bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P164: Walking Pace is Inversely Associated With Heart Failure Risk in the Physicians’ Health Study
Authors: Al-Ramady Omar , Chen Jiaying , Gaziano John M , Djoussé Luc
Published: March 2019

Background:
Heart Failure (HF) continues to place a large burden on the public health. While previous studies reported a lower risk of HF and coronary heart disease with increased physical activity, limited data is known about the role of intensity and duration of exercise, specifically walking pace in relation to heart failure risk.

Objective:
The primary objective is to assess whether walking pace is associated with a lower risk of heart failure among male US physicians.

Methods:
In a prospective cohort study of US male physicians, walking pace was collected through a self-reported questionnaire. Incidence of HF was measured via self-reported annual questionnaires and validated in a subsample.

Results:
We studied 21,345 men with a mean age of 67.6 ± 8.9 years. After a mean follow-up of 8.2 years, 849 cases of HF occurred. In a multivariable Cox regression adjust for age, exercise, prevalent CHD, history of atrial fibrillation, smoking and alcohol consumption, hazard ratios (95% CI) for HF were 1.08 (0.85-1.36) for walking pace of <2 mph, 0.73 (0.60-0.90) for 2-2.9 mph, and 0.55 (0.43-0.71) for ≥3 mph compared to not walking regularly (p trend <0.0001).

Conclusions:
Walking Pace was inversely associated with HF in male physicians in a dose-response manner
Abstract P166: Subendocardial Viability Ratio Associates With Diastolic Function Parameters: Insights From the Bogalusa Heart Study
Authors: Razavi Alexander C , Fernandez Camilo , Barshop Rupert P , Guo Yajun , Bazzano Lydia
Published: March 2019

Introduction:
Recent evidence has linked coronary microvascular dysfunction to impaired diastolic function and severity in heart failure with preserved fraction (HFpEF). While echocardiography remains pivotal in the assessment of this clinical scenario, information is scant on the role of applanation tonometry-derived estimates of coronary microcirculation, such as the subendocardial viability ratio (SEVR), in the evaluation of diastolic function.

Hypothesis:
We hypothesized that SEVR is associated with diastolic function parameters in relatively young and healthy adults in a community setting.

Methods:
We examined 611 participants of the Bogalusa Heart Study (31.3% black, 54.6% female, aged 29 to 51 years) who underwent 2D and Doppler echocardiography as well as pulse-wave analysis via applanation tonometry of the radial artery. Echocardiographic parameters of diastolic function included mitral annular velocity (e’), peak early filling velocity (E), peak velocity cause by atrial contraction (A), isovolumic relaxation time (IVRT), and deceleration time (DT). Diastolic function and SEVR relationships were evaluated with multivariable-adjusted linear regression. Covariates adjusted for included age, race, sex, systolic blood pressure, high density lipoprotein cholesterol, low density lipoprotein cholesterol, serum triglycerides, glucose, body mass index, cigarette smoking as well as blood pressure and lipid medications.

Results:
Compared to men, women had a lower SEVR (p < 0.001). There were no significant sex or race differences in diastolic function parameters, except that black females had lower E/e’ ratios compared to black males (p=0.003). SEVR was significantly associated with the E/A ratio (β=0.20, p<0.001) as well as DT (β=0.32, p<0.001), while no significant associations were found between SEVR and the E/e’ ratio or IVRT. Neither sex nor race modified the relationship of SEVR with E/A ratio, DT, E/e’ ratio, or IVRT.

Conclusion:
In middle-aged adults, SEVR is significantly associated with traditional echocardiographic parameters of diastolic function, including both the E/A ratio and DT. Pulse wave analysis via applanation tonometry is an inexpensive non-invasive tool that may aid in accelerating the diagnosis of diastolic dysfunction in the individuals without overt disease.
Abstract P171: Effect of Intensive and Standard Clinic-Based Hypertension Management on the Concordance Between Clinic and Ambulatory Blood Pressure and Blood Pressure Variability: Systolic Blood Pressure Intervention Trial (SPRINT)
Authors: Ghazi Lama , Pajewski Nicholas M , Rifkin Dena E , Bates Jeffrey T , Chang Tara I , Cushman Wlliam C , Glasser Stephen P , Haley William E , Johnson Karen C , Kostis William J , Papademetriou Vasilios , Pinion Mary , Rahman Mahboob , Simmons Debra L , Taylor Addison , Whelton Paul K , Wright Jackson T , Drawz Paul E
Published: March 2019

Blood pressure (BP) varies over time within individual patients and across different BP measurement techniques. The effect of different BP targets on the concordance between BP measurements is unknown. The goal of this analysis was to evaluate concordance in: 1) clinic BP and ambulatory BP, 2) clinic visit-to-visit variability and ambulatory BP variability and 3) initial and repeat ambulatory BP. We also sought to evaluate whether treatment assignment of intensive vs standard BP target affected these relationships. The Systolic Blood Pressure Intervention Trial (SPRINT) ambulatory blood pressure monitoring ancillary study obtained ambulatory BP readings in 897 SPRINT participants at the 27 month follow up visit and 203 consecutive repeat ambulatory BP readings taken an average of 9.8 months later. There was poor agreement between clinic systolic BP and daytime ambulatory systolic BP (limits of agreement in Bland-Altman plots of -21 to 34 mm Hg in the intensive treatment group and -26 to 32 mm Hg in the standard treatment group). There was poor agreement between clinic visit-to-visit variability (coefficient of variation) and ambulatory BP variability (coefficient of variation of a 24 hr ambulatory BP) with correlation coefficients for systolic BP <0.16. While there was a high correlation between ambulatory BP at 27 months and repeat ambulatory BP (r ~0.56), there was significant variability between repeat ambulatory BP assessments (limits of agreement of -27 to 21 mm Hg in the intensive group and -23 to 20 mm Hg in the standard group). In conclusion, irrespective of treatment target, we found low concordance in BP and BP variability between clinic BP and ambulatory BP, and additionally between repeat ambulatory BP assessments. These results reinforce the need for multiple guideline adherent BP measurements prior to clinical decision making.
Abstract P180: Combined Effect of Income and Medication Adherence on Mortality in Newly Treated Hypertension: a Nationwide Study of 16 Million Person-years
Authors: Lee Hokyou , Park Jong Heon , Park Sungha , Kim Hyeon Chang
Published: March 2019

Introduction:
Low socioeconomic status and poor medication adherence are known to increase mortality among patients with hypertension, but their combined effects have not been well studied.

Hypothesis:
We hypothesized that excess risks for all-cause and cardiovascular deaths by medication adherence are greater in lower income individuals with hypertension.

Methods:
We followed 1,679,527 persons, aged 30 to 80 years, with newly treated hypertension and no prior cardiovascular disease (CVD), for 10 years using the Korean National Health Insurance database. Exposure variables were household income in quintiles and medication adherence estimated by medication possession ratio: good (≥0.8), moderate (0.5 to <0.8), or poor (<0.5). Outcomes were all-cause and CVD-related deaths. We used Cox proportional hazards model to calculate hazard ratios (HR) adjusted for age, sex, comorbidity, and other covariates.

Results:
Both low income and poor adherence were independently associated with higher mortality (HR=1.51, 95% CI=1.49-1.54, lowest vs. highest income; HR=1.65, 95% CI=1.64-1.67, poor vs. good adherence). However, when stratified by combination of income and adherence (figure), excess risk by non-adherence gradually increased towards lower household income, especially in men. Excess risk for death by poor medication adherence was 117% (HR, 2.78 vs. 1.61, poor vs. good adherence) in lowest-income men and 59% in highest-income men. In women, risk difference by income was also present, but was not as prominent as in men. Excess risk for death by poor adherence was 75% (HR, 2.07 vs. 1.32, poor vs. good adherence) in lowest-income women and 54% in highest-income women. Similar findings were observed for CVD-related death also.

Conclusion:
Poor medication adherence is associated with higher mortality, but patients with low income are subject to greater excess risk by non-adherence. This highlights the potential importance of promoting adherence for risk reduction especially in low-income patients with hypertension.
Abstract P189: Blood Pressure Control Among Older Adults - Results From the Atherosclerosis Risk in Communities Study
Authors: Foti Kathryn , Appel Lawrence J , Matsushita Kunihiro , Koton Silvia , Walker Keenan , Coresh Josef , Selvin Elizabeth
Published: March 2019

Introduction:
Recent ACC/AHA guidelines recommend systolic blood pressure (SBP) treatment to <130 mmHg among adults ≥65 with hypertension, though treatment goals for older adults are controversial. Examining SBP levels and associated characteristics among a community-based sample of older adults should increase our understanding of contemporary hypertension management.

Hypothesis:
Among adults ≥65 with hypertension (BP ≥140/90 mmHg or on treatment), those with higher socioeconomic status and physical and cognitive functioning are more likely to meet the ACC/AHA SBP goal (<130 mmHg). It is uncertain whether comorbidities are associated with higher or lower SBP.

Methods:
We conducted a cross-sectional analysis at ARIC visit 5 which took place in 2011-2013; all participants were ≥65. We examined hypertension prevalence and the proportion of adults meeting different SBP goals overall and by demographic, lifestyle, and clinical factors. We used Poisson regression with robust variance to estimate prevalence ratios for SBP <130 mmHg.

Results:
Overall, 74.2% of 5,537 participants had hypertension. Among those with hypertension, 44.2% had SBP <130, 19.6% had SBP 130-<140, 18.2% had SBP 140-<150, and 18.1% had SBP ≥150 mmHg. The prevalence of SBP <130 mmHg was inversely related to age (
Table, see adjusted prevalence ratio
). Men, whites in Washington County, MD, those with higher income, overweight or obesity, diabetes, kidney disease, or cardiovascular disease were more likely, while blacks in Jackson, MS and those with probable dementia were less likely to have SBP <130 mmHg.

Conclusions:
Over 40% of participants met the ACC/AHA SBP goal. Only those in the highest income category were more likely to meet the goal. Those with comorbidities were more likely to meet the goal, which may reflect greater health care seeking, more intensive management, or BP-lowering comorbidities, such as heart failure. Our study highlights the burden of hypertension but shows SBP <130 mmHg has been achieved in a substantial proportion of older adults.
Abstract P191: Birth Weight and Risk of Hypertension: A Mendelian Randomization Study of 183433 Individuals from 60 Studies
Authors: Zheng Yan , Huang Tao , Wang Tiange , Mei Zhendong , Li Xiang , Qi Lu
Published: March 2019

Importance:
Epidemiology studies suggested that low birth weight is associated with a higher risk of hypertension in later life. However, little is known about the causality of such associations.

Objective:
To evaluate the causality of the association between low birth weight and hypertension risk in later life.

Design, Setting, and Participants:
We collected data from 60 studies with 183,433 participants (CHARGE-BIG consortium), and each study analyzed the data following a standard analytic protocol. We applied a Mendelian randomization analysis using a genetic risk score of low birth weight from seven SNPs as the instrumental variable to explore the possible causal association between birth weight and adulthood hypertension.

Main Outcomes and Measures:
Hypertension was defined as systolic blood pressure of 140 mmHg or higher, diastolic blood pressure of 90 mmHg or higher, or current use of antihypertensive medication.

Results:
A total of 70,874 hypertensive participants and 61,933 normotensive controls provided study-level data. In the meta-analysis, each additional risk allele in the risk score was associated with a 0.02 SD decrease in birth weight (p <0.05). Decreased birth weight was associated with a higher risk of hypertension in adults (odds ratio per 1 SD decrease in birth weight: 1.19, 95% confidence interval [CI]: 1.08 to 1.31), while no association was found between a genetic risk score of low birth weight and hypertension risk. The formal Mendelian randomization analysis suggested genetically instrumented birth weight was not associated with risk of hypertension (instrumental odds ratio for causal effect per 1 SD decrease in birth weight: 0.94, 95%CI 0.62 to 1.42). These findings were consistent across different strata of sex, body mass index, or race.

Conclusions:
Our findings suggest that the association of birth weight with hypertension from observational studies could be the result of confounding.
Abstract P198: Why is the 10-Year-ASCVD Risk Higher in Elevated Blood Pressure Group Than Stage-1 Hypertension Group Among Korean Population?
Authors: Jeon Yongwoo , Lee Ho Kyou , Kim Hyeon Chang
Published: March 2019

Introduction:
New guidelines in 2017 by ACC/AHA for evaluation of high blood pressure could be applied to Korean population. However, 10-year-ASCVD risk was higher in the people with elevated blood pressure(EBP) than with stage-1 hypertension(ST1) in Korea.

Methods:
We analyzed 53,746 Korean adults aged over 19 years from the each period section of Korea National Health and Nutrition Examination Survey in 10 years(IV(07’-09’), V(10’-12’), VI(13’-15’) and VII(16’)). The 10-year-ASCVD risk was calculated by using Pooled Cohort Equation modified for Korean population, and blood pressure categories by the new guideline were classified. We also compared the variables(age, total cholesterol, HDL-cholesterol, SBP, smoking, diabetes) of the equation for each blood pressure categories.

Results:
Mean 10-year-ASCVD risk was higher in EBP than in ST1. (7.0±0.5 vs 4.2±0.2 in VII; 6.3±0.3 vs 3.9±0.1 in VI; 5.7±0.3 vs 3.9±0.3 in V; 6.5±0.4 vs 3.8±0.1 in IV, EBP vs ST1 respectively) When comparing the variables in the equation, mean SBP was higher in EBP than ST1 among men, whereas mean age was higher in EBP than ST1 among women. Among ST1, those who have high diastolic blood pressure but without high systolic blood pressure was 74.0%(95%CI 69.8-78.1) in men.

Conclusion:
Higher 10-year-ASCVD risk in EBP could result from higher SBP than ST1 in men due to people with high DBP without high SBP in ST1, whereas higher age in women among Korean population.
Abstract P207: Frequent but Not Infrequent Potato Consumption is Associated With a Higher Risk of Coronary Artery Disease: the Million Veteran Program
Authors: Bodar Vijaykumar , Ho Yuk-Lam , Ward Rachel , Cho Kelly , Gagnon David , Gaziano Michael , Djousse’ Luc
Published: March 2019

Background:
Potato consumption is highly prevalent all around the world. Previous studies have reported a positive association of potato intake with hypertension and diabetes due to high glycemic load. However, data are scarce on potato consumption and risk of coronary artery disease (CAD).

Hypothesis:
We hypothesized that potato consumption is positively associated with risk of CAD.

Method:
We prospectively studied 148,671 participants from Million Veteran Program(MVP). We used a Willett food frequency questionnaire to assess consumption of baked, boiled, and mashed potatoes. The incidence of CAD was assessed through electronic health record. We used Cox Proportional hazard model to compute the hazard ratio and 95% confidence interval (95% CI) for CAD events across categories of potato intake.

Results:
The average age of men was 64 years ( SD = 12) and 90 % were men. A total of 6,309 new cases of CAD occurred during mean follow up of 2.7 ± 1.4 y. Median potato consumption was 1 cup/week. The crude incidence of CAD from lowest to highest categories of potato consumption was 14.1, 15.0, 15.2, 16.1, and 18.9 per 1000 person-years, respectively. Hazard ratios ( 95% CIs) of CAD were 1.00 ( reference), 1.01 (0.92-1.11), 1.02 ( 0.93-1.11), 1.04 (0.95 - 1.15), and 1.21 (1.07-1.36) for potato intake of <1 cup/month, 1-3 cups/month, 1 cup/week, 2-4 cups/week, and 5+ cups/week respectively, adjusting for age, gender, race, body mass index (BMI), alcohol consumption, exercise, smoking, overall diet quality, and education (P for linear trend = 0.01). The observed relation of potato consumption with CAD was not modified by age, BMI, gender, and ethnicity. In a sensitivity analysis, exclusion of CAD events occurred during the first year did not alter the findings.

Conclusion:
Frequent (5+ cups/week) but not infrequent potato consumption was associated with a higher risk of CAD among MVP participants.
Abstract P208: Demographic and Socioeconomic Determinants of Acute Myocardial Infarction Hospitalization Risks in Florida
Authors: Odoi Evah W , Nagle Nicholas , Zaretzki Russel , Jordan Melissa M , Kintziger Kristina W
Published: March 2019

Introduction:
A better understanding of the dynamics of the spatial relationships between myocardial infarction (MI) hospitalization risks and socioeconomic determinants of health (SDoH) is crucial more optimal targeting of efforts geared towards reducing cardiovascular health disparities and improving population health. The objectives of this study were to identify county-level SDoH of MI hospitalization risks, and to explore whether the associations between MI hospitalizations risks and its predictors varied with geographic location to determine if certain predictors are more important in specific geographic areas in Florida.

Methodology:
A multivariable global Negative Binomial Regression model (NBR) was used to identify county-level SDoH predictors of inpatient MI hospitalizations occurring in Florida between 2005 and 2014. A local Geographically Weighted Negative Binomial Regression model was then used to explore whether the associations between MI hospitalization risks and SDoH predictors identified in the global NBR model varied depending on geographic location in the state. The spatial distribution of MI hospitalization risks, significant SDoH predictors and non-stationary local regression coefficients were mapped using ArcGIS.

Results:
The risks of MI hospitalizations were significantly higher in counties with high proportions of residents with less than high school education (P < 0.0001) and divorced residents (P = 0.03). However, they were significantly lower in counties with high proportions of rural residents (P< 0.0001) and African Americans (P = 0.022), and marginally lower in counties with low rates of health insurance coverage (P = 0.056). The strength of associations between MI hospitalization risks and the proportion of population with less than high school education attainment and health uninsurance rate varied based on geographic location in Florida.

Conclusion:
Race, marital status, educational attainment, rurality and health insurance coverage were significant determinants of MI hospitalization risks in Florida. The strength of associations between MI hospitalization risks and education attainment and health insurance coverage were not constant across the state. These findings indicate that a one-size-fits-all approach is not appropriate for reducing the burden of MI and addressing geographic disparities in utilization of MI care in Florida. Rather, policies and interventions prioritizing identified SDoH factors should be tailored to location-specific community contexts to improve cardiovascular health in Florida.
Abstract P212: Higher Rates of Breastfeeding Mediate the Association Between the 2009 Wic Food Package Change and BMI Z-score at Age 4
Authors: Chaparro M. Pia , Anderson Christopher , Crespi Catherine M , Wang May C , Whaley Shannon E
Published: March 2019

Background:
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a federal nutrition assistance program which provides supplemental food and nutrition services to children 0-5 years and their mothers, living in low-income households. In October of 2009, WIC food packages were changed to be better aligned to the Dietary Guidelines of Americans.

Objective:
The objective of this study was to evaluate whether observed differences in children’s BMI z-scores (BMIz) at age 4 years between WIC participants enrolled before and after the 2009 policy change could be attributable to changes in the type of infant feeding package they were exposed to.

Methods:
Our sample is based on children enrolled in WIC in Los Angeles County, CA between 2003 and 2016, from birth to age 5, with infant package issuance data for 11 or more of the first 13 months of life. Infant package exposure was quantified by the number of months receiving the
fully breastfeeding
infant package (a proxy for exclusive breastfeeding). A mediation analysis was performed in which BMIz at age 4 was the outcome, WIC package (new vs. old) was the exposure, and the number of months receiving the
fully breastfeeding
infant package was the mediator. Mediation was assessed by a product of coefficients method, and confidence limits for the mediated effect were based on the non-normal distribution of the mediated effect, using the PRODCLIN program in SAS. Models were gender-stratified and adjusted for child race/ethnicity, maternal education and language preference, household poverty status, initial weight status, and whether the child had a sibling in the sample.

Results:
The sample consisted of 140,204 children. Boys and girls exposed to the new WIC package received the
fully breastfeeding
infant package for 1.40 and 1.45 months longer than boys and girls exposed to the old WIC package. Among boys, the new WIC package was associated with a 0.12 standard deviation lower BMIz at age 4 (SE 0.01, p <0.0001), whereas the corresponding number for girls was 0.07 (SE 0.01, p<0.0001). Number of months exposed to the
fully breastfeeding
infant package partially mediated the association between exposure to the new WIC food package (vs. old) and BMIz at age 4, explaining 22.1% of the total effect (95% CI 19.1-25.1) for boys and 34.4% of the total effect (95% CI 29.9-38.9) for girls.

Conclusions:
Longer exposure to the
fully breastfeeding
infant package seemed to explain part of the association between BMIz at age 4 and receiving the new (vs. old) WIC food package. The percent of the total effect mediated by months of
fully breastfeeding
exposure was greater in girls than in boys. Future revisions to the WIC packages that continue to support women to fully breastfeed are likely to have significant effects on childhood obesity.
Abstract P215: Adherence to the Healthy Eating Index-2015 May Reduce the Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality
Authors: Hu Emily A , Steffen Lyn M , Coresh Josef , Appel Lawrence J , Rebholz Casey M
Published: March 2019

Background:
The Healthy Eating Index-2015 (HEI-2015) score measures adherence to recommendations from the most recent
Dietary Guidelines for Americans
. The HEI-2015 was altered from the HEI-2010 by replacing the empty calories component with saturated fat and added sugar. Few studies have examined the association between the HEI-2015 score and incident cardiovascular disease (CVD), CVD mortality, and all-cause mortality.

Hypothesis:
We hypothesized that a higher HEI-2015 score, indicating better diet quality, would be associated with a lower risk of incident CVD, CVD mortality, and all-cause mortality.

Methods:
We conducted a prospective analysis of 12,135 participants aged 45-64 years from the Atherosclerosis Risk in Communities (ARIC) study. The HEI-2015 score (0-100) was computed using the average dietary intake assessed using food frequency questionnaires at visits 1 (1987-89) and 3 (1993-95) and divided into quintiles. Incident CVD, CVD mortality, and all-cause mortality were ascertained from baseline through December 31, 2016. We conducted Cox proportional hazards models adjusted for covariates to estimate hazard ratios (HR) and 95% confidence intervals (CI).

Results:
There were 4,163 cases of incident CVD, 1,429 cases of CVD mortality, and 5,173 cases of all-cause mortality over a median of 25 years of follow-up. Compared to participants in the lowest quintile of HEI-2015 score, participants in the highest quintile had a 12% lower risk of incident CVD (HR: 0.88, 95% CI: 0.79-0.98), 41% lower risk of CVD mortality (HR: 0.59, 95% CI: 0.49-0.71), and 25% lower risk of all-cause mortality (HR: 0.75, 95% CI: 0.69-0.83) after adjusting for covariates (
Table
). There were significant trends across quintiles of HEI-2015 score for all three outcomes. Results were consistent by subgroups (sex, smoking, diabetes, hypertension).

Conclusions:
Higher adherence to the
Dietary Guidelines for Americans 2015-2020
may reduce the risk of incident CVD, CVD mortality, and all-cause mortality among middle-aged adults in the U.S.
Abstract P221: Diet Quality and Incidence of Coronary Heart Disease and Coronary Revascularization Among US Women and Men With Hypertension
Authors: Raposo Sara , Satija Ambika , Forman John , Li Shanshan , Mukamal Kenneth , Lof Marie , Manson JoAnn , Hu Frank , Rimm Eric
Published: March 2019

Background:
Hypertension affects 45% of American adults and is a major risk factor for cardiovascular disease. Regrettably, about less than half of all affected individuals have their hypertension controlled. Healthy dietary patterns have been associated with a lower risk of cardiovascular disease in the general population. However, less is known about this association among individuals with hypertension.

Aim:
To study four diet quality scores, the alternate Mediterranean Diet (aMED) score; the alternate Healthy Eating Index 2010 (aHEI-2010); the Dietary Approaches to Stop Hypertension (DASH) score; and a Healthful Plant-based Diet Index (hPDI) and the incidence of coronary heart disease (CHD) and coronary revascularization (bypass, angioplasty or stent) among US women and men with hypertension.

Methods:
We included 22,270 women from the Nurses’ Health Study and 9,846 men from the Health Professionals Follow-up Study that had reported a professionally-diagnosed incident hypertension in 1988 or on subsequent biennial questionnaires. At inclusion, participants were free of other chronic diseases (CHD, coronary artery bypass/angioplasty/stent, angina, other heart disease, stroke, diabetes and cancer). Dietary data were collected every 4 years using a validated semi-quantitative food frequency questionnaire and covariate data were collected biennially. Using the cumulative average of dietary intake after hypertension diagnosis, we calculated hazard ratios (HR, 95% CI) comparing quintiles 5 to 1 of each diet quality score with multivariable Cox proportional hazards regression while adjusting for age, energy intake, alcohol (DASH and hPDI only), margarine (hPDI only), smoking, BMI, physical activity, family history of CHD, lipid-lowering medication, NSAIDs, postmenopausal hormone use (women) and hypertension medication.

Results:
We documented 922 incident CHD cases (299,520 person-years) and 1845 incident coronary revascularization cases (298,463 person-years) during follow-up. In pooled multivariable analyses, high adherence to all diet quality scores was inversely associated with risk of CHD (aMED: 0.73, 95% CI 0.59-0.91,
p
trend: <0.01; aHEI-2010: 0.66, 95% CI 0.53-0.82,
p
trend: <0.0001; DASH: 0.65, 95% CI 0.52-0.83,
p
trend: <0.0001; hPDI: 0.78, 95% CI 0.61-0.99,
p
trend: 0.01) and coronary revascularization (aMED: 0.83, 95% CI 0.71-0.96,
p
trend: 0.02; aHEI-2010: 0.80, 95% CI 0.69-0.94,
p
trend: <0.001; DASH: 0.88, 95% CI 0.75-1.03,
p
trend: 0.10; hPDI: 0.81, 95% CI 0.69-0.96,
p
trend: 0.07).

Conclusions:
This study suggests that individuals with hypertension may experience a lower risk of CHD and coronary revascularization with high adherence to healthy dietary patterns. Promoting healthy dietary habits among individuals with hypertension could be a cost-efficient and safe way to prevent the incidence of CHD and coronary revascularization.
Abstract P225: Hyperhomocysteinemia Mediates the Association of Food Deserts With Recurrent Heart Failure Hospitalizations
Authors: Nayak Aditi , Geng Siyi , Kalogeropoulos Andreas , Quyyumi Arshed A , Butler Javed , Morris Alanna A
Published: March 2019

Background:
Food deserts (FD) are low-income areas with low access to healthful foods. Prior studies have shown that a diet rich in fruits, vegetables and dairy products substantially lowers homocysteine (Hcy) levels by supplementing folate, vitamin B
12
, B
6
and choline intake. Since Hcy is an independent risk factor for cardiovascular disease, and may be abnormal in subjects living in a FD, we examined the impact of living in a FD on serum Hcy levels and the risk of recurrent heart failure hospitalizations (HFH).

Methods:
FD status was assessed using the USDA FD Research Atlas in 173 HF patients (mean age 57 ± 12 yrs, 63% male, 38% black), prospectively enrolled in the Atlanta Cardiomyopathy Consortium from 2007 to 2011. Hcy values were log-transformed (log
2
Hcy) for analysis. Linear regression was used to determine the association of FD with log
2
Hcy, and Poisson regression to examine the association of FD with risk of repeat HFH. Models were adjusted for age, gender, race, HF etiology, NYHA class, smoking status, EF, DM, hyperlipidemia, mean arterial pressure, BMI and serum creatinine.

Results:
Patients who lived in a FD (n=29) were younger (p=0.08) and more likely to be black (p<0.001). After adjusting for covariates, FD status was associated with higher log
2
Hcy levels (adjusted β estimate: 0.32, 95% CI: 0.11- 0.52, p=0.003). During a median follow-up of 827 (IQR 506, 1379) days, 60 (34.7%) subjects had at least 1 HFH. The overall frequency of HFH (40.9 vs. 29.2 per 100 patient-years) was higher in patients who lived in a FD. In a fully adjusted model, for each unit increase in log
2
Hcy, there were 1.98 (adjusted, 95% CI: 1.38-2.82, p<0.001) times more HFH. Living in a FD was associated with 1.46 (adjusted, 95% CI: 1.1-1.94, p=0.009) times more HFH. Addition of log
2
Hcy to the Poisson model eliminated the association of FD with recurrent HFH (adjusted HR: 1.14, 95% CI: 0.74- 1.76, p=0.54).

Conclusions:
Living in a FD is associated with higher serum Hcy. These results provide insights into the mechanisms by which FD status influences the risk of recurrent HFH.
Abstract P232: Better Dietary Quality is Associated with Lower Circulating Ceramide Concentrations in the Framingham Offspring Cohort
Authors: Walker Maura E , Xanthakis Vanessa , Moore Lynn L , Ramachandran Vasan , Jacques Paul F
Published: March 2019

Introduction:
Diet quality may alter cardiometabolic risk by the modification of circulating lipid species. Ceramides are a class of sphingolipid implicated in cardiometabolic risk. We hypothesized that a higher diet quality may be associated with lower plasma concentrations of three ceramide species.

Methods:
Diet quality was reflective of adherence to the 2010 Dietary Guidelines for Americans and was determined using the 2010 dietary guideline adherence index (DGAI-2010) score. The DGAI-2010 score is composed of 14 energy specific components and 11 healthy choice components. A higher score represents higher adherence with a maximum score of 100. We determined the average cumulative DGAI-2010, reflective of usual diet quality over 14 years. Plasma ceramide concentrations were assayed using a validated LC-MS/MS protocol. Participants of Framingham Offspring cohort (N = 2174; mean age, 66 years; 55% women) according to quartile of DGAI-2010 score. Multivariable linear regression was used to relate diet quality to plasma ceramide concentrations (C16:0, C22:0, and C24:0), and to ceramide ratios (C22:0/C16:0 and C24:0/C16:0). An initial model was adjusted for age, sex, smoking status, use of lipid-lowering medication, total energy intake, and physical activity, and then additionally for body mass index (BMI).

Results:
The median (IQR) DGAI-2010 score within each quartile was Q1: 49 (7), Q2: 58 (4), Q3: 65 (3), and Q4: 73 (6). On average participants in the highest quartile (Q4) of DGAI-2010 score were older, more likely to be a woman, less likely to smoke, were slightly more physically active, and had a lower BMI (P
trend
<0.05). The DGAI-2010 score was inversely associated with concentrations of the C16:0, C22:0, and C24:0 ceramides and the C22:0/C16:0 ratio (all P

trend

<0.05) but not the C24:0/C16:0 ratio (
Table 1
).

Conclusion:
Inverse relations of dietary quality and select circulating ceramide species may help elucidate how diet may influence cardiometabolic risk.
Abstract P239: Sugar-Sweetened Beverage Consumption and Risk of Type 2 Diabetes in African Americans: Findings From the Jackson Heart Study
Authors: Jackson Chandra L , Norwood Arnita F , Sims Mario , Jackson W. Braxton , Correa Adolfo , Malik Vasanti , Tucker Katherine L
Published: March 2019

Background:
There is a paucity of data investigating whether consumption of sugar-sweetened beverages (SSBs) is associated with an increased risk of type 2 diabetes (T2D) among African Americans. OBJECTIVE: To determine, in a prospective analysis, whether SSB consumption is associated with increased risk of T2D among African Americans. RESEARCH DESIGN AND

Methods:
Using a community-based prospective investigation of Jackson Heart Study adult participants from 2004 to 2010, we estimated risk of T2D by frequency of SSB consumption adjusting for age, sex, marital status, CVD, total energy intake, physical activity, smoking status, alcohol consumption, socioeconomic status, and body mass index (BMI) as a potential mediator.

Results:
Among 3,223 study participants, the mean age was 53±12.5 years, 63% were women, and 66% had at least a college education. Total energy intake, and intakes of carbohydrates, fat, sugar and caffeine increased with increasing SSB consumption, and 21% of participants consumed ≥1 SSB per day. Mean follow-up was 7.5 years with 24,124 person-years, and there were 561 cases of incident diabetes. After age and sex adjustment, SSB consumption was not significantly associated with T2D risk: hazard ratio (HR): 1.61 [95% confidence interval (CI): 0.58-4.48] for 1-4 times/month, HR: 1.77 [95%CI: 0.66-4.76] for 2-6 times/week, and HR: 1.81 [95%CI: 0.67-4.85] for ≥ 1/day (p for trend=0.291) compared to <1/month. In fully-adjusted models, associations remained positive but non-significant and adjustment for BMI attenuated the associations minimally (≤3%).

Conclusions:
Although HRs tended to increase with higher intake, the frequency of SSB intake was not significantly associated with risk of T2D in African Americans. Larger studies in this population with consideration of other aspects of the diet are warranted.
Abstract P240: Sugar-Sweetened Beverage Intake and Cardiovascular Disease Risk in the California Teachers Study
Authors: Pacheco Lorena S , Lacey James V , Martinez Maria E , Lemus Hector , Anderson Cheryl A
Published: March 2019

Introduction:
Previous observational studies have shown a positive association between sugar-sweetened beverage (SSB) consumption and cardiovascular disease (CVD) risk, but many have been relatively short-term.

Objective:
To determine the association of SSB consumption over a 20-year period and incident CVD in a large prospective cohort of middle-aged women.

Methods:
Data are from the California Teachers Study, a US based longitudinal cohort comprised of 133,477 female teachers and administrators who were active or recently retired members of the California State Teachers Retirement System in 1995. After excluding those with a history of CVD and type 2 diabetes mellitus at baseline, our analytic sample was 107,905. SSB consumption constituted regular soft drinks, sweetened bottled waters and teas, and fruit drinks (other than fruit juice) and was derived from a self-administered Block95 food frequency questionnaire. SSB consumption was divided into four categories: Rare or never, >rare/never to <1 serving per week, ≥1 serving per week to <1 serving per day, and ≥1 serving per day. CVD endpoints were based on annual linkage with statewide hospitalization records, defined as first occurrence of myocardial infarction, coronary artery bypass grafting (CABG) or stroke following the International Statistical Classification of Diseases 9
th
and 10
th
Revision coding system. Cox proportional hazards models were used to assess the association between SSB consumption and incident CVD, after adjusting for potential confounders and mediators.

Results:
Of a total of 8,946 CVD incident cases over 20 years, the majority were strokes (5,728). In an age-adjusted model, we observed increased hazard ratios (HR) for CVD (HR 1.24 [95% CI 1.11, 1.38]), CABG (HR 1.39 [95% CI 1.13, 1.71]), and stroke (HR 1.21 [95% CI 1.05, 1.39]) events in women who consumed ≥1 serving/day vs those who rarely/never consumed SSBs. Our fully adjusted model included age, smoking, alcohol intake, physical activity, multivitamin and aspirin use, menopausal status, hormone replacement therapy, oral contraceptive use, history of hypertension, body mass index, fruit and vegetable intake, and total energy intake. This model slightly attenuated the hazard for CVD (HR 1.20 [95% CI 1.07, 1.35]), CABG (HR 1.25 [95% CI 1.00, 1.06]), and stroke (HR 1.18 [1.01, 1.37]) in women who consumed ≥1 serving/day in comparison to women that rarely/never consumed SSBs.

Conclusions:
If this finding is replicated, SSB consumption might be a modifiable dietary target to reduce risk of CVD among women.
Abstract P251: Association Between Different Measures of Obesity and Kidney Function Decline
Authors: Yu Zhi , Grams Morgan E , Ndumele Chiadi E , Wagenknecht Lynne , Boerwinkle Eric , North Kari , Rebholz Casey M , Giovannucci Edward L , Coresh Josef
Published: March 2019

Introduction:
Obesity has been related to increased risk of incident cardiovascular disease, diabetes, and mortality as well as chronic kidney disease (CKD). However, the effect of obesity on long-term kidney function and whether it differs by gender and race are not known.

Hypothesis:
Obesity status is associated with future decline in kidney function.

Methods:
Obesity was measured by baseline body mass index (BMI), waist to hip ratio (WHR), and predicted percent fat (PPF) among 14,020 White (W) and African-American (AA) men and women (M/F) in the Atherosclerosis Risk in Communities (ARIC) study who were diabetes-free, had BMI > 18.5 kg/m
2
, and had estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73 m
2
at baseline. Obesity was categorized into tertiles within each race-sex group. PPF was derived using anthropometric prediction equations including information on age, race, weight, height, and waist circumference. Mixed models with random intercepts and random slopes were used to evaluate the association between baseline obesity status and eGFR trajectories (calculated from serum creatinine at 5 visits). Cox proportional hazards models were used to estimate the hazard ratios (HRs) of end-stage kidney disease (ESKD) associated with baseline obesity status.

Results:
At baseline, participants had a mean age of 54 years, median eGFR of 103 ml/min/1.73 m
2
, and median BMI of 27 kg/m
2
. Over 30 years follow-up, all obesity measures showed some associations with more rapid eGFR decline with PPF showing the most consistent associations across race-sex subgroups (
Table
). All obesity indicators were associated with increased risk of ESKD for all race-sex groups (p trend<0.05). For example, the HRs (95% CI) of ESKD per SD of PPF were 1.20 (1.05, 1.37) for WM, 1.54 (1.31, 1.80) for WF, 1.67 (1.45, 1.92) for AAM, and 1.62 (1.42, 1.84) for AAF.

Conclusion:
In summary, obesity status is a risk factor for future decline in kidney function and development of ESKD in community-dwelling adults with PPF showing some advantages over BMI and WHR.
Abstract P253: The Association of Goal-Striving Stress With Measures of Adiposity in the Jackson Heart Study
Authors: Cain Loretta R , Glover LáShauntá , Joseph Joshua , Bertoni Alain , Sims Mario
Published: March 2019

Introduction:
Obesity is a public health epidemic, with a US prevalence of 39.8%. African Americans (AAs) have an even greater prevalence of obesity (46.8%), when compared to non-Hispanic whites at (37.9%). Behavioral risk factors, such as poor diet and sedentary lifestyle, are important antecedents to obesity, but psychosocial risk factors such as stress and perceived discrimination are also determinants of obesity. Goal-striving stress, (GSS), the difference between aspiration and achievement, weighted by the level of disappointment if goals are not reached, may be an important stressor among AAs that may influence measures of adiposity; however, this has yet to be explored. The objective of this study was to examine the relationship between GSS and measures of adiposity in AAs.

Hypothesis:
GSS is positively associated with measures of adiposity, including BMI, waist circumference, waist-to-height ratio (WHR), and neck circumference.

Methods:
We analyzed data from the baseline exam of the Jackson Heart Study (JHS; n=5306), an AA sample of women and men, 35-84 years old. GSS was derived assessing the difference between aspiration for the following year and current achievement (both using a 10-point scale), weighted by a disappointment is achievement is not reached, using 4-point scale. GSS was then divided by the standard deviation (SD) (5.05) to create GSS-SD units. BMI was measured in kg/m
2
and waist and neck circumference was measured in cm. WHR was derived from waist circumference and height measured in cm. We excluded participants with missing data on GSS, measures of adiposity, and covariates. Spline regression analyses were used to obtain the coefficient. Models were adjusted for sex, age, socioeconomic status, alcohol, smoking, physical activity, nutrition, hypertension, diabetes, history of cardiovascular disease, and discrimination.

Results:
There were 4360 participants included in this analysis; 64.29% female with a mean (± SD) age of 55.47 (± 12.57) years and mean BMI of 31.85 (±7.20) kg/m
2
, mean waist circumference of 100.75 (±16.14) cm, mean WHR of 59.80% (± 9.78), and mean neck circumference of 38.53 (±3.76) cm. After full adjustment, significant results show a positive association of GSS with waist circumference (b=1.30; p=0.0418) and WHR (b=0.80; p=0.0299). GSS was not associated with BMI or neck circumference.

Conclusion:
GSS was positively associated with measures of adiposity, specifically waist circumference and WHR. Potential interventions should consider the extent to which GSS may contribute to increases in adiposity. Also, future research should explore the longitudinal associations of GSS with measures of adiposity.
Abstract P261: Dietary Sodium, Potassium, and Blood Pressure in Normotensive Pregnant Women: The National Health and Nutrition Examination Survey
Authors: Lane-Cordova Abbi D , Scheider Lara R , Tucker William , Cook James , Wilcox Sara , Liu Jihong
Published: March 2019

Dietary sodium, potassium, and the sodium-to-potassium ratio are linearly associated with blood pressure in non-pregnant adults in a dose-response manner. Earlier investigations suggested null or inverse associations of sodium and blood pressure during normotensive pregnancy, but this finding has not been confirmed in a large, racially diverse group while accounting for counteractive effects of dietary potassium. Our purpose was to determine associations of blood pressure with sodium, potassium and the sodium-to-potassium ratio in normotensive pregnant women. We used cross-sectional blood pressure measurements and dietary data from 984 normotensive pregnant women in multiple cycles of the National Health and Nutrition Examination Survey (mean age=27.6 ± 0.2 years). We used Kruskal-Wallis tests to determine differences in blood pressure across quartiles of sodium intake and linear regression to test for associations of sodium, potassium, and the sodium-to-potassium ratio with systolic and diastolic blood pressure. Adjustment variables included: age, race, education, marital status, body mass index, smoking, and month of pregnancy. Average duration of pregnancy was 5.6 ± 0.1 months with no difference between quartiles of sodium intake. There was no difference in unadjusted systolic or diastolic blood pressures across quartiles of sodium intake; Quartile 1: 106/56; Quartile 2: 106/55; Quartile 3: 107/57; Quartile 4: 107/56, p>0.60 for all, and no difference in age and race-adjusted systolic or diastolic blood pressures across quartiles of dietary intake, Figure 1. In adjusted regression analyses, sodium (
b
=0.16, 95%CI: -0.20, 0.52) and potassium (
b
=0.18, 95%CI: -0.24, 0.60) intake and the sodium-to-potassium ratio (
b
= -0.54, 95%CI: -1.55, 0.47) were not associated with systolic or diastolic blood pressure in normotensive pregnant women. Results were similar in analyses stratified by race/ethnicity. Blood pressure may be insensitive to sodium and potassium intake during normotensive pregnancy.
Abstract P283: Serum Metabolites and Cardiac Death in Patients on Hemodialysis
Authors: Hu Jiun-Ruey , Grams Morgan E , Coresh Josef , Hwang Seungyoung , Kovesdy Csaba , Guallar Eliseo , Rhee Eugene P , Shafi Tariq
Published: March 2019

Introduction:
Cardiovascular death is the leading cause of mortality in patients on hemodialysis. Traditional risk factors such as diabetes and hypertension do not fully account for this excess risk. Toxic metabolites that accumulate in renal failure may be responsible for accelerated cardiovascular disease, but these metabolites remain undefined.

Hypothesis:
The goal of this pilot study was to determine if an untargeted metabolomic approach could identify metabolites associated with cardiac death in dialysis patients.

Methods:
In this matched case-control study nested in the HEMO study, cases experienced cardiac death vs. were alive, respectively, at 12 months after enrollment. Cases and controls were matched on sex, race, diabetes, cardiac disease, age, and albumin. Cardiac death included death from ischemic heart disease, heart failure, and arrhythmias. Serum samples frozen at the 4 month visit were profiled by mass spectrometry. Conditional logistic regression assessed each metabolite’s association with cardiac death.

Results:
A total of 47 cases and 47 controls were studied. 777 metabolites available for analysis after data preprocessing. At the p<0.005 threshold, several metabolites were positively associated with cardiac death, and several metabolites were negatively associated with cardiac death. However, no metabolite had significant associations using false discovery rate thresholds.

Conclusions:
Our study is an example of the use of metabolomics as a strategy for identification of metabolites that may explain the high risk of cardiac death in patients undergoing hemodialysis.

Figure 1: Odds ratio for 1-year risk of cardiac death per doubling of metabolite level for each metabolite in the HEMO Study