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Abstract TH916: Differential effects of fruit and vegetable types on lipid profiles and metabolic responses in free-living individuals with untreated prehypertension

Background: Epidemiological evidence shows that fruit and vegetable (FV) intake reduces cardiovascular risk. Comparative effects of diets with different FV types on cardiometabolic disease risk markers remain unclear. Objectives: This study aimed to compare the effects of standardised diets differing in FV types on vascular function, other cardiometabolic disease risk markers, urinary and plasma biomarkers in free-living adults with untreated prehypertension. Methods: In a 9-wk randomised, controlled, crossover trial at 2 centres, 39 adults consumed standardised, provided diets with either 8 daily portions of common FV (apple, banana, pear, bell pepper, carrot, tomato), 8 daily portions of citrus and cruciferous FV, or 2 daily portions (low FV diet, control) for 2 wk per arm, with a 1-wk washout. Adherence was assessed using 24-h urinary potassium, sodium, and targeted plasma carotenoids and metabolites. The primary outcome was office blood pressure; secondary outcomes included pulse wave velocity (pwv), augmentation index standardised at 75 beats per minute (AIX75), lipids, and C-reactive protein (CRP). Between-group differences were assessed using linear mixed models with diet and period as fixed effects, and participant as random effect. Results: Thirty-six participants completed the study (67% male, mean age 54±6 y; systolic BP 131.7±9.0 mmHg, total cholesterol: 5.4±1.1 mmol/L). No between-group differences were observed in office BP, PWV, AIX75, or CRP. Both common and citrus fruits and cruciferous FV diets tended to increase 24-h urinary potassium (by 6.94 mmol/24-h, P ≤0.1; 8.0 mmol/24-h, P ≤0.06, respectively), while 24-h urinary sodium remained comparable across diets (P≥0.87). Common FV diet significantly increased α- and β-carotene, and lycopene ( P ≤6.3x10 -4 ), whereas citrus fruits and cruciferous FV increased lutein/zeaxanthin, β-cryptoxanthin, proline betaine, N-methylproline, and S-methyl-L-cysteine sulfoxide ( P ≤6.9x10 -8 ). Common FV diet reduced total (-0.19 mmol/L, 95% confidence interval (CI): -0.32,-0.05), LDL (-0.15 mmol/L, 95% CI: -0.26,-0.03), and HDL (-0.05 mmol/L, 95% CI: -0.09,-0.00) cholesterol, whereas citrus and cruciferous FV reduced urinary creatinine (-1.19 mmol/24-h, 95% CI: -2.27,-0.11). No effects were observed on weight and physical activity. Conclusions: Objective biomarkers confirmed FV adherence and suggest that FV types differentially modulate lipid and metabolic responses within 2 wk, without measurable vascular effects.

Collective and augmented intelligence outperform artificial intelligence on emotion recognition tests

Abstract 51: Risk of severe hypoglycemia in older adults with diabetes according to cognitive status

Introduction: Severe hypoglycemia (an episode of low glucose requiring assistance) is a rare but serious complication of type 2 diabetes. Diabetes management guidelines for older adults with cognitive impairment recommend less stringent glycemic targets and avoiding insulin and sulfonylureas to reduce the risk of hypoglycemia. However, the risk of severe hypoglycemia according to cognitive status and older adults with diabetes in the general population is poorly characterized. Hypothesis: Older adults with diabetes and mild cognitive impairment or dementia (vs having diabetes and no cognitive impairment) will (1) frequently use high-risk glucose-lowering medications and (2) have an elevated risk of severe hypoglycemia in a community-based population. Methods: We conducted a prospective cohort analysis using data from the Atherosclerosis Risk in Communities (ARIC) Study, with visit 5 (2011–2013) as baseline. We limited our population to the 1,632 participants with diabetes (defined by medication use or self-reported physician diagnosis) and valid cognitive status. Severe hypoglycemia events were ascertained from diagnostic codes. We used the nonparametric cumulative incidence function with a competing risk of death to obtain cumulative incidence estimates for severe hypoglycemia according to baseline cognitive status. We used the Fine-Gray subdistribution hazards model to obtain adjusted (for age, race, and sex) associations of cognitive status with the cumulative incidence of severe hypoglycemia. Results: The study population had a mean age of 75 year (SD, 5), 44% male; and 65% White adults, 7% had dementia, and 25% had MCI. Approximately 50% of participants with dementia or MCI were currently using high-risk glucose-lowering agents (insulin or sulfonylureas). The 5-year risks of mortality were 55%, 26%, and 13% in those with dementia, MCI, or normal cognition, respectively. After accounting for the competing risk of mortality, severe hypoglycemia was strongly associated with dementia and MCI ( Figure ). These associations persisted after adjustment for age, race, and sex (Figure). Conclusions: Cognitive impairment was associated with more than a 2-fold increase in the 5-year risk of severe hypoglycemia. In older adults with diabetes, insulin or sulfonylureas was common in individuals with cognitive impairment despite clinical recommendations for discontinuation in most patients. These results suggest the need to improve guideline adherence.

Abstract MPWE32: Biological Aging, Cognitive Decline, and Dementia Risk in a Community-Based Cohort: the Atherosclerosis Risk in Communities Study

Background: Chronological age is a major risk factor for cognitive decline and dementia, but it does not fully capture individual variability in biological aging processes. While prior studies have examined associations between biological aging—primarily measured using epigenetic clocks or telomere length—and cognitive outcomes, findings have been mixed and often limited by cross-sectional designs or short follow-up periods. The objective of this study was to test the hypothesis that higher midlife biological aging, as measured by homeostatic dysregulation, is associated with accelerated cognitive decline and an increased risk of dementia in later life. Methods: We analyzed data from 14,024 participants in the Atherosclerosis Risk in Communities (ARIC) Study, aged 45-64 years at baseline (Visit 2, 1990-1992), with up to 33 years of follow-up data. Biological aging at baseline (midlife) was quantified as homeostatic dysregulation using the Mahalanobis distance across 19 biomarkers and then categorized into quartiles. Repeat measures of cognitive function were collected and harmonized into a global cognition factor score. Incident dementia was ascertained through cognitive assessments, informant interviews, hospital records, and death certificates. Associations were evaluated using Cox proportional hazards models (for incident dementia) and linear mixed-effects models (for cognitive decline), with multiple imputation for missing data. Results: Over a median follow-up of 23.7 years, 3,482 participants developed dementia. A higher midlife biological aging score was associated with increased dementia risk (HR for highest vs. lowest quartile group: 1.66; 95% CI: 1.50, 1.84; p-trend < 0.001). Higher midlife biological aging was also associated with lower baseline cognitive function (highest vs. lowest quartile group: β = -0.153 SD; 95% CI: -0.207, -0.100) and faster rates of decline in global cognition (highest vs. lowest quartile group: β = -0.038 SD/decade; 95% CI: -0.064, -0.012). Conclusions: Midlife biological aging is a strong, independent predictor of later-life dementia risk and more rapid cognitive decline. These findings support the utility of measuring multisystem biological aging metrics earlier in the lifecourse to identify individuals at elevated risk for cognitive impairment, and also highlight the potential for early-life interventions targeting systemic aging processes.

Research on the plugging mechanism in fractured formations and the drilling fluid system for while-drilling leak prevention

Abstract MPTU23: A Payor-Supported, Post-Discharge Medically Tailored Meal Intervention Reduces Readmissions and Medical Spending in Medicare Advantage Members

Background: Medically tailored meals (MTMs) are an emerging strategy to improve access to evidence-based nutrition, support recovery, and prevent avoidable readmissions for older adults in the post-acute period. In alignment with the AHA Health Care by Food™ initiative, scaling MTM programs requires robust systems to identify eligible members, coordinate timely interventions, and measure their real-world clinical and economic impact. Objective: To describe outcomes of a payor-supported, post-discharge MTM supplemental benefit for Medicare Advantage (MA) members of a large national health plan. It was hypothesized that MTM recipients would have relatively lower utilization and expenditures than non-recipients. Methods: Interoperable administrative claims and vendor data identified MA members discharged to home following acute inpatient hospitalization in 2023 with 6-mo continuous coverage. MTM-eligible members were contacted within 3–5 days post-discharge and offered MTMs tailored to dietary and clinical needs. Meal quantity varied by plan design and member preference. A propensity score–matched (PSM) cohort design with difference-in-difference analysis compared 3-mo pre- and post-discharge outcomes between MTM recipients and matched members who declined MTMs. Supplementary analyses evaluated outcomes by meal volume (≤14, >14 meals). Results: Of 276,226 MTM-eligible members, 113,498 (41.1%) opted in. The final study sample included 103,684 PSM members (51,842 per cohort; mean age 73.6y; 55% female; hypertension [87%], diabetes mellitus [41.9%], and heart failure [37.5%]). At 3-mo post-discharge, MTM recipients had relatively fewer 30-day all-cause readmissions (−2.8 per thousand per member, PTPM), inpatient visits (−62.2 PTPM), and lower total medical spend (−$507.81 per member per month; all P<.001). Utilization and spend were relatively lower among members receiving ≤14 (all P<.001), with mixed findings for >14 meals. Conclusions: A data-informed implementation model enabled timely identification, engagement, and scaled delivery of a MTM benefit to support MA members residing across the US. MTM receipt was associated with favorable differences in 30-day all-cause readmissions, inpatient visits, and medical spend, with variable results by meal volume. Findings may inform policy efforts to advance integration of nutrition-based interventions in post-acute care pathways and emphasize the value of multi-stakeholder coordination across the health care ecosystem.

Abstract 04: Proteomics insights into heterogeneous associations between adiposity measures and all-cause mortality

Background: Heterogeneity of associations between adiposity traits and all-cause mortality is well-reported, but its modifiable contributors are poorly characterized. Proteomics systematically characterizes physiology and pathophysiology of health. No study has comprehensively investigated effect-measure modifications of proteomics on the mortality risk associated with adiposity traits. Methods: Using the UK Biobank data, we evaluated effect-measure modifications of proteomics on all-cause mortality risk associated with nine adiposity traits (i.e., BMI, waist circumference, waist-to-hip ratio, hip circumference, whole body fat mass, arm fat mass, leg fat mass, trunk fat mass, and VAT) using Cox regressions. Restricted cubic splines were implemented to model effect-measure modifications for proteins on the associations between adiposity and all-cause mortality. Through integrating adiposity, proteins, and interaction terms, we developed ObesRISK for predicting all-cause mortality risk using gradient boosting machine. Discrimination was assessed using Harrell C-statistics. We further estimated associations of ObesRISK with multi-organ traits using multivariable linear models. Results: This study analyzed proteomics data from 46,233 participants. During a median follow-up of 14.6 years, 4621 deaths were documented. After applying Bonferroni correction, ADIPOQ ( P int =4.1×10 -6 ), LEP ( P int =7.8×10 -10 ), and RTN4R ( P int =3.9×10 -7 ) modified the associations between BMI and all-cause mortality. We further identified 16 proteins that modified the all-cause mortality risk associated with the other eight adiposity traits. Pathway analyses mapped these proteins to inflammation, hormones (estradiol and glucocorticoid), and lipid metabolism. The mortality risk of adiposity varied depending on different levels of the identified proteins (all Bonferroni-corrected P int <0.05). Empowered by protein-adiposity interactions, ObesRISK outperformed adiposity and routine biochemical profiling in predicting all-cause mortality (ΔC-index=0.036, 95%CI: 0.027-0.042). Furthermore, ObesRISK was associated with multi-organ dysfunctions including the brain, cardiac, and metabolic systems. Conclusion: This study advances the understanding of heterogeneities in mortality risk associated with adiposity traits by utilizing a proteome-wide interaction modelling framework, thereby providing a proteomics approach that may improve precision risk classification and risk prediction of all-cause mortality.

A predictive model for treatment efficacy in RAS wild-type advanced colorectal cancer: development and external validation for EGFR inhibitor plus anti-angiogenic therapy based on a retrospective cohort

Abstract MPTH65: Associations of joint pain and intermittent claudication with objectively measured physical activity: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background: Joint pain and intermittent claudication, two common forms of chronic leg pain syndromes, are associated with reduced physical activity. However, previous studies analyzed these conditions separately, and therefore, their combined association with objectively measured physical activity in a large representative population is unknown. Methods: Using data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), we studied 7,418 adults aged 45-74 years at baseline (2008-2011). Joint pain and intermittent claudication were identified with a questionnaire, and free-living physical activity was objectively assessed over one week, during waking hours, with a hip-worn accelerometer. Daily physical activity measures included: sedentary, light, and moderate-vigorous intensity time, and total activity counts. We used multivariable linear regression models accounting for sampling weights and design factors to estimate differences in activity metrics across joint pain and intermittent claudication groups. Results: In Hispanic/Latino adults, 23% and 26% had joint pain and intermittent claudication, respectively, and 9% had both conditions. Mean of sedentary, light, and moderate/vigorous activity, and total physical count were 493 min/day, 437 min/day, 19 min/day, and 2139 count/day, respectively. After adjusting for potential confounders and each of the leg pain measures, joint pain compared to no joint pain was associated with higher sedentary time and lower total activity counts and showed borderline significance in light and moderate/vigorous activity. In contrast, intermittent claudication was significantly associated with only lower moderate/vigorous activity. Across categories, joint pain without claudication showed the least active profiles (e.g., more sedentary time [+15.1 min/day vs. no joint pain/no claudication], and fewer light active minutes [-12.9 min/day] and activity counts [-86.9 count/day]), except moderate/vigorous activity for claudication without joint pain had the shortest time (-2.9 min/day). Conclusion: Joint pain and intermittent claudication were independently associated with physical activity, with the former associated with a broader range of activity parameters and the latter particularly linked with moderate/vigorous activity. Our findings highlight the importance of evaluating both symptoms in physical activity research and suggest their unique contributions to activity impairment.

Abstract TU116: Prevalence, Temporal Trends, and Risk Factors of Hyperkalemia in U.S. Adults: NHANES 2001–2023

Background: Understanding the prevalence and risk factors for hyperkalemia is critical for public health policy, especially given the burgeoning interest in use of potassium-enriched salt substitutes as a means to reduce sodium intake. Importantly, data on the prevalence of hyperkalemia in the US are sparse, overall and in high-risk subgroups. Aim: To investigate the prevalence, temporal trends, and risk factors for hyperkalemia in the US using nationally representative data. Method: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2001 through 2023. Hyperkalemia was defined as a serum potassium levels >5.0 mmol/L. Prevalence of hyperkalemia was estimated overall and by survey cycle using logistic regression. Candidate predictors of hyperkalemia, including hypertension, chronic kidney disease (CKD), diabetes, sex, age, race/ethnicity, alcohol use, smoking status, renin–angiotensin–aldosterone system (RAAS) inhibitors, were examined in crude models. Then, significant factors were incorporated simultaneously in a multivariable model and presented, along with the prevalence of hyperkalemia in each relevant subgroup. All analyses incorporated sampling weights. Results: Among 45,778 U.S. adults aged 20 years and older pooled across the 2001–2023 NHANES survey cycles, 373 had hyperkalemia. The overall prevalence of hyperkalemia was 0.46% (95% CI 0.29-0.71%). Although the prevalence of hyperkalemia appeared to be increasing from 0.16% (0.07-0.33%) in 2005-2006 to 0.75% (0.46-1.21%) in 2017-2020 ( Figure ), in the entire two decades, its prevalence was largely constant between 0.3% and 0.6%, with no clear temporal trend ( P for trend = 0.07). Factors significantly associated with hyperkalemia included CKD, older age, and male sex ( Table ). Non-White racial/ethnic groups and current alcohol users showed lower prevalence compared to their counterparts. The only subgroups with the prevalence of hyperkalemia exceeding 1% were people with CKD and older adults (≥65 years). Conclusion: The overall low prevalence of hyperkalemia without evident temporal trend supports the safety of promoting potassium-enriched salt substitutes among U.S. adults. However, careful implementation may be warranted for individuals with risk factors, such as CKD, older age, and male sex. In contrast, racial/ethnic minorities and current alcohol users showed a lower prevalence of hyperkalemia and could particularly benefit from potassium-enriched salt substitutes.

Enhanced content-based image retrieval via hybrid color, texture, and deep learning features

Abstract WE537: The Effect of Different Doses of Resistance Exercise on Changes in Monthly Blood Pressure

Background: Although the dose-response relationship between aerobic exercise (AE) and blood pressure has been well studied, the dose-response relationship of resistance exercise (RE) combined with AE with blood pressure (BP) is understudied. Methods: This ongoing randomized controlled trial enrolled 111 participants aged 40 years or older who were inactive, overweight or obese (body mass index [BMI] 25-43kg/m 2 ), and non-smokers. Participants were randomized into one of four groups: 0 minutes (min) (n=30), 15 min (n=28), 30 min (n=26), or 60 min (n=27) of RE twice per week for 6 months. All groups were prescribed 30 min of AE per session following the current US Physical Activity Guidelines recommending both AE and RE. Monthly BP was the average of weekly BP taken before the first exercise of each week. Data was analyzed by a linear mixed model with age, sex, BMI, and month 1 (M1) BP as covariates. Results: For the 111 participants, mean (standard deviation [SD]) age was 57 (10) years, mean (SD) BMI of 32.5 (4.5) kg/m 2 ; 82 (73.8%) participants were female. Mean (SD) of M1 systolic BP (SBP) was 120.8 (12.8) mmHg and mean (SD) of M1 diastolic BP (DBP) was 80.7 (8.7) mmHg. From M1 to M6, SBP decreased -2.30 (95% CI, -4.29 -0.3: p=0.025) mmHg, while DBP decreased -2.29 (95% CI, -4.32 -0.26: p=0.028) mmHg in overall sample. Neither SBP nor DBP in the RE groups decreased differently than AE alone (control group). Although not statistically different, 15 min of RE, followed by AE alone, appear to be more effective to reduce both SBP and DBP, however more RE (30 min and 60 min) did not show larger reductions in SBP and DBP over 6 months. The SBP mean changes from M1 to M2 are -0.87, -2.04, -0.59, 0.12: M1 to M3 are -1.71, -3.13, -1.76, -0.51: M1 to M4 are -3.77, -4.49, 0.25, -0.98: M1 to M5 are -3.05, -2.64, -1.00, -1.86: and M1 to M6 are -2.73, -3.51, -1.59, -1.37 mmHg for the AE only, 15 min, 30 min, and 60 min groups, respectively. The DBP mean changes from M1 to M2 are -0.92, -1.93, -0.59, 0.14: M1 to M3 are -1.81, -3.01, -1.82, -0.71: M1 to M4 are -3.70, -4.65, 0.11, -1.19: M1 to M5 are -2.88, -2.87, -1.00, -1.94: and M1 to M6 are -2.54, -3.62, -1.72, -1.19 mmHg for the AE only, 15 min, 30 min, and 60 min groups, respectively. Conclusions: Preliminary data suggest that RE added to AE does not appear to further reduce (or increase) BP in adults with overweight or obesity. A larger sample (n=240) should confirm the findings after the trial is completed.

Abstract TH817: Development of a new diabetes classification algorithm for epidemiological studies: The Jackson Heart Study

Objective: In epidemiologic studies, diabetes classification is typically based on lab measures (i.e., hemoglobin A1c (HbA1c), fasting or non-fasting glucose, 2-hour post-prandial glucose) and use of diabetes medication from a medication inventory or self-report. However, new medication classes initially intended for diabetes, such as glucagon-like peptide-1 (GLP-1) agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors now have multiple treatment indications such as cardiovascular disease and weight management, presenting a methodological challenge for diabetes classification in observational studies. Our objective was to develop and evaluate a new algorithm to classify diabetes status in cohort studies accounting for novel medication classes with multiple indications. Research Design and Methods: Using data from 1,767 Jackson Heart Study (JHS) participants who completed Exam 4 (2021-2025), we developed a new diabetes classification algorithm based on a combination of lab measures (HbA1c, glucose), identifying diabetes medication classes from the participant’s medication inventory, and using the participant’s self-reported use of medications for diabetes for confirmation of status when using newer medication classes (GLP-1, SGLT2). We compared this new algorithm to the traditional diabetes classification which assumes a single primary indication for diabetes medications. Modified Poisson regression was used to estimate crude associations between diabetes, comparing the newer definition and the traditional definition, and select cardiovascular risk factors. Results: The new definition classified 36.8% of participants as having diabetes compared to 37.0% using the traditional definition. There were 147 (8.3%) participants differentially classified including fewer participants with missing data in the new definition. The two definitions yielded similar prevalence ratios (PR) for the association of diabetes with obesity (New definition PR=1.44(1.27,1.63); Traditional definition PR=1.40(1.23,1.58)) and chronic kidney disease (New definition PR=1.14(1.01,1.29); Traditional definition PR=1.16(1.03,1.30). Conclusions: The new and traditional diabetes definitions led to similar associations in the JHS. However, as the use of newer diabetes medication classes continues to increase for other health conditions, there is greater potential for misclassification in observational studies and the new definition should be considered for use.

Predicting wear behavior of AZ31/TiC composites produced via ultrasonic vibration assisted friction stir processing using machine learning models

Abstract This work aims to produce AZ31 Mg alloy reinforced with 15 vol.% TiC utilizing a unique Friction Stir mechanical vibration Processing (FSVP) technology, emphasizing the improvement in tribological properties of the produced composite. The dry sliding wear characteristics of the composite generated using conventional Friction Stir Processing (FSP) and the suggested FSVP process were assessed under different applied loads utilizing a pin-on-disc tribometer. The experimental findings indicate that FSVP markedly decreases the coefficient of friction and enhances wear resistance, especially under elevated load circumstances. The incorporation of 15 vol.% TiC into the AZ31 matrix reduced the wear rate by approximately 25% at moderate loads and up to 50% at elevated loads. Analysis of the wear mechanisms indicated a progression from mild oxidative and abrasive wear at lower loads to delamination, adhesion and severe plastic deformation under higher load regimes. The superior wear performance of the FSVP-processed AZ31/15 vol.% TiC composites is attributed to increased surface hardness and enhanced work-hardening behavior. Furthermore, a Gradient Boosting machine learning model exhibited excellent predictive accuracy achieving R 2 values of 0.9925.

Abstract WE545: Association between Cardiometabolic Risk Factors and Future Multimorbidity Patterns: A K-means Clustering Analysis

Introduction: Multimorbidity, the co-occurrence of multiple chronic diseases, is associated with increased mortality and reduced quality of life. While cardiometabolic risk factors (CMRs) are strongly linked with cardiovascular events, their relationship with disease patterns across diverse organ systems remains unexplored. We examined associations between baseline CMRs and longitudinal chronic disease clustering patterns. Hypothesis: Baseline CMRs are associated with distinct multimorbidity patterns involving multiple disease domains. Methods: This study was performed with Tsuruoka Metabolomics Cohort Study, which included 11,002 participants (men 46.5%) at baseline in 2012. Of these, 3,396 participants (men 43.3%) who completed three surveys over six years were analyzed. Eighteen self-reported chronic diseases over six years were categorized into seven groups: inflammatory/tumorous gastrointestinal, ulcerative gastrointestinal, metabolic/renal, respiratory, ophthalmic, psychiatric, and skeletal/immune diseases. K-means clustering was applied to classify participants based on their prevalences of seven groups across the three surveys. Baseline CMRs included hypertension, hyperglycemia, dyslipidemia and overweight as defined by clinical guidelines. Multinomial logistic regression was performed to estimate odds ratios (ORs) for cluster membership versus the healthiest cluster, adjusting for age, sex, alcohol, and smoking. Results: A total of seven clusters were identified: one healthy and six disease-dominant clusters, including two inflammatory/tumorous gastrointestinal clusters (persistent and newly developed), metabolic/renal, ophthalmic with skeletal/immune, ulcerative gastrointestinal, and complex multimorbidity patterns. Baseline dyslipidemia showed elevated ORs in three clusters: persistent inflammatory/tumorous gastrointestinal (OR 1.59), metabolic/renal (OR 2.61), and complex multimorbidity (OR 1.81). The metabolic/renal cluster uniquely demonstrated multiple CMR associations with elevated ORs for hypertension (OR 1.60), dyslipidemia (OR 2.61), and overweight (OR 1.76). Conclusions: Baseline CMRs, particularly dyslipidemia, are associated with distinct multimorbidity patterns across diverse organ systems. These findings demonstrate that the impact of CMRs extends beyond the cardiovascular system, underscoring their relevance to multimorbidity across multiple domains. Integrated preventive strategies targeting CMRs may reduce multimorbidity burden.

Abstract WE438: Life’s Essential 8 and Risk of Type 2 Diabetes in Postmenopausal Women

Background: The American Heart Association’s (AHA) Life’s Essential 8 (LE8) identifies essential metrics for cardiovascular disease prevention and includes blood glucose, blood lipids, blood pressure, nicotine exposure, physical activity, diet, sleep duration, and body mass index (BMI). While the LE8 has been linked to cardiovascular outcomes, associations with type 2 diabetes (T2D) remain less established, particularly in diverse populations. Objective: To examine the association between LE8 and incident T2D among postmenopausal women and to evaluate subgroups by race, ethnicity, and age. Methods: We included 19,403 postmenopausal women in the Women’s Health Initiative without T2D at baseline. The overall LE8 score (0–100) was calculated using AHA definitions and categorized as high (80–100), moderate (60–79), and low (0–59), with higher scores indicating a healthier lifestyle. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between LE8 and incident T2D, adjusted for potential confounders. Results: During a mean of 16.3 years of follow-up, 3921 cases of T2D were identified. Women in the highest LE8 category had a 57% lower risk of T2D compared with those in the lowest category (HR, 0.43, 95% CI [0.38, 0.49]). A 20-point higher LE8 score was associated with a 43% lower risk (0.57 [0.54, 0.60]). Among the individual LE8 metrics, per 20-point increase in blood glucose (0.61 [0.59, 0.63]) and BMI (0.88 [0.87, 0.90]) were most strongly associated with T2D, followed by smoking (0.96 [0.94–0.98]), blood lipids (0.95 [0.93–0.97]), and blood pressure (0.95 [0.93–0.96]). Diet, physical activity, and sleep were not significantly associated with T2D in this population. Subgroup analyses showed stronger associations among Hispanic/Latina women (0.58 [0.55, 0.62]) compared with non-Hispanic women (0.46 [0.41, 0.53]), per 20-point increase. Associations were also stronger among younger women, but did not vary by race. Conclusions: Higher LE8 scores were associated with reduced risk of T2D in postmenopausal women, with blood glucose and BMI having the strongest associations with T2D. LE8 may serve as a practical framework for risk assessment to reduce T2D incidence in aging women.

Fluid–structure interaction and thermal performance: a numerical study on crossflow heat exchangers with aerodynamically optimised splitter elements

Abstract 37: Associations of Prenatal Per- and Polyfluoroalkyl Substances (PFAS) Exposures and Childhood Blood Pressure in the Environmental influences on Child Health Outcomes (ECHO) Cohort

Background: PFAS are widespread, persistent chemicals that cross the placenta and may affect fetal development. Animal studies suggest prenatal PFAS exposure increases offspring blood pressure (BP); however, epidemiologic evidence is limited and inconsistent. Hypothesis: We hypothesized that prenatal PFAS exposure is associated with higher childhood BP. Methods: We included children aged 3-13 years in the U.S. ECHO Cohort with data on gestational plasma or serum concentrations of PFOA, PFOS, PFHxS, PFNA, PFDA, and MeFOSAA. Children’s BP was obtained from study visits or medical records. We derived age-, sex-, and height-specific BP percentiles according to the 2017 American Academy of Pediatrics Guidelines and defined elevated BP as systolic BP (SBP) or diastolic BP (DBP) ≥90 th percentile. We used multivariable linear and modified Poisson models with generalized estimating equations and repeated BP measures clustered by participant (adjustment variables shown in Figure 1 footnotes ) and addressed missing data using multiple imputation by chained equations. We conducted subgroup analyses by child sex, ethnicity, and race, and we examined trimester-specific associations. Results: Among 2,435 children (50% female, 21% Hispanic, 25% Black), 22% had elevated BP at their last visit at a median age of 7.3 years ( Table 1 ). In adjusted analyses ( Figure 1 ), each doubling of PFOA was associated with a 1.23 (95% CI: 0.02, 2.45) higher SBP percentile, a 0.95 (0.10, 1.79) higher DBP percentile, and 1.07 (1.00, 1.15) times the risk of elevated BP. Each doubling of PFOS and PFNA was associated with a 1.14 (0.01, 2.27) and 0.85 (0.09, 1.61) higher DBP percentile, respectively. The PFOA-SBP association was stronger in males, and associations of PFOA, PFOS, and PFNA with DBP were stronger in females and non-Hispanic children. In trimester-specific analyses ( Figure 2 ), first-trimester PFOA, PFOS, and PFDA were associated with elevated BP; second-trimester PFOA and PFNA were associated with higher SBP percentiles; and third-trimester PFOS and MeFOSAA were associated with higher DBP percentiles. Conclusions: Prenatal exposure to PFOA, PFOS, and PFNA was associated with higher childhood BP. The trimester-specific associations should be interpreted with caution as they may also reflect cohort differences in PFAS profiles. PFAS may contribute to early-life programming of elevated lifelong cardiovascular risk, reinforcing the importance of population-level prevention.

Abstract 56: Effect of Expanded Child Tax Credit Advance Payments on Population Gestational Diabetes Rates: A Quasi-Experimental Analysis

Background: The temporary expansion of the federal Child Tax Credit (CTC) under the American Rescue Plan provided monthly advance payments to eligible families with children between July and December 2021 in the US. We used quasi-experimental methods to understand the effect of expanded CTC advance payments on rates of gestational diabetes mellitus (GDM). Methods: Using serial monthly cross-sectional US birth certificate data from the National Center for Health Statistics, we evaluated US residents aged 15-44 years who had a live birth between July 1, 2020 to August 31, 2022. We included individuals with a singleton birth, with available GDM and live birth order data, and with a high school education level or less since most would be eligible for CTC advance payments. Differences-in-differences linear probability models were used to evaluate the effects of ≥1, ≥4, or 6 (the maximum possible) advance payments received during pregnancy on population-level GDM rates. Analyses compared parous (likely eligible for CTC payments) and nulliparous (likely ineligible for CTC payments) individuals before (July 2020-June 2021) and after advance payments were disbursed (≥1 payment: July 2021-August 2022; ≥4 payments: October 2021-May 2022; 6 payments: December 2021-March 2022). Linear regression was used to evaluate the association of number of advance payments during pregnancy and GDM rate. Models controlled for maternal age, maternal race and ethnicity, and insurance type. Results: Among 2,834,715 births, 65.3% were to parous individuals. The overall GDM rate was 77.9 per 1000 births. There was a graded association between receiving advance payments during pregnancy and lower GDM rates: a reduction of 1.4 (95% CI, -2.7, -0.2) GDM cases per 1000 births among those who were eligible for ≥1 payment; a reduction of 2.6 (95% CI, -4.0, -1.2) GDM cases per 1000 births for those eligible for ≥4 payments; and a reduction of 3.5 (95% CI, -5.3, -1.7) GDM cases per 1000 births for those eligible for 6 payments. Between July 2021 and August 2022, each additional month of payments during pregnancy was associated with a 0.75 (95% CI, -1.05, -0.45) per 1000 births-lower GDM rate. Conclusions: Advance payments from the expanded CTC were associated with dose-dependent reductions in population GDM rates among parous individuals with a high school education or less. Economic assistance to families may promote health during pregnancy.

Predictive simulations of postural control: exploring the role of signal noise and neural delays in Parkinson’s disease

Abstract Postural instability is one of the key motor symptoms of Parkinson’s disease (PD), which worsens with disease progression, leading to an increased fall risk. The complex internal processes of postural control and the elements causing this instability due to PD are still not fully understood. Predictive neuromusculoskeletal simulations can help to gain insights into internal postural control processes and their correlations, which cannot be measured directly. In this paper, we investigated the influence of increased motor signal noise and neural delays on the postural control of quiet upright standing and the resulting sway parameters using a previously published postural control model following assumptions that higher signal noise and neural delays lead to postural impairments in PD. Simulation results were compared to experimental motion capture data from 31 individuals with PD and 31 age- and sex-matched healthy control participants. We found that both higher signal noise and increased neural delays led to an adapted postural control behavior that can be associated with PD. The variations in sway parameters showed high agreement with the previously measured experimental data and the differences between individuals with and without PD. However, further investigation into additional movement tasks is necessary to strengthen these findings.