bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P175: Maintaining Ideal Cardiovascular Health and Freedom From Coronary Artery Calcification
Authors: Hwang Shih-Jen , Onuma Oyere , Massaro Joseph M , Zhang Xiaoling , Fu Yi-Ping , Manders Emily , Fox Caroline S , Hoffmann Udo , O'Donnell Christopher J
Published: July 2021

Introduction:
Ideal cardiovascular health (CVH), as defined by American Heart Association (AHA), is associated with low levels of cardiovascular disease (CVD) risk factors and freedom from coronary artery calcium (CAC). Hypothesis: Baseline ideal CVH predicts freedom from CAC progression. Methods: In the Framingham Heart Study (FHS), we evaluated prevalence of ideal CVH and investigated associations between ideal CVH and CAC progression. We included 1969 participants who attended the first and second rounds of the FHS Multi-Detector Computed Tomography study (MDCT-I and MDCT-II). The presence and burden of calcification was defined by a modified Agatston score. We calculated the repeatability of two CAC readings performed during MDCT-I and quantified the uncertainty estimate to define CAC progression. At follow-up, an increase in CAC score of 3.4 or higher was defined as positive CAC progression for those free of CAC at baseline. Using criteria modified from the AHA’s Strategic Impact Goal, we defined the prevalence of poor, intermediate and ideal CVH using five of the seven metrics: blood pressure, total-cholesterol, cigarette smoking, body mass index, and fasting glucose. For each metric of CVH, we assigned a score of 0, 1, and 2 points for poor, intermediate, and ideal CVH, respectively, to quantify CVH and extent of change in ideal CVH. Baseline age, baseline CVH status, and change in CVH category were independent variables for logistic regression models to test significant associations between CAC progression and change in ideal CVH. Results: The prevalence of ideal, intermediate, and poor CVH for 1148 participants who were free of baseline CAC were 15.77%, 43.73%, 40.51%, respectively. After an average 6.1 years of follow-up, the prevalence of ideal, intermediate, and poor CVH changed to 6.5%, 43.4%, and 50.1%, respectively, while the CAC progression rates were 8.0%, 13.1%, and 21.6%, respectively. In logistic regression models, there was a non-significant trend for CAC progression by CVH group. Compared to those with poor CVH at baseline, the presence of ideal CVH at baseline was significantly protective against the occurrence of CAC progression; the hazard ratio (HR) for occurrence of CAC progression was 0.36 (95%C.I. 0.19, 0.66, p<0.001). Compared to those with intermediate CVH, there was potential protection against CAC progression, although the HR 0.66 was not statistically significant (95%C.I. 0.36, 1.21, p=0.62).

Conclusions:
In a community-based study, we observed significant protection from progression of CAC at follow-up for participants who were free of CAC with ideal CVH at baseline. These findings support continued public health measures to promote ideal CVH.
Abstract P184: Pulse Wave Velocity is Associated With Coronary Calcification and Improves its Prediction in Young And Middle-Aged Asymptomatic Adults: The Kangbuk Samsung Health Study
Authors: Cainzos-Achirica Miguel , Rampal Sanjay , Chang Yoosoo , Ryu Seungho , Zhang Yiyi , Zhao Di , Cho Juhee , Choi Yuni , Pastor-Barriuso Roberto , Lim So Yeon , Lima Joao , Shin Hocheol , Guallar Eliseo
Published: July 2021

Introduction:
The role of pulse wave velocity (PWV) in assessing cardiovascular disease (CVD) risk in asymptomatic non-elderly adults is unclear. PWV assessment, however, is readily available, non-invasive, cheap, and does not involve radiation exposure.

Hypothesis:
The aim of our study was to evaluate the hypothesis that brachial-ankle PWV was associated with coronary artery calcium (CAC) in a large sample of young and middle-aged asymptomatic adults, and that PWV increases the predictive value of traditional CVD risk factors for predicting the presence of CAC.

Methods:
Cross-sectional study of 15,009 asymptomatic men and women without a history of cardiovascular disease who underwent a health screening program that included both PWV and CAC measurements. Brachial-ankle PWV was obtained from bilateral brachial and posterior tibial artery pressure waveforms using the oscillometric method. Robust tobit regression was used to assess the association between PWV and natural log(CAC+1) and logistic regression was used to model the presence of detectable CAC (CAC>0) and CAC>100 adjusting for multiple CVD risk factors. Measures of calibration and discrimination were calculated to test the incremental value of adding PWV to traditional risk factors in predicting prevalent CAC.

Results:
The mean age of the study participants was 41.6 years (SD 7.2) and 83% (12,452) were men. Subjects with higher PWV had generally less favorable CVD risk profiles. The multivariable-adjusted CAC score ratios (95% confidence interval) comparing quintiles 2 - 5 of PWV to the first quintile were 1.21 (0.78, 1.86), 1.54 (1.01, 2.33), 1.98 (1.30, 3.01), and 2.83 (1.84, 4.37), respectively (P trend 100 were consistent with the results for CAC ratios. The addition of PWV to traditional risk factors significantly improved the discrimination and calibration of models for predicting the prevalence of detectable CAC (net reclassification index [NRI] for predicting detectable CAC and CAC score > 100 of 0.167 and 0.252, respectively; both p<0.001).

Conclusions:
In this large sample of young and middle-aged asymptomatic adults, brachial-ankle PWV was independently associated with the presence and the extent of CAC. PWV measurements improve the prediction of detectable CAC compared to traditional CVD risk factors and may help identify young and middle-age subjects with increased risk of subclinical disease.
Abstract P198: Clinic versus Out-of-Clinic Daytime Blood Pressure Among Older Adults: Data From the Jackson Heart Study
Authors: Tanner Rikki M , Shimbo Daichi , Seals Samantha , Ogedegbe Gbenga , Muntner Paul
Published: July 2021

In the US, antihypertensive medication treatment decisions are primarily based on blood pressure (BP) measurements obtained in the clinic setting. The optimal systolic BP (SBP) goal for adults ≥60 years is controversial and a large difference between clinic and out-of-clinic daytime BP, a white-coat effect, may be present in older individuals. We estimated the white-coat effect and calculated the percentage of untreated and treated adults <60 and ≥60 years with elevated clinic BP (defined as SBP/diastolic BP [DBP] ≥140/90 mmHg), but non-elevated out-of-clinic daytime BP (“daytime BP”, defined as SBP/DBP <135/85 mmHg) among 257 African-American participants in the Jackson Heart Study with at least 10 daytime ambulatory BP measurements. For the overall population, the white-coat effect for SBP was 12.2 mmHg (95% confidence interval [CI]: 9.2-15.1) in older adults and 8.4 mmHg (95% CI: 5.7-11.1) in younger adults (p=0.06). After multivariable (MV) adjustment, this difference was 1.3 mmHg. Among those without diabetes or chronic kidney disease (CKD), the white coat effect for SBP was 15.2 mmHg (95% CI: 10.1-20.2) and 8.6 mmHg (95% CI: 5.0-12.3) for older and younger adults, respectively (p=0.04). After MV adjustment, this difference was 5.9 mmHg. Also, SBP ≥150 mmHg versus <150 mm Hg was associated with a larger white-coat effect in the overall population after MV adjustment. Among those without CKD or diabetes, older age and SBP ≥150 mmHg were associated with a larger white-coat effect after MV adjustment. Among younger and older participants with elevated clinic BP, the prevalence of non-elevated daytime BP was 34% (95% CI: 26%-44%) and 32% (95% CI: 24%-40%), respectively (p=0.64), in the overall population and 35% (95% CI: 24%-48%) and 43% (95% CI: 31%-56%), respectively, for those without CKD or diabetes (p=0.37). In conclusion, a large white-coat effect was present among older adults. These data suggest a role for ambulatory blood pressure monitoring in preventing potential over-treatment for hypertension among older adults.
Abstract P201: Rural/Urban Differences in the Prevalence of Stroke Risk Factors
Authors: Dawson Erica L , Higginbotham John , Kleindorfer Dawn O , Soliman Elsayed Z , Cushman Mary , Safford Monika M , Howard Virginia J , Kissela Brett M , Judd Suzanne E , Howard George
Published: July 2021

Introduction:
Despite previously reported higher stroke (and heart disease) mortality in rural areas, there are few data on the presence or magnitude of rural-urban disparities in the prevalence of stroke risk factors.

Methods:
Participants (n = 28,242) of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were categorized into the 6-level ordinal National Center for Health Statistics Urban-Rural Classification Scheme. The prevalence of 6 traditional risk factors (hypertension, diabetes, cigarette smoking, atrial fibrillation, left ventricular hypertrophy and heart disease) and estimated 10-year risk of stroke (indexed by the Framingham Stroke Risk Function score) was assessed across the rural-urban scale in models adjustment for demographic factors (age, race, sex, and state of residence) and after further adjustment for community-level socioeconomic status disadvantage.

Results:
Hypertension, diabetes and heart disease were all more prevalent in rural regions (p < 0.05); with respective odds 1.25-times (95% CI: 1.11 - 1.42), 1.15-times (95% CI: 0.99 - 1.33), and 1.19-times (95% CI: 1.02 - 1.39) greater in the most rural as compared to the most urban regions (see Table). The estimated 10-year risk of stroke was also greater in rural areas; however, the estimated magnitude of increased stroke risk was relatively small. Adjustment for neighborhood-level socioeconomic status disadvantage attenuated some, but not all, of these relationships (for example, hypertension OR: 1.25 to 1.21, diabetes OR: 1.15 to 1.00, heart disease OR: 1.19 to 1.10).

Discussion: These data suggest that while some of the increased stroke mortality in rural areas may be due to an increased burden of stroke risk factors in rural areas, the contribution of risk factors is quite inconsistent across the rural-urban spectrum. This association was attenuated by the adjustment for socioeconomic status, which suggests that some of the higher stroke risk in rural counties may be due to their lower level of socioeconomic status.
Abstract P207: Incidence of Hypertension in Colombia Similar to That Observed Decades Ago in Developed Countries: An Observation From the Chicamocha Cohort Study
Authors: Villar Juan C , Martínez Luz X , Castellanos Yeny Z , Vásquez Skarlet M , Herrera Víctor M
Published: July 2021

Background:
Overweight is a modifiable risk factor for high blood pressure (BP). Despite the increasing prevalence of both conditions in the Latin American population, there are no estimates of either the incidence of hypertension or the impact of overweight on it that inform the design and evaluation of individual and community-based preventive interventions in the region.

Methods:
We conducted a prospective cohort study in a sample of normotensive, blood donors from Bucaramanga, Colombia, who were free of transfusion-transmitted infectious and cardiovascular diseases at baseline. Participants were re-evaluated after a median follow-up of 12 years to determine the incidence of hypertension defined as: 1) Self-reported diagnosis with evidence of pharmacological treatment; 2) Systolic BP >140 mmHg or diastolic BP >90 mmHg (average of two measures in seated position); or 3) Current systolic/diastolic BP >120/80 mmHg with evidence of increments >10/5 mmHg from baseline. We estimated crude incidence rates of hypertension and age- and sex-adjusted hazard ratios (HRs) for baseline overweight (body mass index ≥25 kg/m2) using Cox regression analysis. The population attributable fraction (PAF) for overweight was also assessed.

Results:
We followed 594 participants (baseline mean age = 38.0 years; 64% male; adherence rate = 78%) at risk of hypertension among which we observed 164 incident cases: Cumulative incidence of 27.6%; incidence rate of 23.4 cases per 1,000 person-years. Incidence rate was similar in men and women (23.4 vs. 23.2 per 1,000 person-years; p>0.05) and tended to increase with age (17.4, 21.2, and 27.8 per 1,000 person-years among participants <30, 30-39, and ≥40 years old, respectively; p>0.05). Participants with overweight at baseline had twice the risk of developing hypertension than participants with normal weight (adjusted-HR = 2.00, 95%CI: 1.11, 3.61). The estimated PAF was 25.7%, considering a national prevalence of overweight equal to 34.6%.

Conclusion:
The incidence of hypertension in our study is similar to that reported two decades ago in cohorts from developed countries, which is consisting with the ongoing epidemiological transition in Latin America. We also confirmed the role of overweight as a risk factor for hypertension, accounting for about 1 out 4 incident cases. This finding highlights the importance of addressing overweight in our population.
Abstract P214: Patient and Physician Factors Influence Decision-Making in Hypercholesterolemia
Authors: Krempf Michel , Simpson Ross J , Ramey Dena R , Brudi Philippe , Giezek Hilde , Lee Raymond , Farnier Michel
Published: July 2021

Objectives:
Little is known about how patient factors influence physicians’ treatment decision-making in hypercholesterolemia. We surveyed physicians’ treatment recommendations in high-risk patients with LDL-C not controlled on statin monotherapy.

Methods:
Physicians completed a questionnaire pre-randomization for each patient in a double-blind trial (NCT01154036) assessing LDL-C goal attainment rates with different treatment strategies. Patients had LDL-C ≥100 mg/dL after 5 weeks’ atorvastatin 10 mg/day and before randomization. Physicians were asked about treatment recommendations for three scenarios: (1) LDL-C near goal (100-105 mg/dL), (2) LDL-C far from goal (120 mg/dL), then (3) known baseline LDL-C of enrolled patients on atorvastatin 10 mg/day. Factors considered in their choice were specified. Physicians had been informed of projected LDL-C reductions for each treatment strategy in the trial. Regression analysis identified prognostic factors associated with each scenario, and projected LDL-C values for physicians’ treatment choices were compared to actual LDL-C values achieved in the trial.

Results:
Physicians at 296 sites completed questionnaires for 1535 patients. The most common treatment strategies for all three scenarios were: 1) not to change therapy, 2) double atorvastatin dose, 3) add ezetimibe, 4) double atorvastatin dose and add ezetimibe. Doubling atorvastatin dose was the most common treatment recommendation in all scenarios (43-52% of patients). ‘No change in therapy’ was recommended in 6.5% of patients when LDL-C was assumed far from goal. Treatment recommendations were more aggressive if actual LDL-C was known or considered far from goal. When compared with the ‘no change in therapy’ recommendation, CV risk factors and desire to achieve a more aggressive LDL-C goal were generally considered in decision-making for each treatment choice, regardless of LDL-C scenario. Patients randomized to a more aggressive regimen than recommended by physicians had larger reductions in LDL-C: the actual reduction in LDL-C in patients randomized to ‘add ezetimibe’ was -20.8% versus a projected reduction of -10.0% when physicians recommended ‘doubling atorvastatin dose’.

Conclusions:
This study provides insight into physicians’ perspectives on clinical management of hypercholesterolemia and highlights a gap in knowledge translation from guidelines to clinical practice. Targeting lower LDL-C and CV risk were key drivers in clinical decision-making but, generally, physicians were more conservative in their treatment choice than guidelines recommend, which may result in poorer LDL-C reduction. When compared with actual outcomes, projected LDL-C control was better if physicians used more comprehensive strategies rather than simply doubling the statin dose.
Abstract P221: Plasma Triglyceride/High Density Lipoprotein Cholesterol Ratio and Subclinical Cardiovascular Disease Parameters in a South Asian Population
Authors: Thanikachalam Mohan , Sunderarajan Jahnavi , Shankar Shravanti , Harivanzan Vijaykumar , Thanikachalam Sadagopan
Published: July 2021

Background:
There is increasing focus on biomarkers for early detection of cardiovascular disease (CVD). Studies suggest that the ratio of triglyceride (TG)/high density lipoprotein (HDL) could be a simple marker for insulin resistant and increased cardiometabolic risk, but the association between TG/HDL ratio and CVD is not fully defined. In the current study we assess the relationship between TG/HDL ratio and subclinical CVD parameters in a South Asian population.

Methods:
In the cross-sectional analysis of 8080 South Indians, the assessments included left ventricular mass indexed (LVMI) to body surface area by echocardiograph, carotid intimal medial thickness (IMT), arterial stiffness by carotid-femoral pulse wave velocity (PWV) and endothelial function by brachial artery flow mediated dilatation (FMD). Generalized linear regression models were used to test the association of TG/HGL ratio with subclinical parameters. All models were adjusted for age, gender, BMI, physical activity, LDL, blood sugar, smoking, stress, and anxiety status.

Results:
After the exclusion of people with evidence of coronary artery disease, 7164 subjects (mean age 43 years, 58% women) constituted the study sample. The value of subclinical parameters by TG/HDL quartiles is shown in the Table. In univariate analysis, TG/HDL ratio was associated with subclinical parameters [PWV (r = 0.14), LVMI (r = 0.11), FMD (r = -0.06); IMT (r = 0.103; p <0.01]. In adjusted linear regression models, TG/HDL ratio was independently associated with PWV (β = 0.029, p = 0.014) and IMT (β = 0.051, p <0.01). Subsequently, in gender specific models, TG/HDL ratio was independently associated PWV and IMT only in women [PWV (β = 0.042, p = 0.006); IMT (β = 0.067, p = 0.01)] and in subgroup analysis in healthy participants below 40 years of age [PWV (β = 0.082, p <0.01); IMT (β= 0.067, p = 0.01)].

Conclusion:
TG/HDL ratio was independently associated with PWV and IMT in South Asian women, including apparently health young individuals.
Abstract P226: Decreasing Cardiovascular Risk via Hypertriglyceridemia Treatment: The Impact of Medical Education on Physician Understanding of the Role of Omega-3 Fatty Acids
Authors: Larkin Amy , Boutsalis George , LaCouture Michael
Published: July 2021

Introduction:
Triglycerides, although lacking the strong atherogenic potential of LDL-C, are an independent risk factor for cardiovascular disease (CVD), as demonstrated by the correlation between hypertriglyceridemia and cardiovascular (CV) death, CV events, and myocardial infarction. The impact of continuing medical education (CME) on improving the knowledge and competence of cardiologists in treating hypertriglyceridemia with omega-3 fatty acids was measured.

Methods:
Cardiologists in the US who treat patients with hypertriglyceridemia participated in an online CME activity on the role of omega-3 fatty acids in treating hypertriglyceridemia and the differences between available formulations. The educational impact was assessed using linked pre- and post-assessment questions, and participants were classified into one of 3 learning categories: improved learners (incorrect pre, correct post), reinforced learners (correct pre and post), and unaffected learners (incorrect pre and post). The educational effect size was calculated using Cohen's
d
formula.

Results:
A total of 169 cardiologists participated in the CME activity, completed the pre- and post-assessment, and were included in the analysis. Comparison of pre- and post-assessment responses for each individual question demonstrated a statistically significant improvement in knowledge and competence among cardiologists (
P
<.05).

After completion of the CME activity, correct responses on post-assessment questions increased between 25% to 158% across all questions compared to pre-assessment responses, with an overall large effect size of 1.065 (Small effect ,<0.4; intermediate effect, 0.4-0.8; large effect, >0.8). Between 17% and 51% of participants showed improvement in understanding individual learning concepts; these concepts were reinforced in 18% to 28% of participants. Improvement was demonstrated in understanding recent American College of Cardiology (ACC)/American Heart Association (AHA) guideline recommendations on the treatment of hypertriglyceridemia. There was a need for further education in understanding the mechanism of action of omega-3 fatty acids, the differences between prescription and supplement forms of omega-3 fatty acids, and the pharmacodynamic differences between the different formulations of omega-3 fatty acids.

Conclusion:
This study demonstrated the success of a targeted educational intervention on improving the knowledge and competence of US cardiologists on the role of omega-3 fatty acids to treat hypertriglyceridemia and reduce CVD. However, the need for additional education was also demonstrated among cardiologists with regard to understanding the different omega-3 fatty acid formulations and their mechanisms of action in order to effectively use these agents.
Abstract P229: Pericardial Fat Density is Associated With Insulin Resistance in Treated HIV Infection: The SATURN-HIV Trial
Authors: Longenecker Chris T , Liu Yiying , Schlucter Mark , McComsey Grace A
Published: July 2021

Objective:
To examine associations of pericardial fat (PCF) volume and density with baseline and changes in insulin resistance among HIV+ subjects participating in a trial of statin therapy.

Methods:
SATURN-HIV was a 96-week double-blind, randomized trial of 10 mg daily rosuvastatin versus placebo among 147 HIV+ subjects on stable antiretroviral therapy with LDL-c ≤130mg/dL and evidence of heightened T-cell activation or increased inflammation (high sensitivity C-reactive protein ≥2mg/L). PCF volume (ml) and density (mean Hounsfield Units) were measured from coronary calcium CT scans at entry. Homeostatic model of insulin resistance (HOMA-IR) was calculated from insulin and glucose at entry, 24, 48, and 96 weeks. Pearson correlations and linear mixed modeling were used to explore relationships between PCF and insulin resistance.

Results:
Median (Q1, Q3) age was 46 (40, 53) years; 78% were male and 68% African American; 49% were on a protease inhibitor. Median HOMA-IR was 1.84 (1.06, 3.33) at baseline, and participants randomized to statin had larger 0-96 week mean percentage increase in HOMA-IR (+73% vs +33%, statin vs placebo, p=0.009). PCF density did not correlate with measures of total body adiposity (BMI r=0.057 and total body fat r=-0.034, both p>0.4), but was negatively correlated to waist-hip ratio (-0.337, p<0.001). In a linear mixed model, PCF density was associated with baseline HOMA-IR independent of PCF volume, BMI, metabolic syndrome, and biomarkers of immune activation and systemic inflammation; however, PCF density was not associated with longitudinal changes in HOMA-IR (see Table).

Conclusions:
Coronary calcium scans are widely used to assess cardiovascular risk and appropriateness of statin therapy. In this HIV+ population, PCF density, a simple measure obtained from these scans, appears to be a novel marker of insulin resistance that is independent of PCF volume. Larger, adequately powered studies are needed to determine if PCF density predicts development of insulin resistance on statin.
Abstract P244: Combined Measures of Total and Abdominal Adiposity and the Likelihood of Subclinical Myocardial Damage
Authors: Collison Amira O , Nambi Vijay , Lazo Mariana , Hoogeveen Ron C , Blumenthal Roger S , Folsom Aaron R , Selvin Elizabeth , Ballantyne Christie M , Coresh Josef , Ndumele Chiadi E
Published: July 2021

Background:
Obesity has been independently associated with subclinical myocardial damage. Both body mass index (BMI) and waist circumference (WC) are recommended for cardiovascular risk assessment, and they provide complementary information about heart failure (HF) risk. However, their combined relationship with subclinical myocardial damage is presently unknown.

Hypothesis:
We hypothesized that high measures of both BMI and WC would have the strongest association with subclinical myocardial damage, as indexed by a high-sensitivity assay for cardiac troponin T (hs-cTnT).

Methods:
We performed a cross-sectional analysis of 9,507 participants at ARIC Visit 4 (1996-99). We excluded individuals with prior cardiovascular disease, with BMI < 18.5 kg/m2 and those not of white or black race. We created tertiles of BMI and WC (sex-specific for WC). We used logistic regression to relate combined tertiles of BMI and WC to elevated hs-cTnT (> 14 ng/L) measured at Visit 4, after adjustment for confounding variables.

Results:
The mean age was 62 years (S.D. 6), 58% were female and 22% were black. After multivariable adjustment, each 1-SD higher of BMI (1.41 [95% CI: 1.30-1.53]) and WC (1.50 [95% CI: 1.37-1.63]) was associated with elevated hs-cTnT. In analyses using combined BMI and WC tertiles, higher WC was associated with trends towards higher associations with elevated hs-cTnT within each BMI tertile (Figure). Among those individuals in the highest 2 BMI tertiles, those who were also in the highest WC tertile demonstrated significant independent associations between the anthropometric measures and elevated hs-cTnT. Conversely, significant associations with elevated hs-cTnT were not seen for those individuals in higher BMI tertiles but lower WC tertiles.

Conclusion:
A combination of high BMI and WC is associated with myocardial damage more often than high BMI with lower WC. This supports using assessments of both total and abdominal adiposity to understand obesity-associated risk.
Abstract P253: Body Mass Index and Heart Failure among Patients with Type 2 Diabetes
Authors: Hu Gang , Katzmarzyk Peter , Horswell Ronald , Wang Yujie , Johnson Jolene , Li Weiqi
Published: July 2021

Background:
Epidemiologic data on the association between body mass index (BMI) and heart failure (HF) risk among diabetic patients is rare.
Aim:
To investigate the association between BMI and HF risk among patients with type 2 diabetic in the Louisiana State University Hospital-based Longitudinal study (LSUHLS). Methods: We performed a prospective cohort study of risk for HF among 31,155 patients of type 2 diabetes (11,468 men and 19,687 women). Cox proportional hazards regression models were used to estimate the association of different levels of BMI with HF risk.
Results:
During a mean follow-up of 7.8 years, 5,834 subjects developed HF (2,379 men and 3,455 women). The multivariable-adjusted (age, race, smoking, income and type of insurance) hazard ratios of HF associated with BMI levels (18.5-22.9, 23-24.9, 25-29.9 [reference group], 30-34.9, 35-39.9, and ≥40 kg/m2) at baseline were 0.95, 1.00, 1.00, 1.16, 1.64, and 2.02 (Ptrend <0.001) for men, and 1.16, 1.16, 1.00, 1.23, 1.55, and 2.01 (Pnon-linear <0.001) for women, respectively. When we used an updated mean value of BMI, the association of HF risk with BMI did not change. When stratified by age, race, smoking status and use of anti-diabetic drugs, the positive association among men and the J-shaped association among women were still present.
Conclusions:
Our study suggests a positive association between BMI and HF risk among men, and a J-shaped association between BMI and HF risk among women with type 2 diabetes.
Abstract P261: Skeletal Muscle Density: A Novel Risk Factor for Hypertension in Aging African Ancestry Men
Authors: Miljkovic Iva , Kuipers Allison , Bunker Clareann , Patrick Alan , Zmuda Joseph
Published: July 2021

Background:
Intramuscular fat is greater in African compared with European ancestry men and is now recognized as a major risk factor for cardio-metabolic diseases, independent of general obesity. However, prospective studies examining health consequences of this important ectopic fat depot are lacking, particularly in high-risk African ancestry populations. Therefore, we sought to determine if change in skeletal muscle density, a measure of intramuscular fat, predicts subsequent development of hypertension in African ancestry men.

Methods:
We measured at two time points calf skeletal muscle density (MD; mg/cm
3
) using computed tomography in 1504 Afro-Caribbean men aged 40-92 years (mean, 59 years), who were recruited without regard to their health status. Hypertension was defined as having a systolic blood pressure of 140 mm Hg or greater, having a diastolic blood pressure of 90 mm Hg or greater, or taking antihypertensive medications. Logistic regression was used to estimate the association between change in MD and incident hypertension adjusting for follow-up time, baseline age and muscle density, and covariates known to be associated with hypertension and intramuscular fat (baseline body weight, body weight change, waist circumference, waist circumference change, current smoking, alcohol intake, physical activity, and baseline type 2 diabetes status). Results were expressed as the odds (95% CI) of hypertension per one standard deviation decrease in muscle density.

Results:
During the 6.2 years follow-up (range of follow-up years: 4.9-9.1 years), we observed a significant annualized percent decrease in muscle density (-0.43 %/yr; P<0.0001). Among the 777 men who were normotensive at the baseline visit, 224 (28.8%) developed hypertension during follow-up. Decreased MD during follow-up was associated with an increased risk of hypertension (odds ratio [95% CI] per SD decrease in MD: 1.31 [1.03, 1.67]). This association remained significant after additional adjustment for baseline waist circumference and change in waist circumference in a separate model (odds ratio [95% CI] per SD decrease in MD: 1.27 [1.02, 1.59]).

Conclusions:
Our novel findings show that ectopic intramuscular fat increases with advancing age, and support a causal role of intramuscular fat in hypertension risk among middle-aged and elderly African ancestry men. Additional studies are needed to elucidate the mechanisms behind this association, and to confirm our findings in other populations.
Abstract P270: Effects of Exercise Training on Cardiorespiratory Fitness and Biomarkers of Cardio-metabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Lin Xiaochen , Zhang Xi , Guo Jianjun , Roberts Christian K , McKenzie Steve , Wu Wen-Chih , Liu Simin , Song Yiqing
Published: July 2021

Context:
Current guidelines recommend exercise for optimal cardiovascular health, although evidence from intervention trials linking exercise to cardiovascular health through intermediate biomarkers remains inconsistent.

Objective:
To perform a meta-analysis of randomized controlled trials (RCTs) to quantify the impact of exercise training on cardiorespiratory fitness (CRF) and a variety of standard and novel biomarkers for cardio-metabolic health in adults without cardiovascular disease (CVD).

Data Sources:
MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 1965 to March 2014.

Study Selection:
Two investigators (X. Lin and X. Zhang) selected 159 RCTs (7,282 participants) that evaluated the effects of exercise interventions on CRF and circulating CVD biomarkers.

Data Extraction:
Data were extracted by two researchers using a standardized protocol.

Data Synthesis:
In the primary analysis, DerSimonian and Laird random-effect models were used to compute weighted mean differences (WMDs) and 95% confidence intervals (95% CIs) comparing exercise groups to control groups. In addition, effect modifications were examined using meta-regression and subgroup analyses stratified by pre-specified potential modifiers, including age, sex, body mass index, lifestyle, health status, and trial duration. Exercise training significantly improved CRF, lipid and lipoprotein metabolism, glucose intolerance and insulin resistance, systematic inflammation, and hemostasis. (
Table
) We also found that exercise effects were modified by age, sex, and health status such that people under 50 years, men, and people with type 2 diabetes, hypertension, hyperlipidemia, or metabolic syndrome appeared to benefit more from exercise interventions.

Conclusion:
This meta-analysis indicates that exercise training significantly improved CRF and some biomarkers of cardio-metabolic health. Significant effect modifications were also identified by age, sex, and health status.
Abstract P287: Autonomy Supportive Healthcare Providers Influence Self-Determined Motivation for Physical Activity in Women With Cardiovascular Disease
Authors: Mason Barber Linda A , Kimble Laura P , Taylor Leslie F
Published: July 2021

Introduction:
Data consistently indicate women with CVD do not regularly engage in physical activity (PA) at levels recommended to reduce CVD risk. Evidence supports healthcare providers delivering health behavior recommendations using an autonomy supportive approach may enhance self-determined motivation to initiate behavior change and support ongoing maintenance of healthy behavior. However, this has not been well documented in women with CVD.

It was hypothesized that: 1) greater perceived autonomy support from healthcare providers by women with CVD would be associated with greater autonomous motivation and greater perceived competence for physical activity as well as greater physical activity itself, and 2) perceived autonomy support, perceived competence for PA, and autonomous motivation, would predict greater physical activity in women with CVD.

Methods:
A cross-sectional, correlational study with a convenience sample of 103 predominantly white (93.2%), educated (92.3%), community-dwelling, English speaking women (mean age 64.7 years [SD 10.3]), with a self-reported history of CVD was conducted. Data were obtained via reliable and valid self-report questionnaires measuring demographic and clinical variables (age, social support, depressive symptoms, CVD symptoms, comorbidity), motivation-related variables (perceived autonomy support, autonomous motivation, perceived competence), PA, and perceived PA limitations. Relationships among the motivation-related variables, PA, and PA limitations were examined using hierarchical multiple linear regression.

Greater perceived autonomy support from healthcare providers was significantly associated with greater autonomous motivation (r = .26, p < .01) and greater perceived competence (r = .50, p < .001) for PA. Regression results indicated the overall model accounted for a significant amount (16%) of the variance in PA. Significant predictors in the regression analysis were perceived competence (b = -.22, p < .05) and age (b = -.36, p < .001). A second regression analysis indicated the overall model accounted for 39% of the variance in perceived PA limitations with perceived competence accounting for 10% of this variance, over and above that accounted for by demographic and clinical variables.

Conclusions:
Findings support the association between an autonomy supportive approach by healthcare providers and autonomous or self-determined motivation for PA in women with CVD. Perceived competence in ability to be physically active predicted perception of PA limitations in this population. Interventional studies testing effects of autonomy support from healthcare providers on motivation for PA in women with CVD are needed.
Abstract P298: Association of Serum Sclerostin with Vascular Calcification in African Ancestry Men
Authors: Kuipers Allison L , Miljkovic Iva , Carr J Jeffery , Terry James G , Nestlerode Cara S , Ge Yaorong , Bunker Clareann H , Patrick Alan L , Zmuda Joseph M
Published: July 2021

Objective:
Sclerostin, a Wnt pathway antagonist, is an established regulator of bone mineralization in humans but its potential importance in the regulation of vascular calcification is less clear. Therefore, our objective was to assess the relationship of serum sclerostin levels with coronary and aortic artery calcification (CAC and AAC, respectively) in African ancestry men on the island of Tobago.

Methods:
Detailed health history, clinical exam and computed tomography scans of CAC and AAC were obtained in 191 men aged ≥40 years (mean(SD): 62.9(8.0)years) recruited without regard to health status. Fasting serum samples were drawn and stored at -80°C until time of assay. Serum sclerostin levels were measured using ELISA according to manufacturer’s protocol (Biomedica Gruppe, Vienna, Austria). Multivariable logistic regression models were used to assess the cross-sectional association of sclerostin with prevalent arterial calcification.

Results:
In unadjusted analyses, the 57 of 191 (29.8%) of men with CAC were older, more likely to be hypertensive, had lower kidney function and had greater serum sclerostin (all P-values<0.05). The 131 of 191 (68.6%) of men with AAC were also older and more likely to be hypertensive, but they had greater total body fat and were more likely to be on statins, as well (all P-values<0.05). Mean(SD) sclerostin was 45.2 pmol/l (15.6 pmol/l). After adjusting for risk factors including age, physical and lifestyle characteristics, comorbidities, lipoproteins and kidney function, 1 SD greater sclerostin level was associated with 1.61-times (95%CI 1.02-2.53) greater odds of having CAC. Sclerostin was not associated with AAC in any model.

Conclusions:
This is the first study to show that, among African ancestry men, greater serum sclerostin levels were associated with CAC. In addition to its known role in bone mineralization, the Wnt antagonist, sclerostin, may also play a role in calcification of the coronary arteries.
Abstract P316: Alcohol Consumption and Incidence of Atrial Fibrillation and Heart Failure: Prospective Findings From the MOLI-SANI Study
Authors: Di Castelnuovo Augusto , Costanzo Simona , Rago Livia , de Curtis Amalia , Persichillo Mariarosaria , Bonaccio Marialaura , Bracone Francesca , Donati Maria Benedetta , de Gaetano Giovanni , Iacoviello Licia
Published: July 2021

Introduction:
The connection between ethanol intake and atrial fibrillation (AF) or heart failure (HF) remains controversial.

Hypothesis:
We assessed the hypothesis that alcohol consumption predicts onset of AF or HF.

Methods:
We analyzed 22,420 (47% men, age≥35) AF or HF-free individuals randomly recruited from the general population included in the MOLI-SANI study, for whom complete data on HF, AF and alcohol were available. The cohort was followed for a median of 4.2 years (91,930 person-years). Alcohol intake was categorized in former, never, occasional (<1 gr/day) drinkers and in four categories of consumers with different intake (Table). Incident cases were identified through linkage to the regional archive of hospital discharges. The end of follow-up was 31/12/2011. Hazard ratios (HRs) were calculated using Cox-proportional hazard models (Table).

Results:
We identified 546 incident cases of HF and 352 of AF. In comparison with never drinkers, both former or occasional drinkers showed an equal risk of developing HF (Table). Drinking at various amount of alcohol revealed a J-shaped protection against HF, with a 25% (95%CI: 1% to 44%) maximum protection at 2-4 drinks a day, independent from common confounders (Table). Concerning AF, we failed to observe any association of alcohol with onset of it. Very similar results were obtained after restriction of the analyses to only men/women or to type of alcoholic beverages (wine, beer or liquor).

Conclusions:
Consumption of alcohol in moderation prevent the incidence of heart failure of 25%, whereas it was not associated with development of atrial fibrillation.
Abstract P320: Dietary Flavonoid Intake and Ischemic Stroke
Authors: Goetz Margarethe , Vaccarino Viola , Hartman Terry , McClellan Bill , Anderson Aaron , Judd Suzanne
Published: July 2021

Introduction:
Diets rich in plant-based foods have been associated with lower stroke risk. Plant-based foods contain a variety of potentially cardioprotective compounds, including flavonoids. We assessed the hypothesis that total flavonoid and flavonoid subclass intakes are associated with incident ischemic stroke in a population-based cohort oversampled for non-Hispanic blacks and Stroke Belt residents.

Methods:
Between 2003 and 2007, REGARDS enrolled black and white Americans age ≥ 45 years. Participants were 20,413 men and women who completed a Block 98 food frequency questionnaire (FFQ) and without stroke at baseline. Total flavonoid and flavonoid subclass (anthocyanidin, flavan-3-ol, flavanone, flavonol, flavone, proanthocyanidin and isoflavone) intakes were estimated using the food consumption reported by the FFQ and the flavonoid contents of each food using USDA databases. Incident strokes were captured by participant report and adjudicated by experts. Quintiles of flavonoid intake were examined as predictors of incident stroke using Cox regression models using the first quintile as the referent. Tests for trend used the quintile medians.

Results:
Adjusting for age and caloric intake, there was a statistically significant inverse association between total flavonoid intake and ischemic stroke (Q5 v Q1: HR=0.68; 95% CI=0.51, 0.90; p-trend=0.04) however, this association weakened after additional adjustment for demographic, socioeconomic and health behavior factors as well as self-reported CHD at baseline (Q5 v Q1: HR=0.77; 95% CI=0.58, 1.03; p-trend=0.31). A similar pattern was seen for flavanones (age, energy adjusted HR=0.74; 95% CI= 0.57, 0.95; p-trend=0.02; fully adjusted HR= 0.82; 95%CI=0.65, 1.05; p-trend=0.06). Effect estimates for total flavonoids, flavanones, proanthocyanidins, and isoflavones, suggested a protective, though nonlinear association with risk reduction emerging at the second quintile, though these did not achieve statistical significance (total flavonoids, fully adjusted HR (95% CI): Q2= 0.80 (0.61, 1.04); Q3= 0.85 (0.65, 1.11); Q4=0.92 (0.70, 1.19); Q5= 0.77 (0.58, 1.03)). Total flavonoid and flavanone intake were significantly associated with IS in fully adjusted models in women (total: Q5 v Q1 HR=0.62; 95% CI= 0.41, 0.94; p-trend=0.15; flavanones HR=0.65; 95% CI=0.44, 0.95; p-trend=0.03) but not in men (total: Q5 v Q1 HR=0.95; 95% CI= 0.63, 1.42; flavanones HR=0.80; 95% CI=0.58, 1.09; p-interaction=0.67). There was no effect modification by race or region of residence.

Conclusion:
Total dietary flavonoids and flavanones are associated with a reduction in risk of incident ischemic stroke, particularly in women. The emergence of a protective effect at the second quintile for total flavonoids, flavanones, proanthocyanidins and isoflavones is consistent with previous studies of dietary flavonoid intake and CVD mortality.
Abstract P327: Adherence to the Alternative Healthy Eating Index is Associated with a Lower Risk of Acute Myocardial Infarction Among Singapore Chinese Adults
Authors: Neelakantan Nithya , Naidoo Nasheen , Choi Hyungwon , Koh Woon-Puay , Yuan Jian Min , van Dam Rob Martinus
Published: July 2021

Introduction:
Adherence to the Alternative Healthy Eating Index-2010 (AHEI-2010) has been associated with lower risk of acute myocardial infarction (AMI) in Western populations. It remains unclear if this association is present in Asian populations. Little is known about potential biological mediators of the association between the AHEI-2010 and AMI.

Objective:
We investigated the association between adherence to the AHEI-2010 and AMI related biomarkers and their potential role as mediators of the association between the AHEI-2010 and risk of AMI in a Chinese population.

Methods:
We conducted a nested case-control study (subcohort: n=2,198; verified AMI events: n=751) within a large prospective cohort of Singapore Chinese established between April 1993 and December 1998 involving Chinese men and women aged 45-74 years. Habitual diet was assessed with baseline in-person interviews using a validated, semi-quantitative food frequency questionnaire. Cases were ascertained via linkage with nationwide hospital databases and Singapore Birth and Death Registry. We evaluated the association between the AHEI-2010 and several AMI related biomarkers, such as HbA1c, markers of dyslipidemia (low-density lipoprotein, high-density lipoprotein and triglycerides) and inflammation (C-reactive protein), and blood pressure measurements. A conditional logistic regression model was used to estimate the odds ratios and 95% confidence intervals of AMI risk associated with quartiles of AHEI-2010 scores adjusting for potential confounders.

Results:
We documented 751 incident AMI events (nonfatal AMI=564; fatal AMI = 288). There were 489 AMI events observed in men and 262 AMI events in women. The AHEI-2010 was inversely associated with the risk of AMI (P
trend
=0.001) in a dose-dependent manner. Compared to the lowest quartile, participants in the highest quartile had a 37% reduction in the AMI risk (OR: 0.63; 95% CI: 0.48, 0.82). Favorable associations were more evident in men (OR: 0.57; 95% CI: 0.40, 0.80) than women (OR: 0.81; 95% CI: 0.51, 1.28). Further adjustments of single biomarkers and their combinations as potential intermediates in the multivariable models did not explain the association between AHEI-2010 and AMI risk (OR: 0.61; 95% CI: 0.44-0.83).

Conclusion:
In the Singapore Chinese adult population, greater adherence to the AHEI-2010 is associated with a lower risk of AMI. The inverse dose-dependent association between AHEI-2010 and AMI risk was not explained by the potential biological intermediates evaluated in this study.
Abstract P334: Ankle-Brachial Index and Future Diabetes: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Hua Simin , Loehr Laura , Tanaka Hirofumi , Heiss Gerardo , Coresh Josef , Selvin Elizabeth , Matsushita Kunihiro
Published: July 2021

Introduction:
Individuals with peripheral artery disease (PAD) often experience reduced physical function and activity, which may increase the future risk of diabetes. Although diabetes is a risk factor of PAD, whether low ankle-brachial index (ABI) predates diabetes has not been studied.

Hypothesis:
Low ABI is independently associated with increased risk of incident diabetes.

Methods:
ABI was measured on a randomly selected leg in 12,244 black and white participants without prevalent diabetes at baseline (1987-1989). Incident diabetes cases were identified by glucose measurements (fasting ≥126 mg/dl or non-fasting ≥200 mg/dl) at subsequent three visits (1990-92, 1993-95, and 1996-98) and self-reported diagnosis or medication use at those visits or during annual phone interview through 2011. We examined the association of ABI with incident diabetes after accounting for potential confounders using Cox proportional hazards models.

Results:
A total of 3304 participants developed diabetes during a median of 21 years of follow-up. Participants with low (<=0.9) or borderline low (0.9-1.0) ABI had 30-40% higher risk of future diabetes as compared to those with ABI of 1.1-1.2 in the demographically adjusted model (Table 1). The associations were attenuated after further adjustment for other potential confounders but remained significant for ABI 0.9-1.0 (HR=1.17, 95%CI 1.04-1.31), even after accounting for fasting glucose at baseline (P=0.046). The association were also attenuated for ABI <=0.9 (HR=1.19 [95% CI 1.00-1.43]) and remained borderline significant in model adjusting for confounders except fasting glucose. The association of low ABI with diabetes was more evident in persons with normal glucose (fasting glucose <100 mg/dl) than in those with impaired fasting glucose (100-125 mg/dl).

Conclusions:
Low ABI was mildly but independently associated with increased risk of incident diabetes in the general population. Attentions are needed regarding diabetes risk and glucose trajectory among people with low ABI.