bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 21: Examining the Impact of Food as Medicine on Heart Health
Authors: Rosas Lisa G , Chen Steven , Xiao Lan , Baiocchi Mike , Chen Wei-ting , Emmert-Aronson Benjamin O , Ng Elliot , Perez Josselyn , Martinez Erica , Melendez Eric , Thompson-Lastad Ariana , Markle Elizabeth , Tester June
Published: May 2024

Introduction:
The recent White House Conference on Hunger, Nutrition, and Health in October 2022 made it a national priority to address food and nutrition insecurity and reduce inequities in nutrition-related chronic conditions such as heart diease. ‘Food as Medicine’ is increasing implemented to address the dual challenge of food/nutrition insecurity and chronic disease. Food as Medicine refers to integration of food-based nutrition interventions into healthcare to prevent and treat disease. However, there is limited rigorous evidence of the impact of Food as Medicine on heart health.

Methods:
We examined the effectiveness of Recipe4Health, a Food as Medicine program, for improving food insecurity and indicators of heart health among patients who accessed care in Federally Qualified Health Centers (FQHCs). Recipe4Health was implemented in 4 FQHCs and included a ‘Food Farmacy’ that provided 16 weekly deliveries of produce with or without a ‘Behavioral Pharmacy’ which was 16 weekly group medical visits. We examined pre/post changes over 4 months in outcomes assessed by surveys (e.g., produce intake, physical activity, food insecurity). We also compared outcomes (e.g., lipids, Body Mass Index [BMI], blood pressure [BP], HbA1c) in the Electronic Health Record (EHR) between Recipe4Health patients and controls over 12 months. Control patients were identified using propensity score matching with patients from similar clinics that had not implemented Recipe4Health. We used linear mixed effects models with repeated measures, adjusting for baseline of each outcome.

Results:
Study participants (n=5,286) were middle-aged (mean age 51.2 SD [13.9]) primarily women (68%), and from diverse racial/ethnic backgrounds with 51% Latinx, 21% Black, and 8% Asian American/Pacific Islander. Based on pre/post surveys, Recipe4Health participants significantly increased their produce consumption (0.41 servings [0.11, 0.72], p=007) and physical activity (41.98 minutes/week [22.33, 61.63], p<.001). Recipe4Health participants also experienced statistically significant improvements in food insecurity with 59% reporting food insecurity at baseline and 48% reporting food security at follow-up (p<.001). Based on EHR data, Recipe4Health participants significantly decreased their non-HDL cholesterol (-17.1 [-26.9, -7.2], p<.001) and HbA1c (-0.37%, 95% CI [-0.65, -0.08]; p=0.01) compared to propensity score-matched controls at 12 months. There were no notable differences between participants and controls with respect to BMI or BP.

Conclusion:
This analysis from participants in the R4H program adds important data to the literature regarding Food as Medicine. Recipe4Health, a Food as Medicine program, was effective for improving some indicators of heart health including produce consumption, physical activity, non-HDL cholesterol, and HbA1c.
Abstract 35: Association of SGLT2 Inhibitors and Other Second Line Therapies With Incident Chronic Kidney Disease in Patients With Type 2 Diabetes
Authors: Wang Wendy , Drawz Paul , Chow Lisa , Chen Lin Y , Walker Rob F , Norby Faye L , Lutsey Pamela L
Published: May 2024

Introduction:
Type 2 diabetes (T2D) is a strong risk factor for chronic kidney disease (CKD). Clinical trials have shown that intensive glycemic control prevents the development of kidney failure and decreases in eGFR in patients with T2D and CKD. Furthermore, sodium-glucose cotransporter-2 inhibitors (SGLT2i) slow the progression of CKD compared to other glucose lowering medications. However, it’s unknown whether SGLT2 inhibitors reduce the risk of incident CKD. Using data from the US MarketScan administrative databases (2014-21), we assessed the association between use of SGLT2i vs. other 2
nd
line therapies and risk of incident CKD among patients with T2D on metformin.

Methods:
We included 428,814 matched patients with T2D on metformin and a 2
nd
line therapy. SGLT2i users were matched with up to 5 other 2
nd
line therapy users by age, sex, date of enrollment, and date of 2
nd
line therapy initiation. Other 2
nd
line therapies included dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, sulfonylureas, thiazolidinediones, and insulin. Incident CKD was defined using ICD codes. Those with prevalent CKD were excluded. Cox proportional hazards models were used.

Results:
Participants were on average age 53±10 years at baseline and 46% were female. Over a median follow-up of 2.0 years, 6,024 patients were diagnosed with CKD. After multivariable adjustments, SGLT2i users had a lower risk of incident CKD than those taking other 2
nd
line therapies (Table; HR [95% CI]: 0.43 [0.39-0.47]). When compared to users of each 2
nd
line therapy individually, SGLT2i users consistently had a lower risk of CKD.

Conclusion:
In this analysis using real-world data, among patients with T2D on metformin, SGLT2i use was associated with a lower risk of incident CKD than other 2
nd
line diabetes therapies (when assessed as a group and individually). Results from this study may inform clinical guidelines regarding treatment options for those with diabetes at high-risk for CKD.
Abstract 39: Circulating Plasma Proteomics of Carotid Intima-Media Thickness in the UK Biobank Cohort
Authors: Chen Ming-Li , Kho Pik Fang , Guarischi-Sousa Rodrigo , Zhou Jiayan , Abbasi Fahim , Panyard Daniel , Watson Kathleen , Assimes Themistocles L
Published: May 2024

Introduction:
Ultrasound carotid intima-media thickness (cIMT) is a well-established tool for improved cardiovascular risk stratification. The relative importance of traditional risk factors, genetic susceptibility, and plasma proteomics in predicting cIMT has not been previously explored among asymptomatic individuals.

Hypothesis:
We hypothesized that conventional atherosclerosis risk factors, polygenic scores (PRSs), and levels of plasma proteins each provide incremental value in predicting cIMT. Plasma proteomic profiles associated with cIMT may provide insight on the biological underpinnings of early atherogenesis in carotid arteries.

Methods:
We examined 6136 UK Biobank participants with 1461 proteins profiled in their plasma at their baseline visit using the proximity extension assay who subsequently returned to a second study visit to undergo a cIMT measure. With cIMT as outcome, we implemented linear regression models, stepwise Akaike information criterion (AIC)-based models, and the least absolute shrinkage and selection operator (LASSO) approach to screen for and select baseline demographic, genetic, physical, medical, and proteomic determinants of cIMT. We evaluated predictive performance of selected predictors by calculating proportion of variance explained (R
2
) of cIMT. Lastly, we performed gene set enrichment analyses with significantly associated proteins.

Results:
The mean follow-up time between baseline and cIMT measurements was 9 years. A LASSO model incorporating 97 proteins, in addition to age, assessment center, genetic risk factors, smoking, blood pressure, trunk fat-free mass index, apolipoprotein B, and Townsend deprivation index, reached the highest R
2
value in the testing dataset (R
2
= 0.237, 95% C.I. 0.193, 0.281). After forcing minimal non-modifiable covariates such as age and sex, a LASSO model trained by proteins alone was almost as predictive as models trained by both covariates and proteins (R
2
= 0.218, 95% C.I. 0.173, 0.262). Non-proteomic covariates of robust predictive value included age at cIMT measurement as a proxy for follow up time (univariate screening R
2
= 19.4%), baseline age (R
2
= 18.8%), blood pressure and anthropometry measurements. Fat-free mass index in trunk was the strongest predictor to cIMT among adiposity measurements (R
2
= 3.6%). CHGB (Secretogranin-1), CST6 (Cystatin-M), and PRELP (Prolargin) were proteins consistently selected across all regression models. Gene set enrichment analysis found overrepresented pathways in hemostasis (MGLL), angiogenesis (IGFBP7), vesicle-mediated transport (VTA1), and glycosaminoglycan metabolisms (HAPLN1 and VCAN).

Conclusions:
Plasma protein profiles provide incremental value in predicting a cIMT measurement on average nearly a decade later. Our findings suggested the roles of vasculogenic signaling and extracellular matrix proteins in remodeling.
Abstract 59: Sugar-Sweetened Beverages, Gut Microbiota, Circulating Metabolites, and Risks of Cardiometabolic Diseases: The Hispanic Community Health Study / Study of Latinos (HCHS/SOL)
Authors: Zhang Yanbo , Luo Kai , Peters-Samuelson Brandilyn , Mossavar-Rahmani Yasmin , Moon Jee-Young , Daviglus Martha L , Van Horn Linda , McClain Amanda C , Cordero Christina , Schneiderman Neil , Floyd James S , Yu Bing , Burk Robert , Kaplan Robert , Qi Qibin
Published: May 2024

Introduction:
Sugar-sweetened beverages (SSBs) remain the top contributor to added sugar intake and contribute to significant cardiometabolic disease burdens. However, associations of SSB intake with gut microbiota and blood metabolites, a potential pathway linking SSB intake to cardiometabolic risks, are unclear.

Hypothesis:
Higher SSB intake alters gut microbial composition and blood metabolites which contribute to higher cardiometabolic risks.

Methods:
We assessed associations of SSB intake with gut microbiome (metagenomics, n=2970) and 653 serum metabolites (untargeted metabolomics, n=6115) among US Hispanic/Latino adults. We examined cross-sectional associations of gut microbiota with cardiometabolic traits and metabolites, and prospective associations of metabolites with risks of cardiovascular disease (i.e., myocardial infarction, stroke, and heart failure) and diabetes over median follow-ups of 7.6 and 10.5 years, respectively.

Results:
Higher SSB intake (median=0.9 servings/d) was related to the enrichment of 2 microbial species and depletion of 7 species with multivariable adjustment (
Fig. 1
). A gut microbiota score, calculated based on the 9 SSB-related species, was related to poorer glycemic, triglyceride, and renal traits (
Fig. 1
). Among 64 metabolites related to both SSB intake and gut microbiota score (
Fig. 1
), 7 metabolites (e.g., 5-aminovaleric acid betaine) were associated with cardiovascular disease risk, and 30 metabolites were associated with diabetes risk, including those in the branch-chained amino acid metabolism (e.g., 2-hydroxyisovaleric acid), tryptophan metabolism (indole-3-propionic acid), and ursodeoxycholic acid, which were reported to closely relate to gut microbiota.

Conclusion:
Among US Hispanics/Latinos, higher SSB intake was associated with unfavorable gut microbiota and circulating metabolites for cardiometabolic risks, suggesting a potential role of gut microbiota and related metabolites in the link of SSB intake with cardiometabolic diseases.
Abstract MP07: Body Weight Change Mediates the Relationship Between Alcohol Intake and Incidence of Hypertension in Japanese Men
Authors: Sakurai Masaru , Ishizaki Masao , Morikawa Yuko , Yoneda Kazuka , Miura Katsuyuki , Nakagawa Hideaki
Published: May 2024

Background:
Heavy drinking is a risk factor for hypertension. Alcohol consumption is also associated with weight changes. Therefore, the purpose of this study is to examine the mediating effect of weight change on the incidence of hypertension depending on the level of alcohol consumption in a cohort study of Japanese men.

Methods:
The participants were 2,137 non-hypertensive male employees (18-61 years old, mean age 38.3) of a metal products factory in Japan. BMI and blood pressure (BP) were measured during a health examination in 2009. BP was measured twice after resting, and the means of BP values were analyzed. Types of alcohol, amount and frequency of drinking were evaluated using a self-administered questionnaire. Follow-up body weight and BP were measured during a health examination in 2014. The incidence of hypertension was defined as systolic BP 130 or higher, diastolic BP 80 or higher, or oral antihypertensive medication. We investigated the mediating effect of BMI on the relationship between alcohol consumption and blood pressure. Associations were adjusted for baseline age, BMI, and systolic BP.

Results:
The mean values (standard deviations, SD) of baseline BMI (kg/m
2
), systolic and diastolic BP (mmHg) were 22.6 (2.7), 111.6 (9.2), 67.0 (7.3), respectively. During the 5-year follow-up, 429 incident case of hypertension were identified. The mean body weight change (kg) over 5 years for each alcohol consumption category (non-drinker, <20g ethanol/day, 20-39 g/day, and ≥40 g/day) was 0.8 (4.4), 0.7 (4.0), 0.0 (3.8), and -0.4 (4.4), and the incidence rates (%) of hypertension were 16.0, 17.7, 28.0, and 32.1, respectively. The multivariate-adjusted odds ratios (95% confidence intervals) for incident hypertension were 1.00 (reference), 1.22 (0.90-1.64), 1.71 (1.19-2.47), and 2.06 (1.37-3.09); ORs were significantly higher for those with 20-39g/day and ≥40g/day groups compared to non-drinkers. In the mediation analysis, the odds ratios for the direct effect of each alcohol consumption group on the development of hypertension were 1.00 (reference), 1.27 (0.94-1.73), 1.91 (1.39-3.44), 2.36 (1.56-3.58), and those for indirect effect mediated by body weight change were 1.00 (reference), 0.99 (0.95-1.04), 0.96 (0.90-1.01), and 0.93 (0.85-0.99), respectively.

Conclusion:
Alcohol consumption was inversely associated with body weight change and positively associated with the incidence of hypertension. Among heavy drinkers, there was a significant indirect effect mediated by body weight, and weight loss due to heavy drinking lowered the risk of developing hypertension. When evaluating the relationship between alcohol consumption and the risk of hypertension for heavy drinkers, the risk due to alcohol drinking may be underestimated through changes in body weight.
Abstract MP29: Ready-to-Eat Food Environment and Risk of Incident Type 2 Diabetes: A Prospective Cohort Study
Authors: Li Xiang , Kou Minghao , Xue Qiaochu , Ma Hao , Wang Xuan , Qi Lu
Published: May 2024

Introduction:
Access to environments providing ready-to-eat food has been linked with a higher prevalence of type 2 diabetes (T2D), however, no study has prospectively assessed the food environment with T2D incidence.

Hypothesis:
We hypothesized that being exposed to ready-to-eat food environments was prospectively associated with a higher risk of developing T2D.

Method:
The current study included 480,909 participants free of T2D at baseline from the UK Biobank. Individual food environment variables, including pubs or bars, restaurants or cafeterias, and fast-food outlets, were objectively measured within 1 km catchment areas of the residential street of the participants. A composite food environment variable was created as the sum of the density of all three individual food environment variables. Cox proportional hazard model was used to assess the prospective relationship between the ready-to-eat food environments and incident T2D.

Results:
During a median of 12 years of follow-up, a total of 28,762 T2D cases were documented. Being exposed to a higher density of ready-to-eat food environments was associated with a higher risk of developing T2D (
Table
): HR = 1.22 (95% CI: 1.16-1.27) for comparing the extreme categories of pubs and bars density; HR=1.05 (95% CI: 1.00-1.10) for restaurants and cafeterias, and HR=1.14 (95% CI: 1.09-1.18) for fast-food outlets. Being exposed to the highest density of a composite food environment was associated with a 26% higher risk of developing T2D (HR=1.26, 95% CI: .1.19-1.33). In addition, we found that the higher T2D risk associated with exposure to ready-to-eat food environments was more pronounced among women than men (p-interaction=0.025).

Conclusions:
Our results indicate that exposure to ready-to-eat food environments is associated with an increased risk of developing T2D.
Abstract MP30: Sugar-Sweetened Beverages, Fruit Juices, and Whole Fruits Throughout Childhood and Adolescence and Glycemic Outcomes in Late Adolescence in Project Viva
Authors: Harnois-Leblanc Soren , Young Jessica G , Rifas-Shiman Sheryl L , Switkowski Karen M , Perng Wei , Aris Izzuddin M , Oken Emily , Hivert Marie-France
Published: May 2024

Objective:
To investigate sex-specific associations of sugar-sweetened beverages (SSBs), 100% fruit juices, and whole fruit intake throughout childhood and adolescence with insulin resistance and glycemic outcomes in late adolescence.

Methods:
We used data from Project Viva, an ongoing pre-birth cohort from eastern Massachusetts. We evaluated intake of SSBs, 100% fruit juices, and whole fruit at early childhood (median age: 3.1 yrs), mid-childhood (7.6 yrs) and early teen research visits (12.9 yrs) using food frequency questionnaires. We measured fasting blood glucose, insulin and glycated hemoglobin (HbA1c) levels in late adolescence (17.4 yrs). We estimated insulin resistance with the homeostasis model assessment for insulin resistance (HOMA-IR). We computed sex-specific linear regression models to estimate associations of average consumption of SSBs, fruit juice and whole fruit across the 3 childhood-early teen visits with late adolescence HOMA-IR, fasting glucose and HbA1c adjusting for demographics, socioeconomic status, mother BMI, child BMI z-score, and parental history of type 2 diabetes in early childhood (model 1), and additionally for lifestyle habits and diet quality in early childhood (model 2).

Results:
A total of 240 girls and 215 boys met eligibility criteria and had an outcome measure in late adolescence. Greater SSB intake throughout childhood and adolescence was associated with higher HOMA-IR, fasting glucose, and HbA1c in boys only (Figure). Also in boys, greater fruit juice intake was associated with higher HbA1c in late adolescence. Effect estimates in girls were of small magnitude and centered to the null, except for fruit juice and HbA1c with associations in the same direction as boys (Figure). We did not observe any association with respect to whole fruits for either sex.

Conclusion:
Findings suggest that SSBs and fruit juice consumption throughout childhood and adolescence are associated with less favorable glycemic traits in boys, suggesting greater risk of developing diabetes.
Abstract MP40: Associations Between Meal Timing and Sleep in Older Adults
Authors: Gupta Niket , Harrington Katharine , Chiluka Sindhu , Ansu Baidoo Velarie , Alexandria Shaina J , Knutson Kristen , Carnethon Mercedes R
Published: May 2024

Introduction:
Poor sleep health has been associated with increased risk and worse outcomes for a number of diseases such as cognitive dysfunction, dementia and Alzheimer’s disease. An emerging area of research has highlighted the association between dietary factors and sleep. Meal timing is one aspect of diet that has unclear effects on sleep. Few studies have examined this relationship in older adults, an important distinction because sleep architecture and dietary habits change significantly across the lifespan. By identifying the involvement of meal timing in sleep health, specific behavioral interventions can be developed for older adults with sleep-related morbidity.

Hypotheses:
We tested the hypothesis that a longer time duration between the last meal of the day and bedtime is associated with positive changes in sleep quality

Methods:
Forty-six healthy older adults (72% (33 of 46) female, 13% (6 of 46) Black, mean age=70.1 years) recruited from the community in Chicago were included in the analysis. Participants underwent sleep assessment with 7 days of sleep actigraphy, one night of sleep profiler, and sleep questionnaires. Two 24-hour diet recalls within 1 week were administered with the ASA24 tool to evaluate meal timing. The data was analyzed with linear regression models adjusting for age, sex, educational attainment, and BMI.

Results:
For every 1-hour increase in time from last meal to bedtime, sleep onset latency (SOL) increased by 7.4 minutes (SE=3.0, p=0.019), total sleep time (measured from actigraphy) decreased by 10.6 minutes (SE=4.4, p=0.022), and sleep midpoint was delayed by 17.5 minutes (SE=0.09, p=0.002). Other sleep measures showed no significant associations with time from last meal to bedtime.

Conclusions:
Meals consumed closer to bedtime were associated with shorter SOL, longer total sleep time, and delayed sleep midpoint in older adults. These findings suggest that meal timing may correlate with sleep, however further investigation with larger sample sizes should be done to clarify this link.
Abstract MP74: Ambient Temperature and Blood Pressure Are Associated in the Jackson Heart Study
Authors: Tan Annabel X , Chang Andrew Y , Shimbo Daichi , Bress Adam P , Sims Mario , Odden Michelle C
Published: May 2024

Extreme temperature events related to climate change may impact blood pressure (BP). Communities of color, especially African-American populations, are disproportionately affected by temperature extremes due to structural inequities. We assessed the association between ambient outdoor temperature and BP among participants in the Jackson Heart Study (JHS), a cohort of African American adults residing in the tri-county area of Jackson, Mississippi. We hypothesized that higher outdoor ambient temperatures would be associated with lower BP. The exposure was average outdoor ambient temperature in degrees Fahrenheit, obtained from Daymet Daily Surface Weather dataset for North America accurate to 1km of Jackson, MS. The two outcomes were systolic and diastolic blood pressure (SBP and DBP). A total of 5309 participants were included across 3 visits: Visit 1 (2000-2004), Visit 2 (2005- 2008), Visit 3 (2009-2013). We used a linear mixed effects model to determine the relationship between ambient temperature and SBP/DBP at three visits. Cardiovascular disease, diabetes, BP medication and visit number were included as adjustment variables. Age, sex, socioeconomic status (captured by level of education, income, and occupation), physical activity, history of cardiovascular disease, BP medications and perceived stress were conceptualized as effect modifiers. To account for non-temperature related seasonal variation in BP, we added season specific coefficients to SBP and DBP readings. The average temperature at each visit was 63.8°F (range: 24.5, 85.6), 64.3°F (range: 30.5, 87.8), 66.3°F (range: 21.9, 90.0), respectively. The average age at baseline was 55.3 years and 63% of the study population was female. For every 10 degrees higher temperature in Fahrenheit, SBP was 0.87 mm Hg (standard error: 0.097, p<0.001) and 0.83 mm Hg (standard error: 0.104, p<0.001) lower in unadjusted and adjusted models respectively. DBP was 0.49 mm Hg (standard error: 0.054, p<0.001) and 0.46 mm Hg (SE: 0.058, p<0.001) lower for every 10 degrees Fahrenheit higher temperature, in unadjusted and adjusted models, respectively. We did not find any significant interactions between the effect modifiers listed and ambient temperature. In conclusion, there was an association between higher ambient temperature and lower blood pressure, independent of season. This study is crucial in understanding how ambient temperature affects BP among African American adults. Greater temperature extremes could lead to greater fluctuation in BP levels with uncertain short and long-term health effects.
Abstract MP77: Both Racial/Ethnic Residential Segregation and Exposure to Outdoor Artificial Light at Night May Impact Cardiovascular Health but Perhaps Not Through Self-Reported Sleep
Authors: Gaston Symielle , Wilkerson Jesse , MacNell Nat , Jackson W. Braxton , Jackson Chandra
Published: May 2024

Introduction:
Due to structural racism, minoritized racial/ethnic groups are overrepresented in racially segregated areas of concentrated disadvantage in which residences may be less protective against outdoor artificial light at night (ALAN). Both racial/ethnic residential segregation (RRS) and ALAN are associated with disparities in both sleep duration, potentially through ALAN exposures in segregated areas disrupting melatonin production, and cardiovascular health (CVH). However, few studies have investigated pathways between RRS and ALAN, sleep, and CVH. We sought to investigate sleep duration as a potential mediator between RRS and ALAN exposures and CVH among US adults.

Hypothesis:
We hypothesized that (1) ALAN would disproportionately burden minoritized racial/ethnic groups, (2) sleep duration would mediate associations between both RRS and ALAN and CVH, and (3) associations would vary by race/ethnicity.

Methods:
We used data collected from 2011 National Health Interview Survey adult participants reporting sleep duration (short [<7 hours(h)]), recommended [7-9 h], long [>9 h]) and CVH (defined as yes vs. no to all: never/former smoking, BMI 18-<25 kg/m
2
, meets physical activity guidelines, and no prior diagnosis of dyslipidemia, hypertension, or pre-diabetes/diabetes). Participants’ home addresses were geographically linked to the 2012 American Community Survey 5-year estimates to assess RRS, measured by the local Getis-Ord G
i
* statistic (z-scores) categories: low (z<0), medium (0≤z≤1.96), and high (z>1.96). Quintiles of residential ALAN were estimated from 2010-2011 US Defense Meteorological Satellite Program’s Operational Linescan System values. We used robust Poisson regression adjusted for sociodemographic characteristics, estimated mediation through sleep duration with the Sobel’s test, and assessed effect modification by race/ethnicity.

Results and Conclusions:
Among 18,057 participants (mean age±SE =45±0.2 years); 35%, 44%, and 21% resided in low, medium, and highly segregated neighborhoods, respectively. ALAN was highest among non-Hispanic White adults. Prevalence of short and long sleep duration overall were 31% and 3% and highest among Black adults (39% and 4%). High (vs. low) RRS was associated with a higher prevalence of CVH (PR=1.13 [95% CI:1.01-1.26]). However, higher ALAN (Q5 vs. Q1) was associated with a lower prevalence of CVH (PR=0.79 [95% CI:0.66-0.95]). Sleep did not appear to mediate associations, which did not vary by race/ethnicity. In conclusion, self-reported sleep did not mediate associations between RRS or ALAN and CVH. Nonetheless, further study using objective measures is warranted given the biological plausibility. The findings/conclusions in this research are those of the authors and do not necessarily represent the views of the Research Data Center, National Center for Health Statistics, or CDC.
Abstract P100: Global Burden of Atrial Fibrillation and Atrial Flutter and Its Trend From 1990-2019 in G20 Countries: Results From the GBD 2019
Authors: MADHU Krupa ishan , Alziadin Nmair , Dadhania Khush , Banala Mallareddy , Gadamidi Vinay Kumar , Thota Anjani Kumar , VEMPARALA Priyatha , Parisapogu Anusha , PATEL Juhi , Desai Hardik Dineshbhai
Published: May 2024

Background:
Atrial Fibrillation and Atrial Flutter (Afib) ranks 6th in mortality and 7th in disability amongst all cardiovascular disease the G20 nations.

Method:
We employed 2019 Global Burden of Disease methodology. Afib and Flutter, non-fatal health outcomes, such as incidence and prevalence, were estimated using the Bayesian meta-regression tool (DisMod MR 2.1). Fatal health outcomes were assessed using the Cause of Death Ensemble Model (CODEm), considering factors like age, gender, year, and location throughout the G20 from 1990 to 2019.

Results:
From 1990 to 2019, prevalence rose from 23.2 million (95%UI: 17.6-29.7) to 48.9 million (37.5-61.6). The annual percentage change (APC) in incidence surged by 102% (1.8-3.8 million), DALYs by 119% (3-6 million), and deaths by 168% (93,864-251,272). Despite these increases, the age-standardized rate per 100,000 person-years declined over the past three decades. In 2019, the U.S. reported the highest age-standardized incidence rate at 109.52 (88.97-131.92) per 100,000, while Sweden had the top mortality rate of 8.63 (4-10.32) per 100,000. The age group 65-69 had the peak incidence count of 700,768 (362,032-1,158,177). Meanwhile, the highest death count was in the 85-89 age bracket with 59,325 (48,618-70,077), and the most DALYs were in the 80-84 age group with 1,083,488 (882,995-1,323,533) in 2019. Males consistently faced a higher burden than females over this period.

Conclusion:
AFib and AF accounted for 1.88% deaths amongst all cardiovascular casualties in 2019. Clinicians in the G20 countries must prioritize early detection and intervention for Afib and flutter, especially in males and the elderly, given its escalating prevalence and its ranking as a major cause of death and disability. Public health strategies in the G20 nations should focus on targeted awareness and interventions to combat the rising burden of atrial fibrillation, with countries like the United States and Sweden requiring heightened attention due to their notably high incidence and mortality rates.
Abstract P136: Trends in Ultra-Processed Food Consumption Among US Adults With Prediabetes and Diabetes, 2001-2018
Authors: Guo Zijing , Wallace Amelia S , Rooney Mary R , Wang Dan , Rebholz Casey M , Steele Eurídice M , Garcia-Larsen Vanessa , Wolfson Julia A , Matsuzaki Mika , Selvin Elizabeth , Fang Michael
Published: May 2024

Background:
For individuals with prediabetes and diabetes, the Centers for Disease Control and Prevention recommends consuming more whole foods rather than highly processed foods as part of the everyday diet. Trends in ultra-processed foods (UPFs) consumption among adults with diabetes and prediabetes in the general population are uncharacterized.

Methods:
We conducted a serial cross-sectional analysis of data in adult participants (aged 20+) in the National Health and Nutrition Examination Survey (NHANES) cycles 2001-2018 (N=76,815). We defined diabetes as either a HbA1C >=6.5% or self-reported diabetes diagnosis and prediabetes as a HbA1C 5.7 – <6.5% and no self-reported diabetes diagnosis. Foods were classified using the NOVA classification system. We characterized the mean percent of total energy intake from UPF and minimally processed foods for adults by diabetes status from 2001-2018, and assessed time trends with linear regression.

Results:
Approximately 15% of the adults in this sample have prediabetes while 8% of the adults have diabetes. UPF consumption was >50% of total energy intake in all survey cycles. From 2001 to 2018, UPF consumption increased for adults with diabetes (51% to 56%, p=0.001), prediabetes (54% to 57%, p=0.009), and no diabetes (53% to 56%, p=0.027)
(Fig, A-C)
. Over the same period, minimally processed food consumption decreased for adults with diabetes (37% to 29%, p<0.001), prediabetes (34% to 28%, p<0.001), and no diabetes (32% to 27%, p<0.001)
(Fig, D-F)
.

Conclusion:
UPF consumption increased among adults with diabetes, prediabetes, and those without diabetes between 2001-2018. Since consuming UPF is linked with poor health outcomes including diabetes and cardiovascular diseases, there should be strategies and interventions designed to enhance overall diet quality for all persons, particularly those with prediabetes and diabetes.
Abstract P144: 1,5-Anhydroglucitol as a Marker of Hyperglycemic Excursions Defined by Continuous Glucose Monitoring in Older Adults
Authors: Malek Natalie D , Fang Michael , Shin Jung-Im , Coresh Joe , Pankow Jim S , Lutsey Pamela L , Valint Arielle , Echouffo Justin B , Selvin Elizabeth
Published: May 2024

Background:
Low levels (≤6 μg/mL) of serum 1,5-anhydroglucitol (1,5-AG) are thought to reflect periods of hyperglycemia. During periods of hyperglycemia, 1,5-AG competes with glucose for reabsorption in the kidney and is excreted in the urine, resulting in low serum concentrations of 1,5-AG. However, the performance of 1,5-AG to identify hyperglycemic excursions detected by continuous glucose monitoring (CGM) is unknown.

Methods:
We conducted a cross-sectional analysis of participants with diabetes in the Atherosclerosis Risk in Communities Study who wore a CGM sensor in 2021-2022 for up to 2 weeks. We evaluated the performance of 1,5-AG, modeled continuously and dichotomously (≤6 μg/mL, >6 μg/mL), to identify CGM derived metrics of hyperglycemia. Hyperglycemic excursions were defined as percent time spent with CGM glucose above 140 mg/dL, area under the curve (AUC) >140 mg/dL*minute, peak (maximum) CGM glucose, and the coefficient of variation (CV).

Results:
Among 322 participants with diabetes (mean age 83, 55% female), 22% had 1,5-AG≤6 μg/mL. The median CGM wear time was 13.9 days. The mean CGM glucose was 125 mg/dL (SD, 28) among those with 1,5-AG>6 μg/mL and 156 mg/dL (SD, 45) among those with 1,5-AG≤6 μg/mL. 1,5-AG was inversely associated with percent of time CGM glucose >140 mg/dL (
Figure
), AUC >140 mg/dL (Pearson correlation,
r
=-0.25), peak CGM glucose (
r
=-0.41) and CV (
r
=-0.25). Individuals with 1,5-AG≤6 μg/mL spent 5.5 hours more per day above 140 mg/dL compared to those with 1,5-AG>6 μg/mL.

Conclusion:
1,5-AG is correlated with CGM-defined hyperglycemia. Low levels of 1,5-AG identify older adults with diabetes experiencing glycemic excursions.
Abstract P159: Echocardiographic Cardiac Phenotype in Val122Ile Variant Transthyretin Amyloidosis Among Hispanics/Latinos: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Pandey Ambarish , Duran Luciano Priscilla , Swett Katrina , Kaplan Robert , Talavera Gregory A , Daviglus Martha L , Schneiderman Neil , Hurwitz Barry E , Shah Sanjiv J , Sofer Tamar , Solomon Scott D , Cheng Susan , Aviles-Santa Larissa , Parada Humberto , Thyagarajan Bharat , Gonzalez Franklyn , Kansal Mayank M , Tauras James M , Maurer Mathew S , Rodriguez Carlos J
Published: May 2024

Background:
Transthyretin amyloidosis, most often caused by Val122Ile mutation, is linked to a higher risk of heart failure (HF) and mortality. Subclinical abnormalities in cardiac structure and function linked to Val122Ile mutations are less well defined in Hispanics/Latinos. We studied the cardiac phenotype of Hispanic/Latino Val122Ile carriers versus non-carriers.

Methods:
Val122Ile carrier status was determined with genome-wide data. We analyzed echocardiographic data from adults 45 years or older (unweighted n= 6376) from HCHS/SOL and the Echocardiographic Study of Latinos, Echo-SOL. Measures of cardiac structure and function
(Table)
were compared among Val122Ile carriers and non-carriers using age-and-sex-adjusted least square means (continuous variables) and proportions (categorical variables). Prevalence of pre-HF, identified by the presence of at least one abnormal echocardiographic parameter, was also compared among those with vs. without Val122Ile mutation. Complex survey statistics and sample weights are utilized for all analyses.

Results:
Val122Ile carriers (0.8%; unweighted n= 40) were younger (mean ±SE, 55.5 years ±1.7), had higher systolic blood pressure (mean ±SE, 130 mmHg ±3.6), but lower body mass index (mean ±SE, 28.5 kg/m
2
±1.4) than non-carriers, p <0.0001. Lower mean values of left ventricle (LV) ejection fraction, LV end diastolic volume, right ventricle (RV) fractional area change, lateral peak e’ velocity and lower pre-HF prevalence was seen among carriers vs non-carriers. Val122Ile carriers also had higher LV mass, worse concentric remodeling, and worse measures of diastolic function than non-carriers. Most measures of RV function were higher among carriers vs non-carriers
(Table)
. However, none of the differences found in cardiac phenotype of carriers vs non-carriers were statistically significant (p >0.05).

Conclusion:
There is a lack of difference in the echocardiographic cardiac phenotype among Hispanic/Latinos who carry the Val122Ile mutation versus non-carriers.
Abstract P170: Cognitive Function at Midlife by Sexual Orientation and Gender Identity in the CARDIA Cohort
Authors: Kawles Allegra , Slone B. R. , Avila Grace V , Mather Molly A , Bhatt Ankeet , Shikany James M , Lewis Cora E , Schreiner Pamela , Sorond Farzaneh A , Yaffe Kristine , Janulis Patrick , Gefen Tamar , Beach Lauren B
Published: May 2024

Introduction:
Sexual and gender minority (SGM) individuals have higher prevalence of dementia risk factors compared to non-SGM individuals. However, it is not known if differences in cognitive function appear during midlife, as prior studies lack comprehensive measures for sex, sexual orientation, and gender identity (SSOGI) or standardized cognitive assessments. We utilized Coronary Artery Risk Development in Young Adults (CARDIA) study data to assess midlife cognition by SSOGI.

Hypothesis:
We hypothesize that middle-aged sexual minority (SM) and transgender and non-binary (TGNB) participants demonstrate worse cognitive test scores compared to non-SM and non-TGNB participants, respectively.

Methods:
A total of 1,978 CARDIA participants completed cognitive assessments at Y25 and self-reported SSOGI measures at Y35. Participants with a history of brain cancer, kidney failure, or stroke prior to Y25 were excluded. Y25 examination included administration of standardized cognitive assessments of verbal memory (Rey Auditory Verbal Learning Test; RAVLT), processing speed (Digit Symbol Substitution Test; DSST), and executive function (Stroop Test). SSOGI variables are listed in
Table 1
. Wilcoxon t-tests were used to compare cognitive test scores between analytic subgroups.

Results:
Mean age of the overall cohort at Y25 was 45 (SD = 3.6) years and 43% identified as Black. TGNB individuals performed significantly worse on a memory recall portion of the RAVLT (
p
<0.001) and DSST (
p
<0.05) compared to non-TGNB individuals. There was no significant difference in cognitive test scores between SM and non-SM and gay/lesbian and bisexual individuals. See
Table 1
for statistical results.

Conclusions:
Preliminary findings suggest TGNB individuals may demonstrate lower midlife cognitive performance related to verbal memory and processing speed compared to non-TGNB individuals. Future studies will analyze associations of depression and chronic conditions with cognitive scores and expand to later CARDIA time points.
Abstract P176: Consumption of Sugar-Sweetened Beverages Lowers Lipoprotein(a) Levels in Obese and Overweight Adults: Findings in a Double-Blind Parallel-Arm Study
Authors: Law Hayley , Stanhope Kimber L , Zhang Wei , Jamshed Zahraa , Myagmarsuren Munkhtuya , Khan Muhammad , Bang Heejung , Havel Peter J , Berglund Lars , Byambaa Enkhmaa
Published: May 2024

Elevated levels of lipoprotein(a) [Lp(a)] are a genetically regulated, causal, and prevalent risk factor for atherosclerotic cardiovascular disease. A size polymorphism in the apolipoprotein(a) [apo(a)] gene, determined by the number of Kringle (K) repeats, inversely regulates Lp(a) plasma levels. Despite strong genetic regulation, non-genetic factors such as diet influence Lp(a) levels. However, the relationship between Lp(a) level and sugar consumption remains understudied. In this double-blinded parallel arm study, we investigated the effect of consuming glucose- or fructose-sweetened beverages providing 25% of energy requirements for 10 weeks on plasma Lp(a) levels in 32 overweight/obese adults. Lp(a) levels were measured using an apo(a) size insensitive ELISA and apo(a) isoform sizes were determined by Western blotting. The mean (SD) age of participants was 54 ± 8 years, 50% were women, and 75% were of European descent. The mean body mass index was 29 ± 3 kg/m
2
and 28% of participants had metabolic syndrome. In all participants, baseline median Lp(a) level was 10.3 mg/dL (IQR: 4, 28 mg/dL). At the end of the 10-week intervention, Lp(a) levels were reduced by an average of -4 mg/dL (-13%) in all participants, by -4 mg/dL (-15%) in the glucose group (n=15) and by -5 mg/dL (-11%) in the fructose group (n=17), respectively. The mean percent changes in Lp(a) levels in the low (≤25 mg/dL) (n=23) vs high (>25 mg/dL) (n=9) baseline Lp(a) groups were similar: -14% (-2 mg/dL) vs -11% (-11 mg/dL), respectively. Notably, the carrier status of an atherogenic small (≤22K repeats) apo(a) size did not substantially impact Lp(a) responses as the mean Lp(a) changes were similar in carriers (-15%) (n=8) vs non-carriers (-13%) (n=24). In conclusion, in overweight/obese adults, consuming sugar-sweetened beverages providing 25% of energy requirements for 10 weeks reduced Lp(a) levels by ~13% independent of apo(a) size variability. The findings suggest that pathways involving carbohydrates and fatty acid metabolism might potentially impact Lp(a) levels. The specific mechanisms underlying the effect of sugar-sweetened beverage consumption to reduce circulating Lp(a) levels warrant further investigation.
Abstract P181: Association Between Non-Alcoholic Fatty Liver Disease Risk SNP Variants and Lipid Metabolism
Authors: Ikezaki Hiroaki , Murata Masayuki , Shimono Nobuyuki , Schaefer Ernst J
Published: May 2024

Introduction:
The impact of non-alcoholic fatty liver disease (NAFLD) risk SNP variants on ipid metabolism in the general population has yet to be determined. We aimed to assess this association using a large prospective cohort study.

Methods:
A total of 1488 Japanese men and women (median age 62 years and median body mass index 24.7 kg/m2) free of cardiovascular disease were studied. Among NAFLD risk SNPs, variants of patatin-like phospholipase domain containing 3 (PNPLA3), transmembrane 6 superfamily member 2 (TM6SF2), glucokinase regulator (GCKR), and neurocan (NCAN) were assessed. Plasma total cholesterol, low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (sdLDL-C), LDL-triglycerides (LDL-TG), high-density lipoprotein cholesterol (HDL-C), HDL3-C, triglycerides (TG), lipoprotein(a), and adiponectin were measured at both baseline and after a five-year follow-up. Univariate and multivariate analyses, Kruskal-Wallis, Wilcoxon’s rank sum, and paired t-tests were performed to examine the associations between NAFLD risk SNPs and lipoproteins.

Results:
All of the measured lipoproteins increased significantly over the 5 years. The TM6SF2 variant did not affect lipoproteins at baseline. However, after 5 years, the non-major allele group had significantly lower HDL-C and HDL3-C and significantly higher LDL-C, sdLDL-C, and LDL-TG than the major allele group. For the GCKR variant, TG, LDL-C, sdLDL-C, and LDL-TG were significantly higher in the non-major allele group at baseline; LDL-C, sdLDL-C, and LDL-TG were still significantly higher in the non-major allele group at 5 years than the CC group. The PNPLA3 and NCAN variants did not affect lipoproteins in this study.

Conclusions:
NAFLD risk SNP variants might influence atherogenic lipoprotein metabolism.
Abstract P183: Cholesterol Ester 18:2 is an Exercise Inducible Metabolite Associated With a Favorable Cardiometabolic Profile
Authors: Leszczynski Eric , Dev Prasun K , Barber Jacob , Rao Prashant , Mi Michael , Ghosh Sujoy , Clish Clary , Bouchard Claude , Robbins Jeremy , Gerszten Robert E , Sarzynski Mark A
Published: May 2024

Background:
Prospective cohort studies have shown plasma cholesterol ester (CE) 18:2 is inversely associated with all-cause and cardiovascular mortality. However, less is known about the association of CE18:2 with cardiometabolic risk factors and whether it is responsive to regular exercise.

Methods:
A total of 193 known plasma lipids, including 11 CEs, were measured using the C8-positive LC-MS method in 671 participants from the HERITAGE Family Study (56% Female, 35% Black, 35 yrs) before and after a 20-week exercise intervention. Linear mixed models were used to test the associations of all lipids with 6 cardiometabolic traits at baseline and post-training adjusting for age, sex, and race, with post-training models also adjusted for baseline lipid and trait values. Paired t-tests were used to test the difference in CE18:2 abundance before and after exercise training.

Results:
Out of the 193 lipids, CE18:2 was consistently among the top 2 associations with each cardiometabolic trait at baseline (
Table 1
). Levels of CE18:2 were inversely associated with triglycerides, visceral fat, glycA, and small LDL, while positively associated with HDL-C and insulin sensitivity. Importantly, CE18:2 abundance was increased following the exercise intervention (p=0.0003). Exercise-induced change in CE18:2 was significantly (FDR<0.05) associated with concomitant changes in all traits except visceral fat in the same directions as baseline, with CE18:2 among the top 3 associations with each training response trait (
Table 1
).

Conclusions:
Plasma CE18:2 levels were associated with cardiometabolic traits in a favorable direction both before and after an exercise intervention. Thus, this plasma lipid may be an exercise inducible metabolite that is indicative of improvements in cardiometabolic health. However, additional studies are needed to confirm the observed findings and determine the mechanisms underlying these beneficial associations.
Abstract P189: Optimal Measures of Carbohydrate Quality to Reduce the Risk of Type 2 Diabetes
Authors: Alessa Hala B , Sawicki Caleigh M , Willett Walter , Bhupathiraju Shilpa , Hu Frank B
Published: May 2024

Introduction:
A plethora of indices have been investigated as optimal measures of carbohydrate quality in relation to risk of type 2 diabetes (T2D), but a systematic comparison has not been conducted.

Hypothesis:
We hypothesized that not all carbohydrate quality indices are equally associated with the risk of T2D.

Methods:
We investigated associations between twenty-two carbohydrate quality variables and T2D risk among 212,883 US adults with up to 32y of follow-up in the ongoing Nurses’ Health Study (NHS), NHS II, and the Health Professionals Follow-up Study. We used multivariable and BMI-adjusted Cox proportional hazards regression models.

Results:
Cereal fiber (comparing extreme quintiles of intake, RR:0.82, 95% CI:0.78, 0.87), whole fruit carbohydrates (RR:0.82, 95% CI:0.78, 0.87), glycemic index (RR:1.18, 95% CI:1.12, 1.24), and sugar-sweetened beverage (SSB) sugar (RR:1.23, 95% CI:1.17, 1.29) had the largest observed risk estimates of T2D (all P-trend<0.001). In addition, dietary glycemic load, starch, starchy vegetables, and potato and legume carbohydrates were positively associated (RR’s= 1.07 - 1.14), while whole grain carbohydrate intake was inversely associated with risk of T2D (RR= 0.94). Total and refined grain carbohydrates, added sugar, and non-starchy vegetables were not associated with risk of T2D. Ratios of carbohydrate or starch to total fiber or cereal fiber were all positively associated with risk of T2D (RR’s=1.11 - 1.33). The alternate Carbohydrate Quality Index (aCQI) (RR:0.73, 95% CI:0.69, 0.77) was more strongly associated with risk of T2D than the original CQI (RR:0.90, 95% CI:0.85, 0.95; both P-trend<0.001).

Conclusion:
Although many indices were associated with risk of T2D, higher intakes of cereal fiber and whole fruit carbohydrates, and lower intakes of glycemic index and sugar-sweetened beverage sugar had the lowest risk of T2D. The aCQI, comprising these four dietary variables and whole-grain carbohydrates, was strongly associated with risk of T2D and warrants further investigation.