bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 002: Self-reported Experiences Of Discrimination In Relation To Incident Dementia: The Multi-ethnic Study Of Atherosclerosis (mesa)
Authors: Bancks Michael P , Byrd Goldie S , Caban-Holt Allison , Fitzpatrick Annette L , Forrester Sarah N , Hayden Kathleen M , Heckbert Susan R , Kershaw Kiarri N , Rapp Stephen R , Sachs Bonnie C , Hughes Timothy M
Published: April 2022

Introduction:
Black and Hispanic Americans have higher rates for dementia than other racial/ethnic groups. Perceived discrimination has many adverse health effects and may contribute to racial disparities in dementia risk. Our objective was to assess the association between lifetime experiences of discrimination and incident dementia.

Methods:
We included data for 6509 participants, 45-84 years of age at baseline (2000-2002) enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). We assessed lifetime experiences of discrimination at baseline in six domains related to: hiring; promotion; police; education; housing; and from neighbors. Incidence of dementia was determined from International Classification of Diseases codes and medication inventory. We used Cox proportional hazards to estimate hazard ratios (HR) for incident dementia over 17 years after accounting for cohort attrition and sociodemographic, clinical, and behavioral factors. We assessed effect modification of the association by race/ethnicity.

Results:
Of the sample, 42% reported experiencing discrimination in their lifetime. We observed 466 incident cases of dementia and lifetime discrimination was associated with incident dementia (Wald χ
2
p=0.03). Individuals reporting lifetime discrimination in ≥2 domains (compared to none) had greater risk for dementia (HR: 1.40; 95%: 1.08, 1.82) after adjustment for sociodemographic, clinical, and behavioral risk factors (
Table
). Associations did not differ by race/ethnicity (p-interaction >0.1).

Conclusion:
Our findings demonstrate an association between discrimination and incident dementia and provide justification to advance research on the association of discrimination with race-disparities in dementia risk.
Abstract 014: Protein Biomarkers Of Healthy Dietary Patterns In The Atherosclerosis Risk In Communities Study
Authors: Du Shutong , Kim Hyunju , Chen Jingsha , Coresh Josef , Chatterjee Nilanjan , Ganz Peter , Boerwinkle Eric , Yu Bing , Rebholz Casey M
Published: April 2022

Introduction:
Molecular mechanisms underlying the benefits of healthy dietary patterns on chronic diseases are poorly understood. Identifying protein biomarkers of healthy diets can help us characterize biological pathways influenced by diet quality and confirm the validity of established healthy dietary patterns.

Objectives:
To identify protein biomarkers that are associated with diet quality using four metrics of adherence to dietary guidelines and healthy dietary patterns: the Alternative Healthy Eating Index-2010 (AHEI-2010); the Alternate Mediterranean Diet (aMED); the Dietary Approaches to Stop Hypertension (DASH) diet; and the Healthy Eating Index-2015 (HEI-2015).

Methods:
We examined 4,877 plasma proteins among 10,593 participants with available proteomics and dietary data from the Atherosclerosis Risk in Communities (ARIC) Study at visit 3 (1993-1995). Dietary intake data were collected through a food frequency questionnaire, and proteins were measured in plasma using an aptamer-based proteomics assay from SomaLogic. We used multivariable linear regression models to examine the association between proteins and each dietary pattern.

Results:
In the multivariable adjusted model, 276 out of 4,877 proteins (5.7%) were associated with at least one dietary pattern (AHEI: 74; aMED: 37; DASH: 250; HEI: 135; p-value < 0.05/4,877=1.0х10
-5
) (
Figure
). There were 140 proteins that were associated with only one dietary pattern (AHEI: 6; aMED: 0; DASH: 116; HEI: 18).

Conclusion:
Large-scale proteomic analysis identified proteins that are representative of a range of healthy dietary patterns and proteins that are specific to single healthy dietary pattern. Future studies are warranted to link diet-related proteins with clinical outcomes.
Abstract 015: Genome-wide Association Study Of Variant-by-thiazide Diuretic Interactions In The UK Biobank Identifies A Novel Locus For Thiazide-LDL-C Interaction
Authors: Downie Carolina G , Highland Heather M , Lee Moa P , Raffield Laura M , Preuss Michael , Whitsel Eric A , Psaty Bruce , Graff Mariaelisa , Avery Christy L
Published: April 2022

Introduction:
Although thiazide diuretics are common therapies for the treatment of hypertension, evidence suggests that they are also associated with elevated blood lipid concentrations after their initiation. Pharmacogenomics studies could help identify potential biological pathways underlying this phenomenon, but few well-powered studies have been conducted.

Methods:
In participants of European ancestry from the UK Biobank, we conducted a genome-wide association study (GWAS) to examine whether common variants (minor allele frequency [MAF] >1%) modified the effect of thiazide diuretic use on three lipid measures: low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) concentrations (mmol/L). TG concentrations were natural log transformed, and LDL-C concentrations were adjusted for statin use. Given the conflicting evidence about the impact of loop diuretics on blood lipid concentrations, unexposed participants were defined as those taking neither thiazides nor loop diuretics. GWAS of UK10K plus 1000-Genomes Phase 3 imputed data were performed using SAIGE, adjusting for age, sex, fasting status, body mass index, study center, and the first 10 ancestral principal components.

Results:
Approximately 7.1% (n=27,971) of participants (n=395,058; mean age=57 years; 54% female [n=214,334]) used thiazides at study baseline. The thiazide-LDL-C GWAS (n=9,680,686 variants) identified one chromosome 19 locus harboring several genome-wide significant variants that modified the effect of thiazide diuretic use on LDL-C. The lead variant rs2199576 (MAF = 0.18) had an effect estimate (standard error) of 0.159 (0.013) among participants exposed to thiazides, and an effect estimate of 0.083 (0.003) among participants unexposed to any diuretic, yielding a significant variant-by-thiazide interaction effect estimate of 0.076 (0.013) (
p
= 1.62 x 10
-9
). These effect estimates are comparable to previously identified main effects of blood lipids loci. The rs2199576 variant resides near the
PVRL2
locus, a cholesterol-responsive gene that is located within 100 kb of
TOMM40
and the
APO
cluster, which have both been associated with blood lipid concentrations and Alzheimer’s disease.

Conclusion:
Our results may provide insights into pathways that influence the adverse effects of thiazide diuretic use and highlight the large sample sizes needed to detect modest pharmacogenetic effects.
Abstract 037: Multimorbidity Is Associated With Lower 24-hour Total Movement Activity Among US Adults
Authors: Dooley Erin E , Chen Ligong , Palta Priya , Martinez-Amezcua Pablo , Hornikel Bjoern , Muntner Paul , Lewis Cora E , Gabriel Kelley P
Published: April 2022

Introduction:
While multimorbidity (having ≥2 chronic conditions) is associated with inadequate higher intensity exercise, less is known about how multimorbidity relates to total movement accumulated throughout the day. We tested the hypothesis that multimorbidity is associated with lower 24-hr movement in a population-based study.

Methods:
We analyzed data from 2011-2014 National Health and Nutrition Examination Survey. A wrist-worn device (ActiGraph GT3X) captured movement over 24 hours in Monitor-Independent Movement Summary units (MIMS-units). Multimorbidity was quantified using 13 chronic conditions included in the CDC recommendations via self-report or clinical thresholds. We conducted multivariable linear regressions analyses to examine the association of each chronic condition and number of conditions with total daily MIMS-units. Models were adjusted for age, sex, race/ethnicity, education, and smoking, as well as the other chronic conditions in the model by condition type, per convention.

Results:
The sample included 7013 US adults aged 30+ (mean (± SE) age 53.2 ± 0.3 years, 53% female, 30% non-White). On average, participants had 2.4 (range 0-11) chronic conditions with 62% having ≥2. Those with ≥2 conditions had -1183.6 (95% CI: -1401.0, -966.2) lower daily MIMS-units. On a continuous scale, for each additional condition, movement was lower by -504.2 (95% CI: -580.4, -427.9) MIMS-units. Compared to those with 0 conditions, there was a dose-response reduction in movement with multimorbidity (
Figure
). Presence (vs absence) of obesity, diabetes, stroke, chronic kidney disease, cancer, depression, and memory problems were each associated with lower 24-hr movement activity.

Conclusions:
Multimorbidity is highly prevalent in US adults and associated with lower 24-hr movement. Intervention strategies focused on promotion of daily lifestyle movement may attenuate population-level multimorbidity burden. Future research should examine which co-occurring conditions contribute to low movement.
Abstract 038: Comparative Effects Of Aerobic, Resistance, And Combined Exercise On Sleep
Authors: Brellenthin Angelique G , Lee Duck-chul
Published: April 2022

Introduction:
Poor sleep quality is associated with high blood pressure and elevated cholesterol, and regular short sleep (<7 hours) has been found to increase the risk of cardiovascular events. The American Heart Association recommends aerobic physical activity to improve sleep, although there are limited data on the effects of other popular types of physical activity, such as resistance exercise, on sleep.

Hypothesis:
We hypothesized that 1 year of aerobic, resistance, and combined aerobic and resistance exercise would significantly improve sleep compared to a no-exercise control group.

Methods:
Participants were 406 inactive adults (53% women, 35-70 years) with overweight/obesity and elevated/stage 1 hypertension at high risk of cardiovascular disease. They were randomly assigned to 1 of 4 groups: aerobic exercise (AE) only (n=101), resistance exercise (RE) only (n=102), combined AE and RE (CE) (n=101), and no-exercise control group (CON) (n=102) for 1 year. All exercise participants performed time-matched supervised exercise 3 times/week, 60 min/session (CE performed 30 min of each AE and RE), at 50-80% of their maximum intensity. Participants completed the Pittsburgh Sleep Quality Index (PSQI) at baseline and 12 months, and only participants with complete baseline data on all PSQI subscales were included (n=386). Primary outcomes were the PSQI total sleep quality score (lower scores = better sleep), sleep duration (hours), sleep efficiency (time asleep/time in bed), sleep latency (time to fall asleep), and sleep disturbances (a combination of the number and frequency of disturbances). Linear mixed effects models following the intention-to-treat principle were used to determine the effects of exercise groups on 12-month changes in sleep outcomes while adjusting for age, sex, and the baseline values of each outcome.

Results:
Overall, 94% of participants completed the intervention with an 83% exercise adherence rate. The PSQI total score and sleep disturbances decreased significantly in all groups, including the control group. Within groups, sleep duration increased significantly by 17 minutes in RE (p=0.005), but not in AE (p=0.73; -2 min), CE (p=0.77; -2 min), or CON (p=0.13; -11 min), among participants getting less than 7 hours of sleep at baseline (p=0.02 for between-within groups interaction). Within groups, sleep efficiency increased in RE (p=0.0005) and CE (0.03), but not in AE (p=0.97) or CON (p=0.86; p=0.04 for between-within groups interaction). Sleep latency also decreased by 3 minutes in RE (p=0.003), although the overall between-within groups interaction effect was not significant (p=0.14).

Conclusions:
These results indicate that resistance exercise may have superior benefits on sleep compared to aerobic exercise, which could provide a novel pathway for the role of resistance exercise in promoting cardiovascular health.
Abstract 042: Trends In Hypertensive Disorders Of Pregnancy Among Nulliparous Individuals With Singleton Live Births In The United States: An Age-period-cohort Analysis Between 1995-2019
Authors: Cameron Natalie A , Petito Lucia , Shah Nilay , Perak Amanda M , Catov Janet M , Bello Natalie A , CAPEWELL Simon , Oflaherty Martin E , Lloyd-jones Don M , Greenland Philip , GROBMAN William , Khan Sadiya
Published: April 2022

Introduction:
Incidence of hypertensive disorders of pregnancy (HDP) has increased concurrently with maternal age at first birth. To better understand the contributions of age, delivery year (period), and maternal birth year (birth cohort) to HDP rates, we performed an age-period-cohort analysis.

Methods:
We included data from the National Center for Health Statistics for nulliparous individuals without pre-pregnancy hypertension who were 15-44 years with singleton live births from 1995-2019. We defined HDP as gestational hypertension, preeclampsia or eclampsia. We determined age effects by calculating HDP incidence adjusted separately for period and cohort in each 5-year age group. Period and cohort effects were quantified as rate ratios (RR) comparing age-adjusted HDP incidence to the median period (2005-2009) and cohort (1980-1984), respectively. Age, period, and cohort effects were summarized as the age-standardized estimated annual percent change (EAPC) in HDP rates adjusted for cohort and stratified by self-reported maternal race and ethnicity group (Hispanic, non-Hispanic American Indian/Alaskan Native [AIAN], non-Hispanic Asian-Pacific Islander [API], non-Hispanic Black [NHB], non-Hispanic White [NHW]).

Results:
Of 38,141,561 individuals included, 0.8% were AIAN, 6.5% API, 20.2% Hispanic, 13.9% NHB, and 57.8% NHW. Mean maternal age increased from 1995-2019 (24.5-26.9). Age, period and cohort were each significantly associated with HDP rates overall and in each race and ethnicity group. Incidence was higher with older maternal age. Age-standardized incidence increased from 1995-2019 (EAPC 2.1%/year [2.1-2.2]). RR of HDP in pregnant individuals born 2000-2004 versus 1980-1984 was 1.5 (1.4-1.5). Differences in RRs among racial and ethnic groups were observed with the largest cohort effects among API and NHB individuals born 2000-2004. (
FIGURE
).

Conclusions:
More recent generations have experienced substantially higher rates of HDP, even with adjustment for maternal age and delivery year.
Abstract 045: Adolescent Arterial Stiffness Precedes Elevated Resting Heart Rate In Young Adulthood: A 7-year Temporal Longitudinal Analysis Using Cross-lagged Structural Equation Model
Authors: Agbaje Andrew O , Barker Alan R , Tuomainen Tomi-Pekka
Published: April 2022

Introduction:
Elevated resting heart rate in adults is an established risk factor in the lifelong process of atherogenesis and its intermediate process such as arterial stiffness. Arterial stiffness is an independent predictor of cardiovascular events. However, it is unclear whether resting heart rate temporally and bi-directionally associates with arterial stiffness especially among healthy adolescents and young adults. Hence, plausible biologic pathways through which elevated resting heart rate associate with arterial stiffness in the young population remains unknown.

Hypothesis:
To examine the temporal longitudinal associations of carotid-femoral pulse wave velocity (cfPWV), a measure of arterial stiffness, with resting heart rate among adolescents aged 17.7 years.

Methods:
We studied 3862 (55.5% female) British adolescents followed up for 7 years until 24.5 years of age, using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, England, UK. At baseline and follow-up, fat mass and lean mass were measured by dual-energy Xray absorptiometry, systolic blood pressure and heart rate by Omron BP/pulse monitor, and cfPWV by Vicorder ultrasound scan. We conducted logistic regression and cross-lagged autoregressive structural equation model analyses and adjusted for age at baseline, sex, moderate to vigorous physical activity, smoking status, family history of cardiometabolic diseases, time in years between measurement at 17.7 and 24.5 years, systolic blood pressure, fat mass, lean mass, and fasting plasma samples viz. low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, high-sensitivity C-reactive protein, glucose, and insulin.

Results:
Participants' mean (SD) age in years was 17.72 (0.33) and 24.54 (0.73) at baseline and follow-up, respectively. Among 3862 adolescents, 10% were at moderate to high risk of elevated resting heart rate at 24.5 years. Higher cfPWV at 17.7 years was associated with the risk of elevated resting heart rate at follow-up [
Odds ratio
= 1.32 (95%
confidence interval
1.06 - 1.65); p=0.014]. In the cross-lagged temporal analysis, higher cfPWV at 17.7 years was associated with higher resting heart rate [
Standardized regression coefficient
(β) = 0.06
standard error
(SE) = 3.85, p<0.0001] at 24.5 years, however, higher resting heart rate at 17.7 years was not associated with cfPWV [β = -0.03, SE <0.0001, p=0.179] at 24.5 years.

Conclusion:
We observed, for the first time, in a large healthy cohort of adolescents that arterial stiffness temporally preceded elevated resting heart rate in young adulthood, after controlling for cardiometabolic and lifestyle factors. This evidence informs that public health and clinical effort may be targeted at early detection and prevention of arterial stiffness from adolescence.
Abstract 048: Changes In Bile Acid Metabolism, Circulating MicroRNA-34a, And Improvements In Lipid Profiles In Response To Weight-loss Diets: The Pounds Lost Trial
Authors: Heianza Yoriko , Xue Qiaochu , Rood Jennifer , Clish Clary , Bray George , Sacks Frank , Qi Lu
Published: April 2022

Background:
Bile acids are synthesized from cholesterol in the liver and play pivotal roles in nutrient absorption and metabolic regulation. Altered bile acid metabolism is related to dyslipidemia, and microRNA-34a (miR-34a) may play a pivotal role in the treatment of lipid homeostasis by regulating the bile acid biosynthesis.

Hypothesis:
We investigated whether weight-loss diet-induced changes in primary and secondary bile acids were associated with the improvements in lipid profiles. We also tested the role of circulating miR-34a in the altered bile acid metabolism in adults with overweight and obesity.

Methods:
A total of 520 participants of a weight-loss dietary intervention (the POUNDS Lost trial) with data on bile acids and miR-34a were included in the present analysis. Circulating levels of miR-34a and bile acid subtypes (primary and secondary unconjugated bile acids and their taurine-/glycine-conjugates) were measured at baseline and 6 months after the intervention. Outcome measurements were improvements in lipids (triglycerides and cholesterol) in response to the interventions.

Results:
At baseline, higher levels of primary bile acids (chenodeoxycholate (CDCA), glycocholate (GCA), taurocholate (TCA), and glycochenodeoxycholate (GCDCA) were associated with elevated levels of triglycerides (

P
FDR

<0.05). Greater decreases in the primary bile acid subtypes (CDCA, GCA, TCA, GCDCA, and taurochenodeoxycholate [TCDCA]) in response to the interventions were significantly associated with larger reductions of triglycerides at 6 months (

P
FDR

<0.05 for all). Decreases in secondary bile acids (deoxycholate and its conjugated forms) also showed significant associations with decreases in triglycerides. Similarly, reductions of total cholesterol at 6 months were associated with decreases in the primary (such as GCA, GCDCA, TCDCA) and secondary bile acid subtypes. We found that greater levels of miR-34a at baseline were related to higher levels of triglycerides at baseline (p=0.038) and higher levels of primary bile acids (such as CA, CDCA, GCA, and TCA [PFDR <0.05 for all]) but not with the secondary bile acids at baseline. Further, weight-loss diet-induced changes in miR-34a were positively correlated with changes in the primary bile acid subtypes (CDCA, GCA, and GCDCA).

Conclusions:
Changes in the specific primary and secondary bile acid subtypes were related to the improvements in lipid profiles in response to weight-loss diet interventions. Circulating miR-34a might in part contribute to the alterations in the primary bile acid subtypes in obese adults.
Abstract 050: Plasma Proteomics And Incident Coronary Heart Disease: The Cardiovascular Health Study
Authors: Huber Matthew , Bis Joshua , Brody Jennifer , Sitlani Colleen , Austin Thomas , Katz Daniel , Psaty Bruce , Floyd James S
Published: April 2022

Introduction:
Coronary heart disease (CHD) is the leading cause of death in most of the developed world. The systematic profiling of plasma proteins levels in a well-characterized cohort may uncover new therapeutic targets for CHD prevention.

Methods:
Plasma levels of 1,298 proteins were measured with SomaScan aptamers in 3,185 participants of the Cardiovascular Health Study. After excluding participants with prevalent myocardial infarction (MI), we evaluated longitudinal associations of protein levels with the primary outcome of incident CHD (acute MI or death from CHD) and with a secondary outcome of angina, coronary revascularization, acute MI, or death from CHD. Primary analyses adjusted for demographic variables, smoking, diabetes, hypertension, body mass index, blood pressure, and LDL cholesterol. A p-value < 7.6 x 10
-5
(corrected for the number of principal components explaining 95% of protein variance) was considered statistically significant. Among significant proteins, we queried the largest available genomic studies to identify potential protein quantitative trait loci, and we interrogated published GWAS to assess potential causal relationships using Mendelian randomization.

Results:
Among 2,868 participants, the mean age at baseline was 74 years, 62% (1,784) were female, and 16% (456) self-identified as Black. After a median follow-up time of 15 years (IQR 10-21) years, 576 (20%) participants had an incident CHD event. Ten proteins were associated with incident CHD, and an additional 27 proteins were associated with the secondary outcome. Adjustment for aspirin and statin use, kidney function, or known cardiac biomarkers (NT-proBNP, high-sensitive cardiac troponin T, C-reactive protein) had little impact on associations, and censoring at a shorter duration of follow-up increased the magnitude of protein-outcome associations.

Conclusions:
Thirty-seven proteins were associated with incident CHD in a cohort of community-dwelling older adults. Two-sample Mendelian randomization analyses are in progress, and proteomic analyses for an additional ~3,700 proteins are planned.
Abstract 054: Hypertension Treatment And Control In A New York City Healthcare System
Authors: April-Sanders Ayana K , Golestaneh Ladan , Zhang Lili , Swett Katrina , Meissner Paul , Bellin Eran Y , Rodriguez Carlos
Published: April 2022

Background:
We investigated the prevalence of and patient characteristics correlated with hypertension control in the Montefiore Health System, a large and predominantly minority healthcare system with locations in New York City and Southern portion of Upstate New York.

Methods:
Using outpatient care data, we included all individuals with hypertension defined by ICD 9/10 codes during 2018. Treatment and control status were defined by the presence of prescribed antihypertensive medication(s) and measured blood pressure (BP): Joint National Commission (JNC) criteria - < 140 / 90 mmHg; or American Heart Association/American College of Cardiology (AHA/ACC) criteria - <130 / 80 mmHg. We report the distribution of hypertension treatment and control by age, sex, and race/ethnicity.

Results:
Among 74,487 hypertensive patients [mean age 62 years ±14), 62% female, predominantly Black (42%) and Hispanic (41%), and low SES (-2.91 ±2.90)], 57% were treated, of which 57% had achieved BP control by JNC criteria and 23% by AHA/ACC criteria. Compared with untreated patients, those prescribed treatments were older (61%), more likely to be NH Black or Hispanic (60%), and report one or more comorbidities (76%) (all p<0.0001). Prevalence of BP control by JNC criteria was lowest for NH Black (53%, p<0.0001) and Hispanic (58%, p<0.0001) patients than NH White and Asian (64%), and highest in patients ≥60 years (63%, p<0.0001) and those with comorbidities (89%, p=0.002). Similar discrepancies were apparent at the 130/80 mmHg threshold. BP control characteristics did not vary by sex.

Conclusions:
Hypertension treatment and control rates in a large, urban health system were significantly lower than reported national averages. Overall, NH Whites had a lower likelihood of hypertension treatment; NH Black and Hispanic patients had significantly lower prevalence of control compared with other racial/ethnic groups, despite having higher treatment rates. Disparities in BP control by patient characteristics was heightened with the AHA/ACC criteria.
Abstract 057: Trends In Blood Pressure Diagnosis, Treatment, And Control Among Nursing Home Residents, 2007-2018
Authors: Odden Michelle C , Li Yongmei , Graham Laura , Steinman Michael , Lee Sei , Marcum Zachary , Liu Christine , Jing Bocheng , Fung Kathy , Peralta Carmen A
Published: April 2022

Inadequate treatment of high blood pressure (BP) can lead to preventable adverse events in nursing home residents, while excessive treatment can lead to associated harms. In this study, we describe the prevalence, pharmacologic treatment, and control of hypertension over time among older adults residing in Veterans Affairs (VA) nursing homes from October 2006 through September 2018 (FY2007-2018). Data were extracted from the VA electronic health record and Bar Code Medication Administration system on 40,079 long-term care residents aged 65 years and older. Hypertension prevalence at admission was identified by one or more ICD code(s) in the year prior, and antihypertensive medication use was considered present if administered ≥50% of days in the nursing home. BP measures were obtained from the electronic health record and averaged over 2 year epochs. The age-standardized prevalence of hypertension diagnosis at admission increased over time from 75.2% in FY2007-2008 to 85.1% in FY2017-2018 (p-value for trend <0.001). Rates of BP treatment and control among residents with hypertension at admission declined slightly over time (all p-values for trend <0.001), but remained high (80.3% of residents treated in FY2017-2018 and 80.1% with average BP <140/90 mmHg). (Figure) The age-adjusted prevalence of chronic low BP, defined as average BP <90/60 mmHg, also declined over this period from 11.1% in FY2007-2008 to 4.7% in FY2017-2018 (p-value for trend <0.001). Persons identified in their health records as being of Black race or Hispanic ethnicity and those with a history of diabetes, stroke, and renal disease were less likely to have average BP <140/90 mmHg. In summary, hypertension is well controlled in VA nursing homes, and recent trends of less intensive BP control were accompanied by lower prevalence of chronic low BP. Nonetheless, some high-risk populations have average BP levels >140/90 mmHg. Future research is needed to better understand the ratio of benefits to harms of BP control in nursing home residents.
Abstract 058: Subclinical Myocardial Injury, Coagulopathy, And Inflammation In Covid-19: A Meta-analysis
Authors: Ogungbe Oluwabunmi , Kumbe Baridosia , Fadodun Oluwadamilola , T Latha , Meyer Diane , Asala Adetoun , Davidson Patricia , Dennison Himmelfarb Cheryl , Post Wendy , Commodore-mensah Yvonne
Published: April 2022

Introduction:
Infection with the SARS-CoV-2 virus can lead to myocardial injury, with cardiac biomarker elevations.

Objective:
To quantify the association between biomarkers of myocardial injury, coagulation, and severe COVID-19 and death in hospitalized patients.

Methods:
Studies were identified from PubMed, Embase, CINAHL, Cochrane, Web of Science, and Scopus, published between December 2019 to August 2021. Effect estimates for association between markers of myocardial injury (Troponin), myocardial stretch (N-terminal-pro hormone BNP, NT-proBNP), and coagulopathy (D-Dimer) and death or severe/critical COVID-19 were pooled using random-effects models. Odds Ratios (OR), Hazard Ratios (HR), and 95% Confidence Intervals (CI) were pooled separately and reported by outcomes of critical/severe COVID-19 and death. A meta-analysis of proportions summarized pooled prevalence of co-morbidities.

Results:
We included 62 articles, with 41,013 patients. Pooled proportion of patients with hypertension history was 39% (95% CI: 34-44%); diabetes, 21% (95% CI: 18%-24%); coronary artery disease, 13% (95% CI: 10-16%); chronic obstructive pulmonary disease, 7% (95% CI: 5-8%), and cancer, 5% (95% CI: 4-7%). Elevated troponin was associated with higher pooled odds of critical/severe COVID-19 and death [Odds Ratio (OR: 1.77, 95% CI: 1.42-2.18)] (
Figure
); also, separately for death (OR: 1.72, 95% CI: 1.32-2.25), and critical/severe COVID-19 (OR: 1.93, 95% CI: 1.45-2.40). Elevated NT-proBNP were associated with higher odds for severe COVID-19/death (OR: 3.00, 95% CI: 1.58-5.70). Elevated D-dimer levels was significantly associated with critical/severe COVID-19 and death (OR: 1.38, 95% CI: 1.07-1.79).

Conclusions:
This meta-analysis synthesizes evidence showing that myocardial injury, and coagulopathy are complications of COVID-19. Patients who have recovered from COVID-19 may benefit from minimally invasive assessment for markers of myocardial injury, stretch and coagulopathy for early risk stratification.
Abstract 067: Outcome Preferences Related To Cardiovascular Preventive Therapies In Older Adults: An Online Survey
Authors: Wang Frances M , Yebyo Henock G , Boyd Cynthia , Puhan Milo A , Matsushita Kuni , Blaha Michael J , Schoenborn Nancy
Published: April 2022

Background:
Personalized cardiovascular disease (CVD) preventive therapy for older adults is important and emphasized in current clinical guidelines. Older adults often have multiple chronic conditions, are at higher risk for medication side effects, and may have different preferences when weighing multiple health outcomes. However, little is known about preferences for outcomes related to CVD preventive therapies in older adults.

Methods:
In May 2021, using an online panel, we surveyed US older adults (age 65-84 years) on outcome preferences related to statin (benefit-related outcomes: heart attack and stroke; side effect-related outcomes: diabetes, abnormal liver test, and muscle pain) or aspirin (benefit-related outcomes: heart attack and stroke; side effects: brain bleed, bowel bleed, and stomach ulcer). We used best-worst scaling, a novel stated-preference research method, to quantify relative outcome priorities. A standardized score was calculated for each outcome to indicate the strength of preference, ranging from -1.0 (least worrisome) to +1.0 (most worrisome).

Results:
304 participants (median age 75, 45% male) completed the statin survey and 303 participants (median age 74, 46% male) completed the aspirin survey. In both surveys, stroke and heart attack, the two benefit outcomes from CVD prevention, were considered significantly more worrisome than outcomes related to side effects of the preventive therapies (
Table
). The general trend was similar for those age 65-74 vs. 75-84, although those age 75-84 tended to worry more about stroke than heart attack.

Conclusions:
Older adults considered the outcomes related to the benefits of CVD preventive therapies more important than outcomes related to the therapies’ side effects. These results suggest that older adults tend to prioritize the benefits of CVD preventive therapies over their side effects. Integrating individualized patient preferences with risk prediction to guide personalized shared decision-making is an important next step.
Abstract 071: Gaps In Statin Initiation And Target Lipid Reduction Arise Early After Diabetes Diagnosis
Authors: Heilman Alexander , Warsavage Theodore , Liu Wenhui , Raghavan Sridharan
Published: April 2022

Background:
Fewer than 60% of US adults with diabetes achieve low-density lipoprotein cholesterol (LDL) targets for atherosclerotic cardiovascular disease (ASCVD) prevention. Examining initiation of ASCVD primary prevention measures after diabetes diagnosis may reveal actionable gaps in diabetes care.

Methods:
We studied individuals in the VA Health Care System with newly diagnosed diabetes based on diagnosis codes and medications without known ASCVD and without a prior statin prescription at the time of diabetes diagnosis. We categorized 10-year ASCVD risk using the AHA/ACC pooled cohort equation (PCE) as <7.5%, 7.5-20%, or ≥20% at the time of diabetes diagnosis. We compared statin initiation, LDL trajectories, and achieving target LDL (defined as two consecutive values <100 mg/dL) within the first 5 years after diabetes diagnosis across ASCVD risk categories using multivariable Cox proportional hazards regression adjusted for baseline HbA1c, body mass index, and glomerular filtration rate.

Results:
Among 72,757 individuals who were statin-naïve at the time of diabetes diagnosis, 41,763 (57.4%) were prescribed a statin within 5 years. Relative to those in the lowest ASCVD risk category, the cumulative incidence of 5-year statin initiation increased in those with intermediate (hazard ratio [HR] 1.11 [1.08, 1.1], p<0.001) and high risk (HR 1.19 [1.15, 1.22], p<0.001) (Figure). LDL levels declined after diabetes diagnosis in all individuals with steeper declines in those at intermediate and high ASCVD risk (Figure). Among 55,844 individuals without LDL at goal at the time of diabetes diagnosis, 32,674 (58.5%) achieved target LDL within 5 years. Achievement of 5-year target LDL increased across ASCVD risk categories: HR 1.22 [1.18, 1.28] (p<0.001) and HR 1.27 [1.22, 1.31] (p<0.001) in those with 10-year risk 7.5-20% and ≥20%, respectively, relative to those with <7.5% risk (Figure).

Conclusion:
Gaps in ASCVD primary prevention through statin therapy and LDL reduction arise early after diabetes diagnosis.
Abstract 072: Statin Eligibility And Use For Primary Prevention Among US Adults Across Strata Of Atherosclerotic Cardiovascular Disease Risk
Authors: Hammond Michael M , Cameron Natalie , Bah Imani , Beltrame Kaitlyn , Khan Sadiya , Shah Nilay S
Published: April 2022

Introduction:
In 2019, primary prevention guidelines broadened consideration for statin eligibility among those at borderline to intermediate risk for atherosclerotic cardiovascular disease (ASCVD) in the presence of a risk-enhancing factor (REF). However, the proportion of US adults affected by these guidelines, particularly among those estimated to be at borderline to intermediate risk for ASCVD, is unclear.

Objectives:
To determine the contemporary prevalence of statin use and eligibility among US adults at low, borderline, intermediate, and high ten-year risk of ASCVD in the presence of ASCVD risk-enhancing factors.

Methods:
We included participants age ≥ 20 years from the National Health and Nutrition Examination Survey from 2015-2018. Ten-year ASCVD risk was classified based on the Pooled Cohort Equations as: low <5%, borderline 5 - <7.5%, intermediate ≥7.5 - <20%, and high ≥20%. The weighted prevalence of statin use was calculated in each risk category. Weighted logistic regression assessed the association between presence of risk-enhancing factors (see Table) with statin use across strata of ASCVD risk.

Results:
Of 1350 participants (representing 37,705,137 US adults), 46% were female and mean (SE) age was 58 (0.6) years. Of these 39%, 15%, 31% and 15% were in the low, borderline, intermediate, and high ASCVD risk groups, respectively. Among adults at borderline and intermediate ASCVD risk, 89% and 90% had at least one risk-enhancing factor, respectively. Of these adults, 88% and 91% were not on a statin, respectively. Odds of statin use for individuals with risk-enhancing factors is shown in the Table.

Conclusion:
A large proportion of adults with borderline/intermediate ASCVD risk were not taking a statin despite a high prevalence of risk-enhancing factors.
Abstract EP05: Plasma Water T
2
Is A Global Marker Of Cardiometabolic Health: The Premier Study
Authors: Sandoval Diana F , Campbell Erin B , Patel Rinkal , Patel Vipulkumar , Dwivedi Alok , Cistola David P
Published: April 2022

Introduction:
Plasma water T
2
detects the multi-component pathophysiology of metabolic syndrome: insulin resistance, dyslipidemia and a pro-inflammatory, pro-coagulation state. In this study, we aimed to determine factors associated with plasma water T
2
to determine if it could serve as a marker of cardiometabolic health. To do so, we analyzed bio-banked samples from the PREMIER study.

Hypothesis:
Plasma water T
2
is associated with multiple measures of cardiometabolic health among PREMIER participants at baseline.

Materials and Methods:
This is an auxiliary study of PREMIER with an observational, cross-sectional design. The parent study recruited 810 subjects: 63% female, 35% black, 65% non-black. The exclusion criteria were diabetes, heart failure, prior CV event, cancer, or psychiatric hospitalization within 2 years. In the present study, we analyzed a subset of participants (n=455), based on the availability of bio-banked samples that had been frozen only once. Transverse relaxation time (T
2
) decay curves were recorded at 37°C for unmodified human plasma using a CPMG pulse sequence and a Bruker mq20 benchtop nuclear magnetic resonance relaxometer. Water T
2
was resolved from non-water components using a discrete inverse Laplace transform. Total plasma protein and albumin were determined, as well as a panel of acute phase proteins, apolipoproteins and metabolic markers. Proteomic analysis was performed using Luminex xMAP technology with Milliplex plates. Statistical analyses were conducted using JMP Pro v16.1.0 (SAS, Inc.). The association of plasma water T
2
(outcome variable) with predictors of cardiometabolic health was analyzed in four stages: (1) screening of predictors using a bootstrap forest machine learning algorithm, (2) clustering of predictors using principal component analysis, (3) associations of predictors with T
2
using multiple linear regression, and (4) validation of regression models using bootstrap forest. Effect size was quantified as standardized beta coefficients, with standard errors and p-values.

Results:
The final regression model includes the following predictors for plasma water T
2
: albumin, globulins, LDL-cholesterol, C-reactive protein, hepatocyte growth factor, serum retinol, race, post-treadmill heart rate, household income and fasting C-peptide. This model had an adjusted R
2
of 0.57; all terms were significant. Thus, plasma water T
2
was independently associated with markers of dyslipidemia, inflammation, hyperinsulinemia, physical fitness, nutrition (vegetable intake), race and household income.

Conclusion:
The association of plasma water T
2
with multiple predictors of cardiometabolic health in PREMIER validates T
2
as a global biomarker of cardiometabolic health in individuals without diabetes. This measurement is practical for the point-of-care and shows promise for cardiometabolic health screening and monitoring.
Abstract MP07: Are Gaps In Anticoagulation Due To Under-prescribing Or Prescriptions Not Being Filled: An Administrative Health Claims Analysis
Authors: Guo Jingchuan , He Meiqi , Gabriel Nico , Magnani Jared W , KIMMEL Stephen E , Gellad Walid , Hernandez Inmaculada
Published: April 2022

Introduction:
Previous studies evaluating factors associated with the underuse of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) relied foremost on claims data, which only contains information on prescription fills but not prescriptions written. Thus it remains unclear to the extent to which OAC underuse is due to providers not prescribing OAC versus patients not filling the medication prescribed.

Methods:
We used Optum’s De-identified Integrated Claims-EHR data, which combined adjudicated claims data with EHR for 24 million patients across the US. We identified patients newly diagnosed with AF between January 2013 and June 2017. The electronic health records (EHR) allowed us to observe the prescriptions ordered by providers, while the claims data provided prescription fill records by patients. We evaluated patient-, provider-, and health plan-related factors associated with under-prescribing of OAC and under-filling after OAC prescribed. Multivariable logistic regression models were constructed to determine factors associated with under-prescribing and under-filling.

Results:
Of the 6,141 individuals in the study cohort, 51% were not prescribed OAC within six months of their AF diagnosis. Of the 2,956 patients who were prescribed, 19% did not fill it at the pharmacy. (
Figure
) In the final adjusted model, younger age, location (Northeast and South), a low CHA2DS2-VAS score, and a high HAS-BLED score were associated with a lower likelihood of being prescribed OAC. Among patients who were prescribed, Medicare enrollment (OR and 95% CI: 2.2 [1.3, 3.7]) and having a direct oral anticoagulant prescription (OR and 95% CI: 1.5 [1.2, 1.9]) were associated with lower likelihood of filling the prescription.

Conclusion:
The underuse of OAC among newly diagnosed patients with AF is largely driven by under-prescribing. Our findings support the development of strategies that target improving prescription orders for the underuse of OAC by millions of patients with AF.
Abstract MP25: Physical Activity And The Progression Of Coronary Artery Calcification
Authors: DeFina Laura F , Radford Nina , Leonard David , Farrell Stephen , Pavlovic Andjelka , Shuval Kerem , Wright Beth B , Levine Benjamin D
Published: April 2022

Introduction:
High volume endurance physical activity (PA) has been shown to associate with increased clinically relevant coronary artery calcification (CAC) but not mortality. A key issue is whether active individuals with CAC have progression of atherosclerosis in the setting of sustained high levels of PA.

Hypothesis:
We hypothesized that changes in CAC are not related to corresponding changes in PA volume. Further, we hypothesized the rate of CAC progression to ≥100 Agatston units (AU) does not depend on baseline PA level.

Methods:
The study included 6,525 men and 2,056 women with ≥2 assessments of PA and CAC (EBT scans (1997-2007) or MDCT scans (2007-2019)). All individuals had at least one follow-up visit (mean=1.8). We used mixed linear regression to relate within-person changes in square-root CAC to changes in PA volume, controlling for between-person effects. We used interval-censored proportional hazards regression to test if progression to CAC≥100 AU was related to baseline PA level: ≥3000, 1500-2999, and <1500 MET·minutes/week (MET·min/wk). Covariates included age, smoking, BMI, glucose, cholesterol, systolic blood pressure, and statin use. In addition, the longitudinal analysis was adjusted for time since baseline, while the time-to-CAC-threshold analysis was adjusted for baseline CAC.

Results:
Mean baseline age was 50 years in men/51 years in women. Mean time to first follow-up was 4.5 years in men/5.1 years in women. PA levels increased by 100 MET·min/wk in men but were stable in women. Cardiorespiratory fitness was stable between visits. Within person changes in CAC were not associated with changes in PA volume (Table). At baseline, 5285 men and 1948 women had CAC<100 AU; at follow-up, 1127 men and 136 women progressed to CAC≥100 AU. Neither PA ≥3000 nor 1500-2999 MET·min/wk exhibited significant risk of CAC progression versus <1500 MET·min/wk. Estimated hazard ratios were ≤1 for both men and women.

Conclusions:
These results show no apparent risk of increasing CAC with sustained PA in active individuals.
Abstract MP32: Healthy Dietary Patterns Are Associated With The Gut Microbiome In The Hispanic Community Health Study/Study Of Latinos (HCHS/SOL)
Authors: Peters Brandilyn A , Xing Jiaqian , Chen Guo-Chong , Usyk Mykhaylo , Wang Zheng , McClain Amanda , Thyagarajan Bharat , Daviglus Martha L , Sotres-Alvarez Daniela , Hu Frank B , Knight Rob , Burk Robert D , Kaplan Robert C , Qi Qibin
Published: April 2022

Introduction:
Dietary patterns high in healthy plant foods play an important role in modulating the gut microbiome and promoting cardiometabolic health. Little is known on the diet-gut microbiome relationship in U.S. Hispanics/Latinos, who have a high burden of obesity and diabetes.

Hypothesis:
Three healthy dietary patterns - the alternate Mediterranean diet (aMED), the Healthy Eating Index (HEI)-2015, and the healthful Plant-based Diet Index (hPDI), will be associated with gut microbiome composition in U.S. Hispanic/Latino adults, and healthy-diet-related species will be related to favorable cardiometabolic traits.

Methods:
HCHS/SOL is a multi-site community-based cohort. At baseline (2008-11), diet was assessed via two 24-hr recalls. Shotgun sequencing was performed on stool samples collected in 2014-17 (n=2,985). Analysis of Compositions of Microbiomes 2 (ANCOM2) was used to identify associations of dietary pattern scores with gut microbiome species and functions, adjusting for sociodemographic, behavioral, and clinical covariates.

Results:
Better diet quality according to multiple healthy dietary patterns was associated with higher abundance of species from class Clostridia, including
[Eubacterium] eligens
,
Butyrivibrio crossotus
, and
Lachnospiraceae bacterium TF01-11
, as well as functions related to fiber fermentation (e.g. pyruvate:ferredoxin oxidoreductase). Poorer diet quality was associated with higher abundance of
Acidaminococcus intestini
, as well as functions of manganese/iron transport, adhesin protein transport, and nitrate reduction. Healthy diet pattern-enriched Clostridia species were related to more favorable cardiometabolic traits such as lower triglycerides (
Figure 1
).

Conclusions:
Healthy dietary patterns in this population are associated with a fiber-fermenting gut microbiome, consistent with previous studies in other racial/ethnic groups. Gut microbiota may be involved in the beneficial effect of higher diet quality on cardiometabolic disease risk.