bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP15: Television Watching in Mid-Life and Long-Term Diabetes Risk: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Fang Michael , Daya Natalie R , Grams Morgan , Selvin Elizabeth
Published: March 2020

Background:
Prolonged television watching is associated with numerous health problems. However, its long-term impact and its joint effect with other risk factors on the development of diabetes remains unclear.

Methods:
We conducted a prospective cohort analysis of television watching and incident diabetes using data from the Atherosclerosis Risk in Communities (ARIC) Study. We used Cox regression models and considered television watching independently and jointly with physical activity, weight status, and family history of diabetes. At baseline (1987-1989), participants self-reported frequency of television watching, leisure-time physical activity, and parental history of diabetes. Body mass index was calculated from measured weight and height and converted into weight status categories. Incident diabetes was defined as having a fasting glucose >126 mg/dL or non-fasting glucose >200 mg/dL, or self-report of a diagnosis of diabetes or diabetes medication with follow-up to 2017.

Results:
There were 13,127 participants without diabetes at baseline (mean age, 54, 23% black, 56% female). During 21 years of follow-up, there were 4,280 incident cases of diabetes. Compared to those who watched low levels of television, those who watched medium and high levels were more likely to develop diabetes (HRs 1.13 and 1.51,
Figure
). Other risk factors combined with television watching jointly increased the risk of incident diabetes. That is, even within categories of physical activity, weight status, and family history, television watching was an independent risk factor for diabetes.

Conclusion:
Currently, there is substantial debate regarding the health effects of screen-time. Our study suggests prolonged television watching confers substantial long-term risk for diabetes, even in the setting of other major risk factors. Decreasing exposure to television and other screens may be an important target for diabetes prevention.
Abstract MP17: Sedentary Behavior and Longitudinal Changes in Kidney Function in US Hispanics/Latinos: Findings From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Hannan Mary , Ricardo Ana , Cai Jianwen , Franceschini Nora , Kaplan Robert , Marquez David , Rosas Sylvia E , Schneiderman Neil , Sotres-Alvarez Daniela , Talavera Gregory A , DAVIGLUS Martha L , Lash James
Published: March 2020

Introduction:
Sedentary behavior increases cardiovascular risk due to detrimental effects on blood pressure, vascular function, and glucose metabolism. U.S. Hispanics/Latinos have a high prevalence of sedentary behavior and a large burden of chronic kidney disease (CKD). Therefore, we evaluated the association between sedentary behavior and changes in kidney function over time.

Hypothesis:
We assessed the hypothesis that higher sedentary time will be associated with increase in proteinuria, decrease in estimated glomerular filtration rate (eGFR), and incident CKD.

Methods:
We used data from the HCHS/SOL, a community-based cohort of self-identified Hispanic/Latino adults (18-74 years) from diverse backgrounds in the U.S. This study includes 11181 adults who underwent one-week accelerometry at Visit 1 (baseline, 2008-2011) and completed Visit 2 (2014-2017). Linear regression was used to assess the association of sedentary time with change in eGFR and urine albumin- to-creatinine ratio (ACR), and Poisson regression with robust variance was used to estimate the association with rate of incident CKD (defined as the composite of either the development of eGFR <60ml/min/1.73m
2
and a decline in eGFR ≥1 ml/min per year, or ACR ≥30 mg/g), adjusted for covariates and time elapsed between visits.

Results:
At baseline, mean age was 42.2 years, 51.4% women, mean sedentary time was 11.8 hours, mean eGFR was 106.1mL/min, and median ACR 6.7mg/g. After a median follow-up of 5.9 years, the average decline in eGFR was 0.8ml/min/year and the average change in ACR was 0.3mg/g/year. In fully adjusted models, individuals with higher sedentary time experienced a greater decline eGFR from Visit 1 to Visit 2 (Table 1). Sedentary time was not significantly associated with change in ACR or incident CKD.

Conclusion:
Sedentary behavior may be associated with a decline in kidney function in U.S. Hispanics/Latinos, which may have important implications for prevention of kidney disease and associated cardiovascular risk in this population.
Abstract MP18: Vicarious Experience Trumps Neighborhood Characteristics in Predicting Leisure-time Physical Activity in the Multi-ethnic Study of Atherosclerosis Dataset
Authors: Kariuki Jacob K , Rockette-Wagner Bonny , Cheng Jessica , Burke Lora E , Erickson Kirk , Mendez Dara , Sereika Susan M , Barone Gibbs Bethany
Published: March 2020

Background:
Social cognitive theory (SCT) postulates that observing similar others succeed (vicarious experience) can improve self-efficacy and motivate action. The utility of vicarious experience has been demonstrated in controlled laboratory and clinical settings, but its operationalization and applicability for promoting physical activity (PA) in community settings remains unknown. Characterizing vicarious experiences and other neighborhood factors that are associated with improved PA in the community could help enhance exercise self-efficacy and PA. This secondary analysis examines neighborhood factors that predict leisure-time PA during exam 5 of the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods:
The sample included MESA subjects who participated in exam 5 (N= 4,716). Leisure-time PA was assessed using the MESA Typical Week PA Survey. Neighborhood behaviors and characteristics, including vicarious experiences (operationalized as observing others “exercise” or “walk”), perceived safety, crime, and walkability, were self-reported. Group comparative analyses were used to evaluate differences in categorical and continuous variables. The relationships between neighborhood characteristics and optimal leisure-time PA (≥10 MET-hrs/wk) were assessed using logistic regression adjusting for age, gender, race, income, body mass index (BMI), and depression, and including interactions between race, BMI and age. Adjusted odds ratios with 95% confidence intervals (CI) are reported.

Results:
Participants with complete data on variables of interest (n=4,417) were elderly (age 69.8 ± 9.4 yrs), predominantly female (53%), and diverse (40% white, 12% Chinese, 26% black, 22% Hispanic). Participants who saw people exercise in their neighborhood were 44% (OR 1.44, 95% CI; 1.22 - 1.69) more likely to engage in optimal leisure-time PA compared to those who did not. Observing other people walk in the neighborhood did not impact leisure-time PA (OR 0.84, 95% CI; 0.68 - 1.04). Older age, female gender, obesity, minority status, and high-risk for depression were associated with lower odds of engaging in optimal leisure-time PA controlling for vicarious experience. Race had significant interactions with BMI and age. Other neighborhood characteristics including perceived safety, crime, and walkability did not influence the association between seeing similar others engage in PA and their own engagement in PA.

Conclusions:
Developing PA programs that expose community-dwelling adults to their peers who engage in PA could improve exercise self-efficacy and adherence to PA guidelines.
Abstract MP23: Interplay of Cognitive Impairment and Short Sleep Duration on Cardiovascular and Cerebrovascular Mortality
Authors: Fernandez-Mendoza Julio , He Fan , Calhoun Susan L , Liao Duanping , Vgontzas Alexandros N , Bixler Edward O
Published: March 2020

Introduction:
Epidemiological and experimental studies have shown that short sleep duration is associated with cognitive impairment as well as cardiovascular (CVD) and cerebrovascular (CBV) diseases. However, its role in predicting CVD/CBV mortality is still not well-established, particularly using objective sleep measures.

Hypothesis:
Polysomnography (PSG)-measured short sleep duration modifies the increased risk of CVD/CBV mortality associated with cognitive impairment in middle-age.

Methods:
We addressed this hypothesis in the Penn State Adult Cohort, a random, population-based sample studied in the sleep laboratory (N=1,524, 48.9±13.4y, 54% women) and followed-up after 20.5 ± 5.7 years to ascertain their cause of death. Cognitive impairment (n=155) was ascertained using a comprehensive neuropsychological battery including Mini-Mental State Examination, Symbol Digit Modalities Test, Trail Making Test parts A and B, Benton Visual Retention Test and Thurstone Word Fluency Test. PSG total sleep time classified subjects as normal (≥6 h) and short (<6 h) sleepers. Out of the 563 subjects who were deceased as of December 31, 2018, 244 died of CVD/CBV. Cox proportional hazards regression controlling for age, sex, race, education, obesity, sleep apnea, mental health problems and physical health problems, including hypertension, diabetes, heart disease and stroke at baseline, was used to assess the association between cognitive impairment and mortality.

Results:
Cognitive impairment was associated with an increased risk of all-cause mortality [(HR: 1.72 (1.35-2.06)], which was significantly modified by objective sleep duration (p-interaction=0.01). The association between cognitive impairment and all-cause mortality was significantly stronger among subjects who slept < 6 hours [HR: 2.00 (1.54-2.59)] than among those who slept ≥ 6 hours [HR: 1.00 (0.59-1.67)]. Despite the smaller sample size, we observed a similar pattern (p-interaction=0.18) that the association between cognitive impairment and CVD/CBV mortality was stronger among subjects who slept < 6 hours [HR: 2.09 (1.43-3.05)] than among those who slept ≥ 6 hours [HR: 1.24 (0.60-2.57)].

Conclusions:
The risk of mortality associated with cognitive impairment in middle-age is significantly increased in adults with objective short sleep duration. Middle-aged adults who sleep objectively short may be more vulnerable to the effect of clinical and subclinical cerebrovascular morbidity on cognitive impairment and, thus, early death from CVD/CBV.
Abstract MP30: The Health and Economic Impact of a Sugar Sweetened Beverage Tax in New York City: A Modeling Study
Authors: Bu Daniel D , Yi Stella S , Eom Heesun , Russo Rienna , Bellows Brandon , Zhang Yiyi , Wang Claire , Siscovick David S , Pagan Jose , Moran Andrew E , Li Yan
Published: March 2020

Background:
Sugar-sweetened beverages (SSB) are currently the single largest source of added sugar in the US diet, and consumption in New York City (NYC) remains high. Evidence suggests that a high sugar consumption increases the risk of coronary heart disease. To date, excise taxes on SSB have been implemented in several US jurisdictions. While reductions in SSB consumption have been reported in several places where the SSB tax was implemented, it is unclear what the long term health and economic impact an SSB tax could have within the demographically and socioeconomically diverse NYC. In addition, the impact of varying tax structures remains unknown.

Objective:
To project the cardiovascular health outcomes and cost-savings of variations on the penny-per-ounce SSB tax structure (simulating a half-penny to two-penny range) using a validated microsimulation model of cardiovascular disease.

Methods:
The Simulations for Health Improvement and Equity (SHINE) CVD Model was used to estimate the lifetime direct medical costs (2019 USD) and effectiveness of SSB tax from a healthcare sector perspective. Population demographics and health profiles were estimated using data from the 2013-2014 NYC Health and Nutrition Examination Survey. CVD risk factor trajectories and risk of incident CVD events were derived from six pooled prospective U.S. cohorts. Policy effects and price elasticity were derived from recent meta-analyses. SSB tax was modeled to directly affect incidence rates of CVD events and was derived from variations of the penny-per-ounce tax scheme. Costs were discounted at 3%.

Results:
Compared to the non-policy situation, the SHINE CVD model projected that an SSB tax would prevent 29,341 (95% CI: 11,747-46,935) coronary heart disease (CHD) events at a half penny-per-ounce rate, 37,034 (95% CI: 19,336-54,732), at one penny-per-ounce, and 68,846 CHD events (95% CI: 51,306- 86,386) at a two-pennies-per-ounce rate over the simulated lifetimes of the NYC population. Total cost savings over this time period ranged from $662 million (95% CI $584-$741 million), $714 million (95% CI: $620-$808 million), and $1.03 billion (95% CI $0.92 - $1.16 billion), or $13.5 million/year, $14.6 million/year, $21.0 million/year for half-penny, one-penny, and two-pennies-per-ounce taxes respectively.

Conclusion:
Using a computer simulation model, we showed how different increments of the penny-per-ounce SSB tax could result in substantial benefits within the NYC population in terms of CVD outcomes and overall health care cost savings. Results from the SHINE CVD model may inform the ongoing policymaking efforts.
Abstract MP31: Blood DNA Methylation Signatures of Incident Coronary Heart Disease: An Epigenome-wide Analysis in the Strong Heart Study
Authors: Navas-Acien Ana , Domingo-Relloso Arce , Tellez-Plaza Maria , Gomez Lizbeth , Herreros Miguel , Devereux Richard B , Baccarelli Andrea , Umans Jason G , Howard Barbara , Zhao Jinying , Tang Wan-Yee , Haack Karin , Fallin M. Daniele , Cole Shelley
Published: March 2020

Background:
In the US, American Indians suffer a disproportionate burden of CHD compared to other racial/ethnic groups. Additional strategies are needed to identify individuals at risk.

Objectives:
Investigate the association of blood DNA methylation (DNAm) with incident CHD in the Strong Heart Study and the prediction ability of DNAm beyond traditional risk factors. We maximized prediction ability using Bayesian Hierarchical Cox (BHCox) and Survival Random Forest models, which allow large numbers of CpGs in a single model, instead of considering them individually.

Methods:
Among 2325 men and women 45-74 years old in 1989-1991, 557 CHD events were identified over 20 years of follow-up. DNAm was measured in 790,026 CpGs, pre-processed and corrected for batch effects. We ran adjusted BHCox models for subsets of CpGs selected from similarly adjusted Cox models for individual CpGs. Prediction ability of CpGs in BHCox was further evaluated with Survival Random Forest, which is robust to overfitting. We also conducted a targeted analysis using Cox regression.

Results:
26 CpGs associated with CVD in previous studies were nominally associated with incident CHD in a targeted analysis. The cross-validated C index for the model with traditional risk factors was 0.703. In BHCox, further entering 30K CpGs in a single model, resulted in 231 CpGs being significantly associated with incident CHD, with a cross-validation C statistic of 0.855. In Survival Random Forest, further entering the 231 CpGs from the BHCox model resulted in a cross-validation C statistic of 0.771 and 182 CpGs with variable importance (VIMP) greater than zero. The top CpGs in BHCox were also VIMP>0 in random forest models and were located in
SLC24A1
(calcium exchanger),
SHBG
(sex hormone binding globulin), and
LINC00346
(non-protein coding RNA 346).

Conclusions:
We found novel CpG sites prospectively associated with incident CHD and confirmed signals from previous studies. DNAm might help to identify individuals at high risk of developing CHD.
Abstract MP35: Discordant Visceral and Liver Fat Phenotypes are Differentially Associated With Incident Cardiovascular Disease and Type 2 Diabetes
Authors: Tejani Sanaa
Published: March 2020

Background:
Visceral adipose tissue (VAT) and ectopic liver fat (ELF) are linked with cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) but little is known about their joint associations when they are discordant in an individual.

Objective and Hypothesis:
This study aims to evaluate cardiometabolic health outcomes associated with discordant VAT-ELF phenotypes in a multi-ethnic, population-based cohort of adults. We hypothesized that high VAT-low ELF, but not low VAT-high ELF, would be associated with incident cardiovascular disease, but both would be associated with incident T2DM.

Methods:
Participants of the Dallas Heart Study with no history of CVD or T2DM had assessments of VAT and ELF by MRI and MRS, respectively, between 2000 and 2002 and were followed for a median (IQR) of 12.0 (11.5-12.7) years for the incidence of CVD or T2DM. Associations between VAT-ELF phenotypes (high/low based on sex- and race-specific median values) and outcomes were evaluated using multivariable adjusted Cox proportional hazards and logistic regression models, as appropriate.

Results:
The study cohort included 1731 participants (mean age 43, 54% female, 44% black, 18% Hispanic, 41% obese). 128 (7.4%) participants had incident CVD and 95 (5.5%) had incident T2DM during follow-up. In unadjusted models, those with high VAT-low ELF had the highest hazard for CVD (
Table
), but associations were attenuated after multivariable adjustment. In both unadjusted and adjusted models, high VAT and/or high ELF phenotypes were associated with T2DM, with the high VAT-high ELF phenotype demonstrating the highest odds for T2DM (
Table
).

Conclusions:
In conclusion, we found that the heterogeneous manifestations of abdominal obesity impact cardiometabolic health outcomes. Elevated liver fat in the presence of low or normal VAT is associated with incident T2DM but not CVD.
Abstract MP39: Incident Heart Failure Within Five Years of Delivery Among Women With Hypertensive Disorders of Pregnancy or Pre-pregnancy Hypertension in a Diverse Population
Authors: Malek Angela M , Wilson Dulaney , Turan Tanya N , Mateus Julio , Lackland Daniel T , Hunt Kelly J
Published: March 2020

Introduction:
Hypertensive disorders of pregnancy (HDP) and pre-pregnancy hypertension are associated with increased morbidity and mortality for the mother, with potential long-term implications. We investigated the relationships between HDP and pre-pregnancy hypertension with fatal and nonfatal incident maternal heart failure (HF) within five years of delivery, and examined racial/ethnic differences.

Methods:
A retrospective population-based study was conducted among 433,636 women aged 13-49 (58.7% non-Hispanic white [NHW], 31.8% non-Hispanic black [NHB], 9.5% Hispanic) with a live, singleton birth in South Carolina between 2004-2016. HDP were defined as pre-eclampsia, eclampsia, or gestational hypertension based on hospitalization/emergency department (ED) visit data, or HDP on birth certificates. Pre-pregnancy hypertension was based on hospitalization/ED visit data or birth certificates. Incident HF was defined by hospital/ED visit and death certificate data. Cox proportional hazards models adjusted for sociodemographic, behavioral, and clinical characteristics.

Results:
Eighteen percent of women were diagnosed with HDP in ≥1 pregnancy (n=78,317; 53.5% NHW, 40.8% NHB, 5.7% Hispanic). Of the 433,636 women, 2.3% had pre-pregnancy hypertension with superimposed HDP, 15.7% had no pre-pregnancy hypertension with HDP, 0.4% had pre-pregnancy hypertension without superimposed HDP and 81.6% had neither condition. Compared to those without pre-pregnancy hypertension or HDP, incident HF risk was increased for women with: no pre-pregnancy hypertension with HDP (HR=4.35; 95% CI: 4.01-4.71), pre-pregnancy hypertension without superimposed HDP (HR=5.07; 95% CI: 3.52-7.29), and pre-pregnancy hypertension with superimposed HDP (HR=6.66; 95% CI: 5.91-7.51). The table shows race/ethnic specific estimates of incident HF risk.

Discussion:
Women with HDP and pre-pregnancy hypertension were at higher risk for HF or HF death within five years of delivery and the risk varied across racial/ethnic groups.
Abstract MP41: Cost-related Medication Nonadherence by Psychological Distress Status Among Adults With Hypertension in the US
Authors: Wang Giujing , Fang Jing , Park Chanhyun
Published: March 2020

Objectives:
Medication adherence is a major factor determining the effectiveness of hypertension management. Financial cost and psychological distress (PD) may influence medication adherence, but research in this field is lacking. This study investigated cost-related medication nonadherence (CRMN) and cost-reduction strategies (CRS) by PD status in US adults with hypertension.

Methods:
The study population included adults aged 18 years and older with self-reported hypertension (n=15,778) from the 2017 and 2018 National Health Interview Survey, a nationally representative health survey. CRMN was defined as persons having skipped medication, taking less medication than prescribed, or delaying a medication refill in the past 12 months to save money. CRS was defined as persons having asked a doctor for lower cost medication, bought prescription drugs from another country, or used alternative therapies in the past 12 months to save money. PD was based on a 6-item scale of the Kessler Psychological Distress Scale classified as no/low, mild/moderate, and severe distress. We calculated adjusted percentages of CRMN and CRS for each PD level. We calculated adjusted odds ratios (AOR) of both CRMN and CRS by PD status for overall and sub-population groups by age and sex. We controlled for race/ethnicity, education level, insurance status, household income, and cardiovascular risk factors.

Results:
Among the adults with hypertension, 10.4% reported CRMN, 24.0% reported CRS, 11.9% had mild/moderate and 6.0% had severe PD. Adjusted percentage of CRMN increased from 7.3% for no/low to 19.0% for mild/moderate and 28.7% for severe PD status (p<0.001); and adjusted percentage of CRS increased from 21.1% to 35.0% and 39.8%, respectively (p<0.001). These patterns hold for age and sex group with a higher percentage for younger (18-64 years) than for older (65 and older) age groups. Compared with patients with no/low PD, patients with mild/moderate and severe PD were more likely to report CRMN with an AOR of 2.81 (95% CI: 2.34-3.37) and 5.12 (4.17-6.30), respectively; and for CRS, the AOR was 1.93 (1.70-2.19) and 2.30 (1.91-2.76), respectively. These patterns were consistent for each age and sex group while the younger age group and women experienced more CRMN and CRS.

Conclusions:
The positive relationships between CRMN and PD, as well as CRS and PD suggest that uncontrolled PD could play a disruptive role in hypertension management. Addressing behavioral health among adults with hypertension may be important to achieving hypertension control goals.
Abstract MP44: Nitrite Generating Capacity Assessed Through the Oral Microbial Metagenome is Associated With Cardiometabolic Risk
Authors: Bohn Bruno , Goh Charlene , Marotz Lisa , Molinsky Rebecca L , Roy Sumith , Paster Bruce , Knight Rob , Rosenbaum Michael , Desvarieux Moise , Papapanou Panos N , Jacobs David R , Colombo Paolo C , Demmer Ryan
Published: March 2020

Introduction:
Nitric oxide (NO) is important for cardiometabolic health. The enterosalivary nitrate-nitrite-NO pathway generates NO following oral microbiota-mediated production of salivary nitrite. We investigated the association between the abundance of genes in this pathway and cardiometabolic biomarkers.

Hypothesis:
Microbial genes favoring increased oral nitrite generation are associated with better cardiometabolic profile.

Methods:
We enrolled 784 diabetes-free adults in the Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS). Subgingival plaques were collected from 6-8 teeth/participant. 16S rRNA microbial genes (Illumina, MiSeq) were sequenced; PICRUSt2 estimated abundance of microbial genes in the nitrate-nitrite pathway associated with either nitrite generation or depletion. Gene abundance was summed within each group, and a ratio between nitrite generation to depletion (GDR) was calculated; higher levels suggest increased nitrite generating capacity. Systolic and diastolic blood pressure were measured and HbA1C, insulin, and glucose levels were determined in fasting blood. Z-scores were calculated for cardiometabolic biomarkers and averaged to form a cardiometabolic z-score (CMZ-score). Adjusted multivariable linear models were used to regress the CMZ-score and individual Z-scores on GDR.

Results:
Participants were 69% female and aged 19-58 years (mean=32±9). Mean CMZ-score was 0.00±0.7. Mean (range) GDR was 1.88 (0.22-7.84). Mean CMZ-scores (SE) across GDR quartiles were 0.17 (0.06), 0.01 (0.05), -0.04 (0.05), and -0.14 (0.05), p-value for trend=0.02. Linear regression coefficients summarizing associations between GDR and individual Z-scores (Table) show lower Z-score for systolic and diastolic blood pressure, HbA1C, and insulin levels in those with higher GDR.

Conclusions:
Increased capacity for nitrite production by oral bacteria, assessed through a metagenome estimation approach, is associated with lower levels of cardiometabolic risk.
Abstract MP46: Metabolomic Response to Randomized Treatment With Estrogen and Estrogen Plus Progestin Therapy in Postmenopausal Women
Authors: Hu Jie , Li Jun , Balasubramanian Raji , Clish Clary , Shadyab Aladdin , Manson Joann E , Rexrode Kathryn M
Published: March 2020

Introduction:
Hormone therapy (HT) has been linked to chronic disease risk in postmenopausal women, but the effect of HT on the metabolome is unclear.

Hypothesis:
Randomized HT is associated with perturbations in the metabolome.

Methods:
The discovery set, from the Women’s Health Initiative (WHI), included 288 women in the conjugated equine estrogens-alone (CEE) trial (139 active; 149 placebo) and 244 women in the CEE + medroxyprogesterone acetate (CEE+MPA) trial (133 active; 111 placebo). Blood samples were collected 1 year after intervention. The validation set included 494 women from the Nurses’ Health Study (NHS) and NHS2 (264 non-users, 158 estrogen-alone users, and 72 estrogen + progestogen users). Plasma metabolome was profiled by liquid chromatography-tandem mass spectrometry; 478 known metabolites were used in analyses. We used elastic net regressions to develop metabolomic signatures for CEE and CEE+MPA in the WHI, adjusting for age and race. We applied the signature models to NHS/NHS2 and compared the signatures of current HT users to those of non-users. Pathway analysis was done using MetaboAnalyst.

Results:
In the WHI, we identified a CEE metabolomic signature comprised of 42 metabolites and a CEE+MPA signature comprised of 34 metabolites (
Fig. A
). The two signatures shared 8 metabolites (4 amino acids, 2 glycerophospholipids, and 2 quaternary amines). In NHS/NHS2, CEE and CEE+MPA signatures were highly correlated (
r
=0.85) and both significantly higher in current HT users than non-users (
P
≤2.7х10
-15
) (
Fig. B
). The CEE+MPA signature metabolites were enriched in 3 pathways (glycerophospholipid metabolism; aminoacyl-tRNA biosynthesis; and glycine, serine and threonine metabolism); no pathway enrichment was found for the CEE signature.

Conclusions:
We identified and validated metabolomic signatures for CEE and CEE+MPA use in postmenopausal women from WHI and NHS/NHS2. Whether alterations in lipid or amino acid metabolism mediate associations of HT use with chronic disease needs future investigation.
Abstract MP61: Evidence of Impaired Microvascular Function a Decade After Delivery in Women With Placental Malperfusion Lesions
Authors: Hauspurg Alisse , Brands Judith , Gandley Robin , Muldoon Matthew F , Parks William Tony , Hubel Carl A , Catov Janet M
Published: March 2020

Introduction:
Maternal vascular malperfusion (MVM) lesions in the placenta are characterized by incomplete vascular remodeling and vessel features similar to atherosclerosis. MVM lesions indicate a maladaptive maternal vascular response to pregnancy, are often detected in hypertensive disorders of pregnancy (HDP), and may provide a pathologic link to future cardiovascular disease. The endothelial glycocalyx is a glycoprotein-rich layer that is critical for microvascular health and damage may have an important role in the pathophysiology of microcardiovascular disease risk.

Hypothesis:
We hypothesized that women with malperfusion lesions of the placenta are more likely to evidence microvascular glycocalyx derangement a decade after delivery compared to women without these lesions and that this effect would be most pronounced among women with a history of HDP.

Methods:
A total of 412 women with placental pathology (N=129 with MVM lesions, N=283 without MVM lesions) were evaluated at 8-10 years postpartum. Placental specimens were reviewed by a blinded perinatal pathologist
.
HDP (including preeclampsia and gestational hypertension) were abstracted from the medical record. Glycocalyx barrier function was assessed using sublingual sidestream dark field imaging, with reduction defined as deeper penetration of red blood cells (RBCs) into the glycocalyx of the sublingual microcirculation (5-25μm diameter). We compared the median diameter (size) of microvessels, penetration of RBCs into the glycocalyx (perfused boundary region, PBR) and microvascular density (total length of perfused microvessels/mm
2
surface area) in women with and without MVM lesions.

Results:
Women with placental MVM lesions had smaller-sized sublingual vessels (median 8.59 μM [IQR 8.12, 9.19] vs. 9.01 μM [IQR 8.37, 9.64]; p<0.001), and a lower density of vessels compared to women without lesions. Glycocalyx perfused boundary region was unexpectedly lower in women with MVM lesions (median 2.20 μM [IQR 2.06, 2.43] vs. 2.32 μM [IQR 2.15, 2.50]; p=0.003) in 10-19 μM vessels. Women with HDP and MVM lesions appear to be the most impacted, with the smallest size vessels (median 8.47 [IQR 8.09-9.13]) and the lowest glycocalyx PBR across all vessel sizes. Women with MVM lesions without a HDP similarly had evidence of microvascular glycocalyx derangement whereas women with HDP without placental lesions had a glycocalyx profile similar to women without MVM or a history of HDP.

Conclusions:
A decade after delivery, women with a history of placental malperfusion lesions had alterations in microvascular perfusion. Women with MVM lesions and a history of HDP appear to be the most severely impacted, which may reflect an underlying maladaptive vascular phenotype detected in the placenta at the time of pregnancy that might provide pathologic insight into future maternal microvascular health.
Abstract MP67: Fatty Acid Desaturase Gene-induced Omega-3 Deficiency In Amerindian-Ancestry Hispanic Populations
Authors: Blomquist Sarah , Coletta Dawn , Mandarino Lawrence J , Hallmark Brian , Yang Chaojie , Rich Stephen , Manichaikul Ani W , Chilton Floyd
Published: March 2020

Hispanic populations in the US have increased risk of obesity, elevated circulating triglycerides, nonalcoholic fatty liver disease, and diabetes. Our previous studies suggest that ancestry-related differences in the frequency of variants in the fatty acid desaturase (
FADS)
gene cluster in the context of the modern Western diet can lead to inadequate circulating and tissues levels of n-3 long-chain (LC-; ≥ 20 carbons) polyunsaturated fatty acids (PUFA); these deficiencies in turn have the capacity to increase metabolic disease risk. Specifically, we and others have demonstrated Amerindian (AI)-Ancestry populations have high frequencies of
FADS
gene variants that may lead to less efficient n-3 LC-PUFA biosynthesis. To test this hypothesis, concentrations of fatty acids, including LC-PUFAs in plasma phospholipids were analyzed in 1,102 Hispanic American participants from Multi-Ethnic Study of Atherosclerosis (MESA) cohort, which represent six Hispanic subgroups based on self-reported region of origin: Central America, South America, Mexico, Cuba, Dominican Republic, and Puerto Rico. These data revealed a striking inverse relationship between genome-wide AI-ancestry and levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Additional analyses revealed that the genotype at
FADS
SNP rs174537, for which the frequency of the T allele increases with AI-ancestry, could primarily explain the associations. There also was a strong association between the number of T alleles (additive model) at rs174537 and circulating triglycerides (18.5 mg/dL per T allele;
P
=2.0 x 10
-5
) as well as an important marker of vascular inflammation sICAM-1 (β=12.7 ng/mL,
P
=0.02). We also genotyped the
FADS
SNP, rs174537, in a separate adult Arizona Hispanic cohort (Arizona Insulin Resistance [AIR] registry) and compared the
FADS
genotypic frequencies with other racial/ethnic groups. Importantly, the TT genotype associated with limited LC-PUFA biosynthesis ranges from <1% in African-Ancestry populations to 40.2% in AI-Ancestry Hispanics in the AIR Registry, with ~11 % in European-Ancestry populations. These data demonstrate that high AI-ancestry populations have a dramatically higher frequency of the TT genotype versus African and European populations. Importantly similar to MESA, there also was a significant association between the number of T alleles and plasma triglycerides (p = 0.0036; GG = 125±8.18 mg/dl, GT = 135±5.63 mg/dl, TT = 143±5.58 mg/dl) again suggesting the AI-associated TT genotype places this population at higher risk of hypertriglyceridemia. Together, these data reveal that
FADS
gene*dietary PUFA interactions give rise to n-3 LC-PUFA deficiencies and may enhance metabolic and inflammatory diseases in a large proportion of individuals in AI-Ancestry Hispanic populations.
Abstract MP70: Conventional and Novel Lipid Measures and Subsequent Risk of Lower-extremity Peripheral Artery Disease: The Atherosclerosis Risk in Communities (aric) Study
Authors: Kou Minghao , Ding Ning , Ballew Shoshana , Salameh Maya , Martin Seth S , Selvin Elizabeth , HEISS Gerardo M , Ballantyne Christie M , Matsushita Kunihiro , Hoogeveen Ron C
Published: March 2020

Introduction:
The association of conventional lipids (total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides [TG]) with incident peripheral artery diseases (PAD) has been reported. Understanding novel lipids (remnant lipoprotein cholesterol [RLP-C], LDL-TG, small dense LDL-C [sdLDL-C], Apo-E containing HDL [ApoE-HDL]) in this regard could inform risk classification and preventive approaches for PAD.

Hypothesis:
Some novel lipids will be more evidently related to incident PAD than some conventional lipid measures.

Methods:
In 8808 ARIC participants (mean age 62.6 [SD 5.7] y) free of PAD at baseline (visit 4, 1996-98), we assessed the associations of each lipid measure (as quartiles and continuous variable) and incident PAD-related hospitalization through 2015 using multivariable Cox models. Since some lipids are closer biologically correlated than others, indicating collective effects among lipids, we used factor analysis to identify underlying factors and modeled them for PAD risk.

Results:
There were 262 incident PAD cases. After accounting for potential confounders, HDL-C, TG, RLP-C, LDL-TG, and ApoE-HDL were independently associated with incident PAD, with the largest hazard ratio between Q4 and Q1 for HDL-C (Table). LDL-C showed a J-shaped association, and Q4 and Q3 became significant when compared to Q2 (1.57 [1.09-2.25] and 1.46 [1.02-2.11], respectively). The associations of LDL-TG, and ApoE-HDL remained significant after adjusting for LDL-C. The factor analysis identified 3 factors (Factor 1: mainly loaded by TG, RLC, LDL-TG and sdLDL-C; Factor 2: by total cholesterol, LDL-C, and sdLDL-C; Factor 3: by HDL-C and ApoE-HDL), and only Factor 3 showed an independent association with incident PAD (0.78 [0.65-0.93]).

Conclusions:
These findings suggest the importance of HDL-related and TG-related lipids in the development of PAD, with potential therapeutic implications.
Abstract MP76: Assessing the Impact of the "Health Bucks" Program on Cardiovascular Disease in New York City: A Modeling Study
Authors: Eom Heesun , Yi Stella S , Bu Daniel , Russo Rienna , Bellows Brandon , Zhang Yiyi , Moran Andrew E , Li Yan
Published: March 2020

Background:
Low fruit and vegetable (FV) consumption is considered one of the leading causes of deteriorating health outcomes, and has been linked to obesity, diabetes, and cardiovascular disease. Yet, few adults in New York City (NYC) consume the daily recommended amounts. In order to address the need for fresh and affordable fruits and vegetables, the NYC Department of Health and Mental Hygiene has implemented the “Health Bucks” program, which provides low-income population with coupons that can be used to purchase fruits and vegetetabls. Previous studies have shown the impact of the Health Bucks program on fruit and vegetable consumption; however, it is unclear how the program would influence cardiovascular health and the associated health care costs in the long term.

Objective:
To estimate the health and economic impact of the Health Bucks program using a validated microsimulation model of cardiovascular disease (CVD) in NYC.

Methods:
We used the Simulations for Health Improvement and Equity (SHINE) CVD Model to estimate the impact of the Health Bucks program on lifetime CVD events and direct medical costs (2019 USD). We considered different program strengths by assuming the program can reduce the cost of fruits and vegetables by 20%, 30%, and 40%. Population characteristics were estimated based on data from the 2013-2014 NYC Health and Nutrition Examination Survey. CVD risk factor trajectories and risk of incident CVD events were derived from six pooled longitudinal US cohorts. Policy effects were derived from the literature. We run 1,000 simulations to account for uncertainties in the parameter. We discounted costs by 3% and reported health care costs in 2019 dollars.

Results:
A Health Bucks program that can reduce the cost of fruits and vegetables by 20%, 30%, and 40% would prevent 2,690 (95% CI: -14,793, 20,173), 27,386 (95% CI: 9,967, 44,805), and 50,014 (95% CI: 15,227, 50,014) coronary heart disease events, respectively, over the simulated lifetimes of the NYC population. The program would also prevent 47,469 (95% CI: 35,008, 59,931), 59,127 (95% CI: 46,676, 71,579), and 85,359 (95% CI: 72,902, 97,815) stroke events based on the price reduction level. The program would result in savings in health care costs, ranged from $937 million to $1.8 billion based on the price reduction level over the lifetime or from $19 million to $37 million annually.

Conclusions:
We projected that the Health Bucks program could prevent a significant number of CVD events among adults in NYC and yield substantial health care cost savings. Public health practitioners and policymakers may consider adopting this program in other locations.
Abstract P100: Improving Ideal Cardiovascular Health in a Pediatric Preventive Cardiology Practice
Authors: Gooding Holly C , Gauvreau Kimberlee , Bachman Jennifer , Baker Annette , Griggs Skylar , Hartz Jacob , Huang YIsong , Mendelson Michael , Palfrey Hannah , De Ferranti Sarah D
Published: March 2020

Introduction:
Achieving ideal cardiovascular health (iCVH) for children necessitates both public health and individual interventions.

Hypothesis:
We hypothesized that children referred to a multidisciplinary preventive cardiology clinic would demonstrate improved iCVH after clinic-based lifestyle counseling.

Methods:
We analyzed data from youth ages 8-19 years seen for ≥2 consecutive visits in the Boston Children’s Hospital Preventive Cardiology clinic between 2010-2017. Demographic information, smoking status, diet, and physical activity were self-reported. Anthropometric data, blood pressure, fasting cholesterol, and fasting glucose were measured using standard protocols. We applied AHA definitions of ideal, intermediate, and poor iCVH with minor adaptations to data extracted from a clinical registry. Each iCVH metric had a possible range of 0 (poor) to 2 (ideal); the total iCVH score could range from 0 (all poor) to 14 (all ideal).

Results:
Median age of the 767 children in the study was 12.5 years [IQR 10.2,15.9]; 414 (54%) were female and 32 (5%) had a moderate or high CVD risk condition (diabetes, renal disease, Kawasaki, congenital heart disease, or heart transplant). Over a median of 3.9 [IQR 3.2, 6.0] months from initial assessment to first follow-up, mean iCVH score improved from 7.7 (SD 2.2) to 8.1 (SD 2.2) (p < 0.001). Females had higher iCVH scores at baseline and follow-up (females 7.9 to 8.4 vs. males 7.5 to 7.9, p<0.001), as did children younger than 14 years of age (data not shown). iCVH score improved to a mean of 8.3 (SD 2.4) for the 449 children returning for a third visit. The largest improvement was observed in total cholesterol and dietary habits (Figure); only 61 (8%) of children were prescribed statin therapy.

Conclusion:
Multidisciplinary clinical care can improve the iCVH of children who present with non-optimal levels, largely without the use of medications. Further work is needed to determine the scalability and long-term effectiveness of cardiovascular health promotion efforts in pediatric care.
Abstract P101: Cardiovascular Health in US Adults Before and After Publication of the American Heart Association 2020 Impact Goals: Results From NHANES 2005-2016
Authors: He Jiang , Zhu Zhengbao , Bundy Joshua D , Mills Katherine T , Bazzano Lydia A , Kelly Tanika N , Zhang Yonghong , Chen Jing
Published: March 2020

Background:
The dissemination of the American Heart Association (AHA) 2020 Impact Goals might promote nationwide efforts to improve cardiovascular health in the US general population. We aimed to compare cardiovascular health metrics in US adults before and after the release of the AHA 2020 Impact Goals.

Methods:
A total of 32,327 adults aged ≥20 years from the National Health and Nutrition Examination Surveys (NHANES) 2005-2016 were included in this analysis. Cardiovascular health comprised 7 health metrics (smoking status, body-mass index, physical activity, healthy diet score, total cholesterol, blood pressure, and fasting plasma glucose), and each metric was scored as poor (0 points), intermediate (1 point), or ideal (2 points). Cardiovascular health score (0-14) was calculated as the sum of all 7 cardiovascular health metric scores. Age-standardized proportions of cardiovascular health metrics and means of cardiovascular health scores were calculated overall and in age, sex, and race/ethnicity subgroups for NHANES 2005-2010 and 2011-2016.

Results:
The age-standardized mean of cardiovascular health score was not significantly different between 2005-2010 and 2011-2016 (7.86 vs. 7.99,
P
=0.14) in the US adult population. However, the cardiovascular health scores significantly increased in young adults aged 20-39 years (8.62 vs. 8.96,
P
=0.002) and non-Hispanic blacks (7.02 vs. 7.30,
P
=0.004). Additionally, although the cardiovascular health behaviors score was not significantly different (3.64 vs. 3.71,
P=
0.24), the cardiovascular health factors score significantly improved (5.74 vs. 5.82,
P
=0.02). Age-standardized proportions of non-current smoking (74.1% vs. 77.0%), ideal physical activity (35.7% vs. 39.0%), and total cholesterol <200 mg/dL (43.3% vs. 48.1%) significantly increased, but body-mass index <25.0 kg/m
2
(32.2% vs. 29.8%) significantly decreased, from 2005-2010 to 2011-2016 in US adults.

Conclusions:
Since the release of the AHA 2020 Impact Goals, cardiovascular health has improved in young adults and non-Hispanic blacks. In addition, the proportions of non-current smoking, ideal physical activity, and ideal total cholesterol have increased in the entire US adult population. However, several cardiovascular health metrics have not significantly improved, or have even worsened. Further nationwide efforts are warranted to promote cardiovascular health, especially weight loss, in the US general population.
Abstract P105: Associations of Childhood Obesity With Cardiometabolic Risk Factors by Era of Birth: The I3c Consortium
Authors: Woo Jessica G , Bazzano Lydia A , Burns Trudy L , Daniels Stephen R , Dwyer Terence , Hu Tian , Jacobs David R , Juonala Markus , Prineas Ronald J , Raitakari Olli T , Sinaiko Alan R , Steinberger Julia , Venn Alison , Urbina Elaine M
Published: March 2020

Introduction:
The prevalence of childhood obesity has increased dramatically over the past several decades, but it is unclear whether children and adolescents with obesity are experiencing more or fewer cardiometabolic risks from obesity now compared with several decades ago. This study leverages data from over 2600 children and adolescents with obesity born from 1951-1996 to determine whether relationships of obesity with cardiometabolic risk have changed over time.

Methods:
The first study visit, age 3-19, was used to classify individuals by era of birth (quartiles: 1951-1963, 1964-1969, 1970-1974, 1975-1996), weight status (obesity defined as BMI>CDC 95
th
%ile and <120% of the 95
th
%ile), high BP (SBP or DBP>95
th
%ile), high total cholesterol (TC>170 mg/dl), high LDL-C (>110 mg/dl), high triglycerides (TG>100 mg/dl), high glucose (>100 mg/dl), and low HDL-C (<40 mg/dl males, <50 mg/dl females). Participants with obesity (excluding severe obesity) were included in this analysis. Logistic regressions were adjusted for age, sex, race and study cohort to calculate odds ratios relative to the most recent era of birth (1975-1996).

Results:
The prevalence of childhood obesity increased from 6.1% in the earliest birth era to 7.7% in the most recent (p<0.0001). The adjusted odds of children with obesity having high TC (p<0.0001), high TG (p<0.0001), and high BP (p=0.003) were half as likely among children born between 1964-69 or 1970-74, compared with the most recent birth era (Table). The odds of children with obesity having high LDL (p=0.59), low HDL (p=0.17) or high glucose (0.33) did not differ across birth eras.

Conclusions:
Childhood obesity in more recent decades has not only become more prevalent, but is associated with greater risks of high TC, high TG and high BP. However, the risks of high LDL, low HDL and high glucose have not significantly changed among children with obesity who were born between 1951 and 1996. Thus, comparisons of children or adolescents with obesity across eras should consider these differing risk profiles.