bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P223: Dietary Magnesium and the Risk of Stroke among Women
Authors: Akarolo-Anthony Sally N , Rexrode Kathryn M , Spiegelman Donna , Willett Walter C
Published: July 2021

Background:
Epidemiology studies suggest that high magnesium intake may decrease the risk of stroke by reducing hypertension, endothelial dysfunction and carotid artery thickness, but the results are inconsistent. We therefore examined the association between magnesium intake and stroke type in a cohort with repeated measurement of diet, long duration of follow up, and a large sample size.

Methods:
We prospectively followed 86,149 women in the Nurses’ Health Study, aged 35 to 55 years, who were free of diagnosed cardiovascular disease and cancer at baseline in 1980. Data on dietary intake were collected with a semi-quantitative food frequency questionnaire at baseline in 1980, 1984, 1986 and then every 4 years, while data on stroke, stroke risk factors and potential confounders were collected at baseline and updated biennially. Strokes were classified according to the National Survey of Stroke criteria; and strokes for which medical records were not available were classified as probable/unknown. We calculated the hazard ratio (95% CI) of stroke by quintiles of magnesium intake, using multivariate Cox proportional hazard models, adjusting for potential confounders.

Results:
During 28 years of follow-up, 3237 total strokes (1664 ischemic, 544 hemorrhagic and 1029 probable/unknown) were documented. In multivariate analyses adjusting for age, total calories, smoking, body-mass index, parental history of heart disease, alcohol intake, physical activity, menopausal therapy, history of hypertension, hypercholesterolemia and diabetes at baseline, as well as use of multivitamin, aspirin, and thiazides, women in the highest quintile of magnesium intake had a relative risk (RR) of 0.85 (95% CI, 0.72 to 0.96; P for trend=0.03) for total stroke; 0.86 (95% CI, 0.72 to 1.01; P for trend=0.05) for ischemic stroke; and 0.85 (95% CI, 0.62 to 1.08; P for trend=0.37) for hemorrhagic stroke, compared with those in the lowest quintile. Further adjustment for potassium and calcium attenuated these associations; for total stroke the risk estimate was 0.90 (0.75 to 1.06; P for trend=0.38).

Conclusions:
Low magnesium intake may contribute to higher risk of stroke, but distinction from potential effects of potassium and calcium is difficult.
Abstract P224: Sex Differences in the Risk of Stroke and HbA1c among Diabetic Patients
Authors: Hu Gang , Katzmarzyk Peter , Horswell Ronald , Wang Yujie , Johnson Jolene , Zhao Wenhui
Published: July 2021

Background:
Epidemiological studies have reported that type 2 diabetes is an independent risk factor for stroke, but how much its effect varies by sex is uncertain.

Aim:
To better understand the relationship between glycemic control and stroke risk in men and women, we studied a large sample of patients with type 2 diabetes with long-term follow up.

Methods:
We prospectively investigated the sex-specific association of different levels of HbA1c with incident stroke risk among 10,876 male and 19,278 female diabetic patients within the Louisiana State University (LSU) Hospital System.

Results:
During a mean follow up of 6.7 years, 2,949 incident cases of stroke were identified. The multivariable-adjusted hazard ratios (HRs) of stroke associated with different levels of HbA1c at baseline (<6.0%, 6.0-6.9% [reference group], 7.0-7.9%, 8.0-8.9%, 9.0-9.9%, and ≥10.0%,) were 0.96 (95% confidence interval [CI] 0.80-1.14), 1.00, 1.04 (0.85-1.28), 1.11 (0.89-1.39), 1.10 (0.86-1.41), and 1.22 (0.92-1.35) (P trend =0.66) for males, and 1.03 (0.90-1.18), 1.00, 1.09 (0.94-1.26), 1.19 (1.00-1.42), 1.32 (1.09-1.59), and 1.42 (1.23-1.65) (P trend <0.001) for females, respectively. The graded association of HbA1c during follow-up with stroke risk was observed among female diabetic patients (P trend=0.066). When stratified by race, with glucose-lowering agents or not, this graded association of HbA1c with stroke was still present. When stratified by age, the adjusted HRs were significantly higher in women older than 55 years compared to younger women.

Conclusions:
The current study suggests a graded association between HbA1c and the risk of stroke among female patients with type 2 diabetes and poor control of blood sugar has a stronger effect in women older than 55 years.
Abstract P229: Magnitude, Treatment, and Impact of Diabetes Mellitus in Patients Hospitalized with Non-ST Elevation Myocardial Infarction: A Community-based Study.
Authors: Awad Hamza H , Tisminetzky Mayra , Goldberg Robert J
Published: July 2021

Background:
Diabetes mellitus is a major risk factor for coronary heart disease (CHD) and CHD related mortality. Despite improvements in the medical management of patients presenting with non-ST segment elevation myocardial infarction (NSTEMI), this condition is still associated with a poor prognosis among diabetic patients. The objectives of this study in residents of a large central Massachusetts metropolitan area were to examine differences in the characteristics, treatment practices, and short-term outcomes of patients with and without a prior history of diabetes hospitalized for NSTEMI at all 11 medical centers in the Worcester, MA, metropolitan area.

Methods:
Data from the Worcester Heart Attack Study were analyzed for 4,366 patients diagnosed with NSTEMI during 6 biennial years between 1997 and 2009. Of these, 1,645 (38%) had previously diagnosed diabetes based on the review of information from hospital medical records.

Results:
Diabetic patients were more likely to be female, and to have a higher prevalence of several important comorbidities including hypertension (85 vs 67%), heart failure (42 vs 23%), stroke (19 vs 11%), and renal disease (32 vs 15%) compared with non-diabetics, respectively. While diabetic patients were significantly more likely to have been treated with ACE Inhibitors/ARBs (65 vs 53%), Calcium

channel blockers (33 vs 26%), diuretics (72 vs 53%), and lipid lowering medications (66 vs 60%) during their index hospitalization, a similar proportion of diabetic and non-diabetic patients received aspirin and Beta Blockers. Diabetics were significantly less likely to have been treated with PCI (24% vs 29%), but were more likely to have undergone CABG surgery (7 vs 5%) than non-diabetics. Compared with non-diabetics, diabetic patients were more likely to have developed important in-hospital clinical complications including heart failure (50 vs 36%), stroke (2.0 vs 1.6%), cardiogenic shock (5 vs. 3%), and to have a longer hospital stay (6.7 vs 5.4 days). Diabetic NSTEMI patients were at significantly higher risk for dying during hospitalization compared with non-diabetics (12 vs 9%). Multivariable adjusted models showed significant declines in hospital death rates during the years under study for both diabetic and non-diabetic patients, though diabetic patients remained at greater risk for dying during each of the years under study.

Conclusions:
Our findings demonstrate that diabetic patients presenting with NSTEMI are more likely to suffer from comorbidities and remain at higher risk for developing complications or dying during hospitalization than non-diabetic patients presenting with NSTEMI at all central Massachusetts hospitals between 1997 and 2009.
Abstract P243: Long-Term Exposure to Air Pollution and Markers of Inflammation, Coagulation and Endothelial Activation: A Repeat Measures Analysis in the Multi-Ethnic Study of Atherosclerosis
Authors: Hajat Anjum , Diez-Roux Ana V , Jenny Nancy , Szpiro Adam , Kaufman Joel
Published: July 2021

Air pollution is associated with CVD and systemic inflammation is posited to mediate this effect. Animal, experimental and epidemiologic studies suggest that increases in short-term air pollution cause an inflammatory response. Few studies, however, have assessed the contribution of long-term exposure to pollutants even though chronic inflammation may be more relevant to the observed risk of atherosclerotic disease. We assessed the hypothesis that long-term exposure to pollutants is associated with markers of inflammation, coagulation and endothelial activation.

We studied participants from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort with repeat measures of serum C-reactive protein (CRP), fibrinogen, D-dimer, soluble E-selectin and soluble Intercellular Adhesion Molecule-1 (sICAM-1). We estimated associations of these markers with outdoor PM2.5, individual-level ambient PM2.5 (integrating indoor concentrations and time-location data) and oxides of nitrogen (NOX). Pollutant concentrations were predicted from likelihood based models from cohort-specific monitoring and were averaged over the year prior to blood draw. CRP and D-Dimer were log-transformed for analysis. A random effects model controlling for relevant covariates was used to account for within person clustering. Participants with a recent history of acute infection were excluded from analysis.

A total of 713 participants contributed 1736 observations (mean 1.8 observations per person over 3 visits). After excluding those with a recent infection we were left with 1233 observations among 491 participants. In multivariable models, both D-dimer and E-selectin were associated with pollutants, specifically PM2.5 and NOx (see table). There was no association between pollutants and CRP, fibrinogen or sICAM-1.

In conclusion, these data are consistent with the hypothesis that associations between long-term exposure to particulate and traffic-related air pollution and CVD may be related to endothelial activation and fibrinolysis.
Abstract P259: Genome-Wide DNA Methylation and Subclinical Cardiovascular Disease in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Hou Lifang , Liu Xin , Zheng Yinan , Zhang Wei , Zhang Xiao , Ning Hongyan , Carr J.Jeffrey , Fornage Myriam , He Ka , Liu Kiang , LIoyd-Jones Donald M
Published: July 2021

Background:
Coronary artery calcification (CAC) and carotid intima-media thickness (CIMT), established measures of subclinical atherosclerosis, that have been demonstrated to improve prediction of coronary artery disease (CAD) risk beyond classical risk factors (CRFs). This study examined the epigenetic mechanisms underlying the appearance of CAC and increased CIMT, which have not been previously explored.

Methods:
We conducted an epigenome-wide association study (EWAS) in 46 non-smoking and non-diabetic white subjects randomly selected from the Coronary Artery Risk Development in Young Adults (CARDIA) study. CAC and CIMT were measured by computed tomography (CT) and catotid artery ultrasound at examination year (Y) 20. The Illumina HumanMethylation450 BeadChip was used to measure DNA methylation in white blood cells collected at Y15. We dropped one sample with >1% of the CpG sites having a detection p-value >0.05 and then exclude ~160k CpG probes due to their ambiguously mapping to the genome or with the presence of common SNPs, etc. Both background adjustment and normalization were performed separately for Infinium I and II probes, and new values were calculated and then transformed into M-values. After correction for potential chip effect, we examined the associations between these pre-processed methylation levels at each CpG site with CAC and CIMT using multiple logistic and linear regression models, respectively. Pathway analysis was performed to explore the gene sets that were significantly associated with CAC and CIMT.

Results:
Several CpG sites in multiple genes were significantly associated with CAC or CIMT. Some of these genes play roles in the regulation of vascular function, such as ion binding and transport (
HRH1
,
LRP1B
,
KCNJ9
,
TRIM40
,
ADAMTS3
for CAC and
BRSK2
,
ZNF428
,
TROVE2
,
C1orf86
for CIMT) and metabolic processes (
LEPR
for CAC and
NUP50
for CIMT). Pathway analyses revealed several common canonical pathways for CAC and CIMT including, calcium signaling, axon guidance, and focal adhesion etc., which are relevant to the occurrence of these two subclinical CADs. The statistical significance of identified CpG sties for either CAC or CIMT did not remain after correction for multiple testing, possibly due to the small sample size.

Conclusion:
Our preliminary findings suggest that methylomic mechanisms may play a role in the development of CAC and CIMT, and subsequently the etiology of CAD. Future replication studies in larger longitudinally studies are needed.
Abstract P263: The Associations of Epithelial Sodium Channel Genes with Blood Pressure Changes and Hypertension Incidence: the GenSalt Study
Authors: Kelly Tanika N , Yang Xueli , Rao Dabeeru C , Gu Dongfeng , Hixson James E , Rice Treva K , Liu Depei , Shimmin Lawrence C , He Jiang
Published: July 2021

We examined the associations of common variants in ENaC genes with BP changes and hypertension incidence in a longitudinal family study. A total of 2755 Han Chinese participants of the Genetic Epidemiology Network of Salt Sensitivity (GenSalt) baseline examination were eligible for the current study. The average of nine BP measurements obtained using a random-zero sphygmomanometer at the baseline and each of two follow-up visits were used for the current analysis. The associations of 43 tag-SNPs in ENaC genes with BP changes and hypertension incidence were assessed using mixed models to account for the correlations of repeated measures among individuals and within families. A genotype by time interaction term was used to model differences in BP change according to genotype over time. The false discovery rate (FDR) method was used to adjust for multiple testing. During an average of 7.4 years follow-up, systolic BP (SBP) and diastolic BP (DBP) increased, and approximately 33% of participants developed hypertension. Multiple variants in ENaC genes were significantly associated with longitudinal changes in SBP after adjustment for multiple testing, including
SCNN1A
SNP rs11064153 (

P
interaction

= 5.8х10
-4
;
FDR-Q
= 0.01);
SCNN1G
SNPs rs4299163 (

P
interaction

= 0.011;
FDR-Q
= 0.05) and rs4401050 (

P
interaction

= 0.001;
FDR-Q
= 0.01); and
SCNN1B
SNP rs1004749 (

P
interaction

= 0.006;
FDR-Q
= 0.03). Similar but not significant trends were observed for the associations between both rs11064153 and rs4401050 and DBP changes (

P
interaction

= 0.024 and 0.005, respectively;
FDR-Q
= 0.41 and 0.17, respectively) and between rs11604153 and hypertension incidence (
P
= 0.017;
FDR-Q
= 0.19). Our findings indicate that ENaC genes may contribute to longitudinal BP changes in the Han Chinese population. Replication of these findings is warranted.
Abstract P270: Niacin Lowers Triglyceride-Rich Lipoprotein Apolipoprotein B-48 Secretion in Statin-Treated Type 2 Diabetics
Authors: Pang Jing , Chan Dick , Hamilton Sandy , Tenneti Vijay , Watts Gerald , Barrett Hugh
Published: July 2021

Background:
Type 2 diabetic subjects often have hypertriglyceridemia and an increased concentration of apolipoprotein B-48 (apoB-48) in circulation, particularly during the postprandial period. There is an accumulating body of evidence to suggest that apoB-48 plays a central role in the development of atherosclerosis. Statins are the frontline therapy to reduce cardiovascular risk, however, a large residual risk still remains. This residual risk suggests that additional therapeutic interventions may be required to further reduce CVD risk.

Aim:
To investigate the effect of niacin on the metabolism of triglyceride-rich lipoprotein (TRL) apoB-48 in men with type 2 diabetes on background statin therapy.

Methods:
Twelve type 2 diabetic men were recruited for this randomized, cross-over design study. Patients required a statin-treated low density lipoprotein (LDL) cholesterol of less than 2.5 mmol/L to enter the trial. Patients were then randomized to rosuvastatin alone or rosuvastatin plus niacin (titrated up from 1 to 2 g daily) for a period of 12 weeks and then were crossed over to the alternate therapy with a 3 week washout period in between. Metabolic studies were performed at the end of each treatment period. A bolus intravenous infusion of D3-leucine was administered as subjects consumed a standardised high-fat liquid meal. Blood samples were collected over 24 hours and TRL apoB-48 tracer/tracee ratios were measured using gas chromatography-mass spectrometry. Kinetic parameters, including fractional catabolic rate (FCR) and production rate (PR), were derived using a multicompartmental model.

Results:
Niacin significantly reduced triglyceride, plasma cholesterol, LDL cholesterol and apoB (all p<0.005). TRL apoB-48 concentration was lower with niacin (8.24 ± 1.98 vs 5.48 ± 1.14 mg/L, p=0.03). ApoB-48 FCR was not altered with niacin (8.78 ± 1.04 vs 9.17 ± 1.26 pools/day; p=0.79). Basal apoB-48 PR (3.21 ± 0.34 vs 2.50 ± 0.31 mg/kg/day; p=0.04) and postprandial apoB-48 PR were significantly lower (1.35 ± 0.19 vs 0.84 ± 0.12 mg/kg; p=0.02) on niacin.

Conclusion:
Niacin reduces TRL apoB-48 concentration by lowering basal and postprandial apoB-48 PR. This effect on apoB-48 metabolism may be beneficial for reducing atherogenic postprandial TRL particles and may provide CVD risk benefit to patients with type 2 diabetes.
Abstract P273: Enhancing Documentation and Control of Lipids in a University-Based Cardiology Clinic
Authors: Karumbaiah Keerthana K , Omar Mazen B , Omar Bassam A
Published: July 2021

Background:
Non-compliance with laboratory appointments, separate from clinic visit appointments, for measuring fasting cholesterol may hinder documentation and control of patients’ lipids.

Methods:
A university-based cardiologist’s clinic notes, from a single year (yr 1), when patients were asked to have a fasting cholesterol a week prior to the clinic visit, were analyzed (100 patients). The poor compliance prompted a same day as the clinic visit measurement (fasting or non-fasting) of lipids, for patients who could not comply with their laboratory appointment, during the following year (yr 2; 130 patients). Lipid values were managed by a subsequent call to the patient. All patients had coronary artery disease or risk equivalent mandating LDL levels < 100 mg/dL.

Results:
In yr 1, 62% (62/100) of patients had documented lipid profiles compared to 83% (108/130) of patients in yr 2. The average LDL in yr 1 was 115 +/- 36 mg/dL compared with 96 +/- 31 mg/dL in yr 2 (P < 0.01). Only 22% of the patients in yr 1 reached goal of < 100 mg/dL, compared with 65% in yr 2. There were no significant differences in the HDL, TG levels or blood pressures documented during the concurrent visits.

Conclusion:
Better documentation and control of lipids may be obtained when lipid profiles are done on clinic visit day, with fewer burdens on the patients who cannot comply with a separate laboratory appointment. Although there were many non-fasting levels as a result, the triglyceride levels where not significantly different among the two groups, probably reflecting an overall more intensive lipid management in yr 2, commensurate with the better documentation. Therefore, as has been shown by others, a lipid profile does not necessarily have to be fasting, especially in patients being treated for stricter targets such as our cohort, which may decrease the burden on patients unable to comply with a fasting state or added clinic visits.
Abstract P278: Effects of the Optimal Macro-Nutrient Intake to Prevent Heart Disease (OmniHeart) diets on urinary excretion profiles
Authors: Loo Ruey Leng , Zou Xin , Appel Lawrence , Nicolson Jeremy K , Holmes Elaine
Published: July 2021

Background:
OmniHeart diets are diets rich in fruit, vegetables, and low-fat diary food with varying amount of carbohydrate, protein and unsaturated fat. These diets have been shown to reduce blood pressure, low-density lipoprotein cholesterol and coronary heart disease risk. However, the biological mechanism for this is unclear.

Objective:
The aim of this study is to evaluate the effects of OmniHeart diets on the urinary profiles by proton nuclear magnetic resonance (
1
H NMR).

Methods:
158 men and women, aged 30 years and older, with prehypertension or stage 1 hypertension, each consumed three different OmniHeart diets for six weeks: a carbohydrate-rich diet (Carb, similar to the Dietary Approaches to Stop Hypertension, DASH diet); a protein-rich diet with protein predominantly from plant sources (Prot); and an unsaturated fat-rich diet mainly using monounsaturated fat (Unsat). All participants provided urine specimens at baseline (on a typical ‘American’ diet), and at the end of each dietary intervention. Spectra were acquired using a standard one dimensional experiment. Pairwise multilevel orthogonal partial least squares-discriminant analysis (OPLS-DA) comparison were made between baseline and each dietary intervention.

Results:
All three multilevel OPLS-DA models showed clear separation between baseline and different OmniHeart diets, with model predictability (Q
2
Yhat) between 75 - 85 %. The urine
1
H NMR spectra for OmniHeart diets were characterised by the higher concentrations of several metabolites of both exogenous and endogenous origin, as well as those derived from gut microbiota. Core molecules common to all three OmniHeart diets were also observed. The baseline urine spectra were characterised by the higher concentrations of molecules present in the aliphatic regions of the urine
1
H NMR spectra.

Conclusion:
NMR-based metabolic phenotyping approach provides an objective method for assessing the impact of different healthy diets in human population. It has the potential to delineate the complexities of dietary effect on human health. Future work aims to determine the identity of these discriminating molecules and to possibly un-cover the biological mechanisms of how these molecules may contribute the reduction of cardiovascular risk.
Abstract P286: The Prevalence of Comorbid Depression & Diabetes across Racial/Ethnic Backgrounds: The National Health and Nutrition Examination Study
Authors: Womack Veronica Y , De Chavez Peter , Andrews Kiarri , Carnethon Mercedes R
Published: July 2021

Background:
Depression, both diagnosed and based on elevated symptom scores, is highly prevalent in individuals with Type II Diabetes (T2DM). Depression predisposes individuals to poorer glycemic control, higher rates of T2DM complications and elevated mortality. African Americans and Hispanics are less likely to be diagnosed with depression than non-Hispanic whites; however, prevalence studies in the general (i.e., non-diabetic) population report that rates of elevated depressive symptoms are similar across race/ethnic groups.

Objective:
To calculate the age-adjusted prevalence of comorbid depression and Type II Diabetes by race/ethnicity and to investigate whether the patterns vary according to treatment of depression or elevated depressive symptoms (EDS). We hypothesize that racial/ethnic differences in depression among adults with diabetes will vary according to whether depression is treated or based on elevated depressive symptoms.

Methods:
Participants from the National Health and Nutrition Examination Study (2005-2010) classified as White (n=459), Black (n=250), Mexican American (n=233), or “Other Racial/Ethnic Background” (n=149) and had T2DM (i.e., fasting glucose >=126, clinician diagnosis, or diabetic medication use) and responses to current prescription drug use and depression syndrome measures were included in the analysis (n=1,091, Mean age=48.2 year). Undiagnosed depression was determined by an elevated depressive symptoms (EDS) score => 10 on the Patient Health Questionnaire-9 and no report of current antidepressant use. Treatment for depression was determined by self-reported current antidepressant use (e.g., SSRI, MAOI, and TCA). Weighted age-adjusted prevalence rates of depression among adults who have diabetes were stratified by race/ethnic background.

Results:
Twelve percent used antidepressants and 7% of the sample had EDS without antidepressant use. The age-adjusted prevalence of antidepressant use among adults with diabetes was higher in Whites (16%, 95% CI: 9%, 22%) than Black (9%, 95% CI: 3%, 15%), Mexican Americans (5%, 95% CI: 3%, 8%), and “Others” (6%, 95% CI: 1%, 10%). These prevalence estimates remained significantly different after adjusting for healthcare provider and income. The prevalence of EDS among adults with diabetes was not significantly different across race/ethnic background groups (Whites- 5%, 95% CI: 3%, 8%; Blacks- 8%, 95% CI: 2%, 13%; Mexican Americans- 8%, 95% CI: 3%, 13%; “Others”- 8%, 95% CI %, 14%). The prevalence estimates of EDS and antidepressants by race/ethnic group did not vary by gender.

Conclusions:
Although African Americans and Mexican-Americans with diabetes were as likely to experience EDS, they were less likely to have to be treated for depression. These findings highlight the importance of screening for both treated depression and EDS in individuals who have Type II Diabetes.
Abstract P288: Exposure To Psychological And Physical Challenges Immediately Prior To Myocardial Infarction And Increased 10-year Mortality
Authors: Smeijers Loes , Mostofsky Elizabeth , Kop Willem J , Mittelman Murray A
Published: July 2021

Objective:
To examine the association between exposure to psychological (anger, anxiety) and physical (high activity levels, coffee consumption) challenge immediately prior to myocardial infarction (MI) as risk indicator of mortality at 10-year follow-up.

Methods:
Participants of the Determinants of Myocardial Infarction Onset Study (N=2176, mean age 60.1±12.5 yrs, 29.2% women) were interviewed to assess exposure to several potential triggers immediately prior to MI, including anger, anxiety, physical activity and coffee. All-cause mortality was assessed using the National Death Index for 10 years follow-up. We constructed Cox proportional hazards models with 95% confidence intervals to examine the relationship between exposure to these potential triggers in the 2 hours prior to MI onset and the rate of all-cause mortality, adjusting for demographic and clinical characteristics.

Results:
Exposure to anger, anxiety, physical activity or coffee consumption prior to MI was associated with a 30% higher mortality rate over 10 years (HR=1.30, 95%CI=1.06-1.59,
p
=0.011) compared to patients who were not exposed to any of these potential triggers. This association was stronger for the first 3 years of follow-up (HR=1.59, 95%CI=1.16-2.19,
p
=0.004) and weaker for years 3 to 10 (HR=1.14, 95%CI=0.88-1.48,
p
=0.32). In separate analyses for each exposure, there was a higher mortality rate associated with anxiety (HR=1.44, 95%CI=1.09-1.91,
p
=0.010) and a suggestion of a higher rate for anger (HR=1.33, 95%CI=0.97-1.81,
p
=0.075), but no association for physical activity or coffee consumption. Sensitivity analyses showed stronger associations for women than men, and patients aged 65 and older compared to younger patients.

Discussion:
MI following episodes of anger, anxiety, physical activity or coffee consumption is associated with higher all-cause mortality in the following 10 years. This association was strongest for anxiety and slightly lower for anger but there was no evidence of a higher mortality rate among MI patients reporting physical activity or coffee consumption immediately prior to MI.
Abstract P307: The Interaction Between An Individual's Acculturation And Community Factors on Physical Inactivity and Obesity
Authors: Zhang Donglan , Shi Lu , Meijgaard Jeroen v
Published: July 2021

Introduction:
Few studies of acculturation examined the interaction between community-level factors (neighborhood median income, ethnic composition, etc.) and individual-level acculturation measures, while an individual’s acculturation status might function through community-level factors to have an impact on his/her health.

Methods:
We pool the 2005 and 2007 Los Angeles County Health Survey data to construct a multilevel dataset, using zip-code-level median household income and immigrant density (drawn from the United States Census) to aggregate ZIP-codes into larger areas to ensure sufficient sample size in each geographic unit for multilevel analysis. We interact the neighborhood median household income (NMHI) and immigrant density variables with each individual’s linguistic acculturation (i.e., speaking English at home) to examine the interaction’s association with physical inactivity, obesity and hypertension. We include perceived public safety as a covariate to test the hypothesis that perceived public safety mediates the association between acculturation and health outcomes.

Results:
Linguistic acculturation is a modifier of the relationship between NMHI and physical inactivity, as well as the association between NMHI and obesity outcome. The interaction between higher NMHI and higher linguistic acculturation is negatively associated with physical inactivity and obesity at the individual level (for physical inactivity: OR=.624, 95% CI=.473 - .823; for obesity: OR=.517, 95% CI=.384 - .696). These odds ratios remain significant after we include the individual’s perceived public safety.

Discussion:
This study shows a possible pathway between acculturation and health outcomes (though no causal conclusions can be drawn): higher-level linguistic acculturation interacts with higher community-level income to generate lower level of physical inactivity and obesity.
Abstract P310: Socioeconomic Inequalities In The Incidence Of Cerebrovascular Accident And Subtypes Among Migrant Groups In The Netherlands: Analysis Of Nation-wide Data
Authors: Agyemang Charles , van Oeffelen Louise , Bots Michiel , Stronks Karien , Vaartjes Ilonca
Published: July 2021

Background:
Inverse relationship between socio-economic status (SES) and the incidence of stroke has been well demonstrated in the industrialized countries. However, this inverse relationship is mainly observed in the majority host population, with earlier studies showing no relation or positive relationship in migrant populations. The general consensus is that socioeconomic inequalities will eventually emerge. This study sought to assessed the current state of socioeconomic inequalities in relation to cerebrovascular accident (CVA) and subtypes (subarachnoid haemorrhage, intracerebral haemorrhage, and ischemic stroke) incidence among major migrant populations in the Netherlands.

Methods:
A nationwide register-based cohort study was conducted (n=2,641,451 persons) between January 1
st
1998 and December 31
st
2010 among migrant groups originating from Suriname, Netherlands Antilles, Indonesia, Morocco and Turkey. Standardized household disposable income was used a as proxy for socioeconomic position. Cox proportional hazard models were used to estimate the socioeconomic inequalities in stroke incidence.

Results:
The incidence of total CVA and all the CVA subtypes were higher in the low-income group than in the high-income group among majority Dutch population. Similar observations were also found among most migrant groups especially among migrants with long migration histories such as Suriname-born and Indonesia-born in whom individuals with low-income consistently had a higher risk of total CVA and all the CVA subtypes: age, sex, and Charlson Index adjusted hazard ratio (aHR) for total CVA was 1.36 (95% CI, 1.17-1.61), and CVD subtypes ranging from 1.45 (95% CI, 1.22-1.73) for ischemic stroke to 1.94 (95% CI, 1.35-2.78) for subarachnoid haemorrhage in Surinamese; and aHR for total CVA was 1.15 (1.03-1.28) and CVA subtypes ranging from 1.21 (95% CI, 1.02-1.44) for intracerebral haemorrhage to 1.26 (95% CI, 1.04-1.53) for subarachnoid haemorrhage in Indonesians. In general, the risk of CVA was higher in all SES groups in migrants from Suriname, Indonesia and Antilles, but lower in migrants from Morocco compared with the Dutch general population.

Conclusion:
Our findings demonstrate socioeconomic inequalities in CVA incidence in most migrants groups and suggest a convergence towards the Dutch general population. Reduction in CVA incidence in poor sections of the migrant groups would represent a major public health improvement for all ethnic groups.
Abstract P319: Comparing Coronary Artery Calcium among U.S. South Asians with Four Racial/Ethnic Groups: The MASALA and MESA Studies
Authors: Kanaya Alka M , Kandula Namratha R , Herrington David , Liu Kiang , Blaha Michael J , Budoff Matthew J
Published: July 2021

Background:
South Asians (individuals from India, Pakistan, Bangladesh, Nepal, and Sri Lanka) have high rates of cardiovascular disease (CVD) which cannot be fully explained by traditional risk factors. We created a community-based cohort of South Asians (MASALA) and compared the prevalence of coronary artery calcium (CAC) to four racial/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods:
We compared 803 South Asians to the four racial/ethnic groups (2,622 Whites, 1,893 African Americans, 1,496 Latinos and 803 Chinese Americans), all free of CVD. We created pooled multivariate Poisson models to examine the effect of race/ethnicity with CAC after adjusting for sex, age, clinical site, education, smoking, BMI, diabetes, hypertension, HDL-, LDL-cholesterol, and cholesterol lowering medication use.

Results:
The age-adjusted prevalence of any CAC was similar between White and South Asian men (68%), but was lower in Latino (58%), Chinese American (58%) and African American men (51%). South Asian women had similar CAC prevalence as other ethnic minority women but significantly lower than White women (37% vs. 43%, p<0.05). The figure shows the mean CAC scores among each of the five racial/ethnic groups by 5-year increments in age. After adjusting for all covariates, South Asian men were similar to White men and had higher CAC scores compared to African Americans, Latinos and Chinese Americans. In fully adjusted models, CAC scores were similar for South Asian women compared to all MESA groups. However, South Asian women ≥70 years had a higher prevalence of any CAC than all other racial/ethnic groups.

Conclusions:
South Asian men are more similar to Whites than the other race/ethnic groups in MESA. The high burden of subclinical atherosclerosis in South Asians may partly explain higher rates of CVD in South Asians. Follow-up data from the MASALA study will determine whether CAC is associated with incident CVD among South Asians and if this relationship differs from that observed in other racial/ethnic groups.
Abstract P328: Effects of Subclinical Disease on Cognitive Function across Age in African Americans
Authors: Bridges John M , Griswold Michael E , Simpson Brittany N , Peyser Patricia A , Bielak Lawrence F , Turner Stephen T , Lirette Seth T , Mosley Thomas H , Windham B Gwen
Published: July 2021

Objectives:
Determine relationships between calcification and cognitive function.

Background:
Dementia affects over 5.4 million Americans; prevalence will quadruple in the next 50 years. Coronary artery calcification (CAC), a measure of subclinical atherosclerosis, may affect cognitive function through microvascular brain effects. Abdominal aortoiliac calcification (AAC) generally precedes CAC and may provide earlier risk determination. Effects of calcification on cognition have not been studied in African Americans (AA).

Methods:
The 2008-2011 GENOA CAC cohort consists of AA sibships (n=657, mean age 69 [range 40-98], 74% women, 82% hypertensive) enriched with hypertension from Jackson, MS with computed tomography (CT) Agatston calcification measures. Cognition was assessed in 4 domains: global cognitive function (Mini-Mental State Examination); processing speed (Digit Symbol Substitution and Trail Making A); memory (RAVLT and WAIS-III Incidental Learning); and executive function (Trail Making B). Relationships of cognition (standardized) and calcification (log base 2 scale accounting for skewness) were examined using linear regressions with GEE to account for sibship clustering, adjusting parsimoniously for age, sex, and education.

Results:
Doublings of CAC were significantly associated with poorer processing speed (ß=-0.049 [-0.072, -0.025] p=0.000) and executive function (ß=-0.037 [-0.070, -0.003] p=0.031) in younger subjects and with poorer global function (ß=-0.0648 [-0.096, -0.020] p=0.000), memory (ß=-0.034 [-0.060, -0.007] p=0.013), and processing speed (ß=-0.051 [-0.076, -0.025] p=0.000) in older subjects. Doublings of AAC were significantly associated with poorer processing speed (ß=-0.0381 [-0.056, -0.020] p=0.000) and executive function (ß=-0.045 [-0.070, -0.020] p=0.000) in younger subjects and poorer processing speed (ß=-0.050 [-0.075, -0.025] p=0.000) in older subjects.

Conclusions:
Calcification is associated with processing speed in young and old AA with prevalent cardiovascular risk factors and may be differentially associated with other cognitive domains by age. Processing speed in particular may be a domain affected early in the calcification process, warranting further study. This supports existing literature addressing the relationship between calcification and cognitive function in ethnically diverse cohorts. Further studies can focus on the temporal and causal relationships between calcification and cognition across age in AA samples enriched for hypertension to identify predictive factors associated with future cognitive decline.
Abstract P329: Low-carbohydrate Diets and Incidence, Prevalence, and Progression of Coronary Artery Calcium in the Multi-ethnic Study of Atherosclerosis (mesa)
Authors: Hu Tian , Jacobs David , Nettleton Jennifer , Steffen Lyn , Bertoni Alain , He Jiang , Bazzano Lydia
Published: July 2021

Background:
The coronary artery calcium (CAC) score is associated with the risk of coronary heart disease. We aimed to assess the relationship between low-carbohydrate dietary patterns and CAC scores in the MESA cohort.

Methods:
Our sample included 5,702 men and women who were free of clinical cardiovascular disease and had food frequency questionnaires at baseline (2000-2002), and at least one measure of CAC during follow-up. We excluded those with implausible energy intake (<600 kcal/day or >6000 kcal/day) or daily physical activity (>24 hours). Two low-carbohydrate-diet (LCD) scores were generated: an overall LCD score was calculated based on total carbohydrate, fat, and protein, and a plant-based LCD score was calculated using intakes of unsaturated fat (excluding trans fat) and vegetable protein. CAC scores at exam 1 and at 2 and 3 (18 and 36 months later) were used in multivariable relative risk regression models to examine the association between LCD scores and CAC prevalence and incidence (binary), while robust regression was used to examine CAC progression (continuous). Analyses were adjusted for demographic, socioeconomic, lifestyle, and cardiovascular risk factors.

Results:
The mean age was 62 years, 48% of participants were male, and 40.8% were White. The mean (SD) levels of carbohydrate intake as a percentage of energy were 64.2 (5.2), 56.1 (4.9), 51.5 (3.7), 47.5 (4.0), and 42.1 (5.6) from the lowest to the highest quintiles of the overall LCD score. There were 2,652 (46.5%) participants who had positive CAC scores at baseline and 252 participants who had newly positive scores for CAC during follow-up. Among those with prevalent CAC at baseline, the median (IQR) of increases in CAC was 47 (132) over follow-ups. For incident CAC, relative risk estimates (95% CI) from Quintile 1 to 5 were 1, 0.73 (0.52, 1.02), 0.65 (0.45, 0.95), 0.90 (0.63, 1.28), 1.05 (0.77, 1.42) for overall LCD scores, and were 1, 1.14 (0.81, 1.61), 0.98 (0.71, 1.37), 1.08 (0.78, 1.49), 1.15 (0.82, 1.62) for plant-based LCD scores, respectively. No significant trend was observed for associations with incident CAC. There was no significant association between any LCD score and CAC prevalence or progression among those with positive CAC scores at baseline.

Conclusions:
A low-carbohydrate diet, including a plant-based low-carbohydrate diet, was not associated with prevalence, incidence, or progression of CAC among those with prevalent CAC at baseline.
Abstract P338: Carotid Extra Media Thickness: An Indicator of Fat, Arterial Stiffness, Inflammation or Thickness?
Authors: McCoy Connie E , Khoury Philip R , Gao Zhiqian , Kimball Thomas R , Dolan Lawrence M , Urbina Elaine M
Published: July 2021

Introduction:
Epicardial fat is an emerging risk factor for cardiovascular (CV) disease. The importance of perivascular fat as a CV risk factor, which can be measured by ultrasound as Extra Medial Thickness (EMT), is less well described.

Hypothesis:
We hypothesized that EMT would be related to obesity and EMT may influence carotid stiffness.

Methods:
EMT defines the interface between the distal common carotid near wall to the jugular vein intima and includes arterial adventitia, interstitial tissue, perivascular fat, and vein intima. Mean of the maximum for right and left carotid EMT was measured at follow-up (5.9 years) with ultrasound (GE Vivid 7, Bothell, Wash.) in 112 subjects (34% male, 68% Non-Caucasian, mean age 22.9 ∓ 3.6 years) in a group of lean (L), obese (O), and T2DM (T) youth from a longitudinal study of CV Risk Factors. Anthropometrics, BP, fasting labs, and vascular measures for CIMT and arterial stiffness (Beta stiffness and Peterson’s elastic modulus) were obtained at baseline and follow-up. Variance stabilizing transformations were performed as appropriate. ANOVA was performed to compare means between the 3 study groups. ANCOVA was used to further delineate determinants of EMT. CV risk factors were regressed on EMT and other covariates in general linear models.

Results:
Mean EMT was lower in L (0.86±.28) compared to the O (0.98±.24) and T (1.00±.28) subjects, p<0.05. Age and BMIz at baseline and change in glucose were determinants of EMT, while differences between study groups were no longer significant. EMT predicted higher CRP, but, significance was lost after adjustment for follow-up BMIz. EMT predicted higher Beta and Peterson’s which persisted after adjustment for BMI, glucose, and CRP.

Conclusion:
Adiposity and poor glucose control may lead to increased perivascular fat. Thicker EMT may lead to increased carotid stiffness, a risk factor for CV events. Public health measures to reduce obesity and glycemic-related arterial changes are needed to prevent future heart attack and stroke.
Abstract P340: Associations between Subclinical Carotid Atherosclerosis and Future Risk of Abdominal Aortic Aneurysm: the Atherosclerosis Risk in Community (ARIC) Study
Authors: Yao Lu , Alonso Alvaro , Lutsey Pamela , Cheng Susan , Folsom Aaron , Tang Weihong
Published: July 2021

Background:
Abdominal aortic aneurysm (AAA) is a potentially lethal vasculopathy that shares multiple risk factors with conventional atherosclerotic disease, including advanced age, male sex, hypertension, and smoking. However, it is still debated whether subclinical atherosclerosis is an independent risk factor for AAA.

Hypothesis:
Subclinical carotid atherosclerosis is positively associated with future risk of AAA, independent of shared cardiovascular risk factors.

Methods:
We included 15,363 ARIC participants (74% whites) who had measures of carotid ultrasound at baseline (1987-89) at 45-64 years of age. Carotid intima-media thickness (cIMT) was measured bilaterally in the common carotid artery, carotid bifurcation, and internal carotid artery. Mean cIMT was estimated by combining the averages of cIMT measures at the 6 carotid sites. The presence of atherosclerotic plaque at any of the 6 segments was defined based on wall thickness ≥1.5 mm, or the presence of luminal encroachment or irregular intimal surface, or characteristics of arterial wall structural heterogeneity. Clinical AAAs were ascertained through hospital discharge diagnoses and death certificates through 2010. We used Cox proportional hazard models to examine the association between baseline carotid ultrasound measures and subsequent occurrence of clinical AAA.

Results:
In the total study sample (age 54±6 years, 45% men), the median (25
th
to 75
th
percentiles) cIMT at baseline was 0.71 (0.62 to 0.82) mm. Over an average of 21 years of follow up, a total of 392 clinical AAAs (74% male and 85% Whites) were ascertained. After adjustment for age, sex and race, participants in the highest quartile of baseline cIMT had 2.25 times higher risk of AAA (95% CI: 1.81, 2.79) compared to those in the lower 75 percentile. The presence of carotid atherosclerotic plaque at baseline was associated with 1.77 times increased risk of AAA (95% CI: 1.44, 2.17) after adjustment for age, sex and race. The associations for cIMT and atherosclerotic plaque remained significant after additional adjustment for baseline height, pack-years of smoking, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and hypertension: HR=1.66 (95% CI: 1.32, 2.08) for cIMT quartile 4 vs lower 75 percentile and 1.34 (95% CI: 1.08, 1.66) for presence of carotid atherosclerotic plaque. Further exclusion of participants with history of coronary heart disease or stroke at baseline slightly attenuated but did not abolish the associations of cIMT and atherosclerotic plaque with AAA (p<0.05 after the exclusions).

Conclusion:
Our study findings suggest that subclinical carotid atherosclerosis in middle-age is independently associated with future risk of clinical AAA.
Abstract P350: Association of Plasma Levels of Soluble Receptor for Advanced Glycation End Products and Risk of Kidney Disease is Explained by Baseline Kidney Function
Authors: Rebholz Casey M , Astor Brad C , Grams Morgan E , Halushka Marc K , Lazo Mariana , Hoogeveen Ron C , Ballantyne Christie M , Coresh Josef , Selvin Elizabeth
Published: July 2021

Introduction:
Advanced glycation end products and their cell-bound receptors (RAGE) are thought to mediate the adverse effects of dysglycemia and vascular disease through oxidative stress, inflammation, and endothelial dysfunction. The soluble form of RAGE (sRAGE) is a 48-kDa, positively-charged cleavage product of RAGE. There is limited evidence on the role of sRAGE in the pathogenesis of kidney disease.

Methods:
We conducted cross-sectional and prospective analyses of a case-cohort study nested within the ARIC Study. Plasma sRAGE was measured at baseline (1990-92) in a cohort random sample (n=1,218) and three case groups of participants with incident chronic kidney disease [estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m
2
and ≥25% eGFR decline; n=151], incident end-stage renal disease [U.S. Renal Data System registry; n=152], and incident kidney failure (eGFR <15 mL/min/1.73 m
2
, U.S. Renal Data System registry, or kidney failure-related hospitalization or death; n=266).

Results:
Baseline sRAGE levels were inversely related to baseline eGFR (r = -0.13). After adjusting for age, sex, and race, one interquartile range increase in log
10
-transformed sRAGE was associated with development of end-stage renal disease [hazard ratio: 1.97; 95% confidence interval (CI): 1.47, 2.64; p<0.001], kidney failure (hazard ratio: 1.59; 95% CI: 1.27, 2.00; p<0.001), and chronic kidney disease (odds ratio: 1.39; 95% CI: 1.06, 1.83; p=0.02). However, none of these associations were significant after additional adjustment for eGFR (all p>0.10; Figure).

Conclusions:
High sRAGE levels are associated with decreased kidney function. The association of sRAGE with kidney disease risk may be explained by its partial clearance by the kidney.