bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP025: Physical Activity and Risk of Coronary Heart Disease in Young Women
Authors: Chomistek Andrea K , Mukamal Kenneth J , Eliassen A. H , Rimm Eric B
Published: July 2021

Background:
The majority of studies on the association between physical activity and coronary heart disease (CHD) risk have been conducted in middle-aged and older populations. Although physical activity has been shown to lower risk of CHD in women by approximately 30%, evidence for the benefits of exercise for CHD in young women is very limited.

Methods and Results:
We conducted a prospective cohort study among 114 054 women, 25–42 years of age at baseline, enrolled in the Nurses’ Health Study II and followed from 1989 to 2009. Leisure-time physical activity was assessed at baseline and during follow-up through a series of questions on the specific type of activity and the average time per week spent on the activity over the previous year. Additionally, at baseline, women were asked the number of months per year they participated in strenuous exercise or sports during high school and ages 18–22. During 20 years of follow-up, we documented 518 new cases of non-fatal MI and fatal CHD. After adjusting for age and other cardiovascular risk factors, the rate ratios (RR) (95% confidence intervals [CI]) corresponding to 0, 0.1 – 3.5, 3.6 – 8.8, 8.9 – 21.0, and > 21 MET-hours/week of physical activity were 1.0, 0.93 (0.71, 1.21), 0.73 (0.56, 0.95), 0.67 (0.52, 0.88), and 0.63 (0.49, 0.83) (p for trend = 0.001). There was no evidence of effect modification by age or body mass index. Specifically in women less than 50 years of age, the corresponding RR were 1.0, 0.97 (0.70, 1.35), 0.75 (0.53, 1.04), 0.69 (0.50, 0.96), and 0.63 (0.45, 0.88) (p for trend = 0.008). Brisk walking alone was also associated with significant reductions in CHD risk. In contrast to physical activity during adulthood, frequency of participation in strenuous activity in high school or during ages 18–22 was not associated with risk of CHD when adjusted for current physical activity.

Conclusions:
These prospective data suggest that physical activity is associated with substantial risk reductions in the incidence of coronary heart disease in young women.
Abstract MP028: Physical Activity Relates to Lower Visceral Adiposity in Children and Adolescents
Authors: Staiano Amanda E , Broyles Stephanie T , Gupta Alok K , Katzmarzyk Peter T
Published: July 2021

Introduction:
Expansion of visceral adipose tissue (VAT) associates with adverse metabolic changes. While regular moderate-to-vigorous activity is associated with lower total body fat in children and adolescents, it is unknown how physical activity relates to other adiposity indices, including VAT.

Hypothesis:
We hypothesized that regular physical activity in children and adolescents associates with lower body fat, percent body fat, abdominal subcutaneous adipose tissue (SAT), and VAT.

Methods:
The sample included 393 boys and girls aged 5–18 years (45.6% White, 50.6% African American, and 3.8% Other). Body fat and percent body fat were measured by dual-energy x-ray absorptiometry. Abdominal SAT and VAT mass were measured by magnetic resonance imaging between the highest point of the liver and the lower pole of the right kidney (using 5 to 8 cross-sectional slices, 4.76 cm apart). Participants were categorized as being regularly active by self-report: moderate-to-vigorous physical activity of ≥ 60 minutes/day, ≥ 4 days/week. Those who were physically active fewer than 4 days/week were categorized as not regularly active.

Results:
In this sample of children and adolescents, 45.6% of participants were regularly active. One-way ANCOVAs adjusted for age and sex demonstrated that regularly active youth had significantly less body fat (p<0.01) and lower percent body fat (p<0.01) than those who were not regularly active. One-way ANCOVAs adjusted for age, gender, and body fat, revealed that regularly active children and adolescents had no difference in SAT but had significantly lower amounts of VAT (p<0.05) when compared to those who were not regularly active.

Conclusion:
Engagement in moderate-to-vigorous physical activity for at least 60 minutes on four or more days of the week in children and adolescents was related to lower body fat, percent body fat and VAT, when compared to those youth who were less active. The promotion of regular physical activity has significant public health implications for body fat accumulation and for controlling excess VAT during childhood and adolescence.
Abstract MP032: Greater Physical Activity Assessed by Accelerometry is Associated with Favorable Adipokine Profile in the Community: Cross-sectional Observations from The Framingham Third Generation Cohort
Authors: Glazer Nicole L , Nelson Kerrie , Sullivan Lisa M , Murabito Joanne M , Vasan Ramachandran S
Published: July 2021

Background:
Adipokines, produced by adipose tissues, contribute to the development of obesity-related metabolic traits. It is unclear, however, if greater physical activity favorably affects cardiometabolic profiles by influencing levels of key adipokines. We related physical activity, as measured by accelerometry, to circulating levels of novel adipokines, including retinol binding protein-4 (RBP4), adipocyte-fatty acid binding protein (A-FABP), adiponectin, leptin and leptin-receptor (LEP-R), in a large community-based sample.

Methods:
We evaluated 2063 participants in the 3rd generation Framingham Heart Study cohort (mean age 47 years, 55% female) who underwent objective assessment of moderate-to-vigorous physical activity (MVPA) by an accelerometer. MVPA was measured in total minutes, and in bouts ≥10 minutes (MVPA10) and nonbouts (MVPA<10 minutes). Blood adipokine levels were log-transformed and related to MVPA, using separate regression models for each adipokine, adjusted for age, sex, smoking, and season.

Results:
On average, participants engaged in 28 minutes/day of MVPA, 19 minutes/day of nonbout MVPA and 9 minutes/day of MVPA10. Mean adipokine levels were 40.7 ± 10.7 ng/ml for RBP-4, 18.6 ± 10.3 ng/ml for A-FABP, 11.4 ± 12.9 ng/ml for leptin, 19.6 ± 8.6 ng/ml for LEP-R, and 8.7 ± 5.5 ng/ml for adiponectin. Total MVPA, as well as MVPA10 and nonbout MVPA, were inversely related to leptin and A-FABP and positively associated with levels of adiponectin (See Table). The directionality of the observed associations - positive for adiponectin and negative for leptin and A-FABP- were consistent with greater physical activity being related to a more favorable cardiometabolic profile.

Conclusions:
In our cross-sectional study of a large community-based sample, both bout and nonbout MVPA were significantly related to a favorable adipokine profile. Additional longitudinal observations are warranted to assess if physical activity influences cardiometabolic health through alterations in adipokine levels.
Abstract MP038: Age at Menarche is Associated with Type 2 Diabetes in Young Adulthood: the CARDIA Study
Authors: Dreyfus Jill , Schreiner Pamela J , Carnethon Mercedes R , Whitham Hilary , Maclehose Richard , Demerath Ellen W
Published: July 2021

Introduction:
Recent studies report an association between early age at menarche and risk of type 2 diabetes (T2D). However, information in young women is limited to self-reported diabetes in primarily white populations. We explored the association of age at menarche and clinically-defined T2D among young black and white women (mean age 25 at baseline) in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort.

Hypothesis:
We assessed the hypothesis that the rate for T2D will decrease with each 1 year increase in age at menarche.

Methods:
Our analysis included 1,258 white and 1,341 black women (total=2,599) who participated in CARDIA during 1985-2006. We used Cox proportional hazards models to estimate hazard ratios (HR) for T2D (yes/no as determined at clinic visits) by continuous age at menarche. We excluded women with diabetes at baseline, missing age at menarche, or menarche <8 or >18 years. T2D was defined cumulatively from baseline among non-pregnant women as fasting blood glucose ≥ 126 mg/dl, A1C ≥ 6.5%, 2-hour oral glucose tolerance ≥ 200 mg/dl, or use of diabetes medication. Adjusted models included race (except race stratified models) and parental history of diabetes, as well as baseline age, education, and BMI as covariates.

Results:
Mean age at menarche was 12.6 years (SD=1.5; black=12.5, white=12.7). We identified 176 cases of T2D over 20 years of follow-up (cumulative incidence=6.8%). Among all women, the rate for T2D decreased by 16% for each 1 year increase in menarche age (
Table 1
); we found no evidence of nonlinearity. HRs remained protective, but no longer statistically significant after adjustment for BMI. HRs were lower for white women compared to black women, although a test for race by menarche age interaction was not significant (p=0.26).

Conclusions:
We found evidence to support the hypothesis that early menarche increases the rate for T2D among young women. Higher baseline BMI among women with earlier menarche appears to attenuate the association of age at menarche and future glucose metabolism.

Table 1.

Hazard Ratio (HR) of Type 2 Diabetes for Each One Year Increase in Age at Menarche in the CARDIA Study, 1985-2006

Crude

Model 1

Model 2

# T2D

HR

95% CI

HR

95% CI

HR

95% CI

All Women
176
0.84
0.76, 0.93
0.88
0.79, 0.98
0.94
0.85, 1.04

White
46
0.78
0.64, 0.96
0.83
0.68, 1.02
0.93
0.76, 1.16

Black
130
0.90
0.80, 1.01
0.90
0.80, 1.02
0.96
0.85, 1.08

Model 1: adjusted for race (except for race-stratified models), family history of diabetes, baseline age, and participant level of education at baseline (HS) Model 2: adjusted for variables in Model 1 plus baseline BMI
Abstract MP042: Overall AHA Cardiovascular Health Score In Latino Men And Women In Zulia State, Venezuela.
Authors: Florez Hermes J , Silva Egle , Castillo-Florez Sumaya , Sulvaran Tulio , Ryder Elena , Maestre Gladys , Oropesa Lisset
Published: July 2021

Introduction:
Cardiovascular (CV) disease has remained the leading cause of morbidity and mortality worldwide. The American Heart Association (AHA) recently set goals for CV health promotion and disease reduction. There are limited CVD data available to plan prevention strategies in developing countries.

Aim:
To assess the effect age and gender on the AHA overall CV health score in the Venezuelan population.

Methods:
In a population-based study in Zulia State, Venezuela, we evaluated 3108 Latino adult men and women on the prevalence of ideal CV health behaviors (nonsmoking, achieving normal weight, enough physical activity, and a healthy diet) and ideal CV health factors (total cholesterol<200 mg/dl, blood pressure< 120/80 mmHg, and fasting blood glucose<100 mg/dl). We calculated AHA global CV health score assigning 1 to each ideal behavior and factor (for a maximum of 7) and 0 for poor status to each one.

Results:
Most (75.7%) of the population had intermediate CV scores (between 3 and 5) while in 10.8% had poor scores (<3) and only 13.5% had ideal scores (>5). Large portions of the population need improvements on diet (97.9%), physical activity (80.9%), weight management (60.2%) and blood pressure (59.6%), while some need interventions to reduce hypercholesterolemia (26.9%), hyperglycemia (23.8%), and smoking (20.8%). The global cardiovascular score significantly decreases with age (p<0.001) but this reduction was steeper in women than in men after age 50 (p<0.001for gender*age interaction).

Conclusions:
CV health promotion strategies are needed in the majority (∼86%) of the Latino population in Zulia, Venezuela. Prevention strategies focusing on weight reduction through healthy diet and increased physical activity may have significant impact improving overall CV health and reducing obesity related comorbidities, such as hypertension and diabetes, in this population.
Abstract MP043: Awareness of Hypertension and Determinants of Treatment in a Community-Based Observational Sample in Da Nang, Viet Nam
Authors: Boas Zachary P , Fitzpatrick Annette L , Ngo Quang V , Logerfo James P
Published: July 2021

Introduction:
Hypertension in Viet Nam is becoming an increasing source of mortality and morbidity. While data collection on hypertension in resource poor environments has been improving through the use of standardized surveys, little is known about how well treatments are being applied. Knowledge of gaps in diagnosis and treatment is necessary if appropriate public health programs are to developed. Using a community based observational sample in the Da Nang province of Viet Nam, we studied both the prevalence of undiagnosed hypertension, as well as the types of treatment those with hypertension received.

Methods:
Randomized cluster sampling methods were used to identify adults age 35 years and older in six communes of Da Nang province, Viet Nam. Using World Health Organization guidelines, data were collected on subject’s demographics, medical history, blood pressure and health behaviors. Subjects were also instructed to bring all medications they take regularly which were then recorded. Separate multivariate logistic regressions were used to identify both factors associated with awareness of hypertension as well as factors influencing whether one received medical therapy.

Results:
The initial survey examined 1,621 adults with 557 (34.5%) having hypertension. Of those, only 232 (41.7%) were aware of the diagnosis. Being male (OR 0.52, 95% CI: 0.36–0.75), older (OR 1.03, 95% CI: 1.02–1.05 per year) and having a low income (OR 1.11, 95% CI: 1.05–1.16 per million dong/month) were each independently associated with being unaware of one’s hypertension. Of those who were aware of their hypertension, 212 (91.4%) had been recommended some behavioral modification (exercise, decreased sodium intake, smoking cessation, or weight loss). Two-thirds (152/229) reported having taken antihypertensives in the past two weeks. Reported use of medication differed by region, 109/150 (72.7%) in urban regions versus 43/79 (54.4%) in rural/mixed-urban regions (p<0.05), but was not associated with any other demographic. Eighty-nine (38.9%) of those aware of their hypertension had adequately controlled blood pressure when evaluated, and this did not differ based on reported medication use. We were able to determine the actual medications used in 91 of the 152 (59.9%). Seven people were on dual therapy, the remainder were on monotherapy. Calcium channel blockers (54, 59.3%) and ACE inhibitors (36, 39.6%) were the most common therapies.

Conclusions:
Undiagnosed hypertension remains a major health problem in the Da Nang province of Viet Nam. The vast majority of those aware of their hypertension were receiving at least some level of behavioral modification with a smaller, but substantial, majority receiving medications. Screening programs focused on young and poor men may be a rich target for improving hypertension control in Viet Nam.
Abstract MP044: Prediction of 10-year and Lifetime Risk for Cardiovascular Disease in Mexico: Results from a National Representative Survey in 2006
Authors: Catzin-Kuhlmann Andres , Rojas Rosalba , Lopez-Ridaura Ruy , Gonzalez Clicerio , Jimenez-Corona Aida , Lajous Martin
Published: July 2021

Introduction:
Mexico is undergoing a fast-paced epidemiologic transition, yet little is known about its cardiovascular risk. In the absence of Mexican prediction tools algorithms developed for other populations may be informative and a first step in the development of risk calculation tools specific to this population.

Methods:
We applied two US-based algorithms based on the Framingham Heart Study data to stratify 5,074 cardiovascular disease-free Mexican adults by 10-year and lifetime cardiovascular risk. We used data from the 2006 Mexican National Health and Nutrition Survey (ENSANUT), a publicly available complex multistage, stratified nationally representative survey. Participants were aged 20 to 82 years and represent 42 million Mexican adults. Ten-year and lifetime predicted risks were combined to define the following groups: low 10-year (<10%)/low lifetime (<39%) predicted risk, low 10-year (<10%)/high lifetime (≥39%) predicted risk and high 10-year (≥10%) predicted risk or diagnosed diabetes.

Results:
While we estimated that according to these tools a slight majority of Mexican adults (56% or 24 million) are at low short-term/low lifetime predicted risk for cardiovascular disease, there are 10 million Mexican adults (24%) that despite a low short-term risk have a high lifetime predicted cardiovascular risk, while 20% (8 million) are at a high short-term risk for cardiovascular disease. Women had a higher prevalence of low short-term/low lifetime predicted risk (64 vs 46%), while men had a high short term predicted risk that was twice that of women (26 vs 14%). The prevalence of low short-term either with low or high lifetime predicted cardiovascular risk was somewhat higher in rural areas, but there was no substantial difference between participants from urban and rural areas in the prevalence of high short-term risk for cardiovascular disease.

Conclusion:
Half of Mexican adults have an elevated risk for developing cardiovascular disease during their lifetimes, but less than a half of those are identified using traditional short-term risk calculation tools only. This is the first exercise of this kind in Mexico, risk stratification was based on algorithms that may not be entirely applicable to Mexican population and require refinement.
Abstract MP046: Gestational Hypertension in Minorities: Can Racial and Ethnic Disparities Be Attributed to Socio-Economic Status?
Authors: Sergeev Alexander V , Nyirati Christina M
Published: July 2021

Background:
Gestational hypertension (GHTN) remains a compelling clinical and public health problem. It can increase risks of intrauterine growth restriction, low-birth weight, and stillbirth. Little is known about whether racial and ethnic minorities and lower socio-economic status (SES) population groups are more vulnerable to GHTN.

Hypothesis:
We hypothesized that racial and ethnic disparities in GHTN exist beyond the scope of SES-related health disparities.

Methods:
A case-control study of GHTN was conducted using the data of 114,298 births in the year 2010 in Ohio. The comprehensive births data were obtained from Ohio Department of Health. Cases were identified as those with GHTN. Controls were identified as those without GHTN. Mothers utilizing Medicaid or the Federal Special Supplemental Nutrition Program for Women, Infants and Children were considered of low SES. Odds ratios of GHTN in relation to mother’s race, ethnicity, and SES were obtained using multivariable logistic regression (SAS software), adjusting for known confounders - gestational age, mother’s age, pre-pregnancy and pregnancy smoking status, pre-pregnancy or gestational diabetes, and plurality.

Results:
GHTN was statistically significantly associated with maternal race and ethnicity, even after adjustment for SES. Compared to non-Hispanic whites, non-Hispanic blacks were more likely to develop GHTN (adjusted OR = 1.867, 95% CI 1.663–2.096, p<0.001), while Asian women were less likely to develop GHTN (adjusted OR = 0.538, 95% CI 0.426–0.679, p<0.001). Hispanic white women were less likely to develop GHTN than non-Hispanic white women, although the difference between them did not reach a conventional p<0.05 level of statistical significance (adjusted OR = 0.651, 95% CI 0.395–1.076, p=0.09). Adjusted for maternal race, ethnicity, age, and known clinical confounders, women of lower SES were more likely to develop GHTN (adjusted OR = 1.475, 95% CI 1.32–1.647, p<0.001).

Conclusions:
Non-Hispanic black women are at the highest risk of developing GHTN, while Asian women are at the lowest. The Hispanic paradox phenomenon extends to the issue of GHTN. Racial and ethnic disparities cannot be attributed to low SES only; other mechanisms need to be investigated further.
Abstract MP053: Coronary Calcium on Standard Chest CT and Cardiovascular Disease Death in Community-Living Individuals
Authors: Blair Katherine J , Allison Matthew , Morgan Cindy , Wassel Christina L , Rifkin Dena E , Criqui Michael H , Ix Joachim H
Published: July 2021

CAC on EBCT by the Agatston method predicts incident CVD events but is not covered by most insurances. Standard chest CT scans are done for many clinical indications. Shemesh et.al. recently proposed a simple CAC scoring system using standard chest CTs but correlations with Agatston CAC on EBCT and associations with CVD events in community-living populations is unknown.

Methods:
4,544 consecutive out-patients presented for elective CT scanning including EBCT for CAC and a standard chest CT for lung disease in 2000-03. Participants were followed through 2009; death certificates classified cause of death. In this nested case-control study, we identified cases of CVD death (n=56) and age/sex matched each with 3 controls. EBCT CAC was scored by Agatston method. Using the standard chest CTs, the 3 major coronary arteries and left main were scored from 0-3 (0, no calcium; 1, <1/3; 2, 1/3-2/3; or 3, >2/3 calcified) and scores were summed (0-12; Shemesh score). Conditional logistic regression determined the odds of CVD death by each score separately.

Results:
Mean age was 72 yrs; 26% were women. The intra-reader and inter-reader kappa (any vs. 0) were 0.90 and 0.76 on 19 randomly selected scans. The median (IQR) Agatston CAC score were 315 (101, 1024) and 202 (5, 794) in cases and controls (P<0.05), whereas the corresponding median (IQR) Shemesh score were 3 (2, 4) and 2 (1, 3) (P< 0.05). The correlation of Agatston and Shemesh scores was 0.72 (p< 0.001). When adjusted for traditional CVD risk factors, the OR (95%CI) for CVD death per 1 SD greater Ln(CAC+1) was 1.57 (1.00-2.46) by Agatston on EBCT, and 1.66 (1.03-2.68) by Shemesh on standard chest CT. The odds of CVD death associated with any CAC vs. none was 2.23 (0.67-7.40) by Agatston, and 2.38 (0.81-6.97) by Shemesh.

Conclusions:
A simple CAC scoring system using standard chest CT is strongly correlated with Agatston CAC on EBCT and provides similar prediction of CVD death in community-living individuals.
Abstract MP054: Coronary Calcification, C-reactive Protein and Prediction of Cardiovascular and All-Cause Mortality in Diabetes: Diabetes Heart Study
Authors: Agarwal Subhashish , Cox Amanda J , Herrington David M , Jorgensen Neal , Xu Jianzhao , Carr John J , Freedman Barry I , Bowden Donald W
Published: July 2021

Objective:
Does coronary artery calcium (CAC) and C-reactive protein (CRP) improve discrimination and risk stratification of cardiovascular (CVD) and all-cause mortality in diabetes.

Background:
Inflammation is associated in the pathogenesis and progression of atherosclerosis. Since diabetes is characterized by both atherosclerosis and high CRP levels, we hypothesized that CAC and CRP will predict CVD and all-cause mortality in diabetes beyond Framingham risk factors (FRS).

Method:
A total of 961 participants, ages 39-86, with complete data on diabetes, vascular imaging, and inflammation in the Diabetes Heart Study were followed for an average of 7.4 years. CAC was assessed by CT at baseline. CRP was measured using enzyme-linked immunosorbent assay. Risk estimates for CVD and all-cause mortality were obtained using logistic regression models. Model 1 included FRS; age, gender, smoking, systolic blood pressure, antihypertensive medication use, total and HDL cholesterol, and ethnicity. Model 2 included FRS plus CRP or CAC. Model 3 included FRS plus CRP and CAC. Models for CVD and all-cause mortality were compared using c-statistics.

Results:
During follow-up there were 183 (19%) deaths of which 80 (8%) were CVD deaths. In FRS adjusted models both CRP and CAC were independently associated with all-cause mortality, however only CAC was associated with CVD mortality. The addition of CAC to a model with FRS and CRP improves discrimination for CVD and all-cause mortality (both p=0.001). However, the addition of CRP to a model with FRS and CAC only improves discrimination in all-cause mortality (p=0.001) (
Table 1
).

Conclusion:
In participants with T2DM, measures of CAC and CRP are significantly associated with CVD (CAC only) and all-cause (CAC and CRP) mortality independent of the FRS; however, the improvement in CVD and all-cause mortality prediction was predominantly driven by CAC.

Table 1

C-Statistics for the Combined Assessment of Framingham Risk Factors, CAC and CRP in Predicting Cardiovascular and All-Cause Mortality

CVD Mortality
All-Cause Mortality

C-Statistic
p-value
C-Statistic
p-value

Model 1 FRS Only
0.715
--
0.701
--

Model 2 vs. Model 1 Adding CRP to FRS Adding CAC to FRS
0.715 0.768
P=0.737 P=0.001
0.709 0.760
p=0.002 P=0.001

Model 3 vs. Model 2 Adding CAC to FRS + CRP Adding CRP to FRS + CAC
0.769 0.769
P=0.001 P=0.981
0.765 0.765
P=0.001 P=0.001
Abstract MP060: Effect of Low Carbohydrate Diets versus Low Fat Diets on Cardiovascular Risk Factors: A Meta-Analysis of Randomized Controlled Trials
Authors: Hu Tian , Mills Katherine , Yao Lu , Demanelis Kathryn , Eloustaz Mohamed , Kelly Tanika , He Jiang , Bazzano Lydia
Published: July 2021

Obesity is a major public health problem in the US population. Low carbohydrate diets are popular as a means of weight loss; however, there is concern for adverse effects on cardiovascular (CV) risk factors. We conducted a meta-analysis of randomized controlled trials comparing the effect of low carbohydrate diets (≤45% of energy from carbohydrates) versus low fat diets (≤30% of energy from fat) on CV risk factors, including systolic and diastolic blood pressure, total cholesterol, high-density-lipoprotein (HDL) cholesterol, low-density-lipoprotein (LDL) cholesterol, triglycerides, body mass index, waist circumference, fasting blood glucose and serum insulin. We searched MEDLINE, EMBASE, Web of Science and the Cochrane Database of Systematic Reviews, and manually examined references in selected articles and relevant literature reviews. Information on participant characteristics, trial design and duration, dietary composition, and CV risk factors were extracted using a standardized protocol. Random effects models were used to pool mean differences between CV risk factors on the two diets. From 785 potentially relevant publications, 23 randomized controlled trials compared low carbohydrate diets with low fat diets with intervention duration ≥ 6 months and reported CV risk factors as primary outcomes. These studies included data from 2,961 participants in total. The average percent of energy from carbohydrate intake was 20.7% on low carbohydrate diets and the average percent of energy from fats was 25.9% on low fat diets. Compared to participants on low fat diets, those on low carbohydrate diets showed favorable changes in HDL cholesterol, triglycerides and body mass index, with pooled net changes (95% CI) of 3.2 mg/dL (1.9, 4.5), -13.0 mg/dL (-17.3, -7.8) and -0.4 kg/m2 (-0.7, -0.1), respectively. After removing studies without intention-to-treat analysis, the change in body mass index was no longer significant (N=16). Changes in total and LDL cholesterol favored low fat diets, but after accounting for publication bias, results were no longer significant for total, LDL and HDL cholesterol. In conclusion, our findings show that low carbohydrate diets were at least as effective as low fat diets for weight loss, and did not have significant adverse effects on other CV risk factors. In fact, low carbohydrate diets had a significant and favorable impact on triglycerides. These findings suggest that low carbohydrate diets can be recommended to obese persons with CV risk factors for the purpose of weight loss.
Abstract MP061: Dietary Patterns and Depression in a Population with High Prevalence of Obesity: The Strong Heart Family Study.
Authors: Mete Mihriye , Shara Nawar M , Calhoun Darren , Eilat-Adar Sigal , Fretts Amanda M , Howard Barbara V
Published: July 2021

Background:
Several studies have evaluated associations among various dietary nutrients (eg n-3 fatty acids, caffeine, magnesium) and depression in different populations. Such analyses, however, may not adequately address possible interactions among nutrients and may overlook unmeasured micronutrients. We examined the relationships among four diet patterns and depression in American Indians (AI) from the Strong Heart Family Study.

Methods:
Four diet patterns were extracted using factor analysis with principal component factoring method based on a sample of 3245 AI aged 14 years or older (excluding extreme calorie intakes, n=203; total var=38%). Linear Regressionmodels of the depression scale by the Center for Epidemiological Studies of Depression (CES-D) were constructed to examine the association between diet patterns and continuous CES-D measures adjusting for age, gender, BMI, waist circumference, Diabetes, education level, physical activity and Locus of Control (LOC) assessed by Multidimensional Health Locus of Control Form-B. Logistic regression models of symptoms of depression vs no depression were also run to estimate the associations of diet patterns to depression.

Results:
Factor 1 (in quintiles), the “less healthy” pattern, includes more fast food, snack chips, fried potatoes, prepared main dishes, sweet beverages, and animal fats. Participants who scored high on this pattern had an increase risk of depression (OR=1.09, 95%CI=1.02-1.18, p=.02). Factor 2, the “traditional AI/Southwestern” pattern consists of traditional American Indian foods common in the Southwest, as well as of meat, stew and dry beans. It is positively related to depression (OR=1.11, 95%CI=1.04-1.20, p=.002). Factor 3 resembles a healthy diet associated with fish, fruits, dark whole bread and low-fat healthier meat and dairy products. Participants who scored high on this pattern were less likely to have depression (OR=.93, 95%CI=.87-.99, p=.03). Factor 4, the “junk-food” pattern includes high amounts of coffee, tea, candy bars, sugar, syrup, animal fats, sweetened grains, doughnuts, cookies, pies, cakes, ice cream, and non-dairy creamer. Participants who scored high on this pattern were more likely to have depression (OR=1.12, 95%CI=1.05-1.20, p=.001). Depression was higher in women (OR =1.99, 95%CI=1.6-2.5, p<.001) and those with abdominal obesity (in cm; OR=1.02, p=.02) and lower in those with greater physical activity (OR=.88, p=.001), increasing age (OR=.99, p=.01), and more education (OR=.89, p<.001).

Conclusion:
A healthy eating pattern as well as greater physical activity and higher education were independently associated with lower depression, while depression was higher in those with central obesity. The results suggest that interventions aimed toward weight loss may also improve rates of depression in some populations.
Abstract MP071: A Healthy Cardiovascular Risk Factor Profile is Associated With Lower Incidence of End-stage Renal Disease Among US Adults With Chronic Kidney Disease
Authors: Muntner Paul , Judd Suzanne E , Gao Liyan , Gutierrez Orlando , Rizk Dana , McClellan William , Cushman Mary , Warnock David G
Published: July 2021

The American Heart Association’s (AHA) Life’s Simple 7 measure of cardiovascular health includes biological and behavioral factors (cigarette smoking, physical activity, diet, body mass index, blood pressure, cholesterol, and glucose). We determined the association of health factors in the AHA Life’s Simple 7 metric with end-stage renal disease (ESRD) incidence among participants with chronic kidney disease (CKD; estimated glomerular filtration rate < 60 ml/min/1.73 m2) from the population-based REasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=30,239). Each of the AHA Life’s Simple 7 components was assessed at baseline and categorized as poor (1 point), intermediate (2 points) or ideal (3 points). At baseline, 3,093 participants had CKD. The mean age of the study sample was 72.2 years, 42% were African American and 45% were men. Amongst this group, 162 participants developed ESRD over a median 4 years of follow-up. For each Life’s Simple 7 component except cholesterol, a graded association was present with a lower incidence of ESRD among participants with better health factor levels. After adjustment for age, race, sex, geographic region of residence, income, and education and compared to individuals with 0 or 1 ideal health factors, the hazard ratios for ESRD among those with 2, 3, and 4 ideal health factors were 0.62 (95% CI: 0.43 - 0.89), 0.54 (95% CI: 0.35 - 0.83), and 0.46 (95% CI: 0.24 - 0.88), respectively. No cases of ESRD occurred among participants with 5-7 ideal health factors. On a scale from 7 (all 7 factors poor) to 21 (all 7 factors ideal), each one point higher Life’s Simple 7 score was associated with a 22% lower ESRD risk (hazard ratio 0.78; 95% CI: 0.72 - 0.85). When biologic and behavioral health factors were evaluated separately, similar patterns of lower ESRD risk with better risk factor profiles were present. In the current study, a strong, graded association was present between a better cardiovascular risk factor profile and lower ESRD risk.
Abstract MP073: Combining Multiple Kidney Markers to Predict Future Risk of Clinical Outcomes: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Waheed Salman , Matsushita Kunihiro , Astor Brad C , Coresh Josef
Published: July 2021

Background
There is substantial interest in investigating how multiple chronic kidney disease (CKD) markers combine to predict risk, in particular using eGFR by cystatin C (eGFR
cys
) as a supplement to traditional CKD markers, eGFR by creatinine (eGFR
cr
) and albumin: creatinine ratio (ACR).

Methods
We followed 10,268 participants for a median of 11.2 years. Participants were classified into 8 categories: (1) no CKD by any marker (reference); CKD by either (2) eGFR
cr
or (3) eGFR
cys
(<60 ml/min/1.73 m
2
) or (4) ACR (≥30 mg/g) only; CKD by both (5) eGFR
cys
and eGFR
cr
or (6) eGFR
cys
and ACR or (7) eGFR
cr
and ACR; and (8) CKD by all 3 markers. Cox proportional hazard models were used to estimate hazard ratios.

Results
Risk increased with the number of markers indicating CKD. eGFR
cr
<60 alone (ACR and eGFR
cys
normal) was associated with increased risk of ESRD but not other outcomes [mortality: 0.95 (0.7, 1.2); coronary heart disease: 0.9 (0.6, 1.2); heart failure: 0.9 (0.6, 1.2); acute kidney injury: 1.3 (0.9, 2.0)] compared to individuals without CKD by any marker. In contrast, eGFR
cys
<60 alone was associated with increased risk of all outcomes except coronary heart disease. When all three markers were abnormal, risk was higher compared to when combination of eGFR
cr
and ACR were abnormal, particularly for ESRD [ESRD: 109.2 (66.3, 179.9) vs. 12.2 (4.6, 32.2)]. More markers indicating CKD were associated with higher risk for each of the five outcomes examined after adjustment for covariates (Table).

Conclusions
Cystatin C is a useful confirmatory marker in those with eGFR
cr
<60 to predict future risk of mortality, cardiovascular and kidney outcomes, particularly in the absence of albuminuria (i.e., when creatinine is the only criterion used to define CKD). Cystatin C may be used as a supplement to traditional CKD markers when more precise information about risk is needed.
Abstract MP077: Dietary Sodium Potassium Ratio as a Risk Factor for Stroke, Cardiovascular Diseases and All-cause Death Among Japanese: Nippondata80.
Authors: Okayama Akira , Miura Katsuyuki , Okamura Tomonori , Okuda Nagako , Saitoh Shigeyuki , Ohnishi Hirofumi , Akasaka Hiroshi , Takashima Naoyuki , Yoshita Katsushi , Arai Yusuke , Nozue Miho , Hayakawa Takehito , Kiyohara Yutaka , Ueshima Hirotsugu
Published: July 2021

Objective
Japanese have higher intake of sodium and lower intake potassium than Western countries. We evaluated the impact of Sodium potassium ratio on mortality from stroke, cardiovascular diseases (CVD) and all causes using 24 year follow-up data of population randomly selected from Japanese at National cardiovascular Survey in 1980.

Method
Participants with age 30 years old or more (n=10536) in the 1980 National Cardiovascular Survey was followed-up for 24 years with a follow-up rate of 92%. We combined individual National Nutrition Survey data conducted for the same participants. Participants without hypertensive treatment and without past histories of stroke and acute myocardial infarction (n = 8982) were divided into quintile according to sodium potassium ratio assessed by 3 day dietary record method at the baseline survey. Observed number of death during follow-up was 1938. Under line causes of death were identified by using Vital Statistics,Japan. Age adjusted and multi-adjusted hazard ratio was calculated using.Cox’s proportional hazard model.

Results
Mean intake of Sodium and potassium at the baseline was 242 and 208 mEq, and 77.7 and 70.8 mEq for men and women, respectively. Sodium potassium ratio was significantly related to mortality from stroke, cardio vascular diseases and all causes of death among men and for all adjusting other major risk factors. Multi-adjusted hazard ratio (95% confidence interval) of mortality from all causes, CVD and stroke for both sexes with one quintile of sodium potassium ratio was 1.04(1.01-1.08), 1.08(1.02-1.14) and 1.14 (1.05-1.24). Relationship was still significant after adjusting SBP levels.

Conclusion
Sodium potassium ratio was significant risk factor for death from all causes, CVD and stroke among Japanese.
Abstract MP078: Endothelial Function and Arterial Stiffness Associated with the Extent of Brain White Matter Disease
Authors: Vaidya Dhananjay , Nyquist Paul , Kral Brian G , Yanek Lisa R , Moy Taryn F , Becker Lewis C , Becker Diane M
Published: July 2021

Background:
Subclinical white matter disease of the brain is presumed to be of vascular origin. However associations with important facets of arterial structure and function have not been well studied.

Methods:
We examined 381 participants in GeneSTAR (57% female, 63% white, 37% black, age 51.6±10.5), a study of subclinical vascular disease in apparently asymptomatic individuals from families with early coronary artery disease (CAD). Volumetric measurement of white matter hyperintensities (lesion volume as a percent of brain volume, WMHV) was acquired from T3 magnetic resonance images. Ultrasound imaging of the brachial artery at rest and during hyperemia induced by 5 minutes of forearm ischemia was used to determine (1) the distensibility coefficient (DC) of the brachial artery at rest and (2) endothelial function as the percentage hyperemic flow mediated dilation (FMD). Mixed model analyses correcting for intrafamilial correlations, adjusting for age, sex, race, total and HDL-cholesterol, diabetes, hypertension, and current smoking, was used to test the association of WMHV with DC and FMD.

Results:
The unadjusted Spearman correlation of WMHV with FMD was -0.19 (p<0.001) and with DC was -0.11 (p=0.030). In adjusted analysis, every 10% higher FMD was associated with 0.1% lower WMHV (p=0.028) and every 10% higher DC was associated with 3.3% lower WMHV (p=0.025). When both arterial measures were included in the same regression model, the association of FMD remained significant (p=0.037), while DC remained at the borderline (p=0.052).

Conclusion:
Two different facets of arterial function, (a) distensibility at rest, which is a material property of vessel walls, and (b) endothelial function resulting in functional reactivity to stimuli, are independently associated with subclinical white matter disease in the brain. This study reinforces the contention that white matter disease of the brain is of vascular origin.
Abstract MP081: Association between Sleep Characteristics and Cardiovascular Disease Risk Factors in a Population Sample: Chicago Area Sleep Study
Authors: Carnethon Mercedes , Knutson Kristen L , de Chavez Peter J , Kim Kwang-Youn , Ng Jason , Liu Kiang , Goldberger Jeffrey J , Zee Phyllis
Published: July 2021

Introduction:
Shortened sleep duration and poor quality sleep are each associated with cardiovascular disease (CVD) risk factors (e.g., hypertension, obesity, diabetes) in prior cross-sectional and longitudinal studies. However, prior studies have often relied on self-reports of sleep duration, which commonly overestimate actual sleep time. Despite known associations of sleep disordered breathing (e.g., obstructive sleep apnea [OSA]) with CVD, prior studies have not excluded people with sleep disorders before testing these associations.

Objective:
We tested whether sleep duration and quality, measured objectively using wrist actigraphy, was associated with fasting glucose, blood pressure, and anthropometric characteristics in adults without a history of OSA and with apnea hypopnea index (AHI)<15 based on one night using in-home apnea detection equipment.

Methods:
The Chicago Area Sleep Study (CASS) recruited 531 participants (56% female) ages 35-64 years (mean= 47.5) via commercially available telephone listings. Participants underwent 1 night of screening using in-home apnea detection equipment (ApneaLink
TM
) and 411 had AHI<15. Participants wore wrist actigraphs for 7 days (Actiwatch
TM
) to determine sleep duration, sleep % (% of time during the sleep interval spent sleeping), and minutes of wake after sleep onset (WASO). The Epworth Sleepiness Scale (ESS) was used to determine daytime sleepiness. Height, weight and waist circumference were measured, hypertension and diabetes were determined according to JNC-VII and American Diabetes Association 2010 criteria, respectively.

Results:
On average, participants slept for 7 hours (SD=1.2), sleep percentage was 83.2% (SD=20.1), WASO was 41.2 min (SD=21), the ESS score was 6.8 (SD=4.1) and 44% of the sample slept for <7 hours/night. SBP and DBP were 114.5 (SD=13.6) and 70.9 mmHg (SD=9.8), respectively, fasting blood glucose was 92.5 mg/dL (SD=19.6), BMI was 26.2 kg/m
2
(SD=4.5) and waist circumference was 87.4 cm (SD=12.7). The prevalence of obesity (BMI>30), hypertension and diabetes was 21%, 14% and 6.1%, respectively. Sleep duration was the only measure to demonstrate statistically significant (p<0.05) associations with metabolic markers, namely inverse associations with SBP, DBP, BMI, waist circumference and the odds of obesity. Following adjustment for age, race, sex, education, physical activity, depressive symptoms, alcohol intake, smoking and sugared beverage intake, sleep duration (<7 hrs. vs. >7hrs) only remained significantly associated with BMI (β= -1.1 kg/m2, SE=0.42) and waist circumference (β= -3.8 cm, SE=1.2).

Conclusions:
Sleep duration is associated with CVD risk factors in adults with a low likelihood of OSA. The presence of other adverse health behaviors accounts for much of the observed association.
Abstract MP084: Childhood and Adult Environmental Tobacco Smoke and Risk of Incident Type 2 Diabetes Among Never-smoking French Women
Authors: Lajous Martin , Tondeur Laura , de Lauzon-Guillain Blandine , Fagherazzi Guy , Boutron-Ruault Marie-Christine , Clavel-Chapelon Francoise
Published: July 2021

Background
There is consistent evidence of a direct relation between active smoking and type 2 diabetes. However, prior studies on passive smoking (or secondhand smoke) and type 2 diabetes have often been limited by insufficiently detailed information on both childhood and adult environmental tobacco smoke exposure.

Methods and Results
We evaluated childhood and adult environmental tobacco exposure (ETS) in relation to incident type 2 diabetes in a prospective cohort study among 37,343 never-smoker women from the E3N-EPIC cohort, who were free of diabetes, cancer or cardiovascular disease at baseline in 1992. Self-reported childhood ETS was defined as having at least one parent who smoked (59 % of women). Adult ETS exposure was defined as the sum of self-reported hours of exposure to tobacco from a smoking spouse (or domestic close contact) and exposure to ETS outside the home, recorded at baseline. Between 1992 and 2007, 795 cases of incident diabetes were identified and validated using a drug reimbursement dataset and a specifically designed supplementary questionnaire. Adjusting for family history of diabetes, education and body silhouette at age 18 women with at least one smoking parent had an 18 % higher rate of diabetes compared to women with nonsmoking parents [HR=1.18 (95%CI 1.02-1.86)]. After additional adjustment for physical activity, BMI, parental smoking, treated hypertension and hypercholesterolemia, menopausal status and menopausal hormone use the multivariate HRs (95%CI) for adult ETS exposure relative to no exposure were 1.08 (0.92, 1.27) for < 1 hours/day, 1.06 (0.77, 1.46) for 1 to 1.9 hours/day, 1.34 (1.00, 1.82) for 2 to 3.9 hours/day and 1.44 (1.11, 1.86) for ≥ 4 hours/ day with p for trend 0.003.

Conclusion
Childhood and adult ETS exposure may be associated to a higher rate of type 2 diabetes. These results further emphasize the health risks of past and current tobacco smoke exposure.
Abstract MP086: Association Between the Angiotensin-Converting Enzyme-2 Gene and Blood Pressure in a Cohort of Canadian Adolescents
Authors: Malard Lucile , Kakinami Lisa , O’Loughlin Jennifer , Roy-Gagnon Marie-Hélène , Labbe Aurélie , Pilote Louise , Hamet Pavel , Tremblay Johanne , Paradis Gilles
Published: July 2021

Background:
The Angiotensin-Converting Enzyme-2 (ACE2) gene, located on chromosome X, is believed to be implicated in blood pressure (BP) regulation. However the few studies that have assessed this association have yielded mixed results. We examined the association between BP and ACE2 single nucleotide polymorphisms (SNPs) in a population-based cohort of adolescents, thereby minimizing confounding by treatment for hypertension and other chronic diseases.

Methods:
Participants were 852 of 1293 adolescents from the Nicotine Dependence In Teens (NDIT) cohort study. Participants provided a blood sample for DNA, and BP was measured on the right arm at rest, in the sitting position, by trained, certified technicians using an automated oscillometric device at age 12, 15 and 17 years. Instruments were calibrated against mercury sphygmomanometer before each data collection. Systolic (SBP) and diastolic blood pressure (DBP) were measured 3 times at 1-minute intervals, and the mean was used for analysis. Four SNPs (rs2074192,
rs233575
, rs2158083, rs1978124) in the ACE2 gene were genotyped. The relationship between ACE2 SNPs and each of SBP and DBP was examined using linear growth models adjusted for height and ethnicity, and stratified by sex.

Results:
Mean age at baseline was 12.7 years; 47.8% of participants were male (n=407 of 852). All SNPs were in Hardy-Weinberg equilibrium (p>0.05), and three of the four SNPs were in linkage disequilibrium (
rs233575
and rs2158083 r2: 0.71; rs1978124 and
rs233575
r2: 0.36; rs2158083 and rs1978124 r2: 0.52) with each other. SNP rs2074192 was in low linkage disequilibrium with these 3 SNPs (r2 <0.3). Compared to boys carrying the G allele, SBP in boys carrying the A allele of SNP rs2074192 was 2.45 mmHg lower (CI: 0.20-4.70, p=0.0350); DBP was 1.67 mmHg lower (CI: 0.47-2.87, p=0.0067). SNPs
rs233575
, rs2158083, and rs1978124 were not significantly associated with SBP or DBP in boys. None of the four SNPs were associated with SBP or DBP in girls.

Conclusion:
Because elevated BP tracks from childhood to adulthood, the ACE2 gene could represent a new therapeutic target in boys to prevent elevated BP. Association between this gene and BP and potential for prevention should be further investigated.