bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P406: Association Between Perceived Interpersonal Racism and Incident Coronary Heart Disease Among Black Women
Authors: Sheehy Shanshan , Brock Max , Palmer Julie R , Albert Michelle A , Cozier Yvette , Rosenberg Lynn
Published: March 2023

Background:
Racism is highly prevalent in our society and has disproportionate impact on Black individuals. However, little data exists about whether perceived interpersonal racism are associated with risk of coronary heart disease (CHD).

Methods:
We followed 48,297 participants in the Black Women’s Health Study from 1997, when they provided information on perceived interpersonal racism and were free of cardiovascular disease and cancer, until the end of 2019. We averaged participant’s responses to the five questions about perceived interpersonal racism in everyday activities, such as “people act as if they think you are dishonest.” We summed up the positive responses to the three questions for perceived racism in interactions that involved jobs, housing, and police; score ranged from 0 (No to all) to 3 (Yes to all). We used Cox proportional hazard models to assess the relation of perceived interpersonal racism with incident CHD, adjusting for major confounders.

Results:
During 22 years of follow-up, we identified 1,036 incident CHD cases. Women who were in the highest quartile of perceived interpersonal racism in daily life had a 21% increased risk of incident CHD (multivariable hazard ratios (HR)=1.21, 95% confidence interval (CI): 0.99-1.48, p trend=0.05), compared to women in the lowest quartile. Women who reported experience of racism in employment, housing, and the criminal justice system had a 29% increased risk (multivariable adjusted HR=1.29, 95%CI: 1.03-1.63, p trend=0.05) of CHD relative to those who reported no such perceived racism.

Conclusion:
Perceived experiences of racism in the context of employment, housing and the criminal justice system were associated with increased incidence of CHD among Black women. These findings support the hypothesis that experiences of racism may explain some of the disproportionately high incidence of CHD in the Black population.
Abstract P409: Estimating the Effect of Statewide Lockdown Orders on Rates of Acute Coronary Syndrome in the United States
Authors: Herbert Brandon M , Brooks Maria M , Magnani Jared W
Published: March 2023

Introduction:
Initial statewide responses to the COVID-19 pandemic varied substantially in restrictions and duration. It is known that acute coronary syndrome (ACS) rates declined during the first wave of the COVID-19 pandemic. Whether statewide lockdowns were associated with overall and age-specific declines remains unknown.
Hypotheses:
1) Statewide lockdown orders were associated with a reduction in ACS rates and 2) decline in rates of ACS were greater among older individuals.

Methods:
Individuals with a principal diagnosis of ACS, defined as unstable angina, non-ST elevation myocardial infarction (NSTEMI), and STEMI, were identified between January 2018 and September 2021 using ICD codes in Optum’s de-identified Clinformatics® Data Mart (CDM) Database. Multiple ACS claims from the same individual within 7-days were counted as a single event. Weekly, state-specific ACS rates were calculated by dividing the number of ACS events per week by the number of enrolled CDM members for the corresponding week. Lockdown dates were obtained from government issued orders. The 7-day case rates of COVID-19 were obtained for each state from the CDC COVID Data Tracker and modelled as per 1,000 cases. Generalized estimating equations were used to estimate the effect of statewide lockdowns on ACS rates overall and by age-stratified groups (<45, 45-64, 65-74, and ≥75 years).

Results:
Across all 50 US states, >17 million patients were enrolled in CDM on average each week (state median: 207,913; interquartile range: 73,510 - 509,593). The mean weekly ACS rate was 17.5 cases per 100,000 enrollees (SD: 10.2). Statewide lockdowns were associated with an 11% decrease in ACS rates (rate ratio [RR]: 0.89 [95% CI: 0.85, 0.94]) after controlling for 7-day case rates of COVID-19 and the peak enrollment month of January. In age-stratified analyses, statewide lockdowns were associated with significant decreases in ACS rates across all age groups: <45 (RR: 0.71 [95% CI: 0.56, 0.90]), 45-64 (RR: 0.80 [95% CI: 0.73, 0.87]), 65-74 (RR: 0.78 [95% CI: 0.69, 0.89]), ≥75 (RR: 0.77 [95% CI: 0.70, 0.84]). Per each 1,000-case increase in COVID-19 case rates, ACS rates declined 18% for those 45-64 (95% CI: 0.75, 0.91) but increased 29% for those 65-74 (95% CI: 1.09, 1.53).

Conclusions:
Statewide lockdowns were associated with a reduction in rates of ACS. The estimate decline in ACS rates were similar across age groups. Further study is needed to determine if ACS events were prevented by state lockdown periods or if the decline was due to other factors such as competing risks of death.
Abstract P410: Spontaneous Coronary Artery Dissection and Intervention With Percutaneous Coronary Intervention (PCI): A Population Based Study 2016-2019
Authors: Khalid Yaser , Dasu Kirti , Umrani Rohan , Roy Trinava , Dasu Neethi , Kadiyala Bhavana
Published: March 2023

Background:
Spontaneous coronary artery dissection (SCAD) remains an important cause of myocardial infarction. A paucity of data exists regarding optimal management of SCAD due to lack of randomized trials comparing medical therapy and revascularization strategies.

Methods:
Data were extracted from the National Inpatient Sample (NIS) 2016-2019 Database. The NIS was searched for hospitalizations for adult patients with SCAD as principal discharge diagnosis with and without intervention with percutaneous coronary intervention (PCI) as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis.

Results:
2,400 patients who had SCAD were divided into those that had PCI versus those who did not-- followed by matching. Majority of the patient population was noted to be females (76.9%) and mean age was a 54.63 years. The adjusted odds ratio (OR) for inpatient mortality for SCAD with PCI intervention showed significantly reduced mortality (OR 0.32, p<0.01), which was statistically significant. Hospital length of stay (LOS) was less (-1.23 days, p<0.04) and total hospital charges were lower (-$3,697.02, p<0.03) in this patient population. The only independent positive predictor of increased mortality for the SCAD and PCI intervention group was acute kidney injury (AKI) (OR 4.99, p<0.001). Independent positive predictors of hospital LOS were the following: cardiogenic shock (4.14 days, p<0.01), AKI (4.99 days, p<0.01), ventricular arrhythmias (3.53 days, p<0.01), and systolic heart failure (2.84 days, p<0.03). Independent positive predictors for total charges were the following: cardiogenic shock ($108,113.9, p<0.015), ventricular arrhythmias ($109,009.6, p<0.04), AKI ($107.635.7, p<0.003), atrial flutter ($134,619.3, p<0.042).

Conclusion:
Previous studies showed that the majority of patients with SCAD except those with high risk should have a conservative revascularization strategy. Our study shows decreased mortality, hospital LOS, and total charges for patients with SCAD who had intervention with PCI. Randomized clinical trials will need to further examine the role of PCI for SCAD in different populations.
Abstract P412: The Effect of Targeted Therapeutic Management in ST-Elevation Myocardial Infarction Cardiac Arrest
Authors: Ahmed Ibrahim , Ahmed Mohamed
Published: March 2023

Introduction:
ST-elevation myocardial infarction (STEMI) is a known cause of cardiac arrest (CA). Little is known about the impact of targeted therapeutic management in CA patients with STEMI (SCA). Our aim was to investigate the effect of TTM on SCA.

Methods:
This was a retrospective cohort study using the 2019 Nationwide Inpatient Sample database to identify admissions in adults with diagnoses of CA and STEMI. Regression models were adjusted for demographic variables. Primary outcome was mortality, and secondary outcomes were length of stay (LOS) and total charge in USD.

Results:
Out of 13895 admissions with SCA, 440 underwent TTM. Compared to Non-TTM-SCA cohort, TTM-SCA cohort had fewer females (18.18% vs 31.03,p<0.05), more males (81.82% vs 68.97,p<0.05), lower mean age (62.17 vs 64.57,p<0.05), more Native American (2.27% vs 0.63%,p<0.05), less South region hospitals (25.00% vs 39.95%,p<0.05), less acute respiratory failure with hypercapnia (0.47% vs 8.53%,p<0.05), acute respiratory failure with hypoxia (1.94% vs 38.90%,p<0.001), history of cardiac arrest (0.11% vs 0.61%,p<0.01), ventricular fibrillation (2.27% vs 50.59%,p<0.001), cerebral infarction (0.29% vs 4.28%,p<0.05), more alcohol abuse (12.50% vs 4.72%,p<0.001), and more persistent vegetative state (1.14% vs 0.15%,p<0.05). Compared to Non-TTM-SCA, TTM-SCA group had similar mortality rates (38.64% vs 42.96%,p=0.3940), mortality OR 1.04 (95%CI 0.66-1.62,p=0.869), higher mean LOS 10.69 vs 6.25 days (95%CI 2.39-6.17,p<0.001), and higher mean total hospitalization charge $238960.90 vs $179880.10 (95%CI 18772.87-98404.78,p<0.01).

Conclusion:
In SCA patients, TTM presence had no difference in mortality rate, odds of mortality, but had higher mean LOS and total hospitalization charge. TTM was associated with fewer females, more males, lower mean age, more Native Americans, less acute respiratory failure, history of cardiac arrest, ventricular fibrillation, cerebral infarction, and more alcohol abuse and persistent vegetative state.
Abstract P414: Modification of Diet-Metabolite Associations by Race and Sex in the Coronary Artery Risk Development in Young Adults Study
Authors: Hullings Autumn G , Howard Annie Green , Meyer Katie A , Avery Christy L , North Kari E , Mhatre Sachin , Sha Wei , Du Xiuxia , Li Yuanyan , Rushing Blake , Sumner Susan , Lewis Cora E , Gordon-Larsen Penny
Published: March 2023

Objective:
There is known heterogeneity in the relationship between diet quality and cardiovascular disease by self-reported race and sex, which may underlie inequities in cardiovascular health.

Methods:
We used data from 2,832 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study (2005-06, aged 37-55, 57% women, 45% Black). Using fasted blood samples, we obtained ultra-high-performance liquid chromatography high resolution mass spectrometry untargeted metabolomics and derived an
a priori
diet quality score using a validated diet history questionnaire, based on classification of 46 food groups with potential beneficial (n=20), adverse (n=13), or neutral (n=13) implications for cardiovascular health. We tested effect modification of associations between metabolites and diet quality by race and sex, separately, using multivariable-adjusted linear regression for 7,522 metabolite peaks, accounting for multiple comparisons, adjusted for batch, field center, demographics, lifestyle behaviors, total energy intake, hypertension and diabetes status, medication use, and BMI. We also used race- and sex-stratified multivariate Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) analyses to examine how metabolites distinguish by diet quality 1
st
and 4
th
quartiles. We identified differing metabolite pathways by race and sex through biochemical pathway analysis (Mummichog version 1.0.10) from regression and OPLS-DA models.

Results:
In linear regression, race significantly modified metabolite-diet quality associations for 231 metabolite peaks; sex modified associations for 1 peak (FDR<0.1). OPLS-DA pathway analysis identified cysteine, methionine, histidine, and alpha-linoleic metabolism and terpenoid backbone biosynthesis as significantly associated with diet quality in Black, but not White, race. Linear regression and OPLS-DA pathway analysis found differences (p<0.05) in arginine biosynthesis by sex. OPLS-DA also found aminoacyl-tRNA and arginine biosynthesis, nitrogen, porphyrin, and chlorophyll metabolism were significantly associated with diet quality in men only.

Conclusions:
Metabolite pathways were statistically different by self-reported race, and to a lesser extent, by sex. Differences in metabolite-diet quality associations may reflect differences in contextual or social variables, and potentially, heterogeneity in metabolism.
Abstract P421: Eggs as Part of a Healthy Eating Pattern Are Not Adversely Associated With Dyslipidemia in the Framingham Offspring Study
Authors: Yiannakou Ioanna , Mott Melanie M , Zhou Xinyi , Singer Martha R , Moore Lynn L
Published: March 2023

Background:
For decades, dietary guidelines have recommended restricting egg consumption out of concern about the high content of dietary cholesterol and potential effects on LDL cholesterol levels and, in turn, cardiovascular risk. However, the evidence supporting these recommendations has been increasingly questioned.

Objective:
To examine the association of egg consumption with plasma lipid levels and risk of dyslipidemia in adults in the Framingham Offspring Study, and to determine whether these effects are modified by other dietary factors.

Methods:
We included 1,852 adults aged 30-64 years with available 3-day food records, and without prevalent CVD or use of lipid-lowering or glucose-lowering medications. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for risks of elevated fasting LDL-C and triglycerides after adjusting for confounding. Analysis of covariance models were used to estimate sex-specific mean plasma levels of total cholesterol, LDL, the ratio of LDL:HDL, and triglycerides associated with categories of egg intake. Confounding factors retained in the final models included age, BMI, and other dietary factors. Stratified analyses were used to evaluate effect modification by several dietary factors.

Findings:
Over approximately 6 years of follow-up, 372 adults developed new-onset elevated LDL and 306 adults developed new-onset elevated triglycerides levels. Overall, those with higher egg consumption (vs. lower) had very similar intakes of other healthy foods at baseline (e.g., whole grains, fruits, vegetables, dairy, and fish). Men and women consuming ≥5 eggs per week (vs. <0.5) had no increased risk of elevated LDL (HR=0.85, 95% CI: 0.59-1.22) or triglycerides (HR=1.25, 95% CI: 0.83-1.86). In fact, men with higher egg intakes (≥5 vs. <0.5 per week) had a total cholesterol level that was 8.6 mg/dL lower, an LDL level that was 5.9 mg/dL lower, and a log-transformed triglyceride level that was 0.13 units lower (p<0.05 for all differences) after 4 years of follow-up. Further, participants with higher egg consumption in combination with higher fiber intake had lower levels of all lipids (p<0.05 for total cholesterol, LDL, and LDL:HDL for the category of higher egg & higher fiber vs. lower egg & lower fiber). Moreover, consumption of >5 eggs/week (vs. <0.5) combined with either higher intakes of total fish or fiber was also associated with statistically significant reductions in LDL levels.

Conclusions:
This study suggests that higher egg intakes had no adverse effects on serum lipids in healthy adults and may be beneficial as part of a healthy eating pattern.
Abstract P424: Associations of Taste-Related Genes With Empirical Dietary Patterns Among Community-Dwelling Adults - The Framingham Heart Study
Authors: Gervis Julie E , Ma Jiantao , Chui Kenneth , Lichtenstein Alice H
Published: March 2023

Background:
Understanding the genetic contribution to food choices and intake is critical for the development of effective precision nutrition guidance. Recent findings by our lab suggest that genetic variants (SNPs) related to bitter and umami taste perception are differentially associated with food group intakes. The aim of this study was to examine the associations of bitter- and umami-related SNPs, combined as polygenic taste scores, with overall dietary patterns.

Methods:
Cross-sectional analyses were conducted in 5,817 Framingham Heart Study Offspring (1998-2001) and Third Generation (2002-05) participants (mean age ± SD: 50 ± 14 years; 54% female). Weighed polygenic taste scores were derived using SNPs identified from prior genome-wide association studies for taste perception (11 SNPs: 9 bitter and 2 umami). Higher scores indicated more alleles for higher taste perception. Empirical dietary patterns were derived using Principal Component (PC) analysis with food groups tabulated from food frequency questionnaires. Associations were assessed using linear mixed effects models with FDR adjustment.

Results:
Three dietary patterns were identified, explaining 32% of total variance in dietary intake: a vegetables, fruits, legumes, and fish pattern (Prudent); a refined grains, sweets, salty foods, and pizza pattern (Western); and a liquor, beer, and wine pattern (Alcohol). On average, after adjusting for age, sex, genetic PCs and energy intake, higher umami polygenic taste scores were associated with lower adherence to the Prudent dietary pattern (OR [95% CI] for upper vs. lower tertial of dietary pattern adherence scores per additional allele for higher umami perception: 0.87 [0.79, 0.97];
P
= 0.01). Subsequent analysis at the SNP-level identified one umami-related SNP (rs7691456_T) independently associated with lower Prudent dietary pattern adherence (
P
= 0.009), potentially driving the observed association. Both associations remained significant after additional adjustment for smoking, physical activity, and BMI. No significant associations were identified for bitter-related genes and dietary patterns.

Conclusions:
Among community dwelling adults, higher genetic predisposition to perceive umami was associated with lower adherence to a Prudent dietary pattern, suggesting the potential benefit of leveraging knowledge of taste-related genes in precision nutrition.
Abstract P426: Food Insecurity is Associated With Insomnia Among Men in the Echorn Cohort
Authors: Oladele Carol R , Elumn Johanna E , Galusha Deron , Khandpur Neha , Martinez-Brockman Josefa L , Nunez-Smith Marcella
Published: March 2023

Background:
Food insecurity (FI), defined as lack of consistent access to enough food for an active, healthy lifestyle, affects 40% of people across the Caribbean and is associated with adverse cardiovascular outcomes. Despite evidence that suggests an association between FI and sleep health and FI prevalence in the Caribbean, few studies have been conducted. We aimed to examine the relationship between FI and sleep health in the Eastern Caribbean.We hypothesized that FI would be negatively associated with sleep health.

Methods:
Baseline data from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS) were analyzed (2013-2018). Participants (n= 2,961) are community-dwelling individuals 40 years or older residing in Barbados, Puerto Rico, Trinidad and Tobago, or U.S. Virgin Islands. Participants completed a questionnaire including the 9-item Latin American and Caribbean Food Security Scale. Responses were summed to create a score (0-9) and create four categories: 0 no FI, 1-3 mild FI, 4-6 moderate, and 7-9 severe FI. FI was also operationalized as a binary variable (yes/no). Sleep outcomes included adequate sleep and insomnia. Sleep variables were measured by the items, “how many hours of sleep do you usually get at night,” and “has a doctor or other health professional has ever told you that you have insomnia.” Adequate sleep was defined as 7+ hours (yes/no) and insomnia was also operationalized as binary variable (yes/no). Other variables included sex and age. Chi-square tests and multivariable logistic regression modeling were used for the analysis.

Results:
Analyses included 2,321 participants. Sixty-five percent were women, and the mean age was 57 years. Findings showed 28% (644 of 2,321) of participants experienced food insecurity: 17.1% (397 of 2,321) mild, 6.2% (144 of 2,321) moderate, and 4.4% (103 of 2,321) severe. Fifty-five percent (1279 of 2,321) of participants had inadequate sleep (<7 hours) and five percent reported insomnia. FI was not significantly associated with inadequate sleep in bivariate or multivariable analyses. Bivariate results for insomnia showed statistically significant associations with FI (p=0.0002). Multivariable results showed moderate and severe FI were associated with 2 (CI=1.01-4.16) and 4 (CI=1.95-7.05) times greater odds of insomnia compared to those who were food secure. Sex-stratified results showed men with severe FI had 9 times greater odds of insomnia (CI=3.2-23.7). Results were not statistically significant for women.

Conclusions:
Future research should examine mechanisms that explain sex differences in the relationship between FI and insomnia.
Abstract P439: Ideal Physical Activity is Associated With Reduced Risk of Atrial Fibrillation in African Americans Without Baseline Cardiovascular Disease: The Jackson Heart Study
Authors: Tiahnybik Jack , Siebert Marielle , Kamimura Daisuke , Yimer Wondwosen , Min Yuan-I , Bhattacharya Kaustuv , Floyd James S , Yang Yi , Heckbert Susan R , Hall Michael E , Correa Adolfo , Suzuki Takeki
Published: March 2023

Background:
The effect of physical activity (PA) on incidence of atrial fibrillation (AF) is unclear in African Americans (AA). This study aimed to determine if higher levels of PA are associated with decreased incidence of AF in the Jackson Heart Study (JHS).

Methods:
Participants of the JHS with PA assessment and without previous AF at baseline were included in the study. PA was categorized based on the American Heart Association physical activity levels. Incident AF was defined as having 12 lead electrocardiogram evidence at a subsequent follow up, or a documented diagnosis code at the time of hospital discharge from 2000 to 2016. Cox proportional hazards models were used to evaluate for the association between baseline PA and incidence of AF. Given significant correlation between PA and baseline cardiovascular disease (CVD), stratified analysis was performed based on CVD status.

Results:
Of the 4,477 participants followed for a median of 12.5 years, 398 developed AF (7.13 cases per 1,000 person-years). Ideal and intermediate PA were associated with a reduced risk of incident AF compared with poor PA (unadjusted HRs with 95% CIs 0.47 [0.34 - 0.64] and 0.72 [0.58 - 0.90], respectively) (Table). After adjustment for traditional cardiovascular risk factors, the associations attenuated and became no longer significant (0.73 [0.53 - 1.00] and 1.00 [0.80 - 1.25], respectively). In stratified analysis based on baseline CVD status, in participants without baseline CVD, ideal PA was significantly associated with a reduced risk of AF while intermediate PA was not (0.68 [0.47 - 0.98] and 1.00 [0.78-1.29], respectively). In participants with baseline CVD, ideal PA or intermediate PA was not associated with incident AF.

Conclusion:
Ideal PA was associated with a reduced risk of AF in participants without baseline CVD in this AA community cohort. Our findings show intertwined relationship among PA, CVD, and incident AF. Physical activity could be a possible therapeutic target to reduce AF incidence in the AA general population without CVD.
Abstract P448: Trends and Predictors of Statin Initiation Among Veterans With Familial Hypercholesterolemia
Authors: Qazi Saadia , Tarko Laura , Ho Yuk-lam , Gagnon David , Orkaby Ariela R , Djousse Luc , Gaziano John M , Cho Kelly , Wilson Peter W
Published: March 2023

Introduction:
Familial hypercholesterolemia (FH), defined as LDL-C ≥190mg/dL, is a strong cardiovascular disease (CVD) risk factor. The AHA/ACC guidelines recommend high intensity statins for primary prevention irrespective of global risk assessment. We sought to characterize trends and predictors of statin initiation among Veterans with FH in the Veterans Health Administration (VHA).

Methods:
Inclusion criteria consisted of care at the VHA (2002-2014), age ≥21 years, baseline LDL-C ≥190 mg/dL, no prevalent CVD, no prior statin use, and statin initiation within 90 days of LDL-C measurement. We defined baseline LDL-C in quartiles: Q1=190-195, Q2=196-202, Q3=203-215, and Q4 >215 (mg/dL). Statin intensity was defined as average intensity over one year following baseline LDL-C measurement. Multivariable logistic regression models were constructed to determine the odds of any statin initiation and high intensity statin initiation.

Results:
Over 12 years, 165,110 Veterans (age=52.9±11.9, men=91%; white race=74%) were included. Statins were initiated in 88,878 patients (overall 54%, 62% in 2014). Overall, 29,533 Veterans were on high intensity statins (overall 33%, 20% in 2002, 50% in 2014). In multivariable-adjusted logistic regression models, significant predictors of statin initiation were age, white race, diabetes hypertension, smoking, baseline LDL-C, and recent calendar year. Among those initiated on high intensity statins, the same predictors were significant; however, African Americans were more likely to be started on a high intensity statin (Table).

Conclusions:
Among Veterans with FH, the odds of statin initiation are higher among older, Caucasian, hypertensive, diabetic, and smoking veterans. The odds of statin prescription have increased over time with a higher proportion receiving high intensity statins more recently. These data reflect the VHA changes in clinical practice concordant with ACC/AHA guidelines.
Abstract P449: Life’s Essential 8 and Risk of Coronary Heart Disease: A Prospective Study Among Racially and Geographically Diverse Populations
Authors: Deng Kui , Gupta Deepak , Shu Xiao-Ou , Lipworth Loren , Zheng Wei , Yu Danxia
Published: March 2023

Introduction:
Life’s Essential 8 (LE8) is a new guideline proposed by American Heart Association to improve cardiovascular health, including four health behaviors (i.e., eat better, be more active, quit tobacco, get healthy sleep) and four health factors (i.e., manage weight, control cholesterol, manage blood sugar, manage blood pressure).

Hypothesis:
Higher adherence to LE8 is associated with reduced risk of coronary heart disease (CHD) among racially and geographically diverse populations.

Methods:
The current analysis was based on CHD case-control studies nested within the Southern Community Cohort Study (baseline: 2002-2009), Shanghai Women’s Health Study (1996-2000), and Shanghai Men’s Health Study (2002-2006), including 900 incident CHD cases identified through 2018 and 900 age-/sex-/race-matched controls (300 pairs of White Americans, Black Americans, and Chinese adults, respectively). Within each cohort, we constructed the LE8 score (range: 0 to 100) based on DASH diet quality, moderate/vigorous physical activity, tobacco smoking, sleep hours, body mass index, total and non-HDL cholesterol, diabetes status/blood glucose, and hypertension status/blood pressure. We used conditional logistic regression to evaluate odds ratios (ORs) between the LE8 score and incident CHD, adjusting for sociodemographic factors and family history of CHD.

Results:
The mean ± standard deviation (SD) of LE8 score was 48.1±13.4 among White women, 48.5±14.4 among White men, 48.1±12.3 among Black women, 50.0±13.6 among Black men, 57.2±12.2 among Chinese women, and 50.7±12.5 among Chinese men. Higher LE8 score was associated with significantly reduced risk of CHD: OR for 1-SD increase was 0.58 (95% CI: 0.51-0.65) among all participants, 0.64 (95% CI: 0.53-0.78) among White Americans, 0.57 (95% CI: 0.46-0.69) among Black Americans, 0.52 (95% CI: 0.42-0.65) among Chinese, 0.49 (95% CI: 0.41-0.60) among women, and 0.65 (95% CI: 0.56-0.75) among men; all
P
<0.001 (
P
interaction
>0.05 for race and
P
interaction
=0.01 for sex). Similar patterns of beneficial associations were also found in stratified analyses by age group, education level, and history of diabetes, hypertension, or dyslipidemia, with ORs ranging from 0.46 to 0.74.

Conclusions:
Higher adherence to LE8 is associated with ~35-50% reduced risk of incident CHD across racially and geographically diverse populations, supporting the importance of promoting healthy lifestyles and maintaining metabolic health.
Abstract P452: The Associations Between Potassium Levels, Arterial Stiffness, and Cardiovascular Disease Risk in the Jackson Heart Study
Authors: Chatterjee Ranee , Davenport Clemontina A , Fox Ervin R , Ramachandran Vasan S , Mitchell Gary F
Published: March 2023

Background:
Low-normal serum potassium (K) and low dietary K intake are more prevalent in Black than White individuals and are potentially modifiable risk factors for cardiovascular disease (CVD), hypertension, and diabetes, conditions that disproportionately affect Black adults. Arterial stiffness predicts the development of CVD. We sought to determine the associations of K measures with arterial stiffness and incident CVD.

Methods:
We used data from participants of the Jackson Heart Study who were free of CVD at baseline. We used multivariable linear regression to assess the associations of serum K and dietary K intake with two measures of arterial stiffness: peripheral pulse pressure (PP) and carotid-femoral PWV (CFPWV) - the gold standard. Additionally, we analyzed associations of K measures with incident CVD using multivariable Cox proportional hazard models.

Results:
Of 4467 participants included in our analyses, 1218 had low-normal serum K (K ≤ 4.0 mmol/L) at baseline, and 407 participants had a CVD event over a median of 13.7 years of follow-up. In minimally-adjusted models, there were significant inverse associations of serum K with PP and CFPWV. The association between serum K and CFPWV persisted after multivariable adjustment (Table). In multivariable models with serum K categorized into quintiles, those with serum K > 4.4 mmol/L had significantly lower CFPWV. There were no significant associations between dietary K and outcomes of arterial stiffness. There were no significant associations between either measure of K and incident CVD.

Conclusions:
In this cohort of Black adults, higher serum K was significantly associated with reduced arterial stiffness.
Abstract P456: The Cardiovascular Profile of Patients by Methamphetamine, Cocaine, Opiate, and Cannabis Use
Authors: Norby Faye L , Chugh Harpriya , Reinier Kyndaron , Chugh Sumeet S
Published: March 2023

Introduction:
The role of recreational substances such as alcohol, tobacco and illicit drugs in the development of clinical cardiovascular disease is established. Recent studies have started to compare cardiovascular endpoints across individual types of substances, but these studies have been limited in generalizability or do not distinguish by drug type. We conducted a cross-sectional analysis to investigate the cardiovascular profile of patients by type of substance in a large health care system.

Methods:
We included 346,008 adult patients who received regular care (at least 1 visit per year in 2 consecutive years) in a California health system during 2016-2020. The baseline visit was defined as the earliest visit in the 2
nd
year, allowing at least 1 year for data capture. Substance use and covariates were ascertained using ICD codes from medical records at or prior to baseline. We used logistic regression to assess the association of cardiovascular characteristics by each substance use.

Results:
Of the 346,008 patients included, the mean age was 53 years, and 58% were female. There were 8752 (2.5%) patients with a history of substance use. The 4 most common substances were 1479 (0.43%) patients with codes for methamphetamine use, 1002 (0.29%) for cocaine, 2310 (0.66%) for opiate, and 3145 (0.91%) for cannabis. Compared to those with no history of substance use, patients with substance use were more likely to be male, and despite being younger or of similar age, had worse cardiovascular risk factors (Table). All substances had a higher adjusted odds of tobacco use and alcohol dependence. Patients with cocaine use had a higher odds of male, CKD, stroke, MI and HF (all odds ratios >2), whereas the profile differed in opiate use, with the highest odds being hypertension and COPD.

Conclusion:
Methamphetamine, cocaine, opiate, and cannabis use each had unique cardiovascular patient profiles. These results offer insight for risk stratification and may represent treatment strategies to prevent adverse events.
Abstract P458: An Examination of the Influence of Daily Intersectional Minority Stressors on Sleep Health in Sexual and Gender Minority People of Color
Authors: Belloir Joseph , Ensari Ipek , Jackman Kasey , Feuer Shayna , Bhargava Anisha , Caceres Billy A
Published: March 2023

Background:
Sexual and gender minority (SGM; e.g., gay, lesbian, bisexual, transgender) people of color are at higher risk for poor sleep health outcomes than both White SGM adults and non-SGM people of color. Growing evidence suggests that chronic minority stressors (i.e., unique stressors attributed to one or more of an individual’s minoritized identities) are associated with short sleep duration and worse sleep quality in SGM adults. However, no study has examined the associations of daily intersectional minority stressors (i.e., attributed to any reason, such as race, sexual identity, gender) with sleep health outcomes in SGM people of color.

Objective:
To determine the associations of intersectional minority stressors (i.e., anticipated and experienced discrimination) with subsequent sleep health outcomes (i.e., sleep duration, sleep disturbances, and sleep-related impairment) at the day level among SGM people of color.

Methods:
An online sample of SGM people of color living in the United States participated in a 30-day daily diary study. Daily anticipated discrimination (i.e., expectation of encountering discrimination) and personally experienced discrimination as well as daily subjective sleep health outcomes were assessed using morning and evening electronic diaries. Daily anticipated and experienced discrimination were assessed using validated measures. Patient-Reported Outcomes Measurement Information System (PROMIS) 4-item measures were used to assess daily subjective sleep disturbances and sleep-related impairment. Continuous wrist-worn actigraphy was used to objectively assess sleep duration. Multilevel linear models (MLMs) were used to estimate the independent associations of daily intersectional minority stressors with subsequent sleep health outcomes, adjusted for demographic factors and chronic minority stressors.

Results:
The sample included 43 SGM people of color with a mean age of 27.0 years (+/- 7.7) of which 84% were Latinx, 47% were multi-racial, and 37% were bisexual. Results of MLMs indicated that greater report of daily experienced discrimination was positively associated with same-night sleep disturbances (
B[SE]
= 0.33[0.12],
p
= 0.01). Further, daily anticipated discrimination was positively associated with sleep-related impairment on the following day (
B[SE]
= 0.39[0.17],
p
= 0.02). However, daily anticipated and experienced discrimination were not associated with same-night sleep duration.

Conclusions:
This is the first study to simultaneously examine the influence of daily anticipated and experienced discrimination on sleep health in any population. Further research is needed to identify factors driving the link between daily intersectional minority stressors and subjective sleep health outcomes in SGM people of color. This work is crucial to inform precision sleep health interventions tailored for this population.
Abstract P459: Socioeconomic Disadvantage and Adverse Childhood Events Associated With Risk of Obesity and Insufficient Sleep in Children
Authors: St-Onge Marie-Pierre , Lin Susan , Woo Baidal Jennifer , Hoven Christina
Published: March 2023

Introduction:
Obesity and sleep problems are risk factors for various health problems. Children with both obesity and sleep problems are more likely than children with only one condition to develop cardiometabolic disorders later in life. This study estimates the prevalence of children with obesity and insufficient sleep duration and examines related demographic and social economic factors for their co-occurrence among children in the United States.

Methods:
Data were from the 2019 and 2020 National Survey of Children’s Health (NSCH). The NSCH provides national and state-level data on the physical and emotional health of non-institutionalized American children 0-17 y of age. For this study, children 10-17 y without missing data in the study variables (N=35678) were included. Age-adjusted, sex-specific body mass index was classified as underweight (<5th percentile); normal weight (5th to <85th percentile); overweight (85th to <95th percentile); or obese (≥95th percentile). Age-appropriate sleep duration was defined according to American Academy of Sleep Medicine guidelines (nighttime sleep for ages 10-12 y=9-12 h; 13-17 y=8-10 h). Children who slept below the minimum recommended duration on an average weeknight in the past week were classified as having insufficient sleep. The main outcome was co-occurrence of obesity and insufficient sleep. Descriptive statistics, chi-square tests and logistic regression were used applying sampling weights to account for non-response and sampling procedures.

Results:
In NSCH, 16.3% of children had obesity and 34.7 % reported insufficient sleep with 7.4% of children having both conditions. Younger children (age 10-12 y) had higher prevalence of obesity with insufficient sleep (11.3%) compared to older children (age 13-17 y; 5%). Non-Hispanic Black and Hispanic children had higher prevalence of co-occurring obesity and insufficient sleep compared to non-Hispanic white children (11.4% and 11% vs 4.7%, respectively). Children in low-income households had higher prevalence (12.4%) of both obesity and insufficient sleep than higher-income counterparts (2.9%) as did children with parents reporting less than high school education compared to those with more highly educated parents (13.8 vs 5.3%). Children exposed to ≥2 adverse childhood experiences had higher prevalence than those without (10.3 vs 5%). Logistic regression analyses show all these factors were significantly associated with co-occurring obesity and insufficient sleep (p-values <0.001).

Conclusion:
Combined prevalence of obesity and insufficient sleep duration among children varied by age, race, poverty, exposure to childhood adversity, and parental education. The study findings call attention from policy makers, pediatricians, and researchers to these co-existing health problems in children and develop effective strategies to combat obesity and improve sleep health.
Abstract P473: Early Onset Stroke in the Black Women's Health Study
Authors: Aparicio Hugo J , Cozier Yvette , Xu Nora , Lioutas Vasileios , Shulman Julie G , Palmer Julie R , Rosenberg Lynn , Sheehy Shanshan
Published: March 2023

Background:
The impact of stroke in young adulthood and mid-life is disproportionately large due to greater disability-adjusted life-years lost and worsened quality of life. There is evidence that stroke incidence has increased among young adults in recent decades, although there is conflicting data, especially among subgroups defined by sex and race. We investigated incidence of early-onset stroke among U.S. Black women.

Methods:
The Black Women’s Health Study is a prospective study of 59,000 Black women from across the U.S. who have been followed since 1995 (aged 21-69 years, median age of 38 years). Both ischemic and hemorrhagic stroke were ascertained by self-report at biennial health questionnaires through December 31, 2019. Stroke mortality was determined through the National Death Index. We stratified by age group: ages 35-54 and ages 55 and older, to distinguish early onset stroke and stroke occurring in later life. We examined crude incidence rates of total stroke cases (per 1000 person-years) during two sequential 12-year follow up periods, 1995-2007 and 2007-2019. Stroke incidence rates were calculated and modeled with Poisson regression.

Results:
Incident stroke or stroke death occurred in 2093/58,386 participants (3.58%) during 1,316,545 person-years of follow-up from 1995 to 2019. Among women aged 35-54 years the incidence rate was 1.59 (95% CI 1.46-1.72) in the 1995-2007 period (564 cases/355,601 person-years) and 1.12 (95% CI 1.02-1.23) in the 2007-2019 period (460 cases/409,870 person-years). For participants aged 55 or older the incidence rate was 4.19 (95% CI 3.69-4.73) in the 1995-2007 period (257 cases/61,357 person-years) and 2.83 (95% CI 2.62-3.05) in the 2007-2019 period (678 cases/239,433 person-years).

Conclusion:
In this preliminary analysis, stroke incidence in Black women decreased across study time periods, from 1995-2019, most clearly among participants aged 55 years or older. These findings are similar to those observed in other population-based cohorts reporting incidence rates among Black Americans, for example in the Atherosclerosis Risk in Communities Study. Black women continue to be a high-risk subgroup for stroke and should be a focus for preventive public health efforts, from as early as young adulthood.
Abstract P517: Ideal Cardiovascular Health and Adipokine Levels: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Broni Eric K , Ogunmoroti Oluseye , Osibogun Olatokunbo I , Echouffo Tcheugui Justin B , Chevli Parag A , Shapiro Michael D , Ndumele Chiadi E , Michos Erin D
Published: March 2023

Introduction:
Adipokines are hormones implicated in obesity and its cardiometabolic consequences. The concept of ideal cardiovascular health (CVH) was introduced to monitor and promote 7 (now 8) key health factors and behaviors in the general population. Although prior studies have found strong associations between obesity and ideal CVH, the link between CVH and adipokines has not been elucidated. We examined the associations between CVH and adipokine levels in MESA.

Methods:
We studied 1,842 MESA participants who were free of cardiovascular disease at baseline, had 7 CVH metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and fasting blood glucose) measured at exam 1 (2000-2002) and adipokine levels measured at either exam 2 or 3 (2002-2004 or 2004-2005). Each metric was assigned a score of 0(poor), 1(intermediate) and 2(ideal), and summed to obtain a total CVH score (0 -14). We used multivariable linear regression models to assess the non-concurrent cross-sectional associations between CVH score and log-transformed serum adipokine levels, adjusting for sociodemographic factors.

Results:
The mean ± SD age was 62.1 ± 9.8 years and 50.2% of participants were men. Median (IQR) adiponectin, leptin and resistin levels were 17.4 (11.8 - 26.3) mcg/mL,13.3 (5.6 - 28.2) ng/mL and 15.0 (11.9 - 19.0) ng/mL, respectively. A 1 unit higher CVH score was significantly associated with 4% higher adiponectin, 15% and 1% lower leptin and resistin levels respectively, after adjusting for sociodemographic factors. Individuals with optimal CVH scores had 27% higher adiponectin and 56% lower leptin levels compared to those with inadequate CVH scores. Similar results were obtained for those with average scores
(Table).

Conclusion:
In a multi-ethnic cohort free of cardiovascular disease at baseline, individuals with average and optimal CVH scores had higher adiponectin and lower leptin and resistin levels compared to those with inadequate CVH scores.
Abstract P530: Building a Heart Disease Detection Web Application
Authors: Tome Joana , Cowan Logan
Published: March 2023

Introduction:
Heart disease continues to be a leading cause of death worldwide; hence early detection of the disease is recommended to reduce the fatality rate. Consequently, prediction models with high accuracy scores become important. Previous research has demonstrated encouraging results; however, concerning issues such as variations in databases and small-seized databases are still present.

Hypothesis:
We assessed the hypothesis that the web application which includes user input, a large database, and a machine learning model, will be able to predict the occurrence of heart disease with a high accuracy score.

Methods:
A web application composed of two modules, the admin and the user side, was built. The admin side consisted of a prediction model that was built based on a database and a classification algorithm. When creating the admin side, this project used data from the third visit of the multi-center population-based cohort study, the Atherosclerosis Risk in Communities (ARIC) study. There were a total of 11,351 participants on the third ARIC visit. Heart disease and other variables such as age, gender, race, education, smoking, drinking, physical activity, etc., were selected to build the prediction model of the web application. The database was split into independent ‘x’s and dependent ‘y’, and was furthermore randomly split into 75% (8,514 of 11,351) training and 25% (2,837 of 11,351) testing data. A model was created through the random forest classifier based on the trained and tested data. The user side consisted of provided fields or features that allow the user to insert his input into the web application. The user input is compared with the data used to build the web application’s prediction model. After the user inputs his information, the prediction model predicts the disease and gives the model test accuracy scores. The web application was built in Python with the help of the main packages and libraries such as streamlit, pandas, numpy, sklearn, and PIL.

Results:
The machine learning model achieved high accuracy in predicting heart disease.

Conclusions:
In conclusion, the current findings suggest that high disease prediction model test accuracy scores can be achieved when using random forest. Machine learning can be an effective tool in the early detection of heart disease and in making decisions for further prevention and treatment improvement.