bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 20061: Towards Predicting the Rate and Rhythm of Rearrest After Out-of-hospital Cardiac Arrest
Authors: Salcido David , Sundermann Matthew L , Koller Allison C , Menegazzi James J
Published: March 2022

Background/Aims:
Rearrest (RA) after resuscitation from out-of-hospital cardiac arrest (OHCA) has been shown to be an independent predictor of death before hospital discharge. The aim of this study was to understand how heart rate and rhythm transitions relate to the timing and presentation of rearrest.

Methods:
Case data for emergency medical services (EMS)-treated OHCA were obtained from the Resuscitation Outcomes Consortium (ROC) for the period 2006-2008. Cases with analyzable electrocardiogram (ECG) signals were included in the study. RA events were ascertained by an inferential scheme involving the presence of a life-threatening ECG rhythm and/or presence of chest compressions. ROSC-RA ECG intervals were extracted from defibrillator source files and imported into custom software for calculation of several heart rate characteristics for 30s, 1min, 3min, and 5min epochs beginning at the onset of ROSC, including: mean heart rate, standard deviation for heart rate (SD-HR), root mean square of the successive differences (RMSSD), and approximate entropy of heart rate (ApEn). Frequency-based heart rate variability measures including normalized high frequency power (HFN), normalized low frequency power (LFN), and ratio of low and high frequency power (LFHF) were calculated. Multivariable generalized estimating equations (GEE) were used to assess the relationship between heart rate characteristics and time-to-RA while controlling for RA event number, presenting OHCA ECG rhythm, and RA ECG rhythm. Rhythm transitions were assessed and compared with Fisher’s exact test.

Results:
In univariate analyses RMSSD in the 30s and 1-minute epoch epochs, SD-HR in the 5-minute epoch, ApEn in the 5-minute epoch, presenting ECG rhythm ventricular fibrillation / ventricular tachycardia (VF/VT), and RA event number were predictive of time-to-RA. In a multivariable model, only SD-HR in the 5-minute epoch was related to time-to-RA (coeff. = -764.16; 95%CI: -1405.92 , -122.40; p = 0.020). The most common first rhythm transition was from VF/VT to VF/VT.

Conclusions:
At least one heart rate-derived measure, SD-HR, was related to time-to-RA event, independent of RA ECG rhythm, presenting OHCA ECG rhythm or RA event number.
Abstract 20160: Early Fluid Resuscitation of Undifferentiated Hypovolemic Hypotensive Patients in the Emergency Department: The Shock Access for Emergent Resuscitation (SAFER) Study
Authors: Paxton James H , Sherwin Robert , Wilburn John , Courage Cheryl
Published: March 2022

Study Objective: To describe initial emergency department (ED) efforts in obtaining adequate vascular access (AVA) and initiating appropriate fluid resuscitation for hypovolemic patients with undifferentiated hypotension within the first 3 hours following ED arrival.

Background:
Hypotensive hypovolemic patients require immediate AVA, to facilitate the administration of medications and fluids to restore homeostasis. Patients with septic shock must receive appropriate intravenous antibiotics within 60 minutes of sepsis diagnosis, and 30 mL/kg fluid challenge within 3 hours.

Methods:
Unplanned interim analysis was performed on data from the first 87 consented patients enrolled in the Shock Access For Emergent Resuscitation (SAFER) study. SAFER is an observational, prospective, multicenter study focused on the early ED management of undifferentiated hypovolemic, hypotensive adult patients triaged to the medical resuscitation bay for suspected shock. AVA was defined as any two of the following vascular access devices (VADs): 20-gauge or larger peripheral intravenous (PIV) or intraosseous (IO) catheter, or central venous catheter (CVC).

Results:
87 patients were enrolled, with a mean age of 60.3 years (SD 13.7 years). Fifty patients (57.5%) were females. The median time required for successful VAD placement was 125 seconds for PIV (IQR 206-75, n=103), 371 seconds for ultrasound-PIV (IQR 409-287, n=12), 129 seconds for IO (IQR 177-107, n=7), and 876 seconds for CVC lines (IQR 1241-660, n=18). AVA was achieved within 3 hours in 57 patients (65.5%). Thirty-three patients (37.9%) were found to have severe sepsis or septic shock, with 20 patients (23.0%) requiring vasopressors. Among septic patients, the mean volume of crystalloid infused was 1361 mL (SD 1028) or 18.6 mL/kg at 1 hour, and 2461 mL (SD 1652 mL) or 34.6 mL/kg at 3 hours. Among 98 vascular access attempts in septic patients, first-attempt success rates were higher for IO (100%, n=6) and CVC (70%, n=20) than for PIV (57.4%, n=61) or US-PIV (36.4%, n=11) lines. Nineteen (57.6%) septic patients received less than the requisite 30 mL/kg fluid challenge.

Conclusion:
Difficulties in obtaining AVA may prevent compliance with current guidelines for the management of septic shock. Further study is needed.
Abstract 20191: Cardiovascular Events and Coffe Use in Stage 1 Hypertension
Authors: Mos Lucio , Palatini Paolo
Published: March 2022

Introduction:
Controversy still exists about the long-term cardiovascular and metabolic effects of coffee consumption in hypertension. Aim of the study was to assess the predictive capacity of coffee use for cardiovascular events (CVE) and to ascertain whether the coffee-CVE association was mediated by the long-term effects of coffee on blood pressure (BP) and glucose metabolism.

Design and methods:
The analysis was made in 1201 participants from the HARVEST, a prospective cohort study of non-diabetic subjects aged 18-45 years, screened for stage 1 hypertension. BP was measured with ambulatory monitoring in all.

Results:
Among participants, 26.3% were abstainers, 62.7% were moderate coffee drinkers (1-3 cups/day) and 10.0% were heavy coffee drinkers (>3 cups/day). During a 12.5 year follow-up there were 60 CVE. In multivariable Cox analyses, coffee was a significant predictor of development of hypertension needing treatment with hazard ratios (HR) of 1.5 (CI,1.1-1.9) for heavy drinkers and 1.1 (0.9-1.3) for moderate drinkers compared to abstainers. Also, coffee was a predictor of future prediabetes with HRs of 2.0 (1-3-3.1) and 1.3 (0.9-1.7), in the heavy and moderate drinkers, respectively. In multivariable Cox analyses, including other lifestyle factors, age, sex, parental CVE, BMI, total cholesterol, 24h ambulatory BP, 24h ambulatory heart rate and follow-up changes in body weight, both coffee categories were independent predictors of CVE with HRs of 4.3 (1.3-13.9) for heavy coffee drinkers and 2.9 (1.04-8.2) for moderate drinkers. Inclusion of hypertension development in the regression attenuated the strength of the coffee-CVE association with HRs of 3.9 (1.2-12.5) for heavy and of 2.8 (0.99-7.8) for moderate drinkers. When future prediabetes was also incorporated, the relationship was of boderline significance for heavy coffee drinkers (HR, 3.2, 0.94-10.9) and was no longer significant for moderate drinkers (HR, 2.3, 0.8-6.5).

Conclusions:
Coffee use is linearly associated with increased risk of CVE in stage 1 hypertension. The effect of coffee on CVE seems to be at least partially mediated by its long-term effects on BP and glucose metabolism. Coffee consumption should be reduced in young-to-middle-age patients with hypertension.
Abstract 9744: Effect of High-intensity Statin Therapy on Strut Coverage After Drug-eluting Stent Implantation, Serial Follow-up Optical Coherence Tomographic Analysis
Authors: Kim Jeong Hun , Kim Jung-Sun , Shin Dong-Ho , Kim Byeong-Keuk , Ko Young-Guk , Choi Donghoon , Jang Yangsoo , Hong Myeong-Ki
Published: March 2022

Introduction:
Using optical coherence tomography (OCT), the impact of high-intensity statin therapy on stent strut coverage was evaluated in drug-eluting stent (DES)-treated patients.

Hypothesis:
The influence of high-intensity statin therapy on the serial stent healing process was not fully investigated

Methods:
Sixty patients were randomly assigned to two groups according to the statin dose (atorvastatin 40 mg as high-intensity statin therapy [n=29] vs. pravastatin 20 mg as low- intensity statin therapy [n=31]). Serial OCT evaluation at post-procedure, and at the 3- and 12-month follow-up was performed in 50 patients with 54 stents (23 atorvastatin-treated patients vs. 27 pravastatin-treated patients). The percentage of uncovered struts was defined as the ratio of uncovered struts to total struts. The primary endpoint was the percentage of uncovered struts at the 12-month follow-up. The secondary endpoint was the percentage of uncovered struts at the 3-month follow-up, and the comparative percentage change (Δ) of uncovered struts at the 3- and 12-month follow-up between the different intensity statin therapies.

Results:
The percentage of uncovered struts was 7.4% (range: 4.3-10.4%) in atorvastatin- treated patients vs. 10.6% (range: 5.7-22.6%) in pravastatin-treated patients at the 3-month follow-up (p=0.13), and 1.3% (0.3–3.8%) vs. 2.5% (0.9–9.7%), respectively, at the 12-month follow-up (p=0.01). The percentage Δ of uncovered struts from 3 to 12 months follow-up was -7.9±8.5% in atorvastatin-treated patients vs. -9.3±12.5% in pravastatin-treated patients (p=0.67).

Conclusions:
This study suggested that high-intensity statin therapy might provide beneficial effect for the vascular healing process after DES implantation.
Abstract 9952: Myocardial PtiO2 is a More Reliable Variable Than FFR, Showing High Potential for Clinical Application in Assessing Myocardial Ischemia Caused by Coronary Artery Stenosis
Authors: Kakihara Ri-ichiro , Inayoshi Manami , Naruse Chinatsu
Published: March 2022

Background:
A patient of effort angina who had 75% stenosis at #7 with high FFR 0.85 underwent PCI. He has had no chest pain at all since PCI.

Purpose:
To find a more reliable variable than FFR in assessing myocardial ischemia (MI) caused by coronary artery stenosis (CAS), animal experiments were done to cover three variables - coronary blood flow (Flow), myocardial PtiO2 (PtiO2) and FFR, which were compared to see which is the most reliable of the three. All the procedures were approved by Clinic’s ethical committee and carried out observing the Declaration of Helsinki of the World Medical Association.

Method:
In twelve pigs, vascular occuluders and flow meters were set at #6 and/or #7 and #11 and/or #13. PtiO2 sensor wires were inserted into the anterior and lateral LV wall transepicardially. FFR sensor wires were placed across the LAD and LCX stenoses. The data was all analyzed by a paired t-test and ROC.

Results:
Flow(ml/min): normal 54.23±5.24 and 50% 27.88±5.53, p< 0.0001; sencitivity(sen.) 1.00, specificity(spe.) 1.00, accuracy(acc.) 1.00 by ROC 38.9. 50% and 75% 17.60±6.06, p < 0.0001; sen. 0.92, spe. 0.83, acc. 0.88 by ROC 21.8. PtiO2(mmHg) : normal 54.91±6.44 and 50% 27.87±3.40, p< 0.0001; sen. 1.00, spe 1.00, acc. 1.00 by ROC 32.1. 50% and 75% 16.85±2.73, p < 0.0001; sen. 0.92, spe. 0.92, acc. 0.92 by ROC 21.7. FFR: normal 0.97±0.01 and 50% 0.89±0.06, p < 0.0001; sen. 0.92, spe. 1.0, acc. 0.96 by ROC 0.96. 50% and 75% 0.83±0.04. p < 0.0002; sen. 0.75, spe. 0.75, acc. 0.75 by ROC 0.86. Thus PtiO2 was the most reliable variable in assessing MI of CAS among three.

To confirm clinical application of PtiO2 , animal experiments using ten pigs was conducted to measure it through coronary artery. 0.5 mm transepicardial sensor wires were attached to the tips of upside-down 0.014 inch guiding wires. The guiding wires perforated LADs and were pushed into myocardium to measure PtiO2 (normal 55.54±3.57, 50% 28.08±2.48, 75% 17.1±2.85). These data showed no significant difference from the transepicardial data described above. A leak of contrast agent through a tiny perforation had expired in ten minutes.

Conclusion:
The results proved PtiO2 was the more reliable valiable than FFR, showing high potential for clinical application in safely assessing MI caused by CAS.
Abstract 9997: Utilizing a Collaborative Learning Model to Decrease Length of Postoperative Ventilation Following Infant Heart Surgery
Authors: Mahle William T , Nicolson Susan , Shekerdemian Lara S , Gaies Michael G , Witte Madolin K , Lee Eva K , Goldsworthy Michelle , Stark Paul , Burns Kristin M , Scheurer Marc A , Cooper David S , Thiagarajan Ravi , Sivarajan Ben , Hollenbeck-Pringle Danielle , Colan Steven ,   Pediatric Heart Network Investigators
Published: March 2022

Introduction:
Collaborative learning utilizes shared experience and expertise to rapidly disseminate knowledge across systems. We employed this strategy to reduce the duration of mechanical ventilation following infant heart surgery.

Hypothesis:
A collaborative learning derived clinical practice guideline (CPG) will result in a significant increase in the rate of early extubation (EE) following surgical repair of tetralogy of Fallot (TOF) or isolated coarctation (Coarct) in infants.

Methods:
A collaborative learning initiative that included site visits was employed at five centers (active sites) in the Pediatric Heart Network (PHN). Participants developed a CPG to achieve EE (within 6 hours of surgery) for infants following 2 index operations: 1) repair of isolated Coarct and 2) repair of TOF (30-365 days). EE rates were calculated at the five active sites during the 12 months before and after CPG implementation, and at five other centers in the PHN not participating in collaborative learning or using the CPG (control sites). A differences analysis was performed to compare changes in EE after CPG implementation.

Results:
Among the five active sites, there were 322 subjects that met eligibility for the CPG (163 pre- and 159 post-implementation). Among the five control centers, there were 259 subjects that would meet eligibility for the CPG (120 pre- and 139 post-implementation). With CPG implementation the rate of EE increased by 44.8% among active sites, from 28.8% to 73.6% (p<0.001). No change in the rate of EE was found in the control sites 11.7% to 13.7% (p=0.58). At active sites, there was no change in the rate of reintubation within 48 hours (3.1% v 3.1%, p=0.97). At active sites there was no statistically significant impact on median intensive care unit (3.0 days pre- vs. 2.9 post-implementation, p=0.6) or total postoperative length of stay (PLOS)(6 days pre- vs. 5 post-implementation, p=0.5) with CPG implementation.

Conclusions:
A collaborative learning strategy designed to shorten postoperative mechanical ventilation led to a significant increase in the rates of EE with no change in the rate of reintubation. The EE CPG did not significantly change intensive care or total PLOS.
Abstract 28: Non-alcoholic Fatty Liver Disease is Associated with Arterial Distensibility, Carotid Intima Media Thickness and Coronary Artery Calcification: The Multi-Ethnic Study of Atherosclerosis
Authors: Oni Ebenezer T , Budoff Matthew J , Zeb Irfan , Li Dong , Veledar Emir , Polak Joseph F , Blankstein Ron , Wong Nathan D , Agatston Arthur S , Blaha Michael J , Blumenthal Roger S , Nasir Khurram
Published: March 2022

Non-alcoholic fatty liver disease (NAFLD) is considered an independent risk factor for increased cardiovascular disease (CVD).

Methods:
The Multi-Ethnic Study of Atherosclerosis (MESA) cohort enrolled 6814 adults without prior CVD. We excluded 2,692 participants who had missing variables, heavy drinkers, history of steroid use and chronic liver disease. NAFLD was defined using non-contrast cardiac CT and a liver/spleen attenuation ratio (L/S) < 1. Arterial compliance and stiffness, was expressed as Distensibility coefficient and Young’s modulus. Common and internal carotid intima media thickness (IMT) and coronary artery calcium (CAC) > 0 were used as markers of subclinical CVD. A multivariate robust linear regression and logistic regression analysis was done to evaluate the association of NAFLD and this subclinical CVD markers.

RESULTS:
Our analysis of 4,123 participants showed a NAFLD prevalence 17% (n=665), 55% were female with a mean age of 63 (±10) years, 39% white, 10% Chinese, 28% African American, and 23% were Hispanic. Individuals with NAFLD had Distensibility coefficient (10
-3
mmHg
-1
) of 2.4 vs. 2.5 without NAFLD, p=0.05. CIMT (mm) was 0.88 in NAFLD vs. 0.87 without NAFLD, p=0.003. Multivariate linear regression analysis showed the presence of NAFLD was associated with both the common carotid and internal carotid IMT and logCAC. Logistic analysis only showed an independent association with CAC>0 (OR 1.44 95% CI 1.18, 1.75) and CIMT >1mm (OR 1.30 95% 1.08, 1.56). When stratified by race the association with CIMT >1mm was only significant among Caucasian whites (OR 1.37 95% 1.00, 1.90) and Hispanic (OR 1.53 95% 1.08, 2. 17) and CAC>0 was only significant among Hispanics (OR 1.52 95% 1.06, 2.19).

Conclusion:
NAFLD is independently associated with Carotid IMT and coronary artery calcification in a multi-ethnic population. This study reaffirms the role of NAFLD in early atherosclerosis and provides opportunity to explore strategies for early screening for subclinical CVD and aggressive preventive therapies.
Abstract 33: Instrumental Variables Regression to Account for Bias in Associations Between the Food Environment and Diet Quality in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Rummo Pasquale E , Guilkey David K , Ng Shu Wen , Meyer Katie A , Reis Jared P , Shikany James M , Gordon-Larsen Penny
Published: March 2022

Introduction:
Although observational evidence suggests that the food environment is associated with diet behaviors, the literature is inconsistent. Most studies ignore potential bias due to healthier people selecting healthier residential neighborhoods and healthier food outlets locating in areas where there is demand.

Hypotheses:
Greater availability of fast food restaurants (vs. full-service restaurants) and convenience stores and grocery stores (vs. supermarkets) is associated with lower diet quality, accounting for potential bias.

Methods:
We used 20 years (1985-6; 1992-3; 2005-6) of data from CARDIA study (n=26,203 observations) with geographically-linked, time-varying neighborhood-level data. Using instrumental-variables regression with a generalized method of moments estimator, we estimated the longitudinal association between the percent of neighborhood fast food restaurants, full-service restaurants, convenience stores, grocery stores, and supermarkets (per total food outlets within 1-km network distance of respondents’ residences at each exam) and an
a priori
diet quality score, with higher scores indicating higher diet quality. We adjusted for individual-level sociodemographics, health behaviors, baseline study center, exam year, and total other food outlets. We included theoretically-justified instrumental variables related to neighborhood-level sociodemographics, road connectivity, physical activity facilities, and housing prices.

Results:
Across exam years the mean diet quality score was 64.3 (SD=12.8; range: 24-107). Relative to the percent of neighborhood full-service restaurants, a 10% increase in the density of fast food restaurants (mean=12.3; SD=13.0) was associated with a lower
a priori
diet quality score over time (β=-3.5; 95% CI=-6.0, -0.90; p=0.01), after adjusting for potential residential selection and purposeful store placement. However, relative to the percent of supermarkets, neither the percent of convenience stores (β=-0.85; 95% CI=0.12, -1.93; p=0.12), nor grocery stores (β=-0.72; 95% CI=-1.70, -0.26; p=0.15), was associated with diet quality.

Conclusions:
Compared to standard regression models, our findings suggest that efforts to reduce the availability of neighborhood fast food restaurants, but not other types of food outlets, may be associated with minor improvements to diet behaviors. This suggests that the selective nature of where people and stores locate may influence associations of the food environment with diet quality.
Abstract 35: The Effect of Type and Amount of Dietary Carbohydrate on Biomarkers of Glucose Homeostasis and Inflammation in Healthy Adults: Results From The Omnicarb Trial
Authors: Juraschek Stephen P , Miller Edgar R , Selvin Elizabeth , Carey Vincent J , Appel Lawrence J , Christenson Robert H , Sacks Frank
Published: March 2022

Background:
Glycemic index (GI) is thought to affect glucose homeostasis. Recently, the OmniCarb Trial reported that GI did not improve insulin sensitivity. We performed an ancillary study in OmniCarb to determine the effects of GI on glucose homeostasis and inflammation.

Methods:
The OmniCarb Trial was a randomized crossover feeding study conducted in overweight or obese adults without diabetes (N=163). Participants were fed each of four diets for 5 weeks, separated by 2-week washout periods. Weight was held constant. The four diets were: high GI (GI ≥65) with high carbohydrate (58% kcal), low GI (GI ≤45) with low carbohydrate (40% kcal), low GI with high carbohydrate; and high GI with low carbohydrate. We measured and compared the following biomarkers at the beginning and end of each dietary period: glycated albumin (GA), fructosamine, fasting glucose, and high sensitivity C-reactive protein (CRP). GA and fructosamine reflect glycemia over a 2-4 week period. Generalized estimating equations were used to compare within-person, end-of-period differences in biomarkers between diets.

Results:
Mean age was 53 years, mean BMI was 32 kg/m2; study population was 52% female, and 50% black. Reducing GI had no effect on GA or fructosamine (Figure), but increased fasting glucose in the setting of a high carbohydrate diet (+2.2 mg/dl; P = 0.02). Reducing carbohydrate content decreased GA in the setting of a high GI diet (-0.2%; P = 0.03) and decreased fructosamine in the setting of a low GI diet (-4 μmol/L; P = 0.003). Reducing carbohydrate while simultaneously increasing GI significantly reduced both GA (-0.2%; P = 0.04) and fructosamine (-4 μmol/L; P = 0.009). Neither reducing GI nor amount of carbohydrate affected CRP.

Conclusions:
During this 5 week trial, reducing the amount of carbohydrate, regardless of high or low GI, decreased GA and fructosamine. This suggests that reducing the carbohydrate content of diets, rather than lowering GI, is a better strategy for lowering glycemia in adults at risk for diabetes.
Abstract 49: Effects of Oral Magnesium Supplementation on Blood Pressure Among Healthy or Hypertensive Adults: A Meta-analysis of Randomized Double-blinded Placebo-controlled Trials
Authors: Zhang Xi , Del Gobbo Liana C. , Zhang Wen , Song Yiqing
Published: March 2022

Introduction:
The role of magnesium (Mg) in blood pressure (BP) is controversial, due to inconsistent results from prior individual trials or systematic reviews and meta-analyses.

Hypothesis:
We aimed to quantify the effect of oral Mg supplementation on systolic and diastolic BP by synthesizing available evidence from randomized double-blinded placebo-controlled trials. We also examined whether changes in BP were related to elevation in serum Mg levels by Mg supplementation.

Methods:
We searched all trials of oral Mg supplementation among healthy or hypertensive adults published before February 1, 2015 from databases of MEDLINE and EMBASE. A random-effects meta-analysis was performed to estimate weighted mean differences (WMDs) and 95% confidence intervals (CIs) of BP changes. The possible heterogeneity between studies were explored by subgroup analyses. We used restricted cubic spline curves to depict time- and dose-responses of BP in relation to changes of serum Mg levels.

Results:
In total, 33 eligible trials involving 2,500 participants were included. Mg supplementation at a median dose of 368 mg/day elemental Mg for a median duration of 3 months led to significantly reduced supine BPs by 2.08 mmHg (95% CI: 0.49, 3.68) for systolic BP and 1.83 mmHg (95% CI: 0.77, 2.90) for diastolic BP compared with the placebo. Overall, Mg supplementation significantly increased serum Mg concentrations by 0.05 mmol/L (95% CI: 0.03, 0.07 mmol/L). Our time- and dose-response analyses showed that Mg supplementation with 200 mg/day for 1 month was sufficient to significantly raise serum Mg and lower supine BPs (all P-values < 0.0001). However, higher doses (≥ 300 mg/day) and longer durations (≥ 2 months) were needed to achieve maximal effects. On average, per 0.1 mmol/L increment in serum Mg was associated with a supine DBP reduction of 2.26 mmHg (95% CI: 0.27, 4.26 mmHg), while the linear or curvilinear relationship with supine SBP was non-significant. In addition, there were non-significant changes in standing BPs (all P-values > 0.05).

Conclusions:
Our meta-analysis showed that Mg supplementation significantly lowered supine BPs which were significantly related with elevated serum Mg levels. Our findings support an antihypertensive effect of Mg, although future large well-designed randomized controlled trials with longer follow-up, selection of participants with low Mg levels, and ambulatory BP monitoring are warranted.
Abstract MP16: Relations of Physical Activity to Gait Speed in Older Adults From the Framingham Offspring Study: Effect Modification by Age
Authors: Spartano Nicole L , Lyass Asya , Larson Martin G , Vasan Ramachandran S , Murabito Joanne M
Published: March 2022

Background:
Older adults (≥ 65 years [y]) may have difficulty meeting the Physical Activity (PA) Guidelines for Americans. Recent literature suggests that light activity is an important determinant of physical function in older adults. We hypothesized that PA (especially light activity) is associated with gait speed in older adults.

Methods:
Framingham Offspring Study examination 9 participants, free of mobility limitations with accelerometry and physical performance data (timed 4 meter walk), were included in this investigation (n=1449, age ≥ 50y). Sedentary time (1486 counts/min) and steps/day were also assessed. We used linear regression to relate gait speed (dependent variable) to PA levels (independent), adjusting for sex and wear time. For interactions observed between PA and age at the p≤0.1 level, regression models were stratified by age group: age 50-64 y (n=422, 55% women), age 65-44 y (n=704, 54% women), and age ≥75 y (n=323, 52% women).

Results:
Only 38% of adults aged 50-64 y achieved the PA Guidelines, i.e., 150 min MVPA per week. Guideline achievement dropped to 15% in participants ≥75 y. Average gait speed decreased from 1.23 to 1.08 m/s across age groups. Each 10 min increment in MVPA was associated with a 0.01 m/s higher gait speed in the full sample (p<0.001); no interaction by age group was detected. The association of light activity with gait speed increased in the older age groups; 10% more time spent in light activity was associated with 0.03 m/s higher gait speed in adults 65-64 y (p=0.04, Table 1) or 0.09 m/s higher gait speed in adults ≥75 y (p<0.001). More steps and lower sedentary time were also associated with higher gait speed.

Discussion:
Our cross-sectional study demonstrated an association of light-intensity PA with gait speed in adults ≥65 y. These data warrant future research on the impact of light activity on physical function and health outcomes in the elderly.
Abstract MP62: Aortic Root Dilation and Incident Cardiovascular Events in African Americans: The Jackson Heart Study
Authors: Kamimura Daisuke , Suzuki Takeki , Musani Solomon K , Hall Michael E , Correa Adolfo , Fox Ervin R , Little William C
Published: March 2022

Introduction:
The structure and function of the proximal aorta is thought to be associated with central aortic pressure. Therefore, it might be associated with cardiovascular (CV) events.

Hypothesis:
Increased aortic root diameter (AoD) is associated with CV events in a large community-based African American cohort in Jackson, MS.

Methods:
We conducted a longitudinal analysis in the Jackson Heart Study, a study of risk factors for CV disease in African Americans. AoD at the sinuses of Valsalva was measured by echocardiography at visit 1 (2000 - 2004). Participants without relevant information on covariates or with past history of CV diseases at baseline were excluded. CV events were defined as coronary heart disease, stroke, or incident heart failure (HF) identified as the first hospitalization for HF after 2005. Cox proportional hazards models were used to evaluate the association between baseline AoD and CV events. Kaplan-Meier survival curves were constructed for two groups classified by the sex-stratified top quintile of AoD (35.2±2.8 mm) vs. others quintiles as a group (AoD 30.8±2.8 mm).

Results:
Among 5301 JHS participants, 3386 participants were included in our study (mean age 56.0 years, 64% women). Participants in the top quintile of AoD were more likely to be older, hypertensive, and obese compared with the rest. Over a mean follow-up of 8.3 years, there were 214 CV events (incident rate: 7.6 per 1,000 person-years). After adjustment for traditional risk factors including age, gender, systolic blood pressure, antihypertensive medications, total cholesterol/HDL ratio, diabetes and smoking status, AoD was independently associated with CV events (hazard ratio per 1 mm increase: 1.05; 95% CI: 1.007-1.102, p < 0.05). Participants in the top AoD quintile had a higher incidence of CV events than those not in the top quintile (Figure).

Conclusions:
An increased AoD was associated with an increased risk of CV events in a community-based African American cohort. AoD measurements may be useful for CV event risk stratification.
Abstract MP67: Transition From Cardiovascular Disease to Cancer as the Leading Cause of Death in US States, 1999-2013
Authors: Harding Michael C , Sloan Chantel D , Merrill Ray M , Harding Tiffany M , Thacker Brian J , Thacker Evan L
Published: March 2022

Introduction:
Cardiovascular disease (CVD) has been the leading cause of death in the US, and cancer the second leading cause of death, consistently since the 1940s. In recent decades, the gap has narrowed due to the steep decline in CVD mortality and relatively modest decline in cancer mortality. We hypothesized that national-level mortality data obscure state-specific transitions from CVD to cancer as the leading cause of death.

Methods:
We used state-specific mortality data from the US National Vital Statistics System to calculate state-specific mortality rate ratios (RRs) of CVD vs cancer for each US state annually from 1999 to 2013.

Results:
From 1999 to 2013 the national CVD mortality rate fell from 265.9 to 193.3 per 100,000 and the national cancer mortality rate fell from 201.6 to 185.0 per 100,000. Accordingly, the national CVD/cancer mortality RR fell from 1.32 to 1.04. However, from 1999 to 2013 many states transitioned from CVD to cancer as the leading cause of death (see Figure). In 1999 CVD was the leading cause of death in 49 states, with median state-specific CVD/cancer mortality RR of 1.29 (IQR: 1.16, 1.36). New York had the highest mortality RR of 1.57. Only in Alaska was cancer the leading cause of death in 1999, with CVD/cancer mortality RR of 0.89. In contrast, by 2013 CVD remained the leading cause of death in only 27 states, with median state-specific CVD/cancer mortality RR of 1.08 (IQR: 1.04, 1.13). New York still had the highest mortality RR of 1.23. Cancer had become the leading cause of death in 23 states by 2013, with median state-specific CVD/cancer mortality RR of 0.95 (IQR: 0.88, 0.99).

Conclusion:
Due to rapidly declining CVD mortality rates, the transition from CVD to cancer as the leading cause of death has already occurred in nearly half of US states. National-level data mask this reality, implying an oversimplified public health message that “CVD is the leading cause of death.” State-specific data highlight successes in CVD prevention and control and the need for further improvements in cancer prevention and control.
Abstract MP75: Assessment of the Genetic Role of Potential Metabolic Therapeutic Targets Along Insulin Signaling and Adipogenesis Pathways
Authors: Chan Kei Hang K , Xu Haiyan , Luo Xi Rossi , Liu Simin
Published: March 2022

Recent studies in rat hepatoma cells identified MAP kinase phosphatase 3 (MKP3) as the key player in antagonizing repression of phosphoenolpyruvate carboxykinase (PEPCK) gene transcription by insulin, indicating that MAP kinase phosphatase can crosstalk with metabolic components of the insulin signaling pathways. The family of histone deacetylases (HDACs) is another set of metabolic therapeutic targets of importance as HDAC1 has recently been shown to be involved in regulating preadipocyte differentiation. We therefore investigated the roles of MKP3 (DUSP6 in human), PEPCK (PCK2), HDAC1&2 single nucleotide polymorphisms (SNPs) in relation to obesity and diabetes risk among 7,287 African American (AA), 3,258 Hispanic American (HA), and 3711 Caucasian American (CA) women participating in the national Women’s Health Initiative (WHI) SNP Health Association Resource (SHARe) and the Genomics and Randomized Trials Network (GARNET). We found significant association between 43 SNPs in the DUSP6 gene region with risk of obesity (risk variants: range of OR=1.08-1.87; protective variants: 0.72-0.93; all P<0.05) and diabetes (risk variants: range of OR=1.08-1.43; protective variants: 0.84-0.93; all P<0.05). Two PCK2 SNPs were associated with obesity risk (risk variant: OR=1.09, P=0.008; protective variant: OR=0.84, P=0.04). Six HDAC2 SNPs were also found to have association with risk of obesity (range of OR: 0.82-0.90, P<0.05) and diabetes (risk variant: OR=1.16; protective variant: 0.77-0.86; all P<0.05). The rs10506969 (C/T) SNP in the DUSP6 gene identified among AA (reference allele=C, OR=0.86, P=0.02) and HA (OR=0.87, P=0.05) was also confirmed in the CARDIoGRAMplusC4D meta-analysis studies of 63,746 coronary artery disease cases and 130,681 controls (reference allele: T, OR=1.05, P=0.003). Our candidate gene study of American women of three ethnicities identified germline mutations in DUSP6, PCK2, and HDAC2 in relation to obesity and diabetes. These human genetic evidence is comparable to data from animal models that support the notion that MAP kinase phosphatase 3, phosphoenolpyruvate carboxykinase, and histone deacetylase 2 may serve as important metabolic therapeutic targets in lowering risk of obesity and diabetes.
Abstract MP87: Achieving Multiple Lifestyle Behaviour Targets Reduces the Risk of Hypertension in Adolescents
Authors: McGavock Jonathan , Carson Valerie ,   Healthy Hearts Investigator Group
Published: March 2022

Introduction:
The benefits of achieving multiple lifestyle behaviour targets on cardiovascular disease risk, in adolescents, remains unclear.

Hypothesis:
We hypothesized that (1) achieving a composite of healthy lifestyle behaviour targets would be associated with a reduced risk of hypertension and (2) the relative risk reduction observed when multiple lifestyle behaviour targets were achieved would be greater than the sum of individual targets among adolescents.

Design and Methods:
We analysed data from a convenience sample of 394 adolescents 9-15 years enrolled in a 2-year prospective cohort study. The main exposure variable was a composite measure of achieving daily behavioural lifestyle targets for: (1) physical activity (>60 mins of MVPA daily-Actical Accelerometer); (2) fitness (>40th centile for age sex- 20m shuttle run test); (3) diet quality (meeting daily intake for food groups from Canada’s Food Guide to Healthy Eating: vegetables and fruits, grain products, milk and alternatives, and meats and alternatives); (4) sodium intake (<2.3g/day-24hr dietary recall); and (5) weight status (healthy weight status for age and sex-assessed directly using digital scale and stadiometer). The primary outcome was hypertension treated as a binary outcome (>90th centile for age, sex and height) measured in triplicate, seated, according to American Heart Association guidelines.

Results:
Hypertension developed in 13.7% (n=54) of youth at follow-up. Only 3% (n=13) of adolescents in the cohort met all 5 behavioural lifestyle targets. Hypertension was evident in 13.9% (n=53) of youth that did not meet all 5 lifestyle targets and 7.7% (n=1) of youth that did (OR: 0.51; 95% CI: 0.07-4.1). Achieving at least 3 behavioural targets was associated with a 67% reduced odds of hypertension (OR: 0.33; 95% CI: 0.16-0.68). In multivariate logistic regression analyses, healthy weight status was the only significant individual behavioural target associated with incident hypertension (OR: 0.17; 95% 0.08-0.38).

Conclusion:
Very few adolescents meet all current behavioural lifestyle targets for preventing cardiovascular disease. Achieving multiple lifestyle targets, particularly healthy weight status, is associated with a significantly reduced odds of hypertension among adolescents. Experimental trials, in adolescents, are needed to determine the efficacy of achieving multiple behavioural lifestyle targets for reducing cardiovascular risk factors, to confirm these observations.
Abstract P002: Black-White Differences in the Association of Neighborhood Socioeconomic Status with AHA’s Life’s Simple 7: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Howard Virginia J , Howard George , Carson April P , Allen Shauntice , Judd Suzanne E , Safford Monika M , Muntner Paul M , McClure Leslie A , Cushman Mary
Published: March 2022

Introduction:
The AHA’s Life’s Simple 7 (LSS) assesses cardiovascular health. Neighborhood socioeconomic status (N-SES) influences health; however, data are limited on racial differences in the association of N-SES and LSS.

Hypothesis:
Higher N-SES is associated with better LSS status similarly in whites and blacks.

Methods:
We studied 9,899 black and white participants aged 45+ without CVD from across the US. The 7 LSS metrics (blood pressure, cholesterol, glucose, BMI, smoking, physical activity, diet) were scored as poor, intermediate or ideal. N-SES was indexed by a composite score of 7 measures of wealth and education. The association of N-SES with both ideal health (vs intermediate or poor) and poor health (vs intermediate or ideal) was assessed adjusting for age and sex, and additional adjustment for individual SES (I-SES as income and education).

Results:
In whites, higher N-SES was associated with both higher ideal and lower poor status for 4 of the LSS metrics, with the remaining 3 associated with either higher ideal or lower poor status (figure). In blacks, only 1 LSS metric was associated with both higher ideal and lower poor status, 3 associated with either higher ideal or lower poor status, and there was no association in 3 metrics. After adjustment for I-SES, in whites N-SES remained associated with both higher ideal and lower poor status for 3 metrics, either higher ideal or lower poor in 3 metrics, and no association in 1 metric; however, in blacks, only 1 metric was associated with either ideal or poor status, no association for 5 metrics, and 1 metric with higher N-SES was associated with higher poor status.

Conclusions:
Higher N-SES was strongly associated with better LSS status in whites, even after adjustment for I-SES. However, the association between N-SES with better LSS status was much weaker in blacks, and was largely attenuated with adjustment for I-SES. With regard to LSS, place matters for whites, but plays a much smaller role for blacks.
Abstract P012: Associations Between Plasma Phospholipid and Cholesterol Ester Fatty Acids and Reproducibility During 10-year Follow-up of Elderly Individuals: A Population Based Study
Authors: Marklund Matti , Lind Lars , Risérus Ulf
Published: March 2022

Background:
Fatty acid (FA) composition in different blood compartments is used as biomarkers of dietary fat quality, but it is unclear how FA compositions differ between compartments and which biomarker is most appropriate for epidemiological studies. Furthermore, as most cohorts use single FA measurements to reflect long-term intake, reproducibility data of plasma FAs are clearly warranted.

Objective:
To investigate inter-correlations of FA compositions in plasma phospholipids (PP) and cholesterol esters (CE), and to evaluate 10-y reproducibility of FA composition in plasma CE.

Methods:
Baseline FA composition of PP and CE was assessed in a population-based cohort of 70-year-old Swedes (n=940), and in a subsample (n=539), FA was additionally measured in CE during follow-up at ages 75 and 80 y. FA in PP and CE was measured by gas chromatography. Spearman’s rank correlation coefficients were calculated between proportions of individual FA measured in plasma PP and CE collected at age 70 y. Plasma CE compositions at ages 70, 75, and 80 y were utilized to assess 10-year reproducibility by calculating intraclass correlation coefficients (ICC) in one-way random-effect models.

Results:
Strong correlations between PP and CC were observed for most FA, with the only exceptions palmitic acid and stearic acid (Table). Fair to good reproducibility was observed for most FA, and was greatest for palmitoleic acid (ICC [95% CI] = 0.72 [0.69-0.76]) and all n-6 polyunsaturated FA (ICC=0.64-0.68). Poor reproducibility was only observed for α-linoleic acid, pentadecanoic acid, and stearic acid, with ICC (95% CI) 0.19 (0.14-0.25), 0.22 (0.17-0.28), and 0.23 (0.18-0.29), respectively.

Conclusions:
Overall, FA levels measured in plasma PP and CE correlates strongly, suggesting that FA composition in these compartments generally can be used interchangeably as biomarkers in epidemiological studies. Overall good reproducibility of FA levels in CE indicates that single a measurement can reliably estimate average levels over a 10-y period.
Abstract P043: Association Between Maternal Smoking During Pregnancy and Childhood Blood Pressure and Lipids in Fifth Grade Children Born Full Term
Authors: Umer Amna , Hamilton Candice , Britton Cris , Pyles Lee , John Collin , Neal William , Lilly Christa
Published: March 2022

Introduction:
Maternal smoking during pregnancy is a well-established risk factor for childhood obesity. However, the relationship between maternal smoking and other childhood cardiovascular disease (CVD) risk factors is unclear. The objective of the study was to assess these associations in fifth grade children.

Methods:
The study used longitudinally linked data from three cross-sectional datasets (the WV Birth Score Project, the Birth certificate at birth, and the Coronary Artery Risk Detection in Appalachian Communities Project in fifth grade West Virginian children who were born full term (N=19,583). The main outcome variables included fifth-grade CVD risk factors (e.g., systolic blood pressure [SBP], diastolic blood pressure and lipid levels including total cholesterol, high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol, log transformed triglyceride [log-TG]), which were significantly correlated with maternal smoking during pregnancy at the bivariate level. Each significant dependent variable was regressed on the main exposure variable with additional covariates (child’s age, sex, race, maternal education at child’s birth, family history of CVD, and birth weight). Childhood body mass index (BMI) was added to the regression model to assess for its role as a potential mediator.

Results:
The significant CVD risk factors associated with maternal smoking during pregnancy included SBP: r=0.02, p= 0.002; HDL: r=-0.06 p<0.0001, and TG: r=0.06, p<0.0001. The results of multiple regression analysis showed significant association between maternal smoking during pregnancy and TG and HDL, which attenuated but remained statistically significant after assessing for BMI as a potential mediator. The association was not significant for SBP (Table 1).

Conclusion:
Our results showed that maternal smoking during pregnancy was an independent risk factor for higher TG and lower HDL after adjusting for covariates and the relationship is partially mediated by the childhood current BMI.
Abstract P080: Associations of Bowel Movement Frequency with Risk of Coronary Heart Disease and Mortality Among Us Women
Authors: Ma Wenjie , Rimm Eric B , Rexrode Kathryn M , Qi Lu
Published: March 2022

Background:
Bowel movement frequency has been related to a variety of cardiovascular risk factors such as inflammation and metabolism of gut microbiota. However, few studies have examined the relations of bowel movement frequency with risk of coronary heart disease (CHD) and mortality in prospective cohorts.

Objectives:
To investigate the prospective associations between bowel movement frequency, incident CHD, and mortality in a large cohort of US women, the Nurses’ Health Study.

Methods:
Bowel movement frequency was self-reported at baseline in 1982 by 85,976 women who were free from cardiovascular disease and cancer. Incident CHD including symptomatic nonfatal myocardial infarction or fatal CHD was subsequently identified. Deaths were reported by the next of kin or the postal authorities or identified by searching the National Death Index. Multivariable Cox proportional hazards models were used to assess the associations of bowel movement frequency with risk of CHD, total mortality, and mortality due to cardiovascular disease.

Results:
During follow-up, we documented a total of 5,805 incident CHD cases (1982-2010) and 20,972 deaths (1982-2012). After adjustment for potential confounders and CHD risk factors at baseline (age, ethnicity, multivitamin use, aspirin use, family history of heart disease, hypertension, hypercholesterolemia, or diabetes at baseline, menopausal status and postmenopausal hormone therapy use, smoking status, alcohol consumption, physical activity, BMI, dietary fiber intake, and AHEI score), having a bowel movement more than once daily was significantly associated with increased risk of CHD, total mortality, and cardiovascular mortality. As compared with women with bowel movement frequency of once daily (reference), the hazard ratios (HRs) for those with more than once daily were 1.09 (95% confidence interval [CI]: 1.01-1.18) for incident CHD; 1.08 (95% CI: 0.99-1.18) for cardiovascular mortality; and 1.13 (95% CI: 1.08-1.18) for total mortality. Less frequent bowel movements were not significantly related to risk of CHD or mortality. Similar findings were observed in sensitivity analyses that excluded participants who had ulcerative colitis history or excluded those who used laxatives.

Conclusions:
Compared to those with daily bowel movements, women with more frequent bowel movements had a modestly increased risk of CHD incidence and total mortality. These associations should be examined in other populations.