bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 032: Life-Course Socioeconomic Position Relates to Higher Arterial Stiffness in Adults From the ELSA-Brasil Cohort Study
Authors: Coelho Debora M , Camelo Lidyane V , Brant Luisa C , Giatti Luana G , Ribeiro Antonio L , Guimaraes Joanna M , Chor Dora , Barreto Sandhi M
Published: July 2021

Background:
Although the association between socioeconomic adversity and risk for cardiovascular disease (CVD) is established, little is known about the effect of socioeconomic disadvantages across the life-course on arterial stiffness, an important marker of subclinical cardiovascular disease (CVD).

Objective:
To investigate whether exposure to adverse socioeconomic position (SEP) throughout the life course and especially in early life, is associated with increased arterial stiffness in adults. In addition, we assessed whether increasing number of unfavorable SEP events during the life course is associated with higher arterial stiffness.

Methods:
A total of 14,497 adults from the ELSA-Brasil cohort study baseline (2008-2010), aged between 34 and 75 years (45.5% men, mean age: 51.9, SD: 9.09), with validated values of femoral carotid pulse wave velocity (cfPWV), and with information available about maternal education were included. ELSA-Brazil is a multicenter cohort of civil servants from universities and research institutions of six Brazilian cities that aims to investigate the determinants of cardiovascular disease. Arterial stiffness was measured by cfPWV. Childhood and adulthood SEP was measured by maternal education and participants’ own education, respectively. Accumulation of SEP disadvantages across the life course was evaluated using a score including maternal and participants’ own education. The following variables were used for adjustments: age, sex, race, mean arterial pressure, heart rate, smoking, physical activity, diabetes, antihypertensive use. Multiple linear regression models were used.

Results:
Both lower childhood and adulthood SEP were associated with higher cfPWV in adult life, although the association with childhood SEP was not independent of adulthood SEP. However, cfPWV increased with increasing number of unfavorable SEP during the life course. Individuals exposed to low SEP in childhood and adulthood presented an average increase of 0.23m/s (95% CI: 0.13-0.34) in cfPWV in relation to individuals with high SEP in both periods of life. After all adjustments this association remained statically significant (β = 0.18, 95% CI: 0.07-0.29).

Conclusion:
Accumulation of exposures to socioeconomic disadvantages throughout life was associated with higher cfPWV in adults. Thus, it may imply that longer exposure to social disadvantages throughout life accelerates arterial aging.
Abstract 035: Prevalence and Predictors of Cholesterol Screening, Awareness, and Statin Treatment Among Individuals With Familial Hypercholesterolemia in the U.S. (1999-2014)
Authors: Bucholz Emily M , Rodday Angie M , Kolor Katherine , Khoury Muin , deFerranti Sarah D
Published: July 2021

Background:
Familial hypercholesterolemia (FH) significantly increases the risk of atherosclerotic cardiovascular disease (ASCVD); however, recent data from ambulatory care centers suggests that prescription rates for statins remain low in patients with severe dyslipidemia or diagnosed FH. National rates of screening, awareness, and treatment with statins among individuals with FH or severe dyslipidemia are unknown.

Methods:
Data from the 1999 to 2014 National Health and Nutrition Examination Survey (NHANES) were used to estimate prevalence rates of self-reported screening, awareness, and statin therapy among U.S. adults ≥20 years of age (n=42,471 weighted to represent 212 million U.S. adults) with FH (defined using the Dutch Lipid Clinic criteria) and with severe dyslipidemia (defined as low-density lipoprotein cholesterol (LDL-C) levels ≥190mg/dL). Logistic regression was used to identify sociodemographic and clinical correlates of hypercholesterolemia awareness and statin therapy. Results were extrapolated to the U.S. adult population.

Results:
The US prevalence of definite/probable FH was 0.47% (standard error 0.03%) and of severe dyslipidemia was 6.59% (SE 0.17%). Rates of cholesterol screening and awareness were high (>80%) among adults with definite/probable FH or severe dyslipidemia; however, statin use was uniformly low (52.3% (SE 8.2%) of adults with definite/probable FH and 37.6% (SE 1.2%) of adults with severe dyslipidemia). Less than half of those on statins were prescribed a high-intensity statin. The prevalence of statin use in adults with definite/probable FH and severe dyslipidemia increased slightly over time but not faster than trends in the general population. Older age, insurance, having a usual source of care, diabetes, hypertension, and having a personal history of early ASCVD were associated with statin use. The discrepancy between cholesterol screening and treatment rates was most pronounced in younger patients, uninsured patients, and patients without a usual source of care.

Conclusions:
Despite high rates of cholesterol screening and awareness, only about half of U.S adults with FH are on statin therapy and even fewer are prescribed a high-intensity statin; young and uninsured patients are at the highest risk for under treatment. A low rate of statin use in young adults is of particular relevance given the early onset of ASCVD in adults with FH. This study highlights an opportunity and an imperative to improve statin treatment rates in this high-risk population. Additional studies are needed to better understand how to close the gap between screening and treatment among adults with FH and improve treatment rates among those with limited access to care.
Abstract 040: The Effects of Coffee Consumption on Insulin Sensitivity and Other Risk Factors for Type 2 Diabetes
Authors: Alperet Derrick Johnston , Rebello Salome Antonette , Khoo Eric Yin-Hao , Tay Zoey , Seah Sharna Si-Ying , Tai Bee-Choo , Tai E-Shyong , Emady-Azar Shahram , Chou Chieh Jason , Darimont Christian , van Dam Rob M.
Published: July 2021

Background:
In observational studies, coffee consumption has been consistently associated with a lower risk of type 2 diabetes mellitus. Trials examining the effect of coffee consumption on glucose metabolism have been limited by the use of surrogate insulin sensitivity indices, small sample sizes, lack of blinding, and short follow-up duration. We aimed to overcome these limitations in a randomized placebo-controlled trial examining the effects of coffee consumption on insulin sensitivity.

Methodology:
We conducted a 24-week randomized placebo-controlled trial in 126 overweight, insulin-resistant (HOMA-IR ≥ 1.30), Chinese, Malay and Asian-Indian males and females aged 35-69 years. Participants were randomly assigned to receive 4 cups of instant regular coffee (n=62) or 4 cups of a coffee-like placebo beverage (n=64) per day. The primary outcome was bodyweight-standardized M-value (M
bw
) assessed with a hyperinsulinemic euglycemic clamp. Secondary outcomes included other clamp-based insulin sensitivity measures, biological mediators of insulin sensitivity, and measures of fasting glucose metabolism, body weight and composition.

Results:
Coffee consumption did not significantly change insulin sensitivity as compared with placebo [% mean difference in M
bw
: 0.3% (95% CI: -12.0% to 14.2%),
P
=0.97]. Furthermore, no significant differences in fasting plasma glucose [3.0% (-1.1% to 7.3%),
P
=0.16] or biological mediators of insulin resistance, such as plasma adiponectin [1.5% (-3.4% to 6.6%),
P
=0.55], were observed between coffee and placebo groups after 24 weeks of intervention. Coffee consumption led to a loss of body weight as compared with placebo [-1.2% (-2.3% to -0.1%),
P
=0.03] resulting from a decrease in fat mass [-3.7% (-7.1% to -0.2%),
P
=0.04] .

Conclusions:
Consuming 4 cups per day of caffeinated coffee for 24 weeks had no significant effect on insulin sensitivity or biological mediators of insulin resistance. Coffee consumption led to a modest decrease in body fat as compared with coffee abstinence.
Trial Registration:
ClinicalTrials.gov identifier: NCT01738399. Registered on 28 November 2012. Trial Sponsor: Nestlé Research Center, Lausanne, Switzerland. Trial Site: National University of Singapore.
Abstract MP01: NMR Metabolomic Insulin Resistance Multimarkers Are Associated With Incident Diabetes: The CARDIA Study
Authors: Keshawarz Amena , Jacobs David R , Otvos James D , Duprez Daniel A , Rana Jamal S , Snell-Bergeon Janet K
Published: July 2021

Introduction:
Standard lipid panel measures (e.g., low HDL cholesterol and high triglyceride levels) are associated with developing diabetes. Lipoprotein and metabolomics profiles measured by nuclear magnetic resonance (NMR) carry additional information and may add to knowledge of future diabetes risk.

Hypothesis:
We assessed the hypothesis that two multimarkers of insulin resistance derived from NMR LipoProfile
®
analysis, LP-IR (lipoprotein insulin resistance index) and IRDRF (insulin resistance diabetes risk factor index), are associated with incident diabetes independent of traditional risk factors in non-diabetic, apparently healthy subjects.

Methods:
LP-IR and IRDRF were measured at LipoScience/LabCorp for 3,564 non-diabetic participants (mean age 32±4 years, 46% [n=1,646] male) in the Coronary Artery Risk Development in Young Adults (CARDIA) study. LP-IR was calculated from 6 lipoprotein subclass and size parameters. IRDRF was calculated by combining LP-IR with levels of branched-chain amino acids, the inflammatory marker GlycA, and 2 additional lipoprotein subclasses. Diabetes status was ascertained by fasting glucose levels, hemoglobin A1c, and diabetes medications.

We used Cox proportional hazards to model the relationship between LP-IR and IRDRF with incident diabetes. Participants were followed for a mean time of 21±5 years. We considered 4 models that examined LP-IR and IRDRF both as continuous and categorical variables and adjusted for various traditional predictors of diabetes.

Results:
Model 3, which adjusted for components of metabolic syndrome, had the best model fit in all cases (
Table 1
). LP-IR and IRDRF had a significant linear relationship with incident diabetes. Participants who had LP-IR and IRDRF scores in Q4 were significantly more likely to develop diabetes than those with scores in Q1.

Conclusions:
In conclusion, LP-IR and IRDRF can be derived from a clinically-available NMR LipoProfile test, and both were associated with incident diabetes independent of traditional predictors.
Abstract MP07: Soluble Urokinase-type Plasminogen Activator Receptor is associated with progression of hypertension-attributed chronic kidney disease in African Americans
Authors: Luo Shengyuan , Coresh Josef , Tin Adrienne , Rebholz Casey M , Chen Teresa K , Hayek Salim S , Tracy Melissa , Lipkowitz Michael S , Appel Lawrence J , Levey Andrew S , Inker Lesley A , Reiser Jochen , Grams Morgan E
Published: July 2021

Introduction:
Soluble urokinase-type plasminogen activator receptor (suPAR), a circulating signaling protein and marker of immune activation, has been linked to incident and progressive chronic kidney disease (CKD) in select patient populations, often with few African Americans.

Hypothesis:
We assessed the hypothesis that higher circulating levels of suPAR are associated with risk for progression of hypertension-attributed CKD in African Americans.

Methods:
We quantified baseline plasma levels of suPAR in participants of the African-American Study of Kidney Disease and Hypertension (AASK), a clinical trial of African Americans with hypertension-attributed CKD, and regular assessment of measured glomerular filtration rate (mGFR), and proteinuria. We used Cox proportional hazards regression to assess the associations of suPAR with CKD progression (defined as doubling of serum creatinine or end-stage renal disease [ESRD]), ESRD, worsening proteinuria (pre-ESRD doubling of 24-hour urine protein to creatinine ratio [UPCR] to ≥220 mg/g), and all-cause death.

Results:
Among 955 AASK participants, the median baseline suPAR was 4462 pg/mL (25
th
to 75
th
percentile: 3425-5923 pg/mL), mean mGFR was 46 mL/min per 1.73 m
2
, and median 24-hour UPCR was 79.6 mg/g. After controlling for baseline demographics, AASK trial arm, mGFR, proteinuria,
APOL1
risk status, and clinical risk factors, there was a 1.42-times higher risk for CKD progression per two-fold higher baseline suPAR (HR 1.42, 95% CI: 1.17-1.71,
p
<0.001). Higher suPAR was also independently associated with ESRD (HR 1.59, 95% CI: 1.26-2.00,
p
<0.001) and death (HR 1.40, 95% CI: 1.12-1.75,
p
=0.003). Only in patients with two
APOL1
risk alleles was suPAR associated with worsening proteinuria (HR 1.77, 95% CI 1.11-2.82,
p
=0.016;
p
interaction
=0.008).

Conclusion:
Our study provides evidence of associations between higher suPAR levels and risk for various adverse outcomes in African Americans with hypertension-attributed CKD, independent of proteinuria and GFR.
Abstract MP08: Coffee Consumption and Incident Kidney Disease: Results From the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Hu Emily A , Selvin Elizabeth , Grams Morgan E , Steffen Lyn M , Coresh Josef , Rebholz Casey M
Published: July 2021

Background:
Moderate coffee consumption has been consistently associated with a lower risk of diabetes, a major precursor to chronic kidney disease (CKD). However, the association between coffee and CKD has not been fully established.

Hypothesis:
We hypothesized that coffee consumption was associated with a lower risk of incident CKD after adjustment for major covariates among adults in the Atherosclerosis Risk in Communities (ARIC) study.

Methods:
We conducted a prospective analysis of 14,209 participants aged 45-64 years from the ARIC study. Coffee consumption (cups/day) was assessed at visit 1 (1987-89) and visit 3 (1993-95) using food frequency questionnaires. Our primary outcome was incident CKD defined as eGFR <60 mL/min/1.73 m
2
accompanied by ≥25% eGFR decline, CKD-related hospitalization or death, or end-stage renal disease.

Results:
There were 3,845 cases of incident CKD over a median of 24 years of follow-up. Men, whites, current smokers, and participants without comorbidities were more likely to consume higher amounts of coffee per day. After adjustment for demographic, clinical, and dietary factors, higher categories of coffee consumption were associated with lower risk of incident CKD (
Table
). Compared to participants who never consumed coffee, participants who consumed any amount of coffee had an 11% lower risk of CKD (HR: 0.89; 95% CI: 0.82-0.96; p for trend<0.001). In the continuous analysis, for each additional cup of coffee consumed per day, the risk of incident CKD was lower by 3% (HR: 0.97, 95% CI: 0.95-0.99, p<0.001). Results were consistent across the three progressively adjusted models and in a sensitivity analysis using a secondary definition of CKD. Stratification of analyses by smoking status suggested an inverse association among never smokers and former smokers.

Conclusions:
Coffee consumption was inversely associated with incident CKD after adjusting for covariates. Coffee consumption may not adversely affect kidney disease risk and may instead be protective.
Abstract MP10: Increasing Obesity Prevalence in the United States End-stage Renal Disease Population
Authors: Shelton Brittany , McWilliams Deanna , Reed Rhiannon D , Mustian Margaux , MacLennan Paul , Sawinski Deirdre , Locke Jayme E
Published: July 2021

Background:
Obesity has become a national epidemic, and is associated with increased risk for comorbid diseases including end-stage renal disease (ESRD). Among ESRD patients, obesity may improve dialysis-survival but decreases likelihood of transplantation, and as such, obesity prevalence may directly impact growth of the incident dialysis population.

Methods:
Incident adult ESRD patients with complete body mass index (BMI, kg/m
2
) data were identified from the United States Renal Data System from 01/01/1995-12/31/2010 (n=1,822,598). Data from the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention (n=4,303,471) represented the US population when weighted. Trends in BMI and obesity classes I (BMI of 30-34.9), II (BMI of 35-39.9), and III (BMI ≥40) were examined by year of dialysis initiation. Trends in median BMI slope were compared between the ESRD and US populations using linear regression.

Results:
Median BMI of ESRD patients in 1995 was 24.2 as compared to 28.0 in 2010, a 15.7% increase, while the US population’s median BMI increased from 24.2 in 1995 to 25.6 in 2010, a 5.8% increase. Comparable trends were noted with respect to prevalence of obesity classes I, II, and III (Table). BMI increase among the ESRD population was significantly more rapid than among the US population (β: 0.15, 95% CI: 0.14-0.17, p<0.001) (Figure).

Conclusion:
The median BMI of ESRD patients and prevalence of obesity among ESRD patients is increasing more rapidly than the US population. Given the increased dialysis-survival and decreased likelihood of transplantation associated with obesity, healthcare costs will likely increase, and thus, future research should be directed at examining medical expenditures.
Abstract MP11: Serum Metabolites Associate With Kidney Function Among Bogalusa Heart Study Participants
Authors: Nierenberg Jovia L , He Jiang , Li Changwei , Li Shengxu , Bazzano Lydia A , Chen Wei , Kelly Tanika N
Published: July 2021

Chronic kidney disease (CKD) is an important public health challenge due to its high prevalence, potential for progression to end-stage renal disease, and associated increases in risks of cardiovascular disease morbidity and mortality. While traditional risk factors for reduced kidney function have been identified, the biological pathways underlying this complex phenotype remain largely unknown. A metabolome-wide association study was conducted among 825 white and 436 African-American participants of the Bogalusa Heart Study (BHS) to identify metabolites associated with kidney function. Estimated glomerular filtration rate (eGFR) was calculated among BHS participants using the CKD Epidemiology Collaboration (CKD-EPI) equation. Untargeted, ultra-high performance liquid chromatography tandem-mass spectroscopy was used to quantify 1,466 metabolites. A total of 1,202 metabolites passing rigorous quality control were tested for association with eGFR in race stratified and combined multiple regression analyses that adjusted for age, sex, education, cigarette smoking, alcohol drinking, physical activity, body mass index, and race (in combined analyses). Significant metabolites were identified as those achieving Bonferroni corrected significance (P<4.16х10
-5
) in one race group and the entire cohort, with a similar trend observed in the other race group. Results of these analyses are presented in the
Figure
. Among 302 significant metabolites, 89 were novel and in known metabolic pathways, 106 were novel and in unknown metabolic pathways, and 107 were previously reported. The 89 novel metabolites were classified into the following pathways: 40 in amino acids, 3 in carbohydrates, 7 in cofactors, 1 in energy, 6 in nucleotides, 9 in peptides, and 14 in xenobiotics. In conclusion, the current analysis not only validated previous findings, but identified novel metabolites associated with kidney function. These data provide important insights into the biological pathways underlying this complex phenotype.
Abstract MP13: Comparative Effectiveness of Direct Oral Anticoagulants and Warfarin on Risk of Bleeding Resulting in Hospitalization Among Venous Thromboembolism Patients
Authors: Lutsey Pamela L , Zakai Neil A , MacLehose Richard F , Norby Faye L , Walker Rob F , Roetker Nicholas S , Adam Terrence J , Alonso Alvaro
Published: July 2021

Background:
Direct oral anticoagulants (DOACs), including rivaroxaban, dabigatran, apixaban and edoxaban, have been approved as alternatives to warfarin for the primary treatment of venous thromboembolism (VTE). However, understanding of their comparative effectiveness in practice-based populations is limited.

Objective:
Among anticoagulant-naïve VTE patients, estimate the association of type of oral anticoagulant (OAC) with the rate of bleeding resulting in hospitalization.

Methods:
Patients with VTE and prescription for an OAC were identified from the US Truven Health MarketScan® Commercial and Medicare Supplemental databases for the period from 2011-2015. Hospitalization related to bleeding events (inclusive of intracranial, gastrointestinal and other) was defined using a validated algorithm. In head-to-head comparisons, initiators of a specific OAC were matched with up to 5 initiators of the comparing OAC by age, sex, and time since database enrollment. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (95%CI) for bleeding by OAC, adjusted for age, sex, and a comorbidity propensity score (created using prevalence of 20 common diagnoses and procedures).

Results:
The final analysis included 83,831 VTE patients who were 49.9% female and on average (standard deviation) 59.0 (16.0) years old. Of these, the initial OAC prescribed for 2,604 was apixaban, for 1,669 dabigatran, for 28,518 rivaroxaban, and for 48,514 warfarin. A total of 1,947 bleeding events occurred over an average of 13 months. Compared to new warfarin users, risk of bleeding was lower among patients initiating apixaban [HR (95%CI): 0.55 (0.36, 0.83)] and rivaroxaban [0.80 (0.72, 0.89)], but similar among new dabigatran users [0.96 (0.72, 1.27)]. In head-to-head DOAC comparisons, relative to rivaroxaban, risk of bleeding was lower among users of apixaban [0.57 (0.36, 0.89)] but similar for users of dabigatran [1.05 (0.73, 1.51)]. Due to low numbers we did not conduct analyses of edoxaban or a head-to-head comparison of dabigatran versus apixaban.

Conclusion:
In this practice-based population of 83,831 patients prescribed OACs for the treatment of VTE, subsequent risk of hospitalized bleeding was lowest among those prescribed apixaban, intermediate among those prescribed rivaroxaban, and highest among those prescribed warfarin and dabigatran. These data demonstrate that differences in bleeding risk exist by DOAC. While risk factors for bleeding might impact choice of warfarin versus the DOACs, the choice between DOACs may be less likely to be based on patient conditions.
Abstract MP15: Aspirin is Effective in Preventing Venous Thromboembolism After Knee or Hip Arthroplasty
Authors: Baumgartner Christine , Maselli Judith , Auerbach Andrew D , Fang Margaret C
Published: July 2021

Introduction:
Venous thromboembolism (VTE) is a known complication of major orthopedic surgery. Although guidelines now allow the use of aspirin as an alternative to anticoagulants as VTE prophylaxis after knee or hip arthroplasty, there is limited data on contemporary use and outcomes with aspirin. We conducted a retrospective cohort study to describe antithrombotic agents used after knee and hip arthroplasty and post-operative VTE outcomes.

Hypothesis:
We assessed the hypothesis that VTE prevention with aspirin was not related to an increased risk of postoperative VTE after knee or hip arthroplasty compared to anticoagulation.

Methods:
We used data from MedAssets, which is an administrative database containing billing details on the patient-level from about 400 hospitals in the U.S., and included all adults with a principal hospital discharge diagnosis of knee or hip arthroplasty based on International Classification of Diseases, 9
th
edition (ICD-9) codes between January 1, 2013, and December 31, 2014. We identified charges for medications used for VTE prophylaxis within 7 days after the index surgery. The primary outcome was postoperative VTE, identified by searching for VTE-specific ICD-9 codes from the index hospitalization, rehospitalization within 30 days, or during an outpatient visit within 90 days. We compared postoperative VTE risk between patients receiving aspirin-only and those receiving anticoagulants using propensity score-adjusted multivariable logistic regression models adjusted for VTE risk factors, hospital characteristics and length of stay.

Results:
We identified 74,234 patients who underwent knee arthroplasty and 36,192 with hip arthroplasty who received pharmacologic VTE prophylaxis. The most common post-operative anticoagulant medications were warfarin (25.2%; 27,850 of 110,426) and enoxaparin (24.1%; 26,560 of 110,426). Aspirin was used as the sole agent in 27.0% (20,047 of 74,234) of knee and 29.8% (10,769 of 36,192) of hip arthroplasties. Patients receiving only aspirin were younger and had fewer comorbidities compared to those who received anticoagulants. Postoperative VTE events occurred in 495 of 74,234 (0.67%) patients undergoing knee arthroplasty and 145 of 36,192 (0.40%) undergoing hip arthroplasty. Patients who received only aspirin after surgery did not have a higher risk for postoperative VTE compared to patients who received anticoagulants: adjusted odds ratio 0.92; 95% CI, 0.61-1.39 for knee and adjusted odds ratio 0.73; 95% CI, 0.56-0.95 for hip arthroplasty.

Conclusions:
In conclusion, aspirin was the most frequently administered individual antithrombotic agent in a large contemporary sample of U.S. patients undergoing knee or hip arthroplasty. Postoperative VTE prophylaxis with aspirin-only may be a safe option in this population and was not associated with a higher risk of postoperative VTE compared to anticoagulants.
Abstract MP36: Poverty Modifies the Association of Health-Related Fitness and School Absenteeism in New York City Middle School Girls
Authors: D'Agostino Emily M , Day Sophia E , Konty Kevin J , Larkin Michael , Saha Subir , Wyka Katarzyna
Published: July 2021

Introduction:
One-fifth to one-third of students in high-poverty, urban school districts do not attend school regularly (missing ≥6 days per year). Health related fitness is shown to be associated with absenteeism, although this relationship may differ across poverty and gender subgroups.

Hypothesis:
We hypothesized that area poverty would be a stronger effect modifier on the association of fitness (cardiorespiratory, muscular endurance, and muscular strength fitness composite percentile scores) and subsequent absenteeism (one-year lagged days absent) in girls compared with boys.

Methods:
Six cohorts of New York City public school students were followed from grades 5-8 during 2006/7-2012/13 (n=349,381). Stratified three-level longitudinal generalized linear mixed models were used to test the modification of poverty on the association of fitness changes and one-year lagged child-specific days absent across gender.

Results:
The fitness-absenteeism association was not significant in boys attending schools in high/very high (p=0.075) or low/mid poverty (p=0.454) areas. In girls attending schools in high/very high poverty areas, greater improvements in fitness the prior year were associated with greater improvements in attendance (p=0.034). Relative to the reference group (>20% decrease in fitness composite percentile scores from the prior year), girls with a large increase in fitness (>20%) demonstrated 10.3% fewer days absent (IRR 95% CI: 0.834, 0.964), followed by those who had a 10-20% increase in fitness (9.2%, IRR 95% CI: 0.835, 0.987), no change (5.4%, IRR 95% CI: 0.887, 1.007) and a 10-20% decrease in fitness (3.8%, IRR 95% CI: 0.885, 1.045). In girls attending schools in low/mid poverty areas, the fitness-attendance relationship was also positive, but no clear trend emerged.

Conclusions:
Fitness improvements may be more important to attendance improvements in high/very high poverty girls compared with low/mid poverty girls, and both high/very high and low/mid poverty boys. In conclusion, expanding school-based physical activity programs for girls in high-poverty neighborhoods may increase student attendance.
Abstract MP49: Racial/Ethnic Differences in Receipt of Follow-up Care and Type 2 Diabetes Diagnosis Following Gestational Diabetes
Authors: Bower Julie K , Francis Brittney , Bose-Brill Seuli , Wassel Christina L
Published: July 2021

Introduction:
Gestational diabetes mellitus (GDM) affects up to 14% of pregnancies in the U.S. and is associated with a sevenfold increased lifetime risk for type 2 diabetes (T2D). Clinical guidelines recommend postpartum glucose screening 4-12 weeks after a GDM pregnancy, and re-screening every 1-3 years thereafter. However, an inadequate proportion of persons with GDM actually receive these screenings. Racial/ethnic differences in risk of developing T2D following GDM may partially be driven by differential receipt of screening services. The aim of this study was to examine racial/ethnic differences in subsequent development of T2D, receipt of screening services, and glycated hemoglobin (HbA1c) in a nationally representative sample of women with a GDM history.

Methods:
We analyzed data from the National Health and Nutrition Examination Survey (NHANES, 2007-2014). Race/ethnicity, GDM and diabetes diagnosis, and receipt of diabetes screening tests were determined by self-report; HbA1c was measured using standard laboratory procedures. Associations of race/ethnicity with outcomes of interest were evaluated using linear, logistic, and Cox regression, with adjustment for demographic, clinical, and healthcare access factors.

Results:
Among 629 women with a history of GDM in NHANES, non-Hispanic Black women had 98% higher risk (95% CI (1.28, 3.08), p=0.003), and Hispanics about double the risk (HR = 2.04, 95% CI (1.25, 3.32), p=0.005) of developing T2D following GDM compared to non-Hispanic Whites. In fully adjusted models, this was attenuated slightly, although still statistically significantly greater risk for both non-Hispanic Black (p=0.05) and Hispanic (p=0.03) women. Both non-Hispanic Black and Hispanic women were less likely to report being screened for diabetes in the past 3 years. In adjusted linear regression models, among women who remained diabetes-free, non-Hispanic Blacks had 0.40-% point higher HbA1c (p=0.02), and Hispanics had 0.26-% point higher HbA1c (p<0.001) compared to non-Hispanic Whites. Additionally, the odds of prediabetes were 4.9-fold higher for non-Hispanic Blacks (p<0.001), and 2.4-fold greater for Hispanics (p=0.03) as compared to non-Hispanic Whites. Odds of undiagnosed diabetes (HbA1c>6.5%) were significantly higher in non-Hispanic Blacks (OR=3.3, p=0.05) and marginally greater in Hispanics (OR=3.5, p=0.07) compared to non-Hispanic Whites.

Conclusions:
Differential receipt of follow-up services by minority women may exacerbate observed disparities in the burden of T2D. In this study, racial/ethnic disparities were apparent with regards to T2D diagnosis, receipt of diabetes screening tests, and HbA1c. Additional investigation to identify underlying factors contributing to this observed disparity will be particularly important to inform recommendations to improve delivery of quality care equitably across population subgroups.
Abstract MP51: Lifetime Risk For Cardiovascular Disease Stratified By Fasting Glucose Level
Authors: Bancks Michael P , Ning Hongyan , Allen Norrina B , Carnethon Mercedes R , Echouffo Tcheugui Justin , Lloyd-Jones Donald M , Wilkins John T
Published: July 2021

Introduction:
Diabetes and insulin resistance are major contributors to atherosclerotic cardiovascular disease (ASCVD) risk, but the lifetime risks (LTR) associated with normoglycemia, impaired fasting glucose (IFG), and diabetes (DM) in middle-aged adults have not been reported.

Hypothesis:
Higher fasting glucose (FG) category will be associated with a monotonic increase in the LTR for ASCVD.

Methods:
We pooled data from 7 observational cohorts of US black and white men and women followed from 1960 through 2015. Categories of FG were normoglycemia (<100 mg/dl), IFG (100-125 mg/dl), and DM (≥126 mg/dl or use of DM medications). ASCVD was defined as fatal and nonfatal coronary heart disease (CHD) and fatal and nonfatal stroke. Individuals were free of symptomatic ASCVD at index age 55 years. LTR for incident ASCVD after age 55 was estimated according to FG category using a modified Kaplan-Meier survival analysis, adjusted for the competing risk of non-ASCVD death.

Results:
Our sample included 19630 individuals (6197 blacks, 11015 women) without a prior ASCVD event. Mean baseline FG level was 90.1 mg/dl for normoglycemics, 107.4 mg/dl for IFG, and 176.6 mg/dl for DM. Greater age, body mass index, blood pressure, and male sex and black race were associated with increasing FG category. LTR for ASCVD through age 85 among women was 15.5% for normoglycemics, 16.4% for IFG, and 38.6% for DM (Figure 1A). Among men, LTR for ASCVD through age 85 was 22.2% for normoglycemia, 25.0% for IFG, and 47.7% for DM (Figure 1B). The difference in LTR for ASCVD between normoglycemics and IFG was not statistically significant for women (LTR difference 95% confidence interval (CI): -3.8, 2.0) or men (LTR difference 95% CI: -5.8, 0.2).

Conclusion:
LTRs for ASCVD were similar among normoglycemia and IFG categories. However, LTR among middle-aged participants with DM were 39-48%; approximately twice as high as those with IFG. These data strongly support the importance of public health and clinical strategies that target prevention of incident DM by midlife.
Abstract MP57: Unfavorable Perceived Neighborhood Environment Associates With Lower Levels of Routine Healthcare Utilization: Data From the Dallas Heart Study, 2007-2009
Authors: Ceasar Joniqua , Ayers Colby , Andrews Marcus , Claudel Sophie , Tamura Kosuke , Das Sandeep , Neeland Ian , Powell-Wiley Tiffany M
Published: July 2021

Background:
It is well documented that perceived neighborhood environment is associated with cardiovascular (CV) health factors but little is known about how neighborhood environment perception (NEP) relates to routine healthcare utilization, a likely determinant of CV health outcomes.

Methods:
Using cross-sectional Dallas Heart Study data, we examined the relationship between NEP and routine healthcare utilization. NEP was defined via total score and sub-scores using factor analysis [perceived neighborhood violence, physical environment (i.e. aesthetics), and social cohesion; higher score=more unfavorable perception]. Routine healthcare utilization was based on self-reported time since last visit to a healthcare provider for routine checkup. We used linear regression to determine the relationship between NEP scores and routine healthcare visits, adjusting for age, sex, race/ethnicity, income, education, health insurance status, CV disease burden, and neighborhood deprivation index (NDI).

Results:
Within the study population (N=1756; 58% black, 27% white and 15% Hispanic), those who reported more recent routine visits were found to be older, more educated and have higher income. When adjusting for confounders (Table), more unfavorable NEP was associated with less frequent routine healthcare visits. Specifically, individuals who perceived a more unfavorable neighborhood physical environment or greater violence level reported greater time since last routine visit. There was no relationship between perceived social cohesion and healthcare usage.

Conclusions:
Unfavorable NEP was found to significantly relate to decreased routine healthcare utilization even when accounting for health insurance, CV disease and NDI. Furthermore, unfavorable perceived neighborhood violence and physical environment are associated with less routine healthcare utilization. Our findings suggest that NEP may act as a barrier to routine preventive healthcare and ideal CV health outcomes in at-risk communities.
Abstract MP58: Racial Residential Segregation is Associated With Worse Cardiovascular Health in African American Adults: The Jackson Heart Study
Authors: Barber Sharrelle , Kershaw Kiarri , Wang Xu , Sims Mario , Nelson Julianne , Diez-Roux Ana V
Published: July 2021

Introduction:
Racial residential segregation results in increased exposure to adverse neighborhood environments for African Americans; however, the impact of segregation on ideal cardiovascular health (CVH) has not been examined in large, socioeconomically diverse African American samples. Using a novel spatial measure of neighborhood-level racial residential segregation, we examined the association between segregation and ideal CVH in the Jackson Heart Study (JHS).

Hypothesis:
Racial residential segregation will be associated with worse cardiovascular health among African American adults.

Methods:
The sample included 4,354 men and women ages 21-93 from the baseline exam of the JHS (2000-2004). Racial residential segregation was assessed at the census-tract level. Data on racial composition (% African American) from the 2000 US Census was used to calculate the local G
i
* statistic- a spatially-weighted z-score that represents how much a neighborhood’s racial/ethnic composition deviates from the larger metropolitan area. Ideal CVH was assessed using the AHA Life’s Simple Seven (LS7) index which includes 3 behavioral (nutrition, physical activity, and smoking) and 4 biological (systolic BP, glucose, BMI, and cholesterol) metrics of CVH. Multivariable regression models were used to test associations between segregation and the LS7 index continuously (range: 0-14) and categorically (Inadequate: 0-4; Average: 5-9; and Optimal: 10-14). Covariates included age, sex, income, education, and insurance status.

Results:
The average LS7 summary score was 7.03 (±2.1) and was lowest in the most racially segregated neighborhood environments (High Segregation: 6.88 ±2.1 vs. Low Segregation: 7.55 ±2.1). The prevalence of inadequate CVH was higher in racially segregated neighborhoods (12.3%) compared to neighborhoods that were the least segregated (6.9%). After adjusting for key socio-demographic characteristics, racial residential segregation was inversely associated with ideal CVH (B=-0.041 ±0.02, p=0.0146). Moreover, a 1-SD unit increase in segregation was associated with a 6% increased odds of having inadequate CVH (OR: 1.06, 95% CI: 1.00-1.12, p=0.0461).

Conclusion:
In conclusion, African Americans in racially segregated neighborhoods are less likely to achieve ideal CVH even after accounting for individual-level factors. Policies aimed at restricting housing segregation/discrimination and/or structural interventions designed to improve neighborhood environments may be viable strategies to improving CVH in this at-risk population.
Abstract MP72: Feasibility, Safety and Acceptability of Soy-Based Diet for Pregnant Women: Preliminary Results From a Pilot Randomized Controlled Trial
Authors: Shi Ling , Iyer Vidya , Norwitz Errol , Moore Simas Tiffany A , Matthan Nirupa , Lichtenstein Alice , Hayman Laura L
Published: July 2021

Introduction:
Previous evidence suggests that soy containing foods may have beneficial effects on lipid and glycemic metabolism due to their biologically active components, including soy protein and isoflavones. Pregnancy is associated with changes in glucose and lipid metabolism, partially attributable to elevated estrogen concentrations. We have previously reported a significant, inverse association between urinary excretion of isoflavones and cardiometabolic risk markers in pregnant women, using data from the National Health and Nutrition Examination Survey (NHANES). Further studies are needed to determine the cardiometabolic health effects of soy intake in pregnant women.

Hypothesis:
We hypothesize that consumption of soy-based whole foods is safe and acceptable for pregnant women and has beneficial cardiometabolic health effects.

Methods:
A pilot randomized controlled trial (RCT) was conducted in 30 pregnant women who received counseling to consume either a high-soy or low-soy foods containing diet. Assessments (physical and anthropometric measurements, food frequency questionnaires, fasting blood samples) were conducted at 14 and 28 weeks of pregnancy, and 6 weeks’ postpartum. Monthly follow-up calls were conducted by research team coordinator to assess safety and encourage adherence.

Results:
Both the high-soy and low-soy groups demonstrated high adherence (80-90%), defined as consuming soy foods ≥ 15 days in the past four weeks for high-soy group and ≤ 5 days for low-soy group. Five subjects in the high-soy group reported adverse events (nausea, vomiting, diarrhea, itchy mouth); all were transient and resolved without sequelae. No adverse events were reported in the low-soy group. Skinfold thickness decreased (-4.8 mm) in the high-soy group and increased (+3.6 mm) in the low-soy group (p=0.04). There was a trend towards lower BMI in the high-soy compared to low-soy group at 28 weeks (+1.4 vs. +3.6 kg/m
2
, respectively, p=0.15) and postpartum (-1.2 vs. +0.6 kg/m
2
, respectively, p=0.14). This decrease in BMI was predominantly a loss of body fat and not lean mass. There were no significant differences between groups in fasting glucose, HDL-C, LDL-C, TG, or VLDL concentrations.

Conclusions:
In conclusion, results from this pilot RCT support the acceptability and safety of consuming soy-based whole foods during pregnancy. A larger-scale RCT is needed to further elucidate the effects of soy-based foods on cardiometabolic risk factors during pregnancy, as well as the transgenerational effects on their offspring.
Abstract MP74: It's Not Too Late to Improve Adherence: Association Between All-Cause Mortality and Statin Adherence Change After Acute Myocardial Infarction
Authors: Hickson Ryan P , Robinson Jennifer G , Annis Izabela E , Killeya-Jones Ley A , Fang Gang
Published: July 2021

Introduction:
Hospitalization for acute myocardial infarction (AMI) affects medication adherence in prevalent statin users. Our objective was to estimate the association between changes in statin adherence and all-cause mortality after AMI discharge.

Hypothesis:
Patients who are adherent both pre- and post-AMI have the lowest risk of all-cause mortality.

Methods:
Medicare administrative claims were used to identify AMI hospitalizations in 2008-2010. Patients were ≥66 years old, continuously enrolled ≥360 days pre-AMI with a statin prescription claim, discharged to home/self-care, and survived ≥180 days post-AMI with continuous enrollment. Statin adherence was measured in the 180 days pre- and post-AMI hospitalization using proportion of days covered and categorized as severely nonadherent, moderately nonadherent, and adherent. The exposure was categorical change in statin adherence from pre- to post-AMI (9 categories, see Figure); adherent/adherent was the reference group. Patients were followed for all-cause mortality from 180 days post-discharge for up to 18 months. A multivariable Cox proportional hazards model estimated hazard ratios (HRs).

Results:
Of 101,011 eligible patients, 15% decreased, 20% increased, and 64% did not change statin adherence categories. Compared to patients who were adherent pre- and post-AMI, the adjusted HR (95% confidence intervals [CIs]) for patients who
increased
from severely nonadherent to adherent was 0.93 (95% CI: 0.85-1.02); other increases in adherence had similar HRs (see Figure). Compared to patients who were adherent pre- and post-AMI, the adjusted HR for patients who
decreased
from adherent to severely nonadherent was 1.22 (95% CI: 1.13-1.33); other decreases in adherence had similar HRs.

Conclusions:
Although patients with decreased statin adherence had the worst mortality outcomes, those with increased adherence had similar or better outcomes than continuously adherent patients, showing that, even after an AMI, it is not too late to improve statin adherence.
Abstract P009: Association of MRI Signs With Development of Mild Cognitive Impairment and Dementia: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Wu Aozhou , Sharrett A. R , Gottesman Rebecca F , Power Melinda C , Mosley Thomas , Jack Clifford R , Knopman David S , Windham B. G , Gross Alden L , Coresh Josef
Published: July 2021

Background:
Brain infarcts, white matter hyperintensities (WMH), and brain atrophy appear to contribute to the development of mild cognitive impairment (MCI) and dementia in selected populations, but few prospective studies are available in general populations.

Methods:
The study included 732 black and white participants, sampled from the original ARIC cohort, who had 3T brain Magnetic Resonance Imaging (MRI) scans, were free of MCI and dementia during 2011-13 (Visit 5), and were evaluated for cognitive impairment during 2016-17 (Visit 6, about 90% complete). We assessed the associations of brain infarcts, WMH, and brain volumes measured on MRI from 2011-2013 with incident MCI and dementia (combined), diagnosed using a computer algorithm based on specified criteria and comprehensive assessment at Visit 6. We used logistic regression, incorporating sampling weights, to evaluate the risk for incident MCI/dementia with adjustment for demographic covariates, major dementia risk factors, and history of cardiovascular diseases.

Results:
Participants had a median age of 75 (IQR: 71, 79) at Visit 5 (baseline); 62% (453) were female and 33% (242) were African American. There were 156 newly identified cases of MCI or dementia during a median follow-up time of 4.9 (IQR: 3.4, 5.2) years. The presence of any brain infarct was associated with a nonsignificantly higher risk of MCI/dementia (OR: 1.50; 95%CI: 0.87 to 2.58), but the only significant individual association was with cortical infarcts (OR: 1.99; 95%CI: 1.03 to 3.85). WMH volume above the median value was nonsignificantly associated with conversion to MCI/dementia. Smaller Alzheimer’s disease (AD) signature region was an independent predictor for greater risk of MCI/dementia (OR: 1.49; 95%CI: 1.00 to 2.22). A similar but nonsignificant association was observed for total brain volume.

Conclusions:
Brain infarcts (cortical infarcts) and lower brain volume (AD signature region), measured in community-based older residents, are risk factors for MCI and dementia incidence.
Abstract P018: Poincare Plot Asymmetry is Associated With Sudden Cardiac Death in the Community: The Atherosclerosis Risk in Community Study
Authors: Bender Aron , Kabir Muammar , Thomas Jason , German David , Mukundan Srini , Hamilton Christopher , Sotoodehnia Nona , Post Wendy , Solomon Scott , Soliman Elsayed , Siscovick David , Tereshchenko Larisa
Published: July 2021

Introduction:
Poincare plot asymmetry has been associated with sustained ventricular tachyarrhythmias, implicating involvement of the autonomic nervous system. An association between sudden cardiac death (SCD) and Poincare plot asymmetry has not previously been studied in a general population cohort. Porta index measures time asymmetry in heart rate variability (HRV), corresponding to disproportionate relative tachycardic predominance.

Hypothesis:
We hypothesized that increasing tachycardic asymmetry as measured by Porta Index is associated with SCD.

Methods:
We analyzed 10-second ECG in 14,247 participants across 5 visits in the Atherosclerosis Risk in Communities (ARIC) cohort (mean age 54.1±5.87y; 6,380 [45%] men; 10,569 [74%] white, 1,582 [11%] with prevalent cardiovascular disease (CVD)). Participants with atrial fibrillation, premature contractions, sinoatrial (SA) or atrioventricular (AV) blocks II-III were excluded. Only normal sinus beats were included in the semi-automated analysis. Accuracy of automated R-peak detection was manually validated. SCD, non-SCD, and non-cardiac death served as competing outcomes in a Fine and Gray competing risk model.

Results:
Overall, there was larger variability in Porta index within the same participant from visit to visit (50.0±12.1) than between different participants (50.0±8.4). Over median follow-up of 24.4 years, there were 497 SCDs (incidence 1.66 [95% CI 1.52-1.82], 742 non-SCD (incidence 2.48 [95%CI 2.31-2.67], and 3,753 non-cardiac deaths (incidence 12.6 [95% CI 12.1-13.0]) per 1,000 person-years. In time-updated analysis, Porta index was independently associated with increased risk of SCD (HR 1.13 [1.04-1.23]). Neither non-sudden cardiac death nor non-cardiac death are associated with Porta ndex.

Conclusion:
Time-updated Poincare Plot asymmetry as measured by Porta index, reflecting tachycardic runs longer than bradycardic runs, is independently associated with SCD in the community. Poincare plot asymmetry requires further study.