bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP61: Preterm Delivery and Patterns of Cardiometabolic Risk Factors Pre- and Post-Childbearing: Coronary Artery Risk Development in Young Adults Study
Authors: Sun Baiyang , Bertolet Marnie , Lewis Cora E , Gunderson Erica P , Catov Janet M
Published: March 2019

Introduction:
Women with preterm delivery (PTD) have excess CVD risk and unfavorable risk factors before, during and after pregnancy, but few studies compare the pre- and post-childbearing eras.

Hypothesis:
Women with PTD have worse patterns of CVD risk factors both pre- and post-childbearing.

Methods:
CARDIA is a multi-center 30-year longitudinal (9 exams, 1985-2016) cohort of black and white adults initially aged 18-30. We included women with ≥1 post-baseline birth (n=1298) and categorized them according to PTD (any birth <37 wks.) or term births (all births ≥37 wks.). Annual changes in CVD risk factor (BMI, waist girth, lipids, and blood pressure [BP]) during pre-childbearing period (before the first post-baseline birth) and post-childbearing period (after the last post-baseline birth) were compared between PTD and term groups, using piecewise linear mixed-models which allowed differing intercepts and slopes for pre- and post-childbearing eras. Intercepts were set at the end of pre-childbearing and the start of post-childbearing; childbearing period, from the first to the last post-baseline birth, was collapsed. Models adjusted for socioeconomics, length of childbearing period, parity, time-varying lifestyle habits and medication use.

Results:
The annual BMI increase during the pre-childbearing period did not differ by group, but the annual BMI increase after childbearing was larger in PTD group than term group (0.22 vs. 0.18 kg/m
2
, p=0.04; Table). The difference in diastolic BP from before to after childbearing period in PTD group was larger than term group (2.77 mmHg, p<0.01), with similar pre- and post-childbearing annual change in each group. No other risk factor differences were found.

Conclusions:
PTD was not associated with pre-childbearing changes in CVD risk factors, but women with PTD exhibited accelerated gains of adiposity during the post-childbearing period, and worse diastolic BP pattern when completing childbearing. Further research is needed to assess the changes during childbearing period.
Abstract P007: Age and Gender Differences in Response to Repeat Blood Pressure Measurement After Brief Rest Period
Authors: Sachdev Sarina , Tahir Hassan , Nguyen Landai , Omar Bassam , Malozzi Christopher , Awan G. Mustafa , Rahimi Farnoosh
Published: March 2019

Background:
Office-based blood pressure (BP) measurement is a snapshot of a patient’s ambulatory BP, and is subject to variations which may influence management. The objective of this study is to assess the effect of age and gender on repeat BP measurement after a brief rest period in an outpatient cardiology clinic.

Methods:
Patient charts reviewed in University-based cardiology clinic identified 170 encounters which contained BP re-measurement data due to elevated initial BP of > 130/80 mmHg. BP was measured initially by a nurse, with the patient in a sitting position and the arm resting at the level of the heart. If BP was > 130/80 mmHg, it was repeated by physician after resting the patient for 15 minutes. There were: 86 males (51%); 84 females (49%); 113 (66%) elderly patients ≥ 60 years; 57 (34%) younger patients < 60 years.

Results:
Allowing 15 minutes of rest resulted in decrease in the systolic BP (SBP) from 153 ± 27 mmHg to 145 ± 27 mmHg (P = 0.003), and decrease in the diastolic BP (DBP) from 87 ± 16 mmHg to 83 ± 15 mmHg (P = 0.04) in the whole patient cohort. The decrease in SBP was 8 mmHg in both males and females (P = NS); while the decrease in DBP was 5 mmHg in males and 2 mmHg in females (P = 0.04). The decrease in SBP was 11 mmHg in the elderly patients compared to 2 mmHg in the younger patients (P = 0.02), while the decrease in DBP was 3 mmHg in the elderly patients compared with 4 mmHg in the younger patients (P = NS).

Conclusion:
Hypertension is a challenging public health problem. JNC guidelines recommend that prior to BP measurement, persons should be seated quietly for at least 5 minutes in a chair, with feet on the floor, and arm supported at heart level. This resulted in a significant decrease in BP in our patients. In this study we found that, after a brief rest period, males and females decrease SBP to the same extent; males drop DBP greater than females; patients ≥ 60 years of age drop SBP greater than patients < 60 years of age. With a high reported prevalence rates of White-coat hypertension in the elderly, between 15% and 25%, this is a clinically significant observation that reinforces that physicians should remeasure the blood pressure, especially the subset of males and the elderly, in whom a bigger decrement may be detected in blood pressure measurement after a brief rest period.
Abstract P013: Serum Uric Acid is Not Associated With Incident Dementia in the ARIC-NCS Cohort
Authors: Alam Aniqa B , Wu Aozhou , Power Melinda C , West Nancy , Alonso Alvaro
Published: March 2019

Background:
Recent studies have investigated the involvement of serum uric acid (SUA) in the progression of cognitive decline and dementia with conflicting results. SUA is known to be associated with hypertension, inflammation, and other cardiovascular risk factors, which often contribute to dementia and dementia-like morbidity, yet several cross-sectional studies have suggested that its antioxidant properties may be protective against cognitive decline.

Hypothesis:
We hypothesized lower levels of serum uric acid at baseline would be associated with an increased risk of incident dementia.

Methods:
The ARIC study is an ongoing, biracial, community-based cohort study in the US with longitudinal data first collected in 1987. Participants were examined during follow-up throughout 6 visits (last one 2016-17). Serum uric acid measurements were collected through fasting blood samples in 1990-92 (age range 47-70 years), baseline for this analysis. Incident dementia was determined based on examiner assessments at visits 5 (2011-13) and 6 (2016-17), dementia surveillance based on dementia screeners conducted over telephone interviews starting from visit 5, hospitalization discharge codes, and death certificates prior to visit 6. We estimated the association of SUA, categorized into quartiles, with incidence of dementia by calculating hazard ratios (HR) using Cox regression models adjusting for potential confounders.

Results:
Our analysis included 11,452 participants free of dementia, prevalent coronary heart disease, or stroke, and with available SUA followed for a median of 24.1 years. Baseline SUA in the highest quartile was associated with incident dementia [HR (95% CI): 1.22 (1.07, 1.38)] when adjusted for age, race, gender, and education level. However, after full adjustment including cardiovascular risk factors, this relationship disappeared (Table).

Conclusion:
Within a large community-based cohort, we found no evidence of SUA’s influence on incident dementia independent of cardiovascular risk factors.
Abstract P024: Hidden Risks: Relationship Among Visceral Adipose Tissue, Interleukin-18, and Adiponectin in the Development of Type 2 Diabetes in Filipino Americans
Authors: Gallegos Julian L , Taylor-Piliae Ruth , Pace Thaddeus , Gallek Matthew , Ritter Leslie
Published: March 2019

Background and Aims:
Filipino Americans (FAs) are at high risk for developing type 2 diabetes however little research exists as to why this occurs. There is evidence that pro-inflammatory Interleukin-18 (IL-18) and anti-inflammatory (adiponectin) markers associated with visceral adipose tissue (VAT) may explain this risk but this postulate has not yet been examined during the course of diabetes progression in FAs. Therefore, in FAs without diabetes, with pre-diabetes and with type 2 diabetes, the aims of this study were to: 1) Quantify VAT, IL-18, and adiponectin and describe the values in relation to known reference ranges (RR) for each group 2) Determine the relationships of VAT, IL-18, and adiponectin within each group and 3) Determine if VAT, IL-18, and adiponectin were different among groups.

Methods:
FAs were recruited from healthcare and community centers in Solano County, California. VAT was measured using the InBody 570 © body impedance analyzer. Blood was obtained for HgA1c and plasma was used to quantify IL-18 and adiponectin with ELISA. Correlation coefficients were conducted to determine the associations among VAT, IL-18 and adiponectin in the three groups. One-way ANOVAs were conducted for each biomarker to determine if there were statistically significant differences among groups.

Results:
Seventy-five participants enrolled (N=25 per group), 68% females with mean age=42 years. VAT values above the RR included 57% of women, but only 27% of men. Participants with an IL-18 above the RR used for this study was greater in the pre- diabetes (68%) and diabetes groups (64%) vs. the non-diabetes group (40%). Interestingly, 90- 100% of the adiponectin values in both men and women were well above the RR. There were no correlations among the biomarkers within any group. VAT and IL-18 were not significantly different among groups. Adiponectin was significantly different among groups (F
2
,72
=3.789, p=0.03), with lower values in the diabetes group vs. the non-diabetes group (Post-hoc Tukey HSD test, p=0.02).

Conclusions:
This is the first time VAT, IL-18 and adiponectin have been examined in FAs without diabetes, with pre-diabetes and with diabetes. While a young, mostly female sample may have confounded the biomarker findings, the results point toward the potential usefulness of inflammation-related biomarkers to identify individuals in the FA population that may be at higher risk for type 2 diabetes and understand the mechanisms of diabetes development and progression in FAs.
Abstract P029: Inflammation Measured by Glyc-A as a Mediating Factor Between Subclinical Thyroid and Cardiovascular Diseases. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Authors: Bensenor Isabela M , Goulart Alessandra C , Lotufo Paulo A
Published: March 2019

Introduction:
An auto-immune process strongly determines subclinical thyroid disorders generating a high grade of inflammation. However, the evidence from epidemiologic studies of the association between subclinical thyroid disorders with coronary heart disease has not been reported as mediated or moderated by a traditional inflammatory marker such as the high-sensitivity C-Reactive Protein. Recently, another inflammatory marker that reflects protein glycosylation in acute-phase reactant proteins - GlycA was associated with coronary heart disease events.

Hypothesis:
The association of GlycA, a more comprehensive biomarker of inflammation, with subclinical hypothyroidism, and subclinical hyperthyroidism, should explain some mechanisms of the association subclinical thyroid disorders and coronary heart disease.

Methods:
We tested this hypothesis among 5060 men and women aged 35 to 74 years-old enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) at baseline. Subclinical thyroid disorders were defined as thyroid-stimulating hormone (TSH) >4 IU/ml (subclinical hypothyroidism) and TSH <0.4 IU/ml (subclinical hyperthyroidism) with normal free-thyroxine levels. The variable of exposure was GlycA measured in serum by proton nuclear magnetic resonance (1H NMR) spectroscopy at (LabCorp, Raleigh, NC). We excluded participants who reported previous cardiovascular disease, use of lipid-lowering agents or drugs that interfere with thyroid function. The cross-sectional relationship between GlycA and subclinical hyperthyroidism and subclinical thyroid was evaluated separately by linear regression models using the category of the subjects with euthyroidism as the reference. Both crude unadjusted and adjusted (age, sex, race, education, smoking, alcohol use, physical activity body-mass index, hypertension, diabetes, smoking, alcohol use, and physical activity data are presented

Results:
After exclusions, we analyzed 47 individuals with subclinical hyperthyroidism (mean age 53.1 (±9.4) years; 61.7% women), 258 with subclinical hypothyroidism (mean age 52.3 (±8.9); 58.1% of women) and 3,642 participants with normal thyroid function (mean age: 50.1 (±8.6); 52% of women). Crude linear regression models showed no significant association between GlycA and subclinical hyperthyroidism (Beta-coefficient [B], 15.77; P = 0.10) or subclinical hypothyroidism (B, 3.60; P=0.39). Results remained nonsignificant after multivariate adjustment for subclinical hyperthyroidism (B, 12.96; P=0.15) and subclinical hypothyroidism (B, 0.44; (P=0.91).

Conclusions:
There is no association between subclinical thyroid disorders and GlycA. Other presumptive inflammatory pathways should be contemplated in further studies addressing the link between subclinical thyroid disorders and coronary heart disease.
Abstract P033: NT-proBNP as a Biomarker to Detect Salt Sensitivity
Authors: Sanchez Otto A , Drawz Paul E , Hanson Michelle , Korczak Renata , Duprez Daniel A , Jacobs David R , Steffen Lyn M
Published: March 2019

Finding a biomarker to identify salt sensitive individuals would be an important step in the personalized management of hypertension. The natriuretic peptide, amino terminal pro-type B natriuretic peptide NT-proBNP, secreted by the heart in response to volume overload, is positively associated with incident hypertension. We hypothesized that when exposed to low salt diets, individuals with elevated NT-proBNP (≥ 100 pg/mL) will have a greater decrease in systolic blood pressure than those with NT-proBNP within the physiological range (40 - 90 pg/mL).

Methods:
Individuals with systolic/diastolic blood pressures greater than 120/85 mmHg and NT-proBNP values ≥ 40 pg/mL were included if they were not on blood pressure lowering medications and were free of cardiovascular or renal disease, diabetes, chronic obstructive pulmonary disease, pulmonary hypertension or any condition that would be associated with secondary causes of hypertension. Low salt diets consisted of meals containing total sodium 50 mmol/day. Meals were prepared at the Fairview University Hospital kitchen and provided to each participant for 10 days. Subjects were instructed to eat only the meals provided by the study. Sitting blood pressure, NT-proBNP, plasma glucose, sodium, creatinine and urinary sodium and creatinine were measured before and after 10 days on the low salt diet. Urinary creatinine and sodium was determined in 24-hour urine on day 10. Statistical analysis. Change (blood pressure after - blood pressure before low salt diet) in systolic blood pressure values were linearly regressed on log transformed NT-proBNP values.

Results:
9 individuals (5 females) mean (SD) age 58.3 (8.1) years were classified into physiological 51.2 (7.8) pg/mL (n = 4) and an elevated 165.7 (84.5) pg/mL (n = 5) category of NT-proBNP. Systolic blood pressures was 127.9 (13.9) and 139.5 (9.6) mmHg for the physiological and elevated category of NT-proBNP, respectively, p = 0.18. Body mass index and plasma glucose, sodium and creatinine at baseline were also similar between the two groups. Following 10 days of low salt diet, systolic blood pressure decreased by a mean (SE) 16.9 (6.8) mmHg in those with elevated levels of NT-proBNP and by 10.9 (3.3) mmHg in those with physiological levels of NT-proBNP, p = 0.4. Baseline log NT-proBNP was inversely associated with change in systolic blood pressure r = - 0.60, p = 0.09. For log NT-proBNP values between 3.697 and 5.745 pg/mL, every log unit increase in NT-proBNP at baseline was associated with a mean (range) systolic blood pressure decrease of 10.4 (5 - 37.7) mmHg, p = 0.09.

Conclusions:
Results from a large-scale study are required to confirm the findings from this small pilot study that elevated values of NT-proBNP can predict who will have a decrease in systolic blood pressure in response to a low sodium diet.
Abstract P034: Circulating Odd-Chain Fatty Acids in Relation to Intake of Dairy and Fiber in Post-Myocardial Infarction Patients
Authors: Pertiwi Kamalita , Küpers Leanne K , Wanders Anne J , Zock Peter L , Geleijnse Johanna M
Published: March 2019

Background:
Odd-chain fatty acids (OCFA) pentadecanoic (15:0) and heptadecanoic acid (17:0) are considered to reflect dairy intakes in studies on cardiometabolic outcomes. A recent randomized controlled trial on dietary fiber showed that circulating proportions of these OCFA may also be related to fiber intake, which may result from fermentation by gut microbes.

Objective:
To examine the associations between circulating OCFA and dairy and fiber intake in patients with a history of myocardial infarction.

Methods:
We performed cross-sectional analyses in a subsample of 896 Dutch post-MI patients of the Alpha Omega Cohort. Proportions of OCFA (as % of total fatty acids) were measured in plasma phospholipids (PL) and cholesterol esters (CE). Dietary intakes (g/d) were assessed using a 203-item validated food frequency questionnaire. Spearman correlations (
r
) were computed between circulating OCFA in PL and CE and intakes of total dairy, types of dairy products, dietary fiber and total meat.

Results:
Patients were on average 69 years old, 78% was male and 89% used statins. Dairy intake was predominantly from milk and yogurt. PL 15:0 was positively correlated with total dairy intake (
r
=0.16, p<0.001; Table 1), especially yogurt. PL 15:0 was not correlated with dietary fiber (
r
=0.01, p=0.75). For CE 15:0, correlations were similar. PL 17:0 was positively correlated with total dairy (
r
=0.15, p<0.001), but also with dietary fiber (
r
=0.13, p<0.001). For CE 17:0 similar correlations were observed, although somewhat weaker (dairy:
r
=0.10, p=0.003; fiber:
r
=0.09, p=0.009). OCFA were not significantly correlated with meat intake.

Conclusions:
Plasma PL 15:0 and CE 15:0 were related to dairy and not to fiber intake. PL 17:0 and CE 17:0 were equally related to dairy and fiber intake. Cardiometabolic health benefits attributed to biomarkers of dairy intake, especially 17:0, may be (partly) attributable to fiber intake. Further research is needed into endogenous OCFA synthesis as a result of fermentation of dietary fiber by gut microbes.
Abstract P036: Association Between Circulating Galectin-3 and Arterial Stiffness in the Atherosclerosis Risk in Communities Study
Authors: Jia Xiaoming , Tanaka Hirofumi , Ballantyne Christie M , Sun Wensheng , Shah Amil M , Hoogeveen Ron C , Aguilar David , Ndumele Chiadi E , Boerwinkle Eric , Virani Salim , Selvin Elizabeth , Heiss Gerardo , Nambi Vijay
Published: March 2019

Introduction:
Galectin-3 (gal-3) is a B-galactoside-binding lectin and is associated with increased risk of heart failure and other adverse cardiovascular outcomes. Circulating gal-3 has been implicated in promoting tissue fibrosis, leading to vascular remodeling and resultant arterial stiffening.

Hypothesis:
Plasma gal-3 levels will be associated with central arterial stiffness in a community-based population.

Methods:
We conducted a cross-sectional analysis of 4,073 participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 5 (2011-2013), with a mean age of 75.1±5.0 years. Central arterial stiffness was measured by carotid-femoral pulse wave velocity (cfPWV). Association between gal-3 and arterial stiffness was assessed using multivariable linear regression models with gal-3 (log transformed) and adjustment first for age, sex, race-center, heart rate, current smoking, mean arterial pressure and use of anti-hypertensive medication (model 1), then for model 1 plus body mass index (BMI), diabetes, hypertension, LDL cholesterol and estimated glomerular filtration rate (eGFR) (model 2).

Results:
The median gal-3 concentration was 16.5 ng/mL (p25, p75: 13.8, 19.8) and mean cfPWV was 1163 (SD, 303) cm/s. Higher gal-3 concentrations corresponded with higher mean cfPWV and central pulse pressure (p-trends <0.001). Higher gal-3 levels were also associated with higher BMI, diabetes, hypertension, LDL cholesterol, cholesterol lowering medication use, prevalent coronary artery disease, and lower eGFR. In regression analysis, gal-3 was significantly associated with cfPWV in model 1 (ß=46.0; 95% CI 15.4-76.6, per natural log higher gal-3, p=0.003). Further adjustment in model 2 strongly attenuated the association and the coefficient was no longer significant (ß=25.0; 95% CI -8.2-58.2, per natural log increase in gal-3, p=0.14).

Conclusions:
Higher levels of gal-3, a known promoter of tissue fibrosis, were associated with greater central arterial stiffness. In addition, circulating gal-3 levels were also associated with many traditional risk factors such as BMI, diabetes, hypertension and eGFR; adjustment for these factors attenuated the association of gal-3 with arterial stiffness measures, suggesting mediation of the gal-3 association.
Abstract P059: 18-Day Lifestyle Interventions Benefits the Kidney
Authors: Ramirez Francisco E , Nedley Neil , Michel Rebecca , Quion Mark , Ciceron-Medor Leslie
Published: March 2019

Introduction:
Chronic kidney disease is a prevalent and expensive pathology defined by the gradual loss of kidney function. BUN/Creatinine gives an indirect measure of the kidneys function. The most common cause of kidney problems is poorly controlled diabetes. We explored the effect that lifestyle changes has on kidney function.

Methods:
Data taken from a medical residential lifestyle program from dates 1987 to 1999 was used. N=553 with abnormal BUN/creatinine laboratories were used for the study most of them with a diagnosis of diabetes and/or hypertension. The 18 day medical residential program took place in Weimar, California. A holistic approach was adopted to cater a specific schedule for each participant. It offered the assistance of an professional team along with a consistent lifestyle intervention. The program included the following components: medical consultations by a board certified physician, health educational training, massage, hydrotherapy, plant-based cooking classes, 2 vegan meals a day, exercise coaching with emphasis on outdoor activities, and spiritual care. Every patient received a baseline and end of the program blood and urine tests.

Results:
From the participants n=553, 65.3% were females. At baseline the BUN/creatinine level average was 12.39 with a ST DEVof 3.74. At the end of the program the average BUN creatinine was 10.50 with a ST DEV of 3.33. The before and after BUN/Creatinine change was significant with p<0.001 paired t-test t(552)=12.35. At the end of the program n=372 (66.2%) participants’ BUN creatinine levels had improved, n=140 (24.9%) worsened, and n=41 (7.29%) remained unchanged.

Conclusion:
The 18 day intervention was able to improve kidney function in more than half of the participants. The increased blood flow could due to the increase in exercise and decrease in protein, specially elimination of animal protein. A long term follow should be done to see if the change remains.
Abstract P069: Longitudinal Associations Between Metabolic Status, Insulin Clearance, and Insulin Sensitivity: The Prospective Metabolism and Islet Cell Evaluation (PROMISE) Cohort
Authors: Semnani-Azad Zhila , Retnakaran Ravi , Harris Stewart B , Zinman Bernard , Hanley Anthony J
Published: March 2019

Metabolically healthy obese individuals (MHO) are those with obesity but normal metabolic profiles. The relationship of MHO to type 2 diabetes mellitus (T2DM) risk is unclear. Limited data are available on metabolic status and declining insulin clearance (IC) and insulin sensitivity (IS), which are well-documented features in the pathogenesis of T2DM.

Objective:
To assess longitudinal changes in IC and IS among metabolically healthy and unhealthy obese and non-obese participants.

Hypothesis:
Longitudinal declines in IC and IS will be greater among participants classified as metabolically unhealthy and/or obese compared to metabolically healthy non-obese (MHN).

Methods:
Adults ≥30 years old at-risk for T2DM in PROMISE had three assessments over 6 years (n=558). Obesity was classified as BMI ≥30 kg/m
2
. Baseline metabolic parameters, including blood pressure, TAG, HDL, fasting glucose, waist circumference, and medication use, were used to determine metabolic status. Metabolically healthy status was defined as the presence of <3 metabolic abnormalities. Values from oral glucose tolerance tests at each visit were used to calculate Matsuda insulin sensitivity index (ISI), and the ratios of fasting C-peptide-to-insulin (IC
FASTING
) and areas-under-the-curve of C-peptide-to-insulin (IC
AUC
). Generalized estimating equations (GEE) evaluated the association of baseline metabolic status with longitudinal changes in IC and IS, adjusting for covariates.

Results:
The multivariate GEE model showed that MHO and MUO had greater declines in IC and IS over time compared to MHN (
Figure
, both p<0.01). Metabolically unhealthy non-obese (MUN) had a longitudinal decline in IC
FASTING
but not IC
AUC
compared to MHN, and a more modest relative decline in IS.

Conclusions:
Compared to MHN, presence of a metabolically unhealthy and/or obese phenotype negatively impacted IC and IS over time. The more pronounced declines in IC in MUO and MHO may reflect a compensatory response to the poorer IS in these groups.
Abstract P070: Hemoglobin A1c Trajectories and Two-year Mortality in Individuals With Diabetes After Cardiac Catheterization
Authors: Raghavan Sridharan , Liu Wenhui G , Baron Anna E , Plomondon Mary E , Ho Michael , Caplan Liron , Maddox Thomas M
Published: March 2019

Background:
Guidelines advise relaxing glycemic control goals in diabetes patients with coronary artery disease (CAD). However, the hemoglobin A1c (HbA1c) trajectories that occur in routine clinical care in diabetes patients with objectively assessed CAD have not been described, and their association with mortality is unknown.

Methods:
We studied 7780 individuals with diabetes using data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program, a registry of US Veterans who have undergone coronary angiography since 2005. We used HbA1c values from the measurement closest in time preceding catheterization and all values during two years of follow-up to fit longitudinal latent class models. We determined optimal trajectory model fit by Bayes Information Criteria, varying the functional form of time and the numbers of HbA1c trajectory classes. We then fit a joint latent class longitudinal mixed model to estimate associations between HbA1c trajectory class and two-year mortality, adjusting for clinical and demographic covariates, including an interaction term between HbA1c trajectory and CAD burden (no, non-obstructive, or obstructive), and with an autoregressive correlation structure for repeated HbA1c measurements.

Results:
Three trajectory classes best fit the data: individuals with stable glycemia after catheterization (class 1; 89%, 6934 of 7780), those with a decline in HbA1c after catheterization (class 2; 4.7%, 364 of 7780), and those with an increase in HbA1c after catheterization (class 3; 6.2%, 482 of 7780). Class 1 participants were older, more likely to be white, less likely to have congestive heart failure, and more likely to be adherent to cardioprotective medications. In multivariable joint mixed models, two-year mortality was 4.3% in class 1, 4.7% in class 2, and 5.0% in class 3 and differed significantly across HbA1c trajectory classes (p=0.047). In pairwise comparisons, two-year mortality differed significantly between individuals in classes 1 and 3 (p=0.03), but not between those in classes 1 and 2 (p=0.9) or between those in classes 2 and 3 (p=0.5). The interaction between trajectory class and CAD burden was non-significant (p=0.1), but limited by the number of participants with no or non-obstructive CAD. In individuals with obstructive CAD, we observed a significant association between HbA1c trajectory and mortality (p=0.04), driven by a difference between classes 1 and 3 (p=0.04) as in the full cohort.

Conclusions:
Distinct HbA1c trajectories were evident within 6 months after cardiac catheterization in patients with diabetes and were associated with two-year mortality. Serial HbA1c measurements in outpatient follow-up after cardiac catheterization could classify individuals with diabetes based on HbA1c trajectory; these trajectories may inform mortality risk stratification, especially in those with obstructive CAD.
Abstract P076: Regression of Prediabetes and Diabetes is Associated with Mild Weight and Waist Loss - ELSA-Brasil
Authors: Canhada Scheine , Duncan Bruce B , Luft Vivian C , Bensenor Isabela M , Barreto Sandhi M , Schmidt Maria I
Published: March 2019

Introduction:
The prevalence of diabetes has risen dramatically in the last decades. Prediabetes, or intermediate hyperglycemia, represents an early stage of diabetes development. Structured diabetes prevention programs can lead to regression of prediabetes, but observational studies may reflect better a real-world scenario for public health planning.

Hypothesis:
We assessed the hypothesis that regression of prediabetes to normoglycemia (and from newly diagnosed diabetes to prediabetes) is associated with weight loss and with decrease in waist circumference in a well-characterized, nonintervention contemporary cohort, ELSA-Brasil.

Methods:
We enrolled 15105 civil servants (34-75 years) in 6 capital cities in Brazil from 2008-10 and followed those without previously known diabetes for an average of 3.7 years. We performed a standardized oral glucose tolerance test and measured fasting and 2h plasma glucose as well as HbA1c in a central laboratory. Diabetes and prediabetes were defined using American Diabetes Association criteria at each visit. We measured weight and waist circumference with standardized protocols and obtained sample characteristics by questionnaire. Those with abnormal glycemia were instructed to seek medical attention.

Results:
Of the 6301 participants with prediabetes at baseline not receiving anti-diabetic medication at either visit, 1671 (27%) had regressed to normal values at follow-up. In Poisson regression analyses adjusting for age, sex, race, family history of diabetes and baseline BMI, glycemia and physical activity, in comparison with those with no change or weight gain, those with weight loss ≤2.05kg had a 30% greater probability of returning to normoglycemia (RR=1.30; 95%CI 1.17-1.43) and those with greater weight loss had a 59% greater probability (RR=1.59; 1.44-1.75). Findings were similar for a decreased waist circumference in comparison to no change or a gain (≤2.6cm loss: RR=1.18; 1.05-1.31; >2.6cm loss: RR=1.52; 1.37-1.68). Of the 661 participants newly ascertained with diabetes at baseline and not receiving medication at either visit, 375 (57%) had non-diabetic values at follow-up. Regression among these newly ascertained cases was also greater among those with decreased weight or waist circumference, though only statistically significant for those with a greater decrease in weight (>2.7kg loss: RR=1.39; 1.19-1.62) or waist circumference (>2.6cm loss: RR=1.35; 1.14-1.61)

Conclusion:
Small decreases in weight or waist circumference in a free-living population not receiving structured interventions to prevent diabetes can lead to important improvement in glycemia, with impact on the prevalence of prediabetes and newly ascertained diabetes.
Abstract P082: Mortality in NSTEMI With Tachycardia is Influenced by Diabetes
Authors: Oni Ebenezer , Oluwole Adegbola , Bozorgnia Behnam
Published: March 2019

Background:
The presence of arrhythmias has been shown to predict mortality in patients presenting with Acute coronary syndrome. We evaluated if the association of Tachycardia and Mortality in Non-ST Elevation myocardial infarction (NSTEMI) patients was independent of the presence of diabetes.

Methods:
Our study population included patients admitted for NSTEMI in a single center between 08/01/2016 and 09/30/2012. Diabetes (DM) was defined by a documented diagnosis or use of diabetic medication. Tachycardia was defined as heart rate (HR) >100 bpm.

Results:
A total of 543 patients were included in this analysis. The mean age was 66 ± 0.6 years, 50% (n-269) were diabetics, and mortality was 10% (n=54). In an unadjusted logistic regression, Tachycardia increased the odds of mortality, OR 2.05 (CI 1.15-3.65), p=0.016. After adjusting for all the risk factors and confounding variables, the relationship was no longer significant. This was however different after stratifying by the presence of diabetes. Diabetics had about four times the probability odds of death compared to non-diabetics in the fully adjusted model. See Table 1.

Conclusion:
The association of tachycardia and mortality in patients who presented with NSTEMI was dependent on the presence of diabetes. The study emphases the impact of diabetes on cardiovascular disease.
Abstract P090: Oculus/PlayStation IV VR Game for Youth to Build Food and Drink Selection Skills
Authors: Tanner Bradley
Published: March 2019

Low-quality food and drink selection by today’s youth is well documented despite their ability to distinguish between low and high-quality foods. In addition, attention spans are short and youth are drawn to screens and gaming technology in our technology-focused culture. We are addressing the need to instill food and drink selection skills using a game-based behavioral intervention utilizing headset virtual reality (VR) technology. As a part of our Obesity Prevention project, we created Food Fight in VR. The virtual reality experience uses current PlayStation VR and Oculus headsets to offer an experience with high ecological validity by presenting high quality and accurate visual and auditory stimuli in a proper social and environmental context. In a realistic virtual world, the game immerses the young player in a believable world with altered game mechanics that control success and failure parameters. VR offers the young player an opportunity to experiment, try out new behaviors, fail, and build confidence. VR success then translates to real-world skills, feelings of empowerment, and improved selection behaviors. In our FoodFight Oculus or Playstation VR game, food cues bombard a young player wearing a virtual reality headset. They inspect each food or drink tossed at them. They quickly decide if the item is unhealthy (based on a diet they have chosen) and thus should be blocked (using a virtual tray), caught and thrown back, discarded, or hit away. Or, if they deem the food to be healthy, they grab it or pull it in with a food magnet and store it in the pantry or fridge for later. Visual cues, points, and active involvement make the process of selecting healthy foods and resisting unhealthy foods easy and fun. The game provides appropriate feedback for saving unhealthy food or rejecting healthy food. Eventually, they have collected enough food to build a healthy meal, win the game level, and proceed to the next level; winning and leveling up are strong motivators for this audience. In the long term, we seek to enhance internal control over the food selection process. Our short-term objectives are for the player to: 1) recognize healthy and unhealthy food, 2) reject unhealthy food/drink, 3) build confidence in rejecting unhealthy foods, and 4) recognize the foods required to build a balanced healthy meal consistent with a dietary guideline. Our future work involves expanding the game to highlight specific dietary requirements beyond the preparation of a single meal and include a wide range of diets such as Dash, Mediterranean, gluten-free, vegan, plant-based whole food, and vegetarian. Initial usability studies show a positive response and innovative use of game mechanics. A more robust evaluation is ongoing.
Abstract P092: Age and Gender-specific Associations of Diet Quality and 4-year Weight Change in Non-obese Adults of the Dutch Lifelines Cohort
Authors: Vinke Petra C , Kromhout Daan , Navis Gerjan , Corpeleijn Eva
Published: March 2019

Introduction:
Diet is an important lifestyle factor in strategies for overweight prevention, but little is known about its dependency on contextual factors like age and gender.

Hypothesis:
We assessed the hypothesis that the strength of the association between diet quality and 4-year weight change differed among age categories and between genders.

Methods:
From the Dutch Lifelines Cohort, 85.618 non-obese, adult participants were included in the study. At baseline, diet was assessed with a 110-item food frequency questionnaire. The Lifelines Diet Score, based on established evidence-based food groups for the prevention of chronic diseases, was calculated to assess diet quality. For analyses, the score was divided in quintiles. Body weight was objectively measured at baseline and after a median follow-up of 44 months (25th-75th percentile: 35-51 months). In between, body weight was self-reported twice. Linear mixed models were used to investigate the association between diet quality and weight change in 6 age categories (18-29 to 70+) and stratified by gender.

Results:
Mean 4-year weight change decreased over age categories. Confounder adjusted linear mixed model analyses showed that the association between diet quality and weight change was dependent on age, more so in women (p
INTERACTION
=0.001).

Poor diet quality (quintile 1 vs. quintile 5) was most strongly related to 4-year weight gain in young men (estimated mean +1.62 kg) and young women (estimated mean +1.13 kg). In contrast, in women aged 70+, poor diet quality was associated with weight loss (estimated mean -1.80 kg).

Conclusions:
Poor diet quality was prospectively related to higher weight gain, especially in young adults. Oppositely, among women aged 70+, better diet quality was related to less weight loss. Therefore, a healthful diet is a promising target for unintentional weight changes in both directions.
Abstract P093: A Nutrition Education Program Through the Farmer’s Market: Lessons Learned From Community-based Research in North Dakota
Authors: Alakaam Amir
Published: March 2019

Introduction:
More than 32% of adults have obesity in North Dakota (ND), cardiovascular diseases and cancer are the leading causes of death, and at least one in ten adults has diabetes in ND. Healthy eating habit has a protective role against chronic diseases and obesity. A community-based nutrition education program was implemented to identify effective and approachable strategies for developing a long-term intervention that increases fruits and vegetables intake and reduces risk of chronic diseases in ND community.

Hypothesis:
(1) Nutrition education would increase intake of fruits and vegetables among participants. (2) Participants who received compensation would be more likely to increase their consumption of fresh fruits and vegetables.

Method:
The pilot program was delivered through the farmer’s market in ND. We delivered six nutrition education sessions focus on the importance of fruits and vegetables on diet, and developing healthy skills related to fruits and vegetables purchasing and cooking. Participants earned a gift certificate at the end of session. Data collected through post-assessment questionnaire.

Results:
Two hundred and thirty nine participants enrolled and benefited from the program. We found significant increase in fruits and vegetables intake among participants. Results show that increasing access to fresh fruits and vegetables, and providing education about healthy food consumption encouraged market’s visitors to purchase fruits and vegetables.

Conclusion:
Nutrition education program through farmer’s market has the potential to increase fruits and vegetables intake. The finding suggests that researcher should implement nutrition education intervention as an approach to positively influence eating habits among community.
Abstract P095: Temporal Associations Between Lifestyle Self-Efficacy and Adherence to Calorie Goal
Authors: Zheng Yaguang , Imes Christopher , Sereika Susan M , Rathbun Stephen L , Burke Lora E
Published: March 2019

Introduction:
Research has shown self-efficacy (SE) to be positively associated with adherence to calorie goal when assessment is based on participants’ recall; however, when assessed in real-time, their association is unclear. Our aim was to examine temporal associations between SE for adhering to the daily recommended lifestyle plan and adherence to calorie goal collected in real-time over 12 months.

Methods:
Ecological momentary assessment (EMA) was used to assess SE for adhering to the daily recommended lifestyle plan in real-time during a behavioral weight loss study. SE was assessed by one question at the beginning of each day in the person’s natural setting “How confident are you that you will be able to stick to your healthy lifestyle plan today?” SE scores ranged from 1 to 10, with 1 reflecting lowest SE. Daily dietary intake was recorded using the Lose It! app. We calculated adherence to the calorie goal by dividing the total number of calories consumed each day by the daily calorie goal, then multiplying by 100 to express the value as a percentage. Adherence for each day was defined as 85%–115%. The mean weekly SE scores and mean weekly number of days adherent to dietary goals were calculated. Random coefficient modeling was used for analysis.

Results:
The sample (N=150) was 90.7% female, 80.7% white, with a mean age (±SD) of 51.1±10.2 years and a mean BMI of 34.0±4.6 kg/m
2
. Mean weekly SE score (b=-0.02, p<.001) decreased from 7.5 to 6.7 beginning at 3 months, while a decline in mean weekly number of days adherent to calorie goal (b=-0.04, p<.001) began immediately (see figure). Weekly SE score was positively associated with weekly number of days adherent to calorie goal (b1=0.17, p<.001).

Conclusion:
Our study found declines in self-efficacy and adherence to calorie goal assessed in real-time and the positive association between them. Future weight loss interventions need to develop strategies to sustain self-efficacy and prevent declines in adherence to a diet that can support a heart healthy lifestyle.
Abstract P098: The Relationship of Neighborhood Greenness to Heart Disease in 249,405 US Medicare Beneficiaries
Authors: Brown Scott C , Wang Kefeng , Lombard Joanna , Rundek Tatjana , Dong Chuanhui , Marinovic Gutierrez Carolina , Byrne Margaret M , Toro Matthew , Nardi Maria I , Kardys Jack , Yi Li , Szapocznik Jose
Published: March 2019

Background:
Nature exposures may be associated with reduced risk for heart disease. The present study examines the relationship between objective measures of neighborhood greenness (vegetative presence) and diagnoses of four forms of heart disease (acute myocardial infarction [AMI], ischemic heart disease, heart failure, and atrial fibrillation), in a large population-based sample of Medicare beneficiaries in Miami-Dade County, Florida.

Methods:
The sample included 249,405 Medicare beneficiaries ages 65 years and older whose location (ZIP+4) in Miami-Dade County, Florida, did not change from 2010 to 2011. Analyses examined relationships between greenness, measured by mean Normalized Difference Vegetation Index (NDVI) from satellite imagery at the Census block level, and four forms of heart disease in 2011. A series of hierarchical regression analyses, in a multi-level framework, assessed the relationship of greenness to each heart disease diagnosis, adjusting successively for individual sociodemographics and neighborhood median household income. A further final model adjusted for biological risk factors (diabetes, hypertension, and hyperlipidemia).

Results:
Higher greenness was generally associated with reduced risk of heart disease, in models adjusting for individual sociodemographics and neighborhood income: When compared to the lowest tertile of greenness, the highest tertile of greenness was associated with statistically significant (ps<.01) reduced odds of AMI by 25% (OR=0.75; 95% CI: 0.63, 0.90), ischemic heart disease by 20% (OR=0.80; 95% CI: 0.77, 0.83), heart failure by 16% (OR=0.84; 95% CI: 0.80, 0.88), and a marginally significant reduced odds of atrial fibrillation by 6% (OR=0.94; 95% CI: 0.87, 1.00, p=.067). In addition, the highest tertile of greenness was associated with 19% reduced odds of any of the four forms of heart disease (OR=0.81; 95% CI: 0.78, 0.84) when compared to the lowest tertile of greenness, adjusting for individual sociodemographics and neighborhood income. These associations were attenuated in a final model which added biological risk factors, suggesting that cardiometabolic risk factors may at least partly mediate the observed relationships between greenness and heart disease.

Conclusions:
Even after adjusting for individual sociodemographics and neighborhood income, neighborhood greenness may be associated with reduced odds of heart disease, possibly as a result of increased time spent outdoors, physical activity, stress mitigation, and/or air pollution. Results suggest that strategies to reduce inequities in area greenness and improve public access to these areas may be a future means of reducing heart disease at the population level.
Abstract P103: Childhood- and Adult Neighborhood-Level Variation in Adult Metabolic Syndrome Measures
Authors: Sponholtz Todd R , Vasan Ramachandran S
Published: March 2019

Objectives:
Metabolic syndrome (MS) risk varies by residential neighborhood across the life-course. We compared the proportional variance of adult MS measures explained at the level of adult and childhood neighborhoods.

Methods:
We defined neighborhoods as groups of Framingham Offspring Cohort (OS) members whose examination 1 (1971-4) residences were geocoded to within 100 m of ≥1 other group member. We included neighborhoods whose residents had ≥5 children in the Generation 3 Cohort (Gen3) aged 0-19 years at the time of their parent’s first examination. Outcomes were measured from 1971-4 for OS and 2002-5 for Gen3; we analyzed residuals of log-transformed body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and serum high-density lipoprotein (HDL) and -triglycerides, regressed on age and sex. We estimated neighborhood-level intraclass correlations (ICCs) and 95% confidence intervals (95% CIs) of all outcomes using multilevel linear regression.

Results:
Among 598 Gen 3 participants (mean age 39.8 years, 49.8% men), parental-residence-defined childhood neighborhoods (n=58) explained 6.6% (95% CI: 2.3, 15.5%) and 6.0% (95% CI: 2.1, 15.9%) of the variance in HDL and triglyceride levels, respectively. The neighborhood-level ICC for BMI was 2.4% (95% CI: 0.5, 11.9%); ICCs for blood pressure measures were similar to BMI. Neighborhoods explained none of the variance in any outcome among 772 OS participants (mean age 38.0 years, 49.2% men).

Conclusion:
Childhood, but not adult, neighborhoods explained a modest percentage of the variance in adult MS measures.