bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P272: Baseline Diet and Long-term Efficacy of a Multivitamin Supplement on Cardiovascular Disease in The Physicians’ Health Study Ii - A Randomized Controlled Trial
Authors: Rautiainen Susanne , Gaziano J. Michael , Christen William G , Glynn Robert J , Manson JoAnn E , Buring Julie E , Sesso Howard D
Published: March 2022

Background:
Many in the US population take a multivitamin supplement to improve or maintain health however, evidence for long-term health benefits remains scarce. The Physicians’ Health Study II (PHS II) is the only randomized trial investigating the effect from a common multivitamin in men, for which no effect was seen on cardiovascular disease (CVD). An important consideration is the modifying role of baseline nutritional status, as a multivitamin may be more or less efficacious to those with extreme nutritional intake.

Hypothesis:
Baseline nutritional status modifies the effect of a multivitamin on the risk of CVD.

Methods:
The PHS II is a randomized, double-blind, placebo-controlled trial evaluating the effects of a multivitamin (Centrum Silver or placebo daily) including 14,641 men aged ≥50 years. Baseline diet was assessed through a 116-item food frequency questionnaire among 13,316 men (91%). We tested the interaction between the randomized multivitamin and tertiles of each dietary factor (Alternate Healthy Eating Index, Alternate Mediterranean Diet score, vitamin B6, B12, folate, vitamin C, calcium, and magnesium) as well as the trend in HRs across tertiles.

Results:
During an average 11.2 years of follow-up, there were 1487 cases of CVD, 586 cases of myocardial infarction (MI), 559 cases of total stroke, 626 CVD death, and 2086 total deaths. There was no consistent evidence for effect modification by dietary factors. Vitamin B6 modified the effect of multivitamin use on MI (P, interaction=0.01) with an increased risk among men in lowest tertile and decreased risk in highest tertile. The effect on CVD death was modified by vitamin B12 intake with a nonsignificant decreased risk only among men in the lowest tertile, with similar effects noted for total mortality (P, interaction=0.04).

Conclusion:
For the majority of dietary factors, there was no evidence that the effect of multivitamin use on major CVD and associated endpoints is modified by individual baseline dietary factors in middle-aged and older male physicians.
Abstract P275: Food Insecurity is Associated with Increased Cardiovascular Risk in US Adults
Authors: Sattler Elisabeth L , Bhargava Vibha
Published: March 2022

Background:
Food insecurity has been associated with hypertension, hyperlipidemia, and diabetes in US adults; however, our knowledge of the association between food security status and overall cardiovascular risk in US adults is limited.

Objective:
To examine the association between food security status and cardiovascular risk in US adults.

Methods:
We performed cross-sectional analysis on 7,439 adults aged ≥ 20 years (mean age 44.12±12.97 years, 52% male, 73% Non-Hispanic White) using data from the National Health and Nutrition Examination Survey 2007-2012. Food security was measured using the validated 18-item US Household Food Security Survey Module. Cardiovascular risk was measured using the American Heart Association’s Life’s Simple 7 (LS7) criteria, with each component being categorized as poor, intermediate, or ideal. Ideal vs. non-ideal levels of each component and the total number of ideal LS7 components (0-4 and 5-7) were compared by food security status. Multivariate logistic regression models were used and adjusted for sociodemographic, economic, and health characteristics.

Results:
A total of 13% of adults were food insecure and 16% attained ideal scores on 5-7 LS7 components. Compared to food secure, food insecure adults were less likely to be non-Hispanic White, have college education, married, have health insurance coverage, and report excellent health. Food insecure adults were significantly less likely to have ideal scores on 5-7 LS7 components than food secure adults (14.5% vs. 17.7%, p=0.04). In logistic regression models, food insecure had significantly lower odds of attaining ideal scores on 5-7 LS7 components [OR=0.72 (95% CI 0.56-0.92)]. Food insecure were also less likely to have ideal scores on total cholesterol [OR=0.78 (0.62-0.98)], blood glucose [OR=0.77 (0.64-0.92)], BMI [OR=0.82 (0.70-0.97)], and smoking [OR=0.60 (0.47-0.74)].

Conclusion:
Food insecure adults are at increased cardiovascular risk. Prevention efforts should be emphasized in this vulnerable population.
Abstract P289: Sex Differences in the Rate of Visceral Adipose Tissue Accrual During Adulthood
Authors: Whitaker Kara M , Choh Audrey C , Lee Miryoung , Czerwinski Stefan A , Demerath Ellen W
Published: March 2022

Introduction:
Excess visceral adipose tissue (VAT) robustly predicts incident cardiometabolic risk, independent of body mass index (BMI), and this association is stronger in women than in men. Cross-sectional studies suggest that VAT accrual accelerates in older women as compared to similarly aged men, in concert with menopausal changes, which may help to explain the greater effect of VAT on subsequent disease risk observed in women. However, a direct test of sex differences in the rate of VAT accrual requires longitudinal VAT data which have been largely lacking.

Objectives:
This analysis evaluated sex differences in the rate of VAT accrual in adults. Secondary analyses examined differences in the rate of VAT accrual in pre-, peri-, and post-menopausal women.

Methods:
Participants were 532 (59% female) non-Hispanic white adults, aged 18-84 years at baseline, who were enrolled in a study of normative changes in body composition over the lifespan. Abdominal VAT mass and subcutaneous adipose tissue (SAT) mass were assessed using multiple-image magnetic resonance imaging at two time points, with an average follow-up of 7.2 ± 2.5 years. Linear regression models were used to examine the effects of sex, baseline age, and their interaction on rate of change per year in body composition measures (ΔBMI, ΔVAT, and ΔVAT/SAT ratio (ΔVSR)) independent of baseline body composition measures and baseline visit year. Secondary analyses examined differences in these rates of change by baseline menopausal status (pre, peri, post), after adjustment for baseline age.

Results:
Levels of BMI, VAT, and VSR all increased over the follow-up period on average; however, the change in BMI (mean ΔBMI = +0.5%) was far smaller than for VAT (mean ΔVAT=+6.3%) and VSR (mean ΔVSR = +3.4%). ΔVAT and ΔBMI decreased linearly with age in both sexes (p<0.001), such that older individuals had lower rates of VAT and BMI gain, and this deceleration in VAT and BMI accrual was greater in men than women (p for interaction 0.007 and 0.038, respectively). ΔVSR did not vary with age in either sex, but remained higher in men than women throughout adulthood. ΔBMI, ΔVAT, and ΔVSR did not differ by baseline menopausal status.

Conclusions:
VAT mass increased with age in both men and women, but the rate of VAT gain gradually declined with advancing age. There was no evidence of accelerated VAT accrual during menopause as previously reported in the literature. However, the rate of VAT gain was more consistent in women during adulthood than in men, who exhibited greater deceleration. Future work will explore whether this sex difference in the pattern of body composition change explains the differential effects of VAT on disease risk in men and women.
Abstract P291: Projected Heterogeneity in the Long-term Effects of Obesity Interventions Across the Life Course
Authors: Avery Christy L , Schönbach Johanna K , Palta Priya A , Wheeler Stephanie B , Lhachimi Stefan K
Published: March 2022

Approximately 69% of U.S. adults are obese or overweight, with African Americans (AA) and Mexican Americans (MA) shouldering disproportionate burdens when compared to Caucasian Americans (CA). Despite the vast resources dedicated to testing obesity interventions, few studies have compared their effectiveness for obesity prevention across the life course or in multi-ethnic populations. We therefore leveraged race/ethnic- and sex-specific body mass index and population size estimates from the National Health and Nutrition Examination Survey (n=15,007; 2007-12; ages 18-80), mortality rates from the National Center for Health Statistics (2010), previously estimated net transition probabilities, and the Dynamic Modeling for Health Impact Assessment simulation tool to project the effects of two classes of obesity interventions by race/ethnicity (AA; CA; MA) and sex: interventions that proportionally decreased the prevalence of overweight and obesity at age 18, thereby modeling the cumulative effect of interventions throughout childhood and adolescence; and interventions that proportionally decreased the probability of transitioning to overweight or obesity in adults 18-80 years. At age 18, the prevalence of obesity ranged from 17-32%, with the lowest prevalence estimated for CA females and the highest estimated for AA females. Interventions achieving a 10% proportional decrease in the prevalence of overweight and obesity at age 18 were associated with modest decreases in the prevalence of obesity later in life, with the greatest benefits projected for MA males (e.g., an 8.8% proportional decrease in obesity at age 40) and the smallest benefits projected for AA females (e.g., a 5.5% proportional decrease in obesity at age 40). In comparison, projected effects of interventions achieving a 10% proportional decrease in the probability of transitioning to overweight and obesity in adults 18-80 years of age were smaller in magnitude, with the greatest benefits projected for CA females (e.g., a 6.2% proportional decrease in obesity at age 40) and the smallest benefits projected for MA males (e.g., a 2.8% proportional decrease in obesity at age 40). When both interventions were applied simultaneously, the largest effects were projected for CA males and females (e.g., a 12.5% proportional decrease in obesity at age 40). We conclude that both classes of interventions decrease the prevalence of obesity across the life course, but they are not equivalent and could potentially exacerbate longstanding disparities. Further work evaluating the race/ethnic- and sex-specific optimal age epochs at which to intervene is therefore warranted.
Abstract P299: Lifespan Body Mass Index Change by Race and Education: Gain and Loss During the Obesity Epidemic
Authors: Quaye Emmanuel M , Selvin Elizabeth , Ndumele Chiadi , Matsushita Kunihiro , Bandeen-Roche Karen , Stevens June , Palta Priya , Wagenknecht Lynne , Coresh Josef
Published: March 2022

Introduction:
The obesity epidemic in the United States accelerated in the late 1970’s and has lifelong effects. Longitudinal patterns of racial/ethnic and socioeconomic differences in weight gain across the lifespan are relatively uncharacterized.

Hypothesis:
Weight gain starts earlier and is larger in individuals who are black or have less education compared to those who are white or have higher education; weight loss after midlife shows similar patterns.

Methods:
We analyzed body mass index (BMI, kg/m2) changes in 14,291 ARIC participants (ages 45 - 64) followed from Visit 1 (1987 - 89) to Visit 5 (2011 - 13, Table 1). Participant BMI at age 25 was ascertained by self-report at the time of study enrollment. BMI change between these time points was categorized as stable (<+/-2 kg/m2, average of <+/-13 lbs.), increasing or decreasing (>+/-2 kg/m2) and analyzed using multinomial logistic regression.

Results:
Table 1 shows BMI change and its associations with race and education. BMI change from age 25 to visit 1 (median age: 54) increased in 71%, was stable in 25% and decreased in 4% of participants. In midlife (visit 1 [1987 - 89] to visit 4 [1996 - 98]), an increase in BMI was more common (33%) compared to a decrease in BMI (7%). However, at older age (visit 4 [1996 - 98] to visit 5 [2011 - 2013]), both an increase and decrease in BMI (23% and 21% respectively) were common. Multinomial logistic regression demonstrated that being black, and having lower education, was consistently associated with weight gain from age 25 to midlife (visit 1). Interestingly, weight loss was also more common among blacks than whites, particularly at older age.

Conclusion:
Increases in BMI over the lifespan are common; weight gain from young adulthood to midlife, and both further weight gain and weight loss are common at older ages. Compared to whites, blacks experience more weight gain to midlife and greater late life weight loss. The implications for cardiovascular risk for weight gain and weight loss (a subset of which may mark poor health) needs to be explored.
Abstract P308: Individualized Statin Benefit for Determining Statin Eligibility in the Primary Prevention of Cardiovascular Disease
Authors: Thanassoulis George , Williams Ken , Altobelli Kathleen K , Pencina Michael J , Cannon Christopher P , Sniderman Allan D , Sniderman Allan D
Published: March 2022

Background:
Current guidelines recommend statins in primary prevention of cardiovascular disease based on predicted cardiovascular risk without directly considering the expected benefits of statin therapy based on the available randomized trial (RCT) evidence.

Methods and Results:
We included 2,134 participants representing 71.8 million American residents potentially eligible for statins in primary prevention from the National Health and Nutrition Examination Survey for years 2005 - 2010. We compared statin eligibilities using three separate approaches: a 10-year risk-based approach, a trials-based approach (i.e. based on inclusion criteria of statin RCTs) and an individualized benefit approach (i.e. based on a predicted absolute risk reduction over 10 years [ARR
10
]

≥2.5% using RCT data). A risk-based, a trials-based approach or a benefit-based approach led to the eligibility of (in millions of Americans): 15.0 (95% confidence interval 13.3-16.8), 24.7 (22.4-27.0) and 24.0 (21.2-26.7), respectively. The corresponding number needed to treat over 10 years was 19 (range: 9-40), 33 (9-1000) and 23 (9-40). A benefit-based approach identified 8.9 million lower-risk (<7.5% 10 year risk) Americans, not currently eligible for statin treatment, who had the same or greater expected benefit from statins (≥2.5% ARR
10
) as higher-risk individuals. This lower-risk/acceptable-benefit group includes younger individuals (mean age 55.3 years vs. 62.5 years;p<0.001 for benefit-based vs risk-based) with higher LDL-C (140 mg/dL vs. 133 mg/dL; p=0.01).

Conclusions:
An individualized statin benefit approach can identify lower-risk individuals who have equal or greater expected benefit from statins in primary prevention than higher-risk individuals. This may help identify individuals who would meaningfully benefit from earlier initiation of statin therapy.
Abstract P311: The Triglyceride Response to a Sugar Load Parallels the Glycemic Response
Authors: Hartz Jacob , Cure Pablo , Carty Cara , Cure-Cure Carlos , Mietus-Snyder Michelle
Published: March 2022

Introduction:
Hyperlipidemia, traditionally defined with fasting lipid values, is a common cardiovascular risk factor, particularly in patients with insulin resistance, prediabetes and type 2 diabetes mellitus (DM). Nonfasting triglyceride levels (TG), however, have shown a stronger association with heart disease and stroke than fasting levels, independent of traditional CV risk factors. The objective of this study was to determine the relationship between TG and glucose levels after administration of a sucrose load (equal parts glucose and fructose) in individuals without a previous diagnosis of DM.

Hypothesis:
Sugar as a sole energy source will elicit both a lipemic and a glycemic response.

Methods:
We use a unique dataset from a single health clinic in Barranquilla, Colombia in which 1,446 adults aged 18 to 80 years (mean age, 49 years, 3 months, 77 percent female) were enrolled from 2002 - 2005. Serum TG and glucose levels were measured after an overnight fast and at two hours after administration of 75 gm of mixed carbohydrate in the form of Panela, a mixed carbohydrate made from an unrefined whole cane sugar used in beverages and in cooking in this area of Colombia. A solid form of sucrose, it contains equal parts of glucose and fructose. Regression analysis was performed to evaluate factors associated with the glycemic and lipemic responses.

Results:
We found that the absolute 2-hour glucose (range: 32-526 mg/dL) is significantly associated (p<0.001) with 2-hour TG levels (range: 34-791 mg/dL), after controlling for sex, age, and waist-to-hip ratio. In the same multivariate model, the change relative to baseline in the glucose level is also significantly associated with change in TG. In a separate analysis, in younger patients (< 49.25 years) the effect of age on triglyceride level is statistically significant (<0.01), while in older patients, the effect of age on triglyceride level is less significant (<0.1).

Conclusion:
These data suggest that a diet rich in refined carbohydrate may pose a significant risk for hyperlipidemia, particularly in younger patients. The independent role of fructose as a trigger for de novo lipogenesis may be relevant in the observed response
Abstract P312: Lack of Association Between Habitual Sleep Duration and Obesity Measures in Adolescents with Adequate Sleep
Authors: He Fan , Bixler Edward O , Fernandez-Mendoza Julio , Vgontzas Alexandros N , Berg Arthur , Imamura Kawasawa Yuka , Liao Duanping
Published: March 2022

Introduction:
In general, 7-8 hours/night of sleep is considered as adequate amount of sleep. Although subjectively reported sleep duration has been associated with obesity, the relationship between objectively-measured sleep duration and obesity has been reported inconsistently.

Hypothesis:
We assessed the hypothesis that there is lack of association between objectively-measured sleep duration and obesity measures in adolescents who generally sleep adequately.

Methods:
We used data from 421 adolescents in the Penn State Child Cohort follow-up examination. Polysomnography (PSG) was used to objectively measure the sleep duration for one night. Actigraphy was used for 7 consecutive nights to objectively measure and calculate each participant’s habitual mean sleep duration. Anthropometric measurements, including waist circumference, weight, and height, were collected from each participant. Age and sex-specific BMI percentile was calculated. The participants also underwent a dual-energy x-ray absorptiometry scan to assess abdominal obesity, as measured by Android/Gynoid (A/G) fat ratio, Android/whole body (A/W) fat proportion, visceral fat area, and subcutaneous fat area. Multivariable adjusted linear regression was used to analyze the association between sleep duration and obesity measures.

Results:
The means (SD) of the PSG and actigraphy-measured sleep duration were 7.4 (0.9) and 7.0 (0.8) hours, respectively. As shown in the table, objectively-measured sleep duration was not significantly associated with BMI percentile, after controlling for age, race, sex, and AHI. After further adjustment for BMI percentile, none of the regression coefficients between sleep duration and abdominal obesity measures reached statistical significance.

Conclusions:
In adolescents with generally adequate amount of sleep, there is lack of association between habitual sleep duration and obesity measures. The findings should not be generalized to adolescents whose sleep duration is outside the range of our data.
Abstract P314: Sleep Quality and High-fat vs High-vegetable Diet: Cross-sectional and Longitudinal Relationships
Authors: Grandner Michael A , Hui Siu-kuen Azor
Published: March 2022

Introduction:
Sleep and diet are closely-related aspects of lifestyle health. Several studies have examined relationships between sleep and diet. However, longitudinal relationships are largely unknown. The present study examined whether sleep predicted changes in diet.

Methods:
Data from the Kansas State Employee Wellness Program from 2008 (N=5,634) and 2009 (N=3,286) were used. Sleep quality was assessed categorized as “Never,” “Seldom,” “Sometimes,” “Often,” or “Always.” Change scores were computed and classified as “Same,” “Better” or “Worse.” Habitual diet was classified as high fat and high vegetable. For both dietary variables, change scores were computed and categorized as no change, no to yes, or yes to no. Binary logistic regressions examined whether sleep quality (reference=”Never”) was associated with high fat or vegetable diets. Multinomial logistic regressions examined whether sleep quality at baseline and change in sleep quality (Better or Worse vs Same) was associated with change in diet. All analyses were adjusted for age, sex, education, race/ethnicity, and body mass index (BMI).

Results:
At baseline, 50.01% of the sample had a high-fat diet, and 48.79% had a high-vegetable diet; notably, 39.98% of those with high fat diets also had high vegetable diets. Overall, poor sleep quality at baseline was associated with an increased likelihood of high-fat diet and decreased likelihood of high-vegetable diet (see Table). Sleep disturbance at baseline was not associated with change in diet, except that sleep disturbance “Always” was associated with an increased likelihood of losing a high-vegetable diet (OR=1.85, 95%CI [1.12,3.05], p=0.016). If sleep quality improved, gaining a high vegetable diet was more likely (OR=1.49, 95%CI [1.07,2.05], p=0.017).

Conclusions:
Poor sleep was associated with poor dietary behaviors. Further, both poor baseline sleep and worsening sleep over time predicted worsening of dietary behaviors. Sleep may therefore play a causal role in dietary change.
Abstract 03: High Neighborhood Incarceration Rate is Associated With Poor Cardiovascular Risk Profiles in Non-incarcerated Black Individual
Authors: Topel Matthew L , Kelli Heval M , Staloch Dustin A , Mohammed Kareem H , Sandesara Pratik B , Samman Tahhan Ayman , Martin Gregory S , Quyyumi Arshed A
Published: March 2022

Introduction:
Over 7 million Americans are current or former prisoners. Blacks are imprisoned at rates 4 to 10 times greater than Whites. While personal incarceration history is associated with greater all-cause mortality and incident cardiovascular disease (CVD), the impact of high neighborhood rates of incarceration on CVD risk in non-incarcerated individuals is unknown.

Hypothesis:
High neighborhood incarceration rate, defined as the upper quartile, is associated with poor individual CVD risk profile.

Methods:
A total of 1368 subjects from the Atlanta area (mean age 49 ± 10 years, 62% female [n=850], 41% Black [n=560]) were recruited from two community cohorts. Zip codes were used to link neighborhood incarceration and crime rates to individual pooled risk scores (ASCVD), risk factors for CVD including hypertension, dyslipidemia and impaired fasting glucose (IFG), and biomarkers including high-sensitivity C-reactive protein (hsCRP) and the homeostatic model assessment for insulin resistance (HOMA-IR).

Results:
High neighborhood incarceration rate was associated with high ASCVD risk score (OR=1.41, 95% CI=1.02, 1.95), hypertension (OR=1.48, 95% CI=1.05, 2.07) and dyslipidemia (OR=1.45, 95% CI=1.04, 2.04), after controlling for relevant demographic, socioeconomic and behavioral covariates. Tests for interaction with race were significant: Black individuals living in areas with high incarceration rates were more likely to have hypertension (OR=1.63, 95% CI=1.03, 2.58), dyslipidemia (OR=1.80, 95% CI=1.15, 2.83), IFG (OR=1.77, 95% CI=1.04, 3.03), and elevated HOMA-IR (OR=2.04, 95% CI=1.20, 3.47); Whites were more likely to have an elevated hsCRP (OR=1.81, 95% CI=1.02, 3.22).

Conclusions:
In conclusion, high neighborhood incarceration rate is associated with a worse CVD risk profile; this effect was more pronounced in Blacks. Neighborhood exposure to increased incarceration rates, particularly in Black communities, represents an additional health disparity that warrants further investigation.
Abstract 11: Associations of Gluten Intake With Type 2 Diabetes Risk and Weight Gain in Three Large Prospective Cohort Studies of US Men and Women
Authors: Zong Geng , Lebwohl Benjamin , Hu Frank , Sampson Laura , Dougherty Lauren , Willett Walter , Chan Andrew , Sun Qi
Published: March 2022

Background:
Gluten-free diets have grown in popularity, but evidence is lacking regarding gluten intake and long-term health.

Methods:
In Nurses’ Health Study (NHS, n=69,276), NHSII (n=88,610), and the Health Professionals Follow-Up Study (HPFS, n=41,908), we estimated gluten intake using a validated food-frequency questionnaire collected every 2-4 years. Incident T2D was defined as physician diagnosed diabetes and confirmed with supplementary information.

Results:
Gluten intake (mean ± standard deviation) was 5.83±2.23, 6.77±2.50, and 7.06±2.76 grams/day in NHS, NHSII, and HPFS, respectively, and strongly correlated with intakes of carbohydrate sources, especially refined grains, starch, and cereal fiber (Spearman correlation coefficients > 0.6). During 4.24 million years of follow-up, 15,947 T2D cases were confirmed. An inverse association between gluten intake and T2D risk was observed in all three cohorts after multivariate adjustment (table), and hazard ratio (HR, 95% confidence intervals [95%CI]) comparing extreme quintiles was 0.80(0.76, 0.84; P<0.001). The associations were slightly attenuated after further adjusting for cereal fiber (HR[95%CI]= 0.87[0.81, 0.93]), but not other carbohydrate components. Among participants without major chronic diseases and aged <65 years, changes in gluten intake were not significantly associated with weight gain in multivariate adjusted model: 4-year weight change (95%CI, lb) was 0.08(-0.06, 0.22; P=0.25) in NHS, -0.05(-0.18, 0.08; P=0.43) in NHSII, and 0.36(-0.24, 0.96; P=0.24) HPFS for each 5 grams increase in gluten intake.

Conclusions:
Our findings suggest that gluten intake may not exert significant adverse effects on the incidence of T2D or excess weight gain. Limiting gluten from diet is thus unlikely to facilitate T2D prevention and may lead to reduced consumption of cereal fiber or whole grains that help reduce diabetes risk.
Abstract 14: Diet Quality and Cardiovascular Disease Risk in Postmenopausal Women With Type 2 Diabetes: the Women’s Health Initiative
Authors: Hirahatake Kristin M , Odegaard Andrew , Wong Nathan , Malik Shaista , Jiang Luohua , Shikany James , Eaton Charles , Allison Matthew , Martin Lisa , Garcia Lorena , Zaslavsky Oleg
Published: March 2022

Introduction:
Both type 2 diabetes (T2D) and cardiovascular disease (CVD) are known to be influenced by dietary intake, however there is little evidence from large and well characterized cohort studies regarding the relationship between popular dietary patterns and CVD risk in populations with T2D. Understanding how common diet scores associate with CVD risk may provide better nutrition recommendations, education, and targeted interventions in the population with T2D.

Hypothesis:
We hypothesize that high diet quality as represented by higher scores on four different a priori diet indices is associated with a lower risk of developing CVD in postmenopausal women with T2D.

Methods:
We analyzed data of 6031 postmenopausal women with type 2 diabetes from the Women’s Health Initiative (WHI) cohort with no history of CVD at baseline. Dietary intake was assessed by a validated WHI food frequency questionnaire. Diet scores for four different diet patterns were calculated: Mediterranean (aMed), Dietary Approaches to Stop Hypertension (DASH), Paleolithic diet, and American Diabetes Association dietary recommendations (ADA). Multivariate Cox proportional hazards regression was used to estimate the hazard ratio of incident coronary heart disease (CHD) and stroke during study follow up for each dietary pattern score, adjusting for demographic, lifestyle and clinical measures.

Results:
Over 21 years of follow up 11.2% (675/6031) of women developed CHD and 6.7% (408/6031) had a stroke. There was a strong, monotonic inverse association between higher aMed, DASH, and ADA diet scores and risk of incident CHD and stroke; and no association between the Paleolithic dietary pattern score and CHD or stroke (Table 1).

Conclusions:
There are multiple dietary avenues to lower CVD risk in a population with T2D via the aMed, DASH, and ADA diets; whereas there was no evidence the Paleolithic diet score is associated with CVD risk in a population with T2D.
Abstract 15: The Impact of Suboptimal Diet on Cardiovascular Disease Mortality in the United States
Authors: Afshin Ashkan , Sur Patrick ,   GBD 2015 Risk Factors Collaborators
Published: March 2022

Introduction:
Poor dietary habits are an established risk factor to cardiovascular disease (CVD). Yet, the impact of suboptimal diet on CVD mortality in the US has not been systematically evaluated.

Objective:
To quantify the effect of suboptimal intake of 11 dietary factors (fruits, vegetables, nuts, whole grains, processed meat, sugar-sweetened beverages, seafood omega-3 fatty acids, polyunsaturated fatty acids, trans fatty acids, fiber, sodium) on CVD mortality by age and sex in the US in 2015.

Methods:
Using the Global Burden of Disease study analytic framework, we conducted a comparative risk assessment analysis to estimate the number of CVD deaths attributable to 11 dietary factors in the US. We obtained data on intake of each dietary factor from the National Health and Nutrition Examination Survey. Etiologic effect sizes of each dietary factor on CVD endpoints were obtained from the most recent meta-analyses of prospective observational studies. Optimal level of intake was determined based on the level associated with the lowest risk of mortality in cohort studies.

Results:
In 2015, suboptimal diet accounted for 222,100 (95% UI: 189,500-252,800) CVD deaths among men and 193,400 (95% UI: 161,100-226,100) CVD deaths among women in the US. Low intake of nuts (100,460 [59,690-148,480] CVD deaths; 11.6% of CVD deaths), low intake of vegetables (99,530 [45,370-161,100]; 11.5%), low intake of whole grains (89,670 [(52,300-132,980], 10.4%) and high intake of sodium (77,260 [22,760-169,690], 9%) were the leading dietary risk factors for CVD mortality in the US (Figure).

Conclusion:
Our results highlights the need for implementation for evidence-based policies to promote the intake of cardioprotective dietary factors in particular nuts, vegetables, and whole grains in the US.
Abstract 16: Effect of Long-Term Selenium Supplementation on Mortality: Results From a Multiple-Dose Randomised Controlled Trial
Authors: Rayman Margaret , Winther Kristian H , Pastor-Barriuso Roberto , Cold Frederick , Thvilum Marianne , Stranges Saverio , Guallar Eliseo , Cold Soren
Published: March 2022

Background:
Selenium (Se) is an essential trace element that is incorporated into selenoproteins with a wide range of health effects. The concentration of selenoproteins plateaus at plasma Se concentrations ~125 μg/L, however, and it is unclear whether Se supplementation is beneficial above this plateau.

Methods:
In a double-blind, randomized, controlled trial of Se supplementation and mortality in Denmark, a population of moderately-low Se status, 491 men and women, 60-74 years of age, were treated with 100, 200, or 300 μg Se/d as Se-enriched yeast or placebo-yeast. From 2008-2009, active treatment was provided for 5 years and post-treatment follow-up for 10 additional years. During 6,871 person-years of follow-up, there were 158 deaths (31 during active treatment and 127 after treatment cessation).

Results:
The hazard ratio (95% confidence interval [CI]) for all-cause mortality comparing 300 μg Se/d to placebo was 1.62 (0.66 to 3.96) after 5 years of treatment and 1.59 (1.02 to 2.46) over the entire follow-up. Se doses of 100 and 200 μg/d non-significantly decreased mortality during the intervention period but their effects vanished after treatment cessation. The effects on cancer and cardiovascular mortality were similar but less precise than on all-cause mortality.

Conclusions:
A dose of 300 μg/d of Se (as high-Se yeast) taken for five years in a country with moderately-low Se status increased all-cause mortality 10 years later. Lower doses showed a non-significant reduction in mortality which dissipated after treatment discontinuation. Total Se intake (diet plus supplements) over 300 μg/d should be avoided.
Abstract 22: Geographic Proximity of Automated External Defibrillators to Out-of-hospital Sudden Deaths in Wake County, North Carolina
Authors: Bogle Brittany M , Joodi Golsa , Simpson Ross
Published: March 2022

Introduction:
Survival rates for out-of-hospital sudden cardiac arrest are substantially improved by access to automated external defibrillators (AEDs) prior to Emergency Medical Services (EMS) arrival. However, AED use may be inhibited if their locations are unknown or far from the bystander.

Objectives:
We sought to classify out-of-hospital sudden death (OHSD) event locations, ascertain if bystanders utilized AEDs prior to EMS arrival, and calculate the distance to the nearest AED.

Methods:
From 2013 to 2015, we screened all EMS-reported out-of-hospital deaths aged 18-64 within Wake County, North Carolina to identify OHSDs. We geocoded event locations from EMS records and classified them as residential, commercial, public, or unknown using US Postal Service Residential Delivery Indicator, EMS narratives, and web searches. AED locations and installation dates, registered by law, were obtained from North Carolina Department of Health and Human Services. We used EMS narratives to determine AED use prior to EMS arrival. Walking distance between coordinates of an OHSD location and every AED installed prior to the death date was estimated using the Great-Circle distance.

Results:
Of 434 adjudicated OHSDs, 390 (90%) were residential, 31 (7%) were commercial, and 11 (2.5%) were public. Of commercial locations, 12 (39%) occurred in hotels. Of public locations, 6(46%) occurred in parking lots or parks. Wake County had 168 registered AEDs during the study period. The mean distance from OHSD to closest AED was 3.2 km (95% CI: 3.0-3.5 km). Only 20 (4.6%) of OHSDs were within 500 meters of an AED; the closest AED was 77 meters from an OHSD. Bystanders used AEDs prior to EMS arrival twice.

Conclusions:
While potentially lifesaving, AEDs are not placed optimally with respect to OHSD locations and are rarely utilized by bystanders, even in non-residential spaces. Public health strategies should be considered that incentivize optimal AED placement to witnessed cardiac arrest locations.
Abstract 26: Validity of Cardiovascular Data From Electronic Data Research Networks: The Multi-Ethnic Study of Atherosclerosis (MESA) and HealthLNK
Authors: Ahmad Faraz S , Chan Cheeling , Rosenman Marc B , Post Wendy S , Liu Kiang J , Kho Abel N , Allen Norrina B
Published: March 2022

Background:
Understanding the validity of data from electronic clinical data research networks compared to population-based CVD cohorts, the gold standard for epidemiological research, is essential for conducting epidemiological research across large, diverse populations more efficiently.

Methods:
We linked individual-level data from MESA with HealthLNK, a 2006-2012 database of electronic health records (EHRs) from 6 major Chicago hospitals. To evaluate for correlation and bias for blood pressure (BP) and BMI between HealthLNK and in-person MESA examinations, we used Pearson Correlation Coefficients and Bland-Altman plots. Median BMI and BP values between 2006-2008 in HealthLNK were compared to MESA exam 4 and between 2009-2012 were compared to MESA exam 5. Using diagnoses in MESA as the gold standard, we also calculated the performance of HealthLNK queries for hypertension (HTN) and obesity using ICD9 codes alone and with the addition of clinical data.

Results:
Of the 1164 MESA participants at the Chicago field center, 802 participants had data in HealthLNK. There was a high correlation between BMI in MESA and HealthLNK (0.94). HealthLNK only slightly underestimated BMI by 0.5 kg/m
2
(Figure). The correlation was lower for systolic BP and diastolic BP (0.3 and 0.4, respectively). Compared to MESA, HealthLNK significantly overestimated SBP and DBP by 6.5 and 3.6 mmHg, respectively. Using ICD9 codes alone, the sensitivity and specificity for HTN were 62.2% and 72.7% and for obesity were 28.1% and 97.4%. The addition of BP and medications to ICD9 codes increased sensitivity and decreased specificity for HTN to 73.2% and 53.2%. The addition of BMI increased sensitivity and decreased the specificity for obesity to 64.3% and 95.4%.

Conclusion:
Significant disagreement between risk factor status and BP exists between HealthLNK and MESA, while BMI is highly correlated. Identifying areas of concordance and discordance informs our understanding of the strengths and limitations of using EHR data for epidemiological research.
Abstract 35: In Singletons Born at Term, Lower Gestational Age is Associated with Lower Cardiorespiratory Fitness Levels Through Adolescence to Young Adulthood: The Northern Ireland Young Hearts Project (NIYHP)
Authors: Ferreira Isabel , Gbatu Pei T , Boreham Colin
Published: March 2022

Decreases in the mean gestational age of term deliveries have been reported over the past decade in several developed countries, linked to increases in the rates of planned births by labour induction and/or pre-labour caesarean sections. In contrast to the effects of pre-term birth, the extent to which lower gestation age within the at-term range (i.e. 37 to 42 weeks) affects individuals’ cardiorespiratory fitness (CRF) health is largely unknown, however. We therefore examined the association between gestational age, accounting for other important perinatal covariates (obtained from the NI Child Health Services’ records), and CRF (VO
2
max) as measured through adolescence to young adulthood in 842 (51.5% female) participants in the NIYHP (all singletons born at term, 98% of whom with birth weight greater than 2.5 kg). Participants’ mean levels of CRF were 45.6 ± 4.8, 43.7 ± 6.8 and 32.9 ± 9.8 ml/kg/min at the ages of 12, 15 and 22 years, respectively. With the use of GEE analyses adjusted for age, sex, socio economic status, birth weight z-scores (relative to UK’s 1990 reference), breast-feeding practices and duration, maternal age at child’s birth and delivery mode, we found that each week increase in gestational age was associated with 0.44 ml/kg/min (95% CI 0.13 to 0.75) higher levels of CRF throughout the whole longitudinal period (p=0.005). Further adjustments for participants’ height, body fatness and maturational level throughout the longitudinal period only attenuated this association slightly [to 0.38 ml/kg/min (95% CI 0.12 to 0.65), p=0.005]. There were no significant interactions between gestational age and sex or participants’ age at the time of CRF assessment, indicating that the decreases in CRF over time were similar across the different gestational ages, with those born early term displaying consistently lower levels throughout the longitudinal period. Finally, each week increase in gestation age was associated with lower risk of poor CRF through adolescence to young adulthood as defined according to current age and sex-specific health-reference values of VO
2
max: RR=0.89 (95% 0.81 to 0.97), p=0.008. These findings suggest that lower gestational age,
even within the at-term range
, may be a key determinant of poorer CRF as each additional week conferred benefits. This aspect may have been neglected by the over-simplistic characterisation of individuals born at-term as a homogeneous group and may have public health and clinical implications for policies around planned deliveries, given the current trends.
Abstract 42: Diabetes Metabolomics Score and Risk of Progression from Gestational Diabetes to Type 2 Diabetes
Authors: Tobias Deirdre K , Demler Olga , Clish Clary , Liang Liming , Manson JoAnn E , Zhang Cuilin , Hu Frank B
Published: March 2022

Background:
A number of individual metabolites have been identified for their relationship with type 2 diabetes (T2D) risk. We sought to evaluate a pattern of T2D metabolites to estimate the collective impact of these markers on elevating the risk of progression to T2D among high risk women with a history of gestational diabetes mellitus (GDM).

Methods:
We conducted a prospective nested case-control study among women with a history of GDM in the Nurses’ Health Study II longitudinal cohort. Three panels of plasma metabolites were assayed via liquid chromatography tandem mass spectroscopy among 175 T2D cases and 175 controls, matched for age and fasting status at blood draw in 1997-1999. Incident type 2 diabetes cases occurred a median of 7 years after blood collection (range 1-15 years). Based on the published literature, we identified 38 metabolites associated with T2D and available among our measured panels, including branched-chain and other amino acids, lipids, and others. Metabolite levels were log-transformed and standardized. We derived a T2D MET SCORE, summing across the points corresponding to individuals’ assigned quintile level for each of the 38 metabolites. We estimated the odds ratios (OR) and 95% confidence intervals (CI) for the association of the T2D MET SCORE with incident T2D risk using multivariable conditional logistic regression models, adjusted for age, fasting status, body mass index (BMI), physical activity, and other established T2D risk factors.

Results:
Cases and controls were on average 43 years at blood draw with a mean of BMI 28.6 kg/m
2
. In the model adjusted for age and fasting status, the T2D MET SCORE was significantly associated with a step-wise increase in T2D risk across quartiles (Q1: [reference]; Q2: OR=2.5 CI=1.2, 5.6; Q3: OR=7.0 CI=3.2, 15.2; Q4: OR=10.9 CI=4.7, 24.9). Adjusting for BMI and other risk factors attenuated the relationship, although the score remained significantly associated with T2D risk (Q4 vs. Q1: OR=7.2 CI=2.5, 20.3). The T2D MET SCORE was associated with T2D risk among both obese and non-obese women (p for interaction=0.4). A BCAA sub-score (3 metabolites) and a lipid sub-score (16 metabolites) were also positively associated with T2D risk (BCAA Q4 vs. Q1: OR=3.5 CI=1.4, 8.8; lipids Q4 vs. Q1: OR=3.6 CI=1.4, 9.1).

Conclusions:
A pattern of high-risk circulating metabolites is significantly associated with progression from GDM to type 2 diabetes later in life.
Abstract MP010: A Prospective Study of DNA Methylation Age Acceleration and Incidence of Coronary Heart Disease, Heart Failure, and Peripheral Arterial Disease in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Roetker Nicholas , Pankow James , Bressler Jan , Morrison Alanna , Boerwinkle Eric
Published: March 2022

Introduction:
DNA methylation patterns used to characterize rate of aging (i.e., epigenetic age acceleration) predict all-cause mortality independently of chronological age and traditional risk factors. It remains unclear how epigenetic age acceleration is associated with cardiovascular disease risk and subclinical atherosclerosis.

Hypothesis:
Higher epigenetic age acceleration is associated prospectively with greater risk of coronary heart disease (CHD), heart failure (HF), and peripheral arterial disease (PAD) and cross-sectionally with higher carotid intima-medial thickness (IMT).

Methods:
Age acceleration of blood was estimated by two published methods (Horvath and Hannum) using DNA methylation levels (Illumina 450K array) at 353 and 71 CpG sites in African Americans of the Atherosclerosis Risk in Communities study in 1990-95 (baseline). Among those without prevalent disease at baseline, Cox and linear regression models were used to estimate the association of age acceleration with incident cardiovascular events occurring through 2013 and with carotid IMT cross-sectionally at baseline. Results were stratified by follow-up time for HF due to violation of the proportional hazards assumption.

Results:
Participants [mean baseline age: 57 years (range: 47-72)] were followed prospectively for a mean 17 years. In fully-adjusted models (Figure), a 1 SD increment in Hannum epigenetic age acceleration was associated with 15-31% greater hazard of incident cardiovascular outcomes, except for HF in later follow-up. Associations using Horvath age acceleration were similar, except it was not associated with myocardial infarction. Cross-sectionally, a 1 SD increment in each age acceleration measure was associated with 0.01 higher baseline carotid IMT (both
P
≤ 0.01).

Conclusion:
This study of African Americans provides evidence that epigenetic age acceleration is associated with greater risk of CHD, HF, and PAD events and higher extent of carotid atherosclerosis, independently of traditional risk factors.
Abstract MP011: Cardiac Markers and Risk for Hospitalization with Infection: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Ishigami Junichi , Hoogeveen Ron , Ballantyne Christie , Folsom Aaron , Coresh Josef , Selvin Elizabeth , Matsushita Kunihiro
Published: March 2022

Background:
Clinical cardiovascular disease (CVD) is a risk factor for infection, but the association may be confounded by other comorbidities. To better understand the underlying pathophysiology, we explored whether subclinical cardiac biomarkers were associated with infection risk in the general population.

Methods:
Using 8,588 individuals free of clinical CVD in the biracial ARIC Study in 1996-98 (mean age 62 years and 22% African American), we assessed the association of high-sensitivity cardiac troponin T (hs-cTnT) and natriuretic peptide (NTproBNP) with risk of hospitalization through 2013 with an infection ICD code anywhere among the listed discharge diagnoses. Cox proportional hazards models were used to estimate hazard ratios (HRs).

Results:
During follow-up (median, 15.2 years), 3,308 individuals were discharged with an infection ICD code. The incidence rate increased proportionally with higher hs-cTnT and NTproBNP (Table1). The association did not change in multivariable Cox proportional analyses, and was consistent after further accounting for incident CVD during follow-up (Table1) or restricting to hospitalizations with infection as the primary diagnosis. No interaction was observed for subgroup analysis by age, sex, race, and status of diabetes or chronic kidney disease (eGFR <60 vs. ≥60 ml/min/1.73m
2
). Although both cardiac markers were associated with different types of infection (pneumonia, urinary tract infections, bloodstream infections, and cellulitis), the association appeared strongest for cellulitis (HR, 1.41 [95%CI, 1.00-2.00] for hsTnT ≥4 vs. <3ng/L; and 1.51 [1.08-2.11] for NTproBNP ≥69 vs. <68 pg/mL).

Conclusions:
Higher hs-cTnT and NTproBNP concentrations were independently associated with increased risk for hospitalization with infection, suggesting a potential relationship between cardiac damage/overload and infection.