bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP32: Body Weight Variability in Young Adulthood and Echocardiographic Precursors of Heart Failure in Later Life: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: AGHAJI QUEEN N , Nwabuo Chike C , Appiah Duke , Yuichiro Yano , Viera Anthony J , Allen Norrina B , Rana Jamal S , Lloyd-Jones Donald , Schreiner Pamela J , AC Lima Joao
Published: March 2023

Background:
The association between variability in body mass index (BMI) in early adulthood and cardiac structure and function in midlife has not been previously examined.

Methods:
We examined 2371 Coronary Artery Risk Development in Young Adults (CARDIA) participants who had BMI assessments across 25-years (CARDIA exam year 0 [1985-1986], 2 [1987-1989], 5 [1990-1991], 7 [1992-1993], 10 [1995-1996], 15 [2000-2001], 20 [2005-2006], and 25 [2010-2011]) as well as echocardiography data at the year-25 exam (2010-2011). BMI variability was assessed by standard deviation (SD) across 25 years. Adjusted multivariable linear regression models were used to assess the association between echocardiography variables (dependent variable) and SD of BMI (independent variable). Model 1 was adjusted for standard cardiac risk factors (age, sex, race, education, blood pressure, anti-hypertension medication use, smoking, fasting plasma glucose, alcohol consumption, physical activity, HDL and total cholesterol. Model 2 was additionally adjusted for mean BMI.

Results:
Among participants included in the analysis, mean [SD] age at the year 25 exam [2010-2011] was 50.4 [3.6] years; 44.5% were men; and 41.3% were black). In model 1, greater SD of BMI was associated with greater left ventricular mass (β 5.18g, p<0.001), left ventricular global longitudinal strain 0.08, p=0.01, and left atrial volume (β 1.60ml, p<0.001). Additional adjustment for mean BMI, attenuated associations (p>.05 for all). Greater SD of BMI was associated with worse diastolic function (E/é) (β 0.11, p<0.001). Observed association between BMI variability and E/é persisted even after accounting for mean BMI (β 0.08, p=0.01).

Conclusions:
Greater body weight variability in young adulthood was associated with modest unfavorable midlife alterations in diastolic function.
Abstract MP39: Associations of Disordered Eating and Weight Control Behavior With Cardiovascular Health Score: The Coronary Artery Risk Development in Young Adults Study
Authors: Polanka Brittanny , Yoon Cynthia , Jacobs David R , Schreiner Pamela , Sherwood Nancy
Published: March 2023

Introduction:
Psychological and behavioral factors negatively impact cardiovascular health (CVH), defined by Life’s Simple 7. Few studies have investigated disordered eating and weight control behaviors and CVH, particularly outside of adolescence.

Objective:
To examine the cross-sectional and longitudinal associations of disordered eating and weight control behaviors with CVH among middle-aged adults.

Methods:
We studied CARDIA participants assessed between Y10 (1995-1996) and Y30 (2015-2016) excluding pregnant/breastfeeding individuals at Y10. The Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) was administered at Y10 and used to create the Problematic Relationship to Eating and Food (PREF) score, an aggregate measure (range 0-8) of eight disordered eating and weight-related behaviors (anxiety surrounding food, compensatory behaviors, overeating, loss of control, distress surrounding overeating, distress surrounding loss of control, shape concerns, time spent dieting). Diet, physical activity, smoking, blood pressure, cholesterol, glucose, and body mass index (BMI) were measured at Y10 and Y30 (except diet at Y7 and Y20) and used to define CVH categories Low-to-Moderate (0-9) or High (10-14). Logistic regression analyses were used to evaluate associations between PREF score and CVH category.

Results:
We included 2,040 participants (mean age 35.2 years, 55% female, 43% Black). At Y10, every 1-unit increment in PREF was associated with 19% higher odds of Low-to-Moderate vs. High CVH in adjusted models (
Table
). At Y30 after 20 years of follow-up (mean age 55.3 years), every 1-unit increment in PREF at Y10 was associated with 11% higher odds of Low-to-Moderate vs. High CVH at Y30 in adjusted models (
Table
). Further adjustment for Y10 BMI attenuated the relationship (OR=0.93, 95%CI: 0.87-0.99).

Conclusion:
Higher levels of problematic behaviors and attitudes towards eating are associated with less optimal CVH throughout middle-age, likely through weight increases.
Abstract MP40: John Henryism Moderates the Association Between Income and Heart Failure Among African American Adults From the Jackson Heart Study
Authors: Glover LaShaunta M , Forde Allana , DeAngelis Reed , Ansari Md Abu Yusuf , Sims Mario , James Sherman
Published: March 2023

Background:
The John Henryism Hypothesis (JHH) posits that repeated high-effort coping in response to systemic social and economic stressors accelerates physiological wear and tear and is, as a result, a major contributor to the well-documented high cardiovascular disease (CVD) risk among African American adults, especially the poor and working-class. There is, however, a paucity of studies that test the JHH using multiple socioeconomic status (SES) indicators and include incident CVD events among African American adults.

Objective:
Determine whether the associations between SES indicators and CVD events are moderated by John Henryism (JH).

Hypothesis:
The inverse association between SES and CVD events will be more pronounced among those who score “high” on the 12-item John Henryism Scale for Active Coping (JHAC) versus those who do not.

Methods:
Jackson Heart Study participants with complete data and no CVD at baseline (2000-2004) were utilized (n=1828, mean age: 52.15 years). SES indicators included insurance status, income, years of education, and years of maternal and paternal education. JH was defined using a tertile distribution of the JHAC scores (0-36): low JHS (<28), moderate JHS (29-32), and high JH (>32). CVD events from baseline to 2016 included coronary heart disease (CHD), stroke, and heart failure (HF). Cox proportional hazards regressions determined the hazard ratio (HR, 95% CI) of CVD events by SES variables. Moderation by JH was determined by including interaction terms in the models and stratification of results. Models were adjusted for age, sex, smoking, physical activity, nutrition, obesity, hypertension, and diabetes.

Results:
There were 94, 61, and 100 CHD, stroke, and HF events, respectively that occurred by 2016 (mean follow-up: 13 years for CHD and Stroke and 10 years for HF). Each SES indicator was inversely associated with CVD events, except for income (only associated with HF) and insurance (not associated with CHD). There was a significant interaction between income and JH in the hazard of HF (p=0.04). Specifically, low-income participants with high JH had a greater hazard of HF after full adjustment (HR 1.85, 95% CI 1.21, 2.83). Low-income participants with low JH also had a greater hazard of HF (HR 1.43, 95% CI 1.06, 1.93) after adjustment for age and sex, but the association attenuated after adding health behaviors and risk factors.

Conclusion:
Engaging in high-effort coping and having low SES is detrimental to cardiovascular health. The association between income and HF was moderated by JH, thus interventionists should consider interactions between SES and high-effort coping when exploring ways to prevent CVD.
Abstract MP43: The Role of the Physical Environment in Racial Differences in Sleep Duration
Authors: Johnson Dayna A , Medearis Krysta , Moore Kari , Redline Susan
Published: March 2023

Background:
Racial and ethnic sleep disparities have been documented; however, the mechanisms are unclear. The physical environment is associated with sleep duration and may explain sleep disparities. We examined the physical environment as a mediator of racial differences in sleep duration using data from the Multi-Ethnic Study of Atherosclerosis (N=2073).

Methods:
Participants underwent 1-week actigraphy, completed questionnaires on the neighborhood environment, and addresses were geocoded and linked to physical environment features. Actigraphy-measured sleep duration was analyzed as both continuously and categorically (short sleep duration < 6 hours vs. ≥ 6 hours). Physical environment characteristics included availability of healthy foods, aesthetic quality, walking environment, walking destination density, the proportion of land dedicated to retail space and an overall built environment score. Multi-level linear and Poisson regression models with robust variance were fit to examine associations of race, physical environment, and sleep duration with adjustment for covariates. Direct and indirect mediation was tested via path models.

Results:
The mean age was 68.6 ± 9.2 years. Approximately 46% of participants were male and 37.7% White, 27.7% Black, 23.1% Hispanic, and 11.5% Chinese American. The prevalence of short sleep (6 hours) was highest for racial minorities, ranging from 32.2% to 44.3% compared to 19.2% for White adults. A higher built environment factor score was associated with shorter sleep duration. The physical environment partially mediated racial disparities in sleep duration between Hispanic and White adults. A significant indirect effect of race on sleep duration via aesthetic quality, walking destination density, proportion retail and the built environment factor score was detected, explaining 4.0%, 27.2%, 7.6%, and 37.8%, respectively of the association between race and sleep duration for Hispanic individuals, compared to White individuals. The physical environment did not explain the Black-White or Chinese-White disparity in sleep duration.

Conclusion:
Black, Hispanic, and Chinese individuals had shorter sleep duration than White individuals. The Hispanic-White disparity in sleep duration was partially explained by the physical environment. These findings suggest that the physical environment may be an important mechanism in which racial disparities in sleep exist and a likely a target for intervention.
Abstract MP45: Nocturnal Hypoxemia, Obstructive Sleep Apnea and the Risk of Cardiovascular Diseases and Mortality: Insights From the Atherosclerosis Risk in Communities Participants of the Sleep Heart Health Study
Authors: Misialek Jeffrey R , Full Kelsie M , Polanka Brittanny M , Lakshminarayan Kamakshi , Gottesman Rebecca F , Himali Jayandra J , Pase Matthew P , Lutsey Pamela L
Published: March 2023

Background:
Nocturnal hypoxemia may better capture disease burden than obstructive sleep apnea (OSA). Using a subset of participants from the Atherosclerosis Risk in Communities (ARIC) study who participated in the Sleep Heart Health Study (SHHS), we examined the association of nocturnal hypoxemia and OSA with cardiovascular diseases (CVD) and mortality in a white, older cohort in the US.

Methods:
A total of 1,455 participants free of CVD had an in-home, overnight polysomnogram; nocturnal hypoxemia (% of total sleep time with oxygen saturation <90%) and OSA (apnea-hypopnea index - # of apneas/hypopneas per hour of sleep) were derived from these readings. Incident CVD events and mortality were identified through the end of 2019 using annual telephone calls, hospital discharge lists and death certificates and were adjudicated by physician review. Included in this analysis were coronary heart disease (CHD), heart failure (HF), stroke, any CVD event (CHD, HF, or stroke), atrial fibrillation (AF), and all-cause mortality. We used Cox proportional hazards models to assess the association of nocturnal hypoxemia (categories: <1%, 1-<5%, ≥5%) and OSA (categories: <5, 5-<15, 15-<30, ≥30) with each outcome.

Results:
At the sleep assessment, participants had a mean (SD) age of 62 (6) years, 53% were female, and 14% had a nocturnal hypoxemia ≥5%. Over a mean follow-up of 17.8 years, a total of 408 participants had any CVD event, and 602 died. Nocturnal hypoxemia ≥5% was associated with incident HF and all-cause mortality in the fully adjusted model (Table). Nocturnal hypoxemia ≥5% was also associated with incident CVD and AF in Model 1; however, adjustment for body mass index attenuated these associations (Table, Model 2). OSA was not associated with the outcomes in any model (data not shown).

Conclusion:
Further research is needed to understand the distinction between nocturnal hypoxemia and OSA and how they relate to the risk of CVD and mortality. It is possible that reducing nocturnal hypoxemia should be targeted over OSA for CVD prevention.
Abstract MP56: Intake of Ultra-Processed Foods is Associated With an Increase in Risk for Type Two Diabetes: Results From Three U.S. Cohort Studies and a Meta-Analysis
Authors: Chen Zhangling , Khandpur Neha , Desjardins Clemence , Monteiro Carlos , Rossato Sinara , Fung Teresa , Manson Joann E , Willett Walter , Rimm Eric B , Hu Frank , Sun Qi , Drouin-chartier Jean-Philippe
Published: March 2023

Introduction:
There is limited evidence on the association between long-term consumption of ultra-processed foods (UPF) and the risk of type 2 diabetes (T2D), among the U.S population. The overall strength of this association has also not been established.

Hypothesis:
Higher intake of UPF is associated with a higher risk of T2D in U.S. adults. The pooled risk estimates from published literature reinforce the positive relationship between the UPF intakes and T2D.

Methods:
We first assessed this relationship among 71,871 women from the Nurses’ Health Study (NHS, 1984-2016), 87,918 women from NHSII (1991-2017), and 38,847 men from the Health Professionals Follow-up Study (HPFS, 1986-2016) who were all free of T2D at baseline. Diet was assessed using food frequency questionnaires, every 2-4 years. UPF were categorized according to the Nova classification. Information on incident cases of T2D was obtained through follow-up questionnaires every 2 years. The association between UPF intake and incident T2D was examined using Cox proportional hazards models. Second, after conducting a systematic review of prospective cohort studies, risk estimates from all included cohorts were pooled in a random-effects, dose-response, meta-analysis to assess nonlinearity of the association between total UPF intake and T2D risk. Finally, the strength of the meta-evidence was assessed using NutriGrade.

Results:
During 5,187,678 person-years of follow-up across the three cohorts, 19,503 T2D cases were documented. The pooled multivariable-adjusted hazard ratios (HRs) for T2D between the extreme quintiles of total UPF intake (% of grams/day), was 1.36 (95% confidence interval (CI): 1.29, 1.44; P
trend
<0.0001). This relationship was driven by intakes of ultra-processed animal-based products, ready-to-eat mixed dishes and artificially- and sugar-sweetened beverages. Ultra-processed cereals and ultra-processed dark breads and whole-grain breads were inversely associated with T2D risk. In the meta-analysis (7 risk estimates, 415,554 participants and 21,932 T2D cases), a significant positive dose-response association between total UPF intake and T2D was observed (P=0.90 for non-linearity): a 10% increase in total UPF intake (% grams from UPF/day) was associated with a 10% higher risk of T2D (95%CI: 8%, 12%; I
2
=23.1%;
P
heterogeneity
=0.25). Per NutriGrade, the evidence supporting the positive relationship between total UPF intake and T2D was of high quality.

Conclusions:
High quality evidence shows that total UPF consumption is associated with higher risk of T2D, although not all individual foods classified as ultra-processed were associated with a higher risk in these U.S. cohorts.
Abstract MP61: Starch Digestion-Related Amylase Genetic Variants, Dietary Carbohydrates, and Changes in Glucose Tolerance: Results From the OmniCarb Trial
Authors: Heianza Yoriko , Wang Xuan , Ma Hao , Appel Lawrence J , Sacks Frank M , Qi Lu
Published: March 2023

Introduction:
Salivary amylase, encoded by the
AMY1
gene, plays a pivotal role in carbohydrate digestion, and genetic adaptation of carbohydrate digestion has been implicated in impaired glucose tolerance, type 2 diabetes, and cardiometabolic diseases.

Hypothesis:
We investigated whether
AMY1
genetic variations are associated with β-cell function and glycemic responses during 2-h oral glucose tolerance tests (OGTTs) and tested whether
AMY1
variations were related to changes in glucose tolerance in a randomized controlled trial testing effects of diets varying in glycemic index (GI) levels and carbohydrate (Carb) amount.

Methods:
The study included participants (n=146) from the OmniCarb trial, a randomized crossover-controlled feeding trial, in which overweight or obese adults were given 4 diets that differed in composition by GI and Carb amount. Each diet was consumed for 5 weeks, followed by a 2-week washout. Genetic risk score (GRS) was calculated using eight
AMY1
SNPs, with higher GRS indicating higher activity of salivary amylase. The primary outcomes were glycemic and insulin responses during OGTTs.

Results:
At baseline, lower GRS was related to a larger area under the curve of glucose (AUC-glucose) and β-cell dysfunction assessed by the insulinogenic index and disposition index (
p
<0.05 for all). After consuming either a high-Carb and low-GI diet or a low-Carb and high-GI diet for 5 weeks, participants with low GRS (tertile 1) showed impaired glycemic responses at 30, 60, and 90 min after OGTTs, as compared to those with high GRS (tertile 3); there was no significant difference according to GRS after eating a low-Carb/low-GI diet. After consuming a high-Carb and high-GI diet for 5 weeks, the participants with low GRS showed a mean 21 (SE 10) mg/dl higher glucose concentrations at 60 min after OGTT, as compared to those with high GRS (
p
=0.038). The effect of increasing GI at low Carb amount for glucose levels at 60 min (

P
interaction

= 0.024) and AUC-glucose (

P
interaction

=0.016) significantly interacted with the GRS. Also, we found a significant interaction between GRS and the effect of increasing Carb amount at high GI for 60-min post-load glucose levels (

P
interaction

= 0.016).

Conclusions:
The
AMY1
genetic variations were associated with β-cell function and impaired glucose tolerance. Effects of changing the amount or quality of carbohydrates on glucose tolerance may be partly determined by individual genetic adaptation of carbohydrate digestion.
Abstract MP66: The Interplay Between Diet, Circulating Indolepropionate Concentrations, and Cardiometabolic Health in US Populations
Authors: Hu Yang , Li Jun , Zhu Lu , Wang Biqi , Li Yanping , Ivey Kerry L , Lee Kyu Ha , Eliassen A.Heather , Qi Qibin , Chan Andrew , Huttenhower Curtis , Rimm Eric B , Hu Frank B , Sun Qi
Published: March 2023

Background:
Indolepropionate (IPA), a tryptophan metabolite of human gut microbiota origin, is associated with lower risk of type 2 diabetes (T2D) in humans. The complex interplay among tryptophan intake, the gut microbiome, prebiotics, circulating IPA concentrations, and T2D risk has not been investigated.

Objectives:
We aimed to identify IPA-producing gut microbiota species and investigate potential diet-microbiota interaction on circulating IPA concentrations.

Methods:
We included 287 men from the Men’s Lifestyle Validation Study, a sub-study of the Health Professionals Follow-Up Study (HPFS), who provided up to two pairs of fecal samples and two blood samples approximately six months apart. Dietary intake was assessed using 7-day diet records. We identified microbial taxonomic features associated with plasma IPA concentrations using generalized linear regression and calculated a rank-based species score to reflect IPA-producing potential. Associations between plasma concentrations of tryptophan metabolites and T2D risk were examined in 13,032 participants from Nurses’ Health Study (NHS), NHSII, and HPFS.

Results:
Plasma IPA concentrations were associated with overall gut microbial profiles (permutational analysis of variance test, p=0.001). We identified 17 microbial species, such as
Eubacterium eligens, Butyrivibrio crossotus
, and
Faecalibacterium prausnitzii
, whose abundance was significantly associated with increased plasma IPA concentrations (false discovery rate < 0.05). A significant association between higher tryptophan intake and higher IPA concentrations was only observed among men who had higher fiber intake and a higher microbial species score consisting of the 17 species (p-interaction < 0.01). Similar modulation was also observed for major tryptophan food contributors including vegetables (p-interaction < 0.01), red/processed meat (p-interaction = 0.02), egg (p-interaction 0.01), dairy (p-interaction = 0.01), and whole grain (p-interaction < 0.01). Moreover, interactions persisted for all fiber subtypes (soluble/insoluble fiber and pectin). We documented 1,744 incident T2D cases during 218,603 person-years of follow-up. Plasma concentrations of tryptophan and three kynurenine-pathway metabolites (kynurenine, xanthurenate, and quinolinate) were positively associated with T2D risk while an inverse association was found for IPA.

Conclusions:
Specific microbial species and dietary fiber jointly modulate the associations between tryptophan intake and circulating IPA concentrations. In a subsequent analysis, IPA levels were predictive of lower T2D risk. Our findings suggest that the health effects of dietary tryptophan may depend on both gut microbiome composition and prebiotic consumption.
Abstract MP69: Day-of-the-Week and Time-of-the-Day Temporal Patterns of Sedentary Behavior Among Hispanic / Latino Adults: Hispanic Community Health Study / Study of Latinos
Authors: Zhao Beibo , Sotres-Alvarez Daniela , Evenson Kelly R , Greenlee Heather , Mossavar-Rahmani Yasmin , Qi Qibin , Marquez David , Elfassy Tali , Vidot Denise C , Arredondo Elva , Diaz Keith
Published: March 2023

Objectives:
Existing sedentary behavior interventions have largely achieved modest results. Conventionally, interventions have attempted to reduce sedentary time using a full-day approach. An alternative strategy is to target specific periods when sedentary behavior is most prevalent. However, little is known when sedentary time is most likely to occur in adults. This study examined the day-of-the-week and time-of-the-day patterns of sedentary behavior among U.S. Hispanic/Latino adults.

Methods:
Participants (n=12,241) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multi-site prospective cohort study of Hispanic/Latino adults, were studied. Sedentary time was measured for one week using a hip-mounted accelerometer. Three sedentary metrics were quantified: total sedentary time, sedentary time in bouts ≥ 60 minutes, and number of sedentary breaks.

Results:
Temporal patterns across days of the week were statistically significant for all three sedentary metrics (Figure, Panels A-C, p < .001). Total sedentary time decreased from 719±2 mins/d on Mondays to 710±3 mins/d on Fridays the lowest and increased over weekends with Sundays (733±3 mins/d) the highest. Temporal patterns across 3-h periods of the day were statistically significant for all sedentary metrics (Figure, Panels D-F, p < .001). Time-of-the-day patterns had a U-curve pattern wherein adults were most sedentary late at night, became less sedentary throughout the day, reached peak activeness around noon, then became more sedentary into the evening. Day-of-the-week and time-of-the-day patterns were robust across age, employment, work shift, and acculturation subgroups.

Conclusions:
Mornings, evenings, and weekends were the most sedentary periods in this cohort of Hispanic/Latino adults, characterized by higher volumes of sedentary time, more prolonged sedentary bouts, and fewer sedentary breaks. These time periods should be considered as important windows for behavioral interventions targeting sedentary behavior.
Abstract MP77: Perceived Stress From Childhood to Young Adulthood and Cardiometabolic Endpoints in Young Adulthood: A Longitudinal Study of the Southern California Children’s Health Study
Authors: Guo Fangqi , Chen Xinci , Danza Phoebe , Niu Zhongzheng , Li Yanjie , Hodis Howard N , Breton Carrie V , Bastain Theresa , Farzan Shohreh F
Published: March 2023

The longitudinal impact of perceived stress on the risk of cardiometabolic disease has not been comprehensively evaluated among children and young adults. We hypothesized that patterns of perceived stress from childhood to adulthood may predict cardiometabolic risk in early adulthood. As part of the Southern California Children’s Health Study (CHS), we examined perceived stress score (PSS) in adolescence (mean age, 13.3 years) and young adulthood (mean age, 23.6 years) among 276 participants. Based on PSS in adolescence and young adulthood, participants were categorized into 4 stress pattern groups: consistently high (n = 85), decreasing (n = 49), increasing (n = 59), and consistently low (n = 65). CHS participants were assessed for seven measures of cardiometabolic disease risk, namely carotid artery intima-media thickness (CIMT), systolic and diastolic blood pressure (SBP and DBP), obesity, percent body fat, android/gynoid ratio, and elevated HbA1c in their young adulthood. An overall cardiometabolic risk score was generated by summing the number of clinically elevated measures to indicate cumulative cardiometabolic risk. Using multivariate linear and logistic regression models, we examined PSS measured at single time points and change in PSS score across adolescence to young adulthood in relation to cardiometabolic disease risk. Results indicated that PSS in adulthood had significant positive associations with overall cardiometabolic risk score (Beta, 0.12: 95% CI, 0.01-0.22;
p
=0.031), CIMT (Beta, 0.01; 95% CI, 0.00-0.02;
p
=0.043), SBP (Beta, 1.27, 95% CI, 0.09-2.45;
p
=0.035), and DBP (Beta, 0.94; 95% CI, 0.13-1.76;
p
=0.024). Further, analyses of PSS patterns suggested that individuals with consistently high PSS had higher cardiometabolic risk scores (Beta, 0.26; 95% CI, -0.02-0.54;
p
=0.066), as well as significantly higher android/gynoid ratio (Beta, 0.09; 95% CI, 0.03-0.14;
p
=0.002), percent body fat (Beta, 0.96; 95% CI, 0.51-5.41;
p
=0.018), and greater odds of obesity (OR, 5.73; 95% CI, 1.96-16.78;
p
= 0.001), compared to individuals with consistently low PSS. Our work suggests that perceived stress from adolescence to adulthood may contribute to cardiometabolic disease risk in adulthood. Interventions to reduce stress earlier in life (e.g., in adolescence) should be investigated for their potential to reduce cardiometabolic disease risk factors in young adulthood.
Abstract P100: Associations Between Urinary Biomarkers at Baseline and Salt and Potassium Sensitivity: The GenSalt Study
Authors: Maroney Kieran J , He Hua , Li Yadan , He Jiang , Chen Jing
Published: March 2023

Introduction:
Salt sensitivity of blood pressure is associated with an increased risk of hypertension and cardiovascular disease. Measurement methods of salt sensitivity of BP are inconvenient thus identifying biomarkers for salt sensitivity of BP has important clinical significance.

Hypothesis:
The urinary excretion of dopamine, kallikrein, norepinephrine and uromodulin at baseline are associated with salt sensitivity of BP.

Methods:
The Genetic Epidemiology Network of Salt Sensitivity (GenSalt) (n=1887) and GenSalt Replication (n=690) studies dietary interventions included a 3-day baseline exam, 7-day low sodium feeding, a 7-day high sodium feeding, and a 7-day high sodium feeding with potassium supplementation. Baseline urinary dopamine, kallikrein, norepinephrine, and uromodulin were measured by ELISA methods. Salt and potassium sensitivity were defined as change in SBP and DBP during dietary intervention. Urinary biomarkers below limit of detection (LOD) were replaced using LOD/√2 and censored likelihood multiple imputation (CLMI). Linear models between standardized log transformed urinary biomarkers and change in SBP and DBP were assessed after adjustment for age, baseline BP, sex, education, physical activity, smoking status, alcohol intake, 24-hour sodium excretion and GenSalt cohort.

Results:
Norepinephrine was positively associated with SBP in CLMI models (0.10 mmHg, CI: 0.00, 0.19) and DBP in LOD/√2 models (0.31 mmHg, CI: 0.05, 0.57) and CLMI models (0.10 mmHg, CI: 0.02, 0.18) during high sodium diet. Uromodulin was associated with decreased SBP in LOD/√2 models (-0.36 mmHg, CI: -0.57, -0.14) and CLMI models (-0.19 mmHg, CI: -0.31, -0.08) during potassium supplementation. Similarly, dopamine was positively associated with DBP during high sodium diet and negatively associated with DBP during potassium supplementation.

Conclusion:
These data indicate urinary biomarkers dopamine, norepinephrine and uromodulin are associated with BP salt sensitivity and may be used in risk stratification.
Abstract P103: Associations Between Brain Volumes and Cerebral Blood Flow and Sex Hormones in the Look AHEAD Brain MRI Cohort
Authors: Yeboah-Kordieh Yvette , Bennett Wendy , Chandran Vidya , Michos Erin D , Kalyani Rita R , Jiajun Wu , Nyquist Paul A , Espeland Mark , Vaidya Dhananjay
Published: March 2023

Background:
Females have greater relative brain volume (BV) and cerebral blood flow (CBF) compared to males. BV decreases after menopause suggesting a possible role of sex hormones. We studied the association of BV, abnormal white matter hyperintensity volumes (WMHV) and cerebral blood flow (CBF) with sex hormones in adults with type 2 diabetes (T2DM), which is associated with risk of brain atrophy.

Methods:
The sample was 215 participants with overweight or obesity and T2DM from the Look AHEAD Brain MRI cohort (mean age 68 years [SD: 6.3], 27% male, 73% female [all postmenopausal]; without exogenous hormones), who had brain MRIs to evaluate their total BV, WMHV and CBF. The ratio of brain measurements to intracranial volume was analyzed to account for body size. Estradiol (E2) and testosterone levels (T) were estimated with electrochemoluminescence assays. In females, who have low E2 and T levels, we compared brain measures in those with detectable (vs. undetectable) hormone levels (E2<20 pg/mL, 79%; T<0.02 pg/mL, 37%). In males, we used Spearman correlation to assess the association between brain measures and sex hormone levels. The associations between BV, WMHV and E2 and T were adjusted for age and BMI using linear regression.

Results:
Females with detectable (vs. undetectable) T levels had higher BV (p=0.04) (Table), which was attenuated after adjustment for age and BMI. WMHV and CBF were not statistically associated with sex hormone levels in females. In males, no brain measures were significantly associated with sex hormones levels.

Conclusions:
In postmenopausal females with T2DM, detectable levels of T were associated greater BV, but not associated any CBF or WMHV. In males, none of the brain measures were associated with sex hormones. Our findings are limited by a small, convenient sample size and low sensitivity of hormone assays with a high proportion of undetectable levels. Our findings suggest that larger samples with high sensitivity hormone assays are needed to assess clinically important differences.
Abstract P106: Prevalence of Cardiometabolic Risk Factors in Patients With versus Without Cancer: Insights From a Large US Healthcare System
Authors: Shahid Izza , Shah Aayush , Gullapelli Rakesh , Avenatti Eleonora , Carrasco Avila Jorge , Mandania Roshni , Farooq Nihan , Nagueh Sherif F , Malahfji Maan , Chang Jenny , Nasir Khurram
Published: March 2023

Background:
Although cardiometabolic dysfunction is associated with an increased risk of cancer, the prevalence of cardiometabolic risk factors in patients with and without cancer remains less well-established. Therefore, we aimed to examine the prevalence and association of cardiometabolic risk factors in patients with versus without cancer who do not have established atherosclerotic cardiovascular disease (ASCVD).

Methods:
Data of ∼1.1 million patients aged 18+ years in the Houston Methodist Learning Health System Outpatient Registry was utilized to identify patients with and without cancer with cardiometabolic risk factors including hyperlipidemia, diabetes mellitus (DM), obesity and hypertension using the ICD-10 codes. Patients with prevalent ASCVD were excluded. Age-adjusted prevalence of cardiometabolic risk factors was calculated and multivariate logistic regression models were utilized to determine the association between cardiometabolic factors and risk of cancer.

Results:
A total of 76,312 (7.8%) patients with cancer and 897,408 (92.2%) patients without cancer were included. Compared with patients without cancer, patients with cancer had increased age-adjusted prevalence of hypertension (38.4% vs 33.4%), obesity (30.7% vs 29.6%), hyperlipidemia (26.0% vs 22.0%) and DM (13.9% vs 11.0%). Compared with patients without cancer, patients with cancer had significantly increased odds of hyperlipidemia (OR 1.32 [1.30, 1.34]), hypertension (OR 1.82 [1.79, 1.85]) and DM (OR 1.42 [1.39, 1.45]). Conversely, obese patients were less likely to have cancer (OR 0.96 [0.95, 0.98]) compared with patients without cancer.

Conclusion:
Amongst patients without established ASCVD, increased prevalence of cardiometabolic risk factors is observed in patients with cancer versus without cancer. Strategies optimizing cardiometabolic health such as routine screening, monitoring, evaluation, and management of these factors should be prioritized to curtail adverse cardiovascular and cancer outcomes.
Abstract P108: Post-Diagnosis Body Weight Change and Cardiovascular Outcomes in Cancer Survivors
Authors: Lee Hyeok-Hee , Lee Hokyou , Lee Ga Bin , Shin Dong Wook , Kang Danbee , Youn Jong-Chan , Cho Juhee , Kim Hyeon Chang
Published: March 2023

Background:
The development of cancer and its treatment often entail changes in body weight. This study aimed to investigate the association of post-diagnosis body weight change with cardiovascular disease (CVD) risk in cancer survivors.

Methods:
From the Korean National Health Insurance database, we identified 112,565 3-year cancer survivors who had been diagnosed with cancer at age ≥20 years from 2006 through 2013 and had normal body weight (body mass index [BMI] 18.5-22.9 kg/m2) before a cancer diagnosis. In categorical analysis, participants were classified into 4 groups according to their post-diagnosis BMI: 1) obesity (BMI ≥25 kg/m2); 2) overweight (BMI 23-24.9 kg/m2); 3) normal weight (BMI 18.5-22.9 kg/m2); and 4) underweight (BMI <18.5 kg/m2). In continuous analysis, post-diagnosis change in BMI was assessed by subtracting pre-diagnosis BMI from post-diagnosis BMI. The primary outcome was CVD event, defined as a composite of myocardial infarction, stroke, heart failure, or cardiovascular death. We examined the association of post-diagnosis BMI change with CVD risk using cause-specific Cox model.

Results:
Over a median follow-up of 5.5 years, 3,797 new CVD events occurred. The cumulative incidence of CVD according to post-diagnosis BMI was the highest in the obesity group, followed by underweight, overweight, and normal weight groups (Figure A). The findings remained broadly consistent after multivariable adjustment; being obese post-diagnosis was associated with a higher CVD risk than maintaining normal weight (HR 1.28, 95% CI 1.05-1.58). However, being underweight post-diagnosis was no more associated with the risk of CVD (HR 0.99, 95% CI 0.86-1.14) (Figure B). Similar findings were observed in a continuous analysis (Figure C).

Conclusions:
Weight gain after a cancer diagnosis was associated with a higher CVD risk, whereas the association was null for post-diagnosis weight loss. CVD prevention programs for cancer survivors should consider incorporating strategies for preventing weight gain.
Abstract P111: Facilitators and Barriers to Physical Activity Among African American Long-Term Breast Cancer Survivors
Authors: Ford Yvonne R , Brown Bobbi
Published: March 2023

Introduction:
Breast cancer survivorship guidelines from the American Cancer Society (ACS) and American Society of Clinical Oncologists (ASCO) contain recommendations for health promotion, specifically obesity, nutrition, and physical activity. Breast cancer treatment is often cardiotoxic because of anthracycline- based drugs, radiation therapy, and use of monoclonal antibodies. Many African American (AA) BCS have preexisting conditions such as hypertension, obesity, and diabetes when diagnosed with breast cancer. Evidence suggests that breast cancer survivors (BCS) with sedentary lifestyles, obesity, and lack of physical activity have poorer outcomes among survivors. Research indicates AA BCS are less likely to be encouraged to lose weight or participate in physical activity by healthcare providers.

Hypotheses:
1) Physical inactivity, smoking, and suboptimal dietary patterns adversely affect cardiovascular health and survival of AA female BCS; and 2) Socioeconomic, cultural, and environmental factors serve as barriers or facilitators to adopting heart healthy behaviors and health outcomes.

Methods:
The sample consisted of 14 participants in three focus groups. Because these women had been discharged from acute oncology care, they were recruited from the AA community in Greensboro and Durham, NC. The organizations included cancer survivor organizations, religious and community organizations, and by referral from participants. Focus groups were held in locations that provided privacy for participants to verbally express themselves and interact with others freely. Anthropometric and biomarker data were collected from each participant and are reported elsewhere.

Results:
Using thematic analysis, verbatim transcripts were analyzed using word processing software. We familiarized ourselves with the focus group data, and continued with coding, theme generation, review and naming. The overarching themes identified were eating habits, thoughts about exercise, thoughts about weight, physician advice, and the importance of regular exercise.

Conclusions:
In conclusion, because many BCS are at risk for late and long-term cardiac effects of cancer treatment therapies, it is advisable to promote cardiovascular health behaviors that connect other health recommendations as suggested by the American Heart Association’s Life’s Simple 7. Accordingly, it is necessary to assess socioeconomic, cultural, and environmental factors that may influence heart healthy behaviors and health outcomes before creating culturally relevant interventions.
Abstract P115: Ethnic Differences in Cardiovascular Disease Deaths Among African American, African Immigrant and Afro-Caribbean Adults in the 1999-2018 National Health Interview Surveys
Authors: Ogungbe Oluwabunmi V , Turkson-Ocran Ruth-Alma , Baptiste Diana-Lyn , Larbi Kwapong Fredrick , Aidoo Emily , Commodore-Mensah Yvonne , Commodore-Mensah Yvonne
Published: March 2023

Background:
Black persons are an heterogenous group in the US and bear a disparate higher burden of worse cardiovascular disease (CVD) outcomes. Our objective was to examine ethnic differences in CVD mortality among Black subgroups; African Americans(AAs); African Immigrants(AIs); and Afro Caribbeans(ACs).

Methods:
We analyzed the 1999-2018 National Health Interview Survey data, prospectively linked to mortality records in the National Death Index on 23,169,679 Black adults. The outcomes was CVD mortality, defined as CVD and cerebrovascular deaths, which was modelled as time till death (in years). This was calculated from each survey year till time of death or December 31, 2019 (administrative censoring) for those who survived. Using multivariable Cox proportional hazards regression analyses to model the survival function, we evaluated differences in CVD-and cerebrovascular-cause specific deaths among the three groups with progressive adjustment for age, sex, socioeconomic status and CVD risk factors.

Results:
With median of 10 years of mortality follow-up, there were 2.44, and 1.86 CVD deaths per 1,000 person-years among AA, and foreign born black adults (AIs and ACs combined), respectively. CVD mortality hazard was 81% lower in AIs [hazard ratio [HR], 0.19 (95% CI, 0.13–0.29],
Table
) and 54% lower in ACs [HR, 0.46 (95% CI, 0.40–0.53], than among AAs. Compared to AAs, age-and sex-adjusted CVD mortality hazard was lower among AIs by 66% [HR, 0.34 (95% CI, 0.23–0.51],
Table
) and ACs (HR, 0.46 [95% CI, 0.40–0.53]) by 54% (unchanged from unadjusted). In the fully adjusted model with SES and CVD risk factors adjustment, ACs had 41% lower adjusted CVD mortality hazard than AA adults (HR, 0.59 [95% CI, 0.45–0.77]).

Conclusions:
Cardiovascular deaths were higher among US-born AAs than foreign-born ACs. Nativity status is an important determinant of CVD mortality, and the heterogeneity of this population should be considered in health disparities research and interventions.
Abstract P116: Racial/Ethnic and Nativity Differences in Cardiovascular Disease Mortality in the United States: Insights From the National Health Interview Survey 1999-2018
Authors: Turkson-Ocran Ruth-Alma , Ogungbe Oluwabunmi V , Nmezi Nwakaego A , Koirala Binu , Larbi Kwapong Fredrick , Aidoo Emily , Commodore-Mensah Yvonne
Published: March 2023

Background:
Racial/ethnic disparities in cardiovascular disease (CVD) deaths continue to persist, despite advances in preventive strategies. Few studies have examined disparities in CVD deaths by nativity status (US- vs. foreign-born).

Objective:
To assess differences in CVD deaths by nativity status across racial/ethnic groups in the US.

Methods:
Using a cross-sectional design, we pooled data from 1999-2018 National Health Interview Survey, with linked death records through 2019. Outcome, cardiovascular related deaths (CVD & CVA) was modelled, in years, as time from interview till year of death, or last date of follow-up (December 31, 2019). Nativity status was defined as US- or foreign-born. We used Cox proportional hazards regression to estimate differences in CVD deaths across racial/ethnic groups (White, Black, Asian, Indigenous American, and Hispanic adults) stratifying by nativity status. Models were sequentially adjusted for sociodemographic and CVD risk factors.

Results:
We included 172,896,665 adults (16% US-born, 84% foreign-born). During median 10 follow-up years, 3.41 CVD deaths /1,000person-years occurred. Among US-born adults, age-and sex-adjusted CVD death rates were 34% higher among Non-Hispanic Black adults (Hazard Ratio: 1.34; 95% CI, 1.29–1.39), 23% higher among Indigenous Americans (HR: 1.23; 95% CI, 1.00–1.52) compared to Non-Hispanic White adults
[Table]
. In the fully adjusted models, CVD death rates were 6% and 23% lower among Black (HR: 0.94 [95% CI, 0.89–0.99]) and Hispanic (HR: 0.77 [95% CI, 0.70–0.84]) adults. Compared to US-born White adults, CVD death was lower in foreign-born White (HR: 0.74; 95% CI, 0.66–0.82), Black (HR: 0.57; 95% CI, 0.45-0.73), Hispanic (HR: 0.55; 95% CI, 0.50–0.61), and Asian (HR: 0.61; 95% CI, 0.53–0.71) adults, respectively.

Conclusions:
Overall, CVD deaths were lower among foreign- than US-born adults. Although, there were some racial/ethnic differences in CVD deaths, we found evidence of persistent survival advantage among foreign-born adults.
Abstract P122: Life’s Simple 7 and Psychosocial Health Predict Physical Frailty, Hospital Frailty, and Comprehensive Frailty Index 10 Years Later
Authors: Wang Qi , Zhu Dongshan
Published: March 2023

Introduction:
Life’s Simple 7 (LS7) is a metric for cardiovascular health (CVH). Evidence has shown that LS7 in late life was linked to late-life physical frailty, while the association of LS7 in midlife with multidimensional frailty indicators in late life remains unclear. In addition, there might be synergistic interactions between cardiovascular health and psychosocial health factors on risk of frailty.

Hypothesis:
Based on the bio-psycho-social medical model, we hypothesized that midlife LS7 status might be related to late life multidimensional frailty indicators (physical frailty, hospital frailty, and comprehensive frailty index), and psychosocial health (social isolation and loneliness) might interact the association between LS7 and frailty.

Methods:
We used cohort data from UK Biobank. CVH was measured by LS7. A higher score indicated better CVH. Psychosocial health status was measured by social isolation and loneliness and divided into good or poor. Frailty was assessed using physical Frailty Phenotype (FP), a validated Hospital Frailty Risk Score (HFRS) and a comprehensive Frailty Index (FI). Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) on the association between the LS7 score, psychosocial health, and frailty. The synergistic effects of LS7 and psychosocial health on frailty were also analyzed. All HRs were adjusted for sex, age at last follow-up, race, education level, alcohol drinking, and income.

Results:
For the association of LS7 with FP and FI, 39,047 individuals who attended baseline and visit 2 were included. After a median follow-up of 9.0 years, FP identified 1,329 (3.4%) people with frailty, and FI identified 5,699 (14.6%) with frailty. For association of LS7 with HFRS, 366,570 people were included. After a median follow-up of 12.0 years, 18,737 (5.1%) people were identified as with hospital frailty. Compared to people with poor LS7 score, those with intermediate (FP:HR=0.64, 0.54-0.77; FI: HR=0.77, 0.69-0.86; HFRS: HR=0.60, 0.58-0.62) and optimal LS7 score (FP: HR=0.31, 0.25-0.39; FI: HR=0.62, 0.55-0.69; HFRS: HR=0.39, 0.37-0.41) were associated with lower risk of frailty. Poor psychosocial health was associated with an increased risk of frailty (FP: 1.87, 1.44-2.43; FI: 1.46, 1.24-1.71; HFRS: 1.53, 1.44-1.62). We observed synergistic effects of LS7 and psychosocial health on frailty. People who had good psychosocial status and optimal LS7 score had the lowest risk of frailty (FP: 0.30, 0.24-0.38; FI: 0.63, 0.56-0.70; HFRS: 0.38, 0.36-0.41).

Conclusions:
Higher LS7 score or good psychosocial health in midlife was associated with reduced risk of physical frailty, hospital frailty, and overall frailty. Psychosocial status interacted with LS7 on frailty. Individuals who had good psychosocial health and optimal LS7 score were associated with the lowest risk of frailty.