Browse Articles

Abstract P3094: Digital Cardiovascular Health Promotion Among Adolescents In Nepal

The burden of cardiovascular diseases (CVDs) and the risk factors in adolescents are rising in Nepal, a low-income setting. Therefore, focusing on health education related to diet and physical activity for adolescents in their formative years is urgent. A digital medium may be an efficient way to reach this technologically oriented group. We developed a digital educational game through a collaboration between researchers in health and informatics from Nepal and Sweden and piloted the game as part of the ‘Heart-Related Intervention with Digitalization Among Young Adolescents (HRIDAYA)’ study. We found that 99% of adolescents had access to smartphones and 92% had access to the internet. The digital game was developed for android devices due to their predominance in Nepal. First, a survey was conducted among 649 adolescents to identify their digital prerequisites as well as their gaps in CVD-related knowledge, attitude, and practice. Second, the identified gaps defined the learning goals of the game, forming the foundation for an initial draft of the game concept. Third, we created a game paper prototype and tested it among 10 adolescents to explore their visual recognition and preferences. Based on the findings, we chose two levels of fidelity and tested them with 44 adolescents. We found that a higher-fidelity abstract style resulted in more positive feelings. This style was subsequently used for the final game. Fourth, the game was developed through an iterative process, which included both culturalization efforts and ensuring educational viability. Finally, the completed digital educational game ‘Happy Heart’ was played by 176 adolescents. It consisted of seven mini-games related to sugar, salt, and fat in different food items, physical activities, balanced diet, and nutrition groups. Immediate audio and video feedback kept the players motivated. Written texts in the game journal addressed knowledge gaps that could not be converted to game mechanics. In conclusion, a digital education like Happy Heart may be helpful in increasing knowledge, attitude and practice regarding CVDs among Nepalese adolescents. The development process indicated that the digital game has the potential to reach many adolescents and that they were receptive to the game. As the game is a low-cost educational effort that can easily be scaled up, it provides a promising avenue for cardiovascular health promotion in similar low-income settings.

Melatonin suppresses PD-L1 expression and exerts antitumor activity in hepatocellular carcinoma

Record of paleo water divide locations reveals intermittent divide migration and links to paleoclimate proxies

Drainage divide migration alters the geometry of drainage basins, influencing the distribution of water, erosion, sediments, and ecosystems across Earth’s surface. The rate of divide migration is governed by differences in erosion rates across the divide and is thus sensitive to spatiotemporal variations in tectonics and climate. However, established approaches for quantifying divide migration rates offer only indirect evidence for the motion of the divide and provide only migration rate averages. Consequently, transience in divide migration cannot be resolved, hindering the ability to explore environmental changes that drive the dynamics of such potential transience. Here, we study a set of datable terraces identified as markers of paleo-divide locations, which provide direct evidence for the paleo motion of the divide. The location and age of the terraces reveal intermittent divide migration at timescales of 10 4 to 10 5 y, with phases of rapid migration—at rates more than twice the average—which coincide with documented regional paleoclimate fluctuations. These findings highlight the intermittent nature of divide migration dynamics over geomorphic timescales and its potential sensitivity to climate changes, underscoring the impact of such changes on the planform evolution of drainage basins.

Abstract P1164: Sex Differences in Cardiovascular Risk Factors among Cardiac Rehabilitation Participants

Introduction: Cardiac rehabilitation (CR) programs collect cardiovascular health measures related to AHA core component recommendations for patient care and American Association of Cardiovascular and Pulmonary Rehabilitation certification. In secondary data analysis, we investigated sex differences in cardiovascular risk factors. Hypothesis: Cardiovascular risk factors will be different by sex. Methods: We obtained certification data [BMI, smoking status (Never, Former, Current), and Patient Health Questionnaire (PHQ9) score] as well as Generalized Anxiety Disorder (GAD7) score and diet (Picture Your Plate) score for CR participants in 2023 from our hospital associated outpatient CR program. Since data did not have a normal or log-normal distribution, categorical analyses were completed. BMI (kg/m 2 ) was categorized into Ideal (<25), Intermediate (25 to <30), Poor (≥30). PHQ9 and GAD7 were categorized as No, Minimal, or >Minimal Symptoms. Diet score categories were based upon published thresholds: Ideal (>60), Intermediate (51-60), Poor (<51). Descriptive statistics and standardized differences were computed. Results: Of the 202 CR participants, 29% were female, 31% were <65 years old, 86% were White, and 25% had a qualifying event of NSTEMI. Heart failure was higher in females (17%) than males (10%). On average, participants completed 31(SD:5.5) sessions. The majority (60% to 99%) of participants with data at program entry and exit did not switch categories regardless of measurement. There were similar proportions of males and females with stable ideal (25% vs 21%) or intermediate (37% vs 36%) BMI; however, a higher proportion of females (36%) had stable poor BMI than males (27%) (Table 1). Higher proportions of males had no symptoms (PHQ9: 22%, GAD7: 48%) than females (9%, 28%) pre-CR (Table 2). Among those with pre-/post-CR PHQ9 (25% missing), we observed improvement in a higher proportion of females (38%) than males (30%). Although 13% of pre-CR diet scores were missing, we observed higher proportions of females with ideal and intermediate (64%, 30%) diet scores than males (58%, 25%) (Table 3). One participant quit smoking post-CR. Except BMI and smoking, missing data was a limitation of post-CR analyses. Conclusions: Females gained greater mental health benefit from CR participation than males. Although exercise prescriptions are personalized, investigating the effect of sex-specific educational content is warranted given the differences we observed.

Abstract P3089: Predicting Reductions In Hemoglobin A1c From Large Dietary Datasets Using Artificial Intelligence Pipeline With Interpretable Encoder-Decoder Deep Neural Networks

Introduction: Artificial intelligence algorithms can help understand and predict the complex interactions between dietary intake and health outcomes, especially from large datasets. Precision nutrition leverages machine learning techniques to analyze such patterns, but the methods and uses need deeper examination. Objective: Demonstrate the viability of fully unsupervised training of a β-Variational Autoencoder (β-VAE, a fully unsupervised and robust framework for capturing latent features from high-dimensional data) to predict improved hemoglobin A1c from complex population-level dietary data. Methods: Our β-VAE neural network architecture (Figure 1) was trained using 10 cycles of cross-sectional datasets from the US National Health and Nutrition Examination Survey from 1999 to 2018. Dietary data were collected with 24-hour recalls. A cumulative 102,957 participants and 5885 food/nutrient items were aggregated into 547 interpretable latent variables. Results: The trained network performance was evaluated through an aggregated multi-participant study case (n=1000) that explored the relationship between the target hemoglobin A1c change percentage and associated potential changes in participants' diet. Among the top five dietary changes required to achieve a 20% reduction in the latent space value corresponding to hemoglobin A1c were increasing coffee/tea and seafood intake and decreasing sweets, pizza, and salt intake (Figure 1). Conclusion: The prediction model showed a reasonable alignment with dietary recommendations despite being trained in a fully unsupervised way. β-VAE may be a first-in-class, efficient, and interpretable framework to analyze complex population-level dietary data for precision nutrition research.

Stability analysis of existing tunnels under dynamic loads during excavation of new tunnels

Mechanical ventilation energy analysis: Recruitment focuses injurious power in the ventilated lung

The progression of acute respiratory distress syndrome (ARDS) from its onset due to disease or trauma to either recovery or death is poorly understood. Currently, there are no generally accepted treatments aside from supportive care using mechanical ventilation. However, this can lead to ventilator-induced lung injury (VILI), which contributes to a 30 to 40% mortality rate. In this study, we develop and demonstrate a technique to quantify forms of energy transport and dissipation during mechanical ventilation to directly evaluate their relationship to VILI. A porcine ARDS model was used, with ventilation parameters independently controlling lung overdistension and alveolar/airway recruitment/derecruitment (RD). Hourly measurements of airflow, tracheal and esophageal pressures, respiratory system impedance, and oxygen transport were taken for six hours following lung injury to track energy transfer and lung function. The final degree of injury was assessed histologically. Total and dissipated energies were quantified from lung pressure–volume relationships and subdivided into contributions from airflow, tissue viscoelasticity, and RD. Only RD correlated with physiologic recovery. Despite accounting for a very small fraction (2 to 5%) of the total energy dissipation, RD is damaging because it occurs quickly over a very small area. We estimate power intensity of RD energy dissipation to be 100 W/m 2 , equivalent to 10% of the Sun’s luminance at the Earth’s surface. Minimizing repetitive RD events may thus be crucial for mitigating VILI.

Abstract MP71: Smoking and Biological Aging Acceleration Measured by Midlife Proteomic Aging Clocks: Insights from the Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Biological age may provide unique health insights beyond chronological age. Proteomic aging clocks (PACs) assess a person’s biological age, and a positive deviation of biological age from chronological age is known as age acceleration. Smoking has been associated with greater risk of age-related diseases and conditions. It is also associated with age acceleration in previous studies that assessed biological age using DNA methylation-based epigenetic clocks; however, this association has not been investigated using PACs. Methods: A total of 5,762 participants free of CVD from the Multi-Ethnic Study of Atherosclerosis (MESA) had over 7,000 plasma proteins measured using an aptamer-based proteomic profiling platform at exam 1 (2000-2002). Two previously published midlife PACs (ARIC and Lehallier) were calculated from available proteins in MESA, and we calculated age acceleration for each PAC as residuals after regressing PAC on chronological age. We used linear regression to assess the association of self-reported smoking (status, pack-years, and secondhand smoke exposure) with age acceleration measured using both PACs, adjusting for demographics and other potential confounders. Results: The analytic sample was 52% female with a mean age of 62 years (range 45-84) and a race/ethnicity breakdown of 39% White, 12% Chinese, 26% Black, and 23% Hispanic. For smoking, 13% were current smokers, 49% had a total pack-years > 0, and 37% of never smokers had exposure to secondhand smoke. The age acceleration median was -0.15 years using the ARIC midlife PAC and -0.13 years using the Lehallier midlife PAC ( Table ). Smoking status and secondhand smoke exposure in non-smokers were not associated with age acceleration measured by either PAC. Pack-years in ever smokers was positively associated with age acceleration after adjustment for demographics only (model 1). Additional adjustment slightly attenuated the association between pack-years and age acceleration (model 2). Conclusion: Further research is needed to examine the effect of smoking on age acceleration measured by other PACs and determine how these associations compare to those between smoking and epigenetic aging clocks.

Abstract P3176: Burden of Stroke Attributable to Air Pollution in India and its Trend from 1990-2021: A cross State Comparative Assessment

Background: Stroke is a leading cause of mortality and disability worldwide, with environmental factors such as air pollution increasingly recognized as significant contributors. This study aims to evaluate the burden of stroke attributable to air pollution in India over a 31-year period. Methods: We conducted a retrospective analysis using burden of disease study 2021 from 1990 to 2021. The study focused on particulate matter (PM2.5 and PM10) as primary pollutants. The population attributable fraction (PAF) of stroke due to air pollution was calculated using risk estimates from contemporary studies, adjusted for demographic changes. Results: Over the three-decade period, the total recorded deaths attributable to air pollution-induced strokes amounted to 8,533,316, with an average of 7,983 deaths per year. The total Disability-Adjusted Life Years (DALYs) accrued due to strokes were over 204 million, averaging around 205,890 DALYs annually. Additionally, the total Years of Life Lost (YLLs) summed up to about 14,836,982, with a mean annual YLL of 192,675. Maharashtra reported the highest burden with 56,407 deaths, around 654,246 DALYs, and 611,353 YLLs due to stroke, indicating it as the state most affected by air pollution-related stroke incidents. In contrast, Sikkim reported the lowest stroke burden, with the smallest numbers across all measures: 109 deaths, 1,436 DALYs, and 1,250 YLLs. Males experienced a slightly higher stroke burden due to air pollution with 168,709 deaths and about 4,040,735 Years of Life Lost (YLLs). Females had about 148,785 deaths and approximately 3,377,256 YLLs. The 65-69 years age group had the highest number of deaths at 51,944 and over 1.26 million YLLs. This was closely followed by the 70-74 years age group, with about 54,945 deaths and over 1.10 million YLLs. Conclusion: Our findings underscore the critical need for stringent air quality control measures and public health strategies to mitigate the impact of air pollution on stroke incidence in India. Younger age groups, particularly below 25 years, show significantly lower numbers, indicating that air pollution primarily impacts the elderly in terms of stroke burden. Addressing this environmental risk factor is crucial for reducing the future burden of stroke and improving public health outcomes.

Muscle transcriptome profiles in elite male ultra-endurance athletes acclimated to a high-carbohydrate versus low-carbohydrate diet

Direct observation of cholesterol monohydrate crystallization

Cholesterol crystallization is integral to the pathology of diseases such as atherosclerosis and gallstones, yet the relevant mechanisms of crystal growth have remained elusive. Here, we use a variety of in situ techniques to examine cholesterol monohydrate crystallization over multiple length scales. In this study, we first identified a biomimetic solvent to generate triclinic monohydrate crystals, while avoiding the formation of nonphysiological solvates and enabling crystallization at rates where the dynamics of surface growth could be captured in real time. Using a binary mixture of water and isopropanol, with the latter serving as a surrogate for lipids in physiological environments, we show that cholesterol monohydrate crystals grow classically by the nucleation and spreading of crystal layers. Time-resolved imaging confirms that layers are generated by dislocations and monomers incorporate into advancing steps after diffusion along the crystal surface and not directly from the solution. In situ atomic force microscopy (AFM) and microfluidics measurements concertedly reveal abundant macrosteps, which engender a self-inhibition mechanism that reduces the rate of crystal growth. This finding stands in contrast to numerous other systems, in which classical mechanisms lead to unhindered growth by spreading of single layers.

Abstract MP75: Novel Heart Failure Stages Incorporating Cardiorespiratory Fitness are Differentially Associated with Heart Failure Risk in the Community

Background: Heart failure (HF) progresses through stages as depicted by the AHA/ACC/HFSA guidelines. These stages advance from the presence of risk factors (stage A), to asymptomatic structural heart disease, elevated filling pressures, or abnormal biomarkers (stage B), to clinical HF (stage C). However, even among individuals classified as having the highest pre-clinical risk (stage B), the majority do not progress to clinical HF. This highlights the need to identify new risk factors to refine preclinical HF phenotypes. Impaired cardiorespiratory fitness (CRF) is a powerful predictor of HF risk but is not currently considered in HF staging. Accordingly, we hypothesized that HF substages incorporating CRF would be differentially associated with HF risk. Methods: We investigated Framingham Heart Study participants with submaximal exercise testing (up to Bruce protocol stage 2) at a routine exam. CRF was estimated based on stage 2 heart rate, weight, age, sex, treadmill grade, and velocity using the equation from Loe, et al. Due to the importance of HR for determining estimated CRF, we excluded individuals on atrioventricular nodal blocking agents. We evaluated the association of HF substages (categorized by CRF above vs. below sex-specific median) with incident HF using Cox models adjusted for age and sex. Results: Our sample included 1683 individuals, 55% women, mean age 58±8 yrs, with estimated CRF 35±3mL/kg/min in women and 40±4mL/kg/min in men. A total of 522 individuals (31%) were classified as having no HF risk factors (“healthy”; stage H), 693 (41%) as stage A, and 468 (28%) as stage B. Over a median follow up of 20 years, 99 incident HF events occurred. HF incidence was highest in individuals categorized as stage B with lower than median CRF (B2, Figure 1A). Stage B participants with estimated CRF above the median did not have a significantly higher risk of HF compared to stage H participants, but those with stage B and low CRF had an over 2.5-fold higher risk of HF (hazard ratio [HR] 2.75, 95% CI 1.50-5.07, P<0.01; Figure 1B). Among stage B participants, every 1-SD higher CRF was associated with lower HF risk (HR 0.57, 95% CI 0.43-0.76, P<0.001). We did not observe an association of CRF with incident HF among individuals categorized as stage A. Conclusion: Incorporating CRF into HF staging criteria may improve risk assessment and facilitate precision targeting of preventive therapies, especially among individuals classified as stage B HF.

Abstract P3136: Association between resilience and health status among adults after myocardial infarction

Introduction: Women and men may recover from myocardial infarction (MI) differently. Resilience promotes psychological recovery post-MI but its association with health status, including health-related quality of life, angina frequency, and physical limitations, has been underexplored. Hypothesis: We hypothesized that higher resilience would be associated with better post-MI health status, and that this relationship would be stronger among women compared to men. Methods: We analyzed a cross-sectional sample of adult participants in the Heart Attack Research Program, a longitudinal study of adults post-MI. Resilience was measured with the Brief Resilience Scale (BRS), range 0-6, and dichotomized to low (BRS score <3) and normal/high (BRS score ≥ 3) resilience. We used Wilcoxon rank-sum tests to assess differences in scores of overall health status (Seattle Angina Questionnaire [SAQ-7]) and its 3 domains – angina frequency (SAQ-AF), physical limitations (SAQ-PL), and quality of life (SAQ-QL), by resilience group. We used multivariable linear regression to examine the association between SAQ scores and resilience. Covariates included age, sex (except in sex-stratified analyses), race, ethnicity, BMI, history of diabetes, hypertension, or hypercholesterolemia, and prior history of MI. Results: The study sample included 161 participants, 38% female, 76% white, with a mean age of 63±13 years. Median time from MI to data collection was 37 days, interquartile range [IQR 21-59 days]. Median SAQ7 score was 75 [IQR 57-89], and 19% of participants reported low resilience. Wilcoxon rank-sum tests showed significant differences in SAQ7, SAQ-QL, and SAQ-AF scores among those with low vs normal/high resilience, p=0.002, p=0.001, p=0.006, respectively, but not in SAQ-PL scores (Figure 1). After full adjustment, SAQ7 and SAQ-QL scores were positively associated with resilience (β 0.21, p=0.01 and β 0.25, p=0.003, respectively), but SAQ-AF and SAQ-PL were not (p=0.201 and p=0.184, respectively). When stratified by sex, the associations between SAQ7 and SAQ-QL, and resilience remained significant among female participants (β 0.33, p=0.036 and β 0.33, p=0.030, respectively), but not among male participants. Conclusions: Normal/high resilience was associated with better health status and higher health-related quality of life among this post-MI cohort, and particularly among women. Resilience building interventions may be considered as strategies to improve post-MI recovery.

Longitudinal observation of psychophysiological data as a novel approach to personalised postural defect rehabilitation

Correction for Huseby et al., Antibiotic class with potent in vivo activity targeting lipopolysaccharide synthesis in Gram-negative bacteria

Abstract MP57: Associations Between Multiple Ectopic Adiposity Depots and Gait Speed in African Caribbean Men

Introduction: Aging causes body fat redistribution, featured by an increase in ectopic adiposity. Gait speed, a key indicator of functional abilities, declines with aging. Persons of African ancestry have less visceral, hepatic, and pericardial, but more skeletal muscle adiposity compared to non-Hispanic Whites. They also have slower gait speed than non-Hispanic Whites. Several studies have reported an association between general or central obesity and gait speed; however, the results were inconsistent. Very few studies have assessed an association of multiple simultaneously-measured ectopic adiposity depots with gait speed. Methods: We measured ectopic adiposity depots (visceral, hepatic, pericardial, and intermuscular (IMAT) in the abdomen, thigh, and calf) by computed tomography, and 4-meter usual gait speed in 775 community-dwelling men of African ancestry (mean age = 63.9 ± 8.6 years, mean body mass index (BMI) = 27.7 ± 4.6 kg/m 2 ) in the Tobago Health Study. Anthropometrics were assessed using standard methods. Demographic, disease, and lifestyle characteristics were collected using a standardized questionnaire. Results: Higher general adiposity, as measured by BMI, and visceral adiposity were associated with slower gait speed in basic models, but associations were attenuated after further adjustment (Table 1). Higher IMAT in all three muscle groups assessed (abdomen, thigh, and calf) was associated with slower gait speed even in fully adjusted models (Table 1). There was no association between hepatic nor pericardial adiposity and gait speed. Conclusion: Ectopic adiposity, particularly within skeletal muscle, may play a key role in the loss of physical function in African Caribbeans. Longitudinal studies are needed to clarify the independent role of skeletal muscle adiposity in gait speed decline, and to identify possible local and systemic mechanisms underlying this association in high-risk persons of African ancestry.

Abstract P1057: Hypertension Screening in Children and Adolescents: A Global Policy Analysis

Introduction: The global prevalence of hypertension (HTN) among children and adolescents is estimated to range from 2% to 5%. However, it ranges from 1% to 22% in lower and middle income countries (LMICs). Differences in demographics, lifestyle and research methodology lead to the varied prevalence. Several high income countries have implemented screening guidelines, but LMICs lack personalised guideline adoption and execution. Methods: We conducted a narrative policy review to examine HTN screening recommendations for children and adolescents. Most recent versions of relevant policy documents (guidelines, policies, practice guides and consensus statements on HTN screening) were identified from countries and regions across the world. Content analysis was used to describe these recommendations qualitatively. Results: 12 policy documents were reviewed and all countries except the United Kingdom recommended regular HTN screening starting at 3 years. Except China and Japan, HTN was defined as systolic or diastolic blood pressure ≥ 95th percentile for age, sex, and height for all countries. Only Japan segregated individuals by school grades. American Heart Association standards for defining HTN were referenced by most guidelines, while India, Africa and Australia replicated them. Both European and American society used the 2004 US Task Force cohort for normal blood pressure values. Conclusion: The rising prevalence of HTN in children and young adults, largely driven by increasing rates of obesity and lifestyle, underscores the need for effective screening and intervention. Further research is needed to study newer cohorts and adapt guidelines to local contexts for optimising screening and intervention programs, particularly in LMICs.

Quantum speed limit time in two-qubit system by dynamical decoupling method

Specific microbial ratio in the gut microbiome is associated with multiple sclerosis

Gut microbiota dysbiosis is associated with multiple sclerosis (MS), but the causal relationship between specific gut bacteria and MS pathogenesis remains poorly understood. Therefore, we profiled the stool microbiome of people with MS (PwMS) and healthy controls (HC) using shotgun metagenomic sequencing. PwMS showed a distinct microbiome compared to HC, with Prevotella copri ( PC ) and Blautia species as drivers of microbial communities in HC and PwMS, respectively. Administration of MS-driving Blautia species ( Blautia wexlerae; BW ) to mice resulted in increased levels of gut inflammatory markers and altered microbiota with increased capacity to induce proinflammatory cytokines. Utilizing experimental autoimmune encephalomyelitis (EAE), an animal model of MS, we identified a lower gut Bifidobacterium to Akkermansia ratio as a hallmark of the disease. BW -administered mice also showed a lower Bifidobacterium to Akkermansia ratio pre-EAE induction which correlated with increased disease severity post-EAE induction. The importance of the Bifidobacterium to Akkermansia ratio at the species level, lower Bifidobacterium adolescentis to Akkermansia muciniphila ( BA:AM ), was validated in our MS cohort and a large International Multiple Sclerosis Microbiome Study. Thus, our findings highlight the BA:AM ratio as a potential gut microbial marker in PwMS, opening avenues for microbiome-based diagnosis, prognosis, and therapy in MS.

Abstract MP07: Derivations of Supine and Standing Blood Pressure and Their Associations with Adverse Cardiovascular and Hypotension-Related Events

Background: Postural drops in systolic blood pressure (SBP) are associated with cardiovascular and hypotension-related adverse events (falls, syncope). These associations are traditionally thought to be secondary to low standing blood pressure; however, the role of both high and low SBP in supine and standing positions has not been thoroughly characterized. Objectives: To compare traditional and alternative derivations of supine and standing SBP with adverse cardiovascular and hypotension-related outcomes. Methods: The Atherosclerosis Risk in Communities (ARIC) study measured supine and standing SBP in adult participants aged 45-64 between 1987–1989 and followed them for over 30 years. We examined low and high values (see Table) of supine SBP, standing SBP, absolute and relative differences in SBP after standing, and mean SBP between both positions in relation to adjudicated coronary heart disease (CHD) or all-cause mortality events as well as medical claims-based falls and syncope. We used Cox regression with adjustment for CVD risk factors. Cutpoints were chosen to match a population percentile approximating a 20 mm Hg difference between supine and standing SBP (the traditional definition for orthostatic hypotension). Results: Among 11,399 participants (mean age 54 yr [SD, 5.7]; 56% female; 25% Black adults), relative or absolute drops in SBP were associated with CHD and mortality. Higher mean supine and standing BP was also associated with CHD (HR 1.72; 1.41, 2.09) and all-cause mortality (HR 1.74; 1.54, 1.96). An absolute decrease (HR 1.24; 1.02, 1.50) or increase (HR 1.27; 1.01, 1.60) in SBP was associated with falls. An absolute or relative decrease (both HRs 1.48) and higher supine SBP (HR 1.30; 1.07, 1.58) were associated with syncope. Lower supine SBP was inversely associated with CHD (HR 0.62) and all-cause mortality (HR 0.82). Lower standing SBP was also inversely associated with CHD (HR 0.78; 0.64, 0.94) but not with falls or syncope. Conclusion: While both cardiovascular and hypotension-related outcomes were associated with postural drops in SBP, these outcomes were not consistently associated with low standing SBP. Rather, high supine SBP was associated with a greater risk of CHD, syncope, and death. Moreover, a rise in SBP with standing was associated with falls. These findings call attention to high SBP as a risk factor for both cardiovascular and hypotension-related outcomes and may have implications for treatment strategies if replicated.