bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 30: High Intra-Individual Variation in Urinary Sodium Excretion in Teenage Girls on a Fixed Sodium Intake
Authors: Martin Berdine , McCabe George , McCabe Linda , Appel Lawrence J , Weaver Connie
Published: July 2021

Introduction:
According to traditional understanding of sodium homeostasis, nearly 100% of daily sodium (Na) intake is excreted in urine, with intra-individual variability attributed to variability in dietary Na intake and non-adherence with urine collection procedures. However, a recent report from a Russian space flight simulation documented unexpectedly high day-to-day variability in urine Na excretion on a fixed intake.

Objective:
To analyze daily urinary Na excretion from a balance study that was conducted in black and white girls on both low and high levels of dietary Na.

Methods:
Sodium balance was assessed in 22 black and 13 white adolescent girls, (11-15 y, BMI 15-29 kg/m
2
) in a randomized, crossover design with controlled diets containing either low (57 mmol/d) or high (167 mmol/d) Na, each for three weeks. Participants collected all urine in acid washed containers. Urine was pooled as 24-h samples and analyzed for sodium by atomic absorption spectrophotometry and creatinine by automated colorimetric method. Coefficients of variation (CV) for urinary Na were calculated for each teen. A mixed model was used to describe the effects of dietary Na and race.

Results:
The figures below give an example of the Na variability of one black teen on both the high (left) and low (right) Na diets. The horizontal line represents the Na intake. The CV analysis indicated higher variation about the mean on low (vs high) Na (40% vs 32%, p=0.02) and in black (vs white) girls (42% vs 30%, p<0.001). There was no diet x race interaction. Excretion of 50 mmol/d or less was documented on 6.6% of the days during the high Na dietary period.

Conclusions:
The high intra-individual variability in urinary Na excretion on a fixed diet highlights the potential for substantial error in (a) using a single 24 hour urine collection to estimate usual Na intake and (b) relating Na excretion from a single 24 hour collection with outcomes.
Abstract MP15: Innovative Self-Regulation Strategies Reduce Weight Gain in Young Adults
Authors: Wing Rena R , Tate Deborah , Espeland Mark , Lewis Cora E , Gorin Amy , LaRose Jessica , Bahnson Judy , Perdue Letitia , Erickson Karen , Ferguson Erica , Lang Wei
Published: July 2021

Introduction:
Young adults gain an average of 2 pounds per year, increasing their risk for obesity and co-morbidities. To date, no approaches have successfully reduced this weight gain. The Study of Novel Approaches to Prevention of Weight Gain (SNAP) is a randomized clinical trial testing two innovative self-regulation interventions.

Hypothesis:
We hypothesized that both interventions would reduce weight change over an average follow-up of 3 years relative to a control.

Methods:
Participants age 18-35 with a BMI of 21-30 were recruited in Raleigh-Durham, NC and Providence, RI. The 599 participants included 27% from minority groups and 22% males, mean age 28.4 (SD 4.4) yrs and BMI 25.4 (2.6). The interventions were based on a self-regulation model, involving frequent self-weighing and changes in eating and activity if weight gain occurred. The SMALL changes approach focused on making small (100 calorie) changes in daily eating and exercise; LARGE changes emphasized larger initial changes in eating and exercise, to create a 5 to 10-pound buffer against anticipated weight gain. Interventions were delivered via 8 face-to-face group sessions in the first 4 months, followed by ongoing weight reporting and feedback and optional Internet refreshers. CONTROL received one face-to-face session. Assessments were at baseline, 4 months, and then annually.

Results:
Data collection ends 12/31/14; final results will be presented. Retention at year 3 is 87%. Currently, mean (SE) weight changes across 3 years differ significantly between the groups (see Fig 1); for LARGE, mean weight loss is -2.48 (0.22) kg, which differs significantly from -0.75 (0.22) kg loss in SMALL, and both differ from the +0.10 (0.22) kg gain in Control. For secondary outcomes of weight gain from baseline to 2 years and % gaining >1 lb at 2 years, both interventions significantly differed from Control, but not from each other.

Conclusion:
Self-regulation approaches using LARGE or SMALL change strategies reduce weight gain in young adults.
Abstract MP21: Achieving Cardiovascular Health in Young Adulthood - Do Adolescent Factors Matter?
Authors: Gooding Holly C , Milliren Carly , Shay Christina M , Richmond Tracy K , Field Alison E , Gillman Matthew W
Published: July 2021

Introduction:
Adults who reach middle age with optimal levels of three physiologic factors – blood pressure, cholesterol, and blood glucose – have lower rates of CVD mortality compared to those with one or more of these risk factors in the non-optimal range. The American Heart Association has identified four healthy lifestyle components – BMI, smoking, diet, and physical activity – important for preserving optimal cardiovascular health as people age. However, which lifestyle components in adolescence are most strongly associated with physiologic markers of cardiovascular health in adulthood is unclear. The purpose of this study was to quantify associations between lifestyle components measured in adolescence and optimal physiologic cardiovascular health in young adulthood.

Methods:
Analyses included 9,697 young adults, age 24-32 years in 2007-2008, who participated in Wave IV of the National Longitudinal Study of Adolescent Health. We defined optimal physiologic cardiovascular heath as untreated blood pressure <120/80 mmHg, untreated fasting blood glucose <100 mg/dL and hemoglobin A1C < 5.7%, untreated total cholesterol in the bottom 7 (women) or 6 (men) deciles for the study population, and absence of diabetes or CVD as measured at Wave IV. We used logistic regression models to estimate the odds of having optimal physiologic cardiovascular health in young adulthood according to BMI category, smoking status, and physical activity patterns measured during Waves I and II when participants were ages 11-20 years. Dietary data were not available. Models were adjusted for age, sex, race, educational attainment, and income in young adulthood.

Results:
Few young adults (16%, 1,592 of 9,697) had optimal physiologic cardiovascular health. Young adults who had been normal-weighted in adolescence were more likely to have optimal physiologic cardiovascular health (18.4%, 1,382 of 7,206) compared to those who had been overweight (9.4%, 142 of 1,429) or obese (6.9%, 68 of 1,062). In models adjusted for young adult sociodemographic factors, participants who had been overweight or obese as adolescents were less than half as likely as those who had been normal-weighted to have optimal physiologic cardiovascular health in young adulthood (overweight odds ratio (OR) 0.43, 95% confidence interval (CI) 0.35-0.61; obese OR 0.40, 95% CI 0.28-0.57). Adolescent tobacco smoking and physical activity were not associated with young adult cardiovascular health.

Conclusions:
Maintaining a healthy weight in adolescence may be the most important lifestyle factor for reaching young adulthood with optimal physiologic cardiovascular health. Overweight and obese adolescents should be encouraged to achieve a healthy weight through adherence to diet and physical activity goals.
Abstract MP52: Beyond Body Mass Index: A Population-Based Comparison Demonstrates Advantages of Abdominal Anthropometry for Identifying Cardiometabolic Dysfunctions
Authors: Kahn Henry S , Bullard Kai M
Published: July 2021

Background:
A weight-based adiposity indicator (body mass index; BMI,

kg/m
2

) is often reported for adults. Indicators based on sagittal abdominal diameter (SAD) or waist circumference have also identified cardiometabolic risk.

Aim:
Compare SAD/height ratio (SADHtR) or waist/height ratio (WHtR) with BMI for identifying risks in a representative sample of non-elderly adults without diagnosed diabetes. Outcome dysfunctions were
Dysglycemia
(glycated hemoglobin ≥5.7%),
HyperNonHDLc
(non-HDL-cholesterol ≥160 mg/dL or taking cholesterol meds),
Hypertension
(SBP ≥140 or DBP ≥90 or taking blood-pressure meds) and
HyperALT
(alanine transaminase ≥75
th
%ile [sex-specific p75]).

Methods:
Non-pregnant adults (ages 20-64 y; N=3,071) in the 2011-2012 US National Health and Nutrition Examination Survey provided conventional anthropometry and supine SAD (by sliding
-
beam caliper). Sample weighting permitted estimation of population characteristics, including odds ratios (ORs) associated with each adiposity indicator (logistic regression models adjusted for age, sex and ancestry). For each dysfunction, we compared the ORs for 3 indicators after rescaling them to the indicator’s sex-specific, interquartile range.

Results:
The population distributions (mean; p25, p75) of indicators among men were: SADHtR (0.129; 0.112, 0.144), WHtR (0.564; 0.505, 0.613), and BMI (28.2; 24.2, 31.0). Among women they were: SADHtR (0.131; 0.112, 0.148), WHtR (0.580; 0.510, 0.636), and BMI (28.3; 23.4, 31.7). Dysfunction prevalence ranged from 21.9% (Dysglycemia in women) to 42.4% (HyperNonHDLc in men). To identify HyperNonHDLc, Hypertension and HyperALT (but not Dysglycemia), the ORs were highest for SADHtR and lowest for BMI. When SADHtR entered models simultaneously with BMI, the ORs associated with BMI no longer contributed to identification of HyperNonHDLc, Hypertension, or HyperALT (Figure).

Conclusions:
Among US adults, the SADHtR provides low-cost estimation of cardiometabolic risk independently of BMI.
Abstract MP57: The Association Between Anthropometrics and Different Measures of Cardiac Structure and Function - The Echo-SOL Study
Authors: Allison Matthew A , Cai Jianwen , Desai Ankit , Hurwitz Barry , Ni Ai , Schneiderman Neil , Shah Sanjiv , Spevack Daniel , Talavera Greg , Rodriguez Carlos
Published: July 2021

Background:
The purpose of this study was to determine the magnitudes and significances of the associations between adiposity and echocardiographically determined measures of left ventricular (LV) structure and function in a diverse cohort of Hispanic/Latino adults.

Methods:
Subjects were 1,350 adult men and women participants of the Hispanic Communities Health Study - Study of Latinos (HCHS-SOL) who enrolled in an ancillary study to determine cardiac structure and function by echocardiography. In addition to echocardiography, subjects were evaluated by extensive survey information, relevant physical measurements (to include bioelectrical impedance) and fasting blood assays.

Results:
The mean age was 56.1 years and 57% were female. Twenty-six percent were Mexican American, 25% Cuban American, 18% Dominican American, 17% Puerto Rican American, 8% Central American and 7% South American. Overall, the mean ejection fraction was 60.5%, while the mean stroke volume was 70 ml, end diastolic volume 83 ml, fractional shortening 31% and cardiac output 4.5 L/min. Results of multivariable linear regression adjusted for age, gender, hypertension, diabetes, dyslipidemia, cigarette smoking, family history of coronary heart disease, C-reactive protein and chronic kidney disease revealed that each 1-unit increment in body mass index (BMI) and fat mass (FM) by impedance was associated with 0.64 and 0.25 (p < 0.01 for both) higher LV mass index (to height), while a 0.1 unit increment in the waist to hip ratio (WHR) was associated with 3.2 higher LV mass index. Concomitantly, each 1-unit increment in BMI and FM was associated with 7 and 3% (p < 0.01 for each) higher odds of LV hypertrophy, while a 0.1 unit increment in WHR was associated with 78% higher odds for LV hypertrophy (p < 0.01). On the other hand, none of these variables were significantly associated with ejection fraction. There were no significant interactions between the anthropometric variables and the different Hispanic groups for LV mass index or hypertrophy.

Conclusions:
Among Hispanics/Latinos from different cultural backgrounds, and by three measures of body composition (BMI, FM and WHR), higher levels of adiposity are significantly associated with higher LV mass indexed for height and the odds for hypertrophy, while not being associated with better or worse ejection fraction.
Abstract MP65: High Mobile Device Usage Associated With Sedentary Behaviors and Less Physical Activity in 6th Grade Students
Authors: Gordon Lauren , Sylvester Rachel , Rogers Robert , Wei Wen-Ching , Pew Alexandra , Jiang Qingmei , Kline-Rogers Eva , Goldberg Caren , DuRussel-Weston Jean , Eagle Kim A , Jackson Elizabeth A
Published: July 2021

Background:
Sedentary screen time (including TV, computer and video games) has been correlated with childhood obesity and other health risks. The American Academy of Pediatrics (AAP) recommends that children limit their daily screen time to two hours in order to reduce the associated risk. Mobile device use has become increasingly popular amongst children and adolescents. However, mobile screen time (cell phone and tablet use) and its effect on physical activity in adolescents has yet to be thoroughly researched.

Methods:
Self-reported survey data were collected from 2,566 6th grade students enrolled in Project Healthy Schools during the 2013-2014 school year. Based on AAP guidelines, we split our sample into low mobile device users (≤2 hours/day) and high mobile device users (>2 hours/day). We compared physical activity, sports team participation and screen time habits between groups.

Results:
20.73% (n=532) of the 6th graders surveyed reported being high mobile device users. 60.5% (n=322) of these were female; 39.5% (n=210) were male. In addition to >2 hours/day on a mobile device, these students spent significantly more time watching TV (2.30 v 1.70, p<0.001), on the computer (1.39 v 0.88, p<0.001), and playing video games (1.47 v 1.01, p<0.001) than low mobile device users. Low mobile device users participated in significantly more strengthening exercises (2.80 v 2.62, p=0.046) and outside of school sports teams (1.20 v 1.09, p=0.03) than high mobile device users.

Conclusions:
A large percentage of middle school students (20.73%) reported spending more time on a mobile device than recommended by the AAP. High mobile device usage appears to be associated with less physical activity and more sedentary behaviors. This illustrates the need to educate children and encourage the reduction of time spent on a mobile device.
Abstract MP68: Risk of Sleep Apnea and Subclinical Cardiovascular Disease in Young-to-Middle Aged Adults: The Bogalusa Heart Study
Authors: HU TIAN , Bertisch Suzie , Chen Wei , Harville Emily , Redline Susan , Bazzano Lydia
Published: July 2021

Obstructive sleep apnea (OSA) may affect cardiovascular risk. Prior studies examining this issue have often been limited to patients in clinical settings or older adults. Given the high prevalence of obstructive sleep apnea in middle-aged adults and the influence of duration of OSA on cardiovascular risk, examining subclinical cardiovascular in middle aged-adults would further elucidate the direct relationship between OSA and cardiovascular disease. We examined the association between risk of OSA and subclinical cardiovascular disease indicators among 914 young-to-middle aged adults who responded to the Berlin Questionnaire assessment of OSA risk in 2010, and had measures of carotid intima-media thickness (IMT) and left ventricular (LV) geometry. Carotid IMT was measured using standard procedures and categorized into quartiles. Indices of LV geometry were assessed by M-mode echocardiography and classified into normal, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy by integrating gender and race specific relative wall thickness and LV mass index. High-risk for OSA was determined using Berlin Questionnaire score as the primary outcome. Secondary outcomes included habitual snoring and excessive sleepiness. Of those included in the analysis, mean (SD) age was 43.1 (4.5) yrs; 42.1% were male and 31.7% were Black. A total of 235 (25.7%) participants had elevated Berlin scores indicating high-risk for OSA. Mean (SD) of carotid IMT was 0.66 (0.15) mm, and 87 (9.5%) and 161 (17.6%) participants had eccentric and concentric LV hypertrophy, respectively. In log-linear regression models adjusted for age, race, sex, education, current smoking, regular alcohol consumption, total cholesterol, high-density lipoprotein cholesterol, and type-2 diabetes, participants at high-risk of OSA were 1.35 (95% CI: 1.07 - 1.71) times more likely to be in the highest quartile of IMT (≥0.74 mm), were 1.68 (1.09 - 2.58) times as likely to have concentric hypertrophy, and 1.64 (0.95 - 2.82) times as likely to have eccentric hypertrophy, compared to those at low-risk of OSA. Similar positive associations were observed for habitual snoring but not for excessive sleepiness. After further adjusting for current obesity status in the models, the association of OSA risk with IMT remained consistent while the associations with LV hypertrophy was attenuated. There was no significant effect modification by race or sex. In summary, being at high risk OSA was associated with substantially higher risk of subclinical cardiovascular disease in this biracial, semi-rural, community-based population of young-to-middle age adults.
Abstract MP78: Effect of Beta-Blocker Therapy, Maximal Heart Rate and Exercise Capacity During Stress Testing on Long-Term Survival
Authors: Hung Rupert K , Al-Mallah Mouaz , Whelton Seamus P , Blumenthal Roger S , Brawner Clinton A , Keteyian Steven J , Blaha Michael J
Published: July 2021

Background:
Whether beta-blocker therapy (BBT) attenuates the prognostic value of percentage-predicted maximal heart rate (ppMHR) achieved during stress testing remains unclear. The combined effect of ppMHR and exercise capacity on long-term mortality is unknown.

Methods:
We analyzed 67,772 adults (54 ± 13 years old, 54% men (36,639 of 67,772), 29% black (19,834 of 67,772)) from The FIT Project, a retrospective cohort study of patients who underwent physician-referred exercise stress testing at a single healthcare system between 1991 and 2009. Patients were categorized by baseline use of BBT. Maximal age-predicted heart rate was defined as 220-age. We derived adjusted mortality rates over the range of ppMHR using margins of response logistic regression models. Our primary model included adjustment for demographic data, resting blood pressures, medical history, pertinent medications, and indication for stress testing. Our secondary model included further adjustment for exercise capacity.

Results:
There were 10,594 deaths over 11 ± 5 years of follow-up. Patients on BBT tended to have more comorbidities and other medication use (P<.001). After accounting for differences between BBT groups, BBT was associated with an 8% lower ppMHR (83% in BBT vs. 91% in no BBT) in both men and women. ppMHR was inversely associated with all-cause mortality in both analyses performed (P≤.001), though the association was significantly attenuated by BBT (P=.03) [Panel A]. Exercise capacity further attenuated the prognostic value of ppMHR in all patients, particularly in those on BBT, and reduced the difference in risk between those on BBT and not on BBT (P=.08) [Panel B].

Conclusion:
BBT attenuated the association between ppMHR achieved during stress testing and long-term mortality. Exercise capacity further attenuated the prognostic significance of ppMHR, particularly in patients on BBT.
Abstract MP85: Mediterranean Diet and Incidence of Stroke in the California Teachers Study
Authors: Sherzai Ayesha Z , Ma Huiyan , Horn-Ross Pamela , Canchola Alison J , Voutsinas Jenna , Willey Joshua Z , Gu Yian , Scarmeas Nikolaos , Sherzai Dean , Bernstein Leslie , Elkind Mitchell S , Wang Sophia S
Published: July 2021

Introduction:
A Mediterranean diet (MeDi) has been associated with a reduced incidence of cardiovascular and neurodegenerative diseases, and overall mortality, in several prospective studies. There is limited data, however, regarding the relationship between MeDi and stroke, and in particular, stroke subtypes. We hypothesized that MeDi would be associated with reduced total, ischemic, and hemorrhagic stroke incidence.

Methods:
The California Teachers Study comprises 133,478 women who enrolled in 1995 and have been continuously followed. Using linked California state hospitalization data and national death records from 1996-2011, incident strokes were identified and validated. Socio-demographic and medical risk factor data were collected from the baseline questionnaire. Diet was assessed using a food-frequency questionnaire in 113,547 women. The Mediterranean diet emphasizes plant-based foods, mono-unsaturated fats, fish and moderate alcohol intake. We used the MeDi adherence score, a nine point scale, which has been used and validated in prior studies. A higher score on the 0-9 scale represents increased adherence. Multivariable Cox proportional-hazard models adjusted for socio-demographic factors including age, ethnicity, socioeconomic status, moderate-to-strenuous physical activity, total calorie intake, body mass index, cigarette smoking, menopausal and hormonal status and vascular risk factors were used to assess the association (hazard ratios and 95% confidence intervals, HR 95% CI) between MeDi score and risk of stroke and stroke subtypes.

Results:
A total of 104,268 participants were eligible for the analysis (mean age 52 ± 13.9 years, 87.4% white, 4.6% Hispanic, 3.2% Asian and 2.1% black). The MeDi score distribution was: 0-2 (16.1%), 3 (18.2%), 4 (21.4%), 5 (20.1%), and 6-9 (24.3%). During follow-up, 3165 stroke events occurred (2270 ischemic ; 895 hemorrhagic). In the multivariable model, compared to those in the lowest MeDi score quintile (score 0-2), those in the fourth quintile (score 5: HR 0.86, 95% CI 0.75-0.98) and highest quintile (score 6 - 9: HR 0.83, 95% CI 0.73-0.95) were at lower risk of stroke (p for trend 0.009). For ischemic stroke, those in the third (HR 0.84, 95% CI 0.72-0.97), fourth (0.85, 95% CI 0.73-0.98), and highest quintile (HR 0.82, 95% CI 0.70-0.95) were all at reduced risk (p for trend 0.02). There was no association with hemorrhagic stroke.

Discussion:

Adherence to the Mediterranean diet is associated with decreased risk of total and ischemic stroke incidence among the participants of the California Teachers Study.
Abstract P013: Cost-Effectiveness of Treating Hypertension in African Americans According to 2014 Guidelines
Authors: Vasudeva Eshan , Moise Nathalie , Tzong Keane Y , Penko Joanne , Goldman Lee , Coxson Pamela G , Bibbins-Domingo Kirsten , Moran Andrew E
Published: July 2021

Background:
Among U.S. ethnic groups, African Americans have the highest prevalence of hypertension and higher rates of hypertension-related morbidity and mortality. We estimated the cost-effectiveness of improved hypertension control in African Americans.

Methods:
The populations studied were African Americans and all U.S. adults aged 35-74 years. Using the CVD Policy Model, we simulated CVD events and non-CVD deaths, quality-adjusted life years (QALYs), and hypertension and CVD treatment costs, before and after implementing 2014 U.S. guidelines. African American and overall U.S. CVD incidence, mortality, and risk factor levels were obtained from cohort studies, vital statistics, and the NHANES. Hypertension treatment effects were derived from a meta-analysis of clinical trials. Stage 2 hypertension was defined as BP ≥160/100 mmHg; stage 1 as BP ≥140/90 and <160/100 mmHg. Incremental cost-effectiveness ratios (ICERs) were calculated as change in costs divided by change in QALYs. An ICER <50,000 was cost effective, ≥$50,000 and <$150,000 intermediate value, and >$150,000 low value.

Results:
Treating hypertension in CVD patients and in stage 2 hypertensives without CVD would be cost-saving in all African Americans and in all but the youngest women overall (Table). Treating stage 1 hypertension would be cost-saving in all African American men except for ages 35-44 without diabetes or CKD, and cost-saving in all women ≥45 years old. Treating the youngest women with stage 1 hypertension was of intermediate or low value in both African Americans and the U.S. overall, but of more value in African American women.

Discussion:
In a computer simulation of hypertension treatment according to 2014 guidelines, we found that controlling hypertension would be cost-saving in all African American adults age 45 or older. These results suggest that investment in effective clinic and community-based interventions aimed at controlling hypertension in African Americans would yield high value to health system payers and to society.
Abstract P045: Western Dietary Patterns are Associated with the Prevalence of Hypertension in South Korea - The Kangbuk Samsung Health Study
Authors: Rampal Sanjay , Cho Juhee , Choi Yuni , Zhang Yiyi , Zhao Di , Pastor-Barriuso Roberto , Chang Yoosoo , Lima Joao A , Shin Hocheol , Ryu Seungho , Guallar Eliseo
Published: July 2021

Introduction:
Diet is a complex exposure of unquestionable relevance for cardiovascular disease (CVD) risk. South Korea, a population with traditionally low rates of CVD, has changed in recent decades from a traditional diet to more Western and modern dietary patterns. The impact of these changes are uncertain.

Hypothesis:
We aimed to evaluate the hypothesis that non-traditional dietary patterns were associated with an increased prevalence of hypertension in a large sample of young and middle-aged Korean adults.

Methods:
We conducted a cross sectional study of 220,979 adult men and women who underwent a screening health examination between January 2011 and December 2013 at the Kangbuk Samsung Total Healthcare Center in Seoul and Suwon, South Korea who did not have any history of cardiovascular disease, cancer, diabetes, hypertension, or dyslipidemia. Diet was assessed using a validated 103-item food frequency questionnaire and principal component analysis was used to derive three major dietary patterns: Western Korean, characterized by higher intakes of noodles, red meat, processed meat, raw or salted fish, shellfish, poultry, soda, and alcohol; Traditional Korean, characterized by higher intakes of vegetables, mushrooms, preserved vegetables, soya and other beans, fruits, fish, and seaweed; and Modern Korean, characterized by higher intakes of bread and cereals, milk and dairy products, snacks, and pizza, and lower intakes of alcohol, rice, and preserved vegetables. Hypertension was defined as having a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥ 90 mmHg. Systolic hypertension was defined as having a systolic blood pressure ≥140 mmHg.

Results:
The prevalence of hypertension was 2.9%. In fully adjusted multivariable models, the odds ratios for hypertension comparing the 90th to the 10th percentile of dietary scores were 1.58 (95%CI 1.42, 1.75), 1.11 (95%CI 1.01, 1.21), 0.73 (95%CI 0.66, 0.81) for Western, Traditional, and Modern Korean dietary patterns, respectively. The corresponding odds ratios for systolic hypertension were 1.50 (95%CI 1.28, 1.76), 1.17 (95%CI 1.01, 1.36), and 0.68 (95%CI 0.58, 0.79), respectively.

Conclusion:
In this large cross-sectional study of young and middle-aged Korean men and women, diet transition to a more Western pattern, characterized by higher intake of meats and alcohol, was associated with a higher prevalence of hypertension and may be associated with increased CVD risk.
Abstract P051: Healthy Lifestyle Factors are Uncommon and Associated with Reduced Risk of Cardiovascular Disease and Mortality in Candidates for Primary Prevention with Statin Therapy
Authors: Booth John N , Colantonio Lisandro D , Cushman Mary , Howard George , Safford Monika , Banach Maciej , Reynolds Kristi , Muntner Paul
Published: July 2021

Introduction:
Adults with a 10 year predicted atherosclerotic cardiovascular disease (ASCVD) risk ≥7.5% are candidates for statin therapy for primary prevention. Lifestyle interventions may benefit this high risk group. Hypothesis: We estimated the use of healthy lifestyles and their association with ASCVD and mortality risk in adults with a 10 year predicted ASCVD risk ≥7.5%. Methods: The REasons for Geographic and Racial Differences in Stroke cohort study enrolled adults ≥45 years old from the 48 continental US states and District of Columbia in January 2003 - October 2007 (n=30,239). The final sample was restricted to adults 45 - 79 years old, without ASCVD or diabetes history, low density lipoprotein cholesterol 70 - 189 mg/dL and a 10 year predicted ASCVD risk ≥7.5% (n=5,709). Ideal lifestyle factors, assessed during an in-home physical exam and through surveys, included non-obese waist circumference (<88/<102 cm for women/men), physical activity (PA) ≥4 times per week, nonsmoking, low saturated fat intake (<7.0% of daily calories) and highest Mediterranean diet score quartile. Participants were contacted every 6 months to detect incident ASCVD events (nonfatal/fatal stroke, nonfatal myocardial infarction or coronary heart disease death) and all-cause mortality for adjudication. Results: The prevalence of ideal lifestyles was 56.9% for non-obesity, 33.5% for PA, 80.7% for nonsmoking, 7.1% for low saturated fat intake, and 27.6% for highest Mediterranean diet score quartile. Overall, 4.8%, 27.2%, 35.5%, 23.5% and 9.0% had 0, 1, 2, 3, and ≥4 of the 5 ideal lifestyles. There were 377 ASCVD events and 471 deaths (median follow up: 5.8 and 6.0 years, respectively). After multivariable adjustment, there was a graded association for lower ASCVD incidence and mortality with 1, 2, 3 and ≥4 versus 0 ideal lifestyles (Table 1). Conclusion: Healthy lifestyles were underused in adults with a 10 year predicted ASCVD risk ≥7.5%. Improving lifestyle factors may significantly reduce ASCVD and delay mortality in this high risk population.
Abstract P055: Six-Month Changes in Ideal Health and Cardiovascular Risk Scores Among Young Adults Enrolled in a Weight Loss Intervention
Authors: Barone Gibbs Bethany , King Wendy C , Jakicic John M
Published: July 2021

The Framingham 10-year (FRS-10) and lifetime (FRS-LIFE) risk scores use clinical CVD risk factors to predict coronary heart disease (CHD) and CVD outcomes, respectively. In contrast, the AHA’s Ideal Cardiovascular Health (IDEAL) paradigm encourages a 7-component, healthy phenotype that additionally includes healthy diet, body mass index (BMI), and physical activity behaviors that are also associated with the avoidance of developing cardiovascular disease (CVD).

Objective:
To compare changes in IDEAL, FRS-10, and FRS-LIFE over 6 months in young adults enrolled in a behavioral weight loss intervention
Methods:
FRS-10 and FRS-LIFE were calculated using published equations at baseline and 6 months in young adults who were overweight or obese at study entry but otherwise healthy. IDEAL was calculated on a 14-point scale where, for each component, 0, 1, or 2 points were given for ‘poor’, ‘moderate’, or ‘ideal’ classification, respectively. Descriptive statistics are reported as % or median [IQR]. McNemar’s test, test of symmetry, and Wilcoxon signed rank test were employed to evaluate pre- to post-intervention changes. Spearman’s correlations evaluate associations.

Results:
In 335 young adults, age 31 [27, 34] yrs, BMI 31 [28, 34] kg/m
2
, and 32% male, the intervention achieved significant 6-month decreases in BMI: -3.0 [-4.3, -1.5] kg/m
2
. Out of a possible 14 points (higher is better), IDEAL was 9 [8, 10] at baseline and 11 [10, 12] at 6 months, with 73% improving and 9% worsening (net improvement 64%) (p<.0001). Though<1% ever had IDEAL diet, a net improvement in diet was observed in 19%, with specific improvements in sugar-sweetened beverage and sodium components (p<0.001). Significant net improvements were also observed in IDEAL classification for BMI (49%), physical activity (39%), total cholesterol (14%), blood pressure (14%) and glucose (11%) components (all p<.0001). FRS-10 was negligible (<1%) for 88% of the cohort at baseline and 94% at 6 months. Across predicted FRS-10 scores, 7% improved and 2% worsened (net improvement 5%) over the 6 months (p<.0001). Improved FRS-10 and IDEAL were correlated (Spearman’s rho = -0.49, p<0.001). IDEAL had a stronger correlation with change in weight compared to FRS-10 (Spearman’s rho = -0.49 vs. 0.30; both p<0.001). FRS-LIFE indicated lifetime risk was high for 35% of the cohort at baseline and 22% at 6 months (p<.0001). FRS-LIFE as a 5-category scale improved in 38% and worsened in 13% (net improvement 26%) (p<.0001).

Conclusions:
In a cohort of overweight or obese, but otherwise healthy, young adults enrolled in a weight loss intervention, IDEAL was able to measure positive lifestyle changes in a majority of participants while the FRS-10 and FRS-LIFE did not. These results suggest that IDEAL may be particularly sensitive and appropriate to detect positive cardiovascular health changes in the growing population of overweight and obese young adults.
Abstract P066: Cortisol/Testosterone and Cortisol/ Sex Hormone Binding Globulin Ratios With Metabolic Syndrome in Women
Authors: Lee Ju-Mi , Colangelo Laura , Schwartz Joseph E , Yano Yuichiro , Siscovick David S , Seeman Teresa , Schreiner Pamela J , Liu Kiang J , Lloyd-Jones Donald M , Greenland Philip Greenland
Published: July 2021

Introduction:
The ability to study chronic stress in humans is complicated due to measurement error of questionnaires and the inability of short-term measures of stress hormones to reflect the chronic state. Therefore considerable controversy remains about whether chronic stress influences cardiovascular disease or not. The cortisol/testosterone (C/T) ratio was suggested to be a better predictor of heart disease in men than cortisol alone, as gonadotropin and cortisol are derived from the same biochemical precursor. This ratio has never been studied with metabolic syndrome (MetS) in a U.S. epidemiologic study, especially in women.

Study question: Are C/T and C/sex hormone binding globulin (SHBG) ratio associated with MetS in women?

Methods:
In the Coronary Artery Risk Development in Young Adults (CARDIA) study, 367 women (age range 32 to 51, mean age 40 years old) who had both cortisol from year (Y) 15 and sex hormones from serum specimen Y16 measured are included. Metabolic syndrome (MetS) from Y15, 20, 25 were assessed. Due to the instability and diurnal characteristics of cortisol, area under the curve (AUC) of six samples and slope of 1st (or 3rd) and 6th (or 5th when 6th is not available) sample of salivary cortisol collected over one day were calculated. Ratios of AUC and of slope of cortisol to total testosterone (TT), free testosterone (FT), and sex hormone binding globulin (SHBG) were computed: AUC/TT, AUC/FT, AUC/SHBG, Slope/TT, Slope/FT, and Slope/SHBG. The associations of these variables categorized into tertiles with MetS were assessed cross-sectionally by logistic regression analysis. Model I controlled for age and race. Model II controlled for model I variables plus menopause, oral contraceptive usage, diabetes mellitus, alcohol consumption, and cigarette smoking.

Results:
MetS was present in 53, 69, and 74 participants at Y15, Y20, and Y25, respectively. The highest tertile of AUC/SHBG ratio was associated with Y15, Y20, and Y25 MetS prevalence in model I (OR 2.17, 3.77, 2.65, 95% CI 1.02-4.61, 1.64-8.44, 1.75-9.20, respectively). This association was slightly stronger in model II (OR 3.72, 4.76, 3.26, 95% CI 1.49-9.30, 2.00-11.34, 1.55-6.85, respectively). The highest tertile of slope/FT ratio was associated with Y20 and Y25 MetS prevalence in model I (OR 2.10, 1.68, 95% CI 1.03-4.26, 0.86-3.31 respectively). This association was slightly stronger in model II (OR 2.32, 2.13, 95% CI 1.09-4.95, 1.03-4.41 respectively).

Conclusions:
Findings suggest that some indicators of chronic stress are cross-sectionally associated with MetS in women.
Abstract P074: Restless Legs Syndrome and Carotid Intima-Media Thickness in Women
Authors: Jacobo Karen , Monge Adriana , Ortiz-Panozo Eduardo , Yunes Elsa , Catzin-Khulmann Andres , Cantu-Brito Carlos , Lopez-Ridaura Ruy , Lajous Martin
Published: July 2021

Introduction:
Restless legs syndrome (RLS) is a common chronic disorder characterized by an irresistible need to move the lower limbs that is usually worse in the evening and is associated with sleep disturbances. RLS has been associated with hypertension and has been proposed as a marker for increased cardiovascular risk.

Hypothesis:
Individuals with RLS have an increased common carotid intima-media thickness (cIMT) relative to individuals without RLS.

Methods:
We evaluated cross-sectional relation of RLS and cIMT in 1,147 disease-free Mexican women of the Mexican Teachers’ Cohort. In 2011, participants responded to a follow-up questionnaire that included standardized questions addressing the four minimal diagnostic criteria of the International Restless Legs Study Group. Participants were asked: “Do you have unpleasant leg sensations (like crawling, loss of sensation or pain) combined with restlessness and an urge to move your legs?”, “Do these symptoms occur only at rest?”, “Does moving improve these symptoms?”, “Are these symptoms worse in the evening or at night compared with the morning?” Women who answered yes to all the four questions were defined as having RLS. Between 2012 and 2013, a subsample of participants were invited for a clinical visit where neurologists assessed cIMT with an ultrasound. cIMT measurements were found to be reproducible in a substudy in 52 participants (intra-class correlation=0.89). We defined subclinical atherosclerosis as a cIMT ≥0.8 mm or the presence of plaque.

Results:
Among women with a mean age of 48.2 (SD±4.3), the prevalence of RLS was 14.2% (cases, 163). The age-adjusted mean difference of cIMT comparing participants with RLS to those without RLS was 0.009mm (95%CI -0.004 to 0.023). After further adjustment for diabetes, hypercholesterolemia, migraine, oral contraceptive use, menopause, smoking, body mass index, physical activity and alcohol, the mean difference of cIMT comparing participants with and without RLS was not statistically different (0.007mm; 95%CI -0.007 to 0.021). The prevalence of subclinical atherosclerosis was 27% (n=44) in those with RLS and 21.9% (n=215) in those without RLS. The age-adjusted OR comparing women with RLS to those without RLS was 1.23 (95%CI 0.83-1.82). In the multivariable model the OR remained non-significant (1.16, 95%CI 0.77-1.74).

Conclusions:
In this cross-sectional study in middle-aged women, RLS was not associated to cIMT. Our results do not support the observation that individuals with RLS are at an increased risk for cardiovascular disease.
Abstract P077: Sleep Disturbances and Risk of First Cardiovascular Events. Results from the MONICA Brianza and PAMELA Cohort Studies in Northern Italy
Authors: Bertù Lorenza , Ferrario Marco M , Gianfagna Francesco , Veronesi Giovanni , Grassi Guido , Cesana Giancarlo
Published: July 2021

Background and aim:
Poor sleep quality has been found associated with increasing risk of cardiovascular diseases. We aim to estimate the long-term risk of first cardiovascular (CVD) event (coronary or ischemic stroke) in subjects with sleep disturbances in North-Italian cohorts.

Methods:
Four independent population-based cohorts were enrolled between 1986 and 1994 from the Brianza population (Northern Italy). At baseline LDL-, HDL-cholesterol, systolic blood pressure, diabetes and cigarette smoking were ascertained through standardized MONICA procedures. The study sample comprises 3047 men and 3097 women, aged 25 to 75 years and CVD-free at baseline, who were followed-up for incidence of first coronary and ischemic stroke events (fatal and non-fatal; MONICA validated). Sleep disturbances were assessed with the Jenkins Sleep Questionnaire, investigating sleep disturbances (4 items) in the last month, and then categorized in three classes: none-some (reference), moderate, severe/extreme. Age and CVD risk factors adjusted HRs for first CVD, coronary or ischemic stroke event were estimated in the overall sample, in men and women, from separate Cox models.

Results:
In a median 15 years of follow-up 437 first CVD events occurred (305 coronary and ischemic stroke). When adjusting for LDL- and HDL-cholesterol, systolic blood pressure, diabetes and cigarette smoking, the risk of first CVD events was higher in subjects with severe sleep disorders compared with none-some (HR=1.84; 95%CI:1.19-2.84). Gender-stratification confirms the association both in men and women, but only in men resulted statistically significant (HR=2.34; 95%CI:1.34-4.08). The association was prominent for ischemic strokes (HR=2.10; 95%CI:1.11-3.97) and less clear for coronary events. These associations resulted higher when the follow-up was shortened to 10 years.

Conclusions:
In this population of middle-aged CVD-free subjects from Northern Italy, severe sleep disturbances were associated with first CVD events. The risk was higher in men and when ischemic strokes were considered only.
Abstract P088: Perceptions of Alcohol as Heart Healthy: The Health eHeart Study
Authors: Whitman Isaac R , Pletcher Mark J , Vittinghoff Eric , Imburgia Kourtney E , Maguire Carol , Betterncourt Laura , Parsnick Todd , Sinha Tuhin , Tison Geoffrey H , Olgin Jeffrey E , Marcus Gregory M
Published: July 2021

Background:
Moderate consumption of alcohol may provide protection against myocardial infarction and mortality, but also likely increases blood pressure and incidence of atrial fibrillation. Despite the absence of rigorous controlled trials on the actual cardiovascular benefits of alcohol, the lay press frequently portrays alcohol as “heart healthy” (HH). No study to date has described individuals’ perceptions regarding the health effects of alcohol, how they gained this perception, nor how that perception may influence behavior.

Methods:
We performed a cross-sectional analysis of data obtained between March 8, 2013 to September 29, 2014 from consecutive participants enrolled in the Health eHeart Study, a prospective, internet-based cohort study. The characteristics of participants that reported alcohol as HH were determined.

Results:
A total of 5,417 participants answered questions regarding their perception of alcohol. Thirty percent (n=1,707) viewed alcohol as HH, 39% (n=2,157) viewed it as bad for the heart, and 31% (n=1,718) were unsure. Of those reporting alcohol as HH, 78% cited lay press as a source of their knowledge, 14% cited their doctor, and 92% reported that red wine exclusively was HH. In adjusted analyses, older age, higher education, higher income, and United States residence were associated with a perception of alcohol as HH (Figure). Those with a history of heart failure (HF) were significantly less likely to cite alcohol as HH. Compared to those who did not report alcohol as HH, those who perceived alcohol as HH consumed more alcohol (median 5 drinks per week, IQR 2-8 vs. median 3 drinks, IQR 1-7, p=0.001; adjusted: 10% more alcohol per week, 95% CI 1-20% more, p=0.02).

Conclusions:
Among more than 5,000 consecutive Health eHeart participants, approximately one third believe alcohol is HH and one third believes it is not. Those who believe alcohol is HH were of higher socioeconomic status, more likely to be American, less likely to have HF, and reported drinking more alcohol.
Abstract P111: A Cluster Randomized Controlled Trial to Examine the Effects of Tai Chi and Walking Exercises on Weight Loss, Metabolic Syndrome Parameters, and Bone Mineral Density
Authors: Xie Yao Jie , Hui Stanley Sai-chuen , Kwok Timothy Chi-yui , Woo Jean
Published: July 2021

Introduction:
Tai Chi and walking are both moderate-intensity physical activity (PA) that can be easily practiced in daily life. The purpose of this study was to better understand that after practicing these two types of PAs in a relative short term and keeping the stable dietary intake in this period, how much body weight would be reduced and what extent the metabolic syndrome parameters would be improved; and if a significant weight loss was observed, whether this exercise-induced weight loss had adverse effect on bone mineral density (BMD).

Methods:
Three-hundred seventy-four healthy and physically inactive adults (45.8±5.3 years) from 9 geographic areas in Hong Kong were randomized to 12 weeks training (45 minutes per day, 5 days per week) of Tai Chi (n=124) or self-paced walking (n=121), or control group (n=129) at area level. Body weight, fat and lean mass, waist circumference, blood pressure and regional BMD, as well as the fasting blood samples were obtained at the beginning and end of trial. Fasting blood glucose (FBG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides were analyzed.

Results:
On average, Tai Chi and walking groups lost 0.50 and 0.76 kg of body weight, 0.47 and 0.59 kg of fat mass, respectively (all p<0.001). No significant changes were observed for lean mass and BMD. Two intervention groups had significant improvements in waist circumference and FBG. The between-group difference of waist circumference and FBG was -3.7 cm and -0.18 mmol/L for Tai Chi vs. control; and -4.1 cm and -0.22 mmol/L for walking vs. control (all p<0.001). No significant differences were observed regarding blood pressure, total cholesterol, HDL-C, LDL-C and triglycerides compared to control (all p>0.05). The effects on all outcomes between Tai Chi and walking were similar (all p>0.05). Among intervention groups, change in lean mass, not fat mass or total weight loss, was significantly correlated to the change in BMD.

Conclusions:
12-week Tai Chi and walking exercises can produce moderate weight loss and improve the waist circumference and FBG in middle-aged Hong Kong Chinese people, with no additional effects on BMD.
Abstract P127: Racial Disparities in Risk Factor Control in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Parrinello Christina , Rastegar Ina , Godino Job G , Miedema Michael D , Matsushita Kunihiro , Selvin Elizabeth
Published: July 2021

Background:
Racial disparities in risk factor control have been documented in middle-aged adults, but much less is known about older adults with diabetes. Our findings will inform clinical guidelines on appropriate risk factor control in older adults with diabetes.

Methods:
In 2011-13, 6,538 ARIC participants attended visit 5, and 4,988 provided data on all key covariates used in these analyses. Of these, 31% had diagnosed diabetes (N=1,561, 72% white, mean age=75 years) and were included in this study. Tight control of risk factors was defined according to American Diabetes Association guidelines: hemoglobin A1c <7%; low-density lipoprotein cholesterol <100 mg/dL; systolic blood pressure (BP) <140 mmHg and diastolic BP <80 mmHg. We evaluated risk factor control overall and by race. We used logistic regression and predictive margins to assess independent associations of race with tight risk factor control.

Results:
Among older adults with diabetes, 64% used glucose-lowering medication, 70% lipid-lowering medication and 82% BP-lowering medication. Only 5% of participants did not take medication for any of these risk factors. Tight control was observed in 72% for glucose, 64% for lipids and 70% for BP. Only 34% had tight control of all three. A higher proportion of whites than blacks consistently achieved tight control (
Figure
). In multivariable analyses of persons with diabetes who were treated for risk factors, racial disparities in tight control of lipids and BP remained significant: adjusted prevalence ratios and 95% CIs (white vs black) were 1.04 (0.91, 1.17) for glucose, 1.21 (1.08-1.34) for lipids, 1.15 (1.03-1.26) for BP, and 1.33 (0.95, 1.70) for tight control of all three risk factors.

Conclusions:
Our results highlight racial disparities in risk factor control in older adults with diabetes that were not explained by demographic or clinical characteristics. Further studies are needed to elucidate the determinants of disparities in risk factor control and strategies to address these.