bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P511: Physical Activity, Medical, and Mental Health Outcomes of a Pilot Multilevel Intervention for People With Metabolic Syndrome
Authors: Millstein Rachel A , Harnedy Lauren , Thorndike Anne N , Kim Sonia , Castillo Crystal , Park Elyse R , Healy Brian C , Huffman Jeff C
Published: March 2023

Background/Objectives:
This pilot randomized controlled trial aimed to help people with metabolic syndrome increase physical activity and well-being. Intervening on lifestyle behaviors such as physical activity, can improve metabolic syndrome outcomes.

Methods:
Primary care patients with metabolic syndrome were recruited from clinics across our hospital system. Eligibility criteria were: <150 minutes/week of moderate-vigorous physical activity (MVPA), having ≥2 of 5 metabolic syndrome criteria, and not having cardiovascular disease or diabetes, as this was a prevention study. The multilevel intervention (MAPP) included 8-weekly 60-minute group sessions, physical activity self-monitoring/goal setting using Fitbits, physical activity/motivational interviewing (MI) topics, positive psychology (PP) topics, a weekly group walk prior to COVID, and neighborhood walkability assessments. Participants were randomized to an immediate or waitlist control group. They wore an Actigraph GT3X+ accelerometer for one week before beginning and after the last session (8-weeks). We obtained pre-post weight measurements. Mean baseline to 8-week individual difference results were compared between groups using t-tests with unequal variances.

Results:
Sixty-four participants enrolled, with 32 randomized to each arm; 51 provided complete follow-up data, and 63% (10/16) of the groups were conducted virtually (post-COVID). Most (92%; 59/64) were non-Hispanic White, 69% (44/64) were female, and mean age was 60. Average daily physical activity did not increase significantly by objective measures. The estimated change in mean difference for sedentary time decreased for the intervention group compared to the control group by 46.8 minutes/day (CI: -47.5-141.1;
d=
0.28). Light physical activity increased by an average of 21.0 minutes/day (CI: -13.9-55.9;
d=
0.34), steps/day increased by 376.6 (CI: -949.6-1702.9;
d
=0.16), and moderate-vigorous physical activity increased by 4.1 minutes/day (CI: -4.5-12.8; d=0.27). The estimated change in mean weight was significant: 8.4 pounds lost for the intervention group compared to the control group (CI: -13.5-3.2;
p
=.002;
d
=0.92).

Discussion:
This 8-week randomized controlled trial of a multilevel physical activity PP-MI intervention was associated with small to medium effect sizes for changes in physical activity, and a significant decrease in weight, despite weight not being an intervention target. Changes of this magnitude are associated with reduced cardiovascular disease risk and mortality. These findings are all in expected directions, producing signals even amidst different modalities and COVID-19-related disruptions. We plan to test this in a larger efficacy trial with broader reach and implementation.
Abstract P513: Adverse Birth Outcomes and Cardiometabolic Outcomes Among Multiracial Children in the U.S.
Authors: Allen Abigail A , Oluwafemi Omobola O , Patel Jenil
Published: March 2023

Background:
Infant birth weight and preterm birth are prime indicators of health risks in adulthood. Specifically, birth weight and preterm birth have associations with cardiometabolic outcomes. Few studies have shown indications of relationships between high birth weight and cardiometabolic indicators. We aimed to assess the association between cardiometabolic disease and adverse birth outcomes among multiracial children within the United States and within each race/ethnicity group.

Methods:
Data from the 2016-2019 National Survey of Children’s Health (NSCH) was utilized. The NSCH is a comprehensive survey providing national and state-level data on children’s lives. Post weighting, descriptive statistics on the population were gathered using chi-square tests for comparing the groups. Association analyses were conducted using univariate and multivariable analysis which was adjusted for age, sex, and race.

Results:
The analyses found that infants with low birth weight have more than two times high odds for heart conditions, a 37% higher likelihood of having diabetes, and were 32% less likely to be overweight. Infants with high birth weight had no associations with heart conditions, but were observed to have a 63% higher likelihood of having diabetes, and are 54% highly likely to be overweight. Infants with preterm birth showed 2.5 times high odds for heart conditions, and are twice as likely to have diabetes, but no associations were found for being overweight. Findings for race and ethnicity showed that for heart conditions there was a consistently higher likelihood (OR > 2) for all race groups within low birth weight and preterm birth. High birth weight was notably higher among Asians with a 63% likelihood, which was close to significant, other categories did not show significance. Preterm birth was 3-times highly likely associated with diabetes among Asians, and 2.4 times higher odds in other race, but not significant among Blacks and Whites. High birth weight had a higher likelihood (46%) among Blacks, compared to 32% among whites.

Conclusion:
Significant associations among preterm birth, low birth weight, and high birth weight adverse outcomes were observed for certain cardiometabolic health outcomes such as heart conditions and diabetes. There may be other external factors including social determinants of health that have historically affected minorities in the past, and may partly explain our findings.
Abstract P515: HIV/HCV Co-Infection and the Risk of Cardiovascular Disease: A Meta-Analysis of 91,153 Patients
Authors: Aljabali Ahmed , Swed Sarya , Sawaf Bisher , Abdelazeem Basel
Published: March 2023

Introduction:
Antiretroviral therapy has improved the life expectancy of people living with human immunodeficiency virus (HIV). However, these patients are more susceptible to developing cardiovascular diseases (CVD) and subsequent mortalities. Many studies examining the association between HIV and hepatitis C virus (HCV) co-infection and the risk of CVD, compared to HIV mono-infection, have inconsistent results. We conducted a meta-analysis to quantify this association. We hypothesized that CVD risk will be synergistically increased by the persistent inflammatory responses of dual viral infections.

Method:
We searched Pubmed, EMBASE, CINAHL, Google Scholar, Cochrane, and Web of Science from inception to July 2022 to identify studies on HIV/HCV co-infection and CVD, defined as coronary artery disease, congestive heart failure, and stroke. We used either a random or fixed effect model considering the heterogeneity. Adjusted hazard ratios (aHR) and crude Odds ratio (COR) for CVD and mortality were used.

Results:
Among the 453 articles reviewed, 11 observational studies met the inclusion criteria, with a total of 91,153 participants. Of these, 9633 (10.5%) were HIV/HCV coinfected, 81,520 (89.5%) were HIV monoinfected. Pooled hazard ratio for the association between HIV/HCV co-infection and CVD was significant (aHR = 1.45, 95% CI: 1.24, 1.65, I2 = 38%, P=0.12) compared to HIV mono-infection. Furthermore, the odds of mortality due to HIV/HCV co-infection in patients with CVD is significantly higher compared to HIV mono-infection (COR = 4.07, 95% CI: 3.19, 5.18, I2 = 0%, P=0.56).

Conclusion:
We found a positive association between HIV/HCV coinfection and increased CVD risk and associated mortality compared to those with HIV mono-infection. However, more research is needed for further assessment of this association, determining potential underlying mechanisms and evaluating whether treatment for HIV and HCV infections can reduce CVD morbidities and mortalities.
Abstract P516: Multilevel Factors Are Related to Blood Pressure in Native Hawaiian Communities
Authors: Ing Claire T , Ahn Hyeong Jun , Kaholokula Joseph K , Hovmand Peter , Seto Todd B , Novotny Rachel
Published: March 2023

The association between blood pressure and cardiovascular disease events (e.g., stroke, heart attack) is continuous, consistent, and independent. Hypertension prevalence is 55% among Native Hawaiians, the indigenous people of Hawai‘i, compared to 23% among Whites. Native Hawaiians have high rates of physical inactivity and poor diet. Discrimination and acculturation have been associated with blood pressure in Native Hawaiians. Household characteristics (e.g., food insecurity) have been linked to hypertension in Hawai‘i. Areas with high proportions of Native Hawaiians have more fast-food outlets. Limited research has been done to examine how multilevel factors impact blood pressure in this high-risk population. The purpose of this study was to examine the contribution of individual-level behavioral, biological, psychosocial; household-level; and community-level factors in explaining variability in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Adult participants (n=150) were recruited from 6 predominantly Native Hawaiian communities across Hawai‘i. Height, weight, and blood pressure were measured using standardized protocols. Behavioral factors included consumption of foods measured by the NCI dietary screener questionnaire and physical activity category and sedentary time measured by the International Physical Activity Questionnaire. Psychosocial factors included cultural identity and perceived discrimination. Household factors included size, financial stability, and food insecurity. Community factors included neighborhood walkability. Sociodemographic factors were also assessed. Four multilevel models for SBP and DBP were developed. The level-1 model for both SBP and DBP included sociodemographic factors. The level-2 model for both SBP and DBP adds behavioral factors (e.g., BMI, physical activity, daily intake of diet components). The level-3 model adds financial stability, food insecurity for SBP and cultural identity and discrimination for DBP. The level-4 model adds walkability for SBP and financial stability, food insecurity, and family use of free school lunches for DBP. For SBP and DBP models, Akaike’s Information Criterion (AIC) decreased from 740.9 and 663.2 to 529.5 and 515.8, respectively, and Bayesian Information Criterion (BIC) decreased from 740.4 and 663.0 to 529.3 and 514.4, respectively. For SBP, each successive model produced a lower AIC and BIC, indicating that the inclusion of behavioral, household, and community factors improved the models’ ability to predict SBP. Similarly, for DBP, the inclusion of behavioral, psychosocial, and household-level factors improved the model's ability to predict DBP. These results illustrate the importance of including multilevel factors in research to understand and address hypertension and cardiovascular disease in Native Hawaiian communities.
Abstract P525: Associations of Body Mass Index Variability From Childhood and Midlife Dyslipidemia
Authors: Kang Soo Jung , De Anda-Duran Ileana , Moukaled Shirine , Fernandez Camilo , Bazzano Lydia A
Published: March 2023

Background:
In adults, short periods of weight loss followed by weight gain, known as body mass index(BMI) variability, has been linked to adverse cardiovascular outcomes. However, the impact of long-term BMI variability from childhood on midlife dyslipidemia is unclear. We identified this effect in a cohort of Black and White midlife adults living in a rural community.

Methods:
We studied 1,268 midlife participants of the Bogalusa Heart Study (age at baseline 9.5 ± 3.5 years, age at midlife 48.2 ± 5.2 years, 59.5% women, 34.4% black) with ≥4 measurements of BMI and other traditional cardiovascular risk factors (CVRF) from childhood. Long-term BMI variability was computed as deviation from age-predicted values (DEV). The associations between long-term BMI variability and dyslipidemia and dyslipidemia subtypes were assessed by logistic regression, adjusting for age, sex, race, CVRF, depression, alcohol use, education, and employment status. Interactions between race, sex and long-term BMI variability were assessed.

Results:
Prevalence of midlife dyslipidemia were 88.01%(n=1116). DEV was positively significantly associated with having midlife dyslipidemia. Stratified analyses showed that men had higher odds of having midlife dyslipidemia, HDL-C<60 mg/dL, and triglycerides ≥150 mg/dL with 1 unit increase in DEV, compared to those of women. White participants had higher odds of having triglycerides ≥150 mg/dL with 1 unit increase in DEV compared to Black participants. (see Table 1)

Conclusions:
We identified associations between long-term BMI variability from childhood and midlife dyslipidemia. Race and sex were found to modify the associations of long-term BMI variability on having midlife dyslipidemia and dyslipidemia subtypes. Further studies are needed to determine the role of long-term BMI variability as a predictor for increased risk of midlife dyslipidemia.
Abstract P526: Associations of Body Mass Index Variability From Childhood and Midlife Class II and Class III Obesity
Authors: Kang Soo Jung , De Anda-Duran Ileana , Moukaled Shirine , Fernandez Camilo , Bazzano Lydia A
Published: March 2023

Background:
Short periods of weight loss followed by weight gain (BMI variability) has been linked to adverse cardiovascular outcomes in adults. However, less is known about the effect of long-term BMI variability from childhood on midlife class II and class III obesity. We identified this effect in a cohort of Black and White midlife adults living in a rural community.

Methods:
We studied 1,268 midlife participants of the Bogalusa Heart Study (age at baseline 9.5 ± 3.5 years, age at midlife 48.2 ± 5.2 years, 59.5% women, 34.4% Black) with ≥4 measurements of BMI and other traditional cardiovascular risk factors (CVRF) from childhood. Long-term BMI variability was computed as deviation from age-predicted values (DEV). Logistic regression, adjusting for age, sex, race, CVRF, depression, alcohol use, education, and employment status, was conducted to assess associations between long-term BMI variability and midlife obesity (class II and III, BMI ≥35kg/m
2
and ≥40kg/m
2
, respectively). Interactions between race, sex and long-term BMI variability were assessed.

Results:
Prevalence of midlife class II and class III obesity were 26.81%(n=340) and 12.7%(n=161), respectively. DEV was positively significantly associated with having midlife class II and class III obesity. For class II obesity, no significant interactions between DEV and race or sex were observed. For class III obesity, interactions of DEV with race and sex were significant; the odds of having class III midlife obesity per unit increase in DEV were greater in White participants and in men compared with Black participants and women(see Table 1).

Conclusions:
We identified associations between long-term BMI variability from childhood and midlife obesity. Race and sex were observed to modify the effect of BMI variability on having midlife obesity. Further studies are needed to elucidate the role of long-term BMI variability as a predictor for increased risk of midlife obesity.
Abstract P527: Epidemiology of Adverse Childhood Experiences and Cardiometabolic Risks
Authors: Dark Tyra , Chernicky Jacob , Harris Rachel
Published: March 2023

Purpose:
Adverse Childhood Experiences (ACEs) have been linked to a wide range of adverse health outcomes. The purpose of this research is to better understand this association and elucidate the mechanisms by which ACEs influence cardiometabolic (CM) risk factors (blood pressure, BMI, pre-diabetes). Racial/ethnic distribution of ACEs and potential health outcomes were also examined.

Methods:
This study utilized data from the Florida Behavioral Risk Factor Surveillance System for the 2019-2021 survey years to examine the racial/ethnic distribution of ACEs and cardiometabolic risks.

Results:
A total of 13,198 participants were included in this study with non-Hispanic Whites representing 76% of the study population. The highest percentage of each racial/ethnic group reported two or fewer ACEs. The Multiracial non-Hispanic group tended to have higher percentages of reported ACEs. The association between ACEs and CM risk factors significantly differed across racial/ethnic groups.
Abstract P528: Acute Kidney Injury Increases Mortality in Patients With Upper Gastrointestinal Hemorrhage (UGIB) and Acute Coronary Syndrome: A Population Based Study
Authors: Khalid Yaser , Dasu Kirti , Umrani Rohan , Dasu Neethi , Roy Trinava , Kadiyala Bhavana
Published: March 2023

Background:
Upper GI Bleeding (UGIB) is a common emergency with a relatively high incidence in the general population. Acute Coronary Syndrome (ACS) is often overlooked in gastrointestinal bleeding as its symptoms and signs are often subtle.

Purpose:
This study aims to compare the outcomes of patients admitted for ACS with and without UGIB.

Methods:
Data were extracted from the National Inpatient Sample (NIS) 2016-2019 Database. The NIS was searched for hospitalizations for adult patients with ACS as the principal discharge diagnosis with and without UGIB as the secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis.

Results:
Among 35,740 patients who had ACS, 463 (1.3%) patients had UGIB. The adjusted odds ratio (OR) for inpatient mortality for ACS with UGIB compared to those without UGIB was higher (OR 1.94, p<0.0001), length of stay was 4.27 days longer (p<0.0001), and total charges were $55,479 higher (p<0.0001). The Independent positive predictors of increased mortality were: Acute kidney injury (AKI) (p<0.0001). Independent positive predictors of LOS and total charges were the following: Coronary artery bypass graft surgery (CABG), Intra-aortic balloon pump (IABP) insertion, AKI (p<0.0001)

Conclusion:
UGIB patients with ACS did have higher inpatient mortality. A positive predictor of mortality included the presence of concomitant AKI. Thus, the prevention of AKI Is of utmost importance. Further, larger studies are warranted to identify new risk factors as predictors of mortality and improve awareness of GI bleeding risk and decrease LOS.
Abstract P531: Arterial Stiffness and Vasomotor Symptoms: Key Factors Related to 10-year Atherosclerotic Cardiovascular Disease Risk in Perimenopausal Latinas
Authors: Marginean Valentina , Cazales Andrea , Harris Latesha K. K , Stoner Lee , Giscombe Cheryl , Perreira Krista , Cortes Yamnia I
Published: March 2023

Background:
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in women in the United States and risk factors increase with menopause. Midlife Latinas have a more adverse ASCVD risk profile than non-Latina White women but remain underrepresented in research. Identifying risk factors and assessing outcomes are necessary to address the primary prevention of ASCVD in this population. Thus, the aim of this analysis was to identify factors related to 10-year ASCVD risk in midlife Latinas.

Methods:
We conducted a cross-sectional analysis using baseline data from 30 participants enrolled in a pilot study designed to reduce ASCVD risk in perimenopausal Latinas. The women were aged 40-60 years, free of ASCVD, and without hormone therapy use in the previous three months. Sociocultural, behavioral, and reproductive factors (e.g., age, education, acculturation, perceived stress, physical activity, age at menarche) were self-reported using an interviewer-administered questionnaire. Carotid-femoral pulse wave velocity (cfPWV) and physical and anthropometric measures (e.g., weight, waist circumference, blood pressure, lipid profile) were collected during a clinical exam. The 10-year ASCVD risk score was determined using the American College of Cardiology ASCVD Risk Estimator tool. We assessed factors related to 10-year ASCVD risk using linear regression models and adjusted for factors associated with the outcome at p<0.1.

Results:
Participants were on average aged 46.8 ± 4.2 years, 48% had less than a high school education, and 97% were born outside of the continental United States. The mean cfPWV was 6.8 ± 1.1 m/s, and the mean 10-year ASCVD risk was 1.4% ± 0.97. In fully adjusted models, we found that higher cfPWV (ß [SE]= 0.48 [0.22], p=0.04) and experiencing any vasomotor symptoms in the previous two weeks (ß [SE]= 1.4 [0.44], p=0.005) were associated with greater 10-year ASCVD risk.

Conclusions:
Though the 10-year ASCVD risk was relatively low (<5%), we found that increased cfPWV and a report of vasomotor symptoms (hot flashes, night sweats) were associated with greater 10-year ASCVD risk in perimenopausal Latinas. These preliminary data indicate that cfPWV and vasomotor symptoms may be important factors to consider for early risk stratification in midlife Latina women.
Abstract P533: Consumption of Foods Away From Home and Cardiometabolic Risk Among Adults in Puerto Rico
Authors: O'Neill June , Mattei Josiemer , Tucker Katherine L , Rodriguez-Orengo Jose F
Published: March 2023

Consuming foods away from home (FAFH) is prevalent in the United States and contributes to high food spending and daily energy intake. We recently showed that adults in Puerto Rico (PR) who frequently consume FAFH had lower diet quality and adherence to dietary recommendations. It remains unknown if these associations translate into poor cardiometabolic health. We aimed to determine the association between the consumption of FAFH and cardiometabolic risk factors among adults in PR. Data were obtained from 1,246 adults (30-75 years) in the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic disease Trends (PROSPECT). Participants self-reported the frequency of consuming FAFH for any meal as "rarely" (<2 times/week), "sometimes" (2-4 times/week), or "frequently" (>4 times/week) at various commercial or noncommercial venues. A food frequency questionnaire assessed usual diet, and the Alternate Healthy Eating Index (AHEI) was calculated to capture diet quality. Clinical and laboratory markers from fasting blood samples were measured using standardized protocols. Generalized linear regression models were used to obtain means (SE) of cardiometabolic markers by FAFH category adjusted for sociodemographic and lifestyle behavioral factors. A second model was adjusted for AHEI. Frequently consuming commercial FAFH (cFAFH) was reported by 15.8% (192 of 1,218) and noncommercial FAFH (ncFAFH) by 4.4% (54 of 1,217), while cFAFH sometimes was reported by 31.8% (387 of 1,218) and ncFAFH by 19.0% (231 of 1,217). Participants who reported consuming cFAFH frequently (vs. rarely) had significantly higher waist circumference (107 (1.6) vs. 103 (1.3) cm;
P=
0.003), BMI (31.5 (0.82) vs. 29.9 (0.64) kg/m
2
;
P=
0.032), and insulin (geometric mean 9.4 (2.1) vs. 7.8 (2.0) μIU/mL; p<0.001), and lower HDL-C (geometric mean 42.9 (1.0) vs. 45.6 (1.0) mg/dL;
P=
0.012). Participants who reported consuming cFAFH sometimes (vs. rarely) had significantly higher plasma triglycerides (geometric mean 126.1 (1.5) vs. 102.1 (1.4) mg/dL;
P=
0.012). Plasma glucose (
P=
0.004) and insulin (
P=
0.041) were higher in individuals frequently reporting (vs. rarely) consuming ncFAFH. Adjusting for AHEI did not appreciably change the models, except to nullify the association with BMI. Consuming FAFH, especially >4 times/week, was associated with adverse adiposity, lipids, and glucose markers and generally independent of overall diet quality. Future studies should identify the directionality of these associations and the potential mechanisms connecting them to cardiometabolic markers. Policymakers and food producers should enhance the quality of FAFH for commercial and at-home consumption for better cardiometabolic health.
Abstract P535: Associations of Genetically Determined Favourable and Unfavourable Adiposity Across the Phenome
Authors: Dib Marie-Joe , Zagkos Loukas , Elliott Paul , Dehghan Abbas , Tzoulaki Ioanna
Published: March 2023

Background:
The large-scale investigation of the genetic architecture of favourable adiposity (FA) and unfavourable adiposity (UFA) may unravel mechanisms coupling higher adiposity and cardiometabolic comorbidities, and may in turn aid in the prevention, prediction and management of these diseases.

Aims and Objectives:
We aimed to interrogate FA and UFA in relation to a plethora of clinical outcomes, investigate their causality, and test whether a healthy lifestyle interacts with FA/UFA for the risk of disease.

Materials and Methods:
We performed a Mendelian randomisation-phenome-wide association study (MR-PheWAS) to identify health outcomes associated with FA and UFA. We first conducted a PheWAS of FA and UFA with 988 phenotypes in 426,295 UK Biobank individuals. Health outcomes passing false-discovery rate (FDR) correction for multiple testing were taken forward to MR analyses. SNP-outcome associations were extracted from external GWAS consortia data. Finally, we examined the association between FA/UFA tertiles of genetic risk and tertiles of lifestyle score and incident health outcomes using proportional hazards models.

Results:
Our two sample MR results suggest that a 1-SD higher genetically instrumented FA is associated with lower odds of type 2 diabetes (OR: 0.05, 95% CI: 0.02 to 0.11), hypertension (0.30, 0.18 to 0.50) and coronary atherosclerosis (0.25, 0.10 to 0.62), and with higher odds of ventral hernia (18.15, 4.22-77.97). Moreover, 1-SD higher genetically determined UFA was associated with increased odds of type 2 diabetes (5.30, 3.27-8.61), hypertension (2.40, 1.55-3.71), myocardial infarction (1.99, 1.49-2.65), cholelithiasis (2.92, 1.87-4.56), and atrial fibrillation (2.17, 1.28-3.69) at significance passing FDR q<0.05. Sensitivity analyses were consistent with the main results. Our Cox regression model indicated that a favourable lifestyle is associated with a more pronounced risk reduction in cardiometabolic health outcomes and can have a more substantial impact on cardiometabolic and inflammatory conditions for individuals with either a high FA and a low UFA GRS profiles.

Conclusions:
Our findings offer novel insight into previously unreported effects of favourable and unfavourable adiposity, suggesting that a healthy lifestyle can benefit individuals with both favourable and unfavourable genetic risk scores. This highlights the importance of population-wide lifestyle approaches to address the problem of obesity and risk-stratifying the population according to favourable and unfavourable adiposity.
Abstract P542: Classifying COVID-19 Related Hospitalizations and Deaths in the Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study
Authors: Krishnaswamy Akshaya , Ali Tauqeer , Arynchyn Alex , Chang Harry , Chen Lucas , Elkind Mitchell , Isasi Carmen R , Jager Lauren , Jin Ling , Kelly Maureen R , Kucharska-Newton Anna , Ortega Victor E , Patel Ashmi A , Reeves Lisa , Ring Kimberly B , Tarlton Cheryl , Tse Janis , Urbina Elman , Vankineni Maya , Morganroth Sally E , Yang Jihyun , Zhang Ying , Post Wendy S , Oelsner Elizabeth C ,   C4R Events Subcommittee
Published: March 2023

Objectives:
Administrative criteria are often used to define COVID-19 outcomes despite challenges in differentiating hospitalization “for” vs “with” COVID-19 and unknown reliability for identifying COVID-related cardiopulmonary complications. We implemented a protocol to adjudicate COVID-related events across 14 studies participating in C4R.

Methods:
C4R cohorts ascertained COVID-related hospitalizations and deaths via questionnaires or ongoing surveillance. Medical records were reviewed by C4R physicians using a standardized protocol to assign COVID-related diagnoses as definite or probable. C4R diagnoses were compared against ICD codes assigned to the events. This report includes data from events centrally adjudicated by C4R as of September 2022.

Results:
Among 144 events ascertained across 7 cohorts as potentially COVID-related, SARS-CoV-2 infection was confirmed in 107/117 (91%) non-fatal hospitalizations and 26/27 (96%) deaths. Of confirmed infections, COVID-19 illness was diagnosed as the cause of 101/107 (94%) hospitalizations and 24/26 (92%) deaths (
Table
). Of non-fatal hospitalizations with infection, 72% were diagnosed with severe or critical COVID-19, 78% with COVID-associated pneumonia, and 29% with renal failure; other complications were less common. C4R review did not validate diagnoses indicated by ICD codes for 1 COVID-19 infection, 5 pneumonias, 1 stroke, and 7 renal failure cases. C4R review did identify diagnoses that were not ICD-coded for 13 infections, 31 pneumonias, 6 myocardial infarctions, 5 venous thromboses, and 21 renal failure cases.

Conclusions:
Protocolized medical records review by C4R confirmed COVID-19 as the cause of hospitalization or death in 87% of events ascertained as potentially COVID-related and 94% of those in which SARS-CoV-2 infection was confirmed. Both false-positive and false-negative misclassification by ICD criteria was observed. Protocolized review may be useful to identify and validate COVID-related events for epidemiologic research.
Abstract P544: Post-COVID-19: Predictors of Pulmonary Fibrosis
Authors: Baena Cristina P , Barreto Haagsma Ariele , Vieira Maria Fernanda , Tebet Maria Letícia , Stival Rebecca
Published: March 2023

Introduction:
From observational studies, it is known that some survivors of COVID-19 pneumonia have developed fibrotic pulmonary remodeling, restrictive lung abnormalities, associated with impaired exercise tolerance and poor quality of life at follow-up. Post-COVID-19 pulmonary fibrosis may be defined as the presence of persistent fibrotic changes identified on follow-up CT scans, such as traction bronchiectasis. It is important to identify the potential risk factors for the occurrence of pulmonary fibrosis in this context, although they have not yet been completely defined.

Hypothesis:
We hypothesize that lung fibrosis may be also a possible long-term consequence of COVID-19 pneumonia and the risk factors associated with the acute phase that enhance the risk of pulmonary sequelae, such as duration of hospitalization and intensive care stay, of high-flow oxygen support, and need for mechanical ventilation.

Methods:
We undertook a cohort study of COVID-19 survivors, that required supplemental oxygenation during the acute phase, who had been discharged from hospitals April 2020 to March 2022 in public hospitals of Curitiba/PR (BRAZIL). At 1-month and 6-month follow-up visit, survivors were interviewed with questionnaires symptoms, received a physical examination, sit-to-stand test, laboratory test ant chest CT scan was performed between two visits. The primary outcomes were persistent fibrotic changes, such as traction bronchiectasis, on follow-up chest CT. Multivariable adjusted logistic regression models were used to evaluate the risk factors of CT scan outcomes.

Results:
We followed 63 COVID-19 survivors with CT scan follow-up. The median age of patients was 52 years (±13.3) and 37 (58.7%) were women. The median CT scan follow-up time was 151 days (38-428). The median hospitalization time during acute phase was 13 (3-48) days. The proportion of patients with persistent dyspnoea, characterized by mMRC score of 1 or more, was 52 (82,5%). The proportion of patients with at least one fibrotic change on CT scan was 35 (55.6%), traction bronchiectasis was identified on 16 (25.4%). Hospitalization time during acute phase was associated with traction bronchiectasis, main persistent fibrotic change on CT scan (OR, 1.19; 95% CI:1.036, 1.207; p=0,004).

Conclusion:
In a follow-up, the duration of hospitalization COVID-19 acute phase was associated with higher odds of traction bronchiectasis on chest CT follow-up.
Abstract P545: Association Between Inpatient Glycemic Variability and COVID-19 Mortality - A Prospective Study
Authors: Baena Cristina P , Stocco Rebecca B , Lopes Julia d , Pereira Marcos R , Olandoski Marcia , Demeneck Henrique , Parolin Salma A
Published: March 2023

Introduction:
The benefit of glycemic control was demonstrated in previous studies for the treatment of inpatients with acute infections, regardless of the diagnosis of diabetes mellitus (DM). DM is considered an important risk factor for poor outcomes in hospitalized patients.

Hypothesis:
This study aimed to determine the association between glycemic variability and mortality in COVID-19 hospitalized patients.

Methods:
This prospective study analyzed the data from patients with confirmed COVID-19, admitted to a private reference hospital, from February 2020 until July 2021 aged > 18 years. They were stratified according to the glycemic variability measured by coefficient of variation (CV) and standard deviation (SD). A logistic regression model was used to determine the association of poor glycemic variability and mortality in diabetic and non-diabetic hospitalized patients with COVID-19.

Results:
Data from 628 patients with confirmed COVID-19 and point-of-care (POC) glucose testing was used to measure SD and CV. The cut-off points for SD ≥ 44.7 and CV ≥ 27.5% was defined using the point of a ROC curve that predicted higher risk of death. Patients were stratified in groups for each used metric: SD < 44.7(n=357) and ≥ 44.7(n=271); CV <27.5% (n=318) and ≥ 27.5% (n=310). When controlling for multiple variables (age, sex, comorbidities and in-hospital corticoid use) there was a significant association between high VG and mortality (SD: OR 3.01 and CV: OR 2.45) (all p values < 0.05). When they were stratified as with previous DM condition and without-DM, after adjusted variables, the risk of mortality was higher in patients with uncontrolled VG, regardless the presence of DM (p<0.001).

Conclusion:
In conclusion, our data suggest that a grate glycemic variability is associated with higher mortality in inpatients with COVID-19 regardless of diabetes status. Efforts should be made to improve the glycemic control of these patients.
Abstract P547: Post Acute COVID Syndrome: Clinical and Laboratory Evaluation of Survivors in a Longitudinal Cohort Study
Authors: Barreto Haagsma Ariele , Stival Rebecca Saray M , Giaretta Otto Felipe , Savogin Andraus Gabriel , Baena Cristina P
Published: March 2023

Introduction:
The infection by the SARS-CoV-2 virus, initially described as an acute disease that only affected the pulmonary system, is now known to chronically affect other systems after the resolution of the acute phase. As a result, a hidden pandemic was born. Still with no clear consensus about its definition and management, post-acute Covid syndrome (PACS) is expected to be the next great burden of health services.

Hypothesis:
Whether sociodemographic, acute infection, current health, and physical examination variables are associated with PACS in survivors of the different forms of acute COVID-19.

Methods:
multicentric and observational study, patients from the city of Curitiba and its outskirts diagnosed with COVID-19 between June/2020 and Feb/2022 were referred due to persistent symptoms and evaluated with questionnaires on their acute infection and current symptoms, along with an interdisciplinary physical examination. A telephone consultation also investigated the quality of life. Patients were classified into two groups according to the National Institute for Health and Care Excellence: subacute infection (SI) and PACS. Individuals without sociodemographic and acute infection-related variables were excluded. The primary outcomes included current symptoms, modified Medical Research Council Dyspnea Scale, mini-mental state examination, multisystemic physical exam, quality of life, and new diagnoses variables, which were used in a univariate analysis to evaluate their significance in between groups.

Results:
113 COVID-19 survivors were included, 63.71% were diagnosed with PACS. The mean follow-up time from the onset of acute symptoms was 104 days (IQR 46 - 163) and the overall median number of sequelae was of 9.0 (IQR 5.0 - 11.0). In the overall sample, 53.1% were women and the mean age was 51.7 ± 13.2 years. 83% were admitted to the intensive care unit and those were more likely to present with PACS (65.0%) (p=0.037). The same was observed when the use of supplementary oxygen by cannula (SI 67.5%; PACS 87.7%; p=0.022) and non-invasive ventilation were analyzed (SI 47.0%; PACS 69.7%; p=0.026). Sequelae that presented with significantly prevalence in the PACS population were (% SI; % PACS; p): dyspnea (80.5%; 59.7%; 0.036), hair loss (48.8%; 19.4%; 0.001), and upper limbs paresthesia (14.6%; 2.8%; 0.049). Meanwhile, sequelae that were found to have higher prevalence within the PACS population were: cough (17.1%; 44.4%; 0.004), gait issues (9.8%; 34.7%; 0.003); dysgeusia (2.4%; 22.2%; 0.005); anosmia (4.9%; 19.4%; 0.047); tremors (2.4%; 15.3%; 0.053); and nail alterations (2.4%; 15.3%; 0.053).

Conclusion:
Patients with PACS were generally also the most severe cases of acute infection, also presenting a higher prevalence of specific sequelae. These data should be reproduced in other settings and countries to help define determinants of PACS in a high-risk population.
Abstract P551: Genetic Variants in the Adenosine Triphosphate-Binding Cassette Transporter A1 and Risk of Age-Related Macular Degeneration
Authors: Nordestgaard Liv , Christoffersen Mette , Afzal Shoaib , Nordestgaard Borge G , Tybjaerg-Hansen Anne , Frikke-Schmidt Ruth
Published: March 2023

Objective:
Genetic variants in the adenosine triphosphate-binding cassette transporter A1(
ABCA1
) is associated with higher concentrations of high-density lipoprotein (HDL) cholesterol. Higher HDL cholesterol concentrations are observationally and genetically associated with higher risk of age-related macular degeneration (AMD). However, whether amino acid changing genetic variants in
ABCA1
associated with high HDL cholesterol concentrations confer a higher risk of AMD in the general population is currently unknown. We tested this hypothesis.

Methods:
We genotyped all amino acid changing
ABCA1
variants with a minor allele frequency above 0.002, measured plasma HDL cholesterol and other plasma lipids, and used Cox regression to assess risk of AMD. We created an HDL cholesterol weighted allele score and tested the association with risk of AMD on a continuous scale and in tertiles. Further, we performed mediation analyses.
Main outcome measures:
1,554 AMD events. Median follow-up of 10 years.

Results:
Of 90,344 study participants, 55% were women. Median age was 58 (interquartile range: 47-67) years. On a continuous scale, higher concentrations of genetically determined HDL cholesterol were associated with higher risk of all-cause AMD, dry AMD, and wet AMD both in an age- and sex adjusted model and in a multivariable adjusted model (See Figure). The
ABCA1
allele score for the third versus the first tertile was associated with HRs (95% confidence intervals (CIs)) of 1.30 (1.14-1.49) for all-cause AMD, 1.26 (1.06-1.50) for dry AMD, and 1.31 (1.12-1.53) for wet AMD in a multivariable adjusted model. 6-8% of the effect was mediated through HDL cholesterol. There was no interaction between weighted allele score tertiles and confounding factors on risk of AMD.

Conclusions:
Amino acid changing genetic variants in
ABCA1
which were associated with higher HDL cholesterol concentrations, were also associated with higher risk of AMD, both on a weighted allele score continuously and when divided into tertiles.
Abstract P554: Association of a Genetic Risk Score With Cholesterol and Cholesterol Control: Findings From the Hispanic Community Heath Study/Study of Latinos
Authors: Hutten Christina G , Sofer Tamar , Scannell Bryan Molly , Sun Jiehuan , Persky Victoria W , Daviglus Martha L , Argos Maria
Published: March 2023

Background:
Hypercholesterolemia is a prevalent cardiovascular (CVD) risk factor among Hispanics/Latinos; however, rates of cholesterol awareness and treatment are low in this population. Using a genetic risk score (GRS) associated with low-density lipoprotein cholesterol (LDL) levels may help identify those who would benefit most from statin therapy. A 223-SNP GRS was previously shown to be associated with baseline LDL levels and CVD risk in European, African, and East Asian populations, but it was not evaluated for use in a Hispanic/Latino population.

Methods:
The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a prospective study that enrolled 16,415 Hispanic/Latino adults aged 18-74 years from four US communities in 2008-2011. We assessed the association of a 223-SNP GRS with baseline LDL levels and cholesterol control among 8,868 HCHS/SOL participants with complete data and consent to conduct genetic research. A weighted GRS was calculated using effect sizes estimated from the Million Veteran Program Genome Wide Association Study that included about 25,000 Hispanic/Latino participants. Multivariable linear regression analysis was used to derive effect size estimates (Betas (β), 95% confidence intervals (CI)) for the association between the GRS, modeled continuously and by quintiles, and LDL levels. Multivariable logistic regression was used to derive odds ratios and 95% CI for the association between GRS and LDL control in statin users. LDL control was defined as LDL <130mg/dL or <100 mg/dL in those with diabetes. Models were adjusted for predefined confounders and accounted for survey weights.

Results:
For each standard deviation increase in GRS, LDL levels increased on average by 8.61mg/dL (95% CI 7.37, 9.83) when adjusted by age, sex, and the first 5 principal components. GRS associations with LDL differed by strata of sex, Hispanic/Latino background group, and European genetic ancestry proportion. In 1,114 statin users, odds of cholesterol control were 38% less likely for those in the highest quintile of GRS compared to the lowest quintile, although not significant (OR 0.62, 95% CI 0.36, 1.08).

Conclusion:
The 223-SNP GRS shows promise to identify those who are more likely to develop higher LDL and may benefit most from statin therapy in a Hispanic/Latino population. However, additional studies are needed in a larger population of Hispanic/Latino statin users for confirmation of these results.
Abstract P556: Temporal and Global Trends of the Incidence of Sudden Cardiac Death in Hypertrophic Cardiomyopathy: A Meta-Analysis
Authors: Abdelfattah Omar M , Martinez Matthew , Sayed Ahmed , ElRefaei Mohamed , Abushouk Abdelrahman , Hassan Ahmed , Masri Ahmad , Winters Stephen L , Kapadia Samir , Maron Barry , Rowin Ethan J , Maron Martin
Published: March 2023

Introduction:
Since hypertrophic cardiomyopathy(HCM) initial description, sudden cardiac death (SCD) has been the most feared complication of HCM.

Hypothesis:
Temporal, geographical, and age-related trends of SCD rates in HCM have drastically decreased over time.

Methods:
Databases were systematically searched to Nov 2021 for studies reporting on SCD event rates in HCM. Patients with SCD equivalents (appropriate ICD shocks and non-fatal SCD) were excluded. Random-e!ects model was utilized to pool study estimates calculating the overall incidence rates(IR) for each time-era, geographical region, and age-group. We analyzed 2 eras (before vs. after 2000, following implementation of ICD in HCM). Following 2000, 5-year intervals were used to reflect the temporal change in SCD.

Results:
98 studies(N=70,510patients and 431,407patient-years) met inclusion criteria. Overall rate of HCM SCD was 0.43%/year (95% CI: 0.37-0.50%; I2=75%; SCD events:1,938; person-years of follow-up: 408,715), with young patients(<18 years) demonstrating a>2-fold-risk for SCD vs. adults(18- 60years) (IR:1.09%; 95% CI: 0.69-1.73% vs. IR: 0.43%; 95% CI: 0.37-0.50%)(P-value for subgroup di!erences:<0.01). Contemporary SCD rates from 2015-present were 0.32%/year; significantly lower compared to 2000 or earlier (IR: 0.32%; 95% CI:0.20-0.52%, vs. IR: 0.73%; 95% CI:0.53-1.02%,respectively). Reported HCM-SCD rates were lowest in North America (IR: 0.28%;95% CI:0.18-0.43%) and highest in Asia(IR: 0.67%; 95% CI:0.54-0.84%).

Conclusions:
Contemporary HCM-related SCD are low (0.32%/year) representing a 2-fold decrease compared to prior treatment eras, with young HCM patients at the highest risk. SCD risk stratification maturation and primary prevention ICD application are likely responsible for the notable decline in SCD trends. Moreover, worldwide geographical disparities in SCD was evident, underscoring the need to increase access to SCD prevention for all HCM patients.
Abstract P560: Pilot Study Reveals Excellent Agreement in the Diagnosis of Diabetes Between the Newly Developed Pastry Sugar Tolerance Test and the OGTT: Africans in America Study
Authors: Schenk Blayne R , Hurston Jamaiica , Gatete Jean de Dieu , DuBose Christopher W , Mabundo Lilian , Yang Shanna , Worthy Charlita , Jagannathan Ram , Courville Amber B , Sumner Anne E
Published: March 2023

Introduction:
Sub-Saharan Africa has the highest percentage of people in the world living with diabetes who are undiagnosed. To avoid end-organ damage, identification of undiagnosed diabetes needs prioritization. Glucola (75g glucose) used for the oral glucose tolerance test (OGTT) is expensive and rarely available in sub-Saharan Africa. Due to hemoglobinopathies, G6PD deficiency, and challenges associated with fasting, both A1C and fasting plasma glucose (FPG) may be diagnostically unreliable. As an alternative to the OGTT, we developed the Pastry Sugar Tolerance Test (PSTT). For the PSTT, pastry sugar (75g glucose powder) is dissolved in hot water. Pastry sugar is more widely available in sub-Saharan Africa and nine times less expensive than Glucola.

Objective:
Our goals were to determine the diagnostic agreement for the detection of diabetes between the OGTT and: (1) PSTT, (2) A1C and (3) FPG.

Methods:
The participants were 36 African-born Blacks enrolled in the Africans in America study (male: 67%; age: 42±10y (mean±SD); BMI: 28.5±5.2 kg/m2). At Visit 1, each enrollee had an OGTT, A1C and FPG. At Visit 2, which occurred 8±3 days after Visit 1, a PSTT was performed. Glucose tolerance status was based on glucose results from the OGTT. The kappa-statistic was used to determine the diagnostic agreement between the OGTT and each of the following: PSTT, A1C and FPG.

Results:
Based on the OGTT, diabetes, prediabetes and normal glucose tolerance occurred in 11%(4/36), 33%(12/36) and 56%(20/36) resp. For diabetes, diagnostic agreement between the OGTT and PSTT was excellent (κ=0.99) but much lower for the OGTT and A1C (κ=0.64) and the OGTT and FPG (κ=0.38) (Figure).

Conclusions:
This pilot study has revealed that for diabetes screening, the PSTT has excellent diagnostic agreement with the OGTT, is less expensive than the OGTT, and is more accurate than A1C or FPG.