bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P027: Gamma-Glutamyl Transferase is More Strongly Associated with Diabetes Risk Than Alanine and Aspartate Aminotransferase: Results from the Atherosclerosis Risk in Communities (ARIC) StudyStudy
Authors: Christman Andrea L , Lazo Mariana , Ndumele Chiadi E , Pankow James , Coresh Josef , Clark Jeanne M , Selvin Elizabeth
Published: July 2021

Introduction:
Liver disease and diabetes often co-occur and have shared risk factors. We undertook this study to investigate which liver enzyme (alanine aminotransferase (ALT), aspartate aminotransferase (AST), or gamma-glutamyl transferase (GGT)) would be most strongly associated with incident diabetes in a large, community-based population.

Hypothesis:
We hypothesized that ALT, AST, and GGT would be independently associated with diabetes and that ALT would be most strongly associated with diabetes due to its liver specificity.

Methods:
We conducted a prospective analysis of 9,524 participants in the ARIC Study without diagnosed diabetes or a history of high alcohol consumption (>14 [women] and >21 [men] drinks/week). Enzymes were measured from stored plasma samples. We examined the association of sex-specific quartiles of liver enzymes with incident diagnosed diabetes using Cox proportional hazards models adjusted for demographic, lifestyle, and behavioral risk factors. Restricted cubic spline models were fit to model the continuous associations.

Results:
Median ALT, AST, and GGT were 13, 18, and 22 U/L, respectively. During a median follow-up of 11 years, there were 1,905 self-reported cases of diabetes. All three liver enzymes were significantly associated with diabetes, even after adjustment for all covariates (HRs (95% CIs): ALT, 1.63 (1.44, 1.85); AST, 1.23 (1.09, 1.40); GGT, 1.99 (1.71, 2.30) comparing Q4 versus Q1). The restricted cubic spline models show similar patterns (Figure). After simultaneously adjustment for the other liver enzymes, only ALT and GGT remained significantly associated with diabetes. In analyses further restricted to participants who reported never consuming alcohol only GGT remained significant.

Conclusion:
In this community-based population, GGT was more strongly associated with diabetes risk than ALT and AST. Although ALT and AST are considered to be more specific markers of liver disease, higher levels of GGT may be a more important risk factor for diabetes.
Abstract P033: Biomarkers Relation to Prevalent Metabolic Syndrome in African Americans: A Multimarker Approach
Authors: Balfour Pelbreton C , Musani Solomon K , Bidulescu Aurelian , Washington Floyd , Taylor Herman A , Ramachandran Vasan S , Fox Ervin R
Published: July 2021

Introduction:
Multiple biological pathways have been related to metabolic syndrome (MetS) in both human and animal models. Whether biomarkers representing these pathways are associated with MetS has not been thoroughly investigated in African Americans.

Hypothesis:
We tested the hypothesis that at least one biomarker from a panel of seven biomarkers representing inflammatory (high sensitivity C-reactive protein; leptin), neuro-hormonal activation (aldosterone, B-natriuretic peptide, BNP; cortisol), and endothelial dysfunction (endothelin; homocysteine) are associated with prevalent metabolic syndrome in a large African American sample population.

Methods:
This study consisted of a total of 4,006 Jackson Heart Study participants (53±13 years, 64% female) that attended two consecutive examination cycles five (4.7±0.8) years apart. Prevalent MetS was defined as the presence of at least 3 of the following conditions: elevated BP (≥ 130 mm Hg systolic, ≥ 85 mm Hg diastolic or treatment with antihypertensive medications); increased waist circumference (≥ 102 cm in mean or ≥ 88 cm in women); hyperglycemia (fasting glucose ≥ 100 mg/ dL) or treatment with oral hypoglycemic agents or insulin; hypertriglyceridemia (≥ 150 mg/dL) or treatment with lipid lowering agents, and low HDL cholesterol (< 40 mg/dL in men, < 50 mg/dL in women). We used backward selection in multiple logistic regression models to identify biomarkers significantly associated with MetS. To account for effect of clinical correlates, we forced age, sex, waist circumference, systolic and diastolic pressures, fasting glucose and log triglycerides into the model.

Results:
Prevalent MetS was 27 % in the entire JHS participants (70% of which were women). Most participants had elevated blood pressure (85%), followed by high waist circumference (28 %) and HDL-cholesterol (20 %). We observed that prevalent metabolic syndrome was significantly associated with serum leptin (P<0.0001) and aldosterone (P<0.0001) after accounting for clinical correlates. Estimated effects, odds ratios (95% confidence interval) were 1.62 (1.38, 1.91) and 1.28 (1.13, 1.40) for serum leptin concentration and aldosterone, respectively.

Conclusions:
In this large community-based epidemiological study we found using a multimarker approach that serum leptin and aldosterone are significantly related to prevalent MetS. These findings support the role of inflammation and neuro-hormonal transmitters in this clinical syndrome in African Americans. Further studies are needed to identify whether these markers predict incident metabolic syndrome and can serve as targets for medical therapy and clinical management.
Abstract P050: Reproducibility of Blood Pressure Responses to Dietary Sodium and Potassium Interventions: the GenSalt Study
Authors: He Jiang , Gu Dongfeng , Chen Jichun , Zhao Qi , Bazzano Lydia A , Huang Jianfeng , Li Jianxin , Lu Fanghong , Mu Jianjun , Rice Treva , Rao DC , Chen Chung-Shiuan , Hamm L. L , Chen Jing
Published: July 2021

Blood pressure (BP) responses to dietary sodium and potassium interventions vary among individuals (salt- and potassium-sensitivity). However, it is unknown whether salt- and/or potassium-sensitivity is a reproducible trait. We repeated the dietary sodium and potassium intervention among 488 Han Chinese who participated in the Genetic Epidemiology Network of Salt Sensitivity (GenSalt) four years after the original dietary intervention. The same dietary intervention protocol, which included a 7-day low sodium-feeding (51.3 mmol/day), a 7-day high sodium-feeding (307.8 mmol/day), and a 7-day high sodium-feeding with an oral potassium supplementation (60 mmol/day), was applied in both the original and repeated studies. Three BP measurements were obtained during each of the 3 days of baseline observation and on days 5, 6, and 7 of each intervention period. Three timed urinary samples were collected to measure sodium and potassium excretion at baseline and during each intervention phase. On average, study participants were 39.7 years old and 49.4% of them were male. Study participants had a mean body mass index of 23.7 kg/m
2
, systolic BP of 118.1 mmHg, diastolic BP of 74.4 mmHg, urinary excretion of sodium of 258.8 mmol/24-hrs, and urinary excretion of potassium of 38.8 mmol/24-hrs. The results from the 24-h urinary excretions of sodium and potassium showed excellent compliance with the study diet. BP responses to dietary intervention in the original and repeated studies were highly correlated. For example, the correlation coefficients for systolic BP between original and repeated studies were 0.7681 at baseline, 0.7902 during low-sodium, 0.8045 during high-sodium, and 0.8232 during high-sodium and potassium supplementation intervention (all p<0.0001). The correlation coefficients for systolic BP changes between original and repeated studies were 0.3659 from baseline to low-sodium, 0.3655 from low to high-sodium, and 0.2850 from high-sodium to potassium supplementation (all p<0.0001). These data indicate that BP responses to dietary sodium and potassium intervention are reproducible traits. Furthermore, our study suggests that identification of individuals who are more sensitive to dietary sodium and potassium intake may improve the efficiency of targeted dietary intervention for hypertension prevention among high-risk individuals.
Abstract P067: Association of Number of Eating Episodes per Day with Blood Pressure: INTERMAP Study
Authors: Aljuraiban Ghadeer S , Chan Queenie , Brown Ian , Daviglus Martha , Stamler Jeremiah , Van Horn Linda , Elliott Paul , Frost Gary ,   INTERMAP Rsch Group
Published: July 2021

Background:
Greater meal frequency per day may relate favorably to blood pressure (BP) levels of individuals.

Aims:
Explore associations of BP with frequency of food intake and meal timing among American participants of the INTERMAP Study. Whether differential nutrient intakes are contributing to observed BP differences is also explored.

Methods:
The INTERMAP Study is a cross-sectional epidemiologic investigation of 4,680 men and women ages 40–59 years in China, Japan, United Kingdom and United States (US). Data include findings from four 24-hour dietary recalls, two 24-hour urine collections, 8 BP measurements and health history questionnaires. Meals and snacks will be referred to as “eating episodes” (EP), where an eating episode is an intake of energy separated from the previous intake of food by a period of time.

Results:
Among 2,195 US participants, mean number of EP was 5.8 (SD 1.7) and average energy/EP was 423.0 kcal (SD 160.6) per day. About 57% of participants had less than 6 EP per day and had significantly higher systolic BP (SBP) compared to 43% of participants having 6 or more EP per day (119.3 mmHg, SD 13.9 vs. 117.7 mmHg, SD 13.9 P=0.01). Mean energy/EP, adjusted for sex, age, population sample and body mass index (BMI), was significantly higher among those having less than 6 EP per day then those with 6 or more EP per day (P<0.0001). Association of average number of EP with SBP was consistently negative in linear regression models adjusted for energy, sex, age, BMI, special diet, physical activity, cigarette smoking, and family history of hypertension (b=−0.04, P=0.04).

Conclusions:
Smaller more frequent intake of meals/snacks relates favorably to BP levels. Several mechanisms may be involved, e.g., improved glucose tolerance and insulin sensitivity, with spreading food intake throughout the day.
Abstract P072: Most U. S. adults do not meet dietary guidelines for sodium and potassium, National Health and Nutrition Examination Survey, 2003-2008
Authors: Cogswell Mary , Zhang Zefeng , Carriquiry Alicia , Gunn Janelle , Kuklina Elena , Saydah Sharon , Yang Quanhe , Moshfegh Alanna
Published: July 2021

Introduction:
The 2010 Dietary Guidelines recommend Americans reduce sodium intake and choose foods that contain potassium to decrease the risk of hypertension and subsequent heart disease and stroke. Limited data exist on the proportion of U.S. adults who meet the 2010 Dietary Guidelines for Americans for sodium and potassium.

Hypothesis:
We hypothesized that the majority of U.S. adults do not meet the 2010 Dietary Guidelines for sodium and potassium.

Methods:
We used 24-hour dietary recalls and other data from 12,581 non-institutionalized adults aged > 20 years who participated in the National Health and Nutrition Examination Survey in 2003–2008. We estimated the distributions of usual daily sodium and potassium intakes by sociodemographic and health characteristics relative to the 2010 Dietary Guidelines. Health characteristics included hypertension (use of anti-hypertensive medications, systolic blood pressure > 140 mm Hg or diastolic blood pressure > 90 mm Hg), diagnosed (self report) or undiagnosed diabetes (fasting plasma glucose > 126 mg/dL or glycohemoglobin > 6.5%), and chronic kidney disease (defined by estimated glomerular filtration rate <60 mL/min/1.73 m
2
or urine albumin-creatinine ratio > 30 mg/g). Estimates of usual sodium and potassium intake were adjusted for within-individual, day-to-day variation using measurement error models (Software for Intake Distribution Estimation) with two-24 hour diet recalls on 89.6% of our sample. Standard errors and ninety-five percent confidence intervals were assessed using jack-knife replicate weights.

Results:
Overall, 99.4% (95% confidence interval [CI], 99.3%, 99.5%) and 90.7% (89.6%, 91.8%) of U.S. adults consumed >1500 mg and > 2300 mg sodium daily, respectively. Among U.S. adults recommended to reduce sodium to 1500 mg daily (i.e., African-Americans, age >51 years, or persons with hypertension, diabetes, or chronic kidney disease), 98.8% (98.4%, 99.2%) consumed >1500 mg daily and 60.4% consumed more than double the recommendation, >3000 mg daily. Regardless of sex, age, race-ethnicity, income, education, body mass index, hypertension, diabetes, or chronic kidney disease more than 84% of adults consumed sodium in excess of guidelines. Overall, less than 2% of U.S. adults and ∼5% of U.S. men consumed > 4700 mg potassium daily, i.e., meeting 2010 Dietary Guidelines for potassium.

Conclusions:
Limitations of our analyses include estimation of nutrient intake from 24-hour diet recalls and inability to account for salt added at the table or from supplements, potentially resulting in an underestimation of sodium and potassium intake. In conclusion, most U.S. adults consume too much sodium and too little potassium.
Abstract P078: Contribution of Nutrients from Consumption of Low/Non-Fat/Light Ice Cream and Frozen Yogurt versus Regular Ice Cream to Total Daily Nutrient Intake
Authors: Smerling Jessica , Balentine Douglas , Kearney Mary , Scrafford Carolyn , Barraj Leila , Bi Xiaoyu
Published: July 2021

Objective:
The impact on nutrient intake of replacing regular ice cream with low/non-fat/light ice cream and frozen yogurt (lower fat ice cream) is heretofore unknown. The objective of this study was to evaluate the contribution of daily nutrient intake from ice cream consumption to total daily dietary nutrient intake.

Methods:
Food intake and frequency of consumption data were based on the National Health and Nutrition Examination Survey (NHANES) (2003–2004 and 2005–2006) and nutrient composition data from the United States Department of Agriculture (USDA) Food and Nutrient Database for Dietary Studies (FNDDS). The NHANES datasets provide nationally representative nutrition and health data of the civilian U.S. population. A total of 16,783 individuals in the 2003–2006 survey periods provided 2 complete days of dietary recalls and nutrient intake estimates were derived using 2-day average intake analysis.

Results:
Mean consumption of regular and lower fat ice cream products in the US population was 68.5 and 77.1 grams/day, respectively and frequency of consumption was 0.2 and 0.22 eating occasion/day, respectively among consumers of ice cream. Figure 1 reveals that lower fat ice cream contributed equal or greater amounts of calcium, phosphorus, potassium, riboflavin, and niacin to daily nutrient intakes for the U.S. population when compared with regular ice cream, with the exception of vitamin D. Alternatively, lower fat ice cream contributed lesser amounts of energy, saturated fat, and added sugar to daily nutrient intakes when compared to regular ice cream; lower fat ice cream contributed 56% less saturated fat to daily nutrient intake compared to regular ice cream.

Conclusion:
Consumers of low/non-fat/light ice cream and frozen yogurt had lower percent contribution of saturated fat to total daily nutrient intake compared to users of regular ice cream.
Figure 1
Abstract P087: Association of Psychological Well-Being With Cardiac Repolarization
Authors: Shah Amit J , Carney Robert , Soliman Elsayed Z , Vaccarino Viola
Published: July 2021

Background:
Abnormal frontal T-axis is an independent predictor of mortality, and may be influenced by increased sympathetic tone and cardiovascular disease risk factors. Factors related to poor psychological health, such as depression, are associated with increased risk of CVD morbidity, although the mechanisms are not clear. We tested the hypothesis that: 1) reduced psychological wellness is associated with abnormal T-axis and 2) this association may help to explain the excess risk of CVD morbidity and mortality related to poor psychological health.

Methods:
We studied 4485 community-based adults aged 25–65 years without a history of CVD from NHANES I (1971–75) who were monitored for CVD hospitalization and death until 1993. Those with ECG evidence of previous MI, left ventricular hypertrophy, and major ventricular conduction defects (QRS interval ≥ 120 ms) were excluded. Frontal T-axis was obtained through 12-lead ECG, and a deviation of ≥ 30° from normal (45°) was considered abnormal. Psychological well-being was measured with the General Well-Being Scale (GWB).

Results:
The mean ± SD age was 43.1 ± 11.5 years and 55% were women. The mean ± SD GWB score was 80.5 ± 17.3, the median frontal T-axis was 51°, and 13% had an abnormal T-axis. In cross-sectional analysis adjusting for age, sex, and race, a 1-SD decrease in GWB was associated with an OR of 1.12 for abnormal T-axis (p=0.01). This effect was unchanged after adjusting for systolic blood pressure, smoking, diabetes, total cholesterol, and BMI. Abnormal T-axis was associated with CVD hospitalization/death (adjusted HR 1.29, p=0.01), as was GWB (adjusted HR 1.104 per 1-SD decrease, p=0.01). When both factors were included in the model, the HR of GWB decreased by 8% to 1.096 (p=0.02).

Conclusion:
Abnormal frontal T-axis is modestly but significantly associated with reduced psychological wellness. Although this association may help understand neurocardiac relationships, it does not substantially explain morbidity and mortality associated with reduced psychological wellness.
Abstract P090: The Effect of Bupropion on Symptoms of Depression Among Patients Attempting to Quit Smoking Post-Myocardial Infarction: The ZESCA Trial
Authors: Filion Kristian B , Grandi Sonia M , Joseph Lawrence , O'Loughlin Jennifer , Paradis Gilles , Pilote Louise , Rinfret Stéphane , Eisenberg Mark J ,   The ZESCA Investigators
Published: July 2021

Background:
Bupropion is a smoking cessation drug that can be prescribed immediately following a myocardial infarction (MI). Depression is prevalent during this period, and bupropion, which can also be prescribed as an anti-depressant, may improve symptoms of depression in this population.

Methods:
The ZESCA Trial is a randomized, double-blind, placebo-controlled trial that examined the efficacy of bupropion as a smoking cessation therapy in 392 hospitalized MI patients. Treatment duration was 9 weeks, and follow-up was 12 months. Depressive symptomatology was defined by a Beck Depression Inventory-II (BDI-II) score > 14. A total of 4 patients were missing baseline BDI-II scores and were excluded from this analysis. Differences in changes in depressive symptomatology from baseline were examined overall and in those with symptoms of depression at baseline.

Results:
The mean age was 53.9 years (standard deviation [SD] = 10.3), and 84% were male. A total of 20% of patients had depressive symptomatology at baseline. The median BDI-II score was 6.0 (inter-quartile range [IQR] = 2.0, 12.0) overall and 19.0 (16.0, 25.0) among those with depressive symptomatology at baseline. The mean BDI-II score was similar between treatment groups throughout the follow-up period (Figure). Similarly, there were no differences in BDI-II score between treatment groups at baseline or 9 weeks when restricted to those with depressive symptomatology at baseline. In this group, patients randomized to bupropion had a higher BDI-II score at 12 months (bupropion - placebo = 5.98, 95% confidence interval = 0.92, 11.04); the difference is likely due to differential participation at 12 months. At all follow-up visits, there were no differences in change in BDI-II score between treatment groups, both in the overall study population and in those with depressive symptomatology at baseline.

Conclusions:
Our results suggest that bupropion does not improve symptoms of depression in patients who are attempting to quit smoking post-MI.
Abstract P099: The Relation of Kidney Disease to Measures of Digital Arterial Tonometry in the Jackson Heart Study
Authors: McClendon Eric , Musani Solomon , Khaire Sushante , Taylor Herman , Fox Ervin
Published: July 2021

Background:
The presence of chronic kidney disease is greater in African Americans than in non-Hispanic whites. Though there is data to show a relation between endothelial dysfunction and end-stage kidney disease, the relation to mild and moderate chronic kidney disease (particularly in African Americans) is unclear.

Methods and Results:
Digital arterial tonometry was performed during Exam 2 and 3 of the Jackson Heart Study using the endoPAT2000. Data from digital arterial tonometry included baseline pulse wave amplitude (BPA) as a measure of endothelial tone and reactive hyperemic index (F-RHI) as a measure of endothelial function. For this study, the estimated glomerular filtration rate (eGFR) was calculated using the MDRD equation. Those participants with eGFR < 60 ml/min/1.73m2 were defined as having CKD. Participants with eGFR < 15 ml/min/1.73m2 were excluded from the analysis. Microalbuminuria in this study was defined as a urinary albumin:creatinine ratio ≥ 17mg/g in men and ≥ 25 mg/g in women. We compared the differences in least square means adjusted for age and sex, and adjusted for multiple traditional clinical covariates using a generalized linear model.

Results:
There were 834 participants in the study population (mean age 58.5 years, 61% women); 87 (10.4%) participants with CKD and 108 (13.0%) with microalbuminuria. In age and sex adjusted samples, we found that both BPA and F-RHI were significantly associated with CKD in the pooled samples. However in multivariable adjusted analysis the relation was no longer significant in either the pooled or sex-specific samples. In the multivariable adusted analysis,BPA was significantly (P=0.036) associated with microalbuminuria in men and F-RHI was weakly significantly (P=0.08) associated with microalbuminuria in women.

Conclusion:
We found that endothelial dysfunction as measured by digital arterial tonometry is not significantly associated with chronic kidney disease. There is an association of endothelial tone in men and endothelial dysfunction in women with microalbuminuria.
Abstract P102: Circulating Adipocytokines and Risk of Chronic Kidney Disease
Authors: Mills Katherine T , Hamm L Lee , Alper Brent , Miller Chad , Hudaihed Alhakam , Balamuthusamy Saravanan , Chen Chung-Shiuan , Liu Yanxi , Tarsia Joseph , Rifai Nader , Kleinpeter Myra , Chen Jing
Published: July 2021

Recent studies have found a link between obesity and chronic kidney disease (CKD). However, the mechanism for this association is not well understood. Obesity-related CKD may be partially mediated by adipocytokines, including leptin, resistin, and adiponectin. In this study we investigated the association of plasma leptin, resistin and adiponectin with risk of CKD in 201 cases with CKD and 201 controls without. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 or presence of albuminuria. Median levels of adipocytokines and odds ratios of CKD were estimated and adjusted for age, gender, race, smoking, drinking, education, physical activity, systolic blood pressure, glucose, low-density lipoprotein cholesterol, and body mass index. Compared to controls, adjusted median plasma leptin (38,385 vs. 17,303 ng/mL, p<0.0001) and resistin (15.0 vs. 8.0 ng/mL, p<0.0001) were significantly higher in CKD cases. The median ratio of high molecular weight adiponectin to total adiponectin was lower in cases than in controls (0.38 vs. 0.43, p=0.0001). The odds ratios (OR) for CKD comparing the highest third to the lowest two thirds of leptin was 4.7 (95% CI, 2.2, 9.8) and of resistin was 17.0 (95% CI, 8.4, 34.2). A non-significant weak inverse effect was seen when comparing the highest third to the lowest two thirds of the adiponectin ratio with an OR of 0.8 (95% CI, 0.4, 1.3). The results did not change substantially after further adjustment for history of cardiovascular disease. Our study found that increased leptin and resistin are associated with an increased risk of CKD. In conclusion, these findings suggest that adipocytokines may play a role in the etiology of CKD. Longitudinal studies are warranted to further evaluate the causal relationship of these adipocytokines with development of CKD.
Abstract P127: Factors related to Medication Non-Adherence for Patients with Hypertension in Taiwan
Authors: Li Wen Wen , Hsu Hsin-Tien , Hwang Shiow-Li
Published: July 2021

Purpose:
To characterize a Taiwanese population and to examine the prevalence of non-adherence to antihypertensive medications and whether cultural (e.g., use of Chinese herbs) and clinical factors (e.g., number of antihypertensive medications) were associated with non-adherence in Taiwan.

Significance:
Non-adherence to antihypertensive medications is a significant clinical problem in Taiwan. However, little is known about hypertension (HTN) control and cultural and clinical factors related to non-adherence in Taiwanese.

Design:
Cross-sectional study design.

Sample:
A convenience sample of 200 participants were recruited from a large teaching hospital (6800 beds) in Northern Taiwan. Inclusion criteria were: Adult ≥18 years old, taking antihypertensive medications at least once daily and being able to speak Mandarin.

Methods:
Following a routine medical visit, participants were consented. Study measures included seven, self-administered questionnaires on cultural and clinical factors. Blood pressure (BP) was taken twice and the averaged BP was calculated. BP control was defined as <140/90mmHg. A total score ≥80% of the highest score of medication adherence scale by Morisky’s et al. was defined as adherence.

Results:
The mean age of the participants was 60.4 (±11.5 years); 62% were male. Two thirds (64.5%) had less than a high school education. The majority (86.0%) were married and lived with family or close friends (93.5%). The averaged length of HTN diagnosis was 8.6 years (±9.0 years). Medication non-adherence rate was 47.5% and uncontrolled HTN rate was 49.0%. Seventeen percent used Chinese herbs for treating their disease (e.g., cough) and promoting health in addition to their regular antihypertensive medications. Statistically significant factors associated with medication non-adherence were: (1) Lower Perceived Susceptibility to HTN-related complications [OR=1.15 (95% CI 1.01, 1.31)]; and (2) Longer Length of HTN Diagnosis [OR=1.06 (95%CI 1.01, 1.12)].

Conclusions:
Non-adherence medication rates were, 47.5%, in the Taiwanese compared to only 20% for US population. In turn, inadequate HTN control was 49% for Taiwanese and 30% for the general US population. Taiwanese who are at risk for non-adherence are those individuals who perceived a lower susceptibility to HTN-related complications or had a longer (in years) diagnosis of HTN. Further studies are needed to identify the influence of herbs on adherence behavior.

Implications:
These findings indicate that culturally sensitive and clinically appropriate nursing interventions for HTN management in Taiwanese are essential if non-adherence to the antihypertensive medications is to be managed.
Abstract P134: Higher Optimal Lifestyle Score is Associated with Greater Workplace Productivity
Authors: Boucher Jackie L , VanWormer Jeffrey J , Britt Heather R , Peacock James M , Graham Kevin J
Published: July 2021

Introduction:
Unhealthy lifestyles are associated with low workplace productivity, but lifestyle risks tend to cluster and the impact of this is not well studied. This analysis examined the cross-sectional association between an optimal lifestyle score (OLS) and overall workplace productivity in the Heart of New Ulm Project.

Hypothesis:
It was hypothesized that a higher OLS would be associated with higher workplace productivity relative to a lower OLS.

Methods:
Complete data was available from 2,987 adults age 18-85 years (with ≥0.40 FTE work agreement) without self-reported diabetes or heart disease, who underwent a cardiovascular risk factor screening in 2009. For each participant, an OLS of 0-4 total points was created by summing one point for each of the following factors: non-smoker, ≥150 min/wk of moderately equivalent physical activity, 1-14 alcoholic drinks/wk, and ≥5 serv/d of fruits and vegetables. Overall productivity loss combined absenteeism and presenteeism from the Work Productivity and Activity Impairment questionnaire, reflecting the percentage loss of all available work hours (per work agreement) due to health reasons.

Results:
After adjustment for age, sex, body mass index, and Perceived Stress Scale score, least squares adjusted mean±SE productivity loss was 9.9±1.9% for an OLS of 0, 5.7±0.6% for an OLS of 1, 4.9±0.4% for an OLS of 2, 4.9±0.4% for an OLS of 3, and 4.7±1.0% for an OLS of 4 (p for trend <0.001). Post hoc comparisons revealed that OLS’s of 0 were significantly different (p =0.05) from all other OLS’s, while OLS’s of 1, 2, 3, or 4 were statistically indistinguishable (p=0.05) from one another.

Conclusions:
A beneficial threshold of having at least one optimal lifestyle factor was observed. When productivity loss is converted to lost dollars under the assumptions that all employees work full time with an annual salary of $50,000, an OLS of 0 (-$4,950/employee) has over two-fold higher annual estimated workplace productivity losses relative to an OLS of 4 (-$2,350/employee). Employees with no optimal lifestyle habits, however, represent a very small proportion (1.5% of this analysis; 46 of 2,987) of the total workforce. As such, greater absolute economic benefits may be realized by focusing interventions primarily on supporting the maintenance of existing optimal lifestyle habits.
Abstract P152: Do Self-reported Race, Socioeconomic Status And Genetic Ancestry Influence Fasting Glucose? Preliminary Results From the Ongoing Bach Prediabetes Study
Authors: Meigs James B , Miyasoto Gavin , Porneala Bianca , Marceau Lisa , McKinlay John B
Published: July 2021

Background:
Race/ethnic disparities in type 2 diabetes (T2D) may have both biophysical and social determinants that likely arise before T2D diagnosis. We examined the association of self-reported (SR) race/ethnicity, socioeconomic status (SES) and genetic ancestry with levels of fasting glucose (FG) in individuals not known to have T2D.

Methods:
The Boston Area Community Health (BACH) Prediabetes study is an ongoing epidemiologic survey of community-dwelling residents of inner-city Boston. A stratified random sample of 3,300 subjects are being drawn from the parent BACH cohort study, recruiting approximately equal numbers in pre-specified age (30–79 years), sex and race/ethnicity groups. Fasting blood is collected, including FG, other health and SES information, during an early AM in-home interview. SES is measured as a standardized composite score of income and education. Genetic ancestry informative markers (AIMs, n=63) that discriminate European, African and Native American continental ancestry are currently available on a random subset. We compared FG levels across groups using ANOVA, testing independent associations of SR race/ethnicity SES using multiple linear regression with significant P=< 0.05.

Results:
Of 2,933 participants recruited, 63% were women and 70% were older than 50 years. Black, Hispanic and white SR race/ethnicity comprised 32%, 33% and 35% of the sample, respectively. The majority had low SES (57%), 35% had moderate SES and 8% had high SES. FG varied significantly by SR race/ethnicity (mean±SD, mg/dL): 113±37 for white, 119±46 for Hispanic and 121±49 for black subjects (P<0.001). FG was inversely associated with SES (low 122±49, medium 113±39, high 106±23, P<0.001). In joint SR race/ethnicity and SES models adjusting for age and sex, both main effects were attenuated but remained associated with FG (SR race/ethnicity P=0.01; SES P<0.001). For the subsample with AIMs data (n=373), predominant AIMs ancestry, defined as the ancestry most likely as predicted by AIMs, was closely linked to SR race/ethnicity. European ancestry was predominant in 100% of 110 SR white respondents, while African ancestry was predominant in 95% of 129 SR black respondents. In 134 SR Hispanics, 43% were predominantly European, 41% African and 16% Native American. FG varied with predominant AIMs ancestry (European 115±45 mg/dL, African 121±53 and Native American 127±67), although not significantly so (P=0.33), likely due to the limited sample size.

Conclusions:
Both self-reported race/ethnicity and SES are associated with FG in community-based individuals without known T2D, and they share explanatory information reflecting a common effect. A larger sample with AIMs will help disentangle the degree to which FG variation is socially patterned in the community versus a biophysical phenomenon determined in part by genetic ancestry.
Abstract P156: Effect of Socioeconomic and Demographic Factors on Control of Cardiovascular Risk in Elderly Hispanics
Authors: Higuera Adriana J , Timaran David E , Rosero Eric B , Timaran Carlos H
Published: July 2021

Introduction:
In elderly Hispanics, the causes contributing to poor control of cardiovascular risk factors (CRF) are not well understood. The purpose of this study was to assess the effect of demographic and socioeconomic factors on CRF control among non-institutionalized elderly Hispanics.

Methods:
A prospective cohort of 350 elderly Hispanics was studied. A face-to-face interview was conducted to obtain data on comorbidities and demographic and socioeconomic characteristics. Anthropometric and blood pressure measurements were obtained for all participants. Fasting blood samples were collected to assess levels of blood glucose, LDL, HDL and total cholesterol. Univariate and logistic regression analyses were performed to test whether socioeconomic and demographic characteristics were independently associated with adequate control of hypertension, dyslipidemia, and diabetes.

Results:
Most subjects (72.5%) were women. Median age was 71 (interquartile range, 64-79) years. The prevalence of hypertension, diabetes, and dyslipidemia was 68%, 65%, and 64%, respectively. Of these, 93% of hypertensive, 87% of diabetics, and 78% of dyslipidemic subjects were on pharmacologic treatment. Adequate control of the CRF was achieved in 33%, 70%, and 68% of hypertensive, diabetic, and dyslipidemic subjects, respectively. In general, 63.5% of the subjects had at least one risk factor not controlled. Univariate analyses revealed that only the level of trust in the health care system was significantly associated with adequate control of dyslipidemia (
P
=0.03) but not with control of the other risk factors. Multivariate analyses revealed that level of education (odds ratio [OR], 0.92; 95% confidence interval [95%CI], 0.86-0.99;
P
=0.03) and understanding of information obtained from health care provider (OR, 1.48; 95% CI, 1.01-2.1;
P
=0.04) were independently associated with adequate control of blood pressure. No other significant associations were found.

Conclusions:
Despite high rates of treatment, elderly Hispanics in our cohort exhibit poor control of cardiovascular risk factors. Demographic and socioeconomic characteristics do not seem to have a strong effect on CRF control among elderly Hispanics.
Abstract P157: Ethnic Differences In the Association Between Inflammatory Markers and Cytokines With Coronary Artery Calcium in Postmenopausal Women
Authors: Araneta Maria Rosario G , Wassel Christina L , Laughlin Gail A , Allison Matthew A , Barrett-Connor Elizabeth
Published: July 2021

Objective:
We assessed the association between TNF-a, IL-6, leptin, and adiponectin with coronary artery calcium (CAC) in postmenopausal women without known cardiovascular disease.

Methods:
Participants were 192 Caucasian (C), 178 Filipina (F) and 181 African-American (AA) with measures of CVD risk factors, inflammatory markers and cytokines in 1995-99 and CAC in 2000-02. Age adjusted geometric means are presented.

Results:
Caucasians were significantly older, while AA had larger BMI (C:26.0, F: 25.5, AA: 29.7 kg/m
2
, p<0.001) but lower triglycerides (C:132, F: 153, AA: 92 mg/dl, p<0.001). Filipinas had elevated type 2 diabetes (T2DM) (C: 5.7, F: 32.6, AA: 12.2%, p<0.001) and hypertension (HTN) prevalence (C: 45.3, F: 66.3, AA: 46.4%, p<0.001), statin use (C: 19.3, F: 31.5, AA: 16.6%, p=0.002) and visceral adipose tissue (C: 61.6, F:68.7, AA: 57.6 cm3, p<0.001). Filipinas had significantly lower adiponectin levels than either group, while AA women had higher IL-6 levels than either group, and lower adiponectin than Caucasians. No ethnic differences were observed in leptin, TNF-a levels nor prevalence of CAC score of 100 or higher (p=0.10).

Caucasian
Filipino
African-American

Age (yrs)
66.7

64.4
*

61.2

†

‡

TNF-a (pg/ml)
1.02
1.10
1.13

IL-6 (pg/ml)
1.46
1.54

2.08

†

‡

Adiponectin (ug/ml)
12.61

6.15
*

‡

8.07

†

Leptin (ng/ml)
14.24
14.09
15.71

CAC >=100 after 5 yrs
27.1%
29.8%
23.8%

p<0.05,

*

F vs C,

†

AA vs C,

‡

AA vs F Multivariable regression showed older age (adjusted OR: 1.08, 95% CI:1.15-1.12), log IL-6 (adj OR: 1.69 (1.20 - 2.40)), HTN (adj OR: 1.79 (1.16-2.76)), T2DM (adj OR: 1.85 (1.09- 3.14)), and current statin use (adj OR: 1.99 (1.24-3.18) were independently associated with CAC>=100, after adjusting for VAT, adiponectin, leptin, TNF-a, HDL-c and estrogen use. When stratified by ethnicity, CAC>=100 was associated with older age (adj OR: 1.19 (1.11- 1.27)) and log IL-6 (adj OR: 3.82 (1.71- 8.52)) in Caucasians; older age (adj OR: 1.08 (1.03- 1.14)), log IL-6 (adj OR: 1.79 (1.02- 3.16)), and HTN (adj OR: 3.74 (1.70- 8.257)) among AA; and HTN (adj OR: 2.62 (1.13- 6.04)) and statin use (adj OR: 2.22 (1.08- 4.57)) among Filipinas.

Conclusion:
IL-6 was associated with CAC>=100 among Caucasian and African-American women, but not among Filipinas. Funding(This research has received full or partial funding support from the American Heart Association, National Center)
Abstract P158: Excess CVD Risk Factors, CAC and Carotid IMT in US South Asians: Preliminary Results from the MASALA study
Authors: Kanaya Alka M , Schembri Michael , Dave Swapna , Gupta Ritu , Khurana Neerja , Srivastava Shweta , Budoff Matthew J , Herrington David , Liu Kiang , Kandula Namratha
Published: July 2021

Background:
South Asians (SA) have a disproportionate risk of heart disease and diabetes and are at greater risk for death from heart disease compared to other racial/ethnic groups. There are almost 3 million SA in the United States; SA are currently the second fastest growing U.S. ethnic group after Latinos.

Objectives:
To assess the prevalence of cardiovascular (CVD) risk factors and subclinical atherosclerosis in SA using similar methods and measures from the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods:
The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study is a community-based cohort enrolling 900 SA between 40-79 years without known CVD at two clinical centers (University of California, San Francisco and Northwestern University, Chicago). At baseline, we are collecting demographic, cultural and lifestyle information, fasting blood tests, 2-hour glucose tolerance test, physical examination, carotid ultrasound for intima media thickness (IMT) and CT for coronary artery calcium (CAC).

Results:
To date, we have enrolled 368 participants in MASALA with a mean age of 56±9 years, of whom 98% are immigrants who have lived in the U.S. an average of 27±11 years. A majority are immigrants from India (85%), 6% from Pakistan, 1% each from Bangladesh, Sri Lanka and Nepal, and 6% from other diaspora countries. The
table
shows demographic, behavioral, and clinical characteristics of the cohort. The cohort has higher socioeconomic status, lower smoking and alcohol use, very low exercise, modest BMI, and higher prevalence of hypertension, diabetes, and subclinical atherosclerosis than reported in MESA ethnic groups.

Conclusion:
Despite having high socioeconomic attainment and modest BMI, SA have low physical activity levels and high prevalence of CVD risk factors and atherosclerosis. This population-based study of U.S. South Asians will provide further insights into the clinical, behavioral, and socio-cultural factors contributing to heart disease.

MASALA participant characteristics, 2010-2011

Overall n=368
Men n=271
Women n=97

Education ≥Bachelor's degree, %
86
87
83

Family income ≥$100,000, %
60
62
55

Current smoking, %
5
6
1

Alcohol intake, >1 drink/week
39
45
22

Exercise, median MET-min/week
960
982
885

BMI, kg/m2
26.6±4.9
26.5±4.9
26.8±5.0

Waist circumference, cm
95±10
97±10
91±11

LDL, mg/dl
108±32
108±31
109±32

HDL, mg/dl (median)
47
44
57

Triglycerides, mg/dl (median)
122
127
112

Hypertension, %
46
48
41

Diabetes, %
26
28
20

Common carotid IMT, mm
0.91±0.22
0.92±0.22
0.89±0.24

Internal carotid IMT, mm
1.24±0.44
1.24±0.45
1.22±0.42

CAC score, zero 1-100 >100
50 31 19
44 35 21
69 20 11
Abstract P162: Lifestyle Intervention Improves Global Cardiovascular Health in Latinos with Prediabetes in Maracaibo, Venezuela
Authors: Florez Hermes J , Stepenka Victoria , Castillo-Florez Sumaya , Rivas Yoleida , Casal Juan , Ryder Elena , Silva Egle , Maestre Gladys , Oropesa Lisset
Published: July 2021

Introduction:
The epidemics of obesity and hyperglycemia are associated with increased cardiovascular (CV) disease. There are limited data on the CV benefits of evidence-based lifestyle intervention strategies in developing countries.

Aim:
To assess impact o lifestyle intervention strategies based on the US Diabetes Prevention Program (DPP) on the global cardiovascular health.

Methods:
In a pilot clinical trial 140 Latino subjects (63.6% women) with prediabetes (ADA guidelines) were randomly assigned to receive either standard of care (SC, n=70) or group lifestyle (LS, n=70) intervention for 2 years in the healthcare system of Maracaibo, Venezuela. Ideal CV health behaviors (nonsmoking, achieving normal weight, enough physical activity, and a healthy diet) and ideal CV health factors (total cholesterol<200 mg/dl, blood pressure< 120/80 mmHg, and fasting blood glucose<100 mg/dl) were evaluated at baseline and every 6 months. We calculated the American Heart Association (AHA) global CV health score assigning 1 to each ideal behavior and factor (for a maximum of 7) and 0 for poor status to each one.

Results:
Subjects were aged 48.1±11.8 years, had a BMI of 32.1±5.5kg/m² and a baseline score CV of 3.9 ±0.1 (i.e., 84.3% in SC and 88.6% in LS had poor to intermediate CV score). Larger improvements in the CV scores from baseline were obtained in the LS vs. SC (p<0.0001) after 6 months (1.7±0.8 vs. 0.6±0.7), 12 months 2.3 ±0.8 vs. 1.2±0.8), 18 months (1.9±0.9 vs. 0.8±0.6) and 24 months (2.0±0.9 vs. 0.8±0.6) of intervention. At study end only 4.3% of LS and 47.1% of SC participants had poor-intermediate CV score (p<0.01).

Conclusions:
Implementation of DPP- based lifestyle intervention leads to moderate improvements in overall CV health among Latinos with prediabetes in Venezuela. Achievement of the proposed 2020 AHA goal for better CV health seems feasible in this high-risk Latino population.
Abstract P163: Global and Regional Consumption of Specific Dietary Fats and Dietary Cholesterol in 1990 and 2005: Systematic Analysis of Country-Specific Nutrition Surveys Worldwide
Authors: Micha Renata , Khatibzadeh Shahab , Giovannucci Edward , Powles John , Shi Peilin , Ezzati Majid , Mozaffarian Dariush
Published: July 2021

Background.
Assessing the impact of diet on chronic diseases worldwide has been limited by availability only of food disappearance data rather than reliable and systematically assessed consumption data on dietary habits globally.

Objective.
To review and access published and unpublished national diet surveys worldwide in a systematic and consistent way to produce comprehensive intake data of specific dietary fats and their uncertainties by country, region, age, and sex in 1990 and 2005.

Methods.
We developed methods to identify, assess, and obtain exposure data (mean, SD) from nationally representative diet surveys worldwide on saturated, n-6, n-3 and trans fats, and dietary cholesterol. To address missing data and estimate mean intake, we developed and applied a multi-level hierarchical Bayesian model that accounted for country- and region-level data, measurement comparability, study representativeness, and diet assessment method. Time-varying country-level covariates were used to inform the estimates, including FAO food availability data, population, GDP, latitude, metabolic risks, and other diet covariates. Uncertainty of the estimates accounted for uncertainty from sampling and statistical modeling.

Results.
We obtained relevant data (85% by direct author contact) from 76 nationally representative and 15 large regional surveys from 49 countries in 15 regions, covering 75% of the world’s population. Several countries and regions lacked representative data. Data were most frequently available for saturated fat and dietary cholesterol (Figure). Results for other fats will be presented at the meeting.

Conclusions.
These new methods developed to systematically assess, compile and estimate the exposure distribution of specific dietary fats and cholesterol in a uniform fashion globally allow, for the first time, characterization of consumption habits and trends by country, region, age and sex. Such global assessment is imperative for estimating the impact of dietary fats on chronic diseases worldwide.
Abstract P166: Distribution of Cardiovascular Risk Factors in ESMaestras: A Cohort Study of 97,174 Mexican Women
Authors: Lajous Martin , Romieu Isabelle , Catzin-Kuhlmann Andres , Willett Walter C , Lopez-Ridaura Ruy
Published: July 2021

Introduction:
The ESMaestras study (
Estudio de Seguimiento la Salud de las Maestras
) is an effort to prospectively study the health effects of dietary and lifestyle factors in Mexico, a country undergoing a fast-paced nutritional and epidemiologic transition. Understanding risk factors for disease in this minimally studied population may provide insights on lifestyle-disease relations in other populations.

Methods:
We evaluated the cross-sectional distribution of cardiovascular risk factors in the baseline evaluation of the ESMaestras cohort study, an ongoing prospective study among 97,174 female teachers living in 12 different states in Mexico. In 2008, participants responded to a detailed questionnaire on lifestyle factors, diet and medical conditions that was sent and received by school district administration. Diet was assessed using a semi-quantitative food frequency questionnaire validated in a similar Mexican population.

Results:
Median age of participants was 44 years [(10
th
, 90
th
percentile) 33, 52] and 17.3% were postmenopausal. Median BMI was 26.7 [(10
th
, 90
th
percentile) 22.2, 33.6] and 66.4% were overweight or obese. Median moderate/vigorous recreational physical activity was 1 hr/week [(10
th
, 90
th
percentile) 0, 6.0]. Only 9.7% participants were current smokers and among them 21.5% reported smoking more than 5 cigarettes per day. Most participants reported alcohol consumption (62%) but daily consumption was very low (1.2% consumed ≥0.5 drink/day). Median (10
th
, 90
th
percentile) intake of fish was 0.98 servings/week (0.28, 3.3), of red meat 4.1 servings/week (1.3, 9.9), of fruits and vegetables 5.3 servings/day (1.8, 12.2) and of sugar-sweetened beverages 1.2 (0.3, 3.6). The prevalence of self-reported, treated conditions was 12.1% for hypertension, 4.3% for diabetes and 11.6% for elevated cholesterol.

Conclusion:
In this relatively young population of Mexican women we observed a high prevalence of some risk factors for cardiovascular disease. Adequate systematic follow-up with repeated evaluation of risk factors in this population may prove to be informative about lifestyle factor and cardiovascular disease relations in Latin-American women.