bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP36: Evaluation of Race and Ethnicity and Pharmacy Dispensing of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide 1 Receptor Agonists in Patients With Type 2 Diabetes
Authors: Rodriguez Luis A , Finertie Holly , Neugebauer Romain S , Gosiker Bennett , Thomas Tainayah W , Karter Andy J , Gilliam Lisa K , Oshiro Caryn , An Jaejin , Simonson Gregg , Cassidy-Bushrow Andrea E , Dombrowski Sarah K , Nolan Margaret B , O'connor Patrick J , Schmittdiel Julie
Published: May 2024

Objectives:
To evaluate pharmacy dispensing of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-Like Peptide 1 Receptor Agonists (GLP1-RA) among patients with type 2 diabetes (T2D) over time and by race and ethnicity.

Methods:
This was a retrospective cohort study of patients (≥18 years) with T2D using 2014-2022 electronic health record data from 6 large US care delivery systems. Cohort entry was at earliest pharmacy dispensing of any T2D medication. We used logistic regression to evaluate the association between pharmacy dispensing of SGLT2i and GLP1-RA and race and ethnicity, adjusting for cardiovascular risk factors, clinical and demographic characteristics at baseline.

Results:
Our cohort included 681,823 patients (median [IQR] age 60 [51,69]; 46.4% female; 16.6% Asian, 10.5% Black or African American, 1.4% Hawaiian or Pacific Islander (HPI), 31% Hispanic, 3.8% Multi-racial or Other/Unknown, 0.3% American Indian or Alaska Native (AI/AN), and 36.4% White). Patients were followed for a median [IQR] of 6 years [3,9]. The age, sex, and site adjusted rate of annual pharmacy dispensing of SGLT2i increased from 0.1% to 12.2% between 2014 and 2022 (Figure 1A) and increased from 0.3% to 3.8% for GLP1-RA (Figure 1B). In the fully adjusted models, SGLT2i dispensing was lower for AI/AN (OR 0.80, 95% CI 0.67-0.93), Black or African American (OR 0.89, 0.86-0.92) and Hispanic (OR 0.87, 0.85-0.89) compared to White adults. GLP1-RA dispensing was lower for AI/AN (OR 0.79, 0.63-0.97), Asian (OR 0.50, 0.48-0.52), Black or African American (OR 0.86, 0.83-0.90), HPI (OR 0.51, 0.46-0.57), Hispanic (OR 0.69, 0.66-0.71), and Multi-racial or Other/Unknown (OR 0.78, 0.73-0.83) compared to White adults.

Conclusions:
Pharmacy dispensing of SGLT2i, and GLP1-RA medications was lower in patients with T2D from minority groups compared to White adults in 6 US large care delivery systems. This suggests the need for equitable interventions to narrow the race and ethnicity gap in the use of these drugs for cardiovascular outcomes in the US.
Abstract MP42: Insomnia Symptoms Are Associated With Poor Cardiometabolic Health Among Bhutanese Refugees in the United States
Authors: Singh Rupsha , Cohen Jeffrey , Suzuki Taku , Raut Shambika , Montiel Ishino Francisco , Jackson Chandra
Published: May 2024

Introduction:
The prevalence of insomnia symptoms is higher among refugees globally compared to the general population, and poor sleep is a risk factor for poor cardiometabolic health. The resettled Bhutanese refugee community is the third-largest refugee group in the United States (US) and appears to be-based on a few existing studies-particularly susceptible to sleep disturbances such as insomnia symptoms as well as cardiometabolic conditions such as hypertension, and type 2 diabetes. No prior studies have investigated associations between insomnia symptoms and cardiometabolic conditions in this community.

Hypothesis:
We hypothesized that participants reporting insomnia symptoms will have a higher prevalence of cardiometabolic conditions.

Methods:
We used data from the 2021-2022 Bhutanese Community of Central Ohio Health Study (N=495) to examine associations between insomnia symptoms and cardiometabolic health. Insomnia symptoms, measured by self-reports of difficulty falling/staying asleep, were categorized as “not at all,” “sometimes,” and “often/all the time.” A cardiometabolic condition was based on self-reported medical diagnosis/treatment of one or more of the following conditions: hypertension, dyslipidemia, and type 2 diabetes. Poisson regression with robust variance was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of cardiometabolic conditions among participants with insomnia symptoms compared to participants without insomnia symptoms while adjusting for sociodemographic characteristics and body mass index (using criteria for Asians).

Results:
The sample was mainly aged between 18-44 years (69.8%), 51% were male, and most lived in the US for ≥11 years (60.2%). Insomnia symptoms prevalence was 56.4% for “not at all”, 30.7% for “sometimes,” and 12.9% for “often/all the time.” Overall, 12.9% of participants had at least 1 cardiometabolic condition, 10.8% had at least 2 conditions, and 6.3% had all 3 conditions. Compared to not having insomnia symptoms, having insomnia symptoms sometimes was associated with a higher prevalence of type 2 diabetes [PR=2.15, 95%CI: 1.19-3.87], hypertension [PR=1.86, 95%CI: 1.24-2.79], dyslipidemia [PR=1.73, 95%CI: 1.01-2.96], and 1 or more cardiometabolic conditions [PR=1.67, 95%CI: 1.20-2.32]. Similarly, compared to not having insomnia symptoms, having insomnia symptoms often/all the time was associated with a higher prevalence of type 2 diabetes [PR=2.18, 95%CI: 1.04-4.54], hypertension [PR=1.71, 95%CI: 1.06-2.74], dyslipidemia [PR=3.03, 95%CI: 1.67-5.47], and 1 or more cardiometabolic conditions [PR=1.68, 95%CI: 1.15-2.47].

Conclusions:
In conclusion, the burden of both insomnia symptoms and cardiometabolic health conditions were prevalent among the US Bhutanese refugee population, and the insomnia-cardiometabolic health associations were strong.
Abstract P272: Association of Depression and Handgrip Strength With Morbidity and Mortality in Patients With Heart Failure: A Secondary Analysis From a Randomized Controlled Trial
Authors: Lapa Matthew E , Rothenberger Scott D , Jeong Kwonho , Muldoon Matthew F , Belnap Bea , Rollman Bruce L
Published: May 2024

Introduction:
Depression is associated with increased morbidity and mortality in patients with heart failure (HF). Handgrip strength (HGS) is a measure of sarcopenia and lower HGS has been associated with adverse HF outcomes. We hypothesized that relationships between HGS and morbidity and mortality would be moderated by depression in HF patients.

Methods:
We conducted a secondary analysis of patients hospitalized with HF categorized by depression status. We calculated HGS adjusted for body weight and categorized the values into tertiles, from lowest to highest. We fitted Cox proportional hazards models to estimate hazard ratios (HRs) comparing HGS tertiles in relation to 5-year mortality and 1-year readmissions among depressed and non-depressed and tested whether relationships differ by depression status. Models included HGS tertile, depression status, tertile-by-depression interaction, age, sex, race, medical comorbidities, educational attainment, employment, and HF severity.

Results:
A total of 494 patients were included in the analysis (mean age 63.4 ± 13.4 years, 44% female, 26% non-white race). A total of 83% of patients had depression and the mean LVEF (SD) was 27.8% (9.2). At 12-months following the index hospitalization the readmission rate was 56% (275 of 494), and the 5-year mortality rate was 41% (204 of 494). Individuals with higher HGS (tertile 2) were less likely to be readmitted compared to tertile 1 (46% vs. 63%; P=0.013). Depression status significantly moderated the relationship between HGS and readmission such that strong handgrip strength predicted readmission among depressed (adjusted HR of 0.35 (95% CI; 0.16, 0.81) comparing tertile 2 to tertile 1) but not among non-depressed patients (0.77 (0.55, 1.06)). However, the HGS-mortality relationship was not moderated by depression.

Conclusion:
HGS is a predictor of hospital readmission among HFrEF patients, and depression is a moderator of the HGS-readmission relationship. We recommend routinely assessing hospitalized HFrEF patients’ HGS and mood symptoms prior to discharge home, and further research is needed to assess the effects of depression on sarcopenia in its relation to clinical outcomes in HF patients.
Abstract P307: Differences in Cardiovascular Disease Burden, Screening, Education, and Care by Clinic Type in the 2022 Health Center Patient Survey (HRSA)
Authors: King Ben , Attri Sarina , Buck David
Published: May 2024

Background:
Persons experiencing homelessness (PEH) have a 2-3-fold risk for cardiovascular disease (CVD) mortality. Evidence has repeatedly shown elevated chronic disease burden, reduced access to care, and lower utilization of medication to control CVD risk factors in this setting. Migrant communities also experience reduced access to care and the impacts from deferring care. There are targeted, federally-funded health clinics in place for both settings. However, these systems are frequently overwhelmed and limited by their scope of care to primary care. There is scarce evidence on differences between access, quality, and experiences of care delivered relative to other safety-net models.

Method:
The 2022 Health Center Patient Survey (HCPS) was collected on behalf of the Health Resources and Services Administration (HRSA). The HCPS is a nationally-representative, three-staged, sample-based survey collected via 1:1 interviews with clinic patients. The survey assessed sociodemographics, health conditions and behaviors, access to and utilization of care, and patients’ experiences with comprehensive services they received at HRSA-funded health centers, including: community health centers (CHC), healthcare for the homeless (HCH) clinics, migrant health centers (MHC), and public housing primary care (PHPC) clinics. A total of 103 unique awardees and 318 health center sites were recruited, and 4,414 patient interviews were completed. Investigators analyzed patient characteristics and multiple survey items related to AHA’s Essential 8 metrics for differences across clinic type.

Results:
MHC and HCH clinics had fewer elderly patients (~7%) than CHC and PHPC clinics (~17%). There were differences across sex, race, and ethnicity across all four clinic types. Cardiovascular disease history ranged from 4.9% (MHC) to 14.7% (HCH). Reported 7-day physical activity measures, average sleep below 7 hours per day, and Lifetime smoking (>100 cigarettes; OR=4.2, p<0.001) were all greatest among HCH patients. Fewer HCH and MHC patients reported ever having or recent lipid tests (both p<0.001). HCH patients were more likely to report hypertension (p=0.003), but less likely to report receiving nutrition advice (all p<0.05). MHC patients were less likely to be prescribed hypertension medication (p=0.044) and HCH patients were less likely to be taking medication even if it was prescribed (p<0.001). Adjustment for differences in age or CVD history were able to explain some observed differences, but increased the magnitude of other disparities.

Conclusion:
CVD burden differs across the various HRSA funding mechanisms for clinics, as do demographics and multiple metrics of health behaviors and biomarkers of cardiovascular health. Greater disease burden in HCH and MHC patients is likely compounded by increased risk factors and under performance in providing health education interventions.
Abstract P324: Training and Technical Assistance to Improve Hypertension Control in Community Health Centers
Authors: Sanchez Eduardo , Cardoso Celicia , Fiegel Sondi , Harrison Nekeisha , Pena David , Pillai Jan , Ramirez Sonia , Smith Alison , Wagner Ashley
Published: May 2024

Introduction:
About 47% of adults in the U.S. have high blood pressure (BP), a contributing factor to major adverse health conditions including heart attack, heart failure, and stroke. Hypertension has also been linked to worse outcomes from COVID-19 infection, resulting in higher rates of hospitalization and death. In 2021, the AHA launched the National Hypertension Control Initiative (NHCI) in 350 community health centers (CHCs). The 3-year initiative aimed to improve BP control and COVID-19 outcomes through training and technical assistance (T/TA) in CHCs with systematic, multi-sector, culturally sensitive and evidence-based interventions, including self-measured blood pressure (SMBP) monitoring. We hypothesize that T/TA with guideline-directed and evidence-based systematic processes can improve BP control in CHCs.

Methods:
The initiative included complementary components: patient and public education, community outreach and integration, health care professional and organization training, and project management and evaluation. Year one focused on laying a foundation of BP control fundamentals to strengthen knowledge and skills with webinars, office hours, tools, and resources. Years two and three reinforced key concepts, introduced new resources, and provided 1:1 support to CHCs, informed by ongoing evaluation. The adoption of systematic processes with evidence-based and guideline-directed practices were encouraged in CHCs. Recognizing potential differences across CHCs, several T/TA methods were deployed during phases of the initiative in anticipation of evolving CHC needs and readiness. The methods for T/TA include providing a core educational curriculum, developing and distributing customized CHC reports with individualized data, using new and existing resources, including a BP measurement policy and procedure and a BP treatment algorithm, and evaluating methods and practice findings. Early

Results:
Based on UDS data, overall, BP control rates increased in NHCI CHCs from 51.3% to 57.6% (as defined by the performance measure <140/90 mm Hg), demonstrating a 6.3% absolute increase and a 12.3% relative increase from 2020 to 2022. This is compared to all HRSA CHCs, where BP control rates increased from 58.0% to 63.4%, demonstrating a 5.4% absolute increase and a 9.3% relative increase from 2020 to 2022. While all NHCI CHCs started with BP control rates less than 58.9%, some health centers have demonstrated control rates higher than 70%.

Discussion:
T/TA with guideline-directed and evidence-based systematic processes may have contributed to increased BP control rates in CHCs. The degree of CHC progress may have been influenced by challenges and limitations, such as the impact of the COVID-19 pandemic on participation, clinical leadership engagement, CHC team staffing turnover, and technology interoperability.
Abstract P331: Diet and Probiotic Administration Significantly Influence Behavior and Forebrain Inflammation in Male Mice
Authors: Lichti Nathan , Kagel Brian , Westlake Jonathan D , Singh Shreya , Houghton Jeffrey , Gigliotti Joseph
Published: May 2024

There is a high degree of comorbidity between psychological and gastrointestinal disease, which implies a functional relationship exists between the two systems. Collectively, research suggests that the gut-brain axis is bidirectional, and involves complex relationships between immune, neural, endocrine, and metabolic pathways. In this pilot study, we seek to further investigate the microbiome’s role in a bottom-up model by studying the short-term effects of different diets and probiotic supplementation on behavior and the expression of inflammatory biomarkers in the forebrain. Weanling, male C57Bl/6 mice were purchased from a commercial vendor and acclimated to a solid diet for one-week. Mice were randomly assigned to receive one of three diets for eight weeks: chow, the American Institute of Nutrition 1993 formulation (AIN), or our novel Americanized diet (AD). After six-weeks of diet, mice were then administered a commercially available probiotic, or water control, for the final two weeks of the study. Aggressive tendencies were measured during the probiotic administration period and dietary intake was recorded during the final week of the study. Animals were then euthanized and the forebrain was dissected and processed for the quantification of mRNA for
Bdnf
(BDNF),
Nfkb1
(Nf-κb),
Gfap
(GFAP),
Ptgs2
(PTGS2), and
Nr3c1
(NR3C1) by real-time RT-PCR. Data were analyzed using General Linear Model Procedures in SPSS with significance determined at P<0.05. There was a significant decline (P<0.001) in aggressive behavior over the testing period, and mice administered the probiotic tended (P=0.15) to display less signs of aggression regardless of the diet. For dietary intake, there was a numerical increase in daily caloric intake in mice consuming the AD (~13 kcal/day), while mice consuming chow and AIN were similar (9 and 10 kcal/day, respectively). Additionally, there were numerical differences between probiotic and control groups for two of the diets. Quantification of gene expression in the forebrain revealed that diet significantly (P=0.002) affected GFAP expression, with mice consuming chow having significantly lower values than mice fed AIN or AD. Probiotic treatment significantly (P=0.02) affected NF-κB expression, with mice administered the probiotic having greater forebrain NF-kb as compared to control mice. This was most obvious in mice fed the chow and AIN diets, but not the AD. Collectively, our pilot study’s findings suggest that short term probiotic supplementation and dietary variation have potential effects on neuroinflammation, brain function, and satiety. Furthermore, our data indicates that the efficacy of probiotic administration is dependent upon the quality of diet consumed.
Abstract P350: Increased Trunk Fat and Decreased Limb Fat Linked to Elevated Cardiovascular Risk in Hong Kong Chinese Women
Authors: Yang Qingling , Xie Yao Jie , Yang Lin , Hao Chun
Published: May 2024

Introduction:
Despite known links between overall body fat and cardiovascular disease (CVD) risk, the relationship involving regional body fat (arm, trunk, and leg) remains underexplored in Chinese populations. This study examined the associations between overall and regional body fat percentage (BFP) and CVD risk in Hong Kong Chinese women.

Hypothesis:
We hypothesized that higher overall and trunk BFP were associated with increased CVD risk, whereas higher arm and leg BFP predicted decreased risk.

Methods:
This study used baseline data of 3616 women (mean age 56.12±8.51) from an ongoing cohort named ‘MECH-HK’ (Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women). The recruitment was conducted between October 2019 and October 2021. BFP was measured using the bioelectrical impedance analysis device of Inbody 270 model. Framingham 10-Year Risk Score (FRS) was calculated to present the CVD risks. Multivariate linear models were used to estimate the BFP-FRS associations. Potential non-linear relationships were assessed with restricted cubic spline models.

Results:
Mean overall BFP was 32.55%, and regional BFP for arm, trunk and leg were 4.59%, 15.38% and 10.76%, respectively. Non-linear associations between overall BFP and FRS were observed (P for non-linear = 0.03). After adjustment for age, education level, monthly family income, smoking and drinking status, physical activity level, family history of CVD and BMI, the overall BFP was associated with increased FRS (β: 0.04, 95% CI: 0.00 to 0.08, P = 0.03) when overall BFP < 35%. However, no significant association was observed when overall BFP >= 35% (β:-0.07, 95% CI: -0.16 to 0.02, P = 0.13). Higher trunk BFP was associated with increased FRS (β: 0.30, 95% CI: 0.21 to 0.38, P < 0.001), while higher arm (β: -0.69, 95% CI: -0.98 to -0.40, P < 0.001) and leg (β: -0.38, 95% CI-0.50 to -0.25, P < 0.001) BFP were associated with decreased FRS.

Conclusions:
Increased overall (when < 35%) and trunk BFP and decreased arm and leg BFP are associated with elevated CVD risk.
Abstract P372: Behavioral Cardiovascular Health in Children With Chronic Conditions
Authors: Zmora Rachel , Wang Yaojie , Phillips Darci , Chopra Aashima , Marma Amanda M , Lloyd-Jones Donald M , De Ferranti Sarah D , Labarthe Darwin R , Davis Matthew , Petito Lucia , Daniels Stephen R , Rosenman Marc , Narayan Rashmi , Gooding Holly , Pletcher Mark J , Alenghat Francis , Gandhi Rupali , Lefaiver Cheryl , Luff Amanda , Khan Huma , Rios Ileah , Yu Amy , Allen Norrina B
Published: May 2024

Background:
A quarter of children in the United States have at least one chronic condition which translates to worse health than their peers. However, there is little information about cardiovascular health (CVH) among children with chronic conditions.

Methods:
We used data from the Young Hearts study, an ongoing longitudinal cohort of CVH trajectories in youth aged 0-20 years. Parents (and children aged 12+ years) completed surveys on CVH behaviors, medical history, and social context. We included children with complete baseline data. Participants were categorized as having at least one self-reported chronic condition or no chronic condition. We calculated CVH using the behavioral components of the American Heart Association Life’s Essential 8 (diet, physical activity, nicotine exposure, sleep). Each component was scored from 0 (most adverse) to 100 (ideal) and averaged to create a composite behavioral (b) CVH score. We used linear regression to assess the association between chronic condition status (any, none) and bCVH score, adjusting for age, sex, race, ethnicity, insurance type, and household income.

Results:
We identified 1138 children with at least one chronic condition and 1406 children without any chronic conditions. Among those with chronic conditions, the most common were heart disease (14.9%), asthma (11.2%), and vision problems/blindness (9.7%). In fully adjusted models (Table), we found individuals with any chronic condition had a 1.3 point lower (95% CI -2.5, -0.2) bCVH score on average. Children with chronic conditions had lower (less favorable) scores for sleep (-4.2; 95% CI -7.1, -1.4) and physical activity (-3.7; 95% CI -6.3, -1.2) compared to their peers with no chronic conditions, but a higher (more favorable) nicotine exposure score (1.4; 95% CI 0.5, 2.4).

Conclusion:
As a group, children with chronic conditions had worse bCVH scores than their peers without chronic conditions. Further research is needed to understand these differences and support CVH promotion in children with chronic conditions.
Abstract P375: Cardiometabolic Risk Factors and Socioeconomic Status Indices in Young Adults in Latin America: A Systematic Review and Meta-Analysis of Observational Studies
Authors: Buitrago-Lopez Adriana , Pellegrino Baena Cristina , Faria Neto Jose
Published: May 2024

Background:
Metabolic syndrome components in children and adolescents have gained attention in low- and middle-income countries due to variability in their effects and measures across socioeconomic status (SES) determinants. Socioeconomic disparities have been studied related to health, and this fact still poses a serious challenge that raises concerns, especially in low-and middle-income countries, where the classification of the population relies on different determinants from wealthier countries. We conducted a systematic review and meta-analysis to illustrate the effects of measures of metabolic syndrome components across SES in Latin American (LA) young adults.

Methods:
We searched PubMed/MEDLINE, Web of Science, Lilacs (Bireme), Embase and Scopus for LA studies published before September 2023. Included studies were those with participants aged 6-19 years in whom metabolic syndrome (MS) components were analyzed across SES in LA. The quality of observational studies was assessed using the adapted New Castle Ottawa quality tool. Blood pressure, abdominal obesity, body mass index, body fat, glucose levels and insulin resistance data were synthesized, and a random effect model was used to measure the collective effect of overweight/obesity and lipid profile on higher SES levels compared with middle and low SES levels. The protocol of this review was registered with the International Prospective Register of Systematic Reviews database (registration number: CRD42020222378) and was developed following PRISMA statements.

Results:
Sixty-three eligible articles (n=255, 521 participants) from nine LA countries were selected. SES definitions were used in 41 studies from five countries with similar criteria. Obesity and overweight (odds ratio: 1.57, 95% confidence interval: 1.18-1.96) and altered lipid profiles were significantly associated with higher SES compared to lower SES. However, high-density lipoprotein-cholesterol levels were lower in patients with a lower SES. The heterogeneity observed could be explained by age, sex, nutrition patterns, standardized cardiometabolic measures, and temporally collected data due to rapid transitions in LA countries.

Conclusions:
Cardiometabolic components may be associated with higher SES in LA countries. As national SES definitions have been used around LA countries to classify populations, this definition needs to be standardized around LA countries to guide national programs to intensify cardiovascular health and prevent detrimental effects in young people.
Abstract P381: Geographic Variation in Financial Strain and Food Insecurity After the COVID-19 Pandemic: Implications for Cardiovascular Health Equity
Authors: Scott Jewel , Toussaint Ebony , Ellis Charles , Magwood Gayenell S
Published: May 2024

Reduced food security is associated with higher healthcare expenditures and increased risk of coronary heart disease, angina, heart attacks, and hypertension. State-level responses to the COVID-19 pandemic and support policies may contribute to regional differences in financial strain and food insecurity, which could have implications for cardiovascular outcomes.

Hypothesis:
We assessed the hypothesis that there is geographic variation in financial strain and food insecurity in the United States three years after the start of the pandemic.

Methods:
This study utilizes weighted data from the U. S. Census Bureau’s Household Pulse Survey Phase 3.10 conducted from August 23 - September 4, 2023. We organized data responses according to the Department of Health and Human Services regions - Boston, New York, Philadelphia, Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco, and Seattle. Food insecurity was measured using a single survey item about having sufficient food to eat in the last 7 days. Financial strain was defined as difficulty paying expenses in the last seven days.

Results:
There were 254,966,752 adults in the total sample population, (59%) reported difficulty with expenses due to the COVID-19 pandemic. The Atlanta region reported the most financial strain (13%), while the Denver region reported the least (2%), p-value=0.000. The rate of food insecurity was highest in the Atlanta region at 8% compared with 5% or less in other regions, p-value=0.000. Among the 8 states in the Atlanta region, Black individuals were disproportionately more likely to be food insecure, with the greatest difference for Kentucky, Florida, Tennessee, and South Carolina. All states in the Atlanta region had similar odds of food insecurity, but Mississippi residents were nearly twice as likely to experience food insecurity than residents of other states (OR 1.87, p =0.016).

Conclusions:
The Atlanta region (i.e., the “Deep South”) consists of the most populous states for non-Hispanic Black people and is experiencing the worst food insecurity and financial strain post-pandemic. The economic toll of the pandemic and post-pandemic inflation may contribute to worsening food insecurity and cardiovascular outcomes in a region that is already burdened by poor cardiovascular health. Multilevel intervention is needed to support full pandemic recovery and avoid exacerbating inequities in cardiovascular disease.
Abstract P393: Trends in Risk Factor Control Among US Adults With Cardio-Kidney-Metabolic Multimorbidity, 1999-2020
Authors: Ostrominski John W , Hirsch Jamie , Miao Benjamin , Donato Bonnie M , Woolley Jonathan , Parrinello Christina , O'Connell Thomas , Vaduganathan Muthiah
Published: May 2024

Background:
Risk factor control is foundational to preventing the onset and progression of cardiovascular, kidney, and metabolic (CKM) syndrome. Although risk factor control has been evaluated for these conditions individually, less is known about individuals with CKM syndrome.

Objective:
To evaluate the control of key risk factors among US adults with CKM syndrome.

Methods:
Nationally representative, cross-sectional data on US adults from the 1999-2020 NHANES cycles were evaluated. CKM conditions included cardiovascular disease (ASCVD or HF), at least moderate-risk chronic kidney disease, and type 2 diabetes (self-reported or HbA1c ≥6.5%). Among adults with advanced-stage CKM syndrome (≥2 conditions), the proportion with joint control of risk factors was estimated. Risk factor control was defined as: BP <140/90 mmHg, HbA1c <8%, and LDL-C <100 mg/dL. Sensitivity analyses included a stricter definition (BP <130/80, HbA1c <7%, and LDL-C <70) and an expanded set of risk factors (BMI <30 kg/m
2
and current non-smoking status).

Results:
Between 1999-2014, the proportion of US adults with CKM syndrome with joint control of BP, HbA1c, and LDL-C increased from 10.5% (95% CI: 7.8%, 13.2%) to 32.5% (29.6%, 35.5%), then declined to 28.8% (24.4%, 33.1%; estimated number without joint control = 14.5 million) in 2015-2020, per the main definition (
Figure
). Considering more contemporary thresholds, joint risk factor control was observed in less than 1 in 10 US adults across the study interval. Using the most comprehensive definition (BP <130/80, HbA1c <7%, LDL-C <70, BMI <30, non-current smoking) only 2.2% (1.3%, 3.1%) demonstrated optimal control in 2015-2020.

Conclusions:
Despite improvement between 1999-2014, comprehensive risk factor control among US adults with CKM syndrome declined in 2015-2020. More than 2 in 3 contemporary US adults with CKM syndrome are estimated to have suboptimal risk factor control, amplifying the need for integrative approaches in this high-risk population.
Abstract P409: Maternal Macronutrient Intake at Pregnancy and Offspring Growth Trajectory Before Adulthood: A Prospective Analysis in the Growing Up Today Study 2 Cohort
Authors: Sheng Chen , Liu Binkai , Chavarro Jorge , Hart Jaime E , Wang Molin , Sun Qi
Published: May 2024

Background:
Childhood obesity has become a public health challenge globally, with increasing prevalence worldwide. Existing studies have indicated a potential link between maternal macronutrients intake and subsequent weight changes in their offspring during childhood. However, the long-term relationship between maternal macronutrient consumption at pregnancy and the growth trajectory of offspring into adulthood remains unclear.

Objectives:
We aim to investigate the relationship between maternal macronutrients intake at pregnancy and the trajectory of the offspring BMI z-score, as well as the risk of becoming overweight or obese before adulthood.

Method:
We included 5,700 children from the Growing Up Today Study 2 born to 4,697 mothers who participated in the Nurses’ Health Study II . Diet was assessed using a validated food frequency questionnaire in 1991 approximately during or before the pregnancy at issue. Age- and gender-specific BMI thresholds described by the International Obesity Task Force were used to define overweight and obesity in childhood and adolescence. Multivariable linear and log-binomial regression models with generalized estimating equations were used to evaluate the association between maternal macronutrients intake at pregnancy and offspring BMI z-score trajectory and the risk of overweight or obesity.

Results:
During follow-up, 2145 (37.6%) GUTS2 participants met the criteria of overweight or obesity.After multivariate adjustment for maternal, offspring risk factors, total maternal total energy and carbohydrate percent energy, comparing to the 1
st
quartile, the highest quartile of total protein consumption at pregnancy was associated with 0.14-unit [β: 0.14 (95% CI: 0.02, 0.26; P-trend = 0.03)] increase in BMI z-score, while no significant association was observed for the risk of offspring overweight or obesity [RR: 1.17 (95% CI: 0.94, 1.46; P-trend = 0.12)]. The relationship persisted for the top quartile of animal protein energy intake [β: 0.14 (95% CI: 0.01, 0.27; P-trend = 0.03)], but not for vegetable protein consumption. Intakes of dietary fats and carbohydrates were not associated with BMI z-score or risk of overweight or obesity. Furthermore, individual macronutrient subgroups, such as saturated fats, mono- and poly-unsaturated fats, or whole grains and refined grains, were not associated with the outcomes of interest, either.

Conclusion:
Maternal animal protein intake at pregnancy is positively associated with higher offspring BMI z-score before adulthood, but not the risk of developing overweight or obesity during childhood. Other macronutrients are not significantly associated with these childhood body weight outcomes. Overall, these data suggest that the macronutrient composition of maternal diet at peri-pregnancy period has minimal impact on offspring body weight in this well-nourished population.
Abstract P411: Child Opportunity and Behavioral Cardiovascular Health in Youth: The Young Hearts Study
Authors: Yu Amy , Chopra Aashima , Zmora Rachel , Phillips Darci , Marma Amanda M , Wang Yaojie , Rios Ileah , de Ferranti Sarah , Labarthe Darwin R , Davis Matthew M , Petito Lucia , Daniels Stephen R , Rosenman Marc , Narayan Rashmi , Gooding Holly , Pletcher Mark J , Alenghat Francis , Gandhi Rupali , Lefaiver Cheryl , Luff Amanda , Khan Huma , Lloyd-Jones Donald M , Allen Norrina B
Published: May 2024

Background:
Low cardiovascular health (CVH) in childhood is linked to risk of cardiovascular events in adulthood in the US. Relationships between neighborhood characteristics could be important for CVH in children, as appears to be the case in adults. We sought to assess such associations, representing neighborhood characteristics by the Child Opportunity Index (COI) and using a composite behavioral CVH score in youth.

Methods:
We used baseline data from the Young Hearts study, which is studying CVH trajectories of children ages 0-20. We linked children’s addresses to the COI, with domains encompassing: (1) social and economic, (2) health and environmental, and (3) educational opportunity. CVH behaviors were defined using the Life’s Essential 8 framework and included: self-reported diet, physical activity, nicotine exposure, and sleep. Linear regression models assessed the association between COI and overall and component behavioral CVH scores after adjustment for child demographics, family SES, and moves in the last year. Overall CVH scores comprised of the mean value of 4 behavior-specific scores (each 0-100 points).

Results:
Participants (N=2202) were 9.5±5.4 years old; 46.3% were female, and 47.05% identified as non-Hispanic White, 25.3% as Hispanic, and 17.9% as non-Hispanic Black. Compared with high (favorable) COI, individuals with low COI had a 2.15-point lower (worse) mean behavioral CVH score (p=0.003); however, those with moderate COI did not have significantly lower mean scores. The pattern for the education domain was similar but weaker. In the social and economic domain, those with low and moderate COI both had lower behavioral CVH scores than those with high COI. The health and environment domain was not independently associated with CVH. Of individual metrics, only sleep scores (beta=68.32, p=0.005) were independently associated with COI after adjustment.

Conclusion:
COI, especially social and economic factors, were associated with overall behavioral CVH among a diverse population of children.
Abstract P422: Lifestyle Intervention Improved Blood Pressure and Cardiovascular Disease Biomarkers in Patients With Chronic Kidney Disease and Resistant Hypertension: Insights From the TRIUMPH Randomized Clinical Trial
Authors: Tyson Crystal C , Sherwood Andrew , Hinderliter Alan L , Smith Patrick J , Mabe Stephanie , Craighead Linda , Watkins Lana L , Lin Pao-Hwa , Kraus William E , Blumenthal James A
Published: May 2024

Introduction:
Evidence is limited regarding the effect of lifestyle modification on health outcomes in patients with chronic kidney disease (CKD).

Hypothesis:
We hypothesized that lifestyle modification involving the DASH diet, exercise and weight loss would improve blood pressure (BP) and cardiovascular disease (CVD) biomarkers in CKD patients with resistant hypertension.

Methods:
The Treating Resistant Hypertension Using Lifestyle Modification to Promote Health (TRIUMPH) trial randomized patients with resistant hypertension to either a 16-week cardiac rehabilitation (CR) facility-based lifestyle modification program involving thrice weekly aerobic exercise and weekly classes on DASH diet and behavioral weight loss (C-LIFE) or to a standard education and physician advice (SEPA) control condition. We conducted a secondary analysis involving participants with CKD. CKD was defined as having eGFR <60 mL/min/1.73 m
2
or albuminuria at baseline. Primary outcome was mean change in clinic systolic BP. Secondary outcomes were mean changes in clinic diastolic BP, 24-hour ambulatory BP, and CVD biomarkers including baroreflex sensitivity (BRS), high-frequency heart rate variability, flow-mediated dilation, pulse wave velocity, and left ventricular mass index.

Results:
Ninety-seven (69%) of 140 TRIUMPH participants were considered to have CKD. Mean age was 62 years, 57% self-identified as Black race, 67% were male, and the majority (82%) had CKD stage 3. Participants with CKD randomized to C-LIFE achieved greater reduction in clinic SBP and greater improvement in BRS compared to SEPA. There were no differences between groups in ambulatory BP or other CVD biomarkers.

Conclusions:
A structured 16-week diet, exercise and weight management program conducted in a CR setting improved BP and resting BRS in resistant hypertension patients with CKD. Future studies are needed to confirm the beneficial effect of multi-component lifestyle modification on CVD biomarkers in CKD and to determine the persistence of benefit over time.
Abstract P430: Waist Circumference is a Key Predictor of Beta-Cell Function in Lean Rwandans With New-Onset Type 2 Diabetes Mellitus
Authors: MUGENI REGINE , Nishimwe Aurore , Smith Gordon I , Sumner Anne , Cade William T , Bushaku Marcus , Reeds Dominic N
Published: May 2024

Introduction:
Type 2 diabetes mellitus (T2D) is common in Rwanda and other middle and low-income countries. Unlike high-income countries, T2D is prevalent in lean people; the reasons for this are unclear but may relate to abdominal obesity. Therefore, we examined the impact of waist circumference (WC) on insulin-resistance (IR) and insulin secretion rate (ISR) in lean, (BMI <25kg/m
2
) Rwandan adults with and without new-onset (<1yr) T2D.

Hypothesis:
We hypothesized that Rwandans with T2D and normal WC would have a lower ISR than both people with T2D and elevated WC and healthy people but that ISR would not be different between Rwandans with T2D and elevated WC and healthy people.

Methods:
BMI, WC, and a 3-hour frequently-sampled oral-glucose tolerance-test (fsOGTT) were performed in 23 Rwandans; 15 with T2D and 8 healthy people. Normal WC was defined as <85cm for women and <90cm for men (>75
th
%ile of group). ISR was determined by mathematical-modeling. Groups were compared by Student’s t-test and ANOVA.

Results:
Groups were well matched; glucose area under the curve (AUC) was greater and insulinogenic-index was lower in T2D overall than healthy people (Table 1). ISR area under the curve (ISR-AUC) was not different between T2D and healthy people. In contrast, Rwandans with T2D and normal WC had an ISR-AUC ~2.5 fold lower than Rwandans with T2D and elevated WC (P<0.001). Matsuda index and HOMA were greater in Rwandans with T2D and elevated WC than healthy people (P=0.09, P=0.07 respectively).

Conclusions:
In lean Rwandan people with new-onset T2D but normal WC, alterations in insulin secretion rather than insulin-resistance are key drivers of hyperglycemia. In T2D with elevated WC, IR rather than insulin secretion may be a major factor. This suggests that the pathogenesis of T2D differs based on WC in Rwanda with implications for prevention and therapy.

Table 1.
Subject Characteristics * P<0.05 vs corresponding value in other groupA, P<0.05 and B, P=0.07 vs corresponding value in other group when comparing on basis of WC.
Abstract P440: Antagonism of Thromboxane-Prostanoid Receptor Attenuates Alcohol-Induced Myocardial Inflammation
Authors: Ai Weilun , Casey Carol , Mishra Paras K , Saraswathi Viswanathan
Published: May 2024

Heavy alcohol use is the leading etiology of non-ischemic dilated cardiomyopathy. Alcohol-Associated Cardiomyopathy (ACM) is a specific cardiac muscle disease which is characterized by inflammation, abnormal fatty acid metabolism, and oxidative stress. TP-R, a G-protein coupled receptor, is widely expressed in the myocardium, and plays a critical role in the pathogenesis of various cardiac diseases including hypertensive heart disease and dilated cardiomyopathy. TP-R is activated by thromboxane A2 (TXA2) and 8-isoprostane. Of note, clinical studies have shown that chronic alcohol use markedly increases the level of thromboxane B2, a stable metabolite of TXA2, in plasma of alcohol use disorder patients. However, the role of TP-R signaling in the pathogenesis of ACM remains unclear. Therefore, we hypothesize that TP-R signaling mediates adverse effects of alcohol on the myocardium. To test this hypothesis, we used the chronic plus binge ethanol feeding model. C57BL/6 wild-type male mice (8-week) were fed with Lieber-Decarli ethanol (5% v/v) diet (ET, n = 10) or isocaloric control diet (CON, n = 6) for ten days followed by single binge of ethanol or maltose-dextrin via oral gavage. A cohort of ethanol-fed mice received SQ 29,548, a TP-R antagonist (ET+SQ, n = 8). Our data indicated that mouse myocardial protein levels of thromboxane A2 synthase (TBXAS1,
P
<0.001), an enzyme responsible for synthesis of TXA2, was increased in response to ethanol exposure. Concomitantly, ethanol-fed mice displayed upregulated myocardial protein levels of pro-inflammatory mediators including tumor necrosis factor alpha (TNF-α,
P
<0.001) and secreted interleukin 1 beta (IL1β,
P
<0.001) compared with their controls. These adverse alterations induced by the ethanol diet were ameliorated by the pharmacological inhibition of TP-R. Interestingly, RNA-sequencing and western blotting analysis showed that expression of thioredoxin-interacting protein (TXNIP) was upregulated in response to ethanol exposure (
P
<0.001). Meanwhile, mice fed with ethanol diet had the increased myocardial protein level of NLR family pyrin domain containing 3 (NLRP3,
P
<0.01) compared with CON mice. These ethanol-induced increases in protein levels of TXNIP (
P
<0.001) and NLRP3 (
P
<0.01) were attenuated due to SQ 29,548 administration. Accordingly, these findings lead us to suggest that pharmaceutical inhibiting TP-R has protective effects on attenuating ethanol-induced myocardial inflammation by inhibiting TXNIP-NLRP3-IL1β axis.
Abstract P441: Alcohol Consumption and Incident Heart Failure, Ischemic Heart Disease and Atrial Fibrillation Among Current Drinkers: The All of Us Research Program
Authors: Bene-Alhasan Yakubu , Osei Albert D , Mensah Samuel , Mishal Ejaz , Akhiwu Ted , Yeboah-Kordieh Yvette , Djousse Luc , Mukamal Ken J
Published: May 2024

Background:
The Alcohol Use Disorders Identification Test (AUDIT-C) is a clinically validated assessment tool with components that quantify last-year frequency of alcohol use, quantity consumed per drinking day and frequency of binge drinking. We determined the associations between AUDIT-C scores, their components and risks of heart failure (HF), ischemic heart disease (IHD) and atrial fibrillation (AF).

Methods:
In the NIH-sponsored ‘All of Us’ Research Program, we followed participants free of HF, IHD and AF who had consumed alcohol in the past year. We created Cox proportional hazards models for incident HF, IHD and AF that simultaneously adjusted for all 3 components of the AUDIT-C, sociodemographic factors, prevalent diseases and smoking status. We also created restricted cubic splines (RCS) regression models to determine the dose-response relationships between AUDIT-C scores and incident HF, IHD and AF.

Results:
The final sample size was 133,025 adults with a mean age of 50 years. There were 1,411 HF, 3793 IHD and 1072 AF cases over a median follow-up of 45 months. RCS demonstrated a J-shape association between total AUDIT-C scores and HF, an L-shaped association with IHD and a positive but non-significant association with AF. For AUDIT-C components, frequency of intake was associated with incident HF and IHD. Compared to drinking monthly or less, drinking 2-4 times/month, 2-3 times/week and 4 or more times per week were all associated with lower risk of incident IHD. Drinking 2-4 times/month and 2-3 times/week were negatively associated with incident HF. We observed no comparable associations of drinking quantity or binge drinking with risk of HF, IHD or AF.

Conclusion:
The AUDIT-C provides a quick, straightforward, and informative assessment of alcohol consumption. Among current drinkers, drinking frequency is associated with lower risk of HF and IHD but not AF. Greater quantity consumed per drinking day and episodes of binge drinking are not associated with lower risk of major cardiac diseases and should be discouraged.
Abstract P448: Urban Trail Infrastructure and Physical Activity Levels: A Systematic Review and Meta-Analysis of Natural Experiments
Authors: Fast Isaak D , McGavock Jonathan , Steiman De Visser Hannah , Nashed Christie , Lötscher Jack
Published: May 2024

Background:
In response to climate change, cities across Canada are investing over $1B in new cycling infrastructure to support more active transportation. Little empirical evidence exists describing the effectiveness of adding protected cycling trails on changes in cycling or physical activity (PA) levels.

Hypothesis:
We hypothesized that areas with new infrastructure would experience increased PA and trail use by cyclists and pedestrians compared to areas without new infrastructure.

Design and Methods:
We searched CINAHL, EMBASE (Ovid), MEDLINE (Ovid), SPORTDiscus, TRD/Transportation Research Information Services (TRIS), Web of Science and Google Scholar for articles published from 2010 to 2023. We included studies with an experimental pre-post design that reported a PA outcome or trail counts for an intervention and control area. The interventions were limited to protected and/or separated bike lanes, including cycle tracks, multi-use trails, greenways, and bike lanes with concrete barriers. Our primary outcomes were individual level physical activity (PA) and trail use counts (cyclists and pedestrians). A modified risk of bias tool will be employed to assess the methodological quality of each selected study. We followed PRISMA reporting guidelines and the review was pre-registered with Prospero (CRD42023438891)

Results:
Three independent reviewers screened abstracts from 3936 articles, of which 58 were included in a full text review. After resolving conflicts, 28 articles describing natural experiments of new cycling infrastructure met eligibility criteria were included for data extraction. We extracted data for population characteristics in both intervention and control areas, such as socioeconomic status, mean age, race, and the percentage of females, as well as outcomes related to physical activity. 1/28 papers used accelerometer data, 12/28 used survey data, 3/28 used eco counter data, 2/28 used manual counters. Of the 15 studies that reported it, sample size ranged from 70 to 21,488. Due to high variance in data reporting style, not all studies could be meta-analyzed. We found a high risk of bias for all natural experiments studies and very few adhered to TREND reporting guidelines for quasi-experimental studies.

Conclusions:
Changes in built environment preliminarily appear to increase cycling and pedestrian counts. Reporting style varies too greatly across research studies for an effective meta-analysis. As a scientific community, we need to work together to follow reporting standards.