bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P220: The Effect of Diet-Induced Weight Loss on HDL Functionality in Individuals with Metabolic Syndrome: Investigating Alteration of the Initial Step in Reverse Cholesterol Transport as a Function of Plasma Lipoprotein Composition
Authors: Vasudevan Madhuri M , Tchoua Urban , Gillard Baiba , Lin Hu Yu , Jones Peter , Ballantyne Christie , Pownall Henry
Published: July 2021

The prevalence of metabolic syndrome (MetS) with obesity-linked diabetes continues to increase globally and is associated with atherogenic dyslipidemia characterized by high triglycerides (TG), small, dense low-density lipoprotein cholesterol (LDL-C), and low high-density lipoprotein cholesterol (HDL-C) levels. HDL orchestrates the reverse cholesterol transport (RCT) process, initiated by macrophage cholesterol efflux (MCE). The traditional hypothesis is that individuals with dyslipidemia have impaired RCT that leads to atherogenesis. However, a recent study showed that one metric of HDL function, macrophage cholesterol efflux (MCE) to diluted patient plasma, inversely correlated with atherosclerotic burden, independent of plasma HDL-C levels. Moreover, cholesterol efflux from ABCA1-upregulated macrophage cell lines to sera of diabetic hypertriglyceridemic subjects is enhanced compared to normolipidemic (NL) controls. The effect of weight loss on MCE in obese individuals with MetS is unknown. The purpose of this study is to evaluate MCE in obese individuals with MetS as a function of plasma dyslipidemia, and to determine the effect of weight loss on the RCT process. We measured the rate of MCE from human monocytic leukemia THP1 cells to plasma of NL controls (n=24) and obese MetS (n=24) patients before and after 4 to 6 weeks of very low calorie, diet-induced weight loss. Weight loss in the MetS patients was significant, averaged 21.3 lbs, with concurrent significant decreases in TG, apoB, TC, LDL-C and non-HDL-C. Measures of insulin resistance, systolic blood pressure and kidney function improved with weight loss. HDL-C was not significantly altered, but apoA-I decreased with weight loss. MCE to plasma of obese MetS patients was higher than MCE to control plasma ((7.44 + 1.36) % vs (6.39 + 1.23) %, p=0.0069). MCE to plasma of obese MetS patients significantly decreased after weight loss (6.23 + 1.69) %, comparable to control values. MCE was strongly correlated to apoB levels (r
2
= 0.13 - 0.38), consistent with apoB lipoprotein function as a cholesterol sink. This was confirmed by size exclusion chromatography analysis of the distribution of effluxed cholesterol among plasma lipoproteins in 1 control and 2 Mets patients. In conclusion, obese patients with MetS demonstrate increased MCE, a measure of HDL function, compared to NL controls, which significantly decreases in response to diet-induced weight loss, concurrent with a reduction in triglyceride and apoB levels. These results suggest that the high apoB lipoprotein levels in MetS pateints facilitate MCE, and may at least partially compensate for the low HDL-C to promote RCT in these patients.
Abstract P228: Genome-Wide Association Study of Lipid Response to Fenofibrate Treatment in the Genetics of Lipid-Lowering Drugs and Diet Network (GOLDN) Study
Authors: Arnett Donna K , Borecki Ingrid B , Irvin Marguerite R , Tiwari Hemant K , Straka Robert J , Ordovas Jose M
Published: July 2021

The lipid-lowering drug fenofibrate (FF) is best known for its triglyceride (TG)-lowering properties, but it also reduces low-density lipoprotein (LDL), very low density lipoprotein (VLDL) and increases high-density lipoprotein concentrations (HDL). Response to FF varies considerably among individuals and may be under genetic influence. This study seeks to uncover genetic variants that underlie the interindividual response of TG, LDL, and VLDL to FF treatment.

Methods:
TG, LDL, and VLDL concentrations were measured as part of the Genetics of Lipid-Lowering Drugs and Diet Network (GOLDN) Study before and after a 3-week FF treatment (160 mg/day). Genotyping was done using the Affymetrix 6.0 genome-wide array. Lipid response phenotypes were generated using growth curve models adjusted for age, agê2, sex, and center. Associations between single nucleotide polymorphisms (SNPs) and lipid phenotypes were assessed with mixed linear models including kinship correlation structure using the R package LMEKIN .

Results:
Genotype and TG, LDL, and VLDL response phenotype data were successfully collected from 769, 772, and 752 participants, respectively. The strongest evidence for association (P=3.80*10-7) was observed for LDL on chromosome 10 (133.7Mb) for SNP rs1646693. This lies near SLC35B4, a gene associated with obesity and glucose homeostasis. LDL also showed evidence of association (P=4.33*10-7) with rs6593376 on chromosome 10 (43.8Mb). The strongest evidence of association (P=5.54*10-7) with TG response was also on chromosome 10 (90.2Mb) at rs7917100 within RNLS, previously associated with cardiovascular function, cardiac hypertrophy, ischemia, and hypertension. Suggestive evidence of association (P=2.52*10-6) of rs11196872, with VLDL was also found on chromosome 10 (132Mb).

Conclusions:
We identified several novel loci suggestively associated with TG, LDL, and VLDL response to fenofibrate treatment.
Abstract P255: Association of Mild Chronic Kidney Disease with Venous Thromboembolism: Pooled Analysis of Prospective General Population Cohorts
Authors: Mahmoodi Bakhtawar K , Gansevoort Ron T , Naess Inger Anne , Lutsey Pamela L , Braekkan Sigrid K , Veeger Nic J , Brodin Ellen E , Meijer Karina , Sang Yingying , Matsushita Kunihiro , Hallan Stein , Hammerstrøm Jens , Astor Brad C , Coresh Josef , Folsom Aaron R , Hansen John-Bjarne , Cushman Mary
Published: July 2021

Background:
Recent findings suggest that mild chronic kidney disease (CKD) might be associated with increased risk of venous thromboembolism (VTE). However, results were partially inconsistent, which may be due to lack of power. We therefore performed a meta-analysis to investigate the association between mild CKD and VTE incidence.

Methods:
A literature search was performed to retrieve community-based cohorts with information on the association of estimated glomerular filtration rate (eGFR) and albuminuria with VTE. Five cohorts were identified that were pooled on individual level. To obtain pooled hazard ratios (HRs) for VTE, linear spline models were fitted using Cox regression with shared-frailty. Models were adjusted for age, sex, hypertension, total cholesterol, smoking, diabetes, history of cardiovascular disease and body-mass index. Random-effect meta-analysis was used to obtain adjusted pooled HRs of VTE with CKD versus no CKD.

Results:
The analysis included 95,154 participants with 1,178 VTE cases and 599,453 person-years of follow-up. Risk of VTE increased continuously with lower eGFR and higher ACR (Figure). Compared with eGFR 100 mL/min/1.73m², pooled adjusted HRs for VTE were 1.3 (1.0–1.7) for eGFR 60, 1.8 (1.3–2.6) for 45 and 1.9 (1.2–2.9) for 30 mL/min/1.73m². Compared with albumin-creatinine ratio (ACR) 5 mg/g, pooled adjusted HRs for VTE were 1.3 (1.04–1.7) for ACR 30, 1.6 (1.1–2.4) for 300 and 1.9 (1.2–3.1) for 1000 mg/g. There was no evidence for interaction between eGFR and ACR (P=0.22). The pooled adjusted HR for CKD (eGFR <60 ml/min/1.73m² or albuminuria ≥30 mg/g) vs. no CKD was 1.5 (95%CI, 1.2–2.1). Results were similar for idiopathic and provoked VTE.

Conclusion:
Both reduced eGFR and elevated albuminuria are novel independent predictors of VTE in the general population.
Abstract P268: Weight Change is a Poor Predictor of Change in Body Fatness in Cardiac Rehabilitation Patients
Authors: Pack Quinn R , Thomas Randal , Squires Ray , Johnson Lezlie , Somers Virend , Lopez-Jimenez Francisco
Published: July 2021

Introduction
: Obesity is a common risk factor in cardiac rehabilitation (CR), yet many CR patients do not realize significant weight loss, despite engaging in regular exercise training while in CR.

Hypothesis
: We hypothesized that standard CR would demonstrate favorable body composition (BC) changes even in the absence of weight loss and sought to measure the performance characteristics of weight loss to predict BC changes.

Methods
: We included consecutive patients enrolled in early outpatient CR who underwent air displacement plethysmography with measurements of height, weight, and waist circumference at initiation and completion of CR. We calculated the accuracy of weight loss to identify significant improvements in BC.

Results
: Data from 112 patients were available for analysis; mean age 60±12 yr., 76% male, mean body mass index (BMI) 30.2±5.3 kg/m
2
. The indication for CR was myocardial infarction (n=33), percutaneous coronary intervention (n=29), coronary artery bypass or valve surgery (n=45), and heart transplant (n=5). Repeat testing occurred after a median of 81 days and 21 phase II CR sessions. There was no change in BMI (-0.53±1.3 kg/m
2
, p=0.43) and weight (-1.6±4.0 kg, p=0.51). Fat mass showed a borderline significant decrease of 2.9±3.9 kg (p=0.08). However, BC improved significantly as measured by body fat % (-2.5±3.2%, p=0.03) and waist circumference (-4.6±5.2 cm; p=0.01). There was a correlation between weight loss and fat mass loss (r=0.85, p=0.0001, positive predictive value=0.94), and % fat change (r=0.67, p=0.0001, positive predictive value=0.91). See
table
1. However, the negative predictive value to detect no fat change for patients who did not lose weight was low (0.49, when assessed by % body fat loss, and 0.57, when assessed by fat mass loss). Among patients who did not lose weight, 29 (51%) had a greater than 1% body fat loss.

Conclusions
: The diagnostic performance of weight change to predict favorable BC changes is poor and highlights the potential utility of BC measurements in the CR setting.

Table.

Diagnostic Characteristics of Weight Loss as a Predictor of Improvements in Body Composition

Weight Loss (kg)
Body Fat % Loss
≤ 1%
Fat Mass Loss (kg)
> 1kg

> 1%
≤ 1kg

> 1kg
49
5
51
3

≤ 1kg or gain
29
28
25
33

Sensitivity
0.63
0.67

Specificity
0.85
0.92

PPV
*

0.91
0.94

NPV
**

0.49
0.57

*

PPV = Positive Predictive Valve,

**

NPV = Negative Predictive Value
Abstract P269: Examining the Unique Contribution of Physical Education and Sports Team Participation to Overall Levels of Adolescent Physical Activity
Authors: Lenhart Clare M , Hanlon Alexandra , Kang Youjeong , Daly Brian P , Brown Michael , Patterson Freda
Published: July 2021

Background:
Adolescent females are significantly less likely to meet physical activity recommendations than males; this gender disparity is also evident among adults. Physical education class and sports teams represent an important opportunity for physical activity among youth. Females, in particular, may rely on these opportunities since they are less likely to be active during unstructured time as compared to males. This study examined the relative contribution of participation in physical education class and sports teams to overall levels of physical activity for females and males, independent of known correlates of physical activity in this group of adolescents.

Methods:
Cross-sectional data was examined from 591 9
th
−12
th
grade students from Philadelphia public schools who completed the 2009 Youth Risk Behavior Assessment. The relationship between the independent variables (participation in physical education class and sports teams) and other selected correlates (race, grade level, body mass index, depression symptoms and suicidal ideation, eating habits and weight concern, drug use, television watching and computer use) and physical activity was evaluated using chi-square tests. Variables with an association of p<.3 were entered into a stepwise regression model to estimate the relative association of each variable with activity levels. A final regression model stratified by gender was generated to estimate gender differences.

Results:
Sixty-two percent of the sample was female, 50% were African American, 19% were overweight, and 33% reported five or more days of activity in the last week. Females were less likely to be active than males (x
2
(2,
N
= 591) = 33.72,
p
= <.01): 27.9% of females were sedentary as compared to 10.6% of males. PE class was not significantly related to overall physical activity among males, while highly active females were seven times more likely to report participating in PE class every day than sedentary females (Exp(B)=7.06; p=.001). Playing on one or more sports teams was significantly associated with low-to-moderate (Exp(B)=2.14; p=.02) and highly active females (Exp(B)=3.24; p<.01). Among males, sports team participation was only associated with high levels of activity (Exp(B)=2.79; p=.05).

Conclusions:
Participation in sports teams and physical education class contribute more to overall activity levels in female than male adolescents. A more rigorous assessment of this hypothesis is warranted to inform efforts to promote adolescent activity levels, particularly among females.
Abstract P296: Joint Impact of 61 Genetic Variants in Seven Nicotinic Acetylcholine Receptor Genes on Subclinical Atherosclerosis in American Indians: A Pathway-based Analysis
Authors: Yang Jingyun , Cole Shelley A , Haack Karin , Zhang Ying , Howard Barbara V , Best Lyle G , Roman Mary J , Devereux Richard B , Lee Elisa T , Zhao Jinying
Published: July 2021

Background:
Atherosclerosis is a complex disease resulting from the joint effects of multiple genetic variants. Cigarette smoking is a strong risk factor for atherosclerotic cardiovascular disease (CVD). Nicotine, the major active component of cigarette smoke, influences CVD by binding to nicotinic acetylcholine receptors (nAChRs). Genetic variants in nAChRs may therefore contribute to atherosclerosis. While each single variant may have only a minor effect, the joint contribution of multiple SNPs to atherosclerosis may be larger.

Objective:
To investigate the joint impact of 61 SNPs in seven nAChRs genes on subclinical atherosclerosis using a pathway-based approach.

Methods:
We genotyped 61 tagSNPs in seven nAChRs genes (CHRNA3-A6, CHRNB2-B4) in 3,665 American Indians recruited by the Strong Heart Family Study from Oklahoma (OK), Arizona (AZ) and North/ South Dakota (DK). Subclinical atherosclerosis was assessed by carotid intima-media thickness (cIMT) and carotid plaque score using ultrasound. We performed a pathway-based analysis to evaluate the joint impact of these 61 SNPs on cIMT and plaque score, separately, adjusting for classical cardiovascular risk factors including age, sex, body mass index (BMI), cigarette smoking status (current, former vs. never), alcohol intake (current, former vs. never), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), blood pressure, diabetes, levels of physical activity, fibrinogen, and renal function (assessed by estimated glomerular filtration rate). To avoid population substructure, all statistical analyses were stratified by study center (OK, AZ, and DK). Multiple testing was adjusted using Bonferroni correction.

Results:
Prevalence of smokers (current plus former) was highest in participants from DK (66%), followed by OK (58%) and AZ (51%). Compared to never smokers, smokers had significantly larger cIMT (0.647mm vs. 0.681mm, P<0.0001) and plaque score (0.568 vs. 0.793, P<0.0001). Among the 61 SNPs examined, only seven SNPs showed significant individual association with cIMT or plaque score in OK after Bonferroni correction. However, a pathway analysis indicates that the nAChRs pathway as a whole in consideration of the joint effects of all 61 SNPs was significantly associated with both cIMT and plaque score in participants from OK and AZ (all p’s<0.001), but not DK.

Conclusion:
Genetic variants in the nAChRs pathway jointly contribute to subclinical atherosclerosis in American Indians. Though the mechanism linking the nAChRs genetic pathway to subclinical atherosclerosis is unclear, our results may provide valuable information for behavioral and/or molecular strategies for reducing cardiovascular risk in American Indians.
Abstract P306: Effect of A Low-Carbohydrate Diet on Weight and Cardiovascular Risk Factors: A Randomized Controlled Trial
Authors: Bazzano Lydia A , Reynolds Kristi , Hu Tian , Yao Lu , Bunol Calynn , Liu Yanxi , Chen Chung-Shiuan , He Jiang
Published: July 2021

There are few studies examining the effects of a diet low in carbohydrates on cardiovascular disease (CVD) risk factors in the long term, particularly in contrast to the current dietary recommendations for decreased fat intake to reduce risk of CVD. We recruited 148 study participants with a body mass index (BMI) of 30–45 kg/m2, who were free of diabetes, CVD and kidney disease at baseline and randomly assigned them (74 in each group) to either a low carbohydrate diet (<40 g/day) or a low fat (<30% energy from fat, <10% from saturated fat) diet. Participants met with a study dietitian weekly for the first month then in group settings bi-weekly for 5 months then monthly for the next 6 months. Each group was provided the same behavioral curriculum related to diet emphasizing portion control and eating habits. Two 24-hour dietary recalls were conducted at each clinic visit (0, 3, 6 and 12 months of intervention). The primary outcome measures were weight, body composition, lipids, blood pressure, and glucose. Mean age of participants was 46.8 years, mean BMI was 35.4 kg/m2; 11.5% were men, and 51% were African-American. Of the study participants, 60 in the low fat group (81.1%) and 59 in the low carbohydrate group (79.7%) completed the entire intervention. At 12 months, mean total energy intake on the low carbohydrate diet was 1,448 kcal/day with 23.6% from protein, 40.7% from fats, and 34.0% from carbohydrate versus 1,527 kcal/day with 18.6% from protein, 29.8% from fats, and 50.0% from carbohydrate on the low fat diet. Compared to low fat diets, over 12 months the low carbohydrate group had greater reductions in weight (net change −3.62 kg, p<0.001), fat mass (−2.83 kg, p<0.0001), waist circumference (−1.79 cm, p=0.03), triglycerides (−12.83 mg/dL, p=0.05), and a greater increase in high density lipoprotein cholesterol (HDL-C, 6.74 mg/dL, p<0.001). There were no differences in net changes between diets for total cholesterol, low density lipoprotein cholesterol, blood pressure, glucose, creatinine, or lean body mass. Our findings document that a low carbohydrate diet was more effective for weight loss than a low fat diet, and did not have significant adverse effects on cardiovascular risk factors. In contrast, the low carbohydrate diet improved HDL-C and triglycerides as compared to a low fat diet. Restricting carbohydrates is an effective method of weight loss and could be recommended for persons with and without increased CVD risk factors who need to lose weight.
Abstract P321: Influence of Cigarette Smoking on Coronary and Aortic Calcification Among Community-based Middle-aged Japanese and Korean Men
Authors: Hirooka Nobutaka , Kadowaki Takashi , Shin Chol , Curb J. David , Barinas-Mitchell Emma , Masaki Kamal , El-Saed Aiman , Seto Todd B , Cho Jina , Fujiyoshi Akira , Okamura Tomonori , Miura Katsuyuki , Ueshima Hirotsugu , Edmundowicz Daniel , Kuller Lewis H , Sutton-Tyrrell Kim , Sekikawa Akira ,   from the ERA JUMP Study
Published: July 2021

Background:
Incidence of coronary heart disease (CHD) among Japanese and Korean men is low among industrialized countries despite their high rates of cigarette smoking. We hypothesized that cigarette smoking is associated with coronary (CC) and aortic calcification (AC) in Japanese and Korean men regardless of their low incidence rates of CHD.

Method:
To test this hypothesis, a community-based sample of 313 Japanese and 302 Korean men aged 40-49 were examined for CC and AC using electron-beam computed tomography. We examined the relationship between cigarette smoking and calcification after adjusting for conventional risk factors (age, BMI, alcohol consumption, systolic blood pressure, high-density and low-density lipoprotein cholesterol, and fasting serum glucose). Current and past smokers were combined and categorized into two groups using the median of pack-years of smoking as a cutoff point. Never-smokers were used as a reference for multiple logistic regression analyses.

Results:
The odds ratios of the presence of CC (Agatston score ≥ 10) for smokers of lower and higher level of smoking were 1.0 and 2.9 (p = 0.035 for trend) in Japanese and 0.8 and 1.3 (p = 0.647 for trend) in Koreans. The odds ratios of the presence of AC (Agatston score ≥ 100) for smokers of lower and higher level were 2.0 and 10.4 (p < 0.001 for trend) in Japanese and 2.1 and 3.6 (p = 0.012 for trend) in Koreans.

Conclusion:
Cigarette smoking is associated with coronary and aortic calcification in Japanese men while smoking is only associated with aortic calcification in Korean men.

Table

Odds ratios of having coronary and aortic calcification by smoking status in Japanese and Korean men

Never smoke
Low pack-years smoke
High pack-years smoke
P value

Japanese

CC Agatston≥10
1.0
1.0
2.9
<0.035

95% C.I.

[0.2, 4.2]
[0.8, 11.3]

AC Agatston≥100
1.0
2.0
10.4
<0.001

95% C.I.

[0.4, 9.8]
[2.3, 47.1]

Koreans

CC Agatston≥10
1.0
0.8
1.3
0.647

95% C.I.

[0.3, 2.4]
[0.5, 3.8]

AC Agatston≥100
1.0
2.1
3.6
0.012

95% C.I.

[0.9, 4.9]
[1.5, 8.6]

AC and CC indicates aortic and coronary calcification, respectively.
Abstract P326: Impact of Cardiac Rehabilitation on Depressive Symptomatology in Female Cardiac Patients
Authors: Reddy Bharathi , Lee Kiseok , Rullo Nancy , Cheslik Candy Donna , Nicholson John P
Published: July 2021

BACKGROUND:
Coronary artery disease (CAD) is the leading cause of mortality in women and is responsible for more than 500,000 lives each year in the United States. Depression and depressive symptomatology in healthy subjects increases cardiovascular mortality in both men and women and its prevalence is exponentially rising in women. Research suggests that participation in a cardiac rehabilitation (CR) program reduces depression. Unfortunately studies have shown that CR is widely underutilized, particularly with significantly lower CR enrollment rates among women.

HYPOTHESIS:
The aim of this study was to demonstrate the effect of CR in the improvement of depressive symptoms in female cardiac patients after a cardiovascular event enrolled at the Cardiac Health Center (CHC) New York Hospital Queens (NYHQ).

METHODS:
The study sample comprised of 295 patients who completed 36 visits of CR at CHC NYHQ from 2007-2009. Out of 295 patients (age 66.85 ±10.64), 214 are males (71%) and 81 are females (29%). Mood scores were assessed using the PHQ-9 at the initial visit and again upon completion of the CR program. Of the 81 female patients enrolled, 31 female patients had documented pre and post CR-PHQ scores and of the 214 male patients enrolled, 81male patients had documented pre and post CR-PHQ scores. Using paired t test average mean difference in mood scores was tested.

RESULTS:
There was a significant decrease in mood scores in female patients (7.57 ± 5.18 to 3.11 ± 4.00, Δ 4.45 p= 0.00) compared to male patients (5.72 ± 5.19 to 2.37 ± 3.95 Δ 3.34 p = 0.00) after the completion of CR.

CONCLUSION:
The result of this study confirms that both male and female cardiac patients demonstrated significant reduction in depressive symptoms upon completion of CR. Female cardiac patients reported higher levels of depressive symptoms than male cardiac patients at the beginning of CR and exhibited a significant decrease in mood scores at the end of CR. This evidence supports that CR is an effective treatment in the reduction of depressive symptoms among female cardiac patients. Future studies are needed to establish the relationship among gender, CR, and depression. Clearly this is a complex issue and further efforts are needed to institute strategies to increase participation rates among female cardiac patients.
Abstract P327: KIF6 Carrier Status in Asians Predicts Beneficial Response to Statins
Authors: Fung Gordon , Aparicio Alberto F , Wu Alan , Smith Andrew , Wong Ivy
Published: July 2021

Introduction:
This is a prospective study of kif6, a genetic biomarker of cardiovascular disease and efficacy for statin therapy, using retrospective analysis of cardiac history. We explored the association between kif6 and cardiovascular disease (CVD) events (ACS, atherosclerosis with PCI or CABG) as well as the frequency of kif6 in Asians. In previous studies, carriers of kif6 had a higher incidence of CVD than non-carriers. The identification of a patient’s kif6 status may have impact on the therapeutic approach to reduce CVD risk.

Hypothesis:
Kif6 carriers with no or low dosage of statins have a higher rate of cardiovascular disease and treatment with higher dose statins have significant reduction in their rate of CVD events.

Methods:
We enrolled 135 patients from UCSF to determine kif6 carrier status and a review of their cardiac history. We analyzed the associations between high (40mg) vs. low (< 20 mg) in carriers and non-carriers and accounted for CVD events. For 11 patients, the statin dose at the time of their CVD event was unknown. Given the standard of care practice, this group was assigned to low statin.

Result:
Prevalence of kif6 mutation in Asians is 72%. Kif6-carriers with low/no statin have higher rates of CVD events (38%) compared to those on high dose statin (13%). Kif6-non carriers did not have significant reduction in CVD events with statin treatment. Study selection bias was a referral population from the community for secondary cardiovascular care at UCSF and small study size. However, enrollment is continuing. Other possible biases are presence of co-morbidities, e.g., smoking status, lifestyle habitus, Diabetes, and hypertension.

Conclusion:
This is the first prospective study looking at kif6 mutation prevalence and impact in Asians. The prevalence of kif6 mutation is high among Asians. Kif6-carrier is predictive of CVD events. There is definitive benefit of high-dose statin therapy for kif6-carriers with reduction in CVD events. There is no definitive benefit of statin therapy for non-carriers.

Table

Kif6-Carrier: (n= 97)
Kif6-Non-carrier: (n=37)

Low statin, no CVD event

46
15

Low statin, w/ CVD event

28
10

Total

74
25

Event rate

38%
40%

High statin, no CVD event

20
9

High statin, w/ CVD event

3
3

Total

23
12

Event rate

13%
25%

P-value

0.0468
0.5983
Abstract P332: Thirty Day Readmissions After Myocardial Infarction in the Community
Authors: Dunlay Shannon M , Weston Susan A , Killian Jill M , Bell Malcolm R , Jaffe Allan S , Roger Veronique L
Published: July 2021

Background:
Hospital readmissions are considered to be a quality of care indicator, yet little is known about their occurrence and predictors after myocardial infarction (MI) in the community.

Methods:
We identified all Olmsted County residents with incident MI from 1987-2007 and evaluated 30-day rehospitalizations. The reason for readmission was categorized based on ICD-9 code. Safety endpoints of revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) or fibrinolysis included stroke, acute kidney injury (rise in creatinine post-procedure of >0.5 mg/dL), access site complication (PCI), and gastrointestinal or other bleeding. Cox proportional hazard regression models were used to examine the predictors of readmission.

Results:
A total of 2617 patients (mean age 67 years, 41% female) had incident MI (32% with ST-elevation) from 1987-2007 and survived their initial hospitalization. A total of 583 readmissions occurred within 30 days among 512 (19.6%) patients. Approximately half (n=286, 49.1%) of readmissions were due to cardiovascular causes, and of these, most were due to ischemic heart disease (n=175, 61.2%) or heart failure (n=56, 19.6%). The proportion of non-cardiovascular rehospitalizations increased over time, from 42.2% from 1993-97 to 59.4% from 2003-07 (p for trend=0.01). A minority of those readmitted for cardiovascular reasons required repeat angiogram (n=110, 38.5%) or revascularization (n=88, 50 PCI, 38 CABG). After adjustment for confounders, key factors were associated with increased rehospitalization risk (
Figure
). Following PCI (n=1230), a stroke or bleeding event (adjusted HR 1.69, 95% CI 1.09-2.61, p=0.02) and acute kidney injury (HR 2.50, 95% CI 1.61-3.87, p<0.01) were associated with markedly increased readmission risk.

Conclusions:
Half of readmissions within 30 days of MI are for non-cardiovascular reasons, and this proportion has increased. Comorbidity and complications of revascularization are key predictors of readmission.
Abstract P334: Gender Disparities in Cholesterol Control Among Patients with Diabetes
Authors: Schroeder Emily B , Bayliss Elizabeth A , Steiner John F
Published: July 2021

Background:
It has been reported that women often receive less aggressive primary and secondary prevention for cardiovascular disease. Diabetes decreases the cardiovascular protection that women experience, and is considered a coronary heart disease equivalent. National diabetes guidelines thus recommend similar LDL-cholesterol (LDL-c), blood pressure, and hemoglobin A1c (HbA1c) goals for men and women.

Methods:
We conducted a retrospective, longitudinal study in a cohort of 6,573 patients with incident type 2 diabetes at Kaiser Permanente Colorado (2000-2008). We examined LDL-c, blood pressure, and HbA1c at the time of diagnosis (baseline) and after one year follow-up. We identified baseline coronary artery disease (CAD) via diagnosis codes.

Results:
Women and men had similar age and race distributions. Women were more likely to be never smokers and had higher BMI (34.0 vs. 31.9 kg/m
2
), while men were more likely to be former smokers and have CAD (20.9% vs. 9.8%). Men had slightly higher baseline HbA1c, but the difference disappeared at follow-up. No gender differences were seen for blood pressure. Women had higher baseline LDL-c (
Table
, p-value <0.0001), with 79% of the initial difference persisting after one year (p-value <0.0001). Women were less likely to have LDL-c < 100 mg/dL at one year follow-up (50.7% vs. 57.2%). In both genders, LDL-c was lower among individuals with CAD than those without CAD. Baseline CAD accounted for 35% of the follow-up LDL-c gender difference. At follow-up, women were slightly less likely to be taking a statin (40% vs. 38%).

Conclusions:
Even with population-based case-management programs aimed at cholesterol management, fewer women than men met the recommended LDL-c goal of < 100 mg/dL one year after diabetes diagnosis. Some of the difference can be attributed to differences in CAD prevalence. These findings suggest that diabetes is often not treated as a CAD equivalent in clinical care, and greater emphasis should be placed on primary CAD prevention among both men and women with diabetes.

Table

LDL-c (mg/dL) by gender and baseline CAD status

Women

Men

Mean difference

Mean (SD)

Median

Mean (SD)

Median

Baseline

No CAD
121.5 (37.0)
119.0
117.4 (36.4)
115.0
4.1

CAD
94.0 (35.0)
88.0
89.1 (29.1)
86.0
4.9

Total
118.8 (37.7)
116.0
111.5 (36.8)
109.0
7.3

Follow-up

No CAD
106.0 (33.7)
102.0
102.2 (31.1)
100.0
3.8

CAD
86.5 (32.8)
82.0
82.9 (26.5)
79.0
3.6

Total
104.0 (34.1)
100.0
98.2 (31.2)
95.0
5.8
Abstract P338: Differences in Costs, Length of Stay and Mortality for Myocardial Infarction and Related Disorders in Non Federal Hospitals
Authors: Okunji Priscilla O , Wutoh Anthony K
Published: July 2021

BACKGROUND:
Validated estimates of costs, length of stay, and mortality rates are necessary for the treatment and prevention of acute myocardial infarction in patient admitted to federal hospitals. Estimates based on data from few healthcare institutions may not be generalizable to all hospitals.

HYPOTHESIS:
To assess the hypothesis that there will be significant differences in costs, length of stay, and in-hospital mortality rates between inpatient with: (1) acute myocardial infarction only, (2) diabetic acute myocardial infarction and (3) diabetes only in non federal hospitals.

METHODS:
Data were extracted and analyzed from 4,400 hospital patients with both diabetes and myocardial infarction using International Classification of Diseases-9-Clinical Modification (ICD 9-CM) primary diagnosis codes from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database. Data were retrospectively extracted from 1,056 hospitals in 42 States. Descriptive and multivariate statistical techniques were used to examine patient characteristics and outcome-related factors associated with the inpatient costs.

RESULTS:
Patients with acute myocardial infarction only incurred the highest average cost ($68,036, n = 24,791), followed by patients with diabetic myocardial infarction ($65,937, n = 4,400), and diabetes only ($33,680, n = 1,021,933) in 2008 hospital stay. The average LOS was at 6.3 days for myocardial infarction, 7.5 days for diabetic myocardial infarction, 4.95 days for diabetes. Inpatient with myocardial infarction only 2,056 (8.2%), diabetic myocardial infarction 350 (7.9%) and diabetes only 25,377 (2.5%) died during hospitalization. Regression analysis showed that patient comorbidities for both diabetic myocardial infarction were highly significant at
p
< .0001 ranking from fluid and electrolyte 306 (6.0%), renal failure 558 (12.6%), peripheral vascular disorders 363 (8.2%) and congestive heart failure 306 (6.0%). For each procedure, as days from admission to the first procedure increased, average costs consistently decreased ranging from less than one day ($11, 681.00) to 9 days ($100.00). Also, average costs were significantly high,
p
< .0001 with patient location, patient disposition, risk mortality and disease severity. Patient gender and ethnicity were also significant,
p
< .005 and
p
<.006 respectively.

CONCLUSIONS:
In conclusion, acute myocardial infarction remains the index for increased inpatient mortality, costs and length of stay in patients with both diabetes and myocardial infarction. Inpatients outcomes could be decreased enormously if patient could be screened and treated appropriately on admission to prevent complications like acute myocardial infarction. This study has revealed that appropriate estimation of costs in acute myocardial infarction disorders would help in accurate allocation of funds for preventive measures.
Abstract P339: Cardiovascular Preventive Care In Patients Using Psychotropes: Impact On Primary Care
Authors: Sudhakar Rajeev , Muthusamy Arun , Levine Diane
Published: July 2021

Background Patients on psychotropic medications are at higher cardiometabolic risk compared to the general population because of obesity, diabetes, hypertension and hyperlipidemia making primary prevention important. We sought to assess preventative strategies in primary care setting for this population. Methods We conducted a cross sectional analysis using the limited access dataset of National Ambulatory Medical Care Survey from year 2000-2009. Patients between 18-85 years who visited primary care clinics were included. Demographics including age, gender, race, region and type of insurance were analyzed. Psychotropes included in our analysis were typical and atypical anti- psychotics, selective serotonin reuptake inhibitors, serotonin - norepinephrine reuptake inhibitors, norepinephrine reuptake inhibitors, monoamine oxidase inhibitors and tricyclic antidepressants. Multivariate logistic regression model was used to compute the adjusted odds ratio to compare the health conditions and its preventative care with and without psychotrope use. Results There were a total of 279,819 patient visits. Psychotropic medication use was documented in 6% of visits. The use of psychotropes was higher among middle age persons (45%), women (67%) and Southern regions(35%). Obesity (41% Vs 29% P = 0.02), hyperlipidemia (18.5% Vs 15.2% P = <0.0001) and smoking (17% Vs 10% P = <0.0001) were reported more often in visits for patients with psychotropes use compared to patients without psychotrope use. There was no difference in the prevalence of hypertension (P = 0.1) or diabetes (P= 0.3). Patients on psychotropes had a higher rate of aspirin use(8% Vs 3%), statin use(48% Vs 36%), antihypertensive use (69% Vs 48%) and stress-management counseling (28% Vs 5%) but a proportionally similar rate of smoking cessation advice (25% Vs 19%) compared to those not on psychotropes. Despite a higher prevalence of obesity and hyperlipidemia, adequate preventive counseling was not provided to patients on psychotropes for diet /nutrition (10.8 Vs 10.4 P = 0.5), exercise (10.1 Vs 8.7 P = 0.8) and weight reduction (9 Vs 6.6 P = 0.1 Conclusion In this large cohort,patients on psychotropes were found to be at increased cardiovascular risk and were treated aggressively with medications. Yet, this at-risk population received lesser degree of counseling for lifestyle modification. It is important for primary care physicians who see nearly one third of this high risk population, to understand this association and focus on preventive and lifestyle counseling.
Abstract P344: Hypothetical Interventions on Fish Consumption in Mid and Later Life and the Risk of Coronary Heart Disease in Women: An Application of the Parametric G-formula
Authors: Lajous Martin , Willett Walter C , Robins James , Mozaffarian Dariush , Hernan Miguel A
Published: July 2021

Background_Long-term randomized trials of interventions on fish and primary prevention of coronary heart disease (CHD) are unavailable. The parametric g-formula uses observational data to estimate the effect of changes on fish consumption that would have been observed under hypothetical interventions. Methods and Results_Among 53,799 women from the Nurses’ Health Study aged 39-67 and free of CHD at baseline in 1986, 1,891 developed incident CHD (1,145 non fatal, 830 fatal) by 2008. Women provided information on risk factors and medical conditions every 2 years and on diet every 4 years. We used the parametric g-formula to evaluate hypothetical interventions from baseline forward on fish intake. Specifically, we estimated the CHD risks if all women had changed their fish intake to zero servings per week, and if all women had changed their fish intake to at least 1, 2, 3 and 5 servings per week during the entire follow-up. We adjusted for age and family history of CHD, and for baseline and time-varying menopausal status, use of oral contraceptives, postmenopausal hormone therapy, aspirin, multivitamin and vitamin E supplements, diabetes, hypertension, hypercholesterolemia, stroke, angina or CABG, BMI, physical activity, smoking and intake of calories, trans fatty acids, cereal fiber and red meat. The estimated CHD risk was 4.13 if fish intake had been changed to zero after 1986, and 3.77, 3.53, 3.32 and 3.35, if all women had changed their fish intake to at least 1, 2, 3 and 5 servings per week, respectively. Compared with changing fish intake to zero, the risk ratio of CHD was 0.85 (95% CI 0.75, 0.91) for changing intake to at least 2 servings/week, and 0.80 (95% CI 0.71, 0.97) for changing intake to at least 3 servings. This estimated protective effect of increased fish consumption was restricted to fatal CHD. Results were not appreciably altered when we specified that red meat was replaced by fish intake. Conclusion_Our results suggest that increasing fish consumption in mid or later life may lower the 22-year risk of CHD in women by 20%. Using the parametric g-formula allowed to explicitly specify hypothetical interventions to evaluate the effectiveness of diet change over a long period. Like all observational estimates, the parametric g-formula estimates may be affected by unmeasured confounding, model misspecification, and measurement error.
Abstract P357: The Impact of Dietary and Metabolic Risk Factors on Cardiovascular and Diabetes Mortality in South Asia: An Analysis from the 2010 Global Burden of Disease (GBD) Study
Authors: Yakoob Mohammad Yawar , Micha Renata , Khatibzadeh Shahab , Afshin Ashkan , Shi Peilin , Singh Gitanjali , Ezzati Majid , Mozaffarian Dariush , On behalf of Global Burden of Diseases, Injuries,and Risk Fa  , Nutrition and Chronic Diseases Expert Group  ,   Metabolic Risk Factors of Chronic Diseases Collaborating Group
Published: July 2021

BACKGROUND: Cardiometabolic diseases are rising in South Asia. The impact of modifiable diet and metabolic risk factors on mortality due to these diseases has not been quantified for this region using consistent methodology.

OBJECTIVE: To estimate disease-specific mortality effects of major diet and metabolic risk factors by age and sex in South Asia.

METHODS: We used a comparative risk assessment analysis (CRA) framework, developed as part of the 2010 GBD study, for six countries of the region (India, Pakistan, Bangladesh, Afghanistan, Nepal, Bhutan). The current national risk factor exposure distribution for these countries was obtained from systematic literature searches of nationally representative surveys and direct author contact. We identified 8 surveys for diet and 50 for metabolic risks. The likely causal effect sizes of risk factor-disease relationships (RRs) were derived from meta-analyses of trials or epidemiological studies. Plausible optimal alternative exposure distributions were identified from other global studies or regions, and total disease-specific deaths were obtained from 2008 WHO data. Missing exposure data were imputed using multi-level hierarchical Bayesian models with time varying covariates. Inputs were combined to compute population attributable fractions and mortality preventable from these risks. We performed sensitivity analyses by varying choice of exposure metrics, causal effect sizes, and alternative distributions. Updated GBD estimates for smoking and physical activity are in progress. RESULTS: Among metabolic risks, high systolic blood pressure and high BMI produced the highest number of preventable cardiometabolic deaths in South Asia in 2008 in both men and women (
Figure
). Other risks, including fruits also contributed to a substantial number of deaths.

CONCLUSIONS: Use of CRA methods allows quantification of the impact of specific modifiable risk factors on disease, informing health policy and priority setting to improve diet and lifestyle in people of South Asia.
Abstract P360: The Impact of Dietary and Metabolic Risk Factors on the Burden of Cardiovascular Diseases and Diabetes in the Middle East and North Africa; An Analysis from the 2010 Global Burden of Diseases, Injuries, and Risk Factors: Nutrition and Chronic Diseases Expert Group, and Metabolic Risk Factors of Chronic Diseases Collaborating Group
Authors: Afshin Ashkan , Micha Renata , Khatibzadeh Shahab , Fahimi Saman , Shi Peilin , Singh Gitanjali , Yakoob Mohammad Y , Ezzati Majid , Mozaffarian Dariush
Published: July 2021

BACKGROUND: The burden of CVD and diabetes is rapidly increasing in the Middle East and North Africa. However, the impact of major dietary and metabolic risk factors on CVD and diabetes has not yet been quantified in this region.

OBJECTIVE: To quantify the CVD and diabetes mortality attributable to non-optimal diet and metabolic risk factors in the Middle East and North Africa.

METHODS: We used a comparative risk assessment framework to estimate the number of disease-specific deaths attributable to 14 dietary and 4 metabolic risk factors by age and sex. The specific inputs we assessed for this analysis included the current national exposure distribution, the etiological effect of risk factor on disease-specific mortality, the alternative exposure distribution associated with the lowest possible disease risk, and the total number of disease-specific deaths in the population. We obtained these inputs as a part of our work in the 2010 GBD study. Using a multi-level hierarchical Bayesian model, we imputed missing exposure data based on non-missing exposure data from other regions and available data on other characteristics in the region or country with the missing data of interest. The first three inputs were used to compute the disease-specific Population Attributable Fraction (PAF) for each dietary and metabolic risk factor. Disease-specific mortality was determined using the PAF and the fourth input. The robustness of the findings was evaluated by their sensitivity to varying assumptions, including likely effect sizes and feasible optimal levels.

RESULTS: In 2008, overweight/obesity and high fasting plasma glucose were responsible for 123,000 and 107,000 cardiometabolic deaths, respectively, in the Middle East and North Africa. Other dietary and metabolic risk factors also caused a substantial number of deaths in this region (
Figure
).

CONCLUSIONS: Our findings inform priorities for policy measures to improve diet and reduce metabolic risk factors to prevent CVD and diabetes in the Middle East and North Africa.
Abstract P377: Insulin, Muscle Mass and Exercise Performance in Overweight Women
Authors: Leon Benjamin , Carnie Andrea , Jenkins Shannon , Smith Kevin , Zalos Gloria , Chen Kong Y , Cannon Richard O
Published: July 2021

Introduction
Obesity is associated with many negative health impacts, including hyperinsulinemia and reduced exercise performance, despite being associated with greater lean skeletal mass which works as the insulin-targeting and exercising organ.

Purpose of Study
We delineated the associations amongst cardiorespiratory capacity, fat mass, skeletal mass distributions, and fasting plasma insulin in overweight, non-diabetic women.

Methods
One hundred and seventy-two sedentary women, age 22 to 68 years (range), body mass index (BMI) (34.2 ± 6.3 [mean ± SD]; range 25.3 to 57.6 kg/m
2
), underwent dual energy x-ray absorptiometry for body composition, fasting insulin, and graded treadmill exercise test using the Bruce protocol with measurement of oxygen consumption (peak VO
2
).

Results
After adjustment for age, fasting insulin (9.8 ± 8.1; range 1.9 to 47.6 mcU/ml) was positively associated with BMI (r = 0.43, p<0.001), fat mass (r = 0.41, p< 0.001), load-bearing skeletal muscle mass (lower extremity lean mass; r = 0.29, p< 0.001), and non-load-bearing skeletal muscle mass (upper extremity lean mass; Figure, Panel A). By multiple regression analysis with age, fat mass and lower and upper extremity lean masses as covariates, fat mass, age and upper extremity lean mass (Figure, Panel B) were independent negative predictors of peak VO
2
(all p< 0.01). Lower extremity, however, trended to be positively predictive of peak VO
2
(p = 0.067).

Conclusions
In non-load-bearing muscle, increased lean mass associated with elevated plasma insulin is predictive of reduced oxygen consumption during exercise, suggesting additional load that may diminish cardiorespiratory exercise performance or intrinsic impairment in skeletal muscle function. In load-bearing muscle, compensatory hypertrophy due to increased fat and lean mass loads may preserve exercise performance.