bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 034: A Healthy Lifestyle Score Including Sleep Duration And Risk Of Cardiovascular Disease
Authors: Guasch-Ferré Marta , Li Yanping , Bhupathiraju Shilpa N , Huang Tianyi , Drouin-chartier Jean-Philippe , Manson Joann E , Sun Qi , Rimm Eric , Rexrode Kathryn M , Willett Walter , Stampfer Meir J , Hu F
Published: May 2021

Objectives:
The aim of this study was to evaluate the relationship between a lifestyle score including sleep duration and CVD risk, and to estimate whether adding sleep duration into a traditional lifestyle score improved CVD risk prediction.

Methods:
A prospective analysis was conducted among 67250 women in the Nurses’ Health Study and 29279 men in the Health Professionals Follow-up Study who were followed from 1986 to 2016. The traditional lifestyle score was defined as not smoking, normal BMI(18.5-24.9 kg/m
2
), ≥30 min/d of moderate physical activity, higher diet quality (top 40% of AHEI), moderate alcohol intake (women:5-15g/day; men:5-30g/day). Low-risk sleep duration, defined as sleeping ≥6 to <8 hours/day, was included as an additional component. Cox proportion hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of CVD, CHD, and stroke. We used the likelihood ratio test and C-statistics to compare the predictive value of the two scores.

Results:
A total of 11826 incident CVD cases were documented. In multivariable-adjusted models, each low-risk factor was independently and significantly associated with lower risk of CVD, CHD, and stroke. The multivariable-adjusted HRs (95% CIs) comparing six with zero low-risk factors in the healthy lifestyle score were 0.17(0.12, 0.23) for CVD, 0.15(0.10, 0.22) for CHD, and 0.19(0.12, 0.33) for stroke. Approximately 67% of CVD and CHD cases, and 62% stroke cases were attributable to poor adherence to a healthy lifestyle.
P-
value for likelihood ratio test comparing nested models including the traditional lifestyle score
vs
traditional lifestyle score plus sleep duration was <0.001. Adding sleep duration to the traditional score prediction model increased the C-statistics from 0.63 (95% CI: 0.62, 0.63) to 0.64 (95% CI: 0.63, 0.65)(
P
<0.001).

Conclusions:
Incorporating sleep duration into traditional lifestyle scores improves prediction of CVD risk and warrants consideration for inclusion in lifestyle recommendations.
Abstract 037: History Of Weight Cycling Is Prospectively Associated With Shorter And Poorer Quality Sleep, And Higher Sleep Apnea Risk In Diverse Us Women: Results From The AHA Go Red For Women Strategically Focused Research Network
Authors: Cao Vivian , Makarem Nour , Maguire Moorea , Samayoa Ivan , Xi Huaqing , Liang Citina , Aggarwal Brooke A
Published: May 2021

Introduction:
Poor sleep and history of weight cycling (HWC) are associated with worse cardiovascular health, yet limited research has evaluated the association between HWC and poor sleep patterns.

Hypothesis:
We hypothesized that HWC would be associated with poor sleep in US women.

Methods:
The AHA Go Red for Women Strategically Focused Research Network cohort at Columbia University (n=506, mean age 37 ± 15.7y, 61% racial/ethnic minority) was used to evaluate cross-sectional associations of HWC and sleep characteristics at baseline, and prospective associations of HWC from baseline with sleep measures at 1-yr. HWC, defined as losing and gaining ≥ 10 lbs at least once (excluding pregnancy), and number of WC episodes were self-reported. Sleep duration, measures of sleep quality, insomnia severity, and obstructive sleep apnea (OSA) risk were assessed using the validated Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Berlin questionnaire. Linear and logistic regression models, adjusted for age, race/ethnicity, education, health insurance status, pregnancy history, and menopausal status, were used to evaluate the relation of HWC with sleep.

Results:
Most women reported ≥1episode of weight cycling (72%). In linear models of cross-sectional and prospective data, each additional weight cycling episode was related to shorter sleep duration, poorer sleep quality, longer sleep onset latency, greater insomnia severity, more sleep disturbances and daytime dysfunction, lower sleep efficiency, and higher sleep medication use frequency. In logistic models, HWC (≥1 vs. 0 episodes) was associated with greater odds for short sleep, poor sleep quality, long sleep onset latency ≥26 min, high OSA risk, and sleep efficiency<85% (
Table
).

Conclusion:
HWC predicted poor sleep among women, suggesting that weight maintenance may represent an important strategy to promote sleep health. Long-term studies are needed to disentangle the complex relations between weight fluctuations and sleep across the life course.
Abstract 039: Insomnia And Short Sleep Uniquely Predict Obesity, Hypertension, And Diabetes
Authors: Knowlden Adam , Grandner Michael A
Published: May 2021

Background:
Epidemiological evidence of short sleep’s (<6 hours) association with negative cardiometabolic health outcomes continues to mount; yet, the complex relationship between sleep and health is still not well-understood. Sleep problems, such as short sleep (SS) and insomnia (IN), are often analyzed as a singular construct at the population level; however, it has been proposed that, although these two sleep problems likely overlap, they are separate phenomena. The purpose of this study was to: (1) determine if SS and IN were independent constructs; and to (2) evaluate whether SS and IN predicted obesity, hypertension, and diabetes.

Methods:
Analyses were based on the 2015-2016 National Health and Nutrition Examination Survey (NHANES). NHANES employs a complex, multistage, probability sampling design to survey a representative sample of non-institutionalized U.S. adults (≥18 years). Data related to short (<6), normal (7-8), and long (9+) sleep duration, insomnia (present: mild, moderate, severe), hypertension (present: previous hypertension/hypertension medications/blood pressure in the hypertensive range), and diabetes (present: history of diabetes/fasting blood sugar of 130+) were extracted for analysis. Age, sex, and obesity (body mass index, 30.0+) were entered as covariates into the models.

Results:
Among the subjects, 0.08% were normal sleepers with IN; 0.21% were SS with insomnia; and, 0.59% had IN with SS. Table 1 summarizes the multivariate and stratified logistic regression models of SS and IN predicting obesity, hypertension, and diabetes.

Conclusions:
Findings from this study suggested SS and IN are independent constructs, uniquely predicting obesity, hypertension, and diabetes. SS and IN neither mediated nor moderated one another, implying these two sleep outcomes are not additive in nature, but are instead separate health problems. The distinction between SS and IN may have important epidemiological and clinical implications.
Abstract 040: Bedscales: Non-Contact Home Health Monitor For Longitudinal Characterization Of Periodic Breathing In Chronic Heart Failure
Authors: Zhang Claire , Harrington Nicholas , Owens Robert L , King Kevin R
Published: May 2021

Periodic breathing (PB), including its subtype Cheyne-Stokes respiration, is a pattern of sleep-disordered breathing marked by cyclic modulations in tidal volume and respiratory rate. PB is commonly identified in patients with chronic heart failure (CHF), and portends a worse prognosis. Due to the impracticality of existing monitoring methods, no longitudinal data exist on whether individual patients may experience prognostically significant fluctuations in PB. Here, we present a novel tool enabling long-term in-home investigation of PB. By passively capturing respirations during sleep via mechanical sensors placed under the legs of a bed, the need for patient compliance is circumvented. PB events were identified by computing an amplitude modulation index, and features including respiratory rate, cycle length, and hyperpnea duration were extracted. To demonstrate viability for longitudinal studies, devices were installed in the homes of 25 CHF patients to continuously record respirations, 9 of whom were found to exhibit PB. In an illustrative case, ~15,000 cycles of PB were captured over 3 months in a patient discharged after hospitalization for heart failure with reduced ejection fraction. Bedscales documented the patient’s worsening tachypnea accompanied by changes in PB parameters (shortened cycle and hyperpnea durations). A chest X-ray showed evidence of pneumonia and antibiotics were prescribed, after which tachypnea improved and trends of PB parameters reversed. This case highlights the potential utility of Bedscales in detecting subtle deviations from an individual’s baseline respiratory signatures; future work is needed to assess the predictive power of these parameters. Taken together, these results demonstrate the feasibility of Bedscales as a low-cost, scalable tool for longitudinal population-level studies of PB in relation to chronic diseases such as CHF. Future research could examine whether such data might predict exacerbations and direct early intervention to prevent rehospitalization.
Abstract 041: Cardiovascular Disease, Hypertension, Diabetes And Cystatin C Jointly Predict Covid-19 Mortality Alongside Age, Male Sex And Black Ethnicity
Authors: Elliott Joshua , Bodinier Barbara , Whitaker Matthew , Tzoulaki Ioanna , Elliott Paul , Chadeau-Hyam Marc
Published: May 2021

Introduction:
Studies of risk factors for severe/fatal COVID-19 to date may not have identified the optimal set of informative predictors.

Hypothesis:
Use of penalized regression with stability analysis may identify new, sparse sets of risk factors jointly associated with COVID-19 mortality.

Methods:
We investigated demographic, social, lifestyle, biological (lipids, cystatin C, vitamin D), medical (comorbidities, medications) and air pollution data from UK Biobank (N=473,574) in relation to linked COVID-19 mortality, and compared with non-COVID-19 mortality. We used penalized regression models (LASSO) with stability analysis (80% selection threshold from 1,000 models with 80% subsampling) to identify a sparse set of variables associated with COVID-19 mortality.

Results:
Among 43 variables considered by LASSO stability selection, cardiovascular disease, hypertension, diabetes, cystatin C, age, male sex and Black ethnicity were jointly predictive of COVID-19 mortality risk at 80% selection threshold (Figure). Of these, Black ethnicity and hypertension contributed to COVID-19 but not non-COVID-19 mortality.

Conclusions:
Use of LASSO stability selection identified a sparse set of predictors for COVID-19 mortality including cardiovascular disease, hypertension, diabetes and cystatin C, a marker of renal function that has also been implicated in atherogenesis and inflammation. These results indicate the importance of cardiometabolic comorbidities as predisposing factors for COVID-19 mortality. Hypertension was differentially highly selected for risk of COVID-19 mortality, suggesting the need for continued vigilance with good blood pressure control during the pandemic.
Abstract 043: Community-level Social Determinants Of Covid19 Mortality In The Chicago Area
Authors: Sunderraj Ashwin , Yang Xiaoyun , Krefman Amy , Kershaw Kiarri N , Khan Sadiya , Allen Norrina B , Pool Lindsay
Published: May 2021

Introduction:
Since the onset of the COVID-19 pandemic, large geographic differences in mortality rates have emerged, with higher rates in predominantly Black and Latinx neighborhoods. In this analysis we examined community-level differences across the city of Chicago to better understand how geographic differences are associated with COVID19 mortality.

Hypothesis:
We hypothesized there would be an association between higher community-level social vulnerability and COVID19 mortality rates.

Methods:
We examined publicly available data from the Cook County Medical Examiner data (Illinois) of all known COVID-19 deaths as of August 21, 2020. Decedent addresses (N = 2397) were restricted to the city of Chicago, geocoded, and classified according to the 77 recognized community areas in the city. Poisson regression models were used to determine significant community-level predictors of COVID19 mortality based on community-level demographic, social, health, and healthcare characteristics collected from the Chicago Health Atlas.

Results:
There was at least one COVID19-related death in each Chicago community area, with a crude mortality rate ranging from 0.571 - 24.5 deaths per 10,000 persons. In the fully adjusted model with 14 community-level predictors, higher community-level population density, percentage of males, living in crowded housing, and limited food access were associated with higher rates of COVID19 mortality. Higher community-level proportion of the population aged 65+ years and having a primary care provider were associated with lower COVID19 mortality. Differences by Black and Latinx race/ethnicity community-level demographics were not significant in the final model.

Conclusions:
Community-level factors of greater social vulnerability (crowded living conditions, limited food access) are strong predictors of community-level COVID19 mortality. These factors may limit effective social distancing and increase the necessity to enter public areas, raising community-level COVID19 mortality.
Abstract 050: Maternal Risk Of Incident Embolism Following Hypertensive Disorders Of Pregnancy Or Pre-pregnancy Hypertension In South Carolina
Authors: Malek Angela M , Wilson Dulaney A , Turan Tanya N , Mateus Julio , Lackland Daniel T , Hunt Kelly J
Published: May 2021

Introduction:
Hypertensive disorders of pregnancy (HDP) and pre-pregnancy hypertension are associated with increased maternal morbidity and mortality, and information on racial/ethnic disparities is lacking. The association of HDP and pre-pregnancy hypertension with incident maternal embolism was examined within five years of delivery and for the study period (≤14 years) overall and by race/ethnicity.

Methods:
Women with a live, singleton birth in South Carolina (2004-2016) aged 12-49 years were included in a retrospective cohort study (n=433,625; non-Hispanic white [NHW; 58.7%], non-Hispanic black [NHB; 31.8%)] and Hispanic [9.5%]). HDP were defined by hospitalization/emergency department (ED) visit data (pre-eclampsia, eclampsia, gestational hypertension) or birth certificates (gestational hypertension). Pre-pregnancy hypertension was also defined by these data sources. Hospitalization/ED visit data and death certificates defined fatal and non-fatal incident embolism. Cox proportional hazards models were used with covariate adjustment.

Results:
In women with ≥1 pregnancy, 81.6% never experienced pre-pregnancy hypertension or HDP, 0.4% had pre-pregnancy hypertension without superimposed HDP, 15.7% had HDP alone, and 2.3% had pre-pregnancy hypertension with superimposed HDP. Incident embolism risk was elevated ≤14 years after delivery for women with HDP alone (HR=1.21, 95% CI: 1.12-1.30) and with pre-pregnancy hypertension with superimposed HDP (HR=1.44, 95% CI: 1.26-1.65) compared to neither condition. Pre-pregnancy hypertension alone was not associated with incident embolism risk (HR=1.23, 95% CI: 0.84-1.80). The table shows the joint impact of racial/ethnicity and the exposure categories.

Discussion:
Fatal and non-fatal embolism up to 14 years after delivery was increased for HDP regardless of pre-pregnancy hypertension suggesting a long-term impact. Incident embolism event rates were highest for NHB women and lowest for Hispanic women across all HDP exposure categories.
Abstract 060: Cardiovascular Disease Burden In A Psychiatric Outpatient Population
Authors: Dhingra Radha , He Fan , Saunders Erika F , Waschbusch Daniel A , Pearl Amanda M , Mukherjee Dahlia , Bixler Edward O , Greaney Jody L , Liao Duanping
Published: May 2021

Objective:
To understand the burden of cardiovascular diseases (CVDs) in a psychiatric outpatient population.

Methods:
We used baseline data from the ongoing Penn State Psychiatry Clinical Assessment and Rating Evaluation System (PCARES) Registry, which is comprised of adult patients who were seen at a psychiatric outpatient clinic affiliated with the Department of Psychiatry and Behavioral Health and the Penn State Milton S. Hershey Medical Center. The Electronic Medical Record (EMR) data from 3,024 patients who sought psychiatric care between 02/17/2015 and 09/18/2019 were included in this report. We compared the prevalence of CVDs and the mean levels of major CVD risk factors in our sample with that reported in the 2013-2016 National Health and Nutrition Examination Survey (NHANES).

Results:
The mean age of the study population was 42.7 (16.7) years, with 63% female and 85% Caucasians. The most common psychiatric diagnoses at baseline were Major Depressive Disorder [ICD-10: F32 & F33] (45%), Generalized Anxiety Disorder [ICD-10: F41.1] (20%), and Bipolar Disorder [ICD-10: F31] (12%). Eighteen percent of patients reported using tobacco products and 1.7% reported using alcohol. The prevalence (%) of CVDs, type 2 diabetes, hypertension, and dyslipidemia in our sample were 9.1, 20, 48, and 41%, respectively (all significantly higher than the NHANES reports, all p < 0.0001). The baseline means (mg/dl) of total cholesterol (C), LDL-C, HDL-C, and triglycerides (TG) were 186, 108, 48, and 156, respectively (all are significantly lower than that reported from the NHANES, except for TG, which was higher than that of the NHANES, all p < 0.0001), while 22% of all patients had prescriptions for lipid-lowering medications. Baseline mean level of glucose and HbA1C were 111 mg/dl and 6.2% (both significantly higher than that from the NHANES, p < 0.0001).

Conclusions:
In this systematic registry of psychiatric outpatients from a mid-Atlantic academic medical center, the baseline CVD burden as measured by common cardiovascular diseases, comorbidities and risk factors are significantly higher than the CVD burden in the general US population. Considering that the mean age of this patient population is 5 years younger than that of the NHANES population, our data underscores the need for control and prevention of CVD in patients with psychiatric conditions, and suggests the potential of integrating mental and physical health care in this type of special population.
Abstract MP03: The Health And Economic Impact Of Using A Sugar Sweetened Beverage Tax To Subsidize Fruit And Vegetable Purchase In New York City: A Modeling Study
Authors: Lou Zhouyang , Eom Heesun , Liu Junxiu , Yi Stella S , Russo Rienna , Bellows Brandon K , Zhang Yiyi , Moran Andrew E , Li Yan , Kong Nan
Published: May 2021

Background:
Both high sugar intake and low fruit and vegetable (FV) consumption increase the risk of coronary heart disease (CHD). Sugar-sweetened beverage (SSB) taxes can reduce sugar intake, whereas FV subsidies increase FV consumption. Several cities in the US have proposed an innovative policy that used the SSB tax revenue towards FV subsidies. It is unclear what the long-term health and economic impact this innovative policy could have in large cities such as New York City (NYC).

Objective:
To project lifetime CHDs averted and costs if a penny-per-ounce SSB tax were used to subsidize FV incentives in NYC using a validated microsimulation model of cardiovascular disease.

Methods:
We used the SHINE CVD model to compare the cost and CHD outcomes of a combination of SSB tax and FV subsidy policy with only SSB tax, only FV subsidy, and no policy from a healthcare sector perspective, respectively. Population demographics and health profiles were estimated using data from the 2013-2014 NYC Health and Nutrition Examination Survey. We simulated 10,000 adults starting at age 40. CHD risk factor trajectories and risk of incident CHD events were derived from six pooled prospective U.S. cohorts. Policy effects and price elasticity were derived from recent meta-analyses. SSB tax (penny-per-ounce) and FV subsidy were modeled to directly affect incidence rates of CHD events. Medical costs were included and discounted at 3%.

Results:
Compared to the non-policy scenario over the simulated lifetime, the SHINE CVD model projected that the policy intervention with SSB taxes only would prevent 62 per 10,000 (95% CI: 57 - 67) CHD events at a penny-per-ounce rate, the intervention with FV subsidies only would prevent 28 per 10,000 (95% CI: 24-34), and the combined policy would prevent 91 CHD events (95% CI: 87 - 96). Total medical cost savings over the simulation period ranged from $22.5 million (95% CI: $21.5 - $23.6 million), $13.1 million (95% CI: $12.3 - $13.8million), and $37.9 million (95% CI: $36.5 - $39.4million), or $0.45 million/year, $0.27 million/year, $0.75 million/year for SSB taxes only, FV subsidies only, and the combined policy, respectively.

Conclusion:
Using a computer simulation model, we showed how converting SSB tax revenues into FV subsidies could result in substantial benefits within the NYC population in terms of CHD outcomes and overall healthcare cost savings. Results from the SHINE CVD model may inform the ongoing policy-making efforts.
Abstract MP07: Metabolic Signature Improves Heart Failure Risk Prediction In Older Adults
Authors: Liu Guning , Nguyen Quynh , Agarwal Sunil K , Aguilar David , Boerwinkle Eric , Chang Patricia , Claggett Brian , Loehr Laura R , Matsushita Kunihiro , Rodriguez Carlos , Rossi Joseph , Russell Stuart D , Stacey Brandon , Heiss Gerardo M , Shah Amil , Yu Bing
Published: May 2021

Introduction:
Circulating metabolome profiling holds promise in predicting HF risk, but its prediction performance among older adults is not well established.

Hypothesis:
We hypothesize that metabolic signatures are associated with the risk of HF and its subtypes (HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)), and they can improve HF risk prediction beyond established risk factors.

Methods:
We measured 828 serum metabolites among 4,030 African and European Americans free of HF from the Atherosclerosis Risk in Communities (ARIC) study visit 5 (2011-2013). We regressed incident HF on each metabolite using Cox proportional hazards models. A metabolite risk score (MRS) was derived by summing individual metabolite levels weighted by beta coefficients estimated from least absolute shrinkage and selection operator (LASSO) regularized regressions. We regressed incident HF, HFpEF and HFrEF on the MRS. Harrell’s C-statistics were calculated to evaluate risk discrimination. We replicated the association between MRS and HF in 3,697 independent ARIC participants with metabolite measured at visit 1 (1987-1989).

Results:
Among 4,030 participants, the mean (SD) age was 76 (5) years. Adjusting for HF risk factors, 302 metabolites were associated with incident HF (false discovery rate < 0.05). One SD increase of the MRS, constructed from 51 metabolites selected by LASSO, was associated with two to three-fold high risk of HF, HFpEF and HFrEF in the fully adjusted models (
Table
). Five-year risk prediction analysis showed that C statistics improved from 0.850 to 0.884 by adding MRS over ARIC HF risk factors, kidney function and NT-proBNP (ΔC (95%CI) = 0.034 (0.017,0.052)). In the replication analysis, a more parsimonious MRS constructed using 15 metabolites, was associated with incident HF (
Table
).

Conclusions:
We identified a metabolic signature that was associated with the risk of HF and improved HF risk prediction. Our findings may shed light on pathways in HF development and at-risk populations.
Abstract MP14: The Effect Of Time-restricted Feeding On 24-hour Ambulatory Blood Pressure: Results From The Time-restricted Intake Of Meals (TRIM) Study
Authors: Turkson-Ocran Ruth-Alma N , Miller Edgar R , Zhao Di , Pilla Scott , Duan Daisy , Jaeger Byron , Muntner Paul , Clark Jeanne , Maruthur Nisa
Published: May 2021

Introduction:
Some studies suggest that time-restricted feeding may decrease blood pressure (BP), but the current evidence is inconclusive.

Objective:
To determine the effect of a time-restricted feeding pattern compared to a usual feeding pattern on ambulatory 24-hour BP in adults.

Hypothesis:
An isocaloric, time-restricted feeding pattern will lower 24-hour BP more than an isocaloric usual feeding pattern over 12 weeks.

Methods:
Forty-one persons with prediabetes (HbA1c 5.7-6.9%) and obesity (BMI 30-50 kg/m
2
) were randomized to consume 80% of their total calories before 1 pm (i.e., time-restricted feeding) or more than 50% of their calories after 5 pm (i.e., usual feeding) with identical macronutrient content. We used ambulatory BP monitoring to measure BP over 24-hours at baseline and 12-weeks. Outcomes of interest were mean systolic and diastolic 24-hr, daytime (7 am - 11 pm), and nighttime (11 pm - 7 am) BP. To examine the difference in BP patterns between time-restricted feeding and usual feeding pattern groups in change in BP outcomes from baseline to 12 weeks, we used linear mixed-effects regression models with participant-specific random intercepts and fixed effects for visit and intervention group. To assess whether feeding patterns affected BP levels over the 12 week intervention period, we tested whether there was an intervention-by-time interaction.

Results:
Thirty-five adults (mean age 60.4 years; 91% female, 91% African American) had sufficient data. We found reductions from baseline in systolic and diastolic BP for both groups for the 24-hour, daytime, and nighttime periods. The decrease in BP was larger in the usual feeding pattern group compared to the time-restricted feeding group (Table).

Conclusion:
Time-restricted feeding may attenuate the effect of a healthy isocaloric diet on BP compared to typical feeding patterns, and at this time, should not be recommended as a way to lower BP more than simply adopting a healthy diet.
Abstract MP16: A Behavioral Weight-loss Intervention, But Not Metformin, Decreases A Marker Of Gut Barrier Permeability In Adult Cancer Survivors With Overweight Or Obesity
Authors: Tilves Curtis , Yeh Hsin-Chieh , Maruthur Nisa , Juraschek Stephen , Miller Edgar R , Appel Lawrence J , Mueller Noel T
Published: May 2021

Background:
Serum lipopolysaccharide-binding protein (LBP), a surrogate biomarker for gut barrier permeability, is higher in adults with obesity and type 2 diabetes and may trigger inflammation. It is unknown whether a behavioral weight loss intervention or metformin — current first-line treatments for obesity or diabetes — can reduce gut permeability.

Objective:
To determine the effects of behavioral weight loss intervention or metformin, compared to self-directed weight loss, on serum LBP.

Methods:
SPIRIT was a parallel-arm, randomized trial of adult cancer survivors with overweight or obesity. Participants were randomized to a self-directed weight loss (control), metformin, or coach-directed (healthy diet/physical activity) weight loss arm. Of 121 randomized participants, a random subset (n=88) had LBP measured at baseline, 6-months, and 12-months post intervention. The effects of interventions on LBP over time were assessed using generalized estimating equations (GEE). Models were further adjusted for absolute change in fiber intake to investigate potential mediation.

Results:
Arms were balanced by sex (83% female), race (48% black), and age (mean 60 years). There were no between-group differences in LBP at baseline (median 42.3 μg/dL). Over the 12-month period, only the coach-directed and metformin arms showed weight loss (both mean -3% from baseline). Similar increases in LBP were seen in the self-directed and metformin arms, while a decrease in LBP was seen in the coach-directed arm (
figure
). In GEE models, the difference in slopes between the coach vs. self-directed arms was statistically significant (β=-1.67, p=0.037), but not between the metformin and self-directed arms (β=0.003, p=0.997). The effect of coach-directed weight loss on LBP was similar by sex and race and was not mediated by changes in fiber intake.

Conclusion:
The manner of weight loss can differentially impact gut permeability and thus subsequent exposure to proinflammatory microbial products.
Abstract MP18: Association Of Longitudinal Social Determinants Through Young Adulthood With Mid-life Cardiovascular Health: The Coronary Artery Risk Development In Young Adults (CARDIA) Study
Authors: Zimmerman Lindsay P , Kershaw Kiarri N , Rehkopf David H , Luo Yuan , Lloyd-Jones Donald M
Published: May 2021

Introduction:
Deeper understanding of the longitudinal associations of social determinants of health (SDOH) at younger ages with cardiovascular health (CVH) in middle age is needed to address persistent health disparities.

Methods:
We used repeated measures of individual and neighborhood-level SDOH data from CARDIA participants (ppts) to understand how SDOH change from ages 18-44 years. There were 48 diverse SDOH exposures measured. Using a novel, machine learning, sequential pattern mining method (Subgraph Augmented Non-negative Matrix Factorization), we identified clusters of time-dependent SDOH variables occurring in 5% or more of ppts. Clusters were then used as independent variables in logistic regression models to assess associations with CVH at age ≥45 years. CVH status was defined using the AHA’s Simple 7 metrics on diet, physical activity, smoking, BMI, cholesterol, blood pressure, and blood glucose, and summarized by a 14-point score (poor 0-7, moderate 8-11, high 12-14 points). We tested associations of clusters with the outcome of poor CVH at age ≥45 years, and identified the characteristics of significant SDOH clusters.

Results:
There were 3,522 ppts included (46.3% Black, 55.9% women; mean age 25.3 years at baseline). Mean CVH score (out of 14) was 10.4 ± 1.8 points at baseline and 8.9 ± 2.3 points at age ≥45 years; 483 ppts (13.7%) had high, 2026 (57.5%) had moderate, and 1013 (28.8%) had poor CVH in middle age. The best performing logistic model included 4 SDOH trend clusters (Table). SDOH Clusters 1, 2, and 3 were each associated with significant 50-80% lower odds of having poor CVH in middle age, whereas Cluster 4 was associated with 2.5-fold higher odds of poor CVH. The most informative variables over time comprising each SDOH cluster are also shown in the Table.

Conclusions:
Specific SDOH clusters through young adulthood are significantly associated with reaching mid-life with poor CVH status. Components of these SDOH clusters may be potential targets for social interventions and policies to improve CVH.
Abstract MP19: Academic-community Partnership To Evaluate The Effectiveness Of The Greater Boston Food Bank’s Healthy Pantry Program
Authors: Jia Jenny , Caty Rachel , Fiechtner Lauren , Zack Rachel , Thorndike Anne N
Published: May 2021

Background:
Food pantries are a significant nutrition source for food-insecure households. Traffic-light labeling is a new strategy in some pantries to help clients and staff identify healthier food choices. Healthy Pantry Program (HPP) is an online training designed by The Greater Boston Food Bank (GBFB) to teach staff of its affiliated pantries how to promote healthier choices by implementing traffic-light labels using Supporting Wellness at Pantries and behavioral nudges, such as placing healthy foods at eye level. Our academic research team partnered with GBFB to evaluate HPP by assessing if food pantries that participated in HPP increased their GBFB purchases of healthier (green and yellow) foods more than matched control pantries.

Methods:
We conducted an observational study of 107 food pantries in the GBFB network in eastern Massachusetts, including 10 pantries that completed HPP training and 97 control pantries matched by organizational characteristics and baseline food purchases. Five HPP pantries participated during Wave 1 (Oct 2018-Jan 2019), and 5 participated during Wave 2 (May 2019-Aug 2019). Outcomes were changes in percentage of pantries’ monthly green and yellow purchases from GBFB at 6-month (Waves 1 and 2) and 12-month (Wave 1 only) follow-ups compared to baseline purchases (6 months pre-HPP). We used a difference-in-differences analysis to examine whether HPP pantries increased green-yellow food purchases more than control pantries.

Results:
In Wave 1, HPP pantries had small but nonsignificant increases in green-yellow purchases at 6 and 12 months compared to matched controls (Table). In Wave 2, HPP and control pantries had similar increases in green-yellow purchases at 6 months.

Conclusions:
An online training implemented by a food bank to improve healthy choices in food pantries did not significantly improve pantries’ purchases of healthier foods. Academic-community organization partnerships to evaluate health promotion initiatives can help guide effective program design and development.
Abstract MP28: Social Isolation, Loneliness, And Cardiovascular Disease Among Older Women In The Women’S Health Initiative
Authors: Golaszewski Natalie M , Lacroix Andrea Z , Lamonte Michael J , Bellettiere John
Published: May 2021

Background:
Now more than ever is a critical time to understand the independent contributions social isolation and loneliness have on cardiovascular disease (CVD) events. This study examined the unique contribution social isolation and loneliness have on incidence of CVD among a large, diverse sample of postmenopausal women. Further, we examined whether levels of social support modified these relationships.

Methods:
Women with no prior history of CVD events (n=57,825; age 79±6) self-reported social activities, living alone, marital status, loneliness, and social support from 2014-2015 and were followed up-to 4 years for incident major CVD (myocardial infarction, stroke, and CVD death). Hazard ratios (HR) and 95% confidence intervals (CIs) for CVD were estimated for 1-interquartile range (IQR) increment in social isolation and loneliness using 3 progressively adjusted Cox proportional hazard models. Social support was tested as an effect modifier using a multiplicative interaction term in model 2 (see Table) separately for social isolation and loneliness.

Results:
Over a cumulative follow-up time of 186,762 person-years, 1,599 incident major CVD events were observed. In fully adjusted models containing both social isolation and loneliness, HRs (95% CIs) for 1-IQR increment in social isolation 1.07 (1.03 - 1.12) and loneliness 1.05 (1.01 - 1.09) (see Table). Social support was not an effect modifier of either association (p’s > .05).

Conclusions:
Higher social isolation and loneliness were each independently associated with higher risk for incident CVD events among older women and associations were not significantly different among those with high and low social support. Findings support emerging evidence regarding the importance of social connection on heart health. Future studies need to explore ways to reduce feelings of social isolation and loneliness, and the mechanisms through which that affects healthy cardiovascular aging and resiliency.
Abstract MP29: Combined Impact Of Chronic Kidney Disease And Hypertension On Lifetime Risk Of Cardiovascular Disease Death: A Pooled Analysis Of Data From The Evidence For Cardiovascular Prevention From Observational Cohorts In Japan Study
Authors: Imai Yukiko , Sakurai Masaru , Hideaki Nakagawa , Hirata Aya , Murakami Yoshitaka , Tanaka Sachiko , Kiyohara Yutaka , Ninomiya Toshiharu , Ishikawa Shizukiyo , Saitoh Shigeyuki , Irie Fujiko , Sairenchi Toshimi , Kiyama Masahiko , Miura Katsuyuki , Ueshima Hirotsugu , Okamura Tomonori
Published: May 2021

Introduction:
Those who are considered to be low risk in short term such as 10 year risk actually have high risk of cardiovascular disease for the remaining lifespan at younger age. Absolute risk of Lifetime risk (LTR) is more useful and understandable for lay audience compared with short term risk or relative risk. CKD (Chronic Kidney Disease) is global burden of cardiovascular disease (CVD) and hypertension is damaging complication of CKD for CVD. To date, there have been no reports of LTR with the outcome of CVD death based on CKD in Asian population.

Hypothesis:
We sought to estimate LTR of CVD death stratified by the status of CKD and hypertension.

Methods:
We used data from EPOCH-JAPAN (Evidence for Cardiovascular Prevention From Observational Cohorts in Japan) which is designed to pool data from nationwide and regional cohort studies in Japan. Modified Kaplan-Meier approach was used to estimate the remaining lifetime risk of cardiovascular death at each index age starting from 40 years according to CKD stratified by Hypertension. Participants were classified into four groups, which were those without CKD and hypertension (CKD-/HT-), those with CKD but without hypertension (CKD+/HT-), those without CKD but with hypertension (CKD-/HT+), and those with both CKD and hypertension (CKD+/HT+).

Results:
A total of 44,582 participants from 8 cohorts was included in the analysis. Mean follow-up period was 14.9 years with 662,488 person years and total CVD death was 1,035 in men and 1,160 in women. The LTRs at the index age of 40 years increased in groups with CKD and/or HT as follows: 12.6% (95% confidence interval: 9.4 - 14.5%) in CKD-/HT- group, 20.6% (11.4 - 25.9%) in CKD+/HT- group, 23.2% (19.9 - 25.2%) in CKD-/HT+ group, and 27.9% (21.7 - 32.9%) in CKD+/HT+ group for men; 11.3%(8.9 - 13.2%), 17.4%(13.2 - 20.4%) , 17.8%(15.3 - 19.8%) , and 22.7%(19.5 - 25.2%) for women.

Conclusions:
We observed that complication of CKD and hypertension are collectively responsible for lifetime risk due to CVD death. Management of blood pressure from an early age is important to reduce CVD mortality in CKD patients.
Abstract MP33: Cardiac Structure And Function Phenogroups And Risk Of Incident Heart Failure: Multi-ethnic Study Of Atherosclerosis
Authors: Hammond Michael M , Krefman Amy , Ning Hongyan , Allen Norrina B , Shah Sanjiv J , Yeboah Joseph , Lloyd-Jones Donald M , Khan Sadiya , Lima Joao , Reyfman Paul
Published: May 2021

Introduction:
Indices of cardiac structure and function, such as left ventricular (LV) mass and ejection fraction (EF), have individually been associated with development of incident heart failure (HF). Identifying HF risk groups (or phenogroups) based on imaging parameters may help inform distinct imaging phenotypes to target for prevention.

Objectives:
To identify phenogroups based on cardiovascular magnetic resonance imaging (cMRI) parameters in participants free of cardiovascular disease at baseline and examine longitudinal risk of incident HF.

Methods:
We included participants from the Multi-Ethnic Study of Atherosclerosis (MESA) who had completed baseline cMRI between 2000 and 2002. We applied latent class analysis to define phenogroups based on cMRI parameters of right ventricular and LV structure and function (including circumferential strain) at baseline (using the Bayesian Information Criterion as well as visual inspection). We used Cox-proportional hazard models to assess the association between membership in a phenogroup and risk of incident HF adjusted for age, sex, race, hypertension, diabetes, and hyperlipidemia.

Results:
Of 1484 participants, 48% were female and mean age was 65 (10) years. Over a median follow-up of 13 years, a total of 91 incident HF events occurred. We identified 3 distinct phenogroups that differed in terms of cardiac structure and function. Adjusted hazards ratio (95% confidence interval) for incident HF was higher among participants in Group 3 (2.08 [1.17, 3.71]) and Group 2 (2.24 [1.15, 4.37]), compared with Group 1 as the referent (
Table
).

Conclusion:
Phenogroups based on cMRI were differentially associated with risk of HF. Classification of cardiovascular imaging phenogroups integrating traditional and strain parameters within the normal range may be useful in identifying risk for HF; further validation is required before implementation.
Abstract MP34: The Association Between Periodontal Disease And Incident Heart Failure: The Atherosclerosis Risk In Communities Study
Authors: Molinsky Rebecca L , Norby Faye L , Yu Bing , Shah Amil M , Lutsey Pamela L , Pankow Jim , Ndumele Chiadi E , Papapanou Panos N , Colombo Paolo C , Yuzefpolskaya Melana , Beck James D , Demmer Ryan
Published: May 2021

Introduction:
Periodontal disease, resulting from inflammatory host-response to dysbiotic subgingival microbiota, has been associated with incident hypertension, heart attack, stroke and diabetes. Limited data exist investigating the prospective relationship between periodontal disease and incident heart failure (HF) and HF subtypes. We hypothesize that periodontal disease is associated with increased risk for heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).

Methods:
We studied 6,707 participants enrolled in the Atherosclerosis Risk in Communities Study who received a full-mouth clinical periodontal examination at visit 4 (1996-1998) and had longitudinal follow-up starting in 2005. Participants were classified as being periodontally healthy, having periodontal disease (based on the Periodontal Profile Classification (PPC)), or being edentulous. Hospitalization records were reviewed, and HF events were adjudicated and classified as HFpEF, HFrEF or HF of unknown ejection fraction (HFunknownEF) from 2005-2018. We used multivariable-adjusted Cox proportional hazards models to assess the association between periodontal disease or edentulism and incident HF.

Results:
Among participants 58% had periodontitis and 19% were edentulous. During a median follow-up time of 13 years, 1,178 cases of incident HF occurred (350 HFpEF, 319 HFrEF and 509 HFunknownEF). Periodontal disease and being edentulous were both associated with increased risk for both HFpEF and HFrEF (Table).

Conclusion:
Periodontal disease measured in mid-life was associated with both incident HFpEF and HFrEF. Adverse microbial exposures underlying periodontal disease might represent a modifiable risk factor for inflammation-induced heart failure pathophysiology.
Abstract MP36: The Development Of A Centralized Recruitment Process For Covid-19 Research: Hopkins Opportunity For Participant Engagement Registry
Authors: Ogungbe Oluwabunmi , Miller Hailey , Peeler Anna , Cassie Lewis-Land , Carey Scott , Lacanienta Cyd , Martinez Elizabeth , Singleton Megan , Gleason Kelly T , Keruly Jeanne , Ford Daniel , Dennison Himmelfarb Cheryl R
Published: May 2021

Introduction:
The COVID-19 pandemic has required urgent scientific response to investigate the disease, its prevention and treatment and interactions with cardiovascular conditions. Consequently, a centralized workflow was needed to effectively recruit, screen and connect volunteers to COVID-19 research opportunities.

Objective:
To create a centralized registry to match eligible and interested volunteers ≥18 years with COVID-19 outpatient research studies at an academic health system.

Methods:
Key stakeholders, including researchers and participant advocates, collaborated to build the Hopkins Opportunity for Participant Engagement (HOPE) Registry in English and Spanish. REDCap, a secure web-based application, served as the Registry platform. Study teams recruiting for outpatient studies were invited to present their studies through the Registry. Study volunteers were recruited using multiple methods, including patient portal messages, email, social media, and online advertisement. The Registry included COVID testing results and participant survey of demographic and COVID-19 related questions. Branching logic was used to pre-screen and present participating studies for which the person was eligible. The individual then selected which studies, if any, they were interested in. Study teams received an automatic notification and reached out directly to individuals expressing interest in their study (
Figure
).

Results:
The HOPE Registry includes 7 studies and has enrolled 4186 people. Over half (55%) were >55 years and the majority were female (64%). Racial/ethnic groups represented were Whites (80%), Black s (9%), Asians (4.7%), Hispanics (5%), and American Indian (0.3%). Participants were interested in: 29%, treatment study; 37%, vaccine study; and 66%, donating plasma. Within 10 weeks, 585 persons were matched with an actively recruiting study.

Conclusions:
The ongoing HOPE registry has shown promise in engaging individuals with COVID-19 research and improving research recruitment workflow.
Abstract MP42: Adherence To Healthy Dietary Patterns In Pregnancy And Placental Dna Methylation- An Epigenome Wide Association Study
Authors: Zhang Cuilin , Wu Jing , Ouidir Marion , Hinkle Stefanie , Ayele Fasil
Published: May 2021

Background:
Accumulating evidence support the intergenerational impacts of diet in pregnancy. The underlying mechanisms, however, remain unclear. Placental epigenetic mechanisms may be involved although data from human epidemiological studies are sparse. We aimed to investigate associations of dietary quality in pregnancy with epigenome-wide placental DNA methylation in a multiracial pregnancy cohort.

Methods:
DNA methylation was measured using the Illumina Infinium Human Methylation450 Beadchip on placentas obtained at delivery from 301 pregnant women who participated in the
Eunice Kennedy Shriver
National Institute of Child Health and Human Development Fetal Growth Studies-Singleton cohort. Dietary information during periconception and early first trimester was collected using food frequency questionnaires, and diet in the second and third trimester was collected using a 24-hour dietary recall during four study visits. Scores for adherence to three healthy dietary patterns, alternate Healthy Eating Index (aHEI), alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH), were calculated. For associations of each dietary pattern score with methylation, we conducted analyses using robust linear regression models after the adjustment for age, pre-pregnancy body mass index, race/ethnicity, physical activity, total energy intakes, and population stratification. Genes annotating the top significant CpG sites (false discovery rate (FDR) adjusted P<0.05) were queried for enrichment of functional pathways using the Ingenuity Pathway Analysis tool.

Results:
Adherence to aHEI was significantly associated with methylation of 8 CpG sites, with the most significant association manifested in cg16724319-
MDH1B
(P=1.9x10
-10
). Adherence to aMED was related to methylation of 14 CpG sites, with the most significant association manifested in cg07835181-
CLCN7
(P=1.7x10
-11
). DASH was significantly related to 33 CpG sites, with the most significant association manifested in cg26292547-
REV3L
(P=4.4x10
-10
). Further, genes annotating the significant CpG sites were enriched in pathways related to cardiovascular and nervous system development and function, cancer, organismal injury and abnormalities, and reproductive system diseases.

Conclusion:
Findings from the epigenome wide study suggest that overall dietary quality in pregnancy is associated with placental DNA methylation changes at different loci potentially related to cardiovascular, neurological, reproductive, and cancer phenotypes.