bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P057: Clusters of Cardiovascular Risk Factors Predict Incidence of Type 2 Diabetes in Men and Women: A Swedish Population-based Study
Authors: Larsson Charlotte A , Daka Bledar , Hellgren Margareta I , Eriksson Maria C , Råstam Lennart , Lindblad Ulf
Published: July 2021

Introduction:
Clusters of metabolic variables and their effects on incidence of type 2 diabetes have been studied previously; however, little is known about the effects on diabetes from risk factor clusters including lifestyle and self-rated health.

Hypothesis:
We assessed the hypothesis that clusters of common cardiovascular risk factors, including lifestyle and self-rated health, can predict development of type 2 diabetes in men and women, respectively.

Methods:
In 2002-2005, 2816 men and women, 30-74 years, were randomly selected from two municipalities in southwestern Sweden and assessed with regard to cardiovascular/metabolic risk factors within the Skaraborg Project (76% participation). Participants performed an OGTT, had blood samples drawn, had anthropometric measurements and blood pressure taken, and answered validated questionnaires about e.g. leisure-time physical activity (with four answer alternatives from intensive to sedentary) and self-rated health (with five alternatives from excellent to very poor). Using the same protocol, 1332 participants from the baseline survey where re-examined in 2011-2014. After excluding those with diabetes at baseline, 1268 participants were included in this prospective population-based study.

Results:
Factor analysis (using varimax rotation) identified significant loadings (≥0.40) on the following three identical factors in men and women: the
metabolic factor
, comprising HOMA-ir, WHR, systolic blood pressure, and apolipoprotein B-to-A1 ratio; the
vitality factor
, comprising physical activity and self-rated health; and the
addiction factor
, comprising smoking and alcohol consumption. After a mean follow-up of 9.7±1.4 years, 76 cases of diabetes were identified; 46 in men and 30 in women. In a logistic regression analysis adjusted for all principal components, age, and educational level, the
metabolic factor
significantly predicted type 2 diabetes in both men (OR: 3.3, CI: 2.3-5.0) and women (OR: 3.5, CI: 2.2-5.6). Furthermore, a predictive effect of the
vitality factor
was also seen in women (OR: 1.8, CI: 1.2-2.9), but not in men (OR: 1.1, CI: 0.8-1.6), whereas the
addiction factor
had no effect in either men or women.

Conclusions:
This is to our knowledge the first time principle components of cardiovascular risk factors, including both metabolic and lifestyle variables, have been used to predict incidence of type 2 diabetes. The gender difference observed with regard to the combined impact of self-rated health and physical activity are novel and indicates a mechanism beside the metabolic syndrome that warrants further gender-specific exploration in future studies.
Abstract P060: Reduction of Cardiovascular Mortality in the United States Population, 1988-2004: A Larger Contribution of Declining Exposures to Cadmium and Lead Compared to Traditional Cardiovascular Risk Factors
Authors: Ruiz-Hernandez Adrian , Navas-Acien Ana , Pastor-Barriuso Roberto , Redon Josep , Guallar Eliseo , Tellez-Plaza Maria
Published: July 2021

Introduction:
Lead and cadmium exposures have markedly declined in the US following the banning of lead in gasoline and the implementation of tobacco control, air pollution reduction, and hazardous waste remediation policies since the mid 1970s. While lead and cadmium have been proposed as cardiovascular disease risk factors, little is known about their potential contribution to the decline in cardiovascular mortality in US adults.

Hypothesis:
We assessed the hypothesis that lead and cadmium exposure reductions partly explain the decreasing trend in cardiovascular mortality that occurred in the US from 1988-1994 to 1999-2004, after controlling for traditional cardiovascular risk factors including smoking, obesity, physical inactivity, hypertension, diabetes, chronic kidney disease, and dyslipidemia.

Methods:
Cohort study of 15,421 men and women ≥40 years old participating in the National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2004. We implemented a mediation approach with additive hazard models to estimate the reductions in cardiovascular disease (CVD) mortality rates over time explained through changes in urine cadmium and blood lead concentrations.

Results:
After adjusting for age, sex, race and smoking, urine cadmium and blood lead concentrations decreased by 20.4 and 38.2%, respectively, between 1988-1934 and 1999-2004. Age-adjusted CVD mortality rates in the US decreased from 712.0 to 356.8 /100.000 person-years comparing 1988-1994 to 1999-2004. Changes in traditional CVD risk factors explained 16% of this decline. The observed reductions in urine cadmium and blood lead levels explained an additional 27.6% of this decline.

Conclusions:
The net impact of declining cadmium and lead exposures on mortality changes in the US was larger compared to traditional risk factors. These findings support that reducing cadmium and lead exposures resulted in a major public health achievement. The general population, however, remains exposed to cadmium and lead at concentrations that have been associated to CVD in the US population. Preventive strategies to enable additional reductions in exposure to cadmium and lead are needed.
Abstract P069: Modifiable Risk Factors as Drivers of Pharmaceutical Expenditures Among US Adults with Atherosclerotic Heart Disease: 2012 Medical Expenditure Panel Survey
Authors: Salami Joseph A , Valero-Elizondo Javier , Ogunmoroti Oluseye , Spatz Erica S , Rana Jamal S , Virani Salim S , Blankstein Ron , Blaha Michael J , Younus Adnan , Arrieta Alejandro , Veledar Emir , Nasir Khuram
Published: July 2021

Background:
Atherosclerotic Cardiovascular disease (ASCVD) remains the leading cause of deaths and costs in the US. Despite advancements in therapies, no study has evaluated drivers of pharmaceutical expenditures among individuals with ASCVD. We aimed to assess the economic impact of modifiable risk factors (MRF) on overall pharmaceutical expenditures among ASCVD patients.

Methods:
We studied the 2012 Medical Expenditure Panel Survey (MEPS) data of adults aged ≥40 years with Body Mass Index ≥18.5Kg/m2 and ICD-9 diagnosis of ASCVD (410, 413, 414, 433, 434, 435, 436, 437, 440, 443, and 447). Using total pharmacy expenditure variable in MEPS as our primary outcome, marginal and actual expenditures associated with predictors were estimated using a two-part econometric model with probit and glm, family(gamma) link (log).

Results:
Based on the 2012 MEPS, an estimated 140.7 million people in US are aged ≥40 years. An estimated 15.4 million had ASCVD (69±15 years; 41% female). Overall, total pharmaceutical expenditure among those with ASCVD was $52.7 billion (95% CI: $44.2-62.0 billion), which accounted for 33.7% of total pharmaceutical expenditures. Individuals with ASCVD had $1,847 (95% CI: $1,655 - 2,038) incremental pharmaceutical expenditure vs. those without it (p<0.001). The two-part econometric model showed that all MRF independently impacted incremental expenditure. By aggregates of MRF, 50% had 2-3; 39% had 4-6; and the rest (11%) had one or none. The estimated pharmaceutical expenditures was lower with favorable MRF status irrespective of comorbid conditions. In adjusted analyses, as compared to those with ≥4 MRF, those with 2-3 had $1,881 (95% CI: $1,242 -2,521) and those with 0-1 MRF had $2,669 (95% CI: $2,317 - 3,020) lower pharmaceutical costs, respectively.

Conclusion:
Our study results suggest attainment of favorable modifiable risk status as delineated in AHA 2020 Impact goals can have a beneficial impact on pharmaceutical costs, which accounts for significant proportion of overall healthcare expenditure.
Abstract P076: Increased Incidence of Cardiovascular Disease Events Among Diabetes Patients with Complications
Authors: Quek Ruben G , Fox Kathleen M , Wang Li , Li Lu , Gandra Shravanthi R , Wong Nathan D
Published: July 2021

Objective:
To estimate the incidence of cardiovascular disease (CVD) events among T2DM patients across the number of diabetic or CHD RE complications.

Research Design and Methods:
Adult (aged ≥18 years) hyperlipidemic patients diagnosed with T2DM who initiated statins and/or ezetimibe from January 2007 to June 2011 were identified retrospectively from the IMS LifeLink Pharmetrics Plus™ commercial claims database. The index date was the initiation date of the statin and/or ezetimibe after ≥ 12 months of continuous health plan eligibility. Incident CVD events among those with a history of multiple (if any) diabetic and CHD RE complications were assessed for ≥ 12 months post-index date. A subset analysis was performed among patients aged ≥ 40 years. A Cox proportional hazard model was performed to assess the relationship between number of complications and incident CVD events.

Results:
A total of 136,854 hyperlipidemic patients had T2DM during the 12 months pre-index (baseline) period. The mean age was 56 years old (±10.5) and 55.8% of the population were male. Those with ≥ 1 complication(s) represented ~18% of the patients (17.9% with diabetic and 17.5% with CHD RE complications). Among patients with 0,1,2,3 and 4 diabetic complications, patients who had incident CVD events during follow-up ranged from 4.0%-15.7%. Among patients with 0,1,2,3 and 4 CHD RE complications, the number of patients with incident CVD events increased from 2.4% to 44.8% (Figure). Similar results were found among patients aged ≥40 years. After adjusting for age, gender, region, payer type and history of CVE, risk (hazard ratio) of incident CVD events increased as the number of diabetic or CHD RE complications increased compared to those without any complications.

Conclusions:
T2DM patients with diabetic or CHD RE complications, despite being on standard lipid-lowering therapy have substantial residual risk for future CVD events compared to those without complications.
Abstract P078: Re-evaluation of Prognostic Values of Clockwise and Counterclockwise Rotation for Total and Cardiovascular Mortality in a Different Cohort (20 Year Follow-up of NIPPON DATA90)
Authors: Nakamura Yasuyuki , Okamura Tomonori , Fujiyoshi Akira , Kadota Aya , Hisamatsu Takashi , Miura Katsuyuki , Okayama Akira , Ueshima Hirotsugu
Published: July 2021

Background:
We previously reported that electrocardiographic (ECG) clockwise rotation (CWR) was positively and counter-clockwise rotation (CCWR) was inversely associated with cardiovascular disease (CVD) mortality in Japanese using 24 Year Follow-up of NIPPON DATA80. Re-evaluation of the prognostic values of CWR and CCWR in a different cohort is needed.

Methods:
We studied prognostic values of CWR and CCWR on total and CVD mortality using the NIPPON DATA90 database with a 20-year follow-up. At the baseline in 1990, data were collected on study participants, ages 30 years and over, from randomly selected areas in Japan. We followed 8,262 participants without major ECG abnormalities, or history of stroke or myocardial infarction (41.8% men, mean age 53.0 y) for 20 years. Analysis was made in men and women combined.

Results:
Among participants, 49.9% were in the normal rotation group, 7.2% in CWR group, and 42.9% in CCWR group. During the 20 year follow-up, there were 1,997 total, and 605 CVD mortality. The multivariate-adjusted hazard ratio (HR) using the Cox model including age, sex, BMI, alcohol and smoking status, hypertension, diabetes and other ECG variables revealed that CWR was significantly positively associated with total mortality (HR=1.19, 95% confidence intervals [CI]: 1.02-1.39, P=0.032), but not with CVD mortality (HR=0.99 [0.68-1.33], P=0.95). CCWR was significantly inversely associated with CVD (HR=0.81 [0.68-0.96], P=0.016), and total mortality (HR=0.91 [0.83-0.997], P=0.043).

Conclusions:
We have reconfirmed a significant positive association of CWR in total mortality, and a significant inverse association of CCWR with CVD and total mortality in men and women combined, independent of confounding factors including other ECG changes.
Abstract P095: Prospective Association of Physical Activity and Heart Failure Hospitalizations Among African-American Adults with Normal Ejection Fraction: The Jackson Heart Study
Authors: Koo Patrick , Gjelsvik Annie , Choudhary Gaurav , Wu Wen-Chih , Wang Wei , McCool F. Dennis , Eaton Charles B
Published: July 2021

Introduction:
Diastolic dysfunction (DD) with normal ejection fraction is prevalent in the African-American population due to a higher prevalence of associated risk factors. The potential benefit of moderate to vigorous physical activity (MVPA) to prevent heart failure admissions in African-American adults with normal ejection fraction is under-researched. The purpose of this study is to investigate the associations of DD and MVPA with heart failure hospitalizations (HFH).

Hypothesis:
We hypothesized that MVPA reduces the risk of HFH among African-American adults with normal ejection fraction.

Methods:
We performed a prospective analysis of 2,427 African-American adults who participated in the Jackson Heart Study and who had 2D echo and physical activity data and normal ejection fraction. MVPA per week is defined as the following: poor health [[Unable to Display Character: –]] 0 minutes; intermediate health [[Unable to Display Character: –]] 1-149 minutes; and ideal health [[Unable to Display Character: –]] ≥ 150 minutes. DD is defined as using ratio of the early to late ventricular filling velocities, ratio of pulmonary venous systolic to diastolic velocities, and pulmonary venous atrial reversal velocity. We employed multiple variable logistic and cox proportional regression analyses adjusted for age, gender, BMI, smoking, hypertension, DM, COPD, CKD, and CHD to determine the associations of DD and MVPA with HFH.

Results:
Of the eligible population, 1,209 (50%) have DD. There were 171 HFH. DD is associated with HFH in the crude analysis (OR=2.24, 95% CI 1.40-3.57). The association was markedly attenuated after adjusting for age (OR=1.03, CI 0.63-1.71). Intermediate and ideal health MVPA in the crude analysis were associated with lower risk of HFH (HR=0.50, 95% CI 0.35-0.71 and HR=0.18, 95% CI 0.09-0.36, respectively), and full models revealed HR=0.71, 95% CI 0.49-1.04 and HR=0.31, 95% CI 0.16-0.63, respectively. There was no interaction between physical activity level and DD on HFH.

Conclusion:
In conclusion, ideal health MVPA is associated with reduced risk of HFH, whereas, intermediate health MVPA revealed a trend in risk reduction in African-American with normal ejection fraction.
Abstract P100: Identification of Patients with Familial Hypercholesterolemia (FH) Using the Dutch Lipid Network (DLN) Criteria in Electronic Health Records (EHR)
Authors: Cohen Sarah S , Shirey-Rice Jana , Hardin Jill , Monda Keri , Fryzek Jon P , Fazio Sergio , Denny Joshua C , Wei Wei-Qi , Lipworth Loren
Published: July 2021

Introduction:
Heterozygous FH is common but under-diagnosed. No uniformly accepted diagnostic criteria for FH exist, and the ability of current algorithms to identify patients using EHR data remains largely untested. Here we present results and challenges in using the DLN criteria to identify FH patients in an EHR.

Methods:
In the Vanderbilt University Medical Center de-identified EHR, patients
>
18 years with 1+ low-density lipoprotein cholesterol (LDL-C) measure from 1996 to 2014 were eligible for study. Using diagnostic and procedure codes, narrative text from clinical care, and laboratory data, patients were assigned points for DLN components (see Table), which were summed to classify definite (DLN≥8) or probable (DLN=6-7) FH. LDL-C values were extracted directly from structured laboratory records. Evidence of physical signs or testing for LDL-C receptor mutations were assessed via keyword searches with simple negation detection rules, the latter including vendor names known to conduct such mutation analyses.

Results:
Among 218,652 eligible patients, 10,812 (5%) had 1+ LDL-C
>
190 mg/dl. We identified 622 probable and 430 definite FH patients (overall prevalence 0.48%). Family history was not ascertainable in a systematic way for most patients and thus not used in scoring. Physical exam signs minimally impacted DLN scores as they were noted infrequently. No definite or probable FH patient records included mention of LDL-C receptor mutation status. Only 5 definite and 3 probable FH patients had narrative keywords noting the presence or suspicion of FH.

Conclusions:
EHRs may be useful to identify FH patients but existing algorithms lack sensitivity when applied to EHRs as they rely on key elements rarely captured. Further, the sizable population with LDL-C
>
190 suggests that FH in this group may not be adequately captured by the DLN criteria. Work is needed to determine how best to utilize EHRs to reliably ascertain FH, via development of new algorithms or by clarifying the positive predictive value of existing algorithms.
Abstract P113: Female Gender is Associated with a Low Ankle Brachial Index in the General Population
Authors: Kapoor Ridhima , Ayers Colby , Kulinski Jacquelyn
Published: July 2021

Background:
The ankle-brachial index (ABI) is a predictor of cardiovascular events, mortality and functional status. Gender differences in ABI have been reported in some population studies. Differences in height might account for these observed gender differences, but findings are conflicting.

Objective:
This study investigated the association between gender, height and ABI in the general population, independent of traditional cardiovascular disease (CVD) risk factors.

Methods:
Participants ≥ 40 years from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 with ABI data, were included. A low ABI was defined as a value < 1.0 (including borderline values). Sample-weighted multivariable logistic regression modeling was performed with low ABI as the dependent variable and height and gender as primary predictor variables of interest. A backward elimination model selection technique was performed to identify significant covariates.

Results:
There were 3,052 participants with ABI data (mean age 57, 51% female (1570 of 3052). The sample-weighted mean (±SE) ABI was 1.09 (±0.006) and 1.13 (±0.005) for females and males, respectively. Women were more likely to have a low ABI compared to men, 42% (659 of 1570) versus 28% (415 of 1482), respectively (p<0.0001). Female gender was associated with a low ABI (OR 1.34, [95% CI, 1.04-1.72]; p=0.025), independent of traditional CVD risk factors (see Figure). Age, diabetes, tobacco use, known CVD, BMI and black race were also associated with a low ABI (all p<0.003). Self-reported hypertension and non-HDL cholesterol levels, however, were not associated with a low ABI. An interaction between height and body mass index (BMI) was identified.

Conclusions:
Female gender is associated with a low ABI in the general population. This association appears to be independent of height and other traditional CVD risk factors and warrants further investigation.
Abstract P130: Patterns of Change in Step Count During the First 12 Months of a Weight Loss Intervention: A Group-based Trajectory Analysis
Authors: Imes Christopher C , Zheng Yaguang , Lu Hu , Mendez Dara D , Goode Rachel W , Mattos Meghan , Ma Qianheng , Sun Ran , Yu Yang , Danford Cynthia A , Sereika Susan M , Burke Lora E
Published: July 2021

Introduction:
Increased physical activity (PA) along with reduced energy intake are the key components of weight loss treatment. Objective measures of PA are more reliable than self-report and are infrequently used in clinical trials. Pedometers are inexpensive, often imbedded in mobile devices (e.g. smartphones), and provide a good estimate of overall daily PA.

Hypotheses:
We hypothesized that groups with different patterns of daily step counts would emerge over the 12-month period.

Methods:
We examined the first 12 months of data from the Self Efficacy Lifestyle Focus Trial during which standard behavioral treatment for weight loss was implemented. Participants were given an Omron HJ-720IT pedometer in the third week of the intervention. Pedometer use was recommended as a way to monitor PA goals, but not required. Mean daily step counts were calculated monthly from pedometer data, with days having zero step counts coded as missing. Group-based trajectory modeling was used to identify distinct classes of trajectories of mean daily step counts.

Results:
The sample (N=120) was 81.8% female, 73.6% White with mean (±SD) age of 53.9±9.0 years and baseline body mass index of 33.2±3.8 kg/m2. Four trajectory groups were identified: active (≥10000 steps/day; n=14, 11.7%), somewhat active (7500 to 9999 steps/day; n=34, 28.3%), low active (5000 to 7499 steps/day; n=33, 27.5%), and sedentary (<5000 steps/day; n=39, 32.5%). Over 12 months, the active group increased their daily step counts, while the low active and sedentary groups decreased their step counts.

Conclusions:
Based on our findings, it appeared that study participation, including pedometer use, had little effect on step counts, except in the group that was already active. This suggests that less active individuals may have difficulty initiating activities that increase steps even when using a pedometer. Increased emphasis on simple strategies to increase step count and PA are needed to change sedentary habits.
Abstract P134: One Year Follow-up of the mActive Randomized Clinical mHealth Trial of Physical Activity
Authors: Urrea Bruno , Feldman David I , Coughlin Janelle W , Blumenthal Roger S , Blaha Michael J , Martin Seth S
Published: July 2021

Background:
Novel mobile health (mHealth) technologies have transformed behavioral change research. Leveraging digital activity tracking technology, the mActive randomized clinical mHealth trial of cardiology patients showed that automated text message coaching increased short-term physical activity by 25%. In this one-year follow-up study, we aimed to understand the post-trial behavior of participants and examine their long-term perspectives.

Methods:
After trial completion, participants retained their digital activity tracking device (Fitbug) and their ongoing behavior was no longer directed by the research team. At one year, 34 of 48 participants answered a Google survey with questions about ongoing activity tracking usage and preferences regarding activity tracking devices and text messages. A proportion for each response was calculated. During focus groups (n=18), open questions were asked to promote discussion with themes assessed in a qualitative analysis.

Results:
On the survey (Table), 50% (17 of 34) reported still having the mActive pedometer and 27% continued activity tracking after the trial. Among those no longer tracking activity, 71% reported wanting to resume doing so; there was not a strong preference towards any particular activity tracking device. Preferences regarding text feedback were varied with most preferring 1-2 messages per day with a mix of positive and negative messages. During focus groups, participants emphasized a desire for feedback through personalized real-time text messages, and also expressed interest in having activity data synchronize with their electronic medical record to review it with their physician.

Conclusions:
After the trial, 1/3 of mActive participants continued to track activity. Integration of activity data with the electronic medical record and long-term delivery of real-time feedback could increase the desirability of long-term activity tracking. Future studies may address whether these capabilities aid in long-term engagement and behavioral change.
Abstract P139: Association of Energy Flux with Change in Cardiovascular Risk Factors in Weight Stable Individuals
Authors: Conway Baqiyyah , Giacobbi Peter , Drenowatz Clemens , Blair Stephen , Hand Gregory
Published: July 2021

Background:
It is generally accepted that body weight is maintained when there is energy balance between intake and expenditure. Energy balance can be achieved at different rates of expenditure through exercise and caloric intake which has been referred to as energy flux: high flux reflects high expenditure and high intake while low flux describes low energy expenditure and intake. Overweight, obesity, and diabetes are major risk factors for cardiovascular disease and CVD risk factors tend to increase with hyperglycemia and BMI. Exercise is a viable way to achieve weight maintenance, however, there is limited data about the role of energy flux on CVD risk factors when individuals maintain their body weight. We investigated the effect of energy flux and change in energy flux on CVD risk factors in when body weight is maintained.

Methods:
One hundred and thirteen overweight or obese class I adults ages 21 to 45 were randomized to a control group, moderate exercise (17.5 kcal/kg/week) or high exercise group (35 kcal/kg/week). The exercise groups performed supervised exercise at and intensity of 70-75% of their heart rate maximum. Impaired fasting glucose was defined as a fasting glucose of 100-125 mg/dL. General linear models were used to test the relationship of exercise intensity and impaired fasting glucose on change in energy flux from baseline to six months, as well as the relationship of 6-month change in energy flux with change in CVD risk factors, namely, HDLc, LDLc, vLDLc, total cholesterol, triglycerides, Apolipoprotein B (ApoB), and C-reactive protein.

Results:
Seventy-two percent of the population was overweight and 22% were obese. Mean change in energy flux from baseline to month six was 128.8 kcal/day. In multivariable analyses including age, sex, BMI, impaired fasting glucose, and energy expenditure group assignment, neither exercise group assignment nor baseline obesity status had any effect on change in energy flux, lipids, or inflammatory markers. Impaired fasting glucose was associated with a significantly greater increase in energy flux from baseline to six months (p=0.03). There was a stepwise change in C-reactive protein from baseline to six months, with a decrease (-2.46 mg/dL) in controls, a moderate increase (+0.32 mg/dL) in the moderate intensity exercise group and a larger increase (+0.82 mg/dL) in the very intensive exercise group, p= 0.03 for moderate intensity and p=0.02 for very intensive exercise groups compared to controls. Finally, increases in energy flux from baseline to six months were associated with increased ApoB (p=0.04), though there were no significant changes in energy flux by group assignment.

Conclusion:
Intensification of exercise and increases in energy flux while maintaining stable weight is associated with increases in certain cardiovascular risk factors, namely C-reactive protein and ApoB.
Abstract P142: Daily Chocolate Consumption is Inversely Associated with Insulin Resistance and Liver Enzymes in Adults: The Observation of Cardiovascular Risk Factors Study
Authors: Alkerwi Ala’a , Sauvageot Nicolas , Crichton Georgina E. , Elias Merrill F. , Stranges Saverio , Stranges Saverio
Published: July 2021

Introduction:
Research into the health effects of cocoa has received much attention over the past few years. Several systematic reviews and meta-analyses of existing studies have generally agreed on a potentially beneficial association between chocolate consumption and risk for cardiometabolic disorders. However, evidence regarding a potential role of chocolate consumption in insulin resistance and hepatic biomarkers, from human epidemiological studies, is lacking.

Hypothesis:
We assessed the hypothesis that daily chocolate consumption would be inversely associated with insulin resistance and hepatic biomarkers in appraently healthy adults.

Methods:
A random sample of 1153 individuals, aged 18-69 years, was recruited between 2007 and 2009 to participate in the Observation of Cardiovascular Risk Factors (ORISCAV-LUX) study. Chocolate consumption in g/day was obtained from a semi-quantitative food-frequency questionnaire. Blood glucose and insulin were used for the homeostasis model assessment of insulin resistance (HOMA-IR). Hepatic biomarkers, namely serum γ-glutamyl-transpeptidase (γ-GT), serum Aspartate Transaminase (AST) and serum Alanine Transaminase (ALT) in mg/l were assessed using standard laboratory assays.

Results:
Chocolate consumers (81.8 %) were more likely to be younger, physically active, affluent people with higher education levels and have fewer chronic comorbidities. After exclusion of subjects taking antidiabetic medications, higher chocolate consumption was associated with lower HOMA-IR (β= -0.16, P=0.004), serum insulin levels (β= -0.16, P=0.003), and liver enzymes, including γGT (β= -0.12, P=0.009) and ALT (β= -0.09, P=0.004) after adjustment for age, sex, education, lifestyle (smoking status and physical activity) and dietary confounding factors, including daily energy intake, consumption of fruit and vegetables, alcohol, as well as polyphenol-rich coffee, and tea.

Conclusion:
This is the first population-based study reporting an independent inverse relationship between daily chocolate consumption and levels of insulin, HOMA-IR and liver enzymes in adults.. Small dietary changes with respect to chocolate consumption may improve liver enzymes and protect against insulin resistance, a well-established risk factor for cardiometabolic disorders.
Abstract P160: Cross-sectional and Longitudinal Associations of Objective Sedentary Time, Physical Activity, and Obesity: The CARDIA Study
Authors: Barone Gibbs Bethany , Carnethon Mercedes , Gary-Webb Tiffany , Jakicic John , Pettee Gabriel Kelley , Rana Jamal , Reis Jared , Sternfeld Barbara , Lewis Cora
Published: July 2021

Higher sedentary time (ST) and lower moderate-to-vigorous intensity physical activity (MVPA) have been independently associated with obesity, but most available studies are cross-sectional and measure ST and MVPA by self-report. It has also been suggested that obesity may predict future ST rather than ST leading to future obesity.

Objective:
To investigate whether objective ST and MVPA were associated with current and 5-year changes in body mass index (BMI) and waist circumference (WC).

Methods:
We analyzed 1,963 CARDIA participants (aged 38-50 years, 57% female, 41% black) with accelerometry data (≥4 days with ≥10 hr/day) in 2005-2006. BMI and WC were assessed concurrently and 5 years later. Linear regression evaluated cross-sectional and longitudinal associations between ST and MVPA with BMI and WC across all participants and in race/gender groups due to the presence of interactions. Standardized coefficients (β
std
) reflect differences per each 1.7 hr/day increase in ST and each time MVPA increases by a factor of 2.

Results:
Average ST was 8.1 ± 1.7 hr/day and 21% met MVPA guidelines of 150 min/wk. During the 5 year follow-up, BMI and WC increased in all groups (Table, all p<0.01). Cross-sectionally, in the combined cohort, higher ST and lower MVPA were each independently related to higher BMI and WC (Table). After stratification, lower MVPA was associated with higher BMI in white women and higher WC in white women and men. Higher ST was directly related to BMI in black men and WC in white and black men. Baseline ST and MVPA did not predict 5-year changes in BMI or WC in the full cohort; higher MVPA predicted a smaller BMI increase only in white men (Table).

Conclusions:
ST and MVPA were each associated with general and abdominal obesity cross-sectionally, but mostly did not predict 5-year changes in these outcomes. These findings do not support that lower ST and higher MVPA will curtail unfavorable gains in general and abdominal obesity over 5 years, but could result from a relationship where greater obesity leads to higher ST and inactivity.
Abstract P168: Evaluation of the American Heart Association’s “Check Change ControlTM”- Blood Pressure Control Program
Authors: Patel Rohini J , Desai Chirag , Lee Cevadne , Oh Sang-Mi , Wong Nathan D
Published: July 2021

Background:
Blood pressure (BP) awareness, treatment and control remains suboptimal among US adults with hypertension. In response, the AHA has developed the “Check. Change. Control. TM” (CCC) BP program to reduce BP in those with elevated BP. We evaluated the efficacy of this program as implemented in a sample of Asian and Hispanic senior citizens in Southern California.

Methods:
We studied 122 participants aged >62 years (93% Chinese and 7% Hispanic) who participated in the CCC program in Los Angeles and Orange Counties, California. Systolic (SBP) and diastolic blood pressure (DBP) was recorded over the CCC program resulting in 8 readings over 4 months during which participants learned self-monitoring, tracking BP, the use of the Heart360 TM digital tool, and self-management skills. Participants in this analysis were required to have baseline, final, and at least two interim BP measures. BP changes from baseline to mid-study and final visit were examined by the paired t-test among the whole cohort and in those with elevated BP (>=140 SBP and/or >=90 DBP) at baseline.

Results:
Average baseline SBP was 136.8 (19.4) mm Hg and DBP was 76.0 (12.0) mm Hg. At baseline, 46.7% of the participants had elevated BP, which was reduced to 41% by the final visit. The figure depicts the change in SBP and DBP from baseline to mid visit and final visit for the overall cohort and those with elevated BP at baseline. There were significant reductions in both SBP and DBP overall and especially among those with elevated BP at baseline. Further, 36.1% of participants had a SBP drop of >10 mm Hg from baseline to final visit.

Conclusion:
In conclusion, the AHA’s CCC program had a significant impact in reducing BP in our AHA CCC participants, especially among those with elevated BP at baseline. Further study should investigate the specific program and patient factors that best predict blood pressure reduction.
Abstract P177: Projected Change in Outpatient Management of Blood Pressure in the United States with the Implementation Of JNC-8 as Compared to JNC-7 Criteria
Authors: Agarwal Sunil K , Sherifi Ines , Tripathi Nidhi , Halperin Jonathan
Published: July 2021

Background:
The 2014 Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) hypertension management guidelines support less restrictive blood pressure (BP) criteria among patients with age ≥ 60, diabetes or chronic kidney disease than the 2007 recommendations (JNC-7). We compared the proportion of patients for whom treatment escalation is recommended according to the JNC-8 guidelines vs. JNC-7.

Methods and Results:
We analyzed the National Ambulatory Medical Care Survey 2008-2010 dataset of about 76,000 US adult (>18 years old) outpatient visits representing 820 million annual outpatient visits. A clinical history of hypertension was present in 33.3%, and BP was recorded at 67.1% of all visits. Of these, 41.7% clinic visits involved patients ≥60 years old, and 15.5% included those with diabetes or non-diabetic renal disease. We restricted further analysis to those with measured blood pressure.

Among patients without a prior diagnosis of hypertension, BP management should be initiated for 6% fewer patients (13.4% vs. 19.4%, p<0.001) for the JNC-8 guidelines than JNC-7 criteria, respectively. In those with a prior diagnosis of hypertension, BP treatment escalation was needed in 17.7% fewer patients (28.8% vs. 46.5%, p<0.001) for the JNC-8 than JNC-7 criteria. The difference of overall patients needing either treatment initiation or escalation was obviously more apparent among those ≥ age 60 years with 23.4% lesser patients (21.8 vs. 45.2%, p<0.001) as well as those with renal disease or diabetes with 31.3% lesser patients (27.1 vs. 58.4% p<0.001).

Conclusions:
In this U.S. representative sample of outpatient visits, implementation of the JNC-8 hypertension guidelines decreases the need for initiation or intensification of anti-hypertensive treatment in about one out of six outpatients visits than JNC-7 guidelines. Thus, such shifts may influence treatment decisions for more than 100 million outpatient encounters annually. The actual implementation and associated change in patient outcomes need to be studied.
Abstract P194: Association of First Birth with Long-term Trajectories of Cardiovascular Health: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Uttal Sarah , Lloyd-Jones Donald , Ning Hongyan , Allen Norrina , Lewis Cora , Gunderson Erica , VanWagner Lisa
Published: July 2021

Background:
Pregnancy is the first major physiologic stress women will experience that may exacerbate cardiovascular risk factors. Little is known about how pregnancy impacts cardiovascular health (CVH), as defined by the AHA. We examined the effects of a first birth on trajectories of CVH in a community-based sample of biracial women.

Methods:
CARDIA is a longitudinal study of 5,115 black and white adults aged 18-30 years at enrollment (1985-86). CVH was defined as poor, intermediate and ideal levels of 6 of 7 available AHA factors (BMI, physical activity, smoking, blood pressure, glucose, and cholesterol) assigned scores of 0, 1, and 2, respectively. A modified CVH score (CVHS) was calculated as the sum of scores from individual health factors (range 0-14; higher score=greater CVH). We employed latent-class modeling to identify distinct trajectories in CVHS over 25 years of follow up after first birth.

Results:
Among 1,775 baseline nulliparas (59.1% white), 888 first live births occurred. In women with ≥1 birth (Figure 1a) and with no births (Figure 1b) there were 6 distinct CVHS trajectories and most tracked over time. Trajectory patterns were similar between women with and without a birth, and select groups experienced a rapid decline in CVHS (Figure 1a: groups 1,2,5; 1b: groups 1,2,3). There is no statistically significant difference in likelihood of group membership based on number of births or exam year of first birth (1a).

Conclusion:
Contrary to expectation, CVHS trajectories through adulthood do not differ markedly between women with and without live births. Future analyses among subgroups at risk for longer adverse effects are being evaluated.
Abstract P204: Depressive Symptomatology, Anti-depressant Use and Hypertension in Young Adulthood
Authors: Suglia Shakira F , Crookes Danielle M , Keyes Katherine M , Koenen Karestan C
Published: July 2021

Objective:
While depression symptoms have been associated with cardiovascular disease in adulthood, little is known of the effects of adolescent-onset depression and hypertension in young adulthood. Furthermore, few studies have examined whether use of anti-depressants is associated with hypertension among young adults.

Research Design and Methods:
We examined the relation between depression symptoms and hypertension in young adulthood in the National Longitudinal Study of Adolescent Health (N=13,722). Adolescents completed the Center for Epidemiologic Studies Depression (CESD)-20 during wave 1 (1994-1995, mean age 16) and the CESD-10 during follow-up wave 4 (2007-2008, mean age 29). Depression symptoms were characterized as a score of 16 or above for the CESD-20 and 11 or above for CESD-10. During follow-up participants were asked to provide to the interviewer all medications they were currently taking or had taken in the previous six months. Antidepressant and antihypertensive medications were identified from all medications provided. Blood pressure was measured during an in-home visit. Hypertension was defined as measured SBP of at least 140mmHg or DBP of at least 90mmHG measured in adulthood, or use of antihypertensive medications.

Results:
The prevalence of hypertension was 20%. In models adjusting for sociodemographic factors, high depression symptoms in either adolescence or young adulthood were not significantly associated with hypertension in young adulthood. Use of anti-depressants in young adulthood was associated with hypertension (OR 2.89, 95%CI 1.82, 4.56) this association remained even after adjusting for obesity. No interactions by gender were noted.

Conclusions:
In this nationally representative sample, antidepressant use was associated hypertension in young adulthood. In accordance with a recent AHA Scientific Statement, our findings suggest that young adults with depression should be monitored closely to prevent the development of risk factors, such as hypertension, which may accelerate the development of cardiovascular disease.
Abstract P211: Impact of Healthy Lifestyle Behaviors and Education Level on Cardiovascular Mortality: The Japan Collaborative Cohort Study
Authors: Eguchi Eri , Iso Hiroyasu , Honjo Kaori , Tamakoshi Akiko
Published: July 2021

Introduction:
Magnitude of impact of healthy lifestyle behaviors and education level on cardiovascular mortality is uncertain.

Hypothesis:
Impact of education on cardiovascular mortality is explained mostly by lifestyle behaviors

Methods:
The survey cohort was a total of 42,647 subjects (18,442 men and 24,205 women) aged 40-79 years with satisfactory information from 1988 to 1990, and followed up until the end of 2009. Education levels were sub-grouped into higher education (last school age of ≥16 years old) and lower education (<16). We defined the healthy lifestyle score (fruits ≥1/day, fish ≥1/day, milk almost every day, exercise ≥5h/week and/or walking ≥0.5h/day, BMI 21-25kg/m2, ethanol intake <46.0g/day, non-smoker, and sleep 5.5-7.5h/day, ranging 0 to 8), and calculated multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) to determine the magnitude of impacts of healthy lifestyle behaviors and education level on cardiovascular mortality with persons who have lower education and 0-3 lifestyle score category as reference. Population attributable fraction (PAF) of lifestyle behaviors on cardiovascular mortality stratified by education level were also calculated.

Results:
During the 19.3 median years of follow-up, there were 8,314 total deaths and 2,377 CVD deaths. Compared with persons with lower education and 0-3 healthy lifestyle score category, those with lower education and 7-8 healthy lifestyles score category and those with higher education and 7-8 healthy lifestyle score category showed lower risk of mortality from total CVD. The respective multivariable-adjusted HRs (95% CI) were 0.37 (0.28-0.48) for those with lower education and 7-8 lifestyle score category, and 0.37 (0.30-0.46) for those with higher education and 7-8 lifestyle score category in total men and women, 0.25 (0.14-0.44) and 0.43 (0.31-0.59), respectively, for men, and 0.43 (0.31-0.60) and 0.36 (0.27-0.49), respectively, for women. PAF of CVD mortality for those who were not in the category of 7-8 lifestyle behavior were 40.1% in higher education group and 68.5% in lower education.

Conclusions:
More than 50% of risk reduction of cardiovascular mortality for those who have 7-8 healthy lifestyle score category compared to those who have 0-3 healthy lifestyles were found irrespective of education level which suggests large part of impact of education on cardiovascular mortality is explained by lifestyle behaviors.
Abstract P222: Significant Inverse Association of Blood Levels of Marine Omega-3 Fatty Acids with Coronary Artery Calcification in Men in Japan
Authors: Sekikawa Akira , Bertolet Marnie , Vishnu Abhishek , Ahuja Vasudha , Evans Rhobert W , Kuller Lewis H , Fujiyoshi Akira , Hisamatsu Takashi , Kadowaki Takashi , Kadota Aya , Kadowaki Sayaka , Arima Hisatomi , Miura Katsuyuki , Ueshima Hirotsugu
Published: July 2021

Background:
Coronary artery calcification (CAC) is an established biomarker of coronary atherosclerosis and predicts future cardiovascular (CV) events. Basic science shows that marine omega-3 fatty acids (OM3) have anti-atherogenic properties yet previous studies in Western countries reported that dietary intake of OM3 had no significant association with CAC. Dietary intake of OM3 in Japan is >10x higher than in the US. We hypothesize that blood levels of OM3 in Japanese have a significant inverse association with CAC.

Methods:
A population-based sample of 982 men in Kusatsu, Shiga, Japan without CV disease was examined for blood levels of OM3, CV risk factors, and CAC. CAC was assessed by electron-beam tomography and quantified using the Agatston method. OM3 was measured by gas-liquid chromatography. We analyzed the association of OM3 with CAC scores at 67th and 80th percentiles adjusting for CV risk factors using quantile regression as the distribution of CAC scores is highly skewed.

Results:
Mean (SD) age of the participants was 58.7 (10.9). Rates (%) of hypertension, diabetes, current smoker were 47.3, 16.3, and 38.4, respectively. Mean (SD) LDL-C and OM3 was 127.8 (33.6) mg/dL and 10.2 (3.2) %, respectively. CAC scores were 0, 2, 19, 83, and 476 at 33th, 50th, 67th, 80th, and 95th percentiles, respectively. Blood levels of OM3 had significant inverse associations with CAC both at 67th and 80th percentiles after adjusting for CV risk factors (Table).

Conclusions:
This cross sectional study of Japanese whose blood levels of OM3 are 2-fold higher compared to the US shows that OM3 had a significant inverse association with atherosclerosis, suggesting that high blood levels of OM3 may have anti-atherogenic properties.
Abstract P227: Cardiovascular Disease (CVD) Risk Factors Have Opposite Associations with Abdominal Aortic Calcium (AAC) Density and Volume: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Forbang Nketi I , Ix Joachim H , Remigo-Baker Rosemay A , Allison Matthew A , McClelland Robyn L , Sandfort Veit , Criqui Michael H
Published: July 2021

Background:
AAC predicts future CVD events independently of CVD risk factors. The standard AAC score, the Agatston method, up-weights for greater calcium density, thus models higher calcium density as associated with increased CVD risk. We evaluated this model by investigating associations of CVD risk factors with AAC density and volume separately.

Methods:
Multivariable linear regression was used to investigate the independent cross-sectional associations of CVD risk factors, markers of inflammation, and potential promoters of calcification with AAC density and
ln
(AAC volume). AAC density was calculated as:

Density = Agatston / (volume, mm
3
/ CT scan slice thickness, mm). Agatston = area, mm
2
X density.

Results:
In 1413 MESA participants with prevalent AAC, mean age was 65 ± 9 years, mean AAC density was 3.0 ± 0.6, 52% were men, 44% were European-, 24% were Hispanic-, 18% were African-, and 14% were Chinese Americans (EA, HA, AA, and CA respectively). In fully adjusted models, older age was non-significantly associated with lower AAC density, but significantly associated with higher
ln
(AAC volume) (Figure). Compared to EA, we observed AAC density was significantly higher in CA, non-significantly higher HA and AA, but
ln
(AAC volume) was significantly lower in CA, HA, and AA. Also, smoking, alcohol use, family history of myocardial infarction, higher systolic blood pressure, elevated total cholesterol, and interluken-6 were significantly associated with higher
ln
(AAC volume), but not AAC density. Lastly, lower body mass index, higher serum HDL and calcium were significantly associated with higher AAC density, but associations with
ln
(AAC volume) were in the opposite direction.

Conclusion:
A greater burden of CVD risk factors was associated with higher AAC volume, but not AAC density. Thus, the Agatston method of up-weighting AAC scores for greater density in CVD risk prediction may be inappropriate. Investigators should evaluate separately associations of AAC density and volume with CVD events.