitudinal arterial stiffness measurements at mid-life are needed to better understand the effect of pregnancy on the trajectory of arterial stiffness among women in later life.
Abstract P177: Discordantly Normal ApoB Relative To Elevated LDL-C In Persons With Metabolic Disorders: A Marker Of Atherogenic Heterogeneity
Authors: Razavi Alexander C , Bazzano Lydia A , He Jiang , Krousel-Wood Marie , Dorans Kirsten S , Razavi Michael A , Fernandez Camilo , Whelton Seamus P , Kelly Tanika N
Published: May 2021

Introduction:
A significant proportion of persons with metabolic syndrome, prediabetes, or type 2 diabetes do not develop atherosclerotic cardiovascular disease (ASCVD). Discordantly normal apolipoprotein B (ApoB) relative to elevated LDL-cholesterol (LDL-C) may help to explain underlying heterogeneity in ASCVD risk among these individuals.

Hypothesis:
We hypothesized that discordantly normal ApoB (<90 mg/dL) relative to elevated LDL-C (
>
100 mg/dL) would be associated with a lower atherosclerosis burden among individuals with metabolic disorders.

Methods:
There were 331 Bogalusa Heart Study participants with metabolic syndrome (n=107), prediabetes (n=291), or type 2 diabetes (n=34) and LDL-C
>
100 who were free of carotid plaque at baseline (2001-02) and underwent carotid ultrasound at follow-up (2013-16). Carotid plaque was defined as a focal wall thickening >1.5 mm. Modified Poisson regression with robust error variance estimated the long-term absence of plaque for normal ApoB after adjusting for established risk factors.

Results:
Participants were on average 36.3 years old at baseline, 202 (61.0%) were women, and 93 (29.9%) were African American. Overall, LDL-C explained 42.3% of the variability in ApoB as the lipoprotein markers were only modestly correlated (r=0.65). Participants with ApoB <90 (51.1%) were more likely to remain free of carotid plaque compared to those with ApoB
>
90 (74.6% versus 57.4%, p=0.001,
Figure
). In multivariable modeling, persons with ApoB <90 were 21% more likely to have long-term absence of plaque (RR=1.21, 95% CI: 1.03-1.43), independent of traditional ASCVD risk factors, including LDL-C.

Conclusions:
More than half of persons with metabolic disorders and elevated LDL-C had normal ApoB with a lower burden of carotid atherosclerosis over 13 years follow-up. ApoB better represents the atherogenic lipid burden among persons with metabolic disorders compared to LDL-C and may be especially helpful for persons with the pattern of high triglycerides and low HDL-cholesterol.
Abstract P178: The Association Between Multiparity And Endogenous Sex Hormone Levels In The Multi-ethnic Study Of Atherosclerosis (mesa)
Authors: Kazzi Brigitte , Ogunmoroti Oluseye , Zhao Di , Minhas Anum , Osibogun Olatokunbo I , Subramanya Vinita , Allison Matthew A , Ouyang Pamela , Michos Erin
Published: May 2021

Introduction:
Parity is a risk factor for adverse cardiovascular events in women compared to nulliparity. A more androgenic sex hormone profile, with increased testosterone to estrogen ratio, is associated with worse cardiovascular disease (CVD) outcomes in women and may be one mechanism that links a history of multiparity with future increased CVD risk. Given this, we investigated the relationship between parity and sex hormone levels.

Methods:
We studied 3,003 female MESA participants (ages 45-84 years and free of CVD) with complete data on parity and endogenous sex hormone levels at the baseline visit (2000 - 2002). Parity (number of live births) was categorized as 0 (reference), 1-2, 3-4, or ≥5. Progressively adjusted linear regression models were used to evaluate the association of parity categories with log-transformed levels of testosterone (T), estradiol (E2), sex-hormone binding globulin (SHBG), dehydroepiandrosterone (DHEA), and testosterone to estradiol (T/E2) ratio.

Results:
Mean (SD) age at the baseline MESA visit was 65 (9) years. Median sex hormone levels by parity group are shown in the
Table
. There were no significant associations of parity with E2, DHEA, and SHBG levels in multivariable-adjusted models. Compared to nulliparity, women with 1-2 and 3-4 live births had higher testosterone levels even after adjustment for CVD risk factors, but this was not significant for ≥5 live births. On the other hand, grand multiparity (≥5 live births) was associated with a higher T/E2 ratio compared to nulliparity, even after full covariate adjustment including demographics, lifestyle factors, CVD risk factors and medications.

Conclusions:
In a multiethnic US cohort of women, a history of grand multiparity is associated with a more androgenic sex hormone profile defined by higher T/E2 ratio at middle to older ages. The clinical significance of this is uncertain. Further longitudinal studies evaluating whether sex hormones influence the relationship between multiparity and CVD are warranted.
Abstract P183: Contribution Of Childhood Risk Factors To Sex Differences In Adult Carotid Imt And Plaques: The Childhood Determinants Of Adult Health Study
Authors: Shah Mohammad , Tian Jing , BUSCOT Marie-Jeanne , Phan Hoang T , Magnussen Costan , Fraser Brooklyn , Dwyer Terence , Marwick Thomas H , Venn Alison , Gall Seana L
Published: May 2021

Background:
Understanding the origins of sex differences in cardiovascular diseases (CVD) may help with prevention. We examined sex differences in carotid artery IMT and plaques in adulthood including the contribution of childhood risk factors.

Methods:
Boys and girls aged 7-15 years old from the Australian Schools Health and Fitness Survey in 1985 were followed up in the Childhood Determinants of Adult Health study at ages 36-49 years between 2014-19. Sex differences in adult carotid IMT and plaques, identified with 2D ultrasound of left and right carotid arteries, were examined with linear and log binomial regression, respectively. Childhood sociodemographic, psychosocial, health-related behavioural and biomedical risk factors that might contribute to sex differences in carotid IMT/plaques were identified with purposeful model building.

Results:
Among 1,286 men and women with vascular measurements of carotid IMT (53% women, mean carotid IMT 0.63 mm ± 0.09 standard deviation) women had thinner carotid IMT measurements than men (β coefficients -0.053 95% CI -0.063, -0.043). Adjusting for age standardised waist circumference (WC), waist/hip ratio (WHR), waist/height ratio (WHtR) and systolic blood pressure (SBP) in childhood reduced the sex difference of carotid IMT in adulthood (see Figure), but a significant sex-difference in carotid IMT remained. Women had a 42% lower risk of plaques than men (Relative Risk 0.58 95% CI 0.42, 0.79). School achievement levels, endurance/power fitness and SBP in childhood partially explained the sex difference in the prevalence of plaques at adulthood (see Figure) as the sex difference decreased and became statistically insignificant.

Conclusion:
Various factors in childhood had contributed to thicker carotid IMT and higher prevalence of carotid plaques in men compared to women. These findings suggest that the origins of adult sex differences in CVD may begin in childhood. There may be benefits of sex-specific primary prevention programs starting in childhood.
Abstract P193: Psychosocial Profiles And Hypertension Control: Results From The Multi-ethnic Study Of Atherosclerosis (MESA)
Authors: Vargas Emily A , Kershaw Kiarri N , Chirinos Diana , Wong Mandy , Everson-Rose Susan A
Published: May 2021

Introduction:
Increasing research demonstrates psychosocial factors are associated with blood pressure control (BPC) among individuals with hypertension. To date, little research has examined multiple psychosocial factors simultaneously to identify distinguishing profiles among individuals with hypertension. The association of psychosocial profiles and BPC remains unknown. Thus, the goal of this study was to characterize the psychosocial profiles of individuals with hypertension and assess whether they are associated with BPC over 14 years.

Hypothesis:
We hypothesize that discrete psychosocial profiles will emerge, and they will be associated with BPC longitudinally.

Methods:
We included 2,665 MESA participants (38.57% Black; 55.43% Female) with prevalent hypertension in 2002-2004. Latent Profile Analysis (LPA) was used to identify distinct psychosocial profiles based on a combination of nine psychosocial variables (Table). We used generalized estimating equations to determine associations of the psychosocial profiles with BPC, defined as systolic blood pressure (SBP) < 140 mm Hg and diastolic blood pressure (DBP) < 90 mm Hg.

Results:
The LPA revealed an optimal model of three psychosocial profile groups (AIC 121,229; entropy = .88) namely “Healthy”, “Depressed Mood” and “Discriminated Against”. There were no significant differences in BPC of both targets (SBP and DBP) combined across the profiles. Examining SBP and DBP separately, participants in the “Depressed Mood” profile group were 60% less likely [95% CI: 0.43, 0.84] to have their DBP < 90 mm Hg as compared to the “Healthy” profile in the unadjusted model, but there was no association with covariate adjustment.

Conclusions:
Discrete psychosocial profiles exist among individuals with hypertension, but were not associated with BPC after full covariate adjustment.
Abstract P198: Short Sleep Duration, Greater Cognitive Arousal, And Eveningness Are Associated With Reduced Left Ventricular Function In Insomnia Disorder
Authors: Petrov Megan E , Kasraeian Kimiya , Jiao Nana , Youngstedt Shawn , mookadam farouk , Angadi Siddhartha S
Published: May 2021

Aim:
Insomnia is associated with cardiovascular disease (CVD), particularly the phenotype with objective short sleep duration and associated physiological arousal. However, what objective sleep and arousal characteristics among patients with insomnia are related to markers of cardiovascular structure and function remains unknown. The present study examined the association of objective sleep metrics and self-reported arousability with arterial stiffness, endothelial function, and left ventricular function among patients with insomnia disorder.

Methods:
Sixteen young, healthy adults (age:
M
[
SD
]=30[7]; 56.3% women) meeting diagnostic criteria for insomnia disorder and reporting no history of CVD, underwent fasting vascular testing including carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness (SphymocorXCEL
TM
), brachial-artery flow mediated dilation (FMD) to assess endothelial function, and 2D echocardiography to assess left ventricular function (Terason uSmart 3300
TM
). Left ventricular function was assessed by ejection fraction (EF), global longitudinal strain (GLS), mitral valve E/e’ (MVE/e’), and lateral e’ using standardized methods. Ten participants wore a portable sleep monitor for 1 night (WatchPat200, Itamar Medical) and an actigraph for 8 nights (Actiwatch Spectrum Plus, Philips Respironics). All participants completed the Pre Sleep Arousal Scale (PSAS; somatic & cognitive subscales), and the Arousal Predisposition Scale (APS). Bivariate correlations and curvilinear regressions (total sleep time [TST] only) were conducted for the associations between actigraphy-assessed TST and WatchPat (WP) TST, actigraphy-assessed mean bedtime, and PSAS and APS scores with cardiovascular markers. Each set of one sleep metric with all six cardiovascular markers were Bonferroni corrected (α level:
p
<0.007).

Results:
On average, participants obtained 7h,9min of TST (range: 6h,26min - 8h,41min) and went to bed at 23:40 (range:21:47-2:13) via actigraphy, and slept 6h,51min via WP. Mean PSAS Somatic, PSAS Cognitive, and APS scores were 13.7(SD=4.5), 24.5(SD=7.5), and 27.9(SD=7.6), respectively. cfPWV (range:4.6-8.0), EF% (range:55.0-70.9), GLS% (range:-25- -19), and MVE/e’ (range:3.6-13.3) were all within age and sex normative ranges. Mean FMD was 7.8% (SD=2.6, range:4.4-14.6), and lateral e’ was 15 cm/s (SD=4.5, range:9-22). Correlations indicated that greater PSAS cognitive scores were related to worsening (less negative) GLS% (
r
=0.77,
p
=0.001), later bedtimes were associated with lower lateral e’ (
r
=-0.84,
p
=0.004), and shorter WPTST was associated with lower EF% (r=0.84, p=0
.
002).

Conclusion:
Among young adults with insomnia disorder, greater cognitive arousal, later bedtimes, and shorter objective total sleep time were associated with subclinical worsening of left ventricular strain, diastolic and systolic function.