bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P356: Women’s Reproductive Factors Are Associated With Future Risk of Hearing Loss
Authors: Zhu Dongshan , Fu Chunying , Wang Qi
Published: May 2024

Introduction:
The association between female reproductive factors and risk of hearing loss (HL) has been unclear.

Hypothesis:
Women’s reproductive factors have been associated with comorbidities such as cardiovascular disease and diabetes, which are all linked to hearing loss (HL). We thus hypothesized that reproductive factors might be associated with the risk of HL.

Methods:
We used data from the UK Biobank (UKB). Reproductive factors included number of children, age at the first/last birth, age at menarche, age at natural menopause, and reproductive period. HL was ascertained using the International Classification of Diseases 10th revision (ICD-10) codes H90 (conductive and sensorineural hearing loss) and H91 (other hearing loss). Cox proportional hazards models were used to examine the association between reproductive factors and hospital ascertained HL, considering death as a competitive event. In addition, we combined age at menopause with HRT status to see their joint effect on HL. All models were adjusted for age at baseline, ethnicity, education level, income, Townsend deprivation index, BMI, smoking status, drinking status, physical activities, cardiovascular disease, diabetes, and HRT use status.

Results:
Compared to women who had no child, women who had two, three and four or more children was linked to elevated risk of HL, with HR (95% CI) of 1.14 (1.04-1.25), 1.24 (1.11-1.38), and 1.35 (1.17-1.55), respectively. Compared to women who had first birth before age 25 years, women who had first birth greater than age 26 years had reduced risk of HL (0.84, 0.76-0.93). Women who gave last birth over age 40 years had elevated risk of HL (1.21, 1.01-1.45), compared to those who had last birth before age 35 years. Compared to women who had menopause at age 46-50 years, those who had early menopause less than age 45 years were associated with 24% higher risk of HL (1.24, 1.00-1.54). In addition, women with reproductive period less than 30 years had elevated risk of HL (1.19, 1.07-1.34), compared to women with reproductive period greater than 35 years. Women who had age at menopause greater than 50 years and used HRT had 25%-50% higher risk of HL, compared to their counterpart who did not use HRT.

Conclusions:
In conclusion, higher number of children, having first birth before age 25 years, having last birth after age 40 years, having menopause before age 45 years, and having reproductive period shorter than 30 years were associated with higher risk of hearing loss. In women with menopause age greater than 50 years, HRT use increased the risk of hearing loss.
Abstract P357: Health Behaviors in Early Pregnancy Are Associated With Mid-Pregnancy Biomarkers of Placental Health and Function
Authors: Kozai Andrea , Barone Gibbs Bethany , Khan Sadiya S , Grobman William , Levine Lisa , McNeil Rebecca , Parry Samuel , Catov Janet M
Published: May 2024

Introduction:
Placental blood biomarkers are dysregulated in adverse pregnancy outcomes (APO). While health behaviors are associated with APO risk, it is not well-characterized whether health behaviors impact placental blood biomarkers. Thus, we examined the associations between health behaviors and placental biomarkers of angiogenesis in mid-pregnancy.

Hypothesis:
Pregnant people engaging in healthier behaviors in the 1
st
trimester would demonstrate more favorable 2
nd
trimester concentrations of placental biomarkers.

Methods:
Data from 2,078 participants with available analytes from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be were included, representing an enriched sample of APO (preterm birth, preeclampsia/eclampsia, small-for-gestational age, or stillbirth; n=1,284) and 12% of those without these diagnoses (n=794). Health behaviors of physical activity, sleep, smoking, and diet assessed in the 1
st
trimester were scored from 0-100 according to the Life’s Essential 8 algorithm; a higher score is more favorable. Biomarkers assayed included total endoglin, pregnancy-associated plasma protein A (PAPP-A), vascular endothelial growth factor, placental growth factor, and soluble FMS-like tyrosine 1. The association between health behaviors and each biomarker was examined using linear (continuous) or logistic (odds of concentration below multiple of the median [MoM] cut point) regression adjusted for demographics, BMI, resilience (Connor-Davidson Scale), and perceived discrimination (Krieger Racism Scale) using a backwards stepwise approach; analyses were repeated stratified by APO status. Bonferroni-corrected significance was p<0.001.

Results:
The overall APO rate in this enriched sample was 62%; this was significantly lower in those with ≥150 min/week compared with no physical activity (58% vs 66%, p=0.04). Lower (worse) smoking score was associated with lower (adverse) PAPP-A concentration in those who developed APO (p<0.001). Higher physical activity score (healthier) was associated with lower PAPP-A concentration (adverse) regardless of APO occurrence; for every 10-point higher physical activity score, odds of PAPP-A < 0.3 MoM increased 10% (OR 1.10; 95% CI 1.05, 1.16). No associations were observed between the other health behaviors and biomarkers.

Conclusions:
Higher levels of physical activity were associated with lower APO occurrence. In contrast, PAPP-A concentrations were lower in those with higher physical activity regardless of pregnancy outcome. Lower 2
nd
trimester PAPP-A was observed in those with higher smoking exposure who developed APO. Our findings support prior work demonstrating lower risk of APO with more physical activity in pregnancy, but also indicate that PAPP-A concentrations may be sensitive to physical activity and smoking. Further work to elucidate the mechanisms of these associations is warranted.
Abstract P359: Neighborhood Disinvestment and Racial/Ethnic Disparities in Peripartum Cardiomyopathy in California, From 2004-2019
Authors: Tucker Curisa M , Ma Chen , Mujahid Mahasin S , Hameed Afshan B , Main Elliott , Carmichael Suzan
Published: May 2024

Introduction:
Peripartum cardiomyopathy (PPCM) is a rare life-threatening medical condition presenting as idiopathic heart failure in late pregnancy or during the early postpartum period in otherwise healthy patients. Racial disparities in the rates of morbidity and mortality of PPCM have been extensively documented where higher rates occur in Black patients. There is minimal research examining the relationship between racial/ethnic disparities in PPCM and social determinants of health such as neighborhood social disadvantage.

Hypothesis:
We hypothesize that neighborhood social disadvantage is associated with PPCM and it contributes to racial/ethnic disparities in PPCM, pre-pregnancy hypertension contributes to disparities, and that the timing of PPCM mostly occurs during the postpartum period.

Methods:
We used data obtained from the California Department of Health Care Access and Information, which included vital records longitudinally linked with hospital discharge records for mothers and infants up to 9 months postpartum for births in California from 1997-2018. We created and standardized the Neighborhood Deprivation Index (NDI) as a proxy measure for neighborhood social disadvantage and categorized it into quartiles, with quartile 1 indicating the least deprivation and quartile 4 indicating the most deprivation. We examined the distribution of population characteristics for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian and Hispanic births in the sample by PPCM status. We sequentially adjusted multivariable logistic regression models by maternal and clinical characteristics to estimate the association of NDI and race/ethnicity with PPCM using non-Hispanic White as the reference group. We report odds ratios (OR) and 95% confidence intervals (CI) that reflect the total change in odds of PPCM, and calculated the timing of PPCM diagnosis.

Results:
Our study included 6,970,681 births and 862 (0.012%) PPCM cases. After adjustment, in the NDI regression models, quartile 2 (Q2) through quartile 4 (Q4) had elevated risk for PPCM (Q2: OR 1.2 (CI 1.0-1.5); Q3: OR 1.7 (CI 1.4-2.1); Q4: OR 1.5 (CI 1.2-1.9)). When adjusting for NDI in the race/ethnicity models, the odds of PPCM slightly decreased for each race/ethnicity. After adjusting for pre-pregnancy hypertension in both the NDI and race/ethnicity models, the odds of PPCM slightly decreased for quartile 3 and 4 and in NH Black births. Most PPCM cases (60.4%) were identified during a postpartum hospital encounter.

Conclusions:
Our results show that neighborhood deprivation and pre-pregnancy hypertension partially explain the racial/ethnic disparities in PPCM. Future research should examine the impact of specific measures of neighborhood deprivation (e.g., access to care, employment levels etc.) on the racial/ethnic disparity in outcomes such as PPCM.
Abstract P360: Association of Neighborhood-Level Socioeconomic Disadvantage and Maternal Cardiovascular Health in Early Pregnancy: The nuMoM2b-HHS Study
Authors: Venkatesh Kartik K , Grobman William , Huang Xiaoning , Yee Lynn , Catov Janet M , Simhan Hy , Cleary Erin , Mercer Brian , Reddy Uma , Silver Robert , Levine Lisa , Chung Judith , Saade George , McNeil Rebecca , Pemberton Victoria L , Varagic Jasmina , Bairey C Noel N , Greenland Philip , Lynch Courtney , Khan Sadiya S
Published: May 2024

Introduction:
To determine whether residing in a more socioeconomically deprived area during early pregnancy is associated with worse maternal cardiovascular health (CVH), as quantified by the American Heart Association Life’s Essential 8 (LE8).

Methods:
Secondary analysis from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study cohort. Participant home addresses in the first trimester were geocoded at the census-tract level. The exposure was neighborhood-level area deprivation index (ADI), categorized by tertile (least deprived [T1], reference; most deprived [T3]). The outcome was CVH defined by the LE8 assessed in the first trimester, which includes physical activity, diet quality, tobacco use, sleep quantity, body mass index (BMI), blood pressure, and serum fasting glucose and lipid levels to create a score ranging from 0 to 100 (higher being better). Multivariable linear regression models were used to examine associations between ADI tertile and CVH scores for each component and a summary CVH score.

Results:
In this cohort of nulliparous individuals in the first trimester, the mean ADI was 45.2 (SD: 30.7), and the mean overall LE8 was 82.2 (SD: 12.0). Compared with those with the least neighborhood disadvantage (i.e., T1), individuals living in neighborhoods with greater neighborhood disadvantage had lower mean LE8 scores, indicating worse CVH (T1 vs. T2 adjusted mean: 84.68 vs. 81.75; adj. ß: -2.92; 95% CI: -4.19, -1.66; and T1 vs. T3: 84.68 vs. 79.15; adj. ß: -5.52; 95% CI: -7.92, -3.12) (p<0.01 for trend). The greatest neighborhood disadvantage (i.e., T3) was also associated with individual elements of the LE8, including poorer diet quality, higher BMI, and higher systolic and diastolic blood pressure.

Conclusions:
Neighborhood-level socioeconomic disadvantage was associated with worse CVH in early pregnancy. Multi-level interventions should consider structural approaches that address the social determinants of place-based disparities in maternal CVH.
Abstract P376: Comparison of Heart Failure Admission Rates Between Rural-Urban Continuum Code Designations
Authors: Burrows William B , Robinson Jimmy , Leigh Mary E , Duncan Meredith S , Kucharska-Newton Anna
Published: May 2024

Introduction:
Approximately 6 million adults in the US have heart failure (HF) and, from 2012 to 2030, the prevalence is estimated to increase by 46%. In 2017, the prevalence of HF among rural residents was 40% higher than among residents of small metropolitan and urban areas and this gap has continued to grow. However, only examining differences among metropolitan vs nonmetropolitan statistical areas or urban vs rural areas means it is impossible to understand within rural variation.

Hypothesis:
We assessed the hypothesis that county-level HF admission rates would differ by Rural-Urban Continuum Code (RUCC).

Methods:
Using 2017 data from the Healthcare Cost and Utilization Project, this cross-sectional study investigated the association between RUCC designation and county-level HF admission rates (number of admissions with a principal diagnosis of HF per 100,000 population aged 18+). The sample included 826 counties across 13 states. Rural, Urban, and Metro designations were defined through RUCCs. One-way ANOVA was performed to identify overall differences in HF admission rates across RUCC designations, with post-hoc pairwise comparisons performed using Tukey’s HSD.

Results:
There was a statistically significant difference in HF admission rates between at least two groups (
F
(817, 8)=[13.99,
p
<.001]). Results from 13 of the 36 pairwise comparisons were statistically significant (
Table
).

Conclusion:
We identified statistically significant differences in county-level HF hospital admission rates by RUCC. Metro counties had significantly higher HF admission rates than urban and rural counties, but differences across rural counties were not observed. HF prevalence is higher among rural Americans than those in urban and metro areas, but HF hospital admission rates in rural counties are much lower. Further research is needed to investigate the drivers of these differences in prevalence and healthcare utilization.
Abstract P382: Epigenetic Regulation of the NF-kB Pathway by the Neural-Hematopoietic-Inflammatory Axis as a Potential Link Between Psychosocial Stress and Cardiovascular Risk: Data From the Washington DC Cardiovascular Health and Needs Assessment
Authors: Sharda Sonal , Cintron Manuel A , Baumer Yvonne , Jacobs Joshua A , Pang Alina P , Ortiz-Whittingham Lola R , Potharaju Kameswari A , Baez Andrew S , Saurabh Abhinav , Gutierrez Huerta Cristhian A , Ortiz Chaparro Erika , Collins Billy S , Mitchell Valerie M , Corley Michael J , Powell-Wiley Tiffany M
Published: May 2024

Introduction:
Chronic psychosocial stress (cPSS) is associated with cardiovascular disease (CVD) risk, caused in part by dysregulation of the neural-hematopoietic-inflammatory axis and epigenetic changes. cPSS may also affect NF-kB dependent pathways, suggesting a potential link to accelerated CVD risk and health inequities for populations most impacted by adverse social determinants.

Hypothesis:
We propose cPSS associates with greater amygdala activity (AmygA), a stress marker, and splenic activity (SpleenA), a hematopoietic activation measure. This relates to higher pro-inflammatory cytokine levels, partially due to less DNA methylation of NF-kB pathway-related genes.

Methods:
60 African American adults (93.3% female, mean age 61) with CVD risk, living in the Washington, D.C. area underwent
18
FDG PET/CT to evaluate AmygA and SpleenA. DNA methylation analysis assessed epigenetic associations of the NF-
κ
B1/2 gene in PBMCs and ELISA- measured serum IL-1β and TNFα. Multivariable regression analysis adjusted for atherosclerotic CVD 10-year risk score and BMI was used to examine associations.

Results:
Greater AmygA and SpleenA were significantly associated with one another (β=0.26; p=0.003) and both were associated with greater pro-inflammatory cytokines IL1-β (AmygA:β =0.36, SpleenA:β=0.72, p<0.05) and TNF-α (AmygA:β=0.31, SpleenA:β=0.58, p<0.05). Further, we identified 2 significant methylation sites out of 81 on the NF-
κ
B1/2 gene. Notably, AmygA and SpleenA were inversely associated with the
NF-κB1
cg01983105 and cg07955720 methylation sites (Table).

Conclusions:
We highlight a possible link between AmygA and SpleenA with decreased DNA methylation of the NF-
κB
gene. Our findings demonstrate a potential relationship between chronic stress-related neural activity and CVD risk through immune function and epigenetic alterations. These results should be examined in larger, diverse population-based cohorts with longitudinal data to identify intervention targets for reducing health inequities.
Abstract P385: Comparison of Food Insecurity Classifications and Associations With Premature Cardiovascular Disease Mortality Among US Adults
Authors: Tian Ling , Jaeger Byron C , Dorans Kirsten , Chen Jing , He Jiang , Bundy Joshua D
Published: May 2024

Background:
Food security is usually measured with the 10-item US Adult Food Security Survey Module (FSSM). Shorter 6- or 2-item tools may capture similar information, but this has not been validated with hard endpoints.

Hypothesis:
We hypothesize a 2-item food security instrument reflects the same premature mortality risk as 10- and 6-item instruments.

Methods:
We included 37,027 participants aged 20-74 years from the National Health and Nutrition Examination Survey (NHANES) 2004-2018, linked to the National Death Index with follow-up through 2019. Cardiovascular disease (CVD) mortality was ascertained by ICD-10 codes for heart disease or stroke. Food security was assessed by the 10-item FSSM, which can derive 6- and 2-item instruments. Multivariable Cox regression was used to assess the associations of food insecurity classifications with risks of premature all-cause and CVD mortality. We calculated C-statistics to estimate model discrimination. We repeated the analyses among 218,136 participants from the National Health Interview Survey (NHIS) 2011-2018.

Results:
During a mean 7.8-year follow-up, 2025 premature deaths (512 from CVD) were recorded in NHANES. In age-sex-race/ethnicity-adjusted models (Model 1), food insecurity with any classification was strongly associated with premature all-cause and CVD mortality (Table). After adjusting for confounders (Model 2), associations were attenuated but remained statistically significant. After further including potential mediators (Model 3), associations diminished, suggesting pathways by which food insecurity is associated with mortality. Hazard ratios and C-statistics were nearly identical comparing 10-, 6-, and 2-item instruments. Results were equivalent among NHIS participants during a mean 5.0-year follow-up including 7025 premature deaths (1711 from CVD).

Conclusions:
Among two independent samples of US adults, a 2-item food security instrument is equivalently associated with premature mortality compared with 10- and 6-item instruments.
Abstract P434: Prediabetes and Diabetes Are Associated With Distinct Gut Microbial Composition in the Framingham Heart Study
Authors: Walker Maura E , Cheng Huimin , Cho Daniel , Lin Honghuang , Dao Maria Carlota , Spartano Nicole L
Published: May 2024

Little is known about how the gut microbiome may be associated with impaired glucose regulation (prediabetes and type 2 diabetes). Relative to normoglycemic individuals, prediabetes and diabetes will be associated with distinct microbial composition, which will provide incremental value in classifying glycemic status. We included 1265 Framingham Heart Study participants (mean age 55 yr, 56% female) with 16S rRNA gene sequencing performed on stool samples. Glycemic status was characterized as normoglycemia (<100mg/dL glucose or <5.7 HbA1c), prediabetes (100-125mg/dL glucose or 5.7-6.5 HbA1c), diabetes (>=126mg/dL glucose, >=6.5 HbA1c, or self-reported diabetes diagnosis/medication). MANOVA was used to characterize the differential abundance of microbial composition and diversity by glycemic status. Microbial diversity was characterized by α- and β-diversity (Shannon and Bray-Curtis index) and richness. We used elastic net regression and generated c-statistics to determine the utility of gut microbial composition and diversity in classifying glycemic status while adjusting for age, sex, antibiotic use, waist circumference, hypertension/lipid-lowering medication (model 1). The prevalence of prediabetes and diabetes was 368 (29%) and 113 (9%), respectively. Compared to model 1, differential abundance at the family domain was associated with a moderate improvement in classifying participants by glycemic status (c-statistic: 0.78 vs 0.80). We observed a differential abundance of 16 bacteria families between diabetes/normoglycemia, 6 between prediabetes/diabetes, and 3 between normoglycemic/prediabetes, but microbial diversity did not differ. The abundance of
Ruminococcacease
and Enterobacteriaceae were the top bacterial contributors to glycemic status prediction. Glycemic status was associated with distinct patterns of microbial composition. The presence of diabetes was associated with a lower abundance of butyrate-producing bacteria, which may be linked to glycemic control.
Abstract P442: Secondhand Smoking Associated With Sleep Apnea Risk Score
Authors: Gorovoy Suzanne B , Patterson Freda , Grandner Michael A , Connick Elizabeth
Published: May 2024

Introduction:
Approximately 18 million people have obstructive sleep apnea. While many people experience occasional nights of insufficient sleep, chronic sleep disorders are more serious and increase the risk of injury, morbidity, and mortality. While the association between smoking and sleep problems is well established, the relationship between secondhand smoke on sleep disordered breathing risk is less clear.

Hypothesis:
Sleep apnea risk increases with the presence of a smoker in the household.

Methods:
Data from N=9,232 adults were leveraged from the NHANES 2017-March 2020 dataset. The outcome/dependent variable of interest was sleep apnea risk score based on modified STOP-BANG criteria combined, as well as the presence/absence of snoring, tiredness, gasping, high blood pressure, BMI > 35, age > 50, and male gender. The exposure/independent variable was smoking status categorized as no smoker at home (reference) compared to whether there was an outside only smoker or someone who smoked indoors. Linear models estimated the association between smoking and overall risk, while logistic regression models estimated the association between smoking and individual risk factors.

Results:
Compared to no-smoking households, those with only outdoor smokers had a 0.187 point greater sleep apnea risk score (
p
= 0.008), while those with an indoor smoker had a 0.211 point greater sleep apnea risk (
p
= 0.018). Outdoor smoking was associated with greater likelihood of concurrent tiredness/sleepiness (OR 1.30,
p =
0.014), gasping (OR 1.29,
p
= 0.024), and less likelihood of being over 50 (OR 0.52,
p <
0.001). Indoor smoking was associated with greater snoring (OR 1.33,
p =
0.027) and tiredness (OR 1.29,
p
= 0.013). Indoor/outdoor smoking was not associated with high blood pressure, BMI, or male gender.

Conclusion:
Having a smoker in the home (Indoor and outdoor) wasere associated with greater apnea risk score. Location of smoking varied in association with individual apnea symptoms, but not in any consistent way. Although studies have shown that smoking worsens sleep apnea risk, future work should explore whether smoking cessation can improve health in other family members as well.
Abstract P444: Pre-Pregnancy Substance Use and First Trimester Cardiovascular Health Among Nulliparous Pregnant People: The nuMoM2b Study
Authors: Marshall Elly M , Bhandari Ruchi , Silver Robert M , Catov Janet , Haas David M , Umer Amna , Barone Gibbs Bethany
Published: May 2024

Introduction:
Pre-pregnancy health, including substance use and cardiovascular risk factors, have been associated with higher risks of maternal-fetal morbidity and mortality. The objective of this study was to determine if pre-pregnancy substance use is associated with early pregnancy cardiovascular health (CVH).

Hypothesis:
Pre-pregnancy use of alcohol, tobacco, marijuana, or illicit substances are associated with worse CVH as early as the first trimester of pregnancy.

Methods:
This is a secondary analysis using data collected in the first trimester of pregnancy in the nuMoM2b cohort (n=9,895). Pre-pregnancy alcohol, tobacco, marijuana, and illicit substance use were assessed through standardized questionnaires. Latent class analysis categorized participants into four subgroups based on their reported pre-pregnancy substance use characteristics: [1] Illicit substances, marijuana, and alcohol use (n=1,234); [2] marijuana and alcohol use (n=2,066); [3] tobacco and alcohol use (n=636); and [4] alcohol use (n=3,194). Non-users were referent (n=2,765). CVH score was assessed using the American Heart Association Life’s Essential 8 (LE8) framework and included scoring of measured height, weight, resting blood pressure, blood glucose, and non-HDL cholesterol as well as self-reported diet, sleep, and exercise from 0 (least healthy) to 100 (most healthy). Multiple linear regression evaluated the relationship between pre-pregnancy substance use subgroups and LE8 score (overall and specific components).

Results:
Mean LE8 score varied by pre-pregnancy substance use subgroup: non-users Mean 65, SD ± 1.3, illicit substances, marijuana, and alcohol use 68 ± 1.3, marijuana and alcohol use 67 ± 1.3, tobacco and alcohol use 62 ± 1.4, and alcohol use 67 ± 1.3 (p<.0001). In adjusted models and compared to non-users, those who used tobacco and alcohol had a lower LE8 score (-2.8, p<.0001), other pre-pregnancy substance use classes had slightly higher scores ranging from 1.8-2.5 points (p<.0001). Similar patterns were observed for individual components of the LE8 score.

Conclusion:
Individuals who used tobacco and alcohol prior to pregnancy, as opposed to other substance use subgroups, begin pregnancy with worse cardiovascular risk and may benefit from CVH promotion efforts.
Abstract P450: Assessing Admission Risk in Under-Resourced Neighborhoods: An Analysis by Race
Authors: Behara Deekshita , Thoma Floyd W , Zhu Jianhui , Mulukutla Suresh R , Magnani Jared W , Johnson Amber E
Published: May 2024

Introduction:
Cardiovascular disease (CVD) disproportionately affects socioeconomically disadvantaged communities and people of racial minority backgrounds. The Area Deprivation Index (ADI) is a validated measure of census-level characteristics based on income, education, employment, housing, and more. Although ADI is often linked to adversity, it is less well known if ADI is associated with racial disparities in CVD admission among cardiac patients living in disadvantaged communities.

Hypothesis:
We hypothesized that among a cohort of cardiac patients, risk for CVD admissions would be associated with ADI and that risk would vary by race.

Methods:
We identified ADI among n=27694 patients receiving care in a large health care system. We compared individual’s demographic variables using chi square for categorical variables and t-test for continuous variables. Using, ANOVA we determined differences in ADI by race. We further used ADI to identify neighborhoods with disproportionate rates CVD admissions using linear regression.

Results:
Figure Panel A shows that the ADI of American Indians, Blacks, and Asians was higher compared with that of Whites. Completion of an ANOVA test provided a p-value <0.05, showing that the average ADI is not equal between race groups. Panel B shows a linear association between higher ADI and increased risk of CVD event. Yet, some block groups were outliers with lower than predicted CVD events, labeled as low utilizers.

Conclusion and Implications:
Racial minority groups tended to have a higher ADI, yet some groups at high risk for CVD had disproportionately lower CVD events. These findings along with our team’s future work will inform interventions to address neighborhood level social determinants of cardiac health. Interventions that account for the unique social and healthcare contexts and inequities specific to at-risk communities will in turn help address the health challenges unique to these groups.
Abstract P467: Patterns of Home Blood Pressure Monitoring Among Older Adults With Ischemic Heart Disease: Preliminary Analysis of the RESILIENT Trial
Authors: Revoori Ritika , Bothwick Victoria , McCabe Paul , Juraschek Stephen P , Meng Yuchen , Johanek Camila , Pena Stephanie , Schoenthaler Antoinette , Schoenthaler Antoinette , Adhikari Samrachana , Dodson John A , Kovell Lara
Published: May 2024

Background:
Hypertension (HTN) is highly prevalent among older adults. Despite evidence that home blood pressure monitoring (HBPM) improves HTN awareness, treatment, and control, engagement with HBPM remains understudied in older adults with ischemic heart disease. This study sought to explain trends associated with HBPM engagement.

Methods:
We performed an interim analysis of the ongoing RESILIENT randomized mobile health cardiac rehabilitation (mHealth-CR) trial of patients age ≥65 years with ischemic heart disease. Participants in the RESILIENT mHealth-CR group were instructed to perform at least weekly home BP measurements over 12 weeks as part of the study intervention. Three engagement groups (high engagement, gradual decline, baseline engagement) were determined by latent class analysis. ANOVA or Chi-Squared tests were used to determine trends in HBPM engagement and changes in blood pressure (BP) overall and between engagement groups over the 12-week study.

Results:
Of the 111 participants, the mean (SD) HBPM engagement was 2.3 (2.3) days of HBPM/week and 31.6 (33.1) measures over 12 weeks (
Table
). Weekly HBPM declined from 74.8% to 50.5% from week 1 to week 12. Frequency of HBPM declined over time in both the gradual decline and baseline engagement groups, though remained consistent in the high engagement group. There were no significant differences in mean BP levels at week 1 and week 12 overall or between groups. However, there was a non-significant trend toward a lower systolic BP in the gradual decline group (106 (SD 20.5) mmHg) compared to the high engagement and baseline engagement groups (130 (SD 11.5) and 126 (SD 15.5) mmHg, respectively, p = 0.14).

Conclusion:
The majority of RESILIENT trial participants measured BP weekly as instructed. There was an overall downward trend in HBPM engagement over time. Once enrollment of the full RESILIENT sample is complete (target N=300 intervention participants), our next steps will be to investigate patient-level factors associated with differential HBPM engagement.
Abstract P471: Association of Food Insecurity With Premature Mortality and Life Expectancy in the United States
Authors: Ma Hao , Wang Xuan , Li Xiang , Heianza Yoriko , Katzmarzyk Peter T , Franco Oscar , Qi Lu
Published: May 2024

Introduction:
Food insecurity has been linked to multiple causes of disease and mortality; however, its relationship with life expectancy by sex, and across racial and ethnic groups remains unknown in the US.

Hypothesis:
Associations of food insecurity with all-cause premature mortality and life expectancy may vary by racial and ethnic, and sex in US adults.

Methods:
We included 57404 adults who participated in the NHANES 1999-2018, with linkage to the National Death Index through December 31, 2019. Levels of food security were assessed with the US Department of Agriculture Adult Food Security Survey Module (full, marginal, low, and very low).

Results:
During a median of 9.3 years of follow-up, 4263 premature deaths were documented. Compared with the full food security group, the adjusted Hazard Ratios (HRs) were 1.50 (95% CI, 1.31-1.71), 1.44 (1.24-1.68) and 1.81 (1.56-2.10) across marginal, low, and very low food security groups, respectively (
P
-trend < 0.001). The corresponding life expectancy at age 50 in each group was 32.5 (95% CI, 32.4-32.6), 29.9 (28.9-30.9), 30.0 (28.9-31.0), and 28.0 (26.8-29.2) years. Equivalently, adults with marginal, low, or very low food security lived on average 2.6 (95% CI, 1.5-3.7), 2.5 (1.4-3.7), or 4.5 (3.2-5.8) years shorter at age 50 years, respectively, compared with those with full food security. The associations appeared to be stronger in women than in men, and stronger in White adults than in Black and Hispanic adults (All
P
-interaction<0.05).

Conclusions:
Although the relation of food security and life expectancy varied across sex, racial and ethnic groups, overall, lower levels of food security are related to a higher risk of premature mortality and a shorter life expectancy.
Abstract P478: Short-Term Voluntary Exercise Significantly Influences the Diet-Induced Changes in Cecal Microbial Content in Male Mice
Authors: Rodriguez Aaron , Le Vey Austin , Nguyen Thuy-Linh , Vail McClain , Houghton Jeffrey , Gigliotti Joseph
Published: May 2024

Two leading environmental factors that influence the overall health of humans are diet and physical exercise. However, it is still unclear how these factors influence health and disease susceptibility. Both diet and exercise have been shown to modulate the microbial flora that may significantly influence health and disease; however, it is unclear if diet modulates the effects of exercise on gut microflora. Therefore, this study aimed to determine how diet and exercise modulate the microbial content of the mouse cecum. Male, weanling, C57Bl/6 mice were randomly assigned to receive one of three diets ad libitum: standard laboratory chow, AIN93-G, and our novel Americanized diet (AD). Within each diet, mice were then assigned to a voluntary exercise regimen (wheel access, 16-hours per day, 3-days per week) or a control sedentary group (individually housed in cage without wheel for the same duration and frequency). After 2-weeks of exercise, mice were euthanized and cecal microbial content was determined by16S rDNA sequencing and RT-PCR for
Firmicutes (FIRM), Bifidobacterium (GBIFD), Lactobacillus (LB)
, and
Bacteroides
(BACT). Data were analyzed using GLM Procedures in SPSS with significance determined at P<0.05. Pilot results found that diet, exercise, and their interaction significantly influenced
FIRM
expression. Mice fed the standard chow diet had the lowest expression of
FIRM
, which was significantly lower than mice fed AIN (P<0.001) and AD (P=0.001). Exercise caused a significant decrease (P<0.001) in
FIRM
presence, especially in mice fed AIN and AD. Diet and exercise also significantly influenced
GBIFD
, with mice fed AIN having significantly more
GBIFD
than mice fed chow and AD (P<0.001 for both). Exercise also caused a significant reduction (P=0.016) in
GBIFD
, and a reduction in
LB
expression in mice fed chow and AD, but not AIN (P=0.03). The results of this study highlight how two key aspects of lifestyle, diet and exercise, independently and additively influence the gastrointestinal flora in a preclinical mouse model. Additional studies are needed to validate these findings and determine their physiological significance.
Abstract P499: Patterns of Sodium Glucose Cotransporter-2 Inhibitor Prescription by Indication in Patients With and Without Diabetes in the US Health System
Authors: Shin Jung-Im , Xu Yunwen , Chang Alexander R , carrero juan jesus , Mukhopadhyay Amrita , Inker Lesley , Blecker Saul , Horwitz Leora , Grams Morgan
Published: May 2024

Introduction:
Multiple clinical practice guidelines strongly recommend sodium-glucose cotransporter-2 inhibitors (SGLT2i) for people with diabetes and atherosclerotic cardiovascular disease or chronic kidney disease as well as for people with urine albumin-to-creatinine ≥200 mg/g or heart failure (HF), regardless of diabetes status. We characterized SGLT2i prescription patterns by indication for SGLT2i therapy in patients with and without diabetes in the US in 2022.

Hypothesis:
The prescription of SGLT2i is low across all indications.

Methods:
Using deidentified electronic health record data from the Optum Labs Data Warehouse, we included adults with estimated glomerular filtration rate ≥20 ml/min/1.73 m
2
across 31 US health systems. We assessed prevalence of SGLT2i prescription by presence of diabetes and indication, and compared them with renin-angiotensin system inhibitors (RASi), which were background therapies in the landmark trials of SGLT2i.

Results:
We classified 760,337 patients with diabetes and 2,640,077 patients without diabetes by their indications for SGLT2i therapy (indication present, absent, or unknown due to lack of albuminuria testing). SGLT2i were prescribed in 11.2%, 11.2%, and 7.1% of patients with diabetes and indication present, absent, or unknown, respectively, and 2.5%, 0.1%, and 0.1% of patients without diabetes. In contrast, RASi were prescribed more frequently among patients with indication present (with diabetes: 31-44%; without diabetes: 16-33%). RASi were prescribed to the majority of patients prescribed SGLT2i (
Figure A
). Practice patterns varied across health systems, but <30% of patients with an indication received a SGLT2i prescription in all systems. (
Figure B
).

Conclusions:
In this large-scale analysis of contemporary US data, prescription of SGLT2i is low, which may deprive patients of needed cardiorenal protection. Future work should investigate whether changes in costs enabled by the 2022 Inflation Reduction Act may stimulate more optimal prescription patterns.
Abstract P529: Ideal Cardiovascular Health May Mitigate Age-Related Increases in Subclinical Myocardial Damage in US Adults
Authors: Aryee Ebenezer K , Zhang Sui , Echouffo Justin B , McEvoy John W , Coresh Joe , Christenson Robert H , Selvin Elizabeth , Ndumele Chiadi E
Published: May 2024

Background:
High-sensitivity cardiac troponins (hs-cTn) levels reflect myocardial damage and increase with age. Even minor elevations in hs-cTn are linked to increased cardiovascular risk. Little data exists on how level of cardiovascular health impacts age-related rises in hs-cTn among individuals in the population.

Methods:
We conducted a cross-sectional analysis of 6,955 adults aged 20 years or older free of self-reported coronary artery disease and heart failure who participated in the 1999-2004 National Health and Nutrition Examination Survey. Hs-cTnT and hs-cTnI were measured from stored samples. Total cardiovascular health was modeled using the AHA’s Life’s Essential 8 metrics (all variables excluding sleep) and categorized as low, moderate, or high. For the distinct participants within each level of cardiovascular health, we compared average levels (geometric means) of hs-cTn across each decade of age. Using multivariable linear regression, we estimated the percent rise in hs-cTn per decade within each cardiovascular health stratum.

Results:
The mean age was 45 years, with 54% being female and 72% being White adults. There was a stepwise rise in average levels of hs-cTn per decade, however the difference in average hs-cTn in older age vs young adulthood was least for those with high cardiovascular health, and greater for those with lesser cardiovascular health (Figure). In linear regression, those with high cardiovascular health had lesser percent rise in hs-cTnT per decade than those with moderate and low cardiovascular health (13% vs 19% vs 23%, p interaction <0.001). Similar differences per decade between those with high versus moderate and low cardiovascular health were seen for hs-cTnI (17% vs 19% vs 23%, p interaction = 0.04).

Conclusion:
Level of cardiovascular health may influence the degree of myocardial damage associated with aging. Mitigation of age-related myocardial damage may be one mechanism underlying the cardiovascular benefits of maintaining ideal cardiovascular health.
Abstract P530: Thoracic Aorta and Coronary Artery Calcification and Atherosclerotic Cardiovascular Disease Risk in South Asian Americans
Authors: Chang Rachel S , Lin Feng , Swaminathan Shreya , Budoff Matthew J , Shah Nilay S , Kanaya Alka M
Published: May 2024

Background:
South Asian populations have a high risk of atherosclerotic cardiovascular disease (ASCVD). Subclinical atherosclerosis measures, including thoracic aortic calcification (TAC) and coronary artery calcification (CAC), are associated with ASCVD events, and TAC is a stronger predictor in women than men. However, no prior studies have investigated TAC in South Asians.

Methods:
We examined data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study from 2015-2018. TAC and CAC were measured from computerized tomography scans using the Agatston method, and scores were categorized as 0, 1-99, and 100 or greater. Ten-year ASCVD risk was calculated using the 2013 pooled cohort equations, categorized as low, intermediate, or high risk. We determined associations of traditional risk factors with TAC and CAC and used multivariable ordinal logistic regression to examine associations between TAC and CAC with ASCVD risk in stepwise models.

Results:
Of 958 participants, 30% had TAC scores between 1-99 and 24% had TAC ≥100. TAC and CAC were modestly correlated (r = 0.30). There was a graded prevalence of TAC and CAC scores with levels of ASCVD risk (Figure). Both TAC and CAC were associated with several traditional risk factors; however, only CAC was associated with current smoking, HDL-cholesterol, triglycerides, and diastolic blood pressure. After adjusting for age, gender, and these four additional risk factors, only TAC ≥100 remained associated with ASCVD risk (OR 3.29, 95% CI 1.86 - 2.23), while CAC and TAC <100 were not. The association between TAC and ASCVD risk was stronger for women than men (p-for-interaction <0.001).

Conclusion:
Though TAC and CAC are associated with traditional risk factors, high TAC levels were independently associated with ASCVD risk, especially among women. Further study is needed to determine whether high TAC scores may be predictive of ASCVD events in South Asian populations.
Abstract P533: Association Between Cardiovascular Health and Carotid Arterial Ultrasound Markers Among Young Adults Using AHA’s “Life’s Essential 8” Metrics
Authors: Guo Fangqi , Chen Xinci , Steve Howland , Maldonado Luis E , Gauderman W. James , McConnell Rob , Yan Mingzhu , Whitfield Lora , Li Yanjie , Breton Carrie V , Bastain Theresa , Hodis Howard N , Farzan Shohreh
Published: May 2024

Background:
In 2022, the American Heart Association (AHA) published a new set of cardiovascular health (CVH) guidelines, named Life's Essential 8 (LE8), as an update to the AHA’s previous definition of ideal CVH, Life’s Simple 7 (LS7). This study used both LE8 and LS7 scores to investigate associations between CVH and carotid markers among young adults.

Methods:
This cross-sectional study included 240 young adults (age 24.2±1.6) who underwent a carotid ultrasound between 2018 to 2022. LE8 score was calculated from 8 metrics including four health factors (body mass index (BMI), non-high density lipid (non-HDL) levels, fasting glucose, and blood pressure), and four health behaviors (physical activity, dietary pattern, tobacco use, and sleep). LS7 was calculated from 7 metrics (all LE8 metrics, except for sleep) with a simpler algorithm. Higher LE8 and LS7 scores both indicate better adherence to CVH guidelines. Carotid artery intima-media thickness (CIMT), arterial stiffness (CAS), and lipid deposition (determined by gray scale median, GSM) were evaluated by carotid ultrasound. Linear regression analyses were conducted to assess the association of LE8 and LS7 with carotid markers, adjusting for age, sex, race/ethnicity, and parents’ highest degree.

Results:
After adjusting for covariates, a one standard deviation (SD) increase in LE8 score was associated with 11.11μm lower CIMT (95% confidence interval[
CI]
, -19.91 -2.30;
p
, 0.014), 1.20 (10
-6
xm
2
/N) greater distensibility (95%
CI
, 0.12 2.29;
p
0.030), and 2.62 greater GSM (95%
CI
, 0.51 4.73;
p
0.015). Analyses using LS7 score demonstrated consistent findings. Individual health factor metrics demonstrated stronger association with carotid markers, as compared to individual behavior metrics. One-SD increase in LE8 BMI score was associated with 19.37μm lower CIMT (95%
CI
, -27.66 -11.07;
p
<0.001), 2.33 greater distensibility (95%
CI
, 1.31 3.35;
p
0.001), and 6.10 greater GSM (95%
CI,
4.18 8.03;
p
<0.001). Similar trends were observed for LE8 scores for lipids and blood pressure with carotid measures.

Conclusion:
Greater adherence to CVH guidelines is associated with better carotid arterial health in young adults, evidenced by lower CIMT, less arterial stiffness, and less lipid deposition. LE8 and LS7 demonstrated comparable associations with carotid markers, with LE8 displaying a slightly stronger association with CIMT.
Abstract P537: Plasma Proteins Partially Explain the Independent Associations of Obesity With Ventricular Hypertrophy and Diastolic Dysfunction in Older Adults Without Cardiovascular Disease
Authors: Ozkan Bige , Echouffo-Tcheugui Justin B , North Kari E , Matsushita Kuni , Ballantyne Christie M , Yu Bing , Selvin Elizabeth , Coresh Josef , Shah Amil M , Ndumele Chiadi E
Published: May 2024

Background:
Obesity is associated with excess heart failure (HF) risk that is not explained by traditional cardiovascular risk factors. Prior proteomic analyses of middle-aged adults with obesity have identified a set of proteins that may significantly mediate the risk of obesity-associated HF. The mediating effect of these proteins on subclinical cardiac dysfunction in obesity is unclear.

Methods:
We conducted a cross-sectional analysis of ARIC Visit 5 (2011-13) participants free of HF and coronary heart disease. We measured 4 plasma proteins positively associated with obesity and HF (ANGPT2, COL28A1, GABARAP, GABARAPL1) and 5 proteins negatively associated with obesity and HF (ART3, EGFR, EPHA4, OMG, SEZ6L) using SOMAScan v4.0. We used linear regression to evaluate the adjusted associations of obesity with echocardiographic parameters and the extent of attenuation after adjustment for these plasma proteins.

Results:
We included 3,244 participants (mean age 75 years, 61% female, 16% Black, 31% with obesity). Individuals with obesity had worse diastolic function and greater ventricular hypertrophy. After adjustment for cardiovascular risk factors, those with obesity still had higher left ventricular (LV) mass index (ß: 3.64, 95%CI: 2.29, 5.00), left atrial (LA) anteroposterior diameter (ß: 0.27, 95%CI: 0.23, 0.30), LA volume index (ß: 1.41, 95%CI: 0.75, 2.06), and lateral E/e’ ratio (0.55, 95%CI: 0.27, 0.82). After adjustment for all 9 plasma proteins, associations were attenuated for LV mass index, LA anteroposterior diameter, and lateral E/e’ ratio (36%, 26%, 22% attenuation, respectively) and the association with LA volume index was no longer significant.

Conclusion:
Proteins associated with HF risk in obesity explain some of the associations of obesity with diastolic dysfunction and ventricular hypertrophy, above and beyond traditional risk factors. These proteins should be investigated to further elucidate and potentially mitigate the development of cardiac dysfunction among individuals with obesity.
Notes on Endoclita C. & R. Felder (Lepidoptera: Hepialidae) feeding on Eucalyptus in Vietnam, with new records and a new species
Authors: PHAM DUY LONG , CHI NGUYEN MINH , GREHAN JOHN R. , KHAI TRAN QUANG , IGNATEV NIKOLAI , JONES LOREN D. , MIELKE CARLOS G.C. , QUANG DAO NGOC , YAKOVLEV ROMAN
Published: May 2024

A new species of Endoclita C. & R. Felder from Yen Lap district, Phu Tho province, Vietnam, E. phuthoensis sp. n. and the female of Endoclita coomani (Viette) are described as new to science. Both are recorded feeding on Eucalyptus plantations for the first time. Larval and pupal tunnels of E. phuthoensis sp. n. and E. coomani in host stems in Phu Tho and Lao Cai provinces, Vietnam are described and illustrated for the first time. Tunnels were found within one meter above the ground. They are initiated at the bark surface, extend into the stem, usually at a downward angle, then bend upwards for a distance of less than 24 cm, contrasting with the proximal (downward) orientation of the tunnel in E. vietnamensis Buchsbaum & Grehan and E. salvazi Tindale. The tunnel entrance is surrounded by callus tissue that larvae feed on under a web of silk and debris. At pupation, larvae first construct a silk membrane across the tunnel entrance. Endoclita marginenotatus (Leech, 1898) is recorded from Vietnam (Mt. Fansipan) for the first time from a single specimen collected within natural forest habitat.