bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P008: Weight Gain and Cardiovascular Risk Reduction Associated With Tobacco Abstinence in Smokers With Serious Mental Illness
Authors: Thorndike Anne N , Hoeppner Susanne S , Cather Corinne , Pachas Gladys N , Achtyes Eric D , Evins A. E
Published: July 2021

Background:
In patients with serious mental illness, high prevalence of smoking and obesity-related risk factors contribute to high rates of cardiovascular disease (CVD) and premature mortality. The impact of smoking cessation on weight gain, obesity-related risk factors, and overall cardiovascular risk among this population is unknown.

Methods:
We conducted secondary analyses to assess weight gain and change in CVD risk of 87 smokers with serious mental illness (schizophrenia, schizoaffective disorder, and bipolar disorder) who participated in a randomized controlled trial to test the long-term effectiveness of varenicline on smoking cessation. Initially, 203 smokers with serious mental illness were enrolled into an open-label 12-week course of varenicline. Subjects who attained abstinence at the end of the open-label phase were eligible to participate in the randomized phase, and 87 subjects were randomized to continue either varenicline or placebo for the following 40 weeks. Smoking cessation at week 52 (end of treatment) was defined as 21-day point prevalence abstinence. We compared subjects who were abstinent at week 52 (N=33) to subjects who had relapsed to smoking (N=54) on changes in weight and Framingham 10-year CVD risk score over the 52-week trial; outcomes were modeled with repeated measures analyses of variance.

Results:
At baseline, subjects who achieved week 52 abstinence were older (52 vs. 46 years, p=0.01) and had higher fasting serum glucose (98 vs. 89 mg/dL, p=0.008) than subjects who relapsed, but they did not differ on sex, race, smoking characteristics, blood pressure, lipids, treatment for diabetes, or treatment with antipsychotic medications. Baseline mean body mass index did not differ between abstinent and relapsed subjects (31.4 vs. 32.4, p=0.52), but the baseline mean Framingham risk score was higher for abstinent than relapsed subjects (14.2% vs. 10.8%, p=0.02). Over the 52 week study period, abstinent subjects gained more weight than relapsed subjects (4.8 kg vs. 1.2 kg, p=0.002 for time*abstinence interaction), but the mean Framingham risk score decreased substantially for abstinent subjects and not for relapsed subjects (-7.6% vs. 0.0%, p=0.003 for abstinence effect adjusting for sex, site, varenicline or placebo, and antipsychotic medications).

Conclusion:
Despite the high prevalence of obesity at baseline and substantial weight gain associated with long-term abstinence, smoking cessation resulted in a large reduction in the Framingham estimated 10-year CVD risk among patients with serious mental illness.
Abstract P009: Dietary Exposure to Polychlorinated Biphenyls and Incidence of Myocardial Infarction in Men - A Population-Based Prospective Cohort Study
Authors: Åkesson Agneta , Bergkvist Charlotte , Bergkvist Marika , Glynn Anders , Julin Bettina , Wolk Alicja
Published: July 2021

Introduction:
Fish consumption may promote cardiovascular health. The role of major food contaminants present in fish, such as polychlorinated biphenyls (PCBs) is, however, largely unexplored. Experimental studies indicate that PCBs cause endothelial cell dysfunction, hyperlipidemia and hypertension and cross-sectional associations have been observed between PCB-biomarkers and several intermediate risk factors for cardiovascular disease. PCBs accumulate and magnify in the food chain and fatty fish is a dominating source of exposure in populations with a relatively high fish intake. We assessed the hypothesis that dietary PCB exposure is associated with increased risk of myocardial infarction (MI) and that the exposure may mask a protective association with marine omega-3 fish fatty acids intake.

Methods:
Validated food frequency questionnaire-based estimates of dietary PCB exposure was obtained at baseline (1997) in 36,759 men from the population-based Cohort of Swedish Men, free of cancer, cardiovascular disease and diabetes. The estimated dietary PCB exposure was based on the food concentrations of PCB congener 153 at the time of baseline. PCB-153 is the most abundant congener in food and an excellent indicator for total PCB in food and in blood. The long-term dietary PCB exposure assessments showed acceptable validity against six PCB congeners in serum (correlation coefficients 0.30 to 0.58). Cases of MI were ascertained
via
register-linkage through 2010. Relative risks (RR) and 95% confidence intervals (CI) were adjusted for known cardiovascular risk factors.
:

Results

During 12 years of follow-up (433,243 person-years), we ascertained 3,005 incident cases of MI. The major dietary sources of PCB exposure was fish, dairy products and meat. Compared with the lowest quintile of dietary PCB exposure (median 113 ng/day), men in the highest quintile (median 436 ng/day) had multivariable-adjusted RR of 1.22 (95% CI, 1.05-1.41) for MI, without adjusting for the intake of marine omega-3 fish fatty acids. In a separate model, we observed no association between the intake of marine omega-3 fish fatty acids and MI (RR, 1.07; 95% CI, 0.93-1.24). In mutually-adjusted models, dietary PCB exposure was associated with RR 1.72 (95% CI 1.28-2.30), and the intake of marine omega-3 fish fatty acids with RR, 0.67 (95% CI, 0.50-0.90), comparing highest quintiles with lowest.

Conclusions:
Exposure to an integrated measure of total PCBs from food was associated with increased risk of MI in men. The results may provide important information regarding the risk-benefit analysis of fish consumption. To increase the net benefits of fish consumption, PCB contamination should be reduced to a minimum: Future studies are needed to clarify the concentrations of PCBs that may offset the beneficial effects of fish consumption.
Abstract P014: Impact of Antihypertensive Class on Central Systolic Blood Pressure and Augmentation Index: A Meta-Analysis
Authors: McGaughey Tracey J , Fletcher Emily A , Shah Sachin A
Published: July 2021

Introduction:
New evidence suggests central systolic blood pressure (cSBP) is a superior predictor of adverse cardiovascular outcomes as compared to peripheral systolic blood pressure (pSBP). Additionally, augmentation index (AI) provides a surrogate assessment of vascular stiffness. We performed a meta-analysis to assess the impact of antihypertensive drug classes on cSBP and AI.

METHODS:
Search terms related to blood pressure and AI were used to identify relevant articles in PubMed, Cochrane Library and CINAHL limited to randomized trials in humans and publications in English. Appropriate data on cSBP, pSBP and AI were extracted along with other study characteristics. Weighted mean differences (WMD) between the pSBP and cSBP with 95% confidence intervals (CI) were calculated using the DerSimonian-Laird random-effects methodology. For AI, the WMD from baseline was determined. Further, the data was sorted by antihypertensive class (angiotensin converting enzyme inhibitors (ACE-Is), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs) and diuretics) to determine their impact on cSBP and AI. Subgroup analyses were performed to assess robustness of results by limiting to the fixed-effects model, a primary diagnosis of hypertension, and excluding studies with JADAD scores < 3. Publication bias was assessed using the Egger’s statistic and visual inspection of funnel plots. Statistical heterogeneity was assessed using the I2 statistic.

RESULTS:
Fifty-one and 58 studies incorporating 4381 and 3716 unique subjects were included for cSBP and AI respectively. Overall, antihypertensives reduced pSBP more than cSBP (2.52mmHg, 95%CI 1.35 to 3.69; I2 =21.9%). ACE-Is, ARBs, CCBs and diuretics reduced cSBP and pSBP in a similar manner (-2.40mmHg, 95%CI -4.89 to 0.08; 1.12mmHg, 95%CI -2.25 to 4.49; 1.01mmHg, 95%CI -2.17 to 4.19; 0.65mmHg, 95%CI -2.47 to 3.77 respectively). BBs posed a significantly greater reduction in pSBP as compared to cSBP (5.19mmHg, 95%CI 3.21 to 7.18). The change in AI from baseline was (-3.09, 95%CI -3.90 to -2.28; I2 =84.5%). A significant reduction in AI was seen with ACE-Is, ARBs, CCB and diuretics (-5.61, 95%CI -6.95 to -4.27; -5.28, 95%CI -8.61 to -1.95; -5.36, 95%CI -6.95 to -3.77; -3.24, 95%CI -5.45 to -1.03 respectively). BBs reduced AI non-significantly (-0.32, 95% CI -1.48 to 0.84). While the Egger’s statistic showed a lack of publication bias (p>0.125), it cannot be ruled out based on visual inspection of funnel plots.

CONCLUSIONS:
BBs are not as beneficial in reducing cSBP as opposed to ACE-Is, ARBs, CCBs and diuretics. In contrast, ACE-Is, ARBs, CCBs and diuretics significantly reduce AI, which is not evident with BB therapy. The views expressed in this material are those of the author(s), and do not reflect the official policy or position of the U.S. Government, the Department of Defense, or the Department of the Air Force.
Abstract P024: Blood Pressure Levels, Aggressiveness of Antihypertensive Therapy, and Prevalence of Left Ventricular Hypertrophy
Authors: Lakkur Sindhu , Soliman Sayed , Oparil Suzanne , Judd Suzanne , Howard George
Published: July 2021

A major cause of left ventricular hypertrophy (LVH) is an excessive hemodynamic load, making LVH more common among people with hypertension. Clinical trials of antihypertensive medication have found that treatment reduces left ventricular mass among those with hypertension, but little is known about the prevalence of LVH in the general population that are taking, and not taking, antihypertensive medication. We examined the cross-sectional association between blood pressure control and LVH among 28,106 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, to test the hypotheses that: 1) within strata of blood pressure control, LVH will be more prevalent in those requiring more intensive treatment, and 2) that within strata of intensiveness of blood pressure treatment, that LVH will be more prevalent at higher blood pressure levels.

The REGARDS study enrolled black and white participants, aged 45 and older, from 2003-2007. Systolic blood pressure was defined as normal (<120 mmHg), prehypertension (120 mmHg - 139 mmHg), stage 1 (140 mmHg - 159 mmHg), and stage 2 hypertension (>160 mmHg). Classes of antihypertensive medications at baseline were defined as 0, 1, 2, or 3 or more. LVH by electrocardiogram was detected in 2,803 participants. Multivariable-adjusted odds ratios (ORs) for LVH and 95% confidence intervals (CIs) were calculated using logistic regression models.

The ORs (95% CIs) for each additional medication class were 1.31 (1.20-1.43) for normal blood pressure, 1.21 (1.14-1.27) for prehypertension, 1.07 (0.98-1.16) for stage 1, and 1.02 (0.88-1.17) for stage 2. The ORs (95% CIs) for each additional increase in blood pressure category were 1.57 (1.41-1.75) for no medications, 1.47 (1.33-1.63) for 1, 1.30 (1.18-1.43) for 2, and 1.21 (1.10-1.34) for 3 medications.

We observed that successful blood pressure control by medication is still associated with elevated odds of LVH compared to untreated normotensive participants, emphasizing the importance of hypertension prevention.
Abstract P048: Sodium Intake is Associated with Weight Status in Australian Schoolchildren Aged 4-12 Years
Authors: Grimes Carley A , Baxter Janet , Riddell Lynn , Campbell Karen , He Feng , Nowson Caryl
Published: July 2021

Introduction:
A high sodium intake stimulates thirst and in turn may promote greater consumption of high energy sugary beverages, which are linked to obesity risk in children. In this study we assessed the hypothesis that sodium intake, as measured by 24-hr urinary sodium excretion, would be positively associated with weight status in primary school-aged children.

Methods:
Cross-sectional study completed within a convenience sample of Victorian primary schools (n=43). Sodium intake was assessed via one 24-hr urine collection. Fourteen percent of samples were deemed invalid and excluded. BMI was calculated from measured weight and height and converted to BMI z-scores using the 2000 Centers for Disease Control and Prevention reference growth charts. Participants were grouped into weight categories using the International Obesity Task Force cut-points. Differences in sodium intake and weight status were assessed using multi-level linear and logistic regression analysis with adjustment for random effects (gender, age) and fixed effect (school cluster).

Results:
Of the 667 children with valid urine samples 55% were male and the average age was 9.3±(SD) 1.8 years. Ten percent were classified as underweight, 73% healthy weight, 14% overweight and 3% obese. Average sodium intake differed across weight categories, underweight 82±29 mmol/day (salt equivalent 4.8±1.7 g/day); healthy weight 102±43 mmol/day (salt 6.0±2.5 g/day); overweight 125±55 mmol/day (salt 7.3±3.2 g/day); obese 148±97 mmol/day (salt 8.7±5.7 g/day) (p=0.001). In the fully adjusted model sodium intake (mmol/d) was significantly associated with BMI z-score (b=0.006, P<0.001). A 17 mmol/day increase in sodium intake (salt 1 g/day) was associated with a 23% (OR: 1.23; 95% CI 1.16, 1.31) greater risk of being overweight or obese, adjusted for age and gender.

Conclusions:
Higher sodium intake is associated with overweight and obesity in Victorian schoolchildren. This may be related to increased energy intake, and this association should be explored further.
Abstract P049: Principal Component Analysis of Dietary Patterns and the Risk of Cardiovascular Disease and Mortality in Older British Men
Authors: Atkins Janice , Whincup Peter , Morris Richard , Lennon Lucy , Papacosta Olia , Wannamethee Goya
Published: July 2021

Background:
Diet quality is a major risk factor for morbidity and mortality, but few studies have examined the relationship between dietary patterns and the risk of cardiovascular disease (CVD) and mortality in older adults. We examined prospective associations between dietary patterns defined using principal component analysis and the risk of CVD and all-cause mortality in older British men.

Methods:
3226 men aged 60-79 years from the British Regional Heart Study, free from CVD at baseline, were followed-up for 11 years. Baseline food frequency questionnaire data were used to generate dietary intake data on 34 food groups. Principal component analysis identified dietary patterns which were then categorised according to quartiles of adherence. Cox proportional hazards regression examined associations between dietary patterns and risk of all-cause mortality, CVD mortality, CVD events and coronary heart disease (CHD) events, adjusting for confounders.

Results:
Principal component analysis identified three interpretable dietary patterns, which explained 20.8% of the total variance. An ‘unhealthy’ dietary pattern explained the greatest single proportion of the variance (7.9%) and was characterised by consumption of red meat, meat products, white bread, fried potato and eggs. A ‘healthy’ dietary pattern was characterised by consumption of poultry, fish, fruit, vegetables, legumes, pasta, rice, wholemeal bread, eggs and olive oil and explained 7.1% of the variance. Finally, a ‘sweet’ dietary pattern was characterised by consumption of biscuits, puddings, chocolate, sweets, sweet spreads and breakfast cereal and explained 5.8% of the variance. There were 899 deaths, 316 CVD deaths, 569 CVD events and 301 CHD events during follow-up. An ‘unhealthy’ dietary pattern was associated with a graded increase in risk of all-cause mortality, after adjustment for sociodemographic, behavioural and cardiovascular risk factors (highest vs. lowest quartile; HR: 1.44, 95% CI: 1.13-1.84, p-trend = 0.007). No significant associations were seen between the risk of all-cause mortality and the ‘healthy’ diet (highest vs. lowest quartile; HR: 0.83, 95% CI: 0.66-1.04, p-trend = 0.28) or the ‘sweet’ diet (highest vs. lowest quartile; HR: 1.00, 95% CI: 0.77-1.29, p-trend = 0.71). None of the dietary patterns were significantly associated with cardiovascular outcomes (CVD mortality, CVD events or CHD events).

Conclusions:
Dietary patterns are an important risk factor for all-cause mortality in the elderly. Older adults should avoid a high consumption of components of an ‘unhealthy’ dietary pattern to reduce the risk of all-cause mortality.
Abstract P061: Dietary Intake of Saturated Fat by Food Source and Incident Coronary Heart Disease: the Zutphen Elderly Study
Authors: de Goede Janette , Soedamah-Muthu Sabita S , Trichia Eirini , Geleijnse Johanna M , Kromhout Daan
Published: July 2021

Introduction:
Associations of saturated fatty acids (SFA) with coronary heart disease (CHD) may depend on their food source. We examined the association of SFA intake from different food sources, with 15-year incidence of coronary heart disease (CHD) in elderly men in the Netherlands.

Methods:
Data were collected from 686 elderly men from the Zutphen Elderly Study, aged 65-85 years with no CHD or diabetes mellitus. At baseline (1985), habitual diet was assessed with a cross-check dietary history method. Information on vital status and incidence of CHD (fatal CHD and nonfatal myocardial infarction) until July 1, 2000 was assessed through municipal population registries and hospital or GP records. Hazard ratios (HR) were calculated with Cox proportional-hazards models, adjusted for age, lifestyle (smoking, BMI, physical activity, socioeconomic status, and alcohol consumption) and dietary factors including total energy, carbohydrates, protein, monounsaturated fatty acids, trans fatty acids and dietary fibre. In addition, substitution models were used to estimate the exchange of 2 en% SFA from different sources, i.e. dairy, meat, and plant or butter SFA.

Results:
During 15 years of follow-up, we observed 132 incident CHD events. Across tertiles (T), the intake of SFA ranged from 14.2 (T1) to 21.7 (T3) energy percent (en%). Plant or butter SFA contributed for 37 en% to total SFA intake, followed by dairy (27%) and meat (17%). Total SFA intake correlated most strongly with plant or butter SFA (r=0.71). Spearman correlation coefficients of total SFA with dairy and meat were 0.34 and 0.09 respectively (all p<0.05). The intake of total SFA was not significantly associated with CHD (HR: 0.76; 95%CI: 0.41-1.39) for T3 vs T1. HRs for plant or butter SFA, dairy SFA, and meat SFA were 0.96 (0.55-1.69), 0.82 (0.48-1.40), and 1.64 (0.89-3.04) respectively, for the top compared to the bottom tertile. A 2 en% higher intake of SFA from dairy or meat, exchanged with plant or butter SFA, resulted in a HR of 0.98 (95% CI: 0.79-1.20) for dairy and 1.12 (0.75-1.66) for meat. The HR (95% CI) for an exchange of 2 en% SFA from dairy with SFA from meat was 1.15 (95% CI: 0.80-1.66).

Conclusion:
In Dutch elderly men, total SFA or SFA from specific food sources were not significantly associated with incident CHD. The association of SFA from meat with CHD deserves further attention.
Abstract P068: Obstructive Sleep Apnea is Associated with an Increase Risk of Osteoporosis
Authors: Sanguankeo Anawin , Upala Sikarin
Published: July 2021

Background:
Obstructive sleep apnea (OSA) is thought to be a systemic disease and has been associated with many disorders such as metabolic, endocrine, and especially cardiovascular diseases. One of the consequences of OSA is hypoxia, which can lead to a reduction in growth of osteoblast and a stimulation of osteoclast. Our meta-analysis was conducted to determine the risk of osteoporosis in patients with OSA compared to controls.

Objectives:
Eligible studies assessing the effects of obstructive sleep apnea on osteoporosis risk were comprehensively searched in PubMed/MEDLINE, EMBASE, and CENTRAL from their inception to September 2014. Two authors independently assessed article quality and extracted the data. Primary outcome were number of participants, prevalence, or risk ratio of osteoporosis in OSA and controls.

Results:
From 40 full-text articles, 3 studies involving 113,090 participants were included in the meta-analysis that were based on the random effects model. Compared with controls, participants who were diagnosed with obstructive sleep apnea had increased risk of osteoporosis (pooled risks ratio, 1.85; 95% CI, 1.34, 2.56).

Conclusion:
Patients with OSA had a higher risk of developing osteoporosis. Further study is needed to evaluate the possible mechanisms between these two conditions and to find potential treatment for OSA that could prevent osteoporosis.
Abstract P072: Short Sleep Duration is Associated with Elevated Homocysteine Levels
Authors: Petrov Megan E , Grandner Michael A , Baldwin Carol M , Buman Matthew P , Youngstedt Shawn D
Published: July 2021

Introduction:
Short and long sleep durations are associated with heightened risk for cardiovascular disease and vascular risk factors. Elevated homocysteine is also associated with greater risk for cardiovascular disease; however, studies have yet to investigate the relationship between sleep duration and homocysteine.

Hypothesis:
We hypothesized that short and long sleep duration would be associated with clinical levels of homocysteine.

Methods:
Adults (n=2,469; ≥20y) from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) were assessed for habitual sleep duration (coded as <5, 5, 6, 7, 8, 9, and ≥10hrs) and fasting plasma homocysteine levels (<10 [normative], 10 to <15 [pre-clinical] and ≥15 [clinical] μmol/L). Participants were excluded if pregnant, lactating, missing data on the primary variables, or if they had a history of cardiovascular disease, cancer, diabetes, kidney disease, or diagnosed sleep disorder. Population weighted, multinomial logistic regression analyses assessed the relationship between sleep duration and homocysteine after adjustment for age, sex, race/ethnicity, marital and menopausal status, shift work, dietary folate, alcohol intake, cotinine levels, reported physical activity, hypertension, and reported frequency of cessation of breathing at night.

Results:
Pre-clinical and clinical levels of homocysteine were present in 13.7% and 2.5% of the sample, respectively. The mean sleep duration was 6.9 ± 1.4 hours. In adjusted analyses, sleep duration was significantly related to homocysteine (
p
< 0.001). See Table. Very short sleepers (<5hrs) were more likely to have clinical levels of homocysteine (OR: 3.01, 95%CI: 1.38, 6.57) compared to 7-hr sleepers.

Conclusions:
In a U.S. representative sample of adults without cardiovascular disease or other major conditions, short sleepers were at greater odds for clinical levels of homocysteine Findings suggest that homocysteine may be one mechanism linking short sleep duration to cardiovascular disease.
Abstract P073: Insufficient and Poor Sleep are Associated with Barriers to Healthy Eating and Lower Physical Activity: Baseline Characteristics of the EMPOWER Study
Authors: Kline Christopher E , Strollo Patrick J , Chasens Eileen R , Rockette-Wagner Bonny , Kriska Andrea , Imes Christopher C , Burke Lora E
Published: July 2021

Background:
Sleep is emerging as an important factor that impacts dietary habits, physical activity, and metabolism. However, minimal attention is typically given to sleep in traditional lifestyle interventions. The purpose of these analyses was to examine baseline associations between sleep and physical activity and perceived barriers to healthy eating, which are two common lifestyle intervention targets, in a sample of apparently healthy adults enrolled in a behavioral weight loss intervention study.

Methods:
150 overweight adults (51.1±10.2 y; 91% female; 79% Caucasian) participated in a 12-month lifestyle intervention that featured adaptive ecological momentary assessment. Sleep, physical activity, barriers to healthy eating and body habitus/composition were assessed prior to the intervention. Objective sleep was estimated with 7 days of wrist-worn actigraphy (Philips Actiwatch 2); sleep onset latency (SOL; the amount of time it takes to fall asleep after going to bed), sleep efficiency (SE; the percentage of time in bed that is spent asleep), and total sleep time (TST; total time spent asleep) served as the primary actigraphic sleep variables. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Physical activity was assessed with 7 days of waist-worn accelerometry (ActiGraph GT3x). Perceived barriers to healthy eating were assessed with the Barriers to Healthy Eating questionnaire. Body mass index (BMI) served as the measure of body habitus, and body fat was assessed with bioelectrical impedance.

Results:
Mean BMI and body fat for the sample were 34.0±4.6 kg/m2 and 43.7±5.5%, respectively. Mean TST was 6.6±0.8 h/night; approximately 23% of the sample averaged less than 6 hours of sleep. Mean SOL and SE for the sample were 15.3±16.2 min and 85.7±6.1%, respectively. Based on the PSQI, 52.0% of the sample had poor sleep quality. Following adjustment for age, sex, and race, longer SOL was associated with fewer steps/day (β=-.19, p=.02) and less time spent in moderate to vigorous physical activity (MVPA; β=-.16, p=.03), and lower SE was related to less MVPA (β=.15, p=.04). Shorter TST was associated with greater barriers to healthy eating (β=-.16, p=.05). Longer SOL was associated with higher BMI (β=.16, p=.05) and body fat % (β=.15, p=.03), and lower SE was related to higher body fat % (β=-.13, p=.06).

Conclusions:
Short sleep duration and sleep disturbance were highly prevalent in this sample of overweight adults. Significant associations were observed between sleep and measures of body habitus/composition and eating and physical activity habits. Efforts to improve sleep during a behavioral intervention for weight loss may reduce barriers to healthy eating and improve physical activity habits as well as weight loss outcomes.
Abstract P082: Neighborhoods and Racial/Ethnic Differences in Ideal Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Mujahid Mahasin , Moore Latetia , Petito Lucia , Kershaw Kiarri , Watson Karol , Diez Roux Ana
Published: July 2021

Introduction:
Neighborhood environments have been investigated in relation to individual cardiovascular disease risk. However, few studies have examined the contribution of neighborhood environments to racial/ethnic differences in cardiovascular health (CVH).

Hypothesis:
We hypothesized that there would be significant racial/ethnic differences in ideal CVH and these differences would be reduced after adjustment for neighborhood factors.

Methods:
We used data from the MESA baseline examination (2000-2002; mean age=62, SD=10). Ideal cardiovascular health was defined using guidelines from the American Heart Association 2020 Strategic Impact Goals. We examined seven CVH indicators (blood pressure, fasting glucose, cholesterol, body mass index, diet, physical activity, and smoking) and three summary measures (health factors, health behaviors, overall CVH). We compared racial/ethnic differences in ideal CVH before and after adjustment for neighborhood factors (socioeconomic, physical activity, healthy food, social environment) using logistic regression and hybrid fixed effects models. Neighborhood-level data were obtained from various administrative data sources including the Neighborhood Community Survey and linked to MESA study participants.

Results:
Among the 5,263 participants in our analytic sample, 215 (4.1%) had ideal CVH. This proportion varied across racial/ethnic groups (6.6% for whites, 2% for African Americans, and 2.1% for Hispanics). Significant racial/ethnic differences were present for all indicators (excluding physical activity and diet) and summary measures of ideal CVH, independent of confounders. Additional adjustments for neighborhood factors produced modest reductions in racial/ethnic differences.

Conclusion:
Neighborhood factors may play a role in shaping racial/ethnic health disparities in CVH. Future research is necessary to better understand the impact of neighborhood context on CVH disparities over the life course.
Abstract P108: Comorbidity Burden in Atrial Fibrillation: A Population-Based Case-Control Study
Authors: Chamberlain Alanna M , Byrne Margaret C , Alonso Alvaro , Gersh Bernard J , Manemann Sheila M , Killian Jill M , Weston Susan A , Roger Veronique L
Published: July 2021

Background:
Differences in the prevalence and duration of co-morbid conditions in atrial fibrillation (AF) patients compared to population controls have not been well documented.

Methods:
The prevalence and duration of 17 chronic conditions defined by the US Department of Health and Human Services, as well as anxiety, obesity, and smoking status, was obtained in a random sample of 1430 patients with incident AF from 2000-2010 and 1430 controls from Olmsted County, MN. Controls were matched to cases 1:1 on sex and age (within 5 years). Chronic conditions were ascertained electronically requiring 2 occurrences of a diagnostic code; the duration of each condition (up to 25 years) was calculated. Logistic regression determined associations of each condition with AF after adjustment for all other conditions.

Results:
Among the 1430 matched pairs (median age 76 years, 48.6% men), the prevalence of chronic conditions was higher in AF cases compared to controls for all conditions except asthma, dementia, depression, hepatitis, and osteoporosis (figure). However, the duration of the conditions were similar in AF compared to controls, except for hypertension (median duration 12.3 and 9.9 years in AF cases and controls, respectively; p=0.002). After adjusting for all other conditions, obesity, hypertension, congestive heart failure, coronary artery disease, chronic kidney disease, and chronic obstructive pulmonary disease remained significantly more common in AF compared to controls (figure). Conditions with the largest attributable risk of AF were hypertension (25.4%), coronary artery disease (17.7%), and congestive heart failure (12.3%).

Conclusions:
AF patients have a higher prevalence of many chronic conditions compared to population controls. However, besides hypertension, these comorbidities do not develop earlier in AF. Nevertheless, the excess comorbidity burden in AF is important to characterize and understand as it may partly explain the excess mortality and healthcare utilization experienced by AF patients.
Abstract P115: Effect of an Environmental Intervention on the Nutrient Content of Food Served at Psychiatric Rehabilitation Centers: Results From the ACHIEVE Trial
Authors: Ho Tiffany F , Gennusa Joseph V , Anderson Cheryl , Dalcin Arlene , Appel Lawrence J , Goldsholl Stacy , Jerome Gerald , Dickerson Faith , Young Deborah , Wang Nae-Yuh , Cook Courtney , Daumit Gail L
Published: July 2021

Introduction:
Institutions that serve on-site meals provide an unrealized opportunity to improve health on a broad scale, especially for underserved populations. Psychiatric rehabilitation programs commonly serve meals to adults with serious mental illness (SMI; schizophrenia and bipolar disorder), a population with a markedly increased prevalence of obesity and high risk of cardiovascular disease mortality. In the context of a behavioral weight-loss trial incorporating weight management counseling for persons with SMI, we delivered an environmental-level intervention, focused on the food environment.

Hypothesis:
We hypothesized the environmental intervention would reduce the overall calories served at the psychiatric rehabilitation program study sites.

Methods:
We partnered with kitchen supervisors to reduce calories and improve the nutritional quality of meals served at psychiatric rehabilitation programs. Intervention staff met with kitchen staff at the beginning and followed up quarterly to assess progress and to reinforce key nutritional messages. Environmental interventions included decreasing sugar sweetened beverages, increasing whole grains, and reducing saturated fat in meals. Breakfast and lunch menus were collected at baseline and 18 months after intervention. We calculated mean (SD) total energy and nutrient content of each meal.

Results:
Ten psychiatric rehabilitation programs participated. Eight sites served breakfast and all sites served lunch. Compared to baseline, average breakfast calories decreased significantly after 18-months from 568.4 to 457.1 (p=0.0048) and average lunch calories decreased from 729.4 to 623.8 (p<0.0001). Saturated fat in breakfast decreased by 1.9g (p=0.015) and 1.8g for lunch (p=0.0061). Total sugars at breakfast decreased from 53.3g to 40.1g (p=0.0008) and at lunch from 38.9g to 33.7g (p=0.004). Sodium was not significantly changed for breakfast (713.5mg to 557.3mg, p=0.148) but decreased by 412.4mg (1527.4mg to 1115.1mg, p=0.0008) for lunch.

Conclusions:
The environmental intervention implemented at psychiatric rehabilitation programs successfully reduced the amount of calories, saturated fat, sugars, and sodium served. This study suggests that modifying the food environment at psychiatric rehabilitation programs is feasible. Such programs can likely be applied to other institutions that serve on-site meals, and may be especially important in preventing cardiovascular disease in other underserved populations.
Abstract P121: Comparative Effectiveness Study of the Diabetes Prevention Program in Families: Preliminary Results
Authors: Wessel Jennifer , O'Kelly-Phillips Erin , Palmer Kelly , Saha Chandan , Hannon Tamara , Carroll Aaron , Marrero David G
Published: July 2021

The prevalence of gestational diabetes (GDM) is increasing substantially and currently affects up to 14% of pregnancies. As many as 70% of women with GDM will develop type 2 diabetes (T2D) in the next 10 years. Moreover as many as 40% of children exposed to in-utero diabetes will develop obesity and T2D. The Diabetes Prevention Program (DPP) is an evidence-based lifestyle intervention that has been shown to lower T2D risk by 58% in high-risk adults. Family based lifestyle interventions that target either children, parents or both have reported mixed results. We modified the DPP curriculum to use with families (DPPF) and recruited mothers with a history of GDM and their children 8-15 years old. We randomized n=130 families to test which method of delivering the DPPF (mothers only (M) or mothers and their children (M+C)) is more effective at lowering families T2D risk. Baseline characteristics of women were similar among each intervention group (n=65 M and n=65 M+C, respectively): age (38±8 vs 39±11, P=0.5), ethnicity (Black 55% vs 55%, White 20% vs 17%, Latino 20% vs 27%, other 5% vs 2%, P=0.6), body mass index (BMI, 37±8 vs 38±7, P=0.24), systolic blood pressure (SBP, 121±11 vs 122±13, P=0.8), diastolic blood pressure (DBP, 103±26 vs 105±21, P=0.6), HbA1c (5.6±0.4 vs 5.7±0.3, p=0.2). The majority of women self-reported low levels of physical activity (PA): moderate PA (2 days or less per week, 42% vs 26%, P=0.06) or vigorous PA (2 days or less per week, 38% vs 25%, P=0.1), and high levels of sedentary activities (3 or more hours per day, 49% vs 58%, P=0.2). For diet related obesogenic behaviors women self-reported high levels of eating meals while watching TV (3 days or more per week, 58% vs 74%, P=.06) and eating at restaurants (3 days or more per week, 28% vs 41%, P=0.1). Follow-up is ongoing and currently n=32 families have completed the 3-month follow-up. Preliminary analyses of mothers show decreases in HbA1c (-.01±.3 vs -.1±.2), SBP (-9.7±30 vs -3.1±8), DBP (-8±19 vs -1±9) but not BMI (0.07±1.6 vs 0.04±1.2); however results were not significantly different by intervention group.
Abstract P135: Body Mass Index and Indicators of Adiposity Are Adversely Associated With Cardiovascular Biomarkers in Youth With Type 1 Diabetes Over 18 Months
Authors: Lipsky Leah M , Nansel Tonja R , Haynie Denise L , Laffel Lori M , Mehta Sanjeev N , Volkening Lisa K , Liu Aiyi
Published: July 2021

Hypothesis:
The association of excess weight with an adverse cardiometabolic profile in patients with type 1 diabetes (T1D) is unclear. The purpose of this study was to test the hypothesis that increasing BMI and adiposity indicators in youth with T1D are adversely associated with glycemic control and cardiovascular biomarkers.

Methods:
Subjects were youth participants of a family-based randomized controlled dietary intervention (N=136, age=12.3±2.5y, baseline A1c=8.1±1.1%). Glycemic control (A1c and 1,5-Anhydroglucitol, 1,5-Ag), body mass index (BMI, from measured height and weight), serum lipids (total cholesterol, TC; HDL-cholesterol, HDL-C; LDL-cholesterol, LDL-C; triglycerides, TG), inflammation (c-reactive protein, CRP), oxidative stress (8-iso-prostaglandin F2alpha, 8-iso-PGF2α), adiponectin and blood pressure (systolic, SBP; diastolic, DBP) were assessed at baseline and every 6 months for 18 months. Total and truncal lean, fat-free mass and percent fat (%fat) were measured by Dual X-ray Absorptiometry (DXA) scan at baseline, 12 months and 18 months. Multi-level linear mixed effects regression models (with a random intercept and a random slope for time) were used to estimate associations of time-varying BMI and body composition with time-varying indicators of glycemic control and cardiometabolic health. Covariates included time, sex, height, baseline age, treatment assignment, baseline diabetes duration, insulin regimen, insulin dose/kg and physical activity. Probability values <0.05 were considered to indicate statistical significance.

Results:
Time-varying BMI and body composition indicators were differentially associated with time-varying glycemic control and cardiometabolic indicators. A1C was unrelated to BMI and body composition, although 1,5-Ag was inversely associated with total %fat; inverse associations of 1,5-Ag with BMI and trunk %fat approached statistical significance (p=0.07). LDL-C was positively associated with trunk fat and trunk %fat; TG and HDL-C were positively associated with BMI and trunk fat, and HDL-C was inversely associated with total lean and trunk lean mass. CRP was positively associated with BMI, and with total and truncal fat and %fat. SBP and DBP were positively associated with BMI, %fat, trunk fat and trunk %fat. TC, 8-iso-PGF2α and adiponectin were unrelated to BMI and body composition.

Discussion: In a sample of youth with moderately well-controlled T1D, time-varying BMI and indicators of body fat were not universally associated with time-varying glycemic control and cardiometabolic indicators over 18 months. Significant associations of adiposity indicators, particularly BMI and trunk fat, with hyperglycemic excursions (1,5-Ag), several blood lipids (TG, HDL-C, and LDL-C), and inflammation (8-iso-PGF2α) suggest a role of excess body weight in the development of cardiovascular risk in this sample.
Abstract P157: Serum Vitamin D is Not Associated With Risk of Incident Diabetes in African Americans: The Jackson Heart Study
Authors: Harman Jane L , Chen Haiying , Sachs Michael C , Hairston Kristin G , Golden Sherita H , Joseph Joshua J , Bertoni Alain G
Published: July 2021

A recent meta-analysis of cohort studies with participants primarily of European ancestry, concluded that the risk of incident diabetes was inversely proportional to serum 25-hydroxy-vitamin D levels (25-OH-D). African Americans have lower levels of vitamin D than European Americans. But, lower levels of vitamin D do not seem to carry the same risk for low bone density or vascular calcification for African Americans. We sought to test the hypothesis that low vitamin D elevates the risk of diabetes in African Americans.

During 2001-5, 5301 African American adults in Jackson, MS, were examined and blood samples drawn; mean age was 55±13. Serum 25-OH-D2 and 25-OH-D3 were measured from stored frozen serum; mean total 25-OH-D (25-OH-D2 plus 25-OH-D3) =14.5±6.7ng/ml. A seasonal pattern was evident for 25-OH-D3 but not for 25-OH-D2 levels. A cosinor model adjusted for seasonality of 25-OH-D3; mean annualized concentrations and seasonal amplitude were significantly higher for men and for persons of normal BMI compared to overweight or obese persons. Total 25-OH-D, as the sum of predicted annualized mean 25-OH-D3 and measured 25-OH-D2, was used in subsequent analysis.

The analysis evaluated 3363 participants after exclusions for missing serum vitamin D (n=141), prevalent diabetes (n=1152), incomplete ascertainment of diabetes (n=62), or no follow-up (n=725). During a mean follow-up of 7.1 years, there were 584 new cases of diabetes. Using a Cox Proportional Hazards model controlling for age and sex, the risk of incident diabetes was significantly and inversely associated with total serum 25-OH-D; after adding BMI to the model, 25-OH-D was not significantly associated with risk of diabetes (Table 1). Physical activity, smoking, and alcohol use did not predict incident diabetes in any model.

In conclusion, we found that in this cohort of African-Americans, with low mean 25-OH-D and a relatively narrow range of 25-OH-D, the risk of incident diabetes was not associated with serum 25-OH-D levels after controlling for sex, age, and BMI.
Abstract P158: Lower Extremity Peripheral Artery Disease and Quality of Life among Older Individuals in the Community: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Wu Aozhou , Coresh Josef , Selvin Elizabeth , Tanaka Hirofumi , Heiss Gerardo , Hirsch Alan T , Jaar Bernard , Matsushita Kunihiro
Published: July 2021

Background:
Lower extremity peripheral arterial disease (PAD), commonly identified by an ankle-brachial Index (ABI) <0.9, increases mortality risk and may impair mobility as well as quality of life (QOL). However, most studies assessing reduced QOL in the relation to PAD rely on small data from vascular clinics, leaving uncertainty about the impact of PAD on QOL in the community.

Method:
Using 5,610 ARIC visit 5 (2011-2013) participants aged 66-90 years, we assessed the associations of ABI with several QOL parameters, including self-evaluated general health status, mental status (the Center for Epidemiologic Studies Depression [CES-D] score and hopeless feeling), social aspect (work interfered by pain and social activity interfered by health status), and physical ability (limited ability to climb stairs and need of walking assistance). Logistic regression models were applied to assess the association of ABI with each QOL parameter, adjusting for potential confounders including comorbidities such as history of heart failure, coronary heart disease, and stroke.

Result:
With ABI 1.1-1.2 as a reference, lower ABI was consistently associated with poor status of all QOL parameters tested (Table), with overall evident dose-response relationship. Interestingly, a poor status of various QOL parameters was observed even in borderline low ABI (0.9-1.0) and low normal (1.0-1.1). High ABI (>1.3), indicative of arterial stiffness, was only significantly associated with limited ability to climb stairs. Similar results for low ABI and QOL were observed in both genders and white and black participants.

Conclusion:
Low ABI was independently and consistently associated with poor status of wide range of QOL domains, with potential important implications on quality-maintained life in older individuals. Further studies are warranted to assess whether the association is due to PAD-related leg symptoms or weakness and/or reflects the impact of systemic atherosclerosis on QOL.
Abstract P165: Effects of Lactation on Postpartum Blood Pressure among Women with Gestational Hypertension and Preeclampsia
Authors: Countouris Malamo , Schwarz Eleanor Bimla , Rossiter Brianna , Althouse Andrew , Catov Janet
Published: July 2021

Introduction:
Lactation is associated with improved maternal blood pressure (BP) in later life and in the postpartum period among normotensive women. However, little is known about whether lactation is also cardio-protective in women with pregnancy-related hypertensive disorders. This study aimed to characterize the relationship between lactation and postpartum BP in women who remained normotensive during pregnancy compared to those who developed preeclampsia or gestational hypertension.

Hypothesis:
Lactation will be associated with lower postpartum BP, particularly in women with hypertensive disorders of pregnancy.

Methods:
Data were obtained from a cohort of normotensive women who participated in the Prenatal Exposures & Preeclampsia Prevention study (n=651; 65% African American; 83% overweight or obese prior to pregnancy). Women were enrolled during pregnancy and attended a postpartum visit where data on lactation and BP were collected following a standardized protocol. Analysis of variance (ANOVA) was used to assess the relationship between lactation and postpartum BP in women who remained normotensive during pregnancy, developed gestational hypertension (2 or more BP measurements >140/90), or developed preeclampsia (gestational hypertension plus proteinuria). Further analyses adjusted for age, race, smoking, prepregnancy weight, and time since delivery.

Results:
A total of 439 women attended the postpartum study visit (mean time since birth 8.5 months); 50 (11%) developed gestational hypertension, and 38 (9%) preeclampsia. Lactation was reported by 246 (56%) with 84 (19%) reporting lactation for ≥ 6 months. Women who lactated were older, wealthier, and more likely to plan to lactate compared to those who did not lactate. There was no association between lactation duration and postpartum systolic BP for women who remained normotensive during pregnancy (never lactated: 111.0 mmHg vs. lactated ≥ 6 months: 112.9 mmHg, p=0.83) nor among women who developed preeclampsia (never lactated: 121.3 mmHg vs. lactated ≥ 6 months: 128.3 mmHg, p=0.35). However, greater lactation duration was associated with lower systolic BP among women who developed gestational hypertension (never lactated: 127.8 mmHg vs. lactated ≥ 6 months: 109.4 mmHg, p=0.04). This relationship remained significant after adjusting for covariates. Similarly, lactation was associated with lower postpartum diastolic BP only for women with a history of gestational hypertension.

Conclusions:
Lactation appears to lower postpartum BP among women who develop gestational hypertension, but do not develop preeclampsia. Future work should investigate the mechanisms driving the relationship between lactation and postpartum BP in gestational hypertension.