bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P275: Objective Short Sleep Duration Increases the Risk of Cancer Mortality Associated With Cardiovascular and Cerebrovascular Disease
Authors: Fernandez-Mendoza Julio , He Fan , Vgontzas Alexandros N , Liao Duanping , Bixler Edward O
Published: March 2019

Introduction:
Cardiovascular/cerebrovascular diseases (CBVD) and cancer share cardiometabolic risk factors (CMR) and underlying immune-related pathophysiologic mechanisms. Short sleep duration is a risk factor for CBVD, while the latter a predictor of cancer mortality. However, the role of sleep duration in predicting cancer mortality in the context of CBVD has not been systematically examined.

Hypothesis:
We hypothesized that objective sleep duration is an effect modifier of the impact of CMR and CBVD on cancer mortality.

Methods:
We addressed this question in the Penn State Adult Cohort, a random, general population sample of 1,654 men and women (47.5 ± 12.3 years) who were studied in the sleep laboratory with 8-hour polysomnography (PSG) at baseline and followed-up for 19.2 ± 5.2 years for cause of death. A total of 512 (30.9%) of subjects died during the follow-up, of whom 131 died of cancer. At baseline, the presence of CBVD was defined by a clinical history of heart disease and/or stroke, while the presence of CMR as stage 2 hypertension (blood pressure ≥140/90mmHg or anti-hypertensive medication) and/or type 2 diabetes (fasting glucose ≥126 mg/dL or treatment for diabetes). PSG-measured short sleep duration was defined as < 6 hours of sleep at baseline.

Results:
We tested the interaction between CMR/CBVD and PSG sleep duration on mortality using Cox proportional hazard models controlling for multiple potential confounders (p-value=.05). Consistent with this significant effect modification, the hazard ratios (95%CI) of cancer mortality associated with CMR and CBVD were 0.98 (0.54-1.79) and 0.55 (0.18-1.64) among individuals who slept ≥ 6 hours and 2.53 (1.23-5.22) and 2.92 (1.28-6.65) among individuals who slept < 6 hours.

Conclusions:
The risk of cancer mortality is significantly increased in adults with CMR or CBVD when they demonstrate objective short sleep duration. Future studies should disentangle the underlying mechanisms (e.g., immune suppression and chronic low-grade inflammation) of the association between short sleep and cancer incidence and mortality in individuals with or at-risk of CBVD.
Abstract P276: Subjective versus Objective Measures of Sleep: Results From an Ecological Momentary Assessment Study
Authors: Imes Christopher C , Kline Christopher E , Mendez Dara D , Sun Ran , Yang Yu , Chasens Eileen R , Rathbun Stephen L , Burke Lora E
Published: March 2019

Introduction:
Reliable and valid measures are essential in research; however, it remains unclear if self-reported sleep measures are concordant with objective measures.

Purpose:
To examine the associations between subjective and objective sleep duration and awakenings among adults enrolled in a behavioral weight loss study.

Methods:
Self-report data included responses to the questions “How many hours of sleep did you get?” and “Number of awakenings?” collected each morning by ecological momentary assessment. Objective measures included actigraphic data on sleep duration and awakenings collected for 7 days at 6 and 12 mos. Concordance between measures was examined using linear mixed models predicting self-report measures of sleep from objectively measured sleep.

Results:
The sample (N = 137) was 89.8% female and 81.8% white with a mean age of 51.5 ± 9.9 yrs. Based on self-report, sleep duration was 417.2 ± 77.7 min./night with 1.7 ± 1.5 awakenings. Based on actigraphy, sleep duration was 413.1 ± 79.5 min./night with 33.0 ± 14.1 awakenings. The fitted model for sleep duration yielded an estimated intercept of 197.3 min. (95% CI, 178.0, 216.6) and slope of 0.54 (95% CI, 0.49, 0.58). In the scatter plot of self-report against objective sleep (Fig 1a), the plotted points were well-scattered about the 45-degree line suggesting that self-report min. of sleep predicted objective min. of sleep. The fitted model for awakenings yielded an estimated intercept of 0.95 awakenings (95% CI, 0.66, 1.2) and slope of 0.02 (95% CI, 0.015, 0.028). In the scatter plot of self-report against objective awakenings (Fig 1b), all of the plotted points fell below the 45-degree line indicating that self-report drastically underestimated actigraphic awakenings.

Conclusion:
Self-reported sleep duration was a good indicator of objective sleep duration, while self-reported awakenings significantly underestimated actigraphic awakenings. Sleep is multi-dimensional and both subjective and objective measures are needed to capture its various features.
Abstract P280: The Association of Sleep Apnea with Psychiatric History: A Veteran Twin Study
Authors: Huang Minxuan , Bliwise Donald L , Shah Amit J , Goldberg Jack H , Ko Yi-An , Murrah Nancy , Levantsevych Oleksiy M , Shallenberger Lucy H , Bremner J. Douglas , Vaccarino Viola
Published: March 2019

Introduction:
Sleep apnea is exceedingly common in elderly men and is associated with higher risk of cardiovascular disease. Post-traumatic stress disorder (PTSD) and depression have been shown to be associated with sleep apnea, however results have not been consistent, and it is unclear whether this association is confounded by cardiovascular and behavioral risk factors. In this study, our objective was to explore the risk factors for sleep apnea with a focus on psychiatric history, and we hypothesized that the association of sleep apnea with psychiatric history can be largely influenced by cardiovascular and behavioral factors.

Methods:
This was a cross-sectional analysis of 100 members of the Vietnam Era Twin (VET) Registry (50 twin pairs, mean age=68; range: 61-71 years). All twins underwent a one night in-lab polysomnography (PSG) to assess the apnea/hypopnea index (AHI). Clinical diagnoses of lifetime history of major depression and PTSD were obtained with the Structured Clinical Interview for DSM V (SCID); we also measured current depressive symptoms with the Beck Depression Inventory-II (BDI-II). To assess associations of study variables with AHI, within-pair differences in multivariable mixed-effects regression models were examined and β coefficients were calculated. In addition to lifetime history of depression and PTSD, we included in the model the following variables previously reported in the literature to be associated with AHI: body mass index (BMI), current smoking, history of alcohol abuse, and physical activity assessed with the Baecke score. Other variables included years of education, sedative/hypnotic use, and antidepressant use.

Results:
The mean AHI among these men was 15.5 [SD=16.1]. A total of 18 and 28 twins had diagnoses of lifetime history of depression and PTSD, respectively. In bivariate analysis without adjustment for covariates, psychiatric history (depression or PTSD) was not significantly associated with higher AHI. In mixed-effects multivariable regression analysis, only higher BMI (β=2.3, 95% CI=1.5, 3.1) and less education (β=-1.3, 95% CI=-2.4, -0.1) were independently associated with higher AHI. Psychiatric history of depression (β=3.9, 95% CI=-3.5, 11.3) or PTSD (β=6.0, 95% CI=-0.9, 12.9) were not significantly associated with AHI. Additional analyses examining number of depressive symptoms (BDI-II) showed similar results.

Conclusion:
As expected, higher BMI was associated with higher AHI, but several other variables thought to be associated with higher AHI were not confirmed, such as smoking status, alcohol abuse, sedative/hypnotic use, and lack of physical activity. In contrast to the prevailing literature, neither lifetime history of depression nor PTSD were associated with sleep apnea. However, the role for poor sleep quality other than sleep-disordered breathing still remains to be investigated.
Abstract P290: Dietary and Serum Omega-6 and Omega-3 Fatty Acids Are Associated With Physical and Metabolic Dysfunction in Chronic Stroke Survivors
Authors: Serra Monica , Hafer-Macko Charlene , Ryan Alice
Published: March 2019

Background:
Higher dietary intake of omega-6/omega-3 ratios is associated with reduced physical functioning in older adults, but is not well documented in chronic stroke survivors.

Purpose:
The purpose of this study was to quantify dietary intake of omega-6 and omega-3 fatty acids, their habitual dietary intake ratios and systemic omega-6/omega-3 profiles and to determine their relationship with physical and metabolic function in a cohort of chronic adult stroke survivors.

Methods:
Twenty-five older chronic stroke survivors (age: 63±8 yrs; BMI: 31±7 kg/m
2
; mean±SD) were assessed for fitness (VO
2
peak) and six-minute walk distance (6MWD). Plasma lipid and glucose profiles were measured and HOMA-IR calculated. Dietary (5-day food records) and serum (mass spectrometry) omega-6/omega-3 profiles were assessed.

Results:
Participants were severely deconditioned (VO
2
peak: 19±4 ml/kg/min; 6MWD: 295±121 m) and at elevated metabolic risk (HOMA-IR: 6.3±4.5). The dietary intake ratio of omega-6/omega-3 fatty acids averaged 12.6±7.1 and the serum concentration ratio was 1.21±0.37, which were positively correlated (r=0.88, P<0.01). Higher dietary intake and serum concentrations of omega-6/omega-3 fatty acids were associated with lower 6MWD (diet: r=-0.49; serum: r=-0.43) and higher HOMA-IR (diet: r=0.39; serum: r=0.34, while a higher serum omega-6/omega-3 concentration index was associated with lower VO
2
peak (r=-0.38) (all P<0.05).

Conclusion:
These preliminary data suggest that both dietary omega 6 and omega 3 fatty acids (quantitated as their intake ratio) and the serum concentration ratio of omega-6/omega-3 may be important indices of physical dysfunction and insulin resistance in chronic stroke survivors.
Abstract P293: Effects of Diets That Vary in Fatty Acid Composition on Fecal Short-chain Fatty Acid Levels and Their Relationship With Circulating Lipids and Lipoproteins
Authors: Bowen Kate J , Kris-Etherton Penny M , Jones Peter J , Reddivari Lavanya
Published: March 2019

Introduction:
The short-chain fatty acids (SCFA) acetic acid, propionic acid, and butyric acid are microbial-produced metabolites that can influence host physiology through regulation of hepatic cholesterol metabolism. These biologically relevant gut metabolites may play a role in the hypocholesterolemic effects of select dietary components. The objective of this exploratory study was to determine the effects of diets that differ only in fatty acid composition on fecal SCFA levels and to assess their correlations with circulating lipids, lipoproteins, and apolipoproteins.

Hypothesis:
We assessed the hypothesis that dietary fat quality will differentially affect fecal SCFA and there will be significant associations between fecal SCFA levels and those of circulating total cholesterol, low-density lipoprotein-cholesterol (LDL-C), non-high-density lipoprotein-cholesterol (non-HDL-C), and apolipoprotein (apo) B.

Methods:
In a double-blind, randomized, three period crossover, controlled feeding clinical trial, participants with ≥2 metabolic syndrome criteria (n=20) were provided with a weight maintenance, controlled feeding base diet plus conventional canola oil, high-oleic acid canola oil (HOCO), or a control oil (control diet formulated to represent a Western diet fatty acid profile) for 6 weeks followed by washout periods of ≥4 weeks. The macronutrient profiles of the diets were: canola diet [17.5% monounsaturated fatty acid (MUFA), 9.2% polyunsaturated fatty acid (PUFA), 6.6% saturated fatty acid (SFA)], HOCO diet (19.1% MUFA, 7.0% PUFA, 6.4% SFA), and control diet (10.5% MUFA, 10.0% PUFA, 12.3% SFA). Fecal and blood samples were collected at study enrollment and at the end of each diet.

Results:
After 6 weeks, a trend toward a treatment effect on endpoint fecal propionic acid was observed (
P
=0.09), with a trend toward a higher concentration following the control compared to the canola diet (
P
=0.09). Acetic acid was increased from baseline following the control diet (
P
=0.04). After the control diet only, fecal levels of propionic acid were positively correlated with blood levels of LDL-C, non-HDL-C, and apo B (r=0.52 to 0.64,
P
=0.003 to 0.02), with a trend for total cholesterol (r=0.39,
P
=0.10), and acetic acid was positively correlated with LDL-C and apo B levels (r=0.48 to 0.49,
P
=0.03 to 0.04), with a trend for non-HDL-C (r=0.44,
P
=0.06). No significant correlations between fecal SCFA and lipids and lipoproteins were observed after the two canola oil-based diets.

Conclusions:
In conclusion, these data suggest that the adverse effects of a contemporary Western diet fatty acid profile on circulating lipid and lipoprotein parameters compared to diets higher in unsaturated fat and lower in SFA may be mediated by gut-derived SCFA.
Abstract P295: Synergistic Effect of Food Insecurity and Intimate Partner Violence on Maternal Depressive Symptoms
Authors: Daundasekara Sajeevika S , Schuler Brittany , Hernandez Daphne C , Longoria Arleen
Published: March 2019

Background:
There are evidence of intimate partner violence (IPV) and food insecurity (FI) as independent predictors of maternal depressive symptoms. However, there are a dearth of studies that have examined how both IPV and FI influence depressive symptoms. The objective of this study was to determine whether IPV, food insecurity, or the combined effect of experiencing both IPV and FI predicted later onset of maternal depressive symptoms.

Method:
Data over a nine year time span from Fragile Families and Child Wellbeing study were used for the current study (N=1421). IPV and FI were both measured at three and five years from the child’s birth. IPV was measured using seven items depicting physical and psychological abuse from spouse/partner. Household FI was measured using the 18-item Food Security Module developed by the United States Department of Agriculture. Four mutually exclusive dichotomous variables were created based on IPV and FI experiences. Mothers who experienced IPV at least at one time but did not experience FI were classified as “IPV only”. Mothers who experienced FI at least at one time but did not experience IPV were classified as “FI only”. Mothers who experienced both IPV and FI at least one time were classified as “both IPV and FI”. The final group “never IPV nor FI” did not experience IPV nor FI. Maternal depressive symptoms at year nine was determined using the Composite International Diagnostic Interview Short Form. Covariate adjusted multivariate logistic regression analysis was used to understand the relation between IPV and FI on onset of depressive symptoms.

Results:
Twenty-seven percent of the study sample experienced both IPV and FI, 63% IPV only, 4% FI only, and 6% never. At year nine 18% of the mothers reported depressive symptoms. Majority of the sample were non-Hispanic black (52%) or Hispanic (23%), married/cohabiting (57%), and with a high school or higher education (76%). After controlling for age, race/ethnicity, education, marital status, financial strain and prior depressive symptoms, mothers who experienced both IPV and FI during 3-5 years after child’s birth had significantly higher odds of having depressive symptoms at 9 years after child’s birth (OR=2.10, 95% CI: 1.04, 4.27) compared to mothers experiencing neither. The odds of having depressive symptoms among mothers experiencing either IPV only (OR=1.33, 95% CI: 0.67, 2.66) or FI only (OR=2.34, 95% CI: 0.94, 5.86) was not significantly different from mothers experiencing neither.

Conclusions:
Maternal cumulative experiences of IPV and FI three to five years after child’s birth increased the likelihood of later onset of depressive symptoms. Currently IPV, food insecurity and depression are typically addressed in isolation. Using a trauma-informed approach, combining IPV counselling with public/private food assistance programs might be effective in preventing maternal depressive symptoms later in life.
Abstract P299: Racial and Sex-Related Differences in Aortic and Mitral Valve Disease
Authors: Gjini Petro , Franzil Jodie , Nicolazzi Joseph , Dharod Ajay , Pu Min , Stacey Richard B
Published: March 2019

Background:
With the proliferation of echocardiography, clinicians are detecting more patients with valve disease and identifying valve disease much earlier in its natural course. Understanding the gender and racial differences in prevalence of valve disease may help guide clinicians to allocate resources in researching strategies to prevent progression of valve disease.

Methods:
We identified 9,625 patients from the echocardiography laboratory database between September 2013 to April 2018 who had a LV ejection fraction ≥ 50%. Data related to left-sided valvular disease, baseline demographics, and clinical history were obtained from our clinical data repository. Crude analyses by sex and race were performed to identify the prevalence of certain valve lesions. Logistic regression was used to adjust these relationships by baseline demographics.

Results:
Our population was 58% female, 21% African-American (AA) with a mean age of 59 ± 17 years. For moderate/severe aortic stenosis (AS), AA had 2.4% compared to 7.5% in Caucasians (CA; p<0.001), and women had 4.8% compared to 8.5% for men (p<0.001). For moderate/severe aortic regurgitation (AR), AA had 4.1% compared to 7.5% in CA (p>0.2), and women had 4.0% compared to 5.4% for men (p=0.003). For moderate/severe mitral regurgitation, AA had 6.6% vs 7.8% for CA (p=0.056), and women had 8.3% vs 6.3% for men (p=0.003). Adjusting for age, race, sex, height, and weight, AA had lower odds ratio (OR) for AS than CA (OR: 0.47; 95% CI: 0.34-0.64; p<0.001), and women had less AS than men (OR: 0.60; 95% CI: 0.50-0.72; p<0.001), less AR (OR: 0.67; 95% CI: 0.54-0.83; p<0.001), but more MR (OR: 1.29; 95% CI: 1.08-1.53; p=0.004).

Conclusion:
African-Americans have a lower prevalence of moderate/severe aortic stenosis than Caucasians. Compared to men, women have a lower prevalence of moderate/severe aortic stenosis, lower prevalence of moderate/severe aortic regurgitation, but a higher prevalence of mitral regurgitation.
Abstract P305: Alternative Ankle Brachial Index Calculation and CVD Events and Mortality: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Unkart Jonathan , Allison Matthew , Araneta Maria Rosario , Ix Joe , McDermott Mary , Criqui Michael
Published: March 2019

Introduction:
The ankle brachial index (ABI) is independently associated with cardiovascular disease (CVD) events and mortality. The recommended ABI calculation for the ankle pressure involves taking the higher (ABI-TRAD) of the dorsalis pedis (DP) or posterior tibial (PT) arteries in the lower of the two legs. However, little is known about using the lower (ALT-ABI) of the DP/PT in evaluating CVD endpoints.

Methods:
Using a multiethnic cohort free of known CVD disease at baseline, participants with complete ABI assessment were followed for incident CVD events, CVD mortality and all-cause mortality. ABI was assessed as categories: low (≤0.9), borderline (0.9-1.0), low-normal (1.0-1.1), normal (1.1-1.4) and high (≥1.4) and continuously using ALT-ABI. Leg symptoms were assessed with the San Diego Claudication Questionnaire. We used cox models to assess associations between ALT-ABI and outcomes adjusting for age, gender, race/ethnicity, ASCVD risk score and leg symptoms.

Results:
Of the 6,669 participants with complete ABI measures, the mean ALT-ABI was 1.03 +/- 0.12 versus ABI-TRAD of 1.10 +/- 0.11. The mean age of participants was 62 years and 1,625 (24.4%) reported some type of leg pain with walking. At a median follow up of 14.2 years, 1,214 deaths, 657 CVD events, and 288 CVD-specific deaths had occurred. Of the 824 individuals with low ALT-ABI, 581 (70.5%) had an ABI > 0.9 using ABI-TRAD. As seen in the Table, lower values and categories of ALT-ABI were associated with increased risk of CVD events, CVD and all-cause mortality.

Conclusions:
Using ALT-ABI identified more individuals with an ABI ≤ 0.9. The ALT-ABI is significantly associated with CVD outcomes, even in asymptomatic individuals. Significant risk increases were present even in those with a low-normal ALT-ABI. While clinical guidelines recommend further workup and risk reduction in individuals with leg symptoms and an ABI-TRAD ≤ 0.9, this method of ABI calculation and cutoff may misidentify individuals at-risk for adverse CV outcomes.
Abstract P307: Additional Prognostic Value of Toe-Brachial Index Beyond Ankle-Brachial Index in Hemodialysis Patients
Authors: Hishida Manabu , Imaizumi Takahiro , Okazaki Masaki , Maruyama Shoichi , Matsushita Kunihiro
Published: March 2019

Background:
Although ankle-brachial index (ABI) is considered the first-line diagnostic test for peripheral artery disease (PAD), ABI can be falsely elevated in some patients with uncompressible ankle arteries. In those patients, toe-brachial index (TBI) is recommended as an alternative test. However, whether TBI provides additional prognostic information beyond ABI is unknown.

Methods:
We examined data from 247 Japanese dialysis patients (mean age 66 years). ABI and TBI were measured bilaterally on the same day, and the lower values were used for analysis. We explored quartiles of ABI and TBI as well as three categories of low ABI (≤0.9), normal/high ABI (>0.9) + low TBI (≤0.6), and normal/high ABI + normal TBI (>0.6) (very few with low ABI and normal TBI). Multivariable Cox models were used to quantify the associations of ABI and TBI with all-cause mortality.

Results:
During a mean follow-up of 5.2 years, we observed 116 deaths. As anticipated, ABI showed a J-shaped association with mortality, with the higher risk seen in the lowest quartile (adjusted hazard ratio 2.70 [95% CI 1.38-5.30]) and the highest quartile (1.46 [0.73-2.90]) vs. the second highest quartile. In contrast, lower TBI showed a dose-response association with mortality (e.g., adjusted hazard ratios 2.41 [1.16-5.01] and 2.21 [1.04-4.71] in the lowest two quartiles vs. the highest quartile). When three categories by ABI and TBI were analyzed, low ABI showed worst prognosis, followed by normal/high ABI + low TBI and then normal/high ABI + normal TBI (Figure). Higher mortality risk in normal/high ABI + low TBI vs. normal/high ABI + normal TBI remained significant after accounting for potential confounders (adjusted hazard ratio 1.84 [1.04-3.25]).

Conclusions:
Lower TBI was independently associated with higher mortality risk in patients on dialysis and classified risk in patients with normal/high ABI. Our results support the importance of evaluating TBI in addition to ABI in dialysis patients.
Abstract P308: The Association of Height With Incident Peripheral Arterial Disease in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Menez Steven P , Kwak Lucia , Ding Ning , Hicks Caitlin , Grams Morgan , Folsom Aaron , Heiss Gerardo , Selvin Elizabeth , Jaar Bernard , Matsushita Kunihiro
Published: March 2019

Background:
A number of cross-sectional studies have reported shorter height as a risk factor for peripheral artery disease (PAD) defined by low ABI. People of shorter stature may have a naturally lower ABI stemming from a relatively lower ankle blood pressure, as function of the shorter distance from the heart to the distal leg arteries. If shorter height is related to PAD, height should also be associated with clinical PAD. We aimed to investigate the association of height with clinical PAD and critical limb ischemia (CLI) in a prospective cohort analysis.

Methods:
Using data from the ARIC Study, we investigated the association of height with development of PAD and CLI, defined based on ICD-9 codes, for the 14,668 participants at Visit 1 without prevalent PAD/CLI over a median follow-up time of 25.9 years. We modeled risk for PAD and CLI over time using Cox proportional hazards regression.

Results:
6,652 (45.4%) participants were men, with a mean age of 55 (SD 6) years old, compared to 54 (SD 6) years old in women. 1,460 (22%) men and 2,321 (29%) women were African American. Men tended to be taller and have a higher weight compared to women. Within each sex, there were no significant differences by quartile of height in terms of demographic factors or clinical comorbidities. For men in height quartile 2 compared to quartile 1, there was a decreased risk of PAD in unadjusted analysis (HR=0.69; 95% CI 0.51-0.94). However, this HR was no longer significant after full adjustment (Table 1). In women, the risk of CLI was higher in the fourth quartile of height compared to quartile 1 after adjustment for demographic factors (HR=1.69; 95% CI: 1.00-2.84). However this HR also became non-significant after full adjustment. For both genders, the HR of either PAD or CLI per one SD increase in height was not significant.

Conclusions:
In contrast to previous cross-sectional studies which showed and association between shorter height and PAD based on ABI, our prospective study showed null associations between height and clinical PAD.
Abstract P310: Erectile Dysfunction and Venous Thromboembolism Risk in the Health Professionals Follow-up Study
Authors: Harrington Laura B , Hagan Kaitlin , Kang Jae H , Kim Jihye , Giovannucci Edward , Mittleman Murray A , Rimm Eric B , Kabrhel Christopher , Jensen Majken K , Mukamal Kenneth J
Published: March 2019

Introduction:
Erectile function requires both intact arterial inflow and venous occlusion, and it has thus been posited that erectile dysfunction (ED) could be a marker of cardiovascular risk. Although a positive association between ED and arterial thrombotic risk has been well-characterized, whether ED is associated with venous thromboembolic event risk is unknown.

Hypothesis:
ED is positively associated with risk of incident venous thromboembolism (VTE) events, including both deep vein thrombosis (DVT) and pulmonary embolism (PE).

Methods:
Eligible men were Health Professionals Follow-up Study (HPFS) participants without VTE and prostate cancer prior to baseline in 2000 (n=27,771). As part of biennial mailed questionnaires, men reported their current erectile function in 2000, 2004, and 2008, which was categorized as ED presence (“very poor” or “poor” erectile function) or ED absence (“fair”, “good”, or “very good”). Self-reported incident VTE included the first occurrence of either PE or DVT. We used Cox Proportional Hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for VTE associated with time-varying ED presence versus absence, with participants censored at death, warfarin use, loss to follow-up, or incident prostate cancer. Multivariable analyses adjusted for age, smoking, body mass index, physical activity, caloric intake, race, alcohol consumption, aspirin use, diabetes, hypertension, hypercholesterolemia, myocardial infarction/angina, and cancer.

Results:
Over 256,678 person-years of follow-up, men self-reported 665 VTE events. At baseline, men were on average 65 years of age and 31% reported presence of ED. In multivariable-adjusted analyses, ED presence was associated with a 30% greater risk of incident VTE (HRadj=1.3; 95% CI: 1.1, 1.6; erectile function linear p-trend=0.003). Estimates were similar in sensitivity analyses of the smaller subgroup of confirmed PE (n=196 PEs confirmed by medical record review/participant reconfirmation or self-reported among persons with prior cancer) (HRadj=1.3; 95% CI: 0.9, 1.8).

Conclusions:
Presence of ED was positively associated with VTE risk in this study of U.S. men, even after multivariable adjustment for traditional cardiovascular risk factors, suggesting that ED has potential as a marker of VTE risk.
Abstract P312: Abstract 14806: Association of Television Viewing With Incident Venous Thromboembolism: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Munger Jordan , Koh Insu , Howard George , Howard Virginia , Plante Timothy , Cushman Mary , Zakai Neil
Published: March 2019

Introduction:
Previous studies have linked TV watching with increased venous thromboembolism (VTE) risk independent of physical activity or other VTE risk factors. This finding warrants replication in a contemporary and geographically diverse cohort.

Hypothesis:
We hypothesized that TV watching is associated with increased hazard of VTE independent of physical activity and other VTE risk factors.

Methods:
From 2003-2007 REGARDS enrolled 30,239 participants aged 45+ years, who were surveyed for baseline TV viewing behavior and followed for VTE events. Daily TV viewing was categorized as <2 hours, 2 to 4 hours, and 4+ hours. Physical activity was classified as high, medium or low based on weekly number of times participants reported activity sufficient to work up a sweat. Excluding those with prebaseline VTE, log-rank tests and Cox proportional hazards models were used to describe associations, adjusting for physical activity, age, sex, BMI, race, region, C-reactive protein (CRP) and estimated glomerular filtration rate (EGFR). In a sensitivity analysis, missing data were imputed by multiple imputation with chained equations.

Results:
TV viewing was not associated with increased VTE incidence by the log-rank test (p=0.33). In multivariable models shown in Table, greater TV watching did not increase VTE risk. In the complete case and imputation analyses, established VTE risk factors (older age, male sex, obesity, and CRP) were strongly associated with VTE. Depending on the model, high or medium physical activity was either significantly protective or trended towards protective against VTE (Table).

Conclusions:
In this contemporary cohort, in contrast to earlier studies, TV watching was not associated with VTE risk after accounting for confounders including obesity and physical activity. Traditional risk factors were associated with VTE risk suggesting this is not a cohort-specific issue. Findings could be due to differences in risk factor profiles in older and newer studies or differences in measurements of TV watching.
Abstract P314: Physical Activity and Sedentary Behavior Phenotypes in a Majority-Minority Community-Based Sample: Houston TRAIN Study
Authors: Pettee Gabriel Kelley , Durand Casey P , Knell Gregory , Salvo Deborah , Dooley Erin , Johnson Ashleigh M , Kohl Harold W
Published: March 2019

Background:
Inadequate physical activity and prolonged sedentary behavior is related to premature mortality and suboptimal cardiovascular health. Yet, the health impacts of these behaviors are typically considered in isolation using a single method assessment approach. Use of accelerometer and reported data from a diverse sample provides the novel opportunity to identify and characterize distinct phenotypes to improve exposure ascertainment.

Methods:
Data are from 366 participants (61.4% female; 70.3% non-white; aged 50.7 years) enrolled in the Houston Travel Related Activity in Neighborhoods (TRAIN) Study; a natural experiment designed to determine the effect of a light rail train expansion on transit use and physical activity. Latent class analysis using baseline accelerometer (ActiGraph wGT3X-BT) and reported (self-administered, 7-day Modifiable Activity Questionnaire) data were used to derive the phenotypes and multinomial regression models were used to determine correlates of membership.

Results:
Four phenotypes emerged with the majority classified as Phenotype 4 or insufficient activity and high sedentary (
Table 1
). When compared to Phenotype 2 (reference group), women were less likely than men to be classified as Phenotype 1 or 3. Every 1 kg/m
2
increase in body mass index increases the odds of membership in Phenotype 3 or 4 when compared to Phenotype 2. Black participants were more likely, and participants identifying as mixed race were less likely, than white participants to be classified as Phenotype 3 compared to Phenotype 2 (all
p
<0.05). Age was not a significant correlate of phenotype membership.

Conclusions:
A phenotype characterized by insufficient physical activity and high sedentary behavior represented the majority of study participants. This supports continued development of physical activity interventions targeting minority groups. Study findings also support use of methodological approaches to combine accelerometer and reported data to reduce potential exposure misclassification.
Abstract P323: Youth Characteristics Related to Participation in Accelerometer-Measured Physical Activity
Authors: Delker Erin M , East Patricia , Wing David , Burrows Raquel , Reyes Susanne , Peirano Patricio , Algarin Cecilia , Gahagan Sheila
Published: March 2019

Introduction:
Accelerometer-measured physical activity is considered the ‘gold standard’ of physical activity (PA) measurement. However, previous studies have found that adults in accelerometer studies are more likely to be male, healthier and employed. Little is known about the correlates of participation among youth. We assessed characteristics associated with participation in accelerometer-measured PA among a cohort of healthy Chilean adolescents.

Methods:
Participants were 670 youth from an ongoing observational study who have been studied since infancy. The adolescent follow-up included measurement of PA with a hip-accelerometer worn for ≥10 hrs/day for ≥5 days or ≥3000 min over a 4-day period. We used multinomial logistic regression to evaluate socioeconomic, lifestyle, and cardiometabolic factors associated with providing sufficient accelerometry data (“Completers”), insufficient data (“Incompleters”), and not participating (“Non-participants”) in adolescence.

Results:
The study sample was 47% female and 17 years of age. About 33% (n=223) were Completers, 10% (n=68) were Incompleters, and 57% (n=379) were Non-participants. Completers reported lower neighborhood crime, 50% less cigarette and alcohol use, had healthier diets, healthier cholesterol, and mothers with higher IQs compared to the other two groups (all p<0.05). Incompleters did not significantly differ from Non-participants.

Conclusions:
Participants providing complete accelerometer data were not representative of the full sample; they had healthier behaviors and perceived less neighborhood crime. There may be additional unmeasured variables, such as attitudes towards the wearable device, that contributed to participation. Selective participation in studies using accelerometry inhibits generalizability and threatens internal validity when analyzing PA as a predictor of cardiometabolic outcomes. More effort is needed in the design of studies to reduce incomplete and refused participation in accelerometry.
Abstract P324: Body Mass Index, Walking Pace, and Risk of Coronary Heart Disease: a Mendelian Randomization and Mediation Analysis
Authors: Zhou Tao , Sun Dianjianyi , Li Xiang , Fan Mengyu , Heianza Yoriko , Manson JoAnn , Qi Lu
Published: March 2019

Introduction:
Being obese has been related to changes in physical fitness, such as pace-speed declination, which was recently associated with increased coronary heart disease (CHD) risk. The causal link between obesity, walking pace declination, and CHD remains to be established.

Hypothesis:
High BMI is causally related to slower walking pace, and the relationship between high BMI and CHD that is mediated by altered walking pace.

Methods:
Data form UK biobank including 408,836 white British participants (enrolled from 2006 to 2010) was used in this study. The usual walking pace was self-reported as slow, steady/average, and brisk, among 352,663 participants with 3,634 CHD cases (enrolled from 2006 to 2010 and followed up to 2016). The causal relation between BMI and walking pace was assessed by Mendelian randomization analysis using 97 BMI related single-nucleotide polymorphisms. A further mediation analysis was performed to assess the association between BMI, walking pace, and incident CHD.

Results and Conclusions:
In Mendelian randomization analysis performed among 408,836 individuals in the UK Biobank (baseline mean [SD] age, 56.8 [8.0] years; 54.1% (221,196 of 408,836) women), we found a significant causal relationship between genetically instrumented higher BMI and slower walking pace (odds ratio: 1.58, 95% CI: 1.45-1.71, per 1 SD increase in BMI), independent of age, sex, socioeconomic status, alcohol intake, and smoking. In mediation analysis, we found that slow and average walking pace was estimated to mediate 29% and 19% of the association between BMI and incident CHD, respectively, compared with brisk walking pace (p<.001). In conclusion, our results indicate that higher BMI may be causally related to a slower walking pace, which mediates a significant proportion of the association between high BMI and CHD risk.
Abstract P328: Domain-Specific Physical Activity and Blood Pressure in 125,402 Adults: The Lifelines Cohort
Authors: Byambasukh Oyuntugs , Snieder Harold , Corpeleijn Eva
Published: March 2019

Introduction:
Whether all domains of daily-life physical activity are associated with lower blood pressure (BP) and how this association depends on age and weight status remains unclear.

Methods:
In this population-based Lifelines cohort (N=125,402), moderate-to-vigorous physical activity (MVPA) was assessed by the SQUASH, a validated questionnaire in different domains such as commuting (CPA), leisure-time (LTPA) and occupational PA (OPA). BP was assessed using the last three of ten measurements after 10 minutes rest in supine position. Hypertension was defined as systolic BP (SBP)>=140 mmHg or/and diastolic BP (DBP)>=90 mmHg or/and use of antihypertensive medication. The exclusion was previously diagnosed cardiovascular disease. Regression analysis was adjusted for age, gender, education, smoking status, and alcohol consumption.

Results:
CPA and LTPA were inversely associated with BP. Commuting-and-leisure-time MVPA was associated with BP in a dose-dependent manner. Beta-coefficients (95%CI) were -1.55 (-1.94;-1.16), -2.17 (-2.56;-1.78) and finally -2.75 (-3.13;-2.36) mmHg SBP for the low, middle and highest tertile of commuting-and-leisure-time MVPA compared to ‘No MVPA’ as the reference group, respectively. There was no significant association between OPA and the risk of hypertension. Further adjustment for BMI attenuated the associations by 30-50%, but more commuting-and-leisure-time MVPA remained significantly associated with lower BP and risk of hypertension. The association between commuting-and-leisure-time MVPA and SBP was age-dependent. Beta-coefficients (95%CI) for highest tertiles of commuting-and-leisure-time MVPA were -1.25 (-1.73;-0.78) and -3.76 (-5.24;2.28) in adults <40 and >60 years, respectively.

Conclusion:
Commuting-and-leisure-time MVPA was significantly associated with reduced BP and lower risk of having hypertension to a similar degree over most ages except for a stronger association between commuting-and-leisure-time MVPA and SBP with older ages.
Abstract P329: Neighborhood Social Cohesion Partially Mediates the Association Between Seeing People Walk and Leisure-Time Walking in Latino Adults
Authors: Murillo Rosenda , Desai Shreya , Reesor Layton M , Hernandez Daphne C
Published: March 2019

Introduction:
Higher frequency of seeing others exercise is associated with higher leisure-time (LT) physical activity. However, few studies have examined the association between frequency of seeing people walk within sight of home and LT walking among Latino adults. Moreover, the extent to which neighborhood social cohesion mediates the relationship between seeing people walk and LT walking is unknown. We examined the association between frequency of seeing people walk and LT walking, and tested whether neighborhood social cohesion mediated this association.

Hypothesis:
We hypothesized that higher frequency of seeing people walk within sight of home would be associated with higher LT walking, and that neighborhood social cohesion would mediate this association.

Methods:
We used cross-sectional data from 4,756 NHIS 2015 Latino participants aged 18+ years. Logistic regression models were used to estimate the association between frequency of seeing people walk (every day, every 2-3 days, and once a week versus less than once a week) and LT walking level (high and medium versus low). Models were adjusted for age, sex, education, and acculturation proxies (based on nativity, years living in the US). Indirect effects were assessed using bootstrap methods outlined by Preacher and Hayes, to quantify the extent to which neighborhood social cohesion mediates the association of seeing people walk with LT walking.

Results:
In adjusted models, those seeing people walk every day, and about once per week were significantly more likely to engage in medium levels of LT walking, relative to low (Odds Ratio [OR]: 2.07; 95% Confidence Interval [CI]: 1.40, 3.06, and OR: 1.96; 95% CI: (1.15, 3.34), respectively). Individuals seeing people walk every day and every 2-3 days were more likely to engage in high levels of LT walking (OR: 2.79; 95% CI: 2.02, 3.85, and OR: 1.98; 95% CI: (1.28, 3.07), respectively). The direct effects of seeing people walk every day (
b=
0.06, CI [0.02, 0.11]), every 2-3 days (
b=
0.07, CI [0.00, 0.14]), and once a week (
b=
0.11, CI [0.03, 0.18]), on medium levels of LT walking were significant. The direct effects of seeing people walk every day (
b=
0.10, CI [0.06, 0.13]), and every 2-3 days (
b=
0.05, CI [0.00, 0.10]) on high levels of LT walking were significant. Indirect effects indicate that neighborhood social cohesion was only a significant mediator of the association between seeing people walk every day on medium levels of LT walking (
b
=0.004, CI [0.00, 0.01]), accounting for 6% of the total effect of seeing people walk every day on LT walking (
b=
0.07, CI [0.01,0.14]).

Conclusions:
These findings suggest that higher neighborhood social cohesion may account for a portion of the contribution of frequency of seeing people walk within sight of home on LT walking among Latino adults. However, the mediation results suggest that other factors may be more pertinent.
Abstract P330: Excluding Participants With Missing or Incomplete Accelerometry Data: Evaluating the Potential for Bias
Authors: Delker Erin , Pampano Laura , Bellettiere John
Published: March 2019

Background:
Investigating the effect of physical activity (PA) on health has been improved with accelerometry. However, accelerometer measurement may increase participant burden, leading some to not wear devices. Previous research suggests that participants who do not wear accelerometers may be less active and have worse health outcomes than those who adhere to measurement protocol. This selection bias may lead to underestimates of the true association between PA and CVD outcomes. Using simulations, we illustrate how the association of meeting WHO PA guidelines and hypertension (HT) might be impacted by missing accelerometry data.

Methods:
Based on observed prevalence of PA and HT in an ongoing cohort study, we simulated data with 2000 participants, with 40% not meeting PA guidelines and 10% having HT. We set the “true” association between not meeting PA guidelines and HT at 1.9 (OR=1.9; 95% CI=1.5, 2.5). Then, we simulated scenarios to show the impact of four different patterns of missing accelerometer data: A) Missingness independent of PA and HT; B) Missingness associated with PA only; C) Missingness associated with HT only; D) Missingness associated with PA and HT. For each scenario, we conducted complete cases analyses using simple logistic regression to assess associations between meeting PA guidelines and HT.

Results:
Odds ratios (ORs) in Scenarios A, B, and C were unbiased. ORs in Scenario D underestimated the magnitude of the “true” association and were increasingly attenuated as the strength of the relationship between study variables and missingness was increased.

Conclusions:
Accelerometer measurement may result in missing data, which can bias odds ratio estimates if the missingness is associated with both the exposure and outcome, a scenario reported in previous research. Efforts to minimize missing data during study design should be prioritized. Carefully considering the structure of missingness in analyses will inform quantification of potential bias, analytic strategies, and interpretation of findings.
Abstract P331: Unfavorable Social Factors Increased the Risk of Future Disability Subsequent to Heart Failure in Elderly Japanese Community Dwellers: The Iwate KENCO Study Group
Authors: Takahashi Shuko , Tanno Kozo , Yonekura Yuki , Tanaka Fumitaka , Ohsawa Masaki , Nakamura Motoyuki , Kuribayashi Toru , Onoda Toshiyuki , Sakata Kiyomi , Koshiyama Makoto , Itai Kazuyoshi , Okayama Akira
Published: March 2019

Introduction:
The risk factors that contribute to future disability after heart failure (HF) are poorly understood. The aim of this study was to determine the risk factors of future disability subsequent to HF in the general elderly population in Japan.

Hypothesis:
We assessed the hypothesis that unfavorable social factors after than traditional cardiovascular risk factors contribute to an increased risk for disability after HF.

Methods:
The subjects were community-dwelling elderly individuals aged 65 years or older without a history of cardiovascular diseases. We defined disabled subjects as individuals who had been newly certified by the long-term care insurance (LTCI) system during the observation period. HF was diagnosed according to the Framingham diagnostic criteria. After excluding subjects who received LTCI without HF (n= 2,305) and subjects who had already received LTCI prior to HF onset (n=33), we classified the remaining subjects (n= 4,644) into 3 groups: event-free (no LTCI and no HF; n= 4,548, mean age = 70.1 years at the baseline survey), no LTCI after HF (n= 52, mean age = 72.3 years) and LTCI after HF (n= 44, mean age =74.6 years). We determined the multivariate-adjusted odds ratio (OR) for having each risk factor (male gender, age (increment of years), unmarried status, less educational years (<7 years), no job status, smoking, drinking, hypertension, diabetes mellitus and dyslipidemia) in the latter two groups (reference: event-free) using polytomous logistic regression analysis.

Results:
The median follow-up period was 10.6 years (49,133 person-years), and the median period [interquartile range] from the incidence of HF to the certification for LTCI was 1.3 [0.3- 4.7] years. Significantly associated risk factors were more advanced age (OR [95% confidence intervals]:1.18 [1.10-1.25]), unmarried status (2.29 [1.14- 4.63]), less educational years (3.36 [1.72-6.55]) and regular drinking (2.58 [1.13- 5.88]) in the group of LTC after HF, while the risk factor was more advanced age (1.08 [1.02-1.15]) in the group of no LTCI after HF.

Conclusion:
The results suggested that unfavorable social risk factors such as unmarried status, shorter education period and regular drinking strongly contributed to the higher risk of disability subsequent to HF, while those unfavorable risk factors did not contribute to the risk of incident HF without LTCI. Preventive measures must be taken to protect elderly individuals with unfavorable social factors from disability after HF via a multidisciplinary approach.