bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P441: Association of Monthly Resistance Training Volume With All-Cause Mortality in NHANES 1999-2006
Authors: Booker Robert , Alexandria Shaina , Wong Mandy , Carnethon Mercedes R
Published: March 2023

Introduction:
The WHO Physical Activity Guidelines recommend at least 2 days of resistance training (RT) per week. RCTs have shown a dose-response between RT volume and improving blood pressure, lipids, and markers of glycemia. There is discordance between the Guidelines recommending a frequency while empirical evidence supports a volume. Our objective was to test whether RT Guidelines and volume were associated with lower mortality.

Methods:
Data are from the 1999–2006 NHANES cycles. Participants self-reported past 30 days of physical activity including type, which was used to assign METs, number of sessions, and average session duration in minutes. Those who reported engaging in RT (push-ups, sit-ups, and weightlifting) with no missing data were included (
N
=1,391). RT volume was measured in monthly MET-minutes, calculated as the product of the number of sessions, mean session duration, and intensity. Mortality was ascertained from the linked National Death Index through the end of 2019. Covariates included monthly aerobic physical activity volume, sex, age, and education. Cox proportional hazards regression was used to estimate hazard ratios for all-cause mortality by RT Guideline adherence and RT volume.

Results:
Participants had a mean age of 41.3±16.3 years and were mostly male (62.7%). Most participants met the Guidelines (
n
=1,041, 74.8%). The mean monthly RT volume was 2,210±2,550 MET-minutes. Mortality incidence was 11.4% with a mean follow-up time of 189±41.6 months (159 events, 263,585 total person-months). Neither meeting the Guidelines nor monthly RT volume was associated with all-cause mortality (Table 1.). There was no evidence of effect modification by sex or age.

Conclusions:
According to these findings, current Guidelines promoting RT for health benefits are not supported by empirical data. However, the absence of an association between monthly RT volume and all-cause mortality warrants further investigation using better instrumentation for assessing RT volume.
Abstract P445: Patterns in Physical Activity Among Individuals With Cardiovascular Risk Factors in the United States: A Population-Based Contemporary Study From NHANES 2017- 2020
Authors: Nabi Wafa , Aminorroaya Arya , Khera Rohan
Published: March 2023

Background:
ACC/AHA guidelines recommend at least 75 and 150 minutes per week of moderate-intensity and vigorous-intensity activity respectively for improved glycemic, blood pressure, and lipid management in patients with diabetes, hypertension, and hypercholesterolemia, and improved long-term CV outcomes. This study aimed to investigate physical activity patterns in these patients with long-standing recommendation for achieving these optimal physical activity goals.

Methods:
We used publicly available NHANES 2017-2020 US Population Data to identify individuals with CV risk factors and their self-reported physical activity. Individuals were diagnosed with diabetes, hypertension, or hypercholesterolemia, based on standardized questionnaire focusing on diagnosis by clinician or receipt of relevant therapies for the treatment of these conditions.

Results:
Of 9693 surveyed adults with mean age of 47.5 (1.0) years, 1445 (14.9%) patients reported a medical history of diabetes. Of these cohort of diabetics, only 636 patients (46.4%) reported doing a sufficient amount of physical activity in adherence to ACC/AHA guidelines. Among patients diagnosed with hypertension (2784) and hypercholesterolemia (2007), only 1410 (50.6%) and 1020 (50.8%) respectively reported performing a sufficient amount of physical activity per guidelines.

Conclusions:
These results point to much room for improvement to optimize modifiable cardiovascular disease risk factors such as insufficient physical activity in patients who are already at increased CV disease risk due to history of diabetes, hypertension, and hypercholesterolemia. Next steps should involve heightened focus on counseling and lifestyle modification to reduce risk of cardiovascular disease.
Abstract P450: The Moli-Sani Risk Score, a New Algorithm for Measuring the Global Impact of Nine Modifiable Cardiovascular Risk Factors
Authors: Di Castelnuovo Augusto , Bonaccio Marialaura , Costanzo Simona , De Curtis Amalia , Persichillo Mariarosaria , Panzera Teresa , Baldassarre Damiano , Roncaglioni Maria Carla , Baviera Marta , Cerletti Chiara , Donati Maria Benedetta , de Gaetano Giovanni , Iacoviello Licia
Published: March 2023

Introduction:
Cardiovascular (CV) disease, the leading cause of death globally, is largely preventable through targeting modifiable risk factors. Scores of modifiable CV risk factors able to collect the combined effect of all the included components were mainly developed in US populations, or do not include nutritional aspects.

Hypothesis:
We assessed the hypothesis that an algorithm for measuring the global impact of nine modifiable CV risk factors, including dietary factors is useful in a Mediterranean population.

Methods:
Data on 16 656 participants of the Moli-sani Study (age ≥45y, 47% men), Italy, were used. The
Moli-sani
Risk Score (MRS) was calculated as a weighted sum of smoking, adherence to Mediterranean diet, LDL and HDL cholesterol, triglycerides, blood pressure, glucose, physical activity and relative fat mass. A composite outcome of fatal or non-fatal CV events was used. The Risk-and-Prevention Study, Italy (N=8606) acted as external validation cohort and the Life's Simple 7 metric as benchmark.

Results:
In the derivation cohort, 816 CV events occurred in 8.1 years (median) of follow-up. In multivariable Cox analysis adjusted for non-modifiable risk factors, 1-unit increase in the MRS was associated with a hazard ratio (HR) for CV events of 1.07 (95%CI: 1.06-1.08). In comparison with individuals in the first quartile, those in the fourth quartile of the MRS had HR=3.18 (2.54-3.97, Table). In the validation cohort, individuals in the fourth quartile reported a HR=1.69 (1.39-2.05). In comparison with the Life's Simple 7 metric, the MRS performed better in the derivation cohort and similarly in the validation cohort.

Conclusions:
The
Moli-sani
Risk Score is a validated, replicable algorithm predictive of CV events, based on nine modifiable CV risk factors, well performing in a Mediterranean population. The MRS can be useful to evaluate the efficacy of preventive strategies, to design intervention schemes and to communicate effectiveness of a preventive action, increasing compliance to the strategy itself.
Abstract P451: Coronary Artery Calcium and the Association Between Dietary Fish Intake and Atherosclerotic Cardiovascular Disease Risk
Authors: Razavi Alexander C , Alfaddagh Abdulhamied , Dzaye Omar , Budoff Matthew J , Whelton Paul , Kelly Tanika N , He Jiang , Bazzano Lydia A , Fernandez Camilo , Harlan Timothy , Morris Alanna A , Quyyumi Arshed A , Blumenthal Roger S , Blaha Michael J , Sperling Laurence , Whelton Seamus P
Published: March 2023

Introduction:
Current guidelines recommend ≥2 servings of fish/week for the prevention of atherosclerotic cardiovascular disease (ASCVD). However, a recent large meta-analysis suggested that the benefit may exist only for persons with a prior ASCVD event. Whether coronary artery calcium (CAC) can help to identify individuals who are likely to benefit from habitual fish consumption is unknown.

Hypothesis:
CAC will stratify persons who may and may not benefit from habitual fish consumption.

Methods:
There were 4977 participants in the Multi-Ethnic Study of Atherosclerosis who reported their frequency of fish intake and underwent CAC scanning at Visit 1. Adjusted Cox proportional hazards regression models stratified by the presence/absence of CAC assessed the association between fish intake and incident ASCVD over a median follow-up of 15.7 years.

Results:
The mean age was 61 years old, 53% were women, 26% were Black, and 49% of participants had prevalent CAC. A similar proportion of individuals reported consuming ≥2 servings of fish/week for those with CAC=0 and CAC >0 (35% versus 33%, p=0.12). The absolute ASCVD event rate for those with <2 or ≥2 servings of fish/week was 5.5 vs. 4.2 per 1,000 person-years for CAC=0 and 18.2 vs. 19.0 person-years for CAC >0 (Figure 1). Each additional serving of fish/week was associated with a 9% lower risk of ASCVD for participants with CAC=0 (HR=0.91, 95% CI: 0.83-0.99) whereas there was no significant association for persons with CAC >0 (HR=1.03, 95% CI: 0.99-1.07).

Conclusions:
A higher amount of fish consumption was associated with a lower risk of incident ASCVD for participants with CAC=0, but not those with CAC >0, although the absolute ASCVD event rate was low for persons with CAC=0 regardless of fish consumption frequency.
Abstract P453: Apolipoprotein B, Low-Density Lipoprotein Particle Number, Non-High-Denisity Lipoprotein Cholesterol, Low-Density Lipoprotein Cholesterol, and Total Cholesterol for Atherosclerotic Cardiovascular Disease Risk Prediction in Young Adults
Authors: Wilkins John T , Ning Hongyan , Sawicki Konrad , Sawicki Konrad T , Sniderman Allan D , Otvos James D , Rana Jamal S , Murthy Venkatesh , Murthy Venkatesh L , Shah Ravi V , Allen Norrina B , Lloyd-Jones Donald
Published: March 2023

Introduction:
Measures of atherogenic particle number (apoB and LDL particle number [LDL-P]) are stronger predictors of atherosclerotic cardiovascular disease (ASCVD) risk than measures of cholesterol concentration (LDL-C, non-HDL-C, total cholesterol [TC]) in middle-aged adults. It is unclear if this is true for younger adults.

Methods:
Among CARDIA participants (ppts), NMR was used to measure apoB and LDL-P. Non-HDL-C and TC were measured using standard assays; LDL-C was calculated using the Friedewald equation. We stratified the ppts into two age windows: age 20-30y (n=1645) and age 30-40y (n=2922). We used adjusted Cox proportional hazards models to assess the associations of 1SD higher apoB, LDL-P, non-HDL-C, LDL-C, or TC with incident ASCVD events. We substituted each measure of atherogenic lipid burden for TC in a modified Pooled Cohort Equation (PCE) model (with and without HDL-C); and model performance (discrimination and reclassification) was evaluated.

Results:
There were 81 and 163 ASCVD events over (median [IQR]) 31.8y (31.1-32.0y) for the age 20-30 age window and over 26.8y (19.1-27.1y) for the 30-40y age window, respectively. In ppts age 20-30y, a 1SD higher apoB, LDL-P, non-HDL-C, and LDL-C were significantly associated with incident ASCVD in demographic adjusted models. The strengths of associations with ASCVD were not significantly different across these measures. For the 30-40y age window, all measures of atherogenic lipoproteins were significantly associated with ASCVD; the strengths of association were not significantly different across atherogenic lipid measures in all models. There were no significant differences in the C-statistic and no improvement in reclassification when each measure was used to replace TC in the PCE model.

Conclusions:
ApoB, LDL-P, LDL-C or non-HDL-C may be slightly better markers of long-term ASCVD risk than TC in adults < 30y. However, in adults between 30-40y all measures of atherogenic lipid burden appeared to be equivalent predictors of long-term risk.
Abstract P464: A 5-Day Lifestyle Program for Tobacco and Paan Cessation in South India
Authors: HANSDAK SAMUEL G
Published: March 2023

Tobacco is a leading global preventable cause of premature death accounting for over 8 million deaths amongst its 1.3 billion users and costing the global economy US$ 1.4 trillion each year. In India, 29% of all adults are users with the most prevalent form being smokeless tobacco. It’s use is the #3 attributable risk factor for death in India accounting for nearly 1.35 million deaths annually. Areca (Betel) nut is consumed by 24% of adults with significant oral & other health consequences. Greater attention needs to be given to preventing initiation and cessation of tobacco, nicotine and areca nut products. This study aimed to assess the response of patients attending to a 5-day tobacco and paan cessation program in a dental clinic of a South India teaching hospital from May 25 to December 25, 2019. All patients attending a dental clinic were screened for tobacco and/or paan use. If present, they were invited to attend a 5-day “Living Free from Tobacco & Paan” program which did not use pharmacologic aids. Nicotine tests are offered to those completing the program. Telephonic follow-up was conducted to ascertain and encourage sustained abstinence. 85 of 179 patients completed 5 days of which 78.8% had a negative nicotine test. Tobacco product users included: smokeless (44%), smoker (31%) and both (26%). About ½ users had low, 1/4 moderate and 20% severe dependence. Most common oral cavity lesions were tobacco pouch keratosis, leukoplakia, and oral submucous fibrosis. This program was well received and has a very acceptable early quit rate. Additional patient follow-up is needed to ascertain sustained abstinence. Intentional habit cessation interventions should be offered by all healthcare providers.
Abstract P465: Impact of Smoking Among Medicare Beneficiaries With HIV Admitted for Acute Myocardial Infarction in the United States; a Perspective Using the 2019 National Inpatient Sample
Authors: Dhillon Balkiranjit Kaur , Sombans Shaheen , Ramphul Kamleshun , Verma Renuka , Rehman Osama A , Mejias Stephanie G , Sanikommu Sailaja , Ramphul Yogeshwaree , Lohana Petras , Arti Fnu , Kumar Nomesh
Published: March 2023

Introduction:
While smoking has shown to influence health negatively, there is a lack of data of its impact among HIV patients hospitalized for Acute Myocardial Infarction (AMI) under Medicare.

Hypothesis:
We assessed the hypothesis that the characteristics of smokers vs. non-smokers differ among Medicare beneficiaries with a diagnosis of HIV admitted for AMI in the US, and that worse hospitalization outcomes may be seen with smokers.

Method:
The 2019 National Inpatient Sample was used for our study. We first found patients with a principal admission for AMI, covered by Medicare and with a diagnosis of HIV. The presence of smoking(nicotine) was compared between various patient characteristics and an adjusted odds ratio (aOR) for the mortality risk among smokers with HIV admitted for AMI was also estimated.

Results:
Our study found 1315 cases of AMI among HIV patients covered by Medicare with 800 (60.8%) smokers. Various differences were seen in patient characteristics. Smokers were younger than non-smokers (mean age 61.13 years vs. 62.74 years) and a higher proportion were males (88.1%). Furthermore, smokers also had a higher prevalence of depression (16.9% vs. 10.7%), drug abuse (14.4% vs. 3.9%), chronic pulmonary disease (40.0% vs. 15.5%), and peripheral vascular disease (13.6% vs 10.0%). However, non-smokers had a higher prevalence of hypothyroidism (6.9% vs. 10.7%), cirrhosis (1.9 vs. 8.7%), diabetes mellitus (33.1% vs. 47.6%), hypertension (78.8% vs. 86.4%), anemia (25.0% vs 38.8%) and chronic kidney disease (35.0% vs 50.5%). After adjusting for variables, smokers in our sample had a higher inpatient mortality risk (aOR 2.203, 95% CI 1.027-4.728, p= 0.043).

Conclusion:
Inpatient mortality risk for HIV Medicare beneficiaries admitted with AMI was higher among smokers. Several differences in patient characteristics were also observed. More strict educational and sensitization campaigns among this population may be helpful.
Abstract P466: Relationship Between Smoking and Sleep Duration Depends on Age
Authors: Gorovoy Suzanne B , Patterson Freda , Grandner Michael A
Published: March 2023

Introduction:
Smoking is a major cardiometabolic risk factor that is associated with worse sleep health, partially since nicotine is a stimulant. The present study examined the population-level association between habitual sleep duration and smoking, and whether this relationship may be stronger in younger adults.

Methods:
Data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) was used. Current smoking status of combustible cigarettes was self-reported (yes/no). Habitual sleep duration was reported in hours and categorized as <=4, 5, 6, 7 (reference), 8, 9, and 10+ hours. Covariates included age group, sex, race/ethnicity, and education level. Population-weighted binary logistic regression with smoking as outcome and sleep duration as predictor, adjusted for covariates, was performed. A sleep-by-age interaction term was computed and analyses were stratified by age group.

Results:
In the complete BRFSS sample (N=375,422), compared to 7 hours, smoking was more likely among those sleeping <=4 (OR=2.6, 95%CI [2.3,2.9]), 5 (OR=2.0, 95%CI [1.8,2.1]), 6 (OR=1.5, 95%CI [1.4,1.5]), 8 (OR=1.1, 95%CI [1.0,1.2]), 9 (OR=1.2, 95%CI [1.1,1.4]), and 10+ hours (OR=1.7, 95%CI [1.5,1.9]). A sleep-by-age interaction was significant (p=0.0002). Results of age-stratified analyses are reported in the Table. Overall, relationships differed by age, with sleep-related associations strongest in the youngest adults and generally weakening in older participants.

Discussion:
Smoking was associated with both short and long sleep durations, across all age groups. However, this depended on age, such that relationships were strongest in the youngest age groups. Future cardiometabolic health efforts in young adults should highlight this association.

Table 1:
Odds of Smoking as a Factor of Age and Sleep Duration
Abstract P467: Left Atrial Appendage Occlusion and Risk of Stroke in Medicare Beneficiaries
Authors: Wang Wendy , Chen Lin Y , Walker Rob F , Alonso Alvaro , Norby Faye L , Lakshminarayan Kamakshi , Lutsey Pamela L
Published: March 2023

Background:
Atrial fibrillation (AF) is a significant risk factor for stroke, with oral anticoagulants (OACs) recommended for stroke prevention. However, a nonpharmacologic option is needed for patients with contraindications for OACs. Recently, percutaneous left atrial appendage occlusion (LAAO) has emerged as an alternative treatment option. Although clinical trials have shown that percutaneous LAAO is non-inferior to warfarin and direct OACs, few studies using real-world data have been done.

Methods:
Using data from the Medicare 20% sample databases (2015-18), we assessed the association between percutaneous LAAO vs. OAC use and risk of all stroke among patients with AF who had an elevated CHA
2
DS
2
-VASc score. Secondary outcomes included death and hospitalized bleeding. Patients undergoing percutaneous LAAO were matched with up to 5 other patients who were taking OACs by sex, age, date of enrollment, index date, and CHA
2
DS
2
-VASc score. A total of 17,514 patients with AF were matched (average [SD] 78 [6] years, 44% female). Cox proportional hazards model was used.

Results:
Over a median follow-up of 10.3 months, 293 stroke events, 1,925 deaths and 618 major bleeding events occurred. After multivariable adjustments, no significant difference for risk of stroke or death was noted when patients with percutaneous LAAO was compared to those taking OACs (HRs [95% CIs]: 1.25 [0.95, 1.67] and 0.94 [0.83, 1.06], respectively). However, there was a 3.24-fold (95% CI: 2.75, 3.81) increased risk for hospitalized bleeding after percutaneous LAAO compared to OAC.

Conclusion:
Using data from the Medicare 20% sample databases, no significant difference in risk of stroke or death were noted when percutaneous LAAO was compared to OAC users. However, there was an increased risk for bleeding. Our results confirm the results of randomized trials that among older patients with AF and a high-risk for stroke, percutaneous LAAO may be an alternative to OAC use; however, patients should be aware of potential risks associated with the implantation.
Abstract P469: Risk of Long-Term All-Cause Mortality After Incident Ischemic Stroke of Different Severity in the Atherosclerosis Risk in Communities Study
Authors: Chen Jinyu , Pike James R , Johansen Michelle C , Palta Priya , Coresh Josef , Gottesman Rebecca F , Koton Silvia
Published: March 2023

Background:
Stroke is associated with increased risk of mortality. However, studies on the association between stroke severity and mortality using prospective cohort data with details on cardiovascular risk factors at midlife have not been published in recent years in the US. We studied the association between stroke severity and subsequent all-cause mortality in the Atherosclerosis Risk in Communities Study (ARIC) study.

Hypothesis:
Risk of all-cause mortality increases after incident ischemic strokes with greater risk at higher stroke severity.

Methods:
Severity of incident ischemic strokes in ARIC from 1987 to 2018 was assessed through review of hospital records using the National Institutes of Health Stroke Scale (NIHSS) and categorized as minor, (NIHSS ≤5), mild (6-10), moderate (11-15), and severe (≥16). Deaths were ascertained through linkage with the National Death Index. We used Cox proportional hazard models adjusted for demographic variables and baseline risk factors to determine the hazard ratios (HRs) for all-cause mortality associated with each category of stroke severity, in participants after incident ischemic stroke compared to those who remained stroke-free throughout the study period.

Results:
Among 15661 participants free of stroke at baseline (1987-1989), 1036 developed incident ischemic stroke. There were 757 deaths among participants with incident ischemic stroke during the follow-up after stroke (median=16.1 years). Mean baseline age was 54.16 years, 55.2% women and 26.8% black participants. Cox proportional HRs of mortality after incident ischemic stroke controlling for demographics (Model 1) and further adjusted for risk factors at midlife (age 45-64) are displayed in Table 1.

Conclusion:
Compared to participants free from ischemic stroke, after adjustment for cardiovascular risk factors at midlife, risk of all-cause mortality was 2 to 12-folds higher in ARIC participants after incident ischemic stroke, with a greater risk of mortality observed in those with higher stroke severity.
Abstract P471: Predictors of Referral to Community-Based Rehabilitation Following Stroke
Authors: Jones Sara B , Johnson Anna M , Mormer Elizabeth R , Ressel Kristin E , Pastva Amy M , Wen Molly , Patterson Charity G , Duncan Pamela W , Bushnell Cheryl D , Freburger Janet K
Published: March 2023

Background:
While several studies have examined care transitions following stroke, few have assessed use of rehabilitation. We explored factors predictive of referral to community-based rehabilitation following stroke.

Setting:
40 NC acute care hospitals that participated in the COMprehensive Post-Acute Stroke Services study from 2016-2019.

Participants:
Adults discharged home following stroke or TIA (N=11,195)

Methods:
Guided by an a priori conceptual framework, 41 predictors of referral to community-based rehabilitation were grouped into 3 patient-level domains: demographics, stroke severity, and medical history (e.g., prior stroke); 2 hospital-level domains: structural characteristics (e.g., bed size) and stroke-specific characteristics (e.g., stroke center status); and 1 community-level domain (county-level therapist supply). We estimated predictors of referral using a logistic mixed model with a hospital-specific random effect. We used a hierarchical backward selection approach, first performing domain-specific model selection, then entering retained variables into a complete model.

Results:
The cohort was 49% female, 72% white, with a mean age of 66.8 (SD=14.0) years and overall low stroke severity [mean [SD] NIHSS 2.4 [3.8]). Thirty-six percent of patients were referred to rehabilitation. Referral varied across hospitals, ranging from 3-78%, with a median of 35%. In the final model, older age, female sex, non-white race, higher stroke severity, longer length of stay, previous stroke, current smoking, and heart failure were associated with higher odds of referral as was hospital-employed vs. external-contracted OT services (Table).

Discussion:
Approximately one-third of stroke survivors discharged home were referred to community-based rehabilitation. Women and non-white patients had higher odds of referral. Hospital and community factors were largely not independent predictors of referral. Unmeasured process measures may play a role in unexplained hospital variation.
Abstract P474: Sex-Specific Prevention of Stroke Through Reproductive Risk Factors and Sex Hormone Effects (STOP STROKE): Preliminary Findings
Authors: Madsen Tracy E , Caniglia Sara L , Thomas Juana , Clark Donat Lindsay , Zhang Ling , Bourjeily Ghada , Burton Tina , Furie Karen L , Liu Simin
Published: March 2023

Background:
There are known associations between sex-specific reproductive health factors such as reproductive lifespan and stroke risk. The relation of endogenous sex hormones, specifically sex hormone binding globulin (SHBG), to stroke risk remains uncertain, however, despite some data showing an inverse association between SHBG and stroke. We conducted a pilot case-control study to evaluate SHBG as a stroke risk factor, to report SHBG levels in the period immediately after acute ischemic stroke (AIS), and to demonstrate the feasibility of collecting data on sex hormones and reproductive history in this study population.

Methods:
In STOP STROKE, postmenopausal women were enrolled from a single large healthcare system in the northeast between July 2020 and May 2022. Case participants were postmenopausal women ≥50 years old newly admitted with AIS to a large stroke center; controls were postmenopausal women without a history of stroke recruited from an outpatient clinic in the same healthcare system. Among others, exclusion criteria included use of menopausal hormone therapy within 10 years, prior stroke, surgical menopause, and history of hormone-related cancers. We ascertained data on stroke risk factors and collected blood samples between 24 and 72 hours after stroke onset or at the time of enrollment for controls. Serum SHBG was measured using enzyme-linked immunosorbent assays. Following descriptive analyses, age- and BMI-adjusted SHBG levels were compared between cases and controls using multiple linear regression. Multiple logistic regression was then performed to assess associations between SHBG, clinical risk factors, and the outcome of AIS, with covariates chosen
a priori
based on prior literature.

Results:
In total, 32 cases and 30 controls were enrolled; median age was 69.0 years (IQR 64.5-82.0) for cases vs. 62.0 (IQR (59.0-68.0) for controls. The mean SHBG of AIS cases was 68.8 (SD 36.1) nmol/L compared to 56.6 (SD 30.0) nmol/L among controls (p=0.16). In models adjusted for age and body mass index (BMI), SHBG was similar between cases and controls (beta = 3.0, 95%CI -15.0 - 21.1, p=0.74). Adjusted for age, BMI, history of hypertension, history of diabetes, and age at menarche and menopause, there was a positive association between SHBG and AIS (OR 1.04, 95%CI 1.004-1.071, p=0.03).

Conclusions:
Our pilot study demonstrates the feasibility of enrolling newly admitted AIS patients and controls among postmenopausal women in the catchment area of our comprehensive stroke center. To understand initial findings of a positive association between SHBG and AIS, work is ongoing to measure estrogens and androgens at study baseline and all hormones in follow-up specimens (3-6 months post stroke).
Abstract P475: Left Ventricular Hypertrophy Prevalence by Electrocardiogram in Patients Presenting With Cerebrovascular Accident
Authors: Parks Alexis , Williams Douglas , Riad Mariam , Shah Nupur , Bardia Nikky , Malozzi Christopher , Omar Bassam A
Published: March 2023

Background:
A strong association has been previously suggested between left ventricular hypertrophy (LVH) and stroke. The prevalence of LVH and hypertension, however, differs depending on demographic variables. In light of the most recent hypertension guidelines, more aggressive blood pressure control is called for to achieve the lower goals set forth. This will hopefully translate into lower incidence of LVH and stroke.

Objectives:
To examine the prevalence of left ventricular hypertrophy in patients receiving an electrocardiogram (EKG) for a diagnosis of stroke, transient ischemic attack, or cerebrovascular accident; all of which will be referred to as CVA.

Methods:
An EKG database from a university cardiology noninvasive lab was examined for the diagnosis of CVA over a one year period. The EKGs were evaluated for the presence of LVH or atrial fibrillation/flutter. The results were analyzed using Chi square test.

Results:
There was a total of 14,798 EKGs performed over one year. There were 272 EKGs with a diagnosis of CVA (1.7%); 2364 EKGs (16%) with diagnosis of LVH, and 481 (3.2%) with diagnosis of atrial fibrillation/flutter. Out of the 272 EKGs in patients with CVA diagnosis, there were 174 EKGs in sinus rhythm without LVH (64%), 78 EKGs in sinus rhythm with LVH (29%, P < 0.05), and 20 EKGs in atrial fibrillation or atrial flutter (7.4%, P < 0.05).

Discussion:
Stroke is a major health problem associated with increased mortality and morbidity. While atrial fibrillation and atrial flutter are well-established causes of stroke and were nearly twice as frequent in CVA patients as the general population in our cohort, LVH by EKG, in the absence of atrial fibrillation/flutter, was also nearly twice as prevalent, underscoring its importance as a potential marker for CVA. Hypertension is a well established risk factor for stroke in addition to cardiovascular events, and is a major cause of LVH on EKG. In our cohort nearly one third of patients with stroke were in sinus rhythm, but had left ventricular hypertrophy by EKG, a prevalence that was nearly four times that of atrial fibrillation/flutter. Since hypertension is the most common cause of left ventricular hypertrophy in our population, this places further significance on hypertension as a major modifiable risk factor and predictor of CVA and cardiovascular disease in general. In light of the most recent hypertension guidelines, aggressive blood pressure management to achieve the newly defined lower limits for a diagnosis of hypertension, with monitoring for signs of left ventricular hypertrophy by EKG, should be emphasized in order to decrease the incidence of stroke and other cardiovascular events.
Abstract P500: Age-Specific Population Attributable Fractions for the Impact of Hypertension on Dementia Risk
Authors: Smith Jason , Sharrett A R , Pike James R , Gottesman Rebecca F , Knopman David , Lee Mark , Lutsey Pamela L , Palta Priya , Windham B Gwen , Coresh Josef , Deal Jennifer A
Published: March 2023

Introduction:
Hypertension in midlife, but not late life, is a robust predictor of subsequent dementia. However, the fraction of dementia attributable to hypertension might vary depending on the age of the population considered, and the age through which dementia onset occurs. Here, we investigated associations of hypertension assessed at various ages with incident dementia by age 80 or 90, then estimated population attributable fractions (PAF) for dementia from hypertension categories at each of these age groups.

Hypothesis:
Given hypertension prevalence increases with age but its relative risk for dementia tends to decrease, we had no prior expectation of the age at which the PAF’s would be highest. We hypothesized, however, that PAFs for incident dementia would be higher when hypertension is measured in midlife age groups versus late-life age groups.

Methods:
We leveraged 32 years of follow-up data from the Atherosclerosis Risk in Communities study (ARIC), a prospective, community-based cohort that enrolled participants aged 45-64 years from four US communities (Washington County, MD; Forsyth County, NC; Jackson, MS; and selected suburbs of Minneapolis, MI) at ARIC visit 1 (1987-1989). Participants were followed through 2018-2019. We used Cox proportional hazards models to estimate hazard ratios, then quantified PAFs, of dementia by age 80 and 90 from hypertension assessed at ages of 45-54 (ARIC visit 1), 55-64 (ARIC visits 1 and 4), 65-74 (ARIC visits 4 and 5), and 75-84 (ARIC visit 5).

Results:
Hypertension was assessed among 7,572 participants aged 45-54; 12,033 aged 55-64; and 6,561 aged 65-74. By age 80 the number identified as having incident dementia was 711, 910, and 372, respectively. Relative to normotension, hypertension in each age category was associated with hazard ratios (HRs) greater than 1.0 for dementia from hypertension by age 80. The PAF for dementia by age 80 from hypertension measured at age 45-54 was 15.3% (95% CI = 6.9, 22.3%), 19.1% (95% CI = 9.9, 26.9%) at ages 55-64, and 19.9% (95% CI = -4.4, 38.5%) at ages 65-74. By age 90, the number of incident dementia cases were 958; 2,302; and 1,327, respectively; and, among the 2,086 participants aged 75-84, 400 incident dementia cases. HRs were slightly smaller than those by age 80, while hypertension assessed in the 75-84 age group was not significant. The PAFs for dementia by age 90 from hypertension at age 45-54 was 13.8% (95% CI = 6.6, 20.0%), 12.9% (95% CI = 7.0, 18.2%) at ages 55-64, 10.9% (95% CI = 0.02, 21.0%) at ages 65-74, and non-significant at ages 75-84.

Conclusions:
Public health interventions targeting hypertension in midlife through early late-life might reduce a sizeable proportion of dementia cases.
Abstract P501: Midlife and Late-Life Non-Alcoholic Fatty Liver Disease and Incident Dementia: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Lu Yifei , Pike James R , Hoogeveen Ron C , Walker Keenan , Raffield Laura M , Selvin Elizabeth , Avery Christy L , Mielke Michelle M , Garcia Tanya , Palta Priya
Published: March 2023

Introduction:
Associations of nonalcoholic fatty liver disease (NAFLD) with dementia are controversial. The full spectrum of NAFLD from simple steatosis to fibrosis has been less investigated.

Hypothesis:
The severity of NAFLD, especially with the stage of liver fibrosis, is associated with dementia.

Methods:
The associations between midlife (1990-92, N=9283, mean age 57, female 55%) and late-life (2011-13, N=5138, mean age 75, female 58%) NAFLD and all cause dementia were quantified by Cox regression. NAFLD was characterized using the fatty liver index and liver fibrosis assessment model (FIB-4). Dementia was adjudicated and ascertained through Dec. 31, 2019 from neuropsychological assessments, annual participant or informant contact, and medical record surveillance. We used Cox models with adjustment for demographics, APOE ε4, alcohol, and kidney function. Additional adjustments were made for metabolic factors to explore the independent contribution of NAFLD to dementia.

Results:
During a median follow-up of 24.5 years after midlife NAFLD assessment, 1854 participants developed dementia. During a median of 6.3 years in late-life, there were 893 dementia cases. A graded increase in dementia risk across the spectrum of NAFLD was observed at midlife (p-trend <0.001), but not at older age (
Figure
). In fact, NAFLD in late-life tended to be protective against dementia. After adjusting for the metabolic factors, the associations remained statistically significant in some categories.

Conclusions:
Remodeling of hepatic architecture and dysregulation in hepatocellular function in NAFLD at midlife plausibly induce peripheral promoters of neurodegeneration and may expose a large segment of the population to increased risk of dementia. The inverse association of NAFLD with dementia at late-life requires further investigation, possibly reflecting the depletion of susceptibles, the reversibility of NAFLD due to weight loss, and the lack of accuracy in identifying NAFLD using clinical prediction models at older age.
Abstract P503: Association Between Life’s Simple 7 and the Risk of Dementia Among Women
Authors: Rist Pamela M , Power Melinda C , Lee I-Min , Buring Julie E
Published: March 2023

Introduction:
Given the higher burden of dementia, it is particularly important to identify risk factors for dementia among women. A growing body of research underscores the need to examine midlife risk factors for dementia, as dementia pathology often begins decades before diagnosis.

Hypothesis:
We hypothesized that higher scores on the AHA Life’s Simple 7 in midlife, indicating better cardiovascular health in midlife, would be associated with a decreased risk of dementia among women followed from middle age into older age.

Methods:
The study population included women enrolled in the Women’s Health Study who had available risk factor information needed to calculate the AHA Life’s Simple 7 at baseline (1992-1994) and approximately ten years later (2004) and were fully covered by fee-for-service Medicare for all eligible person-months. Women received one point for each component of the Life’s Simple 7 (smoking status, diet, physical activity, body mass index, diabetes, blood cholesterol, and blood pressure) for which they had ideal cardiovascular health. We used fee-for-service Medicare data (available from 2011 through 2018) and validated lists of ICD-9 and ICD-10 codes to identify dementia diagnoses. We used logistic regression to examine the association between the score, modeled as a continuous variable, and dementia diagnosis adjusted for age and socioeconomic status at baseline.

Results:
A total of 13,720 women were eligible for these analyses and 1771 (12.9%) dementia cases were observed. The mean age (standard deviation (SD)) was 54.2 (6.6) years at baseline. The average Life’s Simple 7 score at baseline was 4.3 (SD=1.3) and after ten years of follow-up was 4.2 (SD=1.3). Higher Life’s Simple 7 score as measured at baseline (odds ratio per one unit change in score=0.94, 95% CI: 0.90-0.98) was associated with a decreased risk of dementia. This effect was similar for the Life’s Simple 7 score as measured after ten years of follow-up (OR=0.95, 95% CI: 0.91-1.00).

Conclusions:
In this large cohort of women, better cardiovascular health in midlife was associated with a decreased risk of dementia in late life.
Abstract P504: Prospective Associations of Midlife C3, C4 and Their Changes Since Midlife With Future Cognitive Performance: The Study of Women’s Health Across the Nation HDL Ancillary Study
Authors: Qi Meiyuzhen , Brooks Maria M , Janssen Imke , McConnell Dan , Barinas-Mitchell Emma , Derby Carol , Karlamangla Arun , Crawford Sybil , Orchard Trevor , Billheimer Jeffrey , El Khoudary Samar R
Published: March 2023

Objective:
Almost two-thirds of Americans over 65 with Alzheimer’s disease (AD) are women. The menopause transition is characterized by a systemic inflammatory state which increases atherosclerosis risk predisposing to dementia. Complement system was inappropriately activated in the brain of AD patients, which may contribute to local inflammation correlated with cognitive dysfunction. Complement factor 3 (C3) and 4 (C4) are the most clinically used complement components. Increased serum C3 and the presence of C4 null genes producing less C4 are risk factors of cardiovascular disease (CVD), indicating the necessity of analyzing the ratio of C3 and C4. Since serum C3 and C4 markedly increase over the menopause transition, we aimed to assess the associations of midlife C3, C4, and C3/C4 ratio and their changes since midlife with future cognitive function in women.

Design:
Repeated measures of serum C3, C4, and measures of working memory (digit span backward test), processing speed (symbol digit modality test), episodic memory immediate and delayed recall (East Boston memory test) were evaluated among midlife women traversing menopause. Mixed effect models were applied to assess the associations.

Results:
We included 305 women (706 observations) with mean age of 51 (SD=3) and 72% of them being pre- or perimenopausal at baseline. C3 and C4 were measured a median of 1.07 (Q1: 0.94, Q3: 1.81) years before cognitive performance assessment. In final models, higher C4 measured at midlife (baseline) was associated with better future episodic memory levels, and higher midlife C3/C4 ratio was associated with worse future episodic memory (
Table
). Changes in the complement factors were not associated with cognitive measures.

Conclusion:
Among women, higher midlife C4 and lower midlife C3/C4 ratio, but not changes in C4 or C3/C4 ratio since midlife, were associated with better future episodic memory levels. Midlife complement protein levels could be early markers of cognitive impairment known to be linked with CVD.
Abstract P506: Timing of Cognitive Test Score Decline Before Incident Dementia in Middle Age Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Wang Yunzhi , Coresh Josef , Schneider Andrea , Knopman David , Mosley Thomas , Sharrett Richey
Published: March 2023

Background:
The most frequent dementias are a mix of Alzheimer’s, vascular and other pathologies which evolve over many years. Our objective is to determine how many years in advance of dementia cognitive scores are affected.

Methods:
13,749 dementia-free ARIC participants had a cognitive exam at Visit 2 (1990-1992, mean age 57), 10,813 at Visit 4 (1996-1998), 5,605 at Visit 5 (2011-2013) and 3,516 at Visit 6 (2016-2017). Within 5-year intervals after each visit, we compared the combined mean of three cognitive tests (Delayed Word Recall, Digit Symbol Substitution, and Word Fluency) z-scores at baseline in two groups - participants who were diagnosed with dementia within each interval vs. those who survived to the interval without dementia. Baseline visit z-scores were adjusted for age, gender, race-center and education level in separate linear regression models for each visit. We plotted the adjusted z-score mean [95% confidence interval] by time interval following each visit.

Results:
Dementia incidence during follow-up yielded 2,981 , 2,397, 961 and 160 cases after Visits 2, 4, 5, and 6 respectively. The three-test combined scores were already significantly lower at 10-15 years before dementia compared to those who did not experience dementia by that period (Figure). As expected at intervals closer to dementia onset the differences between dementia and non-dementia groups increased, up to their widest point of approximately 1 SD at only 0-5 years prior to onset. Delayed Word and Digit Symbol Substitution tests has similar findings while Word Fluency began to decrease only within 5 years prior to dementia onset.

Conclusion:
We found that the differences in combined cognitive function z-score appeared to be associated with dementia diagnosis as early as 15 years prior to diagnosis. As we got closer to the diagnosis date, the difference in scores of people with and without dementia widened substantially. Periodic testing might allow us to intervene earlier in persons likely to develop dementia.
Abstract P508: Social Polarization and Parent Support for Child Physical Activity and Cardiovascular Health
Authors: Kotireddy Vybhavi , Carr Christopher , Gay Jennifer L , N De Brito Junia , Trofholz Amanda , Tate Allan , Berge Jerica
Published: March 2023

Healthy People 2030 estimates that 3 out of 4 children (ages 6-13) do not meet guidelines for aerobic physical activity, an important contributor to cardiovascular health. Determinants of physical activity (PA) occur at individual, household, and neighborhood levels yet little is known about how geospatial risk factors (neighborhood segregation and income inequity) interact with parental influences on child PA. The current study explored the association between index of concentration of extremes (ICE) and child cardiovascular health outcomes, and whether parents PA, child PA, and parent support of child PA modified this association.

Methods:
A subsample of parent-child dyads from the Family Matters Phase II cohort study (n=350) participated in a multi-method follow up study including survey, geospatial (American Community Survey), and biomarker data collection in Minneapolis-St. Paul, MN (2019-2022). Parents self-reported PA, child PA and parent support of child PA, and sociodemographic characteristics (e.g., family structure, educational attainment, annual household income) via an online survey. Children attended a clinic visit to measure height, weight, pulse, and systolic [SBP] and diastolic [DBP] blood pressure. ICE, used as a measure of census tract social polarization reflecting racial segregation and tract income inequity, was operationalized in these tertiles: concentrated deprivation, middle, and concentrated privilege. Multivariable linear regressions were used to evaluate the association between ICE tertiles and child cardiovascular health indicators (SBP, DBP, pulse, and BMI percentile). Models were adjusted for parent age, education, race and ethnicity, and household income. Interaction terms between ICE and parents PA, child PA, and parent support of child PA were further explored in these models.

Results:
Increases in parent engagement in light- and moderate-intensity PA (~30-45-minute increments) were associated with -2.65 mmHg lower DBP (P<0.001) and -2.39 mmHg lower SBP respectively (P=0.001) among children living in the least privileged tracts. The overall interaction of the relationship depended on the census tract privilege (Int. P=0.014), and there was no evidence of a favorable parent PA relationship in medium and most privileged tracts. Light parent PA and ICE interactions were consistent for child pulse and DBP (Int. P<0.05). Parent limiting of screen time had favorable interaction effects for child moderate PA in medium privilege tracts but not at the extremes (Int. P=0.024).

Conclusions:
Interventions targeting structural disadvantages should consider multilevel components that integrate parent support and modeling of PA to address cardiovascular health disparities in pre-adolescent children. In privileged contexts, alternative interventions may need to target sedentary behaviors to improve child PA.