bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP74: The Effect Of BMI On Metabolic Traits Is Mediated By A Novel Diabetes Marker
Authors: Zhang Ruiyuan , Sun Xiao , Huang Zhijie , Pan Yang , Westbrook Adrianna , Li Shengxu , Bazzano Lydia A , Chen Wei , He Jiang , Kelly Tanika N , Li Changwei
Published: April 2022

Introduction:
2-aminoadipic acid (2-AAA) secreted during adipogenesis is a novel marker for diabetes.

Hypothesis:
2-AAA mediates the associations between body mass index (BMI) and metabolic measures, and the effect of 2-AAA can be modified by environmental factors.

Methods:
We performed cross-sectional analyses among all 1,252 participants in the Bogalusa Heart Study 2016 survey. Serum 2-AAA and 110 xenobiotics were profiled through untargeted UPLC-MS/MS. Mediation effects of 2-AAA on the associations between BMI and metabolic traits were estimated by comparing the BMI-traits associations before and after controlling for 2-AAA. P value for a mediation effect was estimated by 1,000,000 times Monte-Carlo simulation. We further performed interaction analyses to identify xenobiotics that modify the effect of 2-AAA on metabolic traits. Age, sex, race, education, smoking, drinking, and use of lipid, glucose, or blood pressure lowering medications were adjusted in all analyses.

Results:
After Bonferroni correction, 2-AAA significantly mediated the association of BMI with high density lipoprotein cholesterol (HDLC) (beta= -0.03 mg/dL, p=1.70х10
-4
), log transformed triglyceride (lgTG) (beta=0.002, p=1х10
-6
), fasting glucose (beta=0.05 mg/dL, p=2.87х10
-3
), and hemoglobin A1c (HbA1c) (beta=0.002%, p=8.50х10
-4
). The proportions of associations explained by 2-AAA ranged from 5.12% for HDLC to 13.23% for lgTG. When stratified by race and medication usage, the mediation effects were stronger among Whites and those not taking medications (P for interaction <0.05). Furthermore, 14 xenobiotics modified the associations of 2-AAA with HDLC/lgTG or glucose/HbA1c (Table), e.g., the association between 2-AAA and HbA1c was much stronger among participants with higher levels of
4-acetaminophen sulfate
(P for interaction=3.03х10
-5
), a metabolite of commonly used over-the-counter analgesics.

Conclusion:
2-AAA mediated the effect of BMI on metabolic traits, and this effect was modified by environmental factors.
Abstract MP75: Cardiac Biomarkers And Frailty In The Atherosclerosis Risk In Communities (ARIC) Study
Authors: Martinez-Amezcua Pablo , Juraschek Stephen P , Ballantyne Christie M , Forman Daniel E , Gabriel Kelley P , Griswold Michael , Hoogeveen Ron C , Kucharska-newton Anna , Lutsey Pamela L , Matsushita Kuni , Ramonfaur Diego , Selvin Elizabeth , Shah Amil M , Windham B Gwen , Palta Priya
Published: April 2022

Introduction:
Frailty, an increased vulnerability to stressors, is associated with adverse health outcomes. Cardiovascular disease (CVD) is associated with frailty, but whether circulating cardiac biomarkers of subclinical myocardial injury and strain (e.g., high-sensitivity cardiac troponin T [hs-cTnT] and natriuretic peptide [NT-proBNP]) are associated with frailty is unknown.

Methods:
We conducted a cross-sectional analysis of levels of hs-cTnT and NT-proBNP assessed among participants of the ARIC study at visit 5 (2011-2013, mean age: 75.5 years, 42% male, 21% Black). We used the Fried frailty phenotype that counts the presence of each component (weight loss, low physical activity, slow gait, exhaustion, and low grip strength) to classify participants as frail (≥3), pre-frail (1-2), or robust (0 components). Participants without prevalent CVD (stroke, myocardial infarction, or heart failure) were classified into hs-cTnT and NT-proBNP quartiles; those with prevalent CVD were considered in a separate group. Using adjusted multinomial logistic regression models, we tested the hypothesis that hs-cTnT and NT-proBNP are positively associated with odds of being pre-frail and frail, vs. robust.

Results:
Among 5,162 participants, 1,039 had prevalent CVD (20%), 2,447 (48%) were pre-frail, and 358 (7%) frail. Biomarker concentrations had graded associations with frailty and pre-frailty, vs. robust. Estimates comparing the 4
th
vs. 1
st
quartile, (e.g., hs-cTnT frail vs. robust OR=4.37 [95% CI: 2.69-7.09]) were similar to those observed for prevalent CVD vs. 1
st
quartile (e.g., hs-cTnT frail vs. robust OR=5.11 [3.19-8.17]). All frailty components were positively associated with cardiac biomarker concentrations and CVD (Table), except exhaustion with NT-proBNP.

Conclusions:
Cardiac biomarker concentrations, even in the absence of CVD, may help identify people at greater risk for frailty. Future research should examine the role of changes in biomarkers from mid-life on the risk of frailty
Abstract MP76: Association Of Elevated High-sensitive Cardiac Troponin T And Low Ankle-brachial Index With Incident Cardiovascular Events. The Multi-ethnic Study Of Atherosclerosis And The Cardiovascular Health Study
Authors: Tedla Yacob , Driver Steven , Szklo Moyses , Kuller Lewis H , Lima Joao , Michos Erin D , Defilippi Christopher , Greenland Philip
Published: April 2022

Introduction:
Elevated high-sensitive cardiac troponin T (hs-cTnT>14 ng/L) and low ankle-brachial index (ABI
<
0.9) are known to be associated with cardiovascular diseases (CVD) but their joint effect on the risk of CVD events is unknown.

Methods:
We used data from the MESA and CHS among 10,900 participants free of CVD events at baseline (mean age 66.3 years, 44.7% males). Incident coronary heart disease (CHD) was defined as fatal or non-fatal myocardial infarction or revascularization and incident CVD was defined as CHD, transient ischemic attack, stroke, or atrial fibrillation. Hazard ratio (HR) and 95% CI was calculated from a Cox regression model. Interaction on the additive scale was assessed using relative excess risk due to interaction (RERI) and interaction on the multiplicative scale was assessed by Likelihood ratio (LR) test.

Results:
At baseline (2000-2002 for MESA and 1989-1990 for CHS), 10.2% of participants had elevated hs-cTnT and 7.5% had low ABI. During 26.1 years of total follow-up (median follow-up 18.4 years), there were 3,911 incident CVD events. The risk of CHD and CVD was higher in participants with both elevated hs-cTnT and low ABI [CHD HR: 2.1 (1.5, 2.9), CVD HR: 2.1 (1.7, 2.5)], only elevated hs-cTnT [CHD HR: 1.7 (1.4, 2.0), CVD HR: 1.6 (1.5, 1.8)], and only low ABI [CHD HR: 1.8 (1.5, 2.2), CVD HR: 1.5 (1.3, 1.7)] than those with unelevated hs-cTnT and normal ABI. Interaction on the multiplicative scale was observe in both adjusted and unadjusted models for CHD (unadjusted LR test p-value=0.002, adjusted LR test p-value=0.042) and only in unadjusted model for CVD (LR test p-value=0.001). No significant additive interaction was detected for both CHD and CVD (RERI p-value≥0.25 for unadjusted and adjusted models).

Conclusion:
Having both elevated cTnT and low ABI was associated more strongly with CVD events than only elevated cTnT or low ABI. Antagonistic multiplicative interaction was found indicating the observed joint effect of elevated cTnT and low ABI was smaller than the expected combined individual effects.
Abstract P003: Blood Pressure, Antihypertensive Drugs, And Incident Frailty: The Multidomain Alzheimer Preventive Trial
Authors: Rouch Laure , Rolland Yves , Hanon Olivier , Vidal Jean-Sébastien , CESTAC Philippe , brigitte SALLERIN , Andrieu Sandrine , Vellas Bruno , de Souto Barreto Philipe
Published: April 2022

Objectives:
To examine the association of (1) high and low BP levels and (2) AH drug use with incident frailty.

Study design:
We conducted a secondary analysis of the Multidomain Alzheimer Preventive Trial (MAPT). We included and followed-up for 5 years 1,394 non-frail community-dwelling participants aged ≥ 70 years.

Main outcome measures:
High BP was defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg and low BP as systolic BP ≤ 110 mmHg and/or diastolic BP ≤ 70 mmHg. AH drugs were classified according to the Anatomical Therapeutic Chemical (ATC) code. Incident frailty was assessed using the Fried phenotype. Cox proportional hazards models were used for the analyses.

Results:
Low BP was associated with greater risk of frailty (HR = 1.43, 95% CI [1.07-1.92], p=0.02) after adjustment for age, sex, education, AH drug use, BMI, diabetes, ischemic heart disease, congestive heart failure, AF, stroke, MAPT randomization group, sit-to-stand chair test and pre-frailty. Participants with low BP and 2 AH drugs or more were those having the greatest risk. Neither high BP (HR = 0.84, 95% CI [0.63-1.22], p=0.24) nor AH drug use (HR = 1.21, 95% CI [0.89-1.64], p=0.22) were independently associated with incident frailty.

Conclusions:
Low BP could be used as a new marker for identifying older adults at higher risk of frailty. AH medications in older adults with low BP should be continuously reviewed to assure that their potential benefits outweigh potential risks.
Abstract P006: Prevalence And Social Determinants Of Modifiable Risk Factors Of Dementia: An Analysis Of The National Health And Nutrition Examination Survey (nhanes) 2013-2018
Authors: Stulberg Eric , Zheutlin Alexander , de Havenon Adam
Published: April 2022

Introduction:
Dementia causes significant morbidity and mortality. 40% of worldwide cases can be delayed or prevented with risk factor modification. The patterning of modifiable risk factors among US adults remain unknown.

Methods:
We determined the prevalence of total, mid-life, and late-life modifiable risk factors for dementia among US adults
>
18 years of age using NHANES from 2013-2018. Mid-life (45-65 years) risk factors included: self-reported hearing loss, hypertension (via self-report or exam), excess alcohol intake (≥14 alcoholic drinks per week), and BMI
>
30 mg/kg
2
. Late-life (>65 years) risk factors included: self-reported cigarette smoking, depression (PHQ-9 ≥ 10), social isolation, physical inactivity (<150 minutes/week of moderate activity), and diabetes (via self-report or HgBA1C ≥ 6.5) . Having less than a high school degree was included as both a mid- and late-life risk factor. Poisson regressions were used to determine age-adjusted associations between the exposures of race-ethnicity, sex, and poverty-income ratio (PIR, 6-level ordinal variable, higher numbers reflecting more income relative to poverty level) with total number of risk factors, mid-life risks factors among those in midlife, and late-life risks factors among those in late-life.

Results:
After applying survey weights, the sample consisted of 241,727,544 individuals composed of 48.2% male participants, 9.20% identifying as Mexican-American, 6.35% non-Mexican Hispanic, 11.4% non-Hispanic Black, 5.67% non-Hispanic Asian, 3.74% as ‘other,’ and 63.6% as non-Hispanic white. Mid-life and late-life individuals made up 35.70% and 17.85% of the sample respectively. The median (IQR) number of risk factors overall was 2 (1-3). Among mid-life participants, the median number (IQR) of mid-life risk factors was 1 (0-2). Among late-life participants, the median number (IQR) of late-life risk factors was 1 (1-2). Hypertension was the most prevalent risk factor at 42.8%. Mexican-Americans, non-Mexican Hispanic Americans, and non-Hispanic Black Americans had significantly more age-adjusted total risk factors, mid-life risk factors, and late-life risk factors relative to non-Hispanic white Americans. Non-Hispanic Asian Americans had less age-adjusted total and midlife risk factors relative to non-Hispanic white-Americans, but more late-life risk factors. Male sex was associated with a greater prevalence of age-adjusted mid-life risk factors (β =0.18, 95% CI: 0.05 – 0.18), compared to female sex. A 1-level higher PIR was associated with less age-adjusted total, mid-life, and late-life risk factors, with late-life being most pronounced (β = -0.19, 95% CI: -0.21 to -0.17)

Conclusion:
Dementia risk factors seem to be patterned by social determinants, including race-ethnicity and PIR. Given known disparities in dementia, more focus should be given to mitigating risk factors among at-risk populations.
Abstract P008: Atherogenic Cholesterol Across The Lifespan And The Relationship With Midlife Global Cognitive Function: The Bogalusa Heart Study
Authors: De Anda-Duran Ileana , Libon David , Kolachalama Vijaya B , Au Rhoda , Bazzano Lydia A
Published: April 2022

Background:
Higher levels of non-atherogenic cholesterol (HDL) may be protective against vascular risk and inflammation, mechanisms accompanying cognitive impairment in late life. However, the role of atherogenic lipoproteins remains controversial. Evidence suggests that CV risk burden in middle age may be more closely associated with late-life brain health. Therefore, we aimed to explore the relationship between atherogenic cholesterol (non-HDL) in a community-based cohort of midlife adults.

Methods:
A total of 1,266 adult participants (58.9% Woman, 34.5% African American) from the Bogalusa Heart Study, with cognitive function assessment at age 48 ± 5 years and at least 3 observations of lipoproteins since childhood. A standardized global cognitive score (GCS) was obtained from a battery of tests covering major neuropsychological domains. Non-HDL trajectories were created using latent class trajectory modeling. Linear regression models were used to determine the association between non-HDL trajectories and GCS in midlife.

Results:
The mean follow-up for non-HDL and other traditional cardiovascular (CV) risk factors was 41.8 ± 3.4 years. Four distinct trajectory classes were identified: class 1 (n= 451 [ 36%]), class 2(n=168 [13.2%]), class 3 (n=530 [41.8%]), and class 4 (n=117 [9 %] (Figure 1). With class 1 as reference, and after adjustment for sex, race, education, cholesterol medication, hypertension, and diabetes comorbidities. Class 2 and class 4 trajectories were associated with lower GCS (Beta= -0.65 [SE 0.28];
p
=0.022, and Beta = -0.06 [0.31]; p=0.057, respectively). (Table 1)

Conclusions:
These findings suggest that highly-increasing atherogenic cholesterol trajectories over time, particularly from early adulthood to middle age, may adversely affect cognitive performance in midlife, independent of other dementia risk factors. This underscores the importance of addressing CV risk factors earlier in the life course, as their cumulative burden could have a detrimental impact on brain health.
Abstract P010: Relationship Of Pulse Pressure And Cognitive Performance In Individuals With Advanced Carotid Atherosclerosis
Authors: Williams Cedric , Morel Valdés Gloria , Mitchell Carol , Dempsey Robert J , Wilbrand Stephanie , Cook Thomas
Published: April 2022

Introduction:
Elevation in pulse pressure (PP), the difference between systolic and diastolic blood pressure, is associated with vascular remodeling, arterial stiffness, and carotid plaque instability (i.e. strain indices and ulceration), which is a risk factor for vascular cognitive decline. We have previously demonstrated that increased carotid plaque strain indices are associated with poorer cognitive performance in individuals with advanced carotid atherosclerosis. We examined the relationship between pre-operative pulse-pressure and cognition in individuals undergoing clinically indicated carotid endarterectomy. We hypothesized that higher PP will be associated with poorer cognitive performance.

Methods:
Patients with advanced carotid atherosclerosis (>60 % stenosis NASCET, ACAS criteria) underwent neurocognitive testing, blood pressure measurements, and PP calculation (n=128). Cognition was measured using a 60-minute neuropsychological battery recommended by the National Institute of Neurological Disorders and Canadian Stroke Network (NINDS-CSN). Kendell Tau correlations were used to examine the relationship between cognitive tests, ulceration and PP.

Results:
Participants were a median age of 72 (IQR 13) years of age, 50 females (40%), 78 males (60%), median 70% stenosis (IQR 10.8), median systolic blood pressure of 132 (IQR 26) mmHg, median diastolic blood pressure of 71.5 (IQR 15) mmHg, and median PP of 58.5 mmHg (IQR 23.75). PP ranged from 36 mmHg to 163 mmHg. Results did demonstrate evidence of an association between PP and WAIS-IV Block Design in asymptomatic patients (τ=-0.23, p=0.02). It did not show a significant relationship between PP and other subtests (all p-values>0.05). There was no significant association between PP and operative plaque ulceration scores (p=0.542).

Conclusions:
PP was not associated with cognitive performance in individuals with advanced carotid atherosclerosis except for the relationship between PP and WAIS-IV Block Design in asymptomatic patients. This finding is consistent with prior work that suggests visuospatial processing presenting as one of the earliest declines in patients with cerebrovascular disease. Though asymptomatic patients did not show classic signs of stroke, they likely had silent strokes due to plaque instability.
Abstract P011: Blood Pressure Postural Changes Variability Is Associated With Cognitive Decline: The S.ages Cohort
Authors: Mathilde Strumia , Vidal Jean-Sébastien , Hanon Olivier , Rouch Laure
Published: April 2022

Introduction:
Over the past decade, higher blood pressure (BP) variability has been associated with cognitive decline (CD). To date, only one study investigated the specific impact of visit-to-visit BP postural changes variability on dementia but its association with cognition is still unknown. We aimed to investigate the association between BP postural changes variability and cognitive function in noninstitutionalized subjects aged ≥ 65 years.

Methods:
The S.AGES (Sujets Å;gés) cohort followed for three years noninstitutionalized subjects aged ≥ 65 years without major neurocognitive impairment at inclusion. At each visit, an orthostatic systolic BP (SBP) ratio was calculated using the formula (sitting SBP/standing SBP) x 100. An orthostatic diastolic BP ratio was computed using the same method. Subjects with a SBP ratio > 100% had sitting SBP > standing SBP. We assessed the visit-to-visit BP postural changes variability according to several indicators: standard deviation, coefficient of variation (CV), variation independent of mean, residual standard deviation, average real variability, and successive variation. Cognitive performances were evaluated using the Mini-Mental State Examination. Linear mixed models were used for the analyses.

Results:
We included 2,974 subjects (mean age 78 years, women 56%). After adjustment for age, sex, education, baseline body mass index, smoking, alcohol intake, atrial fibrillation, congestive heart failure, transient ischemic attack or stroke, coronary artery disease, type 2 diabetes, dyslipidemia, seated SBP/DBP and antihypertensive treatment, greater visit-to-visit systolic BP postural changes variability was significantly associated with CD over time (adjusted β [95% CI] = -0.17 [-0.29; -0.06], p= 0.004 for CV). Similar results were found for visit-to-visit diastolic BP postural changes variability (adjusted β [95% CI] = -0.14 [-0.25; -0.03], p= 0.017 for CV).

Conclusion:
Greater visit-to-visit BP postural changes variability was associated with CD. Further studies are needed to assess whether controlling orthostatic BP instability over time could be a promising interventional target to preserve cognition among older adults.
Abstract P012: Orthostatic Hypo- And Hyper-tension Are Associated With Cognitive Decline: The S.ages Cohort
Authors: Mathilde Strumia , Hanon Olivier , Vidal Jean-Sébastien , Rouch Laure
Published: April 2022

Introduction:
The association between orthostatic hypotension (OHYPO) and cognition has reported conflicting results. Although orthostatic hypertension (OHYPER) is an emerging cardiovascular risk factor, only very few studies investigated its association with cognition. We aimed to assess the impact of OHYPO and OHYPER on cognitive performances in non-institutionalized subjects aged ≥ 65 years.

Method:
The S.AGES (Sujets Ågés) cohort followed for three years non-institutionalized subjects aged ≥ 65 years without major neurocognitive impairment at inclusion. OHYPO was defined as a decrease in systolic blood pressure (SBP) of at least 20 mmHg and/or diastolic blood pressure (DBP) of at least 10 mmHg from a sitting to a standing position. In contrast, OHYPER was defined as an increase in SBP of at least 20 mmHg and/or DBP of at least 10 mmHg under the same measurement conditions. Cognition was assessed using the Mini-Mental State Examination (MMSE). Linear mixed models were used for the analyses.

Results:
We included 3,170 subjects (mean age 78 years, 56% women). 209 (6.5%) had OHYPO at inclusion and 226 (7.1%) had OHYPER. Over time, MMSE was on average 0.5 points lower in patients with OHYPO compared to those without OHYPO or OHYPER (adjusted β [IC95%] = -0.52 [-0.97 ; -0.08], p=0.021) after adjustment for age, sex, education, baseline body mass index, smoking, alcohol intake, atrial fibrillation, congestive heart failure, transient ischemic attack or stroke, coronary artery disease, type 2 diabetes, dyslipidemia, seated SBP/DBP and antihypertensive treatment. Similarly, patients with OHYPER had, on average, poorer cognitive performances over time compared to those without pathological blood pressure (BP) postural changes (adjusted β [IC95%] = -0.54 [-0.98; -0.09], p = 0.017).

Conclusion:
Both OHYPO and OHYPER were associated with cognitive decline. Considering that BP postural changes are common in the elderly and easy to detect, orthostatic BP measurements could help identify patients with greater risk of cognitive impairment.
Abstract P020: High Sensitivity C-reactive Protein Is Associated With Incidence Of Metabolic Syndrome Among Hispanic/Latino Participants Of The Hispanic Community Health Study/Study Of Latinos
Authors: Mesa Robert A , Schneiderman Neil , Llabre Maria , Palacio Ana , Elfassy Tali
Published: April 2022

Introduction:
High Sensitivity C-reactive protein (HsCRP) is a non-specific marker of systemic inflammation. Elevated levels of HsCRP have been shown to be predictive of cardiovascular disease and cardiovascular related events. The relationship between HsCRP and longitudinal onset of metabolic syndrome (MetS) has not been fully elucidated, especially among U.S. Hispanics/Latinos, which is a growing diverse group in the U.S.

Objectives:
To determine whether HsCRP is associated with incident MetS among U.S. Hispanics/Latinos.

Methods:
The Hispanic Community Health Study/Study of Latinos is a longitudinal observational cohort assessing cardiovascular health among diverse U.S. Hispanics/Latinos. HsCRP was measured at visit 1 (2008-2011) using a Roche Modular Chemistry Analyzer. HsCRP was classified as low, moderate, or high, based on ACC/AHA guidelines. All MetS components (abdominal obesity, triglycerides, HDL cholesterol, blood pressure, and fasting glucose) were measured at visit 1 and visit 2 (2014-2017). MetS was defined as the presence of three or more components based on the definition from the Third Report of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III). Participants free of MetS at visit 1 and with complete data on HsCRP and all MetS components were included (n=6,699 participants). We used Poisson regression analysis to determine whether HsCRP was associated with incident MetS after adjusting for age, follow-up time, sex, Hispanic/Latino background, income, education, marital status, employment, health insurance status, nativity, alcohol use, smoking, anxiety, CESD-10, physical activity, and diet. All analyses included sample weights and accounted for the complex survey design of the study.

Results:
Mean age was 38.2 years, 29.0% had less than a high school education, 59.7% had an income less than $30,000, and 48.4% were female. Average follow-up time was 6.1 years. In fully adjusted models, moderate vs. low HsCRP was associated with a 39% increased risk of MetS (IDR: 1.39, 95% CI: 1.13, 1.71), while high vs. low HsCRP was associated with a 109% increased risk of MetS (IDR: 2.09, 95% CI: 1.70, 2.57).

Conclusions:
Greater levels of HsCRP were associated with new onset of MetS in a diverse sample of U.S. Hispanics/Latinos. Results suggest that HsCRP may be an independent risk factor for, rather than a marker of MetS.
Abstract P023: A Scoring Tool For Identifying Hispanics/latinos With Chronic Kidney Disease: Hispanic Community Health Study/study Of Latinos
Authors: Missikpode Celestin , Pirzada Amber , Sun Jiehuan , Durazo-Arvizu Ramon , Franceschini Nora , Sotres-Alvarez Daniela , Talavera Gregory A , Ricardo Ana , Lash James , Daviglus Martha L
Published: April 2022

Introduction:
Despite the high prevalence of chronic kidney disease (CKD) in the Hispanic/Latino population, most Hispanic/Latino adults with CKD are not aware. This study aims to develop a tool for the Hispanic/Latino population to determine whether an individual has CKD.

Methods:
Baseline (2008-2011) data on 13,636 participants (aged 18 – 74 years; 60.8% female) from the Hispanic Community Health Study/Study of Latinos were analyzed to develop a tool using routinely available information to identify individuals with an increased likelihood of having CKD. CKD was defined as a low eGFR (<60 ml/min per 1.73 m
2
) or the presence of albuminuria [urine albumin to creatinine ratio (UACR)≥30 mg/g]. Based on prior literature, several CKD risk factors were examined using several prediction algorithms (RIDGE regression, LASSO regression, classification and regression tree, and random forest).

Results:
A total of 364 (2.7%) individuals had low eGFR and 1346 (10.1%) had albuminuria. The LASSO model was selected due to its greater accuracy and parsimony. Variables predictive of CKD were weighted to develop a model-based numeric scoring system. Age, self-reported health conditions (i.e., hypertension, diabetes, prevalent coronary heart disease/stroke, balloon angioplasty/stent/bypass surgery), physical functioning limitations, and having health insurance were predictive of low eGFR (Table). Diabetes, hypertension, and pulse were predictive of albuminuria (Table). Multivariate models were internally validated using 10-fold cross-validation (area under the receiver operating characteristic curve of 0.87 and 0.70 for low eGFR and albuminuria, respectively). A score of ≥9 on the eGFR model yielded sensitivity (SN) of 84%, specificity (SP) of 78%, positive predictive value (PPV) of 9%, and negative predictive value (NPV) of 99%. A score of ≥4 on the albuminuria model yielded SN of 62%, SP of 67%, PPV of 18%; and NPV of 94%.

Conclusion:
This community tool may facilitate the identification of undiagnosed CKD in Hispanics/Latinos.
Abstract P024: The Association Of Cardiac Valvular Abnormality With Prevalent And Incident Chronic Kidney Disease In Community-Dwelling Older Adults: The Atherosclerosis Risk In Communities Study
Authors: Karandikar Vedika , Honda Yasuyuki , Ishigami Junichi , Lutsey Pamela L , Hall Michael E , Solomon Scott , Coresh Josef , Shah Amil M , Matsushita Kuni
Published: April 2022

Background:
An improvement in kidney function has been reported after percutaneous valvular replacement therapies, implying pathophysiological contribution of valvular heart disease to chronic kidney disease (CKD). However, this association has not been investigated in community dwelling populations.

Hypothesis:
Valvular abnormality is associated with prevalent and incident CKD.

Methods:
We evaluated the association between valvular abnormality and prevalent CKD (primarily defined as estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m
2
) in 5,216 participants (mean age 75.5 [SD 5.1] years) from the ARIC study (2011-2013) using logistic regression. Then, 3,752 participants without prevalent CKD were analyzed for incident CKD (progression to eGFR <60 mL/min/1.73m
2
with ≥25% decline or hospitalization/deaths with CKD diagnosis) using Cox models. Valvular abnormality included echocardiography-based aortic stenosis (AS), aortic regurgitation (AR), and mitral regurgitation (MR).

Results:
There were 1.4% (n=74) with any AS, 10.6% (n=555) with any AR, and 43.1% (n=2,249) with any MR. The majority (57-96%) had mild or trace abnormality. After adjustment for potential confounders, any MR and moderate/severe AR showed significant associations with prevalent CKD (adjusted odds ratio 1.17 [95% CI 1.03-1.34] and 2.82 [1.12-7.10]), as did any AS in a sensitivity analysis with prevalent CKD defined including albuminuria ≥30 mg/g (1.83 [1.10-3.05]). Only any AS showed an independent association with incident CKD (adjusted hazard ratio: 2.12 [1.13-4.00]). The 5-year cumulative incidence of CKD was 17.3% in any AS and 7.4% in no AS (Figure).

Conclusions:
Different types of valvular abnormality were associated with prevalent CKD. Prospectively, only AS was associated with incident CKD. These findings suggest an etiological link between valvular abnormality and CKD and highlight the importance of clinical attention to kidney function in individuals with AS.
Abstract P028: Do Increased Cardiovascular Comorbidities Explain Excess Covid-19 Morbidity And Mortality In African Americans?
Authors: Dasa Osama , Skaf Yara , Brunson Cory , Sajdeya Ruba , Gurka Matthew , Pepine Carl , Laubenbacher Reinhard , Pearson Thomas A
Published: April 2022

Introduction:
Racial disparities in COVID-19 incidence, severity and mortality have been widely reported, with African Americans (AA) suffering disproportionately compared to White Americans (WA), but the epidemiological basis for these observations remains poorly understood. We hypothesize that AA have an excess of comorbid cardiovascular conditions compared to WA, accounting for the disparity in COVID-19 infection and death.

Methods:
We examined 63545 laboratory-confirmed COVID-19 cases from the One Florida Research Consortium’s sample of recipients of healthcare in Florida from January 2020 to April 2021. We assessed the prevalence of preexisting comorbid conditions, behavioral risk factors, and outcomes of AA, WA, and Hispanic patients testing positive for COVID-19. Outcomes were defined as admission to ICU or all-cause death in the index admission. Associations between risk factors and outcomes were evaluated using multivariate logistic regression analysis.

Results:
Compared to WA, Hispanic and AA COVID-19 patients were younger, more females, and more uninsured. AA patients with COVID-19 had the highest burden of comorbidities (especially cardiovascular), and worse combined comorbidity scores. They also had a higher rate of ICU admission and death. After adjustment for multiple variables, AA patients continued to have the highest adverse outcomes risk (OR=1.44;
P
< 0.001; Figure 1). Other significant predictors in the model included age, sex, poverty, cardiovascular comorbidities, cancer, and mental health disorders.

Conclusions:
Excess comorbidities from cardio-metabolic diseases exist in AA patients with COVID-19, who also suffer excess COVID-19 outcomes. However, these cardiovascular comorbidities did not account for all the risk of adverse COVID-19 outcomes. Reasons for the excess residual risk of in AA even after adjusting for comorbidities and other risk factors require further investigation, such as mediation analyses.
Abstract P032: Initiating Hypertension Treatment To Prevent Incident Cardiovascular Disease: A Population Estimate Using The Cardiovascular Disease Policy Model
Authors: Hennessy Susan , Penko Joanne , Coxson Pamela , Wei Pengxiao , Boylan Ross , Atum Azuka , Bellows Brandon K , Zhang Yiyi , Kazi Dhruv S , Moran Andrew E , Bibbins-Domingo Kirsten
Published: April 2022

Background:
Hypertension is a leading preventable cause of CHD, stroke, and heart failure (HF). WHO hypertension guidelines recommend initiating first dose medication in hypertensive adults with access to healthcare, yet many US adults with a usual source of care are not receiving treatment. We estimate the population impact of initiating hypertensive therapy in untreated US adults with uncontrolled blood pressure (BP) and access to usual healthcare on incident CVD.

Methods:
We used the CVD Policy Model, a dynamic state-transition model of CVD risk factors, events, and outcomes to simulate the impact over 10 years of treating uncontrolled BP in our target population of US adults 35-94 years of age with no prior CVD, baseline systolic BP ≥140mmHg, and no current hypertensive medication use, estimated from National Health and Nutrition Examination Survey years 2015-2018. We initiated first dose medication in the target population reporting access to a usual source of healthcare and at least two visits per year. We used the Law, Morris and Wald equation to estimate the systolic BP effect size for a standard first dose of medication.

Results:
Initiating hypertension medications in those with currently untreated but with regular healthcare access would prevent 214,000 incident CVD events in the US, a quarter of which (52,000) are incident heart failure (Table 1). First dose treatment (and maintenance) would be expected to reduce incident CHD by 9.1%, HF by 6.1%, ischemic stroke by 8.1%, and hemorrhagic stroke by 11.3% over the decade, compared to no treatment. Treatment of hypertension would have the greatest relative benefit in the prevention on incident CVD events in those younger than 65, compared with those over 65 years of age.

Conclusion:
In the US population with regular access to healthcare, initiating first dose medications for hypertension in those with elevated blood pressure but currently untreated would reduce incident CVD in both sexes and all age groups, with particular benefit for prevention in those less than 65 years of age.
Abstract P036: Pooled Cohort Equation As A Predictor Of Incident Hypertension Among Hispanics/latinos: The Hispanic Community Health Study/study Of Latinos (HCHS/SOL)
Authors: Chavez Patricia , April-Sanders Ayana , Lee Un Jung , Elfassy Tali , Schneiderman Neil , Kaplan Robert , Perreira Krista , Castro-Diehl Olga Cecilia , Daviglus Martha L , Talavera Gregory A , Gallo Linda , Sotres-Alvarez Daniela , Rodriguez Carlos
Published: April 2022

Introduction:
Hypertension risk assessment is the first step towards primary prevention of hypertension. The pooled cohort equation (PCE) provides an atherosclerotic cardiovascular disease (ASCVD) risk score. We sought to examine whether incident hypertension varied across categories of ASCVD risk as defined by the PCE

Methods:
Data from the HCHS/SOL baseline and visit 2 exam were used. Hypertension (baseline and incident) was defined as SBP >140 mm Hg and DBP >90 mm Hg. We included participants 40-74 years of age free of hypertension and ASCVD at baseline (n=3,692). Participants were classified into one of four ASCVD risk categories based on the PCE: low (<5%), borderline (5-7.5%), intermediate (7.5-to 10%) and high (>10%). Survey logistic regression models were used to determine the risk of hypertension overall, by age group and Hispanic/Latino background (Dominican, Central American, Cuban, Mexican, Puerto-Rican, South American) accounting for HCHS/SOL complex survey design.

Results::
Overall, at baseline, the mean age was 51.2 ±0.23 years, 56% female, SBP: 119.7±0.26 and DBP: 72.6±0.20, ASCVD risk scores: low (65%); borderline (14.7%), intermediate (7.5%), and high (13.5%); 29.8% developed hypertension over 5.9 (range 4.1 – 9.6) years of follow-up. Intermediate (OR=2.2, CI: 1.5-3.2) and high (OR=2.5, CI: 1.9-3.5) baseline ASCVD risk categories were associated with increased odds of incident hypertension at follow-up compared to the low risk category. Age group and Hispanic/Latino background modified the relationship between increased baseline ASCVD score and incident hypertension, with strongest associations among those aged 50-59 years old (OR=2.3, CI: 1.7, 3.2) and Hispanics/Latinos of Dominican descent (OR=4.1, CI: 2.0, 8.4).

Conclusions:
Higher ASCVD risk was associated with an increased incidence of hypertension that varied by age and Hispanic/Latino background. The PCE ASCVD risk score can help guide public health measures to prevent hypertension.
Abstract P037: Age Modifies The Inverse Association Between Standing Height And Pulse Pressure
Authors: Visaria Aayush , Hameed Fariha , Patel Devam , Jenkins Cole , Khanapure Purva , Lo David
Published: April 2022

Purpose:
While standing height is positively associated with blood pressure in the pediatric population, studies have suggested an inverse association in adults. We sought to therefore determine whether age modified the association between standing height and pulse pressure (PP).

Methods:
The study included adults ≥20 years from the 1999-2018 National Health and Nutrition Examination Surveys who were not taking antihypertensive medications. Standing height was categorized into gender-specific quintiles (Table). High PP was defined as PP ≥60 mmHg. We estimated odds ratios (OR) using logistic regression, adjusting for covariates, accounting for the complex survey design, and stratifying by 10-year age groups.

Results:
Among the 26,779 adults (mean [SD] age of 43 [30], 50% female, 70% White), 16% had elevated PP, ranging from 23% in the lowest height quintile (Q1) to 11% in the highest quintile (Q5). Those in Q5 were younger, of higher socioeconomic status, had greater waist circumference, and less likely to have cardiovascular disease or diabetes compared to those in Q1. Those in Q5 had 46% lower adjusted odds of high PP compared to Q1. Race and gender did not modify associations (race: p for interaction = 0.28; gender: p =0.34). When stratifying by 10-year age groups, odds of high PP significantly decreased with increasing age up to 70 years (Table, P-trend <0.001).

Conclusion:
Standing height was found to be negatively associated high PP, especially in adults 30-69 years. We speculate that augmented pulse wave deflection in shorter individuals may play a role in age-related increases in arterial stiffness.
Abstract P038: Association Of Discordance Between Low-density Lipoprotein And High-density Lipoprotein Cholesterol Versus Particle Concentration With Incidence Of Type 2 Diabetes: Coronary Artery Risk Development In Young Adults Study
Authors: Ruiz-Ramie Jonathan J , Barber Jacob , Wang Xuewen , Wilkins John T , Snell-bergeon Janet , Lloyd-Jones Don M , Lane-cordova Abbi , Sarzynski Mark A
Published: April 2022

Background:
The body of literature on discordance between lipoprotein cholesterol and particle concentrations focuses primarily on the relationship between lipoprotein discordance and clinical and subclinical indices of cardiovascular disease. Data are sparse regarding associations between either high (HDL) or low (LDL) density lipoprotein discordance and incident type 2 diabetes (T2D).

Purpose:
To test the hypothesis that both HDL and LDL discordance status are associated with incident T2D.

Methods:
All included phenotypes were measured at the year 7 exam among 3891 participants of the CARDIA study. Diabetes status at each exam was classified as a fasting glucose above 126 mg/dL. Sex-specific median-based lipoprotein discordance groups were created and combined into four exclusive cholesterol/particle groups for both HDL and LDL: 1) low/low (below the median for both cholesterol and particle concentration), 2) low/high (below the median for cholesterol, at or above the median for particle concentration), 3) high/low, and 4) high/high. The association of incident T2D with lipoprotein discordance was assessed via sex-specific multivariable proportional hazards regression. All sex-specific models were adjusted for self-identified race and the time varying covariates of age, smoking, and BMI. In the instance of a significant race by discordance interaction term, race-specific models were utilized. The low cholesterol/low particle groups were used as the reference group for all analyses.

Results:
Approximately 27% of men and 34% of Women were discordant (either low/high or high/low) for HDL while around 15% of both men and women were discordant for LDL. In women only, both HDL and LDL discordance were associated with incident T2D with higher risk associated with lower HDL-C (Low HDL-C/High HDL-P at highest risk of incident T2D; Hazard Ratio [HR] 1.7, 95% confidence interval [CI] 1.1 to 2.6, p=0.01). Race-specific associations were found for LDL discordance with T2D risk, with the High LDL-C/High LDL-P group at higher risk (Black participants only: HR 1.5, 95%CI 1.03 to 2.4, p<0.01). No significant relationships between lipoprotein discordance and T2D incidence were found for males.

Conclusions:
Lipoprotein concordance/discordance status is significantly associated with incident T2D in women only, although racial differences may be present. These data suggest that measurement of lipoprotein particle concentrations alongside cholesterol measures may provide novel insight into health risks and prevention needs.
Abstract P040: Dyslipidemia And The Incidence Of Subclinical And Clinical Cardiovascular Disease In Adolescents And Young Adults: The Strong Heart Family Study (SHFS)
Authors: Reese Jessica , Roman Mary J , Deen Jason , Ali Tauqeer , Cole Shelley , Devereux Richard B , Fretts Amanda M , Howard Barbara V , Howard Wm. James , Lee Elisa T , Malloy Kimberly , SINGH Parmanand , Umans Jason G , Zhang Ying
Published: April 2022

Introduction:
Dyslipidemia is characterized by high levels of total cholesterol (TC), LDL cholesterol (LDL-C), triglycerides (TG), or low levels of HDL cholesterol (HDL-C) and is an established risk factor for subclinical and clinical cardiovascular disease (CVD) among adults. Although several investigations exist in older American Indian (AI) adults, the data on AI adolescents and young adults are scarce.

Hypothesis:
Dyslipidemia will be prevalent, and the incidence of subclinical and clinical CVD will be higher in young AI with than without baseline dyslipidemia.

Methods:
We evaluated AI participants from the SHFS, who were 14-39 years old at the baseline examination, 2001-2003 (n=1,436). To measure lipids, we drew blood after a 12-hour fast and defined dyslipidemia as any of the following: TC ≥ 200 mg/dL, LDL-C ≥ 100 mg/dL, TG ≥ 150 mg/dL, HDL-C < 40 mg/dL for men, HDL-C < 50mg/dL for women, non-HDL-C ≥ 130 mg/dL or taking lipid lowering medication. We used carotid ultrasound to detect atherosclerotic plaque at baseline and at the follow-up examination, 2006-2009. We identified CVD events through 2019 with a median follow-up of 17.8 years. We used log-rank tests to determine if the incidence of plaque or CVD events differed according to different categories of dyslipidemia.

Results:
Prevalence of dyslipidemia was 42%, 65%, and 73% for participants <20, 20-29, and 30-39 years old, respectively. During follow-up, 109 (9.9%) participants had incident plaque (of 1,107 plaque free participants) and 128 (9%) had a fatal or non-fatal CVD event (of 1,424 CVD free participants). Plaque incidence was higher in participants with high TC, LDL-C, TG, non-HDL-C, and dyslipidemia at baseline. CVD incidence was higher for participants with high TC, TG, and non-HDL-C (Table 1).

Conclusions:
AI adolescents and young adults have an unexpectedly high prevalence of dyslipidemia, which leads to higher incident plaque and CVD events later in life. These data provide evidence for the benefits of lipid screening and intervention among this population.
Abstract P041: Increases In Low-density Lipoprotein Subclasses During The Menopause Transition Are Associated With Greater Risk Of Coronary Calcification And Carotid Atherosclerosis: The SWAN HDL Study
Authors: El Khoudary Samar R , Chen Xirun , Brooks Maria M , Orchard Trevor , Crawford Sybil , Janssen Imke , Everson-rose Susan A , McConnell Dan , Matthews Karen A
Published: April 2022

Objectives:
Increase in LDL-C occurs within 1 year of the final menstrual period (FMP), and this increase has been linked to a greater plaque risk. LDL subclasses have been linked to CAD beyond LDL-C, promising a better risk stratification. We aim to characterize changes in LDL subclasses over the menopause transition (MT) and assess associations of these changes with presence of coronary artery calcification (CAC Agatston score ≥10) and carotid intima-media thickness (cIMT), and test the effect modification of time relative to FMP on these associations.

Design:
Midlife women with nuclear magnetic resonance spectroscopy LDL subclasses measured over the MT for a maximum of 5 timepoints were included (n=471; baseline age 50.19 ± 2.7 years; 81.0% Pre-/Early perimenopausal). A subset of women had CAC and cIMT measured for a maximum of 2 timepoints (n=221). LOESS plots were used to characterize changes in LDL subclasses over the MT in the full sample. Inflection points identified from the LOESS plots suggested timing of changes in slope (Figure). Linear mixed effect models or generalized estimating equation was used for analysis. Effect modification by time relative to FMP was tested.

Results:
All LDL metrics increased around the FMP except for Intermediate LDL Particles (IDL-P), which declined (Figure). Higher total LDL particles (LDL-P) and greater ApoB independently associated with higher CAC prevalence and greater cIMT. Although none of the associations of LDL metrics with cIMT or CAC were modified by time relative to FMP, higher LDL-C, ApoB and total LDL-P were associated with higher cIMT during peri- or postmenopausal stages (Table), while higher LDL-C, small LDL-P and large LDL-P were associated with greater CAC prevalence, mainly during perimenopause stage in adjusted models (Table).

Conclusions:
During the MT women experience significant increases in LDL subclasses found to be related to greater cIMT levels and CAC prevalence. Monitoring LDL subclasses over the MT may help in identifying women at greater risk for future CAD.
Abstract P042: Impact Of Mild Sleep Restriction On Lipid Profile: Influence Of Inflammatory Markers
Authors: Barragan Rocio , Shaw Delaney , Zuraikat Faris M , Scaccia Samantha , Cheng Bin , Jelic Sanja , St-Onge Marie-Pierre
Published: April 2022

Introduction:
Short sleep duration is associated with an increased risk of cardiovascular disease (CVD). Dyslipidemia is one of the main risk factors for CVD but the influence of sleep duration on this risk factor is, for the moment, inconclusive.

Objective:
The goal of this study is to test the impact of mild sleep restriction (SR), sustained for 6 wk, on the lipid profile of participants at risk of CVD.

Methods:
A randomized crossover study was carried out in 64 adults (68% women) aged 20-73 y with a BMI between 19.2-29.9 kg/m
2
. Participants habitually slept ≥7 h/night, verified by 2 wk of wrist actigraphy during screening. Participants underwent 2 sleep conditions of 6 wk each: AS and SR (a reduction of 1.5 h/night relative to AS). Lipid profile was determined from fasted blood samples collected at baseline, wk 3, wk 4 and wk 6 of each phase. In a subset of 34 women, we analyzed inflammatory markers: interleukin- 6 (IL-6), C-reactive protein (CRP) and tumor necrosis factor α (TNF-α). Linear mixed models were used to test the influence of sleep condition on change in lipid profile over time. We further performed Pearson correlations between change in inflammatory markers over each of the the 6-wk phases with lipids measures assessed at endpoint of the respective condition.

Results:
No effect of sleep condition on change in total cholesterol and triglyceride concentrations (β=0.40±1.80; p=0.83; β=0.43±2.38; p=0.86, respectively) was observed. LDL-C decreased over time, and this was more pronounced in SR compared to AS (β=-3.75±1.59; p=0.019). Similarly, HDL-C decreased over time, and this was less pronounced in SR compared to AS (β=1.78±0.64; p=0.006). Findings were similar in sub-group analyses by sex and menopausal status. Correlation analyses revealed trends for inverse correlations between IL-6 and total cholesterol (r=-0.299; p= 0.096), and LDL-C (r=-0.344; p=0.054) during SR. Also, a decrease in CRP during SR was correlated with higher HDL-C levels at endpoint (r=-0.545; p= 0.002). Conversely, in AS, we only detected a positive correlation between change in CRP and LDL-C at endpoint (r=0.354; p= 0.037).

Conclusions:
Six weeks of mild sleep restriction does not adversely impact lipid profile. However, this may be a maladaptive response to increases in inflammatory markers after a period of mild sleep restriction. Further studies are needed to confirm these findings.