bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P430: Educational Attainment, Adherence to Healthy Lifestyle, and Risk of Cardiovascular Diseases
Authors: Li Xiang , Zhou Tao , Ma Hao , Sun Dianjianyi , Heianza Yoriko , Manson JoAnn , Qi Lu
Published: March 2020

Introduction:
Lower educational attainment is one of the major socioeconomic factors contributing to cardiovascular diseases (CVD); higher education tends to be associated with healthier behaviors and lower risk of CVD. However, whether education plays a causal role in adherence to a healthy lifestyle, and if there is causality, how much of the education-CVD association is mediated by the lifestyle factors, has not been established.

Methods:
A healthy lifestyle score was constructed on body mass index, smoking status, physical activity, and diet. The causal relations between educational attainment and adherence to a healthy lifestyle was assessed by two-sample Mendelian Randomization analyses using summary statistics for single nucleotide polymorphisms (SNPs) identified from a genome-wide association study (GWAS) of educational attainment (N=1,131,881) and the UK Biobank cohort (N=425,770). We further performed mediation analyses to quantify the effect of educational attainment on the risk of CVD through healthy lifestyle among 386,442 participants in UK Biobank.

Results:
We found a significant positive causal relationship between years of education and adherence to a healthy lifestyle, independent of age, sex, alcohol intake, and person’s socioeconomic status. In addition, we found that adherence to favorable lifestyle mediated a 42.1%, 40.3%, and 33.5% reduction in the incidence of coronary heart disease (CHD), CVD events, and CVD mortality, respectively (all
p
<0.05).

Conclusions:
Our results indicate that educational attainment is causally associated with adherence to a healthy lifestyle, which in turn, mediates a significant proportion of the effect of educational attainment on cardiovascular events.
Abstract P438: The Impact of a Yearlong Diabetes Prevention Program-based Lifestyle Intervention on Cardiovascular Health Metrics
Authors: Devaraj Susan , Rockette-Wagner Bonny , Arena Vincent , Miller Rachel G , Napoleone Jenna , Conroy Molly , Kriska Andrea M
Published: March 2020

Introduction:
The AHA created “Life’s Simple Seven” metrics to measure progress toward the goal of improving the cardiovascular (CV) health of all Americans, classifying each metric as “ideal”, “intermediate,” or “poor”. Few studies have examined the impact of behavioral lifestyle interventions on CV health metrics. We evaluated changes in CV health metrics during the course of a CDC recognized Diabetes Prevention Program-based lifestyle intervention known as Group Lifestyle Balance (DPP-GLB).

Hypothesis:
DPP-GLB will be associated with improvements in CV health metrics after 6 months of intervention and maintenance of these improvements at 12 months post-baseline.

Methods:
We used combined data from two similar intervention trials (occurring 6 years apart) offering a 12 month DPP-GLB program in the community setting to overweight/obese individuals with prediabetes and/or metabolic syndrome. Changes in individual CV health metrics (BMI, blood pressure, total cholesterol, fasting blood glucose, physical activity; measures of smoking and diet were not available) and total metric score (sum of metric profile where ideal=2, intermediate=1 and poor=0 for each metric, possible “total “range of 0-10) were considered after 6 and 12 months of intervention.

Results:
Among 222 participants (76%) with complete data for all 5 metrics at intervention baseline, 6 and 12 month follow up, there was a significant beneficial shift from baseline to 6 and 12 months in the proportion of participants within CV health metric categories for BMI, physical activity and blood pressure (Figure 1). Total metric score also improved significantly (p<0.01, signed-rank test) at 6 [median (IQR) change: +1.0 (0-1.0)] and 12 months [median (IQR) change: 0.0 (0-1.0)]. Significant improvement was also seen in the median number of ideal metrics at 6 and 12 months (p<0.01 for both).

Conclusions:
The DPP-GLB intervention was successful in improving CV health metrics at both 6 and 12 months, demonstrating the potential of this program to decrease CVD risk.
Abstract P447: Index of Concentration at the Extremes and Diabetes Prevalence: The Reasons for Geographic and Racial Differences in Stroke (regards) Study
Authors: Malla Gargya , Long D. Leann , Black Nyesha C , Zhu Sha , Uddin Jalal , Cherrington Andrea , Dutton Gareth R , Safford Monika M , Cummings Doyle M , Judd Suzanne E , Levitan Emily B , Carson April P
Published: March 2020

Background:
Stark regional and racial disparities in diabetes prevalence exist in the US. Community-level factors (e.g., median income) have been associated with higher diabetes prevalence. However, few studies have investigated how community-level spatial polarization, specifically in race and income, may relate to diabetes burden.

Objective:
To investigate the association between the Index of Concentration at the Extremes (ICE), a measure that reflects polarization in race and income at the community-level, and individual-level diabetes prevalence.

Methods:
This analysis included 24,752 Black and White adults age
≥
45 years at baseline (2003-2007) from the REGARDS Study. The ICE measure quantifies the concentration of community affluence and poverty in a census tract using both income and race jointly, with values ranging from -1 (most deprived) to +1 (most privileged). Diabetes was defined as fasting glucose
≥
126 mg/dL or random glucose
≥
200 mg/dL or use of diabetes medication. Modified Poisson regression was used to obtain prevalence ratios and 95% CI for the association of ICE quartiles with prevalent diabetes.

Results:
The overall prevalence of diabetes was 21% and was highest for adults living in the most deprived census tracts (28.3%) and lowest for those living in the most privileged census tracts (12.5%). The association between ICE and prevalent diabetes was graded in crude analyses but attenuated after adjustment for individual-level sociodemographic, lifestyle and clinical factors (Table).

Conclusion:
Communities with greater polarization in race and income had a higher burden of diabetes. This association was mostly explained by individual-level socioeconomic and lifestyle factors. Further investigation of community-level attributes and how they relate to individual-level factors that increase diabetes risk is needed.
Abstract P465: Standardizing Hypertension Management In A Primary Care Setting In India Through A Protocol Based Model
Authors: Satish Priyanka , Khetan Aditya , Raithatha Shyamsundar , Josephson Richard A
Published: March 2020

Hypertension is a leading cause of death in India. There are numerous barriers to adequate management of hypertension in Indian healthcare settings, including therapeutic inertia and the lack of a systematic approach. Standardizing hypertension management through an evidence based model that sets thresholds for diagnosis, treatment goals, follow up intervals and choice of drugs can lead to improved management of hypertension in an individual hospital or health system. We describe the design of a model that focuses on efficacy, safety and ease of use by healthcare providers with different levels of training. The algorithm endorses a urine albumin first approach in deciding the course of antihypertensive therapy. Providers undergo training in the implementation of this model using a training guide and handout developed for this purpose. The algorithm itself can be utilized as a point of care reference by individual practitioners, hospitals, primary health centers (PHCs) and the Health and Wellness Centers (HWCs) under the Ayushman Bharat initiative. We plan to evaluate the effectiveness of our model at Shree Krishna Hospital, Gujarat, India through a quality improvement framework. The algorithm is designed to allow adaptability to individual institutional requirements in India (and similar low and middle income countries) while standardizing the basic elements of hypertension management.
Abstract P466: Health and Healthcare Disparities in the Management of Systemic Hypertension and Cardiovascular Disease: The Critical Role of Insurance Status
Authors: Okoh Alexis K , Meledathu Sherin , Jackson Dara , Gold Justin , Engell Christian , Bustillo Jose , Residents IM
Published: March 2020

Background:
Minority populations are two to three times as likely to die of preventable cardiovascular events. Two main forces behind the challenge in managing hypertension among minority populations are disparities in health and healthcare.

Aims:
To identify the common health and healthcare disparities (HHD) among hypertensive patients who presented to a community medical center and propose a collaborative alliance for improvement.

Methods:
Internal medicine residents at the Newark Beth Israel Medical Center utilized a (P: Provider, I: Insurance, F: Food, E: Economic stability, N: Neighborhood, C: Culture and Language, E: Education, S: Social (PI-FENCES) model to identify health and health care disparities in hypertensive patients who presented to the ambulatory and inpatient settings over a 12-week-period. Demographic and baseline clinical characteristics were recorded. The distribution of each of the elements of PI-FENCES was documented and their association with respective demographics was determined. A protocol for usability study was designed based on preliminary data collected.

Results:
Between May 2019 and July 2019, a total of 86 hypertensive patients (mean ± SD age: 54 ± 12 years, BMI: 31± 8 kg/m
2
) were identified. Seventy-one (83%) of them were African Americans. Of the patients identified, 51 (59%), presented to the ambulatory setting, 24 (28%) were seen in the in-patient setting and 11 (13%) were admitted to the Intensive care unit. According to the PI-FENCES model, distribution of HHD were as follows: n(%); P: 6 (6.9%), I: 40 (47%), F: 8(9.3%), E: 10 (11.6%), N: 1 (1.2%), C: 10 (14%), E: 26 (30.2%), S: 17 (19.7%). While 61 (71%) patients had at least 1 element of HHD, 9 (1.1%) had more than 2 elements of HHD. Associated cardiovascular conditions noted among admitted patients (n=35) were heart failure exacerbation (n=8) (22%) and cerebrovascular accident (n=4) (11%). Compared to patients with insurance, patients with no insurance were more likely to be admitted to the inpatient service or intensive care unit (Insurance: 31% vs. No insurance: 69%, p<0.0001). Based on the preliminary data, a Reducing ReAdmission Secondary to Hypertension (RRaSH) proposal will be implemented. RRaSH will focus on developing follow-up and referral plans for all uninsured hypertensive patients who present to the in-patient setting. The program will also encourage free health screening of families and friends of this uninsured population.

Conclusion:
About one out of every two patients who presented with systemic hypertension to a community medical center had no insurance. Compared to patients with insurance, patients with no insurance were more likely to be admitted to the inpatient service or intensive care unit. RRaSH will be a follow-up and referral plan to help reduce readmissions secondary to hypertension.
Abstract P472: Addressing Hypertension and Cardiovascular Disease in South Asian San Joaquin Population
Authors: Siddiqui Maha
Published: March 2020

Introduction:
South Asians have a higher death rate than any other population for cardiovascular disease (CVD) and high blood pressure (HBP). San Joaquin has a growing rate of South Asians immigrants who may be at risk for CVD.

Objectives:
Trainees conducted hypertension and CVD screenings at South Asians religious organizations to reduce the risk of CVD and spread awareness about the factors that lead to CVD and its implications in the South Asians population due to environmental racism in the most underserved county for health care, San Joaquin.

Methods:
I trained low-income minority high school students to conduct weekly blood pressure screenings and serve as a health technology coach by each student monitoring 2 hypertensive patients of 48 hypertensive or at risk hypertensive and low-income San Joaquin residents and constantly stressed, and at risk for CVD. CVD screenings were conducted at all San Joaquin gurdwaras and mosques to spread awareness about heart health and track hypertension in the South Asians community.

Findings:
-61.7% of the South Asian population of San Joaquin are at risk for CVD

-3.3% of the South Asian population of San Joaquin are hypotensive

-28.6% of the South Asian population of San Joaquin are Stage 1 hypertensive

-29.7% of the South Asian population of San Joaquin are Stage 2 hypertensive

-38.3% of the South Asian population of San Joaquin have normal blood pressure but consume red meat more than 4 times a month

Direct Outcomes of Events:

-Development of self-advocacy in the South Asian community. Community members became activists for their own heart health.

-Increased participation of youth, in an otherwise adult dominant environment (i.e. the mosques and gurdwaras).

-Increased awareness of CVD, hypertension, hypotension, and periodontal disease (PD) among the South Asian community.

-Increased participation by youth and adults on activities such as games, challenges and information booths dispensing awareness on CVD and PD.

-Increased interaction between community members of different religions, creed, and socioeconomic backgrounds.

-Awareness, education among the South Asian community for better heart and oral health

-Diagnoses and referrals of suspected cases of hypertension and CVD

-Improved patient-provider trust

-San Joaquin high school students trained for community outreach events and determined to address CVD.

-Youth learned the value of empathy, multiculturalism, and service to disadvantaged communities through the program and volunteering.
Abstract P476: Consumption Of Animal And Plant Food And Likelihood Of Left Ventricular Diastolic Dysfunction: A Prospective Study Among Black And White Adults Of The Bogalusa Heart Study
Authors: Razavi Alexander C , Bazzano Lydia A , He Jiang , Fernandez Camilo , Whelton Seamus P , Krousel-Wood Marie A , Ley Sylvia H , Qi Lu , Potts Kaitlin S , Harlan Timothy S , Kelly Tanika N
Published: March 2020

Introduction:
Left ventricular diastolic dysfunction (LVDD) is one key subclinical precursor of heart failure with preserved ejection fraction (HFpEF). Whether dietary correlates serve as independent predictors of LVDD in adults without HFpEF is unknown.

Hypothesis:
We hypothesized that dietary habits in young adulthood would prospectively influence the likelihood of LVDD in middle age.

Methods:
The analysis included 456 individuals of the Bogalusa Heart Study (26.5% black, 62.7% female, baseline age=36.1
+
4.4 years) with an ejection fraction
>
55%. Diet was measured at baseline via food frequency questionnaires. LVDD was defined at follow-up (median=12.9 years) through echocardiographic measurement of the E/A ratio, E/e’ ratio, isovolumic relaxation time, and deceleration time. Logistic regression estimated the odds of LVDD according to protein source, adjusting for cardiovascular disease risk factors and total energy intake.

Results:
There were 72 cases of LVDD. Using the lowest tertile as reference, persons in the middle tertile of total protein (OR=3.31, 95% CI: 1.47, 7.46; p=8.5x10
-3
) and animal protein (OR=2.93, 95% CI: 1.35, 6.37; p=0.03) intake had the highest likelihoods of LVDD. We observed 54% and 57% lower odds of LVDD for persons in the highest vs. lowest tertile of vegetable (OR=0.46, 95% CI: 0.22, 0.95; p=8.0x10
-4
) and legume consumption (OR=0.43, 95% CI: 0.20, 0.92; p=0.02), respectively. Total protein, animal protein, processed meat, and eggs indicated a significant quadratic trend towards increased odds of LVDD, while legumes and vegetables indicated a significant quadratic trend toward decreased odds of LVDD (
Table
). There were no significant relationships of LVDD with other animal or plant foods.

Conclusions:
Animal and plant food consumption result in an increased and decreased likelihood of LVDD, respectively. Adherence to plant-based diets in young adulthood may protect against the development of LVDD, and thus future HFpEF, later in life.
Abstract P478: Trends in Concurrent Heart Failure and Acute Coronary Syndrome Hospitalizations: A Literature Review
Authors: Godfrey Sarah , Cohen Laura , Hennessy Susan , Bellows Brandon
Published: March 2020

Purpose:
Patients who present with concurrent heart failure (HF) and acute coronary syndrome (ACS) have an increased risk of mortality, but changes in clinical practice have improved clinical outcomes. We sought to examine recent trends in concurrent HF and ACS hospitalizations in the United States (US) through review of published literature.

Methods:
We searched the Medline and PubMed databases for studies published after January 1, 2000 reporting the hospitalizations for HF with concurrent acute coronary syndromes. We included studies performed in the US or with at least 25% US participants, that reported the proportion with concurrent HF and ACS, and used a clinical definition of HF (e.g. Killip Class II or III, NYHA Class, or Framingham Criteria). Studies were reviewed by and data was extracted using a standardized form. We extracted study and patient characteristics, definition of HF, and rates of concurrent HF and ACS hospitalizations. We categorized included studies by ACS type: (1) non-specific myocardial infarction (MI) or ACS, (2) non-ST elevation (NSTE) MI or NSTE-ACS, or (3) ST elevation (STE) MI. We descriptively examined recent trends in hospitalizations for concurrent HF and ACS over time; rates reported for multiple time periods or ACS types were considered separately.

Results:
We identified 23 observational studies, systematic reviews, and randomized clinical trials. Of these, we excluded 13 due to non-US populations, use of non-clinical definitions of HF (i.e., diagnosis codes), or not reporting rates of concurrent HF and ACS. Of the 10 included studies, 7 reported concurrent HF with non-specific MI or ACS from 1975 through 2005 across multiple registries and literature reviews. Rates ranged from 12.5% to 48.0% with no clear time-related trends. We identified 3 studies reporting concurrent HF with NSTEMI or NSTE-ACS from pooled analysis or the Global Registry of Acute Coronary Events (GRACE) registry from 1994 to 2008. Reported rates ranged from 8.2%-15.7% for studies starting in the 1990s with one study reporting and 6.1% in 2005. We identified 4 studies reporting concurrent HF with STEMI, including a pooled analysis, the GRACE registry, and a clinical trial. Rates of concurrent HF with STEMI appeared to decrease over time from 32.5% in 1990 to 1998, 15.6%-19.5% from 1999 to 2001, and 2.6%-11.0% in 2005.

Conclusion:
Our literature review found that there may be a decrease in concurrent HF and STEMI hospitalizations in recent decades, but no apparent trends with other types of ACS. This may be related to emphasis on early revascularization strategies, improved primary prevention, and/or earlier time to presentation due to increasing public awareness.. However, there was a dearth of data reporting concurrent HF and ACS hospitalization within the last decade. Further research is needed to understand the impact of multiple changes in clinical practice on secular trends.
Abstract P479: Feasibility Study to Compare Heart Failure Risk Prediction Tools in the Emergency Department
Authors: Scott Andrew , Chronowski Kevin , Peddireddy Snigdha , Fatima Sarah , DeBarmore Bailey , Chang Patricia , Byku Mirnela , Platts-Mills Timothy F , Quackenbush Eugenia , Jonsson-Funk Michele , Meyer Michelle L
Published: March 2020

Background:
In United States (US) emergency departments (ED), ~80% of patients presenting with exacerbation of heart failure (HF) symptoms are admitted to the hospital. However, some patients are at low-risk of adverse outcomes and might be effectively managed as outpatients. While ED HF risk prediction tools guide admission or discharge decisions, they have not been compared, are not routinely used in EDs, and do not include patient-reported outcomes that may be associated with prognosis.

Objective:
To assess the feasibility of collecting variables for three published ED-based HF risk prediction tools (table) and the capacity to collect participant-reported outcomes.

Methods:
We screened a convenience sample of patients age ≥20 years with symptoms of HF (e.g. shortness of breath, edema) receiving care in a US ED. We collected information from medical records, and administered a questionnaire to collect patient-reported outcomes and a 3-minute walking test. We developed a safety protocol to identify participants ineligible for the walking test.

Results:
We screened 66 patients and consented 31 (47%) participants. The average age was 61 years, 6 (19.4%) were female and 28 (90.3%) were admitted. We completed all the questionnaires with an average time of 31 minutes. For the walking test, 15 were ineligible per the safety protocol, 6 completed the test, and 10 did not consent. For the three HF tools, we collected an average of 93.4% of the variables needed per participant (range across tools 91.4%-97.7%; Table). The main missing variables were BMI on ED arrival (n=23) and troponin (due to hemolyzed values, n=5).

Conclusion:
We obtained complete data for the participant questionnaires, yet there were missing values for variables needed for the HF tools. The Emergency Heart Failure Mortality

Risk Grade tool had the most complete data. If a research or clinical study plans to use these tools, the study protocol should include BMI and troponin measurements and consider alternative strategies to collect data, such as by self-report.
Abstract P501: Mobile Daily Physical Activity and Fall Risk Monitor for Lifestyle Management, Disease Prevention and Risk Alert Generation
Authors: Zhang Qingxue
Published: March 2020

Mobile health monitoring is driving many smart health innovations. In this research, we focus on the daily physical activity and fall risk monitoring, for intelligent activity tracking and fall risk detection purpose. Physical activity is of a tremendous value to cardiac and brain health, and has been widely agreed as a metric to improve human health, foster healthy lifestyle, and mine the impacts on diverse health issues. The risk of death can actually be lowered by 20 to 30% with moderate activities for one and half an hour per week (WHO). Besides, fall risk detection is also of huge importance since each year, there are 29% of older adults having around 29 million falls and causing 7 million fall injuries (CDC). The challenge we target is how to accurately recognize diverse physical activities and fall patterns from the biomechanical dynamics sensed by the phone. More specifically, the phone sensor is leveraged to provide real-time always-on streaming of biomechanical dynamics. Then, the data is learned by a deep learning framework (long short-term memory) for activity type and fall pattern recognition. To consider real-world scenarios, the users can put the phone in either left or write waist pockets. The users have performed 9 different kinds of activities such as walking, standing up, going upstairs and jumping, as well as 8 different kinds of fall patterns such as falling backward, sitting and falling, and falling forward with protection. A total of 11,770 activities performed by 30 subjects aging from 18 to 60 have been used to evaluate the framework, yielding an accuracy as high as 95.4%. This encouraging result shows the potential of the mobile monitor in real-world application scenarios.
Abstract P504: Quality Validation Of Different ECG Leads, And An Automatic P-wave Detection Algorithm For Af, Based On Real-world Data
Authors: Samuelsson Magnus , Olsson Åke
Published: March 2020

Background:
Single-lead ECG has shown in research to be affected by artifacts leading to lower diagnostic yield of Atrial Fibrillation (AF). Use of multiple ECG leads and algorithms for detection of AF has shown to increase detection accuracy and reduce false positives.

Methods:
A novel RR- and P-wave based automatic algorithm implemented in the 2-lead Coala Heart Monitor (Coala) was evaluated for detection accuracy and quality by the comparison to blinded manual ECG interpretation. Evaluation was conducted on 100 consecutive anonymous printouts of chest- and thumb-ECG waveforms, where both an irregular RR-rhythm and strong P-waves in either chest or thumb recording were detected.The recordings, without exclusions, were generated from 5,512 real-world data recordings from actual Coala users in Sweden (both OTC and Rx users) during the period of March 5 to March 22, 2019, with no control or influence by the researchers or any other organization or individual. The prevalence of cardiac conditions in the user population was unknown. The blinded recordings were each manually interpreted and assessed for quality by a trained cardiologist. The manual interpretation was compared with the automatic analysis performed by the cloud-based detection algorithm to determine the detection quality of the respective ECG leads.

Results:
Strong P-waves were detected more often in the chest ECG as compared to the thumb ECG (90 vs 32 recordings). The assessed quality of the ECG tracings was higher in the chest ECGs as compared to the thumb ECGs (4.61 vs 3.88). Irregular RR-rhythms were detected in 569 recordings (10 % of a total of 5,512 recordings), the 100 non-AF recordings containing both irregular RR-rhythms and strong P-waves thus constituted 18% of all recordings with irregular RR-rhythms. Non-pathological rhythm (normal) was present in 84% of the recordings although all of these recordings contained irregular rhythm disturbances (respiratory sinus arrhythmia, PAC/PVC etc). Respiratory sinus arrhythmia was the single most prevalent condition and found in 47% of the recordings with irregular RR-rhythms with strong detected P-waves.

Conclusion:
The combination of chest and thumb ECG for detection of AF by an automatic P-wave based algorithm is shown to be more than 300% superior to thumb ECG alone with the majority of automatically detected P-waves and highest assessed ECG quality in the chest recordings.
Abstract P509: Olive Oil Consumption and Risk of Cardiovascular Disease
Authors: Guasch Marta , Liu Gang , Li Yanping , Sampson Laura , Manson Joann E , Salas-Salvado Jordi , Martinez-Gonzalez Miguel A , Stampfer Meir J , Willett Walter , Sun Qi , Hu Frank B
Published: March 2020

Background:
Olive oil intake has been associated with lower risk of cardiometabolic risk factors in Mediterranean populations, but little is known about these associations in the U.S. population, where olive oil intake is relatively low.

Objectives:
To examine whether olive oil intake is associated with total Cardiovascular Disease (CVD), coronary heart disease (CHD) and stroke risk.

Methods:
We included 63,867 women from the Nurses’ Health Study (1990 to 2014) and 35,512 men from the Health Professionals Follow-up Study (1990 to 2014) who were free of cancer, heart disease, and stroke at baseline. Diet was assessed using food frequency questionnaires at baseline and then every 4 years. Cumulative average of intake was used in the primary analysis. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals.

Results:
During 24 years of follow-up, we documented 10,240 incident cases of CVD, including 6,270 CHD cases and 3,970 stroke cases. After adjusting for major diet and lifestyle factors, compared with non-consumers, those with higher olive oil intake (>1/2 tablespoon/d or > 7g/d) had 15% lower risk of total CVD [pooled hazard ratio (95% confidence interval): 0.85 (0.77, 0.93)] and 21% lower risk of CHD [pooled hazard ratio (95% confidence interval): 0.79 (0.70, 0.89)]. No significant associations were observed for total stroke or ischemic stroke. We estimated that replacing 5g of margarine, butter, mayonnaise, or dairy fat with the equivalent amount of olive oil was associated with 5-7% lower risk of total CVD and CHD. No significant associations were observed when olive oil was compared with other plant oils combined (corn, safflower, soybean and canola oil).

Conclusions:
Higher olive oil intake was associated with a lower risk of CHD and total CVD in two large prospective cohorts of U.S. men and women. The substitution of margarine, butter, mayonnaise, and dairy fat with olive oil might lead to a lower risk for CHD and CVD.
Abstract P524: Protein Biomarkers Mediate the Association Between Diet Quality and Incident Cardiovascular Disease and All-cause Mortality
Authors: Ma Jiantao , Lu Sophia , Ho Jennifer E , Yao Chen , Huan Tianxiao , Levy Daniel
Published: March 2020

Objectives:
Molecular mechanism underlying diet and cardiovascular disease (CVD) remains unclear. We aimed to examine the association between habitual diet and protein biomarkers and test whether these proteins mediate the association between diet and incident CVD and mortality.

Methods:
We included 6,596 participants (mean age 50 years; 54% women) of the Framingham Heart Study. A panel of 71 CVD-related circulating protein biomarkers were measured using a modified Sandwich ELISA method, multiplexed on a Luminex xMAP platform. We used three diet scores to represent overall diet quality: Alternate Health Eating Index (AHEI), a Mediterranean-style Diet Score (MDS), and the Dietary Approaches to Stop Hypertension (DASH). Primary outcomes were incident CVD (coronary heart disease, myocardial infarction, stroke, and others), CVD death, and all-cause mortality with median follow-up 14 years.

Results:
After adjusting for sex, age, and energy intake, 40 proteins were associated with at least one diet score at P <0.0007 (Bonferroni correction for 71 proteins) and with P <0.05 for the other diet scores. Additional adjustments for smoking status, physical activity level, and alcohol intake did not materially change these associations. Further adjustment for BMI attenuated association; however, the association remained significant for 36 of 40 proteins (P <0.001 with at least one diet score). Pathway analysis using coding genes of the 36 diet-associated proteins showed, after Bonferroni correction, enrichment of 157 Gene Ontology (GO) biological processes such as regulation of immune response (GO:0050776; P=0.003) and regulation of vasoconstriction (GO:0019229; P=0.03). All three diet scores were significantly associated with incident CVD and all-cause mortality. Among the 36 diet-associated proteins, four proteins (GDF15, UCMGP, ADM, and sICAM1) significantly mediated the association between at least one diet score and all-cause mortality at P <0.001 and with P <0.05 for other diet scores, after adjustment for covariates including BMI and cardiometabolic risk factors at baseline. GDF15 significantly mediated the association of diet scores and incident CVD (fatal and nonfatal). The proportion of mediation by GDF15 ranged from 11% to 21% for diet scores and incident CVD and from 30% to 34% for diet scores and all-cause mortality. In addition, we observed that nine proteins were nominally significant in mediation analyses for incident CVD or all-cause mortality (0.001< P <0.05).

Conclusions:
The present study demonstrates that diet quality is associated with 36 of 71 selected CVD-related circulating protein markers. Our study sheds light into potential pathways underlying the association of diet and CVD and mortality.
Abstract P530: Health Beliefs Shaped by Experiences of Socioeconomic Deprivation and Psychosocial Distress is Critical to Maintaining Lifestyle Choices for Reducing Stroke Risk: A Mixed Methods Analysis
Authors: George Shwetha A , Krishnamurthi Rita V , Barker-Collo Suzanne , Feigin Valery L
Published: March 2020

Introduction:
9 out of 10 stroke events are attributable to modifiable (including lifestyle) risk factors. Therefore, long-term
preventative health behaviour changes (PHBCs)
is critical for reducing stroke incidence. However, current, New Zealand (NZ) education-based behavioral interventions report a high participant non-response rate or relapse into risk-behaviours within 6 months. In this regard, this study is the first to explore influences of psychosocial distress, socioeconomic deprivation and health beliefs influences on motivation for initiating/maintaining PHBC in the NZ population.

Methods:
(1) Qualitative interviews were conducted with 40 NZ participants recruited from the
Reducing the International Burden of Stroke Using Mobile Technology
E-health research program. Participants' perceived stroke susceptibility, barriers to/benefits of PHBCs and managing psychosocial distress were explored. Recorded and transcribed interviews were then thematically analysed. (2) Quantitative: 200 participants completed questionnaires on dietary habits and food choice motivations. Hierarchical regression modelling was performed to evaluate influences of socioeconomic deprivation on food choices.

Results:
(1) Participants acknowledged the beneficial effects of PHBCs in reducing stroke risk. Notwithstanding, performing PHBC during chronic stress/anxiety was challenging due to the instant, short-term relief gained through risk behaviours. Interactions with peers who actively engaged in risk behaviours and inadequate support systems limited self-efficacy in sustaining PHBCs. Mitigating future health risks and being a positive role model were some of the perceived benefits of maintaining PHBCs. (2) The degree of individual deprivation significantly predicted consumption of risk reducing foods (e.g., fruits) (F(4,168)=11.24, R
2
=0.20, p<0.000). After adjusting for demographic variables, individual and community deprivation was found to significantly predict food choice motivations based on familiarity (F(4,168)=2.97, R
2
=0.07, p<0.05; F(5,164)=2.27, R
2
=0.07, p<0.05), price (F(4,168)=13.36, R
2
=0.24, p<0.001; F(5,164)=10.29, R
2
=0.24, p<0.001), natural content (F(4,168)=4.28, R
2
=0.10, p<0.01; F(5,164)=3.97, R
2
=0.11, p<0.01), ethical acceptability (F(4,168)=2.80, R
2
=0.06, p<0.05; F(5,164)=2.66, R
2
=0.08, p<0.05) and convenience (F(4,168)=3.92, R
2
=0.09, p<0.01; F(5,164)=3.09, R
2
=0.09, p<0.05). Nutritional knowledge was also significantly predicted by individual (F(4,168)=4.08, R
2
=0.09, p<0.01) and community (F(5,164)=3.25, R
2
=0.09, p<0.01) deprivation.

Conclusions:
Motivation for sustaining PHBCs can be impeded by socioeconomic deprivation and psychosocial distress. Long-term PHBC maintenance may then be optimised by client-centred strategies as opposed to conventional, education-based prevention paradigms.
Abstract P533: Food Shopping Practices of Low-income African American Women: Associations With Features of the Food Environment
Authors: Raskind Ilana G , Kegler Michelle C , Girard Amy W , Dunlop Anne L , Kramer Michael R
Published: March 2020

Introduction:
The food environment has received considerable attention as a potential correlate of diet-related CV health. Features of the food environment are assumed to influence the places where people shop, which in turn affect the types of foods purchased and ultimately consumed. However, this assumption remains largely untested due to limited data on where people actually shop. Leveraging unique spatial data on food shopping destinations, we examine whether features of the food environment are associated with the food shopping practices of low-income African American women in Atlanta, Georgia (n=199).

Hypothesis:
Access to food retailers will be positively associated with their use.

Methods:
We collected spatial data on locations visited in the past month using a Google Maps-driven questionnaire. Food shopping practices, including the number of retailers, trip frequency, and average distance traveled from home, were assessed separately for supermarkets, convenience stores, and discount (e.g. dollar) stores. We used secondary data on retail food outlets to calculate three measures of food access: density, proximity, and quality. GEE estimated adjusted associations between food access and food shopping practices, controlling for correlation within census tracts. Adjusted models examined supermarket shopping practices, the only outlet used by a majority of women.

Results:
Only 12.1% of women had a supermarket located within 1 mile of home, compared to 53.8% for convenience and 22.6% for discount stores. Women lived farthest from supermarkets (
Mdn
=1.6 mi,
IQR
=0.9-2.3), followed by discount (
Mdn
=1.0 mi,
IQR
=0.6-1.3) and convenience (
Mdn
=0.4 mi,
IQR
=0.2-0.7) stores. Women also traveled farthest to shop at supermarkets (
Mdn
=3.6 mi,
IQR
=2.5-5.3), traveling over twice the distance of the closest outlet. Nearly all women (97%) shopped at supermarkets, 33% at discount stores, and 25% at convenience stores. In adjusted models, exposure to higher supermarket density was associated with a 13% decrease in distance traveled from home to utilized supermarkets (

e
β

=0.87,
95% CI
: 0.80-0.94). Living farther away from a supermarket was weakly associated with distance traveled from home to utilized supermarkets (

e
β

=1.04,
95% CI
: 1.03-1.06).

Conclusions:
Women may seek to overcome limited access to supermarkets, rather than rely on more accessible, but less healthy retailers. While women exposed to a higher density of supermarkets used supermarkets closer to home, living in closer proximity to a supermarket minimally affected how close to home they shopped. Higher retail density offers a greater number of supermarket choices, making it more likely that women will find one closer to home aligned with their personal preferences (e.g. affordability, hours, access from public transport). Interventions to improve food access must acknowledge that proximity alone may not drive outlet use.
Abstract P536: Healthy for Life: A Health Promotion Model Improving Confidence and Dietary Behaviors
Authors: Yuan Meg D , Gavras Heather , Barnes Olivia , Poudel Remy
Published: March 2020

Introduction:
Poor diet is the leading risk factor for death globally. Community-based programs can have a positive impact on promoting healthy dietary attitudes and behaviors. The American Heart Association and Aramark’s initiative,
Healthy for Life 20 by 20
aims to change food and health confidence and behaviors, equipping individuals with new skills for healthy living. The program includes healthy cooking demonstrations, hands-on skills practice and nutrition and heart health workshops.

Objectives:
To examine the effectiveness of the Healthy for Life program over time, specifically:

-Changes in participant confidence in the preparation of healthy foods at home

-Changes in participant consumption of fruits, vegetables, and whole grains

-Changes in participant frequency of healthy shopping habits

Methods:
A community engagement program was implemented and evaluated in 22 community centers. Sessions were focused on enhancement of confidence and behaviors around healthy shopping, cooking and consumption. Two delivery methods were offered: 10 classes over 24 weeks or 4 classes over 8-12 weeks. Community center facilitators administered the same paper survey to participants at the first educational experience, and then again at the final experience or every 3 months following the first educational experience.

Results:
Analysis was conducted with 418 participants to measure change in healthy behaviors and confidence over time. Participants were predominately female (83%), 55 or older (55.9%), African American (68.4%) and non-Hispanic (81.6%). About half (44.7%) had a college degree or higher, nearly a fifth (17.9%) received benefits from SNAP and almost half (48.3%) indicated they are the only person in their household preparing meals. Almost half (42%) of respondents attended 4 or more educational experiences. On average, respondents statistically significantly increased their daily fruit & vegetable consumption by .43 serving(s). After taking classes, 119 of 394 (30.2%) respondents increased their level of confidence to prepare healthy meals at home and 128 of 379 (33.8%) respondents increased their level of confidence to substitute healthier cooking and food preparation methods. Similarly, 120 of 385 (31.2%) respondents reported increased frequency of reading food labels and checking the nutritional values when purchasing food.

Conclusions:
The Healthy for Life community program involving a skills-based format can be an effective health promotion model in improving confidence and dietary behaviors over time. However, additional research studies are required to further assess the long-term health impacts of this type of intervention.
Abstract P541: High Allostatic Load is Associated With Increased Risk of All-cause Mortality - A Systematic Review and Meta-analysis
Authors: Parker Haley W , Abreu Alyssa M , Sullivan Mary , Vadiveloo Maya K
Published: March 2020

Introduction:
Allostatic load (AL) is a measure of physiological damage from chronic stress, quantified using a variety of neuroendocrine, metabolic, cardiovascular, and immune biomarkers. While AL has been associated with several mortality risk factors (e.g., metabolic disorders, inflammation, cardiovascular disease (CVD), frailty), to date, no meta-analyses have examined the relationship between AL and mortality. This systematic review and meta-analysis examines the relationship between AL and mortality (CVD and all-cause).

Hypothesis:
Higher AL (i.e., increased dysregulation) will be associated with an increased risk of all-cause and CVD mortality.

Methods:
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guided this review. Two databases (PubMed and EMBASE) were searched in Feb 2019 with the terms: ((mortality) OR survival) AND ((allostatic load) OR allostasis); references of included studies were also screened. Included studies met the a priori inclusion criteria (i.e. compared mortality (all-cause and/or CVD) in high vs. low AL (defined by study) in adults). Study quality was assessed with the Newcastle Ottawa Criteria. Findings were qualitatively synthesized then the meta-analysis was completed in Review Manager 5.3. Subgroups were examined by design and sample age.

Results:
Database searches and references identified 400 studies; after removing duplicates, 266 abstracts were screened and 32 full texts were reviewed. The systematic review included 12 observational studies (2001-18) examining all-cause mortality; half were also included in meta-analyses. Of the 12 included studies, most examined CVD mortality (n=7), were longitudinal (n=7), from the US (n=7), and had a balanced sex distribution. In the qualitative review, high AL was consistently associated with increased risk of all-cause mortality (n=11 of 12 studies, hazard ratio (HR) range=1.13-2.98), however, the association was less consistent for CVD mortality (n=4 of 7 studies, HR=1.12-3.06). In meta-analyses, high AL was associated with increased risk of all-cause (HR= 1.46 [1.24, 1.72], n=6) and CVD mortality (HR= 1.18 [1.02, 1.38], n=4). High AL was associated with all-cause mortality in subgroup analyses stratified by design (cross-sectional HR=1.44 [1.14, 1.81], n=3; longitudinal HR=1.61 [1.11, 2.33], n=3) and sample age (older adults HR=1.17 [1.10, 1.24], n=3; all adults HR=1.94 [1.45, 2.60], n=3). Heterogeneity was high (I
2
=85-96%) in analyses except for the older adults subgroup (I
2
=18%). Study quality was good in 7 studies (including all studies in the meta-analysis), fair in 3 studies, and poor in 2 studies.

Conclusions:
In this review of relatively high-quality studies, high AL was associated with a 46% increased risk of all-cause mortality and may also be associated with CVD mortality. Thus, AL shows promise as a prognostic indicator for mortality.
Abstract P547: The Relationship Between Alcohol Drinking Before Sleeping(Ne-Zake) or in the Morning(Mukae-Zake) and Sleeplessness Among Farmers
Authors: Sato Rie , Hisamatsu Takashi , Tsumura Hideki , Fukuda Mari , Esumi Yukio , Mikajiri Kaoru , Tamura Shusaku , Kanda Hideyuki
Published: March 2020

Introduction:
Drinking alcohol before sleeping (Ne-Zake) or in the morning (Mukae-Zake) is occasionally seen in Japan although it is well known that drinking alcohol have some negative effects on sleep. There have been studies which indicated that alcohol worsen sleep quality and quantity however few which investigated how alcohol before sleeping and no which noticed on how alcohol in the morning affects. The purpose of this study is to verify the relationship between Ne-Zake and/or Mukae-Zake and insomnia adjusting the influence of quality and frequency of drinking on the relationship.

Hypothesis:
We assessed the hypothesis that there is a significant association between Ne-Zake and/or Mukae-Zake and sleeplessness but this association can be confounded by quality and frequency of drinking.

Method:
Seven hundred and forty-six farmers who underwent annual medical checkups were analyzed. Ne-Zake was defined as “drinking as a sleeping aid” and Mukae-Zake was defined as “drinking in order to get calm down or to fix hungover”. Athene Insomnia Scale (AIS) was used to evaluate objective sleeplessness. AIS consists of 8 questions, which were evaluated from 0 (no sleeplessness) to 3 points (severe sleeplessness), asking the sleeping status in the previous 2 weeks. Insomnia was defined by AIS point more than 6. We conducted the multivariable logistic analysis, setting the presence of insomnia as a dependent variable and the presence of Ne-Zake and Mukae-Zake, quantity of alcohol at one time, frequency of drinking, sleeping related diseases (sleep apnea syndrome, restless leg syndrome, narcolepsy, limb movement disorder, depression), gender, and age as independent variables.

Results:
Among a total of 746 farmers (mean age 59.5 years; 74.1% men), insomnia, Ne-Zake, and Mukae-Zake were observed in 151 (20.2%), 140 (18.8%) and 37 (5.0%), respectively. Adjusted odds ratios (95% Confidence Intervals) of Ne-Zake and Mukae-Zake were 1.75 (1.07-2.88) and 3.01 (1.41-6.42). The association of Ne-Zake was consistent between men and women but that of Mukae-Zake was stronger in men than in women. (P-values for interaction = 0.98 and 0.03, respectively).

Conclusion:
Both Ne-Zake and Mukae-Zake had statistically positive significant association with insomnia independent of quantity and frequency of drinking. It may indicate that the timing of drinking alcohol has a stronger relationship with insomnia than quantity and frequency of drinking does. The feature of farmers’ lives in which they can decide their life style might give more opportunities to have Ne-Zake and/or Mukae-Zake than groups with well-scheduled working environment. This result can be utilized to improve farmers’ further physical and psychological health related to alcohol by encouraging to pay attention to not only the quantity or frequency of alcohol drinking but also the timing in a day.