bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P178: Age-Related Gender and Ethnic Variations of Pulse Pressure and Pulsatile Stress
Authors: Sachdev Sarina , Nguyen Landai , Tahir Hassan , Omar Bassam , Rahimi Farnoosh , Awan G. Mustafa , Malozzi Christopher
Published: March 2019

Background:
Aging causes significant widening of pulse pressure (PP), which has been associated with increased incidence of heart failure, especially diastolic with preserved ejection fraction (HFpEF). Pulsatile stress (PS; the product of PP and heart rate, HR) is a measure of the pulsatile load (per minute) on the cardiovascular system of the beat-to-beat PP, also associated with negative outcomes.

Methods:
Encounters from university-based cardiology clinic with broad referral base were analyzed; 400 encounters were reviewed for PP and PS; with a total of 100 in each of the categories (WM, WF, AAM and AAF). Each group was individually analyzed for PP and PS in young patients (Young; < 60 years of age) versus old patients (Old; ≥ 60 years of age), using a Student’s t-test. PP is reported in mmHg, PS in mmHg/min (PP in mmHg x HR in beats per minute) and mean age in each category is reported in years.

Results:
PP in Young WM (mean age 50; n = 41) was 48 ± 15 mmHg, and in Old WM (mean age 69; n = 59) was 55 ± 19 mmHg (7 mmHg difference; P = NS). PS in Young WM was 3395 ±1158 mmHg/min, and in Old WM was 3805 ± 1386 mmHg/min (410 mmHg difference; P = NS). PP in Young WF (mean age 52; n = 27) was 45 ± 9 mmHg, and in Old WF (mean age 70; n = 73) was 59 ± 21 mmHg (14 mmHg difference; P < 0.05). PS in Young WF was 3319 ± 891 mmHg/min, and in Old WF was 4159 ± 1486 mmHg/min (840 mmHg difference; P <0.05). PP in Young AAM (mean age 50; n = 47) was 51 ± 14 mmHg, and in Old AAM (mean age 70; n = 53) was 56 ± 17 mmHg (6 mmHg difference; P = NS). PS in Young AAM was 3623 ± 1102 mmHg/min, and in Old AAM was 3855 ± 1447 mmHg/min (232 mmHg difference; P = NS). PP in Young AAF (mean age 48; n = 42) was 50 ± 18 mmHg, and in Old AAF (mean age 68; n = 58) was 58 ± 21 mmHg (8 mmHg difference; P < 0.05). PS in Young AAF was 3760 ± 1441 mmHg/min, and in Old AAF 4043 ± 1638 mmHg/min (283 mmHg difference; P= NS).

Conclusion:
The elderly suffer from mostly isolated systolic hypertension , with elevated pulse pressure, an independent predictor of cardiac events. Here, PP was higher in elderly compared with young patients, but the increase was significant only in females. PS was non-significantly changed with age in males. In females PS became non-significantly changed with age in AAF, but was statistically higher in older WF. These differences may help explain the increased incidence of HFpEF in older women compared to men and older white patients compared to blacks. The reason for this variation is unclear, but may be in part related to post-menopausal hormonal changes in older females. These observations are important as they identify significant gender and ethnic-related changes in pulse pressure and pulsatile stress with age affecting females, especially white females, who have elevated cardiovascular risk post-menopause.
Abstract P181: Young Adult Risk Factor Burden and Sleep Hypertension in Middle-Age: the Coronary Artery Risk Development in Young Adults Study
Authors: Booth John N , Schwartz Joseph , Allen Norrina , Jaeger Bryron , Lewis Cora , Shikany James , Yano Yuichiro , Zhang YiYi , Shimbo Daichi , Muntner Paul , Moran Andrew
Published: March 2019

Introduction:
Developing cardiovascular disease (CVD) risk factors at younger ages increases the risk for clinic hypertension. Few data report if earlier exposure to CVD risk factors impacts blood pressure (BP) during sleep.

Hypothesis:
Test whether exposure to CVD risk factors in young adulthood predicts sleep systolic BP (SBP) and sleep hypertension status in middle age, independent of risk factor levels in middle age.

Methods:
In 1985-86, the Coronary Artery Risk Development in Young Adults study enrolled 5115 adults 18-30 years old. CVD risk factors (i.e., body mass index [BMI], fasting glucose, cigarette smoking, alcohol intake, albumin to creatinine ratio [ACR] and estimated glomerular filtration rate [eGFR]) were measured at nine exams over 30 years. We analyzed 781 adults with a complete 24 hour ambulatory BP monitoring (ABPM) recording in year 30 at 48-60 years old. Sleep hypertension was defined as asleep SBP ≥ 120 mm Hg or diastolic BP (DBP) ≥ 70 mm Hg on ABPM. To assess the importance of earlier exposure to CVD risk factors on sleep SBP in middle age, a likelihood ratio test was used to compare nested multivariable adjusted linear regression models with CVD risk factors measured at all exams (Model 1) and year 30 only (Model 2). Poisson regression was used for the sleep hypertension outcome.

Results:
In year 30, the mean sleep SBP / DBP was 113 / 67 mm Hg; 41.1% of adults had sleep hypertension. Compared with CVD risk factors measured at year 30 only (Model 2), BMI, fasting glucose, cigarette smoking, alcohol intake, ACR and eGFR measured at all exams (Model 1) statistically significantly increased the explanatory value for higher sleep SBP in middle age (all p-values < 0.05;
Table
). With the exception of ACR (p=0.057), results were consistent for sleep hypertension.

Conclusion:
Exposure to less healthy levels of CVD risk factors in young adulthood may independently contribute to higher sleep SBP and having sleep hypertension by middle age. Studies with repeated ABPM are needed to track determinants of higher sleep BP over the lifespan.
Abstract P182: Prescribing Blood Creatinine and Urine Protein Tests Lowered the Risk of Cardiovascular Disease in Patients With Hypertension: a Follow-up of 66,362 People Who Started Antihypertensive Treatment
Authors: Kim Hyeon Chang , Lee Hokyou , Park Sung Ha
Published: March 2019

Introduction:
Hypertension treatment guidelines recommend the routine evaluation of target organ damage for better management of hypertension. However, many of the hypertension patients in Korea are not tested for their kidney complications.

Hypothesis:
We hypothesized that prescribing blood creatinine or urine protein tests is associated with the future risk of cardiovascular disease (CVD) in patients with hypertension.

Methods:
The National Health Insurance Service-Health Screening (NHIS-HEALS) cohort comprised a 10% random sample of Korean adults who were aged 40-79 years and completed national adult health screening in year 2002-2003 (n= 514866). From the NHIS-HEALS cohort, we identified 66,362 patients who were diagnosed with hypertension and started antihypertensive treatment in 2003-2008. Exposures were prescriptions for blood creatinine test and urine protein test within one year of starting antihypertensive treatment. CVD outcomes were hospitalization for myocardial infarction or stroke until the end of 2013. Cox proportional hazard models were used to calculate hazard ratio (HR) for CVD, after adjusting for sex, age, employment status, household income, Charlson comorbidity index, antihypertensive drug class, medication adherence, smoking, alcohol consumption, exercise, body mass index, systolic blood pressure before treatment, fasting glucose, and total cholesterol.

Results:
Among the 66362 patients, 37913 (57.1%) and 40361 (60.8%) were tested for blood creatinine and urine protein, respectively. Compared to patients who were tested, those who were not tested had significantly higher risk of CVD: adjusted HR was 1.15 (95% CI 1.05-1.28) for blood creatinine test and 1.19 (95% CI 1.07-1.31) for urine protein test. Compared to those who had both blood and urine tests, the risk of patient who had only one test was not different (adjusted HR 1.00, 95% CI 0.88-1.15) but the risk of patients who did neither of the tests was significantly higher (adjusted HR 1.22, 95% CI 1.10-1.37). Similar findings were observed in sex-specific analysis, but the association was more prominent in women than in men.

Conclusion:
These nationally representative data confirmed the importance of testing kidney complications in hypertension management and CVD prevention.
Abstract P187: The Associations of White Coat and Masked Hypertension With Cardiovascular Disease and Mortality in the Jackson Heart Study
Authors: Tanner Rikki M , Booth John , Yano Yuichiro , Ogedegbe Olugbenga , Cohen Laura P , Sakhuja Swati , Poudel Bharat , Clark Donald , O’Brien Emily , Shahar Eyal , Sims Mario , Correa Adolfo , Schwartz Joseph , Shimbo Daichi , Muntner Paul
Published: March 2019

Introduction:
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline uses lower clinic and out-of-clinic BP thresholds to define hypertension compared to previous US guidelines. Using these thresholds, we determined the associations between white coat hypertension (WCH) and masked hypertension with cardiovascular disease (CVD) events and mortality.

Methods:
We included 993 African Americans participating in the Jackson Heart Study who had clinic BP measured during their baseline study visit between 2000 and 2004 and underwent ambulatory blood pressure monitoring (ABPM). We defined normotension, WCH/white coat effect (WCE), masked/masked uncontrolled hypertension, and sustained hypertension using clinic BP and mean awake BP on ABPM (Table). CVD events (i.e., coronary heart disease and stroke; n=107), and all-cause mortality (n=185) were adjudicated from baseline through December 2014 and December 2016, respectively.

Results:
The mean age of participants was 59 years and 68% were female. Among those not taking antihypertensive medication, 38% had normotension, 27% had WCH, 33% had masked hypertension, and 31% had sustained hypertension. WCH, masked hypertension, and sustained hypertension were each associated with an increased risk for CVD and mortality compared to normotension (Table). Among those taking antihypertensive medication, 26% had controlled normotension, 25% had a WCE, 45% had masked uncontrolled hypertension, and 39% had treated sustained hypertension. Masked uncontrolled hypertension was associated with a higher risk for CVD and a lower risk for mortality compared to controlled normotension. WCE was not associated with CVD events or all-cause mortality.

Conclusions:
According to the ACC/AHA BP guideline, WCH and masked hypertension are common among African American adults. ABPM could have an important role in guiding antihypertensive medication initiation and intensification to reduce CVD and mortality risk among African Americans.
Abstract P190: Association of Hypertension According to New ACC/AHA Blood Pressure Guidelines with Incident Dementia in the Atherosclerosis Risk in Communities Cohort
Authors: Hodis Jeffrey D , Gottesman Rebecca F , Windham B G , Knopman David S , Lutsey Pamela L , Walker Keenan A , Alonso Alvaro
Published: March 2019

Background:
Although associations between hypertension in mid-life and the development of dementia and cognitive decline have been established, the impact of the new 2017 ACC/AHA guidelines on dementia risk at the population level has not been evaluated.

Objectives:
To assess the association of hypertension categories with the risk of incident dementia and to calculate the population attributable fraction (PAF) for dementia from hypertension categories according to the 2017 ACC/AHA guidelines, and compare these associations with hypertension defined according to JNC7.

Methods:
We studied dementia-free participants recruited to the Atherosclerosis Risk in Communities (ARIC) cohort in 1987-89. Hypertension was defined by 2003 JNC7 and 2017 ACC/AHA guidelines using blood pressure measured at baseline; participants using antihypertensive medication were included in hypertension stage 2 for both sets of guidelines. Dementia was defined using adjudicated consensus diagnoses at visit 5 (2011-13), informant telephone interviews, and ICD-9 codes from hospitalizations and death certificates through 2013. Cox proportional hazards regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) by hypertension categories, adjusting for potential confounders, including sociodemographic, lifestyle and clinical variables. PAF of dementia by hypertension category was calculated using rate ratios from Poisson regression and the prevalence of the risk factor in the population.

Results:
Among 13,971 participants followed for a median of 23.0 years, 1381 cases of dementia were identified. Prevalence of elevated BP (systolic BP [SBP] 120-129 and diastolic BP [DBP] <80), hypertension stage 1 (SBP 130-139 or DBP 80-89) and hypertension stage 2 (SBP ≥140 or DPB ≥90) according to 2017 ACC/AHA categories was 13%, 15% and 44%, respectively. Corresponding HR (95%CI) compared to normal BP were 1.35 (95%CI 1.12, 1.61), 1.28 (1.07, 1.52) and 1.36 (1.18, 1.57), respectively. PAF (95%CI) of dementia from hypertension categories were 3% (1%, 5%), 3% (1%, 5%) and 9% (4%, 14%). PAF using JNC7 categories were similar to 2017 ACC/AHA: 6% (3%, 9%) for prehypertension (SBP 120-129 or DBP 80-89), 0% (-2%, 2%) for hypertension stage 1 (SBP 140-159 or DBP 90-99), and 9% (5%, 13%) for hypertension stage 2 (SBP ≥160 or DBP ≥100).

Conclusions:
Risk of dementia was increased across categories defined by the new ACC/AHA hypertension guidelines. However, the population impact on dementia incidence using 2017 ACC/AHA was similar to the impact of JNC7. These results suggest that the new criteria for diagnosis of hypertension will not increase the number of persons in whom hypertension could be reasonably labeled as a risk for dementia.
Abstract P194: Associations of Bone Mineral Density With Blood Pressure and Obesity in Hong Kong Chinese Adults
Authors: Xie Yao Jie , Loke Alice Yuen , Ho Suzanne C. , Chong Marc Ka-chun
Published: March 2019

Background:
There were conflicting results regarding the association between blood pressure (BP) and bone mineral density (BMD) in previous studies. Obesity, often co-existing with high BP, may explain the discrepancy in those findings. The aim of this study was to examine the association between BP and BMD in Hong Kong Chinese adults, and to determine whether the relationship between BP and BMD differed in subjects with and without obesity.

Methods:
Eight hundred and one adults aged from 45 to 86 years were recruited at two outpatient clinics in Hong Kong. Data of weight, height, waist circumference, BP, disease diagnosis were extracted from medical records at the clinics. The femur neck total BMD (g/cm
2
) was measured by dual-energy X-ray absorptiometry (DXA). The demographics, smoking, drinking, and other covariates were collected by a self-administered questionnaire. Osteoporosis, osteopenia, and normal bone mass were classified by BMD T-score for analysis.

Results:
The average systolic BP was 121.5 mmHg, 123.2 mmHg, and 126.9 mmHg, diastolic BP was 71.9 mmHg, 72.6 mmHg, and 75.8 mmHg among osteoporosis, osteopenia, and normal bone mass groups, respectively. Subjects with osteoporosis had lowest BP level (all P<0.01). In the multiple liner regression analysis, after adjustment of age, gender, BMI, cancer, diabetes, and chronic renal failure, higher systolic BP was associated with higher BMD (B=0.00078, 95%CI: 0.00020 to 0.00136, P<0.01). This association was significant in both males and females (both P<0.05). No significant association was observed between diastolic BP and BMD (P>0.05). When subjects were stratified by obesity status, the non-obese (BMI<25) subjects had a lower BMD for a given level of systolic BP (B=0.00064, 95%CI: 0.00006 to 0.00128, P<0.05), whereas the association was no longer significant among obese (BMI≥25) subjects (P>0.05).

Conclusion:
Unlike most previous studies, we found a positive association between systolic BP and BMD, which higher systolic BP predicted higher BMD. This association was not significant in obese subjects but existed in non-obese subjects, indicating more studies are needed to explore the mechanisms of BP and obesity on the changes of BMD.
Abstract P195: Systolic Blood Pressure and 8-Year Mortality in Community-Dwelling Older Adults. Does Frailty Modify This Effect?
Authors: Kremer Kaj , Braisch Ulrike , Rothenbacher Dietrich , Denkinger Michael , Dallmeier Dhayana
Published: March 2019

Introduction:
The current literature does not provide sufficient evidence to support different treatment targets for hypertension in older adults.

Hypothesis:
The effect of systolic blood pressure (SBP) on 8-years mortality may vary by frailty status in community-dwelling older adults.

Methods:
A frailty index (FI) was constructed according to the model of deficit accumulation with 38 items from the baseline exam at the Activity and Function in the Elderly Study. Each item had a score from 0 (no deficit) to 1 (deficit). FI represents the sum of all scores divided by 38. Cox-proportional hazards models adjusted for age, sex, education, smoking, diastolic blood pressure (DBP) and antihypertensive medications analyzed the association between SBP and 8-year mortality, evaluating the presence of effect modification by frailty.

Results:
A total of 940 participants were included in the analysis [median age 74, interquartile range (IQR 70.1, 81.0), 42.4% women]. The prevalence of hypertension was 54%, with median SBP 144.5 mmHg (IQR 135.0, 150.0), and median DBP 78.5 mmHg (IQR 71.0, 86.5). Median follow-up time was 8.1 years. A total of 201 deaths were observed. The median FI was 0.113 (IQR 0.069, 0.113), with 19.9% (n=187, 79 deaths) being identified as frail (FI 0.2). We detected effect modification by frailty (p-value interaction term <0.05). Table 1 summarizes the hazard ratios for the multivariable adjusted models stratified by frailty.

Conclusions:
Our results suggest the presence of effect modification by frailty with a possible protective effect of elevated SBP in frail subjects with respect to 8-year mortality even after adjustment for DBP and antihypertensive treatment.
Abstract P199: Small HDL-C is Associated to Subclinical Hypothyroidism. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Authors: Bensenor Isabela M , Goulart Alessandra C , Bittencourt Marcio S , Blaha Michael , Jones Steven , Toth Peter P , Lotufo Paulo A
Published: March 2019

Introduction:
Although epidemiologic studies have associated subclinical thyroid disorders with coronary heart disease, the role of lipoprotein levels are not well defined as a mediator or moderator of this association.

Purpose:
To test the association of lipoprotein particle concentration and size measured by nuclear magnetic resonance with subclinical hyperthyroidism and subclinical hypothyroidism using baseline data from the Brazilian Longitudinal Study of Health (ELSA-Brasil) of apparently healthy 5024 men and women aged 35 to 74 years old.

Methods:
We measured lipids and lipoproteins subfractions using a new nuclear magnetic resonance spectroscopy (NMR LipoProfile® test spectra, LabCorp, Raleigh, NC): triglyceride-rich lipoprotein particles (TRLP, containing IDL-P and VLDL-P), 3 LDL-P subclasses (large, medium and small) and 3 HDL-P subclasses (large, medium and small). Subclinical thyroid disorders were defined as TSH >4 IU/ml and TSH <0.4 IU/ml for people with normal free-thyroxine levels. We excluded from the sample participants reporting previous cardiovascular disease, those who used lipid-lowering medications and/or other drugs that interfere with thyroid function remaining 3,947 subjects. The cross-sectional relationship between subclinical thyroid diseases (independent variable) and lipids and lipoproteins (dependent variable) were evaluated by linear regression models using euthyroid subjects as the reference. Models were presented as crude and after adjustment for sociodemographic (age, sex, race, and education), cardiovascular risk factors (body-mass index, hypertension, diabetes, smoking habit, alcohol use, and physical activity) and LDL-C, HDL-C and triglycerides measured by enzymatic methods.

Results:
After exclusions, we detected 47 persons with subclinical hyperthyroidism (mean age 53.1 (±9.4 years; 61.7% women), 258 with subclinical hypothyroidism (mean age 52.3 (±8.9); 58.1% women) and 3,642 participants with normal thyroid function (mean age: 50.1 (±8.6); 52% women). After multivariate adjustment, subclinical hyperthyroidism was associated with a decrease in triglyceride-rich lipoprotein particles (Beta coefficient (B) -15.2; P=0.04) and with the very small triglyceride-rich lipoprotein subclass (B, -16.9; P=0.04). Subclinical hypothyroidism was associated with a decrease in small HDL-P subclass (B, 0.42; P=0.03). No association was found for any subclinical conditions with LDL-C.

Conclusions:
Subclinical hyperthyroidism does not show any possible association with an atherogenic profile, and subclinical hypothyroidism revealed an association with lower small HDL-cholesterol levels.
Abstract P201: Separation of Postprandial Lipoproteins: Purification of Chylomicrons Using an ApoB100 Immunoaffinity Method
Authors: Jones Grace Marie , Caccavello Russell , Palii Sergiu P , Pullinger Clive R , Kane John , Mulligan Kathleen , Gugliucci Alejandro , Schwarz Jean-Marc
Published: March 2019

Introduction:
Elevated fasting and postprandial triglyceride-rich lipoproteins (TRL) are associated with increased risk for atherosclerosis. In the postprandial state circulating lipids consist of dietary fat transported from the intestine, by chylomicrons (containing ApoB48) and fat transported from the liver, in very low-density lipoproteins (VLDL, containing ApoB100). Research into the roles of endogenous versus dietary fat has been hindered because current methods are inadequate to fully separate these particles. Specifically, chylomicron fractions have considerable contamination from VLDL.

Hypothesis:
We hypothesized that the generation of resin crosslinked to specific ApoB100 antibodies unique to VLDL would allow purification of chylomicron particles. Proof-of-principle experiments will determine: 1) individual contributions of newly synthesized fatty acids (de novo lipogenesis (DNL)), to triglycerides found in VLDL and chylomicrons; and 2) the proportion of labeled acetyl-CoA (precursor-pool value (PPV)) used to synthesize new palmitate. A difference in DNL and PPV for the purified VLDL and chylomicron fractions will confirm the successful separation of these particles.

Methods:
Polyclonal antibodies were produced against the C-terminus of the ApoB100 protein and crosslinked to resin generating ApoB100-specific affinity columns. To yield purified chylomicron and VLDL particles we used this technique in conjunction with stable-isotope tracer methodology in a human feeding study. Two healthy volunteers consumed a standardized diet accompanied by oral dosing of 1-
13
C-acetate every 30 minutes for 8 hours. Plasma collected hourly was used for the isolation of TRL, which was applied to the affinity resin and purified chylomicrons and VLDL collected. Triglycerides were isolated and derivatized. The enrichment of methyl-palmitate was measured by GC/MS and Mass Isotopomer Distribution Analysis was used to calculate DNL and PPV.

Results:
Western blots confirmed the separation of chylomicrons and VLDL by the described method. From the purified TRL fractions, the DNL-AUC (%DNL x 5 hours) values for subject 1 were chylomicron 4% and VLDL 34%, an 88% difference, and for subject 2 were chylomicron 8% and VLDL 83%, a 90% difference. The PPV calculated for each fraction in subject 1 were chylomicron 10% and VLDL 13% and in subject 2 were chylomicron 10%, VLDL 12%. On average, the PPV in the chylomicron fraction were 18% less than the VLDL fraction.

Conclusions:
In conclusion, results demonstrate that
the immunoaffinity method effectively separated postprandial lipoproteins showing fractionated particles carry unique information regarding tissue of origin
. Future applications include investigating the respective contribution of fat and sugar to atherosclerosis risk.
Abstract P204: Birth Cohort Effects and Lipid Trends—The Impact of the Obesity Epidemic: Evidence From Cohorts Born Between 1930 and 1998 in the United States
Authors: Vu Thanh-Huyen T , Lloyd-Jones Donald , Carnethon Mercedes R , Wilkins John T , Tran Hy , Khan Sadiya S
Published: March 2019

Background:
Decreasing total cholesterol (TC) and increasing high-density lipoprotein cholesterol (HDL-C) levels have been observed over the past several decades in the US population. It is not clear if the obesity epidemic has mitigated these favorable changes.

Hypothesis:
Associations between birth cohort and TC and HDL-C levels are partially attenuated by body mass index (BMI).

Methods:
We examined differences in TC and HDL-C levels across US birth cohorts born between 1930-1998 from the National Health and Nutrition Examination Surveys (NHANES) exam cycles 1999-2016, and the impact of body mass index (BMI) on these differences. A series of 10-year birth cohorts were constructed (1930-1998). Survey-weighted multivariable-adjusted linear regression models were used.

Results:
Among 40,273 participants, 50% were women and 22% non-Hispanic Blacks. After adjustment for age, sex, race, and lipid-lowering medication use, (and age
2
for the TC model), population mean TC decreased by 5.15 mg/dL and mean HDL-C increased by 1.34 mg/dL for each more recent birth cohort (all P<.001) (
Table
). There was an interaction between age and birth cohort for TC, with greater decreases with aging; for example, the mean of TC was 4.14, 6.48, and 8.83 mmHg lower for each more recent birth cohorts at the age of 30, 50, and 70, respectively. BMI was positively associated with TC and negatively associated with HDL-C. However, BMI only slightly influenced the association of birth cohort with TC (2%), but it strongly influenced the birth cohort effect on HDL-C (31%).

Conclusion:
More recent birth cohorts had lower TC levels and higher HDL-C levels than older birth cohorts in the US. These favorable birth cohort effects were partially compromised by BMI. Research into the environmental and behavioral differences between 20
th
century US birth cohorts is needed to support future efforts to reduce the prevalence of dyslipidemia.
Abstract P206: Multiple Sclerosis Risk Factors Improved With Residential Lifestyle Intervention
Authors: Ramirez Francisco E , Nedley Neil , Krueger Amy
Published: March 2019

Rationale:
Previous research suggest that lipids, which are important elements in healthy myelin sheaths, could play a role in multiple sclerosis (MS). This study evaluate the effect on lipids of a medical 18-day lifestyle program.

Methods:
The program is summarized in the word NEWSTART acronym of (N)utrition (vegan diet), (E)xercise, (W)ater, (S)unshine (proper exposure), (T)emperance (proper use of good things and avoiding harmful things), (A)ir (breathing exercises), (R)est, (T)rust in rational, spiritual, and psychological aspects. Patients were seen by certified physicians, nutritionists, and chaplaincy. They received physician consultations, plant-based diet, massage, hydrotherapy and exercise therapy among other modalities.

Results:
Out of 2081 patients that completed the program in an 11 year period, n=10 had a diagnosis of MS. Only n=9 of the n=10 patients had complete laboratories. Average age of MS patients was 51 (SD 15), 89% were female. At baseline, the average of cholesterol, triglycerides, HDL, and LDL (listed in the same order) was 196, 141, 59, and 100, with an SD of 47.7, 84.3, 10.1, 35.6, minimum of 126, 68, 50, 75, maximum 276, 304, 70, 141 and median 203, 100, 58, 85. On completion of the 18-day program, the average of cholesterol, triglycerides, HDL, and LDL was 174, 129, 49, and 99, SD was 27.4, 64.3, 18.0, 30.1, minimum 139, 64, 28, 69, maximum 214, 270, 87, 147, median 175, 115, 47, 88, t-test values 2.6, 1.2, -.2, 2.9, significant change? ( Yes(p<.02), Yes(p<.2), No(p<.8), Yes(p<0.1).

Conclusions:
The program is effective in improving lipids of MS patients. The risk factors cholesterol, triglycerides and LDL responded very well to the intervention. HDL decreased a few point but the change was not significant. Patients seem to benefit from the intervention.
Abstract P209: Trends in Presenting Symptoms Among Acute Myocardial Infarction Patients in Community Surveillance: the Atherosclerosis Risk in Communities Study
Authors: DeBarmore Bailey M , Zègre-Hemsey Jessica K , Kucharska-Newton Anna M , Rosamond Wayne D
Published: March 2019

Introduction:
Recent research shows changing incidence rates of AMI by subtype (ST segment elevation [STEMI] and non-ST segment elevation [NSTEMI]), anatomical location, and severity. However, trends in AMI symptom presentation are less well examined. Not all AMI patients present with classic chest pain of cardiac origin. Presentation without cardiac chest pain has been associated with delayed hospital arrival, lower likelihood of receiving medical therapies and cardiac procedures, and higher mortality, as well as female sex, black race/ethnicity, and diabetes.

Objective:
We examined trends in symptom presentation in subsets of STEMI and NSTEMI by sex and race in the community surveillance of the ARIC Study from 2005 to 2014.

Methods:
Poisson regression was used to estimate sex- and race-specific event rates for AMI with and without classic chest pain of cardiac origin stratified by NSTEMI and STEMI. Events were defined as definite or probable MI with an assigned NSTEMI or STEMI subtype. Event rates were age-standardized to the US 2010 Census population. We examined average annual percent change in event rates over time, and compared comorbidities, in-hospital complications, and 28-day case-fatality of CHD death by symptom presentation, sex, and race, evaluating heterogeneity between sex and race via interaction terms. All analyses were weighted using ARIC sampling fractions.

Results:
Between 2005 and 2014, we observed 12,184 AMI events without classic chest pain and 39,512 events with classic chest pain. Events without chest pain were more often NSTEMI vs. STEMI (22% vs. 13%). The decline in event rates over time was similar among NSTEMI patients regardless of presentation symptoms; however, this decline was greater among STEMI patients without classic cardiac pain (-8.03, 95% CI: -10.12, -5.89) than among STEMI patients presenting with classic cardiac pain (-3.02, 95% CI: -4.83, -1.18). The average annual percent decline in event rates differed by race for STEMI but not NSTEMI. Presentation without classic cardiac chest pain was associated with comorbidities such as diabetes, as well as in-hospital complications in both NSTEMI and STEMI patients. Twenty-eight-day case fatality was greater among STEMI patients presenting without classic cardiac chest pain (9.4%, 95% CI: 5.8, 12.9) compared to those with classic cardiac chest pain (4.8%, 95% CI: 3.7, 5.9).

Conclusion:
AMI without classic chest pain comprised a larger percent of NSTEMI than STEMI events, and while event rates declined over 2005 to 2014, AMI without classic cardiac chest pain was associated with greater 28-day case fatality and in-hospital complications. Future research should explore care pathways and other reasons why these outcomes may differ by cardiac pain presentation.
Abstract P210: Long-Term Outcomes After ST-Elevation Myocardial Infraction After Reducing Fibrinolytic Use in a Rural Cohort
Authors: Benziger Catherine P , Mullvain Richard , Moran Patrick , Solaiman Rakin , Regal Ron , Hitz Paul , Blood Ross , Kaas Krysta , Ginete Wilson
Published: March 2019

Background:
ST-elevation myocardial infarction (STEMI) guidelines recommend lytic therapy if unable to receive primary percutaneous coronary intervention (PPCI) within 120 min. from first medical contact (FMC). Sparse data exists from rural areas; we aimed to evaluate outcomes in rural population after implementing STEMI protocol.

Methods:
Retrospective chart review of NCDR ACTION and internal STEMI registries presenting to 2 PCI-capable hospitals (Essentia Health in Duluth, MN and Fargo, ND) between 5/2009-12/2017. Only patients with rural rural-urban commuting area (RUCA) codes were included. Analysis included using standard STEMI metrics with Cox regression and Kaplan-Meier survival curves for survival analysis, and logistic regression for 30-day and 1-year mortality and 30-day readmission. Results were adjusted for age and sex.

Results:
There were 1229 STEMI activations with 1033 true STEMI events (28.3% female, mean age 63.6 years). Among true STEMIs, 73.3% presented to a non-PCI capable hospital and were transferred to PCI-capable hospital. Only 9.9% were field activated and transported directly to PCI-capable hospital. FMC to device time was <120 min. 33.2% of the time with a median FMC to device time of 135 min. (IQR 111-174 min.). Positive ECG to device time was <120 min. 53.9% of the time with a median ECG to device time of 116 min. (IQR 99-144 min). Lytic use decreased over time from 30.2% in 2009-10 to 6.8% in 2016-17. Survival was not different comparing PPCI vs. lytic therapy (hazard ratio 1.21; 95% CI: 0.83, 1.75, p=0.32). For PPCI, 30-day and 1-year mortality were 8.6% (CI:6.8%-10.4%) and 12.8% (CI:10.6%-15.0%), respectively, while for lytics, 30-day and 1-year mortality were 7.2% (CI:4.6%-9.8%) and 10.8% (CI:7.1%-14.3%), respectively. The 30-day readmission for PPCI was not significantly different compared to lytics (7.6%, CI:6.7%-8.7% for PPCI vs. 12.0% CI:9.8%-14.6% for lytic, p=0.056).

Conclusion:
PPCI in rural areas was associated with similar outcomes compared to lytic therapy for STEMI patients.
Abstract P211: Temporal Trends and Long-Term Outcomes of Elderly Patients With St-Elevation Myocardial Infarction in a Large Rural Healthcare System
Authors: Benziger Catherine P , Moran Patrick , Mullvain Richard , Solaiman Rakin , Regal Ron , Hitz Paul , Blood Ross , Kaas Krysta , Ginete Wilson
Published: March 2019

Background:
Limited data about long-term survival in elderly patients after ST-elevation myocardial infarction (STEMI) exists for patients in rural settings. We aimed to evaluate temporal trends in lytic use compared to primary percutaneous coronary intervention (PPCI) in elderly patients after the American Heart Association’s Mission: Lifeline program was implemented.

Methods:
Retrospective cohort included patients aged >=75 years with STEMI presenting to 2 PCI-capable hospitals (Essentia Health in Duluth, MN and Fargo, ND) between 5/2009 to 12/2017. Cox regression was used for survival analysis and logistic regression for 30-day and 1-year mortality and 30-day readmission. Results were adjusted for age and gender.

Results:
A total of 358 elderly patients with true STEMI were included (51.1% female, mean age 82.2 years, 61.5% rural). The percentage of elderly patients who received lytics decreased from 20.3% in 2009-2010 to 4.8% in 2016-2017. Median first medical contact (FMC) to device time was 128 min (IQR 84-169) and median positive ECG to device time was 107 min (IQR 78-140). FMC to Device <120 min. was 44.3%; ECG to device <120 min. was 61.6%. There was no difference in survival between lytic and PPCI (HR:1.11, 95%CI:0.67-1.86, p=0.68). Mortality was not significantly different between the recent cohort (2016-2017) compared to early cohort (2009-2010) (p=0.16, HR 1.43 (0.86-2.30).

Conclusion:
Long-term mortality remains high among elderly patients with STEMI, even among revascularized patients. Prognosis has not significantly changed over the past 8 years despite system changes in treatment strategy.
Abstract P213: Serum Metabolomic Profile of Dietary Acid Load in Two Chronic Kidney Disease Studies
Authors: Rebholz Casey M , Surapaneni Aditya , Levey Andrew S , Sarnak Mark J , Inker Lesley A , Appel Lawrence J , Coresh Josef , Grams Morgan E
Published: March 2019

Background:
Dietary acid load reflects the balance between acid-producing foods (meat, cheese) and base-producing foods (fruits, vegetables), and is clinically important due to its association with risk of cardiovascular disease, diabetes, kidney disease, and mortality.

Methods:
We used untargeted metabolomics to identify blood biomarkers of dietary acid load in two independent studies of chronic kidney disease patients: the African American Study of Kidney Disease and Hypertension (AASK, n=689) and the Modification of Diet in Renal Disease (MDRD, n=356) study. Multivariable linear regression was used to assess the cross-sectional association between serum metabolites whose identity was known (outcome) and dietary acid load (exposure), estimated with net endogenous acid production based on 24-hour urine levels of urea nitrogen and potassium, and adjusted for age, sex, race, randomization group, mGFR, log-transformed urine protein-to-creatinine ratio, history of cardiovascular disease, body mass index, and smoking status.

Results:
Out of the 757 known, non-drug metabolites identified in AASK, 26 were significantly associated with net endogenous acid production at the Bonferroni threshold for significance (p<6.6 х 10
-5
). Twenty-three of the 26 metabolites were also identified in the MDRD study, and 13 of the 23 (57%) were significantly associated with net endogenous acid production (p<2.2 х 10
-3
), including 5 amino acids, 2 cofactors and vitamins, 1 lipid, and 5 xenobiotics (
Table
). Higher levels of all 13 replicated metabolites were associated with lower levels of net endogenous acid production in both AASK and the MDRD study.

Conclusion:
Untargeted metabolomics of serum specimens from kidney disease patients in two study populations identified 13 replicated metabolites associated with dietary acid load. Additional studies are needed to validate these compounds in healthy populations. These 13 compounds may potentially be used as objective markers of dietary acid load in future nutrition research studies.
Abstract P214: Adherence to Dietary Recommendations of the AHA 2020 Goals and Risk of Preeclampsia Among Danish Women
Authors: Arvizu Mariel , Bjerregaard Anne A , Madsen Marie T , Granström Charlotta , Hallsorsson Thorhallur I , Olsen Sjurdur F , Gaskins Audrey J , Rich-Edwards Janet W , Rosner Bernrad A , Chavarro Jorge E
Published: March 2019

Objective:
Because the role of diet in preeclampsia is unclear, we examined the association between adherence to the American Heart Association’s (AHA) 2020 dietary recommendations and risk of preeclampsia.

Methods:
We followed 66,161 singleton pregnancies from 62,310 women participating in the Danish National Birth Cohort. Diet was assessed around gestation week 20 with a semi-quantitative food frequency questionnaire (FFQ). Adherence to the AHA dietary recommendations was calculated by a score, which addressed 5 dietary components: fruits and vegetables, fish, whole grains, sodium and sugar-sweetened beverages. Preeclampsia was ascertained by linkage to the Danish National Patient Registry. We estimated relative risks [RR] and 95% confidence intervals [95% CI] of preeclampsia according to increasing quintiles of adherence to the AHA recommendations using logistic regression models with generalized estimating equations to account for repeated pregnancies per woman while adjusting for energy intake, age, BMI, parity, smoking status, socio-economic status, height, region, education, and vitamin C and E intakes.

Results:
We identified 1,319 (2%) cases of preeclampsia, including 307 (0.5%) cases of severe preeclampsia. The AHA score ranged from 4 to 49 points with a maximum possible score of 50 points. Stronger adherence to the AHA score was inversely associated with the risk of preeclampsia. The adjusted RR [95%CI] among women categorized with the highest AHA score compared to women in the lowest score category was 0.81 (95%CI 0.68, 0.96). When each component of the score was separately examined, the association with risk of preeclampsia was largely driven by sodium. Specifically, women with the highest sodium intake (median 3,729 mg/day [range: 3611, 3922]) had 20% (95%CI 2, 43%) higher risk of developing preeclampsia compared to women with the lowest sodium intake (median 2,602 mg/day [range 2,435, 2,710]). When sodium intake was excluded from the AHA score, greater adherence to AHA recommendations was no longer related to risk of PE (RR 0.87, 95%CI 0.60, 1.28).

Conclusions:
Higher adherence to the AHA 2020 dietary recommendations during pregnancy was associated with a lower risk of preeclampsia. Although diet sodium tends to be underestimated when measured by FFQ, we found that sodium intake was related to risk of preeclampsia.
Abstract P216: Plant-Based Diets Are Associated With a Lower Risk of Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality
Authors: Kim Hyunju , Caulfield Laura E , Garcia-Larsen Vanessa , Steffen Lyn M , Coresh Josef , Rebholz Casey M
Published: March 2019

Introduction:
Previous studies of plant-based diets and chronic diseases have limited generalizability because most have been conducted among vegetarians or Adventists who may have healthier lifestyles than the general population.

Hypothesis:
We hypothesized that plant-based diets are associated with lower risk of cardiovascular disease and all-cause mortality in a community-based US cohort.

Methods:
We used data from middle-aged adults (n=12,168) in the Atherosclerosis Risk in Communities (ARIC) study who were followed from 1987 to 2016. We classified participants’ diet using a plant-based diet index (PDI) and a provegetarian diet index. For the PDI, higher intakes of all plant foods were scored higher. For the provegetarian diet index, higher intakes of selected plant foods were scored higher. Higher intakes of animal foods were scored lower for both indices. We used Cox proportional hazards models to evaluate associations between plant-based diet indices and incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality, adjusting for several potential confounders.

Results:
On average, participants in the highest quintiles of PDI and provegetarian diet index consumed 4.8 servings of fruits and vegetables (FV) and 0.9 servings of red and processed meat per day. Participants in the lowest quintiles consumed 2.8 servings of FV and 1.5 servings of red and processed meat. Higher adherence to PDI was associated with 16% lower risk of cardiovascular disease, 31% lower risk of cardiovascular disease mortality, and 24% lower risk of all-cause mortality (all
P
-trend<0.001,
Table
). Similarly, higher adherence to provegetarian diet index was associated with a 15% lower risk of cardiovascular disease, 32% lower risk of cardiovascular disease mortality, and 18% lower risk of all-cause mortality (all
P
-trend<0.001).

Conclusions:
Diets high in plant foods and low in animal foods were associated with lower risk of cardiovascular disease outcomes and all-cause mortality in a general population.
Abstract P218: Eating Frequency, Breakfast Consumption, and Abdominal Obesity Among Adults Living in Puerto Rico
Authors: Tamez Martha , Mattei Josiemer
Published: March 2019

Background:
Puerto Rican adults have a high burden of obesity, but little information is available regarding eating frequency and breakfast consumption in this at-risk ethnic minority group. Thus, we examined the association between eating frequency, breakfast consumption, and abdominal obesity among adults living in Puerto Rico.

Methods:
In a cross-sectional study of adults living in Puerto Rico aged 30-75 years old (n=310) were asked to self-report eating frequency, including snacks. Trained interviewers measured waist (WC) and hip circumferences. We calculated the waist-to-hip ratio (WHR) by dividing the waist by the hip measurement. Abdominal obesity was defined as either high WC (men≥94 cm; women≥80 cm) or high WHR (men≥0.90; women≥0.85), using International Diabetes Federation cutoffs. Odds ratios (ORs) and 95% confidence intervals (95% CIs) of having abdominal obesity by frequency of meals (≤1.5; 1.5-3; ≥3 times/d) and for breakfast consumers (vs. non) were estimated using logistic regression models. We adjusted for age, sex, income, smoking status, physical activity, TV watching, energy intake, diet quality, and eating frequency (only for breakfast consumption).

Results:
The majority of the participants consumed breakfast (70%), ate 1.5-3 times/d (47%), had high WC (75%), and had high WHR (77%). Higher frequency of eating was associated with higher WC after adjustment for confounders. Compared with participants who ate ≤1.5 times/d, those who ate 1.5-3 times/d were more likely to have a higher WC (OR: 2.75, 95% CI: 1.23, 6.15) and those who ate ≥3 times/d were more likely to have an increased WC (OR: 2.88; 95%CI: 1.14, 7.31; P-trend=0.04). Breakfast consumption was not significantly associated with abdominal obesity.

Conclusions:
Higher frequency of eating, but not breakfast consumption by itself, was significantly associated with abdominal obesity. Our study denotes which eating behaviors may be more relevant for abdominal adiposity among a high-risk ethnic group.
Abstract P220: Whole Blood Selenium Concentration is Inversely Associated With Prevalence of Stroke: Results From the Canadian Health Measures Survey and the US National Health and Nutrition Examine Survey
Authors: Hu Xue Feng , Stranges Saverio , Chan Hing Man
Published: March 2019

Introduction:
Each year, over 140,000 Americans and 10,000 Canadians die from stroke. Selenium is an essential trace element involved in antioxidant and anti-inflammatory processes, as well as in intracellular redox regulation and modulation. Observational studies have suggested that Se may have beneficial effects on certain cancer and cardiovascular outcomes.

Hypothesis:
We assessed the hypothesis that blood selenium concentration might be inversely associated with prevalence of stroke and the relationship between blood selenium and prevalence of stroke would be non-linear.

Methods:
Adult respondents (aged 20 and over) from the Canadian Health Measures Survey (CHMS 2007-2011, n = 7065) and the US National Health and Nutrition Examination Survey (NHANES 2011-2012, n = 5030) were analyzed. Age, sex, and other major risk factors for stroke were comparable between the two datasets. Whole blood and urinary selenium were measured in the CHMS, whole blood and serum selenium were measured in the NHANES. First, we examined the differences in selenium concentrations by stroke status. Second, we used logistic regressions to investigate the difference in prevalence of stroke by whole blood Se tertiles, adjusting for established risk factors. Third, we quantified the potential non-linear association between Se and stroke by restricted cubic spline regression.

Results:
A total of 82 (1.16%) and 202 (4.02%) stroke cases were identified in CHMS and NHANES, respectively. Respondents with stroke had lower Se levels comparing with those without stroke, with a mean difference of 16 μg/L in CHMS and 12 μg/L in NHANES, respectively. Respondents with high blood selenium concentration (tertile 3) had a lower prevalence of stroke compared to those with low selenium concentration (tertile 1). The adjusted odds ratios were 0.38 (95% CI: 0.15, 0.92) and 0.57 (95% CI: 0.31, 1.03) for CHMS and NHANES, respectively. A continuous decreasing trend of stroke with whole blood selenium was observed in CHMS, whereas the curve plateaued starting at 190 μg/L for NHANES, based on cubic restricted spline regression. Each 10-μg/L increase in whole blood selenium was associated with a 14% decreased prevalence of stroke in CHMS and 19% in NHANES. Sensitivity analysis using serum and urinary selenium demonstrate that our results were consistent across different selenium biomarkers.

Conclusion:
We observed inverse cross-sectional associations between whole blood Se and prevalence of stroke in representative samples of the Canadian and the US population.