bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P131: Is Older Age (≥ 65 years old) Associated with Increased Mortality Following Extra-Corporeal Membrane Oxygenation?
Authors: Narotsky David L , Mosca Matthew , Liao Ming , Mongero Linda , Beck James , Bacchetta Matthew , Mochari-Greenberger Heidi
Published: July 2021

Background:
Extra-corporeal membrane oxygenation (ECMO) is increasingly being used as a life-saving bypass technique for patients whose acute cardiopulmonary failure is potentially reversible and refractory to conventional care. Prognostic data for ECMO among diverse patients are limited. The purpose of this study was to evaluate the association between age (≥ 65 vs. <65 years) and 1-year mortality after ECMO, adjusted for confounders.

Methods:
This was a retrospective cohort analysis of 131 consecutive adult patients (28% ≥65 years old, 26% racial/ethnic minority, 38% female) enrolled in an ECMO database who received veno-arterial ECMO at an academic medical center between 2004-2013. Demographics, comorbid conditions, admission characteristics, and mortality status at 1 year were obtained from the hospital clinical information system, updated monthly with Social Security Death Index data. Univariate and multivariate adjusted Cox proportional hazard analyses were conducted to evaluate the associations between age strata and post-ECMO mortality.

Results:
The 1-year mortality rate post-ECMO was 56% (n=73). Age ≥ 65 vs. <65 was significantly associated with increased mortality (HR=1.8; 95% CI=1.1-2.9); the association was attenuated and did not retain statistical significance after adjustment for comorbid conditions (HR=1.4; 95% CI=0.8-2.5). Figure 1 illustrates mortality risk by age strata adjusted for: a) demographics (race/ethnicity and sex) and b) demographics and comorbid conditions. Race/ethnicity and sex were not significantly associated with 1-year mortality. Significant predictors of mortality included: Medicaid vs. other health insurance status, history of coronary artery bypass graft surgery, peripheral vascular disease, renal failure, dialysis, and shock (p<0.05).

Conclusion:
Older age (≥65) was not independently associated with 1-year mortality among ECMO patients, but may indicate higher comorbidity, which was associated with increased risk of mortality in the year following ECMO.
Abstract P138: Lifestyle Goals in Pediatric Preventive Cardiology: Practical Clinical Application
Authors: Zachariah Justin P , Mendelson Michael M , Griggs Suzanne , Ryan Heather H , Baker Annette L , Buckley Lucy , Desai Nirav K , Yellen Elizabeth , Gillman Matthew W , de Ferranti Sarah D
Published: July 2021

BACKGROUND:
Lifestyle change is recommended by the 2011 NHLBI Expert Panel Integrated Guidelines as the cornerstone of pediatric lipid management. Using a Standardized Clinical Assessment and Management Plan (SCAMP)© (IRCDA Inc, Boston MA) as an implementation tool, we examined in a real-world setting the effect of making 3 lifestyle goals on lipid levels in youth referred to a pediatric Preventive Cardiology clinic.

METHODS:
Prospectively collected anthropometric, clinical, and laboratory data were analyzed on youth referred for lipid abnormalities between September 2010 and March 2014. Percent change in lipid fractions from baseline to last follow-up was calculated. Lifestyle recommendations given at initial visit were predictors of interest considered individually and as groups of 3. Multivariable adjusted linear regression was used to identify lifestyle combination trios that were associated with dyslipidemia change.

RESULTS:
Among 325 patients (55% female, median follow-up time 17 [IQR 10,28] months; mean age 13±4yrs], high LDL (>130 mg/dL) was present in 62%, high TG (> 150 mg/dL) in 35%, and low HDL (<40 mg/dL) in 28%. In those with the relevant lipid abnormality, LDL decreased by 11±17%, TG declined by 22±35% and HDL improved by 15±35%. Overall, BMI percentile declined by 2 points. The most common lifestyle goals given were ‘decrease saturated/trans fat’ (63%), ‘increase vegetables/fruit’ (61%), ‘increase exercise’ (55%), ‘continue exercise’ (35%), and ‘decrease glycemic index’ (30%). In those with HDL<40 adjusted for age and sex, ‘increase fish and nuts’ was associated with HDL improvement (6.52mg/dL[ 2.38,10.66];p=0.002) but, unexpectedly, ‘increase vegetables/fruit’ was associated with worse HDL (-3.87mg/dL[95%CI-6.75,-0.99]; p=0.01). In those with TG>150 as expected, ‘decrease fast food/eating out’ was associated with lower TG (37%[13,54]; p=0.006). After adjustment for age, sex, baseline lipid level, and BMI percentile change, the trio of ‘increasing vegetables/fruit’, ‘decreasing saturated/trans fat’, and ‘continue exercise’ was associated with lower LDL (-17.64mg/dL[-3.62,-31.56];p=0.01). Intriguingly, substituting ‘increase exercise’ instead of ‘continue exercise’ in this trio was not associated with lipid change.

CONCLUSIONS:
In a real-world cohort of dyslipidemic youth, providing lifestyle goals was associated with favorable lipid changes, with some combinations showing particular benefits. More data is warranted to explore the effect of specific lifestyle goal combinations in youth.
Abstract P148: Neck Circumference as an Independent Contributor to Cardio Metabolic Risk Factors - ELSA BRASIL
Authors: Baena Cristina P , Lotufo Paulo A , Fonseca Maria J , Benseñor Isabela J
Published: July 2021

Background:
Neck circumference is a proxy for upper body fat and it is a simple anthropometric measure. Therefore it could be a useful tool to identify individuals with cardiometabolic risk factors in the context of primary care.

Hypothesis:
Neck circumference is independently associated to cardiometabolic risk factors in an apparently healthy population.

Methods:
This is a cross-sectional analysis of baseline data of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort of 15105 civil servants aged 35-74 years. We excluded from this analysis those who fulfilled American Diabetes Association criteria for diabetes diagnosis, were taking antihypertensive and/or lipid-lowering drugs. A sex-specific analysis was conducted. Partial correlation (age-adjusted) was used. Risk factors were set as low HDL<50mg/dL for women and <40mg/dL for men, hypertriglyceridemia ≥ 150 mg/dl , hypertension as systolic blood pressure ≥130 mg/dl or diastolic blood pressure ≥85 mm Hg and insulin resistance(HOMA-IR ≥ 75th percentile). Logistic regression models were built to analyze the association between individual and clustered risk factors as dependent variables and 1-SD increase in neck circumference as independent variable. Multiple adjustments were subsequently performed for age, smoking, alcohol, body-mass index, waist and physical activity. Receiver Operating Curves were employed to find the best NC cut-off points for clustered risk factors.

Results:
We analyzed 3810 men (mean age= 49.0 ±8.3 yrs) and 4916 women (49.2 ±8.0 yrs). Mean NC was 38.9 (±2.6)cm for men and 33.4(±2.6)cm for women. NC positively correlated with systolic and diastolic blood pressure (r=0.21 and r=0.27), HOMA - IR (r=0.44), triglycerides (r=0.31) and negatively correlated with HDL (r= -0.21) in men (p<0.001 for all) with similar results in women. Fully adjusted Odds Ratio (OR) (95% CI) of risk factor per SD increase in neck circumference in men and women were 1.29(1.14;1.46) and 1.42(1.28;1.57) for insulin resistance; 1.24(1.11;1.39) and 1.25(1.11;1.40) for hypertension; 1.33(1.19;1.49) and 1.42(1.29;1.63) for hypertriglyceridemia; 1.07(0.92;1.23) and 1.32 (1.19;1.43) for low HDL. Fully adjusted OR (95% CI) of 2 clustered risk factor per SD increase in neck circumference in men and women were 1.29(1.14;1.48) and 1.37(1.21;1.54 ). Fully adjusted OR (95% CI) of 3 or more clustered risk factors per SD increase in neck circumference in men and women were 1.33 (1.02;1.74) and 1.62 (1.33;1.92). Values of neck circumference of >40 cm for men and >34.1 cm for women were the best cut-off points for 3 or more clustered risk factors.

Conclusion:
Neck circumference is significantly and independently associated to cardiometabolic risk factors in a well-defined non-treated population. It should be considered as a marker of cardio metabolic risk factors in primary care settings.
Abstract P154: Pericardial Adiposity Predicts Incident Diabetes: The Multi-Ethnic Study of Atherosclerosis
Authors: Alman Amy C , Jacobs David R , Allison Matthew A , Carr John J , Hsu Fang-Chi , Terry James G , Snell-Bergeon Janet K , Lewis Cora E , Bertoni Alain G , Goff David C , Ding Jingzhong
Published: July 2021

Pericardial adipose tissue (PAT) is ectopic fat deep (epicardial adipose tissue) and superficial (paracardial adipose tissue) to the pericardium of the heart. PAT has been cross-sectionally associated with diabetes, but the association with development of diabetes is unclear. Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we tested whether PAT at baseline was associated with incident diabetes over nearly 10 years of follow-up. The baseline visit (visit 1) was conducted between 2000-2002. Four follow-up visits were conducted at 2 year intervals with visit 5 between 2010 and 2012. Diabetes was defined as a fasting glucose ≥126 mg/dl or the use of antidiabetic medication. Diabetes-free participants at baseline were followed for incident diabetes at any subsequent visit (visits 2-5). Volume of PAT was measured from computed tomographic (CT) scans taken at visits 1 - 4. CT scans were completed on all participants at baseline. Repeat scans were performed on random halves at visits 2 and 3, and a subset at visit 4. Multivariable Cox proportional hazards models were used to assess the association between PAT and incident diabetes.

The figure presents the mean PAT by visit and the mean PAT at baseline among those without diabetes at any time during the study period and those that develop diabetes over the 10 years of follow-up. In Cox regression models adjusted for age, race, and sex, each SD increment of baseline PAT (42.0 mL) was associated with a hazard ratio (HR) for incident diabetes of 1.6 (95% CI 1.5-1.7, p<0.0001). After adjusting for baseline BMI and waist-to-hip ratio, the HR was attenuated somewhat, but remained significant: HR 1.3 (95% CI 1.2-1.4, p<0.0001). Addition of waist circumference to the model did not alter PAT results further.

We found that PAT was highly stable over time, accumulating very slowly. Its baseline value strongly predicts incident diabetes independent of overall body mass and central fatness.
Abstract P162: The Baseline Ankle Brachial Index (ABI), but Not Change in the ABI, is Associated With 11-Year Change in the SF-36: The San Diego Population Study (SDPS)
Authors: Wassel Christina L , Allison Matthew A , Ix Joachim H , Denenberg Julie O , Rifkin Dena E , Criqui Michael H
Published: July 2021

Background:
Lower extremity peripheral artery disease (PAD) affects approximately 9 million people in the US. Less well-recognized is that PAD, even when asymptomatic, is associated with decreased functional status and quality of life. Previous studies have largely examined associations of the ankle brachial index (ABI) and quality of life in participants with PAD. To our knowledge no studies have examined the impact of ABI and change in ABI on change in quality of life in a population-based setting.

Methods:
The SDPS is a population-based prospective study that evaluated non-Hispanic White, African-American, Hispanic and Asian men and women for lower extremity PAD at two examinations approximately 11 years apart. Participants completed the SF-36 questionnaire, and 802 participants had ABI and SF-36 data available at both examinations. Analyses were restricted to these participants who also had a baseline ABI<1.4. Growth curve models were used to assess the associations of baseline ABI and change in the ABI with change in the SF-36 physical component score (PCS) and mental component score (MCS) over time. Change in the ABI was defined as (follow-up ABI - baseline ABI)/baseline ABI.

Results:
Participants were on average 57±9 years of age at baseline, and 69±9 at follow-up. At baseline, nearly 2 percent had ABI≤0.90, and the mean±SD ABI was 1.12±0.10. After adjustment for age, sex, race/ethnicity, BMI, ever smoking, physical activity, hypertension, diabetes, and dyslipidemia, each SD lower baseline ABI was significantly associated with an average change of -0.63 points (95% CI (-0.10, -1.17), p=0.02) on the PCS. This association was marginally significant for the MCS (-0.54 points (0.14, 1.22), p=0.12). Lower baseline ABI was also associated with negative change in two SF-36 subscales, physical functioning (p=0.02) and vitality (p=0.01). Change in the ABI over 11 years was not associated with change in the MCS (p=0.97) or PCS (p=0.41). Results were similar when excluding participants with ABI≤0.90.

Conclusions:
A lower ABI at baseline is associated with a significantly worse physical functioning quality of life approximately 11 years later. However change in the ABI was not significantly associated with change in quality of life over this time period. Additional studies are warranted in larger samples, especially to confirm the lack of findings for change in ABI.
Abstract P163: Healthful Dietary Patterns and the Risk of Hypertension Among Women With a History of Gestational Diabetes
Authors: Li Shanshan , Bao Wei , Tobias Deirdre K , Zhu Yeyi , Chavarro Jorge E , Forman John P , Hu Frank B , Zhang Cuilin
Published: July 2021

Background:
Women who developed gestational diabetes (GDM) are at an increased risk for hypertension, compared with parous women without GDM. The role of diet in the progression to hypertension among this highly susceptible population is unknown.

Methods:
We conducted a prospective cohort study among 3,818 women with a history of GDM in the Nurses’ Health Study II, as a part of the ongoing Diabetes & Women’s Health Study. These women were followed from 1991 until 2011. Incident hypertension was identified by self-report with a previously validated questionnaire. Adherence scores for the 2010 Alternative Health Eating Index (AHEI-2010), the Alternate Mediterranean Diet (aMed) and the Dietary Approaches to Stop Hypertension (DASH) were computed for each participant; higher scores indicate better diet quality. Cox proportional hazard models were used adjusting for major risk factors for hypertension, including dietary and lifestyle factors, medical history, reproductive factors and medications.

Results:
We documented 1,069 incident hypertension cases during a median of 18.5 years follow-up. After multivariate adjustment, the AHEI-2010, and DASH scores were significantly and inversely associated with risk of hypertension. Hazard ratio (HR) and 95% confidence interval (CI) comparing the extreme quartiles (highest vs. lowest) was 0.78 (0.63-0.96, P for linear trend=0.02) for AHEI-2010, 0.77 (0.62-0.96, P for trend=0.02) for DASH score and 0.80 (0.65-0.99, P for trend=0.06) for aMed score.

Conclusion:
After GDM, adherence to a healthful dietary pattern was related to a lower risk of developing hypertension.
Abstract P164: Blood Pressure During Pregnancy and Risk of Hypertension Later in Life: A Longitudinal Study of POUCHMoms
Authors: Levi Dunietz Galit , Strutz Kelly L , Holzman Claudia B , Tian Yan , Todem David , Bullen Bertha L , Catov Janet M
Published: July 2021

Objectives:
Hypertensive disorders in pregnancy carry a long-term risk of cardiovascular disease (CVD) for women. However, future hypertension status among pregnant women who have moderately elevated blood pressure (MEBP), that does not meet criteria for hypertensive disorders is unknown. We, therefore, investigated the risk of later hypertension among women with MEBP in pregnancy in addition to those diagnosed with gestational hypertensive disorders.

Methods:
Data are from the Pregnancy Outcomes and Community Health (POUCH) study, which enrolled pregnant women from 52 clinics in 5 Michigan Communities (1998-2004). We included 667 women with abstracted gestational BP measurements who also participated in the POUCHMoms follow-up 7-15 years later. MEBP was defined as systolic BP (SBP) ≥120mmHg or diastolic BP (DBP) ≥80mmHg among pregnant women who did not have a hypertensive disorder. Hypertensive disorders were defined as at least two SBP measurements ≥140 or DBP measurements ≥90 or regular use of anti-hypertensives, with or without proteinuria. Weighted multinomial logistic regression models were run to estimate the odds of prehypertension or hypertension at follow-up, before and after controlling for maternal prenatal confounders (e.g. age, parity, race) and time between pregnancy and follow-up.

Results:
The majority of participants (59.6%) met the criteria for MEBP which was significantly associated with hypertension at follow-up before and after adjustment for confounders (AOR=2.76; 95% CI 1.40, 5.46). Significant associations were seen for MEBP first identified prior to 20 weeks, and for MEBP observed due to elevated SBP either alone or in conjunction with elevated DBP. As expected, gestational hypertensive disorders also were associated with increased odds of hypertension at follow-up (AOR=16.99; 95% CI 6.11, 47.24). All of the above relationships held when body mass index (BMI) at follow-up was added into the models.

Conclusions:
Moderately elevated blood pressure in pregnancy may be a risk factor for hypertensive disorders later in life and may identify a group of women who need closer surveillance for CVD risk in the years following pregnancy. Elevated SBP appears to play a more influential role than DBP in the observed association.
Abstract P170: The Association of Serum Potassium with Mortality in Older Community-Dwelling Individuals: The Cardiovascular Health Study (CHS)
Authors: Hughes-Austin Jan M , Rifkin Dena E , Katz Ronit , Sarnak Mark J , Deo Rajat , Siscovick David S , Sotoodehnia Nona , Psaty Bruce M , De Boer Ian H , Kestenbaum Bryan R , Shlipak Michael G , Ix Joachim H
Published: July 2021

Background:
High serum potassium (K) is associated with death in chronic kidney disease (CKD) patients, and in acute illness. Associations in other settings are uncertain. We determined associations between K concentrations and total mortality, coronary heart disease (CHD) death, and sudden cardiac death (SCD) in an older, community-dwelling population.

Methods:
Among 5137 CHS participants aged ≥ 65 years at baseline, we evaluated associations between serum K categories [< 4.0, 4.0-4.5, 4.5-5.0, & ≥ 5.0 mMol/dL] with CHD death, SCD, and all-cause mortality using Cox proportional hazards models. We also evaluated whether associations differed by angiotensin converting enzyme (ACE) inhibitor / angiotensin II receptor blocker (ARB) use, diuretic use, and CKD status [eGFR < 60 vs. higher]. All CHD and SCD events were adjudicated by committee.

Results:
Mean age was 72 years, 39% were male, and 17% were Black. Individuals in the ≥ 5.0 mMol/dL category were older, more frequently men, diabetic, to have CKD, and to use ACE/ARBs. They were also less likely to use diuretics. Mean follow-up was 14 ± 6 years during which there were 4122 total deaths including 971 CHD deaths. Follow-up for SCD was 12 ± 5 years during which there were 162 SCD events. In models adjusted for demographics, CVD risk factors, eGFR, and use of ACE/ARBs, diuretics and K supplements, those with K ≥ 5.0 mMol/dL had 32% higher risk of all-cause mortality (HR 1.32; 95% CI: 1.07-1.63) than the 4.0-4.5mMol/dL reference category. The association was similar irrespective of diuretic or ACE/ARB use or by CKD status (p
interaction
all > 0.18). Those with K < 4.0 mMol/dL had 14% higher risk of all-cause mortality (HR 1.14; 95% CI: 1.05-1.23) than the reference category; and this association was limited to those with K < 4.0 mMol/dL and were not on diuretics and did not have CKD (p
interaction
both < 0.02). No association of K < 4.0 mMol/dL with mortality was observed in those on diuretics or with CKD. There was no significant association of either high or low K with either CHD death (HR 1.08; 95% CI: 0.71-1.65; and HR 0.96; 95% CI: 0.81-1.13, respectively) or SCD (HR 1.13; 95% CI: 0.41-3.11; and HR 1.01; 95% CI: 0.68-1.50, respectively) in adjusted models.

Conclusions:
Higher and lower serum K are independently associated with all-cause mortality but not CHD death or SCD in older community-dwelling individuals. Mechanisms linking high and low K with mortality from diseases other than CHD and SCD require future study.
Abstract P174: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Acute Ischemic Stroke Patients According to Time from Onset to Treatment
Authors: Xu Tan , Zhang Yonghong , Sun Yingxian , Chen Chung-Shiuan , Chen Jing , He Jiang ,   for the CATIS investigators
Published: July 2021

Introduction:
Although elevated blood pressure (BP) is very common in patients with acute ischemic stroke, the management of hypertension among them remains controversial.

Hypothesis:
We tested the effects of immediate BP reduction on death and major disability at 14 days or hospital discharge and 3-month follow-up in patients with acute ischemic stroke according to time from stroke onset to initiation of antihypertensive treatment (<12, 12-23, and ≥24 hours).

Methods:
The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomly assigned patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP) to receive antihypertensive treatment (N=2,038) or to discontinue all antihypertensive medications (N=2,033) during hospitalization. Study outcomes were assessed at 14 days or hospital discharge and 3-month post-treatment follow-up. The primary outcome was death and major disability (modified Rankin Scale score≥3), and secondary outcomes included recurrent stroke and vascular events.

Results:
Mean SBP was reduced 12.7% in the antihypertensive treatment group and 7.2% in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mmHg in the antihypertensive treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At 14 days or hospital discharge, the primary and secondary outcomes were not significantly different between treatment and control groups according to time from onset to treatment. At the 3-month follow-up, death or major disability (odds ratio 0.73, 95% CI 0.55-0.97, p=0.03), recurrent stroke (odds ratio 0.24, 95% CI 0.08-0.72, p=0.01), and vascular events (odds ratio 0.41, 95% CI 0.18-0.96, p=0.04) were significantly reduced in the antihypertensive treatment group among participants with time from stroke onset to treatment initiation ≥24 hours only.

Conclusion:
Among patients with acute ischemic stroke, BP reduction with antihypertensive medications might reduce 3-month death and major disability, recurrent stroke, and vascular events among those who initiated antihypertensive treatment after 24 hours from stroke onset.
Abstract P180: Ten-Year and Lifetime Cardiovascular Risk and Subclinical Cardiovascular Disease in Mexican Women
Authors: Luviano Andrea , Ortiz-Panozo Eduardo , Yunes Elsa , Cantu-Brito Carlos , Flores Fernando , Catzin-Kuhlmann Andrés , Lajous Martín , Lopez-Ridaura Ruy
Published: July 2021

Introduction:
Estimates of Lifetime Cardiovascular Risk may identify individuals with different levels of cardiovascular disease (CVD) risk within the low short-term risk (10-year risk) for coronary heart disease (CHD) category defined by the Framingham Risk Score. Evidence of the applicability of this risk stratification in relatively young people is limited, especially among Hispanics.

Hypothesis:
We assessed the hypothesis that the risk categories from the combination of these two risk stratification scales are positively associated with subclinical CVD in Mexican women.

Methods:
We calculated 10-year CHD risk using the Framingham Risk Score and lifetime CVD risk based on risk factor burden in 759 women in Southern Mexico from the Mexican Teachers’ Cohort and evaluated the presence of subclinical CVD. We evaluated common carotid intima-media thickness (IMT), ankle-brachial index (ABI), and inter-arm blood pressure difference (IAD) using standard protocols and performed laboratory analyses from a fasting blood draw. We defined three risk strata: Low 10-year (<10%)/Low lifetime risk, Low 10-year (<10%)/High lifetime risk, and High 10-year risk (≥10%). We evaluated outcome measures continuously and estimated the prevalence of subclinical CVD for each risk strata. We defined subclinical CVD as IMT ≥0.8 mm or atheromatous plaque, ABI <0.90, systolic IAD ≥20 mmHg or diastolic IAD ≥10 mmHg. We calculated the sensibility and specificity of the predicted risk categories to detect subclinical CVD.

Results:
Women evaluated had a mean age of 48.4 years, 22.5% (n=171) were classified as High 10-year CHD Risk, 58.8% (n=446) as Low 10-year/High lifetime risk and 18.7% (n=142) as Low 10-year/Low lifetime risk. We observed significant increase in IMT measurement according to increasing risk categories: 0.656 mm (±0.062), 0.704mm (±0.085), and 0.739mm (±0.089) (p= <0.001). We found similar significant trends in ABI (p= 0.001), systolic IAD (p= <0.001), and diastolic IAD (p= <0.001). We observed a significant higher prevalence of at least one subclinical CVD as the risk category increased: 10.6%, 26.9%, and 45.6% (p= <0.001). The sensitivity and specificity of the combination of these scores to detect subclinical CVD was of 93% and 23%, whereas only considering the high vs. low 10-year risk categories these parameters were 37% and 83% respectively.

Conclusion:
The combination of these short-term and lifetime risk scores accurately identify differences in objective measurements of subclinical cardiovascular disease in Mexican women. Further calibration of these risk scores is needed to incorporate them in the risk assessment tools to identify individuals at risk for the implementation of preventive strategies in the Mexican population.
Abstract P182: Aortic Arch Pulse Wave Velocity Assessed by MRI as a Predictor of All-Cause Mortality and Incident Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Ohyama Yoshiaki , Ambale-Venkatesh Bharath , Noda Chikara , Kim Jang Young , Chugh Atul , Teixido Tura Gisela , Liu Chia-Ying , Redheuil Alban , Wu Colin , Hundley Gregory , Bluemke David , Guallar Eliseo , Lima Joao
Published: July 2021

Background:
The carotid-femoral pulse wave velocity (PWV) assessed by tonometry is predictive of future cardiovascular disease (CVD) events. However, the predictive value of aortic arch PWV assessed by MRI for mortality and CVD events has not been established in the general population. The aim of this study was to evaluate the association of arch PWV with all-cause mortality and incident CVD events over 10 years in the Multi-Ethnic Study of Atherosclerosis (MESA).

Method:
Aortic arch PWV was measured using phase contrast (PC) cine MRI at the level of the pulmonary artery bifurcation for transit time and black blood sagittal image for transit length at baseline in 3537 MESA participants free of overt CVD. Cox regression was used to evaluate the risk of death and incident CVD in relation to arch PWV adjusted for age, gender, race, and CV risk factors.

Results:
At baseline, participants were aged 62 ± 10 years; 53% women; 36% White, 15% Chinese, 29% African American, 20% Hispanic; 45% hypertension. The mean value of arch PWV was 9.0 ± 6.3 m/s. There were 418 deaths and 236 CVD events over 10-year follow-up. There was significant interaction between arch PWV and mean age for both outcomes, so we stratified by age; below 60 years (n=1503) and above 60 years (n=2034). Increased PWV had a trend with increased risk of all-cause mortality with a hazard ratio for the 4th vs 1st quartile of PWV of 2.1 (95%CI: 1.0-4.6, p=0.05) independent of risk factors in age below 60 years group. There was no significant association of PWV with incident CVD in age below 60 years after adjustment for risk factors. In age above 60 years group, increased PWV was not associated with either all-cause mortality or incident CVD events in univariate or multivariate analysis (Table).

Conclusion:
Arch PWV assessed by MRI is not a significant predictor of all-cause mortality and incident CVD events among individuals without overt CVD.
Abstract P213: Regular Exercise Improves the Lipoprotein Subclass Profile: Meta-Analysis of 10 Exercise Training Intervention Groups
Authors: Sarzynski Mark A , Rankinen Tuomo , Burton Jeffrey , Church Timothy S , Després Jean-Pierre , Hagberg James M , Leon Arthur S , Mikus Catherine R , Rao Dabeeru C , Seip Richard L , Skinner James S , Slentz Cris A , Thompson Paul D , Wilund Kenneth R , Kraus William E , Bouchard Claude
Published: July 2021

OBJECTIVE:
The goal was to examine lipoprotein subclass responses to regular exercise as measured in 10 exercise interventions derived from six cohorts. We hypothesized that regular exercise has beneficial effects on the overall lipoprotein subclass profile in previously sedentary adults.

METHODS:
NMR spectroscopy (LipoScience Inc., Raleigh, NC) was used to quantify average particle size, total and subclass concentrations of very low-density lipoprotein, low-density lipoprotein, and high-density lipoprotein particles (VLDL-P, LDL-P, and HDL-P respectively) before and after an exercise intervention in 1,430 adults from six studies, encompassing 10 exercise training groups: APOE (N=106), DREW (N=298), GERS (N=79), HERITAGE (N=715), STRRIDE I (N=130) and II (N=102). Random-effects meta-analysis was performed to quantify the overall mean change across the unadjusted and adjusted mean change estimates from each exercise group of each study. A Bonferroni-adjusted p-value ≤ 0.003 was considered statistically significant.

RESULTS:
Meta-analysis of unadjusted data found that regular exercise induced significant decreases in the concentration of large VLDL-P (P=1.2x10
-6
) and mean VLDL-P size (P=9.0x10
-5
), with significant increases in the concentration of large LDL-P (P=4.9x10
-13
). The changes in large VLDL-P and large LDL-P concentration and VLDL-P size remained significant after adjustment for age, sex, race, baseline body mass index, and baseline trait value (
Figure 1
); while the increase in LDL-P size (P=0.003) became significant after adjustment. Nominally significant decreases in the concentration of small LDL-P (P=0.004) and medium HDL-P (P=0.007) and increases in large HDL-P (P=0.008) were observed in the adjusted meta-analysis.

CONCLUSIONS:
Despite differences in exercise programs and study populations, regular exercise led to significant improvements in the lipoprotein subclass profile across 10 exercise interventions, as highlighted by changes in VLDL and LDL subfractions.
Abstract P243: Greater Healthful Dietary Variety and Changes in Adiposity Indicators During a Weight-Loss Intervention: The POUNDS Lost Trial
Authors: Vadiveloo Maya , Sacks Frank M , Bray George A , Champagne Catherine , Mattei Josiemer
Published: July 2021

Background:
Adhering to a healthy lower energy diet is essential for sustained weight loss. Greater variety within energy-poor, nutrient-dense foods may improve adherence by making the diet less monotonous, and therefore more enjoyable. Greater healthful dietary variety has been inversely associated with adiposity in cross-sectional studies, but it is unclear if it predicts longitudinal changes in body weight.

Objective:
To examine the longitudinal associations between initial changes in healthful dietary variety (0-6 months) and long-term changes in adiposity over 24-months in a weight-loss trial.

Methods:
Participants in the POUNDS Lost trial were advised to follow energy-restricted diets. Data for participants with complete dietary assessments at baseline and 6-months were analyzed (n=367). Healthful dietary variety was quantified using the validated US Healthy Food Diversity (US HFD) index, which measures the number of foods consumed and consistency of dietary selections and amounts with recommendations from the 2010 Dietary Guidelines for Americans. Changes in the US HFD index between baseline and 6-months were divided into tertiles (T); adults in T1 had reductions in the US HFD index, T2 maintained stable index values, and T3 had increased index values. Body weight and waist circumference (WC) were measured at 6, 12, 18, and 24-months and percent body fat and trunk fat were measured at 6 and 24-months using DEXA. Repeated measures ANOVA was used to test whether US HFD index change tertiles were significantly associated with adiposity over 24-months. Models were adjusted for age, sex, race, smoking, education, income, diet arm, changes in physical activity and energy intake, baseline adiposity indicator, and the interaction between the US HFD index change tertile and time.

Results:
Reductions in energy intake were equivalent across US HFD index change tertiles in multivariable models (-425 vs.-265 kcal in T1 vs.T3, p=0.08). An improved variety (T3) as compared to stable variety (T2) was associated with greater weight loss at 24-months (-4.75 vs. -2.63kg, p=0.03; linear p-trend=0.04) and greater decrease in total body fat in T3 vs. T2 (-1.10% vs. -0.006%, p=0.03; p-trend=0.04) and trunk fat (-1.29% vs. 0.08%, p=0.03; p-trend=0.04). An improved variety (T3) as compared to stable variety (T2) or reduced variety (T1) was associated with greater reduction in WC (-6.48cm (T3) vs. -3.98cm (T2), p=0.01; and -4.14cm (T1), p=0.04; linear p-trend=0.01). Reducing variety (T1) did not reduce or increase other adiposity indicators compared to stable or increased variety.

Conclusions:
Increasing healthful dietary variety while restricting energy intake may improve sustained reductions in adiposity among adults trying to lose weight.
Abstract P251: Weight Change is Associated With Risk of Cardiovascular Mortality Among Singapore Chinese
Authors: Koh Woon-Puay , Yuan Jian-min , Pan An
Published: July 2021

Introduction:
While epidemiologic studies have established overweight and obesity as risk factors of cardiovascular disease (CVD) mortality, findings on the relationship of change in body weight with CVD mortality are inconsistent.

Hypothesis:
We assessed the hypothesis that weight change was related to CVD mortality among middle-aged to elderly Chinese in Singapore.

Methods:
We used prospective data from the Singapore Chinese Health Study, a population-based cohort of 63,257 Chinese men and women aged 45-74 years at recruitment (1993-1998). After 5.7 [standard deviation (SD) 1.4] years, we conducted a follow-up interview (1999-2004) among 52,322 surviving subjects in the cohort. Body weight and height were self-reported among 42,328 participants at both baseline and follow-up interviews. Weight change was computed by percentage difference in weight at both assessments relative to weight at baseline, and categorized as moderate-to-large loss (≥10%), small loss (5.1 to 9.9%), stable (±5%), small gain (5.1-9.9%), and moderate-to-large gain (≥10%). Cox proportional hazards regression model was applied to estimate hazard ratio (HR) after controlling for age, gender, dialect group, dietary pattern, smoking status, alcohol consumption, physical activity, hours of sleep and history of diabetes and hypertension.

Results:
A total of 1,805 CVD deaths were identified during the follow-up until December 31, 2013 [follow-up duration of 11.5 (SD 2.9) years]. Compared to participants with stable weight, those with moderate-to-large weight loss had a 42% higher risk of CVD mortality (HR: 1.42; 95% CI: 1.25-1.61), while those with moderate-to-large weight gain had a 19% higher risk (HR: 1.19; 95% CI: 1.02-1.37). The HR (95% CI) for stroke mortality was 1.77 (1.44-2.18) for moderate-to-large weight loss, and 1.42 (1.12-1.80) for moderate-to-large weight gain. Conversely, for coronary heart diseases (CHD) mortality, only moderate-to-large weight loss was associated with an increased risk (HR: 1.24; 95% CI: 1.05-1.47). The associations were not different by gender or age-group. When stratified by BMI at baseline using 23 kg/m
2
as cutoff for overweight, moderate-to-large weight loss was associated with increased risks of CHD and stroke mortality in both BMI groups. In contrast, moderate-to-large weight gain was only associated with increased risk of stroke mortality but not with CHD mortality in both BMI groups.

Conclusions:
In conclusion, this study suggested that both moderate-to-large weight loss and weight gain significantly increased risk of CVD mortality among middle-aged to elderly Chinese. This study emphasizes the importance of maintaining stable body weight in middle-aged and elderly populations.
Abstract P256: Associations Between Periaortic Vascular Adipose Tissue, Cardiometabolic Risk Factors and Aortic Calcification in a Multiethnic Cohort of Men From the ERA JUMP Study
Authors: Columbus Mindy L , Barinas-Mitchell Emma , McQuaide Belinda , Bai Lina , Bertolet Marnie , Bodomova Marina , Edmundowicz Daniel , Rodriguez Beatriz , Wilcox Bradley , Shin Chol , Masaki Kamal , Sekikawa Akira
Published: July 2021

Background:
Aortic calcification (AC) is a direct measure of subclinical cardiovascular disease (CVD) linked with CVD events and mortality. Periaortic vascular adipose tissue (PVAT) may exert local pro-atherogenic effects on the arteries, through secretion of pro-inflammatory adipocytokines, in addition to systemic effects. Racial differences exist between various adipose depots including visceral and epicardial fats, however little is known for PVAT. Our objectives were to evaluate 1) the associations between PVAT volume and cardiometabolic risk factors and 2) the relationship between PVAT volume and AC among middle-aged White, Japanese American, and Korean men.

Methods:
We measured thoracic PVAT volume (cm
3
) in 54 (17 US White, 19 Japanese American and 18 Korean) men with high AC (AC Agatston Score ≥400) and in 59 (20 US White, 19 Japanese American and 20 Korean) age- and BMI- frequency matched controls with low AC (0-100) from the ERA-JUMP study. PVAT volume was quantified in aortic scans by electron-beam computed tomography using Slice-O-Matic reading software and a Hounsfield Units range of -190 to -30 for adipose tissue. Overall and race-specific univariate correlations were calculated to assess associations of PVAT with cardiometabolic risk factors and logistic regression was used to assess PVAT associations with AC≥400.

Results:
Overall mean (SD) age and BMI were 45.6 (3.0) years and 27.1 (2.8) kg/m
2
, respectively. Median PVAT was 44.4 (IQR: 35.7-56.0) and differed by race; 50.3 (IQR: 39.5-60.0) in Whites, 47.9 (IQR: 37.5-55.8) in Japanese Americans and 37.4 (IQR: 32.5-49.2) in Koreans, p=0.002. Waist circumference, BMI, visceral and subcutaneous fat, total cholesterol, HDL-C, triglycerides, and insulin were significantly associated with PVAT volume in the overall group. In race-specific analyses, all measures of adiposity were significantly associated with PVAT. Furthermore, PVAT volume was significantly associated with HDL-C (inversely) in Whites, with triglycerides in Whites and Japanese Americans and with BP in Japanese Americans. Median PVAT volume was higher in cases than controls [47.9 cm
3
(IQR: 34.5-61.1) vs 44.0 cm
3
(IQR: 36.7-51.0)] though not significantly different. PVAT was not significantly associated with high AC.

Conclusions:
In this multiethnic group of men aged 40-49 years, PVAT was higher in US Whites and Japanese Americans and lower in Koreans. PVAT was associated with overall and central adiposity and with markers of cardiometabolic risk across racial/ethnic groups. However, additional research needs to be done to substantiate these findings.
Abstract P257: Efficacy of Teen Battle Chef Program to Shift the Academic Performance and Health Behaviors in NYC High School Students
Authors: Park Hyunwoo , Fredericks Lynn , Sliva Nicole M , Wang Jun , Irvin Erica D , Wylie-Rosett Judith , Hayes Shawn G
Published: July 2021

Introduction:
Adolescent obesity is one of the leading public health concerns in the United States. Children who are overweight as adolescents are much more likely to become obese adults. Providing nutrition education is a powerful resource for dietary behavioral change among adolescents and children. Teen Battle Chef (TBC), a component of the HealthCorps Living Labs program, uses culinary and nutrition education to promote behavioral change by empowering youth on multiple levels. This study examines impact of the TBC component of HealthCorps on NYC high school students’ food behaviors, leadership skills, attendance and academic performance.

Hypothesis:
That participation in Teen Battle Chef will increase attendance, academic and food behavior indicators
Methods:
We examined several food behaviors, leadership traits, attendance and academic performance of TBC students in the 14 NYC HealthCorps high schools. The TBC curriculum was implemented all 14 schools and a total of 176 students participated in the intervention and 40 students in the comparison group. Pre and Post surveys were conducted. Students from both interventional and comparison groups completed the same survey. Additionally, school performance data in a subset of students from the previous school year in the same schools were examined to determine whether participation affected school performance. Academic data (2012-13) from a total of 88 TBC from 2012-13 were compared to the entire school population. These included attendance, SAT scores, and graduation.

Results:
The TBC intervention group had significantly greater improvements in key food behavior indicators. Students reported an increased “energy level” [t=+2.90; p<0.01]; more likely to consume fruit [t=-2.17; p<0.05], carrots [t=-2.56; p<0.05], and less likely to drink soda [t=2.30; p<0.05]. The TBC group significantly increased their overall dietary quality (0.114; p=0.03) compared with the control group (0.006; p=0.90). An indication of leadership development, participants had significantly greater improvement in discussing the value of local foods with others (t=-3.31; p<0.01). Compared with previous year’s cohort, the mean SAT scores for TBC participants were significantly higher than overall school scores. Additionally, TBC participants attendance rate was 95%, compared to the school attendance rate of 86%.

Conclusion:
This study provides strong evidence that TBC helps develop leadership, teamwork, culinary skills, nutrition knowledge, food systems and self-efficacy for high school students. In addition, our study explicitly shows that TBC students improve their academic performance and attendance and are motivated to succeed in school as a result of their participation in the TBC/HealthCorps programs.
Abstract P274: Physical Activity Patterns and Determinants Following Acute Myocardial Infarction: Insights From the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients)
Authors: Minges Karl E , Strait Kelly M , Camhi Sarah , Lichtman Judith H , Dreyer Rachel P , Geda Mary , Bueno Hector , Curtis Jeptha P , Krumholz Harlan M
Published: July 2021

Introduction:
Despite the benefits of participation in regular physical activity (PA) following acute myocardial infarction (AMI), little is known about the habitual patterns of PA for young AMI patients, especially expanding beyond findings for those engaged in cardiac rehabilitation. We assessed patterns and determinants in levels of PA over a period of 12-months following AMI.

Methods:
A 2:1 (women:men) observational study design enrolled 3,572 AMI patients (2,397 women, 67.1%) aged 18-55 years from 103 US, 24 Spanish, and 3 Australian hospitals (2008-2012). Data were obtained by medical record abstraction and patient interviews at baseline (pre-AMI), 1- and 12-months post-AMI. Patients were assigned to AHA defined levels of PA based on self-reported frequency, duration, and intensity, as follows:
Active
(≥ 150 min/wk moderate or ≥ 75 min/wk vigorous activity),
Insufficient
(10-149 min/wk moderate or 10-74 min/wk vigorous activity), or
Inactive
(< 10 min/wk moderate or vigorous activity). We used a generalized estimating equation model to examine the factors associated with insufficient/inactive PA levels over time.

Results:
At baseline, 1- and 12-months post-AMI, 36.7%, 37.6%, and 40.0% of patients were considered active. There were 27 PA patterns observed from baseline to 12-months (Table). The most frequent were those with no change in PA over time (14% staying active, 7% insufficient, and 13% inactive). Additionally, 25% of patients had an increase (at least a one category change) in PA, while 19% had a decrease between baseline and 12-months post-AMI. Female sex, non-white race, non-active workplaces, smoking, diabetes, hypertension, and obesity were independently associated with being insufficient/inactive over time (all p<.05).

Conclusions:
Despite clinical recommendations, young adults recovering from AMI experience a wide range of PA patterns. By identifying factors associated with insufficient/inactive PA during recovery, targeted interventions can be introduced prior to hospital discharge.
Abstract P276: Gender Associated With Youth Physical Activity Independent of Neighborhood Safety Factors
Authors: Wiemken Andrew S , Patterson Freda , Hanlon Alexandra
Published: July 2021

Introduction:
Low levels of physical activity in youth remains a significant public health problem, particularly among urban youth where less than 30% achieve the recommended 60 minutes of moderate to vigorous activity per day. Elucidating the determinants of urban youth physical activity levels is important for informing programming efforts. Ecological models of health behavior recognize the role that environmental features play in activity levels. To date, the role of neighborhood safety on urban youth activity levels has yet to be fully considered.

Hypothesis:
Neighborhood safety is expected to be associated with physical activity levels, independent of known determinants of youth activity levels including gender, race, age, current alcohol and tobacco use, overweight status and poor mental health.

METHODS:
Cross-sectional data collected by the Centers for Disease Control funded Youth Risk Behavior Survey (YRBS) were used for his analysis. Participants were 9th-12th grade high school students enrolled in the Philadelphia school district. Bivariate logistical regression accounting for the YRBS sampling procedures was used to examine the association between perceived neighborhood safety and physical activity levels. Perceived neighborhood safety was defined as feeling safe walking in the neighborhood during the day and at night. Being physically active was defined as achieving at least 60 minutes of activity on 5 of more days of the week.

RESULTS:
The weighted sample (N=35,005) were mostly Black (57.5%), 50% were male and 66% were 16 years and older. Neighborhood safety was significantly associated with activity levels: 42% of youth who perceived their neighborhood as safe were active as compared to 32% who reported their neighborhood as unsafe (χ
2
= 1.48, p<.05). However, in a fully controlled regression model, gender remained as the only significant correlate of activity. Specifically, males reported a 2-fold greater odds of being active than females (OR=2.06, p<.001).

CONCLUSIONS:
These data suggest that independent of neighborhood safety and other risk behaviors for inactivity, gender emerges as the only significant correlate of physical activity. Gender specific programming to improve physical activity in urban adolescent females is urgently needed.