bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P187: Pre-kidney Transplant Medical Arterial Calcification as a Risk for Post-transplant Mortality by a Propensity Score Weighting Analysis
Authors: Tantisattamo Ekamol , Leelaviwat Natnicha , Lopimpisuth Chawit , Saowapa Sakditad , Polpichai Natchaya , Vutthikraivit Possawat
Published: March 2020

Introduction:
Medial arterial calcification (MAC) detected in the breast by mammography (MG) is exclusively medial and associated with cardiovascular mortality in end-stage renal disease (ESRD). This association is unclear in renal transplant recipients (RTR).

Hypothesis:
By comparing groups of study population balanced by propensity score weighting method, MAC is associated with an increased risk of post-transplant mortality.

Methods:
Female RTR was divided into 2 groups per presence or absence of pre-transplant MAC examined from MG (MAC and non-MAC), and both groups was balanced with by PS weighting leading to a new study population. Association between MAC and post-transplant mortality of the new study population was examined by multi-variable logistic regression analysis.

Results:
Of 51 patients, mean age±SD was 57.08±10.47 years old. The majority were white (54.9%) followed by African American (35.3%) and others (9.8%). Incidence rate of mortality was 0.0307 person-years. Median time to follow-up was 3.95 years (range 0.22 to 6.37). Among 20 patients in MAC group, 5 patients died; whereas, only 1 out of 31 patients in non-MAC died (25% vs. 3.23%, p 0.029). Baseline characteristics of both groups were not equal. After using PS weights with generalized boosted modeling, new study population’s characteristics were balanced (Figure 1). MAC is associated with 5.97 times higer the odd of morality compared to non-MAC, but the association was not significant (OR 5.97; 95%CI 0.61, 58.77). After adjusted for age, race, causes of ESRD, dialysis modality, dialysis vintage, donor type, donor age, and type of immunosuppressive medications, the magnitude of the association was increased and becomes significant (OR 38.40; 95%CI 2.44, 604.54).

Conclusions:
Similar to ESRD, MAC remains associated with higher mortality in RTR and this association is confirmed by well-matched study population. Prevention of pre-transplant MAC should be pursued to mitigate poor post-transplant outcomes.
Abstract P191: Metabolites Associated With Coffee Consumption and Incident Chronic Kidney Disease
Authors: He William , Chen Jingsha , Hu Emily , Yu Bing , Grams Morgan , Parikh Chirag , Boerwinkle Eric , Coresh Josef , Rebholz Casey M
Published: March 2020

Introduction:
Several studies have found moderate coffee consumption to be inversely associated with chronic kidney disease (CKD), however the biological mechanisms underlying this benefit are unclear. Metabolomic studies allow for the characterization of metabolites in biological specimens and are useful for detecting biomarkers of coffee consumption and metabolic pathways underlying the association between coffee and CKD.

Hypothesis:
We hypothesized that metabolites altered by coffee consumption would be associated with CKD incidence.

Methods:
A total of 3,809 African-American and Caucasian ARIC study participants had measurements of serum metabolites: 373 metabolites in sample 1 and 758 metabolites in sample 2. Linear regression models were used to estimate cross-sectional associations between metabolites and average cups of coffee consumed per day. Cox regression models were used to estimate associations between coffee metabolites and incident CKD.

Results:
In sample 1, 13 metabolites were significantly and positively associated with coffee consumption (p<0.05/373=1.3х10
-4
), one of which (hippurate) was inversely associated with incident CKD (
Table
). In sample 2, 29 metabolites were positively associated and 20 were negatively associated with coffee consumption (p<0.05/758=6.6х10
-5
). All 13 metabolites detected in sample 1 were also significantly associated with coffee in sample 2. Higher levels of three metabolites (O-sulfo-L-tyrosine, erythritol, and N-acetylserine) were associated with lower intake of coffee and higher risk of incident CKD.

Conclusions:
We detected 13 candidate biomarkers of coffee consumption that replicated across two samples. Four metabolites, consisting of a food component (erythritol), chemical (O-sulfo-L-tyrosine), and compounds that are involved in the metabolism of benzoate (hippurate), glycine, serine, and threonine (N-acetylserine), may play contribute to the favorable health outcomes observed with coffee consumption.
Abstract P196: Personalized Dynamical System Models Of Individual Text Message Effects On Changes In Physical Activity
Authors: Hojjatinia Sarah , Lagoa Constantino M , West Ashley B , Hojjatinia Sahar , Turrisi Taylor , Brunke-Reese Deborah , Conroy David E
Published: March 2020

Introduction:
Text-message interventions with universal decision rules (treatment algorithms) demonstrate modest and inconsistent effects on physical activity. Efforts to increase effect sizes by targeting, tailoring or generically customizing content have largely been unsuccessful. In this study, system identification methods from control systems engineering were applied to develop person-specific dynamical models of individual responses to motivational text messages.

Methods:
Emerging adults not meeting aerobic physical activity guidelines (verified by accelerometer during a 1-week run-in period) received 0-6 messages/day while wearing a Fitbit Versa watch for 3 months. Experimental messages targeted cognitive or affective determinants of physical activity (move more) or sedentary behavior (sit less); comparator messages were inspirational quotes. For each participant, two dynamical models were estimated using difference equations: one to model the effects of move more and sit less messages and the other to model the effects of affectively- and cognitively-targeted messages. Both models included comparator messages. Effects represent the expected change in behavior immediately after message receipt (vs expected behavior without a message). Model order was determined individually to balance uncertainty and overfitting (range = 2-9).

Results:
The sample (n = 20) was mostly female (60%), White (65%), and not Hispanic or Latino (95%) with a mean age of 24.4 years (SD = 3.3; range = 19-29). Idiographic patterns of behavior change were readily observed from the personalized dynamical models. Most participants’ step counts increased after messages to move more (60% of participants’ responses exceeded the 95% error interval [responders], M = 94.3 steps; 83% of responders increased steps) and sit less (50% responders, M = 114.6 steps; 90% of responders increased steps), as well as control messages (75% responders, M = 59.5 steps; 60% of responders increased steps). Step counts also increased after messages targeting cognitive determinants (80% responders, M = 97.1 steps; 75% of responders increased steps) and affective determinants (75% responders, M = 52.9 steps, 67% of responders increased steps), as well as control messages (75% responders, M = 57.8 steps; 60% of responders increased steps).

Conclusions:
Motivational text messages can alter physical activity dynamics, and responses to different message types are highly personalized. Among responders, most message types increased expected step counts but some messages were iatrogenic and decreased expected step counts. Computational models of those dynamics provide a foundation for personalizing decision rules to select the type and time the delivery of messages to promote physical activity and improve cardiovascular health.
Abstract P203: Dietary Magnesium, C-reactive Protein and Interleukin-6: The Strong Heart Family Study
Authors: Rao Nandana , Lemaitre Rozenn , Sitlani Colleen , Umans Jason G , BEST Lyle G , Fretts Amanda M
Published: March 2020

Background:
Both experimental animal and human observational studies have suggested that magnesium (Mg) deficiency influences systemic inflammation. Whether this association is modified by genes associated with Mg metabolism and transport is unknown.

Objective:
To examine associations of reported Mg intake, and the interaction of reported Mg intake with a single nucleotide polymorphisms (SNP) related to Mg metabolism and transport, on serum markers of inflammation (i.e., C-reactive protein (CRP) and interleukin 6 (IL-6)).

Methods:
This cross-sectional study included 1,924 participants from the Strong Heart Family Study—a study of risk factors for cardiovascular diseases among American Indians (AIs) from 12 communities in the United States. Intake of Mg from foods and dietary supplements was ascertained using a 119-item Block food frequency questionnaire. Serum hsCRP and IL-6 were measured from blood collected after a 12-hour fast, and candidate SNP (rs3740393) was genotyped using MetaboChip. Generalized estimating equations, with clusters defined by family membership, were used to examine associations of Mg intake, and the interaction of rs3740393 with estimated dietary Mg, on CRP and IL-6.

Results:
FFQ-estimated Mg intake was not associated with CRP or IL-6. We observed no interaction of reported Mg intake with rs3740393 on CRP (p-interaction=0.70). However, we observed an interaction (p-interaction=0.018) of reported Mg intake with rs3740393 on IL-6. (Table).

Conclusion:
Reported Mg intake is inversely associated with serum IL-6 among carriers of the C allele at rs3740393. Future research is necessary to replicate this finding, and to examine other Mg-related genes that may influence associations of Mg intake or sufficiency with inflammation.
Abstract P212: Depressive Symptoms Mediate the Relationship Between Dispositional Mindfulness and Diet Quality Among Healthy Midlife Adults
Authors: Donofry Shannon D , Erickson Kirk I , Levine Michele D , Gianaros Peter , Muldoon Matthew F , Manuck Stephen B
Published: March 2020

Background:
Emerging evidence suggests that mindfulness, a practice of non-judgmental awareness of present experience, may reduce eating psychopathology and emotion-driven eating. However, few studies have explored the relationship between dispositional mindfulness and diet quality or sought to identify factors that mediate the effect of dispositional mindfulness on diet quality.

Methods:
Community-dwelling midlife participants (
N
= 406;

M
age

= 43.19,
SD
= 7.26;

M
BMI

= 27.08,
SD
= 5.28; 52% female) reported dispositional mindfulness using the Mindful Attention Awareness Scale, depressive symptoms using the Center for Epidemiological Studies Depression Scale, and perceived stress using the Perceived Stress Scale. Dietary intake was assessed using the Block Food Frequency Questionnaire, from which the 2015 Healthy Eating Index (HEI) was derived. Direct and mediating effects of dispositional mindfulness, depressive symptoms, and perceived stress on overall HEI scores were analyzed using the mediation package in R with bias-corrected bootstrapped confidence intervals (BootCI). Age, sex, education and BMI were entered as covariates in all models.

Results:
Higher dispositional mindfulness was associated with higher diet quality (
β
= 0.095,
p
= 0.04). Depressive symptoms significantly mediated the relationship between dispositional mindfulness and overall diet quality (average causal mediation effect [ACME] = 0.6962, BootCI = 0.104-1.42,
p
= 0.03) such that higher mindfulness was associated with higher overall diet quality through lower depressive symptoms. Perceived stress was significantly negatively correlated with dispositional mindfulness (
β
= -0.310,
p
<0.01) but was not related to diet quality (
β
= -0.039,
p
= 0.44) and therefore did not mediate the relationship between mindfulness and diet quality (ACME = 0.173, BootCI = -0.261-0.65,
p
= 0.46).

Conclusions:
These cross-sectional data provide initial evidence that dispositional mindfulness may relate to diet quality among midlife adults, an effect that may be explained in part by lesser depressive symptomatology. Given that lifestyle behaviors in midlife are leading determinants of risk for cardiovascular and neurocognitive disease in late life, interventions targeted at enhancing mindfulness in midlife may plausibly mitigate disease risk. Additional research assessing the impact of mindfulness interventions on diet quality are warranted.
Abstract P219: The Vast Majority of People Who Eat “Gluten Free” for IBS, Celiac, or Autoimmune Disease Have Markers of Leaky Gut That Resolve When “Gluten Free” Foods Containing Lectins, Like Corn, Other Grains, Beans, and Nightshades are Removed From Their Diet
Authors: Gundry Steven R
Published: March 2020

Initial evaluation of pts referred with Irritable Bowel Syndrome, Celiac, and/or autoimmune diseases includes Celiac HLA genetics, Celiac IgA and IgG markers, and autoimmune markers. Most patients are self described as eating a gluten free diet. Increasingly, and with more affordable tests being made available, we have started to use a battery of tests for leaky gut, wheat, corn, lectin, dairy, and egg proteins reactivity/sensitivity from Vibrant Wellness (San Carlos, Ca) called Zoomers.

Leaky gut was determined by Anti-Zonulin IgG and IgA, Anti-Actin IgG and IgA; Wheat sensitivity panels included Transglutaminase, Wheat Germ Agglutinin, Gliadin, Glutenin, and Non-gluten wheat protein IgG and IgA panels. All corn proteins, including the wheat-corn epitope overlap and the GMO Cry proteins IgG and IgA, as well as IgG and IgA reactions to major lectins and aquaporins in beans, squash, spinach, nightshades, corn, and to protein components of dairy and eggs.

We now report results on the first 50 patients, ages 7-76, M:F ratio 1:1, who, following these initial tests, started the lectin limited diet, The Plant Paradox.

Results:
100% of pts were positive for leaky gut (50/50). Forty nine of 50 (98%) were reactive to more than one component of wheat, although only 35/50 (70%) where positive for HLA gluten genes. Seventy percent of pts (35/50) were sensitive to the corn-wheat cross reaction epitope, while 31/50 (62%) reacted to the GMO cry corn protein. Forty nine of 50 (98%) reacted to one or more bean lectins, while 38/50 (76%) reacted to one or more aquaporins in soy, spinach, corn, potatoes, bell peppers. While sensitivities to dairy and egg proteins did occur, they were rare compared to the above proteins.

Retesting has been done in 11 of 50 pts, 2 to 9 months following the first test. Resolution of leaky gut occurred in 10/11 (91%), and reactivity to all wheat proteins as measured by IgG and IgA disappeared, indicating tolerance.

We conclude that most patients following a gluten free diet still have leaky gut with both gluten and wheat antibodies, all of which resolve when a lectin free diet is followed.
Abstract P220: Obesity in the Italian Adult Population: Preliminary Results of the 2018-2019 Cuore Project-health Examination Survey
Authors: Donfrancesco Chiara , Lo Noce Cinzia , Profumo Elisabetta , Buttari Brigitta , Minutoli Daniela , Di Lonardo Anna , Vannucchi Serena , Bellisario Paolo , Giampaoli Simona , Strazzullo Pasquale , Palmieri Luigi
Published: March 2020

Introduction:
Obesity is associated to an increased risk of hypertension, non-communicable diseases (NCDs), such as diabetes, coronary heart disease, stroke, and cancers, and conditions including obstructive sleep apnoea and osteoarthritis. Obesity is largely preventable and one of the WHO Global Action Plan for the Prevention of NCDs targets is to halt its rise.

Hypothesis:
Between 2000 and 2016, obesity trends showed a steady increase in all WHO regions and income groups. This preliminary analysis aims to assess mean level of BMI and prevalence of obesity in the Italian general adult population using the data collected within the CUORE Project-health examination survey.

Methods:
Within the ongoing survey started in 2018, mean of BMI and prevalence of obesity (BMI>=30 kg/m
2
) and overweight (25<=BMI<30 kg/m
2
) were assessed in random samples of resident population, aged 35-74 years, stratified by age and sex (men 822 and women 869), from 8 Italian Regions in Northern, Central and Southern Italy. Weight and height were measured using standardized methodologies. A standardized questionnaire was used to collect data on education and physical inactivity. The survey is funded by the Italian Ministry of Health-CCM.

Results:
Mean values of BMI resulted 26.8 kg/m
2
(95% C.I. 26.5-27.1) in men and 25.9 kg/m
2
(25.6-26.3) in women. Prevalence of obesity was 19.0% (16.3-21.7) in men and 21.7% (19.0-24.5) in women; prevalence of overweight was 44.5% (41.1-47.9) in men and 28.4% (25.4-31.4) in women. Obesity levels resulted significantly higher in persons with lower education (primary or high school) vs those with higher level of education: 25.6% (20.0-31.1) vs 16.0% (13.0-19.0) in men and 32.5% (27.0-37.9) vs 16.7% (13.6-19.7) in women. Prevalence of physical inactivity during leisure time was 31.9 % (28.7-35.1) in men and 41.4% (38.2-44.7) in women. Both in men and women the prevalence of obesity was significantly higher in the Southern regions, likewise physical inactivity.

Conclusions:
Preliminary data of the first 8 Regions (out of 10 to be examined in the on-going survey) underline that more than half of Italian adults are in excess of weight. In comparison to data measured within the CUORE Project 10 years earlier, a slight increasing of normal weight men seems to occur moving in the direction of the WHO-NCDs obesity target.
Abstract P231: Physical Activity and Sedentary Behavior Trajectories During Pregnancy and Postpartum Blood Pressure
Authors: Lane-Cordova Abbi , Jones Melissa , Catov Janet M , Barone Gibbs Bethany
Published: March 2020

Background:
Pregnancy influences longer-term vascular health for women. Moderate-vigorous physical activity (MVPA) and sedentary behavior (SED) have been associated with blood pressure (BP) in non-pregnant adults. Self-reported pregnancy MVPA has been associated with less risk of hypertension during pregnancy, but associations of MVPA and SED patterns during pregnancy and postpartum BP have not been investigated.

Methods:
MVPA and SED were measured objectively in women in each trimester of a singleton pregnancy using triaxial and positional accelerometers and defined using established cut points. Systolic and diastolic BP obtained at the 6-week postpartum clinic visit were abstracted from medical charts. Latent class trajectory modeling was used to assign women to one of three MVPA and SED trajectory groups: low, medium, and high. Kruskal-Wallis tests were used to evaluate differences in systolic and diastolic BP between trajectory groups and linear regression was used to test for associations of MVPA and SED trajectory group assignment with BP. Adjustment variables included age, race, and postpartum BMI.

Results:
Of the 101 women in the study, 23 were African American, mean age = 31±0.5 years and mean postpartum BMI = 27.6±0.7 kg/m
2
. Mean postpartum systolic and diastolic BP were 114±1 and 71±1 mmHg. Systolic BP was similar among MVPA and SED trajectory groups. Diastolic BP differed between MVPA (low: 76±2, medium: 70±1, high: 70±2 mmHg, p<0.05) and SED (low: 71±3, medium: 69±1, high: 74±1, p<0.05) trajectory groups. In adjusted analyses, SED, but not MVPA, trajectory assignment was significantly associated with postpartum diastolic BP, b=3.1, 95% CI: 0.6, 5.6, p<0.02. Compared to the low SED trajectory, assignment to the high SED trajectory was associated with 4.9 (95% CI: -0.2, 10.0) mmHg higher diastolic BP in the adjusted model.

Conclusions:
SED trajectory across three trimesters of pregnancy was associated with postpartum diastolic BP, even after accounting for biologic covariates and MVPA. Results suggest avoiding high SED during pregnancy might help improve diastolic BP after delivery.
Abstract P232: Poor Lower Extremity Physical Function Increases Risk For Heart Failure In Older Women: The OPACH Study
Authors: Bellettiere John , LaCroix Andrea Z , Di Chongzhi , Eaton Charles , Lamonte Michael J
Published: March 2020

Background:
A hallmark of clinically manifest heart failure (HF) is reduced levels of exercise tolerance and physical function. It is unclear, however, whether an association exists between poor physical function and future development of HF, particularly at older ages.

Methods:
Women (n=5327; mean±SD age = 79±7) with no history of HF completed the Short Physical Performance Battery (SPPB) to measure physical function. The SPPB consists of three timed tasks that assess standing balance (with 3 progressively difficult balance tests), strength (with 5 unassisted chair stands), and gait (with a 4m usual-pace walk), and is scored 0 (worst) to 12 (best). Four previously-defined categories were used: very low (SPPB 0-3; n=237); low (4-6; n=900), moderate (7-9; n=2139), and high (10-12; n=1767; referent group). Women were followed for up to 8 years for incident physician-adjudicated HF hospitalization. Cox proportional hazards regression models were adjusted for age, race-ethnicity, education, smoking, alcohol, diabetes, hypertension, COPD, osteoarthritis, depression, BMI, and accelerometer-measured moderate to vigorous physical activity (MVPA) and sedentary time.

Results:
The number of HF cases (crude rate/1000 person-years) across the above SPPB categories (very low to high) were 41 (33.5), 78 (15.5), 96 (7.8), and 41 (4.0). Covariate-adjusted HRs (95% CIs) were 3.39 (2.05-5.84), 2.20 (1.47-3.31), 1.74 (1.20-2.51) and 1.00 (ref), trend P<.001. After additional adjustment for MVPA and sedentary time, the fully-adjusted HRs (95% CIs) were 2.85 (1.71-4.75), 1.94 (1.29-2.93), 1.61 (1.10, 2.32) and 1.00 (ref), trend P<.001. When modeled continuously (per 3-unit decrement in SPPB score), fully-adjusted associations were consistent over stratum of age (<80: HR=1.72; ≥80: HR=1.56; interaction P=.05), race-ethnicity (white: HR=1.59; black: HR=1.59; Hispanic: HR=1.18; P=.57), and accelerometer-measured total physical activity (<5.6 hr/d: HR=1.54; ≥5.6 hr/d: HR=1.51; P=.81).

Conclusions:
A significant inverse association between SPPB score and HF incidence was observed in ambulatory older women, independent of age, physical activity levels, and other HF predictors. Physical function is a modifiable factor that may be important for HF prevention in later life.
Abstract P238: Incorporating Measured Blood Pressures Into A Code Based Case Definition For Evaluating Trends In Hypertensive Disorders Of Pregnancy
Authors: Bider-Canfield Zoe , Reynolds Kristi , Portugal Cecilia , Avalos Lyndsay , Dublin Sascha , Easterling Thomas , Shortreed Susan , Cheetham Craig T
Published: March 2020

Introduction:
Epidemiologic studies of hypertension in pregnancy traditionally rely on diagnosis codes to identify cases. Electronic medical records make it possible to incorporate measured blood pressures (BPs) into case definitions. Our aim was to examine hypertension trends in pregnancy comparing two methodologies: 1) Traditional and 2) BP-Augmented definitions.

Methods:
All pregnancies between 2009 -2014 were identified within an integrated healthcare delivery system. Hypertension case definitions were applied: 1) A Traditional definition based solely on delivery discharge diagnosis codes, and 2) A BP-Augmented definition using the following criteria during pregnancy: (a) two elevated outpatient BP measures (≥ 140/90 mmHg) on separate days, within 30 days of each other; (b) an antihypertensive medication fill plus a hypertension diagnosis code during pregnancy; or (c) a hospital discharge diagnosis of preeclampsia. Descriptive statistics were used to compare the two case definitions and temporal trends.

Results:
Of the 145,739 pregnancies, 13,637 [9.4%] met the Traditional definition and 14,225 [9.8%] met the BP-Augmented case definition (10,809 [7.4%] met both case definitions). There was a slight increase in hypertension prevalence over time based on both case definitions (figure). With the BP-Augmented definition, the prevalence increased from 9.5% of live births in 2009 to 9.8% of live births in 2014 (3% increase). For the traditional definition, the prevalence increased from 9.2% to 10.2% from 2009 to 2014 (11% increase).

Conclusion:
Results suggest that the prevalence of hypertension in pregnancy increased slightly from 2009-2014 with both case definitions. The two methods identified somewhat different populations with only 10,809 meeting both case definitions. Additional work is needed to validate the BP-Augmented definition’s predictive power to identify clinically important maternal and fetal outcomes.
Abstract P241: Psychosocial Profiles and Cardiovascular Disease Risk Factor Control: The Coronary Artery Risk Development in Young Adults (cardia) Study
Authors: Vargas Emily A , Kershaw Kiarri N , Carnethon Mercedes R , Chirinos Diana , Carroll Allison J , KIEFE Catarina I , Carson April P , Wong Mandy
Published: March 2020

Introduction:
Psychosocial factors are associated with the onset of chronic disease, however few studies have examined the association between these factors and cardiovascular disease risk factor (CVDRF) control over time in individuals who already have a chronic disease. Thus, the goal of this study was to evaluate associations of psychosocial factors with a composite measure of CVDRF control.

Methods:
This study includes 1,018 CARDIA participants (51.6% Black; 41.6% Male) with prevalent hypertension (n = 604), hypercholesterolemia (n = 636), and/or diabetes (n = 210) in 2000-2001 (Year 15 follow-up exam). Latent Profile Analysis (LPA) was used to identify distinct psychosocial profiles based on a combination of personality, social life, and psychological health factors (Table). We used generalized estimating equations to determine associations of the psychosocial profiles with composite control, defined as HbA1c < 7.0%, systolic blood pressure (SBP) < 140 mm Hg, and LDL-cholesterol < 100 mm/dl, all measured in 2005-2016.

Results:
The LPA revealed an optimal model of three psychosocial profile groups (AIC 87,467.545; entropy = .895) namely “Healthy”, “Depressed Mood” and “Discriminated Against”. There were no significant differences in composite control across the profiles. Looking at HbA1C, SBP, and LDL separately in the unadjusted models, we found participants in the Depressed and Discriminated Against profiles were less likely to meet guidelines for SBP compared to individuals in the Healthy profile. Participants in the Discriminated profile were significantly less likely to meet the guidelines for HbA1C levels compared to the Healthy profile. These associations were attenuated with adjustment for sociodemographic covariates.

Conclusions:
Psychosocial profiles were associated with CVDRF control in unadjusted models, but not independent of socio-demographic characteristics.
Abstract P249: Association Between Cardiovascular Event Type And Smoking Cessation Rates Among Outpatients With Atherosclerotic Cardiovascular Disease: Insights From The Ncdr Pinnacle Registry
Authors: Hejjaji Vittal , Tang Yuanyuan , Jones Philip , Ellerbeck Edward , Pacheco Christina , Malik Ali O , Chan Paul S , Spertus John , Arnold Suzanne V
Published: March 2020

Introduction:
Understanding the factors that drive cessation may help inform patient counseling and improve quit rates. We aimed to determine if the type of atherosclerotic cardiovascular disease (ASCVD) event impacts the patient’s likelihood of quitting, independent of patient factors.

Hypothesis:
We assessed the hypothesis that more impactful ASCVD events would be associated with a greater likelihood of smoking cessation (e.g., more likely to quit after CABG vs PCI).

Methods:
Using 2013-2016 data from the NCDR PINNACLE outpatient cardiac registry, we identified patients who were current smokers and had an eventual diagnosis of ASCVD. Self-reported smoking status was assessed at each consecutive visit and rates of smoking cessation after each interim ASCVD event (MI, PCI, CABG, stroke/TIA, and PAD diagnosis) were examined. We then constructed separate Cox models with non-proportional hazards for interim ASCVD events (time-dependent covariates), adjusting for age, sex, race, dyslipidemia, diabetes, hypertension, and heart failure; and compared models using AIC.

Results:
Across 358 cardiology practices, 378478 patients were smokers who eventually had ASCVD (mean age 65.8±11.9, male 63.6%). Cessation rates after each ASCVD event were: MI 30.5%, PCI 30.7%, CABG 28.5%, stroke/TIA 24.7%, and PAD 24.6% (Table). After multivariable adjustment, patients were more likely to quit smoking after a stroke/TIA (HR 2.46, 95% CI 2.40-2.52) followed by CABG (HR 2.45, 95% CI 2.37-2.53), PCI (HR 1.85, 95% CI 1.79-1.91), MI (HR 1.79, 95% CI 1.72-1.86), and a new diagnosis of PAD (HR 1.47, 95% CI 1.42-1.51); p<0.0001 for all events.

Conclusion:
In a large US registry, we found that only ~25-30% of patients reported quitting smoking after an ASCVD event, but the type of ASCVD event significantly impacts the likelihood of smoking cessation. Using these data to inform patient counseling—targeting cessation efforts to those most likely to quit—may help improve outcomes.
Abstract P253: Blood Pressure Status Among Current Cigarette, E-cigarette, And Marijuana Users In The United States: An Analysis Of The National Health And Nutrition Examination Surveys, 2013-2016
Authors: Vidot Denise C , Jones Lenette M , Cuffee Yendelela , Johnson Amber , Ayala Lizelh
Published: March 2020

Introduction:
Tobacco and marijuana have been associated with abnormal blood pressure (BP). Yet, little is known about differences in BP status among individuals who smoke cigarettes, e-cigarettes, and marijuana, independently or in combination. The purpose of this study was to provide prevalence estimates of elevated BP, stage 1 hypertension, and stage 2 hypertension among smokers of varied substances and route of administration.

Hypothesis:
We hypothesized that cigarette users would have higher BP levels compared to e-cigarette or marijuana users.

Methods:
Data from adults (20-to-59 years) who completed the National Health and Nutrition Examination Surveys between 2013 and 2016 (N=6,282) were examined. Smoking status was ascertained by self-report of use in the last 30-days via computer assisted questionnaires as: cigarette only, cigarette + marijuana, cigarette + e-cigarette, e-cigarette only, e-cigarette + marijuana, marijuana only, and non-smokers of any product. BP was ascertained by the average of three systolic and diastolic readings. Following the latest BP guidelines, BP was categorized as elevated, hypertension stage 1 (HTN1), or hypertension stage 2 (HTN2). Survey method-appropriate chi-squared analyses were conducted to provide weighted prevalence estimates.

Results:
Over half (60.6%) of the adults in the sample were current smokers [cigarette only (31.9%); e-cigarette only (1.4%); marijuana only (7.3%); cigarette + marijuana (16.1%), cigarette + e-cigarette (3.1%), e-cigarette + marijuana (0.7%)]. A quarter (25.5%) of the sample had elevated BP; 43.9% had HTN1; and 12.7% had HTN2. Among smokers, cigarette only users had the highest prevalence of elevated BP (7.7%), HTN1 (14.7%), and HTN2 (4.3%); followed by the combined use of cigarettes and marijuana (4.8%, 6.0%, 1.2%, respectively). Marijuana and e-cigarette combination users had the lowest prevalence of HTN1 (0.16%) and HTN2 (0.0%) followed by marijuana only users (2.8%, 0.9%, respectively; p=0.04).

Conclusions:
This analysis is among the first to leverage population-based data to assess BP status among independent and combination users of cigarettes, e-cigarettes, and marijuana. The majority of the sample had at least elevated BP, which is documented to increase cardiovascular disease risk. Additional studies are needed to evaluate the impact of frequency and duration of use on cardiovascular disease risk after considering other lifestyle behaviors (i.e., diet and physical activity).
Abstract P256: Better Mid-life Life’S Simple 7 Status is Associated With Lower Risk of Recurrent Cardiovascular Disease and All-cause Mortality After Stroke: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Commodore-Mensah Yvonne , Mok Yejin , Matsushita Kunihiro , Kucharska-newton Anna , Gottesman Rebecca F , Palta Priya , Rosamond Wayne , Coresh Josef , Koton Silvia
Published: March 2020

Introduction:
Cardiovascular disease (CVD), including stroke, is a leading cause of morbidity and mortality. Ideal levels of the American Heart Association’s Life’s Simple 7 (LS7) metric are associated with lower stroke risk. However, the association between LS7 and recurrent CVD and mortality after incident stroke is unclear.

Hypothesis:
Stroke survivors with higher LS7 scores before incident stroke would have lower risk of recurrent CVD and mortality than those with lower scores.

Methods:
From 14715 individuals free of stroke at ARIC baseline (1987-1989), we analyzed data on 1380 participants who had an incident stroke between 1987-2017. A summary baseline LS7 score (range: 0-14) was derived by assigning 2 points for ideal, 1 point for intermediate, and 0 points for poor on each of the following: smoking, adiposity, physical activity, diet, total cholesterol, blood pressure and fasting glucose at baseline. We calculated adjusted hazard ratios (HR) for a composite and individual CVD outcomes of recurrent stroke, myocardial infarction, heart failure, and all-cause mortality after incident stroke, per a priori categories in baseline LS7 score.

Results:
At baseline, the mean age of participants with incident stroke was 55.7 ± 5.6 years (53% women, 36% black). Participants with the highest LS7 scores (≥10, n= 3287) had 66% lower risk (HR: 0.34, 95% CI: 0.29-0.40) of incident stroke than those with intermediate cardiovascular (CV) health (4-6, n=4166) (
Table
). During a median (SE) follow-up of 7.5 (0.45) years, 42.5% (587/1380) had recurrent composite CVD after incident stroke. LS7 score at baseline (before incident stroke) was inversely associated with recurrent CV outcomes (composite, myocardial infarction, heart failure) and all-cause mortality after incident stroke but not recurrent stroke
(Table)
.

Conclusions:
Better CV health in mid-life before incident stroke was associated with lower risk of recurrent CVD after stroke, suggesting that good CV health is essential for secondary prevention among stroke patients.
Abstract P260: Determinants of Statin Response: A Secondary Analysis of the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER)
Authors: Ajala Oluremi N , Demler Olga , Liu Yanyan , Ridker Paul , Glynn Robert J , Chasman Daniel , Mora Samia
Published: March 2020

Introduction:
Wide variability in LDLC change is observed with statins, yet determinants of statin response are uncertain.

Hypotheses:
Some markers of inflammation are associated with decreased statin response. Components of metabolic syndrome and older age are associated with better response.

Methods:
JUPITER (NCT00239681) randomized participants with LDLC<130 mg/dL and hs-CRP≥2 mg/L to rosuvastatin 20 mg/d or placebo. Baseline and 1-year levels of LDLC and a panel of 20 other biomarkers were measured. We defined optimal statin response as ≥50% LDLC reduction; suboptimal response as <50% reduction; and non-response as no change or increase in LDLC. χ
2
, t-tests and ANOVA were used to compare variables across optimal (N=3,801), suboptimal (N=3,235) and non-responders (N=868). Multinomial regression models evaluated associations of determinants of statin response after adjusting for risk factors including compliance. Backward selection identified variables that associated with response. t-distributed Stochastic Neighbor Embedding (t-SNE) suggested predictor clusters for statin response.

Results:
Compliance was the strongest determinant of statin response (Table). On multivariable analyses, blacks and Hispanics were at higher risk for suboptimal/non-response compared with whites as were greater alcohol use and HbA1c. Higher baseline levels of lipids [lipoprotein(a), apolipoprotein (apo) AI and B], inflammatory biomarkers, and lower branched-chain amino acids associated with decreased statin response (Table). By contrast, determinants of better response included older age, female sex, and higher waist circumference and baseline levels of LDLC, triglycerides, and blood pressure. We observed systematic patterns in t-SNE clustering for statin response by LDLC, LDL particle number, and apo B.

Conclusions:
This study identified determinants for high-intensity statin response and suggests other pathways of CVD risk beyond those addressed by statin treatment that require further investigation.
Abstract P261: Rheumatoid Arthritis And Coronary Artery Disease: Are We Considering The Real Risk?
Authors: Al Asmar Rania , Penumala Sudha , Mansoor Kanaan , Leigh Emilia , Mustafa Bisher , Webb Ralph
Published: March 2020

Background:
Rheumatoid arthritis (RA) is one of the most common inflammatory conditions linked to premature coronary artery disease (CAD). West Virginia (WV) has abundance of population that has metabolic syndrome and RA. We aimed to study the demographics of the RA in patient population of WV. Primary end points included the incidence of coexisting metabolic syndrome and RA, secondary end point was whether these patients were prescribed Aspirin and Statins for primary prevention of CAD.

Methods:
In our observational, retrospective study, we reviewed electronic medical records of patients diagnosed with RA and CAD. Charts were collected based on ICD-10 codes of the diagnoses; RA (M05.79, M06.09, M06.9), and CAD (I25.10, I21.9). SPSS version 20 was used for statistical analysis.

Results:
Out of 2275 patients with RA, 233 patients had coexisting diagnosis of CAD and RA. 20 patients were excluded due to incomplete charts. Mean BMI of the patients was 29.6 kg/m2. Sixty four percent were smokers, and 66% had family history of CAD. Coexisting comorbidities were prevalent; there were 37% diabetic, 88% hypertensive, 80% dyslipidemic, and while 33% had other autoimmune disease. Of note, primary prevention of CAD was only provided to 5% of patients by using a statin, and 5% of patients by using low dose aspirin, and 37% using both.

Conclusion:
Rheumatoid arthritis remains one of the important risk factors for premature coronary artery disease, especially in the predisposed patient population. More studies are needed to assess the exact risk of premature CAD in RA patients with metabolic syndrome, and perhaps consider RA as one additional determinant of the Atherosclerotic Cardiovascular Disease (ASCVD) risk.
Abstract P263: Understanding Facilitators Of Cardiac Rehabilitation Completion In Women: A Grounded Theory Approach
Authors: Siegmund Lee Anne , Burchill Christian , Siedlecki Sandra
Published: March 2020

Research demonstrates that cardiac rehabilitation (CR) programs improve cardiac outcomes and decrease mortality. However, less than 20% of referred women attend CR programs. Of those studies we found, most researchers studied men or barriers to participation. Little is known about factors that motivate or facilitate women to participate in CR. The purpose of this study is to address that gap. A grounded theory (GT) design was used to develop a theoretical understanding of the decision-making process employed by women who attended 25 or more CR sessions. We sought to identify factors that facilitated CR participation. Grounded theory is theory generating, not theory testing; no research questions or hypotheses are appropriate. Digitally recorded interview data from 12 women and 2 men (contrary cases) from a single Phase II CR program at a large healthcare system was reviewed by the research team. Data collection and analysis occurred simultaneously (constant comparative method) and open, axial and selective coding was used to develop the theoretical framework. Data analysis revealed three requisite conditions (catalysts, expectations, reinforcers) for participation in CR by women. Initially, participation was predicated by a cardiac event (catalyst) and CR recommendation. Then women participated because they believed CR would be effective (expectations). Finally, friendliness, reassurance, and validation from the CR team plus feeling better (reinforcers) were the factors that kept them coming back week after week. Unlike previous studies, factors such as transportation and financial resources did not impact the decision to participate in CR. These factors were perceived by the women interviewed to be nice but not necessarily critical to their decision to participate in CR. It was interesting to note that of all reinforcing factors, the relationship between the participant and the CR staff was the most important factor that facilitated continued participation. Previous research and interventions have been directed toward removing barriers to participation. This is the first study to explore factors that facilitate rather than impede participation and to identify requisite factors specific to women. Findings from this study provide a theoretical foundation for understanding ways to improve CR participation by women.
Abstract P264: Cardiovascular and Cardiometabolic Post-hospitalization Mortality Rates are Not Associated With Traditional Risk Factors and Socioeconomic Status at the Population Level in Canada
Authors: Singh Sarah , Stranges Saverio , Wilk Piotr , Frisbee Stephanie J
Published: March 2020

Background:
While existing literature has established individual risk factors for early death post-hospitalization in patients with cardiovascular and cardiometabolic disease (CVD/CMD), few studies to date have examined whether the known effects of these risk factors are maintained at the population level. The aim of this study was to determine whether traditional CVD risk factors and socioeconomic factors at the population level impacted CVD/CMD post-hospitalization mortality rates in Canada over time.

Methodology:
We conducted an ecological, cross-sectional analysis using merged data from two sources: 1) the Canadian Community Health Survey 2000-2011 and, 2) the Canadian Vital Statistics Death Database linked to the Discharge Abstract Database 2000-2012. The study outcome was 1-year mortality rate after hospital discharge for CVD/CMD, calculated by census division (CD) using ICD-9-CA codes for hospitalizations and deaths. The first stage of the statistical analysis reported age- and sex-standardized 1-year mortality rates after hospital discharge for CVD/CMD, across CDs in Canada. The second stage utilized Poisson regression to model associations between traditional CVD risk factors and socioeconomic factors at the CD level and CVD/CMD post-hospitalization mortality rates in Canada over time.

Results:
National 1-year mortality rates in patients with CVD/CMD increased from 146.5 per 100,000 in 2000 to 150.4 in 2012, peaking at 202.4 in 2006, with no significant trend observed over time. Maps of average 1-year mortality rates over the time period (2000-2012) show wide variations in rates across census divisions (CDs) in Canada. Nova Scotia and Ontario had the highest proportion of CDs with worsening rates of mortality over time (3% and 7% respectively) that remained below the national average. Traditional CVD risk factors, demographic factors and socioeconomic factors at the census division level were not associated with 1-year mortality rates after hospital discharge for CVD/CMD over time.

Potential implication:
Reductions in the CVD/CMD post-hospitalization mortality burden at the individual level may benefit from treatment targeted towards traditional risk factors and socioeconomic factors however; reduction in post-hospitalization burden at the population level can benefit from policy focused towards other societal elements such as healthcare and community care resources.
Abstract P265: Trends In Cardiovascular Disease Risk Factors Among Older Adults (65+ Years) In New York City
Authors: Russo Rienna , Li Yan , Kwon Simona , Trinh-Shevrin Chau , Yi Stella S
Published: March 2020

Introduction:
There was a 19% increase in the older adult population ages 65 and older in New York City (NYC) between 2005 and 2015, which now comprises about 1.13 million people. Cardiovascular disease (CVD) is the leading cause of death among this older adult population. Dietary modification has been linked to improved CVD outcomes in older adults, demonstrating that prevention efforts are still effective in older age. Over the past decade, NYC has led numerous initiatives to improve dietary and physical activity behaviors. Little is known about the impact of these policies on CVD health and behavioral risk factors among older adults.

Hypothesis:
We anticipate that cardiovascular disease risk factors (fruit and vegetable intake; sugar-sweetened beverage (SSB) intake; exercise; diabetes; cholesterol; and hypertension) will have remained stagnant over an eight year period, from 2009 to 2017, as older adults remain a largely under-reached population.

Methods:
The New York City Community Health Survey (CHS) is an annual cross-sectional survey among NYC residents. A trend analysis was conducted using data from 2009 to 2017. Adults aged 65 years and older were included in the analysis (n= 20,771). Annual estimates of the percentage of persons with select CVD risk factors were calculated. Linear regression was used to measure changes over time; binary variables were scaled as 0 to 100 to represent percentages. Nonlinearity assessments were conducted and segmented regression models were used when appropriate. All analyses were conducted in SUDAAN v.11.0.3, using appropriate sample weights incorporating the complex survey design.

Results:
In 2017, over one-quarter (27.3%; 703/2,576) of older adults were diagnosed with diabetes, and almost two-thirds (64.8%; 1,664 /2,568) were diagnosed with hypertension. Only 10.4% (257/2,475) of older adults consumed 5 or more servings of fruits and vegetables and 17.3% (440/2,548) consumed at least one serving of SSB per day. From 2009-2017, there was an increase in the prevalence of diabetes among older adults (Average Percent Change [APC] 0.68; p<0.0001). There were decreases in the percentages of older adults consuming five or more servings of fruits and vegetables (APC -0.30; p=0.007) and one or more SSB across the years (APC -0.38; p=0.010). From 2010-2014, there was a decrease in the prevalence of older adults with high cholesterol (APC -1.06; p=0.047). There were no significant changes in hypertension or exercise rates over time.

Conclusion:
Decreases in SSB consumption and cholesterol indicate that some prevention efforts may have reached the older adult population. Despite these successes, more older adults suffer from diabetes and hypertension and fewer consume the recommended five servings of fruits and vegetables. In conclusion, more targeted policies and programs are needed to address CVD risks among older adults, as this population continues to grow.