bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P063: Afro Caribbeans With Type 2 Diabetes Have Lower Body Mass Index And Lower Waist Circumference Than African Americans: New York City Health And Nutrition Examination Survey 2013/14
Authors: Farag Maria , Williams Faustine , Horlyck-Romanovsky Margrethe F
Published: May 2021

African descent populations are experiencing a disproportionate burden of type 2 diabetes. In New York City, almost one third of the Black population are foreign-born Afro-Caribbeans and two thirds are African American. We compared type 2 diabetes risk profiles and disease burden among foreign-born Afro-Caribbean and US-born African American New Yorkers by estimating: a) Prevalence of type 2 diabetes; b) Type 2 diabetes risk profile by ethnicity and c) Odds of type 2 diabetes. Using the 2013/14 New York City Health and Nutrition Examination Survey probability sample weighted to the New York City population, we analyzed data for Afro-Caribbean (n=81) and African American (n=118) participants. Type 2 diabetes was defined as prior diagnosis; or HbA1c≥6.5%; or fasting glucose ≥126mg/dL. Logistic regression estimated odds of type 2 diabetes by BMI category, waist circumference (cm), and physical activity; adjusting for age, sex, education, income, and marital status. Among Afro-Caribbeans (Age (Mean ±SE) 49±2years, BMI 29.2 ±0.7kg/m
2
) and African Americans (Age 46±2years, BMI 30.3 ±0.9kg/m
2
) type 2 diabetes prevalence was 31% (25 of 81) and 21% (25 of 118) respectively. Compared to African Americans with type 2 diabetes, Afro-Caribbeans with type 2 diabetes had lower mean BMI (29.9 ±0.8kg/m
2
vs. 34.6 ±1.78kg/m
2
,
P
=0.01), and lower waist circumference (102 ±2cm vs. 114 ±3cm,
P
=0.0015). Afro-Caribbeans with type 2 diabetes were more likely to be overweight (57.2% vs. 13.5%) rather than obese (33.2% vs. 74.7%), yet less likely to meet HP2010 physical activity goals (23.6% vs 35.3%). Overall type 2 diabetes odds were no different between groups. In the total population odds were 5% higher for each cm waist circumference [aOR=1.05 (95% CI 1.01-1.10),
P
=0.0194]. Compared to the youngest age group, ages 20-49y, type 2 diabetes odds were higher among ages 50-59y [aOR=7.12 (95% CI 2.29-22.14)], and ages 60+ [aOR=5.04 (95% CI 1.65-15.39),
P
=0.0482]. In stratified logistic regression analyses among Afro-Caribbean New Yorkers, odds were 18% greater per cm waist circumference [aOR=1.18 (95% CI 1.03-1.35),
P
=0.0194]. For Afro-Caribbeans, low physical activity was associated with seven times greater odds of type 2 diabetes [aOR=7.03 (95% CI 1.19-41.53),
P
=0.0314]. Compared to African Americans, Afro-Caribbeans with type 2 diabetes are more likely to have lower waist circumference and be overweight rather than obese despite reporting less physical activity. Further examination of the relationship between BMI, waist circumference and visceral vs. subcutaneous adipose tissue may elucidate important intraethnic differences in diabetes risk. To enhance detection of diabetes among Afro-Caribbeans and African Americans in New York City, screening criteria should consider unique diabetes phenotypes.
Abstract P067: Left Ventricular Hypertrophy And Inflammation Modify The Harmful Effects Of Fine Particulate Matter On Sudden Death
Authors: Rappazzo Kristen , Egerstrom Nicole , Thota Sanjana , Capone Alia , Chen Sarah D , Joodi Golsa , Cascio Wayne , Simpson Ross J
Published: May 2021

Sudden death accounts for approximately 10% of deaths among working age adults and is associated with poor air quality. We hypothesize that clinical risk factors for sudden death would modify the relationship of fine particulate matter (PM
2.5
) to sudden death. Sudden death victims in Wake County, NC from 3/1/2013 - 2/28/2015 were identified by screening Emergency Medical Services (EMS) reports and adjudicated based on EMS, medical, and death records (n=399). Daily PM
2.5
concentrations for Wake County from the Air Quality Data Mart were linked to event and control periods for each individual. Using a case-crossover design, conditional logistic regression estimated OR (95%CI) for sudden death for a 5μg/m
3
increase in PM
2.5
with a 1-day lag, adjusted for temperature and humidity, across risk factor strata. Sensitivity analysis assessed consistency of main effects. Left ventricular hypertrophy (LVH) and neutrophil to lymphocyte ratio (NLR) were included as estimates of arrhythmic potential and inflammation, respectively. Low concentrations of PM
2.5
are potential risk factors for sudden death (Table 1). However, no clinical risk factors for sudden death modify that association. LVH and NLR, in contrast to clinical risk factors, are associated PM
2.5
and sudden death. Sensitivity analysis had no effect on the direction and minimal effect on the magnitude of the associations. Left ventricular hypertrophy and inflammation may be the final step in the mechanism whereby poor air quality and clinical risk factors trigger arrhythmia or myocardial ischemia and sudden death. This abstract does not necessarily reflect EPA policy.
Abstract P080: Lifetime Trauma Is Associated With Elevated Blood Pressure In Middle-aged And Older Latinas
Authors: Vo Danny , Caceres Billy A
Published: May 2021

Introduction:
Latina women are more likely than non-Latina White women to have uncontrolled and undertreated hypertension. Prior research suggests greater exposure to traumatic experiences (such as interpersonal violence) is associated with elevated blood pressure and higher cardiovascular disease risk in women. However, few studies have investigated these associations among Latina women, a population that is at increased risk for hypertension. The purpose of this pilot study was to fill knowledge gaps by examining the associations of lifetime trauma (including childhood and adulthood) with blood pressure in middle-aged and older Latinas.

Hypothesis:
We assessed the hypothesis that lifetime trauma is associated with elevated blood pressure in middle-aged and older Latinas.

Methods:
Participants were recruited from an existing study in New York City called the Washington Heights/Inwood Comparative Effectiveness Research Project. Data collection consisted of a questionnaire administered by a research coordinator and in-office assessment of two blood pressure readings using recommended guidelines. The average systolic and diastolic blood pressures were calculated from these two measurements. Lifetime trauma was assessed with the Life Events Checklist which assesses 17 potentially traumatic experiences. We summed responses to the Life Events Checklist to create a count of lifetime trauma. Posttraumatic stress disorder (PTSD) symptoms were assessed with the PTSD Checklist-Civilian Version that assess presence and severity of 17 PTSD symptoms in the last month. We used linear regression models to separately examine the associations of lifetime trauma with systolic and diastolic blood pressure adjusted for demographic characteristics, health behaviors, PTSD symptoms, sociocultural factors (such as discrimination and acculturation).

Results:
The final sample included 50 Latina women (ages 42-77, mean=63.1 [9.7]). All women reported at least one traumatic experience with an average of 4.8 traumatic experiences in their lifetimes (range 1-10). A higher count of lifetime trauma (B [SE] = 5.56 [2.63], p = 0.04) was positively associated with greater systolic blood pressure in adjusted regression models. Although women who reported a higher count of lifetime trauma had higher diastolic blood pressure, this association was not statistically significant (B [SE] = 2.14 [1.67], p = 0.21).

Conclusion:
Findings indicate a higher count of lifetime trauma is associated with elevations in systolic blood pressure among Latina women. This is consistent with results of studies that have examined associations of lifetime trauma with blood pressure among women in the general population. There is a need for larger studies that incorporate longitudinal designs to investigate the associations of trauma and other sociocultural factors with blood pressure among Latina women.
Abstract P083: Sodium Content Of Menu And Commissary Provisions In Rural Jail Exceed Heart-healthy Dietary Recommendations
Authors: Kuss Bonnie , Lopez Nanette , Hardy Shakia T , Camplain Ricky L
Published: May 2021

Introduction:
Incarcerated populations experience nearly two times the risk of Hypertension (HT) and Cardiovascular Disease (CVD) relative to the general population. Incarcerated individuals lack the autonomy to make dietary changes to attenuate these risks. Dietary intake of sodium is considered the most critical and modifiable nutritional determinant to developing HT and CVD. The American Heart Association recommends the cardioprotective Dietary Approaches to Stop Hypertension (DASH) diet which restricts sodium intake to 1500 mg per day, 800 mg less than the recommended Dietary Reference Intake (DRI). Nutrition in jail is obtained through menu provisions and purchasable packaged food and beverage items from the commissary, yet previous research indicating the high sodium content in jail meals has failed to include commissary items in total sodium intake.

Hypothesis:
We hypothesized that estimated daily sodium in a 7 day cycle menu and commissary items at a county jail exceed DRI and DASH diet recommendations.

Methods:
A 7 day cycle menu and commissary food list were obtained from a southwest rural county jail, which included 3 daily meals. Commissary items included 4 purchasable, pre-bundled food snack packs. NutriCalc Dietary Analysis software was used to determine sodium content for each meal, and commissary snack pack. Total sodium from the 7 day menu was divided by the number of days (7) to determine a daily average. For snack pack analyses, sodium of each of the 4 snack packs was added to the 7 day menu provisions and divided by 7, individually. All estimates were compared to DRI and DASH recommendations.

Results:
The sodium content from the menu and commissary significantly exceeded both DRI and DASH recommendations. The daily average sodium from menu provisions was 167% (3847/2300) of the DRI and 256% (3847/1500) of the DASH diet recommendations. Lunch provisions contributed the largest proportion (45%, 12051/26931) of total weekly sodium. When sodium from commissary snack packs was included with the 7 day cycle menu, daily average sodium content ranged from 173 to 292% [(3971/2300) to ( 6712/2300)] of DRI and 265 to 447% [(3970/1500) to (6712/1500)] of DASH diet recommendations.

Conclusions:
Small changes to one meal within the cycle menu and the inclusion of fresh or frozen produce could reduce sodium content to align with DRI and DASH recommendations. Commissary items make up a substantial portion of dietary sodium intake within jails. The addition of reduced sodium options to commissary snack packs may help limit sodium intake without restricting what little autonomy incarcerated individuals have over their diet. These alterations may help alleviate HT and CVD burden for incarcerated populations.
Abstract P089: Diabetes Worsens Length Of Stay In Patients With Reduced Ejection Fraction Admitted With Nstemi
Authors: Oni Ebenezer , Port Zach , Afolabi Brown Olayinka , Bozorgnia Behnam , Amanullah Aman M
Published: May 2021

Background:
Length of stay is an important quality metric and outcome measure in the management of hospitalized patients. We evaluated the association of diabetes in patients admitted for Non-ST Elevation myocardial infarction (NSTEMI) on their length of stay.

Hypothesis:
the impact of diabetes on length of stay in patients admitted for STEMI

Methods:
Our study population included patients admitted for NSTEMI in a single center between 08/01/2016 and 09/30/2012. Diabetes (DM) was defined by a documented diagnosis or use of diabetic medication. A higher length of stay (LOS) was defined as spending more than 5 days in the hospital.

Results:
A total of 720 patients were included in this analysis. The mean age was 66 ± 0.6 years, 50% (n-269) were diabetics, 59% had left ventricular ejection fraction (EF) < 50% and the median LOS was 5 days. A higher number of diabetic patients had LOS> 5days (55%). In an unadjusted logistic regression, diabetics had increased odds of higher LOS, odd ratio (OR) 1.54 (
CI 1.10-2.16
), p=0.012. After adjusting for confounding variables, the relationship remained significant. When stratified by left ventricular systolic function on admission, the impact of diabetes on length of stay only remained significant in patients with EF less than 50%. See Table 1.

Conclusion:
The presence of diabetes was significantly associated LOS in NSTEMI, especially for patients admitted with a reduced left ventricular ejection fraction. This study emphases the impact of diabetes on health comes in cardiovascular disease.
Abstract P090: Does The Increasing Prevalence Of Obesity Explain The Decrease In Blood Pressure Control Among Us Adults With Hypertension?
Authors: Foti Kathryn , Hardy Shakia T , Chang Alexander , Selvin Elizabeth , Coresh Josef , Muntner Paul
Published: May 2021

Introduction:
The proportion of US adults with hypertension who had controlled blood pressure (BP) decreased from 2013-2018. The rising prevalence of obesity has been implicated as a reason for this decline. We investigated trends in BP control from 2013-2018 among US adults with hypertension, overall and among those taking antihypertensive medication, by body mass index (BMI) category.

Methods:
We used National Health and Nutrition Examination Survey data from 2013-2014, 2015-2016, and 2017-2018 for US adults aged ≥18 with hypertension (N=5,580). We examined the BMI distribution [normal (BMI <25 kg/m
2
), overweight (BMI 25-<30 kg/m
2
), class 1 obesity (BMI 30-<35 kg/m
2
), class 2 or 3 obesity (BMI ≥35 kg/m
2
)] in each survey cycle. We calculated the age-adjusted prevalence of BP control (<140/90 mmHg) overall and among those taking antihypertensive medication in each survey cycle by BMI category. We examined trends in BP control within BMI category adjusted for age and other sociodemographic and clinical characteristics; we tested differences in trends by BMI category using interaction terms.

Results:
The prevalence of overweight and obesity among US adults with hypertension did not change from 2013-2018 (
Table
). The overall proportion of adults with hypertension who had controlled BP was higher among those with overweight or obesity than those with normal BMI. BP control among those taking antihypertensive medication was similar among those with overweight or obesity and those with normal BMI. BP control overall decreased over time with no evidence of a difference by BMI category. Among those taking antihypertensive medication, BP control decreased in those who were overweight or had class 1 obesity but not in those with normal BMI or class 2 or 3 obesity.

Conclusions:
Among US adults with hypertension, there was no increase in the prevalence of overweight and obesity from 2013-2018 and BP control decreased in all subgroups. These findings suggest the obesity epidemic is not driving the decrease in BP control in the US population.
Abstract P091: Reasons For Uncontrolled Blood Pressure Among US Adults
Authors: Sakhuja Swati , Colvin Calvin , Akinyelure Oluwasegun , Hardy Shakia T , Muntner Paul
Published: May 2021

Introduction:
In October 2020, the US Surgeon General issued a Call to Action on hypertension control. We investigated the contribution of lack of awareness, not taking antihypertensive medication and an inadequate antihypertensive medication regimen to uncontrolled blood pressure (BP) among US adults.

Methods:
We analyzed data for 2,282 participants ≥18 years of age with uncontrolled BP from the 2015-2016 and 2017-2018 National Health and Nutrition Examination Surveys (NHANES). BP was measured three times by a trained physician following a standardized protocol. Uncontrolled BP was defined by systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. Being aware of having hypertension and antihypertensive medication use were defined by self-report. An inadequate antihypertensive medication regimen was defined as taking antihypertensive medication with uncontrolled BP. Data were weighted to represent the non-institutionalized US population.

Results:
Among US adults with uncontrolled BP, 34.8% were not aware they had hypertension, 13.8% were aware but not taking antihypertensive medication and 51.4% were aware but taking inadequate antihypertensive medication regimen. US adults 18-39 and 40-49 years of age were more likely to be unaware they had hypertension compared to their counterparts ≥70 years of age (multivariable-adjusted prevalence ratios [PR]: 1.62 [95% CI: 1.26-2.07] and 1.41 [95% CI: 1.02-1.95], respectively). Participants who had a healthcare visit in the past year (PR: 0.60 [95% CI: 0.47-0.77]) and who were obese (PR: 0.69 [95% CI: 0.56-0.85]), had diabetes (PR: 0.56 [95% CI: 0.42-0.76]), chronic kidney disease (PR: 0.59 [95% CI: 0.46-0.75]) and a history of cardiovascular disease (PR: 0.41 [95% CI: 0.27-0.61]) were less likely to be unaware they had hypertension. Among those who were aware they had hypertension, US adults who were 18-39 and 40-49 years of age as compared to those ≥70 years of age were more likely to be not taking antihypertensive medication versus taking inadequate antihypertensive medication regimen (multivariable-adjusted PR: 5.48 [95% CI: 3.17-9.48] and 5.14 [95% CI: 2.28-10.26], respectively). In contrast, non-Hispanic blacks and Hispanics as compared to non-Hispanic whites (PR: 0.71 [95% CI: 0.53-0.94] and 0.72 [95% CI: 0.54-0.96], respectively) and those without a usual place to receive healthcare (PR: 0.70 [95% CI 0.51-0.96]) and who had a healthcare visit in past year (PR: 0.47 [95% CI: 0.35-0.62]) were less likely to be not taking antihypertensive medication versus taking inadequate antihypertensive medication regimen.

Conclusion:
The majority of US adults with uncontrolled BP were either unaware they had hypertension or were taking an inadequate antihypertensive medication regimen. Interventions are needed to increase hypertension awareness and assess and titrate patients’ antihypertensive medication regimen.
Abstract P092: Longitudinal Impact Of Blood Pressure On Left Ventricular Geometry In The Hispanic Community Health Study/Study Of Latinos: Echocardiographic Study Of Latinos (Echo-SOL) Ancillary Study
Authors: McLeod Jennifer , Hurwitz Barry E , Sotres-Alvarez Daniela , Kansal Mayank M , Swett Katrina , Kaplan Robert , Bilsker Martin , Daviglus Martha L , Talavera Gregory A , Cai Jianwen , Ponce Sonia , Lee Un Jung , Rodriguez Carlos
Published: May 2021

Introduction:
Abnormal left ventricular geometry (LVG) is an independent predictor of cardiovascular mortality. We assessed the longitudinal transitions of LVG among Hispanic/Latino adults.

Methods:
Echo-SOL provided serial 2D echocardiograms of Hispanic adults. Each subject was identified as hypertensive or normotensive and categorized into four LVG patterns: normal, concentric remodeling (CR), concentric hypertrophy (CH), or eccentric hypertrophy (EH). Hypertensive adults were stratified on whether they maintained blood pressure (BP) control (<140/90mmHg) by visit 2. The normotensive adults were stratified on whether they developed incident hypertension (HTN) by visit 2. Logistic regression was used to evaluate the outcome of normal vs. abnormal LVG at visit 2 adjusting for age, sex, and follow-up time.

Results:
There were 1818 adults at visit 1 (mean age 56 years; 42.6% male, 44.7% hypertensive), with 1643 obtaining serial echocardiograms an average of 4.3 years later. At visit 1, LVG was distributed as follows: normal, 65.3%; CR, 30.6%, CH 3.1%, and EH 1.1%. Among hypertensive adults at visit 1, 59.7% had normal LVG and 34.1% had CR. By visit 2, there was a progression from normal LVG to CR among those with and without BP control; CR prevalence increased to 58.5% and 55.2%, respectively (Fig. 1). For visit 1 hypertensive adults, the incidence of abnormal LVG did not differ with regards to BP control (adjusted OR 1.1, 95% CI: 0.7-1.7). Among normotensive adults at visit 1, 69.8% had normal LVG. If they remained normotensive by visit 2, this prevalence decreased to 52.2%. If they developed HTN, there was an associated progression toward abnormal geometry (adjusted OR 2.5, 95% CI: 1.4-4.2), with the majority (59.2%) demonstrating a CR phenotype.

Conclusion:
Our findings suggest that BP control to 140mmHg is not adequate to prevent progressive LV remodeling among Hispanic/Latino adults. Further study is needed to understand this maladaptive process and how it contributes to cardiovascular disease in this population.
Abstract P097: Association Of Non-appetitive Eating With Hypertension In Women: Mediation By Body Mass Index
Authors: Poon Anna K , Field Alison , Mitchell Karen , Gearhardt Ashley , Jackson Benita , Rimm Eric , Rich-Edwards Janet W
Published: May 2021

Introduction:
Although non-appetitive eating phenotypes are associated with body mass index, the extent to which they are associated with hypertension is unknown.

Hypothesis:
We hypothesize that non-appetitive eating phenotypes are associated with hypertension.

Methods:
We examined participants in a substudy on disordered eating conducted in 2013-2015, nested within the prospective cohort, Nurses’ Health Study 2. Non-appetitive eating was defined by: 1) binge eating with loss of control; 2) disinhibited eating; 3) coping-motivated eating; and 4) food addiction. Prevalent hypertension was defined by self-reported clinician diagnosis. Odds ratios and 95% confidence intervals (OR, 95% CI) were used to estimate the association of non-appetitive eating with prevalent hypertension, adjusted for age and race. The difference method was used to estimate the proportion of the associations mediated by body mass index.

Results:
After excluding missing exposure (n=421), the analytic sample included n=4,687 women (of n=5,108 women). Average age was 60 years (range: 49 to 68); 18% (n=824) reported binge eating with loss of control; average disinhibited eating score was 3 (range: 0 to 7); average coping-motivated eating score was 2 (range: 1 to 5); and 7% (n=349) reported food addiction. Non-appetitive eating was associated with higher odds of hypertension. Binge eating with loss of control was associated with 60% higher odds (95% CI: 1.37, 1.87) of hypertension. Per unit, disinhibited eating was associated with 18% (95% CI: 1.14, 1.21) and coping-motivated eating was associated with 38% (95% CI: 1.29, 1.47) higher odds of hypertension. Food addiction (yes versus no) was associated with a 108% higher odds (95% CI: 1.67, 2.60) of hypertension. Body mass index mediated more than 85% of the associations of each non-appetitive eating phenotype with hypertension.

Conclusions:
Non-appetitive eating is associated with hypertension. Body mass index explained almost all of the associations between non-appetitive eating and hypertension. Prospective studies are needed to confirm the direction of the associations.
Abstract P100: Enhanced External Counterpulsation Reduces Central Blood Pressure In Stable Angina Patients: A Meta Analysis
Authors: Lindemann Elizabeth , Pham Kevin , Kedia Gautam , Prasad Ananth , Shah Sachin A
Published: May 2021

Introduction:
Emerging evidence suggests central systolic blood pressure (cSBP) and augmentation index are superior predictors of adverse cardiovascular outcomes as compared to peripheral systolic blood pressure (pSBP). Enhanced external counterpulsation (EECP) is a non-invasive treatment modality approved for the management of refractory angina. The degree of benefit from EECP on central hemodynamics and arterial stiffness remains unknown. This meta-analysis evaluated the effect of EECP on peripheral (office) blood pressure and central hemodynamic parameters.

Methods:
A comprehensive literature search was conducted in Pubmed, CINAHL, and Cochrane Library databases. All prospective clinical trials assessing the impact of EECP in patients with stable angina and CAD were included. Studies were excluded for not completing a full course of EECP, having a baseline peripheral systolic blood pressure <100 mmHg, or not reporting adequate data for analysis. The primary endpoint was the change in cSBP before and after EECP. The change in pSBP, pDBP, cDBP, and augmentation index before and after EECP were also assessed. The weighted mean difference using the DerSimonian and Laird random-effect model was utilized for determining the change in each parameter before and after EECP. Statistical heterogeneity was evaluated using the Egger’s bias statistic.

Results:
Five studies containing 137 unique patients were included for the cSBP analysis. cSBP was reduced significantly by -7.56 mmHg (95% CI -11.83 to -3.28; Cochrane Q=1.81) post-EECP. In the same set of studies, pSBP was reduced significantly by -9.65 mmHg (95% CI -14.32 to -4.98) post-EECP. pDBP [-4.67 mmHg (95% CI -8.56 to -0.77)] was reduced post-EECP, while no changes were evident in cDBP. Augmentation index was reduced by -3.74% (95% CI -7.05 to -0.43) post-EECP. Two studies included a sham-EECP intervention arm and demonstrated no significant changes in cSBP [0.67 mmHg (95% CI -5.66 to 7.01)] or other parameters.

Conclusion:
EECP significantly reduced cSBP and pSBP by approximately 8 mmHg and 10 mmHg respectively. EECP also demonstrated a mild improvement in arterial stiffness, which translates to reduced wasted left ventricular energy and myocardial oxygen demand. In patients with stable angina and CAD, EECP exerts beneficial effects in both peripheral and central hemodynamics but whether these benefits are sustained over a longer duration need further exploration.
Abstract P102: Variability In Lipid Levels And Risk For Cardiovascular Disease: An Electronic Health Record-based Population Cohort Study
Authors: Manemann Sheila M , Bielinski Suzette J , Moser Ethan D , St. Sauver Jennifer L , Takahashi Paul Y , Roger Veronique L , Olson Janet E , Decker Paul A , Killian Jill M , Larson Nicholas B
Published: May 2021

Background:
Larger within-patient variability of lipid levels has been associated with an increased risk of cardiovascular disease (CVD). However, measures of lipid variability are not currently used clinically. We investigated the feasibility of calculating lipid variability within a large electronic health record (EHR)-based population cohort and assessed associations with incident CVD.

Methods:
We identified all individuals ≥40 years of age who resided in Olmsted County, MN on 1/1/2006 (index date) without prior CVD. CVD was defined as myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention or stroke. Patients with ≥3 measurements of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and/or triglycerides during the 5 years before the index date were retained in the analyses. Lipid variability was calculated using variability independent of the mean (VIM). Patients were followed through 9/30/2017 for incident CVD (including CVD death). Cox regression was used to investigate the association between quintiles of lipid VIMs and incident CVD.

Results:
We identified 18,642 individuals (mean age 60; 55% female) who were free of CVD at baseline and VIM calculated for at least one lipid measurement. After adjustment, those in the highest VIM quintiles of total cholesterol had a 25% increased risk of CVD (Q5 vs. Q1 HR: 1.25, 95% CI: 1.08-1.45; Table). We observed similar results for LDL-C (Q5 vs. Q1 HR: 1.20, 95% CI: 1.04-1.39) and HDL-C (Q5 vs. Q1 HR: 1.25, 95% CI: 1.09-1.43). There was no association between triglyceride variability quintiles and CVD risk.

Conclusion:
In a large EHR-based population cohort, high variability in total cholesterol, HDL-C and LDL-C was associated with an increased risk of CVD, independently of traditional risk factors, suggesting it may be a target for intervention. Lipid variability can be calculated in the EHR environment but more research is needed to determine its clinical utility.
Abstract P104: Higher Leptin Levels Are Associated With Increased Odds Of Coronary Artery Calcium Progression: The Multi-ethnic Study Of Atherosclerosis
Authors: Varma Bhavya , Ogunmoroti Oluseye , Ndumele Chiadi , Zhao Di , Szklo Moyses , Sweeney Ty , Allison Matthew A , Budoff Matthew , Subramanya Vinita , Bertoni Alain G , Michos Erin
Published: May 2021

Background:
Adipokines are secreted by adipose tissue, play a role in cardiometabolic pathways, and have differing associations with cardiovascular disease (CVD). Coronary artery calcium (CAC) and its progression indicate subclinical atherosclerosis and prognosticate CVD risk. However the association of adipokines with CAC progression is not well established. We examined the association of adipokines with the odds of a history of CAC progression in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods:
We performed an analysis of 1,904 community dwelling adults free of clinical CVD in MESA. Participants underwent measurement of serum adipokines [leptin, resistin and adiponectin] at visits 2 or 3 (randomly assigned) and a contemporaneous cardiac CT scan at same visit. Participants also had a prior cardiac CT at visit 1, at a median of 2.4 years earlier. On both CTs, CAC was quantified by Agatston score. We defined a history of CAC progression between the CT scans at visit 1 and at visit 2 or 3 as those with >0 Agatston units of change per year (and compared to those with ≤0 units of change per year). We used logistic regression to examine the odds of having a history of CAC progression by adipokine tertiles using progressively adjusted models.

Results:
The mean participant age was 65 (10) years; 50% were women, 40% White, 13% Chinese, 21% Black and 26% Hispanic. The prevalences of CAC at visits 1 and 2/3 were 49% and 58%, respectively. There were 1,001 (53%) who had CAC progression between the 2 CT scans. In demographic-adjusted models (model 1, Table), higher leptin and lower adiponectin were associated with increased odds of prior CAC progression. In models fully adjusted for BMI and other CVD risk factors (model 3), only the highest tertile of leptin remained associated with a greater odds of prior CAC progression [OR 1.55 (95% CI 1.04, 2.30)].

Conclusions:
Higher leptin levels were independently associated with a history of CAC progression. Atherosclerosis progression may be one mechanism through which leptin confers increased CVD risk
Abstract P108: Metabolic Profile Of Diet Quality In The Multi-Ethnic Study Of Atherosclerosis
Authors: Gadgil Meghana , Wood Alexis F , Karaman Ibrahim , Gomes Da Graca Goncalo , Tzoulaki Ioanna , Zhong Victor , Greenland Philip , Kanaya Alka M , Tracy Russell P , Herrington David M
Published: May 2021

Introduction:
Poor dietary quality is a well-known risk factor for diabetes and cardiovascular disease (CVD), however metabolites marking adherence to U.S. dietary guidelines are unknown. Our goal was to determine a pattern of metabolites associated with the Healthy Eating Index-2015 (HEI-2015). We hypothesize that there will be metabolites positively and negatively associated with the HEI-2015 score, including those previously linked to diabetes and CVD.

Methods:
Sample: 2269 adult men and women from the Multi-Ethnic Study of Atherosclerosis (MESA) longitudinal cohort study without known cardiovascular disease or diabetes.

Data/specimens:
Fasting serum specimens, diet and demographic questionnaires at baseline.

Metabolomics:
Untargeted
1
H NMR CPMG spectroscopy (600 MHz) annotated by internal and external reference data sets.

Statistical analysis:
Metabolome-wide association study (MWAS) using linear regression models specifying each spectral feature as the outcome in separate models, HEI-2015 score as the predictor, and adjustment for age, sex, race, and study site, accounting for multiple comparisons. Elastic net regularized regression was used to select an optimal subset of features associated with HEI-2015 score. Separately, hierarchical clustering defined discrete groups of correlated NMR features also tested for association with HEI-2015 score.

Results:
MWAS identified 1914 spectral features significantly associated with the HEI-2015 diet score. After elastic net regression, 35 metabolomic spectral features remained associated with HEI-2015 diet score. Cluster analysis identified seven clusters, three of which were significantly associated with HEI-2015 score after Bonferroni correction. (Table)

Conclusions:
Cholesterol moieties, proline betaine, proline/glutamate and fatty acyls chains were significantly associated with higher diet quality in the MESA cohort. Further analysis may clarify the link between dietary quality, metabolites, and pathogenesis of diabetes and CVD.
Abstract P114: Sparse Partial Least Squares Regression: A Promising Technique To Identify Heart-healthy Dietary Patterns In The Multi-Ethnic Study Of Atherosclerosis (MESA)
Authors: Gasca Natalie , McClelland Robyn
Published: May 2021

Most nutritional epidemiology studies investigating trends between diet and heart disease use outcome-independent dimension reduction methods, like principal component analysis, to create dietary patterns. While these methods construct patterns that describe important aspects of food consumption, these patterns are not inherently related to heart disease. Incorporating disease data into the pattern construction offers the possibility of more concisely summarizing the most disease-related foods. Sparse partial least squares (SPLS), one such method, was found to have favorable interpretation and prediction properties in the continuous outcome setting; while selecting a subset of relevant foods, it constructed a few dietary patterns that were correlated with BMI while also capturing variation in diet composition. These results were validated with simulated data. We propose incorporating SPLS into the Cox proportional hazards model to analyze a right-censored survival outcome. We hypothesized that this method would inherit the beneficial parsimony properties seen in the continuous setting, and we assessed whether this proposed method could use the most relevant covariates to create a few patterns that were associated with a survival outcome. While the proposed method targets covariate-level sparsity (i.e. variable selection), one competitor method exists that integrates pattern-level parsimony and partial least squares (PLS) in the Cox model, but it imposes more model parameters than the proposed method. We compared the variable selection, pattern selection, and predictive performance of four survival methods (Lasso, PLS, competitor sparse PLS, and proposed SPLS) via a simulation study. Simulation settings were informed in part by the Multi-Ethnic Study of Atherosclerosis (MESA), which has detailed food frequency questionnaire data on a large multi-ethnic population-based sample (6814 participants aged 45-84), as well as subsequent cardiovascular disease follow-up for over 15 years. In most studied simulation settings, the proposed method selected all 9 relevant predictors and the fewest number of irrelevant predictors (of 15) while creating a similar number of patterns and maintaining predictive ability of the outcome. In the setting most comparable to MESA, PLS chose all 24 predictors (by default) and 3.4 patterns (C-statistic=0.90), the competitor SPLS selected 21.1 predictors and 4.4 patterns (C-statistic=0.91), Lasso chose 16.4 predictors (C-statistic=0.91), and the proposed SPLS selected 11.7 predictors and 4.3 patterns (C-statistic=0.91), on average. We will also present an analysis of a coronary event in MESA using these four survival methods. In conclusion, we propose that using methods like SPLS to summarize food intake can create more heart disease-tailored dietary patterns that can complement the current nutritional epidemiology literature.
Abstract P117: Design, Deployment, And Usability Of A Mobile System For Cardiovascular Health Monitoring Within The Electronic Framingham Heart Study
Authors: Ding Eric Y , Pathiravasan Chathurangi H , Schramm Eric , Borrelli Belinda , Kornej Jelena , Benjamin Emelia J , Murabito Joanne M , McManus David D
Published: May 2021

Introduction:
The electronic Framingham Heart Study (eFHS) is an ongoing study nested within the Framingham Heart Study. eFHS examines associations between health data measured by mobile devices and cardiovascular risk and disease. We aim to describe the eFHS app design and deployment methodology, report the characteristics of the eFHS app users, and describe usability of the app.

Hypothesis:
We hypothesize that eFHS participants will find the app highly usable.

Methods:
Participants were eligible if they were part of FHS, had a mobile phone, and were willing to share data with the research center. After consent, they received a smartwatch, digital blood pressure (BP) cuff, and the eFHS smartphone app through which surveys were administered. Three years later, the app was enhanced to include an interactive health dashboard to promote participant engagement and facilitate survey completion. We assessed usability of the new app with the Mobile App Rating Scale (MARS) (specifically app functionality and aesthetics), and survey completion rates at baseline (measures include socio-demographics, self-reported health and health behaviors, and medical history) and 3 months (physical activity).

Results:
A total of 196 participants were recruited using the enhanced eFHS app. Of these, 97 (49.5%) completed the MARS. The average age of survey respondents was 53 years, 51.5% were women, 93.8% were white. At least one instrument of the baseline survey was completed by 86% of participants, and 50% completed the 3-month assessment. The mean score on the “overall impression” subscale of the MARS was 4.2 (SD 0.74) on a scale of 1 to 5, with all sub-domains scoring > 4.0. Of those who shared their health data with others, 46% shared their BP data, and 7.7% shared their physical activity data with a healthcare provider.

Conclusion:
Participants rated the new, enhanced eFHS app positively overall. Mobile app survey completion rates were moderate, suggesting that mHealth-delivered cardiovascular research is feasible.
Abstract P118: Machine Learning Algorithm For Improving Classification Of Myocardial Infarction Across A Diverse Population Using US Veteran Electronic Health Record Data
Authors: Cho Kelly , Link Nicholas , Schubert Petra , He Zeling , Honerlaw Jacqueline P , Cai Tianrun , Orkaby Ariela R , Qazi Saadia , Tanukonda Vidisha , Sun Jiehuan , Dahal Kumar , Galloway Ashley , Costa Lauren , Zhang Yichi , Gagnon David R , Hong Chuan , Ho Yuk-lam , Gaziano J. M , Wilson Peter W , Cai Tianxi , Liao Katherine P
Published: May 2021

Introduction:
The majority of population-based studies of myocardial infarction (MI) rely on billing codes for classification. Classification algorithms employing machine learning (ML) increasingly used for phenotyping using electronic health record (EHR) data.

Hypothesis:
ML algorithms integrating billing and information from narrative notes extracted using natural language processing (NLP) can improve classification of MI compared to billing code algorithms. Improved classification will improve power to compare risk factors across population subgroups.

Methods:
Retrospective cohort study of nationwide Veterans Affairs (VA) EHR data. MI classified using 2 approaches: (1) published billing code algorithm, (2) published phenotyping pipeline incorporating NLP and ML. Results compared against gold standard chart review of MI outcomes in 308 Veterans. We also tested known association between high density lipoprotein cholesterol (HDL-C) and MI outcomes classified using the 2 approaches among Black and White Veterans, stratified by sex and race; prior study showed HDL-C less protective for Black compared to White individuals.

Results:
We studied 17,176,658 million Veterans, mean age 69 years, 94% male, 12% self-report Black, 71% White. The billing code algorithm classified MI at positive predictive value (PPV) 0.64 compared to the published ML approach, PPV 0.90; the latter classified a modestly higher percentage of non-White Veterans. Using ML algorithm for MI, we replicated a reduced protective effect of HDL-C in Black vs White male and female Veterans (Table); with the billing code algorithm no association was observed between low density lipoprotein cholesterol (LDL-C) or HDL-C with MI among Black female Veterans.

Conclusions:
Using nationwide VA data, application of an ML approach improved classification of MI particularly among non-White Veterans, resulting in improved power to study differences in association for MI risk factors among Black and White Veterans.
Abstract P131: Changes In Bile Acid Subtypes And Improvements In Adiposity And Energy Metabolism In Response To Weight-loss Diets
Authors: Heianza Yoriko , Zhou Tao , He Hua , Rood Jennifer , Clish Clary , Bray George , Sacks Frank M , Qi Lu
Published: May 2021

Introduction:
Bile acids (BAs) are synthesized in the liver from cholesterol, and gut microbiota transform the host-derived primary BAs into secondary BAs in the intestine. Emerging evidence suggests that different types of circulating BAs may play pivotal roles in regulating energy metabolism and body adiposity.

Hypothesis:
We comprehensively examined whether changes in different BA subtypes after consuming weight-loss diets were associated with improvements in energy metabolism and body adiposity among patients with obesity.

Methods:
This study included 551 overweight and obese adults who participated in a 2-year weight-loss dietary intervention, the POUNDS Lost trial. Blood levels of 14 types of BAs (primary and secondary unconjugated BAs and their taurine-/glycine-conjugates) were measured at baseline and 6 months after the intervention; changes in BAs from baseline to 6 months after the intervention were calculated. We evaluated changes in resting energy expenditure, weight, and waist circumference. Also, body composition was assessed by the dual-energy X-ray absorptiometry (DEXA) scans, and fat distribution was assessed by computed tomography (CT) scans.

Results:
At baseline, higher primary and secondary BAs were related to greater degrees of adiposity and energy expenditure. At 6 months after the intervention, greater decreases in primary BAs (cholic acid [CA] and chenodeoxycholic acid) and secondary BAs (deoxycholic acid [DCA] and lithocholic acid [LCA]) and their conjugated subtypes (except for glycolithocholic acid) were significantly associated with more decreases in weight and waist circumference at 6 months after the intervention (P values after controlling for the multiple testing,

P
FDR

<0.05). Greater reductions in the primary BAs (both unconjugated and conjugated types) and secondary BAs (DCA and its taurine-/glycine-conjugated forms) were also significantly (

P
FDR

<0.05) associated with more decreases in resting energy expenditure at 6 months. We found that reductions in two BA subtypes, glycocholic acid (GCA) and glycoursodeoxycholic acid (GUDCA), were consistently and significantly associated with improvements in energy metabolism, general and central adiposity, as well as body fat composition and visceral adipose tissue mass. Further, the initial (6-month) changes in several primary and secondary BAs (including GCA and GUDCA) were significantly predictive of the long-term successful weight loss (weight loss of more than 5% loss from the initial weight) at 2 years.

Conclusions:
Weight-loss diet-induced changes in circulating various BAs may be involved in improving general and central adiposity and energy metabolism. Changes in specific BA subtypes would be potential targets for improving regional adiposity and achieving successful weight-loss among patients with obesity.
Abstract P134: Preliminary Data: Dietary Nitrate Supplementation Does Not Extend Dry Static Apnea Or Wingate Performance
Authors: Carriker Colin , Armentrout Phillip , Levine Sarah , Smoliga James
Published: May 2021

Introduction:
Previous studies have examined dietary nitrate supplementation and its effects on dry static apnea, and peak power. Dietary nitrate supplementation has been found to increase maximal apnea and peak power output. The purpose of this study was to determine the effects of beetroot juice on dry static apnea and Wingate performance.

Hypothesis:
Dietary nitrate will improve maximal breath hold time and peak power output. Dietary nitrate will improve tolerance to CO2, thereby improving maximal breath hold time and anaerobic capacity.

Methods:
In a randomized, double-blind, counterbalanced study, five healthy males (20.4±0.89 years) visited the lab on 3 separate occasions each separated by one week. Visit 1 served as a Wingate and breath hold familiarization visit. Prior to visits 2 and 3 participants were instructed to drink a beverage either a placebo (negligible nitrate content, PL) or dietary nitrate rich beverage (12.4 mmol nitrate, NIT) during the 4 days leading up to their next visit. Visits 2 and 3 consisted of two submaximal breath holds (80% of maximal determined during visit 1), with 2 minutes of rest between and three minutes of rest preceding the final breath hold for maximal duration. Finally, participants completed a standardized 10-minute warmup on the cycle ergometer before completing a 30-second maximal effort Wingate test.

Results:
A linear mixed effects model was used to determine whether treatment (NIT vs. PL) was associated with differences in VCO2 or PetCO2. Time (0, 10, 20, 30 min post-breath hold) and Treatment both served as repeated measures. Models were developed using multiple repeated measures covariance matrix structures, and the model with the lowest AIC was chosen as the final model. The interaction between time and treatment was included in the original models, and was removed if it was not statistically significant. Time was a statistically significant factor for VCO2 and PetCO2 (p < 0.001). Treatment, and the Time x Treatment interaction was not significant for either variable. No differences between NIT and PL were observed during the Wingate test for either time to peak power (5.02±2.45 and 6.2±2.43 sec, respectively) or maximal power (9.73±1.01 and 9.72±1.03 watts/kg, respectively) and fatigue index (49.42±14.98 and 47.30±6.99 watts/sec, respectively).

Conclusion:
Preliminary data indicates that in a general population four days of dietary nitrate supplementation may not improve breath hold time, tolerance to carbon dioxide in the lungs, or Wingate performance.