bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P005: Association Between County Elementary and Secondary Educational Policy With Cardiovascular Health
Authors: Christian Adam , Pilkerton Courtney , Singh Sarah , Bias Thomas K , Frisbee Stephanie J
Published: July 2021

BACKGROUND:
Recent research recognizing the socioeconomic influence of educational attainment on population health, including cardiovascular health (CVH), suggests that modifying educational policy to improve educational outcomes could be an effective approach to improving health outcomes. Although the positive association of educational level with health status is well documented, the effect of education policy on health outcomes is not as thoroughly studied. Identifying relationships amongst educational policy and CVH could provide a target for public policy initiatives designed to positively impact population health. OBJECTIVE: The objective was to examine the potential effect of varying county educational policy on county and individual CVH outcomes.

METHODS:
Variables of county educational policy were expenditures per pupil, percent of total revenue from each state and local sources, and pupil teacher ratios. School district data from 1997-2005 sourced from the National Center for Education Statistics were adjusted for inflation using the U.S. Dept. of Labor Consumer Price Index as well as regional cost differences using the NCES Comparable Wage Index by school district, and grouped by county. County and individual CVH for 2011 was scored using the AHA’s CVH metric and data from the Behavioral Risk Factor Surveillance System. Linear regression models were used to compare the county means for each education policy variable with both county and individual CVH scores.

RESULTS:
Mean percent revenue from local sources and mean pupil teacher ratio were both shown to be positively associated with county level CVH (p=0.007 and p=0.023). Individual CVH was inversely associated with mean expenditures per pupil (p=0.023), and positively associated with mean percent revenue from local (p<0.01), mean percent revenue from state (p<0.01), and mean pupil teacher ratio (p<0.001). There was an interactive effect between mean expenditure per pupil and county urbanicity on county CVH (p<0.05), which differed in rural counties compared to the most urban. There was also an interactive effect between mean percent revenue from local and county urbanicity on county CVH (p<0.001). Although no significant effect was observed for mean expenditures per pupil on county CVH, mean expenditures per pupil was inversely related to county CVH in the most urban counties (b=-3.58e-06), and positively related to county CVH in most rural counties (b=4.62e-06). Evidence of relationships between county educational policies and resources with CVH suggests the need for continued research more thoroughly examining variables of education policy as indicators for CVH. CONCLUSION: Further clarification of these relationships will help determine if educational policy adjustments driven by health improvement initiatives would be a useful addition to current strategies aimed at improving population health.
Abstract P007: Maternal Heavy Smoking during Pregnancy in Association with Higher Risk of Gestational Diabetes in the Offspring
Authors: Bao Wei , Michels Karin B , Tobias Deirdre K , Li Shanshan , Chavarro Jorge E , Gaskins Audrey J , Olsen Sjurdur F , Vaag Allan A , Hu Frank B , Zhang Cuilin
Published: July 2021

Introduction:
Maternal smoking during pregnancy is an established risk factor for adverse perinatal outcomes. However, data on the intergenerational impact of maternal smoking during pregnancy on offspring’s long-term risk of adulthood disease are limited.

Hypothesis:
We assessed the hypothesis that maternal smoking during pregnancy may be associated with risk of gestational diabetes mellitus (GDM) in the offspring.

Methods:
The analytical population was composed of 10138 parous women in the Nurses' Health Study II cohort whose mothers participated in the Nurses’ Mothers’ Cohort Study; 819 of the nurses developed GDM. Data on maternal and paternal smoking during pregnancy and associated covariates were recalled by the nurses’ mothers. GDM diagnosis was self-reported by nurse participants and was validated by medical record review in a previous study. We used logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).

Results:
We observed a significant association between maternal heavy smoking during pregnancy and risk of GDM in the offspring. The multivariable-adjusted ORs (95% CIs) of GDM among women whose mothers did not smoke during pregnancy, continued smoking 1-14, 15-24, and ≥ 25 cigarettes/day were 1.00 (reference), 1.13 (0.91-1.42), 1.17 (0.88-1.55), and 1.74 (1.03-2.95) (P for trend = 0.04), respectively. Further adjustment for the nurses’ birth weight, adult life variables and body mass index during various periods of life only slightly changed the association. No significant association was observed between paternal smoking during the pregnancy period and the risk of GDM. We further examined the joint effect of both maternal and paternal smoking during pregnancy on the risk of GDM. The nurses whose parents both smoked during pregnancy ≥ 15 cigarettes/day had an OR (95% CI) of 1.25 (0.94-1.66), compared with those whose parents did not smoke during pregnancy or smoked < 15 cigarettes/day. In an analysis on the joint effect of maternal smoking during pregnancy and the nurse’s smoking during adulthood, we found that the nurses who ever smoked during adulthood and their mothers ever smoked during the pregnancy with them had a significantly higher risk of GDM (OR 1.40, 95% CI 1.08-1.81), compared to the nurses neither themselves nor the mothers smoked.

Conclusions:
In conclusion, maternal heavy smoking (≥ 25 cigarettes/day) during pregnancy is significantly associated with higher risk of gestational diabetes in the offspring. Further studies are warranted to confirm our findings and to elucidate the underlying mechanisms.
Abstract P019: Association Between Hypertension and Kidney Function Trajectory: The Atherosclerosis Risk in Communities Study
Authors: Rebholz Casey M , Chen Yuan , Matsushita Kunihiro , Coresh Josef , Grams Morgan E
Published: July 2021

Introduction:
Cardiovascular disease, including hypertension, increases the risk of kidney disease progression. The relationship between hypertension and change in kidney function has not been fully elucidated. We hypothesized that hypertension is associated with faster kidney function decline.

Methods:
Hypertension status was assessed among Atherosclerosis Risk in Communities (ARIC) Study participants at baseline (1987-89) and defined as systolic blood pressure ≥140, diastolic blood pressure ≥90, or anti-hypertensive medication use in the last two weeks. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) was calculated using creatinine measured at baseline and follow-up study visits (1990-92; 1996-98; 2011-13) and an eGFR value of 15 mL/min/1.73 m
2
was imputed for incident end-stage renal disease cases.

Results:
After excluding those with missing baseline measurements of blood pressure, missing serum creatinine, and prevalent end-stage renal disease, there were 15,622 study participants. Baseline mean age was 55 years, 55% were female, 26% were black, and 35% had hypertension. Mean annual eGFR decline was 1.98 mL/min/1.73 m
2
per year among those with hypertension and 1.54 mL/min/1.73 m
2
per year among those without hypertension, after adjusting for demographic characteristics and co-morbidities (Figure, p<0.001). Participants with hypertension at baseline were more likely to develop chronic kidney disease than those without hypertension. Over 25 years, for those with hypertension and those without hypertension, respectively, the probability of developing chronic kidney disease stage 3A (eGFR <60 mL/min/1.73 m
2
) was 55.3% and 44.5%, stage 3B (eGFR <45 mL/min/1.73 m
2
) was 24.3% and 19.1%, stage 4 (eGFR <30 mL/min/1.73 m
2
) was 9.2% and 7.7%, and stage 5 (eGFR <15 mL/min/1.73 m
2
) was 3.9% and 3.5%.

Conclusion:
Hypertension status was associated with faster kidney function decline. Absolute risk increase was greater for earlier kidney disease stages.
Abstract P039: Dietary Patterns are Associated with Cognitive Function in US Adults
Authors: Pearson Keith , Wadley Virginia , McClure Leslie , Judd Suzanne
Published: July 2021

Introduction:
As America ages, identifying factors that contribute to the preservation of cognitive function is of growing importance to maintain quality of life in advanced years. Of modifiable risk factors, diet quality has emerged as a promising candidate to impact cognition. Although the Mediterranean diet pattern has been associated with cognitive benefits, few other dietary patterns have been considered.

Hypothesis:
We assessed the hypothesis that empirically-derived dietary patterns are associated with cognitive function.

Methods:
The REasons for Geographic And Racial Differences in Stroke (REGARDS) study is a national cohort study of 30,239 black and white participants (age > 45). Previously, five dietary patterns (Convenience, Plant-based, Sweets/fats, Southern, and Alcohol/salads) were derived with principal component analysis using data assessed by the Block98 FFQ. Baseline cognitive impairment (a score ≤4) was assessed using the Six-Item Screener. Logistic regression was used to evaluate the odds of baseline cognitive impairment by quintile of dietary pattern adherence.

Results:
This analysis included 19,888 participants with complete diet/cognitive data who were free of stroke. After demographic and energy intake adjustments, participants with the highest adherence to the Southern pattern had 37% higher odds of being cognitively impaired at baseline (Q5 vs Q1: OR=1.37; 95% CI: 1.11, 1.69; p for trend: <0.01), while those with the highest adherence to the Alcohol/Salads pattern had 27% lower odds of impairment at baseline (Q5 vs Q1: OR=0.73; 95% CI: 0.61, 0.87; p for trend: <0.01). Addition of covariates resulted in loss of significance but direction of association was similar (Table).

Conclusion:
A dietary pattern including salads and alcohol intake was associated with lower odds, and a pattern including fried food and processed meat with higher odds, of baseline cognitive impairment. These associations should be further investigated in relation to preservation of cognitive function over time.
Abstract P040: Animal and Vegetable Protein Intake and Coronary Artery Calcium - The Kangbuk Samsung Health Study
Authors: Choi Yuni , Ryu Seungho , Chang Yoosoo , Lee Jung Eun , Sung Eunju , Cho Juhee , Rampal Sanjay , Zhao Di , Zhang Yiyi , Ahn Jiin , Cainzos-Achirica Miguel , Pastor-Barriuso Roberto , Lima Joao A , Shin Hocheol , Guallar Eliseo
Published: July 2021

Introduction:
Few studies have evaluated the association between type and amount of dietary protein intake and clinically evident cardiovascular disease, with inconsistent findings, and no study has investigated the association between type and amount of dietary protein intake and subclinical coronary atherosclerosis.

Hypothesis:
We examined the associations of total, animal, and vegetable protein intakes with coronary artery calcium (CAC) in a large population of asymptomatic adults.

Methods:
We performed a cross-sectional study of 29,034 asymptomatic young and middle-aged adults (mean age 41.6 years; males 80.3%) who are free of clinically evident cancer or cardiovascular disease. All participants underwent a health screening examination including cardiac computed tomography for CAC scoring and completed a food frequency questionnaire at the Kangbuk Samsung Hospital Total Healthcare Centers in Seoul and Suwon, South Korea from March, 2011 to April, 2013. Protein intake and other nutrient intake were adjusted for total energy intake using the residual method. Multivariable-adjusted CAC score ratios and 95% confidence intervals (CIs) were estimated by robust Tobit regression models for natural logarithm (CAC score + 1).

Results:
The proportion of study participants with detectable CAC (CAC score > 0) was 13.4 %. After adjustment for total energy intake, other nutrient intake, and potential confounding factors, we found an increased prevalence of CAC with higher animal protein intake, but not with total and vegetable protein intakes. In multivariable-adjusted models, CAC ratios (95% CIs) comparing the highest with the lowest quintiles were 1.82 (1.09-3.04;
P
for trend = 0.01) for animal protein intake, 1.25 (0.87-1.81;
P
for trend = 0.13) for vegetable protein intake, and 1.19 (0.74-1.93;
P
for trend = 0.59) for total protein intake.

Conclusion:
High animal protein intake, but not total or vegetable protein, was associated with an increased prevalence of subclinical coronary atherosclerosis and with a greater degree of coronary calcification.
Abstract P050: Vitamin K Intake and Risk of Coronary Heart Disease and Stroke in the Rotterdam Study
Authors: Engelen Anouk I , Geleijnse Johanna M , Vermeer Cees , Witteman Jacqueline C , Hofman Albert , Franco Oscar H , Feskens Edith J
Published: July 2021

Introduction:
Vitamin K serves as a cofactor in the carboxylation of vitamin K-dependent proteins that play a role in blood coagulation and the regulation of vascular calcification. Therefore, vitamin K intake may decrease the risk of cardiovascular diseases (CVD). We aimed to investigate the associations of phylloquinone (vitamin K1) and menaquinone (vitamin K2; MK-4 through MK-10) intake with risk of coronary heart disease (CHD) and stroke in a Dutch population-based cohort study.

Methods:
The analyses included 4,108 participants of the Rotterdam Study, aged 55 years and older, who were free of CVD and diabetes at baseline. Nutrient intake was estimated using a 170-item semi-quantitative food frequency questionnaire. To estimate the phylloquinone and menaquinone intake we compiled a new vitamin K food composition table using analytical and literature-based values. The occurrence of CHD and stroke was confirmed through medical records. Associations of phylloquinone and menaquinone intake with CHD and stroke incidence were examined using multivariable Cox proportional hazard models.

Results:
Participants had a mean phylloquinone intake of 191.7 mcg/day and a mean menaquinone intake of 49.4 mcg/day. During follow-up from 1990 to 2011, 460 CHD cases and 546 stroke cases were confirmed. In multivariable-adjusted analyses, we found no associations of phylloquinone (HR: 0.94; 95%CI: 0.72-1.23) or menaquinone intake (0.97; 0.75-1.26) with CHD incidence when comparing the highest to the lowest tertile of intake. Stroke incidence was also not associated with phylloquinone (1.22; 0.96-1.55) or menaquinone intake (0.86; 0.68-1.10). Moreover, we found no associations with CHD or stroke incidence when analysing the intake of short-chain (MK-4 through MK-6) and long-chain menaquinones (MK-7 through MK-10) separately.

Conclusion:
In this study, phylloquinone and menaquinone intake were not associated with risk of CHD or stroke.
Abstract P056: Emerging Lifestyle Markers Predict Regression of Carotid Intima-Media Thickness Scores
Authors: Masley Steven C , Roetzheim Richard , Masley Lucas V , McNamara Timothy , Schocken Douglas D
Published: July 2021

Introduction:
CVD remains the number one cause of mortality in the western world. Carotid intima-media thickness (IMT) is a safe & reliable predictor of future CVD risk. This study assesses which lifestyle factors best predict a change in IMT over time.

Hypothesis:
We assessed the null hypothesis that all lifestyle changes are effective.

Methods:
A prospective cross-sectional analysis of 289 men & women undergoing health & cardiovascular risk screening every 1-2 years at an outpatient wellness center in Florida. This study reflects the first visit at the clinic, & a second visit that occurred on average 2.8 years later. These subjects ranged in age from 23-65 (mean = 48.2). In addition to testing, subjects received nutrition, fitness, & health coaching.

Measurements were made of fitness using VO2max stress testing, diet intake using a 3-day dietary intake survey. Laboratory & anthropometric measures were obtained fasting. Mean IMT scores used high resolution B-mode ultrasonography of the common carotid arteries. Each subject had ≥10 images collected from the far wall of both distal 1 cm of the common carotid arteries at end diastole. The carotid intimal thickness was measured as a continuous variable, using both multivariate & bivariate linear regression, adjusting for age & gender; as our site IMT precision was = 3%, we selected a 4% change as significant.

Results:
The average decrease in IMT score in this cohort was -0.018 mm over 2.8 years, a 2.04% reduction. The bivariate analyses showing a significant association with a ≥4% reduction in IMT in 62 of 288 subjects; they were a decrease in: Body mass index (BMI) (p=0.047), body fat (p=0.025), total cholesterol (TC) (p=0.031), LDL cholesterol (p=0.028), TC/HDL (0.002), or an increase in dietary intake of: magnesium (p=0.0001), fiber (p=0.017), vitamin D (p=0.016), vitamin K (p=0.001), potassium (p=0.001), & calcium (p=0.024). In a multivariate analysis, starting a statin medication (p=0.0007), a decrease in BMI (p=0.042), baseline IMT, male gender, diastolic BP decrease, & years of follow up were predictive of 4% IMT decline. Prior use of a statin medication was not significant.

Conclusions:
In conclusion, this study shows that a reduction in IMT score over 2.8 years is associated with a decrease in: BMI, body fat, TC, LDL, TC/HDL ratio, & diastolic BP; or, an increase in intake of: magnesium, fiber, vitamins K & D, potassium, & calcium; or, starting a statin medication.
Abstract P057: Cardiovascular Diseases and Cancer Incidences Associated With Cardiovascular Risk Profile: Results from MATISS Italian Cohort
Authors: Ursu Smona C , Palmieri Luigi , Giampaoli Simona , Pannozzo Fabio , Lo Noce Cinzia , Vestri Annarita , Stamler Jeremiah
Published: July 2021

Background:
Individuals with low levels of cardiovascular risk factors experience low incidence of subsequent cardiovascular diseases (CVD). The aims of this study were to assess cancer incidence in people with favorable (low) CVD risk profile and its association with educational level (EL).

Methods:
The MATISS longitudinal cohort comprised 3609 men and 4146 women aged 20-70 years, free of CVD and cancer at baseline with validated non-fatal and fatal CVD and cancer events during a median 17.7 years of follow-up. People at baseline were classified as ‘low risk’ with total cholesterol <240 mg/dl and blood pressure <140/90 mmHg and BMI <30.0 kg/m
2
and no hypertension treatment and no diabetes and no smoking habit and ‘high risk’ (total cholesterol >=240mg/dl or blood pressure >=140/90 mmHg or BMI >=30.0 kg/m
2
or hypertension treatment, diabetes, smoking). EL was classified as low (LEL=elementary school) and middle-high (MHEL=middle/high school/university).

Results:
724 cancer and 571 CVD events occurred; 22.7% of participants were ‘low risk’; 77.3% were ‘high risk; 61.5% had LEL. Cancer and CVD incidences increased with age; age-adjusted cancer and CVD incidence were higher in men compared to women (cancer: 68.92 versus 48.95 x 10,000 person-years; CVD: 64.18 versus 29.5 x 10,000 person-years). Incidences of cancer and CVD were higher in LEL (cancer: 83.22 versus 50.35 x 10,000 person-years in men and 51.67 versus 33.59 x 10,000 person-years in women; CVD: 70.07 versus 64.84 x 10,000 person-years in men and 30.72 versus 17.89 x 10,000 person-years in women). Persons with ‘low risk’ profile experienced less cancers and CVD than persons with ‘high risk (cancer: 37.66 versus 72.3 x 10,000 person-years in men and 39.57 versus 50.07 x 10,000 person-years in women; CVD: 18.49 versus 69.75 per 10,000 person-years in men and 20.34 versus 30.7 x 10,000 person-years in women). In analysis by risk profile and EL considered together for both genders rates of both CVD and cancer were highest in those with less education classified as high risk (cancer: 85.2 versus 56.13 x 10,000 person-years in men and 50.97 versus 35.12 x 10,000 person-years in women; CVD: 74.58 versus 69.06 per 10,000 person-years in men and 30.87 versus 22.69 x 10,000 person-years in women).

Conclusions:
Increasing educational levels and prevalence of low CVD risk profile in the general population may be effective strategies for population-wide CVD and cancer prevention.
Abstract P059: Arterial Thickness and Stiffness are Independent Predictors of Myocardial Strain
Authors: McCoy Connie E , Khoury Philip R , Stewart Stephanie N , Longhshore Lauren E , Madsen Nicolas L , Dolan Lawrence M , Kimball Thomas R , Urbina Elaine M
Published: July 2021

Vascular dysfunction is associated with cardiac dysfunction, a precursor of CV events (MI,CHF) in adults. We hypothesized that abnormalities in vascular structure and function are associated with cardiac systolic dysfunction as measured by cardiac strain and strain rate in young adults.

Carotid ultrasound and echocardiography were performed on 338 subjects (22.2 + 3.7 years; 38% male (M); 63% non-white (NW); 33% lean, 36% obese and 31% T2DM). CIMT was traced along the far wall of the distal CCA, bulb, and proximal ICA. Stiffness measures included carotid-femoral pulse wave velocity (PWVf), brachial distensibility (BrachD) and Peterson’s Elastic Modulus in the CCA (PEM). LV systolic function was assessed by global longitudinal (4-chamber) strain (GS) and strain rate in systole (GSRs). Anthropometry, BP, HR, fasting lipids, CRP, and glucose were collected. Correlations were calculated between vascular measures and cardiac strain. General linear models were constructed to determine if vascular measures were independent predictors of GS and GSRs. Covariates included age, sex, race, BMI z-score, MAP, group, TG, HDL, LDL, insulin, glucose, and CRP.

GS and GSRs correlated with peripheral arterial stiffness (lower BrachD, higher PEM, higher PWVf) and structure (thicker CIMT), all p<.01 (Figure). After adjusting for other risk factors, BrachD was an independent predictor of poorer GSRs: GSRs=-1.1611 -.13*BrachD + .05 (if M) + .06 (if NW) + .004*MAP - .0003*glucose + .07*Insulin. CCA IMT independently predicted both GS and GSRs: GS=-.26 + 4.6* CCA + .92 (if M) + .58*BMIZ + .56*MAP- .03*HDL + 1.06*insulin; GSRs= -1.4 + .26*CCA+ .05 (if M) + .03*BMIZ + .003*MAP - .0003*glucose + .06*Insulin. All factors were significant at p<.05 in these models.

We conclude that adverse pre-clinical vascular and cardiac findings are present in youth simultaneously and may increase risk for future CV events. Assessment of vascular structure and function may add incremental benefit in stratifying risk in young adults for future CV events.
Abstract P062: Cardiovascular Health Awareness Among School Children in the Rural District of Midnapore, India: A School-Based Survey
Authors: Ray Madhab
Published: July 2021

Introduction:
India is the second most populous country in the world with two thirds of the population in their youth. With economic development and adoption of a western lifestyle, a large number of people in India will be affected by cardiovascular disease (CVD). As atherosclerosis starts in the second decade of life and many of the risk factors are better controlled if addressed early, health awareness among the school children assumes a central role for primary prevention. Currently, there is no established school health program for health education about CVD in India. This survey was conducted to assess the present level of health awareness about CVD in the adolescent school children with a goal to establish school-based health education, early detection of different risk factors and development of heart healthy lifestyle.

Methods:
A school-based survey was conducted between 15
th
of June and 15
th
of July, 2014 as a joint venture of Tufts University, USA and Kolkata Medical College, India in the rural district of Midnapore, India with approval from the IRB of Tufts University and the local ethics committee. This involved a pre-test with 20 questions each having 5 statements, a power point presentation by a physician of the study team, and a post-test using the same questions. The data were analyzed by the cluster sampling design method.

Results:
Nine hundred and fifty nine students (32 %) participated in the survey out of a target population of 3003 from 11 schools with a mean age 14.5 years, 58% male, 59% grade IX and 41% grade X. Prevalence of known CAD among the parents (as reported by the students) was 3% and current history of smoking (26%) was the predominant risk factor, while other identified risk factors were less common (hypertension 5%, diabetes mellitus 4%, and hyperlipidemia 3%). In the pretest evaluation, the mean score was 41/100 (IQR 33-48 and SD ± 10.5) with an improvement by 7% in the post test results (IQR 36-59, SD ± 16.9). This improvement was highly significant by Wilcoxon signed rank test with continuity correction (p <0.001). A multivariable regression analysis showed family history of hypertension (p = 0.01) and higher parental education (p = 0.02) were the main determinants for an improved score.

Conclusions:
Cardiovascular health awareness was modest among the adolescent school children in the population under study. A school-based educational program may help improve awareness and reduce disease burden in this community.
Abstract P080: The Combined Effect of Low Income and Low Education on Coronary Heart Disease Outcomes in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Lewis Marquita W , Khodneva Yulia , Safford Monika M
Published: July 2021

Background:
Low income (LoINC) and low education (LoED) have both been associated with higher coronary heart disease (CHD) risk, but few studies have examined the combined effects of both LoINC and LoED.

Hypothesis:
The combination of LoINC and LoED is more strongly associated with incident CHD than either LoINC and LoED, or neither.

Methods:
REGARDS recruited 30,239 black and white participants aged
>
45 years residing in the 48 contiguous US between 2003-2007. Baseline data included telephone interviews and in-home visits, and follow-up was conducted every 6 months to detect potential events with expert adjudication of endpoints based on medical record review. Low income (LoInc) was defined as annual household income <$35,000, and low education (LoEd) was defined as less than a high school education. Income and education were combined into four mutually exclusive exposure groups (noLoInc+noLoEd, noLoInc+LoEd, LoInc+noLoEd ,LoInc+LoEd, ). CHD outcomes were definite or probable myocardial infarction or acute CHD death. We constructed Cox models estimating the hazard ratios (HR) for CHD, sequentially adjusting for sociodemographics, health behaviors, physiologic parameters, access to healthcare, and stress and depression. Because of significant interaction by age (p<0.001), analyses were stratified at age 65.

Results:
We analyzed 24,461 participants without baseline CHD, with numbers in each income/education group as shown in the Table. LoInc+LoEd was associated with the highest risk of CHD among those aged
<
65 years, but not among those >65 years of age. LoEd was associated with higher CHD risk in those age >65 years and LoInc was not, but LoInc was associated with higher CHD risk in those age
<
65 years, but LoEd was not.

Conclusion:
LoInc+LoEd was associated with the highest CHD risk at younger ages, but not at higher ages. Income was more important than education for CHD risk at younger ages, but education was more important than income at older ages.
Abstract P103: Kidney Function and Sudden Cardiac Death in the Community: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Suzuki Takeki , Agarwal Sunil K , Deo Rajat , Sotoodehnia Nona , Grams Morgan , Selvin Elizabeth , Calkins Hugh , Rosamond Wayne , Tomaselli Gordon , Coresh Josef , Matsushita Kunihiro
Published: July 2021

Introduction:
Individuals with chronic kidney disease (CKD), particularly those requiring dialysis, are at high risk of sudden cardiac death (SCD). However, data for the full-spectrum of kidney function and SCD risk in the community are sparse. Furthermore, newly developed equations for estimated glomerular filtration rate (eGFR) and novel filtration markers might add further insight to the role of kidney function in SCD.

Methods:
We investigated the associations of baseline eGFRs using either serum creatinine, cystatin C (CysC), or both (eGFRcr, eGFRcr-cys, and eGFRcys), CysC itself, and β
2
-microglobulin (B2M) with SCD through 2001 among 13,070 blacks and whites participants at the second visit (1990-92) of the community-based ARIC Study. Cox regression models were used to quantify the associations of kidney function and different markers of kidney filtration with SCD after the adjustment for potential confounders. The cohort was divided into 5 groups based on clinical CKD Stages as well as quartiles.

Results:
Over a median of 11 years of follow-up, 205 participants developed SCD (1.4 cases per 1000 person-years). Low eGFR was independently associated with SCD risk: for example, HR for eGFR 30-44 vs ≥90 ml/min/1.73m
2
was 3.97 (95%CI 1.57-10.03) with eGFRcr; HR 6.96 (3.56-13.61) with eGFRcr-cys; and HR 5.47 (2.97-10.09) with eGFRcys. Of note, when eGFRcr and eGFRcys were included together in a single model, the association was only significant for eGFRcys. When we compared all kidney markers based on their quartiles, B2M demonstrated the strongest association with SCD (
Table
). Qualitatively consistent results were observed across clinical and demographic subgroups.

Conclusion:
Kidney function was independently and robustly associated with SCD in the community, particularly when CysC or B2M were taken into account as filtration markers. These results may suggest the importance of kidney function for SCD risk evaluation and the value of novel filtration markers beyond eGFRcr in association with SCD.
Abstract P105: Small Magnitude of the Heart Movement Due to Respiration is Associated With Sudden Cardiac Death
Authors: Kabir Muammar M , Ghafoori Elyar , Waks Jonathan W , Agarwal Sunil K , Arking Dan E , Sotoodehnia Nona , Siscovick David S , Post Wendy , Henrikson Charles , Solomon Scott D , Soliman Elsayed Z , Coresh Josef , Josephson Mark E , Tereshchenko Larisa G
Published: July 2021

Background:
Respiration causes heart movement in the chest and proportional change in the heart’s electrical axis. The ECG can be used to measure respiration-related heart motion. The effect of respiration on the ECG is usually considered an artifact. However, it is unknown whether pattern of heart motion due to respiration holds any prognostic value.

Method:
After excluding those with atrial fibrillation, or atrial or ventricular premature contractions at baseline visit, 14613 ARIC cohort participants (mean age 54.0±5.8 y; 6595 [45.1%] men; 10744 [73.5%] white, 1311 [9.0%] with prevalent cardiovascular disease (CVD)) were included. The digital resting ECG was analyzed using custom Matlab software. The absolute magnitude of the displacement of the heart due to respiration was calculated on X (left-right), Y (up-down), and Z (anterior-posterior) axes. Sudden cardiac death (SCD) and non-coronary heart disease (CHD) death served as competing outcomes in our analysis.

Results:
In CVD-free participants (as compared to prevalent CVD group) heart moved more on X axis (137±46 vs. 128±47 μV; P<0.0001), and less on Z axis (123±52 vs. 127±60 μV; P=0.05). During a median follow-up of 14 years 278 SCDs (96 in CVD group) and 1619 non-CHD (279 in CVD group) deaths occurred. In competing risk analysis that adjusted for age, gender, race, history of myocardial infarction, CHD, heart failure, systolic blood pressure, anti-hypertensive medications, diabetes, smoking, total cholesterol, high density lipoprotein, level of physical activity, use of beta-blockers, left ventricular hypertrophy on ECG and QRS duration, the absolute magnitude of respiration-related heart movement on X axis (SHR 0.74; 95%CI 0.59-0.93; P=0.009) and Z axis (SHR 1.19; 95%CI 1.01-1.41; P=0.042) associated with SCD (but not with non-CHD death) in CVD group, but not in CVD-free participants.

Conclusion:
Greater respiration-caused heart motion on Z axis and smaller - on X axis likely reflects cardiomegaly and is associated with increased risk of SCD in patients with CVD.
Abstract P117: Day to Day Variation in Self-Efficacy Associated with Weight Loss and Risk of Dietary Lapses
Authors: Burke Lora E , Ewing Linda J , Shiffman Saul , Siewiorek Dan , Smailagic Asim , Kriska Andrea , Rathbun Steven
Published: July 2021

Introduction:
Ecological momentary assessment (EMA) assesses individuals' experiences, behaviors, and moods as they occur in real time and in their own environment, making it useful to understand the processes of behavior change. We report the use of EMA to study the triggers of lapses after intentional weight loss in a 12-mo. study that includes a standard behavioral weight loss intervention.

Purpose: We examined daily self-reports of self-efficacy and how they were related to unplanned eating episodes (‘lapses’) and weight change over the first 6 mos. of the study.

Hypothesis:
Higher self-efficacy is related to fewer “lapses” and better weight loss over time.

Methods:
Participants were provided a smartphone app programmed to administer EMA assessments up to 5 randomly-selected times/day. Each assessment included the self-efficacy query, How confident are you that if you have an urge to go off your healthy lifestyle plan, you can resist the urge? measured on a scale of 1-10. Participants were weighed at weekly, and after 3 months bi-weekly, group sessions. To account for replicate observations among subjects, generalized estimating equations were used to fit logistic regression models predicting lapses as a function of self-efficacy, adjusting for location (e.g., home, work, restaurant) and social setting (e.g., with others, alone).

Results:
The sample (N = 151) was 90.7% female and 79.5% White, and on average, 51.18 (10.22) years of age with a mean BMI of 34.0 (4.6) kg/m2. Of the 59,913 random assessments conducted over 6 mos., eating episodes were recorded in 7,991 (13.34%) of those assessments, of which 881 (11.03%) were not planned. Most of the 7,991 planned and unplanned eating episodes were captured when individuals were with others who were eating (49%), or when completely alone (24%). After adjusting for location and social setting, self-efficacy remained a significant predictor of a lapse (p < 0.001). The odds of a lapse decreased by 70% (95% CI, 64%, 76%) for every unit increase in self efficacy. After controlling for social setting, participants were estimated to lose 0.35 more lbs/mo. (SE = 0.14; p = 0.02) for each unit increase in self efficacy. Self-efficacy maintained a stable level between 7.3 and 7.4 for the first 4 mos., before decreasing at a rate of 0.11 points/month (SE = 0.04; p = 0.002) in the last 2 mos. This temporal trend in self-efficacy was paralleled by a similar trend in participants’ weights; they lost an average of 3.26 lbs/mo. (SE = 0.18) in the first 4 mos. compared to only 0.59 lbs/mo. (SE = 0.29) in the last 2 mos.

Conclusions:
The data suggest that as self-efficacy decreased to near 7.0, individuals were at greater risk to experience a lapse in their diet, an integral part of the healthy lifestyle plan. Targeting enhanced and sustained levels of self-efficacy above 7 may enable a person to resist lapses and prevent weight regain.
Abstract P125: The Association Between Chronic Obstructive Pulmonary Disease and Cognitive Status in an Elderly Sample Using the Third National Health and Nutrition Examination Survey
Authors: Sherzai Ayesha , Willey Joshua Z , Vega Sonia , Sherzai Dean
Published: July 2021

Introduction:
Dementia and cognitive impairment is a major public health issue and is likely related to complex interaction between genetics and modifiable risk factors. Chronic Obstructive Pulmonary Disease (COPD) has been associated with dementia, but its relationship with specific cognitive deficits has not been previously explored.

Methods:
Data was analyzed from the Third National Health and Nutrition Examination Survey (NHANES III). Cases of COPD were defined by a ratio of forced expiratory volume to forced vital capacity of < 0.7. The three cognitive tests included 1) three word immediate verbal memory test (9 points), 2) delayed verbal memory test (9 points), and 3) serial subtractions test (5 trials), as a surrogate of executive function. The odds of having poor cognitive status was assessed using logistic regression models between COPD and each of the three cognitive tests. Models were furthers adjusted for demographic variables, including age, sex, height, body mass index education, race, poverty income ratio, and medical coverage, smoking, and medical comorbidities.

Results:
We identified individuals 60-89 years of age (weighted N= 17,181,182) with a diagnosis of COPD (mean age 71.5 ± 0.19 years, 50.1% women, 85.9% non-Hispanic whites). In the unadjusted model, there was a strong association between COPD and poor scores for immediate memory recall (<5 out of 9 points; OR 2.18, 95% CI 1.81-2.62), delayed memory recall (<4 out of 9 points; OR 2.25, 95% CI 1.85-2.70) and serial subtraction (< 5 trials correct; OR 1.44, 95% CI 1.10-1.90). After adjusting for socio-demographic and vascular variables, these relationships remained robust for the immediate and delayed recall tests. In contrast, the association with serial subtraction test was rendered insignificant after adjusting for socio-demographic factors (OR 1.05, 95% CI 0.69-1.60). Upon further adjusting for vascular risk factors such as stroke, coronary heart disease, hypertension, diabetes and congestive heart failure, the odds for poor serial subtraction test increased and became significant (OR 2.74, 95% CI 1.17-6.40, p trend < 0.001).

Discussion: In this nationally representative database, COPD is significantly associated with impaired immediate and delayed memory, but not with executive function. These results shed light on differential susceptibility of the brain in COPD and its relationship with vascular risk factors.
Abstract P137: Updated Trends in CVD Risk Factors and Rurality in Appalachian Children using Surveillance, Clustered Statistical Design and GIS Capabilities
Authors: Lilly Christa , Cottrell Lesley , Fedorko Evan , Umer Amna , Neal William
Published: July 2021

Research suggests a link between rurality and CVD risk factors; however, our previous work found that metropolitan (rather than rural) areas were associated with CVD risk factors in WV fifth grade children. Our goal is to examine developmental trends as well as updated CVD risk factors stratified by Rural-Urban Continuum Code (RUCC) classification.

Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) data include 14,226 Kindergarten, 10,784 Second grade, 80,635 Fifth grade, and 1,451 Teenage children. The clustered analytic design nested children’s results within zip code using a six-category RUCC (Figure 1), and controlling for age, gender, race, and maternal education. Least squares means are reported. Outcomes included BMI percent above ideal (BMI%) for all grades, and HDL, LDL, and SBP for fifth grade.

Developmental Trends: Kindergarten: Significant effect of RUCC on BMI%, p<0.0001, Metro (M=10.11) and Town (10.43) had higher means than Rural (6.66). Second grade: Metro (16.82) and Town (16.41) had higher means than Small Metro (12.48), Rural (10.48; p< 0.0001). Fifth grade: Metro (21.5) and Town (21.5) had higher means than Large Metro (17.78), Small Metro (17.86; p0.05).

CVD Risk Factors: Metro (49.31), Non-metro Urban (49.28), and Town (49.76) had lower HDL than Large Metro (M=52.9), Rural (52.54) and Small Metro (51.36; p<0.05). Metro (95.76) presented with higher LDL than Rural (89.11), Town (90.25), Large Metro (91.08), Small Metro (91.28) and Non-metro Urban (91.8; p<0.05). Large Metro (108.97), Metro (109.03) and Town (108.76) had higher SBP than Rural (106.95) and Small Metro (107.28; p<0.05) Results suggest that younger children from rural areas had lower BMI% than metro and town areas. This trend appears to reverse as children enter middle and high school. Examination of fifth grade CVD risks found mid-sized metro areas presented with the worst outcomes.
Abstract P141: Non-alcoholic Fatty Liver Disease, Insulin Resistance, and the Risk of Incident Ischemic Heart Disease and Stroke - The Kangbuk Samsung Health Study
Authors: Chang Yoosoo , Ryu Seungho , Cho Juhee , Rampal Sanjay , Zhang Yiyi , Zhao Di , Choi Yuni , Ahn Jiin , Cainzos-Achirica Miguel , Pastor-Barriuso Roberto , Lima Joao A , Shin Hocheol , Guallar Eliseo
Published: July 2021

Objective:
Nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance (IR) and with other metabolic abnormalities, but the association of NAFLD with the risk of clinical cardiovascular disease (CVD) is controversial. Furthermore, the risk associated with the combination of NAFLD and IR has not been evaluated in prospective studies. The aim of this study was to evaluate the association of NAFLD with or without IR on the incidence of coronary heart disease (CHD) and stroke.

Methods:
We performed a cohort study in 166,126 adults without CVD at baseline who underwent a health checkup exam during 2008 - 2011 and were followed-up through December 31, 2012 (average follow-up of 3.2 years). NAFLD was defined as hepatic steatosis on ultrasonography in the absence of excessive alcohol use or other identifiable causes. IR was defined as a homeostasis model assessment of IR (HOMA-IR) value ≥ 2.5. Incident hospitalizations for CHD events and strokes were ascertained through data linkage with the Korean Health Insurance Review and Assessment Service (HIRA) database.

Results:
At baseline, the prevalence of NAFLD and of IR were 25.1 and 6.3%, respectively. During follow-up, 831 participants developed CHD and 582 subjects developed stroke. After adjusting for age, sex, center, year of screening exam, BMI, smoking, alcohol intake, physical activity, family history of CVD, and education, the hazard ratios (95 % confidence intervals) for CHD comparing NAFLD without IR, IR without NAFLD, and NAFLD with IR vs. no NAFLD without IR were 1.07 (0.91 - 1.27), 1.19 (0.74 - 1.91) and 1.55 (1.18 - 2.03), respectively. The corresponding hazard ratios for stroke were 0.93 (0.75 - 1.16), 1.40 (0.83 - 2.35) and 1.82 (1.32 - 2.52), respectively. The P-values for the interaction of NAFLD and IR for CHD and stroke were 0.48 and 0.28, respectively. These associations did not differ by clinically relevant subgroups.

Conclusions:
The combination of NAFLD and IR was associated with an increased incidence of CHD and of stroke, but this was not observed in those with either NAFLD or IR alone. The combination of NAFLD and IR may identify individuals at high cardiometabolic risk who may need to receive more intensive preventive intervention.
Abstract P145: Evaluating the Diagnostic Efficacy of A1C, Fructosamine and Glycated Albumin in Determining Glucose Tolerance Status in Africans: The Africans in America Study
Authors: Duong Michelle T , Thoreson Caroline K , Chung Stephanie T , Aldana Paola C , Ricks Madia , Mabundo Lilian S , Sacks David B , Sumner Anne E
Published: July 2021

As both diabetes and pre-diabetes are common in Africa, screening tests must be rapid, simple, and accurate. Hemoglobin A1C (A1C), fructosamine, and glycated albumin (GA) are screening tests of long term glycemia which only require one blood sample obtained any time of day without consideration of recent nutrient intake. A1C is already recommended as a screening test for diabetes by the American Diabetes Association and the International Diabetes Federation, but fructosamine and GA are under active evaluation. Fructosamine is a measure of circulating glycated protein. GA is a subfraction of fructosamine. Data on the effectiveness of fructosamine and GA in African descent populations are scant. Therefore, our goal was to compare the ability of A1C, fructosamine, and GA to predict diabetes. Two hour OGTT were performed in 230 African immigrants (67% male; age 37±10y (mean±SD); BMI: 27.6±4.6 kg/m2). Glucose tolerance category was defined by 2h glucose levels (normal: 2h glucose<140 mg/dL; pre-diabetes: 2h glucose ≥140 mg/dL and <200 mg/dL; diabetes: 2h glucose ≥200 mg/dL). A1C was measured in all participants while fructosamine and GA levels were available in 153 of the enrollees. Pre-diabetes was identified in 26% (61/230) of the participants and diabetes was detected in 7% (15/230). By one-way ANOVA, A1C, fructosamine and GA were higher if diabetes was present (all P<0.01) but did not differ significantly in the normal and pre-diabetes categories. For the prediction of diabetes, area under the receiver operator characteristic (AUC-ROC) curves was higher for GA than either fructosamine or A1C (Table). Overall, in African immigrants, each of the three tests was able to identify diabetes, but none were able to distinguish between normal glucose tolerance and pre-diabetes. Among the three tests, GA may be the best predictor of diabetes.
Abstract P161: Peripheral Arterial Disease in Hispanic Communities: Results from the Hispanic Community Health Study/Study of Latinos
Authors: Allison Matthew A , Gonzales Franklyn , Raij Leopoldo , Kaplan Robert , Ostfeld Robert , Pattany Maria , Heiss Gerardo , Criqui Michael
Published: July 2021

Background:
Compared to non-Hispanic Whites, Hispanic Americans have a significantly lower prevalence of peripheral arterial disease (PAD). Since Hispanic ethnicity in the United States is heterogeneous, the purpose of this study was to determine the differential odds for PAD by Hispanic/Latino subgroup.

Methods:
Subjects were 9,648 men and women over the age of 45 years enrolled in the Hispanic Community Health Study - Study of Latinos (HCHS-SOL) who were evaluated by extensive survey information, relevant physical measurements and fasting blood assays. The ankle brachial index (ABI) was computed as the higher of the posterior tibial and dorsalis pedis systolic blood pressures (SBP) for each leg divided by the higher brachial artery SBP. The index ABI was the lower of the two. An ABI ≤ 0.90 was criterion for the presence of PAD.

Results:
The mean age was 56 years and 62% were female. Thirty percent were Mexican American, while 27% were Cuban American, 19% Puerto Rican American, 9% Dominican American, 7% Central American, 5% South American and 3% Mixed or Other Hispanic ethnicities. Overall, the prevalence of an ABI ≤ 0.90 (PAD), 0.90 to 0.99 (borderline), 1.0 to 1.39 (normal) and ≥ 1.40 (high) was 5.7, 19.3, 72.5 and 2.6%, respectively. Cuban Americans had the highest prevalence of PAD (9.1%), followed by Puerto Rican (5.9%), Central American (5.3%), Mixed/Other (5.0%), Dominican (4.7%), South American (4.6%) and Mexican Americans (3.2%). The prevalence of an ABI ≥ 1.40 ranged from 3.1% (South Americans) to 0.6% (Mixed/Other). After multivariable adjustment, and compared to Mexican Americans, Cuban Americans had nearly a 3-fold higher odds for PAD (OR = 2.85). The odds of PAD for the other Hispanic/Latino groups ranged from 1.23 to 1.82. Although males had over a 3-fold higher odds of an ABI ≥ 1.40 (OR = 3.55), the odds did not differ significantly by Hispanic/Latino ethnicity.

Conclusions:
Compared to Mexican Americans, all other Hispanic/Latino ethnic groups have a significantly higher odds of having PAD, with the odds being nearly 3-fold higher among Cuban Americans.