bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P174: Kidney Function and Progression of Coronary Artery Calcification in Community-Dwelling Older Adults: The Rancho Bernardo Study
Authors: Jassal Simerjot K , Laughlin Gail A , Cummins Kevin M , Chonchol Michel , Smits Gerard , Kramer Caroline K , Barrett-Connor Elizabeth
Published: July 2021

Background:
Despite growing evidence for the separate and joint contributions of declining estimated glomerular filtration rate (eGFR) and presence of albuminuria to cardiovascular death, longitudinal studies of the association of these risk factors with coronary artery calcification, a marker of subclinical cardiovascular disease (CVD), are contradictory.

Methods:
We evaluated 421 community-dwelling men and women (mean age 67 years) without known heart disease who had eGFR estimated by the Modification of Diet in Renal Disease equation and albuminuria assessed by urine albumin/creatinine ratio (ACR) between 1997-99. Coronary artery calcium (CAC) was measured by electron beam computed tomography between 2001-02; 338 participants returned for a repeat scan between 2005-06, a mean of 4.5 (0.5) years later. CAC progression was defined as a difference between the follow-up square-root transformed CAC volume score and the baseline square-root transformed score > 2.5 mm
3
.

Results:
At baseline, mean eGFR was 78 mL/min/1.73m
2
, median ACR was 10 mg/g. Median total Agatston CAC score was 77 at the baseline scan and 112 at follow-up; 45% (191 of 421) of participants had CAC>100 at baseline and 46% (157 of 338) showed CAC progression. Logistic regression analyses showed no separate or joint association between eGFR or ACR with baseline CAC or with CAC progression.
Table
1 shows the odds ratio (95% CI) for CAC progression for each 1 SD decrease in eGFR or increase in ACR.

Conclusions:
In a cohort of community-dwelling older adults, we found no longitudinal association between eGFR or ACR with CAC progression. This information may enhance our understanding of CAC progression across the spectrum of kidney function in community-dwelling adults without prevalent CVD or kidney disease.

4 Year CAC Progression per 1 SD Decrease in eGFR or Increase in ACR 1997-99

Estimated Glomerular Filtration Rate
Urine Albumin/Creatinine Ratio

(n=338)
(n=292)

Covariates
Odds Ratio (95% CI)
p value
Odds Ratio (95% CI)
p value

Model 1
1.07 (0.86, 1.33)
0.54
0.99 (0.78, 1.26)
0.93

Model 2
1.04 (0.84, 1.30)
0.69
0.97 (0.77, 1.24)
0.82

Model 3
1.06 (0.85, 1.33)
0.57
1.06 (0.82, 1.37)
0.67

Model 4
1.07 (0.85, 1.33)
0.57
1.05 (0.81, 1.36)
0.69

Model 5
1.05 (0.82, 1.36)
0.68
1.06 (0.82, 1.38)
0.66

Model 6
1.10 (0.83, 1.43)
0.53
0.99 (0.75, 1.30)
0.94

Model 1: Unadj; Model 2: Age, time lapse adj; Model 3: Age, time lapse, sex adj; Model 4: Age, timelapse, sex, BMI adj; Model 5: Age, time lapse, sex, BMI and (eGFR or ACR) adj; Model 6: Age, time lapse, sex, BMI, SBP, FPG, HDL and (eGFR or ACR) adj
Abstract P175: High-density Lipoprotein Cholesterol and Mortality Prior to Age 90 in a Cohort of Male Physicians
Authors: Rahilly-Tierney Catherine , Sesso Howard D , Gaziano J. Michael , Djousse Luc
Published: July 2021

BACKGROUND:
Few studies have examined prospectively the relationship between baseline high-density lipoprotein (HDL) cholesterol and longevity.

OBJECTIVES:
We sought to examine whether higher HDL levels were associated with lower risk of all-cause, cardiovascular (CVD), and non-CVD mortality prior to age 90 in the Physicians’ Health Study (PHS).

METHODS:
We considered a baseline cohort of 1351 PHS participants who provided bloods between 1997 and 2001 and were old enough to reach age 90 by March 4, 2009. Included subjects had complete baseline data on HDL and total cholesterol; lifestyle factors including smoking, exercise, alcohol consumption, and BMI; and comorbidities including hypertension, diabetes mellitus, congestive heart failure, cancer, and stroke. We used Cox proportional hazards to determine the HRs and 95% CIs for all-cause, CVD, and non-CVD mortality prior to age 90, adjusting for baseline age, co-morbidities, and non-HDL cholesterol.

RESULTS:
At baseline, the cohort had a mean (SD) age of 81.9 (2.9) years and a mean (SD) HDL cholesterol of 44.8(16.5) mg/dL. After a mean follow-up of 6.8 years (maximum 12.3 years), 501 (37.1%) of men died prior to age 90. In multi-variable adjusted analyses, men in the highest HDL-C quartile (≥54.1 mg/dL) had a 28% lower risk (HR 0.72, 95% CI 0.55-0.95) of all-cause mortality prior to age 90 compared to men in the lowest HDL-C quartile (<32.8 mg/dL). From the lowest to highest HDL quartile, age-adjusted HR(95%CI) for CVD mortality prior to age 90 were 0.66 (0.44-0.99), 0.58 (0.38-0.90), and 0.53 (0.34-0.82) (p for trend 0.004). There was no significant association between baseline HDL cholesterol and non-CVD death.

CONCLUSION:
In a cohort of older male physicians with long-term follow-up, baseline HDL cholesterol was inversely associated with the risk of dying prior to age 90, largely explained by an inverse association between HDL and CVD mortality.
Abstract P184: Neighborhood Crime and Poverty is Associated with Systemic Inflammation in Children
Authors: Broyles Stephanie T , Staiano Amanda E , Drazba Kathryn T , Gupta Alok K , Katzmarzyk Peter T
Published: July 2021

Introduction:
The neighborhood environment may contribute to cardiovascular disease risk by promoting physical inactivity and/or unhealthy eating, as well as through exposure to chronic psychosocial stress. Elevated serum C-reactive protein (CRP) concentrations have been associated with increased cardiovascular risk in adults and may also be a marker for stress-related inflammation. Whether CRP is associated with stressful neighborhood conditions among children is unknown.

Hypothesis:
We hypothesized that children and adolescents living in neighborhoods characterized by high levels of poverty or crime have higher concentrations of CRP, independent of adiposity.

Methods:
The sample included 395 children 5-18 years of age (50% African American, 46% white, 4% other race; 48% male, 52% female) from 262 households and 102 census tracts in southeastern Louisiana. Serum CRP levels were measured with a high-sensitivity chemiluminescent immunoassay. High risk neighborhoods were defined as those in the upper tertile of either census-tract family poverty (US Census 2000) or of an index of total crime derived from Uniform Crime Report data (CrimeRisk, Applied Geographic Solutions). Multilevel logistic regression analyses that accounted for both family and neighborhood clustering compared children and adolescents with CRP levels >3mg/L to those with levels ≤3 mg/L across high versus low risk census tracts. Analyses also controlled for race, sex, age, and total body fat (kg) measured by dual-energy x-ray absorptiometry.

Results:
In this sample, 16.0% of children had CRP levels higher than 3 mg/L. After adjustment for covariates, and family and neighborhood clustering, total body fat was positively associated with high CRP levels (p<0.0001) and age was negatively associated with higher CRP levels (p=0.001). Race and sex showed no associations. Independent of adiposity, children from census tracts with the highest levels of either crime or poverty had 2.4 (95% CI: 1.1-5.1) times the odds of having high CRP levels when compared to children from other census tracts.

Conclusions:
Children from neighborhoods characterized by high levels of poverty or crime appear to have higher levels of C-reactive protein, a marker of systemic inflammation and cardiovascular risk. Stress may initiate cardiovascular disease starting in childhood. This research identifies neighborhoods at high risk, where early disease screening and prevention efforts may have maximal impact.
Abstract P203: Association of Sleep Characteristics with Heart Rate Variability: Chicago Area Sleep Study
Authors: Carnethon Mercedes , Knutson Kristen L , Ng Jason , de Chavez Peter J , Kim Kwang-Youn , Liu Kiang , Zee Phyllis , Goldberger Jeffrey J
Published: July 2021

Introduction:
Autonomic nervous system (ANS) dysfunction may contribute to the elevated incidence of hypertension, diabetes and coronary heart disease (CHD) among persons with shortened sleep duration. However, prior studies were conducted in adults who had obstructive sleep apnea (OSA), a correlate of short sleep, or using experimental designs that restricted sleep. To explore whether sleep duration is associated with ANS function in adults free from OSA, we tested whether sleep duration was associated with heart rate variability (HRV) indices that represent autonomic modulation of heart rate.

Methods:
The Chicago Area Sleep Study (CASS) identified men and women ages 35-64 via commercially available telephone listings. Data from 406 participants who had an apnea/hypopnea index<15 based on 1 night of in-home apnea detection (ApneaLink
TM
) were studied. Participants wore wrist actigraphs for 7 days (Actiwatch
TM
) to determine average sleep duration, sleep percentage (% of time during overnight sleep interval spent sleeping) and minutes of wake after sleep onset (WASO). A validated questionnaire, the Epworth Sleepiness Scale (ESS), was used to determine daytime sleepiness. Electrocardiograms were continuously recorded from participants for 10 minutes s from supine participants; time and frequency domain HRV indices were calculated from the RR interval to estimate overall autonomic modulation of heart rate (standard deviation of normal RR intervals [SDNN]) and parasympathetic modulation heart rate (high frequency power [HF], square root of the mean squared difference of successive R-R intervals [rMSSD]). Height and weight were measured and hypertension and diabetes were determined according to JNC-VII and American Diabetes Association 2010 criteria, respectively.

Results:
Participants’ mean age was 47.5 years, and 56% were female. Average sleep duration was 7.03 hours (SD=1.15), sleep percentage was 83% (SD=20.1), WASO was 41.4 min (SD=21) and the ESS score was 6.75 (SD=4.1). Following adjustment for age, race, sex, BMI, hypertension, diabetes, physical activity and smoking, sleep duration (per 1 hr) was significantly (p<0.01) inversely associated with SDNN (β=−2.5, SE=1.12), rMSSD (β=−2.6, SE=1.1) and log-transformed HF (β=−0.11, SE=0.05). Findings were similar in the subset of 285 participants with AHI<5.

Conclusions:
In contrast to prior studies, shorter sleep duration was associated with more favorable parasympathetic modulation of HR. These unexpected findings may suggest that ANS dysfunction associated with OSA may be attributed to hypoxemia rather than the direct effects of shortened sleep duration.
Abstract P224: Whole Genome Sequencing of 8 Indian Asians
Authors: Chambers John , Al-Hussaini Abtehale , Tan Tsung , Sehmi Joban , McCarthy Mark , Scott James , Elliott Paul , Kooner Jaspal S
Published: July 2021

Background
The genetic architecture and variation of Indian Asians, who represent one quarter of the world's population, has not been described. This represents an important obstacle to the identification of the genetic factors contributing to diseases encountered in Indian Asians.
Aim
To identify and describe the patterns of genetic variation in Indian Asians.
Methods
We carried out high-depth whole genome sequencing of 8 Indian Asian men, using paired-end and mate-pair libraries, and Illumina GAII
x
instruments. We used Stampy, with BWA as a pre-mapper, to align reads to Genome Reference Consortium build 37 of the human genome (GRCh37). We used GATK and SAMtools to call SNPs and indels; accepting genetic variants called by both algorithms as confirmed.
Results
Mean coverage was 28.4x (range 13.9 to 32.5x); 99.8% of the mappable genome was covered by at least one read in each sample. We found 6,602,840 autosomal SNPs (mean 3,318,386 per person) of which 436,823 (6.6%) are novel (not in dbSNP132 or 1000G June 2011). The majority of novel SNPs were singletons (88% vs 20% for known SNPs). There were 50,585 novel SNPs present at least twice (ie MAF>10%), and 2,174 novel SNPs predicted to affect protein coding. Amongst the novel cSNPs that are identified as pathogenic by SIFT or PolyPhen2, 145 are in genes linked by OMIM to human disease, including obesity (
FTO
,
UCP1
), diabetes mellitus (
CDKAL1
,
GCGR
,
HNF1B
), lipid metabolism (
APOB
), renal disease (
NPHP4, PKD1
), hypertension (
NOS2
), iron and B vitamin metabolism (
CUBN
,
TCN2, TF
), and susceptibility to malaria and leprosy (
CR1
,
FCGR2A
,
NOS2, TLR1
). There were 65,613 novel autosomal indels of which 35,097 are present at least twice, and 2,301 novel deletions >100bp. We found that amongst the novel SNPs and indels discovered, >50% are not in high LD (r
2
≥0.8) with tagSNPs on available high-density microarrays
Conclusions
Our results reveal 502,436 new genetic variants amongst Indian Asians, including coding SNPs and indels in genes involved in atherosclerosis, carbohydrate and lipid metabolism, immunity and inflammation. The majority of novel variants are in low LD with standard commercial micro-arrays, indicating that these genome-wide arrays do not capture Indian Asian specific genetic variation. Our findings will inform the design of future studies to identify the genetic factors contributing to cardiovascular disease and other disorders that are more common amongst Indian Asians.
Abstract P229: Genetic Risk Scores are Associated with Chronic Venous Disease Prevalence and Severity in a Multi-Ethnic Cohort: The San Diego Population Study (SDPS)
Authors: Wassel Christina L , Rasmussen-Torvik Laura J , Callas Peter W , Denenberg Julie O , Durda Peter , Reiner Alexander P , Smith Nicholas L , Allison Matthew A , Criqui Michael H , Cushman Mary
Published: July 2021

Background:
Chronic venous disease is common, affecting up to 40% of the population, although estimates vary quite widely due to differing evaluation methods and definitions. Chronic venous disease shares some risk factors with venous thromboembolism (VTE). Several genetic loci have been recently discovered and replicated for VTE, mostly in populations of European descent. We tested associations of these loci, as well as a genetic risk score including these variants, with chronic venous disease prevalence and severity in a multi-ethnic cohort.

Methods:
The San Diego Population Study (SDPS) is a prospective cohort study that evaluated 2404 ethnically diverse men and women aged 29-91 for venous disease using duplex ultrasound. The current study includes 1229 participants from the baseline exam who were genotyped for 35 variants in 23 loci. Venous disease was defined as moderate or severe, as well as severe only. Logistic regression was used to examine the association of each variant with venous disease, stratified by ethnic group. A weighted genetic risk score, using the top 20% of variants and weighting by the beta coefficients, was generated for each ethnic group. Associations of this risk score with venous disease were examined stratified by ethnic group.

Results:
The mean ± standard deviation (SD) age was 60±11, with 64% female, and 62% White, 14% Hispanic, 11% African-American, and 12% Asian. The prevalence of moderate and severe venous disease was 41%, and severe venous disease alone was 25%. While some loci overlapped in the ethnic-specific genetic risk scores, others were exclusive to an ethnic group. In models adjusting for known venous disease risk factors, in Whites, Hispanics, African-Americans and Asians, respectively, each SD higher genetic risk score was associated with a 1.42-fold higher odds (95% CI (1.21, 1.66)), 2.06-fold higher odds (95% CI (1.44, 2.95)), a 2.25-fold higher odds (95% CI (1.38, 3.66)), and 2.45-fold higher odds (95% CI (1.57, 3.82)) for moderate or severe disease. The difference in c-statistics was statistically significant between the known venous risk factor model and this model adding the genetic risk factor for Hispanics, African-Americans, and Asians, with 0.67 vs. 0.75 (p=0.03), 0.69 vs. 0.77 (p=0.02), 0.63 vs. 0.74 (p=0.01), respectively. The difference was not significant for Whites, 0.64 vs. 0.66 (p=0.12). All results were similar for severe venous disease only.

Conclusions:
This ethnic-specific genetic risk score is strongly associated with chronic venous disease, and may be of greater importance for venous disease in those of non-European descent. Future work should focus on examining racial/ethnic group genetic architecture in relation to venous disease.
Abstract P247: Ethnic Differences in Infrarenal Aortic Diameter and Area in a Population-Based Study
Authors: Timaran David E , Rosero Eric B , Higuera Adriana J , Peshock Ron , Valentine R James , Timaran Carlos H
Published: July 2021

Objective:
Abdominal aortic aneurysms are defined as a 50% or greater increase in infrarenal aortic diameter (IAD). However, normal IAD has not been defined for all ethnic groups as minorities have been underrepresented in most studies. The aim of the study was to assess ethnic differences in IAD and infrarenal aortic area (AoA) adjusting for the effects of age, gender and body size in the general population.

Methods:
Participants (2,515) in a population based study underwent high-resolution magnetic resonance imaging (MRI) of the abdominal aorta. Analyses of variance and multiple regression analyses were used to assess the relationship between race/ethnicity, age, gender and body size and IAD and aortic area. Subjects with AAA detected by MRI (defined as IAD ≥ 3.0 cm) were excluded from the analysis.

Results:
Decreasing age, female sex, Hispanic ethnicity, and lower height were independent predictors of reduced IAD by multivariate linear regression (all
P
< 0.001). Of these, female sex and Hispanic ethnicity were the factors more strongly associated with aortic size. Female sex was associated with 0.27 cm reduction in IAD and Hispanic ethnicity with 0.39 cm reduction in IAD. Similarly, decreasing age, female sex, Hispanic ethnicity, and lower height were independent predictors of reduced AoA. Female sex was associated with a 51 cm
2
reduction in AoA and Hispanic ethnicity with 11.1 cm
2
reduction in AoA. Although Hispanics had higher BMI than blacks and whites (
P
=.01), and lower height values than blacks and whites (P<.0001), IADs and AoAs were consistently lower among Hispanics.

Conclusions:
Ethnic differences exist in infrarenal aortic diameter. Despite larger body size, Hispanics have significantly lower IAD than blacks and whites in the general population. The reduced aortic size in Hispanics suggests that the thresholds for abdominal aortic aneurysm diagnosis, rupture and repair may be lower and need to be established.
Abstract P248: Oxidized Phospholipids and Risk of Peripheral Arterial Disease in Men
Authors: Bertoia Monica L , Pai Jennifer K , Tsimikas Sotirios , Joosten Michel M , Mittleman Murray A , Rimm Eric B , Mukamal Kenneth J
Published: July 2021

Background:
Peripheral arterial disease (PAD) is highly prevalent, found in 25% of adults ≥70 years, but its risk factors are less well studied than coronary and carotid atherosclerosis. Proinflammatory oxidized phospholipids (OxPL) are a novel cardiovascular risk factor produced by oxidative stress and are preferentially bound and transported by lipoprotein (a) [Lp(a)] in plasma. Previous studies have shown an association between OxPL on apolipoprotein B-100 (OxPL/apoB) and carotid and femoral atherosclerosis. However, no previous studies have specifically examined the prospective association between OxPL/apoB and risk of PAD in a population-based cohort.

Methods:
We conducted a nested case-control study among men free of cardiovascular disease within the Health Professionals Follow-up Study (1994–2008) including 143 men with PAD and 429 controls matched on age, month of blood draw, and smoking. OxPL/apoB and Lp(a) were measured in stored baseline plasma. We identified cases of clinically significant PAD based on at least one of the following: (1) amputation, bypass, or other revascularization procedure for occlusive arterial disease, (2) angiogram/ultrasound confirming at least 50% stenosis of at least one artery with congruent symptoms in the ipsilateral limb, (3) ankle-brachial index < 0.9, or (4) physician's diagnosis. We used conditional logistic regression to estimate odds ratios (OR) for PAD according to level of OxPL/apoB.

Results:
The OR for PAD was 1.24 (95% CI 1.05–1.46) for each 1-standard deviation (SD) increase in OxPL/apoB after adjusting for matching factors. Additional adjustment for family history of MI, triglycerides, HDL-C, LDL-C, C-reactive protein, hemoglobin A1c, pack-years of smoking, physical activity, hypertension, diabetes, hypercholesterolemia, body-mass index, and aspirin use did not change this estimate: 1.24 (95% CI 1.00–1.54). OxPL/apoB was not correlated with any conventional risk factors: Spearman correlation coefficients ranged from 0.0 to 0.13. We observed no interaction with age or LDL-C. Similarly, the OR for PAD was 1.25 (95% CI 0.95–1.63) for each 1- SD increase in ln[Lp(a)] after adjusting for all of the above covariates.

Conclusion:
OxPL/apoB is positively associated with risk of PAD in men with no appreciable attenuation after adjustment for conventional risk factors.
Abstract P253: Impact of Hospital-Acquired Venous Thrombosis on Mortality in Medical Inpatients: The Medical Inpatients and Thrombosis (MITH) Study.
Authors: Mygatt Catherine R , Callas Peter W , Cushman Mary , Repp Allen B , Zakai Neil A
Published: July 2021

Introduction:
The Joint Commission mandates assessing risk and providing venous thrombosis (VT) prophylaxis in hospital inpatients. Pharmacologic VT prophylaxis reduces VT among medical inpatients, but the impact on survival is unknown. We studied the association of hospital acquired VT and VT prophylaxis with risk of inpatient mortality.

Methods:
We identified all cases of VT complicating medical admissions at a 500 bed teaching hospital in Burlington, Vermont from January 2002 to June 2009. VT cases were identified using ICD-9 codes, confirmed by medical record review, and frequency matched 1:2 to patients without VT by admission year and service (oncology, general medicine or cardiology). Death from VT was determined by medical record review and standardized criteria. We calculated odds ratios (OR) of death for hospital-acquired VT and VT prophylaxis using weighted multivariable logistic regression and 95% confidence intervals (CI) using the Taylor series method.

Results:
Of 64,334 admissions, 299 patients had hospital-acquired VT. 56 of these died from any cause and 24 died due to their VT. For every 1000 admissions, 87 ended in death and 4.6 had a hospital-acquired VT. Hospital-acquired VT was associated with increased odds of death, but this was attenuated by adjustment for other risk factors for death (
Table
). VT prophylaxis was inversely associated with odds of death when similarly adjusted (
Table
).

Conclusions:
One in 235 deaths in medical patients was attributable to hospital-acquired VT, a potentially preventable event. Occurrence of VT after admission in medical patients was associated with risk of death, but this was mediated by other patient characteristics. Findings suggest providing VT prophylaxis reduces risk of death in hospital, but this requires confirmation due to the low number of deaths in this study.

Table

Multivariable Model of Risk Factors for In-Hospital Mortality

Risk Factor
Unadjusted Odds Ratio (95% CI)

Adjusted Odds Ratio (95% CI)
*

VT occurring during admission
2.41 (1.54, 3.77)
1.21 (0.58, 2.53)

VT prophylaxis provided throughout admission
**

1.15 (0.51, 2.62)
0.48 (0.16, 1.45)

*

Model adjusted for the following (measured on admission unless indicated): sex, age, systolic blood pressure, diastolic blood pressure, heart rate, hypoxic or ventilated, pneumonia, metastatic cancer, history of myocardial infarction, dementia, use of full anticoagulation, VT prophylaxis stopped during admission, admitted or transferred to intensive care.

**

Reference group: no prophylaxis or anticoagulation during admission.
Abstract P271: Sedentary Behavior and Cardiovascular Disease Risk in a Middle-income Country: The Grenada Heart Project
Authors: Garg Vaani , Vedanthan Rajesh , Sartori Samantha , Woodward Mark , Bansilal Sameer , Iyengar Rupa , Charney Alexander , Graves Claire , Hunn Marilyn , Lewis Marcelle , Farkouh Michael , Fuster Valentin
Published: July 2021

Introduction:
Sedentary behavior (SB) has been associated with an increased risk of cardiovascular disease (CVD) in high-income countries. However, the burden and impact of SB in low- and middle-income countries is not well known. This study examined self-reported sedentary behavior and the association with CVD risk in Grenada, a middle-income country.

Methods:
A modified WHO STEPS survey was administered to a random sample of the Grenadian adult population, and sedentary behavior was assessed. Participants were asked to quantify the amount of time per day spent sitting (at home or work), reclining (excluding during sleep), or traveling in a vehicle. SB was assessed in hourly intervals and also grouped into two categories: 3 hours or less (approximately two thirds of the sample) and greater than 3 hours (approximately one third). Frequency of SB was compared across gender (age-standardized), age, and education groups. The relationship between SB and log-transformed 10-year CVD risk (Framingham) was evaluated using multivariable linear regression. Statistical analyses were performed using STATA v. 10.

Results:
Of 2622 participants, 32.4% reported greater than 3 hours per day of SB. SB was more common among men, among the youngest (age 18-29) and oldest (age 70+) individuals, and among those with higher education (
Table
). In univariate analysis, SB was adversely associated with 10-year CVD risk (p<0.05). However, after controlling for gender, age and education, SB was not significantly associated with 10-year CVD risk.

Conclusions:
Sedentary behavior in Grenada is more common among men, extremes of age, and higher education levels. Increased SB is not independently associated with 10-year CVD risk when controlling for gender, age and education. This is in contrast to findings in high-income countries. These results call for further exploration of the patterns of sedentary behavior, an emerging health issue in low- and middle-income countries, and its effect on CVD risk.

Table

Frequency of reported sedentary behavior (figures are %; all p-values within groups<0.05)

N
Greater than 3 hours per day

Gender

Men
1129

35.2
*

Women
1493

30.3
*

Age
(years
)

≤18-29
634
39.1

30-39
428
30.6

40-49
580
23.6

50-59
448
28.1

60-69
249
28.1

≥70
283
48.4

Education

No schooling to Primary
1532
29.0

Secondary School
639
34.7

Post Graduate
419
39.9

*

Age-standardized rates
Abstract P273: Influence of Fatigue and Depressive Symptoms on Physical Functioning 30-Days after Treatment for Stable Coronary Artery Disease
Authors: Fennessy Michelle M , DeVon Holli , Ryan Catherine , Zerwic Julie J
Published: July 2021

Fatigue and depressive symptoms are pervasive in patients with coronary heart disease. It is unknown how these symptoms impact physical functioning and secondary prevention efforts in patients with stable coronary artery disease (SCAD) who are treated with either percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) or OMT alone. The purpose of this study was to evaluate the influence of fatigue and depressive symptoms on physical functioning in patients with SCAD 30-days after treatment with PCI/OMT or OMT. In this prospective design, a convenience sample of SCAD patients (
n
=180, age M=65.1, SD=8.3) were recruited after treatment with PCI/OMT (
n
=90) or OMT (
n
=90). Data collection occurred at baseline (post-procedure) and 30-days after discharge. Mailed surveys were used at 30-days with a 52.8% (94/180) response rate (OMT
n
=46, PCI/OMT
n
=48). Measurements included the Profile of Mood States (POMS) for fatigue, Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, and Short Form-36 (SF-36) for physical functioning. Two linear regression models (see
table
) were conducted to evaluate physical functioning predictors at 30-days for patients treated with PCI/OMT and OMT. Fatigue was a significant contributor for physical functioning after treatment with PCI/OMT and OMT. For PCI/OMT, fatigue (
b
=-.434,
p
<.001) and age (
b
=-.245,
p
=.03, bivariate: r=-.414, p=.003) were significant predictors for physical functioning at 30-days. For OMT, fatigue (
b
=-.630,
p
=.03) and gender (
b
=.499,
p
<.01) were found to influence physical functioning after treatment, with men demonstrating lower functioning at 30-days (m=37.6, sd=9) compared to women (m=49.6, sd=9.1). Depressive symptoms did not influence physical functioning in treatment groups (PMI/OMT:
b
=-.239,
p
=.05; OMT:
b
=.019,
p
=.89). Persistent fatigue may deter patients from engaging in physical activity to promote secondary prevention. Further research is needed to investigate the impact of fatigue on physical functioning.

Predictors of Physical Functioning 30-Days After Treatment for Stable Coronary Artery Disease

PCI/OMT Predictors
Standardized Beta
t value
p value
95% CI (Lower Bound)
95% CI (Upper Bound)

Age
−.245
−.21
.03
−.495
−.017

Gender
.082
.82
.41
−.273
6.505

Ejection Fraction
.097
.85
.40
−.078
.191

POMS-Fatigue
−.434
−.38
<.01
−1.419
−.441

PHQ-9 Depressive Symptoms
−.239
−.20
.05
−1.673
−.002

OMT Predictors
Standardized Beta
t value
p value
95% CI (Lower Bound)
95% CI (Upper Bound)

Age
.268
1.96
.05
−.008
.606

Gender
.499
.42
<.01
6.470
18.401

Ejection Fraction
−.195
−1.31
.19
−.427
.090

POMS-Fatigue
−.630
−4.37
<.01
−2.319
−.852

PHQ-9 Depressive Symptoms
.019
.13
.890
−1.474
1.691

Abbreviations: CI, Confidence Interval. Model Information: PCI/OMT n=48, f=11.23, df=6, r2=.622,p<.01. OMT: n=46, f=6.91, df=6, r2=.516, p<.01
Abstract P285: Pattern of Atrial Fibrillation and Risk of Outcomes: The Loire Valley Atrial Fibrillation Project
Authors: Banerjee Amitava , Taillandier Sophie , Olesen Jonas B , Lane Deirdre A , Lallemand Benedicte , Lip Gregory Y , Fauchier Laurent
Published: July 2021

Background:
The risk of stroke and thromboembolism (TE) in patients with non-valvular atrial fibrillation (NVAF) can be classified in commonly-used stroke risk stratification scores. The role of the pattern of atrial fibrillation in risk prediction is unclear in contemporary ‘real world’ cohorts.

Methods:
Patients diagnosed with NVAF in a four-hospital-institution between 2000 and 2010 were identified and included. Event rates of stroke/TE were calculated according to pattern of AF, i.e. paroxysmal, persistent and permanent, defined by consensus guidelines. Independent risk factors of stroke/TE were investigated by Cox regression.

Results:
Among 7156 patients with NVAF, 4176 (58.4%) patients with paroxysmal, 376 (5.3%) with persistent and 2604 (36.3%) with permanent NVAF patterns were included. In non-anticoagulated patients, the overall stroke/TE event rate per 100 person-years was 1.29 (95% CI 1.13–1.47). Paroxysmal NVAF patients were more likely to be female (p<0.001). Persistent NVAF patients were less likely to have prior history of stroke (p–0.002) and vascular disease (p<0.001), and more likely to have hypertension (p<0.001) and vitamin K antagonist therapy (p<0.001). Permanent NVAF patients were more likely to have diabetes (p<0.001), heart failure therapy (p<0.001) and less likely to have dyslipidaemia (p<0.001). Compared with paroxysmal NVAF, rates of stroke/TE (p=0.001), bleeding (p<0.001) and all-cause mortality (p<0.001) were significantly higher in permanent NVAF patients but not in persistent NVAF patients. In multivariate analyses, only previous stroke (hazard ratio, HR 2.58, 95% CI 2.08–3.21), vascular disease (HR 1.34,1.12–1.61), heart failure (HR 1.20,1.00–1.44), age≥75 years (HR 2.75, 2.16–3.50) and age 65–74 years (HR 1.60,1.22–2.09) increased stroke/TE risk, but persistent (HR1.13, 0.76–1.70) and permanent (HR 1.44,0.96–2.16) patterns of NVAF did not.

Conclusion:
In this large ‘real world’ cohort of NVAF patients, there were significant differences in rates of stroke, TE, death and bleeding between patterns of NVAF, however only previous stroke, age, heart failure and vascular disease (not pattern of NVAF) independently increased the risk of stroke/TE, death and bleeding in multivariate analyses. Therefore, the risk of stroke is similar across all patterns of NVAF and antithrombotic therapy should be based on clinical risk factors not NVAF pattern.
Abstract P299: BMI and BP Predict Brachial Distensibility in Healthy Adolescents and Young Adults
Authors: Urbina Elaine M , Khoury Philip R , Martin Lisa J , Dolan Lawrence M
Published: July 2021

Introduction:
CV risk-factor (CVRF) related increase in arterial stiffness is associated with adverse CV events in adults. Cross-sectional studies in youth show a relationship between CVRF and arterial stiffness. Longitudinal data are lacking. Hypothesis: CVRFs will predict decreased brachial artery distensibility (BrachD).

Methods:
Demographics, anthropometrics, BP, fasting glucose, insulin, lipids and BrachD were measured in 425 healthy youth in a school-based longitudinal cohort (age 17.4 +2.1 yrs, 41% male, 61% Caucasian). Anthropometrics, BP and BrachD were repeated 2.1 + 0.3 years later. Mean values for baseline and follow-up variables were evaluated by paired t-test. Characteristics of subjects with decrease in BrachD (N=167) were compared by t-test with subjects without BrachD decrease. The multivariable model to determine predictors of follow-up BrachD contained baseline and change of age, sex, BMI, MAP, HR, baseline lipids, glucose and insulin.

Results:
Over 2 years, the cohort increased in HT, WT, BMI, SBP and BrachD (all p<0.02). Predictors of decrease in BrachD were greater baseline and change in BMI, MAP and HR (R
2
= 0.36, model p <0.0001, parameter p< 0.02, BrachD at follow-up = 2.7 + 0.04*Age at baseline + 0.4*Sex (male=1, female=2) − 0.02 Age at baseline*Sex − 0.33*BMI at baseline − 0.02*BMI change - 0.005*MAP at baseline - 0.004*MAP change - 0.002*HR at baseline - 0.003*HR change). BMI at baseline and change in BMI contributed the majority of the variance in BrachD at follow-up (16 and 4%). Subjects with decrease in BrachD were more likely to have gained more BMI (1.3 vs 0.6 kg/m
2
) or increased more in MAP (0.8 vs −1.3 mmHg) and HR (1.1 vs −2.0 beats/min, all p<0.002).

Conclusions:
Development of obesity with subsequent changes in BP and HR may lead to development of arterial dysfunction. Prevention of obesity may be the most important approach to improve the CV health of adolescents and young adults.
Abstract P301: Association of Toenail Cadmium Levels with Measures of Sub-Clinical Atherosclerosis: The Coronary Artery Risk Development in Young Adults (CARDIA) Trace Element Study
Authors: Xun Pengcheng , Liu Kiang , Morris Steve , Daviglus Martha , Loria Catherine , Jacobs David , Goff David , He Ka
Published: July 2021

Background:
Experimental studies have suggested that cadmium (Cd) exposure is a potential risk factor for early atherosclerosis and cardiovascular diseases as it can disrupt integrity of the endothelial cell layer. However, longitudinal data in humans relating Cd levels to sub-clinical atherosclerosis are lacking.

Methods:
2589 participants from the CARDIA Study, aged 20-32 years in 1987 (baseline) with up to 18 years of follow-up were included in the analyses to examine prospectively the associations of toenail Cd concentrations with carotid intima-media thickness (CIMT) and coronary artery calcium score (CAC score). Toenail clippings were collected in 1987 and Cd was assessed by instrumental neutron-activation analysis. Common (c), bulb (b), and internal (i) CIMTs were measured in 2005 and CAC score in 2000 and 2005. CAC presence (score, >0 Agatston units) and CAC progression (incident CAC in 2005 or increase in CAC score by ≥10 Agatston units) were defined based on CAC score. General linear regression or logistic regression was used as appropriate.

Results:
Median Cd levels were 0.003, 0.006, 0.012 and 0.039 μ g/g from 1
st
- 4
th
quartile. We observed a positive linear relation of Cd levels with cCIMT, but not bCIMT and iCIMT (

Table 1

). Null associations between Cd levels and CAC progression [Q
4
vs
. Q
1
: OR=1.11 (95% CI: 0.73, 1.68);
P
trend
=0.14] or presence of CAC [Q
4
vs
. Q
1
: OR=1.05 (0.73, 1.53);
P
trend
=0.56] were documented.

Conclusions:
In this young adult cohort, toenail Cd levels were positively associated with cCIMT, but not bCIMT, iCIMT and CAC score. Further studies are needed to determine whether there is an atherosclerotic mechanism linking Cd exposure to the risk of cardiovascular disease.

Table 1

Multivariable-adjusted carotid intima-media thickness (mm) by toenail cadmium levels

No. of participants
Quartile of toenail cadmium levels

P
trend

Q1
Q2
Q3
Q4

cCIMT
2587
0.781 (0.773-0.790)
0.784 (0.776-0.793)
0.789 (0.781-0.798)
0.791 (0.781-0.798)
0.03

bCIMT
2527
1.010 (0.990-0.1.031)
1.002 (0.982-1.022)
0.981 (0.962-1.001)
1.001 (0.980-1.022)
0.17

iCIMT
2436
0.787 (0.772-0.802)
0.790 (0.776-0.804)
0.784 (0.770-0.798)
0.778 (0.763-0.793)
0.86

Data are geometric means (95%CIs) adjusted for age, gender, race, study center, body mass index, physical activity, education, smoking status, alcohol consumption, systolic blood pressure, LDL/HDL, HOMA, body mass index, long-chain omega-3 polyunsaturated fatty acids intake with toenail zinc, chromium, lead and mass weight.
cCIMT
: common carotid intima-media thickness;
bCIMT
: bulb carotid intima-media thickness;
iCIMT
: internal carotid intima-media thickness.
Abstract P304: Fatty liver disease is Associated with Aortic Valve Sclerosis in the General Population
Authors: Lieb Wolfgang , Markus Marcello R , Baumeister Sebastian E , Wallaschofski Henri , Dörr Marcus , Völzke Henry
Published: July 2021

Background:
Fatty liver disease has been linked to increased cardiovascular risk and mortality, but the precise mechanisms are incompletely understood. We aimed to assess whether fatty liver disease is associated with aortic valve sclerosis in the community.

Methods:
Cross-sectional data (1,150 men and 1,087 women, aged 45–81 years) from the population-based Study of Health in Pomerania (SHIP), in northeast Germany, were analyzed. Fatty liver disease was defined as a hyperechogenic ultrasound pattern of the liver in conjunction with increased serum alanine aminotransferase levels. Aortic valve sclerosis was determined by echocardiography and defined as an abnormal irregular thickening and a focal or diffuse increase of the echogenicity of the leaflets.

Results:
The prevalences of fatty liver disease and aortic valve sclerosis were 15.6% and 32.5%, respectively. Among participants with fatty liver disease, aortic valve sclerosis was much more common than in indivivuals without fatty liver disease (prevalence aortic valve sclerosis 38.3% vs. 29.2%; p=0.001). Upon adjustment for confounding factors (including age, sex, waist circumference, alcohol consumption, physical activity, systolic blood pressure, antihypertensive medication, total/HDL cholesterol ratio, lipid-lowering medication, HBA1c, anti-diabetic medication, and estimated glomerular filtration rate), individuals with fatty liver disease had 38% higher odds ratio of presenting with aortic valve sclerosis as compared to those without fatty liver disease (95% confidence interval, OR 1.02 to 1.88).

Conclusions:
Our findings are consistent with the hypothesis that fatty liver disease is associated with aortic valve sclerosis, independently of classic cardiovascular risk factors. Metabolic changes secondary to fatty liver disease may have a pro-atherogenic effect promoting the development of the aortic valve calcification and sclerosis.
Abstract P311: Effect of Non-Invasive Imaging on Cardiovascular Risk Factors and Downstream Testing: A Meta-Analysis of Randomized Controlled Trials
Authors: Whelton Seamus P , Nasir Khurram , Blaha Michael J , Berman Daniel S , Blumenthal Roger S
Published: July 2021

Introduction:
Non-invasive cardiovascular imaging has been proposed as a method to improve risk stratification and motivate improved patient and physician risk factor modification. Despite increasing use of these technologies there remains limited evidence documenting its effect on downstream testing and improvement in risk factor control.

Hypothesis:
Addition of the EISNER study to a prior meta-analysis will improve statistical power to demonstrate the downstream consequences of non-invasive cardiovascular imaging.

Methods:
A comprehensive literature search of the MEDLINE database (1966 through July 2011) was conducted. Major inclusion criteria required: 1) randomized controlled trial design, 2) participants with no known history of coronary heart disease or stroke, and 3) comparison of a group provided with results of a non-invasive imaging scan versus those without results. A total of eight trials with 4,084 participants met the inclusion criteria for this analysis. We analyzed the data using a random effects model to allow for heterogeneity.

Results:
Among imaging groups there was a significant increase in prescribing for statins (RR, 1.15; 95% CI, 1.01–1.32) and a non-significant trend for increased prescription of aspirin (RR, 1.15; 95% CI, 0.97–1.35), ACE/ARB (RR, 1.12; 95% CI, 0.96–1.31), and insulin (RR, 1.54; 95% CI, 0.75–3.18). There was a non-significant trend towards increased smoking cessation (RR, 1.35; 95% CI, 0.88–2.08). For downstream outcomes there was a non-significant increase in coronary angiography (RR, 1.20; 95% CI, 0.92–1.57), but not for revascularization (RR, 0.92; 95% CI, 0.55–1.53). There was no significant effect of imaging on the change in traditional risk factors.

Limitations:
There remains a limited number of trials in this important area. Therefore, trials included in this analysis use a variety of different imaging modalities and we were not able to pool the results based on appropriate clinical action (intensification at high risk and reduction at low risk).

Conclusions:
Non-invasive cardiovascular imaging leads to increased statin use, but associations with other downstream treatments and change in risk factors are not statistically significant. Our results highlight the limited amount of data for describing the downstream consequences after CAC testing.
Abstract P312: San Diego County Medical Leaders Collaborate to Achieve Leading-Edge Heart Attack and Stroke Prevention Goals
Authors: Dudl Robert J , Ivey Susan L , Dunford James , Mangione Carol M , Fremont Allen M , DeMaria Anthony
Published: July 2021

The Right Care Initiative (RCI) is a California-wide, public-private coalition formed in 2007 to improve healthcare quality and outcomes. One RCI focus is cardiovascular disease (CVD) due to its high prevalence and evidence of specific healthcare improvement strategies. San Diego County, with its small set of large medical groups, was selected as a pilot project site. RCI leaders in San Diego hypothesized that outcome-focused meetings promoting the sharing of CVD prevention efforts among medical group leaders could lead to community-wide collaboration behind measurable action steps to achieve target goals. The high impact potential of the project attracted participation from the majority of San Diego medical groups. Two promising strategies were identified: (1) the delivery of bundled medication therapy consisting of aspirin, an angiotensin-converting enzyme (ACE) inhibitor, and a lipid-lowering medication for all CVD patients and patients > age 55 with diabetes, and (2) the use of pharmacists on care teams to assist with medication management. In addition, collaboration with the American Heart Association, Centers for Disease Control and Prevention, San Diego County Health and Human Services Agency and private citizens leverages existing heart-healthy lifestyle and screening programs. The participants also developed and plan to launch a local media outreach campaign to activate heart-healthy behavior adoption among San Diegans. To build team unity in the pilot project, San Diego medical group and community health leaders conducted monthly “University of Best Practices” conferences. At these non-competitive medical and academic meetings, presenters shared the successful quality improvement strategies of “high-performing” groups and participants experienced the benefits of working together. After several meetings, participants set a goal of reducing heart attacks and strokes in San Diego County by 50% within five years. Their “stretch goal” is to make the San Diego region the first “heart attack and stroke free zone.” The next step will be to track progress by routinely sharing group-specific data and action plans.

Conclusions:
Medical groups who normally compete in the clinical care arena found they could collaborate toward a common goal, as shown by agreement on action steps. The opportunity to regularly convene medical group leaders in San Diego proved critical to establishing necessary trust. This community-based approach is intended to catalyze the uptake of promising, evidence-based practices and improve care for San Diego’s high risk cardiovascular and diabetes patients. The recently announced national “Million Hearts” campaign synergizes closely with this pilot project’s focus on community-wide heart attack and stroke prevention.
Abstract P319: Improvement in Depressive Symptoms in Elderly Cardiac Patients after Cardiac Rehabilitation
Authors: Reddy Bharathi , Lee Kiseok , Rullo Nancy , Cheslik Candy Donna , Nicholson John P
Published: July 2021

BACKGROUND:
Depression effects at least 18% of patients with known coronary artery disease (CAD) and is associated with an increased risk of future cardiac events. There is a strong association between depression and cardiac mortality in patients with known heart disease and these symptoms are very common in patients with acute coronary syndrome (ACS). With the significant prevalence of depression in cardiac patients studies have shown that comprehensive cardiac rehabilitation (CR) programs resulted in beneficial effects on clinical symptomatology and clinical depression in these patients.

HYPOTHESIS:
The purpose of this study was to assess the improvement of depressive symptoms using PHQ-9 mood scale among younger patients (≤ 55 years of age) and older patients (≥ 70 years of age) enrolled in the CR program at the Cardiac Health Center (CHC) of New York Hospital Queens (NYHQ).

METHODS:
The study sample comprised of 237 participants who were enrolled and completed 36 sessions of CR at the CHC from 2007-2009. Depressive symptoms were assessed using the PHQ-9 prior to admission and upon completion of the CR program. Patients were categorized into two groups in relation to their age as younger patients (≤ 55 years of age) and older patients (≥70 years of age).

RESULTS:
Out of 237 patients, 91 patients are ≤55 years of age (38.4%), and 51 patients are ≥ 70 years of age (21.5%). Prior to the start of CR the mood scores of younger patients were 10.11 ± 6.33 and the older patients were 9.00 ± 3.34. After the completion of CR the mood scores of younger patients were 6.11 ± 7.18 and the older patients were 2.94 ± 3.99. Both groups showed significant improvement in their mood scores after CR. Younger patients Δ 4.00 ± 2.16 and elder patients Δ 6.06 ± 1.15.

CONCLUSIONS:
The results of the study confirm that CR improves depressive symptoms in both younger and older patients groups. Although both groups started with comparable mood scores, older patients showed significant improvement in mood scores compared to younger patients. Studies have shown improvement in exercise capacity in the elderly population after CR. Elderly patients need to be encouraged to participate in CR programs as improvements in depressive symptoms along with functional capacity after CR translate into a more productive and satisfying lifestyle and improved quality of life.