bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P080: Glucose Homeostasis, Diabetes, and Orthostatic Hypotension in a Community-based Population: The ARIC Study
Authors: Juraschek Stephen P , Daya Natalie , Sharrett A. Richey , Selvin Elizabeth
Published: July 2021

Background:
Although orthostatic hypotension (OH) screening is recommended for adults with diabetes, the extent to which blood glucose (BG) levels are associated with OH has not been characterized.

Hypothesis:
Higher BG levels are associated with having OH, while low levels of BG are not associated with OH.

Methods:
We examined the cross-sectional association of OH with BG and diabetes status in middle-aged (range 44 to 66 yrs) ARIC participants (1987-1989). OH was defined as a drop in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) within 2 min of standing, when transitioning from the supine to standing position. Using logistic regression, we examined the association of the following 5 categories of BG without diabetes or diabetes and OH: (1) low-normal BG (fasting BG <80 or non-fasting BG <100 mg/dL), (2) high-normal BG (fasting BG of 80-99 or non-fasting BG of 100-139 mg/dL), (3) pre-diabetes (fasting BG of 100-125 or non-fasting BG of 140-199 mg/dL), (4) undiagnosed diabetes (fasting BG ≥126 or non-fasting BG ≥200 mg/dL), or (5) diabetes (self-reported diagnosis or current medication use). We also modeled BG as a continuous variable by diabetes status, using restricted cubic splines to characterize the association between BG level and OH.

Results:
In 12,636 participants (mean age 54.6 ± 5.7 yrs, 55% women, 26% black), 4.3% had OH at baseline. The mean BG was 108 ± 38 mg/dL; 7% had diabetes (self-reported diagnosis or diabetes medications). After adjustment, adults with low BG (group 1) or diabetes (group 5) were both more likely to have OH compared to the normal BG group (group 2) with ORs of 2.15 (95% CI: 1.26, 3.65) and 2.20 (95% CI: 1.65, 2.92), respectively. Continuous characterization of the relationship between BG and OH was U-shaped for participants with or without diabetes (
Figure, panels A&B
).

Conclusions:
Low BG in adults without diabetes, diabetes, and high BG in adults with diabetes were associated with OH. This suggests a more prominent role for BG homeostasis in blood pressure stabilization with standing.
Abstract P089: Fitness and Fatness Are Both Associated With Cardiometabolic Health in 8-10 Year Old New Zealand Children
Authors: Stoner Lee , Castro Nicholas , Skidmore Paula , Lark Sally , Faulkner James , Williams Michaelle
Published: July 2021

Introduction:
In adults, low cardiorespiratory fitness (CRF) and overweight-obesity are associated with greater cardiometabolic disease risk. However, the association between measures of CRF and overweight-obesity upon cardiometabolic risk in youth, particularly pre-adolescents, is less clear. Further, previous studies in children have predominantly examined the relationships between CRF and overweight-obesity upon individual cardiometabolic risk factors. The clustering of cardiometabolic risk factors has been recognized for over two decades, including in young children.

Hypothesis:
We tested the null hypothesis of no association between clustered cardiometabolic risk factors and high CRF or overweight-obesity.

Methods:
This cross-sectional study recruited 392 children (50% F) aged 8-10 years from three representative sample sites across New Zealand. Overweight-obesity was classified according to 2007 WHO criteria for Body Mass Index. CRF was estimated using a shuttle run test, and high CRF was categorized as a maximum oxygen uptake exceeding 35 ml/kg/min in girls, and 42 ml/kg/min in boys. Eleven traditional and novel cardiometabolic risk factors were measured: peripheral blood pressures, central systolic blood pressure, heart rate, augmentation index, fasting total cholesterol, high density lipoproteins, low density lipoproteins, triglycerides, serum glucose, and glycosylated haemoglobin. Principal component analysis identified underlying cardio-metabolic factors, and a 2-way (high fitness, overweight-obese) analysis of co-variance was used to determine associations between cardio-metabolic risk factors with fitness and overweight-obesity. Covariates were: age, sex, ethnicity, socio-economic status.

Results:
Principle component analysis revealed four underling factors: blood pressure, cholesterol, vascular, and carbohydrate-metabolism. Using these factors, a cumulative risk score was also calculated. Only high CRF (P=0.001, Eta=0.028) was significantly associated with the blood pressure factor. Only overweight-obesity associated with vascular (P=0.010, Eta=0.018) and carbohydrate-metabolism (P=0.005, Eta=0.021) factors. Neither high fitness (p=0.728) nor overweight-obesity (P=0.121) significantly associated with cholesterol. For the cumulative risk score, there was an interaction effect (P=0.038, Eta=0.012). High CRF improved cardiometabolic risk in overweight-obese children (P=0.006, Eta=0.02), but not in normal weight children. Conversely, being overweight-obese increased cardiometabolic health risk in children with low fat levels (P<0.001, Eta=0.039), but not in high fit children.

Conclusions:
In pre-adolescent children, fitness and fatness associate with different cardio-metabolic risk. With regards to overall cardio-metabolic risk, high fitness may protect against overweight-obesity.
Abstract P090: Health Informatics Approach to Investigation of Hyperlipidemia in Families
Authors: Pyles Lee A , Joseph Amy P , Armistead Matthew , Lilly Christa I , Cox Jeff , Denney Michael , Neal William A , Mullett Charles J
Published: July 2021

Introduction:
West Virginia exhibits pervasive cardiovascular disease (CVD) that may relate to a combination of ancestry and shared environment in families, including vulnerabilities related to diet, physical activity and tobacco use. Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) is a school-based child risk factor screening program that has evaluated over 90,000 WV fifth graders in the past 20 years. Reverse Cascade screening for Familial Hypercholesterolemia (FH) has been difficult with the CARDIAC population. The WVU CTSI Integrated Data Repository (IDR) includes over 2 million records.

Hypothesis:
Linkage of child CARDIAC data to parent IDR data will allow new information discovery to inform management of CVD.

Methods:
We used direct demographic data linkage via Oracle with Soundex conversion of names, in the IDR, to find parents of the CARDIAC participants. Data was analyzed in the VMWare SSL environment.

Results:
4759 children have a parent(s) identified. 959 mothers and 524 fathers have an LDL level from IDR. Race, BMI and gender was recorded from CARDIAC. 6.8 % of children, 40% of mothers and 44.8% of fathers have an abnormal LDL level >130 mg/dl in IDR. Positive predictive value of the abnormal child lipid level (≥130 mg/dl) is 17% for some parent (56/325) to be abnormal. 4 parents had LDL >190 mg/dl with child > 160, indicating likely FH in the pair (2.7% of pairs or 1 in 371 pairs).

Conclusion:
Formation of a virtual cohort of CARDIAC children and parents allows Virtual Reverse Cascade Screening to find FH. This project highlights the importance of familial tendency to hyperlipidemia that can aid detection of early lipid abnormality and cardiovascular risk in children and their young parents to promote wellness and potentially avoid early coronary artery disease. We are constructing a virtual longitudinal cohort to study CVD in WV as a part of a Learning Health System in which data management is at the forefront of healthcare improvement.
Abstract P102: Menthol Cigarette Use and Subclinical Cardiovascular Disease in African Americans in the Jackson Heart Study
Authors: White Wendy B
Published: July 2021

Background:
African Americans smoke menthol cigarettes at higher rates than other races and have a disproportionate burden of cardiovascular disease (CVD). Whereas smoking is a well described risk factor for CVD, it is unclear if menthol cigarettes are associated with more or less risk. Therefore, our aim was to evaluate the association between menthol cigarette use and subclinical atherosclerosis in the Jackson Heart Study (JHS).

Methods:
JHS participants (n=5,301) were classified by self-reported smoking status as current, past (smoked ≥400 cigarettes/life), or never smokers at Visit 1 (V1, 2000-2004). Menthol cigarette use data were captured at Visit 3 (V3, 2009-2013). We used multivariable logistic and robust linear regression models to examine the associations between cigarette type and measures of subclinical atherosclerosis [carotid intimal medial thickness (CIMT, Visit 1) and coronary artery calcium (CAC) or aorto-iliac calcium (AIC) by computed tomography (Visit 2, V2, 2005-2008)] to estimate β-coefficients (adjusted differences) comparing menthol to non-menthol (reference group) smoking.

Results:
There were 401 current smokers with available data on cigarette preference including 326 menthol (81%) and 75 non-menthol (19%) smokers at V3. Menthol cigarette preference in current smokers was not associated with significant differences in measures of subclinical atherosclerosis: CIMT (β -0.003, 95% CI -0.053, 0.046, p=0.90); CAC (β -0.20, 95% CI -1.09, 0.69, p=0.66) or AIC (β -0.32, 95% CI -1.23, 0.59, p=0.48).

Conclusion:
Our study provides no evidence for an association of menthol cigarette use with subclinical atherosclerosis in African Americans. These findings warrant replication by studies that address the limitations of this study, including the assumption that menthol smokers in V3 were long-term menthol smokers before V1 and V2, potential selection by exclusions of deaths related to smoking and CVD among participants at V3 and lack of longitudinal data on outcomes after the collection of menthol use data at V3.
Abstract P103: Age Differences in Patterns of Use, Health Knowledge, Perception, and Intention to Quit Among Current E-Cigarette Users
Authors: Vu Thanh-Huyen T , Hart Joy , Walker Kandi , Landry Robyn , Groom Allison , Sears Clara , Tompkins Lindsay , Mattingly Delvon , Kesh Anshula , Giachello Aida , Payne Thomas J
Published: July 2021

Background:
Using electronic nicotine delivery systems (e.g., e-cigarette) or vaping may have negative health effects from the aerosol and product constituents. Though the products are relatively new in the US, the use of e-cigarettes has rapidly increased, especially in younger adults. In this study, we examined age differences in use patterns, reasons for use, health knowledge, e-cigarette perceptions, and quit intentions among current e-cigarette users.

Methods:
The sample was 1,494 current e-cigarette users ages 18-64, drawn from a national adult vaping survey conducted in 2016. Intention to quit was categorized into 3 groups: very likely, moderate, and less likely. Descriptive and multivariate analyses were used.

Results:
The sample included participants in the following age groups: 18-24 (17%), 25-34 (38%), 35-44 (23%), and 45-64 (25%). Main reasons for e-cigarette initiation were as a cigarette alternative, perceived as healthier, and attraction to flavors. Only 4% of the participants reported using e-cigarettes on recommendation from a healthcare professional(s); 66% did not hear/see/read about the health effects of e-cigarettes in the past 3 months. Compared to older groups, the 18-24 age group was less likely to use e-cigarettes as an alternative to cigarettes (33% vs. 40-49%) or on a healthcare professional’s recommendation (2.3% vs. 6.8%), but more likely to vape for reasons such as flavors (44% vs. 20-33%) or friends’ use (18% vs. 4%). The 18-24 age group was also more likely than the oldest age group to use flavored e-liquid other than tobacco flavor (67% vs. 53%), have heard/seen/read information about vaping health effects (41.4% vs. 27%), and believe that vaping has no health benefits (26.1% vs. 16%).(All
P
-values for the above comparisons <.05). With adjustment for sex, race/ethnicity, and education levels, compared to the oldest group, the odds of being very likely to quit e-cigarette use versus less likely to quit in the 18-24 age group were 37% lower (95% CI: 0.41-0.98).

Conclusions:
There were significant age differences in use motivation, usage patterns, receipt of health information, perceived risks, and quit intentions. Public health efforts should increase the accessibility of information on e-cigarette use risks. Different health messaging and communication strategy approaches may be required for varying age groups.
Abstract P109: Racial/Ethnic Disparities in Post-Stroke Disability: A Focus on Outcome Measures
Authors: Burns Suzanne , White Brandi , Magwood Gayenell , Ellis Charles , Logan Ayaba , Buie Joy , Lackland Daniel , Adams Robert
Published: July 2021

Background and Purpose:
Several studies suggest that racial/ethnic minority groups experience worse disability across the course of stroke recovery. However, there is little consistency in the measurement of stroke outcomes, which may contribute to some inconclusive evidence of racial/ethnic disparities in post-stroke disability. The objective of the current review is to examine how stroke outcomes are measured to identify racial/ethnic disparities in disability and functioning among stroke survivors in the US.

Methods:
A review of the literature was conducted to identify outcome measures used in racial/ethnic disparities in post-stroke disability literature, use the International Classification of Functioning, Disability, and Health (ICF) model as a frame of reference for mapping the contents of the identified measures, and evaluate the time points of measured outcomes and racial/ethnic representation. Articles published between January 2001 and July 2017 were identified with our search criteria through Scopus, PubMed, CINAHL, and PsycINFO according to predefined inclusion criteria.

Results:
One hundred and ninety-four articles met inclusion criteria for full-text review and 41 articles were included in the final review. Although we found evidence of outcome measure content aligning with all ICF domains, little research has examined contextual factors in post-stroke disability disparities research. Additionally, we discovered the outcome measures are conducted across stroke recovery trajectories including pre-stroke, acute stroke, early recovery (≤90 days), and long-term (>90 days) but little consistency in outcome measure use was discovered. African American and Hispanic populations were assessed most frequently and minimal studies examined disparities among other minority populations comprising the US (i.e., Asian, Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native).

Conclusions:
A variety of outcome measures have been used to assess disparities in disability across the course of stroke recovery. Yet, the lack of consistency in what outcomes are measured and when specific outcomes are assessed may contribute to mixed findings in the racial/ethnic disparities literature. Additional concerns include the lack of evidence on validity of outcome measures among racial/ethnic minority populations, the lack of representation among all racial/ethnic populations comprising the US, and minimal emphasis placed on the disparities in personal and environmental factors that contribute to disability. This review sheds light on the need for additional disparities in post-stroke disability research focusing on contextual factors and greater representation among less studied populations in the US.
Abstract P113: Predictors and Correlates of Secondhand Smoke in Work Environments Among Rural and Urban American Indians
Authors: Anderson Madison , Widome Rachel , Forster Jean , Rhodes Kristine
Published: July 2021

Objective:
In 2010 nearly 60% of American Indian (AI) adults in Minnesota reported they currently used cigarettes, a prevalence 3.5 times greater than the general population in that region. Here, we aim to describe the prevalence of secondhand smoke exposure and its correlates among Upper Midwest AIs in their homes and at work.

Methods:
Between 2010 and 2012 the American Indian Community Tobacco Project (AICTP) administered the Adult Tobacco Survey in collaboration with seven reservations and three urban communities in Minnesota. Eligible participants (n=2926) answered questions regarding exposure to secondhand smoke.

Results:
A third [33% (347 of 1059), 95% CI (30-36%)] of AIs reported being exposed to smoke in their workplace (compared to the 9% of the general Minnesota population). Half of males [50% (155 of 365), 95% CI (42-58%)] were exposed to secondhand smoke in the workplace, whereas only 27% [188 of 686, 95% CI (26-33%)] of females were exposed to secondhand smoke in the work environment. Of those who work on the reservation, 42% [237 of 570, 95% CI (36-48%)] of AI’s were exposed to secondhand smoke at their workplace. Within AI’s who have never smoked 25% [34 of 134, 95% CI (21-41%)] were still exposed to secondhand smoke within the workplace. Among AI’s who reported smoking policies in the workplace 30% [205 of 671, 95% CI (26-38%)] were exposed to secondhand smoke within the workplace, and 27% [158 of 578, 95% CI (20-30%)] of AI’s who stated their workplace was always enforced were still exposed to secondhand smoke in the workplace. A third [37% (120 of 321), 95% CI (35-54%)] of those who reported not having a workplace policy were exposed to secondhand smoke, demonstrating the need for policy development regarding smoking in the workplace.

Conclusions:
In conclusion, although strong policy protects most Minnesotans from secondhand smoke in workplaces, these policies do not seem to be benefitting AIs in the state. Discovery of who is at greatest risk for secondhand smoke exposure can inform future interventions and inform future policy optimization and protection.
Abstract P118: Differences in Tobacco Use of sexual minorities of Diverse Racial and Ethnic Backgrounds
Authors: Giachello Aida L , Vu Thanh-Huyen T , Hart Joy L , Landry Robyn , Walker Kandi L , Groom Allison , Kesh Anshula , Payne Thomas J , Robertson Rose M
Published: July 2021

Background:
Although studies have found that cigarette smoking is more prevalent among persons who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) compared to persons who identify as heterosexual, limited research has examined tobacco use among LGBTQ individuals of different racial and ethnic backgrounds.

Methods:
During summer 2016, the AHA-Tobacco Regulation and Addiction Center (A-TRAC) Project 3 conducted 27 focus groups and 196 surveys in Chicago, New York City and San Diego with smokers and non-smokers. Study inclusion criteria were self-identifying as LGBTQ and White Non-Hispanic (WNH), African American (AA), or Hispanic/Latino (H/L). Our study aim is to examine potential differences in tobacco use by race/ethnicity and factors that may be associated with such differences. Chi-square tests were used for group comparisons using SAS version 9.4. Atlas ti.v 7.5 software was used for qualitative analyses.

Results:
Study participants were: 23% WNH, 16% AA, and 57% H/L; 60% identified as gay/lesbian, 20% as bisexual, and 20% as members of other groups. Socioeconomic status (SES) of the participants varied by smoking status. More smokers than nonsmokers lived in households with incomes under $20,000/year (50% of smokers vs. 39% of nonsmokers (p.001)) or were unemployed (34% vs. 19% (p.003)). Many participants suggested that easy access to tobacco products (e.g., cigarettes are “cheaper,” “you find single cigarettes sold everywhere") contributed to smoking initiation. Continued tobacco use was often mentioned as a way to deal with stress, such as the stress related to “coming out.” For racial minorities (AAs and H/Ls) compared to NHWs, sources of social stress included discrimination based on race, class, and sexual orientation as well as pressures to respond to community and cultural norms and expectations, such as gender roles (e.g., machismo). AAs and H/Ls also reported more heavy marketing of tobacco in their communities and indicated less knowledge about the risks associated with tobacco use. Racial minorities also expressed preferences for different tobacco products (e.g., cigarettes with menthol) than NHWs.

Conclusion:
Differences in knowledge, attitudes and perceptions related to tobacco use were found among LGBTQ individuals of diverse racial/ethnic backgrounds. These findings have implications for culturally tailoring health communication campaigns and educational programs for LGBTQs, as well as for low SES groups. The findings also suggest the need for additional tobacco regulatory efforts in populations most vulnerable to tobacco marketing.
Abstract P123: Comorbid Conditions May Explain Sex/ Race Disparities in Risk of Pulmonary Hypertension
Authors: Tran H. Nicole , Udaltsova Natalia , Siu Stanton , Darbinian Jeanne , Klatsky Arthur L
Published: July 2021

Background:
Pulmonary hypertension (PH) occurs as a rare idiopathic condition or more often with associated conditions (PH-COMORBID) including sleep apnea, COPD, and venous thromboembolism (VTE). Limited data suggest PH is commoner in women and Blacks, but less common in Asians. The sparseness of systematic epidemiologic studies of PH prompted our study of sex/race disparities and the role of 25 PH-COMORBIDs.

Hypothesis:
Sex/racial differences in PH are due substantially to PH-COMORBIDs.

Methods:
We studied PH and PH-COMORBID in 61,459 comprehensive health plan members with self-classified ethnicity on prior health exams. Subjects were 58% female, 42% male, 28% Black, 53% White, and 12% Asian. From 1996-2015, PH (ICD-9 code 416) was diagnosed at outpatient visits or hospitalization in 2,183 persons. We identified PH/COMORBIDs during the same study period. Cox models yielded hazard ratios (HR) and 95% confidence intervals (CI) for PH. The PH-CORMORBID conditions were studied individually as logistic regression endpoints and Cox model covariates with PH as endpoint.

Results:
In adjusted models, sex was unrelated to PH risk with male/female HR=1.05 (0.96-1.15). Increasing age, BMI and smoking were related to increased risk, while higher education was inversely related (table). Compared to Whites, Black women had increased risk, while Asians had similar risk. With p<0.001 (statistically significant), Blacks had higher risk than Whites for 16 PH-COMORBIDs and were at decreased risk for none, while Asians were at higher risk than Whites for 10 PH-COMORBIDs and at decreased risk only for VTE. In the models with individual PH-COMORBID covariates, the greatest individual contributor to change in PH risk in Black women was hypertensive heart disease which decreased the HR from 1.31 (p<0.001) to 1.15 (p=0.03). Several other PH-COMORBID covariates decreased the HR by approximately 0.10.

Conclusions:
Independent sex and race associations with PH are modest and substantially influenced by PH-COMORBID conditions.
Abstract P133: Epigenome-Wide Association Study of Moderate-Vigorous Physical Activity in Adult African Americans Identifies Loci Near
HCCA2
Authors: Nguyen Steven , Guan Weihua , Wu Chong , Grove Megan , Xia Rui , Roetker Nicholas S , Holliday Katie , Hibler Elizabeth , Zheng Yinan , Whitsel Eric , Bressler Jan , North Kari , Fornage Myriam , Boerwinkle Eric , Pankow Jim , Demerath Ellen
Published: July 2021

Regular moderate-vigorous physical activity (MVPA) reduces the risk of cardiovascular and other chronic diseases, among other important benefits at all life stages. It is hypothesized that physical activity may alter disease risk via epigenetic modifications, including potentially long-standing changes in DNA methylation as previous research has shown epigenetic changes following exercise interventions. Most existing reports examine global methylation or study acute exercise effects on DNA methylation. To our knowledge, there are no published epigenome-wide association studies (EWAS) of habitual MVPA. In this analysis, we tested associations between leisure time MVPA and genome-wide variation in CpG methylation, an epigenetic mark, in 2,601 African American participants (1,663 women; mean age 56.6 years) in the Atherosclerosis Risk in Communities (ARIC) study. The Illumina HM450K Bead Chip was used to measure methylation in 471,035 CpG sites in stored frozen leukocyte samples, from visit 2 (1990-1992) or 3 (1993-1995). Linear regression models tested the cross-sectional association of DNA methylation M-value with self-reported leisure time MVPA at the visit of sample collection, modeled as minutes of MVPA per week and by category based on the AHA guidelines for physical activity in adults (none, less than 150, or at least 150 minutes MVPA per week), adjusting for age, sex, body mass index, education, alcohol use in grams per week, smoking status, cancer status, white blood cell count, imputed cell-type proportions using the Houseman method, and batch effects with the top 30 HM450K built-in nonnegative control probe principal components. Three CpGs, cg08269485, cg20272155, and cg08966208, upstream of the cathepsin D encoding gene, CTSD, were observed to be significantly inversely associated (q<0.05, FDR) with MVPA minutes/week. This is a strongly imprinted genomic region (chr11p15.5) and the region has also been reported to include DNA methylation variants that changed in response to an exercise training intervention. Additionally, 163 CpGs that we identified in the literature to be associated with habitual MVPA were also tested using the same models. One CpG, cg07863043, upstream of the adenomatosis polyposis coli gene, APC, in the 5q22.2 genomic region, was observed to be significantly positively associated with achieving at least 150 minutes of MVPA per week compared to none (q=0.0001, FDR). APC encodes a tumor suppressor protein that is an antagonist of the Wnt signaling pathway, and is involved in carcinogenesis and embryonic development. Replication in other populations is ongoing to confirm these findings as well as to identify additional physical activity-related DNA methylation variants.
Abstract P134: Genome-wide Association Study of Heart Rate Response to Mental Stress
Authors: Huang Yunfeng , Hui Qin , Hammadah Muhammad , Pimple Pratik M , Al Mheid Ibhar , Wilmot Kobina , Ramadan Ronnie , Shah Amit J , Pearce Brad , Garcia Ernest V , Kutner Michael , Bremner J. Douglas , Esteves Fabio , Raggi Paolo , Sheps David S , Vaccarino Viola , Quyyumi Arshed A , Sun Yan
Published: July 2021

Ischemia results from an imbalance between myocardial oxygen supply and demand. Ischemia associated with mental stress (MS) has been associated with adverse outcomes in patients with coronary artery diseases (CAD). Higher heart rate (HR) and blood pressure responses to MS are associated with a greater likelihood of MS-induced ischemia. Although multiple genetic loci have been associated with baseline HR, genetic associations for HR responses to MS remain unknown. We aimed to discover the genetic determinants of HR response to MS in a bi-ethnic population.

A sample of 499 Caucasian and 271 African American patients with CAD were recruited into the Mental Stress Ischemia Prognosis (MIPS) study. Race was defined using genetic ancestry. Genome-wide SNP data were genotyped using Illumina’s Multi-Ethnic Genotyping (MEG) chip and then imputed to the 1000 Genome Project phase 3 panel. Cardiovascular risk factors, demographic, behavioral, and medication history data were obtained by questionnaires and chart reviews. MS was induced by a public speaking task and the HR response to MS was measured as post-stress HR minus pre-stress HR. We conducted genome-wide association analysis of HR response to MS using multiple linear regression adjusted for age, sex, beta-blocker use, the pre-stress HR and ethnicity. A meta-analysis was performed across the two ethnicities.

After multiple-testing correction, no significant associations with HR response to MS were identified among Whites .However, fourteen SNPs located in gene
ITGA1
with a mean minor allele frequency of 36.5% (range: 36.3% - 37.1%) were significantly associated with the HR response to MS in Blacks (meta-analysis p<5х10
-8
). The minor alleles of all 14 variants were associated with a higher HR response. On average heterozygotic and homozygotic Blacks of the minor allele in any of these SNPs have a 4.558 beat/min (range: 4.514 – 4.659 beat/min) and 9.116 beat/min (range: 9.028 – 9.318 beat/min) increase in HR response to MS, correspondingly. The
ITGA1
gene encodes the alpha-1 subunit of integrin receptors. This protein heterodimerizes with the beta-1 subunit to form a cell-surface receptor for collagen and laminin. The heterodimeric receptor is involved in cell-cell adhesion and may play a role in inflammation and fibrosis. Further functional studies to follow up these genetic loci may provide insight into regulatory mechanisms of HR response to mental stress that may be prognostically informative for CAD patients.
Abstract P140: High Poverty Among Patients With Noncommunicable Diseases in Rural Haiti
Authors: Kwan Gene F , Isaac Benito , Yan Lily , Jean-Baptiste Waking , Belony Densa , Martineau Loiune , Cleophat Philip
Published: July 2021

Background:
Noncommunicable diseases (NCDs) are a major and growing cause of death and disability in low-income countries, and contribute a substantial portion of outpatient clinic visits. Poverty can be a major barrier to accessing healthcare in rural low-income countries. The objective of this study is to describe the demographics and socioeconomic status of patients attending an NCD clinic in rural Haiti, where poverty is highly prevalent.

Methods:
We analyzed routinely collected clinic data from adult patients in rural Haiti presenting to the NCD clinic at Hôpital Universitaire de Mirebalais. We collected data during routine initial clinic visits from July 2013 through October 2016. We performed descriptive statistics to assess patient demographics and socioeconomic status using available data. We evaluated poverty based on the Multidimensional Poverty Index by evaluating 9 indicators within three dimensions: health, education, and standard of living - we did not assess electricity. We assessed deprivation within each indicator. The “poorest” patients were defined as those deprived in 4 of the 9 poverty indicators. We also assessed measures of catastrophic health spending.

Results:
A total of 518 adults were included, with 72% (373/508) women. The mean overall age was 52.8 years (SD 14.7) and 21% (108/518) were 40 years old or younger. Of the patients, 32% had only hypertension, 18% had only diabetes, 32% had both diabetes and hypertension, 5% had heart failure, and 13% had no recorded diagnosis. 45% of patients travel more than 1 hour for clinic visits. Almost half (49%, 146/296) of adults sold belongings and 61% (178/292) borrowed money to pay for healthcare. Among the poverty measures, the top indicators with deprivation were cooking fuel with charcoal or wood (96%, 290/302), child death in household (70%, 169/243), and no household members completing primary school (25%, 83/324), lack of household assets (25%, 79/313), poor sanitation (19%, 59/304), dirt floor (16%, 50/304), and lack of improved drinking water (9%, 29/308). Of all patients, 21% (78/378) were among the poorest. Throughout Haiti, however, 55% of the population are among the poorest. There were more patients among the poorest living closer to the hospital (27%) than living farther away (10%).

Interpretation:
The great majority of patients were middle-aged women, with predominantly hypertension and/or diabetes. Socioeconomic deprivation was high among many poverty indicators and most patients experienced catastrophic health spending. At this clinic in rural Haiti, the proportion of patients presenting for care who are among the poorest is less than that overall in Haiti. Patients who travel far distances have less poverty. Health systems for chronic disease management in rural low-income countries must account for patient poverty.
Abstract P143: Cardiovascular Health Among Asian Americans, NHANES 2011-2014
Authors: Fang Jing , Zhang Zefeng , Ayala Carma , Thompson-Paul Angela , Loustalot Fleetwood
Published: July 2021

Background:
Non-Hispanic Asian Americans (AA) are one of the fastest growing populations in the U.S., yet little information is known about the cardiovascular health (CVH) of this group. The objective of this study was to assess the CVH of AA using a nationally representative survey.

Methods:
Merging data from the National Health and Nutrition Examination Surveys (NHANES) in 2011-2012 and 2013-2014, we examined 7 metrics of CVH using national guidelines and recommendations: not smoking, normal weight (body mass index, BMI <25 kg/m
2
)
,
adequate physical activity, healthy diet, normal blood cholesterol , normal blood glucose and normal blood pressure. Each CVH metric was weighted evenly, with scores for each metric being a 0 (not meeting standards) or 1 (meeting current standards), and the metrics were summed for a total score. Ideal CVH (ICVH) was defined as the percentage of those meeting recommendations for 6-7 metrics, and poor CVH (PCVH) defined as those meeting only 0-2. We compared the prevalence of ICVH and PCVH between non-Hispanic whites (NHW) and AA, as well as among AA by birthplace and years living in the U.S. We also assessed the adjusted prevalence ratios (APR, 95% Confidence Intervals [CI]) of ICVH for AA, using NHW as referent, controlling for age, sex, education, and health insurance status. Additional sensitivity analyses were performed using a previously established Asian-specific normal weight cut-point (BMI<23 kg/m
2
) for AA.

Results:
In adjusted models, AA were more likely to not smoke, have a normal weight, report a healthy diet and have normal blood pressure, compared with NHWs. However, NHWs were more likely to have normal blood glucose compared with AA, and no difference was identified with reported physical activity and blood cholesterol. The adjusted prevalence of ICVH was 9.2% for AA and 5.7% for NHWs (p<0.01). The adjusted percentage for PCVH was 26.6% for AA and 33.5% for NHWs (p<0.01). AA were significantly more likely to have ICVH (APR 1.41, 95% CI: 1.25-1.60) compared to NHW, but there was no difference in ICVH comparing US-born and foreign-born, nor by years living in the US. Additional sensitivity analyses using lower BMI thresholds for AA, consistently found a higher percentage of normal weight AA compared with NHW (36.4% vs 30.4, p<0.01); with no differences in the adjusted prevalence of ICVH (6.7% vs 5.7%, p=0.4) and PCVH (30.8% vs 33.5%, p=0.2) between AA and NHW (APR 1.18, 95% CI: 0.84-1.66).

Conclusion:
AA currently account for 5.3% of adult population in the US, and have been identified as one of the fasting growing minority populations. In this study, AA had a higher prevalence of overall ICVH compared with NHWs; however, when using a lower BMI threshold for AA as recommended by some, there was no difference of ICVH between AA and NHW. Using unique risk scores for AA may better identify AA with less than ideal cardiovascular health.
Abstract P148: Heart Disease Among Breast Cancer Patients
Authors: Ferguson Tekeda F , Kumar Sunayana , Danos Denise
Published: July 2021

Purpose:
In conjunction with women being diagnosed earlier with breast cancer and a rapidly aging population, advances in cancer therapies have swiftly propelled cardiotoxicity as a major health concern for breast cancer patients. Frequent cardiotoxicity outcomes include: reduced left ventricular ejection fraction (LVEF), myocardial infarction, asymptomatic or hospitalized heart failure, arrhythmias, hypertension, and thromboembolism. The purpose of this study was to use an electronic health records system determine if an increased odds of heart disease was present among women with breast cancer.

Methods:
Data from the Research Action for Health Network (REACHnet) was used for the analysis. REACHnet is a clinical data research network that uses the common data model to extract electronic health records (EHR) from health networks in Louisiana (n=100,000).Women over the age of 30 with data (n=35,455) were included in the analysis. ICD-9 diagnosis codes were used to classify heart disease (HD) (Hypertensive HD, Ischemic HD, Pulmonary HD, and Other HD) and identify breast cancer patients. Additional EHR variables considered were smoking status, and patient vitals. Chi-square tests, crude, and adjusted logistic regression models were computed utilizing SAS 9.4.

Results:
Utilizing diagnoses codes our study team has estimated 28.6% of women over the age of 30 with a breast cancer diagnosis (n=816) also had a heart disease diagnosis, contrasted with 15.6% of women without a breast cancer diagnosis. Among patients with heart disease, there was no significant difference in the distribution of the type of heart disease diagnoses by breast cancer status (p=0.87). There was a 2.21 (1.89, 2.58) crude odds ratio of having a CVD diagnoses among breast cancer cases when referenced to cancer free women. After adjusting for age (30-49, 50-64, 65+), race (black/white), and comorbidities (obesity/overweight, diabetes, current smoker) there was an increased risk of heart disease (OR: 1.24 (1.05, 1.47)).

Conclusion:
The short-term and long-term consequences of cardiotoxicity on cancer treatment risk-to-benefit ratio, survivorship issues, and competing causes of mortality are increasingly being acknowledged. Our next efforts will include making advances in predictive risk modeling. Maximizing benefits while reducing cardiac risks needs to become a priority in oncologic management and monitoring for late-term toxic effects.
Abstract P155: Risk for Recurrent Events Among Patients Receiving Intensive Medical Management Following Myocardial Infarction
Authors: Colantonio Lisandro D , Brown Todd M , Bittner Vera A , Zhao Hong , Farkouh Michael E , Monda Keri L , Rosenson Robert S , Somaratne Ransi M , Woodward Mark , Muntner Paul
Published: July 2021

Background:
Randomized trials have shown that several medications reduce the risk for recurrent coronary heart disease (CHD) events following myocardial infarction (MI). Knowing the risk for recurrent events among patients receiving intensive medical management following MI can inform patient-physician shared decision making.

Objective:
To estimate the risk for CHD events among patients receiving intensive medical management following an MI hospitalization.

Methods:
We identified US adults 18-64 years with commercial health insurance in Marketscan who had an MI hospitalization (defined by an ICD-9 code of 410.x0 or 410.x1 in the primary discharge diagnosis position) in 2014-2015. Intensive medical management was defined as filling a high-intensity statin, renin-angiotensin system inhibitor, beta-blocker and antiplatelet agent within 30 days following hospital discharge for MI. Patients receiving intensive medical management were matched 1:2 by age, sex and calendar year to randomly selected controls from the general population and followed for recurrent MI and CHD events (i.e., MI or coronary revascularization).

Results:
Among MI patients (n=17,643, mean age 55 years, 74% male), 29.6% received intensive medical management. After adjustment for comorbid conditions, intensive medical management was more common among men (relative risk [95% CI] 1.14 [1.07, 1.20]), those who received a stent during their MI hospitalization (2.54 [2.37, 2.73]) and those who received cardiologist care (1.17 [1.11, 1.22]) and cardiac rehabilitation (1.14 [1.08, 1.20]) after hospital discharge. The risk for recurrent MI and CHD events was higher among MI patients receiving intensive medical management compared to controls, overall and when restricted to MI patients with high medication adherence (
Table
).

Conclusion:
MI patients receiving intensive medical management have a substantial residual risk for recurrent CHD events.
Abstract P158: Lipid Management Challenges in Different Clinical Settings
Authors: Nguyen Landai , Omar Mazen , Omar Bassam A , Awan G. Mustafa , Malozzi Christopher
Published: July 2021

Background:
Availability of lipid profile during a patient’s clinic encounter can improve decision-making in regards to therapy, and help achieve therapeutic goals.

Methods:
Encounters from 2 clinics run by one cardiologist; a University-based clinic and a Veterans Administration (VA) clinic were compared for availability of cholesterol profiles and level of cholesterol control in patients with coronary disease.

Results:
There were 93 out of 300 encounters (31%) with documented coronary disease (CAD) in the University clinic and 77 out of 134 encounters (57%) in the VA clinic. University patients with CAD had 61% (57/93) lipid documentation during their encounters, while VA patients had 99% (76/77) documentation. The average total cholesterol and LDL for University patients was 179 ± 42 mg/dL and 111 ± 35 mg/dL respectively, compared with 154 ± 38 mg/dL and 93 ± 35 mg/dL for the VA patients respectively (P < 0.01 for each category). Only 39% (22/57) of the University-based patients achieved LDL < 100 mg/dL, compared with 66% (51/77) of VA patients. Blood pressures, which were consistently documented every clinic visit in both clinics, averaged 128/76 mmHg in the University clinic compared with 131/75 mmHg in the VA clinic, with no statistically significant difference.

Conclusion:
Better control of cholesterol levels is seen in the VA-based clinic compared with the University-based clinic. This may partially be explained by the availability of laboratory results through a unified computer system, allowing more prompt decision-making with regards to medication changes and intensified dietary counseling during the clinic encounter. This may not be always available in other settings where laboratory tests are performed by a different provider utilizing a different reporting system which may not be readily shared or available to the treating cardiologist. Other factors could include variable compliance with laboratory appointments and access to medications. Our findings support establishing means for cardiologists to have access to patients’ laboratory results during their encounter to help more efficient decision making.
Abstract P165: Associations of Coronary Artery Calcium Volume and Density With Incident Heart Failure in the Multi-Ethnic Study of Atherosclerosis
Authors: Forbang Nketi I , Michos Erin , Ponce Sonia , Thomas Isac , Allison Matthew , Bluemke David , Criqui Michael
Published: July 2021

Background:
Coronary artery calcium (CAC) predicts incident heart failure (HF) independent of cardiovascular disease (CVD) risk factors. In MESA, Components of CAC, volume and density, have opposite associations with incident CVD, such that for a given volume of CAC, higher CAC density is inversely associated with events. The relationship between CAC volume and density with HF is unknown.

Methods:
We studied 6814 participants in a multi-ethnic, community-based cohort, free from clinical CVD at recruitment. CAC volume and density were measured by non-contrast cardiac CT at the baseline exam (2000-2002). Adjudicated HF events were assessed through 2014, and analysis limited to those with imaging confirmation and estimated ejection fraction (EF). Cox proportional hazard was used to estimate independent associations of baseline CAC volume and density with incident HF: HF with reduced (< 50%), and preserved EF (HFrEF & HFpEF respectively).

Results:
The mean age was 62
+
10 years, 47% were men, 38% identified as European-, 28% as African-, 22% as Hispanic-, and 12% as Chinese-ethnicity. Average time to 189 HF events (119 HFrEF & 70 HFpEF) was 6.6 years. In unadjusted models, higher CAC volume (HR 1.27 [1.02-1.59], p=0.03), but not CAC density (HR 0.87 [0.67-1.13], p=0.29) was significantly associated with incident HF, non-significant associations were observed with HFrEF, or HFpEF, and no significant associations were observed for all three outcomes after adjustments for demographics and CVD risk factors (Table). Also, in unadjusted analyses, stratified by sex (p-value for interaction = 0.13), higher CAC volume was associated with increased risk for HF (HR 1.37 [1.03-1.81], p=0.03) and HFpEF (HR 1.76 [0.99-3.16], p=0.06), in males only. No significant associations were observed after adjustments.

Conclusion:
In a multi-ethnic cohort, CAC volume and density were not independently associated with HF, the trend for volume was positive while density was inverse. Low frequency of incident HF in our cohort was an important limitation.
Abstract P168: The Association of Longitudinal Changes in Metabolic Syndrome With Incident Heart Failure: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Adesiyun Tolulope A , Kwak Lucia , Sharma Kavita , Nambi Vijay , Michos Erin D , Neeland Ian , Blumenthal Roger S , Ballantyne Christie M , Selvin Elizabeth , Coresh Josef , Ndumele Chiadi E
Published: July 2021

Background:
Metabolic syndrome (MS) is a risk factor for the development of heart failure (HF). However, little is known about how changes in MS over time are associated with HF risk.

Hypothesis:
We hypothesized that increasing MS components over time and a longer duration of MS would be associated with greater HF risk.

Methods:
We studied 8,104 participants at ARIC Visit 4 (1996-98) without baseline HF, coronary heart disease or diabetes. MS components were defined using AHA/NHLBI criteria for waist circumference, hyperglycemia, elevated blood pressure, low HDL-C and hypertriglyceridemia, and MS was diagnosed if ≥ 3 criteria were present. Using data on MS components from Visit 1 (1987-89) through 4, we used multivariate Cox regression models to evaluate associations of changes in MS components over time and duration of MS with incident HF occurring after Visit 4.

Results:
The mean age was 63 years (+/-6), with 58% female. Over a median follow-up of 16 years, there were 902 HF events. Compared to those without MS at Visits 1 and 4, those with MS at both time points had a hazard ratio (HR) for HF of 1.87 (95% CI 1.60-2.19), while those with no MS at Visit 1 but MS at Visit 4 (HR 1.38; 95% CI 1.16-1.64) and those with MS at Visit 1 but not at Visit 4 (1.51; 95% CI 1.13-2.00) had more modest risk associations. Among those without MS at Visit 1, those with 0 MS components at both Visits 1 and 4 had lowest HF risk (reference), with progressively higher risk seen for those who increased to 1-2 (HR 1.66; 95% CI 1.06-2.61), 3 (HR 2.15; 95% CI 1.37-3.38) and 4-5 (HR 2.55; 95% CI 1.58-4.13) MS components by Visit 4. Duration of MS had a positive association with HF risk (Figure), with a HR of 1.08 (95% CI 1.06-1.10) per year of MS duration.

Conclusions:
Progression in MS components over time and a longer duration of MS are associated with increased HF risk. Given the cardiovascular implications of these findings, particularly for the growing number of individuals developing MS components at an early age, strategies to prevent MS onset and progression should be implemented widely.