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Abstract MP73: Long-Term Effects of Physical Activity, Sleep, and Screen-Time on Hypertension Incidence in Adolescents – ABCD Study
Background: Hypertension is a critical risk factor for cardiovascular diseases with a high prevalence in pediatric populations. However, the long-term effects of physical activity, sleep, and screen time on hypertension incidence in adolescents remain unclear. Research Questions: How do long-term physical activity, sleep, and screen time influence the incidence of hypertension in adolescents within the Adolescent Brain Cognitive Development (ABCD) Study? Aims: i) Investigate the long-term effects of physical activity, sleep patterns, and screen time on hypertension incidence in adolescents using Fitbit and self-reports. Methods: Our analysis involved 1,702 adolescents (51.5% boys) from the ABCD study across 21 US cities, followed prospectively from 2018-2020 (T0) to 2020-2022 (T1), focusing on those with complete data on physical activity, sleep, screen time, and covariates (sex, age, waist circumference and social determinants). Hypertension was defined according to AAP guidelines. Movement behaviors were categorized as ≥ 60 minutes of moderate to vigorous physical activity daily, ≤ 2 hours of recreational screen time, and 9-11 hours of sleep. We estimated hypertension incidence and relative risks, examining the individual and joint additive effects of movement behaviors. Results: At the T0, the mean age was 11.9 years, increasing to 14.1 years at T1. Adolescents who did not meet the screen time recommendations had higher hypertension prevalence (1.9%) and incidence (4.0%) compared to those who met the guideline (1.0% prevalence; 1.7% incidence). No significant differences were observed for sleep guideline adherence. Physical activity guideline adherence was associated with higher hypertension incidence (4.7% vs. 3.1%), but not prevalence (1.2% vs. 2.7%). Meeting two or more components of the 24-hour movement behavior guidelines was associated with significantly reduced hypertension risk (RR 0.31, 95% CI 0.09-0.98). Conclusions: High screen time and not meet physical activity guideline are linked to increased hypertension risk in adolescents. Adhering two or more 24-hour movement behavior recommendations reduces this risk of hypertension, emphasizing the need for comprehensive and combined lifestyle interventions to promote cardiovascular health.
Abstract P3005: Blood Biomarkers and the Risk of Coronary Disease in Atrial Fibrillation
Introduction: Atrial fibrillation (AF) is the most common arrhythmia worldwide. Although it was recently identified as a risk factor for coronary heart disease (CHD), the underlying pathophysiology is not well understood. Initial studies suggested an embolic mechanism when compared to those without AF. We studied several biomarkers to understand possible mechanisms and identify potential predictors of CHD in this population. Methods: The REGARDS cohort study enrolled 30,239 White and Black adults aged 45 and older in 2003-7. We included those with baseline AF and no history of stroke, myocardial infarction (MI), or coronary revascularization. We calculated hazard ratios (HR) for incident CHD, defined as definite or probable MI, per 1 SD increment of each biomarker using Cox models adjusted for CHD risk factors and medications. Results: The 1,807 participants had mean age 66 years; 33% were Black, 57% female, 76% had hypertension, and 21% diabetes. Incident CHD was seen in 201 participants (39.8% fatal) over a mean follow-up of 9 years. Among the 14 biomarkers (figure), significant associations were seen with cholesterol (HR 2.9; 1.4-6.2), cystatin C (HR 2.6; 1.6-4.2), GDF15 (HR 2.0; 1.5-2.9), serum creatinine (HR 1.8; 1.1-2.9) NTproBNP (HR 1.4; 1.3-1.6), D-dimer (HR 1.4; 1.2-1.7), IL6 (HR 1.3; 1.2-1.5), CRP (HR 1.3; 1.1-1.5), GGT (HR 1.25; 1.02-1.54), and LP(a) (HR 1.22; 1.05-1.41). Conclusions: Total cholesterol, LP(a), D-dimer, GGT, and biomarkers of kidney function (cystatin C, creatinine), myocardial strain (NTproBNP), and inflammation (IL6, CRP, GDF15) were associated with incident CHD in AF. These findings lay the groundwork for further research to determine potential therapeutic targets to prevent CHD in people with AF.
Abstract P1175: Endometriosis diagnosis, staging, and typology in relation to dyslipidemia
Background: Individuals with endometriosis, a gynecologic condition affecting approximately 11% of people with a uterus, may have an elevated risk for developing cardiovascular disease (CVD) later in life. However, the mechanisms underlying this association are not well understood. Methods: We investigated the association between incident endometriosis diagnosis, staging, and typology and lipid biomarkers measured at time of diagnostic surgery among women participating in the NICHD ENDO study (n=395). Endometriosis was categorized using the American Society for Reproductive Medicine staging (I−IV). Endometriosis typology was defined by lesion depth and location and categorized as superficial endometriosis (SE), ovarian endometrioma (OE), and deep infiltrating endometriosis (DE). With no endometriosis as our reference, we evaluated the associations between endometriosis diagnosis, stage (I/II vs III/IV), and typology (SE, OE, DE, OE+DE) and dyslipidemia using standard clinical thresholds (total cholesterol ≥200 mg/dL, high-density lipoprotein (HDL) <50 mg/dL, low-density lipoprotein (LDL) ≥100 mg/dL, triglycerides ≥175 mg/dL, non-HDL ≥130 mg/dL, VLDL ≥30 mg/dL, Apolipoprotein A-1 (APO-A1) <125 mg/dL, Apolipoprotein B (APOB) ≥120 mg/dL; APOB/APO-A1 ratio >0.78). We calculated adjusted prevalence ratios (aPR) and 95% CIs via generalized linear models, controlling for age, race/ethnicity, marital status, BMI, income (poverty level), and serum cotinine as a marker of smoking. Results: At the time of gynecologic surgery, individuals were mean 32 years (SD: 7 years), non-Hispanic white (79%), married (71%), and mean BMI 28 (SD=8). While we found no differences in endometriosis diagnosis or endometriosis staging and dyslipidemia ( Figure 1; Table 1 ), a pattern emerged regarding endometriosis typology ( Table 2 ). Women with OE+DE, compared to no endometriosis, had increased prevalence of dyslipidemia: total cholesterol >200 mg/dL: 1.87 (0.99, 3.57); triglycerides > 175 mg/dL: 2.48 (1.34, 4.57); VLDL ≥30 mg/dL: 2.08 (1.28, 3.38); and APOB mg/dL ≥120: 2.86 (1.22, 6.66). OE appeared to be driving this association. SE was not associated with dyslipidemia. Conclusions: The association between endometriosis, especially of more severe typology, and subsequent CVD may be through dyslipidemia, which may be detectable at the time of endometriosis diagnosis. Further research in larger, more representative samples is needed before definitive conclusions can be made.
A fuzzy robust optimization model for dual objective forward and reverse logistics networks considering carbon emissions
The inherent unpredictability within the low-carbon integrated supply chain logistics network complicates its management. This paper endeavours to address the challenge of designing a low-carbon logistics network within a context of uncertainty and with consideration of low-carbon policies. It also endeavours to identify locations of facilities and appropriate transportation routes between nodes. Robust optimisation and fuzzy programming techniques are employed to examine the various attributes of the network. In addition, the strategic planning model of a multi-level forward/reverse integration logistics network is examined, with the aims of cost minimisation and emission reduction. Extensive computational simulations substantiate the efficacy of the proposed robust fuzzy programming model. Moreover, analytical results indicate the rationality and applicability of the decisions suggested by the proposed optimisation model and the solution approach. Furthermore, the results indicate that a decision maker can ascertain that the decisions derived from three cases considered have a 50% probability of being the most favourable outcomes.
Abstract 071: Association Between Proximity to Hazardous Waste Sites and Cardiometabolic Diseases: Coronary Heart Disease, Stroke, Hypertension, and Diabetes
Introduction: Proximity to hazardous waste sites may increase cardiometabolic risk. However, differences in these associations by socioeconomic status and urban-rural residency is underexplored. We estimated the associations of proximity to hazardous waste sites with prevalence of coronary heart disease (CHD), stroke, hypertension, and diabetes, while exploring the moderating roles of the Social Vulnerability Index (SVI) and Rural-Urban status. Hypothesis: We hypothesized that neighborhoods closer in proximity to hazardous waste sites have an incrementally higher prevalence of the selected disease outcomes compared to neighborhoods furthest away. Methods: We used data from 57,845 (~70%) U.S. census tracts, creating a percentile-ranked score based on proximity to hazardous waste sites from the Environmental Justice Index, classified into quartiles (Q4 = closest). Prevalence of health outcomes were obtained from the Centers for Disease Control and Prevention (CDC) PLACES dataset, and SVI and Rural-Urban Commuting Area (RUCA) codes were obtained from the CDC and U.S. Department of Agriculture, respectively. A linear mixed-effects model assessed prevalence differences between quartiles, adjusting for percentages of uninsured, race/ethnicity minority, aged ≥65, and <17, with county-level random effects. We also evaluated the moderating role of SVI and urbanicity. Results: After adjustment, neighborhoods closest to hazardous waste sites (Q4) had a significantly higher prevalence of each of the cardiometabolic diseases when compared to Q1: CHD (0.35%; 95% CI, 0.33-0.38), Stroke (0.19%; 95% CI, 0.17-0.21), Hypertension (0.44%; 95% CI, 0.35-0.54) and Diabetes (0.48%; 95% CI, 0.43-0.53). The interaction term between SVI, RUCA, and our exposure was significant for all health outcomes (p<0.05), based on the Wald chi-square test. The magnitude of the associations were stronger in higher socially vulnerable neighborhoods (compared with low) (Figure 1). Although the prevalence of cardiometabolic diseases was higher in non-metro tracts, there was a weaker association with proximity to hazardous waste sites, compared to metropolitan tracts. Conclusion: These findings highlight the potential role of environmental factors in shaping community-level cardiometabolic health disparities. While individual inferences are limited by the study's ecological nature, the results emphasize addressing environmental and social vulnerabilities to promote health equity at a population level.
Abstract P3051: Longitudinal trends in glucose and hearing loss in midlife: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Introduction: Hearing loss (HL) is a common condition that often goes undetected until the deficits are pronounced. Diabetes may affect the vasculature and neural system of the inner ear, damaging both the auditory nerve and the vestibular systems, leading to HL. Less is known about how hyperglycemia over prolonged periods of time from young adulthood is associated with HL in midlife. Hypothesis: Young adults who experience early increases in fasting glucose levels will experience greater odds of future HL compared to those whose glucose levels either stay stable or increase later in life. Methods: CARDIA participants had hearing assessed at the Year 35 exam (Y35, 2020-2022, ages 53-70 years) using an automated method for testing auditory sensitivity to obtain pure-tone air-conduction thresholds. HL was defined as a sound detection threshold >25 dB in the better ear at high frequencies (4000-8000 Hz). Fasting serum glucose was measured by standardized methods starting at baseline (1985-1986). Fasting glucose trajectories were created using PROC TRAJ (SAS) for 1921 participants with complete hearing and covariate data. Results: Mean glucose at Y0 was 81.9 mg/dL and 107.7 mg/dL at Y35. The sample was 57.4% women and 44.1% Black; 61.3% had normal hearing, 21.6% had mild HL and more severe HL was rare. Three distinct trajectories were identified: glucose remained low; glucose increased early; and glucose increased later (Figure). Compared to the remained low group, those whose glucose increased in early adulthood had 93% higher odds of high frequency HL. Those whose glucose increased later in adulthood had 14% higher odds of HL that did not reach statistical significance. Odds ratios were unchanged after adjustment for age, race, sex, education, smoking, drinking, physical activity and obesity. Conclusions: Prolonged exposure to elevated glucose was associated with mild high-frequency HL in midlife in a population-based cohort without severe HL, providing additional motivation to manage hyperglycemia.
Abstract P1146: A Multifaceted Blood Pressure Intervention Improves Medication Adherence in Low Income Adults with Hypertension
Methods: A secondary analysis from the I mplementation of M ultifaceted Pa tient- C entered T reatment S trategies for Intensive BP Control (IMPACTS) cluster randomized trial in federally qualified health centers in the Gulf South was done. Participants were randomized to intervention (standardized BP measurement education, stepped-care treatment algorithm, team-based care, health coaching, home BP monitoring) versus EUC. Adherence was measured with the Krousel-Wood Medication Adherence Scale-4 item (K-Wood-MAS-4; range 0-4); score<1=high adherence. SBP&diastolic BP (DBP) were assessed with a standard protocol using automated BP devices. A multivariable mixed effects logistic regression model with group-by-time interaction estimated predicted probabilities of high adherence for each group at each time point; between-group differences were assessed. A multivariable mixed effects linear regression model estimated difference in SBP for high versus low adherence across all time points. Models were adjusted for baseline socio-demographics, SBP, hypertension duration, number antihypertensive drugs, and comorbidities. Results: Data from 1,272 hypertensive adults from 36 clusters (mean cluster size 35.3, SD 10.6, range 21-60) were analyzed: mean age was 58.3 years (SD 8.9), 56.7% female, 66.5% Black; 62.9% household income <$20K. At baseline, mean SBP&DBP were 147.6 mm Hg (SD 12.5) and 84.6 mm Hg (SD 10.9), respectively; mean K-Wood MAS-4 score was 0.82 (SD 0.89); only 44.3% reported high adherence. Adjusted percent of high adherence at baseline, 6-, 12-&18 months: Intervention group: 43% (95% CI 39%, 47%), 53% (95% CI 48%, 57%), 53% (95% CI 49%, 58%)&54% (95% CI 50%, 59%), respectively; EUC group : 46% (95% CI 42%, 50%), 44% (95% CI 40%, 48%), 48% (95% CI 44%, 53%)&55% (95% CI 50%, 59%), respectively. Between-group differences in probability of high adherence were higher in intervention versus EUC groups at 6 (p=0.001)&12 months (p=0.018) but not 18 months (p=0.463). Across all visits, high versus low adherence was associated with mean 4.35 mm Hg lower SBP (p<0.001). Conclusion: The multifaceted intervention versus EUC increased adherence at 6M and 12M post randomization; higher adherence was associated with lower SBP.
Field size as a predictor of “excellence.” The selection of subject fields in Germany’s Excellence Initiative
We investigate the selection of subject fields in Germany’s “excellence initiative,” a two-phase funding scheme administered by the German Research Foundation (DFG) from 2005 to 2017 to increase international competitiveness of scientific research at German universities. While most empirical studies have examined the “excellence initiative’s” effects at the university level (“elite universities”), we focus on subject fields within universities. Based on both descriptive and logistic regression analyses, we find that the “excellence initiative” reveals a stable social order of public universities based on organizational size, that field selection is biased toward those fields with many professors and considerable grant funding, and that funding success in the second phase largely follows decisions from the first phase. We discuss these results and suggest avenues for future research.
Abstract P1083: Religiosity and Risk of Heart Failure in the Southeastern United States
Introduction: Greater religiosity, or degree of involvement in religious activities, associates with better CV health profiles. Yet, studies of the association between religiosity and incident CV events have yielded mixed results. The southeastern US is characterized by strong religious practice but has among the highest rates of incident heart failure (HF). The relationship between religiosity and incident HF is not well characterized, particularly among low-income populations. Methods: We studied 23,893 Black or White Southern Community Cohort Study participants (median age 53 years, 70% Black, 64% women, 70% annual household income <$15k) without prevalent HF or CAD at enrollment (2002-2009). Religiosity, defined by religious service attendance, was ascertained at enrollment via a single item adapted from the Duke University Religion Index. Incident HF was determined using Centers for Medicare and Medicaid Services Research Identifiable Files (ICD-9/-10 codes 428.x or I50, I110) through December 31, 2016. We quantified the association of religious attendance with incident HF via Cox models adjusted for demographics, HF risk factors (HTN, HLD, DM, BMI, CVA), health behaviors (smoking, alcohol, physical activity, DASH diet), socioeconomic (income, education, employment, neighborhood deprivation, rurality) and psychosocial factors (marital status, social support, depressive symptoms, anti-depressant use). Results: Religious service attendance was common: >1/week (24%), 1/week (27%), <1/week (33%), and never (15%). Participants attending >1/week were more likely to be older and female, had relatively higher SES and more comorbidities, but better health behaviors and psychosocial support. HF developed in 6081 participants (25%; median 10-yr follow-up). Adjusting for demographics and HF risk factors, attendance >1/week associated with lower HF risk (HR 0.88 [0.82,0.94] and HR 0.92 [0.84,1.00] compared to <1/week or never, respectively). Attendance 1/week compared to <1/week showed similar association (HR 0.91 [0.85, 0.97]). Further adjustment for health behaviors, socioeconomic and psychosocial factors attenuated the association to non-significance. There was no interaction between religiosity and race. Conclusion: Greater frequency of religious service attendance associated with lower incident HF risk adjusting for demographics and HF risk factors; however, this association attenuated with adjustment for health behaviors, socioeconomic and psychosocial factors.
Abstract P3065: Unveiling Sex-Specific Disparities in Cardiovascular Risk Factors Among Asian American Ethnic Subgroups
Background: Despite being one of the fastest-growing minority groups in the US, Asian Americans are often studied as a single entity. While some research has explored subgroup differences in CVD risk, sex-specific disparities remain unclear. Since lifestyle, shaped by ethnic background, influences CVD risk, identifying sex-specific differences across subgroups is crucial for tailored interventions. Hypothesis: We assessed the hypothesis that CVD risk factors vary significantly by sex among Asian American subgroups compared to White males. Methods: We analyzed data from the National Health Interview Survey (NHIS) years 2010 to 2018 of 135,809 adults, categorized as non-Hispanic White and Asian subgroups (Chinese, Asian Indian, Filipino, Other Asian). Six CVD risk factors were assessed: hypertension, diabetes, high cholesterol, smoking, overweight, and physical inactivity. Poisson regression models estimated prevalence ratios (PRs), adjusted for demographic and healthcare characteristics. We assessed sex-specific disparities within subgroups, using non-Hispanic White males as the reference group. NHIS survey weights were employed to derive national estimates. Results: The mean age was 51 ± 0.12 years overall, with Asian Indians being the youngest (40.30 ± 0.54 years). Hypertension prevalence was highest in Filipino males (PR 1.10, 95% CI 1.01–1.20), while Chinese females had the lowest prevalence (PR 0.58, 95% CI 0.51–0.66). Diabetes prevalence was reported highest in Asian Indian males (PR 1.42, 95% CI 1.16–1.74) compared to the reference group; however, across subgroups, other Chinese females reported the lowest prevalence of diabetes (PR 0.46, 95% CI 0.34–0.63). Filipino males had the highest prevalence of high cholesterol (PR 1.23, 95% CI 1.11–1.37). Smoking prevalence was highest among other Asian males (PR 0.84, 95% CI 0.74–0.94). Intriguingly, the prevalence of physical inactivity was significantly high across all female subgroups, with Asian Indian women (PR 1.27, 95% CI 1.18–1.36), followed by other Asian women (PR 1.22, 95% CI 1.15–1.28), Filipino women (PR 1.17, 95% CI 1.10–1.25), and Chinese women (PR 1.17, 95% CI 1.09–1.26) (see figure) Conclusion: In conclusion, this study unveils significant sex-specific disparities in CVD risk factors among Asian American subgroups. Culturally tailored, targeted interventions are needed. Addressing these disparities can help mitigate CVD burden in high-risk, sex-specific population and improve health equity.
Abstract P1003: Enhancing Medication Safety and Outcomes for Elderly Patients in Rural Outpatient Cardiology: Year Long Evaluation of a Pharmacist-Led Remote Medication Reconciliation Program
Background: Challenges of ensuring medication safety and compliance are compounded by limited access to healthcare services. Elderly individuals are disproportionately affected, often having to navigate complex medication regimens prescribed by multiple providers. Moreover, rural patients face a similar challenge, constrained by the number of nearby healthcare facilities and providers. Our study investigates the efficacy of a pharmacist-led (PharmD) remote medication reconciliation program, as part of Medicare’s Chronic Care Management (CCM) program, at a rural cardiology clinic serving a predominantly elderly population in Georgia, USA. Methodology: Methodology was centered around evaluation of medication reconciliation encounters (N=2123) performed by the PharmD team at a rural cardiology clinic from February 2023 to February 2024. The team conducted these encounters with 1065 patients (Avg. of 1.99 calls/patient) facilitated by a structured questionnaire. Initial priority for scheduled medication reconciliations was given to patients: with two or more chronic conditions, older than 65 years old, and six or more active medications. Key topics of focus from the questionnaire are shown in Table 1. Data from the questionnaires was retrospectively analyzed to evaluate program outcomes and efficacy. Conclusion: Retrospective analysis strongly illustrated the program’s effectiveness and clinical impact in a rural cardiology setting. The program's success demonstrates the substantial benefits of comprehensive medication reconciliation as part of Medicare’s CCM program in enhancing medication safety and promoting preventive care, especially among older populations with complex health needs. The program’s identification of notable drug-drug interactions allows for better month to month monitoring of patients’ symptoms, particularly those anticipated by the interaction report. The program allows elderly patients, who frequently have extensive medication regimens from multiple providers, to have a thorough up to date review of their medications in their own home. Through careful analysis of the state’s vaccine registry and current guidelines, the PharmD team discovered an alarming shortfall in preventive vaccinations and boosters among this rural patient population. The PharmD team's interventions during the medication reconciliation encounters, aimed at educating and advocating for vaccination, help protect this at-risk population from severe illnesses and complications.
Genetic subtyping by Whole Exome Sequencing across Diffuse Large B Cell Lymphoma and Plasmablastic Lymphoma
Diffuse Large B-Cell Lymphoma (DLBCL) is a heterogeneous disease characterized by a limited number of molecularly defined subtypes. Recently, genomic-based algorithms have been proposed for the classification of this disease. The whole exome sequencing was conducted on 108 diagnostic samples of diffuse large B-cell lymphoma (DLBCL). Somatic variants, predicted copy number alterations (CNAs), and available fusion data were utilized to classify the cases. Additionally, the enrichment of mutations in the TP53, MYC, and MAPK/ERK pathways was analyzed. Genetic subtypes were identified in approximately 55% of the cases. Cases with a specific genetic subtype exhibited a significantly higher Tumor Mutation Burden compared to molecularly unclassified cases (Mann-Whitney U test, p = 0.024). The prevalence of subtypes varied according to the cell of origin phenotypes. GC-B type DLBCL NOS were classified as EZB (5 cases, 16%), ST2 (5 cases, 16%), and BN2 (1 case, 3%). Four cases (13%) were genetically composite. Three cases of HGBCL/DLBCL double-hit (MYC & BCL2) were classified as EZB-MYC. Forty-three non-GC-B type DLBCL cases were classified as ST2 (5 cases, 11%), BN2 (6 cases, 14%), and MCD (3 cases, 7%). Nine cases were genetically composite (20%). MYC pathway mutations were enriched in cases with EZB and ST2 genetic features, while they were absent in the MCD subtype. TP53 mutations were identified in 11% of the cases. Plasmablastic lymphomas exhibit genetic diversity, with 27% of tumors classified as ST2. Recurrent somatic mutations indicate dysregulation of the JAK/STAT, MAPK/ERK, and tyrosine kinase signaling pathways.
Abstract P2082: Discordance of Small Dense Low-Density Lipoprotein Cholesterol beyond Low-Density Lipoprotein Cholesterol or Non-High-Density Lipoprotein Cholesterol and Carotid Plaque Risk
Introduction: We aimed to evaluate the associations of small dense low-density lipoprotein cholesterol (sdLDL-C), large buoyant LDL-C (lbLDL-C), and sdLDL-C/LDL-C ratio with carotid plaque (CP) risk in the general Chinese population, and to conduct discordance analyses to determine which of these lipid biomarkers can more effectively reflect CP risk beyond traditional lipid markers, such as total LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C). Hypothesis: We inferred that sdLDL-C and sdLDL-C/LDL-C ratio would provide additional CP risk information beyond LDL-C and non-HDL-C. Methods: This study enrolled 20,369 participants from the Beijing Healthy Management Cohort. Discordances between sdLDL-C, lbLDL-C, or sdLDL-C/LDL-C with LDL-C or non-HDL-C, as well as discordance between sdLDL-C/LDL-C and sdLDL-C, were defined based on residual differences and medians. CP was diagnosed using Color Doppler ultrasound of the carotid artery. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: In our study, 10,445 (51.28%) participants were men, and the median age was 43.00 [34.00, 54.00] years. Higher sdLDL-C and sdLDL-C/LDL-C ratio, but not lbLDL-C, were associated with increased CP risk. Additionally, discordantly high sdLDL-C (OR, 1.403; 95% CI, 1.283–1.534 for LDL-C; OR, 1.356; 95% CI, 1.240–1.483 for non-HDL-C) and discordantly low lbLDL-C (OR, 1.406; 95% CI, 1.286–1.537 for LDL-C; OR, 1.178; 95% CI, 1.077–1.288 for non-HDL-C), relative to LDL-C or non-HDL-C, were significantly associated with an elevated risk of CP compared to the concordance groups. Conversely, discordantly low sdLDL-C (OR, 0.823; 95% CI, 0.743–0.911 for LDL-C; OR, 0.863; 95% CI, 0.781–0.953 for non-HDL-C) and discordantly high lbLDL-C (OR, 0.825; 95% CI, 0.745–0.913 for LDL-C; OR, 0.930; 95% CI, 0.845–1.023 for non-HDL-C) were associated with a reduced risk. Finally, the discordantly high sdLDL-C/LDL-C ratio versus LDL-C (OR, 1.310; 95% CI, 1.199–1.431), non-HDL-C (OR, 1.228; 95% CI, 1.124–1.343) and sdLDL-C (OR, 1.464; 95% CI, 1.323–1.620) was linked with increased CP risks. Conclusions: The sdLDL-C and sdLDL-C/LDL-C ratio, not lbLDL-C, are superior to LDL-C and non-HDL-C in identifying CP risk, and sdLDL-C/LDL-C further captures additional risk information beyond sdLDL-C alone. These findings underscore the importance of monitoring sdLDL-C and sdLDL-C/LDL-C to enhance residual risk assessment for atherosclerosis in clinical practice.
Abstract P3121: Temporal Changes in Blood and Fecal Metabolites and Fecal Microbiome After Bariatric Surgery
Background: Temporal changes in blood and fecal metabolites and fecal microbiome following bariatric surgery remain unclear. This study thus aimed to explore those intra-individual changes after bariatric surgery. Methods: Plasma and stool samples were collected from 62 patients who underwent first-time Roux-en-Y gastric bypass or sleeve gastrectomy at pre- and 3- and 12-month post-surgery. Global metabolite profiling and targeted short-chain fatty acid profiling were performed using LC-MS/MS. The microbiome was profiled by shotgun metagenomic sequencing. Paired Wilcoxon signed-rank tests and fold change (FC) were applied. Significant changes (FDR<0.05 and FC>1.5 or <0.67) were categorized into three patterns: early changed, late sustained (i.e., significant when comparing 3-month post- to pre-surgery, which sustained comparing 12- to 3-month post-surgery); early changed, late reversed (significant opposite changes in both periods); early unchanged, late changed (only significant when comparing 12- to 3-month post-surgery). Results: Significant changes were observed in 274 plasma metabolites,143 fecal metabolites, and 102 microbial species. Major plasma metabolite changes involved sustained increases in primary bile acids and hemoglobin-related metabolites, and a decrease in tryptophan; reverses in ketone bodies, secondary bile acids, and fatty acids; late increases in lysophospholipids, benzoate, and energy-related metabolites, and a late decrease in long-chain fatty acids. Major fecal metabolite changes included sustained increases in medium- and long-chain fatty acids, and decreases in secondary bile acids and dipeptides; late increases in energy-related metabolites, and decreases in primary bile acids and sterols. Major microbial species changes were sustained increases in Streptococcus parasanguinis , S. salivarius , S. thermophilus , E. coli , and Klebsiella pneumoniae, and decreases in Agathobacter rectalis , Anaerobutyricum hallii , Dorea_A longicatena, Fusicatenibacter saccharivorans, and Roseburia inulinivorans ; reversed changes in Copromonas sp900066785 and Ruminococcus_D bicirculans ; and late increases in Agathobaculum butyriciproducens and Dysosmobacter butyriciproducens . Most changes did not differ significantly by surgical type or patient gender. Conclusions: Our findings indicate temporal changes in metabolites and microbiome following bariatric surgery, warranting further research on these changes and their link to long-term health outcomes.
Abstract 049: Ultra-processed food consumption and MRI-based carotid plaque characteristics: results from the ARIC study
Introduction: Ultra-processed food and beverage (UPF) consumption has been linked with several adverse cardiovascular outcomes, yet its association with detailed characterization of carotid atherosclerosis remains less explored. Objectives: To examine cross-sectional associations between UPF consumption and carotid artery plaque measurements assessed by magnetic resonance imaging (MRI). Methods: A total of 895 white participants (mean age 71 years, 54% female) from the Carotid MRI visit (2004-2005) were stratified sampled from the Atherosclerosis Risk in Communities (ARIC) study and were included in the analysis. Dietary intake was assessed using a food frequency questionnaire, with food processing levels categorized according to the NOVA classification. Carotid artery imaging was performed using MRI and analyzed with semiautomated software. Weighted multivariable linear and logistic regression models were used to assess the associations between quartiles of UPF consumption and standardized plaque measurements or lipid core presence, adjusting for sociodemographic and lifestyle factors. Results: Higher UPF consumption was positively associated with total wall volume [beta-coefficient (β) = 0.28, 95% CI: 0.08-0.48], total lipid core volume (β = 0.53, 95% CI: 0.16-0.90), maximum segmental wall thickness (β = 0.23, 95% CI: 0.02, 0.44), and maximum lipid core area (β = 0.48, 95% CI: 0.11-0.85). UPF consumption was not significantly associated with the presence of lipid core ( Figure ). Conclusion: Higher intake of UPFs was associated with a greater burden of atherosclerotic plaque in the carotid artery. Dietary modifications to minimize UPFs should be considered to prevent vascular changes and future systemic vascular diseases.
Enhancing patient-centered care: Evaluating quality of life in type 2 diabetes management
Aims To evaluate quality of life (QoL) in patients with type 2 diabetes mellitus (T2DM). Methods A cross-sectional study included 151 T2DM patients at the Clinical Centre of Montenegro. The Ferrans and Powers Quality of Life Index (QLI), validated for the Montenegrin population, assessed QoL across five domains. Participants rated items on a Likert scale from 1 (very dissatisfied) to 5 (very satisfied). Data were analysed using SPSS version 22. Results The cohort included 51% women, with a mean age of 60.05 ± 11.63 years. Of the patients, 42% had diabetes for over a decade, and 64% had no additional health conditions. Overall, patients reported satisfactory QoL, especially in self-care and glucose management, though dissatisfaction was high regarding sexual life. Emotional support from family, housing, and friendships significantly contributed to life satisfaction, while financial concerns and job dissatisfaction were common. QoL showed no significant gender differences but declined with age and was notably lower in patients with comorbidities. Conclusion Patients with T2DM report generally satisfactory QoL, with notable concerns in socio-economic and health-related areas. Routine QoL assessments in clinical practice can improve communication, aid in early complication detection, and enable timely interventions to enhance patient outcomes.
Abstract P2125: Association of Gender with Self-reported Physical Activity Among Younger Persons After a Myocardial Infarction
Introduction: Recreational physical activity (PA) is cardio-protective but often underutilized, and women in the general population engage less in leisure PA compared to men. Whether this disparity extends to individuals after a myocardial infarction (MI) in midlife, a high-risk group that may especially benefit from PA promotion, is unknown. Methods: We recruited women and men ≤ 61 years of age who were hospitalized for MI in the previous 8 months in metropolitan Atlanta, balancing the number by sex. We evaluated leisure PA behavior with the validated, self-reported Baecke Habitual Physical Activity Questionnaire. We constructed a linear mixed-effect model to estimate the association between gender and the PA leisure score, then adjusted sequentially for demographics (age, race, income, education), obesity status, and heart failure ( Table ). Results: Our sample included 619 participants (46% women, 59% black) with mean age 51 years (SD: 7). On a Likert scale of 1 (least) to 5 (most), the mean (SD) PA leisure score was lower among women (2.4 (0.5)) compared to men (2.5 (0.5); p=<0.05). Walking was the most common leisure PA activity reported by both groups. In all models, we found that there was a statistically significantly lower PA leisure score for women compared to men ( Table ). More men than women reported they walked (31% vs. 22%), biked (8% vs. 2%), or played sports (10% vs. 2%) often or always during leisure time. Results remained similar when patients with poor functional capacity (defined using the Duke Activity Score Index) were excluded. Discussion: Women reported significantly lower leisure PA as compared to men. Interventions and education about promoting PA, especially walking, should be considered in this patient population.
Abstract P2157: Social Determinants of Health and Health Behaviors Among Adults with Multiple Chronic Diseases: The LINKED-HEARTS Program
Introduction: Social determinants of health (SDoH) contribute to cardiovascular outcomes and health disparities. Despite a recent focus on structural drivers of health disparities, the associations between SDoH and health behaviors among adults with multiple chronic diseases remains understudied. Objectives: To examine the association between SDoH and health behaviors in the “LINKED-HEARTS” (a Cardiometabolic Health Program LINKED with Community Health WorkErs and Mobile HeAlth TelemonitoRing To reduce Health DisparitieS) Program. Method: We conducted a cross-sectional analysis using baseline data from the “LINKED-HEARTS” Program, an ongoing cluster-randomized controlled trial of adults with uncontrolled hypertension in addition to diabetes or chronic kidney disease (CKD). The outcome was adherence to three or more cardiometabolic health promoting behaviors: healthy diet (Mediterranean Eating Pattern for Americans scale), moderate or vigorous physical activity (≥ 150 minutes/week), non-smoking, and recommended sleep duration (7–9 hours/night). The exposures were SDoH ( Table ). To examine the association between SDoH and health behaviors (> 3 vs. ≥ 3), we conducted a multivariable logistic regression analysis, adjusting for demographics (age, sex, race/ethnicity), marital status, and general health status. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated. Results: The study included 214 adults with hypertension in addition to diabetes or CKD, with a mean age of 64 years (±SD 12.3), of whom 61.1% were female, 52.8% were non-Hispanic Black adults. Of the adults included, only 28% (n=60) reported engaging in three or more health behaviors. Participants who reported experiencing any financial strain were 64% less likely to adhere to three or more health behaviors (aOR 0.36, 95% CI: 0.14-0.96) compared to those who never experienced financial strain ( Table ). Additionally, those who reported frequent social isolation were 56% less likely to adhere to ≥ 3 health behaviors (aOR 0.44, 95% CI: 0.21-0.93) compared to those who reported no feelings of social isolation. Conclusion: Financial strain and social isolation were associated with fewer health behaviors among adults with multiple chronic diseases. These findings indicate the need to continually assess and address SDoH in interventions aimed at improving lifestyle behaviors and cardiovascular health outcomes in high-risk populations.
Abstract P2112: Longitudinal Associations Between the Microbiome and Glucose Homeostasis Over Time in The Microbiome and Insulin Longitudinal Evaluation Study (MILES)
Type 2 diabetes (T2D) is associated with both relative, and absolute, changes in the microbes colonizing the digestive tract (the gut microbiome). However, T2D-related pathogenesis predates diagnosis by up to decade, and few studies have examined whether gut microbiome differences also relate to the various components of insulin and glucose homeostasis that contribute to onset. The goal of this study was to conduct such an investigation using repeated stool samples from 114 non-Hispanic White and 44 African American individuals without T2D participating in MILES (mean age 60, 67% female), leveraging MILES’ longitudinal design to minimize the influence of temporary microbiome fluctuations. Participants underwent three oral glucose tolerance test, spaced ~ one year apart, from which fasting glucose (FG) and insulin, and C-peptide were derived, and insulin sensitivity, insulin secretion, and disposition index (DI) calculated. Microbes with a prevalence >= 30% were included in multi-level linear models which examined associations of overall composition (diversity, evenness and richness), as well as the relative abundance of individual species, with each of the six glucose measures. Models used centered log-ratio transformed data, included a correction for bias due to compositional effects, and controled for sequencing depth, batch, demographics, and medication useage. P-values equivalent to a<.05 after an FDR correction for the number of microbes (N=130) were considered significant. FG was associated with lower (Shannon index; b=-0.19(0.08),P=.03) and evenness (Inverse Simpson; b=-0.02(0.01),P=.02), with a similar trend inverse association seen for DI (diversity: b=-0.19(0.08),P=.03; evenness: b=0.02(0.01),P=.02). These two indices were also associated with the relative abundance of seven microbes; both FG (logFC=0.46,P=9.9*10-4) and DI (logFC=-0.54,P=1.1*10-4) were associated with Ruthenibacterium lactatiformans, FG only with Anaerotruncus colihominis (logFC=1.31,P=1.22*10-4) and Flavonifractor plautii (logFC=0.68,P=8.3*10-4), and DI only with Adlercreutzia equolifaciens (logFC =-0.55, P=4.6*10-5 ), Asaccharobacter celatus (logFC=-0.38,P=6.6*10-4), Enterorhabdus caecimuris (lofFG=-0.82,P=8.1*10-4), Gordonibacter pamelaeae (logFC=-0.49,P=5.9*10-4), and Limnochorda Pilosa (logFC=-0.40,P=1.2*10-3). The roles of these microbes in lactate, equol, butyrate, and tryptophan production point to the gut microbiome as a mediator of diet-T2D associations.
Metabolic versatility and nitrate reduction pathways of a new thermophilic bacterium of the Deferrivibrionaceae: Deferrivibrio metallireducens sp. nov isolated from hot sediments of Vulcano Island, Italy
A novel thermophilic (optimum growth temperature ~ 60 °C) anaerobic Gram-negative bacterium, designated strain V6Fe1T, was isolated from sediments heated by the hydrothermal circulation of the Aeolian Islands (Vulcano, Italy) on the seafloor. Strain V6Fe1T belongs to the recently described family Deferrivibrionaceae in the phylum Deferribacterota. It grows chemoorganotrophically by fermentation of proteinaceous substrates and organic acids or by respiration of organic compounds using fumarate, nitrate, Fe(III), S°, and Mn(IV) as electron acceptors. The strain V6Fe1T can also grow chemolithoautotrophically using H2 as an electron donor and nitrate, nitrous oxide, Fe(III), Mn(IV), or sulfur as an electron acceptor. Stable isotope probing showed that V6Fe1T performs denitrification with nitrate reduction to dinitrogen and Dissimilatory Nitrate Reduction to Ammonium (DNRA). Culture experiments with RT-qPCR analysis of target genes revealed that strain V6Fe1T performs DNRA with the nitrite reductase formate-dependent NrfA and denitrification with an Hcp protein and other redox partners yet to be identified. Genomic analysis and experimental data suggest that strain V6Fe1T performs autotrophic carbon fixation via the recently discovered reversed oxidative TCA cycle (roTCA cycle). Based on genomic (ANI) and phenotypic properties, strain V6Fe1T ( = DSM 27501T = JCM 39088T) is proposed to be the type strain of a novel species named Deferrivibrio metallireducens.