bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P136: Healthier Personal Habits Of Primary Care Physicians Increase The Likelihood Of Their Recommending Lifestyle Modifications For Their Hypertensive Patients That Are Consistent With The National Guidelines
Authors: Hung Olivia Y , Keenan Nora L , Fang Jing
Published: July 2021

Introduction:
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) recommended lifestyle interventions, either with or without pharmacologic treatment, for all patients with high blood pressure. The objective of this study is to determine the association of physicians’ personal habits with their attitudes and behaviors regarding JNC VII lifestyle modification guidelines.

Hypothesis:
Primary care physicians who have healthier habits, as defined by eating more cups of fruits and/or vegetables, exercising more frequently, and/or not smoking, would be more likely to recommend lifestyle interventions consistent with JNC VII than their counterparts who have less healthy habits.

Methods:
One thousand primary care physicians completed DocStyles 2010, a voluntary web-based survey designed to provide insight into physician attitudes and behaviors regarding various health issues.

Results:
The respondents’ average age was 45.3 years and 68.5% (685 of 1000) were male. In regards to physician behavior, 4.0% (40 of 1000) smoked at least once a week, 38.6% (386 of 1000) ate ≥5 cups of fruits and/or vegetables ≥5 days/week, and 27.4% (274 of 1000) exercised ≥5 days/week. When asked about specific types of advice offered to their hypertensive patients, physicians reported recommending that their patients eat a healthy diet (922 of 1000), or cut down on salt (961 of 1000), or attain or maintain a healthy weight (948 of 1000), or limit the use of alcohol (754 of 1000), or be physically active (944 of 1000). Collectively, 66.5% (665 of 1000) made all 5 lifestyle modification recommendations. Physicians who were between 40 - 49 years old were 1.6 times as likely of making all 5 lifestyle recommendations compared with those who were under 40 years. Additionally, those who exercised at least once per week or did not actively smoke were approximately twice as likely to recommend these interventions.

Conclusions:
The probability of recommending all five lifestyle modifications increased with both the physician exercising at least once per week and not having smoked.
Abstract P147: Telestroke Software Offers Improved and Novel Methods of Studying Physician Decision Making
Authors: Yang Julian P , Grujovski Andre , Wright Tim , Wu Tzu-Ching , Olson DaiWai M , Kolls Brad J
Published: July 2021

Introduction:
Data quality in stroke registries is typically dependent upon some form of chart review and manual data abstraction. The retrospective nature of this process is inherently prone to incomplete and inaccurate data collection with limited insight into the process of physician decision making.

Hypothesis:
New software packages accompanying telestroke systems will dramatically improve the quality of data by automating the abstraction process and providing real-time access to electronic databases.

Methods:
Telestroke systems provide web-based programs that record various levels of data. InTouch Technologies, Inc. currently provides StrokeRESPOND v3.0, a web-based program that facilitates telestroke consultation by organizing elements of the physician-patient encounter, including history, vitals, physical exam, laboratory results, and radiographs, and by generating a consultation note. Many data elements captured in the user interface mirror traditional metrics of acute stroke care research and can be de-identified and then directly transferred into an electronic database. The “forced choice” (aka hard-stop) design of data entry and elimination of secondhand abstraction can minimize data corruption and loss. Further, because each point of data entry and manipulation is time-stamped, powerful metadata_“data about data”_can be explored. By analyzing the sequence and patterns of clinical information entry and utilization, the actual thought process of the physician user can be investigated and provide new insights into stroke treatment. Optimization of acute stroke management, a complicated protocol, can be driven by identification of physician decision making patterns associated with multiple outcomes, including higher rates of treatment and faster treatment times.

Conclusions:
Specialized software programs will improve registry data collection, completeness and accuracy. The generation of metadata offers exciting, new avenues of research. Prospective stroke research using this methodology will require the collaboration of multiple academic institutions and industry partners.
Abstract P149: A Large-scale Multi Ethnic Study of a Direct Measure of Insulin Sensitivity Demonstrates That South Asians are the Most Insulin Resistant Ethnic Group in the US
Authors: Divakaruni Monica S , Abbasi Fahim , Desai Manisha , Lamendola Cynthia A , Palaniappan Latha , Reaven Gerald M , Assimes Themistocles L
Published: July 2021

Introduction:
Insulin resistance (IR) is a known risk factor for heart disease. Few studies have compared race/ethnic differences in IR using ‘gold standard’ direct measures of insulin sensitivity.

Methods:
A total of 892 non-diabetic subjects (548 White, 106 South Asian, 103 East Asian, 86 Hispanic and 49 Black) underwent a 4-hour insulin suppression test (IST) as a part of various IR related studies at Stanford over the last ∼20 years. We used generalized estimating equations assuming an exchangeable correlation structure to determine the association between race/ethnicity and steady state plasma glucose (SSPG) derived from an IST, accounting for correlation of outcomes among subjects from the same study. We similarly determined whether differences in plasma triglyceride (TG) and high-density lipoprotein (HDL) levels among race/ethnic groups could be explained by differences in SSPG. All analyses were adjusted for age, sex, and BMI.

Results:
Significant differences among the race/ethnic groups in SSPG were observed (p <0.001). South Asians were the most insulin resistant group with a mean increase in SSPG of 38 mg/dL, compared to whites after controlling for age, sex, and BMI, a difference equivalent to ∼1/2 of the standard deviation of SSPG. East Asians were the next most resistant group (mean +33 mg/dl SSPG compared to whites) followed by Hispanics (+20 mg/dl), Whites, and Blacks (−7 mg/dl). South Asians were the only group with significantly higher TG (mean +1.16 fold, p=0.04) and lower HDL (−3.0 mg/dl, p=0.02) levels compared to whites but these differences were no longer evident after controlling for SSPG. In contrast, Blacks had significantly lower TG (mean 0.8 fold, p = 0.006) compared to whites, but this difference was not at all mitigated after adjusting for SSPG. Blacks also had no significant differences in HDL compared to whites.

Conclusions:
Direct measures of insulin sensitivity suggest that South Asians are the most insulin resistant race/ethnic group in the US even after adjusting for the principal determinants of IR. IR may be largely responsible for differences in TG and HDL observed between South Asian and other race/ethnic groups. The etiologies behind differences in insulin sensitivity across race/ethnic groups remain to be determined.
Abstract P159: Coronary Artery Calcium Score Improves the Net Reclassification Index of Prevalent Cardiovascular Disease In African Americans: The Jackson Heart Study
Authors: Yeboah Joseph , Smith Che L , Sims Mario , Fox Ervin , Ge Yaorong , Wilson James G , Terry J G , Taylor Herman A , Carr J J
Published: July 2021

Background:
Prior studies suggest that African Americans (AA) have lower prevalence of coronary artery calcium (CAC) compared to whites, yet CAC has similar ability to predict coronary heart disease (CHD) events. The role of CAC as a screening tool for CHD risk in AA is unclear. We compared the diagnostic accuracy for CHD prevalence using the CAC score and the Framingham Risk Score (FRS) in an adult population of AA.

Methods:
CAC was measured in 2944 participants in the Jackson Heart Study, an NHLBI funded study of AA based in Jackson, MS. Approximately 8% of this cohort had known cardiovascular disease (CVD) defined as prior MI, angina, stroke, PTCA, CABG or PVD. Logistic regression, ROC and net reclassification index (NRI) analysis were used adjusting for age, gender, SBP, total and HDL cholesterol, smoking status, DM and BMI. FRS was calculated and those with DM were classified as high risk.

Results:
The mean age was 60, 65% were females, 26% had DM, 50% were obese and 30% were current or former smokers. Prevalent CVD was associated with older age, higher SBP, lower HDL and total cholesterol, and higher CAC. CAC was independently associated with prevalent CVD in our multivariable model [OR (95% CI): 1.26 (1.17, 1.35), p< 0.0001]. In ROC analysis, CAC improved the diagnostic accuracy (c statistic) of the FRS from 0.617 to 0.757 (p < 0.0001) for prevalent CVD. The FRS classified 30% of the cohort as high risk, 38.5% as intermediate risk and 31.5% as low risk. FRS classfied 51% of subjects with prevalent CVD as high risk. Addition of CAC to FRS resulted in net reclassification improvement of 4% for subjects with known CVD and 28.5% in those without CVD (see figure).

Conclusion:
In AA, the CAC is independently associated with prevalent CVD and improves the diagnostic accuracy of FRS for prevalent CVD by 14%. Addition of CAC improves the NRI of those with prevalent CVD by 4% and the NRI of individuals without CVD by 28.5%. Determination of CAC in AA may be useful in identifying individuals at risk of CVD and reclassifying individuals with low and intermediate FRS.
Abstract P164: Seasonal patterns of mortality from cardiovascular diseases in Panama.
Authors: Motta Jorge A , Gordon Carlos , Gomez Beatriz , Castillo Eva , Herrera-Ballesteros Hugo
Published: July 2021

Seasonal patterns of cardiovascular (CV) mortality have been reported in many regions of the world, but mostly in temperate zones. These cycles and seasonal patterns of mortality have been identified by looking at mortality rate series over extended periods of time and by filtering its stochastic components. The reasons for these variations have been attributed to multiple causes. Empirical observations by health care worker have suggested that in Panama there are seasonal changes of CV disease mortality but this phenomenon had not been studied. The speculation is that this may be related to variation in the incidence of respiratory diseases, weather changes or to population activity patterns associated with holidays. Our hypothesis for this study is that in Panama mortality related to CV disease has a seasonal pattern. We compiled from the National Registry of Mortality all deaths that occurred in the country from cardiovascular diseases (n=36,145) and diabetes (n=7,076) for the years 2001–2009. A monthly time series of mortality was calculated and its components were decomposed utilizing moving averages. Elements, like cycle, seasonal occurrence and stochastic components, were separated. We also developed a seasonal index of mortality for these diseases. For the same years, we performed a similar analysis for all deaths attributed to cancer and external causes. Analysis of these mortality series revealed seasonal cycles for total cardiovascular mortality and diabetes mortality. Death from cancer and external causes also showed seasonal cycles. CV mortality and diabetes mortality peaked at the beginning of the third trimester of the year and were lowest during the first trimester. For the month of July, the CV mortality seasonal index showed a score of 108, and an average number of CV deaths of 364. The lowest seasonal index score for CV mortality was 87 in February, with an average number of CV deaths of 296. The cycles observed for cancer and deaths from external causes did not match the cycles observed for CV diseases and diabetes. We conclude that there is a seasonal pattern of CV mortality in Panama. The drivers of these cyclical changes of CV mortality have not yet been identified, but we are evaluating the relationship of acute respiratory illnesses, population activity patterns and weather changes to these seasonal mortality variations.
Abstract P168: Determinants of Smoking and Quitting in an HIV Cohort Using a Validated Natural Language Processing Tool
Authors: Regan Susan , Meigs James B , Grinspoon Steven K , Triant Virginia A
Published: July 2021

Background:
Tobacco smoking is widespread among HIV patients and is likely to contribute to the development of chronic diseases, yet accurate information on smoking is often difficult to obtain from observational data sources. We sought to validate a natural language processing (NLP) classifier to identify smokers among HIV and control cohorts and investigate whether HIV is an independent predictor of smoking and failure to quit smoking.

Methods:
We applied an NLP classifier developed within the Partners HealthCare System to electronic medical records for a cohort of HIV patients and a control cohort matched on age, gender, race, and number of clinical encounters. The NLP classifier searches free text notes for “tokens”, phrases containing smoking-related words, and assigns a smoking status (current, former, or non-smoker) to each token. We developed an algorithm for combining token classifications from a 12 month period into a single smoking status (current vs. non-smoker). We validated the yearly smoking status on a random sample of 500 patients (250 from each cohort) using as a gold standard a trained nurse medical record reviewer who assigned a tobacco smoking status to each patient for each calendar year observed. We calculated sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Using NLP, we classified the full cohorts as ever versus never smokers and current versus non-smokers at last observation. We used logistic regression to assess HIV as a predictor of smoking and failure to quit (current smoking among ever smokers).

Results:
Smoking-related tokens were found in the records of 2926/3554 HIV and 7039/9601 non-HIV patients, providing 34,956 patient years of data. Using NLP to assign smoking status by year yielded sensitivity of 92.4, specificity of 86.2, and AUC of 0.89 (95% confidence interval [CI] 0.88-0.91). NLP assignment of ever versus never smoking status yielded sensitivity of 94.3, specificity of 73.4 and AUC of 0.84 (95% CI 0.81-0.87). Performance of the classifier did not vary by HIV status, gender, age, calendar year, or number of tokens/year. Ever and current smoking were more common in HIV patients than controls (54% vs. 44% and 42% vs. 30%, respectively, both p<0.001). In multivariate models adjusting for demographics, cardiovascular risk factors, coronary heart disease and history of psychiatric illness, HIV was an independent predictor of ever smoking (odds ratio [OR] 1.41, 95% CI 1.29-1.54, P <0.001), current smoking (OR 1.57, 95% CI 1.43-1.72, P<0.001), and failure to quit (OR 1.51, 95% CI 1.31-1.75, P<0.001).

Conclusions:
We validated a novel tool to ascertain smoking status from HIV observational cohort data. HIV was independently associated with both smoking and failure to quit smoking. These data underscore the need for aggressive smoking cessation strategies specific to HIV patients.
Abstract P170: Neighborhood Socioeconomic Inequalities in Incidence of Acute Myocardial Infarction: a Relative and Absolute Perspective with Reference to Age and Gender.
Authors: Koopman Carla , van Oeffelen Louise , Bots Michiel L , van Rossem Lenie , van Dis Ineke , Engelfriet Peter M , Verschuren W M , Capewell Simon , Vaartjes Ilonca
Published: July 2021

Background:
Socioeconomic circumstances (SEC) have a profound effect on the risk of having a first coronary heart disease (CHD) event. Yet, information on socioeconomic inequalities across age- and gender-groups is lacking. The objective of this study was to examine socioeconomic inequalities in the incidence of acute myocardial infarction (AMI) in the Netherlands from a relative and absolute perspective, with a particular focus on age and gender.

Methods:
We identified all patients with a first AMI event from 1997 to 2007 through linked hospital discharge and death records covering the Dutch population (176,715,060 person-years). Relative risks (RR) of AMI incidence were estimated by mean equivalent household income at neighborhood level for strata of age and gender using Poisson regression models. The absolute magnitude of socioeconomic inequalities was estimated by multiplication of population attributable risks (PAR) with the total number of AMI events within the stratified age-gender groups.

Results:
Between 1997 and 2007, 317,564 people had a first AMI. RR for AMI was 1.34 (95% CI: 1.32 - 1.36) in men and 1.44 (95% CI: 1.42 - 1.47) in women, when comparing the most deprived socioeconomic quintile with the least deprived quintile. The socioeconomic gradient decreased with age. Relative socioeconomic inequalities were most apparent in men under 35 years and in women under 65 years. A total of 50,362 events were attributable to socioeconomic inequalities, with a PAR of 14% in men and 18% in women. The largest burden of absolute AMI events attributable to socioeconomic inequalities was found in men aged 45-74 years, and to a lesser extent in women aged 65-84 years.

Conclusion:
Neighborhood socioeconomic inequalities are seen for AMI incidence in all age-gender groups in the Netherlands.
Abstract P177: Urine Creatinine Based Estimates of Fat Free Mass: The Rancho Bernardo Study
Authors: Jassal Simerjot K , Wassel Christina L , Laughlin Gail A , Barrett-Connor Elizabeth , Rifkin Dena E , Ix Joachim H
Published: July 2021

Background:
Sarcopenia is difficult to identify without imaging. An accurate, easily obtainable screening tool would allow identification of older persons who might benefit from interventions to increase muscle mass. Urine creatinine excretion rate (CER) on 24-hour urine collections is highly correlated with muscle mass but collection is cumbersome. Spot urine creatinine (UCr) may also mark muscle mass, but is influenced by transient changes in urine tonicity. We previously developed a prediction equation to estimate CER (eCER) on 24-hour urine specimens. Whether this equation is associated with measures of muscle mass and whether spot UCr provides similar estimates to eCER is unknown.

Methods:
We measured spot UCr and fat free mass (FFM) by dual energy x-ray absorptiometry (DXA) among 1372 community-dwelling individuals. We used the equation developed in our prior study to estimate CER: eCER (mg/day) = 879.89 + 12.51*weight (kg) - 6.19*age + 34.51 if black - 379.42 if female. Spearman correlation coefficients and linear regression were used to determine strengths of association of eCER and spot UCr with FFM by DXA.

Results:
Mean (SD) age was 70 (11) years, 58% were women, and mean eGFR was 69 (15) ml/min/1.73m
2
. Mean values for FFM by DXA, eCER, and spot UCr were 47 (11) kg, 1107 (339) mg/day, and 94 (55) mg/dL, respectively. eCER was more strongly correlated with FFM by DXA (r = 0.93, p<0.001) than spot UCr (r = 0.39, p<0.001). Figure 1 shows the mean regression lines and 95% limits of agreement for the association of eCER (A) and spot UCr (B) with FFM; the 95% limits of agreement were narrower for eCER compared to spot UCr. The regression equations were: FFM (kg) = 13.21 + 0.03*eCER (mg/day) and FFM (kg) = 39.3 + 0.08* spot UCr (mg/dL).

Conclusions:
An equation incorporating age, weight, sex, and race to estimate CER was highly correlated with FFM by DXA and was more precise than spot UCr in community-dwelling older adults. Future studies should evaluate whether eCER provides a simple method to predict frailty and mortality in older persons.
Abstract P179: Abdominal Skin-fold Thickness Improves Anthropometric Prediction of Insulin Resistance in Prepubescent Colombian Children
Authors: Mueller Noel T , Pereira Mark A , Buitrago Adriana , Rodriguez Diana C , Duran Alvaro E , Ruiz Alvaro J , Rueda-Clausen Christian F , Villa-Roel Cristina
Published: July 2021

Introduction:
Body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), have been considered poor measures of cardiometabolic risk in children, in whom increases in these measures may reflect increases in lean mass more so than fat mass. Hypothesis: We examined the hypothesis that abdominal skinfolds (ASF) have better predictive value than BMI and other anthropometric measures for identifying insulin resistance (IR) in prepubescent Colombian children.

Methods:
We used data from a population-based cross-sectional study of 1,262 children, aged 6-10 y, in Bucaramanga, Colombia. Logistic regression stepwise variable selection (P<0.05 for entry and retention) was performed to identify anthropometric predictors of IR, as determined by homeostatic model assessment (HOMA). Receiver operating characteristic (ROC) curves were used to compare area under the curve (AUC).

Results:
There were 57 boys and 70 girls classified as IR (HOMA >90th percentile). Among anthropometric measures compared - including WC, WHtR, and four skinfolds - only age- and sex-specific ASF and BMI z-scores were retained as independent anthropometric predictors of IR. Prediction of IR was marginally better using ASF z-scores than BMI z-scores (P for contrast= 0.13). However, the final Model, which included both ASF and BMI, significantly increased the AUC from 0.80 (95% CI: 0.75-0.84) to 0.82 (95% CI: 0.78-0.86) - an improvement of 0.02 (95% CI: 0.004-0.04; P for contrast= 0.01)(see
table
). In the final Model, after adjusting for BMI z, a 1-SD increment in ASF z was associated with 2.38 (95% CI: 1.74-3.26) greater odds of IR; whereas a 1-SD increment in BMI z, after adjustment for ASF z, was associated with 1.46 (95% CI: 1.11-1.91) greater odds of IR.

Conclusions:
ASF was independent from and marginally better than BMI in predicting IR in Colombian children. Furthermore, integration of ASF with BMI improved IR risk stratification compared to BMI alone, opening new perspectives in the prediction of cardiometabolic risk in children.

ROC Curve Contrast Estimation and Testing Results for Anthropometric Measures of Insulin Resistance

ROC Curve Contrasts
Difference in AUC
95% CI
P for Contrast

WCz - BMIz
0.006
(-0.016, 0.028)
0.622

WHtRz - BMIz
−0.045
(-0.074, -0.016)
0.002

ASFz - BMIz
0.018
(-0.005, 0.040)
0.126

Model (ASFz + BMIz) - BMIz
0.021
(0.004, 0.038)
0.014

BMI z-score (BMIz) was used as reference in all contrast estimates and tests against waist circumference z-score (WCz), waist-to-height z-score (WHtRz), abdominal skinfolds z-score (ASFz), and the best stepwise-selection Model (includes ASFz + BMIz)
Abstract P191: Does ApoB/A1 Ratio Explain the Increased Risk of Cardiovascular Disease in Indian Asians Compared to Europeans?
Authors: Tan Sian-Tsung , Al-Hussaini Abtehale , Yadav Sunaina , Sehmi Joban , Ala-Korpela Mika , Elliott Paul , Chambers John C , Kooner Jaspal S
Published: July 2021

Introduction
Coronary heart disease (CHD) mortality is ∼2-fold higher in Indian Asians (IA) than in European Whites (EW). This is not accounted for by conventional CHD risk factors (type-2 diabetes, cigarette smoking, hypertension, obesity, total or HDL cholesterol). The INTERHEART Study has reported that ApoB/A1 ratio is the single strongest risk factor for CHD accounting for ∼50% of CHD risk; the contribution of ApoB/A1 ratio to the excess CHD risk in IA is not known.

Hypothesis
We tested the hypothesis that ApoB/A1 ratio is higher in IA than EW and accounts for the ∼2-fold excess CHD risk in IA, independent of conventional CHD risk factors.

Methodology
We studied 1361 IA and 1028 EW men and women aged 35-75 years, participating in the London Life Sciences Population Study. All participants completed a structured health questionnaire and had blood pressure, height, weight, waist-hip ratio, fasting biochemistry measured. Coronary artery calcium (CAC) was measured by electron beam CT; Agatston score >0 was considered to indicate the presence of coronary atherosclerosis.

Results
Compared to EW, IA were younger, had higher prevalence of diabetes and hypertension, had higher WHR, and were less likely to smoke. Total and HDL cholesterol were lower, but Total-HDL cholesterol ratio was higher in IA (
table
). ApoB/A1 ratio was higher in IA compared to EW [0.71±0.15 vs. 0.67±0.16, p<0.001], and was independent of conventional CHD risk factors (p<0.001). In univariate analysis, ApoB/A1 ratio was associated with CAC in both populations [Odds ratio (OR) for CAC per 1 SD increase in ApoB/A1 ratio: IA 1.17 (1.05-1.30), p=0.006; EW 1.40 (1.23-1.59), p<0.001]. After adjustment for age, gender, and total-HDL cholesterol ratio, there was no association between ApoB/A1 ratio and CAC [OR: IA 0.95 (0.74-1.21), p=0.66; EW 0.98 (0.72-1.33), p=0.88].

Conclusions
ApoB/A1 is higher in IA compared to EW, but not independently associated with coronary calcification in either population. ApoB/A1 ratio does not explain the ∼2-fold increased risk of CHD in IA.

Europeans
Indian Asians
P-value

N
1028
1361

Age (years)
55.5
54.2
0.002

Male gender (%)
70.3
62.0
<0.0001

Ever Smoked (%)
54.8
15.1
<0.0001

ApoB/A1 ratio
0.67 (0.16)
0.71 (0.15)
<0.0001

Total: HDL Cholesterol Ratio
4.12 (1.10)
4.23 (1.03)
<0.0001

HDL cholesterol (mmol/L)
1.37 (0.39)
1.24 (0.32)
<0.0001

Type-2 Diabetes (%)
8.2
20.1
<0.0001

Treated Hypertension (%)
19.2
31.3
<0.0001

Waist-Hip Ratio
0.92 (0.08)
0.94 (0.08)
<0.0001

Coronary artery calcium score greater than 0 (%)
54.1
51.1
0.15

Table: Characteristics of study participants
Abstract P192: Lipoprotein(a) is Significantly Associated with ApoB-containing Atherogenic Lipoproteins in African Americans
Authors: Byambaa Enkhmaa , Erdembileg Anuurad , Zhang Wei , Berglund Lars
Published: July 2021

Background:
Lipoprotein(a), Lp(a), is a genetically regulated independent cardiovascular risk factor, where levels differ across ethnicity. The relationship between Lp(a) and apolipoprotein B (apoB)-containing atherogenic lipoproteins across ethnicity is not well understood.

Objective:
To investigate the associations of Lp(a) levels with other apoB-containing lipoproteins with a focus on ethnicity.

Methods:
Plasma lipid and lipoproteins were measured in 336 Caucasians and 224 African Americans undergoing coronary angiography. Lp(a) levels were determined using an apo(a) size insensitive sandwich ELISA. Values for Lp(a) and triglyceride (TG) were square root or logarithmically transformed before analyses. Total and low density lipoprotein (LDL) cholesterol, and apoB levels were corrected for contribution of Lp(a) using previously published algorithms. Values are given mean ± standard deviation or median (interquartile range) for normally or non-normally distributed variables, respectively.

Results:
Levels of total and LDL cholesterol and apoB-100 did not differ between Caucasians and African Americans. As expected, African Americans had significantly higher levels of Lp(a) [110 (60-180) nmol/l vs. 24 (7-79) nmol/l, p<0.001] and high density lipoprotein (HDL) cholesterol (49±17 mg/dl vs. 41±12 mg/dl, p<0.001), as well as significantly lower levels of TG [106 (80-144) mg/dl vs. 153 (114-222) mg/dl, p<0.001] compared to Caucasians. For both ethnic groups, Lp(a) levels were significantly and positively correlated with total cholesterol (p<0.005 for Caucasians and p<0.001 for African Americans), LDL cholesterol (p<0.001 for both groups), apoB100 (p<0.05 for Caucasians and p<0.001 for African Americans) and apoB/apoA-1 ratio (p<0.05 for Caucasians and p<0.001 for African Americans). However, when adjusted for the corresponding contribution of Lp(a) to the levels of these parameters, the associations remained significant in African Americans (p<0.05 for total cholesterol; p<0.05 for LDL cholesterol; p<0.001 for apoB100, respectively), but not in Caucasians.

Conclusion:
Although total and LDL cholesterol, and apoB100 levels were comparable in African Americans and Caucasians, the associations of these parameters with Lp(a) levels differed across ethnicity. For African Americans, but not for Caucasians, associations of all three parameters with Lp(a) remained significant after appropriate adjustments. The findings suggest an interethnic difference in the relation between Lp(a) and other plasma apoB-containing lipoprotein levels, with a closer relationship among African Americans.
Abstract P199: Mean Lipoprotein Levels and Composition in South Asian-Americans Compared to the US Population
Authors: Flowers Elena , Molina Cesar , Mathur Ashish , Aouizerat Bradley , Turakhia Mintu
Published: July 2021

Background
South Asians have increased disk for cardiovascular disease (CVD) that is not captured by traditional risk factors, including TC and LDL-c. Low-density apolipoprotein-B (apoB) containing lipoproteins are heterogeneous in size and composition, and the particles with the greatest triglyceride content are thought to ultimately be the most atherogenic. Specific composition of low-density lipoproteins is not captured by common lipid measures (i.e. TC, LDL-c). A high proportion of triglyceride-rich low-density lipoproteins could be a mechanism for CVD risk in South Asians. Our objective was to compare mean TC, LDL-c, HDL-c, triglycerides, and apoB-triglyceride ratio (an estimate of low-density lipoprotein content) between South Asian-Americans and the US population.

Methods
We studied 2,876 South Asian adults living in the United States participating in a wellness program. Demographics were obtained by self-report. Lipoprotein levels were measured after 10-hour fast. US population means were calculated from NHANES (2007-2008,
n
= 5,113). Individuals on lipid-lowering therapy were excluded (780 (33%) South Asians, 1,194 (19%) NHANES).

Results
LDL-c (118mg/dL vs 116mg/dL, p<0.05) and triglycerides (139mg/dL vs 131 mg/dL, p<0.05) were higher in South Asians than the US population, whereas TC was lower (192mg/dL vs 197 mg/dL, p<0.05). HDL-c was lower in South Asians (46mg/dL vs 52mg/dL, p<0.05). ApoB was not statistically significantly different (93mg/dL vs 92mg/dL, p = 0.1), however the apoB/triglyceride ratio was lower in South Asians (0.8 vs 0.9, p<0.05). After stratifying for age by decade and gender, we found that South Asians have lower HDL-c until the age of 50, and lower apoB/triglyceride ratio until the age of 60, with no substantial differences between men and women.

Conclusions
Mean TC, LDL-c, and triglycerides were normal in South Asians, however the apoB/triglyceride ratio was lower in South Asians than in the US population. This finding indicates that a higher proportion of low-density lipoproteins in South Asians are of the triglyceride-rich atherogenic type. This may portend non-HDL-c as a better indicator of CVD risk than LDL-c in South Asians. Further, low apoB/triglyceride ratio and low HDL-c occurs at a young age in South Asians, suggesting that onset of risk is early. The disappearance of these patterns after age 60 may be the result of sample bias (excluding individuals on lipid lowering therapy), and/or survival bias.
Abstract P211: Test Characteristics of the ABI and Ankle Brachial Difference for Medial Calcification on X-ray in Type 1 Diabetes: the Pittsburgh EDC Study
Authors: Ix Joachim H , Miller Rachel , Criqui Michael , Orchard Trevor
Published: July 2021

Background:
Medial arterial calcification (MAC) is common in diabetes, has a characteristic “tram-track” appearance on x-ray and has been linked with peripheral arterial stiffness, CVD events, and all-cause mortality. While the ankle brachial index (ABI) is often available in epidemiologic studies, few studies have measured MAC by x-ray. It has been suggested that an ABI > 1.30 or ankle brachial difference (ABD) > 75mmHg may identify individuals with MAC, but the test characteristics of the ABI and ABD for MAC are uncertain.

Methods:
Among 185 individuals with type 1 diabetes, we measured ankle and brachial SBP and calculated the ABI and ABD. Lower limb x-rays where read for MAC by two physician investigators and independently reviewed by investigators in the Netherlands. Only linear calcification was considered diagnostic of MAC. The Kappa statistic for any versus none was 0.89 for the two sets of scores. We determined the area under the receiver operator curve (ROC) of the ABI and ABD for MAC on x-ray. and also evaluated the test characteristics at various ABI and ABD cut-points.

Results:
The mean age was 32±6 years and mean diabetes duration was 23±7 years. 97 individuals (57%) had MAC, 15 (8%) had ABI > 1.30, and 14 (8%) had ABD > 75mmHg. The area under the ROC of the ABI for MAC was modest (0.65) and was slightly higher for the ABD (0.75).
Table 1
shows the test characteristics of different ABI and ABD cut-points. Both ABI > 1.30 and ABD > 75mmHg were highly specific for MAC, but with poor sensitivity.

Conclusions:
Individuals with type 1 diabetes who have an ABI > 1.30 or ABD > 75mmHg are very likely to have MAC on x-ray, however many individuals with MAC will not have ABI or ABD above these thresholds. Given high specificity, in studies without x-rays, evaluating high ABI or ABD as surrogates of MAC may prove useful to identify MAC risk factors, but may underestimate the prevalence of MAC.

Table 1.

Test Characteristics of the ABI and ABD for X-ray Medial Arterial Calcification in Type 1 Diabetes

Ankle Brachial Index

ABI
n (%)
Sensitivity
Specificity
PPV
NPV
Accuracy

> 1.05
125 (68%)
70%
35%
54%
52%
54%

> 1.10
84 (45%)
57%
67%
65%
58%
62%

> 1.20
38 (21%)
32%
92%
82%
55%
61%

> 1.30
15 (8%)
14%
99%
93%
51%
55%

> 1.40
7 (4%)
7%
100%
100%
49%
51%

Ankle Brachial Difference

ABD (mmHg)
n (%)
Sensitivity
Specificity
PPV
NPV
Accuracy

> 15
133 (72%)
83%
49%
60^
67%
62%

> 20
115 (62%)
78%
56%
66%
70%
68%

> 25
84 (46%)
66%
77%
76%
67%
71%

> 50
31 (17%)
30%
98%
94%
56%
62%

> 75
14 (8%)
14%
100%
100%
52%
55%
Abstract P216: Blood Pressure Level as Predictor for Developing Diabetes Type 2
Authors: Stahl-Heden@ Christina , Bjorck Lena M , Novak Masuma , Giang Kok Wai , Hansson Per-Olof , Rosengren Annika
Published: July 2021

Introduction and Aim:
The link between diabetes type 2 and hypertension is a well established with both factors parts of the metabolic syndrome. Whether hypertension is an independent predictor for diabetes type 2 development has been examined in previous studies, however with divergent findings. The aim of this study was to investigate whether hypertension, including mildly elevated blood pressure within the normal range predicted subsequent development of diabetes type 2 over an extended follow-up.

Methods and Results:
Data were derived from participants of the intervention group of the Gothenburg primary prevention study where a random sample of 7333 men aged 47-55 years and free of diagnosed diabetes underwent a screening investigation in 1970 to 1973. During a 32-year follow-up, 956 men (13%) were diagnosed with diabetes according to the Swedish hospital discharge register. Development of diabetes type 2 was positively correlated to age, BMI, systolic blood pressure (SBP) and diastolic blood pressure (DBP), serum cholesterol, hypertension treatment, non-manual occupation, high tobacco use, sedentary lifestyle at the midlife screening. In a Cox regression model which adjusted for BMI and other risk factors we calculated the multiple adjusted hazard ratio for developing diabetes type 2 according to blood pressure level. Compared to a reference level of systolic blood pressure (SBP) below 130 mm Hg, men with SBP of 130-139 mmHg, 140-149 mmHg and > 150 mmHg had a multiple adjusted hazard ratios (HRs) of 1.41 (95% confidence interval) 1.11–1.80), 1.38 (1.08–1.75) and 1.67 (1.35–2.07), respectively. Mid-life diastolic blood pressure over 90 mmHg was associated to an increased risk of developing diabetes type 2 (multiple adjust HRs of 1,60 1,21–2,11)

Conclusion:
In this population, at mid-life, hypertension as well as moderately elevated systolic blood pressure levels within the normal range was shown to be independent predictors of diabetes type 2.
Abstract P217: Metabolic Effects of a Nutrient-Dense High Fiber Supplement
Authors: Mietus-Snyder Michele , Shigenaga Mark K , Suh Jung H , Shenvi Swapna V , Lal Ashutosh , McHugh Tara , Olson Donald , McCann Joyce C , Krauss Ronald M , Ames Bruce N
Published: July 2021

Achieving recommended dietary intakes of vitamins and minerals, fiber, and other health-promoting small molecules, such as fruit polyphenolics and essential fatty acids, is difficult, even for healthy adults consuming generally good diets. We assessed the hypothesis that short term consumption of a comprehensive nutrition bar can favorably impact metabolic biomarkers linked to future disease risk.
Methods:
An approximately 100 kcal nutrition bar containing a vitamin, mineral, and docosahexaenoic acid (DHA)-fortified polyphenolic-rich whole food matrix composed of fruit, walnuts, and dark chocolate blended with insoluble and soluble fiber was developed. Pooled results are presented from 3 pilot trials in which 25 generally healthy adults (15 F, 10 M) were enrolled in 2-wk interventions to study the effect of twice-daily consumption of the bar on plasma lipoprotein subfractions (ion mobility analysis), and redox status (thiol amino acids) in addition to conventional biomarkers associated with dyslipidemia, insulin resistance, and inflammation. All variables were continuous, and paired t-tests were used to test for significant change between baseline and follow-up measures.
Results:
Mean HDL cholesterol increased by 6.6 + 9.7% (
p
= 0.001), predominantly due to a rise in the large buoyant HDL2b subclass which rose from 1665.9 ± 1017.7 to 2089.4 ± 1197.6 nmol/L (
p
< 0.0001; 28% increase). Plasma triglyceride and LDL cholesterol levels did not change significantly but there was a trend towards increased LDL peak particle diameter (p = 0.086). Mean plasma homocysteine decreased from 12.6 ± 6.4 to 10.2 ± 3.7 µM (p=0.006, 19.2% decline). Measures of insulin resistance and inflammation did not change. Weight remained stable despite intake of 200 additional daily calories. Participants reported a significant decrease in hunger on an analog scale and compensatory decreased intake of other foods.
Summary:
Twice daily consumption of a low-calorie complete nutritional supplement increases satiety and large HDL particle concentrations within 2 weeks without weight gain.
Abstract P233: Generalization of Adiposity-Related Common Genetic Variants among U.S. Hispanic Women in WHI-SHARe
Authors: Fernández-Rhodes Lindsay , Graff Mariaelisa , Liu Simin , Carlson Christopher , Wassertheil-Smoller Sylvia , Neuhouser Marian , Reiner Alexander , Kooperberg Charles , Rampersaud Evadnie , Manson JoAnn E , Kuller Lewis , Howard Barbara V , Ochs-Balcom Heather M , Johnson Karen C , Vitolins Mara Z , Sucheston Lara , Monda Keri , North Kari E
Published: July 2021

Obesity is a global health concern. Recent studies suggest there may be shared genetic predispositions to obesity phenotypes across diverse racial and ethnic groups, yet the identification of adiposity-related genetic variants among Hispanics, now the largest minority group in the United States (U.S.), remains largely unknown. We interrogated an a priori list of 58 (41 overall body mass and 17 central adiposity) index single nucleotide polymorphisms (SNPs) previously studied in samples of European descent (ED) among 3,587 U.S. Hispanic women in the Women's Health Initiative-SNP Health Association Resource (WHI-SHARe). Body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) were measured using standardized protocols. Inverse normal BMI, WC, and WHR models were adjusted for age, smoking status, study center, and genetic ancestry using principal components. Additionally WC and WHR were adjusted for BMI. Genotyping was performed using the Affymetrix 6.0 array. In the absence of the previously described SNP, the closest available SNP was selected as a proxy (r2≥0.3 in CEU). No SNPs reached genome-wide significance in this analysis likely due to limited power. Eight BMI/weight loci (TMEM18, ETV5, SLC39A8, NUDT3/HMGA1, FAIM2, FTO, MC4R, KCTD15) and two WC/WHR loci (VEGFA, ITPR2-SSPN) were nominally significant (p<0.05) at the reference SNP in the corresponding BMI and WC and/or WHR adjusted BMI models. To account for distinct linkage disequilibrium (LD) patterns in Hispanics and to more broadly assess generalization of genetic effects at each locus, we assessed the evidence for association at the 58 surrounding loci, for each SNP within 500 kb of the reference SNP. Two additional BMI/weight loci (FANCL, TFAP2B) and six WC/WHR loci (DNM3-PIGC, GRB14, ADAMTS9, LY86, MSRA, NRXN3) displayed statistically significant associations with BMI and waist measures after Bonferroni correction (p<0.001 and <0.003, respectively), with varying patterns of LD (r2=0.001-0.871) with the index SNP (using HapMap CEU). Sequential conditional analyses will be used to further determine if our top findings from these loci are tagging the index signal or represent novel secondary signals. In summary, we provide evidence for the generalization of ten BMI and eight central adiposity loci in Hispanic American women. This study expands the current knowledge of common adiposity-related genetic predisposition among Hispanic women in the U.S. and suggests a general relevance of ED adiposity loci to Hispanic descent individuals.
Abstract P240: End of Life Costs in Community Patients with Heart Failure
Authors: Dunlay Shannon M , Shah Nilay D , VanHouten Holly K , Roger Veronique L
Published: July 2021

Background:
Heart failure (HF) care constitutes an increasing economic burden on the healthcare system, and has become a key focus in the healthcare debate. Costs incurred at the end of life can be particularly high in some populations, however, end of life costs among a community population of HF patients have not been well delineated.

Methods:
Olmsted County residents with incident HF from 1987-2006 were identified and followed until death. Direct medical costs incurred in the last 6 months prior to death were obtained using population-based administrative data through 2010. For those that died within 6 months of HF diagnosis, costs were included from diagnosis until death. Costs were inflated to 2010 U.S. dollars using the general Consumer Price Index (CPI).

Results:
A total of 862 HF patients were identified, died during follow-up, and had complete cost data (mean age 79.4 years, 46.4% male, 56.5% EF≥50%). Median costs within the last 6 months of life were $12,069 per person (25
th
-75
th
percentile $1768 - $30,841, mean $24,052), with the majority accumulated during hospitalizations (median $8849 per person, mean $20,263, 84.2% total costs for population). A total of 596 (69.1%) patients were hospitalized in the last 6 months of life, and 235 (27.3%) died in the hospital. Costs progressively increased in the months prior to death (Figure), with nearly half (43.4%) of total costs in the last 6 months of life accumulated during the month before death. End of life costs did not change over the study period (p=0.154 adjusted for age and sex).

Conclusions:
End of life costs are high among community HF patients, particularly in the final month of life. Most of these costs are accumulated during hospitalizations, and a large proportion of HF patients died in the hospital. Among patients with HF nearing the end of life, alternative strategies of care that avoid hospitalizations may be particularly cost-saving.
Abstract P242: Measuring Frailty in Heart Failure: A Community Perspective
Authors: McNallan Sheila M , Chamberlain Alanna M , Gerber Yariv , Singh Mandeep , Weston Susan A , Jiang Ruoxiang , Roger Veronique L
Published: July 2021

Objective:
To compare two measures of frailty in a community cohort of heart failure (HF) patients.

Background:
Frailty is increasingly recognized as an important prognostic indicator in HF. Several methods have been proposed to measure frailty. Some conceptualize frailty as a biological phenotype, while others define it as an accumulation of deficits (impairments, disabilities, comorbid diseases), termed the Cumulative Deficit Index (CDI). Each approach has conceptual strengths and limitations; a distinct feature of the CDI is the ability to extract data from medical records. These two methods have never been compared in a community HF cohort.

Methods:
Olmsted, Dodge and Fillmore County, MN residents with HF between 10/2007 and 12/2010 were prospectively recruited to assess the frailty phenotype. The biological frailty phenotype was defined as ≥3 of the following: unintentional weight loss >10 lbs. in 1 year, physical exhaustion, weak grip strength, and slowness and low activity measured by the SF-12 physical component score. Intermediate frailty was defined as having 1–2 components. The CDI was based on 33 deficits and defined as the proportion of deficits present for each patient.

Results:
Among 131 patients (mean age 70.5±14, 62% male), according to the biological frailty phenotype definition 18% were frail, 50% intermediate frail and 31% not frail. The CDI ranged from 0.03–0.70, with a mean (SD) of 0.22 (0.12). The CDI was significantly correlated with the frailty phenotype (r=0.59, p<0.001). The mean (SD) of the CDI was 0.35 (0.14), 0.21 (0.10) and 0.15 (0.07) among the frail, intermediate frail and not frail phenotypes (Figure).

Conclusion:
The CDI is significantly associated with the biological frailty phenotype and can thus be used as an alternative approach to measure frailty in HF. As the components of the biological frailty phenotype are not routinely assessed clinically, the CDI, which can be ascertained from medical records, is a feasible approach to ascertain frailty in large cohorts.
Abstract P245: Increased Hospital Length of Stay as a Predictor of Heart Failure Readmission
Authors: Djilan Yao , Zoble Robert G , Foulis Philip , Zoble Adam , Neugaard Britta I
Published: July 2021

Background:
Heart Failure (HF) is a major cause of morbidity and mortality with a global prevalence estimated at 16 million. Understanding the risk factors and predictors assists in identifying patients at high risk of subsequent re-hospitalization and death. Consequently, we hypothesized that hospital Length of Stay (LOS) can predict the risk of HF patients’ readmission within a year from an indexed HF hospitalization.

Methods:
A total of 1,255 HF patients admitted to a VA medical center between January 2004 and December 2009, were identified with IDC-9 code for HF. In order to reduce selection bias, patients were required to have at least on HF readmission from the index HF hospitalization. LOS was categorized in two groups (less than 7 days and more than 7days). The study sample was analyzed using Kaplan Meier (KM) estimate and Cox proportional hazard regression in order to assess the risk of patients’ readmission within a year from their indexed HF hospitalization at a significance level of 0.05.

Results:
Among the HF patients identified, 511 met the inclusion criteria. The KM curves below show that patients with LOS greater than 7days are more likely to be readmitted compared to those with LOS less than 7 days. Cox proportional hazard regression confirmed this finding with a hazard ratio of 1.39 (CI: 1.08 – 1.79) and a p-value = 0.012 while adjusting for age, tobacco use, diabetes and medications at first HF discharge.

Conclusion:
From this study sample, we can predict that patients with LOS greater than 7 days are 1.39 times more likely to be readmitted within a year compared to those with LOS less than 7 days.