bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P061: Perfluoroalkyl Acids and Stroke Risk in Persons with and without Diabetes: A Salutatory Effect of High Oxygen Carrying Capacity Environmental Contaminants
Authors: Conway Baqiyyah , Costacou Tina
Published: March 2022

Background:
Perfluroakly acids (PFAAs) are persistent environmental contaminants linked to certain adverse health outcomes; however, their association with macrovascular diseases has been equivocal. PFAAs are also potent oxygen transporters used in organ preservation and synthetic blood development. Little information is available on the relationship of PFAAs with risk of stroke, for which ischemia in the brain blood vessels is a major cause. Persons with diabetes are at 2-to-9-fold increased risk of stroke, largely due to an increased risk of ischemic stroke. We thus tested the association of four common PFAAs with stroke, and whether this varied by diabetes status.

Methods:
Participants were drawn from the C8 Health Project (n=5,270 and 48,832 w/ and w/out diabetes, respectively, age≥20 ys), which collected blood samples, self-reported demographics, medical diagnoses, height, and weight in 2005-2006 as part of a legal settlement following perfluorooctanoate (PFOA) contamination of drinking water in West Virginia and Ohio. Four PFAAs were assessed separately: PFOA, perfluorononaoic acid (PFNA), perfluorohexane sulfonate (PFHxS), and perfluoroctane sulfonate (PFOS). Estimated glomerular filtration rate (eGFR) was assessed via the MDRD formula.

Results:
There were 344 (6.5%) stroke cases among those with diabetes and 731 (1.5%) among those without diabetes. Adjusting for age, sex, and eGFR, higher concentrations of each of the PFAAs were associated with a lower likelihood of stroke (OR for PFOA=0.93, 0.88-0.97; OR for PFNA=0.83, 0.74-0.94; OR for PFOS=0.83, 0.77-0.90; OR for PFHxS=0.82, 0.76-0.89). Effect modification by diabetes status was observed for the sulfonate PFAAs (p-interaction <0.001 each). In those with diabetes, higher concentrations of PFOS were associated with a significantly greater reduction in the likelihood of stroke (OR=0.76, 0.69-0.87) than the risk reduction in those without diabetes (OR=0.93, 0.84-1.04). For PFHxS, higher serum concentrations were associated with 31% lower likelihood of stroke in persons with diabetes (OR=0.69, 0.61-0.79) but only a 3% lower likelihood in persons without diabetes (OR=9=0.97, 0.88-1.07). No such effect modification by diabetes status was observed for PFOA or PFNA (p-interaction>0.30 each).

Conclusion:
PFAAs are inversely related to stroke risk. This relationship appears to be stronger in persons with diabetes, perhaps due to the salutary effect of the high oxygen carrying capacity of these substances and the longer half- life of PFAA sulfonates in human proteins than the non-sufonate containing PFAAs.
Abstract P062: Individual Level Fine Particulate Air Pollution is Associated with Acute Impairment of Cardiac Autonomic Modulation in Adolescents
Authors: He Fan , Yanosky Jeff D , Bixler Edward O , Fernandez-Mendoza Julio , Vgontzas Alexandros N , Chinchilli Vernon M , Liao Duanping
Published: March 2022

Introduction:
Fine particulate (PM
2.5
) air pollution has been associated with impaired cardiac autonomic modulation (CAM) in adults. The association between PM
2.5
exposure and CAM in adolescents is rarely investigated.

Hypothesis:
We assessed the hypothesis that PM
2.5
air pollution is related to acute impairment of CAM in adolescents.

Methods:
We used data from 421 adolescents in the Penn State Child Cohort follow-up examination. We obtained 24-hour ECG data using a 12-lead Holter ECG from each participant. After removing artifacts and arrhythmic beats, we performed heart rate variability (HRV) analysis on normal RR intervals to compute 30-min based high frequency (HF) and low frequency (LF) powers, standard deviation of RRs (SDNN), and the square root of mean of the sum of the squared differences of the adjacent RRs (RMSSD). Individual level 24-hour PM
2.5
concentration was obtained by a personal PM
2.5
monitor. We then calculated, on a 30-min basis, the corresponding time-specific exposure to PM
2.5
. Distributed lag models under a framework of linear mixed-effects model, with a first-order autoregressive covariance structure, were used to assess the segment-specific and cumulative effect of 30-min based PM
2.5
and HRV indices.

Results:
As shown in the table, both individual lag and cumulative effects of PM
2.5
on HRV, based on the lag 0-6 model, were significant after controlling for major covariates. For instance, for a 10 μg/m
3
increase in cumulative PM
2.5
, HF and SDNN decreased by 0.023 (SE=0.006) ms
2
and 0.61 (SE=0.16) ms, respectively. A 10 μg/m
3
increase in PM
2.5
was also significantly associated with elevated heart rate (0.25 (SE=0.09) beat/min). Individual lag effects of PM
2.5
were most consistently associated within 1.5 hours.

Conclusion:
Individual level exposure to PM
2.5
in adolescents is associated with impaired CAM, towards an elevated sympathetic and decreased parasympathetic outflow. The time to the apparent cumulative effect is about 3 hours, with the most consistent individual lag effects within 1.5 hours.
Abstract P072: Early Response Predicts One-Year Weight-Reduction Goal Achievement with MOVE!®
Authors: Garvin Jane , Cota Karen
Published: March 2022

Introduction:
Previous reports suggested that age, gender, race, and participation predicted weight reduction in the weight-reduction program, MOVE!®, available at Veterans Administration Medical Centers. It is not known if early response to the MOVE!® program predicts continued participation or weight reduction.

Hypothesis:
We assessed the hypothesis that early weight reduction success with MOVE!® would predict ongoing participation and weight-reduction goal achievement at one year.

Methods:
Using longitudinal clinical data from electronic health records of 107 MOVE!® program participants with 1-month and 1-year data, MOVE!® sessions and weight reduction were examined in this secondary analysis. Participation was based on group session attendance. Attending 14 or more sessions within the first 6 months was selected as a participation cut point based on the 2013 guidelines for overweight and obesity management. Early response was based on at least 1% weight reduction from baseline at week four. Weight-reduction success at one year was based on at least 5% reduction from baseline.

Results:
Participants were 59.3 (SD=11.1, SEM=1.1) years of age on average; female 13% (14 of 107); African American 54% (58 of 107); Caucasian 46% (49 of 107); with a mean BMI of 35.5(SD=5.0, SEM=0.49) and attended 7.3 (SD=4.9 , SEM=0.5) sessions on average. Total 6-month group session participation was not explained by early weight reduction success (t = 0.81; CI -1.11, 2.63; p = .42). Early responders were no more likely to participate in 14 or more MOVE!® sessions within 6 months than participants who were not early responders (OR = 1.2; CI 0.34, 4.20; p = .78). Early responders were seven times as likely to achieve at least the 5% weight reduction goal at one year compared to those participants who were not early responders, while controlling for age, gender, race, and total group sessions (OR = 6.96; CI 1.85, 26.13; p = .004).

Conclusions:
Early response was a significant predictor of at least 5% weight reduction goal achievement at one year. However, early response was not a predictor of participation or ongoing participation reaching 14 sessions in 6 months. Further study is needed to determine genetics as well as other predictors of early response to MOVE!®.
Abstract P081: Late-onset Asthma Predicts Cardiovascular Disease Events: The Wisconsin Sleep Cohort
Authors: Tattersall Matthew C , Barnet Jodi H , Korcarz Claudia E , Hagen Erika W , Peppard Paul E , Stein James H
Published: March 2022

Background:
Asthma is a heterogeneous syndrome with different clinical subtypes that is associated with an increased risk for cardiovascular disease (CVD). We hypothesized that the late-onset subtype of asthma is associated with a higher risk of incident CVD.

Methods:
Presence of asthma and age of diagnosis were assessed at baseline in the ongoing population-based Wisconsin Sleep Cohort study, an investigation of sleep, respiratory and cardiovascular outcomes in adults followed prospectively since 1988. Late-onset asthma was defined as physician-diagnosed asthma at age 18 years or older. Participants were free of baseline CVD and followed for a mean (standard deviation) 13.9 (5.9) years for development of CVD (coronary death, myocardial infarction, angina, stroke, coronary revascularization, heart failure, or CVD death). Multivariable Cox regression models adjusted for age, sex, smoking, hypertension, body-mass index (BMI), and presence of diabetes mellitus were used to assess associations of late-onset asthma and incident CVD.

Results:
The 1269 participants were 47.3 (8.0) years old; 166 participants had asthma (111 with late-onset asthma, 55 early-onset asthma and 1103 without asthma). Participants with late-onset asthma compared to non-asthmatics were more likely to be female (67% vs 44%), have a higher BMI (32.2 vs 29.4 kg/m2) and more likely to be hypertensive (38% vs 29%) (all p<0.05). Mean age of asthma diagnosis in the late-onset group was 39.5 (9.6) years vs. 8.9 (5.7) years in the early onset group (p< 0.0001). After adjustment for confounders, late-onset asthmatics had a higher risk of incident CVD events than non-asthmatics (Hazard Ratio 1.57, 95% confidence intervals 1.01-2.45, p=0.045, see figure). There was no interaction between BMI and age of asthma diagnosis on incident CVD (p=0.83).

Discussion:
In a large cohort study of adults followed prospectively for over a decade, only late-onset asthmatics had an increased risk of incident CVD events. CVD risk associated with asthma may depend on asthma subtype.
Abstract P094: Accuracy of Self-reported Heart Failure Following a Hospitalized Heart Failure Event: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Camplain Ricky , Kucharska-Newton Anna , Wruck Lisa M , Folsom Aaron R , Wright Jacqueline , Shah Amil , Bertoni Alain , Heiss Gerardo
Published: March 2022

Background:
Self-reports of heart failure (HF) are relied upon to quantify the burden of HF in the community. While self-report of HF is often considered subject to recall bias, accuracy of self-reported HF following a HF hospitalization has not been estimated.

Methods:
Hospital admission of ARIC cohort members is monitored on an ongoing basis. Starting in 2005, hospital records with HF were abstracted and events validated with a standardized protocol based on review of history and physical examination, echocardiography, nuclear imaging, chest X-ray, catheterization reports, cardiac markers, and discharge summary. HF was classified as acute decompensated HF (ADHF) or chronic stable HF (CSHF). Also starting in 2005, ARIC participants were asked annually to report whether a physician had told them they have HF or a weak heart. Those self-reporting HF were asked to authorize release of medical information and their providers of medical care were sent a survey to confirm their patient’s HF status, HF characteristics, and treatment status.

After excluding participants with a HF hospitalization prior to 2005 (defined by an ICD-9 discharge code of 428 in any position), self-reported HF following an incident HF hospitalization was quantified as the proportion of hospitalized participants who self-reported HF (sensitivity) and the proportion of non-hospitalized participants who did not self-report HF (specificity). The proportion of self-reported HF confirmed by physicians was calculated among those with a returned survey.

Results:
Of the 10,509 ARIC participants alive from 2005-2013, 512 were hospitalized with ADHF and 154 were hospitalized with CSHF prior to self-reporting their HF status and 328 self-reported having HF. Comparing self-reported to hospitalized HF, sensitivity was poor (0.28) and specificity excellent (0.99), although some participants who self-reported HF but were not hospitalized may have been diagnosed in the outpatient setting. A physician survey was available for 92 participants who self-reported HF. In 64 (70%; 95% confidence interval (CI): 61, 80) instances, self-reported HF was confirmed by their physician. Of the latter, 23 (36%; 95% CI: 24, 48) were reported as diastolic dysfunction while 19 (30%; 95% CI: 18, 41) and 8 (13%; 95% CI: 4, 21) were characterized as systolic dysfunction or mixed, respectively. HF type was not specified by the physician in 14 cases. Seventy-eight percent (95% CI: 68, 89) of patients with confirmed HF, the physician also reported HF treatment.

Conclusion:
Self-report of HF was highly specific and quite insensitive calling into question the validity of self-reports of HF. Our results underscore the need for methods more effective than self-report to identify persons with clinically manifest HF.
Abstract P101: Menopause and its Related Endogenous Sex Hormone Alterations are Associated with Changes in Function and Subclasses of High-density Lipoprotein in Women at Midlife
Authors: El Khoudary Samar R , Hutchins Patrick , Matthews Karen A , Brooks Maria M , Orchard Trevor J , Heinecke Jay W
Published: March 2022

Objective:
Growing evidence challenges the cardioprotective effects of high-density lipoprotein-cholesterol (HDL-C) in postmenopausal women. HDL particle size and concentration are heterogeneous and HDL-C only measures the cholesterol content of all HDL particles. Therefore, HDL-C does not necessarily reflect HDL subclasses or functionality, which may be more important in predicting CVD risk. Our main objective was to characterize HDL subclasses and functional alterations over menopause and to evaluate their associations with changes in estradiol (E2) and follicle stimulating hormone (FSH), cardinal hormonal markers of menopause.

Methods:
Participants were drawn from the Study of Women’s Health Across the Nation (SWAN) at the Pittsburgh site. The women had stored blood specimens at two time points; one before and one after they reached menopause. HDL particle concentration and size using calibrated ion mobility analyses and HDL cholesterol efflux capacity (HDL-CEC) with radiolabeled J774 macrophages were measured at the two time points. None of the study participants were on lipid lowering medications or hormone therapy.

Results:
The study included 50 women (66% White and 34% Black), who were 47 (45, 49) years old (median (Q1, Q3)) and were either pre- (38%) or early peri-menopause (62%) at the first time point. At the second time point, all participants were postmenopausal with a median (Q1, Q3) time since their final menstrual period of 2.14 (1.55, 3.41) years. After menopause, women had significantly higher concentrations of total and large HDL particles, and smaller sizes of medium and small HDL particles (all P<0.05), independent of race and change in age. HDL-CEC was significantly higher after menopause. Independent of age and race, larger declines in E2 were correlated with a more atherogenic changes (smaller increases in large HDL particles and larger increases in small HDL particles concentrations, P<0.05). Additionally, greater rises in FSH were correlated with bigger reductions in sizes of large and medium HDL particles (P<0.05).

Conclusions:
Within a median of 2.14 years of menopause, an improvement in HDL-CEC and significant alterations in HDL particle subclasses were observed. Whether patterns of these alterations change further in late postmenopause and how they relate to atherosclerotic risk are not known. The reported changes in HDL metrics over menopause warrant further evaluation of their potential risk on CVD after menopause.
Abstract P107: Small Dense Low Density Lipoprotein Subfractions are Independently Associated with Subclinical Atherosclerosis: The ELSA-Brasil study
Authors: Bittencourt Marcio S , Santos Raul D , Staniak Henrique , Jones Steven , Martin Seth S , Toth Peter , Blaha Michael J , Bensenor Isabela , Lotufo Paulo A
Published: March 2022

Introduction:
Low-density lipoproteins (LDL) are established risk factors for cardiovascular disease and a therapy target. Prior studies suggest that among the pool of plasma LDL, the small and dense subfractions are more strongly associated with risk. In the present study, we investigated whether LDL particle density is associated with the presence of subclinical atherosclerosis detected by coronary artery calcium score.

Methods:
We included 2869 (50.3±8.5 years, 54% women) participants from the ELSA-Brasil study who had no prior history of CVD, were not currently using lipid-lowering medications, and underwent CAC evaluation. We measured the fasting lipoprotein cholesterol fractions (in mg/dL) using the vertical auto profile (VAP) ultracentrifugation method. We analyzed the independent predictive values of LDL-1, LDL-2, LDL-3 and LDL-4, as well as the ln transformed ratio of small and dense (LDL-3 and LDL-4) to larger and more buoyant LDL particles (LDL-1 and LDL-2) (LLDR (Logarithmic of LDL Density Ratio)) using logistic regression.

Results:
Overall 749 (26%) of the participants had a CAC >0, and 241 (8.1%) had a CAC > 100. The mean LDL-1, LDL-2, LDL-3 and LDL-4 cholesterol were respectively (mg/dL): 22.5±9.4, 32.7±17.9, 47.1±20.4 and 10.4±10.8. Individuals with CAC>0 had higher LDL-1, LDL-3 and LDL-4, but LDL-2 was not significantly different between groups. LLDLR was also significantly higher in those with CAC>0. LLDR was associated with CAC>0 even after multivariable adjustment for age, gender, smoking, diabetes, hypertension, systolic blood pressure and Friedwald LDL-cholesterol. (p<0.01).

Conclusion:
In a large cohort of asymptomatic individuals, the ratio of small and dense to larger buoyant LDL-C particles is associated with CAC score. This association is independent and complementary to the calculated LDL-cholesterol levels.
Abstract P108: Cardiac Interventions Differing in Lifestyle Modification Intensity Improve Insulin Resistance Through Changes in Lipoprotein Profiles
Authors: Ellsworth Darrell L , Costantino Nicholas S , Blackburn Heather L , Engler Renata J , Vernalis Marina N
Published: March 2022

Background:
Metabolic dysfunction characterized by insulin resistance (IR) is an important risk factor for type-2 diabetes and coronary artery disease (CAD). The Lipoprotein Insulin Resistance (LP-IR) index, derived from measures of lipoprotein subclass particle concentration and size, is useful for assessing IR and identifying patients with increased diabetes/CAD risk.

Hypothesis:
This study addressed the hypothesis that lifestyle modification programs differing in scope and intensity both improve IR through changes in lipoprotein profiles.

Methods:
Patients with CAD or significant CAD risk factors participated in one of two clinical lifestyle interventions: 1) an intensive nonrandomized program with a strict vegetarian diet (n=90 subjects, 90 matched controls) or 2) a moderate randomized trial following a Mediterranean-style diet (n=89 participants, 58 controls). On-treatment and intention-to-treat analyses used regression modelling adjusted for CAD risk factors and lipid-lowering medication use to assess changes over one year in LP-IR, lipoprotein profiles, and CAD risk factors in intervention and control participants in both programs.

Results:
Participants in the intensive lifestyle intervention had poorer baseline cardiovascular health than patients in the moderate program. In the on-treatment analysis, both lifestyle interventions led to weight loss [-8.9% (95% CI: -10.3, -7.4), intensive program; -2.8% (95% CI: -3.8, -1.9), moderate program; adjusted p<0.001] and a decrease in the LP-IR index [-13.3% (95% CI: -18.2, -8.3), intensive; -8.8% (95% CI: -12.9, -4.7), moderate; adjusted p<0.01] compared to respective controls over one year. Of the six lipoprotein parameters comprising LP-IR, only large very-low-density lipoprotein (VLDL) particle concentrations decreased significantly in patients compared to controls in both programs [-26.3% (95% CI: -43.0, -9.6), intensive; -14.2% (95% CI: -27.4, -1.0), moderate; p<0.05]. Intention-to-treat analysis confirmed and strengthened the primary results.

Discussion:
In conclusion, moderate lifestyle modification following a Mediterranean diet is comparable to a stringent intervention with a vegetarian diet for improving IR defined by the LP-IR index. Significant reductions in large VLDL particles may drive improvement in IR irrespective of the magnitude of lifestyle changes.
Abstract P117: Physical Activity Decreases Cardiovascular Events via an Inflammatory Pathway: The Strong Heart Study
Authors: Singh Parmanand , Almarzooq Zaid , Roman Mary , Devereux Richard
Published: March 2022

Background:
Prior work has shown that fibrinogen, an accepted pro-inflammatory marker, predicts cardiovascular (CV) events. While it is known that physical activity imparts CV health benefits, its impact on systemic inflammation has not been fully explored.

Objectives:
To investigate the relationship between activity, inflammation, and CV death, we tested the hypotheses that, (i) activity results in less CV death, and (ii) the CV benefit of activity is partially due to lower systemic inflammation.

Methods:
We examined the association between activity (leisure-time plus occupational as METS-hours per week) and CV death among 4,038 adults (mean age 56 ± 3) without baseline CV disease in phase I of Strong Heart Study (1989-1991), a longitudinal study among American Indians. Regression models were used to assess associations between activity, fibrinogen and CV death. Kaplan-Meir analysis was used to plot survival based on activity.

Results:
After 10 years of follow-up (1989-1999), 308 fatal CV events occurred. Compared to subjects with minimal activity, those with higher activity levels had a significantly lower risk of CV death (p=0.002, Fig 1A). Odds ratios were 0.79 (95% CI: 0.59-1.06), 0.65 (0.48-0.88), and 0.46 (0.33-0.65) for increasing activity (in quartiles), after adjustment for age, sex, smoking, diabetes, hypertension, LDL, and renal disease. In addition, increasing activity was associated with lower fibrinogen levels (p<0.001; Fig. 1B). Moreover, increasing activity resulted in lowest CV death in subjects with low fibrinogen levels, a benefit that extended to patients with high fibrinogen levels (Fig 1C). These results persisted independent of traditional CV risk factors and body fat (p<0.001).

Conclusion:
In a population-based study of American Indians, physical activity was associated with less CV death, in part, mediated via an anti-inflammatory pathway. This study identifies activity as an important modulator of CV outcomes among American Indians, possibly due to lower levels of systemic inflammation.
Abstract P126: Physical Activity, Family History of Premature Coronary Heart Disease, and Incident Atherosclerotic Cardiovascular Disease in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Florido Roberta , Zhao Di , Ndumele Chiadi E , Lutsey Pamela L , McEvoy John W , Windham Beverly G , Pankow James S , Guallar Eliseo , Michos Erin D
Published: March 2022

Background:
Family history (FHx) of coronary heart disease (CHD) is a well-established risk factor for incident atherosclerotic cardiovascular disease (ASCVD). Certain interventions (e.g. smoking cessation) may be more effective in those with a FH of CHD. Physical activity (PA) is associated with reduced risk of ASCVD. Whether this association varies by FHx of premature CHD is not well established.

Methods:
We evaluated 9,996 ARIC participants free of ASCVD, and with data on FHx of CHD or PA at Visit 1 (1987-1989). FHx of premature CHD was defined as CHD occurring in a father before the age 55 or in a mother before age 60, as reported by each participant. PA was assessed using a modified Baecke questionnaire, subsequently converted into min/wk of moderate or vigorous exercise. PA was categorized as per AHA guidelines as recommended, intermediate, or poor (see footnote to
Table
). Incident ASCVD was defined as incident myocardial infarction, fatal CHD, or stroke. Multivariable adjusted Cox proportional hazard models were used.

Results:
The mean age was 54±6 years, 56% were women and 21% of black race. Participants with FHx of premature CHD had more adverse lipid profiles but otherwise similar ASCVD risk factors. Participants with and without a FHx of premature CHD reported similar levels of PA at baseline (409 vs 423 MET/min/week, respectively, p=0.85), and approximately 40% of both groups met AHA recommended PA levels. Over a mean follow-up of 20.9 years, there were 1,723 incident ASCVD events. Compared with poor, recommended levels of PA were associated with a significantly lower risk of incident ASCVD (
Table
) without a significant interaction by FHx status (p-interaction=0.68).

Conclusion:
Despite their FHx and their more adverse lipid profiles, individuals with a FHx of premature CHD had similar PA patterns as compared to those without a FHx, with less than half meeting AHA recommended levels. PA was similarly beneficial against incident ASCVD for both groups. Promotion of PA should be encouraged for all regardless of FHx status.
Abstract P128: Accelerometer-determined Moderate to Vigorous Physical Activity and the Cardiovascular Response to Stress in Children
Authors: Spartano Nicole L , Heffernan Kevin S , Dumas Amy K , Gump Brooks B
Published: March 2022

Background:
Physical activity (PA) has been associated with lower cardiovascular reactivity in adults, but little data is available in children. The purpose of this study was to examine the relationship between PA and cardiovascular reactivity to stress in children.

Methods:
This study sample included children from the Oswego Lead Study (n=79, 46% female, 9-11 years old). Impedance cardiography was performed while children participated in a stress response protocol consisting of three stress tasks in random order, separated by 8-minute intertask rest periods. Change in heart rate (HR) and systolic and diastolic blood pressure (SBP and DBP) (from baseline to stress level) were standardized within each task, then averaged across tasks (zMean [[Unable to Display Character: ∆]]). Total peripheral resistance (TPR) was calculated using BP and cardiac output (CO); TPR = ([(SBP-DBP)/3] + DBP)/CO X 80. Percent change in TPR (from baseline to stress level) was standardized within each task, and then averaged across tasks (zMean %[[Unable to Display Character: ∆]]). Children were also asked to wear Actigraph accelerometers on their wrists for 3 days to measure intensity and duration of PA and sedentary time.

Results:
In multivariable regression models, moderate to vigorous (MV) PA was associated with a lower body mass index (BMI) percentile, lower resting heart rate (HR), and lower TPR response to stress (Table 1; all p < 0.05). After additional adjustment for BMI, MVPA was also associated with lower diastolic blood pressure response to stress (p < 0.05). Sedentary time was not associated with resting measures or cardiovascular responses to stress (data not shown).

Conclusions:
A modest relation was observed between MVPA and vascular reactivity to stress in children after accounting for the effect of BMI. These data provide confirmatory evidence that the promotion of PA recommendations for children are important for cardiovascular health.
Abstract P133: Comparative Effectiveness of Aerobic, Resistance, and Combined Training on Health-related Quality of Life in Inactive, Overweight/Obese, and Pre-/Stage 1-Hypertensive Individuals: A Randomized Controlled Exercise Trial
Authors: Lee Duck-chul , Schroeder Elizabeth C
Published: March 2022

Introduction:
Although regular exercise has been shown to improve health-related quality of life (HRQOL), there is still very little evidence on what type or combination of exercise is most effective for the improvement of HRQOL.

Hypothesis:
We examined the hypothesis that the combination of aerobic and resistance training has a greater improvement in HRQOL than aerobic training (AT) or resistance training (RT) only, in individuals with a relatively lower HRQOL who are inactive, overweight or obese, and pre- or stage 1-hypertensive.

Methods:
This 8-week randomized controlled exercise intervention included 69 adults aged at least 45 years old (mean age 58 years, 61% female, mean body mass index 32.4 kg/m2). All participants were randomly assigned to 1) AT only, 2) RT only, 3) a combination of AT plus RT, or 4) no exercise control group. All exercise participants had the same exercise duration (time-matched), 3 days per week for 60 minutes per session (total 180 minutes per week). We used the Short-Form 36-item Health Survey (SF-36) questionnaire to measure HRQOL. All participants were included in the intention-to-treat analyses. We used linear mixed-effects models for repeated measures over time, and all analyses were adjusted for baseline values of each HRQOL domain, age, and sex.

Results:
From pre to post test, the AT improved two domains of the HRQOL: vitality (p<0.01) and mental health (p=0.03), and the combined AT plus RT improved three domains: vitality (p=0.01), mental health (p=0.04), and general health (p<0.01). Also, all exercise participants reported a significant improvement in health using the health change question of the SF-36 from pre to post test (all p values <0.05). Further, participants in the combined AT plus RT group reported a significant improvement in health, compared to the control group (p<0.01). In the analyses of the changes in total SF-36 score including all HRQOL domains, we found 3.4% (p=0.32), 5.3% (p=0.11), 8.5% (p=0.01), and 1.6% (p=0.63) improvement in total HRQOL in the AT, RT, combined AT plus RT, and control group, respectively, from pre to post test.

Conclusions:
In individuals who are inactive, overweight or obese, and pre- or stage 1-hypertensive, our results suggest that a combined AT plus RT exercise regimen appears to be more effective in improving HRQOL by providing additive benefits, compared to time-matched AT or RT only.
Abstract P136: The Effect of Exercise Training on 10-Year Atherosclerotic Cardiovascular Disease Risk in Individuals with Type 2 Diabetes
Authors: Swift Damon , Johannsen Neil M , Lavie Carl J , Earnest Conrad P , Blair Steven N , Church Timothy S
Published: March 2022

Introduction:
The American Heart Association (AHA) pooled cohort equations provide sex and race specific estimates of 10-year atherosclerotic cardiovascular disease (ASCVD) risk based on traditional risk factors, but not physical activity (PA) or fitness. The effect of exercise training on estimated ASCVD risk has not been previously evaluated, which is clinically relevant to individuals with type 2 diabetes (T2D) who have increased risk of ASCVD. The purpose of the present study is to determine the effect of aerobic (AER), resistance (RES) or combination (COMB) exercise training on 10-year ASCVD risk in individuals with T2D.

Methods:
The present study is an ancillary analysis of the Health Benefits of Aerobic and Resistance Training Study (HART-D). Adults with T2D (n=148) were randomized to 9 months of AER, RES, COMB exercise training or a control group (CON); 10-year ASCVD risk was calculated using the AHA pooled cohort equations based on each participants’ demographic (age, sex, race) and clinical data (high density lipoprotein, total cholesterol, systolic blood pressure/history of hypertension) and known T2D status at baseline and follow-up. Change in ASCVD risk was evaluated with an analysis of covariance with adjustment for baseline ASCVD risk.

Results:
Participants in the present analysis had a mean (SD) 10-year ASCVD risk of 12.2% (9.4). Baseline ASCVD risk was associated with body fat (r=-0.22, p< 0.001) and duration of T2D (r=0.18, p=0.03), but not with peak VO
2
, hemoglobin A
1C
, or other cardiometabolic variables (p>0.05).

No significant change in ASCVD risk was observed in the AERO (-0.36%, CI: -1.44 to 0.71), RES (-0.43%, CI: -1.49 to 0.63) and the COMB groups (-0.54%, CI: -1.57 to 0.49) compared to the CON (0.02%, CI: -1.26 to 1.31) group. However, in exercisers only, the change in diastolic blood pressure was associated with change in ASCVD (r=0.34, p<0.001), but not change in hemoglobin A
1C
, peak VO
2
, body fat mass, or other cardiometabolic risk factors (p>0.05).

Conclusions:
The present study suggests that 9 months of exercise training did not reduce ASCVD risk predicted by the pooled cohort equations. Since exercise training is recommended by the AHA to reduce ASCVD risk especially in adults with T2D, future studies should evaluate if adding a variable that represents physical activity and/or fitness provides additional discrimination in the prediction of ASCVD.
Abstract P137: Examining the Effect of the Accumulation of Physical Activity on Blood Pressure in a Physical Activity Intervention for Community Dwelling Older Adults
Authors: Full Kelsie M , Crist Katie , Godbole Suneeta , Kerr Jacqueline
Published: March 2022

Background:
High blood pressure is one of the most common health conditions experienced by US older adults. Hypertension leads to heart disease, CVD incidence, stroke, and death. In older adults, community based physical activity (PA) interventions have been shown to significantly decrease systolic and diastolic blood pressure.
The American Heart Association Physical Activity Guidelines
recommend that adults accumulate at least 150 minutes of moderate-vigorous intensity physical activity (MVPA) per week in order to obtain substantial health benefits. It is not clear whether accumulation of total minutes of physical activity is more important for significant changes in cardiovascular health, including reductions in blood pressure levels, or whether the intensity of the physical activity is important. New physical activity assessment techniques allow us to assess daily minutes of intensity outside of the clinic environment.

Study Objectives:
The objective of this study was to assess the effects of total accumulation of PA, independent of time spent in MVPA, on changes in blood pressure in older adults participating in a 6-month physical activity intervention.

Methods:
Study data are from a multilevel physical activity intervention (MIPARC) for older adults. Residents over the age of 65 years (N=307, mean age 84) were recruited from 11 retirement communities in San Diego. Study evaluation included collection of blood pressure measures and 6 day hip-worn accelerometry data. Change in blood pressure (dependent variable) and PA (intensity and total) from baseline to 6 months and 6 months to 12 months were examined. To account for within person and within group clustering, hierarchical longitudinal mixed effect models were used.

Results:
Increases in total PA counts was related to significant decreases in systolic blood pressure over the 12-month intervention period, after adjusting for minutes of time spent in MVPA (p<.005).

Conclusions:
Evidence is mixed on the intensity of PA needed for older adults to experience significant health benefits, including reducing blood pressure. The results of this study suggest that for older adults, the total accumulation of PA at any intensity, is more important than PA at moderate to vigorous intensities. These findings have important implications for the design of PA interventions and

PA prescriptions for older adults. More research is needed in older adult populations to examine if MVPA is beneficial to older adults, or if the relationship varies by an individual’s cardiovascular health.
Abstract P143: Potential Dietary Impact of Adding Potassium Chloride to Foods as a Sodium Reduction Technique
Authors: van Buren Leo , Dotsch-Klerk Mariska , Newson Rachel S
Published: March 2022

Introduction:
High sodium intake increases the risk of developing cardiovascular disease, which is particularly concerning as globally sodium intake is too high. The food industry is engaged in the reformulation of products towards a reduced sodium chloride content, however this is challenging to do so while maintaining good preservation, texture and taste properties. To ensure that consumers repeatedly use lower salt products it is important that reformulation is done well. One leading method to achieve sodium reduction is partial replacement of sodium chloride by potassium chloride. Potassium chloride is a good salt replacer as it adds to the salty taste and independently has positive health benefits. However, if the replacement of sodium chloride by potassium chloride widens, it is important to understand the potential health and safety implications of this. Therefore, we evaluated in a population-based survey the current intake of sodium and potassium, the key contributing food groups to both minerals in the diet and the potential impact of different reformulation scenarios.

Methods:
Intake data was obtained from the Dutch National Food Consumption Survey (2007-2010). Sodium and potassium intake were calculated with NEVO values. Reformulation scenarios were calculated where products were theoretically reformulated to: 1) attain a dietary intake of sodium of 2000mg/day, and 2) where removed sodium chloride was replaced by various potassium chloride levels, based on acceptable sensorial limits.

Results:
Of the Dutch population 33% were compliant with the Daily Recommended Intakes for sodium (3,510mg/day). Main contributing food groups to sodium were: bread, processed meat and cheese, which accounted for 53% of intake. For potassium: milk products, beverages, potato/rice/pasta, and fresh meat, which accounted for 50% of intake. In the first reformulation scenario where all sodium chloride was replaced by potassium chloride, potassium intake compliance increased to 67%. The second scenario based on sensorial limits resulted in an increase incompliance of 5%. In all reformulations replacement of sodium by potassium did not exceed safety recommendations on added potassium.

Conclusions:
Sodium intake in the Dutch population is above recommendations and potassium is below. Replacement of sodium chloride by potassium chloride, particularly in key contributing products, according to the current targets would result in better compliance to potassium recommendations (3,510mg/day), but would not exceed EFSA safety recommendations. Based on the intake data and reformulation scenarios, potassium chloride presents as a valuable, safe replacer for sodium chloride in processed foods with a high salt content.
Abstract P145: The Effects of Phosphorus Additives on Albuminuria and Fibroblast Growth Factor-23
Authors: Chang Alex , Miller Edgar , Anderson Cheryl , Moser Melissa , Charleston Jeanne , White Karen , Henry Bobbie , Oh Susan , Appel Lawrence , Juraschek Stephen
Published: March 2022

Background:
Phosphorus-based additives are prevalent in processed foods. Their effects on cardiovascular and renal health are unknown.

Methods:
We conducted a randomized, double-blind, cross-over study to examine the effects of phosphorus additives on albuminuria and fibroblast growth factor-23 (FGF-23) in adults with microalbuminuria and estimated glomerular filtration rate (eGFR) ≥ 45 ml/min/1.73m2. Participants (n=31) received unaltered beverages and breakfast bars (with or without phosphorus additives; 941 mg/d contrast in phosphorus) for 3 week periods, separated by a 2-4 week washout period. Diet was assessed by 24-hour recalls bi-weekly. Primary outcomes were albuminuria and FGF-23 assessed by two 24-hour urine collections and a single fasting blood draw at the end of each period.

Results:
We included 31 participants (32% female, 90% black, 87% hypertension, 48% diabetes) with mean age, eGFR, and 24-hour urine albumin excretion of 66 years, 68 ml/min/1.73m2, and 74.4 mg/d, respectively. Mean self-reported phosphorus intake and 24-hour urine phosphorus excretion was 1113 mg/d and 687.9 mg/d at baseline. Self-reported phosphorus intake (excluding intervention products) decreased by 151 mg/d (p=0.004) during the phosphorus additive period compared to the non-phosphorus additive period as did protein intake (8.0 g/d lower, p=0.02). In unadjusted analyses, consumption of phosphorus additives increased 24-hour urine phosphorus excretion by a mean of 505 mg/d, non-significantly increased albuminuria by 14.3% (95% CI: -2.5% to 34.0%, p=0.1), but had no effect on FGF-23 (3.0%, 95% CI: -9.3% to 16.8%). After adjustment for changes in weight and self-reported dietary intake (sodium, phosphorus, and protein intake), consumption of phosphorus additives increased albuminuria by 22.5% (95% CI: 3.1% to 45.6%, p=0.02). In unadjusted analysis excluding two patients non-compliant with the intervention, consumption of phosphorus additives increased albuminuria by 17.3% (95% CI: 0.08% to 37.5%, p=0.049). Neither sensitivity analysis showed an effect on FGF-23.

Conclusion:
High consumption of phosphorus-based additives may increase albuminuria. Further studies are needed to confirm this finding and determine the long-term effects on cardiovascular and renal health.
Abstract P149: Utility of the Rate Your Plate Diet Survey in Patients Presenting for Coronary Angiography: Higher Diet Quality is Associated with Lower Measures of Body Adiposity
Authors: Ganguzza Lisa , Ngai Calvin , Burdowski Joseph , Flink Laura , Joe Peter , Chiang Vicky , Acosta Victor , Mohan Shivani , Shah Binita , Woolf Kathleen
Published: March 2022

Introduction:
Dietary patterns play a significant role in the development of obesity and atherosclerotic heart disease. Healthcare providers need tools to quickly and easily assess diet quality.

Hypothesis:
The objective of this study was to examine the association between self-reported diet quality and measures of body adiposity in adults presenting for coronary angiography. We assessed the hypothesis that there is an association between diet quality and measures of body adiposity including body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR).

Methods:
This prospective study enrolled subjects (n=185) who presented for coronary angiography at a tertiary medical center in New York City between February and September 2015. Potential subjects were approached in the waiting room prior to their scheduled procedure. Subjects who had previously undergone coronary revascularization, presented for emergent revascularization, or spoke languages other than English or Spanish as their primary language were excluded. Enrolled subjects completed an interview-administered Rate Your Plate - Heart survey, a 24-question tool designed to capture qualitative information related to fat intake, animal protein/dairy, servings of fruit, vegetables, whole grains, snacks, and sweets in 10 minutes. Scores range from 24 to 72, and higher scores indicated better diet quality. Height, weight, and waist circumference were measured by trained personnel to calculate BMI and WHtR. Participants were divided into two groups based on their survey scores (≥58 or ≤57): high (n=47) and low (n=138) diet quality. Measures of adiposity were compared using independent sample t test and correlations between diet score and measures of adiposity were examined using Pearson correlation test. Level of significance was set at p<0.05.

Results:
Of the 185 subjects, 114 were men (62%) and average age was 60.6 ± 11.8 years, BMI 29.2 ± 6.6 kg/m2, WC 103.9 ± 15.8 cm, and WHtR 0.61 ± 0.09. Subjects in the high diet quality group had significantly lower markers of body adiposity than participants in the low diet quality group. (BMI: 26.6 ± 4.0 kg/m2 vs 30.2 ± 7.1 kg/m2, p<0.001; WC: 97.9 ± 11.5 cm vs 105.9 ± 16.6 cm, p<0.001; WHtR: 0.58 ± 0.07 vs 0.63 ± 0.09, p<0.001). There were significant negative correlations between diet score and measures of body adiposity (BMI: r= -0.30, p<0.001; WC: r= -0.29, p<0.001; WHtR r= -0.24, p=0.001).

Conclusions:
Higher diet quality scores correlate with lower measures of body adiposity. Rate Your Plate - Heart survey is an appropriate instrument to capture diet quality prior to coronary angiography in a high-volume clinical setting. Further research to test the validity of this tool as a marker of atherosclerotic heart disease is warranted.
Abstract P153: Association of Habitual Milk Intake with Cognitive Decline From Mid-life to Late-life: The Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study (NCS)
Authors: Petruski-Ivleva Natalia , Kucharska-Newton Anna , Palta Priya , Couper David , Steffen Lyn , Sharrett Richey A , Heiss Gerardo
Published: March 2022

Background:
Animal models and large population studies have related habitual milk intake to impaired cognitive performance via oxidative stress, but results are inconclusive. We report on the association of milk intake at midlife with 20-year cognitive decline in ARIC-NCS cohort.

Methods:
Average daily milk intake was assessed in 15,766 ARIC study participants with a standardized FFQ administered at cohort inception in 1987-1989. Reported milk intake was categorized as almost never, <1glass/day, 1 glass/day, >1 glass/day. Domain-specific and global cognitive decline was assessed on three occasions from 1990 through 2013, testing Delayed Word Recall (memory), Digit Symbol Substitution (executive function), and Word Fluency (language). A mixed effects model adjusted for age, race, sex, education, smoking, physical activity and ApoE4 was used to evaluate the association of milk intake with change in cognitive performance over 20 years. The MICE method was used to account for attrition.

Results:
Among 13,821 participants in the analytic set, the distribution of milk intake across the above four categories was 18.7%, 35.8%, 27.3%, and 18.1%, respectively. In race-combined fully adjusted models greater milk intake was associated with greater cognitive decline (Figure) as indicated by a significant trend (p=0.018). The average difference in the 20-year rate of change in global z between those who reported almost never drinking milk and those who consumed >1glass/day was -0.053 [95%CI: -0.092, -0.014], approximately equivalent to 1 year of additional cognitive aging. The trend met nominal statistical significance in Whites, but not African Americans.

Conclusions:
Results of this study add to reports indicating that greater milk intake may be associated with greater rate of cognitive decline. Replication of these results and insights into interactions with the intestinal microbiota and other putative modifying factors of the reported association is warranted considering the widely prevalent intake of milk in US adults.