bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P184: Occupation Type, Hypertension Status and Awareness Among Hispanic/Latino Adults: Findings From the Hispanic Community Health Study/ Study of Latinos (HCHS/SOL)
Authors: Rosenberg Natalya , Eldeirawi Kamal , Durazo-Arvizu Ramon , Lash James , Chambers Earle , Davis Sonia , Gonzalez Hector , Perreira Krista , Schneiderman Neil , Tarraf Wassim , Daviglus Martha
Published: July 2021

Introduction:
Occupation types, e.g. service, have been associated with hypertension (HTN). Data from Hispanics/Latinos are limited, despite high rates of HTN-related morbidity. We examined prevalence of HTN status and awareness by occupation type and association of occupation type with HTN status among Hispanic/Latino adults.

Methods:
Baseline data from HCHS/SOL, a cohort of diverse Hispanics/Latinos ages 18-74 in 2008-11, were used. Participants (N=7,429, mean age 38.9 years) reported current occupation (definition in Table). HTN was defined as elevated blood pressure (≥ 140/≥90 mm Hg) or self-reported use of antihypertensives; HTN awareness as self-reported physician diagnosed HTN. Survey statistical analyses were weighted and stratified by sex. Effect modification by years in the US, language and social acculturation was tested.

Results:
Non-skilled worker was the most common occupation type (males 30.1%; females 25.3%). Age-adjusted prevalence of HTN was highest in service workers (males 20.7%; females 17.4%); lowest in non-skilled workers (males 15.5 %; females 14.2%). The prevalence of HTN awareness was lowest in non-skilled male workers (48.2%); highest in females in higher status occupations (76.8%). The association of occupation type with HTN status varied by social acculturation (i.e. preferred ethnicity of social relations). In males, service workers with low social acculturation (preferred Hispanic/Latino social relations) had lower odds of HTN compared to those in higher status occupations, while service or skilled workers with high social acculturation had higher odds of HTN. Female non-skilled workers with low social acculturation had higher odds of HTN compared to higher status occupations (Table).

Conclusions:
Among Hispanics/Latinos, prevalence of HTN status and awareness varies by occupation type. Occupation type and social acculturation are jointly associated with HTN status. Strategies for HTN prevention and awareness should take into account occupational differences.
Abstract P193: Metabolomic Profiles Associated With Longevity Women
Authors: Balasubramanian Raji , Paynter Nina , Giulianini Franco , Manson JoAnn E , Chen JC , Vitolins Mara Z , Clish Clary , Albert Christine A , Rexrode Kathryn M
Published: July 2021

Background:
Identifying metabolite profiles associated with longevity may identify key pathways of healthy aging. The Framingham Heart Study previously identified 12 metabolites associated with longevity, but no studies have examined women specifically.

Methods:
Of 2306 women in the Women’s Health Initiative (WHI) without known cardiovascular disease and with metabolomic profiles at baseline (1993-1998), 1386 were age 63 or older (potentially able to achieve age 85 years in 2015), and were not lost to follow-up before death or age 85. Liquid chromatography mass spectroscopy was used to measure metabolites, which were log-transformed and standardized. The 12 candidate metabolites were considered individually in logistic regression models to predict odds of attaining longevity (age ≥ 85): isocitrate, uridine, lysine, aconitate, histidine, malate, threonine, cotinine, C22:6 lysophophatidylcholine (LPC) and C38:6 phoshatidylcholine (PC). Models were initially adjusted for WHI arm and age (model 1), then additionally for baseline BMI, systolic blood pressure, hypertension, diabetes, smoking, total and HDL cholesterol (model 2). An FDR-adjusted p value <0.05 was defined as significant.Significant metabolites were all considered in a backward selection procedure (p for exclusion > 0.05). A composite score of these significant mutually-adjusted metabolites was created based on the quartile score for each metabolite, with higher values indicating higher likelihood of achieving longevity.

Results:
The median baseline age was 71 years (range 63-79), and 712 women reached age ≥ 85. Ten of the 12 previously identified metabolites were significantly associated with longevity in this cohort in model 1; 8 remained significant in model 2 (FDR <0.05). When all 10 metabolites were considered together in a model and subjected to backwards selection, 3 remained significantly associated with longevity in model 2 (OR per SD [95% CI]): isocitrate (0.80 [0.70-0.91]) a substrate of the citric acid cycle, uridine (1.18 [1.04-1.34]) one of the five nucleosides making up nucleic acids, and lysine (1.24 [1.09-1.40]) an amino acid used in the biosynthesis of proteins. Women in the highest quartile of the 3 metabolite score had an OR of 2.24 (95% CI: 1.60-3.15) for longevity, compared to those in the lowest quartile of the score, after multivariate adjustment. Results for the score were significant for women both above and below the median age. For women <71 years, the highest score quartile was associated with an OR of 3.57 (2.22-5.76) for longevity, compared to the lowest.

Conclusions:
Eight metabolites were found to be significantly associated with attaining longevity among women in the WHI. A score comprised of isocitrate, uridine and lysine was associated with a 2-3-fold higher odds of attaining longevity. Further research to understand the mechanisms between these metabolites and longevity is needed.
Abstract P201: Use of Medicare Claims Data for the Identification of Myocardial Infarction. The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Authors: Colantonio Lisandro D , Levitan Emily B , Yun Huifeng , Kilgore Meredith L , Howard George , Safford Monika M , Muntner Paul
Published: July 2021

Background:
Administrative claims are used to conduct epidemiology research. However, few studies have compared results using administrative claims versus primary data collection.

Objective:
To compare myocardial infarction (MI) rates using primary data collection and Medicare claims in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Methods:
We included 9,951 REGARDS study participants ≥65 years of age with Medicare Part A (inpatient) fee-for-service coverage at baseline in 2003-2007. Participants were asked every 6 months to report heart-related hospitalizations which were subsequently adjudicated to detect definite or probable MIs (MI Definition 1, see
Table
footnotes). Events detected through surveillance in REGARDS were supplemented with adjudicated definite or probable MIs detected through Medicare inpatient claims with a diagnosis code for MI (i.e., ICD-9 code 410.x0 or 410.x1) in any position (Definition 2) and in the primary position (Definition 3). MIs were also defined by a Medicare inpatient claim with a code for MI in any position (Definition 4) and in the primary position (Definition 5), without further adjudication. MIs were ascertained through December 2012.

Results:
REGARDS study procedures detected and adjudicated 669 definite or probable MIs over a mean follow-up of 6.3 years, representing 10.7 MIs per 1,000 person-years (Definition 1,
Table
). Supplementing adjudicated MIs with Medicare inpatient claims resulted in a 12% (any diagnosis position, Definition 2) and 6% (primary diagnosis position, Definition 3) higher rate for MI. Using only Medicare claims without adjudication underestimated the rate for MI by 8% (any diagnosis position, Definition 4) and 32% (primary diagnosis position, Definition 5), compared with REGARDS study procedures.

Conclusion:
Supplementing MIs detected through participant self-report with those identified in claims could improve event detection. Using only Medicare claims to identify events may underestimate MI rates.
Abstract P216: Prevalence of Life’s Simple Seven Cardiovascular Health Metrics in the Million Veteran Program
Authors: Nguyen Xuan-Mai T , Quaden Rachel M , Song Rebecca J , Ho Yuk-Lam , Cho Kelly , O’Donnell Christopher J , Concato John , Gaziano J. Michael , Djoussé on behalf of MVP investigators Luc
Published: July 2021

Background:
While previous studies have reported the prevalence of Life’s Simple Seven (LSS) in the general population, no data exist in a national sample of US veterans.

Objective:
To assess the prevalence of ideal LSS in a cross-sectional study of 500,000 US Veterans participating in the Million Veteran Program (MVP) from 2011-2016.

Methods:
We assigned one of three possible values (0=poor, 1=intermediate, 2=ideal) for each of the seven LSS metrics (adiposity /BMI), smoking status, total cholesterol, blood pressure, plasma glucose, diet, physical activity) at baseline using self-reported data and electronic health records. A total score of 0 across all seven metrics indicated overall poor cardiovascular health and a score of 14 indicated ideal cardiovascular health.

Results:
Complete data on all LSS factors were available for 171,146 Veterans (92% men and mean age 65.5yrs ±11.5 SD). Average LSS score was 6.1 ±1.9. Ideal BMI, smoking status, total cholesterol, blood pressure and plasma glucose (fasting and non-fasting) was present in 23.8%, 30%, 22.2%, 22.5% and 42.9%, respectively, in the study population (Fig). Prevalence of ideal diet was 0.4%. Among dietary factors, recommendation for fruits and vegetables (at least 4.5cups/day) was the least likely to be achieved. Physical activity at the workplace, home or at leisure was reported among 25.6% of Veterans (21.8% intermediate and 3.8% ideal physical activity).

Conclusions:
Our data show a low prevalence of ideal LSS among Veterans in the MVP, especially diet (0.4%) and physical activity (3.8%). Compared to NHANES 2005-2006 unadjusted prevalence estimates for AHA 2020 goals, Veterans in MVP have a lower prevalence of all ideal LSS metrics except for diet: BMI (23.8 vs 33%), physical activity (3.8 vs 45%), smoking status (30 vs 73%), total cholesterol (22.2 vs 45%) blood pressure (22.5 vs 42%) and glucose (42.9 vs 58%). These findings underscore the need to improve adherence to modifiable lifestyle factors with subsequent reduction in CVD burden among Veterans.
Abstract P235: Baseline Demographic Characteristics of the Million Veteran Program: Increasing BMI Seen From 2011-2016 Among US Male Enrollees
Authors: Quaden Rachel M , Nguyen Xuan-Mai T , Song Rebecca J , Concato John , Gaziano J. Michael , O’Donnell Christopher J , Gagnon David R , Djousse Luc , Cho on behalf of the MVP Investigators Kelly
Published: July 2021

Background:
More than one-third of US adults are obese and the prevalence has remained stable since 2003. In the largest cohort of 515,912 men and women participating in the Million Veteran Program (MVP), we analyzed trends in baseline weight/obesity across the years of enrollment.

Objective:
The goal of this study is to examine prevalence and trends in baseline characteristics among US Veterans enrolled in MVP between 2011 and 2016. We highlight the trends in BMI over the enrollment period.

Methods:
BMI was computed for 479,521 Veterans who enrolled in MVP between 2011 to September 2016. Participants reported weight and height on the baseline survey. Missing survey data was supplemented with patient EMR data taken closest to enrollment date and stratified by year of enrollment.

Results:
Mean age was 61.2 (SD=13.8), 91.6% (391,124/427,187) were men, 73.8% (353,720/479,520) White, 18.8% (90,020/479,520) Black, and 7.4% (35,593/479,520) Hispanic. Overall, mean BMI was 29.7 [range 11.3 to 78.5]. Prevalence of underweight, normal weight, and overweight was 0.7% (3,164/479,521), 19.4% (93,318/479,521), 38.4% (184,625/479,521), respectively, in this cohort. While the prevalence of obesity increased with consecutive years of enrollment in men and overall, we did not observe such trend for other categories of adiposity (Fig). When stratified by race we did not observe any difference in prevalence of underweight and normal weight among White and Black participants. Prevalence of obesity was higher in Blacks, but the rate of obesity among Whites appears to be growing at a faster rate than in Blacks. Compared to the general VHA (Veterans Health Administration) population, prevalence of obesity and the distributions of race, gender, and ethnicity were similar among participants in MVP.

Conclusion:
Our data show that the prevalence of overweight/obesity is high among US Veterans. Across consecutive years of enrollment, prevalence of obesity but not overweight appears to increase across each ethnic group.
Abstract P238: Cardiovascular Risk Factors for Intimal and Medial Calcification in a High-risk Population
Authors: Hendriks Eva , Zwakenberg Sabine , de Jong Pim , Westerink Jan , de Borst Gert Jan , Cramer Maarten Jan , van der Schouw Yvonne , Beulens Joline ,   SMART Study Group
Published: July 2021

Introduction:
Arterial calcification is associated with an increased cardiovascular risk. Intimal calcification has long been held responsible for this association, whereas the role of medial calcification was unclear.

Hypothesis:
We hypothesize that the risk factor profile in patients with high cardiovascular risk differs for those with intimal or medial calcification of the lower extremity arteries.

Methods:
We conducted a cross-sectional study of 203 patients included in the Second Manifestations of ARTerial Disease (SMART) study, comprising of patients with CVD as well as patients at high risk for CVD, who underwent CT (computed tomography) scanning of the lower extremities. Calcification in the femoral and crural arteries was scored as absent, dominant intimal, dominant medial or indistinguishable according to a previously validated algorithm scoring linearity and circularity. We fitted multinomial regression models assessing the associations of cardiovascular risk factors with different patterns of calcification.

Results:
No calcification was present in 18% for the femoral and 28% for the crural arteries, while prevalence of intimal calcification was 44% and 38%. Medial calcification prevalences were 25% and 20% for the femoral and crural arteries, respectively. We found considerable consistency in the predominant calcification pattern of the crural and femoral arteries (linear weighted Cohen’s kappa [0.41, 95%CI 0.29-0.52]). Patients with dominant medial calcification were older, more often male and more often had diabetes than patients with intimal calcification. Conversely, patients with intimal calcification were more often smokers than patients with medial calcification. In multinomial logistic regression models, age was a significant risk factor for all types of calcification compared with no calcification. Male sex was associated with an increased risk of medial calcification [OR
femoral
10.37, 95%CI 2.14-50.32], but not with intimal or indistinguishable calcification, compared with no calcification. Current smoking was associated with intimal calcification[OR
femoral
3.25, 95%CI 0.98;10.83], but not with medial calcification. No significant relationships were found with other cardiovascular risk factors.

Conclusions:
Within the same individual, a predominant arterial calcification type (intimal or medial) often exists throughout the lower extremity. These patterns of calcification appear to have different associated risk factor profiles.
Abstract P245: Amount and Frequency of Alcohol Consumption and the Risk of Incident Pulmonary Embolism in the Nurses’ Health Study
Authors: Harrington Laura B , Crous-Bou Marta , Kang Jae H , Lindström Sara , Mukamal Kenneth J , Rimm Eric B , Kabrhel Christopher , Jensen Majken K
Published: July 2021

Introduction:
Moderate alcohol consumption has been associated with differences in hemostatic factor levels that may lead to a lower thrombotic risk, but the association between alcohol consumption and the risk of incident pulmonary embolism (PE) has been inconsistent.

Hypotheses:
Moderate alcohol consumption is associated with a lower PE risk than lower or higher quantities, and more frequent alcohol consumption is associated with a lower PE risk than less frequent alcohol consumption.

Methods:
Nurses’ Health Study participants free of venous thromboembolism in 1984 (n=79,914) reported alcohol consumption every two-four years between 1984 and 2012 and number of drinking days per week on five questionnaires between 1986 and 2004. PE were initially identified by self-report and were confirmed for the subset of patients without a previous cancer using a combination of medical record review and participant reconfirmation. Cox Proportional Hazards models estimated multivariable-adjusted hazard ratios for PE associated with average amount of alcohol consumed and, separately, drinking days per week. Secondary analyses estimated the risk of medical-record confirmed idiopathic PE, events which were not associated with surgery, trauma, or cancer.

Results:
We identified 1,112 total incident PE events, including 360 idiopathic PE events, during 28 years of follow-up. In multivariable-adjusted analyses, we found no strong evidence of an association between the amount of alcohol consumed per day and the risk of any PE (quadratic p-trend=0.3) or idiopathic PE (quadratic p-trend=0.4) or between the frequency of alcohol consumption and the risk of any PE (linear p-trend=0.5) or idiopathic PE (linear p-trend=0.8) (Table).

Conclusions:
Among this population of women with relatively low average amounts of alcohol consumption, we found no substantial evidence of an association between the amount or frequency of alcohol consumption and the risk of PE.
Abstract P257: Prevalence Of Intracranial Artery Stenosis and the Association With Conventional Risk Factors of Cardiovascular Diseases in a General Population of Japanese: SESSA Study
Authors: Shitara Satoshi , Fujiyoshi Akira , Hisamatsu Takashi , Torii Torii , Suzuki Sentarou , Ito Takahiro , Arima Hisatomi , Shiino Akihiko , Nozaki1 Kazuhiko , Miura Katsuyuki , Ueshima Hirotsugu ,   SESSA research group
Published: July 2021

Introduction:
Community-based studies that report prevalence of intracranial artery stenosis (ICAS) assessed with magnetic resonance imaging (MRI) are scarce.

Hypothesis:
We aim to describe the prevalent ICAS using MRI in a general population of Japanese men, and tested the hypothesis that ICAS was associated with conventional cardiovascular risk factors.

Methods:
The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) randomly recruited and examined participants from Kusatsu City, Shiga, Japan in 2006-2008. Among 853 male participants in the follow-up exam (2012-2015), we performed 1.5-tesla MRI. All images were evaluated by two board-certified neurosurgeons (by the Japan Neurosurgical Society) who were blinded to participant clinical background. Each artery was graded as no stenosis, <50% stenosis, <99% stenosis and complete occlusion. We defined any-ICAS as ICAS of any grade and heavy-ICAS as ≥50% stenosis. We used multivariable logistic regression to assess independent association between ICAS and risk factors including hypertension, diabetes mellitus (DM), dyslipidemia, smoking, drinking, obesity (body mass index ≥30kg/m
2
) and history of stroke.

Results:
We analyzed 740 men (47-85 years old, mean age 70.0 years) who completed MRI with no missing pertinent information. Thirty-one individuals (4.2%) had history of stroke. We observed at least one lesion of any-ICAS and heavy-ICAS in 30.5% and 6.5% of the participants, respectively. Any-ICAS was most commonly identified in internal carotid artery (21.6% of the entire participants) followed by middle cerebral artery (11.7%). Older age, hypertension, DM, dyslipidemia and prevalent stroke was associated with ICAS. Hypertension and DM were particularly strongly associated with heavy-ICAS (Table). Results were similar when excluding those with stroke history.

Conclusions:
This is the first study on prevalence of ICAS and its association with conventional cardiovascular risk factors in a general population of Japanese men. The prevalence of ICAS in Japanese men and the association with primary risk factors of cardiovascular diseases are revealed and they could be a target for prevention of stroke.
Abstract P268: Impact of Overweight and Obesity in Prevalence and Management of Hypertension
Authors: Lee Hong Seok , Park Yong-Moon , Han Kyungdo , Yang Jin Hong , Kim Sung Rae
Published: July 2021

Background:
Obesity defined by body mass index (BMI) and waist circumference (WC) can affect the epidemiology of hypertension differently, however, there were not enough large national wide hypertension studies using two measurements. Some research reported both were associated with diseases including hypertension in a different way such as gender-specifically. So, we will evaluate the prevalence, awareness, treatment, and control of hypertension according to obese status using nationally representative data

Materials and Methods:
Among adults aged ≥19 years who participated in the Korean National Health and Nutrition Examination Survey between 2008 and 2010, a total of 20,578 subjects (8,777 men and 11,801 women) were analyzed according to BMI and WC. General obesity was defined as BMI ≥ 25 kg/m
2
and abdominal obesity was defined as WC ≥ 90 cm in men and ≥ 80 cm in women, both of which were based on the Asian-pacific criteria. We applied a blood pressure goal of less than 150/90 mmHg for patients 60 years of age or older who did not have diabetes or chronic kidney disease. Patients 18 to 59 years of age without major comorbidities, and those 60 years of age or older who had diabetes, chronic kidney disease, or both conditions, the new blood pressure goal is less than 140/90 mmHg.

Results:
There was the significant increase in the prevalence of hypertension as BMI and WC increased in both genders. Prevalence of hypertension in men was 21.1%, 30.7%, 39.6%, 51.6% with BMI less than 23 kg/m
2
(normal weight), less than 25 kg/m
2
and more than 23 kg/m
2
(overweight), less than 30 kg/m
2
and more than 25 kg/m
2
(obese grade I), more than 30 kg/m
2
(obese grade II), respectively. Prevalence of hypertension in women was 13.1%, 27.4%, 40.2%, and 49.2% in each BMI group. In addition, a prevalence of hypertension was higher in obese individuals than non-obese individuals in all age groups. In women, awareness increased as BMI and WC increased (
p
for trend
<0.001), whereas, control rate has been significantly decreased with increasing BMI (
p for trend
= 0.02). With increasing WC in women, control of blood pressure among treated persons also tended to decrease (
p for trend
= 0.04). However, control rate was not different according to both general and abdominal obese status in men. Compared to those in other age groups, young obese adults less than 40 years had the relatively lower prevalence of hypertension (34.3%) but also had lower awareness (16.8%) and treatment (60.7%).

Conclusion:
Our findings show that prevalence of hypertension was associated with increasing BMI and WC in both genders, suggesting that obese persons were prone to have hypertension. Control of blood pressure in women was decreased with increasing BMI and WC, suggesting that obese women might be an important target for hypertension control. Lower awareness and treatment of hypertension in young obese adults are not negligible.
Abstract P320: Is Co-occurring Endometriosis Among Women With Myocardial Infarction Associated With Worse In-hospital Outcomes? Findings From the Nationwide Inpatient Sample
Authors: Akinjero Akintunde , Adegbala Oluwole , Akinyemiju Tomi
Published: July 2021

Background:
Recent studies have shown that patients with endometriosis have an increased risk of coronary artery disease. Inflammatory diseases that increase the risk of coronary artery disease have also been shown to worsen outcomes. We sought to evaluate the effect of co-occurring endometriosis among women with myocardial infarction (MI) on stroke, length of stay (LOS) and in-hospital mortality.

Methods:
Data was obtained from the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS). We studied women ages 18 and above hospitalized for MI between 2007 and 2011. Admissions for endometriosis, MI and outcomes data were extracted using ICD-9 CM codes. We estimated weighted frequencies and proportions for all patients admitted for MI, co-occurring endometriosis and for all covariates. We then performed bivariate parametric tests of association as appropriate. In order to evaluate the independent effect of co-occurring endometriosis and MI on stroke, LOS and in-hospital mortality, we constructed multivariate regression models.

Results:
We found a total of 420,940 hospital admissions for myocardial infarction. Out of these, 80 had co-occurring endometriosis. Women with these co-occurring conditions were more likely to be white (67.5%) and privately insured (53.8%). In adjusted models, compared to those without, women with co-occurring endometriosis and MI did not have a significantly higher risk of stroke (aOR=1.10, 95% CI: 0.27- 4.56) or prolonged LOS (aOR=1.29, 95% CI: 0.45 - 3.04). Risk was not found to be increased for in-hospital mortality (aOR=0.71, 95% CI: 0.26 - 1.95).

Conclusion:
Our study shows that co-occurring endometriosis among women with MI was not significantly associated with worse in-hospital outcomes. Larger, prospective, studies with longer follow-up time after discharge are needed to further evaluate this association.
Abstract P331: Self-Efficacy to Manage Health After Stroke is Related to Quality of Life
Authors: Damush Teresa M , Mackey Jason , Thomas Kurian , Saha Chandon , Slaven James , Lincoln Flossy , Fleck JD , Myers Laura , Ivan Christina , Williams Linda
Published: July 2021

Objective:
An acute stroke may serve as a major life event that disrupts health-related quality of life. We examined psychosocial and demographic factors related to functioning and well-being after stroke among patients discharged from two health care systems: Veterans Health Administration (VHA) and a Joint Commission Stroke Center.

Methods:
We enrolled 258 participants into a randomized controlled trial to evaluate a stroke self-management program which targeted functional recovery and risk factor management. All participants completed written consent and a baseline assessment which included demographics, depressive symptoms, self-efficacy, stroke specific, health-related quality of life (SSQoL) and psychosocial factors. We conducted multivariate analyses to evaluate factors related to baseline SSQoL using a social cognitive framework.

Results:
We enrolled our sample, on average, within 81.5 days after hospital discharge for stroke/TIA. Our sample included 19% women with an average age of 61.7 (10.8) years. The average NIH stroke scale score was 3.0 indicating minor stroke. Across the total and subdomains of SSQoL, self-efficacy to manage stroke health and symptoms was associated with overall better SSQoL (0.16, p<0.0001), social role functioning (0.12, p < 0.01), family role functioning (0.16, p<0.0003), and work role functioning (0.31, p<0.0001). Depressive symptoms were significantly related to poorer SSQoL across all subdomains; however distance walked in a mobility test was not significantly related. Optimism was related to total SSQoL (p<.07) and perceived energy (p<0.02). Demographics were not significantly related to SSQoL in the multivariate models.

Conclusions:
As social cognitive theory suggests, self-efficacy to manage symptoms and health after stroke and a sense of optimism for recovery are significantly related to greater stroke specific, health-related quality of life shortly after hospital discharge for stroke. Post stroke programs which target building self-efficacy and providing optimism for recovery may enhance SSQoL. Our stroke self-management program targets these concepts and we are currently evaluating our prospective outcomes.
Abstract P338: Medical Cost Hardship and Incident Cardiovascular Disease (CVD) Among High Risk Individuals in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Pool Lindsay R , Reis Jared P , Auer Reto , Jacobs David R , Kiefe Catarina I , Carnethon Mercedes R
Published: July 2021

Introduction:
Having trouble paying for medical care (i.e., medical cost hardship) may impair disease management and thus increase risk of clinical CVD events among adults with CVD risk factor conditions.

Hypothesis:
We hypothesized medical cost hardship was associated with incidence of CVD among individuals with diagnosed hypertension, hypercholesterolemia, or diabetes.

Methods:
CARDIA recruited 5,115 individuals aged 18-30 years in 1985-6 (year 0); we included 2,273 participants who self-reported hypertension, hypercholesterolemia, or diabetes or were taking prescription medications for these conditions at years 10, 15, 20, or 25 (45.2% of all participants). At these visits, medical cost hardship was also queried. CVD events were adjudicated from records of hospital admissions, outpatient procedures, and deaths through 2013. Median follow-up time from initial risk factor diagnosis was 12.4 years. Adjusted Cox proportional hazards models determined hazard ratios (HRs) for the first incident CVD event, examining initial and time-varying medical cost hardship.

Results:
At first report of hypertension, hypercholesterolemia, or diabetes, 27% of subjects reported medical cost hardship, while 51% did so at subsequent examinations. There were 131 CVD events during follow-up. Adjusting for demographic and socioeconomic factors, initial medical cost hardship was a more robust predictor of incident CVD than time-varying cost hardship, HRs 1.54 (95% CI: 1.03, 2.30) and 1.36 (0.88, 2.12), respectively (Table). Risk factor control partially attenuated the association between medical cost hardship and CVD, as did access to healthcare. We found no significant interaction by race and sex.

Conclusions:
Medical cost hardship was associated with incident CVD in this sample of high-risk individuals, possibly via risk factor control or access to care. Identification of cost hardship at the time of high-risk diagnosis may facilitate connection to low-cost care, improving risk factor control and preventing clinical CVD.
Abstract P361: Significant Inverse Association of Blood Levels of Marine Omega-3 Fatty Acids With Aortic Calcification in an International Multi-ethnic Cohort of 1335 Men Aged 40-49 Years: The ERA JUMP Study
Authors: Mahajan Hemant D , Guo Jingchuon , Shangguan Siyi , Willcox Bradley , Miura Katsuyuki , Fujiyoshi Akira , Kadota Aya , Choo Jina , Evans Rhobert , Barinas-Mitchell Emma , Kuller Lewis , Shin Chol , Masaki Kamal , Ueshima Hirotusugu , Sekikawa Akira
Published: July 2021

Introduction:
Aortic calcification (AC) is an independent predictor of future cardiovascular (CV) events. Marine omega-3 fatty acids (OM3) are reported to have anti-atherogenic properties.

Hypothesis:
We hypothesized that blood levels of OM3 have a significant inverse association with AC.

Methods:
ERA JUMP is a population-based study of subclinical atherosclerosis in 1335 men aged 40-49 without CVD (310 European American, 107 African American, 303 Japanese American, 313 Japanese in Japan and 308 Korean in South Korea). Participants were examined for AC, blood levels of OM3, CV risk and other factors in 2002-07 with rigorous standardization. AC was assessed by electron-beam CT and quantified using the Agatston method. OM3 were measured using gas chromatography, expressed as the percentage of total fatty acids and defined as the sum of eicosapentaenoic, docosapentaenoic and docosahexaenoic acids. After excluding missing data for AC (n=36), OM3 (n=8) and heavy drinkers (ethanol >69 g/day) (n=73), our final analytic sample was 1218. The association of the presence of AC with OM3 was analyzed using logistic regression adjusting for age, race, CV risk and other factors. We also performed Tobit regression and ordinal logistic regression to assess the relation between AC score (ACS) and OM3.

Results:
Mean [standard deviation (SD)] of age, LDL-C, and pack-years of smoking were 45.2 (2.8) years, 127 (35) mg/dl and 9.5 (13.6), respectively. Prevalence (%) of hypertension and diabetes was 22.4 and 8.0, respectively. Mean (SD) of OM3 was 6.1 (3.1) (%) and 58.1% had ACS>0. In a fully adjusted model with stepwise backward elimination, odds of ACS>0 was reduced by 10% with one SD increase in OM3 level (p <0.001). Results of Tobit regression and ordinal logistic regression suggest a statistically significant lower ACS for every SD increase in OM3 level. There was no significant interaction on AC between race and OM3.

Conclusions:
This cross-sectional study showed a significant inverse association of OM3 with AC in an international multi-ethnic cohort.
Abstract P372: Trajectories in Fasting Glucose and Insulin Resistance During Young Adulthood and Measures of Cardiac Function and Structure in Middle Adulthood: the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Bancks Michael P , Carnethon Mercedes , Chow Lisa S , Jacobs David R , Kishi Satoru , Lima Joao , Lloyd-Jones Donald , Reis Jared , Schreiner Pam , Zmora Rachel , Allen Norrina B
Published: July 2021

Introduction:
Whether trajectories in fasting glucose (FG) and insulin resistance (HOMA-IR) during young adulthood, before the onset of diabetes, are associated with cardiac function and structure in middle adulthood is unclear.

Hypothesis:
We tested the hypothesis that as compared to low-stable trajectory of FG and HOMA-IR, an increasing trajectory for each would be associated with worse cardiac structure and function in middle adulthood.

Methods:
We determined FG and HOMA-IR for 2,198 CARDIA participants, age 18-30 years, at baseline (1985-1986) and 7, 10, 15, 20, and 25 year follow-up exams who fasted for >8 hours and were not pregnant and were free from diabetes at all exams. At year 30 (2016), Doppler echocardiography and 2D-guided M-mode echocardiography was performed, measuring left atrial dimension, relative wall thickness, left ventricular (LV) mass, LV mass indexed to height, LV ejection fraction percentage, LV end-diastolic and systolic volume, and LV mass to volume ratio. Trajectories were determined using latent class analysis (SAS Proc Traj). We used multivariable linear regression to estimate adjusted means for echo measures according to FG and HOMA-IR trajectory group after adjustment for potential confounding factors.

Results:
For individuals free from diabetes in midlife, we identified three trajectory groups for both FG and HOMA-IR, low-stable to increasing, moderate-increasing, and high-increasing. Compared to low-stable trajectory for FG, increasing trajectory was associated with greater LV end-diastolic volume, whereas for HOMA-IR increasing trajectory was associated with lower LV end-diastolic volume (
Table
). Increasing FG trajectory was also associated with greater left atrial dimension, while HOMA-IR was not.

Conclusion:
Trajectory of both FG and HOMA-IR during young adulthood, in the absence of diabetes, was most prominently and differentially associated with LV end-diastolic volume. Future research should elaborate on differential associations of FG and HOMA-IR trajectory.
Abstract P382: Association of Recurrent Common Infections and Subclinical Cardiovascular Disease in Mexican Women
Authors: Espinosa-Tamez Priscilla , Catzin-Kuhlmann Andres , Monge Adriana , Yunes Elsa , Cantú-Brito Carlos , Marcel Adrian , Lajous Martín , Lopez-Ridaura Ruy
Published: July 2021

Introduction:
Both acute and agent specific chronic infections have been associated with increased cardiovascular risk, however data on the burden of common recurrent infections and cardiovascular disease (CVD) is limited.

Hypothesis:
Women with greater exposure to uncomplicated common infectious events have an increased risk of subclinical CVD (sCVD) compared to women with no events.

Methods:
In a cross-sectional study we assessed the relationship of recurrent infections and carotid artery intima-media thickness (IMT) in 1,945 disease-free women from the Mexican Teachers’ Cohort. Through 2012-2016, participants answered questions on respiratory, urinary tract and vaginal infections during the previous year and IMT was measured using ultrasound by standardized neurologists and log-transformed. Total infectious episodes were categorized as “0”, “1 or 2” and “3 or more”. We defined sCVD as mean right and left IMT≥0.8mm or plaque. Multivariable linear and logistic regression analyses were used to evaluate the association of infectious events with IMT and sCVD adjusting for age, sociodemographic, and cardiovascular risk factors.

Results:
Among participants (50 ±5 years of age) 14% (278 of 1945) reported no infections, 41% (800 of 1945) 1 or 2 infections, and 45% (867 of 1945) 3 or more. Overall prevalence of sCVD was 12% (242 of 1945). Adjusted models for logistic regression showed that women with 3 or more infections had 80% higher odds of subclinical CVD (95% CI 1.1, 2.9) compared to women without infections (p-trend: 0.019). Sub-analyses by type of infection were not significantly associated with sCVD (Image 1). Linear regression analysis did not show a significant association between mean IMT and recurrent infections.

Conclusion:
Recurrent infectious events in women are associated with greater sCVD, which supports the hypothesis of low grade chronic inflammation in CVD.
Abstract 114: Does Size Matter? Comparing Cardiac Arrest Survival to Discharge Rates Based on Number of Hospital Beds
Authors: Thomas Kathie , Gueret Renaud , Miller Art , Myers Gary
Published: July 2021

Background and Objectives:
In-hospital cardiac arrest can be challenging. The frequency of events outside of critical care units is typically low which makes it a stressful event for staff. According to the HEROIC study, there were 209,000 in-hospital cardiac arrests in the United States in 2016. Only 24.9% survived. Get With the Guidelines-Resuscitation is a quality improvement tool for hospitals to measure and evaluate their in-house codes and resuscitation rates. It may be assumed that survival rates are better at larger hospitals. The objective of this study was to examine the association between in-hospital cardiac arrest rates based on the bed size of a hospital.

Methods:
By using number of beds as a comparison and data from Get With the Guidelines-Resuscitation we sampled 46 hospitals in the eleven-state AHA Midwest Affiliate, (IL, IN, IA, KS, MI, MN, MO, NE, ND, SD, WI), comparing survival to discharge from cardiac arrest, with and without shockable rhythms from January 1, 2013-December 31, 2016. All patients are included in a risk adjusted formula that resides within Get With the Guidelines-Resuscitation.

Results:
In our comparison, we included hospitals with licensed and/or staffed beds of <100, 100-199, 200-299, 300-399 and 400 or more beds. Our data showed that higher sustained return of spontaneous circulation rates with survival to discharge are not dictated by the size of a hospital. In fact, in all 4 years shown, successful resuscitation rates were higher at hospitals with fewer beds verses larger facilities.

Conclusions:
Survival to discharge from in-hospital cardiac arrest is not dependent on hospital bed size. It is important that hospitals collect and analyze data regarding in-hospital cardiac arrests to improve survival rates beyond the 24.9% identified in the HEROIC study. A further examination looking at discharge destinations with CPC scores should be considered for a future study.
Abstract 134: Does Low-Level Cumulative Lead Play a Role in Resistant-Hypertension?
Authors: Zheutlin Alex , Hu Howard , Weisskopf Marc , Sparrow David , Vokonas Pantel , Park Sung Kyun
Published: July 2021

Purpose:
Deposition of lead into bone offers a better method over conventional blood lead measurement to discern long-term lead exposure and its insidious accumulation within the body. Bone lead deposition has been identified as an independent risk factor for hypertension (HTN). Yet, little is known how bone lead as a risk factor for HTN can be translated into clinical utility. We examined the association between bone lead levels and resistant-HTN.

Methods:
All subjects were males, participating in the Veterans Affairs Normative Aging Study (NAS) with an age variation of 48-93 years old. Participants were included if there was complete data on HTN (systolic blood pressure, diastolic blood pressure, and anti-HTN medication), lead (blood, bone-patella, bone-tibia), as well as demographic and confounding variables. Cases of resistant-HTN were identified by meeting criteria for a) inadequate SBP (≥140 mmHg) or DBP (≥90 mmHg) on 3 medications or b) requiring ≥ 4 medications for blood pressure control. Resistant-HTN was categorized as a dichotomous variable, based upon meeting the noted criteria, while tibia and patella bone lead were treated as continuous variables. The data was analyzed using a binomial logistic regression, accounting for demographic and confounding variables.

Results:
Of the 871 total study participants, 111 cases of resistant-HTN (12.7%) were identified. Amongst the cases of resistant-HTN, the mean tibia and patella lead levels were 23.1 μg/g and 31.5 μg/g, respectively. Both mean levels were higher than those among the participants without resistant-HTN (21.5 μg/g and 30.9 μg/g, respectively). Tibia lead levels demonstrated a significant association with resistant-HTN (OR=1.27 (95% CI, 1.01-1.59) per one IQR increase in tibia lead (15μg/g), p=0.04) after adjusting for age, BMI, cigarette pack-year burden, income, education, and ethnicity. A weak, non-significant association was observed between patella lead and resistant-HTN (OR = 1.16 (95% CI, 0.92-1.46) per one IQR increase in patella lead (21μg/g), p=0.21).

Conclusion:
Lead has been long-studied for its effect on blood pressure. Yet, lead has not previously been assessed for the role it plays in clinical outcomes. Difficulty in attaining goal blood pressure may be influenced by environmental exposures. Our study demonstrates an increased association between tibia lead and resistant-HTN status, with an OR of 1.27 per one IQR increase in tibia lead. Tibia lead represents a novel risk factor for resistant-HTN. Future research should consider screening and mitigation strategies for populations with resistant-HTN exposed to long-term low-levels of lead.
Abstract 164: Evaluation of Clinical and Social Factors for Patients Taking Very Low Dose of Beta Blockers for Systolic Heart Failure
Authors: Memon Adil , Sharma Prerna , Gilbert Jason , Pettyjohn Eric , Whelan Meg , Nyamndi Barbara , Kemper Suzanne , Carter William
Published: July 2021

Background:
All guidelines agree that beta-blockers (BBs) should be used for patients with systolic heart failure (SHF) to improve survival. BBs are a class Ia indication for treatment of SHF based on 3 landmark clinical trials (CIBIS-II, COPERNICUS, and MERIT-HF). Despite recommendations, the doses of BBs prescribed are commonly less than target dose (TD). Underdosing of BBs is suggested by doses less than 50% of TD and/or sinus rate (SR) above 70 bpm whereas a very low dose of BB is 25% or less of the TD. Clinical and social factors including depression, dizziness, ability to walk without assistance, Morse Fall Scale score and living status, whether independently or in a care facility, could be likely reasons for patients receiving a very low dose of BB. Failure to achieve SR below 70 bpm might lead physicians to use ivabradine which is a relatively new and expensive medication and is a class IIa indication for SHF. The objective is to evaluate the clinical and social factors affecting underdosing of BBs between the two patient groups with ≤25% of TD vs >25% of TD.

Methods:
A retrospective chart review was completed for SHF patients admitted to Charleston Area Medical Center from 2007 to 2016. Doses of BB, SR, and clinical/social factors were recorded. Patients over the age of 18 years with diagnosed SHF (EF<40%) and on BB treatment for more than 8 weeks prior to admission were included.

Results:
An initial sample size of 254 patients with SHF was obtained. 65% (164 of 254) were on approved BBs. Of the patients on approved BBs, 71% (117 of 164) were receiving ≤ 25% of the TD and 29% (47 of 164) were receiving >25% of the TD. Mean SR on admission EKG was 85±19.5 in the ≤ 25% TD group, and 83±21.4 in the >25% TD group. Of the 164 patients on approved BB therapy, SR could only be recorded in 105 patients due to atrial pacing or atrial arrhythmias; and 82% (86 of 105) had a SR >70 bpm on their initial EKG. No statistically significant differences were identified between the two groups when reviewing the clinical and social factors.

Conclusions:
This study will help enable cardiovascular clinicians to realize that although the use of BBs for SHF has improved dramatically since Get With The Guidelines; there is still marked underdosing of approved BB and inappropriate use of non-approved BB. We are unable to explain this practice based on the clinical and social factors that may have led to underdosing of BB. We found the mean dose of BBs to be 25% or less of TD in 71% (117 of 164) patients on approved BBs and only 18% (19 of 105) of these patients had SR <70bpm. Inappropriate dosing of BBs could potentially be responsible for worsening outcomes and possible overutilization of ivabradine.
Abstract 169: Knowledge, Attitude and Behaviors Influencing the Control of Hypertension and Diabetes: A Quantitative Study From India
Authors: Barbhaya Dweep , Satish Priyanka , Khetan Aditya , Madan Mohan Sri Krishna , Josephson Richard , Webel Allison
Published: July 2021

Background:
Approximately 75% of the mortality and morbidity in low and middle-income countries (LMIC) are from non-communicable diseases (NCDs), with cardiovascular diseases (CVD) accounting for nearly 50% of this burden. This is driven, in part, by suboptimal control of hypertension and diabetes. Yet before designing culturally-appropriate self-management interventions to decrease this burden, we must first understand the reasons why hypertension and diabetes is poorly controlled.

Methods:
Project SEHAT is a cluster randomized controlled trial investigating the effect of a community health worker-led program to control hypertension, diabetes and smoking in a semi urban community in West Bengal, India. Seventy- eight participants with hypertension and/or diabetes between 35-70 years of age were enrolled and stratified on gender, medication adherence level, and whether they had seen a physician. Focus group discussions were conducted to examine behavioral factors affecting hypertension and diabetes self-management. All focus groups were digitally recorded and wo coders independently coded the data. Qualitative description was used to analyze the data.

Results:
Most patients and their family members were concerned about their hypertension or diabetes. However, only 26% (6/23) of interviewed patients recognized that they were at increased risk for a CVD event. A majority (72% - 23/32) claimed they were unable to adhere to their medications, often because of cost. Participants did not engage in healthy lifestyle behaviors (i.e., diet and exercise) and were unaware of these interventions. Approximately, 80% (40/50) visited modern physician while 10% (5/50) visited informal health practitioners, usually for financial reasons.

Discussion:
There is a gap in knowledge about how to prevent CVD, even as most patients expressed concern about it. Poor insight into the disease process, belief in traditional practices, and competing financial needs were significant barriers to adopting healthy lifestyle behaviors. Intervention models should consider the existing level of knowledge and work with local traditions in order to improve self-management among those with hypertension and diabetes in this community.