bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP094: Cardiorespiratory Fitness and Birth Outcomes: the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Lane-Cordova Abbi D , Carnethon Mercedes R , Catov Janet M , Lewis Cora E , Montag Samantha E , Schreiner Pamela J , Dude Annie , Sternfeld Barbara , Vu T H , Badon Sylvia , Greenland Philip , Gunderson Erica P
Published: March 2022

Background:
High fitness is related to inflammation, blood pressure (BP), and endothelial dysfunction, the pathways believed to be involved in the development of hypertension in pregnancy. High fitness may also protect against preterm birth (PTB) and small for gestational age (SGA) deliveries, birth outcomes frequently associated with maternal vascular dysfunction.

Hypothesis:
Higher cardiorespiratory fitness in the years preceding pregnancy and childbirth is inversely associated with incident SGA and PTB.

Methods:
The CARDIA study is a prospective cohort study that encompasses child-bearing years. We studied 840 women who were nulliparous at baseline, reported ≥1 live birth(s) between the baseline and year 25 exam, and underwent a maximal treadmill exercise test at baseline. Number of births, gestational age for each birth, and birth weight were obtained by self-report at each exam. SGA was defined as birth weight <10
th
percentile for gestational age, and PTB was any birth that occurred before week 37 of pregnancy. We used Cox regression to determine hazard ratios for incident SGA and/or PTB. We adjusted for demographic and clinical co-variates at the exam immediately preceding the incident SGA/PTB or the 1
st
birth for women who did not report SGA or PTB (Model 2).

Results:
Women who reported SGA (n=118) or PTB (n=185) were younger at baseline, completed fewer years of education, and were more likely to be black compared to women who did not report SGA/PTB (n=537). There was no difference in baseline BP or BMI between groups. Women without SGA/PTB had higher fitness than women with SGA/PTB; treadmill test duration was 541 s (95% CI: 529, 553 s) vs 500 s (95% CI: 483, 518 s). Treadmill test duration was inversely associated with time to SGA/PTB following adjustment (Table). Findings were similar by race.

Conclusions:
Higher cardiorespiratory fitness in the years preceding pregnancy and childbirth was associated with decreased risk of SGA/PTB. Achieving a higher fitness level in young adulthood may help protect against SGA and PTB.
Abstract MP095: Pregnancy as a Window to Racial Disparities in Hypertension
Authors: Margerison-Zilko Claire E , Catov Janet M , Holzman Claudia
Published: March 2022

Background:
Black women in the United States have 50% higher rates of hypertension (HTN) than white women. This disparity persists after accounting for many known HTN risk factors. Evidence indicates that pregnancy complications may reveal increased risks for later HTN, and some complications, such as preterm delivery, are more common in black vs. white women.

Hypotheses:
1) Adjustment for multiple HTN risk factors measured at mid-life will explain some, but not all, of the black-white disparity in mid-life HTN among women. 2) Markers of pregnancy health will help explain the remaining black-white disparity in mid-life HTN.

Methods:
Data came from a Michigan-based cohort study of women enrolled during pregnancy and followed-up at mid-life (n=678, mean age = 37, range 25-58). We included women without pre-pregnancy hypertension (n=652) categorized as African American (AA) (n=242) and white (n=373). We categorized women as hypertensive (systolic BP ≥140, diastolic BP ≥90, or self-reported use of antihypertensive medications, n=126), pre-hypertensive (systolic BP 120-139 or diastolic BP 80-89, n=149), and normotensive (n=340). Mid-life risk factors for HTN were grouped into 4 domains: socioeconomic status ([SES], based on education, occupation, marital status, insurance, and wealth), psychosocial (depression, hostility, job strain), behavioral (current smoking, diet quality score, sedentary hours/day, global sleep score), and physiological (body mass index [BMI], lipids, c-reactive protein [CRP]). We used generalized logit models to assess the degree to which each individual factor attenuated the AA (vs. white) odds ratio (OR) for HTN at mid-life and then sequentially added variables to a multivariable model. We then added indicators of pregnancy health (preterm delivery, pre-pregnancy BMI, and CRP, depressive symptoms, hypertensive disorders, and lipids during pregnancy).

Results:
AA women had 3.28(95% CI:1.96,5.51) times the odds of HTN compared to white women after adjusting for age. Adjustment for SES attenuated the OR to 2.52(95% CI:1.46,4.36). Further adjustment for psychosocial factors and behaviors attenuated the OR to 2.30(95% CI:1.29,4.11), and BMI and CRP attenuated it to 2.13(95%CI:1.15,3.93). Adjustment for preterm delivery, pre-pregnancy BMI, and CRP and depressive symptoms during pregnancy reduced the OR to 1.88(95%CI:0.97,3.64), with BMI, CRP, and depressive symptoms playing a larger role than preterm delivery. Adjustment for hypertensive disorders and lipids during pregnancy did not further reduce the race disparity.

Conclusions:
SES, psychosocial factors, behaviors, and biomarkers measured at mid-life explained some, but not all, of the race disparity in mid-life HTN. Indicators of pregnancy health, particularly pre-pregnancy BMI, inflammation (CRP), and depressive symptoms contributed substantially to the race disparity in HTN at mid-life.
Abstract P006: A Comparative Case Study of the American Heart Association ANCHOR Partnerships Program
Authors: Garney Whitney R , Garcia Kristen , McLeroy Kenneth , King Hahn Laura , Taffe Victoria
Published: March 2022

Purpose:
In 2014, the American Heart Association (AHA) started a new initiative called the Accelerating National Community Health Outcomes through Reinforcing (ANCHOR) Partnerships Program. The ANCHOR Program works to improve cardiovascular health using population-based strategies targeting policy, systems and environmental (PSE) level changes. From March 2015-April 2016, the ANCHOR program supported 15 markets within AHA Affiliates as they implemented community-based interventions using PSE strategies to increase access to healthy food and beverages, physical activity, and smoke-free environments. This community-based approach is relatively new for the organization therefore, a comparative case study was conducted to understanding how the ANCHOR Program worked within the AHA and its Affiliates, as well as what community-based strategies were most successful.

Methods:
Using a systematic selection procedure that assessed level of readiness, the 15 sites were categorized as either “implementation ready (IR)” or “capacity building (CB)”. After stratifying the sites by intervention focus three markets from each category (n=6) were selected as the units of analysis. Evaluators conducted site visits in each market from February-April 2016. During site visits, a total of 24 interviews were conducted with Affiliate staff, program managers, implementation partners, and community partners. Each interview assessed expected outcomes, planning processes, community support, and success. Interviews were audio recorded, transcribed, and synthesized using a thematic analysis.

Results:
Significant differences were found in expected outcomes. IR sites wanted to increase community engagement, while CB focused on policy change. Both sites were supported by their Affiliates and partners. Action plans were developed by program managers with Affiliate input, and were used to plan in both sites. IR sites identified barriers at the beginning of planning, while CB sites made revisions frequently as barriers were encountered. Both sites engaged partners in planning. Program managers at IR sites worked closely with partners on implementation, whereas those at CB sites led implementation and partners provided support and connections. Differences were also found in how sites engaged partners. CB sites built broad community engagement and IR sites focused on implementation partner buy-in. Overall, the IR sites felt most successful, while CB sites laid groundwork but were not able to create tangible outcomes.

Discussion:
This comparative case study provides important information about how the AHA can embed community-based work within their ongoing efforts using existing Affiliate structures. The multiple viewpoints captured provides insight into implementation processes and how this type of work is best accomplished, as well as how level of readiness can impact progress.
Abstract P007: Sex-Specific Disparities in Risk Factor Control of Patients Undergoing Elective Percutaneous Coronary or Peripheral Intervention
Authors: Vani Anish , Berger Jeffrey , Rudy Hayeem , Balakrishnan Revathi , Gianos Eugenia
Published: March 2022

Introduction:
The American Heart Association (AHA) developed 7 health metrics to define “ideal cardiovascular health” in its 2020 Impact Goal. Sex-specific disparities in attainment of the 7 health metrics in patients undergoing elective percutaneous or peripheral interventions has not been well characterized.

Methods:
We interviewed 1,517 patients (1,127 males and 390 females) undergoing elective percutaneous coronary or peripheral intervention at a large tertiary care center between November 2010 and March 2015. Survey data was used to reconstruct the 7 health metrics (blood pressure, physical activity, cholesterol, diet, weight, smoking status, and metabolic control). Multivariable linear regression was performed to identify characteristics associated with ideal metric attainment in the overall cohort and when stratified by sex.

Results:
Overall, males were younger, less likely to be white, more likely to be married, and had higher levels of education and higher prevalence of prior coronary artery disease than females (p<.05 for each). Males achieved fewer ideal health metrics than females (2.0 ± 1.2 vs 2.3 ± 1.1, p<.01), including poorer attainment of the ideal smoking (p<.01), physical activity (p<.01), and diet health metrics (p<.05). Females had poorer attainment of the ideal weight (p<.05) and cholesterol health metrics (p=.01). After multivariable adjustment, males achieved fewer ideal health metrics than females (p<.01; Table). Sex-specific differences are presented in the Table, which includes single marital status and depression as negative predictors of ideal metric attainment in males, and a reduced ejection fraction as a negative predictor in females.

Conclusions:
Attainment of the 7 AHA ideal health metrics is low in both males and females undergoing elective percutaneous coronary or peripheral intervention. Sex-specific disparities in risk factor control illustrate interesting areas for further exploration into the predictors of behavior that may guide future targeted interventions.
Abstract P009: Break the Myth and Revisit Non-Obese Asian American’s Cardiometabolic Risk
Authors: An Kyungeh , Shin Cha-Nam , Lee Mikyung , Oh Kyeung Mi
Published: March 2022

Asian Americans (AA) have been excluded in major research addressing cardiometabolic health mainly due to their low rate of obesity. However, CVD morbidity and mortality are rapidly increasing among AA population and that warrants revisiting their cardiometabolic risks. The recent National Health and Nutrition Examination Survey (NHANES) conducted between 2011-14 included non-Hispanic Asian Americans as the first time ever since the survey started in 1960’s, and that will advance our understanding of the AA population by characterizing their cardiometabolic risk. We aimed to compare AA with other ethnic groups in terms of obesity indices, such as body mass Index (BMI), waist circumference (WC), and sagittal abdominal diameter (SAD): and clinical markers of CVD risks, such as level of cholesterol, triglyceride, and glucose, systolic- and diastolic blood pressure, whether being treated with medication for blood pressure, smoking, and having diabetes.

Method:
From NHANES 2013-2014 data with total 6553 participants, 5992 were selected by age≥19 for analysis. Demographics, obesity indices, CVD risk factors were extracted in six ethnic groups for comparisons using univariate analysis, ANOVA and Chi-square tests.

Results:
AA, compared to all ethnic groups, was the leanest in terms of the BMI (24.86±4.32 vs. 29.05±7.18, p<0.001), WC (88.55±11.26 vs. 98.93±16.70 cm, p<0.001), and SAD (19.80±3.20 vs. 22.76±4.89 cm, p<0.001). However, the plasma levels of cholesterol (195.11±40.73 vs. 190.11±42.37 mg/dL, p<0.005), triglyceride (162.85±106.12 vs. 111.13±76.60 mg/dL, p<0.001), and glucose (106.54±42.10 vs. 102.25±40.81 mg/dL, p<0.05) were all higher in AA than in non-Hispanic Black. AA had the highest diastolic blood pressure among all ethnic groups (71.37±11.55 vs. 69.00-69.28mmHg in other groups, p<0.001), but lower in systolic blood pressure compared to non-Hispanic White and non-Hispanic Black (120.60±17.56 vs. 122.30± 17.82, p<0.05, and 126.60±17.56 mmHg, respectively, both p<0.001). In AA, 7.7% were taking prescription for blood pressure, 24.6% smoked everyday which was the lowest among ethnic groups (p<0.001), however AA started smoking at younger age than all other ethnic groups (18.50 vs. 21.40 years, p<0.05). Morbidity of diabetes was 10.2% in AA, lower than other ethnic groups except other-Hispanics (p<0.001). We conclude that unlike the longtime-believed myth, Asian Americans are at high risk as other ethnic groups. Our findings warrants further studies for the mechanisms of non-obese-related CVD that will advance the precision of intervention for AA and the larger population in the world.
Abstract P024: Administrative Billing Codes Accurately Identify Occurrence of Electrical Cardioversion and Ablation/Maze Procedures in Atrial Fibrillation Patients
Authors: Ehlert Alexa N , Heckbert Susan R , Wiggins Kerri L , Thacker Evan L
Published: March 2022

Introduction:
Administrative billing codes for electrical cardioversion and ablation/maze procedures may be useful for research on atrial fibrillation (AF) progression and treatment if the codes are sufficiently accurate relative to medical record documentation.

Hypothesis:
We hypothesized that administrative billing codes for electrical cardioversion and ablation/maze procedures would accurately identify the occurrence of those procedures.

Methods:
We studied adults ages 30-84 years who experienced new onset AF between 10/2001 and 12/2004, and were patients in Group Health, an integrated healthcare system in Washington state. Using medical record review as the gold standard, we assessed the accuracy of administrative billing codes for detecting the occurrence of electrical cardioversion and ablation/maze procedures. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each billing code separately, and collectively for each procedure.

Results:
Of 1953 study participants with new onset AF, during a mean of 1.5 (SD 0.7) years of follow-up after AF onset, 470 (24%) experienced electrical cardioversion and 44 (2%) experienced ablation/maze procedures according to medical records. For cardioversion, CPT code 92960 performed better than ICD-9 codes 99.61 and 99.62, with higher sensitivity, PPV, and NPV, but slightly lower specificity. For ablation/maze, CPT code 93651 and ICD-9 code 37.34 performed identically, yielding higher sensitivity and PPV than ICD-9 code 37.33. For cardioversion and ablation/maze procedures, combining three codes improved sensitivity and NPV while maintaining high specificity and PPV relative to individual codes. (See Table.)

Conclusions:
Administrative billing data accurately identify electrical cardioversion and ablation/maze procedures, and can be used in place of medical record review. Our findings apply to integrated health systems or other settings where administrative billing databases are available.
Abstract P027: Type 2 Diabetes Status Does nNt Impact Perceived Barriers to Healthy Eating Among Overweight/Obese Hispanic Women
Authors: Vega-López Sonia , Lindberg Nangel M , Leo Michael C , Petrovic Milena , Arias-Gastélum Mayra , Shuster Elizabeth , LeBlanc Erin S , Stevens Victor J , Kapka Tanya J , Meenan Richard T
Published: March 2022

Background:
Hispanic women are disproportionately affected by cardiometabolic disease risk factors including increased adiposity. Addressing barriers to dietary change is an important strategy for ensuring success of behavioral weight loss interventions. However, perceived barriers to healthy eating among Hispanic women have not been thoroughly studied, and how a type 2 diabetes (T2D) or prediabetes (preD) diagnosis and HbA1c levels are related to those perceptions are unknown.

Objective:
To examine the association of perceived barriers to healthy eating for weight loss with HbA1c and T2D status among Hispanic women.

Methods:
Participants (n=197; 86.9±16.6 kg; 36.6±6.5 kg/m
2
) of
De Por Vida
, a culturally-tailored weight loss intervention for adult Hispanic women with or at risk for T2D, completed the Barriers to Healthy Eating (BHE) scale at baseline. The BHE scale was translated into Spanish and slightly modified for use with low-literacy participants. Possible BHE scores range from 22 to 110 for the overall scale, from 11 to 55 for the emotions subscale, from 8 to 40 for the daily mechanics subscale, and from 3 to 15 for the social support subscale, with higher scores indicating greater perceived barriers. Participants were categorized based on their baseline HbA1c concentration as follows: at risk for T2D (n=54; HbA1c <5.7% but history of gestational diabetes, hyperlipidemia or hypertension), preD (n=86; HbA1c ≥5.7% but <6.5%) or T2D (n=57; HbA1c ≥6.5%), regardless of diagnosis in the medical record.

Results:
Among all participants, total BHE score was 65.3±20.7, and scores for the emotions, daily mechanics, and social support subscales were 33.3±11.7, 24.8±8.3, and 7.4±3.2, respectively. HbA1c concentrations were negatively correlated with BHE total (r=-.13; p=.06), emotional (r=-.14; p=.06), and social support scores (r=-.17; p=0.02). When HbA1c was examined as a categorical variable (i.e., T2D status) there were no significant associations with any BHE scale score.

Conclusions:
In general, participants’ rated their perceived barriers to healthy eating as relatively important problems to their ability to lose weight. There was no evidence that having a preD or T2D diagnosis was associated with their perception of barriers. Given the significant health and economic consequence of a T2D diagnosis, interventions should better address perceived barriers to healthy eating in the preD and T2D population.

Funding source:
NIH/NIDDK – 1R01DK099277.
Abstract P031: Mediation Effect of Abdominal Adiposity Between Sedentary Lifestyle and Blood Pressure in General Population From a Middle-income Country
Authors: Herrera Mauricio V , Otero Johanna , Clausen Christian , González-Gómez Silvia
Published: March 2022

Background:
Hypertension is a highly prevalent risk factor for cardiovascular disease (CVD). Middle-income countries have experienced accelerated urbanization resulting in a growing prevalence of sedentary lifestyle (SL) behavior and a trend toward obesity that might explain population-level changes in blood pressure (BP). We aimed to evaluate the association of SL and adiposity on BP.

Methods:
We analyzed data from two surveys conducted on representative samples (15-64 years old) from Santander (Colombia) in 2010 (n=2,419) and 2015 (n=2,158) following the WHO STEPwise approach to assess risk factors for CVD. Physical activity was measured using the GPAQ questionnaire and SL was defined as the lowest level of activity according to the WHO criteria. We measured waist circumference (WC [cm]) and calculated body mass index (BMI [kg/m
2
]) and waist-to-hip ratio (WHR) as indexes of adiposity. BP was measured using an Omron® automatic monitor in sitting position (average of two measurements). Associations were estimated, incorporating post-stratification weights, using censored normal multiple regression (accounting for antihypertensive therapy) and mediation approached by Baron’s criteria.

Results:
Mean systolic/diastolic (S/DBP) were 119.2 (95%CI: 118.7-119.7) / 73.7 (95%CI: 73.4-74.1) mmHg and 1 out 6 participants were hypertensive (2015/2010 prevalence ratio=1.02, p>0.050). BMI, WC and WHR were positively and significantly correlated with systolic (r=0.16, r=0.39, and r=0.41) and diastolic BP (r=0.18, r=0.38, and r=0.33). Sedentary as compare to active participants had higher age- and sex-adjusted WC (1.1 cm, p=0.008) and WHR (0.01 units, p<0.001). SL prevalence was 62.0% (95%CI: 59.8-64.1) and changed across tertiles of SBP (66.4%, 60.3%, and 59.6%) and DBP (59.3%, 63.1%, and 63.1%); however, SL was only associated to higher DBP after adjustment by age, sex, and area of residency (0.8 mmHg, p=0.036). Further inclusion of BMI, WC, or WHR attenuated the strength of the association in 16.7%, 42.3%, and 61.7%, respectively. There was no survey-by-sedentary lifestyle interaction.

Conclusion:
SL is highly prevalent in a middle income country such as Colombia. We confirmed the association of this behavioral risk factor and DBP but not SBP. Furthermore, the attenuation of such relationship by anthropometric indexes, particularly of abdominal obesity, suggests a mediation effect of adiposity that must be validated in longitudinal studies.
Abstract P032: Increased Abdominal Aortic Diameters on Multidetector CT Scan Are Independent Predictors of Incident Adverse Cardiovascular Events: The Framingham Heart Study
Authors: Qazi Saadia , Massaro Joseph M , Chuang Michael L , D’Agostino Ralph B , Hoffmann Udo , O’Donnell Christopher J
Published: March 2022

Introduction:
Adverse aortic remodeling, such as dilation, is cross-sectionally associated with multiple cardiovascular disease (CVD) risk factors. We sought to determine whether increased, though not necessarily aneurysmal, abdominal aortic diameters augment prediction of incident adverse CVD events above standard CVD risk factors in a community-dwelling cohort. This may be useful since the aorta is often incidentally visualized on computed tomography (CT) body scans performed for indications other than CVD risk stratification.

Methods:
Participants (N=3318, aged 50±10y, 51% M) from the Framingham Offspring and Third Generation Cohorts who were free of clinical CVD, had complete risk factor profiles (collected at the adjacent cycle exams), and had non-contrast, abdominal multidetector CT scans (MDCT) during 2002-2005 were included in this study. Anteroposterior (AP) and left-right (LR) diameters were measured in the infrarenal (IAA) and lower abdominal (LAA) aorta. The IAA was measured at 5 cm above the aortoiliac bifurcation and the LAA was measured at one slice level (2.5mm) above the bifurcation of the abdominal aorta into the common iliac arteries. For each segment, the greater of AP and LR diameters was used in the analyses. Adverse events comprised CVD death, myocardial infarction, coronary insufficiency, index admission for heart failure, and stroke. For each aortic segment, hazard of an adverse event for enlarged IAA or LAA diameter (enlarged was defined as ≥ upper 90
th
percentile diameter for age, sex and BSA) was determined using multivariable (MV) adjusted Cox proportional hazards models.

Results:
Over a mean 8.8±2.0y of follow-up, there were 149 incident adverse CVD events. In multivariable models adjusted for traditional CVD risk factors, enlarged IAA was associated with greater hazard of an adverse CVD event (HR 1.62; 95% CI 1.07-2.46; p=0.022). However, the association of enlarged LAA with adverse CVD events was borderline (HR 1.56; 95% CI 0.99-2.46; p=0.054).

Conclusion:
Among community-dwelling adults initially free of clinical CVD, enlarged infrarenal abdominal (IAA) aortic diameter, as determined from noncontrast MDCT scans, augments prediction of incident adverse CVD events above traditional risk factors alone.
Abstract P039: Lipid Rich Plaque by Coronary CT Angiography Associates With Cholesterol Efflux Capacity Independent of Traditional Cardiovascular Risk Factors in Those at Risk for Myocardial Infarction
Authors: Chung Jonathan H , Dey Amit K , Chaturvedi Abhishek , Rivers Joshua P , Lerman Joseph B , Harrington Charlotte L , Ahlman Mark , Playford Martin P , Gordon Scott M , Joshi Aditya A , Remaley Alan T , Chen Marcus , Bluemke David A , Mehta Nehal N
Published: March 2022

Introduction:
Cholesterol efflux capacity (CEC), a measure of high density lipoprotein (HDL) function, has been shown to be associated with future cardiovascular (CV) events. Lipid rich plaque is associated with higher plaque rupture and future CV events, and can be readily phenotyped by coronary CT angiography (CCTA). Whether CEC associates with lipid rich plaque is not known.

Hypothesis:
We hypothesize that CEC associates with lipid rich plaque in those at risk for myocardial infarction (MI).

Methods:
Consecutively recruited patients (N=94) underwent CCTA (Toshiba 320 slice) to assess plaque burden within the coronary arteries by QAngio CT (Medis, The Netherlands); history was obtained and statin use was recorded. CEC was measured using an ex vivo validated assay.

Results:
The study population mean age was 61 and had normal cholesterol, HDL, low density lipoprotein (LDL), and triglyceride levels (Table 1). CEC was 1.03 ± 0.17 while total plaque and lipid rich plaque were 1.05 (0.79-1.37) mm
2
and 1.00 (0.77-1.33) mm
2
, respectively. Lipid rich plaque inversely associated with CEC beyond adjustment for age, gender, systolic blood pressure, statin treatment, total cholesterol, LDL, and HDL (β= -0.18, p=0.002).

Conclusion:
CEC associated with lipid rich plaque independent of CV risk factors to provide additional risk stratification in those at risk for MI and early atherogenesis.

Clinical Implications:
My study will help cardiovascular clinicians to better understand that HDL function may capture additional CV risk in those at risk for future MI.
Abstract P047: The Effect of Serum C-reactive Protein (CRP) or Handgrip Strength Inclusion on the Framingham Risk Score Model of CVD Risk in a Cohort of Middle-aged to Elderly Australian Men
Authors: Martin Sean A , Vincent Andrew , Taylor Anne W , Adams Robert J , O’Loughlin Peter , Wittert Gary A
Published: March 2022

Introduction:
Cardiovascular disease (CVD) risk prediction models are used extensively in clinical practice. Recent reviews have suggested that such models would benefit from the identification of novel predictors to improve specificity and sensitivity. Both serum CRP and lower handgrip strength have been demonstrated to predict incident CVD suggesting its utility as a prognostic CVD marker.

Objectives:
To determine whether handgrip strength improves global CVD risk prediction models based on the Framingham Risk Score (FRS) (using NCEP-ATP-III criteria), and to validate CRP as a marker adding predictive value.

Method:
Participants were drawn from a randomly-selected, community-dwelling cohort of men residing in Adelaide, Australia. Of these, n=2162 men without CVD at baseline (2002-5) and covariate data (age, fasting total & HDL cholesterol, smoking status, mean systolic blood pressure, and anti-hypertensive usage) were followed for a median period of 8.3 years. Incident CVD events (n=248) were identified through a state-wide registry of in-hospital events (emergency department visit or hospital separation) and cardiac-specific mortality. Mean handgrip strength (by dynamometry) and serum high-sensitivity CRP were obtained at baseline visit. The added prognostic value of handgrip strength and CRP was assessed using splines and log-likelihood ratio tests of nested Cox proportional models, BIC and AIC. Model discrimination was assessed using Harrell’s c-index.

Results:
Within the FRS 10-year risk groups 0-<5%, 5-<10%, 10-<20%, and 20+% the estimated 10-year CVD event rates were 3% (95%CI: 2-5%), 7% (5-10%), 15% (13-18%) and 22% (17-27%), respectively. Hand grip strength did not add predictive value above standard Framingham risk factors (
p
=0.25). CRP made a contribution to estimating global CVD risk (
p
=0.002). Both the BIC and AIC were reduced (4.9 and 7.9 units, respectively) and the c-index increased from 0.727 to 0.732 (SE=0.024).

Conclusions:
A global risk prediction model that includes serum CRP improves CV risk classification in men.
Abstract P051: Association of Subclinical Hypoglycemia with Incident Cardiovascular Disease and All-cause Mortality: The Multi-Ethnic Study of Atherosclerosis
Authors: Mongraw-Chaffin Morgana , Bertoni Alain G , Golden Sherita Hill , Mathioudakis Nestoras , Sears Dorothy D , Szklo Moyses , Anderson Cheryl A
Published: March 2022

Trials of intensive glucose control have not improved cardiovascular disease (CVD) risk in type 2 diabetes; however data are inconsistent about the effects of maintaining below normal glucose levels in the general population. Further, it has been suggested that fasting glucose and HbA1c in the lower ranges have a different relationship with CVD and mortality.

In 5992 participants from the Multi-Ethnic Study of Atherosclerosis, free of CVD at baseline, we used logistic regression to investigate the associations of low fasting glucose (<80mg/dL) and HbA1c (<5.0%), from baseline and averaged across follow-up over 13 years, with incident CVD and mortality. We used the normal range (80 to <100mg/dL and 5.0 to <5.7%) as reference. We excluded participants with diabetes at baseline from the low, normal, and impaired groups at baseline, and excluded participants with diabetes at any visit from those groups for averaged values. We matched covariates to the visit of glycemic data collection.

Participants with low fasting glucose were more likely to be younger, female, Asian, use glucose lowering medication, have lower BMI and be normotensive. Those with low HbA1c were more likely to be younger, Asian or Hispanic, and have higher income at baseline. Adjusted for age, sex, race/ethnicity, education, and income, glucose and HbA1c in the impaired (100 to <126mg/dL and 5.7 to <6.5%) and diabetic ranges (≥126mg/dL and ≥6.5%) at baseline were significantly associated with increased CVD and mortality. Low baseline glucose and low baseline HbA1c were positively, but not significantly, associated with mortality; while low average glucose and low average HbA1c were both strongly and significantly associated with increased risk of mortality (Figure).

The relationships between fasting glucose and HbA1c with mortality are J-shaped at baseline, but strongly and significantly U-shaped when average levels are used. Consistently low fasting glucose or HbA1c may be better markers for risk from subclinical hypoglycemia than a single low measurement.
Abstract P063: The Overall Burden of Pre-diabetes and Diabetes in Luxembourg: Resembling the US Scenario
Authors: Stranges Saverio , Ruiz-Castell Maria , De Beaufort Carine , Barré Jessica , De Rekeneire Nathalie , Michel Georges , Donahue Richard P , Kuemmerle Andrea , Bocquet Valery
Published: March 2022

Background:
Type 2 diabetes is an increasingly prevalent disease affecting 422 million adults in the world in 2014. Its surveillance and timely detection are necessary steps to control associated comorbidities. While several national population-based studies in Western European countries have reported diabetes prevalence and associated risk factors, there has been a limited focus on pre-diabetes. Therefore, the aim of this study was to determine the prevalence and associated risk factors of pre-diabetes and diabetes in the general adult population of Luxembourg.

Methods:
Within the framework of the Luxembourg European Health Examination Survey (EHES-LUX), a cross-sectional study was conducted between 2013 and 2015, based on a random sample from the general population. 1451 residents of Luxembourg (25-64 years old) were included. Diabetes, unknown diabetes and pre-diabetes participants were defined by glycemia measures, self-reported medication over the last 2 weeks and medical diagnosis. Logistic regressions analyses adjusted on sex, age and region were performed to determine the factors associated with pre-diabetes and diabetes. Multivariable-adjusted odds ratios (MVOR) were calculated. The explanatory variables were biological and anthropometric indicators as well as patient’s socio-economic status and lifestyle. We considered
P
< 0.05 to be statistically significant.

Results:
The national standardized prevalence of pre-diabetes and diabetes in Luxembourg was 23.7% and 5.8% respectively. We observed a deleterious association between diabetes status and age (MVOR=1.05 [1.01-1.09]), family history of diabetes (MVOR=3.25 [1.95-5.40]), abdominal obesity (MVOR=2.62 [1.53-4.49]), hypertension (MVOR=3.20 [1.78-5.73]), and triglycerides (MVOR=1.08 [1.05-1.12]) whereas a protective association occurred with total cholesterol (MVOR=0.84 [0.78-0.92]). Moreover, we observed a deleterious association between pre-diabetes status and age (MVOR=1.04 [1.02-1.06]), male sex (MVOR=1.83 [1.30-2.58]), family history of diabetes (MVOR=1.52 [1.13-2.05]) and abdominal obesity (MVOR=1.44 [1.06-1.96]) whereas a protective association occurred with second generation immigrants (MVOR=0.63 [0.41-0.98]) and serum HDL (MVOR=0.83 [0.72-0.95]).

Conclusions:
In Luxembourg, an unexpectedly high number of adults may be affected by pre-diabetes and unknown diabetes. These values are close to US prevalence estimates, and are certainly among the highest values in Western European countries, emphasizing even more that these conditions should be prioritized as a public health threat for the country, requesting measures for improved detection and surveillance, especially in the primary care setting.
Abstract P067: Early Exposure to PM
2.5
and Ozone During the Menopausal Transition as Predictor of Subclinical Atherosclerosis in Late Midlife Women: the Study of Women’s Health Across the Nation (SWAN)
Authors: Duan Chunzhe , Broadwin Rachel , Talbott Evelyn O , Brooks Maria M , Matthews Karren A , Barinas-Mitchell Emma
Published: March 2022

Introduction:
Long-term air pollution may be a risk factor for CVD mortality, but few studies have investigated its effect on subclinical atherosclerosis. Moreover, data among women transitioning the menopause are lacking.

Hypothesis:
We hypothesized that mid-life women exposed to higher levels of air pollution across a 5-year period may have a greater burden of subclinical atherosclerosis (higher common carotid intima-media thickness (CIMT), inter-adventitial diameter (AD) and plaque) 5 to 7 years later compared to women exposed to lower levels.

Methods:
This longitudinal study was conducted among 1,188 women from the Study of Women’s Health Across the Nation (SWAN) with available data on both air pollution exposure and CIMT. We excluded participants who had an MI and stroke before the carotid ultrasound scan. Yearly cumulative exposure levels of two air pollutants, particulate matter ≤2.5 μm (PM
2.5
) and ozone (O
3
), were collected from monitors 20km within the participant’s residential address at SWAN visit 3 – 7 (1999-2005). Corresponding years cumulative levels of continuous CVD risk factors were used as covariates. CIMT, AD and plaque presence were assessed at visits 12/13 (2010-2012). Linear regression models were used to estimate the effect of early exposure to PM
2.5
and O
3
on mean and maximum CIMT. Logistic regression was applied to assess the effects of air pollutants on plaque presence. Full models were adjusted for CVD risk factors, including BMI, smoking, cholesterol, triglyceride, HDL-C, menopause status, hormone use, fasting blood glucose, insulin, diabetic medication and hypertension, and the extended models were further adjusted for SBP and inflammatory biomarkers (tPA, PAI-1 and CRP).

Results:
At time of carotid scan, women were on average 59.6±2.7 years old and a majority were postmenopausal (88.4%). The women were White (48.4%), Black (31.2%), Chinese (13.3%) and Hispanic (7.1%). Cumulative PM
2.5
significantly predicted maximum CIMT adjusting for CVD risk factors such that 1 μg/m
3
higher cumulative exposure to PM
2.5
over 5 years was associated with a 7.4 μm (95% CI: 0.4 – 14.4) greater maximum CIMT. The association was not significant after adjusting for SBP but was not attenuated by adjusting for inflammatory biomarkers. PM
2.5
was related to mean CIMT and AD when adjusting for site, SES and age, but not after adjusting for other CVD risk factors. Ozone levels were not associated with any of the outcomes. No association was found between air pollution exposure and plaque presence.

Conclusion:
Early cumulative PM
2.5
exposure was associated with maximum CIMT later in the post-menopausal period. This association was largely explained by SBP suggesting that early exposure to air pollutants may relate to higher values of CIMT potentially by increasing SBP.
Abstract P068: Cigarette Smoking and Peripheral Arterial Disease in African Americans of the Jackson Heart Study
Authors: Hall Michael E , Wang Wei , Okhomina Victoria , White Wendy , Kamimura Daisuke , Blaha Michael J , DeFilippis Andrew P , Clark Donald , Al Rifai Mahmoud , Winscott John , Robertson Rose M , Bhatnagar Aruni , Winniford Michael D , Correa Adolfo
Published: March 2022

Introduction:
African Americans are more than twice as likely to develop peripheral arterial disease (PAD) compared to whites. Increased rates of hypertension, obesity and diabetes may account for some of these differences; however other factors such as cigarette smoking, which is understudied in African Americans, may play an important role.

Aim:
To evaluate the relationship between cigarette smoking and PAD in African Americans in the Jackson Heart Study (JHS).

Methods:
JHS participants (n=5,301) were classified by self-reported smoking status into current, past (smoked at least 400 cigarettes/life) or never smokers. Multivariate logistic and robust linear regression models were used to estimate the associations between smoking status at baseline and measures of subclinical PAD [carotid intimal medial thickness (CIMT, visit 1), ankle-brachial index (ABI, visit 1) and aortic calcium by computed tomography (visit 2)] to yield odds ratios (OR) and β-coefficients (estimated adjusted difference) to compare each smoking status to never smokers (reference group).

Results:
There were 3579 never smokers, 986 past smokers and 693 current smokers identified at baseline. After adjustment for covariates, past and current smokers had an increased risk of ABI < 1, increased CIMT and increased abdominal aortic and aorto-iliac calcium (all p<0.05, Table). Furthermore, current smokers smoking more than 20 cigarettes daily (1 pack) had a higher risk of PAD by all of these measures compared to current smokers smoking 1-19 cigarettes daily suggesting a dose-dependent relationship.

Conclusions:
In a large prospective African American cohort, current cigarette smoking was independently associated with measures of PAD in a dose-dependent manner. Furthermore, cigarette smoking was most strongly associated with abdominal aortic and aorto-iliac calcification. Current smoking is a strong predictor of subclinical PAD in African Americans and smoking cessation should be recommended.
Abstract P081: Are Racial Differences in Cardiovascular Health Factors Explained by Cardiovascular Health Behaviors? The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Carson April P , Goff David C , Jacobs David R , Kiefe Catarina I , Shikany James M , Sidney Stephen , Kershaw Kiarri N , Allen Norrina B , Lloyd-Jones Donald M , Laddu Deepika , Rana Jamal S , Ingram Katherine H , Lewis Cora E
Published: March 2022

Background:
Cardiovascular health (CVH) is worse among African Americans than whites, yet it is unclear whether differences in health behaviors fully account for these racial disparities. We investigated whether racial differences in CVH factors (blood pressure, glucose, and cholesterol) were explained by body mass index (BMI) and CVH behaviors (smoking and physical activity) in CARDIA.

Methods:
This cross-sectional analysis included 2,866 African-American and white CARDIA participants from four field centers (Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA) who completed the year 30 examination (2015-2016; 71% retention). We created a summary CVH factor score (range 0-6) using poor, intermediate, and ideal levels of blood pressure, glucose, and cholesterol, with higher scores indicative of better CVH. Linear regression was used to evaluate the association of race with the summary score in unadjusted and adjusted models.

Results:
Mean age (SD) was 55 (3.6) years, 57% were women, and 47% were African-American. The mean CVH factor score (SD) was 4.4 (1.2) for whites and 3.9 (1.3) for African Americans (p<0.0001). After adjustment for age and sex, African Americans had a lower CVH factor score than whites (Table). This difference was attenuated but persisted after adjustment for BMI. Findings were further attenuated after taking into account smoking, physical activity, and education.

Conclusion:
The racial disparity in CVH factor score persisted after accounting for BMI and CVH behaviors. Thus, roles of other factors, such as social determinants of health and diet, warrant further investigation.
Abstract P085: Cardiometabolic Syndrome Varies Significantly by Geography and Race/Ethnicity
Authors: Houghtaling Laura , Milder Sarah , Eckstein Tom
Published: March 2022

Introduction:
The relationship between cardiometabolic syndrome (CMS) and various risk factors has been studied in a variety of populations. Previously published research using 2007 Behavioral Risk Factor Surveillance System (BRFSS) data from Pennsylvania found that black and Hispanic adults had a significantly higher prevalence of CMS compared with whites. However, CMS has not been presented at the state level for the purpose of comparing the prevalence between states and between subpopulations within states.

Hypothesis:
This descriptive study examines the variation in prevalence of CMS by state and by race/ethnicity. We assessed the hypothesis that significant racial disparities exist in CMS prevalence between and within states.

Methods:
The sample size for this study included 2,380,047 noninstitutionalized adults aged 18 and older. A composite variable for CMS was created using BRFSS variables measuring obesity, hypercholesterolemia, angina (as a proxy for decreased high-density lipoprotein), prehypertension or hypertension, and prediabetes or diabetes. CMS was defined as having 3 or more of the 5 variables. Within BRFSS, obesity is defined as having a body mass index >=30kg/m*m based on self-reported height and weight. . Self-reported diagnosis of high cholesterol was used as a surrogate for elevated triglycerides. Self-reported diagnosis of angina or CHD was used as a surrogate for reduced HDL. Five years of BRFSS data (2011-2015) were aggregated to ensure adequate sample size for stratification by demographic variables. The survey weight used in the analysis was adjusted to represent the average population over the 5-year period. Both unadjusted and age-adjusted prevalence estimates were calculated. All statistical analyses were performed using STATA v14.1.

Results:
Unadjusted prevalence of cardiometabolic syndrome varied from 10.5% (95% CI: 10.0%-10.9%) of adults in Colorado to 23.1% (95% CI: 22.3%-24.0%) in Mississippi. Within Colorado, prevalence of CMS was 7.7% (95% CI: 7.2%-8.1%) among adults aged 18 to 64, and 21.7% (95% CI: 20.7%-22.7%) among adults aged 65 and older. In Mississippi prevalence of CMS was 19.8% (95% CI: 18.8%-20.7%) among adults aged 18 to 64 and 34.3% (95% CI: 32.8%-35.8%) among adults aged 65 and older. CMS prevalence is significantly higher among black adults compared with whites and Hispanics in almost all states (unadjusted for age). Age-adjusted comparisons between states are presented.

Conclusions:
Understanding the burden of CMS relative to other states and among select demographic groups within the state is vital to prevention efforts. Black adults are disproportionately afflicted with poor cardiometabolic health and the degree of affliction is dependent on state of residence. In conclusion, when it comes to CMS, it matters where you live, your age, and your racial/ethnic status.
Abstract P088: The Association of Religious Affiliation With Cholesterol Levels Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study
Authors: Hirode Grishma , Bharmal Nazleen , Kandula Namratha , Kanaya Alka M
Published: March 2022

Background:
South Asians have disproportionately high rates of cardiovascular disease. Dyslipidemia is a common and contributing factor.

Objective:
We hypothesized that lifestyle behaviors are influenced by religious beliefs and may be associated with cholesterol levels. We determined the associations between religious affiliation and LDL-cholesterol, HDL-cholesterol, and triglycerides among South Asians in the U.S.

Methods:
We performed cross-sectional analyses of the 2010-2013 baseline data from the MASALA study (n=906). Using multivariate linear regression models, we examined the associations between self-reported religious affiliation (Hinduism/Jainism, Sikhism, Islam, Other and None) and lipid levels after controlling for age, sex, and cholesterol medication use. We determined whether smoking, alcohol use, physical activity, and dietary pattern would explain the association.

Results:
The mean age was 55±9 years, 46% were women, and 29% were taking cholesterol medications. The majority of respondents were Hindu and/or Jain (74%), followed by 8% Sikh, 7% Islamic, 6% no religious affiliation, and 5% other (Christian, Buddhist, Zoroastrian, and multiple religious affiliations). The mean LDL was 111±32 mg/dl, median HDL was 48 mg/dl (IQR: 40-57), and median triglycerides was 119 mg/dl (IQR: 88-157). The table shows the associations of religious affiliation with lipid levels in serially adjusted models. The majority of the effect of religious affiliation was attenuated by physical activity for LDL; by alcohol use, physical activity and smoking for HDL; and by alcohol use and physical activity for triglycerides.

Conclusions:
Islamic religious affiliation was associated with higher LDL, triglycerides and lower HDL, and Hinduism was associated with lower HDL. However, lifestyle behaviors completely explained these associations. Thus, religion-specific tailoring of interventions designed to promote healthy lifestyle changes to reduce cholesterol levels among South Asians may be useful.