bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P228: Milkfat Consumption, Dyslipidemia, and Body Weight in Children
Authors: Sekkarie Ahlia , Figueroa Janet , Um Caroline , Welsh Jean
Published: July 2021

Background:
Dietary guidelines recommend consumption of 1% or skim (i.e. non-fat) milk for children >2 years due to concerns about the role of saturated fat in raising low-density lipoprotein cholesterol (LDL) levels and cardiovascular disease risk. Low- or non-fat milk is also recommended to promote energy balance and reduce obesity risk. While more recent evidence in adults suggests no association between milkfat and cardiovascular disease risk, this association has not been well studied among children who tend to be the highest consumers of milk. No known studies have demonstrated an association between milkfat consumption and lipid levels in children. Our objective was to determine if there is an association between milk fat consumption and risk of dyslipidemia and obesity among U.S. children.

Methods:
We used cross-sectional data from children 2-19 years from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 (n=7261). Usual milkfat intake (i.e. never/rare milk consumption, non-fat, 1%, 2%, or whole) was self-reported by parent or child. Lipid levels (12-19 years only) and adiposity (BMI z-score and weight category [underweight, normal, overweight, or obese] in all ages) were assessed by trained staff using standardized methods. Covariates included child age, sex, household income, race/ethnicity, physical activity, dieting, and total energy intake. We used multivariate linear and logistic regression models to examine the association between milkfat consumption and our outcomes and conducted pairwise comparisons to assess differences between different milkfat consumers.

Results:
Most children consumed 2% milk (42.3%), followed by whole (26.1%), 1% milk (11.7%), never/rare consumption (10.2%), and nonfat (9.7%). We found no significant trends in mean cholesterol (total, HDL, LDL) with consumption of milk with greater fat content. There was a significant trend towards higher triglycerides as milkfat intake increased (p=0.01) though this association was stronger among 2% milk compared to whole fat consumers. We found no significant trend in prevalence of each BMI category across milk fat intake. Pairwise comparisons demonstrated that usual consumption of 1% and 2% milkfat was associated with both higher BMI Z-score and odds of obesity compared to whole milk.

Conclusion:
We found no significant linear trend between usual %milk fat consumed and indicators of cardiovascular disease (BMI-Z and lipid levels) in children, except for triglycerides which rose as milkfat intake increased. However, triglycerides were higher among the 2% compared to whole milkfat consumers. Overall, whole milk was not associated with increased indicators of cardiovascular disease risk in children.
Abstract P235: Sugar-Sweetened Beverage and Food Intake and Mortality Risk Among U.S. Adults
Authors: Collin Lindsay , Safford Monika , Vaccarino Viola , Welsh Jean A
Published: July 2021

Introduction:
Multiple studies have shown a positive association between consumption of sugar-sweetened beverages (SSBs) and increased obesity and cardiovascular disease risk but few have examined their impact on mortality.

Hypothesis:
The purpose of this study was to examine the impact of (non-milk) sugars on CVD-related mortality and all-cause mortality, and to determine if this impact differs by the form in which they are consumed (beverages vs. foods).

Methods:
This study used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a US based longitudinal cohort of 30,183 black and white men and women over the age of 45. We excluded those with a self-reported history of CVD, stroke, TIA, and type II diabetes at baseline, yielding a final study population of 17,930. Added sugar consumption (in grams) from beverage and from foods were estimated separately using self-administered Block 98 food frequency questionnaires. Sugar-sweetened beverages included those pre-sweetened, such as sodas as well as beverages to which sugar had been added at the point of consumption, such as coffee, or juices. Sugar-sweetened foods included desserts, candy and sweetened breakfast foods as well as foods to which caloric sweeteners (sugars, syrups) had been added. Quartiles of consumption were used for the purposes of analysis, with the lowest category as the reference. Cox proportional hazard models were used to evaluate the association between consumption and all-cause mortality, CHD-related mortality, and CVD-related mortality. Model I adjusted for sociodemographic and behavioral risk factors (age, sex, education, household income, region, smoking, and physical activity). Model II additionally adjusted for possible mediators, including total energy intake, BMI, hypertension, and dyslipidemia.

Results:
In Model I, we observed increased hazard ratios for CVD, CHD-related and all cause related mortality. These results were attenuated but remained significant when adjusting for possible mediators in Model II: HR=1.7, 95%CI 1.1-2.7 for CVD-related mortality; HR=2.5, 95%CI 1.3-4.8 for CHD-related mortality, and HR=1.27, 95%CI 1.02-1.58 for all-cause mortality, when comparing the highest quartile of SSB consumption to the lowest quartile of SSB consumption. We observed similar but attenuated effects between the comparisons for the third and second quartiles of SSB consumption. We did not observe any increased risk with sugar-sweetened foods.

Conclusions:
Older adults who are high consumers of SSBs are at an increased risk of CVD-related and all-cause mortality.
Abstract P236: Association Between Alcohol and Ideal Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis
Authors: Ogunmoroti Oluseye , Osibogun Olatokunbo , McClelland Robyn L , Michos Erin D , Burke Gregory L , Nasir Khurram
Published: July 2021

Introduction:
Alcohol intake is associated with cardiovascular disease (CVD), with moderate drinkers having a decreased CVD risk compared to non- and heavy drinkers. However, this association is yet to be examined using the AHA Life’s Simple 7 (LS7) metrics as a proxy for cardiovascular health (CVH). We explored associations between alcohol intake and CVH in a multi-ethnic population.

Methods:
Our cross-sectional analyses included 6,506 MESA participants, free of CVD, aged 45 to 84 years. The LS7 metrics (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol and blood glucose) were each scored 0-2, with 2 indicating “ideal”, 1 “intermediate” and 0 “poor”. Total LS7 score ranged from 0-14. Alcohol data was obtained from personal history and food frequency questionnaires. Participants were classified as never, former or current drinkers. Current drinkers were categorized as <1 (light), 1-2 (moderate) and >2 (heavy) drinks/day. Multinomial logistic regression models assessed associations between alcohol intake and CVH, adjusted for age, sex, race/ethnicity, education, income and health insurance.

Results:
Mean (SD) age was 62 (10) years, 53% were women; 20% were never, 24% former and 56% current drinkers. Among current drinkers, 44% had <1, 9% 1-2 and 3% >2 drinks/day. Additionally, 47% had inadequate LS7 scores, 33% average and 20% optimal. Compared to never drinkers, those who drank <1 drink/day were more likely to have average and optimal scores, although most of the associations were not significant. Women with 1-2 drinks/day were more likely than men to have optimal scores. Overall and in men, those who drank >2 drinks/day were less likely to have average or optimal scores. Whites and Hispanics with >2 drinks/day were less likely to have optimal and average scores, respectively
(Table).

Conclusion:
Light alcohol intake tended to show favorable CVH, whereas heavy alcohol intake was unfavorable. For moderate alcohol intake, the associations with CVH varied by sex and race/ethnicity.
Abstract P246: Dietary Minerals and Metabolic Syndrome: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Bulka Catherine M , Daviglus Martha L , Sotres-Alvarez Daniela , Durazo-Arvizu Ramon A , Mossavar-Rahmani Yasmin , Persky Victoria W , Argos Maria
Published: July 2021

Introduction:
Minerals play an integral role in lipid and carbohydrate metabolism and defense against oxidative damage, and thus mineral-poor diets may be an important risk factor for cardiometabolic disease. Little is known about the relationship between dietary mineral intake and metabolic health in Hispanics/Latinos - the largest ethnic minority in the U.S.

Hypothesis:
Individuals consuming less than recommended amounts of certain minerals may have a greater burden of metabolic syndrome, independent of individual-level risk factors.

Methods:
We studied 15,051 Hispanic/Latino individuals, aged 18-74 years, from the Hispanic Community Health Study/Study of Latinos, a population-based epidemiologic study of adults enrolled from 4 U.S. communities in 2008-2011. Daily intakes of selected minerals (copper, manganese, selenium, and zinc) from up to two dietary recalls were averaged, and combined with self-reported supplemental intakes. Copper, selenium, and zinc intake levels were dichotomized at the estimated average requirement (EAR); for manganese, the adequate intake (AI) was used as a cutoff point as an EAR has not been established. Metabolic syndrome and its component abnormalities were defined per the harmonized American Heart Association/National Heart, Lung, and Blood Institute criteria as at least 3 of the following 5 criteria: high blood pressure, high triglycerides, low HDL cholesterol, high fasting glucose, or abdominal obesity. Associations of mineral intakes with prevalent metabolic syndrome and its individual components were evaluated using logistic regression models accounting for the complex sampling design of the study.

Results:
Intakes of copper, manganese, selenium, and zinc were below the EAR/AI in 15%, 29%, 4%, and 13% of individuals, respectively. Copper intake below the EAR was positively associated with metabolic syndrome (OR: 1.23, 95% CI: 1.05-1.44) after adjustment for energy intake, age, gender, and Hispanic/Latino background, and was primarily driven by an association with high blood pressure (1.24, CI: 1.04-1.47). Manganese intake below the AI was also associated with metabolic syndrome (1.16, CI: 1.01-1.32), with the strongest associations observed for high fasting glucose levels (1.20, CI: 1.04-1.38) and abdominal obesity (1.19, CI: 1.05-1.36).

Conclusion:
Consuming less than the recommended amounts of copper and manganese was associated with a greater prevalence of metabolic syndrome. Future prospective studies are needed to confirm the importance of achieving copper and manganese adequacy and synergistic aspects of foods containing these minerals for optimal cardiometabolic health.
Abstract P251: Relationship Between Body Size of Social Network Members and Body Size Norms of South Asian Adults
Authors: Lancki Nicola , Siddique Juned , Schneider John A , Kanaya Alka M , Dave Swapna , Puri Ankita , Fujimoto Kayo , Kandula Namratha R
Published: July 2021

Objective:
Perceptions of a healthy body weight may be influenced by social norms within a social network. This study tested the hypothesis that social network body size is associated with body size norms in South Asian adults from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study.

Methods:
South Asian adults (n=700) were asked to list their personal social network members, defined as the “people who you regularly talk with about things that are important to you,” at the social network ancillary study examination (2014-2017). Participants’ perceptions of their network members’ body sizes, their own body size (self-body size), and a healthy body size (body size norm) for men and women were assessed using the Stunkard 9-figure scale. The Stunkard scale is a silhouette figure rating scale consisting of 9 male and 9 female figures of increasing body size (range 1-9). Participants’ height and weight were measured, and body mass index (BMI) was calculated. The average body size of network members was the main independent variable. Body size norm was the dependent variable in a regression model that controlled for age, sex, gender of Stunkard figure, cultural identity, self-body size, participants’ measured BMI, and social network size. A random intercept term was included at the participant level to account for clustering of male and female body size norms within participants.

Results:
Participants’ average age was 59 years (SD+/-9 years) and 43% were female. The average body size norm for male and female Stunkard images was 3.6 (SD+/-1.0) and 3.4 (SD+/-0.8), respectively. Participants’ average self-body size was 4.7 (SD+/-1.5). There were 2,991 social network members identified (mean number of network members=4, SD=1), and the majority (70%) were kin. The average network body size was 3.9 (SD +/-1.1). For every unit increase in their networks’ average body size, participants’ perceptions of body size norms increased 0.31 points on the Stunkard scale (p<0.01; 95% CI: 0.25, 0.36), independent of self-body size and BMI. Perception of a healthy body size norm was 0.25 points lower for female Stunkard figures than for male figures (p<.01; 95% CI: -0.30, -0.20).

Conclusions:
Having social network members with larger body sizes was associated with a higher body size norm in South Asian adults. Norms for female body images were smaller than for male images. Long-term follow-up of the MASALA cohort will determine if network members’ body size and body size norms are associated with weight change and weight-control behaviors in South Asians.
Abstract P255: Long-term Associations Between Non-High Density Lipoprotein and Apolipoprotein B in Young Adulthood and Coronary Artery Calcification in Adults With Nonalcoholic Fatty Liver Disease in Middle Age: The CARDIA Study
Authors: Vanwagner Lisa B , Wilkins John T , Ning Hongyan , Allen Norrina B , Siddique Juned , Lewis Cora E , Terrault norah , Carr J. J , Rinella Mary E , Lloyd-Jones Donald M
Published: July 2021

Background:
Cardiovascular disease (CVD) is the leading cause of death in nonalcoholic fatty liver disease (NAFLD). Apolipoprotein B (apoB) and non-high density lipoprotein-C (NHDL-C) are positively associated with NAFLD in small studies. High apoB predicts atherosclerotic CVD even when NHDL-C is low, suggesting that apoB may be the strongest predictor of atherosclerotic risk in adults.

Objective:
To quantify associations between apoB, NHDL-C and the discordance between apoB and NHDL-C levels in young adulthood with prevalent NAFLD, and coronary artery calcium (CAC) in adults with NAFLD in midlife.

Methods:
CARDIA recruited young adults ages 18 to 30 years in 1985-86. Participants with complete baseline CVD risk factor data and year 25 (Y25) NAFLD assessment and CAC score were included. NAFLD was defined as noncontrast computed tomography (CT) liver attenuation ≤40 Hounsfield Units after exclusions for other causes of liver fat. Presence of CAC was defined as Agatston score >0 on CT. Baseline NHDL-C or apoB values were divided into tertiles and 4 mutually exclusive concordant/discordant groups, stratified based on being above or below median NHDL-C or apoB levels.

Results:
Analysis included 2,508 participants (baseline age: 27 ± 4 years; body mass index: 25 ± 4 kg/m
2
; 58% women; 53% white). Y25 NAFLD prevalence was 10%. Compared with the lowest tertile, higher odds of NAFLD were seen in the middle and high tertiles of both apoB and NHDL-C in separate adjusted models. High NHDL-C and low apoB, but not high apoB and low NHDL-C, discordance was associated with Y25 NAFLD in adjusted models. Among NAFLD participants (n=261), NHDL-C/apoB discordance was not associated with Y25 CAC. Highest odds of CAC were observed in NAFLD participants with high NHDL-C (
TABLE
).

Conclusion:
High NHDL-C is a strong early risk marker for both NAFLD and atherosclerosis among adults with NAFLD in midlife. Based on our study findings, the additional benefit of measuring apoB levels for risk stratification in adults with NAFLD is not apparent.
Abstract P260: Can Metabolic Syndrome Predict the Incidence of Silent Myocardial Infarction? An Analysis From the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Shen Yong , Filipp Stephanie , Gurka Matthew J , DeBoer Mark D , Pearson Thomas A
Published: July 2021

Introduction:
Diabetes patients are at risk for clinical Myocardial Infarction (MI) and have a larger proportion being silent Myocardial Infarction. However, less is known about the impact of Metabolic Syndrome (MetS, also known as prediabetes) on the incidence of silent MI. Here, we studied whether the degree of MetS severity can be predictive for future risk of silent MI.

Methods:
12,527 ARIC study participants who are free of coronary heart diseases (CHD) and diabetes at baseline (1987-1989) were included for the analysis. Silent MI was determined by ECG serial changes of MI without prior clinical history of MI. A continuous MetS severity score was formulated from the integration of MetS components to assess its prediction for future silent MI and clinical MI.

Results and Conclusions:
458 participants (3.7%, 458 of 12,527) developed clinical MI and 87 (0.7%, 87 of 12,527) were diagnosed with silent MI until ARIC visit 4 (1996-1998). Within the 10 years follow-up period, gender, smoking status, MetS components (waist circumference, blood pressure, HDL cholesterol) and the integrated MetS severity score were identified as significant risk factors for the incidence of both silent MI and clinical MI. Participants with MetS had a significant adjusted HR for incident silent MI (HR = 1.98, 95% CI: [1.30, 3.02], p=0.0015) as compared to clinical MI (HR = 1.67, 95% CI: [1.39, 2.00], p<0.0001). The 10-year risk scoring equations of silent MI and clinical MI were constructed as a multivariate predictive tool based on MetS severity score. In conclusion, higher MetS severity score is associated with further risk of both clinical and silent MI, identifying the potential clinical application of MetS severity score in MI prevention.
Abstract P261: Associations of Left Ventricular Mass, Total Body Weight, and Fat-Free Mass With Body Mass Index: The Framingham Heart Study
Authors: Gona Philimon N , Lee Jane J , Salton Carol J , Qazi Saadia , O'Donnell Christopher J , Manning Warren J , Chuang Michael L
Published: July 2021

Introduction:
Increased left ventricular mass (LVM) predicts excess cardiovascular morbidity and mortality. LVM is often indexed to height (HT) or body surface area (BSA). HT-indexation ignores weight and thus obesity. The relationship of indexed LVM with weight, obesity, and adiposity is unclear. We investigated the association of LVM with total-body mass (TBM, i.e. weight) and fat-free mass (FFM), hypothesizing that LVM scales better to FFM than TBM.

Methods:
From the 1794 members of Framingham Offspring cohort who underwent cardiac magnetic resonance (CMR), we identified 845 (aged 65±9y) without any history of hypertension, myocardial infarction, heart failure, or CMR wall-motion abnormality. LVM was measured from cine bSSFP images and indexed to HT, BSA, TBM and FFM (by DEXA). Participants were stratified by sex and body mass index (BMI) category (NL=BMI 18.5 - 24.9; OW=25.0 - 29.9; OB=30.0+ kg/m
2
). We used sex-specific ANCOVA to test for linear trend across BMI categories, and determined sex-specific Pearson correlation coefficients of LVM with BMI; both sets of analyses were adjusted for age and systolic blood pressure. Data are summarized as mean ± SD.

Results:
The Table shows that LVM and LVM/HT increase with greater BMI-category in both sexes. LVM/BSA was similar across BMI-categories, while LVM/TBM decreased. There was no linear trend across BMI-categories for LVM/FFM in either sex. On a continuous basis, LVM and LVM/HT were positively correlated with BMI in both sexes (r=0.20 to 0.35, p<0.001 for all); LVM/BSA was weakly inversely correlated with BMI in women only (r=-0.14, p=0.001) but not men (r=-0.08, p=0.18); LVM/TBM was inversely correlated with BMI (M: r=-0.39, W: r=-0.54; p<0.0001 both); LVM/FFM was not correlated with BMI in either sex (M: r=-0.05, p=0.38, W: r=0.08, p=0.055).

Conclusion:
LVM as a proportion of TBM (weight) actually decreases with greater BMI, while LVM/FFM is not associated with BMI. Whether LVM is better scaled to FFM vs HT, BSA or TBM for risk stratification purposes remains to be determined.
Abstract P262: Association of Weight History With Risk of Diabetes
Authors: Jung Molly , Rebholz Casey M , Stevens June , Coresh Josef , Ndumele Chiadi
Published: July 2021

Introduction:
Weight gain during early adulthood may contribute to diabetes risk above and beyond a single measure in midlife. Nonetheless, most epidemiologic studies have focused on the risks associated with a one body mass index (BMI) value in midlife.

Hypothesis:
Accounting for change in BMI from early to mid-adulthood would add prognostic value for estimating risk of diabetes compared to using a single value.

Methods:
We included 9,857 participants from the Atherosclerosis Risk in Communities (ARIC) Study without diabetes and with BMI ≥18.5 kg/m
2
in 1996-1998 (visit 4). Participants were followed through 2015 for incident diagnosed diabetes. Current BMI was defined as calculated BMI using measured height and weight at visit 4. Early adulthood BMI was calculated from current height and self-reported weight at age 25. We classified current and early adulthood BMI into three categories (18.5-<25, 25-<30, and ≥30 kg/m
2
) and we examined the associations of changes in BMI category with diabetes risk using Cox proportional hazards models.

Results:
Overall, 64% (6,205 of 9,857) of the participants moved from a lower to higher BMI category between age 25 and visit 4 (mean age, 63), 35% (3,446 of 9,857) remained stable, and 2% (206 of 9,857) moved from a higher to lower BMI category. Adding BMI at age 25 to a model with current BMI significantly improved model fit. In analyses using BMI change categories between age 25 and visit 4, relative to persons with normal BMI at age 25 and visit 4, persons who moved from a lower to higher BMI category and those who maintained a high BMI had a higher risk for diabetes (
Table
).

Conclusions:
Current weight is associated with diabetes risk. Past weight gain from early adulthood did not appear to add information above and beyond current weight. Our findings highlight the importance of weight management at all ages for optimal diabetes prevention.
Abstract P263: Acid-Base Status as a Modifier of Loss of Lean Mass During Intentional Weight Loss in Older Adults
Authors: Petrovic Snezana , Leng Iris , Walkup Michael P , Ambrosius Walter T , Rejeski W. J , Nicklas Barbara J
Published: July 2021

Weight loss interventions present a unique challenge in older adults: relative loss of lean mass during weight loss, if superimposed on age-related sarcopenia may increase the risk for mobility disability. Relative loss of lean mass (25-30%) during weight loss depends on the severity/duration of caloric restriction, initial body mass, and concomitant exercise training. We
hypothesized
that subclinical imbalances of acid-base status (reflected in lower serum bicarbonate) may also affect relative loss of lean mass during weight loss. The rationale: even subtle imbalances of acid-base status (e.g. bicarbonate <23 mmol) impact clinical outcomes in older adults such as gait speed or incidence of functional limitation, while bicarbonate supplementation reduces urinary nitrogen wasting and may improve physical function. However, data on acid-base balance and serum bicarbonate during moderate caloric restriction are lacking. We, therefore, analyzed 2 randomized, controlled weight loss trials (including moderate caloric restriction and exercise): The Diet, Exercise, and Metabolism for Older Women [DEMO; (58±5.2 y)] and Cooperative Lifestyle Program; [CLIP; (67±4.7 y)]. Serum bicarbonate was assessed as total CO
2
(in mmol) and whole body lean mass measured by dual-energy X-ray absorptiometry. The analysis showed that 48% of participants had bicarbonate <23. DEMO participants with lower serum bicarbonate at baseline lost more lean mass during the intervention (unadjusted β(SE)=0.32(0.16); p=0.04; n=92). Adjustments for age, BMI, eGFR, % weight loss, baseline, intervention group, had little effect, but adjusting for protein intake during weight loss attenuated the association (β(SE)=0.17(0.15); p=0.28.). Similarly, a change in serum bicarbonate during the trial was associated with % lean mass change, but attenuated after controlling for protein intake. This is not unexpected: protein is acid-producing and one of two major determinants of net dietary acid load; higher dietary acid load correlates with lower serum bicarbonate, in older adults. Results from the CLIP trial were remarkably similar, and consistently, baseline serum bicarbonate level was marginally predictive of baseline daily protein intake, with highest baseline serum bicarbonate having the lowest protein intake [bicarbonate: >24 (n=58); >21-24 (n=121); <21 (N=93); protein in g/kg body weight 0.7(0.4); 0.9(0.4); 0.8(0.4) respectively, p=0.057). In conclusion, our analysis suggests that higher serum bicarbonate before and during weight loss may ameliorate loss of lean mass, however, to obtain definitive answer such analysis needs to be conducted under conditions of controlled or randomized protein intake. Importantly, our findings suggest that oral bicarbonate supplementation, a simple and relatively safe intervention, may ameliorate loss of lean mass during weight loss interventions in older adults.
Abstract P267: Brain Health and Ideal Cardiovascular Health. The Polish Norwegian Study (PONS)
Authors: Vaidean Georgeta , Manczuk Marta
Published: July 2021

Introduction:
The relation between brain- and cardiovascular health has been mainly described through cognitive function. Less is known about the relation of ideal cardiovascular health (CVH) and other brain health characteristics.

Hypothesis:
We assessed the hypothesis that cardiovascular health is associated with brain health constructs: depressive symptoms, sleep quality and duration, self-rated health. As an additional exposure we investigated excessive TV watching, considered an addictive behavior.

Methods:
We used cross-sectional, baseline data of 10687 participants, age 45 to 64 years free of cardiovascular diseases in an ongoing cohort study (PONS). Data were collected through structured questionnaires and fasting blood samples. Ideal CV health was defined according to the American Heart Association criteria (7 metrics assessed at 3 levels: ideal, intermediate, and poor). Brain health was assessed as: 1) depressive mood (PHQ questionnaire, scale 0-7); 2) sleep hours; 3) self-rated overall health (SRH) (1 item, on a scale from 1 to 10); 4) hours watching TV. We used multivariable logistic models and adjusted for age, sex, education, place of residence, antidepressant medication use and past depressive episodes.

Results:
The prevalence of poor CVH (0-2 ideal metrics) was 63% and of ideal CVH (6, 7 ideal metrics) was 0.07%. Reporting 4 or more current depressive symptoms was associated with poor CVH (OR, 95%CI 1.13, 1.02-1.27) after multivariable adjustment. The relation was mainly driven by somatic affective rather than cognitive affective depressive symptoms. Difficulties falling asleep or sleep duration were not associated with CVH after controlling for depression. Watching TV more than 20h/week was associated with poor CVH (OR 1.40, 95% 1.27-1.55) after multivariable adjustment. A SRH score of 6 or lower was associated with poor CVH (OR 1.33, 95% CI 1.22-1.46) after multivariable adjustment. We observed similar relations in a sensitivity analysis after excluding those taking current antidepressant medication.

Conclusion:
In this community-based study we found that there is a moderate association between poor cardiovascular health and current depressive symptoms, independent of past depression episodes or antidepressant treatment. In addition to Life’s Simple 7, monitoring depressive symptoms, sleep, self-rated-health and/or addictive TV-watching may benefit both brain- and heart wellness.
Abstract P269: Cardio-Ankle Vascular Index and the Risk of Cardiovascular Outcomes and All-cause Mortality: A Systematic Review
Authors: Matsushita Kunihiro , Ding Ning , Kim Esther
Published: July 2021

Introduction:
Arterial stiffness is widely used as an index of arteriosclerosis and is associated with cardiovascular disease (CVD). Recently, cardio-ankle vascular index (CAVI) was developed as a measurement of arterial stiffness that is independent of blood pressure at the time of arterial stiffness evaluation. The associations of CAVI with CVD events and all-cause mortality have not been extensively assessed. We therefore systematically reviewed the studies reporting CAVI and relevant outcomes.

Methods:
We searched for both prospective and cross-sectional studies using MEDLINE, Embase, and Cochrane from inception to April 11, 2017. Two independent reviewers screened the retrieved papers, extracted relevant data and assessed the risk of bias. Any discrepancy was solved by discussion or a third reviewer. Heterogeneity among studies was assessed using the I
2
statistic. We pooled the results of studies that were sufficiently homogeneous.

Results:
Among 1,519 records, we identified 9 cohort studies (n=5,292) and 17 cross-sectional eligible studies (n=7,309). All 9 cohort studies reported the outcome of composited CVD (498 cases), but the categorization/modeling of CAVI was not consistent across those studies. The pooled hazard ratio (HR) of CVD for the highest vs. lowest CAVI category in 3 studies was borderline significant (pooled HR=1.34 [0.95, 1.87], p=0.092) (I
2
= 25.2%, p=0.263). For 3 studies examining the continuous association between CAVI and CVD, 1standard deviation (SD) increment of CAVI was significantly associated with CVD risk (pooled HR=1.22 [1.03, 1.45], p=0.023) (I
2
= 27.1%, p=0.253). Only 3 cohort studies investigated CAVI and all-cause mortality, and none of them reported a significant association. All 17 cross-sectional studies reported higher CAVI values in patients with CVD compared to those without CVD, with statistical significance in most studies.

Conclusions:
CAVI was generally higher in patients with CVD compared to their counterparts. In terms of the prospective prognostic value of CAVI, we found a limited number of studies, but they indicated a modest association between CAVI and CVD risk. Our systematic review highlighted the need for large prospective studies to assess the usefulness of CAVI as a predictor of CVD and mortality.
Abstract P271: Women’s Reproductive History and Peripheral Arterial Disease in Late Life: The San Diego Population Study
Authors: Cortes Yamnia I , Parikh Nisha , Allison Matthew A , Criqui Michael H , Suder Natalie , Barinas-Mitchell Emma , Wassel Christina L
Published: July 2021

Background:
Total population burden of peripheral artery disease (PAD) is higher for women than men age ≥40 years. Reproductive factors (e.g., early menarche, parity, early menopause) have been linked with later-life cardiovascular risk in women, but whether they influence PAD has been understudied.

Objective:
To evaluate associations between reproductive factors with later-life ankle-brachial index (ABI), femoral artery intima-media thickness (fIMT), and femoral plaques.

Methods:
Cross-sectional analysis of 707 multiethnic women who participated in a follow-up exam of the San Diego Population Study conducted in 2007-2011. Reproductive exposures included age at menarche, number of live births, age at menopause, surgical menopause, and history of oral contraceptive use. Dependent variables were ABI and Doppler ultrasound measurements of common fIMT and any femoral plaque presence. We performed multiple linear and logistic regression adjusting for age, race/ethnicity, and cardiometabolic factors. Since 30% (n=201) of women reported surgical menopause, we tested for interactions with reproductive factors and stratified by menopause type (natural vs. surgical).

Results:
Women were on average 70.6 years old (SD=9.6) and 56% were White. There were no significant associations in the overall sample after adjusting for covariates. We found interactions between surgical menopause and oral contraceptive use (p=0.03) for ABI, and with parity (p=0.05) and age at menopause (p=0.05) for fIMT. Among women with natural menopause, oral contraceptive use was associated with higher ABI (β:0.03, p=0.007) and older age at menopause was related to greater fIMT (β:0.009, p=0.06) (
Table 1
). Among women with surgical menopause, parity (0 vs. 2) was marginally associated with greater fIMT (β:0.33, p=0.07).

Conclusions:
Findings suggest that reproductive history may be associated with later-life development of PAD in women. Studies are necessary to confirm findings and examine pregnancy-related exposures in relation to PAD.
Abstract P272: Dietary Intake of Vitamin K and the Risk of Incident Pulmonary Embolism in the Nurses’ Health Study
Authors: Harrington Laura B , Mukamal Kenneth J , Hagan Kaitlin A , Kang Jae H , Kim Jihye , Rimm Eric B , Kabrhel Christopher , Jensen Majken K
Published: July 2021

Introduction:
Vitamin K, which is consumed as phylloquinone (K
1
) and menaquinone (K
2
), impacts some vitamin-K dependent proteins involved in hemostasis. It is unknown whether dietary intake of phylloquinone and menaquinone are associated with incident pulmonary embolism (PE) risk.

Hypotheses:
Dietary intake of phylloquinone and menaquinone will be positively associated with the risk of incident PE and, in secondary analyses, idiopathic PE.

Methods:
Eligible women were Nurses’ Health Study participants free of venous thromboembolism (VTE) at 1984 baseline (n=74,821). Participants completed a food frequency questionnaire every four years (1984-2010) and we calculated intake of phylloquinone and menaquinone. Eligible PE cases were confirmed via medical record review or participant reconfirmation, or self-reported among persons with prior cancer. Cases were defined as idiopathic in the absence of cancer, recent surgery, and trauma. Cox Proportional Hazards models estimated hazard ratios and 95% confidence intervals for PE associated with time-varying energy-adjusted quintiles of phylloquinone, and separately, menaquinone. Two models adjusted for time-varying covariates, first including lifestyle and medical factors and next adding energy-adjusted nutrients. Secondary analyses estimated idiopathic PE risk.

Results:
We identified 568 incident PE events during 1,328,669 person-years. In analyses adjusted for lifestyle and medical factors, there was no evidence of a linear association between incident PE risk and energy-adjusted quintiles of phylloquinone intake (linear p-trend across quintile medians = 0.37) or menaquinone intake (linear p-trend = 0.57). Results for idiopathic PE risk were similarly null, as were results after further adjustment for nutrients (Table).

Conclusions:
In this study of U.S. women, there was no evidence of a linear association between energy-adjusted quintiles of phylloquinone or menaquinone intake and incident PE risk, before or after adjustment for other nutrients.
Abstract P276: Activity Tracker Increases Daily Step Count Post-Cardiac Rehabilitation Compared to Placebo Device
Authors: Schorr Erica , Dahl Hilton , Sarkinen Alicia , Brown Rebecca
Published: July 2021

Introduction:
Despite optimal levels of physical activity (PA) among patients immediately post-cardiac rehabilitation, little is known about PA levels long-term. Further, interventions to maintain recommended PA levels and functional capacity achieved during cardiac rehabilitation are lacking.

Objective:
To test the effect of wearing a Garmin vÍvofit for 3 months post-cardiac rehabilitation on PA levels and functional capacity compared to a placebo device.

Methods:
Change in daily step count and 6-minute walk test (6MWT) were assessed over 3 months using the vÍvofit activity tracker in 35 patients (mean age 62±8 years; 83% male; 94% Caucasian) post-cardiac rehabilitation. Goal was 10,000 steps for all participants. Patients were randomized into the control or intervention group with control devices displaying a digital clock. VÍvofit step data were recorded continuously; the 6MWT was conducted at 0, 9, 12, and 15 weeks. Comparisons between the 2 groups were made using test of proportions, t-test, and logistic and linear regression.

Results:
Control and intervention groups were balanced with respect to age, gender, education, baseline step count, and body composition. Although all participants exhibited above average daily step counts (>8,000 steps at 3, 9, and 15 weeks); step counts for intervention group participants were higher at 3, 9, and 15 weeks (by 2,537 steps, 2,022 steps, and 1,545 steps, respectively). Intervention group participants (N=17) increased the distance covered during the 6MWT by 138 feet (sd=28), compared to a 48 foot (sd=18) improvement among control group participants (p=0.500); although not statistically significant, but perhaps clinically relevant.

Conclusion:
These data provide preliminary support for using wrist-worn activity tracking devices to continuously monitor and maintain PA levels post-cardiac rehabilitation. There is a need for larger trials testing the effectiveness of these devices with a more diverse sample over a longer period of time. Wrist worn activity tracking devices should be coupled with other components known to support long-term behavior change (e.g., social support and text messaging) to develop effective interventions for secondary cardiovascular disease prevention.
Abstract P281: All-cause and Cardiovascular Mortality in Men With High Levels of Physical Activity and Coronary Artery Calcification
Authors: Defina Laura F , Radford Nina B , Leonard David , Farrell Stephen W , Pavlovic Andjelka , Willis Benjamin L , Barlow Carolyn E , Levine Benjamin D
Published: July 2021

Introduction:
Recent studies have suggested that extreme levels of physical activity (endurance athletes) are associated with subclinical atherosclerosis as well as increased mortality. The safety of continuing high levels of physical activity is uncertain once coronary artery calcification (CAC) is discovered.

Hypothesis:
We hypothesized that men performing &ge3000 MET·minutes/week of physical activity would have greater all-cause and cardiovascular (CV) mortality compared to those with <1500 or 1500-<3000 MET·minutes/week of physical activity and that mortality risk would be greater in those with CAC&ge100 compared to <100 Agatston units.

Methods:
The cohort studied included 16,109 men without prevalent CV disease who reported physical activity levels and underwent EBT or MDCT scan. Physical activity was categorized into &ge3000 (n=1,266), 1500-3000 (n=3,027), and <1500 (n=11,816) MET·minutes/week. CAC scanning included EBT scans (1997-2007) or MDCT scans (2007-2013), and CAC score was categorized into &ge100 (n=3,547) and <100 (n=12,562) Agatston units. We fit separate proportional hazards regression models to follow-up times for all-cause and CV mortality. The models included all combinations of CAC and physical activity categories and were adjusted for baseline age, smoking, BMI, cholesterol, HDLc, and systolic blood pressure.

Results:
The average age of participants at baseline was 51.3±8.3 years. Men with the highest activity level had a lower BMI and higher HDLc. After an average follow-up of 8.9 years, there were 329 all-cause and 60 CV deaths, including 174 all-cause and 38 CV deaths in those with CAC&ge100. The sample had 80% power to detect all-cause mortality hazard ratios &ge 1.9 and 1.8 for physical activity &ge3000 versus <1500 in those with CAC<100 and &ge100, respectively. The corresponding minimum detectable CV mortality hazard ratios were 3.5 and 2.8. Comparing physical activity &ge3000 to <1500 in those with CAC&ge100, the hazard ratios (95% CI) were 0.9 (0.5, 1.5) for all-cause mortality and 0.9 (0.3, 3.1) for CV mortality. Hazard ratios were similar when comparing physical activity &ge3000 to 1500-<3000 in those with CAC &ge100. Finally, when comparing physical activity categories, there was no evidence that hazard ratios varied by CAC category, p>0.7.

Conclusions:
This sample offers no evidence that levels of activity &ge3000 MET·minutes/week are associated with increased all-cause or CV mortality compared to those with <1500 or 1500- <3000 MET·minutes/week, regardless of CAC level.
Abstract P282: Cross-sectional Relationship Between Physical Activity and Cardiovascular Risk Factors in Kidney Transplant Patients: A Baseline Examination of the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial
Authors: Kang Augustine W , Garber Carol E , Eaton Charles B , Risica Patricia M , Bostom Andrew G
Published: July 2021

Introduction:
Data characterizing the potential relationship between physical activity and cardiovascular disease (CVD) risk factors in kidney transplant recipients (KTRs) are limited in the published literature. Accordingly, we sought to: (1) describe the levels of physical activity (PA) in KTRs; and (2) analyze the associations between PA levels and CVD risk factors in KTRs. We report the largest cross-sectional study of PA levels and CVD risk factors in KTRs to date.

Methods:
Baseline data from the large multiethnic, multicenter trial (FAVORIT) were examined with n = 4034 participants (37% female; mean age 51.9 ± 9.4 years; 75% White; 97% with stage 2T-4T Chronic Kidney Disease; 20% with prevalent CVD). PA was categorized in tertiles (low, moderate, high) derived from a modified PA summary score from the Yale Physical Activity Survey (YPAS). CVD risk factors were examined across levels of PA by ANOVA, Kruskal-Wallis rank test and hierarchical multiple regression modeling.

Results:
Collectively, participants were less active (mean YPAS 39.9 ± 20.6) compared to similar-aged rheumatoid arthritis (48 ± 21) and osteoarthritis (51 ± 20) samples from other studies. Participants in the “high” PA tertile reported more vigorous PA and walking, compared to participants in moderate and low tertiles (both
p
< .001). No differences were observed for daily household, occupational or sedentary activities (i.e., standing, sitting, moving about) across PA tertiles. More participants in the “low” PA tertile were overweight/obese and had a history of prevalent diabetes and/or CVD, compared with more active participants (all
p
< .001). Hierarchical multiple regression revealed that lower age (
p
= .002), having a cadaveric donor source (
p
= .006), shorter transplant vintage (
p
= .025), lower pulse pressure (
p
< .001) and no history of diabetes (
p
< .001) were significantly associated with higher PA scores.

Conclusion:
KTR participants appear to be less active than samples of other chronically ill participants. In our data, lower levels of PA were positively associated with the presence of most CVD risk factors in the KTR population. Furthermore, higher PA levels were associated with younger age and variables associated with more positive KTR outcomes. Future longitudinal analyses of this unique KTR cohort will examine whether higher PA levels are associated with reduced risk for the development of hard, centrally-adjudicated CVD outcomes.
Abstract P284: ClusterAnalysis of Objectively Measured Physical Activity Patterns in Women in the mPEDTrial
Authors: Fukuoka Yoshimi , Zhou Mo , Vittinghoff Eric , Haskell William , Goldberg Ken , Aswani Anil
Published: July 2021

Background:
Determining patterns of physical activity throughout the day could assist in developing more personalized interventions or physical activity guidelines in general, and in particular for women, who are less likely to be physically active than men.

Objective:
The aims of this report are to identify clusters of women based on accelerometer measured raw metabolic equivalent values (METs) and a normalized version of the METs ≥ 3 data and to compare sociodemographic and cardio metabolic risks among these identified clusters.

Methods:
215 women wearing an accelerometer for at least 8 hours per day for the last 7 days prior to the randomization visit were analyzed. A K-means clustering method, the Lloyd’s algorithm, was used. To choose the number of clusters, we used the elbow method, looking at the percentage of variance explained as a function of the number of clusters.

Results:
The results of k means cluster analyses of raw METs revealed three different clusters (Figure 1) and the Low Active Group (n=102) had the highest depressive symptoms score compared to the Afternoon Active (n=65) and Morning Active (n=48) groups (overall
P
< .001). Based on a normalized version of the METs ≥ 3 data Figure 2), the moderate to vigorous physical activity (MVPA) Evening Peak group (n = 108) had higher BMI, and waist and hip circumference than the MVPA Noon Peak group (n=61) (overall
P
=.03, .02, and .03 respectively).

Conclusions:
Categorizing physical inactive individuals into more specific activity patterns could aid in creating timing, frequency, duration, and intensity of physical activity interventions for women. Further research is needed to confirm these cluster groups using a large national dataset.
Abstract P293: The Association of Healthy Lifestyles and Markers of Inflammation: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Linares Jered , Vu Thanh-Huyen T , Pirzada Amber , Wu Donghong , Durazo-Arvizu Ramon , Estrella Mayra , Arredondo Elva , Cai Jianwen , Gallo Linda , Gonzalez Hector , Isasi Carmen , Penedo Frank , Teng Yanping , Daviglus Martha L
Published: July 2021

Background:
Healthy lifestyle factors (HLFs; i.e., healthy diet, ideal weight, ideal physical activity, non-smoking, moderate alcohol intake) are associated with lower risk of cardiovascular disease (CVD), while inflammatory markers such as C-reactive protein (CRP) and white blood cell (WBC) count are associated with higher risk. The association of healthy lifestyles (i.e., HLF combinations) with inflammatory markers is not well established, and has not been examined in US Hispanics/Latinos. We examined cross-sectional associations of HLFs with elevated CRP levels and WBC count in Hispanic/Latino adults.

Methods:
Data from 12,966 men and women ages 18-74 from the baseline HCHS/SOL were analyzed. HLFs examined were: healthy diet (highest sex-specific 40% of Alternate Heathy Eating Index 2010), ideal physical activity (moderate/ vigorous activity ≥150 min/week or vigorous activity ≥75 min/week), no current smoking, moderate alcohol intake (men ≤28g/day; women ≤14g/day) and body mass index (BMI) <25 kg/m
2
. Logistic regression was used to examine associations with CRP levels >3mg/l or WBC count in the highest quintile (≥8x10
9
cells/L), adjusting for demographic and socioeconomic factors, CVD risk factors, and relevant clinical factors, and accounting for the complex survey design.

Results:
In multivariable-adjusted analyses, higher number of HLFs (vs. 0-1 HLF) were associated with progressively lower odds of CRP >3mg/l and WBC count in the 5
th
quintile (p-trend <0.001 for both) (
Table
). In analyses on individual HLFs, BMI <25 kg/m
2
and non-smoking were associated with lower odds of CRP>3mg/l (0.33, [0.28,0.40] and 0.83 [0.71,0.96]) and WBC in the highest quintile (0.74 [0.62-0.89] and 0.37 [0.32-0.44]); moderate alcohol intake and healthy diet were associated with lower odds of WBC in the highest quintile (0.63 [0.48, 0.83] and 0.76 [0.64, 0.89]) (results not tabulated).

Conclusion.
Higher number of HLFs, particularly ideal weight and non-smoking are associated with lower levels of CRP and WBC count.