bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P312: Stress Related to Family Member(s) With Legal/Police Problems and BodyMass Index in the Study of Women’s Health Across the Nation (SWAN)
Authors: Van Dyke Miriam E , Lemon Tiffany , Matthews Karen A , Barinas-Mitchell Emma , Lewis Tené T
Published: July 2021

Introduction:
Millions of Americans encounter the legal system each year, although persons of low socioeconomic status and racial/ethnic minorities are disproportionately impacted. The health implications of having legal or police problems have been well-documented, especially among incarcerated populations. Missing from the literature, however, is an insight into the health of those closest to the individuals facing legal and/or police problems—their family.

Hypothesis:
Using data from the Study of Women’s Health Across the Nation (SWAN), we examined the hypothesis that stress related to family member(s) with legal/police problems (FLPP) is associated with higher body mass index (BMI, kg/m
2
) across 12 years and examined whether this association varied by education or race.

Methods:
Participants were 1,550 white, 935 Black, 281 Japanese, and 250 Chinese middle-aged women. Data from baseline through year 13 were analyzed using generalized estimating equations with a year fixed effect. Models were adjusted for site, year, age, race/ethnicity, education, menopausal status, smoking, alcohol use, physical activity, caloric intake, and depressive symptoms.

Results:
Of the 3,016 women included at baseline, 16.1% of women reported any FLPP, although lower educated women reported more FLPP (20.4%) than higher educated (12.3%) women, and slightly more FLPP than middle educated women (18.9%). Similarly, Black women reported more FLPP (23.8%) than white (14.3%), Japanese (8.5%), and Chinese (7.6%) women. EducationxFLPP interaction was observed such that among lower, but not middle or higher educated women, FLPP that were reported to be very upsetting were on average associated with higher BMI in age, year, race/ethnicity, menopausal status, and site-adjusted models (beta=0.35, p=0.03), although this association became marginal in fully-adjusted models (beta=0.31, p=0.09). Although race/ethnicityxFLPP interaction was not observed, in race-stratified models, very upsetting FLPP were on average marginally associated with increased levels of BMI among Black women only, in both minimally (beta=0.21, p=0.06) and fully-adjusted (beta=0.21, p=0.08) models.

Conclusions:
Our findings based on 12 years of data suggest that lower educated women and Black women who report having a family member with legal or police problems and who find this very upsetting on average have higher BMI. SWAN has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women’s Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). The content of this abstract is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH.
Abstract P315: Is Self-rated Health Associated With Ideal Cardiovascular Health? The Multi-Ethnic Study of Atherosclerosis
Authors: Osibogun Olatokunbo I , Ogunmoroti Oluseye , Spatz Erica S , Burke Gregory L , Michos Erin D
Published: July 2021

Introduction:
Self-rated health (SRH) is a commonly used indicator of health status. It has been identified as a determinant of health-promoting behaviors and a predictor of morbidity and mortality. However, little is known about the association between SRH and ideal cardiovascular health (CVH) as measured by the American Heart Association Life’s Simple 7 (LS7) criteria. We examined whether SRH was associated with ideal CVH, for the overall cohort and by sex and race/ethnicity.

Methods:
We conducted a cross-sectional analysis of 6457 men and women of 4 race/ethnicities, aged 45 to 84 years, who participated in the Multi-Ethnic Study of Atherosclerosis. SRH was measured on a 5-point Likert scale (excellent, very good, good, fair and poor). CVH was determined using the LS7 score with each of the 7 metrics scored from 0-2, and a total score ranging from 0-14. Scores of 0-8 indicate an inadequate score, 9-10, average and 11-14, optimal. Odds ratios (OR) and 95% confidence intervals were calculated for the associations between SRH and LS7 score categories using multinomial logistic regression, adjusted for age, sex, race/ethnicity, education, income, marital status, health insurance status and chronic diseases

Results:
The mean age (SD) of participants was 62 (10) years; 53% were women. Approximately, 16% of participants rated their health as excellent, 33% very good, 41% good and 9% poor-fair. In this population, 47% had inadequate LS7 scores, 33%, average and 20% optimal. The odds of having a higher LS7 score increased as SRH improved. Using participants who rated their health as poor-fair as the reference group, the adjusted OR for having an optimal LS7 score in the overall cohort was: excellent 3.0 (2.1-4.3); very good 1.6 (1.1-2.1); good 1.2 (0.9-1.7). A similar trend was observed in the stratified analyses by sex and race/ethnicity (
Table
)

Conclusion:
A more favorable SRH was associated with better CVH irrespective of sex or race/ethnicity. Further research could explore whether optimization of SRH predicts cardiovascular outcomes.
Abstract P317: An Activity Space Approach to Assessing the Food Environments of Food Secure and Insecure Women
Authors: Raskind Ilana G , Kegler Michelle C , Kramer Michael R
Published: July 2021

Introduction:
Community food environments (FE) are an important correlate of diet- and weight-related CV health. Conventional approaches to measuring the FE focus on residential neighborhoods, and do not assess the full extent of food sources regularly encountered and used. Further, little attention has been given to how individual diet-related experiences, like food insecurity, may interact with features of the FE to affect health. To address these limitations, we use an activity space approach, defined by the locations women routinely visit, to measure FE exposure and use, and assess differences by food security status.

Hypothesis:
Food-related spatial behavior and features of the FE differ between a) conventional and activity space definitions, and b) food secure and insecure women.

Methods:
We present initial results (n=51) from an ongoing clinic-based study of low-income African American women in Atlanta, GA. Data are collected in-person using a Google Map-powered activity space questionnaire. USDA’s 10-item adult scale is used to measure food insecurity. Retail FE data are from Dun & Bradstreet. ArcGIS 10.5 was used to define three environments: residential census tract (CT), and convex hull polygons of
overall
and
food-specific
activity spaces. We tested differences, by food security status, in mean behaviors and FE features with one-way ANOVAs.

Results:
Eighty-eight percent of women were food insecure. Food insecure women were lower income, less often employed, and less often had access to a car. CTs contained fewer supermarkets (μ=1.2
SD
=1.4) and fast food restaurants (μ=3.9
SD
=3.2) than activity spaces (μ=7.9
SD
=7.0; μ=55.5
SD
=44.1, respectively). On average, 6.7% (
SD
=13.5) of utilized food sources fell within CT bounds, while 53.4% (
SD
=35.5) fell within activity spaces. Compared to food secure women, food insecure women had smaller overall (μ=329.8km
2
SD
=340.4 vs. μ=548.3km
2
SD
=422.4;
p
=0.16) and food-specific (μ=48.1km
2
SD
=74.3 vs. μ=85.6km
2
SD
=106.4;
p
=0.28) activity spaces, and a smaller proportion of their utilized supermarkets fell within their activity spaces (μ=60.9%
SD
=42.4 vs. μ=81.9%
SD
=21.4;
p
=0.24). FE features did not differ by food security status.

Conclusions:
Conventional FE definitions likely underestimate the number of food sources women encounter, and do not capture the majority of sources used. Smaller activity spaces among food insecure women suggest that routine spatial mobility may be constrained by factors like transportation access. Still, food insecure women more often traveled
outside
of their activity spaces to utilize supermarkets, suggesting a dual burden of constrained spatial mobility and access. Interestingly, FE features did
not
differ by food security status. In planned future analyses, any observed differences in diet and weight may indicate variation in how women
interact
with the FE, rather than differences in exposure.
Abstract P319: Changes in Perceptions of Neighborhood Environment and Cardiometabolic Outcomes in Two Predominantly African American Neighborhoods
Authors: Gary-Webb Tiffany L , Suder Egnot Natalie , Dubowitz Tamara , Troxel Wendy
Published: July 2021

Introduction:
Perceived neighborhood characteristics, including neighborhood satisfaction, are associated with lower obesity rates and more favorable cardiovascular risk factor profiles. However, prior studies have not evaluated how longitudinal changes in perceived neighborhood characteristics following revitalization efforts may associate with cardiometabolic health indicators.

Methods:
Changes in neighborhood perception scales (infrastructure, safety, aesthetics, and satisfaction) were determined from 2013-2016 and categorized into the following groups: improvement, no change, or worsening over the time-period. Multivariate linear regression was used to measure the association between perceived improvement in each of the neighborhood characteristics with cardiometabolic outcomes (BMI, SBP, HbA1c, HDL-c) assessed in 2016. Outcomes were compared for those who perceived neighborhood improvements to those who perceived no change/worsening of neighborhood characteristics. Models were adjusted for age, sex, income, education, marital status, physical function, neighborhood, years spent in neighborhood. Interaction terms for age and sex were tested in the adjusted models.

Results:
Among the 622 individuals who did not move during the time-period, 93% were African American, 80% were female, and the mean age was 58 years. Many participants reported some improvements in neighborhood environment; infrastructure (48% reporting improvements), safety (47%), aesthetics (46%) and satisfaction (28%). In covariate-adjusted models, those who perceived improvement in their neighborhood aesthetics over the follow-up period had a significantly higher BMI (kg/m
2
) than those who perceived no improvement/worsening (β=1.2, p=0.05). Similarly, perceived improvements in neighborhood safety were associated with higher BMI (β=1.5, p=0.01); however, they were also significantly associated with lower SBP (mmHg) (β=-3.8, p=0.01). A significant interaction was observed between sex and perceived improvement in safety when predicting BMI (interaction term p=0.04), such that the relationship between perceived improvements in safety and higher BMI was observed only among women (β=2.3, p=0.02). We did not observe any statistically significant interactions by age. We also did not find significant associations between changes in neighborhood characteristics and HDL-c or HbA1c.

Conclusions:
These findings suggest that perceived neighborhood characteristics may have differing associations with multiple cardiometabolic outcomes (BMI, SBP). This highlights the complexity of the associations between neighborhood characteristics and health as well as the importance of considering how changes in perceived neighborhood characteristics associate with multiple clinically relevant cardiometabolic risk factors, and how associations may be sex dependent.
Abstract P330: Chronic Kidney Disease is Associated With Short-Term Risk of Hospitalization Among Older Adults
Authors: Wong Eugenia , Ballew Shoshana H , Daya Natalie , Ishigami Junichi , Rebholz Casey M , Matsushita Kunihiro , Grams Morgan , Coresh Josef
Published: July 2021

Background:
Chronic kidney disease (CKD) is now staged by estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR). Risks of cardiovascular disease, dialysis, and mortality are well described, but risks of hospitalization at older age have not been explored to the same depths.

Hypothesis:
CKD stages will be associated with risk of all-cause hospitalizations.

Methods:
The analysis was conducted on 5669 white and African-American participants of the ARIC Visit 5 (2011-2013) cohort (mean age, 76 y; female, 57%; African-American, 23%). CKD was staged according to KDIGO 2012 criteria with eGFR from serum cystatin C (eGFRcys) and ACR. The primary outcome of all-cause hospitalization risk was analyzed by using negative binomial regression to estimate incidence rate ratios (IRR), adjusted for demographics, behaviors, and comorbidities.

Results:
Over a median follow-up period of 3.5 years (by December 31
st
, 2015), 6124 hospitalizations occurred over 19788 person-years (Crude Incidence Rate, 309 per 1000 person-years). Risk of hospitalization increased markedly with lower eGFRcys and higher albuminuria (
Table 1
). Other baseline comorbidities were also associated with hospitalization risk (IRR [95% CI] for heart failure, coronary heart disease (CHD), stroke, cancer were 1.7 [1.4-2.0], 1.5 [1.3-1.7], 1.3 [1.1-1.6], and 1.2 [0.9-1.5]).

Conclusions:
Among older adults, both low eGFR and high ACR are strongly related to risk of hospitalization. These findings provide insight for risk stratification and prevention of CKD at older ages.

Table 1. Risk of hospitalization by CKD stages defined by eGFR and ACR
Abstract P336: The Association Between Goal-Striving Stress, Sleep Duration and Sleep Quality in the Jackson Heart Study
Authors: Cain Loretta , Glover LáShauntá , Johnson Dayna , Sims Mario
Published: July 2021

Introduction:
Research shows that compared to non-Hispanic whites, African Americans (AAs) have poorer sleep quality, lower mean sleep duration, and a higher prevalence of sleep-disordered breathing. AAs also report more frequent exposures to certain stressors over the life course, which may impact physiological processes that may impair sleep. Goal-striving-stress (GSS), the discrepancy between aspiration and achievement, weighted by the subjective probability of success, and the level of disappointment experienced if goals are not reached, may be an important stressor among AA’s that may influence sleep; however this has yet to be explored. The objective of this study was to assess the relationship between GSS and sleep duration and sleep quality in AAs.

Hypothesis:
We assessed the hypothesis that high (versus low) GSS would be associated with short or long sleep duration and poor sleep quality.

Methods:
We utilized data from the baseline exam of the Jackson Heart Study (JHS; n=5306), an AA sample of women and men, 35-84 years old. There were a total of 5082 participants in the sample; 63.34% female with a mean age of 55.30 (± 12.75) and mean sleep duration of 6.43 hours (±1.51). The sample was categorized into GSS tertiles: low (n=2121), moderate (n=1716), high (n=1296). Participants self-reported sleep duration (hours) and rated their sleep quality. Sleep duration was categorized as short (
<
6 hours), normal (7 or 8 hours) and long (
>
9 hours). Sleep quality was categorized as high (good/very good/excellent) and low (fair/poor). Logistic regression models were used to obtain odds ratios (OR, 95% confidence interval-CI) to assess the associations of GSS levels with sleep duration and sleep quality categories. Models were adjusted for sex, age, socioeconomic status, health behaviors, discrimination, and health outcomes.

Results:
Significant results showed that participants who reported high (versus low) GSS had a 29% increased odds [1.29 (1.10, 1.52)] of short (versus normal) sleep after full adjustment. Participants who reported high (versus low) GSS had a 42% increased odds [1.42 (1.20, 1.67)] of low (versus high) sleep quality after full adjustment.
Conclusion
In conclusion, the deficit between goal aspiration and achievement is associated with short sleep duration and poor sleep quality. Potential interventions should consider the extent to which GSS may contribute to the development of short sleep duration and poor sleep quality.
Abstract P340: Information on Bedtimes and Wake Times Improves the Relation Between Self-Reported and Objective Assessments of Sleep in Adults
Authors: St-Onge Marie-Pierre , Campbell Ayanna , Salazar Ismel , Pizinger Theresa , Liao Ming , Aggarwal Brooke
Published: July 2021

Introduction:
Epidemiological studies often utilize self-reports to characterize total sleep time (TST). Studies provide discordant information on the association between self-reported and objective TST with some finding weak or no correlations and bias in reporting based on sex and body mass index.

Objective:
Our goal was to investigate the correlation between self-reported and objective measures of TST in a diverse sample of adult men and women volunteering to participate in sleep studies and determine whether sex, race/ethnicity, and weight status influence this association.

Methods:
Participants were individuals who screened for participation in sleep studies for whom we had >7 d of wrist actigraphy sleep data (TST
obj
) and subjective total sleep time (TST
PSQI
) reported using the Pittsburgh Sleep Quality Index (PSQI) questionnaire (n=53 men and 60 women; n=67 minority/Hispanics; age 30.9±9.7y; BMI 26.2±3.2kg/m
2
).

Results:
Average TST
PSQI
was greater than TST
obj
(0.63±0.99h, p<0.0001). In univariate regression analyses, the difference between TST
PSQI
and TST
obj
did not vary by sex (ß=0.12, p=0.52), race/ethnicity (ß=0.15, p=0.48), age (ß=-0.01, p=0.27), or BMI (ß=0.04, p=0.13). Overall, there was no correlation between TST
obj
and TST
PSQI
(r=0.12, p=0.22), which did not vary when sex was analyzed separately (men: r=0.20, p=0.15; women: r=0.046, p=0.73). Interestingly, there were moderate and highly significant correlations between self-reported and objective assessments of bedtime (r=0.42, p<0.0001) and wake time (r=0.35, p<0.0001). We therefore used bedtime, waketime, and time to fall asleep information on the PSQI to calculate a new TST
bed/wake
. Average TST
bed/wake
was greater than TST
obj
(0.79±0.76h, p<0.0001). This measure was correlated with TST
obj
(r=0.57, p<0.0001); with strong correlation in women (r=0.76, p<0.0001) and moderate correlation in men (r=0.36, p=0.0082). In univariate regression, the difference between TST
bed/wake
and TST
obj
varied by age (ß=-0.020, p=0.0051), BMI (ß=0.054, p=0.0021), race/ethnicity (ß=0.36, p=0.021), and sleep efficiency (ß=-0.089, p<0.0001).

Conclusions:
Self-reported bedtimes and wake times were more accurately reported than estimated TST
PSQI
and provided a more reliable estimate of TST. In general, the degree of over-reporting was greater in younger and heavier individuals, non-White/Hispanics, and those with low sleep efficiency. Although self-reported assessments of sleep duration over-estimated objective measures by approximately 45 min, using information on habitual bedtimes, wake times, and time to fall asleep improved the relation in both men and women.
Abstract P341: Poor Sleep Patterns Are Associated With Decreased Performance on the Montreal Cognitive Assessment in Both Younger and Older Women
Authors: Aggarwal Brooke , Brickman Adam M , Liao Ming , Zimmerman Molly E
Published: July 2021

Introduction:
Poor cardiovascular health has been linked to an increased likelihood of cognitive impairment in older adults. Cognitive impairment has also been identified as an emerging co-morbidity of obstructive sleep apnea, a highly prevalent sleep disorder, particularly in patients with neurological conditions. Whether other aspects of sleep, including sleep duration, sleep quality, sleep onset latency, and insomnia are associated with cognition is not established.

Objective:
The aim of this study was to evaluate whether specific sleep patterns were associated with cognitive function in a diverse population of both younger and older, neurologically healthy women, and to determine whether this association is mediated by cardiovascular disease (CVD) risk factors.

Methods:
This was a baseline analysis of 392 women (59% racial/ethnic minority, mean age=39±16.53y, range 20-76y) participating in the ongoing American Heart Association Go Red for Women Strategically Focused Research Network population-based study at Columbia University Medical Center (CUMC). Cognitive function was assessed by the validated Montreal Cognitive Assessment (MoCA) screening instrument. Sleep duration, sleep quality, and time to sleep onset were assessed using the Pittsburgh Sleep Quality Index; insomnia was assessed using the Insomnia Severity Index. Blood lipids and glucose were measured in the biomarker core laboratory at CUMC. Multivariable linear regression models were used to evaluate associations between sleep, CVD risk factors, and MoCA scores, adjusted for age, race/ethnicity, education, health insurance, and tested for interactions between age and sleep.

Results:
The prevalence of abnormal MoCA (score <26) was 38%; mean scores were lower in adults ≥55y vs. <55y (p<0.0001), and racial/ethnic minorities vs. whites (p<0.0001). Average nightly sleep duration was 6.75±1.29 h, and 50% of women had poor sleep quality. In multivariable models testing for interactions, lower MoCA scores were associated with shorter sleep duration (p=0.007), worse quality sleep (p=0.0005), and higher insomnia level (p=0.04). In stratified analyses, associations between MoCA scores and sleep duration, sleep quality, and insomnia persisted among both younger (<55y) and older (≥55y) groups. Lower MoCA scores were also associated with higher triglycerides (p=0.0001) and lower HDL-cholesterol (p=0.0006); formal tests of mediation suggested that the relation between cognition and insomnia was mediated by triglyceride level.

Conclusions:
Poor sleep patterns were highly prevalent and associated with lower cognitive function, even in younger women in this diverse population. Sleep patterns should be further investigated as a potential mechanism to identify individuals at risk of cognitive decline. Whether the relation is causal or mediated through traditional CVD risk factors deserves further study.
Abstract P345: Short Sleep Duration is Associated With Atrial Fibrillation in a Clinical Cohort
Authors: Genuardi Michael V , Saand Aisha Rasool , Ogilvie Rachel P , Magnani Jared W , Patel Sanjay R
Published: July 2021

Introduction:
Patients who self-report short sleep duration are thought to have a higher risk of atrial fibrillation (AF), but objective data are lacking and it is not clear if this association is independent of sleep apnea. In this cross-sectional investigation, we evaluated the association between objectively measured sleep duration and AF in patients undergoing diagnostic sleep study.

Methods:
We evaluated all 30,572 patients who underwent in-laboratory diagnostic sleep study at one of six centers within the University of Pittsburgh Medical Center system from March 1999 to December 2015. Total sleep time (TST), apnea hypopnea index (AHI), percent sleep with oxygen saturation < 90% (Per90), and cardiac rhythm on overnight EKG were extracted from sleep study reports using automated algorithms. Multivariable linear regression was used to model TST as a function of rhythm accounting for age, sex, body mass index (BMI) and sleep apnea severity using both AHI and Per90. We also performed a sensitivity analysis using patients whose AF status was confirmed by an inpatient or outpatient ICD-9 code at any point up to one day prior to the date of the sleep study.

Results:
The cohort was 52.0% female, aged 50.8±14.6 years (mean ± std dev), had a BMI of 33.7 ± 8.7 kg/m
2
, and an AHI of 17.4 ± 22.6 events/hr. Of the 30,572 patients, 369 (1.2%) had AF, 60 had a paced rhythm, 28,844 were in sinus, and 1299 had unclear rhythm. After adjusting for age and sex, TST was lower by 34 minutes (95% confidence interval, 26-42) in patients in AF compared to those in sinus rhythm. After further adjustment for BMI, AHI and Per90, TST was 28 minutes (18-38) lower for those in AF. The TST difference between patients in AF and sinus was primarily related to reduction in stage 2 non-REM sleep; AF patients had 32 minutes (22-41) less stage 2 sleep after adjustment. In a sensitivity analysis limited to 268 AF subjects with at least one AF diagnostic code and 26,239 sinus rhythm subjects without an AF diagnostic code, TST was 29 minutes (17-41) shorter in AF patients after adjustment.

Conclusion:
After accounting for differences in demographics and sleep apnea severity, patients with AF sleep about half an hour less on objective assessment. Our findings support an association between short sleep and AF. Future prospective studies are needed to determine if short sleep may be a novel mechanism for the development of AF.
Abstract P353: Paradoxical Secular Trends in Stroke and Hypertension Incidences among Men and Women in Rural Areas of China: Results from Two Population-based Cohorts
Authors: Zheng Liqiang , Sun Yingxian
Published: July 2021

Background:
Stroke has been the leading cause of death in China and hypertension accounts for about one-third of deaths due to stroke in Chinese adults. The current study aimed to examine the secular trends of stroke and hypertension in two population-based samples.

Methods:
The study included three cohorts (2004-2008, n=38,949; 2008-2010, n=38,264; and 2013-2016, n=8,880) from two population-based studies: Fuxin Cardiovascular Cohort Study (FCCS) and Northeast China Rural Cardiovascular Health Study (NCRCHS).

Results:
There was a significant increasing trend for incidence of stroke in both men and women (
P
for trend <0.001). The age-adjusted incidence of stroke (per 100,000 person-years) among the 3 Cohorts was 575.3, 893.0, and 1382.7 in men and 358.9, 456.5, and 1046.2 in women, respectively. With the 2004 Cohort as the reference group, we observed a 52.9% increase in 2008-2010 and a 169.9% increase in 2013-2016 among men. However, hypertension incidence decreased steeply in both sexes from 2004-2008 (15.2 in men and 12.6 in women per 100 person-years) to 2013-2016 (9.6 in men and 7.1 in women per 100 person-years) (
P
for trend <0.0001).

Conclusions:
Incidence of stroke has increased and incidence of hypertension decreased since 2004, which has implications for prevention of both diseases in China.
Abstract P366: Repeatability of Cardio-Ankle Vascular Index in Morbidly Obese Individuals
Authors: Yang Chao , Coresh Josef , Ndumele Chiadi , Matsushita Kunihiro
Published: July 2021

Background:
The AHA 2016 Statement for arterial stiffness evaluation introduced several novel parameters. Cardio-ankle vascular index (CAVI) is one of them and has a unique property of being largely independent of blood pressure (BP) at the time of examination. The repeatability of CAVI has been confirmed in healthy population but not in morbidly obese individuals.

Methods:
We investigated 76 participants (mean age 44 years, and mean BMI 48 kg/m
2
[ranged from 36-70]) in the BARI-Heart Study, who underwent 2 standardized visits (1-10 months apart) before bariatric surgery. CAVI was measured twice 5-minute apart at each visit using oscillometric device VaSera VS-1500 (Fukuda Denshi, Tokyo, Japan) at a supine position. We calculated intra-class correlation coefficient (ICC), minimal detectable change (MDC
95
) and minimal detectable difference (MDD) using a nested random-effects analysis of variance model for CAVI. As a contrast, we also calculated these repeatability statistics for brachial and ankle BP measured using the same device when CAVI was measured.

Results:
At the first visit, average CAVI was 6.2 (SD 1.1) and average brachial systolic and diastolic BP was 146 mmHg (SD 13) and 86 mmHg (SD 7). For short-term repeatability in 5 minutes at the first visit, the ICCs were very high for both CAVI and brachial and ankle BPs (all with ICC ≥ 0.82 bilaterally). When we observed longer term repeatability over several months, the ICCs were fair for BPs (ranged from 0.42-0.57) but remained very high for CAVI with ≥0.72 for both sides. The MDC
95
between repeated measures within an individual across two visits was 1.6-1.7 for CAVI and 15-35 mmHg for BP parameters. In this scenario, the MDD for two independent samples of 100 per group was ~0.5 for CAVI and 4-8 mmHg for BP parameters.

Conclusion:
The short- and longer-term repeatability of CAVI was overall good even among morbidly obese individuals. Our results suggest that a longitudinal change of CAVI by 1.6-1.7 indicates a change beyond the measurement error.
Abstract P369: Relation of Breast Arterial Calcification With Ankle Brachial Index
Authors: Iribarren Carlos , Levine-Hall Tory , Sanchez Gabriela , Sadeghi Bahman , Javan Hanna , Cho Hyo-Min , Ding Huanjun , Molloi Sabee
Published: July 2021

Presence of breast arterial calcification (BAC) has been shown to be independently associated with increased risk of subclinical cardiovascular disease (CVD), angiographically-defined coronary disease and with incident coronary heart disease, stroke and heart failure. However, a relationship between BAC and peripheral vascular disease has not been established. The ankle brachial index (ABI) is an indicator of the severity of peripheral arterial disease (PAD) that predicts future CVD risk. We utilized cross-sectional data collected at the baseline examination (2012-15) of the MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease (MINERVA Study), a cohort study of 5,145 post-menopausal women who were members of the Kaiser Permanente Medical Care Program of Northern California (KPNC) who were free of clinical CVD at baseline. Presence and gradation (in mg of calcium mass) of BAC in digital mammograms was ascertained with a validated densitometry method. ABI, the average of two ankle systolic pressure readings divided by the average of two brachial systolic pressure readings, was measured by trained and certified personnel after a ten-minute rest. A total of 3,693 women had complete data on all variables of interest; their mean (SD) age was 66 (4) years and 64% were white, 12% African-American, 14% Asian, 9% Latina and 1% mixed or other. While 28.2% presented with any detectable BAC (i.e., BAC mass > 0 mg), 5.4% had an ABI < 0.90. Three women had ABI>1.40 and were excluded from analyses (none had BAC>0). Prevalence of ABI < 0.90 was 4.8% (27/2,653) in women with BAC=0 and 6.9% (72/1,040) in women with any detectable BAC. The Odds Ratio of ABI<0.90 associated with any BAC was 1.39 (95% CI, 1.03-1.89) in a model adjusting for age and race/ethnicity, and was 1.38 (95% CI, 1.02-1.88) in a model with further adjustment for BMI, smoking status, diabetes, hypertension, LDL cholesterol, HDL cholesterol and hs-CRP. However, among women with any detectable BAC, standardized log_BAC mass (mg) was not significantly associated in bivariate linear regression analysis with ABI (slope=-0.0030 [SE=0.0031]; p=0.32). Our study demonstrates (for the first time) an independent association between presence of BAC and ABI indicative of PAD, with no apparent linear dose-response relationship.
Abstract P371: Twenty-Five-Year (1986-2011) Trends in the Incidence and In-Hospital Case-fatality Rates of Stroke Complicating Acute Myocardial Infarction
Authors: Hariri Essa , Tisminetzky Mayra , Goldberg Robert
Published: July 2021

Introduction:
Stroke after acute myocardial infarction (AMI) is an important complication resulting in increased morbidity and mortality. However, limited long-term trends data are available about the incidence and death rates associated with this serious complication.

Objective:
The aim of this study is to examine the 25-year trends in the incidence rates and outcomes of initial episodes of stroke complicating AMI.

Hypothesis:
We hypothesize that the incidence and outcomes of stroke complicating AMI would decrease over time with recent advances in the management of both diseases.

Methods:
The study population consisted of 11,433 adults hospitalized with validated AMI at all 11 medical centers in central Massachusetts on a biennial basis between 1986-2011.

Results:
Of 11,436 patients (mean age = 69 years; 42% female) without a history of stroke hospitalized with confirmed AMI, 159 patients (1.4%) experienced an acute stroke during their index hospitalization. The proportion of patients with AMI who developed a stroke increased through the 1990s but declined slightly thereafter (Figure 1). Patients who experienced an acute stroke were significantly older, more likely to be female, had a previous AMI, had a significant burden of comorbidities, and were more likely to have developed atrial fibrillation, heart failure, and have died (32.1% versus 10.8%; p<0.001) during their index hospitalization compared with patients who did not develop a stroke. Patients developing a stroke in the most recent years (2003-2011) were 5 times more likely to have died during hospitalization compared to those who did not develop a stroke (OR, 5.05; 95% CI, 2.34-10.90).

Conclusions:
In conclusion, the incidence rates of acute stroke complicating AMI remained relatively stable during the years under study but with an increased likelihood of dying during

hospitalization. Better characterization of factors associated with the risk of stroke remains important for the more optimal care of this vulnerable population.
Abstract P374: Trends in Hypertension Prevalence, Awareness, Treatment, and Control: The National Health and Nutrition Examination Survey, 1999-2014
Authors: Foti Kathryn , Wang Dan , Selvin Elizabeth
Published: July 2021

Introduction:
The decline in cardiovascular disease mortality in the US has stalled in recent years, though patterns have varied by age and sociodemographic characteristics. Trends in prevalence of hypertension, as well as awareness, treatment, and control in population subgroups can shed light on opportunities for improving hypertension management and CVD prevention.

Hypothesis:
There has been greater improvement in hypertension control among adults aged ≥65 years than in middle- and younger-age (45-64 and 25-44 years) adults and that race and socioeconomic disparities may be narrower among adults aged ≥65 years.

Methods:
We analyzed data for adults aged ≥25 years from the 1999-2014 National Health and Nutrition Examination Survey (NHANES). We examined mean systolic blood pressure (SBP), prevalence of hypertension, and among those with hypertension, prevalence of awareness, treatment, and control by age category and survey cycle. We fit linear regression models for trends with interaction terms for age category and time.

Results:
Among those aged ≥65, mean SBP decreased 10.4 mmHg, from 143.2 to 132.9 mmHg, a significantly greater decrease than among those aged 45-64 (-3.1 mmHg) or 25-44 (-0.1 mmHg), though absolute SBP values are highest among those aged ≥65 (
Table
). Hypertension awareness, treatment, and control increased significantly each age category, but to a lesser extent among those 45-64 than those ≥65 (p-values for interaction: 0.031, 0.054, 0.051, respectively). Differences in hypertension control and mean SBP among whites and blacks were greater among those 45-64 than those ≥65. Within age categories, there were few significant differences in trends over time by race/ethnicity, education, or poverty to income ratio.

Conclusions:
Our findings highlight the need to address hypertension management among middle- and younger-age adults. Persistent disparities in hypertension control over time demonstrate that prevention and management of hypertension is a priority health equity issue.
Abstract 17022: Pericardial Decompression Syndrome: Incidence in a Large Consecutive Series of Echocardiographic-Guided Pericardiocentesis Procedures
Authors: Ayoub Chadi , Lekhakul Annop , Assawakawintip Chalailak , Fenstad Eric , Pislaru Sorin , Sinak Lawrence , Garvan Kane C
Published: July 2021

Introduction:
Pericardial decompression syndrome (PDS) has been reported as a spectrum of cardiac decompensation following pericardiocentesis including ventricular failure, cardiogenic shock and pulmonary edema. PDS has been reported in patients undergoing drainage ≥450 mL of pericardial fluid. Hence judicious drainage of large volume effusions to avoid complication has been recommended

Hypothesis:
PDS complicating undergoing transthoracic echocardiography (TTE) guided pericardiocentesis is uncommen

Methods:
Consecutive patients undergoing TTE guided pericardiocentesis at our center from 1/2007 to 12/2016 were reviewed. Procedures were performed in a standard fashion under moderate conscious sedation with TTE determining the location of aspiration and determining adequate resolution of pericardial fluid post procedure. All fluid was removed at time of centesis regardless of the size of effusion, except for patients with severe pulmonary hypertension (n=9), who had staged removal of 100cc every 10 minutes. Post procedure, a pigtail catheter was left in the pericardial space for ongoing intermittent drainage and removed after the total net output was <50 mL/24 hours. Patients were monitored in an intermediate level care unit. All patients underwent repeat TTE at the time of catheter removal. Large volume was defined as ≥450 mL of fluid. Patients in whom pericardiocentesis was technically unsuccessful were excluded

Results:
Over a 10-year period a total of 1067 patients (57% male, mean age 62±16 years) underwent 1164 technically successful pericardiocentesis procedures. Of these, 561 patients had large volume (≥450 mL) aspirated (mean 750±345 mL aspirated, range 450 - 4300 mL). Patients had a pericardial catheter in place for a mean 2.9±2 days. One patient with pre-existing severe biventricular dysfunction after aspiration of 400cc developed hypotension that improved with reversal of sedation, but proceeded to have PEA arrest and die. No other patient developed clinical events of acute left or right heart failure, ventricular dysfunction, unexplained hypotension, cardiogenic shock or other clinical events that could relate to PDS

Conclusions:
At most one episode of PDS was observed after technically successful percutaneous pericardiocentesis in 1164 cases (561 were large volume), although whether this case was PDS is unclear. PDS appears to be very rare, and staging pericardial decompression over time may be unnecessary, other than, perhaps, in patients with severe ventricular dysfunction or severe pulmonary hypertension
Abstract 17032: Substrate Stiffness Alters the Kinetics of Sodium Channel Nav1.5 and Depolarization of Cardiomyocytes
Authors: Xi Yutao T , Su Sheng-An T , Sampaio Luiz C , So Shui Ping T , Sun Junping T , Cheng Jie T , Xiang Meixiang , Taylor Doris A
Published: July 2021

Background:
Myocardial scarring after infarction (MI) can create areas of slowed conduction, which can lead to re-excitation of the heart, or re-entry. Reentrant arrhythmia is one of the electrophysiological mechanisms responsible for ventricular tachycardia after acute myocardial infarction (AMI). Since the sodium channel (Na
v
1.5) is a major contributor to cardiac electrical conduction, the objective of this study was to evaluate the effect of cell substrate stiffness on the kinetics of the Na
v
1.5.

Methods:
MI was created by permanent ligation of the left anterior descending artery in rats. After 7 days, hearts were decellularized and grossed into 1 mm rings for measuring stiffness by using an atomic force microscope. The hearts had an elastic modulus of 263.33±76.8 kPa at scar, and 27.26±3.97 kPa at a remote area (n=3). The surface of p
olydimethylsiloxane
(PDMS) gels was tuned to match the stiffness of decellularized infarcted rat hearts (17.04±2.02 kPa, 110.56±8.70 kPa and 328.4±45.72 kPa, respectively, n=3). Human embryonic kidney 293 (HEK-293) cells were induced to stably express human Na
v
1.5. HEK-293 and human pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) were separately cultured on the PDMS substrate that mimicked stiffness of infarcted rat hearts for 24 h. Sodium channel currents (I
Na
) and action potentials (APs) were recorded by patch clamp techniques.

Results:
As substrate stiffness increased, HEK-293 voltage dependent activation of Na
v
1.5 (I
Na
) shifted significantly towards more positive voltage (Vhalf: -28.42±5.12 mV, -33.47±6.98 mV, -19.84±5.24 mV, respectively, p<0.01 in one-way ANOVA, n=12), and the transition from closed-state into inactivation was faster (tau: 48.47±4.60ms, 40.67±8.07ms, 81.20±9.54ms, p<0.05, n=12). However, the current density, the steady-state inactivation curve and the recovery time were comparable between different PDMS. In iPSC-CMs, the slope of AP upstroke was decreased when stiffness was increased (30.00±1.38V/s, 23.91±0.65V/s, 20.93±0.34V/s, p<0.05, n=15).

Conclusion:
Increased substrate stiffness, similar to myocardial scar, alters the kinetics of Na
v
1.5 and affects the depolarization of cardiomyocytes, which likely contributes to slow conduction after MI.
Abstract 17033: Comparative Effectiveness of Pulmonary Vascular Resistance, Capacitance, and Resistance-Capacitance Time in the ESCAPE Trial
Authors: Tolbert Nora , Bilchick Kenneth , Parker Alex , Bergin James , Mazimba Sula
Published: July 2021

Introduction:
Right ventricular (RV) function portends adverse outcomes in heart failure (HF). Markers of RV load include pulmonary vascular resistance (PVR), pulmonary capacitance (PC), and the Resistance-Capacitance Time (RCT), a product of PVR and PC. The impact of changes in these indices during hemodynamic optimization is unknown.

Hypothesis:
PVR, PC and RCT after therapy and changes in these indices during therapy would be differentially associated with outcomes in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization (PAC) Effectiveness (ESCAPE) trial.

Methods:
Using Cox proportional hazards regression and Kaplan Meier survival analysis, we analyzed associations of PVR, PC, and RCT indices with the outcomes of death, transplantation, and left ventricular assist device (DTxLVAD) and a combined rehospitalization outcome (DTxLVADH) during 6 months follow-up.

Results:
Among 138 patients (age 56.9 ± 13.6 years, 30.4% female), PVR at the end of therapy was associated with increased DTxLVAD (HR 1.28 per 1 W.U. increase; 95% CI 1.11-1.47; P=0.0007), and final PC was associated with a decreased DTxLVAD (HR 0.60 per unit PC increase; 95% CI 0.41-0.87; P=0.0007). The final RCT was not associated with DTxLVAD (HR 0.70; CI 0.48-1.03; P=0.07). Changes in PVR during therapy (median -0.38 W.U.; IQR -1.57 to 0.62 W.U.) were associated with increased rehospitalization (DTxLVADH) during follow-up (HR 1.13; 95% CI 1.02-1.25; P=0.02). In a binary analysis, patients with an increase in PVR > 0.1 W.U. during therapy had a trend for more DTxLVADH events (log-rank P=0.058; Figure). Changes in PVR and PC during therapy were not associated with survival.

Conclusions:
Final PVR and PAC measurements but not changes in these parameters during therapy were associated with survival, although changes in PVR during therapy were associated with rehospitalization. More studies are needed to understand the utility of RV load parameters in HF therapy.
Abstract 17043: Enhanced Na
+
Influx Alters Myocyte Mechanics and Diastolic Function
Authors: Andrade-Vicenty Alejandro , Sun Chaoyu , Cervantes Daniel , Anand Saketh , Sun Dong , O’Malley Heather , Isom Lori , Hintze Thomas H , Rota Marcello
Published: July 2021

The late Na
+
current has emerged as a therapeutic target for conditions characterized by depressed diastolic function, but whether enhanced Na
+
fluxes in cardiomyocytes interfere with cellular and myocardial relaxation remain to be clarified. For this purpose, we employed mice with inducible, cardiac restricted deletion of the non-pore forming beta1 subunit of the Na
+
channel (
Scn1b
-KO), a rodent model associated with enhanced Na
+
influx in cardiomyocytes. Two-dimensional and Doppler echocardiography and ECGs were employed to evaluate cardiac function in
Scn1b
-KO and control (Ctrl) animals. Properties of Ca
2+
transient and contractility were established in isolated left ventricular (LV) myocytes obtained by enzymatic digestion. Deletion of the
Scn1b
gene had no consequences on ejection fraction, whereas LV filling pattern was altered, isovolumic relaxation time prolonged (+30%), and electrical recovery, measured by the QT interval, was protracted (+14%). In a subgroup of animals, acute administration of GS967 (0.5 mg/kg body weight), a specific inhibitor of the late Na
+
current, partly ameliorated diastolic indices and shortened the QT interval. At the cellular level, kinetics of cell shortening and Ca
2+
transients were delayed in
Scn1b
-KO myocytes (n=609-693), with respect to Ctrl cells (369-298). Specifically, time to peak Ca
2+
and time to 50% decay of the Ca
2+
transient were increased in
Scn1b
-KO cells by 5% and 17%, respectively. Similarly, time to peak contraction and time to 50% relaxation were enhanced by 6% and 7% in
Scn1b
-KO. Interestingly, GS967 (300 nM) accelerated temporal parameters of contraction in
Scn1b
-KO myocytes by ~8% and led to an attenuation of fractional shortening. These effects were not observed in Ctrl cells. Thus, enhanced Na
+
influx modulates electromechanical coupling in cardiomyocytes and delays kinetics of contraction and relaxation with consequences on diastolic properties of the heart.
Abstract 17044: Gender Discrepancies in Management and Outcome of Hospitalized Heart Failure Patients
Authors: Bare Idris , Malik Rizwan , Cheng Yangzhao , Mondal Prosanta , Orvold Jason , Akhtar Jawed , Pearce Colin , Haddad Haissam , Zhai Alexander
Published: July 2021

Introduction:
The incidence of heart failure (HF), particularly in women, is increasing rapidly. While earlier reports indicated that HF mortality was higher in men compared to women, recent studies have suggested higher HF mortality in women. The cause of this changing pattern is not well described. The purpose of this study was to explore different clinical factors and management patterns that could contribute to this.

Methods:
We conducted a retrospective chart review study of all the patients admitted to a tertiary academic hospital (Royal University Hospital, University of Saskatchewan, Canada) with a diagnosis of HF in 2015, with follow up analysis up to February 20, 2018.

Results:
In total, 379 patients were admitted with HF, of which 166 (43.8%) were women. Overall, the most important predictors of mortality on multivariate analysis include admission to non-cardiology services (NCS, p < 0.0001), age on admission (p<0.001), readmission (p=0.001), and haemoglobin on admission (P=0.004). Review of baseline characteristics showed that women with HF were older (p<0.001), and more likely to have HFpEF (26.3% vs. 46.4%, p<0.001) than men. However, women were less likely to have comorbidities including COPD, CKD, PVD, HTN, diabetes and dyslipidemia (p<0.001). In spite of this, there was a trend towards higher mortality among women over the follow up period (57.8% vs. 47.9%, p=0.055). Women were significantly less likely to be admitted to cardiology (62% vs. 71.4%, p=0.0084), and less likely to have follow up scheduled on discharge with either an internist or cardiologist (70.4% vs. 53.6%, p<0.001). Similar gender discrepancy in admission to cardiology was also observed among the subgroup of patients with HFrEF.

Conclusions:
In our study, women admitted with heart failure had worse overall prognosis than men, in spite of less associated comorbidities. Admission to cardiology service was the most significant positive prognostic factor overall. However, surprisingly, women were significantly less likely to be admitted to cardiology, possibly contributing to their observed poor outcome. Further studies to elucidate factors underlying this observed difference in admission pattern may help improve the management of women with HF.