bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P086: Metabolic Risk, Galectin-3 And Heart Failure: The Atherosclerosis Risk In Communities (aric) Study
Authors: Echouffo Tcheugui Justin B , Zhang Sui , Florido Roberta , Michos Erin , NAMBI VIJAY , Goldberg Ronald B , Gerstenblith Gary , Post Wendy S , Blumenthal Roger S , Hoogeveen Ron C , Coresh Josef , Folsom Aaron R , Ballantyne Christie M , Selvin Elizabeth , Ndumele Chiadi E
Published: May 2021

Introduction:
Diabetes and metabolic syndrome (MetS) confer an increased risk of heart failure (HF) through poorly understood mechanisms. Galectin-3 (Gal-3) is a marker of fibrosis linked to greater HF risk. The inter-relationships among diabetes, MetS and Gal-3, and related implications for HF risk, are not well understood.

Hypothesis:
Diabetes and MetS are associated with elevated Gal-3, and high Gal-3 indicates greater HF risk among those with diabetes or MetS.

Methods:
We included 8,445 participants (mean age 63, 59% male, 21% Black) at ARIC Visit 4 (1996-1999) without baseline HF. We categorized participants by metabolic risk (no diabetes/no MetS; MetS only; diabetes with or without MetS), and Gal-3 levels (gender-specific quartiles). We assessed the associations of metabolic risk categories with high Gal-3 (≥75
th
percentile) using logistic regression. We used Cox regression to evaluate associations of cross-categories of metabolic risk group and Gal-3 quartiles with incident HF.

Results:
In cross-sectional analyses, those with MetS were more likely to have elevated Gal-3 levels than those with no diabetes or MetS (OR 1.29, 95%CI 1.13-1.47). The additional presence of diabetes did not change the likelihood of elevated Gal-3 (OR 1.29, 95%CI 1.08-1.55). Over 20.5 years of follow-up, there were 1,611 HF events. Higher Gal-3 was associated with higher HF risk in each metabolic risk group, and higher metabolic risk group was associated with greater HF risk in each Gal-3 quartile. There was no interaction between Gal-3 and metabolic risk group on HF risk (
P
=0.15). The combination of diabetes &MetS and high Gal-3 was associated with an almost 5-fold higher risk of incident HF (HR 4.93; 95% CI: 3.77 - 6.44) than the combination of no diabetes/MetS and low Gal-3 (first quartile) (
Table
).

Conclusions:
MetS was associated with higher levels of Gal-3. Metabolic risk group and Gal-3 provided powerful complementary prognostic information regarding HF risk. Fibrosis likely plays a role in the development of HF linked to metabolic risk.
Abstract P087: Goldberger's Electrocardiographic Criteria For Left Ventricular Dysfunction Associated With Increased Mortality
Authors: Xiang Kang Rui , Soliman Elsayed Z , Bhave Prashant , Singleton Matthew J
Published: May 2021

Goldberger’s Electrocardiographic Criteria for Left Ventricular Dysfunction Associated with Increased Mortality

Introduction:
The ability of the Goldberger electrocardiographic (ECG) triad criteria to detect left ventricular dysfunction (LVD) is well-established. However, the prognostic significance of this triad as a predictor of poor outcomes is not known.

Hypothesis:
We hypothesized that the Goldberger ECG-LVD triad is associated with increased all-cause mortality and cardiovascular mortality in the general population.

Methods:
This analysis included 8,426 participants (60.5 ± 13.6 years, 51.5% women, 50% non-Hispanic white) from the Third National Health and Nutrition Examination Survey. The Goldberger ECG-LVD triad was defined as follows: high precordial QRS voltage (SV1 or SV2 + RV5 or RV6 ≥3500 μV); low limb lead QRS voltage (mean QRS amplitude in each of the limb leads ≤ 800 μV); and poor R wave progression (RV4/SV4 <1). Mortality was ascertained using the National Death Index.

Results:
At baseline, 1,384 (47.3%) of the participants had at least one of the criteria of Goldberger triad (1,193 had only one and 191 participants had 2 or more). During a median follow up of 13.8 years, 3,184 deaths occurred, of which 1,405 were cardiovascular. In multivariable-adjusted Cox proportional hazards models, presence of at least one of the Goldberger triad criteria (vs. none) was associated with increased risk of all-cause (HR 1.17, 95% CI 1.08 – 1.26, p = <0.0001) and cardiovascular mortality (1.19, 1.06 – 1.33, p = 0.003).

Conclusion:
The Goldberger ECG-LVD triad for left ventricular dysfunction is associated with increased all-cause and cardiovascular mortality and may offer prognostic value, in addition to its diagnostic utility.
Abstract P093: Sex-stratified Associations Of Urine Electrolytes With 10th & 90th Percentiles Of Systolic Blood Pressure Distribution
Authors: Naser Abu Mohd , Rahman Mahbubur , Alonso Alvaro , Vaccarino Viola , Gribble Matthew
Published: May 2021

Introduction:
Electrolytes intake influence systolic blood pressure (SBP). Studies often explore the association of urine electrolytes with the conditional mean difference of SBP, but limited data exist on the sex-specific associations of urine electrolytes’ excretion with low and high end SBP distribution. We examined the sex-stratified association of urine electrolytes with the 10th and 90th percentiles of SBP.

Methods:
We pooled 9,804 person-visits (n =1467 participants) data of 24-hour urine electrolytes and SBP from three cohorts in coastal Bangladesh. We created sex-stratified restricted cubic spline (RCS) plots from quantile regression for illustrating the associations of urine sodium (Na), potassium (K), calcium (Ca), and magnesium (Mg) excretion with the 10th and 90th percentile of SBP distribution, adjusted for age, body mass index, physical activity, smoking, alcohol consumption, sleep hours, religion, household wealth, cohort ID, and seasonality. Four knots at the 5th, 35th, 65th, and 95th percentiles of each electrolyte distribution were used to create RCS plots.

Results:
We found linear positive associations for urine Na with 10th and 90th percentiles of SBP for males, but such association for the 10th percentile of SBP for females was less steep. Negative associations were found between urine K and SBP for males for the 90th percentile of SBP; no such association was found for the 10th percentile of SBP. Linear negative associations were found between urine Mg and SBP for males for both the 10th and 90th percentile of SBP distributions, but not for females. There was no association of urine Ca and SBP for both sexes for the 10th percentile of SBP, but negative associations existed for the 90th percentile of SBP for males.

Conclusion:
Sex-specific associations of urine electrolytes and SBP varied for the low and high end of SBP distribution. Males with higher SBP could benefit from high urine K, Ca, and Mg, representing high intakes of these minerals. However, such benefits may not be present for females.
Abstract P099: Pulse Pressure And Long-term Post-kidney Transplant Systolic Hypertension Among Different Age
Authors: Tantisattamo Ekamol , Leelaviwat Natnicha , Polpichai Natchaya , Songtanin Busara , Saowapa Sakditad , Lopimpisuth Chawit , Vutthikraivit Possawat
Published: May 2021

Introduction:
Wide pulse pressure (PP) is common in elderly and associated with poor cardiovascular outcomes. Association between PP and long-term hypertension (HTN) in kidney transplant recipients (KTR) among different age groups is unclear.

Hypothesis:
We hypothesize that PP at early post-kidney transplant (KT) predicts different long-term post-KT HTN among different age groups.

Methods:
This is a retrospective cohort study of consecutive KT recipient in a single center. With age categorized into < and ≥ 50 years old, association between PP at 4 and 12 weeks post-KT (when a baseline kidney allograft function is generally established) and post-KT systolic and diastolic HTN (SHTN and DHTN) at a 48-week post-KT defined by SBP and DBP ≥ 130 and 80 mmHg, respectively were examined by using multiple logistic regression.

Results:
Of all 105 KTR, 40 and 65 patients were <50 and 65 years old, respectively. Mean age±SD was 54±12 years with a median follow-up of 47.71 weeks. At a 4-week post-KT, mean PP was 54±13 mmHg with a mean difference
young - old
±SE of -7±3 (p 0.011; 95%CI -11.55, -1.53). Mean PP at a 12-week post-KT was 56±16 mmHg and a mean difference±SE of -8±3 mmHg (p 0.018; 95%CI -13.95, -1.35). At 48-week post-KT, 50% of the young had SHTN 66% of the old had SHTN; whereas, 58% and 38% of the corresponding groups had DHTN. Mean SBP of the young and old groups were 129±16 and 135±16 mmHg, respectively (mean difference -6±3; p 0.076; 95%CI -12.66, 0.63). Mean DBP of the corresponding groups were 80±12 and 75± 10 with a mean difference 5±2; p 0.036; 95%CI 0.332, 9.394). After adjusted for pre-KT BMI, type of KT, and induction immunosuppression, every 1 mmHg increase in PP at the 4-week post-KT was associated with 6% greater the odds of developing SHTN at 48-week post-KT among the older age group (OR 1.06; p 0.041, 95%CI 1.002, 1.117); whereas, the risk was 2% increase in younger group (OR 1.02; p 0.400; 95%CI 0.969, 1.082). The association between PP at the 12-week post-KT and SHTN at 48-week post-KT were in the same direction, but it was attenuated (5%) in the older and strengthen the younger (7%) (OR
old
1.048; p 0.033; 95%CI 1.004, 1.095 and OR
young
1.087; p 0.050; 95%CI 1.000, 1.1801). There were no association between PP at 4- and 12-week post-KT and DHTN at 48-week post-KT.

Conclusion:
Higher early post-KT PP was associated with increased risk of long-term post-KT SHTN, but not DHTN. However, the magnitude of the association was greater among the older KTR at early post-KT, but higher in the younger at later post-KT period. Mechanism of increased PP and outcomes such as post-KT HTN in KTR needs to be further elucidated.
Abstract P109: Plasma Metabolomic Signature Of Healthy Dietary Patterns In The Chronic Renal Insufficiency Cohort (CRIC) Study
Authors: Kim Hyunju , Anderson Cheryl A , Hu Emily A , Zheng Zihe , Appel Lawrence J , He Jiang , Feldman Harold I , Anderson Amanda , Ricardo Ana , Bhat Zeenat Y , Kelly Tanika N , Chen Jing , Grams Morgan , Coresh Joe , Rhee Eugene P , Rebholz Casey M
Published: May 2021

Introduction:
In individuals with chronic kidney disease (CKD), healthy dietary patterns are inversely associated with CKD progression. Metabolomics, an approach which measures many small molecules in biofluids, can identify biomarkers of healthy dietary patterns and elucidate metabolic pathways underlying diet-disease associations.

Hypothesis:
We hypothesized that adherence to 4 healthy dietary patterns would be associated with a set of known metabolites in CKD patients.

Methods:
We examined associations between 634 plasma metabolites assessed using the Broad platform at year 1 and Healthy Eating Index (HEI)-2015, Alternative Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension (DASH) diet, and alternate Mediterranean diet (aMED), and their food components in 1,117 participants in the CRIC Study. Usual dietary intakes were assessed using a food frequency questionnaire at baseline and year 2. We conducted multivariable linear regression models to study associations between diet scores and individual plasma metabolites, adjusting for sociodemographic characteristics, health behaviors, and clinical factors.

Results:
After Bonferroni correction, we identified a total of 362 diet-metabolite associations (HEI=78; AHEI=127; DASH=97; aMED=60), and 101 metabolites were associated with more than 1 dietary pattern. The most common metabolite categories were triacylglycerols and diacylglycerols. Most lipids were negatively associated with healthy dietary patterns, except for cholesterols esters and triacylglycerols with ≥7 double bonds. Triacylglycerols with high number of double bonds were positively associated with healthy fat intake (e.g., higher monounsaturated and polyunsaturated fatty acid, omega-3 fatty acid, fish) within HEI, AHEI, and aMED (
Table
).

Conclusions:
We identified many metabolites associated with healthy dietary patterns, indicative of food consumption. If replicated, they may be considered biomarkers of healthy dietary patterns in CKD patients.
Abstract P112: Impact Of Look Back Period Length On Associations When Using Electronic Health Record Data For Epidemiologic Research
Authors: Bhavsar Nrupen A , Pura John , Navar Ann Marie , Hellkamp Anne , Muntner Paul , Maciejewski Matthew , Raman Sudha , Hammill Brad , Curtis Lesley , Boulware Ebony
Published: May 2021

Introduction:
Studies using electronic health record (EHR) data often have a limited number of years available for analysis. There is a trade off between the look back period length used to define baseline characteristics and follow up duration used to define outcomes.

Objective:
Quantify the impact of 6, 12, and 24 month look back periods on the association between diabetes (DM) and subsequent cardiovascular (CV) events using EHR data alone and in combination with Medicare claims.

Methods:
EHR data from an academic health system and a federally qualified health center from 2009-2014 were linked to Medicare claims data. Eligibility criteria were age ≥65 years, Durham County address, 24 months of continuous enrollment after first claim, EHR encounter in the 2011 index year, and no history of cardiovascular disease (CVD) in the 24 months prior to the index date (i.e., look back period). DM was defined using EHR ICD-9 codes, HbA1c ≥6.5%, or glucose lowering medication, and using claims based diagnosis codes or glucose lowering medication. The outcome was a major CV event (myocardial infarction, stroke, or cardiac procedure) defined by diagnosis or procedure codes. Hazard ratios (HR) compared time to the outcome between patients with and without DM.

Results:
In 5473 patients, mean age was 77 years, 67% were female and 28% were Black. The prevalence of DM using EHR data only increased with a longer look back period (6 months [19%]; 12 months [21%]; 24 months [23%]) but was less than the prevalence using all available data from EHRs and claims together (28%) (Table 1A). Shorter look back periods resulted in higher HRs (6 month HR=1.64) as compared to HRs from longer look back periods (24 month HR=1.41) using EHR data alone or all available data from the EHR and claims together (HR=1.43) (Table 1B).

Conclusions:
To avoid over estimating associations, studies of CVD using EHR data to identify baseline conditions may want to use 12-24 month look back periods in the absence of additional administrative data. This may also lead to a shorter follow-up period.
Abstract P113: Underestimation Of Sudden Death Due To Restrictive Sudden Cardiac Death Criteria
Authors: Tybout Caroline , Keen Susan K , Thota Sanjana , Chang Albert , Lin Feng-Chang , Jiang Huijun , Joodi Golsa , Simpson Ross J
Published: May 2021

Background:
Efforts to prevent sudden death may be hampered by restrictive case definitions impairing accurate estimates of incidence and risk factors of sudden death. Sudden cardiac death (SCD) definitions include requirements for presence of comorbid coronary artery disease (CAD) and various time criteria since onset of symptoms or when victims were last seen well. We compared prevalence of three SCD definitions within a registry of all-cause natural, sudden deaths.

Hypothesis:
We assessed the hypothesis that the restrictive criteria of three SCD definitions underestimate sudden death and exclude populations with increased medical comorbidities.

Methods:
Using a registry of 399 adjudicated sudden death cases among adults aged 18-64 in Wake County, North Carolina in 2013-2015, we included 271 cases after excluding for missing values, chronic kidney disease, or heart failure. Time since last seen alive was classified as less than one hour or 24 hours from scene reports. Presence of CAD and co-morbidities were defined from clinical or autopsy records. Prevalence of SCD using criteria defined by Atherosclerosis Risk in Communities (ARIC), the World Health Organization (WHO), and the Oregon Sudden Unexpected Death (SUD) registry were calculated. Prevalence of SCD risk factors were calculated for the 3 SCD subgroups and compared to the original 271 victims using two-sample t-test and Fisher’s exact test for continuous and categorical variables.

Results:
Among the 271 cases, criteria were met for the three SCD definitions for n (%): ARIC 28 (10%), WHO 54 (20%), and SUD 90 (33%) (Table 1). ARIC and WHO-defined SCD cases were younger than the original 271 cases. There were no significant differences in sociodemographic and clinical factors by any SCD group compared to the original 271 cases.

Conclusion:
Restrictive SCD definitions that require the presence of CAD or a specific time frame of identification of death underestimate the incidence of sudden death and hinder effective prevention efforts for sudden death.
Abstract P125: The Effects Of Vitamin D Supplementation On Orthostatic Hypotension: Results From STURDY
Authors: Juraschek Stephen P , Miller Edgar R , Appel Lawrence J
Published: May 2021

Background:
In some trials, vitamin D supplementation is associated with a lower risk of falls. Observational evidence has implicated orthostatic hypotension (OH) as a potential mechanism for this association.

Objective:
To determine if higher doses of vitamin D supplementation reduce the risk of OH.

Methods:
The Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a double-blind, randomized, response-adaptive trial that tested the effects of 4 doses of vitamin D3 (200, 1000, 2000, and 4000 IU/day) on fall risk in adults age 70 years and older with low serum vitamin D levels (10-29 ng/ml). OH was determined at baseline, 3, 12, and 24 months by taking the difference between seated and standing blood pressure. OH was defined as a drop in systolic or diastolic blood pressure of at least 20 or 10 mmHg, respectively, after 1 minute of standing. Participants were also asked about symptoms related to OH during the OH assessment and in the past month. Odds ratios were determined using generalized estimating equations to account for repeat measurements.

Results:
Among 387 participants with 924 OH assessments, mean age was 77 ± 5 years, 42% were women, and 17% black. Mean baseline systolic/diastolic blood pressure was 129 ± 19/67 ± 11 mm Hg; 2.3% had OH. Compared to 200 IU/day, 1000, 2000, and 4000 IU/day did not lower risk of OH during the trial (
Table
). Furthermore, vitamin D dose was not associated with orthostatic symptoms as participants stood up or after standing. In a subset with more detailed symptom assessments, there was no association between vitamin D dose and orthostatic symptoms or functional limitations in the preceding 30 days.

Conclusions:
Daily, higher dose vitamin D supplementation was not associated with OH or its symptoms. These findings do not support vitamin D as an intervention to prevent OH.
Abstract P127: Associations Between Acculturation, Nutrient Intake, And Diet Quality Among Non-hispanic Black Adults In The United States
Authors: Adeyemi Oluwafikayo S , Roehll Alexandra M , Flores Edson , Singleton Chelsea R
Published: May 2021

Introduction:
Consuming a nutrient poor diet can negatively affect the health status of an individual. Recent increases in African immigration into the U.S. has called for more research on the health and health behaviors of this growing population. Little is known about how acculturation (as measured by place of birth and length of time in the country) affects nutrient intake and diet quality among Non-Hispanic Blacks in the U.S. We aim to address this gap in knowledge by studying the association between acculturation, nutrient intake, and diet quality among a large sample of Non-Hispanic Black adults.

Hypothesis:
We hypothesize that foreign-born (FB) Blacks who immigrated to the U.S. less than 10 years ago are more likely to meet national recommendations for diet and nutrient intake compared to FB Blacks who immigrated more than 10 years ago and U.S. born Blacks.

Methods:
We analyzed cross-sectional data from the 2005-2016 cycles of the National Health and Nutrition Examination Survey (NHANES). The analytical sample comprised 7,073 Non-Hispanic Blacks who we categorized into three groups: FB Blacks less than 10 years (3.35%), FB Blacks greater than 10 years (7.42%), and U.S. born Blacks (89.23%). We analyzed each participant’s 24-hour recall data to determine if they met 2015-2020 Dietary Guidelines for Americans (DGA) recommendations for intake of specific nutrients (e.g., saturated fat, fiber, sugar, cholesterol, sodium, etc.). We used logistic regression to assess differences across the three groups in regards to odds of meeting DGA recommendations for nutrient intake.

Results:
Compared to U.S. born blacks and FB Blacks (≥10 years), FB Blacks (<10 years) had significantly higher odds of meeting DGA recommendations for most nutrients after adjusting for all covariates (e.g., age, gender, education level, poverty level, etc.). Specifically, FB Blacks (<10 years) had significantly higher odds of meeting recommendations for saturated fat (OR: 2.7; 95% CI: 1.6-4.6), cholesterol (OR: 1.7; 95% CI: 1.2-2.5) and sodium intake (OR: 2.2; 95% CI: 1.2-4.3) compared to U.S. born Blacks. FB Blacks (≥ 10 years) had significantly higher odds of meeting recommendations for total fat and dietary fiber compared to U.S. born Blacks.

Conclusion:
FB Blacks (<10 years) had higher odds of meeting DGA guidelines for nutrient intake compared FB Blacks (≥10 years) and U.S. born Blacks. These findings further highlight the importance of acculturation and its impact on dietary intake among immigrant populations. Future studies should evaluate how acculturation influences overall health status and chronic disease risk across the African diaspora in the U.S.
Abstract P145: Demographic And Clinical Predictors Of Incident Clinically-recognized Varicose Veins In Older Adults
Authors: Mok Yejin , Ballew Shoshana , Kucharska-newton Anna , Butler Kenneth R , Henke Peter , Lutsey Pamela L , Salameh Maya , Hoogeveen Ron C , Ballantyne Christie M , Selvin Elizabeth , Matsushita Kunihiro
Published: May 2021

Background:
Varicose veins are common in older adults, and associated with major clinical adverse outcomes such as deep venous thrombosis. Although there are a few established risk factors of varicose veins such as female sex, height, and obesity, some other risk factors demonstrated inconsistent results.

Aim:
To identify demographic and clinical risk factors of incident varicose veins

Methods:
Using data from the Atherosclerosis Risk in Communities (ARIC) Study over five clinic visits, we constructed a cohort of 6612 adults aged 65-70 years to be able to capture outpatient visits using Medicare data. For each participant, the first visit when meeting age range (65-70 years) was used as baseline. Varicose veins were defined as two outpatient encounters (at least a week apart) or inpatient diagnoses through 2015 (ICD9 codes:454.xx). Participants with clinically-recognized varicose veins prior to baseline were excluded. We explored demographic and clinical predictors routinely evaluated in ARIC visits using Cox regression.

Results:
During a median follow-up of 15 years, 348 (5%) of participants developed incident clinically-recognized varicose veins. We confirmed female sex, greater height, and higher body mass index were associated with varicose veins (
Table
). In addition, white race, loop diuretic use, prevalent heart failure were independently associated with incident varicosities. In subsample with relevant data, higher cardiac troponin T and natriuretic peptide were also independently associated with varicose veins. When we censored participants who left Medicare fee-for-service, results were largely consistent.

Conclusions:
In this community-based cohort study of older adults, in addition to established predictors, we found that white race and clinical and treatment factors related to cardiac function were associated with clinically-recognized varicose veins that may help identify those at high-risk of varicose veins.
Abstract P158: Work-related Exertion And Standing/walking Are Associated With Leisure-time Physical Activity In Latinos
Authors: Murillo Rosenda , Desai Shreya , Gonzalez Tailisha , Echeverria Sandra , Vasquez Elizabeth
Published: May 2021

Introduction:
Latinos engage in higher levels of occupational physical activity, yet lower levels of leisure-time physical activity (LTPA), than other racial/ethnic groups. Limited research has examined specific work-based activities that contribute to lower LTPA among Latinos. The purpose of our study was to examine associations between frequency of work-related exertion and standing/walking with LTPA among Latinos.

Hypothesis:
We hypothesized that higher frequency of work-related exertion and standing/walking would be associated with lower levels of LTPA among Latinos.

Methods:
We used cross-sectional 2015 National Health Interview Survey (NHIS) data on employed Latinos ≥18 years of age (n=3,305). We examined two types of work-based activities: frequency of exertion and frequency of standing/walking. Frequency of exertion was assessed based on reported frequency of engaging in repeated lifting, pulling, pushing, or bending at work. Frequency of standing/walking was assessed based on frequency with which their work involved standing or walking around. Responses to work-based activity items were on a Likert scale (0=never, 1=seldom, 2= sometimes, 3=often, 4=always). LTPA was measured based on minutes of moderate-to-vigorous LTPA aerobic physical activity per week, which were categorized into none (0 min/week), some LTPA (>0 min/week of activity but less than recommendation), and meeting the LTPA guideline (≥150 min of moderate-vigorous activity or ≥75 min of vigorous activity or 150 min of moderate activity/week). Multinomial logistic regression models that accounted for the complex survey design of NHIS were used to estimate the associations between frequency of work-related exertion and standing/walking with LTPA. All models were adjusted for age, sex, education, shift work, and acculturation proxies (nativity, years living in the US).

Results:
In adjusted models, compared with those who reported never engaging in exertion at work, individuals reporting always exerting themselves at work were significantly less likely to meet the LTPA guideline (Odds Ratio [OR]: 0.68, 95% Confidence Interval [CI]: 0.50-0.94). In addition, compared with those that reported never standing/walking at work, only those who reported that their job seldom involved standing/walking at work were significantly less likely to meet the LTPA guideline (OR: 0.52, 95% CI: 0.30-0.92).

Conclusions:
In conclusion, these findings suggest that work-related physical activities may contribute to LTPA levels among Latinos, and associations vary based on the type of physical activities performed at work. Future physical activity promotion efforts among Latinos should consider the role of worksite policies to promote wellness.
Abstract P159: Factors Associated With Moderate Physical Activity Among Older Adults With Atrial Fibrillation: SAGE-AF Study
Authors: Mehawej Jordy , Saczynski Jane , Kiefe Catarina I , Ding Eric , Abu Hawa O , Lessard Darleen , Helm Robert H , Bamgbade Benita , Saleeba Connor , Wang Weijia , McManus David D , Goldberg Robert
Published: May 2021

Objective:
Guidelines encourage patients with atrial fibrillation (AF) to engage in moderate-intensity physical activity. We examined the sociodemographic, geriatric, and clinical factors associated with engagement in moderate-intensity physical activity among older adults with AF.

Methods:
Patients aged 65 years and older, diagnosed with AF, and having a CHA
2
DS
2
-VASc ≥ 2 were recruited from multiple clinics in Massachusetts and Georgia between 2015 and 2018. We utilized The Minnesota Leisure Time Physical Activity questionnaire to assess whether participants reported being engaged in moderate physical exercise. We examined the association between sociodemographic, clinical, geriatric elements and engaging in moderate-intensity physical activity using multiple logistic regression modelling.

Results:
The mean age of participants was 76 years and 52% were men. Approximately one-half (52%) of participants met the recommended levels of physical activity. Participants who were cognitively impaired (adjusted OR [aOR]=0.74; 95% CI= 0.56-0.97
)
, morbidly obese (aOR= 0.40; 95% CI= 0.22-0.72), socially isolated (aOR= 0.58; 95% CI= 0.40-0.84), and had a slow gait speed (aOR= 0.44; 95% CI= 0.32-0.60) were less likely, while those with higher AF related quality of life score (aOR=1.66; 95% CI=1.26-2.18) more likely, to engage in moderate physical activity.

Conclusions:
A considerable proportion of older adults with AF did not engage in moderate physical activity. Cognitive impairment, morbid obesity, social isolation, and slow gait speed were associated with not engaging in moderate exercise. Health care providers should identify patients with AF who are sedentary, promote engagement, and tailor interventions to address obstacles in engagement in physical activity.
Abstract P174: First Trimester Blood Pressure Elevation May Have A Greater Impact On The Risk Of Spontaneous Abortion Than Preconception Blood Pressure
Authors: Farooq Fouzia , Basany Kalpana , Jammy Guru Rajesh , Tang Gong , Barinas-Mitchell Emma , Sekikawa Akira M , Catov Janet M , Feghali Maisa , Reddy Sudhakar , Haggerty Catherine
Published: May 2021

Background:
Spontaneous abortion (SAB) is a common early pregnancy complication globally, impacting 15% of clinically recognized pregnancies. The biological pathways leading to SAB are not clearly understood, although early SAB is often attributed to chromosomal abnormalities. Elevated blood pressure (BP) in women of reproductive age predicts cardiovascular disease later in life, but less clear is whether elevated BP during preconception and/or early pregnancy BP elevations can affect prenatal outcomes.

Hypothesis:
Elevated BP during preconception and the first trimester will be positively associated with SAB.

Methods:
We conducted a secondary analysis of data collected from 577 primiparous women (15-35 years) who participated in the Longitudinal Indian Family hEalth (LIFE) prospective pregnancy cohort study in Telangana State, India. Resting blood pressure was measured by trained technicians using a standardized study protocol at a preconception registration visit and in the first trimester. Odds ratio (OR) and 95% confidence intervals (CI) of any SAB (<22 weeks of gestation, n=108), early SAB (<8 weeks of gestation, n=25), and late SAB (8 to <22 weeks of gestation n=83) were assessed with a log link binomial distribution.

Results:
Preconception measurements were assessed at the first study visit, conducted at registration and within a mean±SD of 11±12 months prior to pregnancy. Higher than optimal preconception BP (120/80 mmHg) was not associated with SAB (OR
adj
0.82 (95% CI 0.51, 1.32)). In contrast, first trimester elevated BP was associated with a two-fold increased likelihood of SAB, although results were of borderline significance (OR
adj
2.12 (95%CI 0.87, 5.14). In addition, we observed an association between elevated first trimester BP and late SAB (OR
adj
2.32 (95%CI 0.95, 5.68)); there were no associations between elevated preconception or first trimester BP and early SAB.

Conclusions:
We found that elevated first trimester but not preconception BP was associated with an increased risk of pregnancy loss, suggesting that dysregulated adaption to pregnancy may impact pregnancy loss more than preconception BP status, especially SABs that occur after 8 weeks gestation. Our findings support the notion that clinical and environmental factors may have a greater impact on later SABs as opposed to earlier losses. The null relationship with early pregnancy loss in our study may be due to an expected genetic mutation etiology for those losses. Studies exploring the trajectory of preconception and prenatal blood pressure changes and impact on pregnancy outcomes are warranted.
Abstract P185: Paradoxical Outcomes Among Group Lifestyle Balance Participants In Real-world Clinical Practice
Authors: Azar Kristen M , Huang Qiwen , Venditti Elizabeth , Sudat Sylvia , Pressman Alice R , Romanelli Robert
Published: May 2021

Introduction:
The CDC established the National Diabetes Prevention Program (NDPP) initiative in 2010, leading to implementation of numerous group-based lifestyle interventions, such as the 12-month Group Lifestyle Balance (GLB) program, in community and clinical settings. Heterogeneity in weight outcomes is common. While evidence suggests that session attendance is associated with greater weight loss, some participants do not achieve weight loss even with high session attendance. Conversely, some may achieve clinically significant weight loss (≥5%) with lower attendance. In this study, we sought to identify and characterize such paradoxical interventional outcomes. (i.e., high session attendance and <5% weight loss compared with low attendance and ≥5% weight loss).

Hypothesis:
No
a priori
hypotheses.

Methods:
We conducted a longitudinal descriptive analysis of overweight/obese GLB participants using electronic health record data from an integrated healthcare delivery system in Northern California (2010-2017). We focused on the 12-week intensive core phase of the curriculum because prior studies show that weight loss outcomes achieved during this period are highly correlated with long-term weight loss. We categorized patients into 4 mutually exclusive groups by session attendance (<9/≥9 session) and weight change from baseline to 12-weeks follow-up (<5%/≥5% weight loss). The threshold of 9 sessions corresponds to 75% adherence, a quality metric used by Medicare.

Results:
Among 1,818 evaluable participants, we identified 870 (47.9%) with paradoxical outcomes. Of these, 104 (12.0%) achieved ≥5% weight loss with <9 sessions attended (paradoxical responders) and 766 (88.0%) achieved <5% weight loss despite attending ≥9 sessions (paradoxical non-responders). The remaining 948 participants (52.1%) achieved weight loss consistent with a dose response, based on number of sessions attended.

Conclusions:
Nearly half of all GLB participants in this integrated health system had paradoxical outcomes, with more than 40% classified as paradoxical non-responders. These results suggest that session attendance may not be as sensitive a predictor of weight outcomes as previously thought, and other approaches are needed to understand the complex factors influencing goal attainment in behavioral lifestyle programs.
Abstract P187: Analysis Of Online Information On Lifestyle Modification For Post-Myocardial Infarction Patients
Authors: Moon Jooyoung , Moon Hanna
Published: May 2021

Background:
With continual advancement of treatment modalities, uncomplicated myocardial infarction (MI) patients are being discharged after only one to two days of hospitalization. Though patient education routinely takes place prior to discharge, patients often rely on online information for further guidance. This study aimed to analyze the content and variability of information regarding lifestyle modification for post-MI patients on the internet.

Methods:
The lay terms 'lifestyle changes after heart attack' were queried using the Google search engine. The first 100 websites were reviewed by two independent investigators. Websites were categorized as either professional or informational depending on the target audience, with the former written for healthcare professionals and the latter for average consumers. Websites that were personal, non-accessible, required payments for access, or included videos were excluded. Statistical analyses were performed using the chi-squared test and Fisher's exact test with significance level set at p<0.05.

Results:
A total of 86 websites (49 professional, 37 informational) met our inclusion criteria. The most frequently addressed changes were exercise (86.0%), nutrition (82.6%), smoking cessation (74.4%), mental health (50.0%), weight loss (38.4%), risk factor control (36.0%), adherence to cardiac rehabilitation (30.2%), compliance to prescribed medications (26.7%), alcohol abstinence (20.9%), and compliance to follow-up visits (11.6%). Smoking cessation was addressed significantly more often on informational websites (p=0.025), while alcohol abstinence was addressed significantly more often on professional websites (p=0.003).

Conclusions:
This study demonstrates the variability in information that post-MI patients will encounter on the internet. As it is difficult for patients to determine the credibility of different websites, it is crucial that online resources provide a full range of necessary information for their readers.
Abstract P188: Anxiety Is Associated With Six-year Blood Pressure Change And Incident Hypertension: Findings From The Hispanic Community Health Study/ Study Of Latinos
Authors: Rosas Carlos E , Pirzada Amber , Durazo-Arvizu Ramon A , Sanchez-Johnsen Lisa A , perreira krista , Gallo Linda , Talavera Gregory A , Elfassy Tali , Wassertheil-smoller Sylvia W , Llabre Maria , Cai Jianwen , Daviglus Martha L
Published: May 2021

Introduction:
Prior research on the association of anxiety with hypertension has yielded mixed results. Despite the high burden of both conditions in Hispanics/Latinos, little is known about their association in this population. This study examined the longitudinal relationship of trait anxiety with changes in BP and incidence of hypertension.

Hypothesis:
Higher trait anxiety at Visit 1 (V1) will be associated with greater increases in BP and incident hypertension over 6 years.

Methods:
The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a multi-center prospective community-based study of 16,415 diverse Hispanics/Latinos ages 18-74 at V1 (2008-11). Data included 11,048 participants with complete information on BP, trait anxiety, and other variables at V1 and V2 (2014-17). Trait anxiety was measured at V1 using the 10-item Spielberger Trait Anxiety Scale, which was dichotomized into low and high using a cut-point of 20 points, the top quartile in the HCHS/SOL cohort. BP was measured using a standardized protocol and validated automated device. Hypertension was defined as systolic BP ≥ 140 or diastolic BP ≥ 90 mm Hg or self-reported antihypertensive medication use. Linear regressions were used to examine the association of anxiety with BP change; to account for medication use, 9 mmHg and 6 mmHg were added to systolic and diastolic BP of treated participants, respectively. The association of anxiety with incident hypertension at V2 was examined using Poisson regression among those without hypertension at V1 (
N
= 7,878). Estimates were adjusted for complex survey design, sociodemographic factors, baseline BP, antidepressant/anxiolytic medication use, and health conditions.

Results:
Mean baseline age was 45.8 years and 60% were women. Mean change was 3.13 (
SE
= 15.67) in systolic and 0.21 (
SE
= 9.73) in diastolic BP. Individuals with high, compared to those with low, trait anxiety had greater increases in systolic (
B
= 1.10, 95% CI = 0.28-1.93,
p
= 0.009) and diastolic BP (
B
= 0.69, 95% CI = 0.11-1.27,
p
= 0.02) over 6 years, after adjusting for covariates. Individuals with high, relative to those with low, trait anxiety had an 18% higher risk of hypertension (RR = 1.18, 95% CI = 1.03-1.34,
p
= 0.012).

Conclusions:
Elevated trait anxiety is associated with small increases in BP over 6 years and an 18% higher risk of hypertension among diverse Hispanics/Latino adults. Research on the mechanisms underlying these relationships among Hispanics/Latinos is warranted to develop effective interventions to prevent and treat hypertension in this population.
Abstract P189: Greater Purpose In Life Is Associated With Lower Allostatic Load Among Hispanics/ Latinos: The Hispanic Community Health Study/study Of Latinos (hchs/sol) Sociocultural Ancillary Study (scas)
Authors: Estrella Mayra L , Lamar Melissa , Durazo-Arvizu Ramon A , Mattei Josiemer , Sanchez-Johnsen Lisa A , Gonzalez Sara , Cai Jianwen , Perreira Krista M , Isasi Carmen R , Gallo Linda C , Daviglus Martha L
Published: May 2021

Introduction:
Allostatic load (AL), a multi-system measure of physiological dysregulation that represents cumulative wear-and-tear due to chronic stressors, is related to higher risk of cardiovascular disease (CVD). Evidence on the association of psychosocial factors with AL is mixed despite accruing research that suggests that psychosocial factors are related to CVD, in part, through AL. We examined the associations of psychosocial factors with AL among Hispanics/Latinos.

Hypothesis:
Psychosocial intrapersonal (
ethnic identity
,
optimism, and purpose in life)
and interpersonal (
family cohesion
,
social network embeddedness
, and
social support
) resources will each be inversely associated with AL while stressors (
perceived
ethnic discrimination
,
familism,
and
loneliness
) will each be positively associated.

Methods:
Data from the HCHS/SOL SCAS were used (n=4,914; ages 18-74). AL was assessed using 16 biomarkers representing cardiometabolic, glucose, cardiopulmonary, parasympathetic, and inflammatory systems. The AL score (0-16) was computed as the number of biomarkers for which a participant had a high-risk quartile; higher scores represent greater physiological dysregulation. Psychosocial factors were self-reported. Survey-weighted linear regression models adjusted for sociodemographic factors examined associations of each psychosocial factor with AL. We also examined whether sex modified these associations.

Results:
Mean AL score was 4.0 (SD=3.2). In fully-adjusted models (Table), the purpose in life score was inversely associated with AL. No other significant associations were observed, although regression estimates were generally in the hypothesized direction. Sex did not modify the association of psychosocial factors with AL.

Conclusions:
Greater sense of purpose in life, an intrapersonal psychosocial resource, is associated with lower physiological dysregulation in Hispanics/Latinos. Findings highlight the need to examine prospective associations of purpose in life with AL.
Abstract P192: Depression And Anxiety Are Associated With Cardiovascular Health In Young Adults
Authors: Patterson Sierra L , Marcus Michele , Goetz Margarethe , Gooding Holly C
Published: May 2021

Introduction:
Cardiovascular health (CVH) declines substantially in young adulthood, and mood disorders commonly emerge during this life stage. This study aimed to examine the association between CVH metrics and 1) depression and 2) anxiety among young adults ages 18-34 years.

Hypothesis:
We hypothesized that young adults with depression or anxiety will have less optimal CVH.

Methods:
We used data from the Emory Healthy Aging Study (EHAS), a prospective cohort study of US adults that aims to understand factors associated with aging. We conducted a cross-sectional analysis among participants ages 18-34 years who completed the EHAS Health History Questionnaire (n=882). We classified participants as having poor, intermediate, or ideal levels of the seven CVH metrics using definitions set forth by the AHA, with slight modifications as needed based on questionnaire items, and calculated total CVH scores (range 0-14). We defined depression and anxiety as absent, mild, or moderate-to-severe using standard cutoffs for Patient Health Questionnaire (PHQ-8) and General Anxiety Disorder (GAD) scales. We used multivariable regression to examine the association between CVH, depression, and anxiety, controlling for gender, race, age group, income, and education.

Results:
A total of 134 (15.2%) participants had moderate-to-severe anxiety, and 132 (15.0%) participants had moderate-to-severe depression. The mean total CVH score among participants was 10.4. Compared to those without anxiety, participants with moderate-to-severe anxiety were less likely to meet ideal levels of physical activity (PR: 0.63, 95% CI: 0.44-0.90), smoking (PR: 0.89, 95% CI: 0.81-0.98), and body mass index (PR: 0.78, 95% CI: 0.65-0.94). Participants with moderate-to-severe depression were less likely to meet ideal levels of cholesterol (PR: 0.93, 95% CI: 0.86-1.00), physical activity (PR: 0.45, 95% CI: 0.30-0.69), smoking (PR: 0.89, 95% CI: 0.79-0.99), blood pressure (PR: 0.91, 95% CI: 0.84-0.98), and body mass index (PR: 0.81, 95% CI: 0.71-0.93). Stratified analysis showed that these associations appeared stronger in older young adults (26-34 years). Relative to those without anxiety, participants with moderate-to-severe anxiety had a CVH score that was 0.91 points lower (standard error: 0.18, p-value<0.01). Relative to those without depression, participants with moderate-to-severe depression had a CVH score that was 1.19 points lower (standard error: 0.18, p-value<0.01).

Conclusion:
Anxiety and depression are associated with CVH in young adults. Interventions to address mood disorders in this age group should consider targeting CVH behaviors such as physical activity and weight management to improve both mood and CVH.
Abstract P195: The Association Of Psychological Stress Measures With Allostatic Load Among African Americans With Hypertension
Authors: Hines Anika L , Boulware Ebony , Golden Sherita H , Joseph Joshua J , Han Dingfen , Ephraim Patti , Cooper Lisa A , Greer Raquel , Crews Deidra
Published: May 2021

African Americans experience disproportionate stress over the life course, which has been posited as an explanatory mechanism underlying racial disparities in CVD risk. We studied associations between measures of self-reported psychosocial stress and allostatic load (AL) (elevated or fluctuating endocrine or neural responses resulting from chronic stress) among 74 participants of the Achieving Blood Pressure (BP) Control Together (ACT) study—a randomized control trial to improve BP self-management and control among African Americans. We examined ancillary AL biomarkers (i.e., DHEA-S, cortisol, CRP, IL-6) in addition to ACT study measures (i.e., HbA1c, diabetes status, total cholesterol, HDL-C, triglycerides, hyperlipidemia, urinary microalbumin) collected at 12-months follow-up. We used linear univariable and multivariable regression to estimate correlations between ratings of the Perceived Stress Scale (PSS-10), the Everyday Discrimination Scale, and the Patient Health Questionnaire (PHQ-8) with total AL score (1 point per aforementioned component measure threshold achieved) and its components. Ninety-three percent of the sample reported moderate to severe stress; the mean discrimination score was 14.9 (SD: 7.4) (of a possible 39 points); 22% had moderate to severe depressive symptoms. The mean AL score was 3 of a possible total of 11. Perceived stress was negatively associated with CRP adjusting for other components and patient characteristics. Discrimination was associated with increases in inflammatory factors; however, this association diminished after adjusting for other AL components and patient characteristics. Depressive symptoms were positively associated with inflammatory factors and triglycerides adjusting for other AL components and patient characteristics. In conclusion, the findings from this study of African Americans with hypertension suggest correlations between self-reported psychological stressors and AL components, but not total AL score.