bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P415: Trends in Ultra-Processed Food Intake by Supplemental Nutrition Assistance Program Participation in the U.S.
Authors: Martinez Steele Euridice , Khandpur Neha , Moran Alyssa
Published: March 2023

Introduction:
The Supplemental Nutrition Assistance Program (SNAP) plays an important role in shaping the diet of low-income individuals and families. Trends in ultra-processed food intake (UPF) among SNAP participants and non-participants has not been studied.

Hypothesis:
Compared to non-participants, SNAP participants would have a higher UPF intake; purchases would be larger for foods from SNAP-eligible versus ineligible venues.

Methods:
Data from NHANES survey cycles 2003-2004 through 2017-2018 were used. Dietary recalls from individuals ≥1 year of age were categorized according to Nova classification. Venues from which individuals reported buying food were grouped as SNAP-eligible (ex. grocery/supermarkets, convenience stores) or SNAP-ineligible venues (ex. restaurant/cafeteria). SNAP participation status was self-reported and categorized as SNAP participants; income-eligible nonparticipants (no SNAP + family income ≤130% of federal poverty line, FPL); lower-income, ineligible non-participants (no SNAP + family income >130% - ≤300% of FPL); higher-income ineligible non-participants (no SNAP + family income >300% FPL). UPF (% of total daily kcal) across eight survey cycles was examined using multivariable linear regression, stratified by SNAP participation status. Heterogeneous trends across SNAP participation status were tested by Wald F models. Trends were examined for UPF purchased from different venues. Analyses were conducted in youths (ages 1-19) and adults (≥ 20), separately.

Results:
The sample included 54979 participants from 2003-2004 through 2017-2018. The % of energy from UPF increased over time in both youth (Δ
2018-2003
, 4.3%; 95% CI, 2.9% - 5.8%; P
linear trend
< .001) and adults (Δ
2018-2003
, 2.5%; 95% CI, 0.2% - 4.9%; P
linear trend
= .002). There were no differences between SNAP participants, income-eligible non-participants, lower-income ineligible and higher-income non-participants. The mean contribution of UPF from SNAP-eligible venues decreased in both youth (Δ
2018-2003
, -2.6%; 95% CI, -6.1% - 0.9%; P
linear trend
= .001) and adults (Δ
2018-2003
, -2.3%; 95% CI, -5.0% - 0.8%; P
cubic trend
< .001) with no differences by SNAP participation. UPF purchases from fast-food restaurants increased in youth (Δ
2018-2003
, 2.2%; 95% CI, -0.4% - 4.8%; P
quadratic trend
= .036) and adults (Δ
2018-2003
, 2.9%; 95% CI, 0.6% - 5.1%; P
cubic trend
= .007), while those from schools remained unchanged. There were no differences by SNAP participation status.

Conclusions:
Total UPF consumption increased between 2003-2004 and 2017-2018 and were seen among both participants of SNAP and among income-eligible and ineligible non-participants. UPF were increasingly sourced from SNAP ineligible venues. SNAP benefit allotments should account for secular changes in dietary patterns by enabling the purchase of healthier processed and prepared foods.
Abstract P425: Diets Enriched in Stearate, Palmitate, and Oleate Differentially Modulate Gut Microbiome Composition in Post-Menopausal Women
Authors: Zhang Wen , Matuszek Gregory , Lichtenstein Alice H , Matthan Nirupa R
Published: March 2023

Objective:
Dietary stearic acid (18:0), a major saturated fatty acid (SFA) in Western diets, does not raise plasma LDL-C concentrations relative to other shorter chain SFAs (palmitic [16:0], myristic [14:0] and lauric [12:0]), and is associated with lower CVD risk. We investigated whether the cardioprotective effects of 18:0 and its metabolic product oleic acid (18:1, a monounsaturated fatty acid) relative to 16:0 is mediated via alterations in the gut microbiome.

Methods:
Twenty mildly hypercholesterolemic (LDL-C>100mg/dL) post-menopausal women (50-85 years; BMI 25-35kg/m
2
) consumed each of 3 isocaloric diets for 5 weeks according to a randomized controlled cross-over design. Diets provided 55%E carbohydrate, 15%E protein and 30%E fat with half of the fat provided by 16:0, 18:0 or 18:1, respectively. Fecal samples were collected at the end of each diet phase and shotgun metagenomic sequencing was performed. Alpha diversity (Shannon index, Simpson index and observed counts) was compared between diet groups using two-sample non-parametric tests. Beta-diversity was assessed using Bray-Curtis dissimilarity with PERMANOVA test. Differences in metagenomic features by diet group were evaluated using Partial Least Squares-Discriminant Analysis (PLS-DA) models of pairwise diet differences developed using the R package ‘mixOmics’.

Results:
No significant differences were observed in alpha and beta diversity between diet groups. However, the variability in microbial relative abundance was greater after participants consumed the 18:0 and 18:1 diets compared to the 16:0 diet. Specifically, mean relative abundance of
Bacterioides dorei
,
Bacteroides vulgatus
, and
Ruminococcus
were highest after participants consumed the 18:0 relative to the 16:0 diet and intermediate after the 18:1 diet. The relative abundance of
Coprococcus
,
Parabacteroides distasonis
,
Coprobacillus
and
Blautia
were higher after participants consumed the 18:1 relative to the 16:0 diet. These microbial species have been associated with several anti-inflammatory pathways and decreased bacterial lipopolysaccharide production.

Conclusion:
These data document modest but distinctive effects of dietary SFAs on gut microbiome composition and functionality, suggesting that the favorable effects of 18:0 and 18:1 relative to 16:0 on CVD risk factors could be mediated, in part, by the gut microbiome.
Abstract P427: Nutritional Education Strategies’ Impact on Diet in Patients Undergoing Cardiac Rehabilitation
Authors: Lehenbauer Katy S , Scott Ella , Vant Hof Jeremy R
Published: March 2023

Background:
Nutrition guidelines to reduce cardiovascular disease risk are well-established, and yet few patients regularly eat a healthy diet. Cardiac rehabilitation (CR) is a prime opportunity to provide education and improve nutrition. However, the most effective strategies in nutrition education are not yet established, and outcome data for various nutrition strategies is limited.

Aim:
This study aimed to evaluate self-reported nutrition metrics for individuals in CR who completed a dietician consultation compared to the usual nutrition class.

Methods:
Beginning in 2021, CR patients were offered the choice of a 1:1 dietician consultation (“consultation”) or the usual group nutrition class. This study included patients who completed intake and discharge surveys evaluating self-reported healthy food consumption [Rate Your Plate (RYP), 27-81)], confidence in preparing heart healthy meals (0-10), and percentage of heart healthy meals (0-100%). Data were evaluated based on nutrition education strategy and stratified by median baseline score.

Results:
Of the 166 participants with complete data through August 2, 2022, 87 received a consultation (mean age 65years, 63 males); and 79 chose usual care (mean 63years, 64 males).Final RYP, confidence, and percent healthy meals scores improved in both groups compared to baseline. In general, patients with a lower baseline score had a larger improvement in all nutrition metics regardless of nutrition education group (Table). The average change in RYP score was higher in the consultation arm (+11.7% (59.4 from 53.1); 95% CI [8.3%, 15.1%]), versus usual care (+4.4%, (57.3 from 54.9); 95% CI [2.2%, 6.6%]) . There was no significant difference in change in the other scores between the consultation and usual care group.

Conclusion:
Individual dietician consultation may be beneficial in providing education and improving nutrition habits for CR patients, especially for those with a low baseline level of knowledge of heart healthy nutrition.
Abstract P431: Comparative Safety and Effectiveness of Direct Oral Anticoagulants versus Warfarin in Patients With Non-Valvular Atrial Fibrillation and Severe Chronic Kidney Disease
Authors: Xu Yunwen , Ballew Shoshana , Chang Alex R , Inker Lesley , Grams Morgan , Shin Jung-Im
Published: March 2023

Background:
Landmark trials of direct oral anticoagulants (DOACs) versus warfarin for non-valvular atrial fibrillation (NVAF) excluded patients with severe chronic kidney disease (CKD). Real-world data on safety and effectiveness of DOACs in severe CKD is limited.

Methods:
New users of DOACs (apixaban, rivaroxaban, and dabigatran) or warfarin with NVAF and severe CKD between 2010 and 2020 were identified using the de-identified electronic health records form the Optum Labs Data Warehouse. We estimated the risks of bleeding, ischemic stroke, and death for apixaban and rivaroxaban separately (vs. warfarin) using Cox regression models. Incidence rate (IR) and hazard ratio (HR) were adjusted for baseline characteristics by inverse probability of treatment weighting (IPTW). Dabigatran users were not included for the analysis due to small sample size (n=318).

Results:
Compared with warfarin users (n=7548), apixaban users (n=3719) were older (mean age 77 vs. 76 years) and had more hypertension (94% vs. 90%). In IPTW analysis, apixaban was associated with a lower risk of any bleeding (HR [95% CI], 0.71 [0.56, 0.89]), as well as major bleeding (HR [95% CI], 0.61 [0.46, 0.81]). There were no significant differences in ischemic stroke and death between apixaban and warfarin users (
Figure A
). Rivaroxaban users (n=920) were older (mean age 76 vs. 75 years) and had higher estimated glomerular filtration rate than warfarin users (mean: 25 vs. 23 ml/min/1.73 m
2
). In IPTW analysis, risks of bleeding were higher among rivaroxaban users than warfarin users (any bleeding: HR [95% CI], 1.43 [1.05, 1.95]; major bleeding: HR [95% CI], 1.54 [1.09, 2.17]), with no significant differences in ischemic stroke and death (
Figure B
).

Conclusion:
Apixaban was associated with a lower risk of bleeding, but rivaroxaban was associated with a higher risk of bleeding, compared with warfarin in patients with NVAF and severe CKD. Risks of ischemic stroke and death were similar between agents. Apixaban may be a preferable oral anticoagulant in this population.
Abstract P437: Testing a Clinical Decision Support Tool to Promote Physical Activity
Authors: McCarthy Margaret M , Szerencsy Adam , Taza-Rocano Leslie , Hopkins Stephanie , Melkus Gail D , Mann Devin , Vorderstrasse Allison , Katz Stuart
Published: March 2023

Introduction:
Physical activity (PA) is an essential component of health, yet it is not regularly assessed, nor are patients routinely counseled on PA as recommended by the AHA. The aim of this study was to evaluate the acceptability and clinical utility of incorporating an electronic clinical decision support (CDS) tool and remote patient monitoring to assess, promote and monitor PA in a preventive cardiology clinic.

Methods:
The CDS tool was pilot-tested in the Epic electronic health record (EHR) from July 2021-June 2022. Patients answered 3 questions about routine PA in their patient portal prior to an office visit. The CDS alerted the provider to counsel the patient if their PA level was < 50% of recommended PA. These patients were invited to participate in remote patient monitoring for PA using a Fitbit connected to their EHR. The Practical, Robust Implementation and Sustainability Model (PRISM) was used to guide and evaluate the implementation. Qualitative feedback was collected from providers and patients.

Results:
Over 12 months, patients answered a 3-question PA screener 33%-43 % per month and the CDS tool fired a range of 79-125 times per month. The HCP opened and signed the CDS tool between 3.2% to 21.6% monthly; it was acknowledged (e.g., ‘PA not appropriate for this patient at this time’) between 1-22% per month. Changes to the CDS during the pilot included removing the CDS tool from the medical assistant’s workflow to prevent them from taking action on it, and revising the options for acknowledgements based on provider feedback. Patients (n=59) were enrolled in 12 weeks of remote PA monitoring with 4 patients lost to follow-up, and 58% able to sync their Fitbit to Epic EHR using written directions. Feedback from the providers indicated they found the CDS easy to use but wanted additional information as to why patients were not reaching recommended PA (e.g., boredom). Patients wanted to add more detail about their PA in the patient portal, and spoke about needing motivation and more frequent reminders about being active. All were willing to engage in remote monitoring again.

Conclusion:
Implementing the electronic PA assessment, counseling, and remote monitoring is feasible in a preventive cardiology clinic. However, use of the PA screener by patients and the CDS tool by providers was low and strategies are needed to improve its uptake. Patients may also need more guidance in connecting an activity tracker to the EHR for remote monitoring.
Abstract P438: Physical Activity and Calcification of Coronary Arteries, Aorta, and Cardiac Valves: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Mok Yejin , Ballew Shoshana , Schrack Jennifer , Howard-Claudio Candace M , Butler Kenneth R , Wagenknecht Lynne , Coresh Josef , Budoff Matthew , Tanaka Hirofumi , Blaha Michael J , Matsushita Kunihiro
Published: March 2023

Background:
Regular physical activity (PA) has been associated with reduced risk of coronary heart disease, but conflicting results have been reported regarding its association with coronary artery calcification (CAC), one of the strongest predictors of cardiovascular disease. Moreover, different domains of PA (e.g., sports vs. work) and extra coronary calcification (ECC) have not been extensively studied in this context.

Methods:
We investigated 2,025 ARIC participants (age 73-95 years) who had no coronary heart disease and underwent a non-contrast cardiac-gated computed tomography scan at visit 7 (2018-19). PA was based on a modified Baecke questionnaire, which provides total and domain-specific (sport, non-sport leisure, and work) PA scores. We modeled the cumulative PA scores in middle-age at visit 1 (1987-89) and visit 3 (1993-95). We explored continuous CAC and ECC (log-transformed [Agatston score+1]) or any CAC and ECC (Agatston score >0 vs. 0) as dependent variables using linear regression and multivariable logistic models, as appropriate.

Results:
Higher total and domain-specific PA scores showed no association with lower CAC. Among ECC, descending aorta calcification demonstrated the strongest association with total PA scores (coefficient -0.10 [95% CI -0.21, 0.01], p=0.075) (
Figure
). When specific domains were explored, higher sport and work PA scores were significantly associated with lower descending aorta calcification. When we analyzed any CAC and ECC as the outcome variable, the results were generally consistent.

Conclusions:
Higher PA in midlife was associated with lower calcification of descending aorta in late life. Our results further support the health benefits of PA and unique pathological process across different vascular beds.
Abstract P444: Estimated Power Output for a Distance Run and Maximal Oxygen Uptake in Young Adults
Authors: Lin Gen-Min , Tsai Kun-Zhe , Sui Xuemei , LAVIE Carl J
Published: March 2023

Background:
Both cardiopulmonary exercise testing (CPET) and run field test are recommended by the American Heart Association for assessing maximal oxygen uptake (VO
2
max) of youth. Power output was highly correlated with VO
2
max in a CPET. However, it is unclear the correlations of time and estimated power output (EPO) for a run field test with VO
2
max obtained from a CPET in young adults.

Methods:
This study included 45 participants, aged 20-40 years, from a sample of 1,120 military personnel who completed a 3000-m run field test in Taiwan in 2020. The participants subsequently received a CPET with the Bruce protocol to assess VO
2
max in the same year. According to the physics rule, EPO (watts) for the run field test was defined as a product of half body mass (kg) and [distance (3000-m)/time (s) for a run field test]
2
. Pearson product-moment correlation analyses were performed.

Results:
The Pearson correlation coefficient (r) of time against EPO for the run field test was estimated 0.708 (p <0.001). The correlation coefficient between time for the run field test and VO
2
max (L/min) in a CPET was estimated 0.462 (p =0.001). By contrast, the correlation coefficient between time for the run field test and VO
2
max scaled to body mass in a CPET was estimated 0.729 (p <0.001). The correlation coefficient of EPO for the run field test against VO
2
max in a CPET was estimated 0.813 (p <0.001).

Conclusion:
In young adults, although time for a run field test was a reliable estimate of VO
2
max scaled to body mass, EPO proportionally to the mean velocity squared was found as a superior estimate of VO
2
max.
Abstract P446: Physical Inactivity and Chronic Conditions Are Associated With Lower Functioning in Older Adults With Osteoarthritis
Authors: DE MELLO GRAZIELLA MARTINS DE , Barreto Haagsma Ariele , Frajácomo Fernando T , Souza Dyego Leandro Bezerra de , Barbosa de Oliveira Vanessa , Vieira Neves Ferreira Ana Paula , Jerez-Roig Javier , Baena Cristina P
Published: March 2023

Introduction:
Population aged >60 years compose the age group that grows the most disproportionately. Despite several positive individual and social aspects an increase in the prevalence of chronic non-communicable diseases, including OA is observed.

Hypothesis:
Whether physical activity (PA) levels and number of chronic diseases are associated with handgrip strength (HGS), chair stand test (CST) results, and difficulties to dressing among older adults presenting with hip pain and diagnosed with hip osteoarthritis (OA).

Methods:
We analyzed Wave 5 of the Survey of Health, Ageing and Retirement in Europe. We analyzed two age groups of individuals diagnosed with hip OA: 60-79 and 80-100 year groups. Univariate and multivariate logistic models were constructed considering the poor performance cut-offs in the strength, functioning, and mobility tests as the dependent variables, and physical inactivity, number of chronic diseases, body mass index (BMI), gender and education as the exposure variables.

Results:
We included 2.088 participants (mean age 73.1±8.5 years). The majority (89.3%) reportedly had two or more chronic diseases, the most prevalent being hypertension. The participants were mostly overweight or obese (69.8%); however, two of three (75%) participants reported moderate-to-vigorous daily activity. Low levels of moderate-to-vigorous PA were significantly and independently associated with muscle weakness, dysfunctioning, and poor mobility in both age groups (p<0.05). Having five or more chronic diseases was significantly associated with disability in individuals with hip OA aged ≥60 years (p<0.05).

Conclusions:
Low PA levels and chronic conditions are significantly associated with reduced functioning in individuals aged ≥60 years with symptomatic hip OA, especially in the 80-100 year subgroup. These findings are important for stakeholders to maintain adequate PA levels in older individuals despite their hip OA diagnoses.
Abstract P447: Association Between Cardiovascular Health (CVH) Throughout Early Adulthood With Prevalent Non-Alcoholic Fatty Liver Disease (NAFLD) in Mid-Life: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Park Seong , Ning Hongyan , VanWagner Lisa B , Carnethon Mercedes R
Published: March 2023

Background:
Nonalcoholic fatty liver disease (NAFLD) is associated with high prevalence of cardiovascular disease and its risk factors. More favorable cardiovascular health (CVH) profiles are associated with a lower prevalence of NAFLD in cross-sectional studies. However, the relationship between long-term CVH patterns in early adulthood and prevalence of NAFLD in midlife remains unknown. We aimed to assess these patterns.

Methods:
We used data from participants (18-30 years at baseline) of the CARDIA study who had individual CVH components measured at 7 examinations over 20 years and liver fat assessed by non-contrast computed tomography (CT) at year 25 follow up. Group-based trajectory modeling was used to create CVH trajectories, according to American Heart Association definitions, from baseline through follow-up year 20. NAFLD was defined as liver attenuation of < 51 HU after exclusions. Dichotomous logistic regression was used to examine associations of baseline CVH scores (n=2618) or CVH trajectory group (n=2529) and prevalence of NAFLD at year 25.

Results:
At baseline, 39% of 2618 participants had high and 5% had low CVH, respectively. At year 25, NAFLD prevalence was 23% (n = 609). At year 25, compared to those without NAFLD, participants with NAFLD were more likely be male (54.2% vs. 37.3%) and be a current smoker (27.1% vs. 21.7%) at baseline. Participants with low (HR = 3.24, 95% CI = 2.13, 4.95) and moderate (HR = 1.85, 95% CI = 1.50, 2.29) CVH scores at baseline were more likely to have a higher risk of prevalent NAFLD compared to participants with high CVH scores. Five distinct trajectories of CVH were identified. Lower and decreasing trajectories were associated with higher risk of prevalent NAFLD at year 25 compared to the high stable trajectory (Figure).

Conclusion:
Low CVH scores in young adulthood and low and decreasing CVH trajectories throughout early adulthood are associated with higher prevalence of NAFLD in midlife. Optimizing CVH in early adulthood is critical for lowering risk for prevalent NAFLD in midlife.
Abstract P454: Secular Trend in Cholesterol Management Among US Veterans With ASCVD
Authors: Al-Ani Awsse , Wellman Helen , Ward Rachel , Gaziano John M , Djousse Luc
Published: March 2023

Background:
Current guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) have explicitly highlighted the direct correlation of reduced LDL-C with a subsequent risk reduction in further ischemic events. Little is known about secular trends of LDL-cholesterol below 70 mg/ml among Veterans with ASCVD over the past two decades.

Hypothesis:
Among Veterans with ASCVD who are receiving lipid-lowering therapy, the proportion of those not treated to goal (LDL-C ≥70 mg/dL) has been declining between 2002 and 2020.

Methods:
We conducted a retrospective cohort study with an annual accounting of treatment information and LDL-C lab results between 2003 to 2020 for US Veterans with prevalent ASCVD who had at least one LDL-C lab value during the year prior to January 1st of the index year. Dyslipidemia was defined as LDL-C ≥70 mg/dL and ASCVD was defined as one inpatient or two outpatient diagnoses or one procedure diagnosis for MI, stroke, CAD, PAD, or angina. We investigated annual trends in proportion of Veterans with ASCVD who achieved LDL-C<70 mg/dL using lipid-lowering agents.

Results:
The study population consisted of 1,182,657 Veterans with a mean age of 72.5 years, 97% male, and a mean BMI of 29.8 kg/m
2
. The mean LDL-C in 2003 was 84.7 mg/dl and 739,295 (62.5%) participants had an LDL-C ≥70 mg/dl. We observed a steady increase in the proportion of Veterans achieving LDL below 70 mg/dl during the study period (Figure).

Conclusion:
Our data are consistent with a steady increase in proportion of US Veterans with ASCVD with LDL treated to goal between 2003 and 2020.
Abstract P457: Healthful Lifestyle Factors and Incidence of Early Onset Cardiovascular Disease in the Million Veteran Program
Authors: Elhouderi Eiman , Nguyen Xuan-Mai , Li Yanping , Kim Kelly , Ward Rachel , WILSON PETER , Gaziano John M , Djousse on behalf of the VA Million Veteran Progra Luc
Published: March 2023

Background and Objective:
While previous studies have reported benefits of healthful and modifiable lifestyle factors on the incidence of cardiovascular disease (CVD) among adults, it is unclear whether adhering to healthful lifestyle factors is associated with a lower risk of CVD among young adults. Thus, the purpose of this study is to examine the association of low-risk lifestyle factors including normal weight, regular exercise, not smoking, adequate sleep, and a healthy diet with risk of early onset CVD in the Veterans Affairs (VA) Million Veteran Program (MVP).

Methods:
The study cohort included 49,603 MVP participants with self-reported and electronic health records information on the five low-risk lifestyle factors. Assigning values to each lifestyle factor, we created a score that ranges from 2 to 15 with higher scores indicating a healthier lifestyle. The association between low-risk lifestyle factors and fatal and non-fatal CVD was assessed using Cox proportional hazard model adjusted for age, sex, race, education, income, marital status, alcohol use, total energy intake, diabetes, hypertension, and hypercholesterolemia.

Results:
The mean age was 47 years and 37 % were women. After a follow-up period of 3.1 years, we documented 655 early onset CVD events with an overall crude annual incident rate of 3.5‰ among women and 3.9‰ among men. In Cox proportional hazard model adjusted for confounders, a higher low-risk lifestyle score was associated with a lower risk of early onset CVD [hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.33-0.56, comparing extreme score, Figure].

Conclusion:
Our data show an inverse and graded association of healthful lifestyle factors with risk of early onset CVD among young veterans, suggesting that adherence to low-risk lifestyle factors including not smoking, sufficient sleep, normal weight, and regular exercise may help prevent early onset CVD.
Abstract P463: E-cigarette Use and Seeking Professional Help for Depression Among Young Adults: Evidence From the VapeScan Study
Authors: Liu Justin , Sangapalaarachchi Dona , Fang Chloe , Cepeda Maria , LoIacono Nancy , Gao Siyue , Ilievski Vesna , Hawkins Diane , Shimbo Daichi , Oelsner Elizabeth , Navas-Acien Ana
Published: March 2023

Introduction:
E-cigarettes (e-cigs) are the most commonly used tobacco product among youth. While cigarette use has been associated with a history of depression, research on the associations of e-cig use and depressive symptoms remains limited. While other studies have looked at the incidence of depression among e-cig users, the VapeScan study also factors in dual users who both smoke cigarettes and e-cigarettes.

Hypothesis:
We hypothesized that e-cig use is associated with seeking professional help for depression among young adult participants in the VapeScan Study.

Methods:
Participants aged 18 to 50 years were recruited from the greater New York area to participate in the VapeScan Study from May 2021 to October 2022. Participants were classified as exclusive current e-cig users (e-cig users), current e-cig and former cigarette users, current e-cig and cigarette users (dual users), or non-users of both e-cigs and cigarettes (controls); former vapers and exclusive cigarette users were excluded from the study. Participants self-reported if they had ever “seen a doctor or other health professional for depression.” Rates of professional care for depression were compared by logistic regression test. Logistic regression was used to test the association between e-cig use status and seeking professional help for depression, adjusted for age, sex, and race/ethnicity.

Results:
Among 147 participants, mean (SD) age was 28 (8) years, 54.42% (80 of 147) of participants were assigned female at birth, 36.73% (54 of 147) were Non-Hispanic White (ETC). There were 29 e-cig users, 42 dual users, and 76 controls. Forty-one percent of e-cig users (12 of 29) had seen a health professional for depression versus 64% (27 of 42) of dual users and 29% (22 of 76) of controls (p-value=0.0014). After adjustment, compared to controls, e-cig users were 1.66 times more likely to have sought professional care for depression (95%CI: 0.59-4.71) and dual users were 7.90 times more likely (95%CI: 2.99-20.88).

Conclusions:
E-cig use, and particularly dual use of e-cigs and cigarettes, was associated with having sought professional help for depression among young adults. Persons presenting with depressive symptoms should be screened for tobacco product use, and vice versa, to ensure provision of evidence-based mental health and tobacco cessation programs.
Abstract P468: Time Trends in Severity of Incident Ischemic Stroke in the Atherosclerosis Risk in Communities Study From 1987 to 2018
Authors: Koton Silvia , Chen Jinyu , Johansen Michelle C , Pike James R , Mosley Thomas , Rosamond Wayne D , Schneider Andrea , Gottesman Rebecca F , Coresh Josef
Published: March 2023

Background:
Stroke severity at hospital admission is the most important clinical predictor of short- and long-term functional outcome and mortality after stroke. Decreases in stroke severity over the last two decades have been reported in some countries; however, data on stroke severity from large prospective cohort studies in the US are not available for recent years. We studied trends in stroke severity of incident ischemic stroke from 1987 to 2018 in the prospective Atherosclerosis Risk in Communities (ARIC) study.

Methods:
Severity of stroke on admission was determined through review of ARIC hospital charts for incident ischemic strokes using the National Institutes of Health Stroke Scale (NIHSS). Events with inadequate information for NIHSS score determination were excluded (n=209). Severity was categorized as minor, NIHSS≤5; mild, 6-10; moderate, 11-15; and severe, ≥16. Mean NIHSS scores by year were presented by age group (Figure) and trends in NIHSS score from 1987 to 2018 were studied with linear regression model. Changes in the proportion of minor stroke compared to more severe stroke (NIHSS>5) were assessed using logistic regression. Multivariable models included age at stroke, sex, race-center, and baseline education level, hypertension, BMI, diabetes and smoking status as covariates.

Results:
Among 15,661 participants (age 45-64) free of stroke at baseline (1987-89), 1,036 incident stroke cases with severity scores (NIHSS: 638 [61.6%] minor, 222 [21.4%] mild, 88 [8.5%] moderate and 88 [8.5%] severe) were included. Mean age (SD) at incident stroke was 69.5 (9.9) years, 55.2% women and 26.8% Black. For each 1-year calendar time, the adjusted estimate for the continuous NIHSS score was -0.026 (SE=0.040), p=0.5109, and the adjusted OR (95% CI) for NIHSS≤5 compared to NIHSS>5 was 0.99 (0.97, 1.01).

Conclusion:
Among participants with incident ischemic stroke in the prospective ARIC study, no clear decrease in severity of stroke was observed from 1987 to 2018.
Abstract P470: Total Plaque Area and Association With Stroke Risk Factors in a Native American Population
Authors: Thomas Kevin V , Wilbrand Stephanie M , Hess Timothy , Maybock Jenna , Lee Yurim , Kerwin Brady , Metoxen Melissa , Danforth Debra , Riesenberg Amanda , Dempsey Robert J , Mitchell Carol
Published: March 2023

Objective:
Total plaque area (TPA) has been associated with stroke risk factors; however, it has not been well studied in a Native American population. The objective of this study is to examine the relationship of TPA with stroke risk factors (RF).

Methods:
Participants enrolled in the “Stroke Prevention in the Wisconsin Native American Population” (n=119) underwent a health history risk assessment, cognitive testing, carotid ultrasound to measure TPA, and a meeting with a health wellness coach. TPA for each participant was measured using the LifeQ Medical Plaque Analysis Software (Nicosia, Cyprus). Statistical analyses were performed using SPSS (SPSS, IBM Corporation, Armonk, NY, USA) and SAS (SAS Institute Inc., Cary, NC, USA). Descriptive statistics for continuous variables are reported as the median and interquartile range (IQR). Spearman rho correlation was used to examine relationships between total plaque area and stroke risk factors. Robust M—estimation was used to examine which risk factors predicted TPA after adjustment for other covariates.

Results:
Of the 119 participants, 22 (18.5%) had no plaque and 97 (81.5%) had plaque, 100 (83.3%) were identified as high-risk (≥55 years with three risk factors for stroke) and 19 (15.8%) low-risk (≥55 years with fewer than three risk factors for stroke). Median participant age was 65 (IQR=11.0) years of age, 78.3% female. In univariate analyses, TPA was significantly associated with age (r
s
=.259;p=.005) and body mass index (BMI) (r
s
=-.300;p<.001). In a multivariable robust M-estimation model (including age, sex, BMI, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, hemoglobin A1c, physical activity, and categorical variables (yes/no) current smoker, history of high cholesterol, coronary artery disease, diabetes, hypertension, and transient ischemic attack), only age (p=.03), sex (p=.012), and hemoglobin A1c (p=.028) remained significant for predicting total plaque area (r
2
=16.5%).

Conclusion:
Multivariate analysis demonstrated that age, sex, and hemoglobin A1c predicted TPA. Further work is needed to understand how both traditional and non-traditional stroke RFs may affect the risk of stroke in Native Americans.
Abstract P472: Matching Young Adult Strokes in a Claims Database to the Clinical Get With the Guidelines-Stroke Registry
Authors: Leppert Michelle H , Poisson Sharon N , Scarbro Sharon , Poudel Remy , Booker Quiera , Suresh Krithika , Lisabeth Lynda D , Schwamm Lee H , Daugherty Stacie L , Bradley Cathy , Burke James F , Ho Michael
Published: March 2023

Background:
Due to its lower incidence, strokes in young adults, studies have difficulty answering why there are more women than men less than 35 with incident strokes. The goal of this study is to link claims and registry data to create a new longitudinal and clinical cohort of strokes in young adults.

Methods:
Colorado mandates reporting of commercial and public insurance (Medicaid and Medicare) claims to the All Payer Claims Database (APCD). We identified all first-time stroke admissions using ICD-9 /10 codes between 2012 to 2018 in young adults (18-55). Get with the Guidelines (GWTG) Stroke registry has stroke cases from 41 hospitals in Colorado since 2010. Matching was based on exact birthdate, sex and +/- 1day in admission/discharge dates. Confirmation of match was based on comparing the admitting hospital between the two databases. Cardiovascular(CV) and non-CV risk factors occurring from enrollment until 1 day prior to stroke date in the APCD were included. Student’s T-test, and Z-tests were used to test differences between men and women.

Results:
We identified 3032 stroke cases in the APCD. Of these, 1455 (48.0%) matched to an admission in the GWTG-Stroke registry. Of these, 1303 (89.6%) also matched based on the admitting hospital (Table). The final cohort contained 51% women, 11.3% <35, 35.2% between 35-45, and 63.5% between 45-55. The most common CV risk factors were hypertension, hyperlipidemia, and tobacco use in men, and hypertension, tobacco use, and obesity in women. The most common non-CV risk factors were migraines, renal failure, thrombophilia in men and migraines, malignancy, and thrombophilia in women. The prevalence of cardiovascular risk factors was higher in men, while the prevalence of non-cardiovascular risk factors was higher in women. There was no difference in the severity of strokes between men and women.

Conclusions:
Clinical registries such as GWTG-Stroke can be used to supplement longitudinal administrative cohorts of young adults with stroke to get richer data on stroke etiology and severity.
Abstract P502: Blood Pressure Variability and Neurodegenerative Biomarkers: The Multidomain Alzheimer Preventive Trial
Authors: Bencivenga Leonardo , Strumia Mathilde , Rolland Yves , Andrieu Sandrine , Vellas Bruno , de Souto Barreto Philipe , Rouch Laure
Published: March 2023

Background:
Increased Blood Pressure (BP) Variability (BPV) may represent an alteration in physiological homeostatic patterns, typical of late life, and has been associated with cerebrovascular disease, cognitive impairment and dementia, including Alzheimer’s disease. Accumulation of Brain beta amyloid (Aβ) and neurofilament light chain (NFL) release are typical biomarkers of neurodegeneration, whose assessment requires neuroimaging and cerebrospinal fluid (CFS) measurements, thus limiting their use in large-scale screening of the aging populations. Nevertheless, plasma Aβ42/40 ratio is associated with CSF Aβ42/40 ratio, similarly plasma NFL levels correlate with NFL in CFS. Furthermore, blood progranulin (PGL) is also considered a neurodegenerative biomarker, since deficiency exerts pleiotropic effects on the development, maintenance, stress response, and ageing of neural circuit.

Objective:
We aimed to explore the association of visit-to-visit BPV with blood concentrations of neurodegenerative biomarkers in a population of older adults.

Methods:
Participants were selected among community-dwelling participants aged ≥70 years from the Multidomain Alzheimer Preventive Trial (MAPT) Study. Plasma blood sample was collected 12 months after enrolment and BP was assessed every six months from enrollment (0, 6, 12 months). Systolic BPV (SBPV) and diastolic BPV (DBPV) were determined through several indicators considering BP change over time, the order of measurements and formulas independent of mean BP levels. Multivariable linear regressions were used to assess the association between visit-to-visit BPV and either PGL, Aβ42/40 and NFL.

Results:
The study population consisted of 470 participants (mean age 75.7 ± 4.5 years; female, 59.7%). Visit-to-visit BPV (all indicators, both systolic and diastolic) was not associated with blood levels of neurodegenerative biomarkers after adjustment for demographics, BMI, MAPT randomization group, education, baseline BP, antihypertensive drugs, diabetes mellitus, ischemic heart disease, atrial fibrillation, stroke: per 1-SD increase in systolic BPV (coefficient of variation %): Aβ42/40: adjusted β (SE) = -0.07 (0.04), p=0.13 and NFL: adjusted β (SE) = -0.06 (0.04), p=0.19.

Conclusion:
Neither systolic nor diastolic visit-to-visit BPV were associated with neurodegenerative blood biomarkers (Aβ42/40, NFL, and PGL) in a population of older adults. Further studies with longer-term assessment of BPV are needed.
Abstract P505: Midlife Cognitive Function is Associated With Gut Microbial Species and Metabolic Pathways: Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Meyer Katie A , Lulla Anju , Wu Michael , Demmer Ryan , Yaffe Kristine , YAFFE KRISTINE , Yaffe Kristine , Meirelles Osorio , Launer Lenore
Published: March 2023

Background:
The gut microbiota may play a role in cognitive function and decline. Animal models support mechanisms involving short-chain fatty acid production, amino acid metabolism, and purine metabolism. There is need to replicate these findings in population-based human studies.

Methods:
Data were from 570 participants who attended the Yr. 30 follow-up exam (2015-16, ages 48-60 y, 45%:55% Black:White race, 45%:55% M:F sex), provided a fecal sample, and completed a cognitive battery of 6 assessments: Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Rey-Auditory Verbal Learning Test (RAVLT), Stroop, and Letter and Category Fluency. A global cognition score was derived from the 6 assessments using principal components analysis. Species and metabolic pathways were assigned to whole-metagenomics sequence data using standard reference databases. Multivariable-adjusted linear regression was used to test associations between distinct microbial features and measures of cognition, controlling for false discovery rate (FDR).

Results:
Sequence data mapped to 106 species and 312 metabolic pathways. In multivariable-adjusted regression analysis, adjusted for socio-demographics, health behaviors, and BMI, 5 species and 5 metabolic pathways were significantly associated with measures of cognitive function, FDR < 0.20
(Figure)
. These species/pathways are involved in purine and pyrimidine metabolism and short-chain fatty acid production.

Conclusion:
Identified pathways play a role in neurodevelopment and in the gut-brain axis of physiologic communications. Our findings suggest long-term relationships between gut microbiota composition and cognitive function.
Abstract P509: Does HDL-C Classification as a Criterion for Metabolic Syndrome Contribute to Alleviated Risks of Future Atherosclerosis and Incident Diabetes Among Midlife Women? The Study of Women’s Health Across the Nation (SWAN)
Authors: Wang Ziyuan , Hedderson Monique , Derby Carol A , Brooks Maria M , Thurston Rebecca C , Crawford Sybil L , Janssen Imke , McConnell Daniel , Barinas-Mitchell Emma , El Khoudary Samar R
Published: March 2023

Introduction:
In women, metabolic syndrome (MetS) is identified when at least 3 of the following risk factors exist: waist circumference > 88 cm, HDL-C < 50 mg/dL, triglycerides (TG) ≥ 150 mg/dL, fasting glucose ≥ 110 mg/dL, and hypertension. However, previous studies challenged the belief that HDL-C is protective for midlife women, casting doubts on HDL-C as one of the criteria for diagnosing MetS in this population.

Hypothesis:
We hypothesize that among midlife women classified as having MetS based on criteria independent of HDL-C, HDL-C classification does not contribute to risk of future subclinical atherosclerosis or incident diabetes.

Methods:
Participants from the SWAN study with complete data on MetS were classified into the following groups: 1) no MetS or 2) MetS independent of HDL-C; which was classified into MetS with HDL-C ≥ 50 mg/dL (MetS high), or MetS with HDL-C < 50 mg/dL (MetS low). Carotid intima-media thickness (cIMT) was measured after 13.8±0.6 years of follow-up. Incident diabetes was recorded based on medication use, fasting glucose ≥ 126 mg/dL and/or self-reports over time. Linear regression and discrete-time survival analysis were used for analysis.

Results:
Among 2994 women age 45.9±2.7 years, 2528 had no MetS (88%), 85 had MetS high (3%), and 235 had MetS low (8%) at baseline. In model 1, compared to no MetS group, MetS high or low group had higher cIMT and higher odds of diabetes. The risk did not differ between MetS low vs. high group. Adjusting for levels of MetS criteria other than HDL-C explained the associations of each of the two MetS groups with cIMT. Conversely, MetS with low HDL-C remained associated with a higher risk of incident diabetes (
Table 1
).

Conclusions:
Midlife women with MetS have elevated risk for incident diabetes and subclinical atherosclerosis regardless of HDL-C levels. The elevated risk is explained by levels of criteria of MetS other than HDL-C for cIMT but not for diabetes. Low HDL-C on top of other MetS criteria doesn’t contribute equally to future cardiovascular risk prediction in midlife women.
Abstract P510: Increase in Obesity Reduction Initiatives in San Francisco After Sugary Beverages Tax Implementation
Authors: Voorhees Allison , Inzhakova Galina , Hedderson Monique , Falbe Jennifer , Young Deborah R
Published: March 2023

A diet high in sugar sweetened beverages (SSB, has been shown to be associated with adverse health outcomes. Several cities across the US have implemented SSB taxes to decrease consumption and distribution of sugary drinks. Revenues generated from taxes were often allocated to fund public health programs and enhancements to reduce obesity. We examined efforts in San Francisco where the Sugary Drinks Distributor Tax (SDDT or “soda tax”) was implemented in 2018. SDDT legislation mandated the establishment of the Sugary Drinks Distributor Tax Advisory Committee (SDDTAC), responsible for making annual recommendations for the allocation of tax-generated revenues. We reviewed SDDTAC recommendations and funding for new and existing services that support public health through reduction and prevention of diet related diseases. We assessed if there was a significant increase in funding and number of health promotion programs implemented in San Francisco after the implementation of the SDDT. We documented obesity prevention initiatives resulting from increased tax revenue. We reviewed city government budget documents and press releases at least 1 year before tax implementation (2017) and 4 years post (2018-2022). We cataloged initiatives for adults and children including health education, nutrition and lifestyle, and community projects. The first full year of SDDT implementation (2018-19) saw the highest revenue generated at $16,097,908. Total revenue for the implementation period (2018-2021) was reported as $42,415,548. The revenue generated in the first six months of fiscal year (FY) 2018 was spent in FY2019-2020. During that period, the San Francisco Public Health Foundation awarded 26 one-year SDDT community grants - aligning with priority expenditure categories for SDDTAC - totaling $1,702,211. SDDTAC priority categories include decreasing consumption of sugary drinks, increasing water consumption, oral health, healthy food access, physical activity, and other (e.g. research/Community-Based Participatory Research, new innovations, etc.). [ACV1] In FY2019-2020 78% of SDDT revenues were spent on Healthy Communities, oral health, Healthy Food Purchasing Supplement grants and SF City Funded Agencies’ programming. The remaining 22% were spent on social media grants, infrastructure, and administrative costs. To address COVID-19, $1.65 million of unused funds from FY2019-20 supported food security and food distribution for vulnerable populations. Tax generated funding for 65 new or existing programs since implementation. New programs are funded each year: five new Policy Systems and Environmental Change programs were funded in FY2019-2020 and one new school-based program funded in FY2021-22. We observed a significant increase in number of health programs in San Francisco since SDDT implementation.
Abstract P512: Association Between Resting Rate Pressure Product and All-Cause Mortality Among United States Adults
Authors: Visaria Aayush , Moon Seung Jae , Panahon Pamela
Published: March 2023

Background:
Rate pressure product (RPP) is a measure of myocardial oxygen consumption and often used to quantify cardiac exercise workload. We sought to determine whether resting RPP was associated with all-cause mortality in healthy U.S. adults.

Methods:
This was a nationally representative, retrospective cohort study of the 1999-2018 National Health and Nutrition Examination Survey (NHANES), linked to the National Death Index through 2019. We included adult, non-pregnant participants without cardiovascular disease, kidney dysfunction, hypertension, diabetes, or current chronotropic agent use. RPP was calculated as the product of mean systolic BP (of 3 sitting BPs) and resting heart rate, and classified into quintiles (Q1≤7300, Q2 [Ref]: 7300-8250, Q3: 8250-9200, Q4: 9200-10400, Q5: >10400). We used multivariable Cox regression to estimate risk of all-cause mortality, adjusting for demographics, CVD risk factors, and comorbidities, and accounting for the survey design.

Results:
Among 19,954 participants (mean age 40y; 9,653 [48%] female; 8,056 [66%] non-Hispanic White), 1,013 died over a median follow-up of 10.3 years (IQR, 5.6-15.5). Adults in Q3-Q5 had significantly increased unadjusted risk of all-cause mortality compared to Q2 (HR [95% CI], Q1: 0.89 [0.50,1.58], Q3: 1.69 [1.06,2.72], Q4: 1.97 [1.16,3.34], Q5: 2.69 [1.71,4.22]). Adjustment for covariates attenuated risks of mortality but remained 61% higher for Q5 (Q2 [Ref], Q1: 1.02 [0.77,1.36], Q3: 1.09 [0.85,1.40], Q4: 1.22 [0.93,1.59], Q5: 1.61 [1.25,2.07]). When stratifying by gender, men, but not women, demonstrated increased risk of mortality in Q4 and Q5 (Women, Q4: 0.84 [0.54,1.31], Q5: 1.33 [0.89,1.98]; Men, Q4: 1.53 [1.07,2.18], Q5: 1.79 [1.30,2.46]).

Conclusion:
Healthy adult participants with a resting RPP greater than 10,400 had 61% higher risk of all-cause mortality compared to a RPP less than or equal to 7,300. This effect seems to be more pronounced in men than women. Further longitudinal studies are needed to understand the independent, predictive value of RPP and factors (e.g. aerobic activity) driving RPP.