bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P562: Body Size Dissatisfaction is High in African Immigrants With Obesity: Insight From the Africans in America Cohort
Authors: Hurston Jamaiica S , Shoup Elyssa M , Gatete Jean de Dieu , Worthy Charlita C , Schenk Blayne R , Mabundo Lilian S , DuBose Christopher W , Horlyck-Romanovsky Margrethe F , Jagannathan Ram , Sumner Anne E
Published: March 2023

Background:
In African populations, attitudes towards both optimal body size and healthful weights are evolving. Due to the adverse effect of obesity on health, larger body sizes are beginning to be seen as less ideal. Our goal was to determine body size satisfaction in African immigrants who were obese.

Methods:
The participants were 326 African-born Blacks enrolled in the Africans in America cohort and living in metropolitan Washington DC (female: 39%, age 40±11y (mean±SD). The African region of origin of the participants were: West: 49% (161/326), Central 12% (39/326) and East: 39% (126/326). Twenty-seven percent (89/326) of the countries of origin were francophone. Enrollees were asked to rank their current body size and ideal body size according to the Stunkard Figure Rating Scale. Body size satisfaction was determined by the difference between perceived and wish body size.

Results:
BMI was higher in women than men (29.1±4.9 vs. 27.0±3.9 kg/m
2
, P<0.001). The overall prevalence of obesity was 27% (88/326) and higher in women than men (38% vs 20%, P=0.001). Among participants with obesity, there was no difference by sex in degree of dissatisfaction due to high body size (OR 2.14, 95% CI: 0.48, 9.58, P=0.32). Attitudes towards body size in participants with obesity were: 1% (1/88) considered themselves too small, 8% (7/88) just right and 91% (80/88) too large (Figure). These results did not vary by African region of origin or francophone status.

Conclusions:
The majority of African immigrants with obesity were dissatisfied with their high BMI. To optimize health, risk factors associated with weight gain and body size dissatisfaction should be addressed.
Abstract P563: Exploring Facility and Patient-Level Determinants of Changes in Systolic Blood Pressure Among Patients With Hypertension: A Multicenter Study in Ghana
Authors: Byiringiro Samuel , Hinneh Thomas , SARFO FRED S , Commodore-Mensah Yvonne , Osei Asibey Shadrack , Dennison Himmelfarb Cheryl R
Published: March 2023

Background:
Optimal blood pressure control is essential in averting complications and associated cardiovascular risks. Although a 5-mmHg reduction in systolic blood pressure (SBP) is associated with better health outcomes, individual-level and health facility dynamics might influence optimal blood pressure control. We explored individual and health facility-level factors of SBP changes among patients with hypertension in Ghana.

Methods:
We recruited 15 health facilities that provided hypertension care and from each facility, 15 patients who were currently receiving hypertension care during their clinic appointment. We explored patient-level (adherence to treatment, length of time with hypertension diagnosis, and sociodemographic factors) and health-facility level (accessibility of care, health facility management, bed capacity, provider training, and provider-patient ratio) predictors. We fitted two-level mixed-effect linear regression models to identify predictors of SBP changes.

Results:
We included 222 patients, 81% were female, and 48% had achieved blood pressure control of < 140/90 mmHg. At the patient level, secondary-level education was associated with a 7.5 mmHg (95% CI: -14.74, -0.28) greater reduction in SBP than a primary or lower level of education (Table). Patients treated at private facilities had on average 15.8 mmHg (95% CI: 4.97, 26.62) higher SBP than those in government health facilities. Patients who were receiving care at health facilities where a physician or physician assistant treated ≥ 280 patients/month had 28.4 mmHg (95% CI: 9.77, 46.97) higher SBP than those receiving care from a physician/physician assistant who cared for < 140 patients/month.

Conclusion:
Health system interventions to address individual barriers, the shortage of healthcare providers, and team-based care strategies are needed to address the burden of hypertension in Ghana.
Abstract P567: Cardiovascular Health Awareness and Risk Assessment in Schoolteachers in Calcutta, India
Authors: Ray Madhab , Guha Santanu , Ray Bipasha , Saxena Varun , Viswanathan Badri , Ray Meghna , Desai Vivaan , Velu Nina , Paul Umika , Singh Ishi , Ray Srijani , Mandal Dhriti , Roy Bedatrayee , Mandal Srijon , Hazra Prakash C , Ray Chaya D , Chaudhuri Sudipta , Karak Avik , Chowdhury Basabendra , Bhatt Deepak L , Goldberg Robert J , Selker Harry P
Published: March 2023

Background:
Cardiovascular disease (CVD) is the leading cause of death in India, surpassing all infectious causes. Early awareness of CVD and its risk factors and adoption of heart healthy lifestyle practices are crucial to reducing the impact of CVD in the community.

Objective:
To assess schoolteachers’ awareness of CVD and to compare the calculated ten-year risk of heart attack, stroke, and death by the Atherosclerotic Cardiovascular Disease (ASCVD) model to the observed event rates.

Methods:
We surveyed 4,150 schoolteachers out of 5,321 (78% response rate) from 400 schools in Calcutta during 2019 using a questionnaire assessing their awareness of CVD in five domains: prevalence, spectrum of CVD, its nature, risk factors, and benefits of a heart healthy lifestyle. The study population was stratified by risk tertile of their 10-year calculated ASCVD score.

Results:
Awareness about cardiovascular health among schoolteachers (male 41%, mean age 44 years) was low: 33 (mean score out of maximum 100), varying in different domains as shown below.

Although most (86%) were at mild risk for CVD with ASCVD scores below five, nine percent had moderate risk, and five percent had high risk of CVD. There was no significant association between their risk score and their awareness of CVD health (correlation coefficient r = - 0.022, 95% confidence interval - 0.052, 0.009).

Conclusions:
Cardiovascular health awareness among schoolteachers in Calcutta is suboptimal, many of whom are at risk for CVD. Awareness of the disease, detection of risk factors at an early stage, and adoption of a healthy lifestyle may help reduce CVD in this community.
Abstract P569: Social Determinants of Health and 30-day Readmission or Emergency Department Use After Acute Myocardial Infarction
Authors: Amankwah Koby , Soroka Orysya , Pinheiro Laura , Sterling Madeline R , Amankwah Ernest , Almarzooq Zaid , Safford Monika M
Published: March 2023

Background:
A more complete understanding of associations between social determinants of health (SDOH) and 30-day readmission or emergency department (ED) use following hospitalization for acute myocardial infarction (AMI) will facilitate development of targeted interventions and root cause policies to reduce readmissions.

Methods:
We analyzed 753 adults ≥65 years with linked Medicare data from the REasons for Geographic and Racial Differences in Stroke study who were discharged from the hospital after an adjudicated AMI between 2003-19. We selected SDOH (race, education, income, Medicare+Medicaid, zip code with high poverty, rural residence, living in a Health Professional Shortage Area, and social support) with relative risk for readmission/ED use >1. We grouped participants into 0 or 1, 2, 3, and 4+ SDOH. Poisson models examined crude and fully adjusted associations on risk for readmission/ED visit within 30 days.

Results:
Participant characteristics: 40% were women, mean age was 77 years, and 29% were readmitted or had an ED visit within 30 days. Compared to those without readmission/ED visit, those readmitted had more cognitive impairment (17 vs 10%) and depressive symptoms (57 vs. 46%); were more likely to be hospitalized in the year prior to AMI (42 vs 28%) and have adjudicated heart failure at index AMI (36 vs 25%); and were less likely to have a physician visit within 10 days (41 vs 32%) and 30 days (0/1 SDOH: 79%, 2: 73%, 3: 66%, 4+: 60%, p trend < 0.0001) (all contrast p<0.05). Participants with 4+ SDOH had higher risk of readmission (Table).

Conclusion:
4+ SDOH were associated with higher risk of readmission/ED visit after AMI. Those with the greatest burden of SDOH were also least likely to follow up within 10 or 30 days. Policies such as the American College of Cardiology’s “See You in 7 Challenge” program may be even more effective at reducing readmission after MI if specifically targeted at patients with high burden of SDOH.
Abstract P571: Investigating Factors Relevant to Understanding the Hispanic Health Paradox in Patients After Cardiac Arrest
Authors: Correa Marthina A , Cruz Gaspar J , David Michelle L , Rojas Danielle A , Tincher Isabella M , Sanchez Gabriel J , St. Onge Tara , Birk Jeffrey L , Agarwal Sachin
Published: March 2023

Introduction:
The growing Hispanic community faces disproportionate hardship due to lower financial capital and educational opportunity. The Hispanic health paradox refers to the finding that Hispanics tend to have better cardiovascular outcomes than non-Hispanics, despite facing greater hardships and more cardiovascular risk factors. Behavioral (e.g., sleep) and psychological (e.g., optimism) factors predict recovery after acute coronary syndrome events, but less is known about how these factors differ by ethnicity after cardiac arrest (CA). We tested demographic, psychological, behavioral, and recovery factors that may underlie the Hispanic health paradox among CA survivors.

Hypothesis:
We hypothesized that Hispanic vs. non-Hispanic cardiac arrest survivors would have lower income and education but would not differ in behavioral, psychological, and recovery factors.

Methods:
An observational cohort study,
Psychological predictors of recovery after an Acute Cardiac Event (PACE)
, enrolled 68 neurologically intact CA survivors admitted to NewYork-Presbyterian Hospital. At hospital discharge, self-reported demographic, psychological, behavioral, and recovery variables were assessed. Independent-samples t-tests of Hispanic vs. non-Hispanic CA survivors were conducted comparing income, education, posttraumatic stress symptoms, depression, negative affect, cardiac anxiety, optimism, positive affect, social support, sleep, physical activity, independent activities of daily living, and self-maintenance.

Results:
As hypothesized, Hispanic vs. non-Hispanic participants had lower income, Mann Whitney
U =
99.00,
z
= -3.46,
p
< .01, and lower education, Mann Whitney
U
= 336.00,
z
= -2.65,
p
= .01. Unexpectedly, Hispanic patients reported greater cardiac anxiety
M
= 39.60,
SD
= 16.70) than non-Hispanic patients (
M
= 30.29,
SD
= 11.67),
t
(66) = -2.722,
p
= .008. No other tested factors were significant, all
p
s ≥ .419.

Conclusions:
Cardiac anxiety is the only tested variable that differed by ethnicity. While Hispanic ethnicity may be protective for certain aspects of cardiovascular health, the present findings indicate that Hispanic CA survivors experience higher psychological distress, which itself is a known risk factor for poor health behaviors. Future research should assess potential drivers of cardiac anxiety (e.g., mistrust of healthcare system, poor patient-physician communication). Future intervention research should target heart-related fear during CA recovery.
Abstract P573: Educational Assortative Mating and Cardiovascular Outcomes
Authors: Moafi-Madani Miremad , Baig Muhammad , Roberts Mary , Eaton Charles
Published: March 2023

Objective:
To estimate the association between educational assortative mating and cardiovascular outcomes among postmenopausal women in the Women’s Health Initiative study.

Background:
Between 1970 and 2015, the number of dual professional couples almost tripled. For instance, the likelihood of male attorneys marrying female lawyers and male doctors marrying female doctors has increased. Studies have proposed that educational assortative mating—people marry those with similar educational attainment--affects health disparities through increasing income inequality, creating differential levels of healthcare access, and based on the social cognitive theory, exchanging health knowledge and sharing healthy behaviors.

Methods:
We compared women living in three homogenous educational pairings; married women and spouses who both have 1) a high school degree or lower, 2) an associate or college degree, and 3) an MS, Ph.D., or professional degree. We used logistic regression models for prevalent outcomes (HTN, CHD, HF) at WHI baseline and Cox proportional hazard regression models for incident outcomes, all adjusted for age and total household income. To consider effect modification by membership in different racial or ethnic groups, we also conducted a stratified analysis.

Results:
We found significant associations between educational assortative mating and all cardiovascular outcomes within all groups of women. We found higher odds of prevalent cardiovascular outcomes ranging from 47 to 98 percent and a higher hazard of incident outcomes ranging from 24 to 56 percent. The strongest associations were found for prevalent and incident heart failure among Black women.

Conclusion:
This study provides evidence that educational assortative mating is likely a contributor to widening disparities in cardiovascular outcomes within and between racial groups of women.
Abstract P576: Disparities in Cardiovascular Disease Outcomes Among Cancer Survivors in the United States: A Systematic Review
Authors: Bikomeye Jean C , Awoyinka Iwalola , Kwarteng Jamila L , Beyer Andreas M , Beyer Kirsten M
Published: March 2023

Significance:
Cardiovascular diseases (CVD) and cancer are leading causes of morbidity and mortality in the US; and cancer survivors are at increased risk for CVD. The risk for adverse CVD outcomes is not equitably distributed. Disparities exist; and some groups and/or communities that have been targeted for marginalization are more affected.

Objective:
To document known disparities in CVD outcomes among cancer survivors in the US and identify literature gaps to inform future studies.

Methods:
We used the Peer Review of Electronic Search Strategies (PRESS) guidelines and searched three databases: MEDLINE, PsycINFO, and Scopus on March 15
th
, 2021. With a pre-defined PICOS framework, we used rayyan for articles screening and the PRISMA 2020 reporting guidelines. The Newcastle Ottawa Scale was used to assess the risk of bias. RAW Graphs were used to create alluvial charts. This review is registered with PROSPERO, ID # CRD42021236460.

Results & Discussion:
From 6,000 articles retrieved, 13 articles met our pre-defined inclusion criteria. All studies investigated racial and ethnic disparities. Gender, age at diagnosis, and cancer stage at diagnosis, and sensitivity C-reactive protein disparities were respectively investigated by one study. The most prevalent outcome investigated is CVD mortality, followed by CVD risk, CVD event, hypertension, and cardiotoxicity. Non-Hispanic Black survivors are at increased risk for all outcomes investigated which might suggest root causes of disparities into historical and structural racism.

Conclusions & Implications:
(1)
Policy implication:
There is an urgent need for stakeholders to work to eliminate root causes of disparities and all forms of injustice, by removing all systemic barriers that limit individuals’ access to essential resources needed to maintain health. (2)
Clinical implication:
Clinicians should increase screening for risk factors that exacerbate poor CVD outcomes. (3)
Research implication:
Researchers should enhance community partnerships and broaden their focus in investigating innovative approaches to reduce disparities and advance health equity and justice.

Keywords:
Disparities, cancer survivors, cardiovascular disease (CVD), cardio-oncology, racism, discrimination.
Abstract P577: Demographic Disparities in the Distribution and Severity of Coronary Artery Disease- An Urban-Suburban Comparative Study
Authors: Adeniyi Adeyinka , Weze Kelechi O , Douglass Paul L
Published: March 2023

Background:
Some small powered studies have suggested a paradoxical finding of less severe coronary artery obstruction in African American (AA) males as compared to Caucasian male patients despite a higher prevalence of CVD mortality in AAs. We performed a retrospective study to further identify the difference in the extent of coronary artery obstruction and the prevalence of multivessel disease between an urban hospital and a suburban hospital.

Methods:
A chart review of cardiac catheterization reports was performed on 3,579 patients from 2 different hospitals (1 urban and 1 suburban center). Statistical analysis was done using R and Stata.

Results:
Analyzing the main characteristics of the patient population we found that the suburban patient population (SPP) was 7 years older than the urban patient population (UPP) (P-valve= <0.001), 78.4% of the suburban population were Caucasian while 79.7% of the urban center patient population were African Americans (P value= <0.001). 96% of the patient population at the suburban center were insured while 85% of patients at the urban center were insured (P= <0.001). Comorbidity burden was overall higher in the SPP ( P-Value= < 0.001). SPPs were found to have a higher prevalence of severe CAD than UPP (Table 1). However, no significant difference was noted when comparing the prevalence of multivessel disease (Table 2).

Conclusion:
SPPs are more likely to have severe CAD than UPPs but with a similar level of CAD distribution.
Abstract P584: The Impact of Multimorbidity and Functional Limitation on Mental Health and Quality of Life Among Patients With Heart Failure
Authors: Manemann Sheila M , Hade Erinn M , Haller Irina V , Horne Benjamin D , Benziger Catherine P , Roger Veronique L , Weston Susan A , Killian Jill M , Chamberlain Alanna M
Published: March 2023

Background:
Multimorbidity (MM) and functional limitation (FL) are associated with poor outcomes in heart failure (HF). However, the individual and combined effect of these on mental health and quality of life in patients with HF is not well understood.

Methods:
Patients aged ≥ 30 years with 2 or more HF diagnostic codes and 1 or more HF-related prescription drugs from four US institutions were mailed a survey to measure functional status (activities of daily living [ADLs]), quality of life and mental health (PROMIS-29 Health Profile) and social support (PROMIS Informational Support, Instrumental Support, and Social Isolation Short Forms). The sampling frame was restricted to patients with a first ever-diagnosis of HF on or after 1/1/2013 at 1 of the participating sites and on or after 1/1/2015 for the other 3 participating sites. A total of 3330 patients returned the survey (response rate 35%); among these, 3020 completed the questions of interest for this analysis and were retained. MM was defined as the presence of ≥ 2 non-cardiovascular comorbidities, and FL was defined as reporting any limitation in at least 1 of 8 ADLs. Patients were categorized into 4 groups by MM (Yes/No) and FL (Yes/No). We dichotomized the subscale scores of the PROMIS-29 at the median and calculated odd ratios for the 4 MM/FL groups.

Results:
Among 3020 patients with HF (45% female; mean age 73±12 years), 29% had neither MM or FL, 24% had MM only, 22% had FL only, and 25% had both. After adjustment, having both MM and FL or only FL was associated with increased odds of higher anxiety, depression, fatigue, sleep, and pain scores compared to having neither (Figure); having MM only was associated with a higher pain score.

Conclusions:
Patients with both FL and MM and only FL have similar odds of poor mental health and quality of life scores, underscoring the importance of the role that FL plays in outcomes in patients with HF.
Abstract P586: Patients With Heart Failure and Chronic Kidney Disease Affected by Pulmonary Hypertension Have Greater Risk of Mortality and Worse Clinical Outcomes
Authors: Khokhlov Leonid , Brown Amanda , Aboelnasr Amr , Fatuyi Michael , Pereira Leanne , Hussain Fatima , Ali Mehnaaz , Shemisa Kamal
Published: March 2023

Background:
Heart failure (HF) and chronic kidney disease (CKD) are increasingly prevalent diseases worldwide. Pulmonary hypertension (PH) is a known predictor of adverse outcomes. Nevertheless, there is limited scientific evidence of clinical outcomes of PH in patients with HF and CKD. Therefore, we sought to investigate this population.

Methods:
We queried NIS between 2016-2019 for adult patients who were hospitalized with HF and CKD and were affected by PH. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, acute kidney injury (AKI), invasive mechanical ventilation, length of stay (LOS) and total hospital charge. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value < 0.05 was significant.

Results:
There were 9,221,158 patients with HF and CKD, of which 85,985 (4.3%) had PH. PH and non-PH cohorts were with mean age of 73.3 vs. 72.3 yrs; males 46.8% vs 55.1%; Caucasians 62.5% vs 63.2%; systolic HF 42.2% vs 41.7%; obesity 26.1% vs 22.2%; dyslipidemia 56.1% both; anemia 25.3% vs 21.9%, DM 54.3% vs 58.5%; AF 53.4% vs 41.5%; history of MI 14.4% vs 16.3%; stroke 1.6% vs 2.3%; COPD 39.6% vs 33.1%, smokers 9% vs 11%, respectively. PH cohort had significantly higher mortality and worse clinical outcomes (Table 1).

Conclusion:
HF patients with CKD who had PH showed significantly worse clinical outcomes and higher resource utilization. They were older, females, with more frequent systolic HF, obesity, anemia, AF, COPD. PH may raise risk for systolic dysfunction, cardiometabolic syndrome and lung disease. Hence, early detection and treatment of PH may improve clinical outcomes when managing patients with HF and CKD. Future studies may provide better understanding of this high-risk population.
Abstract P588: The Association of Anthropometric Measures With Risk for Pre-HF
Authors: Esquivel Jill H , Logan Jeongok G , Sotres-Alvarez Daniela , Ponce Sonia , Allison Matthew A , Hurwitz Barry E , Kaplan Robert , Isasi Carmen R , Cai Jainwen , Daviglus Martha L , Kansal Mayank M , Rodriguez Carlos J
Published: March 2023

Introduction:
Obesity is an epidemiologic challenge and a key risk factor for heart failure (HF). Pre-heart failure (pre-HF) has been recognized as an important entity to prevent progression to clinical HF. Defining the long-term effect of obesity on pre-HF is essential for understanding of HF risk and prevention.

Purpose:
To determine the prospective association of obesity on the incidence of pre-HF (defined as the presence of abnormal cardiac structure or function among persons without clinical HF).

Methods:
Data from 1580 individuals without HF and with anthropometric data from the population-based Echocardiographic-Study of Latinos were included.
Pre-HF
was defined as: 1)
Systolic dysfunction
- LV ejection fraction (LVEF) < 50% and global longitudinal strain (GLS) <15%; 2)
LV diastolic dysfunction
- E/e’ >10 and left atrial volume index (LAVI) >34 mL/m
2
; or 3)
LV remodeling
- LV mass index (LVMI)> 115gm/m
2
, >95gm/m
2
(male and female, respectively) and relative wall thickness (RWT) >0.42. Anthropometric data were: (body mass index {BMI}, waist circumference {WC}, waist-to-hip ratio {WHR}, fat mass {FM) and free fat mass {FFM}). Echocardiographic and anthropometric data were collected twice, on average 4.3 years apart, and analyzed using survey-weighted multivariable-adjusted regression models. Incident pre-HF was determined among participants

Results:
Mean age of 56 (42-74) years and 1048 (66%) were female. Baseline mean BMI was 29.9 kgm
2
, FM kg 28.3, FFM kg 50.1, WC 99.7cm, and WHR 0.94. Baseline BMI, FFM, FM, WC and WHR were significantly higher in individuals with prevalent pre-HF (all p<0.007). Longitudinal data showed that WC and WHR were associated with greater probability of incident pre-HF (WC and WHR p<0.0006. Regression models showed BMI, WC, WHR and FFM were associated with increased odds of incident Pre-HF (Table 1).
Abstract P591: Prevalence and Prognosis Comparing the New vs. Old ACC/AHA/HFSA HF Stage Classification: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Mathews Lena M , Nohara Yume , Ding Ning A , Sueta Carla A , Kucharska-Newton Anna , Shah Amil M , Ndumele Chiadi E , Matsushita Kuni , Chang Patricia
Published: March 2023

Introduction:
New guidelines for the management of heart failure (HF) have now incorporated cardiac biomarkers in the definition of those in pre-clinical HF (Stage B). We sought to compare the prevalence and prognosis according to the new vs. old ACC/AHA/HFSA HF Stage classification using data from the ARIC study visit 5 (2011-2013).

Methods:
The “old” classification included Stage 0 (no HF risk factors), Stage A (at risk for HF; without structural heart disease or symptoms), Stage B (structural heart disease; without HF signs and symptoms), Stage C1 (current or previous HF symptoms without HF hospitalization); Stage C2 (current or previous HF symptoms with HF hospitalization); Stage D (marked HF symptoms interfering with daily life). The “new” HF Stage classification included elevated NT-proBNP and cardiac troponin as evidence of Stage B. We examined all-cause mortality over five years, using tKaplan Meier method and multivariable Cox models.

Results:
Among 5,004 participants (mean age 75.3 (SD 5.1) years, 57% women, 22% Black), 28% had diabetes, 74% had hypertension, and 15% had coronary artery disease. With the new HF Stage classification, the prevalence of Stage 0/A decreased from 58% (n=2,887) to 27% (n=1,334), and Stage B increased from 29% (n=1,468) to 60% (n=3,021). The prevalence of Stage C2 and C1 were 7.3% and 5.7%, respectively, regardless of the new or old classification (no individuals had Stage D), with corresponding 5-year cumulative mortality of 33% and 21%. The new classification using cardiac biomarkers newly identified individuals as Stage B with mortality risk similar to those who were originally in Stage B (5-y cumulative mortality 10% and 12%, respectively). This “reclassification” left individuals with lower mortality risk as Stage 0/A (5-year cumulative mortality 5% vs. 8% in the new vs. old classification). When we adjusted for potential confounders, individuals newly classified as Stage B had an elevated mortality compared to those with Stage 0/A (HR 1.32 [0.98-1.77]) but not as high as those in original Stage B (1.83 [1.36-2.45]).

Conclusions:
The new HF classification newly identified a large number of older adults as Stage B, and they indeed had elevated mortality than those who stayed in Stage 0/A. However, after accounting for potential confounders, individuals newly classified as Stage B had slightly lower mortality than those originally in Stage B. Our findings will guide clinicians as to how to interpret new HF classification in terms of prognosis.
Abstract P592: Risk Factors for Heart Failure Subtypes in a Population With a High Burden of Diabetes- Evidence From the Strong Heart Study
Authors: Martinez-Morata Irene , Domingo-Reloso Arce , Galvez-Fernandez Marta , Zhang Ying , Fretts Amanda M , Pichler Gernot , Garcia Pinilla Jose Manuel , Shimbo Daichi , Umans Jason , Cole Shelley A. , Navas-Acien Ana , Devereux Richard B
Published: March 2023

Introduction:
Heart failure (HF) is a leading cause of death. Despite the high burden of CVD and diabetes affecting American Indian (AI) communities, studies of risk factors for HF and HF subtypes in AIs are lacking and critically needed to optimize prevention strategies.

Hypothesis:
We hypothesize that diabetes and diabetes-related complications are HF risk factors in AIs.

Methods:
A total of 3,066 Strong Heart Study (SHS) participants (mean age 56.3±8.1 years, 58% women, all free of CVD) recruited in 1989-91 were followed through 2017. A total of 489 participants developed HF (119 HFpEF, 68 HFmrEF, 98 HFrEF, 204 unclassified). We used Cox proportional hazards models to determine risk factors for HF and HF subtypes progressively adjusting for sociodemographic and traditional CV risk factors (Model 1) and additionally for glycated hemoglobin (HbA1c) and albuminuria (Model 2-main model).

Results:
HRs (95% CI) are shown in Table 1. Age, smoking status, BMI, hypertension treatment, diabetes status, HbA1c, and albuminuria were independently associated with overall HF (Model 2). Some associations differed across HF subtypes: male sex was associated with higher risk of HFrEF and potentially HFmrEF, whereas female sex was associated with higher risk of HFpEF. BMI was associated with HFpEF but not with HFmrEF and HFrEF. Higher HDL-cholesterol was negatively associated with risk of HFmrEF and HFrEF. Diabetes was consistently associated with all HF subtypes. HbA1c was significantly associated with HFmrEF and albuminuria was significantly associated with HpEF and HFrEF. The association with diabetes status was attenuated after adjustment for HbA1c and albuminuria for all forms of HF.

Conclusion:
Diabetes and diabetes-related complications are major risk factors for all forms of HF in the SHS. Indicators of HF risk differ across HF subtypes. Including measures of diabetes control (HbA1c) and target organ damage (albuminuria) in HF risk calculation improves risk prediction and could aid in targeting primary prevention interventions.
Abstract P594: High-Density Lipoprotein Particle Concentrations and Long-Term Atherosclerotic Disease Risk in Young Adults
Authors: Wilkins John T , Alruwaili Waleed , Ning Hongyan , Sawicki Konrad T , Sniderman Allan D , Otvos James D , Jacobs David R , Murthy Venkatesh L , Shah Ravi V , Rohatgi Anand , Allen Norrina B
Published: March 2023

Introduction:
HDL particles vary in size and concentration. Indices of overall HDL particle concentration (HDL-P) and the concentrations of different HDL size subspecies (small: H1-H3, medium: H4, H5, and large: H6, H7) have differential associations with near-term CVD events in middle-aged adults. It is unclear if measures of HDL particle concentration predict long-term ASCVD risk in young adults.

Methods:
Among CARDIA participants (ppts), NMR was used to measure HDL-P and HDL particle size subgroup H1-H7 concentrations. HDL cholesterol (HDL-C) was measured using standard assays. We stratified the ppts into 2 age windows: 20-30y (n= 1645) and 30-40y (n=2922). We used adjusted Cox proportional hazards models to assess the associations between a 1SD higher HDL-C, HDL-P, and HDL1-7 subgroups with incident ASCVD events. We added HDL-P, HDL H1-H7, and HDL-C separately to a modified Pooled Cohort Equation (PCE) model; model performance (discrimination and reclassification) was evaluated.

Results:
81 and 163 ASCVD events occurred over (median (IQR)) 31.8y (31.1-32.0y) for the 20-30y age window and over 26.8y (19.1-27.1y) for the 30-40y age window, respectively. In ppts age 20-30y, a higher HDL-P and HDL-C were not associated with ASCVD events, however a higher HDL H6 subgroup level was associated with lower risk for ASCVD in demographic adjusted models. In the age 30-40y group, higher HDL-P, HDL-C, and H6 subgroup were significantly associated with lower ASCVD risks in all models. There were no significant differences in c-statistics across PCE models. However, there were improvements in reclassification for all HDL measures when added to the PCE model in the 20-30y age window, and significant improvements in reclassification when HDL H1-7 were added to the PCE for the 30-40y age window.

Conclusion:
At younger ages (<40y) differences in HDL particle abundance, in particular large particles, may help reclassify long-term risk for ASCVD in some.
Abstract P595: Low Serum Cholesterol and Coronary Heart Disease Mortality in Veterans
Authors: Nguyen Xuan-Mai T , Li Yanping , Ho Yuk-lam , Song Rebecca J , Orkaby Ariela R , Vassy Jason L , Gagnon David , Cho Kelly , Gaziano John M , WILSON PETER
Published: March 2023

Background:
The lipid hypothesis postulates that lower blood cholesterol is associated with reduced coronary heart disease (CHD) risk, which has been challenged by recent studies that observed a U-shaped relation between cholesterol and mortality. The effect of low cholesterol and CHD risk among Veterans is unclear.

Methods:
This prospective cohort study included Veterans greater than 18 years of age with baseline outpatient visits from 2002 to 2007 and follow-up to December 30, 2018 in the Veterans Health Administration electronic health record system. Veterans were followed to assess CHD mortality risk in relation to outpatient blood cholesterol levels. We used Cox proportional hazard regression to estimate the hazard ratio (HR) and 95% confidence interval (CI) of CHD mortality associated with total cholesterol (TC).

Results:
Among 4,467,942 Veterans, 381,871 CHD deaths were recorded. We observed a V-shaped relation between TC and age-, sex, race and smoking-adjusted risk of CHD mortality. The association became U-shaped after adjustment for statin use, body mass index, hypertension, and diabetes. When further adjusted for high-density lipoprotein level, 11 baseline diseases, and applying a 2-year lag analysis, the relation to CHD mortality was J-shaped--flat for TC<180 mg/dL and greater risk was present at higher cholesterol levels. Compared to Veterans with TC between 180-199 mg/dL, risk for CHD mortality (HR (95%CI)) was 1.03 (1.02-1.04), 1.07 (1.06-1.09), 1.15 (1.13-1.18), 1.25 (1.22-1.28) and 1.45 (1.42-1.49) times greater among Veterans with TC (mg/dL) of 200-219, 220-239, 140-259, 260-279 and ≥280, respectively. Transition of the TC- CHD mortality patterns were J-J-J, V-U-J and L-U-J among young, middle, and older veterans (P for interaction between TC and age group < 0.001). Similar J-shaped but weaker relations were observed in statin users at baseline.

Conclusions:
Based on prospective data for almost 4.5 million adult Veterans, CHD mortality risk steadily increased for TC ≥200mg/dL after adjustment for a range of health conditions. Our results support the lipid hypothesis that lower blood cholesterol is associated with reduced CHD risk and lower prevalence of multimorbidity, mental health disorders, nutritional deficits, and other risk factors for CHD. Furthermore, the hypothesis remained true when TC was low due to use of statins or other lipid-lowering medication. The changes in risk for CHD mortality by TC groups observed in our study (L- to U- to J-shape) highlights the importance of fully adjusting for the presence of multimorbidity and HDL-C to avoid misleading conclusions.
Abstract P596: Familiar Hypercholesterolemia is Associated With Lower All-Cause Mortality Despite Higher Complexity of Coronary Lesions and Interventions Among Patients Admitted With Acute Myocardial Infarction
Authors: Kumi Dennis D , Vardar Ufuk , Karki Sadichhya , Gwira-Tamattey Edwin , Abbasi Ayesha
Published: March 2023

Background:
Familiar hypercholesterolemia is a genetic disorder affecting lipoprotein metabolism which is strongly associated with early atherosclerosis. Our resolve in this study is to evaluate the severity of coronary lesions ,complexity of acute interventions and clinical outcomes.

Hypothesis:
Patients with familiar hypercholesterolemia are relatively younger, have high coronary atheroma burden with less comorbidities, thus likely to have complex atherosclerosis but with paradoxical better prognosis.

Method:
A retrospective cohort study with data from the 2016 to 2018 combined National Inpatient Sample (NIS) database was employed. ICD-10 codes were used to sample all admissions for acute myocardial infarction who were then dichotomized based secondary diagnosis of familiar hypercholesterolemia. Procedure codes of ICD-10 were used to identify patients undergoing coronary revascularizations. We determined relative frequencies of various ischemic injury patterns and complexity of revascularization procedures among the two cohorts. Primary clinical outcome of mortality rate, and secondary outcomes including length of stay and total hospital charge were then assessed. Multivariate linear and logistic regressions were used to adjust for confounders.

Results:
We identified a total of 4,300,389 adult hospitalizations for acute myocardial infarction including 0.033% with familiar hypercholesterolemia. Patients with familiar hypercholesterolemia were younger (55.8 years vs 58.2 years, adjusted mean difference: -7.87 years, 95%CI: -9.49 years to -6.0 years). Table 1 below shows details of outcomes of our study.

Conclusion:
Among patients hospitalized with acute myocardial infarction, comorbid familiar hypercholesterolemia was associated with a 62% reduction in odds of in-hospital all-cause mortality despite a 2.25-fold increased odds of STEMI and higher odds for having multivessel percutaneous. revascularization.
Abstract P608: Dynamic Changes in Dietary Guidelines Adherence and Its Association With All-Cause Mortality Among Middle-Aged Chinese: A Longitudinal Study From the China Health and Nutrition Survey
Authors: Zhang Xiao , Na Xiaona , Wang Yanfang , Shufa Du , Zhao Ai , Liang Wannian
Published: March 2023

Background:
The traditional approach to evaluating dietary quality is based on the achievement of the recommended intakes for each food group, which may overlook the achievement of correct relative proportions between food groups. We propose a “Dietary Adherence Score (DAS)” to assess the degree of similarity between subjects' diets and those recommended in the Chinese Dietary Guidelines (CDG). Furthermore, it is important to incorporate the time-dependent nature of dietary quality into the mortality prediction.

Aim:
To investigate the association between long-term changes in adherence to the CDG and all-cause mortality.

Method:
The study included 4533 participants aged 30-60 from the China Health and Nutrition Survey study with a median follow-up of 6.9 years. Intakes from 10 food groups were collected in 5 survey rounds from 2004 to 2015. We calculated the Euclidean distance between the intake of each food and the CDG-recommended intake, and then summed all the foods as DAS. Mortality was assessed in 2015. The latent class trajectory modeling was used to identify 3 classes of participants with distinct longitudinal trajectories of DAS during the follow-up period. The Cox proportional hazard model was used to assess the risk of all-cause mortality in the 3 classes of people. Risk factors for death and a traditional measure of diet quality, the Alternative Healthy Eating Index (AHEI), were adjusted in the models.

Result:
There were 187 deaths overall. Participants in the first class identified had consistently low and decreasing DAS levels (coefficient= -0.020) over their lifetime, compared with a hazard ratio (HR) of 4.4 (95% confidence interval [CI]: 1.5, 12.7) for participants with consistently high and increasing DAS levels (coefficient= 0.008). Those with moderate DAS had an HR of 3.0 (95% CI: 1.1, 8.4). The effect of DAS was independent of AHEI.

Conclusion:
People with consistently high adherence to CDG-recommended dietary patterns had a significantly lower mortality risk. DAS is a promising method to assess diet quality.
Abstract P609: Polyphenol Metabolite Production Displays Individual Variability and Associations With Usual Diet: A Dietary Challenge Study
Authors: Sprinkles Jessica , Lulla Anju , Shea Jonathan , MacIntosh Beth , Kohlmeier Martin , Meyer Katie A
Published: March 2023

Background:
Fruits and vegetables, rich in polyphenolic compounds, contribute to cardiovascular disease (CVD) prevention. Polyphenolic metabolism is complex and relies on the gut microbiota, which in turn is shaped by usual diet. Individual variability in metabolite production has implications for precision nutrition approaches to CVD prevention.

Methods:
Forty healthy adults were recruited from the Kannapolis, NC, area for a 3-day dietary challenge study [2019; ages: mean (SD)=39.1 (12.3); sex (n=23 female, 17 male); race/ethnicity (n=28 non-Hispanic White, 1 Hispanic White, 5 Black, 4 Asian, 2 mixed race); BMI: mean (SD)=25.4 (3.1)]. On Day 1, participants were provided 2 days of meals, designed to be low in precursors of target metabolites and prepared in a metabolic kitchen; completed the Diet History Questionnaire II (DHQ-II); and had clinical measures taken by trained clinic staff. On Day 2, participants received a combination dietary challenge, including cocoa capsules (750 mg cocoa flavanols) and pomegranate juice (500 mL). Participants collected their urine (not pooled) for 24 hours, from challenge to the morning of Day 3. Targeted LC-MS analysis was conducted on samples within the collection period. Multivariable-adjusted linear regression was used to test associations between urine metabolite concentration and past-year consumption of foods, with multiple comparisons adjusted by the false discovery rate.

Results (Table):
Valerolactones displayed large variability in post-challenge production. Metabolite production was significantly associated with usual intake of several food groups.

Conclusion:
Our findings document appreciable variability in the production of valerolactones, after ingesting constant amounts of precursor-containing products, potentially contributing to differential dietary effects on CVD. Metabolite production was significantly associated with usual intake of several major food groups.
Abstract P610: French Canadian Translation and Validation of the Eating in the Absence of Hunger Questionnaire for Children and Adolescents
Authors: Savard Catherine , Bégin Stéphanie , Robitaille Julie , Hivert Marie-France , Gingras Véronique
Published: March 2023

Background:
Eating in the absence of hunger (EAH), i.e. eating past the point of satiety, has been associated with the development of excess body weight during childhood, independently of other traditional risk factors. EAH is typically assessed with a laboratory-based standardized protocol which is time-consuming and requires important resources. A questionnaire has been developed to simplify the assessment of EAH among children and adolescents, but it has only been validated in English.

Objective:
Our aim was to validate a French translation of the EAH Questionnaire among children and adolescents in Montreal, Canada.

Methods:
Participants aged 7 to 15 years old completed the questionnaire upon recruitment (n=200) and ~4 weeks later (n=159 of 200, 80% of participants). Self-reported body weight and height data was also collected at inclusion and body mass index (BMI) z-scores were computed. The questionnaire includes 14 items divided into three subscales evaluating specific triggers of EAH (fatigue/boredom, negative affect and external cues). The global score for EAH ranges from 14 to 70 points, a higher score indicating a higher tendency to EAH. We assessed internal consistency for the full questionnaire and for each subscale using Cronbach alpha coefficients using data from the first completion of the questionnaire. Temporal stability was evaluated with Pearson correlations between the initial and second completions of the questionnaire, for each of the EAH subscales and for the total score. Association of EAH and BMI z-score was also assessed with Pearson correlation.

Results:
Participants (50% girls, 100 of 200; 71% white, 142 of 200) were 11.9 ± 2.3 years old, had a mean ±SD total score for EAH of 27.2 ± 9.1 points and a mean ±SD BMI z-score of 0.21 ± 1.05. The total EAH score and the negative affect subscale showed good internal consistency (Cronbach alpha = 0.88 and 0.86, respectively), while internal consistency for the fatigue/boredom and the external cues subscales was considered adequate (Cronbach alpha = 0.75 and 0.68, respectively). The total score and each subscale scores from the second completion of the questionnaire were significantly correlated with their respective scores from the first completion (r = 0.75;
ρ
< 0.001 for the total score and r = 0.55 to 0.78;
ρ
< 0.001 for the three subscales). Moreover, participants’ BMI z-score was positively correlated with EAH total score (r = 0.15;
ρ
= 0.03).

Conclusion:
A French translated version of the EAH questionnaire appears to represent an adequate and reliable tool to assess EAH among French-speaking Canadian children and adolescents.
Abstract P612: Alcohol Intake, Kidney Function and Mortality
Authors: laurenzi martino
Published: March 2023

Background:
Data from the Gubbio population study were used to investigate the association of alcohol intake, kidney function and mortality.

Methods:
The Gubbio Study is a longitudinal study on the population of Gubbio, a town in central Italy; it started in 1983, addressing the resident population aged 5 +. Three exams were performed: Exam 1 (baseline) Exam 2 (6-year follow-up) and Exam 3 (20-year follow-up); this analysis is on the 2,069 adult participants (42.8% male) with complete data at Exam 3. Kidney function was estimated as glomerular filtration rate (eGFR) with the CKD-Epi equation, mL/min x 1.73 m
2
. Habitual alcohol intake was assessed by standard questionnaires. Mortality was derived from official records.

Results:
Wine intake accounted for >94% of total alcohol intake at all exams. Alcohol intake tracked significantly over time (R > 0.66, P < 0.001). Daily alcohol intake distribution was skewed at all exams (skewness > 2); we divided it into four strata (grams/day = 0, 1-24, 25-48, and > 48). The goodness of the fit of the strata was confirmed by lab markers of alcohol intake (P<0.001). In multi-variable regression, strata related cross-sectionally to eGFR at all exams and were correlated longitudinally with less negative eGFR change from Exam 1 to Exam 2 and from Exam 2 to Exam 3. In multi-variable Cox models, compared to no intake, intakes > 24 g/d were not correlated with a different mortality while an intake of 1-24 g/d was correlated with a
lower
mortality in the whole cohort (HR= 0.77, P=0.003) and in the subgroup with eGFR < 60 mL/min x 1.73 m
2
(HR= 0.69, P=0.033).

Conclusion:
These data indicate a positive independent association of moderate daily alcohol intake with kidney function not due to a mortality-related selection.
Abstract P614: The Association Between Dietary Patterns and Coronary Artery Calcium Score: A Systematic Review
Authors: Hussain Bridget M , Lappen Hope , Deierlein Andrea , Talegawkar Sameera , Parekh Niyati
Published: March 2023

Background and Objective:
Coronary artery calcium (CAC) score is an early indicator of CVD. Diet is an established primary prevention strategy for CVD, but limited research has systematically evaluated the relationship between diet and CAC. The current study sought to review longitudinal studies evaluating the association between dietary intake and CAC score.

Methods:
Five databases were searched from inception to October 2022. We included prospective studies that included terms to capture food, diet, and nutrient intake in disease-free adults with CAC score measured by computed tomography. Two authors developed the search strategies and screened articles for inclusion.

Results:
Of 58 articles on dietary intake and CAC score, nine assessed the relationship between dietary intake at baseline and CAC score at follow up. Sample size was moderate to large across the nine studies, ranging from 861 to 15,368 participants. Seven studies used a food frequency questionnaire, one used a semi-quantitative interview, and one used a single-item question to assess diet intake. One study was conducted in Germany, while eight were conducted in the US. Three studies derived data from the CARDIA study, a cohort of young adults aged 18-30 at baseline. Two studies used the MESA study, a prospective study of adults aged 45-84 at baseline. Four studies found an association between dietary pattern intake and CAC score, with studies finding that higher fruit and vegetable intake and Mediterranean-like diet associated with lower risk of CAC progression, and low carbohydrate diet and starchy vegetable, meat and alcohol intake associated with increased risk of CAC presence.

Conclusions:
Studies suggested that there is a relationship between diet intake and CAC presence and progression, with research reflecting positive effects associated with patterns rich in fruits and vegetables alongside deleterious effects associated with high saturated fat and low dietary fiber intake. Finding reflect the strong influence of diet on clinical indicators of CVD.