bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P101: Effect of an Intensive Lifestyle Intervention on Biomarkers of Atrial Fibrillation-Related Pathways Among Overweight Adults: The PREDIMED-PLUS Trial
Authors: Li Linzi , Toledo Estefania A , Romaguera Dora , Alonso-Gómez Angel M , Razquin Cristina , Tojal-Sierra Lucas , Fiol Miquel , Martinez-Gonzalez Miguel A , Salas-Salvado Jordi , Fito Montserrat , Alonso Alvaro
Published: March 2023

Background:
Lifestyles influence atrial fibrillation (AF) risk. Blood biomarkers can characterize the atrial substrate that facilitates the development of AF. Therefore, determining the effect of lifestyle interventions on blood concentrations of biomarkers of AF-related pathways could help understand AF pathophysiology and contribute to AF prevention.

Methods:
The PREDIMED-PLUS study is a Spanish multicenter randomized trial in adults (55-75 years) with metabolic syndrome and body mass index between 27-40 kg/m
2
. Participants were randomized 1:1 to an intensive lifestyle intervention (ILI) program, emphasizing physical activity, weight loss, and adherence to the Mediterranean diet, or a control intervention. In a sub-sample, serum biomarkers including carboxy-terminal propeptide of procollagen type I (PICP), high-sensitivity troponin T (hsTnT), high-sensitivity C reactive protein (hsCRP), N-terminal propeptide of B-type natriuretic peptide (NT-proBNP), and 3-nitrotyrosine (3-NT) were measured at baseline and years 3 and 5 after randomization. Mixed models were used to evaluate the effect of ILI on changes in biomarkers through years 3 and 5. Follow-up time was modeled as a categorical and continuous variable.

Results:
Of 481 participants (65 mean age, 40% female, 49% assigned to ILI), 453 (94%) and 442 (92%) had available samples at years 3 and 5. After 5 years, mean changes in log-transformed biomarkers were -0.01 (PICP), 0.20 (hsTnT), -0.17 (hsCRP), 0.12 (3-NT), and 0.25 (NT-proBNP). Participants in the ILI group experienced greater decreases in hsCRP or smaller increases in 3-NT, NT-proBNP, and in hsTnT to a lesser extent, as compared to the control group (Table). The ILI did not affect PICP concentrations. Results were consistent when modeling follow-up time as a continuous variable.

Conclusion:
Over five years, an ILI favorably affected concentrations of hsCRP, 3-NT, and NT-proBNP, and of hs-TnT to a lesser degree, pointing to specific mechanisms in the pathways linking lifestyles and AF.
Abstract P104: Association of Thyroid Peroxidase Antibodies and Mortality Risk in Participants of the ELSA-Brasil Cohort Study
Authors: Meneghini Vandrize , Tebar William , Santos Itamar S , Janovsky Carolina , Lotufo Paulo A , Goulart Alessandra C , Bensenor Isabela M
Published: March 2023

Introduction:
Thyroid peroxidase antibodies (TPOAb) has been considered a new indicator of low-grade inflammation. The presence of TPOAb was associated with a higher risk of cardiovascular diseases and mortality in previous studies.

Hypothesis:
We assessed the hypothesis that there is an association of TPOAb and risk of mortality in middle-aged participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods:
Baseline data of 6,115 men and 7,265 women (median age of 50 years-old) were analyzed. Fasting serum TPOAb levels were determined and categorized as detectable (> 5.00 IU/mL) and positive (≥ 34.00 IU/mL). All-cause, cardiovascular, and cancer-related mortality data up to December 2018 were confirmed by death certificate. The association of TPOAb levels, detectability and positivity with mortality was determined by Cox regression, using hazard ratios (HR) and 95% confidence intervals (CI). The final model was adjusted for age, sex, research center, TSH, smoking status, natural log transformed (ln) BMI, alcohol intake, diabetes mellitus, (ln) serum CRP, (ln) serum LDL cholesterol, and hypertension.

Results:
After a median follow-up of 9 years, the number of events was 296, 86 and 112 for men, and 182, 50, and 85 for women, for all-cause, cardiovascular and cancer-related mortality, respectively. For men, higher levels of TPOAb were significantly associated with cancer-related mortality (HR: 1.25; CI: 1.00-1.57; p=0.049). There was no association of TPOAb levels with all-cause (HR: 1.07; CI: 0.92-1.25) and cardiovascular (HR: 0.73; CI: 0.50-1.08) mortality risk; neither of TPOAb positivity and detectability with any overall or specific mortality risk (p>0.05). For women, the results showed no significant association of TPOAb levels with all-cause (HR: 1.10; CI: 0.97-1.25), cardiovascular (HR: 1.05; CI: 0.81-1.35), and cancer-related (HR: 1.08; CI: 0.89-1.31) mortality. No significant associations were seen between TPOAb detectability and positivity and mortality risk (p>0.05).

Conclusions:
In conclusion, higher levels of TPOAb were associated with a trend for increased risk of cancer-related mortality among men. Despite this interesting association, a longer period of follow-up is necessary to confirm those results. ELSA-Brasil is a cohort with relatively younger participants and low rates of mortality.
Abstract P112: Association of Obesity Sub-Phenotypes With Indices of Cardiac Remodeling in the Framingham Heart Study
Authors: He William J , Prescott Brenton , Xanthakis Vanessa , Cheng Susan , Ramachandran Vasan S
Published: March 2023

Introduction:
Many studies have reported that obesity-related metabolic abnormalities (such as diabetes and hypertension) lead to myocardial dysfunction and adverse cardiac remodeling. However, it is challenging to disentangle the effects of obesity from those of its associated metabolic comorbidities. Comparing metabolically healthy adults across different body mass index (BMI) categories can help delineate the independent effect of obesity on cardiac remodeling from the impact of metabolic comorbidities.

Hypothesis:
We hypothesized that metabolically healthy overweight (MHOW) and obese (MHO) participants will manifest echocardiographic measures consistent with adverse cardiac remodeling relative to their metabolically healthy counterparts with a normal BMI.

Methods:
A total of 6,639 participants of the Framingham Heart Study (mean age of 49 years, 55% women) underwent routine physical examinations and echocardiography. Participants who had prevalent cardiovascular disease were excluded. Individuals were classified into obesity sub-phenotypes based on their metabolic health (metabolically healthy or metabolic unhealthy) and BMI categories (normal weight, overweight, or obese). Obesity sub-phenotypes were related to echocardiographic measures using multivariable regression models adjusting for age, sex, smoking, resting systolic blood pressure (BP), resting diastolic BP, and resting heart rate.

Results:
Compared to metabolically healthy normal weight, MHOW and MHO were associated with increased left ventricular mass (LVM), left atrium end-systolic dimension (LAD), global longitudinal strain (GLS), and the ratio of early trans-mitral flow velocity to early diastolic mitral annulus velocity (E/e’) (
Table
).

Conclusions:
Evidence of adverse cardiac remodeling was seen in individuals with increasing BMI regardless of metabolic health classification. These findings indicate that MHOW and MHO states are associated with adverse cardiac remodeling.
Abstract P118: Association Between Shift-and-Persist and Cardiovascular Health Among Young Adults in Puerto Rico
Authors: Lopez Cepero Andrea A , Suglia Shakira F , Spruill Tanya , Lewis Tene T , Almodovar Israel , Kiefe Catarina I , Tucker Katherine L , Rodriguez-Orengo Jose F , Rosal Milagros C , Perez Cynthia M
Published: March 2023

Background:
Shift-and-persist (SP), defined as the ability to adapt the self to stressors while preserving focus in the future, is associated with favorable cardiometabolic outcomes. SP may be of great importance to individuals in Puerto Rico (PR) given their disproportionate exposure to social and environmental stressors. However, there is a scarcity of data on SP and cardiovascular health (CVH), and none in PR. This study examined the association between SP and CVH, as measured by the Life’s Essential 8 metric, among young adults in PR.

Hypothesis:
We hypothesize that greater SP will be associated with higher CVH scores.

Methods:
Baseline data from the PR-OUTLOOK study were used for this cross-sectional analysis. Young adults (18-29y, 64% women) completed baseline and clinic assessments between September 2020 and September 2022. Those with complete data on CVH were included (n=962). SP was measured with the Chen & Miller scale, with higher scores indicative of greater SP, and categorized in quartiles (SP Q1-Q4). Because dietary data are not yet available, we used questionnaires, anthropometric measurements, and fasting blood samples to calculate an adapted Life’s Essential 8 metric including physical activity, nicotine exposure, sleep health, BMI, blood lipids, blood glucose, and blood pressure; thus, actual CVH scores may be lower due to potentially low diet quality scores. Relationships between CVH and SP scores were assessed with multivariable linear regression models.

Results:
SP was significantly associated with CVH and its components. After adjustment for confounders, individuals in SP Q2-Q4, vs. Q1, had significantly higher total CVH (b=2.81, 95%CI=0.60, 5.03; b=4.68, 95%CI=2.54, 6.82; and b=7.34, 95%CI=4.85, 9.83, respectively) and physical activity CVH-score (b=-11.5, 95%CI=3.96, 19.1; b=11.6, 95%CI=4.27, 18.9; and b=18.6, 95%CI=10.1, 27.1, respectively). Individuals in SP Q3-Q4 also had higher BMI CVH-score (b=8.89, 95%CI=3.10, 14.7; and b=10.4, 95%CI=3.61, 17.1, respectively) than those in Q1. Additionally, those in the SP Q4, vs. Q1, had higher blood lipids (b=7.10, 95%CI=2.24, 12.0), blood glucose (B=3.91, 95%CI=0.41, 7.41), and blood pressure (b=6.23, 95%CI=1.93, 10.5) CVH-scores. Estimates were similar by sex and socioeconomic status.

Conclusion:
Higher SP scores were associated with higher CVH among young adults in PR. Longitudinal analyses are needed to confirm our results. We need to further understand the potential benefits of SP for CVH and identify strategies to improve SP and promote CVH in underserved populations.
Abstract P123: Moderation of Associations Between Lifetime Racial Discrimination and Cardiometabolic Health by Physical Activity in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Jones Melissa A , Barone Gibbs Bethany , Gabriel Kelley P , Kershaw Kiarri N , VanWiel Lisa M , Ajibewa Tiwaloluwa , Jones Raymond , Jacobs David R , Whitaker Kara M
Published: March 2023

Introduction:
Racial discrimination is associated with poorer cardiometabolic health. Whether physical activity can buffer these adverse health effects is unknown. We hypothesized that greater discrimination would be associated with poorer cardiometabolic health, but associations would be blunted with higher moderate-to-vigorous physical activity (MVPA).

Methods:
This was an analysis of 2,129 CARDIA participants. Perceived race discrimination was reported at baseline (2000-2001) and categorized as none, moderate, or high for Black participants and none or any for White participants. Different categorization was used to account for the low percentage of White participants reporting discrimination. Health markers including blood pressure (BP), cholesterol (total, HDL-C, LDL-C), HbA1c, and C-reactive protein were measured at baseline, 5, 10, and 15 years. MVPA was measured using an accelerometer at 5-year follow-up. Race stratified mixed effects linear regression examined the main effect of race specific discrimination with health markers. Moderation by MVPA was examined by its product with discrimination in each model. Main effect estimates were computed using linear predictions at the mean and ± 1 SD of MVPA if the interaction term was p<0.10.

Results:
Participants were 58% female, 40% black, and 45.3 ± 3.5 years of age at baseline. Contrary to our hypothesis, race discrimination was not significantly associated with health markers in Black or White participants. Significant interactions are presented in the
Figure
. Among Black participants, high discrimination was associated with higher HbA1c at higher MVPA (+1 SD) only.

Conclusions:
Perceived race discrimination was not associated with cardiometabolic health among Black or White participants though associations with HbA1c among Black participants may depend on MVPA levels in an unexpected direction. Future studies should further examine MVPA and additional factors which may be related to the health effects of discrimination among minoritized groups.
Abstract P132: Application of Life’s Essential 8 to Assess the Status of Cardiovascular Health Among 4-to-6-year-old Children in the Healthy Start Study
Authors: Perng Wei , Aris Izzuddin , Sauder Katherine , Dabelea Dana
Published: March 2023

Introduction:
The American Heart Association recently put forth the Life’s Essential 8 (LE8) scoring system to assess cardiovascular health (CVH) status based on four health factors: body mass index [BMI], fasting glucose, non-high-density-lipoprotein cholesterol, and blood pressure; and four behavioral factors: first- and second-hand nicotine exposure, diet quality, physical activity, and sleep duration. Few studies have applied LE8 to assess CVH in children, and little remains known about concordance in CVH status based on LE8 vs. Life’s Simple 7 (LS7), the prior scoring system that employed different definitions and thresholds for defining CVH.

Objectives:
(1) Apply LE8 to assess prevalence (%) of low, moderate, high, and optimal CVH in diverse 4-to-6-year old children; (2) Compare concordance in CVH status categories based on LE8 vs. LS7.

Hypothesis:
Use of LE8 will yield at least 20% prevalence of high and optimal CVH; this prevalence will be higher than estimates based on LS7.

Methods:
Using data from 305 children in the Healthy Start cohort, we applied the LE8 scoring system to derive a composite CVH score for each child and estimated % low (LE8 CVH score <50 of 100 possible points), moderate (score 50-<80), high (score 80-<100), and optimal CVH (score=100). Next, we applied the LS7 scoring system to estimate % of participants in the same four categories (low CVH: LS7 CVH score <7 of 14 possible points; moderate CVH: score 7-<10.5; high CVH: score 10.5-<14; optimal CVH: score=14). Finally, we assessed concordance in prevalence across CVH status categories for LE8 vs. LS7 using the Wald chi-squared test, and calculated the correlation between continuous CVH scores based on LE8 and LS7.

Results:
The average age of participants was 4.7±0.6 y. Forty-five percent were female (n=136); 62% identified as white, 23% as Hispanic, and 12% as Black. No children had low or optimal CVH with either scoring system. However, prevalence of high CVH was higher based on LE8 than LS7 (40.6% vs. 33.4%;
P
<0.0001). Twenty-one percent of participants had high CVH according to both scoring systems. We observed a moderate positive correlation (Pearson R
2
=0.55) between continuous CVH scores for LE8 and LS7.

Conclusions:
While no participants had low or optimal CVH in Healthy Start during early childhood, LE8 yielded a higher prevalence of high CVH than LS7. Future studies are warranted to assess determinants and consequences of CVH status during this life stage.
Abstract P167: Residential Exposure to Greenness and Mortality Following Percutaneous Coronary Intervention
Authors: Ashri Saar , Cohen Gali , Golan Lihi , Broday David , Steinberg David M , Shafran-Nathan Rakefet , Witberg Guy , Bental Tamir , Keinan-Boker Lital , Moran Mika , Kornowski Ran , Gerber Yariv
Published: March 2023

Background:
Evidence regarding environmental exposure to green spaces and outcomes in coronary disease patients is lacking. We evaluated the association between residential exposure to greenness and mortality in patients undergoing percutaneous coronary interventions (PCI).

Methods:
Consecutive patients undergoing PCI at the Rabin Medical Center in Israel between 2004-2014 (n = 12,104) were studied. Clinical data at the time of hospitalization were extracted from medical records. Mortality data (through 2017) were obtained from the Ministry of Health. Patients with incomplete information on residential addresses were excluded. Exposure to greenness was estimated using normalized difference vegetation index (NDVI), a satellite-based index derived from Landsat 30 m spatial resolution imagery, with larger values indicating higher levels of vegetative density. NDVI was estimated within a buffer of 300 m around each patient’s home and as the point value of each 30 m pixel (immediate living environment). Additional residential-based environmental measures were obtained. Cox models assessed the hazard ratios (HRs) for mortality associated with greenness measures.

Results:
Among 11,262 patients analyzed [median age, 69 (IQR 61-78) y, 24% women], median NDVI-300 was 0.15 (IQR 0.13-0.17) and median NDVI-30 was 0.14 (IQR 0.11-0.17). Patients with higher NDVI-300 were slightly older; NDVI-30 was inversely correlated to ambient air pollution. During a median follow-up of 8.1 (IQR 5.1-10.6) years, 3,217 participants died. After adjustment for sociodemographic and clinical factors, NDVI-30 -but not NDVI-300- was associated with lower mortality (Figure), with an HR of 0.96 (95% CI: 0.92-0.99) per 1 SD increase.

Conclusions:
In this PCI registry, residential exposure to green spaces in the immediate living environment was associated with lower mortality. Results for the extended area of the living environment were inconclusive. This inconsistency between different spatial resolutions warrants further investigation
Abstract P173: Proteomic Assessment of Progressive Chronic Renal Insufficiency Risk and Mortality in a Heart Failure Community Study
Authors: Shearer Joseph J , Limonte Christine P , Kuku Kayode O , Joo Jungnam , Larson Nicholas B , Bielinski Suzette J , Roger Veronique L
Published: March 2023

Introduction:
Over six million U.S. adults have heart failure (HF). Evaluation of kidney function is critical to the care of patients with HF but may not be fully captured by traditional measures, such as estimated glomerular filtration rate (eGFR) or the Meta-Analysis Global Group in Chronic HF (MAGGIC) risk score. Identifying patients at highest risk of progressive chronic renal insufficiency (PCRI) may improve risk stratification in HF, beyond these traditional measures. High-throughput proteomics has allowed for the development of PCRI risk scores based on novel kidney function biomarkers. However, the prognostic value of a proteomic-based PCRI risk score in HF has not been explored.

Hypothesis:
Proteomic-based PCRI risk scores will improve risk stratification in HF.

Methods:
Clinical data and plasma were collected from 1,389 patients in a HF community cohort from Southeastern Minnesota (2003-2012). Results from the aptamer-based technology SomaScan® were used to derive PCRI risk scores using the SomaSignal™ Kidney Prognosis test, a protein-based algorithm developed to predict risk of PCRI within four years. Cox proportional hazard models were used to estimate the association between quintiles of PCRI and mortality, after adjustment for the MAGGIC score.

Results:
PCRI risk scores were available for 1,349 patients who were on average 75±13 years of age, 48% female, and had a median eGFR of 57 mL/min/1.73m
2
. There was a positive association with mortality across PCRI risk quintiles, after adjustment for the MAGGIC score. (Figure). Overall, the highest quintile was associated over a two-fold higher risk of mortality compared with the lowest quintile (HR 2.3, 95% CI 1.8,2.8). The higher risk of mortality remained in analyses stratified by patients with (HR 1.5, 95% CI 1.1,2.1) and without (HR 2.2, 95% CI 1.4,3.5) an eGFR <60 mL/min/1.73 m
2
.

Conclusions:
In this community HF cohort, proteomic-based PCRI risk scores improve risk stratification, independent of traditional measures of kidney function.
Abstract P178: Incremental Value of Charlson Comorbidity Index Over Disease-Centric Score in Heart Failure
Authors: Kuku Kayode O , Conners Katie , Shearer Joe , Joo Jungnam , Bielinski Suzette J , Larson Nicholas B , Roger Veronique L
Published: March 2023

Introduction:
Heart Failure (HF) is a syndrome of high comorbidity and mortality. The impact of comorbidities on life expectancy in HF is well studied, but guideline-recommended disease-centric risk scores such as the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) score may not fully account for the effect of comorbidities. The Charlson Comorbidity Index (Charlson) is a validated measure that quantifies the prognostic impact of comorbidities.

Objective:
To examine the incremental value of Charlson over MAGGIC in predicting death in HF.

Methods:
In a population-based HF cohort, we computed MAGGIC and Charlson scores using electronically linked medical records. Patients were divided based on ejection fraction (EF) into reduced [EF <50%, HFrEF] or preserved [EF ≥50%, HFpEF]. Cox regression was performed to assess the association between the risk scores and mortality. The incremental value of Charlson over MAGGIC was tested by calculating the area under the ROC [receiver operating characteristic] curves (AUCs) with 95% confidence interval (CI).

Results:
We studied 1,388 patients with HF validated using the Framingham criteria (mean age, 75±13 years, 48% female, mean EF, 49±17%). The median Charlson was 7.0 (interquartile range 5.0-9.0) and was higher in HFpEF than HFrEF (7.0 [5.0-9.0] vs. 6.0 [4.0-8.3] respectively. Over a median follow-up of 13.9 years (13.3-14.2), mortality was 17.4% (95% CI, 15.4 -19.3%) and 36.8% (95% CI, 34.2-39.3%) at 1, and 3 years respectively. In regression analysis, increasing MAGGIC and Charlson were independently associated with death (HR 1.09, 95% CI 1.08-1.11 and HR,1.22, 95% CI 1.20-1.24, both p <0.001) irrespective of EF. Discrimination ability was improved by adding Charlson over MAGGIC (Table), reaching statistical significance at 3 years.

Conclusion:
In this HF cohort, the Charlson index provided an added value over MAGGIC in predicting the risk of death at 3 years. These findings emphasize the importance of accounting for comorbidities in mid-term risk stratification in HF.
Abstract P187: Qualitative Description of Physical Activity Perceptions and Experiences in Older Adults With HIV
Authors: Fridah Harriet , Cook Paul F , Erlandson Kristine , Jankowski Catherine , Oliveira Vitor , Horvat Davey Christine , Do Hoai , Khuu Vincent , McKiddy Sarah , Webel Allison R
Published: March 2023

Background:
The benefits of physical activity, and specifically exercise, among older adults are well known. Yet, globally there is concern regarding limited engagement in physical activity and rising cases of obesity and frailty among older people with HIV (PWH). We explored the experiences and perceptions of PWH enrolled in the High-intensity Exercise study to Attenuate Limitations and Train Habits (HEALTH) study.

Methods:
Thirty-two participants were enrolled between February 2021 and August 2022. We conducted in-depth interviews among sedentary, older PWH in the ongoing HEALTH (NCT04550676) study. A semi-structured interview guide was informed by the two minds theory, which frames behavior change as an intention-behavior gap between two neurocognitive systems. The intuitive system, described as immediate or first reactions, optimizes behavior based on its expected consequences at the moment, whereas the narrative system produces beliefs about possible behavior in the future sequentially and thoughtfully. Interviews explored general exercise perceptions, self-efficacy for exercise, mobile health intervention tailoring, outcome expectations and goals for physical activity. Interviews were transcribed verbatim, and a three-member study team employed deductive and inductive thematic analysis using Dedoose. The sample size provided sufficient data to reach saturation.

Results:
Physical activity was perceived as the ability to maintain daily living activities and address health goals such as becoming and maintaining physical fitness. Previous experiences with physical activity varied among participants and were influenced by chronic illnesses, motivation and interest in physical activity, and availability of social support. Congruent with the two-minds theory, participants reported intuitive-level experiences as barriers to physical activity. These include antiretroviral side effects, lack of self-confidence, and aging. COVID-19 was also noted as a significant barrier. Consistent with the narrative system, participants identified changes in health status, feeling better and having improved sleep, body changes (e.g., weight loss), and changes in relationships as reasons for and benefits of physical activity. Additionally, most participants reported lifestyle changes such as quitting substance use, diet changes, and changes to their social network, all of which helped sustain their increased physical activity. PWH felt that conversations with their healthcare providers supporting their exercise goals was critical to helping them engage in physical activity, but was rarely received.

Conclusion:
Understanding how older PWH experience and perceive physical activity is critical to developing tailored strategies and structuring service delivery within the healthcare setting to improve health by supporting a physically active life.
Abstract P193: Sexual Minority Men of Color With HIV Suggest a Virtual Environment May Be Promising to Support Cardiovascular Health: Findings From an Intervention Mapping Study
Authors: Ramos S. Raquel , Boateng Maame-Owusua , Chin Lauren , Parrilla Jon Andre Sabio
Published: March 2023

Introduction:
Black and Latinx sexual minority men are disproportionately impacted by chronic conditions, such as HIV. Persons with HIV have a 1.5 to 2 times risk of cardiovascular disease (CVD) when compared to White, HIV-negative persons. By the year 2030, it is estimated that 78% of persons with HIV will have CVD. Patient teaching in the clinical setting has been the traditional modality for prevention education. However, persons at the highest risk, and who are based in the community, may not have access to clinic-based prevention education.

Objective:
To use mixed methods to assess HIV illness perceptions, HIV-related comorbid conditions of concern, and understand perspectives on the use of an online virtual environment (VE) for CVD prevention education.

Methods:
The Gaming Protocol Study is a mixed methods study that used Life’s Simple 7 as a framework to map an intervention to support cardiovascular health in sexual minority men of color with HIV, ages 30-65. Data were collected in English, Spanish, and Creole. Using validated measures, HIV illness perceptions, nicotine exposure, and physical activity were assessed. Qualitative interviews explored chronic illnesses of concern outside of HIV and also perceptions about the use of an online VE for CVD prevention education.

Results:
Thirty participants completed the validated measures and interviews. Quantitative findings suggested that greater than 90% of participants had a strong understanding of their HIV status. More than 50% of participants reported they experienced feelings of anxiety or fear by having HIV. Close to 30% reported having used nicotine and/or e-cigarettes. Less than half of participants met the criteria for engaging in vigorous or moderate physical activity. Qualitative findings suggested concerns about existing and potential future conditions, such as hypertension, diabetes, asthma, obesity, and mental health. Additionally, COVID-19 and Monkeypox were highlighted as important considerations because they pose high risk in the community. Perceptions about using a VE were mostly positive. Concerns were focused on online engagement and digital privacy.

Conclusions:
Sexual minority men of color are concerned about health conditions beyond HIV. They desire accessible, culturally relevant information to manage their health. Findings provide early evidence about health communication and education preferences for technology tools so they are meaningful and actionable as CVD prevention education.
Abstract P201: Plasma Proteomic Signatures of Angptl3/8 and 4/8 Before and After Exercise Training
Authors: Miranda-Maravi Sebastian , Hoffman William G , Dev Prasun K , Barber Jacob L , Schwartz Charles S , Clarkson William A , Robbins Jeremy M , Rao Prashant , Mi Michael , Ghosh Sujoy , Clish Clary , Silbernagel Gunther , Chen Yan Q , Konrad Robert J , Bouchard Claude , Gerszten Robert E , Sarzynski Mark A
Published: March 2023

Introduction:
Angiopoietin like protein (ANGPTL) complexes 3/8 and 4/8 are established inhibitors of lipoprotein lipase and modifiable by regular exercise. However, the molecular biomarkers related to their exercise responses have not been fully elucidated. The purpose of this study was to examine the associations between plasma proteins and ANGPTL3/8 and 4/8 before and after exercise training.

Methods:
Measurements were taken before and after 20 weeks of exercise training in 630 adults (36% Black, 56% women, mean age 35 yrs) of the HERITAGE Family Study. Meso Scale Discovery immunoassays were used to measure ANGPTL3/8 and ANGPTL4/8 complexes in serum. Plasma proteins (n=4979 aptamers) were quantified using SomaScan. Linear mixed models tested the association between plasma proteins and each trait at baseline and post- training with full covariate adjustment. Significance was set to FDR<0.05.

Results:
A total of 862 and 126 proteins were significantly associated with ANGPTL3/8 at baseline or post-training, respectively, with 80 proteins associated at both time points, including PCSK9 and PLTP (
Figure 1A
). Conversely, 46 proteins were only associated with ANGPTL3/8 at post-training, 23 of which whose levels significantly changed with training including NRP1, ghrelin, HHIP, and APOA1. A total of 433 and 71 proteins were significantly associated with ANGPTL4/8 at baseline or post-training, respectively, with 46 proteins associated with both time points (
Figure 1B
). A total of 25 proteins were only associated with ANGPTL4/8 at post-training, 12 of which whose levels significantly changed with training including ghrelin, COL6A2, and MMP16.

Conclusions:
We identified a subset of proteins uniquely associated with exercise-induced changes in ANGPTL3/8 and 4/8. Thus, the responsiveness of ANGPTL3/8 and 4/8 to regular exercise may be related to cholesterol esterification, lipoprotein remodeling, inflammatory response, and regulation of fibrinolysis and coagulation among other biological pathways.
Abstract P205: Association of Angptl3/8 and 4/8 With Plasma Metabolites Before and After Exercise Training
Authors: Dev Prasun K , Miranda-Maravi Sebastian , Hoffman William , Barber Jacob L , Schwartz Charles S , Clarkson William A , Robbins Jeremy M , Rao Prashant , Mi Michael , Ghosh Sujoy , Ghosh Sujoy , Clish Clary , Silbernagel Gunther , Chen Yan Q , Konrad Robert J , Bouchard Claude , Gerszten Robert E , Sarzynski Mark A
Published: March 2023

Introduction:
Angiopoietin like protein (ANGPTL) complexes 3/8 and 4/8 are established inhibitors of lipoprotein lipase and modifiable by regular exercise. However, the molecular underpinning of these novel biomarkers has not been fully elucidated. The purpose of this study was to examine the associations between plasma metabolites and ANGPTL3/8 and 4/8 before and after exercise training.

Methods:
Measurements were taken before and after 20 weeks of exercise training in 630 adults (36% Black, 56% women, mean age 35 yrs) of the HERITAGE Family Study. Meso Scale Discovery immunoassays were used to measure ANGPTL3/8 and 4/8 in serum. Plasma metabolites (n=300 named) were measured using LC-MS and the HILIC-pos method. Linear mixed models tested the association between metabolites and each trait at baseline and post-training with full covariate adjustment. Significance was set to FDR<0.05.

Results:
A total of 111 and 93 metabolites were significantly associated with ANGPTL3/8 at baseline or post-training, respectively (
Figure 1A
). A total of 69 metabolites were associated with ANGPTL3/8 at both time points, including ketone bodies, acylcarnitines, and DMGV, while 24 metabolites were only associated at post-training including citric acid, methionine, and glycine. A total of 89 and 40 metabolites were significantly associated with ANGPTL4/8 at baseline or post-training, respectively (
Figure 1B
). A total of 13 metabolites were associated with ANGPTL4/8 at both time points including glycine and lysophospholipids, whereas 27 metabolites were associated only at post-training including hydroxyproline, N-Lignoceroyl Taurine, and methylguanidine.

Conclusions:
We identified several plasma metabolites associated with ANGPTL3/8 and 4/8 before and after exercise training. Our findings indicate potential metabolic pathways related to the exercise responsiveness of ANGPTL3/8 and 4/8, including glucose-alanine cycle, urea cycle, and glycine and methionine metabolism.
Abstract P221: Intake of Ultra-Processed Foods in Relation to Cardiovascular Disease Incidence in US Men and Women With Diabetes Mellitus
Authors: Chen Zhangling , Drouin-chartier Jean-Philippe , Khandpur Neha , Hu Yang , Rossato Sinara , Manson Joann E , Rimm Eric B , Hu Frank , Sun Qi
Published: March 2023

Introduction:
Recent evidence suggests that intake of ultra-processed foods (UPF) is related to unfavorable cardio-metabolic risk profiles among generally healthy populations. However, evidence on the relationship between UPF intake and cardiovascular disease (CVD) among patients with type 2 diabetes (T2D) is lacking.

Hypothesis:
We assessed the hypothesis that higher intake of dietary UPF is associated with higher risks of CVD among individuals with T2D.

Methods:
We prospectively followed 13,272 men and women participating in the Health Professionals Follow-Up Study (HPFS) and Nurses’ Health Study (NHS) with T2D at baseline and during follow-up (HPFS: 1986-2018; NHS: 1980-2014). Diet was repeatedly assessed using validated food frequency questionnaires every 2-4 years. UPF were categorized according to the Nova classification. CVD was defined as fatal and non-fatal coronary heart disease (CHD) (including nonfatal myocardial infarction, coronary artery bypass graft surgery, and coronary angioplasty and stent) and fatal and non-fatal stroke. Associations of UPF consumption with risks of CVD were assessed using Cox regression.

Results:
During 165,761 person-years of follow-up, 1,826 total CHD and 529 total stroke were identified and confirmed. After adjusting for demographics, lifestyle, medical history, dietary factors, and diabetes medication use, higher total intake of UPF was associated with higher risk of CHD. The multivariable-adjusted HRs (95% CIs) were 1.20 (1.02, 1.43) (

P
trend

= 0.03) when comparing the highest and lowest quintiles (Q5 vs. Q1) or 1.03 (1.01, 1.04) for each 1 serving/day increment of UPF. No association between UPF intake and risk of stroke was observed (Q5 vs. Q1: 0.92 (0.67, 1.24)). These results were consistent across subgroups in analyses stratified by age, sex, BMI, diet quality, physical activity, smoking, diabetes medication use, or diabetes duration. In addition, compared with participants who had a stable or decreased consumption of UPF (≤0 change in UPF) from pre- to post-diabetes diagnosis, participants who increased consumption of UPF (>0 increment of UPF intake) after diabetes diagnosis had a 15% (1%, 31%) higher risk of CHD.

Conclusions:
Among participants with T2D, higher dietary UPF consumption was associated with a higher risk of CHD, but not stroke. These results provide further support for the current recommendations to limit UPF consumption for the prevention of CHD among patients with diabetes.
Abstract P222: Consuming a Vegan Diet Compared to Omnivore Diet Leads to No Significant Changes in Serum TMAO, Fasting Glucose, Insulin, or Vitamin B12: The Twins Nutrition Study (TwiNS) Randomized Controlled Trial
Authors: Ward Catherine P , Landry Matthew J , Gardner Christopher D
Published: March 2023

Introduction:
Vegan diets are often encouraged for a myriad of health reasons, traditionally for control of blood lipid, cholesterol, and lipoprotein values. We proposed looking at other markers of health, including serum trimethylamine N-oxide (TMAO), fasting glucose, fasting insulin, or vitamin B12 in identical twins assigned to either a vegan or omnivore diet.

Hypothesis:
We hypothesized that the healthy vegan diet would lead to lower TMAO, fasting glucose, and fasting insulin (better), and lower vitamin B12 (worse) than the healthy omnivore diet.

Methods:
Identical twins were recruited and randomized to a healthy vegan or healthy omnivore diet. All twins consumed an omnivorous diet before enrollment. Meals were provided via a meal delivery service from baseline through week 4, with participants supplementing the delivered meals with their own diet adherent snacks. For delivered meals, both the healthy vegan and healthy omnivore diets were designed to consist of whole grains, legumes, and produce, with the main difference being omnivore diets provided ~1/3 of energy intake from animal-sourced foods. Participants prepared their own meals and snacks from weeks 5-8. Participants received nutrition education at baseline via orientation and were encouraged to choose “healthy” snacks, which for those on the vegan diet included legumes, nuts, seeds, and produce, and for those on the omnivore diet included dairy, nuts, seeds and produce. To assess compliance and intake, 24-hour dietary recalls were taken at weeks 0, 4, and 8. Clinical labs were collected at baseline, week 4, and week 8 through Stanford Medicine and analyzed both onsite and at Washington University St. Louis.

Results:
No significant differences between baseline and 4 or 8 weeks were seen in serum TMAO, fasting glucose, fasting insulin, or vitamin B12 between vegan and omnivorous twins (n=44).

Conclusions:
Vegan diets are often encouraged for their health promoting benefits; however, a healthy omnivorous diet can lead to comparable clinical lab outcomes.

Funding:
This study was supported by a generous donor, by the National Heart, Lung, and Blood Institute (NIH 5T32HL007034), and the Stanford Clinical and Translational Science Award (NIH UL1TR001085).
Abstract P231: Physical Activity During Adolescence and Adulthood Associated to Risk of Diabetes in Mexican Women
Authors: Martinez Claudia F , Mattei Josiemer , Cortés Adrián , Lajous Martin
Published: March 2023

Background:
Mexico has declared an epidemiological emergency in the country due to diabetes. Although the benefits of physical activity in middle age are established, the health effects of long-term changes in PA from adolescence to middle age have not been documented. Our aim is to explore the pattern of vigorous physical activity (VPA) in adolescence and adulthood and the risk of DM2 in a cohort of middle-age women.

Methods:
The Mexican Teacher′s Cohort (MTC) is an ongoing study of 115,307 public school teachers. Every three years participants answered sociodemographic, lifestyle, and medical conditions, including self-reported IPA(hours/wk) for age 15 to18 years, and at the previous year of baseline. Cases of diabetes were identified and validated through electronic health records. We estimated Hazard ratios and IC95% intervals. Based on VPA in adolescence and adulthood respectively, women were classified as: consistently inactive (reference), consistently lower activity, low active in adolescence but increase in adulthood, active in adolescence but reduced in adulthood, and consistently higher. To explore recall bias we performed analyzes stratified by age.

Results:
in a sample of 69,970 women with 41.6 ± 7.3 years of age at enrolment, we identified 4,564 DM cases from 2006-2008 to 2019. Compared with participants who were consistently inactive in both stages, women who increase activity had a lower risk of DM; HR = 0.86 (95% CI 0.74, 1.01). Compared with the reference category, maintaining higher amounts of VPA was associated with lower diabetes risk HR = 0.85, (95% CI 0.75, 0.96). In stratified analyses by age, we observed the same association even in people who reported physical activity up to 35 years before the reference questionnaire.

Conclusions:
Maintaining higher VPA levels during adolescence and adulthood and increasing VPA in adulthood were associated with a similar low risk of diabetes.
Abstract P234: Associations Between Sedentary Time With Physical Activity and Sarcopenia in the Oldest-Old Adults: The Health, Aging and Body Composition (Health ABC) Study
Authors: Bajpai Shivangi , Eberl Eric M , Shiroma Eric J , Simonsick Eleanor , Paluch Amanda E
Published: March 2023

The oldest-old adults (aged 80+ years) are most impacted by sarcopenia, a progressive loss of muscle mass, muscle strength, and physical performance. Physical activity (PA) can slow progression of sarcopenia. However, this population is highly sedentary due to physical limitations and comorbidities. Replacing sedentary time (ST) with light-intensity physical activity (LPA) or small amounts of moderate to vigorous activity (MVPA) may be beneficial and feasible. We hypothesized that replacing ST with LPA or MVPA would be associated with a lower likelihood of developing sarcopenia.

Methods:
We used cross-sectional data (n=155, age 88.3±2.6 years) collected at the year 16 visit (2012-2014). Participants wore a hip-worn ActiGraph GT3X+ during waking hours for 7 days. Physical behaviors were quantified as minutes per day (min/d) in ST (0-99 counts per minute, cpm), low LPA (100-759 cpm), High LPA (760-1040 cpm), and MVPA (1041+ cpm). We defined probable sarcopenia using hand-grip strength cut points (males <27 kg; females <16 kg). Logistic regression and isotemporal substitution models were used to calculate odds ratios (OR) and 95% confidence intervals (95% CIs). Isotemporal substitution estimated the hypothetical effect of substituting ST with one standard deviation (SD) of respective PA categories.

Results:
MVPA was associated with lower odds of probable sarcopenia in the single model (OR=0.50, 95% CI: 0.27-0.83) and partition model (OR=0.35, 95% CI:0.15-0.83). In the substitution model, replacing ST with 13 min/d (1 SD) of MVPA was significantly associated with lower odds of probable sarcopenia (OR = 0.35; 95% CI: 0.15 - 0.83). There were no significant associations with LPA (Table 1).

Conclusion:
Findings suggest that even a modest increment of time spent in MVPA could reduce the likelihood of developing sarcopenia. Alternatively, findings could reflect the impact of sarcopenia on capacity to engage in MVPA. Confirmation of the direction of the association will require examination of these relationships over time.
Abstract P235: The Association Between Neighborhood Walkability and Physical Activity in a Behavioral Weight Loss Trial Testing the Addition of Remotely Delivered Feedback Messages to Self-Monitoring
Authors: Kariuki Jacob K , Bizhanova Zhadyra , Conroy Molly , Burke Lora E , Cheng Jessica , Beatrice Britney , Sereika Susan M
Published: March 2023

Background:
Adding feedback messages (FB) to self-monitoring (SM) may reinforce behavior change. However, socio-environmental conditions (e.g., limited access to parks and low walkability) may limit one’s ability to respond to FB focused on physical activity (PA).

Hypothesis:
Residents of high walkability neighborhoods will achieve higher PA levels at 12 months than those in low walkability neighborhoods regardless of whether FB was randomly assigned.

Methods:
This is a secondary analysis of a 12-month behavioral weight loss trial, where adults with overweight or obesity were randomized to SM+FB (n=251) or SM alone (n=251). The SM+FB group received a smartphone pop-up message every other day tailored to their PA data. Assessment included neighborhood walkability via Smart Walk Score (low [<50] vs. high [≥50]), moderate to vigorous PA (MVPA) minutes and step count via Fitbit Charge 2™, and weight via digital smart scales. We report adjusted regression coefficients (b) with 95% confidence intervals from linear mixed modeling. To normalize the residual distribution, we applied a natural log transformation (ln) to MVPA.

Results:
Participants (N=502) were primarily white (82.5%), female (79.5%), well-educated (16.4±2.8 years), mean age of 45±14.4 years with a body mass index (BMI) of 33.10±3.93 kg/m
2
. Compared to those from neighborhoods with high walkability, participants from neighborhoods with low walkability were more likely to be White (75.3% vs. 87.8%,
P
==.0003) and older (41.4±14.7 vs. 47.7±13.6 years,
P
<.0001) at baseline. After adjusting for these characteristics, baseline BMI and exercise self-efficacy, neighborhood walkability did not moderate the effect of treatment assignment on lnMVPA (b±SE=-0.20±0.15,
P
=.170) or steps (b±SE=-816.48±484.83,
P
=.092) over 12 months. lnMVPA (b±SE=0.12±0.10,
P
=.244) and steps (b±SE=415.05±344.50,
P
=.228) were on average similar between walkability groups. Both lnMVPA (b
6mo
±SE=0.003±0.07,
P
=.968; b
12mo
±SE=-0.23±0.08,
P
=.009) and steps (b
6mo
±SE=-416.18±195.68,
P
=.034; b
12mo
±SE=-1443.75±227.49,
P
<.0001) declined over time. On average, the SM+FB group had greater lnMVPA (b±SE=0.23±0.12,
P
=.047) and marginally greater number of steps (b±SE=674.84±392.91,
P
=.086) than SM group. There were no significant interactions for group and time or group, time, and walkability (
P
≥.05).

Conclusion:
On average, FB had a small but significant positive impact on PA over 12 months, but neighborhood walkability did not moderate the treatment effect of FB on PA. The small effect of FB on PA may have limited our ability to detect moderation of neighborhood walkability on the treatment effects of FB on PA. Future studies need to replicate this analysis in a trial with larger treatment effects and a more diverse sample.