bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P184: Systolic Dysfunction is Associated With Increased Occurrence and Worse Outcomes of Periprocedural Cardiovascular Adverse Events After Percutaneous Transluminal Coronary Angioplasty
Authors: Kumi Dennis D , Gwira-Tamattey Edwin , Vardar Ufuk , Karki Sadichhya , Patel Birju , Abbasi Ayesha
Published: March 2023

Background:
The percutaneous transluminal coronary angioplasty (PTCA) rate continues to increase nationwide, and better strategies to achieve negligible complication rates are required. Data on risk assessment specific to cardiovascular complications are limited.

Hypothesis:
The presence of systolic dysfunction is associated with increased frequency and adverse outcomes of periprocedural cardiovascular complications among patients undergoing percutaneous transluminal coronary angioplasty.

Method:
A retrospective cohort study was designed using data obtained from the 2016 to 2018 combined National Inpatient Sample (NIS) database. The current procedural terminology (CPT) Codes of ICD-10 were used to identify patients admitted for percutaneous transluminal coronary angioplasty. They were then dichotomized into two cohorts based on the presence of systolic dysfunction. Primary outcomes were death, length of stay, total charge, composite of all cardiovascular perioperative adverse events and composite of all cardiovascular perioperative adverse events and death. Secondary outcomes were individual cardiovascular perioperative adverse events for all PTCA admissions and subsequently for patients with post-PTCA cardiac dysfunction. Multivariate linear and logistic regressions were used to adjust for confounders.

Results:
There was a total of 1,176,340 admissions for percutaneous transluminal angioplasty among whom were 145,330 with systolic dysfunction. Details of study outcomes are summarized in table 1 below.

Conclusion:
Among inpatients who underwent PTCA, systolic dysfunction is associated with higher odds of; composite of all periprocedural cardiovascular adverse outcomes, and composite of death and periprocedural adverse outcomes. This is largely driven by increased odds of all-cause mortality and odds of periprocedural cardiac dysfunction, particularly with increased ventricular tachycardias and cardiogenic shock. There was increased length of stay and total charge.
Abstract P188: Diabetes Prevalence and its Risk Factors Among Veterans by Sexual Orientation
Authors: Duncan Meredith S , Streed Carl , Beach Lauren B , O'Leary John , Skanderson Melissa , Goulet Joseph
Published: March 2023

Introduction:
There is evidence that lesbian, gay, and bisexual (LGB) adults have poorer cardiovascular health than their heterosexual peers, but studies of the association between sexual orientation (SO) and diabetes mellitus (DM) have been few. Prior studies have largely been cross-sectional, rely on self-reported data, and have small sample size; findings have been mixed. To further investigate this association, large nationwide cohorts with objective data capture are needed.

Methods and Results:
We used data from the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender EHR cohort which includes veterans with ≥2 encounters October 1, 2009-September 30, 2019. The first clinic visit in this window was the index date with the baseline date one year later; the subsequent year served as a baseline period for observation of prevalent disease and comorbidities. We did not include transgender veterans in this analysis in order to focus on SO rather than on the intersection of SO with gender identity. The SO of 1,108,990 veterans was identified using a natural language processing tool; 185,788 veterans were classified as LGB. Prevalent DM (ICD-9/10 codes or HbA1c≥6.5%) was present among 193,330 veterans (32,986 LGB). We first examined sample characteristics by sex and SO. Mean age (years) and BMI (kg/m
2
) were similar across SO in women (age: 41, BMI: 29) and men (age: 53, BMI: 30). Although the distribution of race was similar across groups, LGB men and women were more likely to be of Hispanic ethnicity (11%, both sexes) than non-LGB men and women (6% and 8%, respectively). Current smoking was more prevalent among LGB (44% men, 39% women) than among non-LGB veterans (40% men, 30% women). We used logistic regression to assess the association between SO and DM. Adjusting for age, sex, race, Hispanic ethnicity, BMI, smoking status, health insurance, marital status, and enrollment priority group (based on military service history, disability and income), LGB veterans had 1.12 [1.10, 1.13] times the odds of DM versus non-LGB veterans. Among women, those classified as bisexual (0.87 [0.74, 1.01]) or lesbian (1.03 [0.97, 1.10]) did not have significantly different odds of DM than non-LGB women. Among men, bisexual men had lower odds of DM (0.86 [0.80, 0.93]) while gay men had higher odds (1.04 [1.01, 1.06]) than non-LGB men. In both men and women, sexual minority individuals whose SO could not be classified had greater odds of DM than their non-LGB peers (women: 1.15 [1.08, 1.23]; men: 1.25 [1.22, 1.28]).

Conclusion:
This is one of the first studies to examine DM in a veteran population stratified by SO. Our sex-specific findings highlight the importance of examining each SO group separately, in addition to jointly, as to further elucidate the association between SO, cardiovascular risk factors, and general cardiovascular health. Future work will examine the intersection of SO with gender identity.
Abstract P197: HbA1c Partially Mediates the Effect of Tyrosine and Phenylalanine on Incident Myocardial Infarction
Authors: Koenigsberg Sarah H , Graff Mariaelisa , Ballou Anna F , Downie Carolina G , Howard Annie Green , Lee Moa P , North Kari E , Raffield Laura M , Yarosh Rina , Gordon-Larsen Penny , Avery Christy L
Published: March 2023

Introduction:
The aromatic amino acids tyrosine and phenylalanine may increase type 2 diabetes risk, but few studies have examined whether these critical molecular precursors exert additional phenotypic effects and whether these effects are independent of insulin resistance. We evaluated associations between two aromatic amino acids - tyrosine and phenylalanine - with a broad range of phenotypic categories in the UK Biobank using polygenic risk score (PRS) instrumental variables that are robust to confounding and reverse causation and tested for mediation by glycated hemoglobin (HbA1c) as a measure of insulin resistance.

Hypothesis:
We hypothesized that tyrosine and phenylalanine would show broad phenotypic effects and that many of these effects would be mediated by HbA1c.

Methods:
We constructed PRS (Crosspred) using all nominally significant and common (minor allele frequency >5%) variants from genome-wide association studies (SAIGE) of unrelated European ancestry participants in the UK Biobank. We evaluated associations with 273 curated phenotypes spanning 20 categories, including endocrine, circulatory, and cancer related traits. We corrected for multiple comparisons using false discovery rate <0.05. Mediation by HbA1c was estimated using the CMAverse package in R, controlling for age, sex, center, ancestral principal components, body mass index, and socioeconomic status.

Results:
A total of 108,554 participants had tyrosine or phenylalanine measured at baseline (mean age=57 years; 54% (58,880/108,554) female). PRS were predictive of tyrosine (R
2
=0.28) and phenylalanine (R
2
=0.26). Tyrosine and phenylalanine PRS showed significant associations with 121/273 (44%) and 124/273 (45%) of phenotypes, respectively, including chronic kidney disease, serum testosterone, lymphocyte count, and myocardial infarction (MI; n=3,349 cases, mean years of follow-up=11). For incident MI, every one standard deviation increase in the tyrosine PRS increased the odds of MI by 4.4% (total effect odds ratio (OR) = 1.044 (95% confidence interval (CI): 1.002, 1.089). The direct effect of the tyrosine PRS on incident MI was slightly decreased (OR= 1.040 (95% CI: 0.997, 1.084) when extending the statistical model to examine mediation by HbA1c, with an estimated indirect effect of 1.004 (95% CI: 1.003, 1.006) and an estimated percent mediated by HbA1c of 9.95% (95% CI: -0.04%, 19.90%). Findings were consistent for phenylalanine, where the percent of the total effect mediated by HbA1c was 8.94% (95% CI: -1.93, 19.80%).

Conclusions:
The effect of tyrosine and phenylalanine on incident MI may primarily operate through pathways other than glucose dysregulation.
Abstract P198: Associations Between Plasma Proteome and Leukocyte Mitochondrial DNA Copy Number: The Atherosclerosis Risk in Communities Study (ARIC)
Authors: Moser Ethan , Steffen Brian T , Xie Jiaqi , Pankratz Nathan , Lane John , Arking Dan E , Mosley Thomas , Guan Weihua , Sedaghat Sanaz , Pankow Jim S , Lutsey Pamela L , Tang Weihong
Published: March 2023

Introduction:
The number of copies of the mitochondrial genome, termed mitochondrial DNA copy number (MTCN), is a proxy for mitochondrial function and varies by cell. Critically, lower MTCN has been associated with aging and chronic diseases such as dementia and cancer. We conducted a large-scale proteomics analysis of leukocyte MTCN (L-MTCN) to elucidate pathways modulated by L-MTCN that may be involved in diseases of aging.

Hypothesis:
We hypothesize that L-MTCN is significantly associated to plasma proteins that have been implicated in biological pathways of L-MTCN and related diseases.

Methods:
Based on whole genome sequencing (WGS) data measured in samples collected in ARIC visits 1, 2, and 3 (i.e., baseline for the current study), L-MTCN was calculated as (2 * coverage of the mitochondrial genome) / coverage of the autosome, using the median coverage of 1000 base pair bins overlapping the mitochondrial genome (16 total) and the median coverage of ~142,000 higher quality autosomal bins. Only samples with read lengths of 150 or 151 were included in subsequent analyses, and L-MTCN estimates were inverse normalized within read length group and WGS group before being merged together. This normalized L-MTCN was then analyzed as a predictor for an association with 4,870 plasma proteins measured by SOMAscan v4 in ARIC visit 3 in race-specific generalized linear models, adjusting for the following covariates at baseline: WGS sample visit, age, gender, field center, smoking status, and a measure of kidney function. Bonferroni correction was applied to account for the number of proteins tested in 5,007 White participants (p≤1x10
-5
). Associations were tested for replication in 1,178 Black participants and considered significant if protein estimates had the same direction of association as Whites at p-value ≤ 2.2x10
-4
.

Results:
Among White participants, 230 proteins were significantly associated with L-MTCN. Of these proteins S100A9, GP1Bα, EGFR, THBS2, and FCGR3B were significantly replicated among Black participants. Strongest associations with L-MTCN were seen with GP1Bα (Estimate: 0.121) and S100A9 (Estimate: -0.191). Biologically S100A9 is a calgranulin and together with S100A8 forms calprotectin, which have roles mediating inflammatory processes. GP1Bα helps mediate platelet activation and forms the glycoprotein Ib-IX-V complex which acts as a platelet surface receptor for von Willebrand factor facilitating platelet adhesion.

Conclusion:
This large proteomics analysis identified 230 plasma proteins significantly associated with L-MTCN. Some of the proteins have been connected to inflammatory diseases, cardiovascular disease, and cancer in the literature. These results provide insight into proteins involved in biological pathways related to L-MTCN.
Abstract P199: Proteomic Markers of Aortic Stenosis: The Atherosclerosis Risk in Communities Study
Authors: Shelbaya Khaled , Arthur Victoria , Buckley Leo , Claggett Brian , Skali Hicham , Ballantyne Christie M , Coresh Josef , Matsushita Kuni , Yu Bing , Shah Amil M
Published: March 2023

Introduction:
Although prevalence of aortic stenosis (AS) is increasing, little is known regarding circulating proteins predictive of AS development.

Hypothesis:
Novel circulating proteins associated with AS hemodynamics and clinical outcomes can be discovered using plasma proteomics.

Methods:
In the community-based Atherosclerosis Risk in Communities study, we measured plasma proteomics using the SOMAscan aptamer-affinity assay (n=4,877 aptamers; Somalogic Inc.) at study Visits 3 (V3; 1992-94; n=11,430) and 5 (V5; 2011-2013; n=4,899). Multivariable linear regression was used to estimate cross-sectional associations of log-transformed proteins at V5 with aortic valve (AV) peak velocity (Vmax) assessed by protocol echocardiography at a false discovery rate (FDR) of <0.05. We then assessed the association of Vmax-related proteins at V3 with incident AV-related hospitalizations post-V3 using multivariable Cox proportional hazard models at FDR of <0.05. All models adjusted for cardiovascular risk factors and diseases at the time of visit.

Results:
At V5 (age 76 ± 5 years; 43% male; 18% Black adults), 946 proteins were cross-sectionally associated with Vmax. At V3, (age 60 ± 6 years; 46% male; 21% Black), 84 of these were associated with risk of AS-related hospitalization post-V3 (median follow-up 22.2 [IQR 14.4 - 24.8] years, n=912 events). Of these 84 proteins, 52 were also cross-sectionally associated with the Dimensionless index (DI) at V5. Hierarchical clustering based on V5 AV hemodynamic indices identified one cluster of 14 proteins associated with lower hemodynamic AS severity and risk of AV-related hospitalization (
Figure
). Proteins in the remaining three clusters were associated with higher Vmax, lower DI, and higher risk of AV-related hospitalization. The nine proteins in cluster 4 were also associated with lower indexed AV area.

Conclusion:
We identified 52 circulating proteins with robust associations with AV hemodynamics and hospitalization risk, providing potential novel biomarkers for AS risk.
Abstract P204: Associations Between Dairy Intake and Serum Metabolites in Middle-Aged Adults in the U.S.
Authors: Bernard Lauren , Chen Jingsha , Kim Hyunju , Huang Zhijie , Bazzano Lydia A , Qi Lu , He Jiang , Rao Varun , Kelly Tanika N , Potts Kaitlin , Wong Kari , Steffen Lyn , Yu Bing , Rhee Eugene P , Rebholz Casey M
Published: March 2023

Introduction:
There is a lack of objective biomarkers of dietary intake. Untargeted studies can unbiasedly identify dairy biomarkers and inform the creation of robust dietary assessment tools that integrate questionnaire and biospecimen data.

Methods:
Dairy products from interviewer-administered questionnaires were categorized as either low-fat or high-fat dairy. Total dairy was a composite of low-fat and high-fat dairy items. Linear regression models were used to assess associations between dairy intake and 360 serum metabolites in the Atherosclerosis Risk in Communities (ARIC) Study (n=3907). Significant associations were then tested for replication in the Bogalusa Heart Study (BHS) (n=819).

Results:
In the ARIC study, 34 dairy-metabolite associations were identified (total dairy, n = 16; low-fat dairy, n = 10; high-fat dairy, n = 8). Total dairy shared 7 metabolic associations each with low-fat dairy and high-fat dairy. Low-fat dairy was associated with pantothenate, vitamin B5, and the catabolic product of vitamin B6, pyridoxate. High-fat dairy was associated with one amino acid, 3-hydroxy-2-ethylpropionate, and eight lipid metabolites, including myristate (14:0), 10-nonadecenoate (19:1n9), and myristoleate (14:1n5). Of the metabolites available for replication in BHS (total dairy, n = 15; low-fat dairy, n = 9; high-fat dairy, n = 8), 2 total dairy metabolites were replicated and 2 low-fat dairy metabolites were replicated (
Table
).

Conclusions:
We identified metabolomic markers of total, low-fat, and high-fat dairy. Pantothenate, myristate (14:0), and tiglyl carnitine replicated across two large, diverse study populations, suggesting that they are markers of dairy consumption.
Abstract P208: Metabolomic Profiles Associated With Blood Pressure Reduction in Response to the DASH and DASH-Sodium Trials
Authors: Kim Hyunju , Appel Lawrence J , Lichtenstein Alice H , Wong Kari , Chatterjee Nilanjan , Rhee Eugene P , Rebholz Casey M
Published: March 2023

Introduction:
The Dietary Approaches to Stop Hypertension (DASH) diet significantly reduced blood pressure (BP) in the DASH and DASH-Sodium trials, but the underlying mechanisms are unclear.

Hypothesis:
We hypothesized that certain metabolites will be associated with BP reductions.

Methods:
Metabolomic profiling was conducted at the end of the diet interventions for participants randomly assigned to the DASH or control diet in multicenter, controlled feeding studies: DASH (N=219) and DASH-Sodium trials (N=395). Using multivariable linear regression models to examine the association between metabolites and BP change, we tested for interactions between diet and metabolites for the following comparisons: 1) DASH vs. control diets in the DASH trial, 2) DASH-high sodium vs. control-high sodium diets in the DASH-Sodium trial, and 3) DASH-low sodium vs. control-high sodium diets in the DASH-Sodium trial. Pathway overrepresentation analysis was constructed for significant metabolites.

Results:
Identified were 65 significant interactions [DASH=12; DASH-high sodium=35; DASH-low sodium=18]. Most amino acids (16/19), cofactors and vitamins (15/15), xenobiotics (9/13), peptides (4/5), and a nucleotide (1/1) were higher in participants consuming the DASH diets vs. the control diets. These metabolites were associated with BP reductions in participants consuming the DASH diets, but not control diets (
Figure
). Many lipid metabolites (10/12) were lower in participants consuming the DASH vs. the control diets. Lipid concentrations were associated with BP elevations in participants consuming the DASH diets and with BP reductions in participants consuming the control diets. Metabolites associated with tocopherol metabolism, ceramides, and pantothenate and CoA metabolism were overrepresented.

Conclusions:
Using data from randomized feeding studies, we identified metabolites that were associated with BP lowering. These metabolites highlight the pathways through which DASH diet reduced BP.
Abstract P210: Dietary Calcium and Phosphorus Intakes at Middle Age and Their Associations With Vascular Calcification at Older Age: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Nohara-Shitama Yume , Mok Yejin , Ballew Shoshana , Rebholz Casey M , Budoff Matthew , Anderson Cheryl , Ishigami Junichi , Blaha Michael , Matsushita Kunihiro
Published: March 2023

Background:
High dietary calcium and phosphorus intakes may accelerate vascular calcification. A few studies have explored the association of dietary calcium and phosphorus intakes with vascular calcification but reported inconsistent results. Most studies relied on dietary assessment at one time point and evaluated only coronary artery calcification.

Aim:
To assess the associations of dietary calcium and phosphorus intakes over two time points during middle age with coronary artery and extra-coronary calcification at older age.

Methods:
We studied 1,940 ARIC participants who underwent chest CT scans at ≥75 years of age in 2018-19 and completed a 66-item food frequency questionnaire at two earlier visits (1987-89 and 1993-95). We calculated the average of dietary calcium and phosphorus intakes across these two visits. Calcification was quantified as Agatston score in coronary arteries, ascending aorta, descending aorta, aortic valve ring, aortic valve, and mitral valve. We ran multivariable linear (for continuous Agatston score) and logistic regression models (for Agatston score >75
th
percentile).

Results:
The mean dietary calcium and phosphorus intake was 659 mg/day and 1,074 mg/day, respectively. Overall, we did not observe any positive associations of dietary calcium intake with vascular/valvular calcification. Rather, we saw its inverse association with ascending aorta calcification (Figure). In contrast, dietary phosphorus was not associated with the calcification of any vascular beds. The results were largely similar in linear regression models and after excluding 332 participants (17%) taking calcium supplements.

Conclusion:
Dietary calcium intake at middle age was largely neutral in its association with vascular calcification while showing a mild inverse association with ascending aorta calcification at older age. No evident associations were seen for dietary phosphorus. Our findings do not support a concern that a calcium or phosphorus-rich diet may accelerate vascular calcification.
Abstract P212: Plasma Metabolomics of Dietary Intake of Protein-Rich Foods and Kidney Disease Progression in Children
Authors: Ren Xuyuehe , Chen Jingsha , Abraham Alison G , Xu Yunwen , Siewe Aisha , Warady Bradley A , Rhee Eugene P , Furth Susan L , Coresh Josef , Denburg Michelle , Rebholz Casey M
Published: March 2023

Introduction:
There is inconsistent evidence on the efficacy of a low-protein diet for patients with chronic kidney disease (CKD) and there is a lack of objective biomarkers of dietary intake. The purpose of this study was to identify plasma metabolites associated with dietary intake of protein among children with CKD and to assess whether protein-related metabolites are associated with CKD progression.

Methods:
We conducted non-targeted metabolomics using plasma samples from 484 Chronic Kidney Disease in Children (CKiD) participants. Multivariable linear regression estimated the cross-sectional association between 949 known, non-drug metabolites and dietary intake of dairy, nuts and beans, red and processed meat, fish, chicken, and eggs, adjusting for demographic, clinical, and dietary covariates. Cox proportional hazards regression models assessed the prospective association between protein-related metabolites and CKD progression defined as kidney replacement therapy or 50% eGFR reduction, adjusting for demographic and clinical covariates. We used a false discovery rate <0.05 as the statistical significance threshold to account for multiple comparisons.

Results:
Fifty-seven unique metabolites were significantly associated with dietary protein intake (dairy: n=21; nuts and beans: n=13; red and processed meat: n=20; fish: n=2; chicken: n=3; eggs: n=0). Among them, ten metabolites were significantly associated with CKD progression
(TABLE)
, including one amino acid, one cofactor and vitamin, four lipids, two nucleotides, one peptide, and one xenobiotic. 1-(1-enyl-palmitoyl)-2-oleoyl-GPE (P-16:0/18:1) was positively associated with dietary intake of red and processed meat and CKD progression, and 3-ureidopropionate was inversely associated with dietary intake of red and processed meat and CKD progression.

Conclusion:
Untargeted plasma metabolomic profiling revealed metabolites associated with dietary intake of protein and CKD progression in a pediatric population.
Abstract P215: Inflammatory and Insulinemic Dietary Patterns Are Associated With Modestly Increased Total and Cardiometabolic Mortality Among Low-Income Americans
Authors: Montgomery Chandler , Yang Jae Jeong , Shrubsole Martha , Shah Ravi , Yu Danxia
Published: March 2023

Introduction:
Diet is a modifiable risk factor for cardiometabolic morbidity and mortality, potentially via increased inflammation. Two hypothesis-oriented dietary patterns, the empirical dietary inflammatory potential (EDIP) and empirical dietary index for hyperinsulinemia (EDIH), have been linked to increased risk of cardiometabolic diseases and overall mortality. However, their associations with total and cause-specific mortality in Black Americans and populations of low socioeconomic status (SES) have not been described.

Hypothesis:
We assessed the hypothesis that higher EDIP and EDIH scores are associated with increased total and cause-specific mortality in a low SES and predominately Black population.

Methods:
In the Southern Community Cohort Study, a prospective cohort of mostly low-income Black and White adults recruited from 12 Southeastern states in the US, we included 77,209 participants who completed a food frequency questionnaire (FFQ) at baseline (2002-2009) and had been followed-up for mortality outcomes through 2019. The EDIP and EDIH scores were estimated based on 18 components derived from the FFQ. Cox proportional hazard models were used to estimate hazard ratios (HRs) of total and cardiometabolic mortality for the highest vs. lowest quintiles (Q5 vs. Q1) of EDIP/EDIH, adjusting for sociodemographics, lifestyles, and history of major chronic diseases. In a subgroup of 5,162 participants with data on blood levels of high-sensitivity C-reactive protein (hs-CRP), we also evaluated the correlations of EDIP and EDIH with hs-CRP.

Results:
Of 77,209 participants, 46,233 (59.9%) were women, 49,925 were Black (64.7%), and mean age was 52.4 (SD: 8.8) years at baseline. During an average follow-up of 12.9 years, we documented 20,028 total deaths, including 6,296 from cardiovascular disease and 1,150 from diabetes. Higher EDIP and EDIH scores were both associated with increased total and cardiometabolic mortality. EDIP and EDIH Q5 vs. Q1 HRs were 1.10 and 1.11 for total mortality, respectively (95% CIs: 1.05-1.16 and 1.06-1.17), 1.20 and 1.15 for cardiovascular mortality, respectively (95% CIs: 1.11-1.31 and 1.06-1.25), and 1.38 and 1.34 for diabetes mortality, respectively (95% CIs: 1.13-1.67 and 1.10-1.63); all p-trend ≤0.001. EDIP and EDIH weakly correlated with hs-CRP, despite statistical significance (r=0.058 for EDIP and 0.081 for EDIH; both p<0.0001).

Conclusions:
In conclusion, empirical inflammatory and insulinemic dietary patterns are associated with modestly increased inflammation and total and cardiometabolic mortality among low-income Black and White Americans. Efforts to improve nutrition may improve overall cardiometabolic health and prognosis.
Abstract P226: Aerobic and Muscle Strengthening Physical Activity and Television Viewing Are Independently Associated With Odds of Nonalcoholic Fatty Liver Disease: The Cardia Study
Authors: McDonough Daniel J , Mathew Mahesh , Pope Zachary C , Schreiner Pamela , Jacobs David R , VanWagner Lisa B , Carr Jeffrey , Terry James G , Gabriel Kelley P , Reis Jared P
Published: March 2023

Introduction:
The prevalence of nonalcoholic fatty liver disease (NAFLD) in US adults is over 25%, yet the etiology of lifestyle factors in the development of NAFLD remains understudied. We examined the independent and joint associations among aerobic physical activity (PA) intensity (moderate, vigorous) and PA type (aerobic, muscle strengthening), television viewing (TV), and odds of NAFLD.

Hypothesis:
Higher levels of aerobic and muscle strengthening PA are associated with lower odds of NAFLD, and higher levels of TV are associated with higher odds of NAFLD.

Methods:
We analyzed data from Year 25 of the CARDIA cohort study. Our exposures (moderate and vigorous aerobic and muscle strengthening PA, TV; hr/wk) were assessed using validated questionnaires. Our outcome (NAFLD) was measured using non-contrast computed tomography. We constructed multivariable logistic regression models to examine the independent and joint associations between PA (moderate or vigorous aerobic and strength), TV, and odds of NAFLD. Covariates were sex, age, race, study center, education, diet, smoking status, alcohol consumption, and waist circumference.

Results:
2726 participants (648 with NAFLD) were analyzed (mean (SD) age, 50.1 (3.6) years; 49% Black; 43% male). Fully adjusted odds ratios per IQR-standardized continuous PA and TV were: moderate aerobic PA (IQR = 4.3), 0.93 (95% CI, 0.81-1.07); vigorous aerobic PA (IQR = 1.9), 0.63 (95% CI, 0.55-0.73); muscle strengthening PA (IQR = 3.3), 0.80 (95% CI, 0.07-0.92); and TV (IQR = 14.0), 1.20 (95% CI, 1.10-1.32). Only vigorous aerobic PA remained statistically significant after waist circumference adjustment, 0.83 (95% CI, 0.70-0.98). A PA-TV index model (Figure) indicated the combination of higher vigorous aerobic and muscle strengthening PA and lower TV resulted in an odds ratio of 0.23 (95% CI, 0.15-0.37).

Conclusion:
Concurrent higher levels of vigorous aerobic PA (≥2 hr/wk), muscle strengthening PA (≥2 hr/wk), and lower levels of TV (<7 hr/wk) were associated with 77% lower odds of NAFLD.
Abstract P227: Paradoxical Associations of Occupational and Non-Occupational Sedentary Behavior With Cardiovascular Risk Factors in Desk Workers
Authors: Alansare Abdullah , Paley Joshua , Quinn Tyler , Barone Gibbs Bethany
Published: March 2023

Introduction:
Sedentary behavior (SB) has emerged as a cardiovascular disease (CVD) risk factor, independent of physical inactivity. Yet, preliminary research suggests that these relationships may differ if SB is accumulated during occupational or non-occupational time. Thus, we examined associations of SB with CVD risk factors, by domain, in desk workers.

Hypothesis:
We hypothesized that non-occupational SB would have more unfavorable associations with CVD risk factors compared to occupational SB.

Methods:
This cross-sectional, secondary analysis of baseline data from the RESET BP clinical trial included 269 desk workers (age=45.2±11.6 years; 83.5% white; 59.3% female). Total SB was measured by activPAL3 and was partitioned into occupational and non-occupational domains. CVD risk factors included resting and nocturnal systolic/diastolic blood pressure (SBP/DBP) and heart rate (HR), resting carotid-femoral (cf) and carotid-radial (cr) pulse wave velocity (PWV), and heart rate variability (HRV) [i.e., natural log transformed standard deviation of R-R intervals (lnSDNN), root mean square of successive differences (lnRMSSD), and high frequency (lnHF)]. Adjusted linear regression estimated associations of SB with CVD risk factors. A Wald test compared the beta-coefficients associating occupational vs. non-occupation SB with these CVD risk factors.

Results:
Participants spent 69%, 77%, and 64% of their time in total, occupational, and non-occupational SB, respectively. Agnostic of the domains, a 1-hour increase in total SB was only associated with higher cfPWV (0.18 m/s; p<0.05). A 1-hour increase in occupational SB was associated with lower (favorable) resting DBP and nocturnal SBP and DBP (-1.02, -1.52, and -1.12 mmHg, respectively; p<0.05). Paradoxically, a 1-hour increase in non-occupational SB was associated with higher (unfavorable) resting DBP (1.04 mmHg), HR (1.07 beat/minute), cfPWV (0.23 m/s), nocturnal SBP (1.41 mmHg), and lower resting lnSDNN (-0.07), lnRMSSD (-0.10), and lnHF (-0.18). Wald tests revealed significant differences in beta coefficients (p<0.05 for all) for all these outcomes where occupational SB was favorably associated with these CVD risk factors while non-occupational SB was unfavorably associated with these CVD risk factors.

Conclusions:
While desk workers accumulate high amounts of occupational and non-occupational SB, paradoxical associations with CVD risk were observed with non-occupational SB being unfavorable and occupational SB being favorable for CVD risk factors. Confirmation is needed in longitudinal and experimental studies.
Abstract P230: Left Ventricular Structure and Function Over 25 Years of Occupational Physical Activity Exposure in Cardia
Authors: Quinn Tyler D , Lane Abbi D , Gabriel Kelley P , Sternfeld Barbara , Jacobs David R , Smith Peter , Barone Gibbs Bethany
Published: March 2023

Introduction:
Leisure-time physical activity (LTPA) is known to promote cardiovascular health, while occupational physical activity (OPA) may have paradoxically negative impacts. One proposed, though untested, explanation for the paradoxical associations may be unfavorable vascular remodeling from OPA-induced chronic cardiovascular strain.

Hypothesis:
High amounts of OPA over 25 years from young adulthood to midlife is associated with adverse left ventricular (LV) structure and function.

Methods:
Data are from 1,893 participants (48.9% female, 57.3% White, aged 30.4±3.4 years at baseline [the Year 5 exam]) from the Coronary Artery Risk Development in Young Adults (CARDIA) Study who reported working full time at baseline and two years later. LV structure and function was measured as LV mass, end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), stroke volume (SV), and e/a-wave ratio (EA) via M-mode and 2-dimensional echocardiograms at baseline and 25-years later. OPA was reported at seven exams during the study period as months/year where the participant performed “vigorous job activities such as lifting, carrying, or digging” for ≥5 hours/week. The 25-year OPA patterns were categorized into three trajectories: zero OPA (0 months/year; n=995), medium OPA (~2-3 months/year; n=526), and high OPA (~6-8 months/year; n=372). Linear regression estimated longitudinal associations between the OPA trajectories and the echocardiogram variables at final follow-up after adjusting for baseline values. Case-wise deletion was used for each model where only those with valid outcome data were included (n=623-1,475).

Results:
EF and EA were significantly lower in high versus zero OPA. No other statistically significant associations were observed. (Figure 1)

Conclusions:
In this sample, OPA’s paradoxical impact on cardiovascular health was partially supported by null or adverse associations between high OPA and LV structure and function. Confirmation is needed using more precise OPA measures.
Abstract P232: Associations Between Park Acreage and Physical Activity Among Adolescents Living in Urban Green Cities: Exploring the Concept of a Park Oasis
Authors: Kramer-Kostecka Eydie N , Espinoza Sarah , de Brito Junia , Barr-Anderson Daheia , Slaughter-Acey Jaime , Kramer-Kostecka Eydie
Published: March 2023

Introduction:
Regular participation in physical activity (PA) improves cardiovascular health outcomes across the lifespan. Previous research has established a relationship between park access (i.e., distance to parks) and youth PA; however, no studies have examined the associations between park acreage and PA among youth living in “green” cities (i.e., residents can access parks via a 10-minute walk).

Purpose:
The present study examined how park acreage is related to PA among adolescents living in two urban green cities: Minneapolis and St. Paul, MN. Further, a “park oasis” was conceptualized.

Methods:
Data were drawn from a large, population-based cohort study (Project EAT 2010; Eating and Activity in Teens). Geospatial analyses determined park access and acreage variables associated with respondents’ home addresses. Study analyses were cross-sectional, and restricted to those with adequate park access, as indicated by living within 800-meters of a park (n=2,271; mean age=14.5±1.9 years; 52.9% female; 82.8% Black, Indigenous, Person of Color). Multivariable linear regression models were used to examine the associations between park acreage and PA, adjusted by individual (e.g., race/ethnicity) and structural (e.g., neighborhood poverty) variables. Park acreage was examined as a continuous (% land-use within a 3000-meter network buffer of home address) and a categorical variable based on park land-use % cut-points (Groups 1-4).

Results:
In unadjusted models, continuous park acreage was positively associated with both total PA (p=.020) and moderate-vigorous PA (MVPA; p=.007). Also in unadjusted models, categorical park acreage was significantly, positively associated with PA outcomes, with Group 1: Park Oasis appearing optimal. All adjusted models were non-significant.

Conclusions:
Findings indicate that park acreage may be an important PA facilitator among adolescents. Future work should explore how individual and structural factors relate to PA outcomes and inequitable allocation of parkland.
Abstract P239: Impact of American Heart Association/American Stroke Association Online Support Network on Quality of Life
Authors: Poudel Remy , Braun Lynne T , Groom Allison , Bahn Katherine , Akel William , Grady Kathleen L
Published: March 2023

Introduction:
Support of patients with cardiovascular (CV) disease and stroke is often associated with improved health-related quality of life (HRQOL).

Hypothesis:
We assessed the hypothesis that change in patient HRQOL, perception of emotional and informational support, and satisfaction with the American Heart Association/American Stroke Association’s (AHA/ASA) online Support Network (SN) would be observed from before joining the SN to two months after joining the SN.

Methods:
Using a pre/post-test design, between April 2018 and March 2020, 2,542 adult patients completed a baseline online survey, of whom 412 completed a survey two months later (response rate=16%). Self-report instruments included: Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Questionnaire, Emotional Support (ES), Informational Support (IS), and an AHA/ASA-developed measure of satisfaction with the SN. After converting raw scores into T-scores, linear mixed effects models were used to compare pre and post T-scores.

Results:
Patients were on average 56± 12.8 years of age, female (63.3%), non-Hispanic White (76.5%), married (58.3%), employed (49.8%), and >high school education (85.0%). 83.5% reported having a CV condition, most commonly hypertension (38.8%), myocardial infarction (31.3%), high cholesterol (31.1%), atrial fibrillation (25.2%); 58.0% reported ≤ 4 co-morbidities. T-scores (mean±SD) did not differ significantly from before to two months after joining the SN: physical health domain (pre=39.2±3.6, post=39.3±3.4) and mental health domain (pre=43.3±9.6, post=44.5±9.7); ES (pre=49.5±9.8, post=49.3±9.8), and IS (pre=49.8±10.3, post=50.5±10.5). At two months, satisfied, neutral, and dissatisfied with SN were 46.3%,44.2%, and 5.1% respectively. 61.5% were likely to recommend the SN to others.

Conclusions:
In conclusion, HRQOL measures remained stable. Before and after SN participation, physical and mental domain global health scores were lower than the U.S. general population mean of 50, while ES and IS scores approximated the U.S. general population mean. Satisfaction with the SN was moderate with the majority of respondents likely to recommend to others. Future research might explore extending the timeframe to observe change in global health scores.
Abstract P240: Higher Body Mass Index is Associated With Lower Placental Expression of EPYC: Results From a Genome-Wide Transcriptomic Study in the Gen3G Cohort
Authors: Majid Sana , Sordillo Joanne E , White Frédérique , Aguet Francois , Ardlie Kristin G , Karumanchi Ananth A , Florez Jose C , Powe Camille , Edlow Andrea G , Bouchard Luigi , Jacques Pierre-Étienne , Hivert Marie-France
Published: March 2023

Background:
Elevated maternal body mass index (BMI) in pregnancy is associated with adverse maternal and fetal outcomes. Identification of alterations in the placental transcriptome may elucidate molecular markers of the biological pathways underlying these associations.

Methods:
We investigated the association of first trimester maternal BMI with the placental transcriptome in Gen3G, a large population-based pregnancy cohort. We completed RNA sequencing of 449 placental samples and performed differential gene expression analysis of over 15,000 genes (Limma Voom). We used maternal BMI as a continuous variable, with estimates reported as change in normalized gene expression per 1-unit increase in BMI (kg/m2), as well as a categorical variable (participants with normal weight (N=270) vs. obesity (N=82)), with RNA expression estimates reported as log2 fold changes. We adjusted models for maternal age, fetal sex, gestational age and 6 surrogate variables inferred from the expression data to adjust for batch effects and other unmeasured sources of variability. We accounted for multiple testing using False Discovery Rate (FDR). Sensitivity analyses were performed by removing cases of gestational diabetes and hypertensive disorders in pregnancy.

Results:
At enrollment in early pregnancy, participants had a mean ± SD age of 28.2 ± 4.4 years and measured BMI of 25.4 ± 5.5 kg/m
2
; 57% of participants were categorized in normal weight, 22% in overweight and 18% in obesity BMI categories. Maternal BMI was significantly associated with decreased expression of
EPYC
, a gene that regulates fibrillogenesis (slope= -0.14, FDR-adjusted P=1.68x10
-5
for continuous BMI; log2 fold change= -1.71, FDR-adjusted P=1.06x10
-2
for obesity vs. normal weight). Both sensitivity analyses with the removal of gestational diabetes and hypertensive disorders revealed similar associations for
EPYC
.

Conclusions:
We identified an association between elevated maternal BMI and downregulation of
EPYC
expression in the placenta. Additional studies are required to examine the role of placental
EPYC
expression in maternal and fetal health.
Abstract P250: Prospective Associations of Coping Strategies and Variability in Their Use With Hypertension and Obesity Incidence
Authors: Zhang Shuqi , Kubzansky Laura , Koenen Karestan , Moskowitz Judith , Rich-edwards Janet , Trudel-Fitzgerald Claudia
Published: March 2023

Objectives:
Stressful adverse experiences (e.g., childhood abuse) are associated to greater cardiometabolic disease risk. Yet, it is unknown whether how individuals cope with these stressors can influence disease risk. Coping strategies are usually characterized as being either adaptive (e.g., seeking social support) or maladaptive (e.g., denying the stressor). However, flexibility in tailoring their implementation to contexts appears critical to optimal adjustment and might matter for cardiometabolic health as well.

Method:
Participants free of hypertension and obesity from the Nurses’ Health Study II completed the validated COPE inventory and reported relevant potential covariates in 2001 (N=32,762). Hypertension and obesity respective incidence were documented every two years until 2019, separately. Cox proportional hazard models estimated hazard ratio (HR) and 95% confidence intervals (CI) of hypertension and obesity associated with the use of individual coping strategies (continuous standardized scores). The Between-Strategy Index, validated in prior epidemiologic research, was used to derive a proxy for coping flexibility, which was considered in tertiles (smaller, moderate, greater levels). This score indicates to what extent strategies chosen within a repertory are (un)equally used and potentially indicates attempts to find the best strategy or favor certain strategies across distinct stressors. In all models, a 2-year lag was introduced to reduce concerns of reverse causation.

Results:
After controlling for baseline sociodemographic and health status (core model), no adaptive or maladaptive strategies were related to a risk of hypertension onset, and only a few adaptive and maladaptive strategies were related to obesity incidence (e.g., per 1-SD increase: Active coping, HR=0.96, 95%CI=0.93, 0.99; Behavioral Disengagement, HR=1.05, 95%CI=1.02, 1.08). When considering coping flexibility, greater levels were related to a marginally significant lower risk of disease (hypertension: HR
greater vs. moderate
=0.95, 95%CI=0.90, 1.01; obesity: HR
greater vs. lower levels
=0.93, 95%CI=0.86, 1.00). In secondary analyses, results were overall similar when further adjusting for behavioral factors.

Discussion:
These findings suggest that how midlife women typically cope with stressors was not clearly associated with incidence of hypertension or obesity, although we cannot rule out a modest association with some individual coping strategies, and a suggestive protective association with greater coping flexibility levels. Since the COPE inventory captures how individuals handle stressors in general, future research on hypertension and obesity incidence should consider stressor-specific measures of coping.
Abstract P252: Financial Strain and Cardiovascular Health Among Young Black Women: Findings From a Community Survey
Authors: Hines Anika L , Auten Allison , Gaskin Darrell
Published: March 2023

Background:
Black women experience disproportionate rates of cardiovascular disease (CVD), including earlier onset, increased number of risk factors, and higher morbidity rates. Higher levels of stress may help to explain this disparity. We sought to examine the relationship between financial strain—a common stressor—and cardiovascular health in a sample of young, Black women.

Methods:
We performed a cross-sectional analysis of data collected through an academic-community collaboration with the AME Zion Church. In 2019, an electronic survey was administered to self-identified Black women aged 18 to 40 years. The survey assessed psychosocial stressors, psychological distress, healthcare utilization, and health status. We examined the association of financial strain—defined as difficulty in paying for necessities—and cardiovascular health (CVH) modeled after the American Heart Association’s “Life’s Essential 8”. The eight domains were defined by four behavioral health factors (sleep, diet, physical activity, and smoking) and four self-reported health conditions (overweight/obesity, prediabetes/diabetes, high blood pressure, and high cholesterol). Each component earned 1 point for positive attributes (e.g., adequate sleep) or 0 for negative attributes (e.g., having high blood pressure). Components were summed to a total score (range: 0-8). We used multivariable regression to examine the relationship between financial strain and CVH score adjusting for other sociodemographic factors.

Results:
This study included 160 Black women with a mean age of 32.36 (SD = 5.68). Nearly half the sample (46%) held graduate or professional degrees, and 28% of respondents earned an income ≥$100,000. The mean score on the 8-point CVH measurement was 5.45 (SD=1.44). Adjusting for age, education, and income, experiencing some financial strain was associated with poorer CVH than little to no financial strain (β = -0.72, p=.006). Age was marginally associated with decreasing CVH (β=-.040, p=0.05). Evaluating individual CVH components, those with some degree of financial strain had higher odds of being sedentary (OR: 2.29; 95% CI: 1.04, 5.04) and getting insufficient sleep (OR: 2.66; 95% CI: 1.17, 6.05) than those with little to no strain. There were no significant associations between financial strain and diet or the health status measures (i.e., overweight/obesity, prediabetes/diabetes, high blood pressure, high cholesterol). Smoking could not be evaluated separately due to low numbers of smokers within the sample.

Conclusion:
Adjusting for age, education, and income, financial strain was negatively associated with overall CVH, and physical activity and sleep, specifically, within this sample of young, Black women. Interventions targeting financial strain may positively affect preventative CVH behaviors within this population.