bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P314: Physical Activity-Mediated Associations of Perceived Neighborhood Violence and Problems on Depressive Symptoms Among Jackson Heart Study Participants
Authors: Tamura Kosuke , Langerman Steven D , Orstad Stephanie L , Neally Sam J , Andrews Marcus R , Ceasar Joniqua N , Sims Mario , Lee Jae E , Powell-Wiley Tiffany M
Published: March 2020

Introduction:
Little is known about whether links between perceived neighborhood social environment (PNSE) and depressive symptoms are mediated by physical activity (PA) levels.

Hypothesis:
We tested the hypotheses that total PA mediates relations between PNSE and depressive symptoms.

Methods:
We used Jackson Heart Study (JHS) baseline data. JHS is a prospective, community-based study of African Americans in the Jackson, MS (valid samples=2082;
M
age 52.4 years; 64% female). PNSE variables included neighborhood violence, problems (higher value=more violence or problems), and social cohesion (higher value=more cohesion). Depressive symptoms were measured by the Center for Epidemiological Studies Depression (CES-D) scale. Validated total PA, based on active living, sport, and work indices, was tested as the mediator. Linear regressions with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) were estimated using SAS 9.4 to test for significant unstandardized indirect effects, controlling for all covariates.

Results:
Participants had a mean depressive symptoms score of 10.8 (
SD
=8.1). Neighborhood violence and problems were indirectly related to depressive symptoms via total PA (
β
for indirect effects=.21, 95%
BC CI
=.02, .48 and .13, 95%
BC CI
=.01, .32, respectively). That is, higher violence and problems were related to lower total PA. In turn, higher total PA was associated with lower depressive symptoms (
Figure 1
). Neighborhood violence and problems also were directly related to depressive symptoms (
p
<.05). Yet, social cohesion was not indirectly or directly related to depressive symptoms.

Conclusions:
Higher perceived neighborhood violence and problems were positively related to depressive symptoms. These associations may be explained in part via lower total PA levels. Future interventions to reduce depressive symptoms attributed to neighborhood issues should consider PA promotion in conjunction with community efforts to reduce neighborhood violence and problems.
Abstract P315: The Impact Of Neighborhood Factors On Hospital Readmission Among Depressed Patients With Systolic Heart Failure.
Authors: Guhl Emily , Holber Julia P , Jeong Kwonho , Abebe Kaleab Z , Anderson Amy , Magnani Jared W , Rollman Bruce L
Published: March 2020

Introduction:
Neighborhood factors such as walkability and proximity to stores, parks, and public transportation have been associated with obesity, diabetes, and physical activity level as well as hospital readmission rates. Among individuals with systolic heart failure (HF), reducing hospital readmissions is challenging, but little is known on the role of neighborhood factors on hospital readmissions in this population.

Hypothesis:
We hypothesized that better walk scores and less deprivation would be associated with a lower readmissions in HF patients.

Methods:
We screened hospitalized patients with systolic HF (EF≤45%) and NYHA class II-IV symptoms for depression at 8 Pittsburgh-area hospitals as part of the Hopeful Heart Study (R01 HL114016) and included patients who screened positive for depression and remained depressed when re-contacted by telephone 2 weeks after discharge. We classified neighborhoods using the validated neighborhood Walk Score®and Area Deprivation Index for each patient’s address at study entry (both 0-100 scales), and assessed readmissions for 12 months following each patient’s enrollment. We then compared the ADI and Walk Score of individuals who were readmitted vs. those who were not.

Results:
Final analysis included 629 depressed patients with systolic HF (43% female, 75% white, 86% HTN, 52% DM). Overall, 73.1% of individuals were readmitted at least once, and readmitted and not readmitted patients had similar walk scores (34.1±25.2 vs. 32.2±27.0, p = 0.40) and ADI (66.6±23.1 vs. 64.2±22.7, p=0.50) as those who were not readmitted. Table 1.

Conclusions:
Among depressed patients with systolic HF, Walk Score and ADI were associated with not associated with readmission rates. Further research is warranted to determine how neighborhood factors adversely impact individual with co-morbid depression and systolic HF. Further analyses are ongoing to determine if individual components of the Walk Score and ADI contribute to differences in readmission.
Abstract P325: Cardiometabolic Factors Associated With Alcohol Use; The New Orleans Alcohol Use In Hiv Study
Authors: Ferguson Tekeda F , Simon Liz , Theall Katherine , Welsh David , Molina Patricia E
Published: March 2020

As people living with HIV (PLWH) live longer, morbidity and mortality related to chronic illness specifically, cardiovascular disease (CVD) has increased. HIV disease has been associated with hypertension (HTN) and dyslipidemia, which are risk factors for developing CVD. The objective of this study was to determine whether heavy alcohol use among PLWH is associated with increased risk of HTN, dyslipidemia, and metabolic syndrome (MS). To investigate this hypothesis we analyzed data from the New Orleans Alcohol Use in HIV (NOAH) Study. Alcohol use was assessed with the Alcohol Use Disorders Identification Test (AUDIT), the Timeline Follow Back (TLFB) Calendar, a Lifetime Drinking History, and the biomarker, Phosphatidylethanol (PEth). HTN stage 1, was defined as a mean systolic 130-139 or diastolic blood pressure 80-89 mmHg; HTN stage 2 as a systolic ≥140 or diastolic ≥ 90 mmHg. MS was defined as having 3 of 5 conditions: HTN, low high-density lipoproteins (≤40 (men)/50 (women)), high triglycerides (≥ 150mg/dl), high glucose (≥100 mg/dl), waist circumference >88(women)/102(men). The NOAH study cohort (n=365) is majority African American (83.6%), mean age 48.2 ±10.4, 68.8% male and 31.2% female. Descriptive statistics and multivariable linear and logistic regression analyses were performed stratifying by sex and adjusting for age, race, smoking, and viral load. Approximately, 41.3% had an AUDIT ≥8 and 14.0% were hazardous drinkers (greater than 40 (women)/60 (men) grams of alcohol per day). MS was prevalent in 36.1%, stage 2 HTN 66.0%, 9.3% with hyperglycemia (>125mg/dl), 23.0% had elevated creatinine, and 27.4% were obese. Creatinine was positively associated with LDH and PEth (p-value <0.04). TLFB grams of alcohol had a positive linear association with glucose among men (beta=0.0033; p=0.0035). LDH was associated with two-fold increase odds of MS (OR=2.69; 95% C.I.: 1.18 - 9.58) with sex as an effect modifier. AUDIT score ≥8 was not a significant predictor of hypertension, dyslipidemia, or MS in adjusted models. Our preliminary results indicate that lifetime drinking history was more associated with increased cardiometabolic risk than recent drinking. As PLWH are living longer, hazardous and chronic alcohol use is a lifestyle choice that has clinical relevance and has to be addressed in the chronic care model of treatment in PLWH.

(Supported by: NIH P60AA009803)
Abstract P331: Impact of Primary Care Access and Continuity of Care in Reduction of Hospital/Emergency Department Admissions in Patients With Hypertension: A Systematic Review
Authors: Rajmohan Divya , Golubykh Konstantin , Avdeeva Anastasiia , Mahmood Ashraf , Aleem Muhammad Sarmad , Hashmi Shahnawaz , Sah Swarnakar Ankur , Shah Prajwol , Soltes Robert , Subedi Imona , Achinefu Reagan , Hameed Rizwanulla
Published: March 2020

Background:
Hypertension, defined as a systolic blood pressure ≥140 mmHg and/or diastolic pressure ≥90 mmHg, is one of the most common chronic diseases (prevalence is 29.0% among adults) and is part of the Ambulatory Care Sensitive Conditions (ACSC). In most cases, hypertension is considered a secondary diagnosis because complications that could result from the disease are the reasons why patients with hypertension are admitted to the hospital and Emergency Department (ED). Thereby, preventive approaches are integral in the management of these complications and access to primary care along with continuity are considered to be crucial components of preventive medicine.

Hypothesis:
We assess the hypothesis that increased access to primary care and continuity of care can reduce ED visits along with hospitalization rates in patients with hypertension.

Methods:
We reviewed articles from years 2005 to 2019 from peer reviewed journals. All publications were written in English and were mostly from the United States. However, we also included studies from other countries for comparison. We identified 2115 articles in total: 784 from Science Direct, 687 from Pubmed and 644 from Google Scholar, using these keywords: Hypertension, Hospitalization, Emergency Department, Primary care, Ambulatory Care Sensitive Conditions. Based on the titles, we investigated abstracts of 198 potentially relevant articles. Abstracts were rated independently by each member of the pair of reviewers and scored for relevance (relevant/ non-relevant). The second step was to have the full text of the remaining studies (n = 146) reviewed by the same team to check whether papers met inclusion criteria. Through this process, 96 studies were excluded. A total of 50 studies remained and were included in our systematic review.

Results:
From 50 research articles that were included; 38 studies showed statistically significant (p < 0.05) finding that increased access to primary care and its continuity decreases hospitalizations and/or ED admissions in patients with hypertension, 8 studies did not find statistically significant association between these factors. 4 studies showed statistically significant conclusion that general or family physicians as PCPs decrease hospitalization and ED admission rate in comparison with specialist physicians as PCP.

Conclusion:
We concluded that increased primary care access and its continuity are associated with a statistically significant decrease in the incidence of hospitalizations and/or ED visits for patients with hypertension.
Abstract P340: 30-Day Readmission Risk Assessment Among Patients Who Underwent Transcatheter Aortic Valve Replacement (TAVR), ACS NSQIP, 2015-2017
Authors: Saxena Anshul , Rubens Muni , Salami Joseph A , McGranaghan Peter , Bhatt Chintan B , Das Sankalp , Ramamoorthy Venkataraghavan , Veledar Emir
Published: March 2020

Background:
In August 2019, FDA approved TAVR for low-risk patients, a paradigm shift in the field of Cardiology. This approval will pave the way for TAVR to rapidly become mainstream, and it will be a preferred procedure for patients with symptomatic aortic stenosis in the coming years. In this study, we considered creating a useful tool to assess the risk of 30-day readmission after TAVR.

Methods:
We utilized data from ACS National Surgical Quality Improvement Program (ACS NSQIP) between 2015 and 2017. We selected 35 past medical history (such as history of CHF, COPD, etc.) and preoperative lab (such as BUN, WBC count, etc.) variables. A binary variable for 30-day readmission was created. Elastic net, random forest, and gradient boosted classification trees machine learning models were run and best performing model was selected based on the AUROC. Variables were plotted according to the importance. We created a nomogram using logistic regression by including important variables.

Methods:
About 594 patients underwent TAVR between 2015 and 2017; 56% patients were 80 years or older; and 45% were females. Majority of patients (62.8%) were Non-Hispanic White, had BMI ≥ 25 (71%), and took antihypertensive medication (82%). History of CHF was reported by 26%, and COPD by 17%. There were 68 (11.4%) patients who were readmitted within 30-days for any cause. Gradient boosted classification performed best. Top 15 variables were selected for logistic regression analysis to construct a nomogram. Five of the top variables were Total hospital LOS, pre-op platelet count, pre-op serum sodium, general anesthesia, pre-op BUN.

Conclusion:
In the US, 1 in 6 patients with TAVR could be readmitted within 30-days due to any cause after TAVR. We presented an interpretable model based on past medical history and pre-operative variables, which can be used to identify high risk patients so that their hospital readmission risk and can be reduced. This will also lower financial burden among patients.
Abstract P343: Associations of Adipose Tissue Distribution With Hypertension and Diabetes in African Ancestry Men: A Novel Approach Using Compositional Data Analysis
Authors: Tilves Curtis , Kuipers Allison , Zmuda Joseph , Carr J. J , Terry James G , Nair Sangeeta , Peddada Shyamal , Bunker Clareann H , Wheeler Victor , Miljkovic Iva
Published: March 2020

Background:
Adipose tissue (AT) distribution, which differs by race/ethnicity, can differentially impact risk for cardiometabolic disease. Traditional analyses using AT volumes tend to place all ATs in a regression model, estimating an increase in one AT volume while “holding other volumes constant”; however, the compositional nature of the data suggests the other ATs cannot remain constant. Compositional data analysis (CODA) methods eliminate this concern by comparing logratios of components. CODA was designed for analyses of data like those of
body composition
, but has yet to be used in this field. We demonstrate the use of CODA for the comparison of visceral AT (VAT) and subcutaneous AT of the abdomen (ASAT) and thigh (TSAT) with prevalence of cardiometabolic diseases.

Methods:
This cross-sectional analysis used 615 African Caribbean men from Tobago aged 50-91 years (mean age 63.6 years, mean BMI 27.7 kg/m
2
). AT volumes were obtained from CT scans of the abdomen (VAT and ASAT) and of the mid-thigh (TSAT). An additive log2 ratio transformation was applied to the ATs to generate the VAT, ASAT, and TSAT component effects relative to the other tissues captured in the respective CT scan. Ordinal logistic regression analyses were performed for increasing hypertension or glucose impairment categories (defined in Table) after adjustment for age, disease status, and lifestyle factors.

Results:
After full adjustment (Table), a 2-fold higher ASAT volume (relative to other abdominal tissues) was associated with higher odds, and a 2-fold higher TSAT volume (relative to other thigh tissues) was associated with lower odds, of being in a higher hypertension category. After BMI adjustment, no AT was associated with glucose impairment category. VAT was not a significant predictor for either outcome in African Ancestry men.

Conclusion:
CODA methods, which avoid problematic assumptions made in traditional analyses, found significant and opposing associations of TSAT and ASAT with hypertension categories in African Ancestry men.
Abstract P347: Associations Between Carotid-femoral and Heart-femoral Pulse Wave Velocity in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Stoner Lee , Meyer Michelle , Kucharska-newton Anna , Stone Keeron , Fryer Simon , Credeur Daniel P , Faulkner James , Matsushita Kunihiro , Tanaka Hirofumi , Hughes Timothy
Published: March 2020

Introduction:
Carotid-femoral pulse wave velocity (cfPWV) is widely used in clinical and epidemiological studies to assess central arterial stiffness and predict cardiovascular outcomes. However, cfPWV assessments require applanation of the carotid artery, which may be challenging in some patients, and assessments may be confounded in the presence of carotid artery plaque. Further, since cfPWV is not consistent with the path of blood flow, the measure is adjusted according to an assumed timing of the pressure wave traveling in the opposite direction. Therefore, we hypothesize that heart-femoral PWV (hfPWV) could be a simpler measure of central arterial stiffness that is consistent with the path of blood flow.

Objective:
To estimate the strength of the association between hfPWV and cfPWV.

Methods:
We evaluated 4,476 older-aged (75.2 y [SD: 5.0]) adults in the community-based Atherosclerosis Risk in Communities (ARIC) Study. cfPWV and hfPWV were measured using an automated cardiovascular screening device (Omron VP-1000plus) equipped with an electrocardiogram, a phonocardiogram, and 2 applanation tonometry sensors attached to carotid and femoral arteries. Agreement between the two measurements was determined by calculating the intraclass correlation coefficient (ICC) and the standard error of estimate (SEE). We considered ICC value estimates of <0.5, 0.5-0.75, 0.75-0.9, and >0.9 as, respectively, poor, moderate, good, and excellent agreement. The SEE represents the average distance that the observed values fall from the regression line. Smaller values indicate that the observations are closer to the fitted line. The uniformity of error was assessed by visual analysis of regression plot.

Results:
There was ‘good’ agreement between hfPWV and cfPWV (ICC = 0.83, 95%CI: 0.82, 0.84). While the mean cfPWV (11.6 m/s [SD: 3.0]) and hfPWV (11.5 m/s [SD: 2.3]) were comparable, the SEE was 1.3 (95%CI: 1.27, 1.33) m/s. Inspection of the regression plot revealed bias, with higher PWV further away from the regression line.

Conclusions:
The current findings suggest good agreement between cfPWV and hfPWV, indicating that hfPWV may be a suitable alternative to cfPWV. Since hfPWV does not require applanation of the carotid artery, the measurement is easier to conduct and may be particularly suited for use in individuals for whom applanation of the carotid artery is challenging.
Abstract P368: Western and Prudent Diet Patterns are Associated With Risk of Developing Non-cancer Related Venous Thromboembolism
Authors: Yi So Yun , Steffen Lyn M , Lutsey Pamela L , Cushman Mary , Folsom Aaron R
Published: March 2020

Background:
Results are inconsistent from published studies about the association between dietary intake and risk of incident venous thromboembolism (VTE). Therefore we proposed to study the association between diet patterns and incident non-cancer related VTE. We hypothesized that a Western diet pattern is positively associated, and a Prudent diet pattern is inversely associated with incident non-cancer related VTE.

Methods:
In the Atherosclerosis Risk in Communities (ARIC) Study, 14,873 middle-aged men and women were followed for incident VTE over an average of 22 years between 1987 and 2015. VTE cases were ascertained via annual phone calls and community hospital surveillance. Hospital records were reviewed to validate cases. Dietary intake was assessed by food frequency questionnaire at baseline and year 6. The Western and the Prudent diet pattern scores were derived by principal components analysis. In separate proportional hazards regression analyses, associations of quintiles of the Western and the Prudent diet pattern scores with risk of developing non-cancer related VTE were examined, adjusting for demographic characteristics, lifestyle factors, body mass index, and diabetes.

Results:
Hazard ratios (95% confidence intervals) of incident non-cancer related VTE (n=634) across quintiles of the Prudent diet pattern score were 1.0 (reference), 0.99 (0.78-1.26), 0.79 (0.61-1.02), 0.66 (0.51-0.87), and 0.81 (0.61-1.07), p
trend
=0.01 (see Figure). Across quintiles of the Western diet pattern score, hazard ratios (95% CI) of incident non-cancer related VTE were 1.0 (reference), 1.14 (0.88-1.47), 1.20 (0.92-1.56), 1.10 (0.82-1.47), and 1.63 (1.17-2.28), p
trend
=0.02.

Conclusions:
In this community-based cohort, a Prudent diet pattern was associated with a lower risk of developing non-cancer related VTE, whereas higher risk was associated with a Western diet pattern.
Abstract P369: Polypharmacy, Adverse Outcomes, and Treatment Effectiveness in Elderly Patients With Atrial Fibrillation
Authors: Alam Aniqa , Chen Nemin , Lutsey Pamela L , MacLehose Richard , Claxton J'Neka , Chen Lin Yee Y , Chamberlain Alanna M , Alonso Alvaro
Published: March 2020

Background:
Polypharmacy is highly prevalent in elderly individuals with chronic conditions, including atrial fibrillation (AF). The impact of polypharmacy on adverse outcomes and on treatment effectiveness in elderly AF patients remains unaddressed.

Methods:
We studied 338,810 AF patients ≥75 years of age with 1,761,660 active prescriptions [mean (SD), 5.1 (3.8) per patient] enrolled in the MarketScan Medicare Supplemental database in 2007-2015. Polypharmacy was defined as ≥5 active prescriptions at AF diagnosis based on outpatient pharmacy claims. AF treatments (oral anticoagulation, rhythm and rate control) and cardiovascular endpoints (ischemic stroke, bleeding, heart failure) were defined based on inpatient, outpatient and pharmacy claims. Multivariable Cox models were used to estimate associations of polypharmacy with cardiovascular endpoints and the interaction between polypharmacy and AF treatments in relation to cardiovascular endpoints.

Results:
Prevalence of polypharmacy was 52% (176,007 of 338,810). Patients with polypharmacy had increased risk of major bleeding [hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.12, 1.20] and heart failure (HR 1.33, 95%CI 1.29, 1.36), but not of ischemic stroke (HR 0.96, 95%CI 0.92, 1.00), compared to those not with polypharmacy (Table). Polypharmacy status did not consistently modify the effectiveness of oral anticoagulants. However, rhythm control (vs. rate control) was more effective in preventing heart failure hospitalization in patients not with polypharmacy (HR 0.87, 95%CI 0.76, 0.99) than among those with polypharmacy (HR 0.98, 95%CI 0.91, 1.07, p for interaction = 0.02).

Conclusion:
Polypharmacy is frequent among elderly patients with AF, associated with adverse outcomes, and potentially affecting the effectiveness of AF treatments. Optimizing management of polypharmacy in elderly AF patients may lead to improved outcomes.
Abstract P370: Opioid and Gabapentinoid Medication Use and the Risks of Atrial Fibrillation and Supraventricular Ectopy in the Multi-ethnic Study of Atherosclerosis
Authors: Harding Barbara N , Wiggins Kerri , Jensen Paul , Psaty Bruce M , Heckbert Susan R , Floyd James
Published: March 2020

Purpose:
Opioids and gabapentinoids may have adverse cardiovascular effects. We evaluated whether these medications were associated with incident clinically-detected atrial fibrillation (AF) or monitor-detected supraventricular ectopy (SVE), including premature atrial contractions (PACs) and supraventricular tachycardia (SVT).

Methods:
We used data from the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort study that enrolled 6,814 Americans without clinically-detected cardiovascular disease (CVD) in 2000-2002. At the 2016-2018 examination, a subset of participants received extended ambulatory electrocardiographic (ECG) monitoring with a device that records up to 14 days of continuous data. Longitudinal analyses investigated time-varying medication exposures at 5 exams (through 2012) and the risk of incident clinically-detected AF through 2015 using Cox proportional hazards regression models. Cross-sectional analyses investigated medication exposures at the 2016-2018 examination and the risk of monitor-detected SVE using linear and logistic regression models.

Methods:
The longitudinal cohort included 6,652 participants. Opioid and gabapentenoid use increased over time (Figure). During 12.4 years of mean follow-up, 961 participants (14.4%) experienced incident AF. Opioid use and gabapentinoid use were not associated with the risk of incident AF compared with no use. The cross-sectional analysis included 1,435 participants with ECG monitoring. Compared with non-use, gabapentinoid use was associated with an 84% greater count of PACs/hour (95% CI, 25%-171%) and with a 44% greater average number of runs of SVT/day (95% CI, 3%-100%) but not with a higher odds of SVT. No associations were found with use of opioids in cross-sectional analyses.

Conclusions:
In this study, gabapentinoid use was associated with more SVE. Given the rapid increase in gabapentinoid use, additional studies are needed to clarify whether these medications increase the risk of CVD complications.
Abstract P372: U.S. National Estimates of Prescription Nonsteroidal Anti-inflammatory Drugs Among Patients With Cardiovascular Disease
Authors: Hwang Andrew Y , Smith Steven M
Published: March 2020

Introduction:
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain, fever, and inflammation, but their ubiquitous use has led to concerns over increased risk of adverse cardiovascular (CV) events, particularly in patients with established CV disease (CVD). In 2005, the FDA revised labels for all NSAIDs to include a boxed warning highlighting the potential for increased CV risk. However, little is known regarding real-world prescribing of NSAIDs among patients with CVD. Our objective was to characterize the use of prescription NSAIDs among patients with CVD from 1988-2016 in the U.S.

Methods:
Using cross-sectional National Health and Nutrition Examination Survey (NHANES) data from 1988-1994 and 1999-2016, we included participants aged ≥18 years with hypertension (defined by self-report, mean blood pressure ≥140/90, or use of an antihypertensive medication), or aged ≥20 years with ≥1 of the following self-reported heart disease conditions: congestive heart failure (CHF), coronary heart disease (CHD), angina, myocardial infarction (MI), or stroke. Survey-weighted data were analyzed to assess prevalence and trends of prescription NSAID use within each CVD population in 6-year examination periods.

Results:
Overall, prescription NSAID use declined among all U.S. CVD populations over the study period. Prevalence of prescription NSAID use was highest during the 1999-2004 examination years, but thereafter, declined during the 2005-2010 examination years for those with hypertension (13.9% to 8.8%), CHF (14.6% to 8.5%), CHD (16.3% to 7.0%), angina (17.6% to 9.73%), MI (16.1% to 8.2%), and stroke (15.7% to 8.8%). Use of prescription NSAIDs since the 2005-2010 examination years has remained consistent in all CVD populations. These decreases were driven in part by reduced use of COX-2-selective NSAIDs, whereas non-selective NSAID use among all CVD populations was relatively steady from 1999 to 2016.

Conclusions:
Prescription NSAID use among patients with CVD appears to have declined from 1988 to 2016, primarily because of less COX-2 NSAID use following removal of 2 approved agents. Otherwise, the prevalence of prescription NSAIDs has remained somewhat stable and relatively high among these high-risk CV populations. Our results suggest additional efforts may be needed to limit the use of NSAIDs among patients with CVD, given that these agents are known to be associated with adverse CVD outcomes.
Abstract P384: Healthy Lifestyle Factors and Cardiovascular Disease Risk in a Prospective Cohort of Women With a History of Gestational Diabetes Mellitus
Authors: Qian Frank , Tobias Deirdre K , Ley Sylvia H , Chavarro Jorge , Liu Gang , Hinkle Stefanie N , Yeung Edwina , Mills James L , Liu Aiyi , Sun Qi , Hu Frank , Zhang Cuilin
Published: March 2020

Background:
Women with a history of gestational diabetes mellitus (GDM) are at increased risk for cardiovascular disease (CVD). Whether healthy lifestyle practices can mitigate this risk is unclear.

Aims:
To prospectively assess associations of healthy lifestyle factors with CVD risk in women with a history of GDM.

Methods:
We included 4,372 women from the Nurses’ Health Study II with a prior clinician diagnosis of GDM who were free of cancer or CVD at the time of the index pregnancy. Healthy lifestyle factors, which were updated every 2-4 years, included non-current smoking, body mass index<25 kg/m
2
, regular physical activity (>500 MET-min/week), high-quality diet (above median on the Alternative Healthy Eating Index), and moderate alcohol consumption (>0-15 g/day). A composite outcome of CVD was defined as the combination of nonfatal/fatal myocardial infarction (MI), stroke, angiographically confirmed angina, and coronary artery bypass surgery or angioplasty/stenting. Multivariate-adjusted Cox models were used to calculate the hazard ratio (HR) and 95% confidence interval (CI).

Results:
During a median 28 years of follow-up, 179 incident CVD events were ascertained. Compared to women with 0 or 1 healthy lifestyle factor, HR (95% CI) for risk of CVD among those who had 2, 3, and ≥4 factors were 1.02 (0.68, 1.53), 0.45 (0.28, 0.74), and 0.32 (0.18, 0.60), respectively (

P
trend

< 0.001) (
Table 1
). Similar results were observed for clinical CVD events (nonfatal/fatal MI or stroke) and total MI. When modeled continuously, each additional healthy lifestyle factor was associated with a lower risk of the composite outcome, HR (95% CI): 0.67 (0.57, 0.80); clinical CVD, HR (95% CI): 0.74 (0.58, 0.94); and MI, HR (95% CI): 0.61 (0.43, 0.86). We estimated that 62.5% (95% CI: 34.9%, 79.0%) of the CVD risk in this population was potentially avoidable with adherence to ≥4 healthy lifestyle factors.

Conclusion:
Greater adherence to healthy lifestyle factors was associated with a significant reduction in CVD risk in women with a history of GDM.
Abstract P398: Relative versus Absolute Neighborhood Economic Conditions and Risk of Stroke in a United States National Cohort
Authors: Twardzik Erica , Kim Yeonwoo , Judd Suzanne E , Verma Manish , Argeseanu Cunningham Solveig , Howard Virginia J , Kleindorfer Dawn , Colabianchi Natalie
Published: March 2020

Introduction:
Neighborhood economic conditions are important predictors of incident stroke. Neighborhood economic conditions can be characterized differently but studies have not identified which characterizations are most predictive of incident stroke. Previous work has suggested that the income distribution within the population may be more relevant for chronic disease than the absolute value of median income of the population. This project aims to estimate the effects of neighborhood income and neighborhood income inequality on incidence stroke.

Hypothesis:
Neighborhood income inequality and absolute neighborhood income will predict incident stroke above and beyond demographic characteristics and individual socioeconomic status.

Methods:
We used data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national longitudinal study of black and white older adults (N=29,443). Baseline median household income and the Gini coefficient of income inequality at the Census Tract level were obtained from the 2000 decennial census. Both variables were standardized to have a mean of 0 and a standard deviation of 1; z-score of median household income was multiplied by -1 (representing neighborhood income deprivation) to allow for comparability. Using Cox Proportional Hazards analysis we examined the risk of stroke associated with these exposures in separate models. Model 1 was unadjusted, Model 2 was adjusted for demographic characteristics (age, race, sex, marital status), and Model 3 was adjusted for individual socioeconomic characteristics (household income and education).

Results:
Within Model 1, neighborhood income deprivation (HR: 1.18; 95% CI 1.11-1.24) and neighborhood income inequality (HR: 1.10; 95% CI: 1.05-1.16) were both significantly associated with risk of stroke. The association persisted in Model 2: neighborhood income deprivation (HR: 1.13; 95% CI 1.07-1.20) and neighborhood income inequality (HR: 1.06; 95% CI: 1.00-1.11). Within Model 3, neighborhood income deprivation maintained its positive association (HR: 1.06; 95% CI 1.00-1.13), while neighborhood income inequality was no longer predictive of stroke risk (HR:1.04; 95% CI 0.99-1.10).

Conclusions:
Neighborhood income deprivation and neighborhood income inequality were similar predictors of incident stroke. The effect of absolute economic resources in a Census Tract was slightly larger than the relative economic standards within a Census Tract. There is a need to investigate other characterizations of neighborhood economic conditions, such as residential income segregation. The findings from this project suggest that there are multiple policy levels that can be used to decrease incident stroke, through decreasing income inequality and improving the absolute economic conditions of deprived neighborhoods.
Abstract P400: The Association Between Cross-sex Hormone Therapy and Cardiovascular Disease Risk Factors Among Male-to-female Transgender Persons in Chiang Mai, Thailand
Authors: Molinsky Rebecca L , Kulprachakarn Kanokwan , Ounjaijean Sakaewan , Demmer Ryan , Rerkasem Kittipan
Published: March 2020

Background:
Cross-sex hormone therapy (CSHT) is prescribed to transition secondary sexual characteristics among individuals undergoing male-to-female (MtF) transitions (age range 18-41, mean age=24). Limited data exist to inform the cardiovascular disease (CVD) risk factor profile associated with CSHT. We investigated the relationship between CSHT and cardiovascular risk factors in MtF transgender persons and hypothesize that CSHT will be associated with adverse CVD risk factor profiles.

Methods:
A cross-sectional study was conducted from October 1
st
, 2018 to November 30
th
, 2018 in 100 MtF transgender people not receiving CSHT vs. 100 receiving CSHT. CSHT use was defined by self-report use of up to 23 medications. Serum testosterone and 17-beta estradiol were assessed to validate CSHT use. Systolic and diastolic blood pressure was measured. Lipid profiles, fasting plasma glucose (FPG), C-reactive protein, cardiac troponin I and pro b-type natriuretic peptide (proBNP) were assessed from fasting blood. Non-invasive arterial examinations included: carotid intima-media thickness (CIMT), ankle-brachial index (ABI), cardio-ankle vascular index (CAVI), and pulse wave velocity (PWV). Multivariable linear regression models, regressed CVD risk factors on CSHT status. Among the subgroup of CSHT users, we assessed the relationship between duration of use and CVD risk factors. Multivariable models included age, gender, education, income, drinking, smoking, exercise, and BMI.

Results:
Participant mean age was 24±0.38 years and did not differ by CSHT use. Mean±SE values of testosterone were in the CSHT vs. control group were 4.8±0.3 vs. 5.8±0.3 ng/ml, p=0.06 and 17-beta estradiol levels were 45.6±14.9 vs. 34.7±14.8, p=0.7). CIMT was modestly lower among CSHT vs. controls (0.35±0.01 vs. 0.38±0.01, p=0.09). The average duration of CSHT use was 6.65±0.522 years. Among CSHT users, for every 1-year increase in duration of CSHT use total cholesterol decreased by -2.360 ± 1.096, p=0.0341 mg/dL, LDL-cholesterol decreased by -3.076 ± 1.182, p=0.0109 mg/dL, ABI decreased by -0.006 ± 0.002, p=0.0087 while FPG increased by 2.558 ± 0.899 mg/dL, p=0.0055.

Conclusion:
Among MtF transgender persons, using CSHT was not associated with increased CVD risk factors levels.
Abstract P413: Latent Class Trajectory Modeling Identifies Distinct Clinical Phenotypes in a Cohort of Patients With Elevated Troponin Levels
Authors: Wang Michael C , Petito Lucia , Pawlowski Anna , Schneider Daniel , Van Assche Lowie , Lloyd-jones Donald M , Feinstein Matthew J
Published: March 2020

Introduction:
Clinicians widely use cardiac troponins I and T, sensitive and specific biomarkers of myocardial damage, as diagnostic criteria for myocardial infarction (MI). A common approach, dichotomizing based on whether troponin levels meet thresholds for MI, may miss meaningful heterogeneity in degree and pattern of troponin elevation, with wider clinical implications.

Hypothesis:
Using latent class trajectory modeling (LCTM) with patients’ patterns of troponin elevations will yield trajectories that represent clinically and prognostically distinct groups of patients.

Methods:
We used Northwestern Medicine’s Enterprise Data Warehouse to identify patients with at least 3 troponin measurements of which at least one was elevated during their inpatient stay. We built a LCTM to capture troponin trajectories from 13,432 patients with 65,162 measurements since 2000, using Bayesian Information Criterion to select the final model (# of classes varied from 3-7). We then described the clinical and prognostic factors associated with trajectory class membership.

Results:
LCTM identified 3 troponin trajectories: stable low (77.3%), moderate rise (9.5%), and severe rise-fall (13.2%). The average posterior probability of assignment was >0.95 for all classes. The low group had the most comorbidities vs moderate/severe groups, including cancer (21.9% vs 13.9%/11.3%), heart failure (12.6% vs 8.9%/7.5%), and COPD (15.0% vs 11.8%/10.1%). The moderate/severe rising trajectories had a greater rate of clinically-diagnosed MI than the stable group (34.5%/44.1% vs 5.6%), with relatively more ST-elevation MI in the severe group (19.8% vs 5.3%) and Non-ST-elevation MI in the moderate group (29.3% vs 24.3%). One-year mortality was greatest in the low group vs moderate/severe groups (25.5% vs 21.4%/18.8%).

Conclusions:
In a cohort of hospitalized patients with elevated troponins, LCTM identified 3 distinct, clinically interpretable troponin trajectories which were associated with differing clinical phenotypes.
Abstract P414: Biomarkers of Very Long-chain Saturated Fatty Acids and Incident Coronary Heart Disease: Prospective Evidence From 15 Cohorts in the Fatty Acids and Outcomes Research Consortium
Authors: Ardisson Korat Andres V , Qian Frank , Imamura Fumiaki , Tintle Nathan , Chen Jiaying , Van Dam Rob M , Virtanen Jyrki K , Bassett Julie K , Bartz Traci M , Hirakawa Yoichiro , Chien Kuo-Liong , Frazier-Wood Alexis , Murphy Rachel A , Samieri Cecilia , Sun Qi , Hu Frank , Wu Jason H , Micha Renata , Mozaffarian Dariush , Lemaitre Rozenn
Published: March 2020

Background:
Biomarker levels of very long-chain saturated fatty acids (VLCSFAs) have been found to be favorably associated with cardiovascular risk factors including lower risk of diabetes and reduced triglycerides. Few studies have examined the association between VLCSFAs and coronary heart disease (CHD).

Aims:
To assess the association of circulating arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0) with incident total, fatal, and nonfatal CHD.

Methods:
We used data from the Fatty Acids and Outcomes Research Consortium consisting of 15 prospective cohorts worldwide which included adults (age≥18 years) who were free of cardiovascular disease and had blood measurements of 20:0, 22:0, and 24:0 at baseline. A study protocol with standardized definitions of exposures, disease outcomes, and covariates was developed, for which each cohort conducted individual participant-level analysis. Cohort-specific associations were pooled using inverse variance-weighted meta-analysis to calculate the overall relative risk (RR) per interquintile range (difference between the 90
th
and 10
th
percentiles) and 95% confidence interval (CI).

Results:
Among 33,083 participants, 6,165 cases of total CHD were ascertained. The overall pooled RR and 95% CI were 0.96 (0.89, 1.02) for 20:0, 1.01 (0.92, 1.11) for 22:0, 0.94 (0.86, 1.02) for 24:0, and 0.96 (0.89, 1.04) for 20:0 + 22:0 + 24:0 (
Figure 1
). However, we noted heterogeneity by lipid compartments, with significant inverse associations for higher 22:0 [0.77 (0.62, 0.96)], 24:0 [0.61 (0.49, 0.77)], and 20:0 + 22:0 + 24:0 [0.73 (0.60, 0.89)] in the total plasma/serum compartment but not in the phospholipid compartment. Similar associations were observed for fatal and nonfatal CHD and when using a random-effects model.

Conclusion:
Higher circulating VLCSFAs were not associated with total CHD in a global consortium of prospective studies. The finding of an inverse association with total CHD for VLCSFAs in the total plasma/serum compartment warrants further research.
Abstract P415: Weight Variation and Change in N-terminal Pro-brain Natriuretic Peptide (NT-proBNP)
Authors: Sbaraini Da Silva Mariana , Lazo Mariana , Daya Natalie R , Tang Olive , Ballantyne Christie M , Ndumele Chiadi E , Selvin Elizabeth
Published: March 2020

Introduction:
Natriuretic peptides (NPs) are biochemical markers of cardiac function and NTproBNP strongly predicts heart failure. NPs also have a role in the adipose tissue, stimulating lipolysis, mitochondrial biogenesis and browning of adipocytes. Cross-sectional studies have demonstrated that diabetes and higher levels of adiposity are paradoxically associated with lower levels of BNP and NT-proBNP, suggesting that NPs may protect against metabolic dysregulation.

Methods:
We hypothesized that increases in NT-proBNP over time would be associated with decreases in weight and a lower risk of obesity in a community-based population. We analyzed data from 10,093 participants from the Atherosclerosis Risk in Communities (ARIC) Study with measurements of NT-proBNP at two time points 6-years apart (visit 2, 1990-92 and visit 4, 1996-98). Multivariable regression models were used, and sensitivity analysis excluding patients with heart failure was performed.

Results:
Mean age at baseline (1990-1992) was 57 years (SD 6), 57% were women and 78% were white. The prevalence of obesity increased from 28% to 35% in the 6-year follow up period. Higher baseline levels of NT-proBNP were associated with reduced risk of obesity after adjustment for other risk factors (

Table

). There was an inverse association between change in NT-proBNP levels between the visits and weight change (

Figure

). Results were similar after excluding cases of heart failure.

Conclusions:
We found inverse associations of NT-proBNP levels with weight change and incidence of obesity. Our results suggest that NPs or their pathways may be potential targets in the treatment of obesity. Nonetheless, the molecular networks involving the natriuretic system are complex and additional work, especially intervention studies, are needed to address the clinical relevance of this finding.
Abstract P419: Association Between Bundle Branch Block and Coronary Artery Status: Insights From The LIFE Heart Study
Authors: Kornej Jelena , Kosich Falco , Henger Sylvia , Thiery Joachim , Thiele Holger , Scholz Markus
Published: March 2020

Background:
Pro-fibrotic changes create a substrate for initiation and perpetuation of arrhythmias. PR interval prolongation (
pPR
) reflects the electrophysiological conduction disturbances in atria, while bundle branch block (
BBB
) mirrors impaired conduction in ventricles. Both pPR and BBB might be caused by fibrosis leading to remodeling processes, which can be recognized using ECG. Coronary artery disease (
CAD
) may impair blood circulation and facilitate cardiomyocytes’ death with their consequent replacement by fibrotic cells.

Aims:
To analyze the association between BBB and coronary artery status in the LIFE-Heart Study. We hypothesized that fibrotic patterns in ECG measured as BBB and pPR are associated with CAD.

Methods:
We analyzed patients with available demographic, echocardiographic, ECG and coronary catheterization data recruited at the Heart Center Leipzig between 2006 and 2014. CAD was defined as stenosis ≥50%, coronary artery sclerosis (CAS) - as plaque obstruction <50%, pPR interval as PR≥200 ms, BBB as QRS ≥120 ms.

Results:
In total, 1.750 patients (median age 65 (IQR 55-71) years, females 36%) were included. There were 376 (22%) patients with CAS and 669 (38%) with CAD, pPR and BBB were documented in 181 (10.3%) and 176 (10.1%) patients, respectively. There was a significant association between pPR and BBB (OR 2.70, 95%CI 1.78-4.03, p<0.001). CAD extent and origin were not associated with pPR and BBB. However, after adjustment for age and gender, CAS (OR 1.51, p=0.021) was associated with BBB. On multivariable analysis, beside age (OR 1.05, 95%CI 1.03-1.08, p<0.001), males (OR 1.72, 95%CI 1.12-2.64, p=0.013), and EF (OR 0.95, 95%CI 0.93-0.96, p<0.001), both CAS (OR 1.61, 95%CI 1.08-2.39, p=0.019), and pPR (OR 2.07, 95%CI 1.30-3.32, p=0.002) remained robustly associated with BBB.

Conclusion:
The prevalence of BBB and pPR was similar in LIFE-Heart Study. Patients with CAS have more often BBB than patients with CAD or normal coronary vessels. Neither CAD extent, nor origin were associated with BBB.
Abstract P425: Central Aortic Stiffening in Late-life and Odds of Dementia: The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS)
Authors: Palta Priya , Wei Jingkai , Wu Aozhou , Meyer Michelle , Sharrett A Richey , Tanaka Hirofumi , Knopman David , Kucharska-newton Anna , Hughes Timothy , Matsushita Kunihiro , Mosley Thomas , HEISS Gerardo M
Published: March 2020

Introduction:
Stiffening of the aorta is associated with greater pulse pressure and transmission of pulsatile energy into the cerebral circulation, which can increase susceptibility to microvascular damage in the brain. We tested the hypothesis that higher aortic stiffness measured in late-life is associated with a greater prevalence odds of dementia measured ~5 years later.

Methods:
Dementia-free ARIC-NCS participants (n=4753; mean age: 75 years; 42% male; 21% black) with measures of aortic stiffness at the visit 5 (2011-2013) examination were included. Aortic stiffness was measured by carotid-femoral pulse wave velocity (cfPWV) using the VP-1000 Plus device (Omron Co., Japan) and modeled as continuous (per standard deviation (SD)), categorical into distribution-based quartiles, and as elevated vs. non-elevated cfPWV according to the upper 25
th
percentile (13.34 m/s). Cognitive status (normal/mild cognitive impairment (MCI)/dementia) was ascertained at the visit 5 and 6 (2016-2017) examinations with expert review by an adjudication committee of in-person cognitive testing. A multivariable logistic regression model estimated the adjusted association of cfPWV with 5-year odds of dementia.

Results:
Among dementia-free participants, a 1 SD higher cfPWV was associated with a greater odds of dementia (Odds Ratio (OR): 1.19 (95% Confidence Interval (CI): 1.03, 1.39). Elevated cfPWV (upper 25
th
percentile) was also associated with a greater odds of dementia (OR: 1.54, 95% CI: 1.08, 2.19) in this sample. This association was stronger among participants who were cognitively normal at visit 5 (n=3758, Table): the multivariable-adjusted OR of dementia = 2.16 (95% CI: 1.35, 3.47) for elevated vs. non-elevated cfPWV. The risk of dementia among those with baseline MCI (n=955) was not associated with cfPWV levels. Results were robust to adjustment for vascular risk factors.

Conclusions:
Among older adults, especially when MCI is not present, greater central aortic stiffness is associated with dementia risk.