bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 32: Joint Associations of Peripheral Artery Disease and Objectively-measured Physical Activity With Mortality: The Hispanic Community Health Study / Study of Latinos
Authors: Gao Yumin , Hua Simin , Mok Yejin , Qi Qibin , Chen Guochong , Allison Matthew A , Kaplan Robert , Matsushita Kunihiro
Published: March 2020

Background:
Peripheral artery disease (PAD) reduces physical activity, and both PAD and lower physical activity levels have been shown to increase mortality risk. Yet, their joint contributions to mortality have not been systematically studied, especially with the objective measure of physical activity.

Hypothesis:
PAD and lower 1-week objectively-measured physical activity are synergistically associated with mortality.

Methods:
We studied 7124 Hispanic adults aged 45-74 years at baseline from the Study of Latinos who adhered to an objective measure of physical activity using wearable accelerometers. We quantified the associations of the status of PAD (ankle-brachial index [ABI] ≤0.90 [PAD], 0.91-1.39 [no PAD], and ≥1.40 [possible PAD with ankle artery calcification]) and two physical activity measures (sedentary time [tertiles] and daily physical movement counts [tertiles]) at baseline with mortality using multivariable Cox models accounting for sampling weights.

Results:
During a median follow-up of 7.0 years, 289 participants died. Sedentary time and daily physical movement counts were weakly correlated (r=-0.17). Both low and high ABI, longer sedentary time, and lower physical movement counts were all independently associated with increased mortality risk (marginal cells in
Table
). In terms of the joint associations of PAD and physical activity with mortality, they generally demonstrated synergistic associations (e.g., hazard ratio 4.43 [95%CI, 2.44-8.03] in ABI ≤0.9 plus top tertile of sedentary time and 5.46 [2.47-12.08] in ABI ≥1.40 plus top tertile of sedentary time vs. normal ABI with shortest sedentary time) (cross-categories in
Table
), with no significant interactions.

Conclusions:
Both low and high ABI, and lower objectively-measured physical activity levels were significantly associated with greater risk of mortality independently of each other and potential confounders. Our results suggest the importance of objectively evaluating daily physical activity levels and leg vascular condition.
Abstract MP11: Effects of Metformin and Behavioral Weight Loss on the Gut Microbiome
Authors: Mueller Noel T , Differding Moira K , Maruthur Nisa , Juraschek Stephen , Miller Edgar R , Yeh Hsin-Chieh
Published: March 2020

Background:
Evidence suggests metformin and behavioral weight loss alter the gut microbiome, with weight loss associated with higher diversity and metformin with higher
Escherichia Coli
. Yet randomized trials on these interventions are limited.

Objective:
To examine the hypothesis that metformin increases E. Coli and and behavioral weight loss increases diversity.

Methods:
We conducted a parallel-arm, randomized trial in which we enrolled overweight or obese adult cancer survivors who had been previously treated for solid tumors, but without active disease or ongoing cancer treatment. We randomized participants (n=121) to: 1) coach-directed behavioral weight loss (with advice on the DASH diet), 2) metformin, or 3) self-directed weight loss (control). We collected stool at baseline, 6 mo. and 12 mo. and extracted microbial DNA from stool to measure the microbiome with 16S rRNA sequencing of the V4 region. We used ‘Aldex2’ in
R
to examine the effect of treatments on the change in relative abundance of microbial taxa amplicon sequence variants from baseline to 6 mo. and 12 mo.

Results:
Groups did not differ by sex (79% female), race (45% black) or age (mean 60 yrs). Mean weight loss was 3.9%, 2.7%, and 0.9% in coach-directed, metformin, and self-directed arms at 6-mo., respectively (both
P
s<0.05 compared to self-directed.) There were no differences within or between arms in measures of alpha or beta diversity (
P
s>0.05). Only the metformin arm altered the relative abundance of microbiota (
Figure
). From baseline, metformin increased relative abundance of
E. Coli
and decreased relative abundance of butyrate-producing
Ruminococcus Intestinalis
and
Intestinibacter Bartletti
at 6 mo. and 12 mo. Metformin also decreased
Roseburia Faecis
at 6 mo. and increased
Ruminococcus Torques
at 12 mo. (
Figure
).

Conclusion:
Metformin increased
E. Coli
and decreased several butyrate-producing genera, but was not associated with microbiome diversity. Moderate behavioral weight loss (~3.9%) did not alter microbiome diversity or composition.
Abstract MP14: Lower Cardiovascular Fitness is Associated With Higher C-Reactive-Protein-Related Cardiovascular Risk in Healthy Adolescents and Young Adults
Authors: Troutman Gregory S , Shipon David M , Fiorella Michele A , Wong Daniella H , Eraso Luis H
Published: March 2020

Introduction:
Inflammatory markers, such as C-reaction protein (CRP), have been shown to be highly associated with cardiovascular disease. However, it is unclear if baseline levels of cardiovascular fitness in young, healthy persons are related to inflammatory biomarkers who have not yet manifested cardiovascular disease.

Methods:
Data was compiled from the National Health and Nutrition Examination Survey (NHANES). Cardiovascular fitness level (low, moderate, high) was categorized by estimated VO2 max (with age/sex adjustment cut points). Associations with CRP-based cardiovascular risk were analyzed using ANOVA/Kruskal-Wallis and Chi-squared. Ordered logistic regression was employed to identify predictors of increasing CRP-based cardiovascular risk. To account for the complex survey design, all analyses were conducted using appropriate estimated weights following NHANES analytic guidelines.

Results:
2,201 participants from 1999-2004 from ages 12-49 completed cardiovascular fitness testing and had full laboratory analysis. A sensitivity analysis was performed grouping participants into CRP-based cardiovascular risk categories (low <1mg/L, moderate 1-3 mg/L, high >3 mg/L) based on the 2003 AHA/CDC Scientific Statement. Increase in cardiovascular fitness category was associated with decrease in CRP-based cardiovascular risk (OR 0.83, 95% CI 0.75 to 0.91, p<0.001). The relationship was strengthened (OR 0.77, 95% CI 0.68 to 0.87, p<0.001) when adjusting for age, sex, BMI, diabetes, and smoking.

Conclusions:
In a sample representative of the United States civilian non-institutionalized population, lower levels of cardiovascular fitness were associated with increased inflammatory biomarkers related to cardiovascular risk, even with adjustment for fitness-related covariates. Further studies will help us to understand the therapeutic role on VO2 max and cardiovascular fitness improvement in reducing atherosclerosis-related inflammation.
Abstract MP24: Does Sleep Disturbance Vary Between Current Combustible and Electronic Cigarette Users?
Authors: Patterson Freda , Brewer Benjamin , Grandner Michael A
Published: March 2020

Smoking cessation is critical to the goal of reducing cardiovascular diseases. Combustible cigarette smokers are more likely to have poor sleep health that is exacerbated upon cessation and can cause relapse. Use of electronic cigarettes has increased exponentially since their introduction to the market in 2007. Not known is the extent to which sleep disturbances that is common in combustible cigarette smokers is also associated with e-cigarette use. Using data collected as part of the Behavioral Risk Factor Surveillance System (BRFSS), we examined the association between non-smoking, smoking combustible, electronic, and dual (combustible + electronic) cigarettes with sleep disturbances (short sleep duration, daytime sleepiness, insomnia symptoms). Exact matching was used to generate matched samples of non-smokers (n=472), combustible only (n=472), e-cigarette only (n=472), and dual use (n=472) smokers on the variables of age, sex, race, educational attainment, overweight/obese, and days of poor mental health in the last month. In a univariate linear regression model of insomnia symptoms, when compared to non-smokers, cigarette only smokers reported an average of 0.87 (p=0.038) more days of insomnia symptoms in the last month while dual users reported an average of 0.77 (p=0.063) more (Table 1). For daytime sleepiness, dual users reported an average of 0.85 (p=0.002) more days with daytime sleepiness in the last month as compared to non-smokers. In terms of sleep duration, when compared to non-smokers, cigarette smokers reported getting 0.28 (p=.021) fewer hours of sleep, and dual users reported getting 0.34 fewer hours of sleep (p=0.005). Overall, as compared to non-smokers, combustible and dual cigarette smokers in this sample reported more disturbed sleep. Dual use smokers may be particularly vulnerable to sleep deficits, that in turn, may impede efforts to quit smoking and improve cardiovascular health.
Abstract MP68: Dietary Lignan and Cardio-metabolic Risk: Exploring the Role of the Gut Microbiome
Authors: Li Yanping , Li Jun , Ivey Kerry L , Wilkinson Jeremy E , Wang Dong , LIU Gang , Li Ruifeng , Chan Andrew , Huttenhower Curtis , Hu F , Sun Qi , Rimm Eric B
Published: March 2020

Background and Study Purpose:
The conversion of plant lignans to enterolignans for absorption is mediated through the gut microbiota. We explored the interconnections between the intake of dietary lignans, circulating concentrations of plasma enterolignans, the gut microbiome, and cardio-metabolic risk factors (LDL-cholesterol, HDL-cholesterol, & triglycerides).

Design and method:
The study was a repeated cross-sectional survey of up to 4 stool samples. Dietary lignan intake was assessed by two 7 day weighed records administered to coincide with fecal sample collection. DNA was extracted from 916 samples provided by 301 participants, and RNA was extracted from 369 samples from a subgroup of 96 participants. P<0.25 after false discovery rate correction was considered statistically significant.

Results:
A high ratio of plasma enterolactone to dietary lignan was significantly associated with the relative abundance of 35 species (24 enriched and 11 depleted species), including 8 Bacteroidetes and 13 Firmicutes species. Greater dietary lignan was only significantly associated with a lower plasma ratio of triglyceride to HDL when plasma enterolactone was high. The association between dietary lignans and ratio of TG to HDL was mainly mediated by plasma enterolactone level (mediation effect: 74.3%, P=0.002), which was partially captured by the weighted species score (mediation effect: 28.6%, P=0.02). We observed several significant interactions between dietary lignans and presence of species on ratio of TG to HDL, suggesting that the protective effect of dietary lignans on CVD risk factor depends on the presence/abundance of certain microbiota. The relative abundance of microbial pathways involved in I-isoleucine biosynthesis and glutaryl-coa degradation pathways were significantly greater in in participants with a higher level of plasma enterolactone.

Conclusion:
The health benefits of dietary lignans on lipid levels may be modified by the greater enrichment of biologically relevant microbiota species.

FIGURE
Abstract P106: Stable versus Changing BMI Trajectories in Relation to Cardiometabolic Risk Factor Trajectories in Adolescent Girls: The NHLBI Growth and Health Study
Authors: Woo Jessica G , Daniels Stephen R , Urbina Elaine M
Published: March 2020

Introduction:
Adolescence is a period of increased independence in lifestyle choices, as well as shifts in cardiometabolic risk factors. Understanding how stability or change in BMI status may be superimposed on risk factor changes will enable focused attention on girls whose risk factors are likely to deteriorate during adolescence.

Methods:
Girls were enrolled at age 10 into the NHLBI Growth and Health Study (NGHS) at 3 centers (n=2379) and assessed annually to age 19. Ideal cardiovascular risk factors (smoking, dietary sodium, dietary saturated fat, BMI, blood pressure (BP), total cholesterol (TC) and glucose), and related risk factors (HDL and LDL cholesterol, and triglycerides (TG)) were assessed. Trajectories of adherence to ideal risk factor definitions were evaluated using group-based modeling, with risk factor trajectories layered over BMI trajectories in change-over-change analysis.

Results:
Four trajectories of BMI across adolescence were: ideal (51%), deteriorating (14%), improving (11%) and poor (25%). Two to 4 trajectories were identified for other risk factors, with similar trajectory shapes (e.g., ideal, improving, deteriorating and poor). Ideal smoking prevalence only deteriorated, with trajectories differing by timing of smoking uptake (early, middle or late adolescence). Most adolescent girls had poor adherence to diet metrics throughout adolescence, with diet intake trajectories improving somewhat at different ages (early or later adolescence) in a small percent of participants. Stable poor or ideal BMI trajectories were associated primarily with stable risk factor trajectories (poor or ideal, respectively), for LDL, HDL, TG, BP (all p=0.0001). The poor BMI trajectory was also associated with late adolescent deteriorating glucose (p=0.0001) and TC trajectories (p=0.02). Changing BMI trajectories, either improving or deteriorating, can unmask the sensitivity of risk factors to change in BMI status. The improving BMI trajectory was more likely to be in the later-improving saturated fat (p=0.003), improving HDL (p=0.0002) and moderate-improving TG trajectories (p=0.01) and less likely to be in the low-deteriorating BP trajectory (p=0.04) compared to the deteriorating BMI trajectory. Smoking trajectories did not differ by BMI trajectory.

Conclusions:
Stable poor BMI is associated with poor, but not with deteriorating cardiometabolic risk profiles during adolescence, suggesting these changes must have occurred before age 10. Decreasing ideal TC and glucose appear to be late adolescent responses to persistently poor BMI. However, improving BMI status during adolescence is associated with improving dietary saturated fat intake and blood lipid profiles, while deteriorating BMI is associated with deteriorating BP and lipids. Thus, specific ideal health factors may be differentially sensitive to BMI changes in adolescent girls.
Abstract P112: Thirty-year Trends in the Incidence of Atrial Fibrillation: The Atherosclerosis Risk in Communities Study
Authors: Ghelani Kunali P , Chen Lin Yee Y , Norby Faye L , SOLIMAN Elsayed Z , Koton Silvia , Alonso Alvaro
Published: March 2020

Objective:
To evaluate the 30-year trends in the incidence of atrial fibrillation (AF) in the Atherosclerosis Risk in Communities (ARIC) cohort and identify race and sex differences in these trends.

Background:
Long-term data to study recent trends in the incidence of AF, overall and across sex and race groups, are scarce.

Methods:
We included 15,343 men and women aged 45 to 65 in 1987-89 without AF from 4 US communities in the ARIC cohort. Incident AF was identified based on study electrocardiograms, hospital discharge codes, and death certificates through 2017. We calculated age and time-period specific incidence rates (IR) of AF. We used Poisson regression to calculate IR ratios of AF over time adjusting for age, sex and race.

Results:
A total of 3,241 AF cases were identified during a mean (SD) follow up of 22 (8.4) years (599 in African Americans, 2642 in whites, 1582 in women, 1659 in men). Overall, the IR of AF in the ARIC cohort was 9.6 per 1000 person-years (6.9 in African American, 10.5 in whites, 8.1 in women, and 11.6 in men). Age-specific IR by time-period did not show significant changes over time (Figure). In a model adjusted for sex, race, and age group, the rate of AF did not change over time from 1987-1991 to 2012-2017 (IR ratio=1.10, 95% CI = 0.89-1.36 comparing 2012-2017 to 1987-1991). Similarly, no evidence of changes over time in AF rates were identified in men or women, whites or African Americans separately.

Conclusions:
Even though the incident rates of AF increase as age increases, our analysis provided evidence suggesting that the overall rates of AF have not changed over time in a multicenter cohort of African American and white individuals in the US from 1987 to 2017.
Abstract P130: Risk Factors for Progression to Type 2 Diabetes Mellitus From Prediabetes
Authors: Hellgren Margareta , Lindblad Ulf , Daka Bledar
Published: March 2020

Background and Aims:
Individuals with prediabetes, impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT), have approximately 50% risk to develop type 2 diabetes mellitus (T2DM) within ten years. This paper examines risk factors for development of T2DM in individuals with prediabetes.

Materials and Methods:
A total of 2816 individuals were randomly selected and completed a careful physical examination and an oral glucose tolerance test. IFG and IGT was defined according to WHO. A representative sample of 1327 individuals were re-examined in a follow-up study after ten years. This study focuses on the participants who were diagnosed with prediabetes, IFG (n=67) and/or IGT (n=89) at baseline and who were re-examined at follow-up. Insulin resistance was estimated by HOMA-ir (Homeostatic Model Assessment for Insulin Resistance). Differences between the participants with prediabetes who developed T2DM and those who did not, were analyzed with general linear models and adjusted for age, sex and BMI. The risk to progress to T2DM in ten years was explored using binary logistic regression, adding the risk-factors one after another.

Results:
Of the 156 individuals with prediabetes 28% progressed to T2DM. Individuals who developed T2DM had higher BMI (α=3.2kg/m
2
, P<0.001), higher HbA1c (α=0.2 mmol/mol, P=0.047), higher C-reactive protein (α=3.3 mmol/L, P=0.040) and also significantly higher HOMAir (α=2.8, P<0.001) at base-line. The risk to develop T2DM increased in a step-wise manner in individuals with prediabetes when successively adding the risk-factors. Having a BMI ≥30kg/m
2
, a known family history for T2DM, HbA1c ≥37mmol/mol, HOMAir ≥2.8 and a low level of physical activity increased the risk to develop T2DM 5.6 times. Table 1.

Conclusion:
In individuals with prediabetes, those with additional risk-factors like obesity, HbA1c and HOMAir above mean values, family history for T2DM and a low level of physical activity require extra attention and intensive lifestyle interventions should be initiated.
Abstract P149: Association Between Disabilities And Cardiovascular Disease Mortality In Diabetic Men And Women
Authors: Lee Chong-Do , Lee Samuel
Published: March 2020

The associations of physical disabilities with cardiovascular disease (CVD) mortality in diabetic patients remains less explored.

Purpose:
We investigated the associations of activities of daily living (ADL), instrumental ADL (IADL), and functional limitation (FL) disabilities with CVD mortality among diabetic men and women in the National Health and Nutrition Examination Surveys.

Methods:
Cox proportional hazards regressions were used to examine the associations of ADL, IADL, and FL disabilities with CVD mortality in men and women after adjustment for covariates. We followed 2,255 men and women, aged 20 to 90 years, who participated in the National Health and Nutrition Examination Surveys (1988-1994, 199-2014). All participants completed baseline demographics and health factors, including blood lipid profiles. Diabetes mellitus was defined as fasting glucose level ≥126 mg/dL, a nonfasting glucose level ≥200 mg/dL, use of hypoglycemic agents, or a history of physician-diagnosed diabetes mellitus. ADL disability was defined as those who had any difficulties in dressing, eating, getting out of bed, or walking a room to another room. IADL disability was defined as those who had any difficulties in preparing meals, managing money, or doing chores around the house. FL disability was defined as those who had any limitations in mobility performance (walking 0.25 mile, climbing 10 stairs, lifting/carrying 10 pounds, or standing from a chair).

Results:
During an average of 15.5 years of follow-up (34,939 person-years), there were a total of 382 CVD deaths. There were direct relationships between the number of ADL, IADL, and FL with CVD mortality after adjustment for age, sex, race, and other CVD risk covariates (All P<0.007). After adjustment for multiple risk factors, the risks of CVD mortality for ADL, IADL, and FL disabilities were (95% CI) 2.01 (1.60, 2.51), 1.99 (1.60, 2.48), and 1.97 (1.59, 2.44), respectively, compared with their counterparts. After further adjustment for chronic medical conditions (personal history of coronary heart disease, stroke, or cancer), diabetic persons with ADL disability had 1.94 times (1.5, 2.43), with IADL disability had 1.93 times (1.54, 2.41), and with FL disability had 1.94 times (1.56, 2.40) the risk of CVD mortality as compared with their counterparts, respectively. The associations remained but were attenuated after further excluding these patients with chronic diseases. The risks of CVD mortality in diabetic persons with ADL, IADL, and FL disabilities were (95% CI) 1.78 (1.30, 2.43), 1.66 (1.22, 2.27), and 1.43 (1.09, 1.89), respectively, compared with their counterparts, after excluding these chronic disease patients.

Conclusion:
Diabetic persons with ADL, IADL, and FL disabilities had a greater risk of CVD mortality. The American Heart Association should establish exercise and dietary guidelines for diabetic persons with physical disabilities.
Abstract P156: Recruitment and Retention of an American Indian Cohort - The Strong Heart Study Reducing Disparities Through Research
Authors: O'Leary Marcia , Ali Tauqeer , West Cynthia , Gross Marie
Published: March 2020

Tribal communities have legitimate reasons for being wary of research. The Strong Heart Study works to coordinate multi-disciplinary efforts towards bidirectional partnerships, with an ethos of respect and capacity development. Best practices are being developed through iterative processes including co-development of survey research through translating/communicating data analysis and applying CBPR practices. Information translation and CBPR throughout the research process also includes participating in community-based research symposia, developing site specific information through informational venues (e.g. Red Talks), formal reporting to Tribal councils and health committees, informal interaction by participating in local Native American community events, engaging Community Advisory groups, and supporting local students through hands-on internships. These activities also enhance transition of traditional public health research to a support a more autonomous, individualized system for the Tribal partners toward greater self-determining their own health. This approach encourages health literacy, promotes Institutional memory and automates longitudinal surveillance of local health issues to reduce disparities in Tribal nations.
Abstract P161: A Learning Healthcare System Improves Cardiovascular Risk Management: Results From the Utrecht Cardiovascular Cohort Initiative
Authors: Bots Michael , Groenhof Katrien , Haitjema Saskia , Lely Titia , Asselbergs Folkert
Published: March 2020

Introduction:
Cardiovascular disease (CVD) is a good example of a high complex, multi-morbid, chronic condition. This asks for multidisciplinary and transmural collaboration and communication between caretakers, forming a care continuum. Research is often conducted outside routine practice, namely in randomized controlled trials and dedicated cohorts with strict in- and exclusion criteria. Since our real world patient does not fit these criteria, generated evidence does not always translate to practice. Yet, we can learn from each patient. Within a learning healthcare system (LHS),
data collection
in routine daily practice is used as input for
analysis
,
interpretation
and
actionable feedback
. CVD management (CVRM) guidelines provide various recommendations for diagnosis, modification and referral from primary to secondary or tertiary care for the evaluation of a CV condition. Starting with uniform structured collection of the CVD risk profile in the our hospital in all patients, we developed a learning health care system focused on CVD risk management.

Hypothesis:
We hypothesize that a learning health care system improves CVD risk management.

Methods:
Embedded in routine clinical practice, the Utrecht Cardiovascular Cohort (UCC) supports structured and uniform assessment and registration of guideline based CVD risk profile in the electronic health record across all departments. We studied, with data from 2800 participants,
data collection
(uniform and linkage);
data extraction
((un)structured);
data analysis
(missings); and
actionable feedback
(computer decision support system).

Results:
Establishment of UCC resulted in more complete CVD risk profile: increase in risk factor completeness ranged from 8% (eGFR) to 50% (HbA1c). Linking UCC patient data to general practitioner records, showed considerable gaps in transmural CVD communication: from GP to specialist and from specialist to GP. To address missing information in electronic health records we developed a text mining algorithm to detect smoking status: algorithm showed a 99% yield, a positive and negative predictive value of 65% and 95%. We developed strategies to handle missing data for risk prediction on an individual level in a ‘live’ setting: joint conditional model led to a lower mean squared error (the lower, the more precise estimates). We developed a CVD risk management computerized decision support system embedded in our electronic health record, filled with extracted information and incorporating all lessons learned from reviews, clinician expert opinions, and patient expert opinions. This dashboard, favorably received by physicians, shows in the consulting room the CVD risk profile, potential treatment effects in one glance and helps with shared decision making.

Conclusions:
Our learning health care approach shows improvement in some areas and provides actionable leads for further improvement.
Abstract P162: Different Types of Health Insurance are Associated With Varying Levels of Glycemic Control and Insulin Resistance: The Multi-ethnic Study of Atherosclerosis (MESA)
Authors: Gold Rebecca , Unkart Jonathan , McClelland Robyn , Gilmer Todd , Bertoni Alain G , Allison Matthew A
Published: March 2020

Introduction:
Health insurance may influence patient access and care, and thereby glycemic control. In this study, we assessed associations of insurance status with measures of glucose regulation and whether these associations varied by different insurance types, diabetes status, and/or diabetes medication use.

Methods:
We used baseline data (2000-2002) from the Multi-Ethnic Study of Atherosclerosis (
N
= 6,627), a cohort study of adults from four racial/ethnic groups without clinically apparent cardiovascular disease. Using multivariable linear regression to adjust for confounders (age, race, sex, study site, usual site of medical care, alcohol and tobacco use, education, income, dyslipidemia, hypertension, BMI), we measured associations of insurance status and insurance type with fasting glucose and homeostasis model assessment of insulin resistance (HOMA-IR).

Results:
Approximately 50% of the cohort were female and the mean age and BMI were 62y and 28 kg/m
2
, respectively. Overall, 598 (9%) participants were uninsured, while 6,029 (3,343-Private, 830-Medicare, 104- Medicaid, 77-Military, 1,675-Multiple) had insurance. Fourteen percent of the total cohort had diabetes. The proportion of undiagnosed diabetes was higher in uninsured (5%) compared with insured (3%). Compared to the uninsured, insured participants had significantly lower fasting glucose (Table 1). This association persisted only among participants with diabetes. Private, Medicare, and Multiple insurance types were associated with lower fasting glucose, and only among participants with diabetes. Notably, Medicaid was associated with higher HOMA-IR.

Conclusion:
In this large multiethnic cohort, health insurance was associated with significantly lower fasting glucose. These findings demonstrate insurance coverage is relevant towards improving glycemic control in patients with diabetes. However, our study also highlights nuances and limitations to this relationship, suggesting that all types of insurance may not be equivalent.
Abstract P179: Uncontrolled Cholesterol Levels In Patients With Severe Hypercholesterolemia
Authors: Groth Nicole , Benziger Catherine P
Published: March 2020

Introduction:
The 2018 American Heart Association/American College of Cardiology cholesterol guidelines recommends patients who have phenotypic severe hypercholesterolemia (SH), defined as a low-density lipoprotein-cholesterol (LDL-c) > 190 mg/dL, be started on maximally tolerated statin therapy without further risk stratification due to high risk for cardiovascular disease (CVD). SH patients on guideline-directed medical therapy (GDMT) should have 50% reduction in their LDL-c levels, with optimal being < 100 mg/dL for primary prevention and <70 mg/dL for secondary prevention. The 2019 European Society of Cardiology/European Atherosclerosis Society cholesterol guidelines recommend an optimal LDL-c level < 55 mg/dL.

Hypothesis:
LDL-c levels vary by intensity of medication and are not at target in patients with SH in a large rural healthcare system.

Methods:
We used an electronic medical record-based SH registry defined by ever having an LDL-c > 190 mg/dL since 01/01/2000 (n=17,925) at Essentia Health (MN, WI, and ND). In this cross-sectional study, patients were excluded if they had: no recent visit within the past 5 years (n=209), <20 or >75 years (n=3,153), listed as being on a statin but intensity was unavailable (n=1,934), or had no recent lab (n=998).

Methods:
We included 12,283 patients (68.5%)(mean age 59.4 + 10.1 years; 59.5% female) with SH and of these only 22.9% were on a high-intensity statin or proprotein convertase subtilisin/kexin type 9 inhibitor. Of the patients that were not on any lipid-lowering therapy (n=4,971; 40.5%), only 16.8% (n=837) had a statin allergy or intolerance documented.
Figure 1
shows the most recent LDL-c levels; <10% of patients in each group had a most-recent LDL-c <70 mg/dL, and 9.4% had an LDL-c <55mg/dL.

Conclusions:
Most SH patients remain untreated or undertreated with GDMT with recent LDL-c levels above target. More aggressive lipid-lowering therapy in patients with SH is needed to reduce risk of CVD.
Abstract P190: Untargeted Metabolomics Study of Glycemic Outcomes Among Bogalusa Heart Study Participants
Authors: Dorans Kirsten S , He Jiang , Nierenberg Jovia L , Li Changwei , Gu Xiaoying , Bazzano Lydia A , Kelly Tanika N
Published: March 2020

Background:
The increasing prevalence of diabetes mellitus, a major cause of morbidity and mortality worldwide, is a critical public health concern. Though a number of studies have evaluated the associations of metabolites with prediabetes and diabetes, further exploration in this relatively new field may identify novel biomarkers for predicting, detecting, and managing hyperglycemia and diabetes.

Objective:
We conducted a metabolome-wide association study among 805 white and 426 African-American participants of the Bogalusa Heart Study (BHS) to identify metabolites associated with markers of glycemia and diabetes.

Methods:
After rigorous quality control, 1,202 metabolites quantified by untargeted, ultra-high performance liquid chromatography tandem-mass spectroscopy were tested for association with fasting glucose, hemoglobin A1c and diabetes. Multiple regression analyses were run in race-stratified and combined samples, adjusting for age, sex, education, blood pressure, body mass index, HDL-cholesterol, smoking, eGFR, fasting glucose (for HbA1c and diabetes), and race (in combined analyses). For fasting glucose and HbA1c, those taking diabetes medications were excluded. Metabolites were considered significant if they were significant (P<4.15х10
-5
; Bonferroni corrected for 1,202 metabolites) in one race group and the entire cohort, with a similar trend observed in the other race group.

Results:
After Bonferroni corrections, among 72 metabolites significantly associated with at least one glycemic outcome, 27 were novel and in known pathways: 5 from amino acid, 1 from carbohydrate, 18 from lipid, 1 from xenobiotics, and 2 from nucleotide pathways. Metabolites consistently associated with diabetes are shown in the
Table
.

Conclusions:
These results identified novel metabolites associated with glycemic outcomes, providing additional evidence on the importance of serum metabolites in hyperglycemia and diabetes.
Abstract P195: Lipoprotein and Metabolite Biomarkers for Coronary and Peripheral Artery Disease: Blood Biomarker Profiling of 32,000 Individuals From Five Prospective Studies
Authors: Tikkanen Emmi , Mustelin Linda , Aittomaki Viljami , Kalimeri Maria , Jousilahti Pekka , Perola Markus , Ala-Korpela Mika J , Salomaa Veikko V , Würtz Peter
Published: March 2020

Background:
Coronary artery disease (CAD) and peripheral artery disease (PAD) share pathogenesis, but the evidence of metabolic risk factors underlying PAD risk is limited. We conducted detailed metabolic profiling of incident CAD and PAD to identify novel risk factors and clarify pathogenesis for these diseases.

Methods:
We measured circulating blood biomarkers using an NMR metabolomics in four large prospective studies from Finland (national FINRISK and Health 2000 studies, total
n
= 32,607). We used Cox proportional hazard modelling to estimate associations between biomarkers and incident CAD and PAD (
n
events = 2010 and 464, respectively, during the median follow-up time of 14 years).

Results:
High VLDL-C increased the risk for CAD (HR=1.30, 95% CI 1.24-1.35 per SD-change), but not PAD (HR=1.09, 95% CI 0.99-1.21). Moreover, LDL-C and apolipoprotein B were only associated with CAD (HR=1.13, 95% CI 1.08-1.19; HR=1.29, 95% CI 1.23-1.35), whereas high triglycerides in LDL and VLDL increased the risk for both endpoints. Glycolysis-related metabolites (glucose, lactate, pyruvate and glycerol), amino acids (phenylalanine, alanine and glutamine) and inflammation biomarker glycoprotein acetyls (GlycA) showed stronger associations with PAD. Biomarker score showed stronger risk discrimination of high-risk individuals for incident PAD when compared to traditional CVD risk factors, suggesting that measuring these biomarkers could help to detect high-risk individuals better than currently used risk factors.

Conclusions:
We identified novel biomarkers for cardiovascular endpoints showed that the associations of these biomarkers were actually stronger for PAD compared to the CAD. Novel biomarkers could be used to guide the development of new therapies and improve the detection of high-risk individuals for these diseases.

Figure. Associations between metabolic biomarkers and incident PAD and CAD.
Abstract P197: Health Information Technology Use Among Patients With Diagnosed Atherosclerotic Cardiovascular Disease: Evidence From The 2010-2018 National Health Interview Survey
Authors: Nwokeji Uchenna , Spaulding Erin , Shan Rongzi , Turkson-Ocran Ruth-Alma N , Baptiste Diana , Koirala Binu , Plante Timothy B , Martin Seth S , Commodore-Mensah Yvonne
Published: March 2020

Introduction:
Atherosclerotic Cardiovascular Disease (ASCVD) is the leading cause of morbidity and mortality worldwide. Health Information Technologies (HIT) have recently emerged as a viable intervention to mitigate the burden of ASCVD. At least 60% of US adults report searching the internet for health information; however, previous research has not examined prevalence and sociodemographic differences in HIT use among adults with ASCVD.

Objective:
To evaluate the prevalence and sociodemographic differences in HIT use among U.S. adults with a history of diagnosed ASCVD.

Methods:
We pooled cross-sectional data from the 2010-2018 National Health Interview Survey (NHIS) to examine HIT use among adults aged ≥18 years (N=2,410) who self-reported being diagnosed with ASCVD (coronary heart disease (CHD) and/or stroke). We evaluated sociodemographic differences in HIT use among respondents with generalized linear models using Poisson distribution. Analyses were weighted according to NHIS standards.

Results:
The mean (±sd) age was 70 (±0.2) years, and 47.7% were female. Among US adults with a history of ASCVD, 22.6% of respondents utilized some form of HIT. HIT users with a history of ASCVD were more likely to be younger in age, have at least some college education, be employed, and be married (
Table 1
).

Conclusion:
HIT use was low among adults with a history of ASCVD, which may represent a barrier to delivering care via emerging HIT. Given the association with sociodemographic factors such as education and employment, there is a need to develop targeted strategies to address sociodemographic barriers that impact HIT usage.
Abstract P221: The Impact of Prevalent and New-onset Cardiometabolic Risk on the Incidence of Hepatic Steatosis
Authors: Aneni Ehimen C , Bittencourt Marcio S , Caínzos Achirica Miguel , Blaha Michael J , Soliman Ahmed M , Al-mallah Mouaz H , Budoff Matthew J , Santos Raul , Nasir Khurram
Published: March 2020

Background:
Little is known about hepatic steatosis (HS) incidence and its relationship to underlying or new-onset cardiometabolic risk. This study aims to assess the incidence of hepatic steatosis in an asymptomatic population and to determine its relationship to both prevalent and new-onset cardiometabolic risk factors.

Methods:
We analyzed retrospective data from a voluntary employer-sponsored routine health promotion evaluation at the Preventive Medicine Center of the Hospital Israelita Albert Einstein (São Paulo, Brazil) collected from October 2004 to December 2016.Medical and demographic history, anthropometric measures including blood pressure, body mass index (BMI) and waist circumference, and fasting blood samples were obtained. Participants also had ultrasonography to assess for HS. We included data from 8,448 individuals who had complete cardiometabolic and ultrasound data at baseline and repeated all tests at least 6 months later.

Results:
The mean age (standard deviation, SD) of participants was 40 (9) years. Over a mean (SD) follow-up of 3.4 (2.3) years, the incidence of HS was 14.7%. As shown in the table, diabetes, poor physical activity, elevated waist circumference and cigarette smoking at baseline were independently associated with hepatic steatosis. There was an additive effect of the increasing cardiometabolic risk factors (see graph) on the risk of developing HS. Participants with new-onset cardiometabolic risk factors also had a higher risk of incident HS after accounting for baseline demographics and cardiometabolic risk factors (see forest plot). This was most pronounced for incident obesity (BMI ≥ 30 Kg/m
2
).

Conclusion:
In this relatively young population, the incidence of HS was high and was both independently and collectively associated with baseline cardiometabolic risk. New-onset cardiometabolic risk tracks with incident HS. This study emphasizes the need for assessing and mitigating cardiometabolic risk in the prevention of HS.
Abstract P222: Sex Moderates Treatment Effects in Integrated Behavior Therapy for Comorbid Obesity and Depression
Authors: Lv Nan , Xiao Lan , Goldman Rosas Lisa , Venditti Elizabeth , Snowden Mark , Lewis Megan , Williams Leanne , Smyth Joshua , Ajilore Olusola , Gerber Ben , Ma Jun
Published: March 2020

Introduction:
Obesity and depression often co-occur, especially in women. Efficacious treatments exist for both conditions, but treatment outcomes vary. Assessing sex-specific responses to integrated therapy of these conditions could inform opportunities for tailoring.

Hypothesis:
Sex will significantly moderate the effects of an integrated collaborative care intervention on weight loss and depression outcomes through 24 months. Short-term treatment response at 6 months will reliably predict 12- and 24-month outcomes by sex.

Methods:
We conducted secondary analyses using data from the RAINBOW trial, which demonstrated efficacy of an integrated collaborative care intervention at reducing weight (BMI) and depression severity (SCL-20) at 12 months relative to usual care in adults with obesity and depression. Linear mixed models were used to assess treatment effects by sex, an
a priori
hypothesized biological moderator, on BMI and SCL-20 at 6, 12, and 24 months. Areas under the receiver operating characteristic curves (AUCs) based on logistic regressions were used to assess sex-specific thresholds of weight loss (%) and SCL-20 reduction at 6 months that reliably predicted clinically significant weight loss (i.e., ≥5% of baseline weight) and depression response (i.e., ≥50% decrease in SCL-20 scores) at 12 and 24 months.

Results:
Sex significantly moderated the treatment effects on BMI and SCL-20. Compared with women, men achieved significantly greater reductions in BMI at 6, 12, and 24 months in the intervention relative to usual care. Compared with men, women achieved significantly greater reductions in SCL-20 at 12 months only in the intervention relative to usual care. AUCs in the logistic models were similar for both sexes: >0.82 at 12 months and >0.65 at 24 months predicting clinically significant weight loss; >0.70 at 12 months and >0.67 at 24 months predicting clinically significant depression response. With 80% specificity to ensure good probability of correctly identifying participants not achieving longer-term outcomes of clinical significance, women who lost 2.5-3.0% weight and men who lost 3.4-4.1% weight at 6 months were likely to achieve ≥5% weight loss at 12 and 24 months. Similarly, women who reduced SCL-20 by 0.70 and men who reduced by 0.60-0.65 were likely to achieve ≥50% decrease in SCL-20 at 12 and 24 months.

Conclusions:
The treatment effects of this integrated intervention for obesity and depression differed significantly by sex, with men showing greater weight loss and women showing greater depression reduction. Sex-specific short-term responses at 6 months were identified for predicting clinically significant weight loss and depression outcomes at 12 and 24 months. Results suggest that sex may be an important tailoring variable when designing collaborative care interventions.
Abstract P225: Effect of Weight Loss Strategies on Serum Uric Acid in Cancer Patients in the Spirit Study
Authors: Hu Jiun-ruey , Yeh Hsin-Chieh , Mueller Noel T , Appel Lawrence J , Miller Edgar R , Juraschek Stephen P
Published: March 2020

Introduction:
Obesity is strongly associated with elevated serum uric acid (SUA), a hypothesized mediator of cardiovascular disease. In observational studies, weight loss is associated with lower SUA. However, trial evidence on weight loss and SUA is lacking.

Hypothesis:
We hypothesized that in a randomized, controlled setting, intentional weight loss would reduce SUA.

Methods:
The Survivorship Promotion In Reducing IGF-1 Trial (SPIRIT) was a three-arm, parallel trial of overweight or obese adult cancer survivors that compared the effects of a coach-directed weight loss intervention or metformin to self-directed weight loss (ref) on insulin growth factor-1 (IGF-1) over a 1-year period. Participants in the coach-directed arm underwent behavioral-based telephonic coaching with web-based support to promote healthy lifestyle and weight loss, targeting a 5% weight loss in the first 6 months. Participants assigned metformin received up to 2,000 mg daily. In our study, SUA was measured in specimens collected at baseline, 3-months, 6-months, and 12-months.

Results:
There were 121 participants, with a mean age of 60 years (standard deviation [SD]: 9), and a mean body mass index (BMI) of 35 kg/m
2
(SD: 5). Compared to the self-directed group, coach-directed weight loss reduced BMI by 0.6 kg/m
2
(95% CI: 0.1, 1.1) and metformin reduced BMI by 0.9 kg/m
2
(95% CI: 0.4, 1.5) over 12 months. However, compared to the self-directed group, coach-directed weight loss significantly increased SUA by 0.3 mg/dL (95% CI: 0.1, 0.6) over 12 months, while metformin did not significantly affect SUA (0.2 mg/dL; 95% CI: -0.04, 0.5). The increase observed with the coach-directed weight loss intervention occurred primarily within the first 3 months of the intervention (Figure).

Conclusions:
Contrary to our expectations, intentional weight loss increased SUA in the short-term. These results question weight loss as a strategy for SUA reduction. Studies testing the long-term effects of weight loss on SUA are needed.
Abstract P226: The Effect Of Isometric Exercise On Aortic Valve Function And Aortic Dimensions In Adolescents With Bicuspid Aortic Valves
Authors: Hartz Jacob C , Mansfield Laura , Brown David , Rhodes Jonathan
Published: March 2020

Introduction:
Central arterial pressure rises to much higher levels during heavy isometric exercise compared to other forms of exercise. For this reason, patients with bicuspid aortic valves (BAV) are often restricted from heavy isometric exercise. Although this approach may be theoretically appealing, no data exists regarding the efficacy of this activity restriction.

Methods:
Patients between the 12-19 years old with BAV were approached during a routine clinic visit. Patients were excluded if they had a diagnosed syndrome or had undergone a procedure involving the aortic valve. Patients were assumed to have been exercise restricted, regardless of aortic dimensions. Patients completed a questionnaire regarding frequency and intensity of isometric exercise during the 12-month period prior to the visit. We then compared aortic dimensions and qualitative (1-4 scale) estimates of aortic insufficiency (AI) from an echocardiogram performed during the current visit and one obtained 2-5 years previously, using paired t-tests and multivariable regression controlling for age, gender, and participation in isometric exercise.

Results:
In this unique data set of 37 individuals (41% female, average age 14.8 years), 6 (16%) participated in isometric exercise. There was no significant increase in the aortic root Z-score (0.004 [95
th
CI -0.20, 0.21) or in the ascending aorta Z-score (0.11 [95
th
CI, -0.15, 0.37], p=0.4) between the first and second visits. Further, there was no differences in the change aortic root Z-score (β=-0.39, p=0.39) and ascending aorta Z-score (β=-0.30, p-0.699) between those who participated in isometric exercise and those who did not. However, although the sample size in this preliminary group of patients was small, the increase in AI severity among those participating in isometric exercise was clinically significant and approached statistical significance (β=0.37, p=0.1). These results did not change even after controlling for age, gender, and time between echocardiograms.

Conclusion:
Most adolescents with BAV follow recommendations to limit isometric exercise. Time-related changes in aortic dimensions were similar among patients who refrained from isometric exercise and those who engaged in isometric exercise. AI however may have progressed more rapidly in those who participated in isometric exercise.