bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P001: Neck Circumference Is Not Associated With Health Outcomes In Older Athletes
Authors: Silva Mayra dos Santos , Lopes Guiomar Silva , Raso Vagner
Published: April 2022

Purpose:
This study was undertaken to understand the relationship of neck circumference with body mass index, waist circumference, disease, functional capacity, physical function, and sleep disorders in older athletes.

Methods:
This was a cross-sectional analysis of 212 older athletes competing at a local level in one of the largest populated cities in the world. Assessments included anthropometrics, disease history with drug treatments, functional capacity, physical function, and sleep disorders.

Results:
Most individuals with an increased neck circumference were overweight (N=69, 89%, p<0.0001) and had a greater waist circumference (N=55, 71%, p<0.0001). Neck circumference was associated with waist circumference (total sample, N=209: R=0.49, adjusted R
2
=0.24, p<0001), but it was only related to BMI when individuals were analyzed by gender (female, N=127: R=0.49, adjusted R
2
=0.24, p<0001; male, N=83: R=0.57, adjusted R
2
=0.31, p<0001). Neck circumference was related neither to disease (p=0.98), drug use (p=0.65), functional capacity (p=0.46), physical function (p=0.15), nor sleep disorders (p=0.61). Metabolic equivalent per week and sleep disorders weakly related to disease (total sample, N=212: R=0.21, adjusted R
2
=0.03, p<0.01) with borderline significance when the sample was subdivided by gender (female, N=129: R=0.22, adjusted R
2
=0.03, p=0.048; male, N=83: R=0.28, adjusted R
2
=0.06, p=0.035).

Conclusion:
Our study allows us to conclude that neck circumference may be associated with waist circumference and BMI. However, relationships with disease, functional capacity, physical function, and sleep disorders were not significant to suggest it as an indicator of health outcomes in older athletes.
Abstract P013: Associations Between Diastolic Blood Pressure With Cognitive Functioning: Differences By Systolic Blood Pressure Among US Adults.
Authors: Matthew Alvin , Nahodyl Lauren , Mesa Robert A , Tremblay Julien , Rundek Tatjana , Zeki Al Hazzouri Adina , Elfassy Tali
Published: April 2022

Introduction:
While elevated systolic blood pressure (BP) is a known contributor to cognitive decline, the role of elevated diastolic BP (DBP) as an independent risk factor for cognitive decline is less clear, especially in relationship to systolic BP (SBP) levels.

Objectives:
To characterize the association between DBP and cognitive functioning at differing levels of SBP.

Methods:
The National Health and Nutrition Examination Survey is a nationally representative survey of U.S. adults conducted annually. Our sample included data from participants of the 1999-2002 and 2011-2014 cycles, age 60+, with measured BP and cognition (N=5,480). BP was measured three times manually with a standardized sphygmomanometer and averaged. Cognitive functioning was measured using the digit symbol substitution test (DSST), a measure of executive functioning (with higher scores indicating better performance: range 0-100). We tested for a statistical interaction between SBP and DBP. To determine whether DBP was associated with DSST score, we used linear regression analyses and stratified by categories of SBP. Models were adjusted for: age, sex, race, education, income, insurance, marital status, BMI, diabetes, BP medication, and cholesterol. All analyses accounted for the complex survey design.

Results:
Almost half (48.9%, SE=1.1) of the sample was aged 60-69 with 55.3% (SE=0.7) female. The association between DBP and cognitive functioning differed by SBP (p<0.01), leading to stratified analyses. Every 5 mmHg increment of DBP was associated with significantly higher DSST scores among individuals with SBP 110-119 mmHg only (beta: 0.76, 95% CI: 0.24, 1.27). Results were not significant among participants with SBP < 110mmHg (beta: 0.84, 95% CI: -0.09, 1.77), SBP 120-129 mmHg (beta: 0.09, 95% CI:-0.49, 0.69), SBP 130-140 mmHg (beta: 0.29, 95% CI: -0.10, 0.69), SBP 140-159 mmHg (beta: 0.23, 95% CI: -0.15, 0.61), or SBP ≥160mmHg (beta: -0.08, 95% CI: -0.56, 0.39).

Conclusion:
In a population-based sample of older US adults, higher DBP was associated with greater executive functioning only among individuals with normal SBP. The results suggest that at non-hypertensive levels of SBP, higher DBP may not be detrimental for cognitive performance.
Abstract P017: Development And Validation Of A Body Composition-based Prediction Model For Cardiovascular Outcomes Among Older Adults
Authors: Wu Chenkai , Chen Lihui , Wang Xinran
Published: April 2022

Background:
Cardiovascular disease (CVD) has long been a leading cause of death in the world and a major public health concern. Precise stratification of cardiovascular risk is critically important to deliver person-centered treatment decisions. Several risk prediction models of CVD have been developed, mainly focusing on demographics, healthy lifestyles, and blood-based biomarkers (mostly lipids). Recent evidence suggests that components of body composition are associated with the risk of CVD. However, it remains unknown whether the use of body composition data could improve the performance of a well-established CVD prediction model.

Objectives:
We aimed to derive and validate a model for predicting the risk of incident CVD based on body composition assessed by the Dual-energy X-ray absorptiometry (DXA) among older black and white adults.

Methods:
Participants were 1,994 adults initially free of CVD from the Health, Aging, and Body Composition Study. We developed and validated a model for risk of myocardial infarction, stroke, heart failure, and cardiovascular death over 10 years based on body composition data. We used the LASSO and stepwise backward elimination for variable selection of body composition data in the Cox model. Weibull accelerated failure time model was used to obtain the risk score. We compared the model performance (goodness-of-fit, discrimination, and calibration) between the body composition model and the Framingham model, in which sex, age, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, diabetes, and smoking were included. We also examined whether the inclusion of body composition data in the Framingham model could improve model performance.

Results:
The average age was 73.0 years (SD=2.8 years); 1,118 (56.1%) were females and 802 (41.3%) were black. A total of 8 body composition variables were retained after variable selection (8-DXA model). The C statistics were 0.608 and 0.616 for the 8-DXA model and the Framingham model, respectively. The 8-DXA plus Framingham model significantly improved the C-statistic by 0.026 (95% CI: 0.011, 0.042). When compared with the Framingham model, the 8-DXA plus Framingham model had an integrated discrimination index of 0.016 (95% CI: 0.009, 0.023) indicating an absolute increase of 12% in average risk for participants with events compared with those without. the 8-DXA plus Framingham model had a net reclassification index (NRI) of 0.167 (95% CI: 0.008, 0.259), with event-specific NRI of 0.018 (95% CI: -0.063, 0.094) and no event-specific NRI of 0.149 (95% CI: 0.098, 0.205).

Conclusion:
Among older adults free of CVD, the inclusion of body composition data assessed by DXA could moderately improve the prediction performance of a well-established CVD prediction model. Future research is needed to validate the usefulness of body composition data in predicting the risk of CVD in other cohorts.
Abstract P019: Compensatory Hyperinsulinemia Is An Independent Risk Factor For Atherosclerotic Cardiovascular Disease: CARDIA 30-year Follow Up
Authors: Farooq Sarah , Dwivedi Alok , Cistola David P
Published: April 2022

Introduction:
Compensatory hyperinsulinemia (CH) is the heightened response of thepancreas and liver to early insulin resistance. Elevated blood insulin compensates for insulin resistance in tissues, maintainingfasting glucose, triglycerides and HDL-cholesterol within normal limits. Individuals with CH, as defined here, do notmeet the harmonized criteria for metabolic syndrome and elude screening for cardiovascularrisk. Previously, we reported that CH isprevalent in the U.S., especially in teenagers, young adults, Hispanic andBlack populations. However, it wasunclear whether CH increases the risk of future atherosclerotic cardiovasculardisease (ASCVD) or simply is a benign adaptation to energy imbalance.

Hypothesis:
Compensatory hyperinsulinemia is an independentrisk factor for ASCVD.

Methods:
We conducted a retrospectivecohort study of CARDIA: Coronary ArteryRisk Development in Young Adults. Theparent study enrolled 5,113 participants, ages 18-30 at baseline, with studyvisits every five years for a mean follow up of 30 years. In our study, the baseline exclusion criteriawere hyperglycemia, hypertriglyceridemia and low HDL-C (all using metabolicsyndrome cutpoints), as well as pregnancy, fasting <8 hours, baseline diabetesor cardiovascular disease. The resulting 3,292 participants wereanalyzed using Cox models that included CH, as well as the 2019 ACC/AHA riskfactors for ASCVD: hypertension, LDL ≥160mg/dL, family history of premature ASCVD, elevated waist circumference or BMI, fitness,race, nicotine use (serum cotinine) and estimated glomerular filtration rate (eGFR)<60 mL/min/1.73 m
2
. Theprimary outcome was time to incident ASCVD. The effect size was hazard ratio (HR) with 95% confidence intervals (CI).

Results:
In an adjusted Cox model that included CH, waistcircumference and the other ACC/AHA risk factors mentioned above, CH atbaseline was an independent risk factor for ASCVD: HR 1.86, 95% CI: 1.32, 2.61, p=0.0004. The other risk factors were significantexcept for race, eGFR, fitness and waist circumference. In an adjusted Cox model that substituted BMIcategory (≥25 vs. <25 kg/m
2
) for elevated waist circumference, CHremained significant: HR 1.74, 95% CI:1.23, 2.46, p=0.0017. In that model, overweight/obesewas statistically significant as well (p=0.0289). To assess possible effect modificationbetween CH and BMI, a Cox model incorporating an interacting categorical variablerevealed that CH is a significant risk factor in overweight/obese participants (HR3.52, 95% CI: 1.76, 7.03, p=0.0004), but not those with BMI<25 (HR 1.23, 95%CI: 0.79, 1.94, p=0.3476). Thisobservation was confirmed using Cox models stratified by BMI category.

Conclusion:
After adjusting for canonical risk factors, compensatoryhyperinsulinemia is an independent risk factor for future ASCVD among CARDIA participantswho were overweight or obese at baseline.
Abstract P025: Cigarette Smoking And Risk Of Hospitalization With Acute Kidney Injury: The Atherosclerosis Risk In Communities (aric) Study
Authors: Chen Mengkun , Ding Ning , Grams Morgan , Matsushita Kuni , Ishigami Junichi
Published: April 2022

Title:
Cigarette smoking and risk of hospitalization with acute kidney injury: The Atherosclerosis Risk in Communities (ARIC) Study

Background:
Smoking has been associated with progression of chronic kidney disease. However, its association with the development of acute kidney injury (AKI) has not been prospectively assessed in the community. AKI poses significant morbidities and healthcare costs, thus understanding modifiable risk factors of AKI is crucial.

Methods:
Among 14,587 participants (mean age 54 [standard deviation: 6] years, 55% females and 25.4% Blacks) from the Atherosclerosis Risk in Communities Study, we quantified the association of smoking status with incident hospitalization with AKI (AKI diagnosis on discharge records in any diagnostic position) through 2019 using Cox models. Sensitivity analyses included censoring interim CVD events during follow-up and restricting to AKI as the primary diagnosis.

Results:
Over a median follow-up of 26.3 years, 2,986 participants had incident hospitalization with AKI (incidence rate per 1,000 person-years: 8.8; 95% CI: 8.4-9.1). In multivariable Cox models, current smokers had a >2-fold higher risk of AKI compared with never smokers (HR: 2.25; 95% CI: 2.04-2.48) (Table). There was a dose-response relationship between smoking pack-years at baseline and risk of AKI (e.g., HRs 1.34 [1.21, 1.50] with 10-25 pack-years, 1.78 [1.59, 1.99] with 25-40 pack-years, and 2.03 [1.80-2.29] with ≥40 pack-years vs. never smokers). These associations were consistent with similar HRs in the two sensitivity analyses censoring interim cardiovascular diseases and analyzing AKI as the primary cause of hospitalization (Table).

Conclusions:
In a community-based cohort, smoking was associated with the risk of incident hospitalization with AKI, which was independent of potential confounders and robust in a few sensitivity analyses. These results suggest the importance of smoking cessation to reduce the risk of AKI.
Abstract P033: Higher Ambulatory Sbp Is Associated With Increasing Number Of Target Organ Abnormalities In Youth: The Ship Ahoy Study
Authors: Urbina Elaine , Hamdani Gilad , Ferguson Michael A , Flynn Joseph T , Lande Marc B , Meyers Kevin , Samuels Joshua A , Mitsnefes Mark
Published: April 2022

Hypertension is associated with elevated left ventricular mass index (LVMI), cardiac dysfunction and increased arterial stiffness in adults which predict cardiovascular (CV) events. The extent to which elevated BP in youth is associated with subclinical CV target organ damage (TOD) is not known. We explored the relation between BP level and number of TOD abnormalities (nTOD). We measured clinic and ambulatory BP (ABP), anthropometrics, and nTOD in 244 adolescents (mean 15.5
+
1.8 years, 67% white, 60% male). Subjects were recruited as low-risk (L=98, SBP%<80
th
%), mid-risk (Mid=60, SBP% 80-<90
th
%); and high-risk (H=86, SBP% >=90
th
%) based on mean of 6 aneroid clinic BPs by age-, sex- and height-specific cut-points. 24-hour ABP was measured with an oscillometric device per pediatric guidelines. Four measures of TOD were: LVMI
>
38.6 g/m
2.7
; LV systolic strain (Strain %)
>
-18; LV diastolic function (E/e’)
>
8; pulse wave velocity (PWV)
>
5.8 m/sec. ANOVA was used to evaluate differences in CV risk factors and chi square for differences in nTOD across groups. Logistic regression models were used to determine if clinic and/or ABP was an independent predictor of nTOD after adjustment for age, sex, race, and BMI z-score. BP groups did not differ in BMI z-score. Clinic and ABP systolic and diastolic BP increased across BP groups. The distribution of nTOD was shifted towards higher BP group with most nTOD= 0 (47%) in the L and all (100%) nTOD = 4 in the H group (X
2
= 0.08) and became significant when L (clinic SBP<75
th
%) was compared to M+H (clinic SBP
>
80
th
%; X
2
=0.04). Daytime ABP index (subject daytime systolic ABP/95
th
% for daytime systolic ABP) and BMI z-score (both p
<
0.003) were significantly associated with nTOD in a model containing clinic SBP, age, sex and race (other covariates NS; full model p
<
0.0001, R
2
=0.22). We conclude that higher ABP is associated with a greater number of cardiac and vascular abnormalities in youth. ABP should be applied in youth with elevated BP to evaluate need for intensification of therapy to prevent CV TOD.
Abstract P052: Identifying Barriers To Healthy Eating In Pregnant Women With Hypertension, Hypertensive Disorders Of Pregnancy, Or Risk Factors For Hypertensive Disorders Of Pregnancy.
Authors: Sibai Diana , Shankara Sravya , Ayturk Didem , Moinul Sheikh , Lynch Katherine , McManus David D , Kovell Lara C
Published: April 2022

Introduction:
Heart healthy diets are important in the prevention and treatment of hypertension (HTN). In pregnant women, the lifestyle barriers to healthy eating are not well-described in literature.

Hypothesis:
There are personal, environmental, and economic barriers impacting adherence to a healthy diet in pregnant women with HTN, hypertensive disorders of pregnancy (HDP), or risk factors for HDP.

Methods:
Pregnant women, aged 20-50 (N=28), diagnosed with HTN, HDP, or risk factors for HDP were recruited from a large academic medical center. Participants completed an electronic survey assessing personal, environmental, and economic barriers to healthy eating. A 5-point Likert scale was used, ranging from strongly agree to strongly disagree.

Results:
The average age of participants was 31.8 (SD=4.5) from urban (34.6%), suburban (34.6%), and rural (30.8%) communities. Finances and time were major barriers to healthy eating, reported by 39.3% and 28.6% of participants, respectively, with 17.8% reporting that they could not afford to eat healthy consistently for all meals (Figure 1). Additionally, 10.7% and 7.1% were unaware of factors promoting healthy eating such as awareness of outside healthy eating resources and confidence in their ability to eat healthy given a new pregnancy. Meanwhile, 28.6% and 17.9% reported ambivalence towards these factors.

Conclusion:
Time management and financial costs emerged as the greatest challenges to healthy eating in pregnant women with or at risk for HDP. These barriers, in addition to certain factors promoting healthy eating, may represent areas of intervention that can help mitigate the obstacles to healthy eating in this vulnerable group.
Abstract P056: Quality Assessment Of Consumer-facing Sodium Reduction Websites
Authors: Hussain Tasfia , Ahmedna Taha , Marklund Matti , Appel Lawrence J , Henry Megan
Published: April 2022

Objective:
To evaluate the quality of information and guidance on dietary sodium reduction available on consumer-facing websites.

Methods:
Google Trends was used to identify the five most used search terms related to sodium reduction. For each term, the top 20 websites were collected. Of 93 unique websites, 69 met inclusion criteria. Each website was evaluated using 14 questions in three categories ("information", "guidance", “accuracy”). For each question, the website was scored using a 3-step scale (“none”, “somewhat”, “adequate”).

Results:
Overall, only three of 14 questions were addressed adequately by a majority of websites (Figure). Many provided information on adverse health effects of a high sodium diet (74%, n=51) or mentioned intake recommendations (64%, n=44). Information on dietary sources of sodium and potassium or the difference between salt and sodium was largely missing. Most websites (80%, n=55) provided information on lifestyle strategies to reduce blood pressure, but a majority did not provide guidance for purchasing or preparing food with less sodium. Misinformation was uncommon.

Conclusion:
Consumers seeking information and guidance online will find most websites offer accurate but limited information, and insufficient guidance on how to lower sodium intake. Practical tools and relevant skills should be included for effective sodium reduction.
Figure. Quality of guidance and information of identified websites (n=69) to help consumers lower sodium intake.
Google trends was used to identify five frequently used search terms regarding sodium reduction. The 14 questions applied to each website were designed to evaluate the presence and quality of information and guidance for dietary sodium reduction. For each question, the information, guidance, or accuracy of the website was scored as “none”, “somewhat”, or “adequate”. Two researchers (TH and TA) independently assessed each question for each website, and disagreements were resolved by consensus or by consulting a third investigator (MEH).
Abstract P080: Health-related Quality Of Life Predictors Of Exercise Intervention Dropout
Authors: Collins Katherine A , Ross Leanna M , Piner Lucy W , Bateman Lori A , Siegler Ilene C , Huffman Kim M , Kraus William E
Published: April 2022

Introduction:
Though many individuals know the health benefits of participating in exercise, few report sufficient activity to meet the US 2018 Physical Activity Guidelines. Current research assessing predictors of exercise adherence and dropout has primarily focused on cognitive factors, physiological factors, and demographic characteristics. The purpose of this analysis was to determine if baseline self-rated HrQoL measures are predictive of dropout from an exercise intervention across two STRRIDE trials.

Methods:
A total of 444 adults with dyslipidemia (STRRIDE AT/RT) or prediabetes (STRRIDE-PD) were randomized to one of seven exercise interventions, ranging from doses of 10-16 kcal/kg/week (KKW); intensities of 50-75% V̇O
2peak
; and durations of 6-9 months. Six groups included aerobic exercise, two groups included resistance training, and one group included dietary intervention (weight loss goal of 7%). Dropout was defined as a participant who did not complete the exercise intervention due to one or more of several reported reasons (e.g., time, motivation, re-occurring injury). Backwards stepwise logistic regression determined significant baseline HrQoL predictors of exercise intervention dropout, while controlling for age, sex, race, and intervention group assignment.

Results:
A total of 117 individuals were classified as being exercise intervention dropouts (STRRIDE AT/RT: n=55; STRRIDE-PD: n=62). In STRRIDE AT/RT, the logistic regression identified baseline sleep quality, sleep latency, sleep efficiency, sleep disturbance, bodily pain, and social functioning scores as predictors of dropout (R
2
=0.39). In STRRIDE-PD, the logistic regression identified baseline role-emotional, satisfaction with appearance, and physical component scores as predictors of dropout (R
2
=0.08).

Conclusion:
Among individuals with dyslipidemia, baseline HrQoL measures were able to explain about 39% of the variance in dropout from an exercise intervention, with primarily sleep measures, bodily pain, and social functioning being identified as important predictors of dropout. In contrast, among individuals farther along the disease spectrum, with prediabetes, baseline HrQoL measures only explained about 8% of the variance in dropout, with emotional well-being, perceived appearance, and physical function being important predictors of dropout. Future research should investigate molecular and biological predictors of dropout in combination with HrQoL, physiological, cognitive, and demographic factors to improve predictive power.
Abstract P088: Valvular Heart Disease Stages And Biomarkers Of Myocardial Stress And Injury Among Older Adults In The Community: The Atherosclerosis Risk In Communities Study
Authors: Shelbaya Khaled , Dorbala Pranav , Claggett Brian , Skali Hicham , Solomon Scott , Matsushita Kunihiro , Konety Suma H , Mosley Thomas , Shah Amil M
Published: April 2022

Introduction:
The AHA/ACC framework of valvular heart disease (VHD) stages emphasizes the progressive nature of VHD. Limited data exist regarding the association of VHD stages with prognostic cardiac biomarkers of myocardial stress (NT-proBNP) and injury (high sensitivity troponin-T [hs-TnT]).

Methods:
Among 6,078 participants in the community-based Atherosclerosis Risk in Communities (ARIC) who underwent echocardiography at the 5
th
study visit (2011-2013) and were free of prior valve replacement, we classified VHD stages based on quantitative and qualitative assessments of mitral and aortic valve stenosis and regurgitation. Multivariable linear regression models were used to relate VHD stages to concentrations of NT-proBNP and hs-TnT at Visit 5. Biomarker values were log-transformed. Models were adjusted for age, sex, race, hypertension, diabetes, heart failure, prior myocardial infarction, body mass index, atrial fibrillation, study center, and systolic blood pressure at Visit 5.

Results:
The mean age was 76±5, 58% were women, 22% were Black. Stage A VHD was present in 2,362 participants (39%), Stage B in 1011 (17%), and Stage C or D in 65 (1%). In multivariable models, higher VHD stage was associated with a graded increase in NT-proBNP and hs-TnT concentrations
(Figure)
. Compared to participants free of VHD, even Stage A (‘at risk’) participants demonstrated higher concentrations of both NT-proBNP (p <0.001) and hs-TnT (p=0.012) in adjusted analyses. Associations of VHD stage with higher NT-proBNP and hs-TnT were consistent within each lesion type, and were most prominent for aortic stenosis stages.

Conclusion:
Worse VHD stages, even in the absence of severe stenosis or regurgitation, are associated with higher concentrations of markers of myocardial stress (NT-proBNP) and injury (hs-TnT) independent of traditional cardiovascular risk factors.

Figure:
Concentrations (median, IQR) of NT-proBNP and hs-TnT by VHD stage.

*p<0.05 compared to Stage 0; ^ p<0.05 compared to Stage A; ~ p<0.05 compared to Stage B.
Abstract P090: Utility Of High-sensitivity Cardiac Troponin T For Short-term Cardiovascular Risk Monitoring In The General Population
Authors: Tang Olive , Wang Dan , Matsushita Kunihiro , Coresh Josef , Hoogeveen Ron C , McEvoy John William , Ndumele Chiadi E , Ballantyne Christie M , Selvin Elizabeth
Published: April 2022

Background:
Cardiac troponins are the cornerstone for the detection of heart attacks. Beyond the acute setting, there is growing evidence that high-sensitivity cardiac troponin T (hs-cTnT) is associated with long-term cardiovascular disease (CVD) risk. The implications of minute elevations in hs-cTnT on short-term CVD risk in the general population has not been investigated.

Methods:
We included 12,632 adults (43% men, 25% black, mean age: 57 years) in the Atherosclerosis Risk in Communities (ARIC) study who had at least one measurement of hs-cTnT (Roche) across visits 2 (1990-1992), 3 (1996-1998), and 4 (2011-2013) without diagnosed CVD, defined as coronary heart disease, heart failure, or stroke. We used bootstrapping to generate confidence intervals for the cumulative incidence of CVD and generalized estimating equation log-binomial models to quantify the short-term relative rates of incident CVD.

Results:
Overall, 3.8% (n=479) had elevated hs-cTnT ≥ 14ng/L at their earliest visit; of whom 65% (n=311) had intermediate or lower predicted 10-year risk by the Pooled Cohort Equation. The cumulative 1-year incidence of CVD among those with hs-cTnT ≥ 14ng/L was 5.7% (95% CI: 4.0%, 7.4%) compared to 1.0% (0.9%, 1.1%) among those with hs-cTnT < 6 ng/L and 1.7% (1.3%, 2.2%) among those with hs-cTnT between 6 to 14 ng/L. Among those with hs-cTnT ≥ 14ng/L, the cumulative incidence of CVD at 2 years was 9.6% (7.3%, 11.8%) and at 3-years was 12.7% (10.0%, 15/3%) (Figure 1A). After accounting for traditional CVD risk factors, hs-cTnT ≥ 14ng/L was associated with 2.9 (2.0, 4.1) times higher incidence of CVD at 1-year compared to 1.9 (1.5, 2.4) times incidence at 3-years (Figure 1B).

Conclusions:
Middle-aged adults in the general population without CVD who had an elevated hs-cTnT experienced a 5.7% 1-year risk of CVD compared to 1% among those with low hs-cTnT. The relative risk associated with elevations in hs-cTnT was most pronounced within the first year, supporting its use for short-term risk monitoring as part of annual preventive visits.
Abstract P099: Fixed-dose Combination Therapy-based Protocol Compared With Nigeria’S National Hypertension Treatment Protocol: Results Of A Cluster Randomized Trial
Authors: Sanuade Olutobi , Ale Boni , ORJI IKECHUKWU ANTHONY , Ojo Tunde , Shedul Grace , Ugwuneji Eugenia , Egenti Nonye , Omitiran Kasarachi , Okoli Rosemary , Eze Helen , Nwankwo Ada , Hirschhorn Lisa , Chopra Aashima , Ye Jiancheng , Tripathi Priya , Banigbe Bolanle , Kandula Namratha , Huffman Mark D , Ojji Dike
Published: April 2022

Abstract Importance:
Out of the >1.2 billion adults with elevated blood pressure globally, treatment (42.5%) and control (20.5%) rates are very low, including in Nigeria, the most populous country in Africa. A treatment protocol that includes fixed-dose combination (FDC) therapy may improve hypertension control rates more efficiently and with no increase in adverse events compared with a standard treatment protocol.

Objective:
To determine the efficacy and safety of a treatment protocol that uses FDC therapy for hypertension control compared with Nigeria’s 2019 National Hypertension Treatment protocol from baseline to 6 months.

Design, setting, and participants:
Cluster randomized (1:1) trial among 60 primary health centers in Abuja, Nigeria, stratified by median case load and control rate. Eligible patients were adults (
>
18 years) who had a history of hypertension, persistently elevated blood pressure (SBP ≥140 mmHg or DBP ≥90 mmHg),or use of blood pressure lowering medications.

Interventions:
Sites were randomized to a protocol that started with and utilized 2- and 3-drug FDC therapy (Step 1: amlodipine 5 mg + losartan 50 mg) to a protocol that started with monotherapy (Step 1: amlodipine 5 mg) and added individuals medications.

Results:
Sixty sites, including 5,576 patients (mean [SD] age=49.2 [12.4] years; 70% female; mean [SD] baseline systolic/diastolic BP=155[SD]/96 [SD] mm Hg), were randomized. At 6-month follow-up, the rates of hypertension control for the FDC therapy and Nigeria’s 2019 National Hypertension Treatment protocol were 54.7% and 48.3%, respectively (
Figure 1
). The final results will be added at a later date.

Conclusion and relevance:
A hypertension treatment protocol that used FDC therapy led to a higher hypertension control rate compared with a standard treatment protocol in Nigeria. These results may have relevance to protocols used in other large-scale hypertension control programs.
Abstract P101: The Double Burden Of Malnutrition Among Women And Preschool Children In Low- And Middle-income Countries: A Scoping Review And Thematic Analysis Of The Literature
Authors: Were Jason M , Stranges Saverio , Sharma Ishor , Vargas-Gonzalez Juan Camilo , Campbell M. K
Published: April 2022

Background:
The double burden of malnutrition (DBM), the simultaneous existence of both underweight and overweight sequelae, is an emerging public health concern in low- and middle-income countries (LMICs). Women of child-bearing age (15-49 years) and preschool children (under 5 years) are among the most vulnerable groups to be affected by the DBM. However, the DBM phenomenon among these population subgroups is understudied.

Objectives:
We explored the following objectives: 1) To determine which nutrition indicators have been used to define the DBM among women of child-bearing age and preschool children; 2) To establish the plausible explanations for the identified DBM phenotypes women of child-bearing age and preschool children; and 3) To identify the risk factors for the DBM women of child-bearing age and preschool children.

Methods:
We systematically searched for literature from the following databases: EMBASE, CINAHL, MEDLINE, LILACS, Scopus and ProQuest Dissertations & Thesis Global. Studies discussing the DBM phenomenon in LMICs were included. Thematic analysis was conducted on extracted information from the literature to reveal emerging themes from included studies. The findings were reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Results:
Preliminary findings indicate that frequently used indicators for defining DBM across all levels of operationalization were anthropometric indices and micronutrients measurements (e.g., overweight/obesity and anemia) for women and anthropometric indices (e.g., overweight/obesity and stunting) for preschool children. The following themes emerged as plausible explanations for the DBM phenotypes: Food insecurity; diet behavior; breastfeeding; illness and metabolic programming. Age, child sex, household wealth, women’s education, occupation and urbanization were frequently occurring DBM risk factors. Of note was the use of the term ‘double burden’ as a buzz word in substantial number of studies without a proper definition or discussion of the DBM concept.

Conclusion:
The DBM phenomenon is loosely understood due to the varying operational definitions of the DBM construct. Emerging themes and common risk factors may provide target areas for public health interventions. Studies with robust designs are needed to succinctly understand the DBM phenomenon.
Abstract P115: Association Of Circulating And Fecal Butyrate And Other Short Chain Fatty Acids With Blood Pressure And Hypertension: Results From The SPIRIT Trial
Authors: Tilves Curtis , Yeh Hsin-Chieh , Maruthur Nisa , Juraschek Stephen , Miller Edgar R , White Karen , Appel Lawrence J , Mueller Noel T
Published: April 2022

Background:
Short chain fatty acids (SCFAs) are the microbially-derived end products of dietary fiber fermentation. The SCFA butyrate is a signaling molecule shown to influence blood pressure (BP) in mouse models. The association of butyrate and other SCFAs on BP in humans is unclear, due in part to predominantly cross-sectional analyses and to differences in which biospecimens (blood vs. fecal) SCFAs were measured. Longitudinal studies including both circulating and fecal SCFAs are lacking.

Objective:
Investigate the cross-sectional and longitudinal associations of fecal and serum SCFAs with hypertension and changes in BP.

Methods:
We leveraged existing data from the SPIRIT trial, which randomized 121 adult cancer survivors with overweight/obesity to a behavioral weight loss intervention, metformin, or self-directed weight loss. Of participants with serum and fecal SCFAs measured at baseline (N=111), a subset also had serum (N=93) and fecal (N=89) SCFA measurements 12 months later. We used Poisson regression with robust error variance to estimate associations of serum or fecal SCFAs with hypertension at baseline (adjusting for age, sex, BMI, and fiber intake). In longitudinal analyses, we assessed the percent change in serum or fecal SCFAs from baseline with corresponding 12-month changes in BP (covariates listed in
Table
).

Results:
Participants were aged 60.2±8.9 years, 78.4% female, and 46.9% identified as White. Higher baseline fecal butyrate was inversely associated with prevalent hypertension (standardized PR [95%CI]: 0.71 [0.54, 0.92]). In longitudinal analyses (
Table
), a 10% increase in fecal butyrate from baseline levels was significantly and inversely associated with systolic BP, and a 10% increase in serum butyrate was significantly and inversely associated with systolic and diastolic BPs. Associations of butyrate with BP were not modified by sex or race.

Conclusion:
Increased serum or fecal butyrate is associated with lowered BP. Butyrate may be a target for SCFA-centered BP-lowering interventions.
Abstract P134: Venous Thromboembolism Mortality And Trends In U.S. Adults 65+: 2011-2018
Authors: Giorgio Katherine , Maclehose Richard , Walker Rob , Norby Faye L , Adrianzen-Herrera Diego , Alonso Alvaro , Zakai Neil , Lutsey Pamela L
Published: April 2022

Introduction:
Venous thromboembolism (VTE) afflicts approximately 1 million Americans annually. Over the past decade there has been a movement towards outpatient management of uncomplicated acute events and use of oral anticoagulant agents for treatment. The purpose of this study was to update the estimated rates and trends of VTE-related mortality in older adults in the U.S.

Methods:
Medicare 20% sample claims data from 2011 to 2018 were used to create a cohort of beneficiaries with a VTE event using validated ICD codes. All-cause mortality, identified by National Death Index linkage, was assessed at 30 days and 1 year after VTE for each year over the full study period. Subgroup analyses were conducted by age, sex, race, and cancer-related VTE. Estimates were standardized for age, sex, and/or race, where appropriate.

Results:
The study included 113,826 VTE patients, mean age 77 years (SD=8), and were 61% (n=69,338) female. The cohort was 84% (n=95,976) non-Hispanic White, 11% (n=12,051) non-Hispanic Black, and 5% (n=5,799) other/unknown, and 34% (n=38,252) VTE events were cancer-related.

Overall, 30-day and 1-year mortality was 2.5% (2,857 of 113,141) and 19.6% (19,621 of 100,035) (Table). Mortality rates increased with age and were slightly higher in men and in non-White patients. Cancer-related VTE was associated with greater 30-day (4.7% vs. 1.5%) and 1-year mortality (32.9% vs. 12.9%) than non-cancer VTE. Mortality rates remained steady over the study period in most subgroups. Mortality following cancer-related VTE appeared to decrease steadily over time for both 30-day (from 5.4% in 2011 to 4.4% in 2018) and 1-year mortality (from 36.3% in 2011 to 31.6% in 2017).

Conclusions:
Among contemporary VTE patients aged 65 and older, the risk of mortality is 2.5% at 30 days and 19.6% at 1 year. Despite notable changes to VTE management, all-cause mortality in Medicare beneficiaries with VTE was largely unchanged from 2011 to 2018, except for decreasing mortality following cancer-related VTE.
Abstract P135: Adherence To Direct Oral Anticoagulants Across Chronic Kidney Disease Status
Authors: Xu Yunwen , Chang Alex R , Inker Lesley , Grams Morgan , Shin Jung-im
Published: April 2022

Background:
Adherence to anticoagulants is critical for effective stroke prevention for patients with atrial fibrillation (AF). Whether adherence to direct oral anticoagulants (DOACs) differs by chronic kidney disease (CKD) status remains uncertain.

Methods:
Using data from the Geisinger, we identified patients with AF initiating a DOAC between 2010-2019 and had at least one-year engagement prior and 3-month after initiation. To assess medication adherence, we compared proportion of days covered (PDC) by DOAC at 3, 6, 9, 12, and 18-month between patients with and without CKD, defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m
2
. Poor adherence was defined as PDC <0.8, indicating that a patient used the drug <80% of the time.

Results:
Among the 4082 patients who initiated dabigatran (n=574), rivaroxaban (n=1502), or apixaban (n=2006), the mean (SD) age was 72 (12) years, 1083 (44%) were female, and the average eGFR was 73 (21) mL/min/1.73 m
2
. Overall, patients with CKD had lower adherence to DOAC compared to those without CKD (mean PDC: 0.89 vs. 0.91 at 3-month [P=0.03]; 0.87 vs. 0.89 at 6-month [P=0.04]; 0.84 vs. 0.87 at 9-month [P=0.02]; 0.83 vs. 0.86 at 12-month [P=0.05]; and 0.80 vs. 0.83 at 18-month [P=0.04]). For individual DOAC, only adherence to rivaroxaban was significantly lower in patients with CKD compared to those without CKD (
Figure
). Poor adherence to rivaroxaban was more common in CKD, particularly in the long-term (31% vs. 24% at 18-month [P=0.04]). Adherence to apixaban was highest and did not differ by CKD (CKD vs. non-CKD, mean PDC: 0.88 vs. 0.88 at 6-month; 0.85 vs. 0.85 at 12-month; and 0.81 vs. 0.83 at 18-month). Adherence to dabigatran was lowest and did not differ by CKD (CKD vs. non-CKD, mean PDC: 0.83 vs. 0.83 at 6-month; 0.76 vs. 0.78 at 12-month; and 0.73 vs. 0.74 at 18-month).

Conclusion:
Medication adherence was highest in apixaban users, followed by rivaroxaban and dabigatran users. Patients with CKD had lower adherence to rivaroxaban compared to those without CKD.
Abstract P136: The Association Between Socioeconomic Status And Use Of Potentially Inappropriate Medications In Older Adults
Authors: Hwang Jimin , Lyu Beini , Ballew Shoshana , Coresh Josef , Grams Morgan , Shin Jung-im
Published: April 2022

Introduction:
The use of potentially inappropriate medications (PIM), defined as medications for which the risk of adverse events outweighs the expected benefits, increases the risk of hospitalization, adverse drug events, and mortality in older adults. As socioeconomic status (SES) influences health care quality, the purpose of this study is to investigate whether PIM use differs by SES in older adults.

Hypothesis:
We hypothesized that low SES was independently associated with increased use of PIM.

Methods:
We studied participants (aged 66-90 years) who were on at least one medication at visit 5 (2011-2013) of the Atherosclerosis Risk in Communities (ARIC) Study. We created a cumulative SES score, based on neighborhood SES (area deprivation index [ADI]) as well as individual SES (education and income). Because PIM for older adults defined by the 2019 Beers Criteria was extremely common (31% of the population), we focused on the use of two or more PIM. We used multivariable logistic regression to examine the associations between SES and PIM use ≥2.

Results:
Among 4927 participants (mean age of 75.6 (SD 5.1) years, 19.6% Black, and 57.8% female), 6.9% were on two or more PIMs. Overall, compared with individuals with high cumulative SES, those with lower SES had higher odds of PIM use in a dose-dependent manner (odds ratio [OR]: 1.40 [95% confidence interval (CI), 1.06-1.83] for middle cumulative SES; 1.83 [1.18-2.86] for low cumulative SES,
Table
), adjusting for demographics and insurance type. For each SES component, low neighborhood SES (i.e., high ADI) and low education was significantly associated with higher odds of PIM use, but not income.

Conclusions:
We found that lower SES was associated with greater use of PIM among older adults, suggesting that there exist disparities in quality of care by SES. Focused efforts targeting older adults with low SES to reduce PIM use may be needed to prevent adverse outcomes.
Abstract P142: Number Of Children Three Or More And Having First Child Before Age 22 Are Linked To Increased Risk Of All-cause Dementia
Authors: Zhu Dongshan , Fu Chunying , Hao Wenting
Published: April 2022

Introduction:
Evidence on the association between number of children and risk of all-cause dementia has been discordant, and whether timing of birth and span of birth are related to the risk of dementia is unclear.

Hypothesis:
Estrogen level maintains high during pregnancy and declines dramatically after giving birth. More times of giving birth means more times of drastic fluctuations of endogenous estrogen. We hypothesized that the times of dramatic estrogen fluctuations in a woman’s life course (indicated by number of children) might be associated with risk of dementia.

Methods:
We used cohort data from UK Biobank, a large population-based prospective cohort study that recruited 502 649 individuals ages 40– 69, between 2006 and 2010. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for the associations between number of children (categorized as zero, one, two, three or more) and incident all-cause dementia. We also examined the role of timing of birth and span of birth in the association with dementia. Timing of birth included age of first birth (categorized as <22, 22-25, 26-29, and ≥30 years) and age of last birth (categorized as <26, 26-29, 30-33, ≥34 yeas). Span of birth (the span between age of first birth and age of last birth) was categorized as ≤2, 3-4, 5-6, and >6 years). All HRs were adjusted for race/ethnicity, education level, income, body mass index, smoking status, physical activities, number of leisure activities, hypertension status, diabetes status and baseline age.

Results:
Overall, 253 169 women were included, and we identified 2426 women with dementia. The median follow-up was 11.9 years. Compared to women with no child, the HRs (95% CI) with incident dementia in women with one, two, three or more children were 0.97 (0.83, 1.13), 0.95 (0.84, 1.07) and 1.17 (1.03, 1.33) respectively. Compared to women who had their first child after age 30 years, those first birth before age 22 years had elevated risk of dementia (HR: 1.25, 95%CI: 1.09-1.44), even after parity was further adjusted (1.19, 1.03-1.37). No association was observed between age of last child, span of birth and incident dementia. Nevertheless, subgroup analysis found that the elevated risk between number of three or more children and dementia was only observed in women with age of last birth less than 30 years (1.31, 1.12-1.53), or span of birth less than seven years (1.24, 1.07-1.44).

Conclusions:
Women with three or more children was linked to 17% higher risk of dementia compared to those with no child, and women who had their first child before age 22 years had around 20% higher risk of dementia compared to those with first child after age 30. Age of last child and span of birth may moderate the relationship between number of children and risk of dementia.
Abstract P160: Perceived Stress May Influence Allostatic Load When The Etiology Of Abnormal Glucose Tolerance Is β-cell Failure: The Africans In America Study
Authors: Wentzel Annemarie , Duhuze Karera M. Grace , Waldman Zoe , Schenk Blayne R , Patterson Arielle , DuBose Christopher W , Horlyck-romanovsky Margrethe , Sumner Anne E
Published: April 2022

Background:
Abnormal glucose tolerance (Abnl-GT) is a summary term for prediabetes and diabetes. The main etiologic determinant of Abnl-GT may be either β-cell failure or insulin resistance (IR). In African-born Blacks Abnl-GT may be predominantly due to β-cell failure rather than IR. Whether perceived and physiological stress profiles differ when Abnl-GT is due to β-cell failure rather than IR is uncertain.

Aims:
In 197 African-born Blacks living in the US (age: 38±11 (mean±SD); 58% men; BMI 28±5 kg/m
2
) the perceived and physiological stress profiles were assessed based on Abnl-GT etiology.

Methods:
OGTT were performed. Abnl-GT was defined as FPG ≥100 mg/dL and/or glucose at 2h≥140 mg/dL. IR was defined by the lowest quartile of the Matsuda index (≤2.97). Abnl-GT-IR required Abnl-GT and IR. Beta-cell failure was defined as Abnl-GT without IR. The 10 question Cohen Perceived Stress Scale (PSS) was applied. Allostatic Load (ALS) included 10 variables: SBP, DBP, Pulse, cholesterol, HDL, homocysteine, BMI, A1C, Albumin, hs-CRP. Statistical analyses included t-tests, Chi-squares, and multiple regressions.

Results:
Abnl-GT occurred in 39% (77/197), with Abnl-GT-β-cell failure in 56% (43/77) and Abnl-GT-IR in 44% (34/77). The Abnl-GT-IR had higher BMI (31±5 vs 28±4) and WC (101±10 vs 90±11) vs Abnl-GT-β-cell failure, both
P
<0.01. PSS did not differ between groups. ALS was higher in Abnl-GT-IR vs the Abnl-GT-β-cell failure (
P
<0.01). Yet, regression analyses, adjusted for age and sex, showed significant associations between PSS and ALS in the Abnl-GT-β-cell-failure-group (
P
=0.01) (
Figure 1A
). However, PSS and ALS were insignificantly associated in the Abnl-GT-IR-group (
P
=0.42) (
Figure 1B
).

Conclusions:
In Abnl-GT-β-cell failure, perceived stress may influence allostatic load. Reasons for the link between perceived stress and allostatic load in Abnl-GT due to β-cell failure need exploration.