bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P133: Deficient Screening for Cardiometabolic Risk Factors in a Central Appalachian Health System
Authors: Pyles Lee A , Lilly Christa , Poffenberger Paige , Kohler Rachel , Burton William H , Cottrell Lesley A , Elliott Eloise
Published: March 2023

Problem:
West Virginia perennially leads the US in child obesity and adult heart disease. We had screened over 100,000 school children for cardiometabolic risk factors (CMRF) in the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) program over 20 years until the 2017 economic downturn. 60,000 had lipid panels. WVU Health System includes encounters with over 200,000 WV children. We hypothesize that CMRF screening has decreased without the statewide CARDIAC Program.

Methods:
We queried our instance of Epic Electronic Health Record that includes much of northern WV to ascertain BMI, Total Cholesterol (TC) , Low Density Lipoprotein Cholesterol (LDL), triglyceride level (TG) and hemoglobin A1C. We also searched for use of cholesterol-lowering medicines.

Results:
137,566 children under 18 years had a BMI measure and we have reported a 5%ile increase in the COVID era. Only 8498 have had a total cholesterol check (avg ± SD 159+34 mg/dl), 9964 had triglyceride (109 ± 74 mg/dl) and 4874 had LDL (92.04 ± 29.8 mg/dl). 2609 children had average HA1C 6.03 ± 1.7%. 607 children had LDL ≥ 130 mg/dl including 174 with LDL ≥ 160 mg/dl. 33 were given lipid-lowering medication and had LDL change from 248 ± 86 mg/dl to 181 ± 42 mg/dl at follow-up. Average decrease was 67 ± 79 mg/dl (p < 0.0001).

Conclusion:
Few children are being screened for TC, LDL and TG absent the statewide CARDIAC lipid screening program in WV. Lipid-lowering medicines are sparsely used in children with significant risk of Familial Hypercholesterolemia (FH). Family history is not available for the cohort. None in FH range were below the 130 mg/dl LDL target value after treatment. In this pediatric population with usual incidence of FH and high prevalence of dyslipidemia of obesity with high BMI and TG levels, little lipid screening is occurring without the statewide school-based program. Child health care providers need to intervene to prevent even greater WV coronary disease in the future. Policy-makers can impact the future health of WV school children by promoting and funding screening for cardiometabolic risk factors now.
Abstract P147: A Community-Based, Heart-Healthy Lifestyle-Promoting Program Using Hybrid Behavioral Strategies: Study Protocol of a Three-Group Randomized Controlled Trial
Authors: Choo Jina , Noh Songwhi , Shin Yura
Published: March 2023

Introduction:
A hybrid intervention of online and offline behavioral strategies can be more effective in promoting multiple lifestyle behaviors than online strategies alone. However, little is known about the effects of hybrid behavioral strategies on the modification of multiple heart-healthy lifestyle behaviors in cardiovascular health. The present study aims to evaluate the effects of a community-based, heart-healthy lifestyle-promoting program (i.e., HeartHELP program) using hybrid behavioral strategies on heart-healthy lifestyle outcomes for individuals at cardiovascular risk.

Hypothesis:
We assessed three hypotheses: 1) a mobile-app group would be more likely to increase heart-healthy behavioral outcomes than a control group 2) a hybrid group would be more likely to increase heart-healthy behavioral outcomes than the control group 3) the hybrid group would be more likely to increase heart-healthy behavioral outcomes than the mobile-app group.

Methods:
The present study is a three-arm, parallel group, randomized controlled trial (clinical trial No. ISRCTN83643383) with assessments carried out at baseline and after a 12-week HeartHELP program. We will recruit 75 participants, each having at least one component of metabolic syndrome, in a community-based setting. The participants will be allocated to one of the following three study arms by age- and gender-stratified block randomization: (1) a hybrid group (n = 25), (2) a mobile-app group (n = 25), or (3) a control group (n = 25). The hybrid group will receive a “HeartHELP program” with hybrid strategies: (1) mobile-app use as an online strategy and (2) motivational interviewing counselling as an offline strategy. The mobile-app group will receive the online strategy exclusively. The control group will receive a brochure that will include information on cardiovascular health. The mobile-app use involves receiving text messages, self-monitoring six heart-healthy lifestyle behaviors, and receiving feedback text messages based on behavioral outcomes obtained from self-monitoring. The motivational interviewing counselling includes customized individual and group counseling based on motivational interviewing principle. At baseline and after 12 weeks, a battery of heart-healthy behavioral outcomes will be measured. The primary outcome will comprise heart-healthy behavioral practices; the secondary outcomes will be heart-healthy knowledge, heart-healthy motivation, heart-healthy self-efficacy, and cardiometabolic biomarkers (i.e., fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides). In conclusion, we expect the community-based HeartHELP program to provide significant data findings on how heart-healthy behavioral practices can be improved, along with other cardiometabolic biomarkers.
Abstract P151: Late-Life Prediabetes, Diabetes, and Diabetes Duration With Risks of Frailty and Mortality: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Rooney Mary R , Windham B Gwen , Palta Priya , Echouffo Tcheugui Justin B , Skow Laura , Selvin Elizabeth
Published: March 2023

Introduction:
Diabetes is a risk factor for frailty and mortality. Longer diabetes duration is associated with higher mortality in older adults, whereas prediabetes is not. Little has been characterized on associations of prediabetes and diabetes duration with frailty risk. Characterizing frailty and mortality risk in older adults with prediabetes and diabetes is useful for planning healthcare resource utilization.

Hypothesis:
Longer diabetes duration, but not prediabetes, is associated with higher risks of frailty and mortality in older adults.

Methods:
We conducted a prospective analysis of 4119 ARIC Study participants (mean age 75, 56% women, 22% Black adults) who attended visit 5 (2011-3) without prevalent frailty and who attended visit 6 (2016-7) or died without attending visit 6. We used the Fried phenotype to classify frailty based on ≥3 components: unintentional weight loss, exhaustion, grip strength, slow walking speed, low physical activity. We used multinomial logistic regression to estimate relative risk ratios (RRR) for baseline categories of normoglycemia (HbA1c<5.7%), prediabetes (HbA1c 5.7-<6.5%), or diabetes duration <5, 5-<10, or ≥10 years with incident frailty and death.

Results:
Over 5 years of follow-up, there were 851 deaths and 229 frailty cases detected at visit 6. The 5-year cumulative incidence of frailty was 3% in older adults without diabetes and 5% in those with diabetes, and the 5-year mortality risk was 15% in older adults without diabetes and 25% in those with diabetes. Compared to those with normoglycemia, older adults with diabetes ≥10 years had higher risk of frailty or mortality after multivariable adjustment (
Table
). Older adults with prediabetes did not have higher risk of frailty or death.

Conclusion:
In older adults, longer diabetes duration was associated with high risks of frailty and mortality, whereas prediabetes was not associated with frailty and mortality. Older adults with long-standing diabetes should be targeted for frailty screening and preventive interventions.
Abstract P153: Intensive Lifestyle Intervention in Type 2 Diabetes Mellitus Results in a More Favorable Sex Hormone Profile in Both Post-Menopausal Females and Older Males (The Look AHEAD Trial Sex Hormone Study)
Authors: Chandran Vidya , Bennett Wendy , Michos Erin D , Kalyani Rita R , Clark Jeanne , Woodward Mark , Wu Jiajun , Everett Allen D , Yang Jun , Zhu Jie , Graham David , Aja Susan , Ellis Greg , Vaidya Dhananjay
Published: March 2023

Background:
Prior studies showed an association between some adverse cardiometabolic outcomes and lower testosterone in males and higher estrogen in both males and post-menopausal females. However, few studies of sex hormones focused on people with type 2 diabetes (T2DM), assessed hormone changes over time or applied highly sensitive laboratory assays. Given the importance of lifestyle modification (i.e., diet, exercise and weight loss) in preventing cardiometabolic complications in people with T2DM, we examined the impact of an Intensive Lifestyle Intervention (ILI) on sex hormones over time and differences by sex.

Methods:
The Look AHEAD (Action for Health in Diabetes) Study was a randomized control trial of 5,145 individuals with BMI ≥25 and T2D to evaluate the effect of ILI compared to the Diabetes Support and Education (DSE) control group on incident cardiovascular events. We selected a sample of 472 males and 426 post-menopausal female participants (mean age 60 years [SD 6.3], 20.5% Black) to examine sex hormones (estradiol - E2, total testosterone - T) and sex hormone binding globulin (SHBG) at baseline and year 1. E2 and T were measured using mass spectrometry analysis and SHBG was measured using an immunoassay.

Results:
In males, ILI increased SHBG by 17.3% and T by 10.6% compared to the DSE group (Table). In postmenopausal females, ILI increased SHBG by 12.0% and decreased E2 by 23.4% compared to the DSE group (Table). The change in the sex hormone levels from baseline to 1-year follow up was attenuated when adjusted for change in BMI.

Conclusion:
ILI resulting in weight loss increased T in males and decreased E2 in postmenopausal females and increased SHBG in both sexes. We plan further analysis with a larger sample and longer follow-up to examine the role of weight loss either as a co-occurring metabolic process or as a mediator for the change in sex hormones to better understand the impact of lifestyle changes and sex diffrences.
Abstract P174: The Association Between Infection-Related Hospitalization and Incident Heart Failure: The Atherosclerosis Risk in Communities Study
Authors: Molinsky Rebecca L , Shah Amil M , Yuzefpolskaya Melana , Yu Bing , Misialek Jeffrey , Bohn Bruno , Vock David , Maclehose Richard , Colombo Paolo C , Ndumele Chiadi E , Ishigami Junichi , Matsushita Kuni , Lutsey Pamela L , Demmer Ryan
Published: March 2023

Introduction:
Infections are associated with worse clinical outcomes among patients with heart failure (HF). However, little is known about the influence of infection-related hospitalizations on development of incident HF and its subtype.

Hypothesis:
We hypothesize that those with an infection-related hospitalization (hereafter ‘infection’) compared to those without infection, will experience an increased rate of incident HF events (any HF, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)).

Methods:
We examined 14,398 participants enrolled in the Atherosclerosis Risk in Communities Study who were HF free at visit 1 (1987-1989). Hospitalized infections and HF were identified via participant self-report and active surveillance of hospitalizations. Among the hospitalized, infection was further defined using ICD-9/10 codes in the first five positions of hospital records. A subset of HF events was further classified as HFpEF or HFrEF via chart abstraction and adjudication by centrally trained and certified physicians. Infection was treated as a time-varying exposure and the co-occurrence of infection and HF in the same hospital visit were excluded. Multivariable-adjusted Cox proportional hazards models assessed the association between infection and incident HF, HFrEF, and HFpEF.

Results:
The overall baseline sample was 54% (7,835 of 14,398) female, 26% (3,688 of 14,398) Black and had a mean(SD) age of 54(5.8). Mean(SD) time to infection was 16.1(8.7) years, and 2.3(7.5) years from infection to incident HF. Average follow-up among the full sample was 23.0(8.5). Overall, 46% (6,603 of 14,398) had an infection and 3,561 developed any HF. Among participants with subtype adjudication, 470 had HFpEF and 450 had HFrEF. Infection-related hospitalization was associated with an increased risk for both HFpEF and HFrEF (Table).

Conclusion:
Infection-related hospitalization was associated with both incident HFpEF and HFrEF. A stronger effect is seen among those with HFpEF.
Abstract P186: HIV Status, Immune Cell Subsets and Type of Incident Heart Failure
Authors: Mensah Samuel , Kundu Suman , Chang Chung-Chou H , Doyle Margaret , Werekuu Alex , Kiyanda Alexis , Patil Prasad , Koethe John , Tindle Hilary A , Freiberg Matthew S , So-Armah Kaku
Published: March 2023

Introduction:
Immune dysfunction is a mechanism involved in atherosclerosis; atherosclerotic cardiac events contribute to heart failure (HF) risk. We investigated whether immune cell subtypes were associated with HF and HF types in people with and without HIV.

Hypothesis:
Six CD4+ and CD8+ T-cell subsets previously associated with atherosclerosis will be associated with increased HF with reduced ejection fraction (HFrEF) risk. Other lymphocyte subsets will be associated with increased HF with preserved ejection fraction (HFpEF) risk.

Methods:
We measured lymphocyte subsets (T-, B-, and natural killer cells) in the Veterans Aging Cohort Study (VACS) Biomarker Cohort. Primary analyses used Cox proportional hazards models to estimate hazard ratios of HFpEF or HFrEF per standard deviation increment in each of the 6 pro-atherosclerotic T-cell subsets. Secondary analyses used survival random forest analysis to rank the importance of a broader under-studied set of lymphocyte subsets in HF risk prediction and Cox models to estimate HF risk.

Results:
Among 2174 (66% PWH) participants without prevalent cardiovascular disease, 269 had incident HF (22% HFrEF, 47% HFpEF) over 8.8 years median follow-up time. Participants were predominantly male (>90%) and black (>66%). After adjusting for age, race/ethnicity, cytomegalovirus status, and HIV status, we did not detect associations the 6 T-cell subsets with HFrEF. We detected positive associations of CD4+CD28-, CD4+CD45RA+CD28-CD57+, TH1, TH17 cells with HFpEF. Survival random forest analysis revealed the relative importance of lymphocyte subsets for prediction of HF beyond those previously associated with atherosclerosis (Fig 1).

Conclusion:
Contrary to hypotheses, pro-atherosclerotic subsets of CD4+ and CD8+ T-cells were associated with HFpEF but not HFrEF. Other lymphocyte subsets previously-understudied for incident human cardiac outcomes were associated with HF incidence. Future work will examine whether these associations differ by HIV status.
Abstract P206: Later Age at Menarche is Associated With Metabolite Signatures for Cardiovascular Diseases: A Metabolome-Wide Association Study of Racially and Ethnically Diverse Women From the Boston Birth Cohort
Authors: Mueller Noel T , Zhang Mingyu , Chen Yingan , Wang Guoying , Hong Xiumei , Wang Xiaobin
Published: March 2023

Introduction:
Later menarche onset portends lower risk of cardiometabolic outcomes in adults (e.g., obesity, diabetes, hypertension, and myocardial infarction) and in pregnancy (e.g., preterm birth). However, the underlying mechanisms underlying these associations are unclear. Metabolome-wide association studies afford an opportunity to identify mechanistic pathways.

Objective:
To identify metabolome signatures of age at menarche in a diverse sample of women.

Methods:
This analysis includes 1301 women from the Boston Birth Cohort who were enrolled 24-72 hrs. after delivery, when we collected maternal plasma sample for metabolome and information on maternal age at menarche (range 7-18y) via a standard questionnaire interview. We used linear regression and restricted cubic splines to examine the association between age at menarche and metabolites. We adjusted for maternal year of birth, place of birth, education, smoking status, Mediterranean diet score, pre-pregnancy BMI, hypertensive disorders, and diabetes.

Results:
Of the 1301 study women, 63.7% identified as Black and 21.3% as Hispanic. Maternal age at delivery was 28.3y ±6.6y and age at menarche was 12.87y ±1.95y. Of the 389 metabolites we examined, 63 were associated with late menarche (>15y vs. menarche 12-13y;

Fig., A

). A 1-yr increment in menarche age was associated with 7 metabolites (

Fig., B

); of these, imidazole propionate and C18:2 SM were (inverse) linear dose-response (

Fig., C

). Other metabolites, including some implicated in cardiovascular disease (e.g., dimethylguanidino valeric acid), showed a threshold effect starting at menarche >14 years (Fig., C).

Conclusion:
In this racially and ethnically diverse cohort of women from Boston, later age at menarche is associated with many metabolites, including inverse associations with metabolites that have been previously implicated in cardiovascular disease. Our findings help inform mechanistic pathways and that, if replicated, could be targeted for cardiometabolic prediction and prevention.
Abstract P263: Associations Between Dimensions of the Social Environment and Cardiometabolic Risk Factors
Authors: Mackenbach Joreintje D , Abreu Taymara C , Heuvelman Fleur , Schoonmade Linda J , Beulens Joline W
Published: March 2023

Introduction:
Although the social environment, including social contacts, norms and support, likely has a significant impact on cardiometabolic disease (CMD) risk, a comprehensive summary of the available evidence is lacking.

Hypothesis:
Exposure to unfavorable social environments is associated with greater CMD risk.

Methods:
We conducted a systematic review and meta-analysis on the association between social environmental characteristics and risk factors of CMD. We systematically searched PubMed, Scopus and Web of Science Core Collection from inception to 16 February 2021. Studies that used a risk factor of CMD, e.g., lipids, HbA1c or blood pressure as outcome and social environmental factors such as area-level deprivation, neighborhood racial segregation or social network size as independent variables were included. Titles and abstracts were screened in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale. Data appraisal and extraction were based on the study protocol published in PROSPERO (CRD42021223035). Data were synthesized through vote counting and random effects meta-analyses, the latter if three or more associations investigated the same exposure-outcome combination.

Results:
A total of 168 studies reporting on 1050 associations were included in this review. Social and Economic Disadvantage was the most studied exposure (45%), followed by Social Relationships and Norms (35%), with less evidence for other social environmental dimensions. Four meta-analyses based on 24 associations suggested that an unfavorable social environment was associated with increased risk of cardiometabolic risk factors, with three of them being statistically significant. For example, individuals that experienced more economic and social disadvantage had a higher CVD risk scores (OR=1.54, 95%CI: 1.35;1.84). Meta-analyzed sex-specific associations showed inconsistent results. Of the 458 associations included in the vote counting, 323 (71%) pointed towards unfavorable social environments being associated with higher CMD risk.

Conclusion:
Higher economic and social disadvantage seem to contribute to unfavorable CMD risk factor profiles, while evidence for other dimensions of the social environment is limited.
Abstract P325: Adverse Clinical Outcomes in Non-Alcoholic Fatty Liver Disease Patients Admitted With Heart Failure and Chronic Kidney Disease
Authors: Khokhlov Leonid , Aboelnasr Amr , Pereira Leanne , Fatuyi Michael , Ali Mehnaaz , Hussain Fatima , Brown Amanda , Shemisa Kamal
Published: March 2023

Background:
Patients with heart failure (HF) are increasingly affected by (CKD). There is a growing evidence connecting Non-Alcoholic Fatty Liver Disease (NAFLD) with poor health outcomes. Nevertheless, there is limited scientific evidence of clinical outcomes in NAFLD population with HF and CKD. Therefore, we sought to investigate this population.

Methods:
We queried NIS between 2016-2019 for adult patients who were hospitalized with HF and CKD and had NAFLD. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), acute kidney injury (AKI), invasive mechanical ventilation, length of stay (LOS) and total hospital charge. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value < 0.05 was significant.

Results:
There were 9,221,158 patients with HF and CKD, of which 405,290 (4.3%) had NAFLD. NAFLD and non-NAFLD cohorts were with mean age of 68.4 vs. 72.7 yrs; males 57.2% vs 53.5%; Caucasians 60.1% vs 63.4%; systolic HF 44.2% vs 41.7%; obesity 21.3% vs 23.0%; dyslipidemia 43.3% vs 56.1%; anemia 24.3% vs 22.4%, DM 59.3% vs 57.7%; AF 43.6% vs 43.5%; history of MI 12.6% vs 16.1%; stroke 1.9% vs 2.2%, COPD 30.5% vs 34.3%, respectively. NAFLD cohort had significantly higher mortality and worse clinical outcomes (Table 1).

Conclusion:
HF patients with co-existent CKD who were affected by NAFLD demonstrated significantly worse clinical outcomes and higher resource utilization. They were younger, male, with prevalent systolic HF, anemia, diabetes, AF. NAFLD is associated with increased GIB and AKI and may raise risk for systolic dysfunction and coagulopathy. Early NAFLD detection and management in HF and CKD population may improve clinical outcomes. Clinicians should be aware of this negative predictor when managing patients with HF&CKD. Further research is needed to describe this population.
Abstract P336: Early Metabolic Imbalance in Young Adults is a Hidden Risk Factor for Midlife Cardiovascular Disease: CARDIA 35-year Follow Up
Authors: Cistola David P , Dwivedi Alok K
Published: March 2023

Introduction:
The U.S. population includes a prevalent group of teens and young adults with early metabolic imbalance or EMI. This insidious condition includes markers of insulin resistance, particularly its interaction with adiposity, as well subclinical inflammation and oxidative stress. High circulating insulin compensates for insulin resistance in tissues, keeping fasting glucose, triglycerides and HDL within normal limits. Thus, individuals with EMI do not meet the criteria for metabolic syndrome or prediabetes. Previously, we reported that compensatory hyperinsulinemia in young adults is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD), based on an analysis of 30-year data from CARDIA: Coronary Artery Risk Development in Young Adults. Here, we expand the analysis to include other components of EMI and the latest 35-year follow up data.

Hypothesis:
In young adults, EMI increases the risk for midlife ASCVD.

Methods:
This is a retrospective cohort study of CARDIA. The parent study enrolled 5,114 participants, ages 18-30 at baseline. In this retrospective analysis, the baseline exclusion criteria were hyperglycemia, hypertriglyceridemia, low HDL, diabetes, CVD, pregnancy or fasting <8 hours, yielding 3,292 participants without metabolic syndrome or prediabetes. The data were analyzed using Cox proportional hazard regression in Stata 17.0 and JMP 16.2. The primary exposures were markers of insulin resistance, inflammation and oxidative stress at baseline; the covariates were the 2019 ACC/AHA risk factors for ASCVD: increased waist circumference (WC), hypertension, poor fitness, LDL ≥160, nicotine use (serum cotinine), family history of premature ASCVD, race, sex and estimated glomerular filtration rate (eGFR) <60. The primary outcome was time to incident ASCVD (or censor), defined as any fatal or nonfatal MI, coronary revascularization, acute coronary syndrome, CHF, stroke, TIA, carotid or peripheral artery disease. Cox results were reported as hazard ratio (HR) and Harrell’s c-statistic (c).

Results:
All reported Cox models met the proportional hazards and linearity assumptions. Model 1 includes the ACC/AHA risk factors, yielding a Harrell’s c of 0.714. For WC, the HR for tertile 3 vs. 1 was 2.1, 95% CI 1.4, 3.1, p<0.0001. Cox Model 2 replaces WC with a categorical variable with both WC and HOMA2-IR, a marker of insulin resistance. The HR for both measures in tertile 3 vs. both in tertile 1 was 2.1, 95% CI: 1.3, 2.5, p<0.0001; Harrell’s c increased to 0.728. Cox model 3 adds markers of inflammation and oxidative stress to Model 2, increasing C to 0.735. In models 2 and 3, high WC was a significant risk factor only in combination with high HOMA2-IR, indicative of effect modification.

Conclusion:
After accounting for canonical risk factors, early metabolic imbalance in otherwise healthy young adults in CARDIA is a hidden risk factor for midlife ASCVD.
Abstract P352: A Review of Trials Designed to Achieve Diabetes Remission With Lifestyle Intervention Alone: Implications for Sub-Saharan Africa
Authors: Gatete Jean de Dieu , Duhuze Karera M. Grace , Wentzel Annemarie , Ishimwe MC Sage , Jagannathan Ram , Horlyck-Romanovsky Margrethe , Sumner Anne E
Published: March 2023

Introduction:
As the prevalence of type 2 diabetes (T2D) in sub-Saharan Africa rises and pharmacological hypoglycemics are often unavailable or prohibitively expensive, the ability to induce T2D remission through medication-free lifestyle interventions (LSI) needs urgent assessment.

Objective:
This scoping review evaluated trials designed to induce T2D remission by LSI without hypoglycemic medications.

Methods:
Using a combination of controlled vocabulary terms and key words specific to each database, PubMed, Embase, Cochrane, and CINAHL databases were searched for trials designed induce diabetes remission through LSI alone and were published before September 16, 2021. Of the 928 identified, 63 duplicates were removed. After title and abstract review, 727 irrelevant articles were excluded. After full-text review 112 inappropriate articles were removed. The remaining 26 articles described 16 trials. So each trial would be represented by one article, the latest publication from each trial was included. Of the 16 trials, 7 trials were on newly-diagnosed, treatment-naïve T2D and 9 trials were on established T2D with LSI initiated after discontinuation of medications.

Results:
The 16 trials were published between 1984 and 2021. They were conducted in 10 different countries. None were conducted in Sub-Saharan Africa. Median number of participants was 180 and 20 for the newly-diagnosed and established T2D respectively. Median duration was 5 years for newly-diagnosed T2D and 5 months for established T2D. For newly-diagnosed T2D, LSI involved dietary counseling with or without calorie restriction (~1500 kcal/d) and exercise. For established T2D trial the main focus was dietary intervention most often divided into 3 phases; Phase 1: low-calorie meal replacement; Phase 2: food re-introduction; and Phase 3: weight maintenance. Median remission rate for the 16 trials was 55%. The consensus across trials was with or without exercise, T2D remission requires diet modification and weight loss. Predictors of remission were: higher BMI and lower A1C at enrollment, shorter T2D at enrolment, and a 10% loss of baseline weight. Nonglycemic benefits of LSI included improved blood pressure, renal function and lipid profile as well as enhanced quality of life.

Conclusions:
LSI without medications can induce remission in both newly-diagnosed and established T2D. In sub-Saharan Africa, LSI as the initial therapeutic option needs exploration.
Abstract P380: Linkage, Empowerment, and Access to Prevent Hypertension: A Novel Program to Prevent Hypertension and Reduce Cardiovascular Health Disparities in Detroit Michigan
Authors: Opara Ijeoma , Brook Robert D , Twiner Michael J , Dawood Katee , Levy Phillip D
Published: March 2023

Background:
Serious health disparities persist across the United States (US) whereby Black communities suffer a disproportionate burden of cardiovascular diseases. A higher prevalence of hypertension along with lower control rates are major contributing factors; while mounting evidence supports that negative social determinants of health (SDoH) play a causal role. Here, we describe a first-of-a-kind approach to reduce health disparities by focusing on preventing hypertension in Black adults with elevated blood pressure (BP) living in socially vulnerable communities.

Methods and Results:
LEAP-HTN (Linkage, Empowerment, and Access to Prevent Hypertension) is part of the RESTORE (Addressing Social Determinants to Prevent Hypertension) Health Equity Research Network, a $20 Million initiative funded by the American Heart Association. The trial will test if a novel intervention reduces systolic blood pressure (BP) (primary outcome) and prevents the onset of hypertension over one year versus usual care in 500 Black adults with elevated BP (systolic BP 120-129 mm Hg; diastolic BP <80 mm Hg) in Detroit, Michigan. LEAP-HTN improves access to health care by leveraging our groundbreaking platform using geospatial health and social vulnerability data to direct deployment of mobile health units (MHUs) to communities of greatest need. Preliminary data suggest that 10% of patients screened for HTN in the MHUs would meet BP inclusion criteria. All patients are referred to primary care providers. Trial participants in the active limb will receive additional collaborative care delivered remotely by community health workers using an innovative strategy termed PAL
2
(Pragmatic, Personalized, Adaptable Approaches to Lifestyle and Life Circumstance)(Figure). PAL
2
emphasizes the mitigation of negative SDoH, thereby reducing allostatic load while fostering greater success in achieving lifestyle changes.

Conclusions:
LEAP-HTN aims to lower BP and prevent hypertension by improving access and linkage to healthcare while mitigating negative SDoH. Through an innovative patient-centered intervention, PAL
2
, our program model may represent a sustainable and scalable strategy to help overcome persistent health disparities in socially vulnerable communities across the US.
Abstract P385: Comparison of Different Algorithms to Measure Adherence to Multiple Anti-Hypertensive Medications Using Administrative Claims Database
Authors: Zhang Donglan , Xu Jianing , Chen Xianyan , Hall Daniel
Published: March 2023

Background:
Adherence to antihypertensive medication is a key component of hypertension management. Insurance claims data provide an opportunity to examine and monitor patients’ adherence rate to prescribed medications. However, patients may take multiple drugs or drug classes simultaneously to control high blood pressure. Little is known regarding the differences between algorithms used to measure adherence to antihypertensive medications using claims database.

Hypothesis:
We hypothesize that different algorithms, number of drug classes and observation periods lead to different medication adherence estimates.

Methods:
Using the 2017-2019 IBM MarketScan Medicare supplement claims database, we conducted retrospective analysis of 107,194 insured members with hypertension diagnosis and were taking anti-hypertensive drugs (e.g., angiotensin II inhibitors, ACE inhibitors, Beta Blockers, Calcium Channel Blockers, Antihypertensive combinations, Alpha Blockers, Diuretics). We calculated medication adherence rates using the proportion of days covered (PDC) for 6 months and 12 months among polytherapy users who use more than one antihypertensive drug classes. Three PDC algorithms were used and compared, including (1) number of days covered by at least 1 antihypertensive medication class (“maximum”) in 6 months and 12 months; (2) number of days covered by all antihypertensive medication classes after they are prescribed in 6 months and 12 months (“minimum”); (3) the average number of days covered by each medication class measured separately in 6 months and 12 months (“average”).

Results:
The proportion of patients who took two, three, or four or more antihypertensive drug classes was 26.96%, 9.44%, and 3.21% for the 6-month observation period, and was 26.73%, 9.37%, and 3.21% for the 12-month observation period. The mean PDC estimate and standard deviation (SD) using the “maximum” algorithm was 89% (0.2) for 6-month and 88% (0.2) for 12-month observation period, respectively. The mean PDC estimate and SD using the “minimum” algorithm was 45% (0.33) and 45% (0.33) for 6- and 12-month observation period, respectively. And the mean PDC estimate and SD using the “average” algorithm was 68% (0.23) and 67% (0.23) for 6- and 12-month observation period, respectively.

Conclusions:
There is a lack of consensus on the algorithms to measure adherence to anti-hypertensive medications based on pharmacy claims data. The PDC estimates based on the “average” algorithm was less dependent on the number of antihypertensive drug classes, and the 6- and 12-month observation period did not significantly influence PDC estimates.
Abstract P397: Hispanic Ethnicity as a Moderator of Exercise Behavior in a Mobile Health Exercise Intervention for Sedentary Adults
Authors: Phan Madeleine , Ede Alison , Sequeira Alec , Teng Hsiang-Ling , Donlin Ayla , Dawson Jacqueline
Published: March 2023

Introduction:
Mobile health (mHealth) lifestyle interventions can help mitigate cardiometabolic disease. However, Hispanic adults are underrepresented in these interventions, report lower physical activity (PA) levels and are disproportionately affected by cardiometabolic disease compared to non-Hispanic White (NHW) adults. We conducted a secondary analysis of the effects of an 8-week mHealth exercise intervention on exercise behavior in Hispanic and NHW adults.

Hypothesis:
A remotely delivered mHealth exercise program involving a wearable sensor, mobile application and wellness education would promote similar exercise behavior in both Hispanic and NHW adults.

Methods:
Thirty-eight Hispanic and 21 NHW sedentary (< 60 min/week of exercise) adults were randomized (1:1:1) to 8 weeks of increasing behavioral resources: Level 1 (wellness education, n=16), Level 2 (wellness education + pre-recorded exercise videos, n=24), or Level 3 (wellness education + livestream group exercise, n=19). Participants were given a chest strap sensor (Myzone MZ-3) to use during exercise and a mobile app to interact with other participants. A weekly email delivered wellness education, feedback and PA encouragement. Level 2 (videos) and Level 3 (classes) performed 35-min 3x/wk of instructor-led, high-intensity functional training designed to improve cardiometabolic risk factors. Sensor use (3x/wk encouraged) and time spent in moderate-to-vigorous exercise effort (MVET) were captured by the MZ-3. MVET was calculated as the time spent in effort >64% maximum heart rate. Baseline and post-intervention PA were captured using the International Physical Activity Questionnaire. Differences between groups were tested using univariate ANOVA with Bonferroni-adjusted t tests in post hoc analyses.

Results:
Hispanic participants were younger (30.6 ± 10.1 yr, mean ± SD) and performed less PA (22.6 ± 70.2 min/wk) at baseline compared to NHW (39.7 ± 16.8 yr, 90.1± 90.2 min/wk; p<0.05). No differences in body mass index or gender were observed between groups at baseline (p>0.05), or in weekly sensor use during the intervention (Hispanic 1.7 ± 1.8 sessions/wk, NHW 2.4 ± 1.6 sessions/wk, p>0.05). Self-reported PA increased from baseline to post-intervention in both groups (p<0.01), but no differences between groups were observed. However, NHW had greater moderate-to-vigorous exercise effort (86.3 ± 67.7 weekly MVET) compared to Hispanic participants (55.9 ± 66.2 weekly MVET, p<0.05) throughout the intervention.

Conclusion:
An 8-week mHealth lifestyle program increased PA behavior in sedentary participants. However, Hispanic participants exercised at lower intensities than non-Hispanic White participants. Future work is needed to identify barriers in meeting MVPA recommendations in minority populations so that culturally tailored interventions can be developed.
Abstract P404: The Virtual Home Clinic: Challenges and Solutions
Authors: Urbina Elaine M , Fernandez Alonso Camilo , Bazzano Lydia A , Woo Jessica G
Published: March 2023

Longitudinal studies provide rich sources of data to explore early risk factors for future CV diseases. However, cohort participants often move away from their initial recruitment site. Therefore, we are assessing feasibility of mailing of devices to the home for collection of biometric data followed by an in-person assessment to validate the home devices. Participants (N=215) from the Bogalusa Heart Study, National Growth & Health Study and the Princeton Lipid Research Study who were initially enrolled as children in the 1970s and 1980s were recruited. Devices sent to the home (
Table
) measure anthropometrics, BP, HR, heart rhythm, resting metabolic rate, O2 saturation, glucose, total cholesterol, physical activity, diet, sleep duration/quality, and arterial stiffness. Stool and saliva are also collected for microbiome, DNA and cotinine. General issues encountered include institutional firewall requiring permission to load apps on an iPAD, apps requiring wi-fi or an email, complicated instructions for participants, different processes for account setup, data retrieval, cleaning/disinfection, need to delete old data/resetting for each device, and differing exported data file formats requiring extensive programming to import into statistical software. This feasibility study will provide new opportunities to continue to follow our participants who have provided invaluable contributions to science for the last 40 years.
Abstract P407: Sex Differences in Microvascular Response to Mental Stress and Adverse Cardiovascular Events Among Patients With Ischemic Heart Disease
Authors: Sullivan Samaah , Young An , Garcia Mariana , Almuwaqqat Zakaria , Moazzami Kasra , Hammadah Muhammad , Lima Bruno B , Hu Yingtian , Alkhalaf Mhmtjamil , Jajeh Mohamad Nour , Alkhoder Ayman , Elon Lisa , Lewis Tene T , Shah Amit J , Mehta Puja K , Bremner J Douglas , Quyyumi Arshed A , Vaccarino Viola
Published: March 2023

Introduction:
Microvascular dysfunction during acute mental stress may be an important determinant of major adverse cardiovascular outcomes (MACE) especially among middle-aged women survivors of an acute myocardial infarction (MI).

Hypothesis:
There are sex differences in the association between microvascular dysfunction and MACE.

Methods:
The Myocardial Infarction and Mental Stress Study 2 enrolled individuals who had been hospitalized for an MI in the past 8 months at the age of 60 years or younger, with an oversampling of women. Reactive hyperemia index (RHI) was used to measure digital microvascular function before and 30 minutes after a public-speaking mental stress task. This assessment was contrasted with macrovascular endothelial function at the brachial artery through flow-mediated dilation (FMD). Participants were followed for 5-years, and MACE was defined as a composite of cardiovascular death, first/recurring events for nonfatal MI, and hospitalizations for heart failure. Cox proportional hazards models were used to examine vascular response to stress (difference between post-stress and resting values) and MACE adjusting for demographics, clinical risk factors, medications, psychological factors, and mental stress ischemia. Lower RHI and FMD values are indicative of greater microvascular and endothelial dysfunction, respectively.

Results:
Of 263 participants, the mean age was 51 years and 48% were women. There were 64 patients with 141 adverse cardiovascular events (first and repeated). In the overall sample, there was no significant association between microvascular response to stress and MACE, but there was a significant interaction with sex (p = 0.03). Each standard deviation decrease in RHI response to stress was associated with 50% greater risk of MACE (HR: 1.50, 95% CI: 1.05, 2.13) among women only, while no association was observed in men (HR 0.93, 95% CI: 0.69, 1.26). Transient endothelial dysfunction in response to stress (for each standard deviation decrease in FMD) was associated with 35% greater risk of MACE (HR: 1.35; 95% CI: 1.07, 1.71), and was similar in women and men.

Conclusions:
Peripheral microvascular dysfunction with mental stress is associated with MACE among women but not among men. In contrast, brachial artery endothelial dysfunction is similarly related to MACE among both men and women. These results suggest that microvascular dysfunction is a female-specific mechanism linking psychological stress to adverse outcomes.
Abstract P419: Ultra-Processed Food Consumption and Risk of Hypertension in US Adults
Authors: Rivera Nikolaos , Du Shutong , Kim Hyunju , Matsushita Kunihiro , Coresh Josef , Rebholz Casey M
Published: March 2023

Introduction:
Ultra-processed food (UPF) consumption has an adverse impact on cardiovascular health. Current research is primarily based on non-US study populations. The purpose of our study was to estimate the association between UPF consumption and risk of incident hypertension in a population of middle-aged black and white men and women.

Methods:
Atherosclerosis Risk in Communities (ARIC) study participants who were hypertension free at baseline and had complete dietary, covariate, and hypertension data from visit 1 (1987 - 1989) were included (n = 8,866). Participants were followed through November 30, 2019 for the development of hypertension defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or recent patient-reported use of blood pressure lowering medication. Processing level was determined using the NOVA classification system. Data were analyzed using three progressively adjusted Cox proportional hazards regression models.

Results:
6,960 participants developed hypertension during a median follow-up of 13 years. Participants in the highest quartile of UPF consumption were 9% more likely to develop incident hypertension than those in the lowest quartile (model 2 HR: 1.09; CI: 1.02-1.16; P for trend = 0.01) (
Table
). Participants who were in the highest quartile of sugar-sweetened beverages and red and processed meat consumption had a 20% higher risk of hypertension (model 2 HR, 1.20; CI, 1.12 - 1.28; P for trend <0.001) and 9% higher risk of hypertension (model 2 HR, 1.09; CI, 1.02 - 1.17; P for trend <0.001), respectively, when compared to the lowest quartile. Participants in the highest quartile of minimally or unprocessed food consumption had 9% lower incidence of hypertension (model 2 HR, 0.91; 95% CI, 0.85 - 0.97; P for trend 0.01).

Conclusions:
High UPF consumption, specifically sugar-sweetened beverages and red and processed meat, was associated with higher risk of hypertension, whereas minimally or unprocessed food consumption was associated with lower hypertension risk.
Abstract P507: Pre-Statistical Harmonization of Cognitive Measures Across Eight Population-Based NIH Cohorts in the Collaborative Cohort of Cohorts for COVID-19 Research (C4R)
Authors: Kraal A. Zarina , Ramirez Evelyn , Gavarrete Olvera Alice , Balte Pallavi , Briceno Emily M , Demmer Ryan T , Elkind Mitchell S , González Hector M , Gross Alden L , Heckbert Susan R , Howard Virginia J , Krishnaswamy Akshaya , Levine Deborah A , Mosley Thomas H , Oelsner Elizabeth C , Seshadri Sudha , Suchy-Dicey Astrid , Yaffe Kristine , Manly Jennifer J , Palta Priya
Published: March 2023

Introduction:
Long-term neurological consequences (eg, stroke, impaired cognition) have been linked to SARS-CoV-2 infection and severity. There are limited data from studies with racial, ethnic, socioeconomic, and geographic diversity. C4R is a prospective study of adults from 14 cohorts that aims to link pre-COVID phenotyping, including cognition (8 studies), to COVID related illness and sequelae. We aimed to conduct pre-statistical harmonization of cognitive tests administered in English and Spanish from 8 cohorts: ARIC, CARDIA, FHS, HCHS/SOL-INCA, MESA, NOMAS, REGARDS, and SHS (Table).

Methods:
We conducted extensive item-level review of administration, scoring, and coding procedures and score distributions for 84 tests administered in English (all studies) and Spanish (NOMAS, MESA, HCHS/SOL-INCA).

Results:
Orientation to time and 3-word registration and recall spanned all studies and both languages. Word list recall and verbal fluency (animal; letter) spanned 7 studies (Table). There was variability in the structure, content, administration, scoring, and data coding procedures for items across cohorts and between Spanish and English. Word lists varied by number of words (9-16) and learning trials (3-5). Animal naming varied by time (30 vs. 60 seconds), animal type (4-legged vs. any animal), and scoring (allowing mythical/imaginary animals). Letter fluency varied by whether both Spanish and English words were permitted. Other tests differed by version, study-specific adaptations, prompts/cues, and specificity of scoring rules across cohorts.

Conclusions:
Cognitive test harmonization requires detailed review of administration, scoring, coding, translation, and procedural differences. Accounting for this variability is essential to cognitive data interpretation. Our pre-statistical harmonization will inform data augmentation and formal harmonization to yield harmonized measures of cognition to clarify population-level differences in cognitive outcomes linked to SARS-CoV-2 infection.
Abstract P536: The Association Between Arterial Stiffness and Incident Chronic Kidney Disease in a Large Community Cohort: The Atherosclerosis in Communities (ARIC) Study
Authors: Yao Zhiqi , Ishigami Junichi , Kim Esther , Ballew Shoshana , Sang Yingying , Tanaka Hirofumi , Meyer Michelle , Coresh Josef , Matsushita Kunihiro
Published: March 2023

Background:
Arterial stiffness was cross-sectionally associated with the prevalence of chronic kidney disease (CKD). Whether arterial stiffness was prospectively associated with incident CKD is not well characterized.

Methods:
Among 3,777 participants (mean age 75 years old, 42.7% female, 21.3% Blacks) without prevalent CKD in ARIC study at visit 5 (2011 to 2013), we examined the association of six measures for arterial stiffness measurements, carotid-femoral pulse wave velocity (cfPWV), heart-ankle PWV (haPWV), brachial-ankle PWV (baPWV), heart-femoral PWV (hfPWV), femoral-ankle PWV (faPWV), heart-carotid PWV (hcPWV) with the risk of incident CKD (defined by >25% decline to estimated glomerular filtration rate <60 ml/min/1.73m
2
or hospitalization with CKD diagnosis) using Cox regression models to estimate hazard ratios (HRs). Each arterial stiffness parameter was stratified by quartiles.

Results:
During follow-up (median 6.6 years) through 2019, 590 had incident CKD (incidence rate 23.2 per 1000 person-years). In the demographically adjusted model, the highest quartile (Q4) of cfPWV, haPWV, baPWV, and hfPWV were significantly associated with an increased risk of incident CKD compared to the lowest (Q1) (HR, 1.70 [95%CI 1.31 to 2.22], 1.29 [95% CI 1.01 to 1.64], 1.51 [95% CI 1.16 to 1.97], and 1.36 [95% CI 1.05 to 1.76], respectively). Once the model was further adjusted for major clinical risk factors for CKD, the associations were modestly attenuated but remained significant for cfPWV and haPWV (HR in Q4 vs. Q1, 1.34 [95% CI 1.02 to 1.76] and 1.38 [95% CI 1.04 to 1.82]), but not for baPWV and hfPWV. Subgroup analyses showed the associations were consistent in subgroups by gender, race, age, hypertension, and diabetes.

Conclusion:
Arterial stiffness as measured by PWV was associated with a higher risk of incident CKD in older adults, especially cfPWV and haPWV. Our findings support the temporal relationship of subclinical arterial stiffness predating incident CKD in older adults.