bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P015: Plasma Brain Natriuretic Peptide Concentration Is Inversely Associated With Prevalent Metabolic Syndrome and Metabolic Syndrome Components: Findings From the Jackson Heart Study
Authors: Nagarajarao Harsha , Musani Solomon K , Ramachandran Vasan S , Bidulescu Aurelian , Taylor Herman A , Fox Ervin R
Published: July 2021

Introduction:
There is emerging evidence that brain natriuretic peptide (BNP) may play a role in human metabolism. Suppressed concentrations in BNP in obese individuals may contribute to clinical phenotypes of metabolic syndrome. There is limited data on the relation of BNP to metabolic syndrome in African Americans.

Methods:
To assess the association between plasma brain natriuretic peptide (BNP) concentration and metabolic syndrome (MetS) and MetS risk factors in blacks, we analyzed cross-sectional data from 3,729 Jackson Heart Study participants free of heart failure (mean age, 54 years; 64% women). We performed sex-specific Tobit regression analysis on log transformed BNP to account for the left censored BNP distribution and adjusted for clinical and echocardiographic variables. Prevalence of MetS was 44% and 35% in women and men, respectively. We estimated percent changes for the underlying variables by back-transformation.

Results:
Plasma BNP concentration was inversely associated with metabolic syndrome components (fasting glucose and waist circumference in both men and women; and triglycerides in women). Sex-specific multivariable adjusted BNP concentrations were significantly lower in subjects with MetS than those without. In men, BNP concentration was 35% lower (P < 0.0001); and in women it was 31% lower (P < 0.0001). Men and women with insulin resistance represented by elevated homeostasis assessment model (HOMA-IR) index had significantly (P < 0.0001) lower BNP concentration compared to those with low HOMA-IR index.

Discussion and Conclusion:
We found in a community based cohort of African Americans a significant relation of low BNP concentration to MetS and individual components of MetS. This data supports a growing body of evidence that BNP plays a potential crucial role in total body metabolism.
Abstract P021: Association of Blood Lactate with Carotid Atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) Carotid MRI Study
Authors: Palamaner Subash Shantha Ghanshyam , Sharrett Richey , Astor Brad C , Coresh Josef , Brancati Frederick , Wasserman Bruce A , Young Hunter J
Published: July 2021

Aim:
Elevated blood lactate, a marker of decreased oxidative capacity, may be associated with high levels of oxidized LDL and consequent atherosclerosis. We assessed the association between elevated blood lactate and carotid atherosclerosis in a sample of 1496 adults, aged 60 - 82 years, in the general population.

Methods:
Maximum wall thickness of the internal carotid artery (MICA) was measured using gadolinium-enhanced magnetic resonance imaging (MRI) in 1496 participants from the Atherosclerosis Risk in Communities (ARIC) Study. Blood lactate was categorized into quartiles (Q1: < 5.9 mg/dl, Q2: 5.9 to 7.2mg/dl, Q3: 7.3 to 9.2 mg/dl, and Q4: >9.2 mg/dl).

Results:
Mean age was 70.3 years; 56% were women and 19% were African American. Higher lactate quartile was associated with greater odds of having MICA above the median (Odds ratio for Q1: 1.00, Q2: 1.06, Q3: 1.24 and Q4: 1.36; p for trend <0.001) after adjustment for age, gender, ethnicity, stature, body mass index (BMI), LDL, hypertension diagnosis, and diabetes diagnosis. The association between MICA and lactate was attenuated but remained significant (Q1: 1, Q2: 1.02, Q3: 1.12, Q4: 1.21, p for trend 0.011) after further adjustment for triglycerides/HDL ratio.

Conclusion:
Blood lactate is associated with internal carotid artery maximum wall thickness, a marker of carotid atherosclerosis. Attenuation of the association with adjustment for triglyceride/HDL ratio, a marker of insulin resistance, suggests that lactate’s association with wall thickness may be mediated through insulin resistance, at least in part.
Abstract P022: Hypertriglyceridemic Waist Phenotype is Associated with Elevated Inflammatory Biomarker Levels
Authors: Shenoy Maithili , Tuliani Tushar , Veeranna Vikas , Zalawadiya Sandip , Patel Krunal H. , Afonso Luis
Published: July 2021

Introduction:
Hypertriglyceridemic waist (TGW) is an easily identifiable clinical phenotype, reflecting visceral obesity. Inflammatory markers and insulin resistance potentially serve as the genetic link between TGW, accelerated atherogenesis and cardiovascular outcomes. We describe characteristics of patients with TGW and the association between inflammatory biomarkers, insulin resistance and TGW.

Methods:
Our sample consisted of 3328 subjects from the National Health and Nutrition Examination Survey III (1988-1994). Subjects who did not have data regarding waist circumference (WC) or fasting serum triglycerides (TG) were excluded. TGW was defined as WC ≥ 90 cm and TG ≥ 176 mg/dl in males and WC ≥ 85 cm and TG ≥ 132 mg/dl in females. Biomarkers studied were serum ferritin, C Reactive protein (CRP), uric acid, fasting insulin and C-peptide. Stata 11 was used to perform T test (using log-transformed variables), Wilcoxon-Mann-Whitney test and logistic regression.

Results:
Our data consisted of 51% (1700) males, 56% (1847) Caucasians/16% (537) African Americans, 54% (1791) had hypertension, 12% (406) had diabetes, 38% (1255) had hyperlipidemia and 35% (1169) had TGW. Mean TG was 163+155mg/dl; mean WC was 99+14cm. Patients with TGW were older (61+ 12 vs. 59+13, p<0.001), male (54 vs. 48%, p 0.003), Caucasian (60 vs. 54%, p<0.001), had more hypertension (61 vs. 50%, p<0.001), hyperlipidemia (47 vs. 33%, p<0.001), diabetes (17 vs. 10%, p<0.001). T test and Wilcoxon-Mann-Whitney test revealed ferritin, CRP, uric acid, insulin and C-peptide to be higher among those who had TGW. They predicted TGW after adjustment for age, sex, race, glomerular filtration rate, hypertension, hypertension medications, hyperlipidemia, hyperlipidemia medications, diabetes, end stage renal disease and hemodialysis. (See table 1)

Conclusion:
Patients with TGW have worse clinical profiles. Inflammatory biomarkers and insulin resistance are associated with TGW. Genetic studies are required for further evaluation.

Table 1.

Biomarker
Ferritin (ng/ml)
CRP (mg/dl)
Uric acid (mg/dl)
Insulin (µU/ml)
C peptide (ng/ml)

Median (TGW)

115
0.33
5.6
13.3
1.02

Median (no TGW)

92
0.21
5.3
8.2
0.69

Β coefficient

0.202
0.236
0.091
0.543
1.171

95% CI

0.098-0.306
0.123-0.349
0.011-0.185
0.266-0.821
0.786-1.556

P value

<0.001
<0.001
0.098
<0.001
<0.001
Abstract P024: Skin Intrinsic Fluorescence is Independently Associated with Coronary Artery Disease in Individuals with Long Duration Type 1 Diabetes
Authors: Conway Baqiyyah N , Aroda Vanita R , Maynard John D , Ratner Robert E , Orchard Trevor J
Published: July 2021

Background:
Advanced glycation end products (AGEs), thought to be a measure of cumulative glycemic exposure and glycemia-induced vascular damage, are increased both in renal disease and diabetes. As AGE formation increases the stiffness of the arterial wall and vascular matrix AGEs interfere with nitric oxide action, AGEs may be an important link between renal and coronary artery disease (CAD). Skin intrinsic fluorescence (SIF) is a noninvasive marker of AGEs. We sought to determine if SIF was associated with CAD in type 1 diabetes and whether this relationship was independent of renal function and renal disease.

Methods:
SIF was measured on the volar area of the forearm of 112 subjects from the Pittsburgh Epidemiology of Diabetes Complications study and 60 subjects from MedStar Health Research Institute when mean age and diabetes duration were 48 and 36years, respectively. CAD was defined as a history of myocardial infarction, bypass surgery/revascularization, percutaneous coronary intervention or stenosis >50%. Overt nephropathy (ON) was defined as albumin excretion rate > 200 µg/min, spot urine albumin/creatinine > 300 ug/mg, or history of dialysis/ renal transplant. Cumulative glycemic exposure (updated mean A1c) was determined by averaging HbA1c values collected over follow-up (mean of 18 years in EDC and 10.3 years in MedStar). SIF and serum creatinine were natural log transformed before analyses. Odds ratios (OR) are expressed as per standard deviation change in a given variable.

Results:
Of the 172 participants, 30 had CAD, with an equal number in each sex. SIF levels were higher in those with CAD (p<0.0001). Sex-specific analyses revealed a strong association between SIF and CAD in men in analyses controlled for age and updated mean HbA1c (HR=5.6, 95% CI=2.1-14.6), but a much weaker non-significant association in women (OR=1.4, 95% CI=0.61-3.3); however, formal analyses revealed no significant effect modification by sex (p=0.11) and thus the sexes were combined for the remainder of the analyses. In the combined analyses, controlling for age, sex, and updated mean A1c, each standard deviation change in SIF was associated with a 2.8 greater likelihood of CAD (95 % CI=1.6-5.1). Controlling for serum creatinine (OR=3.1, CI=1.7-5.6) or ON (OR=2.6, CI=1.4-4.8) rather than updated mean A1c did not change this relationship. Accounting for both updated mean A1c and serum creatinine in analyses that also included age and sex, each standard deviation change in SIF was associated with a 2.7-fold greater likelihood for CAD (CI=1.5-5.1) and remained significant when further controlled for ON (OR=2.0, CI=1.0-3.9, p=0.04)

Conclusion:
Skin intrinsic fluorescence is cross-sectionally associated with CAD, independent of renal function and updated mean A1c in subjects with type 1 diabetes.
Abstract P034: Association between Obesity Indices and Insulin Resistance among Healthy Korean Adolescents
Authors: Kim Hyeon Chang , Choi Dong Phil , Oh Sun Min , Lee Ju-Mi , Cho Hye Min , Lee Won Joon , Cho Jaelim , Lee Ah-reum
Published: July 2021

OBJECTIVE:
To investigate whether five indices of obesity are associated with insulin resistance in a cohort of healthy Korean adolescents.

METHODS:
This is a cross-sectional analysis for 821 healthy adolescents who were aged 14-17 years and free of diabetes. Percentile values of weight-for-height, body mass index (BMI)-for-age, waist circumference (WC)-for-age, and skin fold thickness (SFT)-for-age were calculated comparing to the 2007 Korean National Growth Charts. Waist-to-hip ratio (WHR) percentile value was based on the distribution of study population, because the growth chart did not include WHR values. Insulin resistance was estimated by homeostatic model assessment (HOMA-IR) based on fasting glucose and insulin levels. Logistic regression models were used to estimate odds ratio for insulin resistance according to five different obesity indices. Generalized linear models were used to assess the associations between obesity indices and continuous HOMA-IR levels.

RESULTS:
Mean ± standard deviation of BMI was 22.2 ± 3.3 kg/m
2
for male and 21.2 ± 2.6 kg/m
2
for female adolescents. Sex and age-adjusted odds ratio (95% CI) for insulin resistance, defined as HOMA-IR>2.50, of 50-74th, 75-94th, and ≥95th percentiles of weight-for-height was 1.53 (0.88–2.63), 4.35 (2.63–7.20) and 14.95 (7.50–29.80), respectively, when compared to <50th percentiles. Corresponding odds ratios (95% CI) were 1.28 (0.74-2.22), 3.70 (2.25-6.08) and 14.78 (7.41-29.47) for BMI-for-age percentiles, 1.98 (1.15-3.43), 5.53 (3.24-9.44) and 16.34 (7.70-34.70) for WC-for-age percentiles, 1.90 (1.13-3.18), 4.46 (2.61-7.60) and 15.98 (7.55-33.81) for SFT-for-age percentiles, 1.57 (0.94-2.65), 3.57 (2.19-5.81) and 12.43 (6.08-25.38) for WHR percentiles. Similar findings were observed when insulin resistance was defined as HOMA-IR>3.16. Continuous measure of HOMA-IR was significantly associated with all five obesity indices both in males and females. The associations between obesity indices and insulin resistance were stronger in males than in females. Continuous measure of HOMA-IR was significantly associated with all five obesity indices both in males and females.

CONCLUSION:
Our findings suggest that obesity indices are strongly and progressively associated with insulin resistance even in apparently healthy adolescents.
Abstract P035: Predictors of Diabetes Screening in an Ambulatory Clinical Population
Authors: Chung Sukyung , Wong Eric C , Azar Kristen M , Zhao Beinan , Lauderdale Diane , Palaniappan Latha
Published: July 2021

Introduction
Early screening for diabetes is the most cost effective way to prevent complications. Diabetes screening rates in a clinical population are unknown. There are well-known racial/ethnic differences in diabetes prevalence, with some Asian Americans racial/ethnic subgroups (e.g. Asian Indian and Filipino) having higher rates than Non Hispanic White (NHW) populations, and this may result in higher rates of diabetes screening for Asian Americans.

Hypothesis
We hypothesized that, after taking into account other risks factors suggested by national guidelines, Asian Americans may have higher preventive screening rates, given known higher risk for diabetes.

Methods
We used the electronic health records data from a large multi-specialty, mixed-payer, outpatient, group- practice organization in Northern California, to examine an observational prospective dataset during 1/1/2007-09/30/2010. Active primary care patients who were 35 years or older, not pregnant, identified as Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) or non-Hispanic white (NHW), and were free from diabetes at baseline were included (N=110,477). Screening was defined as fasting glucose, oral glucose tolerance test, or HgBA1C. Racial/ethnic differences in screening rates were initially examined with age-sex standardization. We then estimated a Cox proportional hazard model, which adjusted for diabetes clinical risk factors (including age, sex, BMI, high blood pressure, high LDL, low HDL), family history of diabetes, insurance coverage, and frequency of primary care visits.

Results
Standardized preventive screening rates were higher for all Asian racial/ethnic subgroups (ranging from 82.2%: Japanese to 88.7%: Filipino) than NHW (78.6%)(
P<0.05
). The results were consistent in the fully adjusted Cox model where all the Asian racial/ethnic subgroups, except for Japanese (not significant), were more likely to be screened than NHWs (HR=Asian Indian: 1.29, Chinese: 1.20, Filipino: 1.22, Korean: 1.13, Vietnamese: 1.24; all
P<0.01
). Most clinical risk factors were significant positive predictors of screening, including age, female, high blood pressure, high LDL, low HDL, and family history of diabetes(all
P<0.01
).

Conclusions
Screening rates for diabetes in an insured, ambulatory care population is generally high (∼80%). Clinical risk factors and Asian race/ethnicity are predictors of appropriate diabetes screening.
Abstract P036: Socioeconomic Status and Risk of Diabetes over 35 Years
Authors: Bjorck Lena M , Stahl-Heden Christina , Novak Masuma , Giang Kok Wai , Rosengren Annika
Published: July 2021

Background and aim:
The link between low socioeconomic status (SES) and CHD is well established but whether low SES is also an independent predictor for development of diabetes type 2 is not clear. The aim of this study was to investigate whether SES, measured as occupational class, predicted subsequent development of diabetes type 2 over an extended follow-up.

Methods:
A total of 6941 men 47-55 years old, without prior diabetes, from a population sample of 9998 men, were investigated during 1970-73. Of the men, 23.7% were unskilled workers, 27.2% were skilled workers, 19.7% occupied either a supervisory manual position or were lower officials, 17.9% were officials at an intermediate position, and 11.6% were professionals, executives or senior officials. Follow-up was achieved through the national Swedish patient registry.

Results:
A total of 900 men (13%) were registered at any time with a diagnosis of diabetes over a 35-year follow-up. Compared with men in the highest occupational class, men with intermediate non-manual occupations had a multiple-adjusted hazard ratio (HR) of 1.10, 95% confidence interval (CI) 0.84-1.44, lower officials and foremen had an HR of 1.37 (1.06-1.78), semiskilled and skilled workers 1.39 (1.08-1.78), and unskilled workers 1.66 (1.30-2.13) after adjustment for smoking at baseline, BMI, blood pressure, serum cholesterol, treatment for hypertension and leisure time physical activity.

Conclusions:
Low SES is an independent risk factor for long-term risk of diabetes in men, with a 66% independent higher risk in unskilled workers, compared to professionals/senior officials.
Abstract P037: Vitamin D and Insulin Resistance among Health Korean Adolescents
Authors: Choi Dong Phil , Kim Hyeon Chang
Published: July 2021

BACKGROUND AND PURPOSE:
Vitamin D deficiency is common in adults and has been associated with diabetes or insulin resistance. However the association between vitamin D and insulin resistance has not been fully studied. Thus we investigated the association between serum 25-hydroxyvitamin D level (serum 25(OH)D) and fasting glucose, fasting insulin and insulin resistance in healthy Korean adolescents.

METHODS:
Study participants included 258 (134 males and 124 females) in the first grade students (mean age, 15.5 years) at a rural high school in South Korea. Insulin resistance was calculated using homeostasis model assessment (HOMA-IR). Both categorical (Sex-specific quartiles groups) and continuous measure of serum 25(OH)D were assessed in association with fasting glucose, fasting insulin and HOMA-IR.

RESULTS:
Lower serum 25(OH)D level was significantly associated with fasting glucose, fasting insulin, HOMA-IR after adjustment for age and body mass index in males. But the associations were not significant in females (table).

CONCLUSIONS:
This study suggests that serum 25(OH)D level may be inversely associated with insulin resistance in healthy male adolescents.

Table.

Association between serum vitamin D and glucose metabolism.

Variable
Quartile of serum 25(OH)D
Continuous measure of serum 25(OH)D

Q1
Q2
Q3
Q4
P for trend

β
*

P-value
*

Males
N
33
34
33
34

Serum 25-OH-D (ng/mL, median(min, max))
9.7 ( 5.4, 12.2 )
14.2 (12.3, 15.8)
17.9 (15.9, 19.3)
24.8 (19.6, 40.9)

Fasting glucose (mg/dL)
87.7 ± 5.4
85.7 ± 6.4
86.2 ± 6.7
85.0 ± 6.2
0.125
−0.138
0.004

Fasting insulin (
μ
IU/ml)

9.9 ± 3.5
8.4 ± 3.3
8.8 ± 3.9
7.7 ± 2.8
0.022
−0.570
0.005

HOMA-IR
2.1 ± 0.8
1.8 ± 0.7
1.9 ± 0.9
1.6 ± 0.6
0.018
−2.518
0.004

Females
N
31
31
31
31

Serum 25-OH-D (ng/mL, median(min, max))
7.1(4.5, 8.3)
10.7(8.4, 12.8)
15.5(12.9, 18.5)
23.7(18.9, 36.1)

Fasting glucose (mg/dL)
83.0 ± 5.1
83.0 ± 5.8
81.6 ± 5.9
84.0 ± 6.4
0.726
0.103
0.364

Fasting insulin (
μ
IU/ml)

8.5 ± 2.6
9.0 ± 2.9
7.8 ± 2.6
8.6 ± 2.9
0.698
−0.009
0.970

HOMA-IR
1.7 ± 0.6
1.9 ± 0.6
1.6 ± 0.6
1.8 ± 0.7
0.831
0.316
0.781

*

Adjusted for (sex), age, body mass index
Abstract P043: Does The Severity of Coronary Artery Disease Explain The Increased Risk of Death and Myocardial Infarction From Ambient Air Pollution Exposure?
Authors: Brar Somjot S , Le Denise , Khandhar Sumit , Chang Dong , Short Lindsay , Shen Albert , Mansukhani Prakash , Aharonian Vicken , Moore Naing , Khan Steven , Jorgensen Michael B
Published: July 2021

BACKGROUND:
Ambient air pollution from traffic increases cardiovascular morbidity and mortality and is associated with coronary artery calcification. Whether this increased risk is mediated by severity of coronary artery disease (CAD) remains unknown.

METHODS:
In this pilot study, the relationship between living near a major roadway and multivessel CAD confirmed by invasive coronary angiographic was explored. Subjects undergoing coronary angiography in the Los Angeles metropolitan area in 2009-10 were randomly selected. Investigators blinded to the exposure status reviewed coronary angiograms. Subjects were categorized as having: absence of or non-obstructive CAD, 1-vessel, 2-vessel, or 3-vessel CAD based upon the number of major epicardial vessels with > 70% stenoses. The distance from each subject's residence to the nearest major road was calculated in meters. Multivariate logistic regression was used to explore the relationship between severity of CAD and distance to major roadway.

RESULTS:
There were 642 subjects undergoing coronary angiography. The mean age (SD) was 64 years (12) and 36% were female. In multivariate analysis log-road distance was a predictor of multivessel CAD, odds ratio (OR) = 0.85 (95%CI, 0.75-0.98; p=0. 02) after adjusting for age, gender, hypertension, and diabetes, and smoking status. Other predictors of multivessel CAD included from the multivariate logist model were: male gender (OR, 3.00, 95% CI, 2.06-4.39; p<0.001), diabetes (OR, 2.49; 95% CI, 1.75-3.54; p<0.001), and hypertension 2.58; 95%CI, 1.28-5.21; p=0.008). The most severe form of CAD, >50% stenosis of the left main artery, was observed in 6.6% of the cohort. In a multivariate model, age (P = 0.002) and diabetes (P = 0.002) were significant predictors of severe left main disease; there was a trend for log-road distance (OR, 0.83; 95% CI, 0.67-1.02; P = 0.079) with left main disease.

CONCLUSIONS:
Multivessel CAD was strongly associated with traditional risk factors. After adjusting for these factors, living near a major roadway was also a predictor. This study demonstrates the feasibility of exploring the association between angiographic CAD and traffic pollution. Additional studies are needed to better understand the mechanisms underlying the increase in adverse cardiovascular events from air pollution.
Abstract P063: Vitamin D and Parathyroid Hormone are Cross-sectionally Associated with Higher Levels of B-type Natriuretic Peptide: The Hoorn Study
Authors: van Ballegooijen Adriana , Visser Marjolein , Snijder Marieke B , Dekker Jacqueline M , Nijpels Giel , Stehouwer Coen D , Diamant Michaela , Brouwer Ingeborg A
Published: July 2021

Background:
Low serum 25-hydroxyvitamin D (25OHD) levels have been associated with increased risk of cardiovascular disease. Dysfunction of the vitamin D-parathyroid hormone (PTH)-calcium axis may play a role in the pathogenesis of heart failure.

Hypothesis:
We investigated whether lower serum 25OHD levels and higher PTH levels are associated with higher B-type natriuretic peptide (BNP) levels in older individuals both cross-sectionally and after 8 years of follow-up.

Methods:
We measured baseline serum 25OHD, PTH and BNP in 502 subjects in 2000–2001 in the Hoorn Study, a population-based cohort. Follow-up BNP was measured in 2007–2009 in 278 subjects. Subjects were categorized according to season and sex-specific 25OHD and PTH quartiles at baseline. We studied the association of 25OHD and PTH quartiles with BNP using linear regression analyses adjusting for confounders. Effect-modification by kidney function and CVD presence was examined.

Results:
Subjects had a mean age of 70 years, mean 25OHD level of 52±19.5 (nmol/L) and mean PTH of 6.1±2.4 (pmol/L). The lowest 25-OHD quartile was cross-sectionally associated with higher BNP, in subjects with low kidney function only (eGFR<77.3 mL/min/1.73m
2
)(=sample median). The association attenuated after adjustment for PTH. PTH was cross-sectionally associated with BNP in subjects with low kidney function only (p-for-trend < 0.05), even after adjustment for 25OHD (Figure 1). Neither 25OHD nor PTH was associated with BNP in longitudinal analyses.

Conclusion:
This study showed no strong association between 25OHD and BNP. However, PTH - a potential mediator in the relation between 25OHD and BNP, was associated with BNP in subjects with low kidney function.
Abstract P065: The Amount and Type of Dairy Product Intake and the Risk of Incident Type 2 Diabetes: Results from the EPIC-InterAct Study
Authors: Sluijs Ivonne , Forouhi Nita G , Beulens Joline W , van der Schouw Yvonne T ,   The InterAct Consortium
Published: July 2021

Background:
Dairy product intake may be inversely associated with risk of type 2 diabetes, but the evidence is inconclusive for total dairy products and sparse for types of dairy products.

Objective:
To investigate the prospective association with incidence of type 2 diabetes of total dairy products, and different dairy sub-types in populations with marked variation of intake of these food groups.

Design:
A nested case-cohort within 8 European countries of the EPIC Study (n=340,234; 3.99 million person-years of follow-up) included a random subcohort (n=16,835) and incident diabetes cases (n=12,403). Baseline dairy product intake was assessed using dietary questionnaires. Country-specific Prentice-weighted Cox regression hazard ratios (HR) were calculated and pooled using random effects meta-analysis.

Results:
Intake of total dairy products was not related to diabetes risk; HR comparing highest versus lowest quintile of total dairy products was 1.05 (95%CI: 0.91, 1.21; P-trend 0.76) in age, sex, BMI, diabetes risk factors, education and dietary factors adjusted analysis. Among dairy subtypes, an inverse association with cheese intake was present [HR 0.85 (95%CI: 0.72, 1.00); P-trend 0.01], but not with other dairy subtypes. A higher combined intake of fermented dairy products (cheese, yogurt, thick fermented milk) was inversely related to diabetes risk [HR 0.85 (0.75, 0.96), P-trend 0.01].

Conclusion:
This large prospective study found no association between total dairy products and diabetes risk. The inverse association of cheese intake and combined fermented dairy product intake with diabetes risk is potentially important and merits further study.
Abstract P076: Genetic Factors Modify the Triggering of Acute Myocardial Infarction by Transient Exposure to Coffee Intake
Authors: Baylin Ana , Kardia Sharon , Campos Hannia
Published: July 2021

Introduction:
Caffeinated coffee increases sympathetic nervous activity that may adversely affect a vulnerable atherosclerotic plaque and therefore trigger an acute myocardial infarction (AMI). Additionally, it is possible that genetic variation alter the susceptibility to the acute effects of coffee.

Hypothesis:
We assessed the hypothesis that genetic factors associated to AMI can modify the triggering of AMI by acute coffee intake.

Methods:
We collected information on intake of coffee during the 24 hours and days before the myocardial infarction and habitual intake of coffee in 1,234 incident cases of non-fatal AMI from 1994–2004. Data was analyzed as a case-crossover design assuming a hazard period of 1 hour. We used a genetic score with 3 loci from AMI GWAS that has been validated in this population. People with a higher score have a greater risk for AMI. In addition, we also evaluated one polymorphism in the cytochrome P450 1A2 candidate gene that decreases the enzyme inducibility, resulting in impaired caffeine metabolism. Carriers of the variant CYP1A2*1F allele are slow caffeine metabolizers, whereas individuals who are homozygous for the CYP1A2*1A allele are rapid metabolizers.

Results:
Participants were classified as low AMI genetic risk (1 to 3 alleles) or high genetic risk (4 to 6 alleles) according to the genetic risk score. RR for the association between coffee and AMI were 1.72 (95%CI:1.22, 2.43) and 1.06 (95%CI:0.85, 1.31) for the low and high genetic risk groups respectively (test of homogeneity p-value=0.02). RR were 1.38 (95%CI:1.07, 1.76) and 0.99 (95%CI:0.77, 1.28) for homozygous carriers of the rapid CYP1A2*1A allele and carriers of the slow CYP1A2*1F allele, respectively (test of homogeneity p-value =0.067). Because we have shown previously that coffee intake is not associated with AMI among heavy drinkers (≥ 4 cups/d), we repeated the analysis among light/occasional and moderate drinkers. RR were 1.69 (95%CI:1.28, 2.23) and 1.09 (95%CI:0.80, 1.48) for rapid and slow metabolizers, respectively (test of homogeneity p-value=0.038).

Conclusions:
In conclusion, people with lower genetic risk seem to be more susceptible to coffee. It is possible that the effect of environmental factors (including triggers like coffee intake) is higher among people who are not at risk because of genetic factors. Light and moderate drinkers who are rapid caffeine metabolizers are also more susceptible to coffee. It is possible that light/moderate drinkers who are slow metabolizers develop more tolerance to caffeine than rapid metabolizers.
Abstract P082: Lower Adiponectin Levels May Underlie Association Between Depressive Symptoms And Markers of Cardiometabolic Health
Authors: Clark Cari J , Wang Qi , Guo Hongfei , Bromberger Joyce T , Mancuso Peter , Kravitz Howard M , Henderson Kimberly M , Everson-Rose Susan A
Published: July 2021

Introduction:
Depressive symptoms have been linked to CVD risk factors, including metabolic dysregulation. One pathway by which depression may influence CVD risk is via alterations in adiponectin, an abundant adipocytokine with anti-inflammatory effects. This mechanism has not been studied in population-based samples.

Hypothesis:
The relationship of depressive symptoms with metabolic syndrome (MetSyn) and Framingham Risk Score (FRS) will be partly mediated by adiponectin.

Methods:
Participants were 581 women (61.3% white; 38.7% black) from the Chicago and Pittsburgh sites of the Study of Women’s Health Across the Nation. Adiponectin was measured from stored serum specimens and assayed in duplicate using a commercially available enzyme linked immunosorbent assay and log transformed for analysis. Depressive symptoms were measured with the 20-item Center for Epidemiological Studies Depression Scale (CES-D); a standard cutoff (>16) was used to determine clinically significant symptoms. MetSyn was defined by ATP-III criteria and considered present if the participant had at least 3 of the following: waist circumference >88cm; triglycerides >150 mg/dl; HDL cholesterol < 50 mg/dl; blood pressure > 130 mmHg systolic and / or 85 mmHg diastolic; impaired fasting glucose (>110 mg/dl) or diabetes. The FRS was defined by the participant’s age, smoking status, blood pressure, cholesterol, and use of anti-hypertensives. Logistic regression models were constructed to examine the cross-sectional relationship between depressive symptoms and MetSyn controlling for age, race and study site. A subsequent model included adiponectin to evaluate whether it attenuated the observed association. Linear regression models were used to conduct the same analysis with FRS as the outcome. Due to missing values, analytic sample sizes were 558 for MetSyn and 568 for FRS.

Results:
147 women (25.3%) had elevated CES-D scores and 113 (20.7%) met criteria for MetSyn. Average FRS was 8.7 (sd=4.6) and the mean, untransformed adiponectin value was 9.9 (sd=4.9) μ g/mL. In models adjusted for age, race, and study site, women with high CES-D scores had increased odds of MetSyn (OR=1.64; 95% CI=1.03, 2.60) and a higher FRS (estimate=0.98; se=0.41, p<.02). Separate bivariate analyses showed that adiponectin was inversely related to CES-D scores (p=.03), MetSyn (p<.001) and FRS (p<.001). Subsequently including adiponectin in the regression models attenuated the associations between CES-D and MetSyn (OR=1.45; 95% CI=0.89, 2.36) and FRS (estimate=0.76; se=0.41; p=.06).

Conclusions:
Adiponectin may partially explain the relation between depressive symptoms and measures of cardiometabolic health. Longitudinal studies are needed to more fully understand the temporality of these associations. Supported by NIH/DHHS grants HL091290, AG012505, AG012546, MH59770, AG17719.
Abstract P083: Poor Health Behaviors Explain Increased Risk of Cardiovascular Events in Hostile Patients with Coronary Heart Disease: Findings from the Heart and Soul Study
Authors: Wong Jonathan M , Na Beeya , Whooley Mary A
Published: July 2021

Background:
Hostility is a significant predictor of adverse cardiovascular (CV) events in patients with coronary heart disease (CHD) but the mechanisms that explain this association are unknown.
Hypothesis:
We assessed the hypothesis that controlling for poor health behaviors (physical inactivity, medication nonadherence, and smoking) would eliminate the association between hostility and future CV events.

Methods:
We prospectively examined the association between self-reported hostility and CV events in 1022 outpatients with stable CHD from the Heart and Soul Study. Baseline hostility was assessed using the 8-item Cynical Distrust Scale. Log hazard models were used to determine the extent to which candidate biological and behavioral mediators changed the strength of association between hostility and CV events (myocardial infarction, heart failure, stroke, transient ischemic attack, or death).

Results:
A total of 592 CV events occurred during 8 years of follow-up. Each standard-deviation increase in hostility score was associated with a 20% increased risk of CV events (age-adjusted hazard ratio [HR] 1.20; 95% CI, 1.09-1.31; P=0.0001). The age-adjusted annual rate of CV events was 10.4% among the 185 subjects in the highest quartile of hostility and 6.2% among the 333 subject in the lowest quartile of hostility (HR 1.67; 95% CI, 1.27-2.18; P=0.0002). After adjustment for comorbid diseases and cardiac disease severity, participants with hostility scores in the highest quartile had a 46% higher rate of CV events than those with scores in the lowest quartile (HR 1.46; 95% CI, 1.09-1.98; P=0.01). This association was no longer statistically significant after adjustment for smoking, medication non-adherence and physical inactivity (HR 1.12; 95% CI, 0.87-1.63; P=0.27).

Conclusions:
Hostility was a significant predictor of adverse CV events in this sample of patients with stable CHD, but the association was eliminated after adjustment for poor health behaviors.

Association Between Baseline Hostility (Quartile IV vs. I) and Subsequent Cardiovascular Events
*

Model Adjusted for

†

HR (95% CI)

P value

Age
1.67 (1.27-2.18)
0.0002

Above + Male, White
1.70 (1.29-2.24)
0.0002

Above + depressive symptoms
1.56 (1.17-2.08)
0.003

Above + MI, diabetes, LVEF
1.46 (1.09-1.98)
0.01

Above + CRP
1.36 (1.00-1.84)
0.05

Above + smoking
1.31 (0.97-1.78)
0.08

Above + medication nonadherence
1.26 (0.92-1.72)
0.14

Above + physical inactivity
1.19 (0.87-1.63)
0.27

*

Cardiovascular events include myocardial infarction, heart failure, stroke, transient ischemic attack, and death;

†

Each model adjusts for the variables from the preceding rows, such that the final row adjusts for every variable listed in the table
Abstract P093: Food Insecurity and Cardiovascular Risk Among Adults in the United States
Authors: Ford Earl S
Published: July 2021

Introduction:
The relationship between food security status and 10-year projected cardiovascular risk is poorly understood.

Hypothesis:
The present study sought to examine the associations between food security status and cardiovascular risk factors and projected 10-year cardiovascular risk in a national sample of U. S. adults.

Methods:
A cross-sectional analysis of 11857 adults aged >=20 years from the National Health and Nutrition Examination Survey (2003–2008) was conducted. Four levels of food security status were defined using 10 standard questions. Cardiovascular risk factors included systolic blood pressure, smoking status, body mass index, urinary albumin-creatinine ratio, and concentrations of HbA1c, total cholesterol, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, cotinine, and C-reactive protein. Projected 10-year cardiovascular risk was determined from a multivariable risk algorithm derived from Framingham data.

Results:
Among all participants, 83.6% had full food security, 6.7% had marginally food security, 5.9% had low food security, and 3.7% had very low food security. After adjustment for age, gender, race or ethnicity, educational status, health insurance coverage, alcohol use, cardiovascular disease risk factors, and histories of diabetes, cardiovascular disease, and cancer, mean HbA1c concentration was 0.13% higher (p=0.026) and cotinine concentration was 54.1 ng/ml higher (P <0.001) among participants with very low food security than those with full food security. No significant associations were observed between food security status and, measured as continuous variables, systolic blood pressure, urinary albumin-creatinine ratio, or concentrations of total cholesterol, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and C-reactive protein. Compared to fully food secure participants, those with very low food security were more likely to have diabetes (adjusted prevalence ratio [aPR]: 1.38, 95%CI: 1.16– 1.64), hypertension (aPR: 1.25, 95% CI: 1.05–1.49), elevated cotinine concentrations (aPR: 1.51, 95% CI: 1.35–1.68), and, in women only, obesity (aPR: 1.22, 95% CI: 1.03–1.45) or be current smokers (aPR: 1.63, 95% CI: 1.46–1.83). Among fasting participants aged 30–74 years (N= 3852), adults aged 30–59 years with very low food security were more likely to have a projected 10-year cardiovascular risk >20% than fully food secure participants (adjusted prevalence ratio: 2.27, 95% CI: 1.39, 3.72). Food security status was not significantly associated with projected cardiovascular risk among participants aged >=60 years.

Conclusions:
Food insecurity may be associated with impaired cardiovascular health in adults. Additional research into the relationships between food security and cardiovascular health appears warranted.
Abstract P096: Association of Cystatin C Gene Cluster Variants with Cystatin C levels, Chronic Kidney Disease, and Risk of iIncident Cardiovascular Disease and Mortality
Authors: Tin Adrienne , O'Seaghdha Conall M , Yang Qiong , Katz Ronit , Liu Yongmei , Kao Wen Hong Linda , Fox Caroline S , Shlipak Michael G
Published: July 2021

Background:
Accounting for genetic variation in cystatin C production may improve glomerular filtration rate estimation (eGFR) and the classification of chronic kidney disease (CKD). As the majority of known SNPs influencing cystatin C tend to result in lower circulating levels, we hypothesized that accounting for genetic variation would result in higher eGFR calculated from cystatin C level (eGFRcys) and a lower prevalence of CKD. Furthermore, we hypothesized that adjusting eGFRcys for the genetic component would strengthen the associated cardiovascular and mortality risk estimates.

Methods:
Four prospective cohorts were included: the Atherosclerosis Risk in Communities (ARIC), Cardiovascular Health (CHS), Framingham Heart (FHS), and Health ABC (HABC) studies. We developed a cystatin C genotype score using 7 SNPs within the cystatin gene cluster on chromosome 20, which accounted for 8% of the variability in eGFRcys in FHS. We compared the association of the cystatin C genotype score with cystatin and creatinine-based eGFR and CKD (eGFR <60ml/min/1.73m2). We also tested whether eGFRcys, adjusted for the genotype score, resulted in a change in the prevalence of CKD. Finally, we performed longitudinal analyses of the genotype score, and both adjusted and unadjusted eGFRcys, with mortality and cardiovascular events.

Results
were combined using inverse-variance meta-analysis. Results: A total of 14,647 participants were included. A higher cystatin C genotype score was associated with lower cystatin C levels (beta-coefficient −0.45; p=4.0E−103) and higher eGFRcys (beta-coefficient 0.53; p=1.0E−95), and was not associated with creatinine-based eGFR (p=0.4). The absolute prevalence of CKDcys was 10.7%; after adjustment for the genotype score, the absolute prevalence of CKDcys was 8.9%, a difference of 1.8%. Adjustment for the genotype score had no impact on the association between eGFRcys with CVD events (HR 0.38 [95% C.I. 0.33–0.44] per unit of log(eGFRcys)) and mortality (HR 0.29 [95% C.I. 0.26–0.32] per unit of log(eGFRcys)).

Conclusion:
In general, adjusting for the genetic contribution of cystatin C levels resulted in higher estimated GFR and marginally fewer CKD cases. This indicates the presence of a genetic bias in circulating cystatin C levels; however, this does not appear to be of clinical importance with respect to cardiovascular and fatal outcomes.
Abstract P105: Women with Atrial Fibrillation have Increased Risk of Incident Stroke: Insights from a Propensity-Matched Study of the AFFIRM Trial
Authors: Roy Brita , Desai Ravi V , Ahmed Mustafa I , Fonarow Gregg C , Anorow Wilbert S , Ahmed Ali
Published: July 2021

Background:
Women with atrial fibrillation (AF) have been reported to have poor outcomes. It remains unclear if this association is intrinsic or mediated by the higher comorbidity burden of female AF patients. Therefore, we examined the association between sex and outcomes in a balanced cohort of propensity-matched AF patients who participated in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial.

Methods:
Of the 4060 AFFIRM patients, 1594 (39%) were women. Propensity scores for female sex were calculated for each of the 4060 patients, and were used to assemble a cohort of 1097 pairs of men and women who were balanced on 51 baseline characteristics, including major cardiovascular (CV) risk factors and medication use, including warfarin. Matched Cox regression models were used to estimate the association between female sex and outcomes during 6 years of follow-up.

Results:
Patients (n=4060) had a mean (±SD) age of 70 (±8) years and 13% were African American. All-cause mortality occurred in 19% and 15% of matched men and women, respectively (matched HR when women were compared to men, 0.88; 95% CI, 0.69-1.11; p=0.279). All-cause hospitalization occurred in 61% of both men and women (matched HR for women, 1.06; 95% CI, 0.93-1.21; p=0.372). Sex was not associated with CV hospitalization (matched HR for women, 1.13; 95% CI, 0.97-1.32; p=0.111). Ischemic stroke occurred in 3% and 5% of matched men and women, respectively (OR when women were compared to men, 2.02; 95% CI, 1.28-3.18; p=0.002). There was no sex-related difference in major bleeding (7% each).

Conclusion:
In a cohort of AF patient in which men and women were well-balanced on 51 baseline characteristics including warfarin use, women had increased risk of stroke, but there was no sex-related variation in all-cause mortality or CV hospitalization.
Abstract P107: Association of Longitudinal Change and Fluctuation in QT Interval with Cardiovascular Outcomes: A Cohort Study in a Managed Care Setting
Authors: Iribarren Carlos , Round Alfred D , Lyon Liisa L , Terdiman Joseph F , Zaroff Jonathan G , Klatsky Arthur L , Holve Taylor , Stang Paul
Published: July 2021

Purpose.
Both long and short QT intervals are associated with life-threatening cardiac arrhythmias and adverse cardiovascular (CV) events, but prior studies have typically relied on a single baseline measure of the QT interval. We examined the prospective association of within-person change and fluctuation in QT length over time with subsequent CV outcomes and all-cause mortality in a managed care setting.

Methods.
We assembled a cohort of 187,901 Northern California Kaiser Permanente Medical Care Program (KPMCP) members who underwent three or more standard 12-lead ECGs as part of regular care between 1995 and 2008. Cohort-specific log-linear models stratified by gender, age and race/ethnicity were used to correct raw QT measurements for heart rate (QTc). Non-fatal and fatal CV outcomes and all-cause mortality were identified between the last ECG and right censoring event (CV event, death, termination of health plan membership or 12/31/2009; the median [SD] follow-up time was 4.1 [3.7] years). Cox regression models adjusting for age, gender, race/ethnicity, hypertension, diabetes, hyperlipidemia, smoking status and average QTc were used to simultaneously generate hazard ratios and 95% CI for tertiles 1 and 3 (versus tertile 2) of the linear slope of QTc (change in ms per year) and for tertiles 2 and 3 (versus tertile 1) of the root mean square error of QTc (RMSE, variability about the linear slope in ms).

Results.
The mean QTc slope and RMSE were +2.2 ms/year and 15.3 ms in men and +1.4 ms/year and 14.3 ms in women, respectively. In fully-adjusted models, the sex-specific tertile 3 of the QTc slope was associated with increased hazard of acute coronary syndrome (Number of events; Hazard Ratio; 95% Confidence Interval) (17,920; 1.34; 1.30-1.39), ischemic stroke (11,716; 1.30; 1.25-1.36), heart failure (42,909; 1.47; 1.44-1.51), cardiac arrest (4,700; 1.67; 1.55-1.79) and all-cause mortality (72,392; 1.43;1.40-1.45). In turn, the sex-specific tertile 3 of the RMSE was associated with increased hazard of heart failure (1.34;1.31-1.37), cardiac arrest (1.19;1,11-1.28) and all-cause mortality (1.06;1.04-1.08).

Conclusions.
In an insured population that underwent multiple ECGs, both linear increase and fluctuation of QTc over time were significantly and independently associated with adverse CV outcomes. Whether these associations are causal or represent confounding effects of medications warrant further research.
Abstract P139: Healthy Lifestyle Status, Antihypertensive Treatment and the Risk of Heart Failure among Finnish Men and Women
Authors: Wang Yujie , Tuomilehto Jaakko , Jousilahti Pekka , Antikainen Riitta , Mähönen Markku , Katzmarzyk Peter T. , Hu Gang
Published: July 2021

Background:
It is unclear which is more effective in preventing heart failure (HF) in hypertensive people: lifestyle intervention or antihypertensive drug treatment.

Aim:
To investigate whether there are differences in HF risk among hypertensive patients using antihypertensive drug treatment versus those engaging in a healthy lifestyle at baseline.

Methods:
Study cohorts included 38075 Finnish participants who were 25 to 74 years of age and free of HF at baseline. The study population was classified into five groups according to their blood pressure status at baseline. A healthy lifestyle was defined as having two or more healthy lifestyle factors including moderate or high level of physical activity, never smoking, body mass index <25 kg/m
2
, and vegetable consumption ≥3 times/week.

Results:
During a median follow-up of 14.1 years, 638 men and 445 women developed HF. Compared with normotensive people, hypertensive patients with and without antihypertensive treatment had a higher risk of HF. Engaging in a healthy lifestyle was associated with a decreased risk of HF. The multivariable-adjusted hazard ratios (HRs) of HF in the ten subgroups (normotensive group with a healthy lifestyle; hypertensive, unaware, untreated group with a healthy lifestyle; hypertensive, aware, untreated group with a healthy lifestyle; hypertensive, treated, controlled group with a healthy lifestyle; hypertensive, treated, uncontrolled group with a healthy lifestyle; normotensive group without a healthy lifestyle; hypertensive, unaware, untreated group without a healthy lifestyle; hypertensive, aware, untreated group without a healthy lifestyle; hypertensive, treated, controlled group without a healthy lifestyle; and hypertensive, treated, uncontrolled group without a healthy lifestyle) were 1.00, 1.50, 1.54, 2.24, 1.91, 2.12, 2.68, 3.05, 2.27, and 3.21 (Ptrend <0.001), respectively. Hypertensive subjects who used antihypertensive drugs but did not engage in a healthy lifestyle had a significantly higher risk of HF (HR 2.10; 95% CI 1.68–2.63) than hypertensive subjects who did not use antihypertensive drug but engaged in a healthy lifestyle. Hypertensive subjects who did not use antihypertensive drugs and did not engage in a healthy lifestyle had a significant higher risk of HF (HR 1.44; 95% CI 1.16–1.80) compared with hypertensive subjects who used antihypertensive drug and engaged in a healthy lifestyle.

Conclusions:
The present study demonstrates that the risk of HF was lower in hypertensive patients who engaged in a healthy lifestyle but higher in hypertensive people despite of antihypertensive drug treatment and adequate control of hypertension. Lifestyle intervention may be more effective in preventing HF than antihypertensive treatment in hypertensive subjects.