bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP32: Variation in NT-proBNP Levels After Bariatric Surgery and Its Association With Body Fat Percentage
Authors: Sbaraini Da Silva Mariana , Wallace Amelia , Selvin Elizabeth , Burns Austin , Echouffo Tcheugui Justin B , Gerstenblith Gary , Hoogeveen Ron C , Ballantyne Christie M , Coresh Josef , Ndumele Chiadi E
Published: March 2020

Introduction:
Natriuretic peptides are regulators of the cardiovascular system that are also related to adiposity and insulin resistance. NT-proBNP levels are inversely associated with adiposity and increase with weight loss, which may have hemodynamic implications in obesity. However, it is unclear if the changes in NT-proBNP with weight loss are independent of changes in insulin resistance and related metabolic risk factors.

Hypothesis:
NT-proBNP increases with surgical weight loss are partially independent of changes in other metabolic risk factors.

Methods:
We investigated 71 patients from the BARI-Heart Study, a prospective cohort with anthropometrics, metabolic risk factors and biomarkers before and after bariatric surgery. We compared data between pre- and post-surgical visits (1-2 weeks and 6 months, respectively) using t-tests, and performed regression analysis examining the association of changes adiposity measures with NT-proBNP before and after adjusting for metabolic risk factors.

Results:
After bariatric surgery, major reductions in weight, body-mass index (BMI) and body fat percentage (BFP) (mean change) were observed (Table 1), whereas NT-proBNP levels increased (mean change +61 pg/mL, SD 104). There were significant reductions post-surgery in HOMA-IR (from 9.9 to 2.6; p <0.0001), as well as in triglycerides, total cholesterol, glucose, and blood pressure (all p<0.05). A negative correlation between changes in ln-NT-proBNP and BFP was found (
r
-0.27; p=0.03). In regression analysis, the inverse association remained statistically significant after adjustment for changes in the other metabolic risk factors (Table 2).

Conclusions:
Reductions in adiposity are linked to increases in NT-proBNP independent of changes in metabolic risk factors. The mechanisms and cardiovascular implications of this direct link between weight loss and NT-proBNP deserve further investigation.
Abstract MP40: U-shaped Association Of Altitude With Prevalence Of Hypertension Among Tibetan Residents
Authors: Li Changwei , Zhang Ruiyuan , Shen Luqi , Laba Sangzhu
Published: March 2020

Background:
Tibet has a disproportionately higher prevalence of hypertension, compared to other regions of China. This may be related to long-term exposure to the high altitude. The aim of our study is to evaluate associations of altitudes with prevalence of hypertension among residents aged 15 years and older in Tibet, China.

Method:
A total of 11,407 Tibet residents in the 5
th
National Health Services Survey (NHSS) in 2013-2015 were included in this study. Physician diagnosed hypertension was determined based on self-report. County level altitude was identified and assigned to all residents in a county. Association between altitude and hypertension prevalence was assessed by two logistic regression models: model 1 adjusted for age and gender, and model 2 additionally adjusted for marital status, education, smoking, drinking, exercise, distance to a medical institute, area of residency, and body mass index (BMI). Non-linear relationship between altitude and prevalence of hypertension was explored by restricted cubic spline analyses. Sensitivity analysis were performed by restricting residents in rural and/or nomadic areas.

Result:
The prevalence of self-reported hypertension is 15.7%, the medication adherence rate is 14%, and the control rate is 10.3%. Compared to residents without physician diagnosed hypertension, those with hypertension were closer to a hospital, older, having lower education level, and less likely to be a smoker or live in an urban area. Altitude showed a U shape relationship with the prevalence of hypertension with a turning point at around 3,800 meters. For residents living more than 3,800 meters above sea level, a 1,000 meters increase in altitude was associated with 2.05 (95% confidence interval: 1.62-2.61) times higher odds of having physician diagnosed hypertension, after adjusting for age and gender. When further controlling for all covariates, the OR dropped to 1.87 (1.46-2.41) but still significant. For residents living below the altitude of 3,800 meters, 1000 meters’ increase was associated 0.55 (95% CI: 0.33-0.92) less likelihood of having physician diagnosed hypertension.

Conclusion:
The burden of self-reported hypertension was high among Tibet residents. Altitude was in a U-shaped association with the prevalence of hypertension with a turning point at around 3,800 meters.
Abstract MP48: Sex Difference, Circulating Short-chain Fatty Acids, Dietary Sodium Reduction in Untreated Hypertensives: A Randomized, Double-Blind, Placebo-Controlled Trial
Authors: Zhu Haidong , Chen Li , He Fengjun , Huang Ying , Wang Changqiong , Harshfield Gregory , Dong Yanbin
Published: March 2020

Introduction:
Short-chain fatty acids (SCFAs) are products from the fermentative activity of gut bacteria and almost all circulating SCFAs are microbial in origin. Emerging evidence suggests that circulating SCFAs play a role in blood pressure (BP) control through the host receptors. Animal studies demonstrate that high salt diet modulates the gut microbiome and SCFAs. Moreover, gut microbiome contributes to sex differences in BP regulation.

Hypothesis:
We tested the hypothesis that the modest sodium reduction would alter circulating SCFAs among untreated hypertensives, and the changes in SCFAs would be associated with reduced blood pressure (BP) and improved cardiovascular phenotypes. Moreover, there would be sex differences in circulating SCFA response to sodium reduction.

Methods:
A total of 145 subjects (42% blacks, 19% Asian, 34% females) were included from a completed randomized, double-blind, placebo-controlled crossover trial of sodium restriction with slow sodium or placebo, each for 6 weeks. Targeted circulating SCFA profiling was performed in paired serum samples, which were collected at the end of each period, so as all outcome measures. Two-level mixed-effects linear regression models were used to assess the differences in SCFAs between sodium and placebo tablets while incorporating repeated measured data and controlling for age, sex and BMI as confounding variables. We further tested whether the changes in the SCFAs were associated with the changes in BPs, and cardiovascular phenotypes using mixed-effects models.

Results:
Sodium reduction increased all 8 SCFAs, among which the increases in 2-methylbutyrate, butyrate, hexanoate, isobutyrate, and valerate were statistically significant (
p
<0.05). The increased SCFAs were associated with decreased BP and improved capillary density. There were significant sex differences of SCFAs in response to sodium reduction (
p
<0.05). When stratified by sex, the increases in butyrate, hexanoate, isobutyrate, isovalerate, and valerate were significant only in women (
p
<0.05), but none were significantly changed in men (
p
>0.05). In women, increased isobutyrate, isovalerate, and 2-methylbutyrate were inversely associated with reduced BPs (
p
<0.05). Additionally, increased valerate was associated with decreased carotid-femoral pulse wave velocity (cf-PWV) (
p
=0.04).

Conclusions:
Our results show that dietary sodium reduction increases SCFAs, suggesting that dietary sodium may influence the gut microbiome in humans given almost all SCFAs are microbial in origin. Moreover, increased circulating SCFAs are associated with decreased BPs, improved arterial compliance, and increased capillary density. The sex differences in SCFA response to dietary sodium reduction warrants further investigation.
Abstract MP57: Lactation Duration is Associated With Lower Visceral and Pericardial Fat Volumes in Parous Women: 25-year Follow-up in the Cardia Study
Authors: Appiah Duke , Lewis Cora E , Carr Jeff , Gross Myron D , Jacobs David R , Sidney Stephen , Shikany James M , Quesenberry Charles P , Gunderson Erica P
Published: March 2020

Introduction:
Lactation has been associated with a lower risk of incident type 2 diabetes mellitus and cardiovascular disease (CVD) in women. However, the underlying mechanisms for these associations are not well understood. The longitudinal association between lactation and maternal fat volume has rarely been investigated.

Hypothesis:
We tested the hypothesis that lactation duration is inversely associated with maternal visceral and pericardial fat volumes.

Methods:
Data were obtained from 910 women enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study (1985-86) without diabetes prior to pregnancy who had ≥1 birth during 25 years of follow-up. Cumulative lactation duration across all births since baseline was calculated from self-reports collected at each exam. Volumes of visceral and pericardial adipose tissue were measured from computed tomographic scans at the Year 25 exam in 2010-2011.

Methods:
At baseline, the average age of women (48% black, 52% white) was 24 years (range: 18-30 years). During 25 years of follow-up, 76% of women reported lactation duration of ≥ 1 month. In adjusted linear regression models, lactation duration was inversely associated with visceral fat (p=0.021) and pericardial fat (p=0.001) volumes (Table). There was a significant interaction between race and lactation on visceral (p=0.035) and pericardial fat (p=0.027) volumes (Table). Formal mediation analysis showed a significant indirect effect of lactation duration on visceral (p=0.001) and pericardial fat (p=0.002) volumes through body weight change between the first postbaseline birth and the end of follow-up. Changes in body weight mediated 29.4% and 26.0% of the association between lactation duration and visceral and pericardial fat volumes.

Conclusions:
In this prospective study, the associations of longer lactation duration with lower visceral and pericardial fat volumes were partially mediated by body weight changes.
Abstract MP58: Atherosclerotic Cardiovascular Events Prediction Using Machine Learning Models: Results From Action to Control Cardiovascular Risk in Diabetes Trial
Authors: FAN WENJUN
Published: March 2020

Background:
The AHA/ACC published a pooled cohort 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculator to estimate the probability of initial ASCVD events based on statistical modeling. Our current study aimed to develop machine-learning models with the identical predictors among T2DM patients from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and further compared their performance in predicting composite outcome of myocardial infarction, non-fatal stroke and cardiovascular death.

Methods:
The guideline risk calculator provided 9 predictors including baseline age, gender, race, SBP, antihypertensive medication use, total cholesterol, high-density lipoprotein cholesterol, current smoking status and diabetes mellitus status. We developed three ML ASCVD Risk Calculators based on Linear Model (LM), Supporting Vector Machine (SVM) and Random Forest (RF) algorithms using 10-year follow-up data from ACCORD with the same 9 predictors. T2DM patients with prior ASCVD or with invalid follow-up time were excluded in our analysis. Those who had not experienced the composite outcome by the end of year 10 would be labeled as censored. 5-fold stratified random split was applied as a cross-validation strategy.

Results:
A total of 6581 T2DM participants were included in our final sample, with a mean age of 62.9±5.9 years old (range 51-79 yr), 44.1% female and 60.8% white. Among those, 12.2% (n=802) had developed composite ASCVD during a median follow up of 9.1 years. The performance AHA/ACC 10-year Risk Calculator was modest with AUC=0.604. In contrast, ML models showed better performance from validation data with LM AUC=0.854, SVM AUC=0.848, and RF AUC=0.866 (Figure).

Conclusion:
The ML ASCVD Risk Calculator outperforms the AHA/ACC pooled 10-year ASCVD risk calculator in predicting the composite ASCVD outcomes among those with DM from ACCORD trial. Future studies need to validate ML algorithms in other cohorts and further explore other potential valuable predictors.
Abstract MP60: Do Adults With Metabolic Healthy Obesity Maintain Their Health Over Time? Results From The Atherosclerosis Risk In Communities (ARIC) Study
Authors: Commodore-Mensah Yvonne , Ndumele Chiadi E , Echouffo Tcheugui Justin B , Wang Dan , Selvin Elizabeth
Published: March 2020

Background:
Obesity is a heterogeneous condition, and there is debate about whether adults with “metabolically healthy obesity” (MHO) are protected from health complications. It is also unclear if MHO is a transient state.

Objective:
To examine transition from the MHO to metabolically unhealthy obese (MUO) phenotype during 6 years of follow-up among middle-aged adults.

Methods:
We conducted a prospective analysis of 9,672 adults in the ARIC Study who were free of cardiovascular disease (CVD) at Visit 2 (1990-1992) and attended Visit 4 (1996-1998). Obesity phenotypes were cross-classified using two body mass index subgroups 18.5-29.9 kg/m
2
(non-obese) and ≥ 30 kg/m
2
(obese). The NCEP Adult Treatment Panel III criteria were used to define metabolic health (without waist circumference). We used logistic regression to evaluate risk factors for transition from MHO at Visit 2 to MUO at Visit 4 among those with MHO at Visit 2(N=692).

Results:
At baseline (mean age 57, 21% black, 57% female), 18%, 54%, 7%, and 21% were metabolically healthy non-obese, metabolically unhealthy non-obese, MHO, and MUO, respectively. More adults with the MHO phenotype transitioned to MUO (48.3%) than maintained MHO status (43.4%) during the 6-year period). Most (71%) of those who transitioned from MHO to MUO were women. Adults with higher waist-to-hip ratio were more likely to transition to MUO (HR 2.67, 95% CI 1.09-6.58) than those who maintained their metabolic health during follow-up.
(Table)
.

Conclusions:
Almost 50% of adults who are MHO will transition to higher cardiometabolic risk over 6 years. High waist-to-hip ratio, lower socioeconomic status and smoking were linked to greater likelihood of transition to MUO. Persons with MHO should receive early behavioral interventions to prevent worsening metabolic health.
Abstract MP66: Excessive Gestational Weight Gain is Associated With Maternal Inflammation and Diabetes Risk but Not Dyslipidemia in Midlife Women- The Study of Womens Health Across the Nation
Authors: Hutchins Franya , El Khoudary Samar R , Catov Janet M , Colvin Alicia , Krafty Robert , Barinas-Mitchell Emma , Brooks Maria M
Published: March 2020

Introduction:
Excessive gestational weight gain (GWG) is associated with long-term increased risk of maternal obesity. However, the literature on whether excessive GWG contributes to an adverse cardiovascular risk profile is minimal and conflicting.

Hypothesis:
We hypothesized that a history of excessive GWG would be associated with maternal cardiovascular risk factors representing inflammation, glucose dysregulation, and dyslipidemia at midlife among parous women.

Methods:
This analysis included 1351 participants in the multiethnic cohort Study of Women’s Health Across the Nation with one or more live, singleton births. Excessive GWG in past pregnancies was determined by self-report of prepregnancy weight and GWG, and defined according to Institute of Medicine guidelines. Outcomes were CRP, LDL-C, HDL-C, fasting glucose, diabetes, blood pressure, and medication use, dichotomized based on 2019 ACC/AHA clinical guidelines as applicable. Outcomes were assessed at the baseline visit when women were age 42 to 53. We estimated relative risk between ever-having excessive GWG and each outcome in separate generalized linear regressions. Multivariable models adjusted for demographic, behavioral, and reproductive characteristics including parity and pregnancy complications.

Results:
Of the 1351 participants, 554 (41.0%) experienced excessive GWG. In unadjusted models, excessive GWG was associated with increased relative risk of high CRP, hypertension, low HDL-C, high glucose, and diabetes at midlife, but not high LDL-C (see Table). After adjusting for confounders, only risk of high CRP (RR= 1.34; 95% CI= 1.17, 1.54) and diabetes (RR=2.62; 95% CI=1.14, 5.98) remained statistically significant.

Conclusions:
A history of excessive GWG was linked with an increased risk of inflammation and diabetes but not dyslipidemia, hypertension, or high glucose in parous midlife women, independent of parity, pregnancy complications, and other factors.

Table. Risk Ratios of Cardiovascular Risk Factors by Excessive GWG
Abstract MP73: Years of Potential Life Lost Due to Premature Cardiometabolic Mortality in The United States, 1999-2017
Authors: Shah Nilay S , Lloyd-jones Donald M , Kershaw Kiarri N , Carnethon Mercedes R , Khan Sadiya S
Published: March 2020

Introduction:
Age of onset for heart disease (HD), cerebrovascular disease (CBD), and diabetes (DM) has shifted earlier, with increases in avoidable cardiometabolic deaths. We quantified total and trends in years of potential life lost (YPLL) before the age of 65 from HD, CBD, and DM, to describe population burden of premature preventable cardiometabolic mortality.

Hypothesis:
YPLL from premature cardiometabolic deaths in the U.S. have increased and are highest in black adults.

Methods:
Death certificates from the CDC’s Wide-Ranging Online Database for Epidemiologic Research (WONDER) were used to quantify mean age at death and proportion of deaths that were premature (<65 years) from HD, CBD, and DM as underlying cause of death. We then calculated age standardized premature YPLL (before age 65) per 100,000 people and mean annual percent change (APC) in YPLL, overall and in black and white women and men, before and after the previously published inflection in cardiometabolic death rates in 2011.

Results:
Between 1999-2017, 19% of HD deaths, 14% of CBD deaths, and 27% of DM deaths were premature. Overall, premature YPLL from HD decreased between 1999-2011 from 512 to 416 per 100,000 (APC -1.7%/year, 95% CI [-2.0, -1.5]), then remained unchanged from 2011-2017. For CBD, premature YPLL decreased 1.8%/year (-2.2, -1.5) to 70 per 100,000 in 2011, but remained unchanged through 2017. Premature YPLL from DM remained unchanged at 71 per 100,000 from 1999-2011, then increased 2.5%/year (1.8, 3.1) to 81 per 100,000 in 2017. Premature YPLL were higher in black men and women compared with white men and women, respectively (FIGURE).

Conclusions:
Premature YPLL from cardiometabolic causes plateaued or increased after 2011. Disparities in YPLL have persisted in the past decade with nearly half of cardiometabolic deaths in black men occurring before age 65. Equitable promotion of cardiometabolic health early in the lifespan may reduce population, health system, and financial burden of premature cardiometabolic mortality.
Abstract MP75: Recalibration and Additional Data Domains Leads to Modestly Improved Performance of Risk Calculators for Heart Failure Readmission
Authors: Savitz Samuel T , Lee Keane , Rana Jamal S , Leong Thomas K , Tabada Grace , Sung Sue Hee , Go Alan S
Published: March 2020

Introduction:
Heart failure (HF)-related hospitalizations are a growing public health burden. We evaluated two published risk calculators for predicting 30-day readmission after HF hospitalizations: 1) using the original coefficients, 2) updating the coefficients 3) developing a new model with additional variables and updated coefficients.

Hypothesis:
Recalibrating model coefficients and adding variables would improve the performance of existing 30-day readmission risk calculators.

Methods:
We identified 45,059 adults hospitalized for HF between 2012-2017 within Kaiser Permanente Northern California, an integrated healthcare delivery system. We used split sampling for development and validation testing. The risk calculators tested included: LACE+ Index and Yale CORE. We used logistic regression on our population to derive the recalibrated coefficients. For the model with additional variables, we included all variables used in the original models plus additional variables, including cardiovascular medication use and socioeconomic status. We used gradient boosting with k-fold cross validation to avoid overfitting. We assessed model performance using area under the curve (AUC) and calibration plots.

Results:
Discrimination (AUC) was poor using original models: LACE+ [0.56 (0.54-0.58)] and Yale CORE [0.55 (0.54-0.57)]. Recalibrating coefficients resulted in small improvements for LACE+ [0.58 (0.57, 0.60)] and Yale CORE [0.58 (0.57, 0.60)]. Adding variables resulted in a modest improvement for the gradient boosting model [0.61 (0.59, 0.62)]. Calibration plots (Figure 1) showed good calibration except for the Yale CORE model with the original coefficients.

Conclusions:
Recalibrating coefficients and incorporating prior medication and socioeconomic status led to modest, significant improvements in discrimination while maintaining good calibration. However, overall performance improvements are needed to increase the utility of these published risk calculators to predict readmission.
Abstract MP77: Associations Between Atrial Cardiopathy and Cerebral Amyloid: The Aric Pet Study
Authors: JOHANSEN Michelle C , Mosley Thomas , Knopman David , Wong Dean , Wagenknecht Lynne E , Ndumele Chiadi E , Shah Amil M , Solomon Scott , Gottesman Rebecca F
Published: March 2020

Background:
Atrial fibrillation (AF) is a risk factor for cognitive decline, perhaps due to silent cerebral infarction, but it is unknown if it also acts on Alzheimer’s Disease (AD)-specific mechanisms, such as deposition of β-amyloid (Aβ). Left atrial changes in structure or function, or atrial cardiopathy, can lead to AF but may cause infarcts independently, and thus might also impact cognition. We hypothesize that Aβ is associated with AF and atrial cardiopathy, independent of AF, when defined similarly to an ongoing clinical trial (ARCADIA).

Methods:
321 participants without dementia from the Atherosclerosis Risk in Communities study underwent florbetapir (FBP) PET, electrocardiogram and 2D echocardiography. Atrial cardiopathy was defined as ≥1 of: 1) left atrial volume index (LAVI) >34 ml/m2; 2) P-wave terminal force >5000 uV x ms and 3) serum NT proBNP>250 pg/mL. Cross-sectional associations between global cortical Aβ (>1.2 standardized uptake value ratio (SUVR)) and adjudicated history of atrial fibrillation and atrial cardiopathy, each, were evaluated using multivariable logistic regression.

Results:
Participants, with mean age 76 y, were 56% female and 42% black. Odds of elevated FBP SUVR was increased for those with atrial cardiopathy (Model 3) and nearly doubled among those with enlarged LAVI that remained significant after sequential adjustment, including AF (Table). There was no significant association between either P-wave terminal force or NT proBNP and elevated FBP SUVR (Table), nor between elevated SUVR and AF.

Conclusions:
In this cross-sectional analysis of a cohort of healthy, nondemented community-dwelling older individuals, we report a significant association between atrial cardiopathy as well as LAVI and elevated amyloid, by PET, without a similar association in individuals with AF. Potential limitations include reverse causation and survival bias. Ongoing work will help determine if changes in cardiac structure and function precede, or occur simultaneously with amyloid deposition.
Abstract P109: Consistency of Self-reported Prior Diagnosis of Atrial Fibrillation and Medicare Claims Diagnoses: The Reasons for Geographic and Racial Differences in Stroke
Authors: Akinyele Oluseun O , Soliman Elsayed Z , Chen Ligong , Kamel Hooman , Levitan Emily B
Published: March 2020

Introduction:
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Although self-reported prior diagnosis is a widely used method for ascertainment of AF in population studies, recall bias may impact the accuracy of this method.

Objective:
To examine the consistency of self-reported AF as compared to diagnoses recorded in Medicare claims.

Methods:
Among 30,239 black and white adults aged 45 years and older who enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, 8,588 participants aged 65 years and older with a minimum of 6 months of Medicare fee-for-service coverage at the time of enrollment were included in this analysis. Using AF diagnosis codes from Medicare claims as the “gold standard”, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predicted value (NPV) of self-reported prior diagnosis of AF by a physician or other health professional.

Results:
The average age of the study population was 73.4 years, 50.5% were women, 31.6% were black, and 10.1% reported a prior diagnosis of AF. The prevalence of Medicare claims diagnoses for AF ranged from 28.6% to 32.5% depending on definition (
Table
). Compared to Medicare claims, self-reported prior diagnosis of AF had 22.4-24.5% sensitivity, 95.6-95.7% specificity, 68.8-71.5% PPV, and 71.9-76.0% NPV. Results were consistent across strata defined by age, gender, race, and cognitive status.

Conclusion:
Compared to Medicare claims, self-reported prior diagnosis by a physician or other health professional had low sensitivity but high specificity to detect AF. This suggests that an approach utilizing only self-report to detect AF would not be ideal. However, most participants who reported a prior diagnosis of AF had Medicare claims supporting this diagnosis.
Abstract P119: Non-exercise Cardiorespiratory Fitness Prediction Equations: Accuracy Over Time in Apparently Healthy Adults
Authors: Peterman James E , Harber Matthew , Imboden Mary , Whaley Mitchell , fleenor bradley , Kaminsky Leonard A
Published: March 2020

Introduction:
Mortality risk predictions are improved with routine assessment of cardiorespiratory fitness (CRF). Accordingly, an American Heart Association Scientific Statement suggests routine clinical assessment of CRF in apparently healthy adults minimally using non-exercise prediction equations, which can be calculated from common health metrics. However, no study has assessed the ability of non-exercise CRF prediction equations to accurately detect longitudinal changes.

Hypothesis:
Changes in estimated CRF (eCRF) would be related to directly-measured changes, yet appreciable misclassification would occur at the individual level.

Methods:
The sample included 987 apparently healthy adults (324 females; mean±SD age 43.1±10.4 years) who completed 2 cardiopulmonary exercise tests (CPX) at least 3 months apart (3.2±5.4 years follow-up). The change in eCRF from 27 distinct non-exercise prediction equations was compared to the change in directly-measured CRF determined from CPX. A change of ≥5% was used to classify participants as having a directional increase or decrease in CRF. Analysis included Pearson product moment correlations, standard error of estimate (SEE) values, the Benjamini-Hochberg procedure to compare eCRF with directly-measured CRF, and chi-squared tests to examine the impact of follow-up time on the percentage of participants correctly identified as having a directional increase or decrease in CRF.

Results:
The change in eCRF from each equation was correlated to the change in directly-measured CRF (
P
<0.001) with R
2
values ranging from 0.06-0.43 and SEE values ranging from 0.9-5.9 ml·kg
-1
·min
-1
. For 16 of the 27 equations, the change in eCRF was significantly different from the change in directly-measured CRF. When classifying directional changes, the prediction equations correctly categorized an average of 54% of individuals as having increased, decreased, or no change in CRF. When examining the influence of follow-up time, the average percentage of individuals correctly classified as having a directional increase in CRF was greater when the time between tests was ≤8months (54%) compared to ≥2years (28%). In contrast, the average percentage correctly classified as having a directional decrease in CRF was lower with tests ≤8months apart (8%) compared to ≥2years (73%).

Conclusions:
As hypothesized, discernible variability was found in the accuracy between non-exercise prediction equations and the ability of equations to accurately assess changes in directly-measured CRF over time. Considering the appreciable error that prediction equations had with detecting even directional changes in CRF, these results suggest eCRF may have limited clinical utility.
Abstract P126: Comparing Cardiovascular Risk Factor Progression Between South Asian Men and Women With Diabetes: A Longitudinal Analysis From the Masala Study
Authors: Deshpandey Manasi , Huang Chiung-Yu , Kandula Namratha , Kanaya Alka M
Published: March 2020

Introduction:
South Asians have a high incidence of type 2 diabetes(DM) and cardiovascular disease (CVD). Women with DM may have greater CVD risk compared to men with DM and women without DM. No study has determined whether the incidence or progression of coronary artery calcium (CAC) score, a measure of atherosclerosis burden, differs between South Asian men and women with DM.

Hypothesis:
We hypothesize that CAC progression is greater in women with DM as compared to men with DM and women without DM.

Methods:
We used the data from the MASALA study, a community-based prospective cohort of South Asians from 2 clinical sites without CVD at baseline. We conducted a longitudinal analysis of diabetic participants who were reassessed after 5 years and compared with those without diabetes. We classified incident CAC as any CAC at exam 2 in a participant who had no CAC at baseline. To examine the progression of CVD risk factors over time, we compared change in CAC score, waist circumference, systolic and diastolic blood pressure, HbA1c and lipid levels amongst the diabetic and non-diabetic population by sex. We conducted multivariable linear regression models stratified by diabetes status to determine whether sex was independently associated with change in CAC score and other CVD risk factors.

Results:
Of 749 participants who were seen in follow-up, 176 (23%) had diabetes at baseline, 65% were men, and mean age was 58 years. Approximately 64% women with DM vs. 28% men with DM had CAC=0, and men had higher median CAC score (49 (IQR 0-247) vs. 0 (IQR 0-46, p<0.001). After mean follow-up of 4.8±0.8 years, incident CAC did not differ between men and women with diabetes (p=0.85). Progression of CAC was greater in men with DM (94, IQR 13-290) compared to women with DM (0, IQR 0-30) (p <0.001). Baseline statin and aspirin use was lower in women with DM (statins: 37% in women vs. 56% in men, p<0.001; aspirin 16% in women vs. 43% in men, p<0.001). In multivariable models, the fold-change in CAC in women (0.22, 95% CI 0.10 - 0.47) was lower than in men (4.54, 95% CI 2.08 - 9.89) and comparable to women without DM (0.30 95%CI 0.21 -0.43), after adjusting for age, baseline CAC, systolic and diastolic blood pressure, total and LDL cholesterol, duration of diabetes, smoking and any medication use (statin, diabetes, or hypertension med). Sex was not associated with change in any CVD risk factor among those with diabetes; but women without DM had greater change in total and LDL cholesterol and waist circumference than men without DM.

Conclusion:
In this South Asian population, change in CAC score was lower in women with DM than in men with DM, and was comparable to women without DM. These results suggest among South Asians with DM, overall CVD risk may be greater in men than in women.Continued follow-up of the MASALA cohort will determine whether there are sex differences in CVD outcomes.
Abstract P128: Periodontal Disease and Coronary Artery Calcium in Adults With Type 1 Diabetes
Authors: Snell-bergeon Janet , Alman Amy , Keshawarz Amena , Cech Martin
Published: March 2020

Introduction:
Adults with type 1 diabetes (T1D) have at least a two-fold risk of developing coronary artery disease (CAD) compared to adults without diabetes (Non-DM); Periodontal disease is also increased in T1D, due at least in part to hyperglycemia. There is increasing recognition that periodontal disease is linked to CAD through systemic inflammation, which may be a mechanism through which diabetes increases CAD. In this study, we examined the association between self-reported gum disease and coronary artery calcium (CAC) in the prospective Coronary Artery Calcification in Type 1 Diabetes (CACTI) cohort.

Methods:
There were 1416 adults (652 with T1D, 764 Non-DM, mean±SD age 37±8years, 48% men) enrolled in the CACTI cohort in 2000. The cohort completed four visits between 2000 and 2018: at baseline and after 3, 6 and 14 years of follow-up. At each visit, participants self-reported gum disease diagnosis. CAC volume was measured by computed tomography at each visit and was square root transformed for analysis. Linear mixed effects models were used to examine the association between self-reported gum disease and change in CAC volume.

Results:
At baseline, 12% of Non-DM and 16% of T1D participants (p=0.054) reported having gum disease. The prevalence of gum disease increased across visits to 18% in participants with T1D vs. 13% in Non-DM participants at visit 2 (p=0.01); 22% in participants with T1D at visit 3 vs. 14% in Non-DM participants (p=0.0009) and 25% in participants with T1D vs. 17% in Non-DM participants at visit 4 (p=0.023). Self-reported gum disease was associated with a significantly greater increase in CAC volume over time (Table, p<0.0001) among people with T1D, but not in people without diabetes (p=0.13) when adjusted for age, sex, body mass index, LDL cholesterol and smoking (p-value for diabetes x gum disease interaction <0.0001).

Conclusion:
Periodontal disease prevalence was increased in adults with T1D, and was independently associated with increase in CAC volume over 14 years of follow-up in this population.
Abstract P131: Optimal Phenomapping Strategy to Identify Novel Subgroups of Patients With Type 2 Diabetes and High Cardiovascular Disease Risk
Authors: Segar Matthew W , Vaduganathan Muthiah , Patel Kershaw V , Caughey Melissa , Basit Mujeeb , Willett Duwayne , McGuire Darren K , Pandey Ambarish
Published: March 2020

Introduction:
Phenomapping can be used to identify subgroups of patients with similar risk factor profiles; however, there is no widely accepted clustering method. We compared 3 phenomapping strategies to identify groups of individuals with diabetes mellitus (DM) and high cardiovascular disease (CVD) risk.

Methods:
Participants with DM and no baseline CVD from the ACCORD trial (N = 6591) were included in this study. Among 45 mixed data variables, we used an informed variable selection method with optimization of the Wald index to select the top 20 covariates associated with survival. Gaussian mixture models (GMM), Latent Class Analysis (LCA), and finite mixture model-based clustering (FMM) were performed to identify mutually exclusive phenogroups. Bayesian information criterion (BIC) and Dunn index were calculated for each method and compared. The primary composite endpoint was cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke.

Results:
FMM clustering with 3 phenogroups was the optimal clustering strategy as determined by the lowest BIC and highest Dunn index (Figs A-B). Phenogroup 1 had a higher burden of comorbidities and DM complications; phenogroup 2 were older with intermediate CV comorbidity burden, but lowest complications from DM; and phenogroup 3, the largest group, had a lower prevalence of CV-related comorbidities. In adjusted Cox models, over 4.9 years median follow-up, phenogroup 1 and 2 participants (vs. phenogroup 3) had a significantly higher risk of primary composite endpoint (Fig C). In Cox analysis, when group membership was added to 10 optimal predictors of primary composite endpoint, the
C
-index improved from 0.68 to 0.70 (
P
= 0.02). Similar risk patterns were also observed in an external cohort (Look AHEAD trial, N = 4211) with the highest risk of adverse outcome seen in phenogroup 1 (Fig D).

Conclusion:
Semi-supervised clustering using FMM efficiently identifies phenogroups of patients with DM with distinct clinical characteristics and CVD risk.
Abstract P144: The Modification Effect of Genetic Variants on the Association Between Dietary Red Meat Intake and Telomere Length
Authors: Chang Xuling , Dorajoo Rajkumar , Sun Ye , Wang Ling , Wang Renwei , Friedlander Yechiel , Liu Jianjun , Khor Chiea Chuen , Yuan Jian-Min , Koh Woon-Puay , Heng Chew-Kiat
Published: March 2020

Background:
Telomeres are repetitive nucleotide sequences (TTAGGG) combined with associated protein at the end of eukaryote chromosomes. They shorten with each cell division and thus can act as a biomarker of cellular aging. Many factors can influence telomere length, including nutrition, physical activity and other lifestyle factors. However, the effects of diet, such as consumption of red meat on telomere length, is controversial. In East-Asians, the effect of red meat on telomeres as well as the modification effect of red meat on the association between genetic variants and telomeres are largely unknown.

Method:
Study included 20,011 individuals with complete information. Relative telomere length was determined using monochrome multiplex quantitative PCR (qPCR) and expressed as T/S ratio from 20,011 participants of the prospective Singapore Chinese Health Study (SCHS) Dietary information was collected using a semi-quantitative food frequency questionnaire. Red meat consumption was first adjusted for total energy intake by linear regression and then dichotomized based on median value. Telomere length was standardised by z score transformation. Linear regression was used to test the association between telomere length and red meat consumption. Interaction analyses were performed by introducing the interaction term (red meat x SNP) in the same regression model with adjustment for age, gender, total energy intake and population structure as covariates.

Result:
Higher intake of red meat was significantly associated with longer telomere length in SCHS (β = 0.027, se = 0.013, p = 0.042). Red meat intake can modify the association between rs7536250 and telomere length (β = -0.170, se = 0.025, p
int
= 1.35 х 10
-11
). Rs7536250 was intergenic and found to affect the expression level of several genes through expression quantitative trait loci (eQTL), some of which are known to be involved in T-cell activation, apoptosis and programmed cell death.

Conclusion:
The association between red meat intake and telomeres is consistent with some previous findings. We also found that genetic variant can modify the association between dietary red meat intake and telomere length.
Abstract P147: Genome Wide Assessment of Shared Genetic Architecture Between Rheumatoid Arthritis and Cardiovascular Diseases Using the UK Biobank Data
Authors: Guo Yanjun , Chung Wonil , Shan Zhilei , Liang Liming
Published: March 2020

Background:
Patients with RA have a 2-10 folds increased risk of cardiovascular diseases (CVD) and CVD accounts for almost 50% of the excess mortality in patients with RA when compared with general population, but the mechanisms underlying such associations are largely unknown.

Methods:
We examined the genetic correlation, causality, and shared genetic variants between RA (Ncase=6,756, Ncontrol=452,476) and CVD (Ncase=44,246, Ncontrol=414,986) using LD Score regression (LDSC), generalized summary-data-based Mendelian Randomization (GSMR), and cross-trait meta-analysis in the UK Biobank Data.

Results:
In the present study, RA was significantly genetically correlated with MI, angina, CHD, and CVD after correcting for multiple testing (Rg ranges from 0.40 to 0.43, P<0.05/5). Interestingly, when stratified by frequent usage of aspirin and paracetamol, we observed increased genetic correlation between RA and CVD for participants without aspirin usage (
Rg
increased to 0.54 [95%CI: 0.54, 0.78] for angina;
P
value=6.69х10
-6
), and for participants with usage of paracetamol (
Rg
increased to 0.75 [95%CI: 0.20, 1.29] for MI;
P
value=8.90х10
-3
). Cross-trait meta-analysis identified 9 independent loci that were shared between RA and at least one of the genetically correlated CVD traits including
PTPN22
at
chr1p13.2
,
BCL2L11
at
chr2q13
, and
CCR3
at
chr3p21.31
(

P
single trait

<1х10
-3
and

P
meta

<5х10
-8
) highlighting potential shared etiology between them which include accelerating atherosclerosis and upregulating oxidative stress and vascular permeability. Finally, Mendelian randomization analyses observed inconsistent instrumental effects and were unable to conclude the causality and directionality between RA and CVD.

Conclusion:
Our results supported positive genetic correlation between RA and multiple cardiovascular traits, and frequent usage of aspirin and paracetamol may modify their associations, but instrumental analyses were unable to conclude the causality and directionality between them.
Abstract P153: Multiple Vulnerabilities to Health Disparities and Incident Heart Failure in the Reasons for Geographic and Racial Differences in Stroke Study
Authors: Pinheiro Laura C , Reshetnyak Evgeniya , Sterling Madeline R , Levitan Emily B , Safford Monika M , Goyal Parag
Published: March 2020

Background:
Multiple socially determined vulnerabilities (SDV) to health disparities often cluster within the same individual. Previous studies have shown that SDV are separately associated with increased risk of heart failure (HF). As there may be a cumulative effect of these SDVs in the same individual, understanding their joint impact on the incidence of HF is critical.

Methods:
REGARDS is a national prospective cohort study that recruited 30,239 adults <45 years of age from 2003-2007 with ongoing follow-up. We followed participants free of HF at baseline for incident HF hospitalization through December 31, 2016. Guided by the Healthy People 2020 framework, we examined 10 potential SDVs, retaining those that were associated with incident HF (p<0.10) and creating a count of SDV (0, 1, 2, 3+). We used Cox models to examine associations between the SDV count and incident HF, adjusting for potential confounders. Since disparities in HF have been shown to be greatest in younger individuals models were stratified by age.

Results:
The 25,790 participants were followed for a median of 10.1 years (IQR 6.5, 11.9); their mean age at baseline was 64.8, 55%% were women, and 40% were blacks. In age-adjusted models, Black race, low educational attainment, low annual household income, zip code poverty, poor public health infrastructure, and lack of health insurance were significantly associated with incident HF. In fully adjusted models, among those 45-64 years, compared to having no SDV, having a SDV was significantly associated with incident HF, with a trend toward a higher count conferring greater risk (Fig. 1). There was no association in other age groups.

Conclusions:
An increased number of SDVs was associated with risk of incident HF hospitalization among adults <65 years, even after adjustment for cardiovascular risk factors. Using a simple count of SDVs that could be incorporated into the social history during clinical assessment may identify younger individuals at increased risk of incident HF.
Abstract P157: Obesity Peak Forecast Model
Authors: Granato Joseph , Zhang Nicole , Hughes Mike
Published: March 2020

Intro:
Obesity is well established as a cause of multiple diseases that put excessive strain on healthcare resources. This is particularly true in the United States where obesity levels are among the highest in the world. However, forecasting future trends in obesity prevalence can be problematic given the difficulty associated with accurately quantifying the effect of the many risk factors that have been documented for obesity. In this study, a model is presented to forecast future adult obesity prevalence based on the current childhood obesity prevalence and the conditional probability of adult obesity given childhood obesity.

Hypothesis:
Adult obesity prevalence can be forecast based on current childhood obesity and the likelihood of the former given the latter.

Methods:
The annual change in historical (1975-2016) childhood (ages 5-19) obesity was calculated to ascertain a gender-specific trend. To forecast the prevalence of adult obesity (ages 20-59) in coming decades the model relied upon published age-specific probabilities of adult obesity given childhood obesity. To forecast the annual change in ten-year age-groups of obese adults these probabilities were then applied to the annual change figures derived from the historical childhood obesity data. The model used the linear regression of childhood obesity, from 1996-2016, to extend the forecast and determine a year in which the annual change in adult obesity became negative. Such a forecast provided an age-and gender-specific year in which the obesity epidemic in adult Americans comes to an end and prevalence begins to decrease.

Results:
By using historical childhood obesity data and the probability of adult obesity associated with childhood obesity the model forecasts the American obesity epidemic in males ages 20-29, 30-39, 40-49, and 50-59 to stop increasing and begin decreasing in 2048, 2054, 2059, and 2064 respectively. Likewise, the model estimated obesity prevalence will cease to rise in adult American females about a decade earlier with forecasts for ages 20-29, 30-39, 40-49, and 50-59 to be 2037, 2043, 2048, and 2053 respectively.

Conclusions:
In conclusion, adult obesity in the United States, like most documented disease epidemics will reach a point, beyond which the prevalence is expected to fall. The model was built to handle the difficulty associated with quantifying the effect of the multiple risk factors and the well documented period effects linked to obesity. The proposed model successfully used historical childhood obesity data and the correlation between childhood and adult obesity to forecast when obesity in the United States will cease to grow and start to decline.