bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P159: No Gender Difference in All-Cause Mortality Rates in a Cohort of Heart Failure With Preserved Ejection Fraction in the US Veteran Population
Authors: Kurgansky Katherine E , Gagnon David , Cho Kelly , Gaziano J M , Joseph Jacob , Djousse Luc
Published: July 2021

Introduction:
Heart failure with preserved ejection fraction (HFpEF) affects about 5% of people 65 or older, with a higher prevalence in women. Previous studies suggest that women with HFpEF may live longer than men. Further understanding of mortality outcomes by gender could be useful in implementing gender-specific treatment strategies to improve outcomes in HFpEF patients.

Hypothesis:
We assessed the hypothesis that women have a lower rate of total mortality than males in a US Veteran HFpEF cohort.

Methods:
We used a validated algorithm to curate a HFpEF cohort using ICD9 codes, laboratory values, medications, and ejection fraction values from the national Veterans Affairs database. This algorithm had 88% sensitivity and 96% specificity. We examined crude and adjusted mortality rates by gender, beginning at the time of heart failure diagnosis with follow-up through 2016. The adjusted mortality rate was directly standardized to the population of veterans with heart failure (n= 626,179) according to distribution of age, race, cardiovascular disease (CVD), and chronic kidney disease (CKD). Crude and standardized rate ratios were calculated from the mortality rates.

Results:
Our HFpEF cohort (n= 74,937) included 72,267 men and 2,670 women. Mean age was 72.5 (11.2) in men and 69.1 (14.3) in women at the time of heart failure diagnosis. Males were 85.2% white, 33.7% had CVD, and 27.1% had CKD, whereas females were 82.5% white, 28.7% had CVD, and 20.5% had CKD. During a mean follow up of 4.8 (3.7) years, 52,703 deaths occurred in men and 1,614 deaths occurred in women.The crude mortality rate was significantly lower for females (109.7/1000 person-years) compared to males (153.5/1000 person-years). Corresponding crude incidence rate ratio (95% CI) for total mortality comparing females to males was 0.71 (0.69-0.74; p<.0001). However, after standardizing, there was no significant difference in total mortality rates between men (170.0/1000 person-years) and women (173.4/1000 person-years). The standardized mortality rate ratio was 1.02 (95% CI: 0.84-1.23; p=0.8397).

Conclusions:
In conclusion, our data do not show any difference in total mortality rate between men and women following the diagnosis of HFpEF.
Abstract P163: Coffee Consumption and Risk of Heart Failure in the Physicians’ Health Study
Authors: Bodar Vijaykumar , Chen Jiaying , Sesso Howard , Gaziano MIchael , Djousse Luc
Published: July 2021

Background:
Coffee consumption is highly prevalent in the United States (US). While previous studies have reported a positive association of coffee consumption with hypertension (HTN) and coronary artery disease, only a few studies have examined the association of coffee consumption with risk of heart failure. Hence, we sought to examine the relation between coffee consumption and risk of heart failure among male physicians.

Hypothesis:
We hypothesized that coffee consumption is inversely associated with the risk of heart failure.

Method:
We prospectively studied 20,433 middle-aged and older men from The Physicians’ Health Study. Coffee consumption was assessed using a semi-quantitative food frequency questionnaire. The incidence of heart failure was assessed using annual questionnaires and validated in a subsample using review of medical records. We used Cox Proportional hazard model to compute the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) across categories of coffee and calorie adjusted caffeine intake, and cubic spline to estimate nonlinear trend.

Results:
The average age was 66.4 years. During a mean follow-up of 9.3 years, a total of 901 new cases of heart failure were reported. In a Cox model adjusting for age, diabetes, smoking, atrial fibrillation, exercise, and alcohol intake, the HRs (95% CIs) of heart failure were 1.0(reference), 0.89(0.67-1.20), 1.27(1.00-1.62), 0.99 (0.80 - 1.22), 1.19 (0.99- 1.43), and 1.37 (1.05 - 1.80) for coffee consumption of almost never, <=1 cup/week, 2-6cups/week, 1cup/day, 2-3cups/day, and 4+cups/day, respectively; P for nonlinear trend = 0.02.

In a secondary analysis, higher caffeine intake was associated with a higher risk of heart failure, with Multivariable HRs (95% CIs) from the lowest to the highest quintile of dietary caffeine were 1.00(reference), 1.10 (0.90-1.35), 1.00 (0.81-1.25), 1.17 (0.95-1.45), and 1.25 (1.00-1.56), respectively; P for nonlinear trend = 0.06.

Conclusion:
Heavy (+4 cups/day), but not light to moderate, coffee consumption is associated with a higher risk of heart failure.
Abstract P172: Associations of Body Mass Index From Early-, Mid-, and Older- Adulthood With Incident Heart Failure and Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis
Authors: Fliotsos Michael J , Zhao Di , Ndumele Chiadi , Guallar Eliseo , Burke Gregory L , Vaidya Dhananjay , Rao Vishal , Delaney Joseph (Chris) A , Michos Erin D
Published: July 2021

Background:
Obesity contributes significantly to increased risk of cardiovascular disease (CVD) and particularly heart failure (HF). However, an elevated body mass index (BMI) in older adults might not fully reflect the additional risk associated with excess weight at a younger age. We determined the prognostic value of self-reported weights from early- and mid-adulthood, after accounting for current weight, with incident HF and CVD.

Methods:
We studied 6,437 MESA participants (aged 45-84 years) with self-reported weights at ages 20 and 40 (by questionnaire) and measured weight at the baseline exam (2000-2002). BMI was calculated using measured height at baseline. Cox hazard models assessed relationships between BMI at each age with HF and CVD.

Results:
Participant mean age was 62±10 years and 53% were women. Over a median follow-up of 13 years, 290 HF and 828 CVD events occurred. Elevated BMI at each age point (age 20, age 40, and MESA baseline) was independently associated with HF, and to lesser extent with CVD (
Figure
). After adjustment for demographics, CVD risk factors, and baseline BMI, higher self-reported BMIs at ages 20 and 40 years were independently associated with increased risk of incident HF with hazard ratios (HR) 1.18 (95% CI 1.05-1.32) and 1.30 (1.15-1.46), respectively, per 1 SD higher BMI. Participants with self-reported obesity (BMI≥30) at age 20 [HR 3.20 (1.93-5.32)] and age 40 [HR 1.92 (1.31-2.83)] had greater HF risk, even after accounting for current BMI. For incident CVD, only higher self-reported BMI at age 20 (per 1 SD) was associated after accounting for current BMI [HR 1.09 (1.01-1.17)].

Conclusions:
Assessment of self-reported lifetime weights is a simple tool utilized in any clinical encounter. Although subject to recall bias, self-reported weights provide prognostic information about future HF risk, incremental to current BMI, in a multi-ethnic cohort of middle-aged to older adults.
Abstract P174: Early Onset Parental Hypertension is Associated With Hypertension Status of Their Offspring
Authors: Jeon Yongwoo , Kim Hyeon Chang , Yeom Hyungseon , Jeon Dahye , Shim Jee-Seon , Khaw Kay-Tee , Suh Il
Published: July 2021

Background:
Family history is a important risk factor for hypertension (HT), however impacts of parental early onset versus late onset on offspring’s HT has not been explored yet in Asian countries.

Methods and Results:
We analyzed 1,524 participants from two Korean prospective cohorts in cross-sectional design. Early onset was defined as onset before age of 55 and participants were categorized according to parental hypertension(PH) status; “No PH”, “late onset PH” and “early onset PH”. Logistic regression was conducted to compare risks of HT on parental, maternal and paternal HT status. Participants’ HT onset age was compared using least-square means. Overall prevalence of HT was 25.7% (392/1,524) and that of “early onset PH” group was 33.7% (98/291). This group conferred an OR of 3.83 (95% CI, 2.67-5.54) for HT. The onset age of HT was earliest in this group (48.2 years; 95% CI, 47.3-49.2).

Conclusions:
Early onset HT in parents was associated with high HT prevalence in offspring and also with their onset age. Therefore, for applying early prevention and intervention to the high risk population, it would be beneficial to identify whether individuals had early onset PH.
Abstract P213: Change in Diet Quality and Risk of Incident Diabetes: The Atherosclerosis Risk in Communities Study
Authors: Xu Zhe , Steffen Lyn M , Selvin Elizabeth , Rebholz Casey M
Published: July 2021

Introduction:
Despite the well-established association between diet and chronic disease risk, there is limited evidence on the association between diet change and long-term risk of diabetes in a community-based setting.

Hypothesis:
Decline in diet quality is associated with an increased risk for incidence of diabetes in the Atherosclerosis Risk in Communities (ARIC) Study.

Methods:
We included 8285 ARIC participants who had complete dietary intake assessments by food frequency questionnaire (FFQ) at both visits 1 (1987-1989) and 3 (1993-1995) and had no prevalent diabetes, cardiovascular disease, or cancer prior to visit 3. Change in diet quality was assessed using the Healthy Eating Index (HEI)-2015 and the Alternative HEI (AHEI)-2010 scores calculated at the two study visits. Change in scores was classified into five categories from moderate/large decrease to moderate/large increase. We used adjusted Cox models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between HEI-2015/AHEI-2010 score changes and incidence of diabetes, which is defined using doctor diagnosis, medication use, or elevated glucose.

Results:
There were 2,136 cases of incident diabetes during a median of 18.05 years of follow-up (124,639 person-years). For HEI-2015, there were no statistically significant association between dietary score change and diabetes risk, comparing the five categories of changes (adjusted HRs and 95% CIs for the five categories from decrease to increase were 1.06 [0.90-1.25],1.04 [0.90-1.21],1.00 (ref.), 0.91 [0.79-1.05], 1.04 [0.91-1.20]). Similar trends were found in AHEI-2010 scores changes, but for the moderate to large decrease group, the decrease in dietary scores was associated with a higher diabetes risk (HR 1.23, 95%CI 1.03 to 1.46), compared to the stable group.

Conclusion:
The results suggest that deterioration of diet quality is associated with a higher risk of diabetes.
Abstract P216: Elevated Blood Glutathione Does Not Reduce Arterial Stiffness or Central Blood Pressure in Healthy Males and Females
Authors: Bruggeman Brianna K , Storo Katharine E , Fair Haley M , Wommack Andrew J , Smoliga James M , Carriker Colin R
Published: July 2021

Intro:
Glutathione is endogenous within human plasma, erythrocyte lysate and is also bound to the protein within plasma. Glutathione mediates redox chemistry and prevents oxidative damage within and around cellular components via reduction of reactive species (e.g. reactive oxygen, nitrogen, or sulfur species). Polyphenols and antioxidants have been shown to improve NO bioavailability which may reduce long term incidence of endothelial dysfunction. Less is known about whether changes in antioxidant capacity augments the risk of developing hypertension.

Hypothesis:
We hypothesized that acute glutathione supplementation would decrease arterial stiffness and reduce both brachial (bBP) and central blood pressure (cBP) in healthy male and female volunteers.

Methods:
Six males and six females (25 ± 3 and 22 ± 1 years, respectively) participated in a randomized, double blind, placebo controlled, crossover protocol. On two visits separated by 1 week, following a 12-hour fast, participants consumed either a placebo or glutathione (negligible and 200 mg, respectively) supplement via 90 second sublingual absorption which was then swallowed. Concentrations of oxidized (GSSG) and reduced glutathione (GSH) were spectrophotometrically measured in plasma (protein-bound) and erythrocyte lysate using a kinetic, enzymatic assay. Arterial stiffness was measured via pulse wave velocity (PWV) using applanation tonometry, and cBP was determined non-invasively using pulse wave analysis. All data were recorded before supplementation (baseline) and at 10, 30, 60 and 120 minutes post-consumption.

Results:
Linear mixed effect models revealed a significant (p<0.01) increase in total glutathione (GSH+GSSG) in the supplement group compared to placebo across all post-supplementation time points with the greatest increase occurring at 120 minutes (mean 99.0; 95%CI: 7.9,190.1). At 120 minutes post-consumption, no difference was present between glutathione and placebo groups for PWV (5.86 ± 1.19 and 6.08 ± 1.25 m/s, respectively; p=0.43), resting heart rate (52.95 ± 3.55 and 55.83 ± 6.36, respectively; p=0.16), systolic bBP (123.05 ± 12.75 and 123.13 ± 14.52 mmHg; p=0.22), diastolic bBP (71.81 ± 7.87 and 74.21 ± 6.53; p=0.48), systolic cBP (108.05 ± 10.45 and 108.68 ± 11.14 mmHg, respectively; p=0.11) and diastolic cBP (72.03 ± 7.82 and 74.94 ± 6.42 mmHg, respectively; p=0.46).

Conclusion:
Young healthy males and females experienced an increase in circulating humoral antioxidants in response to glutathione supplementation. However, supplementation had minimal effects on resting hemodynamics. Future research should examine glutathione supplementation’s effect in participants with decreased antioxidant capacity and increased oxidative stress including patients with known disease such as hypertension or peripheral artery disease.
Abstract P231: Alcohol Consumption and Hospitalization Risk: Prospective Results From the Moli-sani Study
Authors: Costanzo Simona , Mukamal Kenneth J , Di Castelnuovo Augusto , Olivieri Marco , Bonaccio Marialaura , De Curtis Amalia , Persichillo Mariarosaria , Cerletti Chiara , Donati Maria B , de Gaetano Giovanni , Iacoviello Licia ,   on behalf of the Moli-sani Study Investigators
Published: July 2021

Introduction:
To evaluate the broad impact of alcohol on health and healthcare utilization, the dose-response relationship of alcohol intake with all-cause and cause-specific hospitalizations was examined.

Methods:
In the Moli-sani study, an Italian population-based cohort, we followed 20,682 initially healthy individuals (48% men, age ≥35 y) free of CVD or cancer. Alcohol intake in the year before enrolment was assessed by the Italian EPIC-FFQ and classified as: abstainers (referent), ex-drinkers, occasional drinkers (<1 gr/day), 1-12, 12.1-24, 24.1-48 and >48 gr/day. We identified hospitalizations by linkage to the regional hospitalization registry. Cause-specific hospitalizations were assigned by the ICD9 code of the primary admission diagnosis. We estimated incidence rate ratios (IRR) for admission by Poisson regression, accounting for repeated hospitalizations.

Results:
At baseline, 27% of participants were abstainers, 3% ex-drinkers, 6% occasional drinkers and 64% regular current drinkers. During a median follow-up of 6.3 y, 12,996 hospital admissions occurred. In multivariable analyses, occasional consumption and intake up to 48 gr/day were associated with a lower risk of all-cause hospitalization than was abstention. There was a roughly dose-dependent association with lower risk of hospitalization for vascular disease. Excessive alcohol consumption was associated with a higher risk of hospitalization for alcohol-related diseases (IRR: 1.92, 95% CI: 1.43-2.59) and for cancer (IRR: 1.33, 95% CI: 1.08-1.63). Former drinkers were at higher risk for vascular and alcohol-related hospitalization. No association was observed with hospitalization for trauma.

Conclusions:
Heavy alcohol consumption is associated with higher risk of hospitalization for alcohol-attributable conditions and cancer, but intake up to 48 gr/day is associated with lower risk of all-cause and vascular hospitalization. These estimates highlight the different healthcare burden imposed by varying levels of alcohol intake.
Abstract P243: Endothelial Function, Arterial Stiffness and Central Blood Pressure are Not Affected by a Single Dose of Dietary Nitrate in Healthy Normotensive Females
Authors: Storo Katharine E , Harrison Caleb D , Bockover Evan J , Ratcliffe Brycen J , Crowe Sierra , Morales Francisco J , Fair Haley M , Gurovich Alvaro N , Carriker Colin R
Published: July 2021

Intro:
Hypertension is a prominent risk factor for cardiovascular disease and arterial stiffness is a related predictor of both mortality and longitudinal onset of hypertension in normotensive individuals. Both vascular compliance and blood pressure have been shown to improve following dietary nitrate supplementation in some healthy and diseased individuals. Dietary nitrate supplementation increases plasma nitrite and may, therefore, enhance bioavailability of endothelium derived nitric oxide. Chronic increased flow mediated dilation (FMD) and reduction of pulse wave velocity (PWV) reduce a person’s long-term risk for developing endothelial dysfunction, atherosclerosis and hypertension.

Hypothesis:
We hypothesized that an acute dose of dietary nitrate would improve FMD, decrease PWV and reduce central blood pressure (cBP) in healthy, young females.

Methods:
Seven healthy, young (21 ± 2 years) females participated in a randomized, double blind, placebo controlled, crossover protocol. Participants had endothelial function measured via FMD, arterial stiffness via PWV and applanation tonometry, and cBP was determined non-invasively using pulse wave analysis following a 12-hour fasting period and 48-hour NIH approved low nitrate diet. Baseline values were measured the day before each treatment visit (placebo or nitrate-rich, separated by a 1-week washout period). Participants consumed either a placebo or nitrate-rich supplement (negligible and 6.2 mmol nitrate, respectively) 2 hours prior to their laboratory visit. Upon arrival, blood was drawn and participants assumed a supine position for 15 minutes. Then brachial artery FMD was assessed via high definition ultrasound imaging following 5 minutes of proximal forearm occlusion, followed by PWV and central blood pressure measurements.

Results:
Plasma nitrite was elevated following consumption of the nitrate rich supplement compared to placebo (26.33 ± 15.76 and 1.18 ± 0.96 arbitrary units, respectively; p<0.05). However, there was no difference between nitrate rich and placebo treatments for endothelial function as measured by FMD (10.33 ± 1.82 and 9.11 ± 5.43%, respectively; p=0.70). No difference was present between nitrate and placebo groups for PWV (5.99 ± 0.85 and 6.16 ± 0.80 m/s, respectively; p=0.90), systolic cBP (101.57 ± 9.29 and 96.90 ± 20.95 mmHg, respectively; p=0.40) and diastolic cBP (72.57 ± 7.67 and 73.20 ± 5.01 mmHg, respectively; p=0.97).

Conclusion:
While a single dose of dietary nitrate does increase plasma nitrite, supplementation has minimal effects on FMD, PWV and cBP in young healthy females. Future research should examine longer duration supplementation protocols as well as the changes in vascular health of patients with known disease such as hypertension or peripheral artery disease.
Abstract P247: Under-reporters of Caloric Intake Have Worst Cardiometabolic Risk Profile Among Children at Risk of Obesity
Authors: Suissa Karine , Benedetti Andrea , Henderson Melanie , Gray-Donald Katherine , Paradis Gilles
Published: July 2021

Introduction:
Misreporting of dietary data in nutritional epidemiology is a major concern for information bias, as they rely on subjects’ ability to accurately remember and report the foods they consumed. In children, underreporting is common and tends to occur differentially according to certain characteristics. We sought to describe characteristics of under-reporters (UR) within a cohort of children with a parental history of obesity, and to examine the bias introduced with underreporting in children.

Methods:
Data stem from the QUALITY cohort of 630 children, 8-10 years at recruitment with at least one obese parent. Three separate 24-hour dietary recalls were administered by a dietitian at baseline. Child and parent characteristics were obtained through direct measurement (blood pressure, blood lipids, anthropometrics) or questionnaires (socio-economic characteristics). Goldberg's cut-off method identified UR, by comparing a ratio of reported energy intake and basal metabolic rate to a calculated cut-off value. We used logistic regression to identify correlates of UR. We examined the bias resulting from underreporting by comparing the coefficients from the linear regression of BMI z-score after 2 years on glycemic load (GL) at baseline in all participants and in the adequate reporters (AR) subset, after excluding UR.

Results:
We identified 167 UR and 408 AR in the QUALITY cohort based on a calculated Goldberg's cut-off of 1.11. UR had a tendency to be older (9.9 vs. 9.5), had a higher BMI z-score (1.5 vs. 0.4) and had poorer cardiometabolic health indicators including higher SBP, DBP, triglycerides and LDL and lower HDL. UR had a lower family income (38,561 vs. 44,078 $CAN), parents were less educated (47.3% vs. 56.9% with a university education) and had a higher BMI compared to parents of AR. In logistic regression, age per year (OR: 1.48, 95%CI: 1.15-1.91), BMI z-score (OR: 2.04, 95% CI: 1.17-3.54), percent fat mass (OR: 1.06, 95%CI: 1.01-1.12) and family income (OR: 0.86 per 10,000$, 95%CI: 0.76-0.98) were the strongest correlates of underreporting. Linear regressions showed that the association between BMI and GL was null when all participants were included, but became significantly positive (ß=0.06 per 10 units, 95%CI: 0.05-0.07) after exclusion of the UR.

Conclusion:
In the QUALITY cohort, UR were different from AR. Underreporting is an important source of error in nutritional epidemiology that can bias measurement of nutritional exposures and the assessment of exposure outcome relationships. To prevent this bias, UR must be identified and an appropriate correction method must be used.
Abstract P256: Stability of Obesity and Metabolic Health and the Risk of Cardiovascular Disease
Authors: Sponholtz Todd , Echouffo-Tcheugui Justin B , Vasan Ramachandran S
Published: July 2021

Introduction:
Metabolic syndrome (MetSyn) reportedly confers higher risk of cardiovascular disease (CVD) than its individual components. Although typically defined as a binary exposure, each of its component factors can vary over time. Little is known about whether CVD risk differs according to MetSyn stability.

Methods:
We defined longitudinal states of obesity and metabolic health among 2,952 Framingham Offspring Study participants for whom we had sufficient data to define MetSyn at ≥4 exams between Exams 2 (1979-1983) and 9 (2011-2014). Obesity was defined as BMI ≥30 kg/m
2
, high triglycerides as ≥150 mg/dL/taking lipid-lowering medication, low HDL as <40 mg/dL for males/ <50 mg/dL for females; high blood pressure as systolic blood pressure ≥130 mm Hg/diastolic blood pressure ≥85 mm Hg/taking antihypertensive medication, and high blood glucose as ≥100 mg/dL/taking antidiabetic medication. Metabolic health was defined as having <2 metabolic conditions. Obesity and metabolic health were classified as
unstable
if there was a change from one state to the other in ≥33% of observations occurring before a CVD event or end of follow-up, stable obese/metabolically unhealthy if not unstable and >50% of observations were classified as stable obese/metabolically unhealthy, or stable non-obese/metabolically healthy otherwise. CVD was defined as any of the following coronary death, myocardial infarction, coronary insufficiency, angina pectoris, stroke, transient ischemic attack, intermittent claudication, or congestive heart failure. We estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) using Cox proportional hazards regression with age as the time scale.

Results:
We classified 332 participants (11.3%) as having unstable metabolic health, and 130 (4.4%) as having unstable obesity. We observed 1,206 events in 75,673 person-years of follow-up (median 30 years). Participants classified as stable metabolically unhealthy had the highest CVD risk (HR 1.77, 95% CI 1.47, 2.13, compared to stable metabolically healthy). Stable obesity was associated with a 48% (95% CI 24, 80) increase in CVD risk relative to stable non-obese. Unstable metabolic health and obesity were associated with moderate increases in risk compared to stable metabolically healthy and stable non-obese (HRs: 1.32, 95% CI 1.03, 1.71 and 1.25, 95% CI 0.88, 1.77, respectively). There was no interaction between obesity- and metabolic health stability (p
interaction
=0.23).

Conclusions:
In our sample, stability of obesity and of metabolic health influenced CVD risk, with the highest risk of CVD observed among stable metabolically unhealthy participants. Instability of both obesity and metabolic health convey a risk intermediate between the stable obese/metabolically healthy and stable non-obese/metabolically unhealthy conditions.
Abstract P258: Prevalence of Metabolically Healthy Obesity in US Adult Population: NHANES 1999-2014
Authors: Liu Tingting , Li Changwei , Li Shengxu
Published: July 2021

Background:
Obesity prevalence has been increasing while cardiometabolic mortality has been decreasing. The reasons for this paradox are not fully understood.

Aim:
To test the hypothesis that the prevalence of metabolically healthy obesity (MHO) in the U.S. adult population increases over time.

Methods:
The study included 16,459 participants of the National Health and Nutrition Examination Survey (NHANES) 1999-2014. MHO was defined as central obesity (waist circumference≥102 cm for men and ≥88 cm for women) without any of the following conditions: elevated levels of blood pressure (<125/85 mm Hg), glucose (<100 mg/dL), and triglycerides (<150 mm/dL), reduced levels of high-density lipoprotein cholesterol (≥40 mg/dL for men and ≥50 mg/dL for women), and any medication use for high cholesterol, hypertension, or diabetes.

Results:
The prevalence of central obesity increased from 45.17% in 1999-2000 to 56.72% in 2013-2014 (P=0.003). MHO prevalence increased from 4.95% in 1999-2000 to 8.92% in 2013-2014. Among those with central obesity, the proportion of MHO increased from 11.0% in 1999-2000 to 15.7% in 2013-2014. Female gender, a younger age, being Hispanic and non-Hispanic Black, and high education (some college or above) were associated with higher prevalence of MHO.

Conclusions:
While the prevalence of central obesity in the U.S. population has increased, the prevalence of MHO and the proportion of MHO among those who are centrally obese have also increased since 1999, which may partly contribute to the paradox between increased obesity prevalence and reduced cardiometabolic mortality.
Abstract P264: Six-Year Incidence of Overweight and Obesity Among Diverse Hispanic/Latino Adults in the US: The Hispanic Community Health Study/ Study of Latinos
Authors: Pirzada Amber , Durazo-Arvizu Ramon A , Sotres-Alvarez Daniela , Isasi Carmen R , Argos Maria , Castaneda Sheila F , Gallo Linda C , García Melawhy L , Perreira Krista M , Turyk Mary , Van Horn Linda , Wu Donghong , Persky Victoria W , Daviglus Martha L
Published: July 2021

Baseline HCHS/SOL data recently showed that prevalence of obesity varied markedly by sex and Hispanic/Latino background. Despite increasing prevalence of obesity in the US, little data exist on incidence of overweight and obesity in diverse US Hispanic/Latino adults. This study examined ~6-year incidence rate of overweight and obesity in this population by demographic factors.

Methods:
HCHS/SOL is a multi-center prospective community-based study of 16,415 diverse Hispanic/Latino adults in the US, ages 18-74 at Visit 1 (2008-11). Visit 2 (2014-17) is ongoing, with 10,914 persons reexamined by August 2017. Analyses included 10,427 persons with complete data on body mass index (BMI) at both visits and on other variables of interest; underweight persons were excluded. Age-adjusted incidence rate of overweight (BMI 25.0-29.9 kg/m
2
; among those normal-weight at baseline), and obesity (BMI
>
30 kg/m
2
; in those non-obese at baseline) was computed by sex and Hispanic/Latino background, accounting for the complex study design.

Results:
In ~6 years, 572 and 765 new cases of overweight and obesity were seen among baseline normal-weight (n=1924) and non-obese (n=5912) participants, respectively. Among men and women, age-adjusted incidence of overweight was 5.45 and 5.33 per 100 person years (PY); age-adjusted obesity incidence was 2.00 and 2.56 /100 PY. Incidence rates varied by background. Among men, overweight incidence was highest in those of Mexican background (6.95 /100 PY), and among women, in those of Puerto Rican background (6.94/ 100 PY). Incidence of obesity was highest in Dominican-background men (2.35/ 100 PY) and Cuban-background women (3.85/ 100 PY) (
Table
). Incidence rates varied slightly by age group, from 4.06 to 5.98/100 PY in those ages 18-44 and 65+ years.

Conclusion:
Of every 100 US Hispanic/Latino adults about 5 and 2 became overweight and obese each year, augmenting the existing high prevalence. Greater efforts are needed to prevent onset of overweight and obesity in this population from young adulthood onwards.
Abstract P268: High Large and Small Artery Elasticity Indexes Decrease the Risk to Develop Hypertension in Women: Skaraborg Hypertension Project
Authors: Daka Bledar , Hellgren Margareta I , Råstam Lennart , Lindblad Ulf
Published: July 2021

Aims:
The aim was to investigate whether non-invasive measurements of the diastolic pulse wave form predicts the incidence of hypertension in population-based cohort.

Methods:
Longitudinal observational study. Between 2002-2005 a sample of 2816 subjects (1400 men) was randomly invited in a cohort study with the goal to study early detection of risk factors for cardiovascular disease. The cohort was followed up between 2012-2014. The mean follow-up time was 9.9 years (±1.1) and in a representative sample of 1327 subjects the protocol was completed. Body mass index was calculated based on measurements at the study clinic. Blood pressure was measured with participants in supine position twice after five minutes rest and the mean was used in analyses. Hypertension was defined based on JNC 8, and diabetes on WHO criteria from 1999. C1 and C2 were assessed using HDI/Pulse wave CR-2000 (Eagan, MN) and were based on three repetitive measurements within 5 min with the patient in a rested supine position. The mean value of the three measurements was used for the statistical calculations. The association between C1 and C2 and systolic and diastolic blood pressure was investigated with linear regression and possible confounding was adjusted in the multivariable regression models.

Results:
The 99 women and 103 men with hypertension at baseline were excluded from analyses. During the follow-up 73 new cases with hypertension were found in women and 95 cases in men. Systolic and diastolic blood pressure was significantly higher at follow-up in both men and women (Men: Baseline SBP 120 (12) mmHg DBP 71 (9) mmHg; Follow-up SBP 125 (12) mmHg DBP 73 (9) mmHg- Women Baseline SBP 115 (13) mmHg DBP 67 (8) mmHg; Follow-up SBP 121 (14) mmHg DBP 70 (9) mmHg). At baseline a strong association was found between both elasticity indexes (C1 and C2) and systolic and diastolic blood pressure in both men and women. C1 was strongly and negatively associated with systolic blood pressure after adjustments for age, BMI, and baseline systolic blood pressure in both men and women (Men .β=-.15 p<0.001, Women β=-.10 p=0.007). Similar results were found for diastolic blood pressure. In similar analyses for C2 was also significantly associated with systolic blood pressure at follow up (Men .β=-.11 p=0.007, Women β=-.10 p=0.013). When analyzing incident cases with hypertension we found that both C1 and C2 could predict hypertension in women but not in men in a model including age, BMI and systolic blood pressure at baseline (C1 Men OR=.97 CI .91, 1.04 Women OR=.87 CI=.79, .97 C2 Men OR=.97 CI .84, 1.03 Women OR=.85 CI=.73, .98)

Conclusions:
This study showed that elasticity indexes are strongly associated with systolic and diastolic blood pressure at follow-up regardless baseline blood pressure at baseline in both men and women. Moreover, high indecxes of artery elasticity C1 and C2 decrease the risk for future hypertension in women.
Abstract P287: Cardiorespiratory Fitness is Associated With Ambulatory Blood Pressure in Adolescents
Authors: Park Eunduck , Volding Devin , Taylor Wendell , Chan Wenyaw , Meininger Janet
Published: July 2021

Introduction:
Low cardiorespiratory fitness (fitness) and high levels of adiposity are independently associated with higher levels of blood pressure in adolescents. However, it remains uncertain whether the associations between fitness and blood pressure are due to fitness itself or results from lower levels of adiposity. Moreover, there are no studies that have determined the extent to which adiposity, including central adiposity, moderates the association between fitness and 24-hour ambulatory blood pressure (ABP).

Hypotheses:
1. Higher levels of fitness will be associated with lower levels of ambulatory systolic (SBP) and diastolic (DBP) blood pressure after adjusting for adiposity and covariates. 2. With adjustments for covariates, adiposity (body mass index [BMI], waist circumference [WC]) will modify the association between fitness and 24-hour SBP and DBP.

Methods:
A cross-sectional study was conducted in Houston, TX with a sample of 370 adolescents aged 11-16 years. Demographically, the sample was 54% female, 37% African American, 31% Hispanic, 29% non-Hispanic white, and 3% other ethnic/racial groups. Fitness was assessed by a height-adjusted step test and estimated by heart rate recovery, defined as the difference between peak heart rate during exercise and heart rate two minutes post-exercise. Adiposity was measured using dichotomized values for percentiles of BMI (≥ 85
th
) and WC (≥ 50
th
). Ambulatory SBP and DBP (Spacelabs model 90207) were measured every 30-60 minutes over 24 hours on a school day. Mixed-effects regression analysis was used to test the hypotheses with the following covariates: activity, location, and position at the time of each ABP measurement, height, age, sex, ethnicity, sexual maturation level, and mother’s education level.

Results:
Hypothesis 1: Each unit increase in fitness was associated with a decrease of SBP (-0.058 mmHg,
p
= 0.001) and DBP (-0.043 mmHg,
p
< 0.0001) after adjustment for WC and covariates. Each unit increase in fitness was associated with a decrease in SBP (-0.058 mmHg,
p
= 0.001) and DBP (-0.045 mmHg,
p
< 0.0001) after adjustment for BMI and covariates. Hypothesis 2: Fitness and BMI ≥ 85
th
percentile (or WC ≥ 50
th
percentile) interactions were not significantly associated with ambulatory SBP or DBP after adjustment for covariates.

Conclusions:
Our findings indicate a small but statistically significant inverse effect of fitness on 24-hour ABP in adolescents, and no evidence of a modifying effect of adiposity on this association. Further research is needed to better understand the protective role of fitness on cardiovascular health in adolescents.
Abstract P291: History of Preeclampsia and Subclinical Cardiovascular Disease in Mexican Women
Authors: Mata Jazmin , Catzin-Kulhmann Andrés , Ortiz-Panozo Eduardo , Cantú-Brito Carlos , Espinosa Luis , Rodriguez Beatriz , Lajous Martín , López-Ridaura Ruy
Published: July 2021

Introduction:
Preeclampsia is a multisystem hypertensive disorder that affects 4 to 16% of all pregnancies worldwide. Because of its impact on maternal mortality and morbidity, it is considered a major public health problem. However its role as a risk factor for future cardiovascular events, especially subclinical cardiovascular disease, remains unknown.

Hypothesis:
Women with history of preeclampsia have an increased risk of subclinical cardiovascular disease (sCVD) compared with women with normal pregnancies.

Methods:
We conducted a cross-sectional analysis of a sample of 1999 women without cardiovascular disease from the Mexican Teacher's Cohort to assess the relationship between history of preeclampsia and carotid intima media thickness (IMT). Information about preeclampsia diagnosis was collected using self-report data from a questionnaire answered by the participants in 2008-2010 which included questions about reproductive history. Carotid IMT was measured on both carotid arteries through ultrasound by standardized neurologists and log transformed. We defined sCVD as mean right and left IMT >0.8mm or the presence of a plaque. Multivariable lineal and logistic regressions were performed to estimate the association between women with history of preeclampsia and IMT or sCVD respectively adjusting for age, sociodemographic factors, BMI at age 18, and age at first pregnancy.

Results:
Women with a history of preeclampsia (187 of 1999) had slightly higher IMT values (0.69 [IQR 0.12]) than women without (0.67 [IQR 0.12]); they also showed higher prevalence of diabetes (34.7% [65 of 187] vs. 16.8% [306 of 1811]), hypertension (33.1% [62 of 187] vs. 21.9% [398 of 1811]), overweight (44.3[83 of 187] % vs. 41.6% [754 of 1811] ), and obesity (43.3% [81 of 187] vs. 35.1% [636 of 1811). The adjusted IMT was 2.36% (95% CI 0.48, 4.27) higher in women with history of preeclampsia compared with those without. There seems to be an association between preeclampsia and sCVD in the adjusted logistic regression model (odds ratio 1.53 95% CI, 0.97, 2.41), however the association lacked statistical significance.

Conclusion:
We found an association between history of preeclampsia and increased carotid IMT values. This results support the need of considering the history of preeclampsia in the risk assessment of cardiovascular disease among women later in life to initiate preventive strategies.
Abstract P294: Greater Peripheral Vasoconstriction During Mental Stress Predicts Adverse Cardiovascular Outcomes
Authors: Kim Jeong Hwan , Hammadah Muhammad , Al Mheid Ibhar , Wilmot Kobina , Ramadan Ronnie , Lima Bruno , Alkhoder Ayman , Obideen Malik , Abdelhadi Naser , Uphoff Irina , Ghafeer Mohamad Mazen , Kaseer Belal , Choudary Fahad , Shah Amit , Raggi Paolo , Vaccarino Viola , Quyyumi Arshed
Published: July 2021

Introduction:
Peripheral arterial vasoconstriction during mental stress (MS) has been associated with mental stress-induced myocardial ischemia, which in turn has been linked with worse cardiovascular outcomes. It is unknown whether the magnitude of peripheral vasoconstriction with MS is predictive of long term outcomes.

Hypothesis:
We hypothesized that greater peripheral arterial vasoconstriction during MS would be associated with adverse events among patients with coronary artery disease (CAD).

Methods:
Four hundred sixty-three patients with stable CAD and normal left ventricular function, (age 63±9, 75% male, 27% Black, EF 60±8 %) underwent MS testing with a standardized public speaking stressor. Digital pulse wave amplitude was continuously measured at baseline and during MS using peripheral arterial tonometry (PAT), and the PAT ratio of pulse wave amplitude (during mental stress/ baseline) was calculated. Cox proportional hazard models were calculated to examine the association between the PAT ratio and outcomes.

Results:
Median PAT ratio during MS was 0.68, indicating 32% average constriction with MS compared to rest. Subjects with greater peripheral constriction [low (<median) PAT ratio] were more likely to be male (80% vs. 70%, P=0.008) compared to those with PAT ratio ≥median, but their risk factor profiles were similar. During 2.8±0.5 year follow-up, 64 patients had adverse cardiac events including 7 cardiovascular deaths, 19 MI, and 54 revascularization events. After adjusting for age, sex, race, hypertension, diabetes, current smoking status, and prior MI, those with low PAT ratio had a greater risk of CV death/MI (HR[hazard ratio] 2.49, 95% CI [1.04-5.99]) and CV death/MI/revascularization (HR 1.77, 95% CI [1.03-3.04]) compared to those with high PAT ratio.

Conclusion:
Greater peripheral arterial vasoconstriction with MS is associated with a higher risk of adverse cardiovascular outcomes in patients with CAD.
Abstract P295: Association Between Remained Number of Teeth and Cardiovascular Disease Among Korean Adults
Authors: Lee Hong Seok , Park Yong-Moon , Han Kyungdo
Published: July 2021

Background:
It has been reported that people with teeth loss have an increased risk of cardiovascular disease. However, there is limited evidence for the specific relationship between remained teeth and cardiovascular disease (CVD).

Method:
Among subjects who participated in Korea National Health and Nutrition Examination Survey conducted in 2008-2013, a total of 12,612 adults with mean age of 60.2±1.2 years old were analyzed. Number of teeth was classified as number less than 20, from 20 to 27 and more than 27. Multiple logistic regression analysis was performed to determine the relationship between cardiovascular disease and remained teeth number after adjusting for potential confounders.

Result:
The prevalence of cardiovascular disease was 6.5%, 3.3% and 1.4% respectively in groups having number less than 20, 20 to 27 and more than 27 (
P
< 0.001). Total number of cardiovascular disease was 666. Diabetes, hypertension, total cholesterol level, waist circumference, metabolic syndrome had large proportion in a group having less than 20 teeth (
P
< 0.001). People having less than 20 remained teeth had statistically significant cardiovascular disease after adjusting for age, sex, body mass index, smoking, drinking alcohol, exercise, education, income status, stress, diabetes, and hypertension. A group having less 20 teeth was likely to have statistically significant relationship with cardiovascular disease. (Odds ratio [OR]: 1.41, 95 % confidence interval [CI]: 1.06-1.89) and stroke (OR:1.90, CI:1.03-3.48).

Conclusion:
Our findings suggest that the number of remained teeth could be a useful additional indicator for assessing cardiovascular disease and stroke
Abstract P296: Poor Functional Capacity is Associated With Peripheral Microvascular Dysfunction in Coronary Artery Disease
Authors: Kim Jeong Hwan , Al-Badri Ahmed , Hammadah Muhammad , Al Mheid Ibhar , Wilmot Kobina , Ramadan Ronnie , Lima Bruno , Alkhoder Ayman , Abdelhadi Naser , Obideen Malik , Uphoff Irina , Ghafeer Mohamad Mazen , Kaseer Belal , Choudary Fahad , Shah Amit , Raggi Paolo , Vaccarino Viola , Quyyumi Arshed
Published: July 2021

Introduction:
Reduced functional capacity, assessed by self-reported Duke Activity Status Index (DASI) is associated with adverse outcomes. Peripheral microvascular dysfunction, measured as reduced digital reactive hyperemia index (RHI) is also associated with adverse events. Whether microvascular dysfunction is related to functional capacity is unknown.

Hypothesis:
We hypothesized that peripheral microvascular dysfunction is associated with diminished functional capacity.

Methods:
In 531 patients with stable CAD (age 62±9, 75% male, 30% Black, EF 55±13%) enrolled in the Mental Ischemia Prognosis Study, self-reported functional capacity was assessed with the DASI questionnaire with a score of >25 as the cutoff for normal. Pulsatile arterial tonometry (EndoPat, Itamar Inc.) was used to measure digital RHI during 5 minutes of upper arm occlusion with blood pressure cuff followed by reperfusion. Logistic regression was used to model reduced RHI (25 vs ≤ 25).

Results:
Median RHI was 2.01 [IQR 1.67, 2.49] while median DASI score was 45 [29,53], equivalent to 8.3 METs. Compared to those with normal DASI score (>25; N=425), subjects with low DASI score (≤25; N=106) had lower RHI (1.88 [1.64, 2.24] vs 2.06 [1.69, 2.54], P=0.048), higher BMI (32±7 kg/m
2
vs 29±5 kg/m
2
, P<0.001), were more likely to be female (48% vs 20%, P<0.001) and Black (42% vs 28%, P=0.005), and more likely to have a history of hypertension (87% vs 75%, P=0.009), diabetes (39% vs 29%, P=0.046), and heart failure (34% vs. 20%, P=0.003). After adjusting for the aforementioned variables in addition to history of dyslipidemia, smoking and prior MI, those with a low DASI score had a significantly higher likelihood of a reduced RHI (<median) (OR 1.72, 95% CI 1.08 - 2.74, P=0.023)

Conclusion:
Poor functional capacity is independently associated with microvascular dysfunction in patients with stable CAD, and illustrates a potential mechanism by which reduced functional capacity increases cardiovascular risk. Whether improvement in functional capacity by exercise/rehabilitation programs improves microvascular function requires further investigation.
Abstract P302: Ethnic Difference of Cardiorespiratory Fitness and Related to Factors in Young Adults: The Nhanes 1999-2004
Authors: LEE Hong Seok , Zhang Zhiwei , Xu Karen , Park Yong-Moon
Published: July 2021

Background:
Cardiorespiratory fitness is a distinct health characteristic that relates to the ability to perform physical activity. Higher cardiorespiratory fitness was reported to have reverse relationship with overall mortality and morbidity rates due to various chronic disease. The assessment of cardiorespiratory fitness was measured by maximal oxygen uptake (VO2max; mL/kg/minute) on a submaximal treadmill test. This study was aimed to examine cardiorespiratory fitness among U.S. adults 20-49 years of age, to describe the distribution of cardiorespiratory fitness and cardiovascular risk factors depends on different ethnicity for without physical limitations or indications of cardiovascular disease.

Method:
Data from the 1999-2004, National Health and Nutrition Examination Survey were used to describe the distribution of cardiorespiratory fitness for adults 20-49 years of age. 8324 out of 31126 subjects have valid values of cardiopulmonary fitness in the dataset with 5391 in low category of cardiorespiratory fitness (VO
2
max < 27), 2606 in medium category (37.1 > VO
2
max ≥27) and 327 in high category (37.1 ≥ VO
2
max). The risk factors for cardiopulmonary fitness was assessed by using logistic regression after adjusting all cardiovascular risk factors. All data were analyzed using SAS Ver. 9.4.

Result:
Overall, there is no significant association of cardiorespiratory fitness with ethnicity (
P
=0.08). 65.9% of study population was male in all races. Among, non-Hispanic whites, those with 25 m
2
/kg > BMI had better cardiorespiratory fitness (more than 37.1 mL/kg/minute) than those with BMI ≥ 35 [Odds ratio (OR): 0.496, Confidence Interval (CI): 0.258-0.957]. A similar pattern was observed for Mexican Americans. Non-Hispanic black with 25 m
2
/kg > BMI had better cardiorespiratory fitness than ones with BMI ≥ 35 m
2
/kg [OR:0.137, CI:0.059-0.318], 35 m
2
/kg > BMI≥30 m
2
/kg [OR:0.269, CI:0.124-0.583], 30 m
2
/kg > BMI≥25 m
2
/kg [OR: 0.241,0.123-0.318]. Non-Hispanic white with higher diastolic blood pressure over 90 mmHg had tendency to have lower cardiorespiratory fitness. Among metabolic panel, only Mexican American with LDL<100 mg/dl has higher cardiorespiratory fitness [OR:0.559, CI:0.319-0.981].

Discussion:
Our findings on cardiorespiratory fitness level among non-Hispanic blacks, non-Hispanic whites and Mexican Americans are similar to previously reported studies, however, non-Hispanic black had different risk factors related to cardiorespiratory fitness, especially significant benefit from lower BMI less than 25 m
2
/kg since other ethnicities with BMI less than 25 m
2
/kg had benefit only compared to BMI> 35 m
2
/kg. These results can be used to improve cardiorespiratory fitness level for future population based on ethnicities. The different risk factors in fitness status can also be used to develop health policies and targeted educational campaigns.