bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P057: Lipid Evaluation in a Large Cardiology Practice
Authors: Sexson Tejtel S Kristen , Cephus Constance
Published: March 2019

Background:
Elevated lipids are becoming an increasing problem in children particularly with increasing rate of obesity. We undertook an evaluation to determine if the risk factors are similar for children in a pediatric cardiology practice who are evaluated for lipids is similar to those for children without congenital heart disease.

Methods:
We performed a medical record review from January 2006- January 2018 of all children in a pediatric cardiology practice who had lipids obtained. We evaluated their weight, height, BMI, blood pressure and the lipid results. A descriptive analysis was performed to determine the rate of risk factors for hyperlipidemia in this population.

Results:
In total, 12,950 children had 38,158 lipid panels obtained. The average age at the time the lipid panel was obtained was 11.4 years and 57% (7,365) were male. Of these children, 4,441 were overweight with a weight over the 90 percentile for age and 3,389 were obese with a weight over 95 percentile. Of these children, 82% (or 30331 labs) had elevated total cholesterol over 130 and 51% (or 19299 labs) were over 160. However, of those with elevated cholesterol, 45% were overweight or obese. In addition to elevated total cholesterols, the HDL level was less than 40 in 32% (or 10,654 labs) and less than 35 in 20% (or 6,508 labs). Sub fractionation of the HDL was rarely performed.

Conclusions:
We are identifying a large population of patients with elevated cholesterol and low HDL cholesterol. The risk factors however may be different as there is a lower proportion of these patients who are overweight or obese than in a typical population. Further evaluation for other risk factors in the population of children with congenital heart disease is necessary.
Abstract P060: Sedentary Behavior is Directly Associated With Higher Prevalence of Chronic Kidney Disease in Older Adults: The Framingham Heart Study
Authors: Lee Joowon , Xanthakis Vanessa , Vasan Ramachandran S
Published: March 2019

Introduction:
Self-reported physical inactivity and sitting time have been associated with a greater prevalence of chronic kidney disease (CKD) in middle-aged populations. However, data are limited regarding the association of objectively-assessed physical activity and sedentary behavior with prevalence of CKD among older adults.

Hypothesis:
We hypothesized that higher physical activity and less sedentary time will individually and conjointly be associated with a lower prevalence of CKD in older adults.

Methods:
We evaluated 1,318 Framingham Offspring cohort participants (mean age 69.3 years, 53.9% women) with accelerometry-derived physical activity data (wear time ≥ 10 hours/day for at least 4 days) at examination 9 (2011-2014). CKD was defined as an eGFR < 60 ml/min/1.73
2
and/or urine albumin-to-creatinine ratio (UACR) ≥ 25/35 micrograms/mg (men/women) at examination 9. Multivariable logistic regression models were used to relate physical activity and sedentary time with the prevalence of CKD adjusting for covariates (Table). In sensitivity analysis to mitigate reverse causality, we excluded participants with more advanced CKD (eGFR<30 ml/min/1.73
2
).

Results:
Men spent more time in moderate to vigorous physical activity (MVPA) (mean 21.7 min/day) and less time in sedentary time (mean, 660.7±76.9 min/day), compared to women (mean MVPA, 15.6 min/day; mean sedentary time, 675.8±70.5 min/day). Overall, 279 participants had prevalent CKD (20.8%; 127 women). Higher sedentary time was associated with a higher prevalence of CKD after adjusting for risk factors and MVPA in sensitivity analysis, the association remained significant. MVPA was inversely associated with CKD prevalence in minimally-adjusted models only.

Conclusions:
Our cross-sectional observations on a sample of older adults are consistent with the notion that reduction of sedentary time in the elderly may have salutary effects on kidney function. Additional studies of multiethnic cohorts are warranted to confirm our observations.
Abstract P085: Extremes of Sleep Duration and Type II Diabetes in Older Women Participating in the Women’s Health Study
Authors: Butler Jonathan Z , Slopen Natalie , Redline Susan , Carnethon Mercedes , Williams David R , Powell-Wiley Tiffany M , Pradhan Aruna , Buring Julie , Albert Michelle A
Published: March 2019

Background:
Extreme sleep duration defined as either short (<6 hours) or long (>9 hours) sleep is positively associated with cardiovascular disease (CVD). Because sleep disturbance is prevalent in older women, we evaluated the relationship between extremes of sleep duration and type II diabetes (diabetes) in older women.

Methods and Results:
In a cross-sectional analysis, we examined the association between self-reported short and long sleep duration and diabetes among 21, 769 older women (mean age = 71. 2 ± 6.0 years old) participating in the ongoing follow-up cohort of the Women’s Health Study. Compared to women with diabetes (N=2539) who slept an average of 6-9 hours, diabetic women who reported short sleep were younger, more likely to be current smokers, less likely to use 1+ drinks/day, were less physically active, had lower annual household income and were less likely to possess a bachelor’s degree. Diabetic women who reported long sleep were older, less likely to be a current smoker, more likely to drink 1+ drinks/day, more likely to have hypertension, depression and anxiety symptoms, were less likely to have a bachelor’s degree, and had a lower annual household income. Logistic regression analyses adjusted for age and race/ethnicity revealed that both short [OR, 95% CI: 1.86 (1.48-2.34)] and long [OR, 95% CI: 1.49 (1.34-1.66)] sleep were significantly associated with a higher odds of diabetes (reference = 6 to 9 hrs sleep). These significant relationships persisted but were somewhat attenuated after control for CVD risk factors and psychological status (i.e., depression and anxiety symptoms) [Short: OR, 95% CI: 1.38 (1.07-1.70); Long: 1.28 (1.14-1.45)].

Conclusion:
Extremes of sleep duration were significantly associated with higher odds of diabetes in older women participating in the Women’s Health Study. These hypothesis-generating data suggest that short and long sleep duration might confer key heightened cardiometabolic risk even in older women.
Abstract P106: Genetically Determined Fibrinogen, Gamma Prime Fibrinogen and Risk of Venous Thromboembolism and Ischemic Stroke: Evidence From Mendelian Randomization
Authors: Maners Jillian , Gill Dipender , Pankratz Nathan , Tang Weihong ,   Cohorts for Heart and Aging Rsch in Genomic Epidemiology (CHARGE) Hemostasis Working Group,   INVENT Consortium,   MEGASTROKE consortium of the International StrokeGenetics Consortium (ISGC), Smith Nicholas L , Morrison Alanna C , Dehghan Abbas , de Vries Paul S
Published: March 2019

Introduction:
Fibrinogen is a key component of the coagulation cascade, and variation in its circulating levels may contribute to thrombotic diseases, such as venous thromboembolism (VTE) and ischemic stroke.

Methods:
Two-sample Mendelian randomization (MR) was applied to estimate the causal effect of circulating fibrinogen and its isoform, gamma prime fibrinogen, on risk of VTE and ischemic stroke subtypes using summary statistics from published genome-wide association studies of fibrinogen, VTE, and ischemic stroke, and an unpublished study of gamma prime fibrinogen. Genetic instruments for fibrinogen and gamma prime fibrinogen were selected by pruning genome-wide significant variants to linkage disequilibrium r
2
< 0.1. The inverse variance weighted MR approach was used to estimate effects in the main analysis, with additional approaches that are more robust to the inclusion of pleiotropic variants applied in sensitivity analyses, including MR-Egger, weighted median MR, and weighted mode MR.

Results:
The main inverse variance weighted MR estimates (
Table
) based on 85 genetic instruments for fibrinogen and 27 genetic instruments for gamma prime fibrinogen indicated a protective effect of both fibrinogen and gamma prime fibrinogen levels on VTE risk. Higher fibrinogen levels decreased the risk of cardioembolic stroke but increased the risk of large artery and small vessel stroke. Higher gamma prime fibrinogen levels decreased the risk of all ischemic stroke, cardioembolic stroke, and large artery stroke. Effect estimates were consistent across sensitivity analyses, indicating that the results are unlikely to be attributable to the inclusion of pleiotropic variants.

Conclusion:
Our results are consistent with effects of genetically determined fibrinogen and gamma prime fibrinogen on VTE and ischemic stroke. The identified protective effects may reflect the diverse roles of the fibrinogen, beyond the formation of fibrin clots, in thrombotic diseases with different etiologies.
Abstract P107: Thirty-Year Risk of Incident and Recurrent Ischemic Stroke in Individuals With Sickle Cell Trait and Modification by Midlife Risk Factors: The Atherosclerosis Risk in Communities Study
Authors: Caughey Melissa C , Derebail Vimal K , Key Nigel S , Reiner Alexander P , Gottesman Rebecca F , Kshirsagar Abhijit V , Heiss Gerardo
Published: March 2019

Introduction:
Sickle cell trait (SCT) has been associated with ischemic stroke in some, but not all, epidemiologic cohorts. Heterogeneity of the association may be related to differences in demographic subgroups or midlife risk factors.

Methods:
The ARIC study is an observational cohort based on 4 US communities. Participation has included 6 clinical visits and ongoing surveillance of acute cardiovascular events. Black participants were genotyped for SCT, excluding any with sickle cell anemia or hemoglobin SC disease. Global genetic ancestry was determined from whole genome variation. Midlife factors were ascertained at ARIC visit 1 (1987-1989), or if missing imputed from visit 2 (1990-1992). Acute ischemic stroke was classified by physician review of the medical record. Associations between SCT and ischemic stroke were analyzed using repeat-events Cox regression with robust estimators, counting all occurrences of ischemic stroke per participant. Models were adjusted for sex, age, global genetic ancestry, and midlife factors (smoking, hypertension, hyperlipidemia, diabetes, chronic kidney disease, and previous myocardial infarction). Effect modification was tested by the multiplicative interaction of SCT with each midlife factor.

Results:
Our population was composed of 3,827 black adults with complete midlife data (32 [0.8%] excluded). SCT was identified in 255 (7%). The mean age at visit 1 was 53 years; the median follow-up time was 26 years. Most (63%) were women. At midlife, individuals with SCT had a greater prevalence of hyperlipidemia (32% vs. 26%;
P
=0.04) and chronic kidney disease (20% vs. 13%;
P
=0.003). From 1987-2016, 579 ischemic strokes occurred in 456 individuals. SCT was more strongly associated with ischemic stroke in participants with chronic kidney disease [HR=2.01 (1.13 - 3.60)] than those without [HR=1.10 (0.77 - 1.57)],
P
for interaction = 0.05,
Figure 1
.

Conclusions:
The association between SCT and ischemic stroke is heterogeneous and appears to be stronger in those with chronic kidney disease.
Abstract P110: Early-Life Exposure to Severe Famine is Associated With Higher Methylation Level in the IGF2 Gene and Higher Total Cholesterol in Late Adulthood: The Genomic Research of the Chinese Great Famine (GRECF) Study
Authors: Shen Luqi , Li Changwei , Wang Zhenghe , Zhang Ruiyuan , Shen Ye , Miles Toni , Wei Jingkai , Zou Zhiyong
Published: March 2019

Objective:
To evaluate association of early-life exposure to the Chinese Great Famine (1959-1961) with DNA methylation in
IGF2
, a gene involved in growth and development, and its subsequent influence on blood lipid levels in late adulthood among participants of the Genomic Research of the Chinese Great Famine (GRECF) study.

Methods:
The GRECF study recruited 790 participants born between 1956 and 1964 from two neighbor provinces, Anhui and Jiangxi, in China through a multistage, clustered, random sampling. Historically, famine was severe in Anhui and moderate in Jiangxi. Besides individuals born in Anhui province, those who were born during or before the Chinese Great Famine in Jiangxi province and reported having siblings starved to death were also categorized as having severe famine exposure; All other participants born in Jiangxi province were considered as having moderate famine exposure. DNA methylation within the
IGF2
gene locus were assayed using the Sequenom’s MassARRAY system among a random sample of 188 participants. Total cholesterol (TC), low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were assayed using enzymatic colormetric tests. Triglycerides was calculated using the Friedman formula and was logarithmically transformed for analyses. Multivariate linear regressions were used to evaluate associations of famine severity with lipids, famine severity with DNA methylation in the
IGF2
, and DNA methylation in the
IGF2
with lipids, respectively, controlling for sex in the base model and additionally controlling for age, education, smoking, and drinking in the fully adjusted model. Mediation analysis was applied to assess the mediation effect of DNA methylation at the
IGF2
gene on the association between early-life exposure to severe famine and adult lipids levels.

Results:
DNA methylation was quantified at 8 cytosine-phosphate-guanine dinucleotides (CpG) sites in the
IGF2
gene. Exposure to severe famine was associated with higher methylation level at one site of the
IGF2
gene (CpG1:
β
=0.07,
P
=5.00х10
-4
) and increased levels of TC (
β
=0.85;
P
=9.30х10
-7
). Furthermore, per unit increase in methylation of the CpG1 site was associated with 1.13-unit increase in TC (
P
=0.02). After further adjustment for all covariates, these associations were still significant (

P
famine-CpG1

=0.03;

P
famine-TC

=7.55х10
-6
;

P
CpG1-TC

= 0.05). Methylation of the CpG1 site mediated 6% (
P
=0.18) of the association between exposure to the severe Chinese Great Famine and adult TC.

Conclusion:
Increased methylation level in the
IGF2
gene may be a consequence of early-life exposure to severe famine during the Chinese Great Famine and this change was also positively associated with TC in late adulthood.
Abstract P124: Comparative Evaluation of African Dance versus a Cultural Educational Program in Mitigating Cardiovascular Risk Among REACT! Study Participants
Authors: Kariuki Jacob K , Bermundez Adrian , Kilkelly Timothy , Stillman Chelsea , Donahue Patrick , Lwanga Charles , Williams Mihloti , Brown Chrisala , Wollam Mariegold , Jedrziewski Kathy , Erickson Kirk
Published: March 2019

Background:
Currently, about 50% of African American (AA) adults are affected by cardiovascular disease (CVD) compared to 38.9% of the general US adult population. Physical inactivity, a major risk factor for CVD, plays a key role in perpetuating the disparities, while physical activity and psychosocial interventions are known to be protective. In this study, we did a secondary analysis of the 6-month Rhythm Experience and Africana Culture Trial (REACT!) to compare the impact of moderate physical activity (African dance) versus an educational control program (culture and health education) in reducing cardiovascular risk.

Methods:
In the REACT! Trial, CVD risk factors including history of smoking and diabetes, body mass index and systolic blood pressure (SBP) were measured using CDC-BRFSS protocols. In this analysis, we used the non-lab based Framingham algorithm to compute pre- and post-intervention absolute CVD risk scores. Chi-square and t test were used to evaluate between group differences in categorical and continuous variables, respectively.

Results:
The 28 REACT! Trial participants (mean age 68 yrs, 93% female) were randomly assigned to either the cultural education control group (13) or African dance intervention group (15). At baseline, both groups had comparable cardiovascular risk profiles, including mean SBP (143 vs 146 mmHg; p=0.80) and absolute CVD risk scores (27 vs 29%; p=0.71). Post-intervention, the control group had a more favorable cardiovascular risk profile compared to the intervention group, with improvements in SBP (136 vs 152 mmHg; p=0.028) and absolute CVD risk scores (24 vs 30%; p=0.175), respectively.

Conclusions:
These data suggest that certain control group characteristics such as social interaction could be potent in lowering SBP compared to moderate physical activity. Possible mechanisms might include the stress-lowering effects of social support and communication in the culture education group.
Abstract P127: Years of Life Lost Due to Cardiovascular Disease Among Asian American Subgroups, 2003-2012
Authors: Iyer Divya , Palaniappan Latha
Published: March 2019

Introduction:
Asian American subgroups (Asian Indian, Chinese, Filipino, Korean, Japanese, and Vietnamese) display significant differences in mortality due to cardiovascular disease. It has previously been proposed that cancer is the leading cause of death for all Asian Americans. However, recent analysis of each individual subgroup reveals that heart disease is actually the leading cause of death for Asian Indian, Filipino and Japanese populations. Additionally, certain Asian American subgroups have an increased burden of risk factors and disease mortality at younger ages when compared to Non-Hispanic Whites.

Years of potential life lost (YPLL) provides a measure of premature mortality due to cardiovascular disease by taking into account race-specific life expectancy and the younger age at death that is specific to Asian American populations.

Hypothesis:
We assessed the hypothesis that certain subgroups, such as Asian Indian and Filipino populations, lost more years of life due to cardiovascular disease when compared to other Asian American subgroups and Non-Hispanic Whites.

Methods:
We used National Center for Health Statistics Multiple Causes of Death mortality files from 2003-2012. Sample size for Asian Americans was 354,256 and for Non-Hispanic Whites was 19,722,445. We calculated life expectancy, mean YPLL, and YPLL per 100,000 population for each Asian subgroup. We further characterized race-specific life expectancy using linear interpolation, and YPLL per 100,000 was standardized and age-adjusted using age categories.

Results:
Asian American subgroups display heterogeneity in cardiovascular disease burden. Asian Indians had a high burden of ischemic heart disease (IHD); Asian Indian men lost a mean of 17 years of life to IHD while Japanese and Non-Hispanic White men lost 14 years of life. Regarding cerebrovascular disease, Vietnamese populations lost a mean of 17 years of life, and Filipino populations lost a mean of 16 years. All Asian subgroups had higher years of life lost to cerebrovascular disease compared to Non-Hispanic Whites.

Conclusion:
Cardiovascular disease burden varies among Asian subgroups, and contributes to significant premature mortality in certain populations. Asian Indian and Filipino populations have the highest years of life lost due to ischemic heart disease. Filipino and Vietnamese have the highest years of life lost due to cerebrovascular disease. Mean YPLL due to cardiovascular disease was higher for Asian Indians, Korean, Vietnamese, and Filipino subgroups than mean YPLL for Non-Hispanic Whites. To address these health disparities, an analysis of risk factors is required and subgroup-specific interventions must be developed.
Abstract P132: Establishing a New Observational Study of Cardiovascular Risk Factors and Chronic Diseases in Puerto Rico: The PROSPECT Study
Authors: Mattei Josiemer , Tucker Katherine L , Rios-Bedoya Carlos F , Falcon Luis M , Kaplan Robert C , Rodriguez-Orengo Jose F
Published: March 2019

Introduction:
Evidence supports a direct link between psychosocial and food-related environmental risk factors, and cardiometabolic conditions. These associations remain markedly understudied at the population level in Puerto Rico (PR), despite the clear and pressing need to alleviate striking disparities in chronic disease in the island. On September 2017, Hurricane Maria devastated PR, imposing urgency for studying trends and associations of risk factors for cardiometabolic conditions under times of distress.

Hypothesis and aims:
We aimed to design and establish ‘PROSPECT: Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic disease Trends’ to study longitudinal associations in psychosocial, food-related, and cardiometabolic risk factors.

Methods:
PROSPECT was designed as an island-wide, longitudinal population cohort that is recruiting 2,000 adults ages 30-75y using a multi-frame sampling combining probabilistic plus community approaches, with examinations and interviews done in a network of partner clinics across the island. Trained interviewers are collecting comprehensive data on multiple psychosocial, dietary, and food-related factors, cardiovascular disease (CVD) biological markers, and medical record data, with follow-up at 2-years, using standardized protocols and validated questionnaires. PROSPECT emulates the goals and methods of other US and Caribbean cohorts inclusive of mainland Puerto Ricans and other Latinos for comparison.

Results:
Expected results include estimates of baseline and 2y prevalence and incidence of psychosocial, dietary, and food environment risk factors, and CVD biological markers; measures of associations between 2y changes in risk factors and CVD biological markers; and estimates of differences in prevalence and 2y changes in risk factors, CVD biological markers, and chronic diseases, with emphasis on CVD, by urban vs. rural area, and pre vs. post-Maria. A supplemental study is investigating how food and water shortages following Hurricane Maria may have triggered allostatic load (i.e. physiological stress) and how social connectedness moderates this in PROSPECT participants, with additional context from qualitative narrative interviews.

Conclusions:
Ultimately, PROSPECT will create a biorepository and participant database for prospective use, and bolster research, academic, and public health partnerships in PR and the US. The study is yielding seminal data to identify priorities on CVD-related disparities, and address them by tailoring public health programs and policy that will effectively improve cardiovascular health in PR, an island with an underserved and high-risk population, under times of distress.
Abstract P137: Impaired Microvascular and Endothelial Function Among African-Americans With Coronary Artery Disease
Authors: Young An , Sullivan Samaah , Moazzami Kasra , Lima Bruno , Shah Amit , Lewis Tene , Elon Lisa , li lian , Quyyumi Arshed , Vaccarino Viola
Published: March 2019

Background:
African-Americans have disproportionately higher burden of mortality from coronary artery disease (CAD) compared to Caucasians even after adjusting for socioeconomic and cardiovascular risk factors. Racial differences in arterial stiffness have been described, but data on microcirculatory and endothelial vascular function are more limited and it is unknown whether they differ by race in CAD patients.

Methods:
We studied 313 patients with a recent history of myocardial infarction (MI). Microvascular function was assessed by digital pulse amplitude tonometry (EndoPAT) to determine reactive hyperemia index (RHI), and endothelial function as brachial artery flow mediated dilation (FMD) using ultrasound. Arterial stiffness was assessed using applanation tonometry (Sphygmocor) to determine pulse-wave velocity (PWV) and central augmentation index (C-AIx). Data on sociodemographics, cardiovascular risk factors, medication use, and CAD severity were collected. Multivariate linear regression models were used to assess the relationship between race and various vascular function measures with adjustment for risk factors. Measures of arterial stiffness were included as control factors in the adjusted model for FMD and RHI.

Results:
The mean age of this post-MI sample was 51 years (± 6.7 SD); 50% were African-Americans and 49% were female. Compared to Caucasians, African-Americans had worse microvascular function as indicated by lower mean (± SD) RHI (1.7±0.5 vs 2.0±0.6, p<0.0001) and worse endothelial function [FMD mean (3.4±2.4 vs 4.7±3.1, p=0.0002)]. African-Americans also had greater arterial stiffness, including a higher mean C-AIx (26.5±9.0 vs 23.0±9.3, p=0.0019) and PWV (7.7±2.0 vs 7.1±1.8, p<0.0267). After adjustment for cardiovascular risk factors, medications, CAD severity, and arterial stiffness (C-AIx and PWV), black race remained significantly associated with lower RHI (β=-0.30, p<0.001) and FMD (β=-1.06, p=0.004).

Conclusion:
African-Americans with CAD have impaired microvascular and endothelial vasodilatory function compared to Caucasians, independent of CAD risk factors and arterial stiffness. Racial differences in microcirculatory and endothelial function may contribute to worse outcomes among African-Americans with CAD.
Abstract P138: Private School Attendance and Later Life Hypertension
Authors: Barrington Debbie
Published: March 2019

Introduction:
Black Americans have the highest prevalence of hypertension in the United States (US). Higher educational attainment has been found to have an inverse association with hypertension, yet research examining the association between hypertension and components of education not captured by quantity of education, such as type of school attended, private vs. public, has been limited. The positive relationship between private school attendance and academic achievement, with effects particularly robust among Black Americans, suggests a potential role for private school attendance as a protective factor in hypertension.

Hypothesis:
Private school attendance compared with public school attendance is hypothesized to be associated with a lower prevalence of hypertension among African American and Afro-Caribbean men and women in the United States.

Methods:
Multiple logistic regression models were used to examine type of school attended, private vs. public, and its independent association between hypertension among African American (N = 2693) and Afro-Caribbean (N = 1308) men and women, 18 years and older, in the National Survey of American Life (2001-2003). Odds ratios (OR) of the association between type of school attended and adult hypertension were estimated after adjusting for age, socioeconomic factors, health and lifestyle measures within the models. Adult socioeconomic factors included marital status, education, occupation, home ownership and poverty status. Adult health and lifestyle covariates included obesity, diabetes, smoking, alcohol use and physical activity.

Results:
Private school attendance was a risk factor for hypertension among African American men; age-adjusted OR = 2.11; 95%CI: (1.07, 4.15). Conversely, private school attendance was a protective factor for Afro-Caribbean men; age-adjusted OR = 0.34; 95%CI: (0.13, 0.89). After adjusting for adult socioeconomic, health and lifestyle factors, the two-fold higher odds of hypertension compared to those who attended public schools remained among African American men who attended private schools; adjusted OR = 2.11; 95%CI: (0.97, 4.60). After covariate adjustment, private school attendance remained a statistically significant protective factor for Afro-Caribbean men; those who attended private schools had 68% decreased odds of hypertension compared to those men who attended public schools, adjusted OR = 0.32; 95%CI: (0.11, 0.94). No association between hypertension and school-type was found for either African American or Afro-Caribbean women.

Conclusions:
These findings suggest that type of school attended is another dimension of education relevant for the cardiovascular health of African American and Afro-Caribbean men. Additionally, it exerts a differential effect on hypertension by ethnicity.
Abstract P144: The Effect of a Community-Based Healthy Lifestyle Behavior Change Program on Simple 7 Score Among Rural Women
Authors: Seguin Rebecca , Folta Sara , Marshall Grace , Graham Meredith , Strogatz David S
Published: March 2019

Objective:
The objective of this study was to evaluate the effects of a multilevel healthy lifestyle behavior change program for women living in rural areas where higher rates of cardiovascular disease are influenced by poverty, reduced access to health care and unique social and built environment challenges.

Methods:
In eleven medically underserved rural towns in New York, 182 overweight and obese sedentary women 40 years and older enrolled in a community-randomized trial. Communities randomized to Group 1 (intervention) participated in six months of hour-long, twice weekly experiential learning classes that included progressive strength training, aerobic exercise and skill-based nutrition education (individual level), and a civic engagement curriculum focused on healthy food and physical activity environments (social, community and policy levels); classes were facilitated by local health educators trained by the research team. Communities randomized to Group 2 (delayed intervention control) received the intervention immediately following the completion of intervention activities for Group 1. All components of the Simple 7 score were recorded at baseline (prior to randomization) and at six months (post-intervention for Group 1, pre-intervention for Group 2). Weight, height, blood pressure, blood cholesterol and blood glucose were measured directly and smoking status, diet and physical activity were self-reported. Multivariate regression analyses were used to examine change in Simple 7 score from baseline to outcome. Initial models controlled for study site, baseline Simple 7 score, education and age, and were based on the 107 participants with complete data.

Results:
Simple 7 scores were similar for both groups prior to randomization (7.91 for Group 1, 7.83 for Group 2). At the end of the six month intervention period for Group 1, the Simple 7 score for Group 2 was unchanged (7.85) but increased to 8.98 for Group 1 participants (p=0.02 for the difference between groups in Simple 7 change). The percentage of Group 1 participants in the optimal range of scores (10-14) rose from 14.8% to 37.0%. The Simple 7 components showing the greatest improvement were BMI, physical activity and healthy diet score. Additional analyses will assess potential bias associated with incomplete data and will examine evidence for the validity of self-reports on physical activity and diet.

Conclusion:
The multilevel healthy lifestyle program is feasible for implementation in rural settings with limited resources and showed promise for reducing cardiovascular disease risk in midlife and older rural overweight and obese women.
Abstract P145: Outcomes of an EMR-Enabled Acute Ischemic Stroke Care Path in a Primary Stroke Center
Authors: Dunn Aaron , Pasadyn Selena , May Francis , Wisco Dolora
Published: March 2019

Background:
One major challenge in health care is to improve value, which is best measured at the disease or treatment level. Evidenced-based, standardized care has been proposed and studied as one potential method to drive this process. We hypothesize that enablement of the Acute Ischemic Stroke (AIS) Care Path within the electronic medical record (EMR) improves clinical outcomes of patients with acute ischemic stroke.

Methods:
We compared the length of stay (LOS), in-patient mortality, rate of hospital readmission within 30 days, NIH Stroke Scale (NIHSS) at admission in patients, and post-discharge modified Rankin Scale (mRS) with ischemic stroke in the periods before (January to December 2015) and after (January to December 2016) EMR-enablement of the AIS Care Path.

Results:
A total of 1,858 patients were diagnosed with acute ischemic stroke during the entire study period. Patients presented with more severe stroke symptoms, as evidenced by a higher NIHSS at admission in the post-intervention period (11.4 ± 0.7 vs 10.5 ± 0.7, p=0.05). There was no difference in LOS (5.2 ± 0.3 days vs 5.3 ± 0.2 days, p=0.41), and there was a significant reduction in rate of hospital readmission within 30 days of discharge (8.9 ± 2.0 vs 10.7 ± 2.0, p=0.05). There were trends toward decreased in-patient mortality (2.6 ± 0.7% vs 3.3 ± 1.5%, p=0.22) and improved functional outcomes (2.3 ± 0.3 vs 2.6 ± 0.4, p=0.20) after EMR-enablement of the AIS Care Path.

Conclusion:
EMR-enablement of the AIS Care Path, a means of further standardizing stroke care, was associated with lower readmission and trends toward lower mortality and improved functional outcomes.
Abstract P148: Early Follow-Up Appointments for Congestive Heart Failure Admissions
Authors: Schultz Emily , Sayegh Peter , Bhandary Akshai
Published: March 2019

Introduction:
Congestive heart failure (CHF) admissions place a financial burden on patients and the healthcare system. The national direct medical costs of CHF have reached $20.9 billion and a CHF related hospitalization costs $14,631 per patient. Studies have demonstrated an association between early post-discharge follow up within 7 days and a reduction in readmission rates. Our study attempts to characterize the rates of follow up appointments in patients discharged from the medicine service in an urban academic hospital.

Hypothesis:
We hypothesized the rate of early follow-up appointments provided to patients with a diagnosis of an acute CHF exacerbation will be low.

Methods:
We performed a chart review of patients admitted to our institution from January 2016- February 2017 to the medicine service, including regular medicine floor and telemetry units, with a primary or secondary discharge diagnosis of acute systolic or diastolic heart failure. Discharge paperwork was reviewed for presence of an appointment with a primary care physician (PCP) or cardiologist scheduled within 7 days of discharge, including date and time of appointment. Patients discharged from the cardiology or other services and patients with dispositions of hospice or death were excluded.

Results:
Over a 13 month period, 63 patients were discharged from the medicine service with a primary or secondary diagnosis of CHF, twelve patients were excluded due to disposition. Among 51 patients, 15.7% (CI 95%, 0.07-0.286) were scheduled for follow-up appointment within 7 days of discharge with a PCP or cardiologist and 2 patients had appointments documented after 7 days. Therefore, 80.4% of patients (CI 95%, 0.695-0.913) did not have any scheduled follow up on their discharge summaries.

Conclusion:
In conclusion, the majority of CHF patients admitted to the medicine service of our institution are not provided appointments within 7 days of discharge. Data has shown that early follow up appointments are associated with reduced readmission rates. Lowering CHF readmissions are important for reducing medical complications and financial burden on patients and the healthcare system. Our future interventions will focus on increasing the number of patients with appropriate 7 day follow up with the aim to reduce readmissions and medical complications.
Abstract P155: Smoking, Its Cessation, and Future Risk of Heart Failure: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ding Ning , Shah Amil M , Blaha Michael J , Chang Patricia P , Rosamond Wayne D , Matsushita Kunihiro
Published: March 2019

Introduction:
Smoking is considered as a major risk factor for cardiovascular disease, including heart failure (HF). Few studies have evaluated the prospective association of detailed smoking parameters (including duration, intensity, and cessation) with incident HF.

Hypotheses:
These smoking parameters will be associated with incident HF.

Methods:
In 14,010 ARIC participants free of a history of HF at baseline (1987-89), we quantified the associations of smoking parameters (pack-years, duration, and intensity [pack/day]) with incident HF (hospitalizations with HF diagnosis [ICD-9: 428.0-428.9] or a death certificate ICD-9 code 428.0-428.9 or ICD-10 code I50.0-I50.9) using Cox models. Years since quitting in former smokers (<5, 5-9, 10-19, 20-29, and ≥30 years) were explored as time-varying variables, with time-varying covariates whenever possible.

Results:
Over a median follow-up of 26 years, there were 3,047 cases of HF. Pack-years was significantly associated with incident HF (HR 1.31 [95% CI 1.28-1.35] per 20 pack-years). Both smoking duration and intensity showed significant associations with HF (HR 1.62 [1.55-1.70] per 20 years of smoking and 1.43 [1.36-1.50] per 1 pack/day). Smoking cessation demonstrated a graded association with HF, with significantly increased risk even after cessation for ≥30 years (1.16 [1.04-1.31]) (Table-Model 2). After further adjusting for incident coronary events, the association was attenuated but remained significant up to cessation for 10-19 years (Table-Model 3).

Conclusions:
All smoking parameters tested in this study consistently show significant associations with incident HF. The HF risk related to smoking lasted at least 19 years after its cessation. Our results further highlight the importance of smoking prevention and early smoking cessation for the prevention of HF.
Abstract P162: Gout and Risk for Incident Heart Failure, Coronary Heart Disease and Stroke: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Authors: Colantonio Lisandro D , Saag Kenneth G , Singh Jasvinder , Reynolds Richard , Gaffo Angelo , Plante Timothy B , Curtis Jeffrey R , Bridges S L , Levitan Emily B , Chaudhary Ninad , Howard George , Safford Monika M , Muntner Paul , Irvin Marguerite R
Published: March 2019

Background:
Gout has been associated with a higher risk for coronary heart disease (CHD) and stroke in some but not all prior studies. There are few data available on the risk for incident heart failure associated with gout.

Objective:
To compare the incidence of heart failure, CHD and stroke among adults with versus without gout.

Methods:
We used data from 5,499 black and white REasons for Geographic and Racial Differences in Stroke (REGARDS) study participants >65 years of age with Medicare coverage without a history of heart failure, CHD or stroke at baseline in 2003-2007. Gout was defined by (1) ≥1 inpatient claim or ≥2 outpatient or carrier claims on separate days with an ICD-9 diagnosis code for gout (274.x) in Medicare prior to each participant’s baseline study visit, or (2) use of allopurinol, colchicine or probenecid based on a baseline medication inventory. REGARDS study participants were followed through December 31, 2015 for heart failure, CHD, and stroke events, which were adjudicated.

Results:
Among participants included in the current analysis (mean age 72 years, 45% male, 31% black), 223 (4%) had gout. The incidence of heart failure and CHD was higher, while the incidence of stroke was similar, among participants with versus without gout (
Figure
). After adjustment for sociodemographic and cardiovascular risk factors, hazard ratios comparing participants with versus without gout were 2.41 (95%CI 1.60, 3.64) for heart failure, 1.41 (0.96, 2.07) for CHD and 0.96 (0.58, 1.59) for stroke. There was no statistically significant effect modification by race or gender. In a sensitivity analysis defining gout only based on Medicare diagnosis codes, multivariable-adjusted hazard ratios for heart failure, CHD and stroke associated with gout were 2.25 (95%CI 1.41, 3.59), 1.26 (0.79, 1.99) and 0.83 (0.45, 1.52), respectively.

Conclusion:
After accounting for sociodemographic and cardiovascular risk factors, gout remains strongly associated with incident heart failure but not with incident CHD or stroke.
Abstract P168: Vascular Stiffness in Young Men Subject to Presence of Chronic Decompensated Tonsillitis
Authors: Evsevyeva Maria , Eremin Mikhail , Italyantseva Elena , Koshel Vladimir
Published: March 2019

The main role in atherosclerotic damage of the vascular wall is given now to the inflammatory process, the development of which is facilitated by a variety of risk factors (RF). Many of these factors begin to affect on the cardiovascular (CV) system in youth and even in childhood. Some authors refer to RF infectious-inflammatory diseases (IID), which were transferred earlier. The aim is to evaluate some parameters of vascular status in young people in the presence of such focal infection (FI) as chronic decompensated tonsillitis (CDT). Material and methods. Within the main group, 52 young patients aimed at performing surgery due to the presence of IID (age from 18 to 27 years) were examined. 76 persons of comparable sex, age and profile of the main RF without any IID were served as control. The control group was formed from the number of students according to the results of the annual preventive examination in the framework of the Federal Program "University of healthy lifestyle". Both groups were quite comparable in age, sex and profile of the main RF. In addition to the assessment RF-profile it was carried out the determination of indicators of the central pressure and vascular stiffness with the help of hardware-diagnostic complex BPLab ("Petr Telegin", Nizhny-Novgorod, Russia) with the use of programs set Vasotens Office. This program involves an in-depth contour analysis of the properties of pulse waves at the level of both the aorta and peripheral arteries. Statistical processing was carried out using the software "Statistica 10.0" (StatSoft Inc, USA).

Results:
It was found that in the main group compared with the control group, the pulse wave propagation velocity in the aorta PWVao equal to 10.61±0.25 versus 9.73±0.15 m/s (p=0.004), the augmentation index in the aorta AIxao was 3.88±0.31 versus -1.04±0.08%. In discussing two groups augmentation index in the brachial artery AIx made up of 32.15±2,70 against -48,89±1,52% (p=0.05), arterial augmentation index, AIx normalized to heart rate heart rate was equal to -35,23±vs -49,67 of 5.39±2.56%. In this case, the values of both peripheral and aortic SBP, DBP, Medium BP and Puls BP in patients with DHT were slightly lower than in persons of the control group.

Conclusion:
The data of the youth study of the dense-elastic vascular potential in different parts of the arterial bed showed a marked increase in vascular rigidity from both the peripheral arteries and the aorta in presence of CDT. In this case, aortic remodeling was more pronounced. It is useful to consider these findings in process of planning and implementing individualized prevention programmes among young people, taking into account the availability of FI.
Abstract P170: Etiologies and Characteristics of Heart Failure for Human Immunodeficiency Virus (HIV)-Infected Persons and Uninfected Controls
Authors: Abutaleb Abdul A , Steverson Alexandra B , Ahmad Faraz S , Lloyd-Jones Donald M , Feinstein Matthew J
Published: March 2019

Background:
Human immunodeficiency virus (HIV) is associated with elevated risks for heart failure (HF). No studies to our knowledge have evaluated physician-adjudicated etiologies of HF (e.g., ischemic vs. non-ischemic) for HIV-infected persons in the modern ART era.

Hypothesis:
We hypothesize that non-ischemic etiologies of HF will comprise a greater proportion of overall HF for HIV-infected than uninfected persons.

Methods:
We performed a nested study of a cohort of HIV-infected and uninfected persons frequency-matched on age, sex, race, zip code of residence, and clinic location receiving care at an urban medical center between 1/1/2000 and 1/1/2018. Two trained MDs independently reviewed clinical notes, imaging and laboratory studies to determine contributing etiologies of HF for 128 patients (75 HIV-infected, 53 uninfected) with physician-adjudicated HF. Laboratory and imaging data as well as clinical notes from clinical care were used to classify etiologies of HF. HF was considered ischemic in etiology based on any prior angiogram demonstrating ≥70% epicardial coronary stenosis, stress testing consistent with ischemia, and/or documented previous myocardial infarction. Non-ischemic heart failure etiologies were subtyped based on pre-specified criteria as valvular, inflammatory, drug induced, hypertensive, infiltrative, hypertrophic, dilated, tachycardia induced, pulmonary hypertension, acute pulmonary embolism, stress cardiomyopathy (Takotsubo), renal volume overload, cirrhotic volume overload, or unspecified. More than one etiology of HF was possible if criteria were met for multiple etiologies.

Results:
Age at HF onset, sex, and race of HIV-infected vs. uninfected persons with HF were similar. Diabetes was less common among HIV-infected (30.7%) vs. uninfected (54.7%; p = 0.01) persons with HF. There were no significant differences in the proportion of HIV-infected vs. uninfected persons with ischemic vs. non-ischemic etiology of HF. Within non-ischemic HF, drug/toxin-induced cardiomyopathy was more common among HIV-infected (17.3%) than uninfected (5.7%) persons (p= 0.049). The left ventricular ejection fraction (LVEF) at HF diagnosis was significantly lower for HIV-infected (37.6% ± 16.4%) than uninfected (44.9% ± 18.3%; p =0.02) persons. The difference was apparent among persons with non-ischemic etiologies (38.0% ± 16.7% vs. 47.9% ± 17.8% for HIV-infected vs. uninfected; p=0.01), but not for those with ischemic etiologies of HF (37.1% ± 15.9% vs. 38.3% ± 18.3% for HIV-infected vs. uninfected; p=0.83).

Conclusions:
HIV-infected persons with HF had lower LVEF at HF diagnosis and were more likely to have toxin/drug-induced HF etiology than uninfected persons with HF. Future studies are needed to understand etiologies of and prognosis HF among HIV-infected persons to inform prevention and treatment.
Abstract P175: Association of Midlife Hypertension and a Novel Biomarker of Accelerated Epigenetic Age: Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Zheng Yinan , Khan Sadiya , Gao Tao , Joyce Brian , Shah Sanjiv , Gross Myron , Jacobs David , Liu Kiang , Greenland Philip , Lloyd-Jones Donald , Hou Lifang
Published: March 2019

Introduction:
Hypertension (HTN) is associated with increased risk of cardiovascular disease (CVD), a hallmark of aging. A new biomarker of epigenetic age using 513 DNA methylation and clinical biomarkers, referred to as phenotypic age, has been derived and validated. Phenotypic age acceleration (PhenoAA) is defined as the residual value of phenotypic age regressed on chronologic age, and is thus independent of chronologic age.

Hypothesis:
We assessed the hypothesis that higher blood pressure is associated with greater PhenoAA.

Methods:
A subset of CARDIA cohort participants (ppts) (n=957) underwent genome-wide blood DNA methylation profiling with the Illumina EPIC 850K array at Year 20 (Y20; age 38-54 years) for estimation of PhenoAA. Ppts with adjudicated CVD or cancer history or who were pregnant at Y20 were excluded (n=113). We used robust linear regression models to examine the association of systolic and diastolic blood pressure (SBP and DBP) with PhenoAA at Y20 after adjusting for age, sex, race, education, study center, BMI, smoking status, physical activity, and anti-hypertensive treatment. We also compared mean PhenoAA across three groups: no HTN (BP <130/<80), HTN controlled with treatment (BP <130/<80), and uncontrolled HTN (BP ≥130/≥80).

Results:
Ppts were 48% female and 40% black with mean chronological age 45±4 years, and mean SBP 116±15 and DBP 73±11 mmHg. Phenotypic age was accelerated by 0.36 years per 10 mmHg higher for SBP (p=0.018,
Figure A
) but not for DBP. Compared with ppts with no HTN, those with controlled HTN had 1.8 years greater (P=0.044) and those with uncontrolled HTN had 3.2 years (P=0.0001) greater PhenoAA (
Figure B
); there was no significant difference between controlled and uncontrolled ppts with HTN.

Conclusions:
PhenoAA is a promising molecular biomarker of aging associated with higher concurrent SBP levels, which reflect greater cumulative SBP exposure. These data suggest that controlling BP after onset of HTN may not fully reverse possible effects of cumulative BP exposure on aging.