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Metasurface enabled high-order differentiator

Temporal Effects of Plozasiran on Lipids and Lipoproteins in Persistent Chylomicronemia

Abstract P3135: Associations Between Cardiovascular Health, Stress, and Emotional Intelligence in First-Year Medical Students; Cross-Sectional Study

Introduction: Medical students encounter stressors that affect their psychological and cardiovascular health. This study aims to evaluate the relationship between cardiovascular health, perceived stress, physical activity, empathy, and emotional intelligence among first-year medical students in a Colombian university Hypothesis: We assessed the hypothesis that Psychoemotional health influences cardiovascular health in medical students. Methods: A cross-sectional study was conducted as a secondary analysis of the longitudinal project "Follow-up on Mind and Body Components in Medical Students at Universidad del Rosario." All first-semester students from 2019-2020 were invited to participate (IRB approval: CEIC 3907-2019). Nonprobabilistic convenience sampling was used. Cardiovascular health was assessed using the AHA’s Cardiovascular Health Index (CVHI) and waist-to-height ratio. Stress, empathy, and emotional intelligence were measured via the Perceived Stress Scale-14, Interpersonal Reactivity Index (IRI), and Trait Meta Mood Scale-24 (TMMS-24). Data were analyzed using correlation matrices and regression models Results: Of the 196 participants (62% female), 79.1% had ideal CVHI, and 92.0% had no cardiovascular risk based on waist-to-height ratio. Moderate-to-poor scores were found in CVHI components: diet (94.7%), physical activity (50.7%), cholesterol (39%), and blood pressure (35%), see figure 1. CVHI was positively correlated with vigorous physical activity and TMMS-24 components (clarity and repair) and negatively correlated with perceived stress. The risk of intermediate CVHI increased with higher TMMS-24 attention (RR: 5.34, CI: 1.03-17.55) and the interaction between IRI personal distress and stress (RR: 2.32, CI: 1.06-5.05). TMMS-24 clarity reduced this risk by 33% (RR: 0.45-1.00). Most students reported moderate (68.6%) or high (9.2%) stress levels, with females reporting higher stress scores (F: 27.1 vs. M: 23.2), see figure 2. Moderate physical activity (RR: 0.71) and higher TMMS-24 clarity (ß: -2.68, CI: -4.02 to -1.33) and repair (ß: -1.60, CI: -2.94 to -0.26) were protective against stress, see figure 3. Conclusions: In conclusion, most medical students had ideal CVHI, but moderate-to-poor scores in key components. Females experienced higher stress levels. Personal distress heightened the negative impact of stress on cardiovascular health, while moderate physical activity and emotional clarity and repair were effective coping strategies.

Abstract P2030: Association of Urinary Arsenic Concentration with Hypertension and Arterial Stiffness in Afro-Caribbean Adults

Arsenic exposure is common throughout the world and is associated with cardiovascular disease (CVD). Blood pressure (BP) and arterial stiffening are sensitive measures of subclinical CVD that are common in the Afro-Caribbean Tobagonian population. However, little is known about arsenic exposure and its relationship to CVD in Tobago. We examined cross-sectional associations of urinary arsenic species and total urinary arsenic (TUA) with BP, hypertension, and arterial stiffness in Tobagonian adults. Concentrations of urinary dimethylarsinic acid (DMA), monomethylarsonic acid (MMA), and inorganic arsenic (iAs) were quantified by inductively coupled plasma mass spectrometry in spot urine samples collected from a random subset of 965 participants from the Tobago Health Study. Arsenic concentrations below the limit of detection were imputed as LOD/√2. Total urinary arsenic (TUA) was calculated as the sum of DMA, MMA, and iAs and log-transformed; %DMA, %MMA, and %iAs were calculated as the proportion of DMA, MMA, and iAs in TUA. Participants underwent brachial-ankle pulse wave velocity (PWV) measurement and measurements of BP, height, and weight. Hypertension was defined as systolic BP≥130 mmHg, diastolic BP≥80 mmHg or use of anti-hypertensive medication. Multiple linear and logistic regressions were adjusted for log-transformed urinary creatinine (all models), age and sex (models 2 and 3), height and weight (model 3) and hypertension status (model 3 for PWV outcomes). Predictors were calculated for 805 individuals without missing data. The median age of this sample was 58 years (range 40-84); 48.2% were female and 72.9% had hypertension. Raw mean ± SD TUA was 16.6±17.6 ng/mL and mean (range) for proportions were: DMA: 80% (22-99%), MMA: 12% (0.2-41%), iAs: 6% (0.6-50%). In model 1, TUA, %DMA and %iAs were associated with higher SBP and greater odds of hypertension and %MMA was associated with lower SBP and lower odds of hypertension; associations were attenuated after adjusting for age and sex (Table). All predictors were associated with PWV in model 1; the association between greater %MMA and lesser PWV was independent of age, sex, height, weight and hypertension (Table). In a sample of Tobagonian adults, TUA was associated with increased BP and PWV. Further research is needed to fully understand the relationships between arsenic exposure and metabolism and CVD in Afro-Caribbean populations who are at high risk for both arsenic exposure and CVD.

Correlation of sdLDL-C and Apob with the degree of cerebral artery stenosis in posterior circulation stroke

Correction for Mayo et al., Band asymmetry–driven nonreciprocal electronic transport in a helimagnetic semimetal α-EuP ₃

Surface-hydroxylated single-atom catalyst with an isolated Co-O-Zn configuration achieves high selectivity in regulating active species

Abstract P1002: MIND Diet, Circulating Inflammatory Biomarkers, and Cognitive Function: A Prospective Study

Background: Mediterranean-DASH Intervention for Neurodegeneration Delay (MIND) diet was associated with better cognitive outcomes, but the role of inflammation in this association was rarely explored. Methods: We included 3777 Health and Retirement Study participants (mean age=65.3 years, 59.0% female) who completed the food frequency questionnaire in 2013 and assayed for 18 inflammatory markers in venous blood in 2016. The inflammatory markers included 5 cytokines and 4 other proteins in serum and 9 blood cell measures. Cognitive function was assessed using the 27-unit modified Telephone Interview of Cognitive Status (TICS-m) in 2016, 2018, and 2020. We used linear regression models to assess the associations of the MIND diet score with inflammatory markers and performed mediation analysis to whether they mediate the MIND-cognitive function association. Results: During the 7-year follow-up, higher MIND diet score indicating higher compliance to the MIND diet was significantly associated with better cognitive function (beta per 3-unit increment with global cognitive function z-score=0.05, 95% CI: 0.02-0.09). Higher MIND score was also related to lower levels of interleukin-1 receptor antagonist (IL-1RA), IL-6, IL-10, soluble tumor necrosis factor receptor-1 (sTNFR-1), C-reaction protein (CRP), cystatin C, neutrophils, and white blood cell count and higher level of albumin (false discovery rates<0.05). Among them, higher levels of IL-6, IL-10, sTNFR-1, cystatin C, neutrophils, and white blood cell count, and lower level of albumin were inversely associated with cognition in later waves (P-values<0.05 for all). Further, the association of the MIND diet with cognitive function was significantly mediated by cystatin C (11.0%), sTNFR-1 (9.5%), IL-6 (4.6%), white blood cell count (3.6%), and IL-10 (3.3%). Collectively, these markers mediated the MIND-cognition association by 11.8% (p<0.001). Conclusion: Adherence to the MIND diet is associated with a panel of circulating systemic inflammatory markers that have been extensively investigated in Alzheimer’s disease. These peripheral blood-based biomarkers significantly mediate the MIND-cognition association and may serve as potential targets or intermediate outcomes of dietary intervention for cognitive health.

Abstract P3109: Exploring the Interplay of Plant-Based Diets, Microbiota, and Metabolites: Implications for Cardiovascular Disease Prevention

Introduction: Plant-based diets have gained attention for their potential to improve cardiovascular health through various mechanisms, including the modulation of gut microbiota and metabolites. To investigate the impact of plant-based diets on cardiovascular disease (CVD) risk factors, we conducted the Study with Appetizing Plantfoods - Meat Eating Alternatives Trial (SWAP-MEAT) (NCT03718988). Participants were assigned to consume either plant-based meats or animal meats for two consecutive 8-week phases, swapping from either plant-to-animal or vice versa at the 8-week midpoint. We previously reported improvements in several CVD risk factors, including a decrease in trimethylamine N-oxide (TMAO) levels in both plant-based diet groups. We found a diet-order effect: participants assigned a plant-based diet for phase 1 did not see an increase in TMAO during their subsequent animal-meat phase, suggesting differential effects on microbiome composition and production of trimethylamine (TMA), a precursor of TMAO, based on the sequence of dietary interventions. Our objective was to determine if the intestinal environment, made up of metabolites, microbiota, and the enzymes they secrete, were altered between groups 1 and 2 after phase 1, mediating the order effect we observed in our original SWAP-MEAT study. Methods: We investigated the expression of specific microbiome-encoded genes in relation to subsequent serum TMAO concentrations, as well as determined fecal metabolite differences that correspond to the different diets. We conducted 16S microbiome analysis, metabolomics analysis, and qRT-PCR analysis to measure the relative abundance of mRNA from genes involved in TMA production. We tested Spearman’s correlations of TMA enzymes, metabolites, and microbes with TMAO across groups to evaluate changes in the intestinal environment in groups 1 and 2. Results: We identified around 50 significant metabolites, and 12 significant microbiota genera correlated with TMAO. No significant correlation was found for the TMA ensues CntA, CutC, and GrdH with TMAO. Conclusions: By identifying trends associated with both dietary patterns and TMA production, we aim to advance personalized patient care and develop targeted therapies for CVD prevention. Ultimately, this research advances microbiome-based approaches for cardiovascular disease prevention and informs future interventions targeting gut microbiota and metabolites.

Abstract P2056: Strengthening Partnerships to Improve Diet and Achieve Nutrition Security: A Social Network Analysis

Introduction: Whole-of-community interventions engage multiple sectors to address determinants of cardiovascular health, particularly for racialized and socioeconomically marginalized populations. The Building Access to Food through Systems and Solidarity (BASIS) project collaborates with academia, farming organizations, elementary schools and community-based organizations to improve diet and achieve nutrition security in Sunset Park, Brooklyn. We conducted social network analysis to evaluate partnerships and community engagement efforts impacting BASIS implementation. Methods: We invited 10 core BASIS partners to participate in a staff-administered network survey between December 2023 and January 2024. We constructed network maps and examined collaboration, relationship strength, and information exchange. Results: Nine out of 10 partners completed the interviews, representing the four BASIS sectors addressing nutrition health disparities in low-income, immigrant, and racialized communities in New York City. On average, partners had been involved with BASIS for two years, with 31 full-time and six part-time employees directly involved. All partners reported strong commitment to BASIS, attending regular meetings, helping with programming, and outreach. Most (88.9%) offered BASIS programming, 77.8% helped with outreach or provided technical assistance, and 22.2% connected BASIS to policymakers. About 80% of reported direct interactions in the past year, with 46.2% indicating occasional communication, 13.8% engaged in coordination, and 40% forming partnership. For information sharing, 63-100% shared information and 50-100% received it. For resources, 37.5-100% shared resources and 25-100% received them. For referrals, 0-88% sent referrals and 12.5-87.5% received them. All partners reported BASIS frequently fostered new, beneficial relationships; 77.8% reported they often had increased access to funding/resources, 66.7% often experienced greater capacity, 55.6% often saw better use of their services, and 44.4% often gained new knowledge/skills. Conclusions: Findings demonstrate the partnership dynamics that inform effective delivery of the BASIS program. We will assess BASIS network characteristics over the four-year project period. Social network actors and activities are important determinants of dissemination and implementation efforts, helping to identify areas for improved engagement and strengthen the network’s capacity for effective health promotion.

Combined utility of genomic breakpoints and frame is a reliable predictor of ALK transcript function

Proteogenomic characterization reveals tumorigenesis and progression of lung cancer manifested as subsolid nodules

Abstract P2009: Education, Income, and Long-Term Risks of Cardiovascular Disease in the U.S. Population from 2011-2020

Background: The American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) equations estimate long-term cardiovascular disease (CVD) risk. The distribution of total CVD risk in the U.S. population across different education and income levels based on the PREVENT equations is currently unknown. Methods: Using the PREVENT base model equations and data on adults aged 30-79 years from the 2011-2020 National Health and Nutrition Examination Survey, we determined age-standardized and survey-weighted risk of CVD based on education and income. Those with existing CVD were excluded from PREVENT model calculations. Results: The study population included 12,852 participants, representing 160.6 million U.S. adults (mean age 51.8 [SD 13.3] years). Overall, adults with lower education and income were more likely to have intermediate to high 10-year risk (≥7.5%) of CVD, particularly those <65 years of age (Table). The prevalence of existing CVD among those with a high school (HS) diploma/GED or below, some college degree, or a college graduate or above education was 12.5%, 9.6%, and 6.3%, respectively. The prevalence of CVD-free U.S. adults with intermediate or high (≥7.5%) predicted 10-year risk of CVD was 21.6% for HS diploma/GED or below, 21.1% for some college degree, and 17.8% for college graduate or above education. Among U.S. adults with low, middle, or high income, the prevalence of existing CVD was 15.7%, 11.1%, and 6.4%, respectively. The prevalence of CVD-free U.S. adults with intermediate or high predicted 10-year risk of CVD was 23.4% for low income, 21.2% for middle income, and 18.6% for high income. Conclusions: U.S. adults who have not graduated from college and those with low or middle income had higher long-term risks of total CVD, with the disparities becoming apparent as early as 30-44 years old. Public health efforts should prioritize reducing these disparities early in life to improve cardiovascular outcomes in vulnerable populations.

Abstract P1045: Relationship Between Cardiovascular Risk Factors and All-Cause and Cancer-Specific Mortality Among Cancer Survivors in the United States

Background: To address the growing burden of cardiovascular disease among cancer survivors, prior studies have assessed the association between cardiometabolic risk factors and mortality among individuals with cancer but have largely focused on specific cancer types or been limited by small sample sizes. We used nationally representative data to examine the relationship between cardiovascular risk factors and mortality among US cancer survivors. Methods: We analyzed data from the National Health Interview Survey (2012-2018), linked to National Death Index, for adults aged ≥18 years with a self-reported cancer history (excluding non-melanoma skin cancer) and cardiovascular risk factors. Cardiovascular risk factors included hypertension, diabetes, hypercholesterolemia, obesity, smoking, and physical inactivity, categorized as low risk (0 factors), intermediate (1-2), or high (3+). Multivariable Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% CI for all-cause and cancer-specific mortality. Results: Among 15,690 cancer survivors (median age 68.0 years; 60.4% female), representing 14.8 million survivors annually, 5.3%, 38.8%, and 55.9% were at low, intermediate, and high cardiovascular risk, respectively. Cancer survivors at intermediate and high risk had a 3.1-fold (HR: 3.11, 95% CI: 2.09-4.64) and 3.6-fold (HR: 3.60, 95% CI: 2.42-5.35) increased risk of all-cause mortality compared to survivors at low risk, respectively. A similar relationship was present for cancer-specific mortality (intermediate vs. low HR: 2.53, 95% CI: 1.50-4.24; high vs. low HR: 2.44, 95% CI: 1.45-4.09). Conclusions: In a sample of cancer survivors, most individuals were at high cardiovascular risk, which in turn was associated with an increased risk of all-cause and cancer-specific mortality. Identifying those at the highest risk as part of oncology survivorship care could impact survival among this vulnerable population.

Abstract P1149: SAHAS-CR: Improving Cardiovascular Disease and Stroke Prevention Awareness in South Asians using a Culturally Tailored Approach

Introduction: The risk of cardiovascular disease (CVD) is nearly doubled in the South Asian population. South Asians experience earlier disease onset and increased morbidity and mortality compared to other ethnic groups. Culturally tailored health education has been shown to improve disease knowledge and clinical outcomes. However, the effectiveness of such initiatives within the South Asian population is not well known. This study aims to investigate changes in knowledge following a culturally tailored CVD and stroke education session in South Asians. Methods: A 20-minute CVD and stroke prevention education session tailored to South Asian culture was conducted at a local community center. Surveys with clinically focused and culturally focused questions were administered pre- and post- session to assess changes in knowledge. Statistical analysis comparing mean change in knowledge was performed using paired t-tests. Results: The session was attended by 161 participants who identified as South Asian, with a mean age of 49 years old, 48% female, and a mean length of residence in the US of 20 years. The following risk factors of CVD were identified amongst participants: hypertension in 31%, diabetes mellitus in 24%, obesity in 17%, hyperlipidemia in 34%, arrhythmias in 5%, prior stroke in 3%, and prior myocardial infarction in 7%. The average pre-session knowledge score was 53 +/- 17 % which increased to 63 +/- 18% post-session (p<0.001). Post-session change in knowledge for questions addressing culturally tailored lifestyle modifications were significantly higher than change in knowledge for questions addressing pathophysiological concepts (p<0.02). Further stratification also reveals that changes in knowledge post-session were greater for questions addressing medical concepts taught in a culturally relevant context than concepts which were not (p<0.05). Conclusion: Community health education appears to be associated with improved CVD and stroke knowledge in the South Asian community. Furthermore, education provided from a cultural perspective is associated with a greater improvement in knowledge than that provided from a clinically focused perspective. These insights are critical for the development of patient education strategies that align with the cultural practices and values of South Asian individuals, who bear a substantial burden of cardiovascular disease.

Assessing Hepatitis B virus infection, risk factors and immunization among particularly vulnerable tribal groups in Eastern India

The DEAD-box helicase eIF4A1/2 acts as RNA chaperone during mitotic exit enabling chromatin decondensation

Abstract During mitosis, chromosomes condense and decondense to segregate faithfully and undamaged. The exact molecular mechanisms are not well understood. We identify the DEAD-box helicase eIF4A1/2 as a critical factor in this process. In a cell-free condensation assay eIF4A1/2 is crucial for this process, relying on its RNA-binding ability but not its ATPase activity. Reducing eIF4A1/2 levels in cells consistently slows down chromatin decondensation during nuclear reformation. Conversely, increasing eIF4A1/2 concentration on mitotic chromosomes accelerates their decondensation. The absence of eIF4A1/2 affects the perichromatin layer, which surrounds the chromosomes during mitosis and consists of RNA and mainly nucleolar proteins. In vitro, eIF4A1/2 acts as an RNA chaperone, dissociating biomolecular condensates of RNA and perichromatin proteins. During mitosis, the chaperone activity of eIF4A1/2 is required to regulate the composition and fluidity of the perichromatin layer, which is crucial for the dynamic reorganization of chromatin as cells exit mitosis.

Abstract P1007: Detecting Physical Frailty Phenotype Using Wearable Device

Introduction: Identifying and monitoring frailty can inform optimal care for older adults. This study aimed to detect frailty using wearable device-measured movement behaviors (MBs). Hypothesis: We hypothesized that random forest models were able to detect frailty using MBs. Methods: This cross-sectional study included 44 older adults living in the community (79.6±9.3 years old; 84% females). The Fried Frailty Phenotype (FFP) was defined as having 3 or more of unintentional weight loss, exhaustion, low physical activity, slowness, and weakness. Participants wore a thigh-worn ActivPAL for 10 consecutive days. MBs were quantified as: 1) overall activity (activity score, daily steps and number of sit-to-stand), 2) time in postures (standing, stepping, sitting and lying), 3) time in bed, 4) time in sitting bouts over 30 min and 60 min, 5) stepping counts and time in <1, 1-5, 5-10 and 10-20 min bouts, 6) stepping counts and time in cadences >75 and >100, and 7) peak stepping counts in 10 seconds, 2, 6, and 10 min. Random forest models were developed to classify FFP and its 5 individual components, with age, sex, BMI, and MBs as predictor variables. Results: Eleven (25%) participants were frail. The average ActivPAL wear time was 9.14±1.49 days. The model achieved an AUC [95% CI] of 0.85 [0.71-0.99] for FFP. The 5 most important predictors were time in standing, stepping time in < 1 min bouts, time in stepping, stepping counts in 10-20 min bouts, and stepping counts in 1-5 min bouts (Table). The models for individual FFP components also achieved AUC [95% CI] of 0.90 [0.77-1.00] for unintentional weight loss, 0.89 [0.78-1.00] for exhaustion, 0.88 [0.76-0.99] for slowness, 0.81 [0.63-0.99] for low physical activity, and 0.94 [0.87-1.00] for weakness (Table). Conclusions: A thigh-worn wearable device can detect FPP with high accuracy. Once validated in an independent sample, our algorithm can be useful for frailty assessment and monitoring.

Abstract 011: Physician-Level Variation in Lipid Management for Secondary Prevention of Atherosclerotic Cardiovascular Disease: Opportunities for Practice Improvement

Introduction: While prior studies have documented suboptimal lipid therapeutic management and low rates of LDL-C goal achievement in patients with ASCVD, the degree of variability between cardiologists in lipid-lowering therapy (LLT) practice patterns is less well described. Hypothesis: Significant variability exists between cardiologists in their use of LLT and achievement of LDL-C goals in patients with ASCVD. Methods: We evaluated the use of LLTs and achievement of LDL-C <70 mg/dL among adults with ASCVD (peripheral arterial disease, coronary artery disease, or ischemic cerebrovascular disease) followed by a cardiologist at a large academic medical center from 1/1/22-6/30/24. LLT utilization and LDL-C goal achievement were modeled using mixed-effects logistic regression with clustering at the cardiologist level, adjusting for patient age, insurance, ASCVD type, and diabetes. From this model, we quantified physician-level variability using the adjusted median odds ratios (aMOR). Results: Among 10,531 patients with ASCVD (mean age 68.5 years, 61.1% male, 69.8% White) seen across 55 cardiologists, 80.6% were on any statin, 51.5% were on a high-intensity statin, 14.9% were on ezetimibe, 5.6% were on bempedoic acid or a PCSK9 inhibitor, and 15.1% were not on any LLT. Of those with a lipid panel in the past year (n= 7,555), 45.9% achieved an LDL-C < 70 mg/dL. Lipid management strategies varied substantially across cardiologists ( Figure ). In mixed-effects models adjusting for patient-level factors, significant physician-level variation was observed in high-intensity statin use (aMOR 1.33, 95% CI 1.25-1.45), ezetimibe use (aMOR 1.62, 95% CI 1.46-1.85), bempedoic acid or PCSK9 inhibitor use (aMOR 2.03, 95% CI 1.75-2.45), and attainment of LDL-C < 70 mg/dL (aMOR 1.27, 95% CI 1.20-1.38). Conclusion: Even among cardiologists at the same academic medical center, practice patterns varied widely in the use of LLT and achievement of LDL-C goals for secondary prevention. Understanding the reasons for this variability and standardizing lipid management across the specialty may improve quality of care for patients with ASCVD.

Abstract P2033: Cumulative Lifetime Estimated Lead Exposure Estimated From DNA Methylation at Midlife and Risk of Incident Cardiovascular Disease: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Lead (Pb) may increase risk of cardiovascular disease (CVD) through several pathways such as endothelial injury, inflammation, oxidative stress, lipid metabolism, and hypertension. Epigenetic biomarkers can be used to estimate cumulative Pb exposure. We tested the hypothesis that greater cumulative Pb exposure estimated through DNA methylation (DNAm)-based biomarkers would be associated with higher risk of CVD. Methods: We included 3,372 ARIC study participants who had Illumina 450K BeadChip DNAm data and were free of prevalent CVD in 1990-1995. We calculated two DNAm-based biomarkers of estimated cumulative Pb exposure that have been validated against measured tibia and patella bone Pb concentrations in an external sample of men. The tibia score was a weighted average of 138 CpG sites while the patella score used 59 CpG sites. ARIC participants were followed through 2021 for incident coronary heart disease (CHD), stroke, heart failure (HF), and a CVD composite. Cox regression was used. Results: Participants were an average of 57±5.9 years old, 62% were female and 70% self-identified as Black and 30% as White. There were 1,342 CVD events and 523 CHD events over a median of 22.0 years. For tibia Pb estimates, interactions (p<0.05) with sex were observed ( Table ). Men in the highest versus lowest quintile of estimated tibia Pb had a hazard ratio (95% CI) of 1.38 (1.03-1.85) for incident CVD and 1.93 (1.24-2.99) for incident CHD, after model 2 adjustments. Magnitudes of association were smaller for HF, and null for stroke. There was no evidence of an association in women. In both sexes, estimated patella Pb was unrelated to both outcomes. Discussion: Epigenetic estimates of cumulative tibia Pb exposure were associated with risk of incident CVD and CHD in this sample of men from the ARIC cohort. DNAm estimates were derived from a sample of men and may not be generalizable to women. There is a longer half-life of Pb in the tibia (a cortical bone) than in the patella (a trabecular bone). Our findings with estimated tibia Pb may reflect longer-term exposure. Additional research is needed to understand the role of cumulative Pb exposure on CVD risk.