bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P177: Hypertension is Considerably More Prevalent, Yet Decreasing Over Time According to the New Guidelines
Authors: Rudy Joyce E , Foraker Randi E , Harris Randall E , Bower Julie K
Published: March 2019

Introduction:
New High Blood Pressure (BP) Guidelines released by the American Heart Association (AHA) and the American College of Cardiology redefined hypertension, imparting implications for monitoring cardiovascular health (CVH). The impact on reclassification of patients according to electronic health record (EHR) data as a result of changes in criteria for BP cut points has not yet been described.

Hypothesis:
We hypothesized that more stringent cut points for hypertension would increase the prevalence of United States (US) adults with poor CVH for BP.

Methods:
We analyzed outpatient visit data recorded in The Guideline Advantage©, a repository of EHRs of patients from eight diverse healthcare systems in the US from 2012-2015. For each year, the first non-missing BP measurement for each patient was categorized into poor (hypertensive), intermediate (pre-hypertensive), and ideal (normotensive) for CVH, first in accordance with AHA’s Life Simple 7 guidelines, and then in accordance with the new guidelines. We compared overall trends with trends stratified by race and sex, in distributions of poor and intermediate categories, and in the proportion eligible for pharmacological treatment (BP ≥ 130/80).

Results:
A total of 172,209 unique patients contributed 348,933 BP measurements, and most were female (58.63%) and white (75.09%). Although the prevalence of poor CVH for BP was consistently 3-fold higher under the new guidelines and the difference in prevalence was significant (p<0.0001), it decreased over time for the both the old (9.4% to 8.7%) and new (27.8% to 26.4%) guidelines. Over time, the proportion classified as hypertensive decreased (12.4% to 10.4 vs. 33.9% to 30.3%) for males and increased for non-whites (10.2% to 13.9% vs. 27.1% to 35.3%) from the old and new guidelines, respectively, but remained stable for females and whites. Similarly, the annual difference in the proportion of intermediate CVH for BP was significant (p<0.0001); however, pre-hypertension prevalence slightly increased under the old (57.9% to 58.5%) and new (39.5% to 40.7%) guidelines. Among untreated adults eligible for pharmacological intervention, the proportion remained relatively unchanged over time; in 2015, patients lacking treatment yet meeting treatment criteria was 23% and 7.3% under the new and old guidelines, respectively, resulting in a difference of 15.7% (p<0.0001). Whites (66.8%) and females (50.6%), compared with non-whites and males, respectively, comprised the majority.

Conclusions:
Prevalence of poor CVH for BP among US adults substantially increases in the outpatient setting when categorizing measures with the new guidelines. Active participation by clinicians and public health practitioners are needed to address the higher prevalence of and disparities in both hypertension and treatment prescription identified with the old versus new guidelines.
Abstract P183: The Multiple Measurements of Urinary Sodium-to-Potassium Ratio Strongly Related With Home Hypertension: the Tohoku Medical Megabank Project Cohort Study
Authors: Kogure Mana , Hirata Takumi , Nakaya Naoki , Tsuchiya Naho , Nakamura Tomohiro , Narita Akira , Miyagawa Ken , Koshimizu Hiroshi , Obara Taku , Metoki Hirohito , Uruno Akira , Kikuya Masahiro , Sugawara Junichi , Kuriyama Shinichi , Hozawa Atsushi
Published: March 2019

Introduction:
Recently, the balance between sodium and potassium intake, i.e. sodium-to-potassium (Na/K) ratio, has received a lot of attention for prevention of hypertension. Previous studies reported that the positive association between 24-hour urinary Na/K (uNa/K) ratio and hypertension. However, no studies have evaluated the relationship between uNa/K ratio measured by casual urine measurement and home hypertension in large populations. We aimed to clarify whether casual uNa/K ratio using the self-monitoring device was associated with home hypertension in general population. In addition, we assessed whether multiple days measurement of uNa/K ratio by casual urine increase the accuracy of the prediction of home hypertension compared with casual urine collected in a single day.

Hypothesis:
We assessed the hypothesis that multiple measurement of uNa/K ratio was positively associated with home hypertension, and increase the prediction of home hypertension compared with a single measurement.

Methods:
The subjects were over 20 years old who participated in The Tohoku Medical Megabank Project Cohort Study. Of these participants, we targeted 2,551 subjects who borrowed home blood pressure monitors (HEM-7080IC) and uNa/K ratio monitors (HEU-001F) for continuous 10 days. To assess the relationship between casual uNa/K ratio and home hypertension, we performed multiple logistic regression analyses and calculated aOR with 95% CI. We included covariate factors as age, sex, BMI and drinking status. In addition, to compare the prediction of home hypertension in multiple measurement with that in a single measurement, we calculated area under the ROC curve (AUROC) of uNa/K ratio. Home hypertension was defined as a SBP ≥ 135 mmHg and/or a DBP ≥ 85 mmHg.

Results:
Among 849 subjects had home hypertension (33.3%). Although uNa/K ratio was even positively associated with home hypertension by a single day (P for trend <0.01, aOR of home hypertension increase per quartile =1.11), the relationship between uNa/K ratio of multiple measurement and home hypertension was more robust (aOR of more than 5 days: 1.23 to 1.25). Similarly, AUROC of uNa/K ratio measurement for home hypertension in 5 days was larger than that in a single day.

Conclusions:
In conclusion, even single measurement of uNa/K ratio was positively associated with hypertension, the multiple measurement of uNa/K ratio strongly related with home hypertension. We suggested that multiple measurement of uNa/K ratio is desirable for assessing home hypertension because long term measurement of uNa/K ratio might reflect participants’ dietary balance of Na/K ratio.
Abstract P184: 2017 ACC/AHA Blood Pressure Classification and Cardiovascular Risk by Sex and Age: a 10-year Follow-up of 17.7 Million Koreans
Authors: Lee Hokyou , Park Sungha , Kim Hyeon Chang
Published: March 2019

Introduction:
The ACC/AHA has lowered the definition of high blood pressure (BP) in 2017 with emphasis on individual risk assessment. However, in clinical settings without feasible risk calculation tools, it is unclear whether such BP classification alone can accurately stratify cardiovascular disease (CVD) risk across various demographic groups.

Hypothesis:
We hypothesized that CVD risks according to ACC/AHA BP categories differ by sex and age subgroups.

Methods:
We followed 17 714 343 persons, who underwent national health screening and had no prior CVD, for 10 years using the Korean National Health Insurance database. BP was classified by ACC/AHA definitions. Stage 1 and 2 hypertensions were further subcategorized into narrower systolic and diastolic BP (SBP/DBP) intervals. Outcome was the first CVD event (myocardial infarction and/or stroke). We used multivariable Cox proportional hazards model, stratified by sex and age subgroups, to calculate hazard ratios (HR) according to BP categories.

Results:
Effect of high BP on CVD risk varied significantly by sex and age, with greater relative hazards in women and in younger ages (figure).
Elevated
BP was associated with higher CVD risk, compared with normal BP, in both sexes of age 20-69, but the association was no longer significant after age 70. Among stage 1 or 2 hypertension, CVD risks significantly diverged when the ACC/AHA category was divided into narrower SBP/DBP intervals. For instance, in men of age 50-59, HRs for SBP/DBP <120/80-89, 120-129/80-89, 130-139/<80, and 130-139/80-89 mmHg—all of which are stage 1 hypertensions—were 1.09, 1.20, 1.41, and 1.43, respectively. Similar trends were seen for both sexes, but there was a greater divergence of HRs toward higher pulse pressure in men and in older ages.

Conclusion:
Effect of high BP on CVD risk varies significantly by sex and age, and heterogeneous risk groups may coexist in the same ACC/AHA BP category. Therefore, an individual-level risk calculation tool is crucial for precise risk assessment in persons with high BP.
Abstract P185: Alcohol Consumption and Cardiovascular Disease Mortality in Adults With Hypertension Following the 2017 Blood Pressure Guidelines
Authors: Brellenthin Angelique G , Lee Duck-chul , Sui Xuemei , Blair Steven N
Published: March 2019

Introduction:
Approximately half of adults have hypertension (HTN) under the 2017 blood pressure (BP) guidelines. The guidelines recommend lifestyle factors, such as limiting alcohol consumption, to manage BP, although safe levels of alcohol consumption have not been investigated for this new population with HTN.

Objective:
To examine the dose-response associations of alcohol consumption and cardiovascular disease (CVD) mortality in 29,499 adults (45±10 years) with HTN defined as systolic/diastolic BP ≥130/80 mmHg or physician diagnosis.

Methods:
Participants received a preventive medical examination during 1974-2003 and were without CVD, cancer, or abnormal electrocardiogram at baseline. Participants self-reported the number of standard alcoholic beverages they consumed per week on a medical history questionnaire. Participants were classified into 5 groups: non-drinkers and sex-stratified quartiles of weekly drinks based on no significant interaction by sex. Non-drinkers with a previous history of alcohol use problems were excluded to minimize a potential selection bias. Mortality follow-up was through 2003 using the National Death Index. Cox regression models included baseline age, sex, examination year, smoking status, body mass index, meeting the aerobic physical activity guidelines, and parental CVD. Models were further adjusted for cardiorespiratory fitness (CRF; in METs).

Results:
During a mean follow-up of 14.5 years, 672 CVD deaths occurred. Quartiles of alcohol consumption were 1-3, 4-7, 8-14, ≥15 drinks per week for men and 1-2, 3-4, 5-9, ≥10 drinks per week for women. Compared with non-drinkers (23%; 6,756 of 29,499), the hazard ratios (95% confidence intervals) for CVD mortality among quartiles of drinking were 0.71 (0.54-0.92), 0.73 (0.58-0.92), 0.76 (0.60-0.98), and 0.84 (0.67-1.05) after adjusting for potential confounders. After additional adjustment for CRF, the HRs were 0.75 (0.58-0.98), 0.79 (0.62-0.996), 0.82 (0.65-1.05) and 0.90 (0.72-1.13) for CVD mortality compared with non-drinkers. We found similar trends for CVD mortality after adjusting for fasting glucose, resting systolic and diastolic BP, total cholesterol, diabetes, and hyperlipidemia. We also found similar results in subgroups of men and women, young (<60 years) and old (≥60 years), and normal weight (<25 kg/m
2
) and overweight/obese (≥25 kg/m
2
) individuals. Similar trends were observed for all-cause mortality, although the associations were attenuated in all quartiles of drinking both before and after adjusting for CRF.

Conclusions:
The risk of CVD mortality was lower in light-to-moderate (quartiles 1-3) alcohol drinking in adults with HTN although these associations became weaker after adjusting for CRF. These results suggest a potential confounding effect of CRF on the association between alcohol consumption and CVD mortality that should be considered for future studies.
Abstract P186: Comparison of Hypertension Prevalence, Treatment, and Control Among African Immigrants and African Americans in the US
Authors: Mensah Danielle S , Commodore-Mensah Yvonne , Foti Kathryn , Turkson-Ocran Ruth-Alma , Patel Nishit , Dennison Himmelfarb Cheryl , Selvin Elizabeth
Published: March 2019

Introduction:
African immigrants make up a growing share of Blacks in the US. However, little is known about their cardiovascular health because data are combined with African Americans, despite cultural, socioeconomic, and genetic differences.

Hypothesis:
There will be significant differences in hypertension prevalence, treatment, and control between samples of African immigrants and African Americans.

Methods:
We included participants in the African Immigrant Health Study, a community-engaged study of African immigrants in Baltimore-Washington, D.C. Participants ≥ 30 years old were recruited from community groups and religious institutions from 2017-2018. They were English-speaking and born in West Africa. We compared them to a weighted sample of African Americans who were ≥ 30 years old from the 2015-2016 NHANES. We used t-test and chi-squared tests to compare hypertension prevalence, treatment, and control between the groups.

Results:
We compared 326 African immigrants (mean age 46; 60% women) to 928 African Americans (mean age 51; 56% women). African immigrants (60%) were more likely to have ≥ college education than African Americans (22%). African Americans (87%) were more likely to be insured than African immigrants (58%) and less likely (12%) to report a household income of ≥ $100,000 than African immigrants (21%). Age-standardized hypertension prevalence was higher in African Americans than African immigrants (
Table
). However, among those with hypertension, African Americans were more likely to be treated and controlled. Both groups had similar high rates of overweight/obesity; diabetes prevalence was higher in African Americans.

Conclusions:
Hypertension prevalence among African immigrants was lower than African Americans. However, hypertension treatment and control rates were lower in African immigrants and this may be due to poor healthcare access. Future studies may further elucidate reasons for differences among Black ethnic groups in hypertension prevalence, treatment, and control.
Abstract P188: Cluster Analysis of Systolic Blood Pressure Trajectories Before and After Initiation of Anti-Hypertensive Therapy
Authors: Gagnon David R , Ho Yuk-Lam , Honerlaw Jacqueline P , Gaziano J. M , Wilson Peter W , Djousse Luc , Cho Kelly
Published: March 2019

Background:
Responses to new anti-hypertensive therapy (AHT) can differ. Cluster analysis of longitudinal systolic blood pressure (SBP) data allows identification of individuals with similar trajectories, which enables hypothesis generation to potentially explain the observed patterns. We examined electronic health data from U.S. Veterans initiating AHT from 2002-2009.

Methods:
SBP was tracked for 1 year before and up to 2 years after AHT initiation. Subjects were clustered using a K-means approach with the mean of the squared Euclidean distances as a distance metric and evaluated for the optimal number of clusters. Thin-plate splines were used to display the smoothed trajectories of each group with predicted SBP measures over time.

Results:
A total of 45,598 subjects contributed 783,852 SBP measurements. Five clusters of subjects with similar trajectories were produced, providing visualization of SBP [Figure 1] prior to initiation, immediately after starting therapy, and after longer treatment duration. For example, Group 1 had the lowest mean age, lowest HDL-C, lowest LDL-C, highest triglycerides, lowest baseline SBP, lowest insulin use, and highest statin use.

Conclusions:
Trajectory clustering for SBP identifies distinct response groups that differ in response to therapy, laboratory measures, and medication use. Future analyses can examine anti-hypertensive medication use, compliance and genetic factors to identify potential causes for these trajectories. These cluster analyses can provide new analytical approaches related to risk factor diagnosis and treatment.
Abstract P196: Mississippi Delta Health Collaborative Community and Faith Based Programs to Screen Hypertension
Authors: Karimi Masoumeh , Dove Cassandra , Walls Tameka , Hopkins Monique
Published: March 2019

Introduction:
The Mississippi Delta Health Collaborative (MDHC) provides leadership in the Delta region to implement heart disease and stroke prevention interventions. Barbers Reaching Out To Educate on Routine Screenings (BROTHERS) is an innovative community based program whereby MDHC partners with existing barbershops to provide routine blood pressure screenings and referrals. The faith-based Delta Alliance for Congregational Health (DACH) supports the mission of its member churches to minister to their communities with regular cardiovascular health screenings and include community outreach events. The MDHC program started in 2008 and has devoted the last 2 years to screen residents’ blood pressure and help them to control it as a risk factor for cardiovascular disease. The aim of this study is to track the community base initiatives outcomes.

Methods:
From October 2016 to March 2018, from all 18 counties of the Mississippi Delta region, 33 barbers participated in the BROTHERS program and completed a total of 4,926 blood pressure screening encounters of 4,301 individuals (97.6% (n= 3943) black; 71.14% (n=3060) male; mean age= 35.67, SD=13.92). Also 26 churches participated in the DACH program and completed a total of 2,658 blood pressure screening encounters of 1,987 individuals (94.5% (n=1877) black; 65.2% (n=1295) female; mean age= 52.62, SD=16.43).

Results:
Barbers screenings showed that 51.84% (n=1688) of men were pre-hypertensive while only 10.81% (n=352) had normal blood pressure. Among all, 16.2% (n=738) participants reported never having their blood pressure checked. Among men, 1,216 (37.34%) had hypertension while 26.8% (n=326) were currently taking blood pressure medications, 37.9% (n=459) were current smokers, 31% (n=375) had no insurance coverage and 46.7% (n=566) had no personal doctor. DACH screenings showed that 42.3% (n=842) of participants were pre-hypertensive and 40.46% (n=804) had hypertension. Among hypertensive participants, 63.8% (n=513) were aware of the high blood pressure status and 58.3% (n=469) were currently taking medications for high blood pressure.

Conclusion:
Health is determined in part by access to social and economic opportunities as well as the resources and support in communities. Because of the innovative health initiatives underway in the Mississippi Delta region, a new story is unfolding. Community based screenings help people to become familiar with their health status, educate them on various methods of prevention and intervention and help them to change their life style to have a healthier life. Each healthy step taken is one towards improved health and prosperity not only for our state, but for the entire country.
Abstract P197: Factors Contributing to the Success of a Multicomponent Intervention for Blood Pressure Control in Argentina: A Mediation Analysis
Authors: Mills Katherine T , He Hua , Irazola Vilma , Poggio Rosana , Beratarrechea Andrea , Chen Chung-Shiuan , Gibbons Luz , Chen Jing , Rubinstein Adolfo , He Jiang
Published: March 2019

Introduction:
The Hypertension Control Program in Argentina (HCPIA), a cluster-randomized trial of a community health worker-led multicomponent intervention on blood pressure (BP) control in low-income patients in Argentina, previously reported a significant reduction in systolic BP in the intervention compared to the control group over 18 months (6.6 mm Hg net difference; p<0.001). Understanding which elements of a multicomponent intervention are important contributors to its success is critical for future BP control efforts. We conducted a mediation analysis to determine the contributions of seven measured intervention targets to the systolic BP intervention effect.

Methods:
HCPIA randomized 18 primary healthcare clinics treating uninsured patients to either a multicomponent intervention, consisting of health coaching, home blood pressure monitoring, blood pressure audit and feedback, physician education, and a mobile health intervention, or usual care. A total of 1,357 hypertensive participants completed the trial and are included in the mediation analyses. Changes in seven potential mediators over the 18-month intervention were assessed: medication adherence score, medication adjustments (addition of new medication or dose titration), waist circumference, physical activity, fruit and vegetable consumption, sodium consumption, and alcohol consumption. Generalized estimating equations were used to compare changes in potential mediators between intervention groups. Path analytic models were used to test single-mediator and multiple mediator indirect intervention effects using the Lavaan package in R statistical software. Mediation was considered significant at p<0.10.

Results:
All potential mediators were significantly improved in the intervention group compared to the control group. Fruit and vegetable consumption, medication adherence, physical activity, and salt consumption are each significant mediators accounting for 4.3, 3.8, 3.3, and 3.2%, respectively, of the intervention effect in single-mediator models. The multiple mediation model explained 15.5% (1.3 mm Hg) of the total intervention effect. Changes in fruit and vegetable consumption and medication adherence remained significant mediators in multiple mediation analysis, responsible for 3.8% and 4.3% of the net reduction in systolic BP, respectively. Other potential mediators did not account for a significant proportion of the intervention effect.

Conclusions:
Increases in medication adherence and fruit and vegetable consumption were responsible for the largest proportions of the explained intervention effect.
Abstract P200: Unsaturated Fat Replacing Carbohydrate or Protein Affects Protein-Based HDL Subspecies of Different Functionality
Authors: Zhang Bo , Guglielmo Barry , Furtado Jeremy D , Sacks Frank M
Published: March 2019

Introduction:
HDL is a heterogeneous group of protein-lipid complexes comprised of stable subspecies defined by their protein content whose functions and associations with cardiovascular disease (CVD) are likely driven by their proteome. The Optimal Macronutrient Intake Trial to Prevent Heart Disease (OMNI Heart) found that unsaturated fat replacing carbohydrate or protein increased HDL cholesterol, but nothing is known about the effect of macronutrient composition on HDL subspecies concentrations.

Hypothesis:
Dietary unsaturated fat (UNSAT) replacing carbohydrate (CARB) or protein (PROT) affects protein-based HDL subspecies.

Methods:
The OMNI Heart Trial employed a randomized cross-over design that fed sequentially each of three study diets emphasizing CARB, PROT, or UNSAT to the participants. The apolipoprotein (apo) A1 concentrations of 16 HDL subspecies, selected to represent the major functions of HDL, were measured in plasma samples from 141 participants collected after 4 weeks on each diet.

Results and Conclusions:
UNSAT replacing CARB or PROT affected the levels of different HDL subspecies involved in lipid metabolism, anti-oxidation, anti-inflammation, and homeostasis (figure). UNSAT replacing PROT increased HDL that contains apoC1, apoL1, PON1, or plasminogen. UNSAT replacing CARB increased HDL that contains apoC1 and HDL that contains apoE, an HDL subspecies associated with protection against CVD. PROT replacing CARB decreased HDL that contains apoE. UNSAT replacing CARB or PROT increased HDL cholesterol, total apoA1, and HDL that contains apoA2, as expected. In conclusion, macronutrients affect HDL subspecies that vary in their functionality, which may contribute to the effects of dietary inventions on the risk of cardiovascular and other diseases.
Abstract P229: Cross-Sectional Investigation of the Relationship Between Fish Consumption and Its Urinary Biomarkers With Blood Pressure Across Asian and Western Populations: Results From the INTERMAP Study
Authors: Gibson Rachel , Lau Chung-Ho E , Chan Queenie , Chekmeneva Elena , Loo Rueyleng , Ebbels Timothy M , Dyer Alan R , Miura Katsuyuki , Ueshima Hirotsugu , Zhao Liancheng , Daviglus Martha L , Elliott Paul , Stamler Jeremiah , Holmes Elaine , Van Horn Linda
Published: March 2019

Background:
Evidence relating to the benefit of fish consumption on blood pressure (BP) management is inconclusive. Recent research has suggested that different patterns in fish consumption across geographic regions may modify the association between fish intake and cardiovascular outcomes.

Objectives:
To investigate the associations between fish intake and BP in Asian and Western population groups and to explore the associations between candidate urinary biomarkers of fish intake and BP.

Methods:
The International Study on Macro/Micronutrients and Blood Pressure (INTERMAP) surveyed 4680 men and women aged 40-59 years from four countries: United States of America (US), United Kingdom (UK), Peoples Republic of China (PRC) and Japan between 1996 and 1999. Standardized quality-controlled measures collected included: four 24-hour dietary recalls and two 24-hour urine collections and eight BP measurements. Proton nuclear magnetic resonance spectra of urine specimens were acquired, and partial correlation analysis adjusted for age, sex, and sample/centre were performed to identify candidate peak variables correlating to total fish and shellfish intakes. Multivariable linear regression models conducted on pooled data by geographic region (Asian: Japan and PRC;
n
= 1984, and Western: UK and US;
n
= 2696) estimated differences in BP per 2SD (33.4g/1000kcal) of total fish intake and identified urinary metabolites.

Results:
Japan reported the highest daily intake of fish (mean 40.3, SD 22.3 g/1000kcal) with 99% of the cohort classified as consuming fish. Mean daily fish consumption patterns were comparable between the US (9.0 SD 15.0 g/1000kcal; 53% consumers) and UK (8.5 SD, 12.4 g/1000kcal; 55% consumers). No associations were observed between total fish intake and BP in individual cohorts or by geographic region. Trimethylamine N-oxide (TMAO), taurine and homarine were identified as candidate urinary biomarkers of fish intake. Homarine showed a strong correlation with shellfish intake (
r
=0.43,
P
<0.0001). Direct associations were observed between TMAO and diastolic BP (DBP) in the Western cohort (
β
0.32 95%CI 0.14, 0.50,
P
= 0.0006; fully adjusted for lifestyle and dietary intakes), this remained significant following adjustment for body mass index (
β
0.23, 95%CI 0.05, 0.41,
P
= 0.012). Taurine and homarine were not associated with BP.

Conclusion:
We observed no association between fish consumption and BP across Asian or Western populations. The differential association between urinary TMAO and DBP in Western and Asian population groups requires further investigation.
Abstract P230: Adherence to the MIND Diet is Associated with a Favorable Profile of Subclinical Cardiac Remodeling in the Framingham Offspring Cohort
Authors: Walker Maura E , O’Donnell Adrienne , Himali Jayandra , Melo van Lent Debora , Xanthakis Vanessa , Seshadri Sudha , Ramachandran Vasan
Published: March 2019

Introduction:
The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet is based on the central components of the Mediterranean and DASH diets and emphasizes foods that may provide a neuro-cognitive benefit. To date, no study has investigated adherence to the MIND diet and indices of cardiac remodeling. We hypothesized that adherence to the MIND diet may have a favorable impact on indices of cardiac remodeling.

Methods:
Multivariable linear regression related the MIND diet score to echocardiographic indices of cardiac remodeling in 2569 Framingham Offspring cohort participants (mean age, 67 years; 55% women). The MIND diet score contains 15 components, each with a maximum score of 1 (max score =15). We averaged MIND diet scores across 2-4 exam cycles. Primary and secondary echocardiographic measures are in
Table 1
. Simple models (model 1) were adjusted for age, sex, and total energy intake, and additional models (model 2) were further adjusted for BMI, smoking, total/high-density lipoprotein cholesterol (TC-HDL) ratio, heart rate, diabetes, systolic blood pressure, and use of anti-hypertensive medication.

Results:
Participants had a mean (±SD) cumulative MIND diet score of 6.9 (± 1.7). The cumulative MIND diet score was significantly associated with favorable measures of E/e’, GLS, GCS, and MAPSE in model 1 (
Table 1
). Associations between the MIND diet score and echocardiographic measures were attenuated and became non-significant in model 2 (
Table 1
). A higher MIND diet score was associated with lower levels of several clinical risk factors including BMI (β±SE (p value): -0.01±0.002 (<.0001)), TC-HDL ratio (-0.05±0.01 (0.0002)), heart rate (-0.83±0.12 (<.0001)), with lower odds of diabetes (OR [95% CI]: 0.88 [0.82, 0.94]), and use of anti-hypertensive medication (0.94 [0.90, 0.99]).

Conclusions:
Favorable associations between cumulative adherence to the MIND diet and echocardiographic indices are likely mediated by the favorable impact of adherence to the MIND diet on clinical risk factors.
Abstract P243: Impact of Menopausal Hormone Therapy on Association Between Heart Fat and Carotid Artery Atherosclerosis Progression in Recently Postmenopausal Women: the KEEPS Trial
Authors: El Khoudary Samar R , Venugopal Vidya , Manson JoAnn E , Brooks Maria M , Santoro Nanette , Black Dennis M , Harman Mitchell , Hodids Howard N , Brinton Eliot , Miller Virginia M , Taylor Hugh S , Budoff Matthew J
Published: March 2019

Objective:
Heart fat depots, within [epicardial adipose tissue (EAT)] and outside [paracardial adipose tissue (PAT)] the pericardium, have been linked to carotid atherosclerosis in various populations. Postmenopausal women have greater volumes of heart fat than premenopausal women. Our previous work suggests that lower endogenous estrogen may contribute to heart fat accumulation, although possibly limited to PAT, while postmenopausal oral hormone therapy (HT) may slow its progression. We evaluated the effect modification of HT use over 48 months on associations between heart fat accumulation and carotid artery intima-media thickness (CIMT) progression in recently postmenopausal women.

Methods:
The Kronos Early Estrogen Prevention Study (KEEPS) was a multi-center, randomized, double-blind placebo-controlled trial to investigate effects over 48 months of oral conjugated equine estrogens (o-CEE) and transdermal 17β-estradiol (t-E2), both given with cyclic progesterone, compared to placebo, on progression of CIMT in recently postmenopausal women. EAT and PAT volumes, and CIMT were measured at baseline and at 48 months. Associations between the absolute changes in heart fat volumes and CIMT as well as effect modification by HT type were tested using linear regression, adjusting for age, race, study site, employment status, diastolic and systolic blood pressure, anti-hypertensive medications, insulin resistance index, lipids, body-mass index, smoking, alcohol consumption, C-reactive protein, and adipokines.

Results:
Of 727 randomly assigned women, 467 [mean age (SD): 52.7(2.5); 78.2% Caucasian] had heart fat volumes and CIMT measured at both time points. Overall, changes in EAT and PAT were not associated with CIMT progression; however, assigned treatment significantly modified the association between changes in PAT, but not EAT, and CIMT progression in unadjusted model, P=0.04. In o-CEE group, CIMT progression was 0.028mm (SE:0.01mm) lower, per 1 unit increase in log PAT, than in t-E2 group, P=0.01, and trended 0.017mm (SE:0.01mm) lower than in placebo group, P=0.09. Although adjusted analysis attenuated these findings (P-value for interaction 0.09), differences between o-CEE and t-E2 groups remained significant, P=0.03.

Conclusion:
HT use modified the association between PAT accumulation, but not EAT, and CIMT progression. Our results suggest a potential beneficial impact of o-CEE (but not transdermal E2) on the relationship between adverse changes in PAT and CIMT. The current findings support the notion that EAT and PAT are distinct fat depots and suggest a complex role of HT in the association between heart fat and CIMT progression in recently postmenopausal women.
Abstract P247: Combination of Obesity and Metabolic Syndrome is Associated With Highest Rate of Depression Secondary to Increased Inflammation
Authors: Moazzami Kasra , Lima Bruno , Sullivan Samaah , Shah Amit , Bremner J. Douglas , Vaccarino Viola
Published: March 2019

Introduction:
A growing body of evidence suggests that obesity and metabolic syndrome (MetS) are associated with depression and that inflammation may play a role. However, the separate and combined associations of obesity and MetS on the prevalence of depression and their relationship with inflammation have not been investigated.

Hypothesis:
We hypothesized that the combination of obesity and MetS would be associated with the highest rates of both depression and elevated inflammation.

Methods:
Data were collected from the National Health and Nutrition Examination Survey between 2009 and 2014. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9) and was defined with a cut-point of ≥ 10. Obesity was defined as BMI ≥ 30 kg/m
2
. MetS was defined based on the American Heart Association consensus definition. Participants were divided into four groups: healthy normal weight, metabolically healthy obesity, metabolically unhealthy normal weight, and metabolic unhealthy obese (MUO). C-reactive protein was assessed in a subsample.

Results:
Participants with MUO had the highest prevalence of depression compared to the healthy group (14.8% vs 6.8, P<0.001). The mean PHQ-9 score was also highest among the MUO group (4.16 ± 0.09). While both obesity and MetS were independently associated with depression, there was a significant interaction between the two (P<0.001, Figure). On adjusted analysis, the MUO group had the highest odds of depression (Figure). The MUO group also showed the highest geometric mean levels of C-reactive protein compared to the healthy group (0.34 ± 0.03 vs 0.11 ± 0.03, P<0.001). Levels of C-reactive protein mediated the effect between MUO and depressive symptoms (80.5% of the total effect).

Conclusion:
Both obesity and MetS are associated with depression independent of each other, but participants with both conditions have the highest odds of depression. These findings underscore the importance of cardiometabolic disturbances as correlates of mental health status.
Abstract P249: Central Obesity and Systemic Inflammation Predict Subsequent Levels of Procollagen Type III N-Terminal Peptide in Framingham Offspring Study Adults
Authors: Pickering Richard T , Singer Martha R , Xanthakis Vanessa , Ramachandran Vasan S , Moore Lynn L
Published: March 2019

Background:
Fibrosis is a process that, in healthy individuals, is characterized by deposition of extracellular matrix (ECM) components. However, in pathological states, such as the low-grade inflammation associated with obesity, excessive tissue ECM production is associated with dysfunction of various organs such as liver, kidney, and adipose tissue. Procollagen Type III N-terminal peptide (P3NP) is produced during collagen synthesis and is linked to adverse outcomes including cardiovascular events. Few studies have examined the relationship between systemic inflammation or body fat distribution and P3NP.

Methods:
Data from the prospective Framingham Offspring study were used to examine the link between systemic inflammation, body fat distribution and P3NP. Of the 944 individuals with P3NP measured at exam 6, 737 had CRP measured at exam 2 and 859 had waist circumference measured at exam 4, along with potential confounders including sex, age, smoking, and body mass index (BMI). Levels of serum CRP at exam 2 were classified into 3 groups (≤1.0, 1.0 to ≤3.0, >3.0 mg/L) and waist circumference was divided in sex specific quintiles. Due to non-normality, levels of P3NP were log transformed. Multivariable general linear models were used to assess the associations between both CRP and waist circumference and P3NP. Age, sex, smoking status, physical activity and BMI were assessed as potential confounders.

Results:
Compared with individuals with the lowest levels of CRP at exam 2 (≤1mg/L) those with intermediate or high levels (CRP: 1.0 to ≤3.0, and >3.0) had statistically significantly higher levels of plasma P3NP at exam 6 (3.8 ± 0.2, 4.2 ± 0.3, and 4.3 ± 0.3 mg/L, from lowest to highest category, respectively, p-trend<0.001). Additionally, men in the two highest quintiles of waist circumference at exam 4 had statistically significantly (p<0.05) higher plasma P3NP levels than those in the lowest quintile (4.6 ± 0.4, 4.5 ± 0.4 vs. 3.7 ± 0.4 mg/L for quintiles 5 and 4 vs. 1, respectively). No effect was seen in women.

Conclusions:
These results suggest a link between both systemic inflammation and waist size (a simple indicator of central adiposity) and circulating markers of fibrosis. These findings may suggest that adverse health outcomes associated with visceral adiposity and systemic inflammation may be linked with development of fibrosis.
Abstract P250: Sex-Related Differences in the Associations of Variability in Body Mass Index and Metabolic Health With Incidence of Obesity and Metabolically Unhealthy Status: The Framingham Offspring Study
Authors: Sponholtz Todd R , Vasan Ramachandran S
Published: March 2019

Introduction:
Higher variability of body mass index (BMI) is associated with both cardiometabolic and cardiovascular disease in high-risk individuals. It is unclear, however if variability of BMI impacts metabolic health or obesity risk in healthy adults and if any potential associations vary for women vs. men.

Methods:
We classified Framingham Offspring cohort participants (n=3,961, mean age 50.8 years, 53.8% women) according to their obesity (BMI ≥30 kg/m
2
) and metabolic health status (<2 non-obesity NCEP ATPIII conditions) and followed them prospectively 1987 to 2014. BMI and metabolic syndrome (MetS)-associated measures in the top quintile of the variance independent of the mean were classified as being variable. ‘Variable metabolic health’ (VMH) was defined as ≥2 ‘variable’ non-obesity MetS components. We estimated sex-specific incident rate ratios (IRRs) and 95% confidence intervals (95% CIs) for the associations of time-varying obesity, metabolic health status, and variability of BMI and metabolic health with the incidence of obesity and metabolically unhealthy state using Cox proportional hazards regression for interval-censored outcomes with age as the time scale.

Results:
On follow-up, 567 participants (313 women) developed new-onset obesity over 9,434 person-periods, and 759 individuals (437 women) developed a metabolically unhealthy state over 5,754 person-periods). After adjustment for covariates, being metabolically unhealthy was associated with a greater risk of new-onset obesity among women (153%, 95% CI 96-229%) compared with men (33%, 95% CI: 1, 79%;

p
sex-

difference
=0.005). Similarly, BMI variability was associated with a higher risk of becoming metabolically unhealthy in women (134%, 95% CI: 76, 212%) compared with men (-11%, 95% CI: -49, 53% (p
sex-difference
=0.0007). Among participants without obesity, BMI variability was associated with a greater risk of incident obesity in women (275%, 95% CI: 185, 393%) compared with men (33%, 95% CI: -22, 129%

p
sex-

difference
=0.005). Obesity was positively associated with greater risk of incident unhealthy metabolic state in women (157%, 95% CI: 93, 342%) compared to men (16%, 95% CI: -17, 62%; p
sex-difference
=0.006). Metabolic health did not alter the risk of either outcome among metabolically healthy or unhealthy individuals.

Conclusions:
Our longitudinal observations in a community-based sample suggest sex-related differences in the associations of variability of BMI and metabolic health on obesity and cardiometabolic risk. Additional investigations are warranted to replicate our findings and elucidate the biological basis for these sex-related differences. .
Abstract P259: Associations of Prior Head Injury With Physical Functioning
Authors: Schneider Andrea L , Wang Dan , Gottesman Rebecca F , Selvin Elizabeth
Published: March 2019

Introduction:
Head injury is associated with significant morbidity and mortality. However, associations of prior head injury with current physical functioning are less clear.

Hypothesis:
We hypothesized that persons with prior head injury would have greater impairment in physical functioning, particularly with functions requiring more complex thinking and organizational skills (e.g., managing money), compared to persons without head injury.

Methods:
We performed cross-sectional analyses of 6,293 participants in the 2011-2014 National Health and Nutrition Examination Surveys (NHANES), a nationally representative sample of noninstitutionalized civilian U.S. adults aged
2
40 years. Prior head injury was self-reported by the question, “Have you ever had loss of consciousness because of a head injury?” Measures of physical functioning were assessed by standard questions. We used logistic regression models to estimate associations and all analyses incorporated survey weights to account for the NHANES sampling design.

Results:
Overall, participants were a mean age of 57 years, 52% were women, 9% were black, and 15.3% had a history of head injury. Persons with a prior head injury were more likely to have limitations in any activity due to a physical, mental, or emotional problem (OR 1.88, 95%

CI 1.54-2.29;
Table
). Persons with a history of head injury were more likely to have difficulty walking up ten steps (OR 1.58, 95% CI 1.07-2.34), walking between rooms on the same floor (OR 2.68, 95% CI 1.02-7.03), performing household chores (OR 1.54, 95% CI 1.02-2.33), dressing (OR 1.75, 95% CI 1.17-2.62), managing money (OR 2.20, 95% CI 1.38-3.51), or attending social events (OR 2.48, 95% CI 1.47-4.19).

Conclusions:
Prior head injury is a potent risk factor for disability and has a strong link to limitations in physical, mental, and emotional functioning. Prospective studies are needed to better characterize the temporality of these observed associations.
Abstract P260: NEFAs, Incident Disability, Mobility Limitation and Frailty
Authors: Ahiawodzi Peter , Djousse Luc , Ix Joachim , Kizer Jorge , Tracy Russell , Arnold Alice , Newman Anne , Biggs Mary Lou , Mukamal Kenneth
Published: March 2019

Background:
Non-esterified fatty acids (NEFAs) play central roles in the relationship between adiposity and glucose metabolism and have been implicated in the pathogenesis of cardiovascular disease, but few studies have assessed their effects on complex geriatric syndromes like frailty that cross multiple organ systems. We sought to determine the relationships between NEFAs and incident frailty, disability, and mobility limitation in a population-based cohort of elders.

Methods:
We measured circulating total NEFAs in 2742 non-frail Cardiovascular Health Study (CHS) participants (mean age 74 years) from stored samples collected in 1992-3. Participants underwent assessment of frailty again in 1996-7 and continue to report their activities of daily living and mobility restrictions. We used ordinal logistic regression to model frailty and Cox regression was used to model disability and mobility limitation in relation to baseline NEFAs. To minimize departure from proportional hazards, we truncated follow-up at 9 years for disability and 6.5 years for mobility limitation.

Results:
A total of 251 participants became frail and 1411 became pre-frail over a four-year period, and we documented 1448 cases of disability and 1609 cases of mobility limitation during follow-up. NEFAs were positively associated in a dose-dependent manner with higher risks of incident frailty, disability, and mobility limitation. The adjusted odds ratios for frailty were 1.31 (95%CI=1.07-1.61, p=0.01) across extreme tertiles and 1.13 (95%CI=1.04-1.23, P=0.004) per standard deviation increment. The corresponding hazard ratios for incident disability were 1.40 (95%CI=1.05-1.87, p=0.02) and 1.22 (95%CI=1.09-1.37, P=0.001), while those for incident mobility limitation were 1.28 (95%CI=0.90-1.84, p=0.17) and 1.18 (95%CI=1.02-1.36, P=0.03). Results were largely consistent among both men and women.

Conclusion:
Circulating NEFAs are significantly associated with frailty, disability, and mobility limitation among older adults. These results highlight the broad spectrum of adverse health issues associated with NEFA in elders.
Abstract P263: Gestational Diabetes and Patterns of Cardiometabolic Risk Factors Before and After Childbearing: Coronary Artery Risk Development in Young Adults Study
Authors: Sun Baiyang , Bertolet Marnie , Lewis Cora E , Catov Janet M , Gunderson Erica P
Published: March 2019

Introduction:
Cardiometabolic risk factor levels before pregnancy affect risk of gestational diabetes mellitus (GDM), and unfavorable risk factors have been found after pregnancy. However, changes in risk factors during both the pre- and post-childbearing periods have not been evaluated longitudinally in prospective studies.

Hypothesis:
Women who develop GDM pregnancy exhibit less favorable patterns of CVD risk factors during both pre- and post-childbearing eras.

Methods:
We used data from CARDIA, a multi-center, longitudinal cohort of black and white young adults initially aged 18-30 with serial in-person exams across 30 years (9 exams, 1985-2016). Women with ≥1 births after baseline (n=1288) self-reported GDM and were classified as “ever” GDM (n=148, at least one GDM pregnancy) and as non-GDM (all non-GDM births; n=1140). Piecewise linear mixed-models, which allowed differing intercepts and slopes for pre- and post-childbearing eras, compared GDM group to non-GDM group on annual changes in CVD risk factor (BMI, waist circumference [WC], lipids, and blood pressure) during pre-childbearing period (before the first post-baseline birth) and post-childbearing period (after the last post-baseline birth). Models adjusted for baseline socioeconomics, length of childbearing period (from the first to the last post-baseline birth), parity, time-varying lifestyle habits and medication use.

Results:
Annual BMI increase before initiation of childbearing was higher in GDM group than non-GDM group (0.35 vs 0.23 kg/m
2
/year; p=0.03). Similarly, WC showed marked pre-childbearing increase for GDM group compared to non-GDM group (0.82 vs. 0.54 cm/year; p=0.04). In contrast, the annual increase in BMI and WC after childbearing did not differ by GDM history. No differences were detected for the other CVD risk factors.

Conclusions:
Accelerated gains in overall and central adiposity before the childbearing period was associated with elevated risk of GDM, but risk factor changes do not show differences after childbearing.