bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P084: Sex Differences In Testosterone On Interleukin-6 At Baseline And In Response To Mental Stress
Authors: Sullivan Samaah , Young An , Garcia Mariana , Almuwaqqat Zakaria , Moazzami Kasra , Pearce Brad , Hankus Allison , Driggers Emily G , Elon Lisa , Levantsevych Oleksiy , Alkhalaf Mhmtjamil , Jajeh Mohamad N , Shah Amit J , Lewis Tene T , Bremner J Douglas , Quyyumi Arshed A , Vaccarino Viola
Published: April 2022

Introduction:
Young and middle-aged women with ischemic heart disease are a high-risk group for morbidity and mortality particularly after a myocardial infarction (MI). This group exhibits higher concentrations of the inflammatory cytokine interleukin-6 (IL-6) at baseline and in response to mental stress compared to men. The reasons for these differences are unknown; however, sex hormones may play a role. While testosterone has been shown to have anti-inflammatory effects among men; the role of testosterone on inflammatory cytokines among women has been understudied, and no research has examined the influence of testosterone on IL-6 response to stress.

Hypothesis:
Among young and middle-aged patients with a recent MI, higher concentrations of testosterone have anti-inflammatory effects among men at baseline and in response to mental stress; but are associated with greater inflammation among women.

Methods:
We studied 269 patients 61 years old or younger who were hospitalized for a MI in the previous 8 months. We measured plasma IL-6 (pg/mL) before and 90 minutes after mental stress (speech task). Inflammatory response was defined as the difference between IL-6 levels 90-minutes post mental stress and resting values. Serum free testosterone (pg/mL) was measured before mental stress. Differences across sex and time were examined with mixed models for repeated measures after natural log-transformation of IL-6.

Results:
The mean age was 51 years (range: 26-61); 48% were women and 64% African American. Mean values of free testosterone among men and women were 12.6 pg/mL (range: 0.9-29.0) and 1.8 pg/mL (range: 0.3-15.6), respectively. After adjusting for demographic factors (age, race, income), lifestyle and medical history (BMI, hypertension, diabetes, depression) and medication use, the association of testosterone with the IL-6 response to stress differed by sex (p for testosterone-by-sex-by-time interaction = 0.06). Among men, higher levels of testosterone were associated with lower concentrations of IL-6 at rest (β = -0.04; p = <.0001), but was attenuated after stress (β = -0.001; p = 0.93). This change in slopes across time or inflammatory response for men was significant (p = <.0001). In contrast, among women, higher levels of testosterone tended to be associated with higher IL-6 at rest (β = 0.04; p = 0.07) and after stress (β = 0.04; p = 0.14), indicating no change between time points or inflammatory response to stress (p=0.75).

Conclusions:
Among young and middle-aged survivors of a recent MI, higher concentrations of free testosterone are associated with lower inflammation among men, but with an opposite trend of higher inflammation among women.
Abstract P104: High Lead Levels Associated With Elevated Blood Pressure In Haiti: A Warning Sign
Authors: Yan Lily D , Rouzier Vanessa , Lookens Pierre Jean , Lee Myung Hee , Muntner Paul , Parsons Patrick J , Apollon Alexandra , Malebranche Rodolphe , Pierre Gerard D , Emmanuel Evens , Nash Denis , Kingery Justin , Walsh Kathleen F , Smith Caleigh , Metz Miranda , Tymejczyk Olga , Deschamps Marie , Pape Jean William , FITZGERALD Daniel , Mcnairy Margaret
Published: April 2022

Introduction:
Cardiovascular disease is the leading cause of death in Haiti and many low-middle income countries. Environmental lead exposure is associated with higher blood pressure (BP) and cardiovascular disease mortality in high income countries but has not been systematically evaluated in lower income countries where 6.5 billion people reside.

Hypothesis:
We hypothesized higher lead levels would be associated with higher BP in Haiti.

Methods:
Blood lead levels (BLLs) were measured among 2,257 participants ≥18 years enrolled in a population-based longitudinal cohort study in Port-au-Prince (Haiti Cardiovascular Disease Cohort Study). BLL screening was conducted using LeadCare II (detection limit ≥3.3 μg/dL). BLLs below detection were imputed. Associations between BLLs (quartiles) and systolic BP (SBP) and diastolic BP (DBP) were assessed, adjusting for age, sex, obesity, smoking, physical activity, and income. BLLs were also categorized as ≥5 versus <5 μg/dL.

Results:
The median age was 40 years; 62.6% were female. The geometric mean BLL was 4.60 μg/dL, 67.3% had detectable BLLs >3.3 μg/dL, and 40.9% had elevated BLLs ≥5 μg/dL. BLLs in quartile four (≥6.5 μg/dL) in both unadjusted and adjusted analyses were associated with higher SBP (adjusted 3.02 mmHg; 95%CI 0.80, 5.25) and DBP (adjusted 2.19 mmHg; 95%CI 0.70, 3.67). BLL ≥5 μg/dL were associated with a higher SBP (2.21 mmHg; 95%CI 0.15, 4.26) and DBP (1.50 mmHg; 95%CI 0.20, 2.81) in unadjusted analysis. After adjustment there was no difference in SBP (1.41; 95%CI -0.25, 3.09) and 1.15 mmHg (95%CI 0.01, 2.30) higher DBP.

Conclusions:
Widespread environmental lead exposure is evident in urban Haiti, with higher BLLs associated with higher SBP and DBP. Lead is a modifiable pollutant in low-income countries that warrants urgent public health remediation.
Abstract P116: Hypertension Severity As Quantified By Hypertension Daily Dose (HDD) And Blood Pressure And Risk Of Stroke In The REGARDS Study
Authors: Loo Ying K , Wilkinson Katherine , Harkness Tyler A , Howard George , Howard Virginia J , Judd Suzanne E , Zakai Neil A , Muntner Paul , Min Lillian , Oparil Suzanne , Plante Timothy B
Published: April 2022

Background:
Hypertension is a modifiable stroke risk factor, but hypertension severity isn't completely captured by blood pressure (BP) alone. Prior studies have shown that among adults with similar systolic BP, those taking a greater number of antihypertensive medications have greater stroke risk. However, count of antihypertension medications does not consider relative dose across classes and incompletely characterizes hypertension medical therapy. The recently described Hypertension Daily Dose (HDD) metric quantifies total dose of BP-lowering medications across multiple classes. The association between HDD and BP with stroke risk is unknown.

Objective:
Determine stroke risk by HDD and BP levels.

Methods:
We included Black and White adults from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study without prevalent stroke at visit 2 (2013-2017; treated as baseline) with follow-up data and full BP assessment. We classified systolic BP using JNC7 groupings and HDD by no BP medications and tertiles among those on BP medications. Cox proportional hazards models estimated hazard ratios (HR) for incident stroke by HDD group and BP group.

Results:
Of 13,265 participants included (mean age 72 [SD 8.5], 36% Black race, 56% women), 344 incident stroke events occurred during a median follow-up of 5.5 years. The stroke rate was higher among Black than White participants (5.6 vs. 5.0/1000 person-years). Relative to no BP medications and normotension, those with systolic BP ≥140 mm Hg and HDD in tertiles ≥2 had a 2.3x to 3.7x greater risk of incident stroke (
Table
). Those with systolic BP <140 mm Hg had similar stroke risk across HDD groupings.

Conclusion:
Among Black and White US adults without prevalent stroke, higher HDD was associated with greater risk of incident stroke in those with systolic BP ≥140 mm Hg, possibly reflecting greater disease severity and treatment resistance. These findings support aggressive BP control with antihypertensive medications to lower stroke risk among adults with hypertension.
Abstract P119: Conceptualizing Cultural Safety When Implementing A Community Based Substance Use Intervention Study Among Urban Native American Youth
Authors: Wimbish-Tompkins Rose
Published: April 2022

Background:
This study was conducted in the United States of America among Urban Native American (NA) youth attending two urban NA youth programs within the State of Florida.

Aim:
To culturally tailor the evidence-based Lowe (2016) Keetoowah-Cherokee Talking Circle intervention for substance use prevention among Keetoowah-Cherokee youth to that of an Urban Taking Circle (UTC) intervention for use among urban NA youth.

Method:
The integration of a culturally relevant theory, Native-Reliance, a community-based program approach, and cultural safety principles guided the intervention study method. The study implemented a 2-condition quasi experimental design and utilized convenience and snowball sampling methods for recruiting 100 urban NA youth as study participants. Participants originated from two urban NA community programs and were randomized by program site. Statistical analysis using multivariate analysis of variance (MANOVA) provided the means for determining if there were significant differences between the scores on measures at pre-intervention (baseline) and post-intervention.

Results:
Data findings indicated there is a direct relationship between the urban NA youth participants’ interests in engaging in drug use, alcohol consumption, and commercial tobacco smoking. However, additional findings provide evidence that a culturally based intervention was significantly more effective for the reduction of these substance use interests and general well-being than a non-culturally based intervention for urban NA youth.

Conclusion:
Study findings also indicated that supporting Urban NA youths’ utilization of urban NA values and beliefs promoted healthy behavior. Culturally safe interventions that support urban NA youth as a means in reducing harm associated with high-risk behaviors, such as substance use, is strongly recommended.

Impact Statement:
During each phase of the study, its method established assurance of cultural safety by operationalizing Native Reliance Theory. Therefore, an in-depth examination of the study methods with cultural safety principles is presented in context and warranted.
Abstract P131: Cerebral Venous Sinus Thrombosis Risk Factors, Treatments, And Sequelae: 2011-2019
Authors: Walker Rob F , Lutsey Pamela L , Zakai Neil A , Maclehose Richard F , Adrianzen-Herrera Diego , Alonso Alvaro , Adam Terrence J
Published: April 2022

Introduction:
Cerebral venous sinus thrombosis (CVST) is a rare but potentially debilitating thrombosis affecting 3-4 cases per million adults in the United States. Risk factors are thought similar to venous thrombosis, but there is little epidemiologic data corroborating this assertion. Concern about a possible association between the Janssen (Johnson and Johnson) and Oxford-AztraZenaca COVID-19 vaccines and cases of CVST resulted in increased global attention to this condition. Thus, large epidemiological assessment of the risk factors, treatment and outcomes of CVST are needed.

Objective:
Estimate the distributions of risk factors antecedent to CVST diagnosis, report CVST treatments in clinical practice, and potential sequelae of CVST in a large retrospective cohort of adults with CVST in the United States.

Methods:
MarketScan Commercial and Medicare Supplemental administrative databases were employed to assess CVST diagnosed between 2011 and 2019 in the U.S. Validated International Classification of Disease (ICD) codes and receipt of an outpatient anticoagulant (either oral or subcutaneous anticoagulant) prescription within 30 days of the ICD code identified incident CVST. Antecedent clinical characteristics, treatments, and sequelae of CVST were identified using inpatient, outpatient, and prescription data. For outcomes, proportions and incidence with 95% confidence intervals (CIs) were calculated, stratified by sex.

Results:
We identified 1,869 CVST patients. Of these 1,314 (70%) were female, with 200 (10%) events identified as a pregnancy-related CVST. The average age was 41 years for females and 48 years for men. Among women, 24.7% were on hormonal therapy (oral contraceptive, estrogen, and progestin) prior to diagnosis. Men had a higher prevalence of comorbidities, such as diabetes (15% men vs. 9% women) and cancer (19% men vs. 10% women). Oral anticoagulant (OAC) use was the most common treatment for CVST in both men (88%) and women (85%) and did not vary by sex. Use of procedures to treat CVST, optic nerve fenestration and catheter directed thrombolysis, were 0.5% and 4.1%, respectively. The most common sequela after CVST was incidence of intracranial hypertension (Incidence: 4.2 per 100 person-years; 95% CI: 3.3, 5.1) and palliedema was rare.

Conclusions:
Overall, a majority of CVST patients were women of reproductive age. Our findings suggest a potential association with both endogenous (pregnancy) and exogenous (oral contraceptives, HRT) hormones which needs further study. In our sample, CVST was managed with oral anticoagulants, regardless of sex, and intracranial hypertension was elevated following CVST. This large claims-based analysis is a descriptive insight into the risk factors and management of CVST, a rare and debilitating condition.
Abstract P139: Changes In Sex Hormones In Premenopausal Black And White Women Associated With Childbearing: The Cardia Women’s Study.
Authors: Dabeer Sadaf , Ingram Katherine H , Appiah Duke , Wellons Melissa , Kim Catherine , Vaidya Dhananjay , Siscovick David S , Lewis Cora E , Quesenberry Charles , Schreiner Pamela , Calderon-Margalit Ronit , Sarkar Monika , Gunderson Erica P
Published: April 2022

Introduction:
Sex hormone binding globulin (SHBG) levels in blood are associated with bioavailability of sex hormones, glucose metabolism, and cardiometabolic health of premenopausal women. Low SHBG levels are associated with insulin resistance in women. Pregnancy is characterized by 6-10-fold increase in SHBG levels. This study is designed to evaluate the long-term associations among pregnancy, and SHBG, free and total testosterone levels in premenopausal women.

Methods:
Premenopausal women, aged 20-32 years, from the CARDIA Women’s Study cohort were tested for levels of serum SHBG, free testosterone, and total testosterone. Hormonal, anthropometric, socio-demographic, and behavioral data, along with self-reported pregnancy and birth data, were collected at baseline (1987-88 [Y0]; n=1,191) and after eight years (Y8; n=809) and 14 years (Y14; n=474) for follow-up. Participants who were pregnant, breastfeeding, had diabetes, hysterectomy, or were using oral contraceptive at any time point were excluded. Participants were divided in parity groups of 0, 1, and 2+births for analyses. Eight-year decrements of SHBG, free and total testosterone were used for primary analyses and 14-year decrements were used for secondary analyses

Results:
SHBG levels decreased more in parous than nulliparous women in a fully adjusted model including race, CARDIA field center, age, education, alcohol, smoking status, baseline BMI, weight gain and change in waist girth. Total testosterone decreased more in parous women between Y0-Y10 but not thereafter. No significant differences in free testosterone levels were observed among parity change groups in fully adjusted models. Hormone decrement analyses from fully adjusted model

Conclusion:
Childbearing is associated with a more pronounced long term decrease in SHBG but not with free testosterone levels in premenopausal women. A strong association was observed among parity and total testosterone decrements at 8-year but not 14-year follow-up.
Abstract P140: Short-chain Fatty Acids Levels Are Lower In Women With Preeclampsia
Authors: Zhao Jianbo H , Liu Tiange , McArthur Kristen , Mueller Noel T
Published: April 2022

Introduction:
Preeclampsia (PE) is a pregnancy-associated hypertension disorder with high morbidity and mortality. Short-chain fatty acids (SCFAs)—molecules produced by gut microbes—have been associated with hypertension, yet their relation to PE remains uncertain.

Objectives:
To review existing human studies that have examined associations of the major SCFAs (acetate, propionate, and butyrate) in pregnancy with the development of PE.

Methods:
Two reviewers independently searched online databases (EMBASE, PubMed, Web of Science, and Cochrane Database of Systematic Reviews) in January 2021 using the following terms: “short-chain fatty acids”, “acetic acid”, “butyric acid”, “propionic acid”, and “preeclampsia”. The final set of included studies had to: report associations of SCFAs with PE, be peer-reviewed, be written in English, and be in humans.

Results:
We screened the abstracts of 723 studies; 19 underwent full-text screening and 7 (980 total participants, 186 with PE) were included in the final review. All studies used a case-control design, but measured SCFAs from a range of bio-specimens (e.g., serum, plasma, feces, amniotic fluid) collected at distinct time points in pregnancy. Four studies showed that acetate was significantly (P<0.05) lower in women with PE compared to healthy women; the other three studies also found acetate was lower in PE cases, albeit the association was non-significant. All three studies that investigated butyrate found it was lower in PE cases vs. controls. The same three studies also reported lower propionate among PE cases vs. controls, though only one of them was statistically significant. Results did not materially differ by bio-specimen or time-point in pregnancy.

Conclusions:
Current evidence, which derives only from case-control studies, indicates that lower SCFA levels in pregnancy (measured in amniotic fluid, blood, and feces) may be related to the development of PE. Large cohort studies are warranted to further investigate this association.
Abstract P147: Characterizing Self-reported Religious Affiliation Among Patients With Vascular Disease And Associations With Health Risk Behaviors
Authors: Powell Chloe A , Kim Gloria Y , O'Connor John P , Byrnes Mary E , Coleman Dawn M , Corriere Matthew A
Published: April 2022

Introduction:
Religion is an important aspect of personal identity, which is linked to education and wealth. Religion is changing in prevalence, notoriously difficult to obtain from surveys, and seldom accounted for in clinical research. We characterized religious affiliation among patients with common diagnoses treated by vascular surgeons and explored associations with patient-level factors and health risk behaviors.

Hypothesis:
We hypothesize health risk behaviors will be more common among vascular patients that are unaffiliated with a particular religion.

Methods:
Patients treated from 2019-2021 at a single center with vascular disease (abdominal aortic aneurysm; carotid, renal, or mesenteric stenosis; or peripheral artery disease) were identified. Self-reported religious affiliation was obtained from the medical record. Patients self-reporting any religion (regardless of religion name or denomination) were categorized as religion-affiliated (RA); self-reporting as atheist, agnostic, or no religion were categorized as unaffiliated (UA). Health risk behaviors were evaluated as individual outcomes and in aggregate based on heavy drinking (per CDC recommendations), tobacco, or illegal drug use. Statistical comparisons used chi-square and Wilcoxon scores.

Results:
Among 3,568 patients identified, 3,247 (91%) had self-reported religion and form the basis of analysis. 2198 (67.7%) reported RA, and over 40 denominations were identified. RA was more common among women [70.3% (1041 of 1480) vs. 65.5% (1157 of 1767); P=0.003] and married patients [71.1% (1162 of 1635) vs. 65.5% (598 of 913): P=0.003]. RA by race was most common among African American patients [70.9% (158 of 223)] and least common among Asians [48.2% (26 of 54)] (P=0.002). Self-reported health risk behaviors were more common among UA patients [33.2% (348 of 1049) versus 27.2% (598 of 2198); P<0.001], who also had a higher median weekly alcohol consumption (1.2 [IQR 3.6] vs. 0.6 [IQR 2.4] ounces; P=0.024).

Conclusions:
Self-reported RA is associated with demographics and health risk behaviors among vascular patients. Interventions leveraging religious organizations and leaders may not reach nearly one third of patients who are UA. Future work will explore associations with socioeconomic factors and surgical outcomes.
Abstract P149: The Relationship Between Daytime Sleepiness, Exhaustion, Fatigue, And Arterial Stiffness. The Atherosclerosis Risk In Communities (ARIC) Study
Authors: Newton Michael A , Heiss Gerardo M , Barinas-Mitchell Emma , Lutsey Pamela L , Tanaka Hirofumi , Gellert Kapuaola S , Stoner Lee , Meyer Michelle L
Published: April 2022

Background:
Excessive Daytime Sleepiness (EDS) is positively associated with the risk of cardiovascular disease (CVD) events and CVD mortality. However, the association between EDS and subclinical markers of CVD, such as arterial stiffness, is not fully understood and could have implications for CVD screening. EDS is multifactorial in origin, thus we incorporated measures of exhaustion and fatigue in order to comprehensively assess the association of lethargy and central artery stiffness. We examined the separate relationships between EDS, exhaustion, fatigue, and aortic stiffness via carotid-femoral pulse wave velocity (cfPWV) in a large population-based study.

Methods:
A cross-sectional analysis of ARIC Study participants (n=2500, mean age: 79.7, 57.2% female) who underwent arterial stiffness measurements (cfPWV) and completed the Epworth Sleep Scale (ESS) questionnaire in 2016-2019. EDS was defined as ESS 11. Exhaustion was derived from the Center for Epidemiological Study’s Depression (CES-D) scale, with positive exhaustion corresponding to increased effort in daily activities and noticeable difficulty in getting “going’. Fatigue was assessed at annual follow up calls in 2012-2013 and calculated as a summary score with participants responses about feeling tired in various scenarios in the past 7 days noted as a numeric value (1-5: never, rarely, sometimes, often or always). We used multivariable linear regression to estimate the association between ESS, exhaustion, and fatigue with cfPWV, adjusting for age, race-study center, body mass index, diabetes, heart rate, mean arterial pressure, and blood-pressure medication use. We evaluated potential effect modification by race, sex, diabetes, and hypertension. Results are presented as unstandardized beta coefficients (β) and 95% confidence intervals (CI).

Results:
A total of 14.2% participants reported EDS, 17.2% reported exhaustion, and the average fatigue score was 8.0. ESS was not associated with cfPWV when adjusting for covariates (β; 95% CI: -1.4; -4.7, 1.9). Similarly, EDS was not associated with cfPWV (β; 95% CI: -4.9; -40.4, 30.6), nor was there an association between ESS quartiles and cfPWV. However, both exhaustion (β; 95% CI: 40.4; 7.8, 73.0) and fatigue (β; 95% CI: 5.4; 0.6, 10.3) were positively associated with cfPWV after adjusting for covariates. There was no evidence of effect modification by race, sex, diabetes, or hypertension.

Conclusion:
EDS was not associated with arterial stiffness. A (positive) association was observed for both exhaustion and fatigue with cfPWV, suggesting a need for further investigation of fatigue related conditions and arterial stiffness in older adults.
Abstract P151: Higher Gut Microbiota Diversity And Abundance Of Butyrogenic Species Are Associated With Lower Pulse Wave Velocity In The Baltimore Longitudinal Study Of Aging
Authors: Differding Moira K , Tanaka Toshiko , Tilves Curtis , Spira Adam P , Ferrucci Luigi , Mueller Noel T
Published: April 2022

Background:
Gut microbiota, particularly butyrogenic species, may affect risk of cardiovascular disease through effects on arterial stiffness. However, studies on gut microbiota and arterial stiffness in human population studies are sparse, with no prior studies having used shotgun metagenomic sequencing to identify species.

Objective:
To investigate associations of gut microbiota with measures of arterial stiffness as measured by pulse wave velocity (PWV).

Methods:
We studied 780 adults from the Baltimore Longitudinal Study of Aging who provided feces for shotgun metagenomic microbiome sequencing and at least 1 measure of carotid-femoral PWV between 2013 and 2017. We examined associations of PWV (continuous and as quartiles) with gut microbiome features using beta-binomial and linear regression models for microbiota relative abundances; linear regression models for microbial alpha diversity (Shannon index); and PERMANOVA for microbial beta diversity (Weighted Unifrac distance). We adjusted all models for age, sex and race. We used an FDR-threshold of q <0.05 for abundance models.

Results:
Approximately 55% of our sample were female and 65% identified as white, with a mean age of 71 years. Microbial beta diversity was significantly associated with PWV (Weighted UniFrac p=0.003, R
2
=0.01), and a 1-SD increase in (Shannon index) alpha diversity was associated with a 0.21 decrease in PWV (p=0.002). Twelve species were associated with continuous PWV, including 4 key butyrate producers in dose-response fashion (Figure). These findings persisted after further adjustment for Mediterranean diet score.

Conclusion:
Higher microbial diversity and abundance of key butyrogenic bacteria were associated with lower arterial stiffness in a racially diverse cohort of US adults. Some of the species associated with arterial stiffness, e.g.
F.
prausnitzii
and other taxa in Figure, have been previously associated with lower cardiovascular disease risk. Clinical trials are needed to determine if these relationships are causal.
Abstract P152: The Association Between Menopause Age And Carotid Plaque In The Multi-Ethnic Study Of Atherosclerosis (MESA)
Authors: Rodriguez Carla , Ogunmoroti Oluseye , Kazzi Brigitte , Whelton Seamus P , Rodriguez Brian , Osibogun Olatokunbo I , Honigberg Michael , Thamman Ritu , Harrington Colleen , Stein James H , Michos Erin D
Published: April 2022

Background:
The menopause transition is associated with an accelerated rise in cardiovascular disease (CVD) risk among women. Early-onset menopause is associated with incident CVD events. Detection of subclinical atherosclerosis may be an opportunity to institute preventive efforts before the onset of clinical CVD. We assessed whether menopause age was associated with carotid plaque, a marker of subclinical atherosclerosis, in a multiethnic cohort.

Methods:
We studied post-menopausal women in MESA free of CVD who had age of menopause onset ascertained by questionnaire and carotid plaque measured by B-mode ultrasound at baseline. Menopause age was categorized as <45, 45-<50, 50-<55 (ref) and ≥55 yrs. Multivariable logistic and linear regression models were performed to evaluate the association of menopause age with carotid plaque presence (yes/no) and extent (carotid plaque score (CPS)), respectively.

Results:
Of the 2,297 women included, 38% were White, 28% Black, 12% Chinese, and 22% Hispanic with a mean age (SD) of 64 (9) yrs. The distribution of menopause age was 22.7% at age <45, 28.8% at age 45-49, 36.1% at age 50-54, 12.5% at age ≥55. Overall, carotid plaque was present in 52%. The association of carotid plaque presence/absence and CPS are shown in the
Table
. There was no statistically significant association of menopause age with carotid plaque presence. Compared to women with menopause age 50-55, menopause before age 45 was significantly associated with a 9% greater CPS [percent difference 9 (95% CI 2, 17) after adjusting for demographics. This was attenuated and no longer statistically significant after further adjustment for CVD risk factors.

Conclusion:
In a multiethnic cohort of women, a younger age of onset of menopause was associated with a greater extent of carotid plaque, which appears to be mediated through traditional CVD risk factors. Further studies are needed to evaluate the association between the age of onset of menopause and atherosclerotic risk.
Abstract P163: Gut Microbiome And Stages Of Diabetes In Middle-aged Adults: CARDIA Microbiome Study
Authors: Hu Yi-Han , Meyer Katie , Lulla Anju , Meirelles Osorio , Launer Lenore J
Published: April 2022

Background:
Animal and human studies suggest the gut microbiome may be linked to insulin resistance and to diabetes. Results from population-based studies are limited and different stages of diabetes in relation to the gut microbiome have not been investigated.

Objective:
Examine cross-sectional associations of insulin resistance (IR), duration of diabetes, and 4 stages of diabetes (normoglycemic, prediabetes, and diabetes with (+) and without (-) anti-diabetic medication) with gut microbiome community composition in the Coronary Artery Risk Development in Young Adults (CARDIA).

Method:
The analysis is based on 605 Black and White participants who attended CARDIA’s Year 30 follow-up examination (2015-2016; aged 48-60 years). Using previously described methods, DNA from stool samples was sequenced using 16S rRNA method. We included 3 genus-level gut microbiome composition measures: alpha-diversity (Shannon index and richness), beta-diversity (Bray-Curtis dissimilarity matrix, PERMANOVA test), and taxonomy. For the analysis, the HOMA-IR levels at Years 25 and 30 were averaged; and diabetes duration was calculated as the sum of years starting at the Year 2 exam. Multivariable-adjusted regressions were used to assess associations of diabetes-related exposures with microbial features, adjusting for socio-demographics, clinical measures, health behaviors, and medication use. Genus-specific analysis was adjusted for multiple comparisons using a false discovery rate (FDR), with significance set to q-value <0.1.

Results:
Among 605 participants, 20% had prediabetes, and 15% had diabetes (9% on anti-diabetic medication treatment) at Year 30. Compared to those without diabetes, richness and Shannon index were inversely associated with diabetes duration and diabetes with treatment but not with HOMA-IR or prediabetes. PERMANOVA tests were significant for all diabetes-related exposures (p-values<0.05). After multivariable and FDR adjustment, 3 genera (all negative associations) were associated with HOMA-IR, 22 genera (2 positive associations) with diabetes duration, and 4 genera (1 positive association) with diabetes+. No genera were associated with prediabetes. There was reduced abundance of several butyrate producers in participants with higher HOMA-IR (ex.,
Lachnospiraceae_UGG.004
and
Veillonella
), longer diabetes duration (ex.,
Agathobacter
and
Ruminococcus
), or diabetes+ (ex.,
Agathobacter and Romboutsia)
.

Conclusion:
This study indicates significant associations of the gut microbiota composition with glycemic control and insulin resistance, which can contribute to our understanding of diabetes pathophysiology and its prevention and management. Certain butyrate-producing bacteria may play a beneficial role in glucose metabolism and insulin regulation. Future studies with longer-term follow-ups are warranted to explore the relevant mechanisms.
Abstract P167: Soluble CD14 Level And Incident Diabetes Mellitus Risk: The Reasons For Geographic And Racial Differences In Stroke (REGARDS) Study
Authors: Cruden Kaileen , Koh Insu , Kamin Mukaz Debora , Plante Timothy B , Reiner Alex P , Zakai Neil A , Carson April P , Long Leann , Cushman Mary , Olson Nels C
Published: April 2022

Introduction:
CD14 is a pattern recognition receptor that plays important roles in the inflammatory response. Circulating soluble CD14 (sCD14) is generated by hepatocyte secretion during the acute phase response and by cleavage from immune cell surfaces, and levels are higher in White than Black individuals. CD14 is implicated in adipose tissue-mediated inflammation and insulin resistance in experimental animal models and in some cross-sectional cohort studies. Prospective studies of sCD14 and incidence of diabetes mellitus (DM) are limited. We evaluated the prospective association of sCD14 with incident DM risk in participants of the REGARDS study.

Methods:
At the baseline study examination in 2003-07, REGARDS recruited 30,239 Black and White participants aged 45-years and older from across the contiguous U.S. A second in-home visit occurred in 2013-16. sCD14 was measured by ELISA in baseline serum samples among participants of the REGARDS Biomarkers as Mediators of Racial Disparities in Risk Factors (BioMedioR) study, a nested race- and sex-stratified random sample of 4400 participants who completed the first and second REGARDS visits. Poisson regression models estimated risk ratios (RR) of incident DM per 1-SD increment higher sCD14, with tiered adjustment for risk factors. We tested a priori for a sCD14-by-race interaction (p
interaction
significance threshold <0.10).

Results:
Among REGARDS BioMedioR participants there were 475 cases of incident DM over a mean follow-up of 9.5 years. Adjusting for age, sex, and body mass index, the sCD14-by-race interaction term was statistically significant (p-interaction=0.05). In analyses stratified by race, higher sCD14 was associated with incident DM in White (RR: 1.18; 95% CI: 1.04, 1.35) but not Black participants (RR: 0.97; 95% CI: 0.86, 1.09). In models additionally adjusted for education, income, lipids, hypertension, and physical activity, the association of higher sCD14 with DM risk was attenuated among White participants (RR: 1.10; 95% CI: 0.95, 1.27) and slightly accentuated among Black participants (RR: 0.89; 95% CI: 0.80, 1.00), although these associations were not statistically significant.

Conclusions:
sCD14 is differentially associated with risk of DM by race with higher levels associated with increased risk among White but not Black adults. Observed associations were explained by other risk factors, providing clues as to potentially novel mechanisms of their association with DM.
Abstract P168: The Association Between Bariatric Surgery And Cardiometabolic Risk Factors: The National Health And Nutrition Examination Survey
Authors: Molinsky Rebecca , Ikramuddin Sayeed , Siddiqui Fayez , Demmer Ryan
Published: April 2022

Introduction:
Bariatric surgery leads to significant weight loss and improvements in cardiometabolic risk factors. To date, limited data exist investigating the relationship between bariatric surgery and markers of impaired glucose regulation. We hypothesize that participants who underwent bariatric surgery will have lower levels of HOMA-IR, fasting glucose and A1c after multivariable adjustment.

Methods:
A total of 9134 participants (52% female, mean age 48 +/- 17.7) in the National Health and Nutrition Examination Survey (NHANES) who were older then 20 years of age, not pregnant and not taking any diabetic medication were assessed. Participants were classified as having bariatric surgery and not having bariatric surgery. Survey design adjusted linear models regressed cardiometabolic outcomes on bariatric surgery status. LSMEANS +/- standard error and p-values are presented summarizing the association between bariatric surgery status and cardiometabolic outcomes including HOMA-IR, glycohemoglobin, mean systolic and diastolic blood pressure, fasting glucose, triglycerides LDL and HDL.

Results:
Among the 9134 participants
,
89 underwent bariatric surgery. Those with vs. without a history of bariatric surgery were 3 years older (51 +/- 12 vs 48 +/- 18 yrs, p < 0.05), more likely to be female (80% vs. 52%, p < 0.05) and more likely to report a history of depression (20.3% vs. 7.8%, p < 0.05). After adjusting for demographic variables, behavioral risk factors and measures of adiposity, bariatric surgery was associated with lower HOMA-IR and triglycerides but higher HDL levels (Table).

Conclusion:
Bariatric Surgery was associated with HOMA-IR, triglycerides, and HDL in a nationally representative sample of U.S. adults.
Abstract P170: Cardiovascular Health Scores, Adverse Pregnancy Outcomes, And Angiogenic Biomarkers Associated With Cognition8-10 Years After Pregnancy
Authors: Gandley Robin , Rosano Caterina , Shaaban C. Elizabeth , Parks W. Tony , Catov Janet M
Published: April 2022

Introduction:
Women with adverse pregnancy outcomes (APO, preeclampsia, preterm birth, small for gestational age neonates), especially those with placental maternal vascular malperfusion (MVM), are at increased cardiovascular and cognitive risk, perhaps due to poor cardiovascular health (CVH) and other vascular pathology.

Hypothesis:
Including history of APO and MVM in CVH scores identifies women with lower cognitive function and circulating angiogenic biomarker profiles indicating ongoing vascular pathophysiology.

Methods:
CVH was evaluated in 39 women 8-10 years after pregnancy (mean age 39.8 ±6 years, 36% Black) using standard metrics (smoking, BMI, blood pressure, total cholesterol, fasting glucose, and physical activity; higher score is healthier). APO history was abstracted from the medical record and added to CVH (no APO [n=14], APO-MVM [n=13], APO+MVM [n=13] to create a CVH-APO score. We evaluated cognitive function (memory, processing speed and executive function) as domain z scores using standard tests. Angiogenic biomarkers (VEGF-A, VEGF-C, VEGF-D, Tie-2, sFlt1, PlGF, and bFGF) were quantified using Angiogenesis Panel 1 (Meso Scale Diagnostics). Associations of CVH with cognition and biomarkers were evaluated using Pearson correlations. CVH groups (poor [CVH ≤7] vs. healthy [CVH >8) were compared with and without APO history using t-test.

Results:
Women with APO+MVM had lower CVH scores compared to those with no APO, adjusted for age and race (-1.5, p=0.03). Poor CVH was associated with slower processing speed (r=0.350, p=0.031) and reduced executive function (r=0.353, p=0.03) but not memory. When APO history was added to CVH, associations became stronger (r=0.402, p=0.012 for processing speed; 0.422, p=0.008 for executive function). Poorer CVH scores also correlated with higher VEGF A (-0.501 p=0.001), VEGF C (-0.653, p<0.001), PlGF (-0.326 p=0.045), and bFGF (-0.383, p=0.018). Using the combined CVH-APO score, women with poor CVH (n=18) compared to healthy CVH (n=20) had higher bFGF (18 vs 9.5 pg/mL p=0.013), VEGF-A (78 vs 44pg/mL p=0.002) and VEGF-C (1319 vs 828 p=0.023).

Discussion:
Poor CVH is associated with lower cognition and higher circulating angiogenic biomarker profiles in women, and APO history may further contribute to the cumulative vascular pathophysiological burden a decade after pregnancy.
Abstract P175: Combined Metabolic Health And Obesity Status Is Associated With Markers Of High-Density Lipoprotein Metabolism: Dallas Heart Study
Authors: Clarkson William A , Barber Jacob L , Armstrong Bridget , Wang Yuan , McGillicuddy Fiona C , Saldanha Suzanne , Akinmolayemi Oludamilola , Neeland Ian J , Rohatgi Anand , Sarzynski Mark A
Published: April 2022

Introduction:
While high-density lipoprotein (HDL) cholesterol is a component of metabolic syndrome, an ASCVD risk factor, other markers of HDL metabolism better associate with ASCVD. However, it is unclear whether these markers better discriminate between metabolic health and obese groups.

Hypothesis:
We hypothesized that higher cholesterol efflux capacity (CEC) and a favorable HDL profile would be associated with metabolically healthy profiles within each weight category.

Methods:
Data from the second phase of the Dallas Heart Study were used to classify participants (n=2156) into four groups based on a harmonized definition of metabolic health and obesity status: Metabolically Healthy, Normal Weight (MHNW); Metabolically Unhealthy, Normal Weight (MUNW); Metabolically Healthy, Obese (MHO); Metabolically Unhealthy, Obese (MUO). MU was classified as having one or more of the following: elevated blood pressure (SBP/DBP ≥130/85 mmHg), fasting glucose (≥100 mg/dL), or fasting triglycerides (≥150 mg/dL); a history of CVD or diabetes; or any medications for these conditions. Obesity was defined as BMI ≥ 30kg/m
2
. CEC was measured using J774 macrophages, BODIPY- and radio-labeled cholesterol, and apoB-precipitated plasma. HDL particle (HDL-P) subfractions were quantified by NMR spectroscopy. Generalized linear models were used to compare paired means of CEC and HDL traits between groups controlling for age, sex, race, and smoking.

Results:
Small HDL-P concentration was higher in MU groups regardless of weight status. Total and medium HDL-P concentrations and radio-labeled CEC were higher in NW groups, regardless of metabolic health status. Mean HDL-P size and large HDL-P concentrations were different across all groups, with the rank order being MHNW, MUNW, MHO, MUO (Table 1).

Conclusions:
In conclusion, associations between HDL subfractions, CEC and metabolic/weight status are heterogeneous, highlighting the complexity of HDL physiology as it pertains to body weight and metabolic disease.
Abstract P183: Elevated Phq-9 Scores In Black And Hispanic Young Adults
Authors: Stephens Janna D , Randolph Jillian , Leissa Sophia , Miller Carla , Melnyk Bernadette , Burke Lora E , Buffington Brenda , Tan Alai
Published: April 2022

Background:
The ASPIRE study is a NIH funded clinical trial seeking to reduce cardiovascular disease risk factors in young adults who identify as Black and Hispanic through the provision of an individualized, text message-based intervention. The intervention has been developed specifically for this demographic group through formative research and seeks to understand the moderating and mediating effects of depressive symptoms, self-efficacy, and discrimination on weight loss maintenance over the 12 months. The goal of this preliminary analysis is to describe baseline depressive symptoms in this population to both conceptualize the mental health needs of students and increase the accessibility of established resources through developing community informed referral guidelines.

Methods:
Participants are recruited into a behavior change clinical trial and randomly assigned to either an intervention group with a health coach or an attention control group. Participants completed the Patient Health Questionnaire for adults (PHQ-9) as a part of baseline surveys. This questionnaire assesses depressive symptoms through 10 self-administered questions. Scores ranging from 5-9 indicate mild symptoms 10-14 moderate symptoms, 15-19 moderately severe, and 20-27 severe symptoms of depression. Participant data is stored in REDCap and preliminary analysis was pulled and summarized for total scores from the PHQ-9 for all participants who have completed a baseline visit. There is no missing data.

Results:
Preliminary baseline data from a large Midwestern community college (N=101; 72% female; mean age = 20.8 (SD=2.02)) indicate the significant experience of depressive symptoms amongst participants. More than 58% of our sample screened for at least mild symptoms of depression. More significantly, greater than 21% of the sample indicates at least moderate symptoms of depression.

Discussion and Conclusion:
There is no comprehensive nationwide data to which we can compare these results, however the American College Health (ACH) National College Health Assessment completed in undergraduate students indicated that 50% of students surveyed had no significant symptoms of depression on the Kessler 6 scale. Therefore, we believe levels of depressive symptoms may be higher in this population of community college students who identify as Black or Hispanic. Due to high levels of depressive symptoms, the research team has since engaged in participatory research methods with the community advisory board and other members of the community to enhance study protocols and identify community-based resources to serve as referrals for participants who score above 5 on the PHQ-9.
Abstract P188: Application Of A Facebook Platform To Engage Rural Populations In Health Awareness And Research On Heart, Lung, Blood And Sleep Disorders: The Risk Underlying Rural Areas Longitudinal Cohort Study
Authors: Cobb Keith O , Henderson Frances C , Ramachandran Vasan S , Fox Ervin R
Published: April 2022

Background:
Data is sparse regarding the utility of social media in engaging southern, rural communities in health awareness education and research. Community Advisory Board (CAB) members of the Mississippi (MS) Core of the Risk Underling Rural Areas Longitudinal (RURAL) Study suggested the use of a Facebook social media platform to promote the RURAL Study while providing live health education presentations that they could review and refer to others.

Objective:
Identify social media strategies using existing Facebook metrics to engage the populations of two rural counties in research on Heart, Lung, Blood and Sleep disorders.

Methods:
The Principal Investigator of RURAL Study’s MS Core collaborated with the University’s Social Media Coordinator to implement a Facebook page for the Study. The team implemented six health awareness education programs focused on monthly health observances that best fit with HLBS disorders and COVID-19 concerns noted by the CABs. Facebook metrics including Reach (Organic and Paid Ads), Views, Likes, Comments and Shares were collected continuously.

Findings:
There were six Health Awareness events between February and June 2021 (Table 1). Paid Ads resulted in a greater reach among those in targeted rural communities. The number of views positively correlated with the number reached. The highest number of views were for short talks on Men’s Health (June events) compared to hour-long panel discussions (Feb, May and Aug events). The numbers of Likes, Comments and Shares were similar among the different approaches. Clicks were greater among Paid Ads compared to Organic Ads. Between February and August the number of followers increased from 39 to 300 with the largest increase in July after the Men Health talks.

Conclusion:
Using social media may be an effective tool for reaching communities with health awareness and health education. Our findings support that Paid Ads (Boosts) focusing on targeted audiences are more effective than Organic Ads. Short talks are more effective than hour long programs.