bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9747: Truth in Advertising: Are We Providing Consumers With the Proper Information to Participate in Decision Making About Hypoplastic Left Heart Therapies?
Authors: Friedman Richard A
Published: July 2021

Introduction:
Consumer Health Informatics has become an integral part of healthcare in 2015. The purpose of this survey study is to examine the information available on the internet to a parent(s) of a fetus diagnosed in utero with hypoplastic left heart disease (HLHD) and compare those to scientific, peer reviewed published data. Specifically, is the the provider data complete enough for prospective parent(s) to make a rational decision as to whether to proceed with a 3 stage repair or choose another option.

Hypothesis:
The formally untested hypothesis is that there is a signifcant "gap" between what is actually known to providers and what is presented to prospective parent(s)on provider websites.

Methods:
Using the list of the top 10 rated Pediatric Cardiovascular programs as ranked by the U.S. News World Report (USNWR) we collected the published information with respect to: # cases of HLHD operated on for Stage 1 Norwood at the hospital/program in question, Stage 2 Glenn shunt and Stage 3 Fontan; mortality at each stage ; interstage mortality ; mortality data for patients completing all 3 stages ; neurodevelopemntal outcomes and other morbidities. For comparison, we used published data on outcomes of HLHD surgery and follow-up from the Society for Thoracic Surgery as it encompasses the largest collection of datasets from many U.S. programs. We compared the STS data set to the publsihed information from the websites..

Results:
Websites did not present the statistical data presented by the STS. In addition, no website listed the exact incidence of their interstage mortality, neurodevelopemntal outcomes nor morbidities at their site.

Conclusions:
1. Information published on websites of the top 10 USNWR programs provide information that tell only part of the story of outcomes for HLHD. 2. Critical pieces of information such as interstage mortality and significant morbidities, are not reported. 3.We must reasses the amount and type of data presented on hospital/program websites
Abstract 9825: Cardiac Strain in a Swine Model of Regional Hibernating Myocardium: Effects of Bypass Surgery on Contractile Reserve
Authors: Kelly Rosemary F , Hocum Stone Laura , Holley Christopher T , Swingen Corey , Crampton Melanie , Ward Herbert B , McFalls Edward O
Published: July 2021

Background:
Clinical studies have suggested that functional recovery of hibernating myocardium may be delayed following coronary artery bypass graft (CABG) surgery. We have shown in a swine model of hibernating myocardium, that recovery of regional function and oxygen consumption during an infusion of high dose catecholamine is sub-maximal at 4-weeks following CABG. Using the same swine model of hibernating hearts along with MRI estimates of circumferential strain (ECC), we tested whether contractile reserve within hibernating myocardial regions during a low dose infusion of dobutamine improves post-CABG. Methods. Ten pigs underwent thoracotomy with placement of a constrictor around the LAD artery. At 12 weeks, MRI imaging was performed prior to CABG and repeated 4-weeks following off-pump revascularization with a left internal mammary artery graft to the LAD artery. MRI studies were performed at baseline and during an infusion of low dose dobutamine (5 μg/kg/min).

Results:
MRI studies prior to CABG showed that circumferential strain in the Hibernating (LAD) Region was lower than the Remote Region at rest (-14.5±0.7 versus -15.1±0.7 respectively; P<0.05) and did not improve during dobutamine (-14.7±0.8 versus -16.7±0.8 respectively; P<0.05). Following CABG, strain measurements in the hibernating LAD region remained lower than remote regions at rest, but improved during the same dose of dobutamine (Figure).

Summary:
Baseline function in hibernating myocardium does not fully recover at 4 weeks post-CABG but contractile reserve during an infusion of low dose dobutamine does improve compared with estimates of strain obtained prior to surgery. Future studies should address the time course of recovery of regional function post-CABG and test whether additional interventions might facilitate earlier recovery of contractile reserve.
Abstract 9908: Three-dimensional Optical Coherence Tomographic Analysis of Eccentric Morphology of the Jailed Side-branch Ostium in Coronary Bifurcation Lesions
Authors: Cho Sungsoo , Kim Jung-Sun , Ha Jinyong , Shin Dong-Ho , Kim Byeong-Keuk , Ko Young-Guk , Choi Donghoon , Jang Yangsoo , Hong Myeong-Ki
Published: July 2021

Introduction:
Using the 3D-OCT, morphologic changes in the jailed side- branch ostium were evaluated before and after a single stent crossover at coronary bifurcation lesions.

Hypothesis:
The severity of angiographic diameter stenosis of the jailed side-branch ostium is usually overestimated over the three-dimensional (3D) optical coherence tomography (OCT)-measured actual stenosis.

Methods:
In 109 patients who received a single stent crossover at coronary bifurcation lesions, the pre- and post-intervention minimal lumen area (MLA) and the eccentricity of the jailed side-branch ostium were measured with 3D-OCT. The eccentricity index was defined as the ratio of maximal diameter/minimal diameter of the jailed side-branch ostium. When the eccentricity index was <1.5, the shape of the jailed side-branch ostium was defined as circular. The MLA of the jailed side-branch ostium was also calculated from the quantitative coronary angiography (QCA) minimal lumen diameter assuming a circular lumen.

Results:
The 3D-OCT-measured MLA of the jailed side-branch ostium decreased from 2.91±1.65 mm2 pre-intervention to 2.37±1.48 mm2 post-intervention (p<0.01). The QCA- derived MLA also decreased from 2.35±1.71 mm2 pre-intervention to 1.68±1.56 mm2 post- intervention (p<0.01). However, the 3D-OCT-measured MLA was significantly larger than the QCA-derived MLA (p<0.01). The shape of the jailed side-branch ostium changed from circular to elliptical after the stent implantation (eccentricity index: 1.40±0.33 pre- intervention; 1.71±0.60 post-intervention, p<0.01).

Conclusions:
Compared to QCA measurements, 3D-OCT analysis could be useful to guide decision for additional intervention or not after stent implantation across coronary bifurcation lesions.
Abstract 9979: Health-Related Quality of Life in Children With Marfan Syndrome
Authors: Handisides Jill C , Hollenbeck-Pringle Danielle , Uzark Karen , Trachtenberg Felicia L , Pemberton Victoria L , Atz Teresa W , Bradley Timothy J , De Nobele Sylvia , Groh Georgeann K , Hamstra Michelle S , Korsin Rosalind , Levine Jami C , Mac Neal Meghan K , Markham Larry W , Morrison Tonia , Mussatto Kathleen , Olson Aaron K , Pierpont Mary Ella M , Roman Mary J , Pyeritz Reed E , Radojewski Elizabeth A , Robinson Michelle , Sparks Elizabeth A , Waitzman Kathryn , Xu Mingfen , Lacro Ronald V ,   for the Pediatric Heart Network Investigators
Published: July 2021

Background:
Marfan syndrome (MFS) is an autosomal dominant disorder that affects the heart, aorta, eyes, skeleton, lungs, and other organs.

Objective:
To assess quality of life (QL) in a large multicenter cohort of children with MFS.

Methods:
The Pediatric Quality of Life Inventory (PedsQL) was administered to 256 subjects with MFS ages 5-18 years as an ancillary study to the Pediatric Heart Network’s Marfan Trial, which compared the effects of atenolol vs. losartan on aortic root growth. PedsQL scores were compared to population norms by one-sample t-tests. Scores > 1 SD below the population sample mean represent at-risk status for impaired health-related QL. The impact of treatment arm (atenolol vs. losartan), severity of clinical features, and patient-reported symptoms on QL was assessed by general linear models.

Results:
The subjects had a mean age of 11.8±3.9 years and were 62% male, 84% white, and 88% non-Hispanic. Mean PedsQL scores for MFS subjects were significantly lower than population norms.

Overall, scores were in the impaired range for physical QL and psychosocial QL in 34% and 27% of subjects, respectively. QL across multiple domains correlated negatively with frequency of patient-reported symptoms (r=0.32-0.40, p<.0001). Subjects with a reported neurodevelopmental disorder (mainly learning disability, attention deficit disorder, and/or hyperactivity) had lower mean QL scores (5.5-7.4 lower, p<.04). There were no significant differences in QL scores between treatment arms. We found no significant association between QL and aortic root z-score, extent of skeletal involvement, or presence of ectopia lentis.

Conclusions:
Children with MFS are at risk for impaired QL. Higher number of patient-reported symptoms had the greatest negative impact on QL, rather than treatment arm or severity of cardiac, skeletal, or ocular findings. Future interventions to address patient symptoms and neurodevelopmental disorders could improve QL for children with MFS.
Abstract 04: Validation of the Instant Blood Pressure Smartphone Application (App)
Authors: Plante Timothy B , Urrea Bruno , MacFarlane Zane T , Blumenthal Roger S , Miller Edgar R , Appel Lawrence J , Martin Seth S
Published: July 2021

Introduction:
Mobile health (‘mHealth’) technologies include unregulated smartphone apps. Instant Blood Pressure (IBP; AuraLife, Newport Beach, CA) estimates blood pressure (BP) using the integrated sensors in the phone, without requiring a cuff. For 392 days in 2014-15, it was a top 50 best-selling iPhone app in the US (requiring ≥950 copies sold on those days). App store reviews document use of the app for treatment of hypertension. IBP has not been independently validated.

Hypothesis:
The absolute mean difference (MD) between IBP and a standard device will be ≤5.0 mmHg for systolic and diastolic BP measurements.

Methods:
Between Jul. and Sep. 2015, we enrolled adults age ≥18 yrs old, at Johns Hopkins clinics. Exclusion criteria were an active arrhythmia, internal device, or contraindication for arm BP measurement. Two order-randomized measurements were taken on two devices: IBP and a validated standard device (Omron-907). Each IBP measurement was compared to the average of the standard measurements. SBP and DBP MD were log transformed and T-tests were used to compare MD and the cutoff of ≤5.0 mmHg.

Results:
Of 85 participants, 52% (44 of 85) were women, mean ± SD age was 57 ± 16 years, and mean BMI was 28 ± 6 kg/m2; 53% (45 of 85) had hypertension. The mean ± SD absolute BP differences (IBP minus standard) were 12.4 ± 10.5 mmHg for systolic (P<0.001) and 10.1 ± 8.1 mmHg for diastolic BP (P<0.001). The app overestimated low BP and underestimated high BP (Figure). Sensitivity and specificity for hypertensive measurements (systolic ≥140 or diastolic ≥90 mmHg) were 0.2 and 0.9.

Conclusions:
BP measurements from an unregulated mHealth app with >148,000 units sold were highly inaccurate. The low sensitivity for hypertensive readings means that four-fifths of individuals with hypertensive BP levels will be falsely reassured that their BP is in the non-hypertensive range.
Abstract 07: Perceptions of Neighborhood Environment are Associated with Shorter Telomere Length in African American Women
Authors: Gebreab Samson Y , Riestra Pia , Khan Rumana J , Xu Ruihua , Gaye Amadou , Davis Sharon K
Published: July 2021

Objectives:
Telomere length (TL) is increasingly being used as a biomarker of cellular aging and age-related cardiovascular diseases (CVD), but the associations between perceptions of neighborhood environment and TL among African Americans is understudied. This study examined whether perceptions of neighborhood environment were associated with TL in African Americans after adjustment for potential confounders.

Methods:
Data was obtained from the Minority Health Genomics and Translational Research Bio-Repository Database (MH-GRID) study recruited from April 2012 and September 2013. 252 (170 women and 82 men) African Americans aged 30 to 55 years were included. TL was measured from peripheral blood mononuclear cells using quantitative real-time polymerase chain reaction. Perceptions of neighborhood environment were assessed using a 12- item scale administered to study participants. The items were summed and averaged to create a score index representing social cohesion, problems and overall unfavorable perception of neighborhood environment. Multivariable linear regression models were used to examine the associations of perceptions of neighborhood environment with TL.

Results:
On average, women had significantly longer TL than men (4868.6 vs. 4574.8 base pairs, p=0.01). After controlling for socio-demographic variables, and CVD and psychosocial risk factors, a one standard deviation (SD) increase in perception of neighborhood problems was associated with shorter TL (mean difference[[Unable to Display Character:  ]]=[[Unable to Display Character:  ]]-106 base pairs; standard error (SE)=42, p[[Unable to Display Character:  ]]=[[Unable to Display Character:  ]]0.014) among women. Overall unfavorable perception of neighborhood environment was also associated with shorter TL among women (mean difference[[Unable to Display Character:  ]]=[[Unable to Display Character:  ]]-80; SE=38, p=[[Unable to Display Character:  ]]0.034). Better perception of social cohesion was associated with longer TL, but did not reach statistical significance (mean difference = 32, SE=29, p=0.282). No consistent association was observed between perceptions of neighborhood environment and TL among men.

Conclusions:
Our findings suggest that perceptions of neighborhood environment may be predictive of cellular aging in African American women. Future longitudinal studies are needed to better determine the causal mechanisms underlying these associations.
Abstract 09: Technology Fluency is Not a Barrier to User Adoption of a Mobile Health (mHealth) Wrist-worn Physical Activity (PA) Monitor System: Observations From the Washington, D.C. Cardiovascular (CV) Health and Needs Assessment
Authors: Yingling Leah , Ayers Colby , Peters-Lawrence Marlene , Wallen Gwenyth , Mitchell Valerie , Todaro-Brooks Alyssa , Sampson Dana , Saygbe Johnetta , Henry JaWanna , Thomas Samantha , Adu-Brimpong Joel , Wiley Kenneth , Graham Avis , Graham Lennox , Johnson Allan , Powell-Wiley Tiffany
Published: July 2021

Background:
Emerging mHealth technologies, like wrist worn PA monitors, offer potential for targeting CV health behaviors among at-risk groups in community-based interventions. It is unknown whether technology fluency impedes user adoption of such mHealth interventions.

Methods:
A CV health evaluation designed using community-based participatory research principles was conducted in African American, faith-based organizations in Washington D.C. wards with the highest obesity rates (NCT01927783). Participants (n=100) underwent a CV health assessment at a community church and were trained to use an mHealth PA monitor for the ensuing 30-day period. Participants wirelessly uploaded PA data weekly to a data collection hub at a participating church and accessed data online. Users were participants with ≥1 days of data; non-users had zero days of data. A validated Computer-Email-Web fluency self-report instrument captured technology fluency, with skill levels from 1 (no fluency) to 5 (high fluency).

Results:
Eighty-one participants were users (mean age=60, 78% female); 19 were non-users (mean age=57, 84% female). Users were more likely than non-users to report a lower household income (p=0.01). No differences were noted for computer access (94% vs 94%, p=0.2) or cell phone ownership (88% vs 89%, p=0.2). Technology fluency was similar, with all non-users and 95% of users reporting some level of technology fluency for the 17 surveyed skills (Table).

Conclusions:
In African-American, faith-based communities in at-risk Washington D.C. areas, lower technology fluency does not appear to impede adoption of this mHealth PA-monitoring system, despite lower socioeconomic status among users. This relationship is likely explained by similar technology access among users and non-users. These findings suggest that an mHealth PA monitoring system using a data collection hub may facilitate a future PA intervention for improved CV health in an at-risk African American community, independent of the population’s technology fluency.
Abstract 16: Economic Cost of Type 2 Diabetes Attributable to Physical Inactivity in the United States in 2012
Authors: Shah Priyank P , Shamoon Fayez , Bikkina Mahesh , Kohl Harold
Published: July 2021

Objective:
Type 2 diabetes has grown to epidemic proportions in the U.S. and physical activity levels in the population continues to remain low, although it is a major primary preventive strategy for diabetes. The objectives of this study were to estimate the direct medical costs of type 2 diabetes attributable to not meeting physical activity Guidelines and to physical inactivity in the U.S. in 2012.

Methods:
This was a cross sectional study that used physical activity prevalence data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS). Estimates of relative risk of type 2 diabetes for subjects not engaging in any leisure time physical activity and those not meeting physical activity guidelines were obtained for multiple studies published in the literature. Using the prevalence of not meeting physical activity guidelines, physical inactivity and the respective relative risks, the population attributable risk percentage (PAR%) for type 2 diabetes was estimated by Levin’s formula. These data were combined with the prevalence and cost data of type 2 diabetes (in 2012) to estimate the cost of type 2 diabetes attributable to not meeting physical activity Guidelines, and to physical inactivity in 2012. Sensitivity analyses were done for i) varying the prevalence of not meeting physical activity guidelines from 30-70%, and ii) varying the average annual cost of type 2 diabetes from $4394 (for person less than 45 years of age) to $11825 (for person greater than 65 years of age).

Results:
The prevalence of U.S. population meeting physical activity guidelines and engaging in no leisure time activity was 50% and 30% respectively in 2012. The average annual cost attributable to type 2 diabetes in the US, was $7888 per person. The cost of type 2 diabetes in the U.S. in 2012, attributable to not meeting physical activity guidelines was estimated to be $18.6 billion, and that attributable to physical inactivity was estimated to be $5.9 billion. Based on sensitivity analyses, these estimates ranged from $10.36 billion to $27.9 billion for not meeting physical activity guidelines and $3.3 billion to $8.87 billion for physical inactivity in the year 2012.

Conclusions:
This study shows that billions of dollars could be saved annually just in terms of type 2 diabetes cost in the U.S., if the entire adult population was active enough to meet physical activity guidelines. Physical activity promotion, particularly at the environmental and policy level should be a priority in the population.
Abstract 18: The Impact of an Ambulation Orderly Program on Hospital Outcomes for Patients with Recent Open Heart Surgery
Authors: Pack Quinn R , Miwa Saki , Woodbury Erin , Engelman Richard , Lagu Tara , Visintainer Paul , Lindenauer Peter
Published: July 2021

Introduction:
The detriments of prolonged bedrest are well described, yet most hospitals fail to provide enough ambulation to their patients to prevent significant deconditioning and patient harm. One potential strategy for overcoming this problem is the use of an ambulation orderly (AO), an employee whose primary responsibility is to walk patients up to 3-4 times per day. In May 2013, our hospital instituted an AO program among post-operative cardiac surgical patients. We hypothesized that the introduction of an AO program would be associated with improved patient outcomes.

Methods:
We evaluated all patients undergoing either coronary artery bypass and/or cardiac valve surgery between September 2012 and March 2014. We evaluated the impact of the AO program on post-operative length of stay (LOS), hospital complications, discharge disposition, and 30-day hospital readmission with both a pre-post study design and an interrupted time-series analysis.

Results:
We identified 925 patients (68.3 years, 68% male, 92% white) during the study period, with no major shifts observed in patient demographics over the study period. Compared to the pre-AO group, the median post-operative LOS (IQR) decreased from 8 (6 to 11) to 7 (6 to 10) days, p < 0.001 for the post-AO group. Additionally, variability around the median length of stay decreased significantly (Brown-Forsythe p = 0.05). See Figure. Time series analysis found that there was no significant baseline trend in LOS (+0.07, p =0.53), but that initiation of the AO program was associated with decreased post-operative LOS (-1.1 ±0.8 days, p =0.16), and a favorable change in the post-AO slope (- 0.30 ± 0.15 days, p = 0.048). Other outcomes were unaffected.

Conclusions:
The institution of an AO program at our hospital was associated with both a significantly reduced LOS as well as reduced LOS variability, without a change in the rate of hospital complications or 30-day readmission. These results suggest that an AO program is a promising strategy for improving quality and decreasing costs.
Abstract MP06: Statins and the Risk of Diabetes Type II in Children Ages 8 to 20 with and without Dyslipidemia
Authors: Joyce Nina , Zachariah Justin , Eaton Charles , trivedi Amal , Wellenius Gregory
Published: July 2021

Introduction:
There is increasing evidence of a causal association between statin use and type II diabetes mellitus (T2DM) in adults. However the risk of incident T2DM in children treated with statins is unknown, and a recent study demonstrating a protective effect of familial hypercholesterolemia suggests there may be heterogeneity of effect by the presence of genetic dyslipdemia. We estimated the association between statin use and the risk of T2DM in a commercially insured population ages 8 to 20 from 2004 to 2013 with and without a diagnosis of dyslipidemia.

Methods:
New users of statins with a minimum 75 percent of days covered (PDC) in the first year of use were matched to up to 10 non-users using year-specific propensity scores within a 0.01 caliper. The outcome was defined as incident T2DM more than 12 months after the match date to address possible confounding by indication and allow for a biologically plausible level of cumulative exposure. Cox proportional hazard models were used to estimate the relative hazards for T2DM among statin users and non-users. Time was defined from the end of the 12 month latency period to either the outcome or censoring. Sensitivity analyses varied the width of this exclusionary window, as well as PDC to test the robustness of our results to study assumptions.

Results:
There were a total of 13,443,478 patients who met eligibility criteria, 755 (0.1%) of whom were started on statins and met the minimum PDC. Of these, 748 (98%) were matched with no significant difference in the year-specific match rate. Statin use was associated with an increased risk of T2DM in children without dyslipidemia diagnosis (HR 2.75, 95%CI 1.20-6.30, p=0.01), but not in children with a recorded diagnosis of dyslipidemia (HR 1.01, 95%CI 0.59-1.70, p=0.98). The results were robust to variations in the latency period and PDC (figure).

Conclusion:
Statin use was associated with increased risk of new onset T2DM in children without a dyslipidemia diagnosis, but not in children with a diagnosis of dyslipidemia.
Abstract MP07: Racial Differences in Incident CHD in Observational Population-based Studies
Authors: Colantonio Lisandro D , Gamboa Christopher M , Richman Joshua S , Levitan Emily B , Soliman Elsayed Z , Howard George , Safford Monika M
Published: July 2021

Background:
In the modern era, black men have twice the risk for fatal CHD versus white men, with similar incidence of total CHD. To examine secular trends in these findings, we compared the risk for incident fatal, nonfatal and total CHD by race across three US cohorts from different time periods.

Methods:
We analyzed data from blacks and whites in the Atherosclerosis Risk In Communities (ARIC) study (n=14,967, all 45-64 years of age, baseline 1987-1989), the Cardiovascular Health Study (CHS, n=4,626, all ≥65 years of age, baseline 1989-1993) and the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (13,115 participants 45-64 years of age, 7,493 participants ≥65 years of age, baseline 2003-2007) who were free of CHD at baseline. Participants were followed for up to 10 years for fatal or nonfatal CHD. Analyses were stratified by age and gender and adjusted for similar risk factors across cohorts.

Results:
After age adjustment, black men 45-64 years of age in ARIC and REGARDS had higher risk for fatal CHD and similar risk for nonfatal and total CHD compared with their white counterparts (Table). After further adjustment for risk factors, blacks had similar risk for fatal CHD and lower risk for nonfatal and total CHD. A higher age-adjusted risk for fatal CHD and lower multivariable-adjusted risk for nonfatal CHD was also found among black versus white men ≥65 years of age in REGARDS; however, these associations were attenuated/absent in CHS. Among women 45-64 years of age in ARIC and REGARDS, blacks had higher age-adjusted risk for fatal, nonfatal and total CHD which were attenuated after adjustment for risk factors. There was no association between black race and CHD among women ≥65 years of age.

Conclusion:
Black-white disparities in the incidence of fatal CHD have remained similar for many years, particularly among those <65 years of age, and are explained by risk factors. The higher risk for fatal CHD is more striking among black men who consistently shown similar risk for total CHD compared with white men across cohorts.
Abstract MP11: Acculturation is Associated with a Higher Prevalence of Cardiometabolic Risk Factors in US Immigrants: An Analysis of the 2010-2014 National Health Interview Survey
Authors: Ukonu Nwakaego , Obisesan Olawunmi , Aboagye Jonathan , Amoakwa Kojo , Agyemang Charles , Commodore-Mensah Yvonne Y
Published: July 2021

Background:
The burden of cardiometabolic disease and associated risk factors including overweight/obesity, diabetes and hypertension is high in ethnic minorities in the United States (US). The size of the immigrant population in the US continues to grow rapidly. It has been posited that acculturation to the US society results in an elevation or reduction of risk for cardiometabolic disease in immigrants.

Hypothesis:
We hypothesized that increased years of US residence (proxy measure for acculturation) would be associated with a higher prevalence of overweight/obesity, diabetes and hypertension, known risk factors for cardiometabolic disease, in US immigrants.

Methods:
We analyzed data on adult US immigrants in the National Health Interview Survey (NHIS) from 2010-2014. The immigrants were from the following 9 regions of birth: Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, India, Central and Southeast Asia. The main independent variable was length of US residence; <10 years and ≥10 years. The main outcome variables were hypertension, overweight/obesity and diabetes. We used multivariable logistic regression to examine these associations and adjusted for known confounders.

Results:
Of the 54,984 immigrants, 62% were overweight/obese, 20 % had hypertension and 8% had diabetes. The mean age (± SE) was 43 (±0.15) years. Half were females and those who had resided in the US for ≥10 years were more likely to have health insurance coverage (70% vs 54%, p<0.001) and older (46 years vs 35years, p<0.001) compared to immigrants with <10 years of duration of stay. After adjusting for region of birth, poverty income ratio, age and sex, we observed that immigrants residing in the US for ≥10 years were more likely to be overweight/obese (Odds Ratio[OR] 1.21, 95% CI 1.11-1.31), diabetic (OR: 1.58, 95% CI 1.32-1.90) and hypertensive(OR: 1.34, 95% CI 1.19-1.50) than those residing in the US for <10 years.

Conclusion:
In an ethnically diverse sample of contemporary US immigrants, we found that increased length of US residence (acculturation) was associated with overall presence of cardiometabolic risk factors. Culturally-tailored public health strategies should be developed and implemented in immigrant sub-populations in the US to prevent the development of cardiometabolic disease.
Abstract MP12: Comparing Effectiveness of Mass Media Campaigns vs. Price Reductions Targeting Fruit and Vegetable Intake on US Cvd Mortality and Race Disparities
Authors: Pearson-Stuttard Jonathan , Bandosz Piotr , Rehm Colin D , Afshin Ashkan , Penalvo Jose , Whitsel Laurie , Danaei Goodarz , Gaziano Thomas , Bromley Helen , Lloyd-Williams Ffion , Mozaffarian Dariush , Capewell Simon , O’Flaherty Martin
Published: July 2021

Introduction:
Cardiovascular disease (CVD) accounts for over 800,000 US deaths annually, with substantial disparities by race. Poor diet is a leading CVD risk factor, including low intake of fruit and vegetable (F&V). Few data exist regarding the potential population level impact and effect on race disparities of policies aimed at increasing F&V intake.

Aim:
To estimate CVD mortality reductions, including by race, potentially achievable by price reduction and mass media campaign interventions in the US population up to 2030.

Methods:
We developed a US IMPACT Food Policy Model to compare three contrasting policies targeting F&V intake: A - a national mass media campaign (MMC); B and C - a universal F&V price reduction of 10 and 30% respectively. The MMC assumed unequal coverage by age, gender and race, and duration of either 1 or 15 years.

Data sources included the National Vital Statistics System, SEER single year population estimates, the US Bureau 2012 National Population projections and NHANES. We used US population and CVD projections to 2030, F&V mortality effect sizes and best evidence effect sizes for each policy. We modelled cumulative deaths prevented or postponed and life years gained (LYG) by age, gender, race and CVD subtype from 2015 to 2030. Results were tested in a probabilistic sensitivity analysis using Monte Carlo simulation.

Results:
Scenario A (MMC) could result in 27,000 (95% CI: 21,000-33,000) to 85,000 (83,000-89,000) fewer deaths dependent upon media campaign duration (from 1 to 15 years), gaining up to 1,280,000 LYGs (1,250,000-1,320,000) by 2030. Approximately 62% of deaths prevented would be CHD; and 53% would be in men, with 20% being saved in year 1.

Scenario B (10% price decrease) could prevent approximately 90,000 deaths (71,000-114,000) and gain 1,450,000 LYGs (1,180,000-1,740,000) by 2030. Scenario C (30% price decrease) could prevent some 270,000 deaths (215,000-338,000) by 2030, representing a 3.9% reduction in expected CVD mortality.

Price reduction policies would have equitable effects in non-hispanic whites vs. blacks. In comparison, a MMC would be ~ 35% less effective in preventing CVD deaths in non-Hispanic blacks.

Conclusions:
Price reduction policies (10 or 30%) and a nationwide MMC would each effectively reduce US CVD mortality. A 30% price reduction policy would save most lives and do so most equitably. Deaths prevented via a MMC might reduce substantially after year 1 and also increase disparities. These results inform potential fiscal and population level strategies to reduce CVD mortality in the US.
Abstract MP26: Biomarkers of n-6 Polyunsaturated Fatty Acids and CVD Risk: A Global Pooling Project of 19 Cohort Studies
Authors: Marklund Matti , Chen Tzu-An , de Goede Janette , Imamura Fumiaki , Laguzzi Federica , Prem Kiesha , Samieri Cécilia , Shi Peilin , Virtanen Jyrki , Wennberg Maria , Wong Kerry , Wu Jason H , Zhou Xia , Lemaitre Rozenn N , Mozaffarian Dariush , Risérus Ulf ,   CHARGE Fatty acids and Outcomes Rsch Consortium (FORCE)
Published: July 2021

Background:
Despite cholesterol-lowering and other potential beneficial properties of dietary linoleic acid (LA; 18:2n-6), LA has been considered pro-inflammatory and is a precursor to arachidonic acid (AA; 20:4n-6), which has also been considered harmful for CVD. Thus, the role of n-6 fatty acids in CVD prevention remains debated.

Objective:
To investigate across harmonized global studies the relation of circulating/tissue biomarker levels of LA and AA with incidence of CVD, CHD, and stroke.

Methods:
We conducted a pooled analysis within a global consortium of prospective cohort or nested case-control studies having circulating or tissue biomarker measures of LA and AA. Each study ascertained CVD risk, including incident CVD, CHD, ischemic stroke (IS), and/or CVD mortality in adults with no prevalent CVD at baseline. Standardized individual-level analysis was conducted in each study using pre-specified models, exposures, outcomes, and covariates. Study-specific estimates were pooled using inverse variance-weighted fixed effects meta-analysis.

Results:
We evaluated 19 studies, including 6,569 total CVD events, 2,407 CVD deaths, 6,557 CHD events, and 2,237 IS events (values may not sum due to cohort-specific outcomes). In continuous (90th vs 10th percentile) multivariable-adjusted analyses, higher levels of both LA and AA were associated with lower risk of incident CVD, with modest between-compartment heterogeneity (I2=33-35%) (Figure). LA and AA were inversely associated with CVD mortality, with RRs (95% CI): LA 0.81 (0.73 - 0.90) and AA 0.90 (0.81 - 0.99). LA, but not AA, was associated with lower risk of incident CHD and IS, with RRs (95% CI) 0.94 (0.88 - 0.99) and 0.80 (0.69 - 0.92), respectively.

Conclusions:
Based on harmonized analysis of multiple studies on free-living populations, biomarker levels of the two major n-6 fatty acids are associated with lower risk of CVD incidence and mortality. Relevance of potential differences in compartment-specific associations requires further investigation.
Abstract MP48: Whole Grain Intake is Inversely Associated with Mortality From All Causes, Cardiovascular Disease, and Cancer in a Dose-response Manner, a Meta-analysis of Prospective Cohort Studies
Authors: Zong Geng , Gao Alisa , Hu Frank , Sun Qi
Published: July 2021

Introduction:
Whole grain intake has been associated with lower risks of multiple chronic conditions, but its association with mortality warrants further evaluation.

Hypothesis:
We performed a meta-analysis of prospective cohort studies on the association of whole grain intake with all-cause and cause-specific mortality, and tested the hypothesis that they followed inverse dose-response pattern.

Methods:
Published studies reporting relative risks (RRs) between whole grain consumption and mortality from Medline and Embase through August, 2015. Original results from National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999-2004 were included. Whole grain ingredients (gram/day) were estimated among studies reporting RRs for ≥3 categories of whole grain intake.

Results:
Fourteen unique analyses were included, which consisted of 786,076 participants, 97,867 all-cause deaths, 23,957 CVD deaths, and 37,492 cancer deaths. Pooled RRs (95% confidence intervals) comparing high with low whole grain categories were 0.84 (0.80, 0.88; P <0.001, I2=74%, P heterogeneity<0.001) for all-cause mortality, 0.82 (0.79, 0.85; P <0.001, I2=0%, P heterogeneity=0.53) for CVD mortality, and 0.88(0.83, 0.94; P <0.001, I2=54%, P heterogeneity=0.02) for cancer mortality. Whole grain consumption was <50 grams/day among most studies. Dose-response meta-analysis showed strong monotonic associations between whole grain and mortality (All P nonlinearity > 0.05): RRs (95%CIs) for each 16 grams/day increase (approximately 1 serving/day) in whole grain were 0.93(0.92, 0.94) for all-cause mortality, 0.91(0.90, 0.93) for CVD mortality, and 0.95(0.94, 0.96) for cancer mortality. These findings were robust in several stratified analyses and/or sensitivity analyses. Egger’s test did not suggest significant publication bias.

Conclusions:
Our findings supported health benefit of increasing current whole grain intake of <1 serving/day to ≥3 servings/day as recommended by current Dietary Guidelines for Americans.
Abstract MP68: Populations with Multiple Adverse Behavioral Factors
Authors: Eckstein Thomas , Houghtaling Laura , Quick Mariah
Published: July 2021

Traditionally, population behavioral characteristics are reported at the individual level. However, just like diseases, the combination of multiple adverse risk factors, even though they are often highly correlated, presents a different challenge and impact on community health than examining these same behaviors in isolation. We analyzed 5 risk factors in the 2014 Behavioral Risk Factor Surveillance Survey; smoking (currently a smoker), inactivity (no physical activity outside of work), excessive alcohol consumption (for women, 4 or more drinks in one sitting or an average of greater than one drink per day; for men, 5 or more drinks in one sitting or an average of greater than two drinks per day), obesity (BMI >=30), and insufficient sleep (< 7 hours per night). These five measures were selected because of their strong association with heart and other disease. We studied the frequency of multiple factors by state, sex, race, urbanicity, educational attainment and income. The attached map illustrates the variation among states in the prevalence of 3 or more risk factors in the population. In Utah, Colorado, and California, less than 9% of the population has 3 or more; in Arkansas, Louisiana, Kentucky and Mississippi, 16% or more of the population has 3 or more of these risk factors. Among demographic subpopulations, differences also exist. For non-Hispanic Asian population 4.5% (CI:3.5%-5.4%) have 3 or more risk factors compared to 16% or more exhibiting 3 or more risk factors in the non-Hispanic black, non-Hispanic American Indian and Alaskan Native, and non-Hispanic multi-racial populations. The variation among these subpopulations within states was also explored.

Understanding the distribution of multiple adverse risk factors within a state’s population can help guide the efforts of public health officials, policy makers, advocacy groups and others to focus on the most affected populations and develop interventions that address multiple related conditions.
Abstract P013: Association Between Serum Chemerin Levels and Coronary Heart Disease: A Meta Analysis
Authors: Agasthi Pradyumna , Aloor Sivakanth , Chenna Avantika , Menon Vivek , Harris Rachel
Published: July 2021

Background:
Chemerin is a novel adipokine linked with obesity, metabolic syndrome and chronic inflammatory diseases. It plays a pivotal role in modulating adipocyte differentiation, activation of macrophages and production of proinflammatory cytokines. It is hypothesized that chemerin promotes vascular remodeling and endothelial dysfunction leading to the development of coronary atherosclerosis. We conducted a meta-analysis to evaluate the relationship between serum chemerin levels and coronary heart disease (CHD).

Methods:
We searched MEDLINE, CINAHL and COCHRANE databases for studies reporting serum chemerin levels in the patients with CHD and healthy controls. We included case controls, cohort and cross-sectional studies. We calculated the weighted standardized mean difference (SMD) in serum chemerin levels between the CHD and control groups.We performed residual maximum likelihood meta-regression analysis on covariates age, BMI and female sex.

Results:
Our search strategy yielded 43 articles and we included 10 studies enrolling 2225 participants. The median age and body mass index(BMI) of the CHD group was 62 yrs (IQR 60-63) and 26 kg/m
2
(IQR 26-28) vs 61 yrs (IQR 58-62) and 26 kg/m
2
(IQR 24-27) in the control group. The median percentage of female population was lower in the CHD group at 39% (IQR 22-52) vs 49% (IQR 31-53) in the control group. The unweighted median serum chemerin levels in the CHD group were 33.3 ng/ml (IQR 25.4-63.2) compared to 29.8 ng/ml (IQR 15.2-38.2) in the control group. The SMD of serum chemerin level was 0.78 (95% CI 0.39 - 1.17)
P
<0.001 comparing those in the CHD group and control group. This association was not explained by age, BMI or sex.

Conclusion:
An elevated serum chemerin level is significantly associated with presence of CHD. Chemerin can potentially used as a novel biomarker and to risk stratify patients with CHD.
Abstract P036: Exploring Systems Thinking as an Underlying Mechanism in Improving Healthy Lifestyles of Overweight and Obese Adolescents: Psychometrics of the Systems Thinking Scale for Adolescent Behavior Change
Authors: Moore Shirley M
Published: July 2021

We have learned from the past that interventions targeting health behavior change involve assisting participants to identify and make changes in the habitual systems in their daily routines. Although the skills to change these habitual systems involve systems thinking (the ability to recognize patterns, interactions and interdependencies in a set of activities), no current measure exists to assess the extent to which systems thinking influences health behavior change. Our team is currently investigating the mediating role of systems thinking in enhancing healthy eating and exercise in overweight and obese adolescents. The purpose of this study was to develop and conduct psychometric testing of the Systems Thinking Scale for Adolescent Behavior Change (STS-AB).

In a first phase of this study, a panel of experts in systems thinking was used to develop an initial item set that was tested for understandability, content validity and stability in a small sample (N= 24) of adolescents enrolled in a weight management program. In a second phase, using a larger study of 359 urban adolescents enrolled in a weight management trail aged 10-13 (58% girls; 80% African American), factor analysis, reliability, and validity of the 16-item STS-AB were assessed.

Results of an exploratory factor analysis of the STS-AB indicated a 1-factor solution with good factor loadings, ranging from .40 to .67. The internal consistency reliability coefficient was .87. Test-retest reliability of the STS-AB was .48, p<.05. Systems thinking scores were higher in children who received systems thinking training compared to children not receiving training. Evidence of construct validity was supported by significant correlations with established measures of other variables commonly associated with health behavior change (motivation and self-efficacy for diet and physical activity). These findings indicate that the STS-AB is a valid and reliable measure of systems thinking for health behavior change in adolescents that can assist investigators to examine the extent to which systems thinking is a mechanism in health behavior change.
Abstract P040: Muscle Metaboreflex Regulation of Arterial Blood Pressure in Children with Congenital Heart Defects
Authors: Tomczak Corey R , Fusnik Stephanie , Hogeweide Elizabeth , Haykowsky Mark J , Stickland Michael K , Runalls Shonah , Kakadekar Ashok , Pharis Scott , Pockett Charissa , Erlandson Marta
Published: July 2021

Introduction:
Metabolically sensitive afferent fibers in skeletal muscle can signal an increase the sympathetic control of arterial blood pressure during exercise. This process, called the muscle metaboreflex, is augmented in adults with cardiovascular disease and contributes to exercise intolerance. The role of the muscle metaboreflex on blood pressure control in children with congenital heart defects (CHD) is not known.

Hypothesis:
We tested the hypothesis that the mean arterial pressure (MAP) response to the muscle metaboreflex would be augmented in children with CHD compared to healthy controls.

Methods:
Twenty-six children with CHD (11±2 years; males=14; females=12) and 21 age- and sex-matched controls (11±3 years; males=10; females=11) were studied. CHD diagnoses included Tetralogy of Fallot (n=7), pulmonary or aortic stenosis (n=3), hypoplastic left or right heart syndrome (n=5), Ebstien’s anomaly (n=1), atrial or ventricular septal defect (n=5), transposition of the great arteries (n=2), double inlet left ventricle (n=1), heart transplantation (n=2), tricuspid or pulmonary atresia (n=2), coarctation of the aorta (n=2), and dilated cardiomyopathy (n=1). Testing included a 3 min rest period followed by isometric handgrip exercise at 30% of maximal voluntary contraction for 2 min. Exercise was followed by 3 min of either a free flow control condition or circulatory occlusion to isolate the muscle metaboreflex. Beat-by-beat MAP was recorded using finger plethysmography. Analyses were completed using mixed designs factorial ANOVA with
P
< 0.05 as the level of significance. Data are mean ± SD.

Results:
During the free flow control condition, there was no significant difference in resting MAP (75±9 mmHg vs. 78±9 mmHg), exercise MAP (86±14 mmHg vs. 87±12 mmHg), or free flow MAP (72±10 mmHg vs. 78±9 mmHg) between children with CHD vs. controls, respectively (
P
> 0.05). MAP significantly increased from rest to exercise and returned to resting levels during the free flow control condition for both groups. For the circulatory occlusion condition, there was no significant difference in resting MAP (73±11 mmHg vs. 74±8 mmHg), exercise MAP (84±15 mmHg vs. 81±11 mmHg), or circulatory occlusion MAP (79±13 mmHg vs. 79±13 mmHg) between children with CHD vs. controls, respectively (
P
> 0.05). MAP significantly increased from rest to exercise and MAP remained elevated above resting levels during circulatory occlusion for both children with CHD and controls (
P
< 0.001 for all).

Conclusions:
Post-exercise circulatory occlusion significantly increases MAP in children with CHD and healthy children, with no significant difference in the magnitude of the MAP response between groups. We conclude that children with CHD demonstrate a normal muscle metaboreflex during post-exercise circulatory occlusion.
Abstract P046: The Subgingival Microbiome, Systemic Inflammation and Insulin Resistance
Authors: Demmer Ryan T , Breskin Alexander , Rosenbaum Michael , Zuk Aleksandra , LeDuc Charles , Leibel Rudolph , Paster Bruce , Desvarieux Moise , Jacobs David , Papapanou Panos N
Published: July 2021

Introduction:
Chronic inflammation is hypothesized as a mechanism linking microbial exposures to insulin resistance. We investigated the association between periodontal microbiota, systemic inflammation and insulin resistance among diabetes-free adults.

Hypotheses:
We hypothesized that subgingival microbial signatures would be related to both inflammatory phenotype and measures of insulin resistance and that there would be evidence of mediation by inflammatory markers.

Methods:
The Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS) enrolled 152 diabetes-free adults (77% female) aged 20-55 years (mean=34±10). 304 subgingival plaque samples (2 per participant) were analyzed using the Human Oral Microbe Identification Microarray (HOMIM) to measure the relative abundances of 379 taxa from eight different phyla. C-reactive protein, interleukin-6, tumor necrosis factor-α and adiponectin were assessed from venous blood and their z-scores were summed to create an inflammatory score (IS). Fasting glucose and insulin levels defined insulin resistance via the HOMA-IR. Associations between the subgingival microbiota and both inflammation and insulin resistance were explored using multivariable linear regression models adjusted for cardiometabolic risk factors; mediation analyses assessed the proportion of the association explained by inflammation.

Results:
The IS was inversely associated with the relative abundance of Actinobacteria and Proteobacteria and positively associated with Firmicutes and TM7 (all p-values<0.05). The IS was positively associated with glucose, insulin and HOMA-IR (all p<0.05). Proteobacteria levels were associated with insulin resistance (p<0.05). Inflammation explained 30%-98% of the observed associations between levels of Actinobacteria, Proteobacteria or Firmicutes and insulin resistance (p-values<0.05). 18 individual taxa were associated with inflammation (p<0.05) and 22 with insulin resistance (p<0.05).

Conclusion:
Subgingival microbial community structure and membership were related to systemic inflammation and insulin resistance in a sample of diabetes-free adults.