bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP47: IFNγ-Mediated Associations Between Chronic Stress Related-Neural Activity And PCSK9: Data From The Washington, D.C. Cardiovascular Health And Needs Assessment
Authors: Ortiz-Whittingham Lola R , Baumer Yvonne , Collins Billy , Mitchell Valerie , Farmer Nicole , Powell-Wiley Tiffany M
Published: April 2022

Introduction:
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key player in dyslipidemia and is linked to cardiovascular disease risk. To our knowledge, the potential link between psychosocial stressors, PCSK9 levels, and related dyslipidemia has not been evaluated.

Hypothesis:
IFNγ mediates the association between amygdalar activity (AmygA) and PCSK9.

Methods:
Participants from the D.C. Cardiovascular Health and Needs Assessment (DC-CHNA), a community-engaged cohort study, were recruited to the NIH Clinical Center and underwent phenotyping, including
18
FDG PET/CT to assess AmygA as a marker of chronic stress-related neural activity. Cytokines, PCSK9, and lipoprotein (a) (Lp(a)) were measured using ELISA-based techniques. Regression modeling identified associations between AmygA and PCSK9 and between PCSK9 and Lp(a) while adjusting for atherosclerotic cardiovascular disease (ASCVD) 10-year risk score and body mass index (BMI). Mediation analysis was used to evaluate IFNγ, TNFα, and IL-6 as potential mediators.

Results:
The DC-CHNA consisted of 60 African American participants (mean age 61±11 years, 93% female) at risk for ASCVD. AmygA associated with PCSK9 and IFNγ after adjusting for ASCVD and BMI; additionally, IFNγ associated with PCSK9 (
Figure
). Mediation analysis indicated that IFNγ mediated 45.8% of the AmygA and PCSK9 relationship. TNFα and IL-6 did not mediate the relationship. Lastly, PCSK9 associated with Lp(a) independent of ASCVD risk factors (β=0.34, p=0.013).

Conclusions:
The role of psychosocial stressors in PCSK9 related-dyslipidemia is not well known. Thus, we show that AmygA, a measure of chronic stress, associated with PCSK9 in an IFNγ-mediated fashion. PCSK9 then associated with Lp(a) which is notable as Lp(a) is thought to be largely genetically determined and highly atherogenic. Future research should further this hypothesis-generating study by prospectively investigating the impact of psychosocial stressors on PCSK9 and dyslipidemia in larger, diverse populations.
Abstract MP48: Daily Spiritual Experiences And Allostatic Load Trajectories In Midlife African American Women
Authors: Williams Elizabeth A , Cortes Yamnia I , Zhang Shuo , Harris Latesha K
Published: April 2022

Introduction:
African American women have a significantly higher risk for cardiovascular disease (CVD) with an earlier age of onset than non-Hispanic whites. Recent evidence suggests that psychological stress may contribute to the disproportionate burden of CVD in midlife African American women. Religion and spirituality have been associated with lower risk of CVD and improved psychological distress.

Hypothesis:
We assessed the hypothesis that daily spirituality may have cardioprotective effects among midlife African American women.

Methods:
We performed a secondary analysis of public-use data from 727 African American women enrolled in the Study of Women’s Health Across the Nation (SWAN), a multi-site longitudinal cohort study. Biological, psychosocial, and physical measures were collected approximately annually. Allostatic load (AL) was calculated at each visit using 10 biomarkers representing neuroendocrine, immune, metabolic, and cardiovascular system functioning. Group-based trajectory modeling identified women with similar patterns of AL over a 7-year period. The Daily Spiritual Experiences Scale was used to categorize daily spiritual experiences (some days or less, most days, daily, many times a day). We used logistic regression to estimate associations between daily spiritual experiences and AL trajectory group. Models adjusted for baseline age, education, and depressive symptoms.

Results:
Three distinct trajectories of AL were identified: low (35.1% = 255 of 727), moderate (44.7% = 325 of 727), and high (20.2% = 147 of 727). We found that women who reported daily comfort in religion and spirituality were less likely to be represented in the high AL trajectory group when controlling for age.

Conclusions:
Our findings suggest that spirituality may have cardioprotective effects among midlife African American women. Further investigation on sociocultural factors that may buffer the negative effects of psychological distress on CVD risk in midlife African American women is needed. This work can inform culturally relevant interventions to improve cardiovascular health outcomes in this population.
Abstract MP58: Eating Behaviors Influence Diet Quality: Impact Of Sleep Restriction
Authors: Barragan Rocio , Tam Victoria , Scaccia Samantha , Cochran Justin , RoyChoudhury Arindam , St-Onge Marie-Pierre
Published: April 2022

Background:
Eating behavior is an important construct with predictive value for energy intake and is associated with health. Two characteristics of eating behavior, eating window and eating frequency, are consistently associated with cardiometabolic risk across populations and have been shown to be related to sleep patterns. Both lifestyle factors have been related to cardiometabolic diseases but no long-term study has analyzed the association between sleep and eating behavior.

Objective:
To analyze the link between eating behavior and diet quality in a randomized, crossover study of sleep restriction (SR) vs adequate sleep (AS).

Methods:
Sixty-one participants (68% women, 20-73y) underwent 2 phases of 6 wk each, AS (sleep ≥7 h/night) and SR (-1.5 h/night relative to AS). Energy intake, diet quality, number of eating occasions (any eating/drinking episode providing at least 210kJ separated by >15min) and eating window (time elapsed between the first and last eating occasion) were assessed at baseline, wk 3 and wk 6 of each phase using 3-d food records. Linear regression models were used to evaluate associations of eating behavior with diet quality by sleep condition, adjusting for confounding variables.

Results:
Participants had more eating occasions during SR compared to AS (β= 0.27±0.12, P=0.028). Duration of eating window also tended to be longer during SR compared to AS (β= 0.38±0.22, P=0.090). We then assessed the impact of these dietary behaviors on diet quality separately by condition. During AS, greater number of eating occasions was associated with greater energy intakes (β= 106.5±41.8, P=0.013), carbohydrates (β= 14.0±5.5, P=0.013), protein (β= 4.6±2.2, P=0.040), monounsaturated fat (β= 1.9±0.9, P=0.028), and fiber intakes (β= 2.1±0.8, P=0.010). Dietary glycemic index was also higher in those with greater eating occasions (β= 70.9±27.9, P=0.013). During SR, greater number of eating occasions was associated with greater energy intakes (β= 168.5±36.8, P<0.001), fat (β= 6.3±2.1, P=0.004), carbohydrates (β= 19.7±4.7, P<0.001), protein (β= 6.9±2.0, P<0.001), saturated fat (β= 1.6±0.8, P=0.043), monounsaturated fat (β= 2.9±0.9, P=0.002), sugar (β= 6.5±1.8, P<0.001), and fiber intakes (β= 2.2±0.7, P=0.003). Dietary glycemic index was also higher in those with greater eating occasions (β= 92.8±23.7, P<0.001). Findings were similar but less pronounced for eating window duration.

Conclusions:
Higher eating frequency is associated with higher intakes of energy and several macronutrients. However, in the context of SR, more frequent eating occasions is associated with a worse dietary profile, namely greater intakes of saturated fat and sugar.
Abstract MP59: Association Between Time-varying Sleep Quality Status And Hypertriglyceridemia Onset In Middle-aged Population
Authors: Lee Ga Bin , Jung Sun Jae , Lee Eun , Ahn Song Vogue , Kim Kyoung Min , Kim Hyeon Chang
Published: April 2022

Introduction:
Deteriorated sleep quality adversely affects insulin sensitivity and inflammation markers, and these factors are commonly associated with triglyceride levels. However, the long-term effects of sleep quality on fasting triglyceride levels have not been investigated in previous studies.

Hypothesis:
We assessed the hypothesis that whether time-varying sleep quality affects the risk of hypertriglyceridemia among healthy middle-aged Koreans.

Methods:
Participants in the Korean Genome and Epidemiology Study were biennially followed up from the baseline. Sleep quality was assessed five times measured over 14 years by the Pittsburgh Sleep Quality Index (PSQI). We utilized data on 1,773 participants (mean age: 49.8) with at least three measures of sleep quality data and without dyslipidemia at baseline. Poor sleep was determined as PSQI >7. Blood samples were collected from every survey and the first visit of triglyceride≥200 mg/dL was defined as hypertriglyceridemia. Cox proportional hazard models with time-varying sleep quality were employed to estimate the effects of time-varying sleep quality on the risk of hypertriglyceridemia. Adjusted covariates included age, socioeconomic factors, body mass index, baseline blood lipids, insulin sensitivity, menopausal status, psychological stress, comorbidities, frequency of night-snack, smoking, drinking, and physical activity. All analyses were conducted separately in men and women.

Results:
During a median follow-up of 11.8 years, 233 men (28.2%) and 192 women (20.1%) developed hypertriglyceridemia. Sleep quality as a time-varying element was significantly associated with the risk of developing hypertriglyceridemia in women after full adjustments; poor sleep increased 53% of hazards for developing hypertriglyceridemia in women (hazard ratio 1.53; 95% confidence interval 1.07-2.17), but not in men (hazard ratio 1.03; 95% confidence interval 0.68-1.55). A sensitivity analysis, which was adjusted for a time-varying status of alcohol drinking and physical activity, showed similar findings. Another sensitivity results with the complete case of sleep quality data were similar to the main results.

Conclusions:
In conclusion, maintaining good sleep quality may have cardiovascular prevention effects, through preventing hypertriglyceridemia, in middle-aged women.
Abstract MP66: Prediabetes, Diabetes By Age Of Onset And Subsequent Risk Of Dementia
Authors: Hu Jiaqi , Pike James R , Lutsey Pamela L , Sharrett A R , Wagenknecht Lynne E , Hughes Timothy M , Seegmiller Jesse C , Gottesman Rebecca F , Mosley Thomas , Coresh Josef , Selvin Elizabeth
Published: April 2022

Objective:
To characterize the direct and indirect association of prediabetes with dementia risk and to examine the age at diabetes onset and subsequent risk of dementia.

Methods:
At baseline (1990-1992), prediabetes was defined based on HbA1C 5.7-6.4% among people without a history of diagnosed diabetes or medication use for diabetes; diabetes was defined based on self-reported physician diagnosis or diabetes medication use or HbA1C level of 6.5% or greater. Incident diabetes with the same definition during the follow-up was included as a time-varying variable. Incident dementia was ascertained using surveillance, interviews and adjudication. Survival analysis used age as the time scale using an origin at age 50 and left and right censoring. Adjustment models included sex, race, education, APOE, BMI, smoking status, alcohol use, physical activity, total cholesterol, HDL cholesterol and hypertension.

Results:
Among the 13,388 participants, 2314 (17.3%) had prediabetes and 1798 (13.4%) had diabetes at baseline. Before adjusting for incident diabetes, the adjusted hazard ratios of dementia were 2.35 (95% CI: 1.99, 2.76) and 1.13 (95% CI: 1.02, 1.25) for diabetes and prediabetes compared to no diabetes in the fully adjusted model. After adding incident diabetes, the excess risk of dementia for prediabetes decreased by ~50% and the association was not significant. The relative hazards of dementia were 3.16 (95% CI: 2.15, 4.66), 1.64 (95% CI: 1.36, 1.97), 1.29 (95% CI: 1.14, 1.47) and 1.06 (95% CI: 0.89, 1.28) for diabetes with age onset at < 60, 60-69, 70-79 and 80-93, respectively (Table).

Conclusion:
Midlife diabetes and prediabetes are associated with excess hazard of dementia and death. Earlier age of onset of diabetes shows a strong dose response with higher dementia hazard. Much of the risk of dementia in pre-diabetes is explained by intervening incidence of clinical diabetes. Dementia prevention efforts would benefit from preventing or delaying the progression of prediabetes to diabetes.
Abstract MP78: Heart Failure And The Subsequent Risk Of Lymphedema In The Community
Authors: Mok Yejin , Joshu Corinne , Platz Elizabeth , Chang Patricia , Ballantyne Christie M , Mathews Lena , Matsushita Kuni
Published: April 2022

Background:
Lymphedema, abnormal lymphatic fluid accumulation in tissues, results in serious complications such as ulceration and reduces quality of life. Cancer treatment, through damage to lymph nodes and lymphatic vessels, is recognized as the main risk factor of lymphedema. However, understanding other risk factors is crucial for the prevention of lymphedema since there is no established curative treatment. Heart failure (HF) is considered an emerging risk factor for lymphedema through increased central and peripheral venous pressure, but the association of HF with incident lymphedema has not been systematically studied.

Methods:
In the Atherosclerosis Risk in Communities study, we included 9,895 individuals without prevalent lymphedema and cancer at visit 4 (1996-98) (n=9362 with no HF and n=533 with HF). Lymphedema was defined as two outpatient encounters (at least a week apart) or inpatient diagnoses through 2015 (ICD-9: 457.1 and ICD-10: I89.0). Participants without prevalent HF were categorized into two groups according to NT-proBNP, a marker of cardiac volume overload (>125 vs. ≤125 pg/mL [reference]), to acknowledge potential contribution of subclinical cardiac overload.

Results:
During a median follow-up of 17.7 (IQI 14.1-18.7) years, 149 participants developed lymphedema. 15-y cumulative incidence was higher in participants with HF and no HF with elevated NT-proBNP than those with no HF and non-elevated NT-proBNP (5.2% vs. 2.0% vs. 0.7%, respectively) (
Figure
). After accounting for potential confounders (e.g., body mass index, blood pressure, diabetes), the associations remained consistent (hazard ratios: 3.07 [95% CI 1.86, 5.08] for HF and 1.95 [1.33, 2.87] for no HF with elevated NT-proBNP). Results were consistent when using HF as a time-varying variable and censoring incident cancer.

Conclusions:
HF and subclinical elevation of NT-proBNP were associated with incident lymphedema, supporting the contribution of HF to the development of lymphedema.
Abstract P004: Modified Step-in-Place Test Measures Exercise Capacity And Tolerance Of Elderly Women
Authors: Raso Vagner , Matsudo Victor Keihan Rodrigues
Published: April 2022

Purpose:
This study analyzed fatigue, heart rate, maximum oxygen consumption, rate of perceived exertion, and steps at 30-second (s) intervals during a modified step-in-place test in elderly women.

Methods:
This was a cross-sectional analysis of 272 physically active, community-dwelling women aged 49 to 85 years. Individuals were instructed to perform as many steps in place as possible for two minutes with a knee elevation height (KH) at the midway point between the patella and iliac crest. Absolute (ABSsteps) and relative (RELsteps) steps, age-predicted maximum heart rate (pMHR), fatigue index, heart rate (HR), rate of perceived exertion (RPE), and estimated maximum oxygen consumption (VO
2
max) were evaluated at every 30-second interval.

Results:
ABSsteps (p<0.0001), HR (p<0.0001), pMHR (p<0.0001), and RPE (p<0.001) increased progressively over time, while RELsteps tended to be steady, except at 30s compared to 60 and 120s (p<0.0001). The percentage of the pMHR was 78 ± 11 at 60s and 85 ± 12 at 120s. The percentage of the VO
2
max reached at 60s was 76 ± 4 and at 90s was 110 ± 4. The RPE at 120s was 15 ± 2. Almost two out of every three individuals achieved at least one of the criteria (pMHR
>
85%, or RPE
>
17, or both) to reach maximal effort (N=201, 63%). Approximately seven out of every ten individuals experienced fatigue (N=174, 65%). About half of the fatigued individuals had a decrease in performance that exceeded 15% (N=77, 44%).

Conclusion:
Our study allows us to conclude that individuals experience a progressive physiological demand with a near-maximal effort during the modified step-in-place test. This procedure provides objective endpoints for exercise capacity and tolerance which can be used for various purposes, including drug development.
Abstract P015: Associations Of Physical Activity And Lactation Duration With Cardiometabolic Risk Factors: The Cardia Study
Authors: Lane Abbi , Whitaker Kara M , Tahir Muna , Barone Gibbs Bethany , Catov Janet M , Carnethon Mercedes R , Gunderson Erica P
Published: April 2022

Background:
Physical activity (PA) and lactation individually benefit cardiometabolic health. Joint associations of PA and lactation with cardiometabolic risk factors have not been described.

Methods:
We averaged PA across all attended exams and summed total lactation duration in 1,068 Black and White parous women who attended the Year 30 Coronary Artery Risk Development in Young Adults (CARDIA) examination. Two categories were created for PA (-PA: below median; +PA: ≥median) and lactation duration (-L: <3 months, +L: ≥3months). Participants were assigned to one of four groups based on PA patterns and cumulative lactation duration: -PA/-L, -PA/+L, +PA/-L, +PA/+L (most favorable). Cardiometabolic risk factors measured at Y30 were combined and standardized into a composite cardiometabolic risk score. We used linear regression to evaluate associations of group assignments with individual cardiometabolic risk factors and risk score. Covariates included age, race, study center, parity, education, smoking, medication use, alcohol consumption, baseline body mass index (BMI), and baseline diet quality.

Results:
Median PA=256 exercise units (IQR: 168-379), and 581 (54%) of participants reported cumulative lactation duration ≥3 months. Of the 1,068 participants, 303 were in the -PA/-L category, 231 in -PA/+L, 184 in +PA/-L, and 350 in +PA/+L. Participants in the +PA/+L category were older, had more years of education, lower BMI, gained less weight during follow-up, and were less likely to be Black versus the -PA/-L category. Mean cardiometabolic risk scores improved across categories and were not significantly different between -PA/+L and +PA/-L: -PA/-L: 0.23±0.04, -PA/+L: 0.08±0.04, +PA/-L: -0.02±0.05, +PA/+L: -0.23±0.03 all p≤0.08. After adjustment, +PA/+L assignment was associated with a lower (better) cardiometabolic risk score (β= -0.15, 95%CI: -0.25, -0.04) with no interactive effect of race, p=0.22. Associations were nonsignificant after accounting for 30-year change in BMI.

Conclusions:
Attaining above average PA combined with ≥3 months of lactation was associated with the most favorable cardiometabolic risk score in Black and White women. Participants who achieved either one of these behaviors had lower risk scores versus those with neither behavior. Attaining these levels of PA and/or lactation may reduce cardiometabolic risk in parous women due to less weight gain over time.
Abstract P021: Performance Of Pooled Cohort Equations And MESA Risk Score Across Race/Ethnicity And Socioeconomic Status To Estimate 10-year Cardiovascular Risk In Diverse New England Cohort
Authors: Zinzuwadia Aniket N , Li Chunying , Dashti Hesam , Chen Lin , Cade Brian , Karlson Elizabeth , Paynter Nina , Mora Samia , Demler Olga
Published: April 2022

Introduction:
The Pooled Cohort Equations (PCE) are the clinical standard for risk estimation of 10-year ASCVD risk, but they have not been extensively validated in minority populations or compared with newer risk estimation calculators such as the Multi-Ethnic Study of Atherosclerosis (MESA) 10-year CHD risk score.

Methods:
We collected 20-year electronic medical record data (1997-2017) from 34,138 patients in New England (age range in 2007: 55-75). These patients were not on statins and had no documented ASCVD event between 1997 and 2007. Cardiovascular risk factors were collected to calculate PCE and MESA (excluding coronary calcium) scores in 2007. 10-year incident ASCVD events were recorded using ICD codes (2007-17). Risk estimates were evaluated in the total population, race/ethnicity subgroups, and by socioeconomic status (SES) (quintiles of median community income).

Results:
Overall, PCE and MESA scores had similar discriminative performance (c-statistic: 0.69 vs. 0.70, p-value = 0.15). Both PCE and MESA scores had the best discriminative performance in whites and among individuals with top quintile SES relative to other racial and SES subgroups. In whites, MESA scores had better discriminative performance than PCE (c-statistic: 0.71 vs. 0.70, p-value = 0.005). PCE had higher discriminative performance for African Americans, Hispanics, and Asians but was not statistically significant. PCE and MESA scores had similar calibration metrics for whites but had differing degrees of calibration in African Americans (O to E: 0.79), Hispanics (O to E: 0.83), and Asians (O to E: 0.95) compared with MESA scores (O to E: African Americans: 1.17, Hispanics: 0.96, Asians: 1.51).

Conclusion:
While MESA and PCE have similar trends in discriminative performance across race/ethnicity and SES, they differed in calibration across minority groups. Clinicians should be cognizant of model performance differences across racial/ethnic and SES subgroups when using risk scores for determining preventive therapies such as statins.
Abstract P022: MS #279 - Use Of Dietary Supplements And Risk Of Chronic Kidney Disease In The Hispanic Community Health Study/Study Of Latinos (HCHS/SOL)
Authors: Mendoza Carmen E , Faurot Keturah R , Lash James , Sotres-Alvarez Daniela , Daviglus Martha L , Heiss Gerardo M
Published: April 2022

Background:
Dietary supplements (DS) are often used for their perceived health-promoting and therapeutic properties. Certain supplements can be nephrotoxic, especially among individuals at risk for chronic kidney disease (CKD). Hispanic/Latino populations are users of DS (30-70%) and have a high prevalence of conditions predisposing CKD. The potential contribution of DS use to risk of CKD in this population has not been studied.

Objective:
To assess whether DS use is associated with higher prevalence and incidence of CKD in Hispanic/Latinos.

Methods:
DS use was assessed in 16,279 of 16,415 Hispanic/Latinos enrolled in HCHS/SOL in 24-hour recall and 30-day medications inventory. Users of any DS were compared to those reporting no DS use. Prevalent CKD was defined with estimated glomerular filtration rate (eGFR) using the serum creatinine-cystatin C equation or urine albumin-to-creatinine ratio (ACR) ≥ 30 mg/g at baseline. Incident low eGFR and incident albuminuria at follow-up were defined as <60 mL/min/1.73 m
2
and ACR ≥ 30 mg/g, respectively. Incident CKD was defined as no prevalent CKD and incident low eGFR with eGFR decline ≥1ml/min/1.73 m
2
/year or incident albuminuria. We used multivariable logistic regression to estimate odds ratios (OR) for prevalence and Poisson regression for incidence rate ratios (IRR). Analyses accounted for HCHS/SOL complex sampling design.

Results:
DS users were older (median age 45 vs 35 years) and more likely to be female (57 vs 48%), have health insurance (54 vs 48%) and be born in the United States (26 vs 19%). Of DS users, 13% had prevalent CKD while 12% of non-DS users had prevalent CKD (adjusted OR 0.77 (95% CI 0.66, 0.91)). IRRs for incident CKD, low eGFR and albuminuria between users and non-users of DS were 1.0 (95% CI 0.84, 1.3), 0.87 (95% CI 0.61, 1.3), and 1.2 (95% CI 0.88, 1.6), respectively.

Conclusions:
DS use was associated with lower prevalent CKD at visit 1 and not associated with incident CKD, low eGFR or albuminuria at visit 2. DS use may be a proxy for health-seeking behavior in this population.
Abstract P027: COVID-19-Related Mortality And A Decline In U.S. Kidney Transplantation During The Second Year Pandemic
Authors: Tantisattamo Ekamol , Polpichai Natchaya , Mutirangura Pornthira , Tanariyakul Manasawee
Published: April 2022

Background:
Since COVID-19 treatment and immunization have been implemented, effects of COVID-19pandemic on kidney transplantations (KT) may be altered from the prior year. We aim to examine the association of COVID-19 cases and deaths with the change in the number of KT in 2022.

Method:
A cross-sectional study examined data of COVID-19 cases and death, and adult KT in the United States, retrieved from the CDC and the OPTN/SRTR, respectively. The association of the cumulative COVID-19 cases and deaths between 1/21/2020 and 10/11/2021 among 52 states in the United States and the difference in the number of KT between the year 2020 and 2021 (ΔKT) was examined by multiple linear regression.

Results:
Of 44,377,493 COVID-19 cases, 713,950 had COVID-19-realted death during the study period. Of all 52 states, 38,947 and 31,273 KT were performed in 2020 and 2021, respectively (mean
difference
±SEM 148±27, 95%CI 93, 202). Median (IQR) ΔKT
2020 - 2021
was 93 (26, 167). Compared to year 2020, every 10,000 increased COVID-19 cases and deaths were associated with a decrease in 2 and 102 KTs in year 2021, respectively (COVID-19 cases: β
coeff
0.00018, 95%CI 0.00016, 0.00021; Figure 1A and COVID-19 deaths: β
coeff
0.01020, 95%CI 0.00839, 0.01202; Figure 1B). After adjusted for categorized KT in 2020 (< or ≥ median KT in 2020 of 468), COVID-19 cases (< or ≥ median cases of 586,869) or COVID-19 deaths (< or ≥ median deaths of 16,635), and the interaction term between KT in 2020 and COVID-19 cases or deaths, the states with a higher COVID-19 cases (≥586,869 cases) had a decrease in 53 KT in 2021; whereas, there was a decrease in 212 KT among states with greater COVID-19 deaths (≥16,635 deaths; COVID-19 cases: β
coeff
53, 95%CI -291, 397, p
interaction
0.874 and COVID-19 deaths: β
coeff
212, 95%CI 96, 329, p
interaction
NS).

Conclusion:
The decline of KT in 2021 compared to 2020 is positively associated with COVID-19-related deaths, but not COVID-19 cases. This association is not modified by the number of KTs in 2020 and COVID-19 deaths in different states.
Abstract P031: Does The Place Of Residence Influence Your Risk Of Being Hypertensive? A Case Study From Nepal
Authors: Sharma Ishor , Campbell Karen , Were Jason M , Vargas-Gonzalez Juan Camilo , Stranges Saverio
Published: April 2022

Introduction:
Area level factors could be an independent risk factor for disease and negative health outcomes. Despite the multiple studies on risk factors for hypertension, area-level influence is poorly investigated especially in low- and middle-income countries.

Hypothesis:
This study aims to test the hypothesis that area-level deprivation (AD) is significantly associated with the risk of hypertension independent of individual risk factors in the context of Nepal.

Methods:
The study is based on the latest Nepal Demographic Health Survey conducted in 2016. The area-level deprivation index was constructed and validated based on the material (household assets, household structure), social and geospatial features. The index ranged from 52 to 146 with higher scores representing higher levels of deprivation. Individuals aged 15 and above were identified as hypertensive if they met any of the following criteria: i) systolic blood pressure ≥140 mmHg; ii) diastolic blood pressure ≥90 mmHg; iii) taking antihypertensive medication irrespective of their blood pressure readings during the survey; iv) history of earlier diagnosis of hypertension by any health care provider. Associations between the quartiles of AD and hypertension were investigated using two-level logistic regression. Further, potential cross-level interaction and mediated pathways between AD and hypertension were explored.

Results:
The overall prevalence of hypertension was approximately 23% of which nearly 50% were unaware of their high blood pressure status at the time of the survey. Individuals from the least deprived areas seemed to have higher odds of hypertension compared to highly deprived areas (Odds Ratio=1.54 (95% CI 1.26, 1.89); p-trend=<0.001). Literate individuals from deprived areas were likely to have a higher risk of hypertension compared to those without formal education. However, the association was not significant in the least deprived areas (p-interaction <0.001). Overweight/obesity seems to explain a significant magnitude of the indirect pathway (67%) between AD and hypertension in the context of Nepal.

Conclusion:
Residing in the least deprived or more affluent areas might increase an individual’s risk of being hypertensive. Association between individual risk factors and hypertension is likely to vary across the areas with varying levels of deprivation. These results seem paradoxical and are inconsistent with epidemiological data from high-income countries. Over-nutrition and changing lifestyle, driven by affluence and higher disposable income, could explain this counterintuitive association in the context of a country like Nepal which is undergoing a rapid socio-demographic and epidemiological transition.
Abstract P035: Seasonal Variations In Blood Pressure Control Among U.S. Adults With Hypertension, 2011-2018
Authors: Hwang Andrew Y , Smith Steven M
Published: April 2022

Introduction:
Blood pressure (BP) varies seasonally, typically manifesting as increased BP during the winter and reduced BP during the summer, that may contribute to difficulty in maintaining BP control among individuals with hypertension. We investigated seasonal differences in population-level BP control among U.S. adults with hypertension and whether such associations were modified by demographic and socioeconomic characteristics.

Methods:
We used cross-sectional 2011-2018 National Health and Nutrition Examination Survey (NHANES) data to identify participants aged ≥20 years with hypertension (defined as self-report, systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or antihypertensive medication use). Participants were categorized into two seasonal periods - winter-spring (November to April) and summer-fall (May to October) - based on their NHANES examination month. Survey-weighted logistic regression modeling was performed to analyze the association of BP control (<140/90 mmHg) with six-month seasonal period, adjusted for age, sex, race and ethnicity, income level, education level, and insurance status. Subgroup analyses were also performed, stratifying by demographic and socioeconomic characteristics.

Results:
Across all panel years, 4,350 participants had examinations in the winter-spring and 4,521 in the summer-fall season. Mean (SEM) systolic BP was significantly higher in the winter-spring season compared to the summer-fall season (136.2 [0.48] mmHg vs 134.7 [0.61] mmHg; p=0.02). A significantly lower proportion of participants had controlled BP during the winter-spring season compared to participants during the summer-fall season (50.7% vs 55.2%; unadjusted odds ratio [OR]: 0.84 [95% CI: 0.72—0.98]), though the association was modestly attenuated after adjusting for covariates (adjusted OR [aOR]: 0.88 [95% CI: 0.75—1.05]). Similar observations were seen among those taking antihypertensive medication (62.5% vs 67.7%; aOR: 0.83 [95% CI: 0.69—0.99]). Subgroup analyses in the overall hypertensive population did not reveal evidence of heterogeneity of effect across age, sex, race and ethnicity, income level, education level, or insurance status.

Conclusions:
Seasonal variations in population-level BP control were observed among U.S. adults with hypertension, with a lower prevalence of BP control seen among those on antihypertensive treatment during the winter-spring season than the summer-fall season. No demographic or socioeconomic characteristics appeared to be more susceptible to these seasonal variations.
Abstract P039: Low-density Lipoprotein Management In Patients With Peripheral Artery Disease With And Without Severe Hypercholesterolemia In A Largely Rural Population
Authors: Ross Lauren , Groth Nicole , Benziger Catherine P
Published: April 2022

Background:
Elevated low-density lipoprotein cholesterol (LDL) is associated with increased risk for peripheral artery disease (PAD) and major limb or adverse cardiovascular events. We aimed to compare the prevalence and appropriate lipid-lowering treatment of patients diagnosed with PAD with and without prior phenotypic severe hypercholesterolemia (SH) in a large, rural healthcare system.

Methods:
Retrospective study of ambulatory adults with a lipid panel at Essentia Health clinics obtained between 7/1/2016-6/30/2019 (MN, WI, and ND, USA) with PAD on the problem list (defined based on ICD-9/10 codes). Patients were divided into two groups, PAD only and PAD with SH. Phenotypic SH was defined as any prior LDL ≥ 190 mg/dL. Patients were excluded if they were currently pregnant (n=232) or if they did not have repeat LDL > 30 days apart (n=1684). High-intensity statin was considered atorvastatin 40mg or 80mg or rosuvastatin 20mg or 40mg daily.

Results:
A total of 10,874 patients were previously diagnosed with PAD (mean age 40.4 + 10.9, 43.3% female (N=4711), 58.1% rural (N=6319). A total of 13.6% (N=1484) had SH. Patients with PAD and SH were more likely to be female, urban, have prior acute limb ischemia, stroke/transient ischemic attack, and were less likely to have diabetes or chronic limb ischemia than patients with PAD only. Patients with PAD and SH were more likely to be on a high intensity statin than those with PAD only (65.8% (N=977) vs. 51.3% (N=4813); p<0.001). Very few patients received no lipid-lowering therapy (PAD with SH 0.7% (N=10) vs. PAD alone 2.1% (N=234). More patients with PAD and SH received PCKS9 inhibitors (2.5% (N=37) vs 0.4% (N=39); p<0.001) and ezetimibe (23.4% (N=347) vs. 8.1% (N=760); p<0.001) than patients with PAD only. Approximately 50% (N=749) of PAD with SH patients achieved a 50% lowering from peak LDL compared to 28.9% (N=2717) with PAD only. Mean LDL in the PAD with SH was 113.9 + 43.4 mg/dL compared to 81.8 + 29.1 mg/dL in patients with PAD without SH. However, fewer patients with PAD and SH achieved a LDL <70 mg/dL compared to those with PAD only (13.3% (N=197) vs 37.1% (N=3487), p< 0.001).

Conclusion:
One in 10 patients with PAD has a history of SH and majority are not achieving target LDL<70mg/dL. There is an urgent need for more aggressive lipid-lowering therapy for all patients with PAD.
Abstract P083: Predicting Dementia In Heart Failure And Atrial Fibrillation
Authors: Manemann Sheila M , Chamberlain Alanna M , Bielinski Suzette , Jiang Ruoxiang , Weston Susan , Roger Veronique L
Published: April 2022

Introduction:
The Framingham Heart Study Dementia Risk Score (FDRS) was developed in a general population of elderly individuals. It is unknown how the FDRS variables predict dementia in heart failure (HF) and atrial fibrillation (AF) populations. Thus, we aimed to evaluate the predictive ability of the FDRS variables in population-based cohorts of individuals with HF and AF and to determine whether the addition of other comorbidities and risk factors improves risk prediction for dementia.

Methods:
Residents aged ≥50 from 7 southeast MN counties with a first diagnosis of HF (ICD-9 428/ICD-10 I50) or AF (ICD-9 427.3/ICD-10 I48 with AF on electrocardiogram/Holter monitor) between 1/1/2013 and 12/31/2017 were identified. Patients with dementia (defined by ICD codes) prior to or within 6 months after their index event and patients who died within 6 months after index were excluded. For both cohorts, models were constructed to predict dementia ≥ 6 months post index including the variables in the FDRS (age, marital status, BMI, stroke/TIA, diabetes and cancer). Additional comorbidities and risk factors were added to the models. For all models c-statistics were calculated.

Results:
Among 3,291 patients with HF (mean age 76 years, 53% male), 626 cases of dementia occurred and among 4,107 patients with AF (mean age 74 years, 57% male), 736 cases of dementia occurred. Among patients with HF, the FDRS variables predicted dementia with a c-statistic of 0.68 (Table). Adding additonal comorbidities and risk factors impoved the c-statistic slightly to 0.69 (p=0.01). Among patients with AF, the FDRS variables also performed well (c-stastic: 0.73; Table) and adding other comorbidities and risk factors improved the performance (c-statistic: 0.75; p<0.01).

Conclusions:
The variables from the FDRS predict dementia well in both HF and AF populations. The addition of comorbidities and other CVD risk factors only modestly improved prediction, thus indicating that the FDRS variables are appropriate to predict dementia in patients with HF and AF.
Abstract P086: Endothelial Dysfunction Markers And Incident Chronic Kidney Disease In The Regards Cohort
Authors: Short Samuel , Wilkinson Katherine , Long Leann , Crews Deidra , Gutierrez Orlando M , Irvin Marguerite M , Wheeler Marsha , Cushman Mary , Cheung Katharine L
Published: April 2022

Background:
Much of chronic kidney disease (CKD) is unexplained by traditional risk factors. Endothelial dysfunction is highly prevalent in CKD and may be a potential target for reducing CKD incidence or progression. We sought to determine the association of plasma biomarkers of endothelial dysfunction with incident CKD in a large prospective cohort.

Methods:
REGARDS is a prospective population-based cohort of 30,239 Black and White US adults aged ≥45. Baseline biomarkers of endothelial dysfunction (plasma factor VIII, E-selectin, intercellular cellular adhesion molecule 1 (ICAM-1), and vascular cellular adhesion molecule 1 (VCAM-1)) were measured in individuals without CKD who attended a second visit a median of 9.4 years after baseline. Incident CKD was defined as eGFR <60 ml/min/1.73m
2
and a decline of 40%. We used sequential logistic regression models adjusted for confounders to assess associations and tested for interactions by each of age, sex, race, and diabetes.

Results:
After exclusions, we studied 3,300 participants (median age 62, 49% women, 46% Black, 50% hypertensive, 15% diabetic). 228 (6.9%) developed CKD by the second visit. Substantial interactions were observed for several markers, so stratified analyses were presented (Table). In minimally adjusted models, independent positive associations with CKD were seen with higher levels of each marker: factor VIII in White non-diabetics, E-selectin in women <65 years, ICAM-1 in all participants, and VCAM-1 in White men and women (Table). Final adjustment attenuated associations in some groups, but not all. Among the above minimally adjusted results, all associations remained independent after final adjustment except models for VCAM-1; trends for increased CKD with higher VCAM-1 were apparent in White women and Black men, but these were not statistically significant.

Conclusion:
Several plasma markers of endothelial dysfunction were highly relevant to CKD incidence in important subgroups, which may reveal insights into reducing the burden of CKD.
Abstract P087: Distinct Associations Between Abdominal Muscle Density And Area With N-terminal Pro-b-type Natriuretic Peptide Among Mesa Participants
Authors: Tristao Parra Maira , Sada Isaac , Gold Rebecca , Eastman Amelia , Vella Chantal A , Price Candice , Miljkovic Iva , Allison Matthew A
Published: April 2022

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is used to identify cardiac stress, manage, and treat cardiac disease progression, and diagnose heart failure (HF). Notably, this peptide is paradoxically lower in HF patients who are obese. In this regard, a growing body of evidence has investigated its association with body composition, but the relationship between NT-proBNP and muscle quality is unknown. Therefore, we investigated the associations between abdominal muscle volume and density with NT-proBNP. We conducted a cross-sectional analysis of participants from the MESA Abdominal Body Composition, Inflammation, and Cardiovascular Disease (ABC) ancillary study. At exams 2 and 3, participants underwent abdominal computed tomography (CT) scans and had venous blood drawn. Images were analyzed using software (MIPAV 41.2), and Hounsfield units (HU) were used to determine the density of muscle groups of interest (total abdominal muscle [oblique, rectus abdominus, paraspinus muscles, psoas], stabilization muscles [oblique, rectus abdominus, paraspinus muscle] and, psoas muscle). NT-proBNP was log-transformed due to the skewed distribution of the variable. Fat, lean, and total tissue areas were measured in square centimeters. Multivariable linear regression models were used to test the associations between muscle quantity and quality (area and density), separately, with adjustment for age, sex, race/ethnicity, diabetes, smoking, hypertension, moderate-to-vigorous (MVPA), sedentary behavior, height, subcutaneous fat, visceral fat, visceral fat density, leptin, adiponectin, CRP, IL-6, and TNF-alpha. We included 1,489 participants with a mean age 64.8 (9.6) years, and 51.6% were female. The majority were non-Hispanic White (42%), followed by Hispanics (26%), African Americans (18%), and Chinese Americans (14%). After full adjustment, stabilization muscle density was inversely associated with NT-proBNP (β = -0.024, 95% CI: -0.038, -0.010). The results were similar for total abdominal muscle density (β = -0.026, 95% CI: -0.042, -0.010) and psoas muscle density (β = -0.013, 95% CI: -0.026, -0.001). For the latter, addition of muscle area as a covariate attenuated the association β = -0.011, 95% CI: -0.025, 0.002). After minimal adjustment, multivariable models of total abdominal muscle and psoas muscle areas for NT-proBNP were inversely associated but became non-significant with the addition of inflammation biomarkers (leptin, adiponectin, CRP, IL- 6, and TNF-alpha) and muscle density. Area of stabilization muscles and NT-proBNP were not significantly associated. Abdominal muscle
area
and NT-proBNP were not consistently associated, whereas abdominal muscle
density
and NT-proBNP were robustly inversely associated independently of muscle area, sociodemographic characteristics, cardiovascular risk factors, and inflammation biomarkers.
Abstract P103: Perceived Stress, Social Support, And Blood Pressure In Urban Haiti
Authors: Lookens Pierre Jean , Yan Lily D , Rouzier Vanessa , Devieux Jessy G , GERBER Linda M , Apollon Alexandra , St-Preux Stephano , Metz Miranda , Deschamps Marie , Pape Jean William , Mcnairy Margaret
Published: April 2022

Introduction:
Stress is associated with multiple adverse health outcomes, including hypertension. The impact of stress on health may be moderated by social support. The distribution of stress, support, and their association with hypertension have not been well described in low-income countries that face severe poverty. Over the past decade, Haiti has suffered massive natural disasters including the 2010 earthquake, cholera outbreak, COVID-19 pandemic, and recurrent civil instability—all of which may act as prolonged stressors.

Hypothesis:
We assessed the hypotheses that 1) there are high levels of both stress and support in Haiti, and 2) high support would moderate the relationship between high stress and hypertension.

Methods:
We measured stress and social support using validated instruments in a population-representative cohort of adults living in urban Port-au-Prince, Haiti between March 2019 and April 2021. Stress was measured using the Perceived Stress Scale, while social support was measured using the Multidimensional Scale of Perceived Social Support. For visualization, continuous scores were categorized using equal-width groups (stress: low (1-5), moderate (6-10), high (11-16); support: low (7-21), low-moderate (22-35), moderate (36-49), moderate-high (50-64), high (65-77)). Linear regression models were used to quantify the associations between: 1) stress and support adjusting for age and sex, 2) blood pressure and stress adjusting for age and sex. A formal moderation analysis was conducted to assess if support moderated the relationship between stress and blood pressure.

Results:
Among 2,817 adults, 59.7% female and the median age was 40 years (IQR 28-55). The majority had an income of less than 1 US dollar a day (69.7%). The median stress score was 8 out of 16 points, and median support score was 61 out of 77 points. Stress was higher with older ages (60+ years versus 18-29 years: +0.79 points, 95% CI 0.51 to 1.08) and in females (+0.85 points, 95% CI +0.65 to +1.06). Support was higher in males (+3.29 points, 95% CI 2.19 to 4.39). Support was inversely associated with stress, adjusting for age and sex (-0.04 points, 95% CI -0.04 to -0.03). Stress was not associated with systolic or diastolic blood pressure after adjustment for age and sex. Support did not moderate the association between stress and blood pressure.

Conclusion:
In this urban cohort of Haitian adults living with chronic civil instability, stress was moderate and support was high. While support was associated with lower stress, it did not moderate the relationship between stress and blood pressure. Despite the high levels of instability in Haiti, participants displayed resiliency through high levels of support, which may be an underutilized resource in reducing stress and long-term negative health outcomes.
Abstract P108: Natural Language Processing Extracted Social And Behavioral Determinants Of Health And Newer Glucose-lowering Drug Initiation Among Real-world Patients With Type 2 Diabetes
Authors: Guo Jingchuan , Wu Yonghui , Guo Yi , Chen Aokun , Yu Zehao , Yang Xi , Magnani Jared W , Hernandez Inmaculada , O'Neal LaToya , Shenkman Elizabeth , Bian Jiang
Published: April 2022

Background:
Sodium-glucose cotransporter-2 inhibitors (
SGLT2i
) and glucagon-like peptide-1 receptor agonists (
GLP1a
) are two newer glucose-lowering drugs (
GLD
) that can reduce cardiovascular disease (
CVD
) risk in patients with type 2 diabetes (
T2D
). Yet, uptake of these newer drugs remains low, especially among racial minority groups. Prior studies evaluating factors associated with underuse of SGLT2i/GLP1a primarily relied on claims or structured electronic health records (
EHR
) data, which contain little information on patients' social and behavioral determinants of health (
SBDoH
). We hypothesized that SBDoH would affect the use of these cardioprotective drugs among real world patients with T2D.

Methods:
EHR from University of Florida Health system were used to identify T2D patients who initiated a second line GLD in 2015-2020. We used a deep learning based natural language processing (NLP) pipeline to extract SBDoH from clinical notes: employment, housing, marital status, smoking, alcohol use and drug use. We constructed a multilevel logistic regression to determine the association of race/ethnicity and SBDoH with initiation of SGLT2i/GLP1a versus other second line GLDs, including zip codes as random effect and adjusting for clinical factors.

Results:
Of 2,964 patients in the cohort, mean age was 59 (14) years and 56% were females. In the adjusted model (
Table
), Black race, male sex, unemployment, housing insecurity, being unmarried, smoking, and drug use were associated with lower likelihood of initiating SGLT2i/GLP1a. In subgroup analyses by race, housing insecurity was only a risk factor for non-initiation of SGLT2i/GLP1a among Black patients, and smoking and drug use were only risk factors for White patients.

Conclusion:
Social and behavioral risk factors contribute to racial disparities in access to novel GLDs. Advanced NLP methods and EHR data enabled us to investigate the social risk associated with real-world treatment access.