bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract MP18: Estimating Coronary Mortality Reductions By Shifting The Population Blood Pressure Distribution Or By Improving The Management Of Hypertensive Patients
Authors: Guzman Castillo Maria , O'Flaherty Martin , Couch Philiph , Lloyd Stephen , Sperrin Matthew , Soiland-Reyes Claudia , Green Benjamin , Buchan Ian , Capewell Simon 
Published: July 2021

Introduction:
Hypertension is an important risk factor for coronary heart disease (CHD) in the UK and US. Although CHD death rates are falling, a large proportion of hypertensive patients are poorly controlled and population salt intake, a major determinant of hypertension, remains well above the recommended daily maximum of 6g/day.

G. Rose identified two strategies to reduce CHD mortality. The first proposes that small, but population-wide, reductions in systolic blood pressure (SBP), achieved by public health measures to reduce salt intake, will deliver large reductions in mortality. The second seeks to reduce mortality by treating hypertensive patients and keeping them below a given risk-threshold.
Here we explore the potential to reduce CHD deaths through a combination of these strategies in England and Wales up to 2030.

Methods:
We used the Stock of Health (SoH) model assuming each individual is born with a SoH, and on an annual basis this stock depreciates due to demographic factors, and fixed and variable risk factors. When the individual’s SoH reaches a critical point, a death from CHD occurs.

The model parameters were calibrated using data from the US Cardiovascular Lifetime Risk Pooling Project. Births, deaths and risk factors distributions were estimated using data from England and Wales (ONS).
We modelled a baseline scenario, three population-level strategies and two high-risk strategies. The population level strategies to reduce SBP were: (1) a reduction of 0.1 mmHg achievable by health promotion or labelling strategies, (2) a reduction of 1.3 mmHg achievable by mandatory reformulation and (3) matching England and Wales SBP levels to the observed values in the US population (average reduction:7 mmHg). In the high-risk strategies, 30% and 50% of the currently uncontrolled hypertensive patients respectively are treated to keep their SBP under 140 mmHg.

Results:
In the baseline scenario, the total number of CHD deaths from 2013 to 2030 will be approximately 465,000 (95% CI 460,308 to 469,334). We predict 1,244 (95% CI -3,320 to 5,807) fewer deaths by health promotion; approximately 16,203 (11,691 to 20,718) fewer deaths by mandatory reformulation of foods and some 78,051 (74,016 to 82,087) fewer deaths by reducing SBP levels to the observed levels in US. Conversely, by controlling the SBP of 30% and 50% of uncontrolled hypertensive patients, we predict 4,594 (6 to 9,191) and 7,172 (6,473 to 11,767) fewer deaths respectively.

Conclusion:
Both risk-targeted treatment strategies and population shifts attributable to salt reduction appear to provide potential substantial contributions to reducing CHD mortality in England and Wales. There remains, however, considerable potential to achieve much greater reductions in mortality by reducing SBP levels to those seen in the US.
Abstract P139: Insulin Resistance in Premenopausal Women with Type 1 Diabetes is Explained by Abdominal Obesity, Physical Inactivity and Altered Sex Hormones
Authors: Duca Lindsey M , Sippl Rachel M , Snell-Bergeon Janet K 
Published: July 2021

Women with type 1 diabetes (T1D) lose the premenopausal protection from cardiovascular disease (CVD) that non-diabetic (non-DM) women have compared to men, and are also more insulin resistant than non-DM women. Standard CVD risk factors have not been found to adequately predict CVD in the T1D population, but insulin resistance is emerging as a potentially important risk factor. The aim of this study was to determine whether sex hormone levels such as estradiol (E2), total testosterone (TT), and sex-hormone binding globulin (SHBG) explained any of the decreased insulin sensitivity in women with T1D, which could be important in CVD prevention.
This study included 25 premenopausal women 18-45 years of age with a mean ± SD age of 33 ± 8 years who completed a three stage (4, 8 and 40 mU/m2/min) hyperinsulinemic-euglycemic clamp during the luteal phase of the menstrual cycle (T1D n=12 and non-DM n=13). A steady state was achieved during the last 30 minutes of the high insulin infusion stage and mean glucose infusion rate (GIR [mg/kg/FFM/min]) during this time was used as an estimate of the skeletal muscle glucose disposal rate. Sex hormones were compared using unpaired Student t tests between T1D and non-DM participants during each phase of the menstrual cycle and during the morning of the clamp.. Significant differences were explored in multivariable linear regression in which stepwise model selection was used to determine the final model adjusting for age and diabetes status.
In age-adjusted analysis, women with T1D were less than half as insulin sensitive as non-DM women (least squares mean ± SE: 7.5±2.2 vs. 19.0±2.1, respectively, p=0.0014). SHBG was significantly higher in the T1D than the non-DM subjects the morning of the clamp (p<0.0001) and during each phase of the menstrual cycle (p = 0.01). TT was significantly higher in T1D women during the early follicular phase of the menstrual cycle (p=0.02) and was negatively correlated with GIR (r = -0.54, p = 0.04). E2 during the early follicular phase was positively correlated with GIR (r = 0.83, p = 0.01). In multivariable analysis, the difference in the GIR was attenuated by 58%(1-(5.1/12.14)) (least squares mean ± SE: 10.9 ± 1.7 in T1D vs. 16.0 ± 1.5 in non-DM, p = 0.07) after adjusting for age, diabetes status, minutes of vigorous activity, average waist circumference, free estradiol index and testosterone during the early follicular phase of the menstrual cycle In conclusion, the decreased insulin sensitivity observed in premenopausal T1D women with regular menstrual cycles can be mostly explained by lower levels of physical activity, greater central adiposity and differences in sex hormone levels. Most of these factors are modifiable, and so could be important targets in the reduction of CVD.
Abstract P249: Urinary Cadmium and Cardiovascular Health: Findings from the Survey of the Health of Wisconsin
Authors: Malecki Kristen M , Nieto F. Javier 
Published: July 2021

Mounting evidence in both human and animal studies suggest cadmium exposure increases the risk for cardiovascular disease morbidity and mortality. Recent evidence have found associations between cadmium exposures and mortality in the general US population, however, studies of incident CVD events have been mixed. Consequently, there is a need to better understand determinants of variations in cadmium exposure and the association of current population exposure levels with cardiovascular risk factors in diverse population-based studies.
Data from a sub-sample of 300 participants from the 2008-11 waves of the Survey of the Health of Wisconsin (SHOW) were used to study the association between urinary cadmium levels and cardiovascular health. SHOW is based on a probabilistic statewide sample of adult (21-74 years old) residents of the state of Wisconsin. Good cardiovascular health (CVH) was defined as recommended by the American Heart Association, using a combination of “ideal or intermediate” levels of seven factors and health behaviors (body mass index, cholesterol, glucose, diet, physical activity, blood pressure and smoking). Associations of log-linear estimates of creatinine-adjusted cadmium levels (ug/g creatinine) and CVH were examined using logistic and linear regression models. Covariates included individual-level demographics (race/ethnicity and gender), SES (median family income and education), smoking status (current or former vs. non), and diet (fruits and vegetable consumption).
Urinary cadmium levels (ug/g creatine) were statistically higher than comparable national estimates among women (geometric mean = .36;95% CI =.30-.44) and populations living 200% above federal poverty estimates (geometric mean =.32; 95% CI .28-.38). Higher cadmium levels were associated with good CVH (OR 1.4; 1.06-1.90). Using linear regression log-cadmium levels were inversely associated with BMI (ß=-1.04; p-value=.002) after adjustment for sociodemographic, smoking and dietary factors. Stratified analyses found associations held among non-smokers but not current or former. Cadmium was not associated with any other individual CVH factors.
Paradoxically, findings suggest that urinary cadmium levels, a marker of chronic cadmium exposure, are associated with high SES, lower levels of BMI and good cardiovascular health in this population based sample, further exploration and long-term follow-up are warranted.
Abstract P299: Narrowing Of Retinal Arterioles Is Associated With Increased Risk Of Incident Microalbuminuria
Authors: Hirayama Atsushi , Kawasaki Ryo , Konta Tsuneo , Watanabe Tetsu , Shibata Yoko , Fukao Akira , Kubota Isao 
Published: July 2021

Microalbuminuria is known as an independent risk factor of cardiovascular diseases. Retinal vessel caliber size is also linked to increased risk of stroke and coronary heart disease. Although there are shared anatomical and physiological characteristics between renal and retinal microvasculature, longitudinal study between renal and retinal microvasculature to illustrate temporal association is scarce.
To determine whether retinal vessel caliber size at baseline associated with incidence of microalbuminuria in a general Japanese population study of the Takahata study.
We conducted a community-based longitudinal cohort study, the Takahata study (Yamagata, Japan). In 2004-6, 711 individuals without microalbuminuria were identified at baseline examination. Microalbuminuria was defined as the urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g. Retinal vessel caliber was determined using semi-automatic software (IVAN, Wisconsin University) as the central retinal artery and vein equivalent (CRAE and CRVE). We analyzed the association between baseline retinal vessel calibers and cumulative incidence of microalubuminuria using multivariate logistic regression model adjusting for age, sex, body mass index, systolic and diastolic blood pressure, Hemoglobin (Hb) A1c, UACR at baseline, and smoking.
During follow-up period (mean, 6.7 years±0.6), 45 subjects (6.3%) developed microalbuminuria. In univariate logistic regression analysis, Age (per 1 years increase, Odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.09), HbA1c (per 1% increase, OR: 2.08, 95%CI: 1.28-3.36), UACR at baseline (per 1 mg/g increase, OR: 1.11, 95%CI: 1.06-1.16) were associated with increased risk of developing microalbuminuria. In multivariate logistic regression analysis, HbA1c (OR: 1.86, 95%CI: 1.07-3.24), UACR at baseline (OR: 1.09, 95%CI: 1.04-1.15), and CRAE (per 1SD decrease, OR: 1.45, 95%CI: 1.00-2.12) were significantly associated with increased risk of incident microalbuminuria.
In conclusion, narrowing of retinal artery seems to be precedent to the incidence of microalbuminuria in this adult population-based cohort.
Abstract P309: Foreclosure Rates During Economic Recession and Cardiovascular Health: Paradoxical Results from the Survey of the Health of Wisconsin
Authors: Nieto F. Javier , Malecki Kristen M , Tapia Granados José Antonio 
Published: July 2021

Contrary to conventional wisdom, research has shown that economic recessions are associated with decreases in mortality and, conversely, mortality increases during times of economic expansion. Most of these studies are based on unemployment data and few have examined morbidity data as outcomes.
The present analyses used data from the 2008-11 waves of the Survey of the Health of Wisconsin (SHOW) to study the association between county rates of foreclosures during the 2009-10 economic recession and cardiovascular health. SHOW is based on a probabilistic statewide sample of adult (21-74 years old, n = 1,643) residents in Wisconsin. The cardiovascular health (CVH) index was defined using a combination of “ideal or intermediate” levels of seven risk factors and health behaviors (body mass index, cholesterol, glucose, diet, physical activity, blood pressure and smoking). Foreclosure rates for the 72 counties of Wisconsin were obtained from commercially available data for the period 2000-2012. Other covariates included Census-based neighborhood socioeconomic status (SES), individual-level SES, and measures of mental wellbeing (using the Depression, Anxiety and Stress Scale, DASS).
Of the 1,643 participants, 1.0% had ideal CVH (“ideal” in all 7 metrics) and 25.6% had overall “good” (ideal or intermediate) CVH (at least one “intermediate,” but no “poor” in any of the 7 components). The prevalence of good CVH was higher in younger, white, higher education and income participants, and those living in suburban areas. Participants recruited from counties in the top quartile of foreclosure rates in 2009 (at the peak of the economic recession) had higher prevalence of good CVH. Compared to the lowest quartile, the demographics-adjusted odds ratio of good CVH were 2.0 (95% CL 1.4-2.9), 2.1 (1.4-3.1) and 2.7 (2.8-3.9) for the 2nd, 3rd, and 4th quartile of foreclosure rates, respectively (p-trend=0.003). Additional adjustment of individual/county SES and measures of individuals’ mental health did not materially change these results. These paradoxical associations were not present when using foreclosure data from years preceding the recession as primary exposures (2000-07).
In conclusion, county foreclosure rates, a marker of the severity of the 2009 economic recession in local communities, appears to be associated with better cardiovascular health. These results are consistent with previous research linking recessions with better health outcomes. However, interpreting these results as meaning that foreclosures improve health at the individual level might be subject to ecological fallacy. Additional analyses controlling for unmeasured confounders and possible selection biases are needed to further understand the significance of these findings.
Abstract P318: Risk factors for 10-year coronary artery calcium progression in the Multi-Ethnic Study of Atherosclerosis
Authors: Gassett Amanda J , Sheppard Lianne , McClelland Robyn L , Kronmal Richard A , Budoff Matthew J , Blaha Michael J , Kaufman Joel D 
Published: July 2021

Coronary artery calcium (CAC) progression has previously been observed to predict coronary events above and beyond its association with baseline CAC. Prior studies show associations between CAC progression and risk factors, but were limited by short follow-up or restriction to individuals with advanced disease. We examined the relationship between risk factors for clinical events and the progression of CAC in MESA, a prospective cohort study.
Participants were 6810 adults without CVD at recruitment in 2000-2002. Agatston scores for extent of calcification were assessed 1-4 times (mean 2.5) over a 10-year period with interim exams spaced at approximately 2-4 years. Mean follow-up time for those with at least 2 scans was 5.0 years. An innovative approach to mixed effects models jointly modeled the associations between risk factors and CAC both at baseline and with CAC progression rate. This method is less biased than controlling for baseline CAC, since the same risk factors are associated with both baseline and progression. Hence, time-varying factors can adjust progression rate, and data from participants with varying follow-up time and number of measurements_even those measured only at baseline_are incorporated.
Mean CAC progression rate was 25 CAC units/year. All models were adjusted for age, sex, site, and race/ethnicity. Strong effects were observed for age, male sex, hypertension, and diabetes. Effects for statins likely reflect poor health status, rather than a causal effect of medication. Simultaneous adjustment for all risk factors produced similar results except the effect of statin use was not observed. See table for estimates and confidence intervals.
In conclusion, CAC progression is associated with risk factors for clinical coronary events, confirming that processes involved in CAC progression mirror development of clinical atherosclerosis. The methods applied for the analysis of repeated continuous noninvasive measures of atherosclerosis extent can also be applied to evaluating novel risk factors.
Abstract P335: The Number of Coronary Arteries with Calcified Plaque is Increased in Type 1 Diabetes
Authors: Duca Lindsey M , Kinney Gregory L , Alman Amy C , Snell-Bergeon Janet K 
Published: July 2021

Adults with type 1 diabetes (T1D) have a higher risk for cardiovascular disease than non-diabetic (non-DM) adults. Coronary artery calcification (CAC) is a marker for subclinical atherosclerosis and the Agatston CAC score is the standard used today. The aim of our study was to look at the number of coronary arteries with calcified plaques to determine if more diffuse disease is present in adults with T1D for a given level of CAC. In addition, we examined risk factors associated with the number of coronary arteries with CAC, as this could be a novel way to risk-stratify individuals.
This study consisted of 1169 participants (T1D n=535 and non-DM n =634) with a mean ± SD age of 39±9 years. CAC was measured by electron beam CT (EBCT) using two scans performed five minutes apart and the maximum number of coronary arteries with CAC was used in the analysis. CAC lesions were determined in the left main, left anterior descending, circumflex, and right coronary arteries, with a maximum number of arteries with CAC ranging from zero to four. Chi square analysis was used to compare the number of coronary arteries with CAC by diabetes group. Subjects were then divided into categories based on their CAC score (>0-10, 10-100, >100-300, >300) and poisson regression was used in multivariable analysis to examine associated risk factors.
Adults with T1D had a significantly higher number of coronary arteries with CAC lesions than the non-DM adults (p > 0.0001). Among subjects with CAC>300 (n=58), adults with T1D had more coronary arteries with CAC than the controls (p = 0.03), but there were no differences in number of arteries with CAC among the other Agatston score categories. In multivariable analysis, HDL and LDL cholesterol, BMI, and hypertension were all independently associated with the number of coronary arteries with CAC lesions when adjusting for age, diabetes and CAC score (p<0.0001). There were no significant associations of number of arteries with CAC with smoking status or hemoglobin A1c. People with T1D were still significantly more likely to have more coronary arteries with CAC lesions than non-DM individuals after adjusting for the above factors.
In conclusion, T1D patients have more diffuse subclinical atherosclerosis, as indicated by a greater number of coronary arteries with CAC compared with non-DM adults. The number of coronary arteries with calcified plaque was independently associated with traditional CVD risk factors, even when accounting for CAC score. These findings are important because traditionally just the Agatston CAC score is used to determine CVD risk, but the number of coronary arteries affected could indicate how diffuse the subclinical artherosclerosis is prompt for aggressive treatment of traditional risk factors.
Abstract P362: Surveillance Of Non-Communicable Diseases By Non-Physician Health Workers In Kerala: the Epidemiology of Non-communicable Diseases in Rural Areas (ENDIRA) study
Authors: Banerjee Amitava , Joseph Jacob , Thachil Ajit , Attacheril Thankachan V , Menon Jaideep 
Published: July 2021

Introduction:
India carries the greatest burden of global non-communicable diseases(NCDs). There are few contemporary, community-based studies of prevalence, particularly in rural settings despite known regional variations. Given the shortage of physicians in rural India, there is an urgent need for large-scale, region-specific studies of NCDs using non-physician health workers.

Methods:
In central Kerala, India, a population of 113,462 was defined by five panchyats(village councils), consisting of 75 wards in Ernakulam district. The "Epidemiology of Non-communicable Diseases in Rural Areas" (ENDIRA) study was conducted via ASHAs (Accredited Social Health Activists), who are non-physician health workers employed by State Government of Kerala to each cover one ward. Standardised questionnaires were used in household interviews of individuals ≥18 years during 2012 to gather sociodemographic, lifestyle and medical data.

Results:
ASHAs recruited 84456 adults who were included in the analyses (25.4% below the poverty line). NCDs were relatively common: prevalence of myocardial infarction(MI) 1.4%, stroke 0.3%, respiratory diseases 5.0%, and cancer 1.1%. 84.1% of the population was vegetarian, 15.9% ate meat/fish ≥ 1 day per week, 4.2% had ≥1 alcoholic drink per week and 8.1% smoked regularly.

Compared with males, females were older, had lower BMI (p<0.0001), more likely to be hypertensive (p<0.0001), less likely to smoke or drink alcohol, have diabetes or dyslipidaemia (p<0.0001). NCDs were more common in males than females: MI (1.9% vs 0.9%), stroke (0.5% vs 0.3%), cancer (1.2% vs 0.9%) and respiratory diseases (5.9% vs 4.0%); p<0.0001.
Age≥65 years, hypertension, diabetes, dyslipidaemia, smoking and male gender were strongly associated with MI and stroke (Table 1).

Conclusions:
Non-physician health workers (ASHAs) were able to effectively conduct a large-scale prevalence study of NCDs in Kerala, including risk factors. In rural Kerala, traditional risk factors were strongly associated with MI and stroke.
Abstract P380: The Cardiovascular Fate in Patients with Amputation or Revascularization for Critical Limb Ischemia
Authors: De Rango Paola , Lenti Massimo , Cieri Enrico , Marucchini Alessandro , Farchioni Luca , Manzone Alessandra 
Published: July 2021

Background:
Critical limb ischemia (CLI) continues to be a significantly morbid disease for the aging population with high likelihood of cardiovascular mortality and morbidity.

Objective:
To analyze incidence and timing of all cause and cardiovascular mortality (CM) in patients who survived after intervention for CLI.

Methods:
Patients consecutively discharged with diagnosis of CLI during the period 2006-2008 were re-evaluated for cardiovascular morbidity after 2 years. Patients receiving revascularization either open or endovascular and those with primary major amputation were compared with Kaplan-Meier analyses. The effect of treatment on outcome was analyzed with Cox analysis.

Results:
There were 257 patients (171 men, aged 74.12y), 39 treated by primary major amputation and 218 by revascularization. During a mean follow-up of 37months, 81 patients died for all cause mortality and 35 for CM. Mean survival time was 57.4months. More than half deaths (n=44) occurred by 15 months with 21 patients dying in the first 6 months and 33 within the first 12 months. Thirty-five myocardial infarctions and 15 strokes occurred.

Cumulative survival rate at 60 months was 54% for all cause mortality and 79% for CM. There was significantly worse survival in patients with primary amputation when compared to those receiving revascularization: rates for all cause mortality were 45% vs. 75% (p=0.001) and rates for CM were 68% vs. 90% (p<0.0001), in primary amputation and revascularization group respectively at 42 months.
Unadjusted odd ratios for all cause and cardiovascular mortality in patients with primary amputation vs. revascularization were 3.07 (95%CI 1.5-6.1, p=0.002) and 5.25 (95%CI 2.3-11.6, p<0.0001), respectively. After adjusting for age and gender, primary amputation persisted as independent predictor of all cause (HR 2.76, p<0.0001) and cardiovascular mortality (HR 5.11; p<0.0001).

Conclusion:
Mortality and CM after 2 years in patients surviving from CLI procedures are high. Primary amputation is a strong predictor of poor prognosis in the mid-long term for patients with CLI. Most deaths occur in the first 15 months after treatment. This data may question the benefits of revascularization.