Browse Articles

Abstract P3046: Association of Epigenetic Age Acceleration with Diabetes and Glucose Metabolism Markers Among Hispanic/Latino Adults in The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Background: Epigenetic age acceleration (AA) has been associated with diabetes, but associations differ across DNA methylation (DNAm) based epigenetic clocks and populations. We examined whether epigenetic age acceleration (EAA) estimated from several epigenetic clocks was associated with the prevalence of diabetes and glucose metabolism markers among Hispanic/Latino adults in the United States. Methods: Genome-wide DNAm was profiled in a random sample of 1,000 participants from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and was used to estimate EAA derived from four well-known epigenetic clocks (Horvath, Hannum, PhenoAge, GrimAge). Using a cross-sectional study design, we investigated the associations between each EAA measure and diabetes status at baseline, as well as their associations with glucose metabolism markers [fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), 2-h post-prandial blood glucose (2hBG), and homeostatic model assessment of insulin resistance (HOMA-IR)]. Survey-weighted Poisson regression models with robust variance were used to estimate prevalence ratios (PRs) for the associations between each EAA measure and diabetes status, adjusting for sex, education, age, smoking status, alcohol use, physical activity, diet, sleep duration, and cell type proportions. Survey-weighted multivariate linear regression models were used to estimate associations between each EAA measure and log-transformed glucose metabolism marker. Results: Five-year increases in EAA were associated with higher prevalence of diabetes for PhenoAA [PR: 1.37 (1.19, 1.57)] and GrimAA [PR: 1.43 (1.06, 1.91)]. Estimates also indicated a higher prevalence of diabetes for HannumAA [PR: 1.22 (0.99, 1.50)] and HovarthAA [PR: 1.13 (0.94, 1.35)]; however, these associations were not statistically significant. In linear regression models, increases in EAA were associated with higher glucose metabolism markers. For example, 5- year increases in PhenoAA were associated with higher levels of FBG [β: 0.02 (0.01, 0.03)] and HbA1c [β: 0.02 (0.01, 0.03)]. Increases in HannumAA, PhenoAA, and GrimAA were associated with higher HOMA-IR (p <0.05). Conclusion: Among a population-based sample of Hispanic/Latino adults, EAA was associated with a higher prevalence of diabetes and higher glucose metabolism markers. Further research on the longitudinal association EAA and diabetes is needed to identify individuals at greater risk for developing diabetes.

Abstract P1033: The Association of Adverse Pregnancy Outcomes with Left Ventricular Structure and Function in Early Midlife: Results from the Bogalusa Heart Study

Background: Studies about the association between the adverse pregnancy outcomes (APO) and cardiac structure and function in midlife are scarce despite evidence that APO increases the risk of cardiovascular disease in later life. Objectives: The current study aims to investigate the association of APO with left ventricular (LV) structure and function after follow-up of approximately 15 years post-pregnancy. Methods: The Bogalusa Heart Study (BHS) is an ongoing rural community-based cohort in Louisiana. We examined 454 women who experienced singleton pregnancies and had follow-up echocardiography performed post-pregnancy. APO included pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), preterm birth, and miscarriage at any pregnancy. Echocardiographic parameters at follow-up included LV ejection fraction (LVEF), LV mass index (LVMi), and LV geometry. LV geometry was classified as normal, concentric remodeling, concentric and eccentric hypertrophy. Multivariable linear and logistic regression analyses were applied and adjusted for age, race, education, smoking, alcohol intake, systolic blood pressure, fasting blood glucose, and total cholesterol. Interactions by age and race were tested. Results: The mean age across any pregnancy was 23.0 ± 5.6 years, and 33.7% were Black. After a median follow-up period of 15.1 years, in adjusted analyses, preterm birth and miscarriage were not statistically associated with LVEF, LVMi, and LV geometry. However, PIH (β coefficient = 0.12; p = 0.014) was associated with greater LVMi in midlife, but not with LVEF or LV geometry. GDM was associated with LV geometry, specifically with an increased risk of concentric hypertrophy (Odds Ratio, 3.42; 95% Confidence Interval, 1.04-11.30; p = 0.044). Interactions by race and age were not statistically significant. Conclusion: We identified the association of APO, specifically PIH and GDM, with greater subsequent LVMi and concentric remodeling 15 years later. Further studies are warranted to replicate these findings; however, women with PIH and GDM might be at higher risk of heart disease later in life. Keywords: Adverse pregnancy outcome, pregnancy induced hypertension, echocardiography, left ventricular mass index

Abstract P2084: Independent prognostic factors of mortality in young patients after STEMI

Young patients (pts) with acute myocardial infarction and ST-segment elevation (STEMI) are a specific subset of a population with different risk factor profiles, clinical presentations, and prognosis as compared to older patients. Despite the more favorable hospital course of STEMI in young pts, major CV events after discharge from hospital remains at a high level. The Aim: To identify independent markers of high death risk in young STEMI pts during long-term follow-up. Materials and Methods: The data of long-term observation of 130 pts aged<45 years (mean 39.4±5.7 years) hospitalized with a diagnosis of STEMI were analyzed. The follow-up period of patients was 4.89±2.66 years. The development of death from any cause assessed. Identification of independent risk factors performed using multivariate analysis (Cox regression). Results: During the 5 years of follow-up, 11 deaths from any cause were recorded (8% or 14.5 cases per 10,000/months). The median time to death is 34 months. The main risk factors for death were smoking (aHR14.17: 95%CI, 2.14-93.69) and arterial hypertension (aHR6.42: 95%CI, 1.45-28.39). More than half of the deaths (6/11) occurred among patients who had both factors – smoking and hypertension. Conclusions: The combination of independent risk factors for death in young pts after STEMI (smoking and arterial hypertension) is important marker of long-term prognosis.

A cross-sectional survey analysis of patient and family knowledge, confidence, and perceived barriers to reporting patient deterioration

Background The knowledge, confidence, and skills of healthcare consumers to identify acute clinical deterioration and appropriately escalate concerns remain largely undetermined. This gap is despite the widespread international introduction of consumer escalation systems intended to provide patients and family an avenue to escalate their concerns if worried about deterioration in their own or relative’s condition during a hospital stay. Aim To explore patient and family knowledge of acute clinical deterioration, and their confidence and perceived barriers to escalating their concerns. Design Cross-sectional, in-person, consumer surveys across an Australian acute adult hospital. The study specific survey tool was developed through a multistage process with healthcare consumer input during creation and testing. Methods Questions explored healthcare consumer knowledge, confidence, and perceived barriers in association with acute clinical deterioration, recognising deterioration, and escalating concerns. Descriptive and inferential analysis was completed, and knowledge, confidence, and barrier scores established. Association between scores and consumer type, gender, age, education level, prior experience with clinical deterioration or rapid response team review, and hospitalisation history in the last 12 months were assessed using multivariable linear regression. Results 133 surveys were completed. Knowledge scores varied across respondents. Awareness of the local consumer escalation system was low. A positive association was identified between knowledge and confidence that diminished with increasing barrier scores. A strong negative correlation was present between barriers and confidence. No significant difference existed in knowledge, confidence, or barrier scores based on consumer type, gender, education level, previous experience with deterioration or rapid response team review, or hospitalisation history. Conclusions Limitations in patient and family knowledge may impede consumer escalation system success. Increasing knowledge may enhance patient and family confidence to identify deterioration and escalate concerns. However, barriers to consumer escalation decrease this potential. Interventions to increase consumer knowledge should therefore be accompanied by strategies to minimise barriers.

Abstract P3080: Factor IX and Incident Hypertension in Black and White Adults: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort

Background: A significant fraction of Americans are diagnosed with hypertension. Prior studies have shown Black adults experience a disproportionate amount of this burden. Certain biomarkers of thrombosis are associated with a greater risk of hypertension. Factor IX is a marker of thrombosis. Whether higher factor IX correlates with an increased risk of incident hypertension or explains some of the disproportionate burden faced by Black adults is not fully known. Methods: We included Black and White participants from the REasons for Geographic and Racial Difference in Stroke (REGARDS) study, excluding those with prevalent hypertension, missing factor IX level, or covariates of interest. Modified Poisson regression estimated risk ratios (RR) for incident hypertension by higher factor IX tertiles. A mediation analysis was performed using inverse odds ratio weighting to assess whether racial differences in hypertension risk could be attributed to factor IX levels. Results: A total of 1,824 participants were included, (55% female and 24% Black race), with 36% of participants developed incident hypertension. Higher factor IX levels were seen in Black participants with a mean of 110% vs 105% for White participants (p=0.0018). As shown in the Table, there was a greater risk of incident hypertension by higher factor IX tertile in all models. Mediation analysis did not demonstrate factor IX level mediated hypertension risk in any model. Conclusions: In this prospective study of Black and White adults without prevalent hypertension, higher factor IX was associated with a greater risk of developing hypertension, after adjusting for known confounders. A mediation analysis did not indicate that the excess burden of hypertension experienced by Black adults could be explained by factor IX level.

Correction to: Prevalence of Coronary Atherosclerosis in Female Masters Endurance Athletes

Abstract P2114: Metabolites Associated with Long Term Risk of Peripheral Artery Disease and Critical Limb Ischemia: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Peripheral artery disease (PAD) is a prevalent yet underrecognized vascular condition associated with significant morbidity and mortality. Traditional atherosclerotic risk factors such as smoking and diabetes increase the risk of PAD but do not fully explain its pathogenesis. Metabolomics offers a novel approach to identifying biochemical pathways, but studies focusing on PAD are sparse. Aim: To identify metabolites independently associated with incident PAD and its severe form critical limb ischemia (CLI). Methods: We included 4,032 participants (mean age 54 [SD 6] years, 62% Black, and 60% female) from the Atherosclerosis Risk in Communities (ARIC) study with serum metabolomic data at visit 1 (1987-89). We investigated 636 endogenous metabolites quantified by an untargeted gas and liquid chromatography–mass spectrometry approach. PAD and CLI were ascertained using discharge codes. We ran Cox proportional hazards models adjusting for sociodemographic, clinical, and lifestyle factors. Multiple testing was corrected using the Benjamin-Hochberg method. Results: Over a mean follow-up of 24 years, there were 453 cases of PAD, including 132 CLI cases. We identified 12 metabolites independently associated with PAD and 10 with CLI, representing peptides, lipids, and carbohydrates. Of these, gamma-glutamylthreonine (HR of PAD per 1SD metabolite increment 0.84 [95% CI 0.76-0.92]), gamma-glutamyltyrosine (0.85 [0.78-0.93]), 1,5-anhydroglucitol (0.79 [0.72-0.87]) and glucose (1.25 [1.10-1.42]) were associated with both PAD and CLI (Table). Asparagylvaline, lysylleucine, 1-docosahexaenoylglycerol, 1-linoleoylglycerol and 1-linoleoylglycerophosphocholine (18:2n6) were uniquely associated with CLI. Conclusion: We identified several metabolites independently associated with PAD and its severe form, CLI. Of these, gamma-glutamylthreonine, gamma-CEHC, asparagylvaline, lysylleucin and arginylproline have not been reported previously for any atherosclerotic diseases.

A study on the mechanism of school support to improve school adjustment of rural left-behind children——Analysis based on CEPS (2013–2014) data

School adjustment is related to the educational achievements and future career development of rural left-behind children. School support is an important institutional measure to promote the school adjustment of rural left-behind children in China. Using Structural Equation Modeling (SEM) based on CEPS data, this paper analyzed the effects of school support on rural left-behind children’s school adjustment, and found that: (1) school support effectively improves rural left-behind children’s school adjustment ability; (2) school support enhances students’ school adjustment ability by improving their educational expectation and mental health, especially the effects of teachers’ relationship support and school soft environment support are significant; (3) teacher support has a greater effect on students’ school adjustment ability than environment support, and soft environment support enhances students’ school adjustment ability by improving their mental health, while the impact of hard environment support is weaker. This study provides theoretical support for the formulation of intervention policies for rural left-behind children and offers practical evidence for understanding the relationship between school education and family education.

Abstract P3061: Uncovering Neighborhood-Level Inequities in Access to Transthoracic Echocardiograms

Methods: From a sample cohort of 274,539 consecutive adults who sought care at Mayo Clinic between 2018-2022, we ascertained demographic and clinical information, including clinically indicated TTE within 15 days and up to a year after the index clinical visit. The Area Deprivation Index (ADI), a tool that captures neighborhood-level disadvantages that are linked to cardiovascular morbidity and outcomes, was extracted from the Neighborhood Atlas and ranked accordingly as state percentiles stratified in quintiles, with the highest values representing “most disadvantaged” areas. We performed non-parametric multivariate regression models that adjusted for cardiovascular risk factors expressed in odds ratio (OR) and 95% confidence interval (CI). Results: A total of 45,823 (16.9%) subjects had a TTE performed, with a mean age of 63±16 years, 48% were women, and 86% were non-Hispanic white. According to the TTE, 4% of subjects had LVSD, while 11% had a high probability of LVSD by AI-ECG. Median state ADI was 4 IQR (2-7). In the whole cohort, subjects residing in the most disadvantaged areas were less likely to have a TTE [OR 0.94 CI (0.91- 0.97)] see Fig. 1-A ; conversely, they were more likely to have LVSD by TTE [OR 1.80 CI (1.52-2.13)] see Fig. 1-B , and higher probability of LVSD by AI-ECG [OR 1.43 CI (1.36-1.51)] when compared to those with the least disadvantage see Fig. 1-C , independent of age, sex, and cardiovascular risk factors, p for trend<0.001. Conclusion: Individuals living in socially disadvantaged areas were slightly less likely to have an echocardiogram despite a significantly higher likelihood of having an LVSD (suspected by AI-ECG and confirmed by TTE), independent of cardiovascular risk factors. Highlighting an important disparity in the diagnosis of LVSD.

Abstract P3082: Pregnancy heavy metal, essential element, and micronutrient mixtures and mid-life blood pressure and hypertension: findings from a prospective U.S. pregnancy cohort study with two decades of follow-up

Background: Heavy metals are cardiovascular disease risk factors, while essential elements possess antioxidant and anti-inflammatory properties and are crucial for health at trace levels. Metals may also interact with elements, leading to synergistic or antagonistic health effects. The associations of a mixture of metals and elements during pregnancy with women’s mid-life blood pressure (BP) and hypertension are unclear. Objective: To examine the prospective associations of a mixture of 6 metals, 5 elements, and 2 micronutrients in early pregnancy with women’s BP and risk of hypertension in mid-life. Methods: Project Viva is a prospective pregnancy cohort that enrolled women between 1999-2002 from Eastern MA. We measured metals (As, Ba, Cd, Cs, Hg, Pb) and elements (Cu, Mg, Mn, Se, Zn) in red blood cells, along with folate and vitamin B12 in plasma, all collected during pregnancy (median: 9.9w gestation). We measured mid-life BP in 2017-2020 (median maternal age: 51.2y). We examined associations of individual metals and elements with BP using linear regression and with hypertension (BP ≥130/80 mmHg or use of anti-hypertensive medication) using modified Poisson regression. We used Bayesian kernel machine regression (BKMR) to examine the mixture effects of all exposures. Models were adjusted for confounders listed in the Figure footnote . Results: Of the 493 women, 72% were White, 78% were college graduates, and 65% had a household income >$70K/y. The median (IQR) follow-up time was 18.1 (17.8-18.6)y. A doubling of Cu and Mn concentrations was associated with 0.75 (95% CI: 0.57, 0.99) and 0.80 (95% CI: 0.71, 0.91) times the risk of hypertension, respectively. A doubling of Cs and Se was respectively associated with 1.22 (95% CI: 0.94, 1.57) and 1.19 (95% CI: 0.77, 1.83) times the risk of hypertension, though the 95% CIs were wide. A doubling of vitamin B12 was associated with a 3.64 (95% CI: 1.23, 6.04) mmHg lower systolic BP and a 2.52 (95% CI: 0.72, 4.32) mmHg lower diastolic BP ( Figure 1 ). BKMR showed similar, linear associations for BP (results not shown) and hypertension ( Figure 2 ) and did not identify metal-element or metal-micronutrient interactions. The essential element mixture was monotonically associated with lower BP and risk of hypertension ( Figure 3 ). Conclusion: Optimizing essential element levels during pregnancy, particularly Cu and Mn, along with vitamin B12, may offer protective benefits against higher BP and hypertension in mid-life women.

Abstract P2128: Can We Swim Our Way to Better Health? A Cross-sectional National Survey

Background: This study examined obesity and comorbidity rates, physical activity levels, and cardiovascular health, using Life’s Essential 8 (LE8), among the United States Masters Swimming (USMS) adult swimmers. Methods: A cross-sectional Qualtrics survey was distributed by USMS via an online newsletter and by 52 local masters swimming organizations via email. Results: We received responses from 1,097 USMS members. The participants’ mean age was 42.8 (range 18-84), body mass index was 25.1 (range 17-47), and 59.0% identified as women and 89.5% as White. The obesity rates among USMS participants were four times lower than the national rate (10.9% vs 41.9%). The obesity prevalence did vary significantly by race, education, and household income but not by age or occupational physical activity. USMS and national rate comparisons were 23.0% vs. 44.5% for hypertension, 5.6% vs. 14.3% for type 2 diabetes, 8.6% vs. 11.4% for high total cholesterol, and 6.3% vs. 17.2% for low high-density lipoprotein cholesterol, respectively. The rate of USMS swimmers who met the recommended ≥150 minutes of aerobic activity a week, ≥two muscle-strengthening activities a week, and both was 96.6%, 65.6%, and 64.5%, respectively. When it comes to LE8 total score, USMS participants had 20% higher score than U.S. young adults free from cardiovascular disease (83.5 and 69.6, respectively, p=0.0001). In our sample, three in four adults had an ideal LE8 total score (≥80), compared to one in four from the NHANES sample that represents an estimated 90 million of the U.S. population. Overall, older USMS participants (mean age of 43; range 18-85) had significantly better LE8 score and estimated cardiovascular health than younger U.S. adults (mean age of 31; range 18-44). Conclusion: We observed low obesity and comorbidity rates and ideal estimated cardiovascular health among adult swimmers who are part of supervised and educational exercise environment overseen by the USMS.

Comparison of generic drug prices in Korea and eight high-income countries across four therapeutic classes

Background The prices of generic drugs in general are known to be higher in Korea than in other countries. However, it remains unknown whether the price levels of generic drugs in Korea relative to other countries can differ by therapeutic class. Therefore, this study compared the prices of generic drugs in four commonly used drug classes in Korea with those in other high-income countries. Methods Using IQVIA’s Pricing Insight data from 2018 to 2022, we calculated the Laspeyres price index for generic drugs in four therapeutic classes (antidiabetic drugs, lipid-modifying agents, antihypertensive drugs, and antibiotics). We selected eight high-income countries, such as Canada, France, Germany, Italy, Japan, Switzerland, the United Kingdom, and the United States, for comparison and Korea as the base country. Price to chemist was used and the currency conversion was based on the exchange rate and the purchasing power parity. Results Prices of generic drugs are lower in all of comparison countries combined than in Korea for lipid-modifying drugs and antihypertensive drugs. For these two drug classes, all countries but the U.S. have the index lower than one. The index for antidiabetic drugs was less than one in all countries except for Canada and the U.S. For antibiotics, all countries but France, Italy, and Japan have the index that is greater than one. Furthermore, the price index for generic antibiotics increased from 2018 to 2022 in all countries but Canada and Japan. Conclusion The prices of generic drugs are higher in Korea than in other high-income countries for lipid-modifying agents and antihypertensive drugs. The prices of generic antibiotics are higher in many comparison countries and have further increased from 2018 to 2021.

Abstract P3106: Association Between Diet Quality, Hypertension, And Hypertension Awareness Among Adults In Puerto Rico

Background: Hypertension (HTN) prevalence in Puerto Rico (PR) is among the highest in the US. Few studies have objectively measured HTN prevalence compared to awareness (i.e., diagnosed) and how diet quality may influence these factors. Objective: Examine the association between diet quality, blood pressure (BP), HTN, and HTN awareness in adults in PR. Methods: We used cross-sectional data from 1050 adults (30-75 yrs) without diabetes in the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) cohort. Diet was assessed using food frequency questionnaires, with the Alternate Healthy Eating Index-2010 (AHEI) to define diet quality. The AHEI score (0-110) includes 11 components; higher scores reflect a healthier diet. HTN was defined per ACC/AHA guidelines as medication use or average BP≥120/80 mmHg from 3 measurements. Participants self-reported HTN awareness as ‘ever told by a health professional’, sociodemographic and lifestyle behaviors. Adjusted linear models evaluated the association between AHEI and BP, and adjusted logistic models estimated the odds ratio (OR;95%CI) of HTN and HTN awareness per-10 unit AHEI score. Results: Of the 53% of participants with HTN, 38% were unaware of their disease. Mean(SD) diet quality was 57.1(10.7). Participants with HTN were older, male, retired, married, past smokers, and with lower education. AHEI was not associated with BP. However, higher fruit and omega-3 intake were significantly associated with lower systolic BP (β(S.E.):-1.16(6.8) and -0.85(0.42), respectively;p<0.05). Lower sugary drink intake was linked to lower diastolic BP (-0.36(0.15);p <0.05). A 10-unit AHEI increase was associated with lower odds of HTN (0.88;0.83,0.93) and higher odds of HTN awareness (1.06;1.02,1.10). Higher whole grain intake was associated with lower odds of HTN (0.91;0.84,0.98), while lower sodium intake was linked to higher odds of HTN awareness (1.07;1.01,1.14). Conclusions: A healthier diet, mainly one rich in whole grains, is associated with lower odds of HTN. In addition, higher fruit and omega-3 and lower sugary drink intake may keep lower BP levels. Participants with higher diet quality and lower sodium intake were more likely to be aware of their HTN status, suggesting HTN awareness may drive adherence to diet recommendations. These results should be confirmed with longitudinal data. Public health efforts in PR should focus on widespread HTN screening and healthy food programs.

Abstract P3163: Social Determinants of Health Among Rural Underserved Patients with Uncontrolled Hypertension

Introduction: Hypertension remains one of the most prevalent chronic conditions in the United States, with significant racial and ethnic disparities. Similar disparities are also seen among individuals with lower socioeconomic status and individuals living in rural versus urban locations. Understanding how specific social determinants of health contribute to these gaps could address the growing burden of hypertension among high-risk populations. Hypothesis: To investigate specific social determinants of health associated with uncontrolled hypertension among rural, underserved patients residing in Alabama. Methods: A retrospective review of EHR data of patients from the UAB Selma Family Medicine clinic was conducted. The de-identified data was then entered into the Population Health Assessment Engine (PHATE) to render social characteristics and Community Vital Sign (CVS) scores, a social deprivation index, by census tracts for each patient. We provide descriptive statistics and compare the stated factors between patients with controlled and uncontrolled hypertension using logistic regression models. Results: Among 2129 patients, 375 (17.6%) had uncontrolled hypertension with a mean age of 58.7 ± 14.4 years. Women represented 66.7% (250) and 65.1% (1142) of the uncontrolled and controlled hypertension populations, respectively. The prevalence of uncontrolled hypertension was 19.1% among Black patients and 8.2% in White patients. Patients with uncontrolled hypertension had a CVS of 82.37 ± 7.31 and 81.81 ± 8.40 patients with controlled hypertension. Patients with uncontrolled hypertension lived in areas where an average of 46 ± 11% of the population was not employed, 36 ± 9% lived in rental housing, and 28 ± 1% lived below the federal poverty line (FPL). Adjusting for age, race, and sex, a unit increase in the proportion of people below the FPL was associated with 43% higher odds of uncontrolled versus controlled hypertension (OR = 1.43, 95% CI 0.44, 4.64). A unit increase in the percentage of single-parent households was associated with 78% higher odds (OR = 1.78, 95% CI 0.44, 7.22), but a unit increase in the percentage of people without a high school diploma was associated with 29% lower odds of uncontrolled versus controlled hypertension (OR = 0.71, 95% CI 0.08, 6.68). Conclusions: Rural, underserved patients with hypertension experience multiple adverse social determinants that may be important to address when caring for this population.

Abstract P2127: AHA Life's essential 8 and ideal cardiovascular health among adult swimmers

Background: This study examined cardiovascular health (CVH), using the American Heart Association Life’s Essential 8 (LE8) scores among the United States Masters Swimming (USMS) adult swimmers. Methods: A cross-sectional Qualtrics survey was distributed by USMS via an online newsletter and by 52 local masters swimming organizations via email. We calculated the overall CVH score (range 0 [lowest] to 100 [highest]) and eight individual component scores, four health behaviors (diet, physical activity, sleep, and tobacco) and four health factors (body mass index [BMI], non-high-density cholesterol [non-HDL-C], hemoglobin A1c [HbA1c], and blood pressure [BP]). Each LE8 component was scored on a 1-100 scale and the final LE8 score represented the average of eight component scores. Results: We received responses from 1,097 USMS members. The participants’ mean age was 42.8 (range 18-84), 59.0% identified as women and 89.5% as White. The overall mean CVH score was 80.4 (±9.9). There were significant differences in the overall mean CVH score by sex (men, 78.3; women, 81.9) and race (range, 74.2-84.3) but not age (range, 79.2-80.7). Mean scores were the lowest for diet and non-HDL-C (51.5 and 75.2, respectively) and the highest for tobacco and physical activity (95.5 and 99.0, respectively). There were significant differences in mean scores across sexes in BMI (range, 77.6-85.8), non-HDL-C (range, 74.5-75.7) and BP (range 79.9-91.3), across races in BMI (range 65.9-87.8) and sleep (range, 57.9-92.5) and across ages in tobacco (range, 88.9-96.4), non-HDL-C (range, 73.2-100) and BP (range, 74.7-97.9). The mean USMS scores, compared to the mean NHANES scores for US adults, were higher for the total CVH score (+24.3%), diet (+42.8%), physical activity (+91.8%), tobacco (+38.0%), BMI (+43.1%), non-HDL-C (+11.5%), HbA1c (+%18.5) and BP (+22.3%) and lower only for sleep (-1%). Conclusion: We observed an ideal CVH score (over 80) among adult swimmers who are part of supervised and educational exercise environment overseen by the USMS.

CEO social capital and implied cost of capital: Based on the empirical evidence of Chinese family businesses

Social capital plays a crucial role in resource integration within Chinese family businesses. This research investigates the relationship between CEO social capital and the implied cost of capital, while also considering the influence of CEO type on this relationship. The empirical results based on China’s A-share family-listed companies show that CEO social capital helps to reduce the implied capital cost of family business. However, compared with non-family CEO, the effect of family CEO social capital on reducing the implied cost of capital is weaker. The mechanism analysis confirms that CEO social capital reduces the implied cost of capital through reducing corporate risk and improving information transparency. The heterogeneity analysis reveals that CEO social capital significantly reduces the implicit cost of capital only in entrepreneurial families, companies with low family control, and those without intergenerational transmission. Additionally, the effect of CEO social capital is more pronounced in fiercely competitive markets and high-tech industries. When economic policy uncertainty is high and investor legal protections are weak, CEO social capital can better exert its complementary effect on formal institutions. These findings not only provide a theoretical foundation for leveraging the informal system of social capital to strengthen family governance but also offer practical insights for addressing the classic decision of whether to choose family succession or hire professional managers.

Abstract P3057: Interactions Between Coffee Consumption and Genetic Pathways Uncover Biological Mechanisms Related to Type 2 Diabetes Risk Reduction

Introduction: Higher coffee consumption has been consistently associated with lower type 2 diabetes (T2D) risk but the underlying mechanisms are largely unknown. Our prior study showed higher coffee intake was associated with improved post-load glucose clarence and insulin sensitivity, and lower visceral adiposity. Hypothesis: We hypothesized that coffee consumption was associated with decreased T2D risk, by lowering genetic susceptibility of T2D in pathophysiological pathways related to insulin sensitivity, insulin production, and central adiposity. Methods: We analyzed data from 333,053 UK Biobank participants who were free of baseline chronic diseases. Coffee intake was assessed by a dietary questionnaire at baseline. We calculated seven partitioned polygenic scores (pPS) denoting 7 distinct physiological mechanisms underlying hyperinsulinemia, ranging from proinsulin, insulin secretion, to visceral adiposity. We examined the association of coffee intake, the pPS, and their interactions, with incident T2D, using Cox regression model. Results: We identified 10,707 incident T2D cases during 13.3 years of follow-up. Higher coffee intake, as expected, was associated with lower risk of T2D; compared to participants who did not regularly drink coffee, those consuming 4-5 cups/day had a 21% lower risk of incident T2D (95% confidence interval, 0.74-0.85) after adjusting for known risk factors including BMI. Of all pPS, 5 significantly predicted T2D risk ( P <0.05/7) but 2 pPS related to proinsulin and insulin secretion, did not ( P >0.05). In multivariable adjusted analyses, we identified a significant multiplicative interaction between coffee intake and proinsulin pPS; this pPS, which was in a genetic cluster linked to lower visceral fat and higher post-load insulin response (Fig. A), was associated with lower T2D risk only among participants who were high coffee consumers ( P interaction = 0.004; Fig. B). Furthermore, the positive associations between pPS for adiposity and pPS for visceral adiposity with T2D risk were attenuated among participants who consumed coffee daily vs. who did not ( P interaction = 0.088 and 0.093, respectively). Conclusions: Our data, coupled with our prior study, suggest that coffee consumption may be associated with lower T2D risk through its interactions with genetic pathways related to insulin secretion, post-load insulin sensitivity, and visceral adiposity. These results may inform tailored dietary recommendations to enhance T2D prevention.

Abstract P1014: The associations of financial barriers to dental health care with incident cardiovascular disease and dementia: a longitudinal analysis in the All of Us cohort

Introduction: Though poor oral health is linked to elevated risk of later-life cardiovascular disease (CVD) and Alzheimer’s Disease and Related Dementias (ADRD) via systemic inflammation, the impact of financial barriers to oral care on CVD and ADRD incidence remains unquantified. Hypothesis: We hypothesized that older adults reporting financial barriers to oral care -particularly women, people marginalized due to racial/ethnic identity, or with periodontitis - have elevated risk for CVD and ADRD. Methods: We used data from All of Us participants aged at least 55 years (N=65,770, 77.2% Non-Hispanic White, 57.9% women). Our primary exposure was self-reported difficulty accessing oral care due to cost within the past year, defined as yes or no. We identified congestive heart failure (CHF), cerebrovascular accident (CVA), myocardial infarction (MI) and ADRD outcomes in linked electronic health records. Using Cox proportional hazards models, we estimated associations of difficulty accessing dental care with each outcome. We assessed heterogeneity by gender, racial/ethnic identity, and prevalent periodontitis diagnosis. We estimated the population attributable fractions (PAF) of each outcome associated with difficulty accessing oral care using national prevalence estimates. Results: Participants who reported difficulty affording oral care had a higher incidence of CVA (adjusted HR=1.72; 95% CI: 0.72, 3.86) and CHF (HR=1.22; 95% CI: 1.01, 1.47). Estimated effects on MI (HR=1.11; 95% CI: 0.85, 1.44) and ADRD (HR=1.02; 95% CI: 0.61, 1.69) were not robust to adjustment for demographic, health behavioral, and clinical confounders. We did not observe differences in these associations by race/ethnicity, gender, or periodontitis. The estimated PAFs suggest that eliminating financial barriers to oral care could, over three years, prevent 9% of incident stroke, 4% of MI, 6% of CHF, and 4% of ADRD. Conclusion: Addressing financial barriers to needed oral care remains an unrealized policy target for CVD and ADRD prevention.

Abstract P3001: Associations of Biomarkers with Epicardial Adipose Tissue Volume and Density in Cardiovascular Risk Assessment: Insights from the PROMISE Trial

Introduction: Epicardial adipose tissue (EAT) has emerged as a potential biomarker due to its relationship with cardiovascular (CV) events. This study leverages data from the PROMISE trial to investigate relationships between EAT characteristics and biomarkers related to metabolic and CV health. Hypothesis: We hypothesize that specific biomarkers are significantly associated with CTA-derived EAT volume (EATv) indexed by body surface area (EATv/BSA) and EAT density (EATd), even after adjusting for clinical variables. Methods: We analyzed 1,544 individuals (mean age: 60.3 + 8.1 years; 52.9% female) with both CTA and blood samples. Biomarkers included alanine transaminase, beta-2 microglobulin, creatinine, cystatin C, galectin-3, high-sensitivity troponin I, glucose, homocysteine, lipoprotein(a), insulin, NT-proBNP, and uric acid. Univariate models assessed the direct relationship between each biomarker and EATv/BSA and EATd. False Discovery Rate (FDR) correction was applied. Significantly associated biomarkers were tested in multivariate models adjusted for age, sex, race, diabetes, hypertension, statin use, and smoking status. For EATv/BSA, models both with and without BMI were considered, due to EATv’s strong association with BMI. For EATd, the multivariate model adjusted for BMI and EATv. Results: Cystatin C, homocysteine, and uric acid were positively associated with EATv/BSA with statistical significance in both univariate and multivariate models (Table 1). Lipoprotein(a) was significant in both the univariate model and multivariate model excluding BMI, but not in the multivariate model including BMI. Cystatin C and uric acid were negatively associated with EATd, with statistical significance in both univariate and multivariate models (Table 2). Conclusions: This study identifies cystatin C and uric acid as significant biomarkers associated with both EATv and EATd in individuals with suspected CAD. The relationship between EAT and these biomarkers may reflect underlying metabolic disturbances, with obesity potentially contributing to higher excretion of cystatin C and elevated uric acid levels. Understanding these associations can enhance cardiovascular risk prediction models, leading to more targeted and effective interventions.

Advancing pearl millet yield forecasting: Comparative analysis of individual and ensemble machine learning approaches over Rajasthan, India

Pearl millet (Pennisetum glaucum L.) is a resilient crop known for its ability to thrive in arid and semi-arid regions, making it a crucial staple in regions prone to drought. Rajasthan, a state in India, emerged as the top producer of pearl millet. This study enhances yield forecasting for pearl millet using machine learning models across nine districts viz. Jaipur, Ajmer, Jodhpur, Bikaner, Bharatpur, Alwar, Sikar, Jhunjhunu and Nagaur in Rajasthan, India. Data from 1997–2019 (23 years), including yield data from the Directorate of Economics and Statistics and weather data from the NASA POWER web portal, were analysed. The study employed individual machine learning methods (GLM, ELNET, XGB, SVR and RF) and their ensemble combinations (GLM, ELNET, Cubist and RF). Discerning the overall best performing model across all locations remained challenging. For instance, while ensemble models exhibited subpar performance in Barmer and Nagaur, their performance ranged from satisfactory to commendable in other locations. To identify the best model, all models were ranked based on their R2 and nRMSE (%) values. Combined average ranks during training and testing revealed the model performance ranking as I-XGB (3.83) >  I-GLM (4.28) >  E-ELNET (4.32) >  I-RF (4.67) >  E-GLM (4.88) >  I-SVR (4.90) >  I-ELNET (4.94) >  E-RF (6.03) >  E-Cubist (7.15), where I denotes individual model, while E denotes ensemble model. Intriguingly, while individual GLM and XGB models demonstrated superior performance during calibration, they exhibited poorer performance during validation, potentially indicating issues of data overfitting. Hence, the ensemble ELNET approach is recommended for accurate prediction of pearl millet yield, followed by the individual RF model. These performances underscore the importance of tailored model selection based on specific geographic and environmental conditions.