bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P302: Longitudinal Evaluation of Impact and Results of the Mississippi Kidney Foundation’s Renal Evaluation and Assessment Program (REAP)
Authors: Latham Laura S , Woodson Adam S , Minor Deborah S , Richards Lynda M , Sweat Gail G , Wells Catherine , Juncos Luis A
Published: July 2021

Introduction:
Health fair-type screenings are one of the most recognizable forms of community-based health promotion. Though these screenings offer benefits in theory, little evidence supports their value. Through REAP, Mississippi Kidney Foundation routinely provides screenings for cardiovascular and renal disease risk factors. At each screening, participants obtain blood pressure, height, weight, laboratory assessments (metabolic/renal blood chemistries, complete blood count, total cholesterol, urinalysis) and complete a questionnaire regarding risk factors and disease history. Participants also receive written information about values/goals and consultation with a healthcare provider. Without a systematic evaluation, the overall value of this program is unknown. The purpose of this study was to review the impact and results of REAP and identify any changes that could improve outreach and patient care.

Methods:
We reviewed demographics and prevalence of cardiovascular and renal disease risk factors among participants over the previous 4 years (2010-2013). Screening sites were classified as urban or rural, according to census data. Risk factors were defined as elevated blood pressure (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg), cholesterol (total > 200 mg/dL), or blood glucose (fasting ≥ 100 mg/dL); reduced kidney function (elevated BUN/Cr and/or eGFR < 60 ml/min); and proteinuria (≥ 30 mg/dL).

Results:
Over the review period, 57 screenings were performed at 34 sites, 15 classified as rural. Of the 5,545 participants, 4,299 were at urban and 1,246 at rural sites. Overall, 1,760 (32%) had elevated blood pressure (36% vs 31%, rural vs urban, respectively), 2,013 (36%, 40% vs 35%) elevated cholesterol and 1,046 (19%, 23% vs 18%) elevated glucose. Reduced kidney function was identified in 762 (14%, 15% vs 13%) participants, while 1,423 (26%, 29% vs 25%) had proteinuria. Among those reporting ethnicity (n=1,948) and gender (n=3,164), 614 (32%) were Caucasian, 1,290 (66%) African-American, and 2,270 (72%) female.

Conclusions:
Through this review, we determined that though REAP appears to target at risk populations, further efforts are needed to improve participation of males and those in rural areas. Elevated risk factors were more prevalent in rural areas; however, this may reflect differences in treatment rates, not absolute values. To better assess the impact of REAP, define risk factors, and influence patient care, we identified that more rigorous tracking, review of disease and treatment history, and further assessments are needed (i.e. full lipid panel). A graded system targeting patient follow-up is necessary, particularly among those at greatest risk. Based on these findings, these changes will be implemented, along with a post-screening evaluation of participants’ perceived benefits and result utilization.
Abstract P304: Food Stores, Food Markets and Healthy Food Availability in Comparable Urban Neighborhoods in Madrid and Baltimore
Authors: Bilal Usama , Diez Julia , Martinez de la Serna Carlos , Franco Manuel
Published: July 2021

Introduction:
Neighborhood environments pose an adequate policy target for the development of interventions aimed at improving the cardiovascular health of their residents. Our objective was to assess the Food Stores, Food Markets and Healthy Food Availability in two comparable neighborhoods in a European (Madrid) and an American city (Baltimore), to shed light into possible food system interventions that would improve resident’s nutritional profile.

Methods:
We selected one neighborhood (~15000 pop) in each city based on the Median Neighborhood Index, a method that selects contiguous areas within a city that are less extreme in terms of education, aging, segregation and urban form. This method looks for clusters of non-extreme neighborhoods using the SaTSCAN statistic.

For each neighborhood we directly collected information on the types of food stores present and the availability of healthy foods carried in side the stores. We classified stores into Public Markets, Supermarkets, Grocery Stores, Specialty Stores and Corner/Convenience/Gas Stations. We measured healthy food availability using a brief and modified version of the Nutrition Environment Measurement Survey in Stores (NEMS-S) developed by the Center for a Livable Future (Johns Hopkins Bloomberg School of Public Health). This score ranges from 0 to 27. We performed a descriptive analysis of stores and public markets, mapping the amount of stores by categories and their healthy food availability.

Results:
The number of stores located in the neighborhood selected in Madrid was 41, with around 25 stores per 10000 residents. The number of stores in Baltimore was 19, with around 17 stores per 10000 residents. The main difference in terms of types of stores was between Madrid’s 12 Specialty Stores (mostly devoted to fruit/vegetable retailing) vs. 0 in the Baltimore area; and Baltimore’s 8 Convenience Stores, vs. Madrid’s 1. In terms of healthy food availability, this was similar across types of stores except for the Corner/Convenience/Gas Station category where Madrid had a mean healthy food availability of 13.2 vs. 9.3 in Baltimore. In terms of public markets, both areas had one market present, with very different characteristics. The Madrid’s market of “Las Ventas” is a three storied indoors market with 112 stands, mostly devoted to fruit/vegetable (n= (n=34), meat/dairy (n=38), and fish retailing (n=19), open all year-round 6 days a week. Only three stands served prepared food. Baltimore’s 32nd Street Farmers Market is a smaller market (50 stands total), open all year-wide once a week (Saturday mornings), mostly devoted to fruit/vegetable retailing (n=20), meat/dairy (n=9) and prepared food (n=10).

Conclusions:
This study compared two neighborhoods in Madrid and Baltimore portraying two different food systems highlighting major differences in the distribution of food stores and food availability.
Abstract P312: Measuring the Food, Tobacco, Alcohol and Physical Activity Urban Environments in Relation to Cardiovascular Health: The Heart Healthy Hoods Pilot Study in Madrid, Spain
Authors: Diez Julia , Bilal Usama , Gullon Pedro , Alfayate Silvia , Escortell Esperanza , del Cura Isabel , Franco Manuel
Published: July 2021

Introduction:
Several features of the residential environment have been related to cardiovascular risk. This pilot study tested the feasibility of measuring four specific domains of the urban environment (food, tobacco, alcohol and physical activity) in 12 census sections within the Heart Healthy Hoods Study in Madrid, Spain.

Methods:
12 census sections within the city limits of Madrid were selected using the Median Neighborhood Index (MNI). The MNI selects median clusters (in terms of aging, education, segregation and urban form) of contiguous areas within a city using the SaTSCAN statistic.

Well-trained data collectors conducted the fieldwork during 3 weeks. To assess the food environment they collected data on the number and type of stores as well as the healthy food availability within stores, using an abbreviated and adapted version of the NEMS-S inventory. For the tobacco and alcohol environment they collected data on the type and number of points of sale. For the physical activity environment they directly measured the attributes of 169 street segments associated with walking and cycling within the 12 census sections using the SPACES inventory. The same tool was used to virtually assess the 169 segments using Google Street View. All data collected were geolocated to produce relevant maps. The cardiovascular health profile of the residents over 40 was assessed using the Primary Care Electronic Health Records from two Health Care Center in the area.

Results:
The food environment included 2 public markets, 41 food stores and 61 food places. In terms of healthy food availability (score ranges from 0-27), the assessed stores had a mean score of 12.03, higher for supermarkets compared to other types of stores. The tobacco and alcohol environment included 64 and 94 points of sale respectively. The physical activity environment score includes function, safety, aesthetics and destinations for walking and cycling. For walking, the total score has a mean of 4.27 (ranges from 0-6.96); and 3.50 (ranges from 0-5.97) for cycling. Of the 15715 residents living in the study area, 23,4% were above 65 years of age, 49,6% did not complete secondary education, and 25,9% were foreign-born. The cardiovascular health profile of 8357 residents over 40 showed the following prevalence estimates: Obesity 9.3%, Diabetes 10.4%, Hypertension 29.8%, Hypercholesterolemia 28.7%.

Conclusions:
This pilot study showed a feasible way to measure four important features of the Urban Environment (food, tobacco, alcohol and physical activity) in direct relation to Cardiovascular Health. We aim to use these assessment tools for the future Heart Healthy Hoods Study that will be conducted in 90 neighborhoods of Madrid in order to study the effect of residential environments on the cardiovascular health of its residents.
Abstract P317: Serum Soy Isoflavones Are Inversely Associated With Coronary Artery Calcification In A Population-based Sample Of 299 Men In Japan
Authors: Sekikawa Akira , Miura Katsuyuki , Vishnu Abhishek , Fujiyoshi Akira , Evans Rhobert W , Kadowaki Takashi , Edmundowicz Daniel , Hisamatsu Takashi , Ahuja Vasudha , Maegawa Hiroshi , Bertolet Marianne , Murata Kiyoshi , Okamura Tomonori , Barinas-Mitchell Emma J , Nakamura Yasuyuki , Kuller Lewis H , Ueshima Hirotsugu ,   for the ERA JUMP Study Group
Published: July 2021

Objectives:
Epidemiological studies in Asia where consumption of soy isoflavones (ISF) are regular and high implicated that isoflavones are protective against coronary heart disease (CHD), especially in post-menopausal women. There is a lack of data on the association of isoflavones with atherosclerosis, especially in men. We aim to determine a cross sectional association of serum ISF with coronary artery calcification (CAC) in men in Japan.

Methods:
A population-based sample of 299 men aged 40-49 years in Japan was examined for CAC and other risk factors in 2002-06. Electron-beam CT was used to evaluate CAC. Stored serum samples were analyzed for ISF (genistein and daidzein). We defined serum ISFs as the sum of genistein and daidzein. Presence of CAC was defined as coronary calcium score ≥ 10. Because the distribution of serum ISF is skewed, we evaluated quartile of serum ISF and analyzed the association of ISF with the presence of CAC using a general linear model.

Findings:
The median value (interquartile range) of ISF was 517 (195, 1,147) nM/l. Serum ISF had a significant inverse association with CAC in crude analysis. After adjusting for age, LDL-C, smoking, and BMI, each of which had a significant univariate association with CAC, the inverse association of ISF with CAC remained, with littel change in point estimates. After further adjusting for other risk factors as well as serum levels of long-chain n-3 polyunsaturated fatty acids, the inverse association remained.

Conclusions:
Serum levels of ISF in Japanese men in Japan had an inverse association of CAC, suggesting that ISF at the levels Japanese in Japan regularly consume have anti-atherogenic properties in men.
Abstract P322: Myocardial Contraction Fraction is an Independent Predictor of Incident Adverse Cardiovascular Events; The Framingham Heart Study
Authors: Chuang Michael L , Gona Philimon , Tsao Connie W , Salton Carol J , Manning Warren J , O'Donnell Christopher J
Published: July 2021

Introduction:
Myocardial contraction fraction (MCF) is the ratio of left ventricular (LV) stroke volume to myocardial volume, and thus a measure of LV pumping capacity per unit of myocardium. We sought to determine whether MCF measured using current steady-state free precession (SSFP) cardiac magnetic resonance (CMR) sequences was an independent predictor of incident “hard” cardiovascular disease (CVD) events, defined by myocardial infarction (MI), stroke, unstable angina (UA), hospitalized heart failure (HF) or CVD death in a community dwelling cohort initially free of these CVD events.

Methods:
1794 members of the Framingham Heart Study Offspring cohort (aged 65±9 years) underwent CMR between 2002-2006 using a 1.5-Tesla system with contiguous multislice SSFP cine imaging to encompass the left ventricle. MCF was determined from the cine images by a single observer blinded to participant characteristics. We tracked incident hard CVD events over median 6.5-year follow up and used Cox proportional hazards models (adjusted for age, sex, body mass index, systolic blood pressure, diabetes, dyslipidemia, smoking, treatment for hypertension) to determine hazard of hard CVD events per increment (0.10) of MCF.

Results:
MCF was determined in 1776 (99%) Offspring (835 men). Overall, MCF was greater in women (0.92±0.14 vs. 0.78±0.15 for men), p<0.0001. There were 60 incident hard CVD events during follow up. Incident hard events included 26 MI, 2 UA, 13 stroke, 14 hospitalized HF and 5 CVD deaths. Offspring experiencing an incident event had lower MCF (0.78±0.19 vs. 0.86±0.15 for those free of events), p=0.002. On MV-adjusted Cox proportional hazards analyses, a greater MCF was protective against hard CVD events, HR [95% confidence intervals] = 0.76 [0.63 - 0.93] per 0.10 increment of MCF.

Conclusion:
Over 6.5-year follow-up, greater MCF is protective against major adverse CVD events, even after adjustment for traditional CVD risk factors in a community dwelling cohort of middle-aged and older predominantly European-descended adults. Determination of MCF requires only knowledge of LV stroke volume and myocardial volume, both of which are routinely determined in a standard CMR examination of the left ventricle, and thus imposes no additional scan-time or analysis burden. While MCF may be clinically useful for prediction of risk for incident hard CVD events, its potential value in younger age groups and other ethnicities remains to be determined.
Abstract P333: Carotid Intima Media Echolucency is Related to Age, Female Sex, Systolic Blood Pressure, BMI and Smoking in Patients with Familial Hypercholesterolemia
Authors: Groenewegen Karlijn A , Peters Sanne A , den Ruijter Hester M , Bots Michiel L
Published: July 2021

Background:
Atherosclerotic vascular disease can be assessed non-invasively with B-mode ultrasound. Echolucency is an ultrasound characteristic which is measured as the Gray Scale Median (GSM). Echolucent structures appear dark on ultrasound images; echogenic structures appear light. Echolucency of the carotid intima-media is thought to be a marker of the content of the vascular wall, where low values of GSM might reflect inflammation and/or high lipid content and high values of GSM reflect increased collagen and/or calcifications. In previous studies in asymptomatic individuals, echolucency of the carotid intima-media was associated with cardiovascular risk factors. Studies in high-risk populations are lacking.

Aim:
To assess the relation between cardiovascular risk factors and carotid intima media echolucency in patients with familial hypercholesterolemia.

Methods:
Baseline data were used from the RADIANCE 1 trial, a randomized controlled trial on the effects of atorvastatin and torcetrapib (a CETP-inhibitor) compared to atorvastatin alone in familial hypercholesterolemia. Echolucency of the common carotid artery intima media was measured as the mean GSM of the first baseline visit. Linear mixed effects models were used to assess the relation between each cardiovascular risk factor and mean GSM (adjusted for age, sex and carotid intima media thickness (CIMT), and in a multivariable model containing all risk factors). We studied systolic blood pressure (SBP), body mass index (BMI), high and low density lipoprotein (HDL and LDL), triglycerides (TGs), smoking, diabetes mellitus and C - reactive protein (CRP).

Results:
875 patients were included in the current analysis. Mean age was 46 years (sd 13) and 50% was female. Mean GSM was 67 (sd 18). In age, sex and CIMT adjusted analyses, higher age (ß/sd: -5.71 (95% CI-6.82;-4.61)), female sex (β:-3.53 (95% CI -5.32;-1.73)), higher SBP (β/sd:-1.86 (95% CI -2.81;-0.91)), higher BMI (β/sd:-2.37 (95% CI -2.26;-1.29)) and higher levels of TGs (β/sd:-1.34 (95% CI -2.21;-0.47 were related to a lower GSM (i.e, more echolucency) and smoking (ß 2.91 (95% CI 0.52-5.29)) was related to a higher GSM. In the multivariable model, age (β/sd: -4.92 (95% CI -6.18;-3.65)), female sex (β: -4.35 (-6.41;-2.29), systolic blood pressure (β/sd: -1.32 (-2.38;-0.25) and BMI (β/sd: -1.82 (-2.90;-0.73)) were related to a lower GSM and smoking (β: 2.78 (0.39;5.18)) was related to a higher GSM.

Conclusion:
Several established risk factors were related to the echolucency of the common carotid intima media in patients with familial hypercholesterolemia.
Abstract P345: Prediction of Cardiovascular Disease Events and Death using Multiple Biomarkers in African Americans: the Jackson Heart Study
Authors: Musani Solomon K , Vasan Ramachandran , Bidulescu Aurelian , Lee Jung , Wilson Gregory , Samdarshi Tandaw , Steffes Michael , Pencina Michael J , Xanthakis Vanessa , Taylor Herman A , Fox Ervin R
Published: July 2021

Background:
The usefulness of biomarkers from different biologic pathways for predicting cardiovascular disease (CVD) events among African Americans is not well understood.

Methods:
We evaluated prospectively 3,102 Jackson Heart Study participants (mean age 54 years; 64% women) with data on a panel of 9 biomarkers representing inflammation (high sensitivity C - reactive protein), adiposity (adiponectin, leptin), neurohormonal activation (B-type natriuretic peptide [BNP], aldosterone, and cortisol); insulin resistance (HOMA-IR); and endothelial function (endothelin and homocysteine). We used Cox proportional hazard regression to relate the biomarker panel to the incidence of CVD (stroke, coronary heart disease, angina, heart failure and intermittent claudication) adjusting for standard CVD risk factors.

Results:
On follow-up (median 8.2 years), 224 participants (141 women) experienced a first CVD event, and 238 (140 women) died. Circulating concentrations of aldosterone, BNP and HOMA-IR were associated with CVD (multivariable-adjusted hazard ratios [HR] and 95% confidence interval [CI] per standard deviation (SD) increase in log-biomarker) were, respectively 1.15, (95% CI 1.01-1.30, p=0.016), 1.97, (95% CI 1.22-2.41, p<0.0001), and 1.30, (95% CI 1.10-1.52, p=0.0064). Blood cortisol and homocysteine were associated with death (HR per SD increment log-biomarker, respectively, 1.17, (95% CI 1.01-1.35, p=0.042), and 1.24, (95% CI 1.10-1.40, pvalue=0.0005). Biomarkers improved risk reclassification by 0.135; 0.120 of which was gained in classification of participants that experienced CVD events and 0.015 from participants that did not. Also, biomarkers marginally increased the model c-statistic beyond traditional risk factors.

Conclusions:
In our community-based sample of African Americans, circulating aldosterone, BNP and HOMA-IR predicted CVD risk, whereas serum cortisol and homocysteine predicted death. However, the incremental yield of biomarkers over traditional risk factors for risk prediction was minimal.
Abstract P349: Association Of Fibroblast Growth Factor 23 With Incident Cardiovascular Disease And All-Cause Mortality In The Framingham Heart Study
Authors: Haring Robin , Vasan Ramachandran S , Wallaschofski Henri , Sullivan Lisa , Enserro Danielle
Published: July 2021

Objective:
To investigate the association of fibroblast growth factor 23 (FGF23) with incident cardiovascular disease (CVD) and mortality risk in the general population.

Methods:
We evaluated 3,236 Framingham Offspring and Omni Study participants to examine the associations of serum FGF23 (measured by immunoassay) with 10-year incident CVD (N = 2,823) and all-cause mortality (N = 3,223) using multivariable Cox regression models.

Results:
During a median follow-up time of 10.8 years (Q1, 10.0; Q3, 11.4), 347 participants developed new-onset CVD and 412 died. Age- and sex-adjusted Cox regression models revealed a positive association of FGF23 with incident CVD (hazard ratio (HR) per unit increase in logFGF23: 1.43, 95% confidence interval (CI) 1.11-1.84) and all-cause mortality (HR 2.26, 95% CI, 1.86-2.75). After multivariable adjustment, the association of FGF23 with incident CVD was rendered non-significant (HR 1.12, 95% CI 0.86-1.46), whereas the positive association of FGF23 with all-cause mortality was maintained (HR: 1.87, 95% CI: 1.52 - 2.29). Analyses modeling FGF23 quartiles yielded similar findings (multivariable-adjusted HR Q4 vs. Q1 for incident CVD: 1.17, 95% CI: 0.87 - 1.59; for death: 1.87, 95% CI: 1.38 - 2.53).

Conclusion:
In our large community-based sample, serum FGF23 shows an independent positive association with all-cause mortality, but not with incident CVD risk.
Abstract P356: Relationship between Serum Cystatin C, Body Mass Index and All-Cause Mortality in Adults with Normal Renal Function
Authors: Amer Muhammad , Curry Bryan H
Published: July 2021

Background:
Cystatin C (Cys-C) is a sensitive biomarker of renal function and an independent predictor of all-cause mortality (ACM) in patients with chronic kidney and cardiovascular disease (CVD). Although higher levels of Cys-C are associated with increased body mass index (BMI), the interplay between serum Cys-C, BMI and ACM in adults with normal renal function is unknown.

Methods:
Utilizing data from the National Health and Nutrition Examination Survey (1999-2002), analysis was conducted on participants (≥18 years) with normal renal function [glomerular filtration rate (GFR) ≥90 ml/min)]. BMI (kg/m2) was categorized as Normal (BMI:18.5-24.9); Overweight (BMI:25-29.9); Obese (BMI >30), while Cys-C (mg/L) was categorized into weight based quartiles [Q1:<0.72(ref); Q2: ≥0.72-0.80; Q3: ≥0.80-0.89; Q4: ≥0.89]. Mortality information was obtained from the National Death Index using probabilistic matching. Cox proportional hazards models (and associated 95% CI’s) estimated the likelihood of ACM by Cys-C quartiles in each BMI category.

Results:
The mean(±) age and GFR of 2649 participants (51% females) was 50±20 years and 123±28 mL/min, while the median (IQR) of CRP and Cys-C was 0.19(0.07-0.44) mg/dL and 0.80(0.72-0.89) mg/L, respectively. Approximately, 33% of the cohort was normal, 34% overweight, and 33% were obese. After a mean(SD) follow up of 5.9(1.3) years, 213 deaths (all-cause) were observed. Cys-C levels increased with increasing BMI (p trend <0.05), however, significant difference was only seen in obese when compared with normal weight adults (p<0.05). Within each BMI category, increasing Cys-C was associated with increased risk of ACM (p trend <0.05), however, the hazard ratio were statistically significant only at elevated Cys-C levels (Q4 vs.Q1) in normal and overweight adults (both p values <0.05).

Conclusions:
Independent of traditional CVD risk factors, elevated Cys-C levels predicts risk of ACM in normal and overweight but not in obese adults who have normal renal function based on GFR.
Abstract P358: Assessing Global Dietary Habits: A Comparison of National Estimates from the Food and Agricultural Organization and the Global Dietary Database
Authors: Del Gobbo Liana C , Khatibzadeh Shahab , Micha Renata , Mozaffarian Dariush ,   on behalf of the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE)
Published: July 2021

Background:
Accurate data on dietary habits are crucial for understanding impacts on disease and informing policy priorities. National food availability estimates from the UN Food & Agricultural Organization (FAO) have been widely used as the only global data available, but with uncertain validity.

Objective:
To investigate the validity of FAO data compared to nationally representative data on individual-based dietary intakes from the Global Dietary Database (GDD).

Methods:
We compared 30 y (1980-2010) of FAO food supply data, comprising 101 food items/y, matched to corresponding GDD survey data for113 countries across major food groups, including fruits & fruit juices, vegetables, beans & legumes, nuts & seeds, whole grains, red & processed meats, fish & seafood, milk, and total energy. Absolute and percent differences in FAO-GDD country-year pairs were compared using t-tests. Statistical significance of heterogeneity was tested using likelihood ratio tests comparing nested models with and without interaction terms. Correction equations were developed and validated using randomly split datasets, using multivariate regression for FAO estimates as predictors of GDD results.

Results:
FAO estimates substantially overestimated individual-based dietary intakes for all food groups except beans & legumes (
p
<0.0001) and nuts & seeds (
p
<0.05). Modest heterogeneity in estimation was evident by age (Figure),sex, diet assessment method, and survey representativeness; substantial heterogeneity was observed by world region for all food groups (
p
<0.01). Results for split-data correction equations to be presented.

Conclusion:
For most food groups, FAO estimates were substantially different than individual-based national surveys, with significant heterogeneity according to several factors. Future national and global dietary analyses should rely on individual-based national survey data or multivariable-corrected FAO data for accurate assessment of undernutrition, disease burdens, and relevant policy.
Abstract P363: Evaluation of Health and Economic Impact of the Current Policy to Eliminate Industrial Trans Fats from Processed Foods in Argentina by 2014
Authors: Rubinstein Adolfo L , Elorriaga Natalia , Garay Ulises , Poggio Rosana , Caporale Joaquín , Mozaffarian Dariush , Matta Gabriela , Pichón-Riviére Andrés
Published: July 2021

Objectives:
Industrial trans fatty acids (TFA) increase CHD risk, but use remains high in developing nations. From 2004-2014, Argentina initiated policies to reduce industrial TFA: voluntary agreements with industry in 2004, mandatory labeling in 2006, and elimination by Food Code by 2014. We aimed to evaluate the policy’s impact on CHD, DALYs and costs.

Methods:
A review of diet trials, local studies, and consultations with experts was performed to estimate baseline TFA intake in 2004 and types of replacements used by industry from 2004-2014. We built an epidemiological simulation model calculating 3 scenarios to estimate effects of isocaloric replacement of TFA with alternative fats/oils, based on (1) changes in the total:HDL-C ratio (Δ TC/HDL) and (2) changes in other risk biomarkers, and the predicted effects of these biomarker changes on CHD; and (3) observed associations of TFA which CHD events in prospective studies, which may better account for pleiotrophic effects. We used Framingham risk equations to estimate first CHD events with vs. without the policy according to individual age-sex-risk factor distributions (including ΔTC/HDL), utilizing an Argentine population-based sample of 4,000 adults weighted to the full population.

Results:
After 2014, this policy would prevent each year from 1.3% (based on Δ TC/HDL only; to 7.4% (based on pleiotrophic effects) of all CHD events in Argentina (Table). Accounting for intervention costs and averted events, the policy is actually cost-saving.

Conclusions:
This is the first model evaluating the impact of an actual policy for eliminating TFA in a developing country. Given the 165,000 annual CHD events in Argentina, at an annual incidence rate of almost 1% in adults, near elimination of industrial TFA might avert under the most conservative assumptions, 1.3% of CHD and saved $36 million. In other low-resource settings, where TFA intake is higher, these effects could be larger. Our findings inform policy makers in Argentina and other developing countries on the huge impact of this policy
Abstract P367: Trends in Mortality and Recurrent Coronary Heart Disease Events Following an Acute Myocardial Infarction Among Medicare Beneficiaries, 2001 - 2009
Authors: Brown Todd M , Deng Luqin , Becker David J , Bittner Vera , Levitan Emily B , Rosenson Robert S , Safford Monika M , Muntner Paul
Published: July 2021

Background:
Few contemporary studies examine trends in recurrent coronary heart disease (CHD) events and mortality following acute myocardial infarction (AMI). Therefore, we examined rates of mortality, recurrent AMI, and recurrent CHD events in the year following AMI overall and by race and sex in the national 5% random sample of Medicare beneficiaries.

Methods:
Beneficiaries were included if they were enrolled in traditional Medicare fee-for-service coverage (Parts A and B), were not enrolled in a Medicare Advantage plan, and experienced an index AMI (ICD9 410.xx except 410.x2) between January 1, 2001 and December 31, 2009. We used Poisson regression to calculate and examine linear changes in age-adjusted rates for all-cause mortality, recurrent AMI, and recurrent CHD events (defined as a hospitalization for AMI in the primary discharge diagnosis position, percutaneous coronary intervention, or coronary artery bypass graft surgery) during the 365 days following hospital discharge for the index AMI. To provide adequate sample size to investigate trends in outcomes by race-sex groups, we pooled calendar years into 3 time periods (2001-2003, 2004-2006, and 2007-2009).

Results:
Overall, 48,688 beneficiaries were included; 46% were men, 90% were white, and 7% were black. Changes in pooled 3 year rates for mortality, recurrent AMI, and recurrent CHD in the first year following an index AMI are shown in the table. Overall, we observed a -3.8% change in pooled 3 year age-adjusted rates for mortality, a -15.0% change in pooled 3 year age-adjusted rates for recurrent AMI, and a -11.1% change in pooled 3 year age-adjusted rates for recurrent CHD events. However, mortality following AMI decreased only in white men, and reductions in recurrent AMI or CHD occurred only for white men and women and black men but not black women.

Conclusions:
Despite the overall favorable trends in lower mortality and recurrent AMI and CHD events following an index AMI, more efforts in reducing disparities in CHD by race and sex are needed.
Abstract P368: N-Terminal Pro Brain Natriuretic Peptide and Microsize Myocardial Infarctions in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Authors: Durant Raegan W , Khodneva Yulia A , Levitan Emily B , Brown Todd M , Glasser Stephen , Howard George , Safford Monika M
Published: July 2021

Background:
N-terminal pro brain natriuretic peptide (NT-proBNP) has been associated with myocardial infarctions (MI), but less is known about the relationship between NT-proBNP and very small non ST-elevation MIs now routinely detectable with modern troponin assays. Since these “microsize MIs” confer high long-term coronary heart disease (CHD) risks, we examined the association of NT-proBNP with incident acute CHD events, total MIs, and two MI subtypes: microsize and typical MIs.

Methods:
REGARDS is a national cohort of 30,237 US community-dwelling black and white adults aged ≥45 recruited from 2003 to 2007. Expert-adjudicated outcomes included incident typical MIs (definite/probable MI with peak troponin ≥0.5 μg/L), incident microsize MIs (definite/probable MI with peak troponin <0.5 μg/L), and total incident acute CHD (nonfatal MIs or CHD deaths). Low-level troponin elevations with the peak at least twice the upper limit of normal which did not have a rising and/or falling pattern or which had a non-ischemic cause were not considered MIs. We assembled a case-cohort study comprised of 1) a stratified random sample of participants free of CHD at baseline and not on dialysis (n=849); and 2) all incident acute CHD cases through 12/31/2010. NT-proBNP was measured in case-cohort participants at baseline and was dichotomized on the sample’s median value (73.3 pg/mL). Adjusted weighted Cox proportional hazards regression models examined associations of NT-proBNP and CHD endpoints, controlling for sociodemographics and CHD risk factors.

Results:
Over a median of 5.9 years follow-up, 139 microsize MIs, 315 typical MIs, and 146 non-MI CHD deaths occurred. NT-proBNP was associated with all CHD outcomes examined (Table).

Conclusions:
Above-median NT-proBNP was independently and strongly associated with all CHD endpoints with a suggestion of greater risks of incident microsize MI. A better understanding of the pathophysiologic differences between typical and microsize MIs is needed.
Abstract P378: Risk Factors for Incident Venous Thrombosis and their Associations with Recurrence
Authors: Wiggins Kerri L , Harrington Laura B , Blondon Marc , Rice Kenneth M , Sitlani Colleen M , Heckbert Susan R , Psaty Bruce M , Smith Nicholas L
Published: July 2021

Background:
Risk factors for incident venous thrombosis (VT) have been studied extensively, yet less is known about risk factors for recurrent VT in population-based settings.

Objective:
To evaluate whether established risk factors for incident VT are associated with recurrent VT in women.

Methods:
In a population-based, case-control study, we identified 1575 incident VT cases in 2002-2010 among women aged 18-89 and 3254 matched controls. Incident VT cases were followed for VT recurrence, defined by physician diagnosis with clinical and/or imaging evidence of a new or expanded clot. We used separate Cox proportional hazards models to evaluate the association of risk factors, assessed at the time of the incident VT, with the hazard of VT recurrence. Established risk factors for incident VT included: age, race, body mass index (BMI), hospitalization or inpatient surgery ≤30 days prior to event, recent cancer diagnosis or treatment, history of cardiovascular disease, and current estrogen use (oral contraceptive or hormone therapy). Incident VT characteristics (distal vs. proximal deep vein thrombosis [DVT] and pulmonary embolism [PE] with or without DVT) were also evaluated. Models were adjusted for all factors simultaneously and were run with and without adjustment for time-dependent oral anticoagulation therapy (OAT). Risk factors were assessed by chart review, telephone interview, and computerized pharmacy records.

Results:
For these interim analyses, follow-up data were available for 1285 women who were followed for a mean of 39.6 months with a 13% probability of a recurrent VT at 3 years. Higher BMI and recent cancer were associated with an increased risk of recurrent VT. When time-dependent OAT was included in the models, estimates were essentially unchanged.

Conclusions:
In our population-based study, most risk factors for incident VT were poor predictors of recurrence. However, we provide further evidence that BMI and recent cancers are associated with modestly increased hazards of VT recurrence in women.
Abstract P387: Race and Sex Differences Exist in the Volumes of Visceral Adipose Tissue Associated With Prevalent Hypertension in Middle Age Adults
Authors: Shay Christina M , Motghare Prasenjeet N , Jacobs David R , Lewis Cora E , Terry J. Greg , Carr J. Jeffrey
Published: July 2021

Background:
Higher visceral adipose tissue (VAT) volume is associated with greater risk for hypertension (HTN). Although VAT volume and prevalence of HTN vary by sex and race, the differences in VAT volumes associated with identification of individuals with prevalent HTN across these groups is unclear.

Objective:
To determine VAT volume cut points that maximize true positive, true negative and optimal identification of prevalent HTN and to compare the cut points across sex and race groups.

Methods:
Data were examined from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a multi-center longitudinal study of the development of cardiovascular risk in black and white men and women ages 18-30 years at baseline. In 2010-11, the Year 25 exam was performed (43-55 years) and VAT volume (cm3) was quantified by computed tomography based on two 5 mm contiguous slices at the level of the 4th-5th lumbar vertebra (n=3,153). HTN was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg and/or anti-hypertension medication use. Receiver operating characteristic (ROC) curve analysis was used to identify VAT volume cut points associated with true positive, true negative and optimal identification of prevalent HTN.

Results:
Year 25 prevalence of HTN ranged from 18.2% (white women) to 49.4% (black women); mean VAT volume ranged from 113.5 cm3 (white women) to 172.1 cm3 (white men). White males exhibited the highest VAT volumes (22-36% higher) and black women exhibited the lowest VAT volumes (3-50% lower) associated with true positive, true negative and optimal identification of HTN compared to other race/sex groups (Table 1). VAT volumes associated with HTN among black participants were generally lower than those exhibited for whites.

Conclusions:
Although the utility of VAT alone to identify HTN cases is modest - likely a result of unaccounted HTN confounders - these findings display the distinct race- and sex-specific differences in VAT volumes associated with prevalent HTN in middle age adults.
Abstract P388: Which Obesity-related Indicator is Better for Predicting Incident Hypertension? Results from the population-based cohort study of Japan
Authors: Nakai Michikazu , Watanabe Makoto , Nishimura Kunihiro , Takegami Misa , Kokubo Yoshihiro , Higashiyama Aya , Okamura Tomonori , Miyamoto Yoshihiro
Published: July 2021

Objective:
Obesity is an established risk factor for hypertension (HT), but it is still controversial which obesity-related indicator is superior in predictability. This study compared the predictability among three indicators, body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR), in the population-based prospective cohort study of Japan, the Suita study.

Methods:
Participants who had no HT at baseline (1,591 men and 1,973 women) aged 30-84 years were included in this study. The Cox proportional hazard model was used to estimate hazard ratios (HRs) of each indicator for incident HT with the adjustment for age, cigarette smoking and alcohol drinking. Harrell’s C statistics were also estimated for comparison of indicators’ accuracy.

Results:
During median follow-up of 7.2 years, 1,325 participants (640 men and 685 women) developed HT. HR (95% CI) of BMI, WC and WHtR for incident HT corresponding to a 1 SD increase was 1.25 (1.15-1.35), 1.21 (1.12-1.31) and 1.23 (1.14-1.34) in men while 1.32 (1.22-1.42), 1.27 (1.18-1.37) and 1.32 (1.21-1.44) in women, respectively. Also, C-statistic (95% CI) of BMI, WC and WHtR was 0.64 (0.62-0.66), 0.63 (0.61-0.65) and 0.63 (0.61-0.66) in men while 0.69 (0.67-0.71), 0.69 (0.67-0.71) and 0.69 (0.67-0.71) in women, respectively. Using 95% CI of each C-statistics, there were no statistical differences among three indicators in both men and women.

Conclusion:
In this study, we showed that all three indicators (BMI, WC and WHtR) were estimated similarly to predict the risk of developing HT in both Japanese men and women.
Abstract P389: Flavonoid intake and incident hypertension in French women
Authors: Lajous Martin , Rossignol Emilie , Perquier Florence , Fagherazzi Guy , Boutron-Ruault Marie-Christine , Clavel-Chapelon Françoise
Published: July 2021

Background:
Flavonoids have been shown to lower blood pressure, however, there is limited information on the relation of long-term intake of flavonoids and the incidence of hypertension.

Methods and Results:
We evaluated the relations of total flavonoid and flavonoid subclasses (flavonols, flavones, flavanones, anthocyanins, flavan-3-ols and polymers) intake to self-reported hypertension in a prospective cohort study among 40,574 disease-free French women in the E3N cohort, a component of the EPIC cohort. Diet was assessed in 1993 using a validated diet history questionnaire. We used the Phenol-Explorer database to estimate total flavonoid and flavonoid subclass intake and categorized them in quintiles. Between 1993 and 2007, 9,348 cases of incident self-reported hypertension were identified using follow-up questionnaires. The validity of self-reported hypertension was evaluated using a health claims database and the positive predictive value was 82%. In multivariable analyses we adjusted for age, education, smoking, BMI, physical activity, menopausal status, hormone use, diabetes, hypercholesterolemia and intake of calories, alcohol, processed meat, caffeine, magnesium, potassium and omega-3. In multivariable Cox regression models, comparing the highest quintile of total flavonoid intake to the lowest, high flavonoid intake was inversely associated with the rate of self-reported hypertension (HR=0.91; 95%CI 0.85, 0.98; p-trend=0.01). When comparing extreme quintiles of intake, we observed inverse associations with flavonols (HR=0.90; 95%CI 0.84, 0.97; p-trend=0.03), anthocyanins (HR=0.91; 95%CI 0.84, 0.97; p-trend=0.008) and polymers (HR=0.91; 95%CI 0.85, 0.97; p-trend=0.005). We evaluated these relations restricting analyses to individuals ≤ 60 years and results did not change. The main foods contributing to total flavonoid intake were tea, chocolate, plums and wine. Comparing the highest to the lowest quintile of plum intake we observed a 14% lower rate of self-reported hypertension (HR=0.86; 95%CI 0.81, 0.93; p-trend=<0.0001). No associations were observed for the other main contributors.

Conclusion:
In this large prospective cohort of French women, we observed a weak association between intake of total flavonoid, flavonols, anthocyanins and polymers intake and self-reported hypertension. Plum consumption appears to be associated with a lower rate of hypertension.
Abstract P395: Non-Alcoholic Fatty Liver Disease in a Lean Population is Associated with Hypertension Independent of Metabolic Risk Factors
Authors: Karim Adil , Sinha Pragya , Aneni Ehimen , Oni Ebenezer T , Blaha Michael J , Blumenthal Roger S , Agatston Arthur , Conceicao Raquel D , Carvalho Jose , Nasir Khurram , Santos Raul
Published: July 2021

Introduction:
Hypertension is the most common causal risk factor for coronary artery disease. The increased prevalence of hypertension in those with nonalcoholic fatty liver disease (NAFLD) is well studied. Less well studied is the prevalence of hypertension in lean (BMI<25) individuals with NAFLD. This warrants attention since the burden of cardiovascular disease is increasingly shifting to the lean.

Methods:
The data for this study was obtained from a cohort of 6464 Brazilians (41.4+/-9 Y, 62% M) free of diabetes mellitus or cardiovascular disease. Of these, 39% (n=2508) were lean (BMI<25). Hypertension was defined as systolic BP (SBP) ≥ 140 mmHg or DBP ≥90 mmHg, self-identification as hypertensive or being on medication for hypertension. NAFLD was diagnosed using ultrasound in those with <20g/d alcohol intake.

Results:
The prevalence of hypertension in the lean population was nine percent. NAFLD was significantly associated with the presence of hypertension. The prevalence of hypertension was 16% and 8% in those with and without NAFLD respectively (p<0.001). In a multivariate analysis controlling for age, gender, triglyceride and high density lipoprotein cholesterol, the risk of hypertension in those with NAFLD was 1.54 times those without NAFLD(p<0.001).

Conclusion:
There is significantly increased prevalence of hypertension in lean, healthy individuals with NAFLD. This association is present even after adjusting for age, gender and metabolic risk factors. This relationship needs to be explored further since an increasing number of lean individuals have NAFLD on examination (Younossi et al., 2012).
Abstract P432: Effects of Weight Management by Exercise Mode on Subclinical Atherosclerosis for Women with Abdominal Obesity: A Randomized Controlled Trial
Authors: Choo Jina , Lee Juneyoung , Sekikawa Akira , Burke Lora E , Jae Sae-Young
Published: July 2021

Purpose:
Few studies have examined differential effects of weight management by exercise mode on subclinical atherosclerosis. We hypothesized that exercise modes of aerobic, resistance, and combination exercises would have differential effects on endothelial dysfunction, aortic stiffness, and carotid intima-media thickness (IMT) in a weight management intervention.

Methods:
We conducted a randomized controlled trial in which 110 sedentary women with abdominal obesity were enrolled in a 12-month weight management program between September 2010 and November 2011. Fifty participants were randomly assigned to an aerobic training group, 30 to a resistance training group, and 30 to a combined aerobic and resistance training group. The weight management had a diet-alone intervention for the first 3 months and a diet-plus-exercise intervention for the next 9 months according to exercise modes. Exercise training was designed for three days per week in 60-minute sessions and a gradual increase in exercise intensity using % heart rate reserve. Flow-mediated dilation (FMD), carotid-femoral pulse wave velocity (PWV), and carotid IMT were measured at 0, 3, 6, 9, and 12 months.

Results:
Participants had a mean age of 43.1 years and a mean body mass index of 28.5 kg/m
2
. After a 12-month intervention, participants experienced a weight loss of approximately 5%. Changes in FMD, PWV, and IMT did not differ significantly by exercise mode, but PWV and IMT were significantly reduced over the diet-plus-exercise intervention.

Conclusion:
Among women with abdominal obesity, the effects of weight management on subclinical atherosclerosis did not differ by exercise mode, but its effects on aortic stiffness and carotid IMT may be beneficial over time.