bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP45: Social Jetlag, Independent Of Other Sleep Characteristics, Is Associated With Obesity-related Outcomes In 9-11-year-old Girls
Authors: Higgins Simon , Stoner Lee , Black Katherine , Wong Jyh Eiin , Meredith-Jones Kim , Quigg Robin , Skidmore Paula
Published: May 2021

Introduction:
Though short sleep has been identified as a predictor of childhood obesity, few have explored the importance of sleep characteristics beyond duration. Literature in adolescents examining the influence of social jetlag, the difference in hours between the midpoint of sleep during weekdays (school) and weekend days (free), has suggested a potential sex-specific relationship with obesity-related indices. However, little is known about the potential sex-specific relationships between social jetlag or other sleep characteristics and obesity-related outcomes earlier in youth.

Objective:
To examine the relationships between sleep duration, disturbances, and social jetlag with obesity-related outcomes during childhood, with an emphasis on sex-specific relationships.

Methods:
This cross-sectional study included 381 children from Dunedin, New Zealand (9-11 years, 49.6% female). Average sleep duration, social jetlag, and physical activity were assessed via wrist-worn accelerometry, measured over 8 consecutive days. Sleep disturbances were quantified from the Children's Sleep Habits Questionnaire, with higher scores (range 1-3) denoting more frequent sleep disturbances. Obesity-related outcomes included age-specific body mass index z-scores (zBMI) calculated using the World Health Organization method, relative (% fat) and absolute (kg) adiposity and fat mass index (kg/m
2
) assessed via bioelectrical impedance analysis, and waist-to-height ratio (WHtR). Linear mixed models that nested children within schools, with a random intercept and fixed slope were used to identify relationships among sleep variables and obesity-related outcomes. Multivariable analyses included all sleep variables (unadjusted) and known covariates (adjusted). Cross-level interactions assessed the presence of sex-specific relationships.

Results:
Positive associations between social jetlag with zBMI, % fat, and fat mass index were seen in univariable and unadjusted multivariable analyses. Associations between sleep duration and sleep disturbances with body composition variables were non-significant. Following adjustments for known confounders, social jetlag remained significantly associated with zBMI (
B
=0.23, 95%CI: 0.03, 0.43,
p
=0.025), though not with any other obesity-related outcome. Furthermore, cross-level interactions were present for social jetlag with zBMI (
B
=-0.40, 95%CI: -0.80, -0.00,
p
=0.051) and LnWHtR (
B
=-0.01, 95%CI: -0.03, -0.00, p=0.042), with simple slopes suggesting positive associations in girls but not boys (girls
B
=0.43 and 0.01, respectively, both
p
<0.05
).

Conclusions:
Social jetlag may be an important target for youth obesity prevention efforts, given its association with obesity-related outcomes. Importantly, these associations were seen in girls but not boys, suggesting that a targeted approach to prevention may be needed.
Abstract MP46: The Associations Between Adverse Pregnancy Outcomes And Cardiovascular Delivery Complications: The National Inpatient Sample
Authors: Minhas Anum , Ogunwole Michelle , Miller Michael , Vaught Arthur J , Wu Pensee , Mamas Mamas A , Gulati Martha , Zhao Di , Hays Allison , Michos Erin
Published: May 2021

Background:
Women with adverse pregnancy outcomes (APOs) are at increased risk of long-term cardiovascular (CV) disease, but less is known about the spectrum of acute CV outcomes in women with various APOs. We evaluated the risk of CV events at delivery in women with gestational diabetes (GDM), gestational hypertension and preeclampsia/eclampsia (PEC), overall and by race/ethnicity, in a US sample.

Methods:
We used the 2016-2017 National Inpatient Sample survey data from the Agency for Healthcare Research and Quality (AHRQ). ICD10-CM diagnosis codes were used to identify women with a delivery hospitalization and to identify CV outcomes. We examined demographics and prevalence of CV events at delivery by the 3 APOs. Logistic regression was used to determine risk of various adverse CV events at delivery by APO, adjusted for age, income and hospital location. To generate national estimates, sampling weights provided by AHRQ were used.

Results:
Among 3,776,531 deliveries in 2016-2017, GDM was the most common APO (n=552,975; 7.3%). GDM occurred more frequently in Hispanics and Asians/Pacific Islanders (23% and 11%, respectively), while PEC occurred more frequently in Blacks (20%). While there was greater occurrence of CV events with all 3 APOs, after adjustment, only PEC was significantly associated with increased odds of adverse CV events [peripartum cardiomyopathy: OR 3.87 (95% CI 3.30-4.55), congestive heart failure: OR 4.04 (3.52-4.63), acute ischemic heart disease: OR 3.67 (2.65-5.08) and arrhythmias: OR 1.39 (1.22-1.59)]. Risk was elevated for Whites, Blacks, Hispanics and Asians/Pacific Islanders, although there was heterogeneity of the magnitude of risk by race/ethnicity (
Table
).

Discussion:
Women with APOs, especially PEC, are more likely to experience acute CV complications at hospital delivery than women without APOs. While Black women are more likely to develop PEC, women of all race/ethnicities with PEC are at risk of CV complications.
Abstract MP49: Application Of A Novel Assessment Of County-level Cardiovascular Health Profile And Its Association With County-level Disease Rates
Authors: Rowen Neil P , Kim Daniel , Rayala Hannah P , Reiter Andrew H , Rosamond Wayne D
Published: May 2021

Background:
The AHA’s definition of cardiovascular health (CVH) is based on seven metrics known as Life’s Simple 7 (LS7): smoking, diet, obesity, physical inactivity, high blood cholesterol, high blood pressure, and diabetes. Although used to evaluate CVH at the national and individual level, its use as a local county-level measure of CVH has not yet been studied. Our objective was to create a modification of LS7 using publicly available data to estimate county-level CVH and to determine its association with CVH outcomes in all 100 counties of North Carolina (NC).

Methods and Results:
Using data on all the LS7 metrics collected by the CDC, USDA, BRFSS, and Community Health Assessments, we created a Modified LS7 scoring system, calculated scores for all 100 counties in NC, and created a regression model that predicts county-level hospital discharge rates for diseases and disorders of the circulatory system (Figure 1). Modified LS7 scores ranged from 60.8 to 80.6 (median = 73.1, SD = 3.9). Hospital discharge rates per 100,000 population ranged from 753.4 to 2223.4 (median = 1345.6, SD = 328.7). We found a negative correlation (R-squared = 0.610) between Modified LS7 scores and county-level hospital discharge rates. Counties in the mountain and piedmont regions had significantly higher mean Modified LS7 scores (74.3, 95% CI: 73.5-75.2; 73.9, 95% CI: 72.8-75.0) and lower mean discharge rates (1167.1, 95% CI: 1074.7-1259.5; 1273.9, 95% CI: 1181.4-1366.2) than counties in the coastal plains region (70.7, 95% CI: 69.4-72.0; 1612.3, 95% CI: 1518.5-1706.1). Studentized residuals and leverage points were used to identify five low performing counties and two high performing counties of interest for further analyses.

Conclusions:
The coastal region of NC was found to have significantly higher CVH risk and poorer CVH outcomes compared to the piedmont and mountain regions. The Modified LS7 model provides a novel approach to examine county-level variation in CVH that had previously only been reported at the national, state or individual level.
Abstract MP50: Neighborhood Social And Economic Environment And Heart Failure Risk Among Adults With & Without Diabetes: The Reasons For Geographic And Racial Differences In Stroke (regards) Study
Authors: Malla Gargya , Cherrington Andrea , Safford Monika M , Goyal Parag , Cummings Doyle M , McAlexander Tara , De Silva Shanika , Judd Suzanne E , Hidalgo Bertha , Levitan Emily B , Carson April P
Published: May 2021

Background:
Heart failure (HF) mortality rates have been increasing since 2011. Individual-level education and occupation have been inversely associated with HF mortality among those with diabetes mellitus (DM) but not among those without DM. However, less is known about the association between neighborhood social and economic environment (NSEE) and HF risk and whether this association varies by DM status.

Methods:
This study included 21,244 Black and White adults age >=45 years at baseline (2003-07) from the REGARDS Study. NSEE quartiles were created using z-scores based on 6 census tract variables from year 2000 (% <high school education, % unemployed, % household with <$30,000, % living in poverty, % on public assistance, % without car). Incident HF events (fatal or non-fatal) were adjudicated based on hospitalization with HF signs and symptoms, supportive imaging or biomarkers. Diabetes was defined as fasting glucose >=126 mg/dL or random glucose >=200 mg/dL or use of diabetes medications. Cox proportional hazards regression was used to obtain hazard ratios (95% CI) with HF follow-up through 2016.

Results:
Mean age was 65 years, 54% were women, 61% were White and 18% had prevalent DM at baseline. During a median 10.1 years, 829 incident HF events occurred. Among adults with DM, neighborhood disadvantage was associated with an increased HF risk , but this association was not statistically significant (Table). Among adults without DM, the risk of HF was higher for participants living in any neighborhood that was not the most advantaged, and the magnitude of association was smiliar across NSEE quartiles.

Conclusion:
Adults living in disadvantaged neighborhoods had a higher risk of HF, particularly among those without DM. Addressing neighborhood social and economic conditions may be important for HF prevention.
Abstract MP53: Consumption Of Ultra-processed Food Is Associated With Risk Of Coronary Heart Disease In The Atherosclerosis Risk In Communities Study
Authors: Du Shutong , Kim Hyunju , Coresh Josef , Rebholz Casey M
Published: May 2021

Introduction:
Ultra-processed food defined as food and drink products formulated through sequences of industrial processes, and generally contain non-culinary used additives. Previous studies have linked higher ultra-processed food intake with several cardiometabolic and cardiovascular diseases. However, longitudinal evidence from US populations remains scarce.

Hypothesis:
We hypothesized that higher intake of ultra-processed food is associated with higher risk of coronary heart disease (CHD).

Methods:
We selected 12,607 adults aged 44-66 years in 4 US communities from the ARIC study at baseline. Dietary intake data were collected through a validated 66-item food frequency questionnaire. Ultra-processed foods were defined using the NOVA classification and the level of intake was calculated for each participant. We conducted Cox proportional hazards models to study the association between quartiles of ultra-processed food intake and incident CHD. Nonlinearity was assessed by using restricted cubic spline regression.

Results:
There were 1,899 incident CHD cases documented after an median follow up of 27 years (291,285.2 person-years). Incidence rates were higher in the highest quartile of ultra-processed food intake (71.6 per 10,000 person-years; 95% CI, 65.8-78.0) compared to the lowest quartile (59.7 per 10,000 person-years; 95% CI, 54.3-65.7). Participants in the highest vs. lowest quartile were associated with a 18% higher risk of CHD (Hazard ratio 1.18 [95% CI, 1.04 - 1.34]; P-trend = 0.010) after adjusting for sociodemographic factors and health behaviors. An approximately linear relationship was observed between ultra-processed food intake and risk of CHD after 4 servings/day (
Figure
).

Conclusion:
In conclusion, higher ultra-processed food intake was associated with a higher risk of coronary heart disease among middle-aged US adults. Further prospective studies are needed to confirm these findings and to investigate the mechanisms by which ultra-processed food may affect health.
Abstract MP60: Blood Pressure Variability And Risk Of Heart Failure In Postmenopausal Women. Results From The Women's Health Initiative.
Authors: Haring Bernhard , Hunt Rebecca , Manson JoAnn , Lamonte Michael J , Klein Liviu , Allison Matthew A , Wild Robert A , Wallace Robert B , Shadyab Aladdin , Breathett Khadijah , Eaton Charles B , Wassertheil-smoller Sylvia W , Shimbo Daichi
Published: May 2021

Introduction:
Little is known about the relationships between visit-to-visit BPV and HF sub-phenotypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). The aim of this analysis was to investigate the relationship of visit-to-visit systolic and diastolic BPV and risk of HF subtypes HFrEF and HFpEF in a large cohort of postmenopausal women.

Hypothesis:
We hypothesized that greater systolic and diastolic BPV would be associated with a higher risk for HFrEF and HFpEF.

Methods:
This study consisted of 23,918 postmenopausal women aged 50-79 enrolled in the Women’s Health Initiative Hormone Therapy Trials. Blood pressure (BP) was measured at baseline (1993-1998) and then annually through 2005 by trained clinical staff. Variability was defined as the standard deviation of the mean BP across visits (SDm). The outcome was first HF hospitalization, which was adjudicated by physician review of medical records. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for HF endpoints with adjustments for demographic, medical history, lifestyle factors, antihypertensive medication use, mean systolic and diastolic BPs, and time-varying coronary events interim to HF hospitalization.

Results:
During a mean follow-up of 15.8 years, 913 incident cases of HFpEF and 421 cases of HFrEF were identified. In fully adjusted models, women in the highest quartile of SDm for systolic blood pressure were at higher risk of HFpEF [HR (95% CI): 1.61, 95% confidence interval: 1.12, 2.31)], but not HFrEF [1.18 (0.70,1.96)] compared to women in the lowest quartile of SDm. Higher SDm for diastolic blood pressure was not related to HFpEF [1.19 (0.85,1.65)] or HFrEF [1.56 (0.89,2.74)].

Conclusions:
Greater systolic BPV was associated with a higher risk of HFpEF independent of mean blood pressure and coronary events interim to HF hospitalization. These findings suggest that control of BPV may be a relevant target for the prevention of HFpEF in postmenopausal women.
Abstract MP63: Childhood-onset Obstructive Sleep Apnea Is Associated With Increased Risk Of Adolescent Hypertension
Authors: Fernandez-Mendoza Julio , He Fan , Calhoun Susan , Vgontzas Alexandros , Liao Duanping , Bixler Edward O
Published: May 2021

Introduction:
Obstructive sleep apnea (OSA) is an established risk factor for hypertension in adults. However, the association of childhood OSA with an increased risk of hypertension has remained elusive.

Hypothesis:
Childhood-onset OSA is longitudinally associated with hypertension in adolescence.

Methods:
We tested this hypothesis in a population-based sample of 421 children (5-12 years) from the Penn State Child Cohort who were followed-up 6-13 years later as adolescents (12-23 years). In-lab polysomnography, to ascertain the apnea/hypopnea index (AHI), and seated blood pressure were assessed at baseline and at follow-up. The presence of hypertension at follow-up was defined based on pediatric criteria dependent upon the subject’s age (below and above 13 years). Logistic regression analyses adjusted for sex, race/ethnicity, age, body mass index percentile and systolic blood pressure percentile at baseline.

Results:
Childhood OSA that persisted in the transition to adolescence was associated with 2.9-fold (95%CI=1.1-7.4) higher odds of adolescent hypertension. In contrast, childhood OSA that remitted in the transition to adolescence was not associated with increased odds of adolescent hypertension (OR=0.9, 95%CI=0.3-2.6). Adolescent-onset OSA was associated with 1.7-fold (95%CI=1.1-2.9) increased odds of adolescent hypertension.

Conclusions:
Childhood-onset persistent OSA is a risk factor for hypertension in adolescence. Remission of childhood OSA during this transitional period, which previous research has shown to be highly determined by weight loss, does not confer a significant risk of adolescent hypertension. Early life chronic adverse sleep exposures predict cardiovascular risk in adolescence, a critical developmental period.
Abstract MP64: Higher Visit-to-Visit Blood Pressure Variability In Early And Middle Childhood Is Associated With Higher Blood Pressure In Adolescence
Authors: Zhang Mingyu , Appel Lawrence J , Wang Xiaobin , Mueller Noel T
Published: May 2021

Background:
In young adults, higher blood pressure (BP) and visit-to-visit BP variability are independent risk factors for incident cardiovascular disease. No studies have examined if BP and visit-to-visit BP variability during early and middle childhood are independently associated with elevated BP during adolescence. Addressing this question can provide targets for primordial prevention of high BP.

Hypotheses:
Higher BP and BP variability in early and middle childhood are independently associated with higher BP in adolescence.

Methods:
We studied 476 children in the Boston Birth Cohort (enrolled 1998-2016) who had BP measured in early (1 to <6 y) or middle childhood (6 to <13y) and in adolescence (13 to <18 y). We modelled visit-to-visit BP variability using variability independent of the mean (VIM). We used linear regression models to examine the associations of mean BP and BP VIM in early and middle childhood (exposures) with mean BP in adolescence (outcome) and adjusted for potential confounders (see Table footnote).

Results:
After multivariable adjustment, a 1-SD higher level of systolic BP (SBP) in early and middle childhood was associated with a 1.89 (95% CI: 1.03, 2.75) and a 4.31 (95% CI: 3.58, 5.03) mmHg higher SBP in adolescence, respectively. A 1-SD higher level of SBP VIM in early and middle childhood was associated with a 1.46 (95% CI: 0.54, 2.38) and a 0.89 (95% CI: 0.05, 1.73) mmHg higher SBP in adolescence, respectively. Higher diastolic BP (DBP) in early and middle childhood was also associated with higher adolescence DBP, but the magnitude was smaller in comparison with SBP results (
Table
). Childhood DBP VIM was not associated with DBP in adolescence.

Conclusion:
In this prospective US predominantly minority birth cohort, both BP levels and variability during early and middle childhood are associated with higher BP in adolescence. Our findings underscore the need for health professionals to collect early-life BP data to facilitate opportunities for the primordial prevention of high BP in adolescence and beyond.
Abstract MP68: The Association Of Long-term Air Pollution Exposure With Left Ventricular Structure And Function In The Multi-ethnic Study Of Atherosclerosis
Authors: Austin Thomas R , Sitlani Colleen , Lindström Sara , Psaty Bruce M , Lima Joao , Kaufman Joel D , Heckbert Susan R
Published: May 2021

Background:
Air pollution contributes to cardiovascular morbidity, including heart failure. Exposure to pollutants has been associated with hypertension and inflammation, which contribute to cardiac remodeling. Few studies have investigated long-term air pollution concentrations and measures of cardiac structure, and no large longitudinal analyses have investigated this association.

Hypothesis:
Long-term air pollution concentrations are associated with magnetic resonance imaging-derived measures of left ventricular structure and function.

Methods:
In the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated cross-sectional and longitudinal associations between modeled fine particulate matter (PM2.5), oxides of nitrogen (NOX) and ozone (O3) concentrations and left ventricular mass index (LVMI), mass to volume ratio, ejection fraction, and circumferential strain by cardiac magnetic resonance imaging (CMR) at two time points roughly 10 years apart. Multivariable linear regression was used to estimate the association between pollutants and both cross-sectional and longitudinal CMR measures.

Results:
At MESA Exam 1 (2000-2002), 4,825 participants in our cross-sectional analysis sample had a mean age of 61 years (standard deviation: 10), 53% were women, 40% were white, 13% were Chinese-American, 25% were African-American, and 21% were Hispanic. At Exam 1, Higher concentrations of PM2.5 and NOX in the year prior to Exam 1 were associated with higher LVMI at Exam 1 (1.6% per 5ug/m3 higher PM2.5, 95% CI: 0.3, 2.9; 1.8% per 40 parts per billion [ppb] NOX, 95% CI: 0.3, 3.3) and higher O3 was associated with lower LVMI (-3.5% per 10ppb, 95% CI: -6.0, -1.0). In longitudinal analyses, higher NOX was associated with a worsening of LV circumferential strain (-0.87% per 40ppb, 95% CI: -1.69, -0.05).

Conclusions:
Our study offers mixed evidence of a cross-sectional association between higher PM2.5 and NOx concentrations and greater LVMI. We also found associations between greater O3 concentration and lower cross-sectional LVMI, though this association may be confounded by other pollutants. These findings suggest a role for NOX, PM2.5, and O3 in cardiac remodeling. Additional work is needed to clarify that role and better understand the biological underpinnings of these associations.
Abstract P006: Multimorbidity In Patients With Atrial Fibrillation: A Community Study
Authors: Chamberlain Alanna M , Alonso Alvaro , Noseworthy Peter A , Killian Jill , Weston Susan , Roger Veronique L , Ryu Euijung
Published: May 2021

Background:
Multimorbidity is common in patients with atrial fibrillation (AF), yet comorbidity patterns are not well documented.

Methods:
The prevalence of 18 chronic conditions was obtained in patients with AF from 2013-2017 from a 27-county region in the Midwest. All patients had AF documented on an electrocardiogram or Holter monitor. To compare comorbidity patterns between patients with and without AF, controls were matched 1:1 on age (± 5 years) and sex. For AF patients and controls separately, the Somers’ D statistic was used to quantify the non-random concordance of each pair of chronic conditions beyond chance (ranging from -1 [perfect disagreement] to 1 [perfect agreement]; 0 indicating coincidental agreement by chance alone). Significance of the Somers’ D statistic was evaluated using a permutation approach with the Benjamini-Hochberg procedure for controlling the false discovery rate at 0.1%.

Results:
Among the 16,543 patients with AF (median age 76 years, 57% men), the most common conditions were hypertension (70%), hyperlipidemia (61%), arthritis (41%), and diabetes (40%). Many pairs of chronic conditions co-occurred more frequently than expected. However, no material differences were observed in the co-occurrence of conditions in patients with AF compared to controls (data not shown). Among patients with AF, the co-occurrence of conditions differed by age (Figure). In those ≤65 years, the strongest co-occurrence of conditions was depression/anxiety, although several condition pairs had Somers’ D statistics of >0.4. In those aged 65-74 years, hypertension/hyperlipidemia and depression/anxiety had the strongest co-occurrence, whereas hypertension/hyperlipidemia was strongest for those aged ≥75 years.

Conclusion:
Although differences in the co-occurrence of conditions did not exist between AF and community controls, among the patients with AF, the patterns of co-existing conditions differed by age. A better understanding of the clinical consequences of multimorbidity in AF patients is needed.
Abstract P007: Ankle-brachial Index And Cardiovascular Outcomes In Older Adults: The Atherosclerosis Risk In Communities Study
Authors: Wang Frances M , Yang Chao , Ballew Shoshana , Kalbaugh Corey A , Meyer Michelle L , Tanaka Hirofumi , Heiss Gerardo M , Allison Matthew A , Salameh Maya , Coresh Josef , Matsushita Kunihiro
Published: May 2021

Introduction:
The ankle-brachial index (ABI) is a representative diagnostic indicator of peripheral artery disease (PAD) and recognized as a risk enhancer in the ACC/AHA guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, our understanding of the association between ABI and cardiovascular (CVD) risk in older adults is limited. Additionally, the prognostic value of ABI among individuals with prior ASCVD is not well understood.

Hypothesis:
In a contemporary cohort of older adults, low ABI is independently associated with higher risk of CVD events, regardless of prevalent ASCVD at baseline (coronary heart disease [CHD], stroke, and/or symptomatic PAD).

Methods:
At ARIC Visit 5 (2011-2013), we studied 5,005 participants (4,160 without prior ASCVD [median age 74 years, 38% male], and 843 with ASCVD [median age 76 years, 65% male]). We quantified the association between ABI categories and subsequent risk of heart failure (HF) and composite CHD/stroke using multivariable Cox proportional hazards models.

Results:
Over a median follow-up of 5.5 years, we observed 400 CHD/stroke and 338 HF cases (242 CHD/stroke and 199 HF cases in those without prior ASCVD). After adjustment for CVD risk factors, in those without ASCVD history, ABI ≤0.9 was associated with a higher risk of both CHD/stroke and HF (
Table
). In those with a history of ASCVD, low ABI was not significantly associated with CHD/stroke, but was associated with HF (hazard ratio 7.1, 95% CI: 2.5-20.5); ABI categories of 0.9-1.1 and >1.3 were also significantly associated with HF. Addition of ABI to traditional risk factors improved prediction of CHD/stroke risk in those without prior ASCVD and prediction of HF, regardless of baseline ASCVD (
Table
).

Conclusions:
Low ABI (≤0.9) was associated with incident CHD/stroke in those without prior ASCVD and HF regardless of baseline ASCVD status. These results support ABI as a risk enhancer for guiding primary prevention of ASCVD and suggest its potential value in HF risk assessment for older adults.
Abstract P010: Cardiac Troponin T Based On The Latest Generation Assay And Cardiovascular Disease: The Atherosclerosis Risk In Communities (ARIC) Study
Authors: Honda Yasuyuki , Mok Yejin , Ishigami Junichi , Ashley Kellan E , Hoogeveen Ron C , Ballantyne Christie M , Karger Amy , Selvin Elizabeth , Matsushita Kunihiro
Published: May 2021

Background:
High-sensitivity cardiac troponin T (TnT) is a potent predictor of cardiovascular disease (CVD) in the general population. Recently, the US FDA has approved Roche fifth generation (Gen 5) TnT assay (more sensitive than the fourth generation [Gen 4] TnT assay). Since many previous epidemiological studies used Gen 4 TnT, it is important to characterize the association of Gen 5 TnT with major CVD events.

Methods:
We first assessed correlation of Gen 5 vs. Gen 4 TnT in a subsample of 91 participants. Then, as the main analysis, we examined the association of Gen 5 TnT at visit 3 (1993-1995) with major CVD events (coronary heart disease [CHD], stroke, heart failure [HF], and peripheral artery disease [PAD]). Gen 5 TnT was categorized as <6 (limit of quantification), 6-<8, 8-<14, 14-<19, and ≥19 ng/L. CHD and stroke events were adjudicated whereas HF and PAD were based on hospitalization codes. We also conducted a subgroup analysis by prevalent CVD at baseline.

Results:
Gen 5 TnT and Gen 4 TnT had a correlation coefficient of 0.98 (0.88 after excluding outliers >3SD). Of 11,979 participants (mean age 60 [SD 6] years, 1,840 [15%] with prevalent CVD), 5,856 (49%) participants had quantifiable levels of TnT. During a median follow-up of 22.1 years, there were 1,850 CHD events, 1,075 stroke events, 2,908 HF cases, and 571 PAD cases. Gen 5 TnT showed a robust dose response association with each CVD type, with adjusted hazard ratio 2-4 for TnT ≥19 (vs.<6) ng/L (
Table
). Even the category 6-<8 ng/L showed significantly elevated risk for all outcomes except stroke. The associations were stronger for HF and PAD than CHD or stroke (all p-values using seemingly unrelated regression <0.001). The associations were similar regardless of baseline CVD status.

Conclusions:
Gen 5 TnT was highly correlated with Gen 4 TnT and gave quantifiable values in half middle-aged adults. Gen 5 TnT was robustly associated with major CVD events (especially HF and PAD) in the general population, supporting its usefulness in epidemiological research and clinical practice.
Abstract P011: Serum Adiponectin And Risk Of Incident Hypertension: The REasons For Geographic And Racial Differences In Stroke (REGARDS) Study.
Authors: Singal Aneesh , Cushman Mary , Zakai Neil A , Olson Nels C , Howard George , Howard Virginia J , Judd Suzanne E , Carson April P , Plante Timothy B
Published: May 2021

Background:
Hypertension is a leading cause of disability-adjusted life years lost in the United States. Adiponectin is a cytokine secreted by adipocytes that increases insulin sensitivity, maintains vascular homeostasis, and is inversely associated with adiposity. We sought to determine the risk of incident hypertension by level of adiponectin at baseline.

Methods:
The REasons for Geographic and Racial Differences in Stroke (REGARDS) study enrolled 30,239 Black and White US adults in 2003-2006, with a second visit ~9 years later. Adiponectin was measured at the baseline visit among a random sample of 4,400 participants who attended the second visit. Modified Poisson regression estimated the relative risk (RR) for incident hypertension by each 1 SD higher of log-transformed adiponectin level adjusting for age, race, and sex in a minimally adjusted model. The fully adjusted model added Southern Diet pattern, dietary ratio of sodium to potassium, BMI, waist circumference, and systolic blood pressure. Restricted cubic splines visualized RR of hypertension by level of adiponectin, relative to the median.

Results:
After excluding those with prevalent hypertension (threshold 140/90 mm Hg or blood pressure medication use; n=2477) and missing adiponectin (n =129), 1,877 participants remained (mean age 62 years, 49% male, 36% Black, with lower adiponectin in Black participants p<0.001). Incident hypertension occurred in 46% (95% CI 43, 50%) of Black adults and 32% (29, 34%) of White adults. The RR for incident hypertension for each 1-SD higher log adiponectin was 0.91 (0.83, 1.00) in the demographic model and 0.99 (0.89, 1.10) in the fully adjusted model. Hypertension risk was similar across the continuum of adiponectin (
Figure
).

Conclusions:
In a cohort of Black and White US adults without hypertension, level of adiponectin did not associate with risk of incident hypertension 9 years later after adjusting for other hypertension risk factors.
Abstract P029: Non-high Density Lipoprotein Is A Residual Risk For The Progression Of Endothelial Dysfunction In Patients With Well Controlled Low-density Lipoprotein Cholesterol: Multicenter Prospective Study FMDJ Study
Authors: Matsumoto Chisa , Tomiyama Hirofumi , Chikamori Taishiro
Published: May 2021

Introduction:
Recently, several guidelines suggest the usefulness of non-high density lipoprotein cholesterol (non-HDLC) as a secondary treatment target for CVD prevention, next to low-density lipoprotein cholesterol (LDLC). However, its effect on endothelial dysfunction have not been fully clarified. The objective of this multicenter-prospective-observational study, FMD-J Study, is to evaluate whether non-HDLC is a residual risk for the progression of endothelial dysfunction in patients with hypertension.

Hypothesis:
Non-HDLC is a residual risk for the progression of endothelial dysfunction in patients with hypertension.

Methods:
633 treated hypertensive patients (mean age 62±9 years) in the FMD-J study were followed for 3 years. Endothelial function was evaluated by the change of flow mediated vasodilation (FMD). Multivariate regression analysis adjusted for established coronary heart disease (CHD) risk factors (sex, age, BMI, systolic blood pressure, heart rate, fasting blood glucose, high density lipoprotein cholesterol, baseline FMD, current smoking, treatment of diabetes, and treatment of dyslipidemia) was performed to evaluate whether LDLC and non-HDLC were associated with the change of FMD. We also performed secondary analysis to evaluate whether non-HDLC is associated with progression of endothelial dysfunction in patients with well controlled LDLC level according to their CHD risk. CHD risk was evaluated by Suita score, which is established risk score to assess the 10-year risk of CHD for the Japanese population. (High-risk: 56≦Suita score, Mid-risk: 41≦Suita score≦55, Low-risk: Suita score≦40) Target controlled LDLC levels according to CHD risk were defined as follows; High-risk: LDLC<70 mg/dl, Mid-risk: LDLC<100 mg/dl, Low-risk: LDLC<70 mg/dl.

Results:
Mean change of FMD after 3 years was 0.07±2.97% and mean Suita score was 46.4±8.9. Overall, both higher LDLC and non-HDLC was significantly associated with impairment of FMD. (Adjusted 1SD increase of LDLC; β: -0.26±0.11, P=0.02, Adjusted 1SD increase of non-HDLC; β: -0.25±0.11, P=0.03 ). In secondary analysis, 97 patients’ LDLC reached target LDLC level according to CHD risk. Among LDLC controlled group, higher non-HDLC was significantly associated with impairment of FMD. (Adjusted 1SD increase of non-HDLC; β: -0.75±0.13, P=0.02). However, among 536 patients whose LDLC did not reach target LDLC value, non-HDLC was not associated with the change pf FMD. (Adjusted 1SD increase of non-HDLC; β: -0.15±0.12, P=0.20).

Conclusions:
Non-HDLC may be a residual risk for the progression of endothelial dysfunction in patients with hypertension, especially in hypertensive patients with well controlled LDLC.
Abstract P032: Specialized Care Is Associated With Higher Cardiovascular Disease Awareness In Young Women
Authors: Patterson Sierra , Palfrey Hannah , De Ferranti Sarah D , Gooding Holly C
Published: May 2021

Introduction:
Awareness of CVD and its risk factors is low among young women. This study compared CVD knowledge and preventive behaviors among women ages 15-24 years seen in primary care versus a preventive cardiology clinic.

Hypothesis:
Young women seen in a preventive cardiology clinic would demonstrate more knowledge about CVD and its causes, and be more likely to engage in preventive behaviors.

Methods:
We recruited 403 females ages 15-24 years from two clinics in Boston, MA: a primary care clinic (n=331) and a preventive cardiology clinic (n=72). We modified the AHA Women’s Health Survey to assess CVD knowledge and lifestyle behaviors. Using logistic regression, we examined the relationship between clinic type and 1) knowledge about CVD and 2) engagement in preventive behaviors, controlling for age group, primary caregiver education level, and race/ethnicity.

Results:
Young women in preventive cardiology clinic were more likely to identify CVD as the leading cause of death for women (PR: 1.65, 95% CI: 0.96-2.85) and identify major causes of CVD, such as high cholesterol and family history of CVD (Figure). Preventive cardiology patients were more likely to report maintaining a healthy cholesterol level (PR: 1.33, 95% CI: 1.03-1.71) and were over twice as likely to discuss CVD risk with their provider within the past two years (PR: 2.34, 95% CI: 1.84-2.97), including topics such as nutrition and exercise. Notably, 41 (70%) preventive cardiology patients did not identify CVD as the major cause of mortality in women despite being able to identify CVD risk factors. Additionally, engagement in behaviors targeted in the specialized clinic remained suboptimal (Figure).

Conclusion:
Young women in a preventive cardiology clinic were more aware of CVD and its risk factors than those seen in primary care. However, gaps remained in knowledge and behavior despite specialized care. Opportunities remain in primary care and preventive cardiology clinics to increase knowledge and promote healthy behavior to reduce CVD risk in women.
Abstract P034: Family Lifestyles And Home Environments Associated With Youth Cardiovascular Health: The Multidimensional Assessment Of Preschoolers Study
Authors: Aguayo Liliana , Pool Lindsay , Davis Matthew M , Hou Lifang , Marino Bradley S , Van Horn Linda , Wakschlag Lauren S , Labarthe Darwin R , Lloyd-Jones Donald M , Allen Norrina B
Published: May 2021

Introduction:
The importance of healthy family lifestyles and home environments (e.g. environments that support healthy choices for food, physical activity, and sleep) on health behaviors and obesity risks are well-recognized. Less is known about the association of family factors with cardiovascular health (CVH) in youth. We examined the cross-sectional association of family factors (reported by youth and their parents) with youths’ CVH.

Methods:
Analyses included data from the Multidimensional Assessment of Preschoolers Study. Parents and youth (11.3± 0.7 years old) reported the frequency of ten family factors (e.g. breakfast intake, monitoring of screen time, etc.). The outcome was a 10-point score of youths’ CVH that included 5 CVH metrics (diet, physical activity, smoking, BMI, and blood pressure) summed using the AHA criteria. Pearson correlations were used to compare youth and parents’ reports of family factors and adjusted multivariable linear regression models to examine the association of both reports with youths’ CVH scores.

Results:
Study included 177 parent-youth dyads, and 22% of youth had ideal, 74% intermediate, and 5% poor CVH. Correlations between parents and youths’ reports of family factors were moderate. Based on parents’ reports, support of healthy beverage choices (i.e. limit sweet and soda beverages and support low fat dairy intake) associated with youths’ CVH scores (β= -0.10, p<0.01). The association of family’ support of youths’ physical activity (i.e. encourage youth's physical activity during leisure time and support enrollment in organized sports/activities) with youths’ CVH scores was nearly significant based on parents’ reports (β= 0.04, p=0.055) and significant based on youths’ reports (β= 0.05, p=0.04). Youths’ CVH scores were not associated with other family factors.

Conclusion:
Youths’ CVH scores were associated with healthy beverage choices and family support of youths’ physical activity, but not other family factors. These important family factors require further research.
Abstract P038: Characterizing Patterns Of Fruits And Vegetables Intake In Adults With And Without Chronic Kidney Disease In The United States
Authors: Pourafshar Shirin , Sharma Binu , Kranz Sibylle , Mallawaarachchi Indika , Kurland Elizabeth , Ma Jennie , Scialla Julia
Published: May 2021

Background:
Due to concerns about hyperkalemia, the recommendation for patients with chronic kidney disease (CKD) is to limit intakes of foods high in potassium, including certain types of nuts, fruits and vegetables (F&V). Detailed patterns of F&V intake have not been described in patients with CKD, limiting our ability to study higher or lower risk patterns. In this study, we aimed to characterize the patterns of F&V intake in adults with and without CKD in a nationally representative sample of the US.

Methods:
We included 16,183 adults, with (n= 3,225) and without (n= 12,958) CKD based on eGFR and albuminuria from the Third National Health and Nutrition Examination Survey (NHANES III). We calculated counts of different types of F&V consumed by the participants according to a 24-h recall interview reported in the NHANES III Individual Food File. Based on their phytonutrient and starch content, F&V were then categorized into: rich in polyphenols; rich in carotenoids; rich in glucosinolates, and high in starch. We also categorized consumption of legumes and nuts. Patterns of legumes, nuts, and F&V intake were identified using latent class analysis (LCA; LCCA package, R 3.0.1). We evaluated differences in serum carotenoids, vitamins A, E, and C as objective biomarkers to help validate patterns. Multinomial logistic regression incorporating survey weights was used to adjust association between CKD status and F&V patterns (SAS Institute, V.9.4).

Results:
LCA analysis classified the food consumption into 3 distinct patterns: low F&V/low starch; moderate F&V/high starch; and high F&V/moderate starch. Consumption of legumes and nuts was low in all three patterns. Pattern of higher F&V consumption had higher serum levels of carotenoids, vitamins A, E, and C (p for difference across patterns <0.0001). Unadjusted patterns of consumption were not different in patients with vs. without CKD (p=0.654). After adjustment for ethnicity, gender, body mass index, waist circumference, diabetes, and hypertension, patients with CKD were more likely to consume moderate F&V/ high starch (OR=1.23, p=0.0316) or low F&V/starch (OR=1.34, p=0.0001) compared to patients without CKD.

Conclusions:
Utilizing the LCA analysis and regression, we found higher likelihood of consuming low F&V patterns in patients with vs. without CKD in the US. Further studies are needed to evaluate outcomes to understand risks of benefits of F&V patterns for patients with CKD.
Abstract P042: Association Between Covid-19 Pandemic Related Unemployment And Change In Sedentary Screen Time Among Previously Employed Adults
Authors: Mattingly Jennifer L , Petrov Megan E
Published: May 2021

Association between COVID-19 Pandemic Related Unemployment and Change in Sedentary Screen Time among Previously Employed Adults Jennifer L. Mattingly, MPH & Megan E. Petrov, PhD

Introduction:
Worldwide, the COVID-19 pandemic has resulted in widespread job loss and disruptions in daily life. However, the role of job loss during the COVID-19 pandemic on health behaviors such as sedentary screen time (SST) is unknown. The purpose of this study was to determine the association between employment status change during the pandemic and change in SST.

Methods:
A 25-minute online survey was distributed through local and global social media from 5/21/2020-7/01/2020. A subsample of employed adults (n=417;
M
=38.45y, range: 18-75; 74.8.% women) provided complete self-reported pre-and during-COVID-19 employment status (categorized as remained employed and became unemployed), pre-and during-COVID-19 hours of daily SST for non-work-related purposes [low: <5h; high: >5]. Change in daily SST was categorized as low-low (ref), low-high, and high-high. The subsample of participants that changed from high to low SST in the sample was low and were removed from subsequent analyses. Multinomial logistic regression models were conducted to examine the association of change in employment status on change in SST while adjusting for age, gender, education level, body mass index, current minutes of physical activity per week, and current typical 24-hour sleep duration.

Results:
Of the 417 participants who were employed prior to the pandemic, 15.6% (n=675). Became Unemployed. The proportion of participants in the low-low, low-high, and high-high change in SST groups were 46.8% (n=195), 25.4% (n=106), and 27.8% (n=116), respectively. Relative to adults who remained employed, adults who became unemployed had a 3.02 greater odds (95%CI:1.51, 6.02) of being in the high-high change in SST group, and had a 2.54 greater odds (95%CI:1.23,5.25) of being in the low-high change in SST group relative to participants who were consistently low in SST.

Conclusion:
In this cross-sectional study of an international, online sample of adults, becoming unemployed was associated with a greater odds of both maintaining high levels of sedentary screen time, and increasing sedentary screen time to high levels. Action to protect people in the workforce from job loss and employment disruption in times of global economic upheaval may prevent increased adoption of maladaptive lifestyle behaviors, such as high levels of SST.
Abstract P043:

Distance And Clinical Outcomes Of Patients Admitted For Covid-19: Lessons Learned From The Neighbors Of An Inner-city Hospital.
Authors: Patel Shivani , Kazmi Aeliya , Sherif Muhammed , Chennu Gouthami , Lee Steve , Khan Umair , Safoah Nana , Mallam Saadul , Chakka Srita , Bustillo Jose , Okoh Alexis K
Published: May 2021

Background:
In rural areas, the distance factor has been identified as key in the utilization of health services. We aim to determine whether distance to an inner-city hospital in Newark, was associated with mortality in patients admitted for COVID-19 during the peak of the pandemic.

Methods:
Patients who were admitted for COVID-19 at the Newark Beth Israel Medical Center (NBIMC) were stratified into two groups based on distance between the zip codes of their primary residence and the hospital. Baseline demographics, clinical characteristics and in-hospital outcomes were compared between subjects living within a 2-mile radius of the zip code of the hospital [Neighbors] and those living further than 2 miles [Distant]. The primary outcome was in-hospital mortality. Secondary outcomes were admission to the intensive care unit (ICU), length of hospitalization, and discharge disposition.

Results:
Between March 09 and May 04, 2020, a total of 769 patients were admitted for COVID-19 at NBIMC. 406 (53%) resided within a 2-mile radius of the hospital location. Of these 44% were obese. History of hypertension, diabetes mellitus and coronary artery disease was documented in 69%, 48% and 23% respectively. Compared with distant patients, neighbors were older (59 vs. 69 yrs. P=0.048), mostly of Black/African American race (64% vs. 82%; p<0.001) and had a higher incidence of diabetes mellitus (40% vs. 48%; p=0.025) or coronary artery disease (17% vs. 23%; p=0.039). Visitors were more likely to report an exposure history to a COVID-19 patient than neighbors (31% vs. 21%, p=0.001). In-hospital death rate were significantly higher in neighbors than visitors (32% vs. 22%, p=0.007). Admission to the ICU was similar between both groups (p=0.438). Among those who survived to discharge, distant patients had longer length of hospitalization (12 vs. 10 days; p=0.006), than neighbors. Discharge disposition was comparable in both groups (p=0.249)

Conclusions:
In this cross-sectional study of patients admitted to an inner-city hospital for COVID-19, majority of patients living within a 2-mile radius were of Blacks/African Americans who had a higher incidence of DM and CAD. A paradoxical association between distance to the hospital and in-hospital mortality was observed. Based on these findings, targeted interventions aimed at Impacting social determinants of health seem prudent.