bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P021: Oral Anticoagulant Use and Risk of Incident Dementia in Persons With Atrial Fibrillation
Authors: Chen Nemin , MacLehose Richard F , Chen Lin Y , Norby Faye L , Bengtson Lindsay G , O’Neal Wesley T , Chamberlain Alanna M , Claxton J’Neka S , Lutsey Pamela L , Alonso Alvaro
Published: July 2021

Background:
Current guidelines recommend oral anticoagulation for the prevention of stroke in most patients with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) are associated with lower risk of ischemic stroke and intracranial bleeding than warfarin and, therefore, may reduce risk of dementia among patients with AF.

Hypothesis:
AF patients initiating DOACs for stroke prevention will have lower risk of dementia than patients initiating warfarin.

Methods:
We used data from two US healthcare claim databases, MarketScan (2007-2015) and Optum Clinformatics (2009-2015). Using validated algorithms, we identified patients with AF who initiated oral anticoagulation. Dementia was defined as having an
International Classification of Diseases, Ninth Revision, Clinical Modification
(ICD-9-CM) code of 290.xx, 294.xx, or 331.0. Comorbidities and use of other medications were defined based on inpatient, outpatient, and pharmacy claims. We performed a series of head-to-head comparisons of different oral anticoagulants (warfarin, dabigatran, rivaroxaban, and apixaban) in propensity score-matched cohorts. In each database, multivariable-adjusted Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident dementia for each comparison of propensity score-matched cohorts, adjusting for age, sex, comorbidities, use of other medications, and markers of socioeconomic status (in the Optum database only). We meta-analyzed database-specific results using a random-effects model.

Results:
The analysis included 307,099 AF patients from the MarketScan database and 161,346 from the Optum database, of which 6,572 and 4,391 respectively had a diagnosis of incident dementia. Mean follow up ranged between 0.7 to 2.3 years and incident of diagnosed dementia between 7 to 14 cases per 1000 person-years across different oral anticoagulant initiator groups. Patients initiating DOACs had a lower risk of incident dementia than those initiating warfarin (dabigatran: HR 0.85, 95%CI 0.71, 1.01; rivaroxaban: HR 0.85, 95%CI 0.76, 0.94; apixaban: HR 0.80, 95%CI 0.65, 0.97). There were no differences in risk of incident dementia comparing DOAC user groups (dabigatran vs. rivaroxaban: HR 1.02, 95%CI 0.79, 1.32; dabigatran vs. apixaban: HR 0.92, 95%CI 0.63, 1.36; apixaban vs. rivaroxaban: HR 1.01, 95%CI 0.86, 1.19).

Conclusions:
Patients with AF initiating DOACs experienced lower rates of incident dementia than warfarin users. No obvious benefit was observed for any particular DOAC in relation to dementia rates.
Abstract P025: Left Atrial Dilatation Predicts The Incidence Of Persistent Atrial Fibrillation In Japanese General Population; The Suita Study
Authors: Higashiyama Aya , Watanabe Makoto , Kokubo Yoshihiro , Okamura Tomonori , Okayama Akira , Miyamoto Yoshihiro
Published: July 2021

Objective:
Atrial fibrillation (AF) is an important risk factor for cardiovascular disease (CVD). Left atrial (LA) dilatation detected by ultrasonic cardiography (UCG) has been reported to be associated with the incidence of AF in Western countries. However, the relationship between LA dilatation and the AF incidence has not been well investigated in Asian countries, with lower incidence of AF and obesity and with higher incidence of hypertension and stroke. To investigate the relationship between LA dilatation and the AF incidence in Japanese general population, we estimated the multivariate-adjusted hazard ratios (HR) of LA dilatation assessed by UCG for the incidence of AF.

Methods:
Participants were 1,585 individuals without AF (665 men, 920 women) who are the participants of a prospective cohort study for CVD incidence in urban Japanese general population (the Suita study). The mean±SD age of the participants were 67.8±7.0 years. Transthoracic UCG was performed from July in 2007 to June in 2013, and LA dimension was determined in accordance with American Society of Echocardiography recommendations by M-mode echocardiograms. After the UCG, the electrocardiograms (ECG) were repeatedly performed until March in 2016. The physicians coded the ECG using Minnesota Code (MC), and AF code is defined as 8-3-1. The HRs of LA dilatation for the incidence of AF with 95% confidence interval (CI) were estimated by Cox proportional hazard model with the adjustment for the followings at the UCG test; age, sex, systolic blood pressure, body mass index, the presence of heavy drinking (more than 2 drinks/day), non-HDL cholesterol, and the presence of the moderate or severe mitral or aortic valve abnormality detected by UCG.

Results:
The mean follow-up period from UCG to the last ECG was 4.6±1.8 years, and 19 AF incidences were detected. The multivariate-adjusted HR of the LA dilatation (>40 mm) for the incidence of AF was 8.19 (95% CI: 2.47-27.14). And the multivariate-adjusted HR of 5 mm increment of LA dimension was 2.95 (1.65-5.29), and that of the highest quartile of LA dimension compared to the lowest was 3.37 (0.64-17.78). Among 674 participants with left atrial volume index (LAVI) data (5 AF cases), the multivariate-adjusted HR of LAVI ≥ 32 (ml/m
2
) for AF incidence was 3.93 (95%CI: 0.34-45.86), and it showed the highest HR among the co-adjusted factors.

Conclusion:
LA diameter assessed by UCG is a simple and non-invasive clinical data, and could be a useful factor for the prediction of AF incidence among Japanese general population. Although the follow-up period was not enough compared to the previous studies in Western population, the present study might indicate that individuals with LA dilation detected by UCG are the important candidate for careful and continuous check-ups about CVD risk factors, ECG and UCG in Asian population.
Abstract P026: Early Repolarization Pattern is Associated With Increased Left Ventricular Mass and Left Ventricular Hypertrophy: Results From the Dallas Heart Study
Authors: McNamara David A , Bennett Ari , Berry Jarett D , Link Mark S
Published: July 2021

Introduction:
Recent studies have shown an association between early repolarization pattern (ERP) ECG morphology and sudden cardiac death. The role of left ventricular mass (LVM) as a potential mediator of ERP has not been well explored.

Methods:
Participants in the Dallas Heart Study who underwent an ECG and cardiac MRI (CMR) were assessed for ERP, defined as J-point elevation ≥1 mm in any 2 contiguous leads. We compared participants with and without ERP by age, gender, race/ethnicity, established cardiovascular risk factors of diabetes, hypertension and hyperlipidemia, lean body mass and percent body fat, and CMR-derived LVM, LVM/body surface area, and LVH defined by standard criteria, using Student’s T-tests and chi-squared tests where appropriate.

Results:
Of the 3,015 participants in our study, 276 (9.2%) had ERP. Participants with ERP were younger (43±9 vs 44±10 yrs, p=0.04), more prevalent in blacks than non-blacks (14 vs 5.0%, p<0.00001), and in men than women (18 vs 2.0%, p<0.00001). Baseline cardiovascular risk factors were not significantly different. Participants with ERP demonstrated higher lean body mass (59±10 vs 52±11 kg, p<0.00001) and lower percent body fat (27±8 vs 36±9%, p<0.00001). The presence of ERP was associated with greater LVM, increased LVM/body surface area, and the presence of LVH in the overall population and in analyses stratified by sex (Table 1).

Conclusion:
In a large, multi-ethnic cohort, ERP is associated with increased total LVM, increased LVM/body surface area, and LVH. These novel associations may provide insight into the biology of ERP. Further studies investigating the relationship of LVM and LVH with ERP are warranted.
Abstract P027: Time-updated Premature Ventricular Contractions on 12-lead ECG Are Associated With the Risk of Sudden Cardiac Death: Atherosclerosis Risk in Communities Study and Cardiovascular Health Study
Authors: Maan Abhishek , German David M , Bender Aron , Mukundan Srini V , Sitlani Colleen , Thomas Jason , Hamilton Christopher , Post Wendy , Biering-Sørensen Tor , Solomon Scott , Soliman Elsayed Z , Sotoodehnia Nona , Siscovick David S , Tereshchenko Larisa G
Published: July 2021

Introduction:
The association between premature ventricular contractions (PVCs) and Sudden Cardiac Death (SCD) remains controversial.

Hypothesis:
We hypothesized that PVCs are associated with SCD.

Methods:
Presence of PVCs was detected on 12-lead ECG recorded at baseline or any of 4 follow-up visits in 15,667 participants (pts) (mean age: 54.2 + 5.8 Yrs; 55% female; 73% Whites) of the Atherosclerosis Risk in Communities (ARIC) study. For validation cohort, we included baseline and 9 follow-up visits ECG data in 5,846 pts (mean age: 72.8+ 5.6 yrs; 57.7% female, 84.2% whites) from Cardiovascular Health Study (CHS). Competing risk analyses models were constructed to test the association between time-updated PVCs and SCD risk. Model 1 was adjusted for age, sex, race and study center. Model 2 in addition was adjusted for time-updated coronary heart disease, heart failure, atrial fibrillation, stroke, and hypertension.

Results:
In ARIC pts, across all study visits, PVCs were observed in 2.6% of the ECGs; 99.7% of pts were PVC-free at least once; 8.8% of pts had PVC at least once. 97.7% of pts without PVCs remained PVC-free at the next visit; 19.1% of pts with detected PVC had PVC at the next visit; 2.4% of pts who were PVC-free on previous ECG, transitioned to having PVC on subsequent visit ECG. In CHS, across all 10 yearly study visits, on average, PVC was observed on 4.85% of ECG recordings; 99.4% of participants were PVC-free at least once; 21.9% of pts had PVC at least once. 96.4% of PVC-free pts remained free from PVC at the next visit. 30.6% of pts with detected PVC on a given ECG had PVC at the next visit. 3.6% of pts who did not have PVC on previous ECG, transitioned to having PVC at the next visit. 69.4% of pts with PVC on a given ECG transitioned to being PVC-free next year. In adjusted competing risk analysis PVC was associated with SCD, but not with non-sudden cardiac death or non-cardiac death (Table).

Conclusions:
Time-updated presence of PVC on a short 10-sec resting 12-lead ECG is associated with SCD.
Abstract P032: Feasibility, safety and efficacy of a modified Dietary Approaches to Stop Hypertension diet for Japanese population
Authors: Miyagawa Naoko , Arima Hisatomi , Yoshita Katsushi , Okuda Nagako , Ohkubo Takayoshi , Hisamatsu Takashi , Kondo Keiko , Miura Katsuyuki
Published: July 2021

Introduction:
The Dietary Approaches to Stop Hypertension (DASH) eating pattern is widely used for lowering blood pressure in the United States. Food preference and intake volume are quite different among American and Japanese diet; therefore, it is necessary to develop a modified version of DASH dietary pattern for Japanese people (JDASH).

Hypothesis:
The JDASH is feasible, safe and effective among Japanese people.

Methods:
This crossover pilot study recruited Japanese men and women aged 30 years and over. Participants were randomized to a three week JDASH diet followed by a three week control diet, or the reverse sequence. Intervention periods were separated by two weeks’ washout in which participants returned to their usual diet. The JDASH dietary pattern consisted of higher potassium, magnesium, calcium, dietary fiber, and n-3 fatty acid and lower sodium than Japanese typical diet. The nutrient balance of the control diet was average Japanese diet based on the National Health and Nutrition Survey in Japan. Primary outcome of this trial was a change in 24 hour urine sodium-to-potassium (Na/K) ratios and secondary outcomes were changes in home and office blood pressure values, lipoprotein profiles and body mass index. These outcomes were from 24 hour urine and blood specimens taken measured before and on the last day of each experimental period. The impact on these measurements was calculated with generalized estimating equation model in consideration of the sequences of intervention.

Results:
The JDASH diet was well tolerated and with no dropouts. No participant reported any adverse effect regarding this intervention diet and no adverse effects were also observed in biological measures. There were no differences in biological measurements between two diets before intervention. A significant difference in 24 hour urine Na/K ratio was observed (-4.33 mol/mol, p<0.001) between the JDASH diet and the control diet. The differences of systolic blood pressure were - 2.1 mmHg (p=0.396) at the office and -0.1 mmHg (p=0.956) at home, respectively. Significant differences in body mass index and low density lipoprotein were -0.4 kg/m
2
(p=0.002) and -11.0 mg/dl (p=0.038), respectively.

Conclusion:
Developed modified DASH dietary pattern for Japanese were significantly decrease 24 hour urine Na/K ratio. In conclusion, the results of this pilot study showed the feasibility, safety and efficacy.
Abstract P033: Impact of Empathetic Touch Therapy on Reducing Feelings of Stress, Anxiety, Pain and Depression
Authors: Arz Donna , McClain Michael , Quach Kathy , Sky Joseph , Steinhorn David , Shah Sachin A
Published: July 2021

Introduction:
The association between post-traumatic stress disorder (PTSD) and cardiovascular disease has been established. Complementary and integrative medicine (CAM) modalities are commonly underutilized due to their mixed results and need further evaluation. Empathetic Touch therapy is a holistic healing tool, which incorporates integrative medicine techniques such as energy healing, acupressure, craniosacral therapy, shamanic healing, aspects of Chinese medicine and spiritual care to promote wholeness in the body, mind, and spirit. The purpose of this study is to analyze symptoms of stress, anxiety, pain, and depression in a primarily veterans affairs population suffering from PTSD and voluntarily undergoing Empathetic Touch therapy sessions at a non-profit organization called the Forgotten Soldier Program.

Hypothesis:
We assessed the hypothesis that Empathetic Touch therapy will reduce feelings of anxiety, stress, pain, and depression.

Methods:
This is a retrospective analysis of 424 participants from the Forgotten Soldier Program who completed surveys before and after an approximately 1-hour session of Empathetic Touch therapy (November 7, 2013 through August 11, 2017). Self-reported scores on a scale of 0 to 10 for feelings of stress, anxiety, pain, and depression were collected before and after every therapy session. The change from baseline was determined and analyzed using a paired t-test.

Results:
Across a cohort of 424 individual patients, a total of 1,359 individual sessions were included for analysis. Self-reported feelings of stress (n=1267), anxiety (n=1223), pain (n=1275), and depression (n=416) were reduced by 3.27±3.34, 2.98±3.53, 2.44±3.66 and 1.46±3.7 (all p-values <0.001), respectively. No significant adverse events related to Empathetic Touch therapy were reported.

Conclusion:
Empathetic Touch therapy significantly reduces feelings of stress, anxiety, pain, and depression. Alternative and integrative modalities need to be further incorporated in a holistic treatment of patients. Assessing the impact of Empathetic Touch therapy on cardiovascular endpoints is warranted.
Abstract P034: The Effectiveness of 12-week Tai Chi Training on the Migraine Attack Days, Body Composition, and Blood Pressure in Chinese Women With Episodic Migraine: A Randomized Controlled Trial
Authors: Xie Yao Jie , Hui Stanley Sai-chuen , Ho Suzanne C. , Suen Lorna Kwai Ping
Published: July 2021

Background:
Tai Chi is a body-mind exercise. It’s prophylactic efficacy on migraine attack remains largely unknown. The purpose of this study was to examine the effect of a 12-week Tai Chi training on the migraine attack days per month, body composition, and blood pressure (BP) in a sample of Chinese women with episodic migraine.

Method:
A two-arm randomized controlled trial was designed. Eighty-two local women aged 18 to 65 years and diagnosed with episodic migraine were randomized to the Tai Chi group or the waiting list control group. A modified 32-short form Yang-style Tai Chi training with 1 hour per day, 5 days per week for 12 weeks was adopted as intervention. An additional 12 weeks follow was conducted. The control group received a “delayed” Tai Chi training at the end of the trial. The difference in migraine days between 1 month before baseline, 3rd month (12nd week) and 6th month (24th week) after the randomization were examined. The changes in weight, body fat, and BP before and after the intervention were also analyzed.

Results:
Of 189 women screened, 82 eligible women completed the baseline assessment. After randomization, 9 women withdrew immediately, finally 40 in Tai Chi group and 33 in control group were involved in the analysis. On average, women in Tai Chi group had 3.6 (95% CI: -4.7 to -2.5, P<0.01) days reduction of migraine attack. Compared with control group, the difference was statistically significant (P<0.001). Tai Chi group also lost 0.6 kg of body weight and 0.6% of body fat at the 3rd month, and 10.8 mmHg systolic BP at the 6th month, respectively (all p<0.001). The between-group difference of systolic BP was -6.9 mmHg (95% CI: -11.6 mmHg to -2.1mmHg, p<0.05), whereas no significant differences were observed regarding weight and body fat at the 3rd month (all p>0.05). Among Tai Chi group, change in systolic BP was significantly correlated to the change in migraine days (P<0.05).

Conclusion:
The 12-week Tai Chi training significantly decreased the frequency of migraine attack and improved the systolic BP. The association between migraine attack reduction and BP improvement needs further investigations.
Abstract P037: Community Lifestyle Intervention Decreases Risk of Suicide and Improves Overall Lifestyle
Authors: Ramirez Francisco E , Nedley Neil
Published: July 2021

Background:
Morbid thoughts are a dangerous cognitive problem that can lead to suicide. It has been documented that educational lifestyle programs can improve metabolic markers, we study the effect in the psychological realm. This study documents the response of an 8-week lifestyle program on depression levels and morbid thoughts.

Methods:
Participants from 5 continents who finished a depression program were studied. Those who chose to participate met once a week for 8 weeks for a 2 hour program. It consisted of a 45 minute DVD presentation followed by a small group discussion, work assignments were given at every session. This program focused on educating participants on healthy behaviors such as exercise, plant-based diets, sleep hygiene, thought control and others. Cooking classes and practical exercises helped teach the principles. Each participant answered at the beginning of the program and at the end of the program the Depression and Anxiety Assessment Test. It assessed depression level based on DSM-5 [The Diagnostic and Statistical Manual of Mental Disorders Volume 5]. No questions were asked about individuals' treatment of depression. The depression was classified according to DSM-5 into 4 categories as none (0-6), mild (7-10), moderate (11-19) or severe (20 or more). The test also inquired the frequency of morbid thoughts, which were defined as thinking about death often, considering harming yourself or others. The degree of morbid thoughts were ranked from A-D ([A] having none or rare; [B] having them 1/4 of the days; [C] being 1/2 of the days; [D] being almost every day in a period of 2 weeks).

Results:
From 5997 participants that finished the 8 week program the mean age was 52.3, SD 15.1, and n= 4209 (70.1%) were female. From this group, n=1924 (32%) participants reported some level of morbid thoughts. Of the morbid thought group, the depression average before the program was 17.7, SD 6.2, median 19, mode 22. At the end of the 8 week program, the depression average of the same group was 9.6, SD 6.5, median 9, mode 5. The pair t-test of depression scores was significant with a t=50.26, p<.001. The levels of morbid thoughts at the beginning was A n=4073, B n=919, C n=587, D=418, and by the end A n=5180, B n=478, C n=236 and D n=103.

Conclusion:
The educational intervention effectively improves this worrisome symptom decreasing even the everyday morbid thoughts therefore decreasing the risk of suicide. The emphasis of the program is to make the lifestyle changes permanent. A long term study is being planned to investigate how the changes continue on the long term.
Abstract P042: Association of Epigenetic Age Acceleration and Adverse Cardiac Mechanics: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Khan Sadiya S , Gao Tao , Zheng Yinan , Colangelo Laura A , Joyce Brian , Allen Norrina B , Shah Sanjiv J , Liu Lei , Zhang Wei , Wang Jun , Lima Joao , Greenland Philip , Lloyd-Jones Donald M , Hou Lifang
Published: July 2021

Background:
Prevalence of diastolic dysfunction increases significantly with aging and becomes more prevalent in middle-age to older adulthood. DNA methylation markers of aging have been identified and integrated into an epigenetic age (EA) score, which has been demonstrated to be associated with cardiovascular morbidity and mortality. Epigenetic age acceleration (EAA) is the residual value of EA methylation markers regressed on chronologic age (CA), and is thus independent of CA. Therefore, we sought to examine the association of a previously identified DNA methylation molecular signature in blood (EAA) with cardiac mechanics.

Methods:
A subset of participants in the CARDIA cohort (n=1200) randomly selected (balanced on race and sex) underwent genome-wide DNA methylation profiling with the Illumina EPIC array from exam year 15 (2000-01 [age 33-45 years]) for calculation of EA and EAA. Echocardiography was completed at exam year 25 (2010-11 [age 43-55]). We used linear regression to examine the association of EA and EAA with parameters of cardiac mechanics. Models were adjusted for age, race, sex, education, study center, and Y15 cardiovascular risk factors (heart rate, body mass index, hypertension, hyperlipidemia, diabetes, and smoking).

Results:
Mean age of participant was 45.4±3.5 years, 52% female, and 41% black. DNA methylation markers of aging (EA and EAA) were associated with tissue Doppler measures of diastolic function, but not with parameters of left ventricular structure and systolic function (
Table
).

Conclusions:
EA and EAA are associated with changes in cardiac structure and function. Abnormalities in cardiac structure and function are an important intermediate phenotype prior to the development of symptomatic heart failure, and additional longitudinal research should examine DNA methylation markers as potential mediator of or novel biomarker for incident heart failure in young to middle-age adults.
Abstract P043: Erythrocyte Long-Chain Omega-3 Fatty Acid Levels Are Inversely Associated With Mortality and With and Incident Cardiovascular Disease: The Framingham Heart Study
Authors: Harris William S , Tintle Nathan , Etherton Mark R , Vasan Ramachandran S
Published: July 2021

Background:
The extent to which omega-3 fatty acid (FA) status is related to risk for death from any cause and for incident cardiovascular disease (CVD) remains controversial.

Objective:
To examine this association in the Framingham Heart Study (FHS).

Design:
Prospective and observational.

Setting:
FHS Offspring cohort.

Measurements:
The primary exposure marker was red blood cell (RBC) levels of eicosapentaenoic and docosahexaenoic acids (EPA and DHA; the Omega-3 Index) which was measured at baseline. Secondary markers included RBC EPA, DHA, alpha-linolenic and docosapentaenoic (n-3) acids. Outcomes included mortality (total, CVD, cancer, and other) and total CVD events. Median follow-up was 7.3 years. Cox proportional hazards models were adjusted for 18 demographic characteristics, clinical status, therapies and other CVD risk factors including C-reactive protein levels.

Results:
Among the 2500 participants (mean age 66 years, 54% women; all free of CVD at baseline) there were 350 deaths (58 from CVD, 146 from cancer, 128 from other known causes, and 18 from unknown causes). There were 245 CVD events. In multivariable-adjusted analyses, a higher Omega-3 Index was associated with significantly lower risks (p-values for trends across quintiles) for total mortality (p=0.02) and non-CVD, non-cancer mortality (p = 0.009; Figure), and for total CVD events (p=0.008). Those in the highest versus the lowest Omega-3 Index quintiles (i.e., >6.8% vs. <4.2%) had a 34% lower risk for death from any cause and a 39% lower risk for incident CVD. Associations were generally stronger for DHA than for EPA. When total cholesterol was compared with the Omega-3 Index in the same models, the latter was significantly related with these outcomes, but the former was not. Substituting the omega-6:omega-3 ratio for the Omega-3 Index did not alter the outcomes.

Limitations:
Relatively short follow-up time and a single exposure assessment.

Conclusions:
A higher Omega-3 Index was associated with reduced risk of both CVD and all-cause mortality.
Abstract P045: Trajectory of Fasting Blood Glucose From Childhood to Adulthood and the Risk of Hypertension: The Bogalusa Heart Study
Authors: Li Xiang
Published: July 2021

Background:
Hyperglycemia in children or adults has been related to an increased risk of hypertension; however, no study has assessed whether life course trajectory of circulating fasting glucose levels, from childhood to adulthood, is related to hypertension risk.

Objective:
In the present study, we aim to characterize trajectories of fasting blood glucose (FBG) from childhood to adulthood, and assess their associations with risk of hypertension in the Bogalusa Heart Study.

Design:
Prospective analysis of 1747 children with >= 4 FBG measurements, of which at least 1 measurement was in childhood (from 4-19 years) and at least 1 measurement in adulthood, during an average of 23.5 years of follow-up. Mixed models were used to test the effect of FBG trajectories on the risk of hypertension.

Result:
Four distinct trajectories of FBG from childhood to adulthood were identified: constant low, low to high, high to low, and constant high (Figure 1). In multivariate model adjusting for baseline age, race, sex, BMI, adulthood blood pressure, smoking, drinking, physical activity, education, and lipids, the risk of hypertension was 1.12 (95% CI: 1.04 to 1.20; p=0.002) in the low to high group compared to constant low group, 1.02 (95% CI: 0.97 to 1.08; p=0.255) in the high to low group, and 1.10 (95% CI: 1.03 to 1.18; p=0.004) in the constant high group. After further controlling for one-time FBG, especially the adulthood FBG, the effect of trajectories still persist.

Conclusion:
We identified four different trajectories of FBG from childhood to adulthood, which shows having diverse relationships with hypertension in adulthood.
Abstract P047: Ideal Cardiovascular Health Score and Oxidative Stress
Authors: Mohamed Kelli Heval , Liu Chang , Samman-Tahhan Ayman , Alghamdi Talal , Ko Yi-An , Choudhary Fahad , Engineer Vanessa , Hammadah Muhammad , Sandesara Pratik , Al Mheid Ibhar , O'Neal Wesley , Vaccarino Viola , Ziegler Thomas , Sperling Laurence , Lampl Michelle , Brigham Kenneth , Martin Greg , Quyyumi Arshed
Published: July 2021

Introduction:
Ideal cardiovascular health (CVH) promotion is effective for cardiovascular disease prevention. Whether increased CVH score improves oxidative stress is less clear. Our study examined the correlation between changes in ideal CVH status and oxidative stress.

Hypothesis:
Improvement in CVH score is correlated with changes in oxidative stress.

Methods:
A total of 569 actively working adult employees (51±11 years, 64% women, 21% Black) underwent a health partner-mediated lifestyle intervention. Serial counseling was delivered by a trained HP focused on promoting clinical self-knowledge and adoption of a healthier lifestyle, based on the subject’s personal schedule. Anthropometric, dietary and laboratory measurements were obtained at baseline and 1- and 2-year follow-up visits. Plasma levels of reduced (glutathione) and oxidized (cystine) aminothiols were measured by high performance liquid chromatography at baseline and follow-up to assess oxidative stress. Ratios of oxidized to reduced aminothiols (cystine/glutathione) were calculated. Linear mixed-effects model was used to examine the correlation between the changes in CVH score and changes in oxidative stress metrics overall 2 years follow-up.

Results:
Over 2-years, cystine (p=0.01) improved while cystine/glutathione (p=0.03) and glutathione (p<0.001) decreased in the entire cohort. At baseline, CVH score was significantly associated with improvement in cystine by -0.39 μM (95% CI, -0.45, -0.32), glutathione by 0.22 μM (95% CI, 0.14, 0.29) and cystine/glutathione by -0.40 (95% CI, -0.46, -0.33). Overall, one unit increase in the CVH score was associated with a decrease of -0.33 μM (95% CI, -0.42, -0.24) in cystine and -0.38 (95% CI, -0.46, -0.29) in the cystine/glutathione ratio over 2 years. Similarly, an improvement in CVH score by one unit at 2 years was associated with improvement in glutathione by 0.30 μM (95% CI, 0.21, 0.39). Furthermore, reduction in BMI, systolic blood pressure and fasting glucose level was significantly associated with improvement in cystine (all p<0.01), glutathione (all p<0.01) and cystine/glutathione (all p<0.01) over 2 years.

Conclusion:
Improvement in CVH with a lifestyle intervention was associated with early and sustained improvement in oxidative stress. Whether the impact of changes in CVH metrics on oxidative stress improves long-term morbidity and mortality needs further investigation in a controlled design.
Abstract P050: Correlates of Serum Cortisol and its Prognostic Value in the Community
Authors: Echouffo Tcheugui Justin B , Short Meghan I , Musani Solomon K , Xanthakis Vanessa , Vasan Ramachandran S
Published: July 2021

Introduction:
Community-based data on correlates of serum cortisol are scarce. We investigated the sources of variability in morning serum cortisol, and its relation to cardiometabolic outcomes in a large biracial sample.

Hypothesis:
Serum cortisol is monotonically associated with cardiometabolic outcomes, an effect that is potentiated by aldosterone.

Methods:
We included 2896 whites (Framingham Heart Study [Generation 3], 53% women, mean age 44 years) and 2479 blacks (Jackson Heart Study, 52% women, mean age 53 years). Cohort-and sex-specific linear regression was used to identify cortisol correlates. Heritability was derived using the variance-components method. Cohort- and sex-specific logistic regression was used to relate cortisol to progression in blood pressure (BP) or fasting blood glucose (FBG) categories, and incidence of hypertension (HTN), diabetes (DM) or metabolic syndrome (MetS).

Results:
Serum cortisol was higher in blacks compared to whites (age-adjusted mean: 13.1 vs 10.2 μg/dL in men [
P
<0.001] and 12.7 vs. 8.1 μg/dL in women [
P
<0.001]). Serum cortisol was positively related to age and smoking in blacks, DM, menopausal status and use of hormonal therapy (replacement or contraception) in both racial groups
(P
<0.005). Body mass index and glomerular filtration rate were inversely associated with cortisol in whites and blacks
(P
<0.01). The age- and sex-adjusted heritability of serum cortisol was 0.20 in whites and 0.11 in blacks (
P
≤0.005). Serum cortisol was not associated with outcomes (
Table
). In blacks, concomitantly high cortisol (>median) and high aldosterone (>median) was associated with incident HTN (odd ratio [OR]: 1.90 [95%CI: 1.14, 3.16]) and DM (1.75 [1.17, 2.62]) compared to normal aldosterone and cortisol; ORs in whites were 1.15 (0.81, 1.63) for HTN and 0.95 (0.52, 1.74) for DM.

Conclusions:
Serum cortisol is a heritable trait influenced by clinical factors. Conjointly high aldosterone and cortisol levels in blacks is associated with increased risk of HTN and DM in blacks, not in whites.
Abstract P057: The Association Between Diabetes and Risk of Abdominal Aortic Aneurysm: A Meta-Analysis
Authors: Yao Lu , Folsom Aaron , Alonso Alvaro , Pankow James , Guan Weihua , Tang Weihong
Published: July 2021

Objectives:
Data regarding the relationship between diabetes and abdominal aortic aneurysm (AAA) are inconsistent across studies: some studies showed an inverse relationship while others did not show an association. We conducted a meta-analysis to examine the association between diabetes and AAA based on published data from case-control and cohort studies.

Methods:
We searched literature in English from online databases including MEDLINE (1966-), EMBASE and Web of Science as of July 2017, plus a manual examination of references in selected articles. The eligibility criteria included (1) a case-control or cohort study conducted in adults; (2) diabetes is the exposure variable and AAA risk is the outcome variable; and (3) association estimates (hazard ratios, odds ratios or relative risks) and measurement of variance (P value, confidence interval, or standard error) were available. The literature review and data abstraction were conducted in duplicate by independent investigators. A DerSimonian and Laird random effects model was used to pool association estimates and their 95% confidence intervals from studies using STATA 13. The Cochran’s Q test was used to assess the presence of heterogeneity and the I-square index to quantify the extent of heterogeneity.

Results:
We included in the meta-analyses a total of 10 cohorts with 10,771 AAAs in 2,625,318 participants and 4 case-control studies with 1,065 AAAs and 11,009 controls that met the pre-determined eligibility criteria. The samples were predominantly white (88%). Study-specific relative risk and pooled relative risk as well as heterogeneity test results were shown in Figure. Diabetes was inversely associated with AAA risk (pooled relative risk: 0.55; 95%CI: 0.49 - 0.61,
Figure)
. Results were overall consistent by sex, study design and setting (hospital- vs community-based).

Conclusions:
The findings suggest that diabetes is strongly and inversely associated with the risk of AAA. Future studies are warranted to investigate the potential mechanisms.
Abstract P062: The Impact of High Fasting Plasma Glucose on Cardiovascular Health at the State-level in the United States
Authors: Ong Kanyin , Afshin Ashkan
Published: July 2021

Introduction:
High fasting plasma glucose (FPG) is an established risk factor for cardiovascular disease (CVD). However, the impact of FPG on CVD mortality and morbidity at the state-level in the US has not been systematically evaluated.

Objective:
To quantify the number of CVD deaths and disability adjusted life years (DALYs) attributable to high FPG by age, sex, year and state among US adults from 1990 to 2016.

Methods:
We used a spatio-temporal Gaussian process regression (ST-GPR) to estimate the mean FPG level by age, sex, year and state. The inputs to the ST-GPR model included data from National Health and Nutrition Examination Survey, state-specific prevalence of obesity, and per-capita lag-distributed income in each state. Using the mean FPG and prevalence of diabetes in each state, we characterized the distribution of the FPG at the state-level. Then, we used the Global Burden of Disease study comparative risk assessment framework to estimate the CVD deaths and DALYs attributable to high FPG.

Results:
In 2016, there were 180,440 CVD deaths attributable to high FPG in the United States: 77% due to ischemic stroke, 21% due to cerebrovascular disease, and <1% due to peripheral artery disease. Alaska had the lowest attributable death rate for both males and females (66.9 per 100,000 and 55.4 per 100,000, respectively) and West Virginia had the highest attributable death rate for both males and females (227.3 per 100,000 and 186.4 per 100,000, respectively). This is contrasted to DALYS, where Colorado had the lowest attributable DALYS rate for both males and females (1,732 DALYS per 100,000 1,379 DALYS per 100,000, respectively) and West Virginia had the highest attributable DALY rate for both males and females (5,219 DALYS per 100,000 and 3,965 DALYS per 100,000, respectively). (Figure)

Conclusions:
Our results highlight the need for evidence-based intervention to control FPG to effectively prevent CVD.
Abstract P067: Long-term Exposure to Ambient Air Pollution and Type 2 Diabetes Incidence: A Time Series Analysis
Authors: Xu Guozhang , Duan Donghuui , You Dingyun , Xu Jiaying , Feng Xiaoqi , Astell-Burt Thomas , He Tianfeng , Xu Guodong , Zhao Jinshun , Zhang Lina , Li Hui , Han Liyuan
Published: July 2021

Introduction:
Epidemiological evidence on long-term exposure to ambient air pollution and type 2 diabetes (T2D) incidence are sparse, and the results are contradictory.

Hypothesis:
We performed a time-series analysis to investigate potential association between long-term exposure to ambient air pollution and T2D incidence in the Chinese

population.

Methods:
Monthly time-series data between 2008-2015 on ambient air pollutants and incident T2D were obtained from the Environment Monitoring Center of Ningbo and the Chronic Disease Surveillance System of Ningbo. Relative risks (RRs) and 95% confidence intervals (95%CIs) of incident T2D per 10 μg/m
3
increase in ambient air pollutants were estimated from Poisson generalized additive models and adjusted for month, temperature, relative humidity, air pressure and wind speed. This model was combined with a distributed lag non-linear model to determine the relative risks.

Main Outcome Measures:
The main outcome measure was T2D incidence.

Results:
Long-term exposure to particulate matter <10 μm (PM10) and Sulphur dioxide (SO2) were associated with increased T2D incidence. The relative risks (RRs) of each

increment in 10 μg/m
3
of PM10 and SO2 were 1.62 (95%CI, 1.16 to 2.28) and 1.63 (95%CI, 1.12 to 2.38) for overall participants, 1.56 (95%CI, 1.12 to 2.17) and 1.59 (95%CI, 1.14 to 2.23) for males, 1.68 (95%CI, 1.15 to 2.44) and 1.76 (95%CI, 1.21 to 2.56) for females, respectively. Whereas for ozone (O3) exposure, the RRs were 0.78 (95%CI, 0.68 to 0.90) for overall participants, 0.78 (95%CI, 0.69 to 0.90) for males, and 0.78 (95%CI, 0.67 to 0.91) for females, respectively. Female participants were more prone to develop T2D after long-term exposed to ambient air pollutants than male counterparts. No statistically significant associations were observed for PM2.5, NO2, and CO exposures, nor in the two- and three-pollutant models.

Conclusions:
Long-term exposure to PM10 and SO2 is positively associated with T2D incidence, whereas O3 is negatively associated with T2D incidence.
Abstract P072: Circulating Phylloquinone Concentrations and Type 2 Diabetes Incidence: A Mendelian Randomization Study
Authors: Remmelzwaal Sharon , Zwakenberg Sabine , Beulens Joline , Feskens Edith , Booth Sarah , Dashti Hassan , van der Schouw Yvonne , Sluijs Ivonne
Published: July 2021

Introduction:
This study aims to investigate the causal relation of genetically conferred circulating phylloquinone levels and the risk of type 2 diabetes (T2D) via a Mendelian Randomization approach.

Methods:
We used data from the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study comprising 10,071 diabetes cases and 13,309 subcohort members from eight European countries. We calculated a weighted genetic risk score (wGRS) including four SNPs (rs2192574, rs6862071, rs4645543 and rs2108622) likely to be related to circulating phylloquinone levels from a genome wide association study. Inverse-variance weighted (IVW) analysis was used to obtain a Hazard Ratio (HR) for the unconfounded relation between circulating phylloquinone levels and T2D incidence. All analyses were adjusted for sex, center, principal components of ancestry, genetic platform, triglycerides and hours fasting. Furthermore, we assessed the robustness of our results with a MR Egger analyses. In follow-up analyses, we have included data from the Diabetes Genetics Replication And Meta-analysis (DIAGRAM) consortium, increasing our dataset to 21,571 participants with diabetes.

Results:
The median follow-up time was 10.9 years. In IVW analysis, genetically conferred higher circulating phylloquinone levels were associated with a reduced risk of T2D with a HR of 0.87 (0.78;0.97) for every ln-nmol/L increase in circulating phylloquinone. The MR Egger method resulted in a HR of 0.88 (0.72;1.08).Adding DIAGRAM data resulted in a summary odds ratio of 0.90 (0.81;1.00).

Conclusion:
Our study suggests that the association between higher circulating phylloquinone levels and lower T2D incidence may be causal.
Abstract P074: Racial Differences in the Association Between Hemoglobin A1c and Hypoglycemic Events
Authors: Lacy Mary E , Whitmer Rachel A , Pletcher Mark J
Published: July 2021

Background:
Rates of severe hypoglycemia are higher in African Americans than in whites. We hypothesize that the elevated rate of hypoglycemic events observed in African Americans is a result of treating African Americans and whites to the same target hemoglobin A1c (hbA1c) despite established racial differences in the association between hbA1c and glucose measures.

Methods:
Using de-identified patient clinical data from 2011- 2017 on 22,554 self-identified African American or white patients with type 2 diabetes from UCSF Health, we examined racial differences in the association between hbA1c and hypoglycemic events.

Results:
Of the 22,554 patients (17% African American; 54% male; mean age 59.6), 275 experienced a hypoglycemic event requiring medical care; 2.20% of African Americans experienced a hypoglycemic event compared to 1.02% of whites (p<0.001). Of the 275 patients experiencing a hypoglycemic event, 102 had a last recorded hbA1c value within 90 days prior to the event. The mean hbA1c value preceding a hypoglycemic event was 7.50% for African Americans compared to 6.91% in whites (mean difference= 0.59%, 95% confidence interval: -0.38%, 1.56%, p=0.24). In models adjusted for age, sex, and duration of diabetes, the difference in hbA1c was slightly attenuated (mean difference= 0.56%, 95%CI: -0.41%, 1.52%, p=0.26).

Conclusion:
In this population, African Americans were significantly more likely to experience a hypoglycemic event than whites. HbA1c values preceding the event were slightly higher in African Americans than whites; this finding was not statistically significant but statistical power was potentially limited by sample size.
Abstract P076: Genetic Predisposition to Hemoglobin A1
c
, Postpartum Weight Reduction, and Glycemic Changes: A Longitudinal Study in Women With Prior Gestational Diabetes
Authors: Han Liyuan , Liu Huikun , Wang Tiange , Duan Donghui , Leng Junhong , Li Nan , Li Weiqin , Sun Dianjianyi , Hu Gang , Qi Lu
Published: July 2021

Introduction:
Hemoglobin A
1c
(HbA
1c
) is a common marker for glycemic control and a major risk factor for diabetes and cardiovascular disease.

Hypothesis:
We examined whether the genetic variation predisposing to HbA
1c
affected glycemic changes in women with prior gestational diabetes mellitus (GDM) and whether such an effect was modified by changes in body adiposity, especially during and after pregnancy.

Methods:
This is a longitudinal study in Tianjin, China. We genotyped 10 genome-wide association study-identified HbA
1c
single nucleotide polymorphisms and assessed weight at 1 to 5 years postpartum and changes in glycemic traits in 1156 women with prior GDM. The genetic risk score was calculated based on 10 HbA
1c
-associated loci.

Main Outcome Measures:
The main outcome measure was postpartum glycemic changes.

Results:
The HbA
1c
genetic risk score significantly interacted with postpartum weight reduction on changes in 2-h glucose and HbA
1c
(P for interaction = 0.02 and 0.03; respectively) after multivariable adjustment. In women with postpartum weight reduction of ≥8kg/y, the genetic risk score was associated with decreased HbA
1c
. The association between postpartum weight reduction and glycemic improvement was more significant among women with a lower genetic risk score.

Conclusions:
In a large cohort of Chinese women with a history of GDM, our data for the first time indicate that the genetic predisposition to HbA
1c
may interact with postpartum weight reduction on long-term glycemic changes.

Figure 1.
Changes in glycemic traits according to weight reduction and HbA
1C
genetic risk score tertiles.
Abstract P079: Alcohol Consumption and Risk of Diabetes in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: He Xintong , Daya Natalie , Rebholz Casey M. , Lazo Mariana , Selvin Elizabeth
Published: July 2021

Background:
Moderate alcohol consumption has been reported to be associated with lower risk for diabetes with some studies showing a U-shaped association. Whether and how the association might differ by gender or obesity status is controversial.

Objective:
To evaluate the prospective association between alcohol consumption and the long-term risk of diabetes in the Atherosclerosis Risk in Communities (ARIC) Study.

Methods:
A prospective analysis of 11,263 ARIC participants without prevalent diabetes (55% women, 81%white, mean age 54 years). Alcohol consumption was assessed at visit 1 (1987-1989). Participants were followed-up for incident diabetes defined by fasting glucose more than 126 mg/dL, non-fasting glucose more than 200 mg/dL, self-reported diagnosis of diabetes or use of diabetic medication. We used Cox models to estimate hazard ratios of diabetes risk by drinking categories in women and men, respectively.

Results:
During a median follow-up of 21 years, there were 3518 incident diabetes cases. In the fully adjusted model, compared to never drinkers, among women, 7-14 drinks/week was associated with a significantly lower risk of diabetes; whereas among men, 14-21 drinks/week was associated with a significantly lower risk (
Table
). There was a significant interaction between drinking categories and smoking status or between drinking categories and body mass index in women. Among women, a U-shaped association was mainly present among non-smokers, and significant decreasing risk is only found among normal-weight and overweight participants, but not obese participants.

Conclusion:
Low levels of alcohol intake (1-2 drinks per day for women and 2-3 drinks per day for men) are inversely associated with diabetes risk. The association is modified by smoking and body mass index in women.