bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract MP73: Geographic Variation of Overweight and Obesity among Women in Sub-Saharan Africa: a Case Study of Nigeria
Authors: Stranges Saverio , Kandala Ngianga-Bakwin
Published: July 2021

Background:
Nutritional research in sub-Saharan Africa has primarily focused on under-nutrition, particularly among vulnerable population subgroups such as women and children. However, there is growing evidence of an ongoing epidemiological and nutritional transition in these settings.

Objective:
This study aimed to examine the geographic variation of combined overweight and obesity prevalence at the state-level among women in Nigeria, while accounting for individual-level risk factors.

Methods:
Our analysis was based on the 2008 Nigerian Demographic and Health Survey (NDHS), including 27,967 women aged 15 and over. Individual data were collected on socio-demographic variables, but were aggregated to the 31 states. We used a Bayesian geo-additive mixed model to map the geographic distribution of overweight/obesity at the state-level, accounting for individual-level risk factors.

Results:
The overall prevalence of combined overweight and obesity (body mass index ≥ 25) was 20.9%. In multivariate Bayesian geo-additive models, there were several significant associations between socio-demographic variables and prevalence of overweight/obesity. Specifically, higher education [odds ratio (OR) & 95% Credible Region (CR): 1.68 (1.38, 2.00)], higher wealth index [3.45 (2.98, 4.05)], living in urban settings [1.24 (1.14, 1.36)] and increasing age were all significantly associated with a higher prevalence of overweight/obesity. There was also a striking variation in overweight/obesity prevalence across ethnic groups and state of residence, the highest being in Cross River State, in south-eastern Nigeria [2.32 (1.62, 3.40)], the lowest in Osun State in south-western Nigeria [0.48 (0.36, 0.61)].

Conclusions:
This study suggests distinct geographic patterns in the prevalence of combined overweight and obesity among Nigerian women, as well as the potential role of demographic, socio-economic and environmental factors driving the ongoing nutritional transition in these settings.
Abstract MP80: Increased Physical Fitness Is Associated With Greater Improvement In Cardiac Parasympathetic Function Among The Obese Than Overweight Or Normal Weight Individuals
Authors: Aneni Ehimen , Oni Ebenezer , Roberson Lara , Meneghelo Romeu , Blaha Michael , Blumenthal Roger , Post Janisse , Agatston Arthur S , Feldman Theodore , Conceiçao Raquel D , Carvalho Jose , Santos Raul D , Nasir Khurram
Published: July 2021

Introduction:
The impact of physical fitness on heart rate recovery (HRR), a marker of cardiac parasympathetic activity, has rarely been studied across weight categories. We examined the effect of physical fitness across different weight categories on HRR at 2 minutes after exercise stress test in an asymptomatic cohort.

Methods:
This is a cross-sectional analysis of 525 Brazilian subjects, free of known cardiovascular disease that underwent exercise stress test. Metabolic equivalents at maximal exercise (METS) were calculated from the volume of oxygen consumed during maximal exercise (VO2max). HRR was defined as peak exercise HR minus HR after 2minutes rest. Weight was classified into obese (BMI ≥ 30), overweight (BMI 25 -29) and normal weight (BMI <25).

Results:
The prevalence of overweight and obesity was 51% and 19% respectively. There was a positive significant correlation between METS and HRR (r= 0.34 p<0.001). The mean HRR was higher among the normal weight than the overweight or obese (92 vs. 89 vs.76 beats; p<0.001) while the average (mean) METS decreased across increasing weight categories (10.6 vs. 10.4 vs. 9.1 METS; p <0.001). In a fully adjusted linear regression model, for every unit increase in METS the HRR increased by 2.0 beats among the obese (p<0.005), 1.1 beats among the overweight (p<0.001) and 0.8 beats among the normal weight (p=0.143). These increases were significantly different among the 3 groups (p<0.001). Line fitted plots (figure below) showed that the increase in HRR associated with increasing METS was greater among the obese than the other weight groups and at high METS value (about 13 METS) the HRR are similar regardless of BMI.

Conclusion:
Our findings suggest that increasing fitness increases HRR, with greater benefit in the obese than other weight groups. Physical fitness, not simply weight loss, should be advocated in the obese. More studies are required to fully understand the temporal relationship between BMI, physical fitness and HRR.
Abstract P004: Impact of Atrial Fibrillation on Healthcare Utilization in the Community: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Smith Lindsay G , Lutsey Pamela L , Loehr Laura R , Kucharska-Newton Anna , Chen Lin Y , Chamberlain Alanna M , Wruck Lisa M , Duval Sue , Stearns Sally C , Alonso Alvaro
Published: July 2021

Background:
Atrial fibrillation (AF) is associated with increased risk of hospitalization. However, little is known about the impact of AF on non-inpatient healthcare utilization or about sex or race differences in AF-related utilization. We examined rates of inpatient and outpatient utilization by AF status in the Atherosclerosis Risk in Communities (ARIC) study.

Methods and Results:
ARIC cohort participants with incident AF enrolled in fee-for-service Medicare, Parts A and B, for at least 12 continuous months between 1991 and 2009 were matched on age, sex, race and center to up to three participants without AF. Healthcare utilization was ascertained from inpatient and outpatient Medicare claims and classified based on primary ICD-9 code. The analysis included 944 AF and 2,761 non-AF participants. The average number of days hospitalized per year was 13.1 (95% confidence interval [CI]: 11.5-15.0) and 2.8 (95% CI: 2.5-3.1) for those with and without AF, respectively. The corresponding number of outpatient claims per year was 53.2 (95% CI: 50.4-56.1) and 23.0 (95% CI: 22.2-23.8) for those with and without AF, respectively (Table). Most utilization in AF patients was attributable to non-AF conditions, particularly other-cardiovascular disease (CVD)-related reasons; the adjusted rate ratio for days hospitalized per year for other-CVD-related reasons was 4.76 (95% CI: 3.51 - 6.44) for those with compared to those without AF. There was suggestive evidence that sex modified the association between AF and inpatient utilization, with AF related to greater utilization in women than men. The association between AF and healthcare utilization was similar in whites and blacks.

Conclusions:
This study highlights the considerably greater healthcare utilization (inpatient and outpatient) among those with AF; the differential in utilization due to other-CVD-related reasons was substantial. In addition to recommended heart rate or rhythm treatment, accompanying cardiovascular comorbidities should be evaluated and managed.
Abstract P010: Cardiac Risk Factors and 6-Year Change in high-sensitivity Cardiac Troponin-T.
Authors: McEvoy Bill , Lazo-Elizondo Mariana , Shen Lu , Nambi Vijay , Hoogeveen Ron , Ballantyne Christie , Blumenthal Roger , Coresh Josef , Selvin Elizabeth
Published: July 2021

Introduction:
Troponin measured with a highly sensitive assay (hs-cTNT) can detect subclinical myocardial injury and may be useful for risk stratification. However, little is known about temporal changes in hs-cTNT in the general population.

Hypothesis:
Traditional cardiac risk factors will predict change in hs cTNT.

Methods:
We analyzed data from 8698 ARIC Study participants, free of cardiovascular disease, who had hs-cTNT measured at visit 2 (1990-1992) and visit 4 (1996-1998). Hs-cTNT was categorized as: undetectable (<5 ng/L), detectable (5-14 ng/L), and elevated (≥14 ng/L). We examined the association of baseline Framingham Risk Score (FRS) groups (low <10%, intermediate 10-20%, high >20%) and individual cardiac risk factors with change across hs-cTNT categories using Poisson regression and with absolute 6-year change using robust linear regression.

Results:
Over 6 years, 2124 study participants went from undetectable to detectable or elevated hs-cTNT and 353 went from detectable to elevated hs-cTNT. The mean crude 6-year hs-cTNT change (SD) within FRS groups were; low (+1.3 (6.0) ng/L), intermediate (+2.3 (9.3) ng/L), and high (+3.7 (8.3) ng/L). Higher baseline FRS was associated with an increase in hs-cTNT over 6 years (
Table
). This association was stronger for incident detectable hs-cTNT than for progression from detectable to elevated. Major predictors of change were baseline age, male gender, diabetes and hypertension. Black race/ethnicity and obesity were also associated with categorical hs-cTNT change. In addition to HDL-c, baseline hypercholesterolemia and smoking may be associated with downwards hs-cTNT change.

Conclusions:
Framingham Risk Score was positively associated with 6-year hs-cTNT change in middle-age adults. The modifiable risk factors primarily driving this association were diabetes, hypertension, and obesity. Additional studies are needed to evaluate if modifying these risk factors can prevent progression of subclinical myocardial damage.
Abstract P014: Clinically Significant Novel Biomarkers for Prediction of First-ever Myocardial Infarction-The Tromsø Study
Authors: Wilsgaard Tom , Mathiesen Ellisiv B , Schirmer Henrik , Lochen Maja-Lisa , Bonaa Kaare H , Hamren Sarah , Rowe Michael W , Sudduth-Klinger Julie , Patwardhan Anil , Njolstad Inger
Published: July 2021

Background:
Identification of individuals with high risk for first-ever myocardial infarction (MI) can be improved. The objectives of the study ere to survey multiple protein biomarkers for association with the 5-year risk of incident MI and identify a clinically significant risk model that adds information to current common risk models.

Methods:
We employed an immunoassay platform that utilizes a sensitive, sample efficient molecular counting technology to measure 51 proteins in samples from the fourth survey (1994) in the Tromsø Study, a longitudinal study of men and women in Tromsø, Norway. A nested case control design was used with 182 first-ever MI cases (60 females/122 males) and 467 controls (277 females/190 males).

Results:
Of the proteins measured, 21 were predictors of MI before and after adjustment for traditional risk factors either in men, women or both. In stepwise multivariable analysis with these biomarkers and traditional risk factors, kallikrein; OR 0.58 (95% CI 0.47 - 0.71), matrix metalloproteinase 8; OR 1.41 (1.13 - 1.75), the interaction term CCL5/RANTES*women; OR 0.57 (0.44 - 0.74), the interaction term apolipoprotein B/apolipoprotein A1 ratio*men; OR 1.53 (1.27 - 1.84) and lipoprotein a; OR 1.33 (1.10 - 1.61) added significantly to the model with a net reclassification improvement of 0.10 (p=0.01), while the ROC area increased from 0.77 to 0.83, p<0.001.

Conclusion:
Novel protein biomarker models improve identification of MI risk above and beyond traditional risk factors with more than 10% better allocation to either high or low risk group than traditional risk factors alone.
Abstract P025: Associations of Fetuin-A with Incident Heart Failure in Participants with and without Diabetes and Insulin Resistance: The Cardiovascular Health Study
Authors: Forbang Nketi I , Bartz Traci M , Mukamal Kenneth J , Djousse Luc , Kizer Jorge R , Zieman Sue J , Siscovick David S , Jensen Majken K , Shlipak Michael , Ix Joachim H
Published: July 2021

Background:
In animal models, the hepatic secretory protein fetuin-A simultaneously inhibits arterial calcification and causes insulin resistance. Increased calcification and insulin resistance lead to arterial stiffness, an important risk factor for heart failure (HF). The relationship between serum fetuin-A concentrations and HF, and whether it is modified by diabetes or insulin resistance has not been extensively studied.

Research Design, Methods, and Objectives:
In a prospective study of 4182 community-dwelling participants aged ≥ 65 years, Cox proportional hazards models were used to determine the association of fetuin-A (measured in 1992) with incident HF (followed up through June 2008). Multiplicative interaction terms determined whether diabetes or insulin resistance status modified the association.

Results:
Mean age was 75 ∓ 5 years, fetuin-A levels were 0.47 ∓ 0.10 g/L, and 1,186 incident HF events occurred during follow-up. In multivariable models adjusting for demographics and CVD risk factors, fetuin-A was not significantly associated with incident HF [HR per SD fetuin-A: 0.97, 95% CI (0.91, 1.04), p-value=0.40] and was not modified by prevalent diabetes status (p-interaction=0.54). However, when prevalent insulin resistant status was defined as previously by the presence of diabetes, or HOMA IR > median (2.22), or obesity (body mass index, kg/m
2
> 30), a significant interaction was observed (p-interaction=0.03). In 1,679 participants with no evidence of insulin resistance by the definition, each SD greater fetuin-A level was associated with a 12% lower risk of HF (95% CI: 2-22%) in a fully adjusted model (Table 1).

Conclusions:
Future studies should consider the presence of insulin resistance when evaluating the relationship between serum fetuin-A with adverse health outcomes.
Abstract P029: Is Non-Ischemic Cardiomyopathy (NICM) Associated With Better Prognosis Than Ischemic Cardiomyopathy (ICM) in Heart Failure Patients?
Authors: Gajanana Deepakraj , Romero-Corral Abel , Shah Mahek , Junpapart Parichart , Figueredo Vincent M , Bozorgnia Behnam
Published: July 2021

Background:
Past data suggest ischemic cardiomyopathy (ICM) is associated with worse prognosis when compared to non-ischemic cardiomyopathy(NICM). With advances in heart failure management, this relationship deserves a fresh look. We hypothesize that all cause mortality from NICM is lower when compared to ICM over five year period.

Methods:
We retrospectively studied consecutive heart failure patients with left ventricular ejection fraction(EF) less than 35% admitted to Einstein Medical Center Philadelphia between 01/01/2007 to 12/31/2007. Data pertaining to patient demographics and clinical characteristics were obtained. All cause mortality was obtained at 5 years using hazard ratio to account for time to event.

Results:
The final cohort consisted of 360 patients of which 63%(224 of 360) had NICM. Mean age was 61±16 years for NICM and 66±11 yrs for ICM. African Americans constituted 83%(185 of 224) of NICM and 59%(80 of 136) of ICM. The clinical characteristics are as shown in the table. There were 160 deaths over the follow up period. Age, CKD, dyslipidemia and EF were significant predictors of mortality. ICM cohort had 81 deaths out of 136(60%) as compared to 85 out of 185((39%) in NICM over the follow up period. However, when adjusted for age, DM, CKD and days of follow-up, there was no statistically significant difference in mortality between the two groups over the five year follow up period.

Conclusions:
In this study, there was no significant mortality difference between ICM and NICM. We also found that despite advances in heart failure management in the last two decades, in clinical practice they are under-utilized.
Abstract P031: Multimorbidity in Heart Failure with Preserved and Reduced Ejection Fraction: A Community Study
Authors: Chamberlain Alanna M , Gerber Yariv , McNallan Sheila M , Dunlay Shannon M , Weston Susan A , Roger Veronique L
Published: July 2021

Background:
Multimorbidity is common in heart failure (HF), yet differences in co-morbid chronic conditions by type of HF (HF with preserved vs. reduced ejection fraction (EF)) are not well documented.

Methods:
We determined the prevalence and distribution of 25 chronic conditions by preserved vs. reduced EF among patients with incident HF enrolled in a community study from 9/2003-6/2012. HF was validated by the Framingham criteria, and an EF ≥50% defined preserved EF. Chronic conditions were identified within the 5 years prior to HF by codes defined by Centers for Medicare & Medicaid Services. Logistic regression determined associations of each comorbidity with type of HF (preserved vs. reduced EF) after adjusting for age and sex.

Results:
Among 668 incident HF patients (mean age 74±14, 51% male), the most common co-morbid conditions were hypertension, hyperlipidemia, and ischemic heart disease. Cataracts, rheumatoid arthritis/osteoarthritis, and anemia were also common, occurring in >1/3 of HF patients. On average, patients with preserved EF had 1 extra co-morbid condition compared to those with reduced EF (6 vs. 5, respectively). After adjusting for age and sex, comorbidities associated with HF with preserved EF include hypertension, hyperlipidemia, cataracts, rheumatoid arthritis/osteoarthritis, anemia, chronic kidney disease, chronic obstructive pulmonary disease, and depression, whereas a prior myocardial infarction was associated with presenting with reduced EF (figure). The remaining co-morbid conditions (including some not shown in the figure, such as breast, colorectal, lung, endometrial, and prostate cancer, and benign prostatic hyperplasia) were not associated with type of HF.

Conclusions:
HF patients presenting with preserved EF have more co-morbid chronic conditions compared to those with reduced EF. This excess comorbidity burden is important to characterize and understand as it may explain differences in outcomes and healthcare utilization between HF patients with preserved and reduced EF.
Abstract P036: Poor Nutritional Intake and Malnutrition in Obese Patients with Heart Failure
Authors: Evangelista Lorraine , Motie Marjan , Lennie Terry A
Published: July 2021

Introduction:
Poor nutritional status and unintentional cachexia have been shown to have a strong association with survival in patients with heart failure (HF). However, there is currently a paucity of research describing the dietary patterns of obese patients with chronic HF.

Objective:
This study was done to identify the food and nutrient intake of the Pro-HEART trial participants and compare participant intake to national guidelines.

Methods:
Pro-HEART is a clinical trial designed to evaluate the short-term and long-term effects of a high protein vs. standard protein diet on body weight and adiposity and other health outcomes in overweight and obese patients with HF, complicated with diabetes and/or metabolic syndrome. Baseline food consumption of 77 participants was analyzed using a validated 3-Day Food Record.

Results:
On average, the participants were 58.1±10.3 years, male (74%), married (65%), Caucasian (49%). The average energy intake was 1358.6 ± 478.9; 58% exceeded the recommended amount of percent calories from fat, 73% exceeded the saturated fat recommendation (of 10% of daily calories), and 92% consumed too much sodium. Only 40% consumed the recommended amount of daily calories from carbohydrates. On average, participants consumed 0.68 ± 0.21 gm/kg of protein; only 9% consumed at least 1 gm/kg of protein as recommended. Less than 50% met the minimum recommended servings for folate, vitamin E, calcium and sodium (see Table).

Conclusions:
Our findings showed that overweight and obese patients with HF exceeded recommended intake of fat, saturated fats, and sodium. Likewise, data suggest that overweight and obese patients with HF are at risk for poor nutritional intake of key micronutrients and minerals essential for reducing the inflammatory and metabolic abnormalities associated with HF and confirm that patients who do not appear cachectic may still be at risk for malnutrition. Thus, the risk for poor nutritional intake should be considered in all HF patients, regardless of whether they appear malnourished or not.
Abstract P040: HEALS Lifestyle intervention through African American churches to control hypertension
Authors: Dodani Sunita , Arora Sahel , Smotherman Carmen , Kraemer Dale
Published: July 2021

Objective:
African Americans (AAs) living in the “Stroke Belt” (Southeastern US including Northeast Florida) are at elevated risk for cardiovascular diseases (CVDs). An approach of proven efficacy is to target hypertension (HTN) as the major modifiable risk factor for CVDs, and to do so by evidence-based lifestyle changes. Here we present the findings of faith-based socio-culturally tailored HEALS HTN control program (modified from PREMIER and DASH diets), offered to AA church parishioners living in the food dessert areas of Duval County, Florida.

Methods:
Large urban church (membership > 400) volunteered for 9-month HEALS program. Four church members were trained as program leaders called CHAs-Church health Advisors, who after 10 hours of receiving training on HEALS session from PREMIER experts delivered weekly HEALS sessions to high-risk church members. 35 church members who were 25-75 year old, self-described AAs and HTN - as defined by JNC-7 were recruited. Farmer Market trucks from Clara White Mission supplied fresh fruits and vegetables (FFVs) at the church. Outcome measures included change in blood pressure (BP), weight and change in consumption of FFVs (measured by increases in purchases).

Results:
The study is ongoing. At baseline, 22% members were pre-HTN, 50% had Stage 1 HTN, and 22% with Stage 2 HTN. After receiving 12 wks HEALS program, mean reduction in systolic and diastolic BP were -14.6 mmHg (±14.3, p= 0.0002) and -6 mmHg (± 9.6, p=0.019) respectively. Mean weight reduction was -3.38 Kg (± 2.23, p<0.0001). For the first two months, the total FFVs sales increased from $97.50 in the first month to $117.50 in the second month. Majority of the sale was on fruits such as watermelons (60%).

Conclusion:
The translation and sustainability of evidence-based lifestyle modification in community-based settings is possible, particularly within churches, which represent the most influential institution in the community lives of AA
Abstract P044: Ten-Year Blood Pressure Trajectories and Long-Term Risk of Cardiovascular Mortality: The Minnesota Business and Professional Men Study
Authors: Tielemans Susanne M , Geleijnse Johanna M , Boshuizen Hendriek C , Soedamah-Muthu Sabita S , Menotti Alessandro , Jacobs David R , Blackburn Henry , Kromhout Daan
Published: July 2021

Introduction:
We characterised 10[[Unable to Display Character: ‑]]year trajectories of annual blood pressure (BP) measurements and studied the added value on long-term cardiovascular disease (CVD) mortality in comparison to a single baseline BP measurement.

Methods:
This study is based on data from 266 men, aged 45 to 55 years, who participated in the Minnesota Business and Professional Men Study. BP was measured annually between 1947[[Unable to Display Character: ‑]]1957, a time when only very high levels of BP were treated. Men who did not die before 1957 and did not have a history of myocardial infarction or stroke were included. We identified BP trajectories by means of finite mixture group-based trajectory modelling (PROC TRAJ in SAS). For each individual, time to death was defined as the difference in years between 1957 and year of death (the last man died in 2002). Cox proportional hazards analysis was used to examine BP trajectories in relation to CVD mortality.

Results:
All 266 men died and 142 (53.4%) from CVD, with mean (± sd) time to death 21±10 years. We identified four systolic BP trajectories with baseline mean systolic BP levels ranging from 112 (SBP1) to 165 (SBP4) mmHg. This difference of 53 mmHg in baseline systolic BP level was associated with a hazard ratio (HR) of 2.4 (95% CI: 1.5-3.8) for CVD mortality. From age 45 to 65, mean systolic BP levels of the four trajectories (Figure 1A) increased from 0.4 to 2.1 mmHg/year for SBP1 to SBP4. For systolic BP trajectories, the HR of CVD mortality increased from 1.6 (SBP2) to 4.2 (SBP4), compared to men in SBP1 (Figure 1A). A similar pattern was observed for diastolic BP (Figure 1B).

Conclusion:
In this population of middle[[Unable to Display Character: ‑]]aged US men, the increase in BP was strongest in those with the highest BP levels. Trajectories of BP predicted CVD mortality much better than a single BP measurement.
Abstract P048: The Association Between Apparent Treatment Resistant Hypertension and Low Mental and Physical Functioning, Depressive Symptoms, and Stress.
Authors: Bromfield Samantha , Shimbo Daichi , Diaz Keith , Booth John , Calhoun David , Irvin Ryan , Krousel-Wood Marie , Redmond Nicole , Oparil Suzanne , Muntner Paul
Published: July 2021

Apparent treatment resistant hypertension (aTRH) is associated with an increased risk of cardiovascular events. There are few data on the association between aTRH, health-related quality of life and psychological well-being. In the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=30,239), we evaluated the association between aTRH and low health-related quality of life, high stress, and depressive symptoms. Also, among those with aTRH we assessed the association of these psychological factors with all-cause mortality. Low mental and physical functioning were defined by SF-12 scores in the lowest quintile for the mental and physical component scores, respectively. High stress was defined as having a Cohen’s Perceived Stress score ≥ 7. Depressive symptoms were defined as having a Center for Epidemiologic Studies Depression score ≥ 4. aTRH was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg despite the use of 3 classes of antihypertensive medication or use of 4 or more classes of antihypertensive medication regardless of blood pressure level. Of the 13,961 REGARDS participants with hypertension included in this analysis 1,954 (14.0%) had aTRH. Low physical functioning was more common among those with versus without aTRH (Table 1). The prevalence of low mental functioning, high stress and depressive symptoms was not significantly different between those with and without aTRH. Among those with aTRH, low physical functioning and depressive symptoms were associated with all-cause mortality after multivariable adjustment [adjusted hazard ratio (95% CI), 1.34 (1.07-1.67); p=0.010 and 1.38 (1.04-1.85); p=0.029, respectively]. In contrast, low mental functioning and high stress were not associated with all-cause mortality. In summary, participants with versus without aTRH have a higher prevalence of low physical functioning, which was also associated with a higher mortality rate.
Abstract P050: Serum Fibroblast Growth Factor 23 and Incident Hypertension: The Atherosclerosis Risk in Communities Study
Authors: Fyfe-Johnson Amber L , Alonso Alvaro , Selvin Elizabeth , Agarwal Sunil K , Pankow James S , Bower Julie K , Lutsey Pamela L
Published: July 2021

Background:
Elevated serum fibroblast growth factor-23 (FGF23), an endogenous hormone, is associated with endothelial dysfunction, chronic kidney disease, arterial wall stiffness, and inflammation. These factors may contribute to an increased risk of hypertension. To date, the association of FGF23 with incident hypertension has not been examined.

Hypothesis:
Elevated serum FGF23 will be positively associated with risk of incident hypertension.

Methods:
The ARIC study measured intact FGF23 in stored serum from 7,948 middle-aged men and women without hypertension at baseline (1990-92). Participants were examined during two follow-up visits, in 1993-95 and 1996-98. Incident hypertension was determined by measured blood pressure (DBP 90 mm Hg, or SBP140 mm Hg) and/or hypertension medication use during the follow-up exams. Multivariate Cox proportional hazards regression models and complementary log-log models were used to adjust for potential confounding variables.

Results:
During a median follow-up of 5.9 years, 27% (2,152/7,948) participants developed hypertension. A nonlinear association between serum FGF23 and incident hypertension was observed; only the highest decile of serum FGF23 was positively associated with incident hypertension (Table). After adjustment for demographics, the hazard ratio for incident hypertension was 1.37 (95% CI: 1.17, 1.60) for the highest decile of FGF23 compared to the lowest quintile. After adjustment for behaviors and adiposity the HR was 1.25 (95% CI: 1.07, 1.46). The association was further attenuated in the final model after adjusting for renal function (HR: 1.20, 95% CI: 1.03, 1.41). Complementary log-log models that accounted for interval censoring did not alter results.

Conclusions:
High levels ( 60.6 pg/mL) of FGF23 are associated with a modestly increased risk of incident hypertension in the general population. Next steps include replication of these findings in other cohorts, and examining the association with a longer follow-up period.
Abstract P058: Cardiovascular Health Screening In 26,063 Adolescent Blood Donors
Authors: Gore Maria Odette , Eason Stephen J , Ayers Colby R , Berry Jarett D , Khera Amit , McGuire Darren K , de Lemos James A , Sayers Merlyn
Published: July 2021

Introduction and Objective:
Cardiovascular risk factors in adolescents track into adulthood and are associated with morbidity and early mortality. As part of a pilot health screening program implemented by Carter BloodCare, the largest independent blood program in Texas, we screened a large adolescent blood donor population for key cardiovascular risk factors.

Methods:
Blood pressure (SBP and DBP), total cholesterol and hemoglobin A1C (HbA1C) were measured in 26,063 volunteer high-school blood donors, 16-19 years of age, between 2011 and 2013. Cardiovascular risk factors were classified as high risk (SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg, cholesterol ≥ 200 mg/dL, HbA1C ≥ 6.5%) and intermediate or high risk (SBP ≥ 120 mm Hg and/or DBP ≥ 80 mm Hg, cholesterol ≥ 170 mg/dL, HbA1C ≥ 5.7%). The main study measures were the prevalence of 1, 2 or 3 risk factors within the same individual in the study population, with stratification by age, sex, race/ethnicity, and school district socioeconomic characteristics.

Results:
In the overall cohort, 66.5% of donors had at least one and 20.3% had at least two intermediate or high risk factors, and 15.3% had at least one high risk factor (Table). The percentage of donors in each non-zero category of intermediate or high risk factors increased with age (Ptrend<0.001), was higher in ethnic minorities (P<0.001 each for Asian, Black and Hispanic vs. White), and there were more boys than girls in all non-zero risk categories (P<0.001 for all). There were no statistically significant relationships between risk factor categories and socioeconomic characteristics (urban vs. rural and low-income vs. not low-income donor school district).

Conclusions:
The prevalence of cardiovascular risk factors among adolescent blood donors is common, with two or more concomitant risk factors identifiable in many donors. Blood donation programs may provide a unique portal for early screening and targeted preventive intervention in youth, with potential for cardiovascular disease prevention in the community.
Abstract P070: A Low Carbohydrate Diet from Plant or Animal Sources and Mortality Among Myocardial Infarction Survivors
Authors: Li Shanshan , Flint Alan , Pai Jennifer , Forman John P , Hu Frank B , Willett Walter C , Rexrode Kathryn M , Mukamal Kenneth J , Rimm Eric B
Published: July 2021

Background:
The healthiest dietary pattern for myocardial infarction (MI) survivors is not known. Specific long-term benefits of a low carbohydrate diet (LCD) is unknown, whether it mainly be from animal or vegetable sources.

Objective:
To examine the associations between post-MI adherence to a low carbohydrate diet (LCD), measured by a total, plant- and animal-based low carbohydrate diet score (LCDS), in relation to all-cause and cardiovascular mortality.

Design:
We included 2,258 women from the Nurses’ Health Study and 1,840 men from the Health Professional Follow-Up Study, who had survived a first MI during follow-up, provided pre-MI and at least one post-MI food frequency questionnaire (FFQ).

Results:
Adherence to a LCD high in animal sources of protein and fat was associated with higher all-cause and cardiovascular mortality (HR=1.31, 95% CI: 1.05-1.63 for all-cause mortality; HR= 1.49, 95% CI: 1.08-2.06 for cardiovascular mortality comparing extreme quintiles). An increase in adherence to an animal-based LCD prospectively assessed from the pre- to post-MI period was associated with higher all-cause mortality and cardiovascular mortality (HR=1.29, 95% CI: 1.03-1.63 for all-cause mortality; HR=1.53, 95% CI: 1.10-2.12 for cardiovascular mortality comparing extreme quintiles). An increase in adherence to a plant-based LCD was not associated with lower all-cause or cardiovascular mortality.

Conclusions:
Greater adherence to a LCD high in animal sources of fat and protein was associated with higher all-cause and cardiovascular mortality post-MI. We did not find a health benefit from greater adherence to an overall LCD post MI.
Abstract P071: Association Between Polyunsaturated Fat Consumption and Hypertension among Statin Users and Non-users
Authors: Kiage James N , Sampson Uchechukwu K , Lipworth Loren , Fazio Sergio , Yu Qilu , Munro Heather , Akwo Elvis A , Blot William J , Kabagambe Edmond K
Published: July 2021

Background:
Numerous prospective studies suggest inverse associations between intake of polyunsaturated fatty acids (PUFA) and cardiovascular outcomes. However, recent randomized studies have failed to demonstrate these benefits. One of the prevailing hypotheses is that the beneficial effects of PUFA may now be masked by the widespread use of statins, which lower lipids and blood pressure and are potent modulators of cardiovascular risk.

Hypothesis:
We tested the hypothesis that the association between PUFA and hypertension varies by statin use.

Methods and Results:
We conducted a cross-sectional analysis based on 74,658 black and white men and women in the Southern Community Cohort Study. Intake of PUFA was assessed by a food-frequency questionnaire, while history of diagnosed hypertension and statin use were self-reported. The mean±SD age was 52±9 years, body mass index was 30±8 kg/m
2
, and energy intake from PUFA was 8.0±1.8%. Sixty percent of the participants were women and 68% were African Americans. Hypertension (55%), statin use (16%), smoking (40%) and alcohol use (55%) were common in this cohort. In an adjusted logistic model with hypertension as the dependent variable, there was no interaction between PUFA intake and statin therapy (
P
=0.13), whereas a significant inverse association was evident between PUFA intake and hypertension among non-statin users (
P
for trend = 0.03) but not among statin users (
P
for trend = 0.36) (
Table
).

Conclusion:
In conclusion, these results support a beneficial effect of PUFA consumption on hypertension, which is only apparent in the absence of statin therapy. These findings underscore the need to stratify by statin therapy when randomizing participants to cardiovascular interventions and support the notion that PUFA may be important in cardiovascular risk reduction in patients where statin therapy is not an option.
Abstract P074: Caffeine Intake May be Associated with a Lower Risk of Type 2 Diabetes in the Physicians’ Health Study and Meta-Analysis
Authors: Matsumoto Chisa , Sesso Howard D , Sesso Howard D , Gaziano J. Michael , Djoussé Luc
Published: July 2021

Objectives:
Short-term metabolic studies have shown that caffeine improves insulin-sensitivity. However, epidemiological studies evaluating the relationship of caffeine intake with risk of type 2 diabetes (DM) have shown inconsistent results. We examined whether caffeine intake is associated with the risk of DM in the Physicians’ Health Study and supplemented the results with a meta-analysis.

Methods:
We prospectively analyzed data on 18,432 PHS participants that were free of DM at baseline (1997-2001). Caffeine intake was assessed using a food-frequency questionnaire. Incident DM was ascertained via annual follow-up questionnaires and validated in a subsample by review of medical records. We used Cox proportional hazards models to estimate the HR and 95% CI of DM. Meta-analysis was conducted through a systematic literature search using PubMed and EMBASE. A random-effect model was used and between-studies heterogeneity was estimated with I
2
.

Results:
In the PHS, mean age at baseline was 66.4 ± 9.3 years, and 1,137 men (6.2%) developed DM during mean follow up of 9.2 years. In a multivariable model adjusted for conventional risk factors of DM, HRs (95% CI) for DM were 1.0 (ref), 1.08 (0.90-1.29), 1.03 (0.85-1.24), 0.98 (0.81-1.18), and 0.86 (0.70-1.04) across consecutive quintiles of caffeine intake (p for linear trend= 0.69). Meta-analysis included 6 studies consisted of 7 separate cohorts comprising 275,971 individuals and 10,048 cases of incident DM. The pooled odds ratio (95% CI) for DM was 0.79 (0.68-0.93) when the highest caffeine intake was compared to the lowest group in random effects model (I
2
=75%).

Conclusion:
While only the highest category of caffeine intake was associated with a modest and non-significant association with DM in the PHS, results from the meta-analysis were consistent with a lower risk of DM.
Abstract P083: Is Change In Ectopic Fat Following A Weight Loss Intervention Associated With Change In Vascular Stiffness In Young Men And Women?
Authors: Hanley Carrie , Barone Gibbs Bethany , Barinas-Mitchell Emma , Cooper Jennifer , Le Giang , Goodpaster Bret H , Conroy Molly B
Published: July 2021

Background:
Ectopic fat may be a better indicator of CVD risk than conventional measures of obesity such as BMI. Data are lacking in how changes in ectopic fat relate to changes in arterial stiffness, and whether there are differences by sex. Our objectives were to determine: (1) how ectopic fat changes after a behavioral weight loss intervention and whether changes differ by sex; and (2) if the changes in ectopic fat are associated with changes in arterial stiffness independently of BMI change.

Methods:
Longitudinal analyses were conducted on 203 participants with complete ectopic fat and vascular stiffness data in the Slow Adverse Vascular Effects study, a randomized trial of a behavioral weight loss intervention in 349 men and women aged 20-45 years and BMI 25-40 kg/m
2
. CT scans measured total abdominal adipose tissue (TAAT), visceral AT (VAT), total thigh AT (TTAT), and intramuscular thigh AT(IMAT). Carotid-femoral (cf) and brachial-ankle (ba) pulse-wave velocity (PWV) were measures of central and mixed central/peripheral arterial stiffness, respectively. T-tests evaluated how ectopic fat and PWV measures differed between men and women at and between baseline and 12-months. Sex-stratified linear regression analyses evaluated associations between changes in regional adiposity and arterial stiffness from baseline to 12 months.

Results:
Mean age of participants at baseline was 38.2 ± 5.9 years; mean BMI was 32.2 ± 3.9 kg/m
2
; 150 (73.9%) were women; and 166 (81.8%) were white. Men were significantly (all p<0.05) different from women at baseline with more VAT (159.1 vs. 100.0 cm
2
), less TTAT (96.1 vs. 147.8 cm
2
), higher BMI (33.5 vs. 31.8 kg/m
2
), higher baPWV (1257.3 vs. 1193.5 cm/s), and higher cfPWV (968.6 vs. 850.9 cm/s). At 12 months, men lost significantly more VAT (-29.2 vs. -13.7 cm
2
) and had a greater decrease in cfPWV (-103.2 vs. -24.7 cm/s) compared to women (both p<0.05). After adjusting for age, baseline PWV, and change in SBP, decreases in TAAT and TTAT were significantly associated with improved vascular stiffness as measured by baPWV among men, and a decrease in VAT was significantly associated with improved cfPWV among women (all p<0.05). These relationships lost significance after adjusting for change in BMI. Change in BMI was itself not a significant predictor for the change in the arterial stiffness measures in either men or women in final models.

Conclusions:
We found several novel associations between changes in ectopic fat and PWV in young adults in a weight loss intervention; these associations differed by sex and dissipated after controlling for change in BMI. Change in BMI itself was not a significant predictor of change in either arterial stiffness measure in men or women. Further research with a larger sample and more diverse population may be warranted to better understand these associations.
Abstract P085: Infant Weight and Length Trajectories Have Different Impacts on Body Composition at Age 3
Authors: Woo Jessica G , Sucharew Heidi , Herbers Patricia M , Khoury Philip R , Edwards Nicholas M , Kalkwarf Heidi J
Published: July 2021

Introduction:
Rapid infant weight gain has been linked with higher childhood body mass index (BMI) and risk of obesity. However, because BMI cannot distinguish lean from fat mass, the role of infant weight or length trajectories on childhood body composition is unclear.

Hypothesis:
This study aimed to evaluate how specific aspects of infant growth trajectories are associated with fat mass, lean mass and % body fat at age 3.

Methods:
Total 323 children age 3 y (46% female, 20% African-American) had body composition measured by dual-energy x-ray absorptiometry, and weight and length measurements from birth to age 2 y from pediatrician growth charts. Growth trajectories were characterized using the SuperImposition by Translation And Rotation (SITAR) model. This technique estimates an average growth curve with random effects that allow individual growth curves to shift up or down (size), shift right or left on the age axis (tempo) or rotate to steepen/flatten the growth curve (velocity). Tempo did not improve model fit so was excluded. Size and velocity parameters for weight and length trajectories were regressed against fat mass (FM), lean mass (LM) and % body fat measurements at age 3.

Results:
On average, girls had higher FM (3.9 vs. 3.4 kg) and lower LM (8.8 vs. 9.5 kg) than boys. Adjusting for sex, LM at age 3 was significantly higher with greater weight velocity and with longer length size between ages 0-2 (Table), but were not related to length velocity or weight size. Adjusting for sex, higher FM was seen for those with higher weight size between ages 0-2, but was not related to either weight or length velocities. Percent body fat at age 3 was associated with both larger weight size and shorter length size between 0-2 years of age, but not with either growth velocities.

Conclusions:
Weight and length size and velocity differ in their impact on children’s body composition by age 3. This study suggests that faster early weight gain (higher weight velocity) and longer lengths but not higher overall weight may lead to leaner body composition by age 3.
Abstract P088: Obesity, Hypertension and Insulin Resistance in a Primary Pediatric Setting in Southern Italy
Authors: De Filippo Giampaolo , Rendina Domenico , Viggiano Domenico , Fasolino Antonio , Sabatini Paola , Strazzullo Pasquale
Published: July 2021

Background:
Obesity is the main risk factor for essential hypertension (EH) in childhood. The O.Si.Me. study (Obesity and Metabolic Syndrome in children and adolescents) evaluated the prevalence of metabolic syndrome (MetS) and its constitutive traits in a sample of obese children and adolescents living in Campania, southern Italy.

Patients and methods:
Four hundred and fifteen children and adolescents consecutively referred to the National Health Service participating Outpatient Clinics for minor health problems and found to have a Body Mass Index (BMI) Z-score > 2.0 were enrolled in the study. The entire sample was screened for MetS, which was defined as the presence of at least 2 of the following alterations in addition to obesity: fasting hyperglycemia, low levels of high-density lipoproteins cholesterol, hypertriglyceridemia, and EH. The present analysis evaluated the clinical characteristics of the O.Si.Me subgroup of EH participants (systolic and/or diastolic BP ≥ 95
th
percentile for age, gender and height) as compared with normotensive participants.

Results:
The prevalence of EH in the O.Si.Me population was 23.6 % (98/415, 48M and 50F.) and two-thirds of the EH participants met the MetS diagnostic criteria. The EH participants featured serum insulin and HOMA-IR levels significantly higher compared with normotensive ones (11.6±0.6
vs.
9.5±0.4 μIU/ml, p = 0.014; 2.6±0.1
vs.
2.2±0.1, p = 0.028 for insulin and HOMA-IR, respectively). These differences were common to boys and girls and remained significant after correction for age, pubertal stage, body weight, length, BMI, gestational age at birth, duration of breastfeeding and anthropometric parental parameters. Accordingly, children and adolescents with EH had a a relative risk of being insulin resistant (defined as a HOMA-IR ≥2.5) significantly greater compared to those without. Moreover, they exhibited higher serum creatinine levels (53.8±7.1
vs.
35.4±6.8 μmol/l, p=0.025) accounting for gender and body weight.

Conclusions:
More than a quarter of obese children and adolescents meet the diagnostic criteria for EH in the Campania region in southern Italy. These obese boys and girls have an increased prevalence of insulin resistance and apparently an initial reduction in renal function compared with obese children and adolescents with normal BP.
Abstract P089: Adiposity and risk of stroke: body shape matters more than body weight
Authors: Judd Suzanne E , Howard Virginia J , Howard George , Lakoski Susan , Cushman Mary , Kissela Brett M
Published: July 2021

Background:
Higher body mass index (BMI) and larger waist circumference (WC), characteristics of increased adiposity, are associated with greater risk of cardiovascular disease (CVD). However, an obesity paradox (improved survival in those with history of stroke) has been observed in some populations. We hypothesized that BMI would be associated with decreased risk of stroke but that this association would be attenuated after accounting for WC.

Methods:
The REasons for Geographic and Racial Differences in Stroke (REGARDS) study recruited 30,239 black and white participants age 45 years and older from across the United States between 2003 and 2007. WC, height and weight were measured during a baseline in home visit and participants were followed every 6 months. Strokes were adjudicated by physicians after review of medical records. Cox proportional hazards models were used to assess stroke risk. BMI and WC were modeled in quintiles.

Results:
We observed 1047 incident and recurrent strokes over a mean of 6.3 years. Higher BMI and lower WC were associated with decreased risk of stroke after adjustment for demographic and medical risk factors (Table). Having both BMI and WC in the model dramatically increased the strength of association for the other variable. Collinearity was not present. The observed association was consistent across race, sex, age, WC, and history of stroke (all p for interaction >0.20).

Conclusion:
Increased BMI, the main measure used to define obesity, was not a stroke risk factor. Increased risk of stroke was observed in WC less than the current recommendations of 88 cm for women and 102 cm for men. Smaller waist sizes and maintenance of lean mass are important targets for stroke prevention.<br