bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P370: Obesity and Incident Coronary Heart Disease in the Million Women Study: A Prospective, Population-based Cohort Study
Authors: Canoy Dexter , Cairns Benjamin J , Balkwill Angela , Green Jayne , Wright Lucy , Reeves Gillian K , Beral Valerie
Published: July 2021

Background:
Higher body-mass index (BMI) has been associated with increased risk for coronary heart disease (CHD) mortality but its association with incident CHD is less investigated, and data for women are limited.

Methods:
We examined the prospective relation between BMI and incident CHD (first CHD hospitalization or death) in 1.2 million women aged ≥50 years without prior CHD, who were recruited through a national breast screening programme in 1996 to 2001 and followed for an average of 9 years (48,842 events with 10.7 million person-years of follow-up). Absolute and relative risks (using Cox regression) associated with higher BMI were estimated.

Results:
After excluding the first 4 years of follow-up, there were 32,465 events (5.9 million person-years) including 3,345 CHD deaths. The adjusted relative risk per 5 kg/m
2
BMI difference was 1.24 [95% confidence interval (CI) 1.22 to 1.25]. CHD risk increased linearly across a wide range of BMI, with no apparent excess risk in the lower end of BMI distribution. The relation persisted after excluding current smokers or limiting cases to myocardial infarction only. For women in this cohort, the 20-year cumulative risk of CHD from age 55 to 74 years (95% CI) ranged from 9% (8 to10) to 18% (16 to 20) for women with BMI of 20 to 22.5 kg/m
2
and ≥35 kg/m
2
, respectively. Never smokers with BMI ≥35 kg/m
2
had comparable cumulative risk to current smokers with BMI of 20 to 22.5 kg/m
2
.

Conclusion:
In this large cohort of women, the impact of excess weight on CHD morbidity and mortality is substantial. Measures to prevent and control excess weight and other CHD risk factors are needed to help reduce CHD burden in women.
Abstract P380: Obesity and Non-Alcoholic Fatty Liver Disease in Children
Authors: Frisbee Stephanie J , Frisbee Jefferson C , Ducatman Alan M
Published: July 2021

The increasing prevalence of childhood obesity has been well documented and is predictive of an increased severity in obesity-related CVD risk factors and metabolic disorders, such as non-alcoholic fatty liver disease (NAFLD). This study determined the association between obesity and risk for altered liver function and NAFLD in 12,476 children (≤18 years) enrolled in the C8 Health Project, which resulted from pretrial settlement of a class action lawsuit pursuant to contamination of the drinking water supply (Frisbee et al, 2009). In this population, 48% were female, median age and BMI percentile were 11.6 years and 76, respectively, with 39.8% classified as overweight (OWT) or obese (OB). Seven serum biomarkers of liver function (ALT, AST, total (bili-t) & direct (bili-d) bilirubin, alkaline phosphatase (AlkPhos), GGT, & lactate dehydrogenase (LDH)) were available for 10,543 children. Based on prior categorization (Schwimmer et al, 2005), ALT or AST≥40IU/L were considered indicative of NAFLD. In linear regression adjusted for age, gender, SES (socio-economic status) and non-HDL cholesterol, BMI (z score) was significantly associated with all liver biomarkers (b coefficient±SE/adj R-square): ALT (1.6±0.1/6.6%); AST (-0.3±0.1/17.8%); bili-d (-0.002±0.0004/16.8%); bili-t (-0.01±0.002/9.4%); AlkPhos (-4.3±0.8/27.7%); GGT (1.0±0.1/18.0%); LDH (2.4±0.3/44.6%). Results for logistic regression assessing for NAFLD risk based on OWT or OB are shown
Table
1. Overall, there was a stronger association between NAFLD risk with increasing BMI for ALT compared to AST (2-6 fold compared to insignificant risk). This pattern was similar for girls and boys. Interestingly, age stratified analysis revealed that obesity was slightly protective from AST-defined NAFLD in younger age groups, but this reversed in older ages. OWT and OB were associated with increased ALT-defined NAFLD, particularly in older ages. These results suggest a complex, non-linear and age-dependent association between obesity and NAFLD in children.

Obesity and Risk for Non-Alcoholic Fatty Liver Disease

OR (95%CI) for ALT >=40 IU/L
OR (95% CI) for AST >=40 IU/L

Total Population

OWT: 2.0 (1.3-3.0)/OB: 5.9 (4.2-8.1)
NSS

Gender Stratified
Female
OWT: 2.2 (1.2-4.3)/OB: 4.7 (2.7-8.1)
NSS

Male
OWT: 1.9 (1.1-3.3)/OB: 6.6 (4.4-10.0)
NSS

Age Group Stratified
< 5 Yrs
NSS
OWT: 0.2 (0.1-0.7)/OB: 0.3 (0.1-0.5)

5-9.9 Yrs
OWT: NSS/OB: 3.6 (1.3-9.9)
OWT: NSS/OB: 0.5 (0.3-0.9)

10-14.9 Yrs
OWT: NSS/OB: 7.0 (4.3-11.1)
OWT: NSS/OB: 2.4 (1.4-4.1)

15-17.9 Yrs
OWT: 2.2 (1.2-4.0)/OB: 5.3 (3.2-8.6)
NSS

Models adjusted for age (except age stratified), gender (except gender stratified), SES,&non-HDL c
Abstract P384: Overweight, Obesity and its Correlates among Adolescents: a Comparison of Eleven Countries in the Eastern Mediterranean Region
Authors: Autenrieth Christine S , Guthold Regina , Cowan Melanie J , Kann Laura , Ben Abdelaziz Faten , Riley Leanne M
Published: July 2021

Background:
Overweight and obesity, physical inactivity, and sedentary behavior are important risk factors for chronic diseases; however, for the youth in countries of the Eastern Mediterranean Region (EMR), comparable prevalence data are lacking.

Methods:
We used data from nationally representative samples of 34,410 13-15 year old schoolchildren who participated in the Global School-based Student Health Survey (Djibouti, Egypt, Jordan, Lebanon, Libyan Arab Jamahiriya, Morocco, Oman, Pakistan, Tunisia, United Arab Emirates, and Yemen). Data on height, weight, physical activity levels, and sedentary behavior were collected from 2005-2009 in these eleven EMR countries and sex- and country-specific prevalence rates were calculated.

Results:
The prevalence of overweight and obese youth ranged from 6.5% in Pakistan (boys: 5.1%, girls: 8.7%) to 37.6% in the United Arab Emirates (boys: 39.2%, girls: 36.1%), whereas underweight was highest in Yemen (20.8%; boys: 25.4%, girls: 13.0%) and lowest in Egypt (4.0%; boys: 4.7%, girls: 3.2%). Six of the eleven countries had an overweight and obese rate higher than 20%. The combined risk factors of overweight, insufficient amount of physical activity (< 5 days of at least 60 minutes per week), and sedentary behavior (≥ 3 hours of sitting activities per day) ranged from 0.5% in Pakistan to 12.3% in the United Arab Emirates.

Conclusion:
These data suggest that prevalence of overweight schoolchildren is high in EMR countries. In addition, physical activity levels were below recommendation guidelines in most of the surveyed countries. Efforts to prevent these unfortunate trends should be taken on regional and national levels.
Abstract P386: Design of a Tailored Text-message Intervention for Weight Loss
Authors: Kolodziejczyk Julia , Barrera Anglica , Patrick Kevin , Dillon Lindsay , Marshall Simon , Arredondo Elva , Rock Cheryl , Raab Fred , Griswold William , Sullivan Mark , Norman Gregory
Published: July 2021

Introduction:
Tailoring information is a commonly used health communication technique to individualize behavior change programs. However, few studies have applied individualized tailoring to a text-message intervention. Using tailoring with text-messages may be a powerful behavior change tool as this technology is inexpensive, asynchronous, and is ubiquitous across socio-economic segments. We developed a tailored, “push/pull,” text-message intervention for overweight/obese English and Spanish-speaking participants that targets weight management behaviors. The development of the theory-driven logic rules for individualized text-messages is described. Methods: A robust web-based participant intake system was developed to gather and store the data needed to individualize the messages by personalization, feedback, and content matching. Feedback and content matching was based on both a baseline weight management behavior survey and continual text message-based assessments related to individual behaviors and perceived barriers. The system is designed so that participants who show rapid and sustained progress can advance through the content, while those having difficulties can receive additional tips and suggestions. Participants will be scheduled to receive 3-4 interactive messages per day from our library of over 6,000 text messages. We categorized the messages into five groups: 1) Subject matter: Content related to nutrition and physical activity behaviors; 2) Behavioral core strategies based on Self-Regulation Theory (e.g. self-monitoring, goal setting); 3) Message type (e.g. reminder, feedback); 4) Personalization (e.g. favorite restaurants, friends’ names); and 5) Location related messages. We also developed a “like/ don’t like” feature so that the system can continuously learn user preferences for message types and adjust the type of future messages sent accordingly.

Conclusion:
A large-scale randomized controlled trial is underway to evaluate the efficacy of this text-message intervention. While this intervention is aimed at weight loss, our tailoring technique will likely apply to other health behaviors as well.
Abstract 007: Nonalcoholic Fatty Liver Disease and Subclinical Atherosclerosis: Analyses from the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: VanWagner Lisa B , Shay Christina M , Ning Hongyan , Wilkins John , Lewis Cora E , Carr Jeff , Terry James G , Lloyd-Jones Donald , Jacobs David , Carnethon Mercedes
Published: July 2021

Background:
Nonalcoholic Fatty Liver Disease (NAFLD) and excess visceral adipose tissue (VAT) are associated with cardiovascular disease (CVD). Recent studies suggest that NAFLD and coronary artery calcification (CAC) are related independent of VAT. In a population-based cross-sectional sample of black and white adults free from prevalent liver or heart disease, we tested the hypothesis that NAFLD is associated with the presence of CAC and abdominal aortoiliac calcification (AAC) independent of VAT and other CVD risk factors.

Methods:
Participants from the Coronary Artery Risk Development in Young Adults study (Y25 exam) with concurrent computed tomography quantification of liver fat, CAC and AAC were included (n=2,163). NAFLD was defined as liver attenuation ≤ 40 Hounsfield Units after exclusion of other causes of liver fat (medication/alcohol use). Using the Agatston method, CAC/AAC presence was defined as a score > 0. Logistic regression models were used to calculate odds ratios and 95% confidence intervals.

Results:
Participant age was 49.9 (3.7) years and the sample was equally distributed by sex (55.6% female) and race (50.1% black). Mean BMI was 30.6 (7.1). The CAC and AAC prevalence was 26.5% and 49.6%. NAFLD prevalence was 9.6%. NAFLD participants were 50.1 (3.7) years old and more likely to be male (59.8% vs. 51.7%, p<0.0001), white (56.5% vs. 49.3%, p<0.05) and have the metabolic syndrome (70.1% vs. 22.6%, p<0.0001) than those with no NAFLD. They were also more likely to have CAC (37.2%) and AAC (60.9%) than those with no NAFLD (25.4% and 49.4%, respectively). In multivariable analyses adjusted for demographics and health behaviors, NAFLD was associated with the presence of CAC and AAC (Table 1). This association was attenuated after adjustment for CVD risk factors and VAT. Effect modification by race and sex was not statistically significant.

Conclusion:
In contrast to prior studies, our results suggest that the relationship between NAFLD and subclinical CVD is mediated by the presence of other CVD risk factors.
Abstract 021: Greater Calcium Density of Coronary Artery Plaque is Protective for Cardiovascular Events. The Multi-Ethnic Study of Atherosclerosis
Authors: Criqui Michael H
Published: July 2021

Background—
Coronary artery calcium (CAC) measured by computed tomography (CT) has strong predictive value for incident cardiovascular disease (CVD) events. The standard CAC score is the Agatston, which is the product of the within slice CAC plaque area and a plaque specific density factor of 1, 2, 3, or 4, summed for all CT slices. Thus, the Agatston score is weighted upward for greater CAC density. However, data from both observational studies and randomized trials suggest increased CAC density
per se
may be protective for CVD.

Methods—
In a multi-ethnic population of 3398 men and women with Agatston scores > 0 at baseline, we derived a formula using the individual Agatston scores and the volume scores to create a per participant CAC density score. We then analyzed the independent associations of CAC volume and CAC density with incident hard CVD, defined as MI, resuscitated cardiac arrest, cardiac death, stroke, or stroke death,

Results—
During a median of 7.6 years of follow-up, there were 265 hard CVD events, 175 of which were coronary heart disease (CHD) events. In a proportional hazards model including the General Framingham Risk Score (GFRS) and both the CAC volume and CAC density score, the CAC volume score showed a strong independent association with incident CVD, with a hazard ratio per natural log standard deviation increase of 1.62, p<.0001. Conversely, the CAC density score showed an independent association that was strongly protective for CVD, with a hazard ratio per standard deviation increase of 0.72, p<.0003. Multivariate quartile analyses showed that at any given volume score, a density score in the 4
th
quartile (range 3.2 to 4.0) decreased the risk of a CVD event by 51%, p=.002. The density score showed no significant interactions with either sex or ethnicity. The addition of the volume score to the model containing the GFRS increased the area under the ROC curve (AUC) from 0.664 to 0.6869, p=.015, and further addition of the density score increased the AUC to .6994, p=.023. Separate analyses limited to CHD events showed similar results.

Conclusions—
At any given volume of CAC, increased density in calcified coronary plaques is protective for incident CVD, consistent with the concept that calcium deposition may increase the stability of atherosclerotic plaques. CAC scoring systems should be modified to weight downward for density rather than upward, and thus improve CVD risk prediction.
Abstract 024: Metabolomics and Incident Hypertension in African Americans from the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Zheng Yan , Yu Bing , Alexander Danny , Mosley Thomas H , Heiss Gerardo , Nettleton Jennifer A , Boerwinkle Eric
Published: July 2021

Introduction:
Development of hypertension is influenced by genes, environmental effects and their interactions, and the human metabolome is a measurable manifestation of gene x environment interaction. We explored the metabolomic antecedents of hypertension in a sample of African Americans (AAs) in the ARIC study.

Methods:
We examined 896 (565 females, aged 45-64 years) baseline normotensives, whose serum metabolome was measured by gas chromatography-mass spectrometry/ liquid chromatography-mass spectrometry. The analyses presented here focus on 204 metabolites having high 4-6 week intra-individual repeatability (reliability coefficients ≥ 0.60). We used principal-components analyses (PCA) to identify patterns in these metabolomic data. Weibull parametric models considering interval censored data were used to assess the hazard ratio of developing hypertension. The analyses adjusted for age, gender, leisure-time physical activity, smoking status, alcohol intake, diabetes status, BMI, and estimated glomerular filtration rate in the full model. An additional model adjusted for the previous variables plus baseline systolic and diastolic BP. We used a modified Bonferroni correction accounting for the correlations among metabolites to determine statistical significance (p <3.9×10-4) in the analysis of association between an individual metabolite and hypertension.

Results:
During 10-years of follow-up, 38% of baseline normotensives developed hypertension (N=344; incidence rate: 63.94 per 1000 person-years). Each SD of baseline 4-hydroxyhippurate, a product of gut microbial fermentation, was associated with 17% higher risk of hypertension (p=2.5×10-4), which remained significant after adjusting for baseline BP (p=3.8×10-4). PCA showed three interpretable metabolomic patterns: sex steroids, alpha amino acids and branched-chain amino acids. The sex steroids pattern mainly consisted of androstenediol and pregnendiol disulfate, and it was significantly associated with risk of incident hypertension independent of all factors in the full model (highest versus lowest quintile HR, 1.72; 95% CI, 1.05 to 2.82; p for trend=0.03). Stratified analyses suggested this association was consistent in both genders.

Conclusions:
In our study of ARIC AAs with 204 reliable metabolites, one metabolite (4-hydroxyhippurate) and one pattern of sex steroids were identified as biomarkers of incident hypertension independent of measured traditional risk factors. Metabolomic analyses such as these may identify novel biomarkers or pathways in the etiology of hypertension and point to new prevention strategies.
Abstract 030: Aspirin Use and Myocardial Infarction in HIV versus Non-HIV Patients
Authors: Suchindran Sujit , Regan Susan , Meigs James B , Grinspoon Steven K , Triant Virginia A
Published: July 2021

Introduction:
Myocardial infarction (MI) risk is increased among HIV populations, but the use of aspirin (ASA) for primary prevention of MI has not been investigated in this group.

Hypothesis:
We hypothesized that ASA use would be associated with a decreased risk of incident MI in both HIV and matched control patients.

Methods:
Patients who received care from the Partners HealthCare System in Boston between 2000 and 2009 without baseline coronary heart disease (CHD) were included. Non-HIV patients were matched to HIV patients by demographic factors, with 33,348 control and 3,698 HIV patients. To ascertain non-episodic ASA use, we developed an algorithm combining medication data and electronic health record free text search and validated it using medical record review. We used a definition of at least two ASA prescriptions, two text strings, or one of each, all occurring more than 30 days prior to MI (sensitivity 73%, specificity 83%, AUC 78%). We used Cox proportional hazard modeling to assess the association between ASA use and first MI within the HIV and control groups. We further assessed the effect of ASA in models stratified by cardiovascular risk (low CHD risk = 0-1 traditional risk factors, high CHD risk = 2 or more risk factors), to minimize potential confounding by indication.

Results:
ASA use was significantly lower in HIV compared to non-HIV patients in the overall groups (12.4% vs. 15.3%, p<0.001) and among men (13.1% vs. 17.3%, p<0.001) but not among women. The relative difference in the rates of ASA use between HIV and non-HIV was greater among patients at high CHD risk (22.1% vs. 42.4%, p<0.001) compared to patients at low CHD risk (5.5% vs. 6.7%, p=.037). Similar patterns were seen within each gender. In multivariate models adjusting for CHD and HIV-related factors, ASA use was not associated with decreased MI risk among HIV patients overall (HR 0.97, 95% confidence interval [CI] 0.64-1.49, p=0.90), by CHD risk category or by gender. In contrast, ASA use was associated with significantly decreased MI risk in the non-HIV group in models adjusted for traditional CHD risk factors, with a reduced hazard of 71% (95% CI: 66%-76%). Relative risk reduction for MI in the non-HIV group was more pronounced among patients with high underlying CHD risk (71% vs. 57% in low CHD risk) and among males (76% vs. 50% in females).

Conclusions:
ASA use was relatively lower in HIV compared to matched control patients, particularly among those with high underlying CHD risk. In contrast to non-HIV patients for whom ASA was significantly associated with decreased MI risk, ASA did not show this effect among HIV patients. Further studies will help to establish whether patients with HIV disease may represent a subgroup in which ASA is less effective for primary prevention of MI.
Abstract 039: A Comparison of Novel and Traditional Risk Factors for Cardiovascular Disease Across the Spectrum of Older Age: The Cardiovascular Health Study
Authors: Odden Michelle C , Shlipak Michael , Whitson Heather , Katz Ronit , Kearney Patricia , deFilippi Christopher , Shastri Shani , Sarnak Mark , Siscovick David , Cushman Mary , Psaty Bruce , Newman Anne
Published: July 2021

Introduction:
There is evidence that some traditional cardiovascular risk factors have weaker associations with outcomes in elderly adults; whereas, some novel risk factors appear important in old age. Whether the risk factors for cardiovascular disease differ in the oldest old compared with younger elders is uncertain.

Hypothesis:
The associations of traditional risk factors - systolic blood pressure, LDL-cholesterol, HDL-cholesterol, obesity, and diabetes - will be attenuated with age, whereas the associations of novel risk factors - kidney disease, inflammation, and cardiac stiffness - will be robust across older age.

Methods:
Participants in the Cardiovascular Health Study ≥65 years (n=4,853), were stratified into three age cohorts: 65-74, 75-84, 85+ years based on the age at the time of risk factor measure (baseline, 3, 7, or 16 years of follow-up). Proportional hazards models were used to assess the associations of the risk factors assessed at the most recent visit and a composite outcome of incident stroke, myocardial infarction, and cardiovascular death over 5 years.

Results:
There were 1,481 events. In adults 65-84 years, systolic blood pressure, HDL-cholesterol, diabetes, kidney disease, inflammation, and cardiac stiffness were associated with the composite outcome, after adjustment for demographic factors. In adults 85+ years, only the novel risk factors were associated with the outcome in demographic-adjusted analyses (Figure). In fully adjusted models, only inflammation was associated with the outcome across the age spectrum. HDL-cholesterol was independently associated with the outcome in adults <75 years; systolic blood pressure, diabetes, cardiac stiffness, and kidney disease were associated with the outcome in adults <85 years.

Conclusions:
The associations of traditional risk factors with cardiovascular outcomes appear attenuated in adults ≥85 years; this could impact optimal prevention strategies in the oldest old. Inflammation is a robust risk factor across the spectrum of old age.
Abstract 046: Excessive Gain in BMI Between Age 7-16 is Related to Cardiovascular Disease Risk in Adulthood: A Longitudinal Study
Authors: Steinberger Julia , Sinaiko Alan R , Jacobs David R , Dengel Donald R , Zhou Xia , Moran Antoinette , Steffen Lyn M
Published: July 2021

Obesity in childhood has been shown to promote adult obesity and the development of cardiovascular disease (CVD) risk. However, little longitudinal information exists on the rate of progression of adiposity during childhood as a predictor of adult insulin resistance and markers of CVD risk. We hypothesize that excessive adiposity in childhood and adolescence predicts adult individual CV risk factors, insulin resistance and vascular changes.

Children (n=383 mean age 7 yrs), were measured periodically for height, weight and blood pressure through adolescence. As adults (n=383, mean age 39 y, 50% female), height, weight, lipids, insulin resistance and carotid intima-media thickness (cIMT) were measured. Body mass index (BMI) categories (normal, overweight, and obese) were created by standard criteria. According to the CDC BMI growth charts, the normal mean change in BMI from age 7-16 at the 50th percentile is 5 kg/m
2
. Linear regression evaluated the influence of excessive weight gain in childhood on the development of adverse CVD risk factors in adulthood stratifying by 50 percentile change in BMI (≤5kg/m
2
vs >5kg/m
2
) between childhood and adolescence, adjusting for confounding factors.

Of 313 normal weight children, 32% stayed normal weight, 68% became overweight and obese in adulthood. Of 45 overweight children 90% stayed overweight or became obese in adulthood. Of 25 obese children 100% became overweight and stayed obese in adulthood. Compared to ≤5kg/m
2
, a BMI gain of >5 kg/m
2
between childhood and adolescence was more common in blacks than in whites and was associated with greater CV risk in adulthood: greater % obesity; higher blood pressure, lipids, insulin resistance (M/lbm=insulin sensitivity) and cIMT (Table).

These findings show that: 1) childhood adiposity is a strong predictor of adult overweight and obesity, and 2) excessive BMI gain between childhood and adolescence is a major determinant of obesity and CVD risk in adulthood.
Abstract MP01: Healthy Lifestyle Factors and Risk of Heart Failure in the Women’s Health Initiative Observational Study
Authors: Agha Golareh , Loucks Eric B , Tinker Lesley , Waring Molly E , Michaud Dominique , Foraker Randi E , Li Wenjun , Martin Lisa W , Greenland Philip , Manson JoAnn E , Eaton Charles B
Published: July 2021

BACKGROUND:
A healthy lifestyle (not smoking, regular exercise, a healthy diet, and a healthy weight) has been shown to be associated with lower risk of coronary heart disease, stroke, and cardiovascular disease mortality. Little is known about the impact of a healthy lifestyle on risk of heart failure (HF).

OBJECTIVE:
To evaluate the effect of a combination of healthy lifestyle factors on incident HF.

METHODS:
Participants included 85,048 post-menopausal women from the Women’s Health Initiative (WHI) Observational Study, aged 50-79, who were free of HF at baseline and had a body mass index (BMI) ≥ 18.5 kg/m
2
. Lifestyle factors, assessed at baseline, were: Smoking (never, former, current), physical activity (inactive, somewhat active, active), Alternate Healthy Eating index (AHEI)- a composite numerical index of dietary quality, and BMI. A healthy lifestyle was defined by the following 4 criteria: never smoking, active, high-scoring AHEI (top 40% of the index), and a healthy weight (BMI < 25 kg/m
2
). Women received 1 point for every healthy lifestyle criterion met, with a possible range of 0-4 points. Self-reported HF was followed up by clinical adjudication using standardized methodology. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS:
There were 1826 cases of HF during a mean follow-up of 11 years. Individually, all 4 healthy lifestyle factors were significantly and independently associated with a decreased risk of HF, in a graded fashion (For example: HR = 0.68 {95% CI: 0.60,0.78} for active vs. inactive; HR=0.77 {95% CI: 0.68,0.88} for somewhat active vs. inactive). In analyses on the combination of healthy lifestyle factors, an increasing number of healthy lifestyle points was significantly associated with decreased risk of HF in multivariable-adjusted models (
Table
).

CONCLUSION:
Among a diverse US sample of post-menopausal women, an inverse and graded association was observed between number of healthy lifestyle factors and risk of HF.
Abstract MP03: Epidemiology of Hospitalized Heart Failure Patients with Preserved Ejection Fraction: The ARIC Heart Failure Surveillance Project
Authors: Agarwal Sunil K , Liu Xiaoxi , Wruck Lisa M , Chang Patricia P , Russell Stuart D , Deswal Anita , Shah Amil , Fox Ervin , Kitzman Dalane , Soloman Scott D , Coresh Josef , Heiss Gerardo , Rosamond Wayne
Published: July 2021

Background
Despite the high burden of heart failure with preserved ejection fraction (HFpEF), information about its epidemiology is limited. We describe the population distribution of HFpEF according to criteria commonly used to ascertain heart failure (HF) and compare the characteristics and outcomes of patients with HFpEF to those with HF with reduced ejection fraction (HFrEF).

Methods
From the Atherosclerosis Risk in Communities (ARIC) HF surveillance of 21 hospitals in four US communities during 2005-2008, potential HF events were sampled based on ICD discharge codes from patients ages 55 years and older, . Trained study personnel abstracted charts (unweighted n =4784), and the presence of HF was determined both by computerized classification and by a panel of standardized physicians. Left ventricular ejection fraction (EF) was missing in 19%; HFpEF was defined as HF with EF ≥ 50%. All statistical analyses incorporated sampling weights. A multivariable logistic model of the probability of HFpEF was developed using variables associated with HFpEF in univariate analyses (p<0.2).

Results
The proportion of the hospitalized HF patients with HFpEF varied only slightly according to HF classification schema: NHANES (49%), Modified Boston (48%), Framingham (47%), ‘2008 Consensus criteria’ (44%), and ARIC review panel (43%). The following characteristics were independently associated with HFpEF (Odds Ratio and 95% Confidence Interval): female (2.28; 1.87, 2.82), history of sleep apnea (1.90; 1.30, 2.77), systolic blood pressure (1.08; 1.05, 1.12) per 10 mm of Hg increase), atrial fibrillation (1.29 (1.03, 1.61), heart rate (0.91; 0.87, 0.95 per 10 beats per minute increase), paroxysmal nocturnal dyspnea (0.70; 0.54, 0.92), and study community.

Length of hospital stay was comparable for HFpEF and HFrEF patients (median = 5 days, p for geometric mean = 0.76). Absolute mortality at one-year was 4.4% lower among HFpEF compared to HFrEF (12.3% vs. 16.7%, p<0.05) with age, gender, and race adjusted case fatality OR= 0.75 (95% CI 0.56, 0.99).

Conclusions
The proportion of patients with HFpEF among HF patients hospitalized in 2005-2008 varied from 43 to 49% according to the main published HF classification schema. HFpEF patients had a similar length of hospital stay but lower one-year case fatality than those with HFrEF. These results support increasing efforts to better characterize HFpEF and its course to reduce the total burden of HF.
Abstract MP14: Long-chain Monounsaturated Fatty Acids and Incidence of Coronary Heart Disease: The Cardiovascular Health Study
Authors: Imamura Fumiaki , Lemaitre Rozenn N , King Irena , Song Xiaoling , Siscovick David S , Mozaffarian Dariush
Published: July 2021

Background:
Decades-old animal experiments demonstrated that consumption of large amounts of long-chain monounsaturated fatty acids (LCMUFA, 22:1 and 24:1 fatty acids) caused cardiotoxicity. We recently found that plasma phospholipid 22:1 and 24:1 were associated with higher incidence of congestive heart failure (CHF) in two independent cohorts: the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities Study. However, their association with incident CHD is unknown.

Aim:
to investigate association of plasma phospholipid 22:1 and 24:1 levels with incident CHD.

Methods:
The study included 3,221 adults free of CHD (age=74.9±5.2) in CHS in whom plasma phospholipid LCMUFA were measured in 1992. Incident CHD events from 1992 to 2006 were centrally adjudicated, and we assessed total CHD, including fatal CHD (fatal MI and other CHD deaths) and non-fatal MI. We examined prospective associations of LCMUFA with incident CHD using Cox proportional hazards. We further evaluated potential confounding or mediation by baseline risk factors and incident CHF.

Results:
Mean±SD phospholipid levels of 22:1 and 24:1 were 0.03±0.01 and 1.96±0.44 percent of total fatty acids. During 34,776 person-years, 628 incident CHD events occurred, including 309 fatal CHD and 401 non-fatal MIs. After multivariable adjustment, higher levels of both 22:1 and 24:1 were associated with higher risk of total incident CHD. Hazard ratios (95% CI) for quintiles 5 vs. 1 of 22:1 and 24:1 levels were 1.48 (1.07-2.06, p trend=0.005) and 1.65 (1.16-2.34, p trend=0.001). The associations with CHD were largely specific to fatal CHD rather than non-fatal MI (Figure). These associations did not change after adjustment for incident CHF and baseline risk factors including circulating lipids, blood pressure, and inflammatory markers.

Conclusions:
Higher levels of circulating 22:1 and 24:1 LCMUFA were associated with higher incidence of CHD, in particular fatal CHD, supporting the possibility of cardiotoxicity by current levels of LCMUFA exposure.
Abstract MP39: A Multi-component Intervention Increased Physical Activity in Preschool Children
Authors: Pate Russell R , Brown William H , Saunders Ruth , Pfeiffer Karin A , Dowda Marsha
Published: July 2021

Introduction:
A majority of preschool-age children spend a significant portion of every weekday in a preschool or child care setting. Studies have shown that children in these settings spend a majority of their time in sedentary behavior and very little time in physical activity.

Hypothesis:
A multi-component preschool physical activity intervention will increase the amount of time young children spend in moderate-to-vigorous physical activity (MVPA) and decrease the time they spend in sedentary activities, compared to children in control preschools.

Methods:
The study included 16 preschools with 4-year-old classrooms, paired and randomly assigned to intervention and control groups. The intervention focused on increasing children’s physical activity by changing instructional practices and the classroom environment. Research staff trained preschool teachers to engage children in physical activity throughout the school day and provided physical activity materials, ongoing support and technical assistance. Intervention components included physical activity opportunities in the classroom, physical activity outdoors, and active lessons. The intervention was designed to be flexible, and research staff encouraged teachers to adapt it to their classroom environment. Four-year-old children and their parents were recruited in two waves at each school. Measures included child height and weight, child physical activity by accelerometry, and parent questionnaires, measured during the fall and spring of each wave. Mixed model analysis of covariance with preschool as a random variable tested the effects of the intervention on physical activity in the total group and by sex.

Results:
A total of 379 children (188 intervention and 191 control) were measured at baseline. Children were 4.5±0.4 years of age, and 50% were boys. The intervention schools included a higher percentage of white children compared to the control schools (44.2% versus 39.3%). After adjusting for wave, parent education and length of the school day (half day vs. full day), children in the intervention schools engaged in significantly more MVPA than children in the control schools (7.4±0.2 and 6.7±0.2 minutes/hour, respectively). In the sex-specific analyses, differences between intervention and control were significant for girls (6.9±02 vs. 6.1±0.2 minutes/hour of MVPA, respectively) but not for boys (7.8±03 vs. 7.3±0.3 minutes/hour, respectively). No differences in time spent in sedentary behavior were observed between intervention and control preschools.

Conclusions:
In conclusion, a flexible, multi-component physical activity intervention that trains teachers to provide children with opportunities to be active throughout the school day increased MVPA in preschool children.
Abstract MP40: A Steps/Day Translation of the Moderate-to-Vigorous Physical Activity Guideline for Children and Adolescents
Authors: Adams Marc A , Johnson William D , Tudor-Locke Catrine
Published: July 2021

Background:
An evidence-based steps/day translation of U.S. federal guidelines for youth to engage in ≥60 minutes/day of moderate-to-vigorous physical activity (MVPA) would help health researchers, medical practitioners, and lay professionals charged with increasing youth’s physical activity (PA). The purpose of this study was to determine the number of free-living steps/day (both raw and adjusted to a pedometer scale) that correctly classified children (6-11 years) and adolescents (12-17 years) as meeting the 60-minute MVPA guideline using the 2005-2006 National Health and Nutrition Examination Survey (NHANES) accelerometer data, and to evaluate the 12,000 steps/day recommendation recently adopted by the President’s Challenge Physical Activity and Fitness Awards Program.

Methods:
NHANES children (n=915) and adolescents (n= 1,302) were included in this analysis. Receiver Operating Characteristic (ROC) curve plots and classification statistics (i.e., false positive and negatives, positive and negative predictive values) revealed candidate steps/day cut points that discriminated meeting/not meeting the MVPA threshold by age group, gender and different accelerometer activity cut points. The Evenson cut point and two Freedson age-specific (3 and 4 METs) cut points were used to define minimum MVPA, and optimal steps/day were examined for raw steps and adjusted to a pedometer-scale to facilitate translation to lay populations.

Results:
For boys and girls (6-11 years) with ≥ 60 minutes/day of MVPA, a range of 11,500-13,500 raw steps/day for children was the optimal range that balanced classification errors. For adolescent boys and girls (12-17) with ≥60 minutes/day of MVPA, 11,500-14,000 raw steps/day was optimal. Translation to a pedometer-scaling reduced these minimum values by 2,500 step/day to 9,000 steps/day. Area under the curve was ≥84% in all analyses.

Conclusions:
A persistent question in the physical activity literature has been “How many steps/day are enough?” No single study has definitively identified a precise and unyielding steps/day value for youth. Considering the other evidence to date, we propose a reasonable ‘rule of thumb’ value of ≥ 11,500 steps/day for both children and adolescents (and both genders), accepting that more MVPA is better. For practical applications, 9,000 steps/day appears to be a more pedometer-friendly value. These steps/day values provide a marker that medical practitioners and lay professionals can use in clinical settings to estimate and increase youth’s moderate-to-vigorous physical activity.
Abstract MP58: Type 2 Diabetes Prediction with 17-, 40-, and 62-variant Genotype Risk Scores: The Framingham Offspring Study
Authors: Vassy Jason L , Porneala Bianca , Florez Jose C , Dupuis Josée , Meigs James B
Published: July 2021

Background
A recent genome-wide association study (GWAS) meta-analysis for type 2 diabetes (T2D) increased by 50% the number of common T2D-associated single-nucleotide polymorphisms (SNPs). We hypothesized that a genotype risk score (GRS) consisting of more SNPs improves T2D prediction achieved by published 17-SNP and 40-SNP scores.

Methods
We used data from four 8-year periods of the Framingham Offspring Study to test the association between effect-weighted 17-SNP, 40-SNP, and 62-SNP GRSs and incident T2D, defined by medication use and fasting glucose criteria. We used pooled logistic regression models with generalized estimating equations adjusted for 1) age and sex and 2) age, sex, parental T2D, BMI, systolic blood pressure, fasting glucose, HDL cholesterol, and triglyceride levels. Model improvement by the addition of each GRS was assessed with C statistics, integrated discrimination improvement (IDI) indices, and net reclassification improvement (NRI) indices with category thresholds at 2% and 8% cumulative incidence.

Results
Mean baseline age was 46, and 46.5% were men. There were 446 cases of incident T2D among 11,358 person-exams. In all models, the inclusion of a GRS resulted in significant T2D risk reclassification (NRI range 22.3-29.8%, see Table). The inclusion of a greater number of SNPs in the GRS increased the C statistics and relative IDI of the age- and sex-adjusted model, but the 62-SNP GRS did not result in a higher NRI than the 40-SNP GRS (28.6% vs. 29.8%). Similarly, the 62-SNP score did not result in a higher NRI for the fully adjusted clinical model than the 40-SNP score (25.6% vs. 29.0%).

Conclusions
A GRS of common susceptibility SNPs from GWAS improves T2D risk reclassification in a prospective study of adults, but incorporating a greater number of SNPs with smaller individual effect sizes may not result in additional reclassification improvement. Further advances in genotype prediction of T2D may require the identification and incorporation of functional risk variants putatively tagged by GWAS SNPs.
Abstract MP82: Body Mass Index and Mortality in Chinese Adults with Newly Diagnosed Type 2 Diabetes
Authors: Mueller Noel T , Odegaard Andrew O , Koh Woon-Puay , Gross Myron D , Yuan Jian-Min , Pereira Mark A
Published: July 2021

In Western populations normal weight adults at the time of incident type 2 diabetes (T2D) diagnosis have been reported to have higher mortality risk than overweight/obese adults. However, little investigation of this topic has occurred in Asian populations who tend to have relatively low body mass index (BMI = kg/m2) yet high rates of T2D. We investigated the association between BMI, reported prior to diagnosis of T2D, and mortality risk among a cohort of Chinese adults with T2D.We used data from the Singapore Chinese Health Study, including Chinese men and women aged 45-74 years of age, free of cancer, heart disease, stroke, and T2D at baseline (1993-1998), and followed for mortality through 2011. A total of 4,288 participants, contributing 57,220 person-years of follow-up, reported physician diagnosed incident T2D at two follow up interviews and reported height and weight at the previous interview, an average of 4.4 years prior to T2D diagnosis. Participants were classified according to WHO Asian-specific definitions as underweight (BMI <18.5), normal weight (18.5-23.49), overweight (23.5-27.49), and obese (≥ 27.5).During an average follow-up of 13.3 years, 470 of the 4,288 participants died: 159 from cardiovascular (CVD) causes and 311 from other causes. After adjustment for demographics, smoking status and alcohol consumption, there were no statistically significant differences in mortality rates across the BMI categories. However, the BMI-mortality association varied markedly by age. Among those who were ≤65 years of age, obesity, compared to normal weight, carried an increased risk of total mortality by 41% (4% to 92%) and of CVD mortality by 56% (-9% to 166%). However, among those >65 years of age we observed no association between BMI and mortality risk. Among Singaporean Chinese adults with type 2 diabetes, being obese prior to diagnosis was associated with increased risk of death in those who were ≤65 years of age, whereas among those >65 years there was no clear association between BMI and risk of mortality.
Abstract MP90: Association of Sleep Duration and Quality with Incident Diabetes: Coronary Artery Risk Development in Young Adults Sleep Study
Authors: Carnethon Mercedes R , De Chavez Peter John D , Lauderdale Diane S , Carson April P , Liu Kiang , Knutson Kristen L
Published: July 2021

Background:
Most prior longitudinal studies investigating the association of sleep characteristics with incident diabetes are based on self-reported sleep duration and quality. However, self-reported sleep is prone to differential error that is based on the amount of actual sleep that a person gets.

Objective:
To test whether objectively-measured sleep duration and quality or self-reported sleepiness were associated with the development of diabetes in a population sample.

Methods:
Participants from the Chicago, IL center of the CARDIA study who wore wrist actigraphs (Actiwatch
TM
) twice between 2003-2005 and who were free from diabetes in 2000-2001 were included in the analysis (n=594). The following sleep parameters were averaged over 6 days: sleep duration, sleep maintenance (percentage of sleep period actually sleeping) and minutes of wake after sleep onset (WASO). The Epworth Sleepiness Scale (ESS) assessed daytime sleepiness; higher scores reflect more sleepiness. Diabetes was determined based on fasting glucose >126 mg/dL, medication use, post-load glucose >200 mg/dL or Hemoglobin A1c >6.5% during examinations in 2005-2006 and 2010-2011.

Results:
Participants were 40.1 years old (SD=3.6), average sleep duration was 365.8 min (SD=64.3), sleep maintenance was 88.9% (SD=5.4), WASO was 46.0 min (SD=24.0) and the ESS was 7.5 (SD=4.3). Over ~10 years, 68 participants (11.4%) developed diabetes. Each sleep measure was associated with diabetes incidence in unadjusted models; however, only the association with daytime sleepiness remained significant following adjustment for demographic characteristics and diabetes risk factors.

Conclusions:
Self-reported daytime sleepiness is a straightforward measurement of sleep quality that can identify adults at risk for diabetes. Although objective measures of sleep duration and quality are associated with incident diabetes, the association is entirely explained by demographic characteristics.
Abstract P045: Differential Associations of Inflammation and Cognitive Function in African and European Americans
Authors: Simpson Brittany N , Griswold Michael E , Bridges John M , Peyser Patricia A , Bielak Lawrence F , Turner Stephen T , Mosley Thomas H , Windham Beverly G
Published: July 2021

Dementia affects approximately 5 million people in the United States and cost $183 billion in 2011, with African Americans (AA) experiencing a disproportionate burden of dementia compared to European Americans (EA). Inflammation is considered by many to be a potential mediator in the development of cognitive dysfunction. High sensitivity C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α), increasingly measured by the soluble TNF receptors 1 & 2 (sTNFRI1, sTNFR2), are among the most frequently cited inflammatory markers associated with dementia and are also elevated in vascular disease. Few studies have compared associations of inflammatory markers with cognitive function in EA and AA. We examined the association of CRP, sTNFR1 and sTNFR2 with cognitive function using detailed neuropsychological assessments in the Genetic Epidemiology Network of Arteriopathy (GENOA)-Genetics of Microangiopathic Brain Injury (GMBI) participants, a cohort considered at high risk of vascular disease due to family history (> 2 individuals in sibships with hypertension at age <60 years) and high prevalence rates of hypertension (74%), diabetes (27%), and obesity (51%). Cognitive function was measured across 5 cognitive domains: global cognitive function, processing speed, language, memory, and executive function. In AA, higher sTNFR2 was associated with poorer performance across all five domains. Higher sTNFR1 and CRP were associated with slower processing speed. In EA, higher sTNFR1 was associated with slower processing speed. CRP and sTNFR2 were not associated with cognitive function in EA. Inflammatory markers in this cohort were associated differentially across cognitive domains in AA and EA, and may reflect racial differences in vascular responses to inflammation.