bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P414: Serum Potassium Trajectories Among Chronic Kidney Disease Patients: The Chronic Renal Insufficiency Cohort Study
Authors: Cueto Jenilee , Stefanescu Andrei R , He Hua , Chen Jing , Grams Morgan , Anderson Amanda H , He Jiang , Mills Katherine T
Published: May 2024

Background:
Patients with chronic kidney disease (CKD) are at an increased risk for blood electrolyte imbalances and compromised cardiac and renal regulatory functions. Our objective is to characterize serum potassium trajectories in patients with CKD.

Methods:
Data from the Chronic Renal Insufficiency Cohort Study were used to analyze 5,625 participants with CKD. Serum potassium measurements were collected annually. Hyperkalemia was defined as >5.0 mmol/L, hypokalemia as <3.5 mmol/L, and normokalemia as 3.5 - 5.0 mmol/L. Trajectory analysis using a semiparametric modeling strategy was conducted, incorporating hierarchical modeling and latent class models. Group-based trajectory models were used to fit longitudinal data and estimate probabilities for multiple trajectories. Models were tested using a censored normal model with various numbers of trajectory groups and functional forms (e.g., linear, quadratic, cubic). Maximum likelihood was used to estimate model parameters and model fit was assessed by comparing Bayesian Information Criterion. Posterior predicted probabilities for each individual were estimated for each trajectory group and participants were assigned the highest posterior predicted probability.

Results:
Participants were 56% male, 43% Black, and had a median age of 67.0 years. Overall mean serum potassium was 4.3 mmol/L over 12 annual visits with a median follow-up of 9 years. Based on model fit and statistical significance, five distinct trajectory groups were identified (Figure). Four trajectories (one hyperkalemia and three normokalemia) were stable over time. One trajectory started in the normokalemia range and increased into hyperkalemia.

Conclusions:
Five trajectories of serum potassium were identified among CKD patients. Characterizing serum potassium trajectories over time can help to understand who may be at increased risk for abnormal potassium and related complications and potentially inform the development of interventions to maintain normokalemia in patients with CKD.
Abstract P416: Higher Household Income is Protective Against Chronic Kidney Disease Among White but Not Black Adults: An Analysis of 2017-2020 NHANES
Authors: Grobman Ben , Turkson-Ocran Ruth-Alma , Zhang Mingyu , Juraschek Stephen P
Published: May 2024

Introduction:
Chronic kidney disease (CKD) disproportionately affects Black adults in the U.S. Prior work suggests that lower income is a risk factor for CKD among Black but not White adults; however, this has not been examined in a nationally representative population, using the updated, race-free kidney function equation.

Objective:
To examine the relationship between household income and CKD between Black and White adults.

Methods:
We used data from the 2017-2020 NHANES. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m
2
based on the race-free CKD-EPI equation and/or a urine albumin-creatinine ratio >30 mg/g. The poverty income ratio (PIR) (ranging from 0 to ≥5) was reported in NHANES (calculated as a multiple of interviewees self-reported income in dollars as compared to the federal poverty line). We examined the association between PIR and CKD using survey-weighted Poisson regression models, adjusted for age, sex, education, marital status, and medical comorbidities. We also examined how this association differed between Black and White adults aged ≥18 years old in separate subgroup analyses via interaction terms.

Results:
The weighted sample was 51.7% female, 15.5% Black, and 84.5% White with mean age (±SE) of 47.5±0.3 years. In the total sample, and among White adults, higher household income was associated with a lower prevalence of CKD (
Table
). A one-unit higher PIR was associated with a 11% (95% CI: 5%, 16%) lower prevalence of CKD in the total sample and a 12% (95% CI: 6%, 18%) lower prevalence of CKD among White adults. However, this association was not significant for Black adults. The interaction term for race and income was significant (
P
= 0.001).

Conclusion:
Higher income was associated with a lower risk of CKD among White, but not Black adults. Further work is needed to characterize the complex relationship between socioeconomic status and race to address disparities in CKD.
Abstract P418: Pre-Stroke Use of Loop Diuretics in Elderly Patients Aggravates Renal Function at the Onset of Acute Stroke: A Propensity Score-Matched, Retrospective Cohort Study
Authors: Mori Takahisa , Yano Tetsundo , Yoshioka Kazuhiro , Miyazaki Yuichi
Published: May 2024

Introduction:
Renal function is often impaired in elderly patients experiencing acute stroke (AS) due to pre-existing chronic kidney disease (CKD), which can progress to severe renal dysfunction (SRD). SRD can limit pharmacological treatments, such as anticoagulants, antiplatelets, diabetes medicines, or antihypertensives during the AS phase. Therefore, preventing CKD progression to SRD and minimizing the use of renal-impairing agents before SRD development is crucial. Loop diuretics, commonly prescribed for heart failure, have been reported to exacerbate renal function. Sex-based differences in renal function due to gonadal hormones exist. However, the impact of loop diuretics on the risk of SRD before AS in both sexes remains unclear.

Hypothesis:
The pre-stroke use of loop diuretics in elderly patients aggravates renal function at the onset of AS in both sexes.

Methods:
We conducted a propensity score-matched, retrospective cohort study involving patients admitted within 24 hours of AS onset between January 2013 and March 2019 with available pre-stroke medication information. We defined SRD as a calculated creatinine clearance (Ccr) of <30 ml/min. We analyzed logistic regression using variables for pre-stroke loop diuretics initiation, calculated propensity scores for pre-stroke loop diuretics usage, and implemented a one-to-one propensity score matching (PSM) by sex. We compared the incidence of SRD between loop diuretics users and non-users within each sex group.

Results:
Among 4294 patients with AS, 3472 met the inclusion criteria. Among these, 129 male and 143 female loop diuretic users were matched with non-users using the one-to-one PSM. After the PSM, median ages were 80 years in males and 86 years in females, respectively. The SRD incidence was 38.0% (49/129) versus 16.8% (21/129) in males (p<0.0001) and 50.4% (78/143) versus 23.1% (48/143) in females (p<0.0001), comparing users to non-users.

Conclusions:
The pre-stroke use of loop diuretics in elderly patients may increase the risk of SRD at the onset of AS in both sexes. Therefore, cautious utilization of loop diuretics in elderly patients is recommended to prevent SRD before AS. A possible option is to switch loop diuretics to other medications, which have been shown to have better renal protective effects. Further prospective studies are needed to validate our findings and establish the appropriate usage of loop diuretics in elderly patients before AS.
Abstract P419: Urinary Na:K Excretion and the Risk of Cardiovascular Events in Patients With Chronic Kidney Disease
Authors: Sunga Cass G , Zelnick Leila R , Bansal Nisha
Published: May 2024

Introduction:
The risk of death from cardiovascular disease (CVD) is three times higher in patients with chronic kidney disease (CKD). Urine sodium and potassium excretion are altered in CKD and have been identified as CVD risk factors in other populations; therefore, they may represent therapeutic targets in persons with CKD. We aimed to examine the association between the ratio of urine Na-to-K (Na:K) with incident atrial fibrillation (AF), heart failure (HF), and myocardial infarction (MI) in patients with CKD.

Methods:
2341 adults with CKD enrolled in the Chronic Renal Insufficiency Cohort free of CVD at study entry. Spot urinary Na:K ratio was measured from 24-hour collections and divided into quartiles. Outcomes included physician-adjudicated hospitalizations for AF, MI and HF (overall, preserved [HFpEF] and reduced ejection fraction [HFrEF]). Incidence rates (with 95% CI) were calculated per 1000 person-years. We performed Cox regression in a series of nested models, adjusting for demographics, habits, baseline comorbidities, kidney function and concurrent medications.

Results:
586 participants were in the highest quartile of urinary Na:K excretion (mean age 54.3 (SD 11.7); 46% women (271 out of 586). Mean eGFR was lower in this group [49.5 (SD 19.4)] and 24-hour urine protein was higher [0.27 (IQR 0.08-1.19)] compared to lower quartiles. Rates of incident HF [18 (95% CI 7.5-12.5)] and MI [10 (95% CI 7.5-12.5)] were higher in persons with higher urine Na:K ratio (Fig 1). In adjusted models, the highest quartile (compared with the lowest quartile) of urine Na:K ratio was associated with AF (1.57, 95% CI 1.08-2.3) and HF (1.43, 95% CI 1.15-4.12). In sensitivity analyses, elevated urine Na:K was significantly associated with HFrEF (2.18, 95% CI in 1.15-4.12), but not HFpEF.

Conclusions:
Urinary Na:K excretion was associated with an increased incidence of atrial fibrillation and heart failure in persons with CKD free of CVD. Sodium and potassium represent possible modifiable risk factors for CVD prevention in patients with CKD.
Abstract P446: Community-Engaged Strategies for Recruitment of Black Men at Risk for Hypertension: The CLIP Study
Authors: Arabadjian Milla E , Green Tanisha , Schoenthaler Antoinette , Ogedegbe Olugbenga , RAVENELL JOSEPH
Published: May 2024

Background:
Recruitment of Black participants in research studies is challenging. Mistrust of academic and medical institutions due to historic mistreatment, medical racism, and lack of culturally tailored strategies to engage Black communities as partners, has led to under-representation of Black participants in studies. Black men have higher prevalence of hypertension (HTN) and worse outcomes than other groups. Yet, Black men are underrepresented in HTN clinical trials. The Community-to-Clinic Linkage Program to Prevent Hypertension (CLIP) is a community-engaged cluster randomized trial to test barbershop facilitation to prevent HTN among Black men residing in Staten Island (SI), New York City.

Objective:
To describe recruitment strategies to engage Black men in CLIP via an academic-community partnership.

Methods and Results:
Approximately 10% of SI residents identify as Black, of which ~ 90% live in 3 census tracts with the highest prevalence of HTN in the borough. The study team collaborates with Community Health Action of Staten Island (CHASI), a grassroots health organization with > 30 years of community focus on addressing the root causes of health disparities on SI, the Director of Health in SI, a community advisory council (CAC) comprised of local leaders and residents, and the New York American Heart Association providing HTN education materials in an academic-community partnership to implement CLIP. Our recruitment goal is to enroll 84 men across 4-5 Black-owned barbershops over 5 cycles (12 weeks each), total N=418. We did not meet recruitment goals for cycles 1 and 2, (~60% enrolled). In consultation with CHASI and the CAC we adjusted our recruitment strategies to: 1) host bi-monthly community events in or around participating barbershops; 2) offer study incentives at the time of enrollment; 3) leverage existing relationships with faith-based organizations and other stakeholders to promote CLIP; and 4) distribute co-branded promotional flyers with CHASI and other stakeholders to publicize events. Subsequently we exceeded recruitment goals in our last cycle (113% enrolled); current cycle recruitment is ongoing. Several strategies have been successful in improving recruitment of Black men for CLIP: 1) deep community ties of our community health partner; 2) enlisting local community health workers representative of the study population; 3) flexibility and open communication between academic and community staff; 4) trust in the competence of each partner; 5) mutual commitment to the mission of the study.

Conclusion:
Partnering with engaged and trusted community partners, stakeholders, and local leaders positively impacts recruitment of Black men participants in HTN research studies. Organizations with deep community ties are crucial for establishing trust and identifying flexible solutions to recruitment challenges.
Abstract P463: The Role of Information and Communication Technology in Cardiovascular Health: A Global Perspective
Authors: Bhattaram Rohan , Basheer Yusairah , Reichert Ryan
Published: May 2024

Introduction:
Information and Communication Technology (ICT) has emerged as a potent tool in shaping modern healthcare systems. Its ease of availability and function for patients, providers, and administrators has led to its integration at many levels. Because of its multidimensional use, we aimed to investigate the relationship between ICT usage and cardiovascular outcomes at a global scale. This study aims to find the relationship between ICT usage and cardiovascular mortality in countries in the Organisation for Economic Co-operation and Development (OECD).

Methods:
OECD Statistics, a freely available online database published by the Organisation for Economic Co-operation and Development, was accessed for data retrieval. ICT use, and cardiovascular death rates (per 100,000) in all 38 OECD countries were acquired. Microsoft Excel was used to store data and perform statistical analysis. A linear regression model was used to find the relationship between ICT use and cardiovascular mortality. Significance was assessed using the p-value, with a threshold set at 0.05.

Results:
A significant relationship between ICT use and cardiovascular mortality was observed (p = 0.02). Notably, Colombia and Japan were excluded from this analysis as they lacked ICT use data. Figure 1 demonstrates the linear relationship.

Discussion:
With a significant, negative relationship between ICT use and cardiovascular outcomes at a global scale, it can be inferred that elevating cardiovascular health outcomes can be significantly advanced through strategic investment in health technology. It should be considered that greater ICT use can be a proxy for other social and technological infrastructure available in the country leading to better cardiovascular health outcomes. Nonetheless, the integration of innovative health technologies, such as telemedicine, wearable devices, and data analytics, offers the potential to enhance early disease detection, promote health literacy, and optimize resource allocation. These advancements enable timely interventions, informed decision-making, and precise allocation of healthcare resources.
Abstract P465: Linking Electronic Health Record and Wearable Device Data Can Provide Insight Into Expected Changes in Captured Heart Rate Due to Medication Usage
Authors: Feldman Keith , Duncan Ray G , Nguyen An , Cook-Wiens Galen , Pevnick Joshua M
Published: May 2024

Introduction:
From remote patient monitoring to arrythmia detection, heart rate (HR) data collected by wearable devices is widely utilized across healthcare practice and research. Although accuracy varies across devices, data are generally assumed to be “internally consistent” (i.e., within-person trends are reliable). As a result, individuals’ change from baseline is commonly used as a biomarker for risk models. However, defining a baseline from device data alone is problematic. External influences such as therapeutic use of HR-altering medications (e.g., beta-blockers) may alter patterns derived from HR data, and computational models not accounting for such may become less effective.

Hypothesis:
Initiation of a HR-altering medication as denoted in an individual’s EHR will correspond to a change in HR data collected by their wearable device.

Methods:
This study utilized data from 1938 patients at Cedars-Sinai Medical Center who linked Apple Watches to their EHR 4/2015 – 11/2018. It focused on 32 patients with ≥10 days of HR data before and after their 1
st
prescription of a HR-altering medication, with no prior orders of these medication over the prior year. Mean daytime (9a-9p) hourly HR were compared before and after medication start (Fig 1) using a linear mixed model, adjusted for hour of the day, measurements per hour, time since medication was started, and time from the start of observation (to account for pre-medication trends) with a patient-level random effect.

Results:
HR-altering medication produced significant changes in device-measured HR. Post-medication HR averaged 3.2 BPM lower [95% CI, 2.8-3.6, p<.001] than pre-medication periods. Secondary analyses identified decreased hourly HR range (p<.001), and increased wear time (p=.005) in pre/post medication periods that may also impact model efficacy.

Conclusion:
Linking EHR and wearable data offers a promising route in identifying events that may bias computational tools and indicate a need for model-retraining or use of adjusted relationships.
Abstract P472: Dietary Consumption of Potatoes and Incidence of Cardiovascular Disease
Authors: Mahbub Hasan M , Manson JoAnn E , Buring Julie E , Kim Eunjung , Lee I-min M , Sesso Howard D , Gaziano Michael , Djousse Luc
Published: May 2024

Background:
Previous studies have reported conflicting results of the relationship between types of potato consumption (baked and boiled potatoes and French fries) and cardiometabolic outcomes. We examined associations of potato consumption with incidence of CVD from 4 large cohorts.

Methods:
We meta-analyzed data from 4 large studies (COSMOS, PHS, WACS, and WHS). Consumption of baked, boiled, and mashed potatoes and French Fries was assessed using a food frequency questionnaire. The primary outcome was 3-point MACE (myocardial infarction, stroke, and cardiovascular death). Within each cohort, Cox regression model was used to compute hazard ratios (95% CI) adjusting for age, sex, race, caloric intake, smoking status, alcohol use, education level, exercise level, body mass index, and dietary factors (e. g., Fruits and vegetables, red/processed meat, beverages, trans fats, etc.), and prevalent diabetes and hypertension. Cohort-specific effect sizes were pooled using an inverse-variance weighted method.

Results:
Among 84,700 subjects, mean age ranged from 54 (WHS) to 72 (COSMOS) years, 68% were women, and 5231 CVD events occurred during follow-up. Consumption of combined baked, boiled, and mashed potatoes was not associated with the incidence of CVD: Pooled HR (95% CI): 1.00 (ref), 0.96 (0.89-1.04), 0.94 (0.86-1.02), and 0.97 (0.87-1.08) for consumption of 0, 0.5-1, >1 to <3, and ≥3 servings per week, respectively, p for linear trend 0.47. Furthermore, Consumption of French fries was not associated with CVD risk with pooled HR (95% CI) of 1.00 (ref), 0.99 (0.92-1.05) and 1.02 (0.88-1.18) for intake of 0, <1, and ≥1 servings/week. The p for linear trend 0.55.

Conclusion:
Our data do not support an association of baked, boiled, and mashed potatoes, or French fries with incidence of CVD.
Abstract P473: WIC-Tailored, Pre-Filled Online Shopping Carts Influence WIC Food Benefit Redemption
Authors: Melo Herrera Yarisbel , Vadiveloo Maya , Oaks Brietta M , Quashie Nekehia T , Blau Sarah , Tovar Alison
Published: May 2024

Introduction:
Most participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) do not fully redeem their benefits, due to barriers like transportation, unclear labeling, and category-specific limits. Online food shopping enables the use of choice architecture to promote benefit redemption. Using a mixed-methods pilot randomized-controlled trial, we evaluated whether a WIC-tailored, modifiable pre-filled online grocery shopping cart (intervention group, I) compared to individually selecting items (control group, C) increased WIC benefit redemption.

Hypothesis:
The I vs. C will have higher change in benefit redemption.

Methods:
We enrolled Rhode Island WIC participants (n=24) who were ≥18 years and primary food shoppers, spoke English or Spanish, had internet, and no special dietary needs. At baseline, participants completed a sociodemographic questionnaire and a simulated shopping episode (SSE) conducted in Gorilla Shop Builder. They were told to shop as if using all monthly food benefits and to buy WIC and non-WIC items to last 10 days. After a week, we randomized participants to the I or C to complete the second SSE. The I had a modifiable cart pre-filled with WIC items providing 100% of the benefits proposed on the 2022 food package revision, except for fruits/vegetables (33%) and milk (25%) and was personalized with items selected in the first SSE. The C selected their items individually. Both groups had a list of their assigned benefits, and WIC labels for approved items. WIC benefit redemption was expressed as % of the maximum allotted amounts for each food group, per person. Between-group t-tests examined differences in redemption rates.

Results:
Women were primarily Hispanic (75%), White (50%), postpartum (63%), and had never shopped online (54%). Redemption increased up to 65% more in the I vs. the C for most WIC categories.

Conclusions:
Results from this pilot trial suggest that a WIC-tailored, pre-filled online shopping cart may be a promising tool to improve WIC benefit redemption.
Abstract P475: Adherence to the EAT-Lancet Planetary Health Diet and Cardiometabolic Risk Markers in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study
Authors: Nair Nilendra K , Bui Linh P , Sawicki Caleigh M , Kandula Namratha , Kanaya Alka M , Lee Kyu Ha , Stampfer Meir J , Willett Walter C , Bhupathiraju Shilpa N
Published: May 2024

Introduction:
Poor diet is among the top risk factors for cardiometabolic disease, which disproportionately burdens South Asians. In 2019, the EAT-Lancet Commission proposed a Planetary Health Diet (PHD) designed to optimize human and global environmental health.

Objective:
We examined associations between a novel Planetary Health Diet Index (PHDI), that reflects adherence to the EAT-Lancet recommendations, and cardiometabolic risk in a prospective cohort of South Asians in the US.

Methods:
We included participants from the MASALA study with complete baseline (n=891) and 5-year follow-up (n=735) examinations. The PHDI was comprised of 15 food components with scoring based on the ranges prescribed by the EAT-Lancet commission for a total score range of 0–140. Higher scores indicate greater adherence to the PHDI. We used multivariable linear and logistic regression models to examine cross-sectional and prospective (5-years) associations between baseline PHDI and measures of glycemia, blood lipids, inflammation, and adiposity, adjusting for demographic, health, lifestyle, and baseline value of biomarker (for prospective models). Logistic regression was used to examine association between baseline PHDI and incident type 2 diabetes (among n=661 participants free from diabetes at baseline)

Results:
Among MASALA study participants (49% female, mean age 57 y), the mean PHDI score was 88.8 (SD 9.47). At baseline, each 10 unit increase in PHDI scores were associated with (β ± SE) lower fasting glucose (-0.5±0.24 mmol/L), HbA1c (-0.49±0.22%), LDL cholesterol (-0.015±0.007 mmol/L), CRP (-5.87±2.35 mg/L), higher adiponectin (4.71 ±2.01 mg/dL), lower body weight (-0.59 ±0.26 kg), BMI (-0.27±0.11 kg/m
2
), waist circumference (-0.82±0.29 cm), visceral fat (-3.22±1.32 cm
2
), and pericardial fat (-0.92±0.43 cm
3
) (
p
<0.05 for all). Higher PHDI scores were associated lower odds of obesity [OR (95% CI): 0.80 (0.71-0.92] and overweight [0.77 (0.74-0.85)]. Prospectively, higher PHDI scores were associated with lower fasting glucose (-0.28 ± 0.14 mmol/L), lower HbA1c (-0.08±0.03%), higher HDL (0.38±0.17 mmol/L), lower body weight (-0.37±0.12 kg), BMI (-0.08±0.03 kg/m
2
), waist circumference (-0.49±0.17 cm), and systolic blood pressure (-0.65 ± 0.30 mmHg) (
p
<0.05 for all). Each 10-unit higher PHDI was associated with a 20% lower risk of incident diabetes [OR (95%CI): 0.80 (0.54-0.86)].

Conclusions:
In the MASALA study, we found that greater adherence to the PHDI was associated with better cardiometabolic risk factors and lower risk of incident type 2 diabetes. These observations support the planetary health diet as a feasible strategy to address planetary health while optimizing human health outcomes.
Abstract P479: Whole Grain and Refined Grain Intake and Associations With Adiposity, Inflammation, and Incident Type 2 Diabetes Among Adults of South Asian Ancestry in the MASALA Cohort
Authors: Sawicki Caleigh M , Kanaya Alka M , Kandula Namratha , Gadgil Meghana , Bhupathiraju Shilpa N
Published: May 2024

Background:
Although growing evidence has suggested that whole grain over refined grain consumption is associated with lower measures of adiposity, no studies have examined these relationships in South Asians, who are at higher risk of less favorable adipose tissue distribution and risk of type 2 diabetes (T2D).

Objective:
We evaluated the associations between whole and refined grain intake with cross-sectional measures of adiposity (waist circumference, visceral, subcutaneous, hepatic, and pericardial adipose tissue), markers of inflammation (CRP, adiponectin), and incident T2D.

Methods:
We included 891 South Asians who completed the baseline visit in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study for cross-sectional analyses and 715 participants who completed exam 2 (~5 y after baseline). Whole and refined grain intake were determined using data from semi-quantitative food frequency questionnaires. We used multivariable linear and logistic regression models to evaluate associations between whole and refined grain intake with adiposity, inflammation, and incident T2D (among n=542 participants free of diabetes at baseline; n=48 incident cases), adjusting for several demographic, health, and lifestyle factors.

Results:
At baseline, participants (45% female) were on average 55 ± 9.2 (mean ± SD) years old with a BMI of 25.3 ± 3.9 kg/m
2
. Cross-sectionally, we observed that higher consumption of whole grains was associated lower pericardial fat (Beta ± SE: -2.3 ± 0.81 cm
3
, p-value=0.005) and higher refined grain intake was associated with higher percent difference in CRP (10.2 ± 4.65%, p-value=0.03) even after adjustment for BMI and other dietary factors (legumes, fruits, vegetables, and dairy). Substitution models also showed that replacing 1 serving/d of refined grain with whole grain was associated with lower pericardial fat (-3.2 ± 1.27 cm
3
, p-value=0.01) and CRP (-11.4 ± 5.38 % difference, p-value=0.02) in the fully adjusted models. Whole grain intake was also associated with greater attenuation of hepatic fat (0.71 ± 0.35 HU, p-value=0.04), but this did not remain significant after adjustment for BMI. Neither whole nor refined grain intake was associated with 5-year incident T2D.

Conclusions:
Higher intake of whole grain was associated with lower pericardial fat, while higher refined grain intake may be associated with higher inflammation. These observations support recommendations to consume whole grains over refined grains, especially among high-risk groups such as South Asians.
Abstract P486: Dietary Acculturation is Associated With Altered Gut Microbiome, Circulating Metabolites, and Cardiovascular Disease Risk in US Hispanics/ Latinos: Results From the Hispanic Community Health Study/Study of Latinos
Authors: Wang Yi , Chen Guochong , Wang Zheng , McClain Amanda C , Jankowska Marta M , perreira Krista , Mattei Josiemer , Isasi Carmen R , Llabre Maria , Thyagarajan Bharat , Daviglus Martha L , Van Horn Linda , Farelo David G , Maldonado Luis E , Levine Steven R , Yu Bing , Boerwinkle Eric , Knight Rob , Burk Robert , Kaplan Robert , Qi Qibin , Peters-Samuelson Brandilyn
Published: May 2024

Introduction:
Dietary acculturation, defined as diet adaptation after migration, is related to human health. However, the influence of dietary acculturation on cardiovascular disease (CVD) is largely unknown, nor is the potential mechanism clear.

Hypothesis:
Dietary acculturation (diet reflecting U.S. exposure - years in the U.S. and nativity [U.S. 50 states/DC vs. foreign-born]) is associated with altered gut microbiota and related metabolites, which may contribute to CVD risk.

Methods:
A dietary acculturation score was derived from 14172 participants with two 24-hr dietary recalls at baseline (2008-11) using LASSO regression (29 food groups as predictors of U.S. exposure). We evaluated associations of dietary score with incident CVD over 7 years follow-up (including coronary heart disease, stroke and heart failure, n=14172/211 total/cases) and gut microbiota (shotgun sequencing, n=2349, 2014-17). Further, we identified serum metabolites associated with diet-related microbiome (n=694, 2014-17) and examined associations of baseline metabolites with incident CVD (n=5256/108 total/cases).

Results:
We identified a dietary acculturation pattern (Fig1A) which increased with years in the U.S. and was highest in U.S.-born adults (Fig1B). Higher dietary acculturation was associated with risk of incident CVD (HR per SD, 1.33 [95%CI: 1.13-1.57]), adjusting for sociodemographic, lifestyle, and clinical factors. We identified 69 diet-related species (17 enriched and 52 depleted, mainly from
Clostridium
,
Prevotella
and
Eubacterium
, Fig1C), and 25 metabolites associated with both diet-related microbiome score and incident CVD (Fig1D). Proxy association analysis based on these metabolites suggested a positive relationship between diet-related microbiome and incident CVD (r=0.70, p<0.001) (Fig1E).

Conclusions:
Among U.S. Hispanics/Latinos, greater dietary acculturation was associated with increased risk of CVD, possibly via diet-related alterations in gut microbiota and related serum metabolites.
Abstract P494: Gene-Level Gene-Environment Interaction Testing Reveals Rare Variants With Large Impacts on the Omega-3 Fatty Acid-Inflammation Relationship
Authors: Westerman Kenneth E , Patel Chirag , Meigs James , Manning Alisa
Published: May 2024

Dietary omega-3 fatty acid (dN3FA) intake affects plasma N3FA (pN3FA) concentrations, circulating biomarkers of chronic inflammation such as high-sensitivity C-reactive protein (hsCRP), and ultimately cardiometabolic disease risk. Genetic variation may modify the N3FA-inflammation relationship, facilitating applications in precision medicine and possibly explaining variable intervention trial responses. Here, we explored the dual hypothesis that pN3FA mediates the dN3FA-hsCRP relationship and that genetic variants across the frequency spectrum modify this association.

Regression models in the UK Biobank (N = 342,120) tested main effects of oily fish intake (a primary dietary source of N3FA; measured by food frequency questionnaire) on hsCRP and its mediation by pN3FA (measured by nuclear magnetic resonance; N = 188,701). Three genome-wide interaction studies tested modification of the dN3FA-hsCRP (“full”), dN3FA-pN3FA (“upstream”), and pN3FA-hsCRP (“downstream”) associations. Regression covariates included demographics, lifestyle indicators, socioeconomic measures, and genetic principal components. Variant-specific GWIS were followed by gene-level enrichment testing using the MAGMA tool. Replication of gene-based signals was conducted in the Women’s Genome Health Study (WGHS; N = 23,294) by testing the interaction of the top variant in each gene with total dN3FA impacting hsCRP.

Oily fish intake associated most strongly with hsCRP compared to other questionnaire-based estimates of fish or fish oil intake, with statistical evidence that plasma N3FA mediated approximately 100% of this diet-inflammation relationship. While the “full” genetic interaction analysis did not produce any FDR-significant gene-level interactions, the “upstream” analysis uncovered nine genes, including a cluster containing the biologically-relevant fatty acid desaturases
FADS1
and
FADS2
, and the “downstream” analysis uncovered four genes. Primary variant interaction effect sizes were small (e.g., -0.02 std. dev. bN3FA / std. dev. fish / allele for the top
FADS1
variant rs174560), but in-depth follow-up at these genes revealed allelic spectra including rare variants with substantially larger effects (e.g., -0.11 for a
FADS1
missense variant with allele frequency of 0.14%, after conditioning on rs174560). WGHS results supported the overall robustness of the findings (consistent interaction effect signs at 8/10 loci), replicated specific signals (p = 0.04 for
FADS1
rs174560), and implicated additional inflammatory biomarkers (e.g., fibrinogen and ICAM-1 for the top
GLTSCR1
variant).

In conclusion, we report (1) the novel epidemiological finding that pN3FA fully mediates the dN3FA-hsCRP relationship, and (2) specific genes with large-effect rare variants that modify the upstream (absorption) and downstream (inflammatory pathways) components of this relationship.
Abstract P497: Saliva, Plasma, and Multi-Fluid Metabolomic Profiles of Excess Adiposity and Their Associations With Diabetes Progression Among Puerto Ricans
Authors: Wang Zicheng , Sawicki Caleigh M , Haslam Danielle E , Liang Liming , Wong David T , Joshipura Kaumudi J , Hu Frank B , Chavarro Jorge E , Bhupathiraju Shilpa N
Published: May 2024

Introduction:
Plasma metabolomic profiles of BMI are associated with type 2 diabetes (T2D) risk but none have examined saliva or combined information from multiple biofluids. Our aim was to identify plasma, saliva, and plasma-saliva multi-fluid metabolomic profiles of BMI and waist circumference (WC) and examine their associations with diabetes progression.

Methods:
We included 911 participants from the San Juan Overweight Adult Longitudinal Study, a 3-year prospective cohort of overweight Puerto Ricans. At baseline, using LC-MS, we quantified metabolites from saliva (n=635) and plasma (n=1,051). We used elastic net regression with 10-fold cross-validation to identify metabolomic profiles from plasma, saliva, and plasma and saliva (multi-fluid) that were predictive of BMI and WC. We used Cox-proportional hazard models to evaluate associations between metabolomic profiles and diabetes progression adjusting for age, sex, socioeconomic factors, lifestyle, and medication use.

Results:
For BMI metabolomic profiles, we identified 207 metabolites in plasma, 118 metabolites in saliva, and 225 in the multi-fluid profile. For WC, we identified 157, 89, and 210 metabolites for plasma, saliva, and multi-fluid profiles, respectively. Highly positively weighted metabolites across all BMI and WC metabolomic profiles included those in pathways of alanine and aspartate metabolism, purine metabolism, and sphingomyelins. BMI and WC metabolomic profiles were highly correlated (r=0.80-0.88). Each SD increase in saliva, but not plasma or multi-fluid, metabolic profile of BMI was significantly associated with diabetes progression (Table). Saliva, but not plasma or multi-fluid, metabolomic profile of WC was significantly associated with progression from pre-diabetes to T2D. All associations became stronger after further adjustment for anthropometric measures of BMI and WC.

Conclusion:
Saliva is an underexplored and easily accessible biofluid to measure metabolites that associate with diabetes progression.
Abstract P506: Multifactorial Risk Control in Atherosclerotic Cardiovascular Disease Among Patients With Type 2 Diabetes Mellitus: Findings From the UK Biobank
Authors: Fan Wenjun , Jiang Luohua , Malik Shaista , Wong Nathan D
Published: May 2024

Objectives:
To determine the association of simultaneous composite clinical and behavioral risk factor control with incident ASCVD among T2DM patients in the UK.

Methods:
We studied diagnosed T2DM patients without baseline ASCVD in the UK Biobank database. AHA Life Essential 8 (LE8) metrics included BMI, non-HDL-C, HbA1c, BP, physical activity, nicotine exposure, sleep health, and diet patterns. Each factor was measured at baseline and was assigned a score ranging from 0 to 100 (poor to ideal), with the unweighted average of all factors constituting a composite CV health (CVH) score. Incident ASCVD was defined as the composite outcome of MI, ischemic stroke and CV death. The follow-up period was between baseline enrollment at 2006-2010 and year 2021. Cox proportional hazard models were built to determine the association of each factor, CVH score, as well as the number of ideal control factors, and incident ASCVD adjusted for demographic characteristics.

Results:
A total of 13,787 T2DM patients were included, 36.4% (5022/13,787) female, 89.1% (12,284/13,787) White, mean age of 60.1 ± 6.8 years, followed up for 11.5 ± 2.9 years. Only 2.2% were at ideal composite control of all factors. ASCVD incidence was significantly lower among those with ideal (>=80) vs. poor (<50) CVH score (adjusted HR=0.30, 95%CI: 0.18-0.51, p<0.0001). Those with ideal simultaneous control for 6 or more LE8 factors had 84% lower ASCVD risks compared to those without any ideal control (adjusted HR=0.16, 95%CI: 0.05-0.51, p<0.01).

Conclusion:
The composite control of multiple risk factors remains poor among T2DM patients in the UK. Having optimal levels of LE8 metrics simultaneously results in significant ASCVD risk reduction in this population.
Abstract P507: Adherence to Pediatric Screening Guidelines for Cardiovascular Risk Factors in a Diverse Cohort of Children in Chicago
Authors: Gauen Abigail , Wang Yaojie , Perak Amanda M , Davis Matthew , Rosenman Marc , Lloyd-Jones Donald M , Zmora Rachel , Allen Norrina B , Petito Lucia
Published: May 2024

Background:
Preventive screenings in children and adolescents encourage maintenance of optimal cardiovascular health (CVH) early in life, but there may be a gap between recommendations and clinical practice. We evaluated adherence to pediatric guidelines for universal age-based and risk-based screening for body mass index (BMI), blood pressure (BP), lipids, and blood glucose.

Methods:
We used 2010-2018 ambulatory visit data from children aged 2-12y within CAPriCORN, an electronic health record network from major healthcare systems in Chicago. For each child who attended a well-child visit and met age and/or risk-based criteria, receipt of BMI, BP, lipids, and/or HbA1c or fasting blood glucose measurements were assessed. For each metric, proportion adherence was calculated via generalized estimating equations with an exchangeable correlation structure and was stratified by age, sex, race/ethnicity, and insurance status.

Results:
This study included 87,549 children who attended 197,559 well-child encounters. Across all encounters, children were 51.5% male and mean (SD) age 6.4 (3.3) years. Universal age-based screening prevalence (95% CI) per 100 eligible children was 77.1 (76.8, 77.3) for BMI, 33.4 (33.1, 33.7) for BP, and 9.6 (9.3, 9.9) for lipids. Risk-based screening prevalence (95% CI) per 100 eligible children was 13.9 (12.2, 15.9) for BP, 6.9 (6.4, 7.5) for lipids, and 13.3 (12.6, 14.1) for blood glucose.

Conclusions:
Early screening of CVH risk factors could lead to earlier interventions, which could alter CVH trajectories across the lifetime. Low levels of adherence to universal age-based and risk-based CVH screening highlight the gap between recommendations and clinical practice, emphasizing the need to understand and address barriers to screening in pediatric populations.
Abstract P527: Acculturation and Family History Are Associated With Sleep Disturbances in US Americans of South Asian Origin
Authors: Vasudev Krish , Vasudev Eshaan , Yanek Lisa , Vaidya Dhananjay
Published: May 2024

Introduction:
Sleep disorders are an important risk for cardiovascular disease. Although the effects of sleep-disordered breathing have been widely studied in general populations, there is a gap in understanding its prevalence and determinants among South Asians in the United States of America (US), a group with high risk of cardiometabolic disease that presents unique genetic burdens and acculturation issues. We examined the association of family history of sleep disturbances and acculturation in a survey of South Asian immigrants.

Methods:
We surveyed 105 US South Asian participants (20-75 years, 69% male, 92% born in South Asia) recruited at a community event. Respondents provided information on age, gender, acculturation (measured by the adoption of English spoken at home), and family history of severe snoring in first degree relatives. We used a modified Berlin Sleep Questionnaire, where the obesity criterion was replaced with current diabetes to identify persons with high-risk sleep disturbances and asked about severe snoring in first degree relatives to identify family history of sleep disturbances. We examined the association of high-risk sleep disturbances with family history and acculturation metrics using Chi-squared tests, followed by logistic regression analysis.

Results:
Of the 105 participants, 28 (26.7%) were identified as high-risk for sleep disturbances. Those at high risk had a median age of 61 years, significantly older than their low-risk counterparts (median age 53; p=0.015). Of the 55% individuals who were acculturated to now speak English at home, 34% had high risk sleep disturbances as compared to 17% with sleep disturbances among those that continued to speak their native non-English language (p=0.044). Of the 10% individuals whose siblings had severe snoring problems, 50% had high risk sleep disturbances vs. 24% in those without sibling history (p = 0.079). In logistic regression models adjusting for age and gender, both sibling history (Odds Ratio 4.6, 95% CI 1.0 to 20.3, p = 0.047) and acculturation (Odds Ratio 3.0, 95% CI 1.1 to 8.6, p = 0.037) were associated with high-risk sleep disturbances.

Conclusions:
Acculturation as measured by adoption of English as the home language and family history of severe snoring are both associated with sleep disturbances among US South Asians in. Healthcare providers should be especially vigilant for sleep disorders in acculturated South Asian patients and those with such family and social history. Further studies are needed to understand the relationships between genetic predispositions, acculturation, and environmental factors in this population.
Abstract P532: Association of Subclinical Atherosclerosis With Cardiac Structure and Function in the Rural Cohort Study
Authors: Deere Bradley P , Kelsey Michelle , Hillegass William B , Judd Suzanne E , Ramachandran Vasan S , Budoff Matthew J , Bloomfield Gerald S , Fox Ervin R
Published: May 2024

Introduction:
Rural communities may have disproportionate cardiovascular disease (CVD) morbidity and mortality, but few data examine relations of subclinical atherosclerosis with cardiac structure and function in Southern rural areas.

Hypotheses:
We hypothesized that subclinical atherosclerosis will be associated with adverse cardiac remodeling.

Methods:
Participants with non-contrast cardiac computed tomography (CT) and artificial intelligence-guided echocardiography (AI echo) in the Alabama subcohort of the Risk Underlying Rural Areas Longitudinal (RURAL) study were included (N=942, median age 51, 70% women, 80% Black). CAC associations with AI echo measures were examined, adjusting for age, sex, and self-reported race/ethnicity.

Results:
Table 1 shows descriptive statistics for AI echo measurements. Table 2 shows CAC score >100 had higher LV mass and lower LVEF compared to those below this threshold in adjusted analyses. LA volume and GLS were not associated with CAC in adjusted analyses.

Conclusion:
Subclinical atherosclerosis associated with adverse cardiac remodeling cross-sectionally in our Southern rural sample.
Social Determinants of Health and Incident Apparent Treatment‐Resistant Hypertension Among White and Black US Adults: The REGARDS Study
Authors: Akinyelure Oluwasegun P. , Jaeger Byron C. , Safford Monika M. , Oparil Suzanne , Carson April P. , Sims Andrew , Hannon Lonnie , Howard George , Muntner Paul , Hardy Shakia T.
Published: May 2024

Background

We examined the association of multilevel social determinants of health with incident apparent treatment‐resistant hypertension (aTRH).

Methods and Results

We analyzed data from 2774 White and 2257 Black US adults from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study taking antihypertensive medication without aTRH at baseline to estimate the association of social determinants of health with incident aTRH. Selection of social determinants of health was guided by the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Blood pressure (BP) was measured during study visits, and antihypertensive medication classes were identified through a pill bottle review. Incident aTRH was defined as (1) systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg for those with diabetes or chronic kidney disease while taking ≥3 classes of antihypertensive medication or (2) taking ≥4 classes of antihypertensive medication regardless of BP level, at the follow‐up visit. Over a median 9.5 years of follow‐up, 15.9% of White and 24.0% of Black adults developed aTRH. A percent of the excess aTRH risk among Black versus White adults was mediated by low education (14.2%), low income (16.0%), not seeing a friend or relative in the past month (8.1%), not having someone to care for them if ill or disabled (7.6%), lack of health insurance (10.6%), living in a disadvantaged neighborhood (18.0%), and living in states with poor public health infrastructure (6.0%).

Conclusions

Part of the association between race and incident aTRH risk was mediated by social determinants of health.