bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P428: Get Active Orlando: Walking, Bicycling, Gardening
Authors: Decker Jonathan W , Dennis Karen E
Published: July 2021

Introduction
Research has consistently demonstrated positive benefits from physical activity (PA) in the primary and secondary prevention of chronic diseases and conditions such as CVD. Even the person going from doing nothing to doing something will see the benefits. The specific aim of this study was to implement and evaluate the short-term effects of walking, bicycling, and community gardening approaches to enhancing PA among urban-dwelling older adults and low-income ethnic minorities.

Methods
Participants included 157 adults of all races/ethnicities who self-selected into one of three interventions: walking (
n
= 47), bicycling (
n
= 35), or gardening (
n
= 75). Interventions were 10 weeks long, with follow-up data collection every 3 months until 1 year. Data collection included self-report questionnaires (Self-efficacy for Exercise Habits Survey, Lubben Social Network Scale, Perceived Environments Attributes scale, Behavioral Risk Factor Surveillance System, self-reported frequency, duration, and distance of PA performed), measured PA (7-day accelerometry), and PA focus groups.

Results
Throughout the course of the intervention and the 9-month follow-up period, only three significant differences in self-reported questionnaire data arose. These differences occurred among bicyclists, with a significant increase (
p
< 0.01) in social networks from pre- to post-intervention, which remained stable across time, to the 9-month data collection. The bicyclists also reported a significant improvement (
p
< 0.001) in the perceived environmental attributes. Bicyclists also reported an increase in duration, frequency, and distance of bicycling. Themes emerging from the focus groups included: meeting new people, a spirit of community, accountability, increasing exercise, and developing community awareness.

Conclusions
The purpose of this study was to increase the overall PA of the participants, not specific exercise routines. However, there were no significant differences from pre- to post-intervention (3 month interval) or to the 9-month follow-up except for the increase in social networks and perceived environmental attributes reported by the bicyclists. They also reported an increase in duration, frequency and distance ridden. In this study, gardening was the most successful intervention, with a greater percentage of individuals who wanted to participate, completed data collection, and continued beyond that time. Walkers demonstrated a lack of sustainability past the intervention period among individual participants. Although there were few statistically significant findings regarding PA and its influences, the results should be considered in their entirety. Participant verbal comments and feedback throughout the study, in addition to during focus groups, reflected the positive impacts that these interventions had upon the participants’ lives.
Abstract P439: Risk Factor Profile and Prevalence of Subclinical Disease in African Americans with Diabetes and Metabolic Syndrome: The Jackson Heart Study
Authors: Gharaibeh Kamel A , Xanthakis Vanessa , Sung Jung Hye , Samdarshi Tandaw S , Taylor Herman A , Sims Mario , Vasan Ramachandran S , Fox Ervin R
Published: July 2021

Background
. Metabolic derangements such as diabetes (DM) and metabolic syndrome (MetS) are common in African Americans (AA) and contribute to the higher cardiovascular disease (CVD) mortality in this group. A greater prevalence of subclinical disease (ScD) among those with DM and MetS in the AA community may be an explanatory factor.

Objective
. We assessed the CVD risk factor profile and distribution of ScD among AA with DM and MetS in the Jackson Heart Study (JHS).

Methods
. We evaluated 4,365 AA participants [mean age (SD) of 53.8 (12.3) years, 64.5% women] free of overt CVD who attended JHS Exam 1 (between 2000- 2004), when ScD assessment was routinely performed(with the exception of CT for coronary calcium that occurred in Exam2). SCD measures included 1) peripheral artery disease (PAD, defined as ankle-brachial index<0.9), 2) high coronary artery calcium (CAC, defined as score>100), 3) left ventricular (LV) hypertrophy (LVH defined as left ventricular mass index>51 g/m
2.7
, 4) low LV ejection fraction (low EF, defined as an EF<50%), and 5) microalbuminuria (MA, defined as an albumin-to-creatinine ratio>25 μg/mg in men and >35 μg/mg in women). We compared the distribution of standard CVD risk factors and ScD prevalence in 1) those without DM or MetS (referent), 2) those with MetS but no DM and 3) those with DM.

Results
. In our study sample, 1,089 (24.9%) had MetS with no DM and 752 (17.2%) had DM. Compared to the referent group, groups with metabolic derangement tended to be older, female, hypertensive, obese, and had lower HDL, higher fasting glucose, and higher triglycerides levels. Table 1 compares the distribution of ScD for the three groups, and demonstrates the greater odds of. CAC, LVH and microalbuminuria in participants with MetS or DM.

Conclusion
. In our large community-based sample of AAs, we observed a significantly high prevalence of ScD overall, especially so in participants with MetS and DM. These findings likely contribute to the high CVD rates in AA with MetS and DM.
Abstract 08: Daily Energy Intake Distribution And Weight Gain In Women
Authors: Lajous Martin , Rossignol Emilie , Fournier Agnes , Fagherazzi Guy , Balkau Beverley , Boutron-Ruault Marie-Christine , Clavel-Chapelon Françoise
Published: July 2021

Background:
Evidence points to an inverse relation between breakfast and obesity. Little information is available on the distribution of energy intake during the day and weight gain.

Methods:
We evaluated the relation of the distribution of daily energy intake, eating frequency and weight change and weight gain in a prospective study of 61,543 disease-free French women in the E3N- EPIC cohort. At baseline in 1993, participants responded to a validated questionnaire on habitual diet over eight possible daily eating occasions. We calculated energy intake at various moments during the day. Women were categorized according to the energy distribution (% energy of total) for each eating moment into quintiles and according to the number of calorie-containing meals. Self-reported weight was updated on six occasions after baseline, using mailed questionnaires. Linear mixed models were used to evaluate mean weight change and Cox models to assess weight gain ≥5kg.

Results:
Between 1993 and 2008, the mean weight change was +2.45 kg (SD± 0.2) and 22,808 women gained ≥5kg. After multivariable adjustment (including total energy), higher energy intake at breakfast was associated with a lower positive weight change from baseline, while higher energy intake at night was associated with a higher positive weight change (p-value <0.0001) (Figure). No association was observed for energy intake at midday or mid-afternoon. In multivariable models, HRs of gaining ≥5kg were 0.90 (95%CI 0.86-0.94; p-trend <0.0001) and 1.09 (95%CI 1.04-1.15; p-trend <0.0001) for women in the highest compared to the lowest energy consumption category at breakfast and at dinner, respectively. Conversely, eating frequency was directly associated to weight change (p-value <0.0001) but not ≥5kg weight gain.

Conclusion:
Higher percent energy intake at breakfast was associated with a lower weight gain, while higher percent energy intake at dinner was associated with higher weight gain. The distribution of daily energy may be important for maintaining a healthy weight.
Abstract 36: Changes in HDL Particle Traits in Response to Regular Exercise: Results from the HERITAGE Family Study
Authors: Sarzynski Mark A , Rankinen Tuomo , Leon Arthur S , Rao Dabeeru C , Skinner James S , Després Jean-Pierre , Bouchard Claude
Published: July 2021

Given the controversy around HDL-C as a therapeutic target, there is a need to investigate other features of HDL and how they respond to various preventive interventions. We tested the hypothesis that regular exercise would have beneficial effects on HDL particle (HDL-P) traits in sedentary adults.

Methods:
The following HDL-P traits were measured via NMR (Liposcience Inc.) before and after completion of a 20-week exercise program in the HERITAGE Family Study (N=715): concentration of total, large, medium, and small HDL-P and mean HDL-P size. ANCOVA was used to test for aggregation of HDL-P trait responses in families controlling for age, sex, and baseline BMI and trait value.

Results:
The concentration of large HDL-P significantly increased in response to regular exercise in both Black and White participants, while the increase was significantly larger in females compared to males (Table 1). In general, regular exercise decreased the concentration of medium and small HDL-P. Together, these responses contributed to a significant increase in the average cholesterol content of HDL particles. Exercise-induced changes in large HDL-P were inversely correlated with changes in fat mass and systolic blood pressure. Moreover, changes in BMI were significantly associated with changes in all of the HDL-P traits, but not with HDL-C. We found significant evidence of familial aggregation for the exercise-induced changes in HDL-P traits in both races, as there was 1.4 to 1.6 times more variance between than within families for the changes in total (p=0.02 in Whites) and large HDL-P (p=0.004 in Whites, p=0.02 in Blacks) and HDL-P size (p=0.0009 in Whites, p=0.009 in Blacks).

Conclusion:
The HDL-P subclass profile favorably responded to regular exercise in sedentary Black and White adults, highlighted by increases in the concentration of large HDL-P, and may be influenced by a significant genetic component. We provide evidence that regular exercise could potentially be used as an HDL-based therapy designed to target beneficial subfractions.
Abstract 60: Higher Fitness is Associated with Lower Health Care Costs: The Veterans Exercise Testing Study
Authors: Myers Jonathan , King Robert , Fonda Holly , Abella Joshua , Froelicher Victor , Kokkinos Peter
Published: July 2021

Introduction:
The association between poor physical fitness and adverse health outcomes is well-established, but few data are available regarding the association between fitness and health care costs.

Hypothesis:
Higher fitness is associated with lower overall health care costs.

Methods:
We studied 1,294 patients (mean 64±12 years) who underwent maximal exercise testing for clinical reasons as part of the Veterans Exercise Testing Study (VETS). Fitness was expressed as the percentage of age-predicted peak METs achieved, and categorized in quartiles. Total and annualized health care costs, derived from the VA Allocated Resource Center, were assessed between 2005 and 2010. Health care costs between quartiles of fitness were compared using ANOVA; multiple regression was used to determine clinical and exercise test predictors of health care costs. Follow-up for all-cause mortality (mean 8.5±5 years) was performed through March 2013.

Results:
A gradient for reduced health care costs was observed with increased fitness, with subjects in the least-fit quartile having approximately twice the overall costs as those in the fittest quartile (Table). Non-survivors were significantly less fit (6.5±5.1 vs. 9.1±3.5 METs, p<0.001) and exhibited roughly 3 times the health care costs of those who survived. In a multivariate model including historical, clinical and exercise test responses, fitness was a significant predictor of health care costs (p<0.01).

Conclusions:
Low fitness is associated with a significant burden on the health care system. Improving fitness should be encouraged for its potential to lower health care costs.
Abstract MP19: Serum 25-hydroxyvitamin D is associated with incident heart failure in whites but not blacks: The Atherosclerosis Risk in Communities Study (ARIC)
Authors: Lutsey Pamela L , Michos Erin D , Pankow James S , Selvin Elizabeth , Loehr Laura R , Kao W.H. L , Eckfeldt John H , Gross Myron D , Foslom Aaron R
Published: July 2021

Background:
Suboptimal 25-hydroxyvitamin D [25(OH)D] is a potential cardiovascular risk factor, likely influencing cardiovascular events via established risk factors, namely hypertension, diabetes, and inflammation. Emerging evidence also suggests that the association between 25(OH)D and cardiovascular risk is stronger in whites than blacks, but these preliminary findings need further confirmation.

Hypotheses:
Serum 25(OH)D is inversely associated with incident heart failure, and (a) partly mediated by traditional cardiovascular risk factors and (b) stronger among whites than blacks.

Methods:
A total of 12,215 ARIC Study participants free of heart failure at baseline in 1990-92 (median age 56, 24% black) were followed through 2010. Total serum 25(OH)D was measured in stored samples at baseline using LCMS. Month of blood draw was accounted for. Incident heart failure events were identified via active surveillance and defined by a hospital discharge code of ICD9-428 and parallel ICD codes for deaths. Multivariable Cox proportional hazards regression models were employed.

Results:
During a median of 17 years of follow-up, there were 1,799 incident heart failure events. Median 25(OH)D was 26.2 and 19.0 ng/mL in whites and blacks, respectively. The association between 25(OH)D and heart failure varied by race (p-interaction = 0.01). Among whites, those in the lowest quintile of 25(OH)D were at 2-fold greater risk of heart failure relative to those in the highest quintile (
Table
). The HR was attenuated, but remained statistically significant after multivariable adjustment. In blacks there was no association between 25(OH)D and heart failure. Results were similar when race-specific quintiles were used.

Conclusions:
Low serum 25(OH)D was independently associated with risk of incident heart failure among whites, but not among blacks in this community-based population. Further work is needed to determine what mechanisms underlie racial variation in the association between vitamin D status and risk of heart failure.
Abstract MP26: Sleep duration and risk of stroke mortality among Chinese adults in Singapore: the Singapore Chinese Health Study
Authors: Pan An , Yuan Jian-Min , Koh Woon-Puay
Published: July 2021

Introduction:
Short or long sleep hours are associated with adverse health outcomes, including diabetes, hypertension, coronary heart disease (CHD) and total mortality. However, the prospective relation between sleep duration and stroke risk is less studied, particularly in Asians. Thus, we assessed the hypothesis that short (≤5 hours) and long (≥9 hours) sleep durations were related to increased risk of stroke mortality among Chinese adults residing in Singapore.

Methods:
The Singapore Chinese Health Study is a population-based cohort that recruited 63,257 Chinese adults aged 45-74 years during 1993 and 1998. Sleep duration was assessed at baseline and categorized to five groups: ≤5, 6, 7, 8 or ≥9 hours. Death information was identified via registry linkage up to December 31, 2011, with ICD-9 codes 430-438 for all stroke deaths, 430-432 for hemorrhagic, and 433-438 for ischaemic or non-specified stroke deaths. Cox proportional hazard models were used to calculate hazard ratios (HRs) with adjustment for socio-demographic, lifestyle and comorbidities.

Results:
We documented 1,381 total stroke deaths (322 hemorrhagic and 1,059 ischaemic or non-specified strokes) during 926,752 person-years of follow-up. Compared to the reference group of sleeping for 7 hours, the multivariate-adjusted HR (95% confidence interval) for total stroke mortality was 1.25 (1.05-1.50) for ≤5 hours, 1.01 (0.87-1.18) for 6 hours, 1.09 (0.95-1.26) for 8 hours, and 1.54 (1.28-1.85) for ≥9 hours. The increased risk was also observed for ischaemic or non-specified stroke deaths with short (1.37; 1.12-1.68) and long (1.68; 1.36-2.06) sleep durations, but not for hemorrhagic stroke deaths (0.92 [0.62-1.36] and 1.14 [0.76-1.72], respectively). We observed significant interaction with baseline hypertension (P-interaction=0.04): positive association was found for short (1.54; 1.16-2.03) and long (1.95; 1.48-2.57) sleep durations among individuals with baseline hypertension, but not among those without baseline hypertension (1.07 [0.85-1.36] and 1.27 [0.98-1.63], respectively). Furthermore, in participants without baseline CHD/stroke, short and long sleep durations were related to an increased risk (HR 1.30 [1.07-1.57] and 1.43 [1.16-1.76], respectively); while in CHD/stroke patients, only long sleep duration was associated with an increased risk (2.34; 1.53-3.57), but not the short sleep duration (0.96; 0.57-1.62).

Conclusions:
In this large cohort study of Chinese adults, both short and long sleep durations were significantly associated with increased risks of stroke mortality. The associations were significant and stronger in hypertensive participants, but not in those without hypertension. Further studies are needed to confirm the interaction with hypertension and explore the mechanisms linking sleep quantity and stroke mortality.
Abstract MP35: The American Heart Association’s Life’s Simple 7 and Mortality by Race and Sex in the U.S.: the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort
Authors: Cushman Mary , Judd Suzanne E , Howard Virginia J , Zakai Neil A , Kissela Brett , Kleindorfer Dawn , Safford Monika M , Howard George
Published: July 2021

Background:
The Life’s Simple 7 (LSS) metric is being used by AHA to track the cardiovascular health of the United States population and move toward a 2020 impact goal for improvement. Levels of LSS are associated with mortality risk but there are limited data on whether this association differs by race or sex.

Hypothesis:
There will be sex and race differences in the association of LSS with mortality in the REGARDS cohort study.

Methods:
We studied 29,692 REGARDS participants; a population sample of black and white men and women aged 45-98 from across the US, enrolled in 2003-7. Extensive baseline risk factor data were measured in participants’ homes. The 7 LSS components (blood pressure, cholesterol, glucose, body-mass index, smoking, physical activity, diet) were each scored in AHA-defined categories of poor (0 points), intermediate (1 point) and ideal (2 points), and were summed to yield scores ranging from poor for all (0) to ideal for all (14). With 6.4 years follow up there were 3709 deaths.

Results:
The LSS score was normally distributed with mean (SD) of 7.9 (2.0) in whites and 6.9 (2.0) in blacks. The age, region, income and education adjusted hazard ratio (HR) of death for a 1-unit worse LSS score, stratified by race and sex, are shown in the table. Race and sex interactions were tested individually in separate models. While better scores for LSS were strongly associated with lower mortality, associations differed by race and sex, being weaker in blacks than whites and in men than women.

Conclusion:
There were large associations of LSS with mortality risk in the REGARDS national sample; 1 point difference in score, corresponding to movement from poor to intermediate or intermediate to ideal for 1 of the 7 factors, was associated with a 16% lower risk of death in white women, 14% lower risk in white men or black women, but only an 11% lower risk in black men. Observed differences in the association of LSS with mortality by race and sex should be considered in efforts to gauge the impact of LSS interventions on health disparities.
Abstract MP38: The Program SI! Intervention for Enhancing a Healthy Lifestyle among Children aged 3 to 5: A Cluster Randomized Trial
Authors: PENALVO JOSE L , SOTOS-PRIETO MERCEDES , SANTOS-BENEIT GLORIA , POCOCK STUART , REDONDO JULIANA , FUSTER VALENTIN
Published: July 2021

The development of CVD risk factors carries a behavioral component that may be corrected at an early age, when behaviors are first formed, by effective health promotion initiatives. School-based interventions are an effective way to promote healthy behaviors, specially when they also reach out to the children’s most proximal environment: their families, teachers and the school itself. Within this framework, the first phase of the long-term Program SI! intervention targets children from 3 to 5 years of age aiming to establish appropriate lifestyle behaviors early in life. The intervention entails a comprehensive approach including four lifestyle-related components: correct dietary habits, promotion of physical activity, understanding how the human body and heart work, and emotion’s management. To evaluate the efficacy of the Program SI! to instill healthy behaviors in children aged 3-5, a cluster-randomized controlled trial in public schools in the city of Madrid (Spain) was initiated in 2011. A total 24 schools were selected on the basis of socio-demographic characteristics. These included 2062 children (3-5 years), 1949 families, and 125 teachers at baseline. Schools were randomized (1:1) to follow their usual school curriculum or to engage in the intervention. The primary outcome of this report is the 2-years differential change from baseline in scores for knowledge, attitudes and habits (KAH) in the four components of the intervention between intervention and control. Children were interviewed by trained psychologists and scored on overall and component-specific KAH questionnaires. The Test for Emotional Comprehension (TEC) was used to assess children’s ability to recognize emotions. Mixed linear models accounting for the cluster-randomized design were used to test for intervention effects. Fixed effects in each model were the corresponding baseline score, the class year, and the treatment group. Schools were handled as random effects. After 2 years, the Program SI! intervention increased children’s overall KAH score (5.6, 95%CI, 4.1-7.1, p<0.001) corresponding to an additional 7% improvement in the intervened children. KAH assessing improved Physical activity contributed the most (3.39, 95%CI, 2.35-4.43, p<0.001) to the difference between groups, followed by KAH relating Dietary habits (1.78, 95%CI, 0.94-2.62, p<0.001). A weak, non-significant improvement in KAH score for Human body (0.37, 95%CI, -0.14-0.89) was also found. Regarding emotion’s management, this component also increased after the intervention (0.50, 95%CI, 0.02-0.97, p<0.040), with greater improvements in older children (5 years old). The Program SI! is demonstrated as an effective and feasible strategy for improving lifestyle behaviors among very young children that may eventually impact in lower rates of development of CVD risk factors.
Abstract MP39: Peer Comparison Feedback and Financial Incentives to Promote Employees’ Healthy Food Choices: a Randomized Controlled Trial
Authors: Thorndike Anne N , Riis Jason , Levy Douglas E
Published: July 2021

Objective:
New strategies are needed to promote healthy food choices. We conducted a 3-arm randomized controlled trial to compare the effectiveness of: 1) peer comparison feedback about food purchases (FB), 2) feedback plus financial incentives (FB+INC), or 3) no feedback (control) to promote healthy purchases by employees in a large hospital cafeteria.

Methods:
Subjects were 2672 employees who made ≥ 6 purchases in 2 months prior to study. All items were labeled green (healthy), yellow (less healthy), and red (unhealthy). The FB group received monthly letters from Oct-Dec 2012 reporting proportion of the individual’s purchases that were green/yellow/red in the prior month, comparing to purchases by “all” and by “healthiest” employees. The FB+INC group received a similar letter plus an incentive ($10) to increase their proportion of green in the next month. Control received no contact. We compared changes in green and red purchases from baseline (Sept) to intervention end (Dec) and to end of a 3 month wash-out (Mar 2013) using random effects models of employee-specific changes in purchases.

Results:
Subjects were: 73% female; 48% > 40 years; 75% white. At baseline, mean proportion of green purchases was 50% for all groups. The Figure shows monthly percentage change in proportion of green purchases compared to baseline. At end of intervention compared to baseline, control had no change, FB increased 1.8% (p=0.07 vs. control), and FB+INC increased 2.2% (p=0.03 vs. control). At end of wash-out compared to baseline, control increased 1.7%, FB increased 2.6% (p=0.4 vs. control), and FB+INC increased 3.0% (p=0.2 vs. control). Red purchases decreased in both intervention groups compared to control at end of intervention (p=0.07 for both) and wash-out (p≤0.04 for both).

Conclusions:
Providing peer comparison feedback with small financial incentives increased healthy purchases by employees. This population-based approach for promoting healthy eating could be effective in other worksite, institutional, and retail settings.
Abstract MP56: Epigenome-wide association study of lipid and inflammatory marker to response fenofibrate in the Genetics of Lipid Lowering Drugs and Diet Network Study
Authors: Hidalgo Bertha , Irvin Ryan , Aslibekyan Stella , Sha Jin , Zhi Degui , Absher Devin , Ordovas Jose , Tiwari Hemant , Arnett Donna
Published: July 2021

Introduction:
There is considerable inter-individual variation in response to lipid-lowering drug therapies. This study aimed to discover the epigenetic factors associated with response to fenofibrate, which may be used to facilitate initiatives in personalized medicine.

Methods:
We conducted an epigenome-wide association study for lipid and inflammatory marker response to 3 weeks of daily treatment with 160 mg of fenofibrate among 749 participants in the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) study. For both lipids and inflammatory markers, we analyzed the ratio of the post-3 week lipid or inflammatory marker concentration divided by the baseline concentration. We fit mixed models with methylation status of each CpG as the dependent variable and lipid or inflammatory ratio as the variable of interest adjusting for age, sex, study site, and T-cell purity (fixed effects) and family structure (random effect). A Bonferroni corrected P-value of 1.1x10^-7 was considered significant.

Results:
Methylation of a CpG site in
CPT1A
on chromosome 11 was significantly associated with LDL cholesterol response to fenofibrate (P=4.18x10
-8
). In addition, a CpG site in
NEU2
on chromosome 2, was significantly associated with IL2 response (P=7.80x10
-7
).
CPT1A
plays an important role in fatty acid metabolism, whereas
NEU2
is a type of salidase known to be involved in the development of atherosclerosis.

Conclusions:
Our findings suggest that methylation of CpG sites within
CPT1A
and
NEU2
are associated with LDL cholesterol and IL2 response to fenofibrate, respectively, and could prove useful for identifying patients who benefit from fenofibrate therapy.
Abstract MP57: Pathway and Network Analysis of GWAS reveals Novel Candidate Causal Links between Key Biological Processes and Coronary Artery Disease
Authors: Assimes Themistocles L , Ghosh Sujoy , Vivar Juan , Segrè Ayellet V , Mäkinen Ville-Petteri , Nelson Christopher P , Willenborg Christina , Nikpay Majid , Erdmann Jeanette , O'Donnell Christopher , Laaksonen Reijo , Stewart Alexandre F , Epstein Stephen E , Shah Svati H , Hazen Stanley L , Reilly Muredach P , Yang Xia , Quertermous Thomas , Samani Nilesh J , Schunkert Heribert , McPherson Ruth
Published: July 2021

Genome-wide association (GWA) studies have identified multiple genetic variants affecting the risk of coronary artery disease (CAD). However, for most of these variants the causal biological mechanisms remain unclear. By integrating GWA data with prior biological knowledge about pathways and functional networks, we sought to obtain novel insights into the causal processes of CAD. Using the iGSEA4GWAS analysis tool and the Reactome pathway database, we carried out a two-stage gene set enrichment analysis strategy. From a discovery cohort of seven large GWAS data sets for CAD (n=9,889 cases, 11,089 controls), nominally significant gene-sets were tested for replication in a meta-analysis of nine additional studies (n=15,502 cases, 55,730 controls) that were part of the CARDIoGRAM Consortium. A total of 32 of the 639 pathways tested representing 22 distinct biological processes showed convincing association with CAD (replication p< 0.05). After adjusting for redundancies by removing pathways with 50% or greater identity with other pathways, 19 pathways representing 9 biological processes remained including those relevant to Notch signaling, extracellular matrix integrity, innate immunity, and lipid metabolism. Network analysis of 751 unique genes within replicated pathways further revealed several interconnected functional modules representing novel associations (semaphorin regulated axonal guidance pathway) as well as confirmatory known processes (lipid metabolism). Our analyses point to potentially novel causal associations between CAD and several biological processes, many of which were not previously linked to CAD. These findings improve our understanding of the biological basis of CAD and highlight potential novel therapeutic targets.
Abstract MP59: Revisiting Heritability Accounting For Common Environmental Effects And Maternal Inheritance
Authors: Liu Chunyu , Dupuis Josée , Larson Martin G , Cupples L. Adrienne , Ordovas Jose M M , Vasan Ramachandran S , Meigs James , Jacques Paul F , Levy Danial
Published: July 2021

Background:
Heritability measures the proportion of phenotypic variation attributable to genetic factors. Reliable heritability estimates are used to determine the necessary sample size and power for subsequent genetic studies of susceptibility genes. In addition to a shared nuclear genetic component, common environmental factors and maternal or mitochondrial inheritance may have strong effects on some phenotypes. Failure to account for necessary variance components may give rise to biased heritability estimates.

Aims:
Our primary goal was to investigate how heritability estimates are biased in the presence of common environmental or/and maternal effects. The second goal was to estimate mitochondrial inheritance for a number of common phenotypes.

Methods:
We employed variance component methods to account for additional variance components using both simulated and Framingham Heart Study (FHS) pedigree data to revisit heritability estimates in the presence of common environmental and maternal effects.

Results:
Using both simulated families and actual FHS extended pedigrees, we demonstrated that heritability is greatly overestimated when key variance components are not properly accounted for. The inflation in heritability ranged from 9% to 214% across several anthropometric, metabolic and life-style phenotypes when we compared models that consider correct variance components and simple models that only consider familial relationships (Table 1). Maternal inheritance was observed in most phenotypes investigated. The estimated maternal inheritance ranged from ~1 to 5%, which is considerable because the mitochondrial genome is about the size of an average gene.

Conclusion/Discussion:
We systematically investigated the influence of common environmental effects and maternal inheritance in heritability estimates using extended pedigrees. Our findings may explain, in part, the missing heritability for some traits and may facilitate further collaborations in the genetic study of mitochondrial DNA in disease susceptibility for common phenotypes.
Abstract MP65: Fish Consumption and Acute Coronary Syndrome: A Meta-Analysis
Authors: Leung Yinko Sylvie S , Stark Ken D , Thanassoulis George , Pilote Louise
Published: July 2021

Background:
While findings on omega-3 supplements in cardiovascular diseases (CVD) are controversial, various studies suggest that fish consumption may be beneficial to cardiovascular health and reduce the risk of acute coronary syndrome (ACS). The purpose of this study was to investigate the association between fish consumption and ACS by conducting a dose-response meta-analysis.

Methods:
We conducted a literature search of Medline and Embase databases from 1966 to June 2013 for prospective cohort and case-control studies that evaluated the association between fish consumption and ACS among general populations without CVD history. Additional studies were identified via hand search of references of relevant articles. Estimates of relative risk (RR) were pooled using random effects model. Sex and age effects were also evaluated.

Results:
Our search retrieved 11 prospective cohort and 8 case-control studies, totaling 408,305 participants. Among prospective cohort studies, the highest category of fish consumption, i.e. ≥4 times per week, was associated with the greatest risk reduction in ACS (RR 0.79, 95% CI 0.70-0.89). Among case-control studies, fish consumption also appeared to reduce ACS risk (RR 0.76, 95% CI 0.67-0.87 for 1 to <2 times per week). In dose-response analysis, each additional 100 g serving of fish per week was associated with a 5% reduced risk (RR per serving 0.95, 95% CI 0.92-0.97). Subgroup analysis and meta-regression suggested that the risk reduction did not differ across sex or age groups.

Conclusions:
Our meta-analysis demonstrated that there is an inverse association between fish consumption and ACS risk. Fish consumption appears beneficial in the primary prevention of ACS and higher consumption was associated with higher protection.
Abstract MP69: Effect of Post Traumatic Stress Disorder and Combat Exposure on Carotid Intima-Media Thickness in Vietnam Era Veteran Twins
Authors: Goetz Margarethe , Shah Amit , Goldberg Jack , Shallenberger Lucy , Murrah Nancy V , Bremner Douglas , Vaccarino Viola
Published: July 2021

Introduction:
Posttraumatic stress disorder (PTSD) is associated with an increased risk of ischemic heart disease, but the pathophysiologic mechanisms remains unclear. Genetic and shared familial and early environmental factors may confound this association. Carotid artery intima media thickness (cIMT) is a measure of atherosclerotic burden and is predictive of future cardiovascular events. In a study of Vietnam era twins, we assessed the hypothesis that PTSD and combat exposure are associated with cIMT after controlling for shared genetic and childhood environmental factors.

Methods:
We studied 465 middle-aged male twins from the Vietnam Era Twin Registry, who were part of the Emory Twin Studies, without a clinical history of cardiovascular disease. A diagnosis of PTSD was obtained with the Structured Clinical Interview for DSM-IV and combat exposure was measured using the Combat Exposure Scale. Carotid IMT was measured using B-mode ultrasound. Mixed effects regression models with a random effect for the twin pair were used to examine overall, between- and within-pair effects. Models were sequentially adjusting for traditional CVD risk factors, genetic and childhood environmental factors.

Results:
About 13% (60 out of 465) of participants met criteria for PTSD and 45% (209 out of 465) served in the Vietnam Theater. When twins were examined as individuals, PTSD was associated with 33.3 μm higher cIMT (p=0.03) after adjustment for potential confounders. In addition, the average cIMT for the twin pair increased by 43 μm for each additional twin affected by PTSD in the pair (p=0.04). However, there was no significant within-pair difference in cIMT comparing co-twins discordant for PTSD. Combat exposure showed a similar pattern of results but its association with cIMT weakened after adjusting for PTSD (unadjusted p=0.01, adjusted p=0.08).

Conclusions:
Among Vietnam era veterans, combat exposure and PTSD are both associated with cIMT, but such associations are largely mediated by shared familial or early environmental factors.
Abstract MP71: The Association of Vascular Endothelial Tone and Function by Digital Peripheral Arterial Tonometry with Left Ventricular Structure and Function by Cardiac MRI
Authors: Tripathi Avnish , Musani Solomon K , Benjamin Emelia , Sheffy Koby , Vasan Ramachandran S , Taylor Herman A , Fox Ervin R
Published: July 2021

Objectives:
Higher vascular endothelial tone and impaired endothelial function as assessed by digital peripheral arterial tonometry (PAT) have been associated with increased cardiovascular morbidity and mortality. However, their relation to left ventricular mass (LVM), geometry and systolic function is not known. We examined this relation in a community-based cohort of African Americans.

Methods:
This study included participants of the Jackson Heart Study who had digital PAT and cardiac magnetic resonance imaging (CMRI) evaluated between 2007- 2013. LVM was adjusted for body size by indexing to height2.7 (LVMI). LVMI was log-transformed within sex and used in the analyses. Age- and sex-adjusted Pearson’s correlations were used to relate baseline pulse amplitude (BPA) and reactive hyperemia index (RHI) (markers of endothelial tone and endothelial function respectively) to LVMI, LV systolic and diastolic volumes (LVSV and LVDV), and stroke volume (SV) by CMRI. Using multivariable adjusted stepwise linear regression with age and sex forced into the model, the relation of PAT parameters to CMRI LV structure and function was evaluated adjusting for body mass index, systolic blood pressure, diabetes mellitus, and total cholesterol: HDL ratio.

Results:
The study population consisted of 440 participants [mean age 59 ± 10 years, 263 (60%) women]. Higher BPA (increased endothelial tone) was significantly and positively correlated with log-LVMI (0.272; p <0.001). Higher RHI (improved endothelial function) was significantly and negatively correlated with log-LVMI (-0.114; p <0.018). In age-sex adjusted models both higher BPA (β = 0.064, SE = 0.011, p < 0.001) and lower RHI (β = -0.069, SE = 0.029, p = 0.018) were significantly related to higher log-LVMI. In the multivariable analyses higher BPA (β = 0.022, SE = 0.010, p = 0.023) but not RHI (p > 0.05) was significantly associated with higher log-LVMI. BPA explained approximately 11% of the total variation of log-LVMI. PAT parameters were not significantly associated with LV volumes or cardiac function parameters in the multivariable analysis.

Conclusions:
In a community-based sample of African Americans higher endothelial tone measured by digital PAT was significantly associated with higher LVMI by CMRI after adjusting for traditional risk factors. Better endothelial function was correlated with lower LVMI and was significantly associated with lower LVMI in the age-sex adjusted model but not the fully adjusted model. These findings suggest that endothelial tone may be one of the potential determinants of LV hypertrophy in African Americans.
Abstract MP82: Exergaming and Physical Activity Guidelines- A Population-Based Study of Young Adults
Authors: Kakinami Lisa , O'Loughlin Erin K , Dugas Erika N , Sabiston Catherine M , Paradis Gilles , O'Loughlin Jennifer
Published: July 2021

Background:
Compared to traditional non-active video games, exergaming may contribute significantly to overall daily physical activity (PA), but the association in population-based samples has not been fully explored.

Objectives:
To assess whether total minutes of PA per week among exergamers differs from non-exergamers, and whether the likelihood of meeting PA guidelines differs between exergamers and non-exergamers.

Methods:
Data were available from the 2011-2012 wave of the Nicotine Dependence in Teens (NDIT) study (n=829). Multivariable models assessed the association between exergaming with moderate, vigorous, and moderate-to-vigorous PA (MVPA) minutes in the past week, and the association between exergaming and meeting PA guidelines after adjusting for age, household income, employment status, education, weight status, and screen time. Exergaming was defined as use ≥ 1-3 times per month in the past year, and PA guidelines were defined as ≥ 150 minutes of moderately intense PA, or ≥ 75 minutes of vigorously intense PA, or a combination. Minutes of PA were measured using the well-validated International Physical Activity Questionnaire. Sex differences in exergaming use and exergaming beliefs and attitudes were also assessed.

Results:
In this population-based sample of young adults (mean age 24 [SD: 0.7] years, 55% female [n=455]), 18% (n=148) of the participants were exergamers (54% female, n=80). Exergaming males and females reported an average of 88.4 and 65.7 exergaming minutes in the past week, respectively. Compared to male exergamers, female exergamers were more likely to believe that exergaming is a good way to integrate PA into their lives (p<0.001), were more likely to prefer exergaming to indoor/outdoor sports (p=0.03), and were more likely to use fitness-training exergames at home (p=0.006). Perceived levels of exertion were also significantly different between male and female exergamers. The majority of male exergamers reported light (51%, n=23) or moderate (44%, n=20) exergaming exertion, whereas female exergamers reported moderate (53%, n=30), as well as light (28%, n=16) and intense (19%, n=11) exertion (p=0.02). After adjusting for covariates, male exergamers were not significantly different from male non-exergamers in total minutes of PA per week, but female exergamers reported 47 more minutes of moderate PA in the past week compared to female non-exergamers (p=0.03). There was no association between exergaming and meeting PA guidelines in either males or females.

Conclusions:
Exergaming contributes to moderate-intensity PA among females but not among males in this population based sample of young adults. Exergaming may therefore be an important source of PA for women, but the current landscape of exergames may be inadequate to substantially increase minutes of PA among males. Differences in attitudes toward exergaming should be further explored.
Abstract MP89: Cardiovascular and Stroke Mortality in Asian Americans (2003-2010)
Authors: Jose Powell O , Frank Ariel T , Kapphahn Kristopher I , Goldstein Benjamin A , Eggleston Karen , Cullen Mark R , Palaniappan Latha P
Published: July 2021

Background:
Asian Americans are a rapidly growing racial/ethnic group in the United States. Our current understanding of Asian American cardiovascular disease mortality patterns is distorted by the aggregation of distinct subgroups, which masks the heterogeneity of cardiovascular disease and survival among diverse Asian American subgroups.

Objective and Design:
We examined cardiovascular disease and stroke mortality rates for the six largest Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) from 2003-2010. U.S. death records were used to identify race/ethnicity and cause of death by ICD-10 coding (I00-I09, I11, I13, I20-I69). Standardized mortality ratios (SMR), relative SMRs (rSMRs), and proportional mortality ratios (PMR) were calculated for each sex and ethnic group relative to Non-Hispanic Whites (NHW).

Results:
15,943,806 death records were examined. Asian Indian men and women and Filipino men had higher relative SMRs and PMRs for all cardiovascular disease and ischemic heart disease compared to NHWs and other Asian subgroups. Every female Asian subgroup except Koreans had higher rSMRs and PMRs for rheumatic heart disease compared to NHWs. Relative SMRs and PMRs were lower for heart failure but higher for hypertensive heart disease and all cerebrovascular disease including both ischemic and hemorrhagic stroke for men and women in every Asian subgroup compared to NHW men and women, respectively.

Conclusions:
The variation in cardiovascular disease and stroke mortality patterns among diverse Asian American subgroups calls to attention the need for more research to help direct more specific treatment and prevention efforts, especially in hypertension and stroke, to reduce health disparities for this rapidly growing population.
Abstract MP95: Title: Self-Reported versus Objective Sedentary Behavior Assessment in Young Adults
Authors: Barone Gibbs Bethany , King Wendy C , Davis Kelliann K , Rickman Amy D , Rogers Renee J , Jakicic John M
Published: July 2021

Background:
Sedentary behavior (SED) has emerged as an independent risk factor for cardiovascular events and mortality in longitudinal studies, but has almost exclusively been measured by self-reported total SED or television (TV) time.

Objective:
Our goal was to compare self-reported SED vs. objective SED by the BodyMedia® armband in young adults

Methods:
Among overweight and obese young adults (age: 31 ± 4 years, BMI: 32 ± 4 kg/m
2
) enrolled in a clinical weight loss trial, baseline SED was assessed by 3 methods: 1) self-reported time spent in 8 common SEDs (TV, computer, transportation, etc.) from a questionnaire adapted from the Coronary Artery Risk Development in Young Adults Study (SED
Q
), 2) a single question about total SED in a ‘typical day’ from the Global Physical Activity Questionnaire (SED
GPAQ
), and 3) objective SED was calculated as the average awake time spent at <1.5 METS over ≥4 days with ≥10 hours of wear time (SED
OBJ
). Also, because it is often used as a surrogate for SED, TV time (SED
TV
) was isolated from the SED
Q
. SED measures were compared using nonparametric sign-tests, Spearman’s ρ, and Bland-Altman plots.

Results:
Valid data were available in 457 of 470 subjects. On average, compared to SED
OBJ
, SED
Q
tended to overestimate while SED
GPAQ
tended to underestimate (Table). SED
Q
and SED
GPAQ
were weakly correlated with SED
OBJ
; the correlation with SED
GPAQ
was stronger (Table). In the Bland-Altman plots, SED
Q
and SED
GPAQ
had highly patterned errors where SED
Q
and SED
GPAQ
underestimated at low values and overestimated at high values. Limits of agreement (LOA) were wide for SED
Q
[-7.4, 10.5 hr/day] and SED
GPAQ
[-8.4, 6.0 hr/day]. Average SED
TV
differed substantially from SED
OBJ
, as expected, but was also not correlated.

Conclusions:
SED
Q
,

SED
GPAQ
, and especially SED
TV
were poorly related to SED
OBJ
in overweight and obese young adults.

The poor validity of these subjective assessment methods may have implications for the interpretation of observational research relating self-reported SED to adverse health outcomes.