bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 047: Impact of Acculturation on Framingham Cardiovascular Risk Factors Among Elderly Mexican Americans
Authors: Lopez Lenny , Peralta Carmen A , Haan Mary N , Lee Anne , Aiello Allison
Published: July 2021

Background:
Acculturation is the process by which immigrant groups adopt the cultural practices and values of the host country. Higher levels of acculturation among Latinos have been shown to be associated with a higher prevalence of traditional CVD Framingham risk factors (FRFs) in some studies. The association of acculturation and prevalence of traditional CVD risk factors in elderly Latinos is less well established.

Hypothesis:
Higher acculturation is associated with higher CVD FRFs prevalence.

Methods:
We evaluated the association of acculturation with prevalence of FRF among 1,789 elderly men and women from the Sacramento Area Latino Study on Aging (SALSA) using multivariate linear and logistic regression. SALSA is a well-characterized, NIH funded cohort study of Mexican Americans aged > 60 followed since 1998–1999. Acculturation was measured using the validated bidimensional Acculturation Rating Scale for Mexican Americans-II and modeled as a continuous variable per interquantile range increase (IQR). We adjusted for age, gender, nativity status, income, insurance and the use of antihyperglycemic and antihypertensive medications. To evaluate whether differences in behavior may mediate the association of acculturation and FRFs we further adjusted for social and behavioral factors (marital status, physical activity, smoking, alcohol). We tested for the interaction of acculturation with FRF by nativity status.

Results:
Median age was 69.8 ± 7.1 and the overall IQR was 24 points. The mean acculturation score for US born Mexican Americans was 30.7 ±9.9 compared to 13.5 ± 9.4 for foreign born (p<0.001). Higher acculturation was associated with lower SBP (beta −1.79, 95%CI [−3.55, −0.02] per IQR increase in acculturation score) and lower LDL (beta −3.59, 95% CI [−6.79, −0.39] per IQR increase in acculturation score) after age and sex adjustment. Acculturation was not associated with total cholesterol, HDL, DM, BMI or smoking (all p values >0.05). The association of acculturation and SBP was attenuated after adjustment (beta −0.90, 95% CI [−2.99, 1.19] per IQR increase in acculturation score. Higher acculturation remained associated with lower LDL levels (β=−4.82, 95% CI [−8.7, −0.9] per IQR increase in acculturation score) after full adjustment. Stratification by nativity status did not affect these results.

Conclusions:
Contrary to other reports in middle-aged persons, higher levels of acculturation were associated with lower LDL and not higher prevalence of CVD FRFs in a large cohort of elderly Mexican Americans. The effect of acculturation in CVD risk factors may differ across the life course.
Abstract 053: Cardioprotective Medication Use Among People with Unrecognized Myocardial Infarction: The REasons for Racial And Geographic Differences in Stroke Study
Authors: Levitan Emily B , Gamboa Christopher , Safford Monika M , Rizk Dana V , Brown Todd M , Soliman Elsayed Z , Muntner Paul
Published: July 2021

Introduction:
Evidence supports use of aspirin, beta-blockers, angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), and statins for secondary prevention in people with myocardial infarction (MI). The prevalence of medication use among individuals who do not report having MI but with evidence of MI on electrocardiogram (ECG) is unknown.

Methods:
The REasons for Geographic And Racial Differences in Stroke (REGARDS) study has 30,239 participants; we analyzed cross-sectional data on 21,036 of the participants who had available 12-lead ECG data. Aspirin was assessed using self-report; other medications were assessed by pill-bottle review. Recognized MI (RMI) (n = 1,574, 7.5% of the population) was defined as self-reported history of MI. Unrecognized MI (UMI) (n = 949, 4.5% of the population) was defined as ECG abnormalities consistent with MI (using the Minnesota Code system) without self-reported history. We calculated prevalence of medication use, and among participants with UMI, we examined the correlates of medication use with prevalence ratios (PR) adjusted for age, race, and sex.

Results:
The prevalence of aspirin, beta-blocker, ACEI/ARB, and statin use in participants with UMI was substantially lower than in participants with RMI; participants with UMI had a somewhat higher prevalence than participants without MI (Figure). Among people with UMI, women and African-Americans were less likely to use aspirin (PR women compared to men = 0.76, 95% CI 0.66–l0.87; PR African-American compared to white participants = 0.82, 95% CI 0.71–0.96). Older individuals and those with diabetes were more likely to use all four medications.

Conclusions:
In this population, the prevalence of cardioprotective medication use among people with UMI was more like the prevalence among people without MI than those with RMI. People with UMI but not major MI risk factors were less likely to use cardioprotective medications.
Abstract MP005: Plasma Phospholipid Concentration of Palmitoleic Acid is Associated with an Increased Risk of Heart Failure in Male Physicians
Authors: Djousse Luc , Weir Natalie , Kotler Gregory , Hanson Naomi , Tsai Michael , Gaziano J M
Published: July 2021

Background:
Plasma fatty acids in the
de novo
lipogenesis including plamitoleic acid have been associated with a higher risk of blood pressure and type 2 diabetes (two major risk factors for heart failure -HF). However, limited data are available on the association between plasma levels of palmitoleic acid and HF risk.

Objective:
To test the hypothesis that plasma palmitoleic acid concentration is associated with an increased risk of HF. In a secondary aim, we examined whether stearoyl-CoA desaturase indices,
cis
-vaccenic acid, and oleic acid were associated with HF risk.

Methods:
We used a prospective nested case-control design for this project among participants of the Physicians' Health Study. For each of the 788 HF cases, we used the risk set method to randomly select a control among all eligible controls at the time of the index case occurrence. Each control was matched on age, year of birth, race, and time of blood collection of the index case. We used gas chromatography to measure plasma phospolipid fatty acids on frozen blood samples collected between 1997 and 2001 on study subjects free of HF. HF events were ascertained via annual follow-up questionnaires and validated in a subsample through review of medical records (positive predictive value 91% -- 50 confirmed out of 55 self-reported cases).

Results:
Mean age was 58.7 ± 8.0 years. In a conditional logistic regression controlling for matching factors, odds ratios (95% CI) for HF were 1.0 (reference), 1.00 (0.75–1.33), 1.22 (0.91–1.64), and 1.48 (1.10–1.99) across consecutive quartiles of palmitoleic acid (p trend 0.005). Additional adjustment for body mass index, smoking, alcohol intake, exercise, prevalent diabetes and coronary disease, marine omega-3 fatty acids, hypertension treatment, and plasma stearic acid did not alter the results [OR: 1.0, 1.00 (0.72–1.37), 1.23 (0.89–1.72), and 1.51 (1.06–2.15) from the lowest to the highest quartile, p trend 0.014]. When analyzed as a continuous variable, each standard deviation increase of plasma palmitoleic acid was associated with a 15% higher odds of HF [OR: 1.15 (1.01–1.31)] in a multivariable adjusted model. In a secondary analysis, plasma phospholipid oleic acid (18:1n−9) and cis-vaccenic acid (18:1n−7) were not associated with the odds of HF. Indices of stearoyl-CoA desaturase-1 (16:1n−7 to 16:0 ratio) and desaturase-2 (18:1n−9 to 18:0 ratio) were not significantly associated with the odds of HF.

Conclusion:
Our data showed that plasma concentration of palmitoleic acid is positively associated with the risk of HF in male physicians. This suggests that fatty acids in the
de novo
lipogenesis may play a role in the development of HF.
Abstract MP027: Systolic Blood Pressure Reduction with Diet and Exercise is Attenuated in Diabetes
Authors: Dobrosielski Devon A , Dhungana Rajat , Desai Dipan , Silber Harry A , Zakaria Sammy , Shapiro Edward P , Ouyang Pamela , Stewart Kerry J
Published: July 2021

Background:
Type 2 diabetes (T2DM) and prediabetes (preDM) are insulin resistant conditions associated with being overweight or obese. Increased BP and excessive abdominal fat further increase the risk of cardiovascular disease in these conditions. Exercise reduces BP and abdominal fat independent of weight loss. We hypothesized that a weight loss diet plus supervised exercise training will produce greater reductions in BP and abdominal fat than diet alone in individuals with T2DM and preDM.

Methods:
This prospective clinical trial randomized persons aged 35–65 yrs with T2DM or preDM to 6-months of either an American Diabetes Association weight loss diet (D); or D combined with supervised moderate-intensity aerobic and resistance exercise training 3 times per week (D+E). Diabetes was defined as having fasting glucose ≥ 126 mg/dl or currently on oral hypoglycemic medication. Prediabetes was defined as having fasting glucose between 100 and 125 mg/dL.

Results:
Fifty five participants (55.9 ± 7.3 years; 27 T2DM, 28 preDM) completed the study (24 D; 31 D+E). At baseline, there were no group differences in the following, and the combined values (mean ± SD) are: body weight (96.8 ± 16.1 kg), BP (126.7 ± 14.3 / 73.0 ± 8.4 mmHg) and total abdominal fat (711.9 ± 143.5 g) as measured by magnetic resonance imaging. At 6 months, reductions from baseline were observed in both groups for body weight (D: −6.1 ± 3.7 %; D+E: −6.9 ± 4.1 %), BP (D:−7.7 ± 13.1 / −5.7 ± 7.1 mmHg; D+E: −8.8 ± 17.1 / −4.6 ± 9.2 mmHg) and abdominal fat (D: −102.0 ± 68.6 g; D+E: ± −98.7 ± 72.7 g) (all p-values < 0.01 for change from baseline ). No differences in the change from baseline for these outcomes were observed between groups. Across the entire cohort, participants with T2DM versus preDM had an attenuated reduction in SBP (−4.1 ± 11.4 mmHg vs. −12.3 ± 17.7 mmHg p<0.05), whereas achieved weight loss or abdominal fat loss did not differ by diabetes status. Change in SBP did not correlate with the change in body weight (r=0.04, p=0.79) or abdominal fat (r=0.06, p=0.73).

Conclusions:
Contrary to our hypothesis, adding exercise to diet did not further reduce SBP or abdominal fat. A novel finding that emerged from these data is that despite similar weight loss with both programs, the mean reduction in SBP was approximately 7 mmHg less in T2DM compared to those with preDM. These data suggest that the factors responsible for improved BP with diet and exercise extend beyond total body weight lost or changes in central obesity, and that these factors may be modified with T2DM.
Abstract MP034: Adiponectin Concentrations are Inversely Associated with Risk of Peripheral Arterial Disease in Men
Authors: Joosten Michel M , Joshipura Kaumudi J , Pai Jennifer K , Bertoia Monica L , Rimm Eric B , Mittleman Murray A , Mukamal Kenneth J
Published: July 2021

Background:
Lower concentrations of adiponectin have been linked to the development of occlusive coronary events in otherwise healthy individuals. Whether similar relationships exist for the development of systemic atherosclerosis, such as peripheral arterial disease (PAD), is unknown.

Methods:
We used data from a prospective, nested case-control study among 18,225 male participants of the Health Professionals Follow-up Study aged 40 to 75 years who were free of diagnosed cardiovascular disease at the time of blood draw (1993–1995). During 14 years of follow-up through January 31, 2008, 143 men developed PAD. Using risk set sampling, controls were selected in a 3:1 ratio matched for age, date of blood draw, fasting status and smoking status (n=429). We used conditional logistic regression models to assess PAD risk.

Results:
Higher adiponectin concentrations were associated with a lower risk of PAD (Odds ratio [OR] per SD increase 0.58; 95% confidence interval [CI], 0.45–0.75) after controlling for pack-years of smoking, type 2 diabetes, hypertension, family history of myocardial infarction, aspirin use, body mass index and physical activity. Additional adjustment for low- and high-density lipoprotein cholesterol and high-sensitivity C-reactive protein concentrations attenuated the association (OR per SD increase, 0.71; 95% CI, 0.54–0.95). Further adjustment for hemoglobin A
1c
, triglyceride, and gamma-glutamyltransferase concentrations did not alter the results. A log-linear inverse dose-response relationship was evident over the full spectrum of total adiponectin concentrations (
P
trend
=0.02; Figure).

Conclusion:
Total adiponectin concentrations are inversely associated with risk of PAD in otherwise healthy men. This relationship can only partly be explained by cholesterol and C-reactive protein concentrations and is independent of triglycerides and glycemic status.

Figure legend:
Dose-Response Relationship between Total Adiponectin Concentrations and Odds Ratio of PAD.
Abstract MP039: Relationship between Nontraditional and Standard Markers of Glycemia
Authors: Juraschek Stephen P , Steffes Michael W , Selvin Elizabeth
Published: July 2021

Background:
Glycated albumin, fructosamine, and 1,5-anhydroglucitol (1,5-AG) may be utilized to monitor glycemic control when standard markers are unavailable. However, their fasting glucose- and HbA1c-equivalents have not been characterized in a general population.

Methods:
We compared glycated albumin, fructosamine, 1,5-AG, HbA1c, and fasting glucose in 1,719 participants (mean age = 71yr) in a cross-sectional subsample of the Atherosclerosis Risk in Communities (ARIC) Study. We modeled the relationship between the markers with generalized linear equations, using R2 and F-statistics. We also used the Area Under the Curve (AUC) to evaluate the ability of nontraditional markers to identify people with diabetes defined by HbA1c ≥6.5%, fasting glucose≥126 mg/dL, or self-report.

Results:
Median fasting glucose and HbA1c were 103 mg/dL and 5.6%, respectively; 25% (n=423) of the study population reported a diabetes diagnosis. Glycated albumin, fructosamine, and 1,5-AG were more strongly associated with HbA1c (r = 0.51, 0.43, and -0.25, respectively) vs. fasting glucose (r = 0.38, 0.34, and -0.15, respectively). Models generally performed better (higher R2) in diabetic subjects (Figure). Glycated albumin was superior to fasting glucose for identification of diabetes defined by HbA1c (AUC, 0.87 vs. 0.83) or by self-report (AUC, 0.84 vs. 0.81).

Conclusion:
Nontraditional glycemic markers can identify people with diabetes when whole blood required for HbA1c is not available. Glycated albumin was superior to fasting glucose in identifying persons with diabetes. The models identified in this study enable comparison of these markers to HbA1c and fasting glucose on a common scale, which could be useful clinically. Figure. Scatter plots of nontraditional serum glycemic markers vs. hemoglobin A1c (%) or fasting glucose (mg/dL) overlaid with a Lowess curve (dash) and best fit model (line). Also presented are formulae for the best model in a subset of the population with diagnosed diabetes (data points and fit not shown).
Abstract MP047: Early-Onset Coronary Heart Disease Mortality Remains High Among Rural Blacks
Authors: Kulshreshtha Ambar , Goyal Abhinav , McClellan William , Veledar Emir , Vaccarino Viola
Published: July 2021

Background:
Deaths from early-onset coronary heart disease (CHD) translate into a large number of potential life-years lost with substantial impact on families and society. Although overall CHD mortality has declined in the past few decades, the extent to which such decline applies to early CHD mortality and to specific racial groups and urbanization levels has not been examined. We sought to describe the pattern and magnitude of racial and urban-rural variations in early-onset CHD mortality in the United States.

Methods:
We used data from the National Center for Health Statistics to examine trends in CHD death rates (ICD-10 codes I20-I25) between 1999 and 2007. Early-onset CHD mortality was defined as death due to CHD in men less than 55 yrs or women less than 65 yrs. Rate changes were calculated in the overall population and by race (blacks vs whites) and urbanization (rural vs. urban). Poisson regression was used to model the data.

Results:
Between 1999 and 2007, there were approximately 400,000 deaths due to early-onset CHD. There was an overall 25% decline in age-adjusted early-onset CHD mortality rates from 79 per 100,000 to 59 per 100,000 but this decline varied by gender, race, and urbanization. Women had a greater decline (27%) compared with men (19%) and blacks had slightly more decline (27%) compared to whites (25%). Urban areas (30%) had twice the decline compared to rural areas (16%). In this period early CHD deaths was higher in blacks than whites and higher in rural than urban areas (Figure). Blacks in rural areas had the highest early-onset CHD mortality, followed by blacks in large metros, while urban whites had the lowest rate. Black-white differences remained similar in urban and rural areas over this time period.

Conclusion:
The overall decline in early-onset CHD mortality is encouraging, but there are important differences by race and urbanization. Blacks in rural areas have the highest early-onset CHD mortality rates. Early-onset CHD can be used to identify and target groups with high risk in order to reduce disparities.
Abstract MP063: The Effects of Lifestyle Interventions on Fruit and Vegetable Intake Assessed by Serum Carotenoids and Self-Report: Results from the PREMIER Trial
Authors: Parker Jessie , Chen Liwei , Mitchell Diane C , Yeh Hsin-Chieh , Anderson Cheryl , Appel Lawrence J
Published: July 2021

Background
Trials that attempt to increase fruit and vegetable (F/V) intake commonly rely on self-reported dietary intake data that are prone to bias. Our primary objective was to assess the magnitude of the effect of a dietary intervention on F/V consumption, using two different measures: serum carotenoids and 24-hour dietary recall. A secondary goal was to explore the use of serum carotenoid levels as an indicator of F/V consumption.

Methods
Three intervention groups in the PREMIER trial (n=554) consisted of an Advice Only control group, an Established group that received counseling on weight loss, physical activity and sodium reduction (but no advice on F/V intake), and an Established +DASH group that also received counseling on the DASH diet (with advice to increase F/V intake). Self-reported F/V consumption was measured via two 24-hour dietary recalls administered at baseline, 6- and 18-months. Serum carotenoids were collected via fasting blood samples at each time point. Linear mixed models were used to examine the relationship between intervention assignment and F/V consumption. Pearson correlation and ROC curves informed the secondary objective.

Results
Compared to the control group, F/V consumption was highest in the Established+DASH group measured by recall (2.95 servings greater, 95% CI 2.43 to 3.47) and serum carotenoids (20.51 ug/dl greater, 95% CI 12.72 to 28.29). However, only 34% (57/167) of the Established+DASH group met the recommended level of 9 servings of F/V per day at 6 months. F/V intake and serum carotenoid levels were similarly and modestly correlated across each time point, ranging from .34 to .42. ROC curves indicated poor or fair performance of carotenoids as indicators of adequate F/V consumption. The area under the curve (AUC) was .692 for 5 servings of F/V, and .697 for 9 servings.

Conclusions
The PREMIER dietary intervention was successful in increasing F/V consumption as measured by serum carotenoids or self-report, but only a minority of study participants achieved recommended levels.

Table 1.

Mean fruit and vegetable consumption over study duration, by intervention assignment

Intervention Assignment

Advice Only (n

1

=186)

Established (n=185)
Established +DASH (n=183)

p-value

2

24-Hour Recall (servings/day: mean, SD)

18 months
4.6 (2.7)
4.8 (2.5)
7.5 (3.5)
<.001

Total Carotenoid Levels

3

(ug/dl: mean, SD)

18 months
61.1 (37.0)
63.8 (38.3)
79.8 (49.2)
<.001

Total Carotenoid Levels+Lycopene, (ug/dl: mean, SD)

18 months
85.4 (41.3)
85.3 (40.1)
102.3 (51.4)
<.001

1

Sample sizes are from baseline visit

2

P-values correspond to difference in mean values across intervention groups

3

Total carotenoids defined as the sum of -carotene, -carotene, -cryptoxanthin and lutein/zeaxanthin
Abstract P013: N-6 And N-3 Fatty Acid Cholesteryl Esters In Relation To Fatal Chd In A Dutch Adult Population: A Nested Case-control Study
Authors: de Goede Janette , Verschuren WM Monique , Boer Jolanda MA , Verberne Lisa DM , Kromhout Daan , Geleijnse Johanna M
Published: July 2021

Aim:
Dietary polyunsaturated fatty acids (PUFA) are inversely related to coronary heart disease (CHD) in epidemiological studies. We examined the associations of plasma n-6 and n-3 PUFA in cholesteryl esters with fatal CHD in a nested case-control study.

Methods
We used data from two population-based cohort studies in Dutch adults aged 20-65 years. Blood sampling and data collection took place from 1987–1997 and subjects were followed for 8–19 years. We identified 279 incident cases of fatal CHD (235 fatal myocardial infarctions and 44 cardiac arrests) and randomly selected 279 controls, matched on age, gender, and enrollment date. Odds ratios (OR) with 95% confidence intervals (95%CI) were calculated per standard deviation (SD) increase of fatty acids in cholesteryl esters using multivariable conditional logistic regression models.

Results
After adjustment for confounders, the OR (95% CI) for fatal CHD per SD increase in plasma linoleic acid was 0.89 (0.74-1.06). Additional adjustment for plasma total cholesterol and systolic blood pressure attenuated this association (OR: 0.95; 95% CI: 0.78–1.15). Plasma arachidonic acid was not associated with fatal CHD (OR per SD: 1.11; 95% CI: 0.92-1.35). The ORs (95% CI) for fatal CHD for an SD increase in n-3 PUFA were 0.92 (0.74-1.15) for plasma alpha-linolenic acid and 1.06 (0.88-1.27) for plasma EPA-DHA.

Conclusion
In this Dutch adult population, arachidonic acid and n-3 PUFA in cholesteryl esters were not related to fatal CHD. Our data support findings from previous prospective studies showing a lower proportion of linoleic acid in plasma cholesteryl esters in CHD cases.
Abstract P017: Reliability of Near-Infrared Spectroscopy in the Evaluation of Forearm Microvascular Function
Authors: Lacroix Sebastien , Gayda Mathieu , Gremeaux Vincent , Juneau Martin , Nigam Anil
Published: July 2021

Background:
The assessment of microvascular reactivity by near-infrared spectroscopy (NIRS) was shown to be associated with cardiovascular status and the number of cardiovascular risk factors and could be of interest in cardiac or high-risk patients. However, the reliability of NIRS parameters measured at the arm has never been studied and should be known before they could be used in research and clinical settings. The aim of this study was to measure the absolute and relative reliability of the most commonly used NIRS parameters during post-occlusive hyperaemia in healthy young men.

Methods:
18 healthy men (33.56±7.88 years), without any cardiovascular risk factors (dyslipidemia, hypertension, abdominal obesity, diabetes and smoking) or cardiac symptoms had their fasting microvascular function evaluated twice, on two mornings separated by at least 7 days. Briefly, NIRS optodes were placed on the brachio-radialis muscle and a pressure cuff was installed on the upper-arm of subjects and inflated at 80mm Hg over the systolic blood pressure. NIRS parameters were registered continuously for 2 minutes at rest, 5 minutes during occlusion and 5 minutes post-occlusion. NIRS parameters listed in the table below were then analyzed.

Results:

CV (%)
SEM
Pearson r
ICC

mVO
2
(ml/min/100g)

6.51
0.0043
0.90

0.90

Half time to O
2
Hb max (sec)

20.04
4.15
0.79

0.78

Time to O
2
Hb max (sec)

15.61
8.24
0.79

0.75

O
2
Hb max (%)

6.68
2.39
0.70
0.66

tHb max (%)
13.32
1.66
0.31
0.31

Time to tHb max (sec)

19.61
4.73
0.86

0.85

AUC O2Hb

16.15
184.01
0.83

0.83

AUC tHb

18.59
175.04
0.80

0.80

AUC HHb
20.37
159.38
0.63
0.63

mVO
2
: muscle oxygen consumption, O
2
Hb : oxyhaemoglobin, tHb: total haemoglobin and HHb: deoxyhaemoglobin

Conclusion:
Reliability of most NIRS parameters was strong (Half time to O
2
Hb max and Time to O
2
Hb max) and very strong (mVO
2
, Time to tHb max and AUC O
2
Hb and tHb). The Coefficient of variations were below 10% for mVO
2
, and O
2
Hb max, and between 10 and 20% for the other parameters, which is in line with previous data at the calf level in healthy subjects and peripheral artery disease patients. We can therefore conclude that NIRS parameters evaluated during brachial post-occlusive hyperaemia were reliable and can be used by physicians and investigators to establish thresholds of relevancy for NIRS parameter changes and to estimate sample sizes in clinical studies.
Abstract P031: Weight Changes and Their Predictors Among 11,140 Patients With Type 2 Diabetes in The Advance Trial
Authors: van Dieren Susan , Kengne Andre Pascal , Chalmers John , Beulens Joline , van der Schouw Yvonne , Zoungas Sophia
Published: July 2021

Background/Aim:
To determine the baseline characteristics and glucose lowering therapies associated with weight change among subjects with type 2 diabetes.

Methods:
11,140 participants in the ADVANCE trial, were randomly assigned to an intensive (aiming for an HbA
1c
≤ 6.5%) or a standard blood glucose control strategy. Weight was measured at baseline and every 6 months over a median follow-up of 5 years. Multivariable linear regression and linear mixed effect models were used to examine predictors of weight change.

Results:
The mean difference in weight between the intensive and standard glucose control arm during follow-up was 0.75 kg (95% CI: 0.56 to 0.94), p-value<0.001. The mean weight decreased by 0.70 kg (95% CI: 0.53 to 0.87), p <0.001 by the end of follow-up in the standard arm but remained stable in the intensive arm, with a non-significant gain of 0.16 kg (95% CI: -0.02 to 0.34), p=0.075. Baseline factors associated with weight gain were younger age, higher HbA
1c
, Caucasian ethnicity and number of glucose lowering medications. Treatment combinations including insulin [3.20 kg (95% CI: 2.90 to 3.50)] and thiazolidinediones [3.05 kg (95% CI: 2.68 to 3.42)] were associated with the greatest weight gain whilst treatment combinations including sulphonylureas were associated with less weight gain [0.71 kg (95%CI: 0.39 to 1.03)] (Figure 1).

Conclusion:
Intensive glucose control regimens are not necessarily associated with substantial weight gain. Patient characteristic associated with weight change were age, ethnicity, smoking and HbA1c. The main treatment strategies predicting weight gain were the use of insulin and thiazolidinediones.

Acknowledgements:
This research was supported by a program grant from the National Health and Medical Research Council of Australia, the Center for Translational Molecular Medicine (CTMM) and the Netherlands Heart Foundation, Dutch Diabetes Research Foundation and Dutch Kidney Foundation (PREDICCt).
Abstract P038: Cadmium Exposure is Prospectively Associated to Cardiovascular Risk in the Strong Heart Study
Authors: Tellez-Plaza Maria , Guallar Eliseo , Howard Barbara , Umans Jason , Francesconi Kevin , Goessler Walter , Silbergeld Ellen K. , Devereux Richard B. , Navas-Acien Ana
Published: July 2021

Introduction:
Cadmium is a widespread toxic metal with potential cardiovascular effects, but establishing cadmium as a cardiovascular risk factor has been limited by the lack of data on its association with incident cardiovascular events.

Hypothesis:
We tested the hypothesis that urine cadmium concentrations would be associated with cardiovascular disease mortality and incidence.

Methods:
Prospective cohort study of 3,347 American Indian adults 45-74 years old without prevalent cardiovascular disease from Arizona, Oklahoma and North and South Dakota who participated in the Strong Heart Study (SHS) in 1989-91 and had urine cadmium measures available. Urine cadmium was measured using inductively coupled plasma mass spectrometry. Follow-up extended through December 30
th
2007.

Results:
We identified 1,028 cardiovascular events, including 372 deaths. After adjustment for known cardiovascular risk factors, the hazard ratios (95% CI) for cardiovascular and coronary heart disease mortality, comparing the 80
th
to the 20
th
percentiles of urine cadmium concentrations, were 1.43 (1.21, 1.69) and 1.33 (1.09, 1.62), respectively. The corresponding hazard ratios for incident cardiovascular disease, coronary heart disease, stroke, and heart failure were 1.16 (1.04, 1.29), 1.11 (0.98, 1.27), 1.50 (1.01, 2.22) and 1.22 (1.01, 1.47), respectively. The associations were similar in different study subgroups, including never-smokers. The figure shows increasing dose-response relations between urine cadmium concentrations and all cardiovascular disease mortality and incidence endpoints except for incident stroke.

Conclusions:
Urine cadmium, a biomarker of long-term exposure, was positively and consistently associated with cardiovascular disease mortality and incidence, overall and across subgroups. These findings support that cadmium exposure is a cardiovascular risk factor irrespective of the source of exposure. Efforts to reduce cadmium exposure in the population are needed.
Abstract P040: Home Proximity to Flower Plantations and Higher Systolic Blood Pressure
Authors: Suarez-Lopez Jose R , Jacobs David R , Himes John H , Alexander Bruce
Published: July 2021

People residing near agricultural plantations have greater risk of pesticide exposure, primarily due to pesticide drift after fumigation. Overall pesticide exposure and pyrethroid pesticides have been associated with increased blood pressure. We previously found that decreases in acetylcholinesterase activity (reflecting organophosphate pesticide exposure) were associated with home proximity to flower plantations. We also found that lower acetylcholinesterase activity was associated with lower blood pressure, which is plausible because higher acetylcholine concentration can decrease blood pressure by vasodilation via muscarinic receptor stimulation; likely a different mechanism of blood pressure alteration than those seen by other pesticides). We here evaluated the hypothesis that proximity of homes to fresh-cut flower plantations increases blood pressure independently of acetylcholinesterase activity among boys and girls living in a rural county in Ecuador with one of the highest concentrations of flower plantations in the country.

METHODS:
Geographic coordinates of homes and flower plantations were collected using global positioning system receivers. Physical examinations and parental home surveys were performed on 288 children aged 4-9 years in the study of Secondary Exposure to Pesticides among Infants, Children and Adolescents (ESPINA).

RESULTS:
The mean home distance to the nearest flower plantation edge was 450m (SD=352) and the median plantation area within a 150m radius from each house was 1049m2 (25th-95Th percentile=492-3172) among those with non-zero values. The mean SBP was 93.2 mmHg (SD=8.3). Proximity of homes to the nearest flower plantation edge was associated with a systolic blood pressure (SBP) increase of 2.45 mmHg per 1000m (95% CI: 5.02-0.00) after adjusting for age, gender, race, heart rate, height-for-age, income, maternal education, flower worker cohabitation, and examination date. Addition of erythrocytic acetylcholinesterase activity and hemoglobin concentration strengthened the association (3.02 mmHg per kilometer, 95% CI: 5.64-0.09). Increasing flower plantation area within a 150 meter radius from each home was associated with SBP increases of 3.25 per 10,000m2. Addition of acetylcholinesterase activity and hemoglobin strengthened this association (3.41mmHg per 10,000m2, 95% CI: 0.23-6.59).

CONCLUSIONS:
Proximity of homes to flower plantations and greater extensions of flower plantations within a 150m radius from the home were associated with systolic blood pressure increases independent of organophosphate pesticide (cholinergic) pathways. This supports the hypothesis that pesticide drifts from agricultural plantations may be sufficient to effect physiologic changes on children living in agricultural communities.
Abstract P053: Sodium and Potassium Intake and Blood Pressure and Risk of Hypertension Among U.S. Adults - Results From NHANES 2003-2008
Authors: Zhang Zefeng , Cogswell Mary , Gillespie Cathleen , Fang Jing , Dai Shifan , Ayala Carma , Peralez Janelle , Kuklina Elena , Carriquiry Alicia , Hong Yuling , Merritt Robert , Yang Quanhe
Published: July 2021

Introduction:
Evidence from randomized controlled trials demonstrates higher sodium and/or lower potassium intake increase blood pressure and the risk of hypertension. However, the relationship between sodium, potassium and blood pressure has not been examined using nationally representative sample and estimated usual intakes of these nutrients.

Hypothesis:
We hypothesized that usual sodium and potassium intake have opposing effects on blood pressure and a higher sodium-to-potassium ratio is associated with elevated blood pressure and hypertension.

Methods:
We analyzed data on 12,854 participants aged 20 years and older from the 2003-2008 National Health and Nutrition Examination Surveys. We estimated the usual intakes of sodium and potassium from the diet accounting for measurement error. Mean blood pressure was calculated from up to three readings on each subject and hypertension included both diagnosed and undiagnosed hypertension. We used multivariable linear regression to examine the associations between intakes of sodium, potassium and their ratio with systolic and diastolic blood pressure, and logistic regression for associations with hypertension.

Results:
The average estimated usual intakes of sodium and potassium were 3465 and 2741 mg/d, respectively. The average sodium-to-potassium ratio was 1.39; higher ratios were observed among males, younger and non-Hispanic black participants. After adjustment for potential confounders, usual intakes of sodium, potassium and their ratio were significantly associated with systolic blood pressure, with an increase of 1.08 mm Hg (95% confidence interval (CI): 0.30 – 1.86) and a decrease of 1.47 mmHg (95% CI: -2.31, -0.63) for every 1000 mg/d increase in sodium and potassium intake, respectively, and an increase of 2.80 mmHg (95% CI: 0.90 - 4.70) for every unit increase in sodium-to-potassium ratio. No association was found for diastolic blood pressure. The adjusted odds ratio (OR) comparing the highest and lowest quartiles of usual sodium or potassium intakes were 1.63 (95% CI: 1.14 - 2.34) and 0.61 (95% CI: 0.45 - 0.82), respectively, for risk of hypertension. For sodium-to-potassium ratio, the adjusted OR was 1.49 (95% CI: 1.17 - 1.89). The patterns of association were largely consistent across age, gender, race/ethnicity, body mass index, and education subgroups.

Conclusions:
In conclusion, our results indicated higher sodium and lower potassium intakes were associated with increased systolic blood pressure and risk for hypertension. The combined effect of sodium and potassium might play a central role in the pathogenesis of hypertension. The results further confirm that reducing sodium and increasing potassium intakes concurrently may have important implications in the prevention of hypertension, and hence, of cardiovascular disease.
Abstract P069: Prognostic Impact of the Omega-3 Index in Chest Pain Patients With a Suspected Acute Coronary Syndrome and Low Dietary Intake of Omega-3
Authors: Leon de la Fuente Ricardo A , Naesgaard Patrycja A , Nilsen Stein Tore , Aarsland Torbjoern , Woie Leik , Dib Ashur Silvia , Gundersen Thomas E , Bolstad Tore , Staines Harry , Harris William S , Nilsen Dennis W
Published: July 2021

Background:
Epidemiological and interventional studies suggest that omega-3 (n-3) fatty acids derived from fish oil can reduce the occurrence of cardiovascular disease. Based on these observations, the omega-3 index [eicosapantaenoic acid (EPA) + docosahexaenoic acid (DHA) content in cell red blood membranes] has been suggested as a novel risk marker for cardiac death.

Objective:
To assess whether the omega-3 index can predict all-cause mortality, cardiac death and sudden cardiac death (SCD) following hospitalization with an acute coronary syndrome (ACS). Material and methods: The omega-3 index was measured in 572 consecutive patients admitted with chest pain and suspected ACS in an inland Northern Argentinean city with a dietary habit essentially based on red meat and a low intake of fish. The median age of the included patients was 63 years and 59 % were males. Clinical endpoints were collected during a 5-year follow-up period, median 3.64 years, range 1 day to 5.46 years. Stepwise Cox regression analysis was employed to compare the rate of new events in the quartiles of the omega-3 index measured at inclusion. In our multivariable analysis we corrected for age, sex, arterial hypertension, diabetes, smoking history, body mass index, previous coronary heart disease, high-sensitivity C-reactive protein, brain natriuretic peptide, Troponin-T release and use of statins and beta-blockers.

Results:
No statistical significant differences in baseline characteristics were noted between quartiles of the omega-3 index. The median omega 3-index was 2.8%, and ranging from 1.9% in the lowest to 3.8% in the highest quartile. During the follow-up period, 100 (17.5%) patients died. Event rates were similar in all quartiles of the omega-3 index, with no statistical significant differences.

Conclusions:
In a population with a low intake of fish and fish oils, the omega-3 index did not predict future fatal events in patients with acute chest pain and suspected ACS, suggesting that index levels less than 4% are too low to be protective.
Abstract P074: Substituting Homemade Fruit Juice for Sugar-Sweetened Beverages is Associated with Lower Odds of Metabolic Syndrome among Hispanic Adults
Authors: Mattei Josiemer , Malik Vasanti , Hu Frank B , Campos Hannia
Published: July 2021

Introduction:
Consumption of sugar sweetened beverages (SSB) has been consistently associated with metabolic syndrome (MetS), while results on the role of fruit juice intake are conflicting. Hispanics consume both SSB and traditional fruit-based beverages; however, studies conducted on such ethnic group are scarce. Given the high prevalence of MetS among Hispanics, describing putative contributors to this condition is essential in proposing approaches that may successfully reduce its prevalence and avoid further complications.

Hypothesis:
We assessed the hypothesis that substituting fruit-based beverages traditionally consumed by Hispanics for SSB may be associated with lower odds of MetS.

Methods:
To determine the cross-sectional association between beverages consumed by Hispanics, and MetS and its components, data were analyzed in 1,872 Costa Rican adults who served as controls of a population-based case-control study of coronary heart disease. Multivariate adjusted means were calculated for components of MetS by servings (never, <1/week, 2–6/week, ≥1/day) of two traditional fruit-based beverages (‘fresco’ and homemade fruit juice, separately) and two SSB (instant drinks and regular sodas, separately and combined). Prevalence ratio (PR) of MetS was calculated for each beverage, and odds ratio (OR) was calculated by substituting one serving of homemade fruit juice or water for one of SSB.

Results:
Significant positive trends were observed for increasing servings of instant drinks and combined SSB with plasma triglyceride and waist circumference, and for regular soda with waist circumference (all
P
-trend<0.001). Increasing servings of homemade fruit juice were associated positively with HDL-C (
P
-trend=0.033). Consuming ≥1 serving/day of instant drinks was associated with higher PR of MetS (1.42, 95%CI: 1.11, 1.83) compared to no consumption; similar results were obtained for combined SSB. Substituting one serving of homemade fruit juice for instant drink was associated with 29% (95% CI=7, 47%) lower odds of MetS, and for regular soda with 30% (1, 50%) lower odds. Substituting water for combined SSB was marginally significant (OR=0.86 (0.74, 1.00).

Conclusion:
In conclusion, reducing consumption of SSB and substituting them with homemade fruit juices in moderation, may be a culturally-appropriate approach to lower metabolic syndrome among Hispanics. Our study provides the groundwork for interventions on beverage intake that aim to prevent MetS and type 2 diabetes in Hispanic ethnic subgroups, and may support current public health efforts on limiting availability and intake of SSB, while substituting with a healthy beverage.
Abstract P085: Effects of Psychological Factors on the Risk of Cardiovascular Diseases in Adolescents
Authors: Zhang Zhen , Gong Ren Rong , Song Yong Yan , Li Yuan Hao , Hu Minshan , Li Rong Hui , Fan Mei , Jiang Zhe , Zhu Xingchun , Liu Hui , Fang Ding Zhi , Ran Mao Sheng
Published: July 2021

The association of psychological factors with the risk of cardiovascular diseases (CVD) has been reported before. However, few studies have evaluated whether psychological factors are associated with increased risk of CVD in adolescents with longitudinal design. Our hypothesis is that post-traumatic stress disorder (PTSD) and depression may increase the risk of CVD by changing its risk factors in adolescents. A total of 746 students at a high school 10 km away from the epicenter of Wenchuan earthquake were enrolled 6 months after the earthquake, and was followed up at 18 months. A total of 737 (98.8%) students completed the study 6 months after the earthquake. In the 18-month follow-up, 478 (64.1%) students completed the study. PTSD was assessed using PTSD Checklist-Civilian Version. Beck Depression Inventory (BDI) was used to assess depression. Fasting blood samples were collected. Serum variables of lipid and glucose metabolism were analyzed. The prevalences of PTSD symptoms were 10.6% and 1.9% at 6- and 18-month follow-up respectively. At 6- and 18-month follow-up, 40.7% and 30.3% of the students were found to have depression. The subjects with PTSD had significantly higher BMI (
p
<0.05), WHR (
p
<0.05) and triglyceride (TG) (
p
<0.05) than subjects with no PTSD 6 months after the earthquake. The boy subjects with PTSD had significantly higher BMI (
p
<0.05) than boy subjects with no PTSD. The girl subjects with PTSD had significantly higher BMI (
p
<0.05) and WHR (
p
<0.05) than girl subjects with no PTSD. In the 18-month follow-up study, the boy subjects with PTSD had significantly lower WHR (
p
<0.05) than boy subjects with no PTSD. Six months after the earthquake, subjects with depression had significantly higher BMI (
p
<0.05) and WHR (
p
<0.05) than subjects with no depression. The boy subjects with depression had significantly higher WHR (
p
<0.05) than boy subjects with no depression. The girl subjects with depression had significantly lower total cholesterol (TC) (
p
<0.05) than girl subjects with no depression. In the 18-month follow-up study, subjects with depression had significantly lower HDL-cholesterol (HDL-C) (
p
<0.05) than subjects with no depression. The boy subjects with depression had significantly higher systolic pressure (
p
<0.05), higher LDL-cholesterol (LDL-C) (
p
<0.05) but lower HDL-C (
p
<0.05) than boy subjects with no depression. The girl subjects with depression had significantly lower systolic pressure (
p
<0.05) and HDL-C (
p
<0.05) than girl subjects with no depression. These findings provide preliminary evidence linking of PTSD and depression symptoms with risk factors for CVD in adolescents.
Abstract P100: Dietary Protein Intake and Chronic Kidney Disease in American Population with Hypertension and Diabetes
Authors: Hong Jin-Liern , Li Xia , Poole Charles
Published: July 2021

Background:
Dietary protein intake has been associated with renal disease progression in patients with chronic kidney disease (CKD). Little is known about the renal impact of protein intake in persons with hypertension or diabetes who are at high risk for CKD.

Objectives:
This study aims to evaluate protein intake in relation to CKD in a representative sample of US adults, stratified by hypertension and diabetes.

Methods:
A cross-sectional study was conducted using data from the US NHANES 2003-2008. Subjects were excluded if they were pregnant, with known weak kidney, or following on special diet. There were 9,284 eligible participants age 20-80 with data from two 24-hour dietary recall questionnaires. Protein intake was adjusted for energy intake and categorized into four evenly spaced groups. CKD was defined as an estimated glomerular filtration rate <60mL/min/1.73m
2
. Logistical regression model was used to estimate the prevalence odds ratio (POR). Analyses were further stratified by hypertension and diabetes.

Results:
The median protein intake was 77 g/day (interquartile range, 66 to 89 g/day) in the study population, and was 59, 72, 83, and 100 g/day for the lowest to the highest quarter of protein intake, respectively. The prevalence of CKD was 4%. For a 25-g increase in protein intake, the POR was 1.18 (95% CI: 0.93 to 1.50), adjusting for age, sex, race, income adequacy, education level, energy intake, physical activity, cardiovascular disease, diabetes, and hypertension. The adjusted POR comparing the highest and the lowest quarter of protein intake was 1.12 (95%CI: 0.73 to 1.72). The stratified analysis showed the highest quarter is associated with CKD among persons with both hypertension and diabetes (
Table
). No association was found in persons with hypertension only, diabetes only, or neither.

Conclusion:
We observed a positive association between protein intake and CKD among American adults with both hypertension and diabetes. This finding adds to the concern of dietary protein intake in persons at high-risk for CKD.

Table.

Adjusted POR of CKD comparing the highest and the lowest quarter of protein intake.

Disease Status
Hypertension

-
+

Diabetes
-
1.05 (0.45 - 2.45)
0.80 (0.44 - 1.47)

+
4.63 (0.33 - 65.70)
3.04 (1.13 - 8.19)