bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P107: Serum Urate Trajectories in Young Adulthood and Incident Cardiovascular Disease Events By Middle Age; The Coronary Artery Risk Development in Young Adults (cardia) Study
Authors: Morikawa Nagisa , Bancks Michael P. , Yano Yuichiro , Kuwabara Masanori , Gaffo Angelo L. , Duprez Daniel A. , Gross Myron D. , Jacobs David R.
Published: March 2020

Introduction:
Higher levels of serum urate (UA) obtained on a single occasion have been shown to be associated with a higher risk of cardiovascular disease (CVD) events among middle-aged or older adults. However, little is known regarding UA trajectory patterns during young adulthood and their associations with CVD outcomes by middle age.

Hypothesis:
We hypothesize that higher UA trajectory is associated with a higher risk for CVD events compared to lower UA trajectories.

Methods:
We included data from 4845 CARDIA Study participants (mean age at the Year 20 exam 44.8±3.7 (37-55) years; 50.8% African American; 55.6% female). Sex-specific UA trajectories were assessed using group-based trajectory modeling (PROC TRAJ in SAS version 9.4) based on UA levels obtained at baseline (Year 0) and 10, 15, 20 years later. Covariates included age, sex, race, and clinical characteristics at Year 20 (body mass index, diabetes and creatinine). We estimated hazard ratios (HR) for CVD events (coronary heart disease, heart failure, and stroke) from Year 20 (2005-06) through 2017.

Results:
We identified 3 UA trajectories in men and 3 similar but lower UA trajectories in women, characterized by low-increasing (men: 30%; n=652, mean UA 5.1; women 43%, n=1191, mean UA 3.9), moderate-increasing (men: 52%; n=1290, mean UA 6.4; women 45%, n=1284, mean UA 5.0), and high-increasing UA (men: 17%; n=377, mean UA 8.0; women 12%, n=305, mean UA 6.4) (Figure 1). Sex-specific trajectories were pooled. Over a median follow-up of 10.9 years, 203 incident CVD events occurred. The adjusted HRs for CVD events were 0.98 (95%CI, 0.66-1.45) for the pooled moderate-increasing group and 1.77 (95%CI, 1.10-2.84) for the pooled high-increasing group compared to the pooled low-increasing group.

Conclusions:
High-increasing UA trajectory during young adulthood was associated with an greater risk of CVD events by middle age. Modeling UA trajectories may help identify young adults at higher risk for CVD events.
Abstract P108: Cardiovascular Health Awareness and the Effect of an Educational Intervention on School-aged Children in Calcutta, India
Authors: Ray Madhab , Guha Santanu , Ray Bipasha , Basu Sayan , Ray Meghna , Karak Avik , Sau Paushaly , Pal Antara , Hazra Prakash , Goswami Santanu , Chaudhuri Sudipta , Selker Harry P , Goldberg Robert , Bhatt Deepak L
Published: March 2020

Background:
India is going through a major economic and epidemiological transition. With the adoption of a Western lifestyle, atherosclerotic cardiovascular disease (CVD) has emerged as the leading cause of death. India is currently the second most populous country with a population of 1.3 billion and two-thirds of this population are less than 35 years of age. As a result, India is facing major challenges in dealing with CVD.

Purpose:
This study was conducted to assess the level of health awareness of CVD in school-aged children (10 to 16 years) and to evaluate the effect of a brief educational intervention in enhancing the level of awareness with a goal of developing a school-based health education program.

Methods:
A school-based survey was conducted in Calcutta, India in August, 2018. This involved a pre-evaluation of CVD health awareness, a short presentation on CVD, and a post-evaluation of CVD health awareness.

Results:
The survey involved 2,564 students from 18 schools (11 girls’, 5 boys’, 2 coeducation). The mean age of participating students was 14.6 years, 72% were girls, 55% of the students were in the 9th grade, 38% were from 10
th
grade, and the rest were from a combination of 8
th
,11
th,
and 12
th
grades. After assessing students’ awareness in six domains with 20 multiple-choice questions, the mean pre-test score was 46.5 (SD ± 13.3) with a maximum score of 100, and the mean post-test score was 53.6 (SD ± 20.6) (
p
< 0.001).

Conclusions:
Awareness of CVD and its risk factors was inadequate among school-aged children in Calcutta. A school-based educational program may promote awareness of CVD and adoption of healthy lifestyle practices. The results of this study may help formulate a nationwide school health program to ameliorate the morbidity and mortality of CVD in India where it has emerged as a modern epidemic.
Abstract P111: Sex Differences in Rate or Rhythm Control and Outcomes Among Elderly Patients With Atrial Fibrillation
Authors: Subramanya Vinita , Claxton J'Neka S , Lutsey Pamela L , MacLehose Richard , Chamberlain Alanna M , Norby Faye L , Chen Lin Yee , Alonso Alvaro
Published: March 2020

Introduction:
Women with atrial fibrillation (AF) experience greater symptomatology, worse quality of life, and have a higher risk of stroke as compared to men, but are less likely to receive rhythm control for the treatment of AF. Whether these differences exist in elderly patients with AF, and whether sex modifies the effectiveness of rhythm versus rate control therapy has not been assessed.

Methods:
We studied 135,850 men and 139,767 women 75 years or older diagnosed with AF in the MarketScan Medicare database between 2007-2015. Rate control was defined as use of rate control medication or atrioventricular node ablation. Rhythm control was defined by use of anti-arrhythmics, catheter ablation or cardioversion. Participants on both rate and rhythm were coded under rhythm control. We used multivariable logistic and Cox regression models to estimate 1) the association of sex and treatment strategy (within 30-day post AF diagnosis and entire follow-up) and, 2) the association of treatment strategy with incident heart failure, stroke and major bleeding.

Results:
Men were on average (SD) 82.5 (5.2) years old and women 83.8 (5.6) years, respectively. Women were less likely to receive rhythm control treatment as compared to men in the 30-day post AF diagnosis period (22% vs 27%), (OR 0.91, 95% CI 0.88, 0.94) and over the entire duration of follow-up (28% vs 32%) (HR 0.93, 95% CI 0.90, 0.96). Rhythm (vs. rate) control was associated with a higher risk of heart failure in women [HR 1.41, 95% CI 1.34, 1.49] than in men [HR, 1.21 95% CI 1.15, 1.28] (p for multiplicative interaction < 0.001,
Table
). Sex did not modify associations between treatment and incident stroke or major bleeding events.

Conclusion:
Women aged 75 years and older were less likely to be prescribed rhythm control as compared to men, and experienced higher risk of heart failure than men when receiving rhythm (vs rate) control. Future studies will need to delve into the mechanisms underlying these differences.
Abstract P122: P-wave Axis is Associated With All-Cause Mortality in Diabetes: The ACCORD Trial
Authors: Ehrhardt-Humbert Lauren , Singleton Matthew J , Upadhya Bharathi , Imtiaz-Ahmad Muhammad , SOLIMAN Elsayed Z , Bhave Prashant , Beaty Elijah H , Yeboah Joseph
Published: March 2020

Introduction:
Abnormal P-wave axis (PWA) has emerged as a novel marker of risk for both cardiovascular disease and all-cause mortality in the general population, though this relationship has not been adequately explored among those with type 2 diabetes.

Hypothesis:
We hypothesized that abnormal PWA is associated with all-cause mortality in a large, well-phenotyped group of participants with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

Methods:
This analysis included 8,899 ACCORD participants with available PWA data on baseline electrocardiogram. Cox proportional hazards models were used to examine the association between PWA and ACM in models adjusted for demographics, ACCORD trial treatment assignment, and potential confounders. PWA was modeled as either normal (0° - 75°) or abnormal (<0° or >75°). We evaluated the predictive value of PWA by comparing area under the receiver operating characteristic curves in models with and without PWA.

Results:
Over 44,000 person-years, there were 609 deaths. Participants with abnormal PWA had increased risk of all-cause mortality (HR 1.61, 95% CI 1.25 – 2.08). After multivariable adjustment, the association remained significant (HR 1.32, 95% CI 1.02 – 1.71; see TABLE). Inclusion of abnormal PWA in prediction models afforded a small increase in area under the receiver operating characteristic curves (AUC 0.653 vs. 0.643, p-value for difference of 0.002).

Conclusions:
In conclusion, among ACCORD trial participants, abnormal PWA was associated with an increased risk of mortality. Abnormal PWA may have added value beyond traditional risk factors in prediction models.
Abstract P123: Metabolic Syndrome Risk Factors' Aggregation Within the Seven Countries' Study: 45 Years Follow Up Results
Authors: Parapid Biljana , Danchin Nicolas , Nedeljkovic-Arsenovic Olga , Kircanski Bratislav , Bubanja Dragana , Stojanovic Milos , Blackburn Henry , Jacobs David , Moschandreas Joanna , Adachi Hisashi , Nissinen Aulikki , Kromhout Daan , Menotti Alessandro , Ostojic Miodrag C , Kanjuh Vladimir
Published: March 2020

Introduction:
Components of the metabolic syndrome (MetSy) have gone through myriad of changes ever since the initial cluster was defined. The Seven Countries Study taught us the basics of classical risk factors for atherosclerotic artery disease and their influence on both cardiovascular and cerebrovascular morbidity and mortality.

Material and Methods:
In a 3-continent, 7-country (USA, Japan, Greece, the Netherlands, Finland, Italy, and former Yugoslavia then, now Croatia and Serbia) sample of 12,763 participants -- all healthy men over 40 at entry -- systematic, quinquennial checkups were conducted over 4 decades and MetSy was defined using the IDF definition.

ResultS:
A total of 9,09% of participants were identified to have MetSy, while the detailed description of risk factors' combination is shown in Table 1 and Figure 1, below.

Conclusion:
The leading combination was hypertension (HTA), diabetes (DM) and dyslipidemia (HLP), while hypertension was the hallmark risk factor irrelevant of presence or absence of MetSy. The results of this study call for a contemporary comprehensive research involving both sexes that could elucidate better real life risk factors' relationships in aforementioned countries.
Abstract P132: Anti-Müllerian Hormone Levels and Risk of Type 2 Diabetes in Women
Authors: Verdiesen Renée M , Onland-Moret N. Charlotte , van Gils Carla H , Spijkerman Annemieke M , Picavet H Susan J , Broekmans Frank J , Verschuren W M Monique , van der Schouw Yvonne T
Published: March 2020

Introduction:
Given its role in ovarian follicle development, circulating anti-Müllerian hormone (AMH) is correlated with timing of menopause. Accordingly, women with higher AMH levels become menopausal at a higher age. Previous research suggests that a higher age at menopause is associated with a decreased risk of type 2 diabetes (T2D). In contrast, AMH levels are increased in women with polycystic ovary syndrome (PCOS), who have a higher risk of insulin resistance and T2D than women without PCOS. However, it is not clear yet whether AMH actually plays a role in the development of T2D. We aimed to investigate whether plasma AMH levels and age-related AMH trajectories are associated with risk of T2D in women.

Hypothesis:
Higher age-specific plasma AMH levels are associated with a decreased risk of T2D.

Methods:
We analyzed longitudinal data from 3104 female participants, aged 20-60 years at recruitment, in the population-based Doetinchem Cohort Study. In total, we analyzed 12460 plasma AMH measurements. We calculated age-specific AMH tertiles, to account for the strong AMH-age correlation. Cox Proportional hazards models adjusted for known risk factors for diabetes were used to assess the relation between age-specific AMH tertiles and T2D. We applied linear mixed models to compare age-related AMH trajectories between T2D cases and non-cases.

Results:
After a median follow-up of 20 years, 163 incident T2D cases were identified. Higher age-specific AMH levels were associated with a lower risk of T2D (hazard ratio (HR)
T2vsT1
= 0.77, 95%CI: 0.53-1.11; HR
T3vsT1
=0.62, 95%CI: 0.40-0.94; p for trend = 0.02). These findings were supported by predicted AMH trajectories, which suggested that plasma AMH levels were lower at younger ages and declined at a slower rate in women who were diagnosed with T2D compared to women who were not. However, differences in trajectories between T2D cases and non-cases were not statistically significant.

Conclusions:
We observed that women with higher age-specific AMH levels were at a lower risk of T2D. In addition, our longitudinal analyses may suggest that AMH is lower in women who develop T2D compared to women who do not. These findings are in line with previous studies that observed that a higher age at menopause was associated with a decreased risk of T2D.
Abstract P133: Circulating Anti-Müllerian Hormone and Subclinical Cardiovascular Disease in Middle-aged and Older Men
Authors: Verdiesen Renée M , Onland-Moret N. Charlotte , van Gils Carla H , van der Schouw Yvonne T
Published: March 2020

Introduction:
Anti-Müllerian hormone (AMH) is primarily known for its role in sexual differentiation during embryogenesis, and ovarian follicle development in premenopausal women. Furthermore, recent research suggests that higher AMH levels are associated with a lower occurrence of (subclinical) cardiovascular disease (CVD) in both women and men. However, these studies only included a small variety of subclinical CVD measures. We aimed to investigate whether circulating AMH is associated with a wider range of subclinical CVD measures in middle-aged and older men.

Hypothesis:
Higher AMH levels are associated with more favorable levels of subclinical CVD measures.

Methods:
We analyzed data from 371 male participants (aged 40-80 years at recruitment) from a Dutch population-based study. AMH was measured in serum samples obtained at recruitment using the Elecsys
®
AMH assay (Roche Diagnostics). At baseline we measured carotid intima-media thickness (cIMT)(μm), pulse wave velocity (PWV)(m/s) and aorta diameter (cm), and calculated Framingham risk score predictions. We investigated associations between AMH (μg/L) levels, both continuously and in tertiles, and these outcomes using linear regression models adjusted for known CVD risk factors, free testosterone, free estradiol and dihydroepiandrosterone sulphate (DHEAS). Sensitivity analyses comprised exclusion of prevalent diabetes and CVD cases.

Results:
Higher AMH levels were associated with a lower cIMT at baseline (β
continuousAMH
= -6.3, 95%CI: -10.7, -1.9; β
T2vsT1
= -30.6, 95%CI: -60.2, -0.9; β
T3vsT1
= -39.8, 95%CI: -70.1, -9.6). We observed no statistically significant associations between AMH and the remaining outcomes, but effect estimates indicated that higher AMH levels may be associated with lower PWV (β
continuousAMH
= -0.02, 95%CI: -0.10, 0.05), and lower Framingham risk score predictions (β
continuousAMH
= -0.004, 95%CI: -0.008, 0.000). Exclusion of prevalent diabetes and CVD cases did not change our conclusions.

Conclusions:
The results of this study suggest that higher AMH levels are associated with a lower cIMT in middle-aged and older men. Based on our results we cannot exclude a possible relation between circulating AMH levels and other measures of subclinical cardiovascular disease.
Abstract P137: Women Experience A Greater Decline In Brachial Artery Distensibility With Age Than Men
Authors: Cech Martin , Keshawarz Amena , Snell-bergeon Janet
Published: March 2020

Introduction:
Brachial artery distensibility is reduced in type 1 diabetes and can predict future coronary artery disease (CAD). Although women generally have reduced cardiovascular risk as compared with men, type 1 diabetes increases cardiovascular risk to a greater degree in women such that their cardiovascular risk matches that in men. Sex differences in arterial distensibility may contribute to the increased cardiovascular risk in women with type 1 diabetes.

Hypothesis:
We tested the hypothesis that brachial distensibility differed by sex and by diabetes status in a cohort of adults with and without type 1 diabetes.

Methods:
We measured brachial distensibility via DynaPulse instrument (PulseMetric, San Diego, CA) in 268 adults with type 1 diabetes (mean age 44±9 years) and 373 adults without diabetes (mean age 47 ±8 years) who completed clinical study visits 8±0.89 years apart.

A linear mixed model was used to calculate mean brachial distensibility by age at the study visits in men and women by diabetes status. This model was adjusted for age, sex, diabetes status, and visit number. An age group*sex*diabetes interaction was used to calculate least squares means (LSmeans) brachial distensibility and examine trends in each stratum of interest.

Results:
Brachial distensibility decreases with increasing age (Figure 1). This reduction is greatest for women with type 1 diabetes and smallest for men without diabetes, with decreases from the oldest to youngest age group of 2.6 %/mmHg and 0.98 %/mmHg, respectively. Prior to the age of 40 years, women have better brachial distensibility than men regardless of diabetes status, while men have better brachial distensibility than women beginning in the 40-45 years age group.

Conclusions:
Women experience a steeper decline in their brachial distensibility than men regardless of diabetes status. Rapid reduction in brachial distensibility may contribute to the increases in cardiovascular risk in women with type 1 diabetes.
Abstract P140: Linear Versus Volumetric Measures Of Left Ventricular Sphericity: Concordance And Normal Reference Values
Authors: Gona Philimon N , Salton Carol J , Qazi Saadia , Tsao Connie W , O'Donnell Christopher J , Manning Warren J , Chuang Michael L
Published: March 2020

Introduction:
Greater left ventricular (LV) sphericity, a more globular shape, is associated with poor outcomes. Two measures of sphericity are commonly used: Linear sphericity (LinS) is the ratio of LV end-diastolic diameter (EDD) to 4-chamber length (4cL); volumetric sphericity (VolS) is the ratio of end-diastolic volume (EDV) to the volume of a sphere with diameter=4cL. We sought to compare LinS to VolS and to determine: 1) whether LinS and VolS differ with sex and age group; 2) normal values for LinS and VolS, 3) whether LinS and VolS are concordant in how they stratify individuals.

Methods:
1794 adults (age 65±9y, 47.1% men) in the Framingham Offspring cohort underwent CMR imaging; LV EDD, EDV and 4cL were measured. A referent group (340M, 512W) free of clinical cardiovascular disease, hypertension, diabetes and smoking was identified. Among these, we compared LinS and VolS between sexes and across age groups (<55, 55-64, ≥65y). Referent-group upper 90
th
percentile (P90) cutpoints for LinS and VolS were determined and applied to the entire cohort (N=1794) to stratify each individual as having or not having high sphericity. Concordance between LinS and VolS was assessed using kappa coefficient and McNemar’s test.

Methods:
LinS was greater than VolS for each sex, but there was robust, positive linear (Pearson) correlation between LinS and VolS for men (r=0.864) and women (r=0.855), p<0.0001 both. The Table shows women had minimally greater sphericity than men. Sphericity did not vary with age group in either sex. LinS and VolS were concordant in classifying individuals as having high (≥P90) sphericity with kappa=0.63 (men) and 0.62 (women), p<0.0001 for both. McNemar’s test for difference was not significant (p>0.27) for either sex.

Conclusion:
Linear and volumetric measures of LV sphericity are concordant in how they rank and stratify adults in a community dwelling cohort, but the measures are not directly comparable, as mean LinS is markedly greater than VolS. Neither measure of sphericity varies with age among healthy adults.
Abstract P143: Methylome-Wide Association Of DNA Methylation And Aircraft Noise Exposure In The Women’s Health Initiative
Authors: Collins Jason M , Gondalia Rahul , Justice Anne E , Holliday Katelyn , Stewart James , Wong Eugenia , Li Yun , Hayden Kathleen , Jordahl Kristina , Assimes Themistocles L , Baccarelli Andrea , Peters Junenette , Whitsel Eric A
Published: March 2020

Background:
Noise pollution is common and can affect health, but mechanisms underlying this relationship remain incompletely characterized. We therefore examined the novel association between aircraft noise and DNA methylation (DNAm), an environmentally modifiable epigenetic phenomenon that affects gene expression and is associated with cardiovascular and neurological disease.

Methods:
We conducted a methylome-wide association study in race/ethnicity-stratified subpopulations of 4,535 post-menopausal Women’s Health Initiative participants (mean age: 64.4 years; 59.6% white; 24.7% African American; 15.7% Hispanic/Latina). We estimated DNAm in whole blood as a proportion of methylated cytosines at each Cytosine-phosphate-Guanine (CpG) site using the Illumina 450k BeadChip. In cooperation with the Federal Aviation Administration, we generated day-night-average sound level (DNL) contours around 90 major U.S. airports using the Aviation Environmental Design Tool. The DNL applies a penalty for nighttime exposure and is the primary metric for informing policy in the U.S. We estimated geocoded participant address-specific, annual, DNL aircraft noise exposures in decibels (dB) from the contours on the day of blood draw. We categorized aircraft noise exposures as non-exposed or exposed (DNL < 45 or ≥ 45dB) and used linear mixed-effects models to estimate CpG site-specific DNAm-noise associations adjusted for sociodemographic, behavioral, and technical covariates. We combined site-specific associations across race-ethnicity strata in fixed-effects, inverse variance-weighted meta-analyses and then identified the significant (
P
< 1.0x10
-7
), non-heterogeneous (
P
Cochran’s Q
> 0.10) associations among them.

Results:
Overall, DNAm was inversely associated with aircraft noise at cg21525369 (Chromosome 15;
P
= 6.40x10
-8
). Cg21525369 is 56 kb upstream from
ACAN
, a gene encoding an extracellular matrix protein (aggrecan). Aggrecan is expressed in response to ultrasound; forms perineural nets around cochlear hair cells and auditory brainstem neurons; affects afferent extension, synaptic transmission, and neuronal vulnerability; deposits in tympanic membranes of patients with sensorineural hearing loss, and redistributes in auditory brainstem after deafferentation.

Conclusions:
The biologically plausible DNAm-noise association among postmenopausal U.S. women suggests aircraft noise pollution may affect methylation of DNA near a gene previously associated with hearing, although its cardiovascular, otologic, and neurological implications remain unclear pending sensitivity analysis, external replication, mediation analysis, and functional characterization.
Abstract P145: Associations Of Corin Protein And Its Coding Gene Methylation With Hypertension In Chinese Adults: A Mediation Analysis In The Gusu Cohort
Authors: Peng Hao , Yu Jia , Ren Liyun , He Yan , Li Jing , Ma Shengqi , Zhang Mingzhi
Published: March 2020

Hypothesis:
Corin protein, a physiological activator of the atrial natriuretic peptide, has been associated with hypertension with unclear mechanisms. Its coding gene methylation may be involved in the underlined mechanisms but with no evidence.

Objectives:
We aimed to examine 1) whether
CORIN
gene methylation was associated with hypertension and 2) whether this association was mediated by corin protein.

Methods:
As illustrated in the following picture, peripheral blood DNA methylation of
CORIN
promoter was quantified by targeted bisulfite sequencing in 2,498 community members (mean aged 53 years, 38% men) as a discovery sample and 1,771 independent participants (mean aged 62 years, 54% men) as a replication sample. We constructed a causal mediation model with DNA methylation as the predictor variable, serum corin as the mediator variable, and blood pressure as the outcome variable, adjusting for age, sex, education level, cigarette smoking, alcohol consumption, obesity, fasting glucose, lipids, and antihypertensive medications. Multiple testing was controlled by adjusting for the total number of CpG loci tested.

Results:
Of the 9 CpG loci assayed, hyper-methylation methylation of 8 CpGs was significantly associated with lower systolic blood pressure in the discovery sample and 7 associations were also significant in the replication sample (all FDR-adjusted
P
<0.05). Of the 8 significant CpGs, DNA methylation at only one CpG locus (located at Chr4:47839981) was significantly associated with serum corin (β=-0.003,
P
=0.038). Serum corin mediated approximately 2.45% (95%CI: 0.05%-7.00%,
P
=0.046), 7.15% (95%CI: 0.60%-28.00%,
P
=0.036), and 6.37% (95%CI: 0.10%-42.00%,
P
=0.048) of the negative associations of hyper-methylation at this CpG site with systolic blood pressure, diastolic blood pressure, and hypertension, respectively.

Conclusions:
Hyper-methylation at
CORIN
promoter is associated with hypertension, at least partially through suppressing corin expression or excretion.
Abstract P150: Association of Cholesterol Measures With Coronary Heart Disease Risk in Blacks and Whites in the Reasons for Geographic and Racial Differences in Stroke Study (regards)
Authors: Zakai Neil , Minnier Jessica , Safford Monika M , Colantonio Lisandro , Irvin Marguerite M , Fazio Sergio , Cushman Mary , Howard Virginia J , Pamir Nathalie
Published: March 2020

Introduction:
Abnormal plasma lipid levels associate with coronary heart disease (CHD) risk. Race interaction for these associations are not established.

Hypothesis:
We hypothesized that the association of HDL, LDL, and triglyceride with CHD is stronger in whites versus blacks.

Methods:
The REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort recruited 30,283 black and white individuals aged 45+ from the contiguous U.S. from 2003-7. Participants were followed until December 31, 2016 for CHD events (i.e., myocardial infarction or CHD death), participants with history of CHD at baseline were excluded. Cox regression models were used to assess the association between baseline lipids and incident CHD events adjusting for traditional cardiovascular risk factors.

Results:
With 23,894 participants (57.8% white and 58.4% female, mean age 64.11± 9.32), over a median 9.9 years of follow-up, 1,487 CHD events occurred (615 among blacks). Overall, higher total Cholesterol, LDL cholesterol, and triglycerides were associated with increased risk of CHD in both blacks and whites with no evidence of a race interaction (Table 1). For HDL, the point estimate was more protective in whites (HR 0.90) than in blacks (HR 0.98), but the interaction was non-significant (p=0.15). However, when HDL was stratified into clinical categories (<40, 40-59, and ≥60), the reduction in point estimates was maintained among whites (HR 1.00, 0.88, and 0.74) but not among blacks (HR 1.00, 1.31, and 1.19) for HDL <40, 40-59, and ≥60 respectively, p-interaction 0.01.

Conclusion:
Total cholesterol, LDL, and triglycerides predict CHD risk equally in blacks and whites in the REGARDS study, however there is heterogeneity in the protective effect by race, especially when traditional clinical categories are used. In whites, higher HDL is associated with reduced risk, whereas in blacks the association is not maintained. These findings suggest that HDL levels are a more viable metric for white than blacks to predict CHD risk.
Abstract P155: Acute Stress From Elections and Hospitalization for Acute Myocardial Infarction
Authors: Mefford Matthew T , Mittleman Murray A , Li Bonnie , Qian Lei , Reynolds Kristi , Zhou Hui , Harrison Teresa N , Geller Alan C , Sidney Stephen , Sloan Richard P , Mostofsky Elizabeth , Williams David R
Published: March 2020

Background:
A growing body of evidence suggests that stressors are associated with heightened cardiovascular risk within hours after the triggering event, and stress from election campaigns is associated with a heightened risk of pre-term birth.

Hypothesis:
Potential stress from the 2016 presidential election was associated with an increased hospitalization rate for acute myocardial infarction (AMI) in the following week.

Methods:
Among active members 18 years of age and older in Kaiser Permanente Southern California, AMI was defined as an inpatient hospitalization with a primary discharge diagnosis of ICD-10-CM codes I21.x or I22.x. In an ecological analysis, we calculated relative risks (RR) and 95% confidence intervals (CI) comparing rates of AMI per 100,000 person-years (PY) within one week following the date of the 2016 presidential election (risk window) to rates in the prior two weeks (control window) overall and within subgroups by age, sex, and race/ethnicity. We repeated the above analysis comparing rates of AMI within one week of the 2016 election date to rates in the prior week.

Results:
Compared to the rates of MI in the two weeks before the 2016 election (171.6 per 100,000 PY), the rate of AMI hospitalization in the week following election day (242.2 per 100,000 PY) was 1.41 times higher (95% CI 1.14, 1.75). (Table) Heightened AMI risk after the 2016 election was also observed among adults 55-74 years of age (RR 1.47, 95% CI 1.10, 1.98), men (RR 1.54, 95% CI 1.17, 2.02), and white individuals (RR 1.52, 95% CI 1.12, 2.06). However, there was no evidence of heterogeneity across age, sex, or race/ethnicity groups (p-values 0.98, 0.30, and 0.65, respectively). Using a one-week control window, similar results were observed.

Conclusion:
Increased AMI rates among subsets of the population coincident with the 2016 election is consistent with published data suggesting that acute sociopolitical stress may have adverse health effects.
Abstract P170: Visit-to-visit Blood Pressure Variability Is Associated With Functional Decline In Older Adults: The S.ages Cohort
Authors: Rouch Laure , Vidal Jean-Sébastien , Hanon Olivier
Published: March 2020

Objective:
To investigate the impact of visit-to-visit systolic, diastolic, mean arterial pressure and pulse pressure variability on functional decline in non-institutionalized patients aged ≥ 65 years.

Methods:
3042 subjects from the S.AGES (elderly subjects) cohort underwent clinical examinations every 6 months during 3 years. Systolic, diastolic, mean arterial pressure and pulse pressure variability were evaluated using standard deviation, coefficient of variation, average real variability, successive variation, variation independent of mean and residual standard deviation. Functional decline was assessed using the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales and defined over time as any help required to perform at least one task. Cox proportional hazards models were used for the analyses.

Results:
Among the 3042 subjects, 527 (17.3%) had functional decline (ADL) over time. After adjustment for demographics, systolic blood pressure, antihypertensive drugs, coronary artery disease, diabetes mellitus, chronic heart failure, atrial fibrillation, transient ischemic attack or stroke, smoking, dyslipidemia and Mini Mental State Examination at baseline, higher systolic blood pressure variability was associated with greater risk of functional decline (ADL) (adjusted HR per 1-SD increase of coefficient of variation = 1.12, 95% CI [1.03-1.22], p<0.01). Similar results were observed for diastolic blood pressure variability (adjusted HR = 1.11, 95% CI [1.01-1.22], p=0.03) and mean arterial pressure variability (adjusted HR = 1.15, 95% CI 1.05-1.25, p<0.01). Higher pulse pressure variability was no longer significantly associated with functional decline after adjustment for age (p=0.6). Similar patterns were found with all indicators of variability and loss of autonomy defined using IADL.

Conclusion:
Higher blood pressure variability could be a novel risk factor for functional decline and controlling blood pressure instability a promising interventional target in preserving autonomy in older adults.
Abstract P173: The Impact of Asleep Blood Pressure on the Prevalence of Masked Hypertension by Race/ethnicity: Analysis of Pooled Population- and Community-based Studies
Authors: Yano Yuichiro , Poudel Bharat , Chen Ligong , Sakhuja Swati , Jaeger Byron , Viera Anthony , Shimbo Daichi , Clark Donald , Anstey D. Edmund , Cora Lewis , Shikany James M , Rana Jamal S , Correa Adolfo , Schwartz Joseph E , Lloyd-jones Donald M , Muntner Paul
Published: March 2020

Introduction:
Masked hypertension is defined as having hypertensive blood pressure (BP) outside of the office setting among adults with non-hypertensive BP when measured in the office. Some guidelines recommend defining out-of-office BP using awake measurements while other guidelines recommend using awake and asleep measurements.

Hypothesis:
We hypothesized that defining masked hypertension using the awake and asleep BP measurements would increase the prevalence of masked hypertension compared to using the awake period alone, and the magnitude of this difference would be greater among non-Hispanic blacks compared with non-Hispanic whites and Hispanics.

Methods:
We pooled previously collected data from 5 NHLBI-funded population- and community-based studies including the Jackson Heart Study, the Coronary Artery Risk Development in Young Adults Study (total participants: 2,866). All participants had office systolic BP (SBP)<140mmHg and diastolic BP (DBP)<90mmHg and underwent ambulatory BP monitoring (ABPM) for 24 hours. Hypertensive awake BP was defined as SBP ≥135mmHg or DBP ≥85mmHg while awake, hypertensive asleep BP as SBP ≥120mmHg or DBP ≥70mmHg while asleep and hypertensive 24-hour BP as SBP ≥130mmHg or DBP ≥80mmHg over the entire ABPM period.

Results:
The prevalence of masked hypertension increased from 29% to 43% when defined using awake, asleep, or 24-hour BP versus using awake BP alone (Table). This increase was larger in non-Hispanic blacks (31-54%) compared with non-Hispanic whites (28-37%) and Hispanics (17-26%). The adjusted prevalence ratio (95% confidence interval) for having masked hypertension for non-Hispanic blacks compared with Non-Hispanic whites was higher from 1.20(1.05,1.37) to 1.33(1.20,1.47) when defined using awake, asleep and 24-hour BP versus awake BP only.

Conclusions:
Including asleep BP to define masked hypertension increased the prevalence of masked hypertension to a larger extent among non-Hispanic blacks compared to non-Hispanic whites and Hispanics.
Abstract P174: Adiposity Mediates the Association Between Gut Microbial Diversity and Hypertension: Cardia Study
Authors: Yano Yuichiro , Lulla Anju , Howard Annie Green , Gidding Samuel , Muntner Paul , Lewis Cora , Blewer Audrey L , Hatano Yu , Lloyd-jones Donald M , Launer Lenore J , Bress Adam , Meyer Katie A
Published: March 2020

Introduction:
We have shown that gut microbial diversity is associated with hypertension in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Animal models have documented gut microbial effects on adiposity, a known risk factor for hypertension. The extent to which adiposity may mediate the association between the gut microbiome and hypertension has not been studied.

Hypothesis:
We hypothesize that adiposity is a mediator of the association between gut microbial diversity and hypertension.

Methods:
We analyzed data from the CARDIA Study (480 participants). Shotgun metagenomic sequencing was performed on DNA extracted from stool samples collected at the Year 30 exam (2015-2016). Taxonomic classification of sequenced reads was performed using Kraken2. Within-person gut microbial diversity was assessed at the genus level using the Shannon Diversity Index and richness (number of distinct genera); lower values indicate less diversity. Hypertension was defined as systolic BP ≥140, diastolic BP ≥90 mm Hg, or taking antihypertensive medication. We performed mediation analyses to quantify the percentage of the total estimated effect of gut microbial diversity on hypertension that is mediated by adiposity as assessed using body mass index (BMI).

Results:
Mean age of the participants was 55.1 (3.4) years, 47% were African American, and 53% were female. In multivariable-adjusted mediation analysis, BMI explained on average 26-34% of the association between gut microbiota diversity and hypertension (Table). Results were robust to adjustment for sociodemographic variables (Model 2) and health behaviors (Model 3).

Conclusions:
Approximately one-third of the total effect of gut microbial diversity on hypertension is mediated through adiposity.
Abstract P178: Relationship of Apolipoproteins With Subclinical Cardiovascular Risk in Youth
Authors: Czeck Madeline A , Northrop Elise F , Evanoff Nicholas G , Dengel Donald R , Rudser Kyle D , Kelly Aaron S , Ryder Justin R
Published: March 2020

Introduction:
Apolipoproteins are key regulators of cholesterol transport and clearance with each apolipoprotein having a specific protective or atherogenic role. The relationship between subclinical cardiovascular risk and each of the apolipoproteins in the pediatric population is insufficiently described within the literature. Therefore, the purpose of this study was to examine the association of apolipoproteins with measures of vascular structure and function in pediatric population.

Hypothesis:
We hypothesized apolipoprotein AI, AII, and CII would demonstrate a positive association, and apolipoprotein B, B/AI ratio, CIII, CIII/CII ratio, and E a negative association with carotid intima-media thickness (cIMT) and carotid-radial pulse wave velocity (PWV).

Methods:
A cross-sectional study of 338 children and adolescents (160 males, 178 females) aged 8-21 years (mean age 13.0±2.8 years) with a range of adiposities from normal body weight to severe obesity (mean BMI 26.8±8.9 kg/m
2
). Apolipoproteins (AI, AII, B, CII, CIII, and E) were measured via human apolipoprotein magnetic bead panel (Millipore, MA, USA). Ultrasound imaging of the carotid artery was used to measure cIMT. PWV, a measure of arterial stiffness, was assessed via applanation tonometry (SphygmoCor
TM
). Total body fat percent (BF%) was measured using dual X-ray absorptiometry. Linear regression models were adjusted for Tanner stage, sex, and race with further adjustments for BF%. Data are presented as mean [95% CI] with Holms-adjusted p-values to account for multiple testing. All apolipoprotein ratios were scaled to 0.1 μg/mL.

Methods:
There were significant positive associations between PWV and apolipoproteins: AII (0.036 m/sec per 10 μg/mL [0.017, 0.056], p = 0.010), E (0.158 m/sec per 10 μg/mL [0.08, 0.235], p = 0.002), and CIII/CII ratio (0.033 [0.014, 0.052], p = 0.019). After adding BF% to the models, PWV remained positively associated with higher levels of apolipoproteins: AII (0.036 m/sec per 10 μg/mL [0.016, 0.055], p = 0.012), E (0.161 m/sec per 10 μg/mL [0.082, 0.239], p = 0.002), and CIII/CII ratio (0.033 [0.014, 0.052], p = 0.02). Before accounting for multiple testing, apolipoprotein CIII/CII ratio was positively associated with cIMT (0.001 [0, 0.003], p = 0.033), but failed to maintain significance after p-value correction. Otherwise, there were no significant associations between any apolipoprotein and cIMT in the presence or absence of BF%.

Conclusions:
These findings suggest higher levels of apolipoprotein AII, E, and CIII/CII ratio are associated with higher arterial stiffness (PWV) in pediatrics, both in the presence and absence of excess body fat. Apolipoproteins, specifically AII, E, and CIII/CII ratio, may exert their effects on vascular function (PWV) before altering vascular structure (cIMT), which is congruent with the chronological pathophysiology of atherosclerosis.
Abstract P180: Low Prevalence of Ideal Cardiovascular Health in Patients With Severe Hypercholesterolemia in a Largely Rural Population
Authors: Groth Nicole A , Benziger Catherine P
Published: March 2020

Introduction:
The American Heart Association’s ideal cardiovascular health (ICH) score is determined by 3 ideal health factors (normal blood pressure, untreated total cholesterol, and glucose) and 4 ideal health behaviors (non-smoking, normal body mass index, high physical activity, and heart healthy diet). Achieving ICH, defined as meeting 5 of the 7 metrics, decreases risk of cardiovascular disease. Prevalence estimates of ICH in patients with severe hyperlipidemia (SH) living in rural areas are lacking.

Hypothesis:
We aimed to determine the prevalence of poor, intermediate, and ICH in patients with SH in a large healthcare system (Essentia Health), where over 60% of the population is rural.

Methods:
The electronic medical record-based SH registry is a cross-sectional cohort study at the Essentia Health of patients who have ever had a low-density lipoprotein - cholesterol value of 190 mg/dL or higher, since 01/01/2000 (n=17,925). Patients were excluded if they did not have a visit at the institution within the past 5 years (n=209) or were outside of the age 20-75 years (n=3,153). Physical activity and healthy diet were not available in the record and were excluded from the score. Patients with missing data were assumed ideal given low clinical suspicion of conditions.

Methods:
A total of 14,544 (81.1%) of the SH registry patients met inclusion criteria (mean age 63 +13 years; 58.9% female).
Figure 1
shows the prevalence of ICH metrics in the total population. Only 3 (0.02%) people met all five of the ideal metrics (score of 10); more females had a score of 8-10 than males (12.5% vs. 9.6%). A total of 13 (0.08%) had a score of 0 (poor) and 3.0% had a score of 0-2 with no sex differences. Not smoking and ideal glucose were the most prevalent health factors. The mean score was 5.6 (+1.6) with no sex differences.

Conclusions:
There is low prevalence of ICH in patients with SH living in rural populations. The metrics with the lowest prevalence and therefore highest potential for improvement are the health factors: total cholesterol and body mass index.
Abstract P181: Atherogenic Lipoproteins and Incident Atherosclerotic Cardiovascular Disease in the Framingham Offspring Study
Authors: Ikezaki Hiroaki , Lim Elise , Liu Ching-Ti , Cupples L Adrienne , Asztalos Bela F , Schaefer Ernst J
Published: March 2020

Introduction:
Elevated plasma low-density lipoprotein cholesterol (LDL-C), small-dense LDL-C (sdLDL-C), LDL-triglyceride (LDL-TG), triglycerides (TG), remnant-lipoprotein cholesterol (RLP-C), triglyceride-rich lipoprotein-C (TRL-C), very low-density lipoprotein cholesterol (VLDL-C), and lipoprotein(a) [Lp(a)] levels have been associated with increased atherosclerotic cardiovascular disease (ASCVD) risk. However, these parameters have not been included in risk factors for ASCVD in the pooled cohort equation (PCE).

Hypothesis:
We assessed the hypothesis that these atherogenic lipoprotein parameters add significant information for ASCVD risk prediction in the Framingham Offspring Study.

Methods:
We evaluated 3,147 subjects without ASCVD at baseline (mean age 58 years) from participants of Framingham Offspring Study cycle 6, 677 (21.5%) of whom developed inclusive ASCVD over 16 years. Biomarkers of risk were assessed in frozen plasma samples. Total cholesterol, TG, HDL-C, direct LDL-C, sdLDL-C, LDL-TG, Lp(a), RLP-C, and TRL-C were measured by standardized automated analysis. Calculated LDL-C, large buoyant low-density lipoprotein cholesterol (lbLDL-C), VLDL-C, and non-HDL-C values were calculated. Data were analyzed using Cox proportional regression analysis and net reclassification improvement (NRI) analysis to identify parameters significantly associated with the incidence of ASCVD after controlling for standard ASCVD risk factor and applying the PCE model.

Results:
All specialized lipoprotein parameters were significant ASCVD risk factors on univariate analysis, but only direct LDL-C, sdLDL-C, and Lp(a) were significant on multivariate analysis with standard risk factors in the model. Together these parameters significantly improved the model c statistic (0.716 vs 0.732, P < 0.05) and net risk reclassification (mean NRI 0.104, P < 0.01) for ASCVD risk. Using the ASCVD risk pooled cohort equation, sdLDL-C, TG, LDL-TG, LDL-C, RLP-C, and TRL-C individually added significant information, but no other parameter added significant information with sdLDL-C (hazard ratio 1.30 for 75th vs 25th percentile, P < 0.0001) in the model.

Conclusions:
In multivariate analysis, sdLDL-C, direct LDL-C, and Lp(a) contributed significantly to ASCVD risk, but only sdLDL-C added significant risk information to the PCE model, indicating that sdLDL-C may be the most atherogenic lipoprotein particle.
Abstract P183: Incident Chronic Kidney Disease and Myocardial Infarction Without Chest Pain: Results From the Atherosclerosis Risk in Communities Study
Authors: DeBarmore Bailey M , Loop Matthew S , Astor Brad C , Matsushita Kunihiro , HEISS Gerardo M , Rosamond Wayne D , Franceschini Nora
Published: March 2020

Background:
Chronic kidney disease (CKD) and cardiovascular disease share similar risk factors, such as diabetes, hypertension, and dyslipidemia promoting atherosclerosis. Acute myocardial infarction (MI) presenting without chest pain is associated with higher case fatality compared to MI with chest pain. Patients with non-ST-elevation MI (NSTEMI) are more likely to present without chest pain than patients with ST-elevation MI (STEMI). Few if any studies have examined the risk of incident CKD following MI with and without chest pain.

Hypothesis:
We hypothesized that MI presenting without chest pain is associated with greater risk of incident CKD after adjustment for demographic factors, in-hospital complications, and comorbidities among adults in the Atherosclerosis Risk in Communities (ARIC) Study.

Methods:
The ARIC Study is a community-based cohort study that began recruitment in 1987. MI without chest pain includes persons presenting with shortness of breath, nausea, or dyspnea that is determined to be of cardiac origin. Follow-up time for this analysis was calculated from date of MI hospitalization (index date) to incident CKD, death, or administrative censoring in 2017. Incident CKD was defined as eGFR <60 mL/min/1.73 m
2
and ≥25% eGFR decline from previous measurements, CKD-related hospitalization or death, or end-stage renal disease. In-hospital complications included acute heart failure, ventricular fibrillation, and cardiogenic shock. Prevalent CHD and chronic heart failure were measured at visit 1 (1987-1989) and history of diabetes and hypertension were captured from the MI hospitalization record.

Results:
There was a total of 1,332 MI hospitalizations with data on MI type and symptom presentation. Among 1,038 NSTEMI events, 19% presented without chest pain, compared to 7% of the 294 STEMI events presenting without chest pain. Age greater than 65 years, female gender, and hypertension at the time of the MI as well as in-hospital complications of heart failure and ventricular fibrillation were more common among NSTEMI without chest pain compared to NSTEMI with chest pain. Median follow-up time was 4.9 years (Q1, Q3: 0.9, 11.4 years). Persons with NSTEMI events presenting without chest pain had 1.82 times the risk of incident CKD (95% CI: 1.39, 2.38) compared to NSTEMI events presenting with chest pain. This association was attenuated after adjustment for age at MI, female gender, and black race (HR: 1.36, 95% CI: 1.04, 1.80) and further attenuated after additional adjustment for reperfusion within 24 hours (HR: 1.30, 95% CI: 0.99, 1.72).

Conclusion:
NSTEMI presenting without chest pain was associated with increased risk of incident CKD, though this association was attenuated after adjustment.