bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P332: Weight Cycling is Associated With Poorer Cardiovascular Health Assessed Using AHA’s Life’s Simple 7 in a Diverse Sample of Women Encompassing Different Life Stages
Authors: Byun Stephanie S , Bello Natalie A , Liao Ming , Makarem Nour , Aggarwal Brooke
Published: March 2019

Introduction:
Prior research has shown weight cycling, the repetitive pattern of weight loss and regain, is associated with increased CVD risk. There is limited evidence on the association of history of weight cycling (HWC) with cardiovascular health (CVH) metrics from the AHA Life’s Simple 7 (LS7).

Hypothesis:
We hypothesized that HWC is associated with poorer CVH in women and that these associations may vary by menopausal status and/or pregnancy history.

Methods:
This was a cross-sectional analysis of 485 women enrolled in the AHA Go Red for Women Strategically Focused Research Network. HWC, defined as losing and gaining ≥ 10 lbs at least once (excluding pregnancy) was self-reported. Participants were given scores of 0 (poor), 1 (moderate) or 2 (high) for each AHA LS7 metric (BMI, BP, total cholesterol, glucose, physical activity, diet and smoking). Metric scores were summed into a composite AHA LS7 CVH score: 0-8 (poor), 9-10 (moderate), 11-14 (high). Logistic regression was used to evaluate associations of HWC with AHA LS7 metrics and composite. Models were stratified by menopausal status and pregnancy history due to a statistically significant multiplicative interaction.

Results:
The majority of women (mean age 37±16y, BMI 26±6 kg/m
2
), 73%, reported ≥ 1 HWC episode, and 26%, 34% and 40% of women had poor, moderate, and high CVH respectively. HWC was associated with lower odds of meeting the BMI metric or moderate or high AHA LS7 composite score, but not with other CVH metrics (
Table
). In stratified analyses, HWC was associated with lower odds of having a high AHA LS7 score in both pre- and post-menopausal women, but only in women who had never been pregnant.

Conclusion:
HWC was associated with lower odds of meeting the BMI metric and poorer CVH as assessed by AHA LS7 composite score. Associations were stronger in women with no pregnancy history. These findings suggest that in addition to having a healthy weight, maintaining a consistent body weight may be important for achieving ideal CVH, but they warrant prospective confirmation.
Abstract P335: Greater Frequency of Olive Oil Consumption is Associated with Lower Platelet Activation in Obesity
Authors: Zhang Ruina , Parikh Manish , Ren-Fielding Christine J , Vanegas Sally M , Jay Melanie R , Calderon Karry , Fisher Edward A , Berger Jeffrey S , Heffron Sean P
Published: March 2019

Healthy lifestyle behaviors, including maintenance of normal weight, are associated with lower risk of atherothrombotic events. In the general population, consumption of olive oil and a Mediterranean diet are associated with reduced risk of cardiovascular disease (CVD). However, less is known about how this affects individuals with obesity. We investigated whether olive oil intake is associated with reduced platelet activation in a cohort of obese, non-smoking, non-diabetic subjects without known CVD. As part of a larger prospective study of platelet function in obesity, we assessed platelet activation (surface P-selectin and PAC1 MFI) with and without agonist (0.025U thrombin, 0.1uM ADP, 0.4uM epinephrine) exposure via flow cytometry. Food frequency surveys were used to estimate diet composition. Subjects were stratified by food intake frequency and platelet activation was compared using ANOVA, with post-hoc independent samples t-testing. Among 63 subjects, the mean age was 32.2 ± 8.0 years and BMI 44.1 ± 8.5 kg/m
2
. Olive oil intake frequency was stratified into 3 groups: ≤ 1 time/wk, n=21; 1 - 3 times/wk, n=18; ≥ 4 times/wk, n=24. The groups did not differ by age, weight, BMI, waist and hip circumferences, platelet count or mean platelet volume. Subjects with more frequent olive oil intake showed lower platelet activation to agonists than those consuming olive oil ≤ 1 time/wk (Figure). Non-agonized platelet activity did not differ significantly by olive oil intake frequency. Notably, we did not observe associations between platelet activity and consumption of red meat, eggs, butter, or margarine. In metabolically healthy obese individuals, more frequent olive oil intake is associated with suppressed platelet activation. We hypothesize that phenolic compounds in olive oil may alter platelet membrane phospholipid content, making platelets less susceptible to activation. For obese individuals, olive oil intake may lower risk of cardiovascular events.
Abstract P339: 30-Year Absolute Risks for Coronary Heart Disease in Individuals With Very Low LDL-C
Authors: Schultz William , Ning Hongyan , Marma-Perak Amanda , Feinstein Matthew , Sniderman Allan , Robinson Jennifer , Berry Jarett , Lloyd-Jones Donald M , Wilkins John T
Published: March 2019

Introduction:
It is unclear if individuals with very low mean low-density lipoprotein cholesterol (LDL-C) during midlife experience significant absolute risk (AR) for coronary heart disease (CHD).

Hypothesis:
Individuals with LDL-C ≤80mg/dL from ages 20-60 years (y) do not develop significant AR for CHD over 30 y of follow-up.

Methods:
Our objective was to quantify and compare the 30-year AR for fatal or nonfatal CHD from index ages 20-40 y and 40-60 y in participants (ppts) with LDL-C ≤80, 81-130, and >130 mg/dL using data from the Lifetime Risk Pooling Project. We included ppts who were free from lipid lowering medications and CHD at baseline. Mean LDL-C was an average of multiple (2-5) fasting LDL-C measurements within 10 years prior to the baseline age. We used a modified Kaplan Meier analysis, adjusted for competing risks of death, to quantify the 30-year CHD AR by LDL-C strata.

Results:
3,781 men and 4,995 women were followed for a combined 110,431 person*years and experienced 778 events. Among all ppts, tobacco use ranged from 20-40% and hypertension prevalence ranged from 13-40%. Non-lipid risk factor profiles were generally more favorable in the low-LDL-C strata. At index ages 20-40, men and women with LDL-C ≤80mg/dL did not experience risk for CHD over 20 and 25 years, respectively (Figure). A similar pattern was seen in the LDL-C 80-130mg/dL strata. At index ages 40-60, men and women with LDL-C ≤80mg/dL experienced no risk for CHD for 5 to 15 years, respectively. However, both sex groups saw a gradual increase in risk up to 13.7% (95% confidence interval [CI] 1.9-25.4%) for men and 5.2% (95% CI 2.0-8.4%) for women at year 30 of follow-up.

Conclusion:
Young ppts with LDL-C ≤80mg/dL had very low CHD risks across midlife despite significant risk factor burden. At older ages, ppts with low LDL-C develop modest AR for CHD suggesting adverse lipid changes over time or alternative mediators of CHD in this age group.
Abstract P342: Life’s Simple 7 Among Statin Users and Non-Users at High Cardiovascular Risk. The Polish Norwegian Study-PONS
Authors: Vaidean Georgeta , Manczuk Marta , Vansal Sandeep
Published: March 2019

Introduction:
Cardiovascular risk reduction requires the pharmacological treatment of hyperlipidemia to be accompanied by the adoption of healthy behaviors. Whether statin users do so, is not clear and both, false reassurance and healthy adherer-phenomena have been theorized. Our objectives were: 1) to compare AHA Life’s Simple 7 (LS7) prevalence in statin users vs. non- users among statin candidates at high cardiovascular risk and 2) to assess LS7 among potential statin users candidates for Ethyl eicosapentaenoic acid (EPA) treatment.

Methods:
We used cross-sectional, baseline data of 12754 participants, age 45 to 64 years in a community-based cohort study (PONS). Data were collected through structured questionnaires and fasting blood samples. LS7 were defined based on AHA criteria. Statin use was recorded by trained nurses. We defined as high risk those with clinical ASCVD or diabetes, and those with LDL higher than 190 mg/dL. Statin users potential candidates for EPA therapy were defined based on the REDUCE-IT trial entry criteria.

Results:
There were 2722 (21.3%) individuals at high risk, of which 791 (29.1%) were using statins. Compared to non-users, statin users were older, mean age (SD) 59 (4) vs. 57 (5), more men (37.4% vs. 32.7%), had lower TC, 185.3 (43) vs. 224.7 (48), lower LDL, 105.6 mg/dL (39) vs. 141.5 (46) , more obesity, 46.1% vs.39.6%, less controlled blood pressure 5.5 % vs. 5.6%, less optimal plasma glucose, 48.3 % vs. 53.2% and more AHA poor diet, 40.1% vs. 32.7% (all p-val. less than 0.05). More statin users than non-users (90.6% vs 73.6%) had poor cardiovascular health, with an age- and sex-adjusted OR (95% CI) of 3.2 (2.4-4.2). The prevalence of potential statin users EPA candidates in the full, community-based sample was low (73 individuals, 0.6%); these individuals had poor glucose control (42.5%), high prevalence of obesity (64.4%) and poor AHA diet (32.4%).

Conclusion:
Statin users had a worse LS7 profile than non-users, with most unhealthy behaviors being poor diet and obesity. In the context of efficacious pharmacological agents, behavioral cardiovascular health remains an unfulfilled target.
Abstract P343: Patients With Cardiovascular Disease Are Not Meeting American Heart Association Secondary Prevention Recommendations
Authors: Ndunda Paul M , Vindhyal Mohinder , Muutu Tabitha
Published: March 2019

Introduction:
In the United States, cardiovascular disease (CVD) is the leading cause of mortality. More than 92 million Americans have one or more types of CVD and 800,000 die from it annually. More than 47% of myocardial infarction survivors and 30% of stroke survivors get recurrent events, and therefore there is need for data on secondary preventive care, if the AHA’s 2020 impact goal is to be achieved. We assessed the hypothesis that patients with CVD were not meeting AHA secondary preventive guidelines, and there was gender and racial disparities in care.

Methods:
This study is an analysis of the 2017 Behavioral Risk Factor Surveillance System a chronic disease survey conducted by the CDC. The sample included 51,626 subjects with a history of stroke and coronary artery disease. The secondary preventive measures analyzed included: exercise, diet, smoking cessation, alcohol intake, body mass index, use of blood pressure medications in hypertensive patients and the use of aspirin. Gender and racial disparities were analyzed using multiple logistic regression analysis and age, race, education and income were adjusted for in the outcomes.

Results:
The median age of the study cohort was 69 years (variance=140). White, black and Hispanic patients represented 79.3%, 8.6% and 6.7% respectively. Females comprised 48.5%. Comorbidities included: hypertension (72.8%), dyslipidemia (63.5%), diabetes mellitus (31.5%) and chronic kidney disease (11.5%). Among CVD patients, 57.1% reported ever smoking and 17.4% of them still smoked. Only 39.2% met AHA aerobic exercise guidelines and 12.1% met both the aerobic and muscle strengthening exercise guidelines. Thirty nine percent of CVD patients undertook more than 150 minutes of aerobic exercise and 12% did 1-149 minutes per week. Obesity/overweight was present in 73.8%. Only 67.8% of patients with CVD were using aspirin, 20% were not on any cholesterol medication (not specified whether statin) while among hypertensive patients, 90.1% were on antihypertensive medications. There were major racial and gender disparities in smoking status [women vs men adjusted OR (aOR) 1.23 (1.21 - 1.25), Hispanic vs white aOR 1.71 (1.66 - 1.76)], aspirin [women vs men aOR 0.66 (0.62 - 0.71), Hispanic vs white aOR 0.56(0.47 - 0.58)]. Women were more likely to be on BP medications [women vs men aOR 1.25 (1.22 - 1.29)].

Conclusion:
Patients with stroke do not meet AHA lifestyle and aspirin recommendations. There are major gender and racial disparities in the use of CVD secondary preventive measures.
Abstract P344: Temporal Trends of Cardiovascular Health Metrics and Population Attributable Risk for Mortality Among 366,270 French adults.
Authors: Gaye Bamba , Vignac Maxime , Thomas Frédérique , Offredo Lucile , Sloten Thomas V , Jouven Xavier
Published: March 2019

Background:
Current time trends of objectively measured cardiovascular health and their relation with population attributable risk for mortality over time -in Western Europe are unknown.We aimed to investigate time trends in cardiovascular health metrics and estimate the population attributable risks of these metrics in relation to all-cause mortality in the population at large, as well as in important subgroups.

Methods:
In this study, we used a community-based sample of 366,270 adults from France who had a standardized examination to assess cardiovascular risk factors between 1992 and 2011 and with outcome surveillance spanning until 2016 (25 years), Temporal trends of cardiovascular health metrics were computed using metrics defined by the American Heart Association:smoking, body mass index, total cholesterol, blood glucose and blood pressure and physical activity. Population attributable fraction for all-cause mortality over 25 years were measure.

Results:
Mean age was 44.7 (SD 13) years and 38% (138,228) were women. Overall, few participants (≤3.5%) met all 6 ideal cardiovascular health metrics at any timepoint. The prevalence of meeting ≥5 ideal cardiovascular health metrics increased from 6.2% in 1992-1996 to 16.6% in 2007-2011 (P<.001). An improvement in cardiovascular health was observed in all subgroups, i.e. younger (from 7.1% to 18.5%) and older individuals (from 1.2% to 4.2%), men (from 3.9% to 12.2%) and women (from 10.1% to 22.5%), those with low (from 8.6% to 11.6%) and high education status (from 14.0% to 19.5%) and those with (from 4.7% to 14.8%)and without depressive symptoms (from 6.5% to 16.8%). However, the rate of improvement was steepest in the most affluent group in comparison with those with lower socio-economic status. Furthermore, the improvement in overall cardiovascular health plateaued between 2002-2006 and 2007-2011, and the population attributable risks for all-cause mortality remained high over time.

Conclusions and relevance:
Overall cardiovascular health improved from 1992 until 2011 in French adults from the community who benefited from a free standardized health examination. However, the improvement in cardiovascular health was less strong in those with low socio-economic status as compared to those with a higher socio-economic status. Furthermore, the fraction of all-cause mortality attributable to cardiovascular health remained high throughout the study period.
Abstract P345: Change in Cardiovascular Health Metrics Over Time, CVD Events and Total and Cause-Specific Mortality
Authors: Gaye Bamba , Tajeu Gabriel S , Offredo Lucile , Vignac Maxime , Allen Norrina B , Jouven Xavier
Published: March 2019

Background:
The impact of changes in cardiovascular health (CVH) on cardiovascular disease (CVD) and total and all-cause mortality has yet to be described.

Methods:
CVH was computed according to smoking, body mass index, total cholesterol, blood glucose and blood pressure, physical activity and diet. Change in CVH was defined as a point-to-point difference in each metric or the score. We used time-dependent Cox Proportional Hazard models to calculate hazard ratios for all-cause mortality and CVD events among 10,656 adult participants from the ARIC study, aged 44 to 66 years at baseline (1987-1989) and followed up until 2014. Hazard ratios for all-cause mortality and CVD event according to CVH change at the component metrics and an aggregate score level were calculated with Cox Proportional Hazard models with consistently low CVH considered as the reference group.

Results:
Overall, 17% of the sample improved their overall CVH, while the percentage which maintained a low CVH or decreased CVH was 29% and 21%, respectively. Higher levels of overall CVH over time were associated with a graded decrease in risk in CVD events and all-cause mortality. The hazard ratios for all-cause mortality among participant that decreased their overall CVH from favorable to low or moderate, that increased their CVH from low to moderate or favorable, and had consistently favorable CVH, as compared with the constantly low CVH group, were: 0.47 (95% confidence interval [CI], 0.39 to 0.57), 0.80 (95 CI%, 0.72 to 0.89), and 0.37 (95% CI, 0.30 to 0.46). The risk reductions were of a same magnitude for CVD events. In the adjusted Cox time dependent model, compared with low overall CVH, having moderate or favorable CVH was associated with a decreased risk in mortality: 24% (HR=0.76, 95% CI, 0.72 to 0.80) and 44% (HR=0.56, 95% CI, 0.51 to 0.62), respectively and a decreased risk in CVD 37% (HR=0.63, 95% CI, 0.59 to 0.66) and 56% (HR=0.44, 95% CI, 0.39 to 0.49), respectively.

Conclusion:
Earlier life stage favorable CVH was associated with lower CVD events and total and cause-specific mortality regardless of CVH change patterns over time. Furthermore, improving CVH is associated with lower CVD event risk and lower total and all-cause mortality. However, we observed an alarming low percentage of overall CVH improvement and a high percentage of maintaining low overall CVH. Understanding the mechanisms underlying CVH change patterns may help to tackle the low prevalence of moderate or optimal CVH.
Abstract P346: High Stress Reasons for Immigration May Increase Risk for Diabetes: The Africans in America Study
Authors: Mugeni Regine , Horlyck - Romanovsky Margrethe F , Aduwo Jessica Y , Briker Sara M , Hormenu Thomas , Chung Stephanie T , Mabundo Lilian S , Dubose Christopher W , Berrigan David , Sumner Anne E
Published: March 2019

Background:
Scant data exists on whether reason for immigration (work, asylum/refugee, study, family reunification and lottery) affects physiologic stress experienced by Africans living in America. It is also uncertain if high stress measured by allostatic load score (ALS), translates into risk for diseases such as diabetes.

Goals:
Working with self-identified healthy African-born blacks enrolled in the Africans in America study (n=147, men 66% (97/147), age 42±10y (mean±SD), BMI 27.6±4.3 kg/m
2
), we (a) determined whether ALS varies by reason for immigration; (b) examined the relationship of ALS to risk factors for diabetes including insulin resistance and visceral adipose tissue (VAT) volume.

Methods:
A priori
it was decided immigration reasons above the median ALS would be defined as high stress and below the median, low stress. ALS was calculated using 10 variables from 3 domains: cardiac (SBP, DBP, pulse, cholesterol, HDL, homocysteine), metabolic (BMI, A1C, albumin) and immunological (hsCRP). One point was assigned if a variable was determined high-risk range and 0 if not. According to the distribution of the variables in the cohort, high-risk was defined by being in the highest quartile for each variable, except for albumin and HDL, which required the lowest quartile. Diabetes was diagnosed by OGTT, insulin resistance by Matsuda Index and VAT by abdominal CT scan.

Results:
Three reasons for immigration were identified as high stress: work, asylum/refugee and study (Fig). Low stress reasons were: family and lottery (Fig). Mean ALS for high and low stress reasons for immigration were: 2.8±0.2 vs 1.8±0.2,
P
<0.01. (Fig). DM was diagnosed in 7% (10/147) of participants, but 90% (9/10) of the immigrants with DM had high stress reasons for living in America. ALS was positively correlated with fasting glucose, 2h glucose, insulin resistance and VAT (all
P
<0.01).

Conclusion:
High stress reasons for immigration were work, asylum/refugee and study. They may be associated with adverse physiologic consequences including diabetes.
Abstract P347: Lower Optimism is Associated With Heart Failure Readmissions
Authors: Wells Gretchen L , Fisher Mary , Du Gaixin
Published: March 2019

Introduction:
Heart failure is one of the most common reasons for hospitalizations in the U.S. and within 30 days of discharge, nearly one in four patients have been readmitted. While optimism is associated with favorable cardiovascular outcomes, including incident coronary heart disease events and readmission post coronary artery bypass surgery, no data exist for the role of optimism in heart failure patients.

Hypothesis:
We assessed the hypothesis that optimism is associated with 30 day hospital readmission in heart failure patients.

Methods:
Optimism is measured using the revised Life Orientation Test (LOT-R) a brief, well-validated scale of optimism. This test was administered by convenience sampling to hospitalized adult (>18 years) heart failure patients to determine if low LOT-R scores (less optimistic) were associated with 30 day hospital readmission.

Results:
Patients in the lower quartile of optimism scores (or pessimistic) had a higher rate of all cause 30 day readmission compared with those in the highest quartile (p=0.0290).

Conclusion:
In a single center series of hospitalized heart failure patients, those patients with low optimism scores had a significantly higher all-cause 30 day readmission rate compared with those in the highest quartile of optimism scores. Optimism is trait-like yet may be modifiable, thus presenting an opportunity for intervention in heart failure.
Abstract P348: Validation of
SGCD
(rs2116737) Genotype-Discrimination Interaction as a Determinant of Blood Pressure Variation in the Jackson Heart Study
Authors: Dumeny Leanne , Hsiao Chu , Bress Adam P , Cavallari Larisa H , Johnson Dayna A , Mulligan Connie J , Shimbo Daichi
Published: March 2019

Introduction:
Previous anthropological studies have demonstrated the utility of integrating genetic and psychosocial data, such as discrimination, to understand complex phenotypes such as blood pressure (BP). In these studies, including both single nucleotide polymorphisms (SNP) and psychosocial measures in the model only revealed significant SNPs after accounting for gene by social environment interactions.

Methods:
We sought to externally validate SNPs associated with BP in African Americans (AAs) identified in a study by Quinlan et al. in 2016 that incorporated novel measures of unfair treatment/discrimination and revealed new genes and biological pathways relevant to BP variation. Our validation was done using a larger cohort study of AAs, the Jackson Heart Study (JHS). Systolic and diastolic BP were measured twice in the same visit using a random-zero mercury sphygmomanometer and averaged. During this visit, perceived discrimination was assessed as lifetime occurrence of unfair treatment in nine social domains using the JHS discrimination instrument. Using available GWAS data, 28 significant SNPs were imputed from 1000 Genomes Project Phase 1 (version 3). Our analysis was conducted separately on participants who reported use of BP medications (n= 1532) and those who did not (n=1407). We similarly tested for associations of SNPs with BP using 3 linear regression models adjusting for global ancestry, sex, age, education, BMI, and relatedness. Model 1 tested only the SNPs, model 2 tested the SNPs and discrimination, and model 3 tested an interaction between SNPs and discrimination.

Results:
JHS participants were 62% female, with a mean age of 55 years, mean BMI of 32, mean systolic BP of 127 and mean diastolic BP of 76. Participants on average experienced unfair treatment in three domains in their lifetime. In participants not on BP medications, we found that rs2116737, in the gene
SGCD
, achieved Bonferroni-corrected significance (p < 0.004) with systolic BP in a recessive genotype model (β= 11.92; p =2.00х10
-4
) and was only identified through model 3, the gene-discrimination interaction model. No significant findings were seen in patients using BP medications.

Conclusions:
rs2116737 was validated in the JHS for a gene-discrimination interaction. rs2116737 is an intronic variant in
SGCD
, a gene that is highly expressed in arterial tissue, suggesting vascular regulation as a possible mechanism behind the interaction. In conclusion, the findings suggest accounting for a gene by social environment interaction can identify new SNPs that deserve further investigation in understanding BP variation.
Abstract P349: Psychosocial Resources and Stressors Associated With Cognition Among Middle-Aged and Older Hispanics/Latinos: Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study
Authors: Estrella Mayra L , Lamar Melissa , Durazo-Arvizu Ramon , Tarraf Wassim , Isasi Carmen R , Perreira Krista M , Marquine Maria J , Lipton Richard B , González Hector M , Gallo Linda C , Daviglus Martha L
Published: March 2019

Introduction:
Evidence suggests that psychosocial factors, e.g., resources and stressors, are associated with cognitive function and risk for dementia in non-Latino Whites and Blacks. Less is known about the associations between psychosocial factors and cognitive function among Hispanics/Latinos, a group at high risk for dementia.

Hypothesis:
Psychosocial resources (
ethnic identity
,
familism
,
family cohesion
,
life engagement
,
optimism
,
social network embeddedness
, and
social support
) will be positively associated, and stressors (
ethnic discrimination
,
loneliness
, and
subjective social status
) negatively associated with global cognition [GC] and individual test scores for verbal learning, memory, verbal fluency, and processing speed.

Methods:
Data from the parent HCHS/SOL and its SCAS were used (N = 2,792; ages 45-74). Cognitive function was assessed using standardized tests and GC score was derived from individual test scores. Psychosocial factors were self-reported; higher scores indicate greater levels. Cross-sectional associations between each psychosocial factor and cognition were examined using weighted linear regression models adjusted for age, sex, Hispanic/Latino background, income, education, depressive symptoms, field center, high cholesterol, hypertension, diabetes, obesity, smoking, diet quality, and physical activity.

Results:
In final models (see Table 1),
ethnic identity
,
life engagement
, and
social support
were positively associated with GC, and
familism
and
loneliness
were negatively associated with GC.
Family cohesion
,
optimism
,
social network embeddedness
,
ethnic discrimination
, and
subjective social status
were not associated with GC.
Life engagement
and
social support
were positively associated with all individual test scores.

Conclusions:
Life engagement
and s
ocial support
may be particularly important psychosocial resources for cognitive health among Hispanics/Latinos. Longitudinal associations and their underlying mechanisms should be explored.
Abstract P351: Psychological Resilience is Associated With Higher Subjective Well-being Among Adults Living With Chronic Disease
Authors: Tecson Kristen M , Wilkinson Lindsay R , Smith Bethany , Ko Jong M
Published: March 2019

Introduction:
While living with a chronic disease can be challenging, some studies have shown that psychological resilience is associated with better outcomes. In this study, we aimed to determine the impact of resilience on well-being among adults living with chronic disease.

Hypothesis:
We hypothesized that resilient participants would have higher quality of life, life satisfaction, happiness, and less psychological distress than those with low resilience.

Methods:
Patients who received treatment for a chronic disease within Baylor Scott & White Health (Dallas, TX) and self-identified an informal caregiver, i.e., a nonpaid friend/family member who provides regular care, were eligible for this study. A phone survey was administered from February-May 2017 by the Center for Community Research and Development at Baylor University. We built linear and ordinal logistic regression models to assess the effect of psychological resilience on well-being while adjusting for sociodemographic and health covariates.

Results:
Forty-one participants completed the study. The average age was 66.5 ± 9.5 years and the most common disease was heart failure (16; 39%). Overall, participants had high resilience (median: 4 [quartile 1=3.3, quartile 3=4.7], scale: 1-5), low psychological distress (4 [2, 7], scale: 0-24), good quality of life (8 [5, 9], scale: 0-10), and high life satisfaction (5 ± 1.6, scale: 1-7). In addition, 33 (81%) respondents were pretty/very happy. The effect of resilience was significant in the expected direction in unadjusted analyses. After accounting for potential confounders, the resilience effect lost significance in the model for life satisfaction (b=0.37, p=0.195), trended toward significance for quality of life (b=0.63, p=0.117), and remained highly significant for psychological distress and happiness (b=-1.91, p=0.003, odds ratio=4.71, p=0.004, respectively).

Conclusion:
In conclusion, psychological resilience may be a resource to preserve well-being for those living with chronic disease.
Abstract P352: The Yoga-meditation Heart Connection: a Pilot Study Looking to Improve Women’s Heart Health
Authors: De Jesus Sasha Y , Schultz Emily , Bond Rachel M
Published: March 2019

Introduction:
Stress, anxiety and depression are nontraditional risk factors for cardiovascular disease (CVD) that are more common in women. Yoga and meditation have shown to improve patient’s overall levels of depression, anxiety, and stress, and possibly decrease CVD risk.

Hypothesis:
We hypothesize that regular, supervised sessions of chair yoga and meditation can be a complementary measure to decrease the level of anxiety, stress and depression in women with or at risk for CVD, and pursue lifestyle modifications.

Methods:
An anonymous survey was provided to the participants of a weekly complimentary chair yoga/meditation workshop supervised by a trained cardiac yoga therapist. The surveys were distributed on day 1 and on week 24 to assess any changes in their reported level of stress, depression, anxiety and lifestyle.

Results:
A total of 16 and 10 female participants with or at risk for CVD completed the initial and follow up survey respectively, which included validated screening tools for depression, anxiety and stress. The Patient Health Questionnaire-9 from the initial session to the follow up survey, showed an increase in the score (2.25 vs 3.2 respectively [P = 0.199]). Despite this increased trend, the severity remained within the definition of minimal depression. The mean Generalized Anxiety Disorder-7 went from 7 in the initial visit down to 4.9 (P = 0.138) for the follow up survey (decreased from a definition of mild anxiety to no clinical anxiety). Lastly, the Perceived Stress Score demonstrated a mean reduction from 18.25 to 15.2 (P = 0.106), both remaining as moderate perceived stress. Participants also endorsed a trend towards integrating more low saturated fat foods, and 37.5% endorsed a 3-9 lbs weight loss.

Conclusion:
Although more research and larger studies are yet to be done to demonstrate a definitive benefit in meditation and gentle chair yoga in CVD risk reduction, our pilot study demonstrated a trend towards overall improvement of novel risk factors for CVD, which predominantly affect women. Given the low harm and cost of these measures, they can be done as adjuvants to our standard of care to increase the patient’s overall well being by improving the psychological aspect of their lives which in turn could reflect on their physical health.
Abstract P353: Health-Related Quality of Life and Risk of All-cause and Cardiovascular Hospitalization in a Healthy General Population: Prospective Findings From the Moli-Sani Study
Authors: Bonaccio Marialaura , Di Castelnuovo Augusto , Costanzo Simona , De Curtis Amalia , Persichillo Mariarosaria , Donati Maria Benedetta , de Gaetano Giovanni , Iacoviello Licia ,   Moli-Sani Study Investigators
Published: March 2019

Introduction:
There is paucity of data on the longitudinal association of health-related quality of life (HRQL) with health outcomes from the general population, and little is known on the pathways of such associations.

Hypothesis:
We assessed the hypothesis that HRQL would predict risk of total and cardiovascular (CVD) hospitalization in a population-based cohort of healthy subjects, and tested four pathways possibly accounting for such associations.

Methods:
Longitudinal analysis on 16,097 subjects from the general population of the Moli-sani study, Italy (2005-2010), free from CVD, cancer and diabetes. HRQL was assessed by the 36-Item Short Form Health Survey including both mental and physical domains. Behavioural, traditional, inflammatory and novel markers of CVD risk (listed in table) were tested as explanatory factors. First hospital admissions were recorded by direct linkage with hospital discharge forms. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression.

Results:
Over a median follow-up of 7.4 years, 5644 all-cause and 1724 CVD hospital admissions were ascertained. The highest quintile of mental HRQL was associated with 23% (95%CI: 17% to 29%) and 27% (15% to 37%; Table) lower risk of total and CVD hospitalization, respectively, as compared to the lowest. Risk estimates for physical health were 0.59 (0.54-0.63 for Q5 vs Q1) and 0.56 (0.48-0.64) for total and CVD risk of hospital admissions, respectively. Novel biomarkers (listed in table) accounted for the largest, although modest, proportion of the association of HRQL with risk of CVD hospitalization.

Conclusions:
In a large sample of disease-free subjects, not only higher physical, but also higher mental HRQL is associated with lower risk of total and CVD hospitalizations. Differences in baseline novel biomarkers slightly explain such associations. Our results suggest that HRQL assessment may be useful in stratifying hospitalization risk among a general population of adults.
Abstract P354: Work-Family Conflict and Ideal Cardiovascular Health Score in ELSA-Brasil Baseline Assessment
Authors: Rocco Priscila T , Bensenor Isabela M , Griep Rosane H , Barreto Sandhi M , Moreno Arlinda B , Alencar Airlane P , Lotufo Paulo A , Santos Itamar S
Published: March 2019

Introduction:
Perceived stress (including work-related stress) is associated with cardiovascular health. We studied the association between work-family conflict and AHA’s ideal cardiovascular health (ICH) score at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline.

Hypothesis:
Individuals with more frequent work-family conflict have worse ICH scores.

Methods:
We analyzed data from 11,351 active workers, aged 35-74 years. ICH scores were calculated based on the four lifestyle (diet, physical activity, smoking and body-mass index) and three health (blood pressure, fasting plasma glucose and total cholesterol) metrics proposed by the AHA. Work-family conflict was assessed as time and strain-based work interference with family; family interference with work and lack of time for personal care and leisure. We used quasi-Poisson regression models to analyze the association between work-family conflict and ICH scores, with positive relative predicted score differences (rPSD) indicating higher predicted ICH scores.

Results:
Subjects with frequent lack of time for personal care and leisure had lower global (rPSD: -2.9%; p=0.01) and lifestyle (rPSD: -8.2%; p<0.01) ICH scores but higher health ones (rPSD: +4.8%; p=0.02). After stratifying by sex, the negative association between lack of time for personal care and leisure and global ICH scores remained significant only in women. In addition, women had a negative association between lifestyle ICH scores and both frequent strain-based work interference with family (rPSD: -5.1%; p<0.01) and family interference with work (rPSD: -8.6%; p<0.01).

Conclusions:
We found significant associations between work-family conflict and ICH scores in this large multicenter sample. Associations between work-family conflict and ICH score (especially lifestyle metrics) were more intense in women.
Abstract P356: Association Between Acculturation and Diet Quality Varies by Acculturation Construct and Heritage: Results From the Hispanic Community Health Study/Study on Latinos
Authors: Mattei Josiemer , Tamez Martha , Sotres-Alvarez Daniela , Siega-Riz Anna Maria , Gallo Linda C , Van Horn Linda , Daviglus Martha , Vidot Denise C , Elfassy Tali , Kaplan Robert C
Published: March 2019

Introduction:
Inconsistencies remain on the reported associations between measures of acculturation and diet quality, particularly among Hispanics/Latinos.

Hypothesis:
We hypothesized that associations between acculturation and diet quality would differ according to the acculturation measure used and by country of origin (heritage).

Methods:
Baseline data were analyzed from 16,275 Hispanic/Latino adults aged 18-74y enrolled in the population-based Hispanic Community Health Study/Study of Latinos cohort. Dietary intake was assessed with two 24-hour recalls. Diet quality was measured via the Alternate Healthy Eating Index (AHEI; range 0-110: lowest to highest quality and categorized into tertiles). Acculturation questions on language preference, US vs. foreign-born, years living in the US, and the Short Acculturation Scale for Hispanics (SASH) language and social subscales (higher score = more English use or US orientation) were interviewer-administered.

Results:
Adjusting for demographic, socioeconomic, and behavioral factors, each acculturation measure (except SASH-social) was independently and inversely associated with AHEI among overall Hispanics/Latinos (i.e. higher US acculturation = lower AHEI). There were significant interactions (at p<0.10) between acculturation measures and heritage, and thus multivariable-adjusted models were stratified by heritage. Analyses by heritage found higher adjusted odds ratios (AOR; 95% CI) for the top tertile (vs. lowest) of AHEI for being foreign-born (vs. US born) in Mexicans [2.36 (1.54, 3.64)] and for each point of the SASH-social subscale in Puerto Ricans [2.20 (1.21, 4.00)]. Conversely, lower AOR for the top tertile (vs. lowest) of AHEI were observed for living <10y in the US (vs. >10y) in Puerto Ricans [0.01 (0.001, 0.19)], and for each point of the SASH-language subscale in Mexicans [0.79 (0.64, 0.97)] and Puerto Ricans [0.69 (0.50, 0.97)]. Higher AOR for the middle tertile (vs. lowest) of AHEI was noted for foreign-born and living <10y in the US in Central Americans, while lower AOR was noted for living <10y in the US in South Americans.

Conclusions:
In conclusion, acculturation measures associated with diet quality are specific to Hispanic/Latino heritage and should be carefully selected in diet and health studies.
Abstract P357: Subclinical Hypothyroidism Alters Autonomous Nervous System. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Authors: Hoshi Rosangela , Lotufo Paulo A , Dantas Eduardo , Varejao Rodrigo , Mill J.Geraldo , Bensenor Isabela M
Published: March 2019

Introduction:
Lifetime stressful conditions have been related to a higher risk of coronary heart diseases events. One recognized way is related to the disbalance of a parasympathetic and sympathetic system that can be mediated by several humoral factors, including thyroid hormones. Although the role of thyroid hormones on cardiovascular system regulation on the autonomous nervous system was very well-defined decades ago for normal conditions and there is scarce information concern to the association between subclinical thyroid disorders and the autonomous nervous system.

Hypothesis:
Subclinical thyroid dysfunctions are associated with autonomic disturbances assessed by the heart rate variability evaluated by linear and nonlinear variables following postural changes.

Methods:
At baseline of the ELSA-Brasil study (15105 adults aged 35-74 years old), we evaluated the heart variability rate at the supine position for everyone, and sampled 855 participants to repeat a standing measure of the heart rate variability. Subclinical hypothyroidism was defined as thyroid-stimulating hormone >4 IU/ml for people with normal free-thyroxine levels. The cardiac autonomic nervous function was evaluated by linear time and frequency domain analyses (standard deviation of consecutive RRi - SDNN; root mean square of successive differences between adjacent regular R-R intervals - RMSSD; low frequency - LF; high frequency - HF; LF/HF ratio) as well as by nonlinear symbolic dynamics (patterns with no variation - “0V”; patterns with one variation - “1V”; patterns with two variations - 2V).

Results:
After exclusions, 666 (93.8%) euthyroid and 44 (6.2%) participants with subclinical hypothyroidism were eligible for analyses. At the baseline, supine rest measurement, the “0V” symbolic pattern, which reflects sympathetic modulation, was higher (31.8 vs. 24.2; P= .01) and “2V”, representing parasympathetic activity, was lower than in the euthyroid group (18.0 vs. 25.3; P= .02). Comparing the variation between positions, the “0V” pattern showed a lower delta in subclinical hypothyroidism than in euthyroid subjects (6.8 vs. 14.2%; P= .04). Additionally, it is suggested that a symbolic analysis of heart rate dynamics is an alternative and, possibly, a more sensitive method for cardiac autonomic assessment following standing position in this population.

Conclusion:
Subclinical hypothyroidism presented lower sympathetic and parasympathetic tonus at rest and a blunted sympathetic response to active postural change, marked by reduced variation in the “0V” of symbolic analysis.
Abstract P364: Validity of Self-Reported Cardiovascular Disease Risk From Survey Questions
Authors: Duval Sue , Van’t Hof Jeremy , Steffen Lyn M , Luepker Russell V
Published: March 2019

Introduction:
Simple questionnaires with dichotomous responses evaluating atherosclerotic risk factors are frequently used to assess cardiovascular disease (CVD) risk in research and clinical settings. Such methods are easier and less costly than direct measurements, but the validity of self-reported risk compared to calculated CVD risk is not well studied.

Hypothesis:
Self-reported history of hypertension, hyperlipidemia, diabetes and smoking will predict measured CVD risk.

Methods:
Using the ACC/AHA Pooled Cohort Risk Equations (PCE), we calculated 10 year CVD risk from a randomly selected population sample of 9,856 individuals aged 40-79 without a history of CVD in the Minnesota Heart Survey (MHS). Using log-linear regression models, we estimated sex-specific PCE risk from the individual’s self-reported history of 4 dichotomous risk factors; hypertension, hypercholesterolemia, diabetes, and smoking. Age was included in all models. Model performance was assessed internally using leave-one-out cross-validation.

Results:
The median PCE 10 year CVD risk in women was 2.1% (IQR: 0.8%-5.6%), and in men was 6.3% (3.1%–13.0%). Using the newly developed equations, which included only the 4 self-reported risk factors and age, the estimated median risk was 2.2% (0.9%-5.8%) in women, and 6.9% (3.2%–13.1%) in men. The measured and estimated PCE risk using a threshold of 7.5% to categorize low and high risk gave an accuracy of 95% for women and 87% for men. The multivariable model-estimated PCE corresponded closely with the actual PCE (Figure).

Conclusions:
Self-reported history of atherosclerotic risk factors may be useful to estimate CVD risk in individuals, avoiding actual measurements.
Abstract P370: Minor Electrocardiographic Abnormalities and Cardiovascular Mortality
Authors: Hari Krupal J , Singleton Matthew J , Ahmad Muhammad Imtiaz , Soliman Elsayed Z
Published: March 2019

Background:
Although minor electrocardiographic (ECG) abnormalities are common in clinical practice, their prognostic significance remains unclear due to inconsistent reports. Such inconsistent reports may be related to the focus on the presence vs. absence of minor ECG abnormalities and ignoring the number of abnormalities.

Hypothesis:
The number of minor abnormalities is associated with cardiovascular disease (CVD) mortality in a dose-response fashion.

Methods:
This analysis included 6,467 participants (mean age 59 years 53% women, 49% non-Hispanic whites) from the NHANES-III who were free of CVD and major ECG abnormalities. ECG abnormalities were defined from digitally recorded and centrally processed standard 12-lead ECGs using the Minnesota Code ECG Classification. Cause of death was identified using the National Death Index. Cox proportional hazards analysis was used to examine the association between baseline minor ECG abnormalities (presence of at least 1 abnormality vs. normal ECG, and presence of 1, or ≥2 abnormalities vs. normal ECG, separately) with CVD mortality.

Results:
About 38% (n=2,438) of the participants had at least 1 minor abnormality at baseline. During a median follow-up of 13.9 years, 755 CVD deaths occurred. Compared to normal ECG, presence of minor ECG abnormally was marginally associated with CVD mortality (HR(95%CI):1.16 (1.00, 134); p= .0045). When the number of abnormalities was taken into account, the association with CVD mortality showed a dose-response relationship. While presence of
only
1 minor abnormality was not associated with CVD mortality, presence of ≥ 2 abnormalities was associated with a 39% increased risk. Also, each additional minor ECG abnormality was associated a 13% increased risk of CVD mortality (
Table
).

Conclusions:
The number of minor ECG abnormalities, not only their mere presence, should be taken into account to both understand the prognostic significance of these common findings and to enhance the potential role of ECG to identify individuals at risk for CVD.
Abstract P374: Healthy Lifestyle Factors Are Associated With a Lower Risk of Cardiovascular and Cancer Mortality in Older Men
Authors: Nujaidi Ali , Chen Jiaying , Gaziano John M , Djoussé Luc
Published: March 2019

Background:
Cardiovascular disease and cancer are the two leading causes of death in the united states. Although individual healthy lifestyle behaviors have been associated with health benefits in middle-age adults, little is known about these factors and mortality in older adults.

Objective:
To assess the association between modifiable lifestyle factors and risk of CVD and cancer mortality in older men.

Methods:
We prospectively studied 8314 men aged 65 years and above from Physicians’ Health Study II. Baseline information on lifestyle factors was self-reported. We assessed healthy lifestyle factors as follows: Not smoking, BMI <25 kg/m2, vigorous exercise for at least 5 days a week, and healthy diet habit (assessed as being in the top 2 quintiles of the alternate healthy eating index-2010). We used COX regression analysis to calculate adjusted hazard ratios with 95% CI for cardiovascular disease (CVD) and cancer mortality.

Results:
After a mean follow up duration of 9 years, 443 participants died due to cardiovascular disease and 349 died due to cancer. Age adjusted hazard ratios (95% CI) of cancer mortality was 0.73 (0.55-0.96), 0.58 (0.43-0.78), and 0.52 (0.36-0.75) for people with one, two, and 3+ healthy lifestyle factors, respectively, compared to people adhering to zero healthy lifestyle factor. Corresponding values for CVD mortality hazard ratios (95% CI) were 1.01 (0.78-1.32), 0.70 (0.53- 0.93), and 0.73 (0.53-1.01), respectively.

Conclusion:
Adhering to healthy lifestyle behaviors is associated with lower risk of cardiovascular and cancer mortality in older men.