bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P104: Impact of Cold Weather on Cardiovascular Diseases in Texas
Authors: Zhang Kai , Chen Tsun-Hsuan
Published: March 2019

Background:
Cardiovascular disease (CVD) has been estimated to account for nearly 50% of total deaths during cold seasons, and cold weather has been shown to have a significant impact on CVD. More importantly, detrimental health effects of cold were particularly pronounced in regions with mild winter climate. Texas is the second largest state in the U.S. and is associated with varying climates. This study aims to improve the understanding of how cold weather affects CVD-related mortality and morbidity in Texas.

Methods:
We obtained mortality data (1990-2013) and emergency hospital admissions (EHA) data (2003-2014) from the Texas Department of State Health Services and weather data from the National Climate Data Center. Our analysis included cases diagnosed as cardiovascular disease (CVD, ICD-9 390-429; ICD-10 I01-I52), ischemic heart disease (IHD, ICD-9 410-414; ICD-10 I20-I52), myocardial infarction disease (MI, ICD-9 410; ICD-10 I21, I22) and stroke (ICD-9 430-438; ICD-10 I60-I69). We first applied Poisson regression models to 12 Texas major Metropolitan Areas (MSAs) to estimate cold effects on deaths and hospital admissions related to CVDs. A random effects meta-regression analysis was then used to estimate pooled effects for the entire state.

Results:
With a 1°C decrease in temperature below a MSA-specific threshold, increased death risks were observed in CVDs (1.8% [95%CI: 1.1%, 2.6%]), stroke (1.2% [95%CI: -0.2%, 2.6%]), IHD 2.5% [95%CI: 1.1%, 4.0%], and MI 4.3% [95%CI: 1.2%, 7.5%]). Estimates of cold effects were lower for EHA risks, and they were 1.1% (95%CI: 0.4%, 1.8%) for CVDs, 2.3% (95%CI: -0.3%, 4.9%) for stroke, 1.7% (95%CI: -0.1%, 3.6%) for IHD, and 0.3% (95%CI: -3.5%, 4.2%) for MI.

Conclusion:
This is the first multi-city study in the U.S. that examined the effect of cold weather on CVD using both mortality and hospital admission data. Cold weather increases mortality risk significantly but less in EHA risk in Texas, and effects vary geographically. Our findings can provide insights to design better intervention strategies for targeted vulnerable populations towards reducing adverse health effects of cold weather.
Abstract P126: The Cardiovascular Health of Afro-Caribbean Immigrants in New York City: a Cross Sectional Study
Authors: Thomas Sabena , Umer Amna , Commodore-Mensah Yvonne , Khalid Sumaira , Abildso Christiaan
Published: March 2019

Introduction:
Afro-Caribbean (AC) immigrants are the largest black immigrant group in the U.S. and generally display better physical health than United States (U.S.) born blacks. Cardiovascular health (CVH) disparities among AC immigrant sub-groups are poorly understood. We examined the prevalence of CVH factors among AC immigrants (Guyanese, Haitian and Jamaican) relative to U.S. born blacks residing in New York City. We hypothesized that some AC immigrant sub-groups will have higher rates of CVH factors than U.S. born blacks.

Methods:
We performed a cross-sectional analysis of pooled data from the 2010-2014 New York City Community Health Survey administrations to estimate the prevalence of CVH and differences among AC immigrant sub-groups. We included 7678 non-Hispanic black participants from Haiti (n=291), Jamaica (n=1031), Guyana (n=369) and U.S. born blacks (5987). Logistic regression was used to examine the association between country of birth and CVH factors. The CVH factors were determined from the AHA’s CVH metrics. We adjusted the models for significant covariates using backward sequential selection.

Results:
In final adjusted models, in comparison to U.S. born blacks, Jamaican immigrants were more likely to self-report diabetes but were less likely to be overweight/obese. Guyanese immigrants were also less likely to be overweight/obese than U.S. born blacks. There were no significant differences between Haitian immigrants and U.S. born blacks for CVH factors.

Conclusions:
Although AC immigrants depict superior health status compared to U.S. born blacks, ethnic differences exist in CVH among AC immigrant sub-groups. Efforts to address cardiovascular health factors among black populations in the U.S. should consider ethnic differences that may provide information about the most at-risk populations for disease-specific programmatic or policy interventions.
Abstract P129: Racial Differences in Cardiovascular Disease Outcomes after Myocardial Infarction: A REGARDS Study
Authors: Blackston J. Walker , Mefford Matthew , Pruitt Elizabeth , Howard George , Howard Virginia J , Safford Monika , Naftel David C , Levitan Emily B
Published: March 2019

Introduction:
Although prognosis following myocardial infarction (MI) has improved overall, it is unclear whether improvements are similar for blacks and whites.

Methods:
We followed black and white participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study from their first adjudicated MI to first occurrence of a composite CVD endpoint (stroke, MI, CVD death). REGARDS includes 30,239 individuals ≥45 years of age across the US.

Results:
We studied 1,056 participants (38% black; 45% female; mean age 73 ± 9 years) with adjudicated MI who survived at least one day. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) comparing blacks to whites, adjusting for demographic and pre-MI clinical covariates. Blacks had higher demographic-adjusted rates of CVD after MI compared to whites (HR 1.28, 95% CI 1.08-1.51) which attenuated after full adjustment (HR 1.00, 95% CI 0.89-1.32) for clinical characteristics.

Conclusion:
Blacks had higher risk of post-MI CVD than whites, which was explained by pre-MI health status.

Figure 1.
Unadjusted=race*CVD; Predisposing factors = age + sex; Need = model 1 + marital status, income, educational attainment, health insurance status, rural or urban residential status; Enabling = model 2 + smoking, BMI, eGFR, ACR (urinary albumin-to-creatine ratio), diabetes, history of stroke, hypertension; In-hospital = model 3 + peak troponin level, ECG status, heart failure, revascularization
Abstract P141: Association of Type of Antidepressant With Bleeding Risk in Atrial Fibrillation Patients Taking Oral Anticoagulants
Authors: Shao Iris Yuefan , Claxton J’Neka S , Lutsey Pamela L , Chen Lin Y , MacLehose Richard F , Alonso Alvaro
Published: March 2019

Background:
Inconsistent evidence suggests that concomitant use of certain antidepressants, particularly Selective Serotonin Reuptake Inhibitors (SSRIs), in patients using oral anticoagulants (OAC) might be associated with an elevated risk of bleeding. This study aims to investigate the risk of bleeding associated with initiation of different types of antidepressants among atrial fibrillation (AF) patients on OAC therapy.

Methods:
72334 AF patients that started using antidepressant after initiating OAC therapy were identified from the Truven Health MarketScan Commercial and Medicare Databases for the period 2011-2015. Exposure was defined as prescription filling for SSRI, Serotonin/Norepinephrine Reuptake Inhibitors (SNRI), Serotonin Reuptake Inhibitors (SRI), Tricyclic Antidepressants (TCA) or other antidepressants. The primary outcome was incident hospitalized bleeding, defined by a validated algorithm, after antidepressant initiation. Associations of bleeding by antidepressant types were assessed using adjusted Cox proportional hazards model in pair-wise propensity score (PS) matched cohorts. PS matched cohorts for combinations of antidepressants were generated based on logistic models that included major risk factors for bleeding such as demographic information, comorbid conditions and other medication usage.

Results:
Among eligible patients, 57% initiated SSRI, 14% SNRI, 9% SRI, 9% TCA and 12% others. During a mean follow-up of 21 months, we identified 4035 bleeding episodes. In pair-wise comparisons, SSRI was associated with an increased risk of bleeding when compared to all other antidepressants (Table 1). In contrast, initiating SRIs was associated with small reductions in the risk of bleeding compared to all other types of antidepressants.

Conclusion:
Our results suggest that compared to all other antidepressants, SSRI is associated with an increased risk of bleeding. This information may be valuable to inform antidepressant choice in anticoagulated patients with AF.
Abstract P142: Heart Healthy Behaviors in Young Women: What Prevents Teens From Going Red?
Authors: Brown Courtney A , Revette Anna C , de Ferranti Sarah D , Liu Jingyi , Stamoulis Catherine , Gooding Holly C
Published: March 2019

Introduction:
Ideal cardiovascular health behaviors are the foundation of primordial prevention as health behaviors initiated in adolescence track into adulthood. Adolescent and young adult (AYA) women may experience unique barriers to and facilitators of heart healthy behaviors. Using an explanatory sequential mixed methods design, we examined how AYA women perceive cardiovascular health.

Methods:
We surveyed a random convenience sample of 331 AYA women ages 15-24 years presenting for care at an urban academic medical center and a community health center using the AHA National Women’s Health Study survey. Survey data guided development of the qualitative guide used during eight online, semi-structured focus groups with 32 young women. We report descriptive statistics performed using Matlab (Mathworks, Inc.) and thematic analyses conducted to synthesize data from the online focus groups using NVivo 11.

Results:
A total of 280 young women (84.6%) performed at least one preventive behavior in the past year. Actions taken included visiting a doctor [261 (78.9%)], exercising [247 (74.6%)], and reducing stress [174 (52.6%)]. AYA’s most commonly reported barriers to heart healthy actions were a failure to perceive oneself at risk for heart disease [130 (39.3%)] and stress [108 (32.6%)]. Focus group participants discussed several barriers including time constraints (“we just don’t have time to worry about our hearts”), lack of access to affordable gyms and healthy food (“improving health would be easier if healthy food weren’t expensive”), and mental health (“working on depression or anxiety so one doesn’t stop exercising or stop eating healthy because of life stresses”). Most [237 (71.6%)] participants identified a desire to improve their health as a reason for performing preventive behaviors, with 62.5% [n=207] wanting to live longer and 61.9% [n=205] wanting to feel better. Many AYA women surveyed were encouraged to take action by a family member [151 (45.6%)], a health care professional [113 (34.1%)], or a friend [106 (32.0%)]. Most participants [241 (72.8%)] felt that increased access to healthy food would help facilitate a heart healthy lifestyle. Focus group participants reported interpersonal connections (“having a strong support system to encourage you”), personal motivation (“I finally get fed up with myself and force myself to go back to the gym”), celebrities (“contact the Kardashians and tell them to promote”), and music as facilitators of preventive behaviors.

Conclusions:
Our results emphasize the competing concerns AYA women face - including time constraints, access to resources, and mental health issues - and how these factors impact their ability to perform preventive behaviors. Future campaigns should address stressors experienced by young women and capitalize on personal support systems, celebrities and music to encourage heart healthy behaviors.
Abstract P151: Plasma Cyclic Guanosine Monophosphate (cGMP) and Heart Failure With Preserved Ejection Fraction: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Zhao Di , Guallar Eliseo , Ndumele Chiadi E , Vaidya Dhanajay , Ouyang Pamela , Post Wendy S , Lima Joao A , Ying Wendy , Subramanya Vinita , Kass David A , Hoogeveen Ron C , Shah Sanjiv J , Michos Erin D
Published: March 2019

Introduction:
Cyclic guanosine monophosphate (cGMP) is an intracellular second messenger, synthesized through nitric oxide (NO) and natriuretic peptide (NP) pathways, with two different downstream effects on the cardiovascular system. Stimulators of cGMP are potential candidates in treating heart failure with preserved ejection fraction (HFpEF). However, the associations between plasma cGMP, HFpEF, and atherosclerotic cardiovascular disease (ASCVD) in the general population are unknown. We hypothesized that cGMP mediates HFpEF and ASCVD events, and that associations differ by sex.

Methods:
We included 1,034 ARIC participants selected by case-cohort design with over-sampling of participants with incident HFpEF. cGMP was measured using visit 4 plasma samples. Cox proportional hazard regression models were used to assess the relationship of cGMP with incident HFpEF, coronary heart disease (CHD), and ASCVD (CHD + stroke). Models were adjusted for sampling weights to provide estimates applicable to the overall ARIC population. Covariates included demographics and CVD risk factors. Models also adjusted for NT-proBNP, which is upstream of cGMP production in the NP regulated pathway.

Results:
Mean (SD) age was 63.2 (5.6) years and median (IQR) cGMP was 3.4 pmol/mL (2.4, 4.6). During 16.7 years of follow-up, there were 272 HFpEF, 179 ASCVD, and 129 CHD incident events. In models adjusted for CVD risk factors, the HRs (95% CI) comparing 3
rd
tertile with 1
st
tertile of cGMP for ASCVD, CHD and HF were 1.8 (1.1, 2.9), 1.9 (1.2, 3.0) and 2.0 (1.2, 3.3), respectively. In models further adjusted for NT-proBNP, associations were attenuated and not significant [HRs 1.2 (0.7, 2.0), 1.5 (0.96, 2.5) and 1.7 (0.98, 2.9), respectively]. There were no significant interactions by sex.

Conclusions:
cGMP levels are associated incident HFpEF, ASCVD, and CHD; however, after NT-proBNP adjustment, associations were attenuated, suggesting that plasma cGMP levels reflect a greater effect as a downstream messenger in NP than NO signaling pathways.
Abstract P159: Relationships Between Objectively Measured Physical Activity, Exercise Performance, and Quality of Life in Older Obese HFpEF Patients
Authors: German Charles A , Brubaker Peter H , Nelson Benjamin , Kitzman Dalane W
Published: March 2019

Introduction:
Heart failure with preserved ejection fraction (HFpEF) is the most rapidly increasing type of heart failure. Markedly reduced exercise capacity (peak VO
2
) is the primary manifestation of chronic HFpEF and impacts quality of life (QOL); however, its relationship to objectively measured physical activity (PA) levels is unknown. Accordingly, we prospectively measured PA, exercise performance, and QOL in older patients with chronic obese HFpEF.

Hypothesis:
PA levels would be low in obese HFpEF patients and would be strongly correlated with reduced exercise performance and QOL.

Methods:
Obese HFpEF patients ≥60 years old (N=58) wore Kenz Lifecorder EX accelerometers to obtain light PA (LPA), moderate-vigorous PA (MVPA), PA energy expenditure (PAEE), and steps. Peak VO
2
and ventilatory anaerobic threshold (VAT) were assessed by cardiopulmonary exercise testing, and six-minute walk distance (6MWD) was assessed using the Guyatt method. QOL was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ), Minnesota Living with Heart Failure Questionnaire (MLHF), and Short Form 36 (SF-36). Pearson correlations were performed to examine relationships between PA, exercise performance, and QOL.

Results:
Patients were 68.0±5.7 years old, 78% (45 of 58) female, 59% (34 of 58) white, obese (BMI 39.1±6.1 kg/m
2
), and had predominantly NYHA class II symptoms (62%, 36 of 58). Patients had low PA levels with 33.4±12.6 min/day of LPA, 10.4±6.7 min/day of MVPA, 3785±1436 steps/day, and a PAEE of 147±57 kcal/day. Patients also had low exercise performance with peak VO
2
of 14.4±2.7 ml/kg/min, VAT of 9.7±1.9 ml/kg/min, and 6MWD of 410±75 meters. LPA (r=0.32, p=0.014) and steps/day (r =0.30, p=0.022) were modestly correlated with peak VO
2
, but MVPA and PAEE were not. All PA measures were moderately correlated with 6MWD (r=0.41-0.49, all p<0.002). None of the PA measures were correlated with any of the QOL assessments (KCCQ r=0.00-0.15, p=0.25-0.99; MLHF r=-0.13-0.00, p=0.33-0.99; SF-36 r=0.05-0.11, p=0.41-0.70).

Conclusion:
Obese HFpEF patients had low levels of objectively measured daily PA and low exercise performance. Contrary to our hypothesis, PA levels were only modestly correlated with exercise performance including peak VO
2
and 6MWD. PA was not correlated with any assessment of QOL. This indicates that measures of PA, exercise capacity, and QOL assess different aspects of the patient experience in obese HFpEF and are largely independent of each other. While each remains a valid potential target for intervention, they should not be considered interchangeable.
Abstract P161: Accelerometer-Measured Physical Activity and Heart Failure Incidence in Women Ages 63-99 Years: The OPACH Study
Authors: LaMonte Michael J , Bellettiere John , Eaton Charles B , Stefanick Marcia L , LaCroix Andrea Z
Published: March 2019

Background:
The burden of heart failure (HF) is increasing in older adults, yet optimal treatment options are not available. Therefore, prevention efforts are paramount to population HF control. Physical activity (PA) has been associated with lower HF incidence, however few studies have evaluated older women and none have measured PA using accelerometry. We prospectively examined 6,173 multiethnic (White, 49%; Black, 34%; Hispanic, 17%) women ages 63-99 (mean 78.6) without known HF at baseline in the Objective Physical Activity and Cardiovascular Health Study.

Methods:
Vector magnitude counts/15-sec epoch from hip worn Actigraph GT3X+ triaxial accelerometers (required ≥4 of 7 days with ≥10 hr/day wear time) were used to define time spent in light (LPA; 19-518 counts/15-sec), moderate-to-vigorous (MVPA; ≥519), and total (average VM counts across wear days) PA. Count cutpoints were determined from a calibration study among similarly aged women. Incident HF cases were ascertained by self-report annually and were adjudicated by medical record review. Cases of hospitalized acute decompensated HF were included here. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for these associations.

Results:
There were 213 (3.5%) incident HF cases identified during a mean 4.5 year follow-up. Crude HF rates (per 1000 person-years) across PA tertiles were 13.2, 5.7, and 4.9 for total PA; 12.3, 5.4, and 5.8 for light PA; and 14.8, 6.1, and 3.3 for MVPA. After adjusting for awake wear time, age, race, ethnicity, smoking, comorbidities including CHD, diabetes and hypertension, and self-rated health, the HR comparing the highest to lowest tertile was 0.61 (0.42, 0.89) for total PA, 0.69 (0.48, 0.98) for light PA, and 0.39 (0.25, 0.59) for MVPA. After adjusting for these covariates and for PA intensity, among all women the HR for a 30-min/day increment in light PA was 0.93 (0.88, 0.99) and in MVPA was 0.73 (0.59, 0.88). Similar magnitudes of inverse associations with HF risk for light PA and MVPA were seen in women <80 and ≥80 years of age, and in women with low physical function (SF36 score <60) and with higher function (≥60). Inverse associations with HF for light PA and MVPA also were seen in white (HR = 0.94 and 0.78), black (HR = 0.92 and 0.58) and Hispanic (HR = 0.97 and 0.65) women, and in those who were obese (BMI ≥30; HR = 0.93 and 0.81) and not obese (HR = 0.93 and 0.54), although HRs across these stratum were more variable. Results among all women were materially the same after discarding HF cases occurring during the first year of follow-up.

Conclusions:
Greater levels of accelerometer-measured total, light intensity and moderate-to-vigorous intensity PA were associated with lower incidence of HF in older community-living women. These findings underscore the potential public health relevance of being physically active in later life for primary HF prevention.
Abstract P172: Association of Interleukin 6 With Hypertension in HIV Positive Participants in the Strategic Timing of Antiretroviral Treatment (START) Trial
Authors: Ghazi Lama , Baker Jason V , Sharma Shweta , Jain Mamta K , Palfreeman Adrian , Necsoi Coca , Murray Daniel , Neaton James D , Drawz Paul E
Published: March 2019

Introduction:
The association between hypertension (HTN) and inflammation [e.g., estimated via interleukin 6 (IL-6)] in HIV positive persons who have a CD4+ count greater than 500 cells/mm
3
has not been well established.

Methods:
We studied HTN in the START trial, a randomized study of immediate vs. deferred antiretroviral therapy (ART) in HIV-positive adults who were ART naïve and had a CD4+ count greater than 500 cells/mm
3
. Our analysis included 4249 of the 4,684 HIV positive persons enrolled in START who had no history of cardiovascular disease and had IL-6 measured at baseline. HTN (prevalence at baseline or incidence) was defined as having a systolic BP ≥140 mm Hg, or a diastolic BP ≥90 mm Hg, or use of BP-lowering therapy. Logistic regression and discrete Cox proportional hazard models were used to test the association between IL-6 and HTN prevalence and incidence. Sensitivity analysis were used to test the association between systolic and diastolic BP and IL-6 levels.

Results:
HTN was prevalent in 18.9% of the cohort at entry. The median age of participants was 36 years, 27% were female, median CD4
+
cell count at entry was 651 cells/mm
3
and median HIV RNA level was 13090 copies/mL. In univariate analysis, HTN was significantly associated with higher IL-6 levels at baseline [OR per doubling of IL-6:1.28, 95%CI (1.18, 1.39)]. This association was attenuated and no longer significant after adjusting for race, age, gender, BMI, diabetes, smoking, RNA and CD4+ levels [OR per doubling of IL-6:1.10, 95%CI (0.99, 1.20)]. The reduced OR was primarily due BMI and age, both which were strongly related to HTN. Overall incidence of HTN was 6.9 cases per 100 person year. Baseline IL-6 was not associated with risk of incident HTN in the crude and fully adjusted model [HR per doubling of IL-6:0.98, 95%CI (0.90, 1.10) in adjusted analysis]. This association did not differ by treatment group (p for interaction=0.21). Risk factors such as age, black race, BMI, and male gender were associated with incident HTN. Continuous systolic and diastolic BP were not significantly associated with IL-6 at baseline or in follow-up analyses.

Conclusions:
IL-6 was not associated with HTN in HIV positive participants with CD4+ counts greater than 500 cells/mm
3
after adjusting for factors known to be associated with HTN and inflammation. Furthermore, baseline IL-6 level was not associated with incident HTN, nor with continuous BP measures. Rather, HTN development was associated with traditional risk factors such as age, race, gender and BMI.
Abstract P173: Blood Pressure Patterns in Young Adulthood Associated With Cardiovascular Disease and All-Cause Mortality by Middle Age: The CARDIA Study
Authors: Yano Yuichiro , Jared Reis , Cora Lewis , Sidney Stephen , Pletcher Mark , Navar Ann Marie , Peterson Eric , Bancks Michael , Kanegae Hiroshi , Gidding Samuel , Muntner Paul , Lloyd-Jones Donald
Published: March 2019

Objectives:
In young adults, which blood pressure (BP) patterns, determined over multiple clinic visits, are most associated with future risk for cardiovascular disease (CVD) and all-cause mortality remains unclear. We determined BP patterns during young adulthood most associated with CVD events and all-cause mortality by middle age. BP patterns included average systolic BP (SBP)/diastolic BP (DBP) levels, cumulative exposure to SBP/DBP, visit-to-visit SBP/DBP variability, and average annual change in SBP/DBP.

Methods:
We analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study, which enrolled 5115 adults aged 18-30 years from 1985-1986, with up to 30 years of follow-up (through 2015). BP patterns were evaluated with measurements at Year 0 [baseline], and 2, 5, 7, and 10 years following baseline. We estimated visit-to-visit BP variability as variability independent of the mean (VIM). Average annual change of BP from the Year 0 to Year 10 exams was calculated using linear regression. Cox proportional hazards models were used to assess the associations between BP patterns and adjudicated CVD events (coronary heart disease, stroke, heart failure, and other vascular disease) and all-cause mortality.

Results:
At Year 10, the mean±standard deviation (SD) age of the 3,394 participants was 35.1±3.6 years, 46% were African American, 56% were female, and only 3% were taking antihypertensive medication. Cumulative exposure to SBP and average SBP levels were highly correlated (Pearson’s correlation = 0.94). Over a median follow-up of 19.2 years, 162 CVD events and 181 deaths occurred. Average SBP and DBP levels and VIM of SBP were associated with increased CVD risk (see table), with no interaction by race or sex (each p>0.4). Only VIM of SBP was associated with all-cause mortality.

Conclusions:
Among young adults, the assessment of visit-to-visit SBP variability in addition to average SBP and DBP levels can help identify young adults who have an increased CVD risk and all-cause mortality by middle age.
Abstract P219: Central Obesity and All-cause and Cause Specific Mortality: a Systematic Review and Dose-response Meta-analysis of Prospective Studies
Authors: Huang Tao , Geng Tingting
Published: March 2019

Background:
The association of central obesity and mortality risk has not been systematically investigated. The strength and shape of dose-response relationship between central obesity and all-cause and cause specific mortality still remains unclear. Therefore, we conducted a systematic review and meta-analysis to clarify the associations.

Methods:
Categorical and dose-response meta-analysis was conducted involving of prospective studies. PubMed and Embase were searched up to April 1st, 2017 for eligible studies of waist circumference, waist-to-hip ratio and all-cause and cause specific mortality. Random-effects models were used to derive the summary relative risks (RRs) and corresponding 95% CI for specific categories of central obesity and a continuous association using generalized least-squares trend estimation.

Results:
A total of 1 760 947 participants in 50 studies were included in the meta-analysis. The pooled RRs for a 10 cm increase in waist circumference were 1.06 (95% CI, 1.04-1.08; I
2
=92.9%), 1.06 (95% CI, 1.03-1.08; I
2
=90.9%), 1.21 (95% CI, 1.06-1.35; I
2
=88.1%) and 1.05 (95% CI, 1.02-1.08; I
2
=86.5%) for all-cause, cardiovascular disease (CVD), coronary heart disease (CHD), and cancer mortality, respectively. We found a nonlinear relationship between waist circumference and all-cause mortality among both women (p<0.001) and men (p=0.011). The summary RRs for a 0.1 unit in waist-to-hip ratio were 1.17 (95% CI, 1.12-1.21; I
2
=88.2%), 1.26 (95% CI, 1.17-1.34; I
2
=66.3%), 1.25 (95% CI, 1.10-1.40; I
2
=67.8%) and 1.13 (95% CI, 1.09-1.16; I
2
=0.0%) for all-cause, CVD, CHD, and cancer mortality, respectively. There was evidence of a nonlinear relationship between waist-to-hip ratio and all-cause mortality among women (p=0.016) rather than men (p=0.424). The dose-response relationship between central obesity and cause specific mortality were linear, except the association of waist circumference and CVD mortality (p=0.037), and waist-to-hip ratio and cancer mortality (p=0.039).

Conclusions:
Higher waist circumference and waist-to-hip ratio measured continuously and categorically, increase the risk of all-cause mortality among men and women and are associated with increased risk of CVD, CHD and cancer mortality.
Abstract P228: Relationships of Dietary and Supplement Magnesium Intake and Its Urinary Metabolomic Biomarkers With Blood Pressure: The INTERMAP Study
Authors: Chan Queenie , Lau Chung-Ho E , Gibson Rachel , Chekmeneva Elena , Dos Santos Correia Goncalo , Loo Rueyleng , Ebbels Timothy M , Posma Joram M , Dyer Alan R , Miura Katsuyuki , Ueshima Hirotsugu , Zhao Liancheng , Daviglus Martha L , Elliott Paul , Stamler Jeremiah , Holmes Elaine , Van Horn Linda
Published: March 2019

Background:
Magnesium (Mg) and other mineral intakes are vital contributors to a healthy diet and appear to have a modest effect on the risk of hypertension. Studies suggest that supplemental Mg can significantly lower blood pressure (BP). Here, we investigate associations of total Mg consumption with the level of its urinary metabolomic biomarkers, and BP.

Method:
We used cross-sectional data from the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP) on 4269 men and women aged 40-59 years from Japan, China, United Kingdom, and United States (US). Regression coefficients with BP per 2 standard deviation (SD) higher dietary Mg from food plus supplement (obtained from 24-hr dietary recalls), urinary Mg (measured by atomic absorption flame photometry) and small molecules (analysed by direct injection mass spectrometry) were estimated using multivariable models, adjusted for age, gender, population sample, intake of total energy and other confounders (see Table). To estimate overall association, country-specific regression coefficients were pooled, weighted by inverse of their variance.

Results:
Average Mg intakes were 454 (SD=207) mg/day for 770 persons who reported Mg supplementation (89% from US), and 300 (SD=101) mg/day for those who did not. High correlation was found between Mg intake from food plus supplements with urinary Mg (
r
=0.38, P<0.0001). Partial correlations of small molecules with total Mg intake ranged from -0.007 to 0.19 for ascorbic acid (P<0.0001). Total Mg intake higher by 261.87 mg/day (2SD) was associated with a systolic BP difference of -2.65 mm Hg (
P
=6x10
-5
). Urinary Mg excretion higher by 2.66 mmol/day was associated with a diastolic BP difference of -1.02 mm Hg (P=0.02). There was a non-significant inversed association between ascorbic acid and BP in some multivariable regression models.

Conclusion:
Higher intake of Mg, including supplements, was associated with lower BP levels.
Abstract P242: Association of Obesity With Arterial Stiffness: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Logan Jeongok , Kang Hyojung , Kim Soyoun , Duprez Daniel , Kwon Younghoon , Jacobs David , Forbang Nketi , Lobo Jennifer M , Sohn Min-Woong
Published: March 2019

Background:
Arterial stiffness is recognized as an important subclinical marker of cardiovascular disease (CVD). However, the relationship between obesity and arterial stiffness is unclear.

Methods:
Applanation tonometry was used to estimate arterial stiffness, defined as high augmentation index (AIx) and low C1 and C2 in participants enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) at baseline. Analysis of covariance was used to compare AIx, C1, and C2 across categories of body mass index (BMI) (<25, 25-29.9, 30-39.9, > 40 kg/m
2
) and waist-hip ratio (WHR) (<0.85, 0.85-0.99, ≥1). Age-obesity interaction was tested among obesity groups across age categories (45 - 54, 55 - 64, 65 - 74, and 75 - 84 years old).

Results:
Among 6,177 participants (mean age 62±10 years, 52% female), there was significant inverse relationship between obesity and arterial stiffness. After adjustments for CVD risk factors, participants with BMI > 40 kg/m
2
had 5.4% lower AIx (mean difference [Δ] = -0.83; 95% CI, -1.12 - -0.54), 13.5% higher C1 (Δ = 1.40; 95% CI, 0.73 - 2.07), and 41.2% higher C2 (Δ = 1.53; 95% CI, 1.19 - 1.88) compared to participants with BMI < 25 kg/m
2
(all p for trend <0.001). Participants with WHR ≥ 1 had 1.7% lower AIx (Δ = -0.26; 95% CI, -0.46 - -0.06), 6.1% higher C1 (Δ = 0.98; 95% CI, 0.53 - 1.43), and 6.1% higher C2 (Δ = 0.28; 95% CI, 0.05 - 0.51) compared to those with WHR <0.85 (all p for trend < 0.05). WHR had a significant interaction with age on AIx and C2, and the inverse relationship between WHR and arterial stiffness was only observed in participants aged < 55 years.

Conclusions:
Obesity as measured by BMI and WHR was associated with lower arterial stiffness presented as lower AIx and higher C1 and C2. There was a significant age interaction with WHR on AIx and C2, but not with BMI. Differential effects of WHR versus BMI on arterial stiffness in older adults should be further investigated in future studies.
Abstract P265: History of Hypertensive Disorders of Pregnancy and Early Manifestation of Vasomotor Symptoms 8-10 Years Post Delivery
Authors: Assibey-Mensah Vanessa , Thurston Rebecca C , Catov Janet M
Published: March 2019

Introduction:
Women with hypertensive disorders of pregnancy (HDP) have excess cardiovascular disease (CVD) risk in the years following delivery compared with women with uncomplicated pregnancies, with black women having excess burden of both HDP and CVD. After pregnancy yet prior to the menopause transition, nearly 30% of women in their late reproductive years report having vasomotor symptoms (VMS) including night sweats and hot flashes. VMS, particularly, early-onset VMS, have also been associated with increases in blood pressure and subclinical CVD. However, it is unknown if underlying vascular dysfunction in women with a history of HDP may increase the risk of VMS and contribute to racial differences in symptom manifestation.

Hypothesis:
Women with a history of HDP will have an increased risk of VMS as compared with women without a history of HDP.

Methods:
Women with a singleton live birth at Magee-Womens Hospital (Pittsburgh, PA) during 2008-2009 were enrolled 8-10 years post-delivery (median age=37.5; interquartile range=8.0) in our ongoing prospective cohort study assessing maternal cardiometabolic and microvascular disease (n=312). Using log-binomial logistic regression, we estimated the risk of VMS associated with history of HDP, adjusting for race, body mass index, current smoking, age, and education. Additional adjustment was made for current hormonal contraceptive use. Women with single or double oophorectomy (n=7) were excluded in a sensitivity analysis. Given the excess burden of HDP and CVD, as well as early-onset VMS in black women, we also assessed effect measure modification by maternal race.

Results:
Thirty percent of women with a history of HDP reported having vasomotor symptoms compared with 18% of women without a history of HDP. This excess risk of VMS persisted after accounting for covariates (adjusted risk ratio (aRR) 1.61, 95% confidence interval (CI) 1.06, 2.47). Excess risk of VMS persisted in women with a history of HDP after excluding those with a single or double oophorectomy (aRR 1.60, 95% CI 1.03, 2.47). Additional adjustment for hormonal contraceptive use resulted in a non-statistically significant increased risk of VMS (aRR 1.59, 95% CI 0.98, 2.59). Race did not modify the association between history of HDP and VMS (P value for interaction = 0.79).

Conclusions:
History of HDP was associated with excess risk of VMS in young women prior to menopause transition. There may be common underlying vascular changes that contribute to HDP and VMS that may also place women at future risk for CVD. How these reproductive factors may converge and be related to excess cardiometabolic risk warrants additional study.
Abstract P267: Lifestyle Program Improves Sleep Quality in Participants With a History of Concussion
Authors: Ramirez Francisco E , Nedley Neil , Hofer-draper Lance
Published: March 2019

Background:
Patients with a history of concussion are susceptible to insomnia. This study documents how lifestyle changes could improve insomnia.

Methods:
The educational depression program is an 8-week community educational program which addresses optimal health through diet, exercise, sleep hygiene, light therapy, and mental/spiritual health. Participants met once a week for 2 hours over an 8 week period. During the first hour, participants listened to a health lecture by a health professional and then divided in small groups. The hypothesis of the program is to try to understand the causes of mental health problems and educating participants on how to apply lasting changes to their daily lives to address these problems. From n=5,861 participants who finished the program, n=275 participants had a history of concussion and their data was used. They answered an 85 question questionnaire at baseline and again at the end of the program that included participant history and measured depression and anxiety. Participants were asked about their sleeping patterns, on a scale of 0-3; 0 being excellent sleep patterns, and 3 being bad sleep patterns.

Results:
Mean age for those with a history of concussion (n=275) was 52.9 (SD 15.7), and 71% were females. Sleep patterns at baseline for those with concussion were: n=48 had excellent sleep, n=30 had good sleep, n=79 had below average sleep, n=118 had bad sleep, and average baseline anxiety was 9.6 (moderate) SD 5.2. At the end of the program, the same test was administered and sleep was: n=111 reported excellent, n=60 had good, n=55 had below average, n=49 had bad, and end mean anxiety was 5.5 (mild) SD 4.1

Conclusion:
The program effectively improves sleep quality in most of the participants. Lifestyle seems to be an important factor in improving insomnia in these participants. Anxiety levels also decreased and may have played a role in the improvements in sleep. Long-term follow-up is planned.
Abstract P268: Long and Short Sleep and Obesity in the Women’s Health Study
Authors: Durazo Eva M , Powell-Wiley Tiffany M , Redline Susan , Slopen Natalie , Prather Aric , Williams David R , Buring Julie E , Albert Michelle A
Published: March 2019

Background:
Although evidence suggests that extremes of sleep (i.e. long and short) are associated with cardiovascular disease-related risk factors in the general population, research examining the association between the extremes of sleep and obesity in older women is limited.

Methods and Results:
We used the Women’s Health Study (WHS) 2012-2013 follow-up cohort of 21,726 older women (mean age = 72.1 ± 6.0 years old) to examine the cross-sectional association between extremes of sleep and obesity. Women with cancer or missing body mass index (BMI) data were excluded. Long sleep was defined as > 9 hours/day, short sleep as < 6 hours/day, and sleep of 6-9 hours/day was the reference. Sleep duration and BMI were self-reported measures. Approximately 23.3% of women were obese (BMI ≥ 30 kg/m
2
).

Overall, women who were obese and had either long or short sleep were less likely to exercise, and more likely to have history of diabetes, depression symptoms, and lower education and income levels. Women who were obese and long sleepers were more likely to use alcohol and have history of hypertension, while short sleepers were more likely to be current smokers. Logistic regression analyses revealed that older women with long sleep and short sleep had 30% higher odds of obesity, respectively, compared to women who slept 6-9 hours, adjusting for age and race/ethnicity. These relationships were attenuated and lost significance when controlling for potential important confounders (Table 1).

Conclusion:
Older women reporting extremes of sleep had higher odds of obesity compared to women who sleep 6-9 hours, after control for age and race/ethnicity. Further adjustment for traditional cardiovascular risk factors and socioeconomic parameters resulted in loss of significance.
Abstract P277: Short Sleep Duration is Associated With Greater Arterial Stiffness Independent of Sleep Quality
Authors: Kline Christopher E , Taylor Christy , Kriska Andrea M , Barinas-Mitchell Emma
Published: March 2019

Introduction:
Sleep duration is commonly associated with cardiovascular disease risk. Surprisingly, though, relatively few studies have examined the association between sleep duration and arterial stiffness, an early marker of cardiovascular risk. The available evidence remains equivocal, and few studies have examined whether sleep quality confounds the association between sleep duration and arterial stiffness.

Purpose:
The purpose of these analyses was to examine the association between sleep duration, sleep quality, and arterial stiffness in a sample of young- and middle-aged adults.

Methods:
The present analyses utilized baseline data from a sample of adults enrolled in a lifestyle intervention (N=324; 37.8±6.2 y, body mass index [BMI]: 32.8±3.9 kg/m
2
, resting systolic blood pressure [SBP]: 113.5±10.4 mmHg, 77.2% female, 80.6% white). Sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI); sleep duration and sleep quality were each assessed with single PSQI items; duration was classified into three categories (< 6 h, ≥ 6 to < 7 h, ≥ 7 h) and quality was dichotomized into good (very good/fairly good) and poor (very bad/fairly bad). Risk for sleep apnea was assessed with the Berlin Questionnaire. Arterial stiffness was assessed with carotid-femoral pulse wave velocity; values were log-transformed prior to analysis. Analysis of covariance models were used to examine the associations between sleep duration and quality with arterial stiffness. All models adjusted for age, sex, race, BMI, SBP, and sleep apnea risk.

Results:
Approximately 13%, 34%, and 53% of participants reported < 6 h, ≥ 6 but < 7 h, or ≥ 7 h sleep duration, respectively; 18% of participants reported poor sleep quality. Arterial stiffness significantly differed across categories of sleep duration (η
p
2
=.02; P=.03); adults reporting < 6 h sleep duration had significantly greater arterial stiffness than adults reporting either ≥ 6 but < 7 h (P=.02) or ≥ 7 h (P=.01). In contrast, arterial stiffness did not differ according to sleep quality (η
p
2
=.00; P=.75). When included in the same model, sleep duration remained a significant predictor of arterial stiffness (η
p
2
=.02; P=.03), while sleep quality remained nonsignificant (η
p
2
=.00; P=.66).

Conclusion:
In a sample of young- to middle-aged adults with overweight or obesity, short sleep duration was associated with greater arterial stiffness independently of sleep quality. Whether increasing sleep duration can improve arterial stiffness deserves further exploration.
Abstract P289: Effects of Dietary App-Supported Tele-Counseling on Sodium Intake, Diet Quality, and Blood Pressure in Patients With Diabetes and Kidney Disease
Authors: Chang Alex R , Bailey-Davis Lisa , Yule Christina , Kwiecen Sara , Graboski Elisabeth , Juraschek Stephen , Krekel Caitlin , Collins Charlotte , Anderson Cheryl
Published: March 2019

Background:
Despite the importance of healthy diet for cardiovascular (CVD) health, the vast majority of patients with chronic kidney disease (CKD) do not receive dietitian counseling or make dietary modifications. Evidence for using dietary apps and tele-counseling to improve CVD risk factors is limited.

Methods:
We examined the effects of dietary app-supported tele-counseling on sodium intake and diet quality in 44 patients with type 2 diabetes and stage 1-3a CKD. Patients recorded and shared dietary data via MyFitnessPal with registered dietitians, who used motivational interviewing to provide telephone counseling weekly for 8 weeks. Outcomes included 24-hour urine sodium (2 collections per timepoint), Healthy Eating Index (HEI) 2015 score (multiple 24-hour dietary recalls per timepoint), 24-hour systolic blood pressure (SBP), and 24-hour urine albumin excretion. We report interim results for patients who completed 8-week and 6-month data collection; final outcome data at 12 months will be completed in November 2018.

Results:
Out of 44 consented patients (mean age 60.3 ± 11.9 y, 43% female, 93% white, 20% <$25,000 annual income, 84% hypertension), 32 (73%) completed 8-week follow-up and 29 (66%) completed 6-month follow-up. While 78% owned a smartphone, 52% entered dietary data using a computer. Among patients who completed 6-month follow-up, sodium excretion did not significantly decrease from baseline to 8 weeks (-345 mg/d, 95% CI: -865, 175) or 6 months: (-182 mg/d, CI: -460, 97)
(Table)
. However, HEI-2015 score improved by 3.19 (CI: 0.51-5.87) at 8 weeks and 7.21 (CI: 3.07, 11.3) at 6 months; 24-hour SBP improved by -3.7 (CI: -7.4, 0.1) at 8 weeks and by -4.9 (CI: -8.8, -0.9) at 6 months.

Conclusions:
An app-supported tele-counseling program with a registered dietitian appears to be a feasible strategy to improve dietary quality and blood pressure, even in patients with diabetes and early CKD. Sodium is ubiquitous in the food supply and hard to change at the individual level. Studies to demonstrate efficacy are needed.
Abstract P294: Estimated Benefits and Risks of Lowering Sodium Intake With Potassium-based Salt Substitutes in China: a Modelling Study
Authors: Marklund Matti , Singh Gitanjali , Greer Raquel C , Cudhea Frederick , Matsushita Kunihiro , Micha Renata , Brady Tammy , Zhao Di , Huang Liping , Neal Bruce , Appel Lawrence J , Mozaffarian Dariush , Wu Jason H
Published: March 2019

Introduction:
Replacement of regular salt (NaCl) with potassium-based salt substitutes is a promising strategy to reduce blood pressure (BP) and prevent cardiovascular disease (CVD), especially in countries like China with high discretionary salt intake and low potassium intake. However, benefits of this strategy remain uncertain, and the risks of hyperkalemia and increased CVD mortality in persons with chronic kidney disease (CKD) are a concern.

Hypothesis:
In China, the estimated benefits of nationwide potassium-based salt substitution on CVD mortality will exceed potential risks.

Methods:
We used a comparative risk assessment framework to estimate potential benefits and risks of nationwide replacement of discretionary salt with potassium-based salt substitute (30±10% KCl) on CVD mortality in China. We incorporated existing data and corresponding uncertainties from randomized trials, the China National Survey of CKD, the Global Burden of Disease, and the CKD Prognosis Consortium (
Table
). We estimated averted CVD deaths from reduced BP subsequent to salt substitution in the adult population (benefits), and CVD deaths attributed to hyperkalemia from salt substitution in CKD patients (risks).

Results:
A nationwide implementation of potassium-based salt substitution in China, could prevent ~400,000 CVD deaths/year through BP lowering in the adult population, and increase ~10,000 CVD deaths/year through hyperkalemia among CKD patients (Table). For each additional death in CKD patients, around 40 CVD deaths could be averted in the adult population. Overall, the intervention could result in 369,258 (95% uncertainty interval: 160,702-576,680) net fewer deaths each year, corresponding to 9.4% (4.1-14.7) of annual CVD deaths in China.

Conclusions:
A nationwide potassium-based salt substitution in China could result in significant net benefits, preventing about 1 in 10 CVD deaths. Strategies to avoid potential hyperkalemic deaths among CKD patients could further improve the benefit:risk ratio.