bluuebunny/crossref_metadata_2025 huggingface dataset:
Псевдомембранозний коліт, ускладнений гострою токсичною дилатацією товстої кишки
Authors: Керничний В. В. , Синчишена Л. В. , Балицький В. В. , Кирик Р. В. , Янчук М. А. , Галушко В. М. , Сідорук С. С. , Лі Б. Е.
Published: May 2021

Мета роботи: демонстрування клінічного випадку гострої токсичної дилатації товстої кишки як ускладнення фульмінантної форми псевдомембранозного коліту.

Псевдомембранозний коліт, асоційований з Clostridium difficile, є тяжким наслідком застосування антибактеріальних препаратів. Токсичний мегаколон – рідкісне і вкрай тяжке, незворотне, інвалідизуюче ускладнення псевдомембранозного коліту, що зустрічається у 0,4 – 3 % випадків та у 35 – 80 % випадків призводить до летальних наслідків. Дане ускладнення вимагає хірургічного лікування, зволікання призводить до тяжкої системної інтоксикації, виснаження пацієнта та летального наслідку. Обструктивна тотальна/субтотальна колектомія – єдиний рекомендований об’єм операційного втручання, що може забезпечити позитивний прогноз для життя пацієнта. Виконання операційних втручань в інших об’ємах асоційоване з високим ризиком пов­торних операцій та летальних наслідків.
65 років Шапринському Володимиру Олександровичу – хірургу України, видатному педагогу, професору, академіку академії наук вищої освіти України
Authors: Avtoriv Kolektyv
Published: May 2021

65 років Шапринському Володимиру Олександровичу – хірургу україни, видатному педагогу, професору, академіку академії наук вищої освіти україни
Por outras e outros Ocañas que merecemos
Authors: Colling Leandro , Cantó Assumpta Sabuco
Published: May 2021

O texto privilegia uma leitura pouco explorada da obra do artista espanhol José Pérez Ocaña. Ao invés de destacar o artista como um precursor do queer na Espanha, o artigo enfatiza a importância da cultura e da religiosidade da Andaluzia na obra de Ocaña, em especial os seus elementos ritualísticos, por meio dos quais ele questiona as normas de gênero e sexualidade e os próprios ritos religiosos.
Pinturas de Massimo Campigli no MAC USP: Entre arqueologia, memória e modernidade
Authors: Rocco Renata Dias Ferrareto Moura
Published: May 2021

O artigo trata das seis pinturas do artista alemão naturalizado italiano Massimo Campigli, do acervo do MAC USP. Esse conjunto, ainda não analisado em profundidade pela historiografia da arte no Brasil, será discutido no contexto mais amplo de sua produçãoo artística. Para tanto, recuperamos aspectos da biografia de Campigli e de sua produção e indicamos como as obras chegaram ao acervo do antigo MAM-SP. Por fim, apresentamos a análise plástica e as considerações finais. Para tratar das telas, nos apoiamos em seus escritos autobiográficos, catálogos de exposições, textos críticos, além de informações fornecidas pelo Arquivo da Bienal de São Paulo e pelo Arquivo Campigli. Sobre a incorporação ao museu, nos valemos das pesquisas da professora Ana Gonçalves Magalhães.
Theodor Heuberger, Kunsthändler: Entre predileções artísticas modernistas e a propaganda nazista no Brasil (1924-1942)
Authors: Mari Marcelo
Published: May 2021

Theodor Heuberger foi Kunsthändler atuante no Rio de Janeiro e em São Paulo. Com formação em Munique, realizou exposições no Brasil com obras importantes do expressionismo alemão; foi, também, o primeiro a expor no país a artista Käthe Kollwitz. Além disso, difundiu, no ambiente cultural brasileiro, padrões renovados de desenho de lojas e de expografia ligados ao gosto estético do Deutscher Werkbund. Em que pese sua atuação em prol do expressionismo, Heuberger fundou uma revista de trocas culturais entre Alemanha e Brasil na qual a arte moderna dividiria espaço, progressivamente durante as décadas de 1930 e 1940, com notícias oficiais da Alemanha. De incentivadora da arte moderna alemã, a revista Intercâmbio terminaria seus dias como veículo de propaganda nazista.
Modernidade e desmaterialização na obra tardia de Gustave Moreau
Authors: Vasconcellos Mariana Garcia
Published: May 2021

Em sua fase final, a obra de Gustave Moreau passa por um processo de desmaterialização que é comum a outros artistas de sua geração. Por meio da análise da pintura e das anotações pessoais de Moreau, este artigo busca compreender as estratégias artísticas e as implicações teóricas envolvidas nesse movimento de idealização do conceito de “obra de arte”. São discutidos o uso simbolicamente carregado do inacabamento da pintura e a descentralização da “obra”, desdobrada em múltiplos estudos e trabalhos menores. Partindo do caso específico do artista, busca-se também contribuir para uma perspectiva geral sobre questões-chave da pintura moderna.
Teoria da maturidade progressiva do menor aplicada no direito à saúde
Authors: Araújo Rodrigo Vasconcelos Coelho de
Published: May 2021

O presente artigo analisou os limites do poder familiar nos casos envolvendo recusa de tratamento  médico por adolescentes. A partir dos dispositivos  constitucionais e infraconstitucionais, pretendeu-se  fazer uma releitura da autonomia do adolescente e,  em virtude do fenômeno da mundialização dos  juízes, reforçar no Direito brasileiro alguns  fundamentos oriundos de precedente inglês que deu  origem à teoria do menor maduro. Concluiu-se  com a análise dos fundamentos e dos requisitos para a recusa de tratamento médico por adolescentes no  direito brasileiro.
COVID-19: parâmetros internacionais, federalismo e a atuação internacional dos estados e municípios
Authors: Silva Gabriela Fideles , Guimarães Vinícius César
Published: May 2021

Tendo como contexto os impactos da pandemia do novo coronavírus e a relevância dada às recomendações da Organização Mundial da Saúde,  este artigo buscou abordar – sob a ótica do Direito  Internacional Público e das Relações  Internacionais - as políticas de saúde sugeridas pelos parâmetros  internacionais de enfrentamento da pandemia da  COVID-19. A partir de documentos internacionais,  artigos acadêmicos e informações veiculadas por  meios de comunicação, analisou-se a adoção dessas  políticas pelo governo federal e por seus entes  subnacionais, levando-se em conta, por fim, as ações  paradiplomáticas despertadas e suas consequências  para o sistema federalista brasileiro. Com base na  revisão da literatura pertinente, buscou-se  apresentar os parâmetros internacionais que  concernem à saúde; quais são os aspectos do  sistema federalista brasileiro no que diz respeito à  saúde; e, com base nesse estudo, qual é o efeito do  federalismo na luta contra a COVID-19 e como ele  pode colaborar para uma atuação cada vez maior de  estados e municípios nas relações internacionais. Por  fim, examinou-se a definição de paradiplomacia  para se compreender o poder que os entes da União  possuem no cenário internacional. Concluiu-se que  os tratados e organizações internacionais têm um  papel fundamental na efetivação do direito à saúde,  servindo de base para que o Judiciário permita que  estados e municípios tomem medidas mais  restritivas no combate à COVID-19. Percebeu-se,  ainda, que a falta de liderança do governo federal e a  autonomia detida pelos entes federativos  permitiram que estes desenvolvessem um  protagonismo maior nas relações internacionais no  contexto da pandemia.
Abstract 025: Mediterranean Diet Trajectories And Changes In Cardiovascular Risk Factors And Inflammation Markers Over A 12.7 Years Follow-up: Prospective Findings From The Moli-sani Study Cohort
Authors: Bonaccio Marialaura , Costanzo Simona , Di Castelnuovo Augusto F , Gialluisi Alessandro , De Curtis Amalia , Persichillo Mariarosaria , Tabolacci Claudio , Facchiano Francesco , Cerletti Chiara , Donati Maria Benedetta , De Gaetano Giovanni , Iacoviello Licia ,   Moli-sani Study Investigators
Published: May 2021

Introduction:
Trends in diet quality worldwide indicate a progressive decline in adherence to Mediterranean diet (MD), but data on longitudinal individual-level changes are still limited, especially in Mediterranean countries.

Hypothesis:
We assessed the hypothesis of an association, in a Mediterranean population, between life course trajectories in MD and concurrent long-term modifications of risk factors for cardiovascular disease (CVD) and inflammatory markers.

Methods:
We followed 2,107 men and women (mean age at baseline 54.6±8.8 y) from the Moli-sani Study (Italy) between 2005 and 2020. Dietary data were measured at baseline and at a re-examination (after an average of 12.7 years) and were collected by a 188-item food frequency questionnaire. Adherence to MD was estimated by a Mediterranean diet score based on 9 food groups, ranging from 0 to 9 points. MD trajectories were identified as downward (-6 to -2 points in MDS), relatively stable (-1 to 0) and upward (1 to 6). Inflammation was measured by both an INFLA-score including C-reactive protein and cellular markers (
e.g
., leukocyte count) and a CYTO-score including 14 selected analytes (cytokines, chemokines and growth factors). Regression models were used to examine changes in MDS, CVD risk factors and inflammation markers within the same period.

Results:
Overall, adherence to MD decreased by an average of 6.5% over follow-up. As opposed to the downward, an upward trajectory in MD adherence was inversely associated with the INFLA-score (β=-0.177; 95%CI -0.296, -0.058) and the CYTO-score (β=-0.311; 95%CI -0.548, -0.073). No significant changes were observed for CVD risk factors, with the exception of an increase in blood glucose (β=0.121; 95%CI 0.001, 0.241) and systolic blood pressure (β=0.110; 95%CI 0.003, 0.217) associated with an upward MD trajectory.

Conclusions:
In a large sample of Mediterranean individuals, diet quality, as reflected by adherence to an MD, has been declining over the last decade. However, in the group of subjects who improved their adherence to an MD, a significant reduction of markers of an inflammatory status was documented, possibly predisposing to a better duration and quality of life.
Abstract 065: Ultra-processed Food And Hypertension Incidence In The Regards Cohort
Authors: Oladele Carol R , Khandpur Neha , Plante Timothy B , Yuan Ya , Lovasi Gina S , Judd Suzanne E
Published: May 2021

Background:
A growing body of evidence demonstrates that diets high in ultra-processed food products (UPF)—ready-to-eat formulations of processed substances that have been extracted or refined from whole foods and that typically contain added flavors, colors, and other cosmetic additives -- lack nutrient quality and contribute to energy imbalance. However, few studies have examined the impact on hypertension, a diet-sensitive condition characterized by racial disparities across the disease spectrum. We sought to determine black-white differences in UPF consumption and associations with incident hypertension.

Methods:
Data from the Reasons for Geographic and Racial Disparities in Stroke (REGARDS) Cohort Study was used. Participants free of hypertension at baseline (2003-2007) who had complete food intake data and completed visit 2 (2013-2017) were included. The NOVA classification system was used to categorize participants food and drink into categories according to their level of processing, from 1 (minimally processed) to 4 (ultra-processed). The percent gram contribution of UPF to total grams consumed was calculated and used to create quartiles of UPF intake. The outcome, incident hypertension, was defined as systolic blood pressure of =>140 mm Hg or diastolic pressure =>90 mm Hg or taking antihypertensive medication at visit 2. Summary statistics were used to examine participant demographics by UPF consumption. Multivariable logistic regression was used to assess the hypothesis that UPF consumption is associated with incident hypertension and that the association varies by race.

Results:
A total of 5,957 participants were included in analyses, 23 percent were Black and 77 White. Black participants had higher UPF intake compared to White participants. Thirty-eight percent of Black participants were in the top quartile of UPF consumption compared to 21 percent among White participants. Women, those with lower educational attainment, lower physical activity, and income below 35K were more likely to be in the top quartile of UPF consumption. Regression model results showed individuals in the top quartile of UPF consumption had 38 percent greater odds of incident hypertension (CI=1.11-1.53) after adjustment for sociodemographic characteristics. Race-stratified model results showed that Blacks in the top quartile had 47 percent greater odds (CI=1.06-2.03) of incident hypertension. UPF consumption was not significantly associated with incident hypertension among Whites (OR=1.19, CI=0.99-1.43).

Conclusions:
Findings demonstrate racial disparities in consumption of UPF and that disparities contribute to higher incident hypertension among Black persons. Results contribute to the growing evidence base needed to inform equitable food system policies, support healthier dietary consumption, and address hypertension disparities.
Abstract P008: Ideal Cardiovascular Health And Hepatocyte Growth Factor In The Multi-ethnic Study Of Atherosclerosis
Authors: Osibogun Olatokunbo , Ogunmoroti Oluseye , Ferraro Richard A , Esuruoso Olumuyiwa A , Ndumele Chiadi E , Burke Gregory , Larson Nicholas B , Bielinski Suzette J , Michos Erin
Published: May 2021

Background:
Hepatocyte growth factor (HGF) is a cytokine released in response to vascular injury and a novel biomarker of cardiovascular disease (CVD) risk. However, the relationship between ideal cardiovascular health (CVH) and HGF is unknown. We examined whether ideal CVH is associated with lower HGF levels in a multi-ethnic cohort of adults free from clinical CVD at baseline.

Methods:
We analyzed data from the MESA study of 6,490 men and women aged 45-84 years. The independent variable was the CVH score derived from 7 metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and blood glucose). Each metric was scored 0 points (poor), 1 point (intermediate) and 2 points (ideal). The total CVH score ranged from 0-14. An inadequate score was 0-8, average, 9-10 and optimal, 11-14. The number of ideal metrics was also counted. The dependent variable was logarithmically transformed HGF. We examined the association between the CVH score and HGF using linear regression models adjusted for age, sex, race/ethnicity, education, income, health insurance and study site.

Results:
The mean (SD) age of participants was 62 (10) years. Fifty-three percent were women. Participants with optimal CVH scores had the lowest HGF concentration [Median (IQR): 807 (678-962) pg/mL] compared to those with average [870 (740-1,036)] and inadequate scores [969 (821-1,159)]. A one-unit increment in the CVH score was significantly associated with a 3% lower HGF concentration (Table). Average and optimal CVH scores were also significantly associated with 8% and 12% lower HGF concentrations, respectively, compared to inadequate scores. Additionally, a greater number of ideal metrics was associated with lower HGF concentrations. Interactions by age, sex and race/ethnicity were not significant.

Conclusion:
In this ethnically diverse cohort, optimal CVH was significantly associated with lower HGF levels. Interventions aimed at promoting ideal CVH may reduce vascular injury as indicated by lower serum HGF levels.
Abstract P012: Association Between Testosterone And Sex Hormone Binding Globulin And Risk Of Ischemic Stroke: The Atherosclerosis Risk In Communities Study
Authors: Northuis Carin A , Michos Erin , Ballantyne Christie M , Hoogeveen Ron C , Lutsey Pamela L , Pankow James S , Selvin Elizabeth , Sullivan Kevin , Lakshminarayan Kamakshi
Published: May 2021

Background:
Sex hormones are associated with obesity, diabetes mellitus, and other stroke risk factors; however, studies on sex hormones and stroke risk report inconsistent results. We assessed the associations of testosterone and sex hormone binding globulin (SHBG) with risk of ischemic stroke among men and post-menopausal women in the Atherosclerosis Risk in Communities (ARIC) Study.

Methods:
A total of 4,349 men and 4,720 post-menopausal women who had SHBG and total testosterone measurements at visit 4 (1996-98) were followed through 2018 for the development of ischemic stroke. We examined log transformed SHBG and testosterone exposure as quartiles and as per 1 SD increment. We used Cox regression to estimate the hazard ratios (HR) for ischemic stroke, adjusting for demographic, behavioral and clinical variables. Analyses were stratified by sex and menopausal hormone therapy (HT) use.

Results:
Participants were aged 63±6 years at baseline, 52% were women (25% HT users), and 21% Black. There were 691 strokes over a median follow-up of 19.8 years. Mean log SHBG (nmol/L) and testosterone (nmol/L) were 4.3±0.7 and 3.1±0.5 for HT users, 3.6±0.7 and 3.2±0.5 for non-HT users, and 3.4±0.5 and 6.2±0.5 for men. Quartile 1 vs Q4 for SHBG and testosterone were ≤50.3 vs >121 and ≤16 vs >28 in HT users, ≤23.3 vs >55 and ≤17.9 vs >32.7 in non-HT users, and ≤23.3 vs >41.8 and ≤388 vs >657 in men. SHBG and testosterone were not significantly associated with stroke in any group (Figure). The HRs [95% confidence interval] for highest to lowest SHBG and testosterone quartiles were 1.04 [0.51-2.14] and 1.64 [0.85-3.17] in HT-users, 1.02 [0.70-1.48] and 1.16 [0.83-1.62] in HT non-users, and 0.96 [0.70-1.32] and 0.87 [0.63-1.21] in men, respectively. The HRs for stroke associated with 1 SD increase in SHBG and testosterone were 1.14 [0.88-1.46] and 1.19 [0.96-1.46] in HT users. Associations were also null among non-HT users and men.

Conclusion:
SHBG and testosterone were not associated with ischemic stroke risk in this cohort of older men and post-menopausal women.
Abstract P013: Validating The Utility Of Plasma Biomarkers In The Prediction Of Readmission Or Mortality Following Congenital Heart Surgery
Authors: Parker Devin , Zappitelli Michael , Thiessen-Philbrook Heather , Everett Allen D , Stabler Meagan , Jacobs Marshall , Jacobs Jeffrey P , Parikh Chirag , Brown Jeremiah R
Published: May 2021

Introduction:
Unplanned readmission is associated with higher risks of complications, death, and increased costs. Accurate statistical models to stratify the risk of 30-day readmission or death after congenital heart surgery could help clinical teams focus care on those patients at highest risk. We hypothesized biomarkers could improve prediction for readmission or mortality.

Methods:
Levels of pre- and postoperative ST2, Galectin-3, NT-proBNP and GFAP were measured in plasma samples from 162 pediatric congenital heart surgery patients from Johns Hopkins Hospital with external validation in 360 pediatric patients from an international multi-center TRIBE-AKI cohort. A model based on clinical variables from the Society of Thoracic Surgery Congenital database (STS-CHSD) was developed in the Hopkins cohort. We tested and externally validated the clinical models and biomarker panels in the TRIBE-AKI cohort using AUROC statistics and Kaplan-Meier cox hazard regression models.

Results:
There were 55 patients (10.5%) that experienced unplanned readmission or died within 30 days after congenital heart surgery. The STS-CHSD clinical model resulted in an AUROC of 0.617 (95% CI: 0.47 - 0.76). The derivation cohort with the biomarker augmented STS-CHSD clinical model resulted in a significantly improved AUROC of 0.802 (95%CI: 0.72 - 0.89; p=0.003). External validation of the biomarker augmented STS-CHSD clinical model showed limited improvement (AUROC: 0.60; 95% CI: 0.49-0.72; p value= 0.47).

Conclusions:
Our findings indicate that these biomarkers can be used for early identification of children at increased risk of readmission or death after pediatric congenital heart surgery. While the addition of biomarkers improve prediction in our derivation cohort, external validation was poor. Our findings suggest there are other potential biomarkers and factors to be explored to improve prediction of readmission or mortality for children following congenital heart surgery.
Abstract P017: Sex Differences Of Longitudinal Changes Of Cognitive Function Over 9 Years Among Older Adults: Findings From Tanushimaru Cohort Study
Authors: Morikawa Nagisa , Adachi Hisashi , Jacobs David R. , Enomoto Mika , Fukami Ako , Sakaue Akiko , Toyomasu Kenta , Yamamoto Maki , Fukumoto Yoshihiro
Published: May 2021

Introduction:
Mild cognitive impairment (MCI) is often a precursor to dementia and is therefore of increasing interest. Some previous studies showed MCI progresses to dementia faster in women than in men. However, sex differences in the progression of cognitive decline requires additional study.

Hypothesis:
Correlates of changing patterns of cognitive function differ between the sexes.

Methods:
We recruited 2653 participants (mean age: 59.2±12.0 years, male 41.6%) as a population-based sample of Tanushimaru, Japan in 2009 and conducted a longitudinal study with a follow-up examination in 2018. Mini-Mental State Examination (MMSE) was a 30-point test used to assess cognitive function. We classified cognitive function as dementia, MCI and normal using MMSE cutpoints ≤23, 24-27, and ≥28, respectively. We performed analysis of covariance (ANCOVA) to examine the correlates of change in MMSE scores in 973 people who attended in both 2009 and 2018.

Results:
Mean MMSE scores in 2009 were 27.7±2.5 (men:27.4±2.8, women:27.8±2.3, p=0.0016) and in 2018 were 28.3±2.3 (men:28.3±2.2, women:28.4±2.5). Changes in MMSE scores were 0.47±3.04 in men and 0.26±3.13 in women. Cognition status progressed from normal to MCI or from MCI to dementia over 9 years in 26.3% (men:24.9%, women:27.2%) and 2.6%(men:2.8%, women:2.5%), respectively. On the other hand, 72.0% of MCI (men:69.7%, women:73.4%) reverted to normal cognitive status. Cognitive improvement for 9 years was associated with higher high-density lipoprotein (HDL) cholesterol, lower log-transformed serum insulin in 2009 in men(p=0.0198, p=0.008),and higher estimated glomerular filtration rate (eGFR) in 2009 in women (p=0.058). Lower serum magnesium levels in 2009 were marginally associated with the progression from MCI to dementia in both sexes. (Figure 1).

Conclusions:
Cognitive status function was better in women and improved in both sexes during 9 years. A sex-stratified approach for describing correlates of cognitive status may be useful.
Abstract P018: Advanced Glycation End Products And And Incident Cardiovascular Disease
Authors: Lamprea-montealegre Julio A , Arnold Alice , McClelland Robyn , Tracy Russell P , Djousse Luc , Mukamal Kenneth J , Psaty Bruce M , Siscovick David S , Zieman Susan J , Brownlee Michael , Biggs Mary Lou , Beisswenger Paul J , Ix Joachim H , Kizer Jorge R
Published: May 2021

Background:
Advanced glycation end-products (AGEs) have been linked to cardiovascular disease (CVD) in populations with and without diabetes. There are limited data, however, regarding the longitudinal associations of the array of circulating AGE adducts with risk of CVD in the general population. We tested the hypothesis that major plasma AGEs, measured by gold-standard liquid chromatography/tandem mass spectrometry (LC/MS) are associated with incident CVD in subsets of two population-based cohort studies with different demographic and risk factor profiles.

Methods:
Analyses were performed in a case-cohort study of 2000 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) and in a random cohort of 466 participants in the Cardiovascular Health Study (CHS). Five AGEs were measured by LC/MS: CML, 3DG-H, CEL, G-H1 and MG-H1. Incident CVD was defined as first occurrence of fatal or non-fatal stroke, myocardial infarction, or coronary heart disease death. Cox regression was used to examine associations between AGEs and CVD.

Results:
Participants in CHS were older than in MESA (median age=74 vs 65), had lower eGFR (67 vs 82 ml/min/1.73m
2
) but higher CRP (median 2.53 vs 2.06 mg/L), and had substantially higher levels of all AGEs
(Table)
. During a median follow-up of 11 years in both cohorts, 439 (22%) participants in MESA and 200 (42%) in CHS developed incident CVD. In unadjusted models, all AGEs were strongly and significantly associated with incident CVD in MESA and CHS
(Table).
In multivariable adjusted models, CML, 3DG-H and a summary variable that accounted for all measured AGEs (PC1) were significantly associated with incident CVD in CHS but not in MESA.

Conclusion:
We found AGEs to be significantly associated with CVD in an older cohort, but not in a healthier middle-aged to older population that had lower systemic inflammation and lower baseline AGE concentrations. In the general population, AGEs may exert detrimental cardiovascular effects only at higher levels over longer cumulative exposure.
Abstract P030: Complementary Variable Selection Methods Highlight Joint Contribution Of Cystatin C And Apolipoprotein B For Cardiovascular Risk Prediction
Authors: Elliott Joshua , Whitaker Matthew , Bodinier Barbara , Elliott Paul , Tzoulaki Ioanna , Chadeau-Hyam Marc
Published: May 2021

Introduction:
Variable selection methods can provide an unbiased means of identifying informative predictors but have rarely been applied to CVD risk prediction.

Hypothesis:
Additional variables beyond those in pooled cohort equations may improve CVD risk prediction.

Methods:
Use of two complementary variable selection methods (LASSO stability selection, parametric, and survival random forests, non-parametric) to identify jointly informative sets of predictors for CVD risk and rank them in order of predictive accuracy. We used a prospective cohort (UK Biobank) of 304,839 participants aged 40-69 years at enrollment (2006—2010) without prior CVD, with follow-up to March 2017. Variables comprised those in pooled cohort equations with additional biochemistry and hematology data and polygenic risk scores for CVD. Outcomes were CVD hospitalization, procedure/operation or mortality. Data were sex-stratified and divided into independent variable selection (40%), training (30%) and test (30%) sets. Variable selection via penalized (LASSO) Cox regression with stability analysis. Variables ranked according to mean change in C statistic after variable permutation in survival random forests.

Results:
Mean age 55.9 years; 10,267 CVD events (6,277 men [59.0%]), median 8.1 years follow-up. The Figure summarizes results from LASSO stability selection. Jointly informative predictors for both men and women were cystatin C, apolipoprotein B, family history of coronary artery disease and polygenic risk score in addition to age, systolic blood pressure, antihypertensive use and current smoking used in pooled cohort equations. Other than variables already included in pooled cohort equations, cystatin C and apolipoprotein B ranked highest in random forests for men and for women.

Conclusions:
Use of two complementary data-driven variable selection methods identified variables more highly selected for CVD prediction beyond those included in pooled cohort equations.
Abstract P033: Identifying Racial/Ethnic Differences In Patterns Of Early Childhood Cardiovascular Health Using Electronic Health Record Data
Authors: Pool Lindsay , Yang Xiaoyun , Krefman Amy , Perak Amanda M , Davis Matthew , Rosenman Marc , Hou Lifang , Marino Bradley S , Van Horn Linda , Labarthe Darwin R , Lloyd-Jones Donald M , Allen Norrina B
Published: May 2021

Introduction:
Racial/ethnic differences in CVH beginning at age 8 have been identified and linked with the development of cardiometabolic disease in adulthood; however, there is scarce research on CVH in very childhood. Our objective was to use a large, diverse pediatric EHR consortium to identify racial/ethnic patterns of clinical CVH from ages 2-12 years.

Methods:
We used ambulatory visit data spanning 2010-2018 from children aged 2-12 years within CAPriCORN - an EHR repository that combines medical records throughout the city of Chicago. The 4 clinical CVH metrics - BMI, blood pressure, cholesterol, and glucose - were categorized as ideal or non-ideal using available values of weight, height, blood pressure, laboratory readings, and ICD diagnosis codes. Multiple measurements within a given integer age were averaged by individual. Frequency of ideal and non-ideal status for each CVH metric was plotted by age in years and stratified by race/ethnicity (Figure).

Results:
There were 162,621 children included (47% female) with a median of 2 visits during follow-up. The race/ethnicity distribution was 4% Asian/Pacific Islander (API), 26% non-Hispanic Black (NHB), 44% non-Hispanic white (NHW), 18% Hispanic, and 8% other/unknown. Sustained decrease in ideal BMI occurred across race/ethnicity groups; however, proportion in ideal was consistently lower for NHB and Hispanic children. Ideal BP appeared to increase across childhood with few racial differences. Ideal cholesterol levels were constant across childhood, but the proportion of NHW children in ideal was lower than NHB and Hispanic children. Almost all individuals had ideal glucose levels throughout early childhood.

Conclusions:
Early childhood declines in CVH appeared to be driven by changes in ideal BMI. Racial/ethnic differences in ideal BMI and cholesterol were present by age 2 and were mostly sustained through age 12. Selection bias may account for some of these findings; consistent monitoring in early childhood is needed to better understand observed differences.
Abstract P037: Progression Of Coronary Artery Calcification And Risk Of Clinical Events In Chronic Kidney Disease
Authors: Bundy Joshua D , Tian Ling , Budoff Matthew J , Scialla Julia J , Mehta Rupal , Saab Georges , Jaar Bernard , Dobre Mirela A , Reilly Muredach P , Rader Daniel J , Townsend Raymond R , Lash James , Greenland Philip , Isakova Tamara
Published: May 2021

Introduction:
Patients with chronic kidney disease (CKD) are at high risk for cardiovascular disease (CVD) events. Coronary artery calcification (CAC) and progression of CAC are associated with higher risk of clinical events in the general population, but this has not been quantified among patients with CKD.

Hypothesis:
Progression of CAC is independently associated with CVD events and mortality among patients with CKD stages 2-4.

Methods:
We pooled individual-level data from 2 prospective longitudinal cohort studies (the Chronic Renal Insufficiency Cohort [CRIC] Study and the Multi-Ethnic Study of Atherosclerosis [MESA]). We included participants with CKD, defined as an estimated glomerular filtration rate <60 mL/min/1.73m
2
or urinary albumin-to-creatine ratio ≥30 mg/g. In both cohorts, CAC was measured at baseline and a follow-up visit using electron beam or multidetector computed tomography. Multivariable-adjusted Cox proportional hazards regression models were used to assess the associations of CAC progression between visits with risks of adjudicated atherosclerotic CVD events (myocardial infarction, stroke) and all-cause mortality. Analyses were stratified by presence or absence of CAC at baseline.

Results:
2111 participants with CKD were included (1314 with and 797 without CAC at baseline). Over an average of 3 years between CAC scans, 192 (24%) participants without baseline CAC developed CAC while 222 participants (17%) with baseline CAC increased ≥100 Agatston units per year. Over an average 9.4-year follow-up after the second CAC scan, we observed 272 atherosclerotic CVD events (178 myocardial infarction, 94 stroke) and 570 deaths. After multivariable adjustment, CAC progression was significantly associated with higher risk of atherosclerotic CVD and mortality, particularly among those with CAC at baseline (Table).

Conclusions:
Among adults with CKD stages 2-4, progression of CAC over approximately 3 years is significantly associated with atherosclerotic CVD and mortality.
Abstract P040: The Effect Of Weight Loss And Aerobic Exercise Training On The American Heart Association’s Life’s Simple 7
Authors: McGee Joshua E , Huff Anna C , Clunan Marie C , Gniewek Nicole R , Grammer Emily E , Osborne Briceida , Matarese Laura E , Carels Robert A , Pories Walter J , Houmard Joseph A , Swift Damon L
Published: May 2021

There is limited evidence on the impact of weight loss via caloric restriction and aerobic exercise on Life’s Simple 7 (LS7), a health assessment tool used by the American Heart Association to promote and track cardiovascular health (CVH) via modifiable risk factors and health behaviors. Individuals with obesity have a greater prevalence of traditional and non-traditional cardiometabolic risk factors than lean individuals.

Objective:
Examine the effect of a weight loss intervention on LS7 and assess predictors of change in adults with obesity.

Methods:
Twenty-six adults (44.9 ± 9.7 years; weight: 93.9 ± 11.1 kg; body mass index: 34.1 ± 3.4 kg/m
2
) participated in a 10-week medical weight loss program (OPTIFAST) and supervised exercise training program (50-75% VO
2
max) to achieve clinically significant weight loss (≥7% body weight). Poor, intermediate, and ideal CVH categories were defined as scores 0 to 4, 5 to 9, and 10 to 14, respectively. Baseline and post-weight loss LS7 scores were calculated via participant demographics, smoking status, anthropometry, physical activity level, diet intake, and blood lab reports. Paired samples t-test and Pearson’s correlations were used.

Results:
Mean weight loss was significant (-9.2 ± 3.6 kg,
p
< 0.001). Mean LS7 score significantly increased from baseline to weight loss (7.3 ± 1.5 vs. 9.6 ± 1.2, respectively,
p
< 0.001) and 57.7% of participants (15 of 26) improved to ideal CVH following weight loss. A significant inverse association was observed between change in LS7 and systolic blood pressure (
r
= -0.41,
p
< 0.05), total cholesterol (
r
= -0.45,
p
< 0.05), and glucose (
r
= -0.41,
p
< 0.05). There were no further significant relationships with LS7 (i.e. change in weight, body mass index, physical activity, diastolic blood pressure).

Discussion:
A combined caloric restriction and aerobic exercise training intervention improved a multitude of cardiovascular disease risk factors. Previous epidemiological studies indicate meeting the ideal LS7 metrics is associated with 78% and 49% reduced risk of cardiovascular disease morbidity and mortality, respectively. Thus, the long-term modification of health behaviors and cardiometabolic risk factors to achieve ideal cardiovascular health may reduce risks of cardiovascular morbidity and mortality in individuals with obesity.
Abstract P046: Prevalence Of Covid-19 Related Concerns And The Association With Participant Characteristics Among Adults With Heart Disease Engaged In Telebehavioral Therapy During The Pandemic
Authors: Kashine Nicole , Greenberger Heidi M , Andreopoulos Evie , Pande Reena L
Published: May 2021

Introduction:
Individuals with cardiac conditions may be at increased risk for behavioral health issues, as well as for adverse COVID-19 outcomes. The purpose of this study was to examine the prevalence and types of COVID-19 related concerns, and associated characteristics, among U.S. adults with heart disease engaged in a telebehavioral therapy program during the COVID-19 pandemic.

Methods:
The analytic sample comprised de-identified data from a consecutive cohort of 480 adults with heart disease (62% female, 27% non-white race/ethnicity, mean age 70.9 ± 12.6 years) that completed an initial consultation for an evidence-based telebehavioral therapy program between March 23 - April 11, 2020. Baseline characteristics including age, sex, race/ethnicity, U.S. region, marital status, living alone, employment status, self-rated health (from the 36-Item Short Form Health Survey), and psychological symptom severity (Depression Anxiety Stress Scales 21) were obtained through standardized assessment conducted by a licensed therapist. COVID-19 related concerns were abstracted from clinical notes and characterized using qualitative research methods. Associations between participant characteristics and the presence of a COVID-19 concern were evaluated using chi-square statistics and logistic regression.

Results:
Forty percent of participants (191/480) reported at least one COVID-19 related concern at their initial consultation. The three most prevalent concerns were anxious feelings associated with the pandemic (14.2%), isolation (11.9%), and health-related concerns (e.g., contracting COVID-19; 11.9%). Depression (39.9%), anxiety (40.1%), and stress (26.3%) symptoms were prevalent among participants. There were no significant associations between having a COVID-19 concern and age >=65 years, U.S. region, unmarried/unpartnered status, living alone, unemployed status, poor/fair self-rated health (p>.05). Female vs. male sex (45% vs. 32%; p=.006) and white vs. non-white race/ethnicity (43% vs. 30%; p=.006) were each associated with higher odds of having a COVID-19 related concern; after multivariate adjustment these associations remained significant (OR female sex = 1.8, 95%CI 1.2-2.7; OR white race/ethnicity = 1.9, 95%CI = 1.2-3.0).

Conclusion:
COVID-19 related concerns were common among adults with heart disease engaged in telebehavioral health care during the COVID-19 pandemic, and more common among female and white participants.
Abstract P049: Diabetes And The Risk Of Hospitalization With Infection
Authors: Fang Michael , Ishigami Junichi , Echouffo-Tcheugui Justin , Lutsey Pamela L , Pankow James S , Selvin Elizabeth
Published: May 2021

Introduction:
Mechanistic research suggests that diabetes may increase susceptibility to infection. However, few epidemiologic studies have examined this association.

Hypothesis:
We hypothesize that adults with diabetes will have a higher risk for infection compared to those without diabetes.

Methods:
We conducted a prospective cohort analysis of diabetes and incident hospitalization with infection using data from the Atherosclerosis Risk in Communities (ARIC) Study. We used Cox regression models with adjustments for demographics, health behaviors, and cardiometabolic and kidney functioning measures. Diabetes status at baseline (1987-1989) was defined as a fasting glucose ≥126 mg/dL or non-fasting glucose ≥200 mg/dL, or self-report of a diagnosis of diabetes, or current diabetes medication use. First hospitalization with any infection and specific types of infections (respiratory, urinary, foot, sepsis, and postoperative wound) were ascertained from ICD-9 codes in hospital discharge records, with follow-up to September 30, 2015.

Results:
We included 13,356 participants (mean age, 55; 26% black; 54% female). During a median follow-up of 18.8 years, there were 7,791 incident hospitalizations with infection. Compared to those without diabetes at baseline, those with diabetes had a greater risk for hospitalization with any infection (adjusted HR: 1.55 [95% CI: 1.45-1.66],
Table
). Results were generally consistent across infection type, and differences were especially pronounced for foot infections (adjusted HR: 6.35 [95% CI: 5.27-7.64]).

Conclusion:
The COVID-19 pandemic has heightened interest in the link between diabetes and susceptibility to infection. Our study suggests diabetes confers significant risk for infection. Enhancing diabetes prevention and management may reduce infection-related morbidity and mortality.
Abstract P074: Heterogeneity In Proportional Mortality Due To Atherosclerosis By Age Amongst Asian Americans
Authors: Chauhan Abhyuday , Nair Deepak R , Vaidya Dhananjay
Published: May 2021

Background:
Asian American subgroups (AAS) differ amongst one another in terms of proportion of mortality (PM) due to atherosclerosis disease (ASD). However, differences in PM based on early onset (35-64 years) and older age (≥65 years) ASD deaths within each subgroup have not been well studied.

Methods:
US resident death records were examined from 2017 mortality data (National Center for Health Statistics). Race/ethnicity and underlying ASD cause (ICD-10 code of ischemic heart disease I20-I25, ischemic stroke I69, atherosclerosis I70, respectively) were tabulated for Asian-American subgroups and major US race/ethnicities (listed in Table). Age and sex standardized PM percentage was calculated overall for each ethnicity and separately for early and older age deaths within each ethnic group. The age by ethnicity interaction was tested using general linear models.

Results:
Over all ages, Filipinos and Asian Indians had the highest ASD PM while Vietnamese and Japanese had the lowest ASD PM, with other groups being intermediate. Compared with NHW, ASD PM was high in both age groups for Asian Indians and Filipino, while age difference PM in these ethnic groups was no different when compared to NHW – suggesting early and persistently high ASD. In contrast, Amerindians, Hispanics, Koreans and Chinese when compared to NHW had a low early age ASD PM, increasing significantly at older ages, suggesting the mortality burden is mostly at older ages.

Conclusion:
AAS are heterogeneous in terms of the overall burden of percent ASD mortality and the age at which it predominates. Asian Indians and Filipinos had the highest PM burden due to ASD over all ages, premature and older. On the other hand, premature ASD mortality burden was lowest in Koreans and Chinese amongst the AAS with a disproportionate increase in death in the elderly population. AAS subgroups need different strategies for prevention, with Asian Indians and Filipinos being targeted earlier in their life course.
Abstract P081: Association Of Homelessness And Anticoagulation Initiation In Veterans With Atrial Fibrillation: A Nationwide Study
Authors: Wilson David , Kim Nadejda , Mor Maria , Fine Micahel , Essien Utibe
Published: May 2021

Introduction:
Homeless individuals, overrepresented by Veterans, are more likely to have chronic medical conditions and comorbidities. They receive less medical care and have poor health outcomes, though remain understudied. Atrial fibrillation (AF), the most common cardiovascular rhythm disorder, is managed largely through anticoagulation. Direct-acting oral anticoagulants (DOACs) have been shown superior to warfarin anticoagulation in efficacy, safety, and adherence, though costlier.

Hypothesis:
Homeless Veterans receive a worse standard of care for AF than non-homeless Veterans in terms of initiation of any anticoagulation therapy, and in prescription of DOACs vs warfarin among those who began therapy.

Methods:
We studied 181,982 Veterans with incident, non-valvular AF in the Veterans Affairs Healthcare system from 2010-2018 who were not previously anticoagulated. Those who died or entered hospice were excluded. We classified Veterans who had experienced homelessness in the 2 years prior to their AF diagnosis using ICD-9/10 diagnosis codes and through VA homeless services use. We used logistic regression to examine the odds of initiation of any, DOAC, or warfarin anticoagulation. Models were adjusted for sociodemographic characteristics (year, age, race, CHA2DS2-VASc stroke risk score, HAS-BLED bleeding risk score, renal disease, BMI) and provider factors (e.g. specialty, had a patient seen a cardiologist within 90 days of their diagnosis). Facility type was modeled as a random effect.

Results:
Most of our cohort were male (178,400, 98%) and White (155,142, 85.6%). The homeless population of 6,472 was overrepresented by Black patients (1,574, 24.5%) and presented with AF at a younger age. The likelihood of being anticoagulated was lower in all populations before 2014. Having a BMI less than 25, liver disease, or bleeding concerns decreased the likelihood of being anticoagulated, while patients with renal disease were less likely to be prescribed DOACs. Black and Hispanic patients were less likely to be prescribed DOACs, regardless of homelessness status. We found the adjusted odds ratio (aOR) of initiating any anticoagulant therapy for homeless Veterans was 0.71 (95% CI 0.67 - 0.75). Among those who initiated anticoagulation, homeless individuals were less likely than non-homeless Veterans to initiate DOACs (aOR 0.88, 95% CI 0.80-0.96).

Conclusions:
In a nationwide cohort of Veterans with AF, we found that homeless Veterans were less likely to initiate any anticoagulation, especially more effective DOAC therapy. These findings persisted after adjusting for sociodemographic and clinical factors within an integrated health system with broad access to medical treatment through a uniform drug formulary. Future research must examine and address systematic biases to ensure high quality and equitable care for the most vulnerable populations, including homeless Veterans.
Abstract P101: Premenopausal Life’s Simple 7 Score Is Associated With High-density Lipoprotein Metrics Later In Life: The SWAN HDL Study
Authors: Nasr Alexis , Matthews Karen A , Brooks Maria M , Orchard Trevor , McConnell Dan , Billheimer Jeffrey T , Rader Daniel J , Barinas-Mitchell Emma , Wang Norman , El Khoudary Samar R
Published: May 2021

Objective:
In midlife women, higher high-density lipoprotein cholesterol (HDL-C) is not always associated with cardio-protection, suggesting a potential dysfunction of HDL. Novel metrics of HDL may provide further information on its cardio-protective features. The AHA developed the Life’s Simple 7 (LS7) score based on 7 lifestyle factors (cholesterol, BMI, diet, physical activity, smoking, glucose and blood pressure). A higher LS7 indicates a healthier lifestyle and is to cardiovascular health. We aimed to assess if higher premenopausal LS7 score is associated with a protective future HDL metrics profile as measured by greater HDL function (cholesterol efflux capacity), lower HDL-triglycerides (HDL-Tg) and higher HDL-phospholipids (HDL-PL) contents, higher large HDL-particles (HDL-P) and lower small HDL-P levels and larger overall HDL size by nuclear magnetic resonance spectroscopy.

Methods:
We included 529 women [baseline age 46.4 (2.6) years, 57% (299 of 529) White] from the Study of Women’s Health Across the Nation (SWAN) HDL ancillary study who had premenopausal LS7 score followed by repeated HDL metrics at later visits [time between LS7 score and first HDL measure: 3.9 (1.4) years]. Multivariable linear mixed models were used to analyze the independent association between premenopausal LS7 score and each HDL metric.

Results:
After adjusting for race, education, and baseline age, menopausal status, economic hardship and high-sensitivity C-reactive protein (Table), higher premenopausal LS7 score was associated with lower HDL-Tg (p<0.0001) and higher HDL-PL (p=0.02), greater total HDL-P (p=0.03), large HDL-P (p=0.0001) and HDL-C (p<0.0001), and larger HDL size (p<0.0001) later in life. Premenopausal LS7 score was not related to HDL function.

Conclusion:
Higher premenopausal LS7 score was not related to HDL function but related to favorable future HDL contents and subclasses. This indicates that a better premenopausal lifestyle and metabolic health may contribute to a better HDL profile later in life.