bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP93: Actigraphy Measured Sleep Indices and Adiposity: The Multi-Ethnic Study of Atherosclerosis
Authors: Ogilvie Rachel , Redline Susan , Bertoni Alain G , Chen Xiaoli , Szklo Moyses , Ouyang Pamela , Lutsey Pamela
Published: July 2021

Background:
Previous findings on sleep and adiposity in adults have been inconsistent. Limitations of these studies include self-reported sleep measures, one measure of adiposity, and racially/ethnically homogenous populations.

Objectives:
We examined the cross-sectional relationship between indices of objectively measured sleep and adiposity in 2,146 MESA Sleep study participants.

Methods:
Sleep duration, sleep efficiency (% time asleep during sleep period), and night-to-night variability in sleep duration were assessed using at-home 7-day actigraphy and were modeled categorically. Adiposity was measured as body mass index (BMI) and waist circumference (WC). Multivariate linear models were used to examine relationships between sleep exposures and each outcome. In models with dichotomous outcomes, we used logistic regression post-estimation commands to calculate adjusted probabilities standardized to the total population for each sleep measure category. These probabilities were used to calculate prevalence differences for overweight (BMI 25-29.9 kg/m
2
), obesity (BMI ≥ 30 kg/m
2
), and abdominal obesity (men: WC ≥102 cm; women ≥88 cm).

Results:
Of 2146 participants (mean age 68.6 years), 53.7% were female, 30% were white, 46.2% Black/African American, 5.0% Chinese, and 41.9% Hispanic. Participants who slept <6 hours/night had significantly higher BMI and WC relative to those who slept 7-8 hours. Those who slept <5 hours had a 15% excess prevalence of obesity (BMI ≥ 30 vs. <25 kg/m
2
) (95% CI: 0.07-0.23) and a 10% excess prevalence of abdominal obesity (95% CI: 0.03-0.17) compared to those who slept 7-8 hours. Poor sleep efficiency and greater night-to-night sleep variability were also associated with a greater prevalence of obesity.

Conclusions:
Among a multi-racial/ethnic cohort, we found robust associations across multiple indices of sleep and adiposity. Targeting sleep characteristics may be of benefit in obesity interventions, but more research is needed to rule out reverse causality.
Abstract MP96: Long Sleep and Evening Chronotype Associated with Poor Cardiovascular Health Behaviors
Authors: Patterson Freda , Malone Susan K , Lozano Alicia , Grandner Michael A , Calamaro Christina , Hanlon Alexandra
Published: July 2021

Sleep duration and circadian preference (morningness/eveningness preference or “chronotype”) have separately been associated with cardiovascular risk behaviors including tobacco use and physical inactivity. Interactive effects are plausible, resulting from combinations of sleep homeostatic and circadian influences. But these have not been explored previously. To address this, associations between combinations of sleep duration (short [≤6h], adequate [7-8h], long [>9h]) and chronotype (morning, intermediate, evening) were examined relative to tobacco use, physical inactivity, sedentary behavior, and overweight, in a cross-sectional sample of 439,933 adults enrolled in the United Kingdom Biobank project. The study sample was 56% female, 95% white, and the mean age was 56.5 (SD=8.1) years. Most participants engaged in 1 (39%) or 2 (35%) risk behaviors; 10% engaged in 3, 1% engaged in 4 while 15% engaged in 0. Compared to morning types with adequate sleep (referent group), evening types with long sleep had 1.98-fold odds of not meeting physical activity recommendations, 1.47-fold odds of being overweight, and 2.19-fold odds of high sedentary behavior. Evening types with short sleep had 3.36-fold odds of being smokers as compared to morning types with adequate sleep. All models were adjusted for age, sex, race, college attendance and shift work. These data suggest an interactive relationship between sleep duration and chronotype, such that evening types who do not get adequate sleep may be most at risk for poor heart health behaviors. Further work is needed to determine the effects of chronotherapeutic interventions (i.e., shifting evening toward morning preference) on heart health behaviors.
Abstract P009: Risk of Mortality According to Burden of Atrial Fibrillation: Results From a 60-year Cohort Study
Authors: McIntyre William F , Tourabi Mahmoud , St John Philip D , Tate Robert B
Published: July 2021

Introduction:
Atrial Fibrillation (AF) is the most common serious cardiac arrhythmia and is associated with an increased risk of stroke and mortality. These risks can be modified with oral anticoagulation therapy. Clinically, the arrhythmia can be permanent or intermittent. Prior studies that have used time-constant, categorical covariates to examine the relationship between the pattern of AF and the occurrence of adverse events have produced conflicting results. We hypothesized that the amount of time that patients spend in AF, hereinafter termed arrhythmia “burden”, may be important in predicting adverse events.

Objective:
To examine the effects of the burden of AF on all-cause mortality.

Methods:
The Manitoba Follow-Up Study is a longitudinal, prospective study of 3983 originally healthy young men (mean age at entry 30 years) who have been followed with routine medical and electrocardiographic examinations since 1948. After 60 years of follow-up to July 1, 2008, AF had been documented on the electrocardiograms of 581 men (15% of the cohort) and 3182 (80%) of the original cohort had died. We created a Cox proportional hazards model with time-dependent covariates to estimate relative risks for mortality according to AF burden. AF status during each follow-up visit was classified as persistent when the patient was in AF on consecutive examinations, transient when the patient reverted to sinus rhythm after being in AF and incident when the patient developed AF after a period in sinus rhythm.

Results:
Results of the Cox proportional hazards regression model are displayed in the Table. Age, persistent AF and incident AF were all significant variables in the model. Holding all the other variables constant, persistent AF increased the risk of death by two times and incident AF increased the risk of death by 87%.

Conclusions:
Persistent AF and incident AF are associated with increased all-cause mortality. Estimating AF burden may have implications for risk stratification in patients with AF.
Abstract P011: Serum Magnesium and the Incidence of Coronary Heart Disease Over 20 Years of Follow-up: The Atherosclerosis Risk in Communities Study
Authors: Misialek Jeffrey R , Alonso Alvaro , Folsom Aaron R , Michos Erin D , Rebholz Casey M , Lutsey Pamela L
Published: July 2021

Background:
Low serum magnesium (Mg) may be linked to higher cardiovascular risk through impaired glucose levels, elevated blood pressure, chronic inflammation, impaired vasomotor tone or peripheral blood flow, and electrocardiogram abnormalities. Relatively few studies have examined the association of serum Mg and coronary heart disease (CHD).

Hypothesis:
Individuals with low serum Mg levels will have an increased risk for CHD.

Methods:
We studied 13,349 participants (75% white, 57% women, mean age 54) free of CHD at baseline from the Atherosclerosis Risk in Communities study. Serum Mg, assessed at baseline (1987-89) and a second visit (1990-92), was averaged. Incident CHD cases through 2012 were ascertained from hospital discharge codes and death certificates and adjudicated by physician review. Multivariate Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals. Interactions by age, race, and sex were tested.

Results:
Over a median follow-up time of 23.4 years, 1,606 incident CHD cases were identified. Low serum Mg was associated with higher CHD risk after adjustment for demographics and behaviors (Table, Model 2). Although the test for trend was significant, most of the excess risk was for the lowest Mg category. The association persisted after adjustment for potential mediators (Table, Mediation Model). There was no evidence of significant interactions between serum Mg and age, race, or sex.

Conclusion:
Low serum Mg was associated with higher CHD risk, which is consistent with the proposed mechanisms and prior studies that have suggested a relationship. Interventional primary prevention studies could be considered to evaluate whether raising low serum Mg levels might lower CHD risk.
Abstract P019: Low Ovarian Reserve is Associated with Cardiovascular Disease Risk
Authors: van der Schouw Yvonne T , de Kat Annelien C , Verschuren W. M , Eijkemans Marinus J , Broekmans Frank J
Published: July 2021

Introduction:
Age at menopause and the postmenopausal state are frequently linked to cardiovascular disease (CVD) risk. Anti-Müllerian hormone (AMH) is produced by ovarian antral follicles and its concentration in peripheral blood is a quantitative estimation of the size of the antral follicle pool, thereby providing a measure of ovarian reserve before the end of the reproductive lifespan. We and others have shown that AMH is related to age at menopause. Literature on whether AMH is related to CVD risk is still scarce and heterogeneous.

Hypothesis:
We hypothesized that a low ovarian reserve, measured by low levels of AMH, is associated with higher risk of CVD risk in premenopausal women.

Methods:
We used data from 2,338 premenopausal women who participated in the second follow-up round of the population-based Doetinchem Cohort Study. In a cross-sectional analysis, CVD risk was compared between women in different AMH level-based categories. AMH was measured in stored serum samples using a Gen-II ELISA assay (Beckman-Coulter, Sinsheim, Germany) in a single laboratory. CVD risk was assessed in three ways: levels of single cardiovascular risk factors (systolic and diastolic blood pressure, total and HDL cholesterol, glucose), a metabolic risk factor score, and predicted 10- and 30-year risk using Framingham prediction rules. The association of AMH categories with CVD risk outcomes was studied using linear regression models, adjusted for age, age-squared, current estrogen use, current smoking, parity, menstrual cycle regularity, current pregnancy and BMI.

Results:
AMH was unmeasurable in 456, and measurable, but below the limit of quantification (0.16 μg/L) in 186 women. In the remaining 1,696 women AMH level could be quantified and the median [IQR] AMH was 1.34 [0.24-5.14] μg/L. After adjustment, women with quantifiable AMH had 0.11 mmol/l (95% CI -0.23; 0.01) lower total cholesterol level than women with unmeasurable and unquantifiable AMH levels. Women with quantifiable AMH had on average 0.11 (95% CI 0.01-0.21) fewer metabolic risk factors compared to women with unmeasurable AMH, adjusted for confounders. Women with quantifiable AMH also had a 5% (95% CI -0.01; 11.0) lower hazard of 10- and 30-year CVD occurrence compared to women with unmeasurable AMH.

Conclusions:
This study indicates that premenopausal women with very low ovarian reserve, expressed by unmeasurable serum AMH levels, may have an increased CVD risk. Longitudinal research with clinical endpoints and more sensitive AMH assays are necessary to confirm a relationship between AMH and CVD risk.
Abstract P022: Associations of Brain Natriuretic Peptide with Adipokines in African Americans: The Jackson Heart Study
Authors: Horbal Steven R , Smiley Abbas , Dibaba Daniel , Musani Solomon K , Hall Michael E , Taylor Herman A , Fox Ervin R , Bidulescu Aurelian
Published: July 2021

Introduction:
Brain natriuretic peptide (BNP) is used to evaluate the presence and the severity of acute congestive heart failure (ACHF). Adipokines such as adiponectin and leptin have been associated with measures of left ventricular structure and function, and also with ACHF. As African Americans experience disproportionate prevalence and magnitude of cardiovascular risk factors, the objective of our study was to assess the relationship between these adipokines and BNP among African Americans.

Methods:
A total of 4,127 (63% female) African American participants from the Jackson Heart Study were recruited. Participants with end stage renal disease or with missing data were excluded from analysis. Multivariable adjusted linear models were used to determine the association between adipokines and BNP. Biomarkers were transformed by their natural logarithm to satisfy the normality assumption. Model 1 was adjusted for demographic factors, body mass index, glomerular filtration rate, diabetes mellitus and hypertension. Model 2 was additionally adjusted for echocardiographic measures. Model 3 was adjusted for those in Model 1 as well as aldosterone, renin and adiponectin or leptin. Sex stratified analyses were conducted for linear models. BNP was dichotomized by the threshold of 100 pg/mL and both adipokines were dichotomized by their 90th percentile. Multivariable adjusted logistic regression was used to calculate the odds ratios for associations of adipokines and BNP.

Results:
Mean (SD) BNP levels were 18.19 (53.00) pg/mL in men and 19.14 (62.23) (t-test p=0.61). Mean (SD) adiponectin levels were 4,091.30 (3,406.40) ng/mL and 6,043.50 (3,406.50) ng/mL in men and women, respectively (t-test p<0.01). Mean (SD) levels for leptin were 11.39 ng/mL (10.33) and 37.79 ng/mL (23.81)] in men and women, respectively (t-test p <0.01). A direct association was observed between adiponectin and BNP (Model 1 β = 0.43 Model 2 β = 0.41, and Model 3 β = 0.35; all p <0.001). For the relationship of leptin and BNP, an inverse association was observed (Model 1 β = -0.17, p < 0.001; Model 2 β = -0.20, p < 0.001; Model 3 β = - 0.07, p=0.047). Stratification by sex yielded similar results in Models 1 and 2, but significance was lost between leptin and BNP in Model 3. In logistic models, those in the highest decile had increased odds of elevated BNP in Model 1 [OR=2.29, 95% CI (1.33-3.94)] and Model 2 [OR=3.65, 95% CI (1.59-3.75)]. Statistical significance was lost after further adjustment. No associations were found significant in logistic models of leptin and BNP.

Conclusions:
Among African American participants, there was an inverse association between leptin and BNP and a direct association between adiponectin and BNP, indicative of a putatively complex compensatory association between these biomarkers.
Abstract P024: A Multimarker Approach to Evaluate Cardiac Structure in African Americans: The Jackson Heart Study
Authors: Pollard James D , White Faren , Vasan Ramachandran S , Bidulescu Aurelian , Fox Ervin R , Musani Solomon K
Published: July 2021

Background:
Cardiac structure is an independent predictor of cardiovascular outcomes including stroke, heart attack and death. Using a multimarker approach we investigated the potential association of a group of biological pathways with cardiac mass and geometry that would suggest a role in the pathophysiology of cardiac remodeling in African Americans, a high risk group.

Objective:
We examined the association of a panel of nine circulation biomarkers with cardiac structure in a community of African Americans.

Methods and Results:
The study sample included participants in the Jackson Heart Study who underwent an echocardiogram and phlebotomy for a panel of biomarkers that included pathways of inflammation (C-reactive protein, CRP); neurohormonal activation (B-type natriuretic peptide, BNP); renin-angiotensin system (aldosterone and renin modeled as a ratio ARR); endothelial (homocysteine, endothelin); adiposity (adiponectin and leptin); and insulin resistance (HOMAIR) with cardiac structure. The main outcomes were left ventricular mass (LVM) and LV geometry (normal geometry [reference] vs. concentric remodeling [CR], concentric hypertrophy [CH] or eccentric hypertrophy [EH]). We used multiple linear and multinomial logistic regression models to relate the biomarker panel to LVM and LV geometry, respectively. We selected the best multiple linear regression model for LVM using Akaike Information Content and backwards elimination in a multinomial logistic regression to evaluate biomarkers associated with LV geometry. Circulating concentrations of ARR, BNP and adiponectin were associated with LVM, multiple adjusted regression coefficients [beta] and standard error [±SE] per standard deviation (SD) increase in log-biomarker were, respectively; 0.056±0.009, p=0.0067; 0.020±0.005, p<0.0001; and -0.011±0.005, p=0.0432. In terms of LV geometry, BNP concentrations was significantly associated with EH (1.38 [1.11-1.72], p=0.0045) and CH (1.34 [1.03-1.75], p=0.0314). ARR was significantly associated with EH (1.34, 95% CI [1.04-1.73] odds ratio [OR], p=0.0434) per SD increment and HOMAIR was significantly associated with CR (1.26, 95% CI [1.05-1.52], p=0.0212) and EH (1.22, 95% CI [1.00-1.48], p=0.0290).

Conclusions:
In a community-based sample of African Americans there were significant and positive relation of ARR and natriuretic peptide pathway to LVM and LV geometry, a significant and positive relation of HOMAIR to LV geometry and a significant and inverse relation of adiponectin to LVM. These observations support the notion of differential influences of biological pathways on cardiac structure.
Abstract P027: Liver Enzymes and Insulin Resistance and Glycemia in Hispanic/Latino Youth: Results From the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth)
Authors: Parrinello Christina M , Rudolph Bryan J , Lazo Mariana , Gallo Linda C , Thyagarajan Bharat , Cotler Scott J , Qi Qibin , Vidot Denise C , Strickler Howard D , Kaplan Robert C , Isasi Carmen R
Published: July 2021

Background:
Associations of insulin resistance and glycemia with liver enzymes have not been well studied in a young, heterogeneous Hispanic/Latino population. We aimed to assess these associations, and to examine the role of endothelial dysfunction as a potential mediator.

Methods:
We examined 1,275 participants aged 8-16 years from the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth) (2012-14). We examined the distribution of liver enzymes (alanine transaminase [ALT], aspartate transaminase [AST], and gamma-glutamyl transpeptidase [GGT]), the pediatric nonalcoholic fatty liver disease (NAFLD) fibrosis index (PNFI), glycemic markers (fasting glucose and hemoglobin A1c [HbA1c]), and insulin resistance (HOMA-IR) by age, sex, and body mass index (BMI). We assessed the adjusted cross-sectional associations of insulin resistance and hyperglycemia (as continuous variables) with elevated liver enzymes and PNFI (as binary variables) using Poisson regression to obtain prevalence ratios (PRs).

Results:
Boys were more likely than girls to have elevated liver enzyme levels (15 vs 10%, 5 vs 2%, 26 vs 16%, and 12 vs 11% had elevated ALT, AST, GGT, and PNFI, respectively) and hyperglycemia (15 vs 6% and 9 vs 8% had elevated glucose and HbA1c), but less likely to be insulin resistant (47 vs 59%). Obese children (BMI≥95
th
percentile) were more likely to have higher liver enzyme levels, hyperglycemia, and insulin resistance than non-obese children. Only HOMA-IR was associated with elevated liver enzymes and PNFI in multivariable models (
Figure
). After additional adjustment for PAI-1, and e-selectin (markers of endothelial dysfunction), only the associations of HOMA-IR with GGT and PNFI remained statistically significant (PRs and 95% CIs: 1.43 [1.03, 1.98] and 1.85 [1.33, 2.56], respectively).

Conclusions:
Among a large sample of Hispanic/Latino youths, insulin resistance was associated with NAFLD. It is possible that these associations are partially mediated by endothelial dysfunction.
Abstract P031: Correlation of Sibling Lipid Levels From a Statewide Child Cardiac Risk Factor Registry
Authors: Pyles Lee A , Lilly Christa , Neal William A
Published: July 2021

Introduction:
Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) is a project that has assessed childhood risk factors for cardiovascular disease (CVD) for nearly twenty years. We have screened approximately 95,000 children from WV that now include 60,403 with lipid panels. Eight-thousand-five-hundred-fifty-seven persons have one or more siblings who have participated in the project. To begin to consider genetic primordial antecedents of CVD in WV schoolchildren, we linked sibships for analysis.

Methods:
Linkage software designed to deduplicate EHRs proved poorly adaptable to the problem of family matching. Successive excel spreadsheets were used to directly match either mother or father’s first and last name with care taken to avoid similar names by requiring additional matching parameters. A group of children were identified with younger siblings subsequently enrolled in CARDIAC and the two older children were matched for analysis when 3 siblings were found. Body Mass Index z-score was calculated for each child. Fasting lipid levels were obtained by venipuncture and measured by a commercial laboratory (LabCorp).

Results:
Children (5259)with at least one sibling with LDL levels available for both were found along with 1384 third siblings. The mean LDL level for the first child was 90.5 mg/dl and 92.1 mg/dl for the second child. The mean BMI z-score was +0.83 for the group of 95,000 children, +0.73 for the first sibling and +0.72 for the second sibling. Sibling BMI z-scores were strongly correlated. Multivariate analysis demonstrated that the LDL level for the second child correlated strongly with both the older sibling’s LDL level and with the second child’s BMI z-score. This model showed R2 = 0.15 and the following prediction equation:

LDLsibling2 = 56.3 + 0.377*LDL-proband + 2.24*BMI-z-score-sibling2

p = 4.33 x 10 -175 for LDL and p = 4.06 x 10 -15 for BMI z-score

Six-hundred-sixty-eight children had an LDL level greater than 130 mg/dl including 88 sets of siblings. 12 pairs of siblings each had an LDL level > 160 mg/dl.

Conclusion:
the analysis demonstrates a strong correlation between sibling LDL-c levels that is not as well explained by the correlation of BMI z-score as by LDL-c. This analysis along with our recent study of LDL and height will help to characterize CVD risk in this population to focus future investigations in children and families.
Abstract P038: US Consumer Attitudes Toward Sodium in Baby and Toddler Foods
Authors: John Katherine A , Cogswell Mary E , Zhao Lixia , Maalouf Joyce , Gunn Janelle P , Merritt Robert
Published: July 2021

Introduction:
Average US sodium intake is 9 times higher among toddlers 12-24 months of age than among infants 0-6 months of age. About 80% of US toddlers aged 1-3 years consume excessive dietary sodium and research indicates that what children eat in the first 2 years of life may influence subsequent preference for salty-tasting foods. Information on consumer attitudes can influence strategies to reduce sodium in commercially packaged baby and toddler foods.

Hypothesis:
The objective of the study was to describe the prevalence of adult consumer attitudes and related sociodemographics on the importance of baby and toddler foods being low in sodium. We hypothesized that parents of children younger than 2 years, individuals with or at higher risk of cardiovascular disease, and those who agree that too much sodium intake is harmful or who are trying to reduce sodium intake would be more likely to agree that toddler foods should be low in sodium.

Methods:
Data was obtained from Porter Novelli’s 2012 ConsumerStyles online survey sent to a random sample of 11636 US adults aged ≥ 18 years enrolled in their national probability-based consumer panel. Of those who completed the survey (N=6728), 6378 responded to the statement, “It is important for baby and toddler foods to be low in sodium.” The data from the respondents were weighted to match 2011 US Current Population Survey Proportions. Compared with non-respondents (N=350), a higher proportion of respondents were male (49% v 34%), but respondents did not differ by race, age, education, income, or region of residence. Potential determinants of agreement included demographic, health, and sodium-related attitudes and behaviors. We used logistic regression to describe the association of adult consumer attitudes and related sociodemographic characteristics with the importance of baby and toddler foods being low in sodium.

Results:
About 7 in 10 (68%, 95% CI: 66%-70%) participants agreed it was important for baby or toddler foods to be low in sodium. More than 6 of 10 in most subgroups agreed, with the highest agreement among parents of children aged 65 years compared with adults aged 18-34 years, those of other non-Hispanic races compared with non-Hispanic whites, participants who reported having high cholesterol, and those currently watching or reducing their own sodium intake.

Conclusions:
The majority of respondents agree it is important for baby and toddler foods to be low in sodium, particularly among parents with children younger than 2 years of age, persons trying to reduce sodium, and those who agree sodium is harmful to their health. In conclusion, these data suggest broad support for strategies to lower sodium in these foods.
Abstract P039: American Indian Youth Wellness Initiative
Authors: Gachupin Francine C , Joe Jennie R , Shirali Rohan , Racette Susan B
Published: July 2021

American Indian youth have the highest prevalence of obesity of all ethnic groups in the U.S. Obese individuals are at higher risk for cardiovascular disease, high blood pressure, dyslipidemia, type 2 diabetes mellitus and stroke. Reducing childhood obesity will require effective prevention strategies that focus on environments and promotion of physical activity and a healthy diet.

Objective:
To understand trends in the prevalence of obesity and severe obesity among American Indian tribal youth during the past 20 years.

Methods:
Participants included American Indian boys and girls aged 10-15 years from 14 different tribes in the Southwest, primarily Arizona, who attended a 1-week residential summer wellness camp from 1995 to 2015. Height and weight were measured on the first day of camp; sex- and age-specific body mass index (BMI) percentile and BMI z-score were computed using CDC SAS code. Obesity in childhood is defined by age- and sex-specific BMI percentile greater than or equal to the 95th percentile; severe obesity is defined as BMI ≥ 120% of the 95th percentile of BMI-for-age or as BMI ≥ 35.0 kg/m2. Chi-square tests and two-sample t-tests were used to determine the effects of sex and time on obesity and severe obesity. The significance threshold was set at p < .05.

Results:
Our sample was comprised of 354 youth, 154 males (43.5%) and 200 females (56.5%), aged 12.7 ± 1.6 years (mean ± SD). Across the 20-year period, the prevalence of obesity was 80.2% (284 of 354) overall, and was greater in males (85.7%; 132 of 154) than females (76.0%; 152 of 200, p = 0.02). Likewise, the prevalence of severe obesity was greater in males (65.6%; 101 of 154) than females (50.0%; 100 of 200, p = 0.003) and was 56.8% (201 of 354) overall. The mean BMI-for-age percentile and z-score were 94.5 ± 11.9 and 2.05 ± 0.71, respectively; BMI z-score was higher in males (2.17 ± 0.7) than in females (1.96 ± 0.7, p = 0.004). There were no clear trends in obesity among our American Indian youth campers from 1995 to 2015, but the prevalence was high in all years (range 62.5 - 95.0%; 10 of 16 youth in 2011 - 19 of 20 youth in 2003).

Conclusions:
Throughout the 20-year period, there was consistently a high prevalence of obesity and severe obesity among American Indian tribal youth. Boys displayed a higher prevalence and severity of obesity relative to girls. Given the strong association between obesity in youth and the risk for chronic disease, our results underscore the critical need to intervene early in regards to establishing healthy eating and exercise behaviors among American Indian youth.
Abstract P052: Glucometabolic State Transitions: The Jackson Heart Study
Authors: Bertoni Alain G , Chen Haiying , Effoe Valery S , Correa Adolfo , Carnethon Mercedes , Kalyani Rita R , Echouffo-Tcheugui Justin B , Joseph Joshua J , Joseph Joshua J , Golden Sherita H
Published: July 2021

Background:
To assess the frequency and determinants of transitions between normal fasting glucose (NFG), prediabetes and diabetes in an African American cohort.

Methods:
We included participants from the Jackson Heart Study who attended the baseline exam (2000-2004) and at least one of two subsequent exams (2005-2008 and 2009-2013), and were not missing data (fasting glucose, hemoglobin A1c, diabetes medication) used classify the glycemic status of participants as NFG, prediabetes, and diabetes at each visit. Transitions were defined as progression (deterioration) or remission (improvement) of glycemic status. Two transitions were possible for those attending all 3 visits. A generalized multinomial logit model, accounting for repeated measures from individuals with 2 transitions as clusters, was used to estimate the odds ratios (OR) for remission versus stable and progression versus stable, adjusting for demographic, anthropometric, behavioral, and biochemical factors.

Results:
Among 3,316 participants (baseline mean age 55 years, 36% male, 32% with IFG, 24% with diabetes) with data on at least one consecutive transition, 58.5% remained in their baseline status, 32.5% experienced a progression, 3.0% a remission, and 6.1% both a remission and progression. Among those classified as NFG, prediabetes, and diabetes at baseline: 1) progression occurred among 59%, 39%, and 2%; and 2) remission occurred among 7%, 13%, and 7%, respectively. The average weight change between exams was +1.4 kg for those experiencing only a progression and -4.5 kg for those with only a remission. Subsequent analyses included 2171 with complete data for all covariates which included baseline age, sex, education, BMI, smoking, alcohol use, hypertension medication, systolic blood pressure, log(triglycerides), baseline diabetes status, change in weight and change in log(CRP) between visits. The outcome of remission was associated only with weight change. A 1 kg increment in weight change was associated with a reduced likelihood of remission (OR 0.97, 95%CI: 0.96 - 0.99, p<0.001). The outcome of progression was associated with baseline BMI, log(triglycerides), diabetes status, and weight change (OR for 1 kg increment weight change 1.04, 95%CI: 1.03 - 1.06, p<0.001).

Conclusions:
In a contemporary adult African American population, transitions between glucometabolic statuses were frequent and most commonly involved deterioration. Weight changes between examinations were strongly associated with both remission and progression.
Abstract P098: Is There a Mismatch Between Length of Hospital Stay and Prognosis in Medicare Beneficiaries Hospitalized for Heart Failure?
Authors: Loop Matthew S , Van Dyke Melissa K , Chen Ligong , Brown Todd M , Durant Raegan W , Safford Monika M , Levitan Emily B
Published: July 2021

Background:
Length of stay (LOS) during heart failure (HF) hospitalizations has decreased, accompanied by recent increases in post-discharge mortality and 30-day readmission rates among these patients.

Methods:
We conducted a retrospective cohort study of 19,477 Medicare beneficiaries in order to determine whether patients with the longest LOS also had the highest risk of death or readmission. We included patients hospitalized for HF and discharged alive between 2007 and 2011 with documented left ventricular (LV) systolic, diastolic, or combined dysfunction. We estimated the associations of LOS, risk for 30-day mortality, and risk for 30-day readmission with: type of LV dysfunction, HF severity, comorbidity burden, discharge disposition, demographics, nursing home residence, and calendar year. Gamma regression, Poisson regression, and Cox proportional hazards were used to model LOS, 30-day mortality, and 30-day readmission, respectively. Each model included all covariates.

Results:
The mean (IQR) LOS was 5 (4 - 8) days, 7% of the patients died within 30 days, and 23% of the patients were readmitted within 30 days. Patients with isolated diastolic dysfunction (DD) had 2% shorter LOS than patients with any systolic dysfunction (SD), but had 10% lower 30-day mortality. Comorbidities were associated with a 3% to 10% longer LOS, with the exception of chronic kidney disease (CKD) (16% longer) and malnutrition (30% longer). Only CKD, malnutrition, and chronic obstructive pulmonary disease (COPD) were associated with 30-day mortality (22%, 51%, and 14% higher risk, respectively). Most comorbidities were associated with 10% - 20% higher risk of 30-day readmission. Regarding discharge disposition, patients discharged home had 40% shorter LOS, 78% lower 30-day mortality, and 11% lower risk for 30-day readmission than patients discharged to a skilled nursing facility (SNF).

Conclusions:
We found no mismatch between LOS and prognosis among Medicare beneficiaries hospitalized for HF.
Abstract P123: The Physical Activity Built Environment: Evaluation of the Concordance of Perceived versus Measured Access to Parks and Bike Paths
Authors: Bollinger Claire E , Hood Darryl B , Bower Julie K
Published: July 2021

Background:
Approximately 80% of pregnant women in the US do not meet the CDC recommendation for moderate-intensity physical activity. The built environment is a key contributor to physical activity (PA) behavior. However, there may be a disconnect between physical attributes of the built environment and perceived access to an environment that supports PA. Use of a geographic information system (GIS) to objectively measure aspects of the built environment can yield important information about proximity of resources for supporting PA. We evaluated concordance of perceived access to multi-use bike paths (MUBP) and parks in a population of pregnant women. We also examined demographic characteristics associated with concordance between perceived and actual supports for PA.

Methods:
A population of 155 pregnant women in the greater Columbus, OH area reported perceptions of access to environmental supports within their neighborhood (defined as 0.5 mi. radius/ 10 min. walk) and community (10 mi. radius/ 20 min. drive), along with self-reported PA information. Addresses were abstracted from medical records and geocoded. Within ArcMap 10.2.2 (ESRI, Redlands, CA), buffers at distances of 0.5, 1, and 10 miles were created around MUBP and parks, respectively. Respondents were classified as “near” a resource if their address fell within those buffers. Logistic regression was used to examine the association between concordance of self-report with objectively measured proximity and demographic factors associated with higher concordance.

Results:
Within the study population of 155, 12% and 28% of women lived within 0.5 and 1 mile of a dedicated MUBP, respectively. More women lived within close proximity to a park (46% within a 0.5 mile radius, and 69% were within a 1 mile radius). The discordancy for parks ranged from 9.68%-49.03%, and from 16.77%-76.13% for MUBP. Concordance of report of parks within the community was higher among non-Hispanic white women (OR=4.2 [1.1, 15.3]) and that concordance or over-reporting of access to parks within the community was higher among married women (OR=5.3 [1.3, 21.5]). There were no significant differences in self-reported PA or changes in PA, however women living within 1 mile of a park reported more minutes of moderate-to-vigorous PA. A greater percentage of those with access reported increasing or maintaining levels of moderate PA from before pregnancy through the third trimester.

Conclusions:
The discordance between perception of access and objectively measured proximity to MUBP and parks suggests a substantial portion of women are not aware of their availability, or do not perceive them as relevant factors in influencing their PA behaviors during pregnancy. It may be that physical proximity is not a major driver in perceived access. Characteristics of the built environment, such as safety or social environment, may play a larger role in influencing PA behaviors.
Abstract P131: Associations Between Joint Symptoms and Prospective Changes in Physical Activity in First-degree Relatives of Rheumatoid Arthritis (RA) Patients
Authors: Hughes-Austin Jan M , Ix Joachim H , Ward Samuel R , Weisman Michael H , O’Dell James R , Mikuls Ted R , Buckner Jane H , Gregersen Peter K , Keating Richard M , Demoruelle M. Kristen , Deane Kevin D , Holers V. Michael , Norris Jill M
Published: July 2021

Background:
CVD is accelerated in RA, and risk of CVD death is 50% higher in RA patients. Physical activity (PA) mitigates increased CVD risk, but RA patients typically have less PA. It is not known whether PA declines prior to RA onset, or whether joint symptoms (sxs) contribute to PA decline. We sought to determine whether RA-related joint sxs were associated with PA over time in first-degree relatives (FDRs) of RA patients, a population at increased risk for future RA.

Methods:
In the Studies of the Etiology of RA (SERA), we evaluated associations between presence of joint sxs and hours of PA in 878 FDRs; of whom, 376 had ≥2 visits. A physician confirmed joint swelling; participants self-reported stiffness and pain in the wrist, elbow, or any MCP, PIP, or MTP joints. Hours sleeping, sitting, and performing slight, moderate, or heavy activity during a typical 24-hour day were obtained through questionnaire, weighted to reflect metabolic expenditure, and calculated as follows: PA = (1.0*h
sleep
+ 1.1*h
sedentary
+ 1.5*h
slight
+ 2.4*h
moderate
+ 5.0*h
heavy
). Linear mixed models were used to evaluate associations between joint sxs and change in PA over time, adjusting for age, sex, race, BMI, smoking, and positivity for RA-related autoantibodies

Results:
Mean baseline age was 50±16 years. 74% were female, 78% were White, 7% had joint swelling, 15% had joint stiffness, and 24% had joint pain. Average PA was 37±7. At baseline, PA was higher in FDRs with joint stiffness (B=1.27±0.64, p=0.05) and joint pain (B=1.43±0.54, p=0.01), and lower in FDRs with joint swelling (B=-1.50±0.91, p=0.10). Adjusting for baseline PA, baseline joint swelling, stiffness, and pain were not significantly associated with changes in PA. However, change in joint swelling was associated with increased PA; and changes in joint stiffness and pain were associated with decreased PA. (Table)

Conclusion:
Joint sxs may not predict future PA, but PA may be lower at the time joint sxs occur. Clinicians should address joint sxs as part of their PA intervention in CVD prevention.
Abstract P154: Systematic Review of Dietary Salt Reduction Policies: Evidence for an Effectiveness Hierarchy?
Authors: Hyseni Lirije , Elliot-Green Alex , Lloyd-Williams Ffion , O’Flaherty Martin , Kypridemos Chris , McGill Rory , Orton Lois , Bromley Helen , Cappuccio Francesco , Capewell Simon
Published: July 2021

Background:
Non-communicable disease (NCD) prevention strategies now prioritise four major risk factors: food, tobacco, alcohol and physical activity. Dietary salt intake is on average 5g/day higher than the recommended intake leading to high blood pressure, cardiovascular disease and gastric cancer. Substantial reductions in salt intake are therefore urgently needed. However, debate continues about the most effective approaches. We therefore systematically reviewed the evidence on possible interventions to inform future prevention programmes. We hypothesised an effectiveness hierarchy whereby “upstream structural” interventions targeting populations are more powerful than “downstream, agentic” interventions targeting individuals.

Methods:
We searched six electronic databases using a pre-piloted search strategy focussing on the effectiveness of population interventions to reduce salt intake. Retrieved papers were screened, appraised and graded for quality independently by two researchers. Extracted data were categorised using nine stages along the agentic/structural continuum, from “downstream”: dietary counselling (individuals, worksite and communities), through media campaigns, nutrition labelling, voluntary and mandatory reformulation, to the most “upstream” regulatory and fiscal interventions. We also considered comprehensive strategies involving multiple components.

Results:
After screening 2464 candidate papers, 65 were included in this systematic review (46 empirical and 19 modelling studies). Quality was variable. Multi-component strategies combining downstream with upstream interventions generally achieved the biggest reductions in salt consumption across an entire population, -3g/day in Finland, -4g/day in Japan and -1.5g/day recently in the UK. Tax interventions were considered in a few modelling studies; effects were mixed and modest. Mandatory reformulation achieved reductions of at least -1.45g/day, more than food labelling or worksite interventions (each typically -1.2g/day, but with a wide range). Smaller population benefits came from interventions in schools (-0.2g/day to -0.7g/day), and even smaller ones from health education media campaigns (-0.2g/day or less). Dietary advice achieved -2g/day reductions in compliant individuals in trials (representing an estimated population reduction of approximately -1g/day).

Conclusions:
Comprehensive strategies involving multiple components and “upstream” population-wide policies such as mandatory reformulation, and food labelling or worksite interventions appear to be most effective in achieving population-wide reductions in salt consumption. In conclusion, this ‘effectiveness hierarchy’ might deserve greater emphasis in future NCD prevention strategies, with correspondingly less emphasis on weaker ”downstream” individually-based interventions.
Abstract P155: Dietary Pattern Improvements are Related to Less Weight Gain During the Transition From Adolescence Into Young Adulthood
Authors: Hu Tian , Jacobs David R , Larson Nicole , Cutler Gretchen J , Laska Melissa N , Neumark-Sztainer Dianne
Published: July 2021

Background:
Excess weight gain during childhood and adolescence is associated with elevated cardiovascular risk factors in young adulthood. Little is known about dietary pattern in relation to weight gain during early life stages.

Objectives:
We assessed change in diet quality, using the A Priori Diet Quality Score (APDQS), and its relationship with concurrent weight change among a large, diverse group of adolescents transitioning into young adulthood.

Methods:
Participants recruited from Minnesota public secondary schools, followed for 10 years, reported on diet and weight status in early adolescence (1999; mean age 15 y), late adolescence (2004; mean age 20 y) and young adulthood (2009; mean age 25 y). We included 1,474 initially non-obese participants with all three surveys. The APDQS was the sum of quintile scores 0 to 4 for the 16 food groups rated as beneficial in terms of hypothesized health effects plus scores in reverse order (4 to 0) for the 9 foods rated as adverse, with 12 food groups rated neutral not adding to the score. The score focused on varied, plant-based, less processed dietary patterns, with contributions from many food groups. A higher score indicates a diet with better quality.

Results:
Mean (SD) weight increased from 61 (14) kg in 1999 to 76 (19) kg in 2009. Over the same period mean (SD) APDQS increased from 46 (12) to 53 (12). The APDQS stabilized with aging (within-person tracking correlation r=0.50 from late adolescence to young adulthood vs r=0.32 from early to late adolescence). An increase in APDQS was associated with less weight gain, with exception over early to late adolescence (Table).

Conclusions:
APDQS captures aspects of Mediterrean and prudent diets and is more powerful than individual food items. This cohort study suggests that an increase in diet quality is associated with less weight gain during the transition from adolescence to young adulthood. Furthermore, this diet pattern begins to track as strongly as physical risk factors like blood pressure starting in late adolescence.
Abstract P171: Association Between Blood Pressure Control and Ten-Year Progression in Carotid Arterial Stiffness Varied by Diabetes Status Among Treated Hypertensive Individuals: The Multi-Ethnic Study of Atherosclerosis
Authors: Tedla Yacob G , Gepner Adam , Colangelo Laura , Stein James , Liu Kiang , Greenland Philip
Published: July 2021

Introduction:
The association between hypertension and arterial stiffness was shown to be stronger among diabetic patients. However, it is not known whether the association between controlled blood pressure (BP) and arterial stiffness progression varies by diabetes mellitus status.

Methods:
We used data from the Multi-Ethnic Study of Atherosclerosis among 879 individuals who were hypertensive and treated at baseline and three follow-up visits (mean age 63.7 years, 44% males at baseline). Carotid arterial stiffness was measured using distensibility coefficient (DC) and Young’s elastic modulus (YEM) at baseline and after a mean of 9.5 years (exam 5). Participants were considered as having controlled BP if their systolic and diastolic BP were <140/90 mmHg. In separate multiple linear regression models, changes in DC and YEM between exams 1 and 5 were regressed on categories of number of visits with controlled BP across visits 1-4. Additional analysis was made stratifying by diabetes status.

Results:
Mean DC and YEM were 2.8x10-3 mmHg-1 and 3.6x103 mmHg at baseline and 2.6x10-3 mmHg-1 and 4.2x103 mmHg at exam 5, respectively. After adjusting for potential confounders, ten-year progression in arterial stiffness was significantly lower among individuals with controlled BP at three or four visits as compared to those with controlled BP at only one or no visit. There was borderline significant interaction between number of visits with controlled BP and diabetes (P=0.06). When stratified by diabetes, the association was significant only among non-diabetic participants. There was significant trend in the progression of arterial stiffness by the number of visits with control BP (Table 1).

Conclusion:
Long-term control of BP among treated hypertensive individuals was significantly associated with lower ten-year progression in arterial stiffness only among non-diabetic individuals. Controlling BP alone may not be enough to slow progression of arterial stiffness among diabetic individuals.
Abstract P180: A Racial Comparison of Vascular Hemodynamics in Middle-aged Americans: The Jackson Heart Study
Authors: Washington Floyd , Musani Solomon K , Benjamin Emelia J , Mitchell Gary F , Fox Ervin R
Published: July 2021

Background:
Despite the higher rates of hypertension and cardiovascular disease (CVD) sequela due to hypertension in African Americans (AA), literature on the hemodynamic factors contributing to vascular stiffness is sparse in this high risk population.

Objective:
We investigated the hemodynamics of vascular stiffness and its components in a middle-aged cohort of AA using arterial tonometry and compared findings to what has been seen in a healthy cohort of non-Hispanic whites from Framingham.

Methods:
Noninvasive hemodynamic factors were measured in 1,750 Jackson Heart Study participants (68±11 years, 65% female). A healthy reference group from published work in Framingham was used to determine the prevalence of abnormals in the Jackson Heart Study sample. Reference group was defined in Framingham as those with: age (<50 years), blood pressure (BP, 140/90 mmHg), total cholesterol (<200 mg/dL), body mass index (<30 kg/m2), no diabetes, not currently smoking, and no history of CVD. Abnormal hemodynamic factors were defined as measurements outside the 95th or 5th percentile of the reference group. Using comparison of proportions, we determined the difference in abnormal prevalence rates between middle-aged AA in the Jackson Heart Study and non-Hispanic whites in Framingham.

Results:
The prevalence rates of abnormal hemodynamic variables in a middle-aged group of AA was compared to that seen in middle-aged non-Hispanic whites in Framingham using a published reference sample of normals in Framingham. Compared to non-Hispanic whites in Framingham, the prevalence of abnormals found in Jackson Heart Study AA was higher for diastolic BP (p=0.009), peripheral resistance (p<0.001), characteristic impedance (p=0.006), carotid-brachial pulse wave velocity (p=0.038) and cardiac output (p<0.001).

Conclusion:
Abnormalities in pulsatile hemodynamic variables are much more common (and severe) in AA than European Americans, which may contribute to higher CVD risk in AA.