bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P211: Association Between Urbanization-related Change in Diet, the Gut Microbiota and Microbiome-related Metabolites in a Rapidly Urbanizing Environment in China
Authors: Howard Annie Green , Fodor Anthony , Sun Shan , Wang Yiqing , Tsilimigras Matthew , Du Shufa , Wang Huijun , Gordon-Larsen Penny
Published: March 2020

Introduction:
Numerous studies suggest that there are rural-urban differences in gut microbial community, partially due the Westernization of diet. However, most studies are based on short-term follow-up and cannot assess how the transition from traditional to Western diets over time shapes human gut microbiota and whether these microbiota changes subsequently impact the metabolomic profile of the host.

Hypothesis:
We hypothesize that trajectories in diet shape components of the gut microbial community, with strong associations for microbiota and microbiome-mediated metabolites.

Methods:
We used growth mixture models to estimate individual-specific intercepts (current % calories from animal source food in 2015) and slopes (change in % calories from animal source food from 1991-2015) in 1,468 adults from the population-based China Health and Nutrition Survey (CHNS) across 20 years of urbanization-related change. We then tested the association between the gut microbiota genera in 2015 with these intercepts and slopes in linear regression models, allowing for interactions between the intercepts and slopes. In the subset of the sample with metabolomic measures collected (n = 500), we then tested whether bacteria associated with change in diet (FDR corrected p-values < 0.05 from the joint test of both main effect and interaction) were associated with microbiome-related metabolites using linear regression models.

Results:
Controlling for current % calories from animal source food, we found 57 gut microbiota measures that were significantly associated with the rate of change in % animal source calories, with the majority (19%) coming from the order Clostridiales. For 55 gut microbiota measures, we found evidence that the association between current diet and gut microbiota was modified by the rate of change in diet. Thirty-two microbiome-related metabolites, over 50% of which were involved in the benzoate metabolism or food component pathways, were associated with these gut microbiota measures.

Conclusions:
Our findings suggest that long-term change in calories consumed from animal source foods may shape the composition of the gut microbial community. Further, our metabolome findings suggest that pathways linking diet and the microbiome through microbial metabolites may be particularly relevant.
Abstract P229: Benefits of Tai Chi Exercise Among Adults With Chronic Heart Failure: A Systematic Review and Meta-analysis
Authors: Taylor-Piliae Ruth E , Finley Brooke A
Published: March 2020

Background:
Regular exercise is beneficial for adults with chronic heart failure (CHF). Tai Chi is popular among older adults and may offer additional exercise options for those with CHF.

Objectives:
A systematic review and meta-analysis was conducted to examine the benefits of Tai Chi exercise among adults with CHF.

Methods:
An electronic literature search of ten databases (AMED, CINAHL, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted from January 1, 2004 to August 1, 2019. Clinical trials that examined Tai Chi exercise, were published in English or German languages, among participants with CHF were included. Study quality was assessed independently by two reviewers, using the modified Downs and Black Quality Index checklist (low quality = score ≤14, moderate quality = score 15-23, high quality = score ≥ 24). Comprehensive Meta-Analysis version 2.0 software (Biostat, Inc.) was used to calculate the effect sizes (i.e., Hedges’ g) and the 95% confidence intervals using random effects models.

Results:
A total of six studies met the inclusion criteria (five RCTs and one quasi-experimental study with a comparison group), enrolling 229 participants (mean age=68 years old, 28% women, mean ejection fraction=37%). The Yang style of Tai Chi was most commonly practiced in these studies (n=5, 83%), with usual care the most common control condition. Study quality was moderate (mean score=23). At least three studies reported outcomes for exercise capacity, quality of life (QOL), depression, and b-type natriuretic peptide (BNP), allowing for meta-analysis. Compared to controls, Tai Chi participants had significantly better exercise capacity (Hedge’s g=0.353; p=0.026, I
2
=32.72%), improved QOL (Hedge’s g=0.617; p=0.000, I
2
=0%), with less depression (Hedge’s g=0.627; p=0.000, I
2
=0%), and decreased BNP expression (Hedge’s g=0.333; p=0.016, I
2
=0%).

Conclusion:
Among adults with CHF, Tai Chi was effective in improving exercise capacity and quality of life, with less depression and BNP levels observed, when compared to controls. Tai Chi is popular and safe form of exercise among older adults, yet few studies have been conducted during the past 15 years examining the benefits of Tai Chi among adults with CHF. Tai Chi can be easily integrated into existing cardiac rehabilitation programs. Further research is needed with more rigorous study designs and larger samples, before widespread recommendations can be made.
Abstract P233: History of Myocardial Infarction and Functional Status: The Reasons for Geographic and Racial Differences in Stroke Study
Authors: Levitan Emily B , Ringel Joanna B , Goyal Parag , Soroka Orysya , Sterling Madeline R , Durant Raegan W , Brown Todd M , Safford Monika M
Published: March 2020

Background:
In addition to traditional measures of cardiovascular health, individuals value the ability to conduct activities of daily living (ADLs) and physical and mental function. Whether myocardial infarction (MI) contributes to declines in these patient-centered health priorities is not known.

Objective:
To evaluate the association of history of MI with impairments in ADLs and physical and mental function.

Methods:
We included participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study without history of stroke who completed a study visit and interview in 2013-2016. Participants reported whether they had no difficulty (assigned a valued of 0), some difficulty (assigned a value of 1), or would require help (assigned a value of 2) conducting 12 basic and instrumental ADLs. We summed values across the 12 ADLs to create a score. Higher ADL impairment scores indicate more impairment. We calculated Physical and Mental Component Summary (PCS and MCS) scores from the 12-Item Short Form Health Survey. Higher PCS and MCS scores represent better function. History of MI included clinician-adjudicated MI, self-reported MI, or evidence of MI on electrocardiogram. We used logistic regression to compare prevalence of at least one ADL impairment and linear regression to compare ADL, PCS, and MCS scores between participants with and without history of MI.

Results:
Among 12,221 participants, 16% (n = 1,960) had a history of MI. The average age at the time of the interview was 72 (SD 8) years, 56% of the population was female, and 36% was black. Compared to participants without a history of MI, participants with a history of MI were more likely to have at least one ADL impairment and had higher average ADL impairment scores and lower average PCS and MCS scores (
Table
).

Conclusion:
History of MI was associated with more impairments in ADLs and worse physical and mental function in this study population. These findings suggest that prevention of MI may help prevent or delay declines functional status.
Abstract P247: Associations of 25-year Smoking Patterns With Year 30 Cardiac Structure and Function: Longitudinal Results From the CARDIA Study
Authors: Carroll Allison J , Patel Ravi B , Colangelo Laura A , Jacobs David R , Mathew Amanda R , Kang Joseph , Lloyd-Jones Donald M , Hitsman Brian
Published: March 2020

Background:
Smoking exposure has a strong dose-dependent relation with cardiovascular disease (CVD). Less is known about how patterns of exposure may impact CVD. In this study, we hypothesized that patterns of high or persistent smoking for 25 years would have worse myocardial structure and function at 30 years, while patterns of quitting smoking would be similar to never smokers.

Methods:
Data were from 5115 black and white, men and women, aged 18-30 years at baseline (1985) in the CARDIA study. Group-based trajectory modeling (SAS
proc traj
) identified smoking patterns from 1985-2010 among 3178 participants with echocardiogram at year 30 (2015). Adjusted linear regression analyses assessed associations between trajectory group with left ventricular (LV) structure (LV mass, LV diastolic dimension, left atrial volume), LV function (ejection fraction, circumferential strain, global longitudinal strain), and right ventricular function (E/A, average e’, E/e’). Interactions between smoking trajectory X sex, race, and BMI with echo measures were also assessed.

Results:
Seven smoking trajectory groups were identified (Figure). Trajectory group was significantly associated with cardiac structure, including LV mass (
p
<.001) and LV diastolic dimension (
p
=.003). For example, LV mass was greater among all smoking groups (except declining heavy smokers, n=49) compared to nonsmokers (all
p
s<.05); moreover, compared to heavy smokers, minimal smokers (
p
=.008) and quitters (
p
=.047) had smaller LV mass (Figure). Trajectory group was not associated with cardiac function (all
p
s>.10). None of the interactions with trajectory group was significant (all
p
s>.05).

Conclusions:
Any level of smoking during young adulthood was associated with poorer cardiac structure, but not function, compared to never smokers. Patterns of minimal and declining smoking also had significantly better structure than heavy smoking. These results suggest that quitting and reducing smoking may help preserve or restore cardiac structure over time.
Abstract P257: Obesity and Diabetes are Jointly Associated With Low Fruit and Vegetable Consumption and Low Physical Activity in Adults With Stroke
Authors: Bailey Ryan , Serra Monica
Published: March 2020

Introduction:
Engaging in unhealthy behaviors (poor diet, insufficient physical activity) increases risk for recurrent stroke, and can be compounded by obesity and diabetes. Although engaging in healthy behaviors is recommended for managing chronic conditions, the joint association of obesity and diabetes with diet and physical activity in stroke survivors is unknown.

Purpose:
To compare prevalences of low fruit and vegetable consumption (Low_FV, <1 fruit and <1 vegetable daily), low physical activity (Low_PA, <150 minutes of weekly moderate-intensity physical activity), and both Low_FV and Low_PA (Low_FV&PA) in stroke survivors, stratified by obesity-diabetes status (neither condition, obesity only, diabetes only, obesity & diabetes).

Methods:
Cross-sectional data from 32,876 noninstitutionalized, U.S. stroke survivors aged ≥45 years from the 2015 and 2017 Behavioral Risk Factor Surveillance System were examined. Weighted, age-adjusted prevalence estimates and adjusted odds ratios (AOR, adjusted for age, sex, race, income, education, and marital status) and 95% CIs were calculated.

Results:
Prevalences and AORs are displayed in the Table. Prevalences of Low_FV and Low_PA exceeded 50% across obesity-diabetes groups. Prevalences were highest in respondents with obesity & diabetes and lowest in respondents with neither condition across outcome variables. Compared to respondents with neither condition, odds for Low_PA were increased for respondents with obesity & diabetes and obesity only; odds for Low_FV&PA were increased only for respondents with obesity & diabetes.

Conclusions:
Our results indicated a joint effect of obesity and diabetes with Low_PA and Low_FV&PA, placing stroke survivors with both chronic conditions at greatest risk for not engaging in protective health behaviors. Regardless of obesity-diabetes status, Low_FV and Low_PA exceeded 50%. Targeted interventions that modify these unhealthy behaviors should be explored for decreasing recurrent stroke risk among stroke survivors.
Abstract P259: Using Natural Language Processing and Machine Learning to Identify Incident Stroke From Electronic Health Records
Authors: Zhao Yiqing , Fu Sunyang , Bielinski Suzette J , Decker Paul , Chamberlain Alanna M , Roger Veronique L , Liu Hongfang , Larson Nicolas B
Published: March 2020

Background:
The focus of most existing phenotyping algorithms based on electronic health record (EHR) data has been to accurately identify cases and non-cases of specific diseases. However, a more challenging task is to accurately identify disease incidence, as identifying the first occurrence of disease is more important for efficient and valid clinical and epidemiological research. Moreover, stroke is a challenging phenotype due to diagnosis difficulty and common miscoding. This task generally requires utilization of multiple types of EHR data (e.g., diagnoses and procedure codes, unstructured clinical notes) and a more robust algorithm integrating both natural language processing and machine learning. In this study, we developed and validated an EHR-based classifier to accurately identify stroke incidence among a cohort of atrial fibrillation (AF) patients

Methods:
We developed a stroke phenotyping algorithm using International Classification of Diseases, Ninth Revision (ICD-9) codes, Current Procedural Terminology (CPT) codes, and expert-provided keywords as model features. Structured data was extracted from Rochester Epidemiology Project (REP) database. Natural Language Processing (NLP) was used to extract and validate keyword occurrence in clinical notes. A window of ±30 days was considered when including/excluding keywords/codes into the input vector. Frequencies of keywords/codes were used as input feature sets for model training. Multiple competing models were trained using various combinations of feature sets and two machine learning algorithms: logistic regression and random forest. Training data were provided by two nurse abstractors and included validated stroke incidences from a previously established atrial fibrillation cohort. Precision, recall, and F-score of the algorithm were calculated to assess and compare model performances.

Results:
Among 4,914 patients with atrial fibrillation, 1,773 patients were screened. 3,141 patients had no stroke-related codes or keywords and were presumed to be free of stroke during follow-up. Among the screened patients, 740 had validated strokes and 1,033 did not have a stroke based on review of the EHR by trained nurse abstractors. The best performing stroke incidence phenotyping classifier utilized Keywords+ICD-9+CPT features using a random forest classifier, achieving a precision of 0.942, recall of 0.943, and F-score of 0.943.

Conclusion:
In conclusion, we developed and validated a stroke algorithm that performed well for identifying stroke incidence in an enriched population (AF cohort), which extends beyond the typical binary case/non-case stroke identification problem. Future work will involve testing the generalizability of this algorithm in a general population.
Abstract P267: Burden of Disease Among Older Adults With Type 1 and Type 2 Diabetes: Results From the Study of Longevity in Diabetes (SOLID)
Authors: Lacy Mary E , Gilsanz Paola , Eng Chloe , Beeri Michal S , Karter Andrew J , Whitmer Rachel A
Published: March 2020

Introduction:
Increasing incidence of type 1 diabetes (T1D) coupled with increasing life expectancy have resulted in an unprecedented number of older adults living with T1D. However, little is known about the burden of aging and diabetes-related complications in this unique group. We hypothesized that older adults with T1D would have greater diabetes and aging-related burden compared to an age, sex, race/ethnicity, and education-matched group of older adults with type 2 diabetes (T2D).

Methods:
We compared the following characteristics by diabetes type among older adults (aged ≥60) with T1D (n=805) and T2D (n=249) from the Study of Longevity in Diabetes (SOLID) using chi-squared tests: diabetes history (age of onset, diabetes duration); diabetes-related complications (retinopathy, neuropathy, nephropathy, severe hypo- and hyperglycemia resulting in hospitalization/emergency department utilization), cardiovascular disease (stroke, MI, coronary bypass), and geriatric syndromes (depression, incontinence, memory problems and functional impairment).

Results:
Average age at diagnosis and duration of diabetes, respectively, were 28 years old and 40 years duration for T1D and 56 years old and 13 years duration for T2D (Table 1). Compared to T2D, participants with T1D were more likely to report history of retinopathy, neuropathy, nephropathy, lifetime hypo- and hyperglycemic events resulting in hospitalization/emergency department utilization, and history of a coronary bypass. By contrast, those with T2D were more likely to be incontinent and have functional impairment.

Conclusions:
Our results show that diabetes-related complications are more prevalent in those with T1D than in comparable adults with T2D, while certain geriatric syndromes were more prevalent in those with T2D. Older adults with T1D are a growing population with unique diabetes-specific and aging-related considerations. Additional research is needed to understand the interplay of aging and diabetes in this group to inform patient care .
Abstract P275: Growth Differentiation Factor (gdf)-15 and Metabolic Outcomes: The ARIC Study
Authors: Echouffo Tcheugui Justin B , Daya Natalie R , Matsushita Kunihiro , Ndumele Chiadi E , Hoogeveen Ron C , Al Rifai Mahmoud S , Ballantyne Christie M , Selvin Elizabeth
Published: March 2020

Introduction:
Mechanistic studies suggest an involvement of growth differentiation factor 15 (GDF-15) in metabolic dysregulation. However, the potential utility of GDF-15 as a marker of diabetes or metabolic syndrome (MetS) risk remains unclear, especially in older adults.

Hypothesis:
GDF-15 is positively associated with biomarkers of hyperglycemia, diabetes, and MetS.

Methods:
We conducted a cross-sectional analysis of older adults who attended visit 6 (2016-2017) of the Atherosclerosis Risk in Communities (ARIC) Study. GDF-15 was measured using electrochemiluminescence immunoassay (Elecsys, Roche Diagnostics). Linear regression was used to assess continuous outcomes after appropriate transformations, and multivariable-adjusted odds of diabetes or MetS by quartiles of GDF-15 were derived using logistic regression.

Results:
Among 3,792 participants (mean age 80 years, 59% women, 23% blacks and 77% whites), higher GDF-15 concentrations (per 1-unit increase in ln[GDF-15]) were associated with higher levels of fasting plasma glucose (mg/dL) (adjusted β coefficient : 10.98, 95% CI:8.86 - 13.09) and HbA
1C
(%)(0.41, 95% CI: 0.35 - 0.48). Higher GDF-15 was associated with greater odds of diabetes (adjusted odds ratio [OR]: 5.81 for highest vs. lowest GDF-15 quartile, 95% CI 4.43-7.61) and of MetS syndrome (adjusted OR: 2.57, 95% CI 2.01-3.20) among individuals without diabetes (Figure).

Conclusions:
In this sample of older adults, elevated GDF-15 was strongly associated with diabetes and metabolic syndrome. These data strongly suggest that GDF-15 could be a robust biomarker of adverse metabolic states.
Abstract P280: Revisiting CVD Risk Prediction Using Machine Learning Approaches: A Case Study
Authors: Dashti Hesam , Liu Yanyan , Glynn Robert J , Ridker Paul M , Mora Samia , Demler Olga
Published: March 2020

Introduction:
Applications of machine learning (ML) methods have been demonstrated by the recent FDA approval of new ML-based biomedical image processing methods. In this study, we examine applications of ML, specifically artificial neural networks (ANN), for predicting risk of cardiovascular (CV) events.

Hypothesis:
We hypothesized that using the same CV risk factors, ML-based CV prediction models can improve the performance of current predictive models.

Methods:
Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER; NCT00239681) is a multi-ethnic trial that randomized non-diabetic participants with LDL-C<130 mg/dL and hsCRP≥2 mg/L to rosuvastatin versus placebo. We restricted the analysis to white and black participants allocated to the placebo arm, and estimated the race- and sex-specific Pooled Cohorts Equations (PCE) 5-year risk score using race, sex, age, HDL-C, total cholesterol, systolic BP, antihypertensive medications, and smoking. A total of 218 incident CV cases occurred (maximum follow-up 5 years). For every participant in the case group, we randomly selected 4 controls from the placebo arm after stratifying for the baseline risk factors (Table 1). The risk factors from a total of n=1,090 participants were used to train and test the ANN model. We used 80% of the participants (n=872) for designing the network and left out 20% of the data (n=218) for testing the predictive model. We used the TensorFlow software to design, train, and evaluate the ANN model.

Results:
We compared the performances of the ANN and the PCE score on the 218 test subjects (Figure 1). The high AUC of the neural network (0.85; 95% CI 0.78-0.91) on this dataset suggests advantages of machine learning methods compared to the current methods.

Conclusions:
This result demonstrates the potential of machine learning methods for enhancing and improving the current techniques used in cardiovascular risk prediction and should be evaluated in other cohorts.
Abstract P283: Where You Shop and Neighborhood Access to Fruit and Vegetables are Associated With Self-rated and Cardiometabolic Health
Authors: Corona Gabrielle , Troxel Wendy M , Dubowitz Tamara , Gary-Webb Tiffany
Published: March 2020

Introduction:
The food environment, including food retail venues, has been shown to be associated with diet, and many disadvantaged neighborhoods lack access to high quality and affordable healthy foods. Research has sought to understand whether and how the food retail environment influences diet, and it is possible that shopping at different types of stores (e.g. full-service vs discount grocery store) influences diet and self-reported health outcomes. There is limited understanding of whether factors of the food environment and primary shopping location impact cardiometabolic health (blood pressure, HbA1c, cholesterol) and self-rated health.

Methods:
We report on 459 individuals who participated in a blood draw in 2018 as part of the Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health, a longitudinal natural-experiment study among African American adults from two socioeconomically similar neighborhoods. Participants reported their perceived access to fruit and vegetables within their neighborhood and where they did their primary food shopping. Outcomes include measured height, weight, blood pressure, cholesterol (HDL, Total), HbA1c, and participant’s self-rated health. We employed logistic regression to examine associations between 1) perceived fruit and vegetable availability, quality, and price and 2) primary food shopping store type and reason for shopping there, with cardiometabolic and self-rated health outcomes. Covariates were neighborhood, years lived in neighborhood, age, race, income, education, and marital status.

Results:
Participants were on average, 60.7 years old (SD=13.9); 81.7% (375 of 459) female; 80.4% (369 of 459) overweight/obese. After covariate adjustment, both more perceived accessibility of purchasing (OR: 0.47, 95% CI: 0.28, 0.79) and pricing of fruits and vegetables (OR: 0.59, 95% CI: 0.36, 0.96) within one’s neighborhood were associated with lower odds of high blood pressure. More accessible purchasing (OR: 0.59, 95% CI: 0.39, 0.90), pricing (OR: 0.62, 95% CI: 0.41, 0.94), and higher quality of fruits and vegetables (OR: 0.64, 95% CI: 0.42, 0.97) within one’s neighborhood were associated with lower odds of poor self-rated health. Doing one’s primary food shopping at a discount grocery store compared to a full-service grocery store was associated with lower odds of being overweight (OR: 0.51, 95% CI: 0.26, 0.99). Choosing a primary food store based on price rather than quality of food was associated with increased odds of high cholesterol (OR: 2.02, 95% CI: 1.19, 3.45).

Conclusion:
These results suggest that higher perceptions of access to fruits and vegetables in one’s neighborhood and choice of primary food shopping store are important correlates of cardiometabolic health. Further research should look towards understanding how direct food choices made at stores impact cardiometabolic outcomes within this population.
Abstract P284: Higher Bitter Taste Perception is Associated With Lower Diabetes Risk Among Older Adults With Metabolic Syndrome - The PREDIMED-PLUS Trial
Authors: Gervis Julie E , Coltell Oscar , Sorlí José V , Corella Dolores , Lichtenstein Alice H
Published: March 2020

Background:
Beyond taste perception, taste receptors in the mouth and gastrointestinal tract have been linked to the regulation of energy balance, endocrine function and glucose homeostasis. Despite this, little is known about the relationship between perception for the 5 tastes (sweet, salt, sour, bitter and umami) and diet-related chronic disease risk.

Objective:
To investigate the association between perception for the 5 tastes and diabetes status.

Methods:
A cross-sectional baseline analysis was performed on older (55-75 years), overweight (BMI, ≥27-<40) adults diagnosed with metabolic syndrome who were participating in the PREDIMED-PLUS Valencia trial (N=367). Taste perception was measured by challenging participants with standard solutions representing sweet, salt, sour, bitter and umami (400 mM sucrose, 200 mM NaCl, 34 mM citric acid, 5.6 mM phenylthiocarbamide [PTC], 200 mM monopotassium glutamate, respectively) and was evaluated on a 0-5 unit scale. Diabetes status was determined by self-reported clinical diagnosis. Multivariable logistic regression models that included all 5 tastes were used to test the association between taste perception and diabetes status.

Results:
The prevalence of diabetes in this cohort was 38%. Compared to individuals without diabetes, individuals with diabetes had significantly lower bitter taste perception (unadjusted means: 1.6 versus 1.1 units, respectively) (t-test p<0.001). After adjusting for age, sex, smoking status, physical activity, BMI and medication use, a 1 unit increase in bitter taste perception was associated with a 42% lower odds of being diagnosed with diabetes (adjusted odds ratio [aOR] = 0.58; 95% CI = [0.38, 0.84], p<0.001). Although mean perceptions for sweet, salt, sour and umami were also lower in individuals with diabetes, the associations did not reach statistical significance.

Conclusions:
Among older adults with metabolic syndrome, higher bitter taste perception was associated with lower odds of being diagnosed with diabetes. Further investigations are warranted to confirm these observations and to determine whether bitter taste receptors may provide a possible therapeutic target for diabetes prevention and treatment.
Abstract P290: The Association of Maternal Pre-pregnancy Weight With Childhood and Adolescent Blood Pressure and the Modifying Role of Vitamin D
Authors: Zhang Mingyu , Wang Guoying , Wang Xiaobin , Mueller Noel T
Published: March 2020

Introduction:
High blood pressure (BP) is the leading modifiable risk factor of cardiovascular diseases. High maternal pre-pregnancy body mass index (BMI) may be one of earliest risk factors for high child BP, but evidence supporting this hypothesis is limited. Vitamin D was recently found to protect against elevated BP in childhood, yet no studies to our knowledge have examined if Vitamin D could be a modifiable target for mitigating the association of pre-pregnancy BMI and child BP.

Methods:
We analyzed longitudinal data of 719 mother-child pairs in the Boston Birth Cohort enrolled from 1998-2012 at the Boston Medical Center. We calculated child systolic BP (SBP) percentile according to a US reference and defined low Vitamin D as cord blood 25(OH)D concentration <11 ng/mL. We examined the change in child SBP percentile per 5-kg/m
2
increment in pre-pregnancy BMI using linear regression models with GEE estimates. We adjusted for confounders (see Figure footnote) and assessed mediation by further adjusting for child BMI-z score.

Results:
Our analytic sample included 451 (63%) African American/Haitian mothers, 361 (50%) girls, and 304 (42%) children with low cord blood Vitamin D. A 5-kg/m
2
increment in maternal pre-pregnancy BMI was associated with a 1.99 (95% CI: 1.08, 2.90) percentile increase in child SBP (during childhood [3-12 years]: 1.85, 95% CI: 0.97, 2.73; during adolescence [13-18 years]: 4.22, 95% CI: 1.19, 7.25). Cord blood Vitamin D status modified the associations (P-interaction = 0.023) (Figure, Panel A). Results were attenuated in the mediation analysis, but the interaction remained significant (Figure, Panel B).

Conclusion:
Higher maternal pre-pregnancy BMI is associated with higher offspring BP in childhood and adolescence, and this association is partially mediated by child weight. The inter-generational association disappeared if mother-newborn cord blood had high Vitamin D. Optimizing maternal Vitamin D status during pregnancy may help prevent the inter-generational cycle of cardiovascular risk.
Abstract P300: C-reactive Protein and Racial Differences in Type 2 Diabetes Incidence: Reasons for Geographic and Racial Differences in Stroke (REGARDS)
Authors: Peper Kaitlyn M , Guo Boyi , Long Leann , Howard George , Carson April P , Howard Virginia J , Judd Suzanne E , Zakai Neil A , Cherrington Andrea , Cushman Mary , Plante Timothy B
Published: March 2020

Introduction:
Black Americans have a higher incidence of diabetes and have elevated inflammatory biomarkers compared to white Americans. Elevated inflammation is a risk factor for diabetes but the impact of inflammation on the racial disparity in diabetes is unknown.

Hypothesis:
Elevated C-reactive protein (CRP) attenuates the observed black-white difference in incident diabetes.

Methods:
REGARDS enrolled 30,239 black and white adults aged ≥45 years from the contiguous US in 2003-07. This analysis included REGARDS participants without baseline diabetes who were assessed for diabetes 9 years later. RRs for incident diabetes by race were calculated using modified Poisson regression adjusting for risk factors known to contribute to the racial difference in diabetes incidence. The attenuation by CRP of the black-white RR of incident diabetes was calculated as the percent difference in the race RR in models with and without CRP adjustment; 95% CI for the difference was estimated using bootstrapping.

Results:
Of 11,073 participants without baseline diabetes (33% black, 67% white), black participants had higher CRP than white participants, and 12.5% developed incident diabetes. The black-white RR for incident diabetes in the base model was 1.74 (95% CI: 1.52, 1.99) for women and 1.44 (1.25, 1.66) for men. Baseline CRP mediated 21% (14, 29%) of this association in women and 20% (12, 34%) in men. These percent attenuations were similar in models adjusting for other diabetes risk factors but were diminished in a fully adjusted model; 5% (-4, 25%) in women and 7% (-43, 50%) in men (Figure).

Conclusion:
Adjustment for CRP in base models accounted for 20% and 21% of the excess risk of incident diabetes observed in black men and women, respectively, in this study. This substantial mediation persisted after adjusting for other risk factors but was diminished in the fully adjusted model. This suggests a role of inflammation in the diabetogenic effects of risk factors contributing to the observed racial difference in diabetes incidence.
Abstract P313: Self-reported Sleep Disturbance is Associated With Poor Hypertension Self-management in Latinos
Authors: Caceres Billy A , Suero-Tejada Niurka , Estrada Leah , Bakken Suzanne
Published: March 2020

Background:
Antihypertensive medication adherence is an important determinant of hypertension control. Although Latinos have high rates of uncontrolled hypertension, factors associated with anti-hypertensive medication adherence in this population are poorly understood. Self-reported sleep disturbance is associated with impaired chronic disease self-management in the general population. To date, no study has examined the association of sleep disturbance with hypertension self-management among Latinos.

Hypothesis:
Sleep disturbances will be associated with poor anti-hypertensive medication adherence and higher rates of uncontrolled hypertension in Latinos.

Methods:
We used cross-sectional data from the Washington Heights/Inwood Comparative Effectiveness Research (WICER) Project to assess the link between sleep disturbance with anti-hypertensive medication adherence and uncontrolled hypertension among Latinos with hypertension. The 8-item Morisky Medication Adherence Scale (MMAS) was used to assess medication adherence (alpha 0.75; range 0-8). The 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance measure was used (alpha 0.75; range 4-20). Uncontrolled hypertension was defined as a systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥80 mm Hg. Multiple logistic regression models were used to examine the associations of self-reported sleep disturbance with low medication adherence (MMAS <6). In addition, we examined whether sleep disturbance was associated with uncontrolled hypertension. Models were adjusted for age, sex, education, preferred language, insurance status, comorbid conditions, and anxiety.

Results:
The final sample consisted of 1,116 Latino participants with hypertension (mean age 63.2, 76.8% were female, and 69.5% had completed less than a high school education). The mean MMAS and PROMIS sleep disturbance scores were 1.9 and 10.1, respectively. A total of 341 (30.4%) participants were classified as having low medication adherence. Participants with low medication adherence were more likely to be younger (p <0.001), single (p <0.001), and have lower educational attainment (p <0.01). After covariate adjustment, a one-point increase in sleep disturbance was associated with higher odds of low medication adherence (AOR 1.05, 95% CI [1.01-1.09]). Sleep disturbance was also associated with higher odds of uncontrolled hypertension (AOR 1.04, 95% CI [1.01-1.07]).

Conclusions:
Reducing sleep disturbance in Latinos may be an important target for improving hypertension self-management. It remains unclear whether sleep disturbances are a cause of poor hypertension self-management in these patients. Additional research that incorporates longitudinal designs is needed to examine associations between sleep disturbance and hypertension self-management among Latinos.
Abstract P320: Temporal Trends In Prevalence & Prognostic Implications Of Cardiac And Non-cardiac Comorbidities Among Patients With Acute Decompensated Heart Failure: Aric Study Community Surveillance
Authors: Pandey Ambarish , Vaduganathan Muthiah , Arora Sameer , Qamar Arman , Mentz Robert J , Shah Sanjiv J , Chang Patricia , Russell Stuart D , Rosamond Wayne D , Caughey Melissa
Published: March 2020

Introduction:
Patients with HF have multiple co-existing CV and non-CV comorbidities. The temporal trends in the burden of co-morbidities and associated risk of mortality among patients with acute decompensated HF (ADHF) is not well-established.

Methods:
HF related hospitalizations were captured in the ARIC surveillance cohort study across 4 US communities 2005 to 2014 using ICD-9 codes. HF hospitalizations were adjudicated using validated algorithm to identify ADHF with reduced ejection fraction (HFrEF, ejection fraction <50%) and preserved ejection fraction (HFpEF). Data on prevalence of CV and non-CV co-morbidities were obtained from medical record review. Mortality outcomes were ascertained for up to 1-year post-admission, by linking hospital records with death files.

Results:
Of the 22,805 hospitalizations sampled between 2005-2004, 8914 were classified as ADHF corresponding to 41,146 weighted hospitalizations for ADHF (53% HFrEF, 47% HFpEF). The burden of CV co-morbidities remained stable while that of and that of non-CV comorbidities increased significantly over time among patients with HFpEF and HFrEF. The overall burden of CV co-morbidities was not significantly associated with risk of mortality among patients with HFrEF and HFpEF. In contrast, greater burden of non-CV comorbidities was significantly associated with higher risk of in-hospital, 28-day, and 1-year mortality for both HFpEF and HFrEF. Among patients with HFrEF, the risk of mortality associated with higher burden of non-CV comorbidities did not change over time. In contrast, for HFpEF, there was a significant temporal decline in the non-CV burden associated risk of in-hospital mortality and an increase in the risk of 1-year mortality over time.

Conclusion:
The burden of non-CV co-morbidities among patients with ADHF has increased over time. Higher burden of non-CV comorbidities was associated with higher risk of mortality, with stable temporal associations in HFrEF and an increasing risk over time for 1-year mortality for HFpEF.
Abstract P321: Assembly and Validation of a Heart Failure Free Cohort From the Reasons for Geographic and Racial Differences in Stroke Study
Authors: Balkan Lauren , Mefford Matthew , Chen Ligong , Sterling Madeline R , Durant Raegan W , Safford Monika M , Levitan Emily B , Goyal Parag
Published: March 2020

Introduction:
Studies of incident heart failure (HF) have provided insights into key risk factors for the disease but have been limited to select populations that often lack geographic, racial, and gender diversity. There is a need to assemble a HF-free cohort using a contemporary, geographically diverse sample.

Aim:
To develop and validate a strategy for assembling a HF-free cohort from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Methods:
To assemble a HF-free cohort, we identified and excluded REGARDS participants who were taking HF-specific medications at baseline including: digoxin without atrial fibrillation, angiotensin converting enzyme inhibitor/angiotensin receptor blocker plus beta-blocker in the absence of hypertension, carvedilol, spironolactone, loop diuretic or a combination of hydralazine and nitrates. We then examined the subgroup of REGARDS participants with at least 6 months of Medicare claims at the time of the baseline assessment; we evaluated diagnostic performance (negative predictive value, positive predictive value, sensitivity and specificity) using three Medicare claims-based definitions of HF as the referent standard: Hospitalization for HF, Principal Diagnosis of HF, and Any Diagnosis of HF.

Results:
Among 28,884 eligible participants, 3,125 used HF-specific medications at baseline, leaving 25,759 (89%) participants in the proposed HF-free cohort. Participants in the HF-free cohort had a lower prevalence of coronary disease, atrial fibrillation, and diabetes compared to excluded participants. Depending on the Medicare definition used as the referent, the percent of the HF-free cohort without evidence of HF based on Medicare claims (the negative predictive value) ranged from 95.0-99.2% (Table 1). Negative predictive value was stable across age, sex, and race strata.

Conclusions:
This medication-based strategy to assembling a HF-free cohort in REGARDS can serve as a basis for future studies to examine incident HF in REGARDS and similar studies.
Abstract P324: Differences in Incident Diabetes Mellitus and Atherosclerotic Cardiovascular Disease in Chronic Inflammatory Diseases
Authors: Chadha Simran , Rivera Adovich , Pawlowski Anna , Lloyd-jones Donald M , Feinstein Matthew J
Published: March 2020

Introduction:
Several chronic inflammatory diseases (CID) are associated with elevated risks for cardiovascular diseases (CVDs). However, the relative magnitude of elevated CVD risk may differ considerably between chronic inflammatory diseases.

Hypothesis:
We hypothesized that not all CIDs are associated with elevated risk for diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD), and that magnitudes of increased CVD risk differ considerably across CIDs.

Methods:
We estimated the incidence of DM and ASCVD in 18,373 patients with any of six CIDs [human immunodeficiency virus infection (HIV), Irritable bowel disease (IBD), psoriasis, rheumatoid arthritis (RA), scleroderma, and systemic lupus erythematosus (SLE)] in regular outpatient care, as well as controls without CIDs in regular primary care, in a large metropolitan health system since January 1
st
, 2000. We assessed incidence of outcomes in patients with each CID compared to controls using quasi-Poisson regression adjusting for age, sex, insurance status, and common CVD risk factors. A 90-day blanking period was applied for identifying incident cases.

Results:
Psoriasis, HIV, male sex, black race, Hispanic ethnicity, and being on public insurance were all associated with significantly elevated risks for DM (Figure). HIV, RA, scleroderma, SLE, male sex, and public insurance were all associated with significantly elevated risks for ASCVD. The magnitude of increased risk for ASCVD was similarly high for HIV (incidence rate ratio 1.79, 95% confidence interval 1.57-2.05), scleroderma (1.79, 1.42-2.27), and SLE (1.95, 1.59-2.39).

Conclusion:
Several, but not all, CIDs are associated with elevated risks for DM and ASCVD, but the magnitude of risk elevation differs depending on the CID. These data demonstrate the importance of nuanced approaches to understanding CID- and inflammation-associated CVD risks.
Abstract P338: Cardiovascular And Cerebrovascular Events Associated With Cancer Surgery In The United States
Authors: Saxena Anshul , Rubens Muni , Ramamoorthy Venkataraghavan , Das Sankalp , Bhatt Chintan B , Salami Joseph A , McGranaghan Peter , Shehadeh Nancy , Veledar Emir
Published: March 2020

Background:
Major adverse cardiovascular and cerebrovascular events (MACCE) are significant causes of perioperative morbidity and mortality but, the incidence and effects following cancer surgeries are unknown. The aims of this study were to evaluate national trends in MACCE after major cancer surgeries and to identify cancer types associated with cardiovascular events using a large national database.

Methods:
Patients who had major cancer surgeries from 2005 to 2014 were identified from the National Inpatient Sample database. Hospitalizations for surgeries for cancer of prostate, bladder, esophagus, pancreas, lung, liver, breast, colon and rectum were identified by
ICD9
diagnosis and procedure codes. The main outcome was perioperative MACCE, defined as in-hospital, all-cause death, acute myocardial infarction (AMI), or acute ischemic stroke, and was evaluated over time.

Results:
Among 2,854,810 hospitalizations for major cancer surgeries, perioperative MACCE occurred in 67,316 hospitalizations (2.4%). Mean (SE) age of patients was 65.4 (0.07) years and 54.2% were male patients. MACCE occurred most frequently in patients undergoing surgeries for lung (6.8%), pancreatic (4.5%), and colorectal (3.3%) cancers. Between 2005 and 2014, the frequency of MACCE declined from 2.7% to 2.2% (
P
<0.001) and was driven by a decline in the frequency of perioperative death (
P
<0.001) and AMI (
P
= 0.002). However, no significant changes were observed for acute ischemic stroke (
P
= 0.6) during the study period.

Conclusion:
Perioperative MACCE occurs in 1 out of every 42 hospitalizations for major cancer surgeries. Despite reductions in the rate of death and AMI among patients undergoing major cardiac surgeries, perioperative ischemic stroke remained constant over time. The lack of improvements in perioperative ischemic stroke rate is concerning and requires additional interventions. Significant efforts should be directed towards improving cardiovascular care during the perioperative period of cancer surgeries.
Abstract P356: Modeling the Impact of Flexibility in Fat Levels of Dairy Foods Consumed to Meet Recommendations From the 2015 Dietary Guidelines for Americans Healthy U.S.-style Eating Pattern
Authors: Hess Julie M , Cifelli Christopher J , Nicholls Jill , Fulgoni Victor
Published: March 2020

Introduction:
The 2015 Dietary Guidelines for Americans (DGA) recommends consuming low-fat or fat-free dairy foods due to concerns about excess intake of energy, which can lead to overweight or obesity, and saturated fat, a type of fat that can increase blood levels of low-density lipoprotein cholesterol, a blood biomarker used to predict cardiovascular disease risk. The 2015 DGA recommends limiting intake of saturated fats to less than 10% of calories per day and balancing energy intake.

Hypothesis:
The objective of this study was to assess the impact of replacing one serving of fat-free dairy foods provided in current models of the 2000-calorie Healthy U.S.-Style Eating Pattern (HUSEP) with one serving of whole- or reduced-fat dairy foods. We hypothesized that this replacement would still result in an eating pattern within calorie, saturated fat, and sodium limits.

Methods:
Utilizing the same food pattern modeling procedures used for the 2015 DGA, we assessed the energy and nutrient composition of six alternative models of the 2000-calorie HUSEP. In each pattern, we replaced 1 of the 3 servings of the USDA’s fat-free dairy food composite with whole- or reduced-fat dairy products or whole-/reduced-fat dairy composites. The 6 replacement models included replacements with: 1) a whole-fat dairy food composite, 2) a reduced-fat dairy food composite, 3) whole milk, 4) reduced-fat milk, 5) whole-fat cheese, and 6) reduced-fat cheese.

Results:
In all 6 models, the amount of saturated fat did not exceed 10% of total calories. In models 2, 3, and 4, saturated fat was 9% of total calories. The amount of energy increased slightly in all models. The original HUSEP provided 2003 calories, and the 6 models in this study provided an additional 45 (Model 4) to 94 (Model 5) additional calories. The amount of sodium also increased. The original HUSEP provides 1787 mg of sodium, and these models provided between 2082 and 2683 mg of sodium. While still lower than the current average sodium intake (3,440 mg/d), the amount of sodium in Models 1, 2, 5, and 6 exceeds 2,300 mg/d, the Chronic Disease Risk Reduction Intake level for sodium.

Conclusions:
Results of this study indicate that some reduced- and whole-fat dairy foods, especially milk, can fit into calorie-balanced healthy eating patterns that also align with saturated fat and sodium recommendations. Allowing some flexibility in fat level of dairy food servings aligns with the 2010 DGA recommendation that calories from solid fats and added sugars are best used to increase the palatability of nutrient-dense foods, which includes milk, cheese, and yogurt.