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Abstract WE442: Disparities in Use of Cardioprotective GLP-1 Receptor Agonists and SGLT2 Inhibitors Among Insured Adults with Type 2 Diabetes at High Cardiovascular Risk

Introduction: Despite evidence from clinical trials showing the cardiovascular benefits of select GLP-1 receptor agonists and SGLT2 inhibitors in patients with type 2 diabetes mellitus (T2DM), uptake has been limited. We investigated the demographic, socioeconomic, and healthcare access factors associated with the use of these medications among insured adults with T2DM and high atherosclerotic cardiovascular disease (ASCVD) risk to identify potential barriers among those with access to care. Methods: Cross-sectional data from the 2021-2023 Medical Expenditure Panel Surveys were used to identify insured adults aged ≥ 18 years old with T2DM at high ASCVD risk, defined as having established ASCVD or ≥ 2 risk factors for ASCVD (hypertension, dyslipidemia, smoking). The primary analysis evaluated associations among demographic, socioeconomic, and healthcare access factors and the use of cardioprotective GLP-1 receptor agonists and SGLT2 inhibitors through multivariable logistic regression. A secondary analysis examined the role of patient-provider interaction factors and use of these medications among subjects with a usual healthcare provider. Results: Of the 5,536 adults with T2DM and high ASCVD risk, 56.9% were aged ≥ 65 years, 53.7% were male, and 59.8% were non-Hispanic White. In multivariable models, age ≥ 65 years (vs. age 18-44 years; OR 0.60; 95% CI 0.42-0.86), identifying as non-Hispanic Black (vs. non-Hispanic White; OR 0.74; 95% CI 0.58-0.95), having less than a high school graduate education (vs. college or more; OR 0.63; 95% CI 0.47-0.85), having low income (vs. high income; OR 0.71; 95% CI 0.57-0.86), and having no usual healthcare provider (OR 0.71; 95% CI 0.54-0.94) were associated with significantly lower odds of using a cardioprotective GLP-1 receptor agonist or SGLT2 inhibitor. There was no association for insurance type. Among the 4,831 adults with a usual healthcare provider, reporting that the provider explained all treatment options was associated with higher odds of using cardioprotective GLP-1 receptor agonists or SGLT2 inhibitors, though the relationship was not statistically significant (OR 1.38; 95% CI 0.88-2.18). Conclusions: Sociodemographic disparities were observed in the use of cardioprotective GLP-1 receptor agonists and SGLT2 inhibitors among insured adults with T2DM and high ASCVD risk. Further research is warranted to determine whether enhancing shared decision-making between patients and providers can promote use of these therapies.

Abstract 74: Resistance Training Lowers Blood Pressure in Older Adults with Low Muscle Strength: Findings from the INERTIA Study

Background: Hypertension and chronic low muscle strength—the primary indicator of sarcopenia—commonly co-occur in older adults and significantly contribute to CVD risk. While resistance training lowers blood pressure (BP) in younger hypertensive populations, its efficacy in older adults with low muscle strength remains unclear. In the INERTIA study, we evaluated the feasibility and preliminary effects of a 12-week progressive resistance training (PRT) intervention on changes in BP in older adults with low muscle strength. Methods: Older adults (≥60 years) without diagnosed CVD or conditions precluding PRT exercise were enrolled. Low muscle strength was defined using standardized criteria for grip strength (<30 kg men; <20 kg women). Participants were randomized (2:1 block allocation) to 12 weeks of biweekly supervised moderate-intensity PRT (60 to 80% 1RM, n=51) or an attention-control group (n=21) receiving home exercise mailings every 3 weeks. Paired t-tests assessed within-group BP changes from baseline to 12 weeks, and linear regression evaluated between-group differences in BP change. Linear mixed effect models estimated BP changes over time within the PRT group at baseline, 6 weeks, and 12 weeks (primary endpoint). Results: Seventy-one participants were randomized (average age 70.1±6.3 years) with 76% female, 44% non-white; and 42% on antihypertensive therapy. At baseline, resting BP was higher in the PRT group versus controls (131/82 mmHg vs 126/81mmHg, p =0.11). Within the PRT group, there was significant reduction in systolic (-7.0 mmHg, 95% CI 1.96, 12.0, p =0.0154) and diastolic BP (-4.8 mmHg, 95% CI 2.13, 7.52, p =0.0016) from baseline to week 12, while negligible changes were observed in controls ( Table ). Between-group differences in BP change were significant for diastolic BP only. Within the PRT group, significant BP reductions were evident by 6 weeks and remained significant at week 12 weeks for systolic (-6.2 mmHg; 95% CI –11.6, –0.79; p=0.025) and diastolic BP (–4.8 mmHg; 95% CI -7.56, -2.00; p=0.001; Figure ). Conclusion: PRT meaningfully reduced BP in older adults with hypertension and low muscle strength. Larger trials are warranted to confirm these findings and examine integrated strategies targeting both muscle health and BP to reduce CVD risk in aging populations.

Telomere shortening in workers occupationally exposed to a wide range of mostly low benzene levels: a multicenter study

Abstract WE557: Estimated Dietary and Health Impact of Implementing a Comprehensive Packaged Food Policy in Ethiopia

Introduction: Consumption of packaged foods and beverages high in sodium, sugar, and saturated fat is increasing in Ethiopia. The Ethiopian government is considering a comprehensive policy package including front-of-pack labeling (FoPL), and restrictions on marketing and procurement to discourage purchase of products exceeding nutrient thresholds. The potential dietary and health impact of this policy is unknown. Objectives: To estimate the dietary and health impacts of implementing the policy package in Ethiopia. Methods: We applied a comparative risk-assessment model to simulate the impact of these policies among adults (≥20 years). Sales data from Euromonitor Passport Database were used as intake proxies, linked with sodium and sugar content from Mintel Global New Products Database. Historic trends were used to project future consumption, and policy-effect on nutrient sales were derived from a real-world evaluation of a similar policy package. Reductions in sodium and sugar intake were used to estimate changes in blood pressure and body-mass index using data from clinical trials, and then converted into averted deaths and disability-adjusted life years (DALYs) using data from global databases and a national survey. Outcomes were estimated for 2025 and 2040 under two packaged food consumption scenarios: current trends (low) and 10% annual growth observed in other middle-income countries (high). Results: Without the policy package, sodium intake from packaged foods is projected to rise from 98 (95% uncertainty interval: 77-119) mg/day (2025) to 125 (96-157) mg/day (low) or 406 (319-500) mg/day (high) by 2040, and sugar from 6.1 (5.7-6.6) g/day to 7.6 (7.0-8.1) g/day (low) or 25.7 (24.1-27.3) g/day (high) ( Figure 1 ). Without policy action, these increases could raise noncommunicable disease (NCD) burden, especially from cardiovascular diseases ( Figure 2 ). Immediate implementation of the policy package could reduce sodium intake by 23% (19–27%) and sugar by 27% (25–29%), averting 384 (253–556) deaths and 5,145 (3,739–6,930) DALYs. Projected benefits substantially increase for both low- and high-trends by 2040 ( Figure 3 ). Conclusions: A policy package including FoPL plus marketing and procurement restrictions, could yield immediate, meaningful health gains in Ethiopia. By 2040, under either current trends or 10% annual growth in packaged-food consumption, these policies could attenuate the projected rise in NCDs driven by sodium and sugar in packaged foods.

Abstract 73: Moderate to vigorous physical activity, genetic susceptibility, and risk of aortic aneurysm: a prospective cohort study

Background and Aims: The benefits of physical activity against atherosclerotic cardiovascular disease are well established, but their role in reducing the risk of aortic aneurysm (AA) remains uncertain. This study aimed to investigate the association between moderate-to-vigorous physical activity (MVPA) and the incidence of AA in mid-aged and older adults. Methods: Utilizing data from the UK Biobank, the primary analysis examined accelerometer-derived MVPA data from 88,005 participants (median age: 62.9 years; female: 56.4%), while the secondary analysis was based on questionnaire-reported MVPA data from 382,268 participants (median age: 57.0 years; female: 52.4%). The primary outcome was the diagnosis of AA incidents, with secondary outcomes included those of abdominal AA (AAA), and thoracic AA and dissection (TAAD). We also examined the joint effects and interactions between MVPA and genetic predisposition on the risks of AAA and TAAD. Results: In the accelerometer-derived cohort, we identified 426 incident AA events, comprising 249 AAA and 167 TAAD cases, over a median follow-up of 6.56 years. The adjusted hazard ratios (HRs) for AA across MVPA quartiles Q2–Q4 versus Q1 were 0.73 (95% CI: 0.57-0.92), 0.58 (95% CI: 0.44-0.76), and 0.51 (95% CI: 0.37-0.70); for AAA, the corresponding HRs were 0.64 (95% CI: 0.47-0.87), 0.54 (95% CI: 0.38-0.77), and 0.37 (95% CI: 0.24-0.59); and for TAAD, the HRs were 0.98 (95% CI: 0.67-1.42), 0.69 (95% CI: 0.45-1.07), and 0.60 (95% CI: 0.37-0.98). For the joint associations, the lowest risks of AAA and TAAD were observed among participants with the highest MVPA quartile and low genetic risk (AAA: HR, 0.25; 95% CI, 0.14-0.44; TAAD: HR, 0.38; 95% CI, 0.21-0.69), compared with those with the lowest MVPA volume and high genetic risk. Similar but less apparent associations were observed in the questionnaire-based cohort. Conclusions: Higher levels of MVPA are associated with a reduced risk of AA, especially AAA. These results highlight that physical activity may serve as a modifiable risk factor in the primary prevention of AA. Further studies with prolonged follow-up or diverse populations are needed to validate and expand on these results.

A species rules syntax model accurately organizes birdsong syllables into songs

Abstract WE418: Incidentally Detected Coronary Calcium and the Burden and Severity of Cardiovascular-Kidney Metabolic Risk Factors

Introduction: Coronary artery calcium (CAC) incidentally found on non-EKG-gated cardiac chest CT scans identifies individuals at elevated ASCVD risk, providing an opportunity for intensified preventive pharmacotherapy. While lipid lowering therapy for those with elevated CAC is a focus of clinical guidelines, it is unclear the extent to which other cardiovascular-kidney-metabolic (CKM) risk factors may represent preventive targets. Methods: We conducted a cross-sectional analysis of 760 adults who underwent non-ECG-gated, non-cardiac chest CTs at the University of Miami between 2019–2021. CAC severity was categorized visually as none, mild, or moderate-to-severe. Across levels of incidental CAC severity, we used logistic regression to estimate the odds of the CKM risk factors of obesity, diabetes, HTN, hyperlipidemia and CKD. We also assessed risk factor control/severity (absent, controlled, mild/moderate, severe) across CAC levels. We used ordinal logistic regression to assess the odds of worse CKM risk factor severity/control for those with mild and moderate-to-severe CAC relative to those with no CAC. Results: Mean age was 63 years, with 52% women, and 54% Hispanic adults. CAC distribution was none (40.7%), mild (27.2%), and moderate-to-severe (32.1%). Across increasing severity of incidental CAC, the odds of prevalent risk factors increased for all CKM risk factors except obesity (Figure 1). The prevalence of more uncontrolled/severe risk factors increased progressively from no CAC to moderate-to-severe CAC for diabetes (11 vs 24%), HTN (39 vs 54%) and CKD (12 vs 41%) (Figure 2). Conversely, less uncontrolled hyperlipidemia was seen with higher CAC (32% with no CAC vs 10% with moderate-to-severe CAC), corresponding to more moderate-high intensity statin use with higher CAC (22% with no CAC vs 62% with moderate-to-severe CAC). Those with higher incidental CAC had higher odds of worse risk factor severity/control for diabetes, HTN and CKD (ORs 3.46, 1.50 and 1.82, respectively, for those with moderate-to-severe versus no incidental CAC), with no associations for obesity or hyperlipidemia (Table). Conclusion: The prevalence and severity of CKM risk factors are associated with more severe incidental CAC. While lipid control has been a clinical focus for individuals with incidental CAC, addressing diabetes, HTN and CKD with proven cardioprotective therapies and lifestyle improvements holds promise for enhancing preventive care for this high-risk population.

Abstract TH930: Potential overtreatment of older adults with diabetes and dementia: a real-world study

Background: Older adults with diabetes and dementia are at increased risk of hypoglycemia due to challenges in diabetes self-management, such as glucose monitoring and insulin dose adjustment. Clinical guidelines emphasize hypoglycemia prevention in this population including less stringent glycemic goals (e.g. hemoglobin A1c [HbA1c] <8%) and avoidance of high hypoglycemia risk medications (sulfonylureas and insulin). Understanding real-word patterns of glucose-lowering medication use and glycemic control among older adults with dementia can inform safe and effective care. Methods: We conducted a cross-sectional study using electronic health record data from the Johns Hopkins Health System from July 2016 to February 2025. We included adults with diabetes who were newly diagnosed with dementia at age ≥65 years and a comparison group of adults aged ≥65 years with diabetes but without dementia. Using chi-squared test, we compared glucose-lowering medication use (any, insulin, metformin, sulfonylureas, dipeptidyl peptidase-4 inhibitors [DPP4i], sodium-glucose cotransporter 2 inhibitors [SGLT2i], and GLP-1 receptor agonists [GLP-1RA]) and HbA1c levels between people with and without dementia. Results: Compared to those without dementia, patients with an incident dementia diagnosis were older (mean age 79.2 vs. 74.0 years) and more likely to have cardiovascular disease (81.0% vs. 55.2%) ( Table ). Patients with dementia were slightly less frequently on any glucose-lowering medication (46.0% vs. 51.6%, p<0.001) but more frequently on insulin (23.4% vs. 15.7%, p<0.001; Figure A ). The use of metformin, sulfonylureas, SGLT2i and GLP1-RA was less common among patients with dementia. However, 22.4% of patients with dementia were on sulfonylureas. Overall, patients with dementia were more frequently on any high hypoglycemia risk medication (31.4% vs. 29.4%, p<0.001). Among patients with available HbA1c measurements (n=18,547; 63.7% of cohort), 60.6% patients with dementia and 61.3% of patients without dementia had HbA1c <7% ( Figure B ). Conclusions: In this single health system study, many older adults with dementia were treated with glucose-lowering medications with a high risk for hypoglycemia and had stringent glycemic control. This pattern of care is inconsistent with clinical guidelines that recommend individualized, less stringent glycemic goals for this vulnerable population, highlighting the need to deintensify therapy and adopt less stringent glycemic goals.

Motor cortex activity during sleep and wake movements sharpens across development but continues to lag the red nucleus

Abstract The development of motor control in primary motor cortex (M1) requires both movements and neural activity. In rats, cortical motor control first appears around postnatal day (P) 25, prior to which movements are generated by subcortical motor nuclei such as the red nucleus (RN). While these subcortically generated movements are thought to provide the activity that guides the development of M1, the specific movements associated with M1 activity and their somatotopic and temporal precision remain unknown. Here, we performed acute electrophysiological recordings of neural activity in the forelimb region of M1 of P12–24 rats as they cycled between sleep and wake and compared M1 and RN activity in P24 rats. At every age, M1 neurons exhibited somatopically precise activity during REM sleep twitches, along with strong activity during wake movements. From P12 to P24, the proportion of neurons exhibiting twitch-related activity decreased, twitch-related activity became more temporally refined, and a larger fraction of spikes occurred before movement onset. At P24, M1 showed less premovement activity than RN. Further, in contrast to the non-selective activity seen in M1, some RN neurons showed movement-selective activity patterns during wake, firing only during particular wake movements. These findings reveal that movement-related activity in M1 is somatotopically precise by P12 and temporally precise by P24. But M1 still lacks the strong premovement activity and selectivity characteristic of RN, suggesting that at P24, subcortical outputs remain the main drivers of M1’s movement-related activity.

Abstract TU250: Racial Disparities in Mortality Trend of Pulmonary Heart Disease in the United States from 2018:2023: A Comprehensive Benchmarking Analysis

Background: Pulmonary heart disease (PHD), often driven by chronic pulmonary vascular remodeling (ICD-10: I27), represents a critical and under-recognized cause of cardiopulmonary mortality in the U.S. While aggregate national trends show a slow rise, this masks acute, multi-level socio-geographic inequalities in risk. Method: U.S. mortality data (ICD-10: I27) for 2018–2023 was extracted from CDC WONDER to estimate PHD deaths. Racial disparities were quantified using Average Annual Percent Change (AAPC) via log-linear regression, stratified by race, age, gender, Hispanic origin, education attainment, U.S. Census region, and 2013 urbanization classification Results: Overall AAPC acceleration was driven by Asian and Pacific Islander (API) populations: Filipino (+12.82%), Vietnamese (+9.44%), and Asian Indian (+6.91%), contrasting sharply with overall declines for White (–4.84%) and Black (–3.60%) groups. Intersecting disparities were stark. By Region/Urbanization, the steepest rises were among Western Other Pacific Islanders (+50.0%), Southern Filipinos (+19.98%), and Asian Indians in large central metros (+14.85%), while Blacks in non-core rural areas declined (–0.92%). By Age/Education, the highest AAPC was found in Asian Indians aged 65–74 (+15.39%) and Non-Hispanic Filipinos with some college (+30.93%). Conversely, Black adults aged 85+ (–13.28%) and Chinese with bachelor’s degrees (–27.78%) showed significant mortality compression. Conclusions: PHD mortality is not uniformly increasing; it is sharply accelerating in structurally marginalized API communities, younger age bands, and those in lower educational strata. These findings underscore the profound role of structural racism, differential care access, and urban-environmental exposure. Urgent disaggregation of national metrics and targeted, upstream preventive strategies for at-risk race-region-education cohorts are required.

Abstract 47: Calibration and Discrimination of PREVENT vs PCE in Hispanics/Latinos across Disaggregated Background Groups, Self-Reported Race, and Genetic Ancestry: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background: Unlike the race-specific pooled cohort equations (PCE) for atherosclerotic cardiovascular disease (ASCVD) risk prediction, PREVENT is a race-neutral tool but Hispanics/Latinos were underrepresented in its derivation. We evaluated calibration/discrimination of PREVENT vs PCE in HCHS/SOL, a large and diverse population-based cohort of US Hispanics/Latinos. Methods: A total of 10,927 HCHS/SOL participants met PREVENT-ASCVD and 5,416 met PCE criteria, Figure 1 . Ten-year ASCVD risk (2008–2019) was estimated with base PREVENT-ASCVD and non-Hispanic Black (NHB), non-Hispanic White (NHW) PCEs. ASCVD (incident myocardial infarction and stroke) were adjudicated from medical records. Mean time to first ASCVD event was 9.6 years (177 events). Hispanic/Latino background groups and race were self-reported. Genetic ancestry proportions (European, African, Amerindian) were estimated using ADMIXTURE for 6,802 PREVENT and 3,329 PCE eligible participants, Figure 1 , and dichotomized by median. Observed ASCVD risk was estimated using Kaplan–Meier analysis. Calibration was evaluated by predicted-to-observed (P/O) ratios, and discrimination by Harrell’s C-statistics. All analyses accounted for complex survey design. Results: Among baseline ASCVD-free adults (mean age 47.4, 52.7% female), the observed 10-year ASCVD event rate was 1.6%. PREVENT predicted event rate was 3.4% (P/O 2.1). PCE had higher predicted event rate than PREVENT, regardless of race-specific equation used ( Figure 2, Table 1 ) . The PREVENT calibrated most closely among adults of Cuban and Dominican descent, while PCE-NHW showed slightly better calibration among Puerto Ricans. PREVENT outperformed PCE across all self-reported race categories except among self-reported Black participants where calibration was paradoxically closer with NHW PCE. Across genetic ancestry, PREVENT performed best with lower African ancestry, whereas NHB and NHW PCEs performed best with lower European ancestry. PREVENT and PCE had higher overestimation among Hispanics/Latino adults with greater Amerindian ancestry. PREVENT discrimination was moderate-to-high overall (C-statistic 0.78–0.89), Table 1. Conclusions: PREVENT improved ASCVD risk prediction vs PCE across Hispanic/Latino backgrounds and most race categories, except self-reported Black participants. Both equations overestimated risk among Hispanics/Latinos with higher Amerindian ancestry. ASCVD risk prediction equations may not apply uniformly across Hispanic/Latino populations.

Abstract 36: CGM-derived dynamic measures of glycemia in relation to hepatic steatosis in adults without diabetes

Background: Prediabetes and type 2 diabetes are associated with increased risk for hepatic steatosis. Yet, the associations between dynamic measures of glycemia and hepatic steatosis among individuals without diabetes remains understudied. Methods: We included 1571 participants from the Framingham Heart Study (FHS) Third Generation based cohorts without diabetes who underwent assessment for hepatic steatosis using vibration-controlled transient elastography (2016-2019), had ≥3 days of continuous glucose monitor data (Dexcom G6 Pro CGM, 2022-2025) and completed a mixed meal tolerance test (MMTT, 2022-2025). The MMTT involved drinking a standardized nutritional beverage (600 kcal; 75 g carbohydrate, 21 g fat, 29 g protein). Hepatic steatosis was determined using controlled attenuation parameter (CAP). We performed multivariable linear and logistic regression to investigate the associations of standardized CGM-derived measures, fasting glucose, HbA1c, and 2-h post-MMT glucose with CAP as a continuous outcome and hepatic steatosis as a dichotomous outcome (CAP≥274dB/m). We adjusted all models for age, sex, smoking status, cholesterol-lowering medication, body mass index (BMI), and fasting blood glucose (except for when fasting glucose was used as a predictor). We also examined stratifying by glycemic status (normoglycemia and prediabetes). Results: In 1571 FHS participants (56.5% female, 55.3% normoglycemia), average age was 59.8y and BMI 28.2kg/m 2 . Steatosis prevalence was 21.4% among those with normoglycemia and 43.8% among those with prediabetes. Higher CGM measures of glycemic burden (e.g., %time above range [TAR] 140mg/dL) and 2-h post-MMTT glucose were positively associated with CAP (per 1 SD increase; β: 2.6 and 6.1, respectively, all p-value <0.05). Similarly, higher CGM measures and 2-h post-MMTT glucose were also associated with higher odds of hepatic steatosis (TAR 140; OR:1.25 [95% CI: 1.09–1.43], 2-h post-MMTT glucose; OR:1.41 [95% CI:1.23–1.62]). These associations appeared to be stronger among individuals with prediabetes and remained significant even after adjusting for BMI and fasting blood glucose. Conclusion: Glycemic burden and variability were associated with hepatic steatosis. CGM and MMTT may offer incremental value in identifying early metabolic dysregulation, beyond traditional measures of glycemia, particularly in those with prediabetes.

Spirohydantoin derivatives exert dopamine D2-like receptor-independent cytotoxicity in glioblastoma cells with possible involvement of calpain inhibition

Abstract Glioblastoma multiforme (GBM) maintains one of the most aggressive brain tumor with increasing resistance. Herein in vitro study investigates spirohydantoin derivatives with diversified dopamine D 2 R-like affinity as potential anti-glioblastoma agents. Cytotoxic studies with three human GBM cell lines (U87MG, A172 and U138MG) and human skin fibroblasts as non-tumor control, led to choose compounds 4 , 6 and 7 with selective cell-damaging activity much greater than these observed for clinically used chemotherapeutic temozolomide (TMZ). The IC 50 values for A172 cells were 56, 5, 21 and 513 µM for 4 , 6 , 7 and TMZ, respectively. Moreover, we demonstrated the potency of 4 , 6 and 7 as adjuvant therapeutics, even in GBM resistant phenotype. Interestingly, we observed a cell-damaging effect of calpain inhibitors in GBM cells and their higher cytotoxicity when combined with 4 , 6 and 7 , which together with molecular docking studies suggest that tested hydantoins might be also calpain inhibitors. Comparing the IC 50 values between used GBM cell lines, dopamine receptors’ affinities and associating these data with expression level of D 2 -like receptors, we rather exclude the involvement of these receptors in anticancer mechanism of investigated compounds. Collectively, these results justify further investigation of compounds from hydantoin family as anti-glioblastoma candidates.

Abstract 55: Rotating Night Shift Work, Gestational Diabetes, and Risk of Type 2 Diabetes Among US Nurses

Aims/hypothesis: Delayed and non-circadian sleep are emerging risk factors for poor cardiometabolic health. We sought to evaluate whether rotating night shift work in female nurses is related to risk of type 2 diabetes, particularly among high-risk women with a history of gestational diabetes (GDM). Methods: The Nurses’ Health Study II is an ongoing longitudinal cohort of 116,429 female nurses enrolled in 1989. Participants self-reported their history of rotating night shift work at baseline and updated recent night shift work (months with ≥3 night shifts) every 2-4 years thereafter. We included participants who were parous at baseline or at any time during follow-up from 1991 through 2019. Using multivariable-adjusted Cox proportional hazards models, we estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between cumulative years of rotating night shift work and incident type 2 diabetes, overall, and by history of GDM. Results: Among 50,122 participants (mean age 37 years in 1991), 36% did not work rotating night shifts, 48% worked <5 years of rotating night shifts, 11% worked 5-10 years, and 5% worked >10 years at baseline. A total of 2,548 participants had a history of GDM and there were 2,814 cases of incident type 2 diabetes. In the overall population, compared with participants who never engaged in night shift work, we observed a graded increase in the risk of type 2 diabetes with cumulative night shift work: HR(95%CI)= 1.14(1.04, 1.24) for <5 years, 1.32(1.17, 1.49) for 5-10 years, and 1.32(1.16, 1.50) for >10 years (p-linear trend <0.001). Stratifying by history of GDM, we observed a similar pattern of associations between cumulative years of night shift work and risk of type 2 diabetes among participants without a history of GDM, but not among those with a history of GDM (p-interaction=0.02). History of GDM was strongly associated with risk of incident type 2 diabetes in all women, including those who never worked night shifts: HR(95%CI)=4.76(3.90, 5.81). Conclusions/interpretation: Cumulative years of rotating night shift work was modestly associated with a higher risk of type 2 diabetes, overall, and among nurses without a history of GDM. Rotating night shift work was not associated with risk of type 2 diabetes among individuals with a history of GDM, an exceptionally high-risk sub-group for type 2 diabetes.

Abstract TH832: Disparities in Knowledge of Clinical Trials by Disease Status: A Health Information National Trends Survey (HINTS) Study

Background: While clinical trials (CTs) are crucial for advancing medical care, public knowledge about CTs remains limited. Literature suggests that individuals with cancer may be more engaged with experimental treatments than those with other chronic conditions. However, little is known about whether people with cardiovascular disease (CVD) or cancer exhibit comparable levels of CT knowledge, or if disparities exist by age, gender, race, income or education Objective: We examine how CT knowledge varies between individuals with cancer and CVD and identify key sociodemographic correlates of CT knowledge within the CVD population Methods: HINTS 5, Cycle 4, is a nationally representative survey of U.S. adults aged ≥18 years. Participants self-reported their cancer history, CVD status, and knowledge of CTs (dichotomized as any vs. none). We used logistic regression to assess associations between disease status (exposure) and CT knowledge (outcome) adjusting for sociodemographic and health-related factors. To identify predictors in the CVD group, we screened sociodemographic variables in univariable models, retaining those with P <0.25 for inclusion in a multivariable model. Analyses applied sample weights Results: Among a weighted sample of ~2.5 million adults (mean [SD] age, 57 [17.0] years; 50% women), 6% and 8% reported history of cancer or CVD respectively. CT knowledge was 7% in CVD and 5% in cancer group; 35% of CVD group were below poverty line. In fully adjusted models, neither cancer [OR 1.01 (95% CI 0.67-1.56)] nor CVD [OR 1.21 (95% CI 0.71-2.05)] was significantly associated with CT knowledge ( Table1a ). In mutually exclusive disease models, neither cancer-only [OR 1.09 (95% CI 0.70-1.68)] nor CVD-only [OR 1.26 (95% CI 0.73-2.18)] status was associated with greater CT knowledge than adults without chronic conditions ( Table1b ). Among those with CVD, participants with less than a high school education [OR 0.15 (95% CI 0.04-0.52)] and those below the federal poverty level [OR 0.23 (95% CI 0.06-0.73)] had significantly lower odds of CT knowledge in univariable analysis ( Fig1 ). However, after adjustment, only income was associated with CT knowledge [OR 0.24 (95% CI 0.06-0.98)] ( Fig2 ) Conclusion: Most adults with CVD and cancer lacked CT knowledge, underscoring need for broader education. While income was a key correlate, targeted efforts to improve CT knowledge may particularly benefit vulnerable patients and expand access to innovative therapies improving CVD outcomes

Abstract TU102: Association between Dementia Caregiving and Psychological Health, Physical Activity, and Heart Rate Variability: Women and Caregivers Study

Dementia caregiving is a prolonged and demanding role that poses significant psychological and physiological health risks. Despite known stress-related consequences, few studies have employed objective wearable measures to capture real-time behavioral and autonomic markers of health in this population. This study compared physical activity, sedentary behavior, heart rate variability (HRV), and psychological and cardiovascular health between older women dementia caregivers and age-matched women non-caregivers. Methods: In a cross-sectional design, 31 women aged 50+ (15 caregivers, 16 non-caregivers) wore a wrist-based EmbracePlus and thigh-worn ActivPal for 8 days. They completed surveys on depression, anxiety, stress, sleep, caregiving burden and diagnosis of cardiovascular risk factors. Group differences were analyzed using Mann-Whitney U tests, and rank-biserial correlations. Results: Compared to non-caregivers, caregivers (73% versus 31%) reported poor psychological health including significantly higher depression and anxiety (r > 0.5). Caregivers had higher stress scores (r = 0.71) and worse sleep quality ( r = 0.39). While caregivers had higher daily step counts, more sit-to-stand transitions (r > 0.4), they engaged in lower self-reported leisure time activity and fewer sustained accelerometer -measured walking bouts (≥5 minutes) (r > -0.4), and greater time in prolonged sedentary bouts ≥1 hour (r > 0.3). Among caregivers, higher caregiving burden was associated with lower HRV day-to-night ratio (r = -0.4), greater sitting time (r = 0.7), less physical activity at higher cadence, and shorter sleep duration (r > 0.4). No significant differences were observed in cardiovascular diagnoses. Conclusions: Dementia caregiving is linked to significant psychological strain and impaired autonomic recovery, particularly among those with higher burden. Caregivers, despite taking more daily steps, accumulated greater time in prolonged sedentary bouts, engaged in fewer sustained walking bouts, and reported less leisure physical activity. Cardiovascular diagnoses were similar between groups, yet caregivers’ elevated psychological and behavioral risk profiles suggest subclinical vulnerability. Simply increasing physical activity may not be the most effective intervention strategy for caregivers. Instead, caregiver-focused approaches combining real-world monitoring, mental health support, and tailored activity interventions may better reduce long-term risks.

Improving movie rating prediction accuracy and interpretability with narrative-aligned multimodal fusion

Abstract WE480: Smoking Cessation or Reduction After Myocardial Infarction and Subsequent Risk of Cardiovascular Events

Introduction: While smoking is a major risk factor for cardiovascular disease, data are scarce regarding the outcomes of smoking cessation and reduction after myocardial infarction (MI) among those who smoked. We hypothesized that smoking cessation but not reduction was associated with a lower risk of major adverse cardiovascular events (MACE) after first MI. Methods: Using the Korean National Health Insurance Service database, we included adults aged ≥19 years who experienced first MI between 2009 and 2019 and had health examination records before MI and during the 2-year landmark period after the MI (Figure 1). Smoking status and amount (cigarettes/day) were self-reported at each examination. Based on changes between pre- and post-MI examinations, participants were categorized as sustained non-smokers, initiators/relapsers, quitters, or continuing smokers. Among pre-MI smokers, participants were further categorized based on post-MI smoking amount as quitters, reducers (≥50% decrease in cigarettes/day), or non-reducers. The primary outcome was first occurrence of MACE (composite of cardiovascular death, stroke, or recurrent MI). Secondary outcomes included all-cause death, first occurrence of each component of MACE, and total (first and subsequent) occurrence (i.e., recurrent event analysis) of MACE. Results: Among 50,809 adults included, mean±SD age was 63.5±11.1 years at landmark, and 19.2% were women. After first MI, 55.2% of pre-MI smokers quit and 11.2% reduced smoking by ≥50%, whereas 3.5% of pre-MI non-smokers initiated or relapsed into smoking. Over a median follow-up of 5.5 years (IQR, 3.5-7.5 years) from the 2-year landmark, 5,033 primary outcome events occurred. Compared with sustained non-smokers, multivariable-adjusted HR (95% CI) for MACE was 1.51 (1.27-1.80) for initiators/relapsers, 1.01 (0.93-1.09) for quitters, and 1.47 (1.36-1.60) for continuing smokers (Figure 2). Among pre-MI smokers, quitting was associated with a lower risk of MACE (HR, 0.69; 95% CI, 0.62-0.76), whereas reducing by ≥50% was not (HR, 0.98; 95% CI, 0.85-1.14), compared with continued smoking without reduction (Figure 3). Smoking reduction was not associated with lower risk even when stratified by pre-MI smoking amount. Results were consistent for secondary and recurrent outcomes. Conclusions: Smoking cessation after MI was associated with a substantially lower risk of subsequent cardiovascular events, whereas smoking reduction without cessation did not confer lower risk.

Abstract WE554: Changes in Intrinsic Capacity and Risk of Cardiovascular Diseases in Older Adults: A Longitudinal Study Based on 19 Countries

Background: Intrinsic capacity (IC), proposed by the World Health Organization, is a core indicator for assessing the physical and mental health of older adults. Past studies have revealed the strong predictive power of IC for adverse outcomes, including mortality and disability. However, its longitudinal association with the risk of cardiovascular diseases (CVD) remains poorly understood. This study aims to explore the association between changes in IC and the risk of CVD in 19 countries across Europe, Asia, and the Americas. Method: This longitudinal multi-region study applied individual-level data from five studies on ageing between 2001 and 2022 in the Program on Global Aging, Health, and Policy: the US Health and Retirement Study (HRS); the English Longitudinal Study on Ageing (ELSA); the Survey of Health, Ageing and Retirement in Europe (SHARE); the China Health and Retirement Longitudinal Study (CHARLS); and the Mexican Health and Aging Study (MHAS). Adults aged 50 or older and free of CVD (including stroke and heart disease) at baseline were included. IC was measured across five domains: cognition, locomotion, psychology, vitality, and sensory. Each domain was scored 0–2, and IC score ranged from 0-10. We categorized IC score into 3 levels (low: 0–4.5, medium: 5–8, high: 8.5–10). IC changes across two waves were classified as “high stable”, “moderate stable”, “low stable”, “improved”, and “decreased”. The main outcome was the occurrence of CVD during the follow-up period. We used cause-specific Cox proportional hazards models to examine the effects of IC change on CVD risk. Models were adjusted for demographics and lifestyles. Result: Among 35660 individuals (46%-62% male), we found a decline in IC was associated with an increased risk of CVD in HRS ( Hazard Ratio (HR) = 1.24, 95% CI: 1.06–1.45), SHARE (HR = 1.28, 95% CI: 1.12–1.46), and ELSA (HR = 2.38, 95% CI: 1.50–3.76) cohorts. In the CHARLS cohort, a non-significant trend toward higher CVD risk was observed. In the MHAS cohort, an improvement in IC was associated with a reduced risk (HR = 0.61, 95% CI: 0.46–0.82). Conclusion: In older adult populations of multiple countries, the decline in IC is related to an increased risk of future CVD, while improving IC from a low level is associated with a reduction in the CVD risk. These findings underscore the prognostic value of IC in predicting CVD and highlight the importance of maintaining functional reserves during aging.

Abstract WE491: Effect Modification of Walkability and Micro-scale Walkability on the relationship between Socioeconomic Deprivation and Cardiovascular Health Outcomes in the Hispanic Community Health Study/ Study of Latinos (HCHS/SOL): A Longitudinal Analysis

Background: Poor cardiovascular health (CVH) remains a leading cause of morbidity and mortality among US Hispanic/Latino adults, with previous research identifying the important role that social determinants play. We aimed to examine longitudinal associations between neighborhood socioeconomic deprivation, walkability, and pedestrian streetscape with changes in CVH in Hispanic/Latino Adults. Methods: Data were from 1,126 Hispanics/Latinos (ages 24 to 80; 56% female; 93% Mexican origin) enrolled in the San Diego site of Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Neighborhood data were collected at Visit 2 (2014-2017), as part of the SOL CASAS ancillary study, and clinical data were examined at Visits 2&3 (2020-2024). Home addresses were geocoded and home areas created using 800m circular buffers. Neighborhood socioeconomic deprivation was created using Census data. Walkability was computed as land use mix and intersection and residential density. Pedestrian streetscape was measured using virtual street audits near each participant's home address. Using the four-health metrics of the American Heart Association “Life’s Essential 8” (body mass index, non-HDL cholesterol, HbA1c, and blood pressure) we built CVH scores for both timepoints. Our primary outcome was defined as residualized change in CVH score across the 6-years between visits. Complex survey models controlling for individual demographic, socioeconomic, and all independent variables were used to estimate the linear associations. Formal interaction tests and stratification by walkability were used to estimate potential interactions across our three independent variables. Results: Average CVH scores at Visit 2 were 65.8/100 and 63.4/100 at Visit 3. In fully adjusted models, socioeconomic deprivation (β = –1.54, SE = 0.67, p=.02) was negatively associated with change in CVH scores while walkability (β = 1.64, SE = 0.72, p=.03) was positively associated. Only the interaction between walkability and pedestrian streetscape was significant (β = 1.20, SE = 0.56, p=.03), with pedestrian streetscape being significant negatively associated with change in CVH scores in the lowest tertile of walkability (β = -3.31, SE = 1.13, p<.01). Conclusion: Neighborhood socioeconomic deprivation and walkability influence changes in CVH among US Hispanic/Latino adults. Pedestrian streetscape may influence changes in CVH but only in the presence or lack of walkability.