bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P325: Effectiveness of the First Outpatient Pritikin Intensive Cardiac Rehabilitation (ICR) Program
Authors: Williams Dominique , Mulkareddy Vinaya , Montgomery Kristin , Carpenter Taylor , Soares Andrea , Graham Christopher , McKenzie Kristin , Rashdi Serene , de las Fuentes Lisa , Rich Mike , Racette Susan , Peterson Linda
Published: March 2019

Introduction:
ICR has been used for the treatment of patients recovering from a myocardial infarction, cardiac surgery, percutaneous intervention, and/or stable angina. Pritikin ICR is a comprehensive program whereby patients follow a structured diet and exercise program. The first outpatient Pritikin ICR program was implemented at Barnes-Jewish Hospital/Washington University School of Medicine. While patients domiciled at the Pritikin Longevity Center show marked improvements in several cardiovascular disease (CVD) risk factors, the effects of the outpatient Pritikin ICR program are unknown.

Hypothesis:
Patients who complete 24 sessions of the outpatient Pritikin ICR program will have improvements in several clinically important CVD risk factors, including body mass index (BMI, primary endpoint), adiposity, lipid profiles, and cardiorespiratory fitness.

Methods:
This observational study of the outpatient Pritikin ICR program was conducted as part of routine clinical care. Patients referred for ICR since 1/1/2017 were invited to participate in assessments at baseline and after completing 24 sessions. ICR was comprised of monitored exercise sessions plus Pritikin education sessions focusing on dietary changes (low-fat, low-sodium, high-fiber foods) and stress management through a series of videos, cooking classes, and workshops. Body composition was assessed using bioelectrical impedance. Fitness was estimated with the 6-minute walk test. Hand grip strength was assessed by dynamometry.

Results:
140 ICR patients (28% women; age 68 ± 9 y, mean ± SD) completed baseline and visit 24 assessments over an average of 9.9 weeks. Significant improvements (
P
<0.001) were observed for BMI (pre 31.0 ± 6.2, post 30.5 ± 6.0 kg/m
2
), weight (mean ± SD, -1.6 ± 3.0 kg), whole-body fat % (-1.2 ± 2.5), trunk fat % (-1.7 ± 3.3), 6-min walk distance (+37.6 ± 53.6 m), and hand grip strength (+1.22 ± 3.42 kg). Improvements also were observed for waist circumference, total cholesterol, and LDL cholesterol (
P
<0.05).

Conclusion:
An outpatient Pritikin ICR program results in significant cardiovascular benefits by reducing adiposity, improving lipid profiles, and enhancing exercise capacity. These favorable results should lead to fewer cardiovascular events.
Abstract P333: The Association of Sedentary Time in Obese Adolescents With Asthma
Authors: Hartz Jacob , Bucholz Emily M , Powell-Wiley Tiffany , de Ferranti Sarah
Published: March 2019

Introduction:
Over the past two decades, both asthma and obesity have increased in prevalence. Evidence suggests that the contemporaneous increase in asthma and obesity may not be coincidental, and that obesity may predispose a person to developing asthma. The mechanism for this relationship is unknown, but persistent, low-grade inflammation may be a key driver. As previous research suggests that increased amounts of sedentary time can lead to inflammation, we examined whether sedentary time was associated with asthma in adolescents with obesity.

Methods:
Using NHANES 2003-2006, we evaluated the average number of minutes of daily sedentary time and number of breaks in sedentary time in youth age 6-19 years old with obesity, defined as a body mass index (BMI) ≥95
th
percentile, with and without asthma. We compared demographic variables, self-reported categories of sedentary time, and objectively measured sedentary time and breaks in sedentary time using an accelerometer. We used multivariate logistic regression analysis to determine associations between the risk of asthma in obese adolescents controlling for accelerometer wear time, gender, age, poverty-to-income ratio, C-reactive protein (CRP) as a marker of inflammation, and tobacco smoke exposure.

Results:
We found that among sample of adolescents with obesity, 13.2% had asthma. Objective measures of sedentary time did not differ between obese patients with and without asthma nor did CRP (
Table 1)
. However, self-reported computer time was significantly higher in obese adolescents without asthma.

Conclusions:
As in our study, previous studies suggest that sedentary time classified as computer time may not increase the risk of cardiovascular disease as much as sedentary time spent watching television.
Abstract P358: Association of Antidepressant Medication Type With the Incidence of Cardiovascular Disease in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Almuwaqqat Zakaria , Jokhadar Maan , Norby Faye , Lutsey Pamela , O’Neal Wesley T , Seyerle Amanda , Soliman Elsayed Z , Chen Lin Y , Bremner Douglas J , Vaccarino Viola , Shah Amit J , Alonso Alvaro
Published: March 2019

Background:
Although antidepressant medications (ADM) are effective in treating depression, a well-established cardiovascular risk factor, they are associated with autonomic dysfunction, also linked to the future risk of cardiovascular disease (CVD). It is unclear if a certain type of ADM’s is associated with less CVD risk than others. We hypothesized that selective serotonin reuptake inhibitors (SSRI) are associated with reduced hazards of atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI) and ischemic stroke (IS) as compared to non-SSRI ADM’s.

Methods:
We studied 2027 participants from the Atherosclerosis Risk in Communities (ARIC) Study (mean age 63 ± 10 years; 29% men; 78% white) who self-reported ADM use during at least one of the five study visits (1987 through 2013). Participants were classified as SSRI users (47%) vs non-SSRI users (53%). Those who never used ADM’s were excluded due to the concern of unmeasured confounding by their underlying depression. CVD events were adjudicated based on hospital records, participant and physician interviews, and death certificates, using validated criteria. Cox regression adjusted for sociodemographic and clinical variables (sex, age, race, center, level of education, cigarette smoking, alcohol use, BMI, use of antihypertensive medications, diabetes, systolic blood pressure, diastolic blood pressure, aspirin, and calendar year of AD initiation) were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) of CVD by type of ADM.

Results:
Participants were followed up from ADM initiation up to 2016 for a median of 13.5 years. In this sample we identified a total of 329 AF events, 366 HF events, 198 MI events and 134 IS events. In multivariable Cox regression models, SSRI use was not significantly associated with hazards of AF, HF, MI and IS, when compared to non-SSRI ADMs (HR= 1.11, 95%CI 0.88-1.40 for AF; HR= 0.93, 95%CI 0.72-1.20 for HF; HR= 0.91, 95%CI, 0.65-1.27 for MI; and HR= 1.02, 95%CI 0.67-1.56 for IS).

Conclusion:
In a community-based sample of individuals using ADM’s, ADM class (SSRI vs non-SSRI) was not associated with significantly different risk of incident CVD. These results do not provide evidence supporting the use of a particular ADM over another in relation to CVD risk.
Abstract P360: Blunted Hemodynamic Response to Acute Mental Stress Among African Americans With Coronary Heart Disease
Authors: Hardy Shakia T , Sullivan Samaah , Hammadah Muhammad , Elon Lisa , Li Lian , Bremner J. Douglas , Quyyumi Arshed , Vaccarino Viola
Published: March 2019

Introduction:
Racial differences in cardiovascular disease morbidity and mortality are well established by middle age with African Americans contributing to higher rates of cardiovascular disease. In addition to traditional risk factors, African Americans experience greater exposure to stressful life events. Both an enhanced and a blunted hemodynamic reactivity to acute psychological stress have been associated with worse cardiovascular health status and may contribute to these disparities.

Methods:
We studied 920 patients with stable coronary artery disease (CAD) and 109 controls without CAD. Systolic blood pressure (SBP), heart rate (HR), and rate-pressure product (RPP) were measured prior to, and following a public speaking stress task. We examined the association between race and hemodynamic reactivity to stress using mixed linear regression models adjusting for cardiovascular disease severity, medication usage and psychosocial, demographic and lifestyle factors.

Results:
Of the 920 patients (mean age 59 years), 39% were African American. African Americans had a more adverse socioeconomic and cardiometabolic profile (hypertension, diabetes, and body mass index) compared to white Americans. In response to mental stress, African American patients exhibited a lower increase in SBP (23 vs 27 mmHg; p <.0001), HR (11 vs 13 beats/minute; p =0.008) and RPP (3205 vs 3718 mmHg x beat/min; p =0.004) compared to white Americans, after adjusting for demographics, lifestyle and medical risk factors. Among controls (41% African American), there were no significant differences in hemodynamic reactivity to mental stress by race, and among CAD patients, there were also no differences in the hemodynamic reactivity to an exercise stress test by race.

Conclusions:
African Americans with CAD exhibit a blunted hemodynamic response to mental stress compared to white Americans. Further research is needed to clarify the determinants of such differences and whether they contribute to race disparities in cardiovascular disease risk.
Abstract P363: Cardiovascular Health as a Mediator of Psychosocial Influences on CVD
Authors: Singh Sarah S , Frisbee Stephanie J
Published: March 2019

Background:
Negative psychosocial factors, such as high stress and poor social support, are strongly associated with disease outcomes, including CVD. Conceptually, it is plausible that better cardiovascular health (CVH) may blunt the association between psychosocial factors and incident CVD. However, few studies have investigated whether CVH, which includes biological and behavioral factors, is a potential pathway between psychosocial factors and CVD.

Objective:
To investigate whether the association between CVD and psychosocial factors is fully or partially mediated by CVH.

Setting:
This study was carried out in a nationally representative sample of Canadian adults aged 20 years and older.

Data and Methods:
This study is a cross-sectional design using data from the Canadian Community Health Survey (CCHS) 2015-2016 database. The CCHS is a nationwide, nationally representative survey that collects information on the health status, health care utilization and health determinants of the Canadian population. The study outcome was CVD, as measured by the self-reported presence of physician-diagnosed heart disease. The potential mediator was individual CVH, defined using the AHA CVH Index (CVHI) and determined using self-reported responses in CCHS. Psychosocial factors included self-reported responses to questions on life stress, work stress, sleep, social support and alcohol and drug use. A structural equation modeling (SEM) approach was then used to explore the mediational role of CVH in the association of CVD with psychosocial factors. Analyses were conducted in MPlus Version 8 software.

Results:
The majority of the population were males (51%), aged 40-60 (37%), with tertiary education (64%) and of the White race (79%). Overall, the mean CVH of the population was 4.5. Results suggested that CVH and all psychosocial factors, except for life stress predicted, CVD. Additionally, all psychosocial factors, except for life stress and drug use, predicted CVH. Standardized coefficients demonstrated that, of all psychosocial factors, work stress had the highest impact on both CVH (std coeff -0.22, p<0.001) and CVD (std coeff -0.07, p<0.0001). Further analyses demonstrated that CVHI partially mediated the association between CVD and work stress (std coeff -0.02, p<0.001), sleep (std coeff -0.002, p<0.001), alcohol use (std coeff -0.009, p<0.001) and social support (std coeff -0.001, p=0.003). None of the associations were fully mediated by CVH.

Conclusion:
Results indicated that the association between psychosocial factors and CVD was partially mediated by CVH. That is, while better CVH weakened the association between psychosocial factors and CVD, the direct association between psychosocial factors and CVD remained. Further analyses should investigate whether accounting for individual characteristics such as age, sex and race may reveal full mediation through CVH.
Abstract P365: Restless Leg Symptoms Predicts Adverse Cardiovascular Outcomes in Patients Undergoing Cardiac Catheterization
Authors: Kim Jeong Hwan , Ali Syed , Dong Tiffany , Samman Tahhan Ayman , Ko Yi-An , Hayek Salim , Alkhoder Ayman , Martini Afif , Gafeer Mohamad M , Sidoti Arianna , Khan Ahsan , Zaheer Eesha A , Lemma Martha , Choudhary Fahad , Choudhary Muaaz , Delawalla Shahla , Bliwise Donald , Quyyumi Arshed A
Published: March 2019

Introduction:
The association between restless leg syndrome (RLS) and CV outcomes remains controversial in the general population, and the impact of RLS among patients with coronary artery disease (CAD) is unknown.

Hypothesis:
We examined our hypothesis that RLS symptoms would be associated with incident adverse CV outcomes in patients with CAD.

Methods:
We inquired about the presence and frequency of RLS symptoms in 3,176 patients enrolled in the Emory Cardiovascular Biobank (mean age 64, 62% male, 23% Black, and 75% with obstructive CAD), who were prospectively followed for death, myocardial infarction (MI), revascularization, and hospitalization for heart failure (HF). Multivariate Cox proportional hazard models were used to examine the association between RLS symptoms and adverse outcomes after adjustment for demographic and clinical risk factors.

Results:
Of the total, 914 (28.8%) and 482 (15.2%) patients reported mild (rare or sometimes) and moderate/severe (often to almost always) symptoms of RLS, respectively. Female sex (Odds ratio [OR] 2.11, P<0.001), higher body mass index (OR 1.12 per 5kg/m2, P=0.007), diabetes (OR 1.43, P=0.003), and beta blocker use (OR 1.35, P=0.013) were independently associated with moderate-severe symptoms of RLS compared to no symptoms. During a median 3.2-year follow-up, 991 patients suffered at least1 adverse event. Those with moderate/severe symptoms had significantly higher adjusted risk of death/MI (Hazard ratio [HR] 1.30 [1.02 - 1.66]), death/MI/revascularization (HR 1.22 [1.02 - 1.45]), and death/MI/revascularization/hospitalization for HF (HR 1.23 [1.04 - 1.45]). Those with mild symptoms had similar risks to those with no symptoms.

Conclusions:
Among patients undergoing cardiac catheterization, moderate or severe symptoms of RLS are associated with significantly higher risk of adverse CV outcomes, independent of traditional risk factors. This is the first study to demonstrate an independent adverse impact of RLS symptoms in CAD patients.
Abstract P367: Application of Hierarchical Cluster Analysis on Five Risk Factors Scores (RFS) to Estimate Individual Patient Risk in Case Where There is No Official Country Specific RFS: Example From Bosnia and Herzegovina
Authors: Ademovic Enisa , Saxena Anshul , Cavaljuga Semra , Veledar Emir
Published: March 2019

Objective:
The accuracy and applicability of various cardiovascular disease (CVD) risk calculators may not be same in different populations. Wecompared 5 RFS for CVD risk on patients from Bosnia and Herzegovina to explore relations between different RFS and estimate use of theircombination.

Methods:
We utilized demographic, medical history, and lipid profile data gathered from patients seen in primary care clinic in 2013. FiveRFS namely, 10 year Framingham CHD score, QRISK 2, AHA/ACC ASCVD risk score, Framingham ATP III score, and EU SCORE were calculatedusing demographic, history of diabetes and hypertension, taking any hypertension medication, and lipid profile variables. Additionally, we entered these scores as dimensions in hierarchical cluster analysis to group people based on their risk of developing CVD.

Results:
There were 1277 patients in thisstudy and majority (65%) were women. The mean (SD) age of the sample was 56.2 (11.4) years. Correlation between these scores are presented inTable 1. We obtained 4 clusters with significant different cluster centers. Clusters were ordered from lowest to highest risk; cluster 1 containing patients with lowest and cluster 4 with highest mean RFS. Cluster centers, which represents mean values for all the RFS are given in Table 2.

Conclusion:
All risk scores performed well in this population. Only EU SCORE correlated less with other RFS. Obtained clusters are more homogenous and were ableto classify patients better. This novel method of using calculated RFCs as dimensions in clustering produced very good estimates of patient’s risk ofdeveloping CVD by combining several RFS, even in a case where originally RFS were created for and from different population.
Abstract P372: Association of Cardiovascular Disease Family History With Major Cardiovascular Risk Factors in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Hutten Christina G , Sachdeva Shruti , Scannell Bryan Molly , Durazo-Arvizu Ramon A , Perreira Krista M , Talavera Gregory A , Gallo Linda C , Castaneda Sheila F , Ostfeld Robert J , Smoller Sylvia , Llabre Maria M , Schneiderman Neil , Lash James P , Daviglus Martha L , Argos Maria
Published: March 2019

Introduction:
Family history (FH) is a well-known risk factor for cardiovascular disease (CVD); however, the association of FH with CVD in Hispanic/Latino populations has not been well investigated. We examined the cross-sectional association of FH of CVD or CVD risk factors with individual CVD risk factors (hypertension, hypercholesterolemia, obesity, diabetes mellitus, and smoking), CVD risk profile, and prevalence of CHD or stroke in the HCHS/SOL.

Methods:
Baseline data on FH and CVD risk factors from 15,104 HCHS/SOL participants were analyzed. Self-reported first-degree FH of high blood pressure (BP), high cholesterol, diabetes, angina, heart attack, heart failure, rheumatic heart disease, angioplasty/bypass, stroke, aortic aneurysm, and peripheral artery disease was ascertained and categorized as any first-degree FH vs. no FH of each condition. Hypertension, high cholesterol, obesity and diabetes mellitus were ascertained by objective measures and/or medication use; smoking was self-reported. The CVD risk profile was calculated by assigning a score of 0 to 5 based on the number of adverse CVD risk factors. Analysis of CVD risk factors was dichotomized as low (0 and 1 risk factor) vs. high (2+ risk factors). Odds ratios and 95% confidence intervals were derived from logistic regression models, accounting for the complex study design and controlling for multiple covariates.

Results:
Prevalence of CVD risk factors and risk profile were associated with self-reported FH (see Table). Furthermore, prevalence of CHD was associated with FH of high BP, high cholesterol, diabetes, angina, heart attack, heart failure, and rheumatic heart disease. Personal history of stroke was associated with FH of high BP, angina, and aortic aneurysm.

Conclusions:
First-degree FH of CVD factors and diseases was associated with hypertension, high cholesterol, obesity, diabetes, CHD and stroke among Hispanics/Latinos in HCHS/SOL. Ascertainment of FH should be an integral part of CVD risk assessment in Hispanics/Latinos in the US.
Abstract P373: Estimation of Atherosclerotic Cardiovascular Disease Risk in Veterans
Authors: Djousse Luc , Vassy Jason L , Gagnon David R , Lu Bing , Ho Yuk-Lam , Costa Lauren , Gaziano J. M , Cho Kelly , Wilson Peter W
Published: March 2019

There are concerns that 2013 ACC/AHA ASCVD pooled risk prediction models are not accurate predictors in contemporary American patient populations, and that these models do not take into account the highly prevalent use of statin therapy or the effects of statins on vascular disease prevention. Using validated phenotyping algorithms, we evaluated the accuracy of the pooled risk model for the development of Hard ASCVD in 1.42 million Veterans (4.3% women, 16.6% black) with mean age 60 years (range 40-79 years) at baseline VA outpatient clinic evaluations in 2002-2004. There were 93,250 Hard ASCVD events over a mean of 8.4 years of follow up. We estimated Hard ASCVD risk using traditional variables (age, sex, race, total cholesterol, HDL cholesterol, diabetes mellitus, systolic blood pressure, blood pressure treatment, and smoking history) employed in the 2013 ACC/ACC ASCVD risk report. Three analytic approaches were undertaken, using 1) published 2013 ACC/AHA prediction equations, 2) 2013 ACC/AHA variables to fit VA-specific Cox regression models for white men, black men, white women, and black women, and 3) model 2 plus baseline statin use. The Harrell’s c-statistics for the models are shown in the table along with the hazard ratios for statins from model 3. Traditional predictor variables were generally statistically significant in all models, and model 1 over predicted absolute risk of Hard ASCVD in VA by approximately 6%, and statin use was associated with up to an 18% reduction in ASCVD risk. In conclusion, these results demonstrate that the pooled ASCVD prediction model performs relatively well in the VA setting, as shown by relatively good c-statistics. The 2013 ACC/AHA over predicted ASCVD risk and statin therapy at baseline was an important determinant of outcomes.
Abstract P382: Association of Passive Smoking Status to Endothelial Vascular Function Among General Japanese Women
Authors: Kadota Aya , Kondo Keiko , Hisamatsu Takashi , Miyazawa Itsuko , Fujiyoshi Akira , Ueshima Hirotsugu , Miura Katsuyuki
Published: March 2019

Objective:
Passive smoking was reported to impair endothelial vascular function in an acute phase. However, studies regarding the vascular effect of passive smoking status among general population are still scarce. We investigated the association of passive smoking status to endothelial vascular function among general Japanese women.

Methods:
Study participants were 243 Japanese women who had never smoked, and aged 69 to 85 years randomly selected from Kusatsu City, Japan. Using self-administered questionnaire, passive smoking status and passive smoking hour per week at recent 1 year and those of 20 years ago were obtained. They were classified into 4 groups (never, past, current; <2 hours/week, ≥2 hours/week). Endothelial vascular function was assessed with reactive hyperemia index (RHI) using Endo-PAT2000 (itamar-medical). RHI ≤1.67 were defined as low RHI. Age adjusted means of RHI according to passive smoking status was estimated. Simple liner regression analysis tested the association between RHI and traditional atherosclerotic risk factors such as age, body mass index (BMI), systolic and diastolic blood pressure, heart rate, lipids, fasting blood glucose and hemoglobin A1c. Age and multivariable adjusted odd’s ratios and 95% confidence intervals (OR, 95%CI) of passive smoking status for low RHI were estimated using logistic regression. Variables which showed statistical significant association to RHI in simple liner regression were adjusted.

Results:
Distribution of passive smoking status was; never 42.4%, past 42.0%, current <2 hours/week 6.5%, ≥2 hours/week 9.1%. Low RHI was confirmed in 41.2% of study participants. Age adjusted means of RHI did not differ significantly by smoking status (Age adjusted mean ± SD of RHI; never 1.94 ± 0.06, past 1.88 ± 0.06, current <2 hours/week 1.85 ± 0.15, ≥2 hours/week 2.15 ± 0.13, p=0.270). In simple liner regression analysis, BMI, diastolic blood pressure, heart rate and fasting glucose showed statistical significant association to RHI, and these variables were adjusted in multivariable adjusted logistic regression model. In logistic regression analyses, significant association of passive smoking status to low RHI was not confirmed [Age adjusted OR (95%CI); never (reference), past 1.00 (0.57-1.75), current <2 hours/week 1.45 (0.50-4.23), ≥2 hours/week 0.66 (0.25-1.76), multivariable adjusted OR (95%CI); never (reference), past 1.02 (0.57-1.82), current <2 hours/week 1.72 (0.57-5.21), ≥2 hours/week 0.61 (0.22-1.73)].

Conclusion:
Passive smoking status was not associated to endothelial vascular function assessed with RHI among general Japanese women. Further investigation is still required.
Abstract P388: Socioeconomic and Demographic Status and Perceived Health Risk of E-cigarettes Among Youth--Results From a National Survey
Authors: Vu Thanh-Huyen T , Groom Allison , Hart Joy L , Tran Hy , Landry Robyn L , Ma Jennie Z , Walker Kandi L , Giachello Aida L , Kesh Anshula , Payne Thomas J , Robertson Rose M
Published: March 2019

Background:
The prevalence of e-cigarette use among youth is on the rise and may be associated with adolescents’ limited knowledge of the health effects of these products. We examined how demographics and socioeconomic status (SES) are correlated with the perceived health risks of e-cigarettes among youth.

Methods:
Data from a national online survey of youth aged 13-18 in 2017, weighted to be representative of the overall U.S. population in age, sex, race, ethnicity, and region were analyzed. Differences in perceived health risks of nicotine and other chemicals provided by vaping were addressed with respect to the demographics and SES of the participants, taking into account their e-cigarette use status.

Results:
Among 3,174 participants, 56.5% were female, 19.3% Hispanics and 14.7% non-Hispanic Blacks. Indicators of low SES [family receiving public assistance (PA) or participating in free school lunch program] were seen in 50.2%. With adjustment for e-cigarette use status in multivariable regression models, perceived health risks from the contents of e-cigarettes differed by gender, age, place of residence, and SES status. For example, the odds of perceiving harm from nicotine in e-cigarette products was 1.6 times higher in girls than in boys; the same odds was lower by 27% for those in families receiving government PA compared to those in families that did not. A parent’s education level also significantly influenced their child’s perception of the harm of the contents of e-cigarette products (
see
Figure
).

Conclusions:
For youth, the perceived health risks of nicotine, toxins or chemicals in e-cigarette products were significantly different by age, gender, race/ethnicity, and SES. The findings may have relevance for developing communications and education strategies targeting specific youth audiences, especially those in vulnerable groups. These strategies could improve awareness among youth concerning the health effects of e-cigarettes, helping to prevent or reduce e-cigarette use.
Abstract P390: Comparison of the Acute Autonomic Effects of Mainstream Cigarette Smoke to Oral Nicotine Spray
Authors: Irfan Affan B , Koromia George , Abusnina Waiel , Studney Mark , Bhatnagar Aruni , Carll Alex
Published: March 2019

Background:
Smoking and exposure to environmental tobacco smoke are associated with sympathetic nervous system activation, a leading putative mechanism of adverse cardiovascular events. However, the role of nicotine in cigarette smoke’s sympathomimetic effects remains unknown.

Methods:
Healthy young smokers were recruited and fasted from food and nicotine/tobacco products for ≥8 hours before each of two visits. On each visit, participants underwent a 12-lead resting electrocardiogram (ECG) for 5 minutes indoors (pre-exposure), 20 minutes outdoors (mid-exposure), and 5 minutes indoors (post-exposure). On the first day, participants smoked cigarette of their preferred brand, and on second day used 4 mg of oral nicotine spray instead. We present preliminary heart rate variability results from 10 smokers who completed two visits (mean age 28 years, 7 males, 0.8 -1.2 mg nicotine per cigarette).

Results:
Heart rate (HR) increased from 65 ± 20 beats/min (BPM) at pre-exposure to 80 ± 25 BPM during cigarette use (23% increase), and to 78 ± 37 BPM during use of nicotine alone (20% increase) (p<0.05 vs pre-exposure). There was no significant difference in average HR between pre and post exposure. SDRR did not change significantly between phases and exposures (Pre, mid and post exposure (ms) for cigarette; 59 ± 20, 68 ± 25, 57 ± 20 and for nicotine; 70 ± 26, 79 ± 37 and 62 ± 22, respectively.) However, RMSSD decreased with cigarette use by 25% (p<0.01), and also with nicotine but was not significant. Conversely, LF/HF increased during cigarette and nicotine-only exposures relative to pre- (>150%) and post-exposure (>15%) (p<0.05).

Conclusion:
Our findings suggest smoking may acutely induce relative sympathetic dominance through nicotine, with potential additive effects of other aerosol constituents within tobacco smoke (e.g., aldehydes and particulates).
Abstract P391: Association of Peripheral Artery Disease With the Use of Smokeless Tobacco, Cigars, or Pipes in the Atherosclerosis Risk in Communities Study
Authors: Van’t Hof Jeremy R , Wang Wendy , Matsushita Kunihiro , Widome Rachel , Folsom Aaron R , Lutsey Pamela L
Published: March 2019

Background:
Cigarette smoking is one of the strongest modifiable risk factors for peripheral artery disease (PAD), a disease which affects over 200 million people worldwide. Though cigarette use has decreased across time, use of cigars, pipes and smokeless tobacco remains unchanged or slightly increased. The association of PAD and non-cigarette tobacco use is not well described. Thus, we tested the hypothesis that the use of cigars, pipes or smokeless tobacco is associated with incident PAD even after adjustment for cigarette use.

Methods:
A total of 14,395 Atherosclerosis Risk in Communities (ARIC) Study participants with no history of prevalent PAD were followed from 1987 to 2015 for PAD events (hospitalizations with PAD diagnosis or leg revascularization). Baseline pipe, cigar smoking and smokeless tobacco use was self-reported. Multivariable-adjusted Cox proportional hazards regression was used.

Results:
At enrollment the 14,395 participants included in the study were on average (SD) 54 (6) years old, 55% female and 27% African American; 489 (3.4%) were current users of smokeless tobacco and 481 (3.3%) current users of cigars or pipes. A total of 1,289 incident PAD events occurred during a median of 25.9 years of follow-up. After adjustment for demographics and cigarette smoking status, risk of incident PAD was higher among current (versus never) users of smokeless tobacco [HR (95% CI): 1.66 (1.29-2.12)], though this association was attenuated with adjustment for CVD risk factors (Table). Cigar and pipe use were not associated with PAD incidence, regardless of degree of adjustment (Table).

Conclusion:
Active use of smokeless tobacco was associated with increased risk for incident PAD compared to non-use, independent of cigarette smoking, although this relationship was not statistically significant after adjustment for cardiovascular risk factors. No association was observed with use of pipes or cigars. Use of smokeless tobacco may increase PAD risk and could be a potential target for intervention.
Abstract P392: Association Between Migration to the US, Cardiovascular Disease, and Cardiovascular Risk Factors Among Mexican Migrants and Non-Migrants
Authors: Martinez-Cardoso Aresha , Geronimus Arline
Published: March 2019

Background:
Mexico-US migration represents one of the largest migration flows across the globe. However, debates abound over whether health selection is a salient driver of migration, and furthermore how migration shapes the health of Mexican migrants.

Objectives:
To address these gaps in the literature, we used binational data from Mexico to compare cardiovascular risk factors and health profiles of (1) Mexico-US nonmigrants and future migrants and (2) Mexico-US nonmigrants and return migrants.

Methods:
Data from the Mexican Family Life Survey, a nationally-representative survey with measures of migration and health, was used for the analysis. We estimated a series of mixed effects logistic regression models to assess the association between (1) cardiovascular health at baseline and future migration status and (2) exposure to the US (migration to the US and time in the US) and cardiovascular health. Cardiovascular health indicators included obesity, wasit-hip-circumference (WHC), high blood pressure, self-reported diabetes, self-reported cardiovascular disease, and smoking and physical activity behaviors.

Results:
Cardiovascular health was not a significant predictor of future migration to the US; that is, the health of Mexico-US migrants’ was on par with their compatriots who do not migrate. However for some cardiovascular indicators, the health of return migrants with exposure to the US was worse than non-migrants. Return migrants had higher levels of adiposity, obesity (OR=1.38, 95% CI 1.05,1.80), and elevated WHC (OR=1.45, 95% CI 1.07,1.95). Furthermore, time spent in the US was significantly associated with obesity (OR=1.005, 95% CI 1.001,1.009), elevated waist circumference (OR=1.003, 95% CI 1.001,1.007), and self-reported cardiovascular disease (OR=1.005, 95% CI 1.002,1.009). Finally, the association between exposure to the US and poorer cardiovascular health was not mediated by physical activity or smoking behavior.

Conclusions:
Our findings shed light on the drivers of Mexican immigrants’ health, and underscore the important of considering the social and environmental context faced by migrants in the US as an important determinant of cardiovascular health.
Abstract P395: Examining the Relationship Between Physical Activity Resources and Self-reported Vigorous Physical Activity in a Resource-limited Community: Data From the Washington DC Cardiovascular Health and Needs Assessment
Authors: Ceasar Joniqua N , Powell-Wiley Tiffany M , Andrews Marcus , Ayers Colby , Collins Billy , Langerman Steven , Mitchell Valerie , Tamura Kosuke
Published: March 2019

Background:
Despite well-documented evidence that one’s neighborhood environment and resource access are associated with cardiovascular (CV) risk, little is known about how physical activity (PA) resource access availability and type are related to vigorous PA (VPA) in urban communities.

Methods:
Using cross-sectional data from the Washington DC CV Health and Needs Assessment, a sample of 37 black adults living in low-income, limited-resource DC communities, we created one outcome: self-reported VPA hours/week. We used Geographic Information Systems to create three exposure variables: counts of parks, recreation facilities, and private gyms within 800 and 1600-meter (m) line-based road network buffers around homes. We examined the relationship between the three exposures and VPA in models adjusted for demographics (age, sex, and income) and neighborhood factors, including neighborhood deprivation index (NDI), neighborhood environment perception (NEP), or walk score (WS), separately.

Results:
Participants (mean age=57.65 years) reported a mean VPA hr/wk of 3.46. After separately adjusting for neighborhood factors, greater availability of parks within 800m and 1600m positively associated with VPA (p<0.01) (Table). Positive associations between recreation facilities and VPA were found with 1600m buffer (p<0.05), but not 800m. Private gyms had the weakest relationship with VPA. When considering WS, only the relationship with parks remained significant.

Conclusions:
Increased availability of parks was positively related to VPA, even after adjusting for NDI, NEP or WS. However, relationships were not as robust for recreation facilities and private gyms, perhaps due to higher likelihood of barriers to use or limited availability in these communities. Our findings suggest that DC public health professionals should consider prioritizing increased availability of PA resources, especially parks, to promote PA and ultimately improve CV health outcomes for residents within limited-resource communities.
Abstract P396: Influence of Social Determinants of Health on Emergency Department Visits Among Individuals With Coronary Heart Disease and Stroke: an Analysis of the 2010-2016 National Health Interview Surveys
Authors: Baptiste Diana Lyn , Commodore-Mensah Yvonne , Turkson-Ocran Ruth-Alma , Dennison Himmelfarb Cheryl R , Han Hae-Ra
Published: March 2019

Introduction:
Coronary heart disease (CHD) and stroke are leading causes of morbidity and mortality in the U.S. Over 92 million Americans have been diagnosed with CHD/stroke and have more costly emergency department (ED) visits to manage acute and chronic symptoms. These visits are often attributed to poor access to primary care, advanced age, and poor social support. Social determinants of health (SDoH) have been suggested for a variety of health outcomes, yet their relation to healthcare utilization such as ED visits among individuals with CHD/stroke is unclear.

Hypothesis:
We hypothesized that SDoH would be associated with having ≥1 ED visit(s) in the prior 12 months among patients with CHD and stroke.

Methods:
A cross-sectional analysis of the 2010-2016 National Health Interview Survey was conducted among those who self-reported CHD/stroke diagnosis. Logistic regression analyses were performed with the outcome reporting ≥ 1 ED visit for any reason in the prior 12 months. SDoH examined were race, employment status, poverty, insurance status, and marital status.

Results:
We included 6,930 participants with diagnosis of CHD/stroke. The mean age (±sd) was 67.09 (±0.10) years. After adjusting for age, sex, perceived health status, Blacks (OR: 1.27, (95%CI: 1.14-1.41) and unmarried persons (OR: 1.21, 95% CI: 1.11-1.31) were more likely to report having at ≥ 1 ED visits than their White and married counterparts
(Table)
. Compared to Whites, Asians (OR: 0.65, 95%CI: 0.51-0.81) had lower odds of having ≥ 1 ED visit. Those who were employed were less likely (OR: 0.75, 95%CI: 0.67-0.83) to have ED visits compared to those who were unemployed. Those who were not poor/near poor (OR: 0.86, 95%CI: 0.78-0.96) had lower odds of ED visits than the poor.

Conclusions:
Being Black, poor, unemployed and unmarried were associated with a higher odds of ED visits in the prior 12 months among those with CHD/stroke. Targeted and culturally-appropriate strategies that address SDoH among this vulnerable, high risk population may help prevent costly ED visits.
Abstract P397: Neighborhood Environment Perceptions Associate With Depression Levels and Cardiometabolic Risk: Data From the Washington, DC Cardiovascular Health and Needs Assessment
Authors: Andrews Marcus R , Ceasar Joniqua N , Tamura Kosuke , Mitchell Valerie , Langerman Steven , Collins Billy , Baumer Yvonne , Gutierrez Huerta Cristhian , Dey Amit , Playford Martin , Mehta Nehal , Powell-Wiley Tiffany
Published: March 2019

Background:
Little is understood about associations between perceived neighborhood characteristics and depression, a known cardiovascular (CV) disease risk factor, in diverse populations. We examined the relationship between neighborhood environment perception (NEP), depression, and CV disease markers within an urban, predominantly African-American (AA) cohort.

Methods:
We conducted the DC CV Health and Needs Assessment, a health evaluation among adults (n=100) in resource-limited DC communities. We measured overall NEP and factor analysis identified three NEP sub-scores: 1) neighborhood violence; 2) physical environment; and 3) social cohesion (higher score=more favorable NEP). Depression was defined by the revised Center for Epidemiologic Studies Depression Scale (CESD-R, higher score=higher depression likelihood). We leveraged linear regression modeling to examine NEP and depression associations adjusting for race, income, Framingham risk score, and neighborhood deprivation index (NDI). A population subset (n=42) provided blood samples which were tested for levels of IL-1β, IL-18, and CRP by ELISA (Mesoscale Diagnostics, USA).

Results:
Participants (n= 100; mean age = 59; 99% AA) had a mean CESD-R score=5.8 (SD=8.9) and mean NEP score=56.1 (SD=12.6). In fully adjusted models, more favorable NEP, specifically physical environment and social cohesion, was associated with significantly lower CESD-R scores (Figure). Higher CESD-R scores were positively associated with increasing IL-1β (β= 20.3 p<.01) and IL-18 (β=0.006 p<.01).

Conclusions:
More favorable perceptions of one’s neighborhood are related to lower depression symptoms in a predominantly AA cohort from Washington, DC resource-limited communities. Additionally, increasing CESD-R score was related to higher pro-inflammatory markers. These results suggest that improving individuals’ neighborhood perceptions may be beneficial in improving the psychological well-being and, ultimately, CV health of urban minority residents.
Abstract P399: Two-Year Trends and Determinants of Electronic Cigarette Use Among Patients With Cardiovascular Disease in the United States
Authors: Ndunda Paul M , Vindhyal Mohinder , Muutu Tabitha , Munguti Cyrus
Published: March 2019

Background:
The use of electronic cigarettes (e-cigarettes) is on the rise in the US. It increased in adults aged 25-44 years from 2.4% in 2012 to 4.2% in 2016 and from 2% to 2.8% between ages 55 to 64 over the same period. Among the youth, the increase was 900% between 2011 and 2015. Much remains to be known about the health effects of e-cigarette use, but epidemiologic studies suggest an independent association between e-cigarette use and cardiovascular disease. There is a need for data on the social and demographic factors that are predictive of use in adults with cardiovascular disease (CVD), to identify the appropriate focus of intervention.

Methods:
This is an analysis of the 2016 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) data, an annual chronic disease and behavioral risk factor survey conducted by the CDC. The sample included the 110,028 respondents that reported a history of heart attack, angina/coronary heart disease or stroke. The rates of e-cigarette use were calculated, and a multiple logistic regression analysis was used to assess associated factors.

Results:
Among respondents with CVD, there was no change in e-cigarette use between 2016 and 2017 [3.1% to 2.8% adjusted OR (aOR) 1.08 (95% CI 0.95 - 1.24)]. The median age of e-cigarette users was 58 years and that of non-users was 69 years (p<0.0001). Women had a higher rate of e-cigarette use compared with men [3.2% vs 2.7% aOR 1.17(1.04-1.31)]. Other factors associated with e-cigarette use were: race [blacks vs whites 1.9% vs 3% aOR 0.37(0.28-0.49], sexual orientation [LGBTQ vs non-LGBTQ 7.1% vs 2.9% aOR 1.56 (1.24-1.96)], smoking [current smokers vs non-smokers 11.1% vs 1.2% aOR 6.0 (5.3-6.8), smoking on some days vs never smoked 12.7% vs 0.24 aOR 51(35.4-73.5)], mental illness [6.4% vs 1.8% aOR 1.57 (1.37-1.810)] and state of residence (p<0.0001).

Conclusion:
In conclusion, there was no significant change in e-cigarette use between 2016-2017 among respondents with CVD. The highest rates of e-cigarette use were among subjects who were: smokers on some days, current smokers, LGBTQ and had a mental illness.
Abstract P401: Female Gender is a Significant Risk Factor for Functional Disability After Hemorrhagic Stroke but Not Ischemic Stroke Among Japanese Community-Dwelling Elderly Individuals
Authors: Tanno Kozo , Takahashi Shuko , Yonekura Yuki , Ohsawa Masaki , Omama Shinichi , Ishibashi Yasuhiro , Itai Kazuyoshi , Onoda Toshiyuki , Kuribayashi Toru , Ogasawara Kuniaki , Tanaka Fumitaka , Nakamura Motoyuki , Koshiyama Makoto , Sakata Kiyomi , Okayama Akira
Published: March 2019

Introduction:
Previous studies have indicated that the female gender is one of the important risk factors for disability after stroke; however, most studies have been conducted in Western countries, and the higher risk of disability after stroke observed in women is thought to be different in Japan, where the proportion of hemorrhagic stroke (HS) is relatively higher than that in Western countries.

Hypothesis:
We assessed the hypothesis that the higher risk of disability after stroke attributable to the female gender was different between ischemic stroke (IS) and HS.

Methods:
We used 10-year community-based cohort data of 8,698 participants aged 65 years or older without cardiovascular disease or long-term care insurance (LTCI) at the time of the baseline survey. The stroke incidence was confirmed by reviewing the Iwate Stroke Registry. Functional disability was defined as being newly certified by the LTCI system. Participants were classified into three groups: G1, event-free (no stroke and no disability, n=7,950); G2, no disability after stroke (IS=177, HS=55); and G3, disability after stroke (IS=346, HS=170). Multivariate-adjusted odds ratios (ORs) of the female gender in G2 and G3 (reference: G1) were calculated using multinomial logistic regression with adjustments for age, hypertension, diabetes, dyslipidemia, overweight, current smoking, regular alcohol consumption, and regular exercise separately in those with IS and HS.

Results:
The ORs of the female gender were not high in G3 in IS, while the OR (95% confidence interval) was significantly high in G3 (1.55 (1.03-2.34)) in HS (see table).

Conclusions:
The proportion of females in the subjects with disabilities after HS was significantly higher than the proportion of males after multivariate adjustment. This suggested that the female gender was a significant risk factor for disability after HS, but not after IS in Japanese community-dwelling individuals.
Abstract P403: Role of Modifiable and Non-modifiable Risk Factors in the Association of Kidney Function With Stroke Risk in Multi-ethnic Study of Atherosclerosis (MESA)
Authors: Sedaghat Sanaz , Bancks Michael , de Boer Ian H. , Kramer Holly , Gutierrez Orlando , Longstreth WT , Kershaw Kiarri N. , Carnethon Mercedes
Published: March 2019

Introduction:
Persons with chronic kidney disease have up to 8 times higher risk of stroke. A role for shared vascular risk factors, such as aging, sex, hypertension, and diabetes has been implicated in this association. We aim to explore the contribution of non-modifiable and modifiable vascular risk factors to this association.

Hypothesis:
We hypothesize that non-modifiable and modifiable vascular risk factors could explain part, but not all, of the association between kidney function and incidence of stroke.

Methods:
We included 6404 participants (mean age 62 yrs, 51% women, 38% white). Kidney function was assessed by estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Participants were followed for an average of 12±4 yrs for incidence of stroke. Multiple Cox regression models, adjusted for baseline non-modifiable (age, sex and race) and modifiable (BMI, smoking, SBP, diabetes, cholesterol, alcohol intake, physical activity, and healthy diet score) risk factors were used to estimate the association of kidney function with incidence of stroke.

Results:
During follow-up, 284 (4.4%) fatal and non-fatal stroke cases were adjudicated. Among them, 233 (3.6%) were non-fatal stroke. Non-modifiable vs. modifiable risk factors were associated with greater reduction in HRs from a crude model for association of each SD lower eGFR with risk of stroke. (25% vs. 12% for non-fatal and 33% vs. 14% for all stroke). Non-modifiable vs. modifiable risk factors were associated with a lower reduction in HRs from a crude model for association of doubling ACR with risk of stroke (6% vs. 12% for both non-fatal and all stroke) (Figure). After adjusting for all factors, worse kidney function remained associated with risk of stroke.

Conclusions:
Findings suggest that conventional modifiable and non-modifiable vascular risk factors do not fully explain the higher risk of stroke in relation to worse kidney function. This finding warrants exploring other potential novel mechanisms of this association.