bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P282: Pooled Cohort Equation Performance at Quantile Thresholds of African and European Ancestry Among Hispanic/Latino: Findings From Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Nriagu Bede N , Flores Rosario Karen , Hansen Spencer , Duran Luciano Priscilla , McClelland Robyn , Joshi Parag H , Mehta Anurag , Khera Amit V , Kaplan Robert , Sofer Tamar , Peralta Carmen A , Rodriguez Carlos J
Published: May 2024

Background:
Current recommendations include using the non-Hispanic White (NHW) pooled cohort equation (PCE) for 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation among Hispanic individuals and the non-Hispanic Black (NHB) PCE when African ancestry is present. We studied PCE performance at thresholds of African and European ancestry among US Hispanics.

Methods:
Hispanic participants from the Multi-Ethnic Study of Atherosclerosis (MESA), ages 44-75 years without diabetes mellitus or prior cardiovascular disease were included. ADMIXTURE software was used to estimate quantile thresholds of continental genetic ancestry (African and European). We compared 10-year survival Kaplan-Meier estimates among Mexican Hispanics, Caribbean Hispanics and Other Hispanics using a log-rank analysis. We calculated the predicted-to-observed (P/O) ASCVD event ratios using the NHW and NHB PCE across quantile threshold of African and European ancestry.

Results:
966 MESA Hispanics were stratified into: Mexican (n=504), Caribbean (n=284) or Other Hispanic (n=178). At 10-years, there were 179 ASCVD events [Mexicans (n=107), Caribbean (n=49), Other Hispanic (n=23)]. We observed overestimation using the NHW and NHB PCE as evidenced by P/O ratios >1. Both PCEs performed better (P/O ratios converge toward 1) with increasing quantiles of European Ancestry and performed worse (P/O ratios diverge from 1) with increasing quantiles of African Ancestry. At a greater than 0.7 quantile of African ancestry, a sharp increase in overestimation was recorded for both PCEs. (Fig1A). Though Mexican Hispanics had the lowest ASCVD-free survival probability at 10 years’ time mark, results were not statistically significant. (Fig 1B)

Conclusion:
We observed overestimation in the 10-year ASCVD risk estimation using the NHW and NHB PCE among Hispanics as evidenced by P/O ratios >1. Both PCEs performed better with increasing quantiles of European ancestry and performed poorly with increasing quantiles of African ancestry.
Abstract P286: The Impact of Obesity Severity on Left Ventricular Mass Index in Adults With Congenital Heart Disease
Authors: Ream Stephen C , Tran Andrew H , Mah May Ling , Lee Marc , Daniels Curt , Hor Kan N
Published: May 2024

Introduction:
Obesity is a global epidemic. Adult congenital heart disease (ACHD) patients are obese at rates comparable to the general population. Obesity is associated with left ventricular hypertrophy (LVH) which can be assessed by LV mass index [LVMI = LVM/Ht
2.7
(g/m
2.7
)]. Elevated LVMI is known to be associated with adverse cardiovascular events in non-CHD populations, however, there is a paucity of data on the relationship of obesity severity and the rate and extent of LVH in ACHD.

Hypothesis:
The rate and extent of LVH in a cohort of obese ACHD patients will increase as obesity class increases.

Methods:
We reviewed transthoracic echocardiogram data including LVMI, BMI, and blood pressure in obese, repaired, ACHD patients 18+ years of age from 2012-2020. Patients were grouped by sex and NIH/WHO obesity class and LVMI was analyzed. Outcome differences were assessed using one-way ANOVA (p < 0.05 = statistically significant).

Results:
We included 386 patients, 202 of whom were female, as seen in Table 1. There were no blood pressure differences between obesity classes (P = 0.18). LVMI was higher with increasing obesity class (42.4±13.5 g/ht
2.7
vs 43.6±12.7 g/ht
2.7
vs 48.9±13.2 g/ht
2.7
respectively, P = 0.004 for females and 45.9±12.8 g/ht
2.7
vs 48.9±13.8 g/ht
2.7
vs 55.3±16.8 g/ht
2.7
, P = 0.019 for males). For females, 36.4% of class I, 31.9% of class II, and 58.3% of class III met LVH criteria ≥ 47 g/ht
2.7
. For males, 29.9% of class I, 44.4% of class II, and 59.4% of class III met LVH criteria ≥ 51 g/ht
2.7
.

Conclusion:
Obesity severity correlates with progressive LVMI and LVH in ACHD patients. Elevated LVMI is most striking in patients with class III obesity. This highlights the potential negative impact of obesity in this population and additionally suggests that even in obese patients, prevention of progression to class III obesity may help prevent deleterious cardiac changes. Further research is needed regarding how this association impacts this high-risk population.
Abstract P296: The Association Between Maternal Occupation and Adverse Birth Outcomes Among Infants With Congenital Heart Defects
Authors: Patel Jenil , Oluwafemi Omobola , Agopian A J , Benjamin Renata , Shumate Charles , Gimeno David
Published: May 2024

Background:
Neonates with critical congenital heart defects (cCHDs) face increased risks of neonatal complications, including low birth weight (LBW) and preterm birth (PTB). Maternal occupation has known associations with adverse birth outcomes in the general population. We aimed to assess the link between maternal occupation and adverse birth outcomes in neonates with cCHDs.

Methods:
We examined Texas Birth Defects Registry (TBDR) data from 1999-2014, focusing on employed mothers of non-syndromic live born singletons with cCHD. Using the NIOSH Industry and Occupation Computerized Coding System (NIOCCS) and manual coding, we categorized maternal occupation into 23 major groups. Neonates with cCHDs and adverse birth outcomes were compared to neonates with cCHDs without adverse outcomes. Logistic regression models assessed the association between maternal occupation and PTB and LBW, with the reference group being all other occupations.

Results:
There were 712 mothers with preterm neonates with cCHDs and 3,076 mothers with full-term neonates with cCHDs. Additionally, 776 mothers delivered LBW neonates, while 3,012 had normal birthweight neonates. Maternal occupations in computer/math science were negatively linked to PTB (OR: 0.29; 95% CI: 0.10-0.79) and LBW (OR: 0.26; 95% CI: 0.09-0.70). Food preparation occupations were positively associated with PTB (OR: 1.67; 95% CI: 1.17-2.38), while arts/entertainment occupations were negatively associated with LBW (OR: 0.30; 95% CI: 0.11-0.84).

Conclusion:
These findings align with previous reports, suggesting that mothers in certain occupations may engage in behaviors linked to adverse pregnancy outcomes in the general population, such as insufficient folic acid supplementation, delayed prenatal care, smoking, and drinking. Understanding these associations can inform targeted workplace interventions, particularly for pregnancies involving birth defects.
Abstract P298: Cross-Sectional and Longitudinal Associations Between Fast Food Outlet Access and Inflammatory Markers in the US-Based Nurses’ Health Study II
Authors: Siddiqui Noreen , Beulens Joline , Hart Jaime , Klompmaker Jochem , Mackenbach Joreintje , Pinho Maria Gabriela , Rimm Eric , James Peter
Published: May 2024

Background:
Access to fast food outlets (FFO) has increased in recent years and may decrease diet quality and increase cardiovascular disease risk. Inflammation is a well-established cardiovascular disease risk factor, but it remains unclear whether inflammation is one of the pathways explaining associations between the food environment and inflammatory markers.

Methods:
We included 6,609 participants from the US-based Nurses’ Health Study II (NHS-II), a prospective cohort of registered female nurses. Counts of FFO were obtained from the Infogroup US Historical Business Data within 1500-meter circular buffers and assigned to participants’ residential addresses from 1998 to 2011. Biomarkers included C-reactive protein (CRP), Interleukin-6 (IL-6), Tumor necrosis factor α receptor 2 (TNFαR2, in a subset), and adiponectin. We evaluated cross-sectional associations between counts of FFO (1998) and inflammatory markers (1999) in linear regression models and evaluated longitudinal associations by the change in counts of FFO between 1998 and 2010 and the change in inflammatory markers between 1999 and 2011 using linear mixed models. Models were adjusted for age, race/ethnicity, partners’ education level, smoking, neighborhood socioeconomic status, and population density. Interaction terms were included to explore effect modification by baseline neighborhood socioeconomic status and population density.

Results:
Our study comprised women with a mean age of 45.3 (+/- 4.4) years at 1998. A one-unit higher count of FFO within a 1500m buffer was not cross-sectionally associated with CRP (β: 0.004, 95%CI: -0.004, 0.010), IL-6 (β: 0.001, 95%CI: -0.001, 0.004), TNFR2 (β: 0.051, 95%CI: -1.495, 1.597), or adiponectin (β: -6.054, 95%CI: -14.576, 2.468). No associations were found in longitudinal models (CRP (β: 0.000, 95%CI: -0.007, 0.008), IL-6 (β: 0.001, 95%CI: -0.002, 0.003), or adiponectin (β: -1.127, 95%CI: -11.889, 14.3152)). No significant effect modification was found between count of FFO and neighborhood socioeconomic status, or population density (P-for-interaction >0.1).

Conclusions:
While several previous studies have found an association between frequency of consumption of food at fast food restaurants and biomarkers of cardiovascular risk, at the community level, we did not find associations between the count of FFO and several inflammatory markers in a population of US female nurses.
Abstract P299: Alteration of Cardiac Autonomic Function Through Inhalation of Biogenic Volatile Organic Compounds
Authors: Stopforth Cameron K , Gallagher Jacqueline , Bhatnagar Aruni , Keith Rachel J
Published: May 2024

Background:
There is an inverse relationship between exposure to greenspaces and prevalence of cardiovascular disease and cardiovascular disease risk factors. More specifically, green exposure is associated with electrocardiogram (ECG) changes, suggesting a potential alteration of cardiac autonomic balance. One proposed mechanism by which cardiac autonomic balance may be altered is a direct physiologic effect of inhalable plant derived compounds, or biogenic volatile organic compounds (bVOCs), including limonene, α- and β-pinene which are commonly released from vegetation. Therefore, we examined the relationship between acute exposure of isolated bVOCs and cardiac autonomic tone.

Hypothesis:
We hypothesize that controlled exposure to isolated individual bVOCs will decrease cardiac sympathetic tone.

Methods:
Under controlled conditions after a bVOC washout period, healthy adults ages 18-70 were exposed to limonene (n=32), α-pinene (n=24), β-pinene (n=17), and a control (room air, n=9). Exposure consisted of one inhalation every 30 seconds for a total of 5 minutes (10 inhalations total). Pre- and post-exposure measurements of supine heart rate variability (HRV) were conducted following a 10-minute rest period. HRV was analyzed using a clean, 5-minute epoch with >95% effective data length. Statistical analysis was performed using paired t-tests to determine changes in HR and HRV. Significance level was set at p<0.05,
a priori
.

Results:
Our population was primarily female (56%, 18 of 32), white (53%, 17 of 32), high income (47%, 15 of 32), and had an education higher than a 4-year degree (62.5%, 20 of 32). There were significant decreases in HR when exposed to limonene (pre: 64.87±9.86bpm vs. post: 63.26±9.10bpm, p<.001) and α-pinene (pre: 63.98±9.32bpm vs. post: 61.64±9.72bpm, p=.008), along with trends seen in β-pinene (pre: 65.78±10.60bpm vs. post: 63.74±9.65bpm, p=.066). Control exposure showed no difference (pre: 65.40±8.38bpm vs. post: 64.14±9.35bpm, p=.301). Normalized low- (LF) and high-frequency (HF) HRV parameters showed no change across isolated bVOCs, however the LF/HF ratio scores decreased significantly following β-pinene exposure (pre: 1.62±1.69 vs. post: 0.96±0.96, p=.039). HRV time-domain parameters RMSSD and SDNN did not change following isolate exposure.

Conclusions:
Post-exposure decreases in HR and LFHF ratios indicate the potential for cardiovascular disease risk reduction from bVOC exposure leading to decreased sympathetic tone. Additional work is required to determine the mechanism of exposure-related changes.
Abstract P301: Nativity Explains Disparities in Provider Experience Scores Among Asian and Pacific Islander Patients With and Without Cardiovascular Disease
Authors: Amaturo Lily , Bacong Adrian M , Gibbs Sophia , Rosales Ana G , Frankland Timothy B , Li Jiang , Daida Yihe , Fortmann Stephen P , Palaniappan Latha
Published: May 2024

Introduction:
Research has shown that Asian patients rate their patient-provider experience lower than Non-Hispanic White (NHW) patients. Few studies have examined whether experience scores differ by cardiovascular disease presence and disaggregated Asian race subgroups.

Hypotheses:
1) NHW patients will have the highest healthcare experience scores, followed by multiracial Asian and Pacific Islander (API) patients, and then single race API patients; 2) patients with CVD will have lower scores than patients without CVD; and 3) longer duration in the U.S. will be associated with higher scores.

Methods:
We examined 5,234 participants, aged 40+ surveyed in two health systems in Hawai'i and California. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey quantified patient experience (range: 5-20). We dichotomized CAHPS to compare patients who scored low (< 18) to high (18+). For immigrants, length of residence determined nativity. Multivariable logistic regression compared the association of race and low CAHPS, adjusting for age, sex, ethnic affiliation strength, education, nativity, and CVD diagnosis.

Results:
There were no significant differences in CAHPS score by CVD (Table). Chinese and Filipino patients had significantly higher odds of low CAHPS than NHW patients with adjustment for age and sex. These differences were fully attenuated when adjusting for nativity. Compared to U.S.-born people, immigrants who have lived in the U.S. between 0-19 years were more likely to have low CAHPS (OR = 2.13, 95% CI = 1.47, 3.10). Even immigrants who have lived in the U.S. for 20+ years had increased odds of low CAHPS (OR = 1.45, 95% CI = 1.16, 1.81).

Conclusion:
Although most people have positive provider experiences, differences remain by race. Nativity and duration in the U.S. explained racial variations in CAHPS among API individuals in our study. Research should continue disaggregating racial data by nativity status to improve the quality of care and health outcomes for immigrant populations.
Abstract P329: Lifetime Risk of Dementia: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Fang Michael , Hu Jiaqi , Sharrett A R , Gottesman Rebecca F , Lutsey Pamela L , Mosley Thomas , Selvin Elizabeth , Coresh Joe
Published: May 2024

Introduction:
Prior studies suggest that 15-20% of adults will develop dementia after midlife. However, current lifetime risk estimates are based on limited dementia ascertainment, potentially resulting in underestimation.

Methods:
We conducted a prospective cohort analysis using data from the Atherosclerosis Risk in Communities Study (ARIC) (baseline 1990-1992). We used non-parametric cumulative incidence function estimation to calculate lifetime risk of dementia while accounting for the competing risk of death, overall and stratified by demographics and APOE
ε
4 status. Dementia was ascertained until December 31, 2019 by: (1) cognitive testing at study visits, with diagnoses generated using a standardized computer algorithm and confirmed by a panel of experts; (2) semiannual telephone cognitive testing and Clinical Dementia Rating interviews with informants; and (3) ICD codes from hospital records and death certificates.

Results:
We included 13,358 participants (mean age: 57 years; 25% of Black race; 55% female sex; 31% carried at least one APOE
ε
4 allele). Over a median follow-up of 24 (IQR: 20, 29) years, there were 2,812 incident cases of dementia. At age 55, the lifetime risk of dementia (up to age 95) was 43%
(Fig A)
. Adults with two copies of the APOE
ε
4 allele had substantially higher lifetime risk (61%) of dementia compared to those with one copy (48%) and those none (40%), with differences beginning at age ~70 years
(Fig B)
. Lifetime risk was higher in women and Black adults
(Fig C-D)
.

Conclusion:
More than 4 in 10 adults will develop dementia after midlife. Comprehensive capture of dementia in the ARIC study results in lifetime risk estimate substantially exceeding prior research.
Abstract P336: The Association of Coronary Artery Calcium Progression and Cognitive Function in Midlife - The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Teramoto Masayuki , Hoang Tina , Sidney Stephen , Terry James G , Pletcher Mark J , Marcus Gregory M , Hoffmann Thomas , Yaffe Kristine
Published: May 2024

Background:
Little is known about the impact of coronary artery calcium (CAC) and its progression on cognitive function in midlife, a time of importance for cognitive aging.

Methods:
In CARDIA, CAC was measured using computed tomography at years 15 (baseline), 20 and 25. CAC progression was defined as: (1) CAC>0 at follow-up among participants with baseline CAC=0; (2) an annualized change of ≥10 units at follow-up among those with 0<baseline CAC<100; or (3) an annualized percent change (annualized change in CAC score divided by baseline CAC score) ≥10% among those with baseline CAC≥100. Cognitive function was measured with Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), Stroop Interference, Montreal Cognitive Assessment (MoCA) and Verbal Fluency (Letter and Category Fluency) at year 35. We used linear regression to estimate the difference between marginal means with 95% confidence intervals (CIs) of each cognitive test by CAC score (0 vs >0) and CAC progression.

Results:
Among 2,341 participants (mean age 40.3 ± 3.6 years, 56% female, 43% Black at baseline), higher CAC score and CAC progression were associated with significantly lower cognitive performance in all cognitive tests. After adjustment for demographics, the association remained for CAC progression, compared to no progression, for most test scores: DSST (-2.70 95% CI: -4.05 to -1.36, p < 0.001), MoCA (-0.44 95% CI: -0.74 to -0.13, p = 0.005) and verbal fluency (-0.85 95% CI: -1.57 to -0.12, p = 0.02). Similar associations were observed for higher CAC score (>0 vs 0): DSST (-3.11 95% CI: -5.16 to -1.06, p = 0.003), MoCA (-0.81 95% CI: -1.28 to -0.34, p = 0.001) and RAVLT (-0.67 95% CI: -1.12 to -0.23, p = 0.003). Additional adjustment for physical activity, depressive symptoms, and APOE, and mutually for baseline CAC score and progression did not materially change the association.

Conclusions:
CAC score and progression were associated with lower cognitive function in midlife. CAC progression may be an independent risk factor for early cognitive aging, independent of baseline CAC score and other risk factors.
Abstract P338: Abdominal Myosteatosis and Cognitive Function: Insights From CARDIA Study
Authors: Acevedo-Fontanez Adrianna I , Rosano Caterina , Yaffe Kristine , Carr J Jeffrey , Terry James G , Nair Sangeeta , Cvejkus Ryan , Miljkovic Iva
Published: May 2024

Introduction:
Skeletal muscle adipose tissue infiltration (i.e. myosteatosis) increases with age and is considered a significant risk factor for cardio-metabolic diseases. Emerging data hint at its role in cognitive decline, but largely from cross-sectional studies in White populations. Longitudinal studies including Black populations, who have a higher risk of both myosteatosis and Alzheimer’s Disease and related dementias than Whites, are warranted.

Aim:
Determine the association between abdominal myosteatosis with cognitive function in a cohort of White and Black American men (n=1,095; 42.1% Black) and women (n=1,450; 49.1% Black) from the Coronary Artery Risk Development in Young Adults (CARDIA), and whether associations vary by race and sex. We included those with baseline (Year 25, 2010-11) and 5-year follow-up (Year 30, 2015-16) cognitive assessment.

Methods:
Computed Tomography measured abdominal intermuscular adipose tissue (IMAT) volume. Cognition assessed by the Digit Symbol Substitution Test (DSST). Linear regression used to assess the cross-sectional and longitudinal (Year 30-Year 25 DSST score) associations of IMAT with cognitive function after adjusting for age, sex, race, center, education, height, follow-up-time, and baseline DSST score (longitudinal models). IMAT was log-transformed, and results were standardized with effects shown per standard deviation (SD). Sex and race interactions with IMAT were statistically significant.

Results:
Overall, participants were 50.2 (3.6) years old, with a BMI of 30.2 (7.1) kg/m
2
, IMAT of 4.9 (0.6) cm
3
, DSST score of 70.6 (15.8) and 5-year change in DSST score of -2.5 (9.3). Compared to men, women had higher BMI, lower IMAT, and higher baseline DSST scores (p-values<0.001), yet a 5-year change in DSST score between sexes was not significantly different (both β=-2.5, p-value=0.94). By race, Blacks had higher BMI, lower IMAT, lower DSST score, and greater DSST score decline than Whites (-3.0 (9.3) and -2.1 (9.3), respectively) (p-values<0.05). Longitudinally, higher IMAT predicted significant DSST decline in women (5-year decrease in DSST score β=-0.68 points for 1 SD of log IMAT, p-value<0.05) but not in men (β=-0.24, p-value=0.345). By race, higher IMAT was associated with significant decline in DSST score in Whites (5-year decrease in DSST: β=-0.79 points for 1 SD of log IMAT, p-value=<0.01) but not in Blacks (β=-0.18, p-value=0.497).

Conclusions:
Abdominal myosteatosis may be a novel risk factor for cognitive decline, especially in women and Whites. Future studies using an expanded battery of cognitive tests and longer follow-ups are warranted to further advance our understanding of the novel role of myosteatosis in dementia risk.
Abstract P345: Is a Fixed Value of the Rate of Gas Exchange Appropriate to Indicate the Maximum Effort of Obese and Nonobese Adults Undergoing a Treadmill Cardiopulmonary Exercise Test?
Authors: Dourado Victor , Matheus Agatha , Barbosa Alan , Romiti Marcello , Arantes Rodolfo
Published: May 2024

Introduction:
Obese individuals present a higher O2 uptake/workload during a treadmill cardiopulmonary exercise test (CPET) in addition to chronotropic and biomechanical impairment, which preclude them, many times, from reaching a maximal rate of gas exchange (Rmax) > 1.0. Therefore, it is necessary to develop reference values for Rmax for a treadmill CPET according to age, sex, and a wide range of body mass index (BMI).

Objectives:
To establish reference values for Rmax for a treadmill CPET according to age, sex, and BMI.

Methods:
We re-examined 1,612 treadmill ramp CPETs of adults (893 women), of which 772 were obese (BMI ≥ 30 kg/m
2
). We excluded tests of nonobese participants with HRmax < 85% of predicted, of any participant with a rate of perceived exertion in the BORG scale < 4 (intense), and of those that we had operational problems during the test. We produced a Rmax percentile table according to sex, age (< 33, 34 to 46, and > 46 years), and BMI (< 30 and ≥ 30 kg/m
2
). We fit stepwise multiple regressions to investigate the influence of age, sex, BMI, and cardiovascular risk on Rmax. We also presented an obesity-specific equation to estimate maximum heart rate (HRmax).

Results:
We evaluated 442 eutrophic participants (BMI < 25 kg/m
2
), 398 were overweighted (BMI = 25 - 29.99 kg/m
2
), 295 had class 1 obesity (BMI = 30 - 34.99 kg/m
2
), 247 had class 2 obesity (BMI = 35 - 39.99 kg/m
2
) and 230 had class 3 obesity (BMI ≥ 40 kg/m
2
). Age, sex, and BMI were the main determinants of Rmax (R
2
= 0.195). The table with percentiles confirmed that the lower limits of Rmax did not reach 1.0, especially in older, obese, and female participants (Table 1). In the obese participants, we could predict HRmax as 195.2 - (0.796 x age).

Conclusions:
The Rmax values in a treadmill CPET should be chosen considering attributes such as age, sex, and BMI. Our results suggest that fixed values of Rmax are not appropriate to indicate maximum effort, especially in people with low cardiorespiratory fitness.
Abstract P363: The Influence of Social Support on Heart Disease Risk Factor Knowledge in Texas African American Women
Authors: Bratcher-Rasmus Brittny , Massey-Stokes Marilyn
Published: May 2024

Introduction:
Heart disease disproportionately impacts African American (AA) women nationwide and in Texas. Heart disease disparities stem from risk factors related to limited heart disease risk factor knowledge and socioeconomic resources. Social support mitigates chronic disease risk, yet this is the first study to examine the relationship between perceived social support and heart disease risk within this population. The study aimed to (1) examine how perceived social support impacts heart disease risk factor knowledge among AA women and (2) examine whether demographic characteristics moderate a relationship between perceived social support and heart disease knowledge.

Hypothesis:
We hypothesize that social support moderates heart disease risk factor knowledge in AA women in Texas based on demographic variables.

Methods:
This was a quantitative study with purposeful, snowball sampling representative of AA women aged 30-55 in Texas (n = 121). The participants completed a survey comprised of demographic questions, the Heart Disease Knowledge Questionnaire, and the Multidimensional Scale for Perceived Social Support.

Results:
Approximately half the participants displayed heart disease knowledge deficiencies. Multiple regression analysis revealed that when demographic variables were controlled, age (standardized β= .28, p = .002) and income (standardized β= .19, p = .037) were the only predictor variables indicating that social support impacts heart disease knowledge, with nonsignificant differences in the regression model (standardized β = -.023, p = .80). Hierarchical multiple regression revealed that age (F change = 1.056, R square change = .008, and p = .306), education (F (3, 115) = .583, p = .627), family history (F (2, 116) = 1.51, p = .225), and income (F change = 1.006, R2 change = .008, and p = .318) as individual predictors yielded nonsignificant differences in the overall predictive model, indicating that demographic variables did not moderate a relationship between social support and heart disease knowledge.

Conclusion:
Overall, the study revealed a need to implement public health education programs to increase heart health knowledge through interventions that combine education and social support among AA women to influence health behavior change and reduce heart health disparities.
Abstract P367: Regularity in Sleep and Eating Timing is Associated With Decreased Carotid Intima-Media Thickness in Healthy Young Adults
Authors: Keiser Thomas , Hoopes Elissa K , Witman Melissa A , Brewer Benjamin , D'Agata Michele N , Edwards David G , Robson Shannon M , Malone Susan , Patterson Freda
Published: May 2024

Introduction:
Greater regularity in daily sleep and eating timing are independently and separately associated with lower carotid intima-media thickness (CIMT), a marker of subclinical atherosclerotic development in early adulthood. Not known is the extent to which achieving regularity in
both
sleep
and
eating would be associated with a lower CIMT as compared to achieving regularity in either behavior alone, or neither. Such information could help identify behavioral target priorities for cardioprotective interventions.

Hypothesis:
We tested the hypothesis that individuals achieving both sleep and eating regularity would have a lower CIMT than individuals with either sleep or eating regularity, or neither.

Methods:
Healthy adults aged 18-45 years (N=65, 29.7±7.2 years, 63% female) completed 14 days of sleep and dietary assessments via wrist accelerometry and photo-assisted diet records, respectively. Mean time for sleep midpoint (midpoint time between sleep onset and offset) and caloric midpoint (time at which 50% of total daily calories are consumed), sleep regularity (i.e., a mean sleep midpoint standard deviation (SD) of <60 minutes), and eating regularity (i.e., caloric midpoint SD < median of 154 minutes) values were generated. A 4-level ‘sleep and eating regularity’ variable was generated that distinguished between participants achieving regularity in: (1) both sleep and eating, (2) only eating, (3) only sleep, or (4) neither. A linear regression model evaluating the association between sleep and eating regularity with CIMT adjusting for age, sex, systolic blood pressure, sleep duration, and total energy intake was estimated.

Results:
Participants who achieved regularity in both sleep and eating (n=23) had the lowest M
CIMT
=0.523mm (SD=0.043), those who achieved only sleep regularity (n=10) had a M
CIMT
=0.549mm (SD=0.078), only eating regularity (n=16) had a M
CIMT
=0.568mm (SD=0.065), and those achieving neither sleep or eating regularity (n=16) had the highest M
CIMT
=0.575mm (SD=0.074). In a controlled model, the 4-level sleep and eating regularity variable was significantly associated with CIMT (F=2.95, p=.04, model R
2
=.33), with regularity in both demonstrating pairwise significance as compared to neither (p = 0.02) and eating regularity only (p = 0.02). Given that a 1-SD increase in CIMT (~0.06-0.07mm) has been shown to confer a 40% increased risk for first-time CVD events in adults <45 years old, the ~0.05mm difference in CIMT between regular vs. irregular groups has clinical meaning.

Conclusions:
Regularity in sleep and eating may be associated with lower subclinical atherosclerosis as early as young adulthood. Future studies evaluating the cardioprotective effects of promoting regularity of modifiable behaviors (eating and sleep) in adults at elevated CVD risk are warranted.
Abstract P368: Differences in Perceived General Health and Health Care Utilization by Race and Ethnicity During the COVID Pandemic: The C4R-MESA Study
Authors: Ogungbe Oluwabunmi V , Tianyou Wang , Balte Pallavi , Krishnaswamy Akshaya , Slone Sarah , Meyer Diane , Hirsch Jana , Allen Norrina B , Hinckley Stukovsky Karen , Barr R. Graham , Oelsner Elizabeth , Post Wendy S
Published: May 2024

Background:
The COVID-19 pandemic reshaped individuals' lives with potential impacts on perceptions of their general health and healthcare utilization.

Objective:
Examine patterns of self-reported general health perceptions and routine healthcare utilization during the pandemic, and assess differences by race and ethnicity, in a community-based sample of US adults.

Methods:
The Multi-Ethnic Study of Atherosclerosis (MESA) assessed the impact of the pandemic on participants via questionnaires designed by the Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study. For the question, “How does your general health compare to before the pandemic?”, responses of “worse” were compared to “about the same” or “better.” For the question, “Since March 2020, did you have to delay or miss out on any healthcare services?”; “yes” responses were compared to “no.” Associations with race and ethnicity were tested using logistic regression models, adjusting for covariates.

Results:
Of 1929 MESA participants (age 75±8 years; 55% female; 40% White; 23% Hispanic; 22% Black; 15% Chinese), worse general health during the pandemic was reported by 15% of participants and 32% reported missed or delayed healthcare services. Race and ethnicity were not associated with worse general health (
Table
). Black (vs White) participants were less likely to report having missed or delayed healthcare (aOR:0.56;95%CI:0.37-0.84). There were no significant differences in missed or delayed healthcare for Chinese and Hispanic participants compared to White participants.

Conclusion:
These findings suggest that 1 in 7 adults experienced worsening general health and 1 in 3 missed or delayed healthcare during the pandemic. However, race and ethnicity were not associated with perceived general health and associations with missed/delayed healthcare were limited. Longer-term effects of the pandemic on general health and utilization, and related health disparities, are being evaluated in this prospective cohort.
Abstract P373: Psychosocial Risk and Resilience Profile in Rural Alabama: A Preliminary Analysis of Risk Underlying Rural Areas Longitudinal (RURAL) Study
Authors: Benjamin Larissa , Broyles Stephanie , Vasan Ramachandran S , Vaccarino Viola , Lewis Tene T , Mujahid Mahasin S
Published: May 2024

Background:
Given the disproportionate burden of cardiovascular disease risk and outcomes, there is an urgent need to understand the psychosocial drivers of these inequities. We characterized the psychosocial risk and resilience profiles of a cohort of rural-dwelling adults in the southeast U.S.

Methods:
This preliminary analysis includes 765 participants with complete covariate data (mean age 47.9 (SD=10.9), 70.7% self-reporting as women, 77.9% Black individuals, 41.4% with annual household income below $15,000; 43.7% possessing a high school diploma/GED or lower) residing in two rural counties in Alabama, part of the larger RURAL study. We evaluated participants across six crucial psychosocial domains: financial strain (continuous), financial adjustments (categorized as 0, 1-3, 4+), housing stability (tertiles), childhood adversity (including general, physical, and emotional trauma experienced before 18 years, categorized into tertiles), depression (measured using CES-D 16; yes/no), and resilience (measured using CD-RISC, categorized into tertiles). We examined the distribution of study outcomes and conducted race and sex-based comparisons.

Results:
Resilience was high overall and did not vary significantly by race or sex. Significant racial disparities were observed, with Black participants experiencing higher financial strain (mean: 2.84 Black vs. 2.34 White), housing instability (30.1% Black vs. 11.9% White), and elevated depressive symptoms (35.2% Black vs. 25.3% White). Conversely, White participants reported greater general trauma and depression (highest tertile: 17.8% Black, 23.8 % White for general trauma; 64.3% Black vs. 73.8% White for depression). Sex-based differences were statistically insignificant across most psychosocial factors, except for financial adjustments (highest tertile: 27.7% men vs. 36.0% women) and physical trauma (38.0% men vs. 22.0% women). When considering the intersection of race and sex, Black men had the highest prevalence of housing instability (highest tertile: 35.2% Black men, 27.8% Black women, 6.8% White men, 15.8% White women), and elevated depressive symptoms (35.8% Black men, 35% Black women, 15.3 % White men, 31.6% White women). White men had the highest prevalence of physical trauma (highest tertile: 35.8% Black men, 21.3% Black women, 44.1% White men, 25.3% White women), and White women had the highest prevalence of financial adjustments (highest tertile: 30.3% Black men, 33.9% Black women, 20.3% White men, 46.3% White women).

Conclusion:
Our preliminary analysis of the RURAL study underscores substantial psychosocial adversity in these Southern rural communities. Future investigations should explore the relationship between these psychosocial factors and CVD risk to help identify potential intervention targets to improve cardiovascular health in rural communities.
Abstract P389: Prevalence, Awareness, Treatment, and Control of Major Cardiovascular Risk Factors in Rural Alabama
Authors: Pool Lindsay R , Durda Peter , Judd Suzanne E , Vasan Ramachandran
Published: May 2024

Background:
CVD rates are high across the rural southern United States, but less is known about risk factor prevalence and control. Using data from two rural Alabama counties, we measured the prevalence, awareness, treatment, and control of hypertension, high cholesterol, and diabetes.

Methods:
The Risk Underlying Areas Longitudinal (RURAL) Heart and Lung Study began in 2021 to assess cardiopulmonary risk across 10 rural southern US counties. This analysis used data from two Alabama counties (N=942), 70% women, 79% non-Hispanic Black individuals, mean age 48.7 years. Hypertension was defined as SBP≥130 mmHg, DBP≥80 mmHg, and/or self-reporting hypertension medication use. High cholesterol was defined as TC≥200 mg/dL and/or cholesterol medication use. Diabetes was defined as fasting glucose≥126 mg/dL, non-fasting glucose>200 mg/dL, and/or diabetes medication use. Awareness, treatment, and control were assessed via self-reported physician diagnoses and medication use. All analyses applied sampling weights to produce representative estimates.

Results:
In the RURAL Alabama sample, the prevalence of hypertension was 73.7%, high cholesterol was 59.5%, and diabetes was 25.4%. The majority of individuals were aware of and taking medication for these risk factor conditions, but one-quarter of hypertension and less than half of diabetes was controlled (Figure). There were no significant sex differences observed. As compared with white individuals, Black individuals had a significantly higher prevalence of hypertension (79.2% vs 61.9%, p<0.001) and diabetes (29.9% vs 17.0%, p=0.005); however, there were no significant racial differences in risk factor control.

Conclusion:
There was a high prevalence of CVD risk factors in rural Alabama, with Black-white racial disparities for hypertension and diabetes, and control was low. This underscores the need for primary prevention of risk factors in the rural south and elucidating factors contributing to ‘treatment-control’ gaps for managing hypertension and diabetes.
Abstract P399: Cardiovascular Risk Factors and Measures of Early Atherosclerosis in Children With Down Syndrome
Authors: Ware Adam , De Ferranti Sarah D , Keenan Heather , Lambert Linda M , Ou Zhining , Urbina Elaine M , Williams Richard V , McCrindle Brian W
Published: May 2024

Background:
Children with Down syndrome (DS) have unique cardiovascular (CV) risk profiles compared to the general population. Early markers of atherosclerosis can be measured and are associated with CV risk factors, although limited data are available for children with DS.

Methods:
A multicenter, cross-sectional study of children with DS between 8-18 years. CV risks assessed: BMI, blood pressure, diet, activity, smoke exposure, congenital heart disease, hypothyroid, cancer, apnea, family history of early coronary disease, lipids, lipoprotein subfractions, glucose, insulin, and HS-CRP. Vascular testing included pulse wave velocity (PWV) and carotid intimal medial thickness (CIMT). Prevalence of categorical CV risks were compared to population prevalence from NHANES data using Fisher’s exact or chi squared. Vascular measures were converted to Z scores using height and compared to population means with single sample t test, and linear regression evaluating associations between CV risks and vascular measures.

Results:
A total of 55 children with DS participated, 28 (51%) female, mean age 14.3 years (range 8.1-18.9). Compared to NHANES, DS children were more likely to have triglycerides >90 mg/dL (63% DS vs. 10% NHANES, p=<0.001) and non-HDL-cholesterol >120 mg/dL (54% DS vs. 22% NHANES, p = <0.001). PWV and CIMT Z scores were not significantly different from general population with mean (SD) of -0.1 (1.0) and 0.27 (1.5), respectively. Univariable analysis for PWV showed significant associations with systolic blood pressure [coefficient (95% CI): 0.04 (0.02, 0.06)] and smoke exposure [1.70 (0.35, 3.05)]. No associations were found for CIMT. Multivariable models are shown in Table 1. PWV was associated with BMI percentile and smoke exposure. No associations were found for CIMT.

Conclusion:
Children with DS had higher rates of lipid abnormalities compared to the general population. Lipid abnormalities were not associated with CIMT or PWV, and vascular measures adjusted for height were similar to children without DS.
Abstract P402: Association of an Overall Healthy Lifestyle With Different Types of Metabolic Dysfunction-Associated Fatty Liver Disease
Authors: Yuan Caimei , Zong Geng , Feng Chengwu
Published: May 2024

Background & Aims:
Metabolic dysfunction-associated fatty liver disease (MAFLD) affects up to one-third of the global population and increases the risk of cardiometabolic disease. Since no approved pharmacotherapy for MAFLD is available, lifestyle modification remains the cornerstone of clinical care. Our study aims to evaluate the association of an overall healthy lifestyle with different types of MAFLD.

Methods:
We conducted a prospective analysis of 15,721 participants from UK biobank. An overall healthy lifestyle including six evidence-based lifestyles (diet, alcohol consumption, physical activity, sedentary behavior, sleep, and smoking) was assessed by questionnaires. MALFD and its typing were diagnosed by blood biochemistry, ICD codes, and medication information from touchscreen and verbal interview. The risk ratios (RRs) were estimated by Poisson regression models with robust variance.

Results:
During a median follow-up of 4.4 years, 5,522 participants had MAFLD diagnosed. Compared with those with zero to two healthy lifestyles, the RRs (95% CIs) of those with six healthy lifestyles were 0.41 (0.36 to 0.47) for MAFLD; 0.41 (0.35 to 0.46) for MAFLD-overweight/obesity (MAFLD-O), 0.27 (0.12 to 0.60) for MAFLD-lean/normal weight and metabolic dysfunction (MAFLD-L), 0.17 (0.11 to 0.26) for MAFLD-type 2 diabetes mellitus(MAFLD-T2D) (P-value for heterogeneity < 0.001); and the RRs (95% CIs) of those with five healthy lifestyles were 0.53 (0.49 to 0.58) for single etiology MAFLD (MAFLD-single) and 0.23 (0.10 to 0.55) for dual (or more) etiology fatty liver disease (MAFLD-dual) (P-value for heterogeneity = 0.08). For one additional point in the overall healthy lifestyle, the RR (95% CI) was 0.83 (0.81 to 0.85) for MAFLD, and 0.83 (0.81 to 0.85) for MAFLD-O, 0.71 (0.62 to 0.81) for MAFLD-L, and 0.68 (0.64 to 0.72) for MAFLD-T2D (P-value for heterogeneity < 0.001); and 0.83 (0.81 to 0.85) for MAFLD-dual and 0.70 (0.58 to 0.85) for MAFLD-single (P-value for heterogeneity = 0.08). Meanwhile, significant differences in the correlations of individual lifestyles with subtypes of MAFLD were discovered for sufficient physical activity, low sedentary time, adequate sleep, and never smoking, and with different etiology MAFLD were discovered for low sedentary time.

Conclusions:
An overall healthy lifestyle that includes six evidence-based factors were strongly associated with lower MAFLD risk, especially MAFLD-L and MAFLD-dual. Our findings support the potential benefits of an integrated healthy lifestyle for MAFLD management and suggest differences in the impact of lifestyle on different types of MAFLD but warrant confirmation by well-designed prospective studies and clinical trials.
Abstract P405: Calibrating Routine Blood Pressures Among Preterm Infants: A Retrospective, Cross-Sectional Analysis
Authors: Loop Matthew S , Park Jieun
Published: May 2024

Background:
Among preterm infants (< 12 months postnatal age and born < 37 weeks gestation), oscillometric systolic blood pressure (SBP) measurements are error-prone. However, some preterm infants have “gold standard” SBPs measured using an arterial line, in addition to the error-prone oscillometric SBPs.

Objective:
To compare different statistical methods to calibrate oscillometric SBPs to mimic arterial line SBPs

Methods:
We sampled participants from an existing pilot study of preterm infants treated with an antihypertensive therapy at the University of Alabama at Birmingham. Participants' data was obtained from the hospital's data warehouse for electronic medical records. Participants for this analysis had at least one arterial line SBP measurement, and for each of these "gold standard" measurements we identified the closest paired oscillometric SBP measurement (<10 minutes apart). We also collected participant factors such as race (white vs. black/African American), gender, gestational age at birth (weeks), postnatal age at arterial line SBP measurement (weeks), and whether the participant had received an antihypertensive medication. We predicted the arterial line SBPs from oscillometric SBPs and covariates using linear regression, linear regression with restricted cubic splines, random forest, and Bayesian additive regression trees (BART). Prediction errors were calculated using 10-fold cross-validation. We used complete case analysis.

Results:
We identified 822 measurements among 28 participants. Ten of 28 (36%) participants were black and 13 of 28 (46%) were female. The median (Q1, Q3) gestational age at birth was 33 (29, 35) weeks. The root mean squared error for predicting arterial line SBP from oscillometric SBP by itself was 17.1 mmHg. The root mean squared error of the predicted arterial line SPBs from different statistical methods varied little from the most error (linear regression with restricted cubic splines: 13.5 mmHg) to the least error (BART: 12.6 mmHg), meaning that any calibration resulted in at least a 21% reduction in error compared to the oscillometric SBPs. BART tended to underpredict the arterial line SBPs that were above 100 mmHg.

Conclusions:
Among preterm infants, statistical calibration is a viable strategy for reducing the variability of error-prone oscillometric SBPs. The different statistical models performed similarly in this small pilot study, but a larger sample size using additional important variables (e.g., birth weight) is required to confirm this finding.
Abstract P412: Exploration of Eating Disorder Behaviors in Adolescent Girls Engaged in a Cardiovascular Risk Assessment Study
Authors: Zeichner Elizabeth H , Jergel Andrew , Karim Brianna , Peters Kourtney , Gooding Holly C
Published: May 2024

Introduction:
Cardiovascular disease risk factors and eating disorders are both common in young women. There is scant research regarding eating disorder behaviors within the context of cardiovascular health interventions focused on nutrition, physical activity, and weight reduction. This project explored eating disorder behaviors while developing a cardiovascular health promotion tool for young women.

Methods:
We used an exploratory sequential mixed-methods approach. We interviewed 10 young women about an existing adult cardiovascular risk assessment tool. Three independent coders analyzed the interview data for themes pertaining to weight, food, exercise, and eating disorder behaviors. We used this qualitative data to inform modifications to the adult tool and create the new tool, HerHeart, focusing on teen-friendly language that deprioritized feedback surrounding weight. We then recruited 60 young women ages 13-21 years to complete HerHeart during a clinical visit; 12 participants returned for a three-month follow-up visit. Participants completed the Eating Disorder Diagnostic Scale (EDDS; score ranges from 0-128) at the baseline and follow-up visits.

Hypothesis:
We hypothesized that there would be no deterioration in EDDS scores over the intervention phase of HerHeart.

Results:
We identified themes in interviews, such as the importance of word choice when discussing weight (“words can hurt […] especially if you're overweight”, "when you're telling somebody they [are] obese, I feel like [you] should word it differently”), influences on body image and dieting (“some people see people who are […] very fit and they're like, okay, I'm going to starve myself”), and emotional eating (“I shouldn’t be eating this much because I am emotional eater […] When I do get sad […] I mostly eat”). At baseline, one participant met criteria for binge eating disorder and one met criteria for night eating syndrome. At follow-up, a separate individual met criteria for night eating syndrome. The median EDDS composite score for these 12 participants changed from 19 (IQR 10.5, 24) to 21 (IQR 10.5, 26).

Conclusion:
In conclusion, there was no significant change in EDDS composite score for young adult participants in a cardiovascular health intervention; very few participants met criteria for eating disorders. This emphasizes the importance of thoughtful language surrounding weight, eating habits, and body image in interventions involving adolescents.