bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P089: Total, Plant and Animal Protein Intake and Blood Pressure: A Meta-analysis of Observational and Intervention Studies
Authors: Tielemans Susanne M , Altorf - van der Kuil Wieke , Engberink Mariëlle F , Brink Elizabeth J , van Baak Marleen A , Bakker Stephan J , Geleijnse Johanna M
Published: July 2021

Background:
Dietary protein may beneficially influence blood pressure (BP), but evidence is not conclusive.

Objective:
To quantify the association of total protein, plant protein, and animal protein intake with BP and incident hypertension by means of meta-analysis.

Methods:
A systematic literature search for eligible studies was conducted until January 2012, using MEDLINE and manual search. Of >3,000 titles evaluated, 29 met the inclusion criteria. Dose-response meta-analyses were performed using STATA 11.0. We included 8 cross-sectional studies (total of 48,985 participants), 4 prospective studies (11,761 participants), and 17 randomized controlled trials (1,449 subjects).

Results:
Total protein intake was significantly inversely associated with systolic BP ([[Unable to Display Character: ‑]]0.20 mmHg per SD, 95%-CI: [[Unable to Display Character: ‑]]0.39 to [[Unable to Display Character: ‑]]0.01) in cross-sectional studies, but no relation was found with incident hypertension in prospective studies (HR of 0.99 per SD, 95%-CI: 0.96 to 1.02). Trials showed an overall reduction of [[Unable to Display Character: ‑]]2.1 mmHg in systolic BP (95%-CI:[[Unable to Display Character: ‑]]2.9 to [[Unable to Display Character: ‑]]1.4) for a weighed difference in protein intake of 41 g/d, compared to carbohydrates. Plant protein, but not animal protein, was weakly inversely associated with BP in cross-sectional studies. Plant protein and animal protein showed similar associations in prospective studies (non-significant HR of 0.96 and 0.98 per SD, respectively) and randomized trials (-2.0 vs -2.2 mmHg, P<0.05, respectively).

Conclusion:
Dietary protein may have a beneficial effect on BP if consumed instead of carbohydrates. No clear difference was observed between plant and animal protein, but data on protein from different sources and BP is scarce and more research is needed to draw conclusions.
Abstract P091: A Comparison of Analytical Methods to Evaluate the Association Between Diet and Long-Term Weight Gain in Three Prospective Cohorts
Authors: Smith Jessica D , Hou Tao , Hu Frank , Rimm Eric B , Spiegelman Donna , Willett Walter C , Mozaffarian Dariush
Published: July 2021

Background:
Because long-term weight gain typically occurs insidiously (~1 lb/y) it is very difficult to study in RCTs and prospective cohorts provide crucial evidence on its key contributors. Most prior studies have evaluated how baseline diet, rather than change in diet that may be more physiologically relevant, relates to future weight gain.

Aim:
To evaluate and compare different methodological approaches for investigating how diet relates to long-term weight gain.

Methods:
Participants from 3 separate cohorts, the Nurses Health Study (NHS, n=50,422), Nurses Health Study II (NHS II, n=47,898), and the Health Professionals Follow-up Study (HPFS, n=22,557), free of obesity and chronic diseases at baseline, were included and followed for up to 20 y. Lifestyle, health status, and weight were assessed by questionnaires every 2 y, and diet by validated FFQ every 4 y. We assessed 3 different analytic approaches, including relations of 1) baseline diet at the start of each 4 y with weight change in the next 4 y; 2) 4-y change in diet with weight change in the same 4 y; and 3) 4-y change in diet with lagged weight change in the next 4 y. We compared these approaches evaluating consistency across cohorts, magnitudes of associations, and biological plausibility of findings.

Results:
Across the three methods, consistent, robust, and biologically plausible associations were only seen between changes in diet and changes in weight in the same 4 y (Figure). Findings evaluating baseline diet and lagged dietary change were less consistent across cohorts, far smaller in magnitude, and often not biologically plausible, suggesting presence of both bias and misclassification of the true relevant dietary metric.

Conclusions:
The methods used to analyze dietary habits and long-term weight gain are crucial. The most robust, biologically relevant, and consistent findings are seen when evaluating dietary change and weight change in discrete periods.
Abstract P117: Episodes of Anger are Associated with a Higher Risk of Myocardial Infarction and Acute Coronary Syndrome: Systematic Review and Meta-Analysis
Authors: Mostofsky Elizabeth , Penner Elizabeth A , Mittleman Murray A
Published: July 2021

Introduction:
Short-term psychological stress is associated with an immediate physiologic response. We assessed the hypothesis that brief episodes of anger may trigger the onset of acute myocardial infarction (MI) and other acute coronary syndromes (ACS).

Methods:
We performed a literature search of the CINAHL, Embase, PubMed and PsycInfo databases from January 1966 through June 2012 using the key words “anger”, “hostility”, “myocardial infarction” and “acute coronary syndrome” without restrictions. We also reviewed the reference lists of retrieved articles and spoke with authors of relevant work to identify unpublished data. We used an inverse-variance-weighted random effects model to perform a meta-analysis of all epidemiological studies that reported relative risks and 95% confidence intervals (CI) for the association between outbursts of anger and nonfatal MI or ACS.

Results:
The meta-analysis included four independent case-crossover studies of anger and risk of MI or ACS published between 1995 and 2007 and one unpublished report. Combined, there were 4546 MI cases (two studies) and 462 ACS cases (two studies), including 180 that experienced an episode of anger in the two hours prior to disease onset; two studies were restricted to first MI or ACS and two included first and recurrent events. All studies used the Onset Anger Scale to assess anger episodes, but the studies differed in the cutoff used to define exposure. The association between outbursts of anger and disease risk in the following two hours was 3.46 (95%CI 2.08-5.76; p<0.001). The results were similar for studies of first and recurrent events and were similar for studies of MI and ACS.

Conclusions:
There is a higher risk of MI and ACS shortly after outbursts of anger. Some of the between-study heterogeneity may be due to regional differences in the type of anger expression and the interpretation of the questions. Further research is necessary to evaluate whether the risk is lower among people who are regularly active.
Abstract P145: Successful Use of Telephone and Mail for Obtaining Usable Accelerometer Data from a National Cohort: The Experience of the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Howard Virginia J , Rhodes J D , Hutto Brent , Hearld Kristine R , Colabianchi Natalie , Vena John E , Seshadri Vena , Le Anh , Stewart Margaret , Blair Steven N , Hooker Steven P
Published: July 2021

Background:
Epidemiologic studies examining physical activity have used self-report or the preferred objective measurement devices of pedometers or accelerometers. NHANES 2003-2004 used remuneration, in-person and express mail methods to obtain accelerometer data from 7176 individuals with 4867 (68%) providing 4+ valid days of wear. Herein we describe the experience of another national epidemiologic study that used telephone and regular mail to obtain accelerometer data.

Methods:
This is an ancillary study to REGARDS, a national, population-based, longitudinal study of 30,239 blacks and whites, aged > 45 years, enrolled January 2003-October 2007. Participants were recruited from communities across all 48 of the lower United States, and include residents of 1,855 of the 3,033 US counties. Baseline evaluations were conducted through computer-assisted telephone interview (CATI), self-administered questionnaires, and an in-home visit. Participants are followed by CATI every 6 months. Starting with the May 2009 follow-up calls, contingent on availability of an accelerometer, participants were asked about willingness to wear an accelerometer for 7 days. Device inventory was 1150. Accelerometer, instructions, and stamped addressed envelope for return were mailed to consenting participants. Postcard acknowledgement, reminders, and < two calls were made to encourage compliance with wearing device and its return. Participants receive summary results but no financial compensation.

Results:
By August 23, 2012, 22 195 were asked in a CATI follow-up to participate; 52% initially consented, 17% deferred and will be recontacted, and 31% declined. Participation rates by race-sex groups were: WM 53%, WF 53%, BM 53%, BF 50%. Devices were shipped to 11,798 with a return rate of 92%; 935 are lost (outstanding > 120 days). Of accelerometers used/analyzed to date (n=9,422), 7819 (83%) provided 4+ valid days of wear, 434 (4.6%) had fewer than 4 valid days of wear, and 1,169 (12.4%) had incomplete/missing log sheet or device malfunction. The consenting-shipment-wearing-tracking-return-processing- and cleaning cycle is about 7-9 weeks per device, suggesting that approximately 6-7 participants can be evaluated per available device per year.

Conclusions:
A high yield of usable accelerometer data can be obtained from a national cohort through mail and telephone methods.
Abstract P165: The Long-term Effect of a Low-Carbohydrate Diet on Endothelial Dysfunction and Insulin Resistance: A Randomized Controlled Trial
Authors: Hu Tian , Reynolds Kristi , Yao Lu , Bunol Calynn , Liu Yanxi , Chen Chung-Shiuan , He Jiang , Bazzano Lydia
Published: July 2021

The long-term effects of low-carbohydrate diets versus low-fat diets on endothelial dysfunction and insulin resistance are unclear.

A total of 148 study participants with a body mass index of 30 - 45 kg/m2 (Mean: 35.4 kg/m2) who were free of diabetes, cardiovascular diseases and kidney disease were recruited. The participants were randomly assigned to either a low-carbohydrate diet (<40 g/day; N=75) or a low fat (<30% energy from fat, <10% from saturated fat; N=73) diet. Two 24-hour dietary recalls were conducted at each clinic visit (0, 3, 6 and 12 months of intervention). Participants met with a study dietitian weekly for the first month followed by group settings bi-weekly for 5 months and monthly for the last 6 months. Each group was provided the same behavioral curriculum related to diet emphasizing portion control and eating habits. Biomarkers for endothelial function and insulin resistance included E-selectin, Intercellular Adhesion Molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), Insulin-like growth Factor-1 (IGF-1), serum insulin, and glucose. Mixed-effect regression models including group, time and their interaction were used to analyze the data.

Of the study participants, 60 in the low-fat group (81.1%) and 59 in the low-carbohydrate group (79.7%) completed the entire intervention. The mean age was 46.8 years, 88.5% were women and 55.1% were African-Americans. The low-carbohydrate group lost approximately 3.5 kg more body weight than did the low-fat group (P= 0.002) on average. Compared to the low-fat diet, the low-carbohydrate diet resulted in greater reductions in E-selectin (net change: -4.5, -4.3, and -3.8 ng/mL at 3, 6, and 12 months, respectively; overall P= 0.002) and ICAM-1 (net change: -7.3, -10.4, and -16.8 ng/mL at 3, 6, and 12 months, respectively; overall P= 0.06). There was no significant change in any other markers.

Our findings suggest that the low-carbohydrate is at least as effective as the low-fat diet at improving endothelial dysfunction and insulin resistance.
Abstract P177: Effects of 1-year Lifestyle Modification Program on Cardiometabolic Risk Profile and Glucose Tolerance Status in Post Coronary Bypass Graft Patients
Authors: Lévesque Valérie , Poirier Paul , Marette André , Mathieu Patrick , Larose éric , Després Jean-Pierre
Published: July 2021

Introduction:
Patients with coronary artery diseases (CAD) are often characterized by impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or type 2 diabetes (T2D), conditions which have also been related to high levels of visceral adipose tissue (VAT) and ectopic fat. Secondary prevention intervention involving physical activity should therefore also target VAT/ectopic fat to improve the cardiometabolic risk (CMR) profile.

Objectives:
The objective of the present pilot study was to compare the response of CMR variables in recent post coronary bypass graft patients with either normal glucose tolerance (NGT), IFG/IGT, and T2D to a 1-year intervention targeting the improvement of lifestyle habits.

Methods:
Anthropometric measurements, assessment of lipid profile, magnetic resonance imaging of the heart and the abdomen, an oral glucose tolerance test and a maximal exercise treadmill test were performed before and after the intervention (n=44).

Results:
No significant difference was found in baseline characteristics of the three subgroups, except that patients with IFG/IGT and T2D had significant higher levels of VAT than NGT patients. In response to the lifestyle intervention, patients with IFG/IGT and T2D improved their CMR profile with decreases in waist circumference (Δ=-5.1cm, p<0.01), abdominal visceral (Δ=-41.1ml/5mm, p<0.01) and subcutaneous adipose tissue volumes (Δ=-32.7ml/5mm, p<0.01) as well as in their intrathoracic epicardial (Δ=-3.5ml/5mm, p<0.0001) and pericardial (Δ=-7.7ml/5mm p<0.0001) adipose tissue volumes. They also improved their lipid/lipoprotein profile with decreases in apolipoproteins B (Δ=-0.02mmol/l, p<0.05), triglycerides (Δ=-0.17mmol/l, p<0.01) and total cholesterol/HDL ratio (Δ=-0.49mmol/l, p<0.0001), while HDL (Δ=+0.20mmol/l, p<0.01) and apolipoproteins A1 (Δ=+0.12mmol/l, p<0.01) increased. Cardiorespiratory fitness (CRF) was also improved as reflected by an increase in VO2peak (Δ=+5.06 mlO2/kg/min, p<0.0001) and by a reduced heart rate assessed at a standardized workload (1.7 mph, 5% slope) (Δ=-10bpm, p<0.0001). Patients with IFG/IG also improved significantly their glucose and insulin homeostasis with decreases in fasting glucose (Δ=-0.12mmol/l, p<0.05) and insulin levels (Δ=-15.53mmol/l, p<0.05), 2h-glucose (Δ=-1.50mmol/l, p<0.01) and insulin levels (Δ=-40.41mmol/l, p<0.05) and glucose area under the curve (Δ=-0.17 ρmolx10-3, p<0.01). Nine of seventeen patients with IFG/IGT normalized their glucose tolerance and two of nine patients with T2D reversed to IGT/IFG. Improvements of CMR variables were significantly correlated with changes in CRF.

Conclusion:
Results of this pilot study suggest that increasing CRF is a relevant target to mobilize VAT/ectopic fat in order to improve the CMR profile including plasma glucose homeostasis in CAD patients, irrespective of their glucose tolerance status.
Abstract P227: Depressive Symptoms and Incident CHD among African Americans and Whites: The Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study
Authors: Sims Mario , Redmond Nicole , Khodneva Yulia , Durant Raegan , Halanych Jewell , Safford Monika
Published: July 2021

Objectives:
African Americans (AA) have higher risk for coronary heart disease (CHD) outcomes than Whites. This racial disparity has been attributed to differences in risk factors such as hypertension, diabetes, smoking, and inactivity. Depression has been associated with CHD risk, both through behavioral factors and possibly through more direct mechanisms. Yet, the role of depressive symptoms in racial disparities in risk of CHD is not clear. Using the REGARDS Study, we examined the association between depressive symptoms and incident CHD.

Hypothesis:
Depressive symptoms are associated with incident CHD among AA, but not Whites.

Methods:
REGARDS is a national cohort of US community-dwelling adults aged >45 recruited from 2003 to 2007. Longitudinal associations of depressive symptoms with incident acute CHD (fatal CHD or nonfatal myocardial infarction or coronary revascularization) by race were examined among 24,261 participants (AA = 10,265; Whites =13,996) free of CHD at baseline, and observed through 12/31/09. Baseline depressive symptoms were defined by the 4-item Centers for Epidemiological Studies Depression Scale (CES-D), with continuous scores (0-12 range) dichotomized as normal (<4) or depressive symptoms (≥4). We estimated multivariable Cox proportional hazards models of incident CHD with depressive symptoms, adjusting for sociodemographics, CHD risk factors and health behaviors.

Results:
Overall mean follow-up was 4.2+1.5 years, CHD incidence was 8.3 events per 1000 person-years (n=366 events) among AA and 8.8 events per 1000 person-years (n=613 events) among Whites, p=0.0015. Depressive symptoms were more prevalent among AA (13.1%) than among Whites (8.5%), p<0.001. There was a significant interaction between race and depressive symptoms, thus models were stratified on race. After adjustment for age, sex, marital status and region, depressive symptoms were significantly associated with incident CHD among AA (HR 1.57 {95% CI 1.18-2.09}) but not among Whites (HR 1.11 {0.80-1.56}). After adding education, income, physical activity, smoking, alcohol consumption, diabetes, BMI, CRP, systolic blood pressure, cholesterol, albuminuria, use of blood pressure or statin medications, the relationship for AA was modestly attenuated but still significant (HR 1.35 {95% CI 1.01-1.81}).

Conclusions:
Depressive symptoms were associated with risk of incident CHD among AA but not Whites. Efforts to reduce racial disparities in CHD may need to address environmental and psychosocial factors that place AA at higher risk.
Abstract P238: Culturally-Competent Heart Health Coaching Improves Lipids in South Asians
Authors: Jose Powell O , Azar Kristin M , Kang Jennifer , Baek Marshall , Palaniappan Latha P , Sathe Anita , Malhotra Donna , Kotrys Jeannette , Deo Vijaya , Patel Shraddha , Mathur Ashish , Molina Cesar
Published: July 2021

Background:
Health coaching programs, delivered by trained non-medical and medical personnel, and focused on diet and lifestyle counseling, have proven beneficial in both primary and secondary prevention of cardiovascular disease. These coaching programs, however, have not been tested or validated in South Asians, who have unique dietary and lifestyle habits, and greatly increased risk of coronary artery disease.

Methods:
We examined lipid values in participants who were invited to enroll in the Heart Health Coaching Program at the South Asian Heart Center at El Camino Hospital in Mountain View, California. Trained volunteer coaches contacted interested participants throughout the year by phone and email to deliver culturally-competent health education on diet, physical activity, and stress reduction. Participants were categorized, based on their level of participation, into three groups: those who did not enroll in the coaching program (non-coached, N=33), those who received some coaching (partially coached, N=145), and those who completed one full year of the program (fully coached, N=558). Fasting lipid measurements were obtained with mean differences being calculated from their baseline and last available follow-up lab test. Paired t-test was used for comparison of baseline and follow-up lab tests within each group. Multivariate age-adjusted analyses incorporated MANOVA to detect for differences between groups.

Results:
There were no significant differences in mean age(43, 42 and 43), mean BMI(25.8, 26.5 and 26.2), or baseline lipid values across the three groups (fully-coached, partially coached, and non-coached respectively). There were significant improvements in total cholesterol(TC) (-5.5±28.4mg/dl), LDL(-4.1±24.3), HDL (1.9±6.4), triglycerides(-16.1±67.3), and TC/HDL ratio(-0.31±0.83) in the fully coached group (p<0.001 for all). The partially coached group demonstrated reductions in total cholesterol(-5.2±27.8, p=0.03), LDL(-8.1±28.0mg/dl, p<0.001), and TC/HDL ratio (-0.42±1.01, p<0.001) with a trend towards increased HDL (4.9±31.3, p=0.06). Non-coached participants did not have any statistically significant differences for any lipid measurement. Coached participants were more likely to improve lipid values than partially coached and non-coached participants (p<0.001).

Conclusions:
Our results suggest the benefit of a volunteer culturally-competent coaching program for South Asians in improving their lipid profile. Benefit was obtained even for partially coached participants. Non-medically trained health coaches may be an effective method to deliver culturally appropriate cardiovascular health messages for South Asians at risk for developing coronary artery disease.
Abstract P254: The Influence of Socioeconomic Status on Childhood Obesity and Familial Hypercholesterolemia
Authors: Ice Christa , Mittal Abhinav , Corridoni Nicholas , Neal William
Published: July 2021

Introduction:
Childhood obesity is a global epidemic with implications of future health problems including dyslipidemia. Recent studies suggest that socioeconomic status (SES) is inversely associated with adolescent weight in developed countries. No such patterns have been found linking SES with Familial Hypercholesterolemia (FH), which is an inherited disorder of high low-density lipoproteins (LDL) cholesterol, associated with increased risk for cardiovascular disease. The goal of this study was to explore parental SES associations with childhood obesity and FH in a rural Appalachian population.

Methods:
Data included 52,002 5th grade children from the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) project. Body Mass Index (BMI) was defined as the percentage difference from median BMI (BMI%diff) corrected for age and gender. LDL was obtained via fasting lipid profiles. FH was defined as LDL ≥190mg/dl. SES was determined by self-reported head of household education level (including 8th grade education, some high school, high school graduate or GED, some college, college graduate, and completed graduate school). Analysis included ANOVAs with pairwise comparisons using Tukey’s HSD and nonparametric procedures.

Results:
There was a clear inverse relationship between SES and obesity as shown in Figure 1; all pairwise comparisons were significant (p<0.0001). The prevalence of FH was 0.2%; there were no significant association with the SES groups.

Conclusion:
There was a significant relationship between higher weight status (after controlling for age and gender) and lower SES, but no moderating relationship of SES on FH. The prevalence of obesity is generally higher in Appalachian children than the rest of the country; identifying modifiable risk factors play an important role in treatment. Targeting initiatives to combat childhood obesity within the context of SES may be the optimal approach leading to better future outcomes - especially in children with additional co- morbidities like FH.
Abstract P292: Severe Obesity is Associated with Dramatic Increase in Cardiovascular Disease Risk Factor Prevalence: Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Kaplan Robert , Avilés-Santa Larissa M , Parrinello Christina M , Castañeda Sheila , Hankinson Arlene L , Isasi Carmen R , Birnbaum-Weitzman Orit , Kim Ryung , Daviglus Martha L , Talavera Gregory A , Schneiderman Neil , Cai Jianwen
Published: July 2021

Introduction:
Prevalence of severe obesity is increasing, especially among the young Hispanic population.

Methods:
In the HCHS/SOL cohort of 18-74 year old US Hispanics, we examined gradients across BMI and age in CVD risk factors.

Results:
Approximately one in five males (total N = 6,547) and one in ten females (total N=9,797) met criteria for class II obesity (BMI 35 - 40 kg/m
2
) or class III obesity (BMI ≥ 40 kg/m
2
). The prevalence of hypertension, diabetes, and elevated C-reactive protein rose with each successive class of overweight/obesity. In contrast, the prevalence of elevated levels of total cholesterol, LDL-c and triglycerides increased across normal weight, overweight (BMI 25 - 30 kg/m
2
), and class I obese (BMI 30 - 35 kg/m
2
) groups, but did not increase in frequency across class I, class II, and class III obesity groups. The
Figure
depicts isolines that identify age- specific subgroups of the normal-weight and class II - III obese groups that had the same estimated prevalence of CVD risk factors, with 95 percent confidence intervals. Among young adults with class II or III obesity, the prevalence of hypertension, diabetes, and the combination of three or more CVD risk factors was similar to that among normal-weight individuals (BMI 18.5 - 25 kg/m
2
) who were 15 to 30 years older. Among young obese individuals, the prevalence of low HDL-c levels and high C-reactive protein levels exceeded that among the oldest adults in the cohort. CVD risk factors had stronger, more consistent gradients across the BMI categories among men than among women.

Conclusion:
Class II and III obesity, defined as BMI ≥ 35 kg/m
2
, are common in the Hispanic/Latino population. Young adults with these severe forms of obesity have dramatically increased frequency of cardiometabolic risk factors. The age-related accumulation of multiple CVD risk factors, such as is typically seen in normal-weight individuals, is accelerated by 1-2 decades in severly overweight women and by 2-3 decades in severely overweight men.
Abstract P314: Moderate to Severe Thinness was Strongly Associated with High Risks of Cardiovascular and Infectious Disease-related Death and Incident Stroke Among Japanese Hemodialysis Patients
Authors: Owada Kyoko , Ohsawa Masaki , Tanno Kozo , Itai Kazuyoshi , Okayama Akira , Kato Karen , Fujishima Yosuke , Onoda Toshiyuki , Sakata Kiyomi , Kidoguchi Takako , Nekohira Ritsuko , Masuda Taeko , Fujioka Tomoaki
Published: July 2021

Background:
Overweight and obese is shown to be associated with a high risk for cardiovascular morbidity and mortality in the general population. While, inverse relationship between body mass index (BMI) and a risk for all-cause death was observed in dialysis patients. Thinner dialysis patients are supposed to be a high risk population. However, whether cardiovascular death contributes to a high risk for all-cause mortality or whether non-cardiovascular death contributes to a high risk for all-cause mortality in thinner dialysis patients has not been fully elucidated.

Methods:
A population-based prospective study of adult hemodialysis patients was carried out. A total of 1209 male and female hemodialysis patients were enrolled and divided into four groups according to BMI (G1: BMI < 17.0; G2: 17.0 ≤ BMI < 18.5; G3: 18.5 ≤ BMI < 25.0; G4: BMI ≥ 25.0 kg/ m
2
). Main outcomes were all-cause death (ACD), cardiovascular death (CVD), infectious disease-related death (IFD), malignant disease-related death (MAD), incident acute myocardial infarction (AMI) and stroke. Sex- and age-adjusted mortality and incidence rates were estimated in the groups using Poisson’s regression analysis.

Results:
A total of 453 patients died during the 5 year observation period (4,790 person-years). Overweight (BMI ≥ 25.0 kg/ m
2
) was not associated with a high risk for ACD, CVD, IFD, MAD, AMI and stroke, while moderate to severe thinness was strongly associated with excessive risks of ACD, CVD, IFD and stroke. Associations between BMI and risks for MAD and AMI were not observed (see table).

Conclusion:
Skinny hemodialysis patients are supposed to be a high risk population for infectious disease-related and stroke-related death and the findings should be known to hemodialysis patients and their caretakers.
Abstract P319: Association of Heart Rate Reserve with Incidence of Hypertension in Men
Authors: Prasad Vivek K , Hand Gregory A , Sui Mei , Lee Duck C , Shrestha Deepika , Jaggers Jason , Blair Steven N
Published: July 2021

Abstract Objectives—
We examined the association between heart rate reserve (HRR) and incident hypertension in men in the Aerobics Center Longitudinal Study.

Research design and Methods—
A total of 10418 healthy normotensive men, who did not have an abnormal electrocardiogram or a history of heart attack, stroke, cancer, or diabetes, performed a maximal treadmill exercise test and were followed for the incidence of hypertension. HRR was defined as the difference between maximal heart rate during exercise test and resting heart rate.

Results—
During a mean follow-up of 6 years, there were 2831 cases of incident hypertension. Compared with men in the reference category (the lowest quartile of HRR), the risk of incident hypertension was significantly lower in the highest quartile of HRR with a hazard ratio 0.67 (95% CI: 0.60-0.75) when adjusted for age and baseline examination year. Further adjustment for smoking, heavy drinking, body mass index (BMI), resting systolic and diastolic blood pressure, cholesterol, blood glucose and cardio respiratory fitness, resulted a hazard ratio of 0.84 (95% CI:0.74-0.95). This result was almost similar when we stratified them into younger and older men with hazard ratio of 0.77(95% CI: 0.62-0.98) and 0.78 (95% CI: 0.66-0.90) respectively. We also found a significant lower hypertension risk associated with higher HRR among high risk groups such as overweight, low fitness, or prehypertension with hazard ratio of 0.82(95% CI:0.70-0.97), 0.80(95% CI:0.67-0.96), 0.76(95% CI:0.64-0.88) respectively.

Conclusion—
Risk of Incident hypertension was significantly lower in men with higher HRR. High HRR was also associated with lower risk of developing hypertension irrespective of age and status of risk factors such as high BMI, low fitness and prehypertension. Therefore, HRR may be considered as a reliable exercise parameter for predicting the risk of incident hypertension.
Abstract P325: Predictors of High Pulse Pressure and Change in Pulse Pressure with Age in the Atherosclerosis Risk in Communities (ARIC)Study
Authors: Butler Kenneth R , Minor Deborah S , Penman Alan D , Mosley Thomas H
Published: July 2021

Introduction
Pulse pressure (PP), an indirect measure of arterial stiffness, is a strong predictor of CVD risk. Determinants of PP and change in PP with age are not well described.

Methods
In a population-based cohort of 10,854 white and African-American men and women 44 - 66 years of age (mean 53.6 years) not taking anti-hypertensive therapy, SBP and DBP were measured at 4 visits 3 years apart (average 3.4 visits per person). At each visit three readings were taken using a random-zero sphygmomanometer and the average of the last two values computed.

Results
In a random effects linear model the average annual change in PP was 1.09 mm Hg (SE 0.02, P <.0001), after accounting for baseline age differences. Race, sex, diabetes, smoking, drinking, and BMI were statistically significant predictors of average PP at any time point, but total and HDL cholesterol were not (Table). Diabetes, the most influential predictor, increased the average PP at any time point by 4.86 mm Hg (SE 0.41). Current (but not former) drinking was the only risk factor associated with a decrease in the average PP at any time point, by 1.05 mm Hg (SE 0.23). In addition, diabetes (women only) and BMI (women only) were associated with an increase, and current drinking with a decrease, in the average annual rate of change in PP.

Conclusion
In this middle-aged cohort, diabetes, BMI, and current drinking are important determinants of both the absolute level of PP and the annual rate of change in PP with age.
Abstract P355: Predicting the 20-year Risk of First Coronary or Ischemic Stroke Event in Northern Italy: The CAMUNI Absolute Risk Equation
Authors: Veronesi Giovanni , Chambless Lloyd E , Gianfagna Francesco , Mancia Giuseppe , Cesana Giancarlo , Ferrario Marco M
Published: July 2021

Aims.
Recent US guidelines advocate the introduction of lifetime or long-term absolute risk prediction for primary prevention of cardiovascular events, especially for young people and women. Therefore, long-term prediction models might be specially beneficial in population considered at low incidence. We aim to develop a 20-year absolute risk prediction equation in a Northern Italy population.

Methods.
Four independent population-based cohorts were enrolled between 1986 and 1994 from the Brianza population (Northern Italy), adopting standardized MONICA procedures. The study sample comprises n=2574 men and 2673 women, aged 35 to 69 years and free of CVD at baseline. Participants were followed-up for incidence of first coronary and ischemic stroke events (fatal and non-fatal; all MONICA validated) for a median time of 15 years (IQ range: 12-20) and up to the end of 2008. We compared several gender-specific Cox Proportional Hazards models: the basic one includes age, total cholesterol, HDL-cholesterol, systolic blood pressure, anti-hypertensive treatment, cigarette smoking and diabetes. Candidates to model addition were diastolic blood pressure, triglycerides, BMI, family history of CHD, and education. Model calibration was tested using the Grønnesby-Bogan goodness-of-fit statistic. The Area Under the ROC-Curve (AUC) was a measure of discrimination, corrected for over-optimism via bootstrapping. Changes in discrimination (Δ-AUC) and reclassification (Net Reclassification Improvement, NRI) defined the improvement from the basic model due to an additional risk factor. Intermediate risk was defined as 20-year risk between 10% and 40%.

Results.
We observed n=286 events in men (incidence rate 7.7 per 1000 person-years) and n=108 in women (2.6 per 1000 person-years). All risk factors included in the basic model were predictive of first cardiovascular event in both genders; discrimination was 0.725 and 0.802 in men and women, respectively. Average specificity in the top risk quintile (cut-off value: 23% in men and 8.5% in women) was similar in men and women (85% vs. 83%), while sensitivity was higher in women (63% vs. 46%). All the models were well-calibrated (p-values >0.05). The addition of a positive family history of CHD in men (Hazard Ratio: 1.6; 95%CI 1.2-2.1) and of diastolic blood pressure in women (HR: 1.4 for 11 mmHg increase; 1.1-1.8) significantly improved discrimination (Δ-AUC=0.01; 95%CI 0.002-0.02 [men] and Δ-AUC=0.005; 95%CI 0.0001-0.01 [women]) and reclassification of subjects at intermediate risk (NRI=8.4%;1.7%-19.1% [men]; and NRI=11.7%; -3.2%-33.5% [women]).

Conclusions.
Traditional risk factors are predictive of cardiovascular events after 20 years, with good discrimination. The addition of family history of CHD may contribute to model improvement, at least among men; the role of diastolic blood pressure in women should be carefully evaluated.
Abstract P369: Left Ventricular Hypertrophy and Coronary Heart Disease Risk Reclassification in Blacks and Whites: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Okwuosa Tochi , Soliman Elsayed Z , Alonso Alvaro , Williams Kim A , Lopez Faye , Ferdinand Keith C
Published: July 2021

Introduction:
Left ventricular hypertrophy (LVH) is more prevalent in blacks than whites, and is a major independent predictor of coronary heart disease (CHD)/CVD survival in blacks. We evaluated the ability of LVH to predict CHD outcomes beyond traditional cardiovascular risk factors in blacks, compared with whites from a large community-based cohort.

Methods:
Data were analyzed on 14,489 participants (mean age 54 +/- 5.7 years, 43.5% men, and 26% black) within the ARIC cohort, with baseline (1987-1989) electrocardiograms (ECG), followed through 2009. Risk estimates for incident CHD were assessed using the 10-year Framingham Risk Score (FRS). Model 1 was the Framingham base model, while model 2 included the base model plus LVH by any of 11 traditional ECG-LVH criteria (Table). Net reclassification improvement (NRI) was calculated, and the distribution of risk was compared using model 2 vs. model 1.

Results:
There were 690 (4.8%) 10-year and 1515 (10.5%) 20-year CHD events. LVH defined by any criteria was associated with CHD events in the entire cohort [HR (95% CI): 1.42 (1.20-1.7)]. LVH defined by the Framingham ECG score and LV strain criteria were the criteria most associated with CHD overall. LVH by Framingham ECG score was most associated with CHD in blacks [HR (95%CI): 2.53 (1.65-3.89)], while LV strain showed the strongest association with CHD in whites [1.73 (1.18-2.56)]. No statistically significant improvement in NRI or C-statistic was observed in model 2 [C-statistic (95% CI): 0.779 (0.763-0.794), NRI = 0.006 (p = 0.41)], compared with the base model [0.777 (0.762-0.792)]; and no racial interactions were observed. Findings were unchanged when the base model was replaced with the 10 and 20-year ARIC risk model (includes diabetes) for CHD.

Conclusions:
In this cohort of black and white men and women, LVH (defined by ECG) was significantly associated with CHD after adjustment for FRS; but did not significantly improve CHD risk prediction beyond the FRS. No significant black-white differences in risk prediction were observed.

Table. Reclassification of Coronary Heart Disease by the addition of each Criterion for Left Ventricular Hypertrophy, based on a 10-year Framingham Risk Model
* Base model factors in age, gender, current smoking, diabetes, systolic blood pressure, diastolic blood pressure, HDL cholesterol and total cholesterol as separate variables.

* NRI categorized as <10%, 10-20% and >20%.

Abbreviations:
NRI = Net Reclassification Index, IDI = Integrated Discrimination Index, HR = Hazard Ratio, CI = Confidence Interval
Abstract P383: Walking Speed is a Significant Indicator of Vascular Health in Late Midlife Women: The Study of Women’s Health Across the Nation
Authors: El Khoudary Samar R , Chen Hsiang-Yu , Barinas-Mitchell Emma , McClure Candace , Sternfeld Barbara , Khalil Naila , Jackson Elizabeth , Karvonen-Gulierrez Carrie , Ylitalo Kelly , Sutton-Tyrrell Kim
Published: July 2021

Objective:
Wider adventitial diameter (AD) is correlated with adverse cardiovascular risk factors and a higher risk of CVD. A dilated artery cannot adapt as well to adverse conditions, which may make it more vulnerable to damage. Slower walking speed, a physical functioning (PF) performance measure, is associated with subclinical measures of atherosclerosis and increased mortality in the elderly. The relationship between PF performance measures and AD, an informative measure of vascular health, has not been evaluated. We assessed whether walking speed and time needed for sit-to stand assessment are associated with carotid AD in a large sample of multi-ethnic, late midlife women. The associations with carotid intima-media thickness (IMT) and presence of carotid plaque were also evaluated.

Design:
Participants from the Study of Women’s Health Across the Nation who were free of CVD and had carotid AD, IMT or presence of carotid plaque assessed at the 12th annual visit were evaluated. Average 40-foot walking speed (calculated as 12.192 meters/time in seconds) (2 repetitions) and average time in seconds needed for sit-to-stand assessment (5 repetitions) were measured at the same time. Linear and logistic regression models were used as appropriate.

Results:
A total of 1224 women (96.9% Postmenopausal; 52.0% Caucasian, 27.9% African American, 14.3% Chinese, 5.8% Hispanic) from 6 sites across the USA, aged 59.6±2.7 years old at visit 12, were included. In models adjusted for site, race, current age, menopausal status and systolic blood pressure, slower walking speed and longer time needed for sit-to-stand (log-transformed) were significantly associated with a wider AD (β(SE):0.43(0.08) mm, P<0.0001; 0.20(0.05) mm, P=0.0002, respectively), a thicker IMT (β(SE):0.05(0.01) mm, P=0.001; β(SE):0.03(0.01) mm, P=0.008, respectively) and a higher probability of presence of carotid plaque (OR (95% confidence interval [CI]) :1.82(1.09,3.04), only with walking speed). Associations between PF performance measures and IMT as well as the association between walking speed and presence of carotid plaque became non-significant after further adjustment for current body mass index. Associations between slower walking speed and wider AD (β(SE):0.18(0.08) mm, P=0.03 ) remained significant even after additional adjustment for current body mass index, lipids, insulin resistance (HOMA index), smoking, ever use of antihypertensive/lipid lowering/heart medications, ever use of hormone therapy and ever reported presence of diabetes.

Conclusions:
Simple objective PF performance measures such as 40-foot walking speed could be a useful tool to assess vascular health. Women with slower walking speed may be at a greater risk of vascular-related diseases.
Abstract P388: Association of Clinical Characteristics and Cardiopulmonary Risk Factors with Aortic and Pulmonary Arterial Enlargement by Magnetic Resonance
Authors: Chuang Michael L , Gona Philimon , Salton Carol J , Tsao Connie W , Yeon Susan B , O’Donnell Christopher J , Manning Warren J
Published: July 2021

Purpose:
To determine the association of clinical characteristics and cardiopulmonary risk factors with aortic and main pulmonary artery (MPA) enlargement by cardiovascular magnetic resonance (CMR).

Methods:
1794 Framingham Offspring cohort members (65±9 y, 844 M) underwent axial 2D black-blood T2-weighted thoracoabdominal CMR. MPA and ascending (ASC) and descending (DSC) thoracic aortic diameters were measured at MPA-bifurcation level, abdominal (ABD) aortic diameter at 5 mm above renal artery origins. We assessed relationship of arterial diameters to height (HT) and body surface area (BSA) using Pearson correlation and determined sex-specific 90th percentile cutpoints (p90) for ASC, DSC, ABD, and MPA in a referent group free of obesity (BMI≥30), emphysema, myocardial infarction, heart failure, and any history of hypertension (HTN) or smoking. For the overall study sample, multivariable logistic regression was used to determine the association of high (≥p90) vessel diameters with the above risk factors and age, sex and pack-years smoked.

Results:
370 Offspring (157 M) met referent-group criteria. In men neither HT nor BSA correlated with aortic diameter. In women DSC, ABD and MPA correlated with HT and BSA (r=0.14 - 0.25, all p≤0.045), but BSA-indexation gave inverse correlations with HT and BSA (all p<0.0001); HT-indexation gave inverse correlations with HT (all p≤0.045). Thus we used unindexed p90 cutpoints of (M,W): ASC=34.9, 31.8mm; DTA=25.3, 22.7mm; ABD=20.0, 17.3mm; MPA=26.6, 24.2mm. Prevalence of and MV-adjusted odds ratios for high diameter are in the Table (N=1794). Obesity was globally and most strongly associated with overall vessel enlargement. ABD enlargement was associated with total pack-years, but not with positive smoking history.

Conclusions:
ABD enlargement was slightly more prevalent in women. In both sexes MPA and general aortic enlargement are associated with greater age and obesity, but smoking (as pack years) was associated with ABD enlargement only and HTN with the thoracic aorta only.
Abstract P391: Marine N-3 Fatty Acids Reduce Atherosclerosis Cardiovascular Disease: A Systemic Review and Meta-analysis of Clinical Trials
Authors: Sekikawa Akira , Hirooka Nobutake , Vishnu Abhishek , Ahuja Vashudha , Sampene Emmanuel , Klem Mary Lou , Desai Krishna , Okamura Tomonori , Evans Rhobert W , Miura Katsuyuki , Willocx Bradley , Masaki Kamal , Ueshima Hirotsugu , Muldoon Matthew F , Kuller Lewis H
Published: July 2021

Introduction:
Although marine n-3 fatty acids are believed to be cardioprotective through their anti-arrhythmic, anti-thrombotic, anti-atherogenic and other effects, results from recent meta-analyses of marine n-3 fatty acids on cardiovascular disease (CVD) are controversial. We performed a meta-analysis of marine n-3 fatty acids on CVD outcomes in randomized clinical trials (RCTs) to test the hypothesis that marine n-3 fatty acids are anti-atherogenic. We also tested the hypothesis that such benefit is dose-dependent.

Methods:
A systematic review of English language articles using PubMed, EMBASE and Cochrane Library through Aug 2012 was performed selecting RCTs evaluating the effect of marine n-3 fatty acids intake for 2 years or more on cardiovascular diseases, coronary disease, arteriosclerosis, cardiac imaging techniques, and carotid artery ultrasound. Descriptive and quantitative information was extracted. Odds ratios were calculated for cardiac event outcome. Correlation coefficients were obtained from studies of which outcome is intima-media thickness (IMT) and coronary lumen diameter (CD). We converted the estimates into a single effect size; the log odds ratio and its corresponding standard error.

Results:
Of 14,236 citations retrieved, 13 studies were selected, including studies reporting IMT (n=3) and CD (n=2) and major CVD events (n=8). Overall, marine n-3 fatty acids significantly reduced atherosclerotic CVD (RR 0.94: 95%CI 0.90 to 0.99, p<0.05). There was no evidence of heterogeneity (p=0.65) or publication bias (p=0.37, Begg’s test). A sub-analysis among 8 studies of major CVD events showed the similar results (RR 0.94: 95% CI 0.89 to 0.99, p<0.05). Another sub-analysis among 4 studies excluding sudden cardiac death as an outcome showed RR of 0.91 (95% CI 0.82 to 1.02, p=0.097). A meta-regression analysis shows that dose of marine n-3 fatty acids was inversely associated with CVD outcome, although the association was not statistically significant (p=0.06).

Conclusions:
The result of our meta-analysis supports a modest anti-atherogenic effect of marine n-3 fatty acids. This benefit may be proportional to the amount of marine n-3 fatty acids consumed.
Abstract P417: Physical Activity, Physical Fitness and Leukocyte Telomere Length: The Cardiovascular Health Study
Authors: Soares-Miranda Luisa , Imamura Fumiaki , Siscovick David S , Swords Jenny Nancy , Fitzpatrick Annette L , Mozaffarian Dariush
Published: July 2021

Background
The influence of physical activity (PA) and fitness (PF) at older ages on changes in telomere length (TL), repetitive DNA sequences that may mark biologic aging, are not well established. Prior studies in older adults were cross-sectional, and few evaluated PF.

Aim
To investigate both cross-sectional and prospective associations of PA and PF with Leukocyte TL in older adults.

Methods
Among 582 adults age 73±5 y at baseline in CHS having serial LTL measures (leucocyte mean terminal restriction length) in 1992 and 1997, PA (walking pace, blocks, combined walking score; leisure time activity) and PF (15-ft walk, chair stands, grip strength) were assessed multiple times from 1989 to 1997. Cross-sectional associations were assessed using multivariable repeated-measures regression of cumulative average serial PA and PF measures from 1989 to 1992 against LTL in 1992; and cumulative averaged PA and PF from 1993 to 1997 against LTL in 1997. Longitudinal analyses assessed cumulative averaged PA and PF from 1989-92 against later changes in LTL from 1992-97; and changes in cumulative averaged PA and PF from 1989-92 to 1993-97 against changes in LTL from 1992-97. We evaluated all subjects, those without poor/fair self-reported health, and those without limited ADLs.

Results
Cross-sectionally, greater walking distance and chair test performance, but not other PA and PF measures, each associated with longer LTL (
P
trend 0.007, 0.04 respectively). Lab measures of DNA integrity suggested measurable degradation that markedly attenuates ability to detect differences in LTL changes over time, especially over only 5 y. For example, baseline PA and PF from 1989-92 were unassociated with later changes in LTL. In contrast, changes in leisure time activity and chair test performance from 1992-97 were each inversely associated with LTL shortening.

Conclusions
Even late in life, certain PA and PF metrics are associated with longer LTL cross-sectionally and, even with likely substantial measurement error, with less LTL shortening over time.