bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P204: Diet Significantly Influences Adipose Tissue Weight and Adipokine Expression in Response to Probiotic Administration in Male Mice
Authors: Kagel Brian , Westlake Jonathan D , Singh Shreya , Lichti Nathan , Houghton Jeffrey , Gigliotti Joseph
Published: May 2024

Diet plays a major role in regulating many factors related to overall health. As obesity numbers in America continue to climb, it is becoming increasingly important to understand the mechanisms of how nutrition contributes to our total level of well-being. Similarly, the makeup of our intestine’s microbiome is linked to nutrient metabolism and the function it plays in both digestive and systemic processes. Taken together, our study aims to demonstrate the influence of probiotic supplements in the context of different diets on the expression of the adipokines leptin and adiponectin. Weanling male C57Bl/6 mice were purchased and acclimated to a solid diet and group housing for one week. Mice were then assigned to receive one of three diets
ad libitum
: a control “chow” group (standard vegetable base), the synthetic American Institute of Nutrition 93 formulation (AIN), and our novel “Americanized Diet” which is similar to the proportion of nutrients consumed in Western societies and were fed for eight weeks. Mice within each diet group received either a commercial probiotic (30 uL) or saline control five days a week for two weeks. Afterwards, the mice were then euthanized, adipose tissue was collected, and tissues processed for the quantification of leptin and adiponectin by real-time RT-PCR. Diet significantly influenced adipose tissue weight (P=0.02), with mice fed the AD having the greatest degree of adiposity. Interestingly, there was a significant diet*probiotic interaction (P=0.003), where probiotic administration caused an increase in adipose tissue weight in mice fed the AIN, but a decrease in mice fed the AD. Diet also significantly influenced adipose adiponectin expression (P<0.001), with mice fed the AD having the lowest expression as compared to mice fed chow and AIN. There was also a significant (P=0.002) diet*treatment interaction, where probiotic administration increased adipose adiponectin expression in mice fed AD to levels similar to the other diets at baseline. There was also a tendency for diet*treatment to influence adipose leptin expression (P=0.054), where probiotic administration increased leptin in mice fed chow, but decreased in mice fed the AD. Taken together, our data suggest that diet and probiotic administration significantly influence the structure-function relationship of adipose tissue. The results of this study underline the significance of maintaining a healthy gut microbiome in today’s culture and the impact that the gut microbiome has on our overall health.
Abstract P205: Poor Sleep Quality and Daytime Sleepiness Associated With Lower Quality Diet in an Israeli Cohort
Authors: Kennedy Kathryn E , Bortz Rockwell , Rosenberg Elliot , Grandner Michael A
Published: May 2024

Introduction:
Sleep health and diet quality are bidirectionally linked. Poor sleep can impair metabolic function and alter eating behavior, while a poor quality diet may negatively impact sleep and daytime function through multiple pathways (i.e. inflammation, obesity, daytime fatigue).

Methods:
In a 2017 Israeli Bureau of Statistics population-based survey of households, 7,230 Israeli individuals reported habitual sleep and diet quality. Sleep variables included sleep duration (≤5, 6, 7, 8, or ≥9 hours per night), sleep disturbances (0, ≤1, 2-3, or 4+ nights per week), and daytime sleepiness (categorized as either “None”, “Not Much”, “Somewhat”, or “Greatly”). Diet variables were categorized as 0, 1, 2, 3, or 4+ daily servings of vegetables, fruits, and whole grains, and 0, 1, 2, 3, or 4+ weekly servings of legumes, red meat, and fish. Covariates included age, sex, BMI, financial status, and ethnicity.

Results:
Individuals who slept ≤5 hours were less likely to eat daily vegetables (oOR=0.863, p<0.05). Individuals who slept ≤7 hours were less likely to eat daily fruits (oOR=0.858, p<0.02), and whole grains (oOR=0.0.772, p<0.0005). Individuals who slept ≥9 hours were less likely to eat daily vegetables (oOR=0.803, p=0.038), fruits (oOR=0.783, p=0.025), or wholegrains (oOR=0.783, p=0.027), as well as weekly legumes (oOR=0.788, p=0.025), and fish (oOR=0.779, p=0.028). Those with severe sleep disturbances (4+ per week) were less likely to eat daily vegetables (oOR=0.675, p<0.0005), fruits (oOR=0.765, p<0.0005), and whole grains (oOR=0.840, p=0.011), or weekly legumes (oOR=0.806), p=0.001). Mild daytime sleepiness was associated with fewer daily vegetables (oOR=0.834, p=0.007), while “great” daytime sleepiness was associated with fewer vegetables (oOR=0.558, p<0.0005), fruits (oOR=0.689, p<>0.0005), wholegrains (oOR=0.751, p<0.0005), and legumes (oOR=0.734, p<0.0005). In a stepwise model adjusting for all sleep variables, many measures of poor sleep were independently associated with fewer daily vegetables, fruits, and wholegrains, fewer weekly legumes, and more weekly red meat.

Conclusions:
While the relationship between sleep and diet is complex, these data suggest that multiple independent pathways link poor sleep with an objectively unhealthier diet. The interaction between diet and daytime function, in particular, warrants further attention. Interventions targeting healthier sleep and diet must consider all aspects of sleep quality, including nocturnal sleep itself and daytime sleepiness.
Abstract P217: Directionality of Associations Between Daily Physical Activity and Cognition Among Older Adults in the Baltimore Longitudinal Study of Aging
Authors: Marino Francesca R , Deal Jennifer A , Tian Qu , Simonsick Eleanor M , Resnick Susan M , Gross Alden L , Wanigatunga Amal A , Schrack Jennifer A
Published: May 2024

Physical activity is a modifiable risk factor for dementia. Associations between physical activity and cognition are likely bidirectional, as cognitive functions are required to initiate and perform activities. Understanding the directionality of these associations has potential implications for both dementia prevention and physical activity engagement. Yet, the directionality between cognitive function and free-living physical activity patterns is unclear. This study included 237 cognitively unimpaired older adults in the BLSA with cognitive test performance and ≥ 3 valid days of wrist accelerometry measured at 2 visits over an average of 1.8 (0.9-4.0) years. Cognitive domain factor scores were derived using confirmatory factor analysis. Accelerometry data were used to calculate daily physical activity patterns: 1) total activity counts (TAC), 2) time spent active, 3) time spent non-active, 4) active-to-sedentary-transition probability (ASTP), 5) mean active bout length, 6) sedentary-to-active transition probability (SATP), 7) mean non-active bout length. Bivariate latent change score models estimated directionality of associations between changes in cognitive factor scores and changes in daily physical activity patterns. Models were adjusted for age, sex, race, education, and number of comorbidities. Participants were on average 77 (60-96) years, 48% women, and 22% Black. After covariate adjustment, one SD higher in baseline TAC was associated with less memory decline (estimate = 0.089, SE = 0.045). One SD higher in baseline time spent non-active was associated with greater declines in language (estimate = -0.068, SE = 0.035), visuospatial processing (estimate = -0.079 SE = 0.034), and global cognition (estimate = -0.058, SE = 0.024). One SD higher in baseline ASTP was associated with greater declines in memory (estimate = -0.114, SE = 0.047) and visuospatial processing (estimate = -0.074, SE = 0.034), whereas mean active bout length was associated with less decline in these domains (memory: estimate = 0.121, SE = 0.046; visuospatial processing: estimate = 0.081, SE = 0.033). There were no associations with time spent active, SATP, or mean non-active bout length and changes in any cognitive factor score. Cognitive factor scores were not associated with changes in any activity pattern. Patterns relating to amount of daily activity, time spent sedentary, and probability of transitioning from active-to-sedentary states were primarily associated with changes in memory and visuospatial processing. This suggests increasing free-living movement or decreasing sedentary behavior might be related to short-term changes in cognition among older adults. Future studies are needed to determine causality of these associations and to evaluate directionality over longer periods of time.
Abstract P218: Moderate to Vigorous Physical Activity to Improve Cardiovascular and Mental Health in Sedentary Middle-Aged Adults
Authors: Moxley Elizabeth A , Habtezgi Desale , Varothai Kris , Henert Shaine , Kowal Rachel , Bode Barrie , Budwhani Sara
Published: May 2024

Introduction:
Anxiety and depression are amongst the most common forms of mental illness, of whom 20-30% experience concomitant cardiovascular disease (CVD). Cardiorespiratory fitness (CRF) improves brain-derived neurotrophic factor (BDNF) potentially improving mental health and resilience. Unique barriers to increasing PA engagement exist in those with mental distress, contributing to CVD risk. Research strategies using guideline-based PA programming and motivation may enhance mental well-being, thereby mitigating CVD risk.

Objective:
To examine the effects of meeting weekly PA recommendations on levels of depression, anxiety, resilience, and associations with CVD risk factors in sedentary middle-aged adults.

Methods:
Sedentary adults (n=29, 40-60 years) completed a tailored 4-week MVPA regimen after establishing baseline CRF (VO
2
max) using an Astrand-Rhyming cycle ergometer test. Activity trackers (Mi Smart Band 6; Xiaomi) recorded heart rate (HR), and daily steps, along with motivational messaging. Mental health status was measured by pre- and post - brain-derived neurotrophic factor (BDNF) levels, and depression (BDI-II), and anxiety (BAI) scores. CVD risk factors included resting HR, systolic blood pressure (SBP), HbA1c, waist circumference (WC), body mass index (BMI), percent body fat, and lean body mass. Logistical regression determined if factors related to mental health affected achieving MVPA goal. Nonparametric analysis compared pre- and post-response to MVPA.

Results:
Percentage change of meeting the PA goal decreased by 29% (p=0.048) when the depression score increased by one point. When anxiety scores increased by one point, the likelihood of meeting PA goals increased by 41% (p=0.057). As the resilience score increased by one point, the percentage change of meeting PA goals increased by 17% (p=0.58). Of 29 participants, 19 (65.5%) exhibited no change depression level, two (6.9%) exhibited increased depression, and eight (27.6%) exhibited a decrease in depression. The BDNF decreased in those meeting PA goals, although platelets harbor significant BDNF content posing a profound confounding variable in measured plasma. Following MVPA average weight, BMI and fat mass decreased by 0.5 pounds, 0.11 kg/m
2
and 0.42 lbs., respectively. HbA1c decreased by 0.05% nearing significance (p=0.056). Significant improvements were observed in SBP by 5.44 mmHg (p=0.026) and resting HR (p=0.001). On average WC, fat free mass and VO
2
max increased by 0.61 cm, 9.44 kg/m
2
and 1.22 ml/kg/min respectively.

Conclusions:
MVPA consistent with the guidelines in middle-aged adults predicts improved anxiety and depression compared to sedentary behavior, likely improving cardiovascular health. A longer-term study to evaluate body composition and metabolic response to PA, in addition to further investigation of BDNF to assess its value in response to MVPA is currently warranted.
Abstract P223: Long Term Impact of COVID19 Pandemic on Estimated Cardiorespiratory Fitness and Physical Activity Level in South American Adults: Results From the Lown Scholars PAFIT Network Online Survey
Authors: ZUNIGA DOURADO Victor , Danaei Goodarz , Poggio Rosana ,   On behalf of Lown Scholars PA&FIT Network
Published: May 2024

Background:
While restriction measures helped to control the further transmission of the SARS-cov2 virus, they also produced undesirable repercussions on physical activity level (PAL) and, potentially, cardiorespiratory fitness (CRF). However, the extent to which CRF has returned to pre-pandemic levels in the current time has yet to be consistently evaluated, especially in South America.

Objective:
We aimed to assess changes in PAL and estimated CRF (eCRF) from before the COVID-19 pandemic until the current time using an online survey with validated questionnaires and identifying the determinants of the observed changes.

Methods:
We conducted a cross-sectional online survey using Global Physical Activity Questionnaire (GPAQ) to assess physical activity and sedentary time on a convenience sample of 1934 adults (68.7% women) from Argentina (n = 484), Brazil (n = 405), Chile (n = 279), Colombia (n = 343) and Uruguay (n = 423). We asked participants questions regarding their physical activity, body weight, socioeconomic status, education and cardiovascular risk factors before the start of the pandemic (Feb/Mar 2020) and at the time of the survey (Jul-Sep 2022). We calculated the eCRF before the pandemic and at the current time using a Brazilian equation including age, sex, body mass index, arterial hypertension, hyperlipidemia, current smoking, physical inactivity, and diabetes. To adjust for age, we also calculated eCRF using only the current time age.

Results:
The participants reported a significant increase in the prevalence of self reported hypertension (12.9% to 16.5%), diabetes (6.8% to 9.8%), dyslipidemia (18.9% to 24%), and obesity (15.4% to 18.2%) comparing pre-COVID-19 period to the time of the survey. In contrast, they reported a significant decrease in PAL at work (median 936.5 to 864.6 METs/min/week; p < 0.032) and within active transportation domains (median 502.6 to 460.3 METs/min/week; p < 0.008). No significant changes were reported in leisure time physical activity. The median sedentary time on weekdays increased by 60 minutes (360 to 420; p < 0.001) post pandemic and eCRF was reduced (mean difference, -1.17 mL/min/kg; p < 0.001). When adjusted for age, the differences remained statistically significant. (-0.50; mL/min/kgmL/min/kg; p 0.001).

Conclusion:
Social restriction policies aimed at controlling pandemics may lead to reduction in physical activity level and cardiorespiratory fitness in the long term.
Abstract P229: Cross-Sectional Relationship Between Posttraumatic Stress Disorder and Atherosclerotic Disease Assessed by Coronary Calcium Score: A Counterfactual Model of Older Male Twins
Authors: Correia Luis C , Shah Amit J , Moncayo Valeria M , Ko Yi-An , Smith Nicholas L , Osei Jeffery , Li Louis , Quyyumi Arshed A , Bremmer J. Douglas , Vaccarino Viola
Published: May 2024

Background:
Posttraumatic stress disorder (PTSD) is a risk factor for cardiovascular disease. However, the causal relationship between PTSD and atherosclerotic burden is controversial, leaving uncertain whether atherosclerosis is implicated in the association between PTSD and cardiovascular events.

Objective:
To test the cross-sectional relationship between lifetime PTSD and coronary atherosclerotic burden assessed by calcium score by comparing PTSD-discordant twin pairs, a design that inherently controls for familial and early environmental factors.

Methods:
We examined 218 male twins from the Vietnam Era Twin Registry, who underwent coronary calcium score assessment with computed tomography as part of the Emory Twin Study Follow-Up study. Lifetime history of PTSD was obtained with the Structured Clinical Interview and PTSD symptom severity with the Clinician-Administered PSTD Scale (CAPS) for DSM-IV diagnostic criteria. Coronary calcium scoring was performed by the Agatston Method as a measure of atherosclerotic burden. The relationship between PTSD and calcium score was tested across individuals and within PTSD-discordant twin pairs as a counterfactual model for genetic and early environmental factors. Initially, 2 linear mixed models were built according to the exposure variable (PTSD clinical diagnosis or symptoms scale), with log-transformed coronary calcium score as the dependent variable. We defined
a priori
that the model with the lowest Akaike Information Criteria (AIC) would be the primary analysis to drive the conclusion. Based on
a priori
direct acyclic graph decision process, we defined the need to adjust for income and education as potential confounders and not to adjust for traditional risk factors, considering their potential roles as mediators.

Results:
Of the 218 twins analyzed, the median age was 68 (IQR 67-70) years, and the calcium score had a median of 114 (IQR 5.2-347). There were 88 twin pairs (30 monozygotic), 26 discordant for the binary diagnosis of PTSD, and 40 discordant for the ordinal PTSD symptom score (within-pair differences in scale points ranged from zero to 48.5). The model with the best AIC was the one with the PTSD score, and showed no increment of log-calcium score as the PTSD symptoms increased, both between individuals (Beta coefficient = - 0.005; 95% CI = -0.02 to + 0.03) and within twin pairs (Beta coefficient = - 0.010; 95% CI = -0.03 to + 0.01).

Conclusion:
The present analysis does not support a relationship between PTSD and coronary atherosclerotic burden. The link between PTSD and cardiovascular events may occur through other pathways, such as microvascular disease.
Abstract P232: Toxic Stress is Associated With Greater Odds of Cardiovascular Disease Among Younger but Not Older Women in the Go Red for Research Dataset
Authors: Honarvar Saam , Sullivan Samaah
Published: May 2024

Introduction:
The incidence of certain cardiovascular diseases (CVD) such as heart attack and stroke have been increasing among younger women (ages 35-54 years). Psychosocial stress may be an important risk factor for CVD among this group of women. We examined whether toxic stress was associated with an increased odds CVD and whether this association was greater among younger women (< 55 years of age) compared to older women (≥ 55 years of age).

Hypothesis:
Toxic stress would only be associated with CVD among younger women.

Methods:
We utilized data from participants enrolled in the American Heart Association Research Goes Red Registry, an online research platform powered by Verily. Women were asked if they had been diagnosed with any of the following heart related conditions (heart attack, hemorrhagic stroke, prior revascularization, or blocked arteries). Women were also asked whether they had experienced toxic stress defined as a significant life-defining stressful activity over a prolonged period unaccompanied by sufficient social resources or support such as loss of a child, racial discrimination, or job loss. Logistic regression models were used to estimate odds ratios between toxic stress and CVD as well as differences by age (< 55 versus ≥ 55 years of age) using an interaction term.

Results:
The analytic dataset included 1,354 women who completed both the RGR Survey and the Healthcare and Experience Survey. The mean age of participants was 47.8 (SD: 12.6), 70% were less than 55 years of age, 83% were Non-Hispanic White, 59% indicated that they had experienced toxic stress, and 12% had CVD. In final multivariable models, there were significant differences in the association between toxic stress and CVD by age group (toxic stress-by-age interaction = 0.05) such that toxic stress was only significantly associated with an increased odds of CVD among women < 55 years of age (OR: 2.00; 95% CI: 1.17, 3.44; p-value: 0.0119). In contrast, toxic stress was not significantly associated with an increased odds of CVD among older women ≥ 55 years of age (OR: 0.97; 95% CI: 0.59, 1.61; p-value: 0.9052).

Conclusions:
Toxic stress was associated with an increased odds of cardiovascular disease among younger, but not older women in this cross-sectional study. Stress may be an underrecognized risk factor for CVD, especially among younger women who may benefit from interventions to mitigate and prevent stress. These findings should be corroborated in future longitudinal or other study designs that can establish temporality and stronger inferences of causality.
Abstract P234: Prison Inmate Awareness of Heart Disease Status While Incarcerated in State and Federal Prisons, 2016
Authors: Powers Shelbie , King Ben
Published: May 2024

Background:
Heart disease (HD) is the leading cause of death of inmates incarcerated in state prisons in the US, as it is in the general population. However, in 2001-2019 the mortality rate of HD in incarcerated populations was reported to increase, while it decreased in the US population. . This is despite constitutionally mandated access to healthcare. There are few studies assessing healthcare utilization in prison populations. The 2016 Survey of Prison Inmates is exceptional in that it explores utilization across both state and federal prisons, and allows us to explore factors that may contribute to decreased understanding of health status.

Methods:
This study is a secondary analysis of the 2016 Survey of Prison Inmates collected by the Bureau of Justice Statistics, a cross sectional survey of the state and federal prison population across the United States. Data collection took place from January to October 2016. All participants were above 18 years of age, incarcerated across 1808 state and 193 federal institutions. All analysis was restricted to those with a reported history HD, which included heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems. Awareness of their current heart disease status was operationalized by combining self-reported history and current heart disease status.

Results:
When asked, 27.9% of survey respondents reported a history of heart disease but denied currently having heart disease. Yet 89.3% of these unaware patients had seen a healthcare provider since incarceration. . Independent of age, those with difficulty walking/climbing stairs or doing activities alone, and older in age (all p<0.01) were more likely to be aware of HD status. Factors including veteran status (OR=0.7; CI: 0.5-0.9), homeless 30 days prior to incarceration (37.8% vs 27.7%; p=0.036) and those experiencing homelessness before 18 years of age (40.4% vs 25.8%; p<0.001) were associated with being unaware of heart disease status. Individuals with ADD/ADHD (prevalence=23.7%) had weaker (non-significant) association between awareness of their heart disease and healthcare utilizing behavior (Mantel-Haenszel test for heterogeneity; p=0.006). Meanwhile, those without ADD/ADHD had nearly 4 times the odds of correctly reporting their heart disease status if they had seen a provider (OR=3.90; CI: 2.32-6.59), compared to those who hadn’t seen one. Those with a history of ADD/ADHD were more likely to report experiencing homelessness prior to age 18 (p<<0.001), 30 days prior to arrest (p=0.002) and 12 months prior to arrest (p<0.001).

Conclusions:
Awareness was associated with utilizing healthcare since incarceration, but only 72.4% were clear that HD is a chronic condition. The associations between awareness and disability and other life experiences show an influence from socioeconomic status which could inform much-needed health promotion programming.
Abstract P265: Housing Instability and Cardiometabolic Health in the Rural South: Findings From Alabama Subcohort of the Rural Study
Authors: Fields Nicole D , Mujahid Mahasin S , Hsu Jesse , Watts Alex C , Durda Peter , King Margaret E , Broyles Stephanie , Vasan Ramachandran , Judd Suzanne E , Vaccarino Viola , Lewis Tene T
Published: May 2024

Introduction:
Housing instability may be an important determinant contributing to cardiometabolic health. However, studies have focused largely on urban contexts. Further, there may be race- and sex-related differences in housing instability, which may help explain racial and sex disparities in cardiometabolic health. We examined the association between housing instability and cardiometabolic health among rural adults and analyzed potential race and sex differences.

Methods:
Data are from the Risk Underlying Rural Areas Longitudinal subcohort (mean [SD] age, 48.8 [11.0] years; 70.1% women; 79.8% Black) sampled in two rural Counties in Alabama (n=903). Housing stability (range: 0-10) was defined using the Rollins Index with higher scores indicating greater housing instability. We examined multiple measures of cardiometabolic health including BMI, HDL and LDL cholesterol, triglycerides, current smoking status (yes/no), and coronary artery calcification (CAC > 0). Multivariable linear and logistic regression models adjusted for age, education, and income were used to examine continuous and categorical measures of cardiometabolic health, respectively. We further examined differences by self-reported race and sex in the association between housing instability and cardiometabolic health.

Results:
In the overall sample, mean (SD) housing instability was 1.1 (1.6). The prevalence of housing instability (Rollins Index ≥ 1) was higher for Black participants compared to White participants (60.5% vs. 27.4%, p<.0001). Housing instability did not differ by sex (52.9% women vs. 57.4% men, p=0.187). In multivariable-adjusted models, greater housing instability was associated with presence of CAC among Black participants (OR 1.12; 95% CI: 1.00, 1.26) but with lower prevalence of CAC among White participants (OR 0.49; 95% CI: 0.25, 0.90). Housing instability was also associated with higher HDL cholesterol levels (b=1.04; 95% CI: 0.08, 2.01) among Black participants and higher triglyceride levels among White participants (b=29.40; 95% CI: 0.49, 58.31). Housing instability was not associated with BMI in either group and was associated with higher prevalence of current smoking among Black participants only (OR 1.20; 95% CI: 1.07, 1.34). We did not observe statistically significant associations between housing instability and cardiometabolic health in sex-stratified analyses.

Conclusion:
Housing instability may be a social determinant of cardiometabolic health; however, findings were mixed and appear to vary for Black adults compared to White adults. Future research should utilize a longitudinal design to assess how changes in housing stability may affect cardiometabolic health over time.
Abstract P266: Burden and Trends of Cardiovascular Disease and Its Attributable Risk Factor in Pakistan From 1990-2019: A Benchmarking Analysis
Authors: Hassan Khawaja Mushammar , Hassan Khawaja Momal , Hassan Khawaja Muthammir , Farrukh Fiza , Farrukh Ameer , Nazir Mohsin , umer Muhammad , Ijaz Aamna , Gadamidi Vinay Kumar , Thota Anjani Kumar , Dadhania Khush , Alziadin Nmair , DESAI Hardik D
Published: May 2024

Background:
Cardiovascular disease (CVD) remains the primary cause for death and disability in Pakistan, yet consistent data estimating its impact is limited.

Method:
Utilizing the Global Burden of Disease tool, we analyzed CVD metrics like prevalence, incidence, DALYs, mortality, and associated risk factors spanning from 1990-2019, categorized by age, gender, year, and region. Results are shown in both absolute numbers and age-standardized rates (ASR) per 100,000 person-years.

Results:
From 1990-2019, the annual percentage change (APC) witnessed a rise in prevalence by 106% (from 4.1 to 8.6 million), deaths by 98% (from 172,525 to 341,108), and DALYs by 119% (from 4.5 to 9.8 million). When assessed through age-standardized rates (ASR), incidence rates grew by 8% (from 852 to 918), deaths by 9% (from 329 to 357), and DALYs by 9% (from 7326 to 7988). In 2019, ischemic heart disease dominated as the top cause of CVD deaths, constituting 53.76% (183,409 out of 341,108). Over the past 30 years, Balochistan emerged as the most adversely affected state. The age bracket of 70-74 saw the maximum CVD fatalities at 41,848, while the 60-64 age group recorded the highest incidence at 135,376. Men experienced a more pronounced CVD impact than women over these three decades. High blood pressure stood out as the primary cause of CVD-related deaths in Pakistan, trailed by elevated LDL cholesterol levels.

Conclusion:
CVD accounted for 22.74% deaths amongst all cause of deaths in Pakistan in 2019. From a clinician's perspective, the escalating prevalence and incidence of CVD emphasize the need for early detection, intervention, and tailored treatments, especially in high-risk demographics like older males. From a public health standpoint, these findings underscore the urgency to implement broad-based preventive strategies, focusing on modifiable risk factors such as high blood pressure and LDL cholesterol, and to bolster healthcare infrastructure, particularly in severely affected regions like Balochistan.
Abstract P268: Predictive Abilities of Anthropometric Indicators for Cardiometabolic Risk Factors and Diseases: The UK Whitehall II Study
Authors: Huang Cunrong , Martin Peter , Lopes Andre , Britton Annie
Published: May 2024

Introduction:
Obesity is an accepted risk factor for cardiometabolic diseases. Body mass index (BMI) is the most commonly-used anthropometric measurement for accessing healthy weight. However, some studies suggested that other adiposity indices may be better predictors of cardiometabolic risks and diseases. Our study aimed to compare the predictive abilities of 5 indices [BMI, waist circumference (WC), waist-to-height ratio (WHtR), waist-by-height0.5 (WHT.5R), and a body shape index (ABSI)].

Hypothesis:
BMI is not good enough for accessing and predicting healthy condition. WHtR may be a more effective index for predicting cardiometabolic risk factors and diseases.

Methods:
Based on the UK Whitehall II study, we included participants with full records of weight, height, and waist circumference in Phase 3 (1991-1994). Our study indices, BMI, WC, WHtR, WHT.5R, and ABSI, were calculated from measured weight, height, or waist circumference. The outcomes were coronary heart disease (CHD), abnormal blood pressure (BP), insulin resistance (IR), hyperglycemia, and hyperlipidaemia. Receiver operator characteristic (ROC) curve analysis and logistic regression analysis were used to assess the predictive values of the study indices to the cardiometabolic risk factors and diseases.

Results:
A total of 7979 participants were included [mean age: 50.1 ± 6.0 years; 2468 (30.9%) females; 7188 (90.4%) whites]. Cross-sectionally, except for the association between ABSI and CHD, a significantly-positive association was observed between the all indices and all outcomes (all P<0.001) in Phase 3. All 5 indicators showed the highest predictive ability when the outcome was IR [all the areas under the curve (AUC)>0.714], and among them, WHT.5R had highest predictive value (AUC: 0.770, sensitivity: 76.5%, specificity: 65.1%). For other outcomes, WHtR showed the best prediction for hyperlipidaemia (AUC: 0.719, sensitivity: 54.7%, specificity: 79.6%) relative to the other 4 measurements, whereas WC had higher AUC for predicting abnormal BP (AUC: 0.704, sensitivity: 64.6%, specificity: 65.8%) than any other indices. However, among all of the study outcomes, these 5 indices had the relatively weak ability to predict CHD (all AUCs<0.654).

Conclusions:
Some indices may provide a more accurate insight into cardiometabolic risk factors and diseases than BMI. WHT.5R appears to be an effective predictor of IR. WHtR has a better prediction for hyperlipidaemia. WC seems to be a good indicator for abnormal BP. We should pay more attention to waist circumference and its derived adiposity indices in the practice of preventing cardiometabolic diseases.
Abstract P288: Sex Differences in Krebs Cycle Metabolites May Explain Differential Predisposition to Cardiovascular Disease
Authors: Stone Christopher , Harris Dwight , Stanley Madigan , Banerjee Debolina , Broadwin Mark , Bellam Krishna , Najman-Licht Yonatan , Sellke Frank W , Usheva Anny
Published: May 2024

Introduction:
Although there have been numerous observational studies in the literature describing differential predisposition to cardiovascular disease between sexes, there is relatively little in the literature that provides a biochemical account suitable to explain these disparities. We hypothesized that there may be a fundamental biochemical distinction between sexes, productive first of differential metabolic contexts, and thence ultimately of the differential predisposition to disease states described in the epidemiologic literature.

Methods:
We employed metabolomic analysis together with an unsupervised learning approach to uncover sex-specific alterations in the abundance of several polar metabolites. Blood was collected from healthy volunteers (5 female, 4 male). Polar metabolites were extracted and analyzed using targeted liquid chromatography coupled with tandem mass spectrometry; we then utilized nonnegative matrix factorization (NMF) to search for metabolomic differences.

Results:
The female and male signatures differ in metabolites related to Krebs Cycle (KC). In males, we observed statistically significant or nearly significant decreases in citrate (P=0.054), isocitrate (P=0.006), and malate (P=0.076); while aconitate, succinate, fumarate, oxaloacetate, and glyoxylate, an intermediate in an alternative KC pathway, were non-significantly decreased. GABA P=0.0008) was also strikingly decreased in males. The KC product GTP (P=0.014) was significantly decreased as well.

Conclusion:
We observed significant decreases in several KC intermediates in males when compared with female counterparts, in GABA, and in GTP, which plays important roles in protein synthesis, gluconeogenesis, and cellular signal transduction. The status of the KC as the central hub of metabolism confers wide-ranging implications on this data: the reduced KC functionality observed in our study may confer disproportionate exposure to processes requiring efficient energy production in males.
Abstract P292: Lessons Learned From the Implementation of a Peer-to-Peer Cardiology Consultation Program in Federally Qualified Health Centers
Authors: Tolbert Emily , Walker Cassie
Published: May 2024

Introduction:
Conventional access to specialist care for cardiovascular disease can be expensive, geographically limited, and unavailable to communities that need it most. Health consultations that include cardiovascular considerations can improve life expectancy without extra costs. The Doctors With Heart (DWH) is an initiative from the American Heart Association (AHA) initially developed to decrease gaps in care by using telemedicine as a vehicle for cardiovascular consultations between volunteer cardiologists and primary care providers at Federally Qualified Health Centers (Health Centers). Despite efforts to on-board and train Health Centers on the consultation process and benefits to patient care, consultation utilization remained low.

Objective:
Identify opportunities to enhance DWH to increase consultation utilization by understanding the need for and barriers to conducting consultations among Health Centers already participating in DWH.

Methods:
An AHA Program Evaluator and the DWH Program Director co-conducted interviews and focus groups with 31 health care professionals from five Health Centers in the Midwest participating in DWH. Thematic analysis revealed key themes across evaluation objectives.

Results:
Interviewees had mixed feelings about the need for consultations which was largely driven by the barriers they perceived to conducting them. Many interviewees felt consultations could be an effective way to expedite care for patients who need specialty cardiovascular care. They could also help patients with complex but manageable co-morbidities since the patient can receive cardiovascular care within the primary care setting. However, a few providers felt they already had sufficient access to cardiovascular care for their patients. Interviewees identified three key barriers to conducting consultations: time and administrative burden for providers and staff, providers forgetting the consultations exist, and provider hesitations and concerns. During Health Center on-boarding, DWH should work with Health Centers to integrate consultations into existing clinic workflows, identify a program champion at each site, train multiple clinic staff about the program, and secure buy-in from providers. After Health Center on-boarding, DWH and Health Center program champions should find ways to regularly remind providers about the program and determine whether non-provider staff can help providers identify potential consultation cases.

Conclusion:
While there was an identified need for cardiology consultations among many Health Centers, more support from DWH and Health Center staff and leadership is needed to establish the program within the clinic setting and ensure on-going consultation utilization. DWH can implement strategies to facilitate consultations during Health Center on-boarding and program implementation.
Abstract P302: The Mississippi Rural Community Listening Project
Authors: Ferrell Christina D , Awuruonye Akachi , Harris Kisa K , Carr-Melvin Sandra , Caples Felicia V , Smith Dantwan S , Ramachandran Vasan S , Henderson Frances C , Fox Ervin R
Published: May 2024

Background:
The Appalachia and Mississippi Delta regions have the lowest life expectancy in the United States. In response, Alabama, Mississippi, Kentucky, and Louisiana were selected for The Risks Underlying Rural Areas Longitudinal (RURAL) Study. The RURAL study is an observational population-based study focused on these at-risk communities in the rural south. During the planning phase, investigators identified the need to incorporate insights from the community in the proposal. Therefore, they initiated the “Rural Community Listening Project” in the four states to seek community members’ points of view on outreach research in their communities. The objectives of this research were to hear from members of the communities their concerns and ideas about health research, approaches that would promote their willingness to participate, and their willingness to have blood drawn and x-rays taken as a part of the research process.

Method:
Mississippi investigators conducted four focus group interviews with 10-12 participants in each focus group. They interviewed a total of 45 men and women between the ages of 35 to 65 in county-specific focus groups. The groups represented four rural Mississippi Counties: LeFlore, Oktibbeha, Panola, and Tishomingo. The investigators digitally recorded the interviews and had them transcribed, then analyzed the transcripts using thematic analysis.

Results:
Two themes arose: (1) Encouragement to Participate and (2) Barriers to Participation. Encouragement to Participate included (1) having trusted community stakeholders involved, (2) helping the community, (3) promoting one’s health, and (4) receiving feedback on one’s health. Barriers included lack of trust, time, location, and transportation. Overall, the focus group interviewees had not participated in health research but would be willing to do so. Participants had little to no experience in doing health surveys or tracking their health information using mobile or electronic devices but did not raise objections to doing so. Word-of-mouth, social media, newspaper, telephone, cell phone, and mail were recommended as modes of communicating with their communities. “Relevance to the individual” arose as a more prominent encourager than monetary incentives. Focus group interviewees reported trusting doctors, nurses, and health care providers in their respective communities to collect health information.

Conclusion:
The in-common barriers to participation in research were time, transportation, and location. Across all focus groups, trust emerged as a requisite for research participation. The model of listening to the community’s experiences, concerns, and recommendations can potentially inform future research practices in rural communities and changes to related state and/or local policies.
Abstract P310: Preference for Home Blood Pressure Monitoring versus Ambulatory Blood Pressure Monitoring for Measuring Sleep Blood Pressure: The BetterBP Study
Authors: Alanaeme Chibuike J , Wen Ying , Chen Ligong , Ghazi Lama , Lenz Kellen , Fang Chloe , Poudel Bharat , Cepeda Maria , Lam Michael , Hardy Shakia T , Schwartz Joseph E , Levitan Emily B , Muntner Paul , Shimbo Daichi
Published: May 2024

Background:
Home blood pressure (BP) monitoring (HBPM) devices have been adapted as an alternative to ambulatory BP monitoring devices (ABPM) for measuring sleep BP. We evaluated participants' preference for using HBPM versus ABPM to monitor sleep BP in the BetterBP study.

Methods:
Participants in the BetterBP study (N=591) completed one night of HBPM (3 measurements total) and 24 hours of ABPM (measurements every 30 minutes) in random order. After completing both procedures, participants were asked about the side effects experienced, willingness to again perform HBPM for one night versus ABPM for 24 hours to monitor sleep BP, and overall preference for HBPM versus ABPM for monitoring BP. We used McNemar’s test to evaluate differences between devices.

Results:
Among all 591 participants, the mean age was 39 years old, and 63% were women. Additionally, 49% were non-Hispanic, White; 21% were non-Hispanic, Black; 15% were non-Hispanic, Asian; and 7% were Hispanic. Interference of normal sleeping pattern was less common for HBPM compared with ABPM (46% versus 57%; p<0.001). Overall, 7% and 6% of participants reported removing the HBPM and ABPM device, respectively, due to disturbance while sleeping (p=0.88). Also, 27% of participants reported pain while undergoing HBPM for one night compared to 47% for ABPM (p<0.001); 43% had irritation while undergoing HBPM for one night compared to 68% for ABPM (p<0.001); and 12% had bruising while undergoing HBPM compared to 23% for ABPM (p<0.001). For the willingness to perform one night of HBPM versus ABPM to monitor sleep BP, 80% were very or completely willing to use HBPM compared to 60% who were very or completely willing to use ABPM (
Table
, p<0.001). For overall preference, 71% of participants preferred HBPM, 24% preferred ABPM, and 5% did not prefer either HPBM or ABPM.

Conclusion:
Participants reported fewer side effects and greater tolerability with HBPM than ABPM and preferred one night of HBPM over 24 hours of ABPM to monitor sleep BP.
Abstract P346: Effect of Low-Fat versus Low-Carbohydrate Diet on Visceral Fat
Authors: Follis Shawna , Cunanan Kristen , Landry Matthew J , Ward Catherine , Stefanick Marcia L , Gardner Christopher D
Published: May 2024

Introduction:
A healthy low fat (HLF) and healthy low carbohydrate (HLC) diet are common strategies for weight loss that vary in their effects on adiposity and metabolism. Visceral adipose tissue (VAT) is the major contributor to metabolism deregulation, beyond subcutaneous adipose tissue (SAT). Despite strong biological evidence that a HLC diet preferentially decreases VAT relative to SAT, the difficulty in measuring adipose sub-types has impeded its use in diet trials. To address this research gap, we measured VAT and SAT in a secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) weight loss trial to compare the effects of HLF and HLC diets and potential effect modification by sex and insulin resistance status.

Hypothesis:
We hypothesized that a HLC diet is associated with greater VAT loss compared with a HLF diet. Secondly, we hypothesized that men and those with greater baseline insulin secretion assigned to HLC diet would experience greater VAT loss.

Methods:
DIETFITS was a single-site, parallel-group, weight loss diet trial, randomizing 609 adults with overweight and obesity to a HLC or HLF diet for 12 months. Data collection occurred at baseline, 6 months, and 12 months. Insulin resistance status was proxy measured using insulin concentration 30 minutes after a glucose challenge (INS 30). In this secondary analysis, we measured VAT and SAT in the abdominal region by reanalyzing the dual-energy x-ray absorptiometry (DXA) scans. We fit a linear mixed model to evaluate the change in VAT after 6 and 12 months on HLF and HLC, with fixed effects: time, diet, and their interaction; and a random effect for repeated observations. We built separate models for each of the secondary hypotheses, with additional fixed effects INS 30 and sex, respectively.

Results:
We included 449 participants with baseline DXA (60% women; mean age 40 years). From baseline to 6-months, participants assigned to a HLC diet experienced a significant 10.6 cm
2
(95% CI: 5.1, 16.1) greater decrease in mean VAT compared to those assigned to a HLF diet. The 12-month difference in diets attenuated to 5.5 cm
2
(95% CI: -0.1, 11.1). Contrary to our hypothesis, INS 30 did not modify the diet-related changes in VAT. Among men, both diets resulted in a 12-month decrease in VAT. The HLC diet was associated with a 12.1 cm
2
(95% CI: 1.6, 22.7) greater loss of VAT compared to HLF. Among women, HLF but not HLC was associated with decreased VAT, and there was no difference in VAT loss between diets 1.8 cm
2
(95% CI: -4.1, 7.6). Models controlling for SAT indicated that VAT decreased independently of SAT.

Conclusion:
These findings contribute to the understanding of the nuanced impacts of HLF and HLC diets on adipose sub-types and underscore the relevance of considering sex in designing effective dietary interventions targeting VAT reduction and metabolic health.
Abstract P351: The Associations of Short-Term, Chronic Localized and Chronic Widespread Pain With Life Expectancy Free of Major Chronic Diseases
Authors: Kou Minghao , Li Xiang , Ma Hao , Wang Xuan , Heianza Yoriko , Qi Lu
Published: May 2024

Introduction:
Pain is among the top underlying causes of years lived with disability.

Hypothesis:
Pain with higher chronicity and widespreadness is associated with shorter life expectancy free of major chronic diseases (cardiovascular disease, cancer, type 2 diabetes, and dementia), and longer lifespan lived with chronic diseases.

Methods:
The study included a total of 427,464 women and men from the UK Biobank study, free of major chronic diseases at baseline and with available information of pain (categorized as short-term pain, chronic localized pain, and chronic widespread pain), followed up until May 31, 2021. Population-based multistate life tables were used to calculate life expectancy with and without major chronic diseases.

Results:
Chronic localized pain was associated with significant but modest loss in healthy life expectancy and gain in lifespan lived with chronic diseases. Chronic widespread pain was associated with the largest loss in healthy life expectancy. Men and women with chronic widespread pain at age 50 years had 3.17 (95% confidence interval, 3.07 - 3.30) and 2.74 (2.66 - 2.83) shorter life expectancy free of major chronic diseases, 1.86 (1.73 - 1.97) and 1.84 (1.75 - 1.92) longer life expectancy with major chronic diseases as compared to individuals without pain (
Figure
). Chronic widespread pain was associated with ~15% and ~10% shorter life expectancy free of major chronic diseases in men and women at age 50 years, respectively, which increased to ~40% and ~30% after age 80 years. In terms of life expectancy in the presence of major chronic diseases, chronic widespread pain was constantly associated with ~25% and >30% longer life expectancy as compared to those without pain in men and women, respectively.

Conclusions:
Chronic pain, especially chronic widespread pain, was associated with larger loss in healthy life expectancy and more lifespan lived with chronic diseases. Our study suggests chronic pain as a potential intervention target to improve quality of life.