bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P301: Menopausal Characteristics and Chronic Kidney Disease in the Women’s Health Initiative
Authors: Cheung Katharine L , Kubo Jessica , Stefanick Marcia , Allison Matthew A , LeBlanc Erin S , Vitolins Mara Z , Winkelmayer Wolfgang C , Kurella Tamura Manjula
Published: July 2021

Introduction:
Vasomotor symptoms (VMS) are common menopausal symptoms and the timing of these symptoms, specifically onset of late VMS, has recently been linked with cardiovascular risk factors. Chronic kidney disease (CKD) affects 13% of all women in the US and carries high risk for cardiovascular disease (CVD). The association between CKD and VMS has not been studied.

Hypothesis:
We hypothesized that the timing of VMS would differ between women with CKD compared to women without CKD. We also hypothesized that CKD would modify the effect of VMS on all-cause mortality, coronary heart disease and stroke.

Methods:
We studied the Women’s Health Initiative (WHI) biomarker cohort, which is comprised of all black and Hispanic participants in the WHI observation study and clinical trials plus a subset of white WHI participants such that the biomarker cohort reflects the age distribution of the HT population. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73m
2
and VMS was defined as self-report of hot flushes and night sweats. We used polytomous logistic regression to determine the cross-sectional associations (unadjusted, demographics-adjusted and multivariable-adjusted between CKD and reported VMS categories (none, early, late, persistent). We used Cox proportional hazards models with an interaction term to determine whether the association between late VMS and all-cause mortality or incident CVD was modified by CKD.

Results:
Among the 18,024 WHI participants, 1281 women (5.86%) had CKD. VMS were less common in women with CKD versus without CKD (37.6%
vs
45.8%, p<0.001). Prevalent CKD was associated with an OR of 0.85 (95% CI: 0.72, 1.00) for early VMS, OR 0.80 (95% CI: 0.66, 0.97) for late VMS, and OR 0.59 (95% CI: 0.50, 0.70) for persistent VMS, as compared to having no VMS. The overall association of CKD was not significant after adjusting for potential confounders (p=0.17). CKD was associated with increased risk for mortality (HR 1.72, 95% CI: 1.52, 1.95), coronary heart disease (HR 1.60, 95% CI: 1.33, 1.92) and stroke (HR 1.49, 95% CI: 1.18, 1.87). Late VMS were associated with increased all-cause mortality (HR 1.16, 95%CI 1.04, 1.30) but not significantly associated with coronary heart disease or stroke. No significant interactions were found between late VMS and CKD on any of the endpoints studied.

Conclusions:
In this multiethnic cohort, VMS were less common in women with CKD and CKD did not appear to modify the association between VMS and either incident CVD or total mortality.
Abstract P303: Economic Crisis in Western Europe and Ischemic Heart Disease Mortality
Authors: Bilal Usama , Nau Claudia , Franco Manuel , Glass Thomas A
Published: July 2021

Introduction:
The effects of economic crisis, like the current recession affecting Europe since 2008, on health have been widely debated. Our objective was to evaluate the effects of economic changes on mortality trends from ischemic heart disease (IHD) in Europe for the period 1980-2010.

Hypothesis:
We hypothesize that economic recession is associated with either increases in IHD mortality rates or halting of previous declining trends.

Methods:
We gathered economic (World Bank) and vital statistics data (WHO Mortality Database) for all Western European countries with more than 5 million inhabitants that had complete mortality data for the period 1980-2010. We defined a period of economic recession as an annual GDP (Gross Domestic Product) growth below 0%. We also computed the cumulative years lived through a given recession period (set to 0 if GDP growth rises above 0% in a given year). We computed age-adjusted (2013 European Standard Population) mortality rates for IHD (ICD9 Codes: 410-414, ICD10 Codes: I20-I25) for the study period and computed yearly changes. We modelled the association between recession and IHD mortality using Generalized Estimating Equations accounting for the correlation among data within country and time using first order autoregressive within-group correlation structures. Changes in ICD coding were introduced as a covariate to account for the shift from ICD-9 to ICD-10. We tested for associations using 0 to 10 year lags. Sensitivity analyses were conducted using unemployment as an alternative indicator of economic recession.

Results:
Twelve Western European countries were included (Austria, Finland, France, Germany, Greece, Ireland, Netherlands, Norway, Spain, Sweden, Switzerland and the United Kingdom). Economic recession was associated with a 2-year lagged 1.49% increase in IHD mortality in men (p=0.016) and 1.74% increase in women (p=0.019). Each additional year of recession was associated with a 2-year lagged 1.21% increase in IHD mortality in men (p=0.003) and 1.17% increase in women (p=0.016). Sensitivity analyses using unemployment as a second measure of economic recession showed analogous results with strongest associations seen in 0-year lags. GDP and Unemployment were highly correlated with two-year lags between GDP and Unemployment changes, confirming the robustness of these associations.

Conclusions:
This study showed a deleterious effect of economic recession on ischemic heart disease mortality rates in Europe for the period 1980-2010. Further studies should look into the specific mechanisms of this association and into the possible interaction with policy responses to economic crisis.

1
Abstract P306: Combined Impact Of Income And Education On All-Cause And Cardiovascular Mortality In Men And Women. Prospective Results From The Moli-Sani Study.
Authors: Bonaccio Marialaura , Di Castelnuovo Augusto , Costanzo Simona , Persichillo Mariarosaria , Donati Maria Benedetta , de Gaetano Giovanni , Iacoviello Licia
Published: July 2021

Background:
Education and income have been reportedly associated with mortality but their combined impact has not been extensively investigated. This study aims at evaluating the combined impact of income and education on overall and cardiovascular mortality in men and women.

Methods:
A prospective cohort study on a large sample of individuals (N=20,600, age ≥35) free from cardiovascular or cancer disease randomly enrolled in the Moli-sani study. The cohort was followed-up for overall mortality for 6.8 years (median 4.3 years). Education was considered as low (≤8 years of study) or high (>8 years). Low income group was defined as gross income ≤25,000euros/year while high income category included subjects reporting >25,000euro/years. A four-level variable was constructed to account for the combination of the two measurements: a) low income and low education group (reference group); b) high income and low education; c) low income and high education; d) high income and high education group. Hazard ratios were calculated using Cox-proportional hazard models.

Results:
During follow-up, 354 all-cause deaths occurred, 61 from cardiovascular causes. In a fully adjusted model, income, but not education, was significantly associated with a reduction of overall mortality. However, the group having both high income and high education levels showed a reduced risk of 54%(HR=0.46; 95CI: 0.32-0.66) compared to the reference group. Cardiovascular mortality was also reduced by 63%. Analyses stratified by sex showed that the highest combination of income and education had a stronger impact on overall mortality among women (HR=0.27; 95CI: 0.10-0.79) than among men (HR=0.50; 95CI:0.34-0.76).

Conclusions:
The combination of high education and high income is associated with a consistent significant reduction of either overall or cardiovascular mortality. The protective effect of the combination is apparent in both genders but is stronger in women than in men.
Abstract P315: Association of Marital Status with Health Care Use among Hispanic/Latino Adults: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Womack Veronica Y , De Chavez Peter , Penedo Frank J , Gonzalez Patricia , Ojeda Lizette , Ostfeld Robert , Cai Jianwen , Gallo Linda C , Giachello Aida , Daviglus Martha L , Carnethon Mercedes
Published: July 2021

Background:
Sociocultural factors have been linked to health care seeking among Latino adults. A supportive social context may encourage proactive steps leading to health maintenance, including healthcare seeking.

Objective:
To explore the cross-sectional association of marital status with annual health care provider visits among Hispanic/Latino adults ages 18-74 with and without chronic diseases.

Methods:
Participants from HCHS/SOL Sociocultural Ancillary Study with measures of social support, marital status, and health care use were included in the analysis (n=3,401). Marital status was self-reported. Health care use was defined as whether the participant saw a health care provider in the past twelve months. Weighted multiple logistic regression models were used to examine the associations of marital status with healthcare use, after adjusting for covariates.

Results:
On average, participants were 40 years old , 83% were currently married, and 73% had at least one health care provider visit in the past twelve months. Analyses were stratified by gender and the findings were null in men, therefore only the findings in women are reported. Among Hispanic/ Latino women with chronic diseases, individuals who were married were more likely to have an annual health care provider visit than those who had never married. However, this association no longer remained significant after adjustment. Among Latino women without chronic diseases, individuals who were married were less likely to have an annual health care provider visit than those who were never married.

Conclusion:
Marital status is associated with health care use among Hispanic/Latino women without chronic diseases. Future research should assess whether marianismo, a culture specific gender role characterized by self-sacrifice and prioritization of familial needs, influences marital status’ association with preventive health care utilization among Latino women.
Abstract P330: Cardiovascular Adipose Depots Of The Heart And Aorta Are Associated With CVD Risk Factors And Vascular Calcification In Women With SLE
Authors: Shields Kelly J , Ahearn Joseph M , Manzi Susan
Published: July 2021

Introduction:
Women with systemic lupus erythematosus (SLE) are at greater risk of developing cardiovascular disease (CVD), which is not explained by traditional CVD and SLE-related risk factors. Mounting evidence implicates small visceral adipose depots surrounding the heart and vasculature in the pathogenesis of CVD. Previously, we found that women with SLE had a greater volume of aortic perivascular adipose tissue (aPVAT) compared to healthy controls (HC). Here we quantify epicardial (EPI), paracardial (PARA), and total heart (TOT = EPI+PARA) adipose and evaluate their associations with aPVAT, CVD risk factors and coronary artery (CAC) and aortic (AC) calcification.

Design:
Data included clinically CVD-free SLE women never (SLEc-) or ever (SLEc+) on corticosteroids, and healthy controls (HC) (HEARTS cohort). Electron beam CT scans were used to quantify adipose depots and AC/CAC. Logistic and linear regressions were used and final models were adjusted for waist-to-hip ratio.

Results:
In this study, age- and race-matched women participated: 15 SLEc-, 15 SLEc+, and 15 HC. More SLE women had hypertension (p=0.04), elevated circulating eSelectin (p=0.04), albumin (p=0.01), and homocysteine (p=0.02) compared to HC. SLEc+ women had decreased circulating C3 (p=0.04) and C4 (p<0.01) compared to SLEc- women. TOT tended to be greater in SLE (mean(std): 108(92)cm3, p=0.07) vs. HC (85.2(30) cm3) and in SLEc+ (122(45) cm3,p=0.06) vs. vs SLEc- (93.5(32) cm3). There were no differences in EPI (p=0.2) or aPVAT (p=0.3), but PARA was greater in SLEc+ (54.2(27) cm3) vs. SLEc-(36.9(19) cm3) (p=0.05).

TOT was correlated with aPVAT in SLE (rho,p: 0.47, 0.01) and HC (0.69, <0.01) with PARA volume (SLE(0.43, 0.02) and HC (0.57, 0.03)) driving this association. In HC, EPI and PARA were correlated with insulin (p<0.03) and HOMA-IR (p<0.04) while PARA was correlated with CRP (p=0.04). Glucose levels were correlated with EPI in SLEc+ (0.53, 0.04) and with PARA in SLEc- (-0.55, 0.03).

AC was detected in 21/28 SLE women and 11/15 HC while CAC was detected in 13/28 SLE and 4/15 HC. Only aPVAT was associated with increasing AC (OR(95%CI),p): 1.09 (1.0-1.2), 0.04) and CAC (1.11 (1.0-1.2), 0.03) in SLEc+. In adjusted models, only aPVAT(log) remained associated with greater extent of AC in SLE(β(SE),p: 2.90(1.3), 0.04), which was driven by SLEc+ (5.13(1.8), 0.02) women.

Conclusion:
Adipose depots surrounding the heart and vasculature are greater in clinically CVD-free women with SLE and specifically SLEc+, with significant associations among CVD risk factors and calcification dependent on their location. Corticosteroid treatment may suppress circulating inflammatory markers, but is associated with greater adipose volumes surrounding the heart and increased calcification. Just as AC generally precedes CAC development, aPVAT may be a precursor to extensive PARA and EPI development, with PARA more strongly associated.
Abstract P341: Associations between Middle-age Risk Factors and Risk of Asymptomatic Abdominal Aortic Aneurysm: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Tang Weihong , Alonso Alvaro , Lutsey Pamela L , Lederle Frank , Yao Lu , Guan Weihua , Folsom Aaron R
Published: July 2021

Introduction:
Abdominal aortic aneurysm (AAA) is an important cardiovascular disease in older adults and rupture of an AAA is associated with high mortality. Although traditional cardiovascular risk factors have been associated with the risk of AAA, their importance in the etiology of AAA is not well established, partly due to limited data for asymptomatic AAA from large prospective studies with a long follow up. The objective of this study was to prospectively assess the association between mid-life atherosclerotic disease risk factors and later-life asymptomatic AAA in the ARIC Study, a large, community-based cohort.

Methods:
Risk factors were measured at baseline, at 45-64 years of age, in 1987-1989. Abdominal aortic ultrasound was conducted in 2011-2013. Ultrasound images with maximal infrarenal abdominal aortic diameter (IAD) ≥ 28 mm were over-read by radiologists. Diagnosis of asymptomatic AAA was made in the over-reading based on IAD ≥ 30 mm. Participants who had a history of repair for abdominal aorta or were identified as clinical AAAs via previous hospital discharge diagnoses were excluded. Multivariable logistic regression models were used to estimate the association of baseline risk factors with AAA risk.

Results:
A total of 113 asymptomatic AAAs were ascertained in 5,904 participants (78% whites) who had an abdominal ultrasound exam (prevalence=1.9%). Age, male gender, white race, smoking, height, total, HDL, and LDL cholesterols, triglycerides, white blood cell count, and fibrinogen were risk factors for asymptomatic AAA (Table). BMI, diabetes, alcohol consumption, hypertension, and peripheral artery disease were not associated with AAA. In multivariable adjustment that included the significant risk factors, age, smoking, height, LDL or total cholesterol, white blood cell count, and fibrinogen remained independently associated with AAA risk (p<0.05).

Conclusions:
Several lifestyle and clinical variables measured in middle-age were associated with risk of asymptomatic AAA during a long follow up.
Abstract P344: Fibrosis-Related Biomarkers and the Risk of Incident Cardiovascular Disease: The Cardiovascular Health Study
Authors: Agarwal Isha , Glazer Nicole , Barasch Eddy , Biggs Mary Lou , Djousse Luc , Gottdiener John , Ix Joachim , Kizer Jorge , Rimm Eric , Siscovick David , Tracy Russell , Zieman Susan , Mukamal Kenneth
Published: July 2021

Background:
Fibrotic changes in the heart and vasculature have been implicated in a diverse range of cardiovascular disease (CVD). However, limited epidemiological data exists to support such associations.

Methods:
We determined prospective associations of two complementary biomarkers of fibrosis, transforming growth factor- β (TGF-β, n=1,371) and procollagen type III N-terminal propeptide (PIIINP, n=2,568), with congestive heart failure (CHF), myocardial infarction (MI), and stroke among community-living older adults in the Cardiovascular Health Study over 14 years of follow-up. Due to potentially pleiotropic effects of TGF-β on inflammation and fibrosis, we investigated effect modification by C-reactive protein (CRP) in secondary analyses.

Results:
In age, sex, race, and site-adjusted models, higher PIIINP was associated with risk of total CVD, CHF, and stroke, as was the combined measure of TGF-β and PIIINP (sum of z-scores). Most of these associations remained statistically significant in fully-adjusted models (Table). TGF-β was not associated with CVD in the full cohort, but associations with total CVD, CHF, and stroke were statistically significant among individuals with CRP above the median (2.3 mg/L) (
P
-interaction=0.05). Associations involving PIIINP were also statistically significant and stronger among individuals with higher CRP. In the high CRP stratum, HRs for total CVD were 1.15 (CI: 1.02, 1.30) per SD TGF-β, 1.14 (CI: 1.04, 1.25) per SD PIIINP, and 1.21 (CI: 1.06, 1.38) per SD of the combined measure. In the low CRP stratum, HRs were 0.96 (CI: 0.82, 1.12) per SD of TGF-β, 1.02 (CI: 0.92, 1.12) per SD PIIINP, and 1.04 (CI: 0.90, 1.20) per SD of the combined measure.

Conclusion:
Our findings provide further evidence that circulating biomarkers of fibrosis, measured late in life, are associated with CVD. Research on whether TGF-β has a stronger pro-fibrotic effect in the setting of increased inflammation is warranted.
Abstract P346: Novel Protein Glycan Derived Marker of Systemic Inflammation is Associated with Incident Coronary Heart Disease and Ischemic Stroke
Authors: Akinkuolie Akintunde O , Buring Julie E , Ridker Paul M , Mora Samia
Published: July 2021

Background:
Enzymatically glycosylated proteins participate in multiple cellular processes, with variations in their concentration implicated in innate immunity and chronic inflammation. In addition, most inflammatory proteins are enzymatically glycosylated. GlycA is a novel nuclear magnetic resonance (NMR) biomarker whose signal originates from the N-acetyl groups of N-acetylglucosmine and N-acetylgalatosamine moieties of protein glycans. We assessed the association of GlycA with both incident CHD and ischemic stroke and performed a comparative analysis with hsCRP.

Method:
GlycA was quantified by proton NMR spectroscopy (LipoScience, NC) and hsCRP by immunoturbidimetric assay (Denka Seiken) in 27 649 participants of the Women’s Health Study. During a median follow up of 17 years, 1 089 incident cases of CHD and 465 incident cases of ischemic stroke were confirmed.

Results:
GlycA correlated with LDL cholesterol (r = 0.17), HDL cholesterol (r = -0.27), triglycerides (r = 0.47), BMI (r = 0.41) and hsCRP (r = 0.61), all p<0.0001. Multivariable-adjusted HRs (95% CIs) for top versus bottom quartiles of GlycA were 1.78 (1.44-2.20) with CHD and 1.50 (1.11-2.03) with ischemic stroke respectively (p-trend for both ≤ 0.006); these associations were similar in magnitude to that obtained for hsCRP and were weakened but remained significant after adjustment for lipids. (Table) Further adjustment for hsCRP attenuated the associations which were no longer statistically significant (p-trend ≥0.40 for both CHD and ischemic stroke).

Conclusion:
A novel protein glycan derived biomarker, GlycA, was associated with a graded increase in the risk of both incident CHD and ischemic stroke in this prospective study of initially healthy women in a manner similar to hsCRP. Adjustment for hsCRP attenuated this association, consistent with a possible role for protein glycans in inflammation.
Abstract P354: Elevated Adiponectin And Tnf-alpha Levels Are Markers For Gluten And Lectin Sensitivity
Authors: Gundry Steven R
Published: July 2021

Adiponectin is a protein hormone secreted by adipose cells and is thought to be a precursor for the inflammatory cytokine TNF-alpha. Although low levels of Adiponectin are associated with visceral adiposity and high levels with weight loss, there is a strong association of elevated Adiponectin and TNF-alpha levels in thin women with dementia, osteopenia, and/or coronary artery disease. This paradox led us to consider that these biomarkers correlated to sensitivity to the plant defense proteins: gluten and other lectins.

We studied serial Adiponectin and TNF-alpha levels every 3 months in 1,000 pts, M:F ratio 1:1 in response to a lectin and gluten elimination diet (The Matrix Diet). All samples were sent to a core lab (Singulex, Alameda, CA). The diet consisted of avoidance of grains, sprouted grains, pseudo-grains, beans and legumes, soy, peanuts, cashews, nightshades, melons and squashes, and non-Southern European cow milk products (Casein A1), and grain and/or bean fed animals.

Eight hundred pts (80%) related some history of autoimmune disease (AID) personally or among family members, including Hashimotos thyroiditis, IBS, arthritis, RA, Lupus, Crohns, colitis, GERD, CAD, Type 1 DM.

Adiponectin levels were elevated in all 800 pts with family hx or personal history of AID (16.6-83 ug/ml)(nl<16.5). TNF-alpha levels were elevated in 760/800pts with AID hx (95%) (>3.0 pg/mL). In contrast, Adiponectin was normal in 200 remaining pts without AID history (<16.5 ug/ml), while TNF-alpha was normal in 100/200 (50%) of pts without AID.

When the lectin and gluten free diet was instituted, all TNF-alpha levels became normal in all 1,000 pts (<3.0 pg/mL), within 6 months and remained normal, if the diet was followed, for up to one year of study. However, despite normal TNF-alpha levels, Adiponectin levels remained elevated in 790/800 pts with AID hx. Late lack of adherence to the diet occurred in 56/1,000 pts (6%) (as determined by questionnaire) resulted in re-elevation of TNF-alpha in 56/56 pts (100%).

We conclude that elevated Adiponectin is a marker for lectin and gluten sensitivity, while TNF-alpha can be used as a marker for gluten/lectin exposure in sensitive individuals. These findings probably explain the Adiponectin paradox. TNF-alpha levels appear to be useful as a marker of response to a lectin/gluten limited diet, and as a marker for degree of adherence to such a diet.
Abstract P359: High Blood Pressure in African HIV+ Patients Increases Long-Term Mortality
Authors: Bloomfield Gerald S , Hogan Joseph W , Keter Alfred , Holland Thomas L , Sang Edwin , Kimaiyo Sylvester , Velazquez Eric J
Published: July 2021

Background:
Patients with human immunodeficiency virus (HIV) in the modern era are at risk of developing cardiovascular diseases. High blood pressure (BP) is common in sub-Saharan Africa, however, global attention in the region has been mostly focused on HIV. The impact of BP on mortality among adults with HIV in this region has not been reported.

Objective:
The objective was to determine the impact of BP on mortality among HIV seropositive (+) adults without acquired immune deficiency syndrome (AIDS) in Kenya.

Methods:
We conducted a retrospective analysis of de-identified medical records of the Academic Model Providing Access to Healthcare HIV treatment program between 2005 and 2010. We excluded patients with AIDS, who were <16 or >80 years old, or with data out of acceptable ranges. There were 49,475 HIV+ individuals who satisfied inclusion/exclusion criteria (Figure 1). Missing data for key covariates was addressed by inverse probability weighting. We summarize crude mortality rates across BP categories, separately by gender. We used proportional hazards regression models to characterize the effect of BP on mortality, adjusting for baseline demographic and clinical factors. We subdivided the sample according to those who were clinically stable, defined as having ≥CD4 350 or WHO Stage 1.

Results:
Our sample was 74% (36,616 of 49,475) women. Mortality rates for men and women were 3.8/100 and 1.8/100 person-years, respectively. Crude mortality rate among clinically stable men was higher with systolic BP ≥140 mmHg (3.0, 95% CI: 1.6-5.5) than with normal systolic BP (1.1, 95% CI: 0.7-1.7). In weighted proportional hazards regression models, clinically stable men with systolic BP ≥140 mmHg carried a higher mortality risk than normotensive men (HR: 2.39, 95% CI: 0.94 to 6.08).

Conclusions:
Blood pressure is an important aspect of the care of HIV+ patients in sub-Saharan Africa. High systolic BP is associated with mortality among clinically stable men without AIDS. Further investigation into cause of death in warranted.
Abstract P371: Healthy Clinics, Healthy Kids - Lifestyle Intervention on Cardiometabolic Disease Prevention in Pediatric Clinical Settings
Authors: Hollar Danielle , Heitz Caitlin , Lombardo Michelle
Published: July 2021

Childhood obesity should be addressed in multiple sectors, including the health services/clinical setting. While many physicians believe it is their responsibility to help adult patients lose weight, the majority feels they are not equipped to manage weight problems of their patients. Healthy Clinics, Healthy Kids (HCHK) was designed to test the impact of addressing obesity, using a lifestyle approach, among pediatric patients and families in a variety of primary care clinical settings.

HCHK interventions took place over a 2-year period (2010-2012) in three states (MI, MS and NM). Lifestyle interventions (nutrition, healthy living, physical activity education/technical assistance), targeted children and caregivers in low-income clinical settings that care for children. The goal was to help clinical staff address obesity issues and concerns of patients and families.

Impact of interventions was assessed using pre and post surveys. 21 sites completed pre and post surveys (MI (9), MS (9), and NM (3)). Respondents included nurses (14), managers (2), physicians (2), coordinators (1), and a registered dietitian. Prevalence of obesity among children was higher than the national average (respondents reported that only 56% were “normal”, as compared to approximately 66% nationally). 32% indicated private insurance pays for some obesity care, and 42% indicated public insurance. 44% indicated they discuss weight with parents of “normal” weight children, and about 73% indicated they discuss this with parents of “overweight” children.

Statistically significantly (at the p<.05 level) more respondents indicated, at the end of the project than at the beginning, that they discuss “the impact of childhood obesity on their future risk for chronic diseases in adulthood” (70% versus 57%). Statistically significantly more indicated that they discuss this topic with parents at the end (76% versus 57%). There was an increase in discussing obesity with patients, topics including exercise and physical activity (+8.5%) and limiting sedentary behaviors (+5.0%). There was an increase in conversations with parents, topics including healthy food and beverage choices (+4.8%), physical activity (+9.4%), limiting sedentary behaviors (+4.7%), “creating a healthy home environment” (+19.1%), and “removing the TV from the bedroom” (+14.3%) Although at baseline it was not discussed much (22.2%), at follow-up, there was an increase in “encouraging breastfeeding for childhood obesity prevention, if pregnant” (38.1%). Regarding parents, although already a topic with high comfort level at baseline, statistically significantly more respondents indicated at the end of the project that they felt comfortable discussing exercise and physical activity (76.2% versus 90.5% respectively). Overall, HCHK showed that implementation of a nutrition and healthy living program for clinics is feasible and effective.
Abstract P384: Disparities in Activity Limitations among Adults with Coronary Heart Disease and Stroke
Authors: Fang Jing , Ayala Carma , Wang Guijing , Loustalot Fleetwood
Published: July 2021

Background:
Cardiovascular disease is the leading cause of mortality and a major cause of disability among US adults. Activity limitations are one aspect of disability and are likely to vary among those with- and without cardiovascular disease, as well as by sociodemographic characteristics. The objective of this report is to use the most recent national surveillance data to assess disparities of self-reported activity limitations among those with coronary heart disease (CHD) and stroke.

Methods:
Using 2012 Behavioral Risk Factor Surveillance System data, an annual, state-based telephone survey of adults collecting health behavior and risk factors information, we identified those with self-reported CHD and stroke. Self-reported activity limitations were assessed using the question, “Are you limited in any way in any activities because of physical, mental, or emotional problems?” Age-standardized prevalence of activity limitations was measured among those with CHD and stroke, respectively. Selected demographic and descriptive characteristics included age, sex, race/ethnicity, education, income, health insurance, arthritis and diabetes.

Results:
Among 471,812 eligible participants, 6.8% and 2.9% reported CHD and stroke, respectively. Self-reported prevalence of activity limitations was significantly higher among those with CHD (50.2% vs 18.1%, p<0.001) and stroke (55.4% vs 19.3%, p<0.001) than those without the conditions, respectively. Among those with CHD, significant higher activity limitations existed among middle aged population (57.0%, 95% confidence interval 55.3-58.7) for 45-64 years compared to 43.7% (39.6-47.8) for 18-44 years; American Indian/Alaska natives (67.5% (57.9-75.9)) compared to Asia-Pacific Islanders (31.8% (19.5-47.2)), non-Hispanic whites (48.2% (45.5-51.0)), non-Hispanic blacks (48.9% (42.7-55.0)) and Hispanics (38.9% (33.2-44.8)); those with less than high school education (54.5% (48.2-60.6)) compared to those with college or higher education (32.6% (29.4-35.9)); as well as those with household income <$25,000 (55.1% (52.1-58.0) compared to those ≥$50,000 (28.6% (24.7-32.7)). Similar patterns were noted among those with stroke. By state, age-standardized prevalence of activity limitation among those with CHD ranged from 30.3% (24.4-36.9) (Maryland) to 62.9% (53.8-71.3) (Tennessee). Among those with stroke, the prevalence of reported activity limitation ranged from 31.1% (20.3-44.4) (Delaware) to 74.6% (66.3-81.4) (Tennessee).

Conclusion:
Among those who report a history of CHD or stroke, more than half reported activity limitations. Significant disparities were noted among subgroups by sociodemographic characteristics and state.
Abstract P391: Clinically Significant Blood Pressure Reduction Among Participants of a Lifestyle intervention Improvement Program strongly associated with Reduced Systemic Inflammation in a High Risk Working Population
Authors: Guzman Henry , Rouseff Maribeth , Tran Thinh , Nasir Khurram , Bou-Khalil Josette , Mora Joseph , Das Sankalp , Brown Doris , Santiago-Charles Joann , Ochoa Teresa C. , Gilliam Cynthia , Lehn Virginia , Aneni Ehimen , Oni Ebenezer , Robertson Lara , Veledar Emir , Post Janisse , Castillo Beatriz
Published: July 2021

Background:
In this study we aim to assess the short term effects of clinically significant Blood Pressure (BP) reduction after a behavioral intervention on systemic inflammation, measured by elevated high sensitivity c-reactive protein (HSCRP), in a high cardiovascular disease (CVD) risk cohort.

Methods:
The study was conducted among 180 employees of Baptist Health South Florida who had 2 or more CVD risk factors such as obesity, diabetes, hypertension or elevated total cholesterol and was involved in a three-month workplace lifestyle intervention. The intervention focused on nutritional and physical activity modifications. At baseline and at 3 months follow-up, anthropometric, clinical, and laboratory measures were obtained. Significant BP reduction was defined as systolic blood pressure (SBP) reduction ≥ 10mmHg or diastolic blood pressure (DBP) reduction ≥ 5mmHg at 3 months of follow-up. A HSCRP >3mg/L was considered elevated.

Results:
Over the 3-month study period the median SBP decline was 16mmHg (IQR 4 -23mmHg) while the median reduction in DBP was 10mmHg (IQR 6 -16mmHg). 87% (156 participants) experienced significant BP reduction. Among those without significant BP reduction, the prevalence of elevated HSCRP at baseline was 58% and at follow-up it was 75% (p = 0.125). However, among those who had significant BP reduction, there was significant reduction in the prevalence of elevated HSCRP from 66.7% to 57.1% (p<0.001). In unadjusted conditional logistic regression analyses significant BP reduction was associated with 94% reduction in the risk of elevated HSCRP at follow-up. In a fully adjusted model, this association persisted.

Conclusion:
Clinically significant reduction in blood pressure over a short period in a high cardiovascular disease risk working population is independently associated with markedly diminished risk of elevate hs-CRP. Longer follow-up intervention studies are required to further understand if these effects are sustained.
Abstract P392: Childhood Risk Factors and Adulthood Risk of Pregnancy-Induced Hypertension: The Bogalusa Heart Study
Authors: Li Shengxu , Xiong Xu , Fernandez Camilo , Chen Wei , Srinivasan Sathanur S , Berenson Gerald S
Published: July 2021

Background:
Hypertension in pregnancy is an important cause of both maternal and fetal morbidity and mortality. Whether hypertension in pregnancy has its risk factor(s) in childhood is not known. The objective of this study was to examine the association between childhood risk factors and hypertension in pregnancy later in life.

Methods:
A nested case-control analysis was performed based on the longitudinal Bogalusa Heart Study cohort (67% white and 33% black), with an average follow-up period of 26.2 years. Cases were defined as women who had hypertension during pregnancy and had normal blood pressure measurements after the pregnancy (n=82). Controls were defined as women with normal blood pressure without hypertension in pregnancy (n=454). Childhood risk factors included body mass index (BMI), systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterols, and triglycerides. Univariable and multivariable logistic regression were used to estimate the odds ratio (OR) and 95% confidence interval (CI), with childhood risk factors standardized to age- and race-specific z-scores based on the total population of 5419 female subjects.

Results:
Cases and controls had comparable age in childhood (10.1 vs 9.8 years, P=0.53). Cases vs controls had higher BMI (19.1 vs 17.6 kg/m2, P<0.001) and systolic blood pressure (101.8 vs 99.2 mm Hg, P=0.002) in childhood. In univariable analysis, significant childhood predictors for having hypertension in pregnancy included BMI (OR corresponding to 1 age- and race-specific standard deviation change =1.45, 95% CI: 1.15-1.83) and systolic blood pressure (1.48, 1.15-1.89). BMI and systolic blood pressure remained as significant predictors for having hypertension in pregnancy in multiple regression analysis (1.34, 1.03-1.75 and 1.33, 1.01-1.74, respectively).

Conclusions:
Childhood BMI and systolic blood pressure are significant predictors for having pregnancy-induced hypertension in adulthood, which underscores the importance of childhood risk factors assessment and early intervention.
Abstract P398: Uric Acid And Prehypertension: Salt Intake in Addition to Insulin Resistance are not Mediators.
Authors: Lotufo Paulo A , Santos Itamar S , Bensenor Isabela M
Published: July 2021

Introduction:
The association "uric acid and high blood pressure" is still matter of debate. Therefore, to distinguish serum uric acid as an independent factor for high blood pressure can start new trials to prevent hypertension. A paleoantropological rationale for this association was a knockout of uricase occurred during the Miocene among hominids that induced high levels of uric acid. As consequence, during food shortage times, high uric acid had an evolutionary benefit increasing salt-sensitivity for keep blood pressure and rising insulin resistance that maintaining high blood glucose levels provided fuel for the brain. Nowadays, the average levels of uric acid are substantially higher compared to chimpanzees, a uricase-deficient primate, and among remote populations as the yanomamo.

Hypothesis:
we assessed the hypothesis that the link between uric acid and blood pressure in individuals without hypertension is independent of sex, age, race, salt and alcohol intakes, glucose homeostasis, body-mass index and renal function.

Methods:
from the 15105 participants of the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) aged 35-74 years, we selected 7954 individuals (median age = 48 years-old; women =58.1; White = 56.6%) without hypertension, diabetes, previous cardiovascular diseases. The presence or not of prehypertension (7th JNC criteria) was the dependent variable and quartiles (Q) of serum uric acid, the independent variable. We applied an unconditional logistic regression adjusted for age and sex. After this, according to our hypothesis, we added the following variables: (1) 24-hour urinary sodium; (2) log Homeostasis Model Assessment (fasting blood glucose (mg/dL) х fasting insulin (mg/dL)/450), and (3) a full model, adding race, body-mass index, alcohol intake, and glomerular filtration rate by CKD-epi).

Results:
the uric acid quartiles ranges (md/dL) were Q1 ≤ 4.1; Q2:4.2-5.0; Q3:5.1-6.0; Q4: ≥ 6.1 and the number of participants were Q1= 1909; Q2=2029; Q3=2000; Q4= 2016. Considering Q1 as reference, the age-sex adjusted odds ratios (95% Confidence Interval) through the quartiles were: Q2= 1.22 (1.05-1.41); Q3= 1.40 (1.20-1.63); Q4= 2.03 (1.71-2.39) [P for trend <0.001]. Adding 24 hour urinary sodium, the ORs (95% CI) were: Q2= 1.19 (1.01-1.40); Q3= 1.37 (1.16-1.62); and 1.94 (1.61-2.33) [P for trend <0.001]. Adding HOMA-IR, the ORs (95% CI) were: Q2= 1.14 (0.97-1.34); Q3= 1.25(1.05-1.48); and Q4=1.62(1.34-1.96) [P for trend <0.001]. Finally, for the full model the ORs were Q2= 1.04 (0.88-1.23); Q3= 1.05 (0.88-1.26) and Q4= 1.32(1.08-1.62) [P for trend <0. 01].

Conclusion:
Uric acid levels were correlated to prehypertension among a middle-aged urban population. It occurred independently of other variables classically associated to high blood pressure or the origin of higher uric acid in hominids.
Abstract P400: Assessing the Fatty Acid Profiles of Dried Blood and Breast Milk Collected on Filter Paper
Authors: Harris Kristina A , Harris William
Published: July 2021

Introduction:
Assessment of the fatty acid status [particularly the highly labile, long-chain omega-3 species eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] of both blood and breast milk is important in epidemiological studies that seek to discover relationships between fatty acid status and health outcomes. Both blood and milk samples are difficult to collect and process in the field, and they are expensive to ship frozen to the laboratory. Hence improved approaches to sample acquisition and transport are needed to expand the research base for these metrics.

Methods:
The purpose of this study was to validate methods to collect, preserve and analyze the fatty acid composition of dried blood spots (DBS) and dried milk spots (DMS). Single drops of blood from 5 volunteers and of milk from 5 lactating women were applied to Whatman 903 cards which had been pretreated with an antioxidant preservative cocktail (OxyStop®). The omega-3 fatty acid content of the milk and the blood samples spanned a 5-fold range. These cards were then kept in the dark at room temperature, 4°C, -20°C, and -80°C for 28 days. Samples were analyzed weekly (in triplicate) and were compared to baseline values and to liquid samples stored under the same conditions. Red blood cells (RBC) from the 5 blood samples were also included in the experiment. Samples were considered stable up until the week that the mean omega-3 fatty acid content had decreased by >10% from baseline. In a separate experiment, the RBC omega-3 index was estimated from the DBS EPA+DHA value using blood samples from 106 healthy subjects.

Results:
Based on the stability criterion, both DBS and DMS samples were stable for 4 weeks under all storage conditions. RBC EPA+DHA (the omega-3 index) was also stable for 4 weeks under all conditions except storage at -20°C at which temperature degradation occurred within 1 week. The correlation between the omega-3 index and DBS EPA+DHA was 0.98 (p<0.0001) indicating that the RBC omega-3 levels can be accurately estimated from whole blood analysis. DHA levels in liquid vs. dried milk were also strongly correlated (r>0.99; p<0.0001).

Conclusion:
Both blood and milk omega-3 fatty acid content can be accurately assessed from samples collected and transported at room temperature on filter paper.
Abstract P407: Associations between Red Meat Intake and Biomarkers of Inflammation and Glucose Metabolism in Women
Authors: Ley Sylvia H , Sun Qi , Willett Walter C , Eliassen Heather , Wu Kana , Pan An , Grodstein Fran , Hu Frank B
Published: July 2021

Background:
Greater red meat intake is associated with increased type 2 diabetes and cardiovascular disease risk (CVD). Recently, inclusion of lean red meat in a heart-healthy diet to reduce CVD risk was suggested based on short-term controlled feeding trial evidence, indicating that varying amounts of lean red meat intakes had similar effects on a lipid profile. However, the fat content of red meat may not be solely responsible for the adverse effects of red meat contributing to progression of metabolic abnormalities. Other components and mediating pathways including obesity-related inflammation and insulin resistance may be involved. We hypothesized that greater red meat intake would be associated with biomarkers of inflammation and glucose metabolism and that these potential associations would be partly explained by body mass index (BMI).

Design:
We analyzed data from diabetes-free female participants in the Nurses’ Health Study (n=3690). Multiple linear regression was conducted to assess the associations of total, unprocessed and processed red meat intakes (quartile categories) with plasma C-reactive protein (CRP), ferritin, adiponectin, fasting insulin, and hemoglobin A1c (HbA1c). The contribution of BMI on the associations between red meat intake and biomarkers was evaluated using publicly available SAS macro. The effect of substituting a serving of red meat with a serving of another major protein food source was estimated.

Results:
Greater total, unprocessed and processed red meat consumptions were associated with higher plasma CRP, ferritin, fasting insulin, and HbA1c and lower adiponectin after adjustment for demographic information (all p for trend ≤0.03). Adiponectin was not associated with any types of red meat intake when further adjusted for medical and lifestyle factors. After adjustment for BMI, most of these associations with inflammatory and glucose metabolic biomarkers were substantially attenuated and no longer significant. BMI accounted for a statistically significant proportion of associations with CRP, HbA1c, and fasting insulin (all p for contribution ≤0.02), but not with ferritin. Substituting a serving of total red meat intake with alternative protein food in a combination of poultry, fish, legumes and nuts was associated with significantly lower CRP (β±SE: -0.106±0.043), ferritin (-0.212±0.075), HbA1c (-0.052±0.015), and fasting insulin (-0.0119±0.036)(all p≤0.02 for comparing extreme quartiles).

Conclusions:
Greater red meat intake is associated with unfavorable plasma concentrations of inflammatory and glucose metabolic biomarkers in diabetes-free women. BMI accounts for a significant proportion of the associations with these biomarkers, except for ferritin. Substituting red meat with another protein food is associated with a healthier biomarker profile of inflammatory and glucose metabolism.
Abstract P412: Simple Cooking with Heart: Culinary Skill-Based Education Improves Diet Quality and Nutrition Literacy
Authors: McKnight Liz , Vafiadis Dorothea , Stitzel Kimberly F , Doolittle Natashia , Robb Karen
Published: July 2021

Background:
Meals eaten away from home, particularly at fast-food restaurants, tend to have more calories, saturated and
trans
fats, and sodium and fewer fruits, vegetables, and whole grains than meals prepared at home. This contributes to higher body mass indexes in children and adults.

Objective:
The objective of the American Heart Association’s
Simple Cooking with Heart
program is to test whether increased consumption of home-prepared meals improves the diet quality of Americans. The theoretical framework for this program is based upon the Socioecological Model and Social Cognitive Theory of behavior change, both proven to be successful in diet and lifestyle interventions.

Methods:
Culinary skill-building based nutrition education that provides tools, recipes, instruction for preparing low-cost, heart healthy meals was administered to low-income families, specifically women (moms) ages 29-54. The program includes experiential skill acquisition through “live” cooking demonstrations and a robust program website which includes tools, low cost recipes and instructional skill videos. A third party 2-year program evaluation measured program impact on skill acquisition, attitudinal change, change in intent, and consumption pattern change.

Results:
Participation in “live” cooking demonstrations was associated with positive attitudinal change and was effective in improving knowledge and skills. The program website and materials are effective interventions to improve culinary skill, attitudinal change and efficacy/confidence, and increase frequency of home prepared meals. An increase in fruits, vegetables and whole grains consumption was also observed. This presentation will include new data regarding participants’ positive gains for social cognitive measures following a 30-day online focus group. Participants experienced positive gains regarding: raised awareness of the health and economic benefits of preparing meals at home, and outcome expectations. Participants also experienced an increase in efficacy and skill aquisition: increased confidence, skills and techniques to prepare meals at home (evaluation study participants identified higher at 30 days for statements reflecting healthful behavior and attitudes, including behavioral capacity, self-efficacy, intentions, outcome expectations and future/continued engagement.) An average of 4 new skills/techniques learned, respondents’ confidence in their ability to prepare healthful meals is near universal (94%) as is their willingness to do so (94%).

Conclusions:
Using a culinary skill development programs is associated with improving diet quality and improving nutrition literacy.