bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP64: High Sodium Intake is Associated with Short Leukocyte Telomere Length in Overweight and Obese Adolescents
Authors: Zhu Haidong , Bhagatwala Jigar , Pollock Norman , Gutin Bernard , Thomas Jeffrey , Parikh Samip , Harshfield Gregory , Dong Yanbin
Published: July 2021

Introduction:
The aging process in children and adolescents is accelerated resulting in the premature development of “adult” diseases such as hypertension and diabetes. Telomere shortening plays a key role in human aging; identifying factors that regulate this process is important for developing effective lifestyle interventions so as to prevent and treat age-associated diseases.
In vitro
and
in vivo
studies demonstrate that high salt content markedly decreases life span, and accelerates cellular aging through increased DNA breakage. However, the effect of high salt diet on telomere length, a marker of biological aging, remains unknown. Therefore, we aimed to test the hypothesis that high dietary sodium intake is inversely associated with leukocyte telomere length, especially in the context of obesity.

Methods:
Leukocyte telomere length (T/S ratio) was assessed by a quantitative polymerase chain reaction method in 766 adolescents aged 14-18 years (50% female, 49% African Americans). Diet was assessed with three to seven 24-h recalls, and physical activity was determined by accelerometry. Participants were classified according to low vs. high sodium intake (below or above the median), and according to weight status (normal vs. overweight/obese). Analysis of covariance and linear regression analyses were used to determine the effects of sodium intake and weight status on leukocyte telomere length.

Results:
After controlling for age, sex, race, energy intake, Tanner stage, and vigorous physical activity, a statistically significant sodium intake by weight status interaction was observed, such that leukocyte telomere length was significantly shorter in the high sodium intake vs. low sodium intake subjects from the overweight/obese group (1.24 ± 0.22 vs. 1.32 ± 0.21, p=0.02), but not the normal weight group (1.29 ± 0.24 vs. 1.30 ± 0.24, p=0.69). Consistent with the low vs. high sodium intake group data, multiple linear regression analyses, adjusting for age, sex, race, energy intake, Tanner stage and vigorous physical activity, revealed that higher dietary sodium intake was associated with shorter leukocyte telomere length in the overweight/obese group (β=-0.37, p=.045), but not the normal weight group.

Conclusion:
High dietary sodium intake is associated with shorter telomere length in overweight and obese adolescents suggesting that high sodium intake and obesity may act synergistically to accelerate cellular aging. Longitudinal studies are warranted to determine the synergistic effect of high sodium intake and obesity on telomere shortening over time.
Abstract MP76: The Impact of Low Consumption of Fruits and Vegetables on Mortality from Cardiovascular Diseases in 187 Countries
Authors: Khatibzadeh Shahab , Afshin Ashkan , Micha Renata , Shi Peilin , Yawar Yakoob Mohammad , Singh Gitangali Maya , Rao Mayuree , Fahimi Saman , Ezzati Majid , Mozaffarian Dariush
Published: July 2021

Background:
Consumption of fruits and of vegetables each influence CVD risk. Yet, the global CVD mortality attributable to low intakes of each, by country, age, and sex, are not established.

Objectives:
To quantify the burdens of CVD attributable to low fruit consumption and low vegetable consumption by age and sex in 187 countries in 2010.

Methods:
We characterized consumption of fruits and vegetables by age, sex, and country based on 204 national and subnational surveys from 109 countries representing 85.2% of the world’s adult population complemented by bayesian hierarchical imputation for missing data. Etiologic effects of fruit and vegetable intake on CHD and stroke were quantified based on meta-analyses of prospective observational studies, supported by effects on CVD risk factors in intervention studies. Cause-specific mortality rates were obtained from the 2010 Global Burden of Diseases Study. CHD and stroke mortality attributable to low intakes of fruits [<300g/d] and vegetables (including legumes) [<400g/d] were estimated using comparative risk assessment, by country, age, and sex.

Results:
In 2010, 2,814,850 CVD deaths [95%UI: 2,652,230-2,977,471] were attributable to low fruit intake [36% CHD, 17% ischemic stroke, 47% hemorrhagic and other nonischemic stroke] and 1,922,582 CVD deaths [1,839,270-2,005,894] were attributable to low vegetable intake [42% CHD, 21% ischemic stroke, 37% hemorrhagic other nonischemic stroke]. Burdens were similar by sex: 55% and 54% of these deaths, respectively, occurred in men. Nearly 1 in 2 CVD deaths attributable to fruits and 2 in 5 attributable to vegetables occurred prematurely, before age 70 y. Substantial heterogeneity was evident across nations (Figure).

Conclusions:
These results highlight the substantial burdens as well as disparities in CVD attributable to insufficient consumption of fruits and vegetables around the world, informing prevention strategies and priorities.
Abstract MP83: Increases in Vigorous Physical Activity Improve Pulse Wave Velocity in Adolescents
Authors: Edwards Nicholas M , Khoury Philip R , Urbina Elaine M
Published: July 2021

Introduction:
The beneficial effects of vigorous physical activity (VPA) on arterial stiffness have been established, but the effect of changes in VPA over time on these vascular measures is unclear.

Hypothesis:
Increases in VPA will be associated with improvement in measures of arterial stiffness.

Methods:
As part of a longitudinal study of the effects of obesity & diabetes on cardiovascular health, 317 subjects (mean age 17.2 years at baseline, 38% male, 63% non-Caucasian) were enrolled and followed up 5 years later. Anthropometrics, accelerometer-measured physical activity, blood pressure, central and peripheral measures of arterial stiffness (pulse wave velocity (PWV), brachial distensibility (BrachD), and augmentation index (AI)), and blood (lipids & metabolic tests) were collected. General linear modeling was performed to test for the independent relationship of change in VPA with change of arterial stiffness.

Results:
Overall, VPA increased slightly (0.2 minutes) from baseline to follow up. Increased VPA from baseline to follow up was significantly associated (P = 0.0364) with a decrease in PWV but was not associated with a change in BrachD nor AI. The effect of change in VPA on change in PWV was independent of change in glucose (P = 0.024), but not independent of changes in BMI, blood pressure, lipids, or CRP.

Conclusions:
Increase in vigorous physical activity during late adolescence is significantly associated with improved pulse wave velocity. This relationship may be mediated through improvements in other cardiovascular risk factors such as body mass index, blood pressure, and lipids.
Abstract MP85: Prognostic Impact of Heart Failure with Preserved and Reduced Ejection Fraction after Myocardial Infarction in the Community
Authors: Gerber Yariv , Weston Susan A , Berardi Cecilia , Chamberlain Alanna M , McNallan Sheila M , Jiang Ruoxiang , Dunlay Shannon M , Roger Veronique L
Published: July 2021

Background:
Contemporary community data on the prognostic importance of heart failure (HF) after myocardial infarction (MI) according to (1) preserved or reduced ejection fraction (EF) and (2) the time of its occurrence are lacking. We examined HF-associated mortality and secular trends in survival among patients with and without HF in a geographically defined cohort of MI survivors.

Methods:
All residents of Olmsted County, Minnesota (n=2,596) who had a first MI diagnosed in 1990-2010 and no prior HF were followed through 2012 for HF incidence and mortality. Framingham Heart Study criteria were used to define HF, which was further classified according to EF. Cox models were used to examine (1) the hazard ratios (HRs) for death associated with HF type (preserved or reduced) and timing (early- or late-onset); and (2) secular trends in survival by HF status.

Results:
During a mean (SD) follow-up of 4 (3) years, 748 patients developed HF (519 within 30 days) and 673 died. After adjusting for age, sex, and year of index MI, HF as a time-dependent variable was strongly associated with mortality (HR=3.33 vs. HF-free subjects). Mortality did not differ by HF type, but was markedly higher for late-onset (>30 days) than for early-onset HF. Further adjustment for indicators of MI severity and comorbidity burden, acute intervention, and recurrent MI attenuated the association (Table). The age- and sex-adjusted HRs for mortality in 2001-2010 vs. 1990-2000 were 0.71 (95% CI: 0.58-0.88) in HF and 0.74 (95% CI: 0.59-0.93) in HF-free patients. These estimates equate to 10.18 (95% CI: 3.82-16.54) and 3.75 (95% CI: 0.90-6.61) fewer deaths per 100 subjects at 5 years of follow-up in participants with and without HF, respectively.

Conclusions:
HF markedly increases the risk of death after MI. The magnitude of this excess risk is similar between preserved and reduced EF but greater for late- vs. early-onset HF. Mortality declined over time in all patients with MI, and the absolute reduction in the risk of death was substantially greater for those with HF.
Abstract MP87: Circulating sRAGE Levels And The Risk Of Heart Failure
Authors: Lazo Mariana , Shen Lu , Halushka Marc K , Astor Brad C , Rebholz Casey M , Rawlings Andreea , Hoogeveen Ron C , Brinkley Tina E , Ballantyne Christie M , Selvin Elizabeth
Published: July 2021

Introduction:
Myocardial fibrosis is a key feature of heart failure, and its mechanisms are incompletely understood. It has been postulated that advanced glycation end-products (AGEs) form an etiologic link between diabetes and its vascular complications. Binding of AGEs to the cellular receptor for AGEs (RAGE) induces a state of increased oxidative stress, inflammation and fibrosis. Circulating soluble RAGEs (sRAGE) compete with cellular RAGE for the binding of AGEs which reduces the activation of the AGE-RAGE mediated pro-inflammatory and pro-fibrotic signaling pathways. We hypothesize that low levels of sRAGE will be associated with higher risk of heart failure.

Methods:
We conducted a prospective analysis of a random subsample of 1,157 participants from the ARIC Study who attended visit 2 (1990-1992). We included participants without a history of heart disease or heart failure, and with measured plasma sRAGE levels. Incident heart failure was defined as death from health failure or hospitalization due to heart failure.

Results:
In this community-based population (mean age 63 years, 60% women, 78% white), there were 132 incident cases of heart failure during approximately 20 years of follow up. Lower levels of sRAGE were significantly and independently associated with an increased risk of heart failure (Table). Analyses stratified by diabetes status at baseline showed that the risk of heart failure among those in the lowest quartile, compared to those in the upper quartile, was consistent but stronger among persons with diabetes compared to those without diabetes with HR=5.31 (95%CI 1.05-26.76) versus HR=2.50 (95%CI, 1.22-5.13), respectively. We did not observe any significant interactions by race or obesity status.

Conclusions:
Lower circulating levels of sRAGE are independently associated with the development of heart failure in older adults. These results highlight the pathophysiological role of the AGE-RAGE-sRAGE axis even among persons without diabetes.
Abstract MP92: Sedentary Behavior: Do Television-viewing and Total Time Sitting Measure the Same Component?
Authors: McGrane Minton Heather A , Thevenet-Morrison Kelly , Fernandez I. Diana
Published: July 2021

Background:
Sedentary behaviors (SB) are activities associated with prolonged time periods of sitting, reclining, or laying down during waking hours. While the relation between SB and physical activity is complex, the common consensus is that SB is not the absence of physical activity and consists of its own determinants posing distinct health outcomes. These behaviors are of significant public health importance as the majority of Americans spend much of their days in SB and due to the increased risks of morbidity and mortality associated with SB. Adverse health outcomes associated with SB include cardiovascular disease, obesity, metabolic syndrome, hypertension and mortality. Television-viewing time and total sitting time have both been used widely to assess time spent in SB and therefore we hypothesize that TV-viewing time and total hours sitting will have high concordance and can be used interchangeably to represent sedentary behaviors.

Methods:
Using a sample (n = 2858) from the Images of a Healthy Worksite study, a group-randomized control trial involving nutrition and physical activity, the current study assessed how two different tools measured time spent in SB. Tertiles were created based upon the distribution of hours sitting and hours spent TV-vewing. Weighted Kappa statistics were used to measure concordance between hours of TV-viewing and total hours of time spent sitting for the entire sample and for subgroup analyses.

Results:
Weighted Kappa statistics for tertiles of hours sitting and tv hours were 0.0046, indicating little agreement on the television and the sitting items. Kappa
w
statistics for BMI categories also showed poor agreement (obese Kappa
w
= 0.02, overweight Kappa
w
= 0.002, and healthy subjects Kappa
w
= 0.006. The Kappa
w
statistics for males and females were -0.006 and 0.02, respectively. Kappa
w
statistics for the intervention group (Kappa
w
= 0.007) and for the control group (Kappa
w
= 0.0005) also showed little agreement.

Conclusions:
These results suggest that although commonly used, using television viewing time and total time spent sitting as interchangeable markers of SB, is not a valid assumption. We propose that total time spent sitting and hours spent television-viewing represent different domains within the construct of sedentary behavior. It is important for future researchers to use measures of sedentary behavior that capture the numerous domains involved in measuring SB to allow for the most sensitive measurement of this high-risk behavior.
Abstract P003: Trajectories of Cardiovascular Risk Factors / Outcomes and Atrial Fibrillation in a 25 Year Follow-up: The Atherosclerosis Risk in Communities Study
Authors: Lopez Faye L , Agarwal Sunil K , Soliman Elsayed Z , Chen Lin Y , Smith Lindsay G , Loehr Laura R , Alonso Alvaro
Published: July 2021

Background:
Little attention has been devoted to the timing of risk factor development in relation to atrial fibrillation (AF) diagnosis. We assessed the long term trajectories of risk factors and cardiovascular (CV) outcomes in the Atherosclerosis Risk in Communities (ARIC) study, a US community-based cohort.

Methods:
Our analysis included 2134 individuals with incident AF and 5674 controls matched with cases 1:3 on age, sex, race and center, participating in the ARIC study. Information on incident AF and risk factors / CV outcomes (obesity, hypertension, smoking, diabetes, heart failure (HF), myocardial infarction (MI), and stroke) was obtained during 5 study exams between 1987 and 2013, and surveillance of CV events through 2010. The prevalence of risk factors / CV outcomes in the period before and after the diagnosis of AF (and the corresponding index date for controls) was modeled using general estimating equations models. Adjusted odds ratios (OR) of risk factors / CV outcomes were calculated, using the index date ±2.5 years as the reference group. The interaction of time with AF was used to compare differences in trajectories.

Results:
During a median follow-up of 24 years, we observed diverse trajectories in the prevalence of risk factors and CV outcomes among AF patients, with steep increases in the prevalence of stroke, MI and HF during the period close to AF diagnosis, while trajectories for hypertension and diabetes showed monotonic increases, and those for smoking and obesity suggested decreases in prevalence after AF diagnosis (Figure A). The trajectories over time for hypertension, obesity, HF, stroke and MI were significantly different based on AF status, with lower increments among those without AF (Figure A and B).

Conclusion:
In this large population-based study, trajectories in the odds of risk factors and CV outcomes were diverse, suggesting they could have different roles in the pathogenesis of AF. The prevalence of CV outcomes increased after AF diagnosis, and trajectories differed by AF status.
Abstract P016: Galectin-3 and Incident Heart Failure among Patients with Pre-existing Coronary Artery Disease: the ADVANCE Study
Authors: Iribarren Carlos , Chandra Malini , Hlatky Mark A , Fortmann Stephen , Quertermous Thomas , Go Alan S
Published: July 2021

Galecin-3 (Gal-3) is a novel beta-galactoside-binding lectin implicated in pro-fibrotic pathways that are upregulated during cardiac remodeling. Gal-3 has been associated with poor prognosis among patients with heart failure and with development of heart failure after acute coronary syndrome. In this study we sought to ascertain: 1) the cross-sectional demographic, behavioral and clinical correlates of serum levels of Gal-3, and 2) its independent predictive value for incident heart failure among 1,312 participants in The Atherosclerotic Disease, VAscular FunctioN and GenetiC Epidemiology (ADVANCE) Study whose initial presentation of coronary artery disease (CAD) between 10/2001 and 12/2003 was acute myocardial infarction (n=871; mean ± SD age; 62 ± 8 years; 23% female) or stable angina (n=441; mean ± SD age; 61 ± 8 years ; 34% female). Gal-3 was measured in frozen serum collected at the baseline examination (2002 to 2004) with the ARCHITECT assay (Abbott Diagnostics, Abbott Park, IL). Follow-up for incident heart failure using ICD-9 hospital principal discharge diagnostic codes 428, 402, 404 and 398 through 12/31/2012 resulted in 74 events (63 among AMI patients, 11 among stable angina patients). The mean ± SD Gal-3 concentration was 16.9 ± 5.3 ng/mL among AMI patients and 16.1 ± 4.4 ng/mL among stable angina patients. The significant independent correlates of Gal-3 were CAD presentation, age, gender, physical activity and estimated glomerular filtration rate (eGFR). In Cox regression with adjustment for age, gender, race and CAD presentation, each 1 SD increment of Gal-3 was associated with 1.64-fold increased hazard of heart failure (95% CI, 1.40 to 1.93; p<0.0001). After further adjustment for smoking status, activity level, alcohol intake, body mass index, LDL-C, HDL-C, triglycerides, diabetes, hypertension, hs-CRP and e-GFR, Gal-3 remained associated with incident heart failure (HR=1.44; 95% CI, 1.18 to 1.75; p=0.0003). Also in fully-adjusted analysis, and relative to quartile 1, the HRs were 1.10 (95% CI, 0.45 to 2.86) for quartile 2, 1.29 (95% CI, 0.53 to 3.11) for quartile 3 and 2.39 (95% CI, 1.06 to 5.37) for quartile 4 of Gal-3. Our results support the value of Gal-3 as a biomarker of heart failure development among patients with pre-existing CAD.
Abstract P026: The Association between Alcohol Consumption and Risk of Heart Failure may be Modified by Sex - the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Gonçalves Alexandra , Jhund Pardeep S , Claggett Brian , Rosamond Wayne , Deswal Anita , Aguilar David , Shah Amil M , Cheng Susan , Solomon Scott D
Published: July 2021

Introduction:
Alcohol is a known cardiac toxin, yet the nature of the association between alcohol consumption and the development of heart failure (HF) in the community, and whether this relationship is different in men and women, is unclear. Therefore we assessed the association between alcohol intake and the development of HF or death in men and women in the Atherosclerosis Risk in Communities (ARIC) Study.

Methods:
We examined 14,993 participants in ARIC without prevalent HF at baseline (1987-89) who were followed through 2009 (median of 20.6 years). Self-reported alcohol consumption was defined as the number of drinks per day (1 drink=14g of alcohol). Using Cox proportional hazards models, we examined the association of alcohol intake with the composite outcome of death or hospitalization for HF, stratified by sex, adjusting for age, diabetes, hypertension, coronary heart disease, body mass index, total cholesterol, physical activity, education level, smoking status, and incident myocardial infarction as a time varying covariate.

Results:
The risk for HF or death in men was lowest among those who consumed 0-1 drink/day (HR 0.81, 95% CI, 0.72-0.90) compared with those who did not consume alcohol. In contrast, in women the risk associated with consuming 1 or 2 drinks/day was not significantly different from the non-drinkers (0-1 drink HR 1.03, 95% CI 0.89-1.20; 1-2 drinks, HR 1.09, 95% CI 0.81-1.46, P for interaction by sex 0.01). Drinking ≥3 drinks/day increased the risk of HF or death by 40% in men (HR 1.44, 95% CI 1.20-1.72) but more than doubled the risk in women (HR 2.44, 95% CI 1.34-4.47).

Conclusion:
Consumption of ≥3 alcoholic drinks/day is associated with increased risk for death/HF in both men and women, with a higher risk in women, even adjusting for body size and other covariates. Compared to alcohol abstinence, low alcohol consumption was associated with a lower risk of death/HF in men but not in women. These findings suggest that the toxic and protective effects of alcohol may be different in men and women.
Abstract P030: Use of Skilled Nursing Facilities in Heart Failure: Role of Multimorbidity in the Community
Authors: McNallan Sheila M , Chamberlain Alanna M , St. Sauver Jennifer , Weston Susan A , Jiang Ruoxiang , Roger Veronique L
Published: July 2021

Background:
As the population ages, it has been reported that discharges to skilled nursing facilities (SNF) have increased. Yet, data on SNF utilization in HF are sparse and predictors are not well defined.

Objectives:
In a community cohort of incident hospitalized HF patients, we evaluated trends in use of SNF from 1987 through 2006 and described predictors of discharge to SNF.

Methods:
All Olmsted County, MN residents hospitalized with first ever (incident) HF (ICD-9 code 428) from 1987 through 2006 were identified. HF was validated by Framingham criteria. Patients residing in a SNF prior to hospitalization were excluded from the analysis. Using logistic regression, we determined whether referral to SNF had increased over time and identified predictors of referral to SNF.

Results:
Among 952 patients (mean age 75±13, 47% male), 185 (19%) were referred to a SNF. After adjustment for age and sex, referral of HF patients to SNF did not change from 1987 to 2006 (p=0.849). Patients with a Charlson comorbidity index of 3 or higher were twice as likely to be referred to a SNF (odds ratio: 1.91, 95% CI: 1.36-2.69, adjusted for age and sex). Individual characteristics associated with referral to a SNF are tabulated. After adjustment, the strongest predictor was dementia, followed by older age, anemia, hypertension and diabetes.

Conclusion:
In the community, approximately one-fifth of hospitalized HF patients are referred to a SNF and this did not change from 1987 to 2006. While older age and cardiovascular-related factors (hypertension, diabetes) were associated with referral to SNF, non-cardiovascular factors (particularly dementia) were strong predictors of referral. These findings underscore the impact of multimorbidity on HF outcomes.
Abstract P032: Adiponectin is Significantly Associated with NT-pro BNP Levels: The Multi-Ethnic Study of Atherosclerosis
Authors: Allison Matthew A , Criqui Michael , Daniels Lori , Maisel Alan , Polak Joseph , Cushman Mary
Published: July 2021

Background:
Increasing adiposity results in an increase in intravascular volume, while natriuretic peptides increase in response to pressure and volume overload. Adiponectin and leptin are cytokines released from adipose tissue (adipokines) that have purportedly opposite associations with CVD and measures of left ventricular structure and function.

Methods:
Subjects were 1970 individuals enrolled in the Multi-Ethnic Study of Atherosclerosis who were without clinical CVD at baseline and evaluated by extensive survey information, relevant physical measurements and fasting venous blood that was analyzed for NT-pro BNP (proBNP) and the adipokines adiponectin and leptin. proBNP was assayed from two different study visits about 4 years apart.

Results:
At baseline, the mean age was 64.8 years and 48% were female. Forty-two percent were White, 26% Hispanic American, 18% African American and 14% Chinese American. Median values for adiponectin, leptin and proBNP were 17.3 μg/ml, 13.1 ng/ml and 66.7 pg/ml, respectively, while the median change in proBNP was 11.6 pg/ml. With adjustment for traditional CVD risk factors, adiposity, renin, aldosterone and LV mass and volume, a 1-SD increment in adiponectin was associated with a 13.7 pg/ml higher proBNP level (p < 0.01), while, compared to the 1st quartile of adiponectin, the 2nd, 3rd and 4th quartiles were associated with 28, 45 and 67% higher proBNP levels (p < 0.01 for all). For changes in proBNP over the follow-up period, and after multivariable adjustment including baseline proBNP, a 1-SD increment in adiponectin was associated with a 25 pg/ml increase in proBNP (p < 0.01), while those in the 2nd, 3rd and 4th quartiles of adiponectin were associated increases of 5, 28 and 65 pg/ml (p = 0.74, 0.09 and < 0.01, respectively). There were no significant multiplicative interactions by race or obesity status. However, there was a significant interaction between adiponectin and gender for proBNP, such that the associations detailed above were significantly stronger in men. Leptin was not associated with proBNP (data now shown).

Conclusions:
Higher adiponectin, but not leptin, is significantly associated with higher levels of proBNP, as well as significant longitudinal increases in proBNP. The findings appear to be stronger in men.
Abstract P037: 24-hour Urinary Amino Acid Excretion And Blood Pressure: The Intermap Study
Authors: Daviglus Martha L , Stamler Jeremiah , Chan Queenie , Brown Ian J , Dyer Alan R , Garside Daniel B , Cai Xuan , Miura Katsuyuki , Ueshima Hirotsugu , Zhao Liancheng , Elliott Paul ,   for the INTERMAP Rsch Group
Published: July 2021

Background:
Available data indicate inverse relations to blood pressure (BP) of dietary vegetable protein and its main amino acid, glutamic acid, also direct relations to BP of meat and animal protein intakes. Data on association of urinary amino acids (UAAs) with BP are limited.

Objective:
To assess the relationship between UAAs and BP.

Methods:
This study assessed relations to BP of 21 urinary amino acids among 4,677 men and women ages 40-59 (17 population samples in China, Japan, UK, USA) from the International Study on Macro/Micronutrients and Blood Pressure (INTERMAP). Urinary amino acid excretion was expressed as log transformed value of each urinary amino acid (μmol/24 h), and as % dietary total protein (based on urinary urea nitrogen excretion).

Results:
In multivariate analyses with all 21 UAAs considered together, independent inverse relations to BP were found for serine, glycine, and lysine, and independent direct relations to BP for threonine, cystine, and 3-methylhistidine, controlling for possible non-dietary and dietary confounders (including body mass index and each of the other UAAs). For example, with log urinary serine at 75th compared to the 25th percentile, SBP/DBP was lower by 2.4/1.8 mm Hg and 2.2/1.7 mm Hg on average without and with adjustment for body mass index in multivariate models. With log urinary 3-methylhistidine at 75th compared to the 25th percentile, SBP/DBP was higher by 3.8/2.7 and 1.6/1.4 mm Hg.

Conclusions:
These significant new findings on relations to blood pressure of urinary amino acids need to be verified by additional - including prospective - data.
Abstract P039: Brachial-ankle Pulse Wave Velocity is Independently Associated with Presence of Coronary Calcification among 1131 Healthy Middle-aged Men. The ERA JUMP Study
Authors: Vishnu Abhishek , Sekikawa Akira , Willcox Bradley J , Choo Jina , Fujiyoshi Akira , Barinas-Mitchell Emma J , Seto Todd B , Hisamatsu Takashi , Edmundowicz Daniel , Torii Sayuki , Evans Rhobert W , Takashima Naoyuki , Bertolet Marianne H , Kadowaki Takashi , Okamura Tomonori , Miura Katsuyuki , Masaki Kamal H , Shin Chol , Kuller Lewis H , Ueshima Hirotsugu ,   ERA JUMP Study Group
Published: July 2021

Objective:
In an international population-based cross-sectional study among men aged 40-49 years, we examined the association between brachial-ankle pulse wave velocity (baPWV): a biomarker of combined arterial stiffness of central and peripheral arteries, and the presence of coronary artery calcification (CAC).

Methods:
Out of 1,335 men without clinical cardiovascular disease recruited during 2002-06, a total of 204 participants taking anti-hypertensive medications, or having missing data were excluded. Remaining participants were 281 Whites and 83 Blacks in Pittsburgh, 235 Japanese Americans in Honolulu, 280 Koreans in Ansan, South Korea, and 292 Japanese in Kusatsu, Japan. baPWV was measured using automated waveform analyzer (VP2000, Omron, Japan). Intra-class correlations of baPWV within and between technicians were 0.97 and 0.91 respectively. CAC was determined using electron-beam computed tomography (Imatron C-150) at all centers; all images were read at University of Pittsburgh by trained staff. Using logistic regression, presence of CAC (≥ 10 Agatston Units) was evaluated with increasing baPWV as a predictor variable (per 100 cm/s; per 1 SD change).

Results:
Prevalence of CAC among individual racial groups was Whites (25%), Blacks (16%), Japanese Americans (28%), Japanese (10%), and Koreans (10%). Overall, increased baPWV was significantly associated with presence of CAC in unadjusted model (Odds ratio=1.31, 95% CI 1.20, 1.44) as well as multivariable adjusted model (Odds ratio=1.19, 95% CI 1.06, 1.35). There was no effect-modification by race in the models. Similar odds ratios for presence of CAC with increasing baPWV were seen for individual races, but were statistically non-significant among Japanese American men and Japanese men in Japan, possibly due to inadequate power.

Conclusion:
Increasing baPWV is associated with presence of CAC, independent of other cardiovascular disease risk factors.
Abstract P046: Association of Stromal Derived Factor 1 (SDF1) and Transforming Growth Factor ß1 (TGFß1) with Incident Hypertension: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Berardi Cecilia , Pankow James S , Tsai Michael Y , Sale Michele , de Andrade Mariza , Sicotte Hugues , Tang Weihong , Hanson Naomi , Decker Paul A , Kirsch Phillip S , Wessel Christina , Bielinski Suzette J
Published: July 2021

Incident hypertension varies across races/ethnicities. Mechanisms implicated in the pathogenesis are endothelial dysfunction with reduction of nitric oxide and alterations of the Renin-Angiotensin-Aldosterone System (RAAS). Stromal Derived Factor 1 (SDF1) and Transforming Growth Factor β1 (TGFβ1) are essential in these processes. SDF1 is a chemotactic protein that regulates migration of endothelial progenitor cells from the bone marrow to the arterial wall to repair endothelial damage; TGFβ1 promotes extra-cellular matrix deposition within arterial vessels, inhibits nitric oxide production and stimulates renin release. In order to investigate the association of circulating levels of these proteins with incident hypertension across different ethnicities, an ethnic stratified random sample of 2,880 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) was used. Of those, 988 participants had available plasma samples and were without hypertension, defined as blood pressure ≥ 140/90 mmHg, or current use of antihypertensive medications, at baseline. During a median follow up of 8.5 years, 388 new cases of hypertension (101 in non-Hispanic whites, 94 in Chinese, 101 in African Americans and 92 in Hispanics) were observed. Time to hypertension incidence was estimated using Cox proportional hazards regression. Hazard Ratios were adjusted for age, sex, diabetes, LDL, HDL, triglycerides, BMI, smoking status and current alcohol use. The race/ethnicity by protein interaction p-values were 0.055 and 0.066 for TGFβ1 and SDF1 respectively, suggesting heterogeneity across races/ethnicities. In Chinese, a difference of one standard deviation of plasma TGFβ1 was associated with a 22% increase in incident hypertension (HR (95% CI) 1.22 (1.02, 1.47), p-value=0.03); and a difference of one standard deviation of plasma SDF1 was associated with a 31% decrease in incident hypertension (HR (95% CI) 0.69 (0.52, 0.91), p-value 0.008). No significant association was found between these proteins and incident hypertension among non-Hispanic whites, African or Hispanic Americans. In conclusion, soluble markers of endothelial integrity and of RAAS activation were associated with the incidence of hypertension among Chinese Americans. These results suggest heterogeneity in the pathophysiology of hypertension according to race/ethnicity.
Abstract P053: Body mass index is a predictor for developing hypertension among the younger Japanese elderly: Findings from the New Integrated Suburban Seniority Investigation project
Authors: Ukawa Shigekazu , Tamakoshi Akiko , Tsushita Kazuyo , Wakai Kenji , Ando Masahiko , Ohira Hideki , Okabayashi Satoe , Matsushita Madoka , Zhao Wenjing , Oikawa Junko , Kawamura Takashi
Published: July 2021

Background:
Obesity has been associated with hypertension. However, few prospective cohort studies have focused on younger elderly people.

Objective:
This study aimed to determine whether body mass index (BMI) was associated with the development of hypertension in younger Japanese elderly from the New Integrated Suburban Seniority Investigation project (NISSIN) project age-specific cohort study.

Methods:
A total of 1,694 (767 males and 927 females) approaching the age of 65 years and without hypertension (systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or undergoing treatment) at baseline (1996-2005) were enrolled. Baseline characteristics of the study participants were obtained from health check-ups and self-administered questionnaires. Development of hypertension was determined during secondary health check-ups at the same site when the participants reached 70 years of age. To obtain multivariate-adjusted odds ratios (ORs) for development of hypertension in relation to baseline BMI, we controlled for possible confounders including survey year, smoking, alcohol consumption, regular exercise, hypercholesterolemia and hyperglycemia at baseline, history of myocardial infarction, and family history of hypertension.

Results:
After eliminating participants who did not participate in the second health check-ups, data from 1,016 (468 males and 548 females) participants were analyzed. At the age of 70 years, 122 (59 males and 63 females) participants had developed hypertension. Using fully adjusted models, compared to participants with a BMI of 18.5 to 22.9, ORs of male participants with a BMI of 23.0 to 24.9 and ≥25.0 were 2.87 (95% CI, 1.40-5.90) and 3.20 (95% CI, 1.48-4.90), respectively. For females with a BMI of 23.0 to 24.9 and ≥25.0, they were 1.06 (95% CI, 0.54-2.11) and 1.84 (95% CI, 0.86-3.93), respectively.

Conclusions:
There was a significant relationship between BMI and development of hypertension among younger Japanese elderly men. Our findings suggest that weight management may be beneficial in the prevention of hypertension, even in the younger elderly.
Abstract P060: A Retrospective Review of Pediatric Hypertension Management in a Hypertension Referral Clinic
Authors: Minor Deborah S , Cadwallader Lucy T , Henson Zeb K , Carbrey Kristin A , Butler Kenneth R
Published: July 2021

Introduction:
High blood pressure (BP) in childhood increases the risk of adult hypertension, cardiovascular disease, kidney disease, and premature mortality. Additionally, hypertensive children are more likely to display other cardiovascular risk factors. Though guidelines for hypertension management exist, there is little published insight from clinical practice, and selection of the appropriate pharmacologic therapy for a child is often difficult for health care providers. The University of Mississippi Medical Center Hypertension Clinic is a referral center for pediatric hypertension management. The purpose of our study was to define characteristics of this clinic’s pediatric population, including modalities of hypertension management, the presence of concurrent disease states, and response to treatment.

Methods:
Records of patients ages 1-17 years presenting to the clinic over a 3-year period were reviewed (N=374). Patients with only one clinic visit or without a diagnosis of hypertension or an elevated BP at the initial visit were excluded. Data collected included demographics; initial and last recorded height/weight and BP; baseline medications and changes; laboratory or test documentation; and presence of concurrent disease states. BP was classified and staged as normal, prehypertension, stage 1 hypertension, or stage 2.

Results:
Patients included were 69% (132/191) male and 67% (128/191) African American, with a mean age of 12.46±3.44 years. The majority of patients were obese at initial visit (62%,118/191), with an additional 12% (23/191) classified as overweight. The mean BP of patients on antihypertensive medications (37%,71/191) at clinic entry was lower than those untreated, 127±15/77±12 versus 133±13/79±11 mm Hg, respectively. At final review, 67% (128/191) were on antihypertensives (40%,76/191 - one medication; 23%,43/191 - two; 5%,9/191 - three or more). Angiotensin converting enzyme inhibitors (ACEIs) were most frequently prescribed (43%, 82/191) by the clinic, followed by calcium channel blockers (CCBs, 32%, 61/191), and diuretics (20%,39/191). Common concurrent disease states were ADHD (12%,23/191) and asthma (9%,18/191). Though 61% (117/191) had BP controlled at the last visit reviewed compared to 41% (78/191) at clinic entry, there was no correlation between BP control and length of follow-up. Both initial systolic and diastolic BP stage appeared to influence the timing of medication initiation (OR=2.4, p<0.001).

Conclusion:
Our results identify that most children in our clinic with hypertension are obese and require medications for BP control, similar to adult populations. ACEIs are the most common medication class used for management, followed closely by CCBs. Systolic and diastolic BP, specifically at the level of stage 2 hypertension, was found to strongly influence medication initiation at initial visit.
Abstract P064: Effects Of Pistachios On Blood Pressure And Systemic Hemodynamics In Type 2 Diabetes
Authors: Sauder Katherine A , McCrea Cindy E , Ulbrecht Jan S , Kris-Etherton Penny M , West Sheila G
Published: July 2021

Controlling blood pressure in diabetes is important for reducing cardiovascular morbidity and mortality. This study compared the effects of two healthy diets that differed in fat content on blood pressure and hemodynamics. We enrolled 30 adults with type 2 diabetes in a randomized, crossover, controlled-feeding study with isocaloric diet periods. After a 2wk run-in on a typical Western diet (36% total fat, 12% saturated fat), participants consumed a low-fat control diet (27% total fat, 7% saturated fat) and a moderate fat pistachio diet (33% total fat, 7% saturated fat) for 4wk each. While on the pistachio diet, participants consumed pistachios equivalent to 20% of daily calories (ranging from 2-5 ounces/day). At the end of each diet period, blood pressure and systemic hemodynamics were assessed at rest and during acute psychological stress (mental arithmetic and hand cold pressor). A subset of participants (n=20) also underwent 24hr ambulatory blood pressure monitoring. Treatment effects were assessed with the mixed models procedure in SAS v9.3. There was no difference between treatments in resting blood pressure or systemic hemodynamics. During acute stress, stroke volume and cardiac output were significantly lower following the control diet (66.4 ml/beat and 4.43 l/min) than the pistachio diet (68.4 ml/beat and 4.57 l/min). Total peripheral resistance was significantly lower following the pistachio diet than the control diet (1682 vs 1746 dyne-sec/cm5). Systolic blood pressure during the 24hr ambulatory monitoring was significantly lower following the pistachio diet than the control diet (113.8 vs 117.3 mmHg). Taken together with other recent studies, these results provide evidence that daily pistachio consumption can benefit blood pressure and systemic hemodynamics in adults with type 2 diabetes.
Abstract P072: Low-Carbohydrate-Diets and Cardiovascular and Total Mortality in Japanese. A 29-year Follow-up of NIPPON DATA80
Authors: Nakamura Yasuyuki , Okuda Nagako , Okamura Tomonori , Kadota Aya , Miyagawa Naoko , Hayakawa Takehito , Kita Yoshikuni , Fujiyoshi Akira , Nagai Masato , Takashima Naoyuki , Ohkubo Takayoshi , Miura Katsuyuki , Okayama Akira , Ueshima Hirotsugu
Published: July 2021

Background:
Long-term safety of low-carbohydrate-diets in Asian populations, whose carbohydrate intake is relatively high, is not known.

Methods:
We examined the association of low-carbohydrate-diets with CVD and total mortality using the National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in the Aged, (NIPPON DATA80) database with a 29-year follow-up. At the baseline in 1980, data were collected on study participants ages≥30 years from randomly selected areas in Japan. We calculated low-carbohydrate-diet scores based on the percentage of energy as carbohydrate, fat, and protein, estimated by 3-day weighed food records. We followed 9,200 participants (56% women, mean age 51 y).

Results:
During the follow-up, there were 1,171 CVD deaths (52% in women), and 3,443 total deaths (48% in women). The multivariate-adjusted hazard ratio (HR) for CVD mortality using the Cox model comparing highest versus lowest deciles for a low-carbohydrate-diet score was 0.59 (95% confidence interval [CI], 0.38-0.92, trend P=0.019) for women; 0.74 (95% CI: 0.55-0.99, trend P=0.033) for women and men combined; HR for total mortality was 0.73 (95% CI: 0.57-0.93, trend P=0.020) for women; 0.84 (95% CI: 0.72-0.99, trend P=0.030) for women and men combined. None of the associations in men alone were statistically significant. We did not note any differential effects between animal and plant based low-carbohydrate-diets.

Conclusions:
Moderate diets lower in carbohydrate and higher in protein and fat were significantly inversely associated with CVD and total mortality in women, and women and men combined.
Abstract P087: Body Mass Index and Change in Obesity Status over 25 Years: The Relationship within Spouse Pairs in the Atherosclerosis Risk in Communities Study
Authors: Cobb Laura K , McAdams-DeMarco Mara , Anderson Cheryl A , Demerath Ellen W , Woodward Mark , Selvin Elizabeth , Coresh Josef
Published: July 2021

Introduction:
Environmental causes have been a focus of efforts to address the US obesity epidemic. Spouses share a similar environment and should therefore experience similar changes in body mass index (BMI) and obesity status over time. Existing longitudinal studies of spouses have not examined whether associations of BMI change within pairs are similar by gender.

Methods:
We analyzed spouse pairs from the community-based ARIC cohort, recruited from 1986 to 1989 at ages 45-64. We used linear mixed models to assess the association of changes in spousal BMI with changes in individual BMI assessed at 5 clinic visits during 25 years of follow-up. We used survival models accounting for interval censoring to evaluate the association between one spouse becoming obese (BMI>30 kg/m2) and the other becoming obese. Analyses controlled for time-varying demographic, lifestyle, and clinical factors, pre-existing illness, and spousal CVD risk factors and illness. We assessed similarity of the results by gender.

Results:
We included 4,003 spouse pairs with information on BMI at more than one visit. Mean BMI in men at baseline was 27.5 kg/m2, increasing to 28.6 in 2011-13. For women, baseline BMI was 27.1 kg/m2, increasing to 28.1 in 2011-13. Baseline BMI correlation within spouses was 0.18 (p <0.001). Among women, mean annual BMI change increased by 0.17 kg/m2 per unit increase in spousal annual BMI change (95% CI: 0.14 - 0.19); this association was lower in men: 0.11 kg/m2 (0.09 - 0.13) (Figure). Non-obese women whose husbands became obese were more likely to become obese themselves compared to women whose husbands stayed non-obese (HR 1.52, 1.09- 2.11). Results for men were similar (HR 1.59, 1.14-2.21).

Conclusions:
Our results suggest that changes in BMI and obesity status in spouse pairs are related, with change in men’s BMI having a somewhat stronger influence on their wives’ BMI. This finding was robust to adjustment for individual and spousal characteristics and suggests weight control strategies might benefit from addressing both spouses.
Abstract P091: Food-Stimulated Neuronal Activation Differs by Feeding Status in Obese and Normal-Weight Women: An fMRI Study
Authors: St-Onge Marie-Pierre , Sy Melissa , Kim Mike S , Hirsch Joy
Published: July 2021

Introduction:
Neurological responses to food stimuli are complex and differ between lean, obese, and post-obese (weight-reduced) individuals. However, the neurological systems that regulate feeding in relation to weight status are not understood. The purpose of this study was to compare satiety mechanisms (fed>fasted) in obese and lean women.

Hypothesis:
We assessed the hypotheses that food-specific neural signals affected by satiety are more active in lean than obese women.

Methods:
Eleven normal weight (BMI 22.8 ± 1.5 kg/m2) and 9 obese (BMI 33.0 ± 3.4 kg/m2) women completed a functional magnetic resonance imaging (fMRI) study. Fasted state scans were performed after an 8-h daytime fast for normal weight women whereas obese women were scanned after an overnight fast. Fed state scans were started 30 min after consumption of a liquid meal replacement providing 35% of resting energy requirements. Testing days were held 2 wk apart.

Results:
Overall, the neuronal activity in response to food stimuli was higher in the fed state than the fasted state for both groups. However, normal weight women had a greater number of activated regions than obese women in both the fed and fasted state. When fed and fasted states were contrasted (fed>fasted) and compared between groups (normal weight>obese), normal weight women had greater activation in the insula, cuneus, lingual gyrus, pre- and post-central gyrus, superior and middle temporal gyrus, and inferior frontal gyrus in the fed state than the obese.

Conclusions:
In conclusion, the findings of this study suggest that obese individuals recruit fewer brain centers in response to food stimuli when fed. This may be associated with a reduced ability to respond to internal satiety signals.