bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP02: Quantifying The Impact Of Maintenance And Changes Of Lifestyles On Risk Of Cardiovascular Disease And All-cause Mortality - The Doetinchem Cohort Study
Authors: Hulsegge Gerben , Daviglus Martha L , van der Schouw Yvonne T , Smit Henriëtte A , Verschuren W M
Published: July 2021

Background:
It is not fully understood to what extent changes in lifestyle over time influence the risk of cardiovascular disease (CVD) and death among healthy adults, since most studies assessed lifestyle at a single point in time.

Objective:
To investigate the association of maintenance and changes in lifestyle profiles over 5 years with risk of CVD and all-cause mortality.

Methods:
Healthy lifestyle factors (HLF), i.e., healthy diet, physically active, not smoking, moderate alcohol consumption, sufficient sleep duration, and normal weight were assessed among 5,290 CVD- and cancer-free adults aged 25-65 years in 1993-1997 (baseline examination). Participants were categorized as having unhealthy (0-2 HLF), moderately healthy (3-4 HLF), or healthy (5-6 HLF) lifestyles. They were subdivided as maintained, improved, or deteriorated HLF 5 years later (1998-2002). Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95%CI) for combined fatal and non-fatal CVD and all-cause mortality following the risk-change period were estimated using Cox proportional hazards models.

Results:
Individuals who maintained their HLF had 62% lower risk of CVD (HR: 0.38, 95%CI: 0.23-0.64) (Figure 1) and 54% for all-cause mortality (HR: 0.46, 95%CI: 0.27-0.77) than those who maintained unhealthy lifestyles. In general, compared to maintenance of HLF, improvement and deterioration of HLF were associated with better or worse HRs than their baseline risks for CVD and all-cause mortality, respectively.

Conclusion:
Maintenance of a healthy lifestyle is associated with significant and independent low risk of CVD and all-cause mortality. Effort is needed to improve the adoption and maintenance of a healthy lifestyle.
Abstract MP07: Increased Risk of Death in Individuals with Premature Atrial, but not Premature Ventricular Contractions on Screening Electrocardiogram
Authors: Shah Amit J , Li Yabing , Solman Elsayed Z
Published: July 2021

Introduction:
Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) detected by long-term electrocardiographic recording have been found to be a marker of increased cardiovascular risk. However, the prognostic significance of PACs and PVCs detected by routine 12-lead screening electrocardiogram (ECG) is not well-established.

Methods:
We investigated the association between PACs and PVCs detected by a single 12-lead ECG with the risks of death from any cause, cardiovascular (CVD) disease, and ischemic heart disease (IHD) in a nationally representative, community-dwelling cohort of 7642 individuals enrolled in the Third Health and Nutrition Examination Survey (NHANES III). Individuals with known coronary artery disease, congestive heart failure, paced rhythms, and atrial fibrillation were excluded.

Results:
Mean age was 60 (± 14) years, 53% were women, 24% were non-Hispanic black, and 23% were Hispanics. PACs were detected in 94 (1.2%) participants while PVCs were detected in 114 (1.5%). Over a follow up period of up to 18 years, the death rates per 1000 person-years were 97, 40, and 21 for all-cause, CVD, and IHD deaths, respectively. In a demographic adjusted model, presence of PACs was associated with 50%, 78% and 151% increased risk of all-cause death, CVD death, and IHD death, respectively. After further adjustment for CVD risk factors, ECG abnormalities, concomitant comorbidities and potential confounders, these risks remained significantly high (Table). For PVCs, however, no significant associations with any type of deaths in any model were detected.

Conclusion:
PACs, but not PVCs, on routine screening ECG are predictive of adverse events in community-dwelling individuals without known heart disease. Given the low cost and widespread use of 12-lead ECG, these findings warrant further investigation into mechanisms and interventions.
Abstract MP12: Dietary Fatty Acids and Risk of Incident Atrial Fibrillation in the Women’s Health Study
Authors: Chiuve Stephanie E , Sandhu Roopinder K , Moorthy M. V , Glynn Robert J , Albert Christine M
Published: July 2021

Background:
Atrial fibrillation (AF) is the most common cardiac arrhythmia and a major risk factor for stroke, heart failure and mortality. Dietary fats may have effects on biologic pathways involved in inflammation, fibrosis, and cellular electrophysiology that influence the development and maintenance of AF. Prior studies evaluating the relationship between N-3 polyunsaturated fats and total AF events have had inconsistent results. Furthermore, few studies have reported the association between other dietary fats and incident AF or whether associations might differ by AF pattern.

Methods:
We followed 33,041 initially healthy women from the Women's Health Study, who were >45 years and free of AF at baseline in 1993. Intake of individual fats was calculated from a food frequency questionnaire administered at baseline. Self-reported AF was confirmed by EKG and medical record review. We defined AF patterns as paroxysmal (self-terminating for <7 days and no cardioversion), persistent (sustained >7 days and/or required cardioversion) and chronic (cardioversion failed / not attempted). Patterns were classified according to the most severe pattern within 2 years of AF onset and we combined persistent and chronic AF for analysis. We used isocaloric multivariable Cox proportional hazards models, adjusting for diet, lifestyle and clinical CVD risk factors, with a competing risk framework to evaluate whether dietary fats share equal associations across various AF patterns.

Results:
We documented 1286 cases of AF (821 paroxysmal & 423 persistent/chronic) over a median follow-up of 17.4 years. There was no significant association between any dietary fat and risk of incident AF. Saturated fat was associated with higher risk, and monounsaturated fat with lower risk of persistent/chronic AF. The RR (95%CI) for a substitution of 5% of energy from saturated fat for an equal percentage of energy from carbohydrates was 1.47 (1.02, 2.12) for persistent/chronic AF and 0.84 (0.64, 1.10) for paroxysmal AF (p, diff = 0.01). For monounsaturated fat, the RR for a 5% increment was 0.67 (0.45, 0.98) for persistent/chronic AF and 0.86 (0.73, 1.27) for paroxysmal AF, although the difference between patterns did not reach significance (p, diff = 0.12). Intake of N-3 and n-6 polyunsaturated fat and trans fat were not differentially associated with risk of paroxysmal or persistent/chronic AF.

Conclusions:
We observed no association between subclasses of dietary fat intake and total AF risk. Saturated fat was positively and monounsaturated fat was inversely associated with risk of persistent/chronic AF. Thus, improving dietary fat quality may help in the prevention of sustained forms of AF, which are often less amenable to treatment and associated with higher rates of morbidity. These results support AHA dietary guidelines to decrease intake of saturated fat for overall cardiovascular health.
Abstract MP15: Single And Joint Associations Of Genetic Variants In The Serum/glucocorticoid Regulated Kinase (sgk) Genes With Blood Pressure Responses To Sodium Intake: The Gensalt Study
Authors: Li Changwei , Yang Xueli , He Jiang , Hixson James E , Gu Dongfeng , Rao Dabeeru C , Jaquish Cashell E , Rice Treva K , Liu De-Pei , Shimmin Lawrence C , Huang Jianfeng , Lu Fanghong , Cao Jie , Chong Shen , Lu Xiangfeng , Kelly Tanika N
Published: July 2021

Background:
Serum and glucocorticoid regulated kinase (SGK) plays a critical role in the regulation of renal sodium transport. We examined the association between SGK genes and salt sensitivity of blood pressure (BP) using single-marker and gene-based association analyses.

Methods:
A 7-day low-sodium (51.3 mmol sodium/day) followed by a 7-day high-sodium intervention (307.8 mmol sodium/day) was conducted among 1,906 Chinese participants. BP measurements were obtained at baseline and each intervention using a random-zero sphygmomanometer. Additive associations between each SNP and salt-sensitivity phenotypes were assessed using a mixed linear regression model to account for family dependencies. Gene-based analyses were conducted using the truncated p-value method. The Bonferroni-method was used to adjust for multiple testing in all analyses.

Results:
In single-marker association analyses, SGK1 marker rs2758151 was significantly associated with diastolic BP (DBP) response to high-sodium intervention (P=0.0010). DBP responses (95% confidence interval) to high-sodium intervention for genotypes C/C, C/T, and T/T were 2.04 (1.57 to 2.52), 1.79 (1.42 to 2.16), and 0.85 (0.30 to 1.41) mmHg, respectively. Similar non-significant trends were observed for SBP and MAP responses (P=0.15 and 0.0026, respectively). In addition, gene-based analyses demonstrated significant associations between SGK1 and SBP, DBP and MAP responses to high sodium intervention (P=0.0002, 0.0076, and 0.00001, respectively). Neither SGK2 nor SGK3 were associated with the salt-sensitivity phenotypes in single-maker and gene-based analyses.

Conclusions:
The current study identified single-marker and gene-based association of the SGK1 gene and BP salt-sensitivity in the Han Chinese population. Further studies are warranted to identify causal SGK1 gene variants.
Abstract MP18: Estimating Coronary Mortality Reductions By Shifting The Population Blood Pressure Distribution Or By Improving The Management Of Hypertensive Patients
Authors: Guzman Castillo Maria , O'Flaherty Martin , Couch Philiph , Lloyd Stephen , Sperrin Matthew , Soiland-Reyes Claudia , Green Benjamin , Buchan Ian , Capewell Simon
Published: July 2021

Introduction:
Hypertension is an important risk factor for coronary heart disease (CHD) in the UK and US. Although CHD death rates are falling, a large proportion of hypertensive patients are poorly controlled and population salt intake, a major determinant of hypertension, remains well above the recommended daily maximum of 6g/day.

G. Rose identified two strategies to reduce CHD mortality. The first proposes that small, but population-wide, reductions in systolic blood pressure (SBP), achieved by public health measures to reduce salt intake, will deliver large reductions in mortality. The second seeks to reduce mortality by treating hypertensive patients and keeping them below a given risk-threshold.

Here we explore the potential to reduce CHD deaths through a combination of these strategies in England and Wales up to 2030.

Methods:
We used the Stock of Health (SoH) model assuming each individual is born with a SoH, and on an annual basis this stock depreciates due to demographic factors, and fixed and variable risk factors. When the individual’s SoH reaches a critical point, a death from CHD occurs.

The model parameters were calibrated using data from the US Cardiovascular Lifetime Risk Pooling Project. Births, deaths and risk factors distributions were estimated using data from England and Wales (ONS).

We modelled a baseline scenario, three population-level strategies and two high-risk strategies. The population level strategies to reduce SBP were: (1) a reduction of 0.1 mmHg achievable by health promotion or labelling strategies, (2) a reduction of 1.3 mmHg achievable by mandatory reformulation and (3) matching England and Wales SBP levels to the observed values in the US population (average reduction:7 mmHg). In the high-risk strategies, 30% and 50% of the currently uncontrolled hypertensive patients respectively are treated to keep their SBP under 140 mmHg.

Results:
In the baseline scenario, the total number of CHD deaths from 2013 to 2030 will be approximately 465,000 (95% CI 460,308 to 469,334). We predict 1,244 (95% CI -3,320 to 5,807) fewer deaths by health promotion; approximately 16,203 (11,691 to 20,718) fewer deaths by mandatory reformulation of foods and some 78,051 (74,016 to 82,087) fewer deaths by reducing SBP levels to the observed levels in US. Conversely, by controlling the SBP of 30% and 50% of uncontrolled hypertensive patients, we predict 4,594 (6 to 9,191) and 7,172 (6,473 to 11,767) fewer deaths respectively.

Conclusion:
Both risk-targeted treatment strategies and population shifts attributable to salt reduction appear to provide potential substantial contributions to reducing CHD mortality in England and Wales. There remains, however, considerable potential to achieve much greater reductions in mortality by reducing SBP levels to those seen in the US.
Abstract MP22: Vitamin D and Subclinical Cerebrovascular Disease: The Atherosclerosis Risk in Communities (ARIC) Brain MRI Ancillary Study
Authors: Schneider Andrea L , Carson Kathryn A , Lutsey Pamela L , Xing Li , Alonso Alvaro , Sharrett A R , Coker Laura , Gross Myron , Post Wendy S , Mosley Thomas H , Gottesman Rebecca F , Michos Erin D
Published: July 2021

Introduction:
Vitamin D deficiency has been associated with incident clinical stroke. Less is known about the association of vitamin D levels, measured by 25-hydroxyvitamin D [25(OH)D], with subclinical cerebrovascular disease.

Hypothesis:
We hypothesized that lower levels of 25(OH)D would be associated both cross-sectionally and longitudinally with subclinical cerebrovascular disease, defined by white matter hyperintensities (WMHs) and infarcts on brain magnetic resonance imaging (MRI).

Methods:
We conducted cross-sectional (1993-1995) and longitudinal (1993-1995 to 2004-2006) analyses of 1,622 participants in the ARIC Brain Ancillary Study with measured 25(OH)D (1993-1995) and without a history of clinical stroke/TIA. These participants underwent a brain MRI in 1993-1995 and a subset underwent a second brain MRI in 2004-2006 (n=888). 25(OH)D measurement was repeated in a subset of blacks in 2004-2006 (n=404). 25(OH)D was analyzed in race-specific quartiles and continuously. Brain MRIs were scored for WMHs and infarcts. Adjusted race-stratified linear and logistic regression models were used.

Results:
Mean age of participants was 62 years, 60% were female, and 49% were black. Mean 25(OH)D was higher in whites than blacks (25.6 versus 17.3 ng/ml, p0.05). In prospective analyses, lower 25(OH)D levels were also not significantly associated with change in WMH volume or with incident infarcts (Table). In the subset of blacks with repeated measures of 25(OH)D, there was no association between change in 25(OH)D levels with incident infarcts on brain MRI over 10 years (OR [per 1 SD decrease in 25(OH)D]: 1.30, 95% CI: 0.94, 1.81).

Conclusion:
25(OH)D was not significantly associated with WMHs, subclinical infarcts, or their progression on serial brain MRIs obtained approximately 10 years apart, suggesting that 25(OH)D levels are not associated with subclinical cerebrovascular disease.
Abstract MP28: Heart Rate At Hospital Discharge Is Associated With Adverse Long Term Outcomes In Patients With Heart Failure
Authors: Alomari Ihab B , Zhao Xin , Hernandez Adrian F , Eapen Zubin J , Fonarow Gregg C , Yancy Clyde W , Heidenreich Paul A , Bhatt Deepak L , Laskey Warren K
Published: July 2021

Background:
Heart rate (HR) has been identified as a risk factor for adverse long-term outcomes in patients with and without heart disease. However, the relationship between discharge HR and outcomes in patients receiving guideline based therapy for HF remains unknown.

Hypothesis:
Heart rate at hospital discharge in patients with HF is an independent predictor of mortality and readmission rates at 1 year.

Methods:
Using the American Heart Association Get With The Guidelines Heart Failure national quality assurance registry linked with Medicare data, long term outcomes for patients ≥65 years of age hospitalized from 2005-2011 were obtained. Univariable and multivariable analyses were performed to examine the relationship between 1-year outcomes (death or all cause readmission) and discharge HR. Heart rate was analyzed as a categorical (tertiles) or continuous variable. Crude and adjusted odds ratios and 95% confidence intervals for the association between discharge HR and the risk of death or hospitalization by 1-year were obtained from logistic regression modeling.

Results:
The analysis sample was comprised of 45,672 patients with a valid link to Medicare data and 1 year outcome status. The mean age was 80 ±8 years; % male was 45.7; and the mean ejection fraction was 43.5 ±16. Median discharge HRs for the first, second and third tertiles significantly differed (61, 72 and 87 bpm, respectively, p <0.0001). In univariable and multivariable analyses adjusted for clinical and hospital level variables there was a statistically significant relationship between 1 year outcomes and discharge HR (Table).

Conclusion:
In hospitalized patients with HF, HR at the time of discharge is an independent predictor of mortality. Despite optimal adherence to current guideline based therapy, the odds for all-cause mortality increased by 13% for every 10 beat increases in HR. The use of HR both as a prognostic variable, as well as potentially modifiable risk factor, may be of value in risk-stratification algorithms at discharge.
Abstract MP31: The Web-based Automated Self-administered 24-hour Dietary Recall Performs Similarly to a Traditional Interviewer-administered 24-hour Dietary Recall
Authors: Subar Amy F , Kirkpatrick Sharon I , Thompson Francis E , Mittl Beth , Dixit-Joshi Sujata , Zimmerman Thea P , Douglass Deirdre , Potischman Nancy
Published: July 2021

Introduction:
Two studies were conducted to evaluate the National Cancer Institute (NCI)’s web-based Automated Self-Administered 24-hour Recall (ASA24) system, which was developed to facilitate the collection of 24-hour dietary recalls in large-scale research.

Hypothesis:
Energy, nutrient and food group estimates, response rates, and preferences are comparable between ASA24 and USDA’s interviewer-administered Automated Multiple-Pass Method (AMPM).

Methods:
Study 1 assessed the response rates and data collected using ASA24 compared to AMPM. About 1200 participants were recruited from three integrated health systems using quota sampling to ensure representation of a range of ages and race/ethnicity groups. Participants were asked to complete two 24HRs, 4-7 weeks apart, and randomized into four study groups: 1) two ASA24s; 2) two AMPMs; 3) ASA24 first and AMPM second; and 4) AMPM first and ASA24 second. Study 2 assessed the validity of ASA24 compared to AMPM in a one-day feeding study. Eighty-one participants visited a study center to consume three meals from a buffet. All containers were unobtrusively weighed before and after each participant served him/herself; plate waste was also weighed. The next day, participants returned to the center to complete either ASA24 or AMPM.

Results:
Study 1: Almost all enrolled participants (95%) completed at least one recall and 80% completed two; response rates did not differ by recall mode. Estimated intakes of energy, nutrients and food groups were comparable for ASA24 and AMPM; for example, energy, 2132 vs. 2126 kcal; fat, 84.9 vs. 82.8 g; saturated fatty acids, 27.9 vs. 26.9 g; fiber, 18.4 vs. 18.4 g; and fruits and vegetables, 3.0 vs. 3.1 cup equivalents. Of participants randomized to complete one ASA24 and one AMPM, a greater percentage preferred ASA24. Study 2: The examination of foods and drinks reported showed that exact or close matches were recalled for 76.9% of items truly consumed among ASA24 respondents compared to 82.5% among AMPM respondents. Far matches were reported for 3.1% of items consumed among ASA24 respondents compared to 0.7% for AMPM. The proportions of foods or drinks consumed but not reported (exclusions) were 20.4% and 16.8% for ASA24 and AMPM, respectively. Median differences between reported and true intakes for energy, nutrient and most food groups were not significantly different between ASA24 and AMPM.

Conclusion:
ASA24 performs well relative to traditional interviewer-administered recalls and is feasible for use in large-scale research. The tool, which offers significant savings over interviewer-administered recalls, is publicly available from NCI and has been used in over 800 studies to collect over 113,000 dietary recalls. The tool is currently being updated to run on mobile applications.
Abstract MP36: Associations of Chronic Individual- and Neighborhood-Level Stressors with Incident Coronary Heart Disease (CHD): The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Kershaw Kiarri N , Diez Roux Ana V , Bertoni Alain , Carnethon Mercedes R , Everson-Rose Susan A , Liu Kiang
Published: July 2021

Background:
Several individual-level measures of stress have been linked to incident CHD in prospective studies, but less attention has focused on the influence of neighborhood-level stressors. We assessed prospective associations of individual- and neighborhood-level stressors with incident CHD.

Methods:
MESA participants were aged 45-84 years at baseline (2000-2002). Analyses were conducted separately for those with complete data on individual- (n=6678) and neighborhood-level stressors (n=6105). Missing values on covariates were imputed with multiple imputation. Baseline individual-level sources of stress were assessed using the chronic burden scale, a measure of the presence and perceived stressfulness of ongoing health, job, relationship, and financial problems lasting over 6 months. Survey-based neighborhood safety (3 items) and neighborhood social cohesion (5 items) were examined as neighborhood-level sources of chronic stress. Each participant’s neighborhood safety and neighborhood social cohesion scores were constructed using Empirical Bayes estimation techniques that incorporated the responses of other MESA participants and a sample of non-participants living within a mile of that participant. Scores for each individual- and neighborhood-level stress measures were categorized into approximate tertiles (low, medium, and high) for analyses. CHD was defined as nonfatal myocardial infarction, resuscitated cardiac arrest, or CHD death. Median follow-up time was 8.5 years. Multivariable Cox proportional hazard models were used to estimate associations of high chronic burden, low neighborhood cohesion, and low neighborhood safety with incident CHD after adjusting for sociodemographic characteristics as well as behavioral and biological risk factors.

Results:
Participants in the high chronic burden category had 55% higher risk of incident CHD (hazard ratio (HR): 1.55; 95% confidence interval (CI): 1.11, 2.15) than those in the low category after adjusting for age, race/ethnicity, gender, education, income, marital status and field center. Findings attenuated slightly but remained significant with further adjustment for hypercholesterolemia, hypertension, diabetes, body mass index, physical activity, current smoking, and current alcohol use (HR: 1.47; 95% CI: 1.03, 2.00). Neither low (vs. high) neighborhood cohesion (HR: 1.23; 95% CI: 0.74, 2.06) nor low (vs. high) neighborhood safety (HR: 1.12; 95% CI: 0.68, 1.84) was associated with CHD in sociodemographic-adjusted models.

Conclusions:
Individual-level sources of stress were more strongly associated with incident CHD than neighborhood-level stressors.
Abstract MP37: Effects of a Behavioral Intervention that Emphasizes Spices and Herbs on Adherence to Recommended Sodium Intake
Authors: Anderson Cheryl , Cobb Laura K , Miller Edgar R , Woodward Mark , Chang Alex , Mongraw-Chaffin Morgana , Appel Lawrence J
Published: July 2021

Introduction:
Adherence to the recommended dietary sodium intake is challenging given the ubiquity of sodium in the US food supply. We hypothesized that a multifactorial, behavioral intervention that emphasized spices and herbs would facilitate adherence to dietary sodium recommendations.

Methods:
SPICE was a two-phase study including adults, 18 years or older, for whom
Dietary Guidelines for Americans
recommends 1500 mg/d of sodium. In phase one, 55 individuals were fed a low sodium diet for 4 weeks to acclimatize them to eating according to dietary sodium recommendations. Participants were provided all food, snacks and calorie-containing drinks. In phase two, 40 participants from phase 1 were randomized to either a multifactorial behavioral intervention designed to reduce sodium intake (n=20) or a self-directed control group (n=20), for 20 weeks. The intervention included advice on replacing sodium with spices and herbs. The primary study outcome was 24-hour urinary sodium excretion. We used linear regression analyses to determine the effects of the intervention on urinary sodium excretion.

Results:
Participants were 65% female, 88% African American; 63% had hypertension, 18% had diabetes; mean(sd) age was 61(9.7) years, and BMI was 30(8.9) kg/m
2
. During phase one (controlled feeding), mean 24-hour urinary sodium excretion decreased (150 mmol/d to 72 mmol/d). At the end of the 20-week behavioral intervention, 24-hour urinary sodium excretion increased in both arms but was 42 mmol/d lower in the intervention group than in the control group, p=0.002 (Figure). These findings were robust to methods excluding incomplete urine collections (Mage equation: mean difference -47.4, p=0.001, Joosens equation: mean difference -34.6, p=0.04).

Conclusions:
A multi-factorial behavioral intervention that emphasizes spices and herbs facilitates adherence to the recommended dietary sodium intake.
Abstract MP41: Health-related Quality of Life and Risk of Hypertension in the Community: A Prospective Analysis from the Western New York Health Study
Authors: Stranges Saverio , Rafalson Lisa , Donahue Richard
Published: July 2021

Health-related Quality of Life and Risk of Hypertension in the Community: A Prospective Analysis from the Western New York Health Study

Background:
Measures of quality of life and health status are strong predictors of mortality and morbidity outcomes including cardiovascular disease (CVD). However, prospective epidemiological evidence from population-based studies on the potential impact of these measures on hypertension risk is scant.

Objective:
We sought to examine the independent role of measures of quality of life and health status on the risk of incident hypertension in a community-based sample from Western New York.

Methods:
A longitudinal analysis, over 6 years of follow-up, among 946 women and men (mean age 54.3 years) from the community, who were free of hypertension, CVD, and diabetes at the baseline examination, in the Western New York Health Study (WNYHS). Baseline variables included socio-demographics, anthropometrics, blood pressure, biomarker data, major behavioural risk factors, and measures of quality of life and health status, such as the physical and mental health component summaries of the short form-36 questionnaire (SF-36). Incident hypertension was defined as blood pressure > or =140/90 or on antihypertensive medication at the follow-up visit.

Results:
The cumulative six year incidence of hypertension was 22.6% (214/942). In bivariate analyses, there were several baseline correlates of incident hypertension, including age, BMI, and baseline blood pressure levels in both sexes; whereas cigarette smoking, change in BMI, family history of hypertension, and the SF-36 physical score were all significantly associated with hypertension only among women. After multivariate adjustment, cigarette use at baseline (OR: 2.96, 1.35, 6.51), family history of hypertension (OR: 2.59, 1.52-4.42), BMI change since baseline (OR: 1.18, 1.06-1.31), and the SF-36 physical score (OR: 0.97, 0.94-0.99 for a unit change) were the only significant predictors of hypertension independent of age and baseline blood pressure levels in women.

Conclusions:
Results from this study suggest that measures of health-related quality of life may represent independent predictors of hypertension risk, at least among women, above and beyond the role of traditional risk factors, such as age, smoking, body weight, and familial predisposition.
Abstract MP44: Assessment and Comparison of Six minute Walk Distance in Patients Undergoing Pharmacological Stress Test
Authors: Supariwala Azhar A , Uretsky Seth , Cohen Randy , Thammaiah Yathin , Sangli Swathi , Correa Amit , Duttuluri Manideep , Dukkipati Sai Sreenija , Price Kelly , Khan Irtaza , Chaudhry Farooq A , Rozanski Alan
Published: July 2021

Background:
Stress testing is widely used for diagnosis, risk stratification and prognosis of patients (pts). Although a normal stress study identifies pts at low risk, compared to exercise stress (Ex), those undergoing pharmacological stress test (PST) are at a higher risk of mortality. We studied the feasibility of a six minute walk test (SMWT) and compared the six-minute walk distance (SMWD) among Ex and PST.

Methods:
328 consecutive patients [Ex=186 (57%); PST= 142 (43%)] referred for stress testing at our hospital were enrolled. Demographic and clinical information was collected. Each patient underwent a SMWT according to American Thoracic Society guidelines.

Results:
Patients in PST were older (62±14 vs. 57±12; p=0.001), had a higher BMI (36±30 vs. 29±6; p0.01), diabetes (46% vs. 25%; p<0.001) and hyperlipidemia (55% vs. 38%; p=0.01). We found a low SMWD achieved in PST (209 m ± 131) vs. Ex (366 m ± 107; p<0.001). When compared to age-gender matched healthy volunteer data, we found a significantly lower predicted SMWD in all patients suspected of CAD, with the lowest predicted SMWD in PST. (Figure) On multivariate analyses, patients undergoing PST had the highest risk (HR=10.1) of achieving lowest tertile of percent predicted SMWD, followed by female gender (HR=2.0), history of CHF, higher BMI. Only patients above 80 yrs of age had significant higher likelihood of undergoing pharmacological stress mode (OR = 7.2; 95CI =1.7 - 30.1; p=0.008). After including the interaction term for age and pharmacological stress mode, low SMWD among PST was seen in both older and young patients (p for interaction=0.46).

Conclusion:
SMWT is feasible in patients referred for PST. Patients with known or suspected CAD achieve a low percent predicted SMWD. This is the first study to show objective evidence of deconditioning in PST irrespective of co-morbidities. Future studies are needed to evaluate the prognostic significance of SMWT in patients undergoing pharmacological stress test.
Abstract MP48: Social Network, Social Support, and the Risk of Incident Stroke: The Atherosclerosis Risk in Communities Study
Authors: Nagayoshi Mako , Everson-Rose Susan A , Iso Hiroyasu , Mosley Thomas H , Rose Kathryn M , Lutsey Pamela L
Published: July 2021

Background and Purpose:
Having a small social network and lack of social support have been associated with incident coronary heart disease, but little is known about their association with incident stroke. Thus, we assessed the association of a small social network and lack of social support with risk of incident stroke and evaluated whether the relation was mediated by vital exhaustion and inflammation.

Methods:
The Atherosclerosis Risk in Communities (ARIC) Study measured social network and social support in 13,686 men and women (mean, 57 ± 5.7 years, 56% female, 24% black; 76% white) initially free of stroke. The 10-item Lubben Social Network Scale and 16-item Interpersonal Support Evaluation List-Short Form were used to assess social network size and social support, respectively.

Results:
Over a median follow-up of 18.6-years, 905 incident strokes occurred. Relative to participants with a large social network, those with a small social network had a higher risk of stroke [HR (95% CI): 1.43 (1.03-2.00)] after adjustment for demographic and socioeconomic characteristics and marital status (
Table
). Further adjustment for other potential confounders attenuated the association slightly. Vital exhaustion, but not inflammation, partly mediated the association between a small social network and stroke. Social support was unrelated to incident stroke.

Conclusions:
In this sample of US community-dwelling men and women, having a small social network was associated with excess risk of incident stroke. As with other cardiovascular conditions, having a small social network appears to be associated with modestly increased risk of incident stroke.
Abstract MP50: Metabolic Predictors of Type 2 Diabetes in American Indians: The Strong Heart Family Study
Authors: Zhu Yun , He Jiang , Best Lyle G , Lee Elisa T , Howard Barbara V , Zhao Jinying
Published: July 2021

Background:
Type 2 diabetes (T2D) is characterized by profound metabolic abnormalities. Current glycemic indicators have limitations in identifying early metabolic alterations.

Objective:
To identify novel metabolic predictors of T2D in American Indians participating in the Strong Heart Family Study.

Methods:
Among 2,129 participants who had normal fasting glucose (NFG) at baseline (2001-2003) and also attended clinical examination after 5-year follow-up (2006-2009), 142 developed incident T2D, 514 developed incident impaired fasting glucose (IFG), and 1,473 remained to be NFG. The current analysis included all incident cases of T2D (n=142), 146 incident IFG (randomly selected from 514 participants with incident IFG) and 144 NFG (randomly selected from 1,473 participants with NFG at both visits). Baseline plasma metabolites were detected by high-resolution LC/MS. The prospective association of each metabolite with risk for T2D or IFG was investigated using weighted Cox’s hazard regression with frailty model, adjusting for sex, study center, age, BMI, renal function, fasting glucose and fasting insulin at baseline. Multiple testing was corrected by Bonferroni correction (significance level 2.8х10-6).

Results:
Thirty-nine metabolites from several major fuel sources, including sugar amino acids, amino acids, lipids, alkaloids, alkylamines, carboxylic acids, steroids, and aromatic homomonocylic/heteropolycyclic compounds, significantly predicted future risk of T2D (10 metabolites), or IFG (27 metabolites), or both (2 metabolites). Of these, N1,N12-diacetylspermine and betanidin, respectively, were the strongest predictors for increased (HR=4.59, 95% CI, 2.55-8.24, P=3.49х10-7) and decreased risk of T2D (HR=0.38, 95% CI, 0.28-0.52, P=4.64х10-10). The corresponding strongest predictors for IFG were hexanoic acid (HR=2.34, 95% CI, 1.84-2.98, P=3.15х10-12) and l-palmitoylcarnitine (HR=0.26, 95% CI, 0.18-0.37, P=1.14х10-13), respectively. Two metabolites, betanidin and dopamine, significantly predicted future onset of both T2D (HR=0.38, 95% CI, 0.28,0.52, P=4.64х10-10 for betanidin; HR=2.48, 95% CI, 1.71-3.58, P=1.42х10-6 for dopamine) and IFG (HR=0.52, 95% CI, 0.43,0.62, P=1.35х10-12 for betanidin; HR=2.24, 95% CI, 1.73,2.89, P=5.79х10-10 for dopamine). Multiple unknown compounds were also independently associated with risk of T2D, IFG or both.

Conclusions:
This study identifies both novel and known metabolic alterations associated with risk of diabetes in American Indians, an ethnic group suffering from disproportionately high rates of T2D. The incomplete overlapping of metabolic profiles between T2D and IFG highlights differential metabolic states of diabetes development. Our results not only provide novel insights in disease pathogenesis but also valuable data on potential new targets for risk prediction and treatment.
Abstract MP51: Global, Regional, And National Intakes Of Sugar-sweetened Beverages, Milk, And Fruit Juice: A Systematic Analysis Including 193 Country-specific Nutrition Surveys Worldwide.
Authors: Singh Gitanjali M , Micha Renata , Khatibzadeh Shahab , Shi Peilin , Lim Stephen , Andrews Kathryn , Engell Rebecca E , Ezzati Majid , Mozaffarian Dariush
Published: July 2021

Background:
Sugar-sweetened beverages (SSBs), fruit juice, and milk each significantly contribute to health and disease. To-date, assessment of their global distributions and health impacts have been limited by insufficient comparable and reliable data by country, age, and sex.

Objective:
To quantify global, regional, and national levels of SSB, fruit juice, and milk intake by age and sex in adults over age 20 in 2010.

Methods:
We identified, obtained, and assessed data on intakes of these beverages in adults, by age and sex, from 193 nationally representative diet surveys worldwide, representing 62% of the world’s population. We developed a multi-level hierarchical Bayesian model to account for differences in national and regional missingness, measurement incomparability, study representativeness, and sampling and modeling uncertainty.

Results:
In 2010, global average intakes were 0.58 (95%UI: 0.37, 0.89) 8 oz servings/day for SSBs, 0.16 (0.10, 0.26) for fruit juice, and 0.57 (0.39, 0.83) for milk. There was significant heterogeneity in consumption of each beverage by region and age (Figure). SSB intakes were highest in the Caribbean (1.9 servings/day; 1.2, 3.0) fruit juice intakes were highest in Australia and New Zealand (0.66; 0.35, 1.13), and milk intakes were highest in Central Latin America and parts of Europe (1.06; 0.68, 1.59). Consumption levels of all three beverages were lowest in East Asia and Oceania. Globally and within regions, SSB consumption was highest in younger adults; fruit juice consumption showed little relation with age; and milk intakes were highest in older adults.

Conclusions:
This quantitative assessment of current beverage intakes at global, regional, and national levels, as well as by age and sex, is imperative for informing public health and policy priorities for intervention strategies, as well as for quantifying the impacts of these beverages on health worldwide.
Abstract MP58: Association Between Plasma Low-Density Lipoprotein Cholesterol Level and Risk of Abdominal Aortic Aneurysm in ARIC: a Mendelian Randomization Study
Authors: Weng Lu-Chen , Lutsey Pamela L , Alonso Alvaro , Guan Weihua , Pankow James S , Folsom Aaron R , Tang Weihong
Published: July 2021

Introduction:
Abdominal aortic aneurysm (AAA) is one of the leading causes of death in the United States. Observational epidemiological studies demonstrated that circulating level of LDL cholesterol is positively associated with AAA risk. However, a causal link between LDL and risk of AAA is still unclear.

Hypothesis:
There is a causal relationship between plasma LDL and risk of AAA, which can be demonstrated by a Mendelian randomization (MR) approach.

Methods:
Using a gene score for LDL as an instrumental variable (IV), we conducted a large MR study to investigate the association between plasma level of LDL and risk of AAA in 8,967 European Americans in the ARIC Study. Twelve SNPs that were reported in a published genome-wide association study for LDL and not associated with other lipids or total cholesterol (TC) were selected. A weighted LDL gene score was created as the sum of the number of risk alleles of the selected SNPs multiplied by the SNP-specific effect size on LDL obtained from the literature and then divided by the total number of SNPs. For participants who took antihyperlipidemic medication, a constant was added to their plasma LDL value to account for the effect of medication. A total of 262 clinical AAA cases were ascertained through hospital discharge diagnoses or death certificates during 23 years of follow-up. The IV-predicted risk for AAA per 1 SD increment of LDL was assessed using an IV probit model adjusted for age, sex, field center, and 10 principal components to account for population stratification. A probit regression model adjusted for known risk factors and other lipids was also performed to confirm the association between LDL and AAA risk at the phenotype level.

Results:
Using the LDL gene score as an IV for LDL, a positive association was observed between plasma LDL and the predicted risk of AAA. Each 1 SD increase in LDL (instrumented by the LDL gene score) was associated with an average increase of 10% (95% CI=0.1%- 20%) in the risk of AAA. The strength of the LDL gene score as an IV was adequate (F-statistic = 20), and this score was not related to other risk factors for AAA, including other lipids. Similar results were observed after we removed participants who took antihyperlipidemic medications. The positive association based on the LDL gene score was concordant in direction with the association between LDL level and AAA without gene score (average increase in the risk of AAA per 1 SD increment in LDL = 0.6%, 95%CI=0.3 %-1%). We conducted a sensitivity analysis by adding SNPs related to TC. This new score was marginally correlated with triglycerides and reduced the adequacy of MR model to below statistical significance.

Conclusion:
Our finding supports a causal relationship between plasma level of LDL and AAA risk, with higher LDL level leading to a higher AAA risk.
Abstract MP61: Dietary Fiber Intake and Mortality Among Myocardial Infarction Survivors
Authors: Li Shanshan , Flint Alan , Pai Jennifer , Forman John , Hu Frank , Willett Walter , Rexrode Kathryn , Mukamal Kenneth , Rimm Eric
Published: July 2021

Background:
Dietary fiber is associated with lower risk of coronary heart disease in healthy populations. It is unclear whether higher consumption of dietary fiber after myocardial infarction (MI) is associated with lower mortality.

Objective:
To evaluate the associations of dietary fiber post-MI and changes from pre- to post- with all-cause and cardiovascular mortality.

Design:
The Nurses’ Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS) are two large prospective cohort studies of US women and men with repeated dietary measurements. We included 2,258 women and 1,840 men who were free of cardiovascular disease, stroke or cancer at enrollment, survived a first MI during follow up, were free of stroke at the time of initial MI onset, and provided both pre-MI and at least one post-MI food frequency questionnaire. We evaluated the associations of dietary fiber post-MI and changes from pre- to post- with all-cause and cardiovascular mortality using Cox proportional hazards models, adjusting for medication use, medical history, and lifestyles factors.

Results:
Higher post-MI fiber intake was significantly associated with lower all-cause mortality (Comparing extreme quintiles, pooled hazard ratio (HR) = 0.75, 95%CI: 0.58-0.97). Greater intake of cereal fiber was more strongly associated with all-cause mortality (Pooled HR=0.73, 95%CI: 0.58-0.91) than were other sources of dietary fiber. Increased fiber intake from pre- to post- was significantly associated with lower all-cause mortality (Pooled HR=0.69, 95%CI: 0.55-0.87).

Conclusions:
In this prospective study of MI survivors, greater post-MI intake of dietary fiber, especially cereal fiber, was inversely associated with all-cause mortality. In addition, increasing consumption of fiber from pre- to post-MI periods was significantly associated with lower all-cause and cardiovascular mortality.
Abstract MP67: Lactation Duration and Subsequent Intima Media Thickness in Women During Midlife Controlling for Pre-pregnancy Cardiometabolic Risk Factors: The CARDIA Study
Authors: Gunderson Erica P , Lewis Cora E. , Ning Xian , Pletcher Mark , Jacobs David , Goff David , Gross Myron , Quesenberry Charles , Sidney Stephen
Published: July 2021

Background:
Greater lactation duration has been associated with lower incidence of the metabolic syndrome, and self-reported type 2 diabetes and heart disease in women later in life. Two retrospective studies reported higher carotid artery intima-media thickness among parous women who never or inconsistently breastfed, but no clear association with duration. However, lactation history was recalled many years later and heart disease risk factors were not measured before pregnancy. We hypothesized that lactation duration has a graded inverse association with subclinical atherosclerosis in women during mid-life independent of pre-pregnancy cardiometabolic risk factors.

Methods:
We examined 846 women (46% Black), aged 18-30 years at enrollment in 1985-1986 (baseline) in the biracial Coronary Artery Risk Development in Young Adults (CARDIA) study. Women included delivered 1 or more live births from 1986-2005, had no history of heart disease or diabetes before pregnancies, and had maximum common carotid intima media thickness (ccIMT, mm) measured in 2005-2006 at ages 38-50 years. Lactation duration was recalled within 1 to 4 years of delivery. We categorized women into four lactation groups according to cumulative duration for all post-baseline births; 0-<1 month (n=262), 1-<6 months (n=210), 6-10 months (n=169) and >10 months (n=205). Multiple linear regression models estimated mean ccIMT (95% CI) among lactation categories adjusted for pre-pregnancy cardiometabolic risk factors [BMI, systolic blood pressure (SBP), HDL-C, HOMA-IR], parity, socio-demographics (age, race, education), and smoking. We also assessed weight gain and change in SBP as mediators of the lactation and ccIMT association.

Results:
Increasing lactation duration showed a graded inverse association with mean ccIMT; differences between >10 months vs. 0<1 month groups ranged from -0.062 from the unadjusted model (p<0.001) and -0.029 from adjusted models (p=0.046) that included pre-pregnancy risk factors and other covariates. Weight gain and SBP change during the 20-year follow up slightly attenuated (~10%) the ccIMT-association with increased lactation duration.

Conclusions:
Greater lactation duration is associated with lower mean ccIMT independent of cardiometabolic risk factors measured before pregnancy, parity, socio-demographics and smoking. Lactation may have lasting favorable effects on cardiometabolic risk factors for heart disease.
Abstract MP70: Ten Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Results from the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: McClelland Robyn L , Jorgensen Neal , Bild Diane , Burke Greg , Post Wendy , Shea Steve , Liu Kiang , Watson Karol , Folsom Aaron , Budoff Matthew , Carr J. Jeffrey , Blaha Michael , Kronmal Richard
Published: July 2021

Objectives:
In the modern era existing risk scores are not well calibrated, and may overestimate or underestimate risk in different populations. Several studies have demonstrated the added value of coronary artery calcium (CAC) over and above traditional risk factors for risk prediction. Our goal was to develop a risk score to estimate 10-year CHD risk using CAC and traditional risk factors.

Methods:
The MESA study is a cohort of 6814 participants aged 45-84 and free of clinical heart disease at baseline (2000-2002) in which CAC (Agatston score) was measured. Incident coronary heart disease (CHD) events included myocardial infarction, CHD death, and angina when accompanied by revascularization. Penalized Cox regression models (“shrinkage” models) were used to perform variable selection and estimate the risk score coefficients. Covariates which were considered for inclusion in the risk score model were: age, gender, race/ethnicity, HDL and total cholesterol, lipid lowering medication use, systolic blood pressure (SBP), anti-hypertensive medication use, body mass index (BMI), current smoking, family history of heart attack, diabetes, and CAC. Pre-specified interactions considered included: age, gender, race/ethnicity and CAC with all other predictors; anti-hypertensive medications-by-SBP; and lipid lowering medications-by- total cholesterol. Bootstrapping was used to establish the internal validity of the model to avoid over-optimism.

Results:
Participants were followed for a median of 10.2 years, and 393 CHD events were observed. With the exception of BMI and diastolic blood pressure, all the risk factors were included in the risk score. The risk score demonstrates good discrimination and calibration, with survival adapted area under the ROC curve (AUC) of 0.81 and discrimination slope of 0.91. The model exhibits improved performance compared to existing risk scores, even after recalibration of traditional risk scores to the MESA population, which have yield an AUC for Framingham risk score of 0.72, and an AUC for traditional risk factors fit to MESA of 0.76. The improvement reflects both the addition of CAC and a tuning of the parameter estimates for the traditional risk factors. The MESA 10-year CHD risk calculator will be available online to facilitate clinical use.

Conclusions:
An accurate estimate of 10-year CHD risk can be obtained using traditional cardiovascular risk factors and CAC.