bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P286: Short-Term Repeatability of Electrocardiographic Criteria of Left Ventricular Hypertrophy
Authors: Meyer Michelle L , Soliman Elsayed Z , Drager Dominique , Heiss Gerardo
Published: March 2019

Background:
Left ventricular hypertrophy (LVH) is a marker of cardiac end-organ damage and a risk factor for cardiovascular morbidity and mortality. Although electrocardiogram (ECG) is the most common tool for LVH assessment in contemporary clinical trials and cohort studies, the repeatability of ECG-LVH criteria has not been sufficiently examined.

Objectives:
Characterize the repeatability and minimal detectable change of ECG-LVH criteria.

Methods:
A total of 63 participants (mean age 50 years; 31 females) underwent two visits one week apart. At each visit, two digital ECGs were obtained following a standardized protocol. The ECG data were processed centrally to automatically obtain waveform measurements needed to calculate Cornell voltage (CV) LVH (SV3 + RaVL >2800 μV for men and >2000 μV for women), Cornell voltage product (CVP) LVH ((RaVL + SV3) X QRS duration ≥244 mV sec; for both Cornell criteria, 0.8 mV was added to the voltage sum for women), and Sokolow-Lyon (SL) LVH (SV1 +RV5/V6 ≥3500 μV). In addition to using these criteria as dichotomous LVH variables, we also used the waveforms measurements composing them as continuous variables, referred to here as CV-index, CVP-index, and SL-index. We used random-effects, mixed models to parse the variance of the variables into their between-participant, between-visit, and within-visit components, and calculated the intra-class correlation coefficient (ICC), minimal detectable change (95% confidence), and Kappas.

Results:
Between-participant variation accounted for 93% to 97% of the total variation in CV-index, CVP-index, and log of SL-index. The ICCs (95% confidence intervals) were 0.97 (0.96, 0.98) for CV-index, 0.97 (0.95, 0.98) for CVP-index, and 0.93 (0.90, 0.96) for log of SL-index. Minimal detectable change between repeat measures of CV-index, CVP-index, and log of SL-index were ≥236.7 μV, ≥26.7 mV, and ≥0.09 μV, respectively. The within-visit Kappa (95% confidence limits) was 0.73 (0.38, 1.00) for SL LVH and 1 for the other two LVH criteria. The between-visit Kappa was 1 for CV LVH, 0.66 (0.04, 1.00) for CVP LVH, and 0.40 (-0.03, 0.83) and 0.64 (0.26, 1.00) for the SL LVH first and second measurements of each visit, respectively. When defining ECG-LVH as presence of ≥1 ECG-LVH criteria, the within visit Kappa became 0.78 (0.49, 1.00) for the first visit and 1 for the second visit; the between visit Kappa values became 0.50 (0.12, 0.88) and 0.70 (0.38, 1.00) for the first and second measurements of each visit.

Conclusion:
CV, CVP, SL indices as continuous variables have excellent repeatability. The dichotomous ECG-LVH criteria have excellent within visit agreement, but between visit agreement ranges from fair to poor, which improved by combining multiple criteria. These results alleviate concerns about the repeatability the ECG LVH use in clinical trials and epidemiologic studies.
Abstract P292: Almond Consumption Increases Satiety Hormones Relative to a High-Carbohydrate Food but Has Minimal Impact on Body Composition: A Pilot Study in Black and Hispanic Adults
Authors: Campbell Ayanna , RoyChoudhury Arindam , St-Onge Marie-Pierre
Published: March 2019

Epidemiological studies show that nut consumers have lower body weight than non-consumers. Individuals who consume more tree nuts have lower odds of obesity and metabolic syndrome than those who are low tree nut consumers. In clinical intervention studies, nut consumption has been shown to lower abdominal adiposity and improving weight loss relative to a low-fat/high-carbohydrate (LF/HC) control food. Those studies, however, have been conducted predominantly in White, non-Hispanic populations. Interestingly, minority adults, who have the highest prevalence of obesity and experience cardio-metabolic health disparities, have low nut intakes. The objective of this study was to evaluate the impact of almond consumption, relative to an energy-matched LF/HC control food, on weight status and adiposity in Blacks and Hispanics. We hypothesized that 24 wk of almond consumption would improve appetite regulation and body composition in Blacks and Hispanics. Twenty-nine adults (17 completers: 9 men and 8 women), BMI >25 kg/m
2
, age 30-65 y, were recruited and randomized to consume either almonds or LF/HC cereal bars providing 17.5% of their estimated energy requirements. Outcome variables were measured at baseline, week 12, and endpoint. Peptide YY concentrations were higher in the almond group compared to LF/HC (time x treatment interaction at 12 wk, P<0.001; 24 wk, P=0.13). Similarly, glucagon-like peptide 1 concentrations were higher in the almond group compared to LF/HC (time x treatment interaction at 12 wk, P=0.10; 24 wk, P=0.015). However, ghrelin levels decreased in LF/HC compared to the almond group at 12 wk but not 24 wk (time x treatment interaction at 12 wk, P=0.017; 24 wk, P=0.23). There was a slight trend for a time x treatment interaction on body weight (P=0.14; change in almond=0.6±1.8 kg; LF/HC=1.9±2.7 kg). There was a time x treatment interaction on inter-muscular adipose tissue (P=0.013; change in almond=-0.10±0.14 cm
3
; LF/HC=0.04±0.07 cm
3
). There was no effect of almond or LF/HC consumption on inflammatory markers concentrations (interleukin-6, C-reactive protein, and tumor necrosis factor; all p>0.18). Daily almond intake for 24 wk, in the context of a usual diet, does not induce profound body composition changes, but may ameliorate appetite and ectopic fat deposition. More studies should be performed in minority population to determine the potential effects of specific foods for weight management in the context of a weight loss diet.
Abstract P303: Clinically Recognized Varicose Veins and Physical Function in Older Individuals: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Mok Yejin , Ishigami Junichi , Kucharska-Newton Anna , Salameh Maya , Schrack Jennifer , Palta Priya , Coresh Josef , Windham B. Gwen , Lutsey Pamela , Folsom Aaron , Matsushita Kunihiro
Published: March 2019

Background:
Varicose veins recently attract attention in medical community due to its high prevalence and potential impact on major clinical consequences like deep venous thrombosis. Also, a few small studies (n<50) have reported that patients with varicose veins have reduced physical function than those without. However, a large study is required to quantify the association of varicose veins and reduced physical function in the community.

Methods:
In 6,506 ARIC participants (aged 71-90 years, 2011-2013 at visit 5), varicose veins were identified using outpatient and inpatient ICD codes from Medicare claims (sample limited to fee for service beneficiaries) or hospitalization data after visit 1 through visit 5. We assessed the cross-sectional associations of clinically recognized varicose veins with the Short Physical Performance Battery (SPPB) score (0-12) (based on the sum of scores from three components [chair stands, standing balance, and gait speed] [0-4 points each]) and frailty (frail if ≥3 of the five components [weight loss, exhaustion, low physical activity, slow walking, and grip strength].

Results:
There were 361 participants with a clinical diagnosis of varicose veins (124 inpatient and 256 outpatient). Varicose veins were independently associated with poor physical function (SPPB ≤6 vs. >6) (adjusted odds ratio 1.72 [95% CI 1.24, 2.37]) and with all individual components of the SPPB (Table). Similarly, varicose veins were associated with being frail (frailty ≥3 vs. <3) (adjusted odds ratio 1.76 [95%CI 1.26, 2.46]) and with only slower walking of frailty components.

Conclusions:
In community-dwelling older adults, persons with varicose veins had lower physical function and were more frail compared to their counterparts. Longitudinal research is warranted to explore the temporality between varicose veins and reduced physical function.
Abstract P313: Sport Participation Associated With Fewer Anxiety Symptoms in Adult Congenital Heart Disease
Authors: Ko Jong , White Kamila , Kovacs Adrienne , Tecson Kristen , Enomoto Junko , Moons Philip , Cedars Ari ,   APPROACH-IS Consortium and International Society for Adult Congenital Heart Disease
Published: March 2019

Introduction:
Physical activity (PA) has well-known benefits for mental health, which is closely related to clinical outcomes in patients with heart disease; however, little is known about the relationship between PA and anxiety. In this study, we examined their association in a large international cohort of adult congenital heart disease (ACHD) patients.

Hypothesis:
We hypothesize that different PA types would have differential impact on anxiety symptoms.

Methods:
We conducted a cross-sectional assessment of data derived from the
Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart Disease - International Study
. This study enrolled 4,028 ACHD patients from 24 centers in 15 countries. Anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS). Participants reported whether they were regular active commuters (either walk or cycle to work/school) and/or regular sport participants (either recreational or competitive). To assess the relationship between PA and anxiety, we constructed ordinal logistic mixed models, treating country as a random effect. We built an optimally-adjusted model via stepwise selection, which considered all variables having significant relations with anxiety in bivariate analyses and missing at a rate of < 5%.

Results:
Of 3,893 patients (mean age of 35 ± 13) who completed the HADS, 53% were female; 27% reported elevated anxiety symptoms (i.e., HADS ≥ 8). No significant relationship was found between active commute and anxiety symptoms in bivariate analysis while sport participation was associated with a 40% lower risk of elevated anxiety. The benefit of sport participation on anxiety remained, even after accounting for relevant demographic and clinical variables (adjusted OR=0.769; 95% CI 0.654 - 0.906; p = 0.002) (Table 1).

Conclusion:
Sport participation is associated with fewer symptoms of anxiety. In conclusion, individualized sport-related exercise prescriptions may reduce anxiety symptoms in cardiac patients.
Abstract P318: The Association of Physical Activity With Serum Metabolomics: Findings From the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Xu Jun , Gabriel Kelley P , Boerwinkle Eric , Yu Bing
Published: March 2019

Background:
Habitual physical activity can attenuate the risk of developing a variety of non-communicable diseases, however, the underlying mechanisms that explain these benefits remain unclear. Metabolomics profiling, a tool to provide metabolic phenotypes characterization, holds promise to describe the perturbed energy metabolism associated with physical activity. Identifying a pattern of physical activity related metabolites may provide novel insights into disease etiology.

Methods:
Metabolomic profiling was performed in 2,472 African Americans (AAs) and 1,551 European Americans (EAs) from the Atherosclerosis Risk in Communities (ARIC) Study. Two hundred forty five serum metabolites were identified and quantified by liquid and gas chromatography-mass spectrometry. Adjusted linear and ordinal logistic regression models were performed to examine the metabolite associations with reported, leisure-time moderate-to-vigorous intensity physical activity (MVPA), expressed continuously (METhrwk
-1
) and categorically based on the American Heart Association (AHA) Recommendations for Ideal Physical Activity (ideal, intermediate, or poor). Covariates included: age, gender, race, body mass index, smoking status, and study center. A metabolite risk score (MRS) was constructed using metabolites related to both MVPA and AHA recommendations to evaluate whether it better characterizes the metabolism associated with physical activity.

Results:
The mean MVPA was 5.8 METhrwk
-1
and 11.1 METhrwk
-1
for AAs and EAs respectively, 22.5% and 43.5% met the ideal category of AHA-recommended guideline. We identified eight metabolites that were significantly associated with MVPA (p < 2.04x10
-4
, Bonferroni correction), including indole propionate, docosahexaenoate (DHA; 22:6n3), 1-docosahexaenoylglycerophosphocholine (22:6n3), 3-carboxy-4-methyl-5-propyl-2-furanpropanoate (CMPF), N-acetylcarnosine, glycerate, threonate, and stachydrine. All eight metabolites showed individual significance in EAs, but only half (the latter four metabolites) had individual significance in AAs (p < 0.006). Except DHA and it derivative, the other six MVPA-related metabolites were also associated with AHA recommendations (p < 2.04x10
-4
). One METhrwk
-1
increase was associated with 2.18 SD increase of MRS (95% CI: 1.56-2.80), and stratification by race revealed a stronger effect in EAs compared to AAs.

Conclusion:
A set of metabolites are associated with physical activity in AAs and EAs, including known biomarkers for cardiometabolic diseases, and the MRS was associated with lower heart failure risk. Our findings provide novel insight into the mechanisms underlying the health effects of physical activity.
Abstract P321: Leisure-Time Aerobic Physical Activity Reduces the Risk of Diabetes-Related Mortality: NHANES III
Authors: Boyer William , Ehrlich Samantha , Crouter Scott , Churilla James , Fitzhugh Eugene
Published: March 2019

Background:
Evidence exists to suggest physical activity (PA) reduces risk for diabetes-related mortality (DRM). However, these studies were limited to examining specific modes of PA with only walking, running, and sports participation being consistently related to a reduced risk for DRM. Given the spectrum of leisure-time PA is inclusive of many different modes, it is important to examine this relationship using a more robust measure of PA.

Purpose:
To examine the relationship between leisure-time moderate-to-vigorous intensity physical activity (MVPA) and the risk of DRM in the Third National Health and Nutrition Examination Survey (1988-1994).

Methods:
The study sample (n=11,017) included adults, 20-79 years of age, with Mobile Examination Center (MEC) data. An age-standardized physical activity score (PAS) was calculated from the self-reported frequency and intensity of 12 leisure-time aerobic activities. PASs were then used to categorize participants into no activity (PAS = 0) versus any MVPA (PAS > 0). DRM was defined as death from diabetes mellitus, either as the primary cause or as a contributing cause in the National Death Index database. Cox Proportional Hazard models were adjusted for age, sex, race-ethnicity, education, smoking, alcohol consumption, healthy eating index, family history of diabetes, body mass index and diabetes status at the time of the MEC. Race-ethnicity specific models (i.e., non-Hispanic white, non-Hispanic black, and Mexican Americans) were also examined.

Results:
There was a 68% [HR=0.32 (95% CI 0.23-0.47)] reduction in the risk of DRM, adjusted for age. Following further adjustment for age, race-ethnicity, gender, education, family history of diabetes, body mass index, glycemic status, healthy eating index, smoking status, and alcohol consumption risk estimates were attenuated, but remained statistically significant [HR 0.63 (95% CI 0.43-0.93)]. No interaction between race-ethnicity and MVPA was found.

Conclusions:
The results of this large, nationally representative prospective study suggest that the accumulation of any volume of MVPA, across a plethora of activities, reduces the risk of DRM.
Abstract P334: Effectiveness of a Questionnaire-based Survey in Improving Awareness of Rheumatic Heart Disease Among School-aged Children in India
Authors: Ray Madhab , Guha Santanu , Ray Meghna , Karak Avik , Choudhury Basabendra , Zubair Haroon , Ray Bipasha , Gangadharamurthy Dakshin , Hazra Prakash C , Goswami Santanu , O’Meara Tara , Kelly Eion , Selker Harry P , Goldberg Robert , Bhatt Deepak L
Published: March 2019

Background:
Rheumatic heart disease (RHD) is prevalent in low income countries, with a regional prevalence in South Asia of 2.2 per 1,000 children aged 10-16 years. Awareness among school children is very important for seeking effective secondary prophylaxis. We studied the current level of awareness in school-aged children and evaluated the effect of a 7-item questionnaire-based survey in improving awareness of RHD. The study was conducted in a rural district of India in August, 2017. The objectives were to assess the level of awareness of RHD and to evaluate the effect of a questionnaire-based survey in improving awareness.

Methods:
The study involved 8,646 students in the age group 10-16 years from 20 schools in Midnapore, India. We carried out a pre-test questionnaire survey, a multimedia presentation on RHD, and a post-test survey that assessed students’ knowledge and awareness of its incidence and prevalence, symptoms and signs, morbidity and mortality, ways to prevent and/or reduce the disease burden, and when to seek medical attention. The data were analyzed to evaluate improvement in the level of awareness by this intervention using a 29-point scoring system in 7 domains. Regression analysis was performed to identify the factors that may enhance awareness.

Results:
Awareness among the school children (mean age 13, 45% boys) was modest. There was a significant improvement in their knowledge after the intervention with the survey questionnaire and the presentation by the study team (Table). Regression analysis showed female sex and higher grade in school were major determinants for improvement of the knowledge level by this intervention (p < 0.05 without any significant interaction noted between sex and grades in school).

Conclusions:
Current awareness among children about RHD is modest. A school-based intervention by administration of a survey questionnaire and presentation can help in improving the awareness about RHD and hopefully promote secondary prophylaxis to reduce the morbidity and mortality from the disease.
Abstract P336: Predictors of High Intensity Statin Initiation for Primary Prevention in Veterans With Familial Hypercholesterolemia Phenotype
Authors: Qazi Saadia , Tarko Laura M , Ho Yuk-Lam , Orkaby Ariela R , Sun Yan V , Assimes Themistocles L , Gagnon David R , Cho Kelly , Djousse Luc , Gaziano J. Michael , O’Donnell Christopher J , Wilson Peter W
Published: March 2019

Introduction:
Familial hypercholesterolemia (FH) phenotype, defined in part by LDL-Cholesterol (LDL-C) ≥190mg/dL, is a strong risk factor for cardiovascular disease (CVD). The 2013 ACC/AHA cholesterol guidelines recommend high intensity statins for primary prevention irrespective of global risk assessment. We sought to determine predictors of high intensity statin initiation in patients with FH phenotype in the Veteran’s Health Administration (VHA).

Methods:
Inclusion criteria consisted of VHA care (2002-2014), age ≥21 years, absence of prevalent CVD, baseline maximum LDL-C ≥190 mg/dL, no prior statin use, and statin initiation within 90 days of outpatient LDL-C measurement. Baseline characteristics were obtained from the electronic health record. We defined baseline LDL-C using quartile cutoffs. High intensity statin definitions were based on the 2013 cholesterol guidelines plus high dose simvastatin when it was available. Multivariable logistic regression models were constructed to determine the odds of high intensity statin initiation versus low or moderate intensity.

Results:
A total of 88,878 Veterans (age=53.7±11.6, men=91%; white race=74%, LDL-C mean=209.5±23.9, Q1=195, median=202, Q3=215) met inclusion criteria. High intensity statin was initiated in 29,533 (33%) of patients. Comorbidities included smoking history (80%), hypertension (39%), diabetes (10%), and chronic kidney disease (3%). Significant predictors were age >40 years, male sex, diabetes, hypertension, black race, smoking, higher baseline LDL-C quartile, and recent calendar year. Veterans with cancer and white race had lower odds of statin initiation.

Conclusion:
Nearly 1/3 of the Veteran population with the FH phenotype was started on high intensity statins. They were more likely to be older, black, smokers, hypertensive, diabetic, and have a higher baseline LDL-C. The odds of high intensity statin initiation increased in recent years, which may partly reflect practice changes concordant with recent cholesterol guidelines.
Abstract P337: CardioClick an Innovative Telehealth Approach to Lifestyle Intervention in High Risk South Asians
Authors: Parameswaran Vijaya , Josan Kiranbir , Winterbottom Jennifer , Shearer Jenny , Khandelwal Abha , Nallamshetty Shriram , Dash Rajesh , Rodriguez Fatima
Published: March 2019

Introduction:
Exercise & nutritional intervention programs are effective in lowering cardiovascular events in randomized control trials but success in real world settings may be limited by resource constraints. We describe the implementation & preliminary effectiveness of a comprehensive telehealth lifestyle approach that provides culturally relevant lifestyle interventions, recognizing the role of acculturative stressors & behavior patterns unique to South Asians.

Methods:
CardioClick was introduced in the Stanford South Asian Translational Heart Initiative on 11/1/2017 to deliver care via video visits. Patients ages 20-60 were offered enrollment. Those who did not consent were followed in the traditional in-person program. Both programs included a comprehensive risk assessment & personalized treatment plan focused on aggressive risk reduction, with a set of 3 cardiologist & 3 dietitian visits over 6 months. CardioClick patients received a lifestyle questionnaire & satisfaction survey at each visit. Based on responses & online dialog, culturally tailored nutrition, exercise recommendations & resources to address sleep deficiencies & perceived stress, were provided.

Results:
Out of 110 currently enrolled 23 have completed CardioClick. These patients were similar in age (44 vs 43 years) BMI (27.1 vs 26.7) & cardiovascular risk (ASCVD 4.8 vs 4.5) but had more dietitian visits (3 vs 1), more likely to lose weight 83% (19/23) vs 54% (44/82) & lost more weight (9lbs vs 0.7lbs) compared to traditional program patients. In the CardioClick group QDiabetes score (9.2 to 7.2) & TG/HDL ratio (2.3 to 1.8) dropped. Questionnaire 100% (23/23) & survey 57%(13/23) responses showed improved lifestyle behaviors & patient satisfaction.

Conclusion:
Early results from a novel telemedicine preventive cardiology program showed improved patient engagement, lifestyle behaviors & cardiometabolic benefits in high risk South Asians.
Abstract P341: Reduction of Insulin Resistance and Carotid Intima-Media Thickness in Older African American Women: A Randomized Comparison of Transcendental Meditation and Health Education
Authors: Schneider Robert , Walton Kenneth , Randall Otelio , Gaylord-King Carolyn , Harris Charlie , Nidich Sanford , Strayhorn Gregory , Rainforth Maxwell , Salerno John , Xu Shichen
Published: March 2019

Background:
High stress level is thought to be a factor in the disproportionate rates of mortality from CHD and stroke in African Americans. Stress-related CVD risk factors such as hyperglycemia, dyslipidemia, obesity, and high blood pressure tend to occur together, and their co-occurrence has been labeled the “insulin-resistance” or “metabolic” syndrome. The Transcendental Meditation (TM) program is reported to prevent or reverse effects of stress and may provide benefits complementary to lifestyle changes based on diet and exercise.

Methods:
A total of 200 older African American women (mean age 65.5, range 55-85 y) in Washington DC and Atlanta, GA were randomly allocated to two behavioral treatment groups—the TM program and a diet-exercise health education (HE) program. The following outcomes were tested before and after one-year: carotid intima-media thickness (CIMT), insulin resistance indicated by homeostatic model assessment (HOMA-IR), serum lipids, blood pressure, and overnight urinary cortisol excretion. Between group and within group changes were analyzed. CIMT change was compared with normative data using t-test for single means.

Results:
CIMT declined significantly in both the TM group [
T
(1, 71) = - 2.25, p < .03] and the HE group [
T
(1, 63) = - 2.656, p = .03] compared to the yearly progression rate from a large normative database. In the TM group, insulin resistance indicated by HOMA-IR decreased compared to the HE group [
F
(1, 138) = 4.72,
p
< .03]. Urinary cortisol excretion (a measure of chronic stress) decreased (statistical trend,
p
< 0.1) in each group.

Conclusions:
In this randomized trial, we found prevention of CIMT progression in both TM and HE groups compared to national norms. In the TM group, this may relate to the reduction in insulin resistance presented here and to the improved dyslipidemia presented previously. Both TM and HE groups tended to lower cortisol secretion, suggesting that the effects of both approaches may be due to lowered chronic stress, a probable contributor to CIMT and CVD.
Abstract P350: Psychological Resilience and CVD-related Health Behaviors: a Cross-sectional Analysis of the Women’s Health Initiative Extension Study
Authors: Springfield Sparkle
Published: March 2019

Introduction:
Psychological resilience (resilience), defined as the self-reported ability to bounce back from stress by the Brief Resilience Scale (BRS), has been associated with CVD-related health behaviors. However, the evidence is limited in ethnically diverse older populations. This study investigates the association between self-reported resilience and CVD-related health behaviors (smoking status, sleep, recreational physical activity, and diet quality) in women aged 62+ years of age.

Hypothesis:
Higher levels self-reported resilience will be positively associated with CVD-related health behaviors after adjustment for age, race-ethnicity, and stressful life events (SLE).

Methods and Materials:
A cross-sectional secondary analysis was conducted on 77,395 women aged 62-85+ [African American (N=4475, 5.8%), White (N=69,448, 89.7%), Latina (N=1891, 2.4%), and Asian or Pacific Islander (N=1581, 2.0%)] who enrolled in the second Women’s Health Initiative Extension Study. Resilience was measured by a short version of the Brief Resilience Scale for assessing the Ability to Bounce Back and divided into 3 levels for descriptive analyses (i.e., low, normal, and high resilience). Multiple regression was used to evaluate the association between levels of resilience and each CVD-related health behavior. Smoking status and sleep were modeled as binary while recreational physical activity and diet quality (as measured by the HEI-2005) were modeled as continuous outcomes.

Results:
Of the 77,395 women, those with high resilience were younger and less likely to have had SLE. African American women were the most likely to self-report high resilience (48.6%; n=2174), followed by White (45.5%; n=31584), and then Asian or Pacific Islander (43.3%; n=684) and Latina women (43.3%; n=819). After controlling for age, race-ethnicity, and SLE, there was a negative association between self-reported resilience and current smoking status (OR=0.92; 95%; CI:0.87-0.97), and a positive association between 7-9 hours of sleep per night (OR=1.20; CI: 1.17-1.22). Linear regression analysis showed a positive association between self-reported resilience and both recreational physical activity (β=
+
0.45; CI: 0.42-0.49) and HEI-2005 (β=
+
0.60; CI: 0.51-0.69).

Conclusions:
Resilience is associated with better CVD-related health behaviors in older ethnically diverse women. These findings warrant further investigation into whether assessing and potentially intervening to improve resilience could help to increase the effectiveness of lifestyle interventions.
Abstract P355: Religious Attendance, Educational Attainment, and Hypertension. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Authors: Varella Ana C , Bensenor Isabela M , Griep Rosane , Fonseca Maria-Jesus , Pereira Alexandre C , Lotufo Paulo A
Published: March 2019

Introduction:
The relationship between the level of religiosity and health-adverse outcomes has been controversial. One reason should be that how "religiosity" is measured or by a self-declaration (meaning more a cultural variable than a manifestation of the spirituality) of by regular religious practices attendance. Several studies pointed out that educational attainment has a close relationship with the practice of religion. In Brazil, the non-practice religious persors have a higher level of formal education than the general population. Therefore, researchers have focused on risk factors, such as hypertension, studying the effect of religious service attendance, besides other religious dimensions, on blood pressure.

Hypothesis:
This study has a premise that attending to religious ceremonies are associated with hypertension according to levels of education.

Methods:
At baseline of the ELSA-Brasil study (15105 adults aged 35-74years old), we asked about the frequency of attendance to religious services. Hypertension was defined as systolic or diastolic blood pressures higher than 140/90 mm Hg or under antihypertensive drugs. Educational attainment was categorized as less or more than high school.Logistic regression models were used to obtain odds ratio (OR) and 95% confidence intervals (95%CI) for the association between frequency of attendance and hypertension adjusted for age, sex, race, income, physical activity and salt consumption (estimated by 12-hour urinary sodium excretion). Further, we added variables that are potential mediators of the religion-hypertension association as smoking, alcohol consumption and body-mass index, depending on the level of education.

Results:
Three-quarters (76.9%) of the participants reported to be religious (mean age of 51.6 years, 58.7% women; 51.8% white), and 49.8% of them declared religious attendance at least weekly. For those with a higher educational level, no association was found an inverse association between frequent religious service attendance and the presence of hypertension, also concerning sociodemographic variables, and between religious practice attendance and hypertension after adjusting for covariates (OR = 1.10, 95% CI 0.98-1.23). However, for subjects with lower educational attainment, religious attendance was inversely associated with hypertension (OR = 0.71, 95%CI 0.53-0.96), after adjusting for covariates. We did not find differences in each educational attainment strata related to association religious attendance and hypertension when stratified by gender, race, family income, and to be Roman Catholic and non-Roman Catholic.

Conclusion:
The effects of religious involvement on hypertension seem to diverge according to socioeconomic status, represented here by educational attainment.
Abstract P359: Pervasive Discrimination and Allostatic Load in African-American and White Adults
Authors: Van Dyke Miriam E , Baumhofer N. K , Slopen Natalie , Mujahid Mahasin S , Clark Cheryl R , Williams David R , Lewis Tené T
Published: March 2019

Introduction:
Self-reported experiences of discrimination have been associated with a range of important clinical disease outcomes; however, most studies have focused on discrimination assessed using a single scale which may fail to capture the pervasive nature of experiences of discrimination in the lives of certain groups. We sought to examine associations between reports of “pervasive” discrimination—conceptualized by combining multiple scales assessing discriminatory experiences-- and an indicator of homeostatic dysfunction, allostatic load (AL), among African-Americans and Whites. We also examined whether associations were stronger among African-Americans than Whites. AL was chosen as it is a measure of cumulative “wear and tear” on the body caused by stressors (i.e., discrimination) and has been associated with cardiovascular-related outcomes.

Hypothesis:
We hypothesized that pervasive discrimination would be associated with higher allostatic load, and that associations would be stronger among African-Americans compared to Whites.

Methods:
We conducted linear regression models using data from 215 African-American and 985 White adults (57% female; mean age=54.7 years) in the Midlife in the United States II (MIDUS II) Biomarker Project. A pervasive discrimination score was created by combining three discrimination scales (Everyday Discrimination, Lifetime Discrimination, and Workplace Discrimination), resulting in a score measuring 0-3 domains of discrimination, and an AL score was created based on a set of 24 biomarkers representing 7 biological systems (including inflammation, lipid metabolism, and cardiovascular, among others).

Results:
African-Americans had higher pervasive discrimination and AL scores than Whites (p<0.001). In models fully-adjusted for demographics and other relevant covariates, raceхpervasive discrimination interaction was observed (p<0.05). A pervasive discrimination score of 2 vs. 0 was associated with a greater increase in AL among African-Americans (b=0.32; p<0.001) compared to Whites (b=0.18; p<0.001).

Conclusions:
African-Americans report more pervasive discrimination than Whites. This pervasive discrimination in turn, has a greater impact on multisystemic physiological dysregulation in African-Americans compared to Whites. Findings suggest that measuring discrimination by combining multiple forms of discriminatory experiences may be particularly important for studying the health effects of discrimination among African-Americans.
Abstract P362: Race and Gender Differences in the Association Between Experiences of Everyday Discrimination and Arterial Stiffness Among Patients With Coronary Artery Disease
Authors: Bromfield Samantha G , Sullivan Samaah , Saelee Ryan , Elon Lisa , Uphoff Irina , Li Lian , Quyyumi Arshed , Vaccarino Viola , Lewis Tene T
Published: March 2019

Introduction:
Self-reported experiences of discrimination have been linked to indices of cardiovascular disease (CVD). However most studies have focused on healthy populations. Thus, we examined the association between experiences of everyday discrimination and arterial stiffness (a known correlate of adverse outcomes among clinically ill and healthy populations) among Black and White patients with a history of myocardial infarction (MI).

Hypothesis:
We hypothesized that higher reports of discrimination would be associated with greater arterial stiffness; and that associations would be more pronounced among Blacks overall, and Black women in particular, potentially due to a “double-jeopardy” effect.

Methods:
Data were from 253 participants (48.6% female, mean age: 50.8 years) who were 6 months post-MI in the Myocardial Infarction and Mental Stress 2 study. Data were collected via self-reported questionnaires, medical chart review, and a clinic visit during which pulse wave velocity was measured noninvasively following a standardized protocol.

Results:
Reports of discrimination were highest in Black men and women (p=0.008) and arterial stiffness was greatest in Black and White women (p=0.290). After adjustment for demographics and relevant clinical variables, discrimination was not associated with arterial stiffness in the overall cohort, or among Blacks. However, discrimination was associated with increased arterial stiffness among Black women but not White women, White men, or Black men (Table 1).

Conclusions:
In conclusion, despite no apparent association between discrimination and arterial stiffness in the overall study sample, further stratification revealed an association among Black women but not other race-gender groups. These data not only support the double-jeopardy hypothesis, but also suggest the importance of implementing psychosocial interventions and coping strategies into the care of clinically ill Black women.
Abstract P366: Pooled Cohort Equation Performance in Primary and Secondary Prevention Subgroups of the SystolicBlood Pressure Intervention Trial (SPRINT)
Authors: Plante Timothy B , Juraschek Stephen P , Zakai Neil A , Tracy Russell P , Cushman Mary
Published: March 2019

Background:
The Pooled Cohort Equation (PCE) estimates 10-y atherosclerotic cardiovascular disease (ASCVD) risk among adults aged 40-79 years without CVD. Recent studies applied the PCE to mixed primary (1°) and secondary (2°) prevention populations to predict risk of future CVD events. However, the PCE is not validated in 2° prevention populations. We studied the impact of prior CVD on PCE performance in a 2° prevention population of the SPRINT trial.

Methods:
SPRINT randomized 9,361 adults with hypertension and ≥1 CVD risk factor or prior ASCVD to standard or intensive BP control. Excluding those age >79 years (n=1,158) or missing PCE covariates (n=52), we calculated 10-year ASCVD risk at baseline using the PCE. We assessed PCE discrimination with the C-statistic among all SPRINT participants and among 1° and 2° prevention subgroups. We estimated the hazard ratio (HR) for incident ASCVD events comparing the 2° to the 1° prevention group, controlling for baseline PCE-predicted 10-y risk.

Results:
Of the 8,151 included participants, 6,874 (84%) and 1,277 (16%) were in the 1° and 2° prevention groups, respectively. Mean (SD) age was 66 (8) years, 35% were female, 34% were black. Median (IQR) baseline predicted 10-year ASCVD risk in the 1° prevention group was lower than the 2° prevention group (P<0.001;
Table
). In the 3.3 years of follow-up, ASCVD events occurred more frequently in the 2° prevention group than the 1° prevention group (P<0.001). The C-statistic was 0.618 (95% CI 0.589, 0.646) in the entire analytic population, and was non-significantly higher among the 1° prevention subgroup. Comparing the 2° to 1° prevention population, HR for incident ASCVD events was 2.6 (95% CI 2.1, 3.3) when controlling for baseline PCE-estimated 10-y risk.

Conclusions:
Adults with prior ASCVD events have a nearly 3-fold higher risk of subsequent events. This study demonstrates that the PCE underestimates risk of recurrent events in 2° prevention populations and use in mixed populations should be avoided.
Abstract P377: Racial and Socioeconomic Trends in Cardiovascular Disease Risk Scores From 1999-2014
Authors: Bucholz Emily M , Gooding Holly C , Lloyd-Jones Donald M , De Ferranti Sarah D
Published: March 2019

Background:
Atherosclerotic cardiovascular disease (ASCVD) incidence and mortality have declined in over the last decade; however, important racial and socioeconomic disparities in ASCVD risk exist. Little is known about trends in these disparities over time and the interplay between these factors.

Methods:
Data from the 1999-2014 NHANES were used to estimate temporal trends in 10-year AHA/ACC ASCVD risk in U.S. adults aged ≥20 years without prevalent ASCVD by race/ethnicity, income, and education. Trends in ASCVD risk were evaluated using linear regression with an interaction term between survey year and race/ethnicity, income, or education.

Results:
Of the 34,543 adults (weighted to 179 million) included in the study, 73.4% (standard error [SE] 1.1) were white, 11.9% (SE 0.7) black, and 14.7% (SE 0.9) Hispanic; 20.6% (SE 0.6) lived below the federal poverty line and 42.3% (SE 0.8) had a high school education or less. White adults had higher ASCVD risk scores on average than black or Hispanic adults (p<0.001) throughout the study period. Mean ASCVD risk scores were initially higher in low-income adults but decreased over time (p=0.001) while scores remained stable for higher-income adults (p=0.85; p for interaction=0.002) such that by 2011-2014, ASCVD risk scores were similar for low- and higher-income adults (p=0.22). Mean ASCVD risk scores decreased over time in less-educated adults and increased in more-educated adults (p=0.007 and p=0.020, respectively; p for interaction <0.001). When stratified by race, the decrease in ASCVD risk among low income adults and less-educated adults occurred exclusively in white adults (p=0.005 and p=0.018, respectively). Mean risk scores remained stable over time in black and Hispanic adults regardless of education or income.

Conclusions:
Differences in ASCVD risk by income and education narrowed over time, but this phenomenon was only observed in white adults. Low-income and less-educated black and Hispanic adults did not experience the same reductions in cardiovascular risk.
Abstract P398: Mexican Mothers’ Experiences With Food Insecurity in Childhood, and Associations With Mothers’ and Children’s Cardiovascular Health
Authors: Aguayo Liliana , Pool Lindsay , Davis Matthew M , Gundersen Craig , Schwingel Andiara , Carnethon Mercedes
Published: March 2019

Introduction:
Food insecurity (FI) is disproportionately experienced by Mexican families. While associations between FI and cardiovascular health (CVH) factors have been recognized, less is known about how fluctuations in FI experiences throughout life relate to CVH or whether FI experiences have intergenerational effects. This study examines the associations between Mexican mothers’ FI experiences in childhood and currently, with their own and their 4-6 year old child’s odds of having optimal CVH.

Methods:
Mexican mother-child dyads were recruited in central Mexico, and central IL, US. Mothers were asked about their experiences with food insecurity “in the last 12 months”, and “when they were children” using an adapted version of the USDA-Food Insecurity and Hunger Module. Optimal CVH was defined as having desirable measurements of six CVH factors: BMI/BMI-Percentile, blood glucose, triglycerides, total cholesterol, HDL, and LDL cholesterol. FI experiences were categorized based upon whether mothers (1) never experienced FI, (2) experienced FI only in childhood, (3) experienced FI currently, but not in childhood, or (4) experienced FI in childhood and currently. Logistic regression was used to determine associations between FI and optimal CVH (6 factors vs. ≤5), adjusted for age, years of education, country of residence, and child sex.

Results:
Overall 28% mothers and 49% children had optimal CVH. FI was experienced by 19% of mothers in childhood only, by 14% currently, but not in childhood, and by 35% in childhood and currently. FI experiences were not associated with optimal CVH among the mothers. Compared to children of mothers who never experienced FI, children born to women who experienced FI only in childhood, but not currently were less likely to have optimal CVH (OR=0.15; 95% CI: 0.03, 0.91).

Discussion:
Mexican mothers who experienced FI during childhood, but not currently were less likely to have children with optimal CVH. Feeding patterns of mothers who experienced FI as children merit further investigation.
Abstract P408: Ischemic Stroke Risk Factor Differences and Their Changes Over Time Among Young (45 Years or Less) Persons in a Rural State: 2012-2017
Authors: Weeks Kristin , Torner James C
Published: March 2019

Introduction:
A positive public health trend in Iowa in the last decade has been the decreasing mortality by stroke. However, there has been an alarming trend in the increased occurrence of stroke in the younger population (≤45 years) in Iowa from 2010-2018. The risk factors responsible for the rising incidence in the young need attention for prevention.

Hypothesis:
This analysis examines whether over time young persons with stroke will have a different frequency and distribution of some cardiovascular risk factors at the time of their stroke. Additionally, we analyze if the risk factor prevalence varies by age cohort and if risk factor prevalence differs from the general age-matched population in Iowa.

Methods:
Using the Iowa Stroke Registry, data from 22,652 patients from 2012-2017 was collected from 32 hospitals. We investigated demographics, medical, social, and family histories by age (≤45, >45) across time (2012-2017) for ischemic strokes. Statistical analysis was done to determine if for each age cohort a factor varied significantly over time, and if factor prevalence varied between age groups. Comparisons were using Chi-Square tests for categorical variables and ANOVA for continuous variables with an alpha=0.05. Trend of change over time was analyzed. We used Iowa Behavioral Risk Factor Surveillance System data from 2015 to compare prevalence of risk factors among stroke patients and the population.

Results:
Compared to over 45 years old stroke patients, 45 or less years old stroke patients in Iowa in 2012-2018 have a higher prevelance at the time of their stroke of obesity, morbid obesity, drug abuse, migraines, a family history of stroke and a smoking history (p=<0.05). There was a lower prevalance of past cardiovascular event, dyslipidemia, hypertension, atrial fibulation, antiplatelet medication use, anticoagulant medication use, and antihypertension medication use (p=<0.05). Dyslipidemia and hypertension decreased in prevelance among stroke patients over years (R
2
0.45, 0.44). Also in comparison to their age-matched Iowa counterparts, Iowa stroke patients have a higher prevelance of smoking, diabetes, prior stroke, prior MI, hypertension, high cholesterol. They have lower diagnosed depression and no difference in obesity.

Conclusions:
Younger persons with strokes experience risk factors at different proportions than older patients with strokes and the prevalence of these risk factors are changing over time. The ≤45 year old stroke patients vary from their overall age-matches state counterparts in their risk factor prevalence. Overall, these findings highlight the need for increased screening and preventive interventions by public health and health care providers.
Abstract P409: Mortality in Subarachnoid Hemorrhage Varies by Day and Month Within the USA
Authors: Rushworth David , Mathews Amber , Khan Adil , Litvak Paul , Mandava Pitchaiah
Published: March 2019

Introduction:
High mortality is associated with aneurysmal subarachnoid hemorrhage (SAH). Despite years of studies and translational research, only a few health and lifestyle factors have been found to definitively associate with an increased risk of SAH incidence and mortality. Prior studies have provided some evidence that environmental factors play a role in the incidence of SAH, but the available data is not often consistent or applicable to the United States of America (USA). Here we provide support that there is a temporal differences in SAH mortality by month of the year and day of the week.

Methods:
The Centers for Disease Control (CDC) and Prevention public health database (wonder.cdc.gov) was accessed. Mortality events for the years 1999-2016 were obtained for deaths attributed to SAH from a named vessel distribution with accounting for day of week and month of year as well as gender from year to year. ANOVA was used to test for differences by week or month.

Results:
Mortality for week day variations found no significant differences (p = 0.13) in women, while men demonstrated a significant difference (p = 0.003) with the most common day of death being Monday. Mortality for monthly variation found a significant difference (p = 0.01) in total with January being the most common month of SAH mortality. However, divided by gender women (p = 0.06) and men (p = 0.10) did not meet predefined statistical significance.

Conclusion:
Mortality from SAH appears to have a variation in time of day of week in men and by month for both genders but this has unclear significance at this time.