bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P020: Associations of Markers of Inflammation with Nocturnal BP Dipping Status Using Two Common Dipping Definitions: the Genetic Epidemiology Network of Arteriopathy
Authors: To Harrison , Wang Wanmei , Windham B. G , Mosley Thomas H , Turner Stephen T , Schwartz Gary , Kullo Iftikhar J , Griswold Michael E , Butler Kenneth R
Published: July 2021

Background:
Compared to those with natural nocturnal blood pressure (BP) decreases, those lacking nocturnal BP decreases (“non-dippers”) are at greater risk of cardiovascular disease (CVD). Substantial evidence also supports a role of chronic systemic inflammation in the pathogenesis of CVD. The purpose of this study was to examine associations of markers of inflammation with two common definitions of BP dipping status using 24-hour ambulatory blood pressure (AMBP) readings.

Methods:
AMBP monitoring and assays of C-reactive protein (CRP), interleukin-6 (IL-6), e-selectin, tissue inhibitor of metalloproteinase-2 (TIMP-2), and a selection of thirteen other inflammatory-pathway biomarkers were performed in 722 participants (mean age 64 [range 42-83] years, 36% men, 39% black, 83% hypertensive) in the Genetic Epidemiology Network of Arteriopathy (GENOA) Study (2001-2004). Non-dippers were classified using two common definitions: (1) nocturnal systolic and diastolic BP both decreased by <10% compared to daytime values [“dual non-dippers”, n=161 (22%)], and (2) nocturnal SBP decreased by <10% [“systolic non-dippers”, n=380 (53%)]. Logistic regressions, fit with generalized estimating equations to account for sibship clustering, yielded odds ratios (OR) of dipping status for log-transformed inflammatory biomarkers, adjusted for age, race, and sex.

Results:
IL-6 (range 0-37 pg/ml) was associated with dual non-dipping status (OR=1.55 [95%CI: 1.03, 2.32] p=0.035), translating into a 55% increase in the likelihood of being a dual non-dipper for every approximate doubling of IL-6. IL-6 (OR=1.63 [1.13, 2.35] p=0.009) and CRP (OR=1.35 [1.08,1.68] p=0.008) overall, as well as e-selectin (OR=0.49 [0.28, 0.87] p=0.014) and TIMP-2 (OR=0.54 [0.30,0.98] p=0.041) in hypertensive subjects were associated with systolic non-dipping status.

Conclusions:
These results suggest that non-dipping classification should be approached with prudence, as the two different criteria may influence conclusions about predictive marker associations. In addition, markers involved in direct versus inhibitory inflammation pathways may operate differentially across patient subgroups. Our findings support the link between inflammation and non-dipping circadian BP patterns and provide novel information on markers and definitions which may be useful for early detection and subsequent prevention of CVD.
Abstract P021: NT-proBNP Predicts Incident Heart Failure Among Individuals in All BMI Categories
Authors: Ndumele Chiadi E , Matsushita Kunihiro , Sang Yingying , Lazo Mariana , Agarwal Sunil K , Nambi Vijay , Deswal Anita , Blumenthal Roger S , Ballantyne Christie M , Coresh Josef , Selvin Elizabeth
Published: July 2021

Background:
The N-Terminal of pro-Brain Natriuretic Peptide (NT-proBNP) is a potent predictor of incident HF in the general population. Persons with obesity, despite their predisposition to developing HF, are known to have low NT-proBNP levels. The utility of NT-proBNP for HF prediction among individuals with obesity is therefore unclear.

Hypothesis:
We hypothesized that NT-proBNP levels may predict incident HF differently across body mass index (BMI) categories.

Methods:
We followed 12,509 ARIC participants free of prior HF at baseline (Visit 2, 1990-1992) with BMI ≥18.5 kg/m2 and available NT-proBNP. BMI (kg/m2) was categorized as normal (18.5-24.9), overweight (25-29.9), obese (30-34.9) and severely obese (≥35). The primary outcome was incident HF (1,986 events during a mean follow-up of 15.8 years). The potential effect modification of obesity on the NT-proBNP-HF relationship was assessed on both relative and absolute scales using multivariable Cox regression models. We also evaluated whether NT-proBNP improves HF prediction beyond traditional risk factors within the ARIC HF Risk Score similarly across BMI categories.

Results:
As expected, higher BMI was associated with lower NT-proBNP (r=-0.09, p<0.0001). Within each BMI category, higher NT-proBNP levels were significantly and similarly associated with increased relative risk for HF (Figure 1A). However, given the higher incidence of HF associated with obesity, the absolute risk difference associated with higher NT-proBNP levels was greatest among individuals with severe obesity (Figure 1B). In all BMI categories, NT-proBNP significantly improved the C-statistic beyond the ARIC HF Risk Score (increases of 0.026 [0.009-0.043] and 0.033 [0.015-0.052] for normal weight and severely obese, respectively).

Conclusions:
Despite the inverse relationship between NT-proBNP and obesity, NT-proBNP provides significant prognostic information regarding HF risk in all BMI categories, supporting its use for HF prediction even among those with obesity.
Abstract P024: Temporal Trends in Hospitalizations for Acute Decompensated Heart Failure in the U.S.: Calibration using The Atherosclerosis Risk in Communities (ARIC) Surveillance Study
Authors: Agarwal Sunil K , Wruck Lisa , Quibrera Miguel , Matsushita Kunihiro , Loehr Laura R , Chang Patricia P , Chambless Lloyd E , Rosamond Wayne R , Wright Jacqueline , Heiss Gerardo , Coresh Josef
Published: July 2021

Background:
Trends for acute decompensated heart failure (ADHF) hospitalizations based on the primary discharge ICD codes have declined in the U.S. However, HF ICD codes are increasingly found in non-primary positions. Validation data are needed to estimate the frequency of ADHF hospitalizations.

Methods:
The ARIC Study conducts surveillance for hospitalized ADHF in four U.S. communities for age ≥ 55 years since 2005. Hospital records are sampled, abstracted, and classified as ADHF or not by an expert physician panel. Analyses were stratified on code groups (a) 428.xx in primary-position, (b) 428.xx in non-primary position, and (c) other sampled HF ICD code (398, 402, 404, 415, 416, 425, 518, 786) in any position. We calculated ADHF probability in each group overall (positive predictive value, PPV), and by using regression models. We estimated the nationwide trends of ADHF hospitalizations from the National Inpatient Sample (NIS), a 20% probability sample of U.S. community hospitals, by applying the calibration factors derived in the ARIC study.

Results:
In ARIC surveillance 42% of eligible hospitalizations (n=12,450 charts) validated as ADHF. NIS data included 9 million eligible hospitalizations during 1999-2010. The estimated numbers of US ADHF hospitalization in 2010 among Americans ≥ 55 years old was 1.8 (SE 0.02) million as compared to 0.8 (SE 0.002) million with 428.xx in the primary position (
Figure
).

The estimated ADHF hospitalizations in the U.S. increased from 1.6 million in 1999 to 1.9 million in 2006, and then decreased to 1.8 million in 2010 (average annual increase of 1%, p-trend <0.01). Estimated ADHF based on regression models for each of the three code groups gave similar results. The temporal increase was steeper among men and in age category 55-64 years than older ages.

Conclusions:
Estimated frequency of ADHF hospitalizations by ARIC validation criteria is about two times higher than ICD 428 in primary position; with an overall increasing vs. declining trend over the last decade.
Abstract P033: Alcohol and Incident Heart Failure among the Cohort of Swedish Men
Authors: Dorans Kirsten S , Mostofsky Elizabeth , Levitan Emily B , Håkansson Niclas , Wolk Alicja , Mittleman Murray A
Published: July 2021

Background:
The relationship between alcohol intake and incident heart failure (HF) is complex. Compared with no alcohol consumption, heavy alcohol intake is associated with higher HF risk whereas light or moderate consumption may be associated with lower risk.

Methods:
We analyzed 34,581 men 45-79 years old with no history of HF, diabetes mellitus or myocardial infarction (MI) who were participants in the population-based Cohort of Swedish Men study. We excluded former drinkers. At baseline, participants reported how frequently they consumed specific alcoholic beverages in the past year and other characteristics. HF was defined as hospitalization for or death from HF (primary diagnosis), ascertained by Swedish inpatient and cause-of-death records from January 1, 1998 to December 31, 2011. Due to missing values for two covariates, we used Markov chain Monte Carlo multiple imputation to simulate 5 complete datasets. We used Cox proportional hazards models to estimate rate ratios and 95% confidence intervals, adjusting for age, total energy intake, education, body mass index, physical activity, a dietary component score, cigarette smoking, marital status, family history of MI before age 60, history of hypertension and history of high cholesterol.

Results:
At baseline, mean age was 58.6 years. There were 1592 incident cases of HF over the follow-up period. Compared with never drinkers, the multivariable-adjusted rate of HF was 19% lower among men who drank <1 drink per week (rate ratio: 0.81, 95% confidence interval: 0.64, 1.04%). The multivariable-adjusted HF rate was similar among men who drank <1 drink per week and men who drank ≥1 drink per week.

Conclusions:
Light-to-moderate drinking is associated with lower rate of HF compared with never drinking, but the association was not statistically significant.
Abstract P075: Influence of Systemic Interleukin-6 on the Inverse Association between Your-Choice American Heart Diet and a 41-Year Mortality Risk from Coronary Heart Disease among Men
Authors: Dai Jun , Acton Anthony J , Considine Robert V , Krasnow Ruth E , Reed Terry
Published: July 2021

Introduction:
Whole diet evaluated using dietary pattern is associated with systemic inflammation and coronary heart disease (CHD). Systemic inflammation also contributes to CHD risk. Genetic factors explain variations in whole diet, systemic inflammation, and CHD. However, it is unknown whether systemic inflammation is a mechanism linking whole diet to the long-term mortality risk from coronary heart disease independent of genes.

Hypothesis:
Systemic inflammation measured as plasma interleukin-6 levels medicates the association between whole diet and long-term mortality risk from coronary heart disease independent of genes.

Methods:
From the National Heart, Lung, and Blood Institute Twin Study, we included 554 white, middle-aged, veteran male twins (105 monozygotic and 109 dizygotic twin pairs; 65 monozygotic and 61 dizygotic unpaired twins). The twins were not on antihypertensive medication and had diastolic blood pressure below 105 mmHg at baseline (1969-1973) and did not have suspected acute inflammation [plasma levels of interleukin-6 (IL-6) above 10 pg/mL or C-reactive protein above 30 mg/L)]. Usual dietary data at baseline were collected through nutritionist-administered dietary history interview. Your-Choice American Heart Diet (YCARD) score was devised to quantitatively evaluate whole diet. Plasma interleukin-6 and C-reactive protein levels were measured with ELISA. Data on vital status and death causes were collected through death certificates until Dec 31, 2010. A frailty survival model was used to estimate various associations: overall (equivalent to the association in the general population), within-pair (independent of genes and environment common to co-twins), and between-pair (indicating influence of the common factors). We controlled for total caloric intake and known CHD risk factors including body mass index and modified Framingham Risk Score.

Results:
There were 75 CHD deaths during a 41-year follow-up (median follow-up of 34 years). The adjusted overall association between YCARD score and the CHD mortality risk was negative [partial coefficient for a 10-unit increment in the YCARD score: βo (95% confidence interval (CI)): -0.13 (-0.24, -0.02); hazard ratio (95% CI): 0.88 (0.78, 0.98)]. The partial regression coefficient was -0.02 [95% CI (-0.23, 0.19)] for the within-pair effect of YCARD (βw) and -0.12 [95% CI (-0.26, 0)] for the between-pair effect of YCARD (βb) in relation to CHD mortality risk. Additional adjustment for IL-6 led to a 15.4% reduction in the βo, a 100% increment in the βw, and a 16.7% reduction in the βb.

Conclusions:
Systemic inflammation measured as interleukin-6 mediates the association between whole diet and long-term coronary heart mortality risk, which is largely through genetic and environmental factors shared between co-twins.
Abstract P081: Increased Hepatic Fat Is Associated With A More Atherogenic Lipoprotein Profile In Adolescents
Authors: Jin Ran , Le Ngoc-Anh , Otvos James , Vos Miriam B
Published: July 2021

Introduction:
Nonalcoholic fatty liver disease (NAFLD) has emerged as the most common liver disease in pediatrics, and it has been estimated to affect more than one third of obese adolescents in the United States. In adolescents with NAFLD, traditional markers of increased cardiovascular risk are commonly reported including elevated triglycerides and reduced HDL-cholesterol levels. Despite the fact that lipoproteins are critically involved in atherogenesis and cardiovascular disease, the independent impact of NAFLD on size and particle concentration of major lipoproteins remains less well described and studies in pediatric population are particularly scarce.

Hypothesis:
In the current study, we assessed the hypothesis that in adolescents, high hepatic fat would have a strong association with an atherogenic pattern of lipoprotein particle size and concentration.

Methods:
Hispanic-American overweight and obese adolescents (n=50) were recruited from pediatric clinics at Emory Children’s Center and from nearby community centers through flyers and presentations at community events. We evaluated their hepatic fat content by magnetic resonance spectroscopy and measured lipoprotein particles by nuclear magnetic resonance (Liposcience, Raleigh, NC).

Results:
Using the 5% hepatic fat to stratify subjects with low (n=13) and high hepatic fat (n=37), adolescents with high hepatic fat have undesirable lipoprotein subclass profiles, including larger VLDL particle size (51.2 ± 1.36 vs. 44.8 ± 1.31 nm, p=0.010), more large VLDL particle numbers (5.75 ± 0.93 vs. 1.32 ± 0.18 nmol/L, p<0.001), and fewer large HDL particles (4.15 ± 0.33 vs. 5.69 ± 0.67 μmol/L, p=0.033). Strong correlations were found between hepatic fat and the number of large VLDL particles (r=0.521, p<0.001), VLDL particle size (r=0.439, p=0.002), and small, dense LDL particle numbers (r=0.291, p=0.040).

Conclusions:
The amount of hepatic fat is closely related to the presence of large VLDL particle and small dense LDL, two important predictors of CVD. This suggests that hepatic fat and the associated dyslipidemia have interrelated mechanisms. Further studies with histologic assessment of NAFLD (liver biopsies) will be needed to confirm our findings and to explore causation.
Abstract P090: Change in Visceral Adipose Tissue and Change in Cardiometabolic Risk in a Minority Cohort: The IRAS Family Study
Authors: Hairston Kristen G , Tooze Janet A , Anderson Andrea , Norris Jill M , Rotter Jerome I , Chen Ida Y , Wagenknecht Lynne E
Published: July 2021

Visceral adipose tissue (VAT), the more metabolically harmful fat depot, has been associated with a higher prevalence of diabetes, insulin resistance, and impaired glucose homeostasis. Higher levels of VAT are associated cross-sectionally with cardiovascular (CV) risk factors, specifically hypertension and unfavorable lipid profiles. Research on the effects of change in VAT on CV risk factors is extremely limited and no studies have explored these questions in minority cohorts. The Insulin Resistance Atherosclerosis Family (IRAS Family) Study offered the opportunity to explore whether changes in
VAT were associated with changes in CV risk, independent of changes in BMI, in a minority cohort.

Abdominal computed tomography (CT) scans were obtained at two time points spanning a five year interval among African-American (N=295) and Hispanic-American participants (N=719), aged 18-65 years. The CV risk factors included 5-year change in insulin resistance (HOMA), high density lipoprotein (HDL) cholesterol and systolic blood pressure (SBP). To account for family structure, we used mixed models stratified by gender to estimate change in CV risk factors as a function of change in VAT, adjusted for change in BMI, age category, race, physical activity level, smoking status, statin use (for HDL) and antihypertensive use (for SBP).

The cohort was 62% female, with an overall mean age of 40 years at baseline. The mean (SD) changes in BMI and VAT over 5-years were 1.1 (2.6) kg/m
2
and 4.2 (31.0) cm
2
, respectively; the mean (SD) changes in HOMA, HDL, and SBP over 5 years were 1.3 units (2.8), 4.8 (9.3) mg/dL and 2.4 (12.7) mm Hg, respectively. On average, a one standard deviation increase in VAT (31 cm
2
) was significantly associated with a 0.58 unit increase in HOMA in men (p<0.0001) and 0.42 unit increase in women (p=0.0048) in the adjusted model. A 31 cm
2
increase in VAT was significantly associated with a 1.8 mg/dL decrease in HDL in women (p=0.0007), but not in men (0.07 mg/dL increase, p=0.87). VAT change was not significantly associated with change in SBP in men or women.

In this study of change in CT measured abdominal fat area in a large minority cohort, modest increases in VAT were significantly related to changes in HOMA and HDL, independent of changes in BMI. Further research is needed to determine whether preventing VAT accumulation may lead to improvements in glucose homeostasis and lipid profile.
Abstract P097: Maternal Vascular Changes during Pregnancy may Persist Postpartum
Authors: Niemczyk Nancy A , Barinas-Mitchell Emma , Catov Janet M , McClure Candace K , Roberts James M , Sekikawa Akira , Tepper Ping G
Published: July 2021

Introduction:
Higher parity (number of births) is associated with increased subclinical cardiovascular disease (CVD) in mid-life and older women, and with increased risk of CVD overall. In the only study of reproductive age women, common carotid artery intima-media thickness (CCA IMT) was greater after each birth. Prospective studies of arterial change throughout normal pregnancy are lacking; without them it is unclear whether unhealthy changes of the vasculature during pregnancy persist postpartum and raise women’s risk of CVD. The goal of this study was to prospectively assess normal vascular adaptation in healthy pregnant women.

Hypotheses:
During the course of healthy pregnancy: 1. CCA adventitial diameter (AD) will increase, then return to baseline postpartum, 2. CCA IMT will initially thin, then thicken as pregnancy progresses, then return to baseline postpartum, and 3. brachial artery distensibility will not change.

Methods:
We assessed 43 healthy women during each trimester of their first pregnancy and 6-8 weeks postpartum with B-mode ultrasound imaging of the CCA IMT and AD, independent predictors of CVD risk. Brachial artery distensibility, representing elasticity of the artery, was measured using the DynaPulse wave form analyzer. Linear mixed models were used to compare measures of CCA IMT, adventitial diameter, and brachial artery distensibility at each time point, after adjustment for age and pre-pregnancy BMI.

Results:
There were 37 women (age 28.2 ± 4.5 years, pre-pregnant BMI 24.4 ± 3.2 kg/m
2
) with uncomplicated pregnancies. Six women with pregnancy complications were excluded from these analyses. After adjustment for age and pre-pregnancy BMI, mean (SE) CCA AD (mm) increased each trimester, from 6.38(0.08) in the 1
st
trimester to 6.92(0.09) in the 3
rd
trimester, and returned to baseline, 6.35 (0.07), postpartum. Pairwise comparisons were all statistically significant at p<.01. Mean (SE)CCA IMT (mm) was increased postpartum (0.567 (0.01)) compared to 1
st
(0.539 (0.01)) and 2
nd
trimester values (0.546 (0.01), p < .05 for each). Mean (SE) brachial artery distensibility (%/mmHg) decreased from 7.64 (0.28) 1st trimester to 6.84 (0.21) 3rd trimester (p < .01) and then remained unchanged at 6.82 (0.21) postpartum.

Conclusions:
As we hypothesized, in uncomplicated first pregnancies CCA AD increased throughout and returned to baseline postpartum. However, contrary to our hypotheses, CCA IMT increased postpartum, and the brachial artery stiffened during pregnancy and remained stiffer 6-8 weeks postpartum. In uncomplicated first pregnancies, some vascular changes resolved (CCA AD) and others persisted (CCA IMT and brachial artery stiffness). Whether this indicates that persistence of specific vascular effects of pregnancy may inform long term CVD risk remains to be explored.
Abstract P126: Influence of CIMT as a Motivator for Health Behavior Change in a Heart Health Program
Authors: Walizer Elaine , Vernalis Marina , Modlin Randolph
Published: July 2021

Introduction:
Carotid intima media thickness (CIMT) ultrasound is a known surrogate marker of atherosclerosis but few studies examine its influence on patient behavior. Motivation and self-efficacy (SE) are known predictors of health behavior change. This randomized, double-blind trial examined 1) use of CIMT images plus associated CVD risk to motivate adherence, and 2) the predictive ability of motivation and SE on adherence change.

Methods:
Patients with ≥ 2 cardiovascular disease (CVD) risk factors and subclinical atherosclerosis were assigned to either the intervention group [receive results weekly (R-CIMT)] or control group [withhold results (W-CIMT)]. All patients received a 12-week lifestyle program (Mediterranean diet, aerobic exercise, group support). Overall change in adherence from baseline to week 12 was determined using an ANCOVA model where % adherence was a composite measure of diet and exercise adherence. Initial motivation plus exercise and nutrition SE were assessed to determine their predictive ability of adherence in a standard regression model.

Results:
166 patients randomized; 161 (R-CIMT n=81; W-CIMT n=80) eligible for intention-to-treat analysis. Patients were middle age (mean age = 54 ± 11 yrs), 62% (100 or 161) women, 48% (77 of 161) black. Baseline group differences: W-CIMT group was younger (52 vs 55 yrs; p=0.05), had a lower systolic blood pressure (120 vs 125; p=0.01), lower % family history of CVD (49 vs 65; p=0.03). In comparing R-CIMT vs W-CIMT groups, no difference was detected in overall % adherence change (16.4 ± 25.6 vs 19.8 ± 25.4; p=0.39). Initial motivation and SE measures were not predictive of change in adherence when added to group assignment (see Table).

Conclusions:
CIMT evidence of subclinical atherosclerosis increased participant CVD risk awareness but did not translate into actionable healthy behavior changes beyond those in the control group. Neither exercise nor dietary adherence was affected by initial motivation or self-efficacy when added to CIMT risk awareness.
Abstract P134: Lifetime Cigarette Smoking is Associated with Increased Indices of Abdominal Obesity Independent of Body Mass Index: The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA)
Authors: Fujiyoshi Akira , Miura Katsuyuki , Kadowaki Sayaka , Kadota Aya , Ohkubo Takayoshi , Miyagawa Naoko , Hisamatsu Takashi , Yoshino Saitoh , Torii Sayuki , Miyazawa Itsuko , Mitsunami Kenichi , Maegawa Hiroshi , Murata Kiyoshi , Ueshima Hirotsugu
Published: July 2021

Background:
Literature has suggested that smoking is causally associated with insulin resistance and type 2 diabetes. The smoking-diabetes association is often believed to be mediated by abdominal obesity. However, literature is scarce concerning whether smoking is related to visceral adipose tissue (VAT) beyond body mass and other lifestyle factors that influence abdominal fatness. We examined whether lifetime cigarette smoking is independently associated with VAT among Japanese men.

Method:
We cross-sectionally investigated community-based samples of Japanese men recruited from Shiga, Japan from 2006 to 2008, aged 40 to 64 years and free of cardiovascular disease. Areas of VAT and subcutaneous adipose tissues (SAT) were calculated upon a computer tomography image taken at the level of participant’s L
4-5
. Adipose tissue was defined as -190 to -30 Hounsfield Unit. Amount of cigarette smoking was assessed using structured self-administered questionnaire, and quantified as Brinkman Index (BI, the number of cigarettes smoked per day multiplied by the number of years of smoking). Using linear regression, we calculated adjusted means of abdominal obesity indices (VAT, SAT, VAT-SAT ratio [VSR], and waist-hip ratio [WHR]) according to tertiles. Adjusting covariates included age, education, body mass index (BMI), physical activity at workplace, and drinking.

Results:
533 men were studied (mean age 56.1 years; 40.1% for current-, 43.5% for former-smoker). Average BMI, VAT, SAT, and VSR were 23.8 kg/m
2
, 117 (cm
2
),122 (cm
2
), and 1.01. Although significant associations between smoking and VAT and SAT were absent, VSR increased significantly with increasing BI (
p
=0.02) independent of BMI and other covariates (Table).

Conclusion:
In Japanese men, cigarette smoking is adversely associated with a rise in the faction of visceral to subcutaneous adipose tissue independent of BMI and other lifestyle factors. Visceral fat may, in part, mediate the smoking-diabetes association.
Abstract P136: Relationships between Health Behaviors and Physical & Mental Health among Smokers in California
Authors: Linke Sarah E , Strong David R , Edland Steve , Al-Delaimy Wael
Published: July 2021

Background:
Tobacco use, physical inactivity (PA), and sedentary behavior (SB) are leading behavioral risk factors for mental and physical health problems. The combination of smoking and other unhealthy lifestyle behaviors heightens the risk from smoking alone. Examining the relationships between health behaviors and health problems in a representative sample of California smokers enables quantification of the negative health effects of engaging in multiple unhealthy lifestyle behaviors over and above any adverse health effects from smoking alone.

Methods:
The 2011 California Longitudinal Smokers Survey (CLSS) surveyed smokers who participated in the previous 2009 California Health Interview Survey (CHIS), a population-based random sample of California residents. The present analyses included 1,718 current smokers surveyed again two years after participating in CHIS. The sample respondents were weighted to the age, gender, geographic place of residence, and ethnicity of the population of all adult California smokers. For the current analyses, physical inactivity was defined as <10 minutes of sustained PA per week; a high level of SB was defined as ≥2 hours of leisure screen time per day; obesity was determined via calculated body mass index (BMI≥30) based on respondents’ self-reported height and weight; and elevated depressive and anxiety symptoms were determined via responses to two questions comprised of clusters of symptoms for each condition on the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) instrument.

Results:
Results revealed a significant relationship between physical inactivity and obesity (t=3.5, p < 0.001) and an interaction between sex and physical inactivity, such that male smokers who reported <10 min/week of PA were more likely than male smokers who reported ≥10 min/week of PA to be obese (t=2.8, p< 0.01). Physical inactivity was also associated with elevated anxiety symptoms among smokers (t=2.9, p<0.01). Smokers who reported ≥2 hours/day of leisure time SB were more likely to report ever receiving a diagnosis of heart disease by a physician (t=3.3, p<0.005). SB was also associated with elevated depressive symptoms among smokers (t=3.7, p<0.001).

Conclusion:
The combination of smoking and physical inactivity or excessive SB is associated with worse mental and physical health than smoking alone. The American Heart Association encourages individuals to improve their cardiovascular health by quitting smoking, increasing PA, reducing SB, and maintaining a healthy weight. Public health efforts to increase awareness of the significant benefits of improving these and other health behaviors rely upon the collection, analysis, and publication of data demonstrating the associations between health behaviors and outcomes.
Abstract P147: Healthcare Resource Utilization and Associated Costs in Type 2 Diabetes Mellitus Patients with Uncontrolled Glycemic Level or Blood Pressure
Authors: Chuang Chien-Chia , Lee Edward , Bhurke Sharvari , Ghosh Sabyasachi , Tawah Alie , Chen Shih-Yin
Published: July 2021

Background:
Poor glycemic and blood pressure (BP) control in patients with type 2 diabetes mellitus (T2DM) may lead to higher risk of complications with varying healthcare resource utilization (HRU). We hypothesize that poor glycemic and BP control are associated with higher HRU/costs.

Methods:
This study analyzed electronic health records from integrated delivery networks across the US between 2008 and 2012. Adult T2DM patients with at least two HbA1c and BP measures over a 12-month baseline period were selected. The end of this baseline period marks the index date. Patients were required to have an additional 12-month follow-up after the index date to evaluate HRU/costs. Uncontrolled HbA1c was defined as ≥ 1 HbA1c measure that was ≥7% during the baseline period. Uncontrolled BP was defined as ≥ 2 measures with systolic BP ≥ 130mmHg or diastolic BP ≥ 80mmHg during the baseline period. Descriptive analysis was conducted to compare HRU/costs across study cohorts. Unit cost approach was applied to derive total medical encounter costs. Logistic regression models were performed to assess the association between uncontrolled HbA1c/BP and HRU.

Results:
Of the 96,312 T2DM patients included in this study (mean age: 62.4 years; female: 51.5%), 55.9% had uncontrolled HbA1c (mean age: 61.2 years; female: 49.4%) and 74.6% had uncontrolled BP (mean age: 62.3 years; female: 52.8%). Patients with uncontrolled HbA1c had a higher proportion of hospitalizations (16.6% vs. 15.0%) , ER visits (21.0% vs. 18.3%), and higher total medical encounter costs ($4,168 vs. $3,773) than controlled patients, but lower utilization of outpatient visits (28.5% vs. 33.1%) and physician office visits (93.9% vs. 94.3%) (all p<0.05). Patients with uncontrolled BP had a higher proportion of hospitalization (17.1% vs. 12.3%), ER visits (21.3% vs. 15.5%), and outpatient visits (33.3% vs. 22.5%) and higher total medical encounter costs ($4,236 vs. $3,282) than controlled patients, but lower utilization of physician office visits (93.6% vs. 95.4%) (all p<0.05). In regression models, uncontrolled HbA1c was associated with greater odds of having any hospitalization (odds ratio [OR]: 1.10; 95% confidence interval [CI]: 1.06–1.14) and ER visits (OR: 1.10; 95% CI: 1.07–1.14). Uncontrolled BP was also associated with greater odds of having any hospitalization (OR: 1.39; 95% CI: 1.33–1.45) and ER visits (OR: 1.37; 95% CI: 1.31–1.43).

Conclusions:
T2DM patients with uncontrolled HbA1c or BP had higher HRU in inpatient/ER settings and incurred higher costs. The findings highlight the clinical/economic significance of managing HbA1c and co-morbid hypertension among T2DM patients.
Abstract P162: Coronary Intervention Procedures in CAD Patients with Diabetes: Racial Disparities Are Associated with Post-Procedure Mortality
Authors: Sergeev Alexander V
Published: July 2021

Background:
The two major intervention treatment procedures for coronary artery disease (CAD) are coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with. Besides being a major risk factor for CAD, diabetes mellitus (DM) also impacts unfavorably CAD patients’ prognosis. We hypothesized that racial and socio-economic disparities are associated with post-procedure mortality in CAD patients with DM.

Methods:
A retrospective cohort study of post-procedure mortality after CABG and PCI in 188,851 CAD patients with DM (mean age 65.5∓11.3 years, 35.3% women) was conducted. In-hospital patient death was a binary outcome of interest. Adjusted odds ratios (OR) were obtained from multivariable logistic regression, adjusted for a number of demographic, socio-economic and clinical confounders, including the severity of comorbid conditions (other than DM) measured by Elixhauser Comorbidity Index, Walraven modification. All results were analyzed with SAS version 9.2.

Results:
Post-CABG in-hospital mortality was higher than post-PCI (adjusted OR 1.89, 95% CI: 1.72-2.08, p<0.01). Post-procedure mortality was associated with higher severity of co-existing conditions (10.6% increase for each point increase in Elixhauser-Walraven score, p<0.01) and emergency room (ER) admission (adjusted OR 1.10, 95% CI: 1.08-1.11, p<0.01). African Americans were more likely to undergo ER admission (43.7%) than other racial groups. ER admission was also significantly higher in lower socio-economic status groups, while severity of co-existing conditions was higher (p<0.01).

Conclusion:
Racial and socio-economic disparities are associated with in-hospital mortality after coronary intervention procedures. Further investigation of mortality disparities in CAD patients with DM is warranted.
Abstract P164: Lipid Management in Diabetes: the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Authors: Gamboa Christopher , Safford Monika M
Published: July 2021

Background:
The Look Ahead trial recently showed that lifestyle intervention did not lower the risk of coronary heart disease (CHD) events in diabetes, emphasizing the importance of risk factor control. This is particularly important for blacks, who have higher risks of CHD mortality than whites. We examined race-sex differences in the prevalence, awareness, treatment and control of hyperlipidemia in a large national biracial cohort with diabetes.

Methods:
REGARDS recruited 30,239 black and white participants ≥ 45 years of age from the 48 continental US from 2003-2007. Telephone interviews were followed by in-home visits. This analysis included participants with physician/nurse diagnosed diabetes or treatment with diabetes medication or insulin. Hyperlipidemia was defined as low density lipoprotein cholesterol >100 mg/dL or statin use. We described the prevalence, awareness, treatment, and control of hyperlipidemia and calculated prevalence ratios and 95% confidence intervals comparing white men (WM) with other race-sex groups, adjusted for factors that influence health services use (sociodemographics, access to care, severity of diabetes, functional status, obesity, depressive symptoms and elevated high density lipoprotein cholesterol).

Results:
The race-sex distribution of the 6,497 participants with diabetes is shown in the Table. Although the prevalence of hyperlipidemia was 80-84% across race-sex groups, more white women (WW) (78%) and fewer black men (BM) (64%) were aware of their hyperlipidemia compared with WM (72%) and black women (BW) (71%). Compared to WM (80%) all other race-sex groups were less treated (WW 70%, BM 72%, BW 69%) and among the treated, less controlled (WM 77%, WW 71%, BM 62%, BW 54%). Results were similar after adjustment (Table).

Conclusion:
These disparities in treatment and control of hyperlipidemia in diabetes warrant further investigation, particularly among blacks, who are especially burdened by diabetes.

Table.
Prevalence ratios (95% CI) for hyperlipidemia prevalence, awareness, treatment, and control among participants with diabetes in REGARDS, n = 6,497.
Abstract P166: Initially Healthy Cuban Immigrants Exhibit Average Increases in Waist Circumference Associated with Insulin Resistance Soon after United States Arrival
Authors: Arguelles William , Brown Scott C , Huang Shi , Perrino Tatiana , Perez-Gomez Gianna , Llabre Maria M , Goldberg Ronald , Mendez Armando , Schneiderman Neil , Szapocznik José
Published: July 2021

U.S. Hispanics are disproportionately burdened by obesity and diabetes compared to non-Hispanic whites. While risk for these conditions appears to increase with longer U.S. residence among Hispanic immigrants, it remains unclear exactly how, when, and for whom the cardiometabolic indices underlying these disorders change upon arrival to the U.S. This study used latent growth modeling to examine change in waist circumference (WC) related to change in insulin resistance (measured via the homeostatic model assessment of insulin resistance, HOMA-IR) over an average 22-month follow-up in a sample of healthy Cuban immigrants assessed within 4 months of U.S. arrival (mean = 40.2 days). Men (n = 194, mean age = 37.1 years) and women (n = 174, mean age = 37.3 years) were analyzed separately. Analyses adjusted for age, days in U.S. prior to baseline, household income, and education. On average, WC increased in both men (0.032 cm per month, p = 0.055) and women (0.098 cm per month, p < 0.001). Lower household income at baseline was associated with greater WC increase in men (B = -0.020, p = 0.043) but not women, adjusted for baseline WC. Age, days in U.S., and education were not related to WC change in either men or women. Furthermore, change in WC was positively related to change in HOMA-IR in both men (B = 0.092, p = 0.001) and women (B = 0.048, p = 0.021), adjusted for baseline WC and HOMA-IR. Findings suggest that initially healthy Cuban immigrants exhibit increases in abdominal adiposity soon after arriving in the U.S., and that this rate of change is (1) about three times higher in female compared to male immigrants, and (2) associated with concurrent increases in insulin resistance. Future research aimed at further elucidating these trends - as well as identifying important environmental and psychosocial predictors - may inform optimal intervention approaches for reducing health disparities observed among Hispanics.
Abstract P174: Increased Cardiovascular Disease Risk Factors in Young Hispanic Women at the High-end of Normal-weight Body Mass Index
Authors: Vella Chantal A , Burgos-Monzon Ximena , Ellis Carla J
Published: July 2021

BMI is often used to assess risk of cardiovascular disease (CVD); however, current BMI cutpoints may not be accurate for all ethnicities. Given the high prevalence of obesity and type 2 diabetes in Hispanics, it is important to examine whether current BMI cutpoints accurately identify those at healthy weight and those at risk. We examined whether there was a difference in CVD risk factors within the normal-weight BMI category in young, Hispanic women. We hypothesized that women in the highest tertile of normal-weight would have significantly more CVD risk factors than those in the lowest tertile of normal-weight. Sixty nine normal-weight Hispanic women (20-39 y) were divided into tertiles of normal-weight BMI: 18.5-20.9 kg/m2 (NW low, n=17), 21.0-22.9 kg/m2 (NW mid, n=31) and 23.0-24.9 kg/m2 (NW high, n=21). CVD risk factors measured included waist circumference, blood pressure and fasting glucose, triglycerides and high-density and low-density lipoprotein. Glucose tolerance was measured by a 2h oral glucose tolerance test. Body composition was measured by dual-energy x-ray absorptiometry. Intra-abdominal adipose tissue, an estimate of visceral adiposity, was calculated. Data were analyzed using multivariate ANOVA, with Levine’s test indicating homogeneity of variances among groups, and Kruskal-Wallace test. Post hoc tests included Bonferroni and Mann Whitney. Results indicated the prevalence of women who were risk factor free was 65%, 39% and 24% for NW low, mid and high, respectively. The prevalence of women with one or more CVD risk factors was 35%, 61%, and 76% for NW low, mid and high, respectively. The prevalence of women with two or more CVD risk factors was 0%, 3%, and 29% for NW low, mid and high, respectively. The prevalence of women with three or more CVD risk factors was 0%, 0% and 10% for NW low, mid and high, respectively. Overall the prevalence of CVD risk factors was significantly higher in NW high than NW low (p=0.006) and NW mod (p=0.04) and approached significance between NW mid and NW low (p=0.08). There was a significant increase in percentage body fat (27.6±5.1%, 30.7±4.6%, 36.9±4.6%, respectively), intra-abdominal adipose tissue (24.2±7.9 cm2, 45.6±12.2 cm2, 66.5±19.7 cm2, respectively), and waist circumference (71.2±3.1 cm, 76.6±4.8 cm, 81.0±5.8 cm, respectively) from NW low to NW high (p<0,001). NW high had significantly higher triglyceride levels than NW low (86.4±40.0 mg/dL vs. 58.9±20.6 mg/dL, p=0.04) and significantly higher 2h glucose levels than NW mid (120.0±27.9 mg/dL vs. 99.1±17.3 mg/dL, p=0.003). In conclusion, young, Hispanic women at the upper-end of the normal-weight BMI range had a significantly higher prevalence of CVD risk factors, body fat and central obesity than women in the mid and lower end of normal-weight BMI range. These findings suggest that the normal-weight BMI cutpoint may need to be adjusted for Hispanic women.
Abstract P175: Effectiveness Of A Community Screening Program For Metabolic Syndrome And Cardiovascular Risk Factor Identification In Young South Asians Adults
Authors: Prasad Megha , Flowers Elena , Mathur Ashish , Sridhar Vishaal , Molina Cesar , Turakhia Mintu
Published: July 2021

Background:
Metabolic syndrome has been associated with increased risk of cardiovascular disease.We aimed to determine the effectiveness of a community-based screening program in identifying cardiovascular risk factors in a healthy young South Asian population.

Methods:
Between 2006 and 2011, 3,314 patients of all ages were recruited as a part of a prospective cohort study investigating cardiovascular risk in South Asians. We analyzed 1537 patients between the ages of 18 and 40. Demographic and baseline characteristics including baseline laboratory markers and blood pressures were obtained at initial visit.

Results:
The total cohort of 1537 patients was 66.5% male, and the mean age was 35±5 years. Among participants who denied a history of hypercholesterolemia, 62% had elevated LDL-C (>100 mg/dL), and 8% had markedly elevated LDL-C (>160 mg/dL). Overall, diabetes was present in 4%, hypertension was present in 12% and hyperlipidemia was present in 46%. Low HDL-C (50% of men, 52% of women) and elevated triglycerides (44% of men, 18% of women) were the most prevalent components of metabolic syndrome. Metabolic syndrome was present in 14% of men and 8% of women and one-third (30%) of men and one-fifth (19%) of women had at least two component risk factors.

Discussion:
This is the largest study to date assessing effectiveness of a community based screening program aiming to identify cardiovascular risk in young South Asians. We note significant modifiable risk at a young age. Such community based interventions can be effective at detecting and managing risk factors early in this vulnerable population.
Abstract P177: Higher Frequency of Fast Food Consumption is Associated with Lower Likelihood of Meeting Dietary Reference Intakes (DRIs): Findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: BASU ARPITA , Shay Christina M , Colangelo Laura , Jacobs David R , Van Horn Linda
Published: July 2021

Background:
Dietary Reference Intakes (DRIs) are reference values established by the Food and Nutrition Board of the Institute of Medicine and are intended for purposes of planning and assessing diets for healthy populations. As consumption of fast food has continued to increase, the question of nutrient adequacy is of growing concern.

Purpose:
The purpose of this investigation is to quantify the association between frequency of fast food consumption and likelihood of meeting DRIs in a middle age adult population.

Methods:
Coronary Artery Risk Development in Young Adults (CARDIA) is a multi-center longitudinal study among black and white men and women who, at year 20 of follow up, were ages 38-50 years (n=3,089). Dietary intake was assessed by trained, certified interviewers using the validated CARDIA Diet History questionnaire. Fast food frequency was quantified based on responses to a dietary behavior questionnaire and categorized according to 0, >0-<1, 1-<3, and 3+ times/wk. Logistic regression was used to quantify associations between fast food frequency and the likelihood of meeting DRIs accounting for age, sex, race, study center, education, smoking status, and energy intake.

Results:
More frequent consumption of fast food was associated with lower likelihood of meeting recommended levels of several essential nutrients and greater likelihood of exceeding recommended intakes of sodium and sugar (Table1).

Conclusions:
These findings raise awareness of the need for targeting public health messages aimed at improving diets of fast food consumers, for example, by improving foods served at fast food restaurants to help meet nutrient needs in the US diet.
Abstract P186: Circulating Desphospho-uncarboxylated Matrix Gla Protein and the Risk of Coronary Heart Disease and Stroke
Authors: Dalmeijer Geertje W , van der Schouw Yvonne T , Magdeleyns Elke J , Vermeer Cees , Verschuren W. Monique M , Boer Jolanda M , Beulens Joline W
Published: July 2021

Background:
Matrix Gla protein (MGP) is a vitamin K dependent protein and a potent inhibitor of vascular calcification. Desphospho-uncarboxylated MGP (dp-ucMGP) is a marker for vitamin K status with high dp-ucMGP concentration reflecting a low vitamin K status. High dp-ucMGP concentrations are thought to be associated with an increased risk of cardiovascular disease, but this has never been investigated in the general population.

Objective:
This study aimed to investigate the association of dp-ucMGP with incident coronary heart disease (CHD) or stroke in the general population.

Design and Methods:
A prospective case-cohort study with a representative baseline sample of 1406 participants and 1154 and 380 incident cases of CHD and stroke, respectively, was nested within the EPIC-NL study. Dp-ucMGP concentrations were measured by ELISA technique in baseline plasma samples. The incidence of fatal and non-fatal CHD and stroke was obtained by linkage to national registers. Cox proportional hazard models adapted for the case-cohort design were used to calculate hazard ratios (HRs) per standard deviation (SD) and per quartile of circulating dp-ucMGP levels, adjusted for cardiovascular risk factors.

Results:
This case-cohort study had an average follow-up of 11.5 years. Circulating dp-ucMGP levels were not associated with CHD risk with a HR per SD of 1.00 (95% CI: 0.93-1.07) and a HR
Q4 vs Q1
of 0.94 (95% CI: 0.79-1.13) after multivariate adjustment. Circulating dp-ucMGP was not associated with stroke risk with a HR per SD of 0.98 (95% CI: 0.90-1.08) and a HR
Q4 vs Q1
of 1.09 (95% CI: 0.78-1.51).

Conclusion:
This study does not support the hypothesis that high dp-ucMGP levels, reflecting a poor vitamin K status, are associated with increased CHD or stroke risk.