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SVLearn: a dual-reference machine learning approach enables accurate cross-species genotyping of structural variants

Abstract P3069: Effect of cocoa extract supplementation on incident hypertension in the COSMOS trial

Backgrounds: Cocoa flavanols have potential blood pressure (BP)-lowering effects in shorter-term, smaller-scale randomized clinical trials (RCTs), but its effect on incident hypertension has not been examined in a large-scale RCT. The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) evaluated whether longer-term cocoa extract supplementation had an effect on incident hypertension in older adults. Methods: COSMOS is a 2x2 factorial, double-blind, placebo-controlled RCT testing cocoa extract (including 500 mg/day cocoa flavanols, with 80 mg/day (-)-epicatechin) and a multivitamin among 21,442 women aged ≥65y and men aged ≥60y. In 8,905 COSMOS participants free from baseline self-reported hypertension, we investigated the effect of cocoa extract on incident hypertension using Cox proportional hazards models. Incident hypertension was defined as self-reported first-time physician diagnosis, initiation of anti-hypertensive medications, or self-reported elevated systolic BP (SBP) ≥ 140 mmHg or diastolic BP (DBP) ≥ 90 mmHg. Results: Mean age at baseline was 71.1 years (SD: 6.2) and 58.8% of the participants were women. 48.6% had baseline SBP < 120 mmHg, corresponding to the normal range. Baseline characteristics were balanced between the cocoa extract and placebo groups. Over a median follow-up of 3.4 years, in intention-to-treat analyses cocoa extract supplementation had no significant effect on incident hypertension, with the incidence rates (IRs) of 71.2 and 73.8 per 1000 person-years in cocoa and placebo groups, respectively (hazard ratio [HR]: 0.96 [95% confidence interval: 0.88, 1.05]). A significant interaction was observed between treatment assignment and baseline SBP (p=0.002). Cocoa extract supplementation reduced the incidence of hypertension among participants with baseline SBP < 120 mmHg (IR: 38.2 vs. 50.3 per 1000 person-years; HR: 0.76 [0.64, 0.90]), but not among those with SBP of 120-139 mmHg (IR: 101.4 vs. 96.8 per 1000 person-years; HR: 1.05 [0.93, 1.18]; Figure ). Consistent results were obtained in sensitivity analyses using different definitions of hypertension: physician diagnosis, initiation of anti-hypertensive medications, or elevated BP alone. Per-protocol analysis using inverse probability weighting to account for non-adherence also supported the effect in SBP < 120 mmHg. Conclusion: In older adults, years-long supplementation of cocoa extract may reduce the risk of incident hypertension among those with normal BP levels.

Abstract 038: Association of Circulating Metabolites with Incident Heart Failure and its Subtypes in Multi-ethnic Populations

Introduction: Metabolic dysregulation is recognized in heart failure (HF). A comprehensive assessment of circulating metabolites, specifically on HF subtypes, in multi-ethnic populations is limited. Hypothesis: We hypothesize that circulating metabolites are significantly associated with the risk of HF and have differential effects on HF subtypes. Methods: Circulating metabolites from seven studies in the Trans-Omics for Precision Medicine Program were analyzed among 21,398 HF-free participants (58% non-Whites, 58% women), from which 1,160 incident HF, 373 HF with reduced (HFrEF), and 439 HF with preserved ejection fraction (HFpEF) events were ascertained with an average of 11.5 years of follow up. Cox proportional hazard regressions were applied by the study, followed by random-effect meta-analyses, to produce metabolite HF associations. Over-representation analyses were performed to identify relevant metabolite pathways. Results: Out of 1,015 metabolites analyzed, 54 were significantly associated with incident HF (Bonferroni corrected p<0.05) after accounting for clinical risk factors. Eleven metabolic pathways were mapped; pentose and glucuronate interconversions and pyrimidine metabolism demonstrated over-representation (FDR<0.05). Most identified metabolites (93%) were positively associated with HF, and the strength of the associations persisted with further adjustment of kidney function. Thirteen metabolites showed consistent effects from all participating studies, and subtype analyses indicated that most metabolites were more strongly associated with HFpEF than HFrEF ( Figure ). For example, N-acetylputrescine, a precursor of γ-aminobutyric acid (GABA), and 4-acetamidobutanoate, a derivative of GABA, were associated with an increased risk of HFpEF but not HFrEF. Conclusions: We identified circulating metabolites associated with the risk of HF in multi-ethnic populations, highlighting the need to better understand the differential metabolic etiology of HFpEF compared to HFrEF.

Abstract MP12: Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies

Background: Hypertension is the leading preventable risk factor for premature death and disability worldwide. Aims: We estimated global disparities in hypertension prevalence, awareness, treatment, and control in 2020 and compared secular changes from 2000 to 2020 worldwide. Methods: We searched MEDLINE from 1995 to June 2023 and supplemented with a manual review of retrieved article references. We applied sex- and age- specific prevalences from each country to population data to calculate the number of hypertensive adults in each region and worldwide. Proportions of awareness, treatment, and control from each country were applied to hypertensive populations to obtain regional and global estimates. Results: A total of 237 population-based surveys with 4,779,321 adults from 118 countries were included in analyses. We defined hypertension as SBP/DBP ≥140/90 mm Hg, or antihypertensive medication use and control of hypertension as SBP/DBP <140/90 mm Hg. An estimated 30.6% (95% CI, 30.0-31.2%) of the world’s adult population had hypertension in 2020. The prevalence was higher in low- and middle-income countries compared to high-income (Table). In 2020 an estimated 1.59 (1.57-1.61) billion people had hypertension; 378 (376-381) million in high-income and 1.21 (1.19-1.23) billion in low- and middle-income countries. From 2000 to 2010 the age-standardized prevalence of hypertension increased by 3.5% among men and 3.3% among women; from 2010 to 2020, the age-standardized prevalence increased by 2.1% among men and decreased by 1.0% among women. From 2000 to 2010 to 2020, worldwide proportions of hypertension awareness (38.7% vs 45.8% vs 48.0%), treatment (29.2% vs 36.9% vs 40.6%), and control among hypertensives (11.3% vs 14.0% vs 19.1%) increased. During the same period, proportions of awareness in high-income countries (57.3% vs 68.9% vs 68.6%) remained higher than in low-and middle-income countries (30.2% vs 37.6% vs 41.6%). Similar trends were identified for treatment in high-income countries (41.9% vs 56.2% vs 62.2%) compared to low- and middle- income countries (23.4% vs 28.8% vs 33.8%). Finally, control among hypertensives remained higher in high-income countries (15.1% vs 28.3% vs. 33.4%) compared to low- and middle-income countries (9.6% vs 9.0% vs 14.6%) in the same timeframe. Conclusions: Collaborative efforts are needed to address the high burden of hypertension worldwide, particularly in low- and middle-income countries.

Co-benefit of forestation on ozone air quality and carbon storage in South China

Abstract P3066: Barriers and Recommendations to Improve Engagement in Workplace Health Programs for Low-Wage Hospital Workers

Low-wage workers comprise 1/3 of workers in the U.S., are essential in many workplaces, and have high risk of cardiometabolic conditions compared to higher-wage workers. Workplaces have the potential to reduce health inequities by offering targeted employee health programs, however, these resources are often underutilized by low-wage workers. Mobile health tools (e.g., SMS, activity trackers) are effective in increasing engagement in health interventions, but their acceptability among low-wage workers is not well understood. This study aimed to explore barriers and facilitators of engagement in workplace health programs among low-wage hospital workers. Methods: Semi-structured qualitative interviews elicited workers’ experiences with workplace health programs, perspectives on mobile health tools, and suggestions for improving engagement. Participants were hospital service workers (janitorial and food service staff; n =43) in a San Diego health system. Interviews were audio-recorded, transcribed, and analyzed by two independent raters using Dedoose 9.0.107 software and structured thematic analysis. Results: Participants ( M age=49 years, range: 21-65) were mostly women (76%), Latinx (88%), and many preferred Spanish (45%). They reported low utilization of workplace health promotion or employee assistance programs. Barriers to engagement included lack of awareness, concerns about privacy, stigma, scheduling challenges, lack of programs in preferred languages, lack of time, and competing needs (e.g., food/housing insecurity). Recommended solutions included in-person vs. email program announcements, increased privacy, flexible delivery modality (e.g., phone, video), flexible scheduling, and resources for social needs (e.g., transportation, childcare, food). They reported high acceptability and willingness to use SMS and activity trackers. Many reported prior use of activity trackers (e.g., FitBits) and use of texts for health purposes (e.g., to communicate with a provider), but described important limitations (e.g., accessing texts only on breaks; not being allowed to wear watch-style trackers in food service work). Conclusions: To improve health equity and engagement in health programs among low-wage workers, employers should consider providing face-to-face announcements, flexible modality and scheduling, increased privacy assurances, social needs resources, and incorporation of mobile health tools - while considering important limitations.

Abstract P1101: Associations Between Cardiovascular Risk Behaviors and Sleep Duration in Young Adult Sexual Minority Men

Introduction: Young adult sexual minority men are at increased risk for cardiovascular disease due to social behaviors, particiulary tobacco use and excessive alcohol consumption. The American Heart Association's Life's Essential 8 provides a framework to enhance cardiovascular health. Tobacco use and excessive drinking are associated with significant cardiovascular risks, with tobacco linked to about one-third of all deaths from heart disease and excessive drinking increasing the risk of liver and heart disease. This study examined the associations between cardiovascular risk behaviors and sleep duration in young adult sexual minority men. Hypothesis: We hypothesized that tobacco use and excessive alcohol consumption would be associated with sleep duration and vary by sleep duration category (7-9 hrs vs. >9 hrs). Methods: Secondary data were analyzed from an HIV prevention behavioral trial with 322 young adult sexual minority men ages 18–34. A step-wise multinomial logistic regression analysis was conducted in R to examine the relationships between tobacco use, alcohol consumption, and sleep duration comparing individuals sleeping 7-9 hours and those sleeping more than 9 hours (reference category). Missing data were addressed using multiple imputation by chained equations. Results: Tobacco use was reported in 21% of participants, while 90% reported alcohol consumption. Tobacco use was significantly associated with increased odds of sleeping 7 to 9 hours (estimate = 0.978, p = 0.003), while alcohol consumption had a significant negative impact on this category (estimate = -0.182, p = 0.038). For those sleeping more than 9 hours, tobacco use was significantly associated with extended sleep (estimate = 0.846, p = 0.005), while alcohol approached significance (estimate = 0.164, p = 0.050). Age and income were not significant. Conclusions This study highlights the complex relationships between tobacco use, alcohol consumption, and sleep duration in young adult sexual minority men. The association of tobacco use with sleeping 7-9 hours is controversial, as tobacco is not cardioprotective and is linked to adverse health outcomes. Smoking may fulfill stress-reducing needs, affecting sleep patterns. Additionally, excessive alcohol consumption negatively impacts sleep duration and may worsen cardiovascular risks. Behavioral interventions grounded in Life's Essential 8 may be beneficial in reducing cardiovascular risk behaviors in young adult sexual minority men.

Effects of Tirzepatide on the Clinical Trajectory of Patients With Heart Failure, Preserved Ejection Fraction, and Obesity

BACKGROUND: Patients with heart failure with preserved ejection fraction and obesity have significant disability and frequent exacerbations of heart failure. We hypothesized that tirzepatide, a long-acting agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, would improve a comprehensive suite of clinical end points, including measures of health status, functional capacity, quality of life, exercise tolerance, patient well-being, and medication burden, in these patients. METHODS: We randomized (double-blind) 731 patients with class II to IV heart failure, ejection fraction ≥50%, and body mass index ≥30 kg/m 2 to tirzepatide (titrated up to 15 mg SC weekly; n=364) or placebo (n=367) added to background therapy for a median of 104 weeks (quartile 1, 66; quartile 3, 126 weeks). The primary end points were whether tirzepatide reduced the combined risk of cardiovascular death or worsening heart failure and improved Kansas City Cardiomyopathy Questionnaire Clinical Summary Score. The current expanded analysis included sensitivity analyses of the primary end points, 6-minute walk distance, EQ-5D-5L health state index, Patient Global Impression of Severity Overall Health score, New York Heart Association class, use of heart failure medications, and a hierarchical composite based on all-cause death, worsening heart failure, and 52-week changes in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score and 6-minute walk distance. RESULTS: Patients were 65.2±10.7 years of age; 53.8% (n=393) were female; body mass index was 38.2±6.7 kg/m 2 ; Kansas City Cardiomyopathy Questionnaire Clinical Summary Score was 53.5±18.5; 6-minute walk distance was 302.8±81.7 m; and 53% (n=388) had a worsening heart failure event in the previous 12 months. Compared with placebo, tirzepatide produced a consistent beneficial effect across all composites of death and worsening heart failure events, analyzed as time to first event (hazard ratios, 0.41–0.67). At 52 weeks, tirzepatide increased the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score by 6.9 points (95% CI, 3.3–10.6; P <0.001), 6-minute walk distance 18.3 meters (95% CI, 9.9–26.7; P <0.001), and EQ-5D-5L 0.06 (95% CI, 0.03–0.09; P <0.001). The tirzepatide group shifted to a more favorable Patient Global Impression of Severity Overall Health score (proportional odds ratio, 1.99 [95% CI, 1.44–2.76]) and New York Heart Association class (proportional odds ratio, 2.26 [95% CI, 1.54–3.31]; both P <0.001) and required fewer heart failure medications ( P =0.015). The broad spectrum of effects was reflected in benefits on the hierarchical composite (win ratio, 1.63 [95% CI, 1.17–2.28]; P =0.004). CONCLUSIONS: Tirzepatide produced a comprehensive, meaningful improvement in heart failure across multiple complementary domains; enhanced health status, quality of life, functional capacity, exercise tolerance, and well-being; and reduced symptoms and medication burden in patients with heart failure with preserved ejection fraction and obesity. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04847557.

Correction for Qian et al., Chemoptogenetic damage to mitochondria causes rapid telomere dysfunction

Responsive DNA artificial cells for contact and behavior regulation of mammalian cells

Abstract P2161: Validation Of a Novel Method to Evaluate Local-scale Community-based Interventions That Improve Access to Fruits and Vegetables

Background: Adequate intake of fruits and vegetables (FV) is important for cardiovascular health. Evaluating community-based dietary programs in under-resourced areas is challenging, necessitating innovative data collection methods. These methods must adapt to community contexts, enhancing the accessibility of impact evaluation for programs operating in neighborhood settings, including community centers, schools, and farmers’ markets. Aims: This study aimed to develop and pilot a survey instrument designed to overcome barriers in data collection within community-based programs, focusing on measuring changes in health behaviors. The tool aims to validate a concise set of process and outcome measures, addressing the evaluation challenges of small, local initiatives. Methods: The survey development was a theory-driven, participatory process with stakeholders to ensure the tool was culturally sensitive and capable of capturing data relevant to health outcomes. The survey was pilot tested in four Social Impact Fund programs in California, Florida, and Georgia. One program provided free meals, two provided discounted produce, and one was a traditional farmers’ market stand. The bilingual survey (English and Spanish) covered demographics, program participation, frequency of FV intake, and barriers to healthy eating. It was delivered via in-person interviews, tablets, and personal smartphones. Results: The pilot achieved high feasibility, with a 98.2% completion rate from 111 participants for the 20-item survey, taking an average of eight minutes. Overall, 62.5% (95% CI 49.7, 75.3) of participants said that their FV intake increased due to the programs, with the top reasons being affordability and quality. Participants also reported barriers to increasing FV intake, Figure 1, with 50% (95% CI 39.9, 60.1) saying cost, followed by time constraints and accessibility. Conclusion: The pilot results affirm the feasibility of evaluating programs aiming to improve diet in high-disparity neighborhoods. The results indicate a strong community desire for such programs and underscore a pivotal finding: when fruits and vegetables are affordable and accessible and meals are readily available at a low cost, community members are more likely to adopt healthier diets. This participatory approach proves that a well-validated, concise survey tool can efficiently collect health data in unconventional settings, promoting health equity by adapting to specific needs of communities.

Abstract P3174: The Benefits of Probiotic Administration in Stroke Risk, Stroke-Related Gastrointestinal Complications, and Intestinal Flora Dysbiosis: A Meta-Meta-Analysis

Introduction: Stroke is the second largest cause of death and third leading cause of disability worldwide. Some high-income countries have one in five lifetime cases and one in two in low-income countries. Due to the high stroke burden and aging population, better preventive and treatment approaches are needed. Recent research shows that stroke patients have a different gut microbiota than healthy people, suggesting a relationship between dysbiosis and stroke incidence and prognosis. Probiotics may improve stroke outcomes by strengthening the intestinal barrier and reducing inflammation. Hypothesis: Our study seeks to evaluate the potential benefits of probiotic supplementation in reducing the risk of ischemic stroke in healthy individuals as well as its impact on the prognosis of stroke patients, specifically in reducing gastrointestinal complications and improving gut microbiota balance (reduce dysbiosis). Methods: We conducted an umbrella meta-analysis of meta-analyses published in the last 10 years using PRISMA guidelines in PubMed. Using RevMan 5.4, we performed an inverse variance random effects model to calculate log (odds ratio) and converted it to pooled OR and 95% confidence interval to obtain a forest plot keeping alpha criteria 0.05. Heterogeneity and risk of bias assessment (by Newcastle-Ottawa Scale) were assessed. Results: While probiotic supplementation in healthy individuals did not significantly decrease the risk of ischemic stroke (OR 0.87 [95%CI 0.75-1.01]), it showed notable benefits in stroke patients. These positive effects included a substantial reduction in the odds of specific GI complications (constipation, diarrhea, gastric retention, esophageal reflux, vomiting, stress ulcers, and gastrointestinal bleeding) by 62% (0.38, 0.29-0.51), non-specific GI complications by 72% (0.28, 0.24-0.34), infection by 73% (0.27, 0.21-0.33) and a significant improvement in gut flora balance, reducing the odds of dysbiosis by 79% (0.21, 0.12-0.36). (p<0.00001) The inter-study heterogeneity was 91% with (p<0.00001, Chi 2 =128.76), a moderate risk of bias. Conclusion: Our umbrella meta-analysis highlights the potential benefits of probiotic supplementation in stroke patients, particularly in mitigating stroke-related GI complications and alleviating intestinal flora dysbiosis. These findings underscore the crucial role of gut-brain interactions in stroke and suggest that probiotics may serve as a promising component of stroke management.

Abstract P1092: Preclinical Heart Failure Risk of Metabolically Healthy Overweight/Obese Adults in Hispanic/Latino Adults.

Intro: People with obesity who are metabolically healthy (MHO) have lower CVD and HF incidence compared to those with obesity and unhealthy metabolic risk factors (MOU), but higher risk than those with normal weight and metabolic healthy profiles (MHNW). However, it is unclear whether there are differences in left ventricle (LV) cardiovascular functioning/structure associated with early-stage HF (i.e., preclinical HF) risk among various metabolic health-body mass phenotypes within the Hispanic/Latino population. Therefore, the current study assessed preclinical HF risk in persons classified as Metabolically Healthy Overweight/Obese (MH-OW/OB) compared with MUO and MHNW, who were enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and ancillary Echocardiographic Study of Latinos (ECHO-SOL). Methods: Data were derived from the HCHS/SOL&ECHO-SOL visit 2 ( n = 2082, M age = 54.5 years old, 51.2% women). Metabolic health was defined as having none of the following: elevated fasting glucose, triglycerides, blood pressure, insulin resistance, low HDL cholesterol and or use of medication for any of the elevated criteria (e.g., hypertension medication). Body Mass was assessed via BMI categories. Preclinical HF was defined as evidence of LV diastolic/systolic dysfunction and or LV hypertrophy measured via echocardiography. Weighted logistic regression assessed preclinical HF risk between MH-OW/OB vs MUO, and MH-OW/OB vs MHNW while controlling age, sex, field center, heritage, years living in US, and time since last visit (years between visit 1 and visit 2). Study design features were incorporated in planned logistic regression analyses. Results: Of the population, 329.1 were MH-OW/OB, 1088.1 were MUO, and 154.1 were MHNW (weighted counts). Weighted logistic regression analyses indicated that MH-OW/OB had lower risk of preclinical HF compared with MUO persons [Odds Ratio (OR): 0.25, 95% CI: 0.12-0.54]. Notably, MH-OW/OB persons were not significantly different in preclinical HF risk compared with MHNW persons [OR: 1.90, 95% CI: 0.58-6.22]. Conclusion: Results suggest that the MH-OW/OB classification may not confer added risk of preclinical HF compared to MHNW. However, findings indicate that MH-OW/OB has lower preclinical HF risk compared with MUO. Additional research is needed to determine if changes in cardiac structure/function are linked with adipocyte physiology that may underlie HF pathophysiology within the Hispanic/Latino population.

Correction for Manik et al., Structural basis for TIR domain–mediated innate immune signaling by Toll-like receptor adaptors TRIF and TRAM

Magnetic and mechanical hardening of nano-lamellar magnets using thermo-magnetic fields

Abstract High-performance magnetic materials based on rare-earth intermetallic compounds are critical for energy conversion technologies. However, the high cost and supply risks of rare-earth elements necessitate the development of affordable alternatives. Another challenge lies in the inherent brittleness of current magnets, which limits their applications for high dynamic mechanical loading conditions during service and complex shape design during manufacturing towards high efficiency and sustainability. Here, we propose a strategy to simultaneously enhance the magnetic and mechanical performance of a rare-earth-free multicomponent magnet. We achieve this by introducing nano-lamellar structures with high shape anisotropy into a cobalt–iron–nickel–aluminum material system through eutectoid decomposition under externally applied thermo-magnetic fields. Compared to the conventional thermally activated processing, the thermo-magnetic field accelerates phase decomposition kinetics, producing finer lamellae spacings and smaller eutectoid colonies. The well-tailored size, density, interface, and chemistry of the nano-lamellae enhance their pinning effect against the motion of both magnetic domain walls and dislocations, resulting in concurrent gains in coercivity and mechanical strength. Our work demonstrates a rational pathway to designing multifunctional rare-earth-free magnets for energy conversion devices such as high-speed motors and generators operating under harsh service conditions.

Abstract P1148: Coping with stressors: Does it predict health behaviors over more than a decade?

Objective: Emerging research suggests the use of certain strategies to cope with stressors relate to disease and mortality risk, and lifestyle habits may be underlying mechanisms. Studies show psychological symptoms (e.g., anxiety) and states (e.g., happiness) predict the likelihood of adopting an integrated lifestyle that encompasses key health-related behaviors, like smoking. Yet, whether psychological processes , including stress-related coping, influence the adoption of a healthy lifestyle is unknown. We investigated whether coping strategies typically deemed adaptive (e.g., seeking emotional support) and maladaptive (e.g., denial) relate to sustaining a healthy lifestyle over a 16-year follow-up. We also explored whether variability in use of these strategies, reflecting attempts to find the best strategy for a given stressor, subsequently relates to lifestyle. Methods: Women (N=46,067) from the Nurses’ Health Study II reported their use of eight coping strategies in 2001, from which we also derived coping variability levels (lower, moderate, greater). Health behaviors (e.g., physical activity, smoking, sleep) self-reported every four years from baseline until 2017, were combined into a lifestyle score. Generalized estimating equations, controlling for baseline demographics and health status, were performed. Results: Most adaptive strategies and greater variability levels were associated with higher likelihood of sustaining a healthy lifestyle (e.g., Active Coping, Relative Risk [RR]=1.09, 95% Confidence Interval [CI]=1.08-1.10), with the reverse evident with maladaptive strategies (e.g., Behavioral Disengagement, RR=0.93, CI=0.92-0.94), but some unexpected results also emerged. Conclusions: Findings highlight the importance of going beyond the usual (mal)adaptive categorization of coping strategies when investigating their predictive value with behavioral outcomes.

Abstract P1124: Investments in Programming by Depts. of Recreation and Parks is Associated with Reductions in Cardiovascular Disease and Other Health Outcomes

Introduction: Parks and park programming have been associated with more physical activity (PA), yet investments in parks are low. For the largest 100 US cities, the average spending for parks and recreation in 2022 was $126 per capita, with an average of $30 per capita devoted to programming. In contrast, the spending for health care in 2022 was $13,493 per capita. Physical inactivity accounts 11% of health care costs, and PA is strongly associated with better health and lower rates of cardiovascular disease. The goal of this study was to assess whether greater investments in parks and recreation will have a positive health benefit. Hypothesis: Spending on parks, programming and maintenance may be associated with better health outcomes, including lower cardiovascular disease (CV), hypertension (HTN) and Type 2 diabetes (T2DM). Methods: We tested the association between per capita spending by Depts. of Parks and Recreation and health outcomes among local residents who receive healthcare from Kaiser Permanente, which serves >20% of the Southern California (SoCal) population. Data consisted of 2022 per capita spending on park maintenance and programming collected by Trust for Public Land and 2022-2023 electronic health records from 732,504 adults in 10 SoCal cities. We calculated the risk ratio for CV, HTN and T2DM using Poisson model with robust variance estimator controlling for body mass index (BMI), population density, neighborhood deprivation index (NDI), age, gender, and race/ethnicity. Results: Of the 732,504 adults in 10 SoCal cities, 48,042 had CV conditions, 205,462 had HTN, 115,758 had Type2 DM. We found that for every $30 per capita per city spent on programming there were 8.9% fewer CV diagnoses (e.g. MI, CHF, atherosclerosis, cardiomyopathy, angina, etc.), 3.9% fewer diagnoses of HTN and 3.8% fewer T2DM cases (p<.0001 for all). Investments in park maintenance were not associated with CV outcomes but were associated with 1.3% lower T2DM and 1.8% lower HTN rates (p <.0001 for both). Conclusions. Programming has a stronger relationship than park maintenance with health outcomes, probably because it is the programming (sports, exercise classes, 5K walks and runs) that more strongly attracts park visitors and supports PA. While this is a cross-sectional study verifying the relationships between investments in park programming, park maintenance and health, a longitudinal study is needed to prove the health benefits of park programming and events.

Abstract 070: The Risk of Arrhythmias and Sudden Cardiac Arrest Associated with Methamphetamine, Cocaine, Opiate, and Cannabis Use: An Analysis of a Large Healthcare Claims Database

Introduction: Arrhythmogenic risks associated with substance use are poorly understood; existing studies are limited in scope or conducted in select populations. We conducted a longitudinal analysis to quantify the association of substance use with incident arrhythmias and sudden cardiac arrest (SCA) in a commercially insured population in the US. Methods: Using data from the MarketScan databases (2016-2022), we used ICD-10 codes to identify substances, outcomes, and covariates at each medical encounter. Substance users were matched with up to five non-substance users by age, sex, insurance enrollment date, and encounter date. Outcomes included atrial fibrillation (AF), ventricular tachycardia (VT), and a combined SCA/ventricular fibrillation (SCA/VF) outcome. We used Cox proportional hazards models to assess the association of each substance with each incident outcome, adjusting for demographics and comorbidities. Results: We matched 154,208 substance users to 697,869 non-users (mean age = 43 years; 46% female). Opiate and cannabis use were the most common (Table). During a mean follow-up of 2.1 years, there were 25,357 AF events, 6,351 VT events, and 2,095 SCA/VA events. After adjusting for potential confounders, the use of methamphetamines, cocaine, cannabis, and opiates was each associated with an increased risk of AF, with cannabis use having the highest risk of AF [HR: 1.84 (95% CI: 1.71, 1.98)] compared to matched non-users. All substances were associated with an increased risk of VT and SCA/VF, with cocaine use having the highest risk of SCA/VF [HR: 3.45 (95% CI: 2.77, 4.28)] compared to non-users. Conclusion: In this representative sample of commercially insured people, methamphetamine, cocaine, cannabis, and opiate use was each associated with a 1.5-3.5 times increased risk of developing arrhythmias. Given the ongoing drug crisis and increasing cannabis use in the US, understanding the association of substance use with arrhythmia risk will help better target arrhythmia prevention in these populations.

Major depressive disorder on a neuromorphic continuum

Abstract P2037: Impact of Extended Opportunistic Hypertension Screening on Cardiovascular Disease Outcomes: A Simulation Study

Background: Hypertension (HTN) is a major risk factor for cardiovascular diseases (CVD). The World Health Organization recommends opportunistic screening, defined as measuring blood pressure (BP) during routine healthcare visits even for unrelated reasons. However, implementation of this approach remains suboptimal, and the impact of extending such screening is unknown. Objective: To estimate the impact of extending opportunistic HTN screening in public healthcare facilities in Bangladesh from 20% to 80% of eligible adults on CVD outcomes. Methods: Using a two-stage modelling framework, we estimated the impact of extending opportunistic screening from 20% (current) to 80%(goal) among adults (age > 25) without HTN treatment. First, we simulated the intervention effect on systolic BP (SBP), using a microsimulation model. Next, we incorporated the SBP effect in a state-transition model to estimate the 10-year impact on incident CVD events and deaths, assuming SBP effects were maintained over 10 years. Key model inputs were derived from clinical trials, the 2018 WHO STEPS survey, and the 2019 Global Burden of Disease Study. Results: Extended screening was estimated to increase HTN treatment coverage and prevent incident CVD events in the model population ( Figure ). Extending opportunistic screening from 20% to 80% could increase the number of people screened from 149,925 to 599,685/million (Panel A), and an additional 15,417/million more persons will be diagnosed and started on treatment (an increase from 16,857 to 32,274/million). Over 10 years, the extended screening could avert ~1,900 incident CVD events and ~340 averted CVD deaths, per 1 million eligible population (Panel B). Conclusions: Extending opportunistic HTN screening with subsequent treatment could substantially reduce CVD burden among adults with untreated HTN in Bangladesh. Understanding the costs related to screening and treatment requires further investigation.