bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract EP36: Socioeconomic Status And Spontaneous Coronary Artery Dissection Outcomes
Authors: Aung Pyi Phyo , Park Kyeeun , Nge Htoo Myat
Published: April 2022

Introduction:
Spontaneous coronary artery dissection (SCAD) is an emerging cause of myocardial infarction. The epidemiology of SCAD is elucidated with recent investigations and analyses. However, the association between socioeconomic status (SES) and SCAD remains to be studied. We performed this study to identify the effects of SES on SCAD.

Methods:
We conducted a retrospective analysis of the 2016 to 2018 National Inpatient Sample database and the 2018 to 2019 Nationwide Readmission Database (NRD). Study populations were selected using ICD-10 diagnosis code and ICD-10 procedure code for MCS. Socioeconomic status was evaluated using median household income of patient’s ZIP code and dived into quarter. Discharge-level weight analysis was used to produce a national estimate. We conducted univariate and multivariable hierarchical regression analysis to calculate odds ratio (OR) with STATA 17.

Results:
During the study period, total 106,970,745 patients were hospitalized of which 30.17% were from 1
st
(lowest), 26.26% from 2
nd
, 23.76% from 3
rd
and 19.82 from 4
th
(highest) quartile. 0.02 % (24,560 of 106,970,745) patients were diagnosed with spontaneous coronary artery dissection. When lowest SES was compared to the highest SES quartile, the patients from the lowest SES tended to be diabetic (34.17 % v 18.39%) and younger (48.39 ± 0.01 v 50.16 ± 0.01) and less prevalence of hyperlipidemia (2.79% v 3.86%). The prevalence of hypertension (29.78% v 28.31%) and proportion of male (43.59% v 43.33%) were similar. After adjusting for age, sex and comorbid burden, the lowest SES quartile was associated with lower risk of SCAD when it was compared to highest quartile (OR 0.70; 95% CI 0.65-0.76; p<0.0001). However, the lowest SES quartile was associated with higher in-hospital mortality (OR 1.51; 95%CI 1.07-2.15; p=0.02) and 30-day readmission rate (OR 1.56; 95%CI 1.39 -1.88; p<0.0001) with SCAD when it compared to the highest quartile.

Discussion:
In this study, the lowest SES was associated with lower risk of SCAD. Individuals with low SES carry substantial burden of cardiovascular diseases. It is possible that SCAD is underdiagnosed in low SES population due to the presence of traditional cardiovascular risk factors. The unfavorable effects of low SES on SCAD can be identified with in-hospital mortality and rate of 30-day readmission. Further research is required to better understand the impact of SES on the outcomes of SCAD.
Abstract EP37: Single Dose Aspirin At The First Sign Chest Pain: Reducing Myocardial Infarction Deaths For Us Adults
Authors: Russo Rienna G , Rahimi Kazem , Wikler Daniel , Danaei Goodarz
Published: April 2022

Introduction:
Acute myocardial infarction (AMI) is a leading cause of morbidity, mortality, and healthcare costs in the United States (US). Aspirin is an effective, low-cost pharmaceutical that can significantly reduce mortality after AMI. The extent of self-administration of aspirin by individuals at the onset of an AMI is undocumented and must be assumed to be the rare exception. Even among adults admitted to an emergency room, only half receive aspirin within a few hours.

Objective:
The objective of this study was to evaluate the benefits and potential harms of adults self-administering a single dose of aspirin at the onset of chest pain in the US, including deaths delayed from AMI, deaths due to excessive bleeding, and costs per year of life saved (YOLS).

Methods:
Estimates of AMI incidence rate from the Global Burden of Disease study and population data from the US Census Bureau were used to derive a study cohort of adults over the age of 40 in the US in 2019. We conducted a systematic review to quantify the positive predictive value of a non-specific chest pain for AMI. A 25% relative risk reduction of mortality, based on the Second International Study of Infarct Survival (ISIS) Trial, was applied to case fatality rates of MI derived from a prior global review study. The main outcome was net deaths delayed from aspirin, calculated from deaths delayed post AMI accounting for deaths from excessive bleeding. Secondary outcomes included YOLS and cost of aspirin/YOLS, calculated summing the YOLS and dividing by total cost of aspirin for all adults experiencing chest pain. All analyses were stratified in 5-year age-sex groups.

Results:
Assuming all adults over the age of 40 years in the US took aspirin within 2 hours of chest pain onset, the total net deaths delayed in 2019 was estimated to be 81,810. There was a total of 83,226 deaths delayed post AMI, which was offset by 1,417 aspirin-related deaths from excess bleeding, leading to an estimated 869,727 YOLS. The cost of the pills was $423,066, translating to $0.49 per YOLS. Benefits were greatest among males and older adults between ages 65 to 75 years.

Conclusions:
For less than fifty cents per year of life saved, aspirin has the potential to save over 80,000 lives in the US. Benefits of reducing deaths post AMI outweighed the risk of bleeding from aspirin. As aspirin is cost-effective and easily-accessed, efforts should be made to promote ready access and timely use of aspirin within the first 2 hours of chest pain to reduce mortality associated with AMI in the US and abroad.
Abstract EP40: Effects Of Ketone Salt Supplementation On Blood Pressure In Adults Diagnosed With Post-traumatic Stress Disorder
Authors: Holland-Winkler Angelia M , Locklin Jordan , Moore Andrew
Published: April 2022

Individuals diagnosed with post-traumatic stress disorder (PTSD) are often in a state of hyperarousal due to overactive sympathetic nervous system activity. This in turn causes resting blood pressure to increase which leads to chronic hypertension. Those diagnosed with PTSD are at an increased risk for developing hypertension and cardiovascular disease. Beta-hydroxybutyrate, a ketone body, has been shown to directly inhibit sympathetic drive at the receptor site. Beta-hydroxybutyrate is both a fuel source and signaling molecule that is produced by the liver from partially broken-down fat. In addition to endogenous sources, beta-hydroxybutyrate can be paired with salt and consumed exogenously. Exogenous ketone salt supplementation has been shown to decrease systolic blood pressure (SBP) in healthy populations. Therefore, the primary purpose of this study was to determine if supplementing with ketone salts for 6-weeks altered SBP or diastolic blood pressure (DBP) in adults diagnosed with PTSD compared to a placebo supplement. This clinical trial included a randomized, double-blinded, parallel-arm and placebo-controlled design. Participants included males and females previously diagnosed with PTSD that were between the ages of 21-65 years. Sixteen participants completed the study; nine consumed ketone salts for six-weeks and seven consumed the placebo supplement. Thirteen subjects were included in the analyses due to incomplete data. Blood pressure was measured in a fasted and rested state immediately before and after the six-week supplementation period. Two 2X2 mixed ANOVAs were used to analyze the SBP and DBP between group and time points. Although the ketone supplementation group experienced an average lowering of SBP (6.14 mmHg) and DBP (4 mmHg) following the supplementation period, no significant interaction was found for SBP,
F
(1, 11) = 1.18,
p
= .30, η
2
= .10, or DBP,
F
(1, 11) = 1.24,
p
= .29, η
2
= .10. The results demonstrated that 6-weeks of ketone salt supplementation did not significantly alter SBP or DBP in this population. However, the sample size for this study was small and thus, this study should be repeated in a larger sample for verification of this finding.
Abstract EP51: Trends, Predictors And Outcomes Of Cardiovascular Complications Associated With Polycystic Ovary Syndrome During Delivery Hospitalizations-A United States National Database Analysis (2002-2019)
Authors: Zahid Salman , Khan Muhammad Z , Narayana Gowda Smitha , Faza Nadeen N. , Honigberg Michael , Vaught Arthur J , Guan Carolyn , Minhas Anum A , Michos Erin
Published: April 2022

Background:
Women with polycystic ovary syndrome (PCOS) have increased risk of pregnancy-associated complications. However, there is scarcity of data on the trends, outcomes, and predictors of cardiovascular (CV) complications associated with PCOS diagnosis during delivery hospitalizations in the United States.

Methods and Results:
We used data from the National Inpatient Sample. ICD-9 or ICD-10 codes were used to identify delivery hospitalizations and PCOS diagnosis. A total of 71,436,308 weighted US hospitalizations for deliveries were identified from 2002 to 2019. Of the included hospitalizations, 0.3% were among women with PCOS (n=195,675). PCOS women were older (mean 30 vs 28 years, p<0.01) and had higher prevalence of diabetes, obesity, and dyslipidemia. After adjustment for age, race/ethnicity, comorbidities, insurance status and median household income, PCOS remained an independent predictor of CV complications at delivery including preeclampsia (aOR 1.56, 95% CI 1.54-1.59, p<0.01), eclampsia (aOR 1.58, 95% CI 1.54-1.59, p<0.01), peripartum cardiomyopathy (aOR 1.79, 95% CI 1.49-2.13, p<0.01), and heart failure (aOR 1.76, 95% CI 1.27-2.45, p<0.01) (Figure, Panel A), compared to no PCOS. An increase in overall prevalence of PCOS, and of obesity among those with PCOS, was also observed during the study period (Figure, Panel B). Moreover, delivery hospitalizations with PCOS diagnosis were associated with increased length (3 vs 2 days, p<0.01) and cost of hospitalization ($6,310 vs $4,468, p<0.01).

Conclusions:
Over a 17-year period, prevalence of PCOS and obesity increased among childbearing U.S. women. Women with PCOS had higher risks of preeclampsia/eclampsia, peripartum cardiomyopathy, heart failure, pulmonary edema, and venous thromboembolism. Moreover, delivery hospitalizations with PCOS diagnosis were associated with increased length and cost of hospitalization. Strategies to optimize pre-pregnancy cardiometabolic health may be particularly important to improve maternal CV outcomes.
Abstract EP59: Duration Of Cannabis Exposure Is Associated With Coronary Heart Disease
Authors: Winsor Scott , McNavish Daniel , Skipina Travis , Soliman Elsayed Z
Published: April 2022

Background:
Cannabis is the most widely used illicit substance in the U.S. Observational studies have shown an increased risk of coronary heart disease (CHD). However, little evidence is available describing how duration of cumulative exposure influences CHD risk. We hypothesized that longer cumulative cannabis exposure is associated with CHD.

Methods:
This study included 12,493 participants (age 38.8 ± 11.6 years, 50.3% male, 37.9% White) from the National Health and Nutrition Examination Survey years 2011-2018. Cannabis use was self-reported. CHD was defined as history of physician-diagnosis of myocardial infarction, angina, or coronary artery disease. Duration of exposure was defined as time since first-reported cannabis use. Multivariable logistic regression was used to examine the association between duration of exposure and CHD. Subgroup analyses were performed based on various demographic and comorbid stratifications.

Results:
About 14.2% (n=1779) of participants were current cannabis users, and 2.3% (n=287) had CHD. In multivariable models, current users with <10 years of cumulative exposure did not have increased odds of CHD compared to never users (p=0.55). However, those with ≥10 years of cumulative exposure had nearly three-fold increased odds of CHD (p<0.001). A similar pattern of results was obtained when 20 years was used as a cut-point for duration of exposure (Table). This association was stronger among those with hypertension versus those without (interaction p-value=0.003), those with diabetes versus those without (interaction p-value<0.001), and those of non-white race versus those of white race (interaction p-value=0.006).

Conclusions:
Longer duration of cannabis exposure was associated with increased odds of CHD, and the association was stronger among those with hypertension, diabetes, and non-white race. These findings underscore the importance of understanding the long-term consequences of cannabis exposure and the need for a personalized risk assessment for certain groups
Abstract EP63: Recurrent Ischemic Stroke And Cigarette Smoking: A Secondary Analysis Of The Point Trial
Authors: Lang Adam E , De Havenon Adam H , Mac Grory Brian , Henninger Nils , Furie Karen , Easton J D , Kim Anthony , Johnston S. Claiborne , Yaghi Shadi
Published: April 2022

Background:
Conflicting data exists surrounding whether or not the effect of clopidogrel on risk reduction of cardiovascular outcomes, including stroke, is more pronounced in smokers. The aim of this study was to determine the effect of smoking status on subsequent stroke risk in all patients with minor ischemic stroke or TIA, as well as subgroups that may be particularly impacted by an effect, and determine whether smoking improves the effect of clopidogrel treatment on subsequent stroke risk reduction. Subgroup analysis included those of older age, black race, and female gender, as these groups may have higher risk of clopidogrel non-response and subsequently poor outcomes.

Methods:
This was a post-hoc analysis of the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. The POINT trial compared clopidogrel plus aspirin (DAPT) to aspirin alone for prevention of recurrent stroke, myocardial infarction, or vascular death within 3 months of a high-risk TIA or minor ischemic stroke. We used multivariable cox-regression models to determine the effect of smoking on the efficacy of DAPT in reducing the risk of subsequent ischemic stroke in all patients and prespecified subgroups stratified based on age, sex, race, and diabetes. We also performed interaction analyses to determine whether the effect of clopidogrel on subsequent ischemic stroke differed with respect to smoking status.

Results:
Data from 4,877 participants enrolled in the POINT trial were analyzed. Among these, 1,004 were current smokers and 3,873 were non-smokers. Smoking was associated with a non-significantly increased risk of recurrent ischemic stroke during follow up (hazard ratio, 1.31 [95% CI, 0.97 - 1.78], P=0.076). The effect of clopidogrel on ischemic stroke was not significantly different in non-smokers (hazard ratio, 0.74 [95% CI, 0.56 - 0.98], P=0.03) compared to smokers (adjusted hazard ratio, 0.63 [95% CI, 0.37 - 1.05], P=0.078), P for interaction = 0.572. In addition, the effect of clopidogrel on major hemorrhage was not significantly different in current smokers (hazard ratio, 2.59 [95% CI, 1.08 - 6.21], P=0.032) compared to non-smokers (hazard ratio, 1.67 [95% CI, 0.40 - 7.00], P=0.481), P for interaction = 0.613. This finding was maintained across different subgroups: males, females, blacks, whites, those with and without diabetes, and those aged < 60 and ≥ 60 years.

Conclusions:
Cigarette smoking was associated with a non-significantly higher risk of subsequent ischemic stroke and smoking did not modify the effect of clopidogrel-based dual antiplatelet therapy on subsequent ischemic stroke risk reduction, even in the subgroups of stratified based on age, sex, race, and diabetes, where greater likelihood of effect was theorized. Every effort should be made to encourage tobacco dependence treatment and cessation in patients with minor ischemic stroke and TIA.
Abstract MP04: Food Insecurity And Blood Pressure Control: The Coronary Artery Risk In Young Adults (cardia) Study
Authors: Taher Sabira , Wong Mandy , Carnethon Mercedes R , Kandula Namratha , Kiefe Catarina I , Kershaw Kiarri
Published: April 2022

Background:
Food insecurity (FI), the limited access to healthy and affordable food, is a social determinant of health that hinders blood pressure (BP) control in individuals with hypertension. Cross-sectional studies that examine this relationship do not allow for observations over time. We used longitudinal data on CARDIA Study participants with hypertension to examine the association between FI and BP control over 15 years.

Methods:
Generalized estimating equations were used to examine the association between FI and BP control across repeated observations on 605 participants with physician diagnosed and self-reported hypertension. Participants had some FI if they endorsed any of the following statements: “We have enough food to eat, but not always the kinds of food we want to eat”; “Sometimes we don’t have enough food to eat”; “Often we don’t have enough food to eat.” We estimated odds ratios (OR) and 95% confidence interval (CI) for control of systolic blood pressure (SBP) <140 mmHg, diastolic blood pressure (DBP) < 90 mmHg and combined measures of SBP and DBP. We calculated sequentially adjusted models and interaction terms based on previous research. Model 1 was adjusted for age, gender, race and field center. Model 2 was additionally adjusted for antihypertensive medication use, maximum education, marital status and household income. Model 3 was additionally adjusted for BMI, physical activity, smoking status and alcohol intake.

Results:
FI was reported by 21.7% of study participants (N=131). FI was reported in Black participants (N=106), and women (N=89) most. Gender modified the association of FI with BP control, whereby food insecure women were less likely to control BP Table 1. Other interactions were not significant.

Conclusions:
Food insecure women had more difficulty with BP control than food insecure men. Explanations for the differential influence of FI on men and women should be studied so that targeted interventions can be developed.
Abstract MP20: Global Burden Of Elevated Low-density Lipoprotein Cholesterol, 1990-2020: Findings From The Global Burden Of Disease Study 2020
Authors: Razo Christian , Johnson Catherine O , Shakil Saate , Roth Gregory A
Published: April 2022

We evaluated low-density lipoprotein (LDL) cholesterol patterns at the population level and quantified associated cardiovascular disease (CVD) morbidity and mortality for the Global Burden of Disease (GBD) 2020 study. Using all available high-quality data, we estimated the CVD burden attributable to elevated LDL (relative to the theoretical minimum risk exposure level of 1.3-1.7 mmol/L) by age, sex, country, and year among adults >25 years from 1990 - 2020. We used a spatiotemporal Gaussian process regression to estimate LDL mean and microdata to estimate standard deviation (SD) and characterize the global LDL distribution. In a meta-regression, we pooled data from 52 randomized control trials to estimate the relative risks for ischemic heart disease (IHD) and ischemic stroke. These were then used to calculate the population attributable fraction and the burden attributable to elevated LDL. We report SD and 95% uncertainty intervals (UI) in brackets. From 1990 to 2020, LDL levels measured in mmol/L increased globally from 1.4 [0.4] to 1.7 [0.4] in males, and from 1.5 [0.4] to 1.8 [0.5] in females. The highest LDL levels over the 30-year period were observed in high-income countries and Central and Eastern Europe and Central Asia. Sub-Saharan Africa had the lowest LDL levels. In 2020, a third (2.9 million [95% UI: 1.2-4.5 million]) and a fifth (1.5 million [919,750-2.1 million]) of deaths due to IHD and ischemic stroke, respectively, were attributable to elevated LDL. The estimated number of deaths and disability-adjusted life-years (DALYs) attributable to high LDL increased since 1990 reaching 4.5 million [2.6 - 6.2] deaths and 91.8 million [53.6 - 127] DALYs in 2020. More DALYs from elevated LDL were experienced by men than women (52.8 [29.7 - 73.4] vs 39 [23.9 - 53.5] million). Over the study period, the global all-age rates for deaths and DALYs per 100,000, remained unchanged at 58 [34-80] and 1,177 [688-1,629], respectively. Age-standardized deaths and DALYs due to high LDL levels decreased from 90 [55-123] to 57 [34-79] deaths per 100,000 and from 1,657 [981-2,251] to 1,610 [650-1,532] DALYs per 100,000. Age-standardized DALYs attributable to high LDL cholesterol were highest in Eastern Europe, Central Asia and North Africa and the Middle East. The lowest levels were observed in high-income Asia Pacific and Andean Latin America. The CVD burden attributable to LDL is increasing globally. In 2020, a fifth of CVD deaths and DALYs were associated with LDL. Differences between the trends of all-ages and age-standardized rates suggest that the LDL burden has been driven partially by population growth and aging. Measurement and estimation error must be considered when interpreting these trends. In addition to safe and cost-effective pharmacological and behavioral interventions, novel population level strategies are needed to reduce the LDL burden.
Abstract MP21: Findings From A Community-based Hypertension Screening Program In Rural Nepal
Authors: Neupane Dinesh , Koirala Sweta , Vaidya Abhinav , Appel Lawrence J , Matsushita Kuni
Published: April 2022

Introduction:
Hypertension is the leading cause of morbidity and mortality in low- and middle-income countries (LMICs). However, data on the prevalence of hypertension in rural areas are limited.

Aim:
To characterize the prevalence of hypertension in rural areas of Nepal.

Methods:
Data were collected from two rural municipalities (Rupa and Biruwa) of Nepal as a part of the baseline assessment of quasi-experimental study evaluating whether community-health workers can diagnose and treat hypertension, the MUTU study (NCT 04521582). We surveyed all residents of the municipalities aged 25 to 70 years at their homes during April-July 2021. Three blood pressures (BP) at the home visit were obtained; the average of the last two readings was analyzed.

Results:
A total of 10,974 adults were screened. Average systolic and diastolic BP (SBP and DBP) were 125.6 (SD 20.3) and 84.2 (SD 11.9) mmHg; 27.7% (n=3,048) had high SBP
>
140 and/or DBP
>
90 mmHg (‘high BP’). Of all screenees, 13.1% had unrecognized high BP, and 1.7% had BP ≥180/120 mmHg (‘very high BP’). Of those with high BP, 52.8% were aware, 16.9% (n=483) were taking antihypertensive medication, and 6.2% (n=191) had BP ≥180/120 mmHg. Of 2,123 participants with high BP eligible for MUTU (exclusion criteria: BP medication, heart diseases, diabetes, breast-feeding, pregnant, and planned migration), 2,049 participants had BP measured again 1-2 weeks later, and hypertension was confirmed in 1,432 participants (69.9%). See figure. Of these, 5.8% had isolated elevated SBP, and 33.8% isolated elevated DBP; most (60.4%) had elevated SBP and DBP.

Conclusions:
In this home-based BP screening program conducted in rural Nepal, ~13% of adults aged 25-70 years had unrecognized high BP, including ~2% with BP ≥180/120 mmHg. These results highlight the importance of community-based BP screening as well as the need for effective treatment programs in rural communities
Abstract MP28: Associations Of Adverse Childhood Family Environment With Adult Sedentary Behavior And Physical Activity: The Coronary Artery Risk Development In Young Adults (CARDIA) Study
Authors: Jones Melissa A , Jenkins Nathaniel D , Gabriel Kelley P , Kiefe Catarina I , Jacobs David R , Kershaw Kiarri N , Whitaker Kara M
Published: April 2022

Introduction:
Adverse family environment (AFE) in childhood may have deleterious health effects; however, whether these exposures relate to health promoting behaviors in adulthood is unknown. We hypothesize that AFE in childhood will be associated with higher sedentary behavior (SED), and lower light- (LPA) and moderate-to-vigorous (MVPA) physical activity in adulthood and that associations will be moderated by social network size or social support.

Methods:
This was an analysis of 2,127 CARDIA study participants. AFE in childhood was self-reported in year 15 (2000-2001) and categorized as low, moderate, or high adversity using a 7-item questionnaire. Average SED, LPA, and MVPA (min/day) were measured using year 20 (2005-2006) accelerometry data and exercise units/day of MVPA was self-reported. Linear regression models examined associations of AFE in childhood with accelerometer measured SED, LPA, MVPA and self-reported MVPA in adulthood. We further tested for interactions between AFE and adult social network size or social support with each activity outcome and stratified analyses if interactions were p<0.10.

Results:
Participants were 57% female and 45.3 ± 3.5 years of age. High AFE (versus low) was only associated with lower SED (ß: -10.72 min/day, p=0.039). Interaction analyses identified a significant social network x AFE interaction with SED and social support x AFE interaction with self-reported MVPA. In stratified analyses, those with small social network and high AFE had lower SED (ß: -17.99 min/day, p=0.015) compared small social network and low AFE. Those with high social support and high AFE had significantly lower self-reported MVPA (ß: -44.74 exercise units/day, p=0.026) compared to high social support and low AFE
(Table).

Conclusions:
In conclusion, high AFE, among those with a small social network, was related to lower SED and among those with high social support, lower self-reported MVPA. These data are hypothesis generating as associations were in unexpected directions.
Abstract MP33: Ultra-processed Food Attenuates The Association Of Nutri-score Front-of-pack Label With All-cause Mortality Risk In The Moli-sani Study Cohort
Authors: Bonaccio Marialaura , Ruggiero Emilia , Di Castelnuovo Augusto , Costanzo Simona , Esposito Simona , Cerletti Chiara , Donati Maria Benedetta , de Gaetano Giovanni , Iacoviello Licia
Published: April 2022

Introduction:
The Nutri-Score front-of-pack label rates foods according to their nutritional quality while the NOVA classification is focused on degree of food processing; both systems are reported to separately predict mortality in population-based studies.

Hypothesis:
We tested the following hypotheses: a) both the Nutri-Score and ultra-processed food (UPF) classification predict mortality in a cohort of Italians from the general population; b) UPF accounts for a proportion of the excess of all-cause mortality risk associated with increased levels of the Nutri-Score.

Methods:
Longitudinal analysis on 22,913 Italian men and women (mean age 54±12 y) from the Moli-sani Study (enrolled between 2005 and 2010) followed for 11.2 y (median). Food intake was assessed by a 188-item food frequency questionnaire. The Food Standards Agency nutrient profiling system (FSAm-NPS) score, used to derive the Nutri-Score, was calculated for each food based on its amount of energy, saturated fat, sugar, sodium, fibre, protein, fruits, vegetables, legumes and nuts per 100 g of product. The FSAm-NPS dietary index was calculated for each participant as an energy weighted mean of the FSAm-NPS score of all foods consumed: increased values indicated lower nutritional quality of diet at individual level. UPF was defined by the NOVA classification according to degree of processing, and categorized as quartiles of the ratio (%) between UPF (g/d) and total food eaten (g/d).

Results:
The FSAm-NPS dietary index and UPF moderately correlated (Pearson’s’ correlation coefficient=0.34), suggesting that these two indices likely cover different, although complementary, dimensions. Multivariable-adjusted hazard ratios [HRs] for all-cause mortality were 1.18 (95%CI 1.03-1.36 Q4 vs Q1) and 1.25 (1.08-1.44 Q4 vs Q1) for the FSAm-NPS dietary index and UPF, respectively. When the two indices were analyzed simultaneously, the magnitude of the association between the FSAm-NPS dietary index with mortality was significantly reduced (HR=1.13; 0.97-1.30 Q4 vs Q1) with UPF explaining 27.5% (p<.0001) of the excess of all-cause mortality risk associated with FSAm-NPS index. At variance, the association of elevated UPF intake with mortality was unchanged when adjusted for FSAm-NPS index (HR=1.24; 1.07-1.43 Q4 vs Q1).

Conclusions:
The higher all-cause mortality risk associated with excessive intake of nutrient-poor foods, as reflected by the FSAm-NPS dietary index underpinning the NutriScore front-of-pack label, is largely explained by the degree of food processing of these foods. Food labelling systems developed to help consumers make healthier food choices should account for the degree of food processing in addition to nutritional content.
Abstract MP37: Contributions Of Social Determinants Of Health And Cardiometabolic Risk Factors To Racial/ethnic Disparities In Premature Mortality In The United States
Authors: Foti Kathryn , Wang Dan , Commodore-Mensah Yvonne , Coresh Josef , Selvin Elizabeth
Published: April 2022

Introduction:
Racial/ethnic disparities in premature mortality in the US arise from complex social, structural, and historical factors. We examined the extent to which differences in social determinants of health (SDoH), cardiometabolic risk factors, and health conditions explained the excess risk of premature mortality.

Methods:
We used nationally representative data for adults aged ≥20 years from the 1999-2010 National Health and Nutrition Examination Surveys with mortality linkage through 2015. We calculated the age-sex-adjusted hazard ratios (HRs) for premature mortality (death <75 years of age) comparing non-Hispanic (NH) Black and Hispanic adults to NH white adults. We used Cox models to determine the excess risk mediated by SDoH, cardiometabolic risk factors, and health conditions by calculating the percent reduction in the HR compared to the age-sex-adjusted model.

Results:
We included 11,854 NH White, 4,201 NH Black, and 5,997 Hispanic adults. The risk of premature mortality was higher among NH Black (HR: 1.7 (95% confidence interval [CI] 1.5-1.9) and Hispanic (HR: 1.5, 95% CI 1.2-1.9) adults than NH White adults. Adjusting for SDoH (
Figure
) attenuated the HRs and explained 62% and 60% of the excess risk among NH Black and Hispanic adults, respectively. Adding cardiometabolic risk factors and health conditions to the age-sex-adjusted model explained 54% of the excess risk among NH Black adults, but only 13% among Hispanic adults. Adjusting for SDoH, cardiometabolic risk factors, and health conditions together explained 73% of the excess risk among NH Black and 54% of excess risk among Hispanic adults.

Discussion:
Differences in SDoH explained 60% of the excess risk of premature mortality among NH Black and Hispanic adults. Differences in health status further explained some of the excess risk among NH Black, but not Hispanic, adults. Interventions to address SDoH and their downstream health consequences may reduce racial disparities in premature mortality and advance health equity.
Abstract MP39: Association Of Race And Ethnicity On The Management Of Acute Non-st Elevation Myocardial Infarction
Authors: Tertulien Tarryn , Broughton Stephen T , Swabe Gretchen , Essien Utibe , Magnani Jared W
Published: April 2022

Background:
Whether differences in acute coronary syndrome (ACS) management are explained or attenuated by social risk factors has important implications for the development of interventions to address health inequities. We examined the associations between (1) race and ethnicity and (2) annual household income with the management of non-ST elevation Myocardial Infarction (NSTEMI).

Hypothesis:
We hypothesized we would identify racial and ethnic differences in the acute management of NSTEMI and that annual household income would attenuate such differences.

Methods:
We employed administrative claims of commercially insured and Medicare Advantage beneficiaries (Optum’s de-identified Clinformatics® Data Mart Database) to examine the rates of coronary angiography and percutaneous coronary intervention (PCI) by race and ethnicity as well as the contributions of social risk factors, particularly annual household income, toward racial and ethnic differences. Race and ethnicity were categorized as Asian, Black, Hispanic, or White. Covariates included demographics (age, sex); conditions compromising the Elixhauser Comorbidity Index; and social risk factors (annual household income, educational attainment).

Results:
We identified 87,094 individuals (age 73.8±11.6 years; 55.6% male; 2.6% Asian, 13.4% Black, 11.2% Hispanic, 72.7% White) with NSTEMI events from 2017 to 2019. The overall incidence rate for coronary angiography was 555 per 1,000 individuals (95% Confidence Interval [CI] 550-560) and for PCI was 297 per 1,000 (95% CI 293-300). Individuals of Black race were 7% less likely to undergo coronary angiography (95% CI 1.02-1.12) and 17% less likely to undergo PCI (95% CI 1.11-1.23) than those of White race. Hispanic individuals were 13% less likely (95% CI 1.08-1.19) to undergo coronary angiography and 18% less likely to undergo PCI (95% CI 1.12-1.24) than White individuals. Higher annual household income attenuated differences in the receipt of PCI for Asian and Black individuals but not those of Hispanic ethnicity.

Conclusion:
We identified significant racial and ethnic differences in the management of individuals presenting with NSTEMI that were marginally attenuated by higher household income. Our findings demonstrate continued evidence of health inequities in contemporary ACS treatment.
Abstract MP40: Associations Of Dietary Macronutrient And Fatty Class Composition With All-Cause And Cardiovascular Mortality: Data From National Health And Nutrition Examination Survey 1999-2014
Authors: Koemel Nicholas A , Senior Alistair M , Celermajer David S , Grech Amanda , Gill Tim P , Raubenheimer David , Simpson Stephen J , Skilton Michael R
Published: April 2022

Introduction:
There is a large body of evidence detailing the associations of individual macronutrients and fatty acids with all-cause and cardiovascular mortality. Studying nutrients in combination may provide additional information concerning complex associations and interactions.

Hypothesis:
We hypothesize that overall macronutrient and fat class composition are associated with all-cause and cardiovascular mortality.

Methods:
This analysis was undertaken using 24-hour food recall data from the National Health and Nutrition Examination Survey from years 1999-2014 (n = 36,138). Participants included both males and females ≥20 years of age (49.8 ± 18.4 years; 53% Female). All-cause (4764 deaths) and cardiovascular mortality (834 deaths) were obtained via linkage to the National Death Index. Associations of diet composition with mortality adjusting for age, sex, total energy intake, ethnicity, education level, household income, physical activity, alcohol intake, and smoking were assessed using 3-dimensional general additive Cox proportional hazard models of macronutrients (Protein; Carbohydrate; Fat) or fat classes (Polyunsaturated; Monounsaturated; Saturated). Response surfaces were generated on the survival function scale to aid interpretation.

Results:
There is a complex 3-way interactive non-linear association of macronutrient composition with both all-cause (Figure A-B) and cardiovascular mortality (both p <0.001). Dietary fatty acid composition was associated with all-cause mortality (p <0.001; Figure C-D), but there was no significant association for cardiovascular mortality (p = 0.09). In general, diets composed of moderate intake of all three macronutrients or low amounts of monounsaturated and polyunsaturated fat were associated with the highest risk of mortality.

Conclusions:
In conclusion, these findings indicate that associations between diet composition and mortality are more complex than previously understood with evidence of interactive and non-linear relationships.
Abstract MP68: Association Of Multiparity With Carotid Artery Plaque Prevalence: The Multi-Ethnic Study Of Atherosclerosis (MESA)
Authors: Rodriguez Carla , Ogunmoroti Oluseye , Rodriguez Brian , Vaidya Dhananjay , Minhas Anum A , Kazzi Brigitte , Harrington Colleen , Kovell Lara , Honigberg Michael , Stein James H , Shapiro Michael D , Michos Erin D
Published: April 2022

Background:
Multiparity may be associated with an increased risk of cardiovascular disease (CVD); however, responsible mechanisms are incompletely understood. Carotid artery plaque is a marker of subclinical atherosclerosis and an indicator of CVD risk. We hypothesized that multiparity would be independently associated with greater atherosclerosis, as measured by carotid plaque.

Methods:
We included women in MESA free of CVD who had data on parity ascertained by questionnaire and carotid plaque measured by B-mode ultrasound at baseline. Parity was categorized as nulliparity (ref), 1-2, 3-4 and ≥5 live births. Multivariable logistic and linear regression were performed to evaluate the association of parity categories with carotid plaque presence (yes/no) and extent [carotid plaque score (CPS)], respectively.

Results:
Of 2789 women included, 38% were White, 29% Black, 12% Chinese, and 22% Hispanic with a mean (SD) age of 62±10 yrs. Carotid plaque prevalence increased with greater parity (
Figure)
. Compared to nulliparity, a history of 1-2 live births, 3-4 live births, and grand multiparity (≥5 live births) were significantly associated with carotid plaque presence after adjustment for demographics (
Table,
Model 1
)
. Grand multiparity remained significantly associated with carotid plaque presence after full covariate adjustment [OR 1.42 (95% 1.01-2.01), Model 2]. In addition, a history of 1-2 live births and grand multiparity was associated with a greater CPS compared to nulliparity after adjustment for demographics (Model 1). The association of parity with CPS was attenuated and no longer significantly associated with CPS after further adjustment for lifestyle and CVD risk factors (Model 2).

Conclusion:
In a multiethnic cohort of US women, grand multiparity was independently associated with carotid plaque presence. Further studies are needed to understand the increased risk and prognostic significance of subclinical atherosclerosis among parous women.
Abstract MP69: Adolescent Experiences Of Racism: Associations With Cardiovascular Disease Risk-related Behaviors In A Diverse Population-based Sample
Authors: Cory Hannah , Mason Susan , Slaughter-Acey Jaime , Neumark-Sztainer Dianne
Published: April 2022

Introduction:
Racism is increasingly accepted as a driver of health inequities, but little is known about how racism impacts cardiovascular health in young people. This paper tests the hypothesis that direct experiences of interpersonal racism in adolescence are associated with traditional and emerging cardiovascular disease risk-related behaviors using cross-sectional observational data.

Methods:
In Project EAT 2010, 1,396 young people (mean age = 14.4 years) reported how often they were teased or harassed about their race, a form of direct interpersonal racism. Participants also reported cardiovascular disease risk-related behaviors: traditional [smoking; not meeting moderate to vigorous physical activity (MVPA) recommendations] and emerging [unhealthy weight control behaviors; binge eating]. Multivariable logistic models assessed associations of direct interpersonal racism with cardiovascular disease risk-related behaviors, controlling for known confounders.

Results:
About 20% (268 of 1396) of young people reported experiencing interpersonal racism directly at least a few times a year. About one in ten participants reported binge eating or smoking in the past year and about half reported engaging in at least one unhealthy weight control behavior in the past year or not meeting MVPA recommendations. In adolescence, sometimes or frequently experiencing interpersonal racism directly was associated with greater odds of reporting smoking, binge eating and unhealthy weight control behaviors (see Table 1), relative to never or rarely experiencing interpersonal racism directly. There did not appear to be a further increase between “sometimes” to “frequently” experiencing interpersonal racism directly and odds of engaging in cardiovascular disease risk-related behaviors.

Conclusions:
These findings support a link between experiences of racism in adolescence and cardiovascular disease risk and further emphasize the need for structural interventions to achieve cardiovascular health equity.
Abstract MP70: Differing Age, Sex, And Ancestry-related Trends In Visceral Fat Between Youth With Healthy Weight, Obesity, And Type 2 Diabetes
Authors: Higgins Simon , Zemel Babette S , Khoury Philip R , Urbina Elaine M , Kindler Joseph M
Published: April 2022

Introduction:
Excess visceral fat is implicated in obesity-related cardiometabolic disease, but normal age, sex, and ancestry-related trends in visceral fat among youth with varying body size and metabolic health status are unknown.

Objective:
The objective of this study was to characterize age, sex, and ancestry-related trends in abdominal visceral fat among youth with healthy weight, obesity, and type 2 diabetes.

Methods:
This cross-sectional sample included youth ages 10 to 23 years (67% female, 56% non-black) with healthy weight (BMI=5
th
to 85
th
percentile, n=236), obesity (BMI
>
95
th
percentile, n=224), and type 2 diabetes (BMI
>
95
th
percentile, n=145). Visceral fat (cm
2
) was assessed via dual-energy X-ray absorptiometry. Multiple linear regression analyses were performed to examine interaction and main effects of age, sex, and ancestry in relation to visceral fat (log) in the three groups separately.

Results:
Age was positively associated with visceral fat in the healthy weight (P<0.001), obese (P<0.001), and type 2 diabetes groups (P=0.051), such that visceral fat was greater in later adolescents and young adults compared to younger children. Non-blacks had significantly greater visceral fat compared to blacks in the healthy weight (P=0.003), obesity (P<0.001), and type 2 diabetes groups (P<0.001). Sex differences in visceral fat differed by group. In the healthy weight group, males had significantly greater visceral fat than females, but in the obesity group, females had greater visceral fat than males (both P<0.001). In the type 2 diabetes group, females tended to have greater visceral fat, but this difference did not reach statistical significance (P=0.060). When accounting for BMI, significant sex and ancestry differences were maintained, but age associations were nullified.

Conclusions:
This study reports novel findings with respect to demographic determinants of visceral fat assessed via DXA in children, adolescents, and young adults. Our findings that sex differences in visceral fat in youth with obesity and type 2 diabetes persisted following control for BMI are novel and of clinical interest. Specifically, that females may accrue greater visceral adiposity with weight gain when compared to their male counterparts might help to explain differing risk for obesity-related chronic disease. Prospective studies of youth during critical periods of growth are needed to define the consequences of excess visceral fat accrual with respect to future cardiometabolic risk.
Abstract MP73: Ultra-processed Food Intake And All-cause And Cause-specific Mortality In Subjects With Type 2 Diabetes: Longitudinal Findings From The Moli-sani Study
Authors: Bonaccio Marialaura , Costanzo Simona , Di Castelnuovo Augusto , Persichillo Mariarosaria , Magnacca Sara , De Curtis Amalia , Cerletti Chiara , Donati Maria Benedetta , de Gaetano Giovanni , Iacoviello Licia
Published: April 2022

Introduction:
Excessive consumption of ultra-processed food (UPF) is associated with increased risk of mortality and disease in general populations but its health impact for individuals with type 2 diabetes is poorly defined.

Hypothesis:
We assessed the hypothesis of an association between elevated UPF intake and all-cause and cause-specific mortality among subjects with type 2 diabetes. We expect that elevated sugar content of UPF is on the pathway of this relation and that established risk factors might act as potential biological mechanisms linking UPF to mortality.

Methods:
Longitudinal analysis on 1,068 men and women (mean age 65±10 y) with type 2 diabetes, at the moment of their enrolled in the Moli-sani Study( between 2005 and 2010), and followed for 10.7 y (median). Food intake was assessed, at enrolment, by a 188-item food frequency questionnaire. UPF was defined using the NOVA classification according to degree of processing, and categorized as quartiles of the ratio (%) between UPF (g/d) and total food consumed (g/d). The possible mediating effects of 18 inflammatory, metabolic, cardiovascular and renal biomarkers were evaluated on the basis of percentage changes and associated p values.

Results:
Study participants reported a median UPF intake of 6.3% (interquartile range: 4.1-9.4%). Food mostly contributing to the total of UPF eaten were processed meat (22.4%), crispbread/rusks (16.6%), non-homemade pizza (11.2%), and cakes/pies/pastries (8.8%). In multivariable-adjusted COX analyses, higher intake of UPF (Q4, ≥9.4% of total food eaten), as opposed to the lowest (Q1, UPF<4.1%), was associated with higher hazards of all-cause (Hazard ratio [HR]=1.72; 95%CI 1.22-2.41) and CVD mortality (HR=2.15; 1.23-3.77). A linear dose-response relationship of 1% increment in UPF intake with all-cause and CVD mortality was also observed. Elevated sugar content of UPF explained about 30% of these associations. Altered levels of serum creatinine accounted for 9.6% and 12.6% of the relation between UPF with all-cause and CVD mortality, respectively.

Conclusions:
An increased dietary share of UPF was associated with higher hazards of all-cause and CVD mortality among individuals with type 2 diabetes, possibly through the high sugar content of these products. Creatinine, as a marker of renal function, was likely on the pathway between UPF and mortality.
Abstract MP77: Circulating Magnesium And Risk Of Major Adverse Cardiac Events Among Patients With Atrial Fibrillation In The Aric Cohort
Authors: Li Linzi , Lutsey Pamela L , Rooney Mary R , Chen Lin Y , Soliman Elsayed Z , Alonso Alvaro
Published: April 2022

Background:
Serum magnesium (Mg) has been reported to be inversely associated with the risk of atrial fibrillation (AF), coronary artery disease (CAD), and major adverse cardiovascular events (MACE). However, whether high serum Mg is associated with a lower risk of MACE, heart failure (HF), stroke, and all-cause mortality among AF patients remains unclear.

Methods:
We evaluated prospectively 503 participants of the Atherosclerosis Risk in Communities (ARIC) Study with available serum Mg and a diagnosis of AF at the time of Mg measurement participating in visit 2 (1990-1992, n = 90) or visit 5 (2011-2013, n = 403). Serum Mg was modeled in tertiles and as a continuous variable in standard deviation units. Endpoints (HF, MI, stroke, cardiovascular (CV) death, all-cause mortality, and MACE) were identified and modeled separately using Cox proportional hazard regression adjusting for potential confounders.

Results:
During a mean follow-up of 7.0 years, there were 105 HF, 50 MI, 36 stroke, 119 CV deaths, 160 total deaths, and 285 MACE. After adjustment for demographic and clinical variables, participants in the 2
nd
and 3
rd
tertiles of serum Mg had lower rates of most endpoints, with the strongest inverse association for the incidence of MI (Table). Serum Mg modeled linearly as a continuous variable did not show clear associations with endpoints. Due to limited number of events, precision of most estimates of association was relatively low.

Conclusion:
Higher serum Mg was associated with lower risk of developing incident MI and, to a lesser extent, other cardiovascular endpoints. Further studies in larger AF patient cohorts are needed to evaluate the role of serum Mg in preventing adverse CV outcomes in these patients.