bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P101: MEGA Analysis of Alcohol Consumption: The PAGE Study
Authors: Young Kristin L , Park Lani , Cheng Iona , Li Yuqing , Stram Dan , Le Marchand Loic , Bien Stephanie , Schurmann Claudia , Peters Ulrike , North Kari , Matise Tara , Buyske Steve ,   PAGE Study
Published: March 2022

Harmful use of alcohol results in 3.3 million deaths annually and 139 million disability-adjusted life years, and is a risk factor for obesity, hypertension, cardiomyopathy, and stroke. According to the NIAAA, while some minority groups (African Americans and Hispanics) are more likely to abstain from alcohol, those who do drink have higher rates of alcohol consumption and binge drinking. In addition, most genetic studies of alcohol have focused on dependence phenotypes. In populations of European and East Asian ancestry, genes related to alcohol metabolism, including
ADH
and
ALDH
, have been identified, and
AUTS2
and
SLC6A1
have been associated with alcohol consumption. Studies focused on diverse populations are necessary to provide insight into population-specific genetic variability and guide precision screening and intervention efforts.

We aim to further efforts in precision medicine using The Multi-Ethnic Genotyping Array (MEGA), a custom array designed to capture genetic variants in minority populations to allow for imputation to low minor allele frequencies (MAF) across ancestries, as well as clinically relevant variants and deep genotyping of previously identified GWAS regions associated with complex diseases.

We performed the first discovery study for alcohol traits using MEGA genotype data in African American, Hispanic, Asian, Native Hawaiian, and Native American PAGE participants to discover novel genetic variants influencing alcohol consumption. Our preliminary results focus on non-pregnant women over 21 (N=21,641), with phenotype data on drinks/week in study-specific single variant additive regression models controlling for age, PCs, and study center. Study-specific results were then meta-analyzed in METAL. Four variants on chromosome 8 (R
2
=0.33-0.81) passed our chip-wide significance threshold of p=2.8E-8. Of these, rs115165977 showed the strongest association with drinks/week (beta=1.93, se=0.32, p=1.70E-09). This variant is monomorphic in European and East Asian reference populations, but has a MAF between 0.01-0.03 in non-Asian PAGE populations. Rs115165977 is near
ZFPM2
, a gene previously associated with cardiomyopathy that codes for a transcription factor regulating GATA proteins important for heart morphogenesis. This mouse ortholog of
ZFPM2
has also been associated with alcohol acceptance and alcohol-induced loss of the righting reflex. Future work will focus on analysis of alcohol consumption using PAGE imputed data in the full sample, as well as fine-mapping known alcohol-related loci typed on the MEGA chip.
Abstract P114: Association Between Socioeconomic Position and Cardiovascular Disease Risk Factors: The Solan Surveillance Study
Authors: Agarwal Anubha , Ajay Vamadevan S , Mandal Siddhartha , Ghosh Shreeparna , Jindal Devraj , Singh Kavita , Huffman Mark D , Tandon Nikhil , Prabhakaran Dorairaj
Published: March 2022

Introduction:
Data are limited evaluating the association of socioeconomic position and cardiovascular disease risk factors in rural India, an area facing rapid economic changes.

Hypothesis:
We hypothesized that socioeconomic position is associated with the prevalence of abnormal cardiovascular disease risk factors in rural India.

Methods:
From 2013-2014, we performed multi-stage, representative, community-based sampling of the rural Solan district of Himachal Pradesh in India as part of a prospective, longitudinal cohort study enrolling 40,017 participants. We collected data on demographics, medical history, anthropometry, blood pressure, and laboratory studies. Using factor analysis for mixed data, we constructed a socioeconomic position index incorporating education, occupation, income, and household assets for each individual. We used multivariable logistic regression models adjusted for age and sex to evaluate the association between quintiles of the socioeconomic position index and cardiovascular disease risk factors.

Results:
Participants’ mean (SD) age was 42.7 (15.9) years, and 57% were women. Fifteen percent of participants were illiterate (n = 6081) and 24% were employed (n = 9502). The mean (SD) BMI was 22.3 (4.1) kg/m
2
. The mean (SD) systolic and diastolic blood pressures were 139.6 (21.8) mmHg and 84.3 (11.4) mmHg, respectively. After adjustment, individuals in the highest quintile of socioeconomic position index had 2.19 (95% CI 2.01, 2.38) higher odds of being overweight, 3.43 (95% CI 2.91, 4.04) higher odds of being obese, 2.45 (95% CI 2.16, 2.78) higher odds of having hypertension, and 1.62 (95% CI 1.44, 1.82) higher odds of having diabetes mellitus (Figure).

Conclusion:
We observed a direct, stepwise association between socioeconomic position and prevalence of abnormal cardiovascular risk factors in rural India. Primordial prevention strategies are needed for rural Indians, including those who experience increases in socioeconomic position, to improve cardiovascular health.
Abstract P117: Mexican Reg

i

stry of Risk Factors for Cerebrovascular Disease: The “RISK” (RIESGO) Study, a Mexican Approach
Authors: Espinosa Luis , Rodríguez Beatriz L , Pozas Gerardo E , Cantu-Brito Carlos , León Carolina , Flores Dolores , Castilla-Cortázar Inma , Góngora Jose J , Vargas Socorro ,   RIESGO investigators
Published: March 2022

Background:
The RIESGO (RISK) study was established to investigate associations between lifestyle, risk factors and cerebrovascular diseases in 300 attendees to the annual meeting of the Mexican Academy of Neurology. In these analyses we describe traditional and several new risk factors for Cerebrovascular Disease on the RIESGO participants as well as a novel way to create a cohort.

Methods:
The RIESGO study employed a sample of the Mexican Congress of neurology attendees and intends to follow them prospectively. All attendees were invited to participate (n=1300). A survey on lifestyle questions, and clinical evaluations were conducted at the congress site, non-parametric descriptive statistics were used.

Results:
300 attendees (68.8% physicians) participated in RIESGO, 18-83 years old mean 47.1(DE=13.9) and 59% were men. In the RIESGO study, self-reported Diabetes (DM) was 6.8% compared to 20.1% using Glycated Hemoglobin (HbA1c) for diagnosis (>6.5%) and 40% of those with self-reported DM had elevated HbA1c. Also remarkable is the 20.3% major and minor electrocardiographic abnormalities. Systolic and diastolic hypertension was observed in 14.1% and 4.1% respectively, vs 18.4% for self-reported hypertension. Obesity and overweight was observed 66.2% based on BMI > 25kg/m2. Active and former smoking rates were 14.3% and 24.4% respectively, active exercise (>150min/week) was reported in 48.5% and high alcohol consumption (>25 12Oz Beer or equivalent/30days) was 19.9%.

The subclinical outcomes were: intima-media thickness (≥0.8mm) found in 2.3%, carotid plaque in 6% and ventricular hypertrophy (Sokolow) in 1.8%.

We also explored other new risk factors associated with stroke, and found a high heart rate at rest (>70 beats per minute) in 35%, ventricular premature beats 1.1%, prolonged QTc 0.6% and 0% in men and women respectively, finally on the perceived stress scale 97% “never” or “almost never” felt stressed and only 2.3% felt “fairly often stressed”. We will also discuss the association of traditional vs newer risk factors with subclinical outcomes.

Conclusions:
These findings indicate a high prevalence and poor awareness and control of major cardiovascular disease risk factors and subclinical outcomes, despite the fact that RIESGO participants have a substantially higher education level and health information than the general Mexican population. These findings reflect the alarming public health problems that diabetes and cardiovascular diseases represent in the Mexican population, even among the most educated individuals. Recurrent attendance at the annual meeting is a novel and convenient way to establish a low cost follow-up study.
Abstract P123: Lipid-lowering Therapy Prescription Patterns and Predictors of High Intensity Statin Prescriptions in Patients With Diabetes or Atherosclerotic Cardiovascular Disease
Authors: Chamberlain Alanna M , Cohen Sarah S , Killian Jill M , Monda Keri L , Hedgeman Elizabeth O , Weston Susan A , Okerson Ted
Published: March 2022

Background:
Many patients with atherosclerotic cardiovascular disease (ASCVD) or diabetes mellitus (DM) do not receive guideline-recommended lipid lowering therapy (LLT). We characterized LLT treatment patterns and identified predictors of high intensity statin prescriptions (Rx) in patients with ASCVD and DM.

Methods:
Olmsted County, MN residents with DM or ASCVD (MI, unstable angina, revascularization, ischemic stroke/TIA) from 2005-2012 were followed for 2 years capturing all LDL-C and LLT Rx. Cox regression examined predictors of high intensity statin Rx, modeling LDL-C as a time-dependent variable.

Results:
8408 patients with DM (n=4881) or ASCVD (n=3527) were identified (mean age 63.1, 55.1% male). Over 2 years, mean (SD) number of LDL-C measurements was 2.7 (1.9); 12.1% had none. Among those with ≥1 LDL-C, the first was ≥100 mg/dL in 46.2%. LLT Rx increased within 30 days after the first LDL-C. (Table). However, among those with LDL-C ≥100, 40.1% were not prescribed LLT; these patients were younger (mean age 56.9 vs 60.8), more likely female (52.7% vs 45.6%) and more likely to have DM vs ASCVD (84.5% vs 54.6%) than those prescribed LLT. High intensity statin Rx increased more for those with LDL-C ≥100 than those with LDL-C <100. Men [HR 1.29 (CI 1.13-1.48)] and patients with ASCVD vs DM [6.12 (5.25-7.12)] were more likely to be prescribed high intensity statins. Higher LDL-C was associated with greater high intensity statin Rx, although associations differed between ASCVD and DM (p-interaction=0.004). Compared to DM, ASCVD patients were more likely prescribed high intensity statins at every level of LDL-C [2.73 (1.70-4.37), 6.47 (4.94-8.47), 5.68 (4.45-7.25), and 7.88 (5.89-10.53) for LDL-C <70, 70-99, 100-130, and ≥130].

Conclusions:
Although high intensity statin Rx increased in response to increasing LDL-C, a large proportion of patients do not receive guideline-concordant care. Efforts should be made to encourage more aggressive treatment of elevated LDL-C and to understand why treatment is neglected or delayed.
Abstract P138: Asthma and Left Ventricular Mass in Young Adults: the Bogalusa Heart Study
Authors: Sun Dianjianyi , Wang Tiange , Heianza Yoriko , Lv Jun , Rabito Felicia , Kelly Tanika , Li Shengxu , He Jiang , Bazzano Lydia , Chen Wei , Qi Lu
Published: March 2022

Background:
A history of asthma from childhood has been related to various risk factors affecting left ventricular (LV) remodeling; however, no prospective study has analyzed the impact of asthma on markers of LV remodeling.

Methods:
Prospective analyses were performed among 1177 Bogalusa Heart Study participants (average age at follow-up: 36.3±8.3), with a baseline history of self-reported asthma collected since childhood (mean first diagnosed age: 25.2±10.3). LV mass was assessed using 2-dimensional guided M-mode echocardiography, and indexed for body height (m
2.7
) as LV mass index (LVMI, g/m
2.7
). A multivariate linear mixed model was fitted for the repeated measures.

Results:
After an average of 9.1 years follow-up, participants with a history of asthma showed significantly greater LV mass (166.9 vs. 156.3, p=0.007) and LVMI (40.1 vs. 37.1, p=0.002) than those without asthma, with adjustment for age, gender, race, smoking status, antihypertensive medicine, heart rate and systolic blood pressure (SBP) at follow-up. Also, we found significant interactions between SBP and asthma on LV mass and LVMI (p for interaction= 0.008 and 0.006). The associations between asthma and LV measures appeared to be stronger among prehypertensive participants (SBP≥130 mm/Hg) compared with those with normal SBP (<130 mm/Hg) [regression coefficient: 26.12 vs. -0.79 for LV mass; and 6.75 vs. 0.29 for LVMI].

Conclusions:
Our findings indicate that a history of asthma is associated with higher LV mass, and such association is stronger among individuals with prehypertension.
Abstract P139: The Association of Cardiorespiratory Fitness With Cardiometabolic Risk Factors and Markers of Endothelial Function in the Study of Latino Youth (SOL Youth)
Authors: Isasi Carmen R , Strizich Garrett , Parrinello Christina M , Kaplan Robert , Daviglus Martha L , Sotres-Alvarez Daniela , Vidot Denise C , LLabre Maria M , Talavera Gregory , Carnethon Mercedes R
Published: March 2022

Background:
Adult cardiorespiratory fitness (CRF) is associated with lower risk of cardiovascular disease and mortality. However, there is scarce information in youth about the role of CRF in subclinical measures of CVD, such as endothelial function. In this study we tested associations of cardiometabolic factors (CMF) and biomarkers of endothelial function (e-selectin; PAI-1).

Methods:
We included 1,380 participants (699 girls and 681 boys) aged 8-16 years from SOL Youth. CRF was assessed by a step test and VO2 max was estimated. CMF included fasting glucose, lipids, blood pressure. Inflammatory markers included hs-CRP and adiponectin. Associations of CRF with e-selectin and PAI-1 were assessed with multiple linear regression models, adjusting for potential confounders: actigraphy derived physical activity (PA) and sedentary time (SED), adiposity, and socio-demographic factors. Odds ratios were derived for the association of CRF and having ≥3 CVD risk factors (RF)(defined by elevated age/sex appropriate BP, lipids, glucose, and obesity), adjusted for confounders. Analyses accounted for complex survey design.

Results:
Boys and US-born youth were more likely to have higher CRF. CRF was positively correlated with PA (r=.23, p<.0001) but inversely correlated with SED (r=-.10, p=.001), BMIz-score (r=-.37, p<.0001), waist circumference (WC)(r=-.38, p<.0001), and %body fat (r=-.43, p<.0001). In multivariate models adjusting for socio-demographic factors, PA and SED (model 1), CRF was strongly and inversely associated with markers of endothelial function, inflammation, and CMF, which were attenuated when adjusting for WC (model 2)(Table 1). The odds of having ≥3 CVD RF was significantly lower at highest quartiles of fitness (ORs Q2=.47, Q3=.68, Q4=.35, p-trend=.001) after adjusting for confounders and WC.

Conclusions:
Among Latino youth, CRF appears to be a strong protective factor for endothelial dysfunction and CMF. Strategies to improve CRF may be a useful approach for improving cardiovascular health in youth.
Abstract P172: Exercise Hemodynamics of Heart Failure with Preserved Ejection Fraction: a Meta-Analysis
Authors: Park Bryan , Khera Rohan , Pandey Ambarish , Haykowsky Mark , Kitzman Dalane , Berry Jarett
Published: March 2022

Background:
Heart failure with preserved ejection fraction (HFpEF) is associated with increased morbidity and mortality, and recalcitrant to available medical therapies. A major challenge in development of effective therapies for HFpEF is the heterogeneity in the underlying pathophysiological mechanisms, with numerous studies demonstrating conflicting findings. We conducted a meta-analysis to characterize the underlying exercise hemodynamic abnormalities that define HFpEF.

Methods:
15 studies comparing hemodynamic parameters between HFpEF and normal or hypertensive controls were pooled. Standardized mean differences (SMD) in the exercise reserve (peak exercise - resting) measures of hemodynamic parameters between the HFpEF and control group were pooled using a random-effects model meta-analysis.

Results:
The meta-analysis included 627 HFpEF patients (age range: 57 - 74 years, 66% women, 80% with hypertension) and 365 normal controls (age range: 47 - 72 years, 58% women, 50% with hypertension). In pooled analysis, HFpEF patients had significantly lower peak oxygen uptake [SMD (95% CI): -1.8 (-1.9 to -1.6)]. HFpEF patients had significantly lower cardiac index (CI)[SMD (95% CI): -2.1 (-2.3 to -1.9)], heart rate (HR) [SMD (95% CI): -1.3 (-1.5 to -1.1)], stroke volume index (SVI)[SMD (95% CI): -0.78 (-0.94 to -0.61)] and arterio-venous oxygen difference (a-VO
2
Diff) reserve [SMD (95% CI): -0.68 (-0.91 to -0.44)]. HFpEF patients also had significantly greater increase in left ventricular filling (LV) pressure [SMD (95% CI): 2.03 (1.76 to 2.3)] and systemic vascular resistance (SVR) [SMD (95% CI): 1.20(0.94 to 1.45)] despite no change in LV end-diastolic volume reserve between groups.

Conclusion:
HFpEF patients have significantly reduced exercise capacity secondary to impaired central (decreased CI, SVI, HR reserve, and increased LV filling pressures without a change in LV diastolic reserve) and peripheral abnormalities (increased SVR and decreased a-VO
2
Diff).
Abstract P185: Hypertensive Disorders of Pregnancy in Women With Gestational Diabetes Mellitus on Overweight Status of Their Children
Authors: Zhang Shuang , Wang Leishen , Leng Junhong , Liu Huikun , Li Weiqin , Zhang Tao , Li Nan , Li Wei , Tian Huiguang , Hu Gang
Published: March 2022

Background:
Hypertensive disorders of pregnancy (HDP) as a group of medical complications in pregnancy are believed to be associated with an increased risk of poor fetal growth, but the influence on offspring’s body composition is not clear.

Aims:
To evaluate the association between maternal hypertensive disorders of pregnancy and overweight status in the offspring of mothers with gestational diabetes mellitus (GDM).

Methods:
A cross-sectional study among 1263 GDM mother-child pairs was performed in Tianjin, China. General linear models and logistic regression models were used to assess the associations of maternal hypertension in pregnancy with anthropometry and overweight status in the offspring from birth to 1-5 years old.

Results:
Offspring of GDM mothers who were diagnosed with hypertensive disorders during pregnancy had higher mean values of Z scores for birth weight for gestational age and birth weight for length, and higher mean values of Z scores for weight for age, weight for length/height, and body mass index for age at 1-5 years old than those of GDM mothers with normal blood pressure during pregnancy. Maternal hypertensive disorders of pregnancy were associated with increased risks of large for gestational age (OR 1.74, 95%CI 1.08-2.79) and macrosomia (OR 2.02, 95%CI 1.23-3.31) at birth and childhood overweight/obesity at 1-5 years old age (OR 1.88, 95%CI 1.16-3.04).

Conclusion:
For offspring of mothers with GDM, maternal hypertension during pregnancy was a risk factor for macrosomia at birth and childhood overweight and obesity.
Abstract P187: Socioeconomic Status and Hypertension in Late Life: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: McDoom-Echebiri M. Maya , Palta Priya , Vart Priya , Juraschek Stephen , Kucharska-Newton Anna , Heiss Gerardo , Diez Roux Ana V , Coresh Josef
Published: March 2022

Introduction:
Individual and area-level socioeconomic status (SES) are associated with hypertension incidence and blood pressure changes in midlife. However, examination of the relationship between SES and late-life hypertension incidence are limited.

Methods:
ARIC Study participants free of hypertension at visit 4 (1996-1998) were followed by annual and semi-annual calls through December 31, 2013 for incidence of hypertension, defined as a self-reported diagnosis or use of antihypertensive medications. Individual and neighborhood SES indicators were assessed at study baseline (using criteria listed in the Table). Among individuals with follow-up and complete data (N=3,374) associations were examined using Cox regression models.

Results:
Among men and women with a median baseline blood pressure of 118/68 mg Hg, mean age was 61 years (SD ± 5.5), 45% were female, 12% were Black, and 21.7% had an annual household income of <$25,000 ($36,941 in 2016 dollars). The median neighborhood SES summary z-score was lower among Black (-6.29) compared to White participants (1.69). Over median follow-up of 9.44 years, 1,876 incident hypertension cases were observed. In analyses adjusted for covariates, White participants with high, as compared to low and intermediate measures of SES had lower incidence of hypertension in late life (Table). Results were less consistent among Blacks, possibly due to the smaller sample size and therefore more limited power. After accounting for individual-level SES, there was no association between neighborhood-level SES and incident hypertension.

Conclusion:
Both neighborhood and individual SES are related to late life incidence of hypertension, at least among Whites. Understanding the mechanisms, such as the role of access to care, for these associations can guide prevention strategies.
Abstract P192: Metabolomic Profiles Associated with Total and CVD Mortality in Women
Authors: Rexrode Kathryn M , Balasubramanian Raji , Paynter Nina , Giulianini Franco , Chen JC , Manson JoAnn E , Vitolins Mara , Albert Christine M , Clish Clary
Published: March 2022

Background:
Using novel metabolomic markers to identify individuals at increased risk for total and cardiovascular mortality may help inform therapeutic or prevention strategies.

Methods:
A total of 2306 women in the Women’s Health Initiative (WHI) Observational Study (WHI-OS) and Hormone Trials (WHI-HT) had 370 plasma metabolites measured at baseline by liquid chromatography tandem mass spectroscopy. The analysis cohort included 2298 women (943 WHI-OS; 1355 WHI-HT) with complete covariate data. Multivariate cox proportional hazards models were constructed to examine the association of metabolites with mortality, adjusting for age, body mass index, systolic blood pressure, hypertension treatment, diabetes, smoking, total and HDL cholesterol. The WHI-OS data were used for discovery analyses; metabolites with a multivariate-adjusted false discovery rate (FDR) adjusted p value <0.05 were considered significant. These candidate metabolites were included for backwards selection (p for exclusion > 0.05) to identify independent metabolites for inclusion in a composite score. The score of these significant mutually-adjusted metabolites was created based on the quartile score for each metabolite, with higher values indicating higher likelihood of all cause mortality and was tested in the WHI-HT cohort.

Results:
During a median follow-up of 16.7 years, 1,102 women died (417 WHI-OS; 685 WHI-HT), with 601 cardiovascular deaths. At baseline, the median age was 68 years (interquartile range 62-72) and median time to death was 9.9 years. In the WHI-OS discovery cohort, 56 metabolites were significantly associated with multivariate-adjusted total mortality (FDR p< 0.05). When all 56 metabolites were mutually adjusted in the same model and subjected to backwards selection, 15 metabolites remained significantly associated with total mortality after multivariate adjustment and were used to create a composite score. In the separate WHI-HT validation cohort, women in the highest score quartile had a hazards ratio (HR) of 2.36 (95% CI: 1.88-3.21) for death. The mortality score was also associated with CVD death (HR 3.27 [2.54-4.22] highest vs. lowest quartile) for the combined WHI-OS and WHI-HT sample. Six metabolites were significantly associated with mortality in both samples with multivariate mutual adjustment; docosatrienoic acid an omega-3 fatty acid, histamine a pro-inflammatory compound , and the alpha-amino acids histidine and tryptophan were protective while 3-ureidopropionic acid an intermediate in the metabolism of uracil, and 18:1 cholesterol ester were associated with increased risk.

Conclusions:
Using a robust discovery and validation design, metabolite profiles were associated with significantly increased total and CVD mortality, even after adjustment for traditional risk factors.
Abstract P197: Observational Evidence of Intentionality of Weight Loss on All-cause Mortality and Major Cardiovascular Events. Systematic Review and Meta-analysis
Authors: Baena Cristina P , Stefani Fernanda , Pietraroia Priscilla , Faria-Neto José
Published: March 2022

Background:
The obesity paradox has been described in several cohort studies. However, evidence of intentionality of weight loss on all-cause mortality and major cardiovascular events (MACE) in prospective cohorts is not clear.

Aim:
To summarize and evaluate the observational evidence of the effects of intentionality of weight loss on MACE and all-cause mortality.

Methods:
Through a systematic review, multiple electronic databases (MEDLINE/PubMed, Web of Science, SciELO and LILACS) were searched and manual search for studies published up to September 2016 was performed. Cohort studies that reported intentionality (intentional and unintentional) weight loss compared to no weight change with risk estimates for MACE and mortality in primary prevention cohorts were included. A pre-defined protocol in accordance with the standards of quality for reporting meta-analysis of observational studies (MOOSE guidelines) was used. Random effects were used to summarize effects and heterogeneity was analyzed with I2. Subgroups were analyzed by age (> 65) and comorbidities reported during follow-up.

Results:
Our search found 22.008 references and 13 studies met the selection criteria and were involved in the meta-analysis, including 142346 participants (51,3% men, age ranging from 42.2 to 75.3 years). Thirteen studies (25522 participants) reported intentional weight loss and 12 studies (25107 participants) reported non-intentional weight loss. Time of follow-up varied from 2 to 20 years. For intentional weight loss RR (95% CI) were 0.99 (0.92; 1.07) (I2 = 58.2%, p=0.003) and 1.03 (0.9; 1.15) (I2 = 0.0%, p=0.995) for all-cause and MACE, respectively. Subgroups by age of cohort and comorbidities did not change the estimates materially. For unintentional weight loss, RR (95% CI) were 1.25 (1.17; 1.34) (I2 = 70.4%, p=0.000) and 1.09 (0.96; 1.23) (I2 = 78.3%, p=0.001) for all-cause mortality and MACE, respectively. Subgroup analysis for participants with comorbidities yielded RR (95% CI) of 1.44 (1.31; 1.56) (I2 = 59.1%, p=0.012) and for participants older than 65 years, RR (95% CI) were 1.93 (1.65-2.22) (I2 = 0.0%, p=0.808) for all-cause mortality.

Conclusion:
Available observational evidence shows that unintentional weight loss significantly impacted on all-cause mortality in primary prevention cohorts, specially in aged populations. These findings should be accounted for when discussing the obesity paradox in general population.
Abstract P204: Dyspnea as Predictor of All-cause Mortality: Reduction in Risk Over Time in a Prospective Cohort Study
Authors: Pesola Gene R , Chinchilli Vernon M , Chen Yu , Argos Maria , Parvez Faruque , Ahmed Alauddin , Islam Tariqul , Tong Lin , Hasan Rabiul , Neugut Alfred I , Barr R. G , Ahsan Habibul
Published: March 2022

Background:
It has been suggested that risk in longitudinal studies may drop with time, but clear-cut documentation has been sparse. The purpose of this investigation was to determine risks at several time points in a recently completed/published longitudinal study to further evaluate this hypothesis.

Methods:
A population-based sample of 11,533 Bangladeshsis aged 18 to 75 was recruited and followed for 11-12 years and all-cause mortality was evaluated in those with and without baseline dyspnea. Dyspnea, the exposure, was ascertained by trained physicians by questionnaire. Kaplan-Meier survival curves and Cox Proportional Hazard models were used to determine differences between groups at 3, 6, and 11-12 years.

Results:
The Kaplan-Meier curves revealed a clear increase in mortality between dyspnea versus no dyspnea groups at the 3, 6, and 11.2 year time periods. The logrank test was significant with a p value less than 0.01 for all three time periods. At 3 years (3-yrs) the unadjusted hazard ratio (HR) was 3.43 (95% C.I.; 2.36 - 5.00). The 3-yrs HR adjusted for age, sex, arsenic well water concentration, education, blood pressure, BMI, and smoking was 2.58 (1.77 - 3.76)-for increased mortality in those with dyspnea versus no dyspnea. At 6-yrs, the crude and adj. HRs were 2.98 (2.28 - 3.88) and 2.23 (1.71 - 2.92), respectively. At 11.2 years, the crude and adj. HRs were 2.73 (2.27 - 3.28) and 2.10 (1.74 - 2.52) in those with dyspnea (relative to no dyspnea), respectively.

Conclusions:
Risk appears to drop over time in longitudinal studies of all-cause mortality, consistent with greater loss of those with the exposure relative to the unexposed. This phenomena might be expected. Therefore, longer longitudinal studies may actually underestimate and probably do not overestimate exposure risk.
Abstract P205: Meat Intake and Risk of Coronary Heart Disease Mortality in Singapore Chinese Adults
Authors: Talaei Pashiri Mohammad , Pan An , Koh Woon-Puay
Published: March 2022

Introduction:
Epidemiological studies have reported inconsistent association between meat intake and coronary heart disease (CHD) mortality. We aimed to evaluate this association in a Chinese population with high fish intake and consumption of pork as red meat.

Hypothesis:
We assessed the hypothesis that intake of red meat, poultry, and fish/shellfish is associated with CHD mortality risk in an Asian population.

Methods:
The Singapore Chinese Health Study is a population-based cohort that recruited 63,257 Chinese adults aged 45-74 years from 1993 to 1998 in Singapore. A validated 165-item semi-quantitative food-frequency questionnaire was used to assess usual diet at recruitment, and mortality information was identified via registry linkage up to December 31, 2014. Cox proportional hazard models were used to calculate HRs (95% CI) with adjustment for potential confounders in 60,298 eligible participants free of self-reported CHD and stroke at baseline.

Results:
Median intake of total meat in this population was 95.9 g/d (interquartile range: 66.5-133), averagely comprised of 27.9% red meat, 18.3% poultry, and 53.6% fish/shellfish.During 981,983 person-years of follow-up, we identified 2,610 CHD deaths among 57,078 subjects who were free of cardiovascular disease at baseline. After controlling for socio-demographic, lifestyle and dietary factors including intakes of poultry and fish/shellfish, red meat intake was associated with increased CHD mortality risk (HR comparing highest vs. lowest quartiles 1.17; 95% CI 1.04-1.32; P-trend=0.005), which became insignificant after adjusting for cholesterol intake (1.11; 0.97-1.26; P-trend=0.11). Conversely, an inverse association was observed for poultry intake (0.88; 0.78-0.99; P-trend=0.03) which remained significant when adjusted for dietary cholesterol (0.85; 0.75-0.96; P-trend=0.007). Fish/shellfish intake was marginally associated with decreased risk of CHD mortality after adjusting for cholesterol (0.91; 0.80-1.03; P-trend=0.045). Dietary cholesterol was associated with an increased risk even after adjusting for intake of red meat, poultry, and fish/shellfish (1.22; 1.07-1.39; P-trend=0.002) or dietary saturated fatty acids, monounsaturated fatty acids, n-3, and n-6 (1.23; 1.07-1.42; P-trend=0.003).

Conclusions:
In this large cohort study of Chinese adults, red meat intake was associated with a higher risk of CHD mortality that was partly mediated by its cholesterol content. Conversely, poultry was related to a lower risk of CHD mortality.
Abstract P212: The Association Between Serum Vitamin D and Valvular Calcification in the Multi-Ethnic Study of Altherosclerosis
Authors: Tibuakuu Martin , Zhao Di , de Boer Ian H , Guallar Eliseo , Bortnick Anna E , Lutsey Pamela L , Budoff Matthew J , Kizer Jorge R , Kestenbaum Bryan R , Michos Erin D
Published: March 2022

Background:
Serum 25-hydroxyvitamin D [25(OH)D] levels have been identified as a possible modifiable risk factor for cardiovascular disease (CVD) but the association may not be linear. Whether 25(OH)D is associated with valvular calcification is unknown. We examined the association of 25(OH)D with Aortic Valve Calcification (AVC) and Mitral Annular Calcification (MAC) in a multi-ethnic cohort. We hypothesized that both deficient and excess 25(OH)D levels are associated with increased calcification (i.e. U-shaped distribution of risk).

Methods:
We studied 5,392 MESA participants who had 25(OH)D levels and a cardiac CT performed at baseline (2000-2002) and a follow-up CT scan at the 2
nd
or 3rd Exam. AVC and MAC were quantified by the Agatston score. Using relative risk regression, we evaluated the multivariable adjusted risk of prevalent and incident AVC and MAC by 25(OH)D quintiles with median quintile as reference.

Results:
The mean age of participants was 62 ±10 yrs; 53% were women and 26% black. Prevalent AVC and MAC were observed in 12% and 9%, respectively. There was no statistically significant association between 25(OH)D and prevalent AVC or MAC in cross-sectional analyses. Over a mean follow-up of 2.5 yrs, 4.1% developed incident AVC and 4.5% developed incident MAC. After adjusting for demographic variables, the 5
th
quintile of 25(OH)D was associated with a 33% [RR 0.67 (95% CI 0.45, 0.99)] lower risk of incident MAC compared to the 3
rd
quintile. However, this association was no longer significant after adjusting for lifestyle and CVD risk factors [
TABLE
]. There was no association of 25(OH)D with incident AVC [0.89 (0.59, 1.36) for 5
th
vs. 3
rd
quintile, Model 1].

Conclusion:
Low 25(OH)D levels were not associated with increased likelihood of prevalent valvular calcification. Higher 25(OH)D were associated with reduced risk of incident MAC independent of demographics, but not with incident AVC. In sum, 25(OH)D may be associated with progression of mitral calcification, but future studies with longer follow-up are needed.
Abstract P223: Starch Digestion Related Amylase Genotypes Affect 2-year Adiposity Changes in Response to Weight-loss Diets: The Pounds Lost Trial
Authors: Heianza Yoriko , Sun Dianjianyi , Wang Tiange , Bray George A , Sacks Frank M , Qi Lu
Published: March 2022

Background/Aim:
Salivary amylase, which is encoded by the salivary gene (
AMY1
), is responsible for digesting starchy foods into sugar, and the
AMY1
shows extensive copy number variations which directly affect differences in salivary and serum amylase amount and activity. Recent evidence suggests associations of low serum amylase levels and obesity. We investigated whether the copy number related AMY1 genotypes were associated with 2-year changes of adiposity in response to weight-loss diet intervention.

Methods:
This study included 692 obese individuals with data on AMY1 variant rs11185098 who were randomly assigned to 1 of 4 diets varying in macronutrient contents. Changes of body weight (BW) and waist circumference (WC) over 2 years during the intervention were evaluated according to the genotype.

Results:
We found that changes in BW and WC were significantly different according to the
AMY1
genotype (Figure). After adjustment for age, sex, ethnicity, diet groups and value for the respective outcome traits at baseline, carrying the minor A allele (which indicates higher amylase amount and activity-associated allele) of rs11185098 was significantly associated with greater reduction of BW at 6, 12, 18, and 24 months (β (SE), p value; -0.7 (0.35), 0.04; -1.21 (0.46), 0.009; -1.63 (0.52), 0.0017; -1.27 (0.49), 0.0095, respectively). Also, increasing number of allele A was associated with a greater decrease of WC at 6, 12, 18 and 24 months (p <0.05 for all). The genetic effects on these outcomes did not significantly differ across the diet groups.

Conclusions:
Our study indicated that the genetic variant responsible for starch metabolism significantly influenced on the response to weight-loss dietary intervention. Obese individuals carrying the
AMY1
genotype that associated with higher salivary amylase activity may benefit from greater weight loss and the improvement of central adiposity in response to low-calorie diet interventions.
Abstract P236: Analysison Time Course Changes of Adipocytokine Levels and Abdominal Obesity afterQuitting Smoking
Authors: Komiyama Maki , Wada Hiromichi , Yamakage Hajime , Asahara Noriko , Shimada Sayaka , Shimatsu Akira , Morimoto Tatsuya , Takahashi Yuko , Hasegawa Koji
Published: March 2022

Background:
Adipocytokines are produced and secreted by the adipose tissue and are strongly associated with obesity. Among these cytokines, adiponectin prevents arteriosclerosis. In obesity, the serum adiponectin levels decrease whereas leptin levels increase. However, the association between these two adipocytokines and abdominal obesity after smoking cessation is unknown.

Purpose:
The present study investigated time-dependent changes after smoking cessation of two adipocytokines, adiponectin and leptin, as well as the changes of body mass index and waist circumstance (WC).

Methods:
All anti-smoking treatments were conducted according to the Standard Procedures for Anti-Smoking Treatment (originally issued in March 2006 by the Japanese Circulation Society, Japan Lung Cancer Society, and Japanese Cancer Association). The patients were treated with transdermal nicotine patches or the oral administration of varenicline. Among patients who attended our smoking cessation clinic, 56 (37 males and 19 females) successfully quit smoking. We measured their serum leptin and adiponectin levels at baseline, 3 months, and 1 year after beginning smoking cessation. Moreover, the changes in data from before to 3 months and 1 year after smoking cessation were compared by unpaired t-test between patients with a WC increase smaller than the median and those with a WC increase greater than the median.

Results:
Body mass index and WC significantly increased from baseline to 3 months to 1 year after beginning smoking cessation. The leptin level significantly increased (5.0 ng/ml → 6.2 ng/ml (p < 0.05) → 7.1 ng/ml (p < 0.001)) in proportion to the weight gain. Adiponectin levels, however, did not change after smoking cessation. Using the median ΔWC (+1.8 %) as the cutoff point, patients were divided into two groups. The percent change in adiponectin level from baseline to 1 year was significantly greater in the ΔWC < median group (+13.4 %) than in the ΔWC ≧ median group (-0.6 %) (p = 0.028).

Conclusion:
Despite weight gain and increased abdominal obesity, serum adiponectin levels did not decrease after smoking cessation. Rather, they increased at 1 year after smoking cessation in patients with less abdominal obesity. Thus, the beneficial effect of smoking cessation may outweigh the adverse effect of weight gain after smoking cessation.
Abstract P241: Health Literacy and Patient Activation Are not Predictors of Positive Health Behaviors Among Young Adult Women
Authors: Mohan Yasmina , Sidell Margo , Tillman Lee , Young Deborah
Published: March 2022

Young adulthood is an important phase during which health behaviors are established. Inadequate health behaviors during this phase may increase susceptibility to future poor health. Health behaviors of young adult women, in particular, will most likely not only affect their health, but that of their families. Research exploring health literacy (enabling informed decision making) and patient activation (confidence to maintain/improve health) as predictors of health behaviors is growing. We examined these variables as predictors of positive health behaviors among a cohort of 22-23 year old females (n=476). Health literacy was assessed using the Newest Vital Sign; scores were categorized as low, marginal, and adequate. The Patient Activation Measure (PAM) was used to assess participant health activation. Scores were categorized as low (<27) or high (>27). Eleven health behavior variables related to nutrition, physical activity, sedentary behavior, sleep, alcohol, and smoking were used to create a health behavior score. These data were collected through health surveys and accelerometry. The health score had a possible range of 0 to 22. We included race/ethnicity, education, body mass index (BMI), and depressive symptoms (CES-D) as potential covariates in multivariable models. About 46% of the cohort was White, 25% Black, and 10% Hispanic; about 77% of middle or low socioeconomic status (SES). About 71% had adequate health literacy (18% marginal, 11% low), while 89% had a high PAM score. Participants who were White (p<0.01), had higher education (p<0.01), reported higher SES (p<0.01), and had a lower CES-D score (p<0.02) had higher health literacy. Participants who had lower CES-D scores (p<0.01) also had higher PAM scores. The mean health behavior score was 12.68 (SD=3.39). Univariate analyses indicated adequate health literacy was associated with individual positive health behaviors: breakfast consumption (p<0.01), low sugar sweetened beverage consumption (p<.01), high physical activity (p<0.01), and no smoking (p<0.04). High PAM score was associated with low sugar sweetened beverage consumption (p<0.04). In univariate linear regression models, higher health literacy was associated with a higher composite health score (p<0.01). PAM score was not associated with health score. Multivariable linear regression models controlling for race/ethnicity, education, BMI, and CES-D score, indicated that neither health literacy nor PAM score were associated with composite health score. Among young adult women, positive health behaviors appear to not be influenced by either their individual health literacy or PAM score. Potential associations may emerge later in adulthood as they become fully independent individuals. Young adults may still be closely tied to their parents; thus parent health literacy and PAM score may predict health behaviors among young adults.
Abstract P242: Periodontal Disease and Incident Venous Thromboembolism: the Atherosclerosis Risk in the Community (ARIC) Study
Authors: Cowan Logan , Pankow James , Lutsey Pamela , Lakshminarayan Kamakshi , Folsom Aaron
Published: March 2022

Background and Purpose:
Previous research has identified an association between periodontal disease (PD) and atherosclerotic cardiovascular disease, but the relationship between PD and venous thromboembolism (VTE) has not been studied. PD may trigger VTE through activating inflammatory, coagulation, and fibrinolysis processes associated with thrombosis. We hypothesize an independent association between PD and increased risk of VTE.

Methods:
PD was assessed among ARIC participants at visit 4 (1996-1998) using self-reported tooth loss due to gum disease and clinical PD definitions based on ARIC dental exams. PD case definitions from the CDC Periodontal Disease Surveillance workgroup in collaboration with the American Academy of Periodontology (CDC/AAP) and the biofilm-gingival interface (BGI) index were used. The outcome of interest was validated VTE, including all cases of deep vein thrombosis occurring in the leg and pulmonary embolism. Follow- up time was from visit 4 to the first VTE hospitalization, dropping out of the study, death, or else, December 31, 2011. Multivariate-adjusted Cox proportional hazards regression models were used.

Results:
There were a total of 424 VTE events among the 10,651 ARIC participants who provided baseline self-reported PD data and 314 VTE events among the 8,119 participants who were edentulous at visit 4 or who completed the dental exam from which baseline clinical PD data were obtained. Compared to those without periodontal disease, self-reported history of tooth loss due to gum disease was associated with higher VTE risk (HR = 1.42 (1.11, 1.82)), as was being edentulous at exam 4 [1.51 (1.07, 2.14)] using the CDC/AAP PD definition. No other statistically significant associations were observed between clinical levels of PD and VTE risk.

Conclusions:
These results suggest that individuals who are edentulous or have experienced tooth loss due to PD may be at higher VTE risk.
Abstract P263: Adjudication of Heart Failure (HF) in an Electronic Cohort of Human Immunodeficiency Virus-infected (HIV+) Persons
Authors: Steverson Alexandra B , Pawlowski Anna E , Schneider Daniel , Nannapaneni Prasanth , Sanders Jes M , Achenbach Chad J , Shah Sanjiv J , Lloyd-Jones Donald M , Feinstein Matthew J
Published: March 2022

Background:
Analyses of administrative data suggest that HIV+ persons have elevated risks for HF from HIV-related and traditional cardiovascular disease (CVD) risk factors. However, none of these studies adjudicated HF diagnoses, which is essential given poor agreement between administrative coding and physician adjudication. We sought to create a reproducible protocol for identifying and adjudicating HF in HIV+ persons and to compare characteristics between those with and without adjudicated HF.

Methods:
We screened for and adjudicated HF diagnoses in a cohort of 5,052 HIV+ persons receiving care at an academic center. Screening for possible HF included any of the following: 1) HF diagnosis code, 2) B-type natriuretic peptide (BNP) >100 pg/mL, or 3) intravenous diuretic use. Two physicians then independently reviewed all records. Definite HF was adjudicated if all of the following were present: HF symptoms, physician diagnosis, HF medication use, and objective evidence of myocardial dysfunction. Demographics and clinical characteristics were compared for HIV+ patients with screened+/adjudicated+ HF, screened+/adjudicated- HF, and those who screened- for HF.

Results:
There was >96% agreement in HF diagnoses between the two adjudicators (Kappa = 0.91). Race differed significantly across the three groups, with more black patients among those with adjudicated+ HF (Table 1). Patients with adjudicated+ HF were significantly more likely than patients who screened+/adjudicated- HF to have diabetes, hypertension, atrial arrhythmias, a diagnosis of myocardial infarction, and any smoking history (p<0.001 for all). Patients who screened+ for HF (whether adjudicated+ or -) tended to have more advanced HIV than those who screened- based on nadir CD4 T cell count and peak HIV viral load (Table 1).

Conclusions:
There are significant clinical differences between HIV+ patients with and without adjudicated HF. These findings underscore the importance of adjudicating HF in future studies characterizing CVD for HIV+ persons.