bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P186: Cardiovascular Outcomes Associated With Early- versus Late-onset Hypertension
Authors: Niiranen Teemu , McCabe Elizabeth , Larson Martin , Lakdawala Neal , Vasan Ramachandran , Cheng Susan
Published: July 2021

Introduction:
It is well known that hypertension confers substantial risk for developing cardiovascular disease (CVD) outcomes when present in either younger or older age. However, there are currently scant data to guide clinicians on the possible importance of distinguishing between the significance of hypertension that develops earlier versus later in life. We conducted an investigation in the original Framingham Heart Study cohort to assess the long-term CVD risks associated with developing early- versus late-onset hypertension over the adult life course.

Methods:
Assessment of hypertension onset was based on blood pressure (BP) data collected from serial biannual examinations performed from 1948 through 2005. We defined hypertension as BP ≥140/90 mmHg or use of antihypertensive medication on ≥2 consecutively attended examinations. We studied the relation of age-of-onset of hypertension with cause-specific mortality using a case (CVD deaths) versus control (non-CVD deaths) design. We used logistic regression to calculate case-versus-control odds ratios, adjusted for age at death, sex, smoking status, total cholesterol, and diabetes.

Results:
In 3614 decedents (1151 CVD deaths, including 630 coronary deaths), the odds of CVD death increased linearly with decreasing age of hypertension onset (Figure). Compared to non-hypertensives, hypertension onset at age <45 conferred a 2.2-fold odds of CVD death and 2.3-fold odds of coronary death, whereas hypertension onset at age ≥65 conferred a lower-magnitude 1.5-fold odds of CVD death and 1.4-fold odds of coronary death (
P
≤.002 for differences in odds between hypertension onset at age <45 and ≥65).

Conclusions:
Early- compared to late-onset hypertension was associated with greater odds of CVD and particularly coronary death. These findings suggest it may be important to distinguish between early- and late-onset hypertension as a specific type of BP trait when estimating risk for CVD outcomes in persons with established hypertension.
Abstract P191: Orthostatic Hypotension and Blood Pressure Symptoms in the AASK Cohort Study
Authors: Juraschek Stephen P , Miller Edgar R , Appel Lawrence J
Published: July 2021

Background:
Orthostatic hypotension (OH) is defined using a consensus-based definition, namely, a drop in systolic blood pressure (SBP) ≥20 mmHg or diastolic BP (DBP) ≥10 mmHg or an increase in heart rate (HR) ≥20 bpm. Whether or not these definitions correspond with patient symptoms is unknown.

Hypothesis:
Traditional metrics for defining OH are arbitrary and warrant revision.

Methods:
SBP, DBP, and HR were assessed after 5 min in the rested, seated position and after 1 min of standing in black participants at each visit of the AASK cohort study (2002-2007; n=677). Postural change was determined by subtracting the seated SBP, DBP, or HR from the standing SBP, DBP, or HR. During each visit, participants were asked whether they experienced 26 distinct BP-related symptoms since last visit (yes or no). Relationships between SBP, DBP, and HR and symptoms were modeled via generalized estimating equations.

Results:
Participants were 40% women; mean age was 60 yrs (SD, 10) and mean number of follow-up visits was 19 (10). Mean (SD) resting SBP, DBP, and HR at baseline were 136 mmHg (22), 81 mmHg (13), and 69 bpm (12). After adjustment for age and sex, dizziness was the only symptom associated with all components of OH: SBP per -10 mmHg (OR 1.13; 95% CI 1.03, 1.23), DBP per -10 mmHg (1.12; 1.00, 1.26), and HR per 10 bpm (1.14; 1.03, 1.26). Light-headedness was associated with SBP (1.12; 1.03, 1.21) and HR (1.14; 1.05, 1.24), but non-significantly with DBP (1.11; 0.99, 1.23). When plotted continuously, there was no clear demarcation of risk between symptoms and conventional cut points. Rather, reduction in standing SBP and DBP were each associated with a higher proportion of symptoms at about -5 mm Hg, while increase in standing HR was associated with a higher proportion of symptoms as low as 5 bpm (
Figure
).

Conclusions:
Dizziness and light-headedness are symptoms most strongly associated with OH. The proportion with symptoms is greater at cut points less extreme than the consensus definition, demonstrating that the consensus definition of OH lacks sensitivity.
Abstract P195: The Relative Contribution of Systolic Blood Pressure in Cardiovascular Risk Prediction Declines
Authors: Rospleszcz Susanne , Thorand Barbara , de las Heras Gala Tonia , Meisinger Christa , Holle Rolf , Koenig Wolfgang , Peters Annette
Published: July 2021

Background:
The Framingham Risk Score (FRS) is an established tool for the prediction of cardiovascular disease (CVD) risk. The established CVD risk factors age, HDL cholesterol, total cholesterol, systolic blood pressure (SBP), antihypertensive treatment, diabetes mellitus and smoking are used in the calculation of the FRS. The prevalence and distribution of these risk factors in the population have changed within the last decades and especially average levels of SBP have declined. However, the impact of this change on the risk prediction performance of the FRS has not been investigated.

Hypothesis:
We assessed the hypothesis that the relative contribution of SBP to CVD risk prediction within the FRS framework has changed from 1985 to 2000.

Methods:
We used N = 11 760 participants aged 30 - 65 years from four prospective population-based cohort studies enrolled in Southern Germany in 1985, 1990, 1995, and 2000. CVD risk was calculated by recalibrated equations of the original FRS. Predicted CVD risks using the actual SBP values were compared to predicted CVD risks using optimal (SBP < 120 mmHg) values for each participant.

We assessed the relative contribution of SBP with three performance measures: First, the median difference in predicted risks with actual and optimal SBP, second, the relative positive predictive value of the FRS using actual compared to optimal SBP values and third, the population attributable risk fraction of SBP using Levin’s formula.

Results:
CVD events occurred in 6.3% of male participants in 1985 and 6.2% in 2000; in women, event rates were 2.4% and 2.3%, respectively. Mean SBP levels decreased from 134 mmHg (Standard Deviation: 17 mmHg) to 132 (SD: 17) mmHg in men and from 127 (SD: 19) mmHg to 121 (SD: 18) mmHg in women.

The difference in median predicted risk declined from 1.21 [Interquartile range 0.52, 3.38] in 1985 to 0.93 [0.35, 2.44] in 2000 in men and from 0.26 [-0.05, 1.45] to -0.07 [-0.19, 0.89] in women. The relative positive predictive value dropped from 0.88 to 0.73 in men and from 0.61 to 0.53 in women. The population attributable risk fraction of SBP decreased from 70.2% (95% CI: 42.1, 89.6) to 29.71% (-6.4, 64.7) in men and from 85.7% (62.9, 93.1) to 57.9% (28.0, 82.0) in women. Given the results from 1990 and 1995, the declining trend was nonlinear for all three performance measures.

Conclusion:
In conclusion, the relative contribution of blood pressure to cardiovascular risk prediction has decreased within the last decades. This affects the future development of CVD risk prediction methods which will have to consider the changing relative importance of SBP. Furthermore, this might also influence public health policies focusing on the management of SBP and hypertension in order to effectively prevent CVD.
Abstract P206: Coffee Intake Was Not Causally Associated With Type 2 Diabetes Risk in Asians: a Mendelian Randomization Based on the Singapore Chinese Health Study
Authors: Talaei Pashiri Mohammad , Huang Tao , Koh Woon-Puay
Published: July 2021

Introduction:
Despite the largely reported inverse association between coffee intake and type 2 diabetes (T2D) risk by observational studies, the causality of such association is not well established.

Hypothesis:
We assessed the hypothesis that the observationally inverse association between coffee intake and T2D risk is causal.

Methods:
In a nested case-control study within the Singapore Chinese Health Study cohort, we included 2436 T2D cases and 2436 matched controls. At biospecimen collections (1999-2004), participants were free of diagnosed T2D, cardiovascular disease and cancer. Cases were participants who reported to have physician-diagnosed T2D at follow-up visits during 2006-2010. Controls were randomly selected among those who remained free of T2D and were matched to the index cases by age, sex, dialect group and date of biospecimen collection. We 1) tested the association between coffee intake and T2D risk using conditional logistic regression analysis; 2) tested the association of the nine single-nucleotide polymorphisms (SNPs) with coffee intake or risk of T2D; 3) used the instrumental variable (IV) estimators to quantify the strength of the causal association of coffee intake and risk of T2D. The IV estimator (β
IV
) which is identical to that derived by the widely used two-stage least squares method, was calculated through dividing the β of the regression coefficients for SNP-T2D by SNP-coffee associations.

Results:
Median intake (inter quartile range) for coffee intake was 1.00 (0.36-2.51) cups/day in this population. Coffee intake was observationally associated with lower risk of T2D and OR (95% CI) was 0.93 (0.88-0.98) in multivariate adjusted model. We found three SNPs that were significantly associated with higher coffee intake with β coefficients (95% CI) as follows: 0.73 (0.23, 1.24) for rs4410790 (P=0.004), 0.72 (0.22, 1.22) for rs6968554 (P=0.005), and 1.60 (0.28, 2.91) for rs7800944 (P=0.017). Among these tree SNPs, two SNPs were marginally associated with higher T2D risk with OR (95% CI) identically 1.08 (0.99, 1.18) for 7:17284577 and 7:17287106, and the other one was insignificantly associated with lower risk (OR 0.94; 95% CI 0.75, 1.18). The estimated β
IV
coefficients (95% CI) was not statistically significant for any of the three SNPs: 0.10 (-0.04, 0.25) for rs4410790 (P=0.16), 0.11 (-0.04, 0.25) for rs6968554 (P=0.15), and -0.04 (-0.19, 0.11) for rs7800944 (P=0.60).

Conclusions:
High coffee intake was observationally associated with lower T2D risk, but our finding does not support a causal association.
Abstract P207: Association Between a 20-year CVD-risk Score Based on Modifiable Lifestyles and Total and Cause Specific Mortality Among US Men and Women
Authors: Sotos-Prieto Mercedes , Sesso Howard D , Hu Frank B , Willett Walter C , Chiuve Stephanie E
Published: July 2021

Background:
The previously validated Healthy Heart Score, based on modifiable health behaviors (diet, physical activity, alcohol intake, smoking, and body weight), effectively predicted the 20-year risk of CVD in mid-adulthood. While these lifestyle behaviors are independently associated with many chronic diseases, it remains unknown whether the Healthy Heart Score may extend to an association with overall mortality risk. Thus, we examined the Healthy Heart Score and total and cause-specific mortality in the Nurses’ Health Study (NHS) and Health Professional Follow-up Study (HPFS).

Methods:
We conducted a prospective analysis among 58,319 women in the NHS (1984-2010) aged 30-55 y and 30,713 in men in the HPFS (1986-2010) aged 40-75 y free of cancer and CVD at baseline. The Healthy Heart Score was calculated at baseline and included 9 factors that best estimated CVD risk: current smoking, higher BMI, low physical activity, lack of moderate alcohol consumption, low intakes of fruits and vegetables, cereal fiber, and nuts, and high intakes of sugar-sweetened beverages and red and processed meats). Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) and adjusted for various demographics, medical history, medication use and total energy.

Results:
During 2,075,504 years of follow-up, there were 19,181 total deaths, including 11,464 in women and 7,717 in men. Compared to participants with the lowest predicted 20-year CVD risk based on the Healthy Heart Score (1
st
quintile, median CVD risk: 0.01%), participants with the highest predictive CVD risk (5
th
quintile, median CVD risk: 0.03%) had a pooled HR (95%CI) of 2.26 (1.86, 2.13) for total mortality; 2.89 (95 CI%, 1.93, 4.32) for CVD mortality; and 2.55 (95% CI 2.39, 2.72) for cancer mortality. Participants in the 5
th
quintile
vs
. the 1
st
quintile of the Healthy Heart Score had also a significantly greater risk of death due to CHD (3.40 [2.20, 5.26]), stroke (1.77 [1.00, 3.14]), lung cancer (6.02 [2.83, 12.79]), breast cancer (1.45 [1.13, 1.85]), colon cancer (1.51 (1.17, 1.94)), respiratory disease (3.94 (1.03, 15.14)), and diabetes (3.63 (2.00, 6.59)).

Conclusion:
The Healthy Heart Score, comprised of 9 self-reported, modifiable lifestyle predictors of CVD, is strongly associated with a greater risk of all-cause and cause-specific mortality. This risk score is a potentially useful tool for risk assessment and counseling of healthy lifestyles to promote longevity
Abstract P233: Handgrip Strength Modifies the Association Between Body Mass Index and Blood Pressure in Children and Adolescents of the United States: Experience in NHANES 2011-2014
Authors: Zhang Rui , Zheng Liqiang , Chen Wei , Li Shengxu
Published: July 2021

Background:
Body mass index (BMI), a measure of obesity, is strongly associated with blood pressure (BP) in children and adolescents. Handgrip strength is a measure of muscular strength and body fitness. We hypothesized that handgrip strength modifies the relationship between BMI and BP.

Methods:
The sample included 3,947 children and adolescents (50.4% boys and 49.6% girls) aged 8-19 years who participated in the National Health and Nutrition Examination Surveys (NHANES) 2011-2014. The sum of the maximum handgrip strength from both hands, standardized to age- and sex-specific z-scores, was used. General linear models were used for data analyses.

Results:
As expected, BMI was positively correlated with systolic BP (partial correlation coefficient r=0.17, P<0.0001). After adjustment for age, race, sex, and handgrip strength, each BMI unit increase was associated with 0.47 (0.03, standard error) mm Hg increase in systolic BP (P<0.0001). Further, handgrip strength significantly (P=0.0002) attenuated the association between BMI and systolic BP. In those with handgrip strength below the median, each BMI unit increase was associated with 0.59 (0.04) mm Hg increase in systolic BP; such increase was only 0.38 (0.03) mm Hg in those with handgrip strength above the median, representing a 36% reduction in the effect size of BMI on systolic BP.

Conclusion:
These results suggest that high fitness, measured by handgrip strength, attenuates the adverse effect of obesity on blood pressure levels in children and adolescents, which indicates that increasing muscular strength and body fitness will have beneficial effects on obesity-associated elevated BP in children and adolescents.
Abstract P251: Substitution to Generic Angiotensin II Receptor Blockers: Impact on Risk of Hospitalizations, Emergency Room Consultations and Mortality
Authors: Leclerc Jacinthe , Blais Claudia , Rochette Louis , Hamel Denis , Guénette Line , Poirier Paul
Published: July 2021

Background:
Substitution from brand-name to generic drugs is one way to reduce costs of pharmacological treatments. Generic drugs licensing is obtained through comparative bioavailability studies for which a variation of up to 20% is generally accepted. However, “real-life” efficacy and tolerance of generic drugs are not studied prior to commercialization. We aimed to evaluate the impact of brand-name to generic losartan, valsartan or candesartan substitution on serious adverse events (hospitalizations, emergency room consultations [ER] or mortality).

Method:
Three cohorts of persistent angiotensin II receptor blockers (ARB) users (losartan [brand-name and 8 generics], valsartan [brand-name and 5 generics] and candesartan [brand-name and 3 generics])aged ≥ 66 years were constituted using data from the Quebec Integrated Chronic Disease Surveillance System. Generic exposition was determined by substitution time-distribution matching. Time free of adverse events up to 365 days after the onset of generic exposition was compared between groups by survival analysis using Cox regression models adjusted for age, sex, comorbidities, concomitant treatments, socioeconomic status, previous brand-name drug, healthcare resources utilization and prescriber’s speciality, to provide hazard ratio (HR). Sensitivity analysis including non-persistent users was also conducted.

Results:
Within cohorts (losartan, n = 15,469; valsartan, n = 17,205; and candesartan, n = 25,008), proportions of exposed to generic substitution vs. unexposed who had at least one adverse event were respectively: 35% vs. 25%, 34% vs. 28% and 31% vs. 27% (all,
p
<0.0001). When adjusted for potential confounders, risk of hospitalizations and ER were higher for those exposed to generic substitution. Specifically, HR for exposed to generic substitution are the following for losartan, valsartan and candesartan: hospitalizations (HR: 1.23 [
p
< 0.0001]; 1.22 [
p
< 0.0001] and 1.08 [
p
= 0.0317]) and ER (HR: 1.55; 1.20 and 1.16, all =
p
< 0.0001). Regarding mortality, HR were respectively: 0.63 [
p
= 0.1456]; 0.95 [
p
= 0.8487] and 0.43 [
p
< 0.0001]). Survival was not significantly different for exposed to generic losartan and valsartan substitution. However, even if the time free of hospitalizations and ER was 8% and 16% shorter for patients exposed to generic candesartan substitution, their survival was 2.3 times better when compared to patients who remained on brand-name candesartan (unexposed). Sensitivity analysis yield similar results.

Conclusion:
Substitution to generic antihypertensive drugs is associated with a significantly reduced delay before hospitalizations and ER for the three ARBs but a better survival for patients exposed to generic candesartan substitution only. Better bioavailability of generics versions of candesartan or differences in health cares between users could explain these differences.
Abstract P256: Increased Risk of Ischemic Stroke in Adolescents and Adults with Congenital Heart Disease
Authors: Duca Lindsey M , Kao David , Khanna Amber , Crume Tessa
Published: July 2021

Introduction:
Improvements in the treatment of congenital heart defects (CHD) have resulted in the majority of infants born with CHD surviving into adulthood. This new population of adolescents and adults living with CHD have unique challenges for lifelong care, such as suffering prematurely from ischemic strokes.

Hypothesis:
The aim of this analysis was to examine specific cardiovascular abnormalities that increase the risk of the early development of an ischemic stroke in individuals with CHD.

Methods:
This study included all patients diagnosed with CHD age 18-65 that sought medical care from 2011 to 2013 at the University of Colorado Hospital, the only adult CHD clinic in Colorado. There were 3,255 individuals mean±SD age of 47±13 years diagnosed with a CHD. Marelli groups were created to categorize the severity of CHD and cardiovascular comorbidities (atrial fibrillation, hypertension, congestive heart failure, and diabetes mellitus) were extracted from the medical records. Logistic regression models were performed to evaluate the association between cardiovascular comorbidities and risk for stroke, adjusting for age, sex, race, insurance status and CHD severity.

Results:
Of the 3,255 adolescents and young adults with CHD (52.3% male, 47.7% female), 146 (4.49%) were diagnosed with an ischemic stroke. The greatest proportion of ischemic strokes occurred in the shunt CHD severity group (Table). In the multivariable analysis of CHD patients, atrial fibrillation (OR=2.13, 95% CI 1.45-3.12, p=0.0001) and congestive heart failure (OR=2.60, 95% CI 1.52-4.44, p=0.0005) were associated with greater than a 2-fold increase in the odds of ischemic stroke after adjusting for age, sex, race, insurance status and CHD severity. Hypertension and diabetes mellitus were not associated with the risk of stroke.

Conclusion:
Cardiovascular comorbidities were strongly associated with the development of an ischemic stroke in adolescents and adults with CHD independent of CHD severity.
Abstract P259: Smoking Increases Risks of Death and Stroke in Both Men and Women. Absolute Risk Difference of Stroke is Likely to be Larger in Women
Authors: Ohsawa Masaki , Ogasawara Kuniaki , Omama Shinichi , Tanno Kozo , Itai Kazuyoshi , Yonekura Yuki , Nakamura Motoyuki , Ishibashi Yasuhiro , Kuribayashi Toru , Onoda Toshiyuki , Sakata Kiyomi , Tanaka Fumitaka , Ohta Mutsuko , Seki Hirobumi , Konishi Kazuki , Okayama Akira
Published: July 2021

Background:
Smoking is an important risk factor for cardiovascular disease, however, to what extent smoking increases excessive deaths and strokes in a general population has not been sufficiently examined especially in women.

Methods:
A total of 10,382 female and male participants aged 65 years or older were divided into two groups according to smoking status (current smoker; never smoker). Past smokers were excluded. Main outcomes were all-cause death and incident stroke. Age-adjusted mortality and incidence rates were estimated in the groups using Poisson’s regression analysis. Age-adjusted rate ratios (RR) and excess events (EE per 1000 person-years) attributable to smoking were determined using the rate in never smokers as a reference.

Results:
There were 1410 deaths and 735 strokes during the 9.0-year observation period (90,099 person-years). Smoking contributed to a 2.3-fold higher risk of death in women and 1.8-fold higher risk in men. It contributed to 12 excess deaths per 1000 person-years in both men and women. The rate ratio and excessive events of stroke were likely to be higher in women than those in men (RR: 2.6 vs. 1.6; EE: 9.3 vs 5.0, see table).

Conclusion:
Smoking significantly increases risks of death and stroke not only in men but also in women. Absolute risk difference of stroke attributable to smoking is likely to be larger in women than in men.
Abstract P267: Paradoxical Association Between Breastfeeding Duration and Hypertension in Later Years in Parous Korean Women: A Nationwide, Population-based Study
Authors: Lee Hong Seok , Han Kyong-Do , Park Yong-Moon
Published: July 2021

Background:
The World Health Organization (WHO) recommends exclusive breastfeeding from birth to 6 months, the introduction of nutritious complementary foods at 6 months and continued breastfeeding up to 2 years or above. A U-shaped association between duration of breastfeeding and systolic blood pressure (BP) or hypertension was reported. However, multiple studies have yielded inconsistent findings.

Method:
Among subjects who participated in the Korea National Health and Nutrition Examination Survey conducted in 2010-2012, a total of 5,011 parous female, aged over 19 years old were analyzed. Hypertension was defined based on JNC 8 guidelines, or a self-reported current use of antihypertensive medications. Based on the JNC 8 criteria, for patients 60 years of age or older who did not have diabetes or chronic kidney disease, a blood pressure goal of less than 150/90 mmHg was the target goal or diagnosis. The blood pressure goal of diagnosis and control is less than 140/90 mmHg for patients 18 to 59 years of age without major comorbidities, and those 60 years of age or older who had diabetes, chronic kidney disease, or both conditions. We divided the duration of breast feeding into none, less than 6 months, less than 1 year and more than 6 months, less than 2 years and more than 1 year, and more than 2 years.

Results:
The distribution of systolic and diastolic BP and hypertension prevalence showed U-shape pattern in non-obese women (BMI < 25 kg/m
2
). Those who breastfed less than 6 months had the lowest blood pressure (123.7±1.1 mmHg for mean systolic BP and 74.2±0.7 mmHg for mean diastolic BP; P=0.06), as well as the lowest prevalence of hypertension (14.6%; P < 0.001) in non-obese women. With increasing duration of breastfeeding, no specific trend was observed in obese women. In non-obese women with BMI < 25 kg/m
2
, compared to women with duration of breast feeding less than 6 months, the odds of hypertension was significantly higher in women with breast feeding more than 2 years in women with [odds ratio (OR): 1.72, 95 % confidence interval (CI): 1.10-2.70], after adjusting for age, body mass index, smoking, drinking alcohol, exercise, income, and education. However, there was no significant association between duration of breastfeeding and hypertension control.

Conclusion:
Our findings suggest that longer duration of breastfeeding might not protect against hypertension in later ages. Previously,breast feeding could be helpful to mother after delivery to normalize her body weight, metabolic panel derangement, however, longer duration of breast feeding especially in non-obese women would not contribute to hypertension prevention. Further prospective studies are warranted to confirm this association.
Abstract P278: Potential Value of Long-term Intensive BP Treatment in 40-year Patients: A Computer Simulation Study
Authors: Thanataveerat Anusorn , Kohli-Lynch Ciaran N , Vittinghoff Eric , Pletcher Mark J , Moran Andrew E
Published: July 2021

Introduction:
Intensive blood pressure (BP) goals are considered for high cardiovascular disease (CVD) risk adults ≥50 years old; the long-term value of intensive BP goals in younger high CVD risk patients has not been studied.

Objectives:
We used individual patient computer simulations to assess the incremental value of intensive BP goals in high CVD risk patients as young as 40 years.

Methods:
Six age/sex cohorts of 100,000 individuals were assembled by sampling NHANES surveys 1999-2010. BP and other risk factor trajectories were projected from ages 60 to 69, 50 to 69, and 40 to 69 years based on Framingham Offspring Cohort analyses. One BP treatment scenario simulated treating BP <140/90 mmHg in all patients ≥140/90; a second scenario added to the first a goal <BP 130/90 mmHg in patients with systolic BP ≥130 and 10-year CVD risk ≥10%. Costs included added treatment and side-effect costs and avoided CVD costs. Incremental cost-effectiveness ratios (ICERs) assessed changes in costs and quality-adjusted life years due to adding intensive BP goals in each cohort.

Results:
Intensive goals were generally cost-effective in high-risk CVD risk patients (Table). Treating 40-year old cohorts was the highest value strategy. This was because of large life-year gains when events are prevented early in life and because hypertensive 40 year-olds “age into” much higher BPs and CVD risk over time. To illustrate the latter, mean untreated systolic BPs at age 60 were 152, 148, and 146 mmHg, and mean 10-year CVD risk scores were 17%, 15% and 13% for 40-, 50- and 60-year-old male cohorts, respectively.

Conclusion:
Intensive BP goals were projected to be cost-effective over a 30-year time horizon in high-risk hypertensive patients as young as 40 years old.
Abstract P282: Potato Consumption, Average Blood Pressure, and the Incidence of Hypertension in 2 Mediterranean Cohorts
Authors: Hu Emily A , Martínez-González Miguel A , Salas-Salvadó Jordi , Corella Dolores , Ros Emilio , Fitó Montse , Gomez-Gracia Enrique , Estruch Ramon , Arós Fernando , Fiol Miquel , Lapetra José , Serra-Majem Lluís , Pintó Xavier , Ruiz-Canela Miguel , Razquin Cristina , Bullo Monica , Sorlí Jose V , Schröder Helmut , Rebholz Casey , Toledo Estefania
Published: July 2021

Objectives:
To assess the association between potato consumption, blood pressure changes and the risk of hypertension in two Mediterranean populations.

Design:
Separate analyses were performed in the PREDIMED (PREvención con DIeta MEDiterránea), a multicenter nutrition intervention trial, and the SUN (“Seguimiento Universidad de Navarra”) project, an open, prospective cohort, both in Spain.

Participants:
The PREDIMED trial included 6,940 participants aged 55-80 years at high risk for cardiovascular disease. The SUN project included 13,837 middle-aged participants who were university graduates.

Main outcome measures:
In PREDIMED, generalized estimating equations adjusted for lifestyle and dietary characteristics were used to assess changes in blood pressure across quintiles of total potato consumption during a 4-year follow-up. Controlled blood pressure levels during follow-up were also assessed. For SUN, multivariable-adjusted hazard ratios (HR) for incident hypertension during an average 6.7-year follow-up were calculated.

Results:
In PREDIMED, the mean (SD) total potato intake was 81.9 (40.6) g/day. No overall significant differences in blood pressure changes were detected based on consumption of potatoes. For total potatoes, the mean change in systolic BP after multivariate adjustment was quintile 5 (Q5) vs. quintile 1 (Q1): -0.90, 95% CI: (-2.56 to 0.76) mmHg, p for trend=0.14 and for diastolic BP it was Q5 vs. Q1: -0.02, 95% CI: (-0.93 to 0.89) mmHg, p for trend=0.81. In SUN, the mean (SD) total potato consumption was 52.7 (33.6) g/day and no significant association between potato consumption and hypertension incidence was observed: HR: for total potato consumption, Q5 vs. Q1: 0.98, 95% CI: (0.80 to 1.19), p for trend=0.84.

Conclusions:
Potato consumption is not associated with changes in blood pressure or risk of hypertension in Mediterranean populations and this might be explained by relatively low consumption of potatoes and characteristics of the traditional Mediterranean diet, particularly the custom of accompanying potatoes with vegetables or legumes and dressing them with olive oil.
Abstract P285: Small Dose of Medium Chain Fatty Acids From Coconut Oil Does Not Enhance Thermogenesis in Overweight Adolescents
Authors: LaBarrie Janna , St-Onge Marie-Pierre
Published: July 2021

Background:
Previous research has shown that consumption of medium chain triglycerides (MCT) in overweight adults can increase energy expenditure and improve weight management, but no research has been done in children. Our study tests the effects of a test oil enriched in MCT from coconut oil, on energy expenditure, satiety, and metabolic markers in overweight and obese adolescents.

Methods:
We conducted a randomized, double blind, crossover study in which 15 children, age 13-18 y, with a body mass index >85
th
percentile for age and sex, were enrolled. Two test meals were administered which contained 20 g of fat from either corn oil or an MCT-enriched baking fat (providing approximately 4.7 g of fatty acids with chain lengths ≤12C). A fasting blood sample was taken before breakfast and the thermic effect of food (TEF) was assessed using indirect calorimetry for 6 h. During the test, satiety was measured using visual analog scales (VAS) and additional blood samples were obtained from an intravenous catheter at times 30, 45, 60, 120, and 180 min post-meal for measurement of hormones and metabolites.

Results:
There was no significant effect of fat type, time, or fat type x time interaction on TEF, appetite and satiety, glucose, and insulin area under the curve (AUC). However, there was a significant effect of fat type on leptin (P = 0.027), triglycerides (P = 0.020), and peptide YY (P = 0.0085) whereby leptin and triglyceride concentrations were lower with corn oil consumption and peptide YY concentrations were higher.

Conclusions:
Our results do not suggest that this MCT-rich test oil enhances thermogenesis and satiety in children. Given that this is the only current study of its kind, more research is needed into the use of MCT as a tool in weight management in overweight and obese children.
Abstract P290: Predicting the Change in the Omega-3 Index with Data from 9 Supplementation Studies
Authors: Jackson Kristina H , Walker Rachel , Shearer Gregory C , Harris William S
Published: July 2021

The omega-3 index (O3I; erythrocyte EPA+DHA % of total fatty acids) is directly associated with favorable cardiovascular and cognitive outcomes. In spite of its utility as a biomarker of omega-3 status, there remains unexplained variability in its response to EPA+DHA supplementation. De-identified data (n=841) from 9 published intervention studies were used to predict changes in the O3I. All studies provided data on EPA+DHA supplementation dose and duration, pre- and post-O3I values, and standard demographic factors. Stepwise regression analysis was performed to select variables and create a predictive model, using % change as the outcome variable. The mean age and weight of the participants was 48 ± 16 years and 83 ± 18 kg (BMI: 29 ± 5). The cohort was 49% (n=409/841) male and 86% (n=722/841) white. Treatment groups took an average of 2115 ± 1048 mg/day of EPA+DHA (range: 300 - 3600 mg/day; placebo groups took 0 mg/day) for 11.5 ± 4.0 weeks (range: 4 - 20 weeks). The O3I increased from 5.28 ± 1.58% to 9.27 ± 2.59% in the supplemented individuals (n=434), and was unchanged in the placebo groups (5.30 ± 1.52% to 5.30 ± 1.50%; n=407; P<0.0001). Variables that were selected into the model were age, sex, weight, dose of DHA, dose of EPA, duration, baseline O3I and an interaction between weight and age. The model R
2
was 0.75 and the root mean square error was 0.18. The correlation between the predicted and observed O3I changes was 0.84 (P<0.0001; Figure). The model predicts individual changes in the O3I with reasonable accuracy, and may be useful for selecting the appropriate supplemental EPA+DHA doses and duration for clinical research studies that aim to reach a target O3I level.
Abstract P299: Resistance Exercise and Obesity Prevention
Authors: Lee Duck-chul , Lavie Carl , Sui Xuemei , Blair Steven
Published: July 2021

Introduction:
Obesity is a significant cardiovascular disease (CVD) risk factor. There is still little evidence, however, on the effects of resistance exercise (RE), independent of and combined with aerobic exercise (AE), on the development of obesity.

Hypothesis:
We hypothesised that RE, independent of AE, has significant benefits in obesity prevention.

Methods:
Participants were 12,583 men and women aged 18 to 89 years (mean age, 47) who received a preventive medical examination during 1987-2005 in the Aerobics Center Longitudinal Study. Participants were free of CVD, cancer, and obesity at baseline. RE, AE, and meeting the 2008 US Physical Activity Guidelines (RE ≥2 days/week and AE ≥500 MET-minutes/week) were determined by self-reported leisure-time exercise. Obesity was defined as body mass index of ≥30 mg/kg
2
using measured weight and height. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident obesity by RE levels after adjusting for baseline age, sex, examination year, current smoking, heavy alcohol drinking, and meeting the AE guidelines.

Results:
During an average follow-up of 5.6 years, 919 (7.3%) developed obesity. Individuals meeting the RE guidelines (26%) had a 20% lower risk of developing obesity (HR: 0.80; 95% CI: 0.68 to 0.94) after adjusting for potential confounders and meeting the AE guidelines. The HRs (95% CIs) of incident obesity were 0.80 (0.60-1.05), 0.68 (0.52-0.88), 0.92 (0.68-1.26), and 0.84 (0.62-1.13) in weekly RE time of 1-59, 60-119, 120-179, and ≥180 minutes/week, respectively, compared with no RE. We found similar results in both men and women. In the combined analysis of RE and AE, HRs (95% CIs) of incident obesity were 0.65 (0.46-0.92) in meeting RE guidelines only, 0.72 (0.62-0.83) in meeting AE guidelines only, and 0.61 (0.51-0.73) in meeting both RE and AE guidelines, compared to meeting none of the guidelines.

Conclusions:
We found that RE, independent of and combined with AE, is associated with significantly lower risk of developing obesity, suggesting that RE should be added to habitual physical activity.
Abstract P318: Wide State-By-State Variation in Maternal Mortality and Chronic Diseases That Contribute to Pregnancy Complications
Authors: Milder Sarah , Kenealy Jamie , Honors Mary Ann , Eckstein Thomas
Published: July 2021

Background:
Among developed countries, the United States has the highest maternal mortality rate. Between 1987 and 2011, the US maternal mortality rate more than doubled from 7.2 to 17.8 deaths per 100,000 live births. More than 1,300 pregnancy-related deaths occurred in the United States in 2011-2012. Additionally, an increasing number of women have chronic health conditions, such as hypertension, diabetes, and chronic heart disease, that increase their risk of pregnancy complications, including maternal mortality. Reducing the prevalence of these diseases may be an important step toward reducing maternal mortality. To examine the current state of maternal mortality and chronic diseases in the United States, the geographical variation of these factors was examined.

Methodology:
State-level prevalence estimates were calculated for diabetes, heart disease, and hypertension awareness among women of reproductive age (18 to 44 years) using data from the 2013-2014 Behavioral Risk Factor Surveillance System. State-level maternal mortality rates were calculated using CDC’s 2010-2014 National Vital Statistics System. Maternal mortality was defined as the number of deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 live births.

Results:
The maternal mortality rate is 6.8 times higher in Georgia (39.3 deaths per 100,000 live births) than in Massachusetts (5.8 deaths per 100,000 live births). Nationally, there are an estimated 19.9 maternal deaths per 100,000 live births. The prevalence of chronic diseases that increase risk of pregnancy complications also vary by state. For example, diabetes (excluding gestational diabetes) ranges from a low of 1.9% of women aged 18 to 44 in Alaska, Minnesota, and Wisconsin to a high of 4.8% in Alabama. Nationally, an estimated 3.1% of women aged 18 to 44 have been told by a doctor that they have diabetes.

Conclusion:
The prevalence of chronic diseases in women of reproductive age vary based on state of residence, as does the maternal mortality rate. Raising awareness about the variation in these measures is an important step toward identifying what strategies are being utilized in states with a low prevalence of diabetes, heart disease, and hypertension, and determining how their public health efforts may help those states facing challenges in these areas.
Abstract P322: The Association Between Parity and Sleep Duration: a Study From the AHA Go Red for Women Strategically Focused Research Network (SFRN)
Authors: Bello Natalie A , Catov Janet , Aggarwal Brooke
Published: July 2021

Background:
Prior research has shown a J shaped association between parity and increased risk of cardiovascular disease (CVD), and several confounding factors have been identified. Sleep is emerging as an important, potentially modifiable risk factor for CVD, however few data have examined the relationship between parity and sleep.

Methods:
We studied 50 women in the AHA Go Red for Women Strategically Focused Research Network who provided information on pregnancy history and sleep patterns [56% non-white (n=28), mean age = 41±18 y]. The Pittsburgh Sleep Quality Index was used to assess sleep duration and quality, and the Insomnia Severity Index was used to assess level of insomnia. Parity was assessed using a standardized questionnaire as any pregnancies lasting > 6 mo. We used linear and logistic regression to examine the cross-sectional relation between sleep (duration, quality, and insomnia severity) and parity.

Results:
Prior pregnancy was reported in 32% (16 of 50) women and 36% (18 of 50) sleep ≤ 6 h/night. Parous women were significantly older (55 vs 34 y), more likely to have a BMI ≥25 kg/m
2
, HTN, and hyperlipidemia compared to nulliparous women. Sleep duration was significantly shorter in parous women (6 h vs 7 h), and the relationship remained significant for primiparous women (1 birth) after adjustment (
Figure
). More than half of parous women reported poor sleep quality (56%, 9 of 16) and insomnia (63%, 10 of 16) compared to 29% of nulliparous women (10 of 34) who reported each sleep disorder. After adjustment for age, there was no difference in sleep quality or insomnia between groups (p>0.05).

Conclusion:
In a diverse cohort of women, sleep duration was inversely related to parity. Primiparous women may be at heightened risk for the adverse cardiometabolic consequences of inadequate sleep duration, and may represent a teachable moment for CVD prevention. Ongoing studies to examine the relationship between sleep and pregnancy may provide important information on the pathways through which these risk factors modify future CVD.
Abstract P323: Cardiac Rehabilitation is Associated With Decreased Mortality in HIV Patients With Cardiovascular Disease
Authors: Bachmann Justin M , Kundu Suman , So-Armah Kaku , Justice Amy , Sico Jason , Marconi Vincent , Warner Alberta , Butt Adeel , Oursler Kris Ann , McGinnis Kathleen , Freiberg Matthew
Published: July 2021

Background:
Human immunodeficiency virus (HIV+) patients are at high risk for cardiovascular disease (CVD). While cardiac rehabilitation (CR) reduces mortality in uninfected (HIV-) patients with CVD, there are no specific data on CR use in CVD patients with HIV.

Methods:
We analyzed data on 7650 veterans (28.4% HIV+) eligible for CR from the Veterans Aging Cohort Study, an observational cohort of HIV+ and HIV- veterans. CR eligibility was defined as a hospitalization for acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, or cardiac valve surgery from 2003-2012, identified using ICD9 and CPT codes. CR use was ascertained from VA and non-VA facilities within one year of discharge from the index CVD hospitalization using CPT codes. We evaluated the association between CR and mortality after adjusting for age, eligibility diagnosis, race, sex, and comorbidities using Cox proportional hazard models.

Results:
CR use was low in HIV+ and HIV- veterans (9.1% vs. 9.6%, respectively, p=0.06). Among the 7650 CR eligible veterans, there were 2211 deaths over 25,715 person-years of follow-up. Mortality rates were higher among those who did not receive CR, regardless of HIV status (Figure). In adjusted models stratified by HIV status, CR was associated with a significant reduction in mortality for HIV+ (hazard ratio [HR] 0.39, 95% confidence interval [CI] 0.26-0.59) and HIV- veterans (HR 0.52, 95% CI 0.42-0.65). Among those receiving CR, HIV was not associated with an increased risk of mortality (Figure) even after adjusting for confounders (HR 1.01, 95% CI 0.63-1.61).

Conclusions:
CR utilization in both HIV+ and HIV- veterans is low. Participation in CR programs is associated with a significant reduction in mortality, regardless of HIV status. When CR is utilized, however, the risk of mortality is the same for HIV+ and HIV- veterans. CR may be particularly important for reducing mortality in HIV+ patients with CVD.
Abstract P326: Myocardial Ischemia and Mobilization of Circulating Progenitor Cells
Authors: Hammadah Muhammad , Samman Tahhan Ayman , Almheid Ibhar , Kindya Bryan Ross , Ghafeer Mazen , Abdelhadi Naser , Levantsevych Oleskiy , Alkhoder Ayman , O’Neal Wesley , Obideen Malik , Mohamed Kelli Heval , Sulivan Samaah , Wilmot Kobina , Ramadan Ronnie , Pimple Pratik , Sandesara Pratik , Raggi Paolo , Shah Amit J , Kim jinhee , Waller Edmund K , Garcia Ernest V , Pearce Brad , Sheps David , Quyyumi Arshed , Vaccarino Viola
Published: July 2021

Background:
Circulating progenitor cells (CPCs) are involved in vascular repair and regeneration. Low levels of CPCs in patients with CAD have been linked to adverse cardiovascular outcomes. The response of CPCs to transient myocardial ischemia in patients with CAD has not been studied before. We aimed to investigate the CPC response to exercise provoked myocardial ischemia (demand ischemia), and compare it to myocardial ischemia detected during pharmacological stress test (flow mismatch).

Methods:
570 patients with stable CAD underwent 99mTc sestamibi myocardial perfusion imaging during exercise (69%), or pharmacological stress (31%). myocardial ischemia was defined as a new or worsening impairment in myocardial perfusion using a 17-segment model. CD34+ CPCs were enumerated by flow cytometry at rest and 30 min after stress testing. The change in CPC count was compared between patients with and without myocardial ischemia using mixed linear models.

Results:
Mean age was 63±9 years, 76% males, 36% with previous myocardial infarction. The incidence of myocardial ischemia was 31% and 41% during exercise and pharmacological stress test, respectively. No difference was observed in resting CPC between patients undergoing exercise vs pharmacological stress test, nor between patients with or without myocardial ischemia. However, patients who developed myocardial ischemia during exercise stress had a significant decrease in CPC with stress in comparison to those without myocardial ischemia (-12% vs 4%, respectively, p=0.006). Furthermore, the change in CPCs was inversely correlated with the magnitude of myocardial ischemia (R=-0.13, p=0.023), suggesting a greater CPC reduction with larger ischemic burden. These findings remained significant even after adjustment for age, gender, race, BMI, previous myocardial infarction, resting levels of CPCs and hematocrit change with stress. No difference was observed in CPC response to pharmacological stress test (change of -1% vs 3%, for patients with and without myocardial ischemia, respectively, p=0.96).

Conclusion:
Exercise stress-induced myocardial ischemia is associated with a decrease in CPC counts, likely due to increased homing of stem cells to the ischemic myocardium. Whether the extent of CPC uptake has prognostic implication, or whether the CPC response can be altered with intervention needs further investigation.