bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P355: Variable associations of dehydroepiandrosterone with cardiovascular risk factors in the Boston Puerto Rican Health Study
Authors: Jimenez Monik C , Tucker Kathrine , Rodriguez Fatima , Meigs James B , Lopez Lenny
Published: July 2021

Introduction:
Low blood levels of dehydroepiandrosterone sulfate (DHEAS) have been shown to have strong positive associations with diabetes, cardiovascular disease (CVD) mortality and stroke. However, the underlying pathways remain unclear, given limited data to systematically examine associations of DHEAS with CVD risk. In exploratory analyses we tested the association between CVD risk factors and DHEAS levels in a large population of Latinos.

Methods:
Among 1,450 participants in the Boston Puerto Rican Health Study between the ages of 45-75 years at baseline, socio-demographic, behavior, medical history, anthropometric and blood pressure data were collected at in-home interviews conducted by trained staff. A certified phlebotomist collected fasting blood samples. All samples were assayed for DHEAS, lipids, and C-reactive protein (CRP), HbA1c, insulin and glucose (GL). Spearman correlations were estimated between DHEAS and continuous CVD risk factors (lipids, systolic blood pressure [SBP] and diastolic blood pressure [DBP], CRP, GL, HbA1c, insulin, body mass index [BMI], waist circumference, physical activity and alcohol consumptions). We used robust multivariable linear regression models adjusted for potential confounders and intermediates with α=0.05 to estimate the association selected CVD risk factors and DHEAS levels. CVD risk factors were identified from a set of potential candidate predictors (age, female gender, history of heart disease, diabetes status, SBP, DBP, total and high density cholesterol [TC, HDL], triglycerides [TG], GL, CRP) using stepwise linear regression with an entry criterion of α=0.20 and exit criterion of α=0.10.

Results:
The mean DHEAS concentration among women was 70.7 μg/dL (s.d. 53.9; median=70.7) and among men was 119 μg/dL (s.d. 87.7; median=100). In age and sex adjusted Spearman correlations, TC, low density lipoprotein cholesterol, physical activity and alcohol were positively significantly correlated with DHEAS, while BMI and waist circumference were inversely correlated. In robust multivariable linear regression adjusted for potential confounders, age (-8.3; 95%CI:-10.0,-6.5; per 5 yrs), sex (β=-32.5; 95%CI:-38.4,-26.6) and TG (β=-0.5; 95%CI:-0.7,-0.2; per 10 mg/dl) were significantly inversely associated with DHEAS concentration, while TC (β=0.9; 95%CI:0.2,1.6;per 10 mg/dL) and GL (β=0.7; 95%CI:0.2, 1.2;per 10 mg/dL) were positively associated, albeit non-statistically significant. Adjustment for history of CVD, diabetes and BMI, only marginally attenuated these associations.

Conclusions:
Our data provide support for a significant association between TG levels and DHEAS concentrations even after adjustment for potential confounders and intermediates, which has been previously untested. These results suggest that DHEAS may work through lipid pathways.
Abstract P364: Recent Trends In Mortality From Coronary Heart Disease Mortality And Its Risk Factors In Selected Developed Countries
Authors: Sekikawa Akira , Miura Katsuyuki , Willcox Bradley , Masaki Kamal H , Tracy Russell P , Miyamoto Yoshihiro , Ueshima Hirotsugu , Kuller Lewis H
Published: July 2021

Objectives:
Mortality from coronary heart disease (CHD) in developed countries started to decline in the late 1960’s and early 1970’s and age-adjusted CHD mortality fell about 50%. This decline is attributed to favorable changes in risk factors in the general population, i.e., total cholesterol, blood pressure, smoking, etc., and improved treatment of CHD. We examined recent trends in CHD mortality and its risk factors in selected developed countries.

Methods:
We selected Australia, Canada, France, Italy, Japan, Spain, Sweden, the UK, and the US. Data on CHD mortality between 1980 and 2005-08 were obtained from the WHO Statistical Information System. To define CHD mortality, codes I20-25 in ICD-10 and corresponding codes in ICDs 8 and 9 were used. Data on risk factors, primarily total cholesterol and systolic blood pressure during the same period were obtained from national surveys as well as literature.

Results:
in 1980, there was a 2 to 3-fold difference in age-adjusted CHD mortality among these countries both in men and women, with the UK, the US and Canada being high and Japan and France being low. Although between 1980 and 2005-08, age-adjusted CHD mortality continuously declined in all these countries, a 2 to 3-fold difference in the mortality remained with the similar order among these countries. Between 1980 and 2008, age-adjusted mean levels of total cholesterol fell by 21 to 31 mg/dl in men and by 8 to 31 mg/dl in women in these countries except for Japan. Age-adjusted levels of total cholesterol in Japan have continuously increased by 16 mg/dl for both men and women during this period. Meanwhile, between 1980 and 2008 age-adjusted levels of systolic blood pressure fell by 5 to 8 mmHg in men and 6 to 13 mmHg in women in these countries without exception. In 1980, the rate of cigarette smoking in men in Japan was the highest among these countries. Although the rate of smoking in men fell in all these countries, the rates remained the higher in Japan.

Conclusions:
Age [[Unable to Display Character: –]]adjusted CHD mortality has continuously declined between 1980 and 2005-08 in these developed countries. The decline was accompanied by a constant decrease in population-levels of total cholesterol by 20 to 30 mg/dl except for Japan where levels of total cholesterol have increased by 16 mg/dl. The reasons for persistently low CHD mortality and its downward trend in Japan are unexplained by traditional risk factors. Identifying preventive factors that determine low CHD rates in the Japanese and implementing such factors to the US would eliminate most of CHD epidemics in the US.
Abstract P370: Healthcare utilization in older adults with chronic heart failure and elevated depressive symptoms: Cardiovascular Health Study
Authors: Carnethon Mercedes R , Delaney Joseph A , Allen Norrina B , Yancy Clyde , Hirsch Calvin , Curtis Lesley
Published: July 2021

Background:
Elevated depressive symptoms (EDS) are common in adults with heart failure (HF) and their joint prevalence is associated with worse short- (1 year) and long-term health outcomes. The contribution of EDS to healthcare costs and utilization in a contemporary population of older adults with HF is unknown.

Hypothesis:
Adults with HF who report EDS will have higher annual healthcare costs and use more resources than their counterparts without EDS.

Methods:
Participants from the Cardiovascular Health Study who developed HF between baseline and the 11-year follow up and whose data were linked to Medicare Part A and Part B claims were included in the analysis (n=441). HF was adjudicated based on review of medical records and physician questionnaires. EDS was determined if participants scored ≥8 on the abbreviated Centers for Epidemiologic Studies Depression scale. Medicare payments were adjusted using the Medical Consumer Price Index and represented in 2009 dollars. Annual healthcare utilization (i.e., total provider visits, inpatient and outpatient visits) is based on Part B. Linear regression with robust variance estimation was used to determine the relationship of EDS with medical costs or provider counts adjusted for confounders.

Results:
Participants were 75.9 years old (SD= 5.3), 55% female, 15% black, and 147 (33%) had EDS. Within 2 years, 19% of patients with EDS died vs. 14% in those without EDS. Differences in annual costs between participants with and without EDS were not statistically significant. However, participants with EDS had more provider visits than their counterparts (Table).

Conclusion:
Despite adults with HF and EDS using more healthcare resources than those without EDS, expenditures did not differ. Higher short-term mortality in adults with EDS could be an explanation.
Abstract P396: Presence of Hypertension and the Effect on Clinical Outcome Scores of IV rt-PA Receiving Patients at a Community Primary Stroke Center (PSC) in Urban Los Angeles
Authors: Garland Jennifer , Antonio Anna , Liu Antonio
Published: July 2021

Background:
Intravenous recombinant tissue plasminogen activator (IV rt-PA) is the only FDA approved thrombolytic treatment for acute ischemic stroke offering at least a 30% chance of improvement over placebo.

Purpose:
The purpose of the study was to examine the effect of hypertension (HTN) and other various covariates of patients receiving IV rt-PA thrombolysis treatment for ischemic stroke on clinical outcome scores over time: mRS (modified Ranking Scale) & NIHSS (National Institute of Health Stroke Scale).

Methods:
A retrospective analysis utilized repeated measures design (SAS Windows version 9.3) on patients receiving IV rt-PA thrombolysis treatment for ischemic stroke from Jan 1, 2012 to Dec 31, 2012. The total cohort used for analysis, N=60. Two cases were not included due to death. Baseline measures were taken at admission and one follow-up time point at discharge. All covariates were included first in univariate models. Those which were found to be significant were then included in multivariate analysis. All statistical significance tests were 2-sided, α=.05 was considered statistically significant.

Results:
In univariate analyses, there is a significant time effect (p=0.0001), evidenced by the decrease in NIHSS over time and a significant difference in average NIHSS scores between those with and without HTN (p=0.0016). A test of interaction of HTN status by time was not significant ( p >0.05). NIHSS scores appear to decrease faster for those without HTN, however, this difference in rate is not significant. Not having HTN was associated with a decrease in mean NIHSS score over time, while having a hemorrhagic transformation (HT) is associated with an increase in mean NIHSS score. Age, gender, ethnicity, and IV rt-PA door to needle time were not found to be significant predictors of mean NIHSS scores over time.

Conclusions:
Patients with hemorrhagic transformation were associated with poorer clinical outcomes, as expected. These patients receiving IV rt-PA for acute ischemic stroke generally improved, as expected. It was interesting to note that individuals with HTN appear to be admitted and discharged with higher NIHSS scores versus those without HTN, despite HTN being promptly treated when present. This demonstrates the importance of HTN prevention and blood pressure control treatment.
Abstract P402: A Rapid Automated Method Detects Probable Errors Among Sequential Clinical Measures Recorded During Clinical Care
Authors: Schwenke Dawn C
Published: July 2021

Information collected during clinical care is increasingly used for research. Such data include errors and a rapid automated method for identifying likely errors is needed. This study aimed to develop a rapid automated method for identifying extreme values among sequential measures recorded during clinical care and to compare this method with the extreme studentized deviate many outlier procedure (ESD). Data were weights (W, n=1,151,434), heights (H, n=760,924), pulses (P, n=1,369,484), and systolic (S, n=1,680,583) and diastolic (D, n=1,680,503) blood pressures for 88,068 Veterans (82,874 men and 5,194 women) receiving care from the Phoenix VA Health Care System who had ≥5 five sequential values for these measures recorded in the electronic medical record during primary care visits from October 1999- September 2013. The new method identified extreme values by comparing individual values with three within-person metrics: 1. median (PMed), 2. interquartile range (PIQR), and 3. modified IQR [ModPIQR: PMed + / - smaller of (PMed - 25th percentile) and (75th percentile - PMed)]. These measures were selected because they were expected to be less perturbed by extreme values than the mean and standard deviation. Values exceeding cut-points (> 99th or < 1st population percentile) for ≥ 2 metrics were considered errors. High errors (0.46% W, 0.40% H, 0.55% P, 0.48% S, 0.50% D) were median 125%, 107%, 156%, 135% and 140% of PMed; median 3.3, 2.3, 2.8, 2.0 and 2.1 fold above PIQR; and median 5.0, 20, 3.4, 2.6, and 2.6 fold above ModPIQR for W, H, P, S, and D, respectively. Low errors (0.48% W, 0.43% H, 0.48% P, 0.46% S, 0.47% D) were 73%, 86%, 62%, 70%, and 65% of PMed; median 4.3, 5.0, 2.0, 1.8, and 2.1 fold below PIQR; and median 6.4, 50, 2.6, 2.3, and 2.4 fold below ModPIQR for W, H, P, S, and D. Compared with the new method, ESD (alpha = 0.01) identified fewer total (high+low) outliers for D (0.21% vs. 0.97%), P (0.58% vs. 1.03%), and S (0.14% vs. 0.94%), more outliers for H (2.40% vs. 0.83%), and similar numbers for W (0.70% vs. 0.94%). Both high (> 99th population percentile) and low (< 1st population percentile) extreme values for percent of PMed were detected with greater sensitivity by the new method (39%, 39%, 50%, 45%, and 46%; 41%, 40%, 43%, 41%, and 42%, respectively for high and low extremes for W, H, P, S, D) than by ESD (19%, 20%, 22%, 6%, 9% and 27%, 31%, 11%, 3%, 7%, respectively) while specificity was equally high (>98%) for both methods. The new method can be easily implemented and effectively identifies extreme values likely to be errors from among sequential clinical measures and could help reveal underlying longitudinal trends in weight/BMI, blood pressure or other clinical measures.
Abstract P404: Validation of a Culturally Modified 24 hour Dietary Recall Questionnaire for use in Rural South Indian Populations
Authors: Subasinghe Asvini K , Thrift Amanda G , Arabshahi Simin , Suresh Oduru , Kartik Kamakshi , Kalyanram Kartik , Walker Karen Z
Published: July 2021

Introduction:
The assessment of dietary intake in rural populations can be extremely challenging because of cultural and environmental limitations.Only one other study in India has been conducted to validate a 24 hour dietary recall. The purpose of this study was to validate a three pass 24 hour dietary recall questionnaire, culturally modified for use in South Indian populations, against a series of weighed food records (WFRs).

Hypothesis:
We assessed the hypothesis that there will be less than 15% variance between amounts of food reported to be consumed in 24 hour dietary recalls and amounts of food weighed during WFRs.

Methods:
Eight life size food portion photographs of common South Indian food servings were created to aid participant recall. Nutrient intake was calculated using a food database specifically created for South Indian food items. Dietary data were compared between the two dietary assessment methods in 30 adults aged 19-85 years. WFRs were conducted in the household by a trained field worker. The amount of food served by each participant was weighed, along with any left overs not eaten. The following day, field workers administered a 24 hour recall interview to the same participant.

Results:
In total, 101 replicate weighed food portions were matched with estimated portions by 24 hour recall for 21 different types of food or drink. Overall, there was an 11% over-estimation by 24 hour recall compared to the WFR and a strong correlation between the two measures (r=0.93). Mean nutrient intakes obtained from each measure were not significantly different.

Conclusions:
The culturally specific modifications made to the 24 hour dietary recall method is valid for assessing energy, macro- and micro- nutrient intake in rural Indian populations.
Abstract P410: Added Sugars Intake, Diet Quality and All-Cause Mortality Among US Adults: Prospective Data from National Health and Nutrition Examination Survey III
Authors: Jung Molly , Kaplan Robert C , Mossavar-Rahmani Yasmin , Viswanathan Shankar , Wylie-Rosett Judith , Beasley Jeannette
Published: July 2021

Objectives:
To better understand the relationship between added sugars intake and diet quality, and to estimate associations between added sugars intake with all-cause mortality

Methods:
National Health and Nutrition Examination Survey III data were linked to mortality data (1988-2006), among 13,902 US adults between ages 18-74 yr having energy intake within 500-3500calories for women and 800-4000 calories for men, no history of a heart attack, stroke, or congestive heart failure. Usual intake of added sugars and energy were estimated using the NCI method and categorized into gender-specific quartiles. Diet quality was assessed using the Healthy Eating Index 2005 score (HEI-2005). Associations between added sugars intake and mortality were estimated using Cox proportional hazards regression adjusting for age, race/ethnicity, body mass index (BMI), and usual total energy intake after testing for multiplicative interaction by each of these covariates.

Results:
Mean intake of added sugar was 17.2 (95% Confidence Interval (CI) 16.8, 17.6) teaspoons (tsp) in women and 25.0 (95% CI 24.4, 25.7) tsp in men. Higher usual intake of added sugars was associated with being younger, a current smoker, and having between 12 and 15 years of education among both men and women. Higher usual intake of added sugars was related to a lower HEI score in women versus a higher HEI score in men (Quartile (Q) 4 for HEI =61.62 versus Q1=64.73 in women, p=0.0002; (Q4=62.71 vs. Q1=60.07 in men, p=0.0209). Higher HEI scores for the grain, fruit, vegetable, meat, and variety components were related to lower intake of added sugars; whereas, the fats, cholesterol, and sodium components of the HEI were related to higher intake of added sugars in men and women. During a median follow-up period of 14 years, a total of 1,889 deaths were recorded. After multivariable adjustment, higher added sugars intake was not associated with increased all-cause mortality (hazard ratio (HR) 95% CI of Q4 vs Q1, 1.08 (0.77, 1.52)).

Interpretation:
Epidemiological studies suggested that higher sugars intake is associated with an increased risk of obesity and cardiovascular diseases (CVD). These findings indicate higher intake of added sugars is associated with lower diet quality in women, but not men. Added sugars intake was not significantly associated with all-cause mortality in this representative sample of the US population.
Abstract P411: Associations Between Dietary Polyunsaturated Fatty Acid Intakes And Serum C-reactive Protein Concentrations In Adults From Nhanes 2003-10
Authors: Sun Sam , Flickinger Brent
Published: July 2021

Background:
Multiple clinical studies and literature reviews suggest that elevated serum C-reactive protein (CRP) concentration may be associated with risks of cardiovascular diseases (CVD), type-2 diabetes, certain autoimmune disorders, and infection or inflammation. Data are very limited and inconsistent about impact of dietary polyunsaturated fatty acid (PUFA) intakes on CRP concentrations.

Method:
PUFA intakes and CRP measurement in adults (aged 19 years and elder) were extracted from databases of NHANES 2003-10. Non-normally distributed data were normalized by log-transformation. SAS survey-mean and survey-regression procedures were used to analyze the dataset extracted.
Result:
In total, 17,785 participants who had valid CRP and PUFA intake data were included in this work. Means of PUFA intake, CRP concentration, and n6- to n3- fatty acids (FA) ratio were 15.11 g/d (median 15.56 and SE 0.07), 1.79 mg/L (median 1.80, SE 0.006), and 9.81 (median 9.21, SE 0.027), respectively. 38.94% (n=6925) participants had CRP concentration ≥3 mg/L with mean PUFA intake 14.36 g/d, 9.54% (n=1,696) ≥10~>30 mg/L with mean PUFA intake 14.41 g/d, and 1.43% (n=254) ≥30mg/L with mean PUFA intake 12.91 g/d. From regression analyses, CRP concentration was significantly and inversely correlated with PUFA intake (P<0.0001) with adjustment for saturated fat intake, gender, age, and BMI, but not correlated with the ratio of n6 to n3 FA (P=0.57). CRP concentration was also significantly and inversely correlated with PUFA intake quartiles (P=<0.0001) with the same adjustment setting. Least square (LS) mean of CRP concentration in the lowest quartile group (2.06 mg/L) was significantly higher (P= 0.001~<0.0001) than the LS means of all other 3 PUFA intake quartile groups. LS means of CRP concentration in the 2nd lowest and the 3
rd
quartile groups (1.85 and 1.79 mg/L) were also significantly higher (P=0.005 and 0.046, respectively) than the LS mean of the highest quartile group (1.69 mg/L).

Conclusion:
Descriptive statistics and multi-covariate regression showed that dietary PUFA intakes were inversely associated with serum CRP concentration in the adult population, but not associated with n6- to n3- FA ratio. This finding is consistent with previous suggestions that sufficient PUFA or n3 FA intakes may enhance immune function, reduce risk of infection, and infection/inflammation-related diseases, such as CVD. In the population analyzed, intakes of linoleic acid, alpha-linolenic acid, n3 FA, n6 FA, and total PUFA were tightly correlated with each other (r=0.833-0.999, Spearman).
Abstract P413: Chocolate Consumption is Associated with a Lower Risk of Heart Failure in Lean US Male Physicians
Authors: Petrone Andrew B , Gaziano J. Michael , Djousse Luc
Published: July 2021

Background:
Previous studies have suggested that dark chocolate consumption may lower blood pressure, a major risk factor for heart failure. However, limited and inconsistent data are available on the association of chocolate consumption with the incidence rate of heart failure.

Objective:
To test the hypothesis that chocolate consumption is associated with a lower risk of heart failure.

Methods:
We prospectively studied 20,278 men from the Physicians’ Health Study. Chocolate consumption was assessed between 1999 and 2002 via a food frequency questionnaire and heart failure was ascertained through annual follow-up questionnaires with validation in a subsample. We used Cox regression to estimate multivariable adjusted relative risk of heart failure.

Results:
During a median follow-up of 9.3 years, there were 876 new cases of heart failure. The mean age at baseline was 66.4 ± 9.2 years. Median chocolate consumption was 1-3 times per month. Hazard ratios (95% CI) for heart failure were 1.0 (ref), 0.87 (0.73-1.04), 0.80 (0.66-0.98), and 0.87 (0.72-1.04), for chocolate consumption of less than 1/month, 1-3/month, 1/week, and 2+/week, respectively, after adjusting for age, body mass index (BMI), smoking, alcohol intake, exercise, and history of atrial fibrillation. In a secondary analysis, chocolate consumption was inversely associated with risk of heart failure in men whose BMI was <25 kg/m
2
but not in those with BMI of 25+ kg/m
2
(
Figure 1
), p for interaction=0.0895.

Conclusions:
Our data suggest that moderate consumption of chocolate might be associated with a lower risk of heart failure, especially in lean individuals.
Abstract P420: Dietary Fat on Whole Blood Gene Expression and Plasma Lipids in the Framingham Heart Study
Authors: Mendelson Michael M , Chen Brian , Liu Chunyu , Joehanes Roby , Munson Peter , Rogers Gail , Ordovas Jose M , Lichtenstein Alice H , Demissie Serkalem , Cupples L. A , Robins Sander , Larson Martin G , Jacques Paul F , Levy Dan
Published: July 2021

Objective:
To describe the influence of type of dietary fat on the activity of metabolic pathways, as measured by gene expression profiles, and the relation to plasma lipids.

Background:
Metabolic studies have demonstrated strong associations of dietary fatty acid composition with plasma lipids. Relatively little is known about the pathways and gene expression changes that mediate these relationships in the general population.

Methods:
We analyzed self-reported dietary intake of fatty acids, plasma lipid levels, and genome-wide gene expression data from Framingham Heart Study Offspring and Third Generation cohort participants. We excluded participants on lipid therapy. Multivariable linear regression models were conducted with plasma lipids as separate outcomes, energy-adjusted residuals of dietary fats as predictors, and adjustment for clinical and dietary covariates. Normalized gene expression from whole blood derived RNA was similarly modeled with additional adjustment for cell count and batch effects.

Results:
Among 3681 participants, higher polyunsaturated fatty acid (PUFA) intake is associated with lower LDL-C (estimated β [regression coefficient] = -0.5, p=0.002), higher HDL-C (β= 0.4, p<0.0001), and lower triglyceride (β= -0.009, p=0.0003) concentrations after adjustment for age, sex, carbohydrate, protein, and alcohol intake. Higher PUFA intake was associated with differential gene expression of cholesterol efflux transporters (ABCA1/ABCG1), LDL receptor degrader (IDOL), and non-lipoprotein metabolism related transcripts (FDR < 0.05). In contrast, higher saturated fat intake (SFA) showed inverse associations with ABCA1 expression levels and HDL cholesterol (
Figure 1
).

Conclusions:
Higher PUFA intake is associated with a less atherogenic lipid profile and higher ABCA1 expression with inverse associations for higher SFA intake. Gene expression analysis reveals important links between dietary fat type, specific cholesterol metabolism pathways, and lipids in a community cohort.
Abstract P433: Emerging Lifestyle Factors Predict Carotid Intimal Media Thickness Scores
Authors: Masley Steven C , Roetzheim Richard , McNamara Timothy P , Masley Lucas V , Schocken Douglas D
Published: July 2021

Introduction:
Cardiovascular disease (CVD) remains the number one cause of mortality in the western world. Carotid intimal media thickness (carotid IMT) is a safe and reliable predictor of future CVD risk.

Hypothesis:
The study aims to assess the hypothesis that lifestyle factors impact carotid IMT, and determine which nutrition and fitness risk factors best predict mean carotid IMT scores.

Methods:
A prospective cross-sectional analysis of 592 men and women undergoing health and cardiovascular risk screening. This study reflects the first visit of these subjects, age 23 to 65 (mean = 48.2), who are followed longitudinally and who were participants at a “wellness” oriented program for patients who are generally well-educated and mostly in good health. Measurements were made of fitness using VO2max stress testing and push-up and sit-up scores following the American College of Sports Medicine testing protocols, diet intake using a 3-day dietary intake survey and computerized analyses. Mean carotid IMT scores were obtained using high resolution B-mode ultrasonography of the common carotid arteries. Each subject had ≥10 images collected from the far wall of the right and left distal 1 cm of the common carotid arteries at end diastole. The carotid intimal thickness was measured as a continuous variable, using both multivariate linear and bivariate linear regression. Multivariate analyses adjusted for potential confounders using multiple linear regression and included measures of body composition, blood pressure, fasting lipid and glucose levels, and statin use.

Results:
Multivariate analyses show that higher mean carotid IMT values are associated with increasing age (p<0.0001), male gender (p<.0.0001), lower aerobic capacity (p=0.0045), lower intake of fish (p=0.05), and lower intake of zinc (p=0.0002). Bivariate analyses controlling for age and gender, with and without statin use, showed higher mean carotid IMT scores were statistically associated with lower levels of aerobic fitness, (p = 0.0007), lower intake of fiber (p=0.02) and lower intake of magnesium (p=0.019). Intake of protein, carbohydrate, and fat as percent of calories; as well as intake of saturated fat, sodium, calcium, potassium, and vitamin K; measures of strength (assessed with push-up and sit-up testing); and self-reported exercise minutes per week were not associated with mean carotid IMT scores.

Conclusions:
In this database, aerobic fitness and dietary intake of fiber, fish, magnesium, and zinc are associated with lower carotid IMT scores. Further studies are warranted to explore the impact of emerging lifestyle factors on cardiovascular risk and clinical outcomes.
Abstract P435: Body Fatness, Cardiorespiratory Fitness And Inflammatory Markers In Adolescents
Authors: Moreira Carla , Abreu Sandra , Santos Paula C , Lopes Luis , Mota Jorge , Santos Rute
Published: July 2021

Introduction:
The alarming increase in obesity worldwide and the decrease in cardiorespiratory fitness (CRF) levels among adolescents are of concern in the development of cardiovascular diseases. Therefore, the purpose of this study was to evaluate the association between body fatness, CRF, and inflammatory markers [C-reactive protein (C-RP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and leptin] in a sample of Portuguese adolescents.

Hypothesis:
We assessed the hypothesis that adolescents with higher body fatness and lower CRF levels will have an increased level of inflammatory markers.

Methods:
A cross-sectional school-based study was conducted on 529 Portuguese adolescents (268 girls) aged 12-18 years (mean age 14.3±1.7).

Body fatness (BF) was assessed using the Bioelectric Impedance Analysis. Intravenous blood samples were taken after an overnight fast to determine inflammatory markers (C-RP, IL-6, TNF-α, and leptin). CRF was measured with the 20m-Shuttle-Run-Test from the Fitnessgram battery test as number of laps. Pearson correlation was used for bivariate associations between BF, CRF and inflammatory markers. Linear regression analyses were used to examine the association between BF, CRF and inflammation markers with adjustments for age and sex.

Results:
Pearson’s correlation analyses, adjusted for age and sex, revealed that BF was positively correlated with leptin (r=0.640, P <0.001) and C-RP (r=0.235, P <0.001), and negatively correlated with CRF (r= -0.473, P <0.001) whereas CRF was inversely correlated leptin (r= -0.420, P <0.001) and C-RP (r= –0.226, P <0.001). Among the inflammatory markers leptin (β= 0.188, p<0.001) and C-RP (β= 0.030, p<0.05) were positively associated with BF whereas leptin (β= -0,160, p<0.001) and C-RP (β= -0.56, p<0.001) were inversely associated with CRF, conversely, TNF-α (β= 0.118, p<0.05) showed a positive association with CRF.

No associations were found between BF, CRF and IL-6.

Conclusions:
Our findings emphasize the importance of increasing CRF levels and decrease body fatness among adolescents in order to prevent metabolic abnormalities predisposed to or associated inflammation and thus contribute to the prevention of cardiovascular diseases later in life.
Abstract P447: Cellular Adhesion Molecules: Early Indicators of Subsequent Clinical Cardiovascular Disease Events in a Young Adult Population. The CARDIA Study.
Authors: Gross Myron D , Odegaard Andrew O , Bielinski Suzette J , Suarez-Lopez Jose R , Carr J. Jeffrey , Duprez Daniel A , Lewis Cora E , Lange Leslie , Jacobs David R , Reiner Alex P
Published: July 2021

Background:
Cellular adhesion molecules (CAM) have a central role in the accumulation of circulating leukocytes at sites of vascular injury, infection and/ inflammation, and have been associated with the development of atherosclerotic plaque and coronary artery disease in mature adults.

Objective:
To test the hypothesis that higher overall circulating CAM levels in young adults predict cardiovascular disease (CVD) events over the next 18 years.

Method:
We measured several circulating CAM molecules (ICAM-1, P-selectin, E-selectin and VCAM) in the Coronary Artery Risk Development in Young Adults (CARDIA) study at exam year 7 (1992-93, black and white men and women, CVD-free, mean age 32, range 25-37 years, n=2428) and monitored incident CVD events (n=70, including coronary heart disease, stroke, and heart failure, adjudicated based on medical records) through exam year 25, mean age of 50 years. We ranked each CAM in quintiles (coded 0-4) and summed the ranks across CAMs into an index to examine the association with incident CVD with Cox regression models.

Results:
Unadjusted cumulative CVD event rates were 1.6% (sum of CAM quartile ranks 0-8: 22 events in 1353 participants), 2.3% (sum of ranks 9-12: 29/813), and 7.3% (sum of ranks 13-16: 19/262). In proportional hazards regression analysis adjusted for year 7 age, sex, race, clinic, education, smoking, diet, physical activity, body mass index, blood pressure, blood lipids, and blood glucose, sum of ranks 13-16 were associated with a higher risk of CVD compared to the referent (rank sum 0-8) (See Table).

Conclusion:
High levels of circulating CAMs at an early stage of adulthood (mean age 32, range 25-37 years) were associated with an increased risk of incident CVD events. CAMs may be an early biomarker for development of subclinical CVD, even in CVD-free young adults with low atherosclerosis burden and decades prior to the development of clinical CVD.
Abstract P448: Exploring Socioeconomic Inequalities In Coronary Heart Disease Prevention
Authors: Ahmed R , O'Flaherty Martin , Hawkins N , Lucy J , Capewell Simon
Published: July 2021

Background:
Between 2000 and 2007, coronary heart disease (CHD) mortality rates in England plummeted by one third. An important part of this substantial CHD mortality decline was achieved through reductions in major cardiovascular risk factors (primary prevention). However, the relative contributions from medications and from population-wide changes remains unclear, particularly the effects on health inequalities.

Methods:
Using a previously validated policy model, the fall in CHD mortality in England was analysed. The contributions from risk factor declines in asymptomatic individuals through medications and through population-wide changes were quantified. Data were stratified using the Index of Multiple Deprivation (IMD). Model outputs were quantified as deaths prevented or postponed (DPPs).

Results:
Between 2000 and 2007, approximately 21,900 fewer CHD deaths were attributable to risk factor declines in systolic blood pressure and cholesterol in the English population.

Some 7,100 of these 21,900 fewer deaths (DPPs) were attributed to medications (32%) and approximately 14,800 DPPs were attributed to secular changes in asymptomatic individuals (68%).

Substantial declines in systolic blood pressure were responsible for approximately 14,300 fewer deaths. This comprised approximately 12,500 DPPs attributable to population-wide changes and some 1,800 DPPs attributable to hypertension medications. The hypertension medications resulted in approximately 350 fewer deaths in the most affluent quintile compared with 270 DPP in the most deprived. In contrast, the population-wide (secular) falls in blood pressure resulted in approximately 2400 fewer deaths in the most deprived quintile compared with only 1900 DPPs in the most affluent.

Cholesterol falls resulted in approximately 7,700 fewer deaths. This comprised some 5,300 fewer deaths attributable to statin medications and approximately 2,400 fewer deaths attributable to population-wide changes (mostly diet).

Statin medications prevented more deaths in the most affluent quintile (1050 DPPs) compared with the most deprived (770 DPPs). Population-wide changes in cholesterol prevented substantially more deaths in the most deprived quintile (820 DPPs) compared with the most affluent (260 DPPs).

Conclusions:
Population-based declines in blood pressure and cholesterol resulted in much greater reductions in CHD deaths than did primary prevention medications.

Mortality falls were greatest in the most deprived quintiles, mainly reflecting their bigger initial burden of disease. Future CHD prevention policies should prioritise healthier diets ahead of medications.
Abstract 1: Statewide Implementation of a Standardized Prearrival Telephone CPR Program Is Associated with Increased Bystander CPR and Survival from Out-of-Hospital Cardiac Arrest
Authors: Bobrow Bentley , Panczyk Micah , Stolz Uwe , Sotelo Mike , Vadeboncoeur Tyler , Sutter John , Langlais Blake , Spaite Daniel
Published: July 2021

Background:
Bystander CPR (BCPR) increases survival from OHCA yet is provided in a minority of cases. The AHA has promulgated guidelines on the provision of pre-arrival Telephone CPR (TCPR) instructions and measurement to increase the proportion of BCPR; however, the impact of those guidelines on survival is unknown.

Objective:
To describe the impact of a comprehensive bundle of 9-1-1 TCPR protocol, training, data collection, and feedback on BCPR and survival from OHCA across the state of Arizona.

Methods:
9-1-1 audio recordings of confirmed OHCAs and suspected OHCAs (10/2010-6/2013) in 7 large 9-1-1 centers were reviewed using a standardized time-stamp methodology linked with EMS and hospital process and outcome data. There were 2343 pre-implementation cases (P1) and 2291 cases post-implementation of a bundle of care (P2) that included staff training and guideline-based protocol changes, data collection and feedback to providers. Univariate and multivariable analyses were used to assess outcomes between P1 and P2.

Results:
There were 2532 OHCAs [1232 P1, 1300 P2; 64% male, median age 62 (IQR: 47-74)]. 83% of cases were identified in P1 compared with 89% in P2 (p<0.001). The rate of telephone-assisted BCPR went from 44% in P1 to 62% in P2 (p<0.001). Time to beginning TCPR instructions decreased from a median of 144 sec (P1) to 126 in P2 (p<0.001). Time to first chest compression also decreased (P1: 178; P2: 155; p<0.001). Outcome data are currently available for 64% of confirmed OHCAs (1630 patient outcomes with 1619 neuro outcomes). Survival was significantly higher in P2 (11.2%) compared to P1 (7.9%; p=0.023), as was good neuro outcome (CPC-1 or 2: 7.7% P2 vs. 4.8% P1 p=0.018). After adjusting for witnessed arrest, shockable rhythms, age, and sex, both survival and good neuro outcome were still significantly higher in P2 vs. P1 [adjusted odds ratios: survival = 1.5 (95% 1.1-2.1); good neuro outcome = 1.7 (95% 1.1-2.6)].

Conclusion:
The implementation of a comprehensive statewide TCPR bundle was associated with significant improvements in the rates of telephone-assisted BCPR, survival and good neurologic outcome after OHCA.
Abstract 109: Patients with Diabetes Have Decreased Survivability with Good Neurological Outcomes After Out-of-Hospital Cardiac Arrest
Authors: Jang Beatrice Dayea , Shin Sang Do , McClellan William , McNally Bryan
Published: July 2021

Objectives:
This study aims to provide a scientific evidence of the association between diabetes and the probability of OHCA survival with good neurological outcomes.

Methods:
Korean registry on patients survived to admission after emergency medical services (EMS)-assessed OHCA with cardiac etiology with known diabetes statuses (2009 to 2012) was used. We excluded patients without available hospital outcomes or diabetes. Diabetes was defined when the patients had history of treatment or diagnosis or positive result at laboratory test during hospital stay. Outcomes were survival to discharge with good brain recovery measured by medical record review by medical record review experts using cerebral performance category 1 or 2. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a multivariate logistic regression model adjusting for individual, Utstein, post-resuscitation factors, and comorbidities. Interaction model between diabetes and gender and heart disease were also analyzed.

Results:
Total 7463 patients including diabetes 1,952 (26.2%), non-diabetes 4,129 (55.3%), and unknown diabetes 1,382 (18.5%) were finally analyzed. Survival to discharge with good brain recovery was 17.7% in non-diabetes, 9.7% in diabetes 16.2% in unknown-diabetes, respectively (p<0.001). Crude OR (95% CI) was 0.50 (0.42-0.59) in diabetes and 0.89 (0.76-1.05) in unknown-diabetes comparing with non-diabetes. Adjusted OR (95% CI) was 0.78 (0.61-0.98) in diabetes and 1.07 (0.75-1.53) in unknown-diabetes comparing with non-diabetes. The adjusted OR measuring the effect of diabetes on survival with good neurological outcomes for male with history of heart disease was 0.32 (0.22-0.48, p-value <0.0001), for male without history of heart disease was 0.55 (0.34-0.89, p-value <0.0001), for female with history of heart disease was 0.60 (0.48-0.76, p-value 0.0152), and for female without history of heart disease was 1.03 (0.71-1.47, p-value 0.8919).

Conclusion:
This study provides evidence of significant associations of diabetes and decreased OHCA survivability with good neurological outcomes where the association is greater in male and patients with heart disease.
Abstract 11026: Aldosterone Level in the General Community Predicts New Onset Cardiometabolic Disease
Authors: Buglioni Alessia , Cannone Valentina , Sangaralingham S. Jeson , Heublein Denise M , Scott Christopher G , Bailey Kent R , Rodeheffer Richard J , Sarzani Riccardo , Burnett John C
Published: July 2021

Introduction:
Plasma aldosterone (Aldo) increases Na and water reabsorption and mediates inflammation. Our recent findings in a general population cohort showed Aldo strongly associated with hypertension (HTN), obesity, chronic kidney disease (CKD) and lower natriuretic peptide levels (NPs) during a first visit (V1), even when Aldo was within the normal range. It is undefined whether Aldo itself (V1) and/or its increase after 4-year (second visit, V2) can predict new onset cardiovascular and metabolic diseases.

Hypotheses:
We hypothesized that: 1) Aldo-V1 predicts new onset disease at V2; 2) The increase of Aldo between V1 and V2 predicts new onset disease-V2; and 3) Aldo-V2 remains associated with cardiovascular and metabolic disease-V2.

Methods:
We defined the correlations between Aldo-V1 and Aldo-V2 with cardiometabolic diseases and medications at V2, in a general community cohort (N=1368) from Olmsted County, MN. Associations were adjusted for age, sex and BMI; Aldo was analyzed as continuous variable and according to tertiles.

Results:
After 4 years, Aldo-V1 continuous variable predicted new onset of central obesity (p=0.0113, OR=1.36, CI=1.07-1.73), HTN (p=0.0012, OR=1.36, CI=1.13-1.63) and use of antilipemic drugs (p=0.0119, OR=1.25, CI=1.05-1.48); while Aldo-V1 in the 3
rd
tertile predicted new onset of type 2 diabetes (T2DM) (p=0.0392, OR=1.96, CI=1.03-3.70), use of antilipemic therapy (p=0.0162, OR=1.59, CI=1.09-2.31) and HTN (p=0.049, OR1.44, CI=1.00-2.08) at V2. Secondly, we observed that the increase in Aldo between V1 and V2 predicted new HTN-V2. Finally, we found higher Aldo-V2, but still within the normal range and Aldo-V2 remained associated with HTN, obesity and CKD, when analyzed as continuous variable and when in the 3
rd
tertile.

Conclusions:
In the general community, Aldo-V1 predicts new onset HTN, central obesity, T2DM and use of antilipemic therapy. Importantly, the increase of aldosterone between V1 and V2 also predicts new onset HTN. Finally, Aldo-V2 correlates with HTN, obesity and CKD as we found at V1. Further studies are warranted to evaluate aldosterone as therapeutic target to delay disease progression, and to support its role as prognostic biomarker to identify high-risk subjects.
Abstract 11059: Role of Sirtuin 6 in Macrophage Polarization and Cardiac Repair in Diabetes
Authors: Thandavarayan Rajarajan A , Joladarashi Darukeshwara , Babu Sahana S , Srikanth Garikipati V , Mackie Alexander R , Verma Suresh K , Vaughan Erin E , Kishore Raj , Krishnamurthy Prasanna
Published: July 2021

Clinical and experimental studies provide evidence that metabolic and inflammatory pathways are functionally interconnected to cardiovascular diseases. Dynamic changes in macrophage activation [classical M1 activation (promote inflammation) or alternative M2 activation (promote wound healing)], in response to various stress signals, modulate cardiac physiopathology in diabetes. Sirtuin 6 (SIRT6), a NAD-dependent nuclear deacetylase plays an important role in genomic stability, cellular metabolism, stress response and aging. However, the mechanism by which SIRT6 activity affects macrophage phenotype and cardiac function in diabetes is still unexplored. Mouse bone marrow-derived macrophages (BMM) exposed to high glucose (HG, 25mM D-glucose) showed reduced expression of SIRT6 as compared to low glucose (LG, 5mM D-glucose)- and osmotic control (OC, 5mM D-glucose+20mM D-mannitol)-treated cells, associated with increased expression of proinflammatory cytokine and transcription factors (NFkb, c-JUN, FOXO, SP1 and STAT1). In addition, SIRT6 level was reduced in peritoneal macrophages of both diabetic models (streptozotocin-induced and db/db mice) as compared to non-diabetic mice. SIRT6 knockdown in RAW 264.7 cells exaggerated inflammatory response when exposed to HG. In contrast, IL-4-induced increase in mRNA expression of macrophage M2 phenotype markers like Arg1, Chi4l4, Retnla and IRS-2, but not IRS-1 expression was repressed suggesting that alternative macrophage (M2) phenotype was defective in SIRT6 deficient BM-macrophages under HG condition. SIRT6 protein expression was low in myocardial infarction-induced (MI) and diabetes-affected hearts. Interestingly, mice receiving intramyocardial injection of SIRT6-deficient macrophages showed further deterioration in left ventricular function, post-MI. Taken together, these data highlight a role for SIRT6 in regulating the balance of M1/M2 polarization, therefore, modulate macrophage mediated cardiac repair and regeneration in numerous inflammatory disease states including diabetes
Abstract 11072: Profiling of a Platelet Proteome Discriminates Between Subjects and the Effects of Antiplatelet Agents Alone and in Combination
Authors: Marcone Simone , Fitzgerald Desmond J
Published: July 2021

Protein profiling of biological samples provides an integrated measurement of genetic, environmental and drug effects. We examined the response to a number of antiplatelet drugs alone and in combination on the human platelet secreteome following stimulation with thrombin. The drugs included a P2Y12 antagonist (PSB0739) and a PAR-1 antagonist (RWJ56110) at concentration (10nM) that blocked the platelet responses to their respective agonists, and aspirin (10microM). Thrombin (1U/ml) was used to stimulate aggregation and secretion of washed platelets despite the presence of the drugs. Platelets were obtained from healthy donors and drugs added in vitro. The proteome profile was determined by label-free quantitative mass spectrometry (Q Exactive and MaxQuant software). The profile was markedly different between individuals (n=3) but it was similar for the same individual over 3 separate samples obtained weeks apart. The addition of the antiplatelet agents showed a similar strong individual clustering of all proteins (>1,000). Cluster analysis of the 270 proteins that changed with drug showed marked differences between drugs although there was no impact on platelet aggregation. Similarly, combinations of 2 or 3 drugs demonstrated distinctive clustering of changes in the protein profile. Functional ontology of the proteome showed marked differences between drugs with very distinctive patterns. Similarly, drugs differed clearly in their effects on discrete functional protein clusters, such as ‘coagulation proteins’. Our findings suggest that individuals have distinct platelet proteomes (‘proteome barcode’) that remain evident in the presence of drug. Despite this, antiplatelet drugs exhibit distinct effects on the platelet proteome, when applied alone and in combination. The profiling of the platelet proteome better discriminates the effects of antiplatelet drugs than is possible with platelet aggregation and may help tailor therapy more effectively.