bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P269: Predictive Value of Midregional Proadrenomedullin Compared to Natriuretic Peptides for Major Adverse Cardiovascular Events in the Population-Based FINRISK 1997 Cohort
Authors: Funke-Kaiser Anne , Havulinna Aki S , Zeller Tanja , Appelbaum Sebastian , Jousilahti Pekka , Blankenberg Stefan , Sydow Karsten , Salomaa Veikko
Published: July 2021

Background and aims:
Biomarkers reflecting vascular function and neurohumoral activity may predict cardiovascular disease (CVD). Midregional proadrenomedullin (MR-proADM) is increased in myocardial infarction and correlates with the severity of heart failure (HF).The aim of the present study was to examine the predictive ability of MR-proADM for incident CVD events in a prospective, population-based setting for the first time and to compare the findings on MR-proADM with those of natriuretic peptides.

Methods:
MR-proADM, B-type natriuretic peptide (BNP), N-terminal pro-BNP (NT-proBNP) and midregional proatrial natriuretic peptide (MR-proANP) were measured from stored samples of the FINRISK 1997 cohort. After excluding individuals with a history of major adverse cardiovascular event (MACE) and pregnant women at baseline, 7,899 individuals were included. The follow-up was until Dec. 31
st
, 2010. We used Cox proportional hazards regression to estimate hazard ratios (HR) per one standard deviation increase in each biomarker and for each type of MACE, adjusting for standard CVD risk factors. Measures of discrimination and reclassification were calculated using ten-fold cross-validation.

Results:
During follow-up 1,074 incident MACE (529 coronary heart disease (CHD) events, 299 ischemic strokes, 505 cases of HF) occured.

Adjusted HRs (and 95% confidence intervals) of outcomes for each biomarker are shown in the table.

Adding MR-proADM improved discrimination and reclassification for HF (C-index improved from 0.822 to 0.840, NRI was 12.1%, IDI was also significant, all p<0.001), but not for CHD events or stroke.

Conclusions:
In the general population of the FINRISK 1997 cohort, MR-proADM had no additional predictive effect for CHD events or stroke beyond natriuretic peptides. However, MR-proADM proved to be strongly predictive for incident HF and improved discrimination and reclassification similarly to NT-proBNP while being more specific.
Abstract P270: Associations of Lipoprotein-associated Phospholipase A
2
Mass and Activity with Coronary Artery Calcium: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Jenny Nancy S , McClelland Robyn , Jorgensen Neal , Garg Parveen , Burke Gregory , Criqui Michael , Greenland Philip , Rosenson Robert , Siscovick David , Cushman Mary
Published: July 2021

Background:
Lipoprotein-associated phospholipase A
2
(Lp-PLA
2
) is an inflammatory enzyme localized in atherosclerotic lesions. However, associations of Lp-PLA
2
with coronary artery calcium (CAC), used as a marker of lesion progression, have not been extensively studied and may vary by sex and type of Lp-PLA
2
assay.

Methods:
We examined these associations in 5486 White, Black, Chinese and Hispanic men and women in the Multi-Ethnic Study of Atherosclerosis (MESA). At baseline, mean age was 62 years; all were free of clinical cardiovascular disease. CAC, by cardiac computed tomography, was assessed at baseline (2000-02) and follow-up; half the cohort at exam 2 (2002-04), the remainder at exam 3 (2004-05). 2758 had CAC (Agatston score>0) at baseline; of those with no baseline CAC, 372 (13.6%) had incident CAC (CAC>0) at follow-up. Lp-PLA
2
mass and activity were measured by immunoassay and enzymatic assay, respectively. Longitudinal models were adjusted for age, sex, ethnicity, smoking, diabetes, obesity, total and HDL cholesterol, blood pressure, hypertension, lipid-lowering medications and time between CAC measures.

Results:
Each standard deviation (SD 36.5 nmol/min/ml) increase in Lp-PLA
2
activity was associated with CAC presence (prevalence ratio 1.03; p=0.01) in the whole group at baseline and incidence in those with no CAC at baseline (odds ratio 1.17; p=0.02). Activity was not associated with CAC progression (increase in Agatston score over time) in the whole group (β=1.32; p>0.4). Lp-PLA
2
mass was not associated with CAC presence or incidence (SD 45.6 ng/ml; associations p>0.2). The only association that differed significantly by sex was that for mass and progression (p interaction 0.01). Mass was associated with CAC progression in women (β=4.99; p=0.004) but not men (β=-0.20; p>0.9).

Conclusions:
In this multi-ethnic cohort, associations of Lp-PLA
2
with CAC varied by sex and Lp-PLA
2
assay type. Lp-PLA
2
activity was associated with CAC presence and incidence, but not progression. Mass was associated with CAC progression in women only. Additional research is needed to support the clinical utility of Lp-PLA
2
in monitoring atherosclerosis progression.
Abstract P277: Circulating Plasma Dairy Fatty Acid Biomarkers and Incident Stroke in Two US Prospective Cohort Studies
Authors: Yakoob Mohammad Y , Shi Peilin , Hu Frank B , Campos Hannia , Rexrode Kathryn , Mozaffarian Dariush
Published: July 2021

Background:
Prior observational studies suggest that self-reported consumption of dairy foods is associated with lower risk of stroke. Few studies have used circulating biomarkers that provide objective measure of dairy consumption.

AIM:
To test the hypothesis that plasma fatty acid biomarkers of dairy, 15:0, 17:0 and 16:1 n-7t, are associated with lower risk of incident stroke, especially ischemic stroke.

Methods:
We performed nested case-control studies in two prospective cohorts, the Nurses Health Study (NHS) and Health Professionals Follow Up Study (HPFS). Blood collected in 1989-90 (NHS) and 1993-94 (HPFS) was used to measure plasma 15:0, 17:0 and 16:1 n-7t biomarkers that are not endogenously synthesized. Stroke was prospectively adjudicated using medical records through 2004. A total of 597 stroke cases (NHS:475, HPFS:122), including 454 ischemic, 122 hemorrhagic and 21 unknown type, were matched 1:1 with controls on age, race, smoking, blood collection date and follow-up time (risk set sampling). Conditional logistic regression was used and cohort findings pooled by fixed-effects meta-analysis.

Results:
15:0 was correlated with self-reported intakes of whole fat dairy foods (r=0.18 in NHS, r=0.18 in HPFS), low fat dairy (r=0.13, 0.11) and dairy fat (r=0.20, 0.30). 17:0 and 16:1 n-7t were less strongly correlated. After confounder adjustment, comparing the top vs. bottom quartiles, 15:0, 17:0 and 16:1 n-7t were not significantly associated with total or ischemic stroke in either cohort or overall (
Table 1
). Results were similar after simultaneous adjustment for the 3 dairy fat biomarkers and for potential mediators.

Conclusion:
In these 2 cohorts, circulating dairy fat biomarkers were not significantly associated with stroke. Possible explanations include no true association, insufficient statistical power or measurement error due to changes in exposure over time. This study emphasizes need for further research on dairy and stroke using objective biomarkers, including studies with serial measures.
Abstract P278: Association of Hemoglobin A1C with Cardiovascular Disease and All-Cause Mortality in Individuals without Diabetes - The Multi-Ethnic Study of Atherosclerosis
Authors: Azeem Amir , Yeboah Joseph , Bertoni Alain , Burke Gregory , Turkbey Evrim , Szklo Moyses , Herrington David
Published: July 2021

Background:
Previous research suggests that hemoglobin A1C (HbA1C) is a cardiovascular risk marker. Currently, ACCF/AHA recommends HbA1c for cardiovascular risk assessment in adults without diabetes. However, the predictive ability of HbA1C, especially in different ethnic groups, remains unclear. We examined the hypothesis that HbA1c predicts cardiovascular disease (CVD), coronary heart diseae (CHD), and all-cause mortality in a multi-ethnic population free of diabetes and CVD, and assessed whether this association varies by race/ethnicity, in Multi-Ethnic Study of Atherosclerosis (MESA).

Methods:
During a median follow-up of 5.9 years (maximum: 7.1), 178 had an adjudicated CHD event defined as MI, definite angina, probable angina if followed by PTCI/CABG, resuscitated cardiac arrest and CHD death; 244 had CVD events defined as CHD, stroke, stroke death or CVD death; and 228 died. Cox regression was used to estimate the association of 1% increases in HbA1c with CVD/CHD/all-cause mortality after adjusting for age, gender, race/ethnicity, total household income, systolic blood pressure, hypertensive medications, total and HDL cholesterol, triglycerides, BMI, and smoking. Receiver Operating Curve analysis and Net Reclassification Improvement were used to examine the predictive value of HbA1C for cardiovascular risk assessment. Similar models were used to evaluate these associations stratified by ethnicity.

Results:
Among 5069 participants, 53% were women, 43% Caucasian, 25% African American, 20% Hispanic, and 11.6% Chinese. Mean age was 63 years and HbA1c was 5.4%. Hemoglobin A1C increased the hazards for CVD and CHD by 32% and 45%, respectively, although the 95% CI overlapped the null slightly [HR (95%CI): 1.32 (0.92-1.89), 1.45 (0.95-2.21)]. Interaction between ethnicity and HbA1c was significant (p<0.001). In stratified analysis, HbA1C was independently associated with CVD only in Caucasians [2.09 (1.25-3.49)] but not in other ethnicities [African Americans: 0.67 (0.35-1.26), Hispanics: 0.89 (0.37-2.14), Chinese: 0.95 (0.17-5.42)]. Overall, addition of HbA1C to Framingham Risk Score did not improve area under the curve for incident CVD (0.703 vs. 0.703; p= 0.18) or net reclassification index (-0.020). However, in Caucasians, the addition of HbA1C to the Framingham Risk Score significantly improved both the area under the curve (0.700 vs. 0.715; p<0.001) and net reclassification index (0.089) for incident CVD. Similar results were obtained for CHD.

Conclusion:
Associations between HbA1c and CHD/CVD observed in predominately Caucasian populations (and confirmed in this study) may not extend to other ethnicities. More data are needed on ethnic-specific variations in the relationship between glucose homeostasis and cardiovascular disease.
Abstract P289: Cesarean Section is Associated with Increased Risk for Overweight and Obesity in Grade Six Children
Authors: Wang Liang , Alamian Arsham , Southerland Jodi , Anderson James , Wang Kesheng , Stevens Marc
Published: July 2021

Introduction—
Few studies have investigated the relationship between delivery mode in the U.S. and the risk of overweight and obesity in the offspring. The findings from these studies have not been consistent.

Hypothesis—
We assessed the hypothesis that children born by cesarean section (C-section) compared with those born vaginally were at an increased risk of overweight and obesity in grade six.

Methods—
Data were obtained from Phase I to Phase IV of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Subjects with complete data through stage 3 (from year 1991 to 2005), when the children were in grade six, were included in this study (n=917). Multiple logistic regression was used to adjust for potential confounding by the maternal factors of age, education, poverty status, living status, depression, breastfeeding, and smoking status during pregnancy and the child factors of sex, race, birth weight, physical activity, total TV time, and video/computer game time. The association between C-section and childhood overweight and obesity was evaluated.

Results—
In grade six, 41.4% (77 of 186) of children delivered by C-section were overweight compared with 32.2% (235 of 731) of children born vaginally while 24.7% (46 of 186) of children delivered by C-section were obese compared with 17.0% (124 of 731) of children born vaginally (both p<0.05). After adjustment for potential confounders, children delivered by C-section compared to vaginal delivery had about twice the risk of being overweight (OR=1.85, 95% CI=1.26-2.71) or obese ((OR=1.87, 95% CI=1.19-2.94). However, after examining the association separately by sex, males delivered by C-section had an increased risk only for being obese (OR=2.56, 95% CI=1.35-4.85) while females delivered by C-section had an increased risk only for being overweight (OR=1.99, 95% CI=1.16-3.40). It was also found that lower maternal education and higher child birth weight were both associated with increased risk of overweight and obesity in sixth grade children.

Conclusions—
In conclusion, C-section was associated with an increased risk of overweight and obesity in children in grade six, and the relationship varied by sex. Additional longitudinal studies are warranted to examine the long-term effects of delivery mode on the risk of childhood overweight and obesity.
Abstract P297: Reduced Fat Mass and Improved Insulin Sensitivity in Overweight Black Women after Completion of 6-month Worksite Weight Loss Program
Authors: Leon Benjamin M , Miller Bernard V , Zalos Gloria , Chen Kong Y , Sumner Anne E , Cannon Richard O
Published: July 2021

Background:
As the epidemic of obesity in the United States steadily worsens, black women are disproportionately affected. Diminished insulin sensitivity has been linked with obesity and heightened risk of subsequent type 2 diabetes (T2D) and cardiovascular disease (CVD).

Hypothesis:
We propose that a decrease in fat mass achievable by weight loss intervention at the worksite improves insulin sensitivity in overweight black women.

Methods:
Fifty-four overweight black women [age 45±10 years (mean±SD), BMI range 25.9 to 54.7 kg/m
2
] completed a 6-month program that included web-based nutrition information and/or dietitian counseling and access to exercise rooms near their work areas. All participants were advised to reduce daily caloric intake by 500 kcal and instructed to increase daily activity by 5,000 steps, measured by pedometer, above baseline readings. The following measurements were performed: weight, total fat mass by dual-energy X-ray absorptiometry, and insulin sensitivity index (S
I
) calculated from the minimal model. Repeat of all measurements was performed at 6 months.

Results:
Baseline S
I
(median 3.0 liter/mU
-1
•min
-1
, range 0.74 to 7.58 liter/mU
-1
•min
-1
, with lower values signifying insulin resistance) was negatively associated with fat mass (r= -0.584, P<0.001) independent of age. Significant reductions in weight (92.6±18.1 to 91.1±18.9 kg, P<0.01) and fat mass (40.8±12.4 to 39.4±12.6 kg, P<0.01) were determined for subjects completing the program. Reduction in fat mass following completion of the program was associated with an increase in S
I
(r= -0.293, P=0.032). When analyzed by tertiles of fat mass change (Figure), compared to the tertile with net fat mass gain (far left bar), the two tertiles with net fat mass loss had significantly improved insulin sensitivity (higher S
I
).

Conclusions:
Even modest fat mass reduction in overweight non-diabetic black women with a combination of diet and exercise can improve insulin sensitivity, which has the potential to reduce or delay the onset of T2D and CVD.
Abstract P321: Is Amyloid Deposition in the Brain of Non-demented Older Adults a Consequence of High Blood Pressure and Arterial Stiffness?
Authors: Hughes Timothy M , Kuller Lewis H , Barinas-Mitchell Emma J , Mackey Rachel H , McDade Eric M , Klunk William E , Mathis Chester A , DeKosky Steven T , Lopez Oscar L
Published: July 2021

Background:
Advances in positron emission tomography imaging using amyloid specific ligands (e.g. PiB-PET) provide
in vivo
measurement of amyloid deposition in the brain, a hallmark of Alzheimer’s disease (AD) and dementia. Hypertension is believed to promote AD through arterial stiffening and cerebrovascular disease. We hypothesize that vascular measures are associated with amyloid in the brain.

Methods:
We studied 92 participants aged 83-96 in a follow-up of the Gingko Evaluation of Memory (GEM) Study with measures of: structural MRI of the brain; PiB-PET of brain amyloid deposition; resting blood pressure (BP), ankle brachial index (ABI) and mean arterial pressure (MAP); and vascular stiffness in the central (carotid-femoral (
cf
PWV) and heart femoral (
hf
PWV), peripheral (femoral-ankle (
fa
PWV), and mixed (brachial-ankle (
ba
PWV)) vascular beds, using a noninvasive and automated waveform analyzer (Colin Co., Komaki, Japan). Before study entry, all participants underwent ApoE-4 genotyping, detailed neuropsychological battery and adjudication of cognition by committee. Participants with a diagnosis of dementia were excluded from the sub-study.

Results:
Half (44/92) non-demented older adults in this sub-study were PiB+ for amyloid deposition in the brain. Amyloid deposition was associated with
ba
PWV, systolic BP and MAP. After adjustment for covariates, one standard deviation increase in
ba
PWV resulted in a 2-fold increase in the odds of being PiB+. ApoE-4 status was not associated with PWV. Additionally, high white matter disease burden, but not total gray matter volume, was associated with increased
cf
PWV (p<0.01),
hf
PWV (p=0.03), SBP (p=0.05) and MAP (p=0.06).

Conclusions:
The adverse effects of hypertension and vascular stiffness on cerebral small vessel disease is one of the most important hypotheses as to the determinants of amyloid deposition and AD. This is the first report of a possible association between vascular stiffness, BP and
in vivo
amyloid deposition in non-demented individuals.
Abstract P354: Reported Prevalence of High Blood Pressure and Cholesterol among US Adults - Behavioral Risk Factor Surveillance System, 2011
Authors: Loustalot Fleetwood , Fang Jing
Published: July 2021

Background:
High blood pressure and cholesterol are leading risk factors for cardiovascular disease (CVD). The Behavioral Risk Factor Surveillance System (BRFSS) is currently the only system that can provide state-level estimates of high blood pressure and cholesterol, and states frequently use the BRFSS when monitoring CVD risk factors. Several methodological changes to the BRFSS were instituted in 2011, to account for rising rates of cellular phone only households and declining response rates. The improvements may result in shifts to state-level estimates, and comparisons with previous years may represent methodological changes, rather than risk factor improvement or worsening. New baseline data are needed and this study uses the most recent data to report high blood pressure and cholesterol estimates among US states.

Methods:
The BRFSS is a state-based, random-digit-dialed telephone survey of non-institutionalized US adults aged ≥18 years. High blood pressure and cholesterol are assessed in odd years, using: “Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure [¼your high blood cholesterol is high]?” Data were analyzed by age, sex, race/ethnicity, education, and state. All estimates were age standardized using the 2000 US standard projected population. Analyses were conducted using SAS-callable SUDAAN to account for the complex sampling design. Within group differences were assessed using pairwise comparisons. The analytic sample was 498,201.

Results:
Overall, 30.3% (95% Confidence Interval: 30.0-30.5%) reported high blood pressure and 34.0% (33.7-34.3%) high cholesterol. Compared with other demographic groups, higher estimates of high blood pressure were reported among males, those with < a high school education, non-Hispanic blacks, and those ≥65 years. In parallel, high cholesterol was most commonly reported among males, those with < a high school education, and those ≥65 years, with non-Hispanic blacks reporting the lowest prevalence, compared with other demographic groups. By state, reported high blood pressure ranged from 24.7% (Colorado) to 38.3% (Mississippi) and high cholesterol from 28.0% (Montana) to 37.8% (Texas).

Conclusions:
In 2011, about 1 in 3 US adults reported high blood pressure and high cholesterol. Marked demographic and geographic disparities were found. Coordinated community and clinical interventions are needed to address the high burden of high blood pressure and cholesterol. For example, the Million Hearts
TM
initiative, a public-private partnership, seeks to align, coordinate, and enhance activities across the US, with prevention and treatment of high blood pressure and cholesterol being key components of the initiative.
Abstract P385: Arterial Stiffness and Contralateral Differences in Ankle Blood Pressure: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Tanaka Hirofumi , Gouskova Natalia , Meyer Michelle L , Ring Kimberley , Nambi Vijay , Heiss Gerardo
Published: July 2021

Background:
A large inter-arm difference in brachial systolic blood pressure (SBP) (>10 or 15 mmHg) is strongly associated with elevated cardiovascular mortality. It is currently not known whether such contralateral differences in SBP occur in ankle blood pressure. Although contralateral differences in SBP have been attributed to peripheral vascular disease, physiologic factors such as arterial stiffness could also be at play. Accordingly, the aims of this study were to assess the prevalence of brachial and ankle contralateral SBP differences in a sample of community dwelling older adults, and to determine whether this difference is associated with arterial stiffness.

Methods:
A total of 2,413 adults (39% male, mean age of 75 years) from the ARIC study with proper consent and non-missing outcomes were included, after excluding 968 subjects with arrhythmias (N=763), BMI >40 kg/m
2
(N=165), and missing covariates (N=40). The automatic vascular screening device was used to measure blood pressure simultaneously in the arms and ankles and to measure arterial stiffness by pulse wave velocity (PWV). PWV was assessed between the heart and ankle (haPWV), femoral artery and ankle (faPWV), and brachial artery and ankle (baPWV) in the right and left sides. The measurements were performed twice, and the results of the 2 readings were averaged. Multivariable logistic regression was used to examine characteristics associated with contralateral differences ≥15 mmHg in brachial and ≥12 mmHg in ankle SBP.

Results:
The mean±SD absolute contralateral differences in brachial and ankle SBP were 0.25±4.95 and 0.17±10.12 mmHg. Prevalences of inter-brachial SBP differences >10 and >15 mmHg were 6.4% and 0.9% respectively; the corresponding prevalences for inter-ankle SBP were 25.6% and 11.7%. Height, body weight, ankle brachial index (ABI), and level of SBP were associated with larger inter-brachial SBP differences. Age, body weight, ABI, and contralateral differences in haPWV, faPWV, and baPWV were related to inter-ankle SBP differences. Inter-ankle SBP differences were associated with contralateral differences of ≥100 cm/s in haPWV (OR=2.9 [95% CI=1.9-4.4]), ≥200 cm/sec in faPWV (OR=2.1 [95% CI=1.3-3.3]), and ≥250 cm/sec in baPWV (OR=2.8 [95% CI= 1.9-4.0]). The associations remained nominally significant after adjustment for age, gender, height, body weight, current smoking, SBP, and ABI.

Conclusions:
Inter-ankle differences in SBP of 10 mmHg or greater and 15 mmHg or greater are common in older adults, namely 25% and 12%, respectively. The magnitude of inter-ankle, but not inter-brachial, differences in SBP in older adults is associated with measures of local/regional vascular elasticity.
Abstract P402: Serum Magnesium and the Risk of Ischemic Stroke among Women
Authors: Akarolo-Anthony Sally N , Jimenez Monik C , Chivue Stephanie E , Willett Walter C , Rexrode Kathryn M
Published: July 2021

Background:
Low magnesium levels may be associated with higher blood pressure as well as endothelial dysfunction. Results from studies examining the association between serum magnesium and risk of stroke are inconsistent, with some studies suggesting a protective association with higher levels.

Methods:
Among 32,826 participants in the Nurses’ Health Study who provided blood samples in 1989-1990, ischemic strokes were identified and confirmed by medical records through 2006. We conducted a nested case-control analysis of 460 cases, matched to controls (1:1) on age, menopausal status, use of postmenopausal hormones, ancestry, date of blood draw, fasting status and smoking status. Magnesium quintiles were created based on the distribution of serum magnesium levels among controls, and a dichotomous variable was also created, based on prior data: low magnesium (<2.0 mg/dL) and high magnesium (≥ 2.0 mg/dL). Conditional logistic regression models were used to estimate the multivariable adjusted association of serum magnesium and the risk of ischemic stroke and unconditional analyses were used to assess effect modification.

Results:
In univariate analysis, median magnesium levels did not differ between stroke cases and controls (median=2.1 in each, p-value=0.16). Conditional on matching factors, women in the lowest magnesium quintile had a relative risk (RR) of 1.34 (95% confidence interval [CI]: 0.85-2.09) for ischemic stroke, compared to those in the highest quintile. Additional adjustment for potential confounders (alcohol intake, body mass index [BMI], physical activity, aspirin use, thiazide diuretic use, history of diabetes, history of coronary heart disease, glycosylated hemoglobin and the ratio of total to HDL-cholesterol) did not substantially alter the risk estimates (RR=1.34; 95% CI: 0.82-2.17). However, women with magnesium levels <2.0mg/dL had a significant increase in the risk of ischemic stroke, compared to women with magnesium levels ≥2.0 (RR= 1.66; 95% CI: 1.18 - 2.34. Controlling for potential confounders (as above) did not significantly alter this risk (RR= 1.63; 95% CI: 1.13 - 2.36). No significant effect modification was observed by age, BMI, hypertension or diabetes.

Conclusions:
Serum magnesium levels <2.0 are associated with increased risk of ischemic stroke among this population of women.
Abstract P408: Intake of Fish and Omega-3 Fatty Acids in the United States: Results of an Analysis of NHANES 2007-2010
Authors: Fulgoni Victor L
Published: July 2021

The American Heart Association’s Strategic Impact Goal Through 2020 and Beyond recommends ≥ two 3.5-oz fish servings per week (preferably oily fish) partly to increase intake of omega3-fatty acids eicoapentaenoic acid (EPA and docosahexaenoic acid (DHA). We examined the intake of total fish, fish high in omega-3 fatty acids, α-linolenic acid EPA, and DHA in U.S. adults (19+ years) using data from the National Health and Nutrition Examination Survey, 2003-2008. Usual intakes from foods alone and from foods plus dietary supplements were determined using the methods from the National Cancer Institute methods. Mean usual intake of total fish and fish high in omega-3 fatty acids was 0.61 ± 0.03 and 0.15 ± 0.03 oz/day, 0.43 and 0.07 respectively. Total fish and fish high in omega-3 fatty acids median intake was 0.43 and 0.07 oz/day, respectively. Intake from foods alone for ALA, DHA and EPA was 1.5 ± 0.01 g/d, 63 ± 2 mg/d, and 23 ± 7 mg/d, respectively. ALA, DHA and EPA from food only median intakes were 1.4 g/d, 50 mg/d and 18 mg/d, respectively. Intake of ALA, DHA and EPA from foods and dietary supplements was 1.6 ± 0.04 g/d, 72 ± 4 mg/d, and 41 ± 4 mg/d, respectively. While intakes of fish high in omega-3 fatty acids, EPA and DHA were higher in older adults (0.13 ± 0.01 oz/d for those 19-50 yrs and 0.19 ± 0.02 oz/d for those 51+ year; p<0.01) and in males as compared to females (0.18 ± 0.02 vs 0.13 ± 0.01 oz/d, respectively; p<0.05), few are consuming recommended levels. Males also had higher (p<0.05) intake of EPA and DHA from foods and dietary supplements as compared to females (44 ± 6 vs 39 ± 4 and 90 ± 7 vs 59 ± 4 mg/d, respectively) and older adults had higher intakes of EPA but not DHA as younger adults (EPA: 34 ± 3 vs 58 ± 9, P<0.05; DHA: 68 ± 4 vs 81 ± 6, P>0.05). Specific strategies to increase fish high in omega-3 fatty acids need to be developed and if EPA and DHA are important to increase then supplementation may need to be considered.
Abstract P419: Association Between Physical Activity and Risk Factors for Metabolic Syndrome in a Sample of HIV+ Men and Women Currently Taking Antiretroviral Therapy
Authors: Jaggers Jason R , Hand Gregory A , Prasad Vivek , Sui Xuemei , Burgess Stephanie , Blair Steven N
Published: July 2021

Background:
Metabolic Syndrome (MetSyn) is a strong predictor of type 2 diabetes and cardiovascular disease (CVD). Recent data show that people living with HIV/AIDS (PLWHA) are at a greater risk of CVD, which could possibly be explained by an increased prevalence of MetSyn as a result of the metabolic disturbances known to be associated with antiretroviral therapy (ART). The purpose of this study is to examine the relationships among physical activity (PA) and risk factors for MetSyn in a sample of HIV+ adults currently taking ART.

Methods:
A total of 32 males and 38 females living with HIV and currently taking ART were enrolled in an ongoing PA intervention aimed to reduce risk factors for CVD. Clinical assessments included measures of resting blood pressure (BP), waist circumference, height, weight, PA levels via accelerometer, and a fasted blood draw. Inactivity was defined as measured activity < 3 metabolic equivalents (METS) or if the person was sedentary, whereas moderate to vigorous PA was defined as any activity ≥ 3 METS. Accelerometer data was considered valid if the participant had a total on-body time of at least 10 hours a day for 4 days. Levels of PA were divided into 4 quartiles (Q1=0-40 mins of PA; Q2=40-80 mins; Q3=80-160 mins; Q4≥160mins). A one-way ANOVA was used to determine differences between quartiles.

Results:
Waist circumference was significantly lower across PA quartiles (p < 0.001). A similar pattern was observed in fasting glucose levels; however the results were not significant. Pearson correlation showed a significant association between PA and waist circumference (r = - 0.526; p < 0.001), but not BP or fasting glucose. Although fasting glucose was not significantly associated with PA, the Pearson correlation did show a significant association between inactivity and fasting glucose (r = 0.433; p = 0.019).

Conclusions:
These data show that greater amounts of PA are significantly associated with a smaller waist circumference for PLWHA who currently took ART. A significant relationship was also observed among inactivity and fasting glucose. In conclusion, routine PA can be beneficial in helping PLWHA reduce waist circumference and decrease sedentary time ultimately leading to a reduction in fasted glucose levels. This in turn would help PLWHA self-manage known risk factors for MetSyn, thus reducing their risk of CVD.
Abstract P420: Healthcare Providers as Role Models for Physical Activity
Authors: Garcia de Quevedo Isabel , Lobelo Felipe
Published: July 2021

Background.
Health care providers (HCPs) are in a privileged position to give credible advice on healthy lifestyles, including physical activity (PA) promotion, a national public health objective (Healthy People 2020). It has been reported that HCPs own habits matter in their counseling practices. Active HCPs that comply with PA guidelines are more likely to counsel and give more motivating PA advice to their patients.

Objectives.
The purpose of this literature review was to summarize the evidence on the association between HCPs personal PA habits and their related counseling practices on PA

Methods.
Search terms such as “attitudes”, “habits”, “health personnel", "physical activity", “exercise", and “role model” were used to identify relevant articles. On-topic articles were retrieved and a snow ball literature search methodology was used to select the most relevant articles in PubMed between 1979 and 2012. Articles were hand-picked and organized by type: observational vs intervention.

Results.
A total of 196 articles were retrieved: 23 were descriptive studies of HCP habits or counseling, and 28 studies (24 observational and 4 interventions) suggested HCPs personal PA habits influence their counseling behavior and attitudes towards PA. The majority of studies were from the US (n=21). Seven included non-physician population (nurses, pharmacists and other HCPs). The most frequent PA assessment method was self-reported questionnaires. For counseling behaviors, studies measured perceived frequency or self-efficacy for their practice. All but one of the 24 observational studies found significant associations between HCPs personal PA or fitness levels and the behaviors towards related PA counseling. This association was observed among physicians (n=15) and non-physicians (n=6) and also among medical (n=6) and nursing (n=1) students. Four observational studies reported physicians PA to be an independent effect for counseling (OR = 5.72, 3.4, 3.2, 1.1, 2.44 p < 0.05). Three studies showed a significant correlation between PA habits of HCP and their perceived frequency for counseling (r = 0.25 - 0.37). Among the 4 interventions found, only one focused on improving medical students’ PA habits and reported a significant association between improved physicians’ PA levels and counseling (OR 1.56 CI 1.04, 2.34; p= 0.03).

Conclusion.
HCPs own PA habits are an independent predictor of PA counseling practices. Interventions to improve HCPs PA habits have the potential to also improve HCPs PA counseling to patients. More research is needed in particular among non-physician populations and in low-to-middle income countries settings where the burden of inactivity is greatest.
Abstract P423: Six Minutes Walk Test in Patients with Severe Aortic Stenosis: A Maximal Exercise Testing Procedure?
Authors: Bastien Marjorie , Bagur Rodrigo H , Rodes-Cabau Josep , Auclair Audrey , Poirier Paul
Published: July 2021

Rationale:
Maximal exercise testing is an absolute contraindication in patients with severe symptomatic aortic stenosis (SSAS). Instead of maximal testing, the 6 minutes-walk test (6MWT) may be recommended to evaluate functional capacity and to establish prognostic. The aim of this study was to compare the 6MWT with a maximal exercise test in patients with SSAS.

Method:
A ramp cardiopulmonary exercise test (CPET) on a cycle ergometer taken as control, and a 6MWT, both with a breath-by-breath gas analysis, were performed in a population with SSAS waiting for transcatheter aortic valve implantation (TAVI). During both tests, patients were monitored with continuous electrocardiogram. Blood pressure was taken every 2 minutes during CPET and at the beginning and the end of the 6MWT test. Patients underwent both tests.

Results:
A total of 12 patients aged 79.5 ± 5.9 years participated to these evaluations. During the 6MWT, patients walked a mean distance of 335±74 m, producing a mean maximal workload of 48.5±13.2 watts during CPET. Through CPET, patients achieved a maximal oxygen consumption (VO2peak) of 11.9±4.2 mL/kg/min, which was similar to the VO2peak reached during 6MWT (12.8±2.5 mL/kg/min, p=0.062). For both tests, the respiratory exchanged ratio exceeded 1.1 (CPET=1.16±0.06 and 6MWT=1.12±0.09, p=0.241), which is one criterion of a maximal exercise capacity test. In comparison to CPET, a higher proportion of the 6MWT was performed at high intensity level (>85% VO2peak); 74.2±29.0% of the 6MWT vs. 31.5±24.0% of CPET, p=0.004*. During CPET, 8 patients experimented abnormal blood pressure (BP) response (4 dropped their BP and 4 achieved maximal BP value during recovery). No complication occurred during both tests except for 3 patients who experienced angina pectoris. In this high-risk elderly cohort, lean body mass was the better anthropometric feature associated with better exercise capacity during CPET (r=-0.73, p=0.03*).

Conclusion:
Both exercise tests were very demanding for patients with SSAS waiting for TAVI. The 6MWT was a maximal effort and high intensity exertion was maintained for almost 75% of the test. The 6MWT was as intense as CPET suggesting the importance of an adequate monitoring while testing those patients. Considering that CPET allow blood pressure measure throughout the test and included a lower test portion in high intensity level, CPET may be more appropriate to evaluate functional capacity in patients with SSAS.
Abstract P426: Quercetin Intake Differentially Affects the Plasma Lipid Levels and Lipoproteins Associated Gene Expression in Normal C57bl Female Mice
Authors: Garelnabi Mahdi , Mahini Halleh
Published: July 2021

Background:
Quercetin is a member of the bioflavonoids family known to have antiatherogenic, antiinflammatory, and antihypertensive properties; and reported to have cardiovascular protective role. Quercetin through its antioxidant action may protect against oxidative stress induced by free radicals consequently decreasing the potential for modification of low density lipoprotein cholesterol (LDL); however it is not clear if the intake of quercetin during exercise may have beneficial effect on plasma lipids.

Goals and hypothesis:
We hypothesized that the intake of quercetin with exercise will affect plasma lipids. The goal of this study is to investigate the beneficial effect of Quercetin on normal female mice.

Study Design and Methods:
We investigated the possible beneficial effects of the combined exercise and quercetin on plasma lipids in C57BL6 normal female mice fed normal mouse chow. Mice (N=29) were divided into four groups. These groups are as follows: Control mice, left untreated; control quercetin group, orally supplied with 100 μg/day of quercetin without exercising; exercise group without quercetin, and exercise group with quercetin supplements. The exercise groups were run on a treadmill for 30 minutes, 15m/m/ 5 days/week for 30 days. At the end of the month of the treatment, mice were sacrificed liver gene expressions for genes associated with lipoprotein metabolism were analyzed, and plasma lipids levels were analyzed.

Results and Discussion:
Our data interestingly showed that Quercetin differentially influences the levels of lipoprotein, oxidative stress and inflammatory markers gene expression during exercise in normal female mice; however plasma lipids, specifically TG plasma levels have elevated among mice consuming quercetin alone or with exercise significantly (P<0.5).

Conclusion:
This study have demonstrated that Quercetin intake with exercise may
differentially affects the plasma lipid levels and lipoproteins associated gene expression in normal C57BL female mice.
Abstract P429: Assessing Physical Activity in Women with CVD Using Generic Versus Disease-Specific Measures of Physical Activity
Authors: Mason Barber Linda A , Kimble Laura , Sudia-Robinson Tanya , Taylor Leslie
Published: July 2021

Introduction and Purpose:
Consistent and adequate measurement of physical activity (PA) in studies involving women with CVD has significant implications for the development of interventions and recommendations for increasing PA in this population. Generic measures of PA may not address or may be less sensitive or relevant to issues and problems faced by women with CVD and their impact on function. The purpose of this secondary analysis was to assess appropriateness of using generic self-report PA measures as opposed to disease-specific measures when assessing PA in women with CVD.

Methods:
A secondary analysis of PA data derived from a cross-sectional study investigating healthcare providers’ influence on motivation for PA in women with CVD was conducted. Community-dwelling, English speaking women with a self-reported history of CVD were recruited via flyers and newspaper ads, subsequently completing mailed self-report questionnaires and a telephone survey. Self-reported PA was measured with the 7-Day PAR. Perceived PA limitations and CVD symptoms were assessed with the Cardiovascular Limitations and Symptoms Scale. Age and comorbid conditions were also assessed. Pearson’s product moment correlations were computed to assess for associations among study variables.

Results:
The sample (
N
=103) were non-Hispanic, primarily white (93.2%) females with a mean age of 64.7 (SD 10.3) years. The majority (94.2%) were NYHA functional status class I. Mean reported CVD symptoms was 1.1 (
SD
1.0). Difficulties with recall bias and descriptions of daily activities by participants during data collection with the 7-Day PAR led to wide variations in self-reported PA, contributing to a highly left-skewed distribution. Mean reported energy expenditure (PA) was 241.8 kcal/kg/week (
SD
20.3, Median 235.9). Mean perceived PA limitations was 15.9 (
SD
4.8). With the exception of a significant correlation with age (p < .01), no association between PA, as measured with the 7-Day PAR, and other study variables was found, including perceived PA limitations. CVD symptoms emerged as a significant predictor of perceived PA limitations in regression analyses in the primary study and was highly correlated (
r
= .51,
p
< .001) with this variable, but not with PA (
p
= .39).

Conclusions:
Lack of correlations between PA and other study variables may have been attributable to discrepancies in estimation of PA as assessed with the 7-Day PAR in this sample. The emergence of CVD symptoms as the strongest predictor of perceived PA limitations in regression analyses in the primary study supports the influence CVD-related factors have on PA in women with CVD. These results suggest including a disease-specific assessment, which takes CVD symptoms and limitations into consideration, when evaluating PA in the population of women with CVD.
Abstract 01: Diabetes is a Risk Factor for 20-year Cognitive Decline
Authors: Rawlings Andreea M , Sharrett A. Richey , Coresh Josef , Albert Marilyn , Couper David J , Griswold Michael , Gottesman Rebecca F , Wagenknecht Lynne , Windham B. Gwen , Selvin Elizabeth
Published: July 2021

Introduction:
Most studies examining the association between diabetes and cognitive decline have been among older individuals and/or have had limited follow-up. We undertook this study to examine the association of diabetes in mid-life with long-term change in cognitive function in a community-based population of blacks and whites.

Hypothesis:
We hypothesized that diabetes and chronic hyperglycemia - as measured by HbA1c at baseline - would be associated with 20-year cognitive decline.

Methods:
We used generalized estimating equations to examine the association of diabetes at baseline (1990-1992, aged 48-67 years) with 20-year change in cognitive performance among 13015 (24% black; 55% female; 1205 with diabetes) ARIC participants. Delayed Word Recall, Digit Symbol Substitution, and Word Fluency were used to assess cognitive performance, and were summarized using a global Z score. Self-reported diagnosis or diabetes medication use at baseline was used to assess diabetes and HbA1c was categorized using clinical cutpoints. Models were adjusted for demographic and clinical variables.

Results:
Diagnosed diabetes was associated with significantly more cognitive decline compared to persons without diabetes (Z = -0.17, 95% CI: -0.26, -0.07) (Figure). This represents 19% faster decline compared to persons without diabetes. We also observed a significant trend in decline among clinical categories of HbA1c, even below the threshold for diagnosis of diabetes. Results were similar in race-stratified analyses. In addition, among white participants poorly controlled diabetes (HbA1c>7) had significantly more decline compared to persons whose diabetes was controlled (Z = -0.24 (95% CI: -0.46, -0.02)).

Conclusions:
Diabetes in middle-age was associated with substantially more rapid cognitive decline across 20 years of follow-up. Our results also suggest that pre-diabetes and poor control of diabetes lead to greater cognitive decline.
Abstract 09: A Community-Based Exercise Intervention Transitions Metabolically Abnormal Obese Adults to a Metabolically Healthy Obese Phenotype
Authors: Dalleck Lance C , Richardson Tara B , Van Guilder Gary P
Published: July 2021

Introduction:
It has been estimated that 32% of obese adults in the US are metabolically healthy. This subset of individuals, referred to as metabolically healthy but obese (MHO), appear to be more resistant to the adverse cardiometabolic consequences faced by their metabolically abnormal obese (MAO) counterparts. Cross-sectional observations indicate that increased physical activity and higher fitness contribute to the protective metabolic characteristics in this subset of obese individuals. However, to date no study has investigated whether a community-based exercise intervention designed to increase exercise volume and fitness can transition MAO adults to a MHO phenotype. Identifying the therapeutic dose of exercise required to convert a MAO person to metabolically healthy would yield important clinical information for the primary prevention of cardiovascular disease.

Hypothesis:
We assessed the following hypotheses: (1) community-based exercise training would transition MAO adults to metabolically healthy, and (2) the odds of successful transition to a metabolically healthy phenotype would be larger for obese individuals who [[Unable to Display Character: –]] (a) performed the highest volume of exercise, and (b) experienced the greatest increase in fitness.

Methods:
Three-hundred thirty-two healthy adults (190 women, 142 men; aged 28-88 years) engaged in a supervised 14-week community-based exercise program designed to favorably modify cardiovascular disease risk factors. Components of the metabolic syndrome (National Cholesterol Education Program ATP III criteria) were measured before and after the exercise program. Obese (BMI ≥ 30 kg·m
2
) adults who met 2-4 criteria for metabolic syndrome were classified as metabolically abnormal. Metabolically healthy was defined if obese adults met 0 to 1 criteria for metabolic syndrome.

Results:
Baseline point prevalence of MAO was 20.5% (N = 68). There was a significant reduction (p<0.05) in point prevalence of MAO to 12.3% by post program as 27/68 individuals (40%) transitioned to MHO. Compared to the lowest quartiles of relative energy expenditure and change in fitness, participants in the highest quartiles were 21.8 (95% CI 4.4[[Unable to Display Character: –]]108.0; p<0.05) and 8.2 (95% CI 3.1[[Unable to Display Character: –]]21.6; p<0.05) times more likely to transition from MAO to MHO, respectively.

Conclusions:
These findings indicate that supervised community exercise can transition MAO adults to a MHO phenotype. MAO adults who engaged in higher volumes of exercise and those who demonstrated greater improvements in fitness were significantly more likely to become metabolically healthy. Importantly, the unfavourable metabolic characteristics of obesity are not irreversible. Community exercise should be considered an effective model for the primary prevention of cardiovascular disease in MAO adults.