bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P102: Comparison Of Existing Cardiovascular Risk Prediction Models In Haiti: Implications For Primary Prevention In Lower-income Countries
Authors: Yan Lily D , Lookens Pierre Jean , Rouzier Vanessa , Théard Michel , Apollon Alexandra , St-Preux Stephano , Kingery Justin , Jamerson Kenneth A , Deschamps Marie , Pape Jean W , Safford Monika M , Mcnairy Margaret
Published: April 2022

Introduction:
Cardiovascular diseases (CVD) are rapidly increasing in low-middle income countries. Accurate risk assessment is essential to reduce premature CVD by targeting primary prevention. Available CVD risk prediction models are built on predominantly Caucasian, high-income country populations, and have not been evaluated in lower-income countries. We aimed to compare six existing models for predicted 10-year risk of CVD and identify high-risk groups for targeted prevention in Haiti.

Methods:
We used cross-sectional data within the Haiti CVD Cohort Study, including 653 adults ≥ 40 years without known history of CVD. Six CVD risk prediction models were compared: pooled cohort equations (PCE), adjusted PCE with updated cohorts, Framingham CVD Lipids, Framingham CVD Body Mass Index (BMI), WHO Lipids, and WHO BMI. Risk factors were measured during clinical exams. Primary outcome was continuous and categorical predicted 10-year CVD risk. Secondary outcome was statin eligibility.

Results:
Seventy percent (460/653) were female, 65.5% (428/653) lived on a daily income of ≤1 USD, 57.0% (372/653) had hypertension, 14.5% (95/653) had hypercholesterolemia, 9.3% (61/653) had diabetes mellitus, and 5.5% (36/653) were current smokers. Predicted 10-year CVD risk ranged from 3.9% in adjusted PCE (IQR 1.7-8.4) to 9.8% in Framingham-BMI (IQR 5.0-17.8), and Spearman correlation coefficients ranged from 0.87 to 0.98. The percent of the cohort categorized as high risk using the uniform threshold of 10-year CVD risk ≥ 7.5% ranged from 28.8% in the adjusted PCE model to 62.0% in the Framingham-BMI model (χ
2
= 331, p value < 0.001). Statin eligibility also varied widely.

Conclusions:
In the Haiti CVD Cohort, there was substantial variation in the proportion identified as high-risk and statin eligible using existing models, leading to very different treatment recommendations and public health implications depending on model choice. There is a need to design and validate CVD risk prediction tools for low-middle income countries.
Abstract P106: Estimating The Difference In CVD Prevalence Among Patients With OUD Identified By NLP & ICD-10-CM Codes Using EHR Data
Authors: Singleton Jade , Akpunonu Peter , Abner Erin , Kucharska-newton Anna
Published: April 2022

Background:
Diagnostic codes may underestimate the prevalence of opioid use disorder, especially among complex patients. We estimated the prevalence of cardiovascular disease (CVD) among patients with OUD identified from electronic health records (EHR) from ICD-10-CM diagnostic codes and by natural language processing (NLP) of clinical notes.

Methods:
We conducted a cross-sectional study using anonymized EHR from one academic medical center, representing inpatient and emergency department visits for 2019. Patients with OUD were identified by ICD-10-CM (ICD) codes and by a rule-based NLP algorithm applied to unstructured EHR clinical notes. CVD was identified using ICD codes for acute myocardial infarction, cardiac arrhythmia, stroke, heart failure, ischemic heart disease (IHD), and infective endocarditis (IE). We estimated crude prevalence of CVD diagnoses (overall and by type) for patients with OUD identified by ICD codes and NLP.

Results:
Among 22,701 patients, 1,878 were identified as having OUD, of which 1,483 (79%) were identifiable by ICD codes and 395 were only identifiable from clinical notes using NLP (Table 1). Patients identified only by NLP tended to be older, more likely African American and more likely Hispanic relative to patients identified by ICD. The prevalence of any CVD among all patients with OUD was 44.7% (841/1878). Prevalence of IE was very low in both groups. For the other CVD types, between 17-29% of diagnoses were among OUD patients found only by NLP.

Conclusion:
NLP can recover OUD cases from unstructured notes that cannot be identified by ICD codes alone. If relying on ICD codes alone to identify OUD from EHR, researchers may underestimate prevalence of both OUD and CVD among patients with OUD (e.g. heart failure, IHD), or overestimate the prevalence of conditions, such as IE.

* CVD was ascertained via ICD codes. Results are n, row %, for ‘ICD-10-CM’ and ‘NLP only’ columns. For the Total column, results are n, column %.
Abstract P107: Trends In Oral Anticoagulation Therapy In Non-valvular Atrial Fibrillation Patients At High-risk Of Stroke After The 2019 AHA/ACC/HRS Update For The Management Of Patients With Atrial Fibrillation Guidelines
Authors: Brod Camille , Groth Nicole , Rudeck Macaela , Benziger Catherine P
Published: April 2022

Background:
Oral anticoagulation (OAC) reduces the risk of ischemic stroke in patients with atrial fibrillation (AF) but is underutilized in high-risk patients. We aimed to assess the impact of the 2019 guideline-recommended use of non-vitamin K OAC (NOACs) as first line therapy over warfarin for high-risk patients with non-valvular AF.

Methods:
Adult patients at Essentia Health with AF or atrial flutter on their problem list, seen in an ambulatory clinic between 7/1/2020-7/12/2021, were included in the baseline cohort. Patients were excluded if they had moderate to severe rheumatic mitral stenosis or mechanical heart valves, or were deceased or missing 1-year follow-up data. High-risk AF was defined as males with a CHA2DS2-VASc score ≥2 and females with a score ≥3. ATRIA bleed score was calculated using electronic health record data and divided into 3 groups: low-risk (0-3), intermediate (4) or high-risk (5-10). Patients were separated into three groups: warfarin, NOAC, or no OAC therapy.

Results:
Of the 12,014 patients in the baseline non-valvular AF registry, 8,032 were high-risk (mean age 75.9 ± 9.8 years, 57.5% male). Over half (57.1%, n=4619) were age ≥ 75 years and 63.4% (n=5095) were rural dwelling. Compared to baseline, at 1-year follow up, high-risk AF patients had similar use of any OAC (75.6%; n=6069 at baseline vs. 75.7%; n=6083 at 1-year follow-up). The use of warfarin decreased 2.3% [from 39.3% (n=3160) to 37.0% (n=2973), p <0.001] while NOAC use increased 2.4% [from 36.2% (n=2909) to 38.7% (n=3110; p <0.001]. Eliquis was the most prevalent NOAC prescribed (57.9%; n=1802). At 1-year follow-up, patients with high-risk AF and low-risk ATRIA bleed score, the use of any OAC therapy increased by 0.9% while those at high-risk AF and high-risk ATRIA bleed score, the use of any OAC therapy decreased 1%. In the multivariate logistical model, age, male sex, CHA2DS2-VASc score 4-6, hypertension, stroke/transient ischemic attack/thromboembolism, and cardiology visit within the last 3 years showed an increased association with prescription of any OAC (p<0.05). Vascular disease, high risk ATRIA bleed score, severe renal risk, prior hemorrhage, and left atrial appendage occlusion device (WATCHMAN) had a decreased odds of any OAC use (p<0.05).

Conclusion:
Implementation of the 2019 ACC/AHA/HRS guidelines that established NOACs as first line therapy over warfarin for non-valvular AF resulted in a slight increase in NOAC use and decrease in warfarin use in a large high-risk non-valvular AF population. Approximately one in four high risk patients with AF are not on any OAC therapy and may benefit from treatment to reduce thromboembolic risk.
Abstract P111: Differentially Methylated DNA Regions In Left Ventricular Hypertrophy: A HyperGEN Study
Authors: Jones Alana C , Patki Amit , Tiwari Hemant K , Chaudhary Ninad S , Claas Steven , Arnett Donna K , Irvin Marguerite M
Published: April 2022

Left ventricular (LV) hypertrophy (LVH) is an independent risk factor for cardiovascular morbidity and mortality that is commonly associated with hypertension. African Americans (AAs) experience an especially high risk of LVH. Genomic studies have identified potential candidate genes associated with LVH, but more research is needed to further explain the high estimated heritability for these traits in AAs. Epigenetic modifications, such as DNA methylation, may account for the unexplained heritability in LVH in AAs. In this study, we used epigenotype and echocardiography data from 636 African Americans selected from the Hypertension Genetic Epidemiology Network (HyperGEN) to identify differentially methylated regions (DMRs) of DNA in association with LV related traits. DNA was isolated from participants’ whole blood, and more than 485,000 CpGs were assayed on Illumina Methyl450K arrays. Linear mixed models were used to test the association between a DMR and LV trait using the
coMethDMR
package in R. We identified several DMRs associated with LV traits in HyperGEN. There was an association between methylation of
XKR6
and ejection fraction (β[SE]:0.005[0.001], FDR: 0.056), as well as
TRAK1
and LV internal diastolic dimension (β[SE]:0.113[0.027], FDR: 0.042). There was also an inverse relationship between LV mass indexed to height and methylation of
GSE1
(β[SE]:-0.002[0.001], FDR: 0.085),
RPS15A
(β[SE]:-0.002[0.001], FDR: 0.085), and
PSMD7
(β[SE]:-0.003[0.001], FDR: 0.085). Additionally, relative wall thickness was inversely associated with a DMR annotated to
DNHD1
(β[SE]:-1.269[0.275], FDR: 0.008). Methylation variations of
GSE1
,
PSMD7
, and
DNHD1
have previously been linked to cardiac structural function, and external validation of these findings is in progress. In summary, differentially methylated regions of DNA may help explain additional variation in LVH-related traits and heritability in AAs. Future studies should evaluate potential relationships between regional DNA methylation patterns and the development and progression of LVH.
Abstract P114: Effects Of Losartan And The Dash Diet On Serum Urate
Authors: Castilla-Ojo Noelle , Turkson-Ocran Ruth-Alma N , Conlin Paul R , Appel Lawrence J , Miller Edgar R , Juraschek Stephen P
Published: April 2022

Background:
The DASH diet and losartan each lower blood pressure (BP) and concurrently affect many cardiometabolic biomarkers. Whether these BP-lowering treatments reduce serum urate, a pro-oxidant associated with cardiovascular health and gout, is uncertain.

Objective:
To determine the independent effects of the DASH diet and losartan on serum urate.

Methods:
We randomized 55 participants with elevated BP in parallel fashion to the DASH or control diet, the standard American diet. While on their assigned diet, participants were randomized in a two-period cross-over design to losartan or placebo, each for 4-weeks. Serum urate was measured at baseline and at the end of each period. Diets were designed to maintain a constant weight constant. We examined the independent effects of DASH (vs control) or losartan (vs placebo) on serum urate, overall and among those with baseline serum urate ≥6 mg/dL, using generalized estimating equations.

Results:
Of 55 randomized participants, mean age of participants was 52 years, 58% were women, and 64% were Black. Mean (±SD) baseline SBP/DBP was 146±12/91±9 and mean (±SD) serum urate was 5.2±1.2 mg/dL. Losartan significantly decreased serum urate (overall mean difference -0.23 mg/dL; 95% CI: -0.40, -0.05). The DASH diet did not significantly reduce urate levels overall (mean difference -0.05 mg/dL; 95% CI: -0.39, 0.28), but did decrease levels in participants with elevated baseline urate levels (≥6 mg/dL), with a mean difference of -0.33 mg/dL (95% CI: -0.87, 0.21;
P
-interaction =0.007 across hyperuricemia groups).

Conclusions:
In adults with elevated BP, losartan significantly reduced serum urate, while the DASH diet only significantly decreased serum urate among participants with higher urate at baseline. Additional research should explore potential mechanisms, as well as the effects of these treatments on clinical outcomes (e.g. gout).
Abstract P123: IL1RN Gene Polymorphism And The Development Of Acute Myocardial Infarction In Young Patients
Authors: Glova Svetlana
Published: April 2022

IL-1RA is a member of the interleukin-1 cytokine family. IL1Ra is secreted by various types of cells, including immune cells, epithelial cells, and adipocytes, and is a natural inhibitor of the pro-inflammatory effect of IL1. This protein inhibits the activity of interleukin 1, alpha (IL1A) and interleukin 1, beta (IL1B) and modulates various interleukin 1-related immune and inflammatory responses.

Hypothesis:
The aim of this study was to investigate the relationship between IL1RN gene polymorphism and the development of acute myocardial infarction (AMI) in young patients.

Material/methods:
In a case-control study, we investigated polymorphisms in the IL1RN gene (rs4251961) using quantitative real-time polymerase chain reaction analysis. The study was conducted with AMI (age range: 36 to 55 years; mean: 42.74 ± 12.47 years) with 11 healthy people in the control group. We also studied the interaction between genetic polymorphism and inflammatory agents such as CRP, IL 1, IL 6. All indicators were calculated using the statistical program Statistica 12.0, a P-value <0.05 was considered statistically significant.

Results:
Statistically significant differences in the distribution of rs4251961 genotypes were observed between the two groups. Carriers of the T allele had a significantly higher risk of developing AMI than carriers of the C allele (P <0.05). Subjects carrying the TT and TC haplotypes have a significantly increased incidence of coronary artery disease. We also found that the CYP1B1 rs1056836 polymorphism had a synergistic effect with CRP levels on the risk of coronary heart disease.

Conclusions:
The rs4251961 gene polymorphism is closely associated with the development of AMI in patients with coronary artery disease. There is a mutual synergistic effect between the inflammatory response and IL1RN gene polymorphism in relation to the development of CAD complications. Functional polymorphisms of the IL1RN gene can affect the susceptibility and progression of CAD, increase the pro-inflammatory response, and destabilize the atherosclerotic plaque.
Abstract P138: Post-partum Maternal Vascular Function Is Reduced In Preeclampsia And Preterm Births: A Pilot Study
Authors: Snippen Janessa , Saffian Eleanor , Lohr Nicole L , McIntosh Jennifer , Kulinski Jacquelyn P
Published: April 2022

Introduction:
Women with a history of preeclampsia (PreE) or preterm (PreT) birth are at elevated risk of future hypertension, ischemic heart disease, and stroke. Mechanisms for this increased risk are unknown. Flow-mediated dilation of the brachial artery (FMD) is an established surrogate for cardiovascular risk.

Hypothesis:
In this pilot study, we hypothesize that maternal vascular dysfunction associated with PreE is reversible, and the extent of recovery is predicated on specific maternal characteristics.

Methods:
In this prospective study, subjects were recruited to three groups: PreE with delivery at 27-34 weeks; PreT delivery at 27-34 weeks without preeclampsia; and healthy controls at 39-40 weeks. Vascular function (FMD), nutrition (validated questionnaire), and physical activity (accelerometers) data were collected at 1-2 days post-partum and 3 months.

Results:
Fourteen subjects were enrolled (mean age 32±6 years). Systolic blood pressure was higher for PreE subjects (average 131±6) compared to controls (109 ± 9, p=0.004) and PreT (110±8, p=0.008) at visit 1. This difference resolved at visit 2. Though non-significant, FMD (mean±SE) was higher in controls compared to PreE and PreT groups at visit 1 (7.7%±0.8 v. 7.4%±0.7 and 6.9%±1.0, Figure 1). FMD remains depressed at 3 months, but subject follow-up was impacted by the Covid 19 pandemic. Alternate Healthy Eating Index scores were non-significantly higher in the PreT group than PreE and controls. PreT subjects were less sedentary and more physically active (higher moderate-vigorous physical activity, higher total steps).

Conclusions:
Maternal FMD is reduced immediately post-partum in PreE and PreT births. The PreT group had lower FMD despite better nutrition and physical activity scores. This is a pilot study, and we are not powered for significance. Data from our small cohort support the ability to collect meaningful data in these understudied populations which could inform future studies of long-term cardiovascular risk.
Abstract P146: A Report On The Outcomes Of The Cleveland Clinic Community Care Health Challenges Project 2018 To 2019.
Authors: Eze-Nliam Chete , Holmes Jonathan , Bailey Jacqueline , Bharmal Nazleen , Khot Umesh
Published: April 2022

Healthy Community Initiatives is a means of directly impacting the health and well-being of the cities and communities served by the Cleveland Clinic. The Health Challenge is the signature program of the Cleveland Clinic Healthy Community Initiatives. It is a collaborative effort between Cleveland Clinic and community partners to engage individuals in the community to help manage chronic conditions and promote a healthier lifestyle. The population is the Cleveland Clinic Central region and other nearby neighborhoods impacting 59 zip codes. Each Health Challenge lasted 8 weeks. Neighborhood participants representing each area acquired points by attending health and wellness classes and events held at the Cleveland Clinic community center and partner locations. Individuals are awarded points for participation and improvement in biometric results and/or completion of a clinical appointment. Data was collected by summing up scores received from the different events in the health challenges as noted : Pre-Program Health Screening (1 point), Post-Program Health Screening (1 point), Decrease in BMI at End of Program (1 Point), Decrease in Blood Pressure at End of Program (1 point), Attend classes, programs, or exercise sessions at partner organizations (1 point), Attend classes, programs, or exercise sessions (2 points), mammography (5 points) and Women's Clinic Appointment (5 points) at the Cleveland Clinic Community Center. The winner of individual health challenge was determined by a point system based on participation and completion percentage. There were 17 eight week Health Challenges held in 2018 and 2019 in which a total of 1889 participants enrolled. Average age was 60 years. Average participant attended 9.4 classes/programs or exercise sessions during the 8 week program - total number attended by all the participants was 7,433. The completion percentage was 47.6%. From 2018 to 2019, enrollment increased by 24.9%, weight (by pounds) decreased by 27.7% (a net total of 2,133.7 pounds lost). However, completion rate decreased by 6.6%. Blood pressure abnormality (number of participants with stage 2 blood pressure abnormality decreased from 33% to 23% (national average 28.3%) ; initial lack of physical activity decreased from 51.2% to 32.2% (national average 25.4%) , initial lack of sleep decreased from 50.2% to 41% (national average 29.2%). The main objective of this report is to show how community health interventions such as these have positive impact on the health and well-being of both individuals and community at large. It is anticipated that dissemination of the positive outcomes of these community health interventions will encourage and consolidate healthy behaviors. It may also create incentives for both community and institutional investment and support in such beneficial health focused activities at the grassroots level.
Abstract P155: Differential Incidence Trends In Non-traumatic Lower Limb Amputations In The Province Of Quebec, Canada: Does The Reduction Applies Equally In Both Sexes?
Authors: OConnor Sarah , Blais Claudia , Anassour Laouan Sidi Elhadji , Leclerc Jacinthe , Poirier Paul
Published: April 2022

Introduction:
Non-traumatic lower limb amputations (LLA) represent an important complication of diabetes (DM) and peripheral arterial disease (PAD). In Quebec, Canada, the latest data between 1996 to 2004 suggested a reduction in the incidence of LLA while other Canadian provinces observed a recent increase between 2010 and 2016. Our objective was to update the incidence trends of LLA in Quebec from fiscal years 2006 to 2019.

Methods:
Age-standardized incidence of LLA among individuals ≥40 years was assessed using the Quebec Integrated Chronic Disease Surveillance System (n=4,527,533 in 2019). The mean age of incident cases and the presence / duration of DM and/or PAD was collected. Estimations were presented for all, by sexes and by types of LLA (minor: below the knee; major: knee and above), with 99% confidence intervals (CI).

Results:
Between 2006 and 2019, incident cases of LLA increased from 818 to 1,099 but age-standardized incidence remained stable (Figure 1) for both sexes. Men had a higher age-standardized incidence of LLA then women (32.7 per 100,000 [99% CI: 29.7-35.9] vs 12.9 per 100,000 [11.2-14.9] in 2019). From 2006 to 2019, the age-standardized incidence of major LLA showed a relative decrease of 48% while minor LLA remained stable (Figure 1). Reduction in age-standardized incidence of major LLA was attributable to men (3.8 per 100,000 [2.7-5.3] to 1.7 per 100,000 [1.1-2.6]). The mean age of incident cases went from 68.2 to 69.5 years from 2006 to 2019 (72.4 for women and 68.3 for men in 2019). Ninety-eight percent of LLA had DM, while 95% had PAD and 95% had both in 2019. Between 2006 and 2019, the average time between the first LLA and DM diagnosis increased from 7.0 to 14.7 years and from 2.0 to 2.6 years for PAD.

Conclusions:
Although the age-standardized incidence of LLA is stable, men remain at higher risk then women. The portrait of incident cases is changing towards an older average age, longer DM duration and a reduction of major LLA. These results emphasize the importance to improve further preventive care of LLA in Quebec.
Abstract P171: Effects Of Covid-19 On Cardiometabolic Outcomes (diabetes, Hypertension, And Obesity)
Authors: Adzrago David , Odame Emmanuel , Dada Oluwabunmi M , Meyer Cynthia , Nriagu Valentine , Paul Trishita , Weierbach Florence M , Stewart David W , Paul Timir K , Mamudu Hadii M
Published: April 2022

Background:
Prior studies have examined cardiometabolic outcomes, but literature on the effects of the COVID-19 pandemic on cardiometabolic outcomes (diabetes, hypertension, and obesity) among the general U.S. population is sparse.

Objective:
To examine differences in the prevalence of cardiometabolic outcomes by sexual identity, cigarette smoking, e-cigarette use, and anxiety/depression before and during the COVID-19 pandemic.

Hypothesis:
We assessed the hypothesis that there will be statistically significant differences in cardiometabolic outcomes between sexual minority and heterosexual individuals before and during the COVID-19 pandemic.

Methods:
Data were drawn from the 2019 (N= 5,359) and 2020 (N= 3,830) Health Information National Trends Surveys on adults. We conducted weighted descriptive and multivariable logistic regression analyses to assess the study objective.

Results:
During the pandemic, compared to before the pandemic, the prevalence of diabetes (18.10% vs. 17.28%) and obesity (34.68% vs. 34.18%) has increased, while the prevalence has decreased for hypertension (36.38% vs. 36.36%). In general, the prevalence of cardiometabolic outcomes was higher during the pandemic (56.09%) than before the pandemic (54.96%). The prevalence has also increased for sexual minority (53.50% vs. 51.12%) and heterosexual (56.45% vs. 54.96%) individuals, former (67.91% vs. 63.86%) and current (59.39% vs. 55.43%) cigarette smokers, current e-cigarette users (37.24% vs. 28.66%), and individuals with mild (59.62% vs. 55.43%) or moderate (61.98% vs. 57.83%) anxiety/depression symptoms. Contrary to our hypothesis, there were no statistically significant differences in the odds of cardiometabolic outcomes between sexual minority and heterosexual individuals before and during the pandemic. Former smokers, compared to never smokers, had higher odds of cardiometabolic outcomes (AOR= 1.38, 95% CI= 1.01, 1.87 vs. AOR= 1.57, 95% CI= 1.10, 2.25) before and during the pandemic, respectively. The odds were lower for current e-cigarette users (AOR= 0.44, 95% CI= 0.23, 0.85) compared to never e-cigarette users before the pandemic, but no significant differences were found in e-cigarette use groups during the pandemic. People with mild anxiety/depression symptoms (before: AOR= 1.52, 95% CI= 1.06, 2.19 vs. during: AOR= 1.55, 95% CI= 1.01, 2.38) relative to those with no anxiety/depression symptoms had higher odds of cardiometabolic outcomes, whereas the odds were higher for those with severe anxiety/depression symptoms (AOR= 2.44, 95% CI= 1.27, 4.69) before the pandemic but not during the pandemic.

Conclusion:
Positive associations were noted between tobacco use and mental health and the risks of cardiometabolic outcomes during the COVID-19 pandemic.
Abstract P172: Association Of Atrial Fibrillation With Severity Of Coronary Artery Disease: The Emory Cardiovascular Biobank (emcab)
Authors: Li Linzi , Almuwaqqat Zakaria , Ko Yi-An , Subramanya Vinita , Quyyumi Arshed A , Alonso Alvaro
Published: April 2022

Background:
Existing literature suggests that atrial fibrillation (AF) can lead to coronary artery disease (CAD). However, little information exists regarding the association between AF and CAD severity.

Methods:
We conducted cross-sectional and prospective analyses of 7819 participants in the Emory Cardiovascular Biobank (EmCAB). EmCAB recruits patients undergoing cardiac catheterization at three Emory Healthcare hospitals in the Atlanta area. At enrollment, data on AF history and four CAD severity measurements were collected: presence of ≥70% coronary stenosis, presence of ≥50% coronary stenosis, number of vessels with ≥50% coronary stenosis, and the Gensini score. To minimize the effect of missing covariates, multiple imputation by chained equation (MICE) was employed. In the imputed dataset, linear, logistic, and Poisson models were used to examine the association between the different measurements and AF history. During follow-up, the occurrence of incident MI, fatal MI, and all-cause death were obtained as primary endpoints, and Cox regression models were used to examine the association of AF history with each endpoint.

Results:
At baseline, the prevalence of AF history was 8.5%. Among patients with and without AF history respectively, the prevalence of ≥50% stenosis was 72% and 76%, and of ≥70% stenosis was 65% and 70%, respectively. AF patients and non-AF patients had similar numbers of vessels with ≥50% stenosis on average (1.7, vs. 1.8) and a median Gensini score (10.0 vs. 10.5). No association was found between AF and the presence of ≥50% and ≥70% stenosis, and numbers of vessels with ≥50% stenosis. AF was associated with 3.32 (95% CI -7.20, 0.57) points lower Gensini score after multivariable adjustment (demographic and clinical factors). In the longitudinal analysis, there was no evidence of an association between AF and nonfatal MI, fatal MI, and any MI. The risk of all-cause mortality among AF patients was 1.66 times (95% CI 1.37, 2.01) that among non-AF patients in the unadjusted model and was strongly attenuated after adjustment for demographic and clinical factors (HR: 1.26, 95% CI 1.03, 1.53).

Conclusion:
In the EmCAB, AF was associated with all-cause mortality but not with CAD severity.
Abstract P174: Toxic Heavy Metals Are Associated With Increased Risk Of Cardiometabolic Disorders
Authors: Agaba Emmanuel I , Brown Tamunoseledia L , Adebamowo Sally N
Published: April 2022

Background:
Cardiometabolic disorders (CMDs) are the leading cause of morbidity and mortality globally. For decades, heart disease, stroke, diabetes mellitus (DM) and chronic kidney disease (CKD) have remained leading causes of death for both men and women in the US. Identification of preventable risk factors is needed to help ameliorate the burden of CMDs. While exposure to toxic heavy metals may contribute to the risk of CMDs, the results of studies examining their association have been inconsistent.

Objective:
To evaluate the association between blood levels of toxic heavy metals - cadmium, lead and mercury - and coronary heart disease (CHD), stroke, CKD, DM, metabolic syndrome (MetS), dyslipidemia, hypertension, and central obesity in a representative sample of US adults.

Methods:
We analyzed data from 36,862 adults aged 20 to 80 years in the US National Health and Nutrition Examination Survey (NHANES) 1999 to 2018 cycles. We dichotomized the levels of each metal using the median levels of the individuals without the outcomes, as the cut point.

Results:
A total of 816 adults had CHD, 1,251 had stroke, 653 had CKD, 6,341 had DM, 6,692 had IR, 18,251 had MetS, 3,597 had dyslipidemia, 20,024 had hypertension and 20,388 had central obesity. In models adjusted for sociodemographic factors and underlying medical diagnoses, we found that cadmium levels were positively associated with CHD [odds ratio: 1.28 (95% confidence interval: 1.06 - 1.55)], stroke [1.21 (1.03 - 1.41)], CKD [1.62 (1.51 - 1.74)] and dyslipidemia [1.17 (1.08 - 1.28)]; and inversely associated with DM [0.65 (0.60 - 0.70)], MetS [0.77 (0.72 - 0.82)] and central obesity [0.72 (0.68 - 0.76)]. In similarly adjusted models, lead levels were positively associated with CKD [1.90 (1.77 - 2.04)] and dyslipidemia [1.18 (1.08 - 1.12)]; and inversely associated with DM [0.51 (0.48 - 0.55)] and central obesity [0.72 (0.68 - 0.76)]. Mercury was positively associated with stroke [1.27 (1.12 - 1.45)], CKD [2.38 (2.23 - 2.54)], MetS [1.14 (1.08 - 1.21)], dyslipidemia [1.09 (1.01 - 1.17)], hypertension [1.19 (1.13 - 1.25)] and central obesity [1.10 (1.04 - 1.15)].

Conclusion:
The results of this large cross-sectional analyses support the findings that cadmium, lead and mercury are significantly associated with several CMDs.
Abstract P176: Reliability Of The Electronic Health Record’s Problem List In Describing Multimorbidity In Patients With Heart Failure In The Emergency Department
Authors: King Brandon , Meyer Michelle , Chang Patricia , Rodgers Jo E , Chari Srihari V , Richardson Karen , Bohrmann Tommy , Casey Martin
Published: April 2022

Introduction:
Patients with heart failure (HF) often suffer from multimorbidity, the co-occurrence of two or more chronic conditions. Electronic health records (EHRs) store data on chronic conditions within the problem list, which can be readily extracted for research purposes.

Objective:
To assess the reliability in using the EHR-based problem list to identify comorbid conditions among patients with HF in the emergency department.

Methods:
A retrospective chart review study was performed on a random sample of 200 patients age >65 years with a diagnosis of HF who presented to an academic emergency department (ED) in 2019 (mean age 78.3 years old, 52.5% women). Manual chart review was performed by a trained medical student (BK) as the gold standard in identifying additional chronic conditions in patients with HF. All diagnoses were mapped to International Classification of Diseases, Tenth Revision, Clinical Modification diagnostic codes and classified into 38 domains using the Agency for Healthcare Research Quality’s Elixhauser Comorbidity Software. We computed sensitivity, specificity, positive predictive value, and negative predictive value of using the EHR’s problem list to capture each domain. We calculated the intra-class correlation coefficient (ICC) to estimate reliability in the total number of domains captured by each method.

Results:
Our chart review found that patients with HF had a mean of 5.4 chronic conditions (SD 2.1). In comparison, the EHR's problem list identified a mean of 4.0 chronic conditions (SD 2.0). The five most prevalent domains were hypertension, diabetes, obesity, chronic pulmonary disease, and renal failure. Specificities for the five most prevalent domains were at least 97% whereas sensitivities were considerably lower and varied widely (28.6%-80.7%; Table 1). The ICC comparing chart review to the problem list was 0.77 (95% CI: 0.68-0.80).

Conclusion:
Multimorbidity in patients with HF in the ED was captured with good reliability using the EHR problem list.
Abstract P224: Optimism And Favorable Cardiovascular Health Maintenance Among African Americans: The Jackson Heart Study
Authors: Lee Harold H , Okuzono Sakurako , Trudel-Fitzgerald Claudia , James Peter , Sims Mario , Kubzansky Laura
Published: April 2022

Background:
Higher optimism is associated with maintaining favorable cardiovascular health (FCH) among White adults, but evidence for this relationship is limited among African American adults, whose cardiovascular disease risk is higher than Whites. We investigated whether higher optimism is associated with more FCH over ~12 years among African American adults.

Methods:
Data were drawn from African-American women (n=2,730) and men (n=1,479) in the Jackson Heart Study (age=20-93 years). Participants free of CVD at baseline (2000–2004) were included in the analyses. Optimism was measured using the Life Orientation Test-Revised at the baseline period, and examined as a binary variable due to its skewed distribution. FCH was characterized according to whether participants had healthy status on each of five components of cardiovascular functioning (i.e., blood pressure, lipids, body mass index, type 2 diabetes, and smoking status) repeatedly assessed 3 times over ~ 12 years of follow-up; measures were obtained either from a clinical visit or via self-report. Linear mixed-effects models examined whether optimism predicted FCH level over time or FCH change rate, adjusting for covariates such as sociodemographic characteristics, depressive symptoms, and health behaviors. In secondary analyses, we evaluated potential effect modification by sex and income as well as the likelihood of meeting the recommendation for each FCH component separately in relation to optimism using generalized estimating equations with the Poisson distribution.

Results:
Adjusting for all covariates, higher (vs. lower) optimism was associated with better FCH pooled across time (β=0.10, 95% confidence interval=0.02–0.17) but not with the rate of change in FCH level. We did not find sufficient evidence for effect modification by sex and income (p-interactions<0.05), which may be due to lack of power. In the analyses examining FCH sub-components, optimism was not associated with the rate of change in meeting the guidelines, except smoking; unexpectedly, participants with higher optimism had a slower rate of change towards non-smoking (p-interaction=0.03). However, this is likely driven by large differences at baseline: optimistic participants’ non-smoking proportion changed from 89.3% (baseline) to 93.2 % (visit 3) vs. 84.8% (baseline) to 92.9% (visit 3) in participants with lower optimism. In the analyses examining FCH sub-components without time-interaction, higher vs. lower optimistic participants had a higher likelihood of not being diabetic (RR=1.03, 95% confidence interval=0.99-1.07) in the fully adjusted model.

Conclusions:
Optimism may contribute to establishing future patterns of FCH in adulthood, but other factors may be more strongly related to how slowly or quickly favorable FCH declines over time.
Abstract P228: Social Networks And Cardiovascular Disease Events Among Men And Women From The Jackson Heart Study
Authors: Glover LaShaunta M , Sutton Janiyah , Cain Loretta , OBrien Emily C , Sims Mario
Published: April 2022

Background:
Cardiovascular disease (CVD) burden disproportionately affects African-American adults in the United States. Greater social networks, or social integration, may lower CVD risk among African-American adults.

Objective:
To determine the association of social networks and incident coronary heart disease (CHD), stroke, and heart failure (HF) and test whether there are differences by sex.

Methods:
Among participants of the Jackson Heart Study without CVD at baseline (mean age: 54.4 years, n=3,053 women, n=1684 men), we used the Social Networks Index at baseline (2000-2004) to develop a continuous social networks score in standard deviation units (range 0-5) and binary categories (high vs. low relative to the median). Surveillance of CHD, stroke, and HF events occurred after exam 1 (2005 for HF) until 2016. We utilized Cox proportional hazards regression to estimate hazard ratios (HR 95% confidence interval-CI) of each CVD event by levels of social networks, adjusting for demographics, education, behaviors, risk factors and depressive symptoms. Interaction terms by sex were used to evaluate sex differences.

Results:
There were 262 CHD events, 213 stroke events, and 331 HF events that occurred by 2016. P-values for interaction terms by sex were statistically significant for stroke and HF (
p
<0.05). After full adjustment, a 1-SD unit increase in social networks was associated with a lower hazard of CHD and HF among women (HR 0.80, 95% CI 0.72, 0.90 and HR 0.81 95% CI 0.69, 0.98, respectively). Men had a lower hazard of CHD with every 1-SD unit increase in social networks (HR 0.88, 95% CI 0.79, 0.99) after full adjustment. High vs. low social networks was associated with a lower hazard of stroke (HR 0.58, 95% CI 0.35, 0.98) and HF (HR 0.61, 95% CI 0.39, 0.94) among women after full adjustment.

Conclusion:
Men and women who reported greater social networks were less likely to have a CHD event, but women with greater social networks were less likely to have stroke and HF.
Abstract P229: The Association Of Cumulative Socioeconomic Status And Incident Type 2 Diabetes Among African Americans: The Jackson Heart Study
Authors: Glover LaShaunta M , Martin Chantel , Adatorwovor Reuben , Loehr Laura R , Staley Brooke , North Kari E , Sims Mario
Published: April 2022

Background:
The burden of type 2 diabetes (T2D) is disproportionately higher among racial and ethnic minorities, particularly African American individuals who have low socioeconomic status (SES). According to the cumulative SES life-course model, stressful experiences in early life and later life can accumulate to influence disease risk. Yet, little is known about the association between cumulative SES, or the combined effects of different SES phenotypes (i.e., education, wealth, income, etc.), over the life course and development of T2D.

Objective:
To estimate the association of cumulative SES and incident T2D among men and women without T2D and cardiovascular disease at baseline (2000-2004) from the Jackson Heart Study (JHS) (n=3078).

Methods:
Using cohort data from JHS (mean age 52.8 years; 1969 women, 1109 men), we derived standardized cumulative SES scores at baseline, conceptualized using 6 SES indicators (e.g. educational attainment, wealth, income, occupation, employment status and mother’s education) and dichotomized the score as high SES (median and above - referent) and low SES (below the median). Incident T2D was defined at exam 2 (2005-2008) or exam 3 (2009-2013) based on a fasting glucose ≥126 mg/dL, or HbA1c ≥ 6.5, or those who had been on diabetic medication 2 weeks prior to these visits, or those who reported a physician diagnosis. Interval censoring proportional hazards regression was used to estimate the association between cumulative SES and incident T2D using hazard ratios (HR, 95% confidence interval-CI), where time-to-event was approximated as the interval between the first visit and the visit in which T2D was ascertained. Sex differences were evaluated using interaction terms and descriptive statistics. The fully-adjusted model included baseline covariates: age, waist circumference, health behaviors, and family history of diabetes.

Results:
There were 544 total incident T2D cases and 65% (351) of cases were characterized as having low SES. The dichotomized cumulative score was associated with incident T2D (
p
<0.05) in unadjusted chi square analyses. In the fully-adjusted models, low (vs. high) cumulative SES and the standardized score were marginally associated with incident T2D (HR 1.14; 95% CI (0.95, 1.38) and HR 0.99; 95% CI (0.90, 1.08), respectively). There were no significant sex differences in the association between cumulative SES and incident T2D.

Conclusion:
Low cumulative SES was not significantly associated with development of T2D when adjusting for potential confounders. Future work should consider examination of adverse experiences related to low SES and other environmental factors such as built environment and neighborhood SES.
Abstract P230: Chronically Uncertain: How Families Of Children With Hypoplastic Left Heart Syndrome Manage The Condition
Authors: Green Michael D
Published: April 2022

Introduction:
41 years ago, comfort care was the only choice for families to care for children with Hypoplastic Left Heart Syndrome (HLHS), meaning that all children born with this condition would die. Recent developments in biomedical care provides families other options. This condition is extremely rare, and research is primarily quantitative and focused on interventions to prolong the life of individuals effected. There is a research gap on barriers and facilitators to care for these families.

Objective:
Qualitatively describe everyday experience and illuminate social determinants of health for families who have a child with Hypoplastic Left Heart Syndrome.

Methods:
5 families currently seeking care for their child at Dartmouth-Hitchcock Health were interviewed using a semi-structured interview guide. These families were recruited through physician referral, and this study was deemed exempt by the Dartmouth-Hitchcock Health Institutional Review Board. The interview transcripts were coded and subsequently examined for overarching themes utilizing deductive analysis. Additionally, the 2 physicians who provided referrals were interviewed separately from the families to illuminate their perspective, and compare them to the families'.

Results:
The families interviewed in this study are in a chronic state of uncertainty involving their child’s condition. Clinicians provide medical advice and guidance on what physically happens with these children’s bodies. Still, these physical observations have large implications on life outside of the clinic. Surgical interventions for HLHS were unsuccessful for a long period but are now improving clinical outcomes, the families interviewed are hopeful about other biomedical innovations that could help them.

Conclusion:
These families still do not know what their future holds because when they were first informed of their child’s diagnosis, they were told they were going into a rapidly developing research landscape. Their outcome in this landscape was one where their children were all able to live through the first three intensive procedures that reconstructed their child’s heart. Despite the chronic uncertainty they face, they also are chronically hopeful for biomedical innovation to enhance their lifestyle.
Abstract P235: Association Between Food Insecurity And Blood Pressure In A Multiethnic Population
Authors: Ing Claire T , Lim Jane , Kaholokula Joseph K , Seto Todd B , Hovmand Peter , Novotny Rachel
Published: April 2022

Hypertension (HTN) is the strongest modifiable risk factor for CVD that is disproportionately higher in racial/ethnic groups, e.g., Native Hawaiians. Native Hawaiians have over a 50% prevalence of HTN (i.e., systolic blood pressure (SBP) of ≥130mmHg or diastolic blood pressure (DBP) of ≥80mmHg), placing them at higher risk for CVD. Behavioral/biological risk factors (e.g., BMI, diet, physical activity) are often the focus of epidemiological and intervention research; yet, socioeconomic factors, such as food insecurity, also affect blood pressure.

The purpose of this study is to examine the association between food insecurity and SBP and DBP in Native Hawaiians communities, controlling for demographics and behavioral/biological risk factors.

Participants in this 2020, cross-sectional study (N = 125) were from six, predominantly Native Hawaiian communities across Hawai‘i. Demographic variables included age, sex, education, and race/ethnicity. Potential confounding variables were leisure-time physical activity, daily servings of processed meat, daily servings of red meat, daily servings of fruit and vegetables, resilience, BMI, use of HTN medication, and COVID-19 related mental health. To assess food insecurity participants were asked to indicate how often money for food runs out by the end of the month on a 5-point Likert scale, with higher scores indicating greater frequency. SBP and DBP were measured according to a standardized protocol. All confounding variables with a significant bivariate correlation with SBP or DBP were entered into the respective multiple regression model.

Participants were predominantly female (73, 58.4%), had some college or were college graduates (73, 58.4%), a mean age of 39.2yrs (
SD
=9.9) and mean BMI of 31.6 (
SD
=8.7). Mean SBP and DBP were in the normotensive range, 122.9±17.5 and 79.5±11.9, respectively. Female sex (
β
=-9.9,
SE
=2.6,
p
<0.001), daily servings of fruit and vegetables (
β
=-2.35,
SE
=1.04,
p
=0.026), BMI (
β
=0.76,
SE
=0.16,
p
<0.001), use of HTN medication (
β
=14.01,
SE
=4.90,
p
=0.005), and food insecurity (
β
=2.09,
SE
=0.95, p=0.030) were associated with SBP (

R
2

=0.40,
SE
=14.05,
p
<0.001). Male sex, fewer daily servings of fruit and vegetables, greater BMI, use of HTN medication, and more food insecurity were significantly associated with higher DBP. Female sex (
β
=-5.03,
SE
=1.90,
p
=0.009), BMI (
β
=0.51,
SE
=0.12,
p
<0.001), and food insecurity (
β
=1.36,
SE
=0.69,
p
=0.05) were associated with DBP (

R
2

=0.31,
SE
=10.18,
p
<0.001). Male sex, greater BMI, and more food insecurity were significantly associated with higher DBP.

After controlling for potential confounders, food insecurity retains a significant, independent association with both SBP and DBP such that a greater frequency of food insecurity was related to higher SBP and DBP. This provides additional evidence for the idea that food insecurity may directly impact CVD risk.
Abstract P239: Dietary Behavior Interventions And Outcomes In Stroke Survivors: A Scoping Review
Authors: Bailey Ryan , Neri Alfonso L , Serra Monica C
Published: April 2022

Purpose:
Secondary stroke prevention is an essential but unmet need for stroke survivors. Current secondary stroke prevention guidelines from the American Heart Association recommend following a Mediterranean-type diet to reduce recurrent stroke risk. However, there is a lack of published data on dietary behavior interventions and outcomes among stroke survivors. Therefore, we conducted a scoping review to characterize published dietary behavior interventions and outcomes among community-dwelling stroke survivors to identify gaps in scientific knowledge.

Methods:
PubMed was used to find research articles published between January 2000 and April 2021. To be included, articles must have undergone peer-review and described both a dietary intervention and dietary outcome among community-dwelling stroke survivors. Study characteristics and dietary outcomes were extracted by 3 team members for studies that met inclusion criteria.

Results:
649 articles were initially identified but 637 were excluded based on eligibility criteria. Study characteristics and outcomes of the 12 included studies are described in the table. All studies (9 randomized controlled trials, 3 cohort studies) delivered multimodal health behavior interventions that included a dietary component. Interventions were delivered weekly to every other month, lasted 1-24 months, and provided 1-132 contact hours. Dietary outcomes included food frequency questionnaires and self-reported fruit, vegetable, salt, or fat consumption. Eight studies reported improvement in dietary outcomes; 6 of which reported ≥16 contact hours.

Conclusions:
This review provides support for the efficacy of dietary behavior interventions in stroke survivors. Intervention format and outcomes varied greatly, which impedes the ability to determine efficacy of dietary interventions in this population and represents a gap in scientific knowledge. Comparative effectiveness studies that compare outcomes across existing interventions may narrow this knowledge gap.