bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P198: Does Neighborhood Poverty Account for Race/Ethnic Differences in Sleep Duration?
Authors: Bright Bonnie R , Carnethon Mercedes R , De Chavez Peter John D , Kim Kwang-Youn , Knutson Kristen L , Liu Kiang , Kershaw Kiarri
Published: July 2021

Introduction:
Shorter sleep duration and poorer quality sleep are commonly observed in non-white vs. white racial/ethnic groups. Reasons for these racial/ethnic differences are unknown. Our objective is to determine whether neighborhood poverty, which may reflect more noise exposure, crowding and social stress, explains racial/ethnic differences in sleep.

Methods:
The Chicago Area Sleep Study identified men and women 35-64 years old without sleep apnea via commercially available telephone listings (N=510; 31% Black, 22% Asian, 21% Hispanic, and 26% White). Participant addresses were geocoded, and residence in a census tract with >20% poverty based on American Community Survey data was classified as “high poverty”. Participants wore wrist actigraphs for 7 days (Actiwatch
TM
) to determine sleep duration and sleep percentage (percentage of time during the primary sleep interval spent sleeping). Multivariable regression analysis was used to test whether race remained significantly associated with sleep following adjustment for neighborhood poverty.

Results:
Black (86%) and Hispanic (66%) participants were more likely to live in high poverty areas as compared with Whites (33%) and Asians (6%). In unadjusted analyses, living in a high poverty census tract was associated with a significantly lower mean sleep percentage (β= -1.80, SE=0.42, p<0.01) and a higher odds of sleeping <6 hrs/night (OR=1.65, 95% CI: 1.02, 2.67). However, these associations were attenuated in adjusted models, and they did not account for race differences in sleep (Table).

Conclusions:
Neighborhood poverty was unassociated with a lower sleep percentage or shorter sleep in adjusted models, and it did not account for racial/ethnic differences in sleep. Further investigation of specific features of neighborhood poverty (e.g., crime, crowding) and household environment factors that may explain racial/ethnic differences in sleep is warranted.
Abstract P207: Medication Use for Secondary Stroke Prevention and Vascular RIsk Factor Modification Remains Low Among Americans
Authors: Albright Karen C , Tanner Rikki M , Boehme Amelia K , Beasley T. Mark
Published: July 2021

Background:
With a US prevalence of 795,000 strokes per year and stroke recurrence rates up to 20%, the objective of this study was to determine the prevalence of prescription medication use for secondary stroke prevention and vascular risk factor modification among noninstitutionalized US adults and compare medication use in Whites and Blacks.

Methods:
A cross-sectional study was performed as part of the National Health and Nutrition Examination Survey (NHANES) 2009-2010. Demographic, disease, and prescription medication use were obtained via a standardized interview. Participants were asked if they had ever been told by a health professional that they had hypertension, diabetes, high cholesterol, or a stroke. Additionally, participants were asked if they had taken or used any prescription medicine in the past month as well as the names of each prescription medication. Statistical analyses used NHANES sample weights to provide prevalence estimates for the US population.

Results:
Among 11,375 participants (21% Black, 47.6% men, age 20-80), medication use for secondary stroke prevention and vascular risk factors remained low (Table 1). Participants who reported taking either an antiplatelet agent or an anticoagulant with a history of stroke remained low (7.9% Whites vs 6.2% Blacks). More Blacks with hypertension reported taking blood pressure lowering agents (38.9 vs 36.1% Whites). Diabetic medication use was lower in Blacks reporting a history of diabetes (24.5 vs 25.7% Whites). Medication use rates were lowest in participants reporting high cholesterol, with more Whites reporting use of a cholesterol lowering medication (19.3 vs 14.6%; p<0.001).

Conclusion:
Despite the prevalence of stroke and vascular risk factors, only a small proportion of people at risk are on medications for secondary stroke prevention and vascular risk factor modification. Overall, Blacks were taking fewer medications for secondary stroke prevention and vascular risk factor modification with the exception of anti-hypertension medication.
Abstract P211: Prediction of Stroke in a Population with High Prevalence of Diabetes: The Strong Heart Study
Authors: Zhang Ying , Wang Wenyu , Lee Elisa T , Welty Thomas K , Kizer Jorge R , Devereux Richard B , Shara Nawar M , Best Lyle G , Stoner Julie A , Yeh Jeunliang , Howard Barbara V
Published: July 2021

Background—
Stroke prediction models are valuable to physicians in evaluating the risk of their patients so that preventive interventions can be promoted. The Framingham Risk Profile is a widely used stroke prediction equation. However, the contributions of some common risk factors for stroke vary across populations and some risk factors are specific to certain populations. For example, albuminuria is an important risk factor in American Indians (AIs), which is not included in the Framingham equation. The objective of the current study is to develop stroke prediction equations using routinely collected variables in AIs, a population with high rates of diabetes and stroke.

Methods—
The data used in the analysis are from 4507 stroke free participants at enrollment in the Strong Heart Study (SHS), the largest population-based longitudinal study of cardiovascular disease (CVD) and its risk factors in AIs in Arizona, Oklahoma, and South/North Dakota. As of December 2008, 379/4507 (8.4%) participants suffered a first stroke during an average follow-up of 17 years. Baseline potential risk factors were included in the Cox proportional-hazard models to develop gender-specific prediction equations. Backward selection was used to choose the predictors. Model performance was assessed using Harrell’s C statistics based on bootstrapping methods.

Results—
Baseline age, untreated systolic blood pressure, treated diastolic blood pressure, HDL-C, current smoking, diabetes, macro-albuminuria, and history of CVD are significant predictors for incident stroke among women. Most of these predictors except HDL-C were also in the prediction equation for men. The equations provided good discrimination ability, as indicated by a C statistic of 0.72 for men and 0.73 for women.

Conclusions—
Predicted risk of stroke in 10 years can be provided for physicians and their patients. Then appropriate intervention can be implemented. The stroke prediction equations from SHS can be applied to other AIs as well as other ethnic groups with high rates of diabetes and albuminuria.
Abstract P215: Trends in Hemorrhagic Stroke in Japan, from 1986 to 2010: Circulatory Risk in Communities Study (CIRCS).
Authors: Eguchi Eri , Ohira Tetsuya , Imano Hironori , Kitamura Akihiko , Kitamura Masahiko , Okada Takeo , Yamagishi Kazumasa , Sankai Tomoko , Umesawa Mitsumasa , Cui Renzhe , Maruyama Minako , Tanigawa Takeshi , Ishikawa Yoshinori , Iso Hiroyasu
Published: July 2021

Background:
The incidence of hemorrhagic stroke has substantially decreased nearly to a quarter over years from 1960s to 1980s in Japan. However, there is little evidence on the trends after 1980, or whether subtypes of hemorrhagic stroke have decreased. We examined trends in the incidence of hemorrhagic stroke and its subtypes.

Hypothesis:
Hemorrhagic stroke have decreased after 1980s. For intraparenchymal hemorrhage (IPH), lobar and cerebellar intraparenchymal hemorrhage has not decreased.

Methods:
All residents aged 30 to 84 years in two communities (Akita and Osaka, census population: 18,998 in 2000) in Japan was surveyed. The incidence of IPH and subarachnoid hemorrhage (SAH) from 1986 to 2010 was ascertained by systematic surveillance of hospital records and confirmed by physicians with CT or MRI images. The implementation rate of CT or MRI has not changed materially over years (78.9~97.4%). IPH was further categorized to lobar and cerebellar IPH, and deep IPH (thalamus, basal ganglia or brainstem). The respective age-adjusted incidence rates per 100,000 person-years were calculated by each 5 years of time periods: 1986-1990, 1991-1995, 1996-2000, 2001-2005, and 2006-2010.

Results:
Age-adjusted incidence of SAH has decreased in 1996-2000 but increased after 2000. Respective age-adjusted incidence rates (per 100,000 person-years) of SAH for 5 time periods were 46.2, 46.5, 14.5, 23.0, and 23.7 (p for trend=0.23). Age-adjusted incidence of all IPH has decreased from 1986-1990 to 2006-2010. Respective incidence rates of IPH were 56.8, 53.7, 48.7, 29.0, and 26.5 (p for trend=0.01). For the subtypes of IPH, incidence of lobar and cerebellar IPH has not decreased from 1986-1990 to 2006-2010, while it have decreased for deep IPH. Respective incidence rates for lobar and cerebellar IPH were 13.1, 7.6, 16.6, 10.9, and 10.3 (p for trend=0.85) and those of deep IPH were 52.0, 53.1, 49.8, 40.8, and 29.5 (p for trend=0.03).

Conclusion:
The age-adjusted incidence of IPH after 1980s has decreased over years, although such trend was not clear for SAH. Among IPH, the incidence of lobar and cerebellar IPH has not decreased, while the incidence of deep IPH has decreased.
Abstract P231: Asian American Disparities in Risk of Coronary Artery Disease
Authors: Hajra Ashim , Li Yan , Siu Stanton , Udaltsova Natalia , Armstrong Mary Anne , Friedman Gary D. , Klatsky Arthur L.
Published: July 2021

INTRODUCTION:
The number of Asian Americans (Asians) has increased substantially in recent decades, yet prospective data about their risk for coronary artery disease (CAD) remain sparse. We hypothesized significant disparities of CAD risk among Asians.

METHODS:
A multi-ethnic population of 126,088 adults in Northern California supplied baseline data from 1978-1985. Self-classified ethnicity yielded 13,448 (10.6%) Asians including 5,951 Chinese (CH), 1,676 Japanese (JA), 4,236 Filipinos (FI), 689 South Asians (SA) (mostly Asian Indians), and 896 Other Asians (OA). Persons with incident CAD hospitalizations through 2008 numbered 7,658, including 700 Asians. Analyses used Cox proportional hazards models which included age, sex, ethnicity, smoking, alcohol, body mass index, education, marital status, and a composite of possible baseline CAD history/symptoms/risk factors. Models with various referents enabled comparison of all Asian groups to each other as well as to whites, blacks, or Hispanics. These models yielded hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS:
With whites as referent the adjusted HR (CI) for all Asians was 1.0 (0.9-1.0). In a separate model the HRs were: CH = 0.8 (0.7-0.9, p<0.001), JA = 0.9 (0.7-1.1), FI = 1.2 (1.0-1.3, p=0.02); SA = 2.4 (1.9-3.2, p<0.001), and OA = 0.8 (0.5-1.1). Addition of blood pressure, total cholesterol, blood glucose, or leukocyte count to the models had minimal effect on the magnitude of these HRs. SAs were at substantially higher risk than whites, blacks, Hispanics, and each other Asian group with HRs ranging from 2.2 to 3.3 (all p values < 0.001). FI were at a higher risk than all groups except for SA, with HRs ranging from 1.3-1.7 (all p values <0.04). The table gives HRs for Asian groups vs. CH.

CONCLUSION:
Disparities in CAD risk among Asian American ethnic groups are marked, indicating the need to study disease outcomes separately for the groups. The high risks of SAs and FIs mandate further investigation into causes and targeted public health measures.
Abstract P242: US Secular Trends in Coronary Heart Disease, Heart Attack/Myocardial Infarction, and Stroke Prevalence, by Race/Ethnicity, 2005-2010
Authors: Hidalgo Bertha
Published: July 2021

Background:
Cardiovascular disease (CVD) trends are important for the evaluation of disease burden in the context of health disparities. The US has become increasingly diverse in the last few decades, calling for a greater understanding of secular trends in coronary heart disease (CHD), heart attack (HA)/myocardial infarction (MI), and stroke, particularly among Hispanics. For this study, the main objective is to identify secular trends in CVD between 2005-2010 by race/ethnicity, with focus on Hispanic men and women, to shed light on the epidemiological phenomenon known as the Hispanic Paradox.

Methods:
Data from the Behavioral Risk Factor Surveillance Survey was used to assess secular trends between 2005 and 2010. Respondents of the survey were 18 years of age or older and all data was self-report. The telephone survey was conducted cross-sectionally each year. Questions included, “Ever diagnosed with angina or coronary heart disease?” “Ever diagnosed with stroke?” and “Ever diagnosed with a heart attack?”. Means, frequencies, chi-square tests, and Cochran-Armitage trend tests were performed to assess comparisons across groups and to determine statistical significance for trends.

Results:
Data in this study were weighted to account for over- and under-representation of ages, race, and income. There were statistically significant differences in prevalence between race/ethnicities for all years, with Hispanics having the lowest prevalence of all three conditions compared to the other races. Among Hispanics, there were statistically significant differences between genders, with men having higher prevalence of CHD/Angina, HA/MI, and stroke than women. No significant trends were found, other than between 2008 and 2010 in all races for CHD/Angina.

Conclusions:
Overall, there were no significant secular trends for CHD/Angina, HA/MI, or stroke among Hispanics in this study. However, the consistently low prevalence over time of CVD among Hispanics, as compared to other African Americans and Caucasians in this sample, may indicate that more attention is needed for relevant social determinants of health in this population. Furthermore, this data may help to further strengthen support for the Hispanic Paradox, though these results should be interpreted within the limitations inherent to the dataset.
Abstract P255: Decrease in Serum Lipids among 5th Grade CARDIAC Participants, 2002-2012
Authors: Gebremariam Yohannes , Ice Christa , Neal William
Published: July 2021

The presence of multiple cardiovascular risk factors such as elevations in body mass index (BMI), systolic blood pressure (SBP), serum low-density lipoprotein (LDL) cholesterol, and the related non high-density lipoprotein (non-HDL) cholesterol in children is predictive of later cardiovascular disease. LDL and non-HDL have recent decreases in the US adult and youth population despite increases in obesity rates. The purpose of this study was to assess these trends among Appalachian 5
th
grade children.

Methods:
47,198 children, mostly between 10-11 years old, participated in a cross-sectional statewide CARDIAC (Coronary Artery Risk Detection In Appalachian Communities) screening between 2002-2012 and had a complete fasting lipid profile (FLP). Consistent with state demographics, 92.6% were Caucasian and 53.6% female.

LDL (Mean = 92.9, sd = 25.5) and non-HDL (M=111, sd = 28.9) cholesterol levels were normally distributed. Covariates included race, gender, age, SBP and BMI (M = 21.36, sd = 5.2). Generalized Linear Models (GLM) and orthogonal contrast matrices were used to test the hypothesis of a linear (v. non-linear) trend over time for LDL and non-HDL values.

Results:
Models predicting LDL and non-HDL were significant and fit a linear trend (p-value < 0.0001) attributable to the explanatory variables (race was not significant and excluded from the final models). For LDL, year of screening was significant (p<0.0001) as was gender, age and BMI (all p < 0.0001). For non-HDL, year of screening was also significant (p<0.0001), as was gender (p=0.0194), age (p<0.0001), BMI (p<0.0001), and SBP (p=0.0013). There was a decreasing trend in LDL (dot) and non-HDL (broken line) over time (Figure 1). Although some non-linear trends were also significant (e.g., a quartic trend, p < 0.001), the linear trend provided the best fit for both models.

Conclusion:
The mean values for LDL and non-HDL of a cross-sectional sample of children in 5
th
grade Appalachia has decreased over time even after adjusting for age, BMI, gender, race and SBP.
Abstract P265: Plasma Phospholipid Trans Fatty Acids, Cardiovascular Diseases, and Total Mortality: The Cardiovascular Health Study
Authors: Wang Qianyi , Imamura Fumiaki , Lemaitre Rozenn N , Rimm Eric B , Sacks Frank M , Spiegelman Donna , King Irena B , Song Xiaoling , Huang Hongyan , Siscovick David , Mozaffarian Dariush
Published: July 2021

Introduction:
Whereas trans fatty acids (TFAs) have generally been evaluated as a group, emerging evidence suggests that trans18:2, but not trans18:1 or trans16:1, isomers are especially adverse for health. Few studies have investigated how biomarkers of different TFA isomers relate to CVD or total mortality.

Objective:
To examine prospective associations of circulating trans16:1n9 (16:1n9t), total trans18:1 (18:1t, the sum of 18:1n5-12), and n9cis/n6trans, n9trans/n6cis, and n9trans/n6trans 18:2 (18:2ct, 18:2tc, 18:2tt) with incident CVD events and total mortality.

Methods:
We prospectively evaluated 2,788 adults in the Cardiovascular Health Study, age 72±5y, free of prevalent CVD, and having plasma phospholipid TFA measures from blood stored in 1992. CVD events and mortality were centrally adjudicated through 2010, including total mortality, CVD death, CHD death, nonfatal MI (NFMI), and ischemic stroke. Risk associated with each TFA was assessed using Cox proportional hazards adjusting for sociodemographics, lifestyle, dietary habits, prevalent diseases, and the 5 TFA mutually.

Results:
During 31,863 person-years, 1,681 deaths occurred including 581 CVD and 373 CHD deaths; as well as 383 NFMI and 328 ischemic strokes. 18:2ct was associated with higher CVD mortality (quintile 5 vs. 1 HR 1.48, 95%CI 0.98-2.23, p trend 0.04), but not total mortality or nonfatal CVD events. 18:2tc was related to higher NFMI (HR 1.69, 95%CI 1.06-2.69, p trend<0.01), while 18:2tt was not significantly associated with mortality or CVD endpoints. Similarly, 16:1n9t was positively associated with NFMI (HR 2.96, 95%CI 1.80-4.88, p trend<0.01), and ischemic stroke (HR 2.00, 95%CI 1.19-3.36, p trend 0.02), but not mortality endpoints. 18:1t was associated with lower CVD (HR 0.52, 95%CI 0.34-0.79, p trend=0.01) and CHD (HR 0.49, 95%CI 0.29-0.84, p trend 0.02) mortality, but these findings for 18:1t were substantially (~50%+) weakened when analyses did not mutually adjust for all 5 TFA, which were intercorrelated (r -0.08 to 0.78).

Conclusions:
Specific 18:2 TFA isomers, 18:2ct and 18:2tc but not 18:2tt, as well as 16:1n9t are prospectively associated with higher incidence of CVD events. 18:1t is associated with lower CVD risk, perhaps owing at least partly to co-adjustment for multiple correlated TFAs. The general specificity of all findings for CVD events, rather than total mortality or non-CVD mortality, is consistent with adverse physiologic effects of TFA on CVD risk factors. These results highlight the need for further investigation of effects and determinants of specific TFA subclasses and isomers.
Abstract P274: FGF-23 is Associated with Left Ventricular Hypertrophy and Systolic Dysfunction among Patients with Coronary Heart Disease: The Heart and Soul Study
Authors: Agarwal Isha , Ix Joachim , Kestenbaum Bryan , Schiller Nelson , Whooley Mary , Mukamal Kenneth
Published: July 2021

Introduction:
Fibroblast growth factor-23 (FGF-23) is a bone-derived phosphaturic hormone strongly associated with cardiovascular mortality and left ventricular hypertrophy among individuals with end-stage renal disease (ESRD). Whether the relationship between FGF-23 and cardiac dysfunction extends to participants without ESRD is not clearly established.

Hypothesis:
We tested whether FGF-23 is associated with left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF) in participants with coronary heart disease (CHD) and a broad range of kidney function in the Heart and Soul Study.

Methods and Results:
In cross-sectional analyses of 887 participants of the Heart and Soul Study, FGF-23 was positively associated with LVMI (2.09 g/m
2
, 95% confidence interval [CI] 0.15 to 4.03 per 1 standard-deviation [SD] higher ln FGF-23) and inversely associated with LVEF (-0.96%, CI -1.71% to -0.21%, per 1 SD higher ln FGF-23) after adjustment for age, CHD risk factors, microalbuminuria, and cystatin-based estimated glomerular filtration rate (eGFR). In multinomial logistic regression, FGF-23 was associated with an increased prevalence of concentric hypertrophy (odds ratio 1.66, CI 1.00 to 2.76, per 1 SD increase in ln FGF-23) but not eccentric hypertrophy (odds ratio 1.14, CI 0.96 to 1.36). The association between FGF-23 and concentric hypertrophy was stronger among individuals with an estimated GFR < 60 mL/min per 1.73 m
2
, and was not statistically significant among individuals with normal to mildly reduced kidney function (Figure, p interaction 0.11).

Conclusion:
In conclusion, FGF-23 was associated with greater left ventricular mass and concentric hypertrophy, particularly among individuals with diminished kidney function. Additional studies are necessary to determine the pathways that mediate this association.
Abstract P276: Differential Association of D-dimer with Stroke and Coronary Heart Disease: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Zakai Neil A , Howard George , McClure Leslie A , Judd Suzanne E , Kissela Brett M , Safford Monika M , Cushman Mary
Published: July 2021

Introduction:
D-dimer, a marker of coagulation activation, has higher levels in blacks than whites and has been variably associated with stroke and coronary heart disease (CHD).

Methods:
REGARDS recruited 30,239 participants in their homes across the continental US between 2003-07; by design 55% were female, 41% black, and 56% lived in the southeast. In a case-cohort study, D-dimer was measured in 646 participants with incident stroke, 515 with incident CHD, and 1104 in a cohort random sample. D-dimer was log transformed and modeled per 1-unit increase. Cox models were used to determine the HR for vascular disease for D-dimer and the difference in HR (95% CI) by race and vascular disease calculated by bootstrapping with 1000 replicate samples and using the 2.5 and 97.5 percentiles of the distribution (see Table for model variables).

Results:
Median D-dimer was higher in blacks (0.45 mcg/mL; IQR 0.26, 0.85) than whites (0.38 mcg/mL; IQR 0.23, 0.69); p <0.001. D-dimer was higher with increasing age, female gender, diabetes, hypertension and prebaseline cardiovascular disease (all p <0.05). The table shows the HR of stroke and CHD by baseline D-dimer. In minimally-adjusted models, D-dimer was associated with both stroke and CHD. Accounting for Framingham stroke and CHD risk factors, D-dimer remained associated with CHD (HR 1.45; 95% CI 1.18, 1.79), but was marginally associated with stroke (HR 1.20; 95% CI 0.99, 1.45). The difference in the HR of D-dimer between CHD and stroke was 0.22 in the basic model and 0.25 in the Framingham model, but this difference was of marginal statistical significance (Table). There was no difference in the HRs for stroke or CHD for D-dimer in blacks compared to whites (Table).

Discussion:
The association of D-dimer with stroke appeared smaller than for CHD with similar associations by race. Findings suggest that hemostasis activation may play a greater role in pathogenesis of CHD than stroke. Further study is needed to confirm these findings and evaluate the association of D-dimer with different stroke subtypes.
Abstract P294: Association between Anxiety Levels and Weight Change in the Multi-Ethnic Study of Atherosclerosis
Authors: Rieke Kate , Kramer Holly , Liu Kiang , Michos Erin D , Durazo Ramon
Published: July 2021

Background:
Psychological factors may influence weight gain. This study assessed the association between anxiety and weight change in a multi-ethnic cohort followed for approximately 5 years.

Hypothesis:
Anxiety level, measured by the Spielberger State-Trait Personality Inventory (STPI), is associated with weight change.

Methods:
The study population consisted of participants of the Multi-Ethnic Study of Atherosclerosis (n=5,798), age range 45-84 at baseline. Weight was measured at baseline and at subsequent follow-up exams with an average of 1.6 years between exams. A locally weighted scatter plot revealed a non-linear association between anxiety and weight change. STPI scores were then divided into sex-specific quartiles (QANX) based on the STPI scoring manual. The relationship between anxiety level and weight change was examined using a mixed-effect model with weight as the dependent variable, QANX and time as the independent variables, and adjusted for age, race, gender, marital status, education level, income level, and MESA site. Time entered the model as a random effect, whereas all other variables were entered as fixed-effects.

Results:
Overall, 52.5% were female and mean age at baseline was 61.7 years. Mean baseline weight was 78.9 kg (range 32.5 to 146.1 kg). The total average weight change was -0.55 kg for men and -0.56 kg for women over the 5 year period. Average annual change in weight (range) was -0.15 kg (-6.90 to 7.13 kg) for QANX 1, -0.11 kg (-5.81 to 7.27 kg) for QANX 2, -0.08 kg (-8.69 to 8.38 kg) for QANX 3, and -0.16 kg (-7.12 to 6.01 kg) for QANX 4. Mean baseline weight for those in Quartile 4 (most anxious) was 78.1 kg (range 38.4 to 146.1 kg) and mean weight change was -0.16 kg. Mean baseline weight and weight change for the bottom 3 QANX combined was 79. 1 kg (32.5 to 142.7 kg) and -0.12 kg, respectively. Individuals in the highest QANX on average weighed 1.63 kg less compared to individuals in the lower three QANX after adjustment for all covariates (95% CI -2.64, -0.61). Interactions terms between anxiety and race, gender, education, and income level on average weight did not reach statistical significance (P >0.1). No significant association was noted between anxiety quartiles and time (0.007 kg/yr; 95%CI -0.09, 0.11) after confounder adjustment.

Conclusions:
Among adults age 45-84, high anxiety defined by being in the upper STPI quartile was associated with a significantly lower average weight in the MESA cohort but it was not associated with weight change. It is possible that that anxiety may influence weight change at a younger age.
Abstract P304: Asthma-Obesity Association Impact on Children’s Physical Activities
Authors: Lamoshi Abdulraouf
Published: July 2021

Background:
children attending hospital clinics for asthma are more likely to be obese and are significantly less active than children with other medical conditions. Asthma is identified as a barrier to exercise by children and parents. Plans to encourage exercise within children asthma community are needed to protect children’s physical health.

Objective:
The aim of the study is to explore the nature of the relationship between asthma and obesity and the impact of that association on children’s physical activities.

Methods:
This is a cross sectional observational study of children (7-12 years) who were recruited from outpatient physician clinics. Body mass index percentile (BMI %) is used to assess children’s weight, parent report of their child’s asthma diagnosis and severity of symptoms is used to assess asthma. Asthma severity is defined by the FEV1 value from a pulmonary function test during the visit and parent report. Children’s level of physical activity is assessed with assigned Metabolic Equivalent of Task (MET) scores for reported weekly activities. Participants are divided into four groups: asthmatics and overweight or obese, non-asthmatics and overweight or obese, non-asthmatics and non-overweight or non-obese, and asthmatics and non-overweight or non-obese.

Results:
A total of 132 children have been recruited into the study; 40 children have complete physical activity data at this time. 59% of the sample is males. The majority of the sample is Caucasian (84%). 45% (59) of participants are asthmatic; 22 of this group presented with moderate to severe asthma. 28 (21%) children are overweight or obese; 79% are of healthy weight. Out of the 40 children, 5 are asthmatics and overweight or obese, 10 are non-asthmatics and overweight or obese, 14 are non-asthmatics and non-overweight or non-obese, and 11 are asthmatics and non-overweight or non-obese. Severe and moderate asthmatic participants tend to have lower MET scores (X = 33 and 38, respectively) compared to mild asthmatic MET scores (X = 86). Overweight and obese children also tend to have lower MET scores (x = 55) than healthy weight (x = 63). When combined, obese, non-asthmatic children have the lowest MET score (x = 55) while non-obese, asthmatics have the highest MET score (x = 64).

Conclusion:
Obesity has more profound impact on children’s activities than asthma alone. Effective ways to control children’s asthma and weight risks may help children exercise more and improve their quality of life.
Abstract P324: Impact of Energy Drinks on Electrocardiographic and Blood Pressure Parameters: A Meta-Analysis of Clinical Studies
Authors: Shah Sachin A , Lacey Carolyn S , Riddock Ian C , Lee Michael , Dargush Anthony E
Published: July 2021

Introduction:
Energy drinks capture 47% of the beverage market share internationally. Several studies have tried to evaluate the health risks of energy drink consumption but a general consensus does not exist. We performed a meta-analysis to assess the cardiovascular effects of energy drinks on notable electrocardiographic and blood pressure parameters.

Methods:
A literature search in PubMed, CINAHL, Cochrane database and by hand searching of relevant references was performed. Human clinical studies published in the English language were included if evaluating the impact of an energy drink on the QT/QTc interval or systolic blood pressure (SBP). Diastolic blood pressure (DBP) and heart rate (HR) were also assessed. A weighted mean change from baseline was calculated using the DerSimonian and Laird random-effects model for all endpoints. Subgroup and sensitivity analyses were performed to assess heterogeneity.

Results:
Our initial search identified 351 studies of which 7 were ultimately included. A total of 93 and 132 individual subjects were incorporated for the QT/QTc interval and SBP analyses respectively. Compared to baseline, QT/QTc interval prolonged significantly by 10.0msec [95%CI 0.41 to 19.67; Cochrane Q p=0.505] and SBP increased significantly by 3.5mmHg [95%CI 0.92 to 6.11; Cochrane Q p=0.635]. DBP and HR increased non-significantly. These effects were maintained in most subgroup and sensitivity analyses.

Conclusions:
Energy drinks significantly prolong the QT/QTc interval and raise SBP. DBP and HR are increased non-significantly. Further safety evaluation of energy drink consumption is warranted to guide public health policy.
Abstract P336: Blood Pressure Responses to Cold Pressor Test and Incidence of Hypertension: The GenSalt Study
Authors: He Jiang , Zhao Qi , Bazzano Lydia A , Chen Jing , Chen Jichun , Huang Jianfeng , Li Jianxin , Cao Jie , Rice Treva , Mills Katherine , Chen Chung-Shiuan , Gu Dongfeng
Published: July 2021

The cold pressor test (CPT), which measures the response of blood pressure (BP) to the stimulus of external cold, has long been a standard test to characterize sympathetic nervous system activity and has been documented to predict cardiovascular risk. We conducted a CPT among 1,998 Han Chinese in 2003-05 and followed the study participants in 2008-09 and 2011-12 for incidence of hypertension. CPT was conducted after the participant had remained sitting for 20 minutes. The participant immersed his or her left hand in the ice water bath (3°C to 5°C) for 1 minute and BP measurements at 0, 60, 120, and 240 seconds were obtained after the left hand had been removed from the ice water bath. During the follow-up examinations, 3 BP measurements were obtained on each of 3 clinical visits. The maximum and area-under-curve (AUC) of systolic BP responses (mean ± SD) to CPT were 13.9±10.2 and 17.1±22.9 at the baseline examination. Over an average of 7.4 years of follow-up, we identified 490 incidence hypertension cases (systolic BP≥140 mmHg and/or diastolic BP ≥90 mmHg and/or use of antihypertensive medication). The age-adjusted cumulative incidences of hypertension by the quartiles of systolic BP responses to CPT were showed in the following table. These associations remained after adjustment for multiple covariates. Our study identified a strong and independent association between BP responses to CPT and subsequent incidence of hypertension. These data suggest that increased sympathetic nervous system activity may play a role in the development of hypertension.
Abstract P347: Sex Differences in Barriers to Antihypertensive Medication Adherence: Findings from the Cohort Study of Medication Adherence among Older Adults (CoSMO)
Authors: Holt Elizabeth W , Joyce Cara , Dornelles Adriana , Morisky Donald E , Webber Larry S , Muntner Paul , Krousel-Wood Marie A
Published: July 2021

Objectives:
We assessed whether socio-demographic, clinical, health care system, psychosocial, and behavioral factors are differentially associated with low antihypertensive medication adherence scores among older men and women.

Methods:
We conducted a cross-sectional analysis using baseline data from the Cohort Study of Medication Adherence in Older Adults (CoSMO, n=2,194). Low antihypertensive medication adherence was defined as a score <6 on the 8-item Morisky Medication Adherence Scale. Risk factors for low adherence were collected using telephone surveys and administrative databases.

Results:
The prevalence of low medication adherence scores did not differ by sex [15.0% (193 of 1,283) in women and 13.1% (119 of 911) in men p=0.208]. In sex-specific multivariable models, having issues with medication cost and practicing fewer lifestyle modifications for blood pressure control were associated with low adherence scores among both men and women. Factors associated with low adherence scores in men but not women included reduced sexual functioning (OR = 2.03; 95% CI: 1.31, 3.16 for men and OR = 1.28; 95% CI: 0.90, 1.82 for women), and BMI ≥25 (OR = 3.23; 95% CI: 1.59, 6.59 for men and 1.23; 95% CI: 0.82, 1.85 for women). Factors associated with low adherence scores in women but not men included dissatisfaction with communication with their healthcare provider (OR = 1.75; 95% CI: 1.16, 2.65 for women and OR =1.16 95% CI: 0.57, 2.34 for men) and depressive symptoms (OR = 2.29; 95% CI: 1.55, 3.38 for women and OR = 0.93; 95% CI: 0.48, 1.80 for men).

Conclusion:
Factors associated with low antihypertensive medication adherence scores differed by sex. Interventions designed to improve adherence in older adults should be tailored to account for the sex of the target population.
Abstract P367: Primordial Prevention of Coronary Heart Disease through Healthy Lifestyle in a Large Prospective Cohort of Young Women
Authors: Chomistek Andrea K , Chiuve Stephanie E , Eliassen A. H , Mukamal Kenneth J , Rimm Eric B
Published: July 2021

Background:
Although overall mortality rates from CHD in the U.S. have continued to decline in recent decades, the CHD mortality rate among women 35 to 54 years old has been increasing on average by 1.5% per year since 1997. This unfavorable trend may be explained, in part, by adverse lifestyle habits among younger adults. The purpose of this analysis was to estimate the burden of CHD among younger women that can be attributed to lack of adherence to a healthy lifestyle.

Methods and Results:
We conducted a prospective analysis among 93,161 women, 27-44 years of age at baseline, enrolled in the Nurses’ Health Study II cohort and followed from 1991 to 2009. Lifestyle factors were assessed repeatedly during follow-up by questionnaire. Healthy lifestyle was defined as not currently smoking, having a BMI of 18.5 [[Unable to Display Character: –]] 24.9 kg/m
2
, engaging in at least 2.5 hours/week of moderate to vigorous-intensity physical activity, having a diet in the top 40% of Alternative Healthy Eating Index-2010, and consuming 5 [[Unable to Display Character: –]] 30g/day of alcohol. To estimate the proportion of CHD that could be attributed to poor adherence to a healthy lifestyle, we calculated the population attributable risk percent. During follow-up, we documented 441 new cases of non-fatal MI and fatal CHD. After adjustment for other CVD risk factors, non-smoking, healthy BMI, exercise, and healthy diet were independently and significantly associated with lower CHD risk. Compared to women with 0 healthy lifestyle factors, the hazard ratio (HR) for CHD was 0.07 (95% CI, 0.03, 0.17) for women with all 5 healthy lifestyle factors (4% of the study population). Approximately 67% (95% CI 28%, 87%) of CHD cases in this population were attributable to poor adherence to a healthy lifestyle. Among non-smokers, 59% (95% CI 13%, 84%) of CHD cases were attributable to poor adherence to the other four healthy lifestyle factors.

Conclusions:
Primordial prevention through maintenance or adoption of a healthy lifestyle may lower incidence of CHD and potentially reverse the unfavorable trend in CHD mortality in younger women.
Abstract P382: Differential Distributions of Carotid-Femoral and Brachial-Ankle Pulse Wave Velocity with Age and Race: The ARIC Study
Authors: Meyer Michelle L , Tanaka Hirofumi , Gouskova Natalia , Aguilar David , Agarwal Sunil K , Heiss Gerardo
Published: July 2021

Background:
Carotid-femoral PWV (cfPWV), a well-studied measure of central arterial stiffness is associated with cardiovascular disease and mortality. Brachial-ankle PWV (baPWV) is commonly used in Asian countries as a measure of peripheral arterial stiffness. Few studies have evaluated the population distributions of cfPWV and baPWV and the degree to which they may measure the same arterial characteristics.

Objectives:
Characterize cfPWV and baPWV in a population of older adults by age, gender and race.

Methods:
We analyzed 2,403 adults (1473 females; mean age 75 years) from the population-based Atherosclerosis Risk in Communities (ARIC) study who had data on cfPWV and baPWV, after excluding 763 individuals due to arrhythmias, 165 with BMI >40 kg/m2, and 300 with missing covariates of interest. Technicians used Omron VP-1000 plus system (Colin Co., Komaki, Japan) and followed a standardized protocol, to measure cfPWV and baPWV twice, and the results were averaged. The cumulative distributions of cfPWV and the right baPWV by age dichotomized at median, sex and race (African American (AA) and non-AA) were evaluated with the Kolmogorov-Smirnov test and the relationship between cfPWV and baPWV assessed by the Pearson correlation coefficient.

Results:
The mean (SD) cfPWV and baPWV was 1159 (303) and 1736 (319) cm/sec. The empirical distribution function of both these measures was higher (p<0.001) among those 75 years and older than those younger than 75 years i.e., mean (SD) of cfPWV was 1229 (321) vs.1099 (274) cm/sec, respectively, and mean (SD) of baPWV was 1814 (328) vs. 1670 (295) cm/sec, respectively. The distribution function of cfPWV was higher among AAs (p<0.001) but the distribution of baPWV was not different by race (p=0.76). The mean (SD) in cm/sec for AA participants compared to non-AA participants for cfPWV was 1232 (335) vs. 1138 (290), and baPWV was 1725 (324) vs. 1740 (317). The distributions of cfPWV and baPWV did not differ by gender, p=0.21 and p=0.23, respectively. The mean (SD) cfPWV and baPWV among males was 1174 (305) and 1728 (318), and among to females was 1150 (302) and 1742 (320) cm/sec. Correlation analysis showed that cfPWV and baPWV were positively correlated, r=0.45, (p<0.001).

Conclusion:
The distributions of cfPWV and baPWV were similar by gender but were different by age and by race. Despite having comparable measure of peripheral vascular stiffness, African Americans showed a higher degree of central vascular stiffness compared to non-African Americans. Our findings indicate that cfPWV and baPWV are correlated measures of arterial stiffness but likely reflect different aspects of segment-specific vascular impairment and cardiovascular risk.
Abstract P410: Alternate Day Fasting with a High Fat Diet: Impact on Body Weight, Body Composition, and Coronary Heart Disease Risk Profile in Obese Adults
Authors: Klempel Monica C , Kroeger Cynthia M , Varady Krista A
Published: July 2021

Background:
Alternate day fasting (ADF) with a low-fat (LF) diet is effective for weight loss and cardio-protection. However, the applicability of these findings is questionable as most Americans consume a high-fat (HF) diet. This study examined if these beneficial changes in weight and coronary heart disease (CHD) risk can be reproduced if a HF diet is used
in place
of a LF diet during ADF.

Methods:
Thirty-two obese subjects were randomized to an ADF-HF (45% fat) or ADF-LF diet (25% fat), which consisted of two phases: 1) a 2-week baseline weight maintenance period, and 2) an 8-week ADF weight loss period. All food was provided to subjects.

Results:
Body weight was reduced (P < 0.0001) by ADF-HF (5 ± 1%) and by ADF-LF (4 ± 1%). Fat mass decreased (P < 0.0001) by ADF-HF (5 ± 1 kg) and ADF-LF (4 ± 1 kg). Fat free mass remained unchanged. Waist circumference decreased (P < 0.001) by ADF-HF (7 ± 1 cm) and ADF-LF (7 ± 1 cm). LDL cholesterol and triacylglycerol concentrations were reduced (P < 0.01) by both interventions (ADF-HF: 18 ± 5%, 14 ± 5%; ADF-LF: 24 ± 3%, 14 ± 4%). The proportion of small LDL particles decreased (P < 0.05) in the ADF-HF and ADF-LF groups by 8 ± 3% and 10 ± 4%.

Conclusion:
Thus, an ADF-HF diet produces similar reductions in weight and CHD risk as an ADF-LF diet. These findings are important in terms of diet tolerability and long-term adherence to ADF diets.
Abstract P413: Do Methodological Issues Account for the Inconsistent Results Observed in Cohort Studies of Sodium Intake and Clinical Cardiovascular Disease Outcomes?
Authors: Cobb Laura K , Anderson Cheryl A , Elliot Paul , He Jiang , Hu Frank B , Ix Joachim H , Liu Kiang , Whelton Paul K , Woodward Mark , Appel Lawrence J
Published: July 2021

Introduction:
As sodium intake (Na) rises, so does blood pressure. However, the results of cohort studies that relate Na to cardiovascular disease (CVD) are inconsistent. We systematically reviewed the quality of cohort studies for methodological issues that could bias assessments of the relationship between Na and CVD.

Hypothesis:
Methodological limitations are common in cohort studies assessing the link between Na and CVD.

Methods:
We included all known articles that examined the association between Na and CVD or all-cause mortality, coronary heart disease, stroke or heart failure. We divided articles based on 1) type of study population, i.e. general population versus targeted samples at elevated risk of CVD and 2) method of Na assessment. We looked for the presence of random and systematic error in Na assessment, analytic issues such as under-adjustment, and potential for residual confounding and reverse causality.

Results:
We identified 26 studies with 31 independent samples. Of the samples, 13 found at least one direct association between Na and CVD, 10 at least one inverse or J-shaped association, and eight only null associations. 20 were from the general population and 11 from targeted groups. Urine collection was used to assess Na in 13 (24-hour collections in 11) and diet-based measures in 18. Overall, 81% of the 31 samples had a high potential for random errors in sodium assessment, eight of the 17 with sufficient information had systematic errors in Na assessment, 29% were conducted in targeted groups with high potential for reverse causality, and 52% were inadequately adjusted.

Conclusions:
Methodological issues are common in observational studies linking Na and CVD.
Abstract P425: Associations between Physical Activity, Cardiorespiratory Fitness, Abdominal Obesity and Cardiometabolic Risk in Obese Women
Authors: Clarke John , Shalev-Goldman Einat , McGuire Ashlee , Ross Robert
Published: July 2021

The independent associations between abdominal obesity, cardiorespiratory fitness (CRF), physical activity (PA) and cardiometabolic risk factors in obese women is unclear. We studied 165 sedentary, abdominally obese women (waist circumference 106.4 ± 10.2 cm, age 51.0 ± 7.8y). Objective measures of PA volume and intensity were obtained by accelerometry and CRF by a maximal treadmill test. Plasma glucose and serum insulin were obtained during a 2-hour glucose tolerance test. The homeostasis model of assessment (HOMA-IR) was used to estimate insulin resistance. Fasting levels for triglycerides, total cholesterol, and high-density lipoproteins were also obtained. Systolic and diastolic blood pressure was measured using the BP True method.

With few exceptions PA variables alone were not associated with any cardiometabolic risk factors. WC was associated with all cardiometabolic risk factors except DBP, 1 and 2-hour glucose (p≤0.05). CRF alone was associated with SBP, fasting insulin, and HOMA-IR (p≤0.05). Multivariate analysis revealed associations between WC and HOMA-IR (r2=0.24, p<0.001), fasting insulin (r2=0.25, p<0.001), fasting glucose (r2=0.03, p<0.05), TG (r2=0.05, p<0.05), and HDL (r2=0.06, p<0.05) following adjustment for PA, and CRF. CRF, PA intensity and PA volume were not associated with cardiometabolic risk factors following control for each other and WC.

In this study of sedentary, abdominally obese women objective measures of PA intensity and volume were not associated with cardiometabolic risk factors independent of WC and CRF. WC was associated with most of the cardiometabolic risk factors independent of PA and CRF; however, the associations with measures of insulin metabolism were modest whereas the associations with lipid variables and blood pressure were weak.