bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P020: Predictors of Depressive Symptoms Across the Spectrum of Hyperglycemia: the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Rawlings Andreea , Sharrett A. Richey , Golden Sherita , Windham B. Gwen , Selvin Elizabeth
Published: July 2021

Background:
Determinants of depressive symptoms in older adults according to diabetes status have not been widely investigated. Here we examine correlates of depressive symptoms in persons without diabetes, with prediabetes, and with diagnosed diabetes.

Methods:
We used data from visit 5 (2011-2013) of the ARIC Study. Depressive symptoms were ascertained using the 11-item CES-D, with scores ≥9 indicating probable major depression, and via self-reported diagnosis of depression in the past 2 years. Diabetes was defined based on self-reported diagnosis or use of glucose lowering medication. We defined prediabetes as HbA1c of 5.7-6.4% in persons without diabetes. We examined demographic factors, markers of health status, and metrics of health care access as correlates of depressive symptoms. Prevalence ratios (PRs) were calculated using Poisson regression with robust variance estimation.

Results:
Among 6319 participants (mean age 76 years, 59% female, and 77% white), the prevalence of depressive symptoms in persons with prediabetes (8.6%) and diabetes (14.7%) was significantly higher than in persons with no diabetes (6.9%). Correlates of depressive symptoms were similar across diabetes categories. In fully adjusted models, the strongest predictors of depressive symptoms were self-reported fair or poor health (compared to excellent health) and variables related to access to, and satisfaction with, health care. In persons with diabetes, insulin use, but not HbA1c control, was significantly associated with depressive symptoms. Measures of socioeconomic status (education, income) were significantly associated with depressive symptoms in all three groups (Table).

Conclusions:
The strongest predictors of depressive symptoms were metrics of health care access and satisfaction, suggesting that system-level factors may be important in addressing depression in diabetes and prediabetes.
Abstract P049: Mitochondrial DNA Copy Number and Diabetes in the ARIC Study
Authors: DeBarmore Bailey , Ashar Foram , Arking Dan , Kalyani Rita , Guallar Eliseo , Zhang YiYi , Selvin Elizabeth , Young J. Hunter
Published: July 2021

Introduction:
In the United States, the rising number of adults with type 2 diabetes (T2D) is thought to be associated with the rise in obesity. Obesity may be associated with T2D through biologic pathways where excess weight strains the body’s metabolic machinery, such as mitochondria. Mitochondria are dynamic organelles whose regulation and function respond to cell stress, such as insulin resistance. Previous research reveals that insulin resistance is associated with obesity prior to hyperglycemia. Mitochondrial DNA copy number is a measure of mitochondrial DNA content, and correlates with both the number and size of mitochondria. We assessed the hypothesis that mitochondrial DNA copy number is associated with T2D in a community-based, prospective cohort study. A lower mitochondrial DNA copy number in these analyses represents worse mitochondrial function.

Methods:
We included 6,633 white ARIC participants without coronary heart disease who had mitochondrial DNA copy number measured from visit 2 (1990-1992). Our sample had a mean age of 57 ± 5.6 years, was 43% male, average BMI of 27 ± 4.9 kg/m2, and 27% with hypertension. Those with diabetes had an average hemoglobin A
1c
of 7.2 ± 1.8 (n=681). The mitochondrial DNA copy number value used in analyses represents a sample’s standard deviation (SD) from a mean of zero for age- and sex-adjusted distributions. The mitochondrial DNA copy number data was then divided into quintiles, with the most negative mitochondrial DNA copy number in quintile 1 (Q1), the mean of zero in Q3, and the most positive in Q5. We defined T2D as self-report of doctor diagnosis, current use of glucose-lowering medication, or fasting blood glucose ≥ 126 mg/dL or non-fasting blood glucose ≥ 200 mg/dL measured at study visits. We used logistic regression to estimate the odds of prevalent T2D for each quintile group compared to Q3. Confounders considered in the base model included age at sample collection, sex, education level, and medication use (thyroid and estrogen). All analyses were done in Stata 14.1.

Results:
The prevalence of T2D was higher in the lower mitochondrial DNA copy number quintiles: 15% in Q1 (mean copy number: -1.40 SD) 11% in Q2 (-0.46 SD), and 9% in Q3-Q5 (0.04 SD, 0.52 SD, 1.33 SD). There was increased odds of T2D in lower mitochondrial DNA copy number quintiles, but with no additional benefit of copy number above the mean. The odds of T2D in each quintile compared to Q3 was 1.9 in Q1 (95% CI 1.49, 2.46), 1.36 in Q2 (95% CI 1.05, 1.77), 0.99 in Q4 (95% CI 0.76, 1.30) and 0.96 in Q5 (95% CI 0.74, 1.26).

Conclusion:
Examining the association of mitochondrial dysfunction and diabetes in a large community-based cohort connects results from experimental studies to epidemiologic studies and provides the opportunity to characterize the complex pathogenesis of diabetes using cohort data.
Abstract P050: Association Between Glycemic Control and Short-term Mortality Varies Across the Spectrum of Coronary Artery Disease
Authors: Raghavan Sridharan , Liu Wenhui G , Ho P. Michael , Plomondon Mary E , Baron Anna E , Magid David , Bradley Steven M , Maddox Thomas M
Published: July 2021

Background:
Diabetes is a significant risk factor for cardiovascular disease, but optimal glycemic control strategies remain unclear. In particular, trials of intensive glycemic control have highlighted a tension between increased mortality risk and macrovascular benefits. In this study we aimed to assess whether the burden of coronary artery disease (CAD) modifies the association between glycemic control and short-term mortality.

Methods:
We studied veterans with diabetes who underwent elective cardiac catheterization between 2005 and 2013 in a retrospective analysis of data from the VA Clinical Assessment, Reporting, and Tracking (CART) Program. Primary exposures were time-varying HbA1c over two years of follow-up after index catheterization, categorized as <6%, 6-6.49%, 6.5-6.99%, 7-7.99%, 8-8.99%, and >=9%, and burden of CAD, categorized as no CAD, non-obstructive CAD, or obstructive CAD. Primary outcome was two-year all-cause mortality. A total of 17394 participants had, on average, five HbA1c measurements over two years of follow-up. We used multivariable Cox proportional hazards regression to estimate the association between HbA1c and mortality, adjusting for demographic and clinical covariates and CAD burden, and including a term for interaction between HbA1c and CAD burden.

Results:
In adjusted models with 6.5 ≤ HbA1c ≤ 6.99% as the reference category, HbA1c < 6% was associated with increased risk of mortality (HR 1.55 [1.25, 1.92]), whereas HbA1c categories above 7% were not. We observed significant interaction between glycemic control and CAD burden (interaction p=0.0005); the increased risk of short-term mortality at HbA1c < 6% was limited to individuals with non-obstructive and obstructive CAD (Figure 1).

Conclusions:
HbA1c below 6% was associated with increased risk of short-term mortality, but only in individuals with CAD. CAD burden may thus inform individualized diabetes management strategies, specifically treatment de-escalation in individuals with any angiographically-defined CAD.
Abstract P052: Subgingival Dysbiosis Predicts Longitudinal Glucose Change
Authors: Demmer Ryan T , Trinh Pauline , Rosenbaum Michael , LeDuc Charles , Leibel Rudolph , Colombo Paolo C , Paster Bruce , Papapanou Panos N , Desvarieux Moïse , Jacobs David R
Published: July 2021

Background:
Microbial dysbiosis and translocation of microbial products across digestive tract mucosal surfaces are hypothesized risk factors for impaired glucose regulation. We specifically investigated whether measures of subgingival dysbiosis predicted longitudinal fasting plasma glucose (FPG) change.

Methods:
The Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS) enrolled 300 diabetes-free adults (77% female) aged 20-55 years (mean±SD=34±10). Subgingival plaque samples were collected and analyzed using 16S rDNA sequencing (Illumina MiSeq; NexGEN) using the Human Oral Microbe Identification using Next Generation Sequencing (HOMINGS) protocol. FPG was measured at baseline and after two-years. Microbial community alpha-diversity was calculated using Simpson’s index. Multivariable linear regressions modeled 2-year glucose change on baseline relative abundance of 376 individual oral taxa (in separate models) with adjustment for age, sex, race/ethnicity, education, smoking status, BMI and baseline glucose levels. All taxa with a p-value<0.05 were used to construct a microbial dysbiosis-index (MD-index) defined as the ratio of taxa abundance in organisms positively vs. inversely associated with FPG change. The MD-index was subsequently used in regression models to predict glucose change. Statistical significance was based on a false discovery rate (FDR)<0.05 or a Bonferroni corrected p-value (1x10
-4
).

Results:
Mean 2-year FPG change±SD was 1.5±8 mg/dl. Mean±SD values of MD-index were 2.2±2.4. Baseline levels of 23 taxa were associated with FPG change (p<0.05), 11 of which had inverse associations. Among these 23 taxa,
Treponema
HOT238,
Leptotrichia
HOT498 and
Stomatobaculum
HOT097 had an FDR<0.05. The MD-index was inversely correlated with alpha-diversity (r=-0.19, p<0.01). Mean FPG-change±SE in the 3
rd
vs. 1
st
tertile of MD-index were 4.5±0.9 vs. -1.6±0.9 (p<1x10
-4
).

Conclusion:
Increased levels of microbial dysbiosis, reflecting decreased microbial diversity, were associated with increased 2-year glucose change among young, diabetes-free subjects.
Abstract P069: Heat, Heat Waves and Hospital Admissions in Indianapolis, Indiana
Authors: Wang Yi
Published: July 2021

Background:
The association between heat and hospital admissions is well studied, but in Indiana where the regulatory agencies cites lack of evidence for global climate change, local evidence of such an association is critical for Indiana to mitigate the impact of increasing heat.

Methods:
Using a distributed-lag non-linear model, we studied the effects of moderate (31.7 °C or 90
th
percentile of daily mean apparent temperature (AT)), severe (33.5 °C or 95
th
percentile of daily mean apparent temperature (AT)) and extreme (36.4 °C or 99
th
percentile of AT) heat on hospital admissions (June-August 2007-2012) for cardiovascular (myocardial infarction, myocardial infarction, heart failure) and heat-related diseases in Indianapolis, Indiana located in Marion County. We also examined the added effects of moderate heat waves (AT above the 90
th
percentile lasting 2-6 days), severe heat waves (AT above the 95
th
percentile lasting 2-6 days) and extreme heat waves (AT above the 99
th
percentile lasting 2-6 days). In sensitivity analysis, we tested robustness of our results to 1) different temperature and lag structures and 2) temperature metrics (daily min, max and diurnal temperature range).

Results:
The relative risks of moderate heat, relative to 29.2°C (75
th
percentile of AT), on admissions for cardiovascular disease (CVD), myocardial infarction (MI), heart failure (HF), and heat-related diseases (HD) were 0.98 (0.67, 1.44), 6.28 (1.48, 26.6), 1.38 (0.81, 2.36) and 1.73 (0.58, 5.11). The relative risk of severe heat on admissions for CVD, MI, HF, and HD were 0.93 (0.60, 1.43), 4.46 (0.85, 23.4), 1.30 (0.72, 2.34) and 2.14 (0.43, 10.7). The relative risk of extreme heat were 0.79 (0.26, 2.39), 0.11 (0.087, 1.32), 0.68 (0.18, 2.61), and 0.32 (0.005, 19.5). We also observed statistically significant added effects of moderate heat waves lasting 4 or 6 days on hospital admission for MI and HD and extreme heat waves lasting 4 days on hospital admissions for HD. Results were strengthened for people older than 65.

Conclusions:
Moderate heat wave lasting 4-6 days were associated with increased hospital admissions for MI and HD diseases and extreme heat wave lasting 4 days were associated with increased admissions for HD.
Abstract P076: Racial Differences in Maintaining Optimal Healthy Lifestyles Until 50 Years of Age: Prospective Data From the Coronary Artery Risk Development in Young Adults Study
Authors: Booth John N , Allen Norrina B , Calhoun David , Carson April P , Deng Luqin , Goff David C , Redden David T , Reis Jared P , Shimbo Daichi , Shikany James M , Sidney Stephen , Spring Bonnie J , Lewis Cora E , Muntner Paul
Published: July 2021

Introduction:
Racial disparities in healthy lifestyles may begin in youth and increase over the lifespan.

Hypothesis:
Maintaining healthy lifestyles until 50 years of age will be lower in blacks compared with whites.

Methods:
The population-based Coronary Artery Risk Development in Young Adults (CARDIA) study enrolled 5115 blacks and whites aged 18-30 years in 1985-1986. Eight exams were completed over 25 years of follow-up. At each exam, optimal lifestyles were defined as body mass index (BMI) < 25 kg/m
2
, never smoking status, moderate or vigorous physical activity ≥ 150 minutes per week, no or moderate alcohol intake (drinks per week [women / men]: 0-7 / 0-14) and Dietary Approaches to Stop Hypertension (DASH) adherence score ≥ 15. Optimal cardiovascular health (CVH) was defined as having ≥ 4 optimal lifestyles. The age-specific percentage of blacks and whites maintaining optimal lifestyles was calculated using a modified Kaplan Meier method. Hazard ratios (HR) were calculated for maintaining optimal lifestyles over 25 years in blacks compared with whites.

Results:
At the baseline exam, 4900 participants (mean age: 26 years; black: 51%) had ≥ 1 optimal lifestyle. By 50 years of age, maintaining BMI < 25 kg/m
2
, never smoking status, moderate or vigorous physical activity ≥ 150 minutes per week, DASH diet adherence and optimal CVH were lower in blacks versus whites while maintaining no or moderate alcohol intake was higher (
Table
). The multivariable adjusted HR (95% confidence interval) comparing blacks to whites for maintaining BMI < 25 kg/m
2
was 0.57 (0.52-0.63), never smoking status was 0.82 (0.66-1.01), moderate or vigorous physical activity ≥ 150 minutes per week was 0.83 (0.76-0.91), no or moderate alcohol intake was 1.19 (1.03-1.37), DASH diet adherence was 0.71 (0.61-0.82) and optimal CVH was 0.63 (0.56-0.72).

Conclusion:
Blacks were less likely to maintain optimal lifestyles until 50 years of age. Reducing racial differences in the maintenance of optimal CVH may help prevent racial disparities in cardiovascular disease.
Abstract P086: The Association between Psychological Distress and Diabetes Prevalence among Foreign-Born Blacks in the United States: An Examination of the 2010-2014 National Health Interview Survey
Authors: Ukonu Nwakaego , Turkson-Ocran Ruth-Alma , Commodore-Mensah Yvonne
Published: July 2021

Background:
Psychological distress, a leading cause of disability globally, is highly prevalent in people diagnosed with diabetes. Blacks in the U.S. are disproportionately affected by chronic conditions such as diabetes. Taken together, psychological distress and diabetes constitute an immense health burden and result in poor health outcomes, increased mortality and decreased quality of life. While the association between psychological distress and diabetes is documented among U.S.-born Blacks, this relationship remains poorly examined among the growing foreign-born Black population in the U.S.

Hypothesis:
We hypothesized that psychological distress (non-specific) would be associated with a higher prevalence of diabetes among a sample of foreign-born Blacks in the U.S.

Methods:
We analyzed data on adult foreign-born Blacks in the 2010-2014 National Health Interview Survey which is a national in-person survey of non-institutionalized persons in the U.S. The main independent variable was psychological distress which was defined as a score of ≥ 12 on the Kessler Psychological Distress Scale (K-6 Scale) . The main outcome variable was diabetes. Multivariable logistic regression was performed to examine the association between psychological distress and diabetes prevalence adjusting for known confounders.

Results:
A total of 2,974 foreign-born Blacks were included in this study. The mean age (±SE) was 43.9 (±15.3)and nearly half (53.3%) were female. Among the individuals who received the K-6 Scale, 13.3% indicated experiencing symptoms of depression within the last 30 days and 10% had diabetes. After adjusting for age, sex, body mass index, poverty status, and marital status, we observed that foreign-born Blacks with higher levels of psychological distress had 2.30 (95% CI: 1.69-3.12) higher odds of being diabetic in comparison to those without psychological distress.

Conclusion:
In a sample of contemporary foreign-born Blacks in the U.S., we observed that psychological distress was associated with prevalence of diabetes, such that individuals with elevated levels of psychological distress were twice as likely to be diabetic. Additional barriers may be associated with managing diabetes when a co-morbid mental health condition such as depression is present. Thus, culturally-tailored behavioral health interventions should be developed and utilized among foreign-born Black sub-populations to help promote adherence to complex behavioral and medical regimens associated with diabetes management.
Abstract P148: Developing a Childhood Obesity Risk Score System Based on Perinatal and Postnatal Risk Factors
Authors: Lilly Christa , Umer Amna , Hamilton Candice , Britton Cris , John Collin , Neal William
Published: July 2021

Introduction:
Few studies have examined the relationship between perinatal and postnatal birth factors with later childhood obesity. One notable exception found only infant weight-related factors (such as adiposity rebound) related to weight at age 7, but not other potential risk factors (such as breastfeeding, parity, maternal age, etc., Reilly et al 2005) Our goal with the current study was to expand earlier work, utilizing an Appalachian sample, and to develop a risk score based on an expanded set of risk factors.

Methods:
The study used longitudinally linked data from three cross-sectional datasets in West Virginia (N=22136). Risk score development followed the tutorial by Sullivan et al (2004). The outcome was defined as childhood obesity at age 10 and calculated as children with 95th percentile BMI for their age and gender. The perinatal predictors included sex, race, health insurance status, family history of cholesterol and cardiovascular disease, smoking during pregnancy, maternal age at birth, breastfeeding intention at birth, and birth weight of the infant. ROC analysis was then performed to establish a cut-off that would maximize the sensitivity and specificity of the perinatal risk factor scores in predicting childhood obesity.

Results:
Table 1 shows the significant risk factors and associated points. A score of 17 maximized sensitivity (50%) and specificity (60%) using the combined risk factor system for predicting childhood obesity at age 10. Nearly 43% (N=4054 of 9494) of the children had a high perinatal risk score; of those, 34.24% (N=1388) were obese (compared to 26.53% of those with a low perinatal risk score). The odds of being obese in fifth grade were 1.44 (95%CI: 1.32, 1.58) times among those who had a high perinatal score compared to those who had a low score.

Discussion:
The results of the study can help in identifying infants at birth who are at higher risk of developing childhood obesity. Future research should include other predictors to increase sensitivity and specificity of the risk score system.
Abstract P150: Linkage Program to Identify Siblings from a CARDIAC Risk Factor Registry
Authors: Pyles Lee A , Mullett Charles J , Lilly Christa , Neal William A
Published: July 2021

Introduction:
The Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project gathers anthropometric, BP and lipid data from fifth graders in West Virginia in the past 18 y. 60,403 children had LDL cholesterol and we found 5259 sets of siblings by direct match on mothers first and last name. The suggestion that more sibships could be identified prompted evaluation of Link Plus software from Centers for Disease Control (CDC) to improve matching.

Methods:
LinkPlus generates potential matches via a probabilistic algorithm that allows relative weighting of multiple factors such as first and last name. For our purposes the deduplication rather than matching algorithm was run using mother’s first and last name using the NYSIIS (New York State Identification and Intelligence System) phonetic schema to avoid creating multiple many-to-many relationships that were difficult to analyze. Additional variables considered included county, street address, telephone, fathers first and last name, school. Subject last name was used as a blocking variable.

Results:
7602 matched siblings were generated by the program that determined a probability score ranging from 61.3 to cut off at 15; few matches were observed below this level. The figure demonstrates exponential decay beginning at a probability score of 26 with 95% accuracy at 25.5. 6827 pairs were included at that level including 6824 matched pairs and only 3 false positive pairs. Partial matches (n = 61) likely are half sibs including exact match of telephone and/or street but only one parent matching. Child surname was not used in the algorithm. Typographical errors were accounted by Link Plus. Lipid correlations were similar to those found with excel but more robust.

Conclusion:
The Link Plus record matching program from CDC is able to successfully determine sibships with increased sensitivity compared with a direct match from a sorted excel file. The program was able to identify likely sibs and half-sibs plus avoid non-match due to minor typo errors in the analyzed fields.
Abstract P155: Cardiovascular Health at Young and Middle Ages and Medical Care Costs at Old Age
Authors: Schiman Cuiping , Liu Lei , Shih Tina , Zhao Lihui , Daviglus Martha , Liu Kiang , Fries James , Garside Daniel , Vu Thanh Huyen , Stamler Jeremiah , Lloyd-Jones Donald , Allen Norrina B.
Published: July 2021

Introduction:
We investigate the association between cardiovascular health at young and middle age and medical care costs and utilization in old age.

Methods:
We linked Chicago Heart Association (CHA) study participants’ baseline cardiovascular health (CVH) (18-59 yrs) to their Medicare claims (1991-2010) for all Part A and Part B services, including inpatient and skilled nursing facility, outpatient, home health, durable medical equipment, and hospice care. Baseline CVH is a composite measure of BP, cholesterol, diabetes, BMI, and smoking and is divided into four strata representing increasing burden. Medical care utilization (e.g., admissions and visits) and costs (in 2010 dollars) were calculated from the claims. We analyzed both the overall costs and the composition of costs among various medical care services and by CVD (non-CVD) morbidity and sex. Conditional quantile regressions were used to estimate the association between increased CVH and costs and negative binomial regressions were used for the number of inpatient admissions and outpatient visits, and the length of inpatient or hospice stay.

Results:
Among the 22,236 participants (222,816 person-years) 41.7% are female, 5.7% had favorable levels of all factors, 19.6% had 1+ risk factors at elevated levels, 40.9% had 1 high risk factor, and 33.7% had 2+ high risk factors. The median (mean) health care costs over the sample is $12,477 ($189,598) per person year in 2010 dollars, poorer CVH was associated with higher total medical care costs and a greater proportion of spending on home health visits (Figure). A greater CVH burden was associated with greater utilization and length of stay. Individuals with 2+ high risk factors on average have 0.22 more inpatient admissions per year and their inpatient stay is almost 2.91 days longer per year than individuals with favorable CVH.

Conclusion:
Unfavorable CVH early in life is associated with higher medical care cost burden in old age. Future interventions to improve CVH may result in reduced healthcare costs and utilization.
Abstract P174: Factors Related to Decreased Readmission within 30 Days for Hispanic Heart Failure Patients
Authors: Lee Hong Seok , Pekler Gerald , Visco Fernand , Mushiyev Savi
Published: July 2021

Objective:
This study was aimed to relate the obesity paradox to readmission and obesity. The obesity paradox remains controversial in the literature. Obesity has detrimental effects on heart failure, but has been found to be paradoxically associated with improved survival. We hypothesized that readmission in heart failure patients is associated with obesity.

Method:
We analyzed 732 patients who were admitted for heart failure exacerbation and enrolled in our heart failure program and excluded those who did not follow-up or patients discharged from the cardiology clinic. Patients who were readmitted within 30 days for heart failure exacerbation were investigated. 688 patients who have been followed since 2013 were included. BMI (body mass index) and WC (waist circumference) were classified according to NCEP-ATP III.

Results:
The number of normal weight (BMI <25kg/m
2
), overweight (30 kg/m
2
>BMI≥25kg/m
2
) and obesity (BMI≥30kg/m
2
) were 35.7%, 35.1% and 29.1%, respectively. Central obesity (WC ≥94 cm for men ,and ≥80 for women) were 62%. The number of patients in our selected populations of HFrEF, HFpEF and HFpEF(i) were 456(67.9%),136(20.2%) and 68(11.9%) respectively. A higher readmission rate had a significantly associated with non-obese (BMI less than 30 kg/m
2)
group compared to obese group(BMI more than 30 kg/m
2)
in HFpEF patients. There was no significant association between central obesity and readmission. In addition, the absence of diabetes mellitus, an ICD (implantable cardioverter defibrillator), no prior cardiac catheterization and age over 65 were associated with a lower readmission rate.

Conclusion:
The obesity paradox with BMI applied to our study group. The obese group had a significant association with reduced readmission rate compared to the normal or overweight BMI group in HFpEF. WC was not associated with readmission. Higher BMI may be related to better cardiopulmonary fitness in HFpEF. To apply to clinical practice, a large randomized study should be warranted. Targeted management in different types of heart failure could be associated readmission.
Abstract P211: Diet Quality Declines and Differs by Race in Early Childhood
Authors: Reynolds Kelly , Kalkwarf Heidi , Summer Suzanne , Khoury Philip , Gavin Marcia , Woo Jessica G
Published: July 2021

Introduction:
Diet quality is an important determinant of health in children, but little is known about how diet quality progresses during early childhood. We hypothesized that overall diet quality, assessed by the 2010 Healthy Eating Index, would decline during early childhood.

Methods:
Three hundred seventy-two (372) healthy 3-year-old children were recruited from the Greater Cincinnati area and assessed every 4 months until age 7 at in-person clinical visits, for a total of 13 visits. Parents completed 3-day diet diaries at each visit which were analyzed for nutrient composition using the Nutrition Data Systems for Research system (NDSR). The 2010 Healthy Eating Index (HEI) total and food-group component scores were calculated and averaged by year of study. Longitudinal mixed modeling was used to evaluate longitudinal trends.

Results:
The population was 52% (195/372) male, 78% (290/372) white and 83% (308/372) completed the final visit. HEI total scores at age 3 were poor (mean±SE: 45.2±0.4) and declined significantly between ages 3-7 (p<0.0001). None of the participants had “good” quality diet (HEI>80) at any point in the study. HEI total scores differed by race, with white children having significantly higher scores (p=0.05, Figure). HEI component scores showed a mixed pattern, with some significantly improving (protein, vegetables and fatty acids), some significantly worsening (dairy, refined grains, sodium, whole fruit and total fruit); other component scores did not change. Differences by race also varied, with African-Americans having consistently better scores for vegetables, greens and beans, protein and fatty acids (all p<0.0001), while white children had better scores for dairy, sodium and refined grains (all p<0.0005).

Conclusions:
The average HEI scores for young children showed poor baseline diet quality at age 3 that became gradually worse throughout early childhood. The varying patterns in HEI component scores indicate specific areas of focus for early dietary intervention, which may differ by race.
Abstract P217: Parathyroid Hormone is Not Independently Associated With Cognitive Decline: 20 Year Follow-up From the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Kim Samuel M , Zhao Di , Schneider Andrea L , Korada Sai Krishna , Lutsey Pamela L , Guallar Eliseo , Alonso Alvaro , Windham B. Gwen , Gottesman Rebecca F , Michos Erin D
Published: July 2021

Background:
Little is known about the role of parathyroid hormone (PTH) in cognitive decline. Elevated PTH may contribute to cognitive impairment and dementia by mechanisms of endothelial dysfunction, increased vascular stiffness, hypertension, and atherosclerosis, as well as via small vessel cerebral disease. We hypothesized that elevated PTH levels will be independently associated with 20-year cognitive decline in a large population-based cohort study.

Methods:
We studied 12,964 middle-aged white and black ARIC participants without history of prior stroke who had serum PTH levels and cognitive function testing measured in 1990-92 (baseline) and repeat cognitive testing at up to 2 follow-up visits in 1996-98 and 2011-13. The cognitive tests included the Delayed Word Recall, Digit Symbol Substitution, and Word Fluency tests, which were summed as a global z score. Using mixed-effects models, we compared the relative decline in global cognitive score between each of the top three quartiles of PTH levels to the reference bottom quartile. Time since baseline was modeled by using a linear spline with a knot at 6 years. We adjusted for demographic variables, education, vascular risk factors, and calcium, phosphorous, and vitamin D levels. We imputed missing covariates and follow-up cognitive data using multiple imputation by chained equations (MICE) methods to account for attrition during study follow-up.

Results:
The mean (SD) age of our cohort was 57(6) years, 57% were women, and 24% black race. There was no cross-sectional association of elevated PTH with cognitive global Z score at baseline (all p>0.05). Over a median of 20.7 years, participants in each PTH quartile showed decline in cognitive function (
Table Part A
). However, cognitive decline was not steeper in participants with PTH levels in the higher quartiles than participants with the lowest PTH levels (all p>0.05). [
Table Part B
].

Conclusions:
Our work does not support an independent influence of PTH on cognitive decline in this biracial population-based cohort study.
Abstract P249: Hemostatic Factors and Long-Term Risk of Peripheral Arterial Disease: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Wu Aozhou , Ballew Shoshana H , Kalbaugh Corey A , Loehr Laura R , Kucharska-Newton Anna , Hoogeveen Ron C , Ballantyne Christie M , Heiss Gerardo , Folsom Aaron R , Coresh Josef , Matsushita Kunihiro
Published: July 2021

Background:
A few cross-sectional studies have reported associations between hemostatic factors and peripheral arterial disease (PAD), but prospective data are largely lacking.

Hypothesis:
Plasma hemostatic factors are associated with incident PAD, independently of traditional atherosclerotic risk factors.

Methods:
In 14,071 men and women (age 45-64 years and 25.4% blacks) at visit 1 (1987-1989) of the ARIC Study, we investigated the associations of fibrinogen, Von Willebrand factor (VWF), factor VIII, factor VII, Antithrombin III (ATIII) with incidence of PAD (defined as hospitalizations with PAD diagnosis [ICD-9: 440.2x, 440.3, and 440.4] or leg revascularization [38.18, 39.25, 39.29 and 39.50]). We also explored associations of d-dimer measured at visit 3 (1993-1995) in 11,619 participants.

Results:
We identified 540 incident PAD during a median follow-up of 24.4 years. Fibrinogen, VWF, factor VIII, and d-dimer demonstrated positive dose-response relationships to incident PAD, independent of other risk factors (Table). In comparison with respective referent categories, significantly higher PAD risk was observed in the top two quintiles of fibrinogen, VWF, and d-dimer and the highest quintile of factor VIII. When fibrinogen, VWF, and factor VIII were modeled simultaneously (d-dimer was measured at a different visit), only fibrinogen and VWF remained significantly associated with PAD.

Conclusion:
Hemostatic factors, particularly fibrinogen and VWF (as well as d-dimer), were independently associated with future risk of PAD. Our findings suggest the pathophysiological involvement of hemostasis in the development of PAD and potential usefulness of those factors for classifying long-term risk of PAD.
Abstract P264: Excess Heart Age in HIV Outpatient Study Participants
Authors: Thompson-Paul Angela M , Palella Frank J , Rayeed Nabil , Ritchey Matthew D , Lichtenstein Kenneth A , Yang Quanhe , Gillespie Cathleen C , Loustalot Fleetwood , Hart Rachel , Buchacz Kate
Published: July 2021

Cardiovascular disease (CVD) is an important cause of morbidity and mortality among HIV-infected adults. Calculating an individual’s excess heart age, or the difference between their chronological age and predicted heart age, can be useful in describing their risk for developing CVD and motivating behavior change to decrease their CVD risk. The overall mean excess heart age is 7.8 and 5.4 years among U.S. men and women, respectively. We evaluated excess heart age among HIV-infected adults in medical care using sex-specific, cholesterol-based models developed from Framingham general CVD risk prediction equations. Included were HIV Outpatient Study (HOPS) participants aged 30-74 y, who had ≥2 HOPS clinic visits during 2010-2014, had no prior CVD at the start of observation, had >1 y of follow-up, and had non-missing data for all covariates. Age-standardized (2010 U.S. census) and weighted means, prevalence and 95% confidence intervals (CIs) were calculated for participant chronological age, predicted heart age, and excess heart age. From 5,088 HOPS participants assessed for eligibility, 1905 men and 584 women were included in the analysis. Heart age exceeded chronological age by 11.3 and 11.9 y among men and women, respectively (Table). Excess heart age was greatest among non-Hispanic Blacks, persons aged 50-59 y, those with less than high school education, and women with a median CD4+ count ≥500 cells/μL. Predicted heart age was higher than chronological age among HIV-infected men and women and surpassed excess heart age estimates observed in the general U.S. population. Greater excess heart age among HIV-infected adults might result from demographic differences, higher frequency of CVD risk factors including smoking, diabetes, HIV-associated excess chronic inflammation, and possibly lower use rates of antihypertensive or statin drugs. Routine clinical use of heart age calculation may help optimize CVD risk communication and interventions for aging HIV-infected persons.
Abstract P309: The Role of Traumatic Stress in Association Between Physical Activity and Cardiovascular Disease Risk Factors Among Hispanic/Latino Adults: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study
Authors: Vasquez Priscilla , Marquez David X , Gallo Linda C , Argos Maria , Carrion Violeta , Durazo-Arvizu Ramon , Isasi Carmen , Lamar Melissa , Lash James , Odoms-Young Angela , Sotres-Alvarez Daniela , Talavera Gregory A , Daviglus Martha L
Published: July 2021

Background:
Physical activity (
PA
) is associated with lower risk, and chronic stress with increased risk of CVD risk factors (
RFs
) such as hypertension (
HTN
) or type 2 diabetes. Little is known about potential interactions between PA and traumatic stress (
TS
) in relation to CVD risk factors.

Objective:
To assess whether the association of PA with CVD RFs is modified by the presence of traumatic stress (
TS
).

Methods:
Cross-sectional data from 4,169 adults ages 18-74 in 2008-11, who participated in the HCHS/SOL Sociocultural Ancillary Study and had complete information on key variables, were analyzed using complex survey design methods. TS was assessed by self-reported lifetime exposure to traumatic events; scores were categorized into tertiles based on number of stressors: low=0-1; intermediate=2; high=≥3. PA was assessed by the Global PA Questionnaire and grouped into 4 levels: inactive, low, intermediate, and high activity. CVD RFs included HTN, obesity, diabetes, smoking, and hypercholesterolemia. Multivariate logistic regression was used for analyses.

Results:
Compared to high PA levels, intermediate PA was significantly associated with HTN, inactivity was associated with obesity, and inactivity and intermediate PA were associated with diabetes (
Table
). Significant interaction between PA with TS was observed for HTN (p<0.001) but not for other CVD RFs. For effect modification by TS, among persons with low TS, intermediate PA was associated with 2.1 times higher odds of HTN vs. high PA levels. Among those with intermediate TS, low PA was associated with 2.3 times higher odds of HTN, and among those with high TS, inactivity was associated with 2.1 times higher odds of HTN vs. high PA levels.

Conclusion:
A statistical interaction was observed between traumatic stress and physical activity among those with hypertension (but not with other CVD risk factors), and the odds of HTN varied by TS. Further evaluation is needed to determine physical activity recommendations to prevent hypertension among those with traumatic stress.
Abstract P313: Dog Walking is Associated With Increased Home-based Exercise in Patients with Coronary Heart Disease
Authors: Dunn Susan L , Sit Michael J , DeVon Holli A , Makidon Devynn , Tintle Nathan L
Published: July 2021

Introduction:
Dog ownership and dog walking have been associated with increased physical activity in the general population. Although evidence suggests an association between pet ownership and increased survival in patients with coronary heart disease (CHD), little is known about how dog ownership and dog walking may be associated with exercise habits in CHD patients.

Hypothesis:
The purpose of this study was to examine dog ownership and dog walking and their relationship with frequency of home- and hospital-based CR exercise in patients with CHD. It was hypothesized that CHD patients who walk their dogs would report more frequent home- and hospital-based CR exercise.

Methods:
The study was based on Self-Determination Theory. A prospective observational design was used. A total of 122 patients with CHD completed a dog ownership and walking survey during their hospitalization and were asked to complete the Cardiac Rehabilitation Exercise Participation Tool by mail at 3, 8 and 12 months later. Patients self-selected whether they walked or biked in a home- or hospital-based Phase II CR exercise setting and self-reported number of days per week of exercise in each setting.

Results:
The sample was predominantly male (n=82; 67.2%) with a mean age of 64.7±9.1 years. Forty-two patients (34.4%) reported owning a dog. There were no differences in participation in home or Phase II CR exercise in dog owners versus non-dog owners (home CR: 57.1% vs. 62.5%, p=0.57 and Phase II CR: 31.0% vs. 32.5%, p=0.86). Among dog owners, 23 (54.8%) reported walking their dog at least 1 day/week. There were no significant differences in Phase II CR exercise among non-dog owners, dog owners who did not dog walk, and those who walked their dogs at least 1 day/week (owners/walkers: 34.8%, owners/non-walkers: 26.3%, non-owners: 32.5%; p=0.83). However, patients who owned but did not walk their dog reported significantly lower levels of home exercise compared to patients who owned and walked their dogs at least 1 day/week (owners/non-walkers: 36.8% vs. owners/walkers: 73.9%, p=0.019) and compared to non-dog owners (owners/non-walkers: 36.8% vs. non-owners: 62.5%; p=0.047).

Conclusions:
Results suggest that dog ownership is not equivalent to dog walking when examining exercise frequency in CHD patients. Dog owners were no more likely to exercise than non-dog owners. However, findings show a beneficial effect on home-based exercise for CHD patients who walk their dogs at least one day a week. Healthcare professionals should encourage CHD patients who are dog owners to walk their dogs as a strategy to increase home-based exercise.
Abstract 104: (In)adequacy of the All Patient Refined-Diagnosis Related Groups for Neonatal Cardiac Benchmarking and Reimbursement
Authors: Anderson Brett R
Published: July 2021

Background:
The All Patient Refined-DRG (APR-DRG) system is commonly used for benchmarking and reimbursement. Little is known about the adequacy when applied to pediatric service lines. Cardiac neonates not on ECMO are billed under one of three APR-DRGs, undifferentiated by case type/complexity. Two are not cardiac specific. We hypothesized that differences in pediatric case mix not captured under the DRG/severity system may have large impacts on pediatric cardiac benchmarking and reimbursement.

Methods:
We utilized national administrative data from 46 pediatric tertiary hospitals from the Pediatric Health Information System Database, 2014. We included all neonates with APR-DRGs 588, 609, and 630 (Newborn <1500gm w major procedure, Newborn 1500-2499gm w major procedure, and Newborn ≥2500gm w major cardiovascular procedure). Log linear regression was used to compare adjusted cost-to-charge ratio (CCR) costs between cardiac and non-cardiac discharges and across clinical case complexity categories (Risk Adjustment for Congenital Heart Surgery, RACHS-1), controlling for DRG/severity category and clustering standard errors by center. Estimated reimbursements were calculated, multiplying New York State 2014 APR-DRG weights by a range of hospital base rates.

Results:
In total, 4,631 neonates met inclusion. Neonates <2500gm undergoing cardiac surgery had 32% higher costs than those undergoing non-cardiac surgeries under the same DRG/severity (CI 20-46%, p<0.001; median $283,000 vs $200,000). Neonates ≥2500gm undergoing high complexity operations (RACHS-1 class 5 or 6) had 44% higher costs than children undergoing lower complexity under the same DRG/severity (CI 26-65%, p<0.001; median $198,000 vs $120,000). Payer mix was similar for cardiac/non-cardiac patients. Assuming 2014 base rates of $6-8,000, average expenses for cardiac neonates <2500gm undergoing major procedures needed to be <45-68% of CCR costs to generate profit (vs <54-80% for non-cardiac); expenses for neonates ≥2500gm undergoing high complexity cases needed to be <42-60% of costs (vs <67-83% for lower complexity).

Conclusions:
The APR-DRG system is inadequate for neonatal cardiac benchmarking, and its role in reimbursement has significant potential ramifications for the revenue of pediatric cardiac service lines paid on DRG.
Abstract 116: Independent Prognostic Value of Guideline-Directed Medical Therapy, Radial Access, and Door-to-Balloon Time in Predicting STEMI In-Hospital Mortality
Authors: Huded Chetan , Johnson Michael , Ballout Jad , Kravitz Kathleen , Menon Venu , Abdallah Mouin , Gullett Travis , Hantz Scott , Ellis Stephen , Podoslky Seth , Meldon Stephen , Kralovic Damon , Brosovich Deborah , Smith Elizabeth , Kapadia Samir , Khot Umesh
Published: July 2021

Background:
Systems-based strategies to improve STEMI care have traditionally focused on improving door to balloon time (D2BT) performance. However, prompt guideline-directed medical therapy (GDMT) and use of radial access for PCI are also associated with reduced mortality in patients with STEMI. The incremental value of each facet of STEMI care on mortality is unknown.

Methods:
On 7/15/14 we implemented a comprehensive four-step STEMI protocol at our institution: (1) ED physician cath lab activation (2) Safe STEMI Handoff Checklist with GDMT decision support (3) immediate transfer to an immediately available cath lab and (4) radial access for PCI. The protocol was intended to minimize care variability in GDMT (aspirin, P2Y12 inhibitor, and anticoagulant) prior to PCI, use of radial access for PCI, and D2BT. We studied consecutive patients with STEMI treated with PCI at our center (1/1/11-12/31/16) to assess the incremental prognostic value of these STEMI care processes using logistic regression models.

Results:
Of 1272 participants mean age was 61+/-12 years and 68% were men. STEMI presenting location was 25% primary ED, 69% inter-hospital transfer, and 6% in-hospital. The rates of GDMT prior to PCI (74% vs 83%, P<0.001) and radial access for PCI (19% vs. 67%, P<0.001) improved and median D2BT (106 [81-140] vs. 90 [68-109], P<0.001) decreased after implementation of the comprehensive four-step STEMI protocol. In a multivariable model, GDMT prior to PCI (OR 0.42, 95% CI 0.25-0.71, P=0.001), radial access for PCI (OR 0.44, 95% CI 0.23-0.82, P=0.002), and decreasing D2BT (10min decrease: OR 0.96, 95% CI 0.94-0.99, P=0.007) were each independently associated with reduced odds of in-hospital mortality. Step-wise modeling of the risk of in-hospital mortality demonstrated that GDMT prior to PCI, radial access for PCI, and D2BT performance provided incremental prognostic value when added in stepwise order of the occurrence of these care processes in clinical practice (Figure).

Conclusions:
Prompt GDMT administration, radial access for PCI, and D2BT performance add incremental prognostic value. Expanding STEMI systems of care from a singular focus on D2BT to a comprehensive focus on multi-faceted STEMI care offers an opportunity to further improve STEMI outcomes.
Abstract 119: Quality of Life Outcomes in Patients With Known Coronary Artery Disease Presenting With Suspected Ischemia Randomized to Pharmacologic Stress Myocardial Perfusion Imaging With Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET)
Authors: Patel Krishna K , Al Badarin Firas , Arnold Suzanne V , McGhie Arthur I , Kureshi Faraz , Kennedy Kevin F , Courter Staci , Spertus John A , Bateman Timothy M
Published: July 2021

Introduction:
In patients with suspected ischemia, myocardial perfusion imaging (MPI) with PET has been shown to provide greater diagnostic accuracy and improved risk stratification over SPECT MPI. As such, PET MPI could lead to improved post-test management, which could impact subsequent patient health status (symptoms, function and quality of life). We compared the health status outcomes for patients undergoing stress MPI for suspected ischemia using PET vs SPECT.

Methods:
At a single health system, patients with CAD and suspected ischemia were randomized to PET or SPECT MPI from 6/2009-9/2013. Post-test management was at the discretion of the referring physician. The Seattle Angina Questionnaire (SAQ) was prospectively collected at baseline, 1, 3, 6 and 12 months, and the Angina Frequency (AF), Physical Limitations (PL), and Quality of Life (QL) domain scores were compared between MPI modalities using linear repeated measures model.

Results:
Among 322 patients with CAD randomized to PET vs. SPECT (n=161 in each group, mean age 66.3 ± 9.7 years, 64.9% men, 27.6% with diabetes, 14.0% with ischemia (≥10% myocardium)), all SAQ domains increased significantly from baseline with the largest changes observed within the first 1 month after MPI (Figure). However, the changes in SAQ domain scores were similar between the imaging modalities (SAQ AF: p=0.70, SAQ PL: p=0.07, SAQ QL: p=0.20).

Conclusions:
In symptomatic patients with CAD undergoing stress MPI, health status improved significantly over a year of follow-up. Although PET MPI more accurately details the ischemia, use of this imaging modality did not translate into improved health status over time.