bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP025: Unfavorable Perceptions of Neighborhood Environment are Associated With Greater Sedentary Time - Data From the Washington, D.C. Cardiovascular Health and Needs Assessment
Authors: Ahuja Chaarushi , Ayers Colby , Hartz Jacob , Adu-Brimpong Joel , Mitchell Valerie , Peters-Lawrence Marlene , Sampson Dana , Brooks Alyssa , Wallen Gwenyth , Grant Faren , Rivers Joshua , Thomas Samantha , Yingling Leah , Johnson Allan , Graham Lennox , Graham Avis , Powell-Wiley Tiffany
Published: July 2021

Background:
Sedentary time (ST) and unfavorable perceptions of neighborhood environment (NE) are independently associated with poor cardiovascular (CV) health. However, little is known about ST’s relationship to NE perceptions.

Methods:
We examined associations between ST and NE perception in the Washington, DC CV Health and Needs Assessment.(NCT01927783) Participants underwent a CV health evaluation designed using community-based participatory research principles and conducted in faith-based organizations in lower socioeconomic (SES) areas in DC. Participants responded, on a 5-point Likert scale, to questions about NE perceptions of sidewalks, recreational areas, crime, etc. Factor analysis was conducted to explore associations with overall NE perception. The factor sums were combined as the Total Perception Score (TPS). For ST, participants reported amount of time (in hours/minutes) “spent sitting or reclining on a typical day”. Linear regression analyses were performed to determine the relationship between TPS (range 15-75, higher score=more favorable perception) and ST for the 1) overall population, 2) Wards 5, 7, and 8 and 3) other DC wards/Maryland (MD) areas.

Results:
For the study sample (N=99, 99% African American, 78% female), DC Wards 5, 7, and 8 had a significantly higher percentage of households with yearly income of <$60,000 (p<0.05) and lower mean TPS than residents of other areas (p < 0.001).Three factors (neighborhood violence, physical and social environment, and social cohesion) were associated with overall NE perception. Among those living in the lower SES Wards 5, 7, and 8, there was a negative association between TPS and ST that remained after adjusting for age, sex, and income (Table). This relationship was not observed for those in higher SES DC/ MD areas.

Conclusions:
Poorer NE perception is associated with greater ST for those living in lower SES areas of DC. Targeted interventions to improve perceptions of physical and social environment in these areas may decrease ST and improve CV health.
Abstract MP031: Prospective Association of Obstructive Sleep Apnea Risk Factors with Heart Failure with Preserved Ejection Fraction and Not Heart Failure with Reduced Ejection Fraction in Postmenopausal Women
Authors: Koo Patrick , Gorsi Umama , Roberts Mary , Eaton Charles
Published: July 2021

Background:
The relationship between obstructive sleep apnea (OSA) and heart failure (HF) has been under-researched especially in postmenopausal women. We therefore evaluated relationship between OSA risk factors and HFpEF and HFrEF in post-menopausal women.

Methods:
We performed a prospective analysis of a subset of participants who had adjudicated heart failure outcomes (n=42,362) in the Women Health Initiative Observational, Clinical Trial, and Extension Studies (1998-Present). The cohort was followed over an average of 13.4 years. Inverse probability weighting was employed to account for potential selection bias. Cox proportional hazards regression was used to examine the association between OSA risk factors and time to first hospitalized HF. Type of heart failure was determined using the ejection fraction (EF) obtained from 2D echocardiography. EF of ≥45% was categorized as HFpEF, and EF of < 45% was categorized as HFrEF. Models were adjusted for age, race/ethnicity, education, income, marital status, systolic blood pressure, waist-to-hip ratio, diabetes, coronary heart disease, atrial fibrillation, use of hormone replacement therapy, use of sleep medications, modified Charlson comorbidity index, smoking, alcohol consumption, physical activity, and hysterectomy. We also created an OSA summary score (obesity, snoring, poor sleep quality, sleep fragmentation, daytime sleepiness, and hypertension) based on the Berlin questionnaire, which reliably predicts OSA, to examine its relationship with HF.

Results:
Of the 42,362 women, 1,054 (2.49%) had preserved EF, and 631 (1.49%) had reduced EF. Four of the 6 risk factors (obesity (HR=1.51, 95% CI 1.29-1.76), snoring (HR=1.23, 95% CI 1.04-1.45), sleep fragmentation (HR=1.15, 95% CI 1.01-1.31), and hypertension (HR=1.46, 95% CI 1.31-1.62)) were associated HFpEF after adjusting for confounders. Each additional OSA risk factor in an OSA summary score compared to no risk factors significantly increased the risk of HFpEF in a dose-response fashion (HR=1.36, 1.61, 2.01, 1.97, 2.02, and 2.74 for scores of 1-6, respectively; P
trend
<0.001) and not HFrEF (P
trend
=0.26). Only hypertension was associated with HFrEF (HR=1.39, 95% CI 1.22-1.60).

Conclusion:
Having more OSA risk factors increases the risk of HFpEF but not HFrEF in postmenopausal women. Early recognition and management of OSA risk factors may play an important role in reducing risk of HFpEF in this population.
Abstract MP038: Soft Drink Consumption Increases the Risk of Hypertension in Korean Adults: A Prospective Cohort Study
Authors: Jo Garam , Kwak SoYoung , Cho Yoonsu , Shin Min-Jeong
Published: July 2021

Introduction:
Several previous studies have reported that consumption of soft drink is associated with increased risk of hypertension (HTN) in Western societies. However, epidemiological information on such associations is very limited in Koreans.

Hypothesis:
We tested the hypothesis whether an increase in soft drink consumption is related to higher risk of HTN among Korean middle aged adults from Korean community based Cohort (Ansan-Ansung cohort).

Methods:
Data from Ansan-Ansung cohort from 2001 to 2010 in the Korean genome and epidemiology study (KoGES) were used for statistical analyses. Among the participants, we selected 5,296 subjects (2,475 men and 2,821 women, aged 39-64 yrs) who were free from presence of HTN, diabetes, cardiovascular disease and cancer at baseline and those who completely followed up for 10.4 years. Participants who completed a semi-quantitative food frequency questionnaire for dietary assessment and questionnaire for baseline health status in 2001-2002 were included in analyses. Subjects were categorized as quartile based on their soft drink consumption. Soft drink consumption was calculated as frequency per week summed up by consumption frequency of soda (such as Coke and Sprite) and other beverages (including sweet rice drink and Citrus tea). To assess the relationship between soft drink consumption and HTN, we estimated multivariable-adjusted hazard ratio (HR) and 95% confidence intervals (CIs) using cox regression analysis. In addition, stratified analysis by body mass index (BMI) was conducted.

Results:
During the follow-up period of 10.4 years, we ascertained 1,035 incident cases (19.5% of study population) of HTN. Total soft drink consumption showed significant association with increased risk for HTN after adjusting for potential confounders (age, sex, total energy intake, BMI, and socio-economic factors). The adjusted HR of HTN for the highest quartile of soft drink consumption was 1.24 (95% CIs: 1.02-1.51) compared to the lowest quartile. Furthermore, we found that higher consumption of soft drink was significantly associated with increased incidence of HTN in subjects with BMI ≥25 (HR: 1.54; 95% CIs: 1.15-2.01), whereas there was no significant association among subjects with BMI <25.

Conclusions:
In conclusion, this study suggested that soft drink consumption contributes to increased risk of HTN, being prominent in obese participants. Our results support recommendations to reduce the consumption of soft drink to prevent and control HTN, although further large prospective studies or randomized controlled trials are warranted to confirm the observed association.
Abstract MP048: Ectopic Muscle and Liver Adiposity are Independently Associated with Type 2 Diabetes in African Ancestry Men
Authors: Miljkovic Iva , Kuipers Allison , Carr J Jeffrey , Terry James , Nair Sangeeta , Cvejkus Ryan , Bunker Clareann , Patrick Alan , Ge Yaorong , Zmuda Joseph
Published: July 2021

Although obesity is a major driver of type 2 diabetes (T2D), many obese individuals do not develop T2D. Indeed, fat around and within non-adipose tissue organs (i.e., ectopic fat) is emerging as a strong risk factor for diabetes. The potential differential contribution of ectopic fat depots throughout the body on T2D risk is unclear because studies have mainly focused on visceral and/or liver fat. No study, to our knowledge, has addressed the potential independent association of visceral, liver, and skeletal muscle adiposity with T2D. Such studies are particularly needed among African ancestry populations, as generalized obesity and other risk factors do not appear to explain the high T2D burden in this population segment. To address this knowledge gap, we measured total body fat by DXA, and visceral, liver, and calf skeletal muscle adiposity by computed tomography in 490 Afro-Caribbean men, aged 50-91 years (mean age=64 years, mean BMI=27.5 kg/m
2
). The prevalence of T2D in this population was 22.3%. We employed multiple logistic regression using total body fat percent and ectopic fat depots as predictors (Table). We found that each 7.9 HU decrease in liver attenuation (indicative of greater liver adiposity) was associated with a 33% increased odds of T2D (p=0.011). Similarly, each 4.2 mg/cm
3
decrease in muscle attenuation (indicative of greater intra-muscular adiposity) was associated with a 31% increased odds of T2D (p=0.04). These associations were independent of total and visceral adiposity. Our results support the “ectopic fat syndrome” theory, as opposed to the “portal theory”, in the pathogenesis of diabetes among African ancestry men. Longitudinal studies are needed to clarify the exact role of specific ectopic fat depots in T2D, particularly in high-risk African ancestry populations.
Abstract MP074: Pathway Linking Depression & Inflammation: A 5-year Longitudinal Twin Difference Study
Authors: Huang Minxuan , Su Shaoyong , Goldberg Jack , Miller Andrew H , Murrah Nancy V , Shallenberger Lucy , Pimple Pratik , Bremner J. Douglas , Vaccarino Viola
Published: July 2021

Background:
Depression and inflammation are risk factors for cardiovascular disease. Depression and inflammation are associated, but the causal direction remains unclear. Genetic background (i.e., genes common to both conditions) may confound this association. We sought to examine the temporal relationship between depression and inflammation, after controlling for genetic confounding, in a 5-year longitudinal monozygotic (MZ) and dizygotic (DZ) twin difference study.

Methods:
This analysis is based on a longitudinal in-person follow-up of a male middle-aged sample of twin pairs from the Vietnam Era Twin Registry. Inflammation was measured by log-transformed plasma levels of interleukin-6 (IL-6), and depression was evaluated using the Beck Depression Inventory-II (BDI). Inflammation and depression were measured at baseline (visit 1) and after 5 years (visit 2). A longitudinal cross-lagged model was run on signed sibling difference scores in IL-6 and BDI (i.e. twin A - twin B). The path coefficient was examined by the robust maximum likelihood test. We also tested the interaction between zygosity and within-pair difference in IL-6 or BDI score.

Results:
A total of 166 male twins (83 pairs, mean age of 54) were examined at both visits, including 94 MZ and 72 DZ twins. There was a significant association between sibling differences in IL-6 and BDI score across two visits. At visit 1, the cross-sectional association between sibling difference in IL-6 and BDI score was not significant, but it became significant at visit 2 in MZ twins. The primary focus of our analysis was the longitudinal cross-lagged bidirectional association of BDI and IL-6. There was no significant association between baseline within-pair difference in BDI and their difference in IL-6 at follow-up for both MZ and DZ twins. However, for MZ twins there was a positive association between baseline within-pair difference in IL-6 and their difference in BDI at follow-up, which suggests that members of the MZ twin pair who had higher levels of IL-6 than their siblings at baseline had significantly higher BDI scores at follow-up. This association was only significant in MZ twins (r=0.36, p=0.001) and not in DZ twins (r=0.09, p=0.49), with a significant interaction (p=0.03) between zygosity and within-pair difference in IL-6.

Conclusion:
Higher inflammation is linked to higher depressive symptoms over time and not vice versa, which suggests that inflammation may be a cause of depression, rather than a consequence. This association is stronger in MZ than DZ twins, thus genetic confounding likely does not play a role.
Abstract MP077: Longitudinal Associations Between Venous Disease Progression and Change in Quality of Life: San Diego Population Study
Authors: Schlang Adrienne M , Wallace Jessica , Denenberg Julie , Criqui Michael , Allison Matthew
Published: July 2021

Background:
Chronic venous disease, one of the most common chronic diseases in the United States, is associated with lower quality of life (QOL). Although earlier studies have identified a significant association between the cross-sectional prevalence of venous disease and QOL, few studies have investigated the association between venous disease progression and change in QOL. Therefore, the aim of this study was to investigate the relationship between progression of venous disease and change in QOL in a longitudinal cohort.

Methods:
A population-based cohort of 1103 participants were examined at baseline and 11 years later. At both visits, QOL and risk factors were assessed by questionnaire, anthropometric measures obtained by clinical examination, and venous disease assessed by visual inspection and duplex ultrasound. QOL was measured with the Medical Outcomes Study 36-Item Short Form (SF-36) with the resulting physical component (PCS) and mental component scores (MCS) being used in the analysis. Using ANCOVA methods to control for age, gender, and ethnicity, changes in venous disease were compared against QOL stratified into tertiles. Then, linear regression models were used to examine the longitudinal association of venous disease at baseline and change in QOL score at follow-up after controlling for covariates.

Results:
In the study population of 1103 individuals, 78 had regression, 340 had progression, and 685 were stable. The average age was 58.7 years (SD 10.4); 33% were male, 61% were non-Hispanic White, 15% were Hispanic, 12% were African American, and 12% were Asian. Mean BMI was 27.1 (SD 5.3), 45.4% had hypertension, 9.9% were diabetic, 3.6% were current smokers, and 34.8% were on medication for hyperlipidemia. Progression of venous disease was significantly associated with change in PCS after controlling for age, gender, and ethnicity (
β
=-0.075;
p
=.04). The association was only slightly attenuated (
β
=-.065, p=.08) after adjustment for BMI, high blood pressure, injury to either leg, smoking history, previous vein procedure, previous hernia surgery, flat feet, marital status, education level, occupation, cardiovascular-related morbidity, diabetes, and heaviness in either leg. No association was found with MCS before or after multiple covariate adjustment.

Conclusions:
This study confirms that individuals with progression of chronic venous disease have a greater decrease in QOL as identified by the physical component score of SF-36. Prevention of chronic venous disease progression may help retain QOL.
Abstract MP078: Are Patients With Less Activation at Greater Risk of Declines in Health-related Quality of Life After Hospitalization for an Acute Coronary Syndrome?
Authors: Erskine Nathaniel A , Gandek Barbara , Waring Molly E , Lessard Darleen M , Kiefe Catarina I , Goldberg Robert J
Published: July 2021

Background:
Patient activation comprises the knowledge, skills, and confidence for self-care, and may lead to better health outcomes.

Hypothesis:
We hypothesized that less-activated survivors of a hospitalization for an acute coronary syndrome (ACS) would be more likely to experience declines in health-related quality of life than more activated patients.

Methods:
We studiedpatients from 6 medical centers in central Massachusetts and Georgia who had been hospitalized for an ACS between 2011 and 2013. At 1 month after hospital discharge, patients completed the 6-item Patient Activation Measure and at 1, 3, and 6 months after discharge generic physical (SF-36 PCS), generic mental (SF-36 MCS), and disease-specific (SAQ - Seattle Angina Questionnaire) health-related quality of life (QOL) scales. Four categories of 1-month activation levels were defined. Multinomial logistic regression estimated odds ratios were calculated for clinically meaningful changes in QOL, with patients in the highest level of activation serving as the referent group, adjusting for sociodemographic and clinical confounders.

Results:
Patients (n=1,042) were on average 62 years old, 34% were female, and 87% were non-Hispanic white; 10% and 29% of patients were in the lowest and highest levels of activation, respectively. Higher proportions of patients in the least activated group vs. the most activated group tended to experience clinically meaningful declines in QOL, for all scales and both follow-up periods (Table). Least activated patients had significantly higher adjusted odds of experiencing clinically meaningful declines in MCS and SAQ scores from 1 to 6 months after hospital discharge, but not PCS scores, with a similar pattern observed between 1 and 3 months after hospital discharge.

Conclusions:
Following hospitalization for an ACS, patients with low activation may be more likely to have declines in mental and disease-specific health-related QOL than highly activated patients, identifying a group at high risk of poor outcomes.
Abstract MP088: Relationship Between Daytime Sleepiness and Poor Physical Performance in Middle-aged Adults of the Bogalusa Heart Study
Authors: Pollock Benjamin D , Stuchlik Patrick , Guralnik Jack , Bertisch Suzanne M , Redline Susan , Chen Wei , Harville Emily W , Bazzano Lydia A
Published: July 2021

Background:
Studies conducted in elderly and frail adult populations, especially those with heart failure, have shown a consistent relationship between poor sleep and poor physical performance. Likewise, a similar association between poor sleep and lower performance has been found in extremely fit, elite athletes. However, this relationship has not been examined in healthy, middle-aged adult populations. Here, we test the cross-sectional association of daytime sleepiness with poor physical performance in our large, bi-racial cardiovascular cohort.

Methods:
From 2013-2016, 1,223 adults from the Bogalusa Heart Study attended follow-up visits to assess physical and cognitive performance and answer questionnaires pertaining to sleep habits. The Epworth Sleepiness Scale (ESS) was used to measure daytime sleepiness on an ordinal scale from 0-24. Short Physical Performance Battery (SPPB), which consists of chair stands, balance testing, and walk speed, was the outcome measure, with a score of <10 out of 12 being considered poor physical performance. Multivariable logistic regression, adjusted for age, race, sex, sleep duration, employment status, BMI, and symptoms of sleep apnea was used to test the association between ESS [both continuously and dichotomized to abnormal (ESS>10) vs. normal (ESS≤10)] and poor physical performance.

Results:
Our study population had a mean(SD) age of 48.1(5.2) and was 58.6% female and 34.7% black. Mean(SD) ESS was 6.3(4.7). 252 (20.6%) adults exhibited poor physical performance. After covariate adjustment, ESS was significantly associated with an increased risk of poor physical performance (Odds Ratio per 1 SD increase=1.17; 95% Confidence Interval=1.01-1.35;
p
=0.03). As a dichotomous exposure, an abnormal ESS resulted in a 53% increased risk of poor physical performance (OR=1.53; 95% CI=1.05-2.23;
p
=0.03).

Conclusions:
Even among relatively healthy middle-aged adults, daytime sleepiness appears to be associated with poor physical performance.
Abstract MP096: Patterns of Physical Activity Across Pregnancy and Their Association With Adverse Pregnancy Outcomes
Authors: Catov Janet M , Parker Corette B , Gibbs Bethany B , Bann Carla , Carper Benjamin , Grobman William A
Published: July 2021

Background:
Cardiovascular disease (CVD) is the leading cause of death among women, and pregnancy complications reveal risk decades before overt CVD. While physical activity is related to CVD, less is known about how the activity patterns during pregnancy may contribute to adverse pregnancy outcomes.

Hypothesis:
Increasing activity across pregnancy is related to reduced risk of adverse pregnancy outcomes.

Methods:
Nulliparous women were enrolled at 8 centers early in pregnancy (n=10,020). Frequency and duration of up to three leisure activities reported in the first, second and third trimester were analyzed as metabolic equivalents (METs). Growth mixture modeling was used to identify activity patterns in pregnancy. Adverse outcomes (preterm birth [PTB], hypertensive disease of pregnancy [HDP], and gestational diabetes [GDM]) were collected by chart abstraction.

Results:
Four patterns of activity across pregnancy were identified: sustained high (3%, n=297); increasing (12%, n=1231); sustained low (77%, n=7717); and decreasing (8%, n=775; Figure). Women with sustained low activity were younger and more likely to be black or Hispanic, obese, or to have smoked prior to pregnancy when compared to those with increasing activity. Women with sustained low vs. increasing activity had higher rates of PTB (9.2 vs. 6.2%), HDP (13.8 vs. 10.5%), and GDM (4.7 vs. 2.5%; all p <0.01). After adjusting for maternal factors (age, race/ethnicity, BMI and smoking), the risk of GDM remained higher in women with sustained low activity compared with those having increasing activity patterns (adjusted OR 1.79 [1.21, 2.66]). Sustained low activity was also associated with higher risk of PTB (adjusted OR 1.36 [1.05, 1.76]).

Conclusion:
The majority of women have sustained low activity across pregnancy, and this is independently associated with higher risks of GDM and PTB. These associations raise the possibility that increased activity during pregnancy may improve pregnancy outcomes, and perhaps long-term maternal cardiovascular health.
Abstract P003: Application of a Lifestyle-based Score to Predict Cardiovascular Health in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Gooding Holly C , Ning Hongyan , Gillman Matthew W , Shay Christina M , Allen Norrina , Goff David C , Rana Jamal S , Chiuve Stephanie , Lloyd-Jones Donald
Published: July 2021

Introduction:
The Healthy Heart Score (HHS) is a lifestyle-based risk prediction tool developed to predict cardiovascular disease (CVD) events in young and middle-aged adults. We evaluated the performance of the HHS to predict cardiovascular
health
(CVH).

Methods:
We applied the HHS to 3288 white and black adults ages 18-30 years at the CARDIA study baseline exam in 1985-6. The HHS includes age, smoking status, body mass index, alcohol intake (g/d), exercise (hours/week) and a diet score composed of self-reported daily intake of cereal fiber, fruits/vegetables, nuts, sugar-sweetened beverages, and red/processed meats. We tested the utility of the HHS to predict having
all ideal CVH factors
at the year 25 exam when participants were ages 43-55 years, defined as the simultaneous presence of unmedicated blood pressure <120/80 mmHg, total cholesterol<200 mg/dl, fasting glucose<100 mg/dl and absence of diabetes or CVD. We assessed the HHS in the total population, in race and sex-specific groups, and in those with and without clinical CVD risk factors (RFs) at baseline. We first applied original HHS coefficients, then cohort specific coefficients. We assessed model discrimination in comparison to age-only models with Harrell’s C-statistic and model calibration with Hosmer-Lemeshow’s chi-square.

Results:
Mean (SD) age at baseline was 25.1 (3.6) years; 57% were female, 46% black, and 8% had at least one clinical CVD RF at baseline. Only 593 participants (18%) had all ideal CVH factors in middle age; the prevalence was lower in men compared to women, blacks compared to whites, and in those with vs. without clinical CVD RFs in young adulthood (Table). The HHS showed moderate discrimination for CVH prediction (Table). The HHS was adequately calibrated overall and within each sub-group.

Conclusions:
The HHS performs moderately well predicting CVH 25 years later when applied to young adults. Its reliance on self-reported, modifiable lifestyle factors makes it an attractive tool for the promotion of CVH across the lifespan.
Abstract P011: Predictive Ability of 35 Frailty Scores for Cardiovascular Events in the General Population
Authors: Aguayo Gloria A , Schritz Anna , Donneau Anne-Françoise , Vaillant Michel T , Stranges Saverio , Malissoux Laurent , Guillaume Michèle , Muller Majon , Witte Daniel R
Published: July 2021

Introduction:
Frailty is a state of vulnerability in elderly people linked to higher mortality risk. Cardiovascular disease (CVD) is highly prevalent in aged populations and associated with frailty. Thus, frailty state could predict higher risk of CVD. Many frailty scores (FS) have been developed, but none of them is considered the gold standard. We aimed to compare predictive and discriminative ability of an extensive list of FS with regard to incidence of CVD in a sample of the general elderly population in England. We assessed the hypothesis that some FS will have better predictive ability than others, depending on their characteristics.

Methods:
We performed a prospective analysis of the association between 35 FS in participants free of CVD at baseline wave 2 of the English Longitudinal Study of Ageing (2004-2005), and incident CVD assessed until February 2012. The sample consisted of 4,177 participants (43.0 % men). Hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated for each FS using Cox proportional hazards model, adjusted for demographic, lifestyle and comorbidity variables. FS were analyzed on a continuous scale and using original cutoffs. The added predictive ability of FS beyond a basic model consisting of sex and age was studied using Harrel’s C statistic (the higher the better).

Results:
The median follow-up was 5.8 years, the incidence rate of CVD events was 301.2 /10,000 person-years and CVD represented 28% of the total cause of death. The mean age was 70.5 (SD: ±7.8) years. In fully-adjusted models with demographics, lifestyles and comorbidity, HRs ranged from: 1.0 (0.7; 1.6) to 12.7 (5.5; 29.3). Using cutoffs, HRs ranged from 0.7 (0.2; 1.9) to 1.8 (1.3; 2.5). Adjusted for sex and age, delta Harrel’s C statistic ranged from -0.8 (-3.4; 1.8) to 3.0 (-0.4; 6.4). The best CVD predictive ability was found for the Frailty Index with 70 variables and the Comprehensive Geriatric Assessment screening FS for continuous and cutoff analyses respectively. In conclusion, there is high variability in the association between different published FS and incident CVD. FS have better predictive ability used as continuous variable. Although most of the analyzed FS have good predictive ability with regard to incident CVD, they do not significantly improve on the discriminative capacity of a basic model. Our results will help to guide clinicians, researchers and public health practitioners in choosing the most informative frailty assessment tool.
Abstract P018: Lifestyle Interventions that Benefit the Heart Also Improve Depression Among Geriatrics
Authors: Ramirez Francisco E , Nedley Neil
Published: July 2021

Objective:
Plant-based nutrition, exercise, proper rest, relaxation techniques and other healthy behaviors can be beneficial to the cardiovascular system. We assess the impact that this healthy behaviors have before and after an 8-week educational community-based program.

Participants and Methods:
The program was developed by the Nedley Clinic in Ardmore, Oklahoma, USA. This medical clinic trained and certified lay and professional people around the world in 4 continents. The program does not create a doctor-patient relationship. Recruitment is done by, for example radio, TV, handouts, newspaper and word of mouth. Those who chose to participate met once a week for 8 weeks for a 2 hour program, it consisted of a 45 minute DVD presentation by a physician experienced in lifestyle interventions and a facilitated small group discussion together with weekly practical assignments. The program was available in Spanish and English. The Nedley Depression Recovery Program Assessment Test (registration TX 7-398-022) was used. It assessed depression level based on DSM-5 [The Diagnostic and Statistical Manual of Mental Disorders Volume 5] criteria, demographics, anxiety, emotional intelligence and patient history. The depression was classified into 4 categories as the DSM-5, as none (0-6), mild (7-10), moderate (11-19) or severe (20 or more). Participants that finished the program from 2007 to 2016 that were of geriatric age (55 years old and older at baseline) were included. Both depressed and non-depressed participated on the program.

Results:
From 5997 participants that finished the program n=2928 were geriatrics. Mean age 64.7 SD 7.2, n=2075 (70.8%) were females. Demographic were White 2598 (88.7%), Black 107 (3.6%), Hispanic 144 (4.9%) and other (2.8%). Participants were from Africa, Europe, Oceania and America. At baseline mean group depression was 11.2 (Moderate), SD 7.3. That group was composed of 960 (32.7%) with none depression, 474 (16.1%) with mild depression, 981 (33.5%) with moderate depression and 513 (17.5%) with severe depression. By the end of the 8-weeks mean depression was 6 (none), SD 5.7. That group was composed of 1854 (69.3%) with none depression, 476 (16.2%) with mild depression, 506 (17.2%) with moderate depression and 92 (3.1%) with severe depression.

Conclusion:
It seems that the intervention effectively improves mental health in this geriatric population with different levels of depression responding well to the program. This seems to be an effective way to apply community wide interventions to improve population-wide health. A control group and further follow up would be recommended.
Abstract P019: Family History of Cardiovascular Disease is Associated With Cognitive Function: The Emory Healthy Aging Study
Authors: Goetz Margarethe E , Marcus Michele , Vaccarino Viola , Goldstein Felicia , Levey Allan , Lah James
Published: July 2021

Background:
Family history of cardiovascular disease (CVD) is a readily available risk indicator of future CVD, combining the influence of shared genetic, environmental and behavioral risk factors. Though CVD risk factors have been associated with an increased risk of cognitive impairment and decline, less is known about the association between family history of CVD and cognitive function. Evaluating this association may further elucidate the role of cardiovascular health in cognitive health.

Methods:
The Emory Healthy Aging Study isan ongoing prospective cohort study aimed at identifying predictors of healthy aging and age-related diseases. Participants are primarily residents of the Atlanta area, at least 18 years old, who completed an online baseline health survey. Multiple recruitment forums were used, including clinic waiting rooms, informational letters and emails, community events and online recruitment. Baseline information about demographic (age, race, gender), socioeconomic (education, household income), and health behavior factors (physical activity, smoking) as well as personal health (diabetes, hyperlipidemia, and hypertension) and family health history were collected by online survey. Family history of CVD was defined as self-reported history for any parent or sibling of coronary artery disease, myocardial infarction, or stroke. Cognitive function was measured using the validated Cognitive Function Instrument (CFI) with scores ranging between 0-14 (lower is better). The association between family history of CVD and CFI score was assessed using multivariable linear regression, adjusting for demographic, socioeconomic, lifestyle and CVD risk factors, as well as family history of mild cognitive impairment (MCI) or Alzheimer’s disease (AD).

Results:
We studied 3801 participants (75% female, 85% white, 10% black, and 5% other), recruited between October 2015 and October 2016. Mean age was 59±13 years and 61% reported a family history of CVD. Adjusting for age, gender, race, education, household income, exercise habits, smoking status and family history of MCI or AD, family history of CVD was associated with poorer cognitive performance (β=0.26; 95% CI (0.12, 0.41)). Additional adjustment for hypertension, hyperlipidemia, diabetes and BMI only slightly attenuated estimates (β=0.22; 95% CI (0.08, 0.41)). In the same model, the estimated β for family history of cognitive impairment was similar: 0.22 (0.07, 0.37).

Conclusion:
In this cross-sectional study of people from the community, family history of CVD was associated with poorer cognitive function, and this association was of the same magnitude as having a first-degree family member with a history of cognitive impairment. Although longitudinal data are needed, these results underscore the link between cardiovascular and neurocognitive health and potential role of shared genetic and behavioral factors.
Abstract P021: Association of AHA Cardiovascular Health Metrics With Cognitive Function, Depression, and Anxiety: The Emory Healthy Aging Study
Authors: Alonso Alvaro , Goldstein Felicia C , Vaccarino Viola , Levey Allan I , Lah James J , Marcus Michele
Published: July 2021

Background:
The American Heart Association (AHA) has developed the Life’s Simple 7 metric (no smoking, high levels of physical activity, normal body mass index, no hypertension, no diabetes, no hyperlipidemia, healthy diet) to track behaviors and risk factors associated with cardiovascular health (CVH). Given the potential role that CVH has in cognition and psychological well-being, we aimed to study the association of the Life’s Simple 7 with cognitive function, anxiety, and depressive symptoms in the Emory Health Aging Study (EHAS).

Methods:
EHAS is an ongoing cohort study with the overall goal of understanding determinants of healthy aging in the general population. Participants 18 years of age or older are recruited at primary care clinics, community events, and through social media, primarily from the Atlanta (GA) area. Information on sociodemographic variables (age, sex, race, education, income), anthropometrics (weight, height), lifestyles (smoking, physical activity), and clinical variables (history of hypertension, diabetes, hypercholesterolemia, cardiovascular disease [CVD]) was collected through online questionnaires. Life’s Simple 7 score (excluding diet; information not available) was defined based on self-reported data, giving 1 point per achieved metric [range 0 (lowest)-6(highest CVH)]. Neurobehavioral variables were measured using validated scales (Cognitive Function Instrument (CFI), range 0-14, for cognition; Patient Health Questionnaire (PHQ)-8, range 0-24, for depressive symptoms; Generalized Anxiety Disorder (GAD) questionnaire, range 0-21, for anxiety; higher scores represent worse function/symptoms). Cross-sectional associations between Life’s Simple 7 score and these scales were assessed using multivariable linear regression adjusting for sociodemographic variables.

Results:
We included 3,774 participants [mean age (standard deviation, SD) 58 (13), 79% women, 84% white, 9% African American, 7% other) free of self-reported CVD, recruited between October 2015 and October 2016. Levels of CVH in the cohort were relatively high, with 62% participants meeting at least 4 health criteria [mean (SD) score 3.9 (1.3)]. The mean (SD) of CFI, PHQ-8, and GAD were 1.9 (2.1), 3.2 (3.8), 2.4 (3.4), respectively. In analyses adjusted for age, sex, race, education, and income, higher values of Life’s Simple 7 score were related to better cognitive function and lower levels of depressive symptoms and anxiety: estimates (95% confidence interval) per 1-point in Life’s Simple 7 score were -0.16 (-0.22, -0.11) for CFI, -0.5 (-0.6, -0.4) for PHQ-8, and -0.3 (-0.4, -0.2) for GAD.

Conclusion:
Higher levels of CVH, as assessed with the AHA Life’s Simple 7, were cross-sectionally associated with a beneficial neurobehavioral profile. Prospective studies should evaluate the impact of improving CVH on cognitive and emotional health.
Abstract P037: Epigenetic Markers of Cardiovascular Health Trajectories and Coronary Artery Calcification in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Hou Lifang , Zheng Yinan , Allen Norrina B. , Nannini Drew , Zhang Zhou , Liu Lei , Zhang Wei , Krefman Amy E. , Fornage Myriam , Ning Hongyan , Lewis Cora E. , Schreiner Pamela , Sidney Stephen , Shikany James , Liu Kiang , Lloyd-Jones Donald M. , Greenland Philip
Published: July 2021

Background:
Trajectory of AHA’s cardiovascular health (CVH) through young adulthood are associated with subclinical CVD. The human epigenome is modifiable by lifestyle and environmental factors and may be an important mechanism of CVH outcomes. We sought to determine associations of epigenetic markers with CVH trajectories and with coronary artery calcification (CAC) through young adulthood.

Methods:
Among CARDIA ppts, we performed methylome analysis at follow up year (Y) 15 and Y20 using Illumina Methylation EPIC array (~850K CpG loci). We compared methylome between those with optimal CVH at baseline and remained stable (optimal-stable, n=645) and individuals with baseline optimal but declining CVH during follow up (n=100) to identify methylomic biomarkers of CVH trajectories. Differentially methylated CpGs were further examined in association with incident CAC risk at Y25 (n=745), and for their potential mediating role in CVH-associated CAC risk.

Results:
In 1,087 CARDIA ppts (mean age=25 at baseline), we identified 25 hypermethylated CpGs (18 at Y15, 13 at Y20, including 6 seen at both Y15 and Y20) significantly associated with optimal-stable CVH trajectories. The 6 common CpGs were stable (mean ICC = 0.66) whereas the remaining 19 CpGs were dynamic (mean ICC = 0.39) over a 5-year interval. Hypermethylation of 6 stable CpGs was associated with a decreased risk of having future CAC incidence (
Table 1
). Hypermethylation of 10 (out of 19) dynamic CpGs at Y20 was associated with a decreased risk for incident CAC while the associations was less pronounced at Y15. Mediation analyses showed that hypermethylation of these 16 CpGs at Y15 and Y20 contributed 15% and 23% reduction in the CVH-associated relative risks (RRs) of CAC incidence at Y25.

Conclusion:
We observed distinct methylomic patterns in young adulthood with stable optimal CVH trajectories relative to those with declining CVH. CVH associated methylomic marks may predict CAC incidence and potentially mediate the associations of CVH trajectories with incident CAC risk.
Abstract P038: Serum Calcium, 25-hydroxyvitamin D and Incidence of Abdominal Aortic Aneurysm: The Atherosclerosis Risk in Communities Study
Authors: Rooney Mary R , Tang Weihong , Folsom Aaron R , Michos Erin D , Alonso Alvaro , Lutsey Pamela L
Published: July 2021

Introduction:
Serum concentrations of calcium and 25-hydroxyvitamin D [25(OH)D] may potentially contribute to the development of abdominal aortic aneurysms (AAA), likely predominately through established AAA risk factors such as hypertension and inflammation. To date, no prospective epidemiologic studies have examined the association between calcium and 25(OH)D and AAA risk.

Hypothesis:
We hypothesized that 20-year risk of AAA is higher among individuals with elevated serum calcium and among those with low serum of 25(OH)D.

Methods:
Serum calcium and 25(OH)D were measured in Atherosclerosis Risk in Communities (ARIC) study participants without prior AAA and who attended visit 2 (1990-92) (N=13,452). Serum calcium was corrected for serum albumin. AAA events were identified through 2011 via annual follow-up phone calls for hospitalized AAAs, and through Medicare for both hospitalized and outpatient AAAs. Multi-variable Cox proportional hazards models were used. Calcium was modeled as quartiles and 25(OH)D as <10, 10-<20, 20-<30, ≥30 ng/ml. Additionally, sex-stratified analysis was conducted.

Results:
The participants were mean±SD age 57±6y, 44% men and 75% white. Mean serum concentrations were 9.2±0.4 mg/dl for calcium and 24.3±8.5 ng/ml for 25(OH)D. Over a median 19.7 years of follow-up, 484 AAA cases were identified. High serum calcium was associated with an increased incidence of AAA [HR Q4 v Q1=1.60 (95% CI: 1.24-2.08)] after adjustment for demographics and with additional adjustment for height, weight and smoking [1.39 (1.05-1.82)], but not after other CVD risk factors were controlled for [1.20 (0.91-1.58)]. In the fully adjusted model, a sex-interaction was present [p-value sex*calcium interaction=0.03], whereby the association was present in women [2.28 (1.20-4.34)] not men [1.05 (0.75-1.47)]. Those with 25(OH)D ≥30 ng/ml vs. <10 ng/ml had a HR for AAA of 1.54 (1.03-2.29) after demographic adjustment, but the association was attenuated with further adjustment for height, weight and smoking [1.24 (0.82-1.88)]. No sex-25(OH)D interaction was detected. As such, stratified results are not presented.

Conclusions:
In this large prospective cohort, there was little evidence that markers of vitamin D metabolism are associated with risk of incident AAA. The positive association of calcium with AAA among women may warrant further investigation and replication in other populations.
Abstract P056: Sex Differences in the Association of Diabetes With Cardiovascular Disease Outcomes Among African Americans in the Atherosclerosis Risk in Communities (ARIC) Prospective Cohort: 1987-2013
Authors: George Kristen M , Selvin Elizabeth , Pankow James S , Windham B. Gwen , Folsom Aaron R
Published: July 2021

Epidemiologic studies have consistently shown in whites that the relative risk of diabetes for coronary heart disease (CHD) is greater for women than for men. However, little is known whether this differential sex association is mirrored among African Americans. We hypothesized that, similar to whites, there would be a multiplicative sex by diabetes interaction for cardiovascular disease (CVD) incidence among African Americans in the ARIC cohort. We conducted a prospective cohort analysis of 14,058, 27% African American and 73% white, participants from the ARIC study initially recruited in 1987-1989 and followed for incident cardiovascular events through 2013. CVD was defined as CHD, total stroke, peripheral artery disease (PAD), or heart failure. Race-specific Poisson regression was used to calculate incidence rates of CVD stratified by diabetes status and sex. Race-specific Cox proportional hazards models were run in three stages; stage 1 examined baseline diabetes status, stage 2 examined baseline diabetes status with the competing risk of non-CVD death, and stage 3 incorporated a time-varying model that updated diabetes status during follow-up and included a competing risk of non-CVD death. At each stage, three sequential models were run adjusting for potential confounders including age, body mass index (BMI), smoking status, physical activity, alcohol consumption, education, hypertension, LDL cholesterol, HDL cholesterol, and kidney function. There were 1,073 incident CVD events among African Americans and 2,475 among whites. In stage 1 analysis among African Americans with baseline diabetes, the CVD incidence rate was nearly identical in women and men, 26.8 and 28.1 per 1000 person years, respectively. Women with diabetes were at 2.3-fold increased hazard (95% CI: 2.0 to 2.7) of CVD compared to women without diabetes after adjustment for age, whereas the corresponding hazard ratio for men was 1.8 (95% CI: 1.5 to 2.1) (p for sex by diabetes interaction=0.014). After full adjustment for potential confounders, the diabetes hazard ratio was attenuated to 2.0 (95% CI: 1.8 to 2.3) in women and remained at 1.8 (95% CI: 1.5 to 2.1) for men (interaction p-value =0.058). This finding of synergy between being a woman and having diabetes on CVD risk was consistent across stages 2 and 3 with marginally significant p-values for interaction. The interaction of diabetes by sex was somewhat weaker among whites. Efforts to prevent diabetes and control CVD risk factors are important to both African American men and women, but are particularly relevant in women. While diabetes and CVD risk factor management have improved over the last several decades, there is a higher relative risk of CVD among African American women with diabetes compared with diabetic men, mirroring the sex differences seen in whites.
Abstract P060: A Point-based Prediction Model for Predicting 10-year Risk of Developing Type 2 Diabetes Mellitus in Japanese Men: Aichi Workers’ Cohort Study
Authors: Li Yuanying , Yatsuya Hiroshi , Hirakawa Yoshihisa , Ota Atsuhiko , Matsunaga Masaaki , Esayas Haregot Hilawe , Chiang Chifa , Zhang Yan , Tamakoshi Koji , Toyoshima Hideaki , Aoyama Atsuko
Published: July 2021

Objective:
Preventive services including screening for diabetes and its potential risk factorsare available to more Americans under Obamacare Preventive Care. Stratifying individuals by the predicted risk of developing type 2 diabetes mellitus (T2DM) would be useful for improving public health with efficient interventions. Although a number of T2DM prediction models have been reported, there is little evidence in East Asians, especially that from long-term follow-up studies. They are reported to have lower ability of innate insulin secretion and develop diabetes at much lower body mass index (BMI) than Caucasians and African Americans. Thus, this study aims to develop a point-based prediction model for 10-year risk of developing T2DM incidence in middle-aged Japanese men.

Method:
We followed 3,540 males in a worksite in Japan who were aged 35-64 years and free of diabetes in 2002 until March 31, 2015. Relationships of baseline age (continuous), BMI (<23, 23- <25 [reference category (Ref)], 25- <27.5, ≥27.5 kg/m
2
), current smoking status (yes, no [Ref]), alcohol consumption(0 [Ref], <23, 23- <46, ≥46 g/day), regular exercise of a moderate or higher intensity, an interval of ≥3 days per week, and a duration of ≥30 minutes per time (yes [Ref], no), medication use for dyslipidemia (yes, no [Ref]), family history of diabetes (having the first degree’s relatives with diabetes, not having [Ref]), serum triglycerides (<150 [Ref], ≥150 mg/dl), high density lipoprotein cholesterol(≥40 [Ref], <40 mg/dl), and fasting blood glucose (<100 [Ref], 100- <110, 110- <126 mg/dl) with incidence of T2DM were examined by Cox proportional hazard model. Variables significantly associated with T2DM (p<0.10) in the univariate models were simultaneously entered into a multivariate model, and backward variable selection procedure was done to determine the final multivariate model. Points were assigned for each predictor according to the method used in the Framingham Study.

Result:
During the median follow-up of 12.2 years, 342 males developed T2DM. The point-based model employing BMI, current smoking status, family history of diabetes, and blood levels of triglycerides and fasting blood glucose showed reasonable discrimination (c-statistics: 0.73) and goodness of fit (Hosmer-Lemeshow p=0.22).

Conclusion:
Our point-based prediction model showed applicability in terms of identifying middle-aged Japanese men at high risk of developing T2DM. The present findings warrants further investigations to determine whether using the point-based prediction models is effective to reduce T2DM incidence.