Browse Articles

Abstract WE477: Physician-determined HIV-associated Heart Failure Etiologies and Phenotypes at Five Sites Across the United States: The Center for AIDS Research Network of Integrated Clinical Systems (CNICS)

Introduction: Limited data exist on physician-adjudicated heart failure (HF) phenotypes and etiologies in people with HIV (PWH), despite a 1.5-2-fold higher risk for HF for PWH compared to the general population. Using a standardized, centralized screening and adjudication protocol, we determined HF phenotypes and etiologies in PWH at five centers across the US participating in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. Hypotheses: Nonischemic etiologies of HF are more common in PWH than ischemic etiologies across different clinical and geographic sites. Methods: Two physicians independently adjudicated incident HF events occurring between 1/1/2010 and 12/31/2024 at five sites across the US (Birmingham, AL; Seattle, WA; Chapel Hill, NC; San Diego, CA; and Nashville, TN). We ascertained possible HF using a protocol incorporating administrative codes and biomarkers of congestion; physician adjudicators then reviewed clinical records including notes, imaging, and laboratory reports, with confirmed HF requiring a combination of symptoms, physician diagnosis, and HF medication use. Adjudicators then determined HF subtypes based on left ventricular ejection fraction (LVEF), and presumed etiologies (e.g., ischemic and/or non-ischemic) based on systematic records review. Results: Among 24,169 PWH across 5 CNICS sites, 460 (1.9%) had incident adjudicated HF over a mean 6.4 years of followup. Antiretroviral therapy use was common at baseline both for those with incident HF (75.2% on antiretroviral therapy) and those without incident HF (80.4%). PWH with incident HF had a higher prevalence of cardiovascular risk factors at baseline, such as hypertension (45.4% vs. 18.8%) and diabetes (19.6% vs. 6.1%), and more commonly used cocaine (15.0% vs. 8.9%). Among PWH with HF, approximately half (49.3%) had HF with reduced ejection fraction (HFrEF; LVEF<40%) and 150 (32.6%) had HF with preserved ejection fraction (HFpEF; LVEF≥50%). The majority (70.0%) had a nonischemic etiology of HF; 53.3% had nonischemic etiology only (without concomitant ischemic contributors). Only 14.1% of PWH with HF had ischemic etiology only. Patterns were consistent across sites; ischemic-only etiology comprised less than 1/3 rd of HF events for each of the 5 sites. Conclusions: Nonischemic etiologies of HF are more common than ischemic etiologies of HF in PWH, and this finding is consistent across geographically and clinically distinct sites in the United States.

Structure and function of mouse lens suture examined by 2-photon fluorescence microscopic imaging

Abstract We used two-photon fluorescence microscopy (2PFM) to examine lens fiber and suture architecture, as well as permeability, in wild-type (WT) lenses and in lenses from klotho-like protein homology (KLPH) knockout (KLPH-KO) mice. KLPH is a type I membrane glycoprotein encoded by the Lctl gene; KLPH-KO mice develop lens suture cataracts. Lens sutures have been hypothesized to serve as pathways for transporting ions, nutrients, and other factors as part of the lens microcirculation required to maintain homeostasis and transparency. Three-dimensional (3D) in vivo imaging revealed typical “Y” and “double-Y” anterior suture geometries, along with depth-dependent variation, in WT lenses. In contrast, KLPH-KO lenses exhibited markedly heterogeneous suture morphologies and misalignment between the anterior and posterior suture planes. Quantification of pattern variability using the mean structural similarity index (SSIM) of individual z-stacks relative to the stack mean projection revealed a significant increase in pattern randomization in KLPH-KO lenses ( p  < 0.05). Both WT and KLPH-KO lenses displayed voids near sutures and enlarged vacuoles distributed throughout the lens in vivo. Notably, KLPH-KO lenses exhibited irregular, enlarged central voids containing ~ 2–5 μm amorphous structures, consistent with subcellular remnants and/or membrane-associated aggregates. In conclusion, this study provides novel morphological markers for characterizing suture cataracts and associated fiber pathology. It further demonstrates that the dye-impermeable lens suture represents a stabilized interface formed by elongated fiber ends, supporting lens integrity and maintaining the organization of lens fibers.

Abstract 64: The Association of the Sentiment of Tailored Feedback on Adherence to Physical Activity Goals and Self-weighing in Intervention Participants in a mHealth Clinical Trial for Weight Loss

Introduction: Standard behavioral weight loss treatment entails self-monitoring (SM) of lifestyle behaviors (e.g., physical activity [PA]) and weight. However, adherence to PA guidelines and self-weighing often declines over time. Digital health devices can reduce the burden of SM and deliver timely tailored feedback (FB) to reinforce behavior change. Hypothesis: Positively worded tailored FB will result in greater adherence to PA goals and self-weighing than neutral or negatively worded FB. Aim: To examine the association between the sentiment of tailored FB received and adherence to weekly PA goals and self-weighing among SM+FB participants in a 12-month mHealth weight loss trial. Methods: Community-dwelling adults (N=502) with body mass index (BMI) from 27 to 43 kg/m 2 were randomized 1:1 to either SM+FB or SM alone. Participants tracked PA via digital activity trackers, weight with smart scales, and diet using logging apps up to 52 weeks. SM+FB participants received up to three FB messages daily, tailored based on their tracking data, using a study-developed app and a curated FB message library. PA-related and self-weighing FB messages were sentiment-coded as positive, neutral, or negative (inter-coder κ=.97). For analysis, a binary indicator denoted whether any positive behavior-specific FB was received in a given week. Weekly PA goal adherence was computed as the percentage of tracked minutes of moderate-to-vigorous PA relative to the study-prescribed PA goal, and weekly self-weighing adherence was computed as the percentage of days with self-weighing. Intensive longitudinal data modeling examined the association between receipt of positive behavior-specific FB and weekly PA goal and self-weighing adherence. Results: SM+FB participants (n=251) were 80% female and 84% white, with mean age of 45.0±14.3 years and BMI of 33.7±3.9 kg/m 2 . On average, participants received 2.3±1.1 PA-related and 0.8±0.4 self-weighing FB messages per week. Although PA goal and self-weighing adherence declined non-linearly over 12 months (p<.001), receipt of positive PA-related FB messages was associated with on average greater weekly PA goal adherence (b=6.50, 95%CI: 2.00,11.01; p=.005), while receipt of positive self-weighing FB messages was associated with a reduction in the linear decline in self-weighing adherence (b=0.20, 95%CI: 0.01,0.40; p=.040). Conclusion: Tailored FB, especially the positive sentiment of the messages, can enhance adherence to PA goals and self-weighing.

Abstract TH925: Associations Between a Validated Dietary Approaches to Stop Hypertension (DASH) Diet Screener Score and Cardiovascular Biomarkers in the Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) Trial

Introduction: Greater adherence to a DASH diet pattern is linked to lower cardiovascular disease (CVD) risk. However, it is unclear whether a brief DASH screener, validated in a healthy, nationally representative population, demonstrates predictive validity in secondary prevention settings. Hypothesis: We examined the associations between 6-month (mo) Δ in DASH screener score and CVD biomarkers at 1-year (yr) and 2-yr follow-up in the SAMMPRIS trial. We hypothesized that improved 6-mo Δ in DASH screener scores were associated with higher high-density lipoprotein cholesterol (HDL-C), and lower systolic blood pressure (SBP), diastolic blood pressure, and low-density lipoprotein cholesterol, at 1-yr and 2-yr follow-ups, and that the associations were not modified by treatment. Methods: This secondary analysis of the SAMMPRIS trial included a subset of 244 participants who did not develop stroke or die ≤ 30 days after enrollment and responded to 8 brief nutrition questions used to calculate a DASH adherence score at both baseline and 6-mo. The screener captures 8 DASH components. Each component was assigned a corresponding weight and summed to obtain a total score (0-100). Higher values indicated better adherence. Multivariable linear regressions assessed associations between 6-mo Δ in DASH screener scores and CVD biomarkers at 1- and 2-yr follow ups, adjusted for covariates. Effect modification by treatment arm was tested, and inverse-probability-of-censoring weight was used to account for informative dropout/death. Results: Participants were on average 61.0(10.9) years, 75% White, 39% female, with a BMI of 30.3(6.1) kg/m 2 and a baseline screener score of 52.5(12.2) (see Table 1 ). Preliminary results show that 6-mo Δ in the screener score comparably increased in both the aggressive medical management plus stenting arm (+3.2) and the aggressive medical management only arm (+4.8). At 1-yr follow up, associations differed by treatment, and 6-month Δ in DASH screener score was associated with lower SBP (ß =-0.23, p=0.04) and higher HDL-C (ß =0.15, p=0.03) in the aggressive medical management plus stenting arm only. At 2-yr follow up, no associations were detected between 6-mo Δ in DASH screener score and CVD biomarkers in either arm (see Table 2 ). Conclusions: The DASH screener demonstrated short-term predictive validity with some CVD biomarkers in a high-risk clinical population who underwent aggressive medical management of vascular risk factors plus stenting.

Abstract TU119: Correlation between plasma atherosclerosis index (AIP) and in-hospital mortality in STEMI patients with and without LDL cholesterol control: findings from The Chinese Cardiovascular Association (CCA) Database-Chest Pain Center

Background: In-hospital mortality after ST-segment elevation myocardial infarction (STEMI) remains high, even in patients with normal admission LDL-C levels. The atherogenic index of plasma (AIP) better reflects atherogenic dyslipidemia than conventional lipid markers, but its association with in-hospital mortality in STEMI patients is unclear. Aim: To investigate the association between AIP and in-hospital mortality in patients with STEMI across different admission LDL-C levels. Methods: We analyzed data from 918,620 adults with STEMI (mean age: 62.4 ± 13 years; 76.6% male) in the Chinese Cardiovascular Association (CCA) Database-Chest Pain Centre Registry study from 2015 through 2024. The primary outcome was in-hospital mortality. We examined the association between AIP and in-hospital mortality using log binomial regression models in the total population and across different admission LDL-C levels. The non-linear association between AIP and in-hospital mortality was assessed by using restricted cubic spline models. Results: A total of 19,190 in-hospital deaths was recorded. Higher AIP was associated higher risk of in-hospital mortality across all LDL-C levels and showed the highest risk ratio (RR: 1.47 [95% CI, 1.31-1.64]; per standard deviation increase) among those with LDL-C levels < 1.4 mmol/L. Similarly, when analyzed as categorical variable, patients in the highest AIP quartile have the highest risk of in-hospital mortality. In the LDL-C < 1.4 mmol/L group, patients in the highest quartile had 124% higher risk of in-hospital mortality (RR: 2.24, 95% CI, 1.63-3.07) after adjustment. Conclusion: Higher AIP levels are associated with higher in-hospital mortality in STEMI patients, even among patients with target LDL-C levels. This suggest that AIP captures residual risk beyond LDL-C and may contribute to risk assessment in this population.

Green-synthesized N-acetylcarnosine–loaded gold nanoparticles as a novel ocular nanocarrier for antioxidant therapy and cataract prevention

Abstract MPWE34: Mechanistic Components of Arterial Stiffness and Incident Dementia in Older Adults

Background: Arterial stiffness measured by pulse wave velocity (PWV) predicts cardiovascular events and all-cause mortality. PWV reflects both intrinsic structural remodeling and pressure-dependent distension. PWV can be decomposed into structural PWV (S-PWV) and load-dependent PWV (LD-PWV), representing distinct mechanisms of arterial stiffening. LD-PWV, driven by blood pressure load, predicts cardiovascular events and decreases with intensive blood-pressure lowering, whereas S-PWV, reflecting age-related elastin fragmentation and collagen accumulation, is associated with cerebral small-vessel disease and cognitive decline. Aim/Hypothesis: We have previously reported in the Cardiovascular Health Study Cognitive Study (CHS-CS) that higher carotid–femoral PWV (cfPWV) was significantly associated with incident dementia. We hypothesize that S-PWV, but not LD-PWV, would be significantly associated with incident dementia. Methods: CHS-CS is a longitudinal cohort of 532 older adults (mean age 78 ± 4 years; 41% men; 22% APOE-e4 carriers) who were free of dementia at baseline and were followed annually for up to 15 years. cfPWV was measured between 1996–2000 using carotid and femoral Doppler recordings. S- and LD-PWVs were estimated using participant-specific exponential models: S-PWV was cfPWV standardized to 120/80 mmHg, and LD-PWV was the difference between observed cfPWV and S-PWV. Dementia was adjudicated by standardized criteria. Cox proportional hazards models estimated hazard ratios for dementia across tertiles of S- and LD-PWV, adjusting for age, race, education, diabetes, body mass index, APOE-e4 carrier status and hypertension medication. Results: During follow-up, 212 participants (59.6%) developed dementia. Baseline total cfPWV was 8.7 ± 2.9 m/s, S-PWV was 10.6 ± 3.7 m/s, and LD-PWV was -0.3 ± 0.8 m/s. Baseline blood pressure was 129.7/66.9 ± 19.5/9.9 mmHg. Higher S-PWV was significantly associated with greater dementia risk, whereas LD-PWV was not. The S-PWV association remained significant after multivariable adjustment. Conclusions: In community-dwelling older adults, S-PWV, but not LD-PWV, was independently associated with incident dementia. These findings suggest that long-term structural changes of the arterial wall, rather than blood pressure–related stiffness, may play a critical role in the pathogenesis of dementia. Targeting mechanisms underlying structural arterial stiffening may help prevent or delay cognitive decline in aging populations.

Response by Bellomo et al to Letter Regarding Article, “Evaluation of Lipoprotein(a) as a Prognostic Marker of Extracoronary Atherosclerotic Vascular Disease Progression”

Abstract TH830: Longitudinal and Demographic Trends in Location of Death Among Patients With Heart Failure in the United States, 2003–2021

Background: Heart failure (HF) remains a leading cause of morbidity and mortality, yet national data on where patients with HF die and how this varies across demographic groups are limited. Understanding death location is essential to improving end-of-life care and promoting equity in the United States. Hypothesis: We hypothesized that the location of death among patients with HF has shifted over time and differs by age, sex, race, and ethnicity. Methods: Using national mortality data from the National Center for Health Statistics for 2003–2021, we identified all U.S. adults aged ≥25 years whose underlying cause of death was HF (ICD-10: I110, I130, I132, I500, I509). Location of death was categorized as inpatient hospital, outpatient hospital, dead-on-arrival (DOA), scene, hospice, nursing home, or unknown. Demographic predictors included age group, sex, race, ethnicity, and year of death. Multivariable logistic regression evaluated associations with each category, and Joinpoint regression quantified temporal trends. Results: Among 1,615,353 HF deaths, 45.7% occurred in inpatient hospitals, 22.0% in nursing facilities, 6.6% in hospice, 4.0% in outpatient settings, 0.1% were DOA, and 21.0% occurred at the scene. From 2003–2021, inpatient hospital deaths declined 3.2% annually and nursing home deaths 2.1%, while hospice deaths rose 19.6% (all p<0.001). Older adults (≥65 years) were more likely to die in nursing homes (OR 8.05) and hospice (OR 2.68) but less likely in hospitals. Males had higher odds of inpatient (OR 1.33) and lower odds of nursing home deaths (OR 0.66). Compared with White patients, Black patients had higher odds of hospital (OR 1.47) and outpatient (OR 2.57) deaths but lower odds of nursing home (OR 0.53) and hospice (OR 0.85) deaths. Hispanic patients had higher inpatient death (OR 1.40) but lower hospice (OR 0.65) and nursing home (OR 0.40) deaths. Conclusions: Over two decades, HF deaths occurring in inpatient hospitals have declined, while hospice deaths increased sharply, signaling shifts toward community- and palliative-based end-of-life care. Persistent racial and ethnic disparities remain, with Black and Hispanic individuals more likely to die in acute-care settings and less likely in hospice or nursing facilities. These findings highlight ongoing inequities in end-of-life care access and emphasize the need for culturally informed palliative strategies to improve care for patients with HF.

Fabrication and characterization of shape memory polyurethane/GNP/MWCNTs nanocomposite thin-films with enhanced UV resistance

Abstract Polymer films provide multifunctional platforms for diverse technological applications such as protective coatings, miniaturized sensors, biomedical devices, and energy storage systems. Shape memory polyurethane (SMPU) is a smart polymer capable of responding to external stimuli; however, its moderate mechanical strength and limited shape recovery efficiency restrict broader utilization. In this study, SMPU thin-films were independently reinforced with 1 wt% graphene nanoplatelets (GNPs) and multi-walled carbon nanotubes (MWCNTs) using the solvent-casting method. The resulting nanocomposite thin-films were comprehensively characterized to evaluate their thermal stability, mechanical performance, structural features, and shape recovery behavior, as well as the influence of nanofillers on their UV resistance under accelerated irradiation. The incorporation of GNPs and MWCNTs markedly enhanced the mechanical, thermal, shape recovery, and UV-resistant properties of SMPU. After 24 h of UV irradiation, tensile strength increased by 69% in GNP-reinforced and 72% in MWCNT reinforced thin-films. Notably, the shape recovery rate accelerated by 10–20%. Moreover, owing to the superior UV absorption and radical-scavenging abilities of both nanofillers, the nanocomposite thin-films exhibited lower photooxidative index values compared to pure SMPU. Hence, the findings of this study contribute to the development of high-performance SMPU-based nanocomposites for various potential applications.

Abstract TU257: Effect of the COVID-19 Pandemic on Cardiovascular Care and Its Impact on CV Disease Mortality in Rural Ohio: A Retrospective Analysis in Portage County

Background: Cardiovascular disease (CVD) is a leading cause of death worldwide. The COVID-19 pandemic was a global health crisis that started around late 2019 and ended in the middle of 2023 according to the World Health Organization that impacted access to specialized cardiovascular care world-wide. We have previously demonstrated improvement in cardiovascular mortality in Portage County, OH through the implementation of preventative screening programs and the availability of 24/7 cardiovascular care. Portage County, a predominantly rural area with some suburban and urban communities, faced significant challenges in cardiovascular care during the pandemic despite having qualified professionals. Lockdown protocols and shortages of essential medical supplies, such as gloves, masks, and gowns, further limited care delivery. Objective: This study evaluates the impact of the COVID-19 pandemic’s effect on cardiovascular care in Portage County, Ohio, through analyzing crude death rates (CDRs) from CVD. Methods: We conducted a retrospective analysis using the CDC WONDER mortality database (2015–2022). A comparison of means of CDRs in the years before and after COVID-19 were used. Results: Following the 2016–2019 intervention, over 3,000 catheterizations were performed, and CDRs declined across all age groups, with reductions of 36% (65–74 yrs), 21% (75–84 yrs), and 28% (85+ yrs). Although these decreases were not statistically significant (p > 0.05), they indicated improved post-intervention outcomes. In contrast, during COVID-19 (2019–2022), the average CDR rose from 306.2 (pre-COVID, 2015–2018) to 315.5, a 3% increase that reached statistical significance (p = 0.009). Conclusions: The COVID-19 pandemic increased CVD mortality in Portage County. We attribute this to lack of access to cardiovascular care because of increased utilization of the hospital resources for COVID-19 patients and limited outpatient appointments due to restricted clinic availability. Despite acheiving an improved mortality rate in previous years due to intervention and preventative measures, there was an increase in CVD mortality during the COVID-19 pandemic. These findings suggest that the earlier mortality gains achieved after the intervention were partially reversed during the COVID-19 period.

Abstract TU150: Associations of Per- and Polyfluoroalkyl Substances with Cardiovascular Risk in Midlife Women and the Potential Protective Role of Dietary Fiber

Background: Per- and polyfluoroalkyl substances (PFAS) are persistent chemicals with widespread human exposure and reported links to dyslipidemia. PFAS bioaccumulation may accelerate after menopause, yet the cardiovascular effects of PFAS in midlife women are understudied. Potential dietary strategies to reduce PFAS burden are also poorly understood. Methods: We analyzed data from 54 women aged 19-59, spanning pre-, peri-, and post-menopause. Serum concentrations of 13 PFAS, CVD risk factors (blood pressure, body mass index, glucose, and lipids), and vascular measures (flow-mediated dilation [FMD] and pulse wave velocity [PWV]) were assessed. In a subset of 29 women, dietary fiber and folate intakes were estimated from dietary records. Multivariable linear regression models estimated associations of PFAS with cardiovascular outcomes, and of dietary factors with PFAS concentrations. Results: Among the six PFAS compounds detected in >70% of samples, perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) had the highest concentrations. Exposures were generally higher in postmenopausal than premenopausal women. Although not statistically significant, ΣPFAS and PFOS were positively associated with total cholesterol, LDL cholesterol, and triglycerides, and inversely associated with HDL cholesterol. Associations of PFAS with FMD were weak and non-significant. Most PFAS compounds were linked to slightly higher PWV, particularly ΣPFAS and PFOS. Folate showed modest, nonsignificant associations with PFAS, whereas soluble fiber was inversely associated with 5 of 6 compounds. Conclusion: These exploratory results suggest that PFAS could adversely influence lipid profile and vascular function in women. Increased soluble fiber intake may reduce PFAS burden. Larger studies are warranted to confirm these findings.

Abstract TU152: Excluding Pseudohypertension to Improve Hypertension Management Through Blood Pressure Device Validations in Cardiac Rehabilitation

Background: The prevalence of pseudo- or missed- hypertension (HTN) due to inaccurate blood pressure (BP) devices during Cardiac Rehabilitation (CR) is unknown. The first step in the workflow of a home-based BP management program is to validate home BP devices for those who already own a device. The goal of this study is to quantitate the proportion of already-owned inaccurate devices on patients starting CR. Devices that do not validate at the time of this screening would need to be replaced before engaging in medication management; this would prevent BP undertreatment and/or overmedicating patients while also engaging in lifestyle modifications in CR. Methods: Based on the American Medical Association self-measured BP device calibration test, we retrospectively reviewed 188 consecutive devices for validations in 160 CR patients enrolled in a single center. Validations consist of i) confirming use of an arm cuff device, ii) use of appropriately sized cuff, and iii) accuracy of home device readings. Once the arm with the highest BP is determined, the patients rest for 5 minutes quietly, and the arm is properly positioned before obtaining a total of 5 BP readings using the home device (readings #1, #2 and #4) and the office device as ground truth (readings #3 and #5). Devices were classified as validated based on a two-step formula to determine that the difference between the average BPs from both devices is ≤5 mmHg in the first step or ≤10 mmHg in the second step. Results: Thirty-two of the 188 (17%) tested devices failed to validate. Of these, 1 (3%) had the wrong cuff size, 4 (13%) were wrist devices, and 2 (6%) gave erratic measurements. Thirty-one of 160 (19%) patients had their validations failed. Twenty-four of them had their devices not valid based on differences between device measurements; 18 (75%) had elevated BP that would have been over or under- estimated by their home devices. Conclusion: High BP at home is a treatable risk factor that is often missed when performing initial assessments of high-risk CR patients. Our data, 19% of patients with inaccurate home devices, supports that the first step in a home-based BP management program ought to confirm that already-owned devices are accurate before they are used. Furthermore, we propose that home BP devices are routinely validated upon CR enrollment to minimize inappropriate medication management of pseudo- or missed- HTN among these high risk patients.

A multi dataset validation model for hybrid feature selection in wind energy maximum power point tracking systems

Abstract WE534: Seven-Day Accelerometer Data Provide a Reasonable Proxy for Longitudinal Exercise Patterns

Introduction: The incorporation of accelerometer data into population biobanks has catalyzed a new wave or research into physical activity. The most common study design uses 7 days of data to define exercise patterns. Hypothesis: Exercise patterns defined using 7-day accelerometer data are consistent with those defined using 90-day data. Methods: We analyzed participants from the All of Us Research Program with accelerometer (FitBit) data prior to enrollment. We defined a subset of dedicated users with sufficient data (>88% of days with ≥12 hours of wear-time) over the 90 day period prior to enrollment, including the 7 days immediately prior to enrollment. FitBit-defined “very active” and “fairly active” minutes were used to estimate vigorous intensity and moderate intensity exercise minutes respectively. Race, ethnicity, gender, and sex at birth were self-reported. Pearson’s correlation coefficients were used to compare the average weekly activity minutes using 7-day versus 90-day data. Meeting guidelines was defined as ≥75 minutes of vigorous intensity and/or ≥150 minutes of moderate intensity exercise per week. Results: The cohort consisted of 12,396 participants. Demographics are reported in the Table. Mean weekly activity minutes over 7-day and 90-day periods were positively correlated for both moderate and vigorous intensity exercise (Figure). The average difference in estimates from 7-day and 90-day data was 7.6 (SD 73.6) minutes/week for vigorous and 3.8 (SD 61.2) minutes/week for moderate intensity exercise. Among the 7,213 individuals who met guidelines based on 7-day data, 983 (14%) did not meet guidelines when considering 90-day data. Of the 5,183 individuals who did not meet guidelines based on 7-day data, 1,007 (19%) did meet guidelines when considering 90-day data. When identifying individuals who achieve recommended weekly exercise, the overall agreement between 7-day and 90-day data was 83.9% with Kappa .670 (95% CI [0.656, 0.682]), reflecting good agreement. Conclusions: In conclusion, exercise patterns derived from 7-day accelerometer data show good agreement with those derived from 90-day data. Though, some individuals may be misclassified. Overall, our findings support the use of 7-day data for studies of exercise patterns in large populations, but the potential impacts of modest misclassification should be considered.

Abstract TH893: Higher Carotid IMT Is Associated With Worse Cognitive Function Independently Of Age In Healthy Adults in Midlife

Introduction: Cognitive decline is a growing public health concern as the prevalence of Alzheimer’s Disease and Related Dementias (ADRD) is expected to rise. Moreover, vascular health has been shown to be linked to the eventual emergence of ADRD. Carotid intima-media thickness (cIMT) is a noninvasive measure that could potentially reveal subclinical vascular disease that could identify individuals at risk of ADRD earlier in life. Hypothesis: Increased cIMT is independently associated with worse cognitive function in healthy adults in midlife. Methods: We analyzed 174 adults (mean age 54±8 years; 83% female; 61% Caucasian) from two International Childhood Cardiovascular Cohort (i3C) studies - National Growth and Health Study and Princeton Lipid Research Study. Anthropometrics and laboratory evaluation were performed. Participants underwent carotid ultrasound to measure cIMT (mean of internal, bulb, and common carotid segments measured bilaterally) and completed the three Rowan Digital Cancellation Tests (RDCT; Letter, Symbol, Mixed Letter/Symbol) to measure executive and graphomotor information processing speed. Cancelation performance was expressed using composite scores that combine accuracy and processing speed. Variables were log transformed if indicated. General linear models with backward selection were used to identify predictors of RDCT performance, with logcIMT, age, sex, race, BMI, blood pressure, LDL, TG:HDL ratio, and logCRP. Results: After backward selection, logcIMT and age remained significant predictors across all RDCT forms. Higher logcIMT was associated with worse cognitive function independently of age (Letter: β=-0.18, p<0.01; Symbol: β=-0.15, p=0.02; Mixed: β=-0.11, p=0.01). Age was also inversely associated with cognitive performance (Letter: β=-0.006, Symbol: β=-0.005, Mixed: β=-0.004; p<0.01 for all). Additional covariates retained in some models included race (Symbol: β=-0.04, p=0.0495), LDL (Symbol: β=0.0006, p=0.04), and logCRP (Mixed: β=-0.01, p=0.04). Model R 2 were 0.15 (Letter), 0.18 (Symbol), and 0.19 (Mixed). Conclusions: In healthy middle-aged adults, greater cIMT is associated with greater executive and graphomotor processing speed deficits, independent of age and select cardiovascular risk factors. These findings suggest that subclinical vascular disease may be associated with cognitive decline earlier in the life course. Future studies should examine whether interventions targeting vascular health can preserve cognition.

Abstract TU265: Temporal Trends and Demographic Disparities in Mortality Associated with Coronary Artery Disease and Sleep Disorders Among Adults in the United States: Insights from the CDC WONDER Database 1999–2020

Background: Sleep disorders have been found to be associated with increased risk of Coronary Artery Disease (CAD) and lead to increased mortality. Despite that, the trends in mortality in CAD and sleep disorders remain underexplored. Research Question: What are the temporal trends and demographic disparities in CAD mortality associated with sleep disorders among adults aged ≥25 years in the United States (U.S.)? Aim: To analyze national trends and demographic disparities in sleep disorder–associated CAD mortality among U.S. adults from 1999 to 2020. Methods: We analyzed the CDC WONDER database, identifying adults aged ≥25 years from 1999 to 2020, where CAD (ICD-10 I20–I25) and sleep disorders (ICD-10 G47) were listed as contributing causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated and stratified by year, sex, race, region, urbanization, and state. Trends were analyzed using Joinpoint regression to calculate annual percent change (APC) and average annual percent change (AAPC). Results: From 1999 to 2020, 72,459 deaths were attributed to CAD and sleep disorders among U.S. adults aged ≥25 years. The overall AAMR increased from 0.45 in 1999 to 2.90 in 2020, with an AAPC of 9.01%. Notably, the AAMR increased sharply from 1999 to 2008 (APC 12.06, p < 0.000001), followed by a moderate increase from 2008 to 2018 (APC 5.42, p < 0.000001), and a steep increase again from 2018 to 2020 (APC 13.77, p =0.00034). AAMRs were higher in men than women (2.47 vs. 0.76), with both genders experiencing significant increases in mortality (AAPC 9.1, p <0.000001 in men vs AAPC 9.3, p < 0.000001 in women). Regionally, the Midwest recorded the highest AAMR (1.90), while the Northeast (1.08) had the lowest. Nonmetropolitan areas had higher AAMRs than metropolitan areas (1.87 vs. 1.43). By race, non-Hispanic (NH) American Indian/Alaska Natives had the highest AAMR (1.65), while NH Asian/Pacific Islanders had the lowest (0.43). State-level disparities were notable, with Oregon and South Dakota having the highest AAMRs (3.05). Most deaths occurred in medical facilities (41.6%). Conclusion: Mortality due to sleep disorders with CAD has significantly increased from 1999 to 2020 in the U.S., disproportionately affecting men, NH American Indian/Alaska Natives, residents of nonmetropolitan areas, and the Midwest. The increasing mortality and existing disparities call for targeted intervention to improve health outcomes, especially in vulnerable populations.

Correction: PDZK1 inhibits MRP2-mediated oxaliplatin chemosensitivity in hepatocellular carcinoma

Abstract TH892: Sex Discordance in a Novel Electrocardiographic Sex Index is Associated with Incident Cognitive Disorder

Background: Sex is a well-known modifier of risk for cognitive disorders including dementia in older adults. However, sex is a complex phenomenon with hormonal and genetic components. Therefore, a binary classification of sex may fail to capture the true heterogeneity of risk for various conditions. Objective: Evaluate the association of sex discordance, the discrepancy between binary sex and a novel electrocardiogram (ECG)-AI sex identification index (ESI), with incident age-related cognitive disorder. Methods: A convolutional neural network for detection of sex from 10-s 12-lead ECG was developed with very high accuracy (AUC=0.96) in >1 million ECGs from Wake Forest Baptist Health (Winston-Salem, NC). The ESI is a scalar value between 0 and 1, with 0=100% model confidence in female and 1=100% confidence in male sex detection per ECG. The sex discordance index (SDI; range 0 to 0.5) was defined as 0.5 minus the absolute value of ESI-0.5, such that values nearer to 0.5 indicate lower model certainty in sex identification. We applied the ESI model to index ECGs in sinus rhythm from 19,793 unique patients in an independent validation cohort and evaluated the association of the SDI with 5- and 10-year incidence of all-cause age-related cognitive disorder based on ICD-10 codes using age-adjusted hazard ratios (HR) from Cox regression models. Results: Patients with <1 year of follow-up time, pre-baseline diagnosis, or with time to event <1 year of the index ECG were excluded, yielding a total sample size of 15,862 (mean [SD] age 54.7 [14.9] years, 54% female). A total of 619 (3.9%; 4.2% female, 3.5% male) cases occurred within 5 years and 1,144 (7.2%; 7.7% female, 6.7% male) occurred within 10 years. Higher SDI was associated with significantly greater incidence of cognitive disorder over 5 years (highest quintile vs. lowest: HR=1.71 [95% CI: 1.31, 2.22]; per 20% increment: HR=1.10 [95% CI: 1.04, 1.17]) and over 10 years (highest quintile vs. lowest: HR=1.45 [95% CI: 1.20, 1.76]; per 20% increment: HR=1.07 [95% CI: 1.03, 1.12]). Associations were similar in male and female sex (all interaction p >0.05). In contrast to SDI, binary sex was not significantly associated with 5-year (female HR=1.16 [95% CI: 0.98, 1.36]) or 10-year (female HR=1.10 [95% CI: 0.97, 1.23]) cognitive disorder incidence. Conclusions: Higher sex discordance in an ECG-AI sex detection model was associated with up to 10-year incidence of age-related cognitive disorder, whereas binary sex was not.

Abstract TH865: Prevalence of High Lipoprotein(a) among People with and without HIV in the UK Biobank

Introduction: The risk of atherosclerotic cardiovascular disease (ASCVD) is elevated in people with HIV despite effective antiretroviral therapy. Lipoprotein(a) (Lp[a]) is an acute phase reactant and pro-inflammatory ASCVD risk factor that could potentially contribute to excess ASCVD risk in people with HIV, who have chronic inflammation. However, Lp(a) levels in this population have not been thoroughly investigated. Research Aim: Determine if people with HIV are more likely to have high Lp(a) than people without HIV. Methods: In UK Biobank participants aged 40–69 years (recruited 2006–2010) with serum Lp(a) measured using isoform-insensitive immunoturbidimetry, we examined the prevalence of high Lp(a), defined as ≥125 nmol/L. We compared the prevalence of high Lp(a) by HIV status using prevalence differences (PDs) estimated from generalized linear models, adjusted for age, sex, and ancestry. We also conducted a subgroup analysis stratified by African vs. European ancestry. Results: We examined 458 people with HIV and 451,548 without HIV. Compared to those without HIV, people with HIV were younger (median [IQR] age 50 [45, 57] vs. 58 [50, 63] years) and more likely to be male (86% vs. 46%) and of African ancestry (18% vs. 2%). Median Lp(a) levels (IQR) were 27 nmol/L (8, 102) for people with HIV and 20 nmol/L (8, 75) for those without HIV. In unadjusted analyses, people with HIV were more likely to have high Lp(a), with a prevalence of 20.5% (95% CI 16.8%, 24.2%) compared to 16.4% (16.3%, 16.5%) in those without HIV, a PD of 4.1 percentage points (0.4, 7.8) (Figure). The adjusted PD comparing people with vs. without HIV was 4.5 percentage points (0.9, 8.1). Among people of African ancestry, the unadjusted prevalence of high Lp(a) was 32.5% (22.2%, 42.8%) in those with HIV and 27.1% (26.1%, 28.0%) in those without HIV. Among people of European ancestry, unadjusted prevalence was 17.7% (13.7%, 21.8%) and 16.5% (16.4%, 16.6%) in those with and without HIV, respectively. Stratified PDs were similar to the overall findings (Figure). Conclusions: People with HIV were more likely than those without HIV to have Lp(a) levels above the risk-enhancing threshold of 125 nmol/L, even when accounting for age, sex, and ancestry. Clinicians should consider Lp(a) screening in people with HIV to inform ASCVD prevention efforts. Future studies should investigate reasons for high Lp(a) in some people with HIV and potential benefit of Lp(a)-lowering therapies in this population.