bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P378: Association Between Height-to-Waist Ratio and Cardiovascular Disease Risk Factors in US Adolescents
Authors: Lee Chong-Do
Published: July 2021

Background:
Although height-to-waist (HtW) ratio is strongly linked to cardiovascular disease (CVD) mortality in adults, the association between HtW and CVD risk factors in children and adolescents remain less unexplored. The purpose of this study was to examine the association between HtW and CVD risk factors in US adolescents (N = 9493), aged 12 to 17 years, from the NHANES (1999-2006).

Methods:
Waist circumference, body weight, height were assessed with standardized protocols for body composition measurement. High blood pressure (BP) was defined as a value at or above the 90
th
percentile for age, sex, and height. Elevated fasting glucose level was defined using the American Diabetes Association guideline of 110 mg/dL or higher. Elevated total cholesterol (TC) level was classified as TC greater than 200 mg/dL. The CVD risk (yes/no) was defined as one or more of these 3 conditions (high BP, elevated glucose, high cholesterol levels). Multivariable logistic regression was used to investigate the association between HtW and CVD risk after adjustment for age, sex, race, physical activity, and dietary habits. We also used the area under a receiver operating characteristic (ROC curve) and a nadir point [(shortest distance from the ROC curve to the perfection (sensitivity = 100% and specificity = 100%)] to define the lowest CVD risk for HtW in boys and girls, respectively.

Results:
HtW was a strong risk factor for CVD risk in both boys and girls (All P<0.001). There was a strong inverse association between HtW and CVD risk in both boys and girls (All P<0.001), respectively. Minima on the receiver operating characteristics curves for CVD risk in boys and girls were 2.17 and 2.03, respectively. The HtW cutoff points of 2.17 (sensitivity = 67%; specificity = 59%; minimum ROC distance = 0.51) and 2.03 (sensitivity = 64%; specificity = 55%; minimum ROC distance = 0.57) in boys and girls were associated with the lowest CVD risk, respectively.

Conclusions:
Height-to-waist ratio was strong risk factor for CVD in boys and girls.
Abstract P383: Do Geographic Patterns of Obesity Prevalence Correlate with Patterns of High Stroke Mortality?
Authors: Le Anh H , Howard George , Allison David B , Oza-Frank Reena , Judd Suzanne E , Howard Virginia , Affuso Olivia
Published: July 2021

Background:
Self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS) survey show higher prevalence of obesity in the south, particularly for the East South Central(ESC) states of LA, MS, and AL. Because obesity is associated with hypertension and diabetes, higher prevalence of obesity has been hypothesized as a primary contributor to the stroke belt, an area of high stroke mortality in the southeast. We assessed measured obesity from the National Health and Nutrition Examination Survey (NHANES) and REasons for Geographic and Racial Differences in Stroke (REGARDS), a national population-based cohort from 48 states, and compared geographic prevalence patterns across studies.

Methods:
Weighted obesity prevalence estimates (with 95% CIs) were calculated from NHANES (2003-2008; n = 6138), REGARDS (2003-2007; n = 30,183), and BRFSS (2003-2007; n = 67,742) in non-Hispanic black and white adults over 45 years of age in the census divisions. Obesity was defined as BMI >= 30 kg/m
2
.

Results:
There is a lack of concordance in the obesity prevalence (see Figure) between BRFSS and both REGARDS (top left) and NHANES (bottom right). In contrast, the comparison of REGARDS and NHANES (top right) shows good agreement in the estimated obesity prevalence for all divisions (including those containing the stroke belt states, shown in red).

Conclusion:
Our results indicate discordance in measured and self-reported obesity prevalence especially in the ESC division. The objectively measured obesity prevalence for both NHANES and REGARDS was high in the West North Central division including ND, SD, NE, KS, MN, IA, and MO. Factors other than obesity may contribute to the high prevalence of hypertension and diabetes, and high stroke mortality rates, in the stroke belt. Additionally, these data suggest that errors in self-reporting height and/or weight differ by region and may have distorted past estimates of obesity rates by region.
Abstract P387: Cardiovascular Risk Factors Among Children in a 20 year Community Study: Influence of the Family
Authors: Nelson Tracy L , Dvorak Laura , Kioussopoulos Kathy , Luckasen Gary
Published: July 2021

Background:
High cholesterol, atherosclerosis, high blood pressure, and obesity can be identified during childhood. Identifying the underlying contributors to such risk factors may allow young families the opportunity to modify health habits. The purpose of this study was to determine the prevalence of cardiovascular risk factors and their associated predictors among Northern Colorado children and their families.

Methods:
The Poudre Valley Health System (PVHS), Healthy Hearts Club has provided a successful cardiovascular screening program for the past ∼20 years (1993–2011) to identify risk factors among students in six Northern Colorado school districts (a primarily white population ∼90%). Schools were selected based on willingness to participate. Data were collected cross-sectionally with objective measures of total cholesterol, high-density lipoprotein cholesterol (HDL-C), blood pressure and body mass index (BMI). Surveys were filled out by the parent and/or legal guardian and included questions about diet and physical activity of the child as well as these behaviors and risk factors among family members.

Results:
There were 9,363 children with information for the measured risk factors (mean age, 10.4 years, range, 6.2–18 years, 49% female). The prevalence of the six measured risk factors included 39% with total cholesterol > 170 mg/dl, 10.7%, with HDL-C < 35 mg/dl, 11.7% with Cholesterol/HDL ratio >4.8, 7.2% with systolic blood pressure > 120 mmHg, 8.2% with diastolic blood pressure > 80 mmHg and 21.1% with BMI > 85 percentile for age and sex. There were 40.8%, 35%, 14.5%, 6.2%, 2.4%, 0.8% and 0.2% with 0–6 risk factors respectively. Of those with zero risk factors 25.7% reported a family member (other than the child) being overweight while 68.2% reported such among those with five risk factors; similarly 16.4% reported a family member who smokes (among children with zero risk factors) as compared to 24% with five risk factors. High cholesterol, high blood pressure and diabetes trended similar.

Conclusions:
The prevalence of CVD risk factors among these children is substantial and is associated with such risk factors among the family. This data suggests risk factor reduction must not be done in isolation of the family.
Abstract P389: Cardiovascular Disease Mortality Risk Prediction in Educational Classes across European Regions, in the MORGAM Project Populations
Authors: Ferrario Marco M , Veronesi Giovanni , Chambless Lloyd E , Tunstall-Pedoe Hugh , Kuulasmaa Kari , Salomaa Veikko , Borglykke Anders , Hart Nigel , Cesana Giancarlo
Published: July 2021

Aims:
Although socioeconomic status is a recognized independent risk factor for CVD mortality, the recommended European risk prediction equation for primary prevention does not consider it; an approach criticized by previous results in the UK and US. We aim to assess whether the SCORE project equation adequately estimates the risk in different educational classes, across several European populations.

Methods:
We considered 47 prospective population-based surveys from Nordic Countries (Finland, Denmark, Sweden), UK (Belfast and Scotland), Central Europe (France, Germany and Italy) and East Europe (Lithuania, Poland) and Russia. Baseline data collection and mortality follow-up (median time 10 years) adhered to standardized MONICA-like procedures. Three educational classes were derived from population-, sex- and birth year-specific tertiles of years of schooling. The individual SCORE risk was computed from age, total cholesterol, systolic blood pressure and smoking; the risk was recalibrated to the average observed risk in each population. We estimated age- and traditional risk factors-adjusted hazard ratios (HR) for 10 year CVD mortality (highest education as the reference), from Cox models. Moreover, the
observed
number of fatal CVD events by educational class was compared to the
expected
number, as estimated by the recalibrated SCORE function.

Results:
The cohorts summed-up 39,215 men and 29,240 women 40 to 64 years old and free from CVD event at baseline. Education was associated with CVD mortality in men (pooled age-adjusted HR for low vs high education: 1.6, 95% CI 1.4–1.9); the hazard ratios ranged from 1.3 (95%CI: 0.9–1.8) in Central Europe to 2.1 (1.6–2.7) in East Europe and Russia. The association attenuated after adjustment for SCORE risk factors and HDL-cholesterol. Among women, the association was significant in Nordic Countries only (age-adjusted HR for low vas high education: 1.7, 95% CI 1.1–2.6), but it was no more significant after adjustment for multiple risk factors. The original SCORE equation overestimated the risk at a population level, both in men and in women, except in East Europe and Russia. After recalibration, the SCORE equation overestimated the risk among the more educated men by 20% to 50% (in Central Europe, East Europe and Russia, respectively), but underestimated it in the less educated men by 7% to 23% (in Central Europe, East Europe and Russia, respectively).

Conclusions:
Our results, based on a well-harmonized study comprising several European populations, suggest the need to include country-specific socioeconomic status in the risk estimation equations.
Abstract P394: The Ongoing Experience of Cardiovascular Risk Assessment Implementation in Primary Care of The Cuore Project
Authors: Palmieri Luigi , Rielli Rita , Donfrancesco Chiara , De Sanctis Caiola Patrizia , Dima Francesco , Lo Noce Cinzia , Brignoli Ovidio , Cuffari Alfredo , De Mattè Luca , Giampaoli Simona
Published: July 2021

Background:
The Italian National Prevention Plan 2005–2008 included a 10-year cardiovascular risk assessment (10-CR) for the general population aged 35–69 years using the CUORE-Project risk score. GPs were encouraged to collect data on risk factors, perform a 10-CR and send these data to the Cardiovascular Risk Observatory (CRO).

Aim:
The aim of this study is to show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population, a first step to implement primary preventive actions at individual level.

Methods:
A training plan for GPs was launched by the Ministry of Health. Data were collected using the
cuore.exe
software, easily and freely downloadable by GPs from the CUORE-Project website (
www.cuore.iss.it
). The CRO provides a web-platform to analyze and compare data on 10-CR and risk factors at both regional and national level. In the subgroup of persons examined at least twice a year, variations in continuous risk factors mean levels and categorical risk factors prevalences between baseline and follow-up and their 95% confidence intervals (C.I.) were calculated using methods for matched pair samples.

Results:
By October 2011, more than 3,000 GPs downloaded
cuore.exe
; 146,322 CR assessments on 137,773 persons were sent to CRO. CR mean was 3.0% in women, 8.4% in men; 30% of men and 65% of women were at lower risk (CR<3%), 9.3% of men and 0.4% of women were at high risk (CR≥20%). Thirty-four percent of men and 19% of women were current smokers, 13% of men and 10% of women were diabetic, and 33% of hypertensive men and 35% of hypertensive women were under specific treatment. Among those with at least two risk assessments (n=8,495), 7% (95%–C.I. 6%–8%) shifted to a lower risk class after one year (9% of men and 5% of women respectively). Systolic blood pressure mean levels decreased by 1.3 mmHg (95%–C.I. 0.9–1.8 mmHg), diastolic blood pressure by 0.9 mmHg (95%–C.I. 0.5–1.3 mmHg), total cholesterol level by 5.7 mg/dl (95%–C.I. 4.4–6.9 mg/dl),6.6 mg/dl6 and smokers prevalence by 3.6% (95%–C.I. 2.6%–4.7%)6.6 mg/dl6; HDL-cholesterol increased in women by 0.8 mg/dl (95%–C.I. 0.4–1.2 mg/dl).

Conclusions:
Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. The individual risk score is becoming a useful tool for GPs to assess their patients’ CR and promote primary prevention by focusing attention on the adoption of healthy lifestyles. These encouraging data can be used to support health policy decision processes.
Abstract P401: Time Trend of Cardiovascular Diseases Prevalence in The Italian Adult Population: The Italian Health Examination Survey
Authors: Donfrancesco Chiara , Palmieri Luigi , Dima Francesco , Lo Noce Cinzia , De Sanctis Caiola Patrizia , Vannucchi Serena , Vanuzzo Diego , Giampaoli Simona
Published: July 2021

Background:
Despite cardiovascular diseases (CVD) are the leading causes of death and hospitalization in nearly all countries in Europe, there are paucity, weak quality and comparability of data. The periodic Health Examination Survey (HES) represents in Italy the major source of information on CVD at national level thanks to the adoption of standardized methodologies throughout the country. The aim is to present differences in trends of CVD prevalence by gender in the Italian adult population from 1998 to 2008.

Methods:
Randomized population samples stratified by age and sex were examined. In 1998, 9,712 men and women aged 35–74 years were enrolled in all Italian regions; ongoing screening started in 2008 is enrolling 9,020 persons. A standardized questionnaire investigates cardiovascular disease and pharmacological treatments. The anamnesis is positive when clinical diagnosis has been made by a physician. Electrocardiograms read in Minnesota code are also performed and used to define previous myocardial infarction.

Results:
Data are from 12 regions in the North, Center, and South of Italy: 3,704 men and women in 1998 and 3,479 persons in 2008 are compared. In men, prevalence of cerebrovascular events decreases from 1.5% (95% confidence interval: 1.0-1.9%) in 1998 to 0.6 (0.3–0.9%) in 2008; in women, prevalence results stable: 0.9% in 1998 (0.5–1.3%) and 0.7% in 2008 (0.4–1.1%). Prevalence of myocardial infarction results stable both in men and women: in 1998, 1.9% in men (1.4–2.4%) and 0.6% in women (0.3–0.9%), and in 2008, 2.0% (1.4-2.7%) and 0.6% (0.3-0.9%) respectively; angina pectoris results stable as well: in 1998, 2.2% in men (1.7-2.8%) and 3.9% in women (3.1-4.6%), and in 2008, 3.2% (2.5-4.0%) and 4.5% (3.6-5.4%) respectively. Prevalence of by-pass or angioplasty surgery increases in men: 2.4% (1.8-3.0%) in 1998, and 4.5% (3.6-5.4%) in 2008; in women increasing is not significant: from 0.2% (0.0-0.4%) in 1998 to 0.7% (0.3-1.1%) in 2008. Stratifying data by geographical area (North, Center, South and Island) all comparisons become not significant; in men only, cerebrovascular decreasing and by-pass or angioplasty surgery increasing trends tend to be confirmed in all three areas.

Conclusions:
Trends between 1998 and 2008 decrease in cerebrovascular events and increase in prevalence of by-pass or angioplasty surgery, especially in men. Stable prevalence resulted for myocardial infarction and angina pectoris. Cerebrovascular decreasing trend is in line with smoking prevalence and mean of blood pressure decreasing in the country. Further analyses considering data from all Italian regions are needed to confirm results.
Abstract 006: Fitness Status Influences the Paradoxical Association Between BMI and Mortality Risk
Authors: Kokkinos Peter , Myers Jonathan , Faselis Charles , Kheirbek Raya , Sheriff Helen , Kokkinos John Peter , Pittaras Andreas , Doumas Michael
Published: July 2021

Introduction:
In some populations, recent evidence supports a higher mortality risk in individuals with relatively low body mass index (BMI), and lower risk in some overweight or obese individuals. However, the role of fitness in this puzzling relationship, termed as the obesity paradox, has not been fully explored.

Hypothesis:
We assessed the hypothesis that fitness attenuates the BMI-mortality risk paradoxical association.

Methods:
The association of exercise capacity and mortality risk in 18,228 individuals (mean age: 58±11) was assessed. Three fitness categories were formed based on the 33
rd
and 66
th
percentiles of exercise capacity (METs) achieved: Low-Fit (≤6 METs; n=6,072); Moderate-Fit: 6.1-8.5 METs; n=6,158); and High-Fit: >8.5 METs; n=5,998). Individuals were also classified based on BMI as Normal-Wt (BMI 18.5-24.9); Over-Wt (BMI: 25-29.9); Moderate-Obese (BMI: 30-34.9) and Obese (BMI ≥35).

Results:
There were 4,770 deaths (median follow-up 10.1 years). After controlling for age, risk factors and medications, we observed a paradoxical association between BMI categories and mortality risk (p<0.001 for trend). We also observed an inverse and graded association between fitness status and mortality for the entire cohort and within BMI categories, with reductions in risk ranging from approximately 30% to 60% (p<0.001). We then assessed mortality risk based on fitness status within each BMI category, using the Normal-Wt/High-Fit individuals as the reference group. A paradoxical BMI-mortality risk association was evident in all fitness categories. However, in Low-Fit individuals the risk was significantly increased within each BMI category (hazard ratios (HR): 2.26; 1.7; 1.7 and 1.76 for Normal-Weight, Over-Wt; Moderate-Obese and Obese categories, respectively; p<0.001 for all comparisons). However, in Moderate-Fit individuals, a significantly higher risk was observed only in the Normal-Wt category (HR: 1.58; p<0.001). Finally, in High-Fit individuals, mortality risk was significantly lower in Over-Wt (HR: 0.79; p=0.03) and Moderately Obese categories (HR: 0.58; p<0.001).

Conclusions:
These findings suggest that the paradoxical association between BMI and mortality risk is strongly modulated by fitness status.
Abstract 053: Gene Expression Signatures of Tobacco Exposure
Authors: Joehanes Roby , Ying Sai-xia , Johnson Andrew D , O’Connor George T , DeMeo Dawn L , O’Donnell Christopher J , Munson Peter J , Levy Daniel
Published: July 2021

Introduction:
Cigarette smoking is a cardinal risk factor of coronary heart disease (CHD), yet its gene expression signatures are not well characterized.

Hypothesis:
We hypothesized that cigarette smoking disturbs expression signatures of many genes, some of which may have long-term implications.

Methods:
To that end, we analyzed whole-blood gene expression of 2,446 Framingham Heart Study participants (204 current, 1,460 former, and 782 never smokers) and compared gene expression signatures of current
vs.
never smokers, and former
vs.
never smokers, adjusting for sex, age, and familial relationship. Smoking status based on self-reported longitudinal data collected over the span of 37 years of observation. P-value and false discovery rate (FDR) were computed for each gene.

Results:
At FDR<0.05, 1,602 genes were significant in current
vs.
never smokers. These genes were associated with many pathways, including immune response, response to stress, blood coagulation, platelet activation, and apoptosis. Of the differentially expressed genes, 112 were also associated with smoking in the San Antonio Family Heart Study. At FDR<0.05, 3 genes were significant in former
vs.
never smokers. These three genes are among the 1,602 genes for current
vs.
never smokers.

Conclusions:
Gene expression analysis of current
vs.
never smokers reveals molecular signatures of tobacco exposure. The differentially expressed genes reflect pathways previously implicated in CHD. Gene expression analysis of former
vs.
never smokers reveals long-term persisting molecular signatures of tobacco exposure.

Table. Top 5 genes in current
vs.
never smokers and in former
vs.
never smokers.
Abstract MP23: Urinary Magnesium Excretion and Risk of Incident Hypertension
Authors: Joosten Michel M , Gansevoort Ron T , Mukamal Kenneth J , Geleijnse Johanna M , Feskens Edith J , Navis Gerjan , Bakker Stephan J
Published: July 2021

Background:
Observational studies on dietary magnesium and risk of hypertension have reported mixed findings, but have lacked direct measures of magnesium uptake. Urinary excretion of magnesium, an indicator of dietary uptake, may clarify these discrepant findings.

Methods:
We examined 4,070 participants aged 28-75 years free of hypertension, kidney disease, and cardiovascular disease in the PREVEND Study, a prospective population-based cohort study. Urinary magnesium excretion was measured in two 24-hour urine collections at baseline. Incident hypertension was defined as blood pressure ≥140/90 mm Hg or initiation of antihypertensive medication.

Results:
During a median follow-up of 7.5 years (interquartile range: 5.5-9.2 years), 1,001 participants developed incident hypertension. Mean 24-hour urinary magnesium excretion was 4.35 ± 1.61 mmol for men and 3.65 ± 1.35 mmol for women. Urinary magnesium excretion was associated with risk of hypertension in a log-linear fashion (Figure) after adjustment for age, body mass index, sex, smoking status, alcohol intake, family history of hypertension, and urinary excretion of sodium, potassium, and calcium. Each 1-unit increment in ln-transformed urinary magnesium excretion was associated with a 26% lower risk of incident hypertension after multivariable adjustment (adjusted hazard ratio, 0.74; 95% confidence interval, 0.65-0.84).

Conclusion:
Urinary magnesium excretion is inversely and independently associated with risk of incident hypertension. Increasing dietary intake of magnesium could reduce the risk of hypertension.

Figure legend:
Natural log-transformed urinary magnesium concentrations and adjusted risk of hypertension. Magnesium levels were back-transformed to original values for ease of interpretation. Association estimated by Cox regression based on restricted splines with three knots. Dashed lines represent the 95% confidence interval. The spline curve is truncated at the 0.5 percentile and 99.5 percentile of the distribution curve.
Abstract MP44: Biomarker Measures of Fish-Derived Omega-3 Fatty Acids and J-Point Elevation in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Gronroos Noelle N , Schreiner Pamela J , Soliman Elsayed Z , Harnack Lisa , MacLehose Richard F , Alonso Alvaro
Published: July 2021

Background:
Higher intake of fish-derived omega-3 polyunsaturated fatty acids (PUFAs) has been associated with lower incidence of Sudden Cardiac Death (SCD), but the exact mechanisms underlying this association are unconfirmed. Early ventricular repolarization characterized by an elevation of the QRS-ST junction (J-Point) in the surface ECG has been associated with idiopathic ventricular fibrillation, the most common cause of SCD. We aimed to study the association of fish-derived PUFAs in plasma with the prevalence of J-Point elevation.

Methods:
We conducted a cross-sectional analysis of participants aged 45-64 (45.7% male, 100% whites) from the Minnesota Field Center of the Atherosclerosis Risk in Communities (ARIC) Study. Participants were excluded if they did not have an ECG, had a QRS duration ≥ 120 ms, were taking Class I or Class III antiarrhythmic agents, or had prevalent cardiovascular disease. Fish-derived PUFAs were measured in plasma phospholipids as a percentage of total fatty acids, categorized into quartiles, and logistic regression was used to estimate the odds of J-Point Elevation, defined as elevation of greater than 100 microvolts in at least two contiguous leads. Models were adjusted for potential confounders and tests of linear trend were conducted by assigning the median values for each exposure category and modeling as a continuous variable.

Results:
Among 3,330 eligible individuals, 126 presented J-Point elevation. Median fish-derived fatty acid percentage was 3.2% (range: 0.7-12.2). Using multivariable analyses, plasma measures of fish-derived omega-3 PUFAs were linearly associated with the log odds of J-Point elevation with increasing fatty acid percentages associated with lower odds of J-Point elevation (see Table).

Conclusions:
In this population, higher plasma levels of fish-derived PUFAs were inversely associated with J-Point elevation. Fish-derived PUFAs could reduce risk of SCD through decreased prevalence of early repolarization.
Abstract MP61: Body Mass Index and Mortality among Adults with Incident Type Diabetes: Results from Two Prospective US Cohort Studies
Authors: Tobias Deirdre K , Pan An , Ding Eric , Jackson Chandra L , O’Reilly Eilis J , Manson JoAnn E , Willett Walter C , Hu Frank B
Published: July 2021

Background:
Recent evidence suggests that having normal weight at time of diagnosis of type 2 diabetes (T2D) is associated with an increased risk of premature death, compared to being overweight or obese; these studies were limited in their sample size and ability to adequately address residual confounding by smoking and reverse causation.

Objective:
To prospectively evaluate the association between body mass index (BMI) at T2D diagnosis and mortality in two large cohorts.

Methods:
Women and men with incident T2D from the Nurses’ Health Study (1978-2010; N=8,984) and Health Professionals Follow-up Study (1988-2010; N=2,443) were included if they were free of major chronic disease (cardiovascular disease [CVD], cancer) at T2D diagnosis. Participants’ self-reported body weight preceding diagnosis (mean 11 months) and height was used to calculate BMI (kg/m2). Cox proportional hazards models estimated the relative risk (HR) and 95% confidence interval (CI) for mortality across BMI categories. Multivariable models adjusted for age, smoking, baseline comorbidities (high blood pressure, cholesterol), and several other lifestyle factors. Fixed-effects meta-analyses were used to combine individual cohort estimates.

Results:
In all, 3,119 total deaths were observed over a follow-up of 36 years in women (18.7 deaths/1,000 person-years) and 26 years in men (25.2 deaths/1,000 person-years). A J-shaped association was observed across BMI categories (18.5-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30.0-34.9, >35.0) and all-cause mortality (HR [CI] by category: 1.26[1.03, 1.55], 1[reference], 1.11[0.97, 1.28], 1.08[0.94, 1.25], 1.19[1.04, 1.37], 1.33[1.15, 1.55]). After stratifying by smoking status, a direct linear association was present among never smokers and a J-shaped relationship persisted among ever smokers. Excluding deaths in the first 4 years of follow-up and adjusting for BMI change prior to diagnosis further accentuated the linear relationship between BMI and all-cause mortality among never smokers (0.90[0.57, 1.43], 1.00 [reference], 1.19[0.91, 1.57], 1.20[0.91, 1.58], 1.27[0.97, 1.65], 1.50[1.14, 1.99]; p-trend<0.001). The association across BMI categories and CVD mortality was also linear among never smokers, and flat among ever smokers. In addition, among ever smokers, cancer mortality was highest among those with BMI 18.5-22.5. No clear trend was observed between BMI and mortality due to other causes. Excluding insulin users did not appreciably modify the associations.

Conclusions:
We found no evidence to support lower mortality rates among diabetics who were overweight or obese at diagnosis, compared to their normal-weight counterparts. In contrast, after accounting for confounding by smoking, we observed direct linear relationships between BMI and both all-cause and CVD mortality in our cohorts. Reducing other biases strengthened these relationships.
Abstract MP69: Prevalence of Treatment Resistant Hypertension Among Individuals with Chronic Kidney Disease: Results from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Tanner Rikki M , Calhoun David A , Bell Emmy K , Bowling C. B , Gutiérrez Orlando M , Irvin Marguerite R , Lackland Daniel T , Oparil Suzanne , Warnock David , Muntner Paul
Published: July 2021

Hypertension requiring treatment with multiple antihypertensive medications is common among individuals with chronic kidney disease (CKD). Small clinic-based studies have reported a high prevalence of treatment resistant hypertension (TRH) among patients with CKD. However, the prevalence of TRH has not been estimated for people with CKD in population-based studies. We hypothesized that lower estimated glomerular filtration rate (eGFR) and higher albumin-to-creatinine ratio (ACR) would be associated with a higher prevalence of TRH. We determined the prevalence of TRH among REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants (n=30,239) by eGFR and ACR and evaluated clinical and demographic correlates of TRH in those with CKD. Blood pressure was measured twice, pill bottles were inspected, and serum creatinine and an ACR were measured during an in-home study visit. TRH was defined as systolic/diastolic blood pressure ≥140/90 mmHg with concurrent use of ≥3 antihypertensive medication classes or use of ≥4 antihypertensive medication classes. CKD was defined as an ACR ≥30 mg/g or a CKD-EPI equation-derived eGFR <60 ml/min/1.73m
2
. The mean age of the 11,285 REGARDS participants treated for hypertension was 66.0 (SD=9.0) years, 56.9% were women and 48.8% were black. The prevalence of TRH was 14.5%, 23.5%, and 31.2% for those with an eGFR ≥60, 45-59, and <45 mL/min/1.73m
2
, respectively. The prevalence of TRH was 11.3%, 18.8%, 25.5%, and 44.5% for ACR <10, 10-29, 30-299, and ≥300 mg/g, respectively. A graded association between lower eGFR and higher ACR with TRH remained present after multivariable adjustment (Table 1). Also, after multivariable adjustment, black race, a larger waist circumference, diabetes, and history of myocardial infarction and stroke were associated with TRH among individuals with CKD. In conclusion, individuals with CKD have a high prevalence of TRH. Strategies are needed to improve blood pressure control in this population and reduce cardiovascular disease risk.
Abstract MP74: Long Term Risk-Factor Profiles for Chronic Kidney Disease in the Framingham Heart Study
Authors: McMahon Gearoid M , Preis Sarah R , Hwang Shih-Jen , Fox Caroline S
Published: July 2021

Background:
Chronic Kidney Disease (CKD) is an important public health issue and is associated with an increased risk of cardiovascular disease. Risk factors for CKD are well established, but most are typically assessed at or near the time of CKD diagnosis. Our hypothesis was that risk factors for CKD are present earlier in the course of the disease. We compared the prevalence of risk factors between CKD cases and controls at time points up to 30 years prior to CKD diagnosis.

Methods:
Participants were drawn from the Framingham Heart Study Offspring cohort. CKD was defined as an estimated glomerular filtration rate of ≤60ml/min/1.73m2. Incident CKD cases occurring at examination cycles 6, 7, and 8 were age- and sex-matched 1:2 to controls. Risk factors including systolic blood pressure (SBP), hypertension, lipids, diabetes, smoking status, body mass index (BMI) and dipstick proteinuria were measured at the time of CKD diagnosis and 10, 20 and 30 years prior. Logistic regression models, adjusted for age, sex, and time period, were constructed to compare risk factor profiles at each time point between cases and controls

Results:
During follow-up, 441 new cases of CKD were identified and these were matched to 882 controls (mean age 69.2 years, 52.4% women). Up to 30 years prior to CKD diagnosis, those who ultimately developed CKD were more likely to have hypertension (OR 1.74, CI 1.21-2.49), be obese (OR 1.74, CI 1.15-2.63) and have higher triglycerides (OR 1.43, CI 1.12-1.84, p=0.005 per 1 standard deviation increase). Each 10mmHg increase in SBP was associated with an OR of 1.22 for future CKD (95% CI 1.10-1.35) Additionally, cases were more likely to have diabetes (OR 2.90, CI 1.59-5.29) and be on antihypertensive therapy (OR 1.65, CI 1.14-2.40, p=0.009) up to 20 years prior to diagnosis. Increasing HDLc was associated with a lower risk of CKD (OR 0.84, CI 0.81-0.97 per 10mg/dl).

Conclusions:
As many as 30 years prior to diagnosis, risk factors for CKD are identifiable. In particular, modifiable risk factors such as obesity, hypertension and dyslipidemia are present early in the course of the disease. These findings demonstrate the importance of early identification of risk factors in patients at risk of CKD through a life-course approach.
Abstract MP85: Lifestyle and Biologic Factors and Risk for Recurrent Coronary Heart Disease Events
Authors: Booth John N , Levitan Emily B , Brown Todd M , Farkouh Michael , Safford Monika , Muntner Paul
Published: July 2021

The 2011 American Heart Association guidelines recommend lifestyle modification and risk factor management for secondary coronary heart disease (CHD) prevention. We determined the association of lifestyle behaviors and clinical management risk factors with recurrent CHD events among participants with electrocardiographic evidence or self-reported CHD history from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=30,239). Ideal health factors (normal waist circumference, physical activity ≥4 times/week, DASH diet adherence, not smoking, systolic/diastolic blood pressure (BP) < 120 / 80 mmHg and LDL-cholesterol (LDL-C) < 70 mg/dL) were assessed through questionnaires and an in home study visit.

Of the 4,174 REGARDS participants with CHD history, the mean age was 68.8 (SD=8.9) years, 35.1% were women and 34.1% were black. Over a median follow up of 4.3 (maximum=6.9) years, 447 (10.7%) participants had a nonfatal or fatal recurrent CHD event. After adjustment for demographics, clinical factors, and co-morbid conditions, participating in physical activity ≥4 times/week versus no activity and not smoking versus current smoking were associated with a reduced risk for recurrent CHD events (hazard ratio [95% confidence interval] 0.48 (0.34-0.68) and 0.45 (0.35-0.56), respectively). In contrast, DASH diet consistency, normal waist circumference, LDL-C and normal BP were not associated with statistically significant reductions in risk for recurrent CHD events. More ideal health factors were associated with a lower risk for recurrent CHD events (Figure). The hazard ratio for each additional ideal health factor was 0.76 (95% CI: 0.69-0.84). If these observations are causal, then if all people with established CHD participated in physical activity 4+ times/week and did not smoke, 40.5% (95% CI: 11.0-63.4) of recurrent CHD events could be avoided.

This analysis suggests that secondary prevention to lower the risk of recurrent CHD events should emphasize physical activity and smoking cessation.
Abstract MP91: History of Infertility and Risk of Type 2 Diabetes Mellitus in Women
Authors: Tobias Deirdre K , Hu Frank B , Missmer Stacey A , Manson JoAnn E , Chavarro Jorge
Published: July 2021

Background:
Increasing evidence supports a biologically plausible association between delayed conception and metabolic dysfunction, including insulin resistance and inflammation; however, few studies have assessed whether infertility is associated with metabolic diseases such as type 2 diabetes (T2D) later in life.

Objective:
We prospectively evaluated the association between a history of infertility and T2D risk in a large cohort of women.

Methods:
Participants of the Nurses’ Health Study II self-reported their infertility status (>12 months attempting a pregnancy), lifestyle characteristics, and several health-related outcomes, via biennial questionnaires (1989-2011). Those reporting infertility were asked to cite the clinical reason(s), if known. Exposure status was updated every two years and carried forward to represent “ever”. Cox proportional hazards models estimated the relative risk (HR) and 95% confidence interval (CI) comparing participants with a history of infertility versus none. Multivariable models adjusted for age, body mass index (BMI), physical activity, healthful dietary pattern score, smoking, alcohol consumption, and several other lifestyle factors.

Results:
Participants (N=115,750) were on average 35 years old (range 25-44) with a BMI of 24.1 (SD=5.0) at baseline, with 91.7% Caucasian. Twenty-one percent (n=24,118) reported a history of infertility at baseline or follow-up. Incident T2D was reported in 5,414 participants during follow-up (2.6 cases/1,000 person-years). Women with a history of infertility had a significant 21% greater risk of T2D compared to women without infertility after adjusting for several T2D risk factors (multivariable HR=1.21, CI=1.14, 1.29). Infertility due to ovulation disorders was associated with a 47% greater risk of T2D (HR=1.47, CI=1.33, 1.64), and tubal blockage with a 32% greater risk (HR=1.32, CI=1.09, 1.61), compared to no infertility. Other reasons for infertility were not associated with T2D risk, including cervical mucus disorder (HR=1.09, CI=0.80, 1.48), male factor (HR=1.13, CI=0.96, 1.32), and “other” (HR=1.08, CI=0.90, 1.28). Tests for interaction did not indicate significant effect modification across BMI categories for total infertility (BMI<25: HR=1.34, CI=1.03, 1.74; BMI 25-29: HR=1.38, CI=1.18, 1.60; BMI 30+: HR=1.15, CI=1.07, 1.34; p-interaction=0.13). Effect modification by BMI category was suggested for infertility due to ovulation disorders (BMI<25: HR=2.14, CI=1.58, 3.67; BMI 25-29: HR=1.43, CI=1.08, 1.89; BMI 30+: HR=1.35, CI=1.20, 1.52; p-interaction=0.06).

Conclusions:
Among women, a history of infertility is significantly associated with T2D later in life, specifically infertility due to ovulation disorders and tubal blockage.
Abstract P003: Survival after Incident Atrial Fibrillation: A Community-Based Study
Authors: Chamberlain Alanna M , Gersh Bernard J , Alonso Alvaro , Chen Lin Y , Berardi Cecilia , McNallan Sheila M , Weston Susan A , Roger Veronique L
Published: July 2021

Background:
Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice, causes substantial morbidity, and is associated with an excess risk of mortality. However, information on contemporary time trends in survival after AF is lacking. Thus, we aimed to determine whether survival after incident AF has changed over the last decade in a community-based cohort of 3413 individuals with incident AF between 2000 and 2010.

Methods:
Olmsted County, MN residents 18 years of age and older with a first-ever AF or atrial flutter event between 2000 and 2010 were identified using inpatient and outpatient diagnostic codes and electrocardiograms. Deaths from any cause were ascertained through August 31, 2012 and time trends in survival after AF were examined using Kaplan-Meier curves and Cox proportional hazards regression.

Results:
Among 3413 individuals with incident AF (52% men, age range 18-104) between 2000 and 2010, 1561 deaths were observed over a median follow-up of 3.4 years. Survival did not differ by year of AF diagnosis (figure). In addition, the proportion of cardiovascular disease-related deaths compared to non-cardiovascular deaths did not differ over time. After adjustment for age, sex, and Charlson comorbidity index, the hazard ratios for all-cause mortality were 1.09 (95% CI 0.97-1.23) for those diagnosed with AF in 2004-2007 vs. 2000-2003 and 1.04 (95% CI 0.90-1.12) for 2008-2010 vs. 2000-2003. Furthermore, the risk of death did not differ by sex after adjustment for age and comorbidity (HR 1.00, 95% CI 0.90-1.11 for men vs. women).

Conclusions:
In the community, survival after AF has remained constant over the last decade despite substantial changes in the recommendations for treatment of AF. This underscores the importance of identification of prognostic factors and continued surveillance of outcomes in AF, as well as a better understanding of how to optimize the management of AF to improve outcomes in these patients.
Abstract P005: Lipid Gene Scores and the Incidence of Atrial Fibrillation: The Atherosclerosis Risk in Communities Study
Authors: Lopez Faye L , Lutsey Pamela L , Arking Dan E , Pankow James S , Agarwal Sunil K , Chen Lin Y , Alonso Alvaro
Published: July 2021

Background—
Recent studies show that
lower
levels of low density lipoprotein cholesterol (LDLc) and total cholesterol are associated with incident atrial fibrillation (AF), whereas AF is not associated with high density lipoprotein cholesterol (HDLc) and triglycerides. To test a potential causal association between lipid levels and AF risk, we assessed whether previously developed lipid gene scores are associated with the incidence of AF in a large community-based cohort.

Methods—
Our analysis included 8849 white participants free of AF at baseline (1987-1989) and with lipid gene scores from the ARIC study. We used previously developed phenotype-specific lipid gene scores, based on loci significantly associated with lipid levels. Incidence of AF was ascertained through 2009 from study visit ECGs, and ICD codes from hospitalizations and death certificates. Cox proportional hazards models were used to estimate the hazard ratio (HR) of AF by each respective lipid gene score quintile and per 1 standard deviation (SD) increase of each effect-size weighted lipid gene score.

Results—
During a median follow-up of 20.7 years, we identified 1207 incident AF cases. The HDLc gene score, the total cholesterol score, and the triglyceride score were not associated with incidence of AF. The continuous LDLc score was not associated with AF overall, but had a significant interaction with gender (p=0.03). A higher LDLc score was associated with a lower incidence of AF in females but not in males (table): multivariable HR and 95% confidence interval (CI) per 1-SD increase: 0.90 (0.83-0.98) vs. 1.03 (0.95-1.11). When the LDLc gene score was split into quintiles, a higher LDLc score for females was associated with a lower AF risk: HR (95% CI) = 0.74 (0.56-0.98) when comparing extreme quintiles (table).

Conclusion—
In this large population-based study, a higher LDLc score in females was associated with a lower incidence of AF. No association with AF was observed in the LDLc score in males or with the gene scores for HDLc, total cholesterol or triglycerides.
Abstract P033: Relationship Between Adiponectin Level and Metabolic Syndrome after Weight Loss in Patients with Abdominal Obesity
Authors: Berezina Aelita , Belyaeva Olga , Berkovich Olga , Baranova Elena , Karonova Tatyina
Published: July 2021

Objective:
to investigate the relationship between adiponectin level and metabolic syndrome (MS) after weight loss in patients with abdominal obesity (AO).

Method:
A 3-year randomized lifestyle intervention trial performed in 153 patients with AO, age 43,2±0,8 yrs, BMI 32,1±1,9 kg/m
2
. 74 patients keep hypocaloric diet (gr.1), 79 patients keep diet and performed aerobic exercise (gr.2). Adiponectin concentration, body mass (BM), waist circumference (WC), body fat (BF), BMI, the levels of BP, glucose, insulin, HOMA-IR, TC, HDL-C, LDL-C, TG, CRP were measured before and after a 3-years outpatient intervention program.

Results.
100% patients with AO had some metabolic disorders and 38% had MS before the treatment. The adiponectin levels and others parameters didn’t differ between the groups before intervention (p>0,05). In 3 years 53 (71,6%) and 58 (73,4%) patients from 1 and 2 groups reduced weight. The rate of improving BM, BMI, BF, WC, HDL-C, TG and insulin was grater in patients gr.2 (p<0,05). The favorable dynamics of MS (MS didn’t appeared at the end of study or didn’t registered in patients who had it before) didn’t differ between the groups 1 and 2 (81,1% and 91,4%, p>0,05). The increasing of adiponectin level occurred more often in patients gr.2, than gr.1 (93,1% and 58,5%, p=0,001, respectively). Adiponectin level increased only in patients gr.2 (18,0±1,1mcg/ml and 23,8±1,3 mcg/ml, p= [[Unable to Display Character: р]]=0,0001), didn’t changed in gr.1 (p>0,05). It was established that in patients with combination of weight loss and increasing of adiponectin level favorable dynamics of MS occurred more often than in patients who lost weight without increasing of adiponectin level (91,7% and 69,2%, p=0,0001). In patients with favorable dynamics of MS increasing of adiponectin level had met more often, than in patients with unfavorable dynamics of MS (MS continued or appeared) (88,6% and 11,4%, p=0,0001). Increasing of adiponectin level associated with positive dynamics of the MS - OR=9,1 (4,0-20,6).

Conclusion.
Combination of weight loss and increasing of adiponectin level associated with favorable dynamics of the metabolic syndrome.
Abstract P044: The Role of Self-Perceived Attributes of the Neighborhood Environment on the Association between Depressive Symptoms and Physical Activity in Older Latino Adults
Authors: Hernandez Rosalba , Prohaska Thomas R , Wang Pin-Chieh , Sarkisian Catherine A
Published: July 2021

Background:
Physical inactivity is associated with the development of cardiovascular risk factors (e.g., hypertension, hypercholesterolemia, obesity, and diabetes) and an increased risk for cardiac-related morbidity and mortality. The impact of depressive symptomatology on self-perceptions of the neighborhood environment may explain the low levels of physical activity (PA) among older Latino adults with depression. The aims of the current study are to examine whether individuals with depression are less likely to view their neighborhood environment as conducive for walking behavior, and to examine the role of self-perceptions of the neighborhood environment in the association between depression and PA.

Methods:
We analyzed baseline in-person interview and pedometer data collected from Latinos ≥60 years participating in an exercise intervention (Caminemos!) at 27 senior centers. Depression was assessed using the Geriatric Depression scale and the Neighborhood Environment Walkability Scale (NEWS) was use to capture self-perceived attributes of the neighborhood environment associated with transport and recreational walking. The NEWS includes multiple subscales capturing the presence and accessibility of sidewalks, neighborhood aesthetics, pedestrian/traffic safety, and crime safety. PA was objectively measured using pedometer data. Bivariate analyses were conducted to examine the association between depression status and measures of PA, overall neighborhood walkability and associated subscales. We followed Baron and Kenny’s four steps to conduct a mediation analysis to examine whether self-perceived attributes of the neighborhood environment served as a mediator between depressive symptoms and PA.

Results:
Baseline characteristics for this sample (n=572) include: mean age of 73 years; 77% female; 83% with incomes below $20,000; and 59% with less than an 8th grade education. Approximately 27.6% screened positive for depression. When using continuous pedometer data as the outcome of interest, depressed individuals were less likely to engage in walking behavior when compared to their non-depressed counterparts (p=0.004), independent of basic demographic variables. T-tests revealed that depression status was only associated with the subscale of neighborhood walkability capturing criminal activity. Older Latino adults with depressive symptoms were more likely to perceive their neighborhood as a high-crime area (p=0.01). Results from the Sobel test did not find self-perceptions of criminal activity in the neighborhood to mediate the relationship between depressive symptoms and PA (p-value=0.31).

Conclusion:
While depressive symptoms are linked to self-perceptions of neighborhood criminal activity in older Latino adults, perceptions of neighborhood criminal activity does not act as a mediator in the relationship between depression and PA.