bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P024: Nonsustained Ventricular Tachycardia is Independently Associated With Lower Cognitive Function: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Norby Faye L , Alonso Alvaro , Rooney Mary R , Maheshwari Ankit , Koene Ryan J , Soliman Elsayed Z , Loehr Laura R , Mosley Thomas H , Coresh Josef , Chen Lin Y
Published: July 2021

Introduction:
-- Atrial fibrillation is associated with greater cognitive decline and increased risk of dementia. Little is known about whether other arrhythmias, such as nonsustained ventricular tachycardia (NSVT), are associated with cognition. We aimed to assess the cross-sectional association of NSVT with cognitive test scores in the Atherosclerosis Risk in Communities (ARIC) study.

Methods:
We included 1367 (mean age, 79 ± 5 years; 55% female; 19% non-white race) participants who underwent cognitive tests and ≥2 days of heart rhythm recording using the Zio
®
Patch (a non-invasive, leadless, 2-week ambulatory continuous ECG recording device by iRhythm Technologies, Inc.) in July 2013-February 2017. NSVT was defined as a wide complex tachycardia >4 beats with a rate >100 beats per minute. Burden was calculated as the number of NSVT episodes divided by recording time and split on the median into higher burden and lower burden. Cognitive domain-specific factor scores consisted of tests of memory, executive function and language. We used multiple linear regression to assess the association of NSVT with standardized z-scores of each cognitive domain.

Results:
The mean recording time of the Zio
®
Patch was 12.6 ± 2.5 days. There were 399 (29%) participants with NSVT recorded, ranging from 0.5-439 episodes per week (median = 0.59; interquartile range = 0.51-1.50). Presence of NSVT was associated with lower memory and lower executive function, but not impaired language (Table). The associations were restricted to participants with higher burden of NSVT compared to those without NSVT (-0.22 z-score units, 95% confidence interval (CI) -0.41, -0.04 for memory, and -0.23, 95%CI -0.41, -0.05 for executive function) (Table).

Conclusion:
Presence and higher burden of NSVT are independently associated with lower cognitive function, specifically executive function and memory. Further research is warranted to elucidate the underlying mechanism.
Abstract P039: Longitudinal measures of serial plasma phospholipid de novo lipogenesis fatty acids and incident congestive heart failure in older adults: The Cardiovascular Health Study
Authors: Lee Yujin , Lai Heidi T , de Oliveira Otto Marcia C , Lemaitre Rozenn N , Song Xiaoling , Siscovick David S , Mozaffarian Dariush
Published: July 2021

Introduction:
De novo lipogenesis (DNL) is an endogenous pathway for converting excess carbohydrates and proteins into fatty acids (FAs). While elevated DNL is linked to several metabolic abnormalities, little is known about associations of longitudinal changes in DNL FAs with incident congestive heart failure (CHF), a growing condition in older adults.

Methods:
We investigated relations of longitudinal changes in DNL FAs, measured at year 0, year 6, and year 13, with incident CHF using serial measures of plasma phospholipid myristic acid (14:0), palmitic acid (16:0), 7-hexadecenoic acid (16:1n-9), palmitoleic acid (16:1n-7), stearic acid (18:0), oleic acid (18:1n-9), and cis-vaccenic acid (18:1n-7). Time-varying covariates were measured using standardized methods in 2,005 older adults with two or more FA measures and free of CHF at baseline. Incident CHF was centrally adjudicated using medical records. Risk was assessed by multivariable-adjusted Cox proportional hazards.

Results:
During 14,628 person-years, 553 CHF events occurred. After multivariate adjustment, serial changes in 16:0, 16:1n-9, and 18:1n-7 were positively associated with incident CHF, with HRs (95% CI) for each 30% change in levels of 2.84 (1.50, 5.37), 1.16 (1.00, 1.33), and 1.42 (1.15, 1.77), respectively (
Table
). Findings were similar in sensitivity analyses excluding individuals with prevalent coronary heart disease (not shown). In analyses evaluating absolute, rather than changes in, DNL FA levels, the associations of 16:0, 16:1n-9, and 18:1n-7 with incident CHF were no longer statistically significant although with consistent directions of association (not shown). Neither changes nor absolute levels of 14:0, 16:1n-7, 18:0, and 18:1n-9 were associated with CHF.

Conclusion:
Serial changes in plasma phospholipid 16:0, 16:1n-9, and 18:1n-7 were associated with an elevated risk of CHF in older adults. These results indicate that potential mechanisms of risk, especially related to DNL, deserve further investigation.
Abstract P049: Serum Uric Acid Levels Are Associated With Non-Calcified Coronary Plaque Independent of Traditional Cardiovascular Risk Factors in Patients With Psoriasis
Authors: Elnabawi Youssef A , Dey Amit K , Belur Agastya D , Goyal Aditya , Groenendyk Jacob W , Chung Jonathan , Rodante Justin , Joshi Aditya A , Playford Martin P , Mehta Nehal N
Published: July 2021

Introduction:
Serum uric acid (sUA), a known inflammosome-inducer, is associated with prospective risk of coronary artery disease in a dose-dependent fashion. Psoriasis (PSO), a chronic inflammatory disease associated with elevated burden of systemic inflammation and subclinical coronary artery disease, provides a reliable human model to study how sUA may relate to non-calcified coronary plaque burden (NCB) measured by computed coronary tomography angiography (CCTA).

Hypothesis:
We hypothesized that sUA would directly associate with NCB beyond traditional cardiovascular (CV) risk factors.

Methods:
103 consecutive PSO patients and 47 healthy volunteers (HV) underwent CCTA (320 detector row, Toshiba) for coronary plaque burden quantification using QAngio (Medis). PSO severity was assessed by Psoriasis Area Severity Score (PASI) and divided into severe PSO (PASI>10) and mild-moderate PSO (PASI<10). All patients had fasting blood draws for the measurement of sUA at a certified clinical lab.

Results:
PSO patients were older than HV and had a higher CV risk by Framingham risk score (FRS) (Table 1). We observed a significant trend towards increase in sUA among severe PSO, mild-moderate PSO, and HV groups (mean 6.4, 5.9, 5.4 respectively, p=0.02 for trend). A positive association was observed between sUA and NCB, which was stronger in severe PSO after adjustment for traditional CV risk, alcohol, statins, and systemic/biologic PSO treatment (Severe PSO: β=0.27, p<0.001; Mild-moderate PSO: β=0.18, p=0.03), not significant in HV (β=0.18, p=0.12).

Conclusions:
sUA is independently associated with NCB in states of chronic inflammation such as PSO, and as such, may potentially serve as a biomarker for subclinical coronary atherosclerosis. However, larger prospective studies of CV outcomes in chronic inflammatory diseases are needed to confirm these results.
Abstract P051: Circulating Beta-2-microglobulin Predicts Cardiovascular, Cancer, and All-cause Mortality: The Framingham Heart Study
Authors: Hwang Shih-Jen , Keefe Joshua , Mendelson Michael , Courchesne Paul , Ho Jennifer , Larson Martin G , Lyass Asya , Yao Chen , Huan Tianxiao , Levy Daniel
Published: July 2021

Beta-2-microglobulin (β
2
M), a multifunctional protein involved in immune function, is a filtration marker that has been reported to predict renal failure, cancer, cardiovascular disease (CVD), and all-cause mortality. Previous studies of β
2
M and mortality were limited to select study samples (elderly or patient-based) lacking information on cancer or kidney function. We examined plasma β
2
M as a predictor of all-cause and cause-specific mortality in those with and without chronic kidney disease (CKD). The study sample consisted of Framingham Heart Study participants from the 2
nd
(n=3196) and 3
rd
(n=3911) generations who attended an on-site examination (2001-2007). Plasma β
2
M concentration was measured using a Luminex bead-based immunoassay. Mortality events were adjudicated by a physician committee. Proportional hazard models were conducted based on standardized values of β
2
M, adjusted for CVD risk factors, prevalent CVD, cancer, and family structure. We additionally analyzed subgroups stratified for CKD (defined as GFR
ckdepi
< 60 mL/min/1.73 m
2
). The study sample included 7107 individuals [mean age 50 years, 54% female, 4% with prevalent CKD, mean length of follow-up: 13 years]. In the overall sample, β
2
M concentrations were associated with increased risk of CVD death (HR=1.42 [CI=1.17-1.72]), cancer death (HR=1.27 [CI=1.07-1.5]), and all-cause mortality (HR=1.27 [CI=1.16-1.4]). β
2
M performed better in participants with prevalent CKD than in those free of CKD. Adjusting for cystatin C, a filtration biomarker, did not affect the results. For all-cause mortality, including plasma β
2
M yielded a relative integrated discrimination improvement of 3% (p-value 0.03) beyond the covariate-only model. The net reclassification improvements (NRI) for all-cause mortality was 4% that was not statistically significant (p-value 0.26). We conclude that among middle-aged adults, plasma β
2
M is a predictor of all-cause and cause-specific mortality. Much of the risk associated with β
2
M is concentrated in those with CKD.
Abstract P068: A Genome-wide Association Study for Diabetic Nephropathy Genes in the Japanese Population: The J-MICC Study.
Authors: Nakamura Yasuyuki , Narita Akira , Ohno Seiko , Takashima Naoyuki , Wakai Kenji , Ueshima Hirotsugu
Published: July 2021

Background:
Diabetic nephropathy is the most common cause of chronic kidney disease in the developed countries. Clinical characteristics do not fully predict development of diabetic nephropathy in diabetic patients. There have been few genome-wide association studies (GWAS).

Methods:
We conducted a GWAS to identify common genetic variations that affected renal function in a Japanese population of 1,117 patients with type 2 diabetes mellitus (T2D) extracted from 14,091 participants appropriate for GWAS as a part of the Japan Multi-Institutional Collaborative Cohort (J-MICC) study. Genotyping was performed at a central laboratory using a HumanOmniExpressExome-8 v1.2 BeadChip array. Genotype imputation was performed using SHAPEIT and Minimac3 software based on the 1000 Genomes reference panel (phase 3). Estimated glomerular filtration rate (eGFR) was calculated according to Matsuo et al. for each patient. The association for the imputed variants with eGFR was performed by a linear regression analysis adjusted for age and sex.

Results:
We found that rs869312667 at NBEA (β=1.23, P=1.03E-08) and rs8523 at ELOVL2 (β=24.4, P=1.64E-08) were significantly associated with eGFR. These genes have been reported to participate in several metabolic functions and were associated with some disease conditions. However, no previous reports have implied that these genes were related to diabetic nephropathy.

Conclusions:
rs869312667 at NBEA and rs8523 at ELOVL2 were significantly associated with eGFR in patients with T2D in Japanese.
Abstract P078: Gestational Weight Gain Modifies the Effect of the Circadian Rhythms Related
MTNR1B
Genotype on Postpartum Glycemic Changes: A Longitudinal Study in Women With Prior Gestational Diabetes
Authors: Nisa Hoirun , Leng Junhong , Zhou Tao , Liu Huikun , Li Weiqin , Wang Leishen , Li Nan , Sun Dianjianyi , Li Xiang , Shang Xiaoyun , Hu Gang , Qi Lu
Published: July 2021

Context:
Gestational diabetes mellitus (GDM) affects postpartum glucose metabolism and future risk of type 2 diabetes. Pregnancy and GDM are related to disturbed circadian rhythms and sleeping, which are determined by genetic variations in genes such as
Melatonin receptor 1B
(
MTNR1B
).

Objective:
We prospectively assessed whether the circadian rhythms related
MTNR1B
genotype was related to on 1-5 years of postpartum glycemic changes among women with a history of GDM, and whether gestational weight gain modified such associations.

Design:
The established circadian rhythms-associated
MTNR1B
genetic variant (rs10830963) was genotyped in 1025 Chinese women with a history of GDM. Body weight and glycemic traits during and after pregnancy were longitudinally collected.

Results:
The frequency of
MTNR1B
rs10830963 was not different among the three categories of gestational weight gain (inadequate, adequate, and excessive). We found women carrying different
MTNR1B
genotype showed distinct postpartum changes in 2-h glucose (OGTT) – 0.36, 0.20, and -0.19 mmol/L per additional copy of the G allele in women with inadequate, adequate, and excessive gestational weight gain, respectively (
p
for interaction=0.028). The corresponding changes in fasting glucose were 0.14, 0.13, and 0.01, though the modification effects of gestational weight gain on the genetic association was marginal (
p
for interaction= 0.067).

Conclusions:
Our findings suggest that gestational weight gain may modify the circadian rhythms related
MTNR1B
genetic variant on long term glycemic changes, highlighting the significance of gestational weight management in diabetes prevention among women with GDM.
Abstract P082: Prevalence and Trends in Dietary Supplement Use Among Diabetic Adults: The National Health and Nutrition Examination Surveys, 1999-2014
Authors: Li Jing , Gathirua-Mwangi Wambui , Song Yiqing
Published: July 2021

With increasing diabetes prevalence in the US general population, many nutritional supplements are taken as alternative medicine by diabetic patients. However, serial trends or patterns in their dietary supplement use are unknown. Using the nationally representative data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2014, we evaluated prevalence and trends of use of any supplements, multi-vitamins/multi-minerals (MVMM), individual vitamins, minerals, and non-vitamin, non-mineral supplements. Information on supplement use in the preceding 30 days was collected during the interview over 8 continuous 2-year waves. Analyses were conducted among 6,348 US diabetic adults aged 20 to 85 years (pregnant women excluded) and also stratified by age, race/ethnicity, gender, educational backgrounds, comorbidity status, and comorbidity status. Overall, the prevalence of use of any supplement (52%-59%;
P
for trend=.09) and that of any mineral (47%-51%;
P
for trend=.24) seemed stable. Use of MVMM decreased from 36% of reported use in 1999-2000 to 32% in 2013-2014 (
P
for trend=.008). Use of any vitamin products increased from 47% to 53% (
P
for trend=.04). Use of a few individual supplements including lycopene, vitamin D, and vitamin B12 significantly increased. The trend of supplement use varied by sex and race/ethnicity. In conclusion, among diabetic patients in the United States, use of any dietary supplements or any minerals remained stable, use of MVMM slightly decreased, and use of any vitamins and several individual supplements increased over the past 16 years.
Abstract P091: Early Life Stressors and Adult Cardiovascular Health in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Howard Virginia J , Long Leann , Bennett Aleena , McClure Leslie A , Kleindorfer Dawn O , Wadley Virginia G , Cunningham Solveig A , Manly Jennifer M , Unverzagt Fred W , Crowe Michael G , Pollock Jennifer S , Feig Dan I , Irvin M R , Glymour M M
Published: July 2021

Introduction:
Prior research suggests early life stressors (ELS) influence development of cardiovascular (CV) risk over the lifecourse, but few national studies have evaluated this. We examined the association of ELS with adult CV defined by
Life’s Simple 7 (LS7)
score within a national US population-based cohort.

Methods:
We used data on 7,469 REGARDS participants (black and white adults, aged
>
45 in 2003-2007), with clinical and behavioral risk factor data from questionnaires and direct measurement. Levels of LS7 components (blood pressure, total cholesterol, fasting glucose, physical activity, smoking, diet, body mass index) were coded as poor (0 points), intermediate (1 point) or ideal (2 points); the primary outcome, LS7 score, was the sum of the components. In 2012-2013, 7 ELS (death of parent, parents separated/divorced, family serious illness, witnessed family violence, family substance abuse, parent’s loss of job and parent incarcerated) were retrospectively assessed by mail questionnaire to active participants. Linear regression was used to characterize the relationship between each ELS and LS7 after adjustment for demographics and region of birth. Mediation by adult income and education was examined.

Results:
ELS were common, ranging from 3% for parent incarcerated to 29% for family serious illness. Lower LS7 was associated with each ELS, with significant association with witnessing family violence (-0.15; 95% CI: -0.29 to -0.02) (see figure.) Additional adjustment for adult education partially attenuated the effect estimates for witnessed family violence by 20.6% (95% CI: 2.0%, 39.1%); adjustment for adult income and education mediated the non-significant estimates for parental death, family illness and separation/divorce.

Conclusions:
Exposure to ELS was associated worse adult cardiovascular health; these associations were partially but not fully mediated by adult socioeconomic status. Further work is needed in categorization of ELS and examination of pathways underlying the associations.
Abstract P095: New Pediatric Hypertension Guidelines Alter Prevalence Distribution and Associations With Cardiovascular Risk Factors and Target Organ Damage in Youth
Authors: Khoury Michael , Khoury Phlip , Dolan Lawrence , Kimball Thomas , Urbina Elaine
Published: July 2021

Introduction:
A Clinical Practice Guideline (CPG) for pediatric hypertension was recently published, serving as an update to the previous guidelines (“4
th
Report”). The CPG includes changes to the cut-points defining pediatric hypertension, including the incorporation of absolute cut-points rather than percentiles for adolescents.

Objective:
To evaluate the impact of the new CPG (compared with the 4
th
Report) on the prevalence of hypertension and associations with cardiovascular risk factors (CVRFs) and target organ damage (TOD) in a population of high-risk youth.

Methods:
Subjects (N=364, 10-18 years) underwent fasting anthropometric, blood pressure (measured as per the Fourth Report), CVRF (lipid profile, insulin, glucose, HbA1C%), carotid artery intima-media thickness (cIMT), pulse wave velocity (PWV), and left ventricular mass and diastolic (via echocardiography) assessments. Blood pressure was categorized as normal, elevated, Stage 1, and Stage 2 hypertension, as defined by the 4
th
report and by the new CPG. The agreement between the prevalence of hypertension using the two guidelines and associations with other CVRFs and markers of TOD were evaluated using weighted Kappa statistics and tests of symmetry.

Results:
Of the 364 subjects (65% female, 15.1 +/- 2.1 years), 36 (10%) had Stage 1 and 11 (3%) had Stage 2 hypertension (as defined by CPG). Hypertension (Stage 1 & 2) was associated with the presence of other CVRFs and TOD (Table). With respect to hypertension prevalence distribution, the 4
th
Report and CPG produced only a moderate agreement (weighted kappa 0.82 (95% CI 0.78, 0.86)) with a significant departure from perfect agreement (test of symmetry p <0.001). Similar findings were noted for associations with other CVRFs and markers of TOD (Table).

Conclusions:
The 4
th
Report and CPG produced asymmetric blood pressure category distributions and associations with CVRFs and TOD. This finding should be considered when using the CPG in clinical and academic settings, and warrants further evaluation.
Abstract P104: Dietary Polychlorinated biphenyls and Long-chain Omega-3 Fish fatty acids Exposures and Risk of Heart Failure
Authors: Kippler Maria , Donat Vargas Carolina , Berglund Marika , Glynn Anders , Wolk Alicja , Åkesson Agneta
Published: July 2021

The potential beneficial effects of fish consumption on heart failure (HF) may be modified by major food contaminants in fish. Polychlorinated biphenyls (PCBs) in particular, have been associated with well-established risk factors of HF such as coronary heart disease, hypertension, and diabetes. Likewise, experimental and cross-sectional studies in humans suggest that PCB exposure may be involved in the development of HF. We aimed to assess the association of both dietary PCB and long-chain omega-3 fish fatty acids exposures with risk of HF in two large population-based prospective cohorts.

We used the Swedish Mammography Cohort and the Cohort of Swedish Men, comprising 32,867 women and 36,545 men, free of cancer, heart failure, myocardial infarction and diabetes at baseline in 1997. A questionnaire on diet (96-food items) and lifestyle factors was completed at baseline. We calculated validated estimates of dietary PCB exposure and intake of long-chain omega-3 fish fatty acids [eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)]. First incident cases of HF were ascertained through computerized linkage to the National Patient Register and the Cause of Death Register, defined as hospitalizations for (listed as the primary diagnosis) or death from HF. We use multivariable-adjusted Cox regression to estimate hazard ratio (HR) and its 95% confidence interval (CI), by quintiles of dietary PCB and EPA/DHA and controlling for known HF risk factors.

During an average of 12 years of follow-up, 1,263 and 1,606 first incident cases of HF were ascertained in women and men, respectively. In multivariable-adjusted models, we observed no association between dietary PCB exposure or EPA/DHA intake and risk of HF. However, after additional mutual adjustments for PCBs and EPA/DHA, HRs for dietary PCB exposure were 1.60 (95% CI, 1.08-2.38) among women and 1.40 (95% CI, 0.97-2.02) among men, comparing extreme quintiles. The corresponding HRs for EPA/DHA intake were 0.62 (95% CI, 0.42-0.92) and 0.79 (95% CI, 0.55-1.13), respectively.

Dietary exposure to PCBs was associated with an increased risk of HF in women, while EPA/DHA intake was associated with a lower risk of HF. Results for men was less evident but showed a similar trend. The results provide important information regarding the risk-benefit analysis of fish consumption, especially in cardiovascular disease prevention.
Abstract P108: Race and Socioeconomic Status Are Strongly Associated With Racial Disparities in Cardiovascular Health and Outcomes in Chicago
Authors: Ofori-Marfoh Claudia D , Volgman Caroline , Volgman Annabelle , Alexander Sarah , Williams Kim
Published: July 2021

Introduction:
Cardiovascular (CV) disease (CVD) is the leading cause of mortality in Chicago according to the most recent data gathered by the Chicago Department of Public Health (DPH). This is also true at the state and national level. The unique distribution of the population in Chicago along racial/ethnic lines promotes disparity in CVD prevalence and, consequently, higher mortality in certain racial minorities and neighborhoods. We sought to identify the factors contributing to racial disparities in CV health, interventions that have been initiated to address these risk factors and lastly, solutions to decrease this gap in Chicago.

Hypothesis:
We hypothesize that unique risk factors put certain racial minorities, especially African Americans (AAs), at greater risk for CVD and mortality.

Methods:
An extensive literature search was performed using PubMed, Scopus and the Chicago DPH Epidemiological database with the search terms/phrases health disparities, CVD, mortality, longevity, life expectancy and Chicago in order to identify contributing factors to racial disparities in CV health and outcomes in Chicago.

Results:
Many CV risk factors identified at the national level held true for Chicago. Race and socioeconomic status (SES) were repeatedly found to be significantly associated with increased prevalence of CV risk factors with one study finding no association between residence in a primary care health provider-deprived area and increased prevalence of CV risk factors after adjusting for SES and race. AAs, persisting into old age, had poorer control of hypertension (45% vs 51%, p <0.001) relative to their Non-Hispanic White counterparts regardless of their Medicare eligibility status and after adjusting for potential confounders such as SES and obesity. Life expectancy for AA Chicagoans was the lowest at 71.7 with Hispanics having the highest life expectancy at 84.6, and Non-Hispanic Whites at 78.8 years. CVD claims the most lives in Chicago with AAs at greatest risk for CV mortality greatly contributing to longevity being the lowest in this racial subgroup. Interventions identified include city-level efforts such as the Healthy Chicago 2.0 initiative and partnerships involving public, community and healthcare organizations striving to narrow the health disparities gap. Recognition that race and SES are strongly associated with adverse CV health outcomes to a greater extent in certain racial subgroups is a huge step in increasing effective strategies to combat the disproportionate burden of CVD in this subgroup.

Conclusion:
African Americans in Chicago suffer the greatest burden of CVD and mortality with studies strongly suggesting that race, itself, and SES are leading culprits in this racial disparity.
Abstract P112: Coronary RevascularizationProcedure Mortality in Coronary Artery Disease Patients With End-Stage Renal Disease: Do Racial Disparities Matter?
Authors: Sergeev Alexander V
Published: July 2021

Background:
Studies have demonstrated that chronic kidney disease (CKD), especially its last stage - end-stage renal disease (ESRD) - is not only an independent risk factor for coronary artery disease (CAD), but it also worsens survival prognosis in CAD patients. It remains unclear whether racial disparities affect the outcomes of coronary revascularization procedures - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - in CAD patients with ESRD (CAD-ESRD).

Study Objectives:
(1) to investigate comparative effectiveness of CABG and PCI on in-hospital mortality outcomes in CAD-ESRD patients and (2) to investigate racial disparities in the utilization and in-hospital mortality outcomes of CABG and PCI in CAD-ESRD patients.

Methods:
We conducted a retrospective cohort study of in-hospital mortality in 23,519 CAD-ESRD patients [mean
+
SD age: 65.4
+
11.6 years; 62.2% (14,626 of 23,519) males] after CABG and PCI during 2007-2011. Patient race was defined as white, black, Asian, or Native American. In-hospital patient death was a binary outcome of interest. Adjusted odds ratios were obtained from multivariable logistic regression (MLR), adjusted for known clinical, demographic, and socio-economic covariates.

Results:
In the covariate-adjusted MLR analysis, post-PCI in-hospital mortality in CAD-ESRD patients was significantly lower than post-CABG mortality (adjusted OR = 0.47, 95% CI: 0.41-0.53, p<0.001). Post-procedure mortality was associated with emergency room (ER) admission (adjusted OR 1.62, 95% CI: 1.44-1.83, p<0.001), older age (3.2% increase for each year, 95% CI: 2.6-3.8%, p<0.001), and higher severity of co-existing conditions other than ESRD measured by the Elixhauser Comorbidity Index (8.5% increase for each point increase in the modified Elixhauser-Walraven score, 95% CI: 7.5-9.5%, p<0.001). Blacks were more likely to undergo an ER admission (48.4%) than Asians (46.0%), Native Americans (43.2%) or whites (42.4%, p<0.05, with multiple comparison correction). In the adjusted MLR analysis, race was not a statistically significant independent predictor of post-procedure mortality. C-statistic for the MLR was 0.729.

Conclusions:
Our results suggest that in-hospital post-PCI mortality in CAD-ESRD patients is lower than post-CABG mortality. Racial disparities in ER admissions - a demonstrated predictor of post-procedure mortality in these patients - may reflect the underlying racial disparities in access to and utilization of primary care. Further studies investigating disparities in CAD-ESRD mortality are warranted.
Abstract P120: Racial Differences in Midlife Brain Health and the Role of Cardiometabolic Risk
Authors: Jorgensen Dana R , Kuan Dora C , Sekikawa Akira , Gianaros Peter J
Published: July 2021

Introduction:
Blacks are at a higher risk for adverse brain-related outcomes, including stroke and dementia. Due to associations of vascular risk factors with brain health, differences in brain health may result from a greater burden of vascular risk factors in blacks, especially in midlife. However, the role of vascular risk factors in midlife racial disparities in brain health have been underexplored. We thus examined racial differences in midlife brain health and tested whether vascular and metabolic risk factors partly explain cross-sectional racial differences.

Hypothesis:
A composite cardiometabolic risk (CMR) score statistically mediates cross-sectional relationships between race and brain health measures.

Methods:
747 adults (20.6% black) aged 30–54, underwent MRI to assess cerebral blood flow (CBF) and morphology. Components of composite CMR were: body mass index, waist circumference, high-density lipoproteins, triglycerides, glucose, insulin, SBP, and DBP. Mediation was tested using the PROCESS v2.14 macro. All models were adjusted for age, sex, income, education, and intracranial volume.

Results:
Blacks exhibited lower gray matter volume, smaller hippocampi, less cortical surface area, and a thinner cerebral cortex than whites (all p’s<0.05). We observed no significant differences in CBF by race. CMR partially mediated the association of race with gray matter volume (6.94% mediation) and cortical surface area (9.33% mediation). Independent of CMR, there was a direct effect of race on hippocampal volume, cortical surface area, and cortical thickness. The effect was equivalent to: 6.9, 9.59, 13.06, and 9.98 years of aging, respectively.

Conclusions:
Race differences in some indicators of brain health are evident in midlife. Cardiovascular and metabolic risk factors may partly explain some of these differences. These results have implications for understanding vascular contributions to disparities in brain health prior to the onset of stroke and other clinical outcomes.
Abstract P121: Racial and Ethnic Differences in Ideal Cardiovascular Health and Perception About Weight Among Females With High Education, Income, and Bmi in the US, 2011-2012
Authors: Saxena Anshul , Arias Lara , Rajan Tanuja , Tian Tian , Khan Gulmeena , Veledar Emir
Published: July 2021

Introduction:
Higher education and income can modify behavioral risk factors for lifetime cardiovascular disease (CVD) risk. The aim of this study was to observe ethnic differences in the CV health, as measured by inadequate cardiovascular health index (CVHI) category, among a cohort of females with high family income, education, and BMI. We also examined differences in perception about self-reported weight and attitudes toward weight loss and exercise.

Methods:
Adult non-pregnant females aged 20 years or older from the 2011-2012 NHANES were included in the study. Participants were at least college educated, had a poverty to income ratio of 350% or above, and BMI (≥ 30). Weighted regression was adjusted for demographics, PHQ-9 score, perception about weight, if participant tried to lose weight last year, and history of CVD, angina, or heart attack.

Results:
The sample represented 2,990,456 eligible females in the US. About 13.2% Hispanic perceived their weight to be about right as compared to 10% Black, and 3.3% White. About 89% Hispanics tried to lose weight in past year compared to 71% White and Black. Weighted regression showed that Hispanic (β: -2.47, 95% CI: -4.44, -0.50) and Black (β: -0.74, 95% CI: -1.93, 0.45) had low CVHI score as compared to White. Higher PHQ9 score (β: -0.12, p > 0.05) and those who did not try to lose weight (β: -1.55, p < 0.01) were associated with lower, and those with positive attitude towards their weight were associated with higher CVHI score (β: 0.38, p > 0.05). Our study suggests huge variations in these characteristics by country of birth and citizenship with corroborated ambiguity in definitions.

Conclusion:
Previous research is inconclusive about existence of Hispanic paradox in cardiovascular health domain. Our study suggests that Hispanic ethnicity was a significant predictor of negative CVHI, when socioeconomic status (SES) was high among all obese females. There was higher prevalence of history of weight management and low CVHI score among Hispanic females; Hispanic females belonging to higher SES may be at a higher risk for CVD related adverse events. In our study, effect of education and income diminished and SES was not associated with participant’s willingness to lose weight despite being obese. Health disparities expressed as differences in CVHI exist despite high education and family income.
Abstract P142: Light Smoking is Associated With Metabolic Syndrome Risk Factors in Chilean Young Adults
Authors: Cheng Evaline , Burrows Raquel , Correa-Burrows Paulina , Blanco Estela , Gahagan Sheila
Published: July 2021

Background:
Metabolic syndrome (MetS) is a cluster of risk factors for CVD and DM2 that includes abdominal obesity, hypertension, hyperglycemia, and dyslipidemia. While cigarette smoking has been associated with MetS risk factors in adults, young adulthood is an under-studied, susceptible period for developing long-term morbidity and mortality related to MetS.

Objective:
This study aims to examine the association between cigarette smoking and MetS in Chilean young adults. We hypothesized that cigarette smoking, even at low levels of exposure (< 30 per week), is associated with an increased risk of developing MetS in young adults.

Methods:
We studied 243 Chilean young adults who were part of infancy studies related to iron deficiency and recruited for a study of cardiovascular risk at age 16. Participant BMI, waist circumference, blood pressure, fasting serum glucose, cholesterol, triglycerides, and HDL were measured. MetS was defined using IDF and AHA/NHLBI criteria, and MetS risk z-scores were calculated using published equations. Participants self-reported smoking and drinking habits using standardized questionnaires. Logistic regressions examined associations between smoking and each MetS risk factor. All models were adjusted for sex, MetS at adolescence, and frequency of alcohol consumption.

Results:
Participants were mean 22.5 years old and 49.8% male (121 of 243). The prevalence of obesity and MetS was 24.3% (59 of 243) and 15.3% (37 of 243) respectively. Among smokers (125 of 243), mean age of smoking initiation was 14.6 years and mean consumption was smoking 28 cigarettes per week. Smokers had significantly higher fasting serum glucose levels, lower HDL, and higher MetS risk scores compared to non-smokers. Smoking was significantly associated with greater odds of fasting hyperglycemia (OR 2.41, CI 1.04 - 5.59) and low HDL (OR 1.87, CI 1.05 - 3.31).

Conclusion:
Cigarette smoking was associated with MetS risk factors, specifically fasting hyperglycemia and low HDL cholesterol levels, in a population-based sample of Chilean young adults. Since our sample had low levels of smoking exposure (< 30 cigarettes per week), these risk factors may herald the onset of MetS associated with light cigarette smoking. Increased emphasis should be placed on preventing the initiation of smoking or promoting cessation during this crucial risk period.
Abstract P149: Retention of Participants in Longitudinal Research: The Multi-Ethnic Study of Atherosclerosis
Authors: Shrager Sandi
Published: July 2021

Background:
Retention of participants is a critical component of ensuring the scientific goals of longitudinal research studies. Differential rates of attrition for ethnic minority participants can be particularly problematic in the fields of health and cardiovascular research, where ethnic minorities are shown to have disproportionately higher rates of both cardiovascular disease and risk factors for heart disease such as diabetes, hypertension, and obesity. The ability to explore the underlying causes of these differences is adversely affected when attrition in a study occurs at a higher rate among the ethnic minority subject participants. Understanding and preventing the causes of subject drop-out to improve retention among all ethnic groups is therefore a vital endeavor of any longitudinal research or cohort study.

Methods:
We analyzed data on ten-year retention rates of Caucasian, Chinese, Hispanic, and African-American participants in the Multi-Ethnic Study of Atherosclerosis (MESA). 6814 participants were recruited into the study in 2000, and 5,865 participants were still alive for the fifth in-person examination ten years later. Of these, 4651 participants returned for this examination. Logistic regression was used to examine the association between retention in the study, race/ethnicity and various baseline demographic characteristics, including age, gender, marital status, income, employment, education, language, place of birth, health insurance status and overall health status as measured by a 10-year predicted cardiovascular disease rate.

Results:
Racial differences in retention were observed, with Chinese, African-American, and Hispanic participants having 30-40% lower odds of being retained than Caucasian participants. However, after adjusting for demographic variables, these differences were primarily explained by indicators of socioeconomic status. Higher income, higher education, employment status, availability of health insurance and health status were significantly associated with ten-year retention in the study across all racial/ethnic groups. Marital status, gender, age, and birthplace (US vs non-US) were not associated with retention.

Conclusions:
Although minority participants were retained at lower rates in MESA, this can be primarily explained by differences in socioeconomic status and health status. Individuals with higher SES indicators may have life circumstances making participation in an examination taking much of a full day more plausible. Future studies should consider how these findings may inform developing support services or incentives which make follow-up participation in clinical research more persuasive for these individuals.
Abstract P151: Primary ASCVD Risk Associated With Undiagnosed Conditions Decreased Over NHANES 1999-2014
Authors: Nelson David R , Davis Jessica A
Published: July 2021

Introduction:
Atherosclerotic cardiovascular disease (ASCVD) is a general term for a group of diseases characterized by atherosclerosis that affect the heart and blood vessels. ASCVD is the leading cause of death in the United States contributing to at least 200,000 preventable deaths from heart disease and stroke each year. Cardiovascular disease, heart disease, and stroke mortality has declined since the year 2000, due to broader use of evidence-based therapies and changes to risk factors and lifestyle modifications, but the decline began to slow after 2011. Two main risk factors contributing to ASCVD are high blood pressure and high cholesterol. Efforts have been made to increase control of these factors at the population-level, however, only those who are diagnosed can be treated. While awareness has increased over time, there is still a significant contribution to ASCVD events from those who were undiagnosed but have high blood pressure, high cholesterol, and/or diabetes.

Hypothesis:
To assess how much of the total U.S. population ASCVD risk is undiagnosed from 1999-2014.

Methods:
The Pooled Cohort Equations assessed 10-year ASCVD risk, based on age, sex, race, total cholesterol, HDL level, systolic blood pressure, use of blood pressure medication, smoking status, and diabetes status. The undiagnosed risk of the primary risk population (age 40-79 years, without missing values for necessary cholesterol, blood pressure, and glucose measures) from 1999-2014 Continuous National Health and Nutrition Examination Survey (NHANES) was calculated based on self-report questions and clinical measures, after age, sex, race, smoking, and diagnosed risks were accounted for. Linear regression for complex survey data tested whether undiagnosed risk was changing over time.

Results:
Applying the ASCVD risk equation to the NHANES subset (n=8,763; weighted n=104,421,757), undiagnosed conditions were associated with 10% of the projected ASCVD events. That is, per 100,000 Americans in this subset, 7,747 ASCVD events were estimated over 10-years, and 800 were based on risk from undiagnosed diabetes, hypercholesterolemia, or hypertension. However, ASCVD risk associated with undiagnosed conditions over time decreased (p<0.001), from 1,169 per 100,000 in 1999-2000, to 642 per 100,000 in 2013-2014.

Conclusions:
NHANES creates a unique opportunity to quantify undiagnosed ASCVD risk in a nationally representative sample. Since 1999, a sizeable portion of the US primary ASCVD risk was based on undiagnosed conditions, however, this proportion of undiagnosed risk decreased over time.
Abstract P156: Comorbidity Profile Preceding Dementia Diagnosis: Findings From the Atherosclerosis Risk in Communities (ARIC) Study Cohort
Authors: Kucharska-Newton Anna , Knopman David , Palta Priya , Heiss Gerardo
Published: July 2021

Background:
Most patients receive a diagnosis of dementia late in the course of the disease. In an effort to learn more about the potential for earlier detection, we examined comorbidity burden preceding a diagnosis of dementia in a cohort of older adults.

Methods:
Cognitive status of ARIC Study cohort participants (n=6,538) was adjudicated at Visit 5 (2011-2013) by a classification committee of physicians and neuropsychologists using a battery of neurocognitive tests, functional assessments, and neurologic exam. Additionally, cognitive status of participants who did not attend the Visit 5 examination, but were alive at the time of the visit (n= 2,289) was ascertained through a Telephone Interview for Cognitive Status-Modified (TICS) or Clinical Dementia Rating (CDR) informant interview. We examined the presence of dementia diagnostic codes in claims for inpatient and outpatient services occurring during the years 1991-2013 and preceding dementia diagnoses among all ARIC cohort participants with a dementia classification. In a sample of study participants who were enrolled in continuous fee-for-service (FFS) Medicare for at least 5 years prior to dementia ascertainment, we examined the comorbidity profile preceding the date of dementia ascertainment using ICD9 diagnostic codes obtained from inpatient records and claims for outpatient office visits.

Results:
Of the 7,283 ARIC participants enrolled in FFS Medicare at the time of ARIC dementia ascertainment (39.6% men, 26.4% black, mean age 76.7 years (SD 5.4)), 901 (12.4%) were classified as having dementia. Only 41.3% of those classified with dementia and 2.6% of those classified as cognitively intact had dementia diagnostic codes in any position in claims for inpatient or outpatient care preceding the ascertainment of cognitive status. In analyses limited to participants with 5 years of continuous FFS Medicare enrollment prior to the cognitive status ascertainment, we observed a consistently greater frequency of hospitalizations among study participants with a subsequent dementia classification, as compared to those with no cognitive impairment (1.62 (SD 0.08) vs. 1.10 (SD 0.05) hospitalizations per participant in the year preceding dementia diagnosis, respectively). No difference in the frequency of outpatient visits was observed. In addition to a greater frequency of diagnostic codes for cerebrovascular disease and cerebral degeneration, those with a positive dementia classification had a greater prior frequency of ICD9 codes for depression, heart failure, acute renal failure, and fluid and electrolyte disorders, as compared to those with no cognitive impairment.

Conclusion:
Dementia patients may have distinct comorbidity profiles in the years preceding a diagnosis. A greater understanding of these profiles is important for characterizing patient factors that may enable early detection and management.
Abstract P173: Hypertension Clusters Across Time and Differential Risk of Mortality: National Health and Nutrition Examination Survey 1999 - 2012
Authors: Jimenez Marcia P , Green Mark A , Verma Amol A , Subramanian S.V. , Loucks Eric B , Razak Fahad
Published: July 2021

Background:
Blood pressure treatment strategies and targets are generally similar for most patients with hypertension, apart from individuals with certain specific comorbidities such as diabetes. We hypothesize that there is latent heterogeneity in the population of adults with hypertension and that this may be associated with differential risk of mortality and might suggest opportunities for more tailored treatment strategies. Our study of adults with hypertension in the US explores whether clusters of social and health-related characteristics exist, how trends in clusters have varied between 1999 and 2012, and how risk of mortality varies between clusters.

Methods:
In a nationally representative sample of adults (> 18 years) with hypertension (physician diagnosed, systolic &ge 140 mmHg or diastolic &ge 90 mmHg, or taking hypertension -related medication) from the National Health and Nutrition Examination Survey from 1999 to 2012 (Total N=16,855), we used a hierarchical cluster analysis approach to identify hypertension sub-groups according to chronic diseases, social factors, and health behaviors.

Results:
We found significant heterogeneity among hypertensive participants across time, according to 7 distinct clusters: Young Mexican-Americans with good health (55% of sample); Low-income non-White elderly with good health behaviors (7%); Elderly obese who smoke (18%); Men with poor health who drink and smoke (1%); Normal weight individuals with high prevalence of cancer (16%); Low-income and fit individuals with poor health (1%); and Obese and morbidly obese with high prevalence of chronic conditions (2%). The prevalence of each of these clusters remained relatively constant throughout the last decade, although there was an increase in the “Elderly obese who smoke” cluster from 14% to 18%. Mortality risk varied by subgroup. For example, the odds of dying for “Obese and morbidly obese with high prevalence of chronic conditions” were 1.73 times higher compared to “Young Mexican-Americans with good health” (p-value<0.001), adjusting for confounders over a 12 year follow-up interval.

Conclusions:
Sociodemographic and clinical clusters among hypertensive individuals in the U.S. remained stable over a decade, with higher risk of mortality associated with specific clusters. Recognizing these clinically-identifiable phenotypes may highlight opportunities to develop and evaluate targeted interventions that account for complex and inter-related clinical and social factors. Further, there is an opportunity through clinical trials to determine whether these clusters merit different blood pressure treatment strategies.