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Abstract P3164: Impact of Neighborhood Disadvantage on Neuroimaging and Plasma Biomarkers associated with Alzheimer’s Disease and Related Dementias
Introduction: Stark disparities exist in the prevalence of Alzheimer’s disease (AD) and related dementias (ADRD) by social determinants of health (SDoH). Limited research is available on associations of SDoH with AD/ADRD biomarkers. This study aims to assess the impact of SDoH measures on ADRD-associated neuroimaging and plasma biomarkers. Hypothesis: SDoH measures of area deprivation index (ADI), social vulnerability index (SVI), and environmental justice index (EJI) will be positively associated with poorer ADRD-associated neuroimaging and plasma biomarkers, and cardiometabolic health will partially account for this association. Methods: This study includes participant data from the Wake Forest Alzheimer’s Disease Research Center from baseline visits. Independent SDoH variables include ADI, SVI, and EJI. Dependent variables include cortical thickness and white matter hyperintensity (WMH) volume, adjusted for intracranial volume, from MRI, and plasma glial fibrillary acidic protein (GFAP) and pTau-181. We conducted bivariate and hierarchical multivariable linear regressions, with demographics (age, sex, education,&cognitive diagnosis) [Model 1], additional adjustment for cardiometabolic health with cardiometabolic index (CMI) [Model 2], and estimated glomerular filtration rate (eGFR) [Model 3; for plasma biomarkers] as covariates. Results: In bivariate analyses, a significant negative association was observed between ADI and cortical thickness (β=-0.08, p=0.047). No other significant associations were observed. In multivariable analyses (Table 1) , EJI was negatively associated with cortical thickness (β=-0.04, p=0.04), and both ADI and SVI were negatively associated with GFAP (β=-0.36, p<0.01&β=-0.52, p<0.01, respectively), in Model 1. Additionally adjusting for CMI in Model 2, the negative associations of ADI and SVI with GFAP were preserved (β=-0.33, p=0.02&β=-0.50, p<0.01, respectively). In Model 3, further adjusting for eGFR, ADI remained negatively associated with GFAP (β=-0.37, p=0.03). Conclusions: Place-based environmental injustice was associated with lower cortical thickness, while neighborhood disadvantage and social vulnerability were associated with higher GFAP levels in adjusted models, suggesting place-based SDoH may be associated with structural brain changes and neuroinflammation. The impact of place-based SDoH needs to be further studied in association with ADRD biomarkers to better understand how we may tackle SDoH among older adults.
Abstract P2133: Physical performance and coronary heart disease, cardiovascular disease and all-cause mortality: the REasons for Geographic And Racial Differences in Stroke prospective cohort study
Background: Poor physical performance, often measured by gait speed and chair stand tests, has been linked to mortality, but patterns may differ depending on prior history of cardiovascular disease (CVD). Objective: To examine associations between physical performance and death from coronary heart disease (CHD), CVD, and all-cause by history of CVD. Methods: Among 14,137 REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants (2013-2016), participants were categorized by quartiles of gait speed and chair stand times or inability to complete the test. Deaths (CHD, CVD, and all-cause) were adjudicated through December 31, 2020. Stratified by history of CVD, we created survival curves and conducted Cox proportional hazards models adjusted for demographics, health behaviors, and medical history. Results: The average age of participants was 72.54±8.5, 56.1% were female, 63.3% were White, 36.7% were Black, and 42.9% had history of CVD; 2,749 participants died. Compared to the fastest quartile, participants with history of CVD and slowest gait speeds had adjusted hazards ratios (HRs) of 1.29 (95% CI: 0.75, 2.23) for CHD, 1.37 (0.92, 2.05) for CVD, and 1.81 (1.47, 2.23) for all-cause mortality; HR for those with incomplete gait speed tests were 1.66 (0.80, 3.44), 3.07 (1.94, 4.86), and 3.19 (2.48, 4.10), respectively. Participants with history of CVD and the slowest quartile of chair stand time had HRs of 1.05 (95% CI: 0.62, 1.78) for CHD, 1.49 (1.08, 2.04) for CVD, and 1.82 (1.48, 2.23) for all-cause mortality; those with incomplete chair stand tests had HR of 1.33 (0.76, 2.33), 2.30 (1.68, 3.16), and 3.18 (2.47, 4.09), respectively. A similar pattern was seen among those without history of CVD, but the magnitude of the associations was lower (p-interaction = 0.345, 0.028, and 0.026 for CHD, CVD, and all-cause mortality, respectively, for gait speed tests and p-interaction = 0.064, 0.084, and 0.034 for CHD, CVD, and all-cause mortality, respectively, for chair stand tests). Conclusions: While physical performance was associated with mortality among individuals with and without CVD, poor physical performance may be a stronger marker for risk of death among those with CVD.
Abstract P1043: Distinct Mortality Patterns in Cancer Patients with Heart Disease: Insights from SEER Database Analysis
Introduction: Heart disease and cancer are two of the leading causes of death worldwide. The interaction between cardiovascular health, cancer, and survival outcomes is a crucial area of investigation. Thus, understanding the treatment and survival outcomes in heart disease patients who develop cancer is vital. Hypothesis: We assessed the hypothesis that variables such as the primary site of cancer, chemotherapy received, median income, and ICD Code, for example, resulted in different treatment outcomes of heart disease patients in the SEER database. Methods: The SEER database, the largest publicly available cancer registry, was used to analyze demographic and clinical data from patients diagnosed with heart disease. Variables such as SDoH, cancer diagnosis and treatment, and survival outcomes were cross-examined. Statistical analyses included Cox proportional hazards models, Poisson regression, and chi-square tests. The sample size includes 783 patients. Results: Survival functions showed statistical differences with a p-value <.001 in 5-year or 10-year hazard experiences based on chemotherapy received, tumor size, RX-Surgery primary site, median income, cause of death (COD), metastasis of the bone, liver, and brain, and between ICD categories, highlighting distinct interactions of these variables with pathological cardiovascular states. The highest ICD-0-3 category was patients with hemangiosarcoma at 26% of the dataset population. Poisson regression showed it was statistically significant to have higher incident rates in patients with Hemangiosarcoma than Giant Cell Carcinoma. Chi-square tests for impact on COD showed it was statistically significant that each pairing of the primary site of cancer, chemotherapy received, median income, RX-Surgery primary site, metastasis of the bone, liver, and brain, and ICD Code combined with COD were different. With the observed frequencies different from expected with a p-value of <.001, this study prompts further investigation into the distinct mortality patterns that involve the interplay of cardiovascular complications and cancer progression. Conclusions: The results demonstrate tangible differences in mortality patterns of heart SEER patients based on many factors. Understanding these relationships is crucial to developing targeted clinical strategies and preventative measures. Future research should strive to foster a better understanding of pathologic cardiovascular conditions and how they interact with cancer states.
An optimized informer model design for electric vehicle SOC prediction
SOC prediction is of great value to electric vehicle status assessment. Informer model is better than other models in SOC prediction, but there is still a gap in practical application. Therefore, based on the health assessment algorithm, a new optimized Informer model is proposed to predict SOC. Firstly, the health assessment is carried out through the historical running data of the electric vehicle to obtain the health matrix. Then, the health matrix is used to improve Encoder and Decoder modules and improve the prediction accuracy and speed of Informer model. Subsequently, the health matrix is utilized to optimize the prediction logic, reduce the influence of truncation error, and further improve the SOC prediction accuracy. Finally, using the Informer model before and after optimization, SOC prediction is performed using four different datasets. The results indicate that after optimizing the En-De module of Informer, prediction accuracy improved by approximately 15%, with prediction speed increasing by about 100%. Furthermore, optimizing the prediction logic to reduce truncation error further enhanced Informer’s prediction accuracy by around 20%.
Abstract P1137: The associations between maternal cardiovascular health scores during pregnancy and growth status of 0-2 years old infants: A birth cohort study
Objective: Many maternal factors during pregnancy have been suggested to influence the physical development of offspring, while the overall effects haven’t been comprehensively evaluated. We aim to revise the Cardiovascular Health (CVH) metrics for pregnant women, a composite health indicator recommended and updated by the American Heart Association in 2022, and to explore its association with growth status within age 2 years based on a birth cohort. Methods: Pregnant women in 20-28 weeks of gestation were recruited in Guangzhou, China, from 2017 to 2018, and their offspring were followed up until 2 years old. Maternal behavioral factors were collected by standardized questionnaires, including diet, physical activity, nicotine exposure, and sleep. Maternal biochemical data were extracted from medical records, including weight, blood glucose, blood pressure, and blood lipid. Higher scores indicating better health (ranging from 0 to 100), three of the eight metrics were specifically adapted for pregnant women. Pre-pregnancy BMI and pregnancy weight gain were used to evaluate weight status. The Chinese Healthy Diet Index and the standard of the Chinese Guidelines for Gestational Diabetes Mellitus were applied to assess diet and blood glucose. Infants’ length and weight were repeatedly measured at 1, 3, 6, 8, 12, 18, and 24 months, and weight-for-length z-scores (WAZ), length-for-age z-scores (LAZ), body mass index z-scores (BAZ), and weight-for-age z-scores (WLZ) were calculated. The generalized estimating equation was conducted to explore the association between maternal CVH scores and infants’ growth status. Results: In 691 mother-child pairs, the average of CVH score was 67.02±9.52, with diet scoring the lowest (42.17±32.94). Approximately 3.47%, 85.82%, and 10.71% of mothers scored low (≤50), moderate (50-79), and high (≥80) in CVH levels, respectively. The CVH and health factor scores were positively correlated with family monthly income. Higher prenatal health behaviors and CVH scores were associated with increased LAZ, and health behavior, especially in sleep, was negatively associated with BAZ and WLZ of infants. Conclusion: This revised CVH score indicated a moderate overall health status for pregnant women, with dietary health warranting further improvement. Priority should be given to modifiable health behaviors during pregnancy, which showed a stronger and more stable association with the infant's physical growth.
Abstract P3041: Association of Urine Metabolites with All-Cause and Cause-Specific Mortality: The Atherosclerosis Risk in Communities (ARIC) Study
Introduction: Circulating metabolites are associated with all-cause and cause-specific mortality. Cardiovascular disease (CVD) and cancer are two leading causes of mortality, providing complementary assessment of disease burden in addition to all-cause mortality. However, the role of urine markers in predicting the risk of mortality is understudied. Hypothesis: We hypothesize that urine metabolites are associated with all-cause, CVD, and cancer mortality. Methods: Using the Nightingale platform, urine metabolite profiling was performed at the Atherosclerosis Risk in Communities (ARIC) Study visit 5 (2011-13). Urine metabolite levels were probability quotient normalized. We conducted Cox proportional models on 42 urine metabolites with all-cause, CVD, and cancer mortality, adjusting for traditional risk factors and kidney function. A metabolite risk score (MRS) was constructed using weights obtained from least absolute shrinkage and selection operator regression. Harrell’s C statistics was calculated to estimate the models’ predictive performance. Results: Over an average of 5 years of follow-up, 372, 113, and 85 all-cause, CVD, and cancer mortality cases were developed among 1,350 participants (mean age: 75 years, 74% women, 35% Blacks). Seven and one urine metabolites were associated with all-cause and CVD mortality (FDR<0.05, Figure.1). 4-deoxythreonate, a carboxylic acid found in foods, was associated with a decreased risk of all-cause (HR per SD: 0.77, 95% CI: 0.68-0.87) and CVD (HR per SD: 0.63, 95% CI: 0.50-0.80) mortality. The highest quartile of MRS, consisting of 13 and 5 selected urine metabolites, had about a three-fold and four-fold risk of all-cause and CVD mortality compared to the lowest quartile, respectively, and a graded effect across quartiles was observed (p for trend: p<0.001, Figure.2). Adding seven significant urine metabolites improved all-cause mortality prediction by 4% over a traditional risk model (p<0.05). Conclusions: We identified urine metabolites associated with all-cause and CVD mortality, suggesting the potential of considering urine markers in clinical practice and for at-risk population identification.
Abstract 066: Inclusion of Social Determinants of Health in Cardiovascular Disease Risk Prediction Models
Background: Social determinants of health (SDOH) impact CV health, but CVD risk prediction models either exclude SDOHs entirely or include a single factor. Here, we assess the incremental value of adding multiple individual- and neighborhood-level SDOHs to the 2013 Pooled Cohort Equations (PCE). Methods: We pooled data from 38,558 individuals in 6 longitudinal cohorts: Framingham Heart Study (Gen3 and Omni2 cohorts exam 1; 2002-2005), Jackson Heart Study (exam 1; 2000-2004), Coronary Artery Risk Development in Young Adults (year 20 exam; 2005-2006), Multi-Ethnic Study of Atherosclerosis (exam 5; 2010-2011), Reasons for Geographic and Racial Differences in Stroke (exam 1; 2003-2007), and Hispanic Community Health Study/Study of Latinos (exam 1; 2008-2011). Included participants were aged 40-79 with complete data on PCE predictors, were free of baseline atherosclerotic CVD (ASCVD), and were followed for 10 years for incident ASCVD (nonfatal MI, fatal CHD, fatal/nonfatal ischemic stroke). The PCEs were fit separately for each combination of sex and race/ethnicity (Black Women, Black Men, White or Hispanic/Latina Women, White or Hispanic/Latino Men) using Cox proportional hazards models with recalibrated beta coefficients for each CV risk factor (age, total and HDL cholesterol, treated/untreated SBP, current smoking, diabetes). Individual- and neighborhood-level SDOHs were added to the PCEs to assess the change in c-statistic, net reclassification improvement (NRI) and relative integrated discrimination improvement (rIDI). Results: During 340,267 person-years of follow-up, 1966 ASCVD events occurred. In both Black women and White or Hispanic/Latina women, jointly adding individual- and neighborhood-level SDOHs improved model performance the most (Black women Δc=0.034, NRI=0.105, rIDI=0.415; White or Hispanic/Latina women Δc=0.026, NRI=0.136, rIDI=0.329), whereas in White or Hispanic/Latino men, the subset of significant individual-level SDOHs most improved model performance (Δc=0.032, NRI=0.114, rIDI=0.163). Among Black men, no group of SDOHs was both significantly associated with incident ASCVD and improved model performance. Conclusion: Adding individual- and neighborhood-level SDOHs to the PCEs modestly improved model performance and the effect of these groups of SDOHs varied by gender and race. Future studies should examine the impact of inclusion of these and additional individual- and neighborhood-level SDOHs in the PREVENT and other risk prediction models.
Reflecting on Dunbar’s numbers: Individual differences in energy allocation to personal relationships
Past studies have investigated the variability in how people engage with their personal networks, yet less is known about how people perceive their energy allocation to different ties. Drawing on an online survey sample (N = 906), we tested whether subjective perceptions of energy allocation conform to so-called Dunbar’s Number(s). In addition, we evaluated the predictive roles of Big Five personality traits and self-esteem while controlling for differences in network structure. Results revealed significant heterogeneity in perceived energy allocation to different layers of personal networks (i.e., inner 5 vs. middle 15 vs. outer 150 relationships). In contrast to expectations, extraversion was not associated with perceived energy allocation, whereas self-esteem was associated with greater energy allocation to the middle (vs. inner) network layer. Our findings add to our knowledge of how people perceive relationship maintenance across their personal networks, along with the links to key psychological traits. More broadly, the findings suggest that more attention should be paid to psychological implications of the middle layer of personal networks. To conclude, we discuss the importance of studying individual differences in how people prioritize – and reflect on – different relationships in their networks.
Abstract P1144: Changes in Dietary Intake, Physical Activity and Cardiometabolic Risk Factors in University Students
It is well recognized that lifestyle habits are more critical during certain stages of life. For young adults, the transition to university appears to be one of these periods. Beginning university involves many changes for young adults. Several studies have described unhealthy student lifestyles with decreased physical activity and deterioration of eating habits. This lifestyle deterioration at the beginning of university has also been associated with weight gain which may impact cardiometabolic health. The purpose of the present study was to examine changes in physical activity, dietary intake and cardiometabolic risk factors in Canadian university students over the course of one academic year. Fifty university students (17 men and 33 women) from 18 to 27 years of age (21.0 ± 1.7 years for men and 20.2 ± 1.3 years for women) were selected to participate in this study. All measurements were performed at baseline and at the end of the academic year. Anthropometric parameters and metabolic risk variables were measured according to standardized procedures. Food intakes were assessed using a web-based food frequency questionnaire. Cardiorespiratory fitness capacity was estimated using the 20m shuttle run test. Over the university year, waist circumference significantly increased in both men (76.1 to 79.1 cm, p=0.0015) and women (69.6 to 71.8 cm, p=0.003) while body mass index was significantly increased only in men (22.5 to 23.1 kg/m 2 , p=0.0024). Total cholesterol, LDL cholesterol and apolipoprotein (apo) B levels significantly increased in men over the study period (p < 0.0175). In women, apo B levels increased significantly, while total cholesterol/HDL cholesterol ratio decreased (p < 0.027). There were small but statistically insignificant changes in total caloric intake during the study. However, daily servings of fruits and vegetables significantly decreased over the study in both men (11.1 to 7.64 servings per day, p=0.0085) and women (8.31 to 5.71, p=0.0202). These decreases seem to be mainly attributable to reduced vegetable consumption (p < 0.04). Lastly, we found that cardiorespiratory fitness did not change significantly over the study period. In conclusion, our results demonstrated deterioration in some cardiometabolic risk factors as well as in some eating habits during the academic year. Targeted interventions should be developed to help university students achieve or maintain a healthy lifestyle during this period.
Abstract P1114: Correlations Between VeggieMeter and Self-reported Carotenoid, Fruit and Vegetable Intake Among Older Adults: Results from Bringing the Diabetes Prevention Program to Geriatric Populations
Background: Fruit and vegetable intake (FVI) among older adults remains below recommended levels for disease prevention. Subjective dietary assessment can be burdensome and costly. Reflection spectroscopy (RS) can be used to non-invasively assess skin carotenoids as a biomarker of fruit and vegetable intake but is an underexplored research area for older adult communities. Objective: To test the hypothesis that VM scores will be positively correlated with self-reported vegetable and carotenoid intake among older adults. Design: This is a secondary analysis of data from an ongoing NIH-funded randomized, controlled trial where participants were counseled to make healthy changes including increased FVI. Participants were n=79 older adults (age ≥ 65 years) with prediabetes and had their skin carotenoids levels (scored 0-800) measured by VeggieMeter® - a portable device that uses RS technology. We performed univariate descriptive analyses of population characteristics, Spearman correlations, and linear regression models to examine the association between VM scores and self-reported FVI and carotenoid intake measured by food records (mean days=5.5 (sd=1.0)), adjusted for participant characteristics, using Python. Results: Participants were 73.0 (sd=5.4) years old, 65.8% were female, 68.4% White, 13.9% Hispanic/Latinx, with an average BMI of 32.4 (sd=4.2) kg/m 2 and 68.4% reported use of dietary supplements. The average FVI was 3.7 (sd=2.0) servings per day, reported carotenoid intake was 10,202 (sd=7,755) mcg, and mean VM score was 294.2 (sd=121.1). VM score was not correlated with self-reported FVI, vegetable intake alone, or fruit intake alone (all p>0.05). VM scores were correlated with carotenoid intake (R=0.25, p<0.05), but this correlation was no longer significant after adjustment for age, sex, race, ethnicity, BMI, smoking status, and reported supplement use. Conclusions: This study supports the hypothesis that VM score is correlated with self-reported carotenoid intake reported on food records, suggesting potential utility of VM in assessing carotenoid status among older adults with prediabetes. Future work will examine sensitivity to change after participation in a Diabetes Prevention Program adapted for older adults.
Abstract P1068: Comparative Analysis of Children’s Persistence in a Lifestyle Modification Program and Body Mass Index Z-Score Changes According to the Access to a Family Grant Program at a Pediatric Obesity Management Clinic
Introduction: Improving access to healthcare for childhood obesity is crucial, especially in contexts where social vulnerability is a significant risk factor for developing obesity in childhood. Little is known about whether family grant programs (FGP) help remove systemic and institutional barriers to lifestyle therapies for children with obesity. Hypothesis: We tested the hypothesis that access to a FGP favors engagement in a lifestyle modification program and body mass index z-score (BMIz) reduction of children with overweight or obesity at a pediatric obesity management clinic, the Maison de santé prévention – Approche 180, in Montreal (QC, Canada). Methods: This study is designed as a retrospective, longitudinal, comparative analysis of medical records of children (2 to 17 years) with overweight or obesity. Data were collected between April 8, 2021 (FGP implementation) and March 31, 2023. Children in youth centers, foster families, with refugee status or whose parents had a low-income per Canada’s Revenue Agency were eligible for the FGP, which fully covered the costs of multiprofessional services at the clinic. Persistence in the lifestyle program, measured by the number of appointments and follow-up duration, and changes in BMIz over the study period were compared between children based on access to the FGP. Results: Among the 198 included children (100 girls, 98 boys; mean age=11.1 years ± standard deviation (SD)=3.0; mean BMIz=3.30 ± SD=1.05), 62 benefited from the FGP and 136 were not eligible to it. Children from non-two-parent families were 2.46 times more likely to receive the grant compared to those from two-parent families (95% confidence interval (CI): 1.46, 4.13; P=0.0007). Children with the grant had longer follow-up duration [10.29 (95%CI: 8.59, 11.99) vs 6.71 (95%CI: 5.48, 7.93) months; P=0.0007] and similar number of appointments per month [0.81 (95%CI: 0.66, 0.95) vs 0.92 (95%CI: 0.81, 1.02); P=0.42] compared to those without it. Children with the grant achieved similar BMIz changes compared to those without it [-0.31 (95%CI: -0.61, -0.01) vs -0.32 (95%CI: -0.57, -0.06); P=0.92]. Conclusions: FGP was associated with persistence in a lifestyle program that surpassed that of those who were not eligible to it. It enabled children with social vulnerabilities to achieve BMIz reductions comparable to those of children without such vulnerabilities. Free care could help address systemic and institutional barriers to childhood obesity management.
Passenger and freight travel patterns: A cluster analysis based on urban networks
While research on population travel patterns and urban networks has been active, it has primarily focused on passenger travel, leaving freight travel relatively underexplored. This study addresses this gap by analyzing both passenger and freight travel patterns, network structures, and central areas. It uses origin-destination (OD) data, considering total travel volume by purpose and mode. The study applies regular equivalence and power centrality to examine differences in human and logistics flows across South Korea from an urban network theory perspective. The key findings are as follows. First, passenger travel, predominantly short-distance, exhibits lower density and intensity than freight travel. Freight travel, on the other hand, demonstrates strong density across short, medium, and long distances, with more travel routes concentrated around nodal regions. Second, passenger travel forms several polynucleated clusters, including short-distance movements. Conversely, freight travel forms a few extensive clusters that encompass medium and long-distance movements. Third, the spatial interaction of passenger travel is influenced by the OD distance, unlike freight travel. Interestingly, the distance between central areas of freight travel can be longer than that of passenger travel. This may stem from the strategic positioning of certain suburban areas as central areas to optimize logistics efficiency. This study emphasizes the importance of morphological and functional linkages between cities by identifying inter-regional differences in passenger and freight flows. It also proposes spatial planning strategies based on urban hierarchy.
Abstract P2015: Perceptions of Health Coaching for Weight Loss Maintenance in Primary Care: Results from the MAINTAIN PRIME Trial
Introduction: Health coaching can expand the capacity of primary care providers (PCPs) in supporting patient self-management of overweight and obesity. Current platforms for weight management health coaching include in-person meetings, phone calls, and asynchronous online messaging. We seek to understand patient perceptions and facilitators and barriers to engagement with asynchronous, online coaching through the patient portal of the electronic health record (EHR). Hypothesis: Patients will find EHR- and primary care-integrated health coaching acceptable for weight management. Methods: Participants in MAINTAIN PRIME were primary care patients with BMI ≥25 before intentional weight loss of ≥5%, randomized to health coaching with tracking tools (coaching) vs. tracking tools alone. Coaching was performed by trained primary care staff via EHR messaging. We are conducting semi-structured interviews at 24-months with active and inactive participants in the coaching arm (active defined as remaining enrolled in trial and responding to messages within 1 week). An interview guide includes the domains of EHR platform for health coaching, patient-coach relationship, and coaching integration with primary care. We analyzed interviews via thematic analysis. Results: Six of 11 completed interviews have been analyzed. Half of participants (3/6) were active, 66.7% were female (4/6), and average age was 39.6 years. Results to date reveal positive perceptions of the EHR platform for health coaching. Most participants found the platform convenient and liked the integration with other health records. Others stated a preference for separating coaching from medical care. Participants liked engaging with coaches at the time of their choosing. Messages were overall helpful, though sometimes felt impersonal and templated. Participants felt coaches were professional but lacked a personal connection, which could have improved with an initial in-person or video meeting. Lastly, many participants were unaware of coaching integration with their PCP teams other than the initial referral to coaching. Conclusions: Overall, participants had positive perceptions of the coaching experience though noted some areas for improvement such as adding a face-to-face meeting with the health coach and further personalizing messages to promote stronger coaching relationships. Discussions between PCPs and coaching participants regarding weight management could bolster a sense of integration and support.
Abstract 009: Association of Accelerated Biological Aging in Midlife with Cardiovascular and Health Outcomes in the Framingham Offspring Study
Introduction: Biological age acceleration (BAA) constructed from multi-organ system biomarkers may better elucidate the aging process relative to chronological age (CA). We evaluated the association of BAA with long-term health outcomes among middle-aged adults. Hypothesis: We related mid-life accelerated BA to the incidence of death, CVD, and dementia. Methods: We modeled BAA using multiple biomarkers (anthropometric and biochemical indicators of vital organ systems) at the sixth examination cycle (1995-1998) for up to 2038 Framingham Offspring participants. Stratified by sex, we estimated BA using the Klemera and Doubal method (KDM) with principal components. Standardized residuals from regressing KDM-BA on CA were used to define accelerated BA (>1 SD), moderate BA ([-1 to 1 SD]), and slow BA (<-1 SD; referent). Utilizing multivariable-adjusted Cox proportional hazards and competing risk models, we related BAA to incident death, CVD, and dementia. Results: Over a median follow-up of 24 years (max 27 years), participants (mean age 57 years, 57% women) experienced 656 deaths, 454 new-onset CVD events, and 170 incident dementia outcomes. Men and women with accelerated BA had a 2.1-fold (95%CI [1.40-3.21]; p=0.0004) and a 1.7-fold higher risk for death (95%CI [1.10-2.55]; p=0.02), respectively, compared to the referent group. Women with accelerated BA had a 1.8-fold higher risk of CVD (95%CI [1.12-2.90]; p=0.02) compared to slow BA. Higher BAA was associated with a higher dementia risk (HR per SD-increase 1.25, 95%CI [1.03-1.53]; p=0.03) in women. Conclusions: Multiple biomarkers that signal the aging of biological organ systems can be combined to reflect BA. In our community-based sample, accelerated midlife BA was characterized by a higher risk of death and CVD in both sexes and with dementia risk in women. These findings underscore the importance of healthy multisystem aging over the life course.
Abstract 069: Healthy Lifestyle and Risk of Cardiovascular Disease Incidence and Mortality Among Survivors with Stages I-III Colorectal Cancer
Introduction: Colorectal cancer (CRC) is a prevalent cancer and a leading cause of cancer deaths in the US. CRC survivors have a high risk of developing cardiovascular disease (CVD), which accounts for nearly 20% of their total mortality, likely due to shared risk factors including lifestyle. Hypothesis: We hypothesized that maintaining a healthy lifestyle after a CRC diagnosis is associated with a lower risk of CVD incidence and mortality. Methods: We analyzed data from 2,737 survivors with stages I-III CRC in the Nurses’ Health Study and Health Professional Follow-up Study. A lifestyle score, ranging from 0 to 5, was calculated for participants based on diet quality, smoking status, alcohol intake, physical activity, and body mass index. We calculated cumulative averaged scores before and after CRC diagnosis and used Cox proportional hazards regression to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD incidence and mortality. We further examined changes in pre- and post-diagnostic lifestyle in relation to CVD outcomes and assessed potential effect modification by age, tumor characteristics, and medical history. Results: Over a median follow-up of 13.3 years after CRC diagnosis, we documented 449 incident CVD cases, including 201 coronary heart disease and 104 stroke cases, and 307 CVD-specific deaths. After adjustment for demographics, medical history, tumor characteristics, and pre-diagnostic lifestyle score, one unit increase in post-diagnostic score was associated with a 13% lower CVD incidence (HR [95% CI]: 0.87 [0.77-0.98]; p-trend: 0.03) and 29% lower CVD mortality (0.71 [0.61-0.83]; <0.0001). When stratified by tumor stage, the inverse association with CVD incidence was observed for stage I (0.74 [0.60-0.92]) but not stages II-III CRC (1.12 [0.93-1.35]; p-interaction: 0.005); whereas no differential associations were found for CVD mortality. Survivors who maintained a healthy lifestyle (score ≥4) pre- and post-diagnosis had a 28% lower risk of CVD incidence (0.72 [0.57-0.92]) and a 48% lower risk of CVD mortality (0.52 [0.39-0.70]) compared to those with a constantly poor lifestyle (score <4). Conclusions: In conclusion, a healthy lifestyle after CRC diagnosis was associated with a substantially lower risk of CVD incidence and mortality, highlighting the role of a healthy lifestyle in improving survivorship. These findings offer valuable insights for integrating lifestyle interventions into CRC oncology care.
Geographical distribution and the impact of socio-environmental indicators on incidence of Mpox in Ontario, Canada
Background Ontario, being one of Canada’s largest provinces, has been central to the high incidence of human Mpox. Research is scarce on how socio-environmental factors influence Mpox incidences. This study seeks to explore potential geographical correlations and the relationship between indicators of social marginalization and Mpox incidence rate in Ontario. Methodology We used surveillance data on confirmed human Mpox cases from May 1, 2022, to March 31, 2024, extracted from the Public Health Ontario website for this study. Spatial autocorrelation of Mpox incidence was investigated using spatial methods including Moran’s Index, Getis–Ord Gi*statistic, and spatial Poisson scan statistic. Following this, we adopted a generalized Poisson regression (GPR) model to estimate the incidence rate ratios (IRRs) based on the association between Ontario PHU-level marginalization and Mpox incidence, while adjusting for age and sex. The goodness-of-fit of the models was assessed using the Log Likelihood (LL), Akaike Information Criterion (AIC), Akaike’s Information Criterion corrected (AICc), and the Bayesian Information Criterion (BIC). Results Our analysis revealed significant localized spatial heterogeneity in Mpox incidence across Ontario. Statistically significant local clusters of Mpox cases were identified in Toronto ( R R = 11.34 , L L = 511.97 ), Ottawa ( R R = 3.21 , L L = 19.88 ), and a secondary cluster, overlapping Hamilton PHU with nine local districts ( R R = 2.07 , L L = 9.64 ), all with p − v a l u e < 0.05 . The incidence rate of Mpox was statistically significantly associated with a higher proportion of ethnic concentration (racialized groups, migrants, or visible minorities) I R R = 9.478 ; 95 % C I = 5.062 − 17.747 , gender I R R = 5.150 ; 95 % C I = 1.159 − 8.324 and higher residential instability I R R = 14.112 ; 95 % C I = 6.596 − 30.189 . Conclusion We identified major Mpox hotspots in Toronto. According to our model results, the high incidence rate may be influenced by the greater population of internal migrants and younger individuals. Based on these insights, we recommend targeted interventions in the high-risk neighborhoods. Efforts to improve Mpox diagnosis and promote health equity among socioeconomically vulnerable populations, including racial and ethnic minorities, should be implemented.
Abstract P3011: Empirically derived biomarker patterns in the REasons for Geographic and Racial Differences in Stroke Study
Background: Contemporary molecular epidemiologic approaches often consider individual or small groups of biomarkers and their relationship to cardiovascular disease risk factors or events. Factor analysis can group many biomarkers that represent the physiology and dysfunction of multiple organ systems into a small number of distinct patterns. These patterns may better reflect the complexity of human physiology and advance understanding of cardiovascular disease onset. We sought to empirically identify such patterns using factor analysis, and hypothesized that biomarkers would cluster into distinct patterns. Methods: REGARDS recruited 30,239 Black and White adults aged ≥45 years from the continuous US in 2003-2007 with a second visit in 2013-2016. Specialized biomarkers were measured in specimens collected at baseline from 4,400 participants who attended both visits; lipids, C-reactive protein (CRP), cystatin C, urine albumin/creatinine ratio, complete blood count, blood urea nitrogen (BUN), and serum albumin were measured in all or most participants. Factor analysis was used to derive patterns in a random split sample. Scree plot guided selection of factors used an eigenvalue cut point of 1. Validity was confirmed across race, sex, and age groups (<55, 55 to <65, 65 to <75, and ≥75 years) A congruence test coefficient >0.5 was considered acceptable. Final factor patterns were derived in the entire analytical sample using a 3-factor solution and named based on biologically known pathways. Results: Of the 4,400 participants, 31% were excluded who were missing any biomarker leaving an analytical sample of 2,723. The congruence coefficient between the factors was >0.78 for all subgroup comparisons. As is shown in the Figure , the “thrombo-inflammatory” pattern (pattern 1) had higher levels of inflammation, coagulation, and leptin; the “renal-inflammatory” pattern (pattern 2) had high levels of inflammation, renal dysfunction, and also high NT-proBNP and proenkephalin; the “dyslipidemic-inflammatory” pattern (pattern 3) had high levels of inflammation and triglycerides and low levels of HDL and adiponectin. Discussion: Three observed biomarker patterns had strong congruence across race, sex, and age groups. Future research will determine if these patterns are associated with cardiovascular risk factors and events.
Abstract P1152: Association of the Alternative Healthy Eating Index with Coronary Artery Calcification Volume and Density: the Multi-Ethnic Study of Atherosclerosis
Introduction: The Agatston score is a measure of coronary artery calcification (CAC) used to predict atherosclerotic cardiovascular disease (ASCVD) events. Notably, the score is upweighted for calcium density, despite evidence that density is inversely associated with cardiovascular disease after accounting for volume. Some studies have found associations between dietary components and the Agatston score, but none have evaluated diet in relation to CAC density and volume. Hypothesis: The Alternative Healthy Eating Index-2010 (AHEI), a measure of diet quality, is associated with lower CAC volume and higher CAC density. Methods: During the baseline exam of the Multi-Ethnic Study of Atherosclerosis, diet was assessed with a 120-item food frequency questionnaire from which the AHEI was derived. At the same exam, CAC was measured from computed tomography scans. In 3,099 participants with non-zero CAC volume, we modeled the associations of AHEI and natural log of Agatston score, natural log of volume, and density with linear regression. Models adjusted for age, sex, race/ethnicity, education, energy intake, cigarette smoking, and physical activity. We further adjusted for volume when density was the outcome and density when volume was the outcome. Results: The analytic sample included non-Hispanic White (45%), Black (23%), Hispanic (20%) and Chinese American (12%) individuals (mean age 66 years; 42% female). The median (Q1, Q3) Agatston score was 88 (22, 299) and volume was 85 mm 3 (25, 277). The mean (standard deviation [SD]) density score was 2.8 (0.7). After adjustment, the association of a one SD higher AHEI and Agatston score was not statistically significant (95% confidence interval [CI]: -0.10, 0.02; p=0.24). Conversely, in models assessing the relationship of AHEI with volume and density independent of one another, associations were significant (p=0.02 for volume; p=0.02 for density). A one SD higher AHEI was associated with a 0.05-unit lower log of volume (95% CI: -0.10, -0.01) and 0.02-unit higher density (95% CI: 0.00, 0.04). Conclusions : Our finding that higher AHEI was associated with lower CAC volume and higher CAC density aligns with research showing that diet is a risk factor for ASCVD. The null association with Agatston score appears to reflect the cancelling effects of the positive associations of density with higher AHEI and volume with lower AHEI, rather than the absence of a potential impact of dietary intake on subclinical atherosclerosis.
Abstract P2067: Artificial Light at Night and Asleep Blood Pressure in Black Adults
Background: Misalignment between internal circadian timing and environmental time cues, such as light, has been associated with poor cardiometabolic health. We examined whether artificial light at night (ALAN) was associated with higher asleep blood pressure (BP) and lower melatonin levels in a sample of Black adults. Methods: Normotensive Black adults were recruited from a parent study examining circadian contribution to BP. Participants wore the Philips Respironics Actiwatch 2 for seven consecutive days and during the first 24 hours, they also completed 24-hour ambulatory BP monitoring (ABPM) using the SpaceLabs 90227 device. Saliva was collected hourly during a 30-hour constant routine protocol, one of the gold standard methods to assess circadian amplitude in humans. Radioimmunoassay (RIA) was performed to quantify salivary melatonin. Pearson correlations were performed to examine the associations between 1) ALAN exposure duration and asleep BP and 2) salivary melatonin amplitude and asleep BP. Results: Nine participants with complete data from the parent study were included in the analyses, including 5 women (56%) and 4 men (44%) with a mean age of 39.67 ± 15.11 years. Actigraphy revealed a mean sleep duration of 393.44 ± 77.11 minutes (6.56 hours), mean wake after sleep onset (WASO) of 69.42 ± 78.40 minutes and mean white light exposure equivalent to 713.58 ± 1890.25 lux during the sleep period of ABPM. There was no significant correlation between ALAN exposure duration and asleep systolic BP or diastolic BP, r(7) = .56, p = 0.12; r(7) = .45, p = .23. RIA is ongoing and analyses to determine whether there is a correlation between salivary melatonin amplitude and asleep BP will be presented at the meeting. Conclusions: Preliminary findings suggest that ALAN is not correlated with asleep BP in normotensive Black adults; however, our interpretation is limited by small sample size. Given the existing literature demonstrating a relationship between ALAN and asleep BP in other populations, it is possible that this relationship exists in Black adults. Participants exhibited suboptimal sleep, which may have also contributed to their elevated asleep BP. Findings from the salivary melatonin data will provide helpful insights into a potential circadian mechanism underlying elevated asleep BP. Our study is one of few examining the impact of an environmental determinant of circadian health on cardiovascular health in Black adults.
Experimental study on operation limit of ground heat exchanger based on ground source heat pump unit
The heat transfer performance of a ground heat exchanger (GHE) directly influences the operational performance of a ground source heat pump (GSHP) system. The fluid temperature within the GHE is constrained by the protective temperature limits of the GSHP unit. Specifically, the inlet water temperature has an upper limit in summer and a lower limit in winter. These temperature limits further affect the heat exchange efficiency between the GHE and the surrounding soil. In this study, an experimental station featuring a single U-shaped GSHP system was constructed, and a three-dimensional model of the system was developed. Experiments were conducted by operating one or two GHEs to investigate the heat transfer per unit well depth and the matching relationship between cooling capacity and indoor load when the inlet water temperature of the heat pump unit approaches its summer and winter limits. In summer, when operating a single GHE, the heat transfer per unit well depth reached 134.4 W/m at an inlet temperature of 45 °C. When the cooling supply just matched the cooling load demand, the heat transfer per unit well depth was 131.5 W/m. However, prolonged operation led to a scenario where the cooling supply could no longer meet the load demand. In winter, operating a single GHE resulted in a heat transfer per unit well depth of 43.95 W/m at an inlet temperature of 5 °C. These results indicate that when the number of heat exchangers is insufficient, the inlet water temperature of the heat pump unit may reach or exceed the limit value, leading to decreased unit efficiency. Additionally, inadequate heat exchange between the GHE and the soil results in insufficient cooling or heating capacity, failing to meet the indoor load requirements.