Browse Articles

Abstract MPTU07: Patterns of one-year change in HbA1c and Continuous Glucose Monitoring (CGM) Metrics in Older Adults with Type 2 Diabetes

Background: There is growing interest and use of continuous glucose monitoring (CGM) technology as an adjunct or substitute for HbA1c in assessing glycemic control. However, how changes in CGM metrics and HbA1c track together over time is poorly understood, particularly in type 2 diabetes. We investigated the patterns of change in HbA1c and CGM metrics among older adults with type 2 diabetes. Methods: We analyzed data from 88 older adults with type 2 diabetes from the Atherosclerosis Risk in Communities (ARIC) Study who had measurements of HbA1c and wore CGM sensors at visit 9 (2021-22) and visit 10 (2023). HbA1c, CGM mean glucose, and time in range (TIR, percent time with CGM glucose 70-180 mg/dL) were compared using Deming regression, Bland-Altman plots, and Pearson’s correlations. Variability was assessed using the within-person coefficient of variation (CV w ). Proportion of variance in HbA1c change explained by changes in CGM metrics was estimated using linear regression with splines. Discordance was defined as having different direction or magnitude of change, based on an absolute HbA1c change of 0.5% and the corresponding changes in CGM metrics derived from linear mixed-effects models. Results: At baseline, the mean age was 82 years, 42% were women, and 27% self-identified as Black. The mean CGM wear time was 13 days (SD, 2) at both visits. Over a median of 1.6 (1.3, 1.8) years, the population mean HbA1c, CGM mean glucose, and TIR did not significantly change, with baseline means of 6.9% (SD, 0.9), 138.2 mg/dL (SD, 35.8), and 77.5% (SD, 21.4), respectively. CGM mean glucose showed higher variability (CV w =18.8%) than HbA1c (CV w =8.4%) and TIR (CV w =11.7%) ( Figure 1 ). Changes in CGM mean glucose explained 52.0% of the variance in HbA1c change, while changes in TIR explained 45.6%. We found that approximately one-third of the participants had discordant changes between HbA1c and CGM metrics over time, with percent agreement of 67.0% between HbA1c and CGM mean glucose, and 65.9% between HbA1c and TIR ( Figure 2 ). Similar results were found in subgroups by sex, race, diabetes medication use, and after excluding participants with reduced kidney function. Conclusions: Among older adults with type 2 diabetes, HbA1c is less variable than CGM mean glucose or TIR, and long-term changes (>1 year) in HbA1c and CGM metrics are frequently discordant. This suggests the complementary nature of using HbA1c and CGM together to monitor glucose control.

Data-driven springback prediction of curved metal sections in curtain wall systems

Abstract TH985: Optimal Dietary Patterns for Improving Health-Related Quality of Life during the Menopausal Transition: Two Large Prospective United States Cohort Studies

Background: In aging societies, improving health-related quality of life (HRQoL) is vital, as it not only predicts cardiovascular disease and mortality but also reflects overall wellbeing. Because HRQoL often declines across menopause, a pivotal stage of women’s aging, we prospectively examined and compared 11 dietary patterns with HRQoL change during the transition. Methods: We analyzed 23,129 women from the Nurses’ Health Study (NHS) and NHSII who entered menopause between the first diet and the last of HRQoL assessment (NHS: 1984–2000; NHSII: 1991–2001). HRQoL was measured with the Medical Outcomes Study 36-Item Short Form Health Survey, yielding eight domains summarized as Physical (PCS) and Mental (MCS) Component Scores. Diet was assessed with validated food-frequency questionnaires. We calculated cumulative average scores for 11 dietary pattern indices across assessments prior to outcome assessment and categorized them into quintiles. Generalized linear models with repeated measures estimated mean 4-year changes in HRQoL. Results: During the follow-up, mean (SD) PCS declined [−1.30 (7.41) points/4-years] and MCS improved [1.58 (8.26)]. Healthier dietary patterns [Plant-based Diet Index (PDI), healthy PDI (hPDI), Mediterranean Diet (MedDiet), Dietary Approaches to Stop Hypertension (DASH), Mediterranean–DASH Intervention for Neurodegenerative Delay (MIND), Alternative Healthy Eating Index(AHEI)-2010, Planetary Health Diet Index (PHDI)] were associated with less declines in PCS scores and unhealthy patterns [unhealthy PDI (uPDI), empirical dietary inflammation pattern (EDIP), empirical dietary index for hyperinsulinemia (EDIH), ultra-processed foods (UPF)] were associated with more PCS declines, with the largest magnitudes [Δ, Q5 vs. Q1 (95% CI)] observed for MIND [0.56 (0.38, 0.75)]. Healthier dietary patterns (hPDI, MedDiet, DASH, MIND, AHEI) were associated with greater MCS improvement, and unhealthy patterns (uPDI and UPF) were associated with less MCS improvement, showing the largest magnitudes for DASH [0.46 (0.27, 0.65)]. Associations were similar across eight domains. More vegetables, fruits, fish aligned with better HRQoL change; more fast/fried foods, sweetened drinks or snacks, and red and processed meat aligned with worse. Conclusions: Plant-forward, neuroprotective and blood pressure–lowering patterns, including healthy animal based and less processed foods may optimize physical and mental wellbeing across menopause.

Abstract TH902: Joint Impact of Social Determinants of Health Burden and Coronary Artery Disease on All-Cause and Cardiovascular Mortality: 18-Year Follow-up From National Health And Nutrition Examination Survey 2000–2018

Background: Coronary heart disease (CHD) remains the leading cause of death in the United States, yet the benefits of modern cardiovascular care are not equitably distributed. Social determinants of health (SDoH), which includes economic stability, education, healthcare access, and neighborhood environment, may substantially shape outcomes among patients with CHD. Our study evaluates the joint association of SDoH burden and CHD with mortality outcomes. Methods: We analyzed adults ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2000–2018, linked with the National Death Index through 2018. Cumulative SDoH burden was derived from eight domains (employment, poverty-to-income ratio, food insecurity, education, healthcare access, insurance, housing, marital status), categorized as low (0–2), moderate (3–5), or high (6–8). Weighted Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cardiovascular mortality by SDoH burden, stratified by CHD status, with sequential adjustment for demographic and cardiometabolic factors. Results: Among 49.3 million U.S. adults (mean age 46.1 ± 15.6 years; 44.8% female), 3.7% had CHD. Those with CHD were older (64.7 vs 45.4 years, p < 0.001), more often non-Hispanic White (94.2% vs 81.5%), and had greater waist circumference (106.1 vs 87.5 cm) but lower cholesterol (176 vs 202 mg/dL, p < 0.001). Participants with high SDoH burden had lower income and education. In weighted regression, higher SDoH burden and CHD were independently associated with greater all-cause and cardiovascular mortality. Fully adjusted models showed high SDoH burden tripled all-cause mortality risk (HR 3.00, p < 0.001), while CHD further amplified risk. Compared with low SDoH/no CHD, those with CHD and high SDoH burden had nearly a 14-fold higher all-cause mortality (HR 13.6, p < 0.001) and 17-fold higher cardiovascular mortality (HR 17.7, p < 0.001). Findings were consistent across sex, race, and metabolic subgroups, with mortality hazards often exceeding tenfold among those with both CHD and high SDoH burden. Conclusions: Cumulative SDoH burden is strongly and independently associated with mortality among adults with CHD, with evidence of a synergistic effect between biological and social vulnerability. These findings underscore the need for policies and interventions addressing upstream social inequities to improve survival in cardiovascular populations.

Abstract TU161: Raised Blood Pressure and its Awareness and Control Surveillance in Adults: Italian Health Examination Survey 2023-2025 - CUORE Project

Introduction: Heart attack, stroke, kidney failure, dementia and blindness risk are significantly increased by raised blood pressure (RBP). The WHO recommends a 25% relative reduction in the RBP prevalence by 2025 (baseline 2010). RBP prevalence and mean blood pressure were assessed in the Italian general adult population by periodic Health Examination Surveys (HESs) conducted within the CUORE Project. A new survey started in 2023 and is still ongoing, promoted and financed by the Ministry of Health – CCM and the European Commission through JACARDI. Hypothesis: This analysis aims to assess if Italy can meet the RBP WHO target in the general adult population using data measured in the periodic HESs conducted within the CUORE Project. Methods: In the period 2023-2025, BP measurements within a new HES were implemented. Up to now, data from random samples of residents in 17 Regions (out of 20 regions) distributed in North, Centre and South of Italy are available (1731 men, 1749 women aged 35-74 years). BP was measured by automated oscillometric device using standardized procedures and methods. RBP was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Statistics were standardized by Italian 2024 age-sex distribution. Results: Mean value of systolic BP is 134 mmHg (95% confidence interval: 133-136 mmHg) in men and 126 mmHg (95% CI: 125-128 mmHg) in women. Mean value of diastolic BP is 79 mmHg (95% CI: 78-80 mmHg) in men and 75 mmHg (95% CI: 74-76 mmHg) in women. Prevalence of RBP is 37% (95% CI: 32-41%) in men and 23% (95% CI: 19-27%) in women. Among those with RBP and/or in treatment (49% of men and 37% of women), 41% of men and 31% women are unaware they could have BP control problems, 12% and 15% are aware but not in treatment, 23% and 35% are under treatment and at target, 24% and 19% are under treatment but not at target, respectively. Conclusions: Considering 2023-2025 preliminary data, significant reductions in RBP prevalence occurred compared to 25 years ago and 15 years ago HES data, while an increasing trend was found in comparison to 5 years ago. RBP is still high in the Italian adult population, and improvements on RBP awareness and control are still necessary. Prevalence of unaware persons with RBP supports the WHO recommendation to monitor targets by periodic survey based on measured data - HESs.

Serogroups, antibiotic resistance profiles and virulence factors of non-O157 Shiga-toxin producing Escherichia coli from ovine and caprine

Abstract TU267: Cardiovascular Health Scores in Patients with Sleep-Disordered Breathing

Objective: Sleep-disordered breathing (SDB) and obstructive sleep apnea are associated with increased cardiovascular (CV) disease risk. Life’s Essential 8 (LE8) is the American Heart Association’s comprehensive framework evaluating CV health across 8 domains: diet, physical activity, nicotine exposure, sleep duration, body mass index (BMI), lipids, glucose, and blood pressure (BP). This study evaluates overall CV health in SDB patients using the LE8 framework. Methods: Patients with SDB presenting to a sleep surgery clinic from May 2024 – October 2025 were included. Demographics and LE8 components were obtained from chart review. Dietary quality was assessed via Mini-EAT questionnaire (score <61, unhealthy; 61-69, intermediate; >69, healthy). Laboratory values were within 1 year of their visit and included fasting glucose, hemoglobin A1c (HbA1c), and non-high-density lipoprotein (non-HDL) cholesterol. Use of anti-hypertensives, cholesterol-lowering medications, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) was recorded. Composite LE8 score was calculated using modified AHA guidelines, with <50 representing poor, 50-79 intermediate, and >80 ideal CV health. Results: In total, 69 patients (75.4% male, 60.9% White) were included. Patients were middle-aged (55.2 ± 11.9 years), overweight (BMI 29.2 ± 5.1 kg/m2), and had intermediate dietary quality (Mini-EAT score 63.8 ± 8.0). Only 56.5% of patients met the AHA’s recommendation of ≥150 minutes of moderate or ≥75 minutes of vigorous physical activity per week. Nineteen patients (27.5%) were using GLP-1 RAs, 34 (49.3%) using anti-hypertensives, and 32 (46.4%) using cholesterol-lowering medications. On average, non-HDL cholesterol was 120.7 ± 41.7 mg/dL; fasting glucose, 100.7 ± 34.0 mg/dL; HbA1c, 5.6 ± 0.85%; systolic BP, 125.8 ± 18.6 mmHg; diastolic BP, 79.9 ± 9.7 mmHg. Nightly sleep duration averaged 6.5 ± 1.3 hours. Mean composite LE8 score was 66.2 ± 15.6, indicating intermediate CV health. Only 11 patients (15.9%) had scores in the ideal category. LE8 scores did not significantly differ by sex (p = 0.33) or age (p = 0.47). In multivariable regression analyses, Black or African American race was significantly associated with lower total LE8 scores (p = 0.002). Conclusion: Patients with SDB have intermediate or poor CV health as evaluated via LE8. Interventions targeting modifiable factors could improve CV health in this population susceptible to increased risk.

Abstract TH905: Social Drivers of Health Screening and In-Hospital Outcomes for Cardiovascular Patients in Oregon

Background: Social drivers of health (SDOH) are tied to cardiovascular disease (CVD) prevalence, disease progression, and outcomes. Federal requirements mandate SDOH screening in inpatient settings. Objective: Examine rates and predictors of in-hospital SDOH screening, positive screens, and outcomes for CVD patients. Methods: Retrospective cohort study of CVD patients from 7 Providence Oregon hospitals between 10/01/2023 – 4/24/25. In-hospital admissions with a CVD primary diagnosis were included. SDOH screening included the following domains: food, housing, transportation, utilities, financial strain, and intimate partner violence. Patient characteristics, SDOH screening data, and in-hospital outcomes were obtained from the electronic medical record. Rural-urban commuting area (RUCA) and the Center for Disease Control&Prevention social vulnerability index (SVI) were linked to patient zip code. The primary outcome was a positive screen in ≥1 SDOH domain. Secondary outcomes were receiving care by a CVD physician or advanced practice clinician, cardiac ICU stay, length of stay (LOS), mortality, and readmission. Logistic regression models accounting for age, sex, race, ethnicity, primary language, BMI, insurance, RUCA, SVI, and SDOH screening were run, with a random effect for screening hospital. Results: There were 11,731 CVD patients, the majority of whom were screened for SDOH (85.5%) (Table 1). Of screened patients, 6.9% screened positive in any domain, with the highest rates in housing (3.6%) and food (2.1%). Patients with positive screens were younger, more often Black, of other or unknown races, Hispanic, with higher rates of Medicaid insurance, and higher SVI (Table 1). Patients with positive screens had lower rates of receiving care by a CVD clinician (45% vs 55%), longer LOS, and higher 90-day readmission (Table 1). Patients with Medicaid were 8x more likely to screen positive than patients with private insurance, and those with Medicare, other government, or other insurance were ~3x more likely (Figure 1). Patients who screened positive were 23% less likely to see a CVD clinician, as were female (39%), Asian (22%), Black (23%), non-English speaking (20%), and Medicaid patients (28%, Figure 2). Conclusions: High rates of in-patient SDOH screening were observed. Positive screens were associated with lower rates of specialty care, longer LOS, and higher readmissions, suggesting room for improvement in care processes following a positive screen.

Abstract WE419: A Mixture of Metals and Per-/polyfluoroalkyl Substances Exposures Is Associated with Lower Kidney Function among Former US Military Service Members and Civilians

Introduction: Chronic Kidney Disease (CKD) affects around 1 in 7 Americans but is more prevalent among former military service members, reaching nearly 1 in 3 in some cohorts. Metals, such as cadmium (Cd) and lead (Pb), and per-/polyfluoroalkyl substances (PFAS), such as perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS), are known nephrotoxicants to which civilians are regularly exposed. However, military populations may experience higher exposures due to service-related activities. Despite elevated exposures and CKD burden, the relationship remains poorly characterized among US veterans. Hypothesis: We hypothesized that (1) a higher concentration of a metal-PFAS mixture would be associated with lower eGFR for both military and civilian populations, and (2) the mixture composition most associated with eGFR would differ across subgroups defined by veteran status and sex. Methods: In a cross-sectional analysis of the 2003-2018 NHANES, we assessed the association of a metal-PFAS mixture with eGFR among civilians and veterans and conducted sex-stratified analyses. Our sample included 5,503 men (4,244 civilians, 1,259 veterans), and 5,765 women (5,690 civilians, 75 veterans). We used weighted quantile sum regression (WQSR) to estimate the joint effect of blood Cd and Pb, and serum PFOA and PFOS on eGFR (mL/min/1.73m 2 ). Covariates included age and BMI. Results: Among veterans, a one unit higher mixture index was associated with a 1.4 mL/min/1.73m 2 (95%CI: 0.9, 1.9) lower eGFR, wherein Pb accounted for 74% of the mixture effect. Among civilians a one unit higher mixture index was associated with a 2.2 mL/min/1.73m 2 (95%CI: 1.9, 2.5) lower eGFR, wherein PFOS accounted for 47% of the mixture effect. We observed similar results among men in sex- and veteran status-stratified models. Pb accounted for 79% of the mixture effect among veteran men, while PFOS accounted for 64% among civilian men. Among women civilians a one unit higher mixture index was associated with a 2.3 mL/min/1.73m 2 (95%CI: 1.9, 2.6) lower eGFR, wherein PFOS and Cd accounted for 63% of the mixture effect. The mixture index was not significantly associated with eGFR in veteran women, potentially due to small sample size. Conclusion: Metal-PFAS mixtures were associated with lower eGFR, with differing mixture profiles across sex and veteran status subgroups. Additional studies of the effects of environmental mixtures among military populations are needed, especially among women.

Automated real-time surveillance of Bithynia snails using a comparative YOLO based approach for liver fluke host detection

Abstract Bithynia species serve as obligate intermediate hosts for Opisthorchis viverrini , a Group 1 carcinogen endemic to Southeast Asia and the primary etiological agent of cholangiocarcinoma. Accurate identification of morphologically similar Bithynia species is critical for effective disease surveillance. This study systematically evaluates four You Only Look Once (YOLO) models—YOLOv5, YOLOv8, YOLOv10, and YOLOv11—for automated detection and classification of Bithynia species. Models were trained on 4,204 images containing 8,559 annotated specimens of Bithynia funiculata , B. siamensis goniomphalos , and B. s. siamensis . Model performance was assessed through comparative analyses of YOLO architectures and direct benchmarking against five human experts. YOLOv10 demonstrated the highest classification accuracy (98.7%), robust performance across diverse environmental conditions, and computational efficiency (model size: 31.9 MB; processing speed: 4.54 FPS). Our analysis reveals a fundamental complementarity between AI and human expertise: humans achieved perfect detection accuracy, while the artificial intelligence model provided superior classification of detected specimens (74.5% for YOLOv10 and 48.3% for human experts, respectively). These findings indicate that integrating human detection with automated classification in hybrid human–AI workflows could substantially improve diagnostic accuracy and throughput. This study establishes a technological foundation for scalable surveillance systems to support control of O. viverrini transmission in resource-limited endemic regions.

Abstract TU247: Stress, Forgetfulness, and Hypertension: The Mind-Heart-Body Link in Refugee Health

Introduction: The world is witnessing the highest number of refugees ever recorded. Poor blood pressure (BP) control is prevalent among refugees, who also face elevated stress and poor mental health. Psychosocial stressors can exacerbate hypertension and cognitive decline (forgetfulness), yet these connections are not explored in refugees. We sought to determine whether subjective cognitive decline and psychosocial stressors were associated with poor BP control in refugees. Hypothesis: We hypothesized that subjective cognitive decline would be associated with uncontrolled BP and linked to psychological stressors. Methods: A convergent mixed-methods study among hypertensive Syrian and Iraqi refugees aged ≥21 years. Recruitment occurred from 4/2021 to 4/2022 through a federally qualified health center serving a refugee-majority neighborhood in San Diego, CA. Primary exposure was self-reported forgetfulness; secondary exposures were worry about BP, belief that stroke could be prevented, and medication adherence. Primary outcome was hypertension control (uncontrolled BP ≥130/80mmHg) from averaged home readings. Pearson chi-square and binary logistic regression were used to examine forgetfulness, hypertension control, and related health beliefs adjusting for age, sex, and BMI. Interviews were thematically analyzed using an adapted mind-heart-body framework. Results: Of 101 hypertensive Syrian and Iraqi refugees (mean age=64±9.7; 51.5% male; 79.2% Iraqi), 59.4% had uncontrolled BP and 81.2% were forgetful. Forgetfulness correlated with greater worry about BP (χ2=8.92, p=.012) and lower belief that stroke is preventable (χ2=7.62, p=.022). Belief that controlling BP can prevent stroke predicted forgetfulness (OR 16.80, CI 2.07-136.02, p=.008). Participants reporting being forgetful had higher odds of uncontrolled BP (OR 0.520, CI 0.075-3.617, p=.508), though not significant. Quantitative and qualitative findings, integrated through the mind-heart-body framework, showed that stress, worry, and cognitive perceptions were strong influences of BP control. Conclusions: Subjective cognitive decline among hypertensive refugees was prevalent and associated with worry about BP and stroke prevention, but not associated with uncontrolled BP. Psychosocial stress was perceived by refugees as related to BP control. Culturally tailored, mind-heart-body-integrated interventions for refugee care are needed to address these interconnected pathways to achieve BP control for all.

Abstract MPTU15: Awareness of and Response to Myocardial Infarction and Stroke Symptoms Among Cancer Survivors in the United States

Background: Cancer survivors are at greater risk of cardiovascular disease compared to individuals without cancer in the general population. Despite this increased risk, it is unknown the extent to which this population is aware of symptoms of myocardial infarction (MI) and stroke, and whether disparities in awareness exist. Methods: We used data from the cross-sectional 2014 and 2017 National Health Interview Surveys and included individuals aged ≥18 years with self-reported cancer and complete data on awareness of MI and stroke symptoms. The MI symptoms included 1) chest pain/discomfort, 2) shortness of breath, 3) pain/discomfort in arms/shoulders, 4) feeling weak, lightheaded, or faint, and 5) jaw, neck, or back pain. Stroke symptoms included 1) numbness of face/arm/leg, 2) confusion/trouble speaking, 3) difficulty walking/dizziness/loss of balance, 4) trouble seeing in one/both eyes, and 5) severe headache. Awareness of and response to symptoms (i.e., calling 9-1-1 or emergency medical services [EMS]) were assessed using multivariable logistic regression with adjustment for sociodemographic characteristics. Results: Among 4,312 cancer survivors (median age: 67.0 years), representing 14.3 million survivors annually, 37.4% and 21.0% were unaware of all MI and stroke symptoms, respectively. Those who were of Hispanic ethnicity (MI: aOR [adjusted odds ratio], 1.55 [95% CI, 1.17-2.05]; stroke: 1.54 [95% CI, 1.13-2.09]), had lower level of education (MI: aOR, 1.32 [95% CI, 1.14-1.52]; stroke: aOR, 1.41 [95% CI, 1.20-1.66]), and were of non-US-born immigrant status (MI: aOR, 1.82 [95% CI, 1.37-2.42]; stroke: aOR, 1.41 [95% CI, 1.03-1.92]) had an increased likelihood of being unaware of all MI and stroke symptoms. Hispanic (MI: aOR, 2.10 [95% CI, 1.12-3.93]) and non-Hispanic Asian individuals (MI: aOR, 2.70 [95% CI, 1.11-6.59]) and those with a lower level of education (MI: aOR, 1.54 [95% CI, 1.06-2.24]) were more likely to not be aware of any MI symptoms. Adults with a lower level of education (MI: aOR, 1.42 [95% CI, 1.05-1.92]) and those with a lower income (stroke: aOR, 1.77 [95% CI, 1.19-2.62]) were significantly more likely not to call EMS in response to MI and stroke symptoms, respectively. Conclusions: Despite having an increased cardiovascular risk, many cancer survivors are not aware of MI and stroke symptoms. Increasing education of common symptoms, particularly among cancer survivors experiencing disparities, could potentially reduce these inequities.

Abstract MPWE41: Association of better adherence to the Dietary Approaches to Stop Hypertension with all-cause mortality and food groups driving this association: data from a large population-based study from Germany

Background: Human nutrition is tightly linked to health and disease and, as such, to longevity. Consequently, high adherence to a healthy diet, such as the Dietary Approaches to Stop Hypertension (DASH), has repeatedly been associated with a reduced mortality risk. However, the contribution of individual score components driving this association is incompletely understood. Objectives: We assessed the association of adherence to the DASH score as well as its individual components to all-cause mortality in the largest German population-based study, the German National Cohort (NAKO). Methods: We included n=131,486 individuals from the NAKO baseline examination (51.3% women, mean age 49.6 (±12.6) years). Dietary intake was assessed with a multiple source method combining up to four 24h dietary recalls with a self-administered, validated Food Frequency Questionnaire. DASH score was derived based on quintiles of consumption scoring fruits, vegetables, legumes/nuts, wholegrains, and low-fat dairy products positively, while scoring red/processed meat, soft drink, and sodium intake negatively. Cox proportional hazards regression models, adjusted for age, sex, body mass index, smoking, socioeconomic status, physical activity, alcohol, and total daily energy intake, were used to relate DASH adherence to all-cause mortality. Furthermore, we related individual components of DASH (per 1-portion increment) to all-cause mortality. Results: Over a mean follow-up time of 6 (±2) years, n=2,058 participants died. In multivariable-adjusted models, better adherence to DASH was associated with a reduced risk of all-cause mortality (HR: 0.88 [95% CI: 0.84; 0.91] per 5-point increment). When relating individual score components to all-cause mortality, we particularly observed a reduced mortality risk associated with the positively-scored food groups ‘vegetables’ (HR: 0.83 [95% CI: 0.74; 0.93] per 100g increment) and ‘legumes/nuts’ (HR: 0.85 [95% CI: 0.73; 0.92] per 25g increment), while the negatively-scored food groups ‘red/processed meat’ (HR: 1.57 [95% CI: 1.29; 1.92] per 100 g increment) and ‘sodium’ (HR: 1.57 [95% CI: 1.36; 1.83]) were associated with an increased mortality risk. Conclusion: Better adherence to DASH is associated with a reduced risk of all-cause mortality in a large sample from the German general population, with higher intake of vegetables, legumes, and nuts and lower intake of red/processed meat and sodium possibly having a particularly protective effect.

Adaptive training load optimization for track and field athletes: A reinforcement learning approach

Abstract TU239: Psychological Distress, Cardiovascular Disease Risk Factors, And Resilience Among University Students In The US

Background: The transition from adolescence to adulthood is a highly susceptible period for increased cardiovascular disease (CVD) risk, due in part, to emerging self-reliance and its associated stressors. We examined the association between psychological distress and established CVD risk factors among university students and whether associations were modified by psychological resilience. Methods: Data from 188 young adults (20.1±1.3 years of age; 27.6% female; 52.6% non-Hispanic White) from a northeastern university (Fall 2024-Spring 2025) were included in this analysis. Self-reported psychological distress was measured via the validated 4-item Perceived Stress Survey (PSS-4) and the 7-item Center for Epidemiologic Studies Depression Scale (CESD-7). Scores for both measures were derived by summing each of the items for a total stress and depression symptom score. Resilience was measured via the Brief Resilient Coping Scale. Life’s Essential 8 (LE8) related outcomes of blood pressure [systolic (SBP) and diastolic blood pressure (DBP)], body mass index (BMI), total cholesterol, and fasting glucose were measured by trained staff. Sleep quality was self-reported using the Pittsburgh Sleep Quality questionnaire, and current leisure physical activity (PA) was self-reported via the Global PA Questionnaire. Linear regression was used to examine the associations between psychological distress and the LE8-related outcomes, adjusting for age, gender identity, race, overall PA minutes, and year in school. Results: Average (±SD) PSS-4 and CESD-7 were 6.1±2.5 and 5.1±3.4, respectively. Mean and SD for cardiometabolic outcomes were: SBP (114.5±7.8 mmHg), DBP (70.4±7.9 mmHg), BMI (24.6±4.0 kg/m 2 ), total cholesterol (159.8±32.0 mg/dL), fasting glucose (90.5±11.9 mg/dL), leisure PA (520.7±350.8 MET-mins/week), and sleep quality (2.8±0.7) score. In fully adjusted models, stress [-0.09 (95%CI, -0.13, -0.05)] and depression symptoms [-0.07, (-0.09, -0.04)] were associated with lower quality sleep. Psychological distress was not associated with any other CVD risk factors, nor was psychological resilience a significant effect modifier of these associations (ps>0.05). Conclusions: Psychological distress may be particularly damaging for sleep quality among college-aged young adults. Given the emerging self-reliance during this transition to adulthood, promoting better sleep may assist in improving cardiovascular health among emerging adults.

Abstract WE420: Association Between Plasma Homocysteine and Stroke Risk in Hypertensive Patients with Metabolic Syndrome

Background: Folic acid therapy has been shown to reduce the risk of incident stroke in hypertensive adults with elevated plasma total homocysteine (tHcy). However, data are limited among people with metabolic syndrome (MetS), who have higher comorbidity burdens. Aim: To investigate the association between tHcy and the risk of incident stroke among adults with MetS and the therapeutic effect of daily small dose folic acid therapy. We will also consider the modifying effect of methylenetetrahydrofolate reductase ( MTHFR ) C677T genotype, a common genetic variant in Chinese people that has been linked to higher risk of stroke. Methods: We conducted a post hoc analysis of data from the China Stroke Primary Prevention Trial (CSPPT), a randomized, double-blind, multicenter clinical study conducted from May 2008 through August 2013. The analysis included 10,331 participants who met the NCEP ATP III criteria for MetS. Of these, 5,131 were taking enalapril only (control group), and 5,200 were taking enalapril and a daily 0.8 mg folic acid (treatment group). The primary outcome was incident stroke, and the secondary outcome was incident ischemic stroke. Results: During a median follow-up of 4.5 years, 185 cases of stroke were found in the enalapril group, compared with 140 in the enalapril-folic acid group. In the enalapril-only group, tHcy was significantly associated with the risk of incident stroke. For each unit increase in log-transformed Hcy (Ln-Hcy), stroke risk increased by 62% (HR: 1.62, 95% CI: 1.18, 2.24). Compared with participants in the lowest Hcy tertile, those in the highest Hcy tertile had a 111% increased risk of stroke (HR: 2.11, 95% CI: 1.39, 3.22). Compared with participants with Hcy <15 μmol/L, those with Hcy ≥15 μmol/L had a 48% increased risk of stroke (HR: 1.48, 95% CI: 1.04, 2.10). This association was not observed in the folate supplementation group. Furthermore, the MTHFR C677T genotype significantly modified treatment effects, with the greatest reduction in first-stroke risk observed in CC genotype patients (up to 37%), a 28% risk reduction in CT genotype patients, and no significant benefit in TT genotype patients. Similar results were observed for ischemic stroke. Conclusion: This study found that an increased tHcy levels was significantly associated with the risk of incident stroke among adults with MetS, even with daily enalapril treatment. More importantly, daily low-dose folic acid supplement appeared to mitigate this association.

Abstract TH883: Social Determinants of Health and Circulating Biomarkers of Neurodegeneration: the REasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort

Introduction: Neuropathologic changes precede dementia symptoms by decades, complicating prevention. Technological advances now allow detection of low abundance circulating neurodegeneration biomarkers enabling early risk assessment; higher plasma glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) relate to incident cognitive impairment (ICI) risk. The burden of cognitive disorders is uneven among demographic groups, prompting our investigation of associations of adverse social determinants of health (SDOH) and these biomarkers, and whether any biomarkers attenuated associations of SDOH with ICI. Hypotheses: 1. Adverse SDOH are associated with higher circulating biomarkers of neurodegeneration. 2. Biomarkers may attenuate relationships between SDOH and ICI. Methods: REGARDS is an ongoing, national cohort study of 30,239 Black and White participants enrolled in 2003-2007. Baseline risk factor data, cognitive function testing, and blood samples were collected. SDOH exposures included income, education, race, and neighborhood socioeconomic status (nSES). In an 1104-person random sample, linear regression was used to assess associations of SDOH and biomarkers, with interaction testing by sex, race, and age. For significant associations, attenuation analysis was performed using Cox regression models for the association of SDOH’s with ICI without then with inclusion of the biomarker. Results: Three SDOH were significantly associated with ICI: lowest income HR 5.64, 95%CI 1.85-17.1; Black race HR 1.60, 95%CI 1.01-2.52; and lowest nSES tertile HR 2.69, 95%CI 1.42-5.11. After multivariable adjustment, only lower income was associated with higher biomarker concentrations, specifically NfL in all participants (Beta exp 1.19, 95%CI 1.03-1.37), and UCH-L1 in females only (Beta exp 1.52, 95%CI 1.13-2.04). Thus, attenuation analysis for UCHL-1 was sex-stratified. Biomarkers associated with income did not attenuate the income relationship ( Table ). Conclusions: SDOH had limited associations with studied biomarkers; lower income with higher NfL, and lower income in females with higher UCH-L1. Black race, low income and low nSES were associated with ICI risk, but biomarkers did not weaken these relationships. Consequently, targeting interventions to Black people, and those with low-income, or living in low-advantage neighborhoods may reduce ICI burden in the US population regardless of biomarker status.

Chaotic fluctuations mark the sign of mental activity in task-based heart rate variability

Abstract Heart rate variability (HRV), regulated by the autonomic nervous system, is typically assessed using standard time-domain and frequency-domain methods to evaluate autonomic function. However, conventional linear analyses capture only a limited aspect of HRV, as the human body, including the cardiovascular system, is intrinsically nonlinear. In light of this, there has been growing interest in nonlinear analyses grounded in chaos theory and complexity science. In this study, we conducted a comprehensive comparison of time-domain, frequency-domain, and chaos/complexity indices derived from R-R interval (RRI) analysis during both physical and mental tasks. The results clearly demonstrate a significant increase in chaos/complexity indices during mental tasks, while conventional indices remain unchanged—underscoring the unique sensitivity of nonlinear measures to cognitive processes. These findings highlight the relevance of chaotic dynamics and complexity in HRV as a valuable perspective for understanding brain-heart interactions. Furthermore, based on the experimental findings, we propose a new hypothesis, consistent with previous research, regarding the emergence of chaotic features in HRV during cognitive activity.

Abstract WE503: Concordance Between Household and Area-Level Food Security Among People with Pre-Clinical Heart Failure

Introduction: Diet is a key component of cardiovascular risk profiling in pre-clinical heart failure. Food insecurity, defined as limited or uncertain access to nutritionally adequate food, is a barrier to a healthy diet and warrants evaluation for intervention. However, self-reported food security is rarely measured, with researchers/clinicians often relying on area-level measurements. This study evaluates concordance between household and area-level food security to assess whether county-level food security is an appropriate proxy for household-level food security. Hypothesis: County-level food security is a poor proxy for household-level food security. Methods: In September 2024, we enrolled 400 participants via the YouGov online survey platform from the Southern Atlantic Region, with a design to include equal proportions of male vs female, Black vs non-Black, and high vs low-income individuals. Household food insecurity was assessed by the 6-item USDA questionnaire. County-level food security was measured by Feeding America’s Mind the Meal Gap study and the CDC’s Social Vulnerability Index (SVI), linking participants’ ZIP codes to county data. Concordance was assessed between household food security categories (high/marginal vs low vs very low) and county food security tertiles (1 = most secure; 3 = least secure), as well as county SVI tertiles. Results: The final sample included 398 participants from nine states (mean age 61.6 ± 11.6). Half lived in counties in food insecurity tertile 1, while 7.5% lived in tertile 2 counties. There was no concordance between county tertiles and household food insecurity categories (weighted kappa = 0.05, 95% CI: -0.03 to 0.12). The concordance between ZIP code SVI tertiles and household food insecurity was weak (weighted kappa = 0.05, 95% CI: 0.002 to 0.09). A weak correlation existed between household food insecurity scores and ZIP code-level SVI (Spearman’s rho=0.15), driven mainly by SVI sub-measures of socioeconomic status (rho=0.20) and housing/transportation (rho=0.19). Conclusion: In this study, county-level food security classifications were not valid proxies for household-level food security. Using them interchangeably for risk stratification may lead to misclassification. Clinicians and researchers should directly assess food security at the household level when evaluating risk.

Spontaneous Myocardial Infarction After Left Main Revascularization: The EXCEL Trial

BACKGROUND: Limited data are available regarding the relative rates, etiology, and long-term prognostic implications of spontaneous myocardial infarction (MI) after percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery for left main coronary artery disease (LMCAD). METHODS: MIs after PCI and CABG for LMCAD were adjudicated from the EXCEL trial (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization). Cox proportional hazards regression was performed to assess the association between spontaneous (and procedural) MI and cardiovascular and all-cause mortality at 5 years. RESULTS: Among 1882 patients who underwent LMCAD revascularization, spontaneous MI during 5-year follow-up occurred in 60 (6.8%) patients after PCI and in 29 (3.4%) patients after CABG (adjusted hazard ratio [adjHR], 2.01; 95 CI, 1.29–3.15; P =0.002). By multivariable analysis, spontaneous MI (as a time-adjusted covariate) was a strong independent predictor of subsequent cardiovascular mortality (adjHR, 9.39; 95% CI, 5.22–16.87) and all-cause mortality (adjHR, 4.77; 95% CI, 2.92–7.80) within 5 years, with consistent effects after PCI and CABG ( P interaction =0.60 and 0.78, respectively). In the same models, procedural MI as defined by extensive myonecrosis was associated with 5-year cardiovascular (adjHR, 3.02; 95% CI, 1.64–5.56) and all-cause mortality (adjHR, 2.38; 95% CI, 1.48–3.80), with consistent effects after PCI and CABG ( P interaction =0.23 and 0.34, respectively). CONCLUSIONS: In the EXCEL trial, spontaneous MI occurred relatively infrequently within 5 years after LMCAD revascularization but at a higher rate after PCI compared with CABG. Spontaneous MI after revascularization was strongly related to subsequent cardiovascular and all-cause mortality, consistently after PCI and CABG, and was more strongly associated with mortality than was large procedural MI. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT01205776