bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP090: “Life’s Simple 7” and Risk of Incident CHD in the REasons for Geographic And Racial Differences (REGARDS) Study
Authors: Safford Monika M , Brown Todd M , Cushman Mary , Gamboa Christopher , Judd Suzanne , Kulshreshtha Ambar , Muntner Paul
Published: July 2021

The American Heart Association’s “Life’s Simple 7” (LS7) is a tool intended to encourage improvements in cardiovascular health. It is not clear whether LS7 scores are associated with similar risks for fatal and nonfatal acute coronary heart disease (CHD) events across race-sex groups in the 21st century. REGARDS is following 30,239 community-dwellers age >45 years recruited between 2003-7 from the contiguous US states. Recruitment was designed to balance race and sex; the final sample was 55% female and 41% black. Participants were telephoned every 6 months for cardiovascular disease endpoints, with retrieval of medical records, death certificates, interviews with next-of-kin or proxies, and expert adjudication of endpoints following national consensus recommendations. Acute CHD was defined as definite or probable myocardial infarction (MI) not resulting in death within 28 days (nonfatal acute CHD) or fatal acute CHD. Among participants free of CHD at baseline, we used Cox models to examine hazard ratios for incident overall acute CHD, and, separately, fatal and nonfatal acute CHD for white and black men and women through 2008, examining associations with LS7 score (blood pressure, cholesterol, glucose, body mass index, smoking, physical activity, and diet), each scored as poor (1 point), intermediate (2 points) or ideal (3 points). The score ranged from 7-21 with 21 being the best cardiovascular health. The study sample numbered 24,431 with mean age 64.1 (SD+9.3) years. Mean follow-up over 3.4 (maximum 5.9) years resulted in 515 incident acute CHD events (355 nonfatal, 160 fatal). Race-sex specific hazard ratios for incident acute CHD and incident nonfatal acute CHD per point higher LS7 score are shown in the table. The AHA’s goal of improving cardiovascular health by 20% by 2020 as assessed by LS7 could have major impact on improving CHD outcomes among black and white Americans.
Abstract MP094: Projected Decline in the United States of Combined Heart Disease and Stroke Mortality below Cancer Mortality by the Year 2020
Authors: Sidney Stephen
Published: July 2021

Background / Objectives:
Heart disease (HD) has been the leading cause of mortality in the United States since 1910 and stroke (STK) is the 4th leading cause. Data from 2009 shows that mortality from HD (179.8 / 100,000 [100K] person years [PY]) is slightly higher than cancer (CAN) mortality (173.6 / 100K PY) and that the gap between combined HD/STK and CAN mortality has narrowed considerably between 2000 (318.5 HD/STK, 199.6 CAN) and 2009 (218.7 HD/STK, 173.6 CAN). These rates are projected through 2020 to determine whether combined HD/STK mortality is likely to fall below cancer mortality overall and within major race-ethnicity groups.

Methods:
HD, STK, and CAN U.S. mortality rates were projected from 2009 to 2020 based on annualized rate of change in mortality from 2000-2009. Because published race-ethnicity specific rates were available only through 2007, 2020 rates were based on the annualized rates of change from 2000-2007. Rates are age-adjusted based on the 2000 US census and expressed per 100K PY.

Results:
HD mortality is likely to decline below CAN mortality by 2011 and in each race-ethnicity group by mid-decade. By 2020, combined HD/STK mortality is likely to be lower than CAN mortality in the U.S. population, declining to 138.3 for HD/STK and 144.5 for CAN (see figure), and in each race-ethnicity group except Blacks (BL). The rates in whites (WH), BL, Asians (AS), and Hispanics (HIS) are expected to decline as follows: WH decline from 228.3 HD/STK, 199.6 CAN in 2007 to 128.9 HD/STK, 145.8 CAN in 2020; BL 307.6 HD/STK, 215.5 CAN in 2007 to 183.4 HD/STK, 165.7 CAN; AS 135.5 HD/STK, 106.7 CAN in 2007 to 65.9 HD/STK, 83.1 CAN; and HIS 168.7 HD/STK, 116.2 CAN in 2007 to 86.6 HK/STK, 88.2 CAN.

Conclusions:
The decline of HD/STK below CAN mortality will represent a major milestone in public health, culminating a half century during which rates of HD/stroke have trended lower due to better primary and secondary prevention and improved medical care. However, we must address ongoing disparities associated with race-ethnicity and socioeconomic status.
Abstract P003: Serum Urate and Subclinical Atherosclerosis: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Wang Huifen , Jacobs David R , Gaffo Angelo L , Gross Myron D , Goff David C , Carr J. Jeffrey
Published: July 2021

Background:
Elevated serum urate (sUA) has been related to risk of cardiovascular disease (CVD), while evidence is limited among young and apparently healthy populations.

Objective:
To examine whether sUA concentration is positively associated with subclinical atherosclerosis as reflected in coronary artery calcified plaque (CAC), aortoiliac artery calcified plaque (AoIC), common carotid intima-media thickness (cCIMT), and carotid stenosis, among young adults.

Methods:
The Coronary Artery Risk Development in Young Adults (CARDIA) Study tracked a cohort of 5,115 black and white adults aged 18-30 years since 1985-86 (year 0), with 7 subsequent examinations at approximately 5 year intervals. sUA concentration was assayed at years 0, 10, 15, and 20, while subclinical atherosclerosis was measured at years 15 (i.e. CAC), 20 (i.e. CAC, carotid stenosis, and cCIMT) and 25 (i.e. CAC and AolC). A dietary history questionnaire was administered at year 0, 7 and 20. Logistic and generalized linear regressions were used as appropriate to examine the relations of sUA at year 0 or 20 with subclinical atherosclerosis. sUA was modeled as continuous variable or gender-specific quartiles that were pooled for the analyses. Covariates at the year of sUA measurement were selected and adjusted in the models based on biological relevance and statistically significant confounding effects.

Results:
The mean (standard deviation [SD]) year 20 sUA concentrations were 6.61 (1.29) mg/dL in men and 4.95 (1.15) mg/dL in women. Adjusting for year 20 age, sex, race, clinic, education, physical activity, smoking status, and intakes of alcohol, protein and total calories, per SD higher year 20 sUA concentration was associated with 26% (95% confidence interval [CI]=9-44%) and 18% (95%CI=3-34%) higher risk of the presence of CAC at years 20 and 25, respectively. However, further adjustment for year 20 body mass index (BMI) and other metabolic factors (i.e. full model) substantially attenuated these relations. In contrast, the positive associations between year 20 sUA and the presence of AolC at year 25 or cCIMT at year 20 retained statistical significance in the model including BMI and metabolic factors: the odds ratio of year 25 AoIC was 1.38 (95%CI=1.03-1.86) for the highest vs. lowest year 20 sUA quartile; and per SD higher sUA was related to 0.01mm greater year 20 cCIMT (p=0.002). Year 20 sUA was not related to carotid stenosis. Parallel analysis using year 0 sUA as the predictor variable and year 0 covariates found a similar pattern in relation to years 15, 20 and 25 subclinical atherosclerosis markers, which, however, were all attenuated to non-significance in the year 0 full model.

Conclusion:
The sUA concentration may be an early biomarker for subclinical atherosclerosis in young adults prior to the development of clinical CVD, operating in part through its relation with BMI and other metabolic factors.
Abstract P004: Association of C-Reactive Protein with Incident Coronary Events in Blacks and Whites: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: Zakai Neil A , Cushman Mary , McClure Leslie A , Brown Todd M , Glasser Stephen P , Shikany James M , Safford Monika M
Published: July 2021

Background:
Elevated C-reactive protein (CRP) is associated with coronary heart disease (CHD) risk independent of traditional CHD risk factors. Few studies include many non-white participants despite known racial differences in CRP. We assessed whether there were racial differences in the association between CRP and incident CHD in a large cohort of AA and white Americans.

Methods:
30,239 AAs and whites were enrolled and examined in their homes across the US from 2003-07. CHD, defined as myocardial infarction or acute CHD death, was captured by participant report and physician medical record review. We used Cox models in those free of CHD at baseline to assess the association of CRP with incident CHD.

Results:
Over a median 3.7 years follow-up (maximum 5.9 years), 505 CHD events occurred in 24,297 individuals without baseline CHD (223 in 10,337 AA). AA had higher levels of many traditional CHD risk factors, including hypertension (69% vs 47%), diabetes (28% vs 13%), current smoking (17% vs 12%, all <0.01), but higher high-density lipoprotein cholesterol (54 vs 52 mg/dL, p<0.01) and similar total cholesterol (195 vs 192 mg/dL, p=0.16). Median CRP was higher in AA than whites (2.85 vs 1.82 mg/L, p<0.01), with 4,615/9,558 (48%) of blacks vs. 4,548/13,217 (34%) of whites having a CRP ≥3 mg/L (p<0.01) . The table presents the HR of CHD for CRP ≥3 mg/L and per 1 unit increase in log CRP stratified by race. AA did not have a higher hazard of CHD than whites in any model (data not shown).

Discussion:
Despite higher levels of CRP in AA, CRP was not differentially associated with CHD between AA and whites. Though the HR for CRP ≥3 mg/L appeared weaker in AA vs. whites this was not supported by a significant p-interaction. The paradox of an adverse CHD risk factor profile but similar risk of CHD was not explained by differential associations of CRP with CHD in AA vs. whites. Further analyses of fatal and non-fatal MI as well as the performance of traditional and non traditional CHD risk factors in AA vs. whites are warranted.

Table

Association of CRP with Incident CHD in African-Americans and Whites

All HR (95% CI)
Blacks HR (95% CI)
Whites HR (95% CI)
P-interaction between race and CRP

CRP ≥3 mg/L

Model 1
1.63 (1.35, 1.96)
1.46 (1.11, 1.93)
1.75 (1.37, 2.24)
0.57

Model 2
1.37 (1.14, 1.66)
1.26 (0.95, 1.67)
1.46 (1.13, 1.88)
0.52

Model 3
1.33 (1.10, 1.61)
1.20 (0.90, 1.61)
1.41 (1.10, 1.82)
0.58

Per 1 unit increase in log CRP

Model 1
1.32 (1.22, 1.43)
1.29 (1.15, 1.45)
1.34 (1.20, 1.49)
0.95

Model 2
1.23 (1.13, 1.33)
1.23 (1.09, 1.39)
1.22 (1.09, 1.36)
0.81

Model 3
1.21 (1.12, 1.31)
1.21 (1.07, 1.37)
1.20 (1.07, 1.34)
0.73

Model 1: Age, Sex, and Region

Model 2: Model 1 + Hypertension, Diabetes, Smoking, Total Cholesterol, HDL Cholesterol, Taking Dyslipidemia Meds

Model 3: Model 2 + Income, Education
Abstract P011: White Blood Cell Count in Young Adulthood and Coronary Artery Calcification in Early Middle Age: Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Hou Lifang , Lloyd-Jones Donald , Ning Hongyan , Huffman Mark . D , Fornage Myriam , He Ka , David Jacobs R , Goff David C , Sidney Stephen , Carr Jeffrey J , Liu Kiang
Published: July 2021

Background:
White blood cell (WBC) count is associated with incident coronary heart disease (CHD). Coronary artery calcification (CAC) is a measure of subclinical atherosclerosis that predicts CHD events. Since data are sparse regarding the association of WBC count with future CAC, we examined the association of WBC count in early adulthood (age 18-30 yrs.) with the presence of CAC 15 or 20 years later (age 33-50 yrs.).

Methods:
We included CARDIA participants who had baseline data on risk factors and WBC counts, and participated in the Year (Y) 15 or Y20 examinations with CAC score information. We performed age-, sex-, and race-adjusted linear regression analyses to examine the cross-sectional association between baseline (Y0) WBC count (total and subtypes) and known CHD risk factors, including systolic blood pressure (SBP), BMI, smoking (packs/year), total and HDL-cholesterol. We used multiple logistic regressions to assess prospective associations between Y0 WBC count and the presence of CAC at Y15 and Y20.

Results:
Among 3094 participants, mean (SD) age at baseline was 25± 4 years, 57% were women and 45% were black. In total, 263 and 566 subjects had CAC score>0 at Y15 and Y20 examination, respectively. Y0 SBP, BMI, and smoking (p<0.001), and HDL-cholesterol (p=0.01) were significantly associated with Y0 total WBC counts. Compared to participants without CAC at Y20, those with CAC score>0 had higher Y0 counts (10
9
/L, SD) of total WBC (6.0 ± 1.8 vs. 6.2 ± 1.9, p=0.04), lymphocyte (2.16 ± 0.75 vs. 2.23 ± 0.76 p=0.05), and eosinophil (0.16 ± 0.13 vs. 0.18 ± 0.16, p<0.001). These counts were positively associated with the presence of Y20 CAC after adjusting for potential confounders (
Table 1
). Similar patterns were observed for Y15 CAC (data not shown).

Conclusion:
Total WBC and certain subtype counts in young adulthood are significantly associated with presence of CAC 15 or 20 years later in early middle age. These findings suggest the possible involvement of WBC in the initiation and/or early development of atherosclerosis.

Table 1.

Y0 WBC counts and CAC presence at Y20 (OR (95% CI) per 1 x 10
9
/L

WBC counts

Model 1
*

Model 2
**

Total WBC
1.24 (1.12, 1.37)
1.11 (1.00, 1.24)

Monocyte
1.02 (0.93, 1.13)
0.96 (0.87, 1.07)

Neutrophils
1.13 (0.99, 1.28)
1.06 (0.93, 1.21)

Lymphocyte
1.16 (1.05, 1.28)
1.03 (0.93, 1.14)

Eosinophil
1.17 (1.05, 1.29)
1.14 (1.02, 1.27)

*

Age, sex, race adjusted;

**

Model 1 plus Y0 education, SBP, BMI, TC, HDL, smoking and blood pressure lowering medication use.
Abstract P029: Diabetes Mellitus and Disabling Dementia among Japanese: The Circulatory Risk in Communities Study (CIRCS)
Authors: Eguchi Eri , Yamagishi Kazumasa , Ikeda Ai , Chei Choy-Lye , Noda Hiroyuki , Ohira Tetsuya , Kitamura Akihiko , Imano Hironori , Kiyama Masahiko , Ishikawa Yoshinori , Asada Takashi , Iso Hiroyasu
Published: July 2021

Introduction:
The evidence for the relation between diabetes mellitus and risk of dementia in Asian population has been limited. This study investigated the association between diabetes mellitus and risk of dementia in community-based samples of Japanese.

Hypothesis:
There is an association between diabetes mellitus and risk of disabling dementia

Methods:
We performed a nested case-control study based on a cohort of about 6,000 Japanese aged 45-69 at baseline between 1984 and 1994. The information of the status of diabetes at baseline was collected for 174 disabling dementia cases incident between 1999 and 2004 and 348 controls matched with cases by age±3, sex and baseline-year. Incident disabling dementia was defined as dependent individuals who had moderate to severe dementia-related behavioral disturbance or cognitive impairment. This criterion was previously validated with 5-cog test. Dementia cases were further classified according to presence of history of stroke. The conditional odds ratio (OR) for dementia was calculated according to the status of (1) glucose intolerance; fasting serum glucose 110-125mg/dl or non-fasting serum glucose 140-199 mg/dl; and (2) diabetes; fasting serum glucose ≥126 mg/dl, non-fasting serum glucose ≥200 mg/dl, and/or the use of glucose-lowering medication or insulin therapy. Variables for multivariable adjustment were body mass index, smoking status, total cholesterol and hypertension status (140≤SBP<160 mmHg, 90≤DBP<95 mmHg for hypertension of grade 1, SBP ≥160 mmHg, DBP ≥95mmHg for hypertension of grade 2 and 3, and the treatment with an antihypertensive drug). Sex-specific analysis was also conducted as subanalysis.

Results and Conclusions:
Mean follow-up year was 11.4 years. The proportion of men was 32.8% and the prevalence of glucose intolerance and diabetes among controls were 16.7% and 5.8%, respectively. Of dementia cases, 44.8% had history of stroke. Compared with persons with normal glucose level, ORs (95%CI) for glucose intolerance and diabetes were 1.12 (0.68-1.84) and 2.18 (1.13-4.22), and multivariable ORs were 0.98 (0.58-1.65) and 2.04 (1.03-4.03), respectively. For sex stratified analysis, ORs for diabetes were 1.39 (0.45-4.31) for men, and 2.79 (1.20-6.50) for women. The association of diabetes was primarily observed in dementia cases with stroke history [OR=3.19 (1.04-9.82)], but not in those without it [OR=1.78 (0.78-4.07)]. In conclusion, we found an association between diabetes mellitus and risk of disabling dementia. The association was confined to women, and dementia with stroke history.
Abstract P030: Variations in Cardiovascular Risk Among Different Clinical Presentations of Metabolic Syndrome in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Authors: Brown Todd M , Richman Joshua , Bittner Vera , Lewis Cora E , Voeks Jenifer , Safford Monika M
Published: July 2021

Background:
Some individuals classified as having metabolic syndrome (MetSyn) are centrally obese while others are not with unclear implications for cardiovascular (CV) risk.

Methods:
REGARDS is following 30,239 individuals ≥45 years of age living in 48 states recruited from 2003-7. MetSyn risk factors were defined using the AHA/NHLBI/IDF harmonized criteria with central obesity being defined as ≥88 cm in women and ≥102 cm in men. Participants with and without central obesity were stratified by whether they met >2 or ≤2 of the other 4 MetSyn criteria, resulting in the creation of 4 groups. To ascertain CV events, participants are telephoned every 6 months with expert adjudication of potential events following national consensus recommendations and based on medical records, death certificates, and interviews with next-of-kin or proxies. Acute coronary heart disease (CHD) was defined as definite or probable myocardial infarction or acute CHD death. To determine the association between these 4 groups and incident acute CHD, we constructed Cox proportional hazards models in those free of CHD at baseline by race/gender group, adjusting for sociodemographic variables.

Results:
A total of 20,018 individuals with complete data on MetSyn components were free of baseline CHD. Mean age was 64+/−9 years, 58% were women, and 42% were African American. Over a mean follow-up of 3.4 (maximum 5.9) years, there were 442 acute CHD events. In the non-centrally obese with>2 other risk factors, risk for CHD was higher for all but AA men, though significant only for white men. In contrast, in the centrally obese with >2 other risk factors, risk was doubled for women, but only non-significantly and modestly increased for men. Only AA women with central obesity and ≤2 other risk factors had increased CHD risk (Table).

Conclusion:
The CHD risk associated with the MetSyn varies by the presence of central obesity as well as the race and gender of the individual.
Abstract P041: Cumulative Exposure to Air Pollution, Socioeconomic Status and Post-Myocardial Infarction Outcomes in Central Israel. A Cohort Study
Authors: Molshatzki Noa , Broday David , Koton Silvia , . Yuval , Myers Vicki , Drory Yaacov , Steinberg David , Gerber Yariv
Published: July 2021

Objective:
In a community-based cohort of myocardial infarction (MI) survivors, we examined whether cumulative residential exposure to air pollutants constitutes a risk factor for adverse outcomes.

Methods:
Patients aged ≤65 years (n=1,428), admitted with first MI in 1992-1993 to the 8 hospitals serving the population of central Israel, were followed up through 2005. Extensive data were collected on socio-demographic, clinical, and environmental factors. Daily measures of nitrogen dioxide (NO
2
), nitric oxide (NO) and fine particles (PM
2.5
) recorded at air quality monitoring stations were summarized and cumulative exposure was estimated for each patient based on geo-coded residential location at study entry. Cox models were used to assess the hazard ratios (HRs) for all-cause death, cardiac death, recurrent MI, heart failure and stroke associated with a 10 μ g/m
3

increase in pollutant exposure.

Results:
Patients residing in more polluted areas had better socioeconomic status at both the individual and neighborhood levels. Exposure to pollutants was inversely associated with outcomes. However, these associations were either removed or reversed upon multivariable adjustment for socioeconomic and clinical variables (HRs [95% CIs] of PM
2.5
are reported in the Table).

Conclusions:
In this unique setting and in contrast to other reports, better socioeconomic status was associated with higher exposure to pollution. In multivariable models accounting for socioeconomic and clinical variables, we observed a weak positive association between PM
2.5
exposure and post-MI outcomes, consistent with findings in the general population. Considering exposure misclassification, the true association is likely stronger.

Unadjusted
Multivariable-Adjusted

All-Cause Death
0.93 (0.53-1.62)
1.51 (0.85-2.67)

Cardiac Death
0.74 (0.38-1.44)
1.37 (0.70-2.68)

Recurrent MI
1.06 (0.62-1.81)
1.67 (0.96-2.92)

Heart Failure
0.60 (0.32-1.12)
1.39 (0.73-2.62)

Stroke
0.64 (0.29-1.40)
1.04 (0.46-2.33)
Abstract P044: Urine Arsenic Concentrations and Glycated Hemoglobin: Associations by Diabetes Status in the Strong Heart Study
Authors: Gribble Matthew O , Howard Barbara V , Umans Jason G , Shara Nawar , Francesconi Kevin A , Goessler Walter , Crainiceanu Ciprian M , Silbergeld Ellen K , Guallar Eliseo , Navas-Acien Ana
Published: July 2021

Introduction:
Low-moderate exposure to inorganic arsenic has been associated with hemoglobin A1c (HbA1c) in some studies. While HbA1c is a marker of diabetes control among individuals with treated diabetes, the association between arsenic and HbA1c has not been evaluated according to diabetes status. Hypothesis: Arsenic is positively associated with HbA1c. Methods: We included 3,567 (1774 with diabetes and 1793 without diabetes) American Indian adults who participated in the Strong Heart Study in 1989-1991 with measured urine arsenic, HbA1c and other covariates. We compared HbA1c levels by urine arsenic quartiles using linear regression stratified by diabetes status and adjusted for urine creatinine, demographic variables, body mass index and smoking. Among diabetics, we ran models stratified by fasting glucose and by diabetes treatment. Results: Median (interquartile range) HbA1c levels were 8.1 (6.1, 10.3)% and 5.1 (4.7, 5.4)%, in participants with and without diabetes, respectively. Adjusted mean HbA1c levels were 0.55 (95% CI 0.20, 0.90)%, 1.13 (0.76, 1.49)% and 1.28 (0.77, 1.59)% higher in quartiles 2-4 compared to the lowest quartile; p for trend <0.001. Urine arsenic was not associated with HbA1c levels in those without diabetes: mean difference in HbA1c levels comparing quartiles 2-4 to the lowest quartile were 0.08 (0.01, 0.15)%, -0.03 (-0.10, 0.05)% and -0.05 (-0.13, 0.04)%, respectively; p for trend =0.10. Among diabetics, the association between arsenic and HbA1c was strongest among participants with fasting glucose ≥180 mg/dL, in untreated participants, and in those taking only oral hypoglycemics (Table).

Difference (95% Confidence Interval) in HbA1c by Total Urine Arsenic (adjusted for age, sex, region, obesity, smoking and urine creatinine)

Fasting Plasma Glucose (mg/dL)
Diabetes Treatment

Urine Arsenic (μg/L)
<1.6 (N=291)
≥126 and <180 (N=594)
≥180(N=865)
None (N=688)
Oral(N=637)
Insulin (N=436)

Q1 (<8.83)
0.00 (referent)
0.00 (referent)
0.00 (referent)
0.00 (referent)
0.00 (referent)
0.00 (referent)

Q2 (≥8.83 and <15.38)
0.15 (-0.33,0.64)
0.04 (-0.34, 0.42)
0.41 (0.03, 0.80)
0.57 (0.07, 1.06)
0.37 (-0.15, 0.89)
0.35 (-0.27, 0.97)

Q3 (≥15.38 and <26.37)
0.43 (-0.12, 0.98)
0.38 (-0.04, 0.80)
0.49 (0.09, 0.90)
0.93 (0.39, 1.46)
0.73 (0.19, 1.28)
0.61 (-0.07, 1.28)

Q4(≥26.37)
−0.21 (-0.86, 0.44)
0.27 (-0.17, 0.71)
0.58 (0.12, 1.04)
0.91 (0.34, 1.49)
0.90 (0.25, 1.54)
0.36 (-0.38, 1.11)

p for trend
*

0.29
0.22
0.08
0.02
0.01
0.69

*

Based on quartile medians Urine arsenic concentrations were positively associated with HbA1c in Strong Heart Study participants with diabetes. No association was found among participants without diabetes. Prospective analyses that evaluate the relationship between arsenic exposure and diabetes, including measures of diabetes control, are needed.
Abstract P047: Circulating Levels of the DDT Metabolite p,p'-DDE are Related to Prevalent Hypertension in the Elderly
Authors: Lind Monica , Salihovic Samira , Bavel Bert v , Lind Lars
Published: July 2021

Background:
Exposure to PCBs and dioxin to experimental animals increase blood pressure. We therefore investigated if circulating levels of persistent organic pollutants (POPs) were related to hypertension in a population-based sample.

Methods:
1016 subjects aged 70 years were investigated in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Hypertension was defined as either use of antihypertensive treatment or blood pressure > 140/90 mmHg. Twenty-one different POPs, including 16 PCBs, three pesticides (HCB, DDE and TNK), one dioxin (OCDD) and one brominated compound (BDE47) were analyzed by high-resolution chromatography coupled to high-resolution mass spectrometry (HRGC/ HRMS) at age 70.

Results:
732 subjects (72%) showed hypertension. When the POPs were treated as continuous variables and adjusted for gender only, several of the PCBs with a low number of chlorine atoms (PCB74, 99, 105, 118 and 138) were related to prevalent hypertension. Also the OC pesticides, HCB, TNK, pp-DDE, and the brominated compound BDE47 were related to hypertension. The strongest of these associations were seen for pp-DDE (OR 1.35 for a SD change, 95%CI 1.17-1.56, p<0.0001). Following further adjustment for serum cholesterol and triglycerides, BMI, smoking, education and exercise habits, only pp-DDE was still significant (OR 1.23 for a SD change, 95%CI 1.06- 1.43, p=0.006).

Conclusion:
In this cross-sectional analysis of an elderly population, high levels of circulating levels of pp-DDE were associated with prevalent hypertension, further strengthening the experimental findings that POPs might influence blood pressure.
Abstract P049: Meeting Aerobic Physical Activity Guidelines And Hypertension Status Among Us Adults - NHANES, 1999-2006
Authors: Loustalot Fleetwood , Gillespie Cathleen , Zhang Zefeng , Yoon Paula W , Fulton Janet E , Carroll Dianna D
Published: July 2021

Introduction:
One in three adults in the United States has hypertension, and no significant changes in the prevalence of hypertension have been noted in the past decade. Participation in physical activity can aid in the prevention and control of hypertension, yet prevalence of physical activity participation remains low. The purpose of this study was to assess the prevalence of meeting aerobic guidelines for physical activity by hypertensive status, and to examine the associations between physical activity and hypertension treatment and control.

Methods:
Data from the National Health and Nutrition Examination Survey 1999-2006 were used to allow for more detailed analyses and due to consistency of physical activity measures. Hypertension was defined by blood pressure (BP) ≥140/90mmHg or taking BP medications; treated (i.e., BP medications) and controlled (<140/90mmHg) hypertension was defined among those with hypertension. Physical activity was categorized by minutes per week of aerobic physical activity based on
2008 Physical Activity Guidelines for Americans (2008 Guidelines)
(inactive, <10; insufficiently active, 10-149; active, ≥150-300; highly active, >300). Additional variables included sociodemographic and lifestyle characteristics (i.e., smoking, alcohol, sodium intake, fruit and vegetable intake). Participants <18 years of age, pregnant, or missing data for study variables were excluded, resulting in an analytic sample of 12,040. Univariate analysis was used to calculate prevalence estimates and 95% confidence intervals (95%CI). Multivariable logistic regression analysis was used for calculating odds ratios (OR).

Results:
Significantly fewer adults with hypertension were active or highly active (31.9%, 95%CI: 29.4, 34.0) compared to those without hypertension (45.3%, 95%CI: 43.3, 47.4) (p<0.01). Among those with treated hypertension, 30.1% (95%CI: 27.7, 32.6) were active or highly active, compared to 34.5% (95%CI: 30.8, 38.3) who were not treated (p<0.05). Following adjustments for sociodemographic and lifestyle characteristics, adults meeting
2008 Guidelines
(i.e., active or highly active) were less likely to be hypertensive compared to adults who did not meet
2008 Guidelines
(OR: 0.77, 95%CI: 0.67, 0.87). Meeting
2008 Guidelines
was not significantly associated with either treatment or control of hypertension.

Discussion:
Adults with hypertension are less likely to meet the
2008 Guidelines
, compared to those without hypertension. Those with treated hypertension were less likely to meet
2008 Guidelines
than those not treated. Clinicians should counsel all of their patients about physical activity as recommended in clinical guidelines, and evidence-based community-wide efforts and policies that support opportunities to participate in physical activity should be encouraged.
Abstract P057: Adiposity Associated Inflammation and Hypertension
Authors: Allison Matthew A , Morgan Cindy , Rifkin Dena , Criqui Michael H
Published: July 2021

Background:
The aim of this study was to test whether selected markers of adiposity associated inflammation (adipokines) are associated with hypertension (HTN) and isolated systolic hypertension (ISH).

Methods:
Subjects were 1970 individuals who were enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Subjects provided a wide range of health history information and had several physical measurements performed. Blood pressure was measured three times using a standard protocol, with the last two measurements being averaged. HTN was defined as a systolic blood pressure (SBP) > 140 mmHg, diastolic blood pressure (DBP) > 90 or taking a blood pressure medication while ISH was SBP > 140 or taking a blood pressure medication and a DBP <= 90. Fasting venous blood collected at this visit was analyzed for the following adipokines: leptin, adiponectin, tumor necrosis factor - alpha and resistin.

Results:
The mean age was 64.7 years and 50% were female. The mean SBP, DBP, mean arterial pressure (MAP) and pulse pressure (PP) was 124, 70, 88 and 54 mmHg, respectively. Forty-four percent had HTN. The Table shows the results of multivariable logistic regression for the adipokines and both HTN and ISH. As shown, leptin was consistently associated with a significantly higher odds for the presence of either HTN and ISH. This applies to whether leptin was utilized as a continuous or categorical variable (in quartiles). Adding body mass index to model #3 modestly attenuated the associations, but remained statistically significant (p ≤ 0.01 for all). Associations for the other adipokines were inconsistent and not significant after full adjustment.

Conclusion:
Higher leptin, but not the other adipokines studied, is significantly associated with diagnoses of both hypertension and isolated systolic hypertension independent of relevant covariates including body mass index. This suggests that leptin may have an influence on blood pressure beyond the effects of adiposity.
Abstract P058: Elevated Systolic Blood Pressure is Associated with Mortality in Faster, but Not Slower Walking Elderly Adults
Authors: Odden Michelle C , Peralta Carmen A , Haan Mary N , Covinsky Kenneth E
Published: July 2021

Introduction:
The association between high blood pressure (BP) and risk of death varies by age and appears to be attenuated in some elderly adults. Walking speed is an excellent measure of functional status and may identify which elders may be most at risk for the adverse consequences of hypertension. Hypothesis: We hypothesized that elevated BP would be associated with greater risk of mortality in faster walkers, but not in slower walkers.

Methods:
The study population included 2,340 persons ≥ 65 years, with measured BP, in the National Health and Nutrition Examination Survey (NHANES) waves 1999-2000 and 2001-2002. Mortality data was linked to death certificate data in the National Death Index. Walking speed was measured over a 20-foot walk; 243 (8%) did not complete the walk for various safety and logistical reasons. Participants with walking speed above the mean (2.7 ft/sec) were classified as faster walkers. Potential confouders included age, sex, race, survey year, lifestyle and physiologic factors, chronic health conditions, and antihypertensive use.

Results:
There were 589 deaths recorded through December 31
st
, 2006. Among faster walkers, those with elevated systolic BP (≥140 mmHg) had a higher mortality rate compared to those with systolic BP <140 mmHg (236 vs. 161 per 100,000 person-years). Among slower walkers, mortality rates did not appear to differ by the presence of elevated systolic BP (586 vs. 563 per 100,000 person-years). This pattern remained after multivariable adjustment; there was an association between elevated systolic BP and mortality in faster, but not slower walkers (Table). Elevated diastolic BP was not independently associated with an increased risk of mortality.

Conclusions:
If confirmed in other studies, walking speed could be a simple measure to identify elderly adults who are most at risk for poor outcomes related to high blood pressure.

Table

Association of elevated blood pressure and mortality, stratified by walking speed

Hazard Ratio (HR) of Death

Faster Walking Speed >2.7 ft/sec (n = 1,279)
Slower Walking Speed ≤ 2.7 ft/sec (n = 818)
p-value for interaction

HR (95% CI)
p-value
HR (95% CI)
p-value

Elevated Systolic BP (≥140 mmHg)
1.44 (1.04, 1.99)
0.03
1.08 (0.82, 1.42)
0.56
0.11

Elevated Diastolic BP (≥90 mmHg)
1.09 (0.52, 2.27)
0.82
0.65 (0.30, 1.45)
0.28
0.28

Funding (This research has received full or partial funding support from the American Heart Association, Western States Affiliate (California, Nevada&Utah))
Abstract P068: Dietary Acculturation in Two Ethnic Populations Has a Differential Impact on Diet Quality
Authors: Abu-Saad Kathleen , Murad Havi , Lubin Flora , Ziv Arnona , Freedman Laurence S , Alpert Gershon , Atamna Ahmed , Kalter-Leibovici Ofra
Published: July 2021

Introduction:
The indigenous Arab minority population in Israel has higher rates of cardiovascular morbidity and mortality than the Jewish immigrant population. Differences in dietary intake may underlie some of these health disparities. We tested the hypothesis that dietary patterns differ by ethnicity.

Methods:
A population-based, random sample (n=1,100) was selected, stratified by sex, ethnicity, and age (25–74 years). A food frequency questionnaire with 240 food items, including ethnic foods, was used to assess dietary intake and dietary change during adulthood. Food items were collapsed into 51 groups and entered into principle component analysis to identify dietary patterns. Multivariate regression models were fitted to assess the association between participant characteristics and the dietary patterns.

Results:
Of 4 dietary patterns identified (Traditional Arabic, Healthy, Animal Protein, and Snack/Fast Food), the Traditional Arabic and Healthy patterns were the most dominant. The Traditional Arabic pattern included high intakes of “Mediterranean diet” components (e.g., olive oil, dairy products, whole grains, legumes, vegetables), as well as less healthy foods (e.g., refined-flour pita bread, meat dishes). Participants with a low score on this pattern had a high intake of starchy, high-fat, and sweet foods. The highest and lowest intake tertiles of this pattern were virtually mono-ethnic (98% Arab, and 98% Jewish, respectively), while the middle tertile was ethnically mixed. Arabs in the middle/lowest tertiles were younger (OR for 10y age increment: 0.71, 95% CI: 0.59–0.84), male (OR: 2.01, 95% CI: 1.38–2.95), and had made non-health related dietary change (OR: 2.40, 95% CI: 1.53–3.77). In contrast, Jews in the middle/highest tertiles had made health-related dietary change (OR: 2.06, 95% CI: 1.27–3.36). The Healthy pattern included a high intake of foods typically found in healthy Western dietary patterns (e.g., vegetables, fruit, low-fat dairy products, whole grains). Arabs had lower odds than Jews of being in the top tertile of the Healthy pattern among never-smokers (OR: 0.12, 95% CI: 0.07–0.21) and current smokers (OR: 0.16, 95% CI: 0.07–0.37); however the strength of this association diminished among past smokers (OR: 0.45, 95% CI: 0.20–1.04).

Conclusions:
Jews are more likely than Arabs to have classic Western healthy eating patterns, and those who have undergone some dietary acculturation have done so for health-related reasons. The indigenous Mediterranean-style diet of Arabs has deteriorated, and adoption of foods of the immigrant population did not improve the health properties of their diet. These dietary characteristics may place Arabs at higher risk for cardiovascular morbidity and mortality.
Abstract P077: Differences and Similarities in Dietary Pattern and Nutrient Profiles between the Sexes and Blacks and Whites. The Adventist Health Study 2
Authors: Rizzo Nico S , Jaceldo-Siegl Karen , Fraser Gary
Published: July 2021

Objective:
To describe the associations between dietary patterns with nutrient intakes differentiated by sex and race.

Methods:
Cross-sectional study of 71751 subjects (mean age 59 years, 65% female, 76% white) from the Adventist Health Study 2. Participants completed a 204-item validated semi-quantitative food frequency questionnaire. Five dietary patterns were established: non vegetarian, semi vegetarians, pesco vegetarians, lacto ovo vegetarians and strict vegetarians. ANCOVA and linear regression analysis were used to determine differences of nutrient intakes by dietary patterns. Non-dietary variables, such as age, smoking and physical activity were taken into account and associations between dietary pattern and BMI were compared. Analysis was repeated by stratifying for sex and race.

Results:
Strict vegetarians had the lowest BMI, with graded higher BMI levels for dietary patterns with greater fractions of animal plant protein, total fat and saturated fatty acids but similar total caloric intakes. Mean nutrient intake was more dissimilar across dietary pattern than between the sexes or blacks and whites. In general nutrient intakes were more similar between males and females than between blacks and whites with blacks revealing a strikingly higher percentage of non vegetarians than whites. Supplement intakes were often markedly higher in females than in males and higher in whites than in blacks with mean micronutrient intakes for all dietary patterns being well above the estimated average requirements for American adults in both sexes and blacks and whites.

Conclusions:
All groups met current American nutrient requirements. Nutrient intakes varied more markedly between dietary pattern than between sex or race. Lower BMI levels were associated with dietary patterns characterized by higher plant food intake despite generally similar caloric intake across dietary patterns warranting further investigation.
Abstract P080: Dietary Protein, Especially Meat Protein, is Positively Associated with Bone Stiffness Index in Population Consuming Relatively Low Amounts of Protein
Authors: Oh Sun Min , Suh Il , Park Seon-Joo , Lee Hae-Jeoung , Kim Hyeon Chang , Willett Walter C , Feskanich Diane
Published: July 2021

Introduction:
Dietary protein has a mixed effect on bone health, and it may differ by amount or source. The majority of epidemiological and clinical studies have demonstrated that dietary protein has a positive association with bone health. However, most studies, so far, have been performed in women and in people with moderate- to high-protein diet. Little is known about relationship between dietary protein and bone health in men and in people who consume relatively low amounts of protein.

Hypothesis:
Since Korean traditional meals depend heavily on carbohydrate, Korean rural residents consume protein, especially animal protein, at relatively low levels compared with that in the Western diets. Therefore, we assessed whether protein intake is beneficial for the people who consume relatively low amounts of protein.

Methods:
Participants were recruited for a baseline examination of a community-based cohort study in Kangwha, which consist of ten islands with rural villages and a small town on the west coast of South Korea. Among 3,330 participants recruited for a baseline examination between 2008 and 2010,1,182 men and 1,393 postmenopausal women were eligible for the present analyses. Diet was assessed over a 1-year period using a 103-item semi-quantitative food-frequency questionnaire developed for Korean adults. Bone density, measured at the os calcis with a quantitative ultrasound device, was expressed as the stiffness index (SI). A series of analysis of covariance was performed to calculate the adjusted mean SI across sex-specific tertiles of protein intake and their linear trends using a generalized linear model procedure. Total energy intake, age, weight, current smoking status (men only), current hormone therapy (women only), and moderate to high intensity of exercise were potential confounders.

Results:
In the present study population, the median daily protein intake was 50.5 g in men and 44.0 g in women. In men, the multivariate-adjusted mean SI showed an increasing trend with a higher total protein intake (
P
for trend = 0.041). Among various sources of protein, only meat protein was positively associated with the SI (
P
for trend = 0.009). Meanwhile, in postmenopausal women, neither total protein nor any protein subtype showed a significant association with the SI.

Conclusions:
Our findings suggest that total protein, especially meat protein, contributes bone health in men who consume relatively low amounts of protein. Further research is needed to evaluate long-term effects of protein on bone health in this population.
Abstract P081: Effect of Exercise and Quercetin on Atherosclerotic Plaque and Lipoprotein Metabolism
Authors: Garelnabi Mahdi , Jin Jun , Chai Fei , Mahini Halleh
Published: July 2021

Atherosclerosis is a chronic disease of the large arteries; mostly attributed to oxidative stress and inflammation. This results in arterial heart disease, and stroke. Animal studies using a variety of antioxidants strongly suggest that antioxidants may protect against cardiovascular disease (CVD). Paradoxically, exercise which induces a severe oxidative stress resulting in the depletion of plasma and tissue antioxidants is an important deterrent of CVD. We propose that quercetin a flavonoid will have profound effects on the pathophysiology of atherosclerosis if combined with exercise by inhibiting lipids oxidation, promoting clearance and improving the acute exercise induced oxidative stress resulting in lowering cholesterol, artery lipids deposition and plaque regression. This study tested the possible beneficial effects of the combined exercise and quercetin on modulators of oxidation and inflammation in C57BL6 LDL –/– mice fed atherogenic diet. 40 mice were divided into four groups (10 each). These are: Control mice, left untreated; quercetin group, orally supplied with 100 ug/day of quercetin; exercise group, exercised in a treadmill for 30 minutes, 15 m /min; and the exercise and quercetin group which received quercetin and exercise dose similar to the respective groups. All animals were on atherogenic diet. The treatments were provided 5 days/week for 30 days. At the end of the month of treatment, mice were sacrificed, and atherosclerotic lesions in aorta were quantified. Liver, aorta and adipose tissue gene expressions for genes associated with oxidative stress, inflammation and lipoproteins were analyzed. The above figure shows the differences in atherosclerotic plaque formations between groups. However in addition to the changes seen between the groups as the result of quercetin and exercise treatment; one of the most Intriguing findings, is the significant (P<0.001) drop in mice body weigh associated with the combined quercetin and exercise treatment compared to control.
Abstract P086: Ideal Cardiovascular Health and Depressive Symptoms in the Adult Population
Authors: España-Romero Vanesa , Artero Enrique G , Lee Duck-chul , Sui Xuemei , Baruth Meghan , Ruiz Jonatan R , Pate Russell R , Blair Steven N
Published: July 2021

Introduction:
Ideal cardiovascular health is a new construct defined by the American Heart Association as part of its 2020 Impact Goal. The World Health Organization recognizes depression as 1 of its 10 most important global public health issues. We hypothesized that the simultaneous presence of ideal cardiovascular health behaviors and factors could reduce the risk of depressive symptoms.

Methods:
Participants were examined between 1987 and 1998 and followed for a median period of 6 years. Ideal cardiovascular health behaviors (never smoking, body mass index [BMI] <25 kg/m2, physical activity at goal, and appropriate diet consistent with a DASH-type eating plan) and factors (total cholesterol <200mg/dL, blood pressure <120/80 mm Hg, and fasting blood glucose <100 mg/dL) were measured at baseline. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D) in 1990, 1995 or 1999 and a score of 8 or greater was considered having depressive symptoms.

Results:
From a total of 5110 participants, 641 reported depressive symptoms. Participants meeting 3–4 or 5–7 ideal cardiovascular health components had a 28% (odds ratio, OR= 0.72, 95% confidence interval, 95% CI=0.59 – 0.87) and 36% (OR= 0.64, 95% CI=0.50 – 0.82) lower risk of depressive symptoms, respectively, compared with those meeting 0–2 components. Ideal behaviors were associated with lower risk of depressive symptoms: OR= 0.81, 95% CI=0.67–0.98 and OR= 0.72, 95% CI=0.57–0.91 in participants meeting 2 or 3–4 ideal behaviors, compared with those meeting 0–1. Individual or combination of ideal factors was not associated with depressive symptoms.

Conclusion:
Ideal cardiovascular health, especially health behaviors, may be useful for predicting depressive symptoms.