bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 075: Sociodemographic And Pregnancy Related Differences In Blood Pressure Phenotypes A Decade Following Pregnancy
Authors: Scott Jewel , Hauspurg Alisse , Muldoon Matthew F , Davis Esa M , Catov Janet M
Published: April 2022

Introduction:
Hypertensive disorders of pregnancy (HDP) such as preeclampsia are associated with a 3-fold increased risk of chronic hypertension (HTN). Office based measurements alone results in frequent HTN misclassification, prompting the need for out-of-office measurements to ensure proper classification.

Hypothesis:
We hypothesized that individual and neighborhood level sociodemographic factors and adverse pregnancy outcomes are different within the BP phenotypes of persistent normotension, and sustained, white-coat, masked, and isolated diastolic HTN.

Methods:
Data were from 401 women who gave birth between 2008 - 2009 and participated in a research study 8-10 years following pregnancy. We determined BP phenotypes by comparing the mean office BP (3 measures) and home BP (13 measures) assessed following research protocols. HTN was defined as BP ≥130/80. Sociodemographic characteristics were age, race, education, adiposity, and perceived stress. Neighborhood characteristics were from the CDC Social Vulnerability Index (i.e., socioeconomic status, household composition, minority status, housing type) measured at the census tract level, with higher values representing greater vulnerability. Chi-square determined differences in BP phenotypes for categorical data, and ANOVA for continuous data, both with Tukey correction.

Results:
Participants had a mean age of 37.6 (5.9), 15.1 (2.6) years of education, 34.7% (n=155) were Black and 22.8% (n=102) had a history of HDP. BMI and central adiposity were higher in all BP phenotypes compared to the normotensive group. Women with sustained HTN ( 6.2%, n=25) and isolated diastolic HTN (18.2%, n=73,) were more likely to be Black and have a history of HDP. However, only women with isolated diastolic HTN were more likely to have less education and higher stress scores. Compared to the normotensive women, those with masked HTN (n=25, 6.2%) tended to have a history of HDP. The BP phenotype groups did not differ by neighborhood level factors, although there was a trend toward lower neighborhood socioeconomic status among the isolated diastolic and masked HTN groups (p< .10).

Conclusion:
Isolated diastolic HTN was the most common adverse BP phenotype in this sample of young women, and was more common among Black women and those with a history of HDP. Isolated diastolic HTN may be more prevalent than generally recognized in clinical practice. Research is needed to determine the long-term implications of this phenotype, especially among women with a history of HDP. BP phenotypes differed on individual characteristics and neighborhood socioeconomic status, however, neighborhood characteristics such as violence, air quality, and cohesiveness should be considered in future research. This research was supported by T32HL007560 (PIs: Thurston & Gianaros, Trainee: Scott) and AHA award 16SFRN28930000 (PI: Catov).
Abstract EP11: Long-term Outcomes Of Transcatheter Aortic Valve Replacement Compared With Surgical Aortic Valve Replacement: A Retrospective Cohort Study With Overlap Propensity Score Weighting
Authors: Li Zhe , Edwards Jodi
Published: April 2022

Objectives:
This longitudinal observational study utilized surgical procedure data from Ontario, Canada to compare mid- and long-term clinical outcomes in a representative real-world cohort of patients (2007-2019) after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).

Methods:
A novel overlap weighting propensity score method was used to match patients on the date of TAVR or SAVR, conditional on baseline patient characteristics. Primary outcomes were all-cause and cardiovascular mortality either in-hospital or at 1, 3 and 5 years post-discharge. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, acute kidney injury, vascular complications, atrial fibrillation, endocarditis, permanent pacemaker implantation, defibrillator, reintervention, and cause-specific readmission at 1, 3 and 5 years post-discharge. In-hospital outcomes were compared using multivariable logistic regression. Long-term primary and secondary outcomes for patients undergoing TAVR vs. SAVR were compared using an overlap propensity score-weighted competing risks sub-distribution proportional hazards model.

Results:
The study included 9,355 SAVR and 2,641 TAVR patients. Hazards of all-cause mortality at 1 year (Hazard Ratio [HR], 1.25; 95% CI, 1.06-1.48), 3 years (HR, 1.48; 95% CI, 1.31-1.68) and 5 years (HR, 1.51; 95% CI, 1.36-1.69) were significantly higher in the TAVR compared to SAVR group. Cardiovascular mortality was significantly higher in the TAVR group at 3 (HR, 1.40; 95% CI, 1.08-1.80) and 5 years (HR, 1.41; 95% CI, 1.13-1.77). Non-cardiovascular mortality was also significantly higher in the TAVR group at 1 year (HR, 1.46; 95% CI, 1.03-2.06), 3 years (HR, 1.48; 95% CI, 1.17-1.88), and 5 years (HR, 1.41; 95% CI, 1.16-1.72). Hazards of myocardial infarction were significantly greater in the TAVR at 1 year (HR, 1.72; 95% CI, 1.08-2.74), 3 years (HR, 1.86; 95% CI, 1.35-2.57), and 5 years (HR, 1.82; 95% CI, 1.37-2.42). Hazards of angina readmission were significantly greater in the TAVR at 3 years (HR, 1.94; 95% CI, 1.26-3.00) and 5 years (HR, 1.87; 95% CI, 1.26-2.78).

Conclusions:
In real-life patients who underwent a TAVR experienced an excess cardiac and non-cardiac mortality compared to SAVR. More studies with long-term follow-up are needed to confirm the long-term clinical benefits of TAVR and effort to improve patient selection are warranted.
Abstract EP12: Uric Acid Predicts Recovery Of Left Ventricular Function And Adverse Events In Heart Failure With Reduced Ejection Fraction: Potential Mechanistic Insight From Network Analyses
Authors: Wang Xiqiang , Fan Xiude , Wu Qihui , Wang Junkui , Fang Jiansong
Published: April 2022

Background and Aims:
Heart failure with reduced ejection fraction (HFrEF) still carries a high risk for a sustained decrease in left ventricular ejection fraction (LVEF) even with the optimal medical therapy. Currently, there is no effective tool to stratify these patients according to their recovery potential. We tested the hypothesis that uric acid (UA) could predict recovery of LVEF and prognosis of HFrEF patients and attempted to explore mechanistic relationship between hyperuricemia and HFrEF.

Methods:
HFrEF patients with hyperuricemia were selected from the National Inpatient Sample (NIS) 2016-2018 database and our Xianyang prospective cohort study. Demographics, cardiac risk factors, and cardiovascular events were identified. Network-based analysis was utilized to examine the relationship between recovery of LVEF and hyperuricemia, and we further elucidated the underlying mechanisms for the impact of hyperuricemia on HFrEF.

Results:
After adjusting confounding factors by propensity score matching, hyperuricemia was a determinant of HFrEF [OR 1.247 (1.172-1.328);
P
<0.001] of NIS dataset. In Xianyang prospective cohort study, hyperuricemia is a significant and independent risk factor for all-cause death (adjusted HR 2.387, 95% CI 1.141-4.993;
P
=0.021), heart failure readmission (adjusted HR 1.848, 95% CI 1.048-3.259;
P
=0.034), and composite events (adjusted HR 1.706, 95% CI 1.001-2.906;
P
=0.049) in HFrEF patients. UA value at baseline was negatively correlated to LVEF of follow-ups (r=-0.19;
P
=0.046). Cutoff UA value of 312.5 μmmol/L at baseline can work as a predictor of LVEF recovery during follow-up, with the sensitivity of 66.7%, the specificity of 35.1%, and the accuracy of 0.668 (95% CI, 0.561-0.775;
P
=0.006). Moreover, gene overlap analysis and network proximity analysis demonstrated a strong correlation between HFrEF and Hyperuricemia.

Conclusion:
Lower baseline UA value predicted the LVEF recovery and less long-term adverse events in HFrEF patients. Our results provide new insights into underlying mechanistic relationship between hyperuricemia and HFrEF.
Abstract EP19: Obesity And Diabetes Risk According To Age Groups; An Analysis Of The National Health Screening Program For The People In Transition In Korea
Authors: Yoo Tae Kyung , Rhee Eun-Jung , Miyashita Satoshi , Davoudi Farideh , Han Kyung-Do , Lee Won-Young
Published: April 2022

Objective:
The prevalence of type 2 diabetes mellitus (DM) and obesity is increasing among young population. However, the effect of obesity on the development of diabetes in different age groups is unclear. Therefore, we assessed the risk of development of future DM in two different age groups without diabetes at baseline, according to baseline body mass index (BMI) and waist circumference (WC).

Research Design and Methods:
The Korean National Health Insurance Service record, a nationwide population-based cohort was used to retrospectively analyze 4,145,321 Korean adults without DM, who had national health screening in Korea between 2009 and 2014. We included participants with mean age of 40 (n=2,905,752) and 66 (n=1,239,569) years old. Participants were categorized into 5, and 6 groups based on their BMI and WC, respectively. Each participant was followed either until 2017 or until the new diagnosis of DM was made. We assessed the risk of developing DM based on BMI and WC. Obesity (O) was defined as BMI≥25. Abdominal obesity (AO) was defined as WC ≥ 90cm for men, and ≥85cm for women. Multiple confounding factors were adjusted for multivariable analysis.

Results:
The median duration of follow-up was 5.6 years. In a multivariable analysis, higher BMI and WC among subjects with a mean age of 40 were associated with a higher risk of developing DM in the future. There was a linear association between BMI, WC, and the risk of DM (BMI<18.5, ref; BMI≥30, HR 10.35, P
trend
<0.001; WC 75-80 cm, ref; WC≥100 cm, HR 3.23, P
trend
<0.001). A similar pattern was observed among patients with mean age 66 years old (BMI<18.5, ref; BMI≥30, HR 3.16, P
trend
<0.001; WC 75-80cm, ref; WC≥100, HR 1.98, P
trend
<0.001). When participants were categorized based on the presence of O and AO, AO had a stronger impact on the development of DM than O in the 66 years old group (O(-)/AO(-), ref; O(-)/AO(+), HR 1.55; O(+)/AO(-), HR 1.45; O(+)/AO(+), HR 2.09). At the same time, O had a stronger impact on DM development than AO in the 40 years old group. (O(-)/AO(-), ref; O(-)/AO(+), HR 2.18; O(+)/AO(-), HR 2.62; O(+)/AO(+), HR 4.94).

Conclusions:
Regardless of age, both obesity and abdominal obesity increase the risk of DM. Among younger people, obesity was associated with a higher impact on the risk of DM. In older adults, the presence of abdominal obesity might have a greater effect on the development of DM in the future.
Abstract EP27: Development Of An Electronic Health Record-based Prediction Model For Hyperkalemia And Clinical Outcomes In Aldosterone Receptor Antagonist-prescribed Heart Failure Patients
Authors: Dumeny Leanne , McDonough Caitrin W , Duarte Julio , Cavallari Larisa H
Published: April 2022

Background:
Multiple clinical trials have evaluated the efficacy and safety of aldosterone receptor antagonist (ARA) use in heart failure (HF). They indicate that not all HF patients have the same level of hyperkalemia risk or morbidity risk reduction on ARAs. Identification of clinical predictors of patient response to ARAs would allow for treatment better tailored to the potential risks and benefits of each individual patient. The study’s objective was to identify a clinical predictive model for both hyperkalemia and all-cause mortality or HF-related hospitalization in ARA-prescribed patients with HF.

Methods:
This retrospective analysis used an anonymized EHR dataset of 8742 adult patients with a diagnosis of HF and an ARA prescription from the University of Florida health system. A list of potential clinical predictors identified from the literature was refined via feature selection using the least absolute shrinkage and selection operator (LASSO) technique. With the variables selected via LASSO, a logistic regression model for hyperkalemia and a Cox proportional hazards regression model for death or HF hospitalizations were used to identify the most significant predictors.

Results:
A model of 25 significant predictors for hyperkalemia in ARA-prescribed HF patients was identified (AUC = 0.70), including an ACE inhibitor/angiotensin receptor blocker (ARB) prescription, type 2 diabetes diagnosis, and chronic kidney disease diagnosis as predictors (Table 1). For death or HF hospitalizations, a predictive model of 20 significant predictors included a loop diuretic prescription, pulmonary hypertension diagnosis, and arrhythmia diagnosis (C-statistic = 0.76; Table 1).

Conclusions:
We developed an EHR-based model to predict hyperkalemia and morbidity and mortality in ARA-prescribed HF patients. Once validated, these findings should assist clinicians in providing more individualized and effective ARA therapy.

Table 1: Significant Predictors in Model for Hyperkalemia and Death or HF Hospitalizations
Abstract EP35: Longitudinal Lipidomic Profiling Of Left Ventricular Mass In American Indians: The Strong Heart Study
Authors: Chen Mingjing , Miao Guanhong , Zeng Wenjie , Roman Mary J , Lee Elisa T , Devereux Richard B , Howard Barbara V , Fiehn Oliver , Zhao Jinying
Published: April 2022

Background:
Dyslipidemia is a major risk factor for CVD. Left ventricular mass (LVM) is an independent predictor of heart failure and other cardiovascular events. It is unclear whether and how altered plasma lipidome (all lipids in a plasma sample) affects LVM. The relationship between longitudinal change in plasma lipidome and change in LVM is also unstudied in any racial/ethnic group.

Objective:
To identify molecular lipid species associated with LVM, independent of traditional risk factors.

Methods:
Using an untargeted LC-MS, we repeatedly measured 1,542 lipids in 3,162 fasting plasma samples collected at two time points (2001-2003, 2006-2009, mean 5.5 years apart) from 1,581 American Indians in the Strong Heart Family Study. All participants were free of overt CVD at both time points. LVM was measured by M-mode echocardiography and LVM index (LVMI) was calculated as LVM/height
2.7
. Lipids associated with LVMI were identified by generalized estimating equation (GEE) models, adjusting for age, sex, center, BMI, smoking, blood pressure, renal function, LDL-c, and diabetes. We first conducted the analysis at each time point, separately, and then combined the results by meta-analysis. The longitudinal association between change in lipids and change in LVMI was examined by GEE, adjusting for the same covariates plus baseline lipids and LVMI. Multiple testing was controlled by false discovery rate at 0.05.

Results:
The mean age of participants was 39.8 years (62.5% women) at baseline and 45.1 years at follow-up. We identified 325 lipids (125 known), largely fatty acyls, sterol lipids, sphingolipids, glycerolipids, and glycerophospholipids, significantly associated with LVMI at both time points. Longitudinal changes in 17 lipids, including glycerolipids, glycerophospholipids, and sphingolipids, were either positively (ORs: 1.09 -1.95) or negatively (ORs: 0.50 - 0.69) associated with change in LVMI over 5 years of follow-up. Changes in lipids explain up to 1.58% of the variability in the change of LVMI during follow-up. Additional adjustments for use of anti-hypertensive and lipid-lowering drugs did not change the results.

Conclusion:
Altered fasting plasma lipidome and its longitudinal change over time were significantly associated with LVMI beyond clinical factors and baseline lipids. Our results shed light on the mechanisms through which dyslipidemia may affect LV remodeling, thereby contributing to heart failure or other cardiovascular events.
Abstract EP38: Women With Type 2 Diabetes Are 1.5 Times More Likely To Have Alzheimer’s Disease Than Men
Authors: Zhou Chunmiao , Zhu Dongshan
Published: April 2022

Introduction:
Mounting evidence has suggested that diabetes mellitus (DM) is a risk factor for the development of dementia. However, whether the association of DM with dementia differs by sex remains unclear.

Hypothesis:
Almost two-thirds of Alzheimer's patients are women. We hypothesized that there might be a sex difference in the association between DM and dementia, and the effect of DM on the risk of dementia might be greater in women than in men.

Methods:
We used cohort data from UK Biobank, a large population-based prospective cohort study that recruited 502 649 individuals ages 40-69, between 2006 and 2010. Type 1 diabetes (T1DM), type 2 diabetes (T2DM) and all-cause dementia (including Alzheimer's disease (AD) and vascular dementia (VD)) were ascertained from hospital medical records. Cox proportional hazards models were used to estimate the sex-specific hazard ratios (HRs) and 95% confidence intervals (CI), and women-to-men ratio of HRs (RHR) for the association between DM and incident dementia.

Results:
A total of 502 422 people (54.4% women) with no prevalent dementia at baseline were included. After 11 years (median) follow-up, 5652 participants (46.6% women) developed dementia. The crude incidence rates of all-cause dementia were 8.53 for women and 11.97 for men, per 10,000 person-years. Both T1DM and T2DM were associated with higher risk of all-cause dementia, AD and VD. After the analyses were stratified by sex, compared to people without DM, the HRs (95%CI) between T2DM and AD in women (HR: 3.06, 95% CI 2.48-3.79) were higher than the estimates in men (1.94, 1.62-2.33), with an RHR (95%CI) of 1.56 (1.20, 2.02) (Table 1). No sex difference was observed in association between T2DM and VD, or T1DM and dementia.

Conclusions:
There is a sex difference in the association between T2DM and dementia. Women with type 2 diabetes are 1.5 times more likely to experience AD than men.
Abstract EP41: Relationship Between Body Mass Index And Low Total Bilirubin In US Adults
Authors: Visaria Aayush , Reddy Shivani , Sharma Akarsh , Nagaraj Bharath , Hameed Fariha
Published: April 2022

Background:
Low total bilirubin (TBili) is associated with increased cardiovascular risk, in part mediated by adipose tissue-related hormones. determined whether excess adiposity (measured by BMI) is associated with low TBili levels.

Methods:
Our study population consisted of 14,129 (6,902 male and 7,227 non-pregnant female) adults aged ≥20 years from the 1999-2018 National Health and Nutrition Examination Surveys. Participants with elevated liver enzymes (AST>80 or ALT >112 IU/L; AST/ALT >5), excessive alcohol consumption (>20 drinks/week for males; >10 for females), iron overload (transferrin >50%), anemia (hemoglobin<12 g/dl if female; <13 g/dl if male), elevated TBili (≥1.2 mg/dl), low albumin (<3.5 g/dl), or positive hepatitis B/C serology were excluded. We categorized measured BMI into 7 categories (<18.5, 18.5-22.9, 23.0-24.9, 25.0-27.4, 27.5-29.9, 30-34.9, ≥35). Low TBili, our primary outcome, was defined as <0.4 mg/dl for both males and females. We used sex-stratified multivariable logistic regression, sequentially adjusting for demographics, cardiometabolic factors, and liver function.

Results:
Among 14,129 adults (mean age [SD] of 47 [15] years, 51% female, 69% White), nearly 32% had BMI ≥30. Both males and females with BMI ≥30 had >50% odds of low TBili compared to a BMI of 23-24.9, even after adjustment for covariates (Table). There was no significant association between overweight range BMIs and low TBili. Adjustment for serum albumin most significantly attenuated the associations between obese-range BMIs and low TBili, especially in males. Further classifying each BMI category into high and normal waist circumference (WC;<88cm for female, <102cm for male) groups revealed that high WC individuals, even with BMI of 23-24.9, had increased odds of low TBili (OR [95% CI]: 2.35 [1.40, 3.94]).

Conclusions:
Obese BMI is associated with higher likelihood of low TBili. Longitudinal studies are needed to determine directionality of association and risk of downstream cardiovascular disease.
Abstract EP45: Validation Of The Edinburgh Claudication Questionnaire For Identifying Peripheral Artery Diseasein Outpatient Cardiology Clinic: Single-center Experience
Authors: Daneshrad Justin , Jeon Hee D , Lo Kevin B , Gebre Matthew , Garcia Manolo R , Amini Reza
Published: April 2022

Background:
Peripheral artery disease (PAD) is prevalent in patients with chronic heart disease, and portends a worse cardiovascular outcome. Edinburgh Claudication Questionnaire (ECQ) is a commonly used screening tool aimed to identify PAD in general practice. Despite its common use, its accuracy had not been validated in a cardiac population in the USA. We aimed to evaluate the diagnostic accuracy of the ECQ as a means of identifying PAD in an outpatient cardiology clinic.

Method:
Subjects were recruited at outpatient cardiology clinic at Loma Linda University Medical Center between 2017 and 2019. Patients with previously diagnosed PAD were excluded. 119 patients completed ECQ during their routine clinic visit, and were subsequently referred for duplex ultrasound and Ankle-Brachial Index (ABI) measurement. ABI was used as a reference standard for the diagnosis of PAD.

Result:
rom a total of 119 patients, 53% were male with mean age was 68. Majority (87%) of patients had hypertension, and 16% were active smokers. There were 16% of patients who tested positive on the ECQ and 47% of them had positive ABI. In patients with a negative ECQ, 23% had a positive ABI result. Receiver operating characteristic curve analysis showed ECQ had sensitivity of 28% (95% CI 13.7-46.7), specificity of 89% (95% CI 79.8-94.3), PPV of 2.5% (95% CI 1.1-5.5) and NPV of 77.8% (0.7 to 1.0), which equates to a positive and negative likelihood ratio of 2.6 and 0.8 respectively. On subgroup analyses, the ECQ performed better among current smokers (AUC=0.64 95% CI 0.43 to 0.84) and among male patients (AUC=0.66 95% CI 0.53 to 0.78). In the subgroup of male patients who were currently smoking, the ECQ performed better with 50% sensitivity and 99% specificity (AUC=0.75 95% CI 0.56 to 0.94).

Conclusion:
The ECQ had good specificity but poor sensitivity in the cardiology outpatient setting making it a poor tool for screening on its own. Sensitivity was higher in male current smokers. Further study of its utilization in high-risk patients such as in male smokers may be of benefit.
Abstract EP52: Using Human-Centered Design Methodology To Identify Challenges In Cardiac Recovery And Cardiac Rehabilitation From Diverse Patient, Patient Health Partner, And Clinician Perspectives
Authors: MacFarlane Zane T , Isakadze Nino , Molello Nancy , Spaulding Erin , Gao Yumin , Young Lisa , Khoury Shireen , Michos Erin , Cingolani Oscar H , Street Angela , Mathews Lena , Marvel Francoise A , Commodore-Mensah Yvonne , Martin Seth S
Published: April 2022

Introduction:
Despite overwhelming evidence for improved patient outcomes with Cardiac Rehabilitation (CR) after a cardiovascular event, CR participation remains markedly low, especially for women and those from underrepresented racial/ethnic groups.

Objective:
To identify challenges encountered during cardiac recovery and CR by engaging key stakeholders in human-centered design (HCD) sessions to guide development of solutions to increase CR participation.

Methods:
HCD is a methodology that is used to solve complex problems with the engagement of end-users. We recruited a) patients who were eligible for CR and deemed low to moderate risk for exercise, b) patient health partners, and c) clinicians with experience providing care to cardiovascular patients. We conducted separate meetings for patient/patient health partner and clinician groups virtually via Zoom to identify challenges, motivators, and themes for these groups in the setting of cardiac recovery and CR participation. Sessions were conducted using a semi-structured interview guide based on HCD methodology to identify emerging themes.

Results:
There were 11 patients, 4 patient health partners, and 10 clinicians enrolled in the study. Demographics and broad themes identified during virtual HCD sessions summarizing challenges shared by key stakeholders are reported in Figure 1.

Conclusions:
HCD sessions engaging a diverse group of patients, patient health partners, and clinicians identified challenges in the setting of cardiac recovery and CR and highlighted similar concepts among different stakeholders. We aim to conduct future sessions to further co-design a digital health intervention for virtual delivery of CR addressing these challenges.

Figure 1.
Demographics and top themes from virtual HCD sessions summarizing challenges during cardiac recovery and CR. CR = cardiac rehabilitation, CABG = coronary artery bypass graft surgery, IQR = interquartile range, MI = myocardial infarction.
Abstract EP54: Ideal Cardiovascular Health Metrics: Are They Just Cardiovascular Protective Factors?
Authors: Huang Rongchong , Chen Weihua , Shi Shanshan , Jiang Yizhou , Chen Kaihong
Published: April 2022

Background:
The American Heart Association (AHA) proposed the concept of ideal cardiovascular health (CVH) to reduce the risk of cardiovascular mortality. However, the overall CVH status is still unsatisfactory. We attempted to contribute to AHA 2030 goals by identifying the relationship between CVH and non-cardiovascular diseases such as sarcopenia.

Methods:
We analyzed data on 3311 adults
>
20 years of age from the NHANES 2011-2018. Sarcopenia was defined as the lowest for gender-specific sarcopenia index cut-off values. CVH was categorized as inadequate, average, or optimum. We used multinomial logistic regression to assess the association between CVH and sarcopenia.

Results:
This cohort study involving 3,311 adults
>
20 years comprised 1329 females (42.4%). The number of intermediate or ideal and poor CVH participants was 1719 and 1592 with mean CVH score of 9.3 ± 0.1 and 5.43 ± 0.1, respectively. After adjusting for related confounding factors, intermediate or ideal CVH was associated with a risk reduction of sarcopenia than poor CVH (aOR: 0.39, 95% CI; 0.22-0.69,
P
< 0.001) and the risk of sarcopenia was significantly lower for each incremental increase of 1 in CVH metrics (aOR: 0.76, 95% CI: 0.70-0.83,
P
< 0.001). Moreover, if the number of ideal CVH metrics was
>
5, the risk of sarcopenia decreased by up to 85% (aOR: 0.15, 95% CI: 0.06-0.38,
P
< 0.05).

Conclusions:
Our findings suggest a relationship between the CVH and the prevalence of sarcopenia in adults. Our analysis confirms that CVH extends beyond protection against cardiovascular disease. The results of our study can contribute to achieving the 2030 public health goal of achieving CVH for all, which may be supported by efforts to reduce the prevalence of sarcopenia.
Abstract EP58: Getting Personal: Improved Statin Adherence Through Individualized Communication
Authors: Khan Amir , Desai Kevin , Aronov Avi , Recht Bradley
Published: April 2022

Background:
Statin adherence remains suboptimal for primary prevention despite its proven benefits in reducing the risk of future adverse atherosclerotic cardiovascular disease (ASCVD). We aim to determine the effectiveness of personalized communication in improving adherence rates for the primary prevention of ASCVD.

Methods:
This was a quality improvement initiative involving three primary care clinics at the Jesse Brown Veteran Affairs Medical Center in Chicago, Illinois. Patients were ages 40-79, without a history of ASCVD and prescribed a statin within the past year. Those with a refill rate < 80% were mailed a letter educating them on their individualized 10-year ASCVD risk and statins’ utility in reducing this risk. Statin adherence data were obtained prior to and 90 days following the intervention to assess for an improvement in composite statin refill rate. A control chart was used before sending the mailed letters to determine if special causes of variation existed prior to intervention. A 2-sample t-test was used to compare the mean daily adherence rates pre- and post-intervention.

Results:
There was a statistically significant improvement in daily average statin adherence in the 90-day post-intervention period (84.88 ± 0.39 vs 83.40 ± 0.09;
p
< 0.001).

Conclusion:
Mailed letters that include individualized ASCVD risk scores may be an effective way of improving adherence to statins among patients with no prior history of ASCVD.
Abstract EP60: Modification Effects Of Migraine Status And Stress Level On The Relationship Between Sleep Disturbance And 10-year Cardiovascular Disease Risk In Hong Kong Women
Authors: Longben TIAN , Xie Yao J
Published: April 2022

Background:
Evidence has shown that worse sleep disturbance, frequent migraine attacks, and higher stress level predicted the higher cardiovascular diseases (CVDs) risk. Also, the significant associations between migraine, stress, and sleep quality have been identified in many previous studies. The purpose of this study was to explore the modification effects of migraine status and stress level on the relationship between sleep disturbance and 10-year CVDs risk in a sample of Hong Kong Chinese women.

Method:
Data were analyzed from the Hong Kong Women's Health Study 2019, a cross-sectional survey conducted in Hong Kong female nurses aged 30 years and above between 2019 and 2020. Mailed questionnaires were used for data collection. Sleep quality and stress level were measured by the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS), respectively. The ID Migraine™ screening and doctor-diagnosed migraine that reported by the nurses were used together to identify the migraineurs. The 10-year CVDs risk was calculated by the Framingham 10-year risk score (FRS). The modification effect was tested by the stratified analysis and multiple linear regression model.

Result:
In total, 1,344 nurses with a mean age of 46.12 (SD=10.47) were involved in the study. Twenty-one percent of them had migraine and 29.6% had moderate or high level of stress (PSS score > 28). Among 704 (52.4%) participants who had poor sleep quality (Global PSQI score > 5), 96.9% of them had sleep disturbance. The mean score of FRS was 3.6% (3.3%), and 5.1% of the participants had a high level of CVDs risk (FRS≥10%). After adjusting of educational level, employment status, daily fruit and vegetable consumption, postmenopausal status and family history of CVDs, the sleep disturbance score was significantly associated with FRS [β=0.005; 95% confidence interval (CI): 0.003-0.010]. The stronger sleep disturbance-FRS association was observed among migraineurs (β=0.009; 95% CI: 0.004-0.013) and those with moderate or high level of stress (β=0.008; 95% CI: 0.004-0.013).

Conclusion:
Migraine status and stress level modified the strength of association between sleep disturbance and 10-year CVDs risk. Among nurses who had sleep disturbance, migraine and high level of stress aggravated the 10-year CVDs risk.
Abstract EP61: Short Sleep Duration, Late Sleep Timing, And Late Eating Timing: A Trilogy Of Behavioral Risk Factors For High Blood Pressure?
Authors: Hoopes Elissa K , Witman Melissa , D'Agata Michele , Brookstein-Burke Talia , Robson Shannon M , Malone Susan K , Goel Namni , Patterson Freda
Published: April 2022

Introduction:
Short sleep duration (<7 h/night) is a risk factor for hypertension and other cardiovascular diseases (CVD). Not clear is if delayed timing of sleep or eating behaviors adds to this risk. We tested the hypothesis that later sleep and eating timing would be associated with higher blood pressure (BP), and that adults with short sleep + late behavior timing would have the highest BP vs those with one (short sleep OR late timing) or no risk behaviors (adequate sleep + early timing).

Methods:
Over a 14-day period, 30 healthy, non-shift working adults wore wrist actigraphs to evaluate sleep duration and onset timing, and completed image-assisted diet records to estimate eating onset (time of first caloric intake after awakening) and offset (time of last caloric intake before sleep). Fasted morning systolic (SBP) and diastolic BP (DBP) were obtained. Regression models of SBP and DBP tested associations with sleep onset, eating onset, and eating offset. Sleep duration (<7 vs ≥7h) and behavior timing metrics (median split) were dichotomized, and ANOVAs compared BP between sleep duration + behavior timing groups.

Results:
Participants were 28±7y, 43% male, BMI 23.9±2.6 kg/m
2
, and BP 114±10/70±7 mmHg. Sleep duration was 6.8±0.8 h, sleep onset 23:45±1.3 h, eating onset 08:49±1.5 h, and eating offset 20:40±1.2 h. Independent of age and sex, later sleep onset was associated with higher SBP (B= 3.0±1.3 mmHg/h,
p
=0.03) and DBP (B= 2.5±0.9 mmHg/h,
p
=0.01). Later eating onset was associated with higher DBP (B= 2.1±0.9 mmHg/h,
p
=0.03), and later offset with higher SBP (B= 4.1±1.4 mmHg/h,
p
<0.01) and DBP (B= 3.3±1.0 mmHg/h,
p
<0.01). When grouped according to sleep duration and eating offset, short sleep + late timing participants exhibited higher DBP vs adequate sleep + early timing (75±7 vs 67±7,
p
=0.03) and tended to exhibit higher SBP and DBP vs short sleep OR late timing (both
p
=0.07).

Conclusion:
These data indicate later sleep and eating timing, especially in the setting of short sleep, exemplifies a chrono-behavioral phenotype of CVD risk.
Abstract EP64: Creating A Comprehensive Lifestyle Intervention For Stroke Survivors
Authors: Bailey Ryan , Miner Natalie , Waddoups Sarah , Metos Julie , Allen Nancy A
Published: April 2022

Purpose:
Approximately 795,000 people experience a stroke each year, 23% of which are recurrent events. Among stroke survivors, comprehensive lifestyle intervention (CLI) is recommended for secondary stroke prevention, and obesity and glucose management. American Heart Association (AHA) guidelines for CLI recommend that interventions address physical activity and dietary intake through ≥14 sessions delivered over ≥6 months. Few existing programs meet these recommendations. Therefore, the purpose of this project was to create a 6-month, 14-session CLI using stakeholder input that adheres to the AHA recommendations.

Methods:
The study team, which included individuals with expertise in stroke, nutrition, nursing, and occupational therapy, adapted the content, structure, and format of an existing 1-year, 22-session diabetes prevention program, the Group Lifestyle Balance—CVA (GLB-CVA), to create the CLI. An advisory board of health professionals with expertise in nutrition, exercise science, occupational therapy, and physical therapy then provided feedback on the CLI through 2 focus group meetings. Qualitative data from focus groups were transcribed and used to modify the CLI.

Results:
Study team adaptions included shortening the GLB-CVA to 14 sessions, tailoring content to accommodate stroke-related disability (e.g., sitting-based and one-handed exercise and cooking recommendations), and including a care-partner. Advisory board modifications included shortening individual sessions, simplifying language, and ensuring physical activity and dietary recommendations were appropriate for stroke survivors. Additional modifications are listed in the table.

Conclusions:
Evidence-based CLIs for stroke survivors are lacking. Our adapted CLI meets the AHA recommendations for CLI and provides recommendations appropriate for stroke survivors based on expert opinion. Future directions include efficacy testing of the adapted CLI and intervention implementation in clinical and community settings.
Abstract EP68: Can A Single Model For General Population Predict Cardiovascular Events In Cancer Survivors?
Authors: Lee Hokyou , Lee Hyeok-Hee , Lee Gabin , Kang Danbee , Lee Jin , Lim Jihyun , Cho Juhee , Shin Dong Wook , Youn Jong-Chan , Kim Hyeon Chang
Published: April 2022

Introduction:
No specific guideline exists for the primary prevention of cardiovascular disease (CVD) in cancer survivors. We hypothesized that CVD risk and its association with risk factors are comparable between cancer survivors and the general population, such that they may share currently available risk scores (e.g., Pooled Cohort Equation; PCE) for initial risk discussion.

Methods:
We studied 59 445 cancer survivors (≥5 years from diagnosis) and 59 445 age/sex-matched non-cancer controls aged 40-79 years (51.6% female) and free of CVD among participants of 2009 Korean National Health Insurance health screening. We calculated 10-year cumulative incidence of CVD events (composite of myocardial infarction, stroke, or cardiovascular death) and hazard ratios for traditional CVD risk factors in cancer survivors vs. non-cancer controls. We then evaluated discrimination and calibration of a previously-derived, general Korean population-based CVD risk model (having similar predictors as the PCE) applied to cancer survivors.

Results:
During a median follow-up of 10.3 years, 6,809 CVD events occurred. Multivariable-adjusted 10-year cumulative CVD incidence was 2.8% (2.7-3.0) among cancer survivors and 3.0% (2.0-3.2) among non-cancer controls (Figure A). Associations of traditional risk factors with CVD events were similar between cancer survivors and controls (Figure B). Results were consistent when stratified by sex and age. A CVD risk model, previously derived from the general Korean population similarly as the PCE, showed good discrimination (C-index, 0.747) and calibration (Figure C) when applied to cancer survivors. By cancer subtype, some cancers were associated with higher or lower CVD risk than controls (Figure D).

Conclusions:
CVD risk and associations with predictors were similar between cancer survivors and non-cancer individuals. Pre-existing models for general population may perform well in overall cancer survivors, although subtype-specific recalibration may be desirable for some cancers.
Abstract MP01: Disentangling The Relationship Between Genetic Predisposition And Social Environment In The Development Of Myocardial Infarction
Authors: Wu Chenkai , Sheng Chen
Published: April 2022

Background:
The interrelatedness between social determinants of health impedes researchers to identify important social factors for cardiovascular health. A new approach is needed to quantify the aggregate effect of social factors and develop person-centered interventions. In addition, it remains largely unknown whether social environment could offset the increased risk of cardiovascular disease among genetically predisposed persons.

Objective:
This study aimed to create a polysocial score to comprehensively quantify the effect of a variety of social factors of myocardial infarction (MI) and examine the synergistic effect of genetic and social factors for predicting MI.

Methods:
Data are from the 2006 or 2008 wave of the Health and Retirement Study. Social determinants of health encompassed five social domains: economic stability, neighborhood and physical environment, education, community and social context, and healthcare system. We used the forward stepwise logistic regression to derive a polysocial score model for 10-year incidence of MI. We calculated the incidence rate by each polygenic score tertile and polysocial score tertile. We used the interaction approach to examine the synergistic effect of polygenic score (continuously) and polysocial score (continuously) on MI.

Results:
4,372 participants (55% female) initially free of MI were included. A polysocial score for MI was created using five social determinants of health. Participants with intermediate (OR=0.72; 95% CI, 0.54, 0.95) and high (OR=0.46; 95% CI, 0.33, 0.64) polysocial scores had lower odds of MI than those with low polysocial scores. In each tertile of polygenic score, higher polysocial score was associated with a lower incidence of MI. Compared with persons with a low polygenic and a high polysocial score, those with a high polygenic and low polysocial score had a 5-fold higher odds of MI (95% CI: 2.51, 11.50). A desirable social environment, indicated by a high polysocial score, could offset the increased risk of MI among persons with a high genetic risk. The incidence rate of MI was 7 per 1,000 person-years (PYs) for persons with a low genetic predisposition but an undesirable polysocial score and was 7 per 1,000 person-years (PYs) for those with a high genetic predisposition but a desirable polysocial score. Results persisted after adjustment of sex, age, and race/ethnicity (white and black).

Conclusion:
The polysocial approach may offer possible solutions to monitor social environments and suggestions for older people to improve their social status for cardiovascular health regardless of level of genetic predisposition. Establishment of a desirable social environment could offset the increased risk of cardiovascular disease associated with genetics.
Abstract MP02: Association Of Socioeconomic Status With Stroke In Non-elderly Adults
Authors: Nguyen Ryan T , Khan Safi U , Valero-Elizondo Javier , Cainzos-Achirica Miguel , Nasir Khurram
Published: April 2022

Background:
Stroke is increasing among the non-elderly adults (<65 years of age) in the United States (US). We investigated the combined effects of socioeconomic status (SES), race/ethnicity, and traditional risk factors on stroke in this population.

Methods:
Using the National Health Interview Survey (NHIS) database from 2012 to 2018, we examined the association of traditional risk factors (hypertension, diabetes, hypercholesterolemia, smoking, obesity, and insufficient physical activity), sociodemographic, cardiovascular risk factor (CRF) profile (CRF range: Optimal (0-1 cardiovascular risk factors) to Poor (≥ 4 cardiovascular risk factors)), family income (high to low based on income as percentage of poverty limit), and educational attainment (categorized as some college degree or higher vs high school (HS) degree/GED or less) with stroke in the young (18-44 years) and middle-aged (45-64 years) adults.

Results:
Among 168,862 non-elderly adults (55% in young adults) included in this study, the prevalence of stroke was 1.83% among the non-elderly which translates to roughly 3.1 million adults. Of these, 598 and 2,509 were young- and middle-aged adults, translating to 624,000 and 2.5 million US adults, respectively. Adults with low family income, lesser education, and who were black were more likely to have stroke. The majority of young adults without stroke had an optimal CRF profile (65%) with only 3.5% having a poor profile. In contrast, 17.7% of middle-aged adults had a poor CRF profile. Lower income status coupled with a poor CRF profile increased the odds of stroke in both young (adjusted [a]OR: 3.12 [2.12-4.59]) and middle-aged (aOR: 2.31 [1.97-2.72]) adults when compared to those with average or optimal CRF profiles.

Conclusions:
This national survey of non-elderly US adults showed that poor CRF profiles led to higher odds of stroke compared to optimal profiles. Additionally, low income and education, factors contributing to SES, and race/ethnicity contributed to worsening stroke odds.
Abstract MP08: Using Electronic Health Record Data To Link Families: The Pythonic Relationship Inference From The Electronic Health Record Algorithm
Authors: Krefman Amy E , Ghamsari Farhad , Turner Daniel R , Lu Alice , Borsje Martin , Schneider Daniel , Witherup Wood Colby , Ahmad Faraz S , Allen Norrina
Published: April 2022

Introduction:
Intergenerational patterns are an important part of understanding disease, but much of the family-based research can be costly or biased. Emergency contacts in electronic health records (EHR) can be used to link family members using a population that is more representative of a community than traditional family cohort studies.

Hypothesis:
Creating family trees using emergency contacts will result in robust data that can be used in intergenerational research.

Methods:
We revised a published algorithm: relationship inference from the electronic health record (RIFTEHR). Our version, pythonic RIFTEHR (P-RIFTEHR) was run on 8/5/21 in the Northwestern Medicine Electronic Data Warehouse (NMEDW) on approximately 3.7 million individuals and was validated using the existing link between children born at NM hospitals and their mothers as the gold-standard. As proof-of-concept, we modeled the association between parent and child obesity using logistic regression.

Results:
The P-RIFTEHR algorithm matched 1,427,622 individuals in 500,408 families. The median family size is 2, the largest family is approximately 300 persons, and 115 families span four generations or more. Of the EDW-linked mother-child pairs, all matching pairs in P-RIFTEHR were correctly identified as mother-child, resulting in 100% sensitivity. Children are two times more likely to be obese if a parent is obese (OR: 2.01; 95% CI: 1.94, 2.09). This association persists after adjustment (OR: 2.19; 95% CI: 2.10, 2.28) and in mixed models nesting children within parents (OR: 2.70; 95% CI: 2.56, 2.85).

Conclusions:
P-RIFTEHR works well in a large, diverse population in an integrated health system. Our obesity results are consistent with the literature, including a 2017 meta-analysis by Wang, et al, showing a strong parent-child obesity association (pooled OR: 2.22; 95% CI: 2.09, 2.36). While the information used in the EHR can be completely deidentified, privacy concerns will be addressed before these data are more widely available for research.
Abstract MP09: Partnering With Employers To Provide Worksite-based Health Assessments In Rural Communities
Authors: Burch Ashley , Chivela Fernando , Lee Elisabeth , Shackelford Paul , Bolin Paul
Published: April 2022

Introduction:
Office-based healthcare delivery with limited hours of operation can be a deterrent to seeking medical care for many individuals. Innovative approaches to healthcare delivery, particularly health assessment and screenings, could improve patient engagement and ultimately yield better long-term public health outcomes.

Hypothesis:
Compared to national averages, elevated rates of undiagnosed and uncontrolled disease will be found among participants living in a rural area with known high endemic disease through worksite-based health assessments.

Methods:
Between December 2020 and October 2021, we partnered with 13 business for on-the-jobsite health screening clinics. Participants completed a series of questionnaires and a physical assessment. Disease screenings included diabetes, hypertension, kidney disease, cholesterol, sleep apnea, and stroke risk. Results were available immediately following the screening. Physicians conducted one-on-one consultations with participants to discuss their results and advise them, as needed, on treatment and management of their condition.

Results:
A total of 463 individuals (44.7% white) (54.4% male) were screened. On-site lab results identified 41 (9.0%) participants with an indicator of diabetes (HbA1c ≥6.5) that were previously undiagnosed*. An additional 44 (9.6%) participants had been previously diagnosed with diabetes, but testing results indicated their diabetes was not well controlled (HbA1c ≥6.5). Undiagnosed hypertension (SBP ≥140) was found in 114 (24.7%) participants and 93 (20.2%) participants had diagnosed but uncontrolled hypertension. We also identified 33 (15.9%) participants with indicators of chronic kidney disease (urine protein ≥1), 13 (3.9%) participants with high cholesterol (total cholesterol ≥240), 122 (26.3%) participants with moderate increased risk of heart attack or stroke (CHA
2
DS
2
-VASc ≥2), and 27 (22.0%) with moderate to severe risk of obstructive sleep apnea (STOP-BANG ≥4).

Conclusion:
Of over 450 individuals screened, nearly a quarter of participants revealed a moderate increased risk of heart attack or stroke. Nearly half of participants had uncontrolled or undiagnosed hypertension and twenty percent of participants suffered from uncontrolled or undiagnosed diabetes. Our mobile, on-the-jobsite health screening clinics provide patients with convenient, walk-in service, immediate results, and physician consultation as a bridge to accessing ongoing care. This screening strategy addresses issues of complexity, cost, and privacy and captures individuals who may otherwise underutilize or avoid engagement with the healthcare system. Longer-term follow-up is planned to determine the public health impact of these on-the-jobsite health screenings. *Percentage based off number screened per condition