bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P316: Very Low Prevalence of Ideal Cardiovascular Health in Young Adults Studying at the Université de Sherbrooke
Authors: Hivert Marie-France , Doyon Myriam , Forget Geneviève , Lacerte Guillaume , Labonté Melissa , Brown Christine , Langlois Marie-France
Published: July 2021

Introduction:
In 2010, the American Heart Association (AHA) published a special report to define and set national goals for cardiovascular health promotion and disease reduction (2020 Strategic Impact Goals). Ideal cardiovascular health was defined based on seven metrics including both ideal health behaviors (nonsmoking, body mass index < 25 kg/m2, physical activity at goal levels, and pursuit of a diet consistent with current guideline recommendations) and ideal health factors (untreated total cholesterol < 200 mg/dL [5.2 mmol/L], untreated blood pressure < 120/ < 80 mm Hg, and fasting blood glucose 8h of overnight fasting, using standardized procedures. Resting blood pressure was measured in the sitting position (twice, using the average for analyses). Physical activity was assessed by a validated questionnaire. Dietary intake was assessed by 3-day food diary; the average per day or the estimations per week were used accordingly to the specific dietary component recommendation.

Results:
The cohort was composed of young adults (20.6 ± 2.9 years old), mainly of European origin (97.8%), and 74.6% were female. Overall, only one participant (0.4%) achieved ideal cardiovascular health (all seven ideal health metrics). Very few participants (2.2%) achieved ideal healthy diet score (4-5 components /5). Investigating individual dietary component, our results showed that 9.4% consumed ≥ 4.5 cups/day of fruits and vegetables, 25.7% had ≥ two servings/week of fish, 14.5% reported ≥ three servings/day of fiber-rich whole grains, 8.0% consumed < 1500g/day of sodium, and 75.4% reported drinking < 36oz / week of sugar-sweetened beverages. Concerning the other health metrics, 22.8% achieved the recommended level of physical activity, 93.8% were non-smokers, 75.7% had a BMI < 25kg/m2, 42.4% had a blood pressure in the ideal range ( < 120/ < 80 mmHg), 99.6% had a normal fasting glucose ( < 5.6 mmol/L), and 42.4% had a total cholesterol < 5.2 mmol/L.

Conclusions:
The prevalence of ideal cardiovascular health is very low, even in a population of young adults interested in healthy lifestyle. The low prevalence is mainly dependent on the healthy dietary score where the biggest challenges seem to be consumption of fruits and vegetables, and limiting sodium intake. Public health actions are seriously needed to improve these health metrics.
Abstract P335: Building Assessment Tools for Unrecognized Myocardial Infarction: The REasons for Geographic and Racial Differences in Stroke Study
Authors: Levitan Emily B , Safford Monika M , Kilgore Meredith L , Soliman Elsayed Z , Glasser Stephen P , Judd Suzanne E , Muntner Paul
Published: July 2021

Introduction:
People with unrecognized myocardial infarction (UMI) have elevated risk for cardiovascular events and death. Population-wide electrocardiogram screening for detection of UMI would be resource intensive. We therefore sought to develop assessment tools for targeted UMI screening.

Methods:
Using logistic regression and a backward selection procedure, we developed two models among 16,653 participants without coronary revascularization or known myocardial infarction in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. UMI was defined as electrocardiogram evidence (using the Minnesota Code system) of myocardial infarction without a self-reported history (n = 740). The basic model used demographics, self-reported medical history, blood pressure, and body mass index; the expanded model used information on 51 potential variables including health behaviors, clinical measurements, and participant-reported health scales and symptoms.

Results:
The basic model had a c-statistic of 0.638 (95% CI 0.617 − 0.659) and included age, race, smoking status, body mass index, systolic blood pressure, transient ischemic attack, deep vein thrombosis, falls, diabetes, and hypertension. The expanded model had a c-statistic of 0.654 (95% CI 0.634−0.674) and included age, race, income, smoking status, self-reported hypertension, unrecognized dyslipidemia, perceived stress score, waking at night due to breathlessness, body mass index and body mass index squared, HDL cholesterol squared, systolic blood pressure, albumin:creatinine ratio, heart rate, and heart rate squared. The Framingham coronary heart disease risk score had a c-statistic of 0.587 (95% CI 0.566−0.609).

Conclusions
: Even with a large number of potential risk factors, the models did not provide sufficient discrimination to warrant use as an assessment tool. Identifying individuals at high risk of UMI for further screening using an assessment tool may be challenging.
Abstract P342: Assessing Interaction in GFR-risk Associations in Meta-analyses: An example of Hypertension in the CKD Prognosis Consortium
Authors: Mahmoodi Bakhtawar K , Matsushita Kunihiro , Sang Yingying , Grams Morgan , Astor Brad C , Woodward Mark , Gansevoort Ron T , Coresh Josef
Published: July 2021

Background:
Meta-analysis methods for evaluating interactions are not well described. Assessing interactions with eGFR is particularly challenging due to its non-linear association with risk. We describe methods to evaluate point-wise and overall interactions using an example of hypertension-eGFR interaction on mortality risk.

Methods:
The applicability of our methods was evaluated in 28 out of 46 cohorts joining the Chronic Kidney Disease Prognosis Consortium (CKD-PC). In each study, eGFR linear splines (knots at each 15 from 15 to 105 ml/min/1.73m²) and their product terms with hypertension were fitted, providing hazard ratios (HRs) for eGFR (vs. eGFR 95) in both hypertensive and non-hypertensive groups. From this model, the interaction was evaluated as the relative HR (rHR) in hypertension vs. non-hypertension at each 1 ml/min/1.73m² of eGFR between 15 and 120 (point-wise interaction). HRs and rHRs for each eGFR value in each cohort were then pooled using random effects models. The overall interaction was assessed as the inverse-variance average of differences in all spline coefficients for the entire range of eGFR between hypertensive vs. non-hypertensive groups.

Results:
There were 942,429 participants and 69,072 deaths. Low eGFR was associated with increased mortality in the hypertensive (gray line) and non-hypertensive (black line) groups (
figure
). Significant interactions by hypertension status were observed at eGFR range below 60 ml/min/1.73m² at each eGFR value p-interaction<0.05 is noted by “x” in the
figure
. In this range, the impact of low eGFR on mortality was weaker in the hypertensive group as compared with the non-hypertensive group. Overall interaction test was also significant (P<0.001).

Conclusion:
We developed and implemented meta-analytic methods to assess point-wise and overall interactions in non-linear regression models. Interactions can be comprehensively evaluated using both methods and should be interpreted based on biological and clinical relevance.
Abstract P347: The Impact of the Length of the Follow-up on the the Strengths of the Associations Between Cardiovascular Risk Factors and Future Myocardial Infarction, Stroke and Heart Failure
Authors: Lind Lars , Ingelsson Erik , Sundström Johan , ärnlöv Johan
Published: July 2021

Objective:
The aim of this study was to investigate how the length of the follow-up period influences the strength of the associations between major cardiovascular risk factors and different cardiovascular outcomes (myocardial infarction [MI], stroke and heart failure).

Methods:
We examined 1826 men aged 50 regarding cardiovascular risk factors in 1970-74. The follow-up time was 33 years. The hazard ratio (HR) was calculated yearly for each risk factor and outcome. During follow-up, 571 cases of MI, 381 cases of stroke and 384 cases of heart failure occurred.

Results:
Two major patterns were found regarding influence of the follow-up time on the associations between risk factors and the different cardiovascular outcomes. First, a gradual decline in the HR over time was seen for blood pressure in relation to all three outcomes, with the most rapid decline for heart failure and stroke. This pattern was also seen for BMI in relation to MI and heart failure, and for smoking regarding MI and stroke. Second, we observed a gradual increase in HRs to a maximum at 20-25 years, and thereafter a slight decline. This pattern was seen for the apoB/A1 ratio, HDL, and triglycerides, mainly in relation to MI and heart failure.

Conclusion:
The length of follow-up influenced the associations between traditional risk factors and cardiovascular outcomes in different ways. The collective influence of the risk factors did however show a substantial decline in discrimination over time for the outcomes stroke and heart failure, but not regarding myocardial infarction.
Abstract P349: Dietary Sodium Intake according to the Hypertension Management Status: The Fourth Korea National Health and Nutrition Examination Survey.
Authors: Lee Won Joon , Kim Hyeon Chang , Oh Sun Min , Choi Dong Phil , Cho Hye Min , Lee Ju-Mi , Suh Il
Published: July 2021

Introduction
: High sodium intake is an established risk factor for hypertension and cardiovascular diseases. The average sodium intake in Koreans was estimated at 4,645mg/day, which was more than two times compared to the recommended amount, 2000mg/day. We assessed whether people who diagnosed with hypertension or treated for hypertension consume less sodium than those without hypertension.

Methods
: The present study analyzed data from a total of 6,577 Koreans (3,816 women and 2,761 men) aged 40 years and older, participated in the Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007-2008). Participants were classified into five groups as follows: normal blood pressure, pre-hypertension, hypertension without treatment, hypertension with treatment, and hypertension with complications. The association between sodium intake and hypertension management status was estimated using exponential regression coefficient, adjusted for potential confounders including age, energy intake, body mass index, income, education, marriage, occupation, the frequency of eating out and effort to lower sodium intake.

Results
: In women, the median sodium intake tended to decrease according to the following groups; 3,708mg in normal blood pressure, 3,515mg in pre-hypertension, 3,191mg in hypertension without treatment, 3,113mg in hypertension with treatment, and 2,862mg in hypertension with complications (P for trend < 0.001). In men, a similar trend was shown, but sodium consumption was the highest in the prehypertension group; 5,099mg in normal blood pressure, 5,353mg in pre-hypertension, 5,118mg in hypertension without treatment, 4,708mg in hypertension with treatment, and 3,798mg in hypertension with complications (P for trend < 0.001). After controlling for potential confounders (energy intake, body mass index, occupation, the frequency of eating out), the trend was not significant both in women (P for trend= 0.887) and men (P for trend=0. 204). Only in men with prehypertension, sodium intake was 1.08 times higher than that in normal blood pressure group (P = 0.025).

Conclusions
: The present study showed that Korean women and men consumed sodium more than the recommended amount regardless of the presence of, the treatment for, or knowing the complications of hypertension. Moreover, men with prehypertension consumed the highest amount of sodium.
Abstract P350: Short-Term Ginger Consumption Does Not Affect Metabolic Profile and Inflammatory Markers in Overweight Men
Authors: Ni Yu-Ming , Mansour Muhammad , St-Onge Marie-Pierre
Published: July 2021

Introduction:
Functional foods are foods that exhibit beneficial health effects beyond their inherent nutritional value. Spices, in particular, have been targeted for their apparent thermogenic and anti-inflammatory properties. Ginger has been used in ancient medicine to treat a variety of conditions, including hypertension, hyperlipidemia, hyperglycemia, and hypercholesterolemia. However, while several studies have examined the effects of ginger in animal or in vitro models, few studies have verified the health effects of ginger consumption in humans. The purpose of this study was to determine the metabolic, inflammatory, and gut hormone effects of ginger consumption in overweight men. Hypothesis: We hypothesize that acute ginger consumption would improve metabolic profile and inflammatory markers compared to a no-ginger condition.

Methods:
Ten men completed this 2-arm randomized pilot crossover study in which they consumed a standard breakfast with either 2 g ginger powder dissolved in hot water (treatment phase) or hot water only (control phase). Blood samples were drawn before and at 0, 30, 45, 60, 120, 180 min after breakfast consumption and analyzed for glucose, insulin, leptin, adiponectin, triglycerides, inflammatory markers (interleukin-6, C-reactive protein, and tumor necrosis factor alpha) and gut hormones (ghrelin, peptide YY, glucagon-like peptide 1). Regression analysis was done to test the effects of ginger intake on hormones and metabolites after adjusting for age, body weight, and race.

Results:
There was no significant ginger x time interaction on any of the hormones and metabolites assayed. Total ghrelin levels tended to be higher in the ginger compared to the control condition (P = 0.096), and removing the data from a diabetic subject led to a significant difference (P = 0.0416). Active ghrelin levels were not significantly different between test conditions (P = 0.15).

Conclusions:
This study provides preliminary information on the effects of ginger consumption on metabolic risk factors in humans. Future research should examine the long-term effects of regular ginger consumption as prolonged consumption may be necessary to observe changes in metabolic risk factors.
Abstract P353: Acute Consumption of Walnuts Increases Ex Vivo Cholesterol Efflux and Postprandial Lipid Response in Overweight and Obese Adults
Authors: Berryman Claire E , Grieger Jessica A , West Sheila G , Rothblat George H , Zhang Jun , Kris-Etherton Penny M
Published: July 2021

Introduction:
Epidemiological and clinical evidence demonstrate benefits of walnuts on cardiometabolic risk factors.

Hypothesis:
Previously, we conducted a study that evaluated the acute, postprandial effects of walnut components [separated nut skins (5.6 g), de-fatted nutmeat (34 g), and nut oil (51 g)] versus whole walnuts (85 g) on lipid/lipoprotein responses and other measures of CVD risk. The results reported herein are from an ancillary study that compared postprandial whole walnut values to fasting values, to test the hypothesis that the whole walnut treatment would improve reverse cholesterol transport.

Methods:
A randomized 4-period crossover design was conducted with healthy overweight and obese adults (n=15; 9 women and 6 men) with moderate hypercholesterolemia. Plasma lipids were measured at 0 (fasting), 30, 60, 120, 240, and 360 min post meal consumption; serum for
ex vivo
cholesterol efflux analysis was collected at 0 and 240 min. The mean fractional efflux of radiolabeled cholesterol was conducted in J774 macrophage cells cultured with 2.5% human serum.

Results:
A mixed linear model demonstrated an increase in TG postprandially (P < 0.01). TG levels were significantly increased at 120, 240, and 360 min compared to baseline (30.1 ± 5.1 mg/dl, 42.7 ± 5.2 mg/dl, 21.1 ± 5.1 mg/dl, respectively; P < 0.01 for all). HDL-C and the total cholesterol:HDL-C (TC:HDL) ratio also increased postprandially (P = 0.04 and P < 0.01, respectively). HDL-C increased at 60 min (1.8 ± 0.7 mg/dl; P = 0.01) and TC:HDL increased at 120, 240, and 360 min (0.2 ± 0.1, 0.3 ± 0.1, 0.3 ± 0.1, respectively; P < 0.01 for all) compared to baseline. Cholesterol efflux was increased by 3.3 % in cells cultured with postprandial serum relative to fasting baseline (baseline: 18.6 ± 0.3 %, 240 min: 19.2 ± 0.3 %; P = 0.02). Cholesterol efflux correlated positively with plasma HDL-C concentrations (r = 0.43; P = 0.02).

Conclusion:
Acute consumption of walnuts increased
ex vivo
cholesterol efflux, suggesting a novel mechanism by which walnut consumption may reduce cardiovascular risk.
Abstract P356: In Vitro Effect of Blackcurrant Anthocyanins on Flow-Dependent Dilatation of Human Intracerebral Arteries and Alzheimer Nanoplaque Formation
Authors: Siegel Guenter , Ermilov Eugeny , Hammersen Stephanie , Elmen Gwenda
Published: July 2021

Background:
Vascular wall amyloidosis, one of the important cell and tissue changes in dementiae of the Alzheimer type, is characterized by massive deposition of β-amyloid in the walls of leptomeningeal and cortical arteries and arterioles, as well as in vessels in the brainstem and cerebellum. This deposition depends critically on both lipoprotein isoform and cholesterol, which has prompted research on the link between coronary disease and Alzheimer's disease. High cholesterol diets were found to induce accumulation of β-amyloid in the brain. Anthocyanins from blackcurrant extract (BCE) may have beneficial effects on Alzheimer dementiae via other target points than cholesterol lowering.

Materials and Methods:
Flow-dependent isometric tension was measured in segments of isolated human intracerebral arteries from consciousness areas, coming from brain surgery. The blood vessel segments were stretched by 1.5 g pretension. The flow of the blood substitute solution (Krebs) was varied in the steps 3, 5, 20, 40, and 100 mL/min. Krebs solution without and with addition of 0.01% BCE (BC ACL-1.5, BerryPharma AG, Leichlingen, Germany) was used as superfusate. Nanotechnologic biosensor ellipsometry, photometric methods, ELISAs and EIAs were applied. VLDLapoE4/E4 (10 mg/dL) from genotypized patients and human β-amyloid peptide (1-42) (Aβ) were used in the ellipsometric measurements.

Results:
In the controls (n = 14), the smooth muscle cells of the brain arteries relaxed from 1.416 ± 0.009 g to 1.011 ± 0.033 g (p < 0.001) corresponding to 28.6% of their initial tone. Under blackcurrant liquid extract (n = 5), the decrease in wall tension was much more distinct. Vascular tone decreased from 1.454 ± 0.010 g (flow 3 mL/min) to 0.867 ± 0.052 g (flow 100 mL/min) (p < 0.001; against the control p < 0.0354). This is equivalent to a 40.4% reduction in tension, a 45.2% increase in flow-dependent relaxation, and an estimated 50.7% rise in blood perfusion under blackcurrant. BCE (0.001%) is strongly bound to membrane integral proteoheparan sulphate (HS-PG), the natural flow sensor and peripheral lipoprotein receptor, as measured by ellipsometric techniques. Addition of VLDLapoE4/E4, Aβ, and Ca
2+
ions (2.52 to 17.64 mmol/L) to HS-PG adsorbed to a silica surface led to quaternary Alzheimer plaque formation in control experiments. Preincubation of HS-PG with BCE reduced VLDL docking by 5.9%, ternary plaque formation with Aβ by 11.6%, and quaternary calcified Alzheimer nanoplaque formation by 17.3%.

Conclusion:
The flow experiments impressively show that BCE clearly improves endothelial function by an additional NO release. This vasodilatation together with the reduction of Alzheimer nanoplaque neoformation, detected here for the first time as a novel pleiotropic action of BCE, may have a beneficial effect on the cognitive functions in dementiae of the Alzheimer type, in the prevention of TIA and stroke.
Abstract P358: Dietary Fat Quality and Risk of CHD in the 28 Year Follow-up of a Large Prospective Study of US Women
Authors: Chiuve Stephanie E , Hu Frank B , Albert Christine M , Rexrode Kathryn M , Manson JoAnn E , Willett Walter C , Rimm Eric B
Published: July 2021

Background:
The importance of fat quality is reflected in the recent 2010 Dietary Guidelines for Americans, which recommend reducing saturated fat intake, and replacing this with polyunsaturated fat. Health effects of dietary fat are often estimated as an isocaloric substitution with carbohydrates (nutrient density models). Expressing fat intake as a % of total fat instead better quantifies fat quality, in overall diet and individual foods, and may provide an alternative approach to evaluate associated disease risk. We evaluated this novel measure of dietary fat quality, the % of fat type relative to total fat intake, on CHD risk among women in the Nurses' Health Study.

Methods:
We followed 84,531 women, free of chronic disease at baseline, from 1980-2008. Data on diet and other factors were ascertained every 2-4 years via questionnaires. For saturated and polyunsaturated fats, fat quality was calculated as grams of fat type / grams of total fat, and included in Cox proportional hazards models with total fat (fat density model), to estimate the association between fat intake and risk of CHD. We also estimated these associations using traditional nutrient density models, with isocaloric replacement of fat with carbohydrates.

Results:
Over 28 years, there were 3373 cases of CHD. A greater proportion of fat intake as saturated fat was associated with higher risk of CHD (p, trend<0.001) (

Table

). Conversely, a greater proportion of fat intake as polyunsaturated fat was associated with lower risk (p, trend<0.001), which was seen for both N-6 and N-3 fats. Compared with nutrient density models, RR obtained from fat density models were greater in magnitude for saturated and N-3 fats, but similar in magnitude for total and N-6 polyunsaturated fat.

Conclusions:
Saturated and polyunsaturated fat, quantified as a % of total fat, were significantly associated with CHD risk. This novel measure of dietary fat may aid in the translation of dietary recommendations of fat quality and may provide guidance in distinguishing foods based on fat quality.
Abstract P374: Short-term Weight Loss Patterns and Physical and Psychological Predictors within a Randomized Trial
Authors: Yank Veronica , Xiao Lan , Goldman Rosas Lisa , Stafford Randall S , Wilson Sandra , Huang Qiwen , Ma Jun
Published: July 2021

Objective
To examine weight loss patterns and their baseline predictors among participants in a Diabetes Prevention Program-based group lifestyle intervention.

Methods
Overweight/obese participants in the intensive intervention arm (n=72) of an ongoing 3-arm randomized weight loss trial were weighed at each of 12 weekly classes. Cluster analysis grouped participants with similar patterns of 12-week weight loss. Bivariate analysis identified candidate baseline predictor variables (P<0.1), which were then entered into a stepwise multinomial logistic regression analysis to identify variables significantly associated with greater weight loss patterns.

Results
Participants had a mean age of 55.0 yrs (SD 10.8); 49% were female, 79% Non-Hispanic White, and 97% college educated; and 58% earned >$125,000/yr. Mean Body Mass Index was 31.9 kg/m
2
(SD 5.2), 56% had pre-diabetes, and 90% had metabolic syndrome. Cluster analysis identified three weight loss patterns (Figure): modest & delayed (G1: n=15; 21%); moderate & steady (G2: 43; 60%); and substantial & early (G3: 14; 19%). Only participants in G2 and G3 had significant weight loss. Candidate predictor variables included sex, physical activity, physical function, family/friend encouragement for dietary change, obesity-related problems, depression symptoms, and body image dissatisfaction. On stepwise logistic analysis comparing G2 and G3 vs. G1, greater weight loss patterns were associated with higher physical activity (standardized β=0.62 (95% CI 0.09, 1.14), P=0.01) and physical function (0.47 (-0.04, 0.99), P=0.05), fewer obesity-related problems (-0.48 (-1.03, 0.07), P=0.09), and
less
friend encouragement for dietary change (-0.79 (-1.37, -0.22), P=0.003).

Conclusion
We identified 12-week weight loss patterns and baseline variables that may be important predictors of response to an evidence-based group lifestyle intervention. Friend encouragement for dietary change may have a more complex relationship to weight loss than suggested by prior research.

Funding(This research has received full or partial funding support from the American Heart Association, National Center)
Abstract P381: Recruiting Young Adults Into Obesity Trials: Lessons From The Early Trials
Authors: Lytle Leslie , Loria Catherine , Svetsky Laura , Jakicic John , Johnson Karen , Olson Christine , Patrick Kevin , Wing Rena , Tate Debra , Fernandez Diana
Published: July 2021

Early adulthood is a time of weight gain yet there is a paucity of evidence about how best to prevent weight gain or promote weight loss in this age group. Data from the Coronary Artery Risk Development in Young Adults (CARDIA) study show that young adults (18-40y) gain an average of 1-2 pounds per year with the largest weight gain (about 3 pounds a year) during the ages of 20-29. Excess weight gain in early adulthood is associated with later adverse levels of cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes. To address this issue, in 2009 the National Heart, Lung, and Blood Institute, along with the Eunice Kennedy Shriver National Institute of Child Health and Human Development funded seven separate randomized controlled trials to refine and test behavioral approaches for weight control among young adults (18-35y) at high risk for weight gain. All studies focus on prevention of weight gain or weight loss among young adults, conduct formative research, conduct a two-year randomized controlled trial, and use innovative technologies (e.g.., social media, texting, smart phones). Recruitment issues for health-related interventions in this population group have been recognized as a significant challenge. Recruitment challenges include high mobility, competing demands (school, jobs, young families), low perceived risk of health consequences, and lack of investigator experience targeting this population, Each of the seven EARLY studies tests its own primary hypotheses, with a cumulative estimated sample size of 6063 young adults. To date with the trials approximately half way through the recruitment period, the 7 studies have had an initial contact with 12,669 participants and have screened 6425 participants. After prescreening, screening and the consent procedure, 1554 participants have been randomized, representing about 12% of those initially contacted about the study. The EARLY trials have recruitment targets for males, Hispanic and non-white participants and success with those goals has differed across the seven trials. The objective of this presentation is to present details on prescreening, screening, consent and randomization rates across the trials and to describe the recruitment process for the EARLY trials. We will describe recruitment methods and strategies that have been found to be most effective in recruiting young adults into the EARLY obesity trial. Strategies used to target Hispanic and non-White young adults as well as male participants will also be detailed.
Abstract P399: Cardiovascular and Non-Cardiovascular Disease Associations with Hip Fractures in the Elderly: A Population-Based Case-Control Study
Authors: Gerber Yariv , Melton L. J , McNallan Sheila M , Jiang Ruoxiang , Weston Susan A , Roger Veronique L
Published: July 2021

Background:
There is growing awareness of an association between cardiovascular disease (CVD) and fractures, and a temporal increase in fracture risk after myocardial infarction has been noted but the mechanisms are not delineated. To evaluate this relationship, we systematically examined the association of hip fracture with all disease categories and assessed related secular trends.

Methods:
Using resources of the Rochester Epidemiology Project, a population-based incident case-control study was conducted. Disease history was compared between all Olmsted County, Minnesota, residents aged 50 years or older with a first hip fracture in 1985–2006 and community control subjects individually matched (1:1) to cases on age, sex, and index year (n=3,808; mean age [SD], 82 [9] years; 76% women).

Results:
All CVD and numerous non-CVD categories (e.g., infectious diseases, nutritional and metabolic diseases, mental disorders, diseases of the nervous system and sense organs, and diseases of the respiratory system) were associated with fracture risk. However, increasing temporal trends were almost exclusively detected in categories of CVD (Figure). The largest increases in association were observed for ischemic heart disease, other forms of heart disease (including heart failure), hypertension, and diabetes and were more pronounced among elderly women than other demographic groups.

Conclusions:
While the association with hip fracture was not specific to CVD, temporal increases were mainly detected in cardio-metabolic diseases, all of which have also been linked previously to frailty. This could delineate a common pathway that warrants further investigation.
Abstract 010: Population-wide Weight Loss and Regain in Relation to Diabetes and Cardiovascular Disease Mortality: Cuba 1980-2010
Authors: Bilal Usama , Franco Manuel , Orduñez Pedro , Benet Mikhail , Morejon Alain , Caballero Benjamin , Kennelly Joan F , Cooper Richard S
Published: July 2021

INTRODUCTION
The Cuban economic crisis in the early 1990’s led to weight loss of about 4-5 kg in the entire population, leading to a sharp drop in diabetes and cardiovascular mortality. Following modest economic recovery (1996-2012) body weight was regained as adequate food sources became available and public transportation was restored. Our objective was to evaluate the association of these population-wide body weight changes with mortality trends from diabetes and cardiovascular disease, cancer, and all-causes.

HYPOTHESIS
We hypothesize that the previously observed mortality improvements in diabetes and cardiovascular disease due to population-wide weight loss will be reversed following the population-wide weight rebound.

METHODS
Changes in daily energy intake, physical activity, and body weight were tracked from 1980 to 2010 using national and regional surveys from Cuba. Body weight data was measured in four local surveys in the city of Cienfuegos in 1991(n=1657), 1995(n=1351), 2001(n=1667), and 2011(n=1492). Diabetes prevalence and incidence trends were obtained from population-based registries. Mortality trends were modeled using national vital statistics over the period 1980-2010.

RESULTS
A rebound in population-wide body weight was observed starting in 1996 and by 2011 obesity prevalence had already exceeded pre-crisis levels. The upward weight trend was accompanied by a 140% increase in diabetes incidence (from 1 per 10000 in 1997 to 2.4 per 10000 in 2003), a 47% increase in diabetes mortality (from 9.3 per 10000 in 2002 to 13.9 per 10000 in 2010) and a deceleration in the rate of mortality decline in coronary heart disease.

CONCLUSIONS
This unique, 30-year natural experiment demonstrates the strong association at the population level of weight reduction on diabetes and cardiovascular mortality and the contrary effect of weight regain. Moderate and healthy weight loss, affecting the totality of contemporary populations, could yield significant public health benefits.
Abstract 011: Prevalence and Control of Diabetes in Chinese Adults: The China Metabolic Risk Factor Study
Authors: Bi Yufang , Xu Yu , Li Mian , Wang Weiqing , Wang Tiange , Wang Limin , Jiang Yong , Xu Min , Lu Jieli , Li Jianhong , Mi Shengquan , Chen Chung-Shiuan , Lai Shenghan , Wang Linhong , Zhao Jiajun , Mu Yiming , Li Guangwei , He Jiang , Chen Jialun , Kong Lingzhi , Zhao Wenhua , Ning Guang
Published: July 2021

Objective:
Diabetes is a major risk factor for vascular disease in the general population. We investigated the prevalence of diabetes and glycemic control in the Chinese adult population.

Methods:
We conducted a cross-sectional survey in a nationally representative sample of 98,658 Chinese adults aged ≥18 years in 2010. After an overnight fast, participants without known diabetes underwent an oral glucose-tolerance test (OGTT) using 75 g anhydrous glucose dissolved in water. Previously diagnosed diabetes was determined on the basis of self-report. Undiagnosed diabetes was defined as a hemoglobin A1c (A1c) ≥ 6.5% or fasting plasma glucose (FPG) ≥126 mg/dl (7.0 mmol/l) or 2-h plasma glucose (2-h PG) ≥200 mg/dl (11.1 mmol/l) during an OGTT according to the 2010 American Diabetes Association criteria. Pre-diabetes was defined as FPG 100-125 mg/dl (5.6-6.9 mmol/l) or 2-h PG 140-199 mg/dl (7.8-11.0 mmol/l) or A1c 5.7-6.4%. Prevalence was calculated by weighting sampling factors derived from China population census data in 2010 to obtain national estimates.

Results:
Prevalence of self-reported diabetes was estimated to be 3.5% in the Chinese population aged ≥18 years (3.6% in men and 3.4% in women) or 34.2 million persons (18.0 million men and 16.3 million women). Prevalence of undiagnosed diabetes was 8.1% (8.5% in men and 7.7% in women) or 79.6 million persons (42.5 million men and 37.1 million women), and the prevalence of pre-diabetes was 50.1% (52.1% in men and 48.1% in women) or 493.4 million persons (260.1 million men and 233.3 million women). The prevalence of diabetes was higher in urban (14.3%) than in rural (10.3%) residents, and higher in persons who were older, heavier, and living in economically developed areas. The proportion of controlled (A1c <7.0%) was 42.8% among self-reported diabetes (42.3% in men and 43.4% in women) in the general population in China.

Conclusions:
Our study shows that the prevalence of diabetes in the general population in China is much higher than previously reported. More troublesome, 7 out of every 10 diabetic patients are undiagnosed. Among self-reported diabetes, 3 out of 5 were poorly controlled. Our findings indicate that diabetes has become a major public health problem in China and suggest an urgent need to develop national strategies for prevention and treatment of diabetes.
Abstract 029: Racial Disparities in Coronary Heart Disease Mortality in the Regards Study
Authors: Safford Monika , Brown Todd M , Gamboa Christopher , Durant Raegan W , Glasser Stephen P , Halanych Jewell , Shikany James M , Prineas Ronald
Published: July 2021

Background:
Coronary heart disease (CHD) mortality has long been higher among US blacks compared with whites, especially among younger individuals. Recent progress on eliminating these disparities has not been reported.

Methods:
We examined CHD mortality in the REGARDS study, a 30,239-member national prospective cohort study that oversampled blacks (41%) and residents of the southeastern US, recruiting from 2003-7. Baseline data included interviews and in-home collection of physiologic and medication data. Telephone follow-up was conducted every 6 months to detect endpoints, triggering medical record retrieval and expert adjudication. Deaths prompted interviews with next-of-kin or proxies, collection of medical records and death certificates. We examined risks for definite or probable CHD mortality overall, and separately for in-hospital and out-of-hospital CHD death. Cox models stratified on age 65 estimated hazard ratios (HR) for CHD mortality for blacks compared with whites, adjusting for sociodemographics and CHD risk factors.

Results:
We analyzed 14,992 participants <65 years of age (44% blacks) and 14,678 >65 years of age (38% blacks). There were 126 CHD deaths among those age <65 and 273 among those age >65 over a mean follow-up of 4.2+1.5 SD years. Adjusting for age and region of residence, excess risks among blacks were generally more pronounced for those age <65, but this excess risk attenuated after adding all risk factors, except for in-hospital mortality for those >65 years of age (Table).

Conclusions:
Risks for CHD mortality were higher among blacks, largely attributable to higher risk factor burden especially among the young, suggesting that targeted intervention efforts are needed to overcome this disparity. The excess risk for in-hospital mortality among older blacks warrants further attention.
Abstract 059: Do Healthier Foods or Diet Patterns Cost More Than Less Healthy Options? A Systematic Review and Meta-Analysis
Authors: Rao Mayuree , Afshin Ashkan , Singh Gitanjali , Mozaffarian Dariush
Published: July 2021

Background:
Conventional wisdom holds that healthier foods cost more than less healthy options. Yet, this research question has not been systematically evaluated, including consideration of types of foods and diet patterns and definitions of healthfulness.

Methods:
Using MOOSE guidelines, we conducted a systematic review and meta-analysis of prices of healthier vs less healthy foods and diet patterns, evaluating and accounting for key sources of heterogeneity. We searched PubMed, related articles, and citations for original studies comparing retail food prices by metrics of healthfulness. We estimated pooled price differences per serving for different food groups and per day for diet patterns. We also evaluated prices per calorie and weighted by intensity of differences in healthfulness of foods/diets being compared (range 1 to 10, determined in duplicate).

Results:
Of 1,101 articles, 26 met inclusion criteria. Among food groups, meats/protein had largest price differences by healthfulness (
Figure
): healthier options cost $0.33/serving (95% CI 0.19, 0.47) more than less healthy options, with heterogeneity by type of protein source. Comparing extremes (e.g., quintile 5 vs 1) of diet patterns (20 studies evaluating 13 metrics, e.g. energy density, Mediterranean diet), healthier diet patterns cost $1.43/day (0.82, 2.04) and $1.92/2000 calories (1.57, 2.26) more, with some heterogeneity by type of diet pattern (to be shown). Results were similar weighted by intensity of differences in healthfulness or stratified by study location.

Conclusions:
This systematic assessment quantifies price differences of healthier vs less healthy foods, including for specific food types, diet patterns, intensities of differences, and units of cost (serving, day, calorie). Healthier diet patterns and some healthier foods cost more; for diet patterns, the pooled price difference was ~$1.50/day. These findings highlight both the nuanced challenges and the opportunities for reducing financial barriers to healthy eating.
Abstract MP08: Cardiovascular Health and Incident Cardiovascular Disease and Cancer
Authors: Foraker Randi , Abdel-Rasoul Mahmoud , Kuller Lewis , Jackson Rebecca , Van Horn Linda , Seguin Rebecca , Safford Monika , Wallace Robert , Kucharska-Newton Anna , Robinson Jennifer , Martin Lisa , Agha Golareh , Hou Lifang , Allen Norrina , Tindle Hilary
Published: July 2021

Cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality. A favorable risk factor and behavior profile, reflected by a metric of cardiovascular health (CV health) recently introduced by the AHA, predict a lower risk of CVD in younger populations, yet has not been well-characterized in older adults. Achieving ideal CV health may also lower cancer risk, since cancer and CVD share common risk factors. We used multivariable Cox regression to estimate hazard ratios (HR) for the association between CV health and incident CVD and cancer, respectively, among Women’s Health Initiative (WHI) participants. We characterized CV health as the number [0 (worst) - 7 (best)] of ideal CV health behaviors and factors at baseline: 1) never smoking, or quit for >1 yr; 2) body mass index <25 kg/m
2
; 3) physical activity of ≥150 min/wk moderate, ≥75 min/wk vigorous, or ≥150 min/wk moderate and vigorous; 4) at least 4 of 5 healthy diet components (≥4.5 cups/day of fruits and vegetables; ≥3.5 oz servings/wk of fish; ≥3 1-oz servings/day of whole grains; <1,500 mg/day of sodium; and ≤36 oz/wk of sugar-sweetened beverages); 5) total cholesterol (untreated) <200 mg/dL; 6; blood pressure (untreated) <120 mmHg / <80 mmHg; and 7) fasting glucose (untreated) <100 mg/dL. Approximately 300 women (<1%) had a CV health score of 7 (best) in both CVD- and cancer-free groups at baseline. Among 115,302 women free of CVD at baseline, the hazard of CVD was inversely related to CV health (Figure 1a), controlling for age, race/ethnicity, family history, marital status, and education. Among 129,145 women free of cancer at baseline (Figure 1b), we observed a similar pattern, controlling for the same factors, although HRs were of smaller magnitude. Lower CV health is associated with an increased risk of CVD and cancer in older post-menopausal women, emphasizing the importance of prevention efforts among older adults.

Figure 1. HRs and 95% CIs for (a) incident CVD and (b) incident cancer by ideal CV health score: WHI observational study participants
Abstract MP11: Elevated High Sensitivity C-Reactive Protein as a Risk Marker of the Attenuated Relationship Between Serum Cholesterol and Coronary Heart Disease at Older Age - Atherosclerosis Risk in Communities Study
Authors: Whelton Seamus , Roy Probal , Astor Brad , Zhang Lin , Hoogeveen Ron , Ballantyne Christie , Coresh Josef
Published: July 2021

Introduction:
The relationship between serum cholesterol and coronary heart disease (CHD) risk is attenuated at older age, making it difficult to estimate risk in this age group.

Hypothesis:
We hypothesized that high sensitivity C-reactive protein (hs-CRP) would identify two subgroups of older individuals (≥65 years): one in whom cholesterol is less predictive of CHD and one in whom it is equally predictive compared to younger individuals.

Methods:
We calculated crude incident rates per 1,000 person-years and used adjusted Cox proportional hazards models to analyze cholesterol as a predictor of CHD in 8,947 participants with no known history of CHD who were stratified by age (53-64 or 65-75 years) and hs-CRP level (<2 or ≥2 mg/L) at baseline.

Results:
Among younger participants, total serum cholesterol was significantly associated with an increased risk of CHD regardless of hs-CRP group HR 1.39 (95% CI 1.20-1.61) for hs-CRP <2 mg/L and HR 1.37 (95% CI 1.22-1.53) for hs-CRP ≥2 mg/L. Among older participants with a low hs-CRP, total cholesterol had a similar association with CHD, HR 1.46 (95% CI 1.24-1.71), as in younger individuals. In contrast, among older individuals with higher hs-CRP, the association of CHD with total cholesterol was attenuated, HR 1.14 (95% CI 1.00-1.29), p-value for interaction = 0.02. Similar trends were observed between age groups and hs-CRP categories for LDL cholesterol.

Conclusions:
Among individuals aged 65-75 years, the association of cholesterol with CHD was strong in those with a low hs-CRP and weak in those with an elevated hs-CRP. Thus, in addition to its use as a risk factor, an elevated hs-CRP could be useful for stratifying the elderly population to aid in the interpretation of serum cholesterol in the prediction of subsequent CHD risk.
Abstract MP17: Testosterone Change Relates to Lipid Change on Statins
Authors: Golomb Beatrice A , Koperski Sabrina
Published: July 2021

Background:
Cholesterol is a precursor for steroid hormones. We sought to assess whether as well as how lipid change in men on statins relates to testosterone change.

Methods:
694 men over age 20 without DM or CVD were randomized equally to simvastatin 20mg, pravastatin 40mg or placebo for 6 months in a double blind RCT. For each arm, final (6mo) testosterone (ng/mL) was compared to baseline testosterone (paired t-tests). Testosterone-change-on-statin was compared to testosterone-change-on-placebo (unpaired t-tests). Regression examined how change in testosterone related to change in lipid elements (mg/dL), stratified by statin.

Results:
Baseline testosterone was comparable across arms (~4.4ng/mL). Testosterone on-treatment was significantly lower than at baseline (paired t-tests) on statins but not on placebo (Table). Testosterone drop was significantly greater in the statin than the placebo group (unpaired t-test, Table). Change in testosterone on simvastatin (but not pravastatin) related significantly to change in LDL (P<0.001). In contrast, change in testosterone on pravastatin (but not simvastatin) related significantly to change in HDL (P=0.005).

Discussion:
Statins produced modest but significant average declines in testosterone in men. Change in testosterone on statins related significantly to change in lipids, differently for simvastatin and pravastatin.
Abstract MP41: Comparisons of Built Environment Characteristics Inside and Outside of Spatial Clusters of Physical Activity and Obesity in Older U.S. Women
Authors: Tamura Kosuke , Puett Robin C , Hart Jaime E , Starnes Heather A , Laden Francine , Troped Philip J
Published: July 2021

Introduction:
Spatial clustering methods have been applied to cancer for over a decade. These methods have been used in studies on physical activity (PA) and obesity. One recent study examined differences in built environment attributes inside and outside PA clusters. We tested two hypotheses: 1) PA and obesity would spatially cluster in older women; and 2) built environment attributes typically related to higher walkability would be found in high PA clusters, while attributes related to lower walkability would appear in high obesity clusters.

Methods:
We used data from 22,589 Nurses’ Health Study participants (mean age = 69.9 ± 6.8y) in California, Massachusetts, and Pennsylvania. Two outcomes were examined: meeting PA guidelines via self-reported walking (≥ 500 MET-min/week) and obesity (BMI ≥ 30.0). Objective built environment variables were created: population and intersection density, diversity of facilities, and facility density. We used a spatial scan statistic to detect clusters (i.e., areas with high or low rates) of the two outcomes. Built environment attributes were compared inside and outside clusters.

Results:
Six spatial clusters of PA were found in California and Massachusetts. Two obesity clusters were found in Pennsylvania. Overall there were significant differences (p<0.05) in population and intersection density, and diversity and density of facilities inside and outside clusters. In some cases, built environment attributes related to higher walkability appeared in high PA clusters, while in other PA clusters we did not find this pattern. Differences in built environment attributes inside and outside obesity clusters showed inconsistent patterns.

Conclusion:
Although PA and obesity clusters emerged, the comparison of built environment attributes inside and outside clusters revealed a complex picture not fully consistent with existing literature. Further examination of PA and obesity clusters in older adults should include other built environment factors that may be related to these outcomes.