bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 047: Using Geospatial Data To Eliminate Disparities In Covid-19 Testing
Authors: Heath Gregory W , Moreland Tim , Stephenson Shannon , Houser Jesse A , Schmitt Colleen
Published: May 2021

Introduction:
The first case of COVID-19 in Chattanooga/Hamilton County, Tennessee (CHC) was identified on March 13, 2020. By early April, 51 RT-PCR confirmed cases were identified, with white, non-Hispanic males and females representing 82% (41/51) of positive cases and remaining cases representing black residents (18%; 9/51). That few people from racial/ethnic minorities were being tested became a key public health concern. We
hypothesized
that local mapping of health-related data would identify regions where individuals at greater risk for COVID-19 live and work and have limited access to testing and healthcare services.

Methods:
The CDC 500 Cities data was used to generate layered maps of prevalence estimates for cardiovascular disease, type 2 diabetes mellitus, chronic lung disease, and the behavioral risk factors of physical inactivity and obesity. Layers also included the CDC Social Vulnerability Index, age distribution, gender, race, ethnicity, and zip codes. Maps were shared with intersectoral collaborators representing the black and Hispanic/Latinx communities who provided specific neighborhood information to the maps. Collaborators included hospital systems, the local health department, community health centers, the private sector, and non-profit organizations. Maps were used to identify geographic sites for mobile and strategic testing within communities at higher risk for the spread of the coronavirus. Specific diverse neighborhoods along with worksites were then provided with testing beginning in early May and ongoing.

Results:
Strategic and mobile testing beginning in early May increased three-fold the number of identified new cases of COVID-19. Seventy percent (652/932) of these positive tests were among ethnically Hispanic/Latinx and 16% (149/932) among black residents. Positive tests continued to increase at a greater rate among Hispanic/Latinx and black residents compared with white residents through the months of May-July (68/10K vs. 2.6/10K, OR = 4.85, 95% CI 2.66, 9.02).

Conclusions:
This example of inter-sectoral collaboration, data sharing, and data use through strategic mapping of vulnerable populations for COVID-19 was an effective means to enhance COVID-19 testing and identification of positive cases throughout CHC. This expanded partnering resulting in targeted testing may be a useful approach among similar communities and subsequent outbreaks.
Abstract 066: Association Between Nocturnal Blood Pressure Dipping Magnitude And Chronic Kidney Disease Risk Among Patients With Controlled Office Blood Pressure
Authors: Cho So Mi J , Lee Hokyou , Yoo Tae-Hyun , Jhee Jong Hyun , Park Sungha , Kim Hyeon Chang
Published: May 2021

Although abnormal diurnal blood pressure (BP) patterns are associated with adverse cardiorenal outcomes, their risks are yet unquantified by BP dipping magnitude. We assessed chronic kidney disease risk across nocturnal BP dipping spectrum among patients with controlled hypertension without prior advanced kidney disease. Ambulatory BP measurements were collected from 995 middle-aged patients with controlled office BP (<140/90 mmHg). The magnitude of dipping was defined as the difference between daytime and nighttime systolic BP divided by daytime systolic BP. Accordingly, patients were categorized as extreme-dipper (≥20%) dipper (10-<20%), non-dipper (0-<10%), or reverse-dipper (<0%). We cross-sectionally analyzed continuous and categorical associations of dipping with albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and decreased estimated glomerular filtration rate (<60 ml/min/1.73m
2
), adjusting for office/ambulatory BP, antihypertensive class, body mass index, total cholesterol, fasting glucose, socioeconomic status, and health behavior. The participants (mean age 60.2 years; 52.9% male) consisted of 13.5% (134 of 995) extreme-dippers, 43.1% (429 of 995) dippers, 34.7% (345 of 995) non-dippers, and 8.7% (87 of 995) reverse-dippers. In reference to dippers, odds ratios (95% confidence interval) for albuminuria were 1.73 (1.04-2.60) in reverse-dippers, 1.67 (1.20-2.32) in non-dippers, and 0.62 (0.38-1.04) in extreme-dippers; this reflects significantly lower risk (0.77, 0.55-0.95) per 10% dipping. Likewise, persons presenting reduced and reverse-directional dipping were at higher risk for decreased estimated glomerular filtration rate: reverse-dippers 2.02 (1.06-3.84); non-dippers 1.98 (1.07-3.08); extreme-dippers 0.69 (0.20-1.17), with lower risk (0.74, 0.22-1.02) per every 10%. In short, monitoring nocturnal BP patterns may identify chronic kidney disease risk otherwise overlooked based on office BP.
Abstract 072: Being Mindful Is Associated With Being More Physically Active: A Study Of Stage B Heart Failure Patients
Authors: Tristao Parra Maira
Published: May 2021

Background:
Being mindful in daily life appears to be relevant to maintain adequate psychological and physical health. An active lifestyle is essential to maintain cardiovascular health, prevent diseases, and to delay and prevent the progression of heart failure (HF). Little is known about the relationship between being mindful and engaging in healthy behaviors such as physical activity in individuals with HF. This study aimed to explore the association between mindfulness and physical activity.

Hypothesis:
We hypothesized that individuals with higher mindful scores would be more physically active.

Methods:
A cross-sectional analysis including patients recruited from the UC San Diego and the Veteran Affairs San Diego Health Care Systems between 2011 and 2014. Asymptomatic stage B HF was diagnosed according to the ACC/AHA definition, and echocardiograms followed guidelines from the American Society of Echocardiography for functional and structural cardiac assessments. Mindfulness was assessed using the Five Facets of Mindfulness Questionnaire. Weekly leisure-time physical activity was captured by the Leisure Time Exercise Questionnaire, MET-based scores were calculated, and patients were stratified into active, moderately active, or insufficiently active. Pearson’s correlations and ANOVAs were calculated. Adjusted linear regression models assessed associations. Significance for all analyses was set at p ≤ 0.05.

Results:
A sample of 256 patients was analyzed. Continuous PA scores was significantly correlated with observe mindfulness domain (r = 0.148, p = 0.017), but not with describe (r = 0.087, p = 0.16), act with awareness (r = 0.021, p = 0.736), non-judgment (r = 0.043, p = 0.49), or non-reactivity (r=0.07, p = 0.22). ANOVAs revealed that patients who were active or moderately active had higher scores in the mindfulness domains of observe (p = 0.017), describe (p=0.026), and the total score (p = 0.008) than insufficiently active patients. Observe domain (independent variable) remained significantly associated with physical activity (independent variable) when adjusted for age, sex, race, and ethnicity (β = 0.152, p = 0.019).

Conclusions:
These cross-sectional findings suggest that certain domains of mindfulness are associated with being more physically active in individuals with HF. Broadly, being more mindful, as well as identifying internal and external experiences such as sensation, emotions, and thoughts (observe) and, labeling internal experiences with words (describing), were associated with being more physically active. The directionality of these associations merits further investigation.
Abstract MP01: Effect Of The DASH-Sodium Diet On Serum Biomarkers Of Inflammation And Mineral Metabolism
Authors: Sullivan Valerie K , Appel Lawrence J , Seegmiller Jesse C , Rebholz Casey M
Published: May 2021

Background:
The blood pressure-lowering effects of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and reduced sodium intake are well-established. The effects on other biomarkers related to vascular health are of interest and may assist in explaining cardiovascular benefits of the DASH diet.

Objective:
We hypothesized that a low-sodium DASH diet improves biomarkers of inflammation [i.e. reduces C-reactive protein (CRP) and soluble urokinase plasminogen activator receptor (suPAR)] and mineral metabolism [phosphorus and fibroblast growth factor-23 (FGF23)].

Methods:
We conducted a post hoc analysis of the DASH-Sodium trial using stored frozen serum samples. This controlled feeding study randomized 412 adults to consume either a DASH diet or control diet representative of a typical American diet. Within each arm, participants received three sodium levels (low, intermediate, high) in random sequence, each for 30 days. To maximize contrast, samples collected at the end of the low-sodium DASH (n=198) and high-sodium control (n=194) diets were compared. Between-diet differences in biomarker concentrations were assessed by t-test or Wilcoxon rank sum test for normally distributed and skewed variables, respectively.

Results:
CRP concentrations did not differ between groups (
P
=0.19), but suPAR was higher after the low-sodium DASH diet than the high-sodium control (median, IQR: 2473, 2127-2887 pg/mL vs. 2281, 1929-2679 pg/mL;
P
=0.003). FGF23 was also higher after the DASH diet (35.9, 26.9-44.8 pg/mL vs. 30.2, 23.5-37.5 pg/mL;
P<
0.001). Serum phosphorus was higher after the DASH diet (mean±SEM: 3.5±0.04 mg/dL) versus the control (3.4±0.04 mg/dL;
P
=0.02).

Conclusions:
Contrary to our hypothesis, biomarkers of inflammation and mineral metabolism were increased or unchanged by a low-sodium DASH diet compared to a high-sodium control diet. Potential reasons (e.g. short duration of the trial, sodium-specific effects, bioavailable phosphorus-rich dairy intake) require further investigation.
Abstract MP11: Systematic Discovery Of Thousands Of Gene-Environment Interactions For Cardiometabolic Serum Biomarkers
Authors: Westerman Kenneth E
Published: May 2021

Background:
Gene-environment interaction (GEI) analysis enables us to understand how genetic variants modify the effects of environmental exposures on cardiometabolic risk factors, providing a foundation for genome-based precision medicine. Ideally, these interactions could be mapped comprehensively across all measured genetic variants, exposures, and outcomes, but this approach is computationally intensive and statistically underpowered. Recent studies have shown that variance-quantitative trait loci (vQTLs), or genetic variants that associate with differential variance of an outcome, are substantially enriched for underlying GEIs. Here, we sought to first identify vQTLs for cardiometabolic traits, then use this smaller genetic search space to uncover novel gene-environment interactions across thousands of environmental exposures.

Methods:
A two-stage, multi-ancestry analysis was conducted in 355,790 unrelated participants from the UK Biobank. First, we performed a genome-wide vQTL scan for each of 20 serum metabolic biomarkers, including but not limited to lipids, lipoproteins, and glycemic measures. This scan used Levene’s test to identify genetic markers whose genotypes are associated with the variance, rather than the mean, of the biomarker. Next, we collected over 2000 variables corresponding to socioeconomic, dietary, lifestyle, and clinical exposures, and conducted an interaction analysis for each combination of exposure and vQTL-biomarker pair. For each stage, the analysis was initially stratified by ancestry then meta-analyzed to generate the primary set of results.

Results:
vQTLs were identified at 514 independent regions in the genome, with most of these genetic variants already known to affect the mean biomarker level. In the subsequent gene-environment interaction analysis, we found 2,162 significant interactions passing a stringent significance threshold adjusted for multiple testing (
p
< 0.05 / 578 vQTL-biomarker pairs / 2140 exposures = 4х10
-8
). Some of these expanded on existing findings; for example, genetic marker rs2393775 in the
HNF1A
gene interacted with education level (as a proxy for socioeconomic status) to influence hsCRP (
p
= 1.3х10
-10
), building on a previous finding that
HNF1A
variants modify the effect of perceived stress on cardiovascular outcomes. Others highlighted novel biology, such as an interaction between variants near the fatty liver-associated gene
TM6SF2
and oily fish intake on total and LDL-cholesterol levels (
p
= 6.6х10
-9
).

Conclusions:
Our systematic GEI discovery effort identified thousands of interactions that may impact cardiometabolic risk, both expanding on previous research and identifying novel biological mechanisms. This catalog of vQTLs and interactions can inform future mechanistic studies and provides a knowledge base for genome-centered precision approaches to cardiometabolic health.
Abstract MP12: Proteomic Predictors Of High-density Lipoprotein Cholesterol Response To Regular Exercise
Authors: Barber Jacob L , Cai Guoshuai , Robbins Jeremy M , Gerszten Robert E , Rao Prashant , Bouchard Claude , Sarzynski Mark A
Published: May 2021

Introduction:
Regular exercise beneficially increases plasma HDL-C levels at the group level. However, variation in individual HDL-C responses to exercise highlight a need for predictive biomarkers of exercise response.

Hypothesis:
We hypothesized that baseline abundance of circulating proteins is predictive of HDL-C response to exercise and that identified proteins are part of a complex biological network of exercise response.

Methods:
We measured over 5,000 circulating proteins using an aptamer-affinity based platform (SomaScan) in 667 black and white adults from the HERITAGE Family Study. Fasting plasma HDL-C was measured at baseline and following 20 weeks of supervised endurance exercise training. To predict exercise induced changes in HDL-C using baseline abundance of circulating proteins, models were created using LASSO regression and a 70/30 training test data split with 10-fold cross validation. Biological pathways, networks, and functions involving proteins identified in predictive modeling were investigated by ingenuity pathway analysis (IPA) and integrated molecular pathway level analysis (IMPaLA).

Results:
Regular exercise significantly increased HDL-C in the sample by 1.5 ± 4.6 mg/dL (p<0.0001), however marked inter-individual differences in response were present (range: -19.5 to +17.4 mg/dL). LASSO regression of circulating proteins only yielded a model of 120 proteins with similar but stronger predictive power to a model of 19 clinical traits (root mean square error = 4.52 and 5.3 mg/dL respectively). LASSO regression of both clinical and proteomic predictors resulted in a final model of baseline HDL-C and 116 circulating proteins, with an improved root mean square error of 4.11 mg/dL. Furthermore, this panel of 116 proteins was able to explain 40.0% of the variance in exercise induced changes in plasma HDL-C, while clinical predictors alone (including baseline HDL-C) explained only 3.9%. Pathway analysis of these 116 proteins identified several biological processes including pathways involved in the progression towards atherosclerosis, angiogenesis, mTOR signaling, and mitochondrial fatty acid synthesis.

Conclusions:
Circulating proteins may allow for prediction of exercise induced changes in HDL-C. Additionally, proteins predictive of HDL-C response to exercise are associated with important biological pathways and may provide insights into the molecular mechanisms of the benefits of regular exercise.
Abstract MP20: Implementation Of Social Determinants Of Health Screening And Referrals In A Medicaid Accountable Care Organization: A Qualitative Study
Authors: McCurley Jessica , Browne Julia , Fung Vicki , Levy Douglas , Clark Cheryl , Thorndike Anne N
Published: May 2021

Introduction:
Systematic screening for social determinants of health (SDOH), such as food and housing insecurity, is increasingly implemented in primary care, particularly in the context of Accountable Care Organizations (ACO), to improve health outcomes. The objective of this study was to explore aspects of implementation of annual SDOH screening and referrals in a Medicaid ACO, including facilitators and barriers and experiences of community resource staff.

Methods:
Qualitative interviews were conducted between January and March 2020 with fifteen staff (eight frontline resource staff and seven managers) in a large health care system in Massachusetts. Interviews focused on barriers and facilitators of screening for and addressing SDOH and the experiences of staff involved in this process. Interviews were audio recorded, transcribed, coded, and analyzed using the Framework Method of qualitative analysis.

Results:
Facilitators for addressing SDOH included close collaborations with community organizations, updated resource lists, leadership buy-in, and trusting relationships with patients. Barriers that prevented staff from addressing patients’ social needs effectively included high caseloads, time constraints, inefficiencies in workflows, lack of availability of resources, and patient characteristics (e.g., immigration status, mental health challenges). Resource staff described rewarding and stressful aspects of their jobs, including distress when unable to address challenging social needs such as housing. The Table provides examples of quotes from staff related to the themes identified in this study.

Conclusions:
Facilitators and barriers for successful SDOH screening and referrals occur at the health system, community, and individual levels and must be considered for developing effective screening and referral processes. The psychological burden on resource staff is an important and underrecognized factor that could impact patient care and contribute to staff burnout.
Abstract MP23: Neighborhood Disadvantage And Oral Anticoagulant Use In Patients With Atrial Fibrillation
Authors: McDermott Anne M , Kim Nadejda , Mor Maria , FINE MICHAEL J , Essien Utibe
Published: May 2021

Background:
Atrial Fibrillation (AF) is the most common heart rhythm disorder in the US and is treated with anticoagulation to mediate patients’ increased risk of ischemic stroke and death. Direct-acting oral anticoagulants (DOACs) are associated with better patient outcomes than warfarin, but prior studies show disparities in DOAC prescription. AF patients with low socioeconomic status (SES) have an increased risk of AF incidence, adverse outcomes, and mortality. Despite SES disparities in AF outcomes and prescribed medications, the impact of neighborhood SES (ADI) on AF management is unclear. We hypothesized that in comparison to patients with high ADI (e.g. the most disadvantaged), those with low ADI will be more likely to initiate any oral anticoagulants (OACs) and will be more likely to initiate DOACs.

Methods:
We conducted a retrospective observational study using national data from the Veterans Health Administration (VA) of newly diagnosed AF patients. Our independent variable was ADI, a marker of SES incorporating income, education, employment etc. Our model assessed numerous baseline patient, provider, and system-level covariates. We grouped patients into ADI quintiles, with Q1 being the lowest ADI (e.g., the least disadvantaged) and Q5 being the highest ADI, and used Q5 as a reference value. We used mixed effects logistic regression models, with site as a random effect, to determine the adjusted odds of initiating any OACs and of initiating DOACs by ADI quintile.

Results:
In our final cohort including 111,666 patients, 10,9386 (98.0%) were male and 2280 (2.0%) were female. The overall mean age at diagnosis was 72.86 (SD 10.4). Patients had the following medical comorbidities: Congestive heart failure: 18212, (16.3%); Hypertension: 84944, (76.1%); Diabetes: 70673, (63.3%); Vascular Disease: 46599, (41.7%). The ADI quintiles included the following patients: Q1: 21570, (20.3%); Q2: 21032, (19.8%); Q3: 21439, (20.2%); Q4: 20974, (19.8%); Q5: 21215, (20.0%). There was no significant difference in the odds of initiating any OAC between ADI quintiles compared to Q5 (Q1: adjusted odds ratio [95% CI], 0.95 [ 0.9, 1.01]; p=0.11). Among patients initiating DOAC, there was a significant association between low ADI and higher odds of initiating DOAC (Q1: 1.39 [1.29, 1.50]); (Q2: 1.18 [1.10, 1.27]); (Q3: 1.13 [1.06, 1.20]); (Q4: 1.09 [1.02, 1.16]). Each ADI quintile had a significantly higher odds of initiating DOACs compared to the highest ADI quintile.

Conclusions:
Patients with lower ADI are significantly more likely to be prescribed DOACs compared to patients with the highest levels of ADI. We found no significant difference in initiation of any OAC between ADI quintiles, which may result from high Warfarin utilization in the VA compared to the general population. Our data suggests that differences in neighborhood deprivation contribute to disparities in the prescribing DOACs in the VA.
Abstract MP44: Adolescent Predictors Of Changes In Weight Status From Adolescence To Adulthood: Evidence From The Addhealth Study
Authors: Aguayo Liliana , Argeseanu Cunningham Solveig
Published: May 2021

Introduction:
The persistence of obesity from adolescent to adult ages is associated with risk of cardiovascular disease later in life. Data from cohorts that passed through childhood before 1980 show that when obesity is first observed in youth it often persists into adulthood. However, less is known about current weight trajectories of adolescents transitioning to adulthood. We examined the changes in weight status from adolescence to adulthood and baseline predictors of normal weight in adulthood.

Methods:
Study used data from the National Longitudinal Study of Adolescent Health (AddHealth) (n=14,135), a nationally representative sample of adolescents recruited in 1994 and followed up in 1996, 2001, and 2008. Weight and height measurements collected at each visit were used to classify weight status; we identified 4 trajectories between mean ages 16 and 30: 1) maintained normal weight, 2) achieved normal weight, 3) gained weight to enter the obesity category, and 4)maintained overweight or obesity. Logistic regression models included individual and family characteristics.

Results:
Among adolescents with normal weight, 56% gained weight to enter overweight or obesity categories 14 years later. Of those with overweight at baseline, 68% gained weight to enter obesity and 8% achieved normal weight; among adolescents with obesity, 89% maintained obesity, and only 2% achieved normal weight. After controlling for sex, age, race-ethnicity, and baseline weight status, adolescents who were trying to lose weight, skipped breakfast, ate dinner with their parents, had a mother with diabetes or obesity, a father with obesity, parents with less than high-school education, or married in high-school were less likely to have normal weight as adults. Independent of baseline weight status, adolescents who reported feeling loved were more likely to have normal weight in adulthood.

Conclusion:
Findings shed light on individual and family factors associated with normal weight outcomes after the transition from adolescence to adulthood.
Abstract MP67: Long-term TV Viewing Is Associated With Grey Matter Brain Volume In Midlife: The Coronary Artery Risk Development In Young Adults (CARDIA) Study
Authors: Dougherty Ryan J , Hoang Tina , Launer Lenore J , Jacobs David R , Sidney Stephen , Yaffe Kristine
Published: May 2021

Introduction:
While it is generally accepted that a physically active lifestyle is important for overall health, sedentary behavior has become a public health focus due to evidence that it may impart unique risk for chronic diseases. The purpose of this study was to examine the association between 20-year television (TV) viewing patterns, as a proxy for sedentary behavior, with grey matter volume in midlife. We hypothesized that greater TV viewing in early to mid-adulthood would be associated with lower grey matter volume at midlife, independent from physical activity.

Methods:
We evaluated 599 participants (306 female, 264 black, mean age 30.3±3.5 at baseline and 50.2±3.5 years at follow-up and MRI) from the prospective CARDIA study. We assessed TV patterns with repeated interviewer-administered questionnaire spanning 20 years. Structural MRI (3T) measures of grey matter were assessed at year 20 during midlife. We used multivariable linear models to examine the association between long-term TV viewing (mean hours) and frontal cortex, entorhinal cortex, hippocampal, and total grey matter volumes, adjusting for demographics, intracranial volume, and study site.

Results:
Over the 20 years, participants reported viewing an average of 2.5±1.7 hours of TV per day (range: 0-10 hours). After multivariable adjustment, greater TV viewing was negatively associated with grey matter volume in the frontal (β= -0.773;
p
= 0.01) and entorhinal cortex (β= -23.8;
p
= 0.05) as well as total grey matter (β= -2.089;
p
= 0.003) but not hippocampus. These results remained unchanged after additional adjustment for physical activity. For each one standard deviation increase in TV viewing, the difference in grey matter volume z-score was approximately 0.06 less for each of the three regions (
p<
0.05; Figure 1).

Conclusions:
Among middle-aged adults, greater TV viewing in early to mid-adulthood was associated with lower grey matter volume. Sedentariness or other facets of TV viewing may be an important risk factor for brain aging even in middle age.
Abstract MP69: A Proteomic Approach For Investigating The Pleiotropic Effects Of Statins In The Atherosclerosis Risk In Communities (ARIC) Study
Authors: Bohn Bruno , Lutsey Pamela L , Tang Weihong , Pankow James S , Norby Faye L , Ballantyne Christie M , Whitsel Eric A , Matsushita Kunihiro , Demmer Ryan
Published: May 2021

Background:
Statins are prescribed to reduce LDL-cholesterol (LDL-c) and the risk of cardiovascular disease. Statins may influence other outcomes such as dementia through pleiotropic effects unrelated to lipid metabolism. We compared the proteome of statin users and nonusers. We hypothesized that statin use would be associated with proteins in biological pathways unrelated to lipid metabolism.

Methods:
Among 11,471 participants enrolled in the ARIC study at visit 3 (1993-95), plasma concentrations of 4,638 proteins were determined using the SOMAlogic DNA aptamer-based capture array. We identified 402 participants who initiated statin use within the 2 years prior. Propensity scores (PS) were calculated based on visit 2 (1990-92) LDL-c levels and visit 3 demographic characteristics, CVD risk factors and medications, kidney function, and prevalent CVD. Statin users were matched to nonusers (controls) based on PS similarity, yielding 382 matched pairs. Log2-transformed and standardized protein levels were compared between statin users and controls using t-tests. The false discovery rate (FDR) adjusted for multiple comparisons. Ingenuity Pathway Analysis (IPA) was used to identify potentially altered biological pathways.

Results:
After PS matching, LDL-c levels at visit 3 were lower in statin users vs controls (125.4 vs 147.1 mg/dL; p <.0001), but all other covariates were balanced. We identified 344 enriched and 298 depleted proteins in statin users (p <.05). After FDR adjustment, 12 proteins were enriched and 17 were depleted. Proteins involved in lipid metabolism were altered in statin users, including proteins in the mevalonate pathway. Proteins unrelated to lipid metabolism also differed between groups (Figure). IPA analysis suggested 20 pathways were altered among statin users.

Conclusion:
Several proteins unrelated to lipid metabolism differed by statin use. Pending external validation, exploring the biological functions of these proteins could elucidate pleiotropic effects of statins.
Abstract P016: Association Between Life’S Simple 7 Score And Cognitive Status In Older Adults With Atrial Fibrillation
Authors: Ding Eric Y , Wang Weijia , Lessard Darleen , Mehawej Jordy , Mailhot Tanya , Bamgbade Benita , McManus David D , Saczynski Jane
Published: May 2021

Introduction:
The American Heart Association’s Life’s Simple 7 (LS7) score is a well-validated metric of cardiovascular health shown to be associated with cognitive status in numerous cardiac cohorts. However, little is known regarding this relationship in older adults with atrial fibrillation (AF). We aim to characterize LS7 scores in this population and examine its relationship with cognitive status.

Hypothesis:
We hypothesize that LS7 score is associated with cognitive status in older adults with AF.

Methods:
The Systematic Assessment of Geriatric Elements in AF (SAGE-AF) study is a longitudinal cohort of patients over 65 years of age who are diagnosed with AF from Massachusetts and Georgia. The LS7 components are collected through self-reported data from the baseline visit as well as medical records. Cognitive status is operationalized using the Montreal Cognitive Assessment (MoCA). Descriptive statistics were calculated and univariate logistic regression using tertiles of LS7 as exposure was used to assess the relationship between LS7 score and cognitive status.

Results:
A total of 1241 participants were included in study sample. Average age of the population was 76, 49% were female, and most of the sample were White (89%). Mean LS7 score was 7.92 (SD 2.05), and the tertile thresholds were 0-6, 7-9, and 10-14 (n = 302, 671, 268). Those in the lowest and middle tertiles of LS7 score were more likely than those in the highest to be cognitively impaired (lowest - OR 1.86, 95% CI 1.33 - 2.61; middle - OR 1.52, 95% CI 1.14 - 2.03)

Conclusions:
Most older adults with AF had LS7 scores of between 7-9 out of 14, and those with more favorable cardiovascular health were less likely to be cognitively impaired.
Abstract P051: Lifestyle Change In Mid-life And Long-term Weight Gain In Women With And Without History Of Gestational Diabetes Mellitus
Authors: Yang Jiaxi , Rich-Edwards Janet , Wang Molin , Fawzi Wafaie W , Zhang Cuilin , Tobias Deirdre K
Published: May 2021

Introduction:
Identifying strategies to mitigate gradual long-term weight gain is critical for preventing obesity and its related chronic diseases, particularly for persons at high risk, such as women with a history of gestational diabetes mellitus (GDM). We prospectively examined the independent associations between lifestyle changes in mid-life with long-term weight change among women with and without a history of GDM.

Hypothesis:
We hypothesized that favorable improvements in lifestyle would be associated with less long-term weight gain, particularly among women with a history of GDM.

Methods:
We used data from the longitudinal Nurses’ Health Study II, with self-reported lifestyle, diet via food frequency questionnaire, and body weight updated every 2-4 years. We analyzed repeated 4-year changes of the following lifestyle factors among parous women after age 40: adherence to a healthy dietary pattern (Alternate Healthy Eating Index score [AHEI]), physical activity (MET-hrs/wk), moderate alcohol intake (servings/d), and non-smoking, in relation to concurrent 4-year change in body weight (lb). We used multivariable generalized estimating equation models to estimate the least-squares mean of 4-year weight change and 95% confidence interval (CI) for each lifestyle change category (e.g., decrease, remain stable, and increase).

Results:
Our analysis included 61,637 women, of which 3,444 (5.6%) had a history of GDM. Mean of repeated 4-year weight change after age 40 was 3.0 lb (SD=14.3). Improving diet was associated with favorable 4-year weight change, particularly among women with a history of GDM vs. without GDM (AHEI score change from low to high: -6.3 lb [CI: -9.3, -3.4] vs. -2.7 lb [CI: -3.2, -2.2], respectively; p-interaction=0.04). Increasing physical activity was associated with weight maintenance for GDM women only (MET-hrs/wk change from low to high: 0.6 lb [95% CI: -0.6, 1.7] vs. 2.0 lb [95% CI: 1.8, 2.2] for GDM vs. non-GDM, respectively; p-interaction=0.01). Reducing alcohol (decreased servings/d: 1.9 lb [95% CI: 1.2, 2.6] and 2.8 lb [95% CI: 2.6, 2.9] for GDM vs. non-GDM, respectively) and smoking cessation (recent quitter: 9.8 lb [95% CI: 7.1, 12.5] and 8.5 lb [95% CI: 8.0, 9.1] for GDM vs. non-GDM, respectively) were associated with similar patterns in weight change for women with and without prior GDM. Further, the joint association of improving both diet and physical activity from low to high was related to -12.3 lb (95% CI: -19.5, -5.0) and -6.1 lb (95% CI: -8.0, -4.2) of weight loss for GDM vs. non-GDM women, respectively.

Conclusions:
We observed that attainable improvements in diet quality and physical activity were associated with weight gain prevention. These findings support continued efforts to improve lifestyle as a beneficial strategy to prevent long-term weight gain, particularly among women with a history of GDM.
Abstract P065: Odds Of Heart Disease And Arrhythmia Associated With Exposure Dose To Homelessness
Authors: King Ben
Published: May 2021

Background:
Adults experiencing homelessness are at 40-50% greater mortality risk from cardiovascular disease (CVD) than the general population, however little is understood about how the duration or degree of homelessness increases the risk of CVD. The Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT v1, 2012) is a 50-item measure intended to proscribe appropriate levels of intervention and prioritize the waiting list for housing. The measure also includes an item to assess history of CVD. The objective of this study is to examine the relation between duration and frequency of homelessness and CVD diagnosis, while controlling for potential confounders.

Method:
Version 1 of the VI-SPDAT was used to assess a cohort of individuals experiencing homelessness (n=4,739 unique participants; median age=47, {17-88}) and seeking subsidized housing services in a single county in Texas between 2014 and 2017. Medical questions were validated through electronic, deterministic linkage to the Community’s Health Information Exchange (HIE) for indigent populations. Logistic regression models identified independent covariates and potential effect modifiers of a theoretical dose-response relationship between homelessness and CVD.

Results:
A history of heart disease or arrhythmia was reported in 24.98% of the sample. For participants with repeated assessments (n=713; median interval of homelessness: 306 days; IQR: 216-441 days) the prevalence increased from 25.6% to 30.6% (p<0.05). Criterion validation of the tool using HIE data supported that this prevalence estimate was under-reported (38.67%; 26.44% adjusted for full sample). Odds of CVD increased with age (OR=1.03; 95%CI:1.02-1.04) and spending more than two years in homelessness (OR=1.45; 95%CI:1.27-1.67). Proportion of the sample with CVD was also higher for females, non-Hispanic participants (both p<0.05), those reporting medication adherence issues, problems with concentration, history of traumatic brain injury, and mental health-related ED visits (all p<0.001). Age at assessment (p<0.001), total time spent homeless (p<0.001), and recent episodes (p<0.05) were all independently associated with CVD. Cognitive deficits and medication adherence issues mediated the relationship between multiple demographics, homeless episodes, and reported CVD diagnosis, but fit independently into a model with age, gender, and 2 years or more spent in homelessness.

Discussion:
This study presents a rare window into the complex interrelationships of the time-dose of exposure to homelessness and the concomitant social and medical vulnerabilities. Time spent in homelessness and the number of recent homelessness periods were independently associated with CVD, even while controlling for age, suggesting a complex dose-response relationship.
Abstract P068: The Relationship Of Air Pollution And Menopause On The Progression Of Coronary Artery Calcification In Midlife Women: Study Of Women’s Health Across The Nation
Authors: Zhu Lei , Talbott Evelyn O , Matthews Karen , Adibi Jennifer , Broadwin Rachel , Youk Ada , Janssen Imke , El Khoudary Samar R
Published: May 2021

Knowledge of the association between air pollution and atherosclerosis risk has been generated in the general population. Our study targeted middle-aged women during the menopause transition who might be vulnerable to PM2.5 on CAC risk, due to their unique physiological profiles. We assessed the association of PM2.5 and CAC presence/progression in menopause transition women.Women included had data of CAC Agatston score, menopause profile measures, and PM2.5 from the SWAN Heart Ancillary study. The yearly mean baseline PM2.5 was estimated based on monitors within 20km of the women’s home. Logistic regression model was used to estimate the association between PM2.5 and CAC presence (any) and progression (defined), and generalized linear mixed model was used for repeated measures of CAC, adjusting for confounders. Time-varing menopause status and baseline PM2.5 measure time to final menstrual period (FMP), were tested as modifiers by adding interaction terms into the final model.366 women averaging 51.3 years were identified (N=198 pre-/early peri- menopause, N=129 late peri-/natural post- menopause), and 21% women had CAC presence. For the 253 women with two CAC measures, 20.9% had progression. Overall mean PM2.5 was no difference by CAC (p=0.54). There was no association between PM2.5 and CAC presence/progression, in both cross-sectional and longitudinal analyses. The tested interactions were not statistically significant. Although those are non-significant, larger odds ratios with higher precision of PM2.5 to CAC progression were detected among women in late peri-/natural post- menopause (OR=1.08 95% CI 0.74, 1.58) and of 2 years after FMP (OR=1.03 95% CI 0.60, 1.92), as compared to premenopausal women and those within/prior to FMP with lower values of PM2.5. (Table)We observed no evidence that PM2.5 was associated with the CAC presence/progression among middle-aged women overall. The contrasts were sharpened among women after menopause transition. More methodologic work is needed to evaluate the relationships.
Abstract P072: Income And Education Inequities Increase Hospitalizations In Atrial Fibrillation
Authors: Tertulien Tarryn , Althouse Andrew D , Johnson Amber E , Chen Yimin , Magnani Jared W
Published: May 2021

Background:
Individuals with atrial fibrillation (AF) experience increased hospitalization. Income and education are major social determinants of health, but their contributions to hospitalization risk in AF have had limited investigation. We examined the associations between (1) annual income and (2) educational attainment with hospitalization in a cohort with prevalent AF.

Hypothesis:
We hypothesized that individuals with lower income or education would have an increased risk of hospitalization.

Methods:
In an institutional cohort with prevalent AF, we related annual income (≤$19,000/year; $20,000-49,000/year; $50,000-99,000/year; ≥$100,000/year) and educational attainment (high school/vocational; some college; bachelor's; graduate) to hospitalization events. We used the Anderson-Gill model to accommodate multiple events per participant in models adjusted for relevant covariates and co-adjusted for income or education.

Results:
In 339 individuals with AF (age 72.3±10.1 years; 43% women) followed for a median of 2.6 years (range 0-3.4), we observed 417 hospitalization events. We observed an increase in hospitalization risk as income or education level decreased (
Figure A
and
B
). Individuals with the lowest annual income had a 2.5-fold increased hospitalization risk compared to the highest (95% Confidence Interval [CI] 1.29-4.71). Individuals with the lowest education had a 2-fold increased hospitalization risk than those with the highest education (95% CI 0.87-3.11).

Conclusion:
We identified inverse relations between hospitalization risk in individuals with AF and their income or education. Our findings support the consideration of social factors to reduce hospitalization risk in individuals with AF
Abstract P079: Examining Associations Of Sexual Identity And Cardiovascular Disease Risk In A Nationally Representative Sample: The Mediating Role Of Sleep Duration
Authors: Caceres Billy A , Vo Danny , Sharma Yashika , Ensari Ipek , Jackman Kasey , Belloire Joseph
Published: May 2021

Introduction:
There is growing evidence that sexual minority (e.g., gay/lesbian and bisexual) adults have higher cardiovascular disease (CVD) risk and report shorter sleep duration than heterosexual adults. Previous research suggests that sleep duration is inversely associated with CVD risk in adults. To date, no study has examined the associations of sleep duration and objectively measured CVD risk in sexual minority adults.

Hypothesis:
We investigated the hypothesis that sexual minority adults have higher systolic and diastolic blood pressure (BP) and waist-to-height ratio (WHtr) than heterosexual adults and that sleep duration mediates these associations.

Methods:
Cross-sectional data from the National Health and Nutrition Examination Survey (2005-2016) were used. Sexual identity and sleep duration were assessed based on self-report. We used the average of systolic and diastolic BP across two readings to assess BP. We calculated the ratio between waist and height (in cm). We used sex-stratified linear regression models to compare CVD risk factors between sexual minority (i.e., gay/lesbian and bisexual) and heterosexual adults. Next, we used path analysis to determine whether the associations of sexual identity with systolic and diastolic BP and WHtr were mediated by sleep duration. Models were adjusted for demographic characteristics and tobacco use.

Results:
The sample included 17,858 adults. Participants had a mean age of 38.0 (SD = 12.1), 48.4% were female, and 65.6% were Non-Hispanic White. Gay men reported higher sleep duration (
B
0.27 [0.07]) relative to heterosexual men. However, WHtr and diastolic BP did not differ between gay and heterosexual men. No differences in sleep duration or diastolic BP were found between sexual minority and heterosexual women. Bisexual women had a higher systolic BP (
B
1.64 [0.70]) and WHtr (
B
0.02 [0.01]) than heterosexual women, but these associations were not mediated by sleep duration. Compared to heterosexual men, sleep duration partially mediated the associations of sexual identity with diastolic BP (
B -
0.12 [0.05]) and WHtr (
B -
0.01 [0.01]) in gay men.

Conclusion:
This is the first study to assess the associations of sexual identity, sleep duration, and an objectively measured marker of CVD risk in a nationally representative sample of US adults. We found that bisexual women had higher systolic BP and WHtr than heterosexual women and that higher sleep duration was associated with lower diastolic BP and WHtr in gay men. Findings can inform future studies investigating the interplay between sexual identity, sleep duration, and CVD risk in adults.
Abstract P082: Racial/ethnical Disparities In The Utilization Of Telehealth Services Among Medicare Beneficiaries With Atrial Fibrillation Before The Covid-19 Pandemic
Authors: Guo Jingchuan , Gabriel Nico , Magnani Jared W , Essien Utibe , Gellad Walid , Brooks Maria M , Trinquart Ludovic , Benjamin Emelia J , Hernandez Inmaculada
Published: May 2021

Introduction:
Telemedicine facilitates continued access to care for management of chronic diseases while preventing exposure to health care facilities; however, reliance on telemedicine may exacerbate disparities based on the persistent digital divide. Documenting racial variation in the uptake of telemedicine is crucial to understand the potential aggravation of health care access inequities in the era of COVID-19. We used a nationally representative sample of Medicare beneficiaries with atrial fibrillation (AF) to quantify racial disparities in telehealth utilization before the COVID-19 pandemic.

Hypothesis:
Black patients are less likely to be engaged with telehealth services than White patients.

Methods:
Using a 5% random sample of Medicare claims data, we extracted telehealth visits in 2016 using modifiers GT, 95, and GQ and place of service code 2 in medical claims. We used multivariate Poisson models to estimate incidence rate ratios (IRR) comparing the number of telehealth visits across White, Black, and patients of other races.

Results:
Among 135,164 patients with AF, 404 (0.3%) had a total of 1420 telehealth visits in 2016. After adjusting for age, sex, AF duration, rurality, CHA2DS2-VASc score, Alzheimer's disease, use of direct oral anticoagulants and warfarin, and receipt of low-income subsidy, Black were 60% less likely than White to receive telehealth services (IRR 0.4 [0.3, 0.5]), and the ‘others’ group were 70% less likely to receive telehealth services (0.3 [0.2, 0.5]). Among rural residents, however, the racial difference in telehealth use was only seen in Black (0.4 [0.2, 0.6]) but not in the ‘others’ group (0.9 [0.6, 1.4]). The gap in telehealth use between White and Black was larger among those with higher CHA2DS2-VASc scores (
Figure)
.

Conclusion:
Before the COVID-19 pandemic, telehealth service use was rare overall in patients with AF. However, Black patients, especially those with increased stroke risk, were still significantly less likely to have access to telemedicine than White patients.
Abstract P103: Association Of Lipid Variability With Incident Alzheimers Disease And Alzheimers Disease Related Dementias
Authors: Moser Ethan D , Manemann Sheila M , Larson Nicholas B , St Sauver Jennifer L , Takahashi Paul Y , Mielke Michelle M , Rocca Walter A , Olson Janet E , Roger Veronique L , Decker Paul A , Killian Jill M , Bielinski Suzette J
Published: May 2021

Background:
Prevention strategies for Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRDs) are urgently needed for reducing incidence. Intra-patient variability in lipid levels is a potentially modifiable risk factor for incident AD/ADRD. Although regular lipid measurements are a part of common clinical practice and longitudinal data routinely available in electronic health records (EHR), research examining this association between AD/ADRD and lipid variability across multiple lipid types remains scarce.

Methods:
All residents living in Olmsted County, MN on 1/1/2006 age ≥60 years without an AD/ADRD diagnosis were identified using Centers for Medicare & Medicaid Services diagnostic codes. Persons with ≥3 lipid measurements (total cholesterol or triglycerides) in the 5 years prior to index date were retained. Lipid variability was quantified using variability independent of the mean (VIM). Models were adjusted for traditional risk factors. Associations between lipid variability quintiles and incident AD/ADRD were assessed using Cox proportional hazards regression. Multiple imputation was used for missing covariates. Participants were followed through 2018 for incident AD/ADRD.

Results:
The final analysis included data on 11,551 participants with total cholesterol and 11,502 participants with triglycerides. Participants had a mean age of 71 (range 60-99) years, and were primarily white (96%). Females (54%) were also slightly more frequent than males. Median follow up was 12.9 years (range: 0-13). Participants in the highest quintile of variability for total cholesterol and triglycerides had a 20% increased risk of incident AD/ADRD. Similar results were found in the subset with complete covariate data.

Conclusion:
In a large EHR derived cohort, persons in the highest quintile of lipid variation had an increased risk of incident AD/ADRD. Further studies to identify the mechanisms behind this risk factor and replication of these results across a more diverse population are needed.