Browse Articles

Abstract TH912: Acculturation and Diet in Asian and Pacific Islander Immigrants: A Scoping Review

Introduction: Acculturation has a documented and important relationship with diet among immigrant populations. While this relationship has been extensively studied in Latino immigrants in the U.S., less research has focused on Asian and Pacific Islander immigrant (APII) populations, and few reviews have synthesized this evidence. Aims: The objective of this scoping review is to summarize quantitative research and approaches to examining acculturation and diet in studies of both aggregated APII populations and disaggregated APII subgroups. A secondary objective is to review the socio-ecological factors studied in relation to acculturation and diet. Methods: We identified articles from a search of MEDLINE and Embase conducted in July 2024 that assessed the relationship between acculturation status and diet among individuals identifying as Asian or Pacific Islander. Included articles were quantitative studies that focused on adult APIIs who resided in the U.S. The data extracted included details of the study design, APII subgroups represented, dietary measures used, acculturation/dietary acculturation measures, socio-ecological factors studied, and relevant results. Results: Out of 1,244 articles that were screened, 23 articles met our inclusion criteria. In studies with disaggregated analyses, Korean, Chinese, and Asian Indian immigrants were the most frequently studied. No study reported separate estimates for Pacific Islander populations. Most studies were cross-sectional and only one used longitudinal data. Most studies measured the construct of acculturation rather than dietary acculturation. Studies measured acculturation using one of four approaches: proxy measures, unidimensional and bidimensional scales, and cluster analysis. Most studies looked at individual factors, and not at other potentially relevant socio-ecological factors such as intrapersonal and community factors. Intrapersonal factors examined included family members’ dietary preferences. Conclusions: The review documented that there are some studies examining acculturation and diet among APII, but that more rigorous research is needed to understand the unique relationships between acculturation and diet for APII subgroups, particularly underrepresented Pacific Islander populations. Additionally, longitudinal studies that incorporate broader socio-ecological factors are needed to provide insight into mechanisms that explain the association between acculturation and diet.

Mechanical properties of body-centered tetragonal lattice structures in 316L stainless steel fabricated by SLM

Abstract Response surface methodology (RSM) was employed to investigate the mechanical performance of body-centered tetragonal (BCT) lattice structures fabricated from 316L stainless steel. A combined approach of numerical simulation and experimental validation was undertaken to explore the influence of structural parameters on mechanical properties. During the simulation stage, lattice models with different structural parameters were constructed using SolidWorks and subjected to uniaxial compression simulations in ABAQUS to obtain mechanical properties, including yield strength (YS) and modulus of elasticity (MOE). The simulation results were incorporated into the response surface model to quantitatively evaluate the influence of structural parameters on mechanical performance. To validate the numerical predictions, BCT lattice specimens with various structural parameters were fabricated using selective laser melting (SLM) and tested under uniaxial compression. The experimental results showed good agreement with the simulation results. The results indicate that both YS and MOE increase with increasing rod diameter and inclination angle, but decrease with increasing rod length. The maximum variations in YS and MOE were 143.69 MPa and 3379.54 MPa, respectively. When the rod length, rod diameter, and inclination angle were 4 mm, 1.5 mm, and 60°, respectively, the maximum YS and MOE values of 144.85 MPa and 3406.26 MPa were obtained. These findings provide a theoretical basis for the optimized design of BCT lattice structures.

Abstract TH900: Prediabetes in U.S. Adolescents: National Prevalence and Disparities in Hospitalized Populations, 2022

Background: With the global rise of pediatric obesity, prediabetes has emerged as a growing public health concern with the increased risk of early microvascular complications and metabolic disorders. Yet, data on national prevalence and socioeconomic disparities among hospitalised adolescents remain limited. Understanding these differences is essential for developing targeted interventions to mitigate clinical and economic burden of prediabetes in this vulnerable patient population. Method: We analyzed data from the 2022 National Inpatient Sample (NIS), identifying hospitalizations among adolescents aged 11-19 years, excluding those with diabetes. Prediabetes was defined using ICD-10 CM codes. Prevalence was calculated overall and stratified by sex, race/ethnicity, income quartile, and hospital region. Chi-square tests were used to assess differences across subgroups, with p<0.05 considered statistically significant. Result: Among 817,825 hospitalizations, 3150 cases with prediabetes were identified, yielding the prevalence of 0.4%. Significant disparities were evident across demographic and socioeconomic groups. When stratified by race, the prevalence of prediabetes was highest among Native Americans (0.74%) and Black adolescents (0.64%), compared to White adolescents (0.25%; p <0.001). Adolescents from the lowest household income quartile had a higher prevalence compared to the highest income quartile (0.44% vs 0.33%; p <0.001). Regional variation was notable, with the Northeast showing the highest prevalence and the South showing the lowest prevalence (0.51% vs 0.31%; p <0.001). However, the prevalence did not differ significantly by sex (0.40% in males vs 0.38% in females; p = 0.078). Conclusion: In 2022, prediabetes affected 0.4% of hospitalized U.S. adolescents, with significant disparities by race, socioeconomic status, and hospital region, but not by sex. These differences reflect the structural inequities apart from nutrition or preventive care access. Identifying prediabetes during hospitalization offers an opportunity for early intervention, especially in disproportionately affected populations. Our study highlights the need for targeted screening for high-risk groups during hospitalization which may serve as a step towards more equitable and preventive healthcare.

Abstract TH886: Associations between Life’s Essential 8 and Plasma Biomarkers of Alzheimer’s Disease Pathology, Neurodegeneration, and Neuroinflammation across Mid- to Late-Life: The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS)

Introduction: Emerging blood-based biomarkers provide a non-invasive and accessible means of quantifying dementia-related pathology and may help elucidate the biological mechanisms linking known cardiovascular risk factors and overall cardiovascular health to dementia risk. We tested the hypothesis that better midlife cardiovascular health, as measured by the American Heart Association's Life’s Essential 8 (LE8), is associated with lower levels of plasma biomarkers of neurodegeneration and neuroinflammation. Methods: Plasma biomarkers of amyloid beta (Aβ) 42 and 40, phosphorylated Tau-181 (p-Tau181), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP) were measured using Quanterix Simoa immunoassays at Visits 3 (1993-1995), 5 (2011-2013), and 6/7 (2016-2019) in a sample of 1515 ARIC participants (Visit 3 mean age: 58.5 years, 39% male, 25.5% Black). Biomarker ratios (Aβ42:Aβ40, p-Tau181:Aβ42) and base-2 log transformed values of p-Tau181, NfL, and GFAP were derived and standardized to Visit 3 to facilitate comparisons between biomarkers. Visit 3 measures of diet, physical activity, smoking, sleep health, body mass index (BMI), blood lipids, blood glucose, and blood pressure were used to calculate a summary LE8 score (0-100) that was classified as low (0-49), moderate (50-79), or high (80-100), with higher values indicating better cardiovascular health. Covariate-adjusted linear mixed-effects models estimated associations of LE8 categories with 10-year rates of change in standardized biomarkers from 1993-2019 (median follow-up: 18.6 years). Attrition and selection weighting was applied to reduce potential bias. Results: A slower rate of increase in NfL was observed among participants with moderate ( Figure 1; β = -0.145, 95% CI: -0.213, -0.076) and high (β = -0.206, 95% CI: -0.289, -0.124) LE8 scores compared to those with low LE8 scores. Differences in the rates of change of other plasma biomarkers were not statistically significant. Conclusions: Better midlife LE8 scores were associated with slower increases in a biomarker of neurodegeneration. Midlife LE8 scores were not associated with biomarkers reflective of Alzheimer’s disease pathology. These findings suggest that the connection between LE8 measures in midlife and dementia decades later may be expressed in changes to biomarker levels, opening the door for tracking brain health changes through biomarkers of neurodegeneration.

Abstract TU251: Misinformation on cardiovascular disease prevention and control spreads through social networks: A scoping review.

Background: Misinformation about cardiovascular health significantly impairs health outcomes. Despite its critical importance, a comprehensive mapping of the existing literature on this issue remains lacking. This scoping review aims to synthesize current evidence on cardiovascular health-related misinformation across diverse populations and settings. Methods: This scoping review was conducted following the Joanna Briggs Institute guideline, and various databases (MEDLINE, EMBASE, SCOPUS, Global Health, CINAHL, Web of Science) and grey literature were searched using the comprehensive search strategies based on the inclusion criteria of the review. Study selection involves (first title and abstract, then full-text review) a dual-reviewer approach using Covidence software, with conflicts resolved through discussion by a third reviewer. Two reviewers performed data extraction, and a narrative synthesis was accompanied by tabulated and graphical presentations of the data. Results: Out of 6,348 screened articles, 22 were included in the study. This review highlights the widespread misinformation in cardiovascular health, covering topics such as smoking, blood pressure, weight control, and alcohol. Misleading claims include the safety of e-cigarettes, the benefits of moderate alcohol intake, and the preference for unproven home remedies over pharmacological treatments. Notably, 28.6% of posts falsely warned against salt reduction, reaching 1.5 million followers, while 36.7% of diet and exercise vlogs on YouTube contained inaccuracies. Additionally, one-third of YouTube videos on acute myocardial infarction featured unreliable information, often from low-quality sources. <span style="box-sizing:border-box; margin:0px; padding:0px"> Conclusion: This review's findings underscore the alarming prevalence of misinformation related to cardiovascular diseases and their detrimental impact, which highlights the need to mitigate their harmful effects.</span>

A SMT pin soldering defect detection system based on improved connectivity domain algorithm

Abstract TH943: Healthy Hearts&Healthy Minds: A Case Study on Centering Wellness Across Cardiovascular and Mental Health Throughout the Perinatal Period Among African American Communities

The Black maternal health landscape in New York City remains critical, with Black women being more likely to face pregnancy-related death and experience severe maternal morbidity (8x and 2.3x respectively) compared to their White counterparts. Key drivers for these adverse outcomes continue to be cardiovascular and mental health conditions. To address these stark disparities in maternal health outcomes, a community-academic partnership was leveraged to develop a culturally competent and community informed health education intervention that prioritized the intersections of cardiovascular health, mental wellness and maternal health. The piloted initiative utilized a community based participatory research (CBPR) approach to conduct a program evaluation. In leveraging an existing community-academic partnership, community needs were identified to inform programmatic activities and support participant outreach. Five responsive health education workshops were implemented, reaching 190 community members. Participants were educated and empowered with knowledge on nutrition, cardiovascular and mental health critical for the perinatal period. Survey data was collected for programmatic evaluations. Participants identified as Black (68%), and female (82%). Survey analysis shows 85% of workshop participants felt empowered to apply what was learned into practice, and found the content easy to understand and effectively communicated. Moreover, 81% of participants responded being likely to share the health information learned within their social network. The CBPR approach used in designing this community-level intervention is critical in addressing maternal health disparities within communities of color. It ensured the sustainable delivery of cardiovascular related education programs with integrated mental health knowledge critical for the perinatal period.

Abstract TU261: Objectively Measured Sleep Duration and Incident Kidney Stone Disease: The Multi-Ethnic Study of Atherosclerosis

Background: Kidney stone disease (KSD) is linked to chronic conditions such as hypertension, diabetes, and cardiovascular disease. Both short and long sleep duration have been associated with these conditions, but their relationship with KSD is unclear. We examined the association between sleep duration, an indicator of sleep health, and the risk of KSD. Hypothesis: Both short and long sleep duration are associated with higher risk of KSD. Methods: We analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA) Sleep ancillary study , conducted at Exam 5 (2010-2012), with kidney stone data collected by self-report at Exams 5 and 6 (2016-2018). Sleep duration, measured by wrist actigraphy, was categorized as short (<6 hours/night), medium-short (≥6 to <7 hours/night), medium-long (≥7 to <8 hours/night), and long (≥8 hours/night). The medium-long group served as the reference category. Incident KSD was defined as a first kidney stone between Exams 5 and 6; recurrent KSD was defined as a stone in this interval plus a prior stone before Exam 5. Multivariable Poisson regression with robust variance estimates was used to estimate risk ratios (RR). Results: Of 1,557 participants with complete actigraphy and KSD data, 151 reported KSD at Exam 6. In a fully adjusted multivariable model, long sleep duration was associated with higher risk of a kidney stone at follow-up (RR 1.57, 95% CI: 1.05-2.35; Table 1). This association was also statistically significant for incident KSD (RR 2.07, 95% CI: 1.04-4.10), but not statistically significant for recurrent KSD (RR 1.52, 95% CI: 0.92-2.51). Conclusion: Long sleep duration was associated with incident kidney stones in this study. This finding aligns with evidence linking long sleep duration to adverse health outcomes. Future studies are needed to confirm this finding and explore underlying mechanisms.

Abstract MPWE43: Multi-trait Polygenic Risk Scores Improve Prediction of Heart Failure

Background: While clinical risk factors (CRF) have been used to predict heart failure (HF), an end-stage syndrome with high morbidity and mortality, the role of polygenic risk score (PRS) in identifying HF risk prediction remains unclear. Method: Using genome-wide summary statistics, we constructed 52 PRSs, including 1 for HF, 43 for echocardiographic(echo) traits, and 8 for CRF. Associations with incident HF were evaluated in 31,650 trans-ancestry participants (55% non-White; mean follow-up 16 years) from seven cohorts from the Trans-Omics for Precision Medicine (TOPMed) program, randomly divided into training (80%) and testing (20%) sets. Cox regression models adjusted for demographic and CRF were used to relate PRSs and to incident HF. Least absolute shrinkage and selection operator (LASSO) feature selection was performed on HF-related PRSs to build a multi-trait PRS (mPRS) in the training set. Associations of mPRS with incident HF, HF with preserved and reduced left ventricular (LV) ejection fraction (HFpEF and HFrEF, respectively), were examined in the testing set, with predictive performance evaluated by the C-statistic. Replication was conducted in 510,074 participants from the Million Veteran Program (MVP). Results: In the training set (n=25,320, HF cases=3,380), 17 out of 52 PRSs were associated with incident HF, where PRSs for HF and LV ejection fraction showed the largest effects (Figure 1a, HR HF-PRS : 2.02,95% CI 1.97-2.08, HR LVEF-PRS :0.93, 95% CI 0.89-0.97, p-value <0.05). Nine HF-related PRSs (1 HF, 6 echo, 2 CRF) were selected by LASSO to construct a multi-trait PRS (mPRS). In the testing set (n=6330, HF cases=856), per SD increase of mPRS was associated with about twofold increase in the risk of incident HF and its subtypes (Figure 1b, HR HF : 1.81, 95% CI 1.68–1.96; HR HFpEF : 2.08, 95% CI 1.78-2.43; HR HFrEF :1.97, 95% CI 1.68-2.31), and the associations were stronger in White vs Non-white participants. The associations of mPRS with incident HF and its subtypes were replicated in MVP (Figure 1b, HR HF : 1.13, 95% CI 1.11–1.15; HR HFpEF : 1.09, 95% CI 1.07-1.11; HR HFrEF :1.17, 95% CI 1.15-1.19). Adding mPRS over CRF modestly improved HF and HFrEF prediction in the trans-ancestral and white group (Figure 1c, HF trans-ancestral : estimated C: 0.89, delta C=1%, all p-values<0.05). Conclusion: The component PRS and mPRS were associated with HF risk, and mPRS can improve the prediction of incident HF, highlighting the potential for identifying at-risk populations.

Temporal Learning with Dynamic Range (TLDR) for modeling recurrent exposure and treatment outcomes

Abstract WE571: Comorbidities and Outcomes in Patients with COVID-19–Associated Ischemic Stroke: Data from the NIH COVID-19 NeuroDatabank

Introduction: The association between comorbidities and poor functional outcome in patients with non-COVID-19 ischemic stroke (IS) is well-established. This report aims to examine the differences in the distribution of comorbidities between COVID-19 IS patients with a devastating functional outcome and those without. Additionally, the impact of comorbidities on oxygenation and ICU admission was assessed. Methods: The data was queried from the NIH COVID-19 NeuroDatabank. We included hospitalized COVID-19 patients who developed IS and had available outcome data. A devastating functional outcome was defined as a modified Rankin Scale (mRS) >= 5 at hospital discharge. Individual comorbid conditions and comorbidity burden were examined. Wilcoxon signed-rank test and Fisher’s exact test were used. Multivariate regression was conducted for variables with significant differences. Results: Three hundred twenty-seven hospitalized COVID-19 IS patients were included; mean age: 63 years; males 57.9%. Out of 290 cases with mRS data, 120 (41.4%) had an mRS score >= 5 at discharge. Individual comorbidities showed no significant difference between mRS groups except for a higher frequency of asthma (p = 0.018) and kidney disease (p = 0.017) in the devastating outcome group. The number of cases with two or more non-communicable diseases (NCDs) was significantly higher in the mRS >= 5 group (p = 0.013). A Charlston Comorbidity Index-derived score was also higher in the devastating outcome group (mean[SD] = 2.04[1.96] vs. 1.57[1.7], p = 0.032). Out of 288 cases with oxygenation data, 193 cases received oxygen. The frequency of diabetes and the burden of NCDs were significantly higher in oxygenated cases (p = 0.028&0.034, respectively). Out of 278 cases with ICU data, 186 received ICU admission. Admitted cases had significantly lower mean age, frequency of stroke &/or dementia, psychiatric disorders, and hypertension. The frequency of asthma was significantly higher in ICU admitted patients. Multivariate regression analysis showed no significant association between any of the comorbidities or scores and oxygenation or ICU admission. Conclusion: Comorbidities associated with poor functional outcome in non-COVID-19 IS patients showed no differences among outcome groups in COVID-19 IS patients. Demographics, COVID-19-related and hospitalisation factors, appear to play a more pronounced role in shaping the outcomes in this group. The small sample size and retrospective nature limit the study.

Abstract TU154: Apparent Resistant Hypertension in US Adults: Temporal Trends, Renal Denervation Eligibility, and the Impact of Isolated Systolic Hypertension

Background: The 2025 AHA/ACC (American Heart Association/American College of Cardiology) and ESC/ESH (European Society of Cardiology/European Society of Hypertension) guidelines introduced new diagnostic and risk-based blood pressure (BP) thresholds, while renal denervation (RDN) has emerged as a device-based therapy for resistant hypertension. The impact of these guidelines on the prevalence, trends, and RDN eligibility among US adults with apparent resistant hypertension (aTRH) remains unclear. Methods: We analyzed adults aged ≥20 years treated for hypertension from NHANES 2005–2020. aTRH was defined by AHA/ACC (uncontrolled BP on ≥3 antihypertensive medications including a diuretic, or controlled BP on ≥4) and ESC/ESH (office BP ≥140/90 mmHg on ≥3 drug classes including a diuretic) criteria. aTRH cases were stratified by 2025 AHA/ACC risk-based thresholds. RDN eligibility was assessed using strict (SBP ≥140 and DBP ≥90 mmHg) and inclusive (including isolated systolic hypertension) criteria among patients on optimal therapy with eGFR ≥40 mL/min/1.73m2. Survey-weighted and multivariable regression analyses estimated national prevalence, temporal trends, and predictors of RDN eligibility. Results: Among 39.7 million US adults with treated hypertension, aTRH prevalence by AHA/ACC criteria declined from 21.6% (2005–06) to 16.6% (2017–20); ESC/ESH criteria yielded lower rates (6.4–9.6%). The AHA/ACC definition identified 2.4 times more cases than ESC/ESH (17.2% vs 7.3%). The prevalence was higher in adults ≥65 years versus 20–64 years (23.3% vs 12.9%, p<0.001). Multivariable regression showed older age ≥65 years (adjusted OR 1.73, 95% CI: 1.09–2.74) and male sex (OR 1.78, 95% CI: 1.29–2.50) were significantly associated with RDN eligibility. By 2025 risk stratification, 95.9% of aTRH cases were low-risk, 3.7% had CVD, 1.8% had diabetes/CKD/elevated PREVENT score, and 0.1% met BP-only criteria. Among 1,899 aTRH patients, 72,805 (1.06%) met strict RDN eligibility; inclusion of isolated systolic hypertension increased eligibility tenfold (10.26%; adjusted OR 25.58, 95% CI 8.5–12.3). Conclusions: aTRH prevalence in US adults varies substantially by guideline definition and has declined over time. Regression analysis identified age and sex as predictors of RDN eligibility. Integrating risk-based thresholds into aTRH management and expanding RDN criteria to include isolated systolic hypertension may enhance patient selection and optimize hypertension control.

Abstract WE492: The mediating role of environmental and lifestyle factors in cardiovascular disease in The Maastricht Study

Introduction: Individuals with lower socioeconomic position (SEP) are at a higher risk of developing cardiovascular disease (CVD). Harmful neighborhood conditions may contribute to higher allostatic loads and also make it more difficult to achieve healthy behaviors. We investigated the relationship between SEP and incident CVD and aimed to determine whether the environment independently, and jointly with lifestyle factors, mediated this association. Methods: Data from 7,195 participants with a mean age of 59.5 years from The Maastricht Study in the Netherlands were used. The measure for SEP was education level. A standardized composite score was calculated for the environment (food environment, walkability, social cohesion) and lifestyle factors (diet, moderate-to-vigorous physical activity, alcohol, smoking). CVD incidence was defined by self-reported non-fatal events in an annual questionnaire over up to an 11-year follow-up period. Generalized structural equation modeling tested the mediating effects of the environmental and lifestyle factors, and the serial pathway of the environment through lifestyle factors between education and CVD. Results: Lower education was associated with a higher risk of developing CVD (HR: 1.08; 95% CI: 1.03, 1.12). Harmful environments independently mediated 12.4% of this association (HR: 1.01; 95% CI: 1.00, 1.02), while 62% was mediated by harmful lifestyle factors (HR: 1.04; 95% CI: 1.03, 1.05). Harmful environments through harmful lifestyle factors mediated a small proportion (3.1%) of the effect of lower education and CVD (HR: 1.00; 95% CI: 1.00, 1.00). Conclusion: This study shows that harmful lifestyle factors mediated a greater proportion of the association between low SEP and CVD while the neighborhood environment had a smaller influence, both independently and jointly. Further studies should investigate additional environmental exposures, behaviors, and risk factors on the pathway to CVD.

Metabolic changes in normal-appearing white matter associate with MRI measures of disease burden in relapsing-remitting multiple sclerosis over three years

Abstract Myo-inositol (mI) and total N-acetylaspartate (tNAA) are potential MR spectroscopic imaging (MRSI) biomarkers of smouldering-associated worsening in multiple sclerosis (MS). In this study, we explored metabolic changes in normal-appearing white matter (NAWM) in patients with relapsing–remitting MS (pwRRMS) using 7 T MRSI. 20 pwRRMS were scanned annually with 2D-MRSI, with follow-up ranging up to three years. Metabolic ratios were calculated within NAWM for each measurement and assessed cross-sectionally and longitudinally with established and emerging MRI measures of disease burden, including paramagnetic rim lesions (PRLs), brain atrophy, and T2 lesion load. At baseline, pwRRMS showed higher mI/tNAA (β = 0.058; p  = 0.047) and lower tNAA/total creatine (tCr) (β = − 0.106; p  = 0.029) compared to controls. tNAA/tCr was further reduced in pwRRMS with PRLs (β = − 0.138; p  = 0.022). mI/tNAA was associated negatively with cerebral WM volume (β = − 0.001, p  = 0.015) and positively with T2 lesion volume (β = 0.009; p  = 0.044). mI/tNAA increased longitudinally in pwRRMS (β = 0.014; p  = 0.022), especially with higher PRL count (β timepoint:PRLcount  = 0.016; p  = 0.045). An association between tNAA/tCr and the interaction of time with total GM volume was observed but did not survive FDR-correction (β = 0.001; p  = 0.078). These findings further support the clinical relevance of mI and tNAA alterations as imaging biomarkers of underlying pathology in MS. They highlight the value of 7 T MRSI in capturing subclinical disease burden and underscore the association of PRLs with overall widespread WM damage.

Abstract TU168: Diet Quality: Magnitude and Predictors of Change in Response to a Six-Month Physical Activity Intervention

Introduction: Engaging in health promoting behaviors such as physical activity (PA) may elicit improvements in other healthy behaviors, such as improved dietary choices. Hypothesis: Participants enrolled in a PA intervention group will demonstrate greater improvements in DQ compared to control. Methods: This analysis examined changes in diet quality (DQ) using the Mediterranean Eating Patterns for Americans (MEPA) questionnaire and assessed whether baseline characteristics predicted DQ change. Participants were enrolled in the Active You study, a 6-month weight agnostic RCT that examined the feasibility of using curated exercise videos to promote PA in adults with obesity and self-reported non-adherence to national PA guidelines. Participants were randomized to one of two groups: attention control (AC) or PA for the heart (PATH) intervention. AC group participants received a booklet that provided strategies to integrate PA into daily life and met biweekly with a study coordinator. PATH group participants had access to the PATH platform and met biweekly with an exercise coach for a supervised activity session. All participants received a fitness tracker, digital scale, blood pressure monitor, and a bimonthly newsletter focusing on ways to improve DQ. We calculated change in MEPA score from baseline to 6-months and explored baseline measures and sociodemographic characteristics as predictors of MEPA change using multiple linear regression analysis. Intention-to-treat analysis used multiple imputations for participants with missing 6-month MEPA scores. Results: The sample (N=89) was 46% white, 91% female with a mean age of 48.7±12.2 years and mean baseline BMI of 39.7±6.8 kg/m 2 (AC) and 41.0±7.6 kg/m 2 (PATH). At baseline, there were no significant group differences in sociodemographic or key measurements. At study end, MEPA score significantly increased only in the PATH group (p <0.001) while self-reported PA significantly increased in both groups. Regression analysis revealed higher baseline BMI was modestly associated with MEPA improvement (β = 0.08, p < 0.05). When treatment and baseline MEPA were added to the model, only baseline MEPA score predicted of DQ change (β = –0.34, p < 0.05). Conclusions: Though all participants received bimonthly diet quality newsletters, only those in the PATH intervention group improved their DQ score. Future studies need to examine if the changes in DQ are sustained over time and explore other factors that may influence DQ.

Abstract WE409: Rising Cardiac Arrest–Related Mortality Among Amyloidosis Decedents in the United States, 1999–2023

Background: Cardiac amyloidosis is an underrecognized cause of heart failure and cardiac arrest. Amyloid fibril deposition in the myocardium causes restrictive physiology and conduction abnormalities leading to cardiac arrest. Despite diagnostic and therapeutic advances, national mortality trends remain unclear. This study evaluated temporal and demographic patterns in cardiac arrest–related mortality among amyloidosis decedents in the United States. Methods: Data from the CDC WONDER Multiple Cause of Death database (1999–2023) were analyzed to identify adults (≥25 years) with both cardiac arrest (I46.x) and amyloidosis (E85.x) listed on death certificates. Age-adjusted mortality rates (AAMRs) per 100 000 population (2000 U.S. standard) and annual percent changes (APCs) were calculated using Joinpoint regression across sex, race, region, urbanization, and age groups. Results: From 1999 to 2023, 6,312 deaths involved both cardiac arrest and amyloidosis. The AAMR remained stable from 1999–2014 (≈0.09 to 0.10; APC = +0.2 %, p = 0.79) but increased markedly to 0.17 by 2023 (APC = +6.7%, p < 0.001). Males had higher mortality than females (AAMR 0.13 vs 0.08) and demonstrated a greater post-2011 rise (APC +6.9%, p < 0.001). By race, Black decedents showed a steady increase (APC +4.2 %, p < 0.001), while White decedents remained stable until 2014, followed by a significant acceleration (APC +7.7 %, p < 0.001). Mortality rose most sharply among adults aged ≥75 years (APC +7.0 %, p < 0.001). Geographically, the South and Northeast exhibited the highest rates of increase, and by urbanization, mortality climbed most in large-fringe metropolitan areas.The rising trend persisted through 2023, indicating a sustained national increase beyond the pandemic period. Conclusions: Cardiac arrest–related mortality among amyloidosis decedents has risen markedly since 2014. The trend parallels improved disease recognition via bone scintigraphy, cardiac MRI and therapies such as tafamidis. Persistent disparities were evident, with men, older adults, and Black individuals experiencing disproportionate increases. These patterns likely reflect a combination of hereditary factors, including the V122I transthyretin variant, delayed diagnosis, and unequal access to specialized care.Broader awareness, early screening in high-risk groups, and equitable integration of amyloidosis management into cardiac-arrest prevention efforts are essential to address this evolving cardiovascular disparity.

Abstract TU260: Demographic and Geographic Disparities in Mortality Among Patients with Heart Failure and Obstructive Sleep Apnea: A Nationwide Study (1999–2020)

Background: Heart failure (HF) remains a leading cause of morbidity and mortality in the United States, with obstructive sleep apnea (OSA) increasingly recognized as a prevalent comorbidity that may exacerbate hemodynamic stress, sympathetic activation, and adverse cardiovascular outcomes. Although OSA affects a large proportion of individuals with HF, it remains underdiagnosed and undertreated. Despite this growing awareness, national mortality trends and disparities in HF-related deaths involving OSA have not been comprehensively characterized. Hypothesis: We hypothesized that mortality from HF with comorbid OSA has increased over the past two decades and varies significantly by sex, race, urbanization level, and geographic region. Methods: Mortality records from the CDC WONDER database were analyzed for 7,414 individuals aged > 35 years between 1999 and 2020. HF (ICD-10 codes I11.0, I13.0, I13.2, I50) was designated as the underlying cause of death, and OSA (ICD-10 code G47.3) was identified as a contributing cause. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated. Temporal trends were evaluated using Joinpoint regression to estimate the annual percent change (APC). Results: From 1999 to 2020, the AAMR for HF deaths with OSA increased from 0.7 (95% CI, 0.5–0.8) to 4.4 (95% CI, 4.1–4.7), with an APC of 8.9% (p < 0.001). Cumulative AAMR was higher among males (2.6 [95% CI, 2.5–2.6]) than females (1.5 [95% CI, 1.4–1.5]). By race, African American individuals had the highest AAMR (3.8 [95% CI, 3.6–4.0]), followed by Whites (1.8 [95% CI, 1.7–1.8]), American Indians (1.3 [95% CI, 0.9–1.8]), and Asians (0.5 [95% CI, 0.4–0.6]). Large-fringe metropolitan areas had the lowest AAMR (1.6 [95% CI, 1.5–1.7]), while small-metropolitan (2.3 [95% CI, 2.1–2.4]) and micropolitan-rural (2.3 [95% CI, 2.2–2.5]) areas had the highest. Among U.S. regions, the Midwest and West showed the greatest AAMRs (2.3 [95% CI, 2.2–2.4]), followed by the South (1.9 [95% CI, 1.8–2.0]) and Northeast (1.3 [95% CI, 1.2–1.4]). Conclusions: Mortality from heart failure with comorbid OSA has increased substantially since 1999, with a disproportionate burden among males, African American individuals, rural communities, and residents of the Midwest and West. These findings underscore the need for integrated strategies that address OSA diagnosis and management in patients with HF, with attention to equity-focused interventions across underserved regions.

Physical activity coaching programme for people with Long COVID: a pilot randomised clinical trial

Abstract Low physical activity-PA may affect health outcomes in people with Long COVID. This study assessed the feasibility, safety and preliminary efficacy and effectiveness of a PA coaching programme vs. usual care. A randomised, parallel-group, pilot trial compared a twelve-week multicomponent PA coaching intervention (EG: self-monitoring, feedback, and goal setting/review) with usual care (CG: self-managed PA). PA (inertial sensors-light/moderate/vigorous PA [min·day -1 ], steps·day -1 ), functional capacity (6-minute walk test-6MWD; 1-minute sit-to-stand test-1minSTS), dyspnoea (modified Medical Research Council scale-mMRC), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue scale-FACIT-FS) and health-related quality of life-HRQoL (European Quality of Life-Five Dimensions-Five Levels visual analogue scale-EQ-5D-5L) were assessed at baseline, three- and six-months afterwards. Recruitment (≥70%), retention, adherence (≥80%) and preliminary efficacy/effectiveness explored feasibility. Adverse events determined safety. Fifty participants (EG: n=25, 47±10y, 80%♀; CG: n=25, 46±11y, 76%♀) were enrolled. Recruitment (89%), retention (92%) and adherence (83%) met feasibility criteria. At three-months, the EG improved PA, sedentary behaviour and functional capacity compared to the CG (light PA: +53[19;89]min·day -1 ; steps·day -1 : +4632[2626;6638]; sedentary time: -71[-141;-2]min·day -1 ; 6MWD: +119[51;187]m). Dyspnoea, fatigue and HRQoL also improved (mMRC: -1[-2;-1]; FACIT-FS: +11[6;17]; EQ-5D-5L: +21[13;29]). These changes were maintained or further improved at six-months/three-months post-intervention (light PA: +73[36;111]min·day -1 ; moderate-to-vigorous PA: +7[1;14]min·day -1 ; steps·day -1 : +5236[3070;7402]; sedentary time: -98[-165;-31]min·day -1 ; 6MWD: +136[69;203]m; 1minSTS: +9[2;15]reps; mMRC: -1[-2;-1]; FACIT-FS: +19[13;24]; EQ-5D-5L: +25[18;33]). No adverse events occurred. The PA coaching programme was feasible, safe and may enhance and sustain PA, sedentary behaviour, functional capacity, symptoms, and HRQoL in Long COVID up to three-months post-intervention. A large trial is warranted. ClinicalTrials.gov: NCT06165978

Abstract WE512: The Importance of Specific Guidance on Trans-fat Elimination in a Healthy Food Procurement Policy: An Evaluation from Schools in Nepal

Background: 540,000 deaths per year are attributed to industrially produced trans-fatty acids. Trans-fat has no known health benefits and is a major dietary risk factor for cardiovascular disease. Nepal passed national legislation in 2024, joining over 50 countries in restricting trans-fat. Healthy public food procurement and service policies were implemented at the municipality level and included language to limit or prohibit availability and purchase of trans-fat foods, a one-day training, nutrition posters, and follow-up visits in schools. Objective: To assess the change in availability of packaged foods containing trans-fat in school canteens and retail settings after policy implementation in Nepal. Methods: A quasi-experimental pre-post study was conducted in 238 schools in Nepal in 2024-25. Packaged foods were determined to contain trans-fat if non-zero levels of trans-fat were declared on nutrition information labels. Mutually exclusive categories were created for schools where packaged foods containing trans-fat were 1) unavailable, or available in 2) canteens only, 3) retail settings only, or 4) both. A Sankey plot was used to visualize the distribution. A mixed-effects logistic regression (MELR) model with random intercepts for schools and adjusting for different municipalities was used to assess change. Results: 74 schools (31%) had packaged foods containing trans-fat in canteen and/or retail settings prior to policy implementation, and 47 (20%) after, a decrease of 11%. Schools with packaged foods containing trans-fat in retail settings dropped from 35 to 11, but the number rose from 30 to 34 for canteens (Figure). MELR showed a lower odds ratio for schools with packaged foods that contained trans-fat after policy implementation (OR 0.54, 95%CI [0.35, 0.83]), consistent with a lower odds ratio in retail settings (OR 0.008, [0.001, 0.050]) and both retail settings and canteens (OR 0.000642, [0.000640, 0.000644]), but not in canteens only (OR 1.16, [0.68, 1.96]). Conclusions: Although schools reduced the availability of packaged foods containing trans-fat by about half after policy implementation, they were not eliminated. Significant decreases were observed in retail settings only, whereas canteens showed higher but nonsignificant levels. Without strong national enforcement of trans-fat elimination, a robust food procurement policy at the municipality level presents an opportunity to monitor and replace products containing trans-fat in schools.

Abstract WE439: The generalizability of the Dietary Approaches to Stop Hypertension for Diabetes (DASH4D) Diet

Background: We recently showed that a DASH-style diet optimized for diabetes (DASH4D diet) significantly reduced blood pressure and improved glycemic control in a randomized trial of adults with type 2 diabetes. To better understand the generalizability of the DASH4D findings, we compared demographic and clinical characteristics and the baseline dietary intake of the trial participants with those of the general US adult population with type 2 diabetes. Methods: We analyzed pre-randomization data from 103 participants in the DASH4D trial. For the comparison population, we analyzed data from 546 participants from NHANES 2021-2023 who met the inclusion criteria of the DASH4D study (aged 18 years and older with type 2 diabetes, systolic blood pressure of 120 – 159 mmHg, and diastolic blood pressure of <100 mmHg). Participants with HbA1c >9 were excluded. Typical dietary intake was assessed using 24-hour dietary recall in both studies. We assessed dietary recall data along with demographic, physical and clinical characteristics in both study populations. Analyses of NHANES accounted for the complex survey design and were weighted to provide nationally representative estimates. Results: The DASH4D participants were more likely to be female, Black race, and have higher attained education, and have lower total cholesterol than US adults with diabetes. The prevalence of obesity was similar in the two populations (Table 1) . Participants in DASH4D and US adults had comparable intake of protein (17 vs.16 % of total energy intake), carbohydrates (44 vs. 45% of total energy intake), and total fat (39 vs. 38% of total energy intake) (Figure 1) . DASH4D participants consumed a higher average level of fiber (10 g per 1,000 kcal) compared to NHANES (8 g per 1,000 kcal). Both populations had similar intakes of calcium, magnesium, phosphorous and potassium (Figure 2) . Conclusion: The usual dietary intake of participants in the DASH4D trial is broadly representative of US adults with diabetes, suggesting findings from the DASH4D trial are likely generalizable to the US population with diabetes.