bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P351: Inflammation and Stroke Risk in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Jenny Nancy S , Callas Peter , Zakai Neil A , McClure Leslie , Judd Suzanne , Kissela Brett , Meschia James , Lakoski Susan , Cushman Mary
Published: July 2021

Background:
Levels of the pro-inflammatory cytokines interleukin (IL)-6 and IL-8 and the anti-inflammatory cytokine IL-10 are altered in acute stroke patients compared to controls. However, results for IL-10 are inconsistent (higher in stroke patients compared to controls in some studies and decreased in others) and very few studies have examined associations of these biomarkers with risk of incident stroke.

Methods:
We examined associations of baseline levels of IL-6, IL-8 and IL-10 with stroke risk factors and risk of incident stroke in 1,572 white and black men and women from the REGARDS Study; an observational cohort of 30,239 adults followed for 5 years. Among those without prebaseline stroke, stroke cases (n=592, 53% men, 59% white, mean age 70 years) were compared to a cohort random sample (n=980, 44% men, 58% white, mean age 65 years). We used Cox proportional hazards models to examine associations of biomarkers with incident stroke. Hazard ratios (HR; 95% confidence intervals) for highest compared to lowest quartile for each biomarker are presented.

Results:
Baseline IL-6 was significantly higher in incident stroke cases compared to the cohort sample (p<0.001) while IL-8 and IL-10 levels did not vary significantly (p>0.05 for both). Adjusting for age, sex and race, IL-6 was higher in blacks compared to whites and higher in current smokers compared to never/former smokers (all p≤0.01). IL-6 was inversely associated with physical activity, alcohol use and education (all p≤0.01). IL-8 and IL-10 did not vary significantly with the risk factors examined. Adjusting for age, sex and race, the HR for risk of incident stroke in those in the highest compared to lowest quartile of IL-6 was 2.4 (1.6-3.4). HRs for IL-8 and IL-10 were 1.5 (1.0-2.1) and 1.4 (1.0-1.9), respectively. Adjusting for Framingham stroke risk factors and history of coronary heart disease, only IL-6 remained significantly associated with stroke risk (HR 2.0; 1.3-3.2). HRs for IL-8 and IL-10 were 1.1 (0.7-1.6) and 1.2 (0.8-1.8), respectively. IL-6 remained significantly associated with stroke risk when C-reactive protein was added to the model (HR 1.7; 1.1-2.7). Associations did not differ by race.

Conclusions:
In this population-based sample of US black and white adults, IL-6, but not IL-8 or IL-10, was associated with stroke risk factors and risk of incident stroke. Further study is needed on the clinical utility of IL-6 measurement in stroke risk assessment.
Abstract P353: Serum Levels of Monocyte Chemoattractant Protein-1 and All-cause and Cardiovascular Mortality among Patients with Coronary Artery Disease
Authors: Ding Ding , Su Dongfang , Li Xinrui , Li Zhongxia , Qiu Jian , Lin Puqing , Zhang Yuan , Wang Min , Lv Xiaofei , Xia Min , Hu Gang , Ling Wenhua
Published: July 2021

Background:
Monocyte chemoattractant protein-1 (MCP-1) is an important chemokine at multiple phases of atherosclerosis in animal studies, but results of human studies are inconsistent.

Objective:
To investigate the association of serum MCP-1with all-cause and CVD mortality among CAD patients and determine whether the novel biomarker can add secondary prognostic value to standard risk predictors.

Methods:
MCP-1 was measured at baseline in 1411 CAD patients who were 40-85 years of age in the Guangdong Coronary Artery Disease Cohort. Cox proportional hazards regression models were used to estimate the association of different levels of serum MCP-1with risk of mortality.

Results:
During a median follow-up of 3.3 years, 117 deaths were recorded, 88 of which were due to CVD. The multivariable-adjusted (age, sex, education, occupation, marriage, leisure-time physical activity, smoking, alcohol drinking, body mass index, systolic blood pressure, fasting plasma glucose, low-density lipoprotein cholesterol, glomerular filtration rate, type, severity, duration, and treatment of CAD, history of heart failure, and use of antihypertensive, anti-diabetic, cholesterol-lowering, and anti-platelet drugs) hazard ratios across tertiles of MCP-1 were 1.52 (95% CI 0.90-2.57), 1.00, and 1.93 (95% CI 1.20-3.10) for all-cause mortality, and 1.38 (95% CI 0.75-2.55), 1.00, and 1.93 (95% CI 1.12-3.34) for CVD mortality. Further adjusting for C-reactive protein, all the hazard ratios remained similar. The addition of MCP-1 increased the C-statistic of the fully adjusted all-cause mortality model from 0.811 to 0.820 (p<0.0001) and the CVD mortality model from 0.827 to 0.835 (p<0.0001). After stratifying CAD type, age, gender, body mass index and C-reactive protein levels, the associations became stronger in acute coronary syndrome, males, normal-weight, and elevated C-reactive protein subgroups, while the hazard ratios turned insignificant in stable performance, females, obese, and normal C-reactive protein subgroups.

Conclusions:
Elevated MCP-1 level is associated with an increased risk of all-cause and CVD mortality among CAD patients. MCP-1 can add prognostic value to standard risk predictors and merits further study.
Abstract P357: Omega-3 Fatty Acid Biomarkers and Coronary Heart Disease: a Pooling Project of 17 Cohort Studies
Authors: Del Gobbo Liana C , Aslibekyan Stella , Barberger-Gateau Pascale , Campos Hannia , Chiuve Stephanie E , Djoussé Luc , Franks Paul , Guallar Eliseo , Imamura Fumiaki , Jansson Jan-Håkan , Khaw Kay-Tee , Lemaitre Rozenn N , Luben Robert , Marklund Matti , Matsumoto Chisa , Rimm Eric B , Risérus Ulf , Samieri Cecilia , Siscovick David , Virtanen Jyrki K , Voutilaninen Sari , Wennberg Maria , Yakoob Mohammad Yawar , Mozaffarian Dariush ,   on behalf of the Fatty Acids & Outcomes Pooling Project Group
Published: July 2021

Background:
Recent trials have raised questions about the role of seafood-derived long-chain omega-3 fatty acids for prevention of CHD; and evidence linking intermediate-chain omega-3 fatty acids to CHD remains weak.

Methods:
We developed a global consortium of 17 prospective (cohort or nested case-control) and retrospective studies having circulating or tissue biomarker measures of eicosapentaenoic (EPA; 20:5n-3), docosapentaenoic (DPA; 22:5n-3), docosahexaenoic acid (DHA; 22:6n-3), and α-linolenic acid (ALA; 18:3n-3). Each study ascertained CHD risk, including total CHD, nonfatal MI, and/or fatal CHD. Associations of each omega-3 fatty acid biomarker with CHD were evaluated within each cohort using standardized models, exposures, outcomes, and covariates across studies. Omega-3 fatty acid levels were analyzed continuously (per SD) and categorically (quintiles), and study-specific estimates were centrally pooled using fixed effects meta-analysis.

Results:
Current findings (Oct 2013) were based on 13 of 17 participating studies, including 7105 total CHD, 4926 nonfatal MI, and 2466 fatal CHD events. In both continuous and categorical multivariable-adjusted analyses, each omega-3 biomarker was inversely associated with fatal CHD. For each 1 SD unit increment, ALA was associated with 9% lower risk [HR 0.91 (95% CI 0.84-0.99)]; EPA, with 8% lower risk [HR 0.92 (95% CI 0.85-1.00)]; DPA, with 8% lower risk [HR: 0.92 (0.87-0.98)]; and DHA, with 9% lower risk [HR: 0.91 (0.86-0.96)] (Figure). Associations with total CHD and nonfatal MI were generally weaker and non-significant, except for EPA and nonfatal MI [HR: 0.93 (0.89-0.98)] and DHA and nonfatal MI [HR: 0.95 (0.91-0.99)].

Conclusions:
Based on all available studies from around the world, both long and intermediate-chain omega-3 fatty acids, measured using objective biomarkers, are associated with lower risk of fatal CHD. These findings support potential benefit of omega-3 fatty acids for reducing CHD death.
Abstract P360: Hypertension Treatment Rates And Health Worker Density: An Analysis Of Worldwide Data
Authors: Vedanthan Rajesh , Ray Mondira , Fuster Valentin , Magenheim Ellen
Published: July 2021

Introduction:
Hypertension is the leading global risk for mortality and its prevalence is increasing in many low- and middle-income countries. Hypertension treatment rates are low worldwide, potentially in part due to insufficient human resources. However, the relationship between health worker density and hypertension treatment rates is unknown.

Objective:
To conduct an econometric analysis of the relationship between health worker density and hypertension treatment rates worldwide.

Methods:
Hypertension treatment rates were collected from published reports between 1980 and 2010. Data on health worker (physician and nurse) density were obtained from the World Health Organization (WHO). Data for potential confounding variables--per capita gross domestic product, hospital bed density, burden of infectious diseases, land area and urban population--were obtained from WHO and World Bank databases. Potential interaction by per capita gross domestic product was evaluated. Multivariable logistic-logarithmic regression analysis was performed using Stata.

Results:
Full data were available from 146 countries spanning all World Bank income classification categories. Health worker density was significantly associated with hypertension treatment rate in the unadjusted model (beta = 0.23; p < 0.005). In the fully adjusted model, the association remained positive but was not statistically significant (beta = 0.30; p = 0.078) (Figure). Hypertension treatment rates were more strongly related to physician than nurse density (beta = 0.21 vs 0.08; p = 0.10 vs 0.49).

Conclusion:
Hypertension treatment rates across the world appear to be related to health worker density, although the relationship does not achieve strict statistical significance. Our results suggest that a 10% increase in health worker density is associated with a 2-3% increase in hypertension treatment rate. Given the global burden of hypertension and other chronic diseases, WHO guidelines for health workforce staffing may need to be reconsidered.
Abstract P362: Surveillance Of Non-Communicable Diseases By Non-Physician Health Workers In Kerala: the Epidemiology of Non-communicable Diseases in Rural Areas (ENDIRA) study
Authors: Banerjee Amitava , Joseph Jacob , Thachil Ajit , Attacheril Thankachan V , Menon Jaideep
Published: July 2021

Introduction:
India carries the greatest burden of global non-communicable diseases(NCDs). There are few contemporary, community-based studies of prevalence, particularly in rural settings despite known regional variations. Given the shortage of physicians in rural India, there is an urgent need for large-scale, region-specific studies of NCDs using non-physician health workers.

Methods:
In central Kerala, India, a population of 113,462 was defined by five panchyats(village councils), consisting of 75 wards in Ernakulam district. The "Epidemiology of Non-communicable Diseases in Rural Areas" (ENDIRA) study was conducted via ASHAs (Accredited Social Health Activists), who are non-physician health workers employed by State Government of Kerala to each cover one ward. Standardised questionnaires were used in household interviews of individuals ≥18 years during 2012 to gather sociodemographic, lifestyle and medical data.

Results:
ASHAs recruited 84456 adults who were included in the analyses (25.4% below the poverty line). NCDs were relatively common: prevalence of myocardial infarction(MI) 1.4%, stroke 0.3%, respiratory diseases 5.0%, and cancer 1.1%. 84.1% of the population was vegetarian, 15.9% ate meat/fish ≥ 1 day per week, 4.2% had ≥1 alcoholic drink per week and 8.1% smoked regularly.

Compared with males, females were older, had lower BMI (p<0.0001), more likely to be hypertensive (p<0.0001), less likely to smoke or drink alcohol, have diabetes or dyslipidaemia (p<0.0001). NCDs were more common in males than females: MI (1.9% vs 0.9%), stroke (0.5% vs 0.3%), cancer (1.2% vs 0.9%) and respiratory diseases (5.9% vs 4.0%); p<0.0001.

Age≥65 years, hypertension, diabetes, dyslipidaemia, smoking and male gender were strongly associated with MI and stroke (Table 1).

Conclusions:
Non-physician health workers (ASHAs) were able to effectively conduct a large-scale prevalence study of NCDs in Kerala, including risk factors. In rural Kerala, traditional risk factors were strongly associated with MI and stroke.
Abstract P365: Turning in the Mortality Trends from Coronary Heart Disease in Japan: Age-Specific Analysis of the Regional Difference in Japan from 1969 to 2007
Authors: Okayama Akira , Okuda Nagako , Ueshima Hirotsugu
Published: July 2021

Objective:
To examine the recent mortality trends of coronary heart disease (CHD), we compared the age specific CHD mortality trends in Japan and in urban and in the rest of Japan, respectively using Vital Statistics.

Methods and Results:
We compared CHD mortality rates in all Japan, the urban population (20 million) and in the rest of Japan (100 million) from 1969 to 2007 for 30 to 69 years of age. In 1969 [[Unable to Display Character: ‑]] 1970, the age[[Unable to Display Character: ‑]]adjusted CHD mortality rate was 57.7 per 100,000 for men and 25.9 for women in Japan, and was the same as those of the urban population (59.2 for men and 26.8 for women) and the rest of Japan (57.3 for men and 25.9 for women). The CHD mortality rate in the rest of Japan decreased to 28.4 for men and 7.6 for women in 2006-2007. Although CHD mortality rate in the urban population also decreased to 39.9 for men and 10.1 for women in 2006 - 2007, the decline was much smaller. Trends in age-specific CHD mortality rates was compared between Period I (1969 - 1978), Period II (1981- 1994) and period III (1996 - 2007). Among men in Japan and in the rest of Japan, the decline in the mortality rate for the 30 to 49[[Unable to Display Character: ‑]]year[[Unable to Display Character: ‑]]old[[Unable to Display Character: ‑]]age group was initially observed in Period I and II, and has turned to increase significantly (p<0.001) in the Period III while continuous declining trends in 50-59 and 60-69 year old-age-group. Trends in urban population went ahead, changes in the declining trends was observed both the Period II and III among 30-49 year-old-age group and period III among 50-59 year-old-age group while continuous decline was observed among 60-69 year-old-age group. Similar trends were observed among women. These trends coincide with the increase in the fat intake mainly among younger generation.

Conclusions:
Observed increase in CHD mortality of men in Japan among younger generation proceeded by those in the urban population may predict the future increase in CHD mortality in Japan.
Abstract P366: Examining the Impact of Captivity in Men and Women on the Slaves Returning to South Sudan
Authors: Feldman Joseph , Espinoza Cholene , Beckord Brian J , Kumar Niketa , Chaplin William , Iyengar Rupa L , Sadural Ernani , Soloway Barry , Timmapuri Sarah , Ogedegbe Chinwe
Published: July 2021

Background:
South Sudan became an independent state on July 9 2011, after having endured two civil wars with Republic of the Sudan lasting 51 years. Over the 51 years approximately 300,000 South Sudanese were abducted and in held in captivity in the Republic of the Sudan. The South Sudanese abductees suffered abuse and deprivation. Presently it is estimated that 35,000 are still in captivity. Assessing the health status of returning South Sudanese citizens immediately after their return is imperative. The aim of this report is to examine the effect of captivity on heart rate, (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and basic chemistry panel between men and women.

Methods:
In March of 2013, an American medical team performed health assessments for 48 hours in the state of Bahr el Gazal located in the northwest region of South Sudan. All returnees received health assessments within four days of their return. Health assessments defined as returnees’ demographics, along with their full history and physical examination. During physical exam height, weight, SBP, DBP, and HR, electrolytes and blood urea nitrogen (BUN) were recorded and analyzed.

Results:
Analysis was run on 186 participants, 50.5% (94) male, and 49.5% (92) female. Females were significantly younger at age of abduction, whereas men spent a significantly longer time in captivity (Table). SBP and DBP were significantly higher in males compared to females, even after adjusting for Age (p = 0.002, p = 0.036). HR was significantly less in males compared with females, even when adjusting for age (p < 0.001). BUN was significantly lower in females compared to males adjusting for age (p < 0.001)

Conclusion:
Although a majority of measurements in both men and women slaves returning to South Sudan fell within normal ranges, it is crucial to continue to monitor this group’s cardiovascular health because their deprivation while in captivity may have significantly impacted their health and risk for long term cardiovascular disease.
Abstract P369: Impact of Enhanced External Counterpulsation on Exercise Duration in Patients With Chronic Stable Angina: A Meta-analysis
Authors: Shah Sachin A , Williams Bradley R , Andrews-Pestana Atiera
Published: July 2021

Introduction:
Enhanced External Counterpulsation (EECP) is a non-invasive Food and Drug Administration approved treatment for patients with chronic stable angina and heart failure. Typical treatment regimen comprises of 35, 1-hour sessions of synchronized compressions of the calf, thigh, and sacral muscles over a seven-week period. Exercise duration measured using an exercise tolerance test is a commonly utilized marker of worsening ischemic disease and is predictive of cardiovascular mortality. Several studies have evaluated the impact of EECP on exercise duration with conflicting results. We sought to determine the magnitude of benefit of EECP on exercise duration.

Methods:
A literature search was performed in MEDLINE, CINAHL, and the Cochrane database along with hand searching of relevant articles limited to those published in the English language. Studies were included for analyses if assessing patients with stable angina and reporting exercise duration data using either the Bruce or modified Bruce exercise treadmill test. Appropriate data were extracted at baseline and after completion of the full course of EECP. Studies were excluded if presenting duplicate data or using a non-Bruce protocol. A weighted mean difference from baseline along with 95% confidence interval was calculated using the DerSimonian-Laird random-effects model. Sub-group analyses, the Cochran Q statistic, and JADAD scores were utilized to assess for heterogeneity, non-combinability, and quality of published studies respectively. Publication bias was assessed using visual inspection of funnel plots and the Egger bias statistic.

Results:
Our search strategy identified 1117 independent studies of which 15 were included for analyses. A total of 484 individual subjects were incorporated in the primary analysis. Exercise duration improved by 55.5 seconds (95%CI 36.1 to 74.9; Cochran Q, p=0.246) from baseline. The benefits were maintained when using a fixed-effects model, excluding small studies and limiting to studies using the Bruce protocol only. While the Egger statistic showed a lack of publication bias (p=0.121), it cannot be ruled out based on visual inspection of funnel plots.

Conclusion:
EECP significantly increases exercise duration by 56 seconds in patients with chronic stable angina. Further studies are needed to determine the impact of EECP on long-term outcomes. The views expressed in this material are those of the authors, and do not reflect the official policy or position of the U.S. Government, the Department of Defense or the Department of the Air Force.
Abstract P375: Decade Long Trends in the Magnitude, Treatment, and Outcomes of Young Adults Hospitalized with ST-Segment Elevation Myocardial Infarction and Non-ST-Segment Elevation Myocardial Infarction
Authors: Tisminetzky Mayra , Coukos Jennifer , McManus David , Darling Chad , Joffe Samuel , Gore Joel , Lessard Darleen , Goldberg Robert
Published: July 2021

Background:
Although acute myocardial infarction (AMI) occurs primarily in the elderly, this disease also affects young adults. Few studies have, however, presented data on relatively young patients hospitalized with AMI. The objectives of this population-based study were to examine recent trends in the magnitude, management, and in-hospital and long-term-outcomes associated with either an initial ST-segment elevation acute myocardial infarction (STEMI) or non-ST-segment elevation acute myocardial infarction (NSTEMI) in patients between the ages of 30-54 years old.

Methods:
We reviewed the medical records of 745 residents of the Worcester (MA) metropolitan area between the ages of 30 and 54 years who were hospitalized for an initial STEMI or NSTEMI in 6 annual periods between 1997 and 2007 at 11 greater Worcester medical centers.

Results:
Between 1997 and 2007, the proportion of young adults hospitalized with an initial STEMI decreased from approximately two-thirds to two-fifths of all patients. Patients with STEMI were less likely to have a history of heart failure, hypertension, hyperlipidemia, and kidney disease than NSTEMI patients. Both groups were similarly treated with evidence-based therapies during their acute hospitalization with encouraging trends in the prescribing of various cardiac medications observed over time (Figures 1A and B). Important in-hospital clinical complications and mortality were low and no significant differences in these endpoints were observed between STEMI and NSTEMI patients. One year post-discharge death rates were also similar in both groups (1.9% vs. 2.8%).

Conclusion:
The present results demonstrate recent decreases in the proportion of relatively young patients diagnosed with an initial STEMI. Patients with STEMI and NSTEMI had similar in-hospital outcomes and long-term survival. Trends in these and other important outcomes warrant continued monitoring.
Abstract P376: 40-year Population Trends in Cardiovascular Risk Factors in Finland
Authors: Borodulin Katja , Vartiainen Erkki , Peltonen Markku , Jousilahti Pekka , Juolevi Anne , Laatikainen Tiina , Mannisto Satu , Salomaa Veikko , Sundvall Jouko , Puska Pekka
Published: July 2021

Background:
Finland has experienced remarkable changes both in population levels of coronary heart disease risk factors and mortality over the past decades. For the national monitoring of risk factors in major non-communicable diseases, National FINRISK Studies have been implemented from 1972 to 2012. The 40-year changes in CHD risk factors are presented.

Methods:
Study population included participants aged 30 to 59 years in the series on independent random population samples. Data were collected in five-year intervals in 1972-2012. FINRISK studies so far comprised 53 589 men and women who participated in a health examination, gave a venous blood sample, and filled in questionnaires. Serum total cholesterol, systolic and diastolic blood pressure, and body mass index were measured using standardized protocol, and smoking status was recorded.

Results:
Total serum cholesterol decreased remarkably until the year 2007, but has thereafter turned to an increase. Systolic blood pressure has continued to decline over time since 1972, while decrease in diastolic blood pressure has leveled off during last ten years. Smoking prevalence has markedly decreased. Body mass index has increased in the population, yet the significant changes occurred in the earlier survey years, not in past 10 years. These changes in trends are shown in both sexes and all age groups in all geographical locations.

Conclusions:
After three decades of favorable development, the population risk factor levels showed some increase in total cholesterol and diastolic blood pressure. Some of these changes, such as in total serum cholesterol can be partially explained by unfavorable changes in dietary cholesterol intake. Our findings emphasize the need for continued efforts towards national disease prevention and health promotion.
Abstract P379: The Burden of Hypertension in US Emergency Departments - a report from 2006-2010 HCUP Nationwide Emergency Department Sample
Authors: Venkitachalam Lakshmi , Ahmed Arif , Hackman Jeffery , Kumari Nivedita , Williams Karen B , Lafferty William E , Gerkovich Mary M
Published: July 2021

Background:
In spite of temporal advancements in medicine, hypertension (HTN) remains a leading cardiovascular risk factor with suboptimal rates of control. The burden imposed by this cardiovascular risk factor on the nation’s emergency system is not well-understood. We sought to characterize emergency department (ED) visits among adults ≥18 years that included a diagnosis of hypertension in the 2006-2010 Nationwide Emergency Department Sample.

Methods:
We defined hypertension using ICD-9 diagnosis codes based on the Agency for Healthcare Research and Quality indicators for potentially preventable conditions. Appropriate sampling weights were applied to obtain national estimates and 95% confidence intervals.

Results:
Over the 5-year period, the estimated total annual rate of ED visits among US adults was 98.3 million - 19.9% (n=19,534,992) of these visits included HTN as diagnosis. Rates of ED visits with HTN tended to increase over time [
2006:
18.1 (17.6 - 18.6),
2007:
19.0 (18.5 - 19.5);
2008:
20.0 (19.4 - 20.5);
2009:
20.7 (20.1 - 21.3);
2010:
21.5 (20.9 - 22.1)]. Annual weighted rates of HTN varied across age groups, payer status, and neighborhood income (
Table
). In the multivariable logistic regression model, that accounted for clustering and sampling weights, the odds of ED visits with HTN was significantly lower among younger patients and those who were uninsured/self-pay, higher among Medicare recipients, and lower among patients from neighborhoods with higher median income or urban locations.

Conclusion:
Between 2006 and 2010, an estimated 1,953 per 10,000 visits to the ED each year included a diagnosis of hypertension among adult patients. National estimates of ED visits with HTN differ across patient and hospital characteristics, and likely represent an opportunity to monitor and address the burden of this potentially preventable condition.
Abstract P380: The Cardiovascular Fate in Patients with Amputation or Revascularization for Critical Limb Ischemia
Authors: De Rango Paola , Lenti Massimo , Cieri Enrico , Marucchini Alessandro , Farchioni Luca , Manzone Alessandra
Published: July 2021

Background:
Critical limb ischemia (CLI) continues to be a significantly morbid disease for the aging population with high likelihood of cardiovascular mortality and morbidity.

Objective:
To analyze incidence and timing of all cause and cardiovascular mortality (CM) in patients who survived after intervention for CLI.

Methods:
Patients consecutively discharged with diagnosis of CLI during the period 2006-2008 were re-evaluated for cardiovascular morbidity after 2 years. Patients receiving revascularization either open or endovascular and those with primary major amputation were compared with Kaplan-Meier analyses. The effect of treatment on outcome was analyzed with Cox analysis.

Results:
There were 257 patients (171 men, aged 74.12y), 39 treated by primary major amputation and 218 by revascularization. During a mean follow-up of 37months, 81 patients died for all cause mortality and 35 for CM. Mean survival time was 57.4months. More than half deaths (n=44) occurred by 15 months with 21 patients dying in the first 6 months and 33 within the first 12 months. Thirty-five myocardial infarctions and 15 strokes occurred.

Cumulative survival rate at 60 months was 54% for all cause mortality and 79% for CM. There was significantly worse survival in patients with primary amputation when compared to those receiving revascularization: rates for all cause mortality were 45% vs. 75% (p=0.001) and rates for CM were 68% vs. 90% (p<0.0001), in primary amputation and revascularization group respectively at 42 months.

Unadjusted odd ratios for all cause and cardiovascular mortality in patients with primary amputation vs. revascularization were 3.07 (95%CI 1.5-6.1, p=0.002) and 5.25 (95%CI 2.3-11.6, p<0.0001), respectively. After adjusting for age and gender, primary amputation persisted as independent predictor of all cause (HR 2.76, p<0.0001) and cardiovascular mortality (HR 5.11; p<0.0001).

Conclusion:
Mortality and CM after 2 years in patients surviving from CLI procedures are high. Primary amputation is a strong predictor of poor prognosis in the mid-long term for patients with CLI. Most deaths occur in the first 15 months after treatment. This data may question the benefits of revascularization.
Abstract P383: Possible Effect Modification of Beta-Blockers on the Association Between Heart Failure and Fracture Risk: A Cohort Study
Authors: Gerber Yariv , Roger Veronique L , Melton L. Joseph , Weston Susan A , Dunlay Shannon M , Chamberlain Alanna M , Jiang Ruoxiang , McNallan Sheila M , Amin Shreyasee
Published: July 2021

Introduction:
Heart failure (HF) is a chronic illness that occurs within a context of multiple comorbidities, including osteoporosis and fractures. While the causal pathway leading to elevated fracture risk in HF has yet to be determined, a potential mechanism may be increased sympathetic activation that inhibits bone formation and enhances resorption. By antagonizing sympathetic tone, β-blockers may protect against bone loss and, thereby, fractures. We assessed the association of HF with subsequent osteoporotic fractures by β-blocker use in a community setting.

Methods:
Olmsted County, Minnesota, residents meeting Framingham criteria for incident HF from 1990-2002 and community controls without HF, who were matched (1:1) to cases on age, sex, and index year, were studied using the resources of the Rochester Epidemiology Project. Major osteoporotic fracture (proximal femur, lumbar/thoracic vertebrae, distal forearm, or proximal humerus) risk in HF was compared directly with that in their matched controls utilizing a stratified Cox model with the case/control pairs forming the strata. Death as a competing risk was accounted for using the Fine & Gray model.

Results:
Among 1,050 participants (50% women; 525 with HF and 525 controls) 229 developed osteoporotic fractures during a mean follow-up of 6 years. The incidence rates of osteoporotic fracture per 1,000 person-years were 47.5 in HF cases and 30.4 in controls (
P
=0.001). After adjustment for prior fracture and Charlson comorbidity score, the hazard ratio (HR) for fracture in HF cases vs. controls was 1.70 (95% CI: 1.17-2.47). β-blockers were prescribed in 45% of HF cases after diagnosis. The association between HF and fractures differed according to β-blocker usage. The HRs were 1.45 (95% CI: 0.86-2.47) and 2.16 (95% CI: 1.23-3.79) in HF cases prescribed and not prescribed β-blockers, respectively, when compared with their matched controls. Accounting for death as a competing risk, the HRs were 1.06 (95% CI: 0.64-1.76) and 1.63 (95% CI: 0.99-2.70) in HF cases on and off β-blockers, respectively.

Conclusion:
These findings suggest a modifying effect of β-blockers on the association between HF and osteoporotic fractures, which warrants a more thorough evaluation.
Abstract P386: Salt is an Important Risk Factor for Hypertension in Rural Disadvantaged Populations
Authors: Subasinghe Asvini K , Arabshahi Simin , Busingye Doreen , Evans Roger G , Walker Karen Z , Riddell Michaela A , Thrift Amanda G
Published: July 2021

Introduction:
Hypertension is the greatest contributor to mortality globally, and its prevalence is high in low to middle income countries (LMICs). High salt intake and poor dietary choices are associated with the risk of hypertension, but their role in rural areas of LMICs is unclear.

Hypotheses: We aimed to establish the prevalence of high salt intake and to examine whether there is a clear relationship between high salt intake and hypertension in disadvantaged rural settings. We also aimed to assess the available information about the association of hypertension with other dietary factors.

Methods:
We searched electronic databases to identify studies in rural LMICs, in which the association of salt and other dietary factors with hypertension were assessed using multivariable models. A meta-analysis was conducted to assess these associations using a random effects model.

Results:
We identified 13 studies with a total of 134,404 participants for the systematic review. The pooled effect sizes (ESs) and 95% confidence intervals (CIs) for studies in which salt intake was assessed as a categorical variable (n=5) were 1.31 (95% CI: 1.19,1.44) in all participants, 1.70 (0.99,2.92) in males and 1.27 (95% CI: 1.04,1.54) in females. We also found a positive association between fat intake and the risk of hypertension (n=2) 1.47 (95% CI: 1.13, 1.90).There were few studies of other dietary factors and hypertension in rural regions of LMICs.

Conclusions:
To the best of our knowledge, no other systematic review and or meta-analyses have been conducted to investigate the relationship between diet and hypertension in rural populations of LMICs. Our findings show that high salt intake is a significant risk factor for hypertension in rural areas of LMICs. We also show a large gap in the literature regarding the relationship between dietary factors other than salt with the risk of hypertension. Salt reduction strategies should be implemented on a community level in these populations in order to drive a change in dietary behaviour.
Abstract P390: Relationship between BMI and Risk of Hypertension in an urban Japanese cohort study: the Suita study
Authors: Nakai Michikazu , Watanabe Makoto , Nishimura Kunihiro , Takegami Misa , Kokubo Yoshihiro , Higashiyama Aya , Okamura Tomonori , Miyamoto Yoshihiro
Published: July 2021

Objective:
The positive relation between body mass index (BMI) and risk of incident hypertension (HT) has been reported mainly in the Western subjects with high BMI. However, there are a few reports in the Asian with relatively lower BMI. This study investigated the relation of BMI with risk of incident HT in the population-based prospective cohort study of Japan, the Suita study.

Methods:
Participants who had no HT at baseline (1,591 men and 1,973 women) aged 30-84 years were included in this study. BMI categories were defined as following: underweight (BMI<18.5), normal (18.5≤BMI<25.0), and overweight (BMI ≥ 25.0). The Cox proportional hazards model was used to estimate hazard ratios (HRs) of BMI categories for incident HT by sex. HRs were adjusted for age, cigarette smoking and alcohol drinking. The HRs according to quartiles of BMI were also estimated, using the lowest quartile of BMI as a reference.

Results:
During median follow-up of 7.2 years, 1,325 participants (640 men and 685 women) developed HT. The HR (95% CI) of 1kg/m2 increment of BMI for HT in men and women was 1.08 (1.05-1.11) and 1.10 (1.07-1.12), respectively. When we set a normal BMI as a reference, HR of overweight BMI in men and women was 1.37 (1.13-1.67) and 1.45 (1.18-1.77), whereas HR of underweight BMI in men and women was 0.63 (0.45-0.90) and 0.60 (0.45-0.80), respectively. In addition, compared to the lowest quartile, HR of the highest quartile of BMI in men and women was 1.67 (1.33-2.10, trend p<0.001) and 2.10 (1.67-2.64, trend p<0.001), respectively.

Conclusion:
In this study, we showed that higher BMI was associated with increased risk of hypertension in both Japanese men and women.
Abstract P393: Consumption of Bread and Tortilla and Incidence of Self-Reported Hypertension in Mexican Women
Authors: Monge Adriana , Barrientos Tonatiuh , Romieu Isabelle , Lopez-Ridaura Ruy , Lajous Martin
Published: July 2021

Background:
Mexico is undergoing a fast-paced epidemiologic and nutritional transition and hypertension affects 31% of Mexicans. Bread and wheat tortilla have almost three times more sodium than corn tortillas and long-term sodium intake may increase the risk of hypertension.

Methods and Results:
We investigated the relation between bread and tortilla intake and the incidence of self-reported hypertension in 43,619 women from the Mexican Teachers’ Cohort who were free of hypertension at baseline in 2008 when diet was assessed using a food frequency questionnaire. Between baseline and 2011 we identified 2,699 incident cases of self-reported hypertension. Total bread (white and whole grain) and corn and wheat tortilla consumption were categorized into energy-adjusted quintiles and logistic regression models were fit. Median servings per week for extreme categories were 2.0 and 12.5 for total bread (1.4 and 11.0 for white bread; 0.2 and 3.0 for whole grain), 3.0 and 17.5 for corn tortilla, and 0.2 and 3.0 for wheat tortilla, respectively. The multivariable-adjusted odds of hypertension in the highest quintile of intake of total bread were 18% higher than the odds for individuals in the lowest quintile (OR=1.18; 95%CI=1.03-1.35; P-trend=0.12); corn tortilla intake was not significantly associated with hypertension (OR=0.88; 95%CI=0.76-1.01; P-trend=0.05). White bread appeared to be responsible for the observed association, the OR comparing extreme quintiles was 1.18 (OR=1.18; 95%CI=1.03-1.35; P-trend=0.0007). We did not observe an association between whole grain bread and wheat tortilla and hypertension.

Conclusion:
Bread consumption may affect the incidence of hypertension, while corn tortilla, a substitute for bread in the Hispanic population was not associated with incident hypertension. Results need to be confirmed with extended follow-up.
Abstract P397: Cardiovascular Health Among US Adults In Metropolitan And Micropolitan Statistical Areas
Authors: Loustalot Fleetwood , Fang Jing , Moore Latetia , Shah Nilay S , Schieb Linda
Published: July 2021

Background:
Cardiovascular disease (CVD) is the leading cause of death in the US and primary risk factors for CVD are well known. Promoting the ideal state of cardiovascular (CV) health factors and behaviors has been previously defined as CV health. The objective of this study is to assess CV health among US adults in urban areas.

Methods:
Data from the Behavior Risk Factor Surveillance System (BRFSS) 2011 were used for analysis and included 307,101 participants from 198 metropolitan and micropolitan statistical areas (MMSA) with an adequate sample size for estimates (range: 493 to 9,241 participants). Seven indicators were used to define ideal levels of CV health using self-reported data: no hypertension, no diabetes, no high cholesterol, no current smoking, no obesity, and meeting physical activity guidelines and fruit and vegetable consumption targets. Each metric was given a score (0=no, 1=yes) and summed. The percentage achieving ideal CV health (all 7 metrics at ideal level), good CV health (6-7 metrics at ideal levels), poor CV health (0-2 metrics at ideal levels), and the mean CV health score were calculated for each MMSA. Estimates and 95% confidence intervals were age-standardized.

Results:
Overall, 16.7% (16.4-17.1) and 11.5% (11.2-11.8) of participants among the 198 MMSAs had good and poor CV health, respectively. Few respondents in MMSAs met all ideal CV health standards (<1%), likely driven by the limited number of participants meeting fruit and vegetable consumption targets (5.7%) in this sample. The overall mean CV health score was 3.91 (3.90-3.92). The percentage of participants with good CV health varied from 3.0% (1.5-5.8) (Mobile, AL) to 23.8% (17.0-32.3) (Kalispell, MT). The percentage of participants with poor CV health varied from 6.1% (4.2-8.6) (Boulder, CO) to 26.5% (18.2-36.8) (Kingsport-Bristol-Bristol, TN-VA). The mean CV health score ranged from 3.44 (3.2-3.7) (Kingsport-Bristol-Bristol, TN-VA) to 4.7 (4.5-4.9) (Boulder, CO).

Conclusions:
Across select US MMSAs, few adults met ideal CV health standards, and only 16% had good CV health. CV health varied significantly across MMSAs. Reducing the burden and mitigating the deleterious effects of CVD can be achieved through the promotion of CV health. Local clinical and public health agencies have the unique opportunity to tailor evidenced-based interventions to promote CV health in their populations. The methodology and findings used in this study can be utilized by local jurisdictions to target lagging health indicators with focused interventions.
Abstract P401: Predicting Future Coronary Heart Disease Mortality Trends In England And Wales: A Bayesian Age Period Cohort Forecast Up To 2030
Authors: Guzman Castillo Maria , Gillespie Duncan , Allen Kirk , Bandosz Piotr , Schmid Volker , Capewell Simon , O'Flaherty Martin
Published: July 2021

Background:
Although the rate of death (mortality) from Coronary Heart Disease (CHD) has halved since the 1970s, CHD remains a major cause of all-cause mortality in the UK. Furthermore, population ageing plus recent increases in obesity and diabetes may soon increase total CHD deaths. Predictions of future CHD mortality are thus potentially problematic. Here we explore future projections of CHD mortality in England & Wales under two conventional but dramatically contrasting assumptions.

Materials and Methods:
In SCENARIO A, we used a conventional counterfactual, assuming that the last-observed CHD mortality rates (ONS) from 2011 would persist unchanged to 2030.The future number of deaths was then calculated by applying those rates onto 2012-2030 population estimates. In SCENARIO B, we assumed that the recent trend in CHD mortality rates would continue. We used a well-established hierarchical Bayesian Age Period Cohort (BAPC) model, which works under the assumption that variability in CHD mortality can be explained by a combination of age, period and cohort effects. We fitted this model to the observed CHD mortality from 1979 to 2011 and then continued the linear trends in age, period and cohort effects up to 2030. We then used the BAPC model to predict mortality rates in 2012-2030, and then applied these rates to population projections to compute future deaths.

Results:
In scenario A, by assuming that 2011 mortality rates would continue at that level, the number of CHD deaths would increase 61.5% (39,597 of 64,323) by 2030. In scenario B, by assuming recent trends continued, the number of deaths would decrease 56.7% (-36,500 of 64,323) by 2030. This substantial decrease would occur despite a predicted slowing of mortality decline in middle aged groups.

Conclusion:
The decline in CHD mortality has been reasonably continuous since 1979, and there is little reason to believe it will soon halt. The underlying assumption of a commonly used mortality counterfactual thus appears slightly dubious. By contrast, the BAPC model offers a far more plausible prediction of future trends by simultaneously considering age, period and cohort effects and projecting each into the future. Thus, despite population ageing, we estimated that the number of CHD deaths would halve again between 2011 and 2030. Even so, shifts in population risk factors might still cause CHD mortality to move away from a trajectory of decline. There is no room for complacency and the promotion of cardiovascular health remains a top policy priority.
Abstract P408: Plasma Alkylresorcinol, A Biomarker of Whole-Grain Intake, Is Not Associated With Progression of Coronary Artery Atherosclerosis In Postmenopausal Women With Coronary Artery Disease
Authors: McKeown Nicola M , Hruby Adela , Landberg Rikard , Herrington David M , Lichtenstein Alice H
Published: July 2021

Background:
Higher whole-grain intake has been associated with lower risk of cardiovascular disease in prospective observational studies. Few observational studies have incorporated biomarkers of whole-grain intake to confirm self-reported diet-disease associations. Plasma alkylresorcinols (AR) have been used as biomarkers for whole-grain wheat and rye intake.

Objective:
To assess the relationship between plasma AR concentrations and atherosclerotic progression over a 3-y period.

Methods:
Plasma AR concentrations were measured by gas chromatography mass spectrometry in baseline samples from 163 post-menopausal women (aged 49-78 y; median BMI: 29.0 kg/m2) with established coronary artery disease (CAD) who participated in the Estrogen Replacement and Atherosclerosis Study (enrolled 1995-1996) and had baseline food frequency questionnaire (FFQ), baseline and follow-up angiography measures, and complete covariate data. Dietary fiber intake was estimated by FFQ and energy-adjusted. Atherosclerosis progression, defined as change in mean minimum coronary artery diameter (MCAD, mm) and change in percent stenosis (%ST), was regressed on plasma AR in mixed models accounting for within-person correlations of coronary segments, and adjusted for the baseline measure, treatment allocation, clinic, age, race, BMI and follow-up time.

Results:
Median plasma AR was 16.1 nmol/L (interquartile range: 10.9-25.7). Over 3.1±0.7 years of follow-up, MCAD decreased by approximately 0.09±0.02 mm, while %ST increased by approximately 3.2±0.7%. No significant association was observed between AR and change in MCAD or %ST: a 10% increment in AR was associated with a -0.0002±0.0008 mm (P=0.76) change in MCAD and a 0.008±0.03 change in %ST (P=0.79). Further adjustment for lifestyle and risk factors did not materially change these results. As expected, AR correlated with FFQ- derived intake of cereal fiber (Spearman r=0.27, P<0.001) and whole grains (Spearman r=0.28, P<0.001). Of note, this cohort reported low whole-grain and cereal fiber intakes (9.5 servings/wk and 5.3 g/d, respectively).

Conclusions:
Plasma AR concentrations were not significantly associated with coronary narrowing over a 3-y period in postmenopausal women with CAD. We cannot rule out that large measurement errors in the biomarker, owing to low intake and short half-life may explain the findings.
Abstract P418: Trans Fats Consumption Linked to Higher BMI
Authors: Golomb Beatrice A , Koslik Hayley J
Published: July 2021

Background:
Increasing evidence suggests that factors beyond calorie balance may affect fat deposition (consider environmental obesogens like bisphenol A). Trans fats are prooxidant, proinflammatory, have shown adverse metabolic effects and increased fat deposition in animals.

Goal:
To assess the relation of dietary trans fatty acid (
dTFA
) consumption to BMI in humans.

Method:
Subjects were 1018 adult men and women clinical trial screenees (age 20-85, without known diabetes, CVD, with screening LDL 115-190mg/dL). Height and weight were measured at screening and BMI calculated. The Fred Hutchinson Food Frequency Questionnaire provided data on dTFA (gm/d) and calories. Surveys elicited activity, and chocolate consumption (times/week, previously linked
favorably
in this sample to BMI). Mood (adversely linked to dTFA in this sample and in literature) was assessed by the CES-D (depression scale). Regression assessed the relation of BMI (outcome) to dTFA, unadjusted and in models adjusted for age and sex, calories and activity, chocolate consumption, and mood.

Results:
Higher dTFA was linked with higher BMI across adjustment models, with strong statistical significance. The coefficient was strengthened, not attenuated, when calories and activity were considered. Each additional gram/day of dTFAs was associated with around 0.4 points greater BMI.

Discussion:
These findings extend adverse metabolic associations of dTFA, and comport with evidence suggesting that composition of calories, as well as their number, has relevance to BMI.