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Abstract P3132: Triglycerides are the Only Serum Lipid in Adolescence that are Significantly Related to Left Ventricular Mass in Black and White Young Women
Introduction: Increased left ventricular mass (LVM) is a risk factor for adult CV disease and is associated with hyperlipidemia. The effects of the burden of different lipids during adolescence on increased LVM in young adulthood are not well described. Hypothesis: We hypothesized that the burden of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) across adolescence would be associated with increased LVM in women during young adulthood. Methods: We analyzed data from the National Growth and Health Study, a longitudinal study of racial differences in CV risk factors in young women. Serum lipids (collected at ages 14-20) and left ventricular mass (LVM) by echocardiography (assessed at ages 24-27) were the primary variables of interest. Adolescent measures of lipids, BMI and systolic blood pressure (SBP) were summarized as the area under the curve (AUC), and LVM was indexed by dividing by height 2.7 . Adjusted linear regression analysis was used to assess the associations of HDL-C, LDL-C, and TG AUCs with LVM Index (LVMI). in a combined model to assess for contributions to LVMI. Models were adjusted for BMI AUC, race, and systolic blood pressure AUC amongst all participants and then models were repeated after stratifying by race. Results: The analysis included 517 women (52.6% Black, mean age 24.9 ± 0.7 yrs at time of echocardiography). In analyses including all lipids (Table), TG was significantly associated with increased LVMI (0.06±0.03, p=0.02, R 2 =0.40), along with BMI (0.65±0.05, p<0.01) and Black race (0.06±0.02, p<0.01), while HDL, LDL, and SBP were not. These findings were similar to models of each lipid analyzed individually. Stratifying by race (Table), TG remained the only lipid significantly associated with increased LVMI in Black participants (0.08±0.04, p=0.04, R 2 =0.39), along with BMI (0.64±0.06, p<0.01). In White participants, BMI was the only covariate that was significantly associated with increased LVMI (0.66±0.09, p<0.01, R 2 =0.33). Conclusions: In conclusion, the burden of TG over adolescence is associated with increased LVMI in early adulthood, particularly in Black women. Interventions should be targeted toward reducing TG to prevent early cardiac disease.
Abstract 075: Diurnal postprandial glucose responses to meals with different carbohydrate content and glycemic index and their effects on lipid metabolomics: The OmniCarb trial
Background and aims: Meal timing has been suggested as a circadian disruptor that may be linked cardiovascular disease by influencing fatty acid metabolism and specific metabolomic pathways. We aimed to test associations of diurnal postprandial glucose responses (PPGRs) after consuming diets varying in carbohydrate amount (Carb) and glycemic index (GI) with comprehensive lipid subtypes and lipidomic signatures. Materials and methods: This ancillary analysis included 61 adults from the OmniCarb trial, a randomized crossover, controlled feeding trial of 4 diets that differed in Carb and GI levels. Each diet was based on a healthful DASH-type diet and was provided for 5 weeks, with a 2-week washout. Twelve-hour meal tests were conducted at the end of each intervention. Participants were given the same diet type for that diet period for breakfast, lunch, and dinner, which had a mean 486, 610, 618 kcal, respectively, for a typical 2000-kcal diet. The area under the curve (AUC) of glucose after each meal was calculated and analyses were performed per 1 SD higher of AUC-glucose. Lipid subtypes considering the presence of apolipoprotein C-III (apoC-III) were measured in fasting samples collected at the end of the intervention. Serum lipid metabolites were analyzed using Metabolon's complex lipids targeted panel. Results: At the end of high-carb and high-GI diet interventions, PPGRs after dinner, but not after lunch, were associated with higher levels of atherogenic apoC-III (β [SE]: 0.3 [0.1]; p=0.035), apoB (β 0.2 [0.1]; p=0.04), and cholesterol (β 1.2 [0.5]; p=0.018) in LDL with apoC-III. PPGRs after breakfast were not significantly related to cholesterol in LDL with apoC-III. When analyzing effects on lipid class concentrations, a low-carb and low-GI diet compared to high-carb and high-GI diet lowered triacylglycerol (TAG) and phosphatidylcholines but slightly increased phosphatidylethanolamines (PE) and lactosylceramides ( p <0.05 for all). At the end of low-carb and low-GI diet interventions, greater AUC-glucose after dinner and AUC-glucose differences between lunch and dinner showed significant associations with higher levels of cholesteryl esters, dihydroceramides, TAG, and PE. Conclusion: Greater PPGRs were associated with atherogenic lipid subtypes and lipidomic pathways after evening meals but not after daytime meals. The atherogenic lipid pathways associated with PPGRs in the evening may vary depending on Carb content and dietary GI of the meals.
Abstract P2016: Feasibility, acceptability, and preliminary effects of a 4-week mindfulness-based stress reduction program for young women in Puerto Rico
Background: Young women in Puerto Rico (PR) experience a high burden of psychological distress, a non-traditional risk factor for cardiovascular disease. Mindfulness practice may help reduce psychological distress and improve health behaviors, benefiting cardiovascular health. However, conventional 8-week mindfulness-based stress reduction (MBSR) programs’ time requirements and in-person format pose participation barriers. We evaluated the feasibility and acceptability of a virtual, 4-week MBSR program tailored for young PR women and explored post-intervention changes in distress and health behaviors. Methods: Participants (n=24; mean age=25.7y±3.1) were PR women with elevated stress and no severe depression or self-harm thoughts. Recruitment (February 2024) was through social media and email blasts. The program consisted of weekly group sessions and daily at-home practice. Feasibility was measured through recruitment, enrollment, retention, attendance, and at-home practice. Acceptability was assessed via satisfaction ratings. Symptoms of depression, anxiety, post-traumatic stress disorder, perceived stress, emotional eating, and physical activity were assessed through validated scales at baseline, post-intervention, and 2-mo. Analyses included paired t-tests and McNemar tests for comparisons between baseline vs. post-intervention and baseline vs. 2-mo. Results: Recruitment, enrollment, and retention rates were 66%, 100%, and 96%, respectively. Median number of sessions attended was 4; 84% attended all sessions. Half of the participants practiced at-home exercises > 3-4 times/week; frequency declined at 2-mo. Participants were very/somewhat satisfied (96%) with the intervention. There were significant reductions in depression (-5.1; p<0.01), anxiety (-3.0; p<0.01), PTSD (-1.8; p<0.01), and stress (-2.7; p<0.01) symptom scores at post-intervention (vs. baseline). These differences remained at 2-mo. There was a significant decrease in emotional eating scores at 2-mo (-0.2; p=0.03) and a marginal increase in the proportion of participants meeting the guidelines of 150min/week of physical activity at post-intervention (38% vs. 50%; p=0.08). Conclusion: This 4-week virtual MBSR program had good feasibility and acceptability among PR women, with the potential to reduce psychological distress and emotional eating. Strategies are needed to boost at-home mindfulness practice. Future studies should assess how 4-week MBSR programs may improve cardiovascular health.
Structural basis for dimerization and activation of UvrD-family helicases
UvrD-family helicases are superfamily 1A motor proteins that function during DNA replication, recombination, repair, and transcription. UvrD family monomers translocate along single-stranded (ss) DNA but need to be activated by dimerization to unwind DNA in the absence of force or accessory factors. However, prior structural studies have only revealed monomeric complexes. Here, we report the first structures of a dimeric UvrD-family helicase, Mycobacterium tuberculosis UvrD1, both free and bound to a DNA junction. In each structure, the dimer interface occurs between the 2B subdomains of each subunit. The apo UvrD1 dimer is observed in symmetric compact and extended forms indicating substantial flexibility. This symmetry is broken in the DNA-bound dimer complex with leading and trailing subunits adopting distinct conformations. Biochemical experiments reveal that the Escherichia coli UvrD dimer shares the same 2B–2B interface. In contrast to the dimeric structures, an inactive, autoinhibited UvrD1 DNA-bound monomer structure reveals 2B subdomain–DNA contacts that are likely inhibitory. The major reorientation of the 2B subdomains that occurs upon UvrD1 dimerization prevents these duplex DNA interactions, thus relieving the autoinhibition. These structures reveal that the 2B subdomain serves a major regulatory role rather than participating directly in DNA unwinding.
Abstract P2148: Adverse Childhood Experiences are Associated with Poor Sleep Among Racial and Ethnic Minoritized Patients with Recent Myocardial Infarction
Introduction: Disparities in sleep are well documented and may increase the risk of poor cardiovascular disease (CVD) outcomes in racial and ethnic minoritized groups. These groups are also more likely to report adverse childhood experiences (ACEs), which can impact sleep. The relationship between ACEs and sleep quality in adults with CVD, including those recovering from myocardial infarction (MI), is underexplored. Objective: To examine the association between ACEs and sleep quality in patients with recent MI. Methods: We analyzed baseline data from an ongoing longitudinal study of adults post-MI. Exposure to five ACEs was assessed (each yes/no): living with someone with chronic illness/disability, mental illness or substance abuse; parental separation/divorce; long-term financial problems. Sleep quality over the past 7 days was assessed with a single item rated 0–10, dichotomized as poor (0–3) vs. fair/good/excellent (4–10). Participants completed validated measures of anxiety, depressive symptoms and perceived stress. We used chi-square tests and linear regression to test associations between ACEs exposure and sleep quality. Results: The 161 participants (36.9% women, 34.4% from racial and ethnic minoritized groups, age 62±13 years) completed questionnaires at median 37.5 days post-MI (IQR=21–61). About half of participants (50.9%) reported ≥1 ACE and 21.7% reported poor sleep; these were somewhat more common among participants from minoritized groups vs. non-Hispanic White adults (≥1 ACE, 60.0% vs. 46.7%, p=0.08; poor sleep, 30.9% vs. 17.1%, p=0.04). Participants from minoritized groups with ≥1 ACE were more likely than those with no ACEs to report poor sleep (45.4% vs. 9.1%, p=0.006). This association was significant after adjusting for sociodemographic (age, sex, race/ethnicity, low income, marital status) and clinical (time since MI, diabetes, hypertension, body mass index) factors (B=-1.683, p=0.03), and was no longer significant when psychological factors (anxiety, depressive symptoms, perceived stress) were added (B=-1.344, p=0.10). There was no difference in poor sleep between non-Hispanic White participants who did vs. did not report ACEs in univariate (18.4% vs. 16.1%, p=0.80) or multivariate analyses (B=-0.054, p=0.91). Conclusions: ACEs exposure was associated with poorer self-reported sleep quality in MI patients from racial and ethnic minoritized groups. This association was mediated in part by effects of ACEs on psychological distress.
Abstract MP77: Achieving Guidelines within a 24-Hour Movement Paradigm and Risk of Cardiovascular Disease and All-Cause Mortality in United States Adults
Introduction: Lifestyle factors such as achieving recommended levels of aerobic moderate to vigorous physical activity (MVPA) intensity ( > 150 min/wk), sedentary behavior (SB) ( < 8h/d), and sleep duration (7-9h/d) comprise the 24-hour movement paradigm and are independently linked to mortality risk. Limited evidence exists on whether adherence to the 24-Hour Movement Guidelines (24H-MG) in combination is associated with mortality risk. Purpose: Examine the association of meeting the 24H-MG and risk of cardiovascular disease mortality (CVD) and all-cause mortality and estimate the number of deaths that could be prevented by meeting all components of the 24H-MG in a national representative sample of US adults. Methods: Participants enrolled in the 2005 and 2010 National Health Interview Survey were analyzed. MVPA, SB, and sleep were self-reported. Mortality was ascertained from National Death Index through December 31, 2019. Meeting a 24H-MG was classified by meeting following criteria sleep 7-9h/d, SB < 8h/d, and MVPA > 150 min/wk. Results: Among US adults, 4.9% (95% CI 4.6- 5.2), 23.9% (23.4-24.5), 44.6% (44.0-45.2), 26.6% (26.0-27.2) met 0,1, 2, or all 3 24H-MG respectively. After adjusting for covariates and excluding deaths in the first two years, meeting a greater number of 24H-MG was associated with lower risk of all-cause mortality in a dose-dependent fashion over a median follow-up of 9.9 years (Figure, Panel A). Hazard ratios (HR [95% CI]) comparing US adults meeting 1, 2 or 3 guidelines versus meeting 0 guidelines were 0.71 (0.59-0.85), 0.61 (0.51-0.73), and 0.52 (0.43-0.64), respectively (p-trend <0.001). Meeting a greater number of 24H-MG was also associated with a reduced risk of CVD (Figure, Panel B): HRs=0.85 (0.60, 1.21), 0.75 (0.53, 1.06), 0.42 (0.28, 0.63) for meeting 1, 2 or 3 guidelines, respectively, versus meeting 0 guidelines (p-trend <0.001). By targeting all but those who meet all 3 movement guidelines, 16.8% (95% CI: 13.7-19.0) of total deaths and 38.7% (95% CI: 31.0-41.4) of CVD deaths could be prevented by shifting US adults to meet all 3 guidelines. Conclusions: In a national representative sample of US adults, there is a dose-response association between meeting 24-hour movement guidelines and mortality risk. Meeting all three guidelines was associated with a 48% reduced risk of all-cause mortality and 58% reduced risk of CVD. These findings support the need to promote a healthy 24-hours to reduce mortality risk in US adults.
Abstract P3026: Prevalence of Cardiac Arrhythmias by Cardiovascular-Kidney-Metabolic Syndrome Stage: The Atherosclerosis Risk in Communities Study
Background: Cardiovascular-kidney-metabolic (CKM) syndrome is a systemic disorder resulting from the complex relationships between obesity, diabetes, kidney disease, and the cardiovascular system. CKM syndrome is associated with atherosclerotic cardiovascular disease, heart failure, sudden cardiac death, and atrial fibrillation (AF), but the prevalence and burden of other major arrythmias have not been characterized in CKM. Methods: We conducted a cross-sectional study of participants in the Atherosclerosis Risk in Communities (ARIC) Study who attended Visit 6 (2016 – 2017) and wore a non-invasive single-lead electrocardiogram patch (Zio XT) for up to 2 weeks. We evaluated the age-adjusted prevalence of 4 major arrhythmias (AF, long pause lasting >3 seconds, non-sustained ventricular tachycardia, and Mobitz type 2 or third-degree atrioventricular block) by CKM stages. CKM stage is defined as: Stage 0/1 – no risk factors or excess/dysfunctional adiposity; Stage 2: metabolic risk factors or moderate- to high-risk chronic kidney disease; Stage 3: subclinical CVD, high predicted CVD risk, or very high-risk chronic kidney disease; and Stage 4: clinical CVD. Results: Our study included 2,616 ARIC participants (mean age 79.2 years; 58% female; 26% Black). Overall, prevalence of advanced CKM syndrome was high (Stage 4: 37.8%, Stage 3: 42.2%, Stage 2: 16.4%, Stage 0/1: 3.3%). Compared to participants with Stage 0/1 CKM, participants with Stage 4 CKM were more likely to be older (mean age 80.2 vs. 76.1 years), male (48% vs. 31%), Black (29% vs. 7%), have <High School education (16.9% vs. 3.4%), smoke cigarettes (8.0% vs 2.4%), and were less likely to drink alcohol (44.0% vs. 60.0%). Age-adjusted prevalence of all major arrhythmias was highest among participants with Stage 4 CKM, including non-sustained ventricular tachycardia (36.8%) and AF (15.6%) ( Figure ). Conclusions: The age-adjusted prevalence of clinically significant arrhythmias is high among older community-dwelling adults with advanced CKM syndrome. Efforts to achieve and maintain more optimal CKM health may help to reduce the odds of developing major arrhythmias.
Abstract P3015: Maintenance of Ideal Cardiovascular Health Among Latinos Over a Decade in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and National Health and Nutrition Examination Survey (NHANES)
Objective: The long-term trends of cardiovascular health (CVH) in the US Hispanic/Latino population are incompletely understood. We aimed to assess CVH longitudinally using metrics based on the American Heart Association's Life's Essential 8 (LE8). To investigate the "Hispanic resilience" phenomenon, we compared Hispanic and non-Hispanic data from US-wide samples. Methods: We included HCHS/SOL enrollees aged 28 to 74 free of cardiovascular diseases at baseline (2008-2011, n=12,724) and at Visit 2 (2014-2017, n=9,246). We evaluated the weighted prevalence of meeting the ideal levels for five LE8 metrics repeatedly measured at both visits: nicotine exposure, body mass index (BMI), blood lipids, blood glucose, and blood pressure. We also assessed the prevalence of meeting multiple CVH metrics (defined as meeting four or five of the total five measured metrics) by demographic subgroups. Comparisons were made with data from corresponding timeframes from NHANES-Hispanics and NHANES-non-Hispanic Whites (NHW). Results: Over time, among Hispanics, the prevalence of meeting the blood lipid CVH metric increased (30.0% at baseline, 40.4% at Visit 2), while the prevalence of meeting the blood glucose metric decreased (47.6% to 39.1%). Nicotine exposure, BMI, and blood pressure metrics were unchanged. Among Hispanic/Latino backgrounds, South Americans consistently were most likely to meet multiple CVH metrics over time (18.4% to 18.5%), while Puerto Ricans showed the most improvement across time periods (9.9% to 14.0%). Both Hispanic males and females improved over time, with females having higher achievement of CVH metrics. US-born (i.e., 50 states/DC) Hispanics were more likely to meet most CVH metrics compared to those born outside the US. In comparison with NHANES, the prevalence of meeting the nicotine exposure metric was consistently higher in both HCHS/SOL and NHANES-Hispanics than in NHW. NHANES-NHW participants had a higher prevalence of meeting the BMI and blood lipid metrics compared to Hispanics in HCHS/SOL and NHANES. Across all Hispanic and NHW groups, there was a consistent trend of improvement in the blood lipid metric and a decline in the blood glucose metric. Conclusion: Across different metrics of CVH, Hispanics/Latinos have both advantages and disadvantages relative to NHW in the US. Across the US, among both Hispanics and NHW, blood lipids have improved over time, while the blood glucose component of CVH has worsened.
Abstract 026: Poor Hypertension Care Cascade Performance in Adults from South-Central Uganda: A Population-Based Cohort Study
Background: Hypertension, a potent risk factor for cardiovascular disease, is increasingly prevalent in sub-Saharan Africa. Identifying intervention targets requires an examination of hypertension management. This study analyzed the hypertension care cascade—prevalence, awareness, treatment, and control—to identify management gaps in adults > 25 years in south-central Uganda. Methods: Data from the Rakai Community Cohort Study, a longitudinal, open, population-based cohort from 34 communities in south-central Uganda, were used. Hypertension was defined as systolic BP > 140 mmHg, diastolic BP > 90 mmHg, or current use of anti-hypertensive medication. A care cascade was constructed to describe hypertension prevalence, awareness, treatment, and control, stratified by age (25-49 and > 50 years) and HIV serostatus. Modified Poisson regression was used to assess factors associated with hypertension and cascade levels by estimating adjusted prevalence ratios (aPR). Results: Among 10,132 adults aged 25-49 years and 1,647 adults > 50 years, hypertension prevalence was 13% and 36%, respectively. Of participants with hypertension aged 25-49, 23% were aware of their diagnosis, 9% were receiving treatment, and 4% had controlled hypertension. Men aged 25-49 with hypertension had a 1% control rate. Among those > 50 years, the cascade rates were 44%, 27%, and 12%, respectively. Adjusted analyses showed that factors associated with higher prevalent hypertension included older age [aPR 1.62 (1.57–1.68)], male sex [aPR 1.13 (1.02–1.24)], obesity [aPR 2.01 (1.79-2.26)], moderate to heavy alcohol consumption [aPR 1.37 (1.24–1.52)], and living in a trading community [aPR 1.16 (1.06–1.27)]. Older age and higher BMI were also linked to higher rates of diagnosis awareness, treatment, and BP control. Male sex, however, was associated with lower attainment of all care cascade levels. Persons with HIV were more likely to be on treatment [aPR 1.39 (1.07–1.80)] and controlled [aPR 1.65 (1.12–2.42)]. Conversely, new study participants were less likely to be aware of their hypertension [aPR 0.74 (0.59–0.91)] and on treatment [aPR 0.61 (0.42–0.91)]. Conclusions: These findings reveal that hypertension is prevalent in this population, with substantial gaps throughout the care cascade, particularly among men. Urgent improvements in diagnosis, treatment, and control are needed. Cost-effective interventions and integrated care models are essential to improve hypertension management in this region.
Abstract P3107: Relationship between adherence to Canada’s Food Guide 2019 and the risk of cardiovascular disease in Canada: A Protocol
Introduction: Cardiovascular disease (CVD) is a leading cause of death in Canada. A healthy diet plays an integral role in CVD prevention. In 2019, Canada’s Food Guide (CFG) was updated to reflect current evidence on healthy eating. The Healthy Eating Food Index (HEFI) was developed as a tool to measure adherence to CFG. However, the extent to which adherence to CFG influences CVD remains unexplored within Canada. Objective: 1.) Assess the association between HEFI scores and the risk of CVD in a population-based cohort. 2.) Estimate the number of preventable CVD-related deaths from improvements in HEFI scores. 3.) Estimate potential healthcare cost savings from improvements in HEFI scores. Methods: Data linkages between the Canadian Community Health Survey – Nutrition (2004) and the Canadian Vital Statistics Death and Discharge Abstract Database (2017) will be used, with over 80% of CCHS respondents successfully linked to these databases. Weighted Cox proportional hazards models will be used to examine the prospective association between HEFI scores and CVD outcomes. Analyses will be stratified by sex to account for potential differences in associations between males and females. Multivariate models will be adjusted for dietary recall-related factors (e.g. weekday/weekend, sequence of recall), sociodemographic factors (e.g., age, education) and lifestyle-related factors (e.g., alcohol consumption, physical activity, smoking). The population attributable fraction (PAF) will be estimated for the number of preventable CVD deaths attributable to improvements in HEFI scores. To estimate the potential economic impact of HEFI improvements, the PAF will be multiplied by direct and indirect costs of CVD. Significance: This study will be the first to explore the prospective association between HEFI scores and CVD risk in a Canadian population as well as to quantify the number of preventable deaths and potential economic savings associated with improvements in HEFI scores. Analyses are currently underway, and results are forthcoming. Findings will inform dietary guidance and shape Canadian health and economic policy strategies, enhancing both public health and financial outcomes.
Abstract P2038: Factors Associated with Food Insecurity in Clinic Populations in Kingston, Jamaica
Introduction: Food insecurity (FI), defined as the limited or uncertain availability of nutritionally adequate and safe foods, is a major public health issue in the Caribbean and worldwide. Estimates show that 41% of Caribbean households experience FI, which has been linked to poor cardiovascular health. Yet, little research exists to understand factors that contribute to high FI prevalence in the region that experiences a high cardiovascular disease burden. Hypothesis: Sex, age, socioeconomic position, and comorbidities are associated with FI. Methods: We analyzed data from the Addressing Blood Pressure Control Through Dietary Approaches (ABCD) Study, a cross-sectional study that examined the effects of food insecurity on hypertension control in Kingston, Jamaica. Patients were recruited from two chronic disease clinics. Consenting participants completed an interviewer-administered questionnaire including the Latin American and Caribbean Food Insecurity Scale (ELCSA), demographics, social and clinical characteristics, and lifestyle behaviors questions. ELCSA scores ranged from 0-9, categorizing patients as 0 food secure, 1-3 mild FI, and ≥4 moderate/severe FI. Chi-square tests and multinomial logistic regression identified factors associated with FI. Results: The final sample included 252 patients with complete study variables. Results showed that 77% of patients had FI and that younger patients were more likely to have FI (p=0.02). There were no statistically significant differences in FI according to sex, marital status, educational attainment, and employment. Multinomial logistic regression model results showed perceptions of the food environment as affordable, and the number of people living in a household were significantly associated with FI. Patients who lived in households with 5-7 people had 6 times greater odds of severe FI (vs. food secure) (CI=1.72-18.46) than those who lived in households with up to four people. Those who perceived their food environment as affordable had 86 percent lower odds (OR=.143, CI=0.06-0.37) of moderate/severe FI compared to patients who perceived their food environment as rarely/never or sometimes affordable. Conclusion: Study findings show a high prevalence of FI among hypertensive patients in Kingston, Jamaica. Findings vary in consistency with existing research on contributing factors to FI and suggest the need for structural interventions to reduce FI in Jamaica.
Abstract P2162: Contributions of life-course socioeconomic position to later-life MRI measures of vascular brain injury: Results from SOL-INCA-MRI
Introduction: Cardiovascular and brain health are closely related. Increasing research has shown that cumulative exposure to low socioeconomic position (SEP) over the life-course increases the burden of poor cardiovascular and brain health. However, the influence of life-course SEP in later-life measures of vascular brain injury has rarely been evaluated Hypothesis: Life-course SEP is associated with white matter hyperintensity volume-WMHV and brain infarcts, two magnetic resonance imaging-MRI derived measures of vascular brain injury Methods: We used data from adults aged 50-85 years (n=2400) of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL-INCA-MRI), a population-based cohort study in the U.S. Participants' self-reports of their parental educational attainment was used as a proxy for childhood SEP (<high school-HS and ≥HS). Indexes combining participant’s education, household income, employment, and house ownership were used as proxy for adult SEP (lower and higher SEP) at visit 1 (2008-2011) and visit 2 (2014-2017). Using childhood and adult SEP at visit 1, we classified participants into four socioeconomic mobility categories (stable low or high SEP, upward or downward mobility). WMHV and brain infarcts were quantified (2018-2022) using 3T MRI scans. We used inverse probability weighting and marginal structural models accounting for the complex sampling design, demographic, behavioral, and clinical covariates to quantify the association between life-course SEP and log-WMHV and brain infarcts (Yes or No) Results: Hispanic/Latinos with higher adult SEP at visit 2 had -0.25 (-0.46, -0.04) log-WMHV relative to those with lower SEP. Similarly, adults with upward socioeconomic mobility had -0.24 (-0.47, -0.02) log-WMHV relative to those with stable low SEP. We did not find associations between childhood or adult SEP at visit 1, downward or stable high SEP with log-WMHV. No associations were found between measures of life-course SEP and brain infarcts, except for upward socioeconomic mobility (OR: 0.52 [0.27, 1.00]) Conclusion: This study shows that, among U.S. Hispanic/Latinos, higher adult SEP at visit 2 and upward socioeconomic mobility have a positive influence on WMHV or brain infarcts, highlighting the benefits of an advantageous life-course SEP on measures of vascular brain injury. This study also suggests that vascular brain injury is mostly influenced by stressors in later adulthood rather than in early life
Abstract P3175: Navigating Stroke Recovery: The Association of Insurance Coverage on Hospital Discharge Disposition in Rural versus Urban Settings in North Carolina
Introduction/Hypothesis: Hospital discharge disposition of stroke patients is influenced by various factors, including health status, recovery needs, and healthcare resource availability. Health insurance coverage as a proxy for access to post-stroke care may reveal disparities in discharge outcomes. We examined the association between insurance status and discharge outcomes for stroke patients in rural and urban North Carolina, emphasizing the importance of stratifying by rurality to explore potential differences in access to care. Methods: We obtained demographics, county of residence, insurance, admission date, and discharge disposition of adult patients with principal discharge diagnosis codes for stroke (ICD-10-CM I60.xx-I63.xx) from an inpatient database of hospitalizations from January 2019 to September 2020 across 115 NC hospitals. We categorized patient insurance status as Private, Self-pay, Medicare, Medicaid, or Other. We dichotomized discharge disposition to Home or Healthcare Facility. Multivariable logistic regression estimated associations between insurance and discharge outcomes, adjusting for age, sex, stroke type, and rurality. Separate models for rural and urban populations explored differences in discharge patterns. Results: Among 31,935 patients with a mean age of 69, 38% lived in rural counties, 50% were female, and 60% were discharged home. Medicaid (OR=0.64, 95% CI: 0.58-0.70) and Medicare (OR=0.75, 95% CI: 0.71-0.80) patients had lower odds, and Self-pay (OR=2.07, 95% CI: 1.83-2.35) patients had higher odds of being discharged home compared to patients with private insurance. Discharge outcomes based on insurance status were consistent across rural and urban subgroups. Conclusions: Insurance status is significantly associated with discharge outcomes, with Medicaid and Medicare patients less likely and Self-Pay patients more likely to be discharged home compared to private insurance, regardless of rurality. Understanding discharge dynamics can inform policies to improve access and equity in post-stroke care. Further research should explore discharge disparities for vulnerable patient groups.
Broken time-reversal symmetry in visual motion detection
Our intuition suggests that when a movie is played in reverse, our perception of motion at each location in the reversed movie will be perfectly inverted compared to the original. This intuition is also reflected in classical theoretical and practical models of motion estimation, in which velocity flow fields invert when inputs are reversed in time. However, here we report that this symmetry of motion perception upon time reversal is broken in real visual systems. We designed a set of visual stimuli to investigate time reversal symmetry breaking in the fruit fly Drosophila ’s well-studied optomotor rotation behavior. We identified a suite of stimuli with a wide variety of properties that can uncover broken time reversal symmetry in fly behavioral responses. We then trained neural network models to predict the velocity of scenes with both natural and artificial contrast distributions. Training with naturalistic contrast distributions yielded models that broke time reversal symmetry, even when the training data themselves were time reversal symmetric. We show analytically and numerically that the breaking of time reversal symmetry in the model responses can arise from contrast asymmetry in the training data, but can also arise from other features of the contrast distribution. Furthermore, shallower neural network models can exhibit stronger symmetry breaking than deeper ones, suggesting that less flexible neural networks may be more prone to time reversal symmetry breaking. Overall, these results reveal a surprising feature of biological motion detectors and suggest that it could arise from constrained optimization in natural environments.
Abstract MP25: The association between egg consumption, total serum cholesterol concentration, and cardiovascular disease incidence among American Indians: The Strong Heart Family Study
Prior studies suggest associations between egg consumption, serum cholesterol levels, subclinical atherosclerosis and cardiovascular diseases (CVD). However, existing evidence remains controversial and limited. This study aimed to investigate the association between egg consumption, serum cholesterol profiles, subclinical atherosclerosis incidence, and CVD incidence among American Indians. The Strong Heart Family Study (SHFS) is a multicenter, family-based, prospective cohort study of CVD among American Indian communities. We evaluated SHFS participants at the baseline between 2001 and 2003 (n=2147). Carotid ultrasounds were used to detect plaque at baseline and follow-up examinations between 2006 and 2009, with a median follow-up of 5.3 years (Q1, Q3: 4.8, 6.4 years). We identified 422 incident CVD events through 2022, with a median follow-up of 20.2 years (Q1, Q3: 16.6, 21.1 years). General linear mixed models were used to evaluate the association between egg consumption and changes in serum total cholesterol, triglycerides, LDL-C, and HDL-C levels. The analysis revealed very weak associations, with respective regression coefficients of -0.06, 0.0004, -0.02, and -0.05, and corresponding P-values of 0.005, 0.68, 0.05, 0.01. These findings suggested that egg consumption had minimal impact on serum cholesterol levels. Shared frailty proportional hazards models were used to assess the association between egg consumption and subclinical atherosclerosis or CVD. We did not find a significant association between egg consumption and the development of carotid plaque. After adjusting for age, study site, hypertension, diabetes, and total caloric intake, the hazards ratios for incident CVD in the 2 nd , 3 rd , and 4 th quartiles of egg consumption were 0.77(95%CI: 0.56-1.05; P: 0.1), 0.74 (95%CI: 0.55-0.98; P: 0.04), and 1.12 (95%CI: 0.8-1.49; P: 0.42), compared to those in the 1 st quartile. Participants in the 3 rd quartile had a significantly lower risk of developing CVD. This study found weak associations between egg consumption and serum cholesterol levels in the SHFS. Moderate egg consumption was associated with a significantly lower risk of developing CVD compared to the lowest consumption in this population. This association was not observed in the group with the highest egg consumption. Moderate egg consumption appeared to be a way for low-income communities to obtain essential nutrients, particularly proteins, without burdening on the cardiovascular system.
Abstract 054: Prospective associations of pregnancy heavy metals and essential elements with women’s mid-life obesity risk: implications of folate supplementation as a possible intervention strategy to mitigate metal-related health effects
Background: Pregnancy is a critical period for women’s long-term cardiometabolic health, with women being particularly sensitive to environmental exposures. The effects of heavy metals and essential elements during pregnancy on long-term obesity risk are understudied. Cohort studies and trials suggest that folate may mitigate metal toxicity—a recent AHA Scientific Statement on metals identified this area of research as a critical gap and priority. Objective: 1) To investigate the associations of pregnancy levels of metals and elements with women’s mid-life obesity risk; and 2) to explore whether adequate pregnancy folate mitigates the obesogenic effects of metals. Methods: Project Viva is a pregnancy cohort enrolled in Eastern MA between 1999-2002 (median age: 32.9y). We measured (As, Ba, Cd, Cs, Hg, Pb) and elements (Cu, Mg, Mn, Se, Zn) in red blood cells and folate in plasma collected during the first trimester. At the Mid-Life visit (2017-2021; median age: 51.2y), we measured weight and height and defined obesity as BMI >30 kg/m 2 (reference: ≤30 kg/m 2 ). We examined associations of metals and elements with obesity using modified Poisson regression, adjusting for confounders ( Figure 1 footnote ). We used Bayesian kernel machine regression (BKMR) to assess the mixture effects of all metals, elements, and folate. Results: We followed 500 women (72% White, 11% Black) for a median of 18.1y (range: 17.5-20.8y). Cs and Cu were associated with a lower risk of obesity: per doubling, Cs and Cu were associated with 0.78 (95% CI: 0.63-0.97) and 0.71 (95% CI: 0.50-0.99) times the obesity risk, respectively. Mg, Se, and Zn were also associated with >10% lower obesity risk, though the 95% CIs crossed the null ( Figure 1 ). BKMR results confirmed consistent dose-response associations ( Figure 2 ). Although neither As nor folate was individually associated with obesity, they showed an interaction in association with obesity ( Figure 3 ): at lower folate levels, As was associated with a higher obesity risk, but as folate levels increased, the As-obesity association was attenuated and eventually became inverse. Conclusion: Optimal pregnancy levels of essential elements (e.g., Cu, Se, Mg, Zn) were associated with a lower risk of mid-life obesity, while adequate folate levels may counteract the obesogenic effects of As. Our study advances a research priority in the AHA Scientific Statement, suggesting folate as a potential intervention strategy to mitigate metal-related health effects.
Abstract P1021: Leadless Pacemakers: A Systematic Review on Superior Alternative for Cardiac Support in Post-Valvular Interventional Patients
Background: Around 10% of patients need a permanent pacemaker due to conduction issues in heart post-valvular interventions. The transvenous pacemaker has many complications compared to novel Leadless pacemaker(LPM) implantation. Objective: The main aim of this review is to compare the outcomes between conventional transvenous pacemakers and leadless pacemaker implantation after valvular intervention. Method: We conducted a comprehensive search of PubMed and ScienceDirect databases for relevant studies published between 2019 and 2024 using the keywords- pacemaker implantation and valvular intervention. Studies available in full text and in English language were included. After removing duplicates using the Rayyan tool, the remaining studies were screened and selected based on predefined inclusion criteria. Eligible studies included retrospective analyses of patients aged over 40 years, with indications for leadless pacemaker implantation such as atrial fibrillation, sick sinus syndrome, complete heart block, or complications following pacemaker implantation. Patients who had previously undergone implantations were excluded. We performed a qualitative synthesis of data to note the comparisons. Result: A total of 9 studies were included, comprising 10,776 patients, of whom 1121 underwent LPM implantation and 9655 received conventional transvenous pacemakers. Indications for LPM following valvular interventions included atrial fibrillation(n=24), complete heart block(n=20), bradycardia(n=26), high-degree atrioventricular (AV) block(n=30), and left bundle branch block(n=9). For conventional transvenous pacemakers, complete heart block(n=24) and high-degree AV block(n=7) were the primary indications. Compared to LPM, patients with conventional pacemakers reported more complications like pocket formation, pericardial effusion, pneumothorax, and infections, along with increased hospital stay duration. A few patients with LPM suffered from device-related complications like device dislodgement and device thrombus formation. Conclusion: The above findings suggest that while both the devices showed some device related risks, LPMs presented with fewer overall adverse outcomes, and thus, may be a safer alternative than conventional pacemakers. There is insufficient data on the use of LPM after valvular interventions. Further studies are required to fully assess the risks and benefits of LPM and their usage in patients of conduction abnormalities after valvular interventions.
Cryo-EM meets crystallography: A model-independent view of the heteronuclear Mn <sub>4</sub> Ca cluster structure of photosystem II
Photosynthesis converts solar energy to chemical energy by splitting water molecules and carbon dioxide to produce oxygen and carbohydrates with an efficiency that engineers working on solar energy device can only dream of. Photosystem II (PSII) is the enzyme that catalyzes the light-driven oxidation of water that occurs during photosynthesis. This oxygen-producing reaction occurs in the Mn 4 Ca cluster found inside the enzyme’s oxygen-evolving center (OEC). Even though the structure and mechanism of action of the OEC have been intensively investigated for many decades, questions still remain about both. The Mn 4 Ca cluster stores the high-energy oxidizing equivalents required for water oxidation so that its own oxidation state depends on its chemical composition, i.e., the number of its oxygen ligands. The issue addressed here is the number of oxygen ligands associated with the Mn 4 Ca cluster after PSII has been exposed to two of the four flashes of light necessary for it to produce an oxygen molecule, PSII 2F. Comparisons of recently published cryo-EM maps and crystallographic OEC-omit maps described here reveal the OEC structure of PSII 2F contains only five internal oxygen ligands, and that the sixth O ligand identified earlier in PSII 2F crystal structures is an artifact caused by model bias. This finding should have a significant impact on our understanding of the mechanism of water oxidation that is catalyzed by PSII because it is incompatible with prevailing high valence paradigm (HVP) models for this process.
Abstract P3030: Associations of Co-Existing Hypertension and Diabetes with Mortality Risk in US Adults: A Prospective Analysis of the 1999-2018 National Health and Nutrition Examination Surveys
Introduction: Hypertension (HTN) and type 2 diabetes (T2D) prevalence is on the rise resulting in an increasing number of US adults living with multiple cardiometabolic morbidities. The association of co-existing HTN and T2D with mortality risk has not been quantified. Hypothesis: Co-existing HTN and T2D are associated with higher all-cause and cardiovascular mortality risk compared to having either condition alone or neither condition, and associations vary by sex, race and ethnicity. Methods: Participants were 48,727 adults from the 1999-2018 National Health and Nutrition Examination Surveys (NHANES). Blood pressure and glycemic indicators were used to categorize participants into 4 groups: 1) neither condition, 2) HTN only, 3) T2D only, 4) co-existing HTN and T2D. Mortality was ascertained using the National Death Index. Kaplan-Meier curves and multivariable Cox proportional hazards models evaluated associations with mortality. Results: Overall, 50.1% of participants had neither condition, 38.4% had hypertension alone, 2.8% had T2D alone, and 8.7% had both. During a median follow up of 9.2y, there were 7,734 total deaths, of which 2,013 were CVD deaths. Compared to having neither condition, co-existing HTN and T2D were associated with >2-fold and ~3-fold higher all-cause and CVD mortality risk (HR(95%CI): 2.46 (2.45, 2.47) and 2.97 (2.94, 3.00), respectively). Compared to having T2D or HTN only, co-existing T2D and HTN status was associated with up to 82% and 93% higher all-cause and CVD mortality risk. In stratified analyses, associations were stronger in females vs. males (p-interaction<0.01), and differential associations were observed by race and ethnicity (p-interaction<0.01) (Figure). Conclusions: The co-existence of HTN and T2D substantially increases all-cause and CVD mortality risk. Findings underscore the critical need for multilevel contextual interventions that address multiple cardiometabolic morbidities to extend lifespan and address chronic disease inequities in the US population.
Abstract P1084: Association of Body Composition and Incident Heart Failure and Heart Failure with Preserved Ejection Fraction and Heart Failure with Reduced Ejection Fraction in postmenopausal women
Background: As the US population ages, Heart Failure (HF) is reaching epidemic proportions, with heart failure with preserved ejection fraction (HFpEF) placing a particular burden on elderly women. While the association of obesity with the risk of heart failure is well established, the role of visceral adiposity and other measures of body composition have had limited research. Methods: A cohort of 10,527 postmenopausal women, mean age 63.3 (7.4) at baseline had DXA measures of VAT area ( cm 2 ), SAT area (cm 2 ), VAT/SAT ratio, Fat mass(kg), Lean mass (kg), % body fat and BMI (kg/m 2 ) and were followed for 16.7 years with 852 cases of incident HF . A sub-cohort of 3528 women were followed for the same period were evaluated for adjudicated HFpEF and HFrEF with 116 cases of HFpEF and 107 cases of HFrEF. We evaluate the association of the above body composition variables using multiple variable cox proportional hazards models (see tables below) .We also evaluated a comprehensive model including all sociodemographic and lifestyle variables as well as potential confounders/mediators of medical co-morbidities. Results: Both quartile and continuous measures of VAT, SAT, VAT/SAT ratio, Fat mass, lean mass, and BMI were associated with increased risk of HF and HFpEF with stronger associations with HFpEF but not HFrEF in our main model. The comprehensive model including potential mediators showed persistent but diminished associations for VAT, VAT/SAT ratio, Fat mass, Lean mass, and BMI but not SAT or %body fat. Time varying measures of VAT, VAT/SAT ratio showed persistent and stronger associations than baseline measures for HF and HFpEF but not HFrEF. Competing risk models for death and HF subtype when evaluating HFpEF or HFrEF showed similar but slightly attenuated results. Conclusion: Visceral Fat and VAT/SAT ratio, Fat mass, and Lean mass are associated with increased risk of HF and HFpEF but not HFrEF in this cohort of elderly women. Whether new treatments for weight loss that reduce visceral fat will reduce the risk of HF and HFpEF is worthy of future research.