bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P158: Hypoglycemia Prediction From The Coefficient Of Variation For Each Hba1c Value
Authors: Takeishi Soichi
Published: April 2022

It has also been reported that the coefficient of variation (CV) corresponding to the number of hypoglycemia cases decreases as HbA1c values decrease. Therefore, when an association between the CV and hypoglycemia is considered, the possibility that the CV varies according to HbA1c values should be considered. If hypoglycemia can be predicted from both HbA1c values and the CV, the relationship between glycemic variability and hypoglycemia can be assessed in detail. Thus, we studied a formula that could predict hypoglycemia based on HbA1c values and the CV. Materials and Methods This was a prospective observational study. One hundred and one outpatients with type 2 diabetes mellitus underwent HbA1c testing, wore a flash glucose monitor (FGM: FreeStyle Libre Pro, Abbott Diabetes Care, Alameda, CA, USA), and did not change diabetic treatment at the hospital visit. The CV and mean glucose levels were calculated using the FGM data over 24-h х 13 days. The glucose management indicator (GMI) was calculated using the mean glucose levels, and we compared the GMI to the HbA1c values mainly to detect differences between sensor glucose levels (SG) and blood glucose levels. It has been previously reported that the HbA1c value minus (-) GMI >0.5% is associated with the risk of hypoglycemia, and the GMI - HbA1c value >0.5% is associated with the risk of hyperglycemia. Therefore, we assessed the difference between the GMI and HbA1c value with real numbers. We calculated the “percentage of mean absolute deviation to mean glucose levels” (Metric1) as a new metric. Hypoglycemia (<70 mg/dL) absence could be significantly predicted from the CV, HbA1c value, and “glucose management indicator (GMI) minus HbA1c value” (ΔA1c) (Nagelkerke=0.68, p<0.001). When a response variable was hypoglycemia absence and explanatory variables were the CV, HbA1c value, and ΔA1c, the optimal predicted value for the logistic regression analysis was 0.35 (sensitivity: 90%, specificity: 84%; area under the curve: 0.93, p<0.001) (predicted values=1÷(1+e
-(-0.28хCV+2.18хHbA1c+1.85хΔA1c-7.48)
) [e: Napier's constant]), where CVs corresponding to HbA1c values of 6%, 7%, 8%, 9%, and 10% were 22.0%, 29.8%, 37.5%, 45.3%, and 53.0%, respectively. The CV correlated with Metric1 (r=0.99, p<0.001, Metric1=0.82хCV-0.006 [formula1]). The CV should be reduced more to prevent hypoglycemia as HbA1c values decrease. For avoiding hypoglycemia, an “alarm threshold using ‘mean glucose levels (Mean) corresponding to the HbA1c values’, and ‘Metric 1 corresponding to the CV calculated using formula 1’ ” (Mean ± Mean х Metric 1 ÷ 100) should be used for personal continuous glucose monitoring, and all glucose levels should be kept within the alarm threshold.
Abstract P161: Plasma Betaine, But Not Trimethylamine N-oxide Or Choline, Associated With 15-year Incident Diabetes: Coronary Artery Risk Development In Young Adults Study
Authors: Meyer Katie , Howard Annie Green G , Shah Ravi V , Murthy Venkatesh L , Jacobs David R , Gordon-Larsen Penny
Published: April 2022

Objective:
Data from animal models supports a role for metabolites in the choline pathway in glycemic control and diabetes. Cross-sectional and case-control studies have documented positive associations between trimethylamine N-oxide (TMAO) and prevalent diabetes, but these findings have not been replicated in prospective analysis. Circulating choline has been positively, and betaine negatively, associated with diabetes in some, but not all, prospective data. We tested associations between three metabolites in the choline pathway (TMAO, choline, betaine) and 15-year incident diabetes in a diverse cohort of early-middle-aged adults.

Methods:
Study participants were from the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a multicenter cohort of Black and White Americans established in 1985/86 (baseline n=5,115; ages 18-30). Plasma concentrations of TMAO, choline, and betaine were measured from Year 15 (2000-01) stored plasma (-70°C) with liquid chromatography mass spectrometry (LC-MS). Logistic regression was used to quantify associations between plasma metabolites and diabetes, adjusting for sociodemographic, behavioral, and clinical covariates.

Results:
Among 3,317 participants without diabetes at Year 15, n=373 developed diabetes over 15 years of follow-up (2000-2016). Plasma TMAO and choline were not significantly associated with incident diabetes in all multivariable-adjusted models, while betaine was negatively associated with incident diabetes in all models (Table).

Conclusion:
In this population-based cohort of early-middle-aged US adults, plasma TMAO and choline were not associated with incident diabetes over 15 years of follow-up, while plasma betaine was negatively associated with incident diabetes.
Abstract P173: Sex Differences In Risk Factors For Cardiovascular Disease Mortality Among US Women And Men
Authors: Tian Ling , Anderson Amanda H , Dorans Kirsten , Krousel-wood Marie A , Bundy Joshua D
Published: April 2022

Ling Tian, Amanda H. Anderson, Kirsten S. Dorans, Marie A. Krousel-wood, Joshua D. Bundy

Introduction:
Previous studies suggest cardiovascular disease (CVD) risk factors differ among women compared with men. Quantifying sex differences in the associations of risk factors for CVD mortality in US nationally representative data could aid researchers and clinicians in improving the efficiency of primordial prevention of CVD.

Hypothesis:
Associations of systolic blood pressure (SBP), total cholesterol, glycated hemoglobin (HbA1c), body mass index (BMI), current smoking, and predicted 10-year risk of atherosclerotic CVD with CVD mortality differ among women compared with men, and these sex differences are modified by age.

Methods:
Data from non-pregnant and non-breastfeeding participants aged ≥40 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2006, linked to the National Death Index through December 31, 2015, were analyzed. Multivariable-adjusted Cox proportional hazards regression was used to estimate hazard ratios (95% confidence intervals) for CVD mortality. Interaction terms were used to model associations by age (40-49, 50-59, and ≥60 years) and sex (women and men) subgroups.

Results:
9,486 participants (mean age, 57.7; 51.9% women) were included in the current analysis. During an average 12.3-year follow-up, we observed 807 (8.5%) CVD deaths (328 in women; 479 in men). Associations of risk factors with CVD mortality were similar among women compared with men, although they were attenuated with increasing age (Figure).

Conclusions:
Among both US women and men, higher levels of SBP, smoking, and predicted 10-year ASCVD risk are strongly associated with higher risk of CVD mortality. Population-level interventions targeting these risk factors as early as possible in US men and women could reduce the burden of CVD.
Abstract P180: Relative Contributions Of Six Lifestyle Components To Epigenetic Aging In The Coronary Artery Risk Development In Young Adults (CARDIA) Study
Authors: Kim Kyeezu , Zheng Yinan , Joyce Brian , Jiang Hongmei , Greenland Philip , Jacobs David R , Zhang Kai , Liu Lei , Allen Norrina , Wilkins John T , Forrester Sarah , Lloyd-jones Don M , Hou Lifang
Published: April 2022

Background:
DNA methylation-based epigenetic age acceleration (EAA) is associated with age-related health outcomes including cardiovascular disease. Since DNA methylation is modifiable by external stimuli, including lifestyle components, interventions for healthier lifestyles could contribute to decreased risk of health conditions related to epigenetic changes including EAA. In consideration of public health intervention, it is also important to identify which lifestyle components have the greatest impact on EAA. Here, we assessed the relative contributions of lifestyle components to EAA, as well as their collective association.

Methods:
We included 744 participants (391 men and 353 women) from the Coronary Artery Risk Development in Young Adults (CARDIA) study with DNA methylation information at Y20 (2005-2006, mean age 45.9). Six lifestyle components at Y20 were included in the analysis: cumulative smoking, cumulative alcohol consumption, education, diet, sleep, and physical activity. We used quantile-based g-computation (QGC) and Bayesian kernel machine regression (BKMR) methods to assess the relative contribution of each lifestyle component to EAA. We also assessed overall association of the six lifestyle components as a combination with EAA. Finally, we performed stratified analyses by participants’ smoking history, race, and sex.

Results:
Cumulative smoking showed the greatest positive contribution to EAA in total participants. Healthy diet and education years showed inverse contributions to EAA. We observed a non-linear pattern in the contribution of cumulative alcohol consumption to EAA. We observed positive associations between the collective lifestyle components and greater EAA. While cumulative smoking was the greatest contributor across sex and race subgroups, the relative contributions of other components varied by subgroups.

Conclusion:
Cumulative smoking, cumulative alcohol consumption, diet, and education showed the highest contributions in our study. Higher amounts of smoking and alcohol consumption were likely to contribute to greater EAA, whereas healthier diet and achieved education were likely to contribute to lesser EAA. Identifying pertinent lifestyle components in a context of collective lifestyle components can provide a direction for intervention strategies, and suggests which components should be the primary focus for promoting younger EAA.
Abstract P186: Healthcare Access Disparities Among Asian, African, And Latino Immigrants With Hypertension Or Diabetes In The 2010-2018 National Health Interview Survey
Authors: Azoba Chinenye C , Turkson-Ocran Ruth-Alma N , Ogungbe Oluwabunmi B , Koirala Binu , Commodore-Mensah Yvonne
Published: April 2022

Background:
Morbidity and mortality due to cardiovascular disease (CVD) disproportionately affects racial and ethnic minorities and can be mitigated by access to preventative services. However, research describing health access in immigrants with CVD risk in the US is lacking.

Hypothesis:
Immigrants with hypertension or diabetes will have less healthcare access (HCA) than US-born non-Hispanic (NH) White persons.

Methods:
We analyzed cross-sectional data from the 2010-2018 National Health Interview Survey on 75,631 Asian (N=3,120), African (N=393), and Latino (N=7,315) immigrants and US-born NH White (N=64,803) people with hypertension or diabetes. HCA was defined as insurance coverage, usual place for sick care, and delay in care due to cost. We used multivariable logistic regression to examine disparities in HCA between immigrants and NH Whites and compared HCA among immigrants stratified by length of US residence.

Results:
Participants had a mean (±SE) age of 60.4 (±0.1) years (52% female). After adjusting for sociodemographic factors, health status, and region, Asian immigrants were 13% more likely to be insured than NH Whites, but this pattern was not statistically significant (95% CI: 0.93-1.39,
Table
). Compared to NH Whites, African [adjusted odds ratio (AOR): 0.56; 95% CI: 0.39-0.80] and Latino (AOR: 0.65; 95% CI: 0.57-0.74) immigrants were less likely to be insured, and Asian (AOR: 0.50; 95% CI: 0.41-0.60) and Latino (AOR: 0.70; 95% CI: 0.63-0.79) immigrants were less likely to delay care due to cost. All immigrant groups were less likely to have a usual place for sick care. Compared to those with <10 years of US residence, HCA did not improve in African immigrants with ≥10 years of residence (data not shown).

Conclusion:
Immigrants with CVD risk are less likely to establish a usual place for sick care, yet Asian immigrants may be less likely to experience gaps in HCA compared to NH White people. CVD health policies must account for heterogeneity among and within immigrant groups to improve HCA and prevent CVD complications.
Abstract P193: Life’s Simple 7 Risk Factors and Cardiovascular Disease Among Gender Minority Populations in the 2019 BRFSS
Authors: Bellinger Grace C , Beach Lauren B
Published: April 2022

Gender minority (GM) populations encompass individuals who identify with a gender different from their sex assigned at birth. This includes transgender adults, which make up 0.6% of the U.S. population. Despite cardiovascular disease being the leading cause of morbidity and mortality worldwide, there is little research on the cardiovascular health of GM populations. GM adults may be at higher risk for myocardial infarction, coronary heart disease, and stroke compared to their cisgender peers due to minority stress and the impact of stigma on health. The Behavioral Risk Factor Surveillance System (BRFSS) is a federal survey administered by state health departments and the CDC. The BRFSS has offered an optional standardized Sexual Orientation and Gender Identity (SOGI) module with measures to identify transgender respondents since 2014 and 30 states included the module in 2019. Life’s Simple 7 criteria are used in preventive medicine and public health to describe ideal cardiovascular health. The seven associated risk factors are smoking, obesity, physical inactivity, poor dietary habits, high cholesterol, high blood pressure, and high blood glucose. The 2019 BRFSS included core modules related to each of the risk factors and therefore provides a unique opportunity to investigate the cardiovascular health of GM respondents. BRFSS data (N = 177,322) were used to determine prevalence rates of cardiovascular risk factors and disease among GM compared to cisgender adults. R was used to conduct weighted estimates and regressions comparing behavioral and clinical cardiometabolic risk factors and events by gender identity (cisgender male, cisgender female, transgender male-to-female, transgender female-to-male, and transgender gender nonconforming). On average, GM respondents were younger, more racially/ethnically diverse, less likely to have graduated college, less likely to be straight, and reported lower annual household incomes than cisgender males or females. After adjusting for age, race/ethnicity, education, income, and sexual orientation, gender nonconforming transgender adults were less likely than both cisgender males (adjusted odds ratio = 1.17, 95% confidence interval: (1.02, 1.34)) and cisgender females (1.15 (1.00, 1.32)) to report exercise in the last 30 days. Gender nonconforming transgender adults were less likely to report a diagnosis of diabetes than cisgender males (0.97 (0.94, 1.00)). No significant differences between gender minority and majority adults were detected for cardiovascular events after adjusting for demographic variables and Life’s Simple 7 risk factors. This may be due to the age difference between the cisgender and GM groups, since older adults have higher risk of cardiovascular disease. Analyses may have been underpowered due to small GM sample sizes, emphasizing the importance of all states including the optional standardized SOGI module.
Abstract P195: Title
Authors: Ishigami Junichi , Kansal Mayank M , Mehta Rupal , Srivastava Anand , Rahman Mahboob , Dobre Mirela A , Al-Kindi Sadeer , Go Alan S , Navaneethan Sankar , Chen Jing , He Jiang , Bhat Zeenat Y , Jaar Bernard , Appel Lawrence J , Matsushita Kuni
Published: April 2022

Background:
A bidirectional relationship between cardiovascular disease and chronic kidney disease (CKD) is well-recognized, but the association of cardiac dysfunction and structure with the risk of CKD progression has not been systematically evaluated in a CKD population.

Methods:
We analyzed Chronic Renal Insufficiency Cohort participants who underwent an echocardiogram at baseline. We evaluated the association of left ventricular mass index (LVMI), left ventricular ejection fraction (EF), left atrial area (LAA), and peak tricuspid regurgitation (TR) velocity with CKD progression, defined as ≥50% decline in estimated glomerular filtration rate (eGFR) or incident end-stage kidney disease. A secondary outcome was annual eGFR slope. We used multivariable Cox models and mixed-effects models for these outcomes, respectively.

Results:
Among 3,025 eligible patients, mean age was 59 (SD 11) years, 54% were men, 46% had diabetes, and mean eGFR was 43 (17) ml/min/1.73m
2
. Higher LVMI, LAA, peak TR velocity, and lower EF were each significantly associated with an increased risk of CKD progression. Corresponding HRs for the highest vs. lowest quartiles [lowest vs. highest for EF] were 2.38 (95% CI, 1.87-3.03), 1.51 (1.21-1.88), 1.57 (1.20-2.06), and 1.22 (1.02-1.47) (Table). Participants in the highest quartile (vs. lowest quartile) of LVMI and peak TR velocity had a significantly faster eGFR decline (i.e., ΔeGFR slope per year, -0.33 [95% CI, -0.43 to -0.22] and -0.33 [-0.46 to -0.20] ml/min/1.73m
2
, respectively) (Table). In contrast, EF and LAA were not associated with eGFR slopes (p for linear trend >0.05).

Conclusions:
While echo-based parameters of cardiac structure and function were generally associated with increased risk of CKD progression, only higher LVMI and peak TR velocity were independently associated with faster eGFR decline in slope analyses. Our findings may indicate different mechanisms associated with adverse kidney outcomes based on cardiac structural and functional phenotypes.
Abstract P198: Association Between Oral Microbiome, Inflammation, Endotoxemia, And Heart Failure Severity
Authors: Bohn Bruno , Yuzefpolskaya Melana , Onat Drew D , Pinsino Alberto , Takeda Koji , Yoshifumi Naka , Johnson Abigail , Nandakumar Renu , Uhlemann Anne-Catrin , Paster Bruce , Colombo Paolo C , Demmer Ryan
Published: April 2022

Introduction:
Gut microbial imbalance may contribute to endotoxemia, inflammation and oxidative stress in heart failure (HF). Changes occurring in the oral microbiota and inflammatory/oxidative milieu during HF progression are unknown.

Hypothesis:
The oral microbiome will be associated with HF severity New York Heart Association, Class I/II, III, IV.

Methods:
We enrolled 167 patients with HF with reduced ejection fraction (mean age 59±14, 85% Male, 47% White, mean LVEF 20±9, 49% smokers). Biomarkers of endotoxemia (LPS, sCD14) and inflammation (CRP, IL6, TNF-α) were measured in 150 blood samples. A total of 167 oral samples were analyzed using 16S rRNA sequencing. Alpha diversity was assessed via Shannon Index and regressed on HF severity and biomarker levels with linear models. The association between HF severity and Beta diversity (Bray-Curtis dissimilarity) was assessed with PERMANOVA. DESeq2 regressed taxa abundance on HF severity and below vs. above median biomarker levels; multiple comparisons were controlled with the false discovery rate. Models were adjusted for age, sex, race/ethnicity, and smoking status.

Results:
Mean Shannon Index values±SD across HF class I/II (N=50), III (N=65), and IV (N=52) were 3.28±0.47, 3.42±0.49, 3.20±0.78. NYHA class was associated with both Alpha (p<.01) and Beta diversity (p<.05). Decreased Alpha diversity was associated with ischemic etiology (p<.05), but not with sex, smoking, age, race/ethnicity, or clinical variables, including antibiotic use. In unadjusted models, increased Alpha Diversity was associated with decreased inflammation: IL6 (r=-0.16), TNF-α (r=-0.18), CRP (r=-0.21); all p<.05. Statistical significance was lost after adjustment. Several taxa differed by NYHA class, levels of inflammation, and endotoxemia in multivariable models (
Figure
).

Conclusions:
HF severity, inflammation, and endotoxemia were associated with oral microbial diversity and bacteria linked to poor oral health, including
Treponema denticola
and
Porphyromonas gingivalis
.
Abstract P200: A Polygenic Risk Score Improves Prediction Of Lifetime Risk For Heart Failure
Authors: Alkis Taryn , Luo xi , Wall Katherine , Chang Patricia , Norby Faye L , Hoogeveen Ron C , Ballantyne Christie M , Coresh Josef , Boerwinkle Eric , Shah Amil M , Yu Bing
Published: April 2022

Introduction:
Heart Failure (HF) has shared genetic architecture with its risk factors, including atrial fibrillation (AF), body mass index (BMI), coronary heart disease (CHD), systolic blood pressure (SBP), and type 2 diabetes (T2D). The risk prediction performance of polygenic risk scores (PRS) for those HF risk factors and HF itself over an established risk equation warrants investigation.

Methods:
Within the Atherosclerosis Risk in Communities (ARIC) study, six PRSs were constructed for AF, BMI, CHD, SBP, T2D, and HF by summing the product of pre-computed weights from genome-wide association studies and SNP allele dosages in European and African Americans separately. The association between PRSs and incident HF was assessed using cox proportional hazard models, and the 10-, 20-, and 30-year risk prediction performance of PRS over the ARIC HF risk equation was assessed using C-statistics. Associations between AF PRS and HF subtypes, echocardiographic measures, and 4,877 proteins were examined.

Results:
Over 30 years follow-up, 1,922 (22%) and 735 (29%) HF cases developed in 8,624 European (mean age=54.2, 52% female) and 2,525 African (mean age=53.3, 61% female) Americans. The PRSs for AF and HF were associated with incident HF in both European and African Americans (P<0.05). The AF PRS showed the greatest effect on HF risk in European (HR=1.47, 95% CI: 1.41 to 1.53) and African (HR=1.29, 95% CI: 1.20 to 1.39) Americans. Addition of AF PRS to the ARIC HF risk equation significantly improved the C-statistics for 10-year risk prediction in European (ΔC=0.017, 95% CI: 0.009 to 0.026) and African (ΔC=0.015, 95% CI: 0.004 to 0.026) Americans. The AF PRS was further associated with HF with reduced (HR=1.45, 95% CI: 1.29 to 1.64) and preserved (HR=1.49, 95% CI: 1.34 to 1.66) ejection fraction, and higher left atrial volume index (P=1.67х10
-4
). Protein analyses revealed that 61 proteins were associated with AF PRS, where NT-proBNP and Coagulation factor X showed the strongest positive and negative associations respectively.

Conclusions:
The PRS of AF was associated with incident HF, and had significant incremental value over an established HF risk prediction equation. These findings suggest that PRS may be useful in identifying individuals with high risk of HF.
Abstract P202: Optimism Moderates The Effects Of Neighborhood Disadvantage On Incident Heart Failure Among African-Americans In The Jackson Heart Study (JHS) And Atherosclerosis Risk In Communities (ARIC) Study
Authors: Bey Ganga S , Heiss Gerardo M , Pike James R , Palta Priya , Barber Sharrelle
Published: April 2022

Background:
African-Americans experience a disproportionate burden of heart failure. Although previous research has identified neighborhoods as an important contributor to these disparities, less is understood about how psychosocial resilience factors, such as optimism, may provide protection from the effects of neighborhood disadvantage on heart failure risk. We tested the hypothesis that higher levels of optimism will attenuate the associations between greater neighborhood disadvantage and higher incidence of heart failure.

Methods:
Among 1,448 African-Americans dually enrolled in two community-based cohorts in Jackson, Mississippi—JHS and the ARIC study—who were free of heart failure as of January 1, 2000, 459 failure events classified by reviewer panel accrued through December 31, 2019. Multi-level age- and sex-adjusted Cox regression models with interaction terms were used to examine whether individual-level optimism moderated the associations of four measures of census tract-level neighborhood socioeconomic and social environment characteristics (the national Area Deprivation Index (ADI), a JHS neighborhood disadvantage score, racial residential segregation, and perceived physical disorder) on individual-level incident hospitalized heart failure.

Results:
Optimism moderated the associations of some neighborhood disadvantage measures (ADI and JHS neighborhood disadvantage score) on hospitalized heart failure risk (Table). Compared to participants reporting the lowest level of optimism, those in the highest tertile had 12%, 6%, 16%, and 9% lower rates of heart failure associated with increasing neighborhood disadvantage, respectively for each exposure. Interaction estimates for racial residential segregation and perceived physical disorder did not reach statistical significance.

Conclusions:
Optimism may provide resilience to the detrimental effects of neighborhood disadvantage on risk for heart failure.
Abstract P203: Metabolomic Markers Of Gestational Weight Gain In Overweight And Obese Pregnant Women-a Longitudinal Study
Authors: Dai Jin , Liu Jihong , Boghossian Nansi , Luo Feng , Sun Xiaoqian , Fiehn Oliver , Chen Liwei
Published: April 2022

Background:
Optimal gestational weight gain (GWG) is critical for fetal development and maternal health. Few studies have investigated metabolomic markers of GWG. Thus, we performed a metabolome-wide association study with GWG among pregnant women in the US.

Methods:
This longitudinal study included overweight or obese pregnant women (pre-pregnancy BMI ≥ 25) enrolled in the Health in Pregnancy and Postpartum study in early pregnancy (mean gestational week (GW) at baseline=12). Fasting plasma samples were collected both at baseline (N=39) and 32 GW (N=29). Untargeted metabolomic profiling was conducted using three different analytical platforms, including GC-TOF MS, HILIC-QTOF MS/MS, and CSH-QTOF MS/MS. Linear regressions were performed to identify metabolites at each time point and the change between two time points (i.e., metabolites
32 wk
- metabolites
baseline
)/metabolites
baseline
) that were individually associated with total GWG, a difference between delivery weight and pre-pregnancy weight. The least absolute shrinkage and selection operator (LASSO) regressions were conducted to select metabolites that were jointly associated with total GWG.

Results:
The mean (SD) age of 39 women enrolled was 30.4 (5.4) years and 38.5% were Blacks. A total of 769 known metabolites were profiled and annotated. Eight metabolites at 32 GW, including PC (34:4), LPC (22:5), isoleucine, arachidonic acid, TAG (52:6), TAG (58:7), and glyceric acid were positively whereas 3-Hydroxybutyrylcarnitine was negatively associated with GWG in both linear regressions (FDR < 0.1) and LASSO regressions (with no-zero coefficients) after adjusting for age, race, parity, and pre-pregnancy BMI (Figure 1). Metabolites at around 12 GW or changes between two time points were not associated with GWG (all FDRs ≥ 0.1).

Conclusions:
We identified eight metabolites at 32 GW that were significantly associated with total GWG in this longitudinal study of overweight and obese pregnant women. Future studies are warranted to replicate our findings.
Abstract P209: Like Parent, Like Child? Examining Associations Among Parent And Emerging Adult Intuitive Eating
Authors: Burnette Blair , Hazzard Vivienne , Hahn Samantha , Neumark-Sztainer Dianne R
Published: April 2022

Introduction:
Intuitive eating (IE) is an approach that emphasizes relying on hunger and satiety cues to guide eating. Accumulating data highlight positive associations between IE and mental health and health-promoting behaviors, and some preliminary data suggest increasing IE might benefit cardiometabolic markers. However, little is known about what helps individuals eat intuitively. Although caregivers’ own eating patterns often shape those of their children, no known research to date has explored familial associations of IE. Elucidating factors that foster health-promoting behaviors is crucial to inform interventions that reduce cardiovascular disease.

Objective:
This cross-sectional, population-based study examined the concordance of IE between caregivers and their emerging adult children, and associations between concordance and sociodemographic characteristics and weight perceptions.

Method:
Data came from the second wave of the population-based, longitudinal EAT and F-EAT 2010-2018 studies. The analytic sample included 891 emerging adults (53.6% female;
M
age=22.0) and their primary caregiver who were diverse across race/ethnicity and socioeconomic status (SES). Caregivers and emerging adults were grouped into dyads: (1) neither are intuitive eaters (
n
=194); (2) emerging adult only is an intuitive eater (
n
=203); (3) caregiver only is an intuitive eater (
n
=218); and, (4) both are intuitive eaters (
n
=289). Chi-square analyses and independent samples
t
-tests examined differences across dyads.

Results:
Caregiver and emerging adult IE were weakly correlated (
r
=.07,
p
=.03). Dyads differed across race/ethnicity, SES, and weight perceptions. Concordant dyads who ate intuitively were more likely to be high SES and perceive their weight as “about right,” whereas concordant dyads who did
not
eat intuitively were more likely to be low SES and perceive their weight as “overweight.” Asian emerging adults were more likely to belong to concordant non-intuitive eater dyads, whereas White and Black emerging adults were more likely to belong to concordant intuitive eater dyads. Discordant dyads were generally distinguished by weight perceptions. Emerging adults who shared their caregiver’s perception that their weight was “overweight” were less likely to be intuitive eaters (even if their caregivers were).

Discussion:
In this sample, weight perceptions were strongly related to IE, and IE differed across race and SES. Individuals who perceived their own weight as “overweight” were less likely to be intuitive eaters, as well as emerging adults whose caregivers perceived their weight as “overweight.” Rather than motivate healthy eating, perceiving one’s weight as “overweight” might actually hinder IE. Longitudinal research is needed to evaluate the temporality of associations, and future work is needed to explore the role of IE in cardiovascular disease risk.
Abstract P210: Acculturation And Associations With Ultra-processed Food Consumption Among Asian Americans: NHANES, 2011-2018
Authors: Pachipala Krithi , Shankar Vishal , Rezler Zachary , Vittal Ranjana , Ali Shahmir , Srinivasan Malathi , Palaniappan Latha , Yang Eugene , Juul Filippa , Elfassy Tali
Published: April 2022

Introduction:
Ultra-processed food (UPF) consumption is linked to adverse health outcomes, including cardiovascular disease and all-cause mortality. Asian Americans (AAs) are the fastest growing ethnic group in the United States (US), yet their dietary patterns have seldom been described.

Objectives:
To characterize UPF consumption among AAs and determine whether acculturation is associated with increased UPF consumption.

Methods:
The National Health and Nutrition Examination Survey (NHANES) is an annual, cross-sectional survey representative of the US population. We examined NHANES dietary data, combining years in which AAs were over-sampled (2011-2018). We included 2,404 AAs ≥ 18 years old with valid 24-hour dietary recall data. Using day 1 dietary recalls, we characterized UPF consumption as the percentage of caloric intake from UPFs, using the NOVA classification system. This framework classifies foods from any culture based on degree of industrial processing. Acculturation was characterized by nativity, nativity/years in the US, home language, and an acculturation index (based on a sum of levels related to nativity/years in the US and home language). We assessed the relationship between each acculturation measure and UPF consumption using linear regression analyses adjusted for age, sex, marital status, education, income, self-reported health, and self-reported diet quality. All analyses accounted for the complex survey design.

Results:
Among all AAs, the percentage of caloric intake attributable to UPFs was 39.3% (95% CI: 38.1-40.5). In adjusted regression analyses, UPF consumption was 14% (95% CI: 9.5-17.5; p<0.05) greater among those with the highest vs. lowest acculturation index score, 12% (95% CI: 8.5-14.7: p<0.05) greater among those who speak English only vs. non-English only in the home, 12% (95% CI: 8.6-14.7: p<0.05) greater among US-born vs. foreign-born AAs, and 15% (95% CI: 10.7-18.3: p<0.05) greater among US-born vs. foreign-born AAs with less than ten years in the US.

Conclusions:
Among AAs, UPF consumption was common, and acculturation was strongly associated with greater proportional UPF intake. As the US-born AA population continues to grow, UPF consumption in this group is likely to increase. Further research is necessary to characterize trends in dietary patterns across disaggregated AA subgroups to better inform culturally tailored dietary interventions.
Abstract P212: Circulating And Tissue Omega-3 Fatty Acid Biomarkers And Incident Atrial Fibrillation: An Individual Participant-level Pooled Analysis Of Prospective Studies
Authors: Qian Frank , Tintle Nathan , Lemaitre Rozenn , Imamura Fumiaki , Nomura Sarah , Guan Weihua , Kim Eunjung , Virtanen Jyrki K , Bork Christian , Hirakawa Yoichiro , O'Donoghue Michelle , Sala-Vila Aleix , Ardisson Korat Andres V , Sun Qi , Rimm Eric B , Forouhi Nita G , Tsai Michael Y , Pester Julie , Albert Christine M , Ninomiya Toshiharu , Bayés-Genís Antoni , Wu Jason H , Mozaffarian Dariush , Harris William S , Siscovick David S
Published: April 2022

Background:
Evidence for the role of omega-3 fatty acids in the prevention of atrial fibrillation (AF) remain inconsistent, with some recent RCTs even suggesting possible harm. Whether long-term dietary intake of these fatty acids, as assessed using objective biomarkers, is related to AF is not known.

Aims:
To prospectively evaluate circulating and tissue levels of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), and the sum of EPA and DHA (also known as the omega-3 index), with respect to incident AF.

Methods:
We used data from a global consortium of 13 prospective cohort studies with measurements of EPA, DPA, or DHA in adults (age≥18) identified through March 2021. Participating studies conducted
de novo
participant-level analyses using a prespecified analytical plan with harmonized definitions for exposures, outcomes, covariates, and subgroups. Associations were pooled using inverse-variance weighted meta-analysis.

Results:
Among 45,910 participants, a total of 6,229 incident cases of AF were ascertained, with median follow-up ranging from 0.9 to 29.1 years. In the multivariable analysis, per interquintile range (difference between the 90
th
and 10
th
percentiles for each fatty acid), DPA, DHA, and EPA+DHA (
Figure 1
) were associated with 11%, 13%, and 9% lower incidence of AF, respectively (
P
<0.01 for each). EPA levels were not associated with incident AF. Heterogeneity as measured using

I
2

ranged from 0% for DPA to 56.7% for EPA+DHA. Associations were broadly consistent irrespective of baseline cardiovascular risk, global region, age, sex, or lipid fraction.

Conclusion:
Biomarkers of omega-3 fatty acids including DPA, DHA, and EPA+DHA demonstrated an inverse association with incident AF. In the absence of RCTs examining long-term dietary omega-3 intake and AF risk, our results do not suggest that higher levels of these fatty acids are associated with harm.
Abstract P216: Association Of Heart Rate Variability With The Risk Of Heart Failure And Its Sub-types In Post-menopausal Women: A Longitudinal Cohort Study
Authors: Baig Muhammad , Miremad Moafi-Madani , Roberts Mary , Eaton Charles B
Published: April 2022

Background:
Previously our research findings revealed that low heart rate variability, a measure of autonomic imbalance, is associated with increased incidence of coronary heart disease (CHD) and heart failure (HF) in a cohort of post-menopausal women. Since CHD is strongly associated with HF, we investigated the effect of CHD on relationship of HRV and HF subtypes, i.e., heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), in post-menopausal women.

Methods:
Total of 28,603 post-menopausal women free of baseline CHD, HF and cardiac arrhythmias enrolled in Women’s Health Initiative (WHI) study, were followed for incident hospitalized CHD, HF and its subtypes (HFrEF vs HFpEF). Using multivariate cox proportional hazard model, we estimated the association of above outcomes with baseline quartiles of HRV measures; SDNN (standard deviation of normal-to-normal RR interval) and RMSSD (root mean square of successive difference of RR interval) produced by 10-second twelve-lead ECG on enrollment. We then evaluated the relationship between HRV and HF subtypes stratified by incident CHD.

Results:
A total of 2279 incident CHD and 1562 incident HF events occurred during a median follow-up duration of 17.5 years. After adjusting for incident CHD in a multivariate cox proportional model, association of low SDNN and RMSSD with incident HF remained significant (SDNN HR 1.19, CI 1.05 - 1.35; RMSSD HR 1.13 (1.00 - 1.29). However, in stratified analysis low SDNN was associated with increased incidence of HFpEF only among participants without incident CHD (HR 1.29, CI 1.05 - 1.58) and not in those with incident CHD (HR 1.06, CI 0.77 - 1.47). Whereas low SDNN was associated with increased incidence of HFrEF only among participants with incident CHD (HR 1.44. CI 1.05 - 1.98) and not in those without incident CHD (HR 1.18, CI 0.87 - 1.61).

Conclusion:
Post-menopausal women with low HRV who develop CHD have an increased risk of HFrEF while those who don’t develop CHD have an increased risk of HFpEF. The relationship between autonomic imbalance and HF subtypes is dependent on CHD status.
Abstract P221: ASSOCIATION OF PSYCHOLOGICAL RESILIENCE WITH ALL-CAUSE AND CARDIOVASCULAR MORTALITY IN A GENERAL POPULATION IN ITALY: PROSPECTIVE FINDINGS FROM THE MOLI-SANI STUDY
Authors: ghulam anwal , Bonaccio Marialaura , Costanzo Simona , Gialluisi Alessandro , santonaso francesca , Di Castelnuovo Augusto F , cerletti chiara , Donati Maria , De Gaetano Giovanni , Gianfagna Francesco , Iacoviello Licia
Published: April 2022

Introduction:
Psychological resilience (PR) is understood as the capacity to adapt positively in face of adverse events. Its role as an independent protective factor for health has been increasingly acknowledged in recent years.

Hypothesis:
We tested the hypothesis that psychological resilience could act as a protective factor towards disease, in particular, could decrease risk of premature death from cardiovascular (CVD) or all causes. We further investigated the association of single domains of PR with all cause and CVD mortality.

Methods:
We analysed prospective data on 10,406 individuals (mean age 52±10 y, 50.4% women) from the Moli-sani Study cohort, recruited between 2005 and 2010 and followed up for all-cause and CVD mortality for a median of 11.2 y. PR was assessed at baseline by the 25-item Connor and Davidson resilience scale (CD-RISC). A polychoric factor analysis was used to identify main domains reflecting different aspects of PR. Association of PR (or its domains) with all-cause and CVD mortality was tested using multivariable Cox proportional hazard models.

Results:
Higher levels of PR were associated with reduced all-cause mortality as compared to lower PR in a model adjusted for sex and age (HR=0.78; 95%CI 0.62-1.00 for Q4 vs Q1; p for trend=0.029). The association decreased after inclusion of socioeconomic, clinical, and behavioural factors into the model (HR=0.80; 95%CI 0.62-1.03; p for trend=0.059). No relation was observed with CVD mortality in the fully adjusted model (HR=0.89; 95%CI 0.56-1.39 for Q4 vs Q1). The polychoric factor analysis resulted in 5 main factors: Factor 1 reflected positive acceptance of change; Factor 2 reflected faith and hope; Factor 3 reflected secure attachment and secure relationships; Factor 4 reflected external locus of control and confidence in one’s abilities; and Factor 5 reflected strengthening effects of stress and self-efficacy. When individual PR factors were considered, an inverse association of Factor 1 with all-cause mortality (HR=0.89; 95%CI 0.82-0.98; p value=0.01) was apparent.

Conclusions:
Though at a borderline not significant way, PR total score predicts all-cause mortality in a general population of CVD-free adult Italians. This is supported by the finding that PR’s domain reflecting a positive acceptance of change is significantly associated with all-cause mortality. However, no association between PR and CVD mortality was found.
Abstract P222: The Psychological Predictors Of Recovery After Acute Cardiac Events Study: Rationale And Design
Authors: Rojas Danielle A , David Michelle A , Cruz Gaspar J , Sullivan Alexandra M , McMurry Cara L , Birk Jeffrey , Agarwal Sachin
Published: April 2022

Objective:
To estimate the prospective association of cardiac anxiety at cardiac arrest (CA) discharge with subsequent risk for cardiovascular disease (CVD)/mortality after adjusting for general psychological distress and test its independent association with health-related quality of life (HRQoL). Our second objective is to test whether cardiac anxiety after CA is associated with low physical activity (PA) and/or short sleep shortly after discharge. Our third objective will test if low PA and/or short sleep mediate the association between cardiac anxiety and 12-month CVD/mortality post-discharge for CA. Further, the study will test the associations of general psychological distress with cardiac vagal control assessed by activity-adjusted heart rate variability.

Background:
Survivorship after CA is on the rise. However, survivors remain at markedly elevated risk for CVD, and many report poor HRQoL in the year after CA. Cardiac anxiety (i.e., cardiac specific-fear, avoidance behavior, and excessive cardiac symptom monitoring) has been shown in non-CA CVD patients to be associated with higher rates of psychological distress, avoidance of PA and poor sleep, patient-reported disability, and poor perceived health. Further, despite the association of low PA and poor sleep in CVD risk, no study has assessed those health behaviors in CA survivors.

Design/Methods:
This observational cohort study (anticipated
n
= 246) will evaluate CVD prognosis, HRQoL in the first year of survivorship of neurologically intact CA survivors admitted to New York Presbyterian Hospital between May 2021 and April 2026. At hospital discharge, 1, 6, and 12 months, study participants will be assessed for cardiac anxiety, and general psychological distress (screening measures for depression, posttraumatic stress, generalized anxiety symptoms), positive psychological factors (optimism, positive affect, purpose in life), functional (modified Rankin Scale) and telephone-based cognitive assessments. For 1-week post-discharge, and 1 week at 6-months post-discharge we will assess the level of PA and sleep duration using wrist-worn actigraphy, daily psychological factors using mobile ecological momentary assessment, and heart rate/heart rate variability using chest-worn patches.

Results:
Of the 21 patients enrolled to date (mean age 57 years, 10 women). The presentation will describe patterns of physical activity, sleep, both negative and positive psychological factors at 1-month post-discharge relative to discharge status.

Conclusions:
This is the first major prospective cohort study of CA survivorship, and the first to objectively assess health behaviors. By identifying malleable intervention targets for improving both CVD/mortality risk and post-CA HRQoL, this study could ignite the development of the first generation of CA survivorship interventions.
Abstract P231: The Impact Of Intelligence In Youth On Cardiovascular Diseases Among 54-61 Years Old Americans
Authors: Tome Joana , Cowan Logan
Published: April 2022

Introduction:
The association between intelligence measured in youth and all cause-mortality has been previously established, where people with lower intelligence had a higher mortality risk. Few studies have looked at the relationship between intelligence and CVD morbidity.

Hypothesis:
We assessed the hypothesis that higher intelligence in youth is associated with lower odds of CVD adjusting for the social determinants of health.

Methods:
Our sample population consisted of 9,964 men and women who participated in the National Longitudinal Survey of Youth 1979 and responded to the 2018 survey (round 28). The intelligence was measured when participants were around 15 to 23 years of age using the Armed Forces Qualification Test and was scored as a percentile and z-scored. CVDs were measured as self-reports of a doctor ever diagnosing hypertension, myocardial infarction, angina, congestive heart failure, ischemic stroke, or general heart problems in 54-61 years old Americans. Crude and adjusted for age, sex, ethnicity, highest grade of education completed, and total net family income logistic regression models were used to test the association between intelligence and CVD.

Results:

Conclusions:
In conclusion, the current findings suggest that higher intelligence may be a protective factor against CVD. Previous associations in populations younger than ours were attenuated, suggesting that the relationship may no longer exist when including older Americans. However, identifying the most vulnerable groups as priority areas for reducing CVD morbidities is key to reducing impact and promoting health equity. The data from this study can inform health and social policies, which can help reduce the burden of CVD. Public health efforts that account for variation and contribution of intelligence, as well as social determinants of health, are needed to reduce CVD and its risk factors.
Abstract P233: Child Opportunity Index And Prevalence Of Obesity And Hypertension In Adolescents With Congenital Heart Disease
Authors: Tran Andrew H , Walsh Aaron , Hor Kan N
Published: April 2022

Introduction:
The Child Opportunity Index (COI) is a measure of neighborhood conditions encompassing educational, health, environmental, social, and economic components that affect child development. Worse COI has been associated with increased cardiometabolic risk in children. Hypertension (HTN) and obesity leads to left ventricular hypertrophy (LVH) and are risk factors for cardiac events in adulthood. However, the impact of COI on patients with congenital heart disease (CHD) has not been well described.

Hypothesis:
We hypothesized that CHD youths with lower COI would have higher rates of obesity and hypertension compared to higher COI patients.

Methods:
We retrospectively reviewed adolescent CHD patients with an echocardiogram between 2012-2019. Patients aged 13-17 years with blood pressure (BP), height, weight, and echo measurement for LVMi-HT
2.7
were included. Home location was geocoded and linked to public COI data. Patients were classified by COI into Very Low (VL), Low (L), Moderate (M), High (H), and Very High (VH) opportunity levels. Obesity was defined as body mass index (BMI) ≥ 95
th
percentile. Blood pressure was defined as normotensive (NT, SBP < 120 mm Hg), elevated BP (E-BP, 120 ≤ SBP < 130 mm Hg), Stage 1 HTN (HTN-1, 130 ≤ SBP < 140 mm Hg), and Stage 2 HTN (HTN-2, SBP ≥ 140 mm Hg). Left ventricular hypertrophy (LVH) was defined as LVMi-HT
2.7
≥ 38.6 g/ht
2.7
.

Results:
A total of 801 patients (mean age 15.5 ± 1.5 years, 57.43% male [460/801]) were included in this analysis. COI groups were VL 157/801 (19.6%), L 165/801 (20.6%), M 226/801 (28.2%), H 142/801 (17.7%), and VH 111/801 (13.9%). Overall, 117/801 (14.6%) patients were obese, 141/801 (17.6%) patients were hypertensive, and 209/801 (26.1%) patients had LVH. Obesity within COI groups was VL 34/157 (21.7%), L 26/165 (15.8%), M 30/226 (13.3%), H 20/142 (14.1%), and VH 7/111 (6.3%). HTN-1 or HTN-2 was seen in VL 25/157 (15.9%), L 36/165 (21.8%), M 41/226 (18.1%), H 23/142 (16.2%), VH 16/111 (14.4%). LVH was present in VL 50/157 (31.9%), L 47/165 (28.5%), M 63/226 (27.9%), H 26/142 (18.3%), and VH 23/111 (20.7%).

Conclusions:
Youths with CHD living in lower opportunity areas have a high proportion of obesity and hypertension. Furthermore, end-organ changes are seen with a high prevalence of LVH in lower opportunity CHD youths. In conclusion, these findings support the importance of considering social determinants of health like neighborhood opportunity in assessing cardiovascular risk in CHD youths.