bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP81: Habitual Physical Activity And Arterial Stiffness In Older Adults: The Atherosclerosis Risk In Community (ARIC) Study
Authors: Tanaka Hirofumi , Gouskova Natalia , Folsom Aaron R , Evenson Kelly , Windham Gwen , Aguilar David , Matsushita Kunihiro , Heiss Gerardo
Published: July 2021

Introduction:
Arterial stiffness increases with advancing age and is associated positively with coronary artery disease, stroke, dementia, and death. Regular physical activity appears to attenuate or even reverse age-related arterial stiffening. Yet, it is not clear if the reduced stiffening associated with habitual physical activity is also observed in community-dwelling older adults.

Methods:
We analyzed pulse wave velocity (PWV) data from 4,294 participants (mean age: 75 years, 42% male, 19% African-American) in the 5th clinic examination of the ARIC cohort conducted in 2011-13. Out of 6538 participants who completed the examination, we included all who had proper consent, PWV data, BMI<40 kg/m2, and non-missing outcomes and covariates. Sports and leisure physical activity indices were calculated using the Baecke physical activity questionnaire modified for the ARIC Study. The Short Physical Performance Battery (SPPB) was calculated by summing scores on repeated chair stands, balance, and 4m walk tests. Arterial stiffness was measured using the average of two measurements of carotid-femoral then brachial-ankle pulse wave velocities (cfPWV and baPWV). Bivariate and multivariate regression analyses examined the relationships between arterial stiffness and physical activity.

Results:
Both sports and leisure physical activity scores were significantly and inversely associated with cfPWV (Pearson r = -0.126 and -0.091; both P<0.0001). The associations remained highly significant after adjustments for age, gender, race, BMI, diabetes, hypertension, and smoking status (Pearson partial r = -0.099 and -0.058; both P<0.0001). Similarly, the SPPB was inversely related to cfPWV (Pearson r = -0.155; P<0.0001). After adjusting for covariates, the relation remained highly significant (Pearson partial r = -0.082; P<0.0001). In contrast, the associations between baPWV and physical activity indices were only borderline significant (Pearson r = -0.03 for both; P=0.048 and 0.051). Association of baPWV with SPPB score was significant in univariate analysis (Pearson r = 0.04;, P =0.0082), but was attenuated after adjustment for covariates (Pearson partial r=-0.005, P=0.7348).

Conclusions:
Greater participation in sports and leisure physical activity and greater physical performance are associated with lower central arterial stiffness in a large population-based sample of community-dwelling older adults.
Abstract MP88: Fetuin-A, a Vascular Biomarker of Cognitive Decline in Older Adults
Authors: Laughlin Gail A , McEvoy Linda K , Barrett-Connor Elizabeth , Daniels Lori B , Ix Joachim H
Published: July 2021

Objectives:
The contribution of vascular disease to neurocognitive decline is now widely recognized. Fetuin-A is an abundant plasma protein known to predict vascular disease. Prior studies have shown that fetuin-A levels are lower in patients with Alzheimer’s disease in direct proportion to the severity of cognitive impairment; however, their association with normal cognitive aging is unknown. We evaluated the association of serum fetuin-A levels with cognitive function in relatively high-functioning, community-dwelling older adults from the Rancho Bernardo Study.

Methods:
This is a population-based study of 1382 older adults (median age 75) who had plasma fetuin-A levels and cognitive function evaluated in 1992-96; 855 had repeat cognitive function assessment a median of 4 years later.

Results:
Adjusting for age, sex, education, and depression, higher levels of fetuin-A were associated with better baseline performance on the Mini-Mental Status Exam (MMSE) (P=0.012) and a tendency for better Trails Making B scores (P=0.066). In longitudinal analyses, the likelihood of a major decline (highest decile of change) in Trails B was 29% lower (P=0.010) for each SD higher baseline fetuin-A level; odds of major decline in MMSE was 42% lower (P=0.005) per SD higher fetuin-A for individuals with no known CVD, but were not related to fetuin-A in those with CVD (P=0.33). Fetuin-A was not related to Category Fluency performance. Results did not vary by sex and were not explained by numerous vascular risk factors and comorbidities.

Conclusions:
Higher plasma fetuin-A concentrations are associated with better performance on tests of global cognitive function and executive function and with reduced likelihood of major decline in these cognitive abilities over a 4-year period. These observations are consistent with the hypothesis that higher fetuin-A protects against cognitive decline in relatively high functioning older adults, although this may be less apparent in those with established vascular disease. Fetuin-A may serve as a biological link between vascular disease and normal age-related cognitive decline.
Abstract MP91: Self-Reported Sitting Time Using a Two-Question Method Is a Good Measure of Sedentary Behavior: Findings in the New York City Adult Population
Authors: Yi Stella , Bartley Katherine , Firestone Melanie , Eisenhower Donna
Published: July 2021

Introduction:
Sedentary behavior is defined as activities that require low energy expenditure (1.0 - 1.5 [METs]). Sitting time is a specific domain of sedentary behavior that is associated with metabolic disturbances, decreased life expectancy, and mortality - outcomes that occur independent of meeting physical activity guidelines. Population-level prevalence estimates of the ‘active couch potato’, or active adults who engage in at least 7+ hours of sitting time a day, are needed.

Hypothesis:
We tested that the two-question method of self-reported sitting time would have adequate construct validity for population surveillance.

Methods:
The New York City Health Department conducted the 2011 Physical Activity and Transit (PAT) Survey using random-digit dial (cell and landline telephones) methods (n=3811); an additional subset of participants wore accelerometers for a seven-day period (n=679). Sedentary time was defined as accelerometer minutes with <100 counts on valid days (those with 10 hours of wear time). Self-reported sitting time was assessed from two questions on time spent sitting awake for daytime and evening. Construct validity was assessed using Spearman’s Rho and examination of a Bland-Altman plot. Multivariable regression models were used to assess demographic factors associated with sitting time and measured sedentary time. Prevalence of the ‘active couch potato’ was defined as those adults who were meeting the 2008 Physical Activity Guidelines for Americans of at least 150 min/week of physical activity, but who also self-reported sitting for 7+ hours per day, using both accelerometer and self-reported data. All data were weighted and analyzed in SUDAAN 10.

Results:
Self-reported mean daily sitting time was 444 min (7.4 hours); accelerometer-based mean daily sedentary time was 494 min (8.2 hours; correlation: r=0.32, p<0.01). The mean difference was 49 min/d (Limits of Agreement: -441-343). In adjusted models, higher measured sedentary time was associated with older age and higher education. Sitting time was higher in women, Asians and those with a higher education, and lower in foreign-born persons and Hispanics, compared to referent groups. The prevalence of being an ‘active couch potato’ was 56.9% and was highest among high-income, highly educated New Yorkers.

Conclusions:
Sitting time can be accurately assessed by self-report for population surveillance, but may be limited in characterizing individual-level behavior. Differences in measurement characteristics suggest that accelerometer-based measurements may not be an appropriate way to validate self-reported sitting time. Sedentary behavior appears to be prevalent in two different groups: (1) older adults and; (2) working-age adults of higher socioeconomic status. Targeted interventions to minimize extended periods of sedentary activity among these groups are warranted.

1
Abstract P002: Gender Differences in Atrial Fibrillation Hospitalizations
Authors: Naderi Sahar , Wang Yun , Foody JoAnne
Published: July 2021

Background:
While there are recognized gender differences in cardiovascular disease, little is known regarding the role of gender in atrial fibrillation (AF). We therefore sought to determine differences in characteristics of AF hospitalization between men and women.

Methods:
Data from the 2009-2010 Healthcare Cost and Utilization Project were used to model AF hospitalizations as a function of patient age and gender.

Results:
Of 192,846 AF hospitalizations, 50% of patients were female. Mean age was 74 years versus 66 years for men. Figure I shows AF hospitalizations stratified by age and gender. Women were less likely than men to have diabetes (24 vs 25%, p<0.001), chronic kidney disease (11.2 vs 12.2%, p<0.001), and obesity (12.2 vs 12.9%, p<0.001). They were more likely to have a history of stroke (2.0 vs 1.7%, p<0.001), hypertension (68.7 vs 62.5%, p<0.001), and depression (9.6 vs 5.4%, p<0.001). Females were more likely to be admitted from the emergency room (72.9 vs 66.6%, p<0.001), were hospitalized longer (mean days 3.6 vs 3.3, p<0.001), and were more likely to be discharged to a skilled nursing facility (10.1 vs 4.5%, p<0.001). Women were less likely to have an electrical cardioversion (12.4 vs 18.4%, p<0.001) or AF ablation performed (5 vs 10%, p<0.001) and had a higher mortality than men (0.95 vs 0.75%, p<0.001).

Conclusion:
Women are hospitalized with AF later in life than men, with the greatest burden in female octogenarians. There is a high prevalence of depression among this cohort. While they have fewer comorbidities, women appear to be more symptomatic from AF and more debilitated upon discharge. Despite this, women are less likely than men to have procedures commonly used to treat AF and are more likely to die during hospitalization.
Abstract P005: Evaluation of the Association between the Free Fatty Acid to serum Albumin Ratio with the Time to Cardiac Repolarization
Authors: Conway Baqiyyah N , Evans Rhobert W , Trevor Orchard
Published: July 2021

Background:
Elevated free fatty acid (FFA) levels have been shown to increase cardiac repolarization time and are a hypothesized mediator of arrhythmic death. However, as albumin binds and transports FFA, it has been argued that it is the ratio of serum FFA to serum albumin (SA) that is critical. As FFA are chronically elevated in type 1 diabetes and form a major part of the counterregulatory response to hypoglycemia, we investigated the association of the FFA-to-SA ratio with the corrected Q-T (Q-Tc) interval in 87 men and 96 women with type 1 diabetes from the Pittsburgh Epidemiology of Diabetes Complications Study. We also investigated whether this relationship varied by cardiac autonomic neuropathy (CAN: R-R interval<1.1) status.

Methods:
FFAs were measured using a colorimetric method in participants with a mean age and diabetes duration of 44 and 33 years, respectively. The corrected Q-T interval was calculated using Hogdes formula and the FFA-SA ratio determined as FFA (mmol/L) ÷ SA (mg/dL). Because of the sexual dimorphism in FFA metabolism and the Q-T interval, analyses were also conducted sex-specifically.

Results:
Mean (std) FFA levels were 0.95 (o.48) mmol/l and did not vary by sex (men vs women: 0.93 (0.46) vs 0.96 (0.49) mmol/L, p=0.76). The FFA-SA ratio demonstrated a modest association with Q-Tc interval in men (r=0.23, p=0.03), but no association in women (r=-0.07, p=0.48). Overall, in multivariable analyses controlling for sex, visceral adipose tissue, blood glucose levels and albumin excretion rate, FFA-SA, and CAN, a significant interaction was observed between the FFA-SA ratio and CAN in the association of the Q-Tc interval (p=0.03). FFA remained significantly associated with the Q-Tc interval in those without CAN (p<0.05), but not in those with CAN (p=0.30). Sex-specific analyses revealed that although no significant FFA-SA ratio and CAN interaction was observed in men (p=0.42), a relationship between the FFA-SA ratio and Q-Tc interval existed in men free of CAN (p=0.04). No association was observed in women with or without CAN.

Conculsion:
We conclude that a higher FFA-SA ratio is associated with an increased time to cardiac repolarization in those without CAN, particularly in men, helping to explain why the "dead in bed" syndrome is predominantly seen in men.
Abstract P008: Ultra-Sensitive Troponin I Strongly Predicts Incident Coronary Heart Disease in the General Population Independently of Traditional Risk Factors. Results From the MONICA/KORA Augsburg Case-Cohort Study
Authors: Koenig Wolfgang , Zierer Astrid , Karakas Mahir , Meisinger Christa , Peters Annette , Todd John , Herder Christian , Thorand Barbara
Published: July 2021

Background:
High-sensitive (hs) troponin T and I assays as well as ultrasensitive (us) troponin I enable measurement of troponins in 65% to 98% of the general population. We prospectively investigated whether increased concentrations of us-troponin I are associated with an increased risk of coronary heart disease (CHD) after controlling for traditional risk factors.

Methods:
We conducted a population-based case cohort study in middle-aged healthy men and women within the MONICA/KORA Augsburg studies. Serum levels of us-troponin I (Single Molecule Counting technology, Singulex) were available in 2,745 men and women including 803 incident CHD cases. Geometric mean us-troponin I was 1.56 ng/L. Mean (SD) follow-up was 16.0 (5.8) years.

Results:
Baseline concentrations of us-troponin I were higher in cases compared to non-cases (geometric mean 2.56 vs. 1.49 ng/L, p<0.0001) and in men compared to women (geometric mean 1.93 vs. 1.27 ng/L, p<0.0001). After adjustment for variables of the Framingham Risk Score, the hazard ratio (HR) with 95% confidence interval (CI) for a CHD event in the top quartile compared to the bottom quartile was 2.76 (95% CI, 1.87-4.09). After additional adjustment for alcohol intake, physical activity, and body mass index, hazard ratios remained essentially unchanged.

Conclusions:
Troponin I measured by an us-assay was detectable in almost all subjects. This is the first population-based prospective study with long-term follow-up showing that even modestly increased concentrations of us troponin I are strongly associated with incident CHD independently of a variety of traditional risk factors.
Abstract P013: Prevalence and Prognostic Impact of Kidney Dysfunction among Patients with Acute Decompensated Heart Failure in Community: The ARIC Community Surveillance
Authors: Matsushita Kunihiro , Hyun Noorie , Agarwal Sunil K , Loehr Laura R , Ni Hanyu , Chang Patricia P , Wruck Lisa M , Coresh Josef , Rosamond Wayne D
Published: July 2021

Introduction:
Several studies reported that kidney dysfunction is prevalent and is associated with poor prognosis in patients with acute decompensated heart failure (ADHF). However, most of these reports were from clinical trials or a single hospital, limiting their generalizability to clinical practice in the community.

Methods:
We tackled these questions using data from community-based surveillance for ADHF conducted as a part of the ARIC Study from 2005 to 2009 for residents aged ≥55 years in 4 US communities (Jackson, Mississippi; Washington County, Maryland; Minneapolis, Minnesota; and Forsyth County, North Carolina). All analyses were weighted to account for the stratified sampling design. The association of kidney function with mortality (in-hospital, 28-day, and 1-year) was assessed using logistic regression. The CKD-EPI equation with worst serum creatinine during hospitalization was used to calculate estimated glomerular filtration rate (eGFR), and persons from nonblack and nonwhite racial groups or with missing key variables were excluded.

Results:
Among 10,450 sampled hospitalizations, 3,651 ADHF events adjudicated as definite or probable were included in this analysis, corresponding to weighted 17,378 events after applying sample weights (average length of stay, 8.3 days). The prevalence of reduced eGFR (defined as <60 ml/min/1.73m
2
) was 83.4% overall, and 37.7% of ADHF cases had eGFR <30. Lower eGFR, particularly eGFR <30, was significantly associated with higher mortality during hospitalization or 1 year of follow-up independently of potential confounders (Table). The association was largely consistent across demographic and clinical subgroups.

Conclusion:
Severely reduced eGFR (<30 ml/min/1.73m
2
) was observed in ~38% of ADHF cases during hospitalization and was a strong predictor of poor prognosis during hospitalization or after discharge in community. These findings suggest that ADHF patients with kidney dysfunction warrant special attention in the management for ADHF.
Abstract P018: Calibration of Analytes Over Twenty-Five Years in the Atherosclerosis Risk in Communities Study
Authors: Parrinello Christina M , Grams Morgan E , Couper David , Ballantyne Christie M , Hoogeveen Ron C , Eckfeldt John H , Selvin Elizabeth , Coresh Josef
Published: July 2021

Background:
Comparability of laboratory measures over time is important for studies of disease prevalence and progression. While a small amount of bias may seem negligible on an individual level, it can result in substantial misclassification of disease in the population. We conducted a calibration study of important biomarkers across five study visits (25 years) in ARIC.

Methods:
We re-measured 15 analytes in 200 blood samples to calibrate original measurements at each time point using Bland-Altman plots and Deming regression. We also assessed the impact of calibration on the prevalence of chronic kidney disease (CKD), defined by estimated glomerular filtration rate using creatinine (eGFRcr), and on trends over time.

Results:
Assays in samples frozen 12-27 years were highly correlated with original values (median r=0.95) after removing outliers (median 4% of values). The range of bias (% difference in means) across visits for each original analyte compared to its reference were: creatinine: 13-49%; uric acid: 3-24%; C-reactive protein: 3-9%; total cholesterol: 1-6%; high density lipoprotein cholesterol: 4-8% (but new methods differed); low density lipoprotein cholesterol: 1-5%; triglycerides: 2-4%; glucose: 1-4%; N-terminal prohormone of brain natriuretic peptide: 2-12%; high sensitivity cardiac troponin T: 1-9%; alanine transaminase (ALT): 21%; aspartate transaminase (AST): 17%; gamma glutamyl transpeptidase: 0.2%; ß2-microglobulin: 1%; beta-trace protein: 13%. Four analytes met calibration criteria: creatinine, uric acid, ALT and AST. The impact on CKD prevalence was substantial and similar to previous statistical calibration (22% uncalibrated, 1.9% previously and 1.3% current laboratory calibration). Trends in eGFRcr over time were better aligned after calibration (
Figure
).

Conclusions:
Repeat assay of samples shows high correlation with original values. Calibration enables application of absolute cutoffs (required for defining CKD and other conditions) and improves longitudinal analyses.
Abstract P019: Identifying Laboratory Markers of Incident Myocardial Infarction through Electronic Health Records
Authors: Goldstein Benjamin A , Chang Tara I , Hastie Trevor , Winkelmayer Wolfgang C
Published: July 2021

Background:
Patients on hemodialysis (HD) are at high risk of cardiac events including myocardial infarction (MI). Electronic health records (EHRs) present a unique opportunity to observe biomedical changes in patients over time.

Purpose:
To assess whether there were any distinct changes in laboratory values prior to an incident MI.

Methods:
Using EHR data from a large dialysis organization, we identified 6,468 patients with an incident MI and selected an equal number of patients receiving dialysis on the same date without an MI. We abstracted six months of 12 regularly collected laboratory measures for their potential utility as a marker for incident MI: albumin, calcium, co2, creatinine, ferritin, hemoglobin, iron saturation, phosphorus, platelet, potassium, single pool Kt/V and white blood cell count. We used natural cubic spline regression to determine whether the trajectory of the laboratory values differed amongst patients with and without an incident MI.

Results:
Of the 12 laboratory measures, 7 showed a distinct change between patients with and without MI, 14 to 28 days before the incident event. Three measures were related to inflammation (white blood cell count, iron saturation, and ferritin; see Figure 1), 3 measures were related to malnutrition (albumin, creatinine, phosphorous), along with single pool kt/v.

Conclusion:
Distinct changes in routinely collected laboratories are observed prior to an MI. Future studies based on our results will focus on whether these changes can be used in real-time to predict MI risk in HD patients.
Abstract P035: Respiratory Muscle Trainings as a Way of Physical Rehabilitation for Old Patients With Heart Failure
Authors: Kolesnikova Elena , Arutyunov Gregory , Rylova Anna , Rylova Natalia , Lobzeva Valentina
Published: July 2021

Background:
Physical exercises are well known to be an important part of comprehensive cardiac rehabilitation(CR), but many protocols of physical exercises are not applicable for the old patients for many reasons.

Purpose:
To study the possibility of respiratory muscles trainings (RMT) in old patients with heart failure (HF) as a way of physical rehabilitation.

Methods:
57 patients 84,4±5,7 years old with NYHA II- III HF were randomized to either an exercise training group (EG)(29pts) or to a control group (CG). The CG patients had standard CR according to the national guidelines. The EG participated additionally in a RMT with gradual increase of inspire and expire resistance. Trainings were held for 20 minutes twice a day for 12 months. Peak oxygen consumption (VO2peak) during 6 minute walking test (6 MWT), maximal inspiratory mouth pressures (PI max) were measured at baseline and in 12 months.

Results:
After 12 weeks there was significant increase in results of 6 MWT in EG (299,6±19,37 m in EG vs 298,2±18,12 m in CG at baseline, [[Unable to Display Character: р]]>0,05; after (12 months 342±12,76m vs 297,3±11,85 m [[Unable to Display Character: р]]<0,05), VO2peak in EG 14,96±1,84ml/kg/min in EG vs 14,99±1,91 ml/kg/min in CG at baseline, [[Unable to Display Character: р]]>0,05; after 12 months 16,18±1,46 ml/kg/min vs 14,35±1,11 ml/kg/min, [[Unable to Display Character: р]]<0,01) and PImax in EG (median PI max, 6,4 in both groups [25th-75th percentile range 6,4-6.9 in EG vs 25th-75th percentile range 6,3-6,9 in CG] at baseline, p=0,7), after 12 months EG median PI max, 6,9 in EG [25th-75th percentile range6,9-7,2] vs median PI max, 6,5 [25th-75th percentile range 6,3-6,5] in CG, [[Unable to Display Character: р]]<0,01). EG patients had significantly less hospitalizations because of HF progression (16,9% in EG vs 27,5% in CG) and pneumonias (14,1% vs 19.3%). There were 7 lethal outcomes in EG vs 12 in CG.

Conclusion:
RMT in old patients with HF improves physical capacity, maximal inspiratory mouth pressures, e and decrease the number of hospitalizations because of HF progression and pneumonias
Abstract P041: Functional Status Modifies Treatment Effectiveness in the Systolic Hypertension in the Elderly Program Trial
Authors: Odden Michelle C , Charlesworth Christina , Peralta Carmen
Published: July 2021

Introduction:
We have previously demonstrated that high blood pressure is not associated with mortality in elders with impairments in functional status. Whether functional status modifies the effectiveness of treatment to lower blood pressure is not known.

Methods:
The Systolic Hypertension in the Elderly Program (SHEP) was a multicenter, randomized, double-blind, placebo-controlled trial of 4,736 adults aged 60 and older with isolated systolic hypertension. Participants were randomized to chlorthalidone +/- atenolol or reserpine or matching placebo and followed for an average of 4.5 years. Functional limitation was assessed by the self-reported inability to do any one of the following activities: i) heavy work around the house, ii) walk up and down stairs, or iii) walk a half a mile. Analyses were conducted by intention-to-treat within the post-hoc subgroups.

Results:
There was a pattern of effect modification by functional limitation, where the association of active treatment was attenuated or inverted in persons with functional limitation compared with those without (Table). The interaction of treatment and functional limitation was strongest for the outcomes of myocardial infarction: hazard ratio = 0.57 (95% confidence interval (CI): 0.40, 0.81) and 1.33 (95% CI: 0.57, 3.07) in persons without and with functional limitation, respectively; and for mortality: 0.78 (95% CI: 0.66, 1.01) and 1.27 (95% CI: 0.83, 1.95) in persons without and with functional limitation, respectively.

Conclusions:
Antihypertensive therapy appears less effective in persons with self-reported functional limitation. More evidence is needed to guide optimal blood pressure control in elderly adults with functional limitation.
Abstract P043: National Trends in Hypertension Control 1999-2012 and Projected Impact on Incident Stroke by Age, Sex, and Race: The Cardiovascular Disease Policy Model
Authors: Mason Antoinette , Coxson Pamela , Moran Andrew , Guzman David , Pletcher Mark J , Johnston S. C , Kim Anthony , Sidney Stephen , Goldman Lee , Bibbins-Domingo Kirsten
Published: July 2021

Background:
Blood pressure (BP) control rates have improved over the decade, as have stroke rates. We determined the impact of secular BP trends on national stroke rates by age, sex, and specifically for US Blacks.

Methods:
We estimated national BP distributions from NHANES and quantified changes from ‘99-‘04 to ‘07-‘12 by age (35-64, 65-84 years), sex, and separately for Blacks. We used these as inputs to the Cardiovascular Disease Policy Model (CVDPM), a population-based computer simulation of CVD nationally. CVDPM data inputs include the Census, vital statistics, NHANES, national hospitalization data, and Framingham among others. CVDPM has been adapted to US Blacks (CVDPM-AA) using these sources as well as cohorts including ARIC and REGARDS. Both models are calibrated to reproduce event rates in the baseline year and outcomes of intervention studies. We projected changes in incident strokes attributable to changes in BP distribution and also modeled universal BP control (systolic BP <140 mmHg). Baseline values of other CVD risk factors were also included to isolate effects attributable to BP.

Results:
Among older US adults, the prevalence of systolic BP ≥140 mmHg decreased over the period (Table). Among younger adults, improvements in BP control were only observed in all US and Black women, not US or Black men. The projected benefit from prevented stroke attributable to improvements in BP control is substantial for all older adults and for younger women, and the magnitude is particularly striking for Blacks. Stroke reduction attributable to BP control is not observed in younger men. Universal BP control is projected to have a large impact on incident stroke reduction, at least twice the impact estimated from the secular trends in BP reduction from 1999-2012 in most groups.

Conclusions:
Recent improvements in BP control are projected to contribute to stroke prevention in all groups in the US, except men younger than 65 years. Additional hypertension control efforts will yield considerable additional benefits in stroke prevention.
Abstract P049: Race/Ethnic Differences in Patterns of Antihypertensive Medication Uptake and Clinical Outcomes among Hospitalized Diabetic Patients with Hypertension
Authors: Mochari-Greenberger Heidi , Mosca Lori
Published: July 2021

Background:
Hypertension increases the risk of complications in patients with diabetes. Race/ethnic differences in the uptake of antihypertensive medications may contribute to disparities in clinical outcomes, but this has not been formally evaluated. We aimed to assess patterns of antihypertensive medication prescription by race/ethnic group and the association with clinical outcomes among hospitalized diabetic patients with hypertension.

Methods:
This was a 1 year prospective study of individuals with existing diabetes and hypertension (N=1126, 42% black/Hispanic [minority]; 39% female) that participated in an NHLBI clinical outcomes study of patients admitted to a cardiovascular service. Baseline clinical/medication data and outcomes (rehospitalization/death) were documented by electronic medical record, National Death Index, and standardized mail survey. Logistic regression was used to evaluate associations between race/ethnicity, antihypertensive prescription, and outcomes adjusted for demographics/comorbidities.

Results:
Overall utilization of antihypertensive medication prior to admission did not differ between minority (92%) vs. white/other (93%) patients; minorities were more likely to report taking calcium channel blockers (OR=1.40;95%CI=1.08-1.81) and less likely to use beta blockers (OR=0.65;95%CI=0.50-0.84) vs. whites/others. Race/ethnic differences in prescription type did not persist at discharge after adjustment for demographics/comorbidities (96% prescribed any antihypertensive medication: 62% ACE inhibitor/ARB, 81% beta blocker, 29% calcium channel blocker, 48% diuretic). A total of 676 (60%) of participants were rehospitalized/dead at 1 year; predictors of rehospitalization/death included minority race/ethnicity, lack of health insurance, renal failure/dialysis, peripheral vascular disease, and heart failure (p<0.05). Prescription of beta blocker (OR=0.60;95%CI=0.43-0.82) was associated with lower odds of rehospitalization/death at 1 year. Race/ethnic minority status remained a significant predictor of death/rehospitalization at 1 year after adjustment demographics, comorbidities and beta blocker prescription at discharge (OR=1.31;95%CI=1.01-1.71).

Conclusion:
In this study of hospitalized diabetic patients with hypertension, antihypertensive prescription at discharge did not vary by race/ethnicity; beta blocker prescription at discharge was associated with lower odds of rehospitalization/death at 1 year. Higher odds of rehospitalization/death among minorities was not explained by measured covariates including type of antihypertension medication.
Abstract P051: Longitudinal Decline in Gait Speed is Associated with Hospitalization in the AGES Reykjavik Study
Authors: Siggeirsdottir Kristin , Aspelund Thor , Launer Lenore J , Harris Tamara B , Gudnason Vilmundur
Published: July 2021

Background:
Functional decline is a characteristic of old age measured by physical performance, such as gait speed and muscle strength. Poorer cardiovascular health may explain much of the functional decline with age. We studied the association of longitudinal change in gait speed and hospitalization, testing whether any association was secondary to baseline subclinical cardiovascular measurements, or physical function.

Material and methods:
Participants were from two phases of the longitudinal AGES Reykjavik Study. A population study of 3316 men and women (58%), who entered both stages 5 years apart, mean age 75.0 (SD 4.9) at baseline. The time in seconds (s) to walk 6m was measured at both visits. Baseline characteristics were Agatston score of coronary artery calcium (CAC), carotid plaque, carotid intima media thickness (IMT), type 2 diabetes mellitus, physical activity, quadriceps strength and activity of daily living (ADL). The study group was divided into two groups; those who were hospitalized during the follow-up and those who were not. Repeated measures models were used to estimate longitudinal change in gait speed.

Results:
Mean time to walk 6m was 6.0 (SD=1.2) (s) for men and 6.6 (SD=1.6) (s) for women at baseline and did not differ by hospitalization status. For those hospitalized after the baseline visit (73%) the increase in time to walk 6 m was 0.68 (95%CI: 0.60-0.76) (s) whereas for those not hospitalized the increase in time was significantly smaller (0.39 (95%CI: 0.29 - 0.52) (s), (p<0.0001 for interaction). Those who were not hospitalized had significantly lower levels of CAC, IMT, carotid plaque, ADL, were more physically active, and had greater quadriceps strength (p<0.05 for all measures). After adjustment for these baseline variables, the difference in longitudinal change in gait speed between those who were admitted to hospital and not admitted was still statistically significant. The risk was attenuated only by 7%.

Conclusion:
Individuals who were hospitalized showed greater decline in health, reflected in slower gait speed. This was not explained by cardiovascular status or other measured variables in this study related to health although those hospitalized had worse profile. This suggests that there are different trajectories influencing the rate of loss of gait speed explained by other factors than cardiovascular indices.
Abstract P055: Adverse Early Life Exposures and Carotid Atherosclerosis in Midlife: LEAP study
Authors: Eaton Charles B , Maccani Jennifer , Agha Golareh , Allison Matthew , Roberts Mary , Loucks Eric , Buka Steve
Published: July 2021

Background:
The developmental origins hypothesis suggests that adverse early life exposures predispose individuals to the development of chronic disease later in life. We tested this hypothesis by evaluating prenatal, birth, infancy and early childhood factors as predictors of midlife carotid intimal thickness and presence of atherosclerotic plaque in the carotid arteries.

Methods:
Participants were from the New England Family Study (N= 371), over-sampled for racial/ethnic minorities and small/large size for gestational age at birth, who had carotid IMT assessed in 2010-2011. Socioeconomic position (SEP) was prospectively measured prenatally and at age 7. Self-reported maternal pre-pregnancy BMI, birth weight, placental weight and gestational age, Growth velocity (change in weight from birth to age 4 months), BMI and blood pressure at the age 7 were measured. At midlife carotid IMT(cIMT)was measured at three angles of the far wall of the common segment for both carotid arteries; the mean of maximum measurement for these 6 segments was determined, as well as presence of plaque.

Results:
Of the 371 middle aged (44-51 years) participants, 56% were women and 65% were white. After adjusting for age, gender and race, robust statistically significant associations with carotid IMT and carotid plaque were found for placental weight and BMI at age 7. Socioeconomic position at age 7 was associated cIMT while the association with carotid plaque was of borderline significance. Maternal pre-pregnancy BMI and systolic blood pressure (SBP) were marginally associated with the presence of any plaque in the offspring, while cIMT was not significantly associated. Early growth velocity was marginally associated with plaque but not cIMT and birth weight was not associated with either cIMT or plaque.

Conclusion:
This study provides some evidence to support the developmental origins hypothesis during the prenatal period, infancy and early childhood predicting carotid atherosclerosis in mid life.
Abstract P057: Heterogeneity in Blood Pressure and Lipid Trajectories throughout Childhood: Project HeartBeat!
Authors: Allen Norrina B , Hallman D. Michael , Gooding Holly , Rasmussen-Torvik Laura , Shay Christina , Steffen Lyn , Labarthe Darwin R
Published: July 2021

Background:
Previous studies have examined blood pressure (BP) and lipid changes through childhood and adolescence using population averages. We hypothesized that trajectories for these are heterogeneous, with sub-groups of the population showing different patterns in BP and lipid changes through childhood and adolescence.

Methods:
This study includes 678 children in Project HeartBeat!. Children were ages 8, 11, or 14 at baseline in 1991 and were examined every 4 mos for up to 4 yrs (mean number of exams, 8). At each exam, lifestyle, anthropometric and laboratory data was collected. Group-based modeling (PROC TRAJ) was used to identify trajectories in systolic BP (SBP), fifth phase diastolic BP (DBP5), total cholesterol (Chol), HDL Chol, LDL Chol and triglycerides as a function of age. The optimal number of race- and sex-adjusted trajectories was determined using the Bayesian Information Criterion and clinical expertise.

Results:
Among 678 children (49% female; 75% nonblack), 314 were enrolled at age 8, 197 at age 11, and 167 at age 14. Four distinct BP trajectories were identified (figure panels A-B). For SBP the low, low-intermediate, high-intermediate and high groups contained 16.4%, 36.3%, 34.5% and 12.7% of the sample, respectively; for DBP5, they contained 9.5%, 34.2%, 41.0%, and 15.3%. Three trajectories were identified for lipids (panels C-F). The low, intermediate, and high groups included 43.9%, 49.0% and 7.0% of the sample for total Chol, respectively. Corresponding figures were 33.4%, 49.3%, and 17.2% for HDL; 33.5%, 53.9%, and 12.7% for LDL; and 75.3%, 20.3%, and 4.5% for triglycerides, respectively. Girls were less likely (39% vs 61%) to be in the highest SBP groups as compared to the lowest. Blacks were more likely to be in the higher risk trajectories for DBP5 and HDL (p<0.01).

Conclusion:
Significant heterogeneity exists in BP and lipid trajectories throughout childhood. Finding predictors of the low and high trajectory classes may help target interventions to preserve low risk and manage high risk for future CVD.
Abstract P059: The Association between Fruit and Vegetable Intake and Alanine Aminotransferase Levels in Children
Authors: Choo Jina , Kim Hye-Jin , Yang Hwami , Kim Suyeon , Lee In-Young
Published: July 2021

Purpose:
Increasing the intake of fruits and vegetables is recommended for the prevention of childhood obesity. Obesity in children affects the liver, causing conditions such as elevated alanine aminotransferase (ALT) levels. Elevated ALT levels in obese children may be associated with features of metabolic syndrome. Yet empirical evidence on the association between fruit and vegetable intake and ALT levels in children has been lacking.

Methods:
A cross-sectional study design was used. Participants were 115 children aged 6 to 12 years, who were recruited from community child care centers in a community of Seoul metropolitan area in South Korea. Eating and activity behaviors were obtained by questionnaire administration. ALT levels were analyzed as a dichotomous variable with normal vs. abnormal values (≥30 IU/dL in boys and ≥19 IU/dL in girls). According to body mass index (BMI) percentile, participants were categorized into a normal-weight group of below the 85
th
percentile, an overweight group between the 85
th
and <95
th
percentiles, and an obese group at or above the 95
th
percentile. Eating behaviors were assessed via daily intake of fruits and vegetables as a dichotomous variable of 7 days vs. <7 days per week, and frequent intake of fast foods and sweetened beverages as dichotomous variables of < 3 days vs. ≥3 days per week. Daily physical activity was assessed as a dichotomous variable of 7 days vs. < 7 days per week. A logistic regression analysis was performed with an outcome variable of abnormal ALT and a predictor variable of daily fruit and vegetable intake, after adjusting for age, sex, income, alcohol consumption, frequent intake of fast food, frequent beverage intake, daily activity, and obesity groups.

Results:
Participants were 53.0% female, with a mean age of 9.7 years and a mean BMI percentile of 49.4%. Of the total participants, 28.7% were overweight or obese, and 24.3% were in the abnormal range for ALT levels. In a multivariate-adjusted model, children with a daily intake of fruits and vegetables were significantly less likely to have abnormal ALT levels (odds ratio [OR]=0.27, p=.017). Moreover, the obese group was significantly more likely to have abnormal ALT levels than the normal-weight group (OR=9.6, p=.005).

Conclusions:
Among children aged 6 to 12 years, daily fruit and vegetable intake was significantly and inversely associated with abnormal ALT levels, even after adjusting for overall obesity levels. Moreover, obesity in children was significantly associated with abnormal ALT levels. Therefore, ALT levels may reflect healthy eating behavior, especially fruit and vegetable intake, and a risk for obesity in children.
Abstract P062: The Effect of Food Pricing on Dietary Behaviors and Adiposity: a Systematic Review and Meta-analysis
Authors: Afshin Ashkan , Del Gobbo Liana , Silva Jose , Michaelson Melody , Mozaffarian Dariush
Published: July 2021

Background:
While food pricing is a promising strategy to improve diet and reduce cardiometabolic disease, most prior evidence comes from cross-sectional price elasticity estimates. The prospective impact of food pricing on dietary behaviors and obesity has not been systematically evaluated.

Objective:
To systematically investigate and quantify the effect of price change on dietary intake and on adiposity, as well as whether other underlying factors alter these effects.

Methods:
Using MOOSE and PRISMA guidelines, we systematically searched PubMed, Embase, EconLit, OVID, Cochrane library, Web of Knowledge, and CINHAL for prospective observational or interventional studies of price differences and diet (foods, drinks, energy) or adiposity. Studies were excluded if cross-sectional; price data collected before 1990; or reporting only crude risk estimates. Data were extracted independently and in duplicate. Findings were pooled using inverse-variance meta-analysis

Results:
From 2,299 identified abstracts, 21 met inclusions. These included 6 randomized trials and 7 quasi-experimental studies in different settings (supermarket, school/workplace cafeteria, restaurant) in 3 countries (US, New Zealand, Netherland); and 8 observational studies mostly using nationally representative US data. Studies evaluated effects of increase (n=10, 1-35% increase) in price (fast food, energy dense snacks, soda) and decrease (n=11, 10-50% decrease) in price (fruits, vegetables, low fat/calorie products) among adults (n=13) and children (n=8). Studies consistently showed that price increases led to decreased consumption; effects of price decreases on consumption and price increases/decreases on BMI were less consistent. A mean $0.43/serving (12 oz) increase in price of soda was associated with 2.77 servings/wk lower consumption (95% CI: 1.58. 3.96, n=4 studies). A mean %30/serving decrease in price of fruits and vegetables was not significantly associated with consumption (+536 g/d, 95% CI: -427, 1500, n=2 studies). High between study heterogeneity was evident for price increase and soda intake and price discount and fruit intake.

Conclusions:
These prospective results support taxation to reduce soda intake. More evidence from prospective studies and trials is needed on food pricing and other dietary outcomes and adiposity.
Abstract P065: Effects of Palm Oil Consumption on Blood Lipids: A Meta-Analysis of Clinical Trials
Authors: Sun Ye , Neelakantan Nithya , Wu Yi , van Dam Rob M
Published: July 2021

Introduction:
Palm oil is among the most commonly consumed cooking oils worldwide and, in contrast to most other vegetable oils, contains a high amount of saturated fatty acids. It has been suggested that palm oil has unique characteristics resulting in less detrimental effects on blood lipids than expected from its fat content. We therefore evaluated the effect of palm oil consumption on blood lipid concentrations as compared with vegetable oils high in natural unsaturated fatty acids, partially hydrogenated vegetable oils (rich in
trans
-fat), or animal fats.

Methods:
We searched PubMed, the Cochrane Library, Scopus, ProQuest, and Web of Science databases up to 31 October 2012 for trials of at least 2 weeks that compared the effects of palm oil consumption with at least one of the aforementioned comparison oils. Data on effects on total, LDL and HDL cholesterols and triglycerides were pooled using random effects meta-analysis.

Results:
A total of 25 studies were identified comparing palm oil with natural highly unsaturated vegetable oils. Palm oil significantly increased total cholesterol by 0.32 mmol/L (95% CI: 0.19, 0.44; I
2
=85.9%), increased LDL cholesterol by 0.20 mmol/L (95% CI: 0.09, 0.32; I
2
=82.9%), and increased HDL cholesterol by 0.02 mmol/L (95% CI: 0.01, 0.04; I
2
=56%) as compared with control oils. The considerable amount of heterogeneity in study results were partly explained by the type of control oil used, funding source, geographical location, and level of intake of test oil. Statistical tests suggested that this meta-analysis might be subject to publication bias.

Eight studies were identified comparing palm oil with partially hydrogenated vegetable oils. When compared to
trans
-fat rich oils, palm oil significantly increased HDL cholesterol by 0.07 mmol/L (95% CI: 0.05, 0.09; I
2
=19.2%). However, palm oil did not significantly change total cholesterol (0.15 mmol/L, 95% CI: -0.04, 0.33), LDL cholesterol (0.11 mmol/L, 95% CI: -0.04, 0.27), or triglycerides (-0.02 mmol/L, 95% CI: -0.12, 0.07). Geographical location, method of preparation of test oils, and level of intake of
trans
-fat in control intervention were contributors to the heterogeneity in the study results.

The pooled results from the 2 studies on comparison between palm oil and animal fats did not show a significant difference between the two dietary groups for total cholesterol (0.00 mmol/L, 95% CI: -0.08, 0.08), LDL cholesterol (-0.01 mmol/L, 95% CI: -0.08, 0.07), HDL cholesterol (0.00 mmol/L, 95% CI: -0.03, 0.04), or triglycerides (0.02 mmol/L, 95% CI: -0.15, 0.17).

Conclusions:
Palm oil consumption results in higher LDL cholesterol levels than other natural unsaturated vegetable oils. However, palm oil may be preferable to
trans
-fat rich oils based on its effect on HDL cholesterol. More studies are needed to evaluate the effects of palm oil consumption on incidence of coronary heart diseases.