bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P097: Sociodemographic Differences in the Dietary Quality of Food Purchases Among Participants in the Nationally-Representative Food Acquisition and Purchase Study (FoodAPS)
Authors: Vadiveloo Maya , Parker Haley , Juul Filippa , Parekh Niyati
Published: March 2019

Background:
Self-reported dietary data may not accurately represent usual dietary intake. Grocery purchase records provide an objective measure of diet, but little research has explored whether the diet quality of grocery purchases reflects individual-level diet quality and whether it differentiates between groups with known differences in dietary quality. This study evaluated whether there are sociodemographic differences in the dietary quality of grocery purchases akin to those observed in existing individual-level national data.

Hypothesis:
The diet quality of grocery purchases will reflect trends observed with individual-level diet quality.

Methods:
Grocery purchasing data from 3,961 households in the nationally-representative Food Acquisition and Purchase Study (FoodAPS) were used. Dietary data was collected using hand scanners over 7-days, and demographic data was self-reported. The Healthy Eating Index (HEI) 2015 was used to determine grocery purchase quality, and multivariable-adjusted regression with Tukey adjustment or planned contrasts were used to determine whether HEI-15 scores differed according to food insecurity, Supplemental Nutrition Assistance Program (SNAP) participation, obesity within a household, race/ethnicity, and interactions between these variables. FoodAPS sample weights and Taylor series linearization method for variance estimation accounted for the complex sample design.

Results:
Primary respondents were, on average, 50.6 years, non-Hispanic White (70.3%), female (70.2%) and had attended some college (57.8%). The mean HEI-15 score was 54.7; 14.0% of households were food insecure and 12.7% received SNAP benefits. HEI-15 scores differed across all sociodemographic predictors (p<0.05). Additionally, interactions (p<0.1) were detected between SNAP participation and (1) food insecurity and (2) obesity within the household as well as race/ethnicity and obesity within the household. Food secure, non-SNAP households had higher HEI-15 scores than food insecure, SNAP participating households (53.9±0.5 vs. 50.3±0.7, p=0.007) in models adjusted for age, income, smoking, and education. Similarly, non-SNAP households without obesity present had significantly higher HEI-15 scores than all other households. Obesity presence within a household was associated with lower HEI-15 scores in non-Hispanic White (50.8±0.5 vs. 52.5±0.7, p=0.046), and Black households (48.8±1.5 vs. 53.1±1.4, p=0.018), but not Hispanic households (54.4±1.0 vs. 52.2±1.2, p=0.21).

Conclusions:
Disparities in the diet quality of grocery purchases reflect individual-level trends and vary based on sociodemographic factors. This analysis highlights the interrelationships between SNAP, food insecurity, race/ethnicity, and obesity within a household, demonstrating how the co-occurrence of risk factors may modify associations with diet quality.
Abstract P099: Heart Rate Variability Differences Between Green and Suburban Walking: A Pilot Crossover Study
Authors: Pope Zachary C , Brito Junia N , Mitchell Nathan R , Schneider Ingrid E , Horton Teresa H , Pereira Mark A
Published: March 2019

Introduction:
Heart rate variability (HRV) assesses the sympathetic and parasympathetic innervation of the heart. Lower HRV indicates greater sympathetic tone and is associated with adverse cardiovascular outcomes. During exercise, factors like activity intensity influence HRV. Yet, an environment’s inherent anxiety-/stress-promoting characteristics may also affect HRV.

Hypothesis:
Given nature’s calming characteristics, we hypothesized green (i.e., nature-based) walking would promote higher HRV and less HRV reduction than suburban walking.

Methods:
Twenty-four middle-aged adults (20 female; 49.3 ± 6.7 yrs; BMI: 30.7 ± 7.9 kg/m
2
) participated in this nine-week crossover study comprised of once-weekly 50-minute moderate-intensity walking sessions. Participants walked for three weeks in each of two treatment conditions: (1) green walking: nature-based walking on trails of local arboretum; and (2) suburban walking: walking on sidewalks of a local suburb’s downtown area. Half were assigned to suburban walking in the first treatment period, and half completed green walking first. A two-week washout separated treatments. The Zephyr BioHarness 3 assessed HRV—reported as standard deviations of normal-to-normal RR intervals in milliseconds (ms) while also tracking activity intensity. For analysis, walks were split into 15-minute intra-walk phases with the first, second, and third phases representing each walk’s beginning, middle, and end. Five-minute pre- and post-walk sitting phases for HRV were also created. Linear mixed models with repeated measures evaluated HRV phase differences between treatments and HRV change between phases by treatment.

Results:
Lower HRV was observed during the pre-walk sitting phase in the green (56.5 ms) vs. the suburban walking treatment (62.4 ms;
p
= 0.04); however, a sequence effect was present (
p
= 0.02). Due to lower walking intensity during green walking (0.31 g vs. 0.27 g;
p
< 0.01), activity intensity was a covariate in all intra-walk analyses. Intra-walk phase analyses revealed higher green vs. suburban walking HRV during the second (29.1 ms vs. 24.2 ms, respectively;
p
< 0.01) and third (33.9 ms vs. 23.8 ms, respectively;
p
= 0.03) phases. Further, less HRV reduction was seen between the first and second intra-walk phases during green (-7.6 ms) vs. suburban walking (-12.4 ms;
p
= 0.05). Between-treatment HRV differences were not found for the post-walk sitting phase. No sequence effects were observed for the intra-walk or post-walk phases. Finally, no carryover effects were observed—suggesting adequate washout between treatments.

Conclusions:
Green walking elicits higher HRV and less HRV reduction vs. suburban walking. Activity intensity did not explain these observations. Fully powered longer-term trials should rigorously evaluate green walking’s potential anxiety-/stress-reducing characteristics.
Abstract P101: Neighborhood Walkability and Risk of Hypertension
Authors: Jones Alana , Colabianchi Natalie , Howard Virginia , Howard George , Irvin Ryan , Chaudhary Ninad , Judd Suzanne E
Published: March 2019

Introduction:
Over the past decade, studies on associations between built environments and health outcomes have exponentially increased, particularly regarding walkability. Some studies have shown associations between walkability and lower blood pressure, as well as other cardiometabolic risk factors.

Objective:
The purpose of this study was to investigate associations between objectively measured neighborhood walkability and incidence of hypertension in older adults in a national cohort study in the United States.

Methods:
Neighborhood walkability was measured by Walk Score, and scores were generated for participants in the Reasons for Geographical and Racial Differences in Stroke Study (REGARDS, n=30,172). Descriptive statistics were reported by the categories of Walk Score: Car-Dependent, Somewhat Walkable, Very Walkable, and Walker’s Paradise. Associations between walkability and blood pressure were tested both cross-sectionally and longitudinally. Covariates included age, race, sex, geographical region, income, education, health behaviors (i.e., smoking, alcohol use, exercise), and cardiovascular comorbidities (i.e., dyslipidemia, diabetes). Linear models tested associations between Walk Score and systolic and diastolic blood pressure. Logistic regression models tested associations between Walk Score and incident, prevalent, and treated hypertension.

Results:
In adjusted analyses, Walk Score category was not associated with incident hypertension in the entire cohort. However, among white participants, a higher Walk Score category was associated with a lower odds of incident hypertension. In secondary analyses, higher Walk Score category was associated with lower odds of treated hypertension (OR 0.87, 95% CI 0.78-0.97, p=0.03). Higher Walk Score was linearly associated with higher diastolic blood pressure cross-sectionally in black participants but not among the entire cohort (P-interaction=0.02).

Conclusions:
We found limited evidence that higher walkability was an important contributor to hypertension. Further studies are needed to understand the associations between walkability and cardiovascular health outcomes. A better understanding of the relationship between residential features and hypertension could potentially help redefine intervention strategies for cardiovascular disease risk reduction.
Abstract P102: Air Pollution, Traffic Noise and Development of Subclinical Atherosclerosis in the Thoracic Aorta
Authors: Hoffmann Barbara , Hennig Frauke , Geisel Henrike , Lucht Sarah , Moebus Susanne , Erbel Raimund , Jöckel Karl-Heinz , Scherag André , Kälsch Hagen
Published: March 2019

Background:
Air pollution and noise are suggested to be related to subclinical atherosclerosis, but evidence is scarce and inconsistent. We investigated the independent associations and interactions of long-term exposure to air pollution and road traffic noise with development and progression of thoracic aortic calcification (TAC).

Methods:
We used baseline (2000-2003) and follow-up (2006-2008) data from the German Heinz Nixdorf Recall Study, a population-based cohort of 4,814 randomly selected participants. We assessed residential long-term exposure to air pollution and noise with chemistry transport and noise propagation models, respectively. TAC was quantified from non-contrast enhanced electron beam computed tomography. Incident TAC and percent increase in TAC progression were analyzed with multiple logistic and linear regression, respectively, adjusted for age, sex, lifestyle variables, and individual and area-level socioeconomic status.

Results:
The analysis sample comprised 3,125 participants (mean age 59.4 years, 49.9% male) with a mean follow-up of 5 years. Traffic-related air pollutants and night-time noise (L
night
) were associated with incident TAC (OR 1.18 [95%CI: 0.98-1.41] per IQR of particle number concentration and 1.20 [0.99, 1.46] per 5 dB(A) L
night
). Similar associations were observed for TAC progression (0.14% [0.00; 0.28%] per IQR of NO
2
and 0.18% [0.02; 0.35%] per 5 dB(A) L
night
), in those with minimal calcification at baseline. Results did not change upon mutual adjustment.

Conclusion:
Our study suggests that air pollution and road traffic noise may be weakly associated with the development of subclinical atherosclerosis, which remained robust when taking the other exposure into account.
Abstract P108: Wnt Pathway Gene Expression is Associated With Greater Arterial Stiffness
Authors: Kuipers Allison L , Barinas-Mitchell Emma , Nestlerode Cara S , Wheeler Victor W , Miljkovic Iva , Zmuda Joseph M
Published: March 2019

The wingless (Wnt) pathway is known to regulate many systems, including embryonic development, bone mineralization, and cancer. Now there is emerging evidence from Basic and our own Population research that Wnt pathway activation is associated with cardiovascular disease (CVD) pathologies, including atherosclerosis and arterial stiffening. However, research on this association in humans is still under-studied and limited in scope. As such, we aimed to survey the entire Wnt signaling pathway for association with subclinical CVD, using a custom gene expression panel (Nanostring, Seattle, WA) of 43 Wnt genes with previous Basic research evidence for a role in vascular disease. We ran this panel in stabilized peripheral blood RNA from 369 African Ancestry men in the Tobago Health Study (mean age 64 years, range 51-89 years). Subclinical CVD assessments were completed at the same study visit as the blood draw, including: arterial stiffness measured by brachial-ankle pulse-wave velocity; atherosclerosis measures of carotid plaque and intima-media thickness via B-mode ultrasonography; and vascular calcification measured by computed tomography in the chest (coronary) and abdomen (aorta). Gene expression was measured in counts per sample, was normalized to housekeeping genes, and the background signal was subtracted. All gene expression and outcome measures were transformed to normality after excluding any extreme outliers. Fourteen Wnt genes showed variable expression in our sample and were tested individually as predictors of subclinical CVD using multiple linear or logistic regression, as appropriate. A conservative Bonferroni-corrected alpha (0.05/14 genes = 0.0036) was used to account for multiple comparisons in unadjusted models. Associations passing this threshold were then adjusted for common CVD risk factors including age, height, weight, hypertension, pulse, diabetes, smoking, alcohol intake, and sedentary lifestyle. After full adjustment, expression of APC, WNT signaling pathway regulator (
APC
) and transcription factor 4 (
TCF4
) showed significant association with arterial stiffness (P=0.012 for both). When entered into a single model (Spearman r=0.14, P=0.007),
APC
and
TCF4
expression were independently associated with arterial stiffness (P=0.004 for both), such that higher expression of
APC
, but lower expression of
TCF4
, was associated with greater arterial stiffness. No other tested genes or subclinical CVD measures passed both the conservative unadjusted alpha level and the full model adjustment. This study represents the first test of the association between broad Wnt signaling pathway gene expression and subclinical CVD. While
APC
and
TCF4
have shown some association with vascular pathologies in Basic research, this is the first study to establish the association of their expression with human arterial stiffness.
Abstract P109: Genetic Correlates of Resilience Among African American Families From the Jackson Heart Study
Authors: Glover La’Shaunta’ , Sims Mario , North Kari , Norris Keith , Smith Jennifer , Taylor Jacquelyn , Singh Abanish , Musani Solomon
Published: March 2019

Background:
Research has reported that measures of resilience, such as optimism, social support, and religious coping are positively associated with longevity, but there are limited studies on the genetic contribution of resilience among African Americans. Utilizing Jackson Heart Study (JHS) data, we examined the heritability estimates of markers of resilience and their association with proportion of West African genetic ancestry (pAfr) in order to understand familial patterns of resilience among African Americans.

Hypothesis:
We hypothesized that genetic variation would contribute significantly to variation in indicators of resilience, and that pAfr will be positively associated with greater resilience in African Americans.

Methods:
Resilience measures (optimism, social support, social networks, religious experiences, and religious practices and coping) were obtained from validated questionnaires. Scores were created for each resilience measure and then all measures were summed to create a total resilience score among 1,200 related and 1,456 unrelated individuals of the JHS cohort. We then analyzed the subset of related individuals to estimate polygenic heritability for resilience measures using Sequential Oligogenic Linkage Analysis Routines (SOLAR), and evaluated the subset of unrelated participants for the association between resilience and pAfr using a multiple linear regression model. The pAfr was estimated from more than 1,400 ancestry informative markers that differentiate West African genetic ancestry from European ancestry using HAPMIX genetic software. In both analyses, we controlled for age, sex, age-by-sex interaction, education, physical activity, smoking and depressive symptoms.

Results:
In related individuals, we found a significant proportion of variation (h
2
±SE; p-value) due to familial correlation on religious practices and coping (0.15±0.09; p=0.0371); religious experience (0.26±0.09; p<0.001); social networks (0.32±0.07; p<0.001); and optimism (0.21±0.08; p<0.001). Heritability estimates for total resilience and social support were not significant. In the subset of unrelated individuals, we found that pAfr was significantly associated (beta±SE; p-value) with total resilience (3.08±1.44; p=0.0327), religious experience (5.16±2.55; p=0.0437), and religious practices and coping (3.77±1.23; p=0.0023) in men but not in women.

Conclusion:
In this sample of African Americans, we found evidence that variation in markers of resilience are influenced by genetic ancestry and sex. West African genetic background was associated with markers of resilience in men only. Due to lack of household effects we could not account for influence of the common environment, which is a limitation of these findings. However, because we found genetic influences of resilience, future studies that explore associations with longevity loci are warranted.
Abstract P114: Genetic Polymorphisms of
CD36
Associated With Metabolic Syndrome in Chinese Han Population: A Nested Case-Control Study
Authors: Zhang Ruiyuan , Zhang Dongdong , Liu Yu , Sun Xizhuo , Yin Zhaoxia , Zhao Yang , Wang Bingyuan , Ren Yongcheng , Liu Xuejiao , Liu Dechen , Liu Feiyan , Chen Xu , Liu Leilei , Cheng Cheng , Zhou Qionggui , Li Changwei , Hu Dongsheng , Zhang Ming
Published: March 2019

Aims:
CD36
, an important gene involved in cholesterol and fatty acid metabolism,, has been associated with many metabolic-related traits, including diabetes, hypertension, and obesity in different populations. However, the association of this gene with metabolic syndrome (MS) has not been well-studied. We aimed to investigate the association of
CD36
with the risk of MS and longitudinal changes of its components in among participants of the Rural Chinese Cohort Study (RCCS).

Materials and Methods:
The RCCS enrolled 20,194 participants aged
2
18 years old between July of 2007 and August of 2008. A total of 17,265 participants (response rate 85.5%) were examined in the follow-up survey between July of 2013 and October of 2014. During the six years, 729 new incident cases of MS were ascertained. We conducted a nested case-control study within the RCCS. Specifically, 408 MS randomly cases and 408 one-to-one matched controls were included in the current study. In addition to follow-up time, non-MS controls were matched to MS cases on age, gender, marital status, and residence village. Human genomic DNA was extracted using a standard method from blood samples collected at the baseline. After quality control, 4 single nucleotide polymorphisms (SNPs) within the
CD36
were successfully genotyped. MS was defined according to the 2009 criteria proposed by IDF and AHA/NHLBI. Multivariate conditional logistic regression was used to determine additive associations of SNPs and SNP-haplotype with MS adjusting for body mass index (BMI), smoking, drinking, and physical activity at baseline. Multivariate linear regression models were conducted among the control group to examine association of SNPs and SNP-haplotypes with MS components, controlling for age, gender, BMI, smoking, drinking and physical activity. Multiple testing was corrected by false positive discovery rate (FDR) method.

Results:
Two SNPs, rs7755 and rs1049673, were associated with risk for MS. Per minor allele increase in rs7755 and rs1049673 was associated with 2.29 (95% confidence interval [CI]: 1.24-4.24,
p
=0.008) and 2.30 (95% CI: 1.24-4.26,
p
=0.008) times higher odds of MS, respectively. In addition, rs1194197 was associated with changes of triglycerides level (β=0.151,
p
=0.014), and rs7755 (β=-0.065,
p
=0.028) and rs1049673 (β=-0.067,
p
=0.025) were associated with changes of high density lipoprotein cholesterol in the control group. One haplotype of the four SNPs, AGAG, was associated with the change of waist circumference (β=-1.773,
p
=0.048).

Conclusions:
We identified important SNPs and SNP-haplotypes of the CD36 associated with MS and changes of MS components in a Han Chinese population.
Abstract P115: Prevalence of Undiagnosed Diabetes Decreases by Eighty Percent When A1C Replaces the OGTT: The Africans in America Study
Authors: Briker Sara M , Mugeni Regine , Horlyck-Romanovsky Margrethe F , Aduwo Jessica Y , DuBose Christopher W , Mabundo Lilian S , Ha Joon , Sherman Arthur , Sacks David B , Sumner Anne E
Published: March 2019

Introduction:
Africa has the highest prevalence of undiagnosed diabetes (DM) in the world. It is unknown whether programs designed to screen for DM in Africa should rely on hemoglobin A
1C
(A1C) or the 2h oral glucose tolerance test (OGTT). In general, the prevalence of undiagnosed DM is lower when detection is based on A1C rather than the OGTT. However, the degree to which the prevalence of undiagnosed DM would be lower in Africans if A1C rather than the OGTT was used is unknown. Heterozygous hemoglobinopathies such as sickle cell trait (SCT) and hemoglobin C (HbC) trait may lower A1C independent of the degree of glycemia, potentially compromising the ability of A1C to detect DM.

Objective:
Our goals were to determine in Africans the rate of detection and reproducibility of the diagnosis of DM by both A1C and OGTT.

Methods:
Ninety African-born blacks (66% (59/90) male, age 40±11y (mean±SD), BMI 27.6±4.6 kg/m
2
) who self-identified as healthy, currently live in the Washington DC area and enrolled in the Africans in America study had two OGTT performed 10±8 days apart. At both visits A1C was assayed by HPLC from whole blood and glucose from plasma samples taken at -15, 0, 30, 60, 90 and 120 minutes. For A1C, DM was diagnosed by levels ≥6.5%. For the OGTT, fasting glucose ≥126 mg/dL or 2h glucose≥200 mg/dL was required to diagnose DM. The κ-statistic was used to evaluate reproducibility. Hemoglobin electrophoresis was performed.

Results:
At Visit 1: DM was diagnosed by A1C in 4% (4/90) and by OGTT in 26% (23/90). At Visit 2: DM was diagnosed by A1C in 3% (3/89) and by OGTT in 21% (19/90). Diagnosis by A1C and OGTT displayed substantial (κ=0.74) and almost perfect (κ=0.88) reproducibility, respectively. All persons with DM diagnosed by A1C criteria at either visit were also diagnosed by OGTT. However, 83% (19/23) of people with DM diagnosed by OGTT were not detected by A1C. In the entire cohort the combined prevalence of HbS and HbC trait was 14% (13/90). However, the prevalence of SCT and HbC trait in people with DM diagnosed by OGTT was 42% (8/19), but no one with SCT or HbC trait had an A1C level≥6.5%.

Conclusion:
Diagnosis of DM by both A1C and OGTT are highly reproducible in African immigrants. However, A1C detects 80% fewer people with DM than does the glucose criteria for the OGTT. The clinical consequences of this lower rate of detection of DM by A1C remains to be determined in prospective studies.
Abstract P116: The Oral Glucose Tolerance Test is Highly Reproducible for the Diagnosis of Diabetes in Africans: The Africans in America Study
Authors: Briker Sara M , Mugeni Regine , Horlyck-Romanovsky Margrethe F , Aduwo Jessica Y , DuBose Christopher W , Chung Stephanie T , Ha Joon , Sherman Arthur , Sumner Anne E , Mabundo Lilian S
Published: March 2019

Introduction:
As the diabetes epidemic spreads across Africa, the oral glucose tolerance test (OGTT) has the potential to provide important information on glucose tolerance category for the individual and across the population. However, for both patient care and the collection of prevalence statistics, there needs to be a high degree of certainty that the diagnosis made by a single OGTT is reproducible. There are no rigorous studies on the reproducibility of the OGTT in Africans.

Objective:
By performing two OGTT in African-born blacks living in the Washington DC area, our goal was to evaluate the reproducibility of: a) the glucose tolerance category b) time to glucose peak, c) shape of glucose curve, d) glucose concentration at 60 minutes.

Methods:
The participants were 90 African-born blacks (66% male (59/90), age 40±11y (mean±SD), BMI 27.6±4.6 kg/m
2
), who self-identified as healthy and were enrolled in the Africans in America cohort. Two OGTT were performed 10±8 days apart. At each OGTT plasma samples were taken at -15, 0, 30, 60, 90 and 120 minutes. Diabetes (DM), prediabetes (pre-DM) and normal glucose tolerance (NGT)was defined by ADA guidelines for glucose. The shape of the glucose curve was characterized as monophasic, biphasic or indeterminate. During the OGTT, glucose at 60 minutes ≥ 155 mg/dL was defined as elevated. The κ-statistic was used to evaluate reproducibility (slight 0.00 to 0.20, fair 0.21 to 0.40; substantial 0.61 to 0.80, excellent 0.81 to 1.0).

Results:
At OGTT-1, DM, pre-DM and NGT occurred in 26% (23/90), 27% (24/90) and 48% (43/90), resp. At OGTT-2, DM, pre-DM and NGT occurred in 21% (19/90), 28% (25/90) and 51% (46/90) resp. Reproducibility for the diagnosis of glucose tolerance status (NGT, pre-DM, or DM) was just substantial (κ=0.66). However, reproducibility for the diagnosis of diabetes (DM or no DM) was excellent (κ=0.88). Furthermore, no one without DM at OGTT-1 was identified as having DM at OGTT-2. The reproducibility of time to glucose peak was only fair (κ=0.32), but 100% of participants with DM had peak glucose after 30 min. Similarly, the shape of the glucose curve had fair reproducibility (κ=0.21), but no one with DM had a biphasic curve. For elevated 60 min glucose, reproducibility was substantial (κ=0.62) and 96% (22/23) of the participants with DM had elevated glucose at 60 min.

Conclusion:
When duplicate OGTT were performed in Africans, the diagnosis of DM and the morphology of the glucose curves were highly reproducible.
Abstract P122: Intersectional Effects of Racial and Gender Discrimination on Cardiovascular Health Vary Among Black and White Women and Men in the Cardia Study
Authors: Bey Ganga S , Person Sharina D , Kiefe Catarina
Published: March 2019

Background:
Some evidence suggests an association of perceived racial but not gender discrimination with disparities in cardiovascular health (CVH) among U.S. black women and men. We assessed whether there are race-gender differences in the effects of reporting experiences of racial and gender discrimination simultaneously compared with racial or gender discrimination alone, or no discrimination, on future CVH.

Methods:
Data were from a sample of 3,758 black or white adults in CARDIA, a population-based cohort recruited in Birmingham, AL; Chicago, IL; Minneapolis, MN, and Oakland, CA in 1985-6 (year 0). Racial and gender discrimination were assessed using the Lifetime Discrimination Scale at year 7. CVH at year 30 was evaluated using a 12-point composite outcome modified from the AHA’s Simple 7, with higher scores indicating better health. Multivariable linear regressions evaluated the associations between level of perceived discrimination at year 7 and CVH scores at year 30 stratified by race-gender.

Results:
Reporting racial and gender discrimination in ≥2 settings were 48% (496/1039) of black women, 42% (311/743) of black men, 10% (109/1045) of white women, and 5% (45/931) of white men. Year 30 CVH scores (mean, SD) were 7.9 (1.4), 8.1 (1.6), 8.8 (1.6), and 8.7 (1.3), respectively. Table: Compared with those of their race-gender groups reporting no discrimination, white women reporting gender only saw an adjusted score difference of +0.3 (
p
=0.04); white men reporting racial only, +0.4 (
p
=0.02), and both racial and gender, -0.6 (
p
=0.03).

Conclusions:
Racial and gender discrimination interact in their association with CVH differently for different race-gender groups. While modest, a 1-point decrease in CVH score among white men has been shown to correspond to an ~30% increase in the rate of CVD development. More research is needed to understand why perceived discrimination might better predict CVH for whites than blacks, and which other factors associated with race-gender contribute variability to CVH among these groups.
Abstract P134: Greater Burden of Cardiovascular Disease Among Incarcerated Women of Color Compared to Whites
Authors: Jimenez Monik C , Lopez Lenny , Rexrode Kathryn M
Published: March 2019

Background:
Although non-institutionalized black American and Latino adults exhibit a disproportionate burden of cardiovascular disease (CVD) compared to US whites, racial/ethnic disparities are not consistently observed among those incarcerated. Importantly, it is uncertain whether the burden of multiple cardiovascular conditions varies by race/ethnicity among incarcerated individuals.

Hypothesis:
We assessed the hypothesis that the burden of multiple CVD conditions would be higher among incarcerated non-Hispanic blacks (black) and Latinos compared to non-Hispanic whites (white).

Methods:
Data from a sample of 14,499 men and women (weighted N=689,161) from the 2004 Survey of Inmates in State Correctional Facilities, a nationally representative sample of adults incarcerated in state facilities, were analyzed. Computer-assisted personal interviews were utilized to collect information on medical history, demographic and socioeconomic factors, prison activities and various offense related factors. Race/ethnicity was defined as self-reported white, black, Spanish/Latino/Hispanic (Latino), or Other. Prior or current CVD conditions (hypertension, diabetes, BMI≥30 kg/m
2
, heart problems, or stroke) were obtained by self-report. Body mass index (BMI, kg/m
2
) was based on self-reported height and weight. Three separate outcomes were defined based on the cumulative number of CVD conditions (≥1, ≥2 or ≥3 CVD conditions). Age-adjusted survey weighted multivariable logistic regression was used to estimate racial/ethnic disparities in the burden of CVD conditions separately by sex.

Results:
The median age was 34 years (IQR: 26-42) among men and 35 years (IQR: 27-41) among women. A history of ≥1 CVD condition was reported by 41% of men and 51% of women, while 26% of men and 37% of women reported ≥2 CVD conditions and 10% and 15% of men and women, respectively, reported ≥3. In age adjusted models, among women, significant racial/ethnic disparities were observed among both black and Latina women across all three definitions of CVD burden. The greatest disparities were observed among black women with ≥2 CVD conditions (OR=1.94, 95% CI: 1.62-2.33) followed by Latinas (OR=1.67, 95% CI: 1.32-2.13) compared to whites. Among men in age-adjusted analyses, black men exhibited a similarly greater odds of ≥2 or ≥3 CVD conditions (OR=1.31, 95% CI: 1.18-1.45 and OR=1.36, 95% CI: 1.17-1.57, respectively) compared to white men. Among Latino men compared to whites, modest disparities were only observed for ≥2 CVD conditions (OR=1.17, 95%CI: 1.03-1.33).

Conclusions:
Black and Latina women and black men exhibited a significantly greater burden of CVD conditions compared to white women and men, respectively. These data highlight the prominent racial/ethnic disparities among incarcerated populations of color and the need for tailored interventions to reduce cardiovascular risk in these populations.
Abstract P135: Regional Differences in Epidemiology and Outcomes of Heart Failure Admissions Across the United States
Authors: Goel Akshay , Paydak Hakan , Mehta Jawahar
Published: March 2019

Introduction:
Periodic surveillance of geographical variations in cardiovascular health is important to achieve the goal of reducing regional disparities in healthcare delivery. We aimed to study differences in epidemiology and outcomes of heart failure admissions by geographic regions in the United States.

Hypothesis:
We assessed the hypothesis that there exist differences in the outcomes of heart failure admissions based on geographic region.

Methods:
The National Inpatient Sample database for the year 2016 was queried. Adult patients admitted with a principal diagnosis of heart failure were identified using validated ICD-10 codes. Comparisons were made between four regions - Northeast, Midwest, South and West. Baseline characteristics of heart failure admissions were identified. The main outcomes of interest were inpatient mortality, length of stay and hospital charges. Statistical analysis was performed using STATA.

Results:
A total of 807,764 hospitalizations with a principal diagnosis of heart failure were identified. Of these, 153,233 (18.97%) were in the Northeast; 184,090 (22.79%) in the Midwest; 331,506 (41.04%) in the South; and 138,935 (17.20%) in the West. The baseline characteristics of these admissions and outcomes of interest are depicted in the table. There was a small difference in the mortality rates (highest in West at 3%, and lowest in South at 2.66%, p=0.03) and length of stay (longest in the Northeast, and shortest in the West, p<0.001) between regions. A significant difference was observed in the total hospital charges per hospitalization (nearly $65,000 in the West, and only $37,000 in the Midwest, p<0.001). The differences in all outcomes persisted after adjusting for variables like age, gender, race and co-morbid conditions.

Conclusions:
Our study demonstrates the existence of regional differences in the costs and outcomes of healthcare delivery to heart failure patients. Further research is needed to explore the reasons for these differences.
Abstract P136: The Association Between Depressive Symptoms and Cardiovascular Disease Risk Factors Among West African Immigrants in the African Immigrant Health Study
Authors: Nmezi Nwakaego A , Turkson-Ocran Ruth-Alma , Commodore-Mensah Yvonne
Published: March 2019

Introduction:
Cardiovascular disease (CVD) is the leading cause of death globally and in the US. Blacks have a higher burden of CVD compared to other racial/ethnic groups. However, Blacks are not monolithic and include both foreign-born and US-born individuals. West African immigrants (WAIs)—a sub-group of US Blacks—are a growing immigrant population. It is unknown whether depressive symptoms are associated with CVD risk factors among WAIs.

Hypothesis:
We hypothesized that depressive symptoms will be associated with having ≥2 CVD risk factors among WAIs.

Methods:
We included WAIs born in Ghana, Nigeria, Liberia, Sierra Leone and Cameroon who participated in the African Immigrant Health Study in Baltimore-Washington D.C. The main predictor was depression scores on the Patient Health Questionnaire (PHQ-8). The main outcome variable was CVD risk defined as having ≥2 risk factors, including body mass index, self-reported diabetes, hypertension, and hyperlipidemia. Multivariable logistic regression was used to examine the association between depressive symptoms and CVD risk adjusting for age, sex, household income, marital status, and level of education.

Results:
A total of 326 WAIs were included. The mean age (±SD) was 46 (±10.6) years. Females made up approximately 60% of the sample (n=194). Approximately half of participants reported residing in the US for ≥10 years. Also, 31% were diagnosed with hypertension, 88% were overweight/obese, 20% were diagnosed with high cholesterol and 13% were diagnosed with diabetes. Overall, 41% of participants (n=133) had ≥2 CVD risk factors and 7% (n=22) had moderate/severe depression (PHQ-8 scores ≥10). WAIs who had mild to severe depression were 2.31 (95%CI: 1.2-4.4) times more likely to have ≥2 CVD risk factors compared to those without reported minimal depression levels in the adjusted analyses.

Conclusion:
We observed a positive association between symptoms of depression and CVD risk factors. WAIs with elevated symptoms of depression had a higher likelihood of having ≥2 CVD risk factors than those reporting minimal depressive symptomology. Targeted behavioral health interventions are needed to help address psychosocial determinants of cardiovascular health among WAIs residing in the US.
Abstract P153: Depressive Symptoms and First Hospitalization for Heart Failure: Findings From the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Khodneva Yulia , Goyal Parag , Levitan Emily , Jackson Elizabeth , Sterling Madeline , Cherrington Andrea , Durant Raegan , Safford Monika
Published: March 2019

Introduction:
Depressive symptoms are independently associated with cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke. It is unclear whether depressive symptoms are associated with first heart failure (HF) hospitalization and whether this relationship differs by ejection fraction (EF). We hypothesized that depressive symptoms are associated with increased risk of first HF hospitalization among community dwelling adults free of HF or coronary heart disease at baseline, and that this relationship would be similar by EF.

Methods:
We examined this relationship in the REGARDS study, a prospective longitudinal cohort of community dwelling adults aged ≥45 years (55% women, 41% black) from across the continental US, with oversampling of blacks and residents of the Southeast. Participants completed a baseline survey on medical history and health behaviors, and an in-home visit which collected physiologic parameters, blood and urine samples, ECG, and medication inventory. Participants are followed prospectively and hospital records are collected for CVD-related hospitalizations. Depressive symptoms were defined as score ≥4 on the 4-item Center for Epidemiologic Studies Depression scale (CES-D-4). HF hospitalizations were expert adjudicated and specified according to EF as preserved EF (EF >40%) (HFpEF) or reduced EF (EF≤ 40%) (HFrEF).

Results:
Over a median [IQR] of 9.3 [6.4-11] years of follow-up, there were 614 first HF hospitalizations among 22,465 individuals (384 HFpEF, 230 HFrEF). Participants with depressive symptoms had less education and lower annual income. The age-adjusted first HF hospitalization incidence rates per 1000 person-years were 4.6 (95% CI, 3.2-4.0) for participants with depressive symptoms versus 2.6 (95% CI, 2.3-2.8) for non-depressed, p 0.0002. This elevated risk remained significant after controlling for a host CVD risk factors. When HFpEF was assessed separately, depressive symptoms were associated with increased risk of hospitalization after controlling for all covariates (hazard ratio [HR] 1.54, 95% CI 1.06-2.22). In contrast, depressive symptoms were not associated with first HFrEF hospitalization in both unadjusted and adjusted analyses.

Conclusions:
Depressive symptoms at baseline were independently associated with future risk of first hospitalization for HFpEF but not for HFrEF.
Abstract P154: Healthy Lifestyle and Risk of Incident Heart Failure With Preserved and Reduced Ejection Fraction in Postmenopausal Women: The Women’s Health Initiative Study
Authors: Noel Corinna A , LaMonte Michael J , Pearlman Deborah , Allison Matthew , Shadyab Aladdin H , Haring Bernhard , Warsinger Martin Lisa , Banack Hailey , Laddu Deepika , Nguyen Patricia K , Manson JoAnn E , Eaton Charles B
Published: March 2019

Background:
Heart failure (HF) is a growing health concern in the United States. Lifestyle risk factors including diet, physical activity, cigarette smoking, and body mass index (BMI), have been shown to be independently and jointly associated with incident heart failure. However, these associations have not been evaluated for HF subtypes, HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF).

Objective:
To assess the combined associations of diet, physical activity, cigarette smoking, and BMI with risk of HFpEF and HFrEF subtypes.

Methods:
39,893 postmenopausal women aged 50-79, without self-reported HF at baseline, were included in this analysis. A lifestyle score was created following a similar method previously used in WHI, defining the following healthy criteria: high diet quality (Alternate Healthy Eating Index quintile 4 or 5), being physically active (more than 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise or equivalent combination), not a current cigarette smoker, and BMI between 18.5 and 25 kg/m
2
. Women received 1 point for each healthy criterion that was met, and points were summed to obtain the healthy lifestyle score, ranging in value from 0 (least healthy) to 4 (most healthy). Trained adjudicators determined cases of incident heart failure through 2018, defining HFpEF as EF≥45% and HFrEF as EF<45%.

Results:
Over a mean follow-up of 14.5 years, 2426 HF incident hospitalized cases were documented and confirmed, classifying 1345 cases as HFpEF and 685 cases as HFrEF. Healthy lifestyle was strongly associated with a decreased risk of both HFpEF and HFrEF (Table).

Conclusion:
Findings suggest that a healthy lifestyle may be associated with decreased risk of HF subtypes among postmenopausal women. Results from this research provide a better understanding of the role of modifiable lifestyle factors in each of the HF subtypes, allowing for the development of more targeted primary and secondary prevention strategies specific to HFpEF and HFrEF.
Abstract P157: Association of Rurality With Death in Patients With Heart Failure: a Community Study
Authors: Manemann Sheila , St. Sauver Jennifer , Finney Rutten Lila , Fabbri Matteo , Chamberlain Alanna , Weston Susan , Jiang Ruoxiang , Roger Veronique L
Published: March 2019

Background:
Previous studies have indicated that living in a rural or non-urban area may be associated with poor health outcomes. However, data on rurality and death in heart failure (HF) are scarce.

Methods:
Residents from 11 southeast MN counties with a first-ever code for HF (including codes ICD-9 428 and ICD-10 I50) between 1/1/2013 and 12/31/2016 were identified. Resident address was geo-coded and classified according to the Rural-Urban Commuting Area (RUCA) codes, which classifies US census tracts to measure population density, urbanization and daily commuting. Rurality was defined as living in a non-metropolitan area. Cox proportional hazards regression was used to determine the association between living in a rural vs. urban area and death.

Results:
Among 6,996 patients (mean age 73 years, 52% male), 54% of patients lived in a rural area. These patients were older and had a lower level of educational attainment and comorbidity burden (p<0.001). After a mean (SD) follow-up of 2.9 (1.3) years, 1,856 deaths occurred. Living in a rural area was univariately associated with a higher risk of death (HR 1.20, 95% CI: 1.09-1.31; Table). After adjustment for age, sex, education status and comorbidity burden, rurality remained associated with an increased risk of death (HR 1.15; 95% CI: 1.04-1.27).

Conclusions:
Among patients with HF, living in a rural area is associated with an increased risk of death. Further study to identify and address the mechanisms through which rural residence influences mortality in patients with HF is needed.
Abstract P160: Racial Differences in the Association of NTproBNP With Risk of Incident Heart Failure in REGARDS Participants
Authors: Patel Nirav , Cushman Mary , Gutiérrez Orlando , Howard George , Safford Monika , Muntner Paul , Durant Raegan , Prabhu Sumanth , Arora Garima , Levitan Emily , Arora Pankaj
Published: March 2019

Background:
Black individuals have lower N-terminal-pro-B-type natriuretic peptide (NTproBNP) levels than whites. Higher NTproBNP levels are associated with increased risk of incident heart failure (HF). Although, the ability of NTproBNP for risk stratification is variable in the setting of obesity and kidney disease. We studied the 1) association of NTproBNP with incident HF stratified by race and 2) tested the predictive ability across body mass index (BMI) and estimated glomerular filtration rate (eGFR) categories.

Methods:
Using a case-cohort design, NTproBNP levels were measured from the Reasons for Geographic And Racial Differences in Stroke study for 855 participants who subsequently developed incident HF and 3,680 randomly selected participants. Multivariable Cox proportional hazard modeling including all the factors which can affect NTproBNP levels was used to assess 1) the association of NTproBNP with incident HF; 2) interaction by race, and 3) predictive ability of NTproBNP based on percentage contribution in global Wald Chi-square score across BMI and eGFR categories.

Results:
The mean age of the random sub-cohort was 66.6 (12.1) years, 1,847 (50.2%) were females and 1,775 (48.2%) were blacks. The magnitude and strength of the relationship of NTproBNP with incident HF differed by race (p=0.01 for interaction). A doubling in NTproBNP levels was associated with greater risk of incident HF among whites [(hazard ratio (HR): 1.82; 95% CI: 1.62-2.04] compared with blacks (HR: 1.54; 95% CI: 1.35-1.75). NTproBNP remained a strong predictor (25%-50% Wald score) of incident HF across all BMI and eGFR categories in whites. However, among blacks with obesity (BMI ≥ 30 kg/m
2
) and eGFR ≤60 mL/min/1.73 m
2
, NTproBNP was a weak predictor of incident HF (<7% Wald score) (
Figure
).

Conclusions:
Higher NTproBNP was more strongly associated with incident HF among whites compared with blacks. The predictive ability of NTproBNP levels with incident HF was preserved with obesity and impaired renal function among whites, but not in blacks.
Abstract P163: Sex-Based Differences in Cardiac Function, Biomarkers and Exercise Capacity Heart Failure With Preserved Ejection Fraction - Findings From the RELAX Trial
Authors: Pandey Ambarish , Mauricio Rina , Patel Kershaw , Ayers Colby , Berry Jarett , Grodin Justin
Published: March 2019

Background:
The biological mechanisms underlying the higher burden of Heart failure with preserved ejection fraction (HFpEF) and associated worse clinical outcomes in women vs. men is not well-known.

Methods:
In a cohort of patients with chronic stable HFpEF that were enrolled in the PDE--5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure trial, sex-based differences in echocardiographic parameters, cardiac biomarkers, and directly measured peak exercise oxygen uptake (peak VO
2
) were assessed using adjusted linear regression models that accounted for relevant confounders (
Figure
).

Results:
Among the 214 study participants (49% women), there were no significant differences in measures of cardiac function such as stroke volume (38.1 v. 39.0 ml/m
2
), diastolic function (E/A: 1.4 v. 1.5), and pulmonary artery systolic pressure (41 v. 43 mm Hg) among women vs. men in unadjusted and adjusted analysis. Women had significantly lower burden of chronic myocardial injury (hs-Troponin-I: 7.3 v. 11.4 ng/l, p < 0.001) and myocardial fibrosis (CTIP: 5.8 v. 6.7 ng/L p = 0.02) and comparable NT-ProBNP levels to men in unadjusted and adjusted comparisons (
Figure
). However, women had significantly lower measures of exercise performance as compared with men including lower peak VO
2
(10.8 vs. 13.3 ml/kg/min, p < 0.01), peak exercise work (60 vs. 83 Watts, p < 0.01), and anaerobic threshold (600 v. 795 ml/min) compared with men. These differences in exercise capacity persisted in adjusted analyses that accounted for demographics, clinical characteristics, measures of cardiac function and biomarkers, and, cardiac biomarkers, and exercise parameters (
Figure
).

Conclusion:
Among stable patients with HFpEF, despite favorable comparable cardiac structure and function, and lower burden of chronic myocardial injury and fibrosis, women have worse exercise capacity as compared with men. These differences in exercise capacity are not explained by differences in myocardial performance.