bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P057: High Risk for the Development of Type 2 Diabetes Mellitus in Patients With Coronary Artery Disease
Authors: Saely Christoph H , Vonbank Alexander , Rein Philipp , Drexel Heinz
Published: July 2021

Introduction and Hypothesis:
Diabetes mellitus is a major risk factor for coronary artery disease (CAD); the important question whether conversely CAD confers an increased risk for future diabetes has not been studied so far and is addressed in the present study.

Methods:
We prospectively recorded incident diabetes over 7.5 years in 506 consecutive non-diabetic Caucasian patients undergoing coronary angiography for the evaluation of stable CAD, covering 3795 patient years.

Results:
During follow-up, 107 patients developed diabetes, i.e. 21.1% of the study population or 2.8% per year. Patients with significant CAD (n = 293) were at a 33% (p = 0.027) increased diabetes risk compared to subjects who did not have significant CAD at the baseline angiography. In search for the factors predisposing to diabetes we identified the metabolic syndrome (MetS) stigmata low HDL cholesterol (OR 1.97 [1.24-3.12]; p = 0.004), high triglycerides (OR = 2.01 [1.26-3.20]; p = 0.004), large waist (OR 2.55 [1.61-4.05]; p <0.001 using the NCEP-ATPIII, 2.10 [1.24-3.54]; p = 0.005 using the IDF cut-off values), and elevated fasting glucose (OR = 3.86 [2.33-6.38]) as well as the clinical entity of the MetS (OR 2.91 [1.83-4.64]; p <0.001) to be powerful predictors of diabetes. Consequently, the relationship between CAD and incident diabetes was attenuated after adjustment for the MetS status. Statin use was not significantly associated with diabetes incidence.

Conclusions:
The presence of CAD indicates a strongly increased risk for incident diabetes. Repeated diabetes screening of coronary patients and targeted programs to prevent diabetes in these high-risk patients are warranted.
Abstract P067: HDL Particles, Immune Activation, Inflammatory and Coagulation Markers in Relation to CVD and All-Cause Mortality Among Adults Aged 80+
Authors: Mackey Rachel H , Hughes Timothy M , Tracy Russell P , Newman Anne B , Chang Yuefang , Lopez Oscar L , Kuller Lewis H
Published: July 2021

HDL particles, particularly small HDL particles, may be more functional (e.g. anti-inflammatory) than large HDL particles which carry more cholesterol, but levels are little affected by recent HDL-raising therapies that substantially raised HDL-C without decreasing CHD. Furthermore, lower levels of total and small HDL particles predict CHD and CVD, but have not been evaluated among elderly adults, for whom lipids are generally not positively related to CVD. Therefore, we hypothesized that among adults aged 80+, incident CVD and all-cause CVD mortality would be related to lower levels of total and small HDL particles in addition to higher levels of coagulation, inflammation and immune response biomarkers. Participants (n=162) without dementia at baseline (2001-2002) were followed through 2011 for incident CVD and total mortality. Concentrations of HDL particles (HDL-P) were measured by NMR spectroscopy (LipoScience, Inc), D-dimer, IL-6, sCD-14, and sIL-2r were measured using ELISA (R&D Systems), and soluble receptors sIL6r, and sTNFr1/r2 were measured by Multiplex Panel (Millipore) on stored baseline plasma. Among adults with mean age=83.5 years at baseline, both CVD and total mortality over 8 years follow-up (mean= 5.2 years) were associated with lower baseline levels of total and small HDL-P (but not HDL-C, large HDL-P or larger mean HDL particle size), and higher levels of IL-6, sTNFr1 and sTNFr2 (Table). Total mortality was also associated with higher levels of D-dimer and sIL2r. In Cox models adjusted for age, sex and lipid-lowering medication, lower small HDL-P remained inversely associated with total and CVD mortality, with HR (95%CI) for Q1 vs. Q4 = 3.35(1.30, 8.62) and 5.39 (1.15, 25.34) respectively, and higher IL-6 remained associated with CVD mortality HR(95% CI) for Q4 vs. Q1= 5.22 (1.10, 24.75). Among adults aged 80+, higher IL-6 and lower total and small HDL-P levels were associated with incident CVD and total mortality over 8 years, suggesting an important anti-inflammatory role for HDL particles in late life.
Abstract P078: Accelerated Coronary Atherosclerosis in Postmenopausal Women with Claudication - Data from Women’s Angiographic Vitamin and Estrogen (WAVE) Trial
Authors: Jhamnani Sunny , Patel Dhavalkumar , Xue Zhenyi , Silverman Angela , Lindsay Joseph
Published: July 2021

Introduction:
Claudication, a manifestation of peripheral artery disease (PAD), and coronary artery disease (CAD) often coexist. Both are thought to be due to atherosclerosis. The presence of PVD in patients with CAD is associated with an increased incidence of adverse cardiac events. It is not clear, however, if this increased risk is associated with a more rapid progression of coronary atherosclerosis in patients with CAD.

Hypothesis:
We assessed the hypothesis that the increased cardiovascular risk associated with PAD in patients with CAD is due to an increased progression of atherosclerosis.

Methods:
The Women’s Angiographic Vitamin and Estrogen (WAVE) trial evaluated the effects of hormone replacement therapy and antioxidant vitamins in postmenopausal women with known CAD. In WAVE, 320 women underwent careful clinical follow-up for 2.8 years and had entry and exit quantitative coronary angiograms. The degree of coronary narrowing was blindly assessed. We looked at the incidence of clinical events and changes in angiographic coronary luminal diameter between women who had claudication and those who did not.

Results and Conclusion:
Women with claudication were more likely to be current smokers and hypertensive. Prior to WAVE, they had had more cerebrovascular accidents. Those with claudication had more rapid progression of coronary narrowing (Table). The difference in previously diseased segments remained significant after multivariate adjustment for baseline differences and traditional cardiovascular risk factors. The presence of claudication was not associated with a risk-adjusted increase in all-cause mortality and myocardial infarction, which may be a reflection of the low power of the cohort. In conclusion, after 2.8 years of follow-up, a history of claudication was associated with a more rapid progression of coronary narrowing.
Abstract P097: Consumption of Branched Chain Amino Acids and Risk of Coronary Heart Disease in US Men and Women
Authors: Qi Qibin , Rexrode Kathryn , Rimm Eric , Willett Walter , Manson JoAnn , Hu Frank , Qi Lu
Published: July 2021

Background
Plasma concentrations of branched chain amino acids (BCAAs; valine, leucine, and isoleucine) have recently been associated with risk factors for coronary heart disease (CHD), including obesity and type 2 diabetes. Diet is the only source of these essential amino acids in humans. However, it is unknown whether dietary BCAA intake is associated with risk of CHD.

Methods and Results
The present study included 74,275 women and 44,421 men from two prospective cohorts: the Nurses’ Health Study (NHS) and Health Professionals Follow-up Study (HPFS) who were free of diagnosed cardiovascular disease, diabetes or cancer at baseline. We documented 3,060 incident CHD events (including nonfatal myocardial infarction and fatal CHD) during 24 years follow-up of the NHS and 4,128 incident CHD events during 22 years follow-up of the HPFS. BCAA intake was calculated by summing intakes of valine, leucine, and isoleucine estimated from food frequency questionnaires obtained every 4 years. After adjustment for age, ethnicity, smoking, physical activity, alcohol consumption, family history of myocardial infarction, history of hypertension and hypercholesterolemia, aspirin use, menopausal status (women only), glycemic load, intakes of total energy, cereal fiber, fruits, vegetables, saturated fat, polyunsaturated fat and trans fat, BCAA intake was significantly associated with increased risk of CHD in women (for highest vs lowest quintiles of BCAA intake, hazard ratio [HR] = 1.40 [95% CI 1.21-1.62]; P for trend <0.001), men (HR = 1.15 [1.02-1.29]; P for trend =0.01) and combined by meta-analysis (HR = 1.24 [1.13-1.36]; P for trend <0.001). Adjustment for body mass index and diabetes status attenuated the association but the result remained significant in the combined samples (HR = 1.13 [1.04-1.24] for highest vs lowest quintiles of BCAA intake; P for trend =0.008). In separate analyses, intakes of individual BCAA (leucine, isoleucine, and valine) were each associated with increased risk of CHD.

Conclusions
Our data suggest that higher consumption of BCAAs is associated with moderately increased risk of CHD in women and men and the association is partly explained by obesity and diabetes status.
Abstract P098: The Association Between Obesity Status and Long-Term Adherence to Mediterranean Diet in the PREDIMED Trial
Authors: Cohen Jessica , Rimm Eric B , Martínez-González Miguel A , Salas-Salvadó Jordi , Covas María I , Corella Dolores , Lamuela-Raventós Rosa M , Estruch Ramón ,   on behalf of the PREDIMED Study Investigators
Published: July 2021

Background:
The aim of this study was to determine if long-term adherence to a prescribed diet, in the context of the PREDIMED trial, a multi-year, randomized, controlled trial, was different among obese and non-obese participants after an average follow-up of three years. Previous studies only examined short term compliance or were not sufficiently powered to compare obese with nonobese participants.

Methods:
This randomized clinical trial included 6,463 subjects. All subjects were asymptomatic; females aged 55-80 years and males 55-80 years and were at high-risk for cardiovascular disease at baseline. Participants’ characteristics were measured at baseline and every 12 months. Obesity was defined as having a BMI of 30kg/m2 or more. The main outcome measure was achieving an average score of 10 points or more on a validated 14-point Mediterranean diet adherence scale over follow-up.

Results:
In all three dietary intervention groups, obesity status was significantly inversely associated with adherence to the Mediterranean diet; In the olive oil group, the odds ratio of obtaining a score of 10 or more was 23.4% (95% CI: 6.3, 37.5%) lower for obese subjects than for non-obese subjects after an average follow-up of three years. A similar pattern was also seen in the nuts group; the odds of obtaining a score of 10 or more was 24.3% (95% CI: 5.1,39.6%) lower for obese subjects than for non-obese subjects. In the low fat group, subjects who were obese at baseline had 25.7% (95% CI:5.7, 40.8%) lower odds of obtaining a score of 10 or more on the adherence score. All models were adjusted for relevant covariates.

Conclusion:
In this long-term trial of the Mediterranean Diet, adherence was high across all intervention groups. However, adherence was appreciably lower among obese participants after three years. Additional intervention efforts may be necessary to achieve the same adherence among high-risk obese individuals.
Abstract P112: Peripheral Arterial Disease and Carotid Atherosclerosis among Middle-aged Women Living in Chiapas, Mexico: Preliminary Results
Authors: Ortiz-Panozo Eduardo , Lajous Martin , Yunes-Díaz Elsa , Mercado Nataly , Luviano Andrea , Flores-Silva Fernando , Dircio-Delgado Vidal , Cantu-Brito Carlos , Catzin-Kuhlmann Andres , López-Ridaura Ruy
Published: July 2021

Background:
Mexico is undergoing a fast-paced epidemiological and nutritional transition. Evaluating the presence of early cardiovascular disease and understanding risk factors leading to it in this context may provide insight on prevention strategies for the growing burden of this disease in developing countries.

Methods and Results:
We evaluated subclinical cardiovascular disease in 443 women aged ≥40 years in an urban and a rural site in Chiapas, Mexico. All women were participants in the ongoing ESMaestras cohort, a prospective study of 116,683 Mexican female teachers, which started in 2006-2008. In September 2012, an evaluation of subclinical cardiovascular disease was undertaken in a sub-cohort of 2,000 ESMaestras participants. We present preliminary results from this initial effort. Women were invited to a clinical site where ankle-brachial index (ABI) were measured by previously standardized personnel using the automated VaSera VS-1000 sphyngmomanometer. Carotid intima-media thickness (IMT) was assessed by a neurologist. In 52 participants IMT measurements were repeated to assess the reproducibility of the measurements. Mean age was 48.1 (SD 4.2) and mean body mass index (BMI) was 28.7 kg/m2 (SD 4.7). Mean ABI was 1.06 (SD 0.09) and peripheral artery disease (ABI of <0.90), was present in 4.1% of participants. Mean IMT was 0.68 mm (SD 0.08) and the prevalence of carotid atherosclerosis (IMT ≥1.2 mm) was 1.9%. The intraclass correlation to assess reproducibility of IMT measurements was 0.89 (95% confidence interval 0.82-0.94). Pearson’s correlation coefficients for IMT and BMI (n=312) and ABI and BMI (n=443) were 0.25 (p<0.001) and -0.17 (p<0.001), respectively. No differences were observed between the urban and rural site.

Conclusions:
In an initial effort to characterize subclinical cardiovascular disease we found a relatively high prevalence of peripheral arterial disease in a middle-aged population of Mexican women, underlining the increasing burden cardiovascular disease in this population.
Abstract P116: Trait Anger Increases Short-term and Long-term Risk for Recurrent CHD: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Williams Janice E , Wyatt Sharon B , Rose Kathryn M , Couper David J , Kucharska-Newton Anna
Published: July 2021

Though several large epidemiologic studies have demonstrated the positive association of anger with coronary heart disease (CHD) onset, a dearth of population-based evidence exists regarding the relationship of anger to the clinical course of CHD among people with established disease. Trait anger is conceptualized as a stable personality trait and defined as the tendency to experience frequent and intense anger. Therefore, it is plausible that the effects of trait anger on CHD are long standing. We assessed the hypothesis that trait anger predicts short-term and long-term risk for recurrent CHD among middle-aged men and women. Participants were 611 black or white men and women, ages 48 - 67, who had a history of CHD at the second clinical examination (1990-1992) of the Atherosclerosis Risk in Communities (ARIC) Study. They were followed for the recurrence of CHD (myocardial infarction or fatal CHD) from 1990 through three different time intervals: 1995, 2003, and 2009 (maximum follow-up = 19.0 years). Trait anger (measured at Visit 2) was assessed using the Spielberger Trait Anger Scale, with scores categorized as high, moderate, and low. Cox proportional hazards regression analyses were adjusted for age, sex, race-center, educational level, waist-to-hip ratio, plasma LDL-and HDL-cholesterol levels, hypertension, diabetes, cigarette smoking status, and pack-years of cigarette smoking. After 3 - 5 years of follow-up, the risk for recurrent CHD among participants with high trait anger was more than twice that of their counterparts with low trait anger (2.24 [95% C.I: 1.14 to 4.40]). After 11 - 13 years, the risk was 80% greater (1.80 [95% C.I: 1.17 to 2.78]) and after 17 - 19 years, it was 70% greater (1.70 [95% C.I: 1.15 to 2.52]). The risk for recurrent CHD was strongest in the first time interval but remained strong and statistically significant through 19 years of follow-up. In conclusion, the experience of frequent and intense anger increases short-term and long-term risk for recurrent CHD in middle-aged men and women.
Abstract P123: The Association of Inflammatory Markers with Subsyndromal Depression the Multi-Ethnic Study of Atherosclerosis
Authors: Camacho Alvaro
Published: July 2021

Objective.
Subsyndromal (mild) depression can be a disabling condition that has been associated with increased cardiovascular risk, yet mechanisms governing this association are unclear. Some studies indicate that clinical depression is associated with higher levels of inflammation, yet this association has not been explored in subsyndromal depression. Therefore we examined the association between inflammatory markers and subsyndromal depression.

Methods.
Blood levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF) were measured in a cross-sectional analysis of 6814 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). Based on scores from the Center for Epidemiologic Studies Depression Scale (CES-D), participants were classified as depressed (≥16), subsydromally depressed (8-15), or normal (<8). The inflammatory markers were highly skewed and, therefore, log-transformed. Inflammatory markers with subsyndromal and depression groups were entered into multivariable regression model adjusting for demographic, behavioral, biological and comorbid confounders.

Results.
The mean age was 62.1 (SD=10.2) and 53% were women. Twenty four percent had subsyndromal depression and 13% were depressed. Thirty nine percent were Caucasian, 28% were African-American, 22% Hispanic and 12% Chinese-American. In unadjusted analyses, and compared to normals, there was a suggestion oftrend towards a significant association of subsyndromal depression with
ln
CRP (β=0.06
p
=0.06), but not
ln
IL-6 (β= 0.03
p
=0.18) or
ln
TNF (β= 0.05
p
=0.23). Moreover, there was a significant association of depressed individuals with
ln
CRP (β= 0.06
p
<0.001
)
and
ln
IL-6 (β= 0.10
p
<0.001), but not for
ln
TNF (β= 0.05
p
=0.23). After adjusting for demographics, the association of depression with
ln
CRP was attenuated (β= 0.00
p
=0.96
)
but remained significant for
ln
IL-6 (β= 0.06,
p
=0.01
).
Final adjustment for smoking, alcohol intake, walking for exercise, as well as for BMI, lipids, glucose, blood pressure, comorbid antihypertensives and antidepressants resulted in non-significant associations of depression with
ln
CRP (β= -0.06,
p
=0.13
)
and
ln
IL-6 (β=0.02,
p
=0.45
)
.

Conclusion.
While there is no association between subsyndromal depression and inflammatory markers, the significant association of depression with CRP and IL-6 appears to be explained by various biological and behavioral covariates. Future studies are needed to examine the association of novel inflammatory markers with the different spectrum of mood states.
Abstract P124: Unfair Treatment and Prevalent Hypertension among Women: Data from the Women’s Health Study
Authors: Akinkuolie Akintunde O , Slopen Natalie , Glynn Robert J , Jacobs Aryana S , Williams David R , Buring Julie E , Albert Michelle A
Published: July 2021

Background:
Discrimination is recognized as a chronic psychological stressor related to poor health outcomes. However, investigations about lifetime discrimination and hypertension (HTN), a major risk factor for cardiovascular disease (CVD) have yielded mixed results. Data are limited by small sample size and lack of studies involving women. Therefore, we assessed the association between unfair treatment (UT), a form of discrimination, and prevalent HTN in women.

Methods and Results:
In this cross-sectional analysis, we used data from women the Women’s Health Study follow-up cohort who responded to questions about UT (n= 30,873; mean age 69 years). HTN was defined as:a physician’s diagnosis of HTN, the use of anti-hypertensive treatment or self-reported systolic blood pressure (BP) ≥ 140 mmHg, or diastolic BP ≥ 90 mmHg. UT asked about experiences over their lifetime in 4 domains [obtaining housing, getting a job, being fired/not promoted, being stopped/questioned by the police; response (yes/no) to each question was used to compute an UT score (range 0-4; coded in 3 categories: 0 (reference), 1, and 2-4 domains). Logistic regression models estimated the likelihood of HTN if treated unfairly. Among WHS participants, the prevalence of HTN was 67% (20,808 of 30,873); and, 15% (4,614 of 30,873) of women reported UT in at least one domain. In the crude model, increasing UT score was associated with increasing relative odds of HTN (1.01 and 1.26 for 1 and 2-4 domains, vs 0;ptrend=0.03); adjustment for age, race/ethnicity and socioeconomic status (education and income) strengthened the magnitude of observed association (1.00, 1.16, 1.36; ptrend<0.0001). This association was attenuated in a fully adjusted model additionally accounting for factors that may lie in the mechanistic pathway including smoking status, diabetes, physical activity, alcohol use, history of hyperlipidemia, use of hormone replacement therapy, and body mass index (1.00, 1.00, 1.18, ptrend=0.32).

Conclusion:
These data are hypothesis generating in that they suggest UT is related to hypertension, a potent risk factor for CVD. Additional research is needed to better understand the influence of UT for cardiovascular health disparities in the United States.
Abstract P153: Genetic Linkage and Association of Echocardiographic Measures in the Fels Longitudinal Study
Authors: Choh Audrey C , Lee Miryoung , Curran Joanne E , Demerath Ellen W , Dyer Thomas D , Bellis Claire , Siervogel Roger M , Blangero John , Towne Bradford , Czerwinski Stefan A
Published: July 2021

Measures of cardiac structure such as left ventricular mass (LVM) have been shown to be significantly heritable. Relative to other complex traits, however, gene variants influencing echocardiographic traits have been less frequently identified. In this study of subjects from the Fels Longitudinal Study, our aim was to perform quantitative trait linkage and genome-wide association (GWA) analyses on LVM, relative wall thickness (RWT), fractional shortening (FS), aortic root diameter (ARD), and LVM index (LVMI; LVM/height
2.7
).

The study sample consisted of 1,060 (467 male, 593 female) whites aged 8-97 years from 131 families. Variables were inverse normal transformed for all analyses. Each subject was genotyped with the Illumina Human 610-Quad BeadChip containing more than 550,000 single nucleotide polymorphism (SNP) markers. Variance-component linkage analyses were conducted using a subset of 17,561 genome-wide SNP markers in genetic equilibrium with each other. GWA analyses were conducted using all SNPs and the measured genotype method implemented in SOLAR, allowing for residual non-independence among relatives

After adjusting for covariates of age, sex, BMI, and population stratification, all echocardiograpic traits were significantly heritable (p < 0.00006);

h
2

(SE) for LVM, LVMI, RWT, FS, and ARD were 0.28 (0.07), 0.36 (0.07), 0.22 (0.07), 0.27 (0.06), and 0.55 (0.06), respectively. Linkage analyses revealed significant linkage of LVMI to chromosome 1p31 (LOD=3.64 at 96cM) in a region where the
LEPR
(leptin receptor),
PDE4B
(phosphodiesterase 4B, cAMP-specific),
NEGR1
(neuronal growth regulator 1), and
TNNI3K
(TNNI3 interacting kinase) genes are located. For ARD, we identified chromosomal region 13q14 (LOD = 3.88 at 45cM) which harbors the
FOXO1
(forkhead box O1) and
TSC22D1
(TSC22 domain family, member 1) genes. Suggestive (LOD > 2.0) linkages were found on chromosomes 1, 2, 3, 4, 9 and 19 for the various traits. In GWA analyses, significant (
χ
2
>27.85) association was found between LVMI and SNP rs7939215 on chromosome 11p15. For LVM we observed evidence of a suggestive association (
χ
2
>22.70) with rs660464 in the
NRG3
(neuregulin 3) gene, which has been associated with hypertrophy among the Amish. Other suggestive associations were found between FS and SNPs rs12485048 and rs5753622 on chromosome 22q12, and SNP rs2993639 chromosome on 3q21.

In summary, we identified several significant linkage and association signals for cardiac measures. Future work will include replicating these results in other study populations.
Abstract P168: Primary Prevention of Cardiovascular Disease with Aspirin: Self-Reported and Validated Aspirin use in a Minnesota Community
Authors: Zantek Nicole D , Luepker Russell V , Duval Sue , LaMarre Heather , Finnegan John R , Peterson Kevin A , Miller Karen , Oldenburg Niki , Hirsch Alan T
Published: July 2021

Introduction:
Aspirin (ASA) is recommended for the primary prevention (PP) of cardiovascular disease (CVD, defined as a first myocardial infarction or stroke) by the American Heart Association, Centers for Disease Control, and the U.S. Preventive Services Task Force. Rates of current ASA use for primary prevention of CVD are not well established. Furthermore, self-reported ASA use may be higher than actual use. We thus investigated self-reported and validated ASA use in a Minnesota population.

Hypotheses:
Current ASA use for primary prevention is low and self-report overestimates actual use.

Methods:
A population-based telephone survey was conducted of males 45-79 and females 55-79 years of age in a Minnesota community in 2012. Subjects were classified as PP or secondary prevention (SP) based on a history of CVD or previous cardiovascular procedures. Self-reported aspirin use was validated by measurement of serum thromboxane B
2
(sTXB
2
), a stable metabolite of thromboxane A
2
, measured in a subset (n=54) using the Thromboxane B
2
EIA Kit (Cayman Chemical, Ann Arbor, MI) and reported as median (IQR).

Results:
A sample of 103 subjects (response rate 56%, age 64±9, 67% male) included both PP (n=74) and SP (n=29) cohorts. Risk factors were prevalent in both PP and SP groups: hypertension (41 vs 62%); diabetes (12 vs. 38%); hyperlipidemia (46 vs 76%); and current smoking (20 vs 23%). Daily aspirin use was reported by 37% of the PP vs. 76% of the SP groups. Within the PP group, most (96%) took aspirin to reduce the risk of CVD events. sTXB
2
levels were 165.6 (18.5, 250.1) ng/mL in aspirin non-users and were 2.8 (0.5, 12.0) ng/mL in self-reported aspirin users. A sTXB
2
cutpoint of 25 ng/mL to validate ASA exposure was associated with a sensitivity of 94% and specificity of 73%.

Conclusions:
Self-report of ASA use is a valid measure. Use is relatively low in a contemporary primary prevention population.
Abstract P173: Community Engagement Makes for Recruitment Success into a Randomized Controlled Intervention Trial for Deaf Adults
Authors: Lowenstein Lisa M , DeWindt Lori , Sutter Erika , Barnett Steven , Pearson Thomas A ,   National Cntr for Deaf Health Rsch
Published: July 2021

The majority of Americans are either overweight or obese, including Deaf adults who use American Sign Language (ASL). Together, Deaf community members and researchers at the Rochester Prevention Research Center: National Center for Deaf Health Research (NCDHR) in Rochester, NY, identified obesity as a top health priority and chose to adapt a healthy lifestyle intervention for Deaf adults.

Since this is one of the few healthy lifestyle interventions involving the Deaf community, we wanted to learn more about recruiting Deaf adults to participate in a healthy lifestyle intervention. Thus, we explored different recruitment strategies to learn what worked to recruit Deaf individuals into a 16-week healthy lifestyle intervention, Deaf Weight Wise (DWW), delivered by a Deaf counselor who uses ASL. Prior to DWW recruitment, we implemented an educational campaign to increase the Deaf community’s knowledge and awareness of NCDHR and how and why the research is conducted. Several different recruitment strategies were used including NCDHR-hosted events, outreach to other Deaf organizations/groups and local faith-based organizations, social media, existing research recruitment lists, word of mouth, and peer recruitment. At the initial study visit, NCDHR research staff asked all individuals who inquired about DWW how they learned about the study. All responses were documented and entered into our database.

From August 2011 to June 2012, a total of 165 individuals inquired about DWW. Out of the 165, 132 attended a screening visit, and 104 fully enrolled into the study. Out of the 104 who enrolled into the study, many learned about DWW through one of the community organizations (28%, n=29), study participants (24%, n=25), or NCDHR hosted events (22%, n=23). None of the study participants reported that they learned about the study via a faith-based organization or social media. Participants were 68% (71/104) female, 91% (95/104) White, and 33% (34/104) had at least a 4-year college degree. On average, participants were 53.5 years old, weighed 92.9 kg, and had a Body Mass Index of 33.3 kg/m
2
. Retention and participation in the randomized trial has been excellent.

In conclusion, recruitment was most successful with organizations and individuals with whom we had previously established relationships/networks with whom the NCDHR had long-term and positive engagement. Recruiting from faith-based organizations was challenging, which lacked this engagement. Future recruitment strategies include continued relationship-building with faith-based organizations and with individual community members and organizational leaders. Lessons learned from programs with the Deaf community likely also pertain to other linguistic and cultural groups.
Abstract P187: Gender Equality and female-to-male Smoking Ratio: Trends in Spain Over the Last 50 Years (1960-2010)
Authors: Beltran Paula , Bilal Usama , Navas-Acien Ana , Fernández Esteve , Bolumar Francisco , Franco Manuel
Published: July 2021

INTRODUCTION
Gender empowerment has been associated with higher gender smoking ratio (GSR) and proved to be a strong predictor of the GSR. Our aim is to study how changes in gender equality may be associated with female-to-male smoking ratio trends in Spain over the last 50 years.

HYPOTHESIS
We hypothesize that greater gender equality will increase female-to-male gender smoking ratio.

METHODS
Values of the United Nations Development Programme’s Gender Inequality Index (GII) were calculated in 5-year intervals from 1960-2010, using data from the National Institute of Statistics. The GII ranges from 0-1 (1 meaning highest inequality) and contemplates 3 dimensions: reproductive health (measured by maternal mortality ratio and adolescent fertility rate), empowerment (share of parliamentary seats and % of each gender with at least secondary education), and female and male labor force participation rates. Female and male smoking prevalence and female-to-male smoking ratio were measured by retrospective reconstruction of National Health Surveys conducted in 2001, 2003, 2006, 2009 (n=20.426, n=21.358, n=29.478, n=22.188), attending to smoking initiation and cessation dates and birth cohorts. In order to test the association between the GII and GSR over the 5 decades we performed Pearson’s correlation.

FINDINGS
The GII decreased from 0.65 to 0.09 in Spain in the last 50 years. Higher women’s empowerment (parliamentary representation: from 0% to 36%; attainment of secondary education: from 5% to 63%), higher women’s participation in the labor force (from 19% to 68%), and lower maternal mortality ratio (from 45.36 to 4.11 deaths/100.000 live births), can account for most of the reduction in the GII. The smoking prevalence reconstruction reproduced the model of the epidemic in developed countries. Women born after 1951 had a smoking prevalence pattern similar to men’s, as opposed to women born prior to this date. GSR increased from 0.05 to 0.66, indicating that smoking prevalence of both genders converged in time. A gradient of the GSR by level of education was observed and women with higher education had equal smoking prevalence compared to men since 1990. The relation between the GII and GSR over time resulted inversely proportional (r=-0.99) with decreases in gender inequality relating to higher female-to-male smoking ratio.

CONCLUSIONS
We found a strong negative correlation between gender inequality and female-to-male smoking ratio. Gender equality has significantly improved in Spain over the last 50 years and this process has been accompanied of differential smoking prevalence patterns by genders, which eventually result in analogous female and male smoking prevalence. Gender sensitive tobacco control measures specifically targeted to women are necessary to prevent female smoking prevalence from rising, especially in the context of social transitions involving women’s development.
Abstract P203: Restricting Sleep Duration Alters Resting and Postprandial Respiratory Quotient, but has Minimal Effects on Overall Energy Expenditure
Authors: Shechter Ari , Rising Russell , Albu Jeanine , St-Onge Marie-Pierre
Published: July 2021

Introduction:
Epidemiological evidence has demonstrated a link between short sleep and obesity. Clinical studies suggest a role of increased energy intake in this relationship, whereas the contributions of energy expenditure (EE) and substrate utilization are less clearly defined. Our aim was to investigate the effects of short sleep on EE and respiratory quotient (RQ) during sleep, basal conditions, and in response to a high-fat meal.

Methods:
Seven females (age and BMI: 27.4 ± 8.1 years and 26.2 ± 1.6 kg/m2, respectively) participated in a randomized, crossover study lasting 4 days. Participants were studied under two separate conditions: short (4 h/night; time in bed 0100-0500 h) and habitual (8 h/night; time in bed 2300-0700 h) sleep. Meals were served at 0800, 1200, and 1900 h, with a snack at 1600 h. Data included 24-h EE and sleep metabolic rate (SMR) from the metabolic chamber and fasting resting metabolic rate (RMR) and postprandial energy expenditure (PPEE) over a 6 h period after consumption of a high-fat breakfast on day 4. Results are expressed as mean ± SD.

Results:
Total 24-h EE was 1,907 ± 229 kcal and 1,830 ± 63 kcal for short and habitual sleep, respectively (p=0.084, paired t-test). Mean SMR was 0.967 ± 0.19 kcal/min throughout the 4-h sleep period and 0.895 ± 0.09 kcal/min throughout the 8-h sleep period (p=0.211, paired t-test). When we examined the 8-h period spanning the sleep episode during the habitual sleep phase, there was a significant sleep condition x time interaction for EE (p<0.001). During the short sleep phase, this measurement included 4 h of sleep and 4 h of non-sleep time. Specifically, EE in the short sleep condition was significantly higher than in the habitual sleep condition mostly during non-sleep times: at 0000-0100, 0100-0200, 0500-0600, and 0600-0700 h, resulting in an increase of 0.21 ± 0.19 kcal/min (p=0.009) throughout the full 8-h period. RQ significantly declined across the 2300-0700 time period (p<0.001), but did not differ between conditions. RMR after 3 nights of short vs. habitual sleep did not differ between conditions, whereas fasting RQ was significantly lower (p=0.026) after short vs. habitual sleep. Postprandial RQ and PPEE did not differ between conditions. The postprandial RQ peak was significantly reduced in short vs. habitual sleep (p=0.008, paired t-test).

Conclusions:
We demonstrate here that short sleep results in increased EE during nocturnal hours spent awake, but does not significantly alter SMR. Over the 24-h period, however, it results in a slight increase in EE, which was not significant with this sample size. These findings imply that the greater prevalence of obesity in individuals with short sleep observed in epidemiological studies is most likely attributable to greater food intake that is not offset by the small increase in EE associated with greater time spent awake.
Abstract P209: Gender Differences in Characteristics, Outcome at Discharge and 3-Month after Stroke in a National Acute Stroke Registry
Authors: Koton Silvia , Tanne David ,   on behalf of the NASIS Investigators
Published: July 2021

Introduction:
Outcome of stroke has been reported poorer for women compared to men; however patients’ characteristics differ by gender, therefore adjusting for potential confounding effects is crucial for understanding the effect of gender on outcome after stroke.

Hypothesis:
We assessed the hypothesis that patients’ characteristics on admission, outcome at discharge and 3-months after stroke differ by gender.

Methods:
Data were derived from the triennial two-month national hospital-based Acute Stroke Israeli Registry (Feb-March 2004, March-April 2007, April-May 2010; the NASIS project). Unselected patients admitted to all hospitals (n=28) in Israel were included. Outcome at 3-month was assessed in a sub-sample of patients in the 2007 and 2010 periods. Logistic regression models were used in the study of gender as an independent risk factor for death and poor functional outcome.

Results:
In total, 5034 patients [ischemic stroke 4,452 (88.5%), ICH-485 (9.6%), undetermined stroke-97 (1.9%)] were included, of them 2285 (45.4%) women. Women were significantly older [mean (SD) 73.3 (13.1) years] than men [68.7 (12.9)] (p<0.0001). The proportion of hypertension, atrial fibrillation, prior heart disease, peripheral artery disease and prior disability (mRS≥2) was higher in women, and they presented with more severe stroke than men. Rates of in-hospital death and poor functional outcome were higher for women compared with men. Following adjustment for age, NIHSS, risk factors and prior disability, risk estimates (ORs, 95%CI) were 0.7 (0.6-1.0) for in-hospital death, 1.4 (1.0-1.9) for discharge to a nursing home, and 1.0 (0.9-1.2) for disability. Follow-up at 3-month was completed for 1040 patients, 436 (41.9%) women. Rates of 3-month mortality, Barthel Index≤60, dependency by 2-simple questions and living in a nursing home were significantly higher for women compared with men. However, adjusted risk estimates were not higher: OR 1.0 (95%CI 0.5-1.8) for death at 3-months, 1.4 (1.0-2.0) for Barthel Index≤60, 1.2 (0.9-1.7) for dependency and 0.9 (0.6-1.4) for living in a nursing home.

Conclusion:
In conclusion, women are at increased risk of death and poor functional outcome after stroke mainly due to differences in age, risk factors, functional status prior to stroke and stroke severity compared with men.
Abstract P233: Prevalence of Healthy Lifestyles by Country of Origin and Level of Acculturation among Diverse Hispanic/Latino Men and Women: Results from the Hispanic Community Health Study / Study of Latinos
Authors: Bustos Juan P , Pirzada Amber , Vu Thanh Huyen T , Giachello Aida , Van Horn Linda , Daviglus Martha L
Published: July 2021

Introduction:
Hispanics/Latinos experience a high burden of CVD risk factors, particularly diabetes and obesity, and CVD is a leading cause of death in this ethnic group. Individual healthy lifestyle factors (HLF) - ideal weight, healthy diet, moderate alcohol consumption and physical activity, and non-smoking are associated with favorable levels of CVD risk factors. Little data exist on prevalence of combined HLF among diverse Hispanics/Latinos with varying levels of acculturation.

Hypothesis:
Prevalence of all 5 HLF varies among Hispanic/Latino men and women of different backgrounds and levels of acculturation. Number of HLF will be higher with lower acculturation.

Methods:
HCHS/SOL participants (6164 men, 9356 women) ages 18-74. Five HLF were considered: BMI[[Unable to Display Character: ˂]]25kg/m2, healthy diet (highest sex-specific 40% of Alternate Healthy Eating Index), moderate physical activity (moderate-vigorous activity [[Unable to Display Character: ˃]]150 min/week; or vigorous activity [[Unable to Display Character: ˃]] 75 min/week), not currently smoking, and moderate alcohol consumption (men ≤30g/day; women ≤15g/day). Measures of acculturation included nativity, years resided in the US, and language preference. Prevalence of HLF was examined by gender, Hispanic/Latino background, and level of acculturation.

Results:
Prevalence of having all 5 HLF was low, i.e., only 3.0% in men and 4.4% in women; 18.3% and 22.0% had any four HLF. Among women, prevalence of 5 HLF was highest among Mexicans (7% of 3910), followed by Central (3.8% of 993) and South Americans (3.8% of 609), Cubans (2.3% of 1177), Dominicans (1.6% of 913), and Puerto Ricans (0.7% of 1497). Proportion of those US-born or who had resided in the US [[Unable to Display Character: ˃]]10 years was lower with higher number of HLF; proportion preferring Spanish was higher with higher number of HLF. For example, 17% of women with 5HLF (n=354) were US-born, vs. 40% of those with 0-1 HLF (n=444, all p-values: [[Unable to Display Character: ˂]]0.0001). Among men, Mexicans had highest prevalence of all 5 HLF (4.7% of 2333), followed by Central Americans (4.4% of 648), South Americans (2.4% of 411), Dominicans (1.5% of 474), Puerto Ricans (1.3% of 1057), and Cubans (1.2% of 1036). Among all men, there were no differences in number of HLF by levels of acculturation (p-values: 0.0007-0.019).

Conclusions:
Having all 5 HLF was low among all Hispanics/Latinos although this differed by Hispanic/Latino background. For women only, greater acculturation was associated with lower prevalence of having all 5 HLF; the lower the acculturation the higher the number of HLF. Public health efforts targeting adverse lifestyles are required to prevent cardiovascular risk factors and disease among Hispanic/Latinos.
Abstract P249: Incident Sleep-Disordered Breathing is Associated with Obesity: Penn State Child Cohort
Authors: Bixler Edward O , Vgontzas Alexandros N , Liao Duanping , Calhoun Susan , Fernandez-Mendoza Julio , He Fan , Rodriguez-Colon Sol M
Published: July 2021

Objectives:
To study the epidemiology of sleep-disordered breathing (SDB) in adolescents, which has received little attention.

Methods:
The Penn State Child Cohort (PSCC) is a representative general population sample of 700 children aged 5-12 years. Our preliminary results are based on an average 8 year follow up of the initial 300 prospective subjects (~43%) from this ongoing cohort study. A logistic regression was used to assess the association between potential risk factors and incident SDB.

Results:
The mean age at the 8-year follow up examination was 17.2 ± 0.1 years, with an average BMI percentile of 66.6 ± 1.6 and 56.5% boys. At baseline 1.5% of this subsample had SDB, defined by Apnea Hypopnia Index (AHI > 5 /hour). Surprisingly, there was
no persistence
of SDB. Eight-year incident SDB was 10.5%. The average AHI in those with incident SDB was 12.7 with a maximum of 92.4. Incident SDB was similar for girls (7.8%) and boys (12.7%). Those with SDB were older than those without (18.7 vs 17.0 years, P<0.001) and girls with SDB were older than boys with SDB (20.0 vs 18.0 years, P=0.002). Those with incident SDB tended to have a greater change in BMI percentile (8.2 vs 1.8, P = 0.143) during the follow up and slightly higher minority representation (25.8% vs 21.9%, P=0.655). A logistic regression model identified three variables that were associated with incident SDB, controlling for baseline AHI: age (OR = 1.5 (1.3, 1.9) P<0.001), male (OR= 2.5 (1.11,10.00) P=0.021), and [[Unable to Display Character: ∆]]BMIPCT (OR=1.2(1.02, 1.5) P=0.032).

Conclusion:
In this population based sample of adolescents, the 8-year incidence of SDB was high (10.5%), whereas childhood SDB did not persist into adolescence. Further, the results indicate that risk factors for incident SDB in adolescents are age, male and the development of obesity.
Abstract P257: Feeding Styles and Childhood Obesity in Rural Appalachia
Authors: Ice Christa , McCartney Kristin , Leary Janie , Neal William , Cottrell Lesley
Published: July 2021

Researching mechanisms for treating childhood obesity is necessary for preventing associated health risks. One mechanism of change may be parental feeding styles, which may promote overweight in children. Permissive feeding style (high responsiveness, low demands) may result in child’s eating behaviors of eating quickly or being a picky eater. Authoritarian feeding style (high demands, low responsiveness) may result in children having control issues around food. Authoritative feeding styles (high demands and responsiveness) are characterized by appropriate eating behaviors. The goal of this study is to explore health outcomes of parenting styles.

Procedure
Data was collected via questionnaire from 2008-2010 CARDIAC Kindergarten, 2nd, 5th and 8th grade parents after participating in a statewide school-based health screening.1252 parents participated out of 8135 (15.4%) eligible parents.

Parenting style questions resulted in 4 parenting styles: disengaged (6.8%), permissive (32.7%), authoritarian (4.2%), and authoritative (56.2%). Parent and Child Nutrition items were developed from USDA guidelines that include daily intake of fruits and vegetable subgroups of dark green, orange, legumes, and other vegetables. CDC epi info software calculated age and gender adjusted Body Mass Index (BMI) percentiles.

Results
50.6% of the students were female, 93.8% Caucasian, 30.3% overweight or obese. Parenting style was associated with parent (p = .003), and child nutrition (p = .002); Figure 1. Specifically, authoritative differed from disengaged (p = .02 for parent, p = .01 for child) and permissive styles (p = .06 for parent, p = 0.01 for child). There was an effect of mean rank for BMI percentile across parenting styles (p = .047); children with permissive parents tended to be heavier than those with authoritative (p = .043).

Discussion
Improved outcomes among authoritative parents compared to permissive parents may suggest a venue for intervening on changeable parental behaviors in order to improve child health outcomes.
Abstract P260: Low Physical Activity Level, Underweight and Abdominal Obesity among Nigerian Rural Adolescents; Implication for Cardiovascular Disease Prevention Program among Rural Adolescents in Nigeria
Authors: Odunaiya Nse A , Louw Quinette A , Grimmer-sommers Karen
Published: July 2021

Cardiovascular disease (CVD) is a global health problem. Studies have shown that the majority of people dying from CVD have one or more major risk factors that are influenced by lifestyle. Major predisposing risk factors include obesity, physical inactivity, abdominal obesity. These risk factors have been seen in adolescents in developed countries. Throughout the world the risks are starting to appear earlier. Adolescence is a critical temporal window for the development of obesity in adult age. Researchers have advocated that children and adolescent populations should be the target for cardiovascular risk factors prevention programs, however, there is paucity of information on these risk factors especially among rural adolescents. It is a general belief in Nigeria that rural dwellers are active, consume natural foods as such CVD and other chronic diseases may not be highly prevalent among rural people However, primordial prevention for cardiovascular is needed even in rural communities since prevention is better than cure. The study aimed to ascertain selected CVD risk factors such as physical activity level, BMI Waist Hip ratio and dietary pattern of adolescents in rural Nigeria The study was a cross sectional survey of 1079 adolescents aged 15-18 years, attending schools at Ibarapa central local government of South West Nigeria. Ethical approval was sought and obtained from Stellenbosch University ethics committee, approval from the local Education authority and principals of the selected schools. Informed consent was obtained from the principals of the schools who acted in place of the parents and guardians who were not in the community and also from parents within the community. Assent was obtained from adolescents either written or verbal. CVD risk factors were assessed using standard measures .Result shows 23% of adolescents are underweight, 75% normal weight and 1.4% overweight. Waist hip ratio of 84.6% of adolescents are normal, 15.4% abdominal obesity, for physical activity level; 27.9% had low physical activity level, 36.5% moderate physical activity level and 35.6% high physical activity level. More female had low activity level compared to male, 63.5% compared to 36.5% The adolescents generally have bad dietary pattern such as high fat consumption, low fruit and vegetable intake

Underweight is still a major problem among rural adolescents. Many of the rural adolescents are not active enough to safeguard their future health. Sedentary living is more among female than male. Although these rural adolescents are not generally obese but there is a high prevalence of abdominal obesity, low fruit and vegetable consumption which is associated with cardiovascular disease

Implication; there is need for CVD primordial and primary prevention program for Nigerian rural adolescents