bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P256: Psychosocial Risk Factors Are Associated With Lower Cardiovascular Health, Measured by Life’s Essential 8, in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Peter Kennedy M , Kucharska-Newton Anna , Wong Eugenia , Palta Priya , Mok Yejin , Lutsey Pamela L , Rosamond Wayne D
Published: March 2023

Introduction:
Psychosocial factors (social isolation, social support, trait anger, and depressive symptoms) are associated with cardiovascular disease risk factors and incidence; few studies investigate whether they are associated with cardiovascular health (CVH), and none with a new definition of CVH, Life’s Essential 8 (LE8) published by the American Heart Association (AHA).

Hypothesis:
Cross-sectional associations of psychosocial factors and CVH will be inverse, and will be modified by sex and race.

Methods:
We included 11,674 ARIC cohort participants (58% women; 23% Black; mean age 57 (standard deviation (SD): 6) years) who attended Visit 2 (1990-1992) and had complete data. All psychosocial factors and the following LE8 components were measured at Visit 2: nicotine exposure, sleep, body mass index, blood lipids, blood glucose, and blood pressure. Physical activity and diet were measured at Visit 1 (1987-1989). Psychosocial factors were categorized per standard convention or by tertiles. LE8 was scored per the AHA definition (0-100 range). Associations of each psychosocial factor with continuous LE8 score were assessed using multivariable linear regressions.

Results:
Mean LE8 score was 61 (SD: 15). Poorer scores on psychosocial factor assessments were associated with lower LE8 scores, with the largest magnitude of association for depressive symptoms (Figure). Participants with high levels of depressive symptoms had an LE8 score 8 points lower than those with low levels of depressive symptoms. Stratum-specific estimates and p-values for interaction terms suggested no modification by sex; however psychosocial factors were associated with approximately a 1 point lower LE8 score in White participants than in Black participants.

Conclusion:
Poorer psychosocial health factors were associated with lower CVH among middle-aged men and women in ARIC. Future work could investigate whether psychosocial factors modify the relationship between CVH and incident cardiovascular disease.
Abstract P257: Self-Perception of Mental and Physical Health Are Significant Predictors of Activities of Daily Living
Authors: Dagli Chaitali , Chang Chih-Hung , Hattori Robin , Wubie Mersha , Connor Lisa T
Published: March 2023

Background:
Stroke is a leading cause of long-term disability and death worldwide. Stroke results in impaired physical, psychological, and social functions. This study examined the extent to which self-perception of physical and mental health, conditions manageable by behavioral intervention (MBI), and medical conditions contribute to activities of daily living (ADL) performance post-stroke among adults aged 65 and above.

Methods:
Data from the 2017 Medicare Health Outcomes Survey Cohort 19 were analyzed. The outcome variable was defined as, being able to independently perform basic ADL such as bathing, dressing, eating, getting in and out of the chair, walking, and using the toilet. Stepwise binary logistic regression was used to identify risk factors that predict overall ADL performance.

Results:
A total of 9,531 older adults with stroke were included in the study, 56.97% of whom were females. Overall, 58.6% had some difficulty or were unable to perform ADLs post-stroke. In the final model, self-perception of physical (OR=0.89, 95% CI=0.883, 0.896) and mental (OR=0.961, 95% CI=0.954, 0.968) health and older (74+) age (OR=1.7, 95% CI=1.452,1.895) were associated with difficulty in self-perception of ADL. A 12.2% increase in explained variance after adding medical conditions such as diabetes, hypertension, cancer, etc. to demographic factors; a 13.6% increment in explained variance after adding conditions MBI such as obesity, smoking, pain, etc.; and a 10.5% increment after adding self-perception of mental and physical health was obtained. The final model explained 39.4% of the total variance in the self-perception of ADL.

Conclusion:
Not only conditions manageable by behavior interventions, and medical conditions predict performance, but self-perceptions of mental and physical health have an impact on ADL. The significant association between self-perception and ADL found in this study signals the need for new avenues for interventions for persons with stroke with respect to their ability to perform self-care activities. These findings can inform future work that identifies and addresses psychosocial and behavioral risk factors that contribute to ADL.
Abstract P259: Associations of Adverse Childhood Experiences With Cardiovascular Health (Life’s Essential 8) Among Women in Midlife
Authors: Rifas-Shiman Sheryl L , Hivert Marie-France , Chavarro Jorge E , Rich-Edwards Janet , Oken Emily
Published: March 2023

Introduction:
Many women experience suboptimal cardiovascular health (CVH) during midlife and CVH is related to upstream social, behavioral and environmental factors. However, associations of adverse childhood experiences (ACEs) - more common among women - with CVH are understudied.

Hypothesis:
ACEs would be associated with poorer CVH among women in midlife.

Methods:
At mean (SD) 50.9 (5.1) years, participants in the Project Viva cohort completed questionnaires and research staff measured their height, weight, blood pressure, and blood levels of glucose, HbA1c and cholesterol. We calculated Life’s Essential 8 (LE8), a 0-100-point score that includes 8 components of CVH: heart healthy levels of diet, physical activity, sleep, avoidance of nicotine, body mass index (BMI), blood lipids, blood glucose and blood pressure. In 2021, women reported their personal history of ACEs (10 possible types) prior to age 18y. We used linear regression models adjusted for childhood SES measures (race/ethnicity, parental education, US birth) and age at outcome.

Results:
Among 319 participants, 114 (36%) reported 0 ACEs and 58 (18%) reported ≥4 ACEs. In midlife, mean (SD) LE8 score was 77 (12) points. In age-adjusted models, ACEs (4+ vs 0) were associated with poorer LE8 score (β -6.15; 95% CI -9.91, -2.40) and behavioral (β -5.84; CI -9.98, -1.69) and biological (β -6.47; CI -11.8, -1.12) domains; covariate adjustment attenuated the results, though the trends remained significant for LE8 and behavioral domain (Figure). In fully adjusted models, each additional ACE was associated with poorer LE8 score (β -0.74; CI -1.44, -0.04) and associations were stronger for ACEs related to abuse (β -2.72; CI -5.57, 0.12) and neglect (-2.48; CI -5.81, 0.85). Of the LE8 components (0-100-points), associations were strongest for glucose (β -1.76; CI -2.85, -0.67) and physical activity (β -1.86; CI -3.92, 0.20).

Conclusions:
Adverse childhood experiences may have persistent associations with several measures of cardiovascular health among women into midlife.
Abstract P261: Associations Between Adolescent Social Determinants and Adult Cardiovascular Health in the Add Health Cohort
Authors: Higgins Simon , Cowley Emma S , Stoner Lee
Published: March 2023

Introduction:
Hypertension is the leading risk factor for cardiovascular disease in the US. Individual social determinants of health (SDoH; e.g., housing and healthy food availability) are associated with hypertension in cross-sectional samples. However, there is a need to better understand how the social environment during youth impacts future hypertension risk to identify targets for primordial prevention and reduce health disparities.

Objective:
This study aimed to identify whether patterns of SDoH during adolescence were associated with hypertension risk during adulthood in a nationally representative sample.

Methods:
This analysis utilized public-use data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) waves I and V (n=1,703). Using the Healthy People 2030 Framework, proxy measures for each domain of SDoH were identified from adolescent survey data (Wave I, age range 12-19 years). Blood pressure (BP) from in-home assessments (Wave V, age range age 32-42 years) was categorized as ‘normal’, ‘elevated’, or ‘hypertensive’ by ACC/AHA criteria. K-metoid (PAM) cluster analysis and assessment of silhouette width identified clusters of participants with similar patterns of SDoH during youth. Multinomial logistic regressions with bootstrapping estimated the odds of BP category membership relative to cluster membership. Models controlled for body mass index, smoking, age, sex, race, ethnicity, and medications. Analyses accounted for the complex sampling design, including appropriate Wave V weighting factors.

Results:
Three clusters were identified with distribution among ‘normal’, ‘elevated’, and ‘hypertensive’ BP categories, respectively, as: Cluster 1 (n=715), 40.3%, 12.3%, and 47.4%, Cluster 2 (n=499) 37.0%, 11.3%, and 51.7%, and Cluster 3 (n=489) 33.7%, 10.9%, and 55.4%. Primary differences among clusters included more frequent history of physical examinations in Cluster 1 vs. 2 and 3, and Cluster 2 vs. 3, greater feelings of safety in school and closeness to people at school in Cluster 2 vs. 1 and 3, and greater perceived prejudice at school in Cluster 1 vs. 2 and Cluster 2 vs. 3 (all p<0.05). In fully adjusted models, participants in Cluster 3 had greater odds of being hypertensive than those in Cluster 1 (OR: 1.45, 95% CI: 1.02, 2.08). Black or African American participants had greater odds of elevated (OR: 2.53, 95% CI: 1.56, 4.12) or hypertensive (OR: 2.22, 95% CI: 1.58, 3.11) BP, relative to whites. Females had lower odds of elevated (OR: 0.56, 95% CI: 0.34, 0.91) or hypertensive (OR: 0.32, 95% CI: 0.23, 0.45) BP, relative to males.

Conclusions:
SDoH during adolescence, specifically health care access and quality, may be associated with cardiovascular health during adulthood. Future research that includes more direct assessments of each SDoH domain across the lifespan will help to identify interventional targets for primordial prevention.
Abstract P264: Interleukin-1 β Mediation of Chronic Stress-Related Neural Activity and Trimethylamine- N-oxide - Data From the Washington DC Cardiovascular Health and Needs Assessment
Authors: Cintron Manuel , Ortiz-Whittingham Lola , Baumer Yvonne , Farmer Nicole , Collins Billy , Wallen Gwenyth , Powell-Wiley Tiffany M
Published: March 2023

Introduction:
Chronic stress is a cardiovascular disease (CVD) risk factor but the mechanisms by which it promotes CVD are unclear. Chronic stress can affect amygdalar activity (AmygA), leading to increased levels of activity. We evaluated mediators of the relationship between chronic stress-related amygdalar activity (AmygA) and trimethylamine n-oxide (TMAO), a cardiovascular risk marker.

Hypothesis:
IL-1 β mediates the association between amygdalar activity and TMAO.

Methods:
60 African American adults (93% female, mean age 61±11 years) at risk for CVD living in the Washington DC area participated in a cross-sectional, community-focused study. Participants had a
18
FDG PET/CT to assess chronic stress-related AmygA, phenotyping, and ELISA-based techniques to measure serum cytokines and TMAO. Multivariable regression analyses adjusted for atherosclerotic cardiovascular disease (ASCVD) 10-year risk score and body mass index (BMI) identified associations between AmygA and TMAO. IL-1 β, TNF-α, IL-6, IL-8, IL-17 and IFN-γ were evaluated as mediators of indirect associations between AmygA and TMAO.

Results:
Multivariable regression modeling revealed significant associations between AmygA and TMAO (β=0.32, p=0.02), AmygA and IL-1 β (β=0.36, p=0.003), and IL-1 β and TMAO (β=0.39, p=<0.001) in the fully adjusted model. IL-1 β mediated the AmygA and TMAO relationship (mediation effect = 43.51%).

Conclusions:
Chronic stress measured by AmygA directly associates with TMAO, a CVD risk biomarker. This relationship is mediated by IL-1 β, suggesting the potential for chronic stress-related inflammation in the brain-gut axis potentially influencing CVD in underserved communities. These hypothesis-generating results should be studied further in the future by including large, diverse populations.
Abstract P300: Peripheral Neuropathy is Associated With All-Cause Mortality Among Older Adults in the Atherosclerotic Risk in Communities Study
Authors: Hicks Caitlin W , Wang Dan , Matsushita Kunihiro , Windham B Gwen , Selvin Elizabeth
Published: March 2023

Background:
Peripheral neuropathy (PN) as assessed by monofilament testing (decreased sensation in the foot) is associated with mortality. The mechanisms by which PN increases mortality risk are unclear but may be partially explained by fall risk, a major contributor to morbidity and mortality in older adults.

Hypothesis:
We aimed to assess the hypothesis that PN is associated with all-cause mortality in older adults, and that this association may be partially explained by increased susceptibility to falls.

Methods:
We conducted a prospective cohort analysis of 3371 Black and White participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent standardized monofilament PN testing at visit 6 (2016-2017; age 71-94 years). We used Cox models to assess the associations of PN with mortality before and after accounting for the intervening occurrence of injurious falls or fractures as identified using hospitalization discharge codes.

Results:
At visit 6, PN was prevalent in 34.6% of participants (overall mean age 79.4±4.7 years, 58.7% female, 20.9% Black, 32.5% had diabetes). During a median of 2.6 years of follow-up there were 602 falls or fractures (PN=22% vs. no PN=16%) and 219 deaths (PN=9.8% vs. no PN=4.8%). All-cause mortality was higher among older adults with PN (P<0.001;
Figure
). In adjusted models, PN was significantly associated with all-cause mortality (HR 1.37, 95%CI 1.03-1.82), and this association was not attenuated after additionally adjusting for incident injurious falls or fractures (HR 1.37, 95%CI 1.03-1.81) or fractures alone (HR 1.37, 95%CI 1.03-1.82).

Conclusion:
PN was independently associated with all-cause mortality in older adults, but this association was not mediated by the intervening occurrence of injurious falls or fractures. These findings suggest that monofilament screening may provide critical prognostic information for mortality that is unrelated to fall risk.
Abstract P302: Midlife Predictors of Extreme Survival Among Israeli Men: A Nested Case-Control Study
Authors: Goldbourt Uri , Gerber Yariv
Published: March 2023

Background:
Midlife characteristics have been associated with survival to advanced ages. However, the predictive ability of such indicators to distinguish extreme from above-average longevity remains uncertain. We assessed a variety of potential indicators of exceptional vs. above-average longevity in a cohort of working males.

Methods:
A nested case-control study was conducted within the Israeli Ischemic Heart Disease (IIHD) cohort (n=10,059), consisting of civil servants and municipal employees recruited in 1963 at ages 40-65 years and followed-up for mortality over 55 years (last follow-up, 2019). All participants who survived to age 95 years or more (n=692) were individually matched (1:3) on year of birth to controls who died at ages 80-94 (n=2,076). Sociodemographic, behavioral, clinical, biochemical, and psychosocial data were obtained in 3 study cycles (1963, 1965, and 1968). Logistic regression models were constructed to identify significant predictors of extreme longevity, with over 500 variables screened.

Results:
Among participants in the IIHD cohort, 52.1% died before reaching 80 years of age, 41.0% survived to age 80-94 years, and 6.9% survived to age 95 years or more [median (IQR) age at death, 79 (70-87) years]. In the case-control analysis, after removal of highly correlated variables, 10 variables were significantly associated with exceptional (95+) longevity (Table). In a multivariable model, education level, low self-perceived employment difficulties, avoiding heavy smoking, maintaining optimal blood pressure and cholesterol levels, and absence of coronary heart disease were the variables most strongly associated with reaching 95 years of age.

Conclusions:
Using data from a large cohort of male employees assessed during midlife and followed to end of life, we were able to identify a few sociodemographic, lifestyle, clinical, and psychosocial variables associated with extreme longevity, some of which are genetically mediated.
Abstract P305: Peripheral Neuropathy is Associated With Slow Gait Speed in Older Adults in the Atherosclerosis Risk in Communities Study
Authors: McDermott Katherine M , Wang Dan , Jeon Yein , Skow Laura , Windham B Gwen , Schrack Jennifer , Selvin Elizabeth , Hicks Caitlin W
Published: March 2023

Introduction:
Peripheral neuropathy (PN) (decreased sensation in the foot) is associated with falls and mortality. Small studies have found an association between slow gait speed and PN, primarily in adults with diabetes, but evidence is limited in adults without diabetes.

Hypothesis:
We hypothesized that PN is associated with slow gait speed in older adults.

Methods:
We performed a non-concurrent cross-sectional analysis of 360 participants in the Atherosclerosis Risk in Communities (ARIC) Study who completed standardized monofilament testing for PN at visit 6 (2016-2017) and Zeno Walkway mat-sensor gait testing at visit 8 (2019-2020). Gait speed was assessed categorically (normal (≥1.0m/s) or slow (<1.0m/s)) and continuously. Logistic and linear regression were used to examine the association between PN and slow gait speed overall and stratified by diabetes status after adjusting for traditional risk factors.

Results:
The prevalence of PN was 32.2% (34% in adults with diabetes and 30% in adults without diabetes). Slow gait speed was observed in 53% of patients with PN compared to 40% of patients without PN (p=0.022). In adjusted models, PN was significantly associated with slow (categorical) and slower (continuous) gait speed in the overall sample, and these associations were particularly robust among adults without diabetes (
Table
).

Conclusions:
PN was associated with slow gait speed in a community-dwelling cohort of older adults. The specific association of PN and slow gait speed in persons without diabetes is novel. Despite a relatively small sample size, the difference between PN and non-PN participants’ continuous gait speeds exceeded the accepted threshold for clinically meaningful differences (generally >0.05m/s). A better understanding of additional PN-specific gait changes may help elucidate mechanisms underlying the association of PN with slow gait, falls, and mortality.
Abstract P308: The Determinants of Fasting and Post-Load Non-Esterified Fatty Acids in Older Adults: The Cardiovascular Health Study
Authors: Bene-Alhasan Yakubu , Siscovick David S , Ix Joachim H , Kizer Jorge R , Tracy Russell , Djousse Luc , Mukamal Ken J
Published: March 2023

Aim:
Non-esterified fatty acids (NEFA) are associated with key cardiometabolic diseases of aging and are potential targets for prevention, but their population-level correlates remain uncertain. We sought to identify modifiable factors associated with higher fasting and post-load NEFA levels in older adults.

Methods:
We used linear multivariable regression models to determine the cross-sectional associations of demographic, anthropometric, lifestyle characteristics, and medication use with serum fasting and post-load NEFA concentrations amongst community-dwelling older adults enrolled in the Cardiovascular Health Study (n = 1,924).

Results:
In general, fasting NEFA levels demonstrated a broader set of determinants, while post-load NEFA were more consistently associated with metabolic factors. Waist circumference and weight were associated with higher fasting and post-load NEFA. Cigarette smoking and caffeine intake were associated with lower levels of both species, and moderate alcohol intake was associated with higher fasting levels whereas greater consumption was associated with lower post-load levels. Unique factors associated with higher fasting NEFA included female sex, higher age, loop and thiazide diuretic use and calcium intake, while factors associated with lower fasting levels included higher educational attainment, beta-blocker use, and protein intake. Hours spent sleeping during the daytime were associated with higher post-load NEFA, while DASH score were associated with lower levels.

Conclusion:
Fasting and post-load NEFA appear to have both common and unique modifiable risk factors, including sociodemographics, anthropometric, medications, and diet. Post-load NEFA were particularly sensitive to metabolic factors, while a broader range of determinants were associated with fasting levels. These factors warrant further study as targets for lowering levels of NEFA in older adults..
Abstract P309: Biomarkers of Mitochondrial Dysfunction and Inflammaging in Older Adults and Blood Pressure Variability
Authors: Bencivenga Leonardo , Strumia Mathilde , Rolland Yves , Andrieu Sandrine , Vellas Bruno , de Souto Barreto Philipe , Rouch Laure
Published: March 2023

Background:
Most physiopathological mechanisms underlying Blood Pressure (BP) Variability (BPV) are implicated in aging. Vascular aging is associated with chronic low-grade inflammation occurring in late life, known as "inflammaging", and the hallmark “mitochondrial dysfunction” due to age-related stress. We aimed to determine whether plasma levels of the pleiotropic stress-related mitokine Growth/Differentiation Factor 15 (GDF-15) and two inflammatory biomarkers, Interleukin 6 (IL-6) and Tumor necrosis factor receptor 1 (TNFR-1), are associated with visit-to-visit BPV in a population of community-dwelling older adults.

Methods:
The study population consisted of 1,096 community-dwelling participants [median age 75 (72-78) years; 699 females, 63.7%] aged ≥70 years from the MAPT study. Plasma blood sample was collected 12 months after enrolment and BP was assessed up to seven times over a 4-year period. Systolic (SBPV) and diastolic BPV (DBPV) were determined through several indicators taking into account BP change over time, the order of measurements and formulas independent of mean BP levels.

Results:
Higher values of GDF-15 were significantly associated with increased SBPV (all indicators) after adjustment for relevant covariates [adjusted 1-SD increase in GDF-15: β (SE)= 0.07 (0.04), p< 0.044, for Coefficient of Variation%]. GDF-15 levels were not associated with DBPV. No significant associations were found between IL-6 and BPV, whereas TNFR1 was only partially related to DBPV.

Conclusion:
Unlike inflammation biomarkers, higher GDF-15 levels were associated with greater SBPV. Our findings support the age-related process of mitochondrial dysfunction underlying BP instability, suggesting that BPV might be a potential marker of aging.
Abstract P310: Dietary Pattern Associated With Future Better Gait Speed in a Japanese General Population: Tanushimaru Cohort Study
Authors: Morikawa Nagisa , Enomoto Mika , Fukami Ako , Sato Hiromi , Adachi Hisashi , Fukumoto Yoshihiro
Published: March 2023

Introduction:
Sarcopenia is a core contributor to falls, fractures and disability. Previous cohort studies showed that healthy dietary pattern like plant-focused diets had beneficial effects on cognitive and physical health. However, few longitudinal studies have investigated the association between dietary patterns and future gait speed, which is strongly related to sarcopenia. Therefore, we aimed to evaluate the relationship between dietary patterns and gait speed in a 9-year follow-up.

Methods:
We recruited 1943 men and women aged 40 to 95 years in the prospective Tanushimaru cohort study in Japan in 2009. Their dietary intake was assessed using a brief self-administered diet history questionnaire (BDHQ). Principal component analysis (PCA) identified the main dietary patterns. In 976 participants re-examined in 2018, walk time for 5m was examined and <1m/sec of gait speed was defined as slow gait speed. Multivariable logistic regression analyses were performed to examine the association of the main dietary patterns with slow gait speed. Covariates included traditional cardiovascular risk factor (hypertension, dyslipidemia and diabetes), history of cardiovascular diseases, physical activity and cognitive function at baseline.

Results:
The prevalence of slow gait speed in 2018 was 46.9%. The PCA revealed three major dietary patterns: vegetable pattern (vegetables, potatoes, mushrooms and seaweeds); rice pattern (rice, bread and miso soup); and alcohol pattern (alcoholic beverages, cakes and snacks). The higher vegetable pattern score was significantly associated with slower gait speed (p=0.002), while other patterns were not. Estimated risk for slow gait speed in the fully-adjusted model was 39.1% in the highest versus 55.8% in the lowest tertile of vegetable dietary pattern scores (p=0.001).

Conclusions:
The vegetable pattern was significantly associated with a lower risk for slow gait speed in a 9-year follow-up.
Abstract P312: Mortality Analysis: The Long-Term Health Benefits of 50-Mile Ultra-Marathon Participation Outweighs the Risks, 1951-1979
Authors: O'Donnell Erin , Carriker Colin R , Smoliga James M
Published: March 2023

Introduction:
Aerobic exercise training yields numerous health benefits including a reduced risk of cardiovascular disease and improved overall health. However, there are concerns that “excessive” exercise can have delirious effects. For example, research reveals elevated cardiac injury biomarkers (i.e., cardiac troponins) following participation in ultra-marathon competitions (running races >26.2 miles). However, the long-term clinical implications of ultra-marathon participation remains unknown.

Hypothesis:
The extreme cardiac stress of ultra-marathon running may lead to earlier death rates among the most elite participants.

Methods:
The 150 fastest finishers of 50-mile ultra-marathons from 1951-1979 were identified using the “Ultra Marathon Statistics” database (http://statistik.d-u-v.org/). Online search engines and databases were used to identify each runner’s birthdate and date of death (if deceased) or most recent date known to be alive. Kaplan Meier curves with median survival times were computed using the available data.

Results:
Data from 58 elite ultra-marathoners were identified with a high-level of confidence as confirmed by a minimum of two reviewers. Twenty-four of these athletes were deceased (median age of death = 73.0 years, interquartile range = 15.2 years, range = 36.0-98.7 years, median birthyear = 1936), and 34 were last known to be alive (median age = 75.7 years, IQR = 9.4 years, range = 62.0-88.8y, median birthyear = 1943). The median 50 mile finish time was identical for each group (5h 43min; pace of 6min 51.6 seconds per mile). The Kaplan Meier curve yielded a median survival time of 85.8 years (95% confidence interval = 80.8 to 90.7 years).

Conclusion:
The lifespan of elite ultra-marathon runners is greater than that of the general population. The long lifespans of elite athletes completing 50-mile races suggests the long-term health benefits of ultra-marathon participation outweigh the risks. Future research should investigate the mortality of elite athletes competing in longer ultra-marathons (e.g., 100M, 6-day races) to ascertain whether mortality rates differ from those training for and completing 50-mile races.
Abstract P313: Characteristics and Patterns of a Middle-Class Australian Cohort With Cardiometabolic Multimorbidity: A Cross-Sectional Study
Authors: Parmenter Belinda J , McLeod Kelly , Jones Matthew , Burley Claire , Feng Xiaoqi
Published: March 2023

Introduction:
Prevalence rates of cardiometabolic disease are rising, placing a significant burden on healthcare sectors, with cardiovascular disease (CVD) and type 2 diabetes contributing the most burden and being overweight the most contributing risk factor. With an ageing population, unfavourable risk factor trends and the challenges associated with CVD, we aimed to analyse a group of middle-class Australian adults for patterns in body composition, fitness and function.

Methods:
Data collected from adults attending a health clinic in eastern Sydney were analysed. Data were self-reported to or measured by an allied health clinician during initial consultations. Conditions reported included those contributing to the Australian disease burden in adults 45 years and over in 2018. Cardiometabolic multimorbidity was defined as the presence of two or more conditions simultaneously. Simple linear and stepwise regressions were used to assess potential relationships.

Results:
Data from 533 people (mean age 66.6±12.1 yrs; 67% female) were analysed. In total, 418 had a biological cardiometabolic risk factor or diagnosed CVD, of which 85.2% satisfied the criteria for cardiometabolic multimorbidity (73% female; 62% male), with most reporting 2-3 conditions. The most reported was coronary heart disease (64.4%), followed by hypertension (34.6%), type 2 diabetes (12.9%), cerebrovascular (5.1%), chronic kidney (1%) and peripheral artery (1%) disease. There was no relationship between the number of conditions and key outcomes, except for balance (r=0.12; p=0.03). There was a significant relationship between age and greater systolic blood pressure (SBP) (r=0.26; p<0.001), a larger waist (r=0.11; p=0.03) and poorer 6-minute walk (r=-0.38; p<0.001), muscle strength (r=-0.34; p<0.001) and balance (r=-0.30; p<0.001). A high SBP was significantly related to a higher body mass index and waist and lower body strength, with waist and lower body strength being the strongest predictors of higher SBP (p=0.005). A higher waist and lower body strength were significantly related to a poorer 6-minute walk, together with age, accounting for 41% of the variance in performance (p<0.001).

Conclusion:
Three in 4 Australian adults in this cohort had cardiometabolic multimorbidity, with a greater prevalence in females. Cardiometabolic multimorbidity was unrelated to key body composition parameters or fitness test performance. However, those that were older had a higher waist measurement and poorer lower body strength and performance in the 6-minute walk. Those with higher SBP also had a higher waist and lower body strength. With these fitness measures strongly related to cardiovascular mortality, more older adults need to participate in evidence-based healthy lifestyle education programs to help improve overall body composition, fitness and function, thereby reducing CVD.
Abstract P317: Heterogeneity in Prevalence of Hypertension and Overweight/Obesity Among US-Born and Foreign-Born Latino Subgroups: Evidence From the 2010-2018 National Health Interview Survey
Authors: Elias Sabrina , Alharthi Abeer , Ogungbe Oluwabunmi , Turkson-Ocran Ruth-Alma N , Benjasirisan Chitchanok , Commodore-Mensah Yvonne , Dennison Himmelfarb Cheryl R
Published: March 2023

Introduction:
Latino individuals account for almost 20% of the U.S. population and are disproportionately affected by cardiovascular disease (CVD) risk factors, such as hypertension and overweight/obesity. They are not monolithic, but diverse in culture, lifestyle, and health exposures that impact their cardiovascular health. Further examination of heterogeneity in CVD risk factors among US-born and foreign-born Latino subgroups is needed to deepen our understanding of the burden of CVD risk in this population.

Hypothesis:
We hypothesized that there would be significant heterogeneity in the prevalence of hypertension and overweight/obesity among foreign-born Latino individuals as compared to their US-born counterparts.

Methods:
We examined the prevalence of CVD risk factors using a cross-sectional design, among Latino adults in the 2010-2018 National Health Interview Surveys. Generalized linear models using Poisson distribution were fitted to obtain adjusted odds ratio and risk of self-reported hypertension and overweight/obesity among US-born and foreign-born Latino subgroups.

Results:
We included 175,761 participants with mean(±sd) age 41 (0.2) years, 50.1% female, 32.4% with less than high school education, 84.5% with ≥10 years of length of US residence, and 72% with health insurance. We observed a statistically significant lower prevalence of hypertension among foreign-born Mexicans (adjusted odds ratio [AOR]: 0.98, 95% confidence interval or [CI]: 0.80 - 0.99) and Puerto Ricans (AOR: 0.75; 95% CI: 0.65 - 0.86) compared to their US-born counterparts. (
Table
)

Conclusion:
We observed heterogeneity in the prevalence of hypertension when foreign-born and US-born Mexicans and Puerto Ricans are compared. No differences were found for overweight/obesity. Our results highlight the need to evaluate CVD risk differences by nativity status.
Abstract P322: Transcriptomic Analysis of Severe Obesity Identifies Novel Genes in Hispanic/Latino Populations With a High Burden of Disease
Authors: Sharma Priya , Chen Hung-Hsin , Zhu Wanying , Polikowsky Hannah G. , Mccormick Peter , Karastergiou Kalypso , Fried Susan , Justice Anne E , Lee Miryoung , Graff Mariaelisa , Mohammad Yasser , Mccormick Joesph , Fisher-hoch Susan P , North Kari E , Below Jennifer
Published: March 2023

The US prevalence of severe obesity [(SevO), body mass index [BMI] ≥40 kg/m
2
)] is increasing at an alarming rate; women and Hispanic Latino populations have experienced among the greatest increases. While genome-wide association studies (GWAS) have identified >1000 loci associated with body mass index, the function of much of this variation is unknown. Gene expression measures can ] link genetic variation and disease highlighting pathways for targeted therapeutic intervention, but to-date, few studies have examined the role of gene expression to identify molecular signatures associated with SevO. To this end, we leveraged extant whole blood (WB) RNA sequencing (RNAseq) data in 75 SevO cases and 116 controls (with BMI = 18-25) collected from randomly selected Mexican Americans in the Cameron County Hispanic Cohort (CCHC) to identify patterns associated with SevO. We used established protocols and alignment, yielding 18,565 genes after quality control. We applied DESeq2 to assess DE associated with SevO, using a negative binomial regression model with a gene-specific dispersion parameter, adjusted for sex, age, T2D, hypertension, hypercholesterolemia, and 10 probabilistic estimation of expression residual (PEER) factors. After FDR correction, 124 genes were significantly DE, including top genes
C1RL
,
IL4R, and RGS16
. We identified several replications of the 124 genes in a transcriptomic follow-up study of 52 SevO cases and 59 normal weight controls- 20 genes displayed directionally consistent and FDR significant evidence of replication. We additionally identified several replications of the 124 genes in subcutaneous adipose tissue (SAT) from 19 NYC community volunteers, including for
RGS16
,
C1RL
, and
IL4R.
2-
sample MR assessed causal associations between SevO and gene dysregulation, using SevO GWAS from DIAMANTE and CCHC eQTLs. Upregulated IL4R demonstrate pleiotropy, among other genes (e.g.,
REM2, ENGASE, and SCAP
). Collectively, these data demonstrate how transcriptomic studies may elevate understanding of SevO and inform efforts to reduce health disparities associated with SevO in HL populations.
Abstract P324: Female Reproductive Factors and Risk of Type 2 Diabetes and Cardiovascular Disease Among Women With a History of Gestational Diabetes
Authors: Birukov Anna , Guasch Marta , Tobias Deirdre K , Ley Sylvia H , Wittenbecher Clemens , Yang Jiaxi , Manson Joann E , Chavarro Jorge , Hu Frank B , Zhang Cuilin
Published: March 2023

Introduction:
The link between gestational diabetes mellitus (GDM) and long-term risk of type 2 diabetes (T2D) and cardiovascular disease (CVD) is well established; however, risk factors underlying the progression of disease remain uncertain.

Hypothesis:
Female reproductive factors including ages at menarche, menopause, and first birth, number of live births, and surgically-induced menopause (uni- or bilateral oophorectomy or hysterectomy) are associated with higher risk of progression, while breastfeeding is associated with lower risk of progression from GDM to T2D/CVD.

Methods:
Participants in the Nurses’ Health Study II reported reproductive history at cohort baseline and over follow-up, including 5346 women with a history of GDM. Self-reported incident T2D or CVD (myocardial infarction, coronary revascularization or stroke) were confirmed via questionnaire or medical records. We estimated the hazard ratios (HR [95%]) across quintiles of each reproductive factor with incident T2D and CVD using Cox models adjusting for age, race/ethnicity, smoking, BMI at 18 years, physical activity, family history of T2D or CVD, alcohol intake, menopausal status, aspirin use, and Alternate Healthy Eating Index.

Results:
We documented 988 incident T2D and 149 CVD cases over 25 years of follow-up. In adjusted models, higher total lactation duration was associated with lower risk of T2D (5 categories: 0, 1-6, 7-12, 13-24, >24 months, p for trend=0.01; highest vs. lowest category: HR 0.77 [95%CI: 0.60, 0.98]) and CVD (p for trend=0.03, HR 0.39 [95%CI: 0.19, 0.80]). Early age at menarche was linearly associated with higher risk of T2D (5 categories: ≤11, 12, 13, 14, >14 y: p for trend <0.0001), lowest (≤11 y) vs. reference (13 y) category: HR 1.28 [95%CI: 1.06, 1.53], while no trend could be observed for CVD outcomes (p for trend=0.48). Higher age at 1
st
birth was associated with lower CVD risk (5 categories: <23, 23-25 [reference], 26-29, 30-34, ≥35 y, p for trend=0.001; highest vs reference category: HR 0.17 [95%CI: 0.05, 0.57]), but not T2D). Compared with natural menopause, surgically induced menopause was associated with higher T2D risk: 1.32 (1.00, 1.73). Number of live births and age at menopause were not associated with T2D or CVD among women with GDM history.

Conclusions:
Breastfeeding was associated with lower T2D and CVD risks among women with GDM history, suggesting some shared risk factors or etiologies across reproductive lifespan and long-term cardiometabolic health. Ages at menarche and 1
st
birth showed differential associations with T2D and CVD.
Abstract P326: Higher Mortality and Risk for Cardiogenic Shock in Patients With Diabetes Mellitus and Atrial Fibrillation Affected by Pulmonary Hypertension
Authors: Khokhlov Leonid , Aboelnasr Amr , Hussain Fatima , Ali Mehnaaz , Fatuyi Michael , Pereira Leanne , Shemisa Kamal
Published: March 2023

Background:
Population with diabetes mellitus (DM) & atrial fibrillation (AF) is a growing medical problem. Although, pulmonary hypertension (PH) is a recognized entity that poses higher medical risks, there is limited scientific evidence of clinical outcomes in population with AF&DM affected by PH. Therefore, we sought to investigate this population.

Methods:
We queried NIS between 2016-2019 for adult patients who were hospitalized with AF&DM and had PH. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, acute respiratory failure, invasive mechanical ventilation, length of stay (LOS) and total hospital charge. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value < 0.05 was significant.

Results:
There were 6,723,293 patients with AF&DM and 802,004 (12%) had PH. PH and non-PH cohorts were with mean age of 74.6 vs. 73.6 yrs; males 46.6% vs 56.9%; Caucasians 70.9% vs 74.2%; HTN 13.4% vs 30.9%; HF 83% vs 52.6%; CKD 58.5% vs 43.7%; obese 33.4% vs 26.3%; dyslipidemia 62.2% vs 61.3%; anemia 24.4% vs 18.7%; history of MI 13.3% vs 13.2%; stroke 2.5% vs 4.2%, COPD 41.5% vs 29.6%; nicotine use 7.5% vs 9.5%, respectively. PH cohort had significantly higher mortality and worse clinical outcomes (Table 1).

Conclusion:
AF&DM population affected by PH showed significantly worse clinical outcomes and higher resource utilization. They were older with more HF, obesity, dyslipidemia, anemia, CKD, COPD. PH is associated with cardiac dysfunction & a 2-fold greater risk for cardiogenic shock. Awareness of PH among patients with AF&DM is needed and additional long-term outcomes research is necessary.
Abstract P327: Device-Measured Sedentary Behavior and Risk of 1-Year Hospital Readmission After Suspected Acute Coronary Syndrome
Authors: Boudreaux Benjamin D , Xu Chang , Sanchez Gabriel , Murdock Margaret , Cruz Gaspar , Jurado Ammie , Duran Andrea T , Kronish Ian M , Edmondson Donald , Diaz Keith
Published: March 2023

Background:
Patients hospitalized with acute coronary syndrome (ACS) have an increased risk of a readmission during the first year after discharge; necessitating a need to identify modifiable therapeutic targets to improve outcomes. While moderate to vigorous physical activity (MVPA) has been a hallmark of secondary prevention efforts to prevent hospital readmission, sedentary behavior (SB) has emerged as a potentially unique and clinically important aspect of the physical activity profile. Yet, little is known regarding whether SB is associated with hospital readmission in ACS patients independent from or in addition to MVPA levels.

Purpose:
To examine the association between device-measured SB and risk of 1-year hospital readmission among patients evaluated for ACS, independent of MVPA.

Methods:
Patients (n=603, 47.8% female, 62.5±13.0 yrs) evaluated in the emergency department for ACS were fitted with a GENEActiv accelerometer in-hospital and were instructed to wear the device on their non-dominant wrist continuously in-hospital and for 30 days post-discharge. Hospital readmissions were ascertained by proactively searching medical records for any possible hospitalizations and by contacting participants or their closest contacts at 1- and 12-months follow-up; with supporting documentation secured from hospital medical records.

Results:
Over 1-year follow-up, 281 (46.6%) patients were readmitted. SB was associated with increased risk of 1-year hospital readmission after adjusting for socio-demographic factors, comorbidities, and disease severity indicators [HR per 1-hour per day increase in SB= 1.09, 95% CI: 1.01, 1.18]. The association remained significant after further adjusting for MVPA [HR per 1-hour per day increase in SB= 1.11, 95% CI: 1.02, 1.22]. In joint association analyses, high sedentary time in combination with low MVPA was associated with the greatest risk of 1-year hospital readmission in a fully adjusted model (HR: 2.18; 95%: CI: 1.44, 3.31) compared to the referent group (low SB/high MVPA). However, even among participants with higher levels of MVPA; high sedentary time was associated with a greater risk of 1-year re-hospitalization (HR: 1.54; 95% CI: 1.05, 2.27). For participants with low MVPA and low sedentary time, no significant association was observed (HR: 1.37; 95% CI: 0.84, 2.21).

Conclusions:
SB was associated with an increased risk of 1-year hospital readmission among patients evaluated for ACS. This increased risk was independent of MVPA and was not eliminated by high levels of MVPA. Implications of this study suggest that reducing SB should be considered as a modifiable therapeutic target in addition to MVPA to improve outcomes in ACS survivors.
Abstract P337: Determinants and Influence of Breast Arterial Calcifications on Risk of Cardiovascular Disease
Authors: Azam Shadi , Tamimi Rulla , Drotman Michele , Babagbemi Kemi , Levy Allison , Pena Jessica
Published: March 2023

Background:
Breast arterial calcifications (BAC) are incidentally observed on screening mammography. BAC has been shown to be associated with the presence of coronary artery calcification (CAC) and increased risk of coronary artery disease (CAD). Given that population-based mammography is currently recommended to women, the evaluation of BAC may be important in identifying high-risk women without additional cost or radiation exposure.

Aims:
We sought to identify reproductive and cardiovascular risk factors associated with the presence of detectable BAC and CAC in women participated to mammography screening. Also, we aimed to determine the association between BAC and presence of CAC. Further, we investigated presence of BAC, CAC and estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD).

Methods:
In this cross-sectional study, reproductive history and CVD risk factors were obtained in 215 women ≥ 18 years of age that underwent mammography and cardiac computed tomographic angiography (CCTA) within 2 years of each other between January 2007 and September 2017 at Weill Cornell Medicine/ New York Presbyterian hospital (WCM/NYP). BAC was recorded in two ways: a binary scale (presence/absence) and a semi-quantitative scale (mild, moderate, severe). CAC was calculated using the Agatston method and was recorded as a binary variable (presence/absence). Information regarding reproductive history and CVD risk factors, medical history, and relevant demographics were obtained by chart review. Odds ratios (ORs) and 95% confidence intervals (CIs), with adjustment for age at study entry as a potential confounder, were estimated. The 10-year risk of atherosclerotic cardiovascular disease (ASCVD) was calculated using the Pooled Cohort Risk Equations.

Results:
The odds of presence of BAC increased with increasing age . Women age ≥60 had a near 6-fold higher odds of BAC (OR = 5.77; 95% CI = 2.45 to 16.00) compared with women <60 years old. Other factors associated with presence of BAC after controlling for age were diastolic blood pressure ≥80 (
P =
0.0008), systolic blood pressure ≥140 (
P =
0.0009), number of children
(P =
0.01). Younger age at first birth (≤28 years) was associated with 3-fold higher odds of BAC compared with women with age at first birth >28 years. Except for age at study entry, the only factor associated with presence of CAC was hyperlipidemia (
P =
0.002). We found no association between presence of BAC with CAC. We observed women with presence of both BAC and CAC had the highest estimated 10-year risk of ASCVD: 18.54%, followed by presence of BAC but absence of CAC 11.65%, absence of BAC and presence of CAC 6.01%, and women with no BAC and no CAC presence had a mean 10-year risk of ASCVD of 5.25%.

Conclusions:
These findings support the value of BAC in identifying women at potentially increased risk of future cardiovascular disease without additional cost and radiation exposure.