bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P103: Tobacco-21 Policy Implementation In A Texas Community: Utilizing Interorganizational Network Analysis To Evaluate Tobacco Coalition Dynamics
Authors: Panjwani Sonya , Garney Whitney R , Garcia Kristen
Published: March 2020

Introduction:
In El Paso County, TX, a local tobacco coalition is working in partnership with the American Heart Association’s (AHA) Heart Racial and Ethnic Approaches to Community Health (REACH) program to focus efforts on aligning local activities with the new, statewide Tobacco-21 policy. As coalitions have been on the forefront of spearheading policy implementation efforts, understanding and quantifying coalition dynamics is necessary to increase collaboration and leverage resources. The purpose of this study is to highlight the findings of a baseline Interorganizational Network (ION) analysis of a tobacco coalition in El Paso County, TX in order to determine current levels of collaboration between organizations and strength of relationships.

Hypothesis:
We assessed the hypothesis that by using ION analysis, we can characterize relationships between organizations, identify organizations that are working in silos, and leverage ties between organizations to implement new, tobacco control initiatives that support the Tobacco-21 policy.

Methods:
Evaluators from Texas A&M University worked in conjunction with the AHA to conduct an ION survey that assessed information sharing and joint planning of organizations involved in the tobacco coalition (n=18). Using UCINET© network analysis software, density and centrality scores at the network-level were calculated. Network diagrams were then developed to depict relationships among partners using Gephi© visualization software.

Results:
Network collaboration related to
information sharing
had a network density score of 0.340 (SD=0.474) while
joint planning
had a network density score of 0.297 (SD=0.457). The centralization index for
information sharing
was 0.055 and 0.0729 for
joint planning
with the coalition as the most central for both domains.

Conclusion:
This study shows how determination of organizational relationships within a coalition can be leveraged for strategic planning. Density measures were useful to understand the connectedness of the network, and centrality measures at the network-level were helpful in determining network structure. In conclusion, results from this study informed program implementers on how to better foster collaboration among organizations. Subsequent iterations of the survey will allow for documentation of changes in the strength of relationships over the project period.
Abstract P110: High Serum Urate Levels are Associated With an Increased Risk for Sudden Cardiac Death in the Reasons for Geographic and Racial Differences in Stroke (regards) Study
Authors: Colantonio Lisandro D , Reynolds Richard , Merriman Tony , Gaffo Angelo , Singh Jasvinder A , Plante Timothy B , Chaudhary Ninad S , Soliman Elsayed , Bridges S. Louis , Howard George , Safford Monika M , Saag Kenneth , Muntner Paul , Irvin Marguerite M
Published: March 2020

Background:
Higher serum urate (SU) levels were shown to causally increase the risk for sudden cardiac death (SCD) in a Mendelian randomization analysis of white adults, most of whom had coronary heart disease (CHD). It is unclear if these results are generalizable to more racially diverse adults without CHD.

Objective:
To assess the risk for SCD and incident CHD associated with SU levels in adults without a history of CHD using data from a large, population-based cohort of US black and white men and women ≥45 years of age, the REason for Geographic And Racial Differences in Stroke (REGARDS) study.

Methods:
We conducted a case-cohort analysis of REGARDS study participants without a history of CHD at baseline between 2003 and 2007. Participants were followed for SCD or incident CHD (i.e., myocardial infarction or CHD death excluding SCD) from baseline through December 31, 2013. Baseline SU levels were measured in a random sample of participants (n=840) and among 235 participants with SCD and 851 participants with incident CHD.

Results:
Participants with higher SU levels were older and more likely to be black and male. The crude hazard ratio (95%CI) per 1 mg/dL higher SU level was 1.26 (1.14, 1.40) for SCD and 1.17 (1.09, 1.26) for incident CHD. Analyses modeling SU levels using splines supported that these associations were linear. After multivariable adjustment, higher SU levels remained associated with an increased risk for SCD, but not for incident CHD (
Table
). There was no effect modification in the association of SU levels with SCD or incident CHD by either age, gender, race or chronic kidney disease. However, the increased risk for SCD associated with higher SU levels was present in whites but not among blacks.

Limitations:
The study has limited statistical power for subgroup comparisons. Race differences in the association between SU levels and SCD require further investigation.

Conclusions:
In adults without a history of CHD, higher SU levels appear to be an independent risk factor for SCD, but no association was detected with incident CHD.
Abstract P117: Implementing the Physical Activity Vital Sign in an Academic Preventive Cardiology Clinic
Authors: McCarthy Margaret M , Heffron Sean , Fletcher Jason , Szerencsy Adam , Mann Devin , Vorderstrasse Allison
Published: March 2020

Background:
Physical activity (PA) can protect against cardiovascular disease but it is not routinely assessed in clinical settings. The current PA recommendations are 150 minutes of moderate- or 75 minutes vigorous-intensity PA/week.

Purpose:
The purpose of this study was to implement physical activity screening as part of the electronic kiosk check-in process in an adult preventive cardiology clinic in an academic medical center and assess factors related to patients’ self-reported PA.

Methods:
The physical activity vital sign (PAVS) was embedded into the Epic electronic health record and includes 3 questions about the average days, minutes and intensity (light, moderate, vigorous) of PA per week. Analysis of patient records from a recent 60-day period included descriptive statistics, bivariate analyses and logistic regression to identify sociodemographic factors associated with not meeting current PA recommendations.

Results:
A total of 1,322 patients checked into the clinic using a kiosk. Patients were 42% female, 71% White, 62% married, had a mean age 64±15 years, 41% worked full-time and the majority (57%) were never smokers. The three most common primary diagnoses were hyperlipidemia (n=197), coronary artery disease (n=189), and hypertension (n=127). Of those patients, 72% (n=951) completed the PAVS questions:10% reported no PA; 55% reported some PA; and 35% reported achieving at least 150 minutes moderate or 75 minutes vigorous PA/week. In bivariate analyses (at recommended PA vs. not at recommended PA), factors associated with not achieving recommended levels of PA included sex (p<.001), race (p=.045), marital status (p<.001), and employment (p<.001). In the final logistic model, being female vs. male (OR=1.4, 95%CI: 0.99-1.8, p=.05), Black (OR=2.0, 95%CI: 1-3.7, p=.037) or ‘Other’ race (OR=1.5, 95%CI: 1-2.2, p=.04) vs. White, those reporting being partnered or in ‘other’ relationships vs. married (OR=.03, 95% CI: 0.14-0.55, p<.001), and those who were retired (OR=2, 95% CI: 1.4-2.8, p<.001) or unemployed (OR=2.2, 95%CI: 1.3-3.7, p=.002) vs. full-time workers were factors associated with not achieving recommended levels of PA.

Conclusion:
In a preventive cardiology clinic, only one-third reported achieving AHA recommended levels of PA. Our data support particular attention to PA counseling and prescription in female, Black, and retired or unemployed patients. Additionally, embedding the PAVS into a clinical electronic health system is a feasible and scalable intervention to collect data on this cardiovascular risk factor.
Abstract P118: The Ongoing Experience of Cardiovascular Risk Assessment Implementation in Primary Care of the CUORE Project
Authors: Palmieri Luigi , Vannucchi Serena , Lo Noce Cinzia , Di Lonardo Anna , Minutoli Daniela , Unim Brigid , Grisetti Tiziana , Meduri Claudia , Donfrancesco Chiara
Published: March 2020

Background:
The Italian National Prevention Plan 2005-2008 included a 10-year cardiovascular risk assessment (10-CR) for the general population aged 35-69 years using the CUORE-Project risk score. GPs were encouraged to collect data on risk factors, perform a 10-CR and send data to the Cardiovascular Risk Observatory (CRO).

Aim:
The aim of this study is to show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population, a first step to implement primary preventive actions at individual level.

Methods:
A training plan for GPs was launched by the Ministry of Health. Data were collected using the
cuore.exe
software, easily and freely downloadable by GPs from the CUORE-Project website (www.cuore.iss.it). The CRO provides a web-platform to analyze and compare data on 10-CR and risk factors at both regional and national level. In the subgroup of persons examined at least twice a year, variations in continuous risk factors mean levels and categorical risk factors prevalence between baseline and follow-up and their 95% confidence intervals (C.I.) were calculated using methods for matched pair samples.

Results:
By October 2019, about 3,500 GPs downloaded
cuore.exe
; about 300,000 CR assessments on about 140,000 persons were sent to CRO. CR mean was 3.1% in women, 8.5% in men; 28% of men and 64% of women were at lower risk (CR<3%), 9.9% of men and 0.4% of women were at high risk (CR≥20%). Twenty-six percent of men and 16% of women were current smokers, 13% of men and 10% of women were diabetic, and 33% of hypertensive men and 35% of hypertensive women were under specific treatment. Among those with at least two risk assessments (31% of the sample), 11% shifted to a lower risk class after one year (14 of men and 7% of women respectively). Systolic blood pressure mean levels decreased by 0.6 mmHg (95%-C.I. 0.3-0.8 mmHg), diastolic blood pressure by 0.5 mmHg (95%-C.I. 0.2-0.7 mmHg), total cholesterol level by 3.1% (95%-C.I. 2.3%-4.0%)6.6 mg/dl6; HDL-cholesterol increased in women by 0.3 mg/dl (95%-C.I. 0.1-0.5 mg/dl).

Conclusions:
Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. The individual risk score is becoming a useful tool for GPs to assess their patients’ CR and promote primary prevention by focusing attention on the adoption of healthy lifestyles. These encouraging data can be used to support health policy decision processes.
Abstract P138: The Association of Long-Term Air Pollution Exposure With Left Atrial Structure and Function in the Multi-Ethnic Study of Atherosclerosis
Authors: Austin Thomas , Venkatesh Bharath Ambale , Sitlani Colleen , Lindström Sara , Psaty Bruce M , Lima Joao A , Kaufman Joel D , Heckbert Susan R
Published: March 2020

Air pollution exposure is an important risk factor for cardiovascular morbidity and mortality. Acute exposure is associated with episodes of atrial fibrillation (AF), and long-term exposure may influence ventricular mass and volume. However, little is understood about the relationship between long-term pollution exposure and atrial structure and function, which may influence risk of AF and heart failure. We sought to determine the association of long-term exposure to oxides of nitrogen (NO
X
), particulate matter smaller than 2.5 micrometers (PM
2.5
), and ozone (O
3
) with left atrial structure (LA) and function, as measured by LA volume, emptying fraction, and peak longitudinal strain.

In the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal study of 6,814 participants in six United States communities, we used estimated 5-year average exposure to PM
2.5
, NO
X
, and O
3
prior to outcome measurement from validated hierarchical spatio-temporal models developed from extensive monitoring of MESA participants. Left atrial measures were calculated from cardiac magnetic resonance imaging occurring between 2010 and 2012. Linear regression was used, adjusting for MESA study site and potential confounding characteristics.

In 2,250 MESA participants, 5-year average exposure to PM
2.5
, NO
X
, and O
3
varied greatly by study site and was not associated with LA volume, emptying fraction, or peak longitudinal strain. Results were particularly sensitive to adjustment for study site, suggesting that there was substantial unmeasured confounding by US city/region. Using recently developed study-specific exposure estimation and highly accurate imaging, we did not find evidence to suggest an association between long-term exposure to several common pollutants and measures of left atrial structure and function. Additional analyses in areas of higher pollution may be useful in determining whether associations are consistent across exposure levels.
Abstract P151: Race/ethnic Differences in Six Minute Walk Distance Among Older Adults: The Multi-ethnic Study of Atherosclerosis
Authors: Bertoni Alain G , Bancks Michael , Crago Lenore , Chen Haiying , Barr R G , Smith Benjamin , Shah Sanjiv J
Published: March 2020

Introduction:
Data about race/ethnic differences in functional capacity among U.S. minority groups is limited, although some studies suggest blacks have a shorter six minute walk distance (6MWD), a test of functional capacity. We measured 6MWD in the Multi-Ethnic Study of Atherosclerosis (MESA), and hypothesized that health behaviors, CVD risk factors, prevalent CVD, and pulmonary function may account for any race/ethnic differences observed.

Methods:
MESA enrolled 6814 adults aged 45-84 years free of clinical CVD during 2000-2002. During the 6
th
examination (2016-2018) trained staff measured the distance (in meters) walked by participants who walked laps at their own pace for 6 minutes along a flat and marked 20 meter distance. Race/ethnicity, gender, and education level were ascertained at baseline; Exam 6 values for all other variables were used. Prevalent CVD was defined as having a previously adjudicated event (ischemic heart disease, stroke, or heart failure). The race/ethnicity-6MWD association was evaluated via general linear regression models. We included adjustment for age, sex, education, smoking, alcohol, height, waist circumference, self-reported health status, Kansas City Cardiomyopathy Questionnaire score, diabetes, systolic blood pressure (BP), total cholesterol, BP and cholesterol medication use, creatinine, and prevalent CVD (and FEV1 and FVC for those with spirometry data).

Results:
A 6MWD was obtained in 2,539 participants (mean age 73 years (range 59-96) 53% female, 41% white, 14% Chinese, 24% Black, and 22% Hispanic; 8% prevalent CVD). The observed 6MWD differed by race/ethnicity by 30-50 m (Table). Covariate adjustment reduced these differences modestly. In the subset (n=2138) with spirometry (Model 4), 6MWD remained different across race/ethnicity.

Conclusions:
Race/ethnic disparities in functional capacity in this diverse sample are not fully explained by differences in health behaviors, CVD risk factors, prevalent CVD, heart failure symptoms, or pulmonary function.
Abstract P152: Racial Disparities In The Prevalence Of Peripheral Artery Disease And Diabetes And Amputation Rates Among Medicare Patients
Authors: Eid Mark A , Barnes J Aaron , Wanken Zachary , Stone David H , Suckow Bjoern , Gladders Barbara , Powell Richard J , Creager Mark A , GOODNEY Philip P
Published: March 2020

Background:
Patients with peripheral artery disease (PAD) and diabetes are at increased risk for nontraumatic amputations. The associations of race with amputation risk among patients with both PAD and diabetes is not well understood in recent national patient cohorts.

Methods:
Using data from the Centers for Medicare and Medicaid Services from 2007-2016, we identified a cohort of patients concurrently diagnosed with both PAD and diabetes (N= 10,506,254). Patients were followed from time of diagnosis to identify major and minor amputation events, and stratified by race (Black, White, Hispanic) in order to determine differences in outcomes. We examined associations between the regional prevalence of PAD and diabetes and amputation rates, at the level of the state and the hospital referral region (HRR).

Results:
The average rate of amputation between 2007 and 2016 was 0.3 amputations per 1000 Medicare patients. When analyzed by race, Black patients had an almost 3-fold higher rate of amputation as compared to White patients (0.89 v 0.36 per 1000 patients, P<0.001) and a 2-fold higher rate as compared to Hispanic patients (0.89 v 0.39 per 1000 patients, P<0.001). States with larger populations of Black patients with diabetes and PAD had higher rates of amputation. We also observed a direct and significant association between regional prevalence of PAD and diabetes and amputation risk for both White and Black patients (R
2
=0.36 and 0.25 respectively); some states such as Mississippi had disproportionately higher amputations rates among Black patients for a given prevalence of PAD and diabetes (Figure 1).

Conclusion:
Black patients with PAD and diabetes are at disproportionally higher risk for amputation. Moreover, regional prevalence of concomitant PAD and diabetes is closely related to amputation risk across races.
Abstract P159: In-hospital Mortality Of Transcatheter Versus Surgical Aortic Valve Replacement: A Nationwide Analysis
Authors: Aguilar Rodrigo , Abusnina Waiel , Mansoor Kanaan , Rueda carlos
Published: March 2020

Background:
Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis Commercial use or TAVR has expanded widely, nonetheless, is still considered a developing procedure and is not used widely in the country. Methods, techniques, training and valves are continuously evolving.

Methods:
Nationwide inpatient sample (NIS) data from 2005 to 2012 was queried. Patients who had aortic stenosis and underwent consequent either TAVR or SAVR were selected. Cases who received both techniques were excluded. We further stratified the groups according to the propensity match score and used TAVR as a reference. All statistical analyses were performed using SAS version 9.3 (SAS Institute, Cary, North Carolina). All p-values were based on 2-tailed tests and were considered statistically significant when p < 0.05.

Results:
Among 48,022 patients admitted for aortic valve replacement between 2005 and 2012, 96.67% (n=46,424) underwent SAVR and 3.33% (n=1,598) underwent TAVR. Mortality prior to propensity match was higher in TAVR (4.51% vs3.21%,
p
= 0.004). ). The all-cause mortality remained higher in TAVR (4.62% vs 3.57%,
p
= 0.15), after adjusting for age, sex, race, insurance payer, diabetes, hypertension, hyperlipidemia, smoking status, heart failure, coronary artery disease (CAD) and prior myocardial infarction. Length of stay was shorter in TAVR (8.38 days vs 11.52 days).

Conclusion:
Data analysis results demonstrated that patients with higher mortality have occurred when performing TAVR as compared to SAVR, however recent reports support improving techniques, faster recovery, shorter length of stay. Furthermore, usually TAVR candidates usually have more comorbidities and lower performance status, hence the expected mortality is higher. Further studies are suggested to further stratify mortality across the years.
Abstract P165: Comparing Grip Strength, Weakness, And Frailty Based On Comorbidity And Laboratory Data Among Patients With Cardiovascular Disease
Authors: Kim Gloria , Gangadharan Arati A , Corriere Matthew A
Published: March 2020

Introduction:
Some approaches to frailty screening use diagnostic or laboratory data that may be incomplete. Grip strength can identify weakness, a component of phenotype-based frailty assessment. We compared grip strength as a reductionist, phenotype-based approach to frailty screening with comorbidity and laboratory-based alternatives.

Hypothesis:
Grip strength and categorical weakness are correlated with the modified frailty index-5 (mFI-5) and lab values associated with frailty.

Methods:
Weakness based on grip, BMI, and gender was compared with mFI-5 comorbidities and lab values. Patients with at least 3/5 mFI-5 comorbidities were considered frail. Lab data collected within 6 months of grip measurement was assessed. Associations were evaluated using multivariable models and kappa.

Methods:
2,597 patients had grip strength measured over 5 months. Mean age was 64.4±14.6, mean BMI was 29.5±6.9;46% were women, and 87% white. Prevalent comorbidities included hypertension (28%), CHF (22%), diabetes (29%), and COPD (26%); 9% were functionally dependent. 34% were weak, but only 13% were frail based on mFI-5. Hemoglobin, creatinine, and CRP differed significantly based on weakness (
Table
). Laboratory data were missing for 36%- 95% of patients. Multivariable models identified significant associations between weakness, hemoglobin, and all MFI-5 comorbidities. Categorical agreement between weakness and frailty was limited (kappa =0.09; 95% CL 0.0641-0.1232).

Conclusion:
Weakness based on grip strength provides a practical, inexpensive approach to risk assessment, especially when incomplete data excludes other approaches. Comorbidity-based assessment categorizes many weak patients as non-frail.

Table. Demographic, laboratory values, and comorbidities by categorical weakness based on grip 20
th
percentile.

Mean values for continuous variables by weakness adjusted for gender and BMI, p-value for T-test; frequency and total percent for categorical variables, p-value represents chi-square test.
Abstract P171: Prevalence, Awareness and Control of Hypertension and Associated Risk Factors in Older Population in Vietnam
Authors: Vu Nguyen C , Dang Linh T , Saito Yasuhiko , Phan Ngoc T , Pham Nga T , Komazawa Osuke , Vu Thanh-Huyen T
Published: March 2020

Background:
In Vietnam, the population is aging rapidly and hypertension (HTN) is on the rise. However, no national representative data are available on HTN in Vietnam’s older population. Our study describes the current prevalence, awareness and control of HTN and examines their sociodemographic and heath behavioral determinants using baseline data from the Longitudinal Study on Aging and Health in Vietnam (LSAHVN).

Methods:
The baseline LSAHVN used a multistage clustered sampling to select 6,050 participants from the general population aged 60 and older in 2018-19. Systolic/diastolic blood pressures (thrice taken) were calculated using the average of the second and third measurements. Data on HTN awareness and treatment, sociodemographic characteristics, and health behaviors were collected using standard questionnaires. Definitions of HTN, awareness and control, names of risk factors, and analysis samples were showed in the Table. Adjusted prevalence ratios (PR) of HTN, awareness, and control by risk factors was estimated.

Results:
Population mean age was 70.8 years, 57.14% were female, 82.23% were Kinh (majority), and 33.75% lived in urban settings. The prevalence of HTN was 62.90%, 62.73% were aware of their HTN situation, 53.99% were treated, and 38.63% had HTN controlled. Generally, age, ethnicity, education levels, resident place, and BMI are risk factors for HTN prevalence, awareness, and control. For example, the PR of having HTN was 33% higher in the 80+ age group vs. the 60-69 age group; PRs of HTN awareness and control were 13% and 50% higher in urban vs. rural residents, respectively. BMI levels were associated with all 3 outcomes.

Conclusion:
In Vietnam’s aged 60+ population, hypertension is prevalent, with low rates of awareness, treatment, and control, and those are associated with age, socio-demographic characteristics, and BMI levels. The findings may have relevance for developing intervention strategies addressing hypertension in older people, especially in ethnic minority and rural populations.
Abstract P176: Associations of Gestational Lipids and Apolipoproteins With Pregnancy Outcomes: The Hyperglycemia and Adverse Pregnancy Outcome Study
Authors: Perak Amanda M , Kuang Alan , Lancki Nicola , Labarthe Darwin R , Shah Svati H , Lowe Lynn , Wilkins John T , Lowe William , Lloyd-jones Donald M , Scholtens Denise
Published: March 2020

Introduction:
Gestational hyperlipidemia has traditionally been considered physiologic and benign, but the significance of inter-individual variation in lipid levels for maternal-fetal health are poorly understood. We examined associations of gestational lipids and apolipoproteins with adverse obstetric and neonatal outcomes.

Methods:
Data from the Hyperglycemia and Adverse Pregnancy Outcome Study were analyzed, including 1,813 mother-child dyads from 9 field centers in 6 countries: US (25%), Barbados (24%), UK (20%), China (16%), Thailand (8%), and Canada (7%). Fasting lipids and apolipoproteins were directly measured at a mean of 28 (range 23-34) weeks’ gestation. Cord blood was collected at delivery, neonatal anthropometrics were measured within 72 hours, and medical records were abstracted for obstetric outcomes. Logistic regression was utilized to test associations of lipids and apolipoproteins (per +1 SD; log-transformed if skewed) with pregnancy outcomes, adjusted for center, demographics, and maternal covariates such as BMI, blood pressure, and glycemia.

Results:
See
Table
for lipid and apolipoprotein levels in pregnant mothers. In fully adjusted models (
Table
), 1 SD higher log-triglycerides (i.e., ~2.7-fold higher triglyceride level) in late pregnancy was significantly associated with higher odds for preeclampsia (OR 1.53 [95% CI, 1.15-2.05]), large for gestational age infant (1.42 [1.21-1.67]), and infant insulin sensitivity <10
th
percentile (1.25 [1.03-1.50]), but not with unplanned primary cesarean section or infant sum of skinfolds >90
th
percentile. There were no significant associations of maternal HDL-C, LDL-C, or log-ApoB/A1 ratio with any outcome.

Conclusion:
Triglyceride levels in the latter half of pregnancy were uniquely associated with both maternal risks (preeclampsia) and neonatal risks (large for gestational age and insulin resistance), even after adjustment for maternal BMI, blood pressure, and glycemia.
Abstract P182: Diet Quality and Longitudinal Change in Kidney Function: Findings From the Hispanic Community Health Study/Study of Latinos (hchs/sol)
Authors: Missikpode Celestin , Ricardo Ana , Durazo-Arvizu Ramon , Mattei Josiemer , Isasi Carmen R , Mossavar-Rahmani Yasmin , Sotres-Alvarez Daniela , Talavera Gregory A , Abbott Kevin , Manoharan Anjella , DAVIGLUS Martha L , Lash James
Published: March 2020

Introduction:
Recent studies suggest an association between healthy diet and incident chronic kidney disease (CKD), but these included few Hispanics/Latinos. We examined the relationship of diet quality with change in kidney function in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Given the bidirectional relationship between CKD and cardiovascular disease (CVD), we assessed prevalent CVD as a potential effect modifier.

Methods:
Data from HCHS/SOL Visits 1 (2008-2011) and 2 (2014-2017) were used. The Alternative Healthy Eating Index (AHEI-2010), a measure of diet quality, was calculated from two 24-hour dietary recalls administered at Visit 1 and analyzed as quintiles (lowest to highest quality). Kidney function was assessed using CKD-EPI
creat
glomerular filtration rate estimating equation (eGFR), and urine albumin-to-creatinine ratio (UACR). Annualized change was computed as the difference in eGFR or UACR between visits divided by follow-up time in years. CVD was defined at Visit 1 as self-reported coronary heart disease, cerebrovascular events, peripheral artery disease or heart failure. Of 16415 HCHS/SOL participants, data from 9336 and 9209 persons with complete information on dietary intake, and change in eGFR and UACR, respectively, were analyzed using linear regression. Interaction between AHEI-2010 and CVD was explored. Analyses accounted for complex sampling design.

Results:
Average age was 41 years, 52% were women, and 22% had prevalent CVD. On average, eGFR declined by 0.67 mL/min/1.73 m
2
/ year, and UACR increased by 2.0 mg/g/year. A significant interaction between diet quality and CVD was seen (p < 0.01). Lower AHEI-2010 quintiles were associated with greater decline in eGFR in a dose-response manner in persons without CVD (P-trend <0.01, Table). The association between diet quality and eGFR was stronger in those with CVD. AHEI-2010 was not associated with change in UACR.

Conclusion:
These findings have important implications for CKD prevention, especially for those with CVD.
Abstract P199: A Digital Health Platform For Weight Loss In Metabolic Syndrome: A 6-month Prospective Study In China
Authors: Senecal Conor , Collazo-Clavell Maria , de Andrade Mariza , Lerman Lilach O , Lerman Amir , Lopez-Jimenez Francisco
Published: March 2020

Introduction:
Metabolic Syndrome represents a constellation of findings known to increase cardiovascular risk and all-cause mortality and is becoming more frequent in China. Smartphone applications may provide a cost-effective method to engage in weight loss and improve metabolic syndrome components.

Methods:
Prospective study of changes in weight and metabolic syndrome risk factors at 6 weeks and 6 months using a smartphone application utilizing a wireless scale, meal replacement biscuits and e-coaching in China. All participants had or were at high risk for metabolic syndrome and all interaction was online, without face to face contact.

Results:
218 individuals ,55% female, participated. Median weight loss at 6 weeks and 6 months was 7.3kg and 8.4 kg (P<0.001) respectively. At baseline, 60% met a diagnosis of metabolic syndrome this dropped to 38% at 6 weeks (P<0.001) and stayed at 38% at 6 months (P<0.001). At 6 week the prevalence of all components of metabolic syndrome were improved (P<0.05) except HDL.

Conclusions:
A smartphone weight loss platform that utilizes a wireless scale, meal replacement biscuits and e-coaching was associated with significant weight loss and improvement in several metabolic syndrome components at 6 weeks and 6 months. This program may provide a scalable intervention against metabolic syndrome, especially in developing countries such as China.
Abstract P206: Diet Quality is Lower Among Adolescents Who Skip Lunch
Authors: Clason Spencer M , Spruance Lori , Myers Leann , O'Malley Keelia , Johnson Carolyn
Published: March 2020

Introduction:
A healthy diet is key in preventing chronic diseases and black adults have higher rates of hypertension, obesity, and heart disease death rates compared to their white counterparts. Because dietary habits track from adolescence to adulthood, it is important to understand dietary habits of adolescents. This study aimed to examine the dietary quality among adolescents who skip lunch compared to those who do not.

Methods:
Data were collected in 2012 from 718 adolescents attending schools in New Orleans, Louisiana. Schools were high-poverty and closed-campus. Adolescents participated in a 24-hour dietary recall using the Automated Self-Administered 24-Hour (ASA24) Dietary Assessment Tool and data were converted into Healthy Eating Index (HEI-10) scores (range 0-100; higher scores reflect higher quality diet). Mean scores were compared between students who skipped lunch and those who did not.

Results:
Of the 718 respondents, 88.3% were black and 15.3% of students skipped lunch. Students who ate lunch had a mean HEI score of 46.6 compared to a mean score of 41.7 for students who skipped lunch (p<0.001). Students who skipped lunch also had significantly lower intake of total vegetables, whole fruits, total dairy, total protein, and higher intake of empty calories (Solid fats, alcohols, and added sugars (SoFASS)).

Conclusions:
Skipping lunch was associated with lower quality diet, though diet quality was low among all students. Students who skip lunch are less likely to consume vegetables, whole fruits, whole grains, and proteins and have higher intake of SoFASS. Considering over 15% of the sample did not eat lunch in a closed-campus school setting, further research should consider how to encourage students to participate in the National School Lunch Program.

Table 1. HEI score comparisons between those who skip and do not skip lunch.
Abstract P208: Dietary Acculturation Impacts the Gut Microbiome in a Diverse U.S. Population
Authors: Peters Brandilyn , Yi Stella , Beasley Jeannette , Cobbs Emilia , Choi Hee Sun , Beggs Dia , Hayes Richard B , Ahn Jiyoung
Published: March 2020

Introduction:
Risk of chronic diseases such as obesity, diabetes, and cardiovascular disease are known to increase with duration and generations of U.S. residence, though it remains unclear how living in the U.S. negatively impacts immigrant health.

Hypothesis:
We hypothesize that dietary acculturation, or shifting of dietary patterns towards a native U.S. pattern, contributes to the disease risk transition in immigrants, via modulation of the gut microbiome.

Methods:
We characterized disparities in the gut microbiome between racially/ethnically diverse U.S. immigrant and U.S.-born groups, and determined the impact of dietary acculturation on the microbiome. Stool samples were collected from 863 U.S. residents, including U.S.-born (315 White, 93 Black, 40 Hispanic) and foreign-born (105 Hispanic, 264 Korean) groups. We determined dietary acculturation from dissimilarities based on food frequency questionnaires (
Figure 1a
), and used 16S rRNA gene sequencing to characterize the microbiome.

Results:
Gut microbiome composition differed across study groups, with the largest difference between foreign-born Koreans and U.S.-born Whites (
Figure 1b
).
Bacteroides plebeius
, a seaweed-degrading bacterium, was strongly enriched in foreign-born Koreans, while
Prevotella copri
and
Bifidobacterium adolescentis
were strongly enriched in foreign-born Koreans and Hispanics, compared with U.S.-born Whites. Dietary acculturation in foreign-born participants was associated with specific sub-operational taxonomic units (s-OTUs), resembling abundance in U.S.-born Whites (
Figure 1c-d
); e.g., a
Bacteroides plebeius
s-OTU was depleted in highly diet-acculturated Koreans.

Conclusions:
Dietary acculturation may result in loss of native species in immigrants. Longitudinal research is necessary to determine the role that acculturation-related microbiome changes may play in immigrant and racial/ethnic health disparities.
Abstract P210: Associations Of Early Parental Feeding Concerns And Behaviors With Child’s Dietary Intakes Throughout Childhood
Authors: Gingras Veronique , Switkowski Karen M , Rifas-Shiman Sheryl L , Faleschini Sabrina , Oken Emily , Hivert Marie-France
Published: March 2020

Introduction:
Parental feeding behaviors have been found to be associated with dietary intakes and weight status in children, although the longitudinal associations of parental feeding behaviors in early life with diet later in childhood have been scarcely studied.

Hypothesis:
We hypothesized that parental feeding restriction, pressure to eat, and concerns about child’s weight would be associated with poorer diet quality throughout childhood.

Methods:
Among 1172 mother-child pairs from Project Viva, we examined associations of parental feeding behaviors at 2 years assessed via questions from the Child Feeding Questionnaire (behaviors dichotomized as yes vs. no) with diet quality in early (mean: 3.2, SD 0.2 years; n=1076) and mid-childhood (mean: 7.8, SD 0.7 years; n=993) assessed via food frequency questionnaires. We used linear regression models adjusted for socio-demographic characteristics, maternal and paternal body mass index, and maternal diet quality in pregnancy.

Results:
At 2 years postpartum, 47% of parents pressured/encouraged their child to eat more, 8% restricted their intakes, 15% were concerned about their child being overweight and 7% about their child being underweight. Parental pressure to eat at 2 years was associated with higher child intake of fruit juice (β 0.17 serving/day; 95% CI 0.01, 0.34) and snack foods (0.12 serving/day; 0.01, 0.22) in early childhood and with lower youth healthy eating index score (-1.32 points; -2.54, -0.10; score from 0 to 85 points) in mid-childhood. Parental feeding restriction at 2 years was associated with lower intake of sugar-sweetened beverages (-0.17 serving/day; -0.27, -0.06) in early childhood and with lower intake of dairy (-0.29 serving/day; -0.56, -0.02) in mid-childhood. Parental concerns about their child being underweight was associated with lower youth healthy eating index score (-2.18 points; -4.30, -0.05; score from 0 to 95 points) in early childhood while concerns about their child being overweight was associated with higher intakes of red and processed meat (0.14 serving/day; 0.04, 0.23) in early childhood and higher intake of baked products in mid-childhood (0.07 serving/day; 0.01, 0.13).

Conclusions:
We found that early parental feeding behaviors may have a modest contribution to dietary intakes throughout childhood. However, only a few associations persisted after adjusting for socio-economic and parental characteristics and effect sizes were modest. Strategies to improve diet quality in children might need to focus on the broader family and socio-economic context.
Abstract P213: Chocolate Intake is Associated With Decreased Epigenetic Aging Among African Americans
Authors: Chen Li , Zhu Haidong , Bhagatwala Jigar , Raed Anas , Huang Ying , Sesso Howard D , Dong Yanbin
Published: March 2020

Introduction:
Chocolate intake has shown potential cardiometabolic health benefits in recent studies. We recently reported an association between chocolate intake and longer telomere length. Epigenetic age acceleration, an emerging marker of biological aging, predicts cardiovascular morbidity and mortality. But the relationship between chocolate intake and epigenetic aging has not been investigated.

Hypothesis:
We examined the association between chocolate intake and epigenetic aging among African Americans.

Methods:
A genome-wide methylation scan was performed among 50 overweight and obese African Americans using the Illumina Human Methylation 850K Bead Chip on peripheral blood mononuclear cell DNA. DNA methylation ages were calculated according to the Horvath and the Hannum clocks. Methylation-based age acceleration (ΔAge) was extracted from a linear regression of DNA methylation age on chronological age. Chocolate intake frequency over the past year was obtained by questionnaire, along with other major cardiovascular risk factors.

Results:
Fifty participants (aged 26.1 ± 9.3 years, 16% male) were included in the study. Fifteen (30%), 20 (40%), and 15 (30%) participants consumed less than 1 serving/month, 1-3 servings/month, and ≥1 serving/week of chocolate, respectively. Chocolate intake of ≥1 serving/week was associated with decreased Δage in both Horvath clock (β= -3.31, p-value = 0.046) and Hannum clock (β= -3.59, p-value = 0.096) after adjustment of age, sex, body mass index, 25(OH)D and CD4%.

Conclusions:
Chocolate intake may be associated with decreased epigenetic aging, with randomized controlled trials needed to establish any beneficial effects of chocolate intake on epigenetic aging processes.
Abstract P215: Medical Lifestyle Residential Program Reduces Anxiety In 10 Days
Authors: Ramirez Francisco E , Heisler Payton , Nedley Neil
Published: March 2020

Introduction:
Anxiety is a condition that can lower the quality of life of an individual.

Hypothesis:
It is proposed that after going through a residential depression and anxiety program, patients could decrease in their anxiety levels.

Methods:
Participants (n=181), completed a 10-day residential depression and anxiety recovery program in the town of Weimar California. At the beginning of the program, the participants were given different mental condition tests including the Beck Anxiety Inventory Version II (BAI-II) to determine baseline conditions. The BAI-II test refers to levels of depression in four categories: Minimal(0-7), Mid(8-15), Moderate(16-25), Severe(26-63). While participating in the program, the patients partook of exercise therapy, light therapy, interactive lectures with health professionals, plant based healthy meals, and one on one consultations with appropriate physicians and cognitive behavioral therapy from clinical counselors as well as chaplaincy care to deal with other stress sources. Patients also read books on cognitive behavioral therapy.

Results:
At baseline mean Beck Anxiety was 18.22, SD 11.86, median 16, mode 11. At the end of the program the mean Beck Anxiety score was 7.4, SD 7.7, median 4, mode 0. The change was significant with a t(180) = 13.8 p<.001.

Conclusion:
The residential medical residential program was very effective in decreasing anxiety. Long term follow up is being done at the moment.
Abstract P224: Effect Of Body Mass Index On In-hospital Outcomes In Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Ndunda Paul M , Vindhyal Mohinder Reddy , Okut Hayrettin , Khayyat Sinan , Muutu Tabitha , Fanari Zaher
Published: March 2020

Introduction:
The prevalence of obesity in the US is 41.1% and is on the rise. Data are limited and results are mixed on the effect of body mass index (BMI) on outcomes of transcatheter aortic valve replacement (TAVR). The objective of this study was to determine the effect of BMI on the in-hospital outcomes of patients undergoing TAVR.

Methods:
Data from the 2015 and 2016 Health Cost and Utilization Project Nationwide Inpatient Sample database was used. Patients who underwent TAVR were identified and in-hospital outcomes compared between patients with a normal BMI and underweight, overweight, obese, and severely obese patients. Propensity score matching was done using a greedy matching algorithm.

Results:
A total of 2,618 patients were included in this study. The rate of in-hospital mortality was highest in underweight patients (2.94%) and lowest in overweight (0.49%) patients. It was 2.13% in normal weight, 1.23% in obese and 1.97% in severely obese patients. There was no statistically significant difference in in-hospital mortality between overweight and underweight (0.49% vs. 2.94% p=0.056) overweight and normal BMI (0.49% vs. 2.13% p=0.16), overweight and obese (0.49% vs. 1.23% p=0.35) and overweight and severely obese (0.49% vs. 1.97% p=0.14). Compared with overweight patients, underweight (5.6 vs. 7.0 days p=0.07 ) and normal patients (5.6 vs. 7.5 days p=0.03) had the highest mean length of hospital stay (LOS). There was no significant difference in the proportion of patients discharged home among all BMI categories (p=0.23).

Conclusions:
There was no significant difference among the BMI categories for in-hospital mortality and the proportion of patients discharged home. Overweight patients had a shorter LOS compared with underweight and normal BMI patients.
Abstract P228: Do Cardiometabolic Risk Profiles Differ Across Race-Ethnicity? An Analysis of the Most Active U.S. Adults in the 2003-2006 NHANES
Authors: Boyer William , Richardson Michael R , Churilla James R , Toth Lindsay , Fitzhugh Eugene , Bassett David R
Published: March 2020

Introduction:
Previous studies have revealed a significant, inverse dose-response relationship between total activity counts/day (TAC/d) and several cardiometabolic risk factors (CMRF). An ongoing line of research is the examination of the contributions of behavioral, environmental, and physiological factors to CMRF differences across race-ethnicity. However, it is unknown if these differences exist among the most physically active adults.

Hypothesis:
Among the most active U.S. adults, we hypothesize that CMRF measures will differ across race-ethnic groups.

Methods:
Study sample (n=1,059) included adult (20-79 years of age) participants from the 2003-2006 NHANES who wore an ActiGraph model 7164 accelerometer on the right hip. The top quartile of accelerometer-derived age- and gender-specific TAC/d was used as a cutpoint to define the “most active”. All participants were without T2D (fasting glucose <126 mg/dL, no medication, no self-reported diagnosis) and without CVD (self-report). CMRF included HOMA-IR, fasting insulin and glucose, systolic (SBP) and diastolic blood pressure (DBP), HDL, LDL, triglycerides, BMI, waist circumference (WC) and C-reactive protein (CRP). Multiple linear regression was used to examine CMRF differences between non-Hispanic white (NHW), non-Hispanic black (NHB) and Mexican American (MA) participants. Regression models were adjusted for age, sex, education, smoking, wear time, BMI (except BMI and WC models), objectively-measure MVPA (≥760 counts/min) and race-ethnicity.

Results:
No significant differences were found in mean TAC/d across race-ethnicity. When compared to NHW, NHB had significantly higher HOMA-IR, fasting insulin, SBP, WC, and BMI. Compared to NHW, MA had significantly higher HOMA-IR, fasting insulin, triglycerides, WC and BMI. When comparing NHB to MA, MA had significantly higher triglycerides and HDL and significantly lower SBP.

Conclusions:
It has been proposed that the race-ethnic differences in PA participation could be contributing to disparities in elevated CMRF, but even among U.S. adults in the 75th percentile for total activity volume (i.e. TAC/d), race-ethnic differences in CMRF still exist. It is probable that other social, environmental, and genetic factors are responsible for moderating the beneficial effects PA has on CMRF specifically among NHB and MA adults.
Abstract P240: Discrimination Mediates the Adverse Effect of Neighborhood Problems on Cardiometabolic Risk Among Latino/a Adults
Authors: Hussain Maryam
Published: March 2020

Introduction:
Latino/as in the US on average present with low high-density lipoprotein (HDL) cholesterol and high body-mass index (BMI), putting them at higher risk for future cardiometabolic disease. Neighborhoods have been implicated, directly and indirectly, in poorer cardiometabolic health among ethnic minorities. US Latino/as often live in neighborhoods where they may not have access to engage in positive health behaviors, such as proper diet and physical activity. However, the mediating role of discrimination experienced in these neighborhoods has hardly been examined within the context of Latino/a cardiometabolic health.

Methods:
We analyzed data from the Texas City Stress and Health Study. Participants were self-identified Latino/a/Hispanic (
N
= 500, 61.8% female,
M
age
= 49.08,
SD
age
= 15.80) who reported on their perceived experience of discrimination (higher scores reflecting more discrimination) and their perception of their neighborhood (higher scores reflecting more positive environment) validated survey measures. A trained phlebotomist drew blood in a clinic or in the participant’s home between 8 and 11 AM after fasting for HDL (mg/dL). Blood samples were centrifuged to obtain plasma, which was stored at –70°C until testing. All specimen were batch analyzed and read blind-coded. Additionally, they took clinical measures of participant’s height and weight, to calculate BMI (adjusted for sex). To estimate the mediating effect of discrimination through perception of neighborhood on cardiometabolic risk, path analysis with bootstrapped linear regression models were conducted. We conducted analyses unadjusted and adjusted for age, sex, education, and nativity. All analyses were conducted in the PROCESS macro in SPSS.

Results:
Participants on average had high HDL levels (
M
mg/dL
= 51.00, SD = 15.59). Males on average were overweight (
M
BMI
= 29.78, SD = 5.49) and females (
M
BMI
= 31.42, SD = 7.27) on average were obese. Bootstrapped estimates showed that perception of neighborhood fully mediated the effect of discrimination on HDL (b = -.43, SE = .18
p
= .015) and BMI (b = .02, SE = .01,
p
= .023), unadjusted for covariates. Although the fully mediated model for BMI withstood adjustment for covariates, the model for HDL did not withstand adjustment.

Conclusion:
Discrimination accounts for the negative impact that neighborhood problems have on poor cardiometabolic health among adult Latino/as. Future research should examine how positive neighborhood interactions (e.g., walking clubs or playgroups) can mitigate the adverse effects on cardiometabolic health among this at-risk population.