bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P300: Cross-ethnic Differences in Ectopic Fat Depots Variably Predict Coronary Artery Calcium
Authors: Garg Sachin K , Lin Feng , Kandula Namratha R , Ding Jingzhong , Carr Jeffrey , Allison Matthew , Liu Kiang , Herrington David , Vaidya Dhananjay , Vittinghoff Eric , Kanaya Alka M
Published: March 2022

Background:
Established risk factors do not fully explain racial/ethnic variations in coronary artery calcium (CAC), a measure of atherosclerotic burden that is independently associated with incident cardiovascular events. Obesity is a known CAC risk factor but common measurements like body mass index (BMI) incompletely capture known racial/ethnic differences in body composition or the complexity of ectopic fat depots.

Hypothesis:
We assessed whether differences in ectopic fat could further explain cross-ethnic variations in CAC after adjustment for BMI and other known risk factors.

Methods:
We examined the associations of four ectopic fat depots measured with computed tomography - visceral abdominal, intermuscular abdominal, intrahepatic, and pericardial - with CAC among participants ages 44-84 years without known cardiovascular disease at baseline and among five race/ethnicities: 803 South Asians, 2622 Whites, 1893 African Americans, 1496 Latinos, and 803 Chinese Americans. We harmonized data from the Multi-Ethnic Study of Atherosclerosis (MESA) with the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, which was modeled on MESA to allow for cross-ethnic comparisons. Pooled and race/ethnicity-specific multivariable models for log-transformed CAC [ln(CAC+1)] were adjusted for age, sex, BMI, family history of heart disease, exercise, alcohol use, smoking, hypertension, cholesterol medication use, low-density lipoprotein, and diabetes.

Results:
After BMI-adjustment, South Asians had the highest intrahepatic fat of any race/ethnic group, while both African Americans and South Asians had the least pericardial fat. Greater amounts of ectopic fat were associated with higher CAC in each race/ethnicity for pericardial fat volume (p-for-trends in all groups<0.001), visceral abdominal (p-for-trends<0.05), and intermuscular abdominal (p-for-trends<0.05). However, only pericardial fat volume remained independently correlated (p<0.001) with CAC after multivariable adjustment. In race/ethnicity-specific models, pericardial fat significantly predicted CAC in Whites (β 0.21; p<0.001), South Asians (β 0.26; p<0.01), and African Americans (β 0.15; p<0.05), but not in Chinese Americans or Latinos. In the pooled multivariable model (N=7363), geometric CAC means were: 30 (men) and 7 (women) in Whites, 20 and 5 in South Asians, 14 and 4 in Latinos, 11 and 5 in Chinese Americans, and 10 and 4 in African Americans. Adding pericardial fat to this multivariable model minimally changed mean CAC scores.

Conclusions:
We found significant racial/ethnic variation in ectopic adiposity, particularly for pericardial fat, independent of BMI. However, this variation did not measurably explain cross-ethnic differences in CAC scores. A further assessment of how ectopic fat depots may variably promote cardiovascular disease is needed.
Abstract P303: Early Changes in Vascular Structure and Function after Bariatric Surgery in an Appalachian Population
Authors: Grogg Kristin A , DeVallance Evan , Lemaster Kent , Hull Robert , Tabone Lawrence , Chantler Paul , Frisbee Stephanie
Published: March 2022

Obesity is associated with an elevated risk of cardiovascular disease, metabolic disease, and cardiac mortality. Reactive oxygen species and inflammation in an obese individuals are among a number of suspected driving forces behind obesity’s detrimental health effects. These factors can elevate cardiovascular risk by causing impairments in cardiovascular structure and function. It is hypothesized that gastric bypass surgery will lead to near immediate reversal of metabolic deviations and rapid weight reduction, in addition to remodeling and improvements in arterial function as weight is lost.

Patients that meet protocol inclusion criteria are invited to join the study during their 1 week pre-operative clinical appointment. At this time patients are consented and instructed to lie supine for 10 minutes of quite relaxation. Patients then begin a sequence of non-invasive examinations starting with a 12-lead electrocardiogram, followed by an echocardiogram, carotid artery ultrasound, radial applanation tonometry, and endothelial function analysis using EndoPAT technology. Upon completion of the non-invasive procedures a blood sample is taken for analysis.

Preliminary results on 12 study subjects suggests the following. As hypothesized, body weight had decreased (pre: 131.8 ±5.6 to post: 125 ±5.2 kg) along with BMI (pre: 45.2 ±2.3 to post: 42.9 ± 2.2) and waist circumference (pre: 122.1 ±5.0 to post: 111.9 ± 3.2 cm) at the 1-week time point. Decrease in body size and weight was aided by a reduction in low-density lipoprotein (pre: 127 ±6.2 to post: 113 ±4.5 mg/dL). In addition, a number of improvements to the cardiovascular system were also marked at the 1-week time point. Estimated left ventricular end systolic pressure and direct measure of left ventricular end systolic volume (pre: 66 ±4 to post: 55 ±3 mmHg) declined post-GBS. This is in consort with an increase in contraction rate (dP/dt pre: 672 ±54 post: 737 ±46, p<0.01), a reduction in LV ejection time (pre: 291 ±10 to post: 211 ± 30ms), and a decrease in myocardial oxygen demand (PTIs pre: 2346 ±120 post: 2194 ±107 area/min, p<0.05). Similar improvements in augmentation index can be seen in assessments of peripheral vessels. Independent of brachial artery blood pressure, central systolic blood pressure (pre: 112 ± 4 to post: 105 ±2 mmHg, p=0.08), augmentation index (pre: 16 ±3 to post: 8 ±3, p=0.06), an indirect measure of arterial stiffness, and central augmentation pressure (pre: 4.9 ±1.1 to post: 2.5 ±0.9 mmHg, p=0.06) tended to decrease 1-week post GBS. The data suggests that vascular changes are happening in the early stages of recovery, prior to dramatic weight loss, thus suggesting vascular changes are a result of an alternate surgical benefit. In conclusion, the preliminary results of this study suggest noteworthy cardiovascular improvements post-gastric bypass surgery, yet prior to significant weight loss.
Abstract P323: Urinary Sodium and Potassium Excretion in Relation to Risk of Stroke in Japanese Men and Women: The Circulatory Risk in Communities Study (CIRCS)
Authors: Cui Renzhe , Yamagishi Kazumasa , Imano Hironori , Ohira Tetsuya , Tanigawa Takeshi , Kiyama Masahiko , Okada Takeo , Kitamura Akihiko , Iso Hiroyasu
Published: March 2022

Background:
Limited evidence is available on the association of urinary sodium and potassium excretion and risk of stroke in population samples of Japanese.

Method:
A total of 1,403 Japanese men and women aged 40 to 79 years with no history of cardiovascular disease at baseline survey, whose was measured 24-hour urinary excretion of sodium and potassium in the Circulatory Risk in Communities Study (CIRCS).

Results:
During the median 11.1-years of follow-up, we documented 62 incident strokes and 87 incident cardiovascular disease (stroke and coronary heart disease). The age-adjusted risks of stroke and total cardiovascular disease were higher among persons in the highest tertile of urinary sodium excretion compared with those in the lowest tertile (9.0g/day). These associations did not change substantially after adjusting for cardiovascular risk factors. There were no associations of the urinary potassium excretion with risk of stroke and cardiovascular disease. The respective multivariable hazard ratios (HRs, 95%CI) of stroke and total cardiovascular disease for highest tertile of urinary sodium excretion were 2.06(1.08-3.96) and 1.90(1.09-3.24). For urinary potassium excretion, the corresponding HRs was 1.09(0.51-2.34) and 1.45(0.85-2.49), respectively.

Conclusions:
Higher excretion of urinary sodium was associated with higher risk of stroke and total cardiovascular disease in general Japanese men and women.
Abstract 09: Excess Weight, Cardiovascular Events, and Healthy Longevity: The Lifetime Risk Pooling Project
Authors: Khan Sadiya S , Ning Hongyan , Wilkins John T , Allen Norrina B , Carnethon Mercedes , Berry Jarett D , Sweis Ranya N , Lloyd-Jones Donald M
Published: March 2022

Background:
Compared with normal BMI, overweight status (body-mass index [BMI] 25.0-29.9 kg/m
2
) appears to be associated with greater longevity, but it is unclear to what extent this comes at the expense of greater burden of cardiovascular disease (CVD) and years lived with CVD.

Methods:
We pooled individual-level data from 10 prospective cohorts and included adults free from CVD, stratified by index age (20-39, 40-59, and 60-79 years). We used: (1) modified Kaplan-Meier analysis to estimate lifetime risks for CVD events and non-cardiovascular death; (2) Irwin’s restricted mean to estimate years lived free from and with CVD; and (3) adjusted competing Cox models to estimate joint cumulative risks for CVD or non-cardiovascular death.

Results:
The mean (SD) baseline BMI in middle-age (ages 40-59 years) was 27.4 (4.1) kg/m
2
for men and 27.1 (6.0) kg/m
2
for women. Through 72,490 person-years of follow-up, 13,457 CVD events (coronary heart disease, stroke, and heart failure; including 6,309 CVD deaths) and 11,782 non-CVD deaths occurred in middle-aged participants. Compared with normal BMI, lifetime risks for CVD were higher in overweight and obese adults. Average years lived free from CVD were longest for normal BMI individuals, whereas years lived with CVD were longer for overweight and obese
(FIGURE)
. Compared with middle-aged men and women, respectively, with normal BMI, competing hazards ratios (95% CI) for incident CVD were 1.21 (1.14-1.28) and 1.32 (1.24-1.40) for BMI 25.0-29.9; 1.67 (1.55-1.79) and 1.85 (1.72-1.99) for BMI 30-39.9; and 3.14 (2.48-3.97) and 2.53 (2.20-2.91) for BMI 40.0 and greater. Similar patterns were observed in younger and older adults.

Conclusions:
Compared with normal BMI, both overweight and obesity are associated with similar or shorter total longevity and more years of life lived with CVD. These data suggest that the “obesity/overweight paradox” present after the diagnosis of CVD occurs because of earlier onset of CVD.
Abstract 18: Spatiotemporal and Demographic Trends in Cardiovascular Disease in the US Elderly Based on 108 Million Hospitalization Records
Authors: Singh Gitanjali M , Cruz Melissa , Peñalvo José L , Zhang Jianyi , Mozaffarian Dariush , Naumova Elena N
Published: March 2022

Background:
The US population is rapidly aging, with concurrent increases in chronic disease burdens, particularly CVD. Yet, to-date, the spatial, temporal, and demographic distributions and trends in CVD incidence in the US elderly have not been characterized in detail using data with full coverage of this population.

Objective:
To characterize trends, 1991-2004, in CVD hospitalizations among US elderly, by single year of age/ sex/race/county/state using records from US Centers for Medicare and Medicaid (CMS), which provide full coverage of the US population aged 65+.

Methods:
We abstracted 108,357,431 hospitalization records compiled by CMS indicating CVD in any of 10 diagnosis codes, and tabulated total cases of CVD by sex, single year of age, state and calendar year (1991-2004). CVD incidence rates were calculated using stratum-specific population data from the US Census in conjunction with CMS records. We characterized distributions of CVD cases by single year of age for the US and further by state and calendar year, determining the sex-specific age at which the largest number of incident CVD cases were registered (peak age).

Results:
CVD hospitalization rates increased from 1991-2004 for women aged 65-90 and men aged 65-80, but declined in the oldest-old. In 1991, CVD hospitalization rates for women aged 75 were 48 per 100,000 population, rising to 70 per 100,000 in 2004; men aged 75 had rates of 66 per 100,000 in 1991 versus 87 per 100,000 in 2004. Nationally, peak age of CVD hospitalizations increased 1991-2004, from 77 to 83 years of age for women and from 70 to 77 years of age for men. Men and women in Southern states had among the lowest peak ages of CVD in the nation in 1991 as well as 2004. (
Figure
) Trends by race/CVD subtype are forthcoming.

Conclusions:
Emerging national trends and regional heterogeneity in CVD hospitalization rates and peak age of CVD hospitalization in the US elderly emphasize the need for targeted population-level policy/interventions to reduce CVD burdens and promote healthy aging.
Abstract 30: Carotid Artery Stiffness and Decline in Cognitive Function Among Women With, or at Risk for, HIV Infection
Authors: Huck Daniel , Hanna David B , Maki Pauline , Valcour Victor , Rubin Leah , Springer Gayle , Anastos Kathyrn , Kaplan Robert C , Kizer Jorge R
Published: March 2022

Background:
Vascular stiffness is associated with aging and cognitive impairment in populations without HIV infection. HIV is also associated with increased vascular stiffness. The objective of this study was to examine the association of baseline carotid artery stiffness with progression of cognitive decline among women with, or at risk for, HIV infection, and to determine whether HIV modified this association.

Methods:
We used available baseline carotid stiffness and serial cognitive assessments from 2004 to 2015 in the Women’s Interagency HIV Study, a longitudinal cohort study of women with, or at risk for, HIV. Baseline measurements of carotid stiffness (distensibility) were determined from B-mode carotid artery ultrasound. Serial neurocognitive testing including Trail Making Tests A and B (TRLA, TRLB) and the Symbol Digit Modalities Test (SDMT) was conducted over a median 8.5 years of follow-up. Linear mixed effects models were used to determine associations of baseline measures of carotid stiffness with progression of cognitive decline, with time operationalized as participant age. Models were adjusted by HIV serostatus and demographic, behavioral, and cardiometabolic factors.

Results:
Among 1732 women (1244 HIV+; 488 HIV-) median age at baseline was 41 (IQR 34-47), and the majority were non-Hispanic black (60%) or Hispanic (28%). Greater baseline distensibility, indicating less carotid stiffness, was associated with lower cognitive decline over time in SDMT (β = 0.006 per 10
–6
х Newton
–1
х meter
2
, p <0.001), TRLA (β = -0.01; p = 0.04), and TRLB (β = -0.05; p = 0.002), depicted in the figure. Longitudinal associations did not differ by HIV status (p interaction ≥ 0.13).

Conclusions:
Less baseline carotid stiffness was associated with slower progression of cognitive decline in women with, or at risk for, HIV infection, independent of potential confounders. Targeting of cardiovascular risk factors could prevent cognitive decline regardless of HIV serostatus.
Abstract 36: Fitness and Reclassification of Risk for Incidence of Heart Failure: The Veterans Exercise Testing Study
Authors: Myers Jonathan , Kokkinos Peter , Chan Khin , Dandekar Eshan , Yilmaz Bilge , Nagare Atul , Faselis Charles , Soofi Muhammad
Published: March 2022

Background:
It is well-established that fitness is inversely associated with cardiovascular and all-cause mortality, but little is known regarding the association between cardiorespiratory fitness (CRF) and incidence of heart failure (HF).

Methods:
CRF was determined in 21,080 US Veterans (mean age 58.3 ± 11) free of HF at baseline from the Veterans Affairs Medical Centers in Washington, DC and Palo Alto, CA, and followed for a mean of 12.3±7.4 years. Subjects were classified by quintiles of fitness based on age-specific peak metabolic equivalents (METs) achieved. Participants were followed for incidence of HF, determined through review of computerized medical records. Multivariable Cox models were used to determine the association between incidence of HF and clinical and exercise test variables. Reclassification characteristics of fitness relative to standard clinical risk factors were determined using the category-free net reclassification improvement index (NRI), and the integrated discrimination improvement.

Results:
During the follow-up, 1902 subjects (9%) developed HF, with an average annual incidence rate of 7.4 events per 1,000 person-years. When fitness status was considered as a binary variable (Unfit/Fit), low fitness was the strongest predictor of risk for HF among clinical and exercise test variables (HR 1.91, 95% CI 1.74-2.09, p<0.001). In a fully adjusted model with the least fit group as the reference, there was a graded and progressive reduction in risk for HF as fitness level was higher. Risks for developing HF were 36%, 41%, 67%, and 76% lower among increasing quintiles of fitness compared to the least fit subjects (p<0.001) (Figure). Adding CRF to standard risk factors resulted in an NRI of 0.37 (p<0.001).

Conclusion:
CRF is strongly and inversely associated with future incidence of HF, and significantly reclassifies risk for HF. Reducing the growing burden of HF by improving fitness provides an additional impetus for health care providers to recommend physical activity.
Abstract MP017: Association of Change in Plasminogen Activator Inhibitor-1 Through Young Adulthood With Metabolic Disease in Middle Age: the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Khan Sadiya S , Vaughan Douglas E , Colangelo Laura A , Liu Kiang , Shikany James M , Lloyd-Jones Donald M
Published: March 2022

Introduction:
Circulating plasminogen activator inhibitor-1 (PAI-1) levels are elevated in obesity and diabetes mellitus (DM) in cross-sectional studies. Preclinical studies support a role for PAI-1 in obesity development and insulin signaling. To date, no studies have investigated the prospective association of PAI-1 in young adults with incident obesity and DM.

Hypothesis:
Higher PAI-1 concentrations and greater increases in PAI-1 during young adulthood are associated with higher incidence of obesity and diabetes.

Methods:
We performed an ancillary study in CARDIA measuring PAI-1 in plasma at exam year (Y) 7 and Y20 in a subset of 1200 participants (ppts) free of obesity and DM at Y7. Multivariable logistic regression was used to examine the association between PAI-1 at Y7 and change from Y7 to Y20 with incident obesity and diabetes by Y30. Covariates for adjustment included demographics (age, race, sex, center, education), lifestyle risk factors (physical activity, energy intake, smoking), metabolic traits (BMI, fasting glucose [for DM]), and Y7 PAI-1 level.

Results:
At Y7, ppts (32±4 years, 54% female, 37% black) had mean BMI 24.5±3 kg/m
2
, fasting glucose 89±8 mg/dL, and median PAI-1 14 (IQR: 8-24) ng/mL. Median change in PAI-1 from Y7 to Y20 was +10.0 ng/mL (IQR: +1.0-28.0 ng/dL). Each 1 standard deviation higher ln(PAI-1) at Y7 was associated with an adjusted hazards ratio for incident DM of 1.35 (95% CI: 1.09-1.67). Each 1 standard deviation greater increase in PAI-1 from Y7 to Y20 was associated with an adjusted odds ratio (OR) for incident obesity and DM of 1.21 (1.02-1.43) and 1.36 (1.10-1.68), respectively. When examined by quartiles, the highest (vs. lowest) quartile of Y7 to Y20 PAI-1 change was associated with an adjusted OR of 2.37 (1.33-4.21) for incident obesity and 3.11 (1.45-6.68) for incident DM by Y30, independent of Y7 BMI and PAI-1
(FIGURE)
.

Conclusions:
Higher plasma PAI-1 levels and greater increases in PAI-1 during young adulthood are positively associated with incident obesity and DM by middle age.
Abstract MP026: Effects of Substituting Sedentary Behavior With Light and Moderate-to-vigorous Physical Activity on Obesity Indices in Adults
Authors: Gonze Bárbara B , Sperandio Evandro F , Gagliardi Antônio R , Romiti Marcello , Arantes Rodolfo L , Dourado Victor Z
Published: March 2022

Sedentary behavior (SB) has emerged as an independent risk factor for the occurrence of cardiovascular problems and all-cause mortality. However, the deleterious effect of SB may be a consequence of replacing time spent in light and moderate-to-vigorous (MVPA) physical activities. Few studies have explored this topic, especially in prospective follow-up studies with adults. We hypothesized that substituting SB with light and MVPA may be associated with 1-year change in body weight, body mass index (BMI) and fat body mass (FBM) in asymptomatic adults. We aimed to use isotemporal substitution modeling to investigate cross-sectional and longitudinal effects of reallocating SB with light and MVPA on obesity indices in asymptomatic adults. Also, we examined the correlations between 1-year changes in physical activity intensity categories (i.e., sedentary, light, moderate, vigorous, very vigorous, and MVPA) and changes in FBM. We included 780 participants over the age of 20-yr. Body weight, BMI, and FBM (bioelectrical impedance), as well as its 1-year changes, were the outcomes. We objectively measured physical activity using triaxial accelerometers (ActiGraph GT3X) worn above the dominant hip during waking hours for at least four consecutive days (4-7 days). After 1-year follow-up, 242 completed all the assessments. We reallocated time spent in SB by light or MVPA and assessed the cross-sectional and prospective associations with the outcomes. The cross-sectional isotemporal substitution analysis showed that substituting 10-min blocks of SB with MVPA was significantly related to decreases of 1.23 kg in body weight, 0.30 kg/m2 in BMI and 0.38% in FBM. Substituting 10-min blocks of SB with light physical activity produced significant lower values of body weight (1 kg) and BMI (0.1 kg/m2). We found no effects of substituting SB with light physical activity on FBM. As for the longitudinal analysis, we observed that reallocating SB with MVPA was only associated with a significant decline in FBM (-0.31%). We found no other significant effects of substituting SB with light or MVPA. We observed significant correlations between change in FBM and changes in sedentary (r = 0.147), light (r = -0.290) and vigorous (r = -0.277) physical activity. After stepwise multiple regressions adjusted for all physical activity intensities and covariates, change in vigorous physical activity was the only intensity selected as a significant predictor for 1-year absolute change in FBM (β = -0.312; ΔR
2
= 0.102). We may conclude that SB presents non-consistent influence on obesity indices in asymptomatic adults and its substitution with MVPA is associated with significant improvement in body composition over a short-term follow-up. Our results suggest that vigorous physical activities play the most important role in obesity in adults.
Abstract MP027: Gene-environment Interaction Analysis Reveals Evidence for Independent Influences of Physical Activity and Sedentary Behavior on Obesity: Results From the Hispanic Community Health Study/study of Latinos (HCHS/SOL)
Authors: Moon Jee-Young , Wang Tao , Sofer Tamar , North Kari E , Isasi Carmen R , Cai Jianwen , Gellman Marc D , Moncrieft Ashley E , Sotres-Alvarez Daniela , Argos Maria , Kaplan Robert , Qi Qibin
Published: March 2022

Background:
Studies using self-reported data support gene-physical activity interaction on obesity, yet the influence of sedentary behavior, distinct from lack of physical activity, on genetic associations with obesity remains unclear.

Methods:
We examined interactions of accelerometer-measured physical activity and sedentary behavior with genetic variants on BMI/obesity risk in 9,645 participants aged 18-74 years from the HCHS/SOL, a population-based cohort of US Hispanics/Latinos (2008-2011). A genetic risk score (GRS) was calculated by summing the BMI-increasing alleles of known 97 SNPs (identified primarily in European-ancestry in the GIANT BMI GWAS;
P
<5х10
-8
). Specific GRSs were also calculated based on the possible biological categories of these SNPs.

Results:
The overall GRS was significantly associated with BMI in the HCHS/SOL (β=0.65 per SD [~6-allele increase]; P=1.0х10
-39
). The genetic effect on BMI was stronger in participants with lower moderate-to-vigorous physical activity (MVPA) (1
st
tertile, <8min/day) compared to those with higher MVPA (3
rd
tertile, >23min/day) (0.78 [0.10] vs 0.39 [0.10]; P
int
=0.005), as well as in participants with more sedentary time (3
rd
tertile, >13h/day) compared to those with less sedentary time (1
st
tertile, <11h/day) (0.73 [0.1] vs 0.44 [0.1]; P
int
=0.005). The genetic effects on obesity risk were stronger in participants with lower MVPA (P
int
=0.016) or more sedentary time (P
int
=0.016). Interactions of GRS with MVPA and sedentary behavior remained significant after further adjustment for each other. Of note, 4 biological category-specific GRSs showed nominally significant interactions with both MVPA and sedentary behavior, while a number of different GRSs interacted with only MVPA or sedentary behavior, in relation to BMI (
Figure
).

Conclusions:
Our data suggest that both increasing physical activity and reducing sedentary behavior may attenuate the genetic association with obesity, possibly through interacting with shared and different genetic pathways.
Abstract MP032: Anemia is Associated With Increased Risk of Mortality in Heart Failure With Preserved Ejection Fraction in the US Veteran Population
Authors: Imran Tasnim F , Kurgansky Katherine E , Patel Yash R , Orkaby Ariela R , McLean Robert R , Gagnon David R , Qazi Saadia , Selvaraj Senthil , Ho Yuk-Lam , Cho Kelly , Gaziano J Michael , Djousse Luc , Joseph Jacob
Published: March 2022

Background:
Anemia is increasingly being identified as a poor prognostic factor in patients with heart failure with reduced ejection fraction. However, few studies, and with small sample sizes, have examined the role of anemia in patients with heart failure with preserved ejection fraction (HFpEF). Thus, the purpose of our study is to examine whether anemia is associated with mortality in a large national cohort of patients with HFpEF.

Methods:
We identified subjects with HFpEF using a validated algorithm in the national Veterans Affairs patient database from 2002 to 2012. The criteria for HFpEF included: all recorded ejection fractions > 50% and symptoms, signs and treatment for heart failure. Anemia was identified using the International Classification of Diseases (ICD-9) code at the index time of HFpEF diagnosis. All-cause mortality was confirmed from medical death records and Center for Medicare Services data. Using a multivariable Cox proportional hazards model, we examined the association of anemia at the time of HFpEF diagnosis with all-cause mortality.

Results:
In total, 29,022 HFpEF patients met criteria for HFpEF. Mean age of the participants was 71±12 years; 96% were men, 84% were white, 35% had anemia, 88% had hypertension, 65% had hyperlipidemia and 42% had coronary artery disease at baseline. After a median follow-up of 3.6 years (IQR: 1.7-6.4), 17,269 deaths occurred. After adjusting for age, sex, race, body mass index, coronary artery disease, hypertension, hyperlipidemia, atrial fibrillation, chronic obstructive pulmonary disease, diabetes mellitus, serum sodium, renal function, heart rate and ejection fraction, patients with anemia had higher mortality (HR 1.52, 95% CI 1.47-1.57, p < 0.0001) as compared to those without anemia.

Conclusion:
Our study suggests that prevalent anemia is associated with an increased risk of all-cause mortality among US veterans with HFpEF. Further studies may shed light on its role as a prognosticator and potential therapeutic target in this population.
Abstract MP041: Time Course of Change in Blood Pressure From the DASH Diet and Sodium Reduction
Authors: Juraschek Stephen P , Woodward Mark , Sacks Frank M , Carey Vincent J , Miller Edgar R , Appel Larry J
Published: March 2022

Background:
The time course of change in BP from lifestyle interventions, particularly sodium reduction, is uncertain.

Hypotheses:
(1) The DASH diet and sodium reduction will lower BP rapidly (within 1 wk), and (2) BP effects will be sustained over time.

Methods:
In the DASH-Sodium trial, adults without cardiovascular disease, not using antihypertensive medications, were randomly assigned to either a control diet or the DASH diet. With either diet, participants were fed each of three sodium levels in random order in 4-wk periods separated by 5-day breaks. The three sodium levels were: low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). BP was measured during the run-in period and weekly over 12 wks of the trial. Differences in BP were determined at the end of each wk. Trends in differences were modeled via linear regression.

Results:
The trial enrolled 412 participants (57% women, 57% black, mean age was 48 yrs, mean SBP/DBP was 135/86 mmHg). Compared with the control diet, DASH lowered SBP at wk 1 (-4.36; -6.96,-1.77) and wk 12 (-3.82; -6.03,-1.61); corresponding changes in DBP were -1.07 (-2.66, 0.53) and -0.99 (-2.32, 0.33) (
Figure
). From wk 1 to 12, there was no trend in the difference between DASH and control diets for either SBP (
P
-trend = 0.91) or DBP (
P
-trend = 0.99). In the context of the control diet, reducing sodium from high to low, changed SBP by -4.03 (-6.66,-1.39) and DBP by -0.80 (-2.50, 0.89) after 1 wk, and SBP by -6.66 (-8.84,-4.47) and DBP by -3.43 (-4.72,-2.13) after 4 wks. Trends in differences from wk 1 to 4 were significant for SBP (
P
-trend = 0.02) and non-significant for DBP (
P
-trend = 0.1). There was no trend over time in SBP or DBP from reducing sodium while on the DASH diet (
P
-trend for SBP = 0.71 and for DBP = 0.25).

Conclusions:
The DASH diet lowers SBP and DBP early and its effects were maintained with dietary adherence over time. Meanwhile, the effects of sodium reduction on SBP were not fully realized by 4 wks in the context of a typical American diet, suggesting that the effect of lowering sodium on SBP continues to increase over time.
Abstract MP049: Fermented vs. Non-fermented Dairy and Risk of Coronary Heart Disease in Men: the Kuopio Ischaemic Heart Disease Risk Factor Study
Authors: Koskinen Timo , Virtanen Heli E , Voutilainen Sari , Tuomainen Tomi-Pekka , Mursu Jaakko , Virtanen Jyrki K
Published: March 2022

Introduction:
Most of the recent dairy studies, including multiple meta-analyses, show either no relationship or an inverse association between total dairy intake and risk of cardiovascular diseases. Some of these studies have suggested that especially fermented rather than non-fermented dairy might provide benefits on cardiovascular health, but the data is inconclusive. Also, the average dairy intake has been modest in many study populations, which reduces the generalizability of the findings to populations with high dairy intake.

Hypothesis:
We assessed the hypothesis that fermented and non-fermented dairy products have distinct associations with the risk of coronary heart disease (CHD) in men from eastern Finland, a population with high intake of dairy products.

Methods:
A total of 1981 men from the population-based Kuopio Ischaemic Heart Disease Risk Factor Study from eastern Finland, aged 42-60 years, with no CHD at baseline, were included. The consumption of foods was assessed with instructed 4-day food recording by household measures. Dairy products with fat content <3.5% were considered low-fat. Multivariable Cox regression analyses included age, examination year, smoking, leisure-time physical activity, education, family history of CHD, and intakes of alcohol, energy, fiber, polyunsaturated fatty acids, and fruits, berries and vegetables. Fatal and non-fatal CHD events were ascertained from national registries, with no loss to follow-up.

Results:
The mean±SD intakes were 733±375 g/d for total, 187±218 g/d for fermented and 546±345 g/d for non-fermented dairy. Low-fat products comprised 87% (162±218 g/d) of the fermented and 43% (317±291 g/d) of the non-fermented dairy intake. During the mean follow-up of 20.1 years, 472 CHD events occurred. The multivariable-adjusted hazard ratio (95% CI) in the highest (>280 g) vs. the lowest (<26 g) quartile of total fermented dairy was 0.73 (0.56-0.95, P-trend=0.02) and in the highest (>727 g) vs. the lowest (<258 g) quartile of total non-fermented dairy 1.44 (1.06-1.94, P-trend=0.009). When low-fat and high-fat dairy were evaluated separately, only low-fat products were associated with the risk. The extreme-quartile hazard ratios (95% CIs) were 0.74 (0.57-0.96, P-trend=0.02) for low-fat fermented dairy and 1.47 (1.08-1.99, P-trend=0.02) for low-fat non-fermented dairy. Intakes of total dairy (extreme-quartile HR 1.03, 95% CI 0.74-1.42, P-trend=0.727), high-fat fermented dairy (HR 0.92, 95% CI 0.69-1.22, P-trend=0.32) or high-fat non-fermented dairy (HR 1.09, 95% CI 0.77-1.56, P-trend=0.44) were not associated with the risk of CHD.

Conclusions:
Our results suggest that low-fat fermented dairy products are associated with a lower risk of CHD, whereas low-fat non-fermented dairy products are associated with a higher risk in a population with high intake of dairy products.
Abstract MP082: Sex Hormone Levels and Change in Left Ventricular Structure Among Men and Women With Preserved Ejection Fraction The Multi Ethnic Study of Atherosclerosis
Authors: Subramanya Vinita , Zhao Di , Ouyang Pamela , Lima Joao A , Vaidya Dhanajay , Ndumele Chiadi E , Bluemke David A , Guallar Eliseo , Nwabuo Chike C , Allison Matthew A , Heckbert Susan R , Post Wendy S , Michos Erin D
Published: March 2022

Background:
Heart failure with preserved ejection fraction (HFpEF) is more common in older women than men. Differences in sex hormone (SH) levels may contribute to sex differences in HFpEF risk. Left ventricular (LV) hypertrophy and concentric remodeling [increased Mass (M): Volume (V) ratio] are risk markers of HFpEF. In a multi-ethnic cohort of men and women with preserved EF, we examined whether SH levels were associated with LV structure. We hypothesized that a more androgenic pattern would predict adverse concentric remodeling in women but not men.

Methods:
We studied 4279 MESA participants (49% women) aged 45-84 yrs with serum SH levels and cardiac MRI performed at baseline (2000-2002) and baseline EF ≥50%. Among these, 2957 participants underwentMRI at Exam 5 (2010-2012). Stratified by sex, we used linear regression for cross-sectional analyses and mixed model effect methods for longitudinal analyses to test the associations of SH and binding globulin (SHBG) levels [per 1 SD greater log(SH)] with baseline levels and changes in LV mass (LVM), end diastolic volume (LVEDV) and M:V ratio. Models were adjusted for age, ethnicity, center, height, weight, education, physical activity and smoking, and for hormone use and menopause in women.

Results:
The mean (SD) age was 64 (9) for women and 62 (10) yrs for men. Cross-sectionally, among women, higher Testosterone (T) and Dehydroepiandrosterone (DHEA) levels were associated with greater LVM (
Table
). Among both men and women, higher free T and lower SHBG were associated lower LVEDV and greater M:V ratio. In men, greater estradiol levels were associated with lower LVEDV and greater M:V ratio. After a mean followup of 10 yrs, higher free T and lower SHBG were associated with an increase in LVM in both sexes. Findings were generally consistent after adjustment for possible mediators of these associations such as blood pressure and other CV risk factors.

Conclusion:
A more androgenic profile of higher free T and lower SHBG is associated with greater increase in LVM over 10 yrs in both men and women.
Abstract MP090: Sleep Duration Predict Incident Obesity in Childhood and Adolescence: Meta-analysis of Prospective Studies
Authors: Miller Michelle A , Kruisbrink Marlot , Wallace Joanne , O’Keeffe Andrew , Valint Sam , Ji Chen , Cappuccio Francesco P
Published: March 2022

Objectives:
To assess the longitudinal evidence of a relationship between duration of sleep and both incidence of overweight and/or obesity and changes in body mass index in infants, children and adolescents.

Methods:
We performed a systematic search of publications using MEDLINE (1966-2016), EMBASE (from 1980), Web of Science (from 1945), the Cochrane Library and manual searches without language restrictions. Studies were included if they were prospective, had a follow up >1 year, had measured duration of sleep at baseline and assessed either incident cases of overweight and/or obesity or changes in body mass index prospectively. Relative risks (RR), regression coefficients (beta) and 95% C.I. were extracted and pooled using a random effect model. Sensitivity analyses and meta-regressions were performed, heterogeneity and publication bias were also assessed.

Results:
Overall, 41 studies provided 56 independent cohort samples, including 98,130 boys and girls aged 0-18 years (follow-up 1 to 27 years). Sleep duration was assessed by questionnaire, either to parents or to children, actigraphy or polysomnography. Body mass index (BMI) was measured in all participants. In the pooled analyses, short duration of sleep was associated with a greater risk of becoming overweight or obese (RR: 1.57; 95% CI 1.34, 1.85; p<10
-5
; n=59,471). There was significant heterogeneity (I
2
=92%, p<0.001), accounted for by three studies (I
2
=3% after their removal) and evidence of publication bias (p=0.007). The effect size increased with age (infants 1.40 [1.19, 1.65]; early childhood 1.53 [1.33, 1.76]; middle childhood 2.23 [2.18, 2.27]; adolescence 1.30 [1.11, 1.53]; p for heterogeneity <10
-5
). The effect was not associated with average length of follow-up (p=0.923) or quality (p=0.475). BMI decreased for every hour of increased sleep (pooled beta: -0.01; -0.03, 0.00 kg/m
2
per h, p=0.032; n=16,225).

Conclusion:
Short duration of sleep is a significant predictor of the development of overweight, obesity and weight gain from birth to adolescence.
Abstract MP092: Ultrasound Measures of Abdominal Fat Predict Gestational Insulin Resistance
Authors: Ingram Katherine H , Amason Janeen , Pierre Kareem
Published: March 2022

Introduction:
Gestational diabetes mellitus (GDM) is a serious condition affecting approximately 10% of pregnancies. Obesity, and particularly abdominal obesity, is strongly associated with insulin resistance, the hallmark characteristic of diabetes. The current standard-of-care is the use of an oral glucose test to diagnose GDM at approximately 25 weeks gestation. After diagnosis, a lifestyle intervention is prescribed. If abdominal fat can be measured during routine prenatal ultrasounds, then it may provide an option for early identification of women at high risk for GDM and, in turn, earlier intervention.

Hypothesis:
This pilot study tested the hypothesis that deep abdominal fat depots are predictive of gestational insulin sensitivity, regardless of overall body fat.

Methods:
In 31 nulliparous pregnant women (age 27±4.5, BMI 27±7.8, 71% non-hispanic white), abdominal fat was measured at 18-20 weeks gestation via ultrasound. Two measurements were collected 1 inch above the umbilicus (deep intra-abdominal (IAAT) and subcutaneous (SAT1)); two were immediately below the xyphoid process (pre-peritoneal (PPAT) and subcutaneous (SAT2)). Overall body composition was calculated via 4-compartment model from body density via air displacement plethysmography (BodPod) and body water via bioelectrical impedance (InBody 720) measured at 18-20 weeks gestation, along with post-partum bone density via DXA. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was computed using fasting glucose and insulin at 24-28 weeks gestation. Gestational weight gain (GWG) was monitored by medical records. After testing variables for normality, HOMA-IR was log-transformed for partial correlation and multiple regression analyses.

Results:
HOMA-IR was strongly correlated to overall gestational body fat (
r
=.666,
p
=.003) and measures of regional adiposity (
r
=.673 for IAAT,
r
=.471 for PPAT,
r
=.627 for SAT1,
r
=.627 for SAT2,
p
<.05 for all), but not GWG (
r
=.012,
p
=.957), when controlling for age and race. HOMA-IR remained strongly associated with IAAT and SAT1 (
r
= .510 and .490, respectively,
p
<.05 for both), but not PPAT or SAT2 (
r
=.143 and .380,
p
=.559 and .108, respectively), when correlations were repeated controlling for age, race, and percent body fat. Multiple regression analysis revealed that IAAT and SAT1 were significant independent predictors of HOMA-IR (β= .570 and .491, respectively,
p
<.05 for both), but not PPAT, SAT2, or overall body fat (β = -.384, .473, and -.164, respectively,
p
= ns for all).

Conclusions:
Gestational insulin resistance is strongly associated with intra-abdominal and subcutaneous adipose accumulation in the lower abdomen, independent of overall body fat. Thus, abdominal fat ultrasound measures may be a simple way to identify, early in pregnancy, those who are at high risk for gestational diabetes.
Abstract P004: Shift-working Firefighters Have Poorer Heart Health Than They Think: An Intervention Opportunity
Authors: Patterson Freda , Suminski Richard , Malone Susan K , Lozano Alicia , Jahnke Sara A , Poston Walter S
Published: March 2022

Background:
As an occupational sub-group, career firefighters experience a disproportionately higher prevalence of cardiac events and risk factors than the general population. The pervasive nature of poor cardiovascular health (CVH) in this population might belie an occupational norm. Underestimation of poor health could be a barrier to the adoption of health-enhancing behaviors.

Methods:
Baseline data from a sample of 478 male firefighters from five different fire houses were used to examine the relationship between objective and perceived health. Objective CVH was defined as meeting the American Heart Association ideal recommendations for the following six, CVH metrics:
tobacco use
(non-smoker),
body mass index
(≤24.9 kg/m
2
),
physical activity
(≥75 min/wk vigorous or ≥150 min/wk moderate activity),
fruit and vegetable intake
(≥4.5 cups/d),
blood pressure
(<120/80 mm Hg) and
total lipids
(<200 mg/dL). Firefighters rated their perceived health as excellent, average, fair or poor. The proportion of firefighters meeting the ideal status for each CVH metric, and total CVH metrics achieved, was generated. A chi-square test of independence examined differences between the binary ideal CVH metrics (0-3 versus 4-6 ideal CVH metrics) and perceived excellent/average health.

Results:
The mean age of the sample was 38.2 years (SD=9.9), 89% (413/478) were Caucasian, 73% (334/478) were married, 67% (290/478) had an annual income of at least $75,000, and 90% (410/478) had attended college. Three-quarters (76%; 225/478) of the sample met the ideal recommendations for tobacco use, 20% (93/478) for body mass index, 0% for physical activity, 36% (174/478) for fruit and vegetable intake, 39% (184/478) for blood pressure, and 88% (345/478) for lipids. Overall, none of the firefighters sampled had ideal status on all 6 CVH metrics considered. Ninety-two percent (426/478) of the sample rated their health as average to excellent, although only 10% (47/478) of the sample had ideal status for 4-6 of the CVH metrics; 90% (431/478) had ideal status for 0-3 metrics (X
2
= 4.54; p=.03).

Conclusion:
The CVH status of firefighters is poor, but firefighters with poor heart health inaccurately perceive their health as average or better. Addressing this misperception gap will be necessary to optimize responses to CVH interventions delivered to this population.
Abstract P010: Obesity Status in Younger Age, 39-year Weight Change and Physical Performance in Older Age: the Chicago Healthy Aging Study (CHAS)
Authors: Vu Thanh Huyen T , Carnethon Mercedes R , Liu Kiang , Lloyd-Jones Donald M , Ogbole Godwin I , Garside Daniel B , Daviglus Martha L
Published: March 2022

Background:
Obesity is associated with serious medical complications and impaired quality of life. In older adults, obesity can aggravate the age-related decline in physical performance and lead to other forms of disability. However, the association of obesity status and weight change over decades with physical performance in older age has not been well studied.

Methods:
In 1,325 men and women who were initially examined in 1967-73 and re-examined in 2007-10 in the CHAS study, we stratified by baseline BMI and categorized weight change over 39 years (categories in table footnote). At follow-up (FU) when participants were ages 65+, muscle strength (hand grip) and performance [4m gait speed and Short Physical Performance Battery (SPPB)] were measured. We used multivariate logistic regression analysis to determine the association of baseline obesity status and weight change categories with categorized low strength and performance measures adjusted for baseline (BL) CVD risk status, FU age, sex, race, education, ankle-brachial index, SBP, total cholesterol, smoking status, diabetes, and cholesterol and BP medication use.

Results:
The mean age at baseline was 33 and at FU was 71, 28% were women and 9% were black. At follow-up, 10.3 % had SPPB score ≤ 8, 8.4 % had gait speed on 4 meter course < 0.8 m/s, and 23.8 % had low sex-specific handgrip strength (<18kg for women, <30kg for men). As compared with those who were normal weight at baseline with minimal weight change (-10lbs to 20lbs), participants who were overweight initially and gained the most weight (> 20lbs) were more likely to have a low SPPB score, gait speed <0.8 m/s, or sex-specific handgrip strength (ORs: 4.55, 4.58, and 1.86, respectively). Weight loss > 10 lbs is associated with SPPB score, and can be seen among those with BL BMI <25 kg/m
2
but not among those with BL BMI ≥ 25 kg/m
2
.

Conclusion:
Obesity and overweight in younger age and significant weight gain over time are each associated with poor physical performance in older age.
Abstract P055: Cooking Methods for Meats and Risk of Type 2 Diabetes: Results From Three Prospective Cohort Studies
Authors: Liu Gang , Zong Geng , Hu Yang , Hu Frank B , Willett Walter C , Eisenberg David , Sun Qi
Published: March 2022

Importance:
The role of high-temperature cooking methods (broiling, barbequing, or roasting) on the association of meat consumption with risk of type 2 diabetes (T2D) is unknown.

Objective:
To examine cooking methods for meats (chicken, fish, and red meat) in relation to T2D risk among men and women who consumed meats regularly (≥2 servings/week).

Design, Setting, and Participants:
The prospective studies included 52,720 women from the Nurses’ Health Study (NHS 1996-2012), 60,809 women from the Nurses’ Health Study II (NHS II 2001-2013), and 24,679 men from the Health Professionals Follow-Up Study (HPFS 1996-2012) who were free of diabetes, cardiovascular disease, and cancer at baseline.

Main Outcomes and Measures:
Incident cases of T2D were identified through self-report and confirmed by validated supplementary questionnaires.

Results:
We documented 7,893 incident T2D cases during 1.74 million person-years of follow up. After multivariate adjustment of demographics, lifestyle factors, and total intake of chicken, fish, and red meat, a higher frequency of high-temperature cooking of meats was independently associated with an increased T2D risk. When comparing >15 times/month with <4 times/month, the hazard ratios (HRs) and 95% confidence intervals (CIs) of T2D were 1.36 (1.22, 1.52;
P
trend<0.001) in NHS, 1.82 (1.56, 2.12;
P
trend<0.001) in NHS II, and 1.10 (0.90, 1.36;
P
trend=0.78) in HPFS; and the pooled HR was 1.43 (1.32, 1.56;
P
trend <0.001). The results remained significant when analyzing by source of meats; and the pooled HRs (95% CI) were 1.64 (1.49, 1.81;
P
trend <0.001) for red meat and 1.22 (1.13, 1.32;
P
trend <0.001) for white meat. In addition, a higher frequency of high-temperature cooking of meats was associated with greater weight gain and higher risk of obesity, especially among women. Mediational analyses showed that the significant associations of high-temperature cooking with T2D risk were partially explained by changes in body mass index (41.6% in NHS and 46.6% in NHS II) in women.

Conclusions and Relevance:
Our results suggest that, independent of meat consumption, high-temperature cooking methods may further increase diabetes risk, especially in women.