bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P075: Five Dietary Patterns Emerge in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Authors: Letter Abraham J , Judd Suzanne E , Shikany James M , Roth David L , Newby P. K
Published: July 2021

Introduction:
Examining diet as a whole using dietary patterns methods rather than focusing on single food group or nutrient exposures may be more informative when studying associations of diet and disease. Several large cohorts have used factor analysis to empirically derive dietary patterns but few have employed a cohort as geographically and racially diverse as the REGARDS study.

Methods:
The REGARDS study is a cohort of 30,239 Black and White adults age 45 and older, half of whom reside in the Southeastern US (also known as the stroke belt); the remainder reside elsewhere in the continental US. The present analysis included 21,636 participants who completed the Block 98 food frequency questionnaire at baseline. Principal Component Analysis (PCA) with varimax rotation was used on a split sample to determine dietary patterns based on 56 food groups. Race, sex, and region-specific solutions were evaluated for congruence alongside scree plots, eigenvalues, and interpretability. Confirmatory Factor Analysis (CFA) was utilized on the second half of the sample for validation of the PCA findings.

Results:
Sub-group analyses showed acceptable congruence and interpretability, thus we performed PCA on the entire sample in the final solution. Five dietary patterns emerged: the “traditional” pattern was characterized by mixed dishes; the “healthy” pattern by fruits and vegetables; the “sweets” pattern by sweet snacks and desserts; the “Southern” pattern by fried food, organ meat, and sweetened beverages; and the “alcohol” pattern by beer, wine, liquor, and salads. There were marked differences in factor score means across demographic and socioeconomic groups. For example, Blacks were much more likely than Whites to have a Southern diet.

Discussion:
Clear and meaningful dietary patterns emerged in this large cohort of Black and White Americans. Variability in dietary intake across demographic factors emphasizes the need to explore how these factors contribute to differential susceptibility to stroke and other chronic diseases.
Abstract P094: Weekly Variation of Circadian Peaks for the Onset of Acute Myocardial Infarction in the Working Population
Authors: Sato Hiroshi , Edahiro Ryuya , Nakatani Daisaku , Suna Shinichiro , Usami Masaya , Matsumoto Sen , Hara Masahiko , Sakata Yasuhiko , Hamasaki Toshimitsu , Hori Masatsugu , Komuro Issei
Published: July 2021

Variations in the incidence of acute myocardial infarction (AMI) during the day and week may differ among the subpopulations within the communities. It is well known that AMI onset shows characteristic circadian variations involving a definite morning peak and a vague nighttime peak: the former is often explained by biologic rhythms, while the latter by socioeconomic factors. Interestingly, we previously found that female patients aged 65 years or more showed a morning peak alone, whereas and male patients aged less than 65 years with an occupation and the habits of cigarette smoking and alcohol intake showed a nighttime peak alone. On the other hand, it is also reported that working population shows a weekly variation with an increased incidence for the AMI onset on Mondays. Accordingly, circadian variation for the onset of AMI could be influenced by each or combination of working status, gender, and the day of the week. However, there are few reports investigating circadian variation of AMI onset in relation with working status, gender and/or weekly variation. Therefore, we sought to investigate circadian variation patterns of AMI onset in relation with week variation according to gender and/or working status, especially in the working populations. From the registry database of the Osaka Acute Coronary Insufficiency Study (OACIS), a prospective observational study of AMI in Osaka area, Japan, a total of 7755 consecutive patients whose time of AMI onset was definitely identified between 1998 and 2009 were enrolled. The mean age of study population was 66+12 years old, 5872 (76%) were male, and 3364 (48%) had occupation. As previously reported, an increased incidence of AMI onset was observed in the morning and at the nighttime in overall populations. Interestingly, however, subgroup analysis revealed that the nighttime peak was completely attributable to the increase of nighttime onset on the weekend in the working subjects, especially working men, whereas the morning peak was common throughout the week with a peak on Monday in all other subgroups. As the weekend nighttime peak for AMI onset was not evident in other subgroups, this phenomenon may account for the social and/or economic reasons on the weekend in the working population. Although confirmation in other cohorts is required, this finding may help identify triggers of AMI and guide subjects to prevent an onset of AMI.
Abstract P095: Assessing Improvement Of eGFR Risk Classification In Meta-analysis: An Example of CKD-EPI and MDRD Study Equations On Cardiovascluar Mortality (for The CKD-PC Collaborators)
Authors: Matsushita Kunihiro , Sang Yingying , Woodward Mark , Mahmoodi Bakthtawar K , Astor Brad C , Levey Andrew S , Coresh Josef
Published: July 2021

Purpose:
Risk prediction models are assessed by calibration, discrimination, and reclassification. Net reclassification improvement (NRI) is a popular reclassification statistic in clinical epidemiology. However, methods to assess NRIs in a meta-analysis are not well described. Using an example of the CKD-EPI and the MDRD Study equations, we demonstrate a method to meta-analyze NRIs for eGFR category based on different equations.

Methods:
In a sample of 29 of 46 cohorts joining the CKD Prognosis Consortium (CKD-PC), NRI was calculated for reclassification across the following six eGFR categories (≥90, 60–89, 45–59, 30–44, 15–29, <15 ml/min/1.73m
2
) for CKD-EPI vs. MDRD Study equations. Standard errors of NRIs were calculated in analogy to McNemar’s test for paired proportions as √{(proportion of reclassification to high risk [low eGFR] category in those who developed events + proportion of reclassification to low risk [high eGFR] category in those who developed)/(# of events) + (reclassification to low risk category in those who did not develop events + reclassification to high risk category in those who did not develop)/(# of no events)}. NRIs were meta-analyzed in a random effects model applying the
metan
command in STATA.

Results:
There were a total of 830,132 participants and 22,647 deaths due to cardiovascular disease (coronary heart disease, stroke, or heart failure). NRIs for cardiovascular mortality based on eGFR category varied from −0.07 to 0.27 (p-values from <0.001 to 0.921; 22 of 29 studies with p<0.05) among cohorts. Standard errors also varied from 0.005 to 0.049. Meta-analyzed NRI was 0.09 (95% CI: 0.07–0.12, p<0.001), suggesting that the CKD-EPI equation classifies individuals more correctly than the MDRD Study equation. The I-squared was 96.0% (p<0.001), suggesting high heterogeneity across studies.

Conclusion:
We demonstrated how to meta-analyze NRIs, which estimate the clinical risk implication of new eGFR equations on cardiovascular disease, a leading cause of death among individuals with CKD.
Abstract P098: Slower Gait Speed is Associated with Increased Mortality Risk in Chronic Kidney Disease.
Authors: Roshanravan Baback , Robinson-Cohen Cassiane , Patel Kushang V , Levin Greg , de Boer Ian H , Himmelfarb Jonathan , Kestenbaum Bryan
Published: July 2021

Objective:
Skeletal muscle dysfunction (sarcopenia) is an under-recognized complication of chronic kidney disease (CKD) that may have important clinical consequences. Gait speed is associated with sarcopenia and comorbid disease burden among older adults; however, little is known about the prognostic significance of gait speed in CKD. We determined the association of gait speed with all-cause mortality in a prospective cohort of non-dialysis CKD patients.

Methods:
We measured usual gait speed over 4-meters in 309 participants from a prospective study of non-dialysis CKD. Included subjects had an estimated glomerular filtration rate (eGFR
ckdepi
) <90mL/min/1.73m
2
, were stroke-free and did not require a wheelchair for ambulation. Study coordinators assessed mortality during follow-up by phone contacts, medical record review, and the social security death index. We evaluated gait speed continuously, and using a cut point of 0.8 m/s, consistent with previous studies. We used Cox's proportional hazards to estimate the association of gait speed with mortality after adjustment for age, sex, race, smoking, diabetes, pre-existing CAD, BMI, eGFR and hemoglobin.

Results:
Median follow-up time was 2.7 years; range 27 days to 4.8 years. The mean age was 58.9 ± 13 years and mean eGFR by cystatin C (eGFR
cysc
) was 48.5 ± 23mL/min/1.73m
2
. There were a total of 31 deaths (10.4%) during follow-up. Unadjusted mortality rates were 23 and 80 deaths per 1,000 person-years among participants who had a gait speed of >0.8m/s
versus
≤0.8m/s, respectively. After full adjustment, gait speed ≤0.8m/s was associated with a 2.8-fold greater risk of death compared to a gait speed >0.8 m/s. Gait speed was also strongly associated with mortality when analyzed as a continuous variable (
Table
) and a stronger predictor of death than age, history of CAD, or diabetes.

No. Deaths (%)

Model 1
+

Model 2
#

Hazard Ratio
95% CI
Hazard Ratio
95% CI

Gait speed
*

32(10)
0.74
(0.64-0.86)
0.75
(0.64-0.87)

>0.8m/s
13 (6)
Reference

Reference

≤0.8m/s
19(19)
3.49
(1.54-7.95)
2.84
(1.25-6.48)

*

Gait speed analyzed continuously per 10cm/s increase in speed. +Model 1: Adjusted for age, sex, race, study site #Model 2: adds smoking, BMI, eGFR
cysc
, diabetes, prevalent coronary disease.

Conclusion:
Gait speed is strongly associated with death in a cohort of middle-aged CKD patients.
Abstract P114: Interaction of Dietary n-3 Fatty Acids on Cardiac Risk by J-point Elevation in Japanese Men: NIPPON DATA80
Authors: Hisamatsu Takashi , Miura Katsuyuki , Ohkubo Takayoshi , Miyagawa Naoko , Fujiyoshi Akira , Takashima Naoyuki , Kadota Aya , Okuda Nagako , Murakami Yoshitaka , Horie Minoru , Okamura Tomonori , Okayama Akira , Ueshima Hirotsugu
Published: July 2021

Background:
Early repolarization, characterized by an elevation of QRS-ST junction (J-point) on a 12-lead electrocardiography, has recently been considered an independent predictor of cardiac or sudden death. Meanwhile, protective effects of n-3 fatty acids (FAs) on cardiovascular diseases have been demonstrated in epidemiologic studies and clinical trials. Therefore, we assessed the hypothesis that an increased dietary intake of n-3 FAs may reduce poor prognosis of J-point elevation (JpE).

Methods:
A total of 4443 community-dwelling men (mean age of 49.5 years) without previous cardiovascular diseases from randomly selected areas across Japan were included for the analysis. The primary endpoint was cardiac death during a mean follow-up of 20.4±6.1 years. JpE was defined as an elevation of J-point at least one lead: ≥0.2mV in V
1-4
leads or ≥0.1mV in other leads. Dietary intakes of n-3 FAs were calculated by a combined method using household-based food-weighing records and an approximation of the proportions of each dish or food shared in the household. The hazard ratios (HRs) (95% confidence interval [95%CI]) of JpE for cardiac death were estimated by Cox proportional hazard models adjusted for age, sex, body mass index, systolic blood pressure, total cholesterol, diabetes mellitus, smoking status, drinking habits, medication status, cohort, heart rate, dietary sodium, dietary fiber, dietary saturated fatty acids, high R wave on electrocardiography (based on Minnesota Codes 3.1 and 3.3), and suspected coronary heart disease on electrocardiography (based on Minnesota Codes 1.1 to 1.3, 5.1 to 5.2, 4.1 to 4.3, 7.1, and 7.4).

Results:
JpE were present in 153 of 2176 (7.0%) and 187 of 2267 (8.2%) individuals in low (<the median n-3 FAs level of 1.06%kcal) and high (≥1.06%kcal) n-3 FAs groups, respectively. During follow-up period, the number of deaths from cardiac causes in low and high n-3 FAs groups were 128 (5.9%) and 85 (3.7%), respectively. In the low n-3 FAs group, individuals with JpE had a significantly higher HR of cardiac death than those without JpE (2.77; 95%CI, 1.60-4.82; P=0.001). In contrast, in the high n-3 FAs group, a HR was not significantly increased (0.85; 95%CI, 0.37-1.97; P=0.711) (P for n-3 FAs-JpE interaction = 0.032).

Conclusions:
An increased risk of cardiac death related to JpE was attenuated in individuals with higher dietary intake of n-3 FAs, suggesting that a higher n-3 FAs intake may prevent long-term cardiac risk associated with JpE
Abstract P116: African Americans Have the Highest Risk of Stroke-Events and In-Hospital Mortality With Atrial Fibrillation Related Hospitalizations Among All Racial/Ethnic Groups: A Nationwide Analysis
Authors: Turagam Mohit , Velagapudi Poonam , Visotcky Alexis , Szabo Aniko , Kocheril Abraham
Published: July 2021

Introduction:
There continues to be an increase nationwide in hospitalizations for atrial fibrillation (AF). However the impact of age, race and gender on in-patient mortality and stroke events for AF hospitalizations is unknown.

Methods:
This is a cross-sectional study utilizing data from the 2008 Nationwide Inpatient Sample (NIS). NIS is the largest, all-payer, hospitalization database in USA. We identified all AF-related hospitalizations through the presence of the appropriate ICD-9-CM codes. We calculated the adjusted odds of in-hospital mortality and stroke events with respect to age, gender and race in AF patients using multivariate logistic regression. All analyses were adjusted for the survey design.

Results:
There were an estimated to 425,470 AF-related hospitalizations in 2008 with 4,041(0.95%) in-hospital deaths and 3,531(0.83%) stroke-related events associated with such hospitalizations, respectively.
Table 1
shows the results related to in-hospital mortality and stroke events, adjusted for other comorbidities such as history of diabetes, hypertension, coronary artery disease, myocardial infarction, congestive heart failure and dyslipidemia.

Conclusion:
African Americans have the highest risk of stroke-events and in-hospital mortality with AF related hospitalizations among all racial/ethnic groups. Increasing age is associated with a large increase in the risk of in-hospital mortality, and a smaller increase in stroke events. Gender was not found to be an independent risk factor for either stroke events or in-hospital mortality for AF. Further research is needed to better characterize the natural history and treatment outcomes in this cohort.

Table 1

Odds ratio and confidence limits for in-hospital mortality and stroke events adjusted for co-morbidities.

Predictor
Comparison
In-hospital mortality
In-hospital stroke events

Point Estimate
95% Wald Confidence Limits
p-value
Point Estimate
95% Wald Confidence Limits
p-value

Sex
Female vs Male
1.019
0.864 - 1.201
0.82
1.076
0.903 - 1.282
0.41

Race / Ethnicity
Black vs White
2.123
1.625 - 2.774
0.0007
2.030
0.731 - 1.450
0.004

Hispanic vs White
1.495
1.068 - 2.093
0.28
1.479
1.061 - 2.062
0.26

Asian or Pacific Islander vs White
1.364
0.752 - 2.477
0.70
0.976
0.481 - 1.982
0.79

Native American vs White
0.732
0.227 - 2.358
0.30
0.260
0.037 - 1.856
0.14

Other vs White
1.083
0.659 - 1.779
0.60
1.282
0.807 - 2.036
0.17

Age
62 - 72 vs ≤ 61
2.454
1.723 - 3.496
0.028
1.277
0.995 - 1.640
0.75

73 - 80 vs ≤ 61
3.997
2.847 - 5.612
0.0001
1.287
0.990 - 1.674
0.69

> 80 vs ≤ 61
7.900
5.721 - 10.910
<.0001
1.476
1.147 - 1.901
0.018
Abstract P119: Erythrocyte n-3 and n-6 Polyunsaturated and Trans Fatty Acids and Survival of Sudden Cardiac Arrest
Authors: Lemaitre Rozenn N , King Irena B , Johnson Catherine O , Sotoodehnia Nona , McKnight Barbara , Rice Kenneth , Siscovick David S , Rea Thomas D
Published: July 2021

Lower levels of erythrocyte n-3 polyunsaturated fatty acid (PUFA) and higher levels of trans-fatty acid are associated with incident cardiac arrest (SCA) risk. However, it is not known whether these fatty acids also influence post-arrest survival. In addition, n-3 and n-6 PUFA play key roles in brain function and may be involved in brain resuscitation. We investigated the association of n-3, n-6 and trans-fatty acid levels with resuscitation outcomes in a population-based study of SCA. Subjects (mean age 68, 82% male) were out-of-hospital SCA patients found in ventricular fibrillation and attended by paramedics in King County, Washington, with available fatty acid measurements (n=492). Using logistic regression, we examined association between fatty acid levels and surviving to hospital admission (a proxy for heart resuscitation), and also to surviving to hospital discharge (a proxy for brain resuscitation). Both analyses adjusted for age; sex; race; year of cardiac arrest; time to arrival of emergency medical services; whether the event was witnessed, occurred in public, and whether bystander CPR was administered. Levels of arachidonic acid and trans-18:2 fatty acids were associated with SCA survival (
Table
). An increase of one SD in levels of arachidonic acid was associated with decreased likelihood of survival to both hospital admission and hospital discharge (OR (95% CI), uncorrected p-value: 0.75 (0.62-0.92),
p
=0.006 and 0.69 (0.55, 0.87),
p
=0.002, respectively). A one SD difference in trans-18:2 fatty acid levels was associated with decreased likelihood of survival to hospital discharge (0.74 (0.57-0.96),
p
=0.02)). Levels of n-3 PUFAs and trans-18:1 fatty acids were not associated with SCA survival. Our findings suggest arachidonic acid and trans-18:2 may influence SCA survival. Further work is needed to explore the role of fatty acid metabolism in heart and brain resuscitation.

Association of Erythrocyte Fatty Acids with Resuscitation Outcomes

Survival to hospital admission
Survival to hospital discharge

OR
*
(95% CI)

p-value

OR
*
(95% CI)

p-value

n-3 fatty acids
α-Linolenic acid
1.01 (0.83-1.22)
0.95
0.85 (0.67-1.07)
0.60

EPA+DHA
1.05 (0.87-1.28)
0.60
1.10 (0.87-1.38)
0.44

n-6 fatty acids
Linoleic acid
0.97 (0.80-1.18)
0.77
1.05 (0.83-1.33)
0.66

Arachidonic acid
0.75 (0.62-0.92)
0.006
0.69 (0.55-0.87)
0.002

Trans-fatty acids
Trans-18:1
1.06 (0.87-1.29)
0.56
1.06 (0.84-1.34)
0.47

Trans-18:2
0.99 (0.80-1.22)
0.93
0.74 (0.57-0.96)
0.02

*

OR corresponding to one SD higher levels
Abstract P124: Provider Recommendations and Patient Intentions and Confidence to Make Lifestyle Changes Following Acute Coronary Syndromes: Preliminary Data from TRACE-CORE
Authors: Waring Molly E , Saczynski Jane S , Parish David C , Kiefe Catarina I
Published: July 2021

Background:
Lifestyle changes are associated with prognosis following acute coronary syndromes (ACS). Less is known about patients’ intentions or confidence in their ability to make changes.

Purpose:
To examine patient report of provider lifestyle recommendations post-ACS and their intentions and confidence to make changes.

Methods:
Adults in central MA or GA were interviewed during hospitalization for ACS and at 1 month (1M) as part of the NHLBI-funded Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE). At 1M (n=253 to date), patients reported recommendations by clinicians during hospitalization or follow-up visit, intentions (no plans, thinking about, or started to make changes), and confidence (not at all/somewhat, moderately, or very/completely confident). X
2
or Fisher’s exact tests provided p-values.

Results:
Participants were 65% male, 82% non-Hispanic white and 9% African-American, and aged 61.3±11.0 years. Patient report of provider recommendations ranged from 20% to 83% (Figure). Alcohol reduction was recommended to 13% of occasional, 23% of moderate, and 41% of heavier drinkers (p<0.01). Obese patients were more likely to report weight loss advice (58% versus 14% of overweight patients; p<0.01). Stress management advice was more likely among patients with higher perceived stress (18%, 29%, and 59% across tertiles; p<0.01). Dietary and activity recommendations did not differ by baseline behavior (p=0.13 and p=0.56, respectively). Among patients reporting recommendations, most had started to make changes (range: 54% to 96%; Figure) and intentions were positively associated with confidence for some (diet p<0.01; activity p<0.01; stress p=0.01; cardiac rehab p<0.01) but not all lifestyle changes (alcohol p=1.0; smoking p=0.10; weight p=0.11).

Conclusions:
Our findings may reflect less-than-ideal counseling rates or poor patient recall. Low confidence to make lifestyle changes may be an important target for intervention post-ACS.
Abstract P126: Availability of Fast-food Outlets is Associated with Intake of Fast-food
Authors: Glümer Charlotte , Erbs-Maibing Peter , Toft Ulla
Published: July 2021

Introduction:
Intake of fast-food is associated with an increased risk of health outcomes. The prevalence of obesity and chronic diseases is higher among deprived individuals; studies have shown that the availability of fast-food outlets (FFO) are higher in deprived neighbourhoods than in non-deprived neighbourhoods. Some studies find an association between the availability of FFO and unhealthy diet. Most of studies are performed in US or Australia with different context to Denmark. We hypothesize that a high degree of availability of fast-food is associated with high intake of fast-food in a Danish population. The aim is to examine the association between availability of FFO and frequency of fast-food intake.

Methods:
Health survey data from the Capital Region of Denmark used in the analyses included a random sample of 95.150 inhabitants aged 16+ from 29 municipalities. Response rate:52,3%. Information’s on fast-food intake and socioeconomic factors is derived from a questionnaire survey (How are you 2010?). Information on FFO is collected through central a register using a validated name recognition method (sensitivity: 82%). Using network analyses in Geographic Information System proximity (Road network distance to the nearest FFO) and density (numbers of FFO within 1 km) of FFO are calculated for each participant. Multilevel regression analyses taking neighbourhood, individual social factors, age and sex into account are performed.

Results:
17 % of the population eats fast-food at least once a week, the proportion varies between 10.1% in the rural areas to 27.2 % in the inner-city of Copenhagen. Individuals living in high density areas or with low proximity have a significantly higher risk of eating fast-food once weekly; Compared to individuals living with 0-4 FFO within 1 km the OR’s were 1.4 (95% CI: 1.3-1.6) and 1.8 (95 % CI: 1.7-2.0) for individuals living with 5-9 or ≥ 10 FFO, respectively. After adjustment for individual and contextual factors the OR’s diminished to 1.13, but remained significant. The same picture was seen for proximity, the greater distance to the nearest FFO the lower risk of eating fats-food.

Conclusions:
This paper shows that availability of fast-food outlets is associated with frequency of eating fast-food weekly. In order to prevent the epidemic of obesity and development of chronic diseases, this may have an impact on future urban planning of fast-food outlets.
Abstract P128: The Association between Stressful Life Experiences and Hyperuricemia in Korean Adults
Authors: Lee Ju-Mi , Kim Hyeon Chang , Cho Hye Min , Oh Sun Min , Choi Dong Phil , Lee Won Joon , Cho Jaelim , Suh Il
Published: July 2021

Background:
Stressful life events (SLEs) may influence disease intensity and duration. However, the direct association between SLEs and disease manifestations are still controversial and not fully understood. Thus, we evaluated the quantitative associations between number of SLEs and hyperuricemia in a community-based cohort study in South Korea.

Hypothesis:
Prevalence of hyperuricemia in people with the more SLEs is higher than that in people with less SLEs.

Methods:
We performed cross-sectional analysis of baseline data of 1758 men and 2826 women (aged 27-87) in the Korean Genome and Epidemiology Study- Kangwha study (2006 to 2010). Life Experience Survey questionnaire was used to measure SLEs during the last 3 months. People who experienced at least five SLEs during the last 3 months were classified as frequent SLE group (N=413, 9.0 %). Blood samples were collected after at least 8-hour fast. Hyperuircemia is defined as serum uric acid level ≥ 6.0 mg/dL in men, and ≥ 7.0 mg/dL in women. Multiple logistic regression was used to assess independent association between SLEs and hyperuricemia.

Results:
Frequent SLE group had a significantly higher prevalence of hyperuricemia than those who were not (10.9 % versus 5.4 %) : odds ratio (95% CI) was 2.32 (1.59-3.38) when adjusted for age, sex, body weight, blood pressure, pulse rate, serum total billirubin, leukocyte count, smoking status, alcohol consumption, and physical activity. The association was similar in men (OR 2.17, 95% CI 1.45-3.25) and women (OR 3.80, 95%CI 1.38-10.43).

Conclusion:
These findings suggest that recently experienced SLEs are positively associated with hyperuricemia.
Abstract P130: Weight Maintenance after a Worksite Nutrition and Exercise Program: A Randomized Controlled Trial
Authors: Thorndike Anne N , Sonnenberg Lillian , Healey Erica , Myint-U Khinlei , Kvedar Joseph C , Regan Susan
Published: July 2021

Background:
To address rising healthcare costs associated with obesity, many employers are providing programs to help employees lose weight and make lifestyle changes. Improving health outcomes and reducing costs will depend on whether employees sustain these changes, but few studies have evaluated worksite interventions to maintain a reduction in weight and cardiovascular risk factors over time.

Methods:
At a large hospital in Boston, MA, we conducted a randomized controlled trial to determine if a 9-month maintenance program immediately following a 10-week team-based worksite exercise and nutrition program would improve weight and cardiovascular risk factor outcomes at 1 year. In 2008, 330 employees from 24 teams completed a 10-week program and were randomized by team to the maintenance intervention or control (usual care) for 9 months. The maintenance intervention included both 1) Internet support with a website for individualized goal-setting and self-monitoring of weight and exercise and 2) minimal personal support with optional individual nutrition and exercise training sessions. Main outcome measures were weight loss, percentage weight loss, waist circumference, fasting lipids, and blood pressure at 1 year. For participants who did not follow up, we used a baseline observation carried forward method for 1 year outcomes. We used random-effects regression models adjusted for clustering within team, and the intervention effect was modeled as the interaction of study arm and time.

Results:
At 1 year, 238 subjects (72%) completed follow-up assessments. Mean baseline BMI was 27.6 and did not differ between intervention and control. Compared to baseline, both groups lost weight during the 10-week program and maintained 65% of weight loss at 1 year (p<.001). There was no difference in weight loss between intervention and control groups at end of the 10-week program (4.8 lbs vs. 4.3 lbs, p=.53 for group x time interaction) or end of maintenance at 1 year (3.4 lbs vs. 2.5 lbs., p=.40 for group x time interaction). All subjects had significant reductions in percentage weight loss, waist circumference, total cholesterol, and LDL cholesterol at 1 year but did not differ by group.

Conclusions:
A 10-week worksite nutrition and exercise program resulted in significant reductions in weight and cardiovascular risk factors at 1 year, and participation in an Internet-based maintenance program did not improve these outcomes. Worksite programs to maintain weight loss and lifestyle changes may require more resource-intensive behavioral counseling or incentives to engage participation and improve long-term effectiveness.
Abstract P132: Effectiveness of a Worksite Wellness Program on Dietary Intake, Adiposity, Exercise Performance, Insulin Sensitivity, and Lipids in Overweight Women
Authors: Carnie Andrea V , Lin Jonathan , Courville Amber B , Dellavalle Diane , Zalos Gloria , Cannon Richard O
Published: July 2021

Introduction
The prevalence of obesity is increasing, especially among black women. Wellness programs have been proposed to prevent obesity-associated disease. Success of worksite programs in achieving weight loss and improving obesity-associated metabolic complications for women is widely variable.

Hypothesis
A program emphasizing reduced fat and energy intake in addition to exercise at the worksite can improve health measures in overweight female NIH employees, especially when provided with regular nutritional counseling.

Methods
One hundred overweight (BMI 25 to 57 kg/m2) women (59% black) were provided web-based nutritional information, then randomized to regular meetings and weigh-ins with a dietitian (intervention) or control; all were instructed to increase pedometer counts by 5000 over baseline and given access to a private fitness room. Three day food records, body composition (DXA), lipids, glucose, insulin, and treadmill exercise capacity were measured at baseline and 6 month visits.

Results
At 6 months, subjects reported decreased daily energy intake (-21%), total fat intake (-24%), and percent calories from fat (-6%), all p< 0.001. Significant reduction in weight, fat mass, and percent truncal fat was determined for all subjects, in addition to improvement in functional exercise capacity (Table). Subjects improved insulin sensitivity (HOMA), and showed reduction in cholesterol and triglyceride levels (Table). There were no significant differences between interventions vs. controls in outcome measures. Intervention subjects who attended > 80% of nutrition classes (n= 17) tended to lose more weight (-3.8 ± 4.4 vs. -1.3 ± 3.0 kg, p=0.06) and fat mass (-2.7 ± 3.9 vs. -1 ± 2.8 kg, p= 0.07), than women who attended less regularly (n=38).

Conclusion
Overweight female employees provided with web-based nutritional information and worksite exercise resources significantly improved health measures. Consistent attendance at nutrition counseling sessions may facilitate achievement of weight and fat loss.
Abstract P137: Aerobic, Resistance or Combination Exercise Training does not Reduce C-Reactive Protein Levels in Individuals with Type 2 Diabetes
Authors: Swift Damon L , Johannsen Neil M , Earnest Conrad P , Blair Steven N , Church Timothy S
Published: July 2021

Introduction:
Type 2 diabetes is associated with elevated C-reactive protein levels (CRP), which is an independent risk factor for cardiovascular disease. Aerobic exercise training especially with weight/adiposity reduction has been shown to improve CRP, however few studies have evaluated the effect of other exercise training modalities (aerobic, resistance or combination training) on CRP in individuals with type 2 diabetes.

Hypothesis:
We hypothesize that combination training will improve CRP to a greater extent than other modalities of exercise training, and change in CRP levels will be associated with changes in weight and adiposity.

Methods:
The present study is a secondary analysis of the Health Benefits of Aerobic and Resistance Training in Individuals with Type 2 Diabetes (HART-D) study. Participants (n=204) were randomized to aerobic exercise (aerobic), resistance exercise (resistance) or a combination of both (combination) for nine months.

Results:
Baseline CRP was correlated with fat mass, waist circumference, BMI, and inversely correlated with VO2 peak (p<0.05). CRP was not reduced in the aerobic (0.16 mg•L-1, 95% CI: -1.0, 1.3), resistance (-0.03 mg•L-1, 95% CI: -1.1, 1.0) or combination (-0.49 mg•L-1, 95% CI: -1.5 to 0.6) groups compared to control (0.35 mg•L-1, 95% CI: -1.0, 1.7). Change in CRP was associated with change in fasting glucose (r=0.20, p= 0.009), glycated hemoglobin (HbA1C) (r=0.21 p=0.005), and fat mass (r=0.19, p=0.016), but not change in fitness or weight (p > 0.05).

Conclusions:
In conclusion, aerobic, resistance or a combination of both did not reduce CRP levels in individuals with type 2 diabetes. However, exercise related improvements in HbA1C, fasting glucose, and fat mass were associated with reductions in CRP.
Abstract P160: Is Higher Educational Attainment or Higher Income Protective for Cardiovascular Risk in Deaf American Sign Language (ASL) Users?
Authors: McKee Michael M , McKee Kimberly C , Sutter Erika , Pearson Thomas
Published: July 2021

Background:
Deaf ASL users appear to be burdened with higher cardiovascular risk due to communication barriers in the health care setting and from lack of accessible health educational and outreach programs. It is well known among the general population that higher educational attainment and income are highly correlated and provide cardiovascular protection. It is unknown if the same effect is seen among Deaf ASL users. Objective We sought to examine whether educational attainment and/or annual household income are inversely associated with cardiovascular risk in a sample of Deaf ASL users.

Methods:
The Deaf Health Survey (DHS) is an adapted and translated Behavioral Risk Factor Surveillance System (BRFSS) into sign language. A sample of 339 Deaf adults from the Rochester, New York MSA participated in the 2008 DHS and is included in the analysis. We assessed education (≤high school [low education], some college, and 4 year college degree or higher [referent]) and annual household income (<$25,000 versus ≥$25,000 [referent]). We constructed an aggregate (i.e. self-report of any of the four cardiovascular disease (CVD) equivalents: diabetes, myocardial infarction (MI), cerebral vascular attack (CVA), and angina) and conducted χ² tests of association for education and income. After excluding for any missing data on key variables, we conducted multi-logistic regression adjusting for : age, sex, race/ethnicity, and smoking.

Results:
In the study sample, 17.6% had ≤ high school education while 36.1% earned <$25,000; income and education were poorly correlated (r= 0.355). Among this sample (mean age= 46.4, range= 18-88), the prevalence of outcomes was: diabetes (9.4%), MI (5.0%), CVA (0.9%), and angina (4.5%). Unadjusted, low education was significantly associated with reporting an aggregate outcome (χ² =15.6; p=0.0004) whereas income was not (χ² =0.79; p=0.37). Low education continued to be significantly associated with increased likelihood of reporting an aggregate outcome (OR 5.057; 95% CI 1.73-14.82) whereas income was not significantly associated with reporting an aggregate outcome (OR 0.91; 95% CI: 0.39-2.12) even after adjustment.

Conclusion:
This is the first known study documenting that low educational attainment is associated with higher likelihood of reported cardiovascular disease among Deaf individuals. Higher income did not appear to provide a cardiovascular protective effect, unlike in the general population. This may be partially explained by the poor correlation between educational attainment and income in the study sample. Effective and accessible health communication and education with Deaf individuals with lower educational attainment could be addressed by the use of language-concordant providers and interpreters and following principles of clear communication (e.g. teach-back) to address ongoing cardiovascular health disparities.
Abstract P178: Famine Exposure in the Young and the Risk of Type 2 Diabetes in Adulthood
Authors: van Abeelen Annet F , Elias Sjoerd G , Bossuyt Patrick M , Grobbee Diederick E , van der Schouw Yvonne T , Roseboom Tessa J , Uiterwaal Cuno S
Published: July 2021

Background The developmental origins hypothesis proposes that undernutrition during early development is associated with an increased risk of type 2 diabetes mellitus (T2DM) in adulthood. We investigated the association between moderate and severe undernutrition during childhood and young adulthood and the risk of T2DM in later life. Methods We studied 7,837 women from the Prospect-EPIC cohort who were exposed at various degrees to the short but severe 1944-1945 Dutch Famine when they were between 0 and 21 years. We used Cox proportional hazard regression models to explore the effect of famine exposure on the risk of subsequent T2DM in adult life. We adjusted for potential confounders, including age at famine exposure, smoking, and level of education as a proxy for socio-economic status. Findings Famine exposure during childhood and young adulthood was associated with an increased T2DM risk in a dose-dependent manner (p for trend <0·001). In those who were moderately famine exposed the T2DM hazard ratio (HR) was 1·36 (95% CI 1·09 to 1·69); in those severely famine exposed the HR was 1·64 (95% CI 1·26 to 2·13) relative to unexposed women. These effects did not materially change after adjustment for confounders (HR for moderate: 1·33, 95% CI 1·06 to 1·67; HR for severe: 1·51, 95% CI 1·16 to 1·98). Interpretation This study provides the first direct evidence, using individual famine exposure data, that a short period of moderate or severe undernutrition during postnatal development increases the risk of T2DM in adult life.
Abstract P189: Women with Gestational Diabetes Informed, but not Convinced of Power to Prevent CVD
Authors: Remsberg Karen E
Published: July 2021

Introduction:
Women with a history of gestational diabetes (hGDM) are more prone to develop overt type 2 diabetes and possibly CVD at a younger age than their peers with no history of GDM (non-hGDM). It is less clear how often these women are being screened and taking preventive action against developing these conditions.

Hypothesis:
We examined the hypothesis that women with hGDM are more knowledgeable than their non-hGDM controls regarding the risks that GDM poses for long-term development of type 2 diabetes and CVD.

Methods:
The Maternal Health Survey was piloted in a population sample (146 singleton live births; 73 hGDM and 73 non-hGDM) drawn from the 2008 Ohio birth records file (Vital Statistics, Ohio Department of Health). Health histories, health providers’ advice, and mothers’ health knowledge regarding screening and risks for diabetes and CVD were ascertained. To compare hGDM and non-hGDM, descriptive statistics, adjusted odds ratios, and chi-squared statistics were performed.

Results:
hGDM cases were more likely than controls to report a family history of gestational diabetes [OR= 1.60 (95% CI: 1.12, 2.90)], type 2 diabetes [OR= 1.71 (95% CI: 1.18, 2.49)], hypertension [OR= 2.00 (95% CI: 1.04, 3.87)], and polycystic ovary syndrome [OR= 2.28 (95% CI: 1.57, 3.29)]. hGDM cases were more likely to be encouraged to attend a postpartum visit [OR= 2.50 (95% CI: 1.05, 5.98)], told they were at risk for diabetes [OR= 56.20 (95% CI: 7.40, 426.57)] though not significantly more for CVD [OR= 2.60 (95% CI: 0.96, 7.34)], and how to avoid diabetes and CVD [OR=2.34 (95% CI: 1.40, 3.89)]. In addition, hGDM believed that they were more likely to develop diabetes than their peers (p = 0.002), equally likely to develop CVD (p = 0.211), and less able to change this situation (p = 0.036).

Discussion:
In conclusion, hGDM reported family histories that were positive for cardiometabolic diseases. Women with hGDM were better informed than the controls regarding their increased risk for diabetes, CVD, and their personal abilities to intervene, but not as confident in the value of prevention measures.
Abstract P193: Increased High Density Lipoprotein Cholesterol:ApolipoproteinA1 Ratio is Associated with Less Progression of Coronary Atherosclerosis in Statin-Treated Patients
Authors: Mani Preethi , Uno Kiyoko , Thornton Julie , Nicholls Stephen
Published: July 2021

Background
HDL cholesterol (HDL-C) and apolipoprotein AI (apoAI) levels are inversely related to adverse cardiovascular outcome. Associations between these HDL related measures and their ratio with coronary plaque progression have not been studied. It has been proposed that increasing HDL particle cholesterol content impairs HDL function, but impact on disease progression is unknown. We hypothesize that all HDL related measures are inversely associated with coronary plaque progression.

Methods
Retrospective analysis was performed of 1528 statin treated patients with angiographic CAD who had serial evaluation of atheroma burden with intravascular ultrasound. Relationships between achieved levels of HDL related measures with clinical characteristics and changes in plaque burden were determined.

Results
Strong correlation between HDL-C and apoAI (r=0.73, p<0.0001) was noted. Patients with highest levels of HDL-C:apoAI were more likely to be female, black, and have lower BMI and less likely to be smokers or have previous revascularization (all p<0.001) or acute coronary syndrome (p=0.013). HDL-C, apoAI, and HDL-C:apoAI demonstrated negative correlation with change in total atheroma volume (p<0.01). For HDL-C:apoAI and HDL-C, increasing tertiles of achieved levels were associated with a linear benefit in slowing progression. For apoAI, a nonlinear association was seen, with similar benefit on progression in the middle and upper tertiles (
Table
). There was no statistical interaction for heterogeneity between HDL-C:apoAI and atheroma burden based on achieved levels of HDL-C (p=0.581).

Change in IVUS Measures By Tertiles of Achieved HDL-related Parameters

Percent Atheroma Volume

Parameter
T1
T2
T3
P Value

HDL-C
0.58±0.27
0.26±0.27
0.11±0.27
0.012

ApoAI
0.28±0.26
−0.04±0.26
−0.08±0.26
0.10

HDL-C:ApoAI
0.22±0.27
0.13±0.27
−0.27±0.27
0.021

Total Atheroma Volume

Parameter
T1
T2
T3
P Value

HDL-C
−2.46±2.21
−4.18±2.20
−5.31±2.20
0.035

ApoAI
−4.94±2.13
−6.30±2.13
−7.40±2.13
0.135

HDL-C:ApoAI
−4.59±2.25
−6.38±2.24
−8.07±2.26
0.022

Conclusions
Increase in all HDL related measures was associated with less progression of coronary atherosclerosis. Association of higher HDL-C:ApoAI with favorable effect on plaque progression at all levels of HDL-C suggests intact HDL functionality of larger cholesterol rich particles. Interventions that increase HDL particle cholesterol content, such as CETP inhibitors, may thus have beneficial effect at the artery wall.
Abstract P208: Mortality Trends 1987 to 2004 in 404,480 Hospitalized Heart Failure Patients with and without Diabetes
Authors: Bjorck Lena M , Lanitis Michailis , Lappas George , Novak Masuma , Rosengren Annika
Published: July 2021

Introduction and Aim:
To investigate the influence of diabetes on trends in 3-year survival in patients hospitalized with heart failure (HF).

Method:
The Swedish Hospital Discharge and Cause of Death Registers were used to estimate age and gender-specific trends in 3-year case-fatality in 404,480 patients hospitalized with HF in 1987 to 2004, among whom 73,153 (18%) had diabetes.

Results:
3-year case-fatality was 28% higher among HF patients with diabetes compared to non-diabetics (age- and sex-adjusted HR 1.28, 95% CI 1.26-1.29). Overall, case-fatality among men with HF aged < 65 years decreased by more than half and among men aged 65 years and older by 30%, irrespective of the presence of diabetes. Women aged 65 and over with diabetes also displayed a decrease of 30%, whereas there was a leveling off in survival after the mid-90s among women without diabetes, such that the difference in survival between diabetic and non-diabetic women decreased.

Conclusions:
3-year mortality in patients with HF decreased more for younger, compared to older individuals and more for men than women. Coexistence of diabetes did not influence the trends in outcome adversely, with continuing improvement in prognosis also for heart failure patients with diabetes.
Abstract P213: Marital status and Risk of type 2 Diabetes in the Health Professionals Follow-up Study
Authors: Cornelis Marilyn C , Glymour Maria , Kawachi Ichiro , Chiuve Stephanie E , Chang Shun-Chiao , Koenen Karestan C , Liang Liming , Rimm Eric B , Tchetgen Tchetgen Eric J , Kubzansky Laura
Published: July 2021

Married individuals may enjoy better physical and mental health than their unmarried counterparts. Previous work has suggested that never entering marriage or marital termination by death or divorce increases risk of premature mortality and cardiovascular disease, with more pronounced effects among men. Few studies to date have investigated the role of marital status in the development of type 2 diabetes (T2D). We tested the hypothesis that men who are not married have increased risk of incident T2D in the Health Professionals Follow-up Study, an on-going cohort of men. A total of 41,379 men ages 40 to 75 without diabetes at baseline in 1986 were followed until 2008. T2D, marital status and covariates were assessed by questionnaires biennially. New cases of T2D were confirmed by a supplementary questionnaire validated by medical record review. Cox proportional hazards models estimated the effect of time-dependent measures of marital status on incident T2D. Potential confounders and components of the causal pathway were included as time-dependent covariates. During 22 years of follow-up (801,850 person-years), we documented 2952 incident cases of T2D. Strongest associations were evident for widowed men, while associations among men who were either never married or divorced/separated were less consistent. Compared to married men, RRs (95% CIs) of developing T2D for divorced/separated, widowed and never married men were 1.09 (0.94–1.27), 1.29 (1.06–1.57), and 1.17 (0.91–1.52), respectively, after adjusting for age, family history of diabetes and ethnicity. The RR of T2D associated with widowhood was attenuated after adjusting for lifestyle and dietary factors [RR: 1.21 (1.00–1.48)] and no longer significant when further adjusting for BMI [RR: 1.16 (0.95–1.41)]. The opposite trend was observed for divorced/separated men: when adjusting for lifestyle and dietary factors [RR: 1.12 (0.96–1.30)] as well as BMI [1.14 (0.98–1.32)] the RR of T2D increased slightly. Among men who were never married, diet and lifestyle did not alter RR of T2D [1.17 (0.91–1.52)], however, after further adjusting for BMI there was a notable enhanced RR of T2D [1.23 (0.95–1.60)]. When allowing for a 2-year lag period between marital status and disease, RRs of T2D for widowers were augmented and when further adjusting for BMI remained borderline significant [RR: 1.24 (1.00–1.55)]. In conclusion, being widowed is associated with an increased risk of T2D in men and this may be mediated, in part, through unfavorable changes in lifestyle, diet and adiposity. Together with prior work, our findings suggest that widowhood has important implications for metabolic functioning and greater attention to the cardiometabolic health of this population is warranted.