bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 43: Genetic, Sociodemographic, Lifestyle, and Clinical Risk Factors of Coronary Artery Disease Recurrent Events: Population-Based Cohort Study
Authors: Cho So Mi J , Koyama Satoshi , Honigberg Michael C , Surakka Ida , Patel Aniruddh P , Bhattacharya Romit , Lee Hokyou , Kim Hyeon Chang , Natarajan Pradeep
Published: March 2023

Introduction:
Contemporary guidelines remain to uniformly classify patients with established atherosclerotic cardiovascular disease as high risk despite substantial heterogeneities in risk factors distributions. We examined the independent associations and relative predictabilities of genetic, sociodemographic, lifestyle, and clinical risk factors on coronary artery disease (CAD) recurrence.

Methods:
From population-based UK Biobank cohort, we identified 7,024 participants aged 40-69 years with established CAD at enrollment. Based on multivariable Cox regression model, we evaluated the hazard ratio (HR) and discrimination index of age at enrollment, age at first CAD diagnosis, sex, smoking, physical activity, diet, sleep, socioeconomic deprivation, body mass index, blood pressure, lipids, glucose, lipoprotein(a), C-reactive protein, estimated glomerular filtration rate, statin prescription, and CAD polygenic risk score (PRS) on first CAD recurrence since enrollment.

Results:
Over a median [IQR] follow-up of 11.6 [4.0] years, 2,003 (28.5%) recurrent CAD events occurred. Of studied risk factors, the HR [95% CI] for CAD recurrence was the most pronounced with current smoking (1.35 [1.13-1.61]) and per SD increase in age at first CAD (0.74 [0.67-0.82]). Moreover, age at enrollment, Townsend Deprivation Index, sleep quality, cholesterols, glucose, renal function, C-reactive protein, and CAD PRS also significantly associated with recurrence. CAD PRS (C index: 0.58 [0.57-0.59]) largely predicted CAD recurrence, followed by high-density lipoprotein (HDL) cholesterol (0.57 [0.57-0.58]) and age at first CAD (0.57 [0.56-0.57]). In addition to traditional risk factors, a comprehensive model improved the C index from 0.64 [0.63-0.65] to 0.68 [0.67 to 0.69].

Conclusion:
Genetic risk, age at first CAD event, and HDL cholesterol contributed the most to CAD recurrence. These features may identify high risk subgroups for treatment intensification or trials for new therapeutic strategies among those with CAD.
Abstract 44: Plasma Sphingolipids in Relation to Cognitive Decline and Incident Dementia
Authors: Moseholm Kristine F , Cronje Héléne , Fitzpatrick Annette L , Kuller Lewis H , Lopez Oscar L , Otto Marcia D , Longstreth W T , Hoofnagle Andy , Mukamal Ken J , Lemaitre Rozenn N , Jensen Majken K
Published: March 2023

Introduction:
Sphingolipids are fundamental components of brain structure and function. They are located in the myelin sheath insulating neuronal axons and in the cell membranes of neurons, astrocytes, and microglia involved in signal transduction. Although circulating sphingolipid profiles reflect clinical neurodegeneration, few prospective studies have investigated their utility as pre-clinical risk markers in community-based cohorts. For heart disease and diabetes, themselves risk factors for dementia, associations with sphingolipids differed across species and the length of the saturated fatty acid carried.

Hypothesis:
We hypothesized that plasma levels of sphingolipid species containing palmitic acid (16:0) would be positively associated with incident dementia risk and cognitive decline, while those with arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0) would be associated with lower risk.

Methods:
We measured 18 sphingolipid species in plasma samples from 4612 participants of the Cardiovascular Health Study (CHS) (mean age 76.2 years; 40% male; and 25% APOE ε4 allele carriers). Cognitive decline was assessed across 6 years using annual 100-point modified Mini-Mental State Examination (3MSE) and Digital Symbol Substitution Test (DSST) scores. A total of 3088 non-demented participants were enrolled in the CHS Cognition Study and followed with adjudication for dementia. To correct the analyses for multiple comparisons, we applied a false discovery rate (FDR) correction and used a significance threshold of 0.05.

Results:
Higher baseline levels of lactosylceramide-24:0 (LacCer-24) were associated with a faster 6-year cognitive decline (time x sphingolipid interaction p=0.04 for 3MSE and 0.03 for DSST). Conversely, higher baseline plasma levels of hexosylceramide -16:0 (HexCer-16) and sphingomyelin-22:0 (SM-22) were associated with slower cognitive decline measured with DSST (time x sphingolipid interaction p=0.02 for HexCer and p=0.05 for SM-22). During a median follow-up of 4.5 years, we identified 366 incident dementia cases. In proportional Cox regression analyses, higher plasma levels of ceramide-16:0 (Cer-16) were positively associated with incident dementia upon adjustment for demographics, lifestyle factors, medical history, C-reactive protein, and lipids [hazard ratio per SD: 1.18 (95% CI, 1.06; 1.31)].

Conclusions:
In older adults without dementia, higher plasma levels of Cer-16, a species previously associated with cardiovascular disease and mortality, were associated with higher risk of clinical dementia as we hypothesized. LacCer-24 was associated with faster, and HexCer-16 and SM-22 with slower, cognitive decline, but these species were not statistically associated with dementia risk. These novel and inconsistent findings will need to be replicated in other longitudinal studies.
Abstract 45: Life's Essential 8 and the Risk of Stroke in Finnish Men: The Kuopio Ischaemic Heart Disease Risk Factor Study
Authors: Isiozor Nzechukwu M , Kunutsor Setor K , Voutilainen Ari , Kauhanen Jussi , Jouven Xavier , Gaye Bamba , Laukkanen Jari A
Published: March 2023

Background:
Primordial prevention is an important way towards reducing risk of stroke with its associated health and economic burdens. So far, no study has shown how the recently updated American Heart Association’s cardiovascular health metrics, Life’s Essential 8 (LE8), relates to stroke events. Therefore, we sought to examine the association between LE8 and the risk of stroke among Finnish men.

Methods:
We employed the population-based Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) comprising men, aged 42 to 60 years, without pre-existing history of stroke at baseline. The LE8 was computed for 2614 men using AHA’s recently updated metrics. The LE8 includes four health behaviours (diet, physical activity, nicotine exposure, and sleep health) and four health factors (BMI, blood lipids, blood glucose and blood pressure). Each factor had points ranging from 0 to 100. Participants were classified into quartiles based on LE8 scores - Q1, ≤ 420; Q2, >420 to 485; Q3, >485 to 550; Q4, >550. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LE8 scores for stroke event.

Results:
During a median follow-up of 26 years, 446 stroke events were recorded. The higher the LE8 scores, the more protection from future risk of stroke event. Thus, per quartile increase was associated with 26% lower risk of stroke (HR:0.74; 95%CI:0.68-0.82). Men within the 4
th
quartile (Q4) of LE8 score had the highest protection (65%) from risk of stroke when compared with those within the 1
st
quartile (Q1) (HR: 0.45; 95%CI:0.34-0.60).

Conclusion:
Life’s Essential 8 was strongly and inversely associated with the risk of stroke among middle-aged and ageing Finnish men. Measures that promote LE8 should be encouraged among the general population in Finland.
Abstract 46: MIND Diet-Related Transcriptomic Alterations in the Aging Human Brain is Associated With Lower Dementia Risk and Slower Cognitive Decline
Authors: Li Jun , Capuano Ana , Agarwal Puja , Wang Yanling , De Jager Philip , Arvanitakis Zoe , Bennett David , Liang Liming , Grodstein Francine
Published: March 2023

Background:
Healthy diets are associated with lower dementia risk; however, the underlying molecular mechanisms are largely unknown.

Hypothesis:
A healthy diet is associated with brain transcriptomic alterations that are related to a better cognitive health.

Methods:
RNA sequencing was conducted using dorsolateral prefrontal cortex from 1,204 deceased participants of the Religious Orders Study and Rush Memory and Aging Project. Annual cognitive/clinical assessments were performed from enrollment through death. Diet was assessed at baseline/follow-ups in 482 individuals using a validated food-frequency questionnaire. Among these individuals, we calculated a MIND diet score (
M
editerranean-DASH Diet
I
ntervention for
N
eurodegenerative
D
elay) to assess intakes of a presumed neuroprotective diet pattern, and applied elastic net regression to identify a brain transcriptomic profile associated with the MIND diet.

Results:
In individuals with dietary data (n=482), we identified a transcriptomic profile, consisting of 50 genes, for the MIND diet; the profile score was significantly correlated with MIND diet score (
r
=0.15;
P
=0.001). In multivariable analyses of the remaining 722 independent individuals, a higher transcriptomic profile score was significantly associated with lower odds of dementia (OR=0.76 per SD increment in transcriptomic score;
P
=0.003) and slower annual rate of decline in global cognition (β=0.011;
P
=0.004). In secondary Mendelian randomization analysis, genetically predicted MIND diet-transcriptomic profile score was associated with lower Alzheimer’s dementia risk (OR=0.93;
P
=0.04), but not vice versa.

Conclusion:
MIND diet was associated with gene expressions in the human brain that were related to less dementia and cognitive decline. Associations did not appear due to reverse causation. Our findings suggest that associations between diet and brain health may involve molecular alterations at the transcriptomic level; and may inform future therapeutics design for dementia prevention.
Abstract 49: The Effects of Vitamin D Supplementation on Subclinical Cardiovascular Disease: Results From the Sturdy Trial
Authors: Earle William , Rainer Katharine , Appel Lawrence J , Miller Edgar R , Michos Erin D , Schrack Jennifer , Wanigatunga Amal , Mitchell Christine , Rebuck Heather , Christenson Robert H , Juraschek Stephen P
Published: March 2023

Background:
In observational studies, older adults with insufficient or deficient serum vitamin D levels are at higher risk of cardiovascular disease (CVD), but randomized trials have failed to demonstrate reduction in CVD risk from vitamin D supplementation. This is possibly because the doses of vitamin D supplements tested were too low.

Objective:
To determine if higher doses of vitamin D supplementation lower high sensitivity cardiac troponin level (hs-cTnI) and N-terminal pro b-type natriuretic peptide (NT-proBNP), markers of subclinical CVD.

Methods:
The Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a double-blind, randomized, response-adaptive trial that tested the effects of 4 doses of vitamin D3 supplementation (200, 1000, 2000, and 4000 IU/day) on fall risk in adults aged ≥70 years old with low serum 25-hydroxyvitamin D levels (10-29 ng/ml). Hs-cTnI and NT-proBNP levels were measured at baseline and at 3-, 12- and 24-month follow-up visits. For analysis, participants were divided into low (200 IU/day) and high dose (1000+ IU/day) vitamin D treatment groups. The effects of vitamin D dose on hs-cTnI and NT-proBNP were assessed via mixed effects tobit models.

Results:
Among 688 participants (mean age of 77 ± 5 years, 44% were women, and 18% were Black), 50.7% were in the high-dose treatment group (1000+ IU/day). Hs-cTnI increased in both the low and high dose groups by 5.1% and 5.8%, respectively; likewise, NT-proBNP increased in both groups by 11.3% and 9.3%, respectively (
Figure).
Compared to the low-dose group, high-dose vitamin D treatment did not affect hs-cTnI (1.7 % difference; 95% CI: -5.3, 9.3) or NT-proBNP (-1.8 % difference; 95% CI: -9.3, 6.3).

Conclusions:
Compared to low dose vitamin D supplementation, a higher dose did not affect markers of subclinical CVD in older adults with low serum vitamin D levels. These findings do not support higher doses of vitamin D as an intervention to reduce the risk of CVD in this population.
Abstract 51: Better Sleep Health is Associated With Greater Adherence to Lifestyle Modification During a 12-month Behavioral Weight Loss Intervention
Authors: Kline Christopher E , Imes Christopher C , Sereika Susan M , Buysse Daniel J , Rockette-Wagner Bonny , Bizhanova Zhadyra , Burke Lora E
Published: March 2023

Introduction:
Consistent evidence suggests that poor sleep may impede weight loss efforts; however, the impact of poor sleep on lifestyle modification during attempted weight loss is unclear.

Purpose:
To examine the relationship between sleep health and measures of lifestyle modification in a sample of adults who participated in a 12-month behavioral weight loss intervention.

Methods:
Adults (N=125) with overweight or obesity (50.3±10.6 years, 91% female, 81% White) participated in a 12-month behavioral weight loss intervention. Assessments occurred at baseline, 6 months, and 12 months. Six dimensions of sleep were included in our operationalization of sleep health: regularity, satisfaction, alertness, timing, efficiency, and duration. Sleep dimensions were assessed using validated questionnaires and actigraphy, with values dichotomized into ‘good’ and ‘poor’ sleep. A composite sleep health score was calculated based upon the count of the ‘good’ individual dimensions (range: 0-6), with higher scores indicating better sleep health. Measures of lifestyle modification included attendance at group intervention sessions, daily adherence to caloric intake goals (% of days), and change in average daily moderate-vigorous physical activity (MVPA). Linear mixed modeling was used to examine the relationship between baseline and 6-month sleep health and lifestyle modification during the subsequent 6-month interval with adjustment for age, gender, bed partner, and race. The composite sleep health score and individual sleep health dimensions were evaluated in separate models.

Results:
Mean sleep health was 4.5±1.1 (mean±standard deviation) at baseline and 4.5±1.2 at 6 months; from 0-6 months and 6-12 months, participants attended 79.4±15.0% and 62.3±32.3% of the group intervention sessions, adhered to caloric intake goals on 35.6±23.3% and 21.1±23.3% of the days, and changed MVPA by 8.7±13.6 min/day and -3.7±13.6 min/day. Better sleep health was associated with higher rates of attendance at group intervention sessions (b=2.71, SE=1.29; P=.038), greater adherence to caloric intake goals (b=4.60, SE=1.34; P<.001), and a trend for greater change in MVPA (b=1.41, SE=0.82; P=.088). Associations with lifestyle modification outcomes were observed with the following individual sleep dimensions (each P<.05): regularity with attendance and caloric intake, satisfaction with caloric intake, and duration with MVPA.

Conclusions:
Better sleep health was associated with greater adherence to lifestyle modification during a 12-month behavioral weight loss intervention. Whether improving sleep health prior to or during a weight loss intervention facilitates better lifestyle modification outcomes merits examination.
Support:
NIH R01HL107370.
Abstract 57: Distinct Gestational Blood Pressure Trajectories Predict Pregnancy, Birth, and Postpartum Health in a Low-Income Hispanic Population
Authors: Niu Zhongzheng J , Yang Tingyu , Guo Fangqi , Grubbs Brendan , Eckel Sandrah P , Toledo-Corral Claudia M , Johnston Jill , Dunton Genevieve F , Lerner Deborah , Lurvey Nathana , Al-Marayati Laila , Habre Rima , Bastain Theresa , Breton Carrie V , Farzan Shohreh
Published: March 2023

Objective:
Blood pressure (BP) typically drops to a nadir around 20 to 24 gestation weeks in a normal pregnancy. Distinct BP trajectories over pregnancy could reveal underlying cardiovascular function and predict future cardiovascular risk, but little is known about BP trajectories in Hispanic women. We aim to identify BP trajectories during pregnancy among low-income, Hispanic women.

Methods:
In the prospective Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) pregnancy cohort, we abstracted clinic BP measures of 732 participants who had an average of 12 BP measures over pregnancy, ranging from 4 to 41 weeks. We used latent class mixture modeling to identify BP trajectories. We examined associations of population characteristics, pregnancy and birth outcomes, and 1-year postpartum BP with the identified trajectories.

Results:
We identified three distinct BP trajectories (
Figure
). Compared to the majority (class 1, n=569), the consistently high class 2 (14.8%, 108) was characterized by a higher pre-pregnancy BMI (ppBMI, 32.3±7.6 vs. 27.6 ±6.1 Kg/m
2
) and a higher proportion of having college or above education (21.3% vs. 14.9%), while the high-low-high U-shape class 3 (7.5%, 55) had a higher ppBMI (32.0±7.9 Kg/m
2
) but lower proportion of having college or above education (9.1%). Risk of preeclampsia was the highest in class 3 (43.6%), followed by class 2 (10.2%) and class 1 (6.0%), while the risk of gestational diabetes was the highest in class 2 (14.8%), followed by class 1 (7.9%) and class 3 (7.3%). Birthweight and gestational duration were both significantly lower in class 3 than classes 1 and 2. One-year postpartum systolic BP was significantly higher in class 2 (120.2±16.0 mmHg) and class 3 (122.4±16.0 mmHg) than class 1 (111.7±26.2 mmHg) after adjusting for maternal age, pre-pregnancy BMI, parity, and education.

Conclusion:
Elevated blood pressure may develop into district trajectories in pregnancy that further predict pregnancy and birth outcomes, as well as postpartum blood pressure.
Abstract 58: Timing of Outpatient Postpartum Care Utilization Among Women With Chronic Hypertension and Hypertensive Disorders of Pregnancy
Authors: Aqua Jasmine K , Ford Nicole D , Kuklina Elena V , Hayes Donald K , Vaughan Adam S , Coronado Fátima
Published: March 2023

Objectives:
The postpartum period represents an opportunity to intervene on the cardiovascular health of women who experience chronic hypertension in pregnancy or hypertensive disorders of pregnancy (HDP), including gestational hypertension, preeclampsia or eclampsia, and chronic hypertension with superimposed preeclampsia. This study sought to determine whether women who experience chronic hypertension or HDP access timely postpartum care compared to women with no documented hypertension.

Methods:
We used insurance claims data from the IBM MarketScan® Commercial Claims and Encounters Database. We included n=274,714 women 12-55 years old with a delivery hospitalization between 2017-2018 with continuous insurance enrollment from 3 months before the estimated start of pregnancy to 6 months after delivery discharge. Chronic hypertension and HDP were identified using International Classification of Diseases 10th Revision Clinical Modification codes. Distributions of time-to-event survival curves (time to first outpatient postpartum visit with a women’s health, primary care, or cardiology provider) were compared between the hypertension types using Kaplan-Meier estimators and logrank tests. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Time points of interest (3, 6, and 12 weeks) were consistent with visit benchmarks in traditional and updated postpartum care guidelines.

Results:
The prevalences of HDP, chronic, and no documented hypertension were 11.7%, 2.6%, and 85.7%, respectively. The proportions of women with a visit within 3 weeks of delivery discharge were 28.0%, 26.8%, and 15.8% for HDP, chronic, and no documented hypertension, respectively. By 12 weeks, the proportions increased to 59.6%, 61.3%, and 51.5%, respectively. Kaplan-Meier analyses indicated significant differences in utilization by hypertension type and interaction between hypertension type and time before and after 6 weeks. In adjusted Cox proportional hazards models, the utilization rate before 6 weeks among women with HDP was 1.42 times the rate for women with no documented hypertension (aHR=1.42, 95% CI: 1.40, 1.45). Women with chronic hypertension had similarly higher rates compared to women with no documented hypertension (aHR=1.29, 95% CI: 1.24, 1.35). There were no significant associations by hypertension type after 6 weeks.

Conclusions:
Women with HDP and chronic hypertension attend outpatient postpartum care visits faster than women with no documented hypertension. However, there were no significant associations by hypertension type after 6 weeks due to interaction with time before and after the traditional 6-week visit. Overall, utilization remains low in all groups. Addressing barriers to postpartum care attendance can ensure timely care for women at high risk for cardiovascular disease.
Abstract 60: Impact of a Multisite, Protocol-Driven, Nurse Practitioner-Led, Cardiovascular Prevention Program in a Hispanic Medicare Advantage Population at High Risk for ASCVD: Healthy Heart Program at Cano Health.
Authors: MCCLOSKEY Veronica , Nasir Khurram , Khera Rohan , Oikonomou Evangelos K , Diaz Robert , Kenney Robert , Aguilar Richard , Gulati Martha , Cingolani Oscar H , Gluckman Ty J , Blankstein Ron , Hernandez Marlow B , Rivera Juan
Published: March 2023

Introduction:
Despite availability of effective and inexpensive pharmacologic therapies for hypercholesterolemia and hypertension, many patients at high risk for atherosclerotic cardiovascular disease (ASCVD) do not achieve optimal low-density lipoprotein (LDL) and systolic blood pressure (SBP) levels. We hypothesized that risk factor control could be improved by using nurse practitioners and a guideline-directed protocol in a Medicare Advantage (MA) population.

Methods:
We designed and implemented an ongoing 18 site, multistate (FL, TX, NV), ASCVD risk assessment and management program (Healthy Heart) in a large national MA primary care clinic (Cano Health). The cardiometabolic risk assessment and management program was designed by a team of preventive cardiologists, with the plan of being Nurse Practitioner (NP)-led, with remote support by a cardiologist. Protocols provided details on initiation and titration of drug therapy to achieve LDL-C and SBP goals. Patients with organ transplants, advanced cancer, an ejection fraction <35%, and on hemodialysis were excluded.

Results:
From October 2021-October 2022, 5430 patients were enrolled in the program. A total of 1858 (34.2%) had established ASCVD, 1033 (19.0%) had diabetes mellitus (DM). A total of 713 (13.1%) had both ASCVD and DM. In patients who had ASCVD and diabetes together, high intensity statin use increased from 39.4% to 68.3% after enrollment; 52.66% achieved an LDL-C <70 mg/dl after enrollment compared to 31.0% at baseline. Antihypertensive medications were intensified in 408/1041 (39.2%) of ASCVD and 276/558 (49.5%) of DM patients, with a higher proportion achieving a SBP <130 mm Hg after enrollment.

Conclusions:
Implementing a novel cardiovascular prevention program in a population of mostly Hispanic MA patients at high risk for ASCVD, using NPs, with strict adherence to a step-by-step evidence-based protocol supervised by cardiologists, is associated with reduction in LDL levels and SBP and with improvement in reaching LDL and SBP targets.
Abstract 63: Life’s Essential 8 and Life Expectancy Free of Cardiovascular Disease, Diabetes, Cancer, and Dementia in Adults
Authors: Wang Xuan , Ma Hao , Li Xiang , Heianza Yoriko , Manson Joann E , Franco Oscar H , Qi Lu
Published: March 2023

Background:
Average life expectancy has increased substantially in recent decades in most developed countries; however, a sizable proportion of the increased life expectancy is spent in suboptimal health.

Hypothesis:
We investigated whether levels of cardiovascular health (CVH), estimated by the American Heart Association’s newly released Life’s Essential 8 (LE8) metrics, was associated with life expectancy free of major chronic disease including cardiovascular disease (CVD), diabetes, cancer, and dementia, in UK adults.

Methods:
This study included 136,599 adults in the UK Biobank who were initially free of CVD, diabetes, cancer, and dementia and had complete data on LE8 metrics. Eight components were used to create the LE8 score, including diet, physical activity, tobacco/nicotine exposure, sleep, body mass index, non-high-density-lipoprotein cholesterol, blood glucose and blood pressure. Multistate life tables were applied to calculate the total life expectancy and years lived with and without diseases (CVD, diabetes, cancer, and dementia) according to adherence to the levels of CVH (poor, intermediate and ideal) in men and women.

Results:
Compared to those with poor CVH (referent), men and women with ideal CVH had an average 5.2 (95 % CI, 3.6 to 6.8) and 6.3 (95% CI, 4.9 to 7.9) more years of total life expectancy at age 50, respectively. The percentage of life expectancy free of chronic diseases out of total life expectancy was 75.9% for men and 83.4% for women who had ideal CVH, compared to 64.9% and 69.4%, respectively, for those with poor CVH. Moreover, we found that disparities in disease-free years related to low socioeconomic status were substantially narrowed by adhering to ideal CVH in both men and women.

Conclusions:
Adherence to ideal CVH, evaluated with the LE8 metrics, is associated with markedly extended life expectancy and more years lived free of major chronic diseases, as well as narrowing of socioeconomic health inequalities, in both men and women.
Abstract 65: DNA Methylation at
ABCG1
and Long-Term Changes in Adiposity in Response to Diet Interventions: The POUNDS Lost Trial
Authors: Li Xiang , Shao Xiaojian , Xue Qiaochu , Kou Minghao , Grundberg Elin , Bray George A , Sacks Frank M , Qi Lu
Published: March 2023

Introduction:
Epigenome-wide association studies identified that DNA methylation (DNAm) at the
ABCG1
gene (cg06500161) was associated with obesity. However, little is known about whether DNAm at
ABCG1
is associated with long-term changes in adiposity and body fat distribution in response to dietary weight-loss interventions.

Hypothesis:
We hypothesized that participants with varying DNAm at
ABCG1
might respond differently to dietary weight-loss interventions on long-term changes in adiposity and body fat distribution.

Methods:
The current study included 673 participants with overweight/obesity, who were randomly assigned to 1 of 4 diets varying in macronutrient components. Blood DNAm level was profiled by a high-resolution methylC-capture sequencing at baseline. The regional DNAm at
ABCG1
was defined as the average methylation level over CpGs within ± 250 bp of cg06500161. Two-year changes in adiposity and Computed Tomography (CT)-measured body fat distribution were calculated.

Results:
We found that regional DNAm at
ABCG1
significantly interacted with dietary protein intake on long-term changes in body weight and waist circumference (WC) at 6 months and 2 years (P-interaction<0.05 for all,
Figure
). Among participants assigned to an average-protein (15%) diet, lower regional DNAm at
ABCG1
was associated with greater reductions in body weight and WC at 6 months and 2 years, while opposite associations were found among those assigned to a high-protein (25%) diet. Similar interactions were also observed for body fat distribution, including visceral adipose tissue, subcutaneous adipose tissue, deep subcutaneous adipose tissue, and total adipose tissue at 6 months and 2 years (P-interaction<0.05 for all).

Conclusion:
Our data indicate that DNAm at
ABCG1
interacted with dietary protein intake on long-term changes in adiposity and body fat distribution. Participants with hypomethylation at
ABCG1
benefited more in long-term improvement in adiposity and body fat distribution by consuming an average-protein diet.
Abstract 67: Obesity Paradox of Cardiovascular Mortality in Older Adults: National Health Interview Survey 1997-2018
Authors: Chen Yuling , Koirala Binu , Commodore-Mensah Yvonne , Dennison Himmelfarb Cheryl R , Ying Wu
Published: March 2023

Background:
The optimal body mass index (BMI) for cardiovascular disease (CVD) prevention in older adults remains uncertain. We aimed to evaluate the relationship between BMI and CVD mortality and identify the nadirs for CVD mortality in older (≥65 years) and younger (<65 years) individuals.

Methods:
We used data from the 1997 to 2018 National Health Interview Survey, linked to the National Death Index (NDI). We included adults aged 18 years and older with BMI and NDI follow-up data available. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for the association between BMI and CVD mortality. Fully adjusted models were stratified by age and controlled for baseline age, sex, race, income, education, marital status, diabetes, cancer, general health, physical activity, smoking, and alcohol status.

Results:
Among 490,037 adults, the mean(±SD) age was 47(18) years; 55% were female. During a median follow-up period of 11 years, 19,194 CVD deaths occurred. The associations between BMI and CVD mortality were J-shaped in adults aged ≥ 65 years and < 65 years. The CVD mortality was minimized at a BMI of 26 kg/m
2
in adults aged ≥ 65 years and 22 kg/m
2
in those aged < 65 years. In adults aged ≥ 65 years, being overweight was associated with a lower risk of CVD mortality (HR 0.93, [95% CI, 0.89-0.96]); having level I obesity (0.90 [0.94-1.05]) and level II obesity (1.06 [0.97-1.16]) did not increase the risk of CVD mortality; and level III obesity was associated with increased risk of CVD mortality in comparison with individuals who had a normal BMI (
Figure
). In individuals aged < 65 years, being overweight, level I, II, and III obesity were associated with a progressively higher risk of CVD mortality.

Conclusion:
Overweight and level I obesity seem to be protective against CVD mortality in older adults. This obesity paradox suggests that the optimal BMI might be sensitive to age. Thus, weight management should be individualized.
Abstract MP03: Adiponectin Levels in Young Adulthood and the Association With Midlife Cognition: The Bogalusa Heart Study
Authors: De Anda-Duran Ileana , Carmichael Owen , Kolachalama Vijaya B , Fernandez Camilo , Au Rhoda , Libon David , Bazzano Lydia A
Published: March 2023

Objective:
Adiponectin (ApN), has anti-inflammatory and anti-atherogenic properties. Low levels of ApN are found even after normalization of glucose in patients with diabetes, and are implicated in atherosclerosis, and dementia onset but results vary across the lifespan. We assessed the relation of ApN levels in young adulthood, with midlife atherosclerosis, measured by carotid intima media thickness (cIMT), and with cognitive function among Black and White individuals from the Bogalusa Heart Study (BHS).

Methods:
A total of 604 participants from the BHS, a community cohort in rural Louisiana, were examined for ApN levels with lowest quartile of ApN levels (<5.4 μg/mL) defined as low-ApN. Structural equation models assessed mediation via the temporal association of low-ApN (age 36±4) with midlife (age 49±5) cIMT, dichotomized above the 50
th
percentile (>0.88mm), and a global cognitive score(GCS) standardized for age, race and sex. Adjusted models included education attendance.

Results:
Individuals with low-ApN were more likely men [ 56.2% (77), p<0.001] and White [54.7% (75), p<0.001]. No differences in education were found. There was a direct association between low-ApN and GCS (P=0.025), low-ApN and cIMT ≥ 50
th
(P=0.001), and cIMT ≥ 50
th
and GCS (P=0.002). (
Figure1)
In mediation analysis, the ratio of Indirect effect/Total effect was 0.108, indicating that ~11% of the effect of low-ApN on GCS was mediated by cIMT. Education was not associated with low-ApN.

Conclusion:
Low-ApN levels in early adulthood was associated with poor cognition after ~10 years of follow-up, and the association was partially mediated by subclinical atherosclerosis. This suggests that ApN may play a role in neurodegeneration mechanisms and contribute to the development of dementia, underscoring the importance of addressing cardiometabolic influences earlier in the lifespan to prevent/delay cognitive decline.
Abstract MP05: Prospective Associations of Midlife Physical Activity and Sedentary Behavior With Brain Structure: The Cardia Study
Authors: Whitaker Kara M , Gabriel Kelley P , Helverson Annika , Zhang Dong , Sternfeld Barbara , Sidney Stephen , Jacobs David R , Palta Priya , Yaffe Kristine , Bryan Nick
Published: March 2023

Introduction:
Strong evidence suggests physical activity may prevent cognitive decline. Less research has explored potential associations of physical activity with brain structure. This is an important research gap given that age related alterations in brain structure are thought to occur prior to signs of cognitive decline.

Objective:
To determine if accelerometer measured sedentary time (SED), light-intensity physical activity (LPA), and moderate-to-vigorous intensity physical activity (MVPA) at ages 38-50 years are prospectively associated with brain structure.

Methods:
We studied 562 Black and White men and women enrolled in CARDIA who participated in the 2005-06 exam (baseline) and exams 5 (2010-11) and/or 10 years later (2015-16). SED, LPA, and MVPA were measured by the ActiGraph 7164 accelerometer at baseline. Magnetic resonance imaging (MRI) was used to quantify whole brain, white matter, gray matter, and abnormal tissue volume of white matter at the 5- and/or 10-year follow-up. Compositional isotemporal substitution analysis examined associations of SED, LPA, and MVPA at baseline with repeated measures (unstructured covariance) of MRI measures at follow-up after accounting for intracranial volume and adjusting for confounders (
Table
).

Results:
Consistent with our hypothesis, substituting 30 minutes of SED to LPA was associated with 0.044% greater total white matter volume (95% CI: 0.001, 0.086). The effect size was larger when substituting SED to MVPA, but this association was not statistically significant. There were no associations observed between accelerometer measures and total brain, total gray matter, or abnormal white matter tissue volumes. Associations did not differ by sex or age.

Conclusions:
Statistical substitution of time from SED to higher intensity physical activity (LPA or MVPA) was associated with greater total white matter volume. It is unclear why this association was observed in white matter only. Additional research with longer follow-up is needed to confirm these findings.
Abstract MP07: Changes in Weight From Sugar- or Artificially-Sweetened Beverages or Water Intake in a Prospective Cohort
Authors: Espinosa-Marrón Alan , Wan Yi , Mattei Josiemer , Hu Frank B , Willett Walter C
Published: March 2023

Background:
It is still unclear if sustained intake of artificially sweetened beverages (ASB) in lieu of sugar-sweetened beverages (SSB) is associated with long-term weight reduction or maintenance. This study aimed to evaluate the long-term changes in weight and BMI in relation to changes in ASB intake, and to estimate the effects of replacing SSB with ASB or water on body weight.

Hypothesis:
Habitual ASB intake is unrelated to weight or BMI changes. The modeled substitutions are expected to show a reduction in weight and BMI, larger for water than for ASB.

Methods:
We used data from the Nurses' Health Study I, a prospective cohort study conducted among female US nurses aged 39 to 65y at enrolment and assessed every four years from 1986 to 2010. Food-frequency questionnaires evaluated usual dietary intake including beverages (in 12 oz servings/day). Self-administered questionnaires collected lifestyle and anthropometric information. We excluded participants with any major disease at baseline (e.g., diabetes, cancer, cardiovascular disease), and censored those reaching 65 years during follow-up. Pregnant or lactating women were not considered during these periods. We evaluated the association between changes in ASB intake with changes in weight and BMI using generalized estimating models adjusting for multiple dietary and lifestyle risk factors. Substitution models assessed how replacing SSB with ASB, SSB with water, or ASB with water relates to weight and BMI changes, adjusting for the same covariates.

Results:
Among 51,805 participants, 64.6% consumed ASB at baseline averaging 0.25 ± 0.53 servings/day. Over 4-year follow-up intervals, a one-serving/day increase of ASB was associated with an estimated weight change of -0.06 kg (95% CI: -0.11, -0.02) and BMI change of -0.02 kg/m
2
(95% CI: -0.04, -0.01). Substituting SSB with ASB was associated with -0.37 kg change in weight (95% CI: -0.41, -0.33) and -0.14 kg/m
2
in BMI (95% CI: -0.17, -0.11). Similar estimates were observed when replacing SSB with water (
β
=-0.35 kg, 95% CI: -0.41, -0.30 for weight and
β
=-0.13, kg/m
2
, 95% CI: -0.15, -0.11 for BMI). Substituting ASB with water was not associated with changes in weight (
β
=-0.004 kg, 95% CI: -0.05, 0.04) or BMI (
β
=-0.0002 kg/m
2
, 95% CI: -0.02, 0.02).

Conclusion:
A long-term daily increase in ASB intake was not associated with greater weight gain in US women. Replacing SSB with ASB was associated with significantly less weight gain, likely by reducing energy intake. Change in water was not associated with weight changes, suggesting it may help sustain weight maintenance when replacing SSB. Future studies should evaluate the roles of changes in intakes of water, ASB, and SSB in relation to changes in other weight- and metabolically-related outcomes in diverse populations of both sexes.
Abstract MP09: Diets Varying in Glycemic Index and Carbohydrates With Meal-Timing Specific 12-hour Postprandial Metabolic Changes: The Omnicarb Trial
Authors: Wang Xuan , Ma Hao , Heianza Yoriko , Appel Lawrence J , Sacks Frank M , Qi Lu
Published: March 2023

Background:
Both the glycemic index (GI) and amounts of carbohydrates are important determinants of postprandial glucose changes. Recent studies suggest the effects of carbohydrate intake on postprandial glucose metabolism may differ according to meal timing, showing circadian patterns.

Hypothesis:
We investigated whether the relations of altering both GI levels and the carbohydrate amount with postprandial response of glucose, insulin, and c-peptide differed by meal timing (breakfast, lunch, and dinner), in overweight and obese adults.

Methods:
The OmniCarb trial was a randomized trial with a crossover design in which participants were given 4 diets varying in GI levels and carbohydrate content. We included 61 participants attended the 12-h postprandial study and completed at least two diets. Area under the curve increment (AUCi) of glucose, insulin, and c-peptide after breakfast (180 min), lunch (240 min), and dinner (120 min), was calculated as outcome.

Results:
After consuming each diet for 5 weeks, we observed that the diet replacing effects on the postprandial responses in glucose, insulin and c-peptide significantly differed by meal timing. For postprandial glucose response to breakfast, the beneficial effects (lowered AUCi) of replacing high- by low-GI in high-carb diet, replacing high- by low-carb in high-GI diet, and replacing high-GI/high-carb by low-GI/low-carb diet were consistently observed. Such beneficial effects were less significant for lunch and dinner (Figure). For the response of insulin, the beneficial effects of the corresponding diet replacements were more consistently observed in dinner, followed by breakfast. For the response of C-peptide, similar beneficial effects of the corresponding diet replacements were observed for breakfast and dinner, but not lunch.

Conclusion:
Our results indicate that the beneficial effects of replacing high-GI and/or high-carbohydrate diets by low-GI and/or low-carbohydrate diets on postprandial metabolic changes may differ according to meal timing.
Abstract MP13: Disparities in Home Blood Pressure Monitoring Among Adults Diagnosed With Hypertension Receiving Primary Care in a Large Academic Health System
Authors: Liu Xiaoyue , Dennison Himmelfarb Cheryl R , Hall Cherilyn , Cooper Lisa A , Commodore-Mensah Yvonne
Published: March 2023

Background:
Uncontrolled hypertension (HTN) remains a major global public health challenge. Home blood pressure monitoring (HBPM) in combination with co-interventions is an effective strategy for managing and controlling HTN. Our objective was to examine disparities in HBPM among patients diagnosed with HTN in an academic health system.

Methods:
Using a cross-sectional design, we invited patients with an HTN diagnosis in their electronic health record (EHR) and primary care visit in the past 12 months to complete an anonymous online survey through the EHR patient portal. We used logistic regression to examine disparities in self-reported home blood pressure (BP) monitor ownership (yes/no), frequency of HBPM in the past month (< once or ≥ once), and sharing of BP readings with healthcare provider in the past 6 months (yes/no).

Results:
We recruited 4,181 adult patients; 48%, ≥ 65 years old; 55%, female; 63%, White; 28%, Black; and 4% Asian adults. About 86% owned a home BP monitor. Those who self-identified as Black race (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.58-0.91), other race (odds ratio [OR] = 0.62, 95% confidence interval [CI]: 0.41-0.95) and who were unemployed (OR = 0.54, 0.42-0.70) had lower odds of having a home BP monitor than patients who were White adults and were employed, respectively. Adults aged ≥ 65 years had lower odds of checking BP at home ≥ once a month than their counterparts who were < 65 years old (OR = 0.75, 0.62-0.91). Although women (OR = 1.51, 1.29-1.77) and adults who earned > $100,000 (OR = 1.42, 1.11-1.81) were more likely to check their BP in the previous month than men and those earned < $50,000, they (Female: OR = 0.83, 0.71-0.97; Income > $100,000: OR = 0.77, 0.60-0.99) were less likely to share home BP readings with healthcare provider.

Conclusions:
We observed substantial disparities in HBPM among adults with HTN. Although HBPM has the potential to advance equity in HTN control, factors such as age, race, and socioeconomic status should be considered in the design and implementation of such programs.
Abstract MP15: Mediation Effects of Social, Behavioral, and Metabolic Risk Factors on Racial Disparities in Cardiovascular Disease Mortality in US Adults
Authors: He Jiang , Bundy Joshua D , Geng Siyi , Tian Ling , He Hua , Mills Katherine T , Chen Jing
Published: March 2023

Background:
Traditional cardiovascular disease (CVD) risk factors contribute to racial disparities in CVD mortality. However, there are scarce data on the role of social determinants in these disparities.

Methods:
A nationally representative sample of 50,808 individuals aged ≥20 years from NHANES 1999-2018 were included in the analysis. Data on social, behavioral, and metabolic factors were collected in each NHANES survey. CVD deaths were ascertained from linkage to the National Death Index with follow-up through 2019. Multiple mediation analysis was used to simultaneously investigate the contribution of each risk factor to racial differences in CVD mortality.

Results:
Over an average 9.4 years of follow-up, 2,589 CVD deaths were confirmed. Age- and sex-adjusted CVD mortality rates (95% CI) per 100,000 were 380.1 (334.0, 437.3) in White, 479.6 (393.3, 592.5) in Black, 288.2 (214.1, 397.8) in Hispanic, and 251.2 (140.9, 502.8) in other racial/ethnic populations. After adjusting for all risk factors in the table, individuals who were unemployed, had a low family income, did not own a home, were not married or living with a partner, were a current smoker, reported no leisure time physical activity, slept <6 hours or >8 hours per day, had obesity, hypertension, diabetes, or hypercholesterolemia, or had an albumin-to-creatinine ratio ≥30 mg/g or estimated glomerular filtration rate <60 ml/min/1.73 m
2
were at significantly higher risk for CVD mortality. After adjusting for the above risk factors, the hazard ratio (95% CI) for the Black-White difference in CVD mortality decreased from 1.54 (1.34, 1.77) to 0.86 (0.75, 1.00). Family income, not being married or living with a partner, not owning a home, and unemployment explained 24.8%, 20.8%, 14.5%, and 12.8% of Black-White differences in CVD mortality, respectively.

Conclusion:
Social determinants of health play an important role in racial disparities in CVD mortality. These findings call for public health interventions beyond lifestyle changes and medical treatment.
Abstract MP16: Status of Cardiovascular Health in US Immigrants Using the AHA’s Life’s Essential 8 Metrics: Prevalence Estimates and Social Determinants From the 2013-2018 National Health and Nutrition Examination Survey
Authors: Makarem Nour , Hosalli Rahul , Dinh Vanessa , Caceres Billy A , McClain Amanda C , Mullachery Pricila , Quesada Odayme
Published: March 2023

Introduction:
The US has the largest immigrant population globally, with a record high ~47 million foreign-born residents in 2022. Immigrants endure social and structural factors that may adversely influence their cardiovascular health (CVH).

Hypothesis:
Overall and individual metrics of CVH will vary by immigration status (US-born vs. foreign-born) and among foreign-born sub-populations.

Methods:
The analytic sample included 13,471 adults (19% foreign-born), ages 20-79 y (not pregnant or institutionalized) and free of CVD, from the 2013-2018 NHANES. We calculated the CVH score (range 0-100, low CVH: <50) and component scores, consistent with AHA’s Life’s Essential 8 guidelines. T-tests were used to compare CVH scores by nativity and, among foreign-born individuals, by sex, ethnicity, years in the US, and citizenship. Survey weighted logistic models evaluated social determinants of health (SDOH) in relation to odds of having low CVH.

Results:
Compared to US-born adults, foreign-born adults had higher overall CVH, diet, nicotine exposure, BMI, and blood pressure scores, but lower physical activity, glucose, and cholesterol scores (p<0.01); there were no differences in sleep health scores (Figure A). Among immigrants, those who were men, Hispanic, and living in the US ≥15y had lower CVH scores (p<0.001); CVH scores did not differ by citizenship (Figure B-E). Scores for individual CVH metrics also varied across immigrant sub-populations. In logistic models, being male, 45+ y, Hispanic, food insecure, or having < college education, depression, or ≥15y in the US was related to 57%-150% higher odds of having low CVH. Marital status, income, health insurance, citizenship, and home ownership were not related to CVH.

Conclusions:
While US immigrants have higher overall CVH compared to US-born persons, CVH status is complex and varies across immigrant sub-populations. Understanding immigration as a SDOH is essential for effective public health initiatives aimed at improving CVH in the heterogeneous US immigrant population.