bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP044: Fatty Liver Disease, Visceral Fat and Pectoral Muscle Area Are Independently Associated with Subclinical Atherosclerosis in Heavy Smokers
Authors: Young Kendra A , Kinney Gregory L , McDonald Merry-Lynn , Washko George R , Lutiz Sharon M , Pratte Katherine A , SIlverman Edwin K , Crapo James D , Budoff Matthew J , Hokanson John E
Published: March 2022

Introduction:
Cardiovascular disease is a leading cause of death in those with chronic obstructive pulmonary disease. Coronary artery calcium (CAC) is a subclinical measure of cardiovascular disease. Fatty liver disease and visceral fat (VAT) are associated with CAC, and pectoral muscle area (PMA) has been shown to be associated with CAC in our population. However, it is unclear if fatty liver disease, VAT and PMA are all independently associated with CAC or if confounding exists.

Hypothesis:
We hypothesized that fatty liver disease will be associated with CAC independent of VAT and PMA.

Methods:
We utilized cross-sectional data from COPDGene, a cohort of former and current smokers with at least 10 pack-years of smoking history with CT measures of CAC, VAT, PMA, and liver and spleen attenuation. CAC positivity was defined as greater than 2.5 units of square root transformed total CAC volume to account for measurement variability. The liver/spleen ratio (LSR) was calculated, and fatty liver disease was defined as LSR < 1. Multiple logistic regression was used to assess the association between the presence of CAC and fatty liver disease. Models were adjusted for age, sex, race, and current smoking, pack-years of smoking, high cholesterol, hypertension, diabetes, pectoral muscle area and visceral fat. Interactions between fatty liver disease and sex and fatty liver disease and race were tested.

Results:
Of the 5873 individuals with complete data, 3210 (54.7%) had CAC and 1153 (19.6%) had fatty liver disease. Both PMA (p<0.0001) and VAT (p=0.0002) were associated with having CAC, and with having fatty liver disease (p<0.0001 for both). There was a significant interaction between race and fatty liver disease (p=0.03). In non-Hispanic whites (NHW), fatty liver disease was associated with having CAC (OR=1.10, 95% CI 0.92-1.32), while in AA, fatty liver disease was not associated with CAC (OR=0.79, 95% CI 0.58-1.07). Removing VAT and PMA did not attenuate these results. There was no significant interaction between fatty liver disease and sex.

Conclusion:
In a large cohort of heavy smokers, fatty liver disease, VAT and PMA were associated with subclinical atherosclerosis independent of traditional cardiovascular risk factors in NHW but not AA. The racial differences in this association could indicate different biologic pathways in cardiovascular disease.
Abstract MP089: Sleep Apnea is Reduced Following a Behavioral Weight Loss Intervention but Impedes Weight Loss Outcomes
Authors: Kline Christopher E , Burke Lora E , Sereika Susan M , Imes Christopher C , Baniak Lynn M , Mendez Dara D , Strollo Patrick J , Ye Lei , Chasens Eileen R
Published: March 2022

Introduction:
Several trials have documented that behavioral weight loss interventions reduce obstructive sleep apnea (OSA) severity. However, despite the known bidirectional association between body weight and OSA severity, few studies have addressed whether the presence of OSA impedes weight loss outcomes in a lifestyle intervention.

Hypothesis:
We hypothesized that a behavioral weight loss intervention would significantly reduce OSA severity, but that the presence of OSA would lead to poorer weight loss outcomes.

Methods:
Overweight and obese adults (N = 101; 50.6 ± 10.3 y, body mass index: 34.1 ± 4.6; 91.1% female, 80.2% white) who participated in a 12-mo behavioral weight loss intervention study and had OSA assessed were included in these secondary analyses. Participants wore a limited-channel home sleep testing device (ResMed ApneaLink Plus) for one night at baseline, 6 and 12 mo. Measures of OSA severity included the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and snoring index (i.e., number of snoring events divided by flow recording time). Weight change at 6 and 12 mo was expressed as percentage change from baseline. Linear mixed models were used to evaluate the effect of the intervention on OSA measures, and ANCOVA models examined the effect of weight change on OSA and the effect of OSA on subsequent weight loss. All analyses were adjusted for age, sex, and race.

Results:
Baseline AHI, ODI, and snoring index were 6.6 ± 7.1, 8.7 ± 8.3, and 109.9 ± 122.0, respectively; 50.5% of the sample had a baseline AHI ≥ 5. AHI and ODI, but not the snoring index, were significantly reduced by the end of the intervention (12-mo changes: -1.3 [P < .05], -2.3 [P < .01], -2.8 [P = .82], respectively). Weight loss at 6 and 12 mo were 9.0 ± 6.0% and 9.1 ± 8.3%, respectively. Participants with ≥ 5% weight loss at 6 mo had significant reductions in AHI (P = .02), ODI (P < .05), and the snoring index (P < .001) at 6 mo; adults with ≥ 5% weight loss at 12 mo had a significant reduction in the snoring index at 12 mo (P < .01), but not AHI (P = .29) or ODI (P = .39), relative to baseline. Participants with a baseline AHI ≥ 5 lost significantly less weight at 6 mo compared to those without OSA at baseline (-8.4% vs. -11.4%; P < .01), and those with an AHI ≥ 5 at 6 mo lost significantly less weight at 12 mo compared to those without OSA at 6 mo (-7.1% vs. -10.9%; P = .04).

Conclusion:
Behavioral weight loss interventions in overweight and obese adults lead to significant improvement in OSA severity. However, the presence of at least mild OSA is associated with less favorable weight loss in this population. Future work should explore the mechanisms underlying the blunted weight loss in overweight and obese adults with OSA.
Abstract MP093: Preterm Delivery is Associated with Maternal Cardiovascular Risk Factors
Authors: Tanz Lauren J , Stuart Jennifer J , Rimm Eric B , Williams Paige L , Missmer Stacey A , Rich-Edwards Janet W
Published: March 2022

Background:
Women with a history of delivering a child preterm have a higher risk of cardiovascular disease (CVD). We sought to evaluate whether these women are also at higher risk of developing CVD risk factors after adjustment for multiple pre-pregnancy risk factors.

Methods:
We examined the association between preterm delivery (<37 weeks) and development of subsequent chronic hypertension, hypercholesterolemia, and type 2 diabetes mellitus (T2DM) among 59,315 women in the Nurses’ Health Study II. We restricted our study population to parous women who did not experience gestational diabetes or a hypertensive disorder in their first pregnancy and were free of CVD risk factors of interest and events at baseline. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between preterm delivery in first pregnancy and each CVD risk factor. We additionally investigated the association between preterm delivery over a woman’s entire reproductive history and CVD risk factors.

Results:
Compared to women who delivered their first pregnancy at term, preterm delivery was associated with HRs of 1.13 (95% CI: 1.07, 1.19) for chronic hypertension, 1.06 (95% CI: 1.02, 1.11) for hypercholesterolemia, and 1.21 (95% CI 1.08, 1.35) for T2DM, after adjusting for age, race/ethnicity, parental education, and other pre-pregnancy risk factors (e.g., BMI, smoking, family history of chronic hypertension and T2DM). These associations were stronger in the very preterm group (<32 weeks) than in the moderate preterm group (≥32 to <37 weeks). The risk was highest in the first 10 years after a preterm first birth with HRs of 1.45 (95% CI: 1.23, 1.71) for chronic hypertension, 1.13 (95% CI: 1.02, 1.25) for hypercholesterolemia, and 2.14 (95% CI: 1.33, 3.45) for T2DM. When investigating a woman’s entire reproductive history, we found that, compared to women with at least two births all of which were at term, women with a preterm first birth were at increased risk of chronic hypertension regardless of the gestation lengths of future pregnancies, while women with a preterm first birth and no future births had the highest risk of T2DM.

Conclusions:
Women with a history of preterm delivery have higher risk of developing chronic hypertension, hypercholesterolemia, and T2DM after pregnancy. These results suggest potential benefits of including preterm delivery in CVD risk scores and screening.
Abstract P036: RBC Omega-3 Fatty Acids, Incident CVD and Total Mortality: Framingham Heart Study
Authors: Harris William , Tintle Nathan , Robins Sander J , Vasan Ramachandran S
Published: March 2022

Background:
The potential role of the marine omega-3 fatty acids (FA) EPA and DHA in cardiovascular disease (CVD) is unclear. Diet- and biomarker-based prospective studies have shown cardioprotective associations while several recent (relatively low dose, short term) randomized trials have shown no benefit.

Methods:
We examined CV outcomes and death in 2899 individuals in the Framingham Heart Study Offspring cohort (mean age 66 years, 54% women; 399 individuals had prior CVD) as a function of baseline levels of EPA+DHA in erythrocyte membranes (the Omega-3 Index). The latter is expressed as a % of total membrane FAs and is a validated surrogate for tissue EPA+DHA content. Clinical outcomes were monitored for up to 9.5 years (median follow up, 7.26 years). Cox proportional hazards models stratified by prior CVD were adjusted for a variety of demographic characteristics, clinical status and RBC omega-6 FA content.

Results:
There were 296 CV events, 157 CHD events, 116 ischemic strokes, 76 CVD deaths, and 362 deaths from all causes. A 1-SD higher Omega-3 Index was associated with significantly lower risks for total CVD (29%), ischemic stroke (39%), and total mortality (24%) (Table). In individuals in the bottom 20% of Omega-3 Index (vs. the top 20%, i.e., <4.2% vs >6.8%) risk was reduced by 44% for any CV event, by 65% for ischemic stroke, by 65% for CHD death, and by 53% for death from any cause (Table). Relations with these outcomes for EPA and DHA separately were weaker than for the combined metric but in the same direction.

Conclusions:
Higher circulating levels of the marine omega-3 fatty acid levels are associated with reduced risk for incident CVD and ischemic stroke and for death from CHD and all-causes. Evidence for a causal connection between omega-3 fatty acids and these outcomes must await the results of longer-term and/or higher-dose intervention studies that are currently in progress.
Abstract P058: Hostility Attitudes & Prevalent or Future Diabetes Among Black Adults: The Jackson Heart Study
Authors: Apenyo Tsikata , Ridout Samuel , Taveira Tracey , Wu Wen-Chih
Published: March 2022

Background:
Hostility and diabetes mellitus (DM) share common determinants such as obesity, tobacco use and physical inactivity. Thus, we investigated their unstudied relationship at baseline and at 10 yrs after among Black adults in the Jackson Heart Study (JHS), a group with high rates of DM.

Hypothesis:
Hostility and its subdomains (hostile affect, aggressiveness, and cynicism) correlate with DM at baseline or at 10 yrs after.

Methods:
From the JHS cohort (n=5301), we studied 3,434 Blacks who completed the Cook-Medley Hostility Scale. Hostility was measured in 3 subdomains: hostile affect, cynicism and aggressiveness; higher scores correlated with higher hostility levels. Participants were stratified into quartiles based on the hostility scale. Frequency of DM at baseline or at 10 yrs after was compared amongst quartiles and tested for trend. Using multivariate logistic regression, we studied the cross-sectional relationship between quartiles of levels of hostility and the combined outcome of presence of diabetes at present or at 10 yrs after, adjusting for known confounders of DM. Subanalyses were conducted at each hostility domain level.

Results:
Our population was 35% men with a mean age of 54.3 (SD 12.6) yrs. Quartiles were associated with age, BMI, smoking, hA1c, caloric intake, hs-CRP, and alcohol intake (all p<0.05). Overall hostility quartiles and its subscales correlated with DM at baseline but only the subdomains of hostile affect and cynicism correlated with DM at 10 yrs. When prevalent or DM at 10 yrs were assessed as a combined risk, individuals in the last quartile of the hostile affect subdomain was associated with a higher DM risk versus first quartile (Table). Similar link was not found in other subdomains.

Conclusions:
Hostility attitude was associated with DM risk factors and prevalent DM. Only 2/3 of the hostility subdomains correlated with DM at 10 yrs after. Individuals from the last quartile of hostile affect subdomain was related to a higher risk of prevalent or DM at 10 yrs when compared to the first quartile.
Abstract P137: Effect of Obesity & T2DM on Cardiac Strain in Youth
Authors: Haley Jessica E , Gao Zhiqian , Khoury Philip , Stewart Stephanie N , Madsen Nicolas L , Kimball Thomas R , Dolan Lawrence M , Urbina Elaine M
Published: March 2022

Introduction:
Heart failure is a complication of long standing T2DM. Advanced echo measures can identify early sub-clinical systolic dysfunction in adults with T2DM. We hypothesized that subtle systolic dysfunction was present in young diabetics.

Methods:
Longitudinal strain was measured in 151 subjects with T2DM matched by age, race and sex to a lean (L=146), and non-diabetic (proven by OGTT) obese (O=162) control (23.0 ± 4.0 years, 35% male, 63% African American). Anthropometrics, BP, HR, fasting lipids, glucose and CRP and echocardiograms for LVM, shortening fraction (SF), global longitudinal 4-chamber strain (GLS) and strain rate in systole (GLSR) were obtained. ANOVA was performed to compare differences among groups for CV risk factors and strain measures and ANCOVA to determine if presence of T2DM remained an independent predictor of strain after correction for risk factors (full model=age, sex, race, presence of T2DM, BMI, SBP, DBP, HR and lab values).

Results:
CV risk factors worsened and there was a graded decline in GLS from L to O to T2DM subjects. GLSR was less negative and LVM/ht
2.7
was higher in O & T as compared to L (all p < 0.05). There was no difference in SF among groups. Presence of T2DM was an independent determinant of GLS and GLSR adjusted for most CV risk factors but lost significance when BMI was added to the model. GLS = -21.6 -age*0.088 - male*1.8 + 0.12*BMI + 0.045*DBP + 0.058*HR - 0.023*HDL (R
2
= 0.38, p<0.0001); GLSR = -1.20 -male*0.093 + WHR*0.48 + DBP*0.0029 (R
2
= 0.23, p<0.0001).

Conclusion:
Early in the course of T2D in youth, obesity has a greater deleterious effect on systolic function than T2DM. Treatment of obesity in youth is necessary for prevention of future heart failure.
Abstract P202: Cardiovascular Risk Prediction Using Machine-learning Methods in the Middle-aged Korean Population
Authors: Kim Hyeon Chang , Jo In-Jeong , Sung Ji Min , Chang Hyuk-Jae
Published: March 2022

The purpose of the current study was to evaluate the utility of using machine-learning (ML) algorithm and their ability to integrate data inputs to make predictions of future development of cardiovascular disease (CVD) in a nationwide sample of middle-aged Korean adults. Study population was randomly sampled from the Korea National Health Insurance (NHI) database. We identified 143,453 people (79,584 men and 63869 women) who were aged 40 years or older, free from CVD or cancer, and completed health screening tests between 2002 and 2003. CVD was defined as composite of cardiovascular death, myocardial infarction, stroke, and coronary artery disease requiring coronary artery intervention or bypass surgery until 2013, and were identified from the NHI claim database. We employed multiple supervised ML algorithms to build a CVD prediction models using clinical and laboratory data during the follow-up period. Prediction performance of the ML algorithm was compared to those of traditional scoring system or logistic prediction models. ML algorithm [area under curve (AUC) 0.895, 95% confidential interval (CI) 0.889-0.902] outperformed a traditional scoring system (AUC 0.721, 95% CI 0.713-0.730), logistic regression model with baseline characteristics (AUC 0.731, 95% CI 0.723-0.739) and logistic model with time-series analysis (AUC 0.804, 95% CI 0.797-0.811) in prediction of future CVD in men. In women, ML algorithm (AUC 0.908, 95% CI 0.901-0.915) also exhibited the most accurate predictive power, compared to the traditional scoring system (AUC 0.749, 95% CI 0.740-0.758), logistic regression model with baseline characteristics (AUC 0.775, 95% CI 0.767-0.784) and logistic model with time-series analysis (AUC 0.842, 95% CI 0.834-0.849). Our findings suggest that ML algorithm with time-series data can improve the performance of CVD risk prediction.
Abstract P214: Mediterranean Diet, Vegetable-based Dietary Patterns and Diet Quality are Associated With Higher Resilience: Findings From the Moli-sani Study
Authors: Bonaccio Marialaura , Di Castelnuovo Augusto , Costanzo Simona , De Curtis Amalia , Pounis George , Persichillo Mariarosaria , Donati Maria Benedetta , de Gaetano Giovanni , Iacoviello Licia ,   Moli-sani Study Investigators
Published: March 2022

Introduction:
Resilience is a measure of stress coping ability and has been favourably associated with cardiovascular health. Yet little is known on the likely association between diet and resilience.

Hypothesis:
We tested the hypothesis that diet quality is associated with resilience.

Methods:
Cross-sectional analysis on 10,812 subjects (mean age 52.7±10.8, 50.5% men) recruited within the cohort of the Moli-sani study from 2005 to 2010. Resilience was measured by the 25-item Connor-Davidson Resilience Scale ranging from 0-100 with the higher score reflecting greater resilience. Food intake was recorded by the EPIC food frequency questionnaire and adherence to the Mediterranean diet was appraised by both a Greek and an Italian dietary score. Empirically-derived dietary patterns were obtained by principal components analysis (PCA), while dietary polyphenol and antioxidant intakes and fruit and vegetables variety were assessed by specific holistic scoring. Multivariable linear regression analysis (95%CI) was used to test the association between dietary scores and resilience.

Results:
As compared to those below the median value of resilience (score=67), more resilient subjects had higher educational status (19.4%
vs
13.5% for university or postgraduate education) and were more likely to report favourable health behaviours (leisure-time physical activity and less prevalence of smoking habit) . In a multivariable model, greater adherence to Mediterranean-type diets or vegetables-based dietary pattern obtained from PCA, as well as dietary polyphenol or antioxidant intakes and greater variety in fruit and vegetables consumption were all positively associated with resilience (Table) . No association with Western-like diets was found.

Conclusions:
Diet quality, as measured by a number of dietary scores, was positively associated with higher resilience, whereas western-type diets were not. Modulation of stress coping ability may be a factor in considering healthy effect of high quality diet.
Abstract P219: Dairy Consumption and Body Mass Index: Mendelian Randomization Analysis of 184,802 Participants and Systematic Review of 37 Randomized Controlled Trials
Authors: Huang Tao , Ding Ming , Bergholdt Helle K , Wang Tiange , Heianza Yoriko , Sun Dianjianyi , Nordestgaard Børge , Ellervik Christina , Qi Lu
Published: March 2022

Objective:
Using the Mendelian randomization (MR) approach and meta-analysis of selected randomized controlled trials (RCTs), we aimed to assess whether dairy intake was causally related to BMI.

Methods:
We used a genetic polymorphism in
MCM6
(
LCT
-13910 C/T, rs4988235), located upstream of the lactase gene (
LCT),
as an instrumental variable (IV) for dairy intake in a MR design. The causal effect of dairy intake on BMI was quantified by IV estimators among 184,802 participants from 25 studies. We further conducted a new meta-analysis of RCTs on the effect of dairy consumption on changes in body composition among 3,007 participants in 37 RCTs.

Results:
Higher dairy intake was associated with higher BMI (multivariable-adjusted β = 0.03 kg/m
2
per serving/day; 95% CI, 0.00, 0.06; p=0.04), while the
LCT
-13910 C/T CT+TT genotype was significantly associated with higher dairy intake (β = 0.20 serving/day; 95% CI, 0.14, 0.25; p=3.15х10
-12
) and higher BMI (β = 0.12 kg/m
2
; 95% CI, 0.06, 0.17; p=2.11х10
-5
). The IV analysis showed that higher dairy intake was significantly associated with higher BMI (β = 0.60 kg/m
2
per serving/day; 95% CI, 0.27, 0.92; p=3.0х10
-4
). In addition, our systematic review of 37 RCTs indicated that higher dairy intervention significantly increased body weight (0.36 kg, 95% CI: 0.01, 0.70) and marginally increased lean mass (0.14 kg, 95% CI: -0.06, 0.33) in trials without energy restriction.

Conclusions:
The present study provides evidence to support a causal effect of higher dairy intake in the absence of caloric restriction on increased BMI.
Abstract P244: MicroRNAs Implicated in Angiogenesis Are Upregulated in Lower Extremity Peripheral Artery Disease (PAD): the San Diego Population Study (SDPS)
Authors: Wassel Christina , Freedman Jane E , Tanriverdi Kahraman , Durda Peter , Tracy Russell P , Allison Matthew A , Ix Joachim H , Denenberg Julie O , Criqui Michael H
Published: March 2022

Introduction:
Lower extremity PAD affects approximately 9 million people in the US. However, the genetic factors underlying PAD remain elusive. MicroRNAs are short non-coding RNA segments that regulate gene expression post-transcriptionally. MicroRNAs are hypothesized to be involved in angiogenesis, inflammation, and immune processes central to atherosclerotic process, are modifiable, and thus have potential as therapeutic targets. No previous studies have assessed the role of microRNAs in PAD in a population-based sample.

Methods:
The SDPS is a prospective population-based cohort of non-Hispanic White, African-American, Hispanic and Asian men and women designed to study PAD and venous disease. A sex- and age-matched nested sample of 24 PAD cases and 24 controls were chosen from 1103 participants who attended the 2007-11 exam. PAD was defined as ankle brachial index (ABI)<0.90, while the ABI range for controls was 1.1-1.3. Thirty-five microRNAs hypothesized to be of importance in development of atherosclerosis were measured in plasma using a high throughput RT qPCR method on the BioMark microfluidic System. MicroRNA expression levels (Cq values) were compared between PAD cases and controls using linear regression and least squares means, with adjustment for age and sex to remove residual confounding.

Results:
Overall mean±SD age was 79±7, with mean ABI among the PAD cases of 0.60±0.12 and among controls was 1.17±0.06.Six microRNAs, miR-181b, -195, -22, -27b, -424, and -503, were significantly upregulated in PAD cases vs. controls (
Figure
), all p<0.05. Existing evidence indicates that miR-195,-27b, -424, and -503 are involved in angiogenesis, and miR-503 is upregulated in ischemic leg muscle of patients with diabetes.

Conclusions:
Individuals with PAD have significantly higher expression of miRNAs linked to angiogenesis.Additional research is needed in larger studies to further assess associations with clinical and subclinical PAD, as well as the viability of these miRNAs as therapeutic targets for PAD.
Abstract P250: Emergency Room Consultations and Hospitalizations Following Generic Clopidogrel Commercialization in Quebec, Canada
Authors: Leclerc Jacinthe , Blais Claudia , Rochette Louis , Hamel Denis , Guénette Line , Poirier Paul
Published: March 2022

Background:
Clopidogrel is widely used to prevent atherothrombotic events. Federal standards regulate bioequivalence of generic and brand-name drugs through comparative bioavailability studies but does not regulate clinical equivalence nor tolerability in “real-life” settings. We evaluated the impact of the generic clopidogrel commercialization on some adverse events: emergency room consultations (ER) or hospitalizations.

Methods:
This is an interrupted time series analysis using the Quebec Integrated Chronic Disease Surveillance System. Rates of adverse events for clopidogrel users (n=75,130) aged ≥ 66 years were calculated monthly, 12 months before and 12 months after generics commercialization. Periods before and after generics commercialization were compared by negative binomial segmented regression models for all users with a specific variable for generic and brand-name users after generics commercialization.

Results:
Generic clopidogrel analogs (n=6) were commercialized in 2012. There was an approximated monthly mean rate of 157 adverse events per 1000 brand-name and generic users-month. After generics commercialization, there was an immediate increase in rates of adverse events for generic vs. brand-name users (22 vs. 2%,
p
< 0.0001, Figure 1). This was explained by increased rates of ER (+22%) and hospitalizations (+20%) the month of generic clopidogrel commercialization. Hospitalization trend up to 1 year after generics commercialization was stable for generic users but reduced for brand-name users (-0.9 vs. -2.9%,
p
= 0.01), while ER trends were comparable (-1.1 vs. -1.8%,
p
= 0.2443).

Conclusion:
Among generic clopidogrel users, increased rates of ER and hospitalizations were observed soon after generics commercialization. The trend of hospitalizations was also affected following generic clopidogrel commercialization. Risk and survival analysis studies controlling for potential confounding are required to better characterize generic substitution.
Abstract P260: Patients Experiencing Homelessness Have Longer Hospital Lengths of Stay After Admission for Ischemic Stroke or TIA
Authors: Corless Leslie , Lucas Lindsay , Baraban Elizabeth
Published: March 2022

Introduction:
There is little information available regarding stroke care and outcomes specific to patients experiencing homelessness. This study assesses the provision of stroke care and outcomes for these patients and identifies opportunities to improve their care.

Methods:
Data was obtained from a large, multi-state health system’s Get With The Guidelines registry for patients discharged between January 2009 and September 2016. Patients with an ischemic stroke or transient ischemic attack (TIA) were included. Patients with time of last known well (LKW) to hospital arrival of more than two weeks or hospital arrival to CT times of more than two days were excluded. Homeless patients were matched to non-homeless patients with a 1:5 ratio using case control matching on age, stroke type, gender and year. Patient characteristics between homeless and housed patients were compared before and after matching using t-tests, Mann Whitney tests, or chi-squared tests, as appropriate. Primary outcomes were discharge modified Rankin score (mRs), with disability categorized as none/slight (mRs≤2) or moderate or greater (mRS > 3) and length of stay (LOS). Logistic regression was used to analyze the relationship between homeless status and mRs, and Cox proportional hazards regression was used to assess the effect of homelessness on LOS. LKW to hospital arrival time and admit National Institutes of Health Stroke Scale (NIHSS) score were added as covariates to both models. Adjusted odds ratios (AOR) and hazards ratios (AHR), and their corresponding p-values were reported.

Results:
A total of 20,516 patients met inclusion criteria with 28 experiencing homelessness. Prior to matching, homeless patients were more likely to be male (78.6% vs 48.9%, p=.007), younger (58 vs 72 years, p<.001) and have longer median LKW to arrival times (921 vs 386 minutes, p=.066). After matching, the analytic sample size was 168 patients with 16.7% (n=28) experiencing homelessness and 83.3% (n=140) housed. Multivariable analyses indicated that homeless patients leave the hospital at a slower rate compared to the non-homeless (AHR=0.666, p=.056). They also had lower disability scores at discharge (AOR=0.104, p=.095); however, this result only approached significance.

Conclusion:
Patients experiencing homelessness had longer LKW to hospital arrival times indicating an opportunity for targeted intervention around the need for quick arrival after symptoms. In addition, homeless patients also had longer LOS which is likely related to challenges in safely discharging this population. Further research with a larger number of patients is needed in order to compare other aspects of acute stroke care, including treatment rates and time to treatment, and assess ways to address the challenges of shortening last known well to arrival times and safe discharge.
Abstract P275: Hypertension, Diabetes, and Obesity Among African Immigrants in the 2010 - 2014 National Health Interview Surveys
Authors: Turkson-Ocran Ruth-Alma N , Ukonu Nwakaego A , Commodore-Mensah Yvonne Y
Published: March 2022

Background:
Cardiovascular disease (CVD) is the leading cause of death in the United States (US). Immigrants of African-ancestry are a fast-growing population in the US. However, little is known about the prevalence of CVD risk factors such as hypertension, diabetes, and obesity in this population.

Hypothesis:
We hypothesized that sex-differences exist in the prevalence of cardiovascular risk factors among African immigrants.

Methods:
We performed a retrospective analysis of the National Health Interview Surveys for the 2010-2014 period. We examined demographic and CVD history variables to determine if differences existed by sex in the prevalence of CVD risk factors. We performed multivariable logistic regression analyses and computed predictive margins (with standard errors) to obtain the predicted probabilities of hypertension, diabetes, overweight/obesity, and hyperlipidemia.

Results:
A total of 2,019 adult African immigrants were included in the sample. Table 1 describes the socio-demographic characteristics of the respondents. Overall, 61% (1234 of 2019) of the sample was overweight/obese, 18% (403 of 2019) were hypertensive, and 16% (47 of 2019) had a history of CVD. Males were significantly more likely than females to have diabetes (OR(95% CI):1.79(1.16,2.78); p<0.05). Females had a 0.42 (95% CI: 0.21-0.83; p=0.01) odds of hyperlipidemia compared to males and females were 0.76 (95% CI: 0.59-0.99; p<0.05) times less likely to be hypertensive compared to males. There was no difference in the prevalence of overweight/obesity between the sexes.

Conclusion:
In conclusion, we observed significant sex-differences in the prevalence of hypertension, diabetes, and hyperlipidemia. It is important to highlight sex-differences in CVD risk factors among African immigrants to inform the development of effective preventative health interventions. Culturally-appropriate public health strategies and policies designed to meet the specific needs of African immigrants may reduce the prevalence of CVD risk factors and improve health outcomes.
Abstract P284: The Prospective Association Between Unprocessed Meat Consumption and Incident Cardiovascular Disease in Korean Adults
Authors: Park Kyong , Son Jakyung , Jang Jiyoung , Chung Hye-Kyung , Kang Ryungwoo , Lee Kyong Won , Shin Min-Jeong
Published: March 2022

Introduction:
Cumulative evidence has shown that total meat consumption is associated with the risk of cardiovascular disease (CVD) in Western societies. However, epidemiological information is limited regarding such associations in the Korean population whose consumption level of meat is much lower than the global average.

Hypothesis:
We hypothesized that higher intake levels of unprocessed total meat would not increase the overall risk of CVD incidence, and healthier alternatives to red meat (such as poultry) would have protective effects in middle-aged Korean population.

Methods:
Ansung-Anasan cohort 2001-12 analyses were conducted from 2001 to 2012 among 9,370 adults, aged 40-69 years, without CVD or cancer at baseline, from two communities, Ansan (urban) and Ansung (rural). Dietary information was ascertained at baseline and at the second follow-up visit. Total meat consumption was estimated as the sum of unprocessed red meat (sum of beef, pork, and organ meat) and chicken consumption. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI).

Results:
During a median follow-up of 7.8 years, 486 incident CVD cases were identified. In the fully adjusted Cox regression model, relative risks of CVD across increasing quintiles of total meat intake were 1.0 (reference), 0.72 (95% CI 0.55-0.95), 0.57 (95% CI 0.42-0.78), 0.69 (95% CI 0.51-0.95), and 0.69 (95% CI 0.48-0.97). Regarding specific types of meat, frequent chicken consumption was significantly associated with decreased risks of CVD, showing participants in the highest quintile of chicken intake were 1.5 times less likely to develop CVD than those in the lowest quintile (95% CI: 0.47-0.99), and this association showed a dose-response relationship for all statistical models (
P
for trend <0.05).

Conclusion:
Higher intakes of unprocessed total and red meat showed inverse associations with incident CVD in a large, prospective, population-based cohort study of middle-aged Koreans. These findings require further confirmation from other populations whose meat intake is relatively lower than the global average.
Abstract P287: Systematic Review of Dietary Trans-fat Reduction Policies: Evidence for an Effectiveness Hierarchy?
Authors: Hyseni Lirije , Bromley Helen , Kypridemos Chris , O’Flaherty Martin , Lloyd-Williams Ffion , Guzman-Castillo Maria , Pearson-Stuttard Jonathan , Capewell Simon
Published: March 2022

Background:
The four major risk factors prioritised in WHO non-communicable disease prevention strategies are tobacco, alcohol, physical inactivity and, crucially, poor diet. Trans-fatty acid intake in most countries still exceeds the WHO target of 2g/day, mainly reflecting consumption of industrial trans-fats in junk food. Furthermore, the most effective policies for reducing trans-fats remain unclear. We therefore systematically reviewed the evidence on trans-fat policy interventions to inform future prevention strategies. We also explicitly compared “upstream” interventions covering whole populations with “downstream” interventions targeting individuals.

Methods:
A pre-piloted search strategy was used to systematically search six electronic databases (Cinahl, CRD, CDSR, Medline, SCI and SCOPUS) for papers evaluating the effectiveness of trans-fat interventions, with intake (g/day) as the main outcome measure. Two researchers independently screened, extracted and graded the papers for quality. Each study was then categorised on a continuum ranging from “downstream” interventions targeting individuals (dietary counselling, media campaigns or nutrition labelling) to more “upstream” structural interventions covering the entire population - reformulation, regulation, fiscal policies and comprehensive strategies involving multiple policies. A narrative synthesis was used to summarise and compare the effectiveness of different interventions.

Results:
After screening 996 candidate papers, a total of 22 papers were included in this systematic review: 12 empirical studies and 10 modelling studies. Quality was variable. The largest trans-fat reductions occurred in Denmark. Multiple interventions decreased intake from 4.5g/day in 1976 to 1.5g/day in 1995 and then virtually zero after a legislative ban in 2005. The US now intends to emulate this approach. No studies quantifying tax interventions were identified. Voluntary reformulation reduced trans-fat intake by 1.5g/day followed by worksite interventions (1.2g/day) and food labelling (0.8g/day). Dietary counselling targeting individuals achieved the smallest reductions (0.8g/day).

Conclusions:
Multi-component interventions including a legislative ban to eliminate trans-fats from foods appear the most effective strategy to minimise intake, as achieved in Denmark, and ongoing in the US. However this approach remains underused. Reformulation and other multi-component interventions can also achieve useful reductions. By contrast, more “downstream” interventions targeting settings or individuals consistently achieve much smaller reductions. This “effectiveness hierarchy”, previously observed in tobacco and alcohol control, might perhaps be considered more often when planning future prevention strategies; for instance to control other harmful nutrients such as salt or sugar.
Abstract P335: Health Care Discrimination and C-Reactive Protein in US Adults
Authors: Nguyen Thu T , Glymour M. Maria , Nuru-Jeter Amani
Published: March 2022

Background:
Healthcare discrimination has been documented and remains common in the US. However, little is known about the association between healthcare discrimination and objective health indicators such as C-reactive protein (CRP), a marker of inflammation and a correlate of cardiovascular outcomes.

Methods:
We used 2008-2012 data from the Health and Retirement Study, a nationally representative study of US adults ages 54+, to examine the association between self-reported experiences of healthcare discrimination and high sensitivity CRP among those reporting a history of chronic disease (N=12,110). Dried blood spots were assayed for CRP. Respondents were asked how often they received poorer service or treatment than other people from doctors or hospitals (six-point likert scale ranging from “almost every day” to “never.”) Participants reporting any healthcare discrimination were compared to those reporting “never.” We used Generalized Estimate Equation (GEE) models to examine the associations between healthcare discrimination and CRP (< vs. ≥ 3 g/L), specifying a compound symmetry working correlation structure to take account of the dependency of repeated measures of the biomarker. To examine whether the relationship differs across the outcome distribution, quantile regression models were fitted, examining the 10
th
, 25
th
, 50
th
, 75
th
, and 90
th
percentiles of the CRP distribution, and accounting for repeated measurements. All models were adjusted for age, sex, race/ethnicity, education, log-household size adjusted wealth and income, current employment, marital status, and year indicators.

Results:
In 2008, 18% of participants reported past experiences of health care discrimination. Report of healthcare discrimination was associated with increased odds of CRP ≥ 3 g/L (OR: 1.12, 95% CI: 1.02, 1.24), similar in magnitude to a 6-year age difference. Health care discrimination was not associated with CRP at the 10
th
(β=0.01; 95% CI: -0.04, 0.06) or 25
th
percentile (β=0.05; 95% CI: -0.03, 0.14). At the 50
th
percentile (~2.1 g/L) and at 75
th
percentile of CRP (~4.5 g/L), participants who reported experiencing health care discrimination had 0.14 g/L (95% CI: 0.01, 0.26) and 0.32 g/L (95% CI: -0.04, 0.61) higher CRP, respectively, than participants who did not report health care discrimination.

Conclusion:
Adults reporting prior healthcare discrimination have elevated levels of CRP. The estimated effect was largest for people at the higher end of the CRP distribution, who would be at greater risk of adverse cardiovascular outcomes.
Abstract P343: E-Epidemiology to study the Associations of Socioeconomic Status with Risk of Cardiovascular Disease Hospitalization Among Patients with Chronic Kidney Disease
Authors: Bhavsar Nrupen A , Goldstein Benjamin A , Phelan Matthew , Boulware Leigh E
Published: March 2022

Introduction:
There has been a paradigm shift in epidemiology to integrate large, disparate sources of information, including electronic health record (EHR) data, to identify, prevent and treat individuals at risk for cardiovascular disease (CVD). This developing field, termed “e-epidemiology,” has the potential to enhance our ability to utilize these resources more efficiently, however limited data exists on how results from EHR based studies compare to traditional cohort studies.

Objective:
Quantify the association between socioeconomic status (SES) and CVD hospitalization among patients with chronic kidney disease (CKD) using EHR clinical and public SES data.

Methods:
We quantified the odds of incident or recurrent CVD hospitalization for a fatal/nonfatal heart disease or stroke event (defined by ICD-9 codes) among patients with lower vs. higher SES. We included patients ≥40 years old with prevalent CKD receiving care in 2 Durham NC health systems from 2007-13. Annual cross sectional cohorts of patients (new and returning) were created to calculate the probability of a CVD hospitalization in the following year. We measured SES using the AHRQ SES score (based on income, education, occupation, wealth and housing data). In logistic regression models, we estimated the odds of CVD hospitalization in the next year per quartile of SES score, adjusting for demographic and clinical covariates.

Results:
Of 60463 patients, 61% were female, 45% were Black, 89% had hypertension, and 41% had diabetes. Examined continuously, the probability of a CVD hospitalization was inversely associated with SES score (Figure 1). Patients in the lowest quartile of SES had a 32% greater odds of CVD hospitalization in the next year as compared to patients in the highest quartile of SES (OR = 1.32, 95% CI=1.08-1.61).

Conclusions:
Our results support published data from traditional cohort studies that lower SES is associated with CVD hospitalizations. The EHR is a feasible, efficient and robust data source that may have great potential to advance CVD research.
Abstract P344: Tipped-wage Work is Associated With Greater Perceived Stress in US Women
Authors: Andrea Sarah B , Boone-Heinonen Janne , Messer Lynne C
Published: March 2022

Background:
Low income and income volatility are risk factors for stress and stress-induced illnesses such as hypertension. Subminimum wage, ranging from $2.13 to $7.82 in 43 states, applies to certain service occupations such as wait staff. The implicit assumption behind this law is that, combined with tips, subminimum wage ensures earnings equal to or greater than the minimum wage. However, tips are unpredictable and vary based on shift, day of week, season, and fluctuations in the economy. Women make up 67% of the tipped-wage workforce. We tested the hypothesis that women in tipped-wage occupations experience greater perceived stress and hypertension relative to women in non-tipped service occupations and non-tipped non-service occupations.

Methods:
We used data from the National Longitudinal Study of Adolescent to Adult Health (Wave IV, 2007-2008; age 24-33 years; n=3,562). In multivariable ordinal logistic regression, perceived stress tertiles (Cohen’s Perceived Stress Scale score: 0-3, 4-6, and 7-16) and hypertension (Normotensive, Stage 1, and Stage 2 relative to 7
th
Report of the Joint National Committee standards) were modeled as a function of self-reported occupation type (US Bureau of Labor Statistics categories, classified as tipped-wage, non-tipped service, and non-tipped non-service). Models were adjusted for early life and adolescent confounders, such as parental socioeconomic status (SES) and experiences of maltreatment.

Results:
On average, women in non-service non-tipped occupations were from higher SES families and were themselves more educated than tipped and non-tipped service workers. Women in tipped and non-tipped service occupations were similar, with non-tipped workers coming from slightly lower SES families. For women in tipped-wage occupations, the odds of being in a higher perceived stress score tertile were 54% greater than women in non-tipped service occupations (OR: 1.54; 95%CI: 1.08,2.19) and 65% greater when compared to women in non-tipped non-service occupations (OR: 1.65; 1.21,2.26). The odds of having a higher hypertensive stage among tipped-wage workers were 45% lower than women in non-tipped service occupations (OR: 0.55; 95%CI: 0.32,0.94) but were similar to women in non-tipped non-service occupations (OR: 0.72; 95%CI: 0.43,1.21).

Conclusions:
In a nationally representative sample of women, working in a tipped-wage service occupation was associated with greater perceived stress, even when compared to other service occupations that similarly offer low wages with limited job control and employ women from relatively similar backgrounds. The negative association between tipped-wage occupations and hypertension may reflect selectivity related to the physical demands of tipped-wage work. Our findings suggest that reliance on tips to supplement wages may exacerbate stress relative to similar work afforded a reliable minimum wage.
Abstract P357: The Association between Sleep and Waist Circumference Varies among Women as a Function of Race and Ethnicity
Authors: Makarem Nour , Liao Ming , Aggarwal Brooke
Published: March 2022

Background:
Waist circumference (WC) is an established predictor of global 10-y risk for cardiovascular disease (CVD). Sleep duration and quality have also been associated with CVD risk. The association between sleep and WC and how it may vary among racially/ethnically diverse women has not been fully established.

Hypothesis:
We assessed the hypothesis that sufficient sleep duration (≥6 h), good sleep quality, and lower insomnia severity would be associated with reduced WC and that associations would vary by race/ethnicity.

Methods:
Participants were English or Spanish speaking females (n=50), aged 20-79y, recruited as visitors of patients or members of the community surrounding an urban medical center, as part of the American Heart Association Go Red for Women Strategically Focused Research Network. Sleep duration and quality were assessed using the Pittsburgh Sleep Quality Index, and insomnia was assessed using the Insomnia Severity Index (ISI). Anthropometric measures were obtained by trained personnel. A standardized health questionnaire was used to obtain medical and demographic data. Linear regression models were used to evaluate cross-sectional associations between sleep patterns and WC in the overall sample and stratified by race/ethnicity.

Results:
The mean age of the sample was 41±18y and 56% (28 of 50) were racial/ethnic minorities. The mean body mass index (BMI) was 26.0±4.5 kg/m
2
and half of women had a BMI ≥25 kg/m
2
. One third were current/former smokers, 36% (18 of 50) were postmenopausal and 60% (30 of 50) reported a history of chronic disease. In the overall sample, a sleep duration of <6 versus ≥6 h was associated with higher WC in univariate (beta(SE)=4.90(1.44), p=.001) and multivariable models adjusted for age, race/ethnicity, education, marital status, menopausal status and history of chronic disease (beta(SE): 4.38(1.76), p=.02). In analyses stratified by race/ethnicity, null associations between sleep duration and WC were observed for non-Hispanic whites in univariate (beta(SE)=3.30(2.19), p=.15) and multivariable-adjusted models (beta(SE)=0.97(2.68), p=.72). However, among racial/ethnic minorities, a sleep duration <6 versus ≥6 h was associated with higher WC in both univariate (beta(SE)=5.65(1.07), p=.01) and multivariable-adjusted models (beta(SE)=6.68(2.12), p=.01). In general, the mean WC among minority women who slept <6 versus ≥6 h was 41.1 versus 35.5 inches (p=.03). Sleep quality and ISI were not significantly associated with WC.

Conclusions:
In this diverse sample of women, sleeping for ≥6 h/night had a protective impact on WC, particularly among minority women. These preliminary findings suggest that minority women with insufficient sleep may be particularly prone to central adiposity, thereby predisposing them to increased CVD risk. Analyses are ongoing to confirm these results in a larger sample.