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Abstract P3114: Measured Obesity and Overweight in the Adult Population: the Italian Health Examination Survey 2023-2024 - CUORE Project

Introduction: Obesity is associated with an increased risk of non-communicable diseases, such as diabetes, coronary heart disease, stroke, cancers, and other conditions, including obstructive sleep apnea and osteoarthritis. Obesity is largely preventable, and the WHO recommends to Member States to halt the rise of obesity by 2025, considering 2010 as baseline. Hypothesis: This analysis aims to assess if Italy can meet the WHO target in the general adult population using data measured in the periodic health examination surveys (HESs) conducted within the CUORE Project. Methods: In the HES started in 2023, mean level of BMI and prevalence of obesity (BMI>=30 kg/m 2 ) and overweight (25<=BMI<30 kg/m 2 ) were assessed in representative random samples of resident population, aged 35-74 years, stratified by age and sex (1,216 men and 1,235 women), from 12 (of 20) Italian Regions, in Northern, Central and Southern Italy. Weight and height were measured using standardized methods. Insufficient physical activity was defined as less than 150 minutes of moderate-intensity activity per week or less than 75 minutes of vigorous-intensity activity per week. The survey is implemented with the technical and financial support of the Ministry of Health - National Centre for Disease Prevention and Control. Results: Prevalence of obesity was 23% (95% Confidence Interval -95% CI: 18-28%) in men and 24% (95% CI: 19-28%) in women; prevalence of overweight was 47% (95% CI: 41-52%) in men and 30% (95% CI : 25-35%) in women. Mean level of BMI was 27.6 kg/m 2 (95% CI : 27.3-27.9 kg/m 2 ) in men and 27.3 kg/m 2 (95% CI : 26.5-28.1 kg/m 2 ) in women. Obesity had a tendency to be higher in persons with insufficient physical activity (28% - 20-36% in men; 27% - 20-33% in women) than among those with sufficient physical activity (19% - 13-24% in men; 20% - 14-27% in women), and in persons with primary or secondary school education (30% - 21-40% in men; 32% - 22-42% in women) than in those with higher educational level (20% - 14-25% in men; 20% - 15-25% in women). Conclusions: Going in the direction of WHO target, preliminary data collected within 2023 showed a prevalence of obesity not statistically different compared to HES data of 15 and 5 years ago, both in men and women. However, 70% of men and 55% of women are in the overweight/obesity condition. Preventive actions at national and community level should be still massively implemented.

Abstract 020: An Innovative HTN Intervention in Partnership with the AHA Promotes Access to Self-Measured Blood Pressure Monitoring in Public Libraries

Background: In response to the 2020 Surgeon General’s call to action for HTN control, this study examines a unique intervention leveraging public libraries to promote self-measured blood pressure (SMBP) access. Although the American Heart Association (AHA) advocates for SMBP as a crucial tool for HTN diagnosis and management, it remains underutilized. Partnering with libraries nationwide, the AHA provides SMBP devices at no cost in non-clinical settings. This study, the first of its kind, aims to evaluate SMBP access in public libraries by comparing SMBP alone versus SMBP combined with blood pressure screening, education, and case management. Methods: A multidisciplinary team of health sciences professionals at a large academic medical center partnered with suburban public libraries to design, implement, and evaluate a HTN intervention. In 2021, the AHA of Long Island, New York, distributed 689 SMBP devices within an educational kit to 53 public libraries for patron checkout. A subset of these libraries (n=15) implemented the Stony Brook Medicine Healthy Libraries Program (HeLP), in which an interprofessional team of faculty-supervised students from nursing, physician assistant, social work, and public health provided patrons’ with BP screenings, health education, and case management. Using a quasi-experimental design, SMBP kit usage over a 24 month period was compared between libraries offering only SMBP access (n= 32) and those offering SMBP and HeLP interventions (n= 15). Results: Among 852 BP screenings conducted, 56% (n=474) were “high” per AHA guidelines. Of these high readings, 56% (n=268) of individuals reported previously being told they had high BP by a healthcare provider, while 38% (n=180) had not received such a diagnosis, and 38% (n=182) reported current use of antihypertensive medications. The SMBP kits were borrowed a total of 1,653 times, averaging 2.26 checkouts per month. Notably, HeLP locations showed a significantly higher average monthly SMBP borrowing rate (M=3.32, STD 1.85), nearly twice that of SMBP-only locations (M=1.80, STD 1.42) (p = 0.0055). Conclusion: Public libraries offering integrated BP screenings, health education, and case management demonstrate significantly higher SMBP kit usage, underscoring the impact of comprehensive, co-located health services. The AHA’s investment in expanding SMBP access through public libraries is effectively enhanced by pairing these resources with supportive HTN education and case management.

Abstract P2160: Exploring Racial and Ethnic Disparities in the Social Determinants of Health among Participants in a Hypertension Prevention Trial, the LINKED-BP Program

Background: Hypertension (HTN) remains a highly prevalent risk factor for cardiovascular disease. To reduce the burden of HTN and advance health equity, social determinants of health (SDOH) should be assessed and addressed. Methods: The LINKED-BP Program is an American Heart Association-funded cluster-randomized pragmatic trial among adults with elevated blood pressure (BP) or stage 1 HTN. Participants have been recruited from two community-based health systems in Maryland. The LINKED-BP Program compares the effectiveness of support from community health workers and home blood pressure (HMBP) telemonitoring via a mobile app to enhanced usual care with HMBP in preventing progression to stage 2 HTN. We used the Accountable Health Communities Health-Related Social Needs Screening Tool to measure SDOH through telephone-administered surveys in English or Spanish. SDOH factors were compared among non-Hispanic Black, non-Hispanic White, and Hispanic adults using chi-square tests. Statistical significance was set at p<0.05. Results: Among 325 adults, the mean age was 43.1 (±12.7) years, 66% were female, 18% were Hispanic, 32% were non-Hispanic Black, and 47% were non-Hispanic White. Hispanic adults had lower education levels: 32% had <high school education, compared to 11% among non-Hispanic Black and 5% non-Hispanic White adults, p<0.001. Hispanic adults were overrepresented in the lower annual household income category: 33% earn ≤ $39,999 vs. 22% non-Hispanic Black and 14% non-Hispanic White adults, p=0.009. Similarly, transportation needs were greatest among Hispanic adults: 19% vs. 13% of non-Hispanic Black and 5% non-Hispanic White adults, p=0.007. Conclusions: Racial and ethnic disparities in SDOH were evident among LINKED-BP participants, with Hispanic adults experiencing the highest burden, and non-Hispanic White adults the lowest. Lower education, income, and transportation access have potential negative impacts on HTN prevention because they could limit access to care, relevant health information, and medical devices (e.g., BP devices). Interventions to prevent HTN should prioritize addressing SDOH factors to achieve desired cardiovascular health outcomes and promote health equity.

Retraction: GNB2L1 and its O-GlcNAcylation regulates metastasis via modulating epithelial-mesenchymal transition in the chemoresistance of gastric cancer

Abstract 045: Genome-wide Association Study for Metabolites in the Tryptophan Metabolism Pathway among African American Patients with Chronic Kidney Disease

Introduction: Impaired tryptophan metabolism is a signature in chronic kidney disease (CKD), leading to adverse cardiovascular outcomes. Genome-wide association studies (GWAS) in CKD patients may uncover genes involved in tryptophan metabolism that are only detectable in individuals with CKD. Therefore, we conducted GWAS for tryptophan related metabolites among 1,322 African American participants of the Chronic Renal Insufficiency Cohort (CRIC), a minority patient group that genomic studies of tryptophan are lacking. Methods: Thirty-two tryptophan-related metabolites were profiled from baseline 24-hour urine samples. Genome-wide array data were imputed to the Trans-Omics for Precision Medicine reference panel. After stringent quality control, GWAS of each metabolite was conducted, adjusting for age, sex, and 10 genetic principal components. Variants with P < 5×10 -8 were considered significant. Conditional association analysis using GCTA-cojo, followed by fine-mapping using SuSiE, was performed on the 1000 kb region around a significant variant to identify independent signals and causal variants. Results: Twenty-seven independent variants were identified for 17 tryptophan-related metabolites ( Table ). Seventeen, including 10 African specific, variants were novel. Of note, ACY3 intronic variant rs527362164 was associated with N-acetylkynurenine and was fine-mapped to two missense mutations, rs74533283 and rs76819752, in ACY3 . The three variants were African specific (minor allele frequency [MAF]>1%) and missing in other populations (MAF<0.1%). Interestingly, the two missense variants were also the causal variants of a previously reported African-specific intronic variant, rs115780269, associated with plasma N-acetyltryptophan . Similarly, AFMID missense variant rs61742958 was significantly associated with N-formylanthranilic acid and N-formylkynurenine . This variant was also African specific and fine-mapped as the causal variant of a previously identified intronic variant, rs114080902, for plasma N-formylanthranilic . We also replicated 12 associations for 10 independent variants in well-established genes involved in tryptophan metabolism. Conclusion: We identified 17 novel variants for tryptophan metabolism in African American CKD patients. Ten variants, including missense variants in AFMID and ACY3 genes, were African specific. Our findings underscore the importance of genetic studies in population subgroups to reveal novel mechanisms of tryptophan metabolism.

Abstract P1115: A Qualitative Study of Perspectives on South Asian Dietary Practices: Exploring a Framework for Culturally Tailored Food-is-Medicine Interventions

Introduction: South Asians (SA) have a 2-4-fold increased risk of developing cardiometabolic disease (CMD) compared to non-Hispanic Whites in the US. Certain dietary practices (“fried snacks, sweets, high-fat dairy") that are rooted in cultural values may contribute to the higher risks. Addressing CMD disparities in SA through Food-is-Medicine (FIM) interventions requires culturally adapted approaches and community input. Methods: This qualitative study aimed to understand cultural influences on SA dietary practices and identify facilitators and barriers to engaging SA in FIM interventions. We conducted in-depth interviews among SA adults aged 18-85 with CMD (e.g., diabetes, HTN, HLD, CAD, CVD) or their caregivers until thematic saturation was reached. Open-ended questions explored food choices, barriers to dietary change, and preferences for intervention designs. Interest in FIM program features and the importance of family involvement for dietary change were measured by 5-point Likert type questions (1: not important/open; 5: extremely important/open). Ratings were analyzed with descriptive statistics. Qualitative template analysis using NVivo identified key themes. Results: Among 20 SA adults with CMD (60% female, 70% first-generation, mean BMI 27.1), most (70%) favored South Asian (vs. American) foods in their daily diet. Rationale included: familiarity, preference, health, cultural preservation, and cooking knowledge/skill. Participants wished to maintain healthy aspects of the SA diet, like vegetable dishes and spices, but were open to reducing intake of “carb-rich” staples (e.g., white rice, roti) and cooking with too much oil. Social environments were seen as a major barrier to healthy eating due to social pressures to eat more and tempting food at gatherings. Most (80%) were open to participating in dietary interventions and were highly interested in features like written education materials (4.3/5), individual nutritional counseling (4.15/5), and customized meal plans with instructions (4.15/5). The majority (75%) viewed family involvement as extremely important for long-term dietary change. They also preferred interventions that were recommended by healthcare providers (4.23/5) and delivered remotely (65%). Conclusion: Future designs of culturally tailored FIM interventions for SA should incorporate healthy modifications to traditional cuisine, personalized education, and family involvement. This may enhance program acceptability and participation.

Abstract P3007: Relationship between ET-1 Gene Polymorphism rs5370 and Cardiovascular Disease among Hispanics Using All of Us data

Background: The Hispanic population in the continental US has grown by 23% over the last decade. Cardiovascular disease (CVD) remains the leading cause of death in this group, affecting 42.7% of Hispanic women and 52.3% of Hispanic men. Endothelin-1 (ET-1), a potent vasoconstrictor, is proposed as a novel biomarker for cardiovascular risk prediction. The ET-1 genetic polymorphism rs5370 involves a substitution of Guanine by Thymine at codon 198. This polymorphism appears to play a role in developing CVD risk factors. However, it has not been studied in the Hispanic population. Hypothesis: ET-1 gene polymorphism in Hispanics will be associated with CVD and can be used as a CVD risk factor to assess Hispanic persons clinically. Methods: This study included 73,491 Hispanic participants from the All of Us data. ET-1 genotypes were assessed for CVD risk factors (hypertension, obesity, and T2DM) and CVD (disorders of the cardiovascular system, HF, myocardial infarction, cerebrovascular accident, and cerebral infarction) in the Hispanic population. Fischer's exact test and multinomial logistic regression were applied to predict the association between ET-1 gene polymorphism rs5370 and CVD. Preliminary Results: The ET-1 gene polymorphism rs5370, which has a frequency of 19.77% in the Hispanic population, was found to be associated with a risk for hypertension (OR=1.214, p<.0001), obesity (OR=1.194, p<.0001), and T2DM (OR=1.152, p<.0001). Additionally, it was associated with a risk for disorders of the cardiovascular system (OR= 1.290, p<.0001), myocardial infarction (OR=1.117, p<.05), cerebrovascular accident (OR=1.231, p<.001), and cerebral infarction (OR=1.227, p<.0001). However, the polymorphism was not found to be associated with HF. Conclusions: The association of ET1 gene polymorphism rs5370 with CVD in the Hispanic population is a significant finding. Screening for this polymorphism could potentially identify vulnerable populations at risk for CVD, leading to targeted interventions and early detection.

Comparative assessment of macrophage responses and antileishmanial efficacy in dynamic vs. Static culture systems utilizing chitosan-based formulations

The discovery of novel anti-leishmanial compounds is essential due to the limitations of current treatments and the lack of new drugs in development. In this study, we employed the Quasi Vivo 900 medium perfusion system (QV900, Kirkstall Ltd, UK) to simulate physiological fluid flow, allowing us to compare macrophage responses and therapeutic outcomes under dynamic versus static conditions. After 24 hours, phagocytosis and macropinocytosis decreased in all cell types under flow conditions compared to static cultures. Under slow (1.45 x 10-9 m/s) and faster (1.23 x 10-7 m/s) flow conditions ((simulating in vivo lymphatic flow), phagocytosis decreased by around 42.55% and 56.98% in peritoneal macrophages (PEMs), 42.21% and 56.11% in bone marrow-derived macrophages (BMMs), and 49.75% and 63.32% in THP-1 cells, respectively. Similarly, macropinocytosis decreased by approximately 40.7% and 62.2% in PEMs, 34.8% and 60.9% in BMMs, and 33.3% and 59.3% in THP-1 cell line under this same conditions. In this study, we further assessed the impact of medium perfusion on drug efficacy and macrophage functions using a Leishmania major amastigote-macrophage assay. We evaluated the performance of both standard and nanoparticle-based drug formulations within dynamic and static culture systems. After 72 hours of medium perfusion, chitosan solution, blank chitosan-sodium tripolyphosphate (TPP) nanoparticles, and amphotericin B (AmB)-loaded chitosan-TPP nanoparticles exhibited a statistically significant reduction in antileishmanial activity by approximately 30-50% under slow flow conditions and 60-80% under faster flow conditions. In comparison, pure AmB showed a 40% decrease in efficacy at slow flow and a 67% decrease at faster flow, both statistically significant. These results highlighted the importance of considering fluid flow dynamics in in vitro studies for a more accurate simulation of in vivo conditions, potentially leading to better therapeutic strategies for cutaneous leishmaniasis (CL).

Abstract 008: Effect of a daily multivitamin on 2 year changes in DNA methylation measures of biological aging: Findings from the COSMOS Randomized Clinical Trial

Introduction: Although some trials have reported that multivitamin-multimineral (MVM) supplements reduce age-related chronic conditions such as cancer, cataracts, and cognitive decline among older adults, whether MVM slows the aging process remains unknown. Hypothesis: We hypothesized that a daily MVM could reduce biological aging measured by DNA methylation after 2 years of follow-up in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS). Methods: COSMOS is a large, randomized, double-blind, placebo-controlled, 2×2 factorial trial testing a daily MVM (Centrum Silver) and cocoa extract among women aged ≥65 y and men aged ≥60 y free of major cardiovascular disease and recently diagnosed cancer. We included 958 participants from the COSMOS Blood subcohort with biospecimens collected at baseline, year 1, and year 2. We calculated five epigenetic aging measures encompassing the first generation trained on chronological age (PCHorvath, PCHannum), the second generation trained on all-cause mortality (PCPhenoAge, PCGrimAge), and the third generation trained on pace of aging (DunedinPACE) on the Infinium Human Methylation EPIC+ Array. For the first two generations, we calculated age acceleration (Accel) by residualizing these clocks for chronological age. Linear mixed-effects models evaluated the treatment effects of a MVM on each measure. Results: The mean age was 70.2±5.6 years, and 482 (50.3%) were female. Compared with placebo, daily MVM use significantly reduced the second generation of age clocks, with a between-group difference in yearly change of -0.111 years (95% CI, -0.203 to -0.018; P=0.02) for PCGrimAge Accel and -0.209 years (-0.405 to -0.013; P=0.037) for PCPhenoAge Accel. The effect of daily MVM use was not significant for PCHorvath Accel, PCHorvath Accel, or DunedinPACE. When stratified by baseline epigenetic aging measures, the effect of MVM on PCGrimAge Accel was more pronounced among those with higher baseline PCGrimAge Accel (-0.201 [-0.334 to -0.068]) than their counterparts (-0.014 [-0.135 to 0.107]; P interaction=0.041). The effect was consistent when stratified by other baseline characteristics.. Conclusion: Our study provides the first evidence from a large-scale, long-term, randomized controlled trial that MVM supplementation potentially slows biological aging among older adults, as measured by the PhenoAge and GrimAge epigenetic clocks, with more pronounced effects among those with greater baseline accelerated biological aging.

Abstract MP09: Number of incident cardiovascular disease events and deaths prevented among Black adults by achieving blood pressure equity with White adults in the US.

Background: There are preventable disparities in blood pressure (BP) levels by race in the US, that contribute to a higher rate of cardiovascular disease (CVD) events and mortality among non-Hispanic Black compared to non-Hispanic White US adults. We estimated the number of CVD events and CVD deaths that could be prevented among non-Hispanic Black adults by achieving the same mean systolic BP (SBP) as non-Hispanic White adults ≥45 years of age. Methods: We calculated the difference in mean SBP between non-Hispanic Black versus White US adults and the number of non-Hispanic Black US adults from the National Health and Nutrition Examination Survey 2015-2020. The 10-year cumulative incidence of CVD, including stroke, coronary heart disease, or heart failure, and CVD mortality for non-Hispanic Black adults was calculated using data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. We applied the relative risk reduction for CVD events and CVD mortality with initiation and intensification of antihypertensive medication from the Blood Pressure Lowering Treatment Trialists Collaboration, calibrated to reflect the SBP reduction for non-Hispanic Black adults to have the same SBP as non-Hispanic White adults. Results: Among non-Hispanic Black and White US adults, mean SBP was 130.7 (95%CI 129.0-132.5) and 124.2 (95%CI 123.1-125.3) mmHg for those not taking antihypertensive medication (difference 6.5 mmHg; 95%CI 4.5-8.5), respectively, and 137.8 (95%CI 135.8-139.8) and 131.2 (95%CI 129.7-132.7) mmHg for those taking antihypertensive medication (difference 6.5 mmHg; 95%CI 4.0-9.1), respectively. Achieving equity in SBP between non-Hispanic Black and White adults was projected to reduce the number of CVD events over 10 years by 50,434 (95%CI 33,985-71,137) among non-Hispanic Black US adults not taking antihypertensive medication and 122,881 (95%CI 83,220-176,826) among non-Hispanic Black adults taking antihypertensive medication. Equity in SBP between non-Hispanic Black and White adults was projected to reduce the number of CVD deaths over 10 years by 21,702 (95%CI 7,313-40,278) among non-Hispanic Black US adults not taking antihypertensive medication and 55,055 (95%CI 19,823-99,693) among non-Hispanic Black adults taking antihypertensive medication. Conclusions: Achieving SBP equity between non-Hispanic Black and White adults may substantially reduce the number of CVD events and deaths experienced by non-Hispanic Black adults.

Abstract MP45: Proton Pump Inhibitors Increase Pathobiont Species in the Gut Microbiome: Findings from the Baltimore Longitudinal Study of Aging

Background: Proton pump inhibitors (PPIs) have been linked to increased risk of heart and kidney disease, but causal mechanisms remain to be elucidated. Cross-sectional studies have linked PPI use with higher pathobiont bacteria (e.g., Streptococcus ) in the gut microbiome. Here, we aimed to examine the effects of PPIs on the gut microbiome through new-user target-trial emulation. Methods: We included participants from the Baltimore Longitudinal Study of Aging who had ≥2 visits with microbiome data, were ≥60 years old, not on antibiotics, and not on PPIs at baseline. New users were defined as those who initiated PPIs within 2 follow-up visits, while eligible controls reported no PPI use. We matched each new PPI user to 2 non-user controls using a nearest neighbor algorithm and propensity scores based on baseline age, sex, race, ever smoking, history of gastrointestinal conditions (ICD-9 530), obesity, and antidiabetic medication use. We evaluated PPI-related changes in microbial diversity and in the relative abundance (RA) of selected bacteria with ANCOVA and estimated the average treatment effect in the treated using g-computation of marginal effects. Results: After matching each of the 16 new PPI users to 2 non-users, selected from 403 eligible controls, there were no differences in baseline covariates by treatment group. Participants were, on average, 75.5 years old, 60.4% female, and 79.2% white. Mean follow-up was 716.3±251.7 days. By follow-up, PPI initiation non-significantly increased gut microbiome richness by 6.9 species (95% CI: -0.9—14.6) compared to no initiation (Figure). PPI initiation was associated with change in several bacteria in the gut, including the oral pathobionts Streptoccocus parasanguinis and S. salivarius , whose RA were respectively increased by 0.7% (0.02–1.2%) and 3.7% (0.7–6.8%) in the PPI initiators vs controls. Conclusion: PPI initiation increased several pathobiont species in the gut, including Strepcococci spp. commonly found in the oral microbiome and linked to cardiovascular disease.

Early warning strategies for corporate operational risk: A study by an improved random forest algorithm using FCM clustering

To enhance the accuracy and response speed of the risk early warning system, this study develops a novel early warning system that combines the Fuzzy C-Means (FCM) clustering algorithm and the Random Forest (RF) model. Firstly, based on operational risk theory, market risk, research and development risk, financial risk, and human resource risk are selected as the primary indicators for enterprise risk assessment. Secondly, the Criteria Importance Through Intercriteria Correlation (CRITIC) weight method is employed to determine the importance of these risk indicators, thereby enhancing the model’s prediction ability and stability. Following this, the FCM clustering algorithm is utilized for pre-processing sample data to improve the efficiency and accuracy of data classification. Finally, an improved RF model is constructed by optimizing the parameters of the RF algorithm. The data selected is mainly from RESSET/DB, covering the issuance, trading, and rating data of fixed-income products such as bonds, government bonds, and corporate bonds, and provides basic information, net value, position, and performance data of funds. The experimental results show that the model achieves an F1 score of 87.26%, an accuracy of 87.95%, an Area under the Curve (AUC) of 91.20%, a precision of 89.29%, and a recall of 87.48%. They are respectively 6.45%, 4.45%, 5.09%, 4.81%, and 3.83% higher than the traditional RF model. In this study, an improved RF model based on FCM clustering is successfully constructed, and the accuracy of risk early warning models and their ability to handle complex data are significantly improved.

The Journey of Resistant Hypertension: From the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure to American Heart Association/American College of Cardiology Guidelines

Abstract MP63: Associations of Salt intake With Risk of Hypertensive disorders of pregnancy in Women with and Without Calcium Supplementation

Background: To examine the associations between salt intake and hypertensive disorders of pregnancy among women with and without calcium supplementation. Methods: Researchers used questionnaires to collect dietary information including calcium and multivitamin supplement use, and condiments such as salt and soy sauce consumption were obtained through weighing. Salt consumption was estimated based on salt and soy sauce during cooking. Hypertensive disorders of pregnancy were ascertained through the clinical records. Logistic regression models were used to estimate odds ratios (ORs) and 95% CIs. Interactions were assessed by adding interaction terms between calcium supplement use and salt intake levels in the models. Results: The analysis included 4192 pregnant women with complete follow-up data until delivery, and there were 109 cases of hypertensive disorders of pregnancy. Among women without calcium supplements at baseline, higher daily salt intake (≥5.0 g) was significantly associated with an 86% increased risk of hypertensive disorders compared to those with intake <5.0 g (95% CI 1.07-3.24, P=0.029). This association was not found in those taking calcium supplements (OR 0.66, 95% CI 0.34-1.28, P=0.218). Interaction analysis showed significant heterogeneity in the association between salt intake and hypertensive disorders of pregnancy based on calcium supplement use (P for interaction=0.019). Similar results were observed when the low-calcium group was redefined based on multivitamin supplements and dietary calcium intake. Joint analysis showed that compared to those taking calcium supplements with salt intake <5.0 g/day, the ORs for hypertensive disorders of pregnancy among those taking calcium supplements with salt intake ≥5.0 g/day were 0.64 (95% CI 0.34-1.22, P=0.177) and 0.49 (95% CI 0.26-0.93, P=0.030) for non-users with salt intake <5.0 g/day. For non-users of calcium supplements with salt intake ≥5.0 g/day, the OR was 0.90 (95% CI 0.50-1.61, P=0.719). These results were consistent across subgroup and sensitivity analyses. Conclusions: Our study revealed that in the participants without calcium supplements, higher salt intake was associated with a higher risk of hypertensive disorders of pregnancy, while this association was not observed in the people taking calcium supplements. These findings suggest that the balance between sodium and calcium intake may be an important factor influencing the development of hypertensive disorders of pregnancy.

Abstract P2129: A scoping review comparing individual and multi-level physical activity interventions in rural women in the United States

Purpose: The aim of this review is to summarize physical activity interventions in rural women in the United States using the socio-ecological model of health framework. Methods: We conducted a scoping review of peer-reviewed literature in Medline, CINAHL Complete, Web of Science, and PsychINFO in August 2023. We narratively synthesized the evidence and, in studies with a comparison group, calculated pooled estimates to compare intervention effects by levels of the socio-ecological model. We used an adapted GRADE approach to assess study quality. Findings: Our search yielded 41 reports of 38 different interventions that met our eligibility criteria (24 individual and 17 multi-level). Nineteen individual (83%) and eight multi-level (73%) interventions increased physical activity. Pooled estimates indicated that multi-level interventions increased physical activity to a greater extent (1.09 [-0.44, 2.16]) than individual-level interventions (0.18 [-0.26, 0.62]). Limited studies included measurements of feasibility, acceptability, strengths, and barriers or clearly defined rurality. Special considerations for intervention design included ensuring that participants feel supported, training and supporting strong interventionists using new technology, and assessing cost-effectiveness. Conclusion: Our findings suggest individual-level interventions often increased physical activity in rural women, but multi-level interventions yielded larger effects. More high-quality, multi-level interventions that track key implementation factors (feasibility, acceptability, strengths, barriers) and define rurality are needed Figure 2. Individual vs. Multi-level Intervention Effects.

Failure mechanism of soft– hard- interbedded rock slopes in cold regions: Numerical simulation and theoretical analysis

The soft– hard- interbedded rock slope in cold regions generally undergo the differential weathering due to the freeze-thaw effects, for which the irregular rock fractures increase the risk of geological disasters occurrence. To investigate the failure mechanism of the rock slope, both the numerical simulation and theoretical analysis were adopted in the present research. The structural integrity of the soft– hard- interbedded rock slope subjected to three different conditions (e.g., freeze-thaw cycles, natural, and anchored surroundings) was evaluated. The results indicated that the stability of the rock slope is significantly affected by the freeze-thaw cycles, the performance of which is much different from that under the natural- and anchored conditions. The failure process of the soft– hard- interbedded rock slope in cold regions exhibited the unloading-tensile cracking-sliding characteristics. The damage of the irregular structural surfaces subjected to the long-term weathering and freeze-thaw cycles is the one of the main factor controlling the failure mode. As revealed by numerical simulation, the application of the anchor rods can effectively prevent and control the collapse of the soft– hard- interbedded rock slope. The findings obtained from this research provide an important guidance for the stability assessment and mitigation design of the soft– hard- interbedded rock slopes in cold regions.

Abstract 073: Gestational Diabetes, Mid-life Cardiovascular Health, and 10-year Predicted CVD Risk in South Asian Women in the United States

Background: Gestational diabetes mellitus (GDM) increases the risk of suboptimal cardiovascular health (CVH). The association of GDM with overall CVH and predicted cardiovascular disease (CVD) risk in mid-life remains to be defined among South Asian women in the US, a subgroup at excess risk for CVD. Methods: In female participants of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study with a history of ≥1 live birth, we examined the association between self-reported GDM history with Life’s Essential 8 (LE8) CVH score (scale 0-100) and 10-year predicted CVD risk calculated by the base and HbA1c-enhanced PREVENT total CVD risk models. Multivariable linear regression models adjusted for age, site, parity, and post-menopausal status. Additional models adjusted for social determinants of health inclusive of income, education, years lived in the United States, and acculturation per the validated traditional cultural beliefs scale. Results: Among 511 participants, 48 (9.4%) reported a history of GDM, mean (SD) age was 55.9 (8.7) years, and participants lived in the U.S. for a mean 26.9 (11.5) years. There were 70 participants (13.7%) with a parity of 1, 320 (62.6%) with a parity of 2, and 121 (23.7%) with a parity of ≥3. Mean (SD) LE8 CVH score was 68 (12). Median (25th, 75th percentile) PREVENT 10-year total CVD risk was 4.0% (1.8%, 7.5%) in the base model and 4.1% (2.0%, 7.7%) in the HbA1c-enhanced model. GDM history was significantly associated with lower (i.e., worse) LE8 CVH score and higher PREVENT 10-year predicted CVD risk (Table) . After adjustment, GDM was associated with a 3.9-point lower LE8 CVH score (95% CI [-7.5, -0.4]), a 1.5% (0.4, 2.5) higher absolute 10-year predicted total CVD risk in the PREVENT base model, and a 1.9% (0.8, 2.9) higher absolute 10-year predicted total CVD risk in the PREVENT HbA1c-enhanced model. Conclusions: Among U.S. South Asian women in mid-life, a history of GDM was associated with worse CVH and clinically significant higher predicted risk for CVD.

Abstract P1081: Urine Metabolomic Profiles Associated with Incident Heart Failure in Older Adults

Introduction: Metabolomic biomarkers have enhanced heart failure (HF) prediction in addition to clinical risk factors. However, urine metabolites related to incident HF have not been studied. Hypothesis: Novel urine metabolites, as well as uremic toxins, are associated with an increased risk of HF. Methods: Metabolomic profiling was performed in the Atherosclerosis Risk in Communities (ARIC) study at visit 5 using urine samples. Urine metabolite levels were probabilistic quotient normalized prior to the analyses, and 914 known urine metabolites were evaluated with incident HF using Cox proportional hazard regression. Replication analyses were performed on 3,431 participants, including 172 HF cases (mean age=58) from the German Chronic Kidney Disease (GCKD) study (100% Whites). Results: During an average of 7 years of follow-up, 226 incident HF events occurred among 1,242 ARIC participants (54.3% Whites, mean age= 76). After adjusting for clinical risk factors and eGFR, ten urine metabolites were associated with incident HF (FDR p-value <0.05). Guanosine-3',5'-cyclic monophosphate (cGMP), a biologic marker reflecting renal activities of natriuretic peptides, was associated with an increased risk of HF (HR=1.40, 95% CI= 1.21-1.63). Sucrose, a disaccharide composed of glucose and fructose, was also associated with an increased effect on HF (HR=1.30, 95% CI= 1.12-1.50), and the effect persisted with further adjustment of fasting glucose levels. The associations of urine cGMP and sucrose with HF were replicated in GCKD (HR cGMP =1.40, 95% CI= 1.24-1.56; HR sucrose = 1.19, 95% CI= 1.03-1.35, Figure). Additional analyses revealed that cGMP was more strongly associated with HF with reduced (HFrEF) than with preserved ejection fraction (HFpEF), while sucrose was more strongly associated with HFpEF than HFrEF. Conclusions: Urinary metabolites associated with incident HF and its subtypes were identified, providing complementary insights into the molecular mechanism of the development of HF.

Abstract P1044: External validation of a novel cancer-associated venous thromboembolism risk assessment score in a safety-net hospital

Background: Cancer-associated VTE (CAT) is the second leading cause of death in patients diagnosed with cancer. However, pharmacologic thromboprophylaxis use in cancer patients must be tightly regulated due to a two-fold increased risk of experiencing a major bleeding event within this population. A cancer-associated venous thromboembolism (CAT) risk assessment model (RAM) has recently been developed utilizing patient electronic health records (EHR) that reports improved performance over the prior state-of-the-art Khorana score. Objective: To externally validate a recently published RAM using EHR data from 2,103 cancer patients at Boston Medical Center, New England’s largest safety-net hospital, and to compare this RAM to the Khorana score. Methods: We conducted a retrospective study of Boston Medical Center (BMC) cancer patients diagnosed between January 2014 and December 2022 using data from the BMC tumor registry and electronic health record system. We validated the risk assessment model using measures of discrimination and calibration. Results: The recently published score exhibited a strong ability to discriminate risk of CAT (C statistic, 0.67) substantially higher than the classic Khorana score (C statistic, 0.58). This increased discrimination power reflects the 20% of patients correctly reclassified into high or low risk by the expanded score. Model calibration was also strong in this dataset. Conclusion: In our external validation, the recently published CAT score clearly and improvedly separated patients at high and low risk for CAT. This expanded CAT score could facilitate improved selection of prophylactic therapy among cancer patients.

The impact of postoperative glucocorticoids on complications after head and neck cancer surgery with free flap reconstruction: A retrospective study

Background After head and neck cancer surgery with free flap reconstruction, the use of glucocorticoids is often required to alleviate inflammation and edema. However, the impact of glucocorticoid on postoperative complications and cancer progression remains unclear. Methods This retrospective cohort study included 711 elderly patients who underwent head and neck cancer surgery with free flap reconstruction at Shanghai Ninth People’s Hospital from January 1, 2014, to December 31, 2022. Patients were categorized based on postoperative glucocorticoid usage into a high-dose steroid group (n = 307) and a control group (n = 404). The study focused on the impact of postoperative GC use on postoperative complications and long-term oncological outcomes. Results Multivariate analysis indicated that compared to the control group, the high-dose steroid group had a significant increase in postoperative complications, including atelectasis (OR: 3.83, 95% CI: 1.27–14.11, P = 0.025), postoperative hyperglycemia (OR: 1.54, 95% CI: 1.14–2.08, P = 0.006), and flap complications (OR: 4.61, 95% CI: 3.31–6.47, P < 0.001). These complications often required extended hospital stays (β: 1.656, 95% CI: 1.075-2.236, P <  0.001). Additionally, the high-dose steroid group had a higher rate of unplanned readmissions within one year (OR: 5.61, 95% CI: 3.87–8.25, P < 0.001). The increased readmission rates were notably due to difficulties swallowing requiring percutaneous gastrostomy (OR: 3.62, 95% CI: 1.97–6.98, P < 0.001), recurrence (OR: 9.34, 95% CI: 5.02–19.05, P < 0.001), and metastasis (OR: 4.78, 95% CI: 2.58-9.44, P < 0.001). Conclusion The use of high-dose postoperative glucocorticoids is associated with increased postoperative complications, higher readmission rates, and poorer oncological outcomes in patients. The results advocate for cautious use and dosage management of perioperative glucocorticoids in head and neck surgeries to optimize patient outcomes.