bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP50: The Development of Severe Obesity in Urban Girls
Authors: McTigue Kathleen M , Stepp Stephanie , Cohen Elan , Hipwell Alison , Moore Charity , Loeber Rolf , Kuller Lewis
Published: July 2021

Introduction:
Despite rising prevalence of youth-onset severe obesity, its development is poorly understood.

Hypothesis:
Girls who are severely obese in early adolescence will show more rapid growth between ages 7-10 and 11-14 compared with those who have normal BMI in early adolescence. The two groups’ BMI trajectories will diverge in late childhood.

Methods:
To estimate the prevalence and incidence of youth-onset severe obesity (BMI >99
th
percentile-for-age) and compare weight development between girls with severe obesity and those with healthy BMI. We examined data from participants in an accelerated longitudinal cohort study of urban girls from a single US city (n=2206; 51% African American). Data were collected annually from 2003-2004 (when participants were aged 7-10) to 2008-2009. Girls were excluded who became pregnant (n=143) or provided no weight data (n=102) in those six years. Prevalence data calculations were compared using the standard severe obesity definition as well as an alternative definition (120% of the 95
th
BMI-percentile-for-age). We used unconditional latent growth curve models (LGCM) to compare the BMI development of girls who were severely obese at age 12-15 with those who had normal BMI at age 12-15.

Results:
Severe obesity prevalence was 4.5% at age 7-10 and 6.3% (3.6% of white girls and 8.2% of African American girls; p<0.001) at age 12-15. Incident severe obesity was 0% to 1.9% annually. The alternative definition of severe obesity yielded slightly higher prevalence estimates (6.2% at age 7-10 and 9.5% age 12-15). When we compared 12-15 year-old girls with severe obesity versus healthy BMI, average body weight was already distinct 5 years earlier [16.5 kg (SD 2.2) versus 27.0 kg (SD 4.7)].The difference in average BMI between the two groups widened with each sample year. Unconditional latent growth curve models between ages 7-10 and 11-14 indicated an average increase of 0.59 kg/m
2
annually in the healthy BMI group and 2.32 kg/m
2
annually in the severe obesity group.

Conclusions:
Severe obesity was relatively common in urban girls, particularly African American girls, by age 7-10. Girls with severe obesity showed a nearly 4-fold rate of BMI change over 5 years, compared to girls with healthy BMI. Girls with early adolescent severe obesity already showed significantly higher BMI by age 7-10. Prevention is essential prior to age 7, with emphasis on minority populations.
Abstract MP56: A Gene-centric Association Study of Activated Partial Thromoplastin Time in European Americans and African Americans: The ARIC Study
Authors: Weng Lu-Chen , Tang Weihong , Cushman Mary , Pankow James S , Basu Saonli , Folsom Aaron R
Published: July 2021

Introduction:
Activated partial thromboplastin time (aPTT) is commonly used to screen for coagulation factor deficiencies. Shorter aPTT is also a risk marker for incident and recurrent venous thromboembolism (VTE). Genetic factors influencing aPTT are not well understood. aPTT was associated with common genetic variants of coagulation factors V (F5), XI (F11), XII (F12), KNG1, HRG, and ABO in previously reported genome-wide association studies (GWAS) that were conducted in individuals of European ancestry; no data have been reported in other race groups. Hypothesis: The present study aimed to identify aPTT-related gene variants in European Americans (EAs) and African Americans (AAs).

Methods:
We conducted a large-scale candidate gene study for aPTT in 9,719 EAs and 2,799 AAs from the Atherosclerosis Risk in Communities (ARIC) study. Subjects on anticoagulants were excluded. Nearly 50,000 single nucleotide polymorphisms (SNPs) located in 2,100 candidate genes were genotyped by the Candidate gene Association Resource (CARe) gene chip. The association between each SNP and aPTT was assessed with an additive genetic model using linear regression adjusted for age, sex, and field center. We additionally adjusted for principal components in AAs to account for potential population stratification. P-value for significant threshold was set at 2x10-6 after accounting for multiple testing.

Results:
In EAs, fifty-five SNPs from F5, HRG, KNG1, F11, F12, and ABO genes exceeded the significant p-value threshold. The signals in HRG, KNG1, F11, F12, and ABO genes replicated the previously reported GWAS findings. The top variant in F5 identified in EAs was only weakly associated with the previously reported GWAS variant (rs2239852, p=1.89x10-08 and r2=0.02 with rs9332701 reported in the previously reported GWAS). In AAs, twenty-seven SNPs from the HRG, KNG1, F12, and ABO genes were significantly associated with aPTT. The top signals from the HRG (rs9898, p=1.19x10-27) and KNG1 genes (
rs710446
, p=8.41x10-42) replicated the previously reported signals in EAs with similar effect size and direction of association, but the top signals in the F12 and ABO genes were weakly associated with the previously reported variants in EAs (rs1801020 in F12: p=1.01x10-84 and r2=0.12 with rs2545801, and rs8176722 in ABO: p=1.62x10-29 and r2=0.26 with
rs687621
, respectively).

Conclusions:
Our study replicated the previously reported associations of aPTT with HRG, KNG1, F11, F12, and ABO genes in EAs and with HRG and KNG1 in AAs. The signals from F5 identified in EAs and from F12 and ABO identified in AAs may represent new genetic variants for aPTT.
Abstract MP59: Associations of Maternal Pre-pregnancy Body Mass Index and Gestational Weight Gain with Offspring Longitudinal Change in BMI
Authors: Lawrence Gabriella M , Shulman Shani , Hochner Hagit , Sitlani Colleen , Burger Ayala , Savitsky Bella , Granot-Hershkovitz Einat , Lumley Thomas , Enquobahrie Daniel , Wander Pandora L , Manor Orly , Siscovick David S , Friedlander Yechiel
Published: July 2021

Introduction
A number of studies have demonstrated significant associations between changes in obesity-related phenotypes and subsequent risk of CHD. While accumulating evidence suggests that maternal pre-pregnancy body mass index (mppBMI) and gestational weight gain (GWG) may impact adult offspring adiposity, no study has examined their associations with longitudinal changes in obesity. Changes in obesity are likely to reflect genetic-environmental interactions and may have important implications for understanding CHD risk.

Objectives
We examined the associations of mppBMI and GWG with longitudinal change in offspring’s BMI and assessed whether these associations are explained in part by genetic effects.

Methods
We used a birth cohort of 1400 young adults born in Jerusalem, with extensive archival data as well as clinical information at age 32, and longitudinal change in BMI based on two examinations at ages 17 and 32. Genotyping of mothers and offspring was carried out for 180 candidate genes related to cardio-metabolic outcomes. We created genetic propensity scores using a subset of 388 SNPs from 53 adiposity-related genes that were predictive of the exposures and outcome, and fit linear regression models both with and without genetic scores to examine the associations of mppBMI and GWG with offspring change in BMI. Analyses used inverse probability weighting to account for a stratified sampling scheme (i.e. oversampling of offspring with low and high birth weight as well as of overweight and obese mothers).

Results
mppBMI was positively associated with change in BMI over time (p<0.001), independent of GWG and confounders; there was an increase of 0.21 kg/m
2
in BMI change per increase of one standard deviation (SD) in mppBMI. A one-SD change in GWG was associated with a 0.16 kg/m
2
BMI change, independent of mppBMI and confounders. These associations were maintained irrespective of offspring BMI at age 17. The association between mppBMI with offspring change in BMI was slightly attenuated with the addition of genetic scores in the model (b=0.213 vs. 0.187). In the GWG model, when adjusted for the genetic scores a substantial decrease of 28.2% in the coefficient for GWG was observed (b=0.163 vs. 0.117).

Conclusions
This study points to the strong relationship between maternal excess weight and weight gain in pregnancy with offspring change in body size from adolescence to adulthood. Our findings suggest that genetic factors account, in part, for the association between GWG and offspring longitudinal change in BMI. Mapping genes underlying these associations with longitudinal change in BMI may potentially lead to targeted intervention strategies to reduce CHD risk.
Abstract MP64: Body Mass Index and Waist Circumference are More Strongly Associated with Abdominal Adiposity Compared to a Body Shape Index in Middle-aged Adults: The Cardia Study
Authors: Machiorlatti Michael , Shay Christina M , Jacobs David , Lewis Cora E , Lovato James , Terry J. Gregg , Carr J. Jeffrey
Published: July 2021

Background:
A Body Shape Index (ABSI) has been recently shown to better predict mortality when compared to BMI and waist circumference. Although individuals with higher abdominal adiposity generally exhibit greater mortality risk, the association between ABSI and imaging-based measures of abdominal adiposity has not been thoroughly explored.

Objective:
To quantify and compare associations between ABSI, BMI, and waist circumference with computed-tomography assessed measures of visceral (VAT), subcutaneous (SAT), and total (TAT) abdominal adipose tissue volumes in middle age adults according to race and sex.

Methods:
Coronary Artery Risk Development in Young Adults (CARDIA) is a community-based, prospective study of black and white men and women. Height (cm), weight (kg), and waist circumference (WC) were assessed during the year 25 exam (43-55 yrs), from which, BMI (kg/m
2
) and A Body Shape Index (ABSI) were calculated. VAT, SAT, and TAT volumes (cm
3
) were concurrently measured by computed tomography (n=3,155). Linear regression was used to assess the amount of variation in VAT, SAT and TAT explained by BMI, WC and ABSI composition measure accounting for age, sex, race, and study center

Results:
Height, weight, BMI, WC and ABSI were all univariately associated with VAT, SAT and TAT with significant interactions by race and sex. Across all race/sex groups, BMI, WC and weight explained greater variance in VAT, SAT and TAT compared to ABSI (Table 1). WC generally explained the most variance in abdominal adiposity measures (R
2
=0.56-0.74). BMI explained the largest amount of variance in SAT (R
2
= 0.74-0.78). ABSI and height explained the least variance in abdominal adiposity (range R
2
< 0.29).

Conclusions:
Although ABSI may provide additional information related to mortality that is not explained by more simple anthropometric measurements, the associations reported may not be strongly mediated through abdominal adiposity. BMI and WC remain simple clinical measures that strongly account for variations in abdominal adiposity.
Abstract MP79: Association of Long-term Risk Factor Levels with Carotid Atherosclerosis: The Chicago Healthy Aging Magnetic Resonance Imaging Plaque Study (CHAMPS)
Authors: Berry Jarett D. , Lin Kai , Liu Kiang , Garside Daniel , Ayers Colby , Carroll Timothy J , Daviglus Martha , Lloyd-Jones Donald M
Published: July 2021

Background:
The absence of risk factors (RFs) in early middle-age is associated with a markedly lower risk for cardiovascular disease across the lifespan. However, the mechanism for this association is not fully understood.

Methods:
We performed carotid MRI on 440 randomly-selected participants of the Chicago Healthy Aging Study in 2009-11, whose RFs were measured in 1967-73. We examined association of the burden of RFs at baseline with measures of carotid atherosclerosis (i.e., wall thickness and lipid-rich necrotic core (LRNC)) at follow-up. High resolution carotid MR images were acquired (Siemens, 1.5T) using Time of Flight and standard, Turbo Spin Echo T1 and T2 sequences; 16 consecutive images were acquired, and centered on the bifurcation. Risk groups were defined according to RFs present ~40 years earlier (baseline examination): blood pressure, cholesterol, diabetes, and smoking. Participants were divided into 4 groups (See Table footnote for definitions). The association of wall thickness measures and LRNC with baseline low-risk status was assessed in models adjusted for age, current RF, and mean wall thickness.

Results:
Among 423 ppts with evaluable images, the mean age was 32±5 y at baseline and 71±5 y at follow-up; 65% were male, 84% white, and 37% were “Low Risk” at baseline. Higher risk status at baseline was associated with greater burden of carotid atherosclerosis as measured by mean and maximum wall thickness and LRNC, with the lowest burden among individuals with low-risk status (see Table). In age-adjusted models, low-risk status was associated with a lower risk for LRNC in older age [OR 0.58 (95% CI, 0.35-0.97)]. This association persisted after adjustment for current RF burden [0.59 (0.35-0.99)] and mean wall thickness [0.57 (0.33-0.99)].

Conclusions:
The presence of low-risk status in early life is associated with a lower prevalence of carotid LRNC in older age. These findings suggest that the decades-long protective effect of low risk status might be mediated through a lower burden of high-risk plaque.
Abstract MP81: Differences in Body Composition Between Metabolically Healthy Obese and Metabolically Abnormal Obese Phenotypes
Authors: Camhi Sarah M , Katzmarzyk Peter T
Published: July 2021

Purpose:
Studies of body composition between metabolically healthy obese (MHO) and metabolically abnormal obese (OA) cardiometabolic profiles have been limited to mostly small sample sizes and postmenopausal women. Thus, the purpose is to determine whether measures of body composition differ between MHO and OA using men and women across a wide age range.

Methods:
The sample included 395 obese (≥30 kg/m
2
) adults (66% women; 62% white, 38% African American) from the Pennington Center Longitudinal Study, 18-68 years of age (mean±SD: 40.6±13.2). Adults were classified as OA (≥2 cardiometabolic risk factors: blood pressure ≥130/85 mmHg; triglycerides ≥150 mg/dL, high density lipoprotein cholesterol men <40, women <50 mg/dL; fasting glucose ≥100 mg/dL) or MHO (<2 cardiometabolic risk factors). Whole-body bone mineral density (BMD; g/cm
2
), bone mineral content (BMC; kg), percent body fat (%), fat mass (kg), lean mass (kg) and trunk adipose tissue mass (kg) were measured with dual-energy x-ray absorptiometry. Visceral (VAT; cm
2
), subcutaneous (SAT; cm
2
), and total abdominal adipose tissue (TAT; cm
2
) were measured with computed tomography. Non-normally distributed variables were log transformed for analysis (lean mass, VAT, BMD and BMC) but means were reverse-transformed for presentation of results. Gender-specific general linear regression models (men: n=136; women: n=259) were used to determine differences in body composition between MHO (men: n=57; women n=153) and OA (men: n=79; women n=106) controlling for age, race, smoking status, and menopause status (in women).

Results:
In men, OA had greater fat mass (OA vs. MHO mean±SE; p-value for difference: 31.4±1.2 vs. 28.6±1.2 kg; p=0.02) and greater trunk adipose tissue (16.5±0.7 vs. 14.3±0.8 kg; p=0.002) compared with MHO, but no significant differences between MHO and OA profiles for BMD, BMC, % fat, lean mass, VAT, SAT, or TAT. Women with OA profiles had greater lean mass (54.4±1.0 vs. 51.5±1.0 kg; p<0.0001), greater VAT (119.4±1.1 vs. 95.7±1.1 cm
2
; p<0.0001) and greater trunk adipose tissue (18.0±0.5 vs. 17.1±0.5 kg; p=0.03) when compared with MHO women, with no significant differences between MHO and OA for BMD, BMC, % fat, fat mass, SAT or TAT.

Conclusion:
OA and MHO cardiometabolic profiles are characterized by differences in body composition that vary by gender. Men have differences in overall and trunk adipose tissue while women have differences in lean mass and centralized fat (VAT and trunk). Future studies should confirm these results in different race and age groups.
Abstract MP86: The Joint Effect of Outdoor Recreational Activity and 25-Hydroxyvitamin D on Cardiovascular Mortality in THE NHANES III Population
Authors: Donneyong Macarius , Hornung Carlton A
Published: July 2021

Purpose
Recreational physical activity (PA) reduces the risk of cardiovascular disease (CVD) morbidity and mortality. Outdoor-based recreational physical activities (ORA) have been reported to be associated with elevated 25(OH)D levels. We investigate the joint effects of frequent ORA and 25(OH)D levels on the risk of CVD mortality and the modifying effects of 25(OH)D.

Methods
Our sample consisted of 13,031 nationally representative adults (20 - 90 years old) free from CVD and cancer at baseline in the NHANES III (1988 - 1994) linked mortality dataset with follow-up mortality data through 2006. CVD mortality was based on reported deaths with corresponding ICD-10 codes for CVD as underlying cause of death. ORA was defined as self-reported participation in recreational physical activities considered to have occurred outdoors in the past month. Time to CVD mortality was estimated from multivariable adjusted Cox proportional hazards (CPH) models. A joint effects model was used in estimating multiplicative and additive interaction between ORA and 25(OH)D.

Results
A crude unweighted CVD mortality rate of 7.4% (964/13,031) occurred during a median follow-up of 14.33 years. Frequency of ORA <5 in the past month (HR=1.38, 95%CI:1.09 - 1.75) and 25(OH)D <30 ng/mL (HR=1.28, 95%CI:1.01 - 1.60) were associated with increased risk of CVD mortality compared to ORA ≥5 and 25(OH)D ≥30 ng/mL respectively, in a multivariable adjusted CPH model. In the joint effects model, frequency of ORA <5 and 25(OH)D <30 ng/mL (HR=1.81, 95%CI:1.05 - 3.10) and frequency of ORA <5 and 25(OH)D ≥30 ng/mL (HR=1.33, 95%CI:1.02 - 1.73) were associated with elevated risk of CVD mortality compared to the joint effects of ORA ≥5 and 25(OH)D ≥30 ng/mL. The joint effects model indicated the presence of multiplicative interaction. The synergy index, 1.52 (95%CI:0.31 - 7.41) suggested presence of additive interaction even though not statistically significant.

Conclusion
Lower frequency of ORA and serum 25(OH)D levels were jointly associated with elevated risk of CVD mortality. Serum 25(OH)D modified the risk of CVD mortality associated with lower frequency of outdoor-based recreational activities.
Abstract MP92: Processed and Unprocessed Red Meat Consumption and Incident Type 2 Diabetes Mellitus: An Updated Systematic Review and Meta-Analysis
Authors: Tamez Martha , Micha Renata , Lajous Martin , Mozaffarian Dariush
Published: July 2021

Background:
Several studies have recently evaluated the relation of processed and unprocessed red meat consumption and type 2 diabetes mellitus (DM). An updated review and quantitative assessment of these studies is crucial for public health recommendations.

Methods:
We performed a systematic review and meta-analysis of the relation of processed (salted or otherwise preserved), unprocessed, and total red meat consumption with DM. We updated a prior systematic search (to Mar 2009) for additional cohort, case-control, or randomized studies through Oct 2012. Among prior identified studies and 208 newly identified abstracts, 13 studies, all prospective cohorts, met inclusion criteria. These included 4 prior identified studies, 3 updated analyses, and 6 new cohorts. Data were extracted independently in duplicate. Random-effects generalized least squares models for trend were used to derive pooled dose-response estimates. Statistical heterogeneity between studies was tested with goodness of fit (λ2), and publication bias by funnel plots and Begg’s test.

Results:
The 13 studies provided 34 separate estimates for relations of processed, unprocessed, and total red meat consumption with incident DM. These included 574,212 individuals and 33,482 DM cases. In pooled analyses, per 50-g serving/d of processed meats, DM risk was 35% higher (13 studies; 34,077 cases; RR 1.35; 95% CI, 1.24-1.55; P<0.001). The latter corresponded to 82% higher DM risk (RR 1.82; 95% CI, 1.64-2.02; P<0.001) for each 100-g serving/d of processed meats. Per 100-g serving/d of unprocessed red meats, 13% higher risk of DM was seen (12 studies; 31 591 cases; RR 1.13; 95% CI, 1.08-1.17; P<0.001). Fewer studies evaluated total red meat, with intermediate results (5 studies; 16,747 cases; RR per 100-g serving/d 1.16; 95% CI, 1.11-1.21; P<0.001). Heterogeneity was evident by study location, with stronger risk estimates in US vs European populations. Evidence for publication bias was not seen.

Conclusions:
Consumption of red meat is associated with high incidence of DM. Per gram, risk is highest for processed meats, highlighting the need for investigation of key responsible constituents and informing policy priorities.
Abstract MP94: Consumption of Specific Fruits and Incidence of Type 2 Diabetes in Men and Women
Authors: Muraki Isao , Imamura Fumiaki , Hu Frank B , Willett Walter C , van Dam Rob , Sun Qi
Published: July 2021

Background:
Consumption of whole fruits, but not fruit juice, has been associated with lower risk of type 2 diabetes. However, individual fruits have different compositions of carbohydrate, phytochemicals and other nutrients, and may thus have different effects on diabetes risk. We examined whether consumption of specific fruits was prospectively associated with risk of type 2 diabetes in US men and women. In addition, we evaluated whether the associations of fruits with diabetes were determined by the glycemic load (GL) of fruits consumption.

Methods:
After excluding participants with chronic diseases at baseline, we evaluated 66,720 women from the Nurses' Health Study (1984-2008); 85,961 women from the Nurses’ Health Study II (1991-2009); and 26,149 men from the Health Professionals Follow-up Study (1986-2008). Validated semi-quantitative food frequency questionnaires were administered to assess habitual consumption of fruits and other foods every two to four years. Incidences of type 2 diabetes were identified using biennial self-reported questionnaires and confirmed using supplementary questionnaires. The associations were prospectively assessed in each cohort, using Cox proportional hazard regression. Sociodemographics, lifestyle, caloric intakes, intakes of other fruits, and other dietary factors were adjusted for to control for confounding. Cohort-specific estimates were pooled by a random-effects meta-analysis.

Results:
During 3,447,866 person-years of follow-up, 11,521 participants were newly diagnosed with type 2 diabetes. The pooled multivariable-adjusted hazard ratios (HRs) for type 2 diabetes (for every 3 servings/week increase of fruit intake) were 0.74 [95% confidence interval (CI): 0.66, 0.83] for blueberries; 0.86 (0.80, 0.93) for grapes or raisins; 0.86 (0.75, 0.99) for prunes; 0.91 (0.81, 1.03) for bananas; 0.93 (0.88, 0.97) for apples or pears; 0.95 (0.91, 1.00) for grapefruits; 0.96 (0.90, 1.02) for peaches, plums or apricots; 1.01 (0.97, 1.05) for oranges; 1.06 (0.96, 1.19) for strawberries; and 1.11 (1.03, 1.20) for cantaloupe. No significant heterogeneity was found among the three cohorts, except associations with banana consumption. In contrast, each drink per day of fruit juice was associated with a HR (95% CI) of 1.07 (1.00, 1.14). The HRs for type 2 diabetes were 0.81 (0.69, 0.96) per 1 serving/day of high GL fruits, 0.96 (0.86, 1.07) for moderate GL fruits, and 1.05 (0.92, 1.19) for low GL fruits.

Conclusion:
Our data suggest that intakes of certain whole fruits, including grapes or raisins, prunes, apples or pears, grapefruits, and blueberries, are associated with lower risk of type 2 diabetes, whereas high consumption of fruit juice may lead to increased risk. Future research is needed to confirm our findings and elucidate mechanism underlying the associations for individual fruits.
Abstract MP96: Dysglycemia and Mortality in Older Adults With and Without Diabetes
Authors: Palta Priya , Huang Elbert S , Kalyani Rita R , Golden Sherita H , Brancati Frederick L , Yeh Hsin C
Published: July 2021

Studies in middle-aged adults report higher levels of glycated hemoglobin are associated with increased risk of mortality in non-diabetic individuals. Few studies have sufficient data to assess this association in older adults. We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994), Continuous NHANES (1999-2004), and their linked mortality data (through December 2006) to determine the risk of mortality by levels of HbA1c in older adults with and without diabetes. All analyses are weighted to represent the US population and to account for the complex survey design. Cox proportional hazard models examining the relationship between HbA1c and mortality were adjusted for age, sex, race, education, body mass index, smoking status, HDL cholesterol and hypertension. At baseline, in 7,405 adults, age ≥65 with HbA1c data (42.9% men; 7.5% black; 2.4% Mexican; mean age 73.5 (0.13)), 22.8% had clinically diagnosed diabetes (defined as self-reported physician diagnosis of diabetes and/or use of insulin or hypoglycemic medications). Over a median follow-up of 7.8 years, 4,625 participants (41.9%; 68.1 per 1000 person-years) died due to cardiovascular disease (CVD; n=1520) or non-CVD (n=3105). Non-diabetic older adults with a HbA1c between 5.7-6.4% (defined as “at risk for diabetes” by the American Diabetes Association) had a significantly greater risk of all-cause (HR: 1.39; 95% CI: 1.03-1.89) and non-CVD (HR: 1.55; 95% CI: 1.13-2.13) mortality compared to those with HbA1c<5.0% (referent). In older diabetic adults, there was a graded increase in mortality risk with significant associations found between HbA1c and all-cause (HR: 1.90; 95% CI: 1.13-3.28) and CVD (HR: 2.67; 95% CI: 1.17-6.09) mortality, in analyses comparing participants with a HbA1c between 8.0-8.9% to those with HbA1c <6.5% (referent). These data from a large, nationally representative sample of older adults indicate that dysglycemia is associated with increased mortality risk in older adults with and without diabetes.
Abstract P002: Heavy Alcohol Consumption Increases the Risk of Atrial Fibrillation -Circulatory Risk in Communities Study(CIRCS)
Authors: Sano Fumihiko , Ohira Tetsuya , Kitamura Akihiko , Imano Hironori , Cui Renzhe , Kiyama Masahiko , Okada Takeo , Yamagishi Kazumasa , Sankai Tomoko , Tanigawa Takeshi , Ishikawa Yoshinori , Kario Kazuomi , Iso Hiroyasu
Published: July 2021

Background—
Evidence on the relationship of a wide range of alcohol consumption with risk of incident atrial fibrillation has been limited.

Methods—
Between 1991 and 1995, 8602 Japanese men and women aged 30 to 80 years and free of clinical atrial fibrillation took part in the first examination of the Circulatory Risk in Communities Study(CIRCS)- a population based cohort study of cardiovascular risk factors, cardiovascular disease incidence, and their trends in Japanese communities. In the first examination, we checked a detailed medical history, physical examination, blood and urine examination, and electrocardiogram (ECG). An interviewer obtained histories in detail for weekly alcohol intake. In the follow-up period, incident atrial fibrillations were ascertained by annual ECG record and medical history of treatment of atrial fibrillation. ECGs were coded with the Minnesota Code by trained physician-epidemiologists. Differences in baseline characteristics between atrial fibrillation cases and controls were compared using Student t-tests or chi-squared tests. The hazard ratios (HRs) of incidence of atrial fibrillation and 95% confidence interval (CI) relative to the never-drinking group were calculated with adjustment for age and other potential confounding factors using the Cox proportional hazard model.

Results—
During an average follow-up of 6.4 years, 290 incident atrial fibrillation occurred. The higher incidence rate of atrial fibrillation was observed among participants with more than 69 g of ethanol drinking per week, compared with less than 69 g of ethanol drinking per week. On the other hand, light to moderate alcohol consumption was not associated with risk of atrial fibrillation. Compared with the never drinking group, the multivariable-adjusted HRs of past, light (<23 g), light moderate (23-46 g), moderate (46-69 g), and heavy (>69 g) drinking groups were 1.20 (95% CI, 0.61-2.35), 0.85 (95% CI, 0.57-1.27), 1.05 (95% CI, 0.63-1.75), 1.34 (95% CI, 0.78-2.32), and 2.92 (95% CI, 1.61-5.28), respectively.

Conclusions—
Heavy alcohol consumption was associated with the higher risk of atrial fibrillation, whereas there was no association of less than moderate alcohol consumption and atrial fibrillation.
Abstract P013: Prevalence and Outcomes of Anemia in Patients Hospitalized with Acute Decompensated Heart Failure: The ARIC Study Community Surveillance
Authors: Caughey Melissa , Laura Loehr , Avery Christy , Ni Hanyu , Astor Brad , Matsushita Kunihiro , Wruck Lisa , Rosamond Wayne
Published: July 2021

Background:
Anemia has been associated with increased mortality in heart failure patients. The prevalence and outcomes of anemia in patients hospitalized with acute decompensated heart failure (ADHF) in population-based settings are unknown.

Methods:
Hospitalizations related to heart failure among black and white residents 55 years and older were sampled by stratified design from 4 US communities (total population age 55+ =177,000), January 1, 2005 -December 31,2008 in the Atherosclerosis Risk in Communities (ARIC) Study. Events were validated by physician review of medical records, and linked to mortality files. Those classified as definite or probable ADHF were included in the analysis; chronic, stable heart failure and hospitalizations not for heart failure were excluded. ADHF was further classified as heart failure with preserved (≥50%) or reduced (<50%) ejection fraction. Laboratory values were abstracted from the hospital record. Anemia was defined by WHO guidelines (< 12 g/dL for women; < 13 g/dL for men), using the lowest hemoglobin. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-Epi formula using serum creatinine. Length of stay and mortality outcomes were analyzed by linear and logistic regression, respectively. All analyses were weighted to account for the sampling design and adjusted for race, age, sex, eGFR and smoking.

Results:
Over four years, 13,554 (weighted) hospitalized events for definite or probable ADHF occurred, based on 2,804 sampled events. Comorbidities of ADHF included: hypertension (84%), coronary heart disease (55%), chronic bronchitis or COPD (34%), diabetes (48%), and chronic kidney disease (eGFR < 60 mL/min/1.73m
2
) (73%). Prevalence of anemia was 77% (95%CI: 75-79%) overall and did not differ by race (p=0.6), gender (p=0.1) or by subtype of heart failure based on preserved or reduced ejection fraction (p=0.09). Anemia was more common in patients over age 75 (80%; 95%CI: 78-83%) than patients aged 55-74 (73%; 95% CI: 70-76%); p<.0001. Anemia was associated with an increased length of stay by 3.6 (95%CI: 3.0-4.3) days, and with 1-year mortality (OR=1.3, 95%CI: 1.0-1.8). In a subset of ADHF hospitalizations (N=7,989; 59%) with two hemoglobin values, anemia prevalence was 84% (95%CI:82-86%) by the lowest hemoglobin, improving to 72% (95%CI: 70-75%) by the last documented hemoglobin. Anemia resolved over the course of the hospitalization for 15% of patients; more commonly for women than men (18% vs. 11%; p=.002).

Conclusion:
Among patients hospitalized for ADHF in these 4 US areas, anemia was common, particularly for those over age 75, and was associated with a longer length of hospital stay and higher 1-year mortality.
Abstract P026: Effects of Weight Loss on Serum Uric Acid Concentrations
Authors: Masuo Kazuko , Lambert Gavin W
Published: July 2021

Objective:
We previously reported that serum uric acid (UA) levels might predict future BP elevation and renal complications. Obese and hypertensive individuals have frequently higher UA than lean or normotensive individuals. Furthermore, epidemiological studies demonstrated that hyperuricemia (hyperUA) is a cardiovascular risk (
i.e.
coronary artery disease, myocardial infarction). The present study evaluated the effect of weight loss (WL) on serum UA levels and its mechanisms, and further compared the benefits of WL protocol on UA levels between calorie restricted diet and exercise.

Methods:
The 3 groups each comprised 30 obese, hypertensive men. BMI, fat-mass, waist-to-hip ratio (W/H), BP, plasma norepinephrine (NE), HOMA-IR and UA were measured every 2 weeks over 24 weeks with WL regimen. WL protocol was achieved with
i)
mild calorie restricted diet (1800 kcal & 8-10g NaCl/day; D) alone,
ii)
mild exercise (>1-hour walking, approximately 20,000 steps/day; EX), or
iii)
mild calorie restricted diet (1800 kcal &8-10g NaCl/day) + mild exercise (D+EX).

Results:
All basal parameters and prevalence of hyperUA were similar among the 3 groups (prevalence of hyperUA at entry, D 66.7%, EX 66.7%, D+EX 70.0%). At 24 weeks, the D+EX group showed a significantly higher prevalence of normotensive subjects and subjects with normal UA levels compared to the D or EX alone group (prevalence of normal UA: D+EX 80.0%, D 63.3%, EX 53.3%, D+EX vs. D, χ
2
=8.71, P<0.05, D+EX vs. EX, χ
2
=13.92, P<0.05, D vs EX, χ2=4.32, P=0.057). In the D alone group, plasma NE decreased significantly at 2 weeks, and UA decreased at 4 weeks. Significant reductions in BMI, fat-mass and BP were observed at 8 weeks, and HOMA-IR decreased at 12 weeks. In the EX alone group, significant reductions of fat-mass and HOMA-IR were observed at 4 weeks. UA and NE were significantly reduced at 8 weeks whilst decreases in BP were detected at 12 weeks. BMI and W/H were similar at 8 weeks between D alone and EX alone groups. In the D+EX group, significant reductions in UA and NE were observed at 2 weeks followed by significant decreases in BMI, fat-mass, W/H, BP and HOMA-IR at 4 weeks. The magnitudes of reductions of all parameters were greatest in the D+EX group than D or EX alone groups. Reductions in UA over 24 weeks correlated positively with decreases in total fat-mass (r=0.391, P<0.05) and plasma NE (r=0.301, P<0.05) in all subjects.

Conclusions:
Serum UA levels decreased significantly in all WL regimens (D, EX, D+EX), however a mild calorie restricted diet was more beneficial treatment on serum UA reduction associated with suppression on plasma NE than exercise. Serum UA reduction with WL regimen were observed prior to significant WL or BP reduction, but synchronized with suppression on sympathetic nervous activity. In conclusion, WL is a beneficial treatment for UA reduction in obese hypertensive patients.
Abstract P047: Improved Clinical Outcomes Associated with Dual-Goal (HbA1c and LDL-C) Achievement in Newly Diagnosed Type 2 Diabetes Mellitus
Authors: Shi Lizheng , Ye Xin , Lu Mei , Wu Eric Q , Sharma Hari , Thomason Darren , Kang Amiee L , Fonseca Vivian A
Published: July 2021

Background:
Compared with studies on achieving a single goal of either glycated hemoglobin (HbA1c) or low-density lipoprotein cholesterol (LDL-C) in type 2 diabetes mellitus (T2DM), the clinical benefits of dual-goal achievement (LDL-C<100 mg/dl and HbA1c<7%) are not well documented. This study investigated factors and clinical benefits associated with dual-goal achievement in newly diagnosed T2DM patients.

Methods:
Newly diagnosed adult T2DM patients with ≥2 measures of LDL-C and HbA1c were identified in the Veterans Integrated Services Network 16 data warehouse (01/2004-06/2010).

A logistic regression model was used to identify factors associated with dual-goal achievement during 7-12 months following the index date (first HbA1c recorded within three months of the first T2DM diagnosis). Factors included demographics and 0-6 month dual-goal achievement, as well as diabetes-related comorbidities, medications, surgeries, and healthcare utilization, all measured during the 1-year period surrounding the index date.

Multivariate Cox proportional hazards models were used to assess the association between time-varying goal achievement status and post-index date clinical outcomes, including microvascular complications (retinopathy, nephropathy, and neuropathy), cardiovascular-related complications (cardiovascular death, stroke, or myocardial infarction) and acute coronary syndromes (ACS).

Results:
A total of 16,829 T2DM patients were included in the study. Factors associated with an increased likelihood of dual-goal achievement include older age, higher Charlson Comorbidity Index (CCI), prior dual-goal achievement, diagnosis of ketoacidosis or hypersmolarity, and lipid-lowering drug use. Conversely, patients with prior diagnoses of retinopathy, neuropathy, and congestive heart failure, as well as prior insulin use were less likely to achieve both goals.

Compared with failure to achieve either goal, achieving only LDL-C goal was associated with a lower risk of cardiovascular-related complications (HR:0.76; 95% CI:0.71-0.81) and ACS (HR:0.76; 95% CI:0.67-0.86), while achieving only HbA1C goal was associated with a lower risk of microvascular complications (HR:0.73; 95% CI:0.71-0.74), cardiovascular-related complications (HR:0.80; 95% CI:0.74-0.87) and ACS (HR:0.66; 95% CI:0.60-0.72). Dual-goal achievement was associated with additional reduction in risk of microvascular complications (HR: 0.69; 95% CI: 0.63-0.76) vs. only LDL-C goal achievement, but had similar risk to achieving HbA1c goal alone.

Conclusions:
Older age, higher CCI, prior dual-goal achievement, and lipid-lowering drug use were associated with a greater likelihood of dual-goal achievement. Dual-goal achievement in newly diagnosed T2DM patients is associated with decreased risks of microvascular complications than those with only LDL-C goal achievement.
Abstract P077: Plasma Homocysteine, Dietary B Vitamins, and Risk of Peripheral Artery Disease
Authors: Bertoia Monica L , Pai Jennifer K , Joosten Michel M , Mittleman Murray A , Rimm Eric B , Mukamal Kenneth J
Published: July 2021

Background:
Clinical trials of vitamin B supplements to lower homocysteine levels have not consistently lowered risk of PAD, but these interventions were typically 1-2 years duration and limited to participants with pre-existing vascular disease. Whether long-term homocysteine levels influence the development of incident PAD remains uncertain.

Objective:
To examine the association between levels of plasma homocysteine and dietary B vitamins (folate, B6 and B12) and risk of PAD.

Methods:
We identified 276 cases of PAD in the Nurses’ Health Study (NHS) which followed 121,700 female nurses from 1980-2010, and 406 cases in the Health Professionals Follow-up Study (HPFS) which followed 51,529 male health professionals from 1986 to 2008. B vitamin intake was measured using a FFQ administered every four years. After excluding individuals with a history of CVD at baseline, plasma homocysteine was measured in baseline blood samples in two nested case-control studies with three controls matched to each case: NHS (1989-2010; 144 cases and 432 controls) and HPFS (1994-2008; 143 cases and 429 controls). PAD cases were confirmed by medical record based on at least one of: (1) amputation, bypass, or revascularization procedure, (2) angiogram/ultrasound confirming at least 50% stenosis, (3) ankle-brachial index < 0.9, or (4) documented physician’s diagnosis. We used Cox proportional hazards models to estimate hazard ratios (HR) for PAD in the cohorts and conditional logistic regression to estimate relative risks (RR) for PAD in the nested case-control studies.

Results:
Men in the highest tertile of plasma homocysteine had more than double the risk of PAD compared to men in the lowest tertile (Table). This association was not replicated in women. Lower folate intake was also associated with an increased risk of PAD in men but not women (Table). Total B6 and B12 intake was not consistently associated with risk of PAD in men or women.

Conclusions:
Higher plasma homocysteine levels were associated with an increased risk of PAD in men but not women.
Abstract P118: Association of Comorbid Depression and Diabetes with Mortality: A Pooled Cohort Analysis
Authors: Carnethon Mercedes R , De Chavez Peter John D , Golden Sherita H , Campbell-Jenkins Brenda , Biggs Mary L , Lewis Tene T , Durant Nefertiti , Liu Kiang , Tindle Hillary , Dyer Alan R
Published: July 2021

Background:
Reports from prior studies testing whether adults with comorbid depression and diabetes have higher mortality than adults with diabetes alone are inconsistent. Explanations may include sample sizes, inadequate follow-up, or populations selected based on disease status (e.g., post- CHD). In a large sample of adults free from prevalent CHD, we tested whether the presence of depressive symptoms in persons with diabetes led to higher mortality than what would be expected by either condition alone.

Methods:
Participants from the Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study and Multi-Ethnic Study of Atherosclerosis longitudinal cohort studies who had measures available to determine diabetes, depression and mortality were included in the analysis (n=17,160). Diabetes was determined based on medication use or fasting glucose > 126 mg/dL. Centers for Epidemiologic Studies Depression (CES-D) scores > 16 (> 8 short version) indicated high depressive symptoms. We tested whether comorbid depressive symptoms and diabetes exceeded what would be expected by the sum of the two conditions independently on the additive scale by calculating the Relative Excess Risk due to Interaction (RERI; > 0 indicates interaction).

Results:
Crude mortality was highest in participants who had high depressive symptoms and diabetes, followed by participants who had diabetes and low depressive symptoms. Despite a significantly elevated adjusted hazard ratios (HR) comparing participants with diabetes who had high vs. low depressive symptoms, the RERI was 0.058 (95% confidence interval [CI]: -0.298, 0.413) indicating an absence of additive interaction. Findings were similar across strata by sex, age (< 65, >65), race (non-white vs. white) and education (< high school vs. > high school).

Conclusions:
While comorbid diabetes and depressive symptoms do not act synergistically to increase mortality, death rates are highest in this subgroup of participants.
Abstract P139: Do Your Income and Occupation Affect Your Leisure Time Physical Activity? Evidence from NHANES 1999-2006
Authors: Kakinami Lisa , Barnett Tracie , Gauvin Lise , Paradis Gilles
Published: July 2021

Background:
Over ¾ of Americans fail to meet the AHA recommendations for leisure time physical activity (LTPA), with higher proportions found among lower income adults. However, this association may be moderated by activity levels that are necessary as a part of daily life, such as active transportation among those that cannot afford a vehicle, or physical labor in some lower wage-earning occupations. Data are limited to studies either not distinguishing between occupational and daily life PA, or using broad occupation job titles which may not represent the PA on an individual level.

Objective:
Determine the association between activity levels of daily life and LTPA.

Methods:
Participants were adults (20+ years) from the 1999-2006 National Health and Nutrition Examination Survey. Analyses were stratified by self-reported lifestyle (work, housework and school): 1) sedentary during the day (n=4233); 2) minimally active: stands or walks but does not carry or lift things often (n=11,853); 3) moderately active: carries light objects, or climbs hills often (n=4117); and 4) and very active: carries heavy objects (n=1586). Multivariable linear regression analyzed the association between annual household income (<$20K, $20K-45K, $45K-75K, $75K+ [reference]) and self-reported weekly minutes of moderate, vigorous, and total LTPA. Analyses included sampling weights to account for NHANES’ complex sampling design and adjusted for sex, age, marital status, ethnicity, weight status, whether the person actively commuted, and number of hours worked per week.

Results:
Lower income participants that were either very active, or sedentary during the day reported significantly less LTPA than those with comparable daily life activity levels but annual income $75K+.

Conclusions:
A gradient relationship between income and LTPA was seen in the two lifestyle extremes: the sedentary and very active. Public health actions aimed at increasing LTPA should be multimodal and aimed at changing both messaging and environments likely to promote LTPA.
Abstract P143: Vigorous Physical Activity and 3-year Changes in Weight and Other Cardiometabolic Parameters in Youth: A Prospective Cohort Study
Authors: McGavock Jonathan , Carson Valerie , Rinaldi Randi Lynn , Torrance Brian , Maximova Katerina , Ball Geoff D ,   Healthy Heart Investigator Team
Published: July 2021

Introduction:
Few data exist describing the temporal association between the time spent within various intensities of physical activity (PA) and cardiometabolic health outcomes in youth.

Study Hypotheses:
In contrast to light- or moderate-intensity physical activity (PA) Vigorous- intensity PA would be associated with a reduced risk incident overweight and high normal blood pressure and (2) time spent in vigorous-intensity but not moderate- or light-intensity PA would be associated with cardiometabolic risk factors two years following baseline measurements.

Design and Methods:
This was a 3-year prospective cohort study of objectively-measured PA (Actical) in 315 youth aged 9 to-17 yrs of age studied in 14 schools. The primary exposure variable was PA intensity. The main outcomes measures were incident overweght status and high normal blood pressure. Secondary outcomes included disproportionate weight gain (annual change in body mass index Z score), waist circumference, systolic blood pressure (SBP), and cardiorespiratory fitness (VO
2
max) at the three year time point.

Results:
After three year follow-up, increasing time spent in any of the three PA intensities was not associated with incident overweight or incident high normal blood pressure. Compared to the lowest quartile, waist circumference [β = -0.04 95% CI = -0.07 to -0.01; p trend <0.01) and SBP [β = -3.08 95% CI = -6.79 to 0.64; p trend = 0.05] were lower in boys while VO
2
max was significantly higher [43.3 (39.6-46.4) vs 50.2 (43.8-52.9) mL/kg/min; p trend <0.01] in both boys and girls in the highest quartile of vigorous PA. These trends were not observed or reversed across quartiles of moderate- and light-intensity PA.

Conclusions:
Increasing time spent in vigorous-intensity PA at 12 years of age was associated with a more favorable cardiometabolic profile two years later. Similar trends were not evident for lower intensity PA. Experimental trials are needed to determine if these associations are causal in nature.