Browse Articles

Abstract P2059: Clinical Engagement Trajectories and Patient Factors Associated with Optimal Blood Pressure Management Patterns among Patients with Incident Diagnosis of Hypertension

Introduction: The established paradigm of “awareness (i.e. diagnosis), treatment and control” as a central strategy to achieve blood pressure control is well accepted as the optimal approach to hypertension (HTN) management, but few studies have explored real-world patterns of healthcare engagement, treatment and blood pressure control within the first two years of diagnosis of HTN, and how they may differ for different sociodemographic patient groups. Methods: We analyzed electronic health records from a large integrated healthcare system in Northern California to characterize trajectories of clinical engagement, blood pressure treatment and control after incident HTN diagnosis. The cohort included 40,469 primary care patients between 2012-2019, with incident HTN. Each month for 24 months after diagnosis, patients were assigned to one of 8 mutually exclusive states for HTN treatment with medications (Y/N), blood pressure control (Y/N), and visit status (up to date Y/N). We applied sequence and cluster analysis to identify common types of BP management trajectories. Using multinomial logistic regression, we estimated associations between patients’ race and ethnicity and these trajectories. We hypothesized that more optimal engagement trajectories are less common among non-Hispanic Black (NHB) individuals, given well documented disparities in BP control among this patient subgroup. Results: We observed 20,564 distinct care management trajectories among individuals that were classified into four clusters representing “Control without medications” (36.4%), “Control with medications” (16.7%), “Medications without control” (10.7%), and “Minimal engagement” (36.2%). The first two of these were classified as optimal care management (OCM), representing 52.6% of individuals. By 24 months only 50% of patients were up to date with their visits, and more than one-third of patients (36.2%) exhibited virtually no follow-up visit after the initial index visit. Comparing OCM with medication to the minimal engagement, those who self-identify as NHB had significantly lower odds (OR [95%CI] 0.75 [0.6, 0.9]) of belonging to the OCM cluster compared to non-Hispanic white (NHW) counterparts. Conclusion: Patients who self-identify as NHB experienced lower odds of OCM compared to NHW. Future studies are needed to identify predictors of clinical engagement trajectories resulting in lack of clinical engagement post-diagnosis, and interventions to encourage better engagement.

Abstract P3113: Impact of MRI Body Fat Imaging Report on Obesity-Related Cardiometabolic Risk: Findings From The BODY-REAL Study

Introduction: Excess visceral adipose tissue (VAT) is more discriminatory of obesity-related cardiometabolic risk than body mass index (BMI) but is not routinely assessed by clinicians. It is not known whether providing patients with direct visualization of VAT could improve cardiometabolic health. Hypothesis: We tested dual hypotheses that presenting patients with body fat imaging results will be superior to BMI alone, and that giving reports directly to patients will be superior to giving reports to their providers when comparing changes in risk perception, lifestyle and cardiometabolic outcomes. Methods: The BODY-REAL study is a single-site, 2x2 factorial design pilot trial, randomizing adults with BMI≥25, A1C≥5.7% and additional cardiovascular risk factors to 1) receive a visual report of body fat distribution based on MRI analysis or BMI alone and 2) have the report received by the patient or their provider. At 2 weeks, 3 months and 6 months from baseline, we used validated survey instruments to assess physical activity, medication adherence, risk perception of diabetes and heart disease, and measured changes in BMI, blood pressure, lipid profile, A1C and fasting glucose. We created analysis of covariance models and linear models with both fixed and random (time-updated) effects. Results: 29 patients (31% female) were assigned to 4 study arms, with average baseline BMI of 33.6 kg/m 2 . Changes in HDL and preventive behaviors varied by report recipient, and lifestyle changes by report type. Among patient-received reports, those with MRI data (vs BMI data) showed a mild but significant increase in HDL over time (p=0.047). Preventive behavior scores increased over time among those with provider-received reports (p=0.009), regardless of report type. Lifestyle scores decreased among those with BMI data vs MRI data (p=0.004), regardless of report recipient. There were no significant changes over time in BMI, blood pressure, LDL, total cholesterol, A1C or risk perception associated with body fat imaging vs BMI data, or with patient- vs provider-received reports. Conclusions: This pilot study demonstrated potential for direct-to-patient visualization of VAT to improve HDL and preventive behaviors, however was likely underpowered to detect significant change in cardiometabolic risk indicators, thus warranting further investigation.

Cross-cultural validation of acculturation measures: Expanding the East Asian acculturation framework for global applicability

In a globalised world, understanding acculturation, the process by which individuals adapt to new cultural environments, is crucial, especially in multicultural societies experiencing increased migration. The East Asian Acculturation Measure (EAAM), based on Berry’s acculturation model, has been a cornerstone for assessing acculturation strategies among East Asian populations in the United States; however, its cultural specificity limits utility in broader contexts. This study addresses this gap by adapting and validating the EAAM for diverse populations, producing the Shortened Adapted Acculturation Scale (SAAS). Across two phases involving 490 university students from 87 nationalities in Germany and 329 university students from 25 nationalities in South Africa, both Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis (EFA) identified a five-factor structure: Social Disconnection, cultural adaptation, Social Perception, Interpersonal Comfort, and Language Integration. The SAAS showed high internal consistency and measurement invariance across genders. These results highlight the importance of culturally adapting psychological measures to ensure their relevance and reliability in global contexts. The SAAS offers practical benefits for clinicians, educators, and policymakers who serve multicultural populations. By illuminating specific dimensions of acculturation, the scale can help identify areas where targeted interventions such as mental health counselling, cultural orientation programs, or inclusive campus policies may foster better social integration and well-being. Although the present study focused on structural validity, future research should examine the SAAS’s predictive utility for mental health and social integration outcomes. These findings contribute to cross-cultural psychology and underline the need to refine and validate tools for assessing acculturation in an increasingly interconnected world.

The structural basis for the human procollagen lysine hydroxylation and dual-glycosylation

Abstract P3052: Ttitle: Multi-Omic Responses to Low-Calorie Diet Intervention for Remission of Type 2 Diabetes and Individual Variability Short title: Multi-Omics, Low-Calorie Diet, and Diabetes Remission

Introduction: Remission of type 2 diabetes (T2D) can be achieved by a low-calorie diet (LCD) intervention, but molecular mechanisms remain poorly understood. Furthermore, whether responders for T2D remission and non-responders to an LCD intervention have distinct molecular responses and genetic determinants is yet clear. Methods: A 6-month LCD intervention (815-835 kcal/d) was conducted among Chinese patients with T2D who had BMI of 24-45 kg/m 2 and HbA1c level of 6.5-12.0%. Clinical biomarkers, genome, serum proteome, metabolome (serum and feces), and gut microbiome were measured at baseline and weeks 1, 12, and 24. Linear mixed models were used to identify significant changes in multi-omic markers during the 24-week intervention. A noise-augmented von Mises-Fisher mixture model was used to cluster the trajectories of significant omic markers. Different multi-omic responses between responders for T2D remission and non-responders were identified using linear mixed models, adjusting for age, sex, T2D duration, visit time, and baseline BMI as fixed effects and participant ID as random effect. Genome-wide association analysis (GWAS) was used to find single nucleotide polymorphisms (SNPs) associated with T2D remission. We used the Benjamini-Hochberg procedure to control the false discovery rate < 5% for all analyses. Results: Thirty-two participants were analyzed (mean age: 39.8 years, BMI: 29.8 kg/m 2 , HbA1c: 8.0%; 34% women). Significant changes in omic markers post intervention were observed in 46 proteins, 106 serum metabolites, 222 fecal metabolites, and 153 gut bacteria, clustering into 6-8 distinct trajectories per omics. Pathway enrichment analysis mapped these signatures to cholesterol metabolism, glycolysis, and TCA cycle pathways. Between responders and non-responders, 261 proteins, 197 serum metabolites, 212 fecal metabolites, and 171 gut bacteria differed; among these markers, 11 proteins, 27 serum metabolites, 37 fecal metabolites, and 23 gut bacteria also changed significantly post the LCD intervention. However, no SNP was associated with T2D remission. Significant associations of multi-omic markers with muscle mass, liver fat, glycemic control, insulin resistance, and insulin secretion were found. Conclusions: Dramatical changes in multi-omic markers, enriched in glucose, lipid, and energy metabolism pathways, were observed following an LCD intervention. Multi-omic differences between responders and non-responders for T2D remission were delineated.

Abstract MP08: The Association of Urinary Sodium with Incident Apparent Treatment Resistant Hypertension among African Americans: Findings from The Jackson Heart Study

Background: Hypertension is a leading cause of cardiovascular disease and disproportionately affects African American (AA) adults, contributing significantly to morbidity and mortality in this population. Apparent Treatment Resistant hypertension (aTRH), where blood pressure (BP) remains uncontrolled despite the use of multiple antihypertensive medications, is particularly prevalent among AA adults. Sodium intake is associated with BP levels, yet the relationship between urinary sodium (a measure of dietary sodium intake) and aTRH in AA adults remains unclear. This study examined the association between 24-hour urinary sodium excretion and incident aTRH among AA adults with hypertension, using data from the Jackson Heart Study (JHS). Methods: The JHS included 5,306 self-identified AA adults from Jackson, Mississippi, with data collected at three visits (2000-2013). For this analysis, we focused on 452 participants with hypertension at baseline with non-missing urinary excretion and medication data. Urinary sodium excretion was categorized into quartiles, and aTRH was defined as uncontrolled BP while taking ≥3 classes of antihypertensive medication. We used a semi-parametric proportional hazards regression model to determine the association between 24-hour urinary sodium excretion and incident aTRH, adjusting for potential confounders. RESULTs: Participants were 63 years old on average and 27.7% men. Higher sodium excretion was associated with younger age, higher income, alcohol consumption, and greater antihypertensive medication use, whereas those with history of stroke or chronic kidney disease had lower sodium excretion. Over a median follow-up of 7.5 years, 123 participants (27.2%) developed aTRH. Participants in quartiles 3 and 4 of urinary sodium excretion showed higher incidence rates of aTRH, though fully adjusted hazard ratios were not statistically significant [HRs (95% confidence intervals [CIs]): [Q2=0.71 (0.34, 1.46), Q3=1.02 (0.50, 2.06), Q4=0.95 (0.46, 2.00); P=0.166). Conclusions: There was no statistically significant association between urinary sodium and incident aTRH among AA adults with hypertension. However, the findings highlight the need for targeted public health interventions to reduce sodium consumption in this population. Larger, longitudinal studies are needed to confirm these findings and explore the complex associations between sodium intake and hypertension management.

Abstract P2090: Comparison of Medicare Claims Recorded and Surveillance Identified Myocardial Infarction in the Strong Heart Study

Introduction: The Strong Heart Study (SHS) is a cohort study of cardiovascular disease (CVD) in American Indians. Center for Medicare and Medicaid Service (CMS) data may improve CVD outcome capture. Hypothesis: Participants with myocardial infarction (MI) events captured in CMS will align with those identified in SHS morbidity and mortality (M&M) surveillance. Methods: CMS data were available from 2010-2021 for 2,144 SHS participants. A CMS-identified MI event was defined as meeting the Chronic Conditions Data Warehouse (CCW) claims criteria (at least one inpatient claim with an MI ICD-9 or ICD-10 diagnosis code in first or second position) during this timeframe. SHS MI and coronary heart disease (CHD) events were identified by medical chart review, adjudicated by physicians, and classified as definite, possible, or probable (MI only). We defined SHS-identified MI as having a fatal or non-fatal definite MI event during 2010-2021. A summary table compared participants with SHS-identified and CMS-identified MI. Cohen’s kappa coefficient, sensitivity, specificity, and positive predictive value (calculated using SHS as the gold standard) assessed diagnosis agreement. Results: We identified 206 participants with SHS-identified MI and 198 participants with CMS-identified MI. There was moderate agreement between SHS-identified and CMS-identified MI (kappa=0.601, 95% CI: 0.542, 0.660). About 63% of those with SHS-identified MI had a CMS-identified MI and 65% of those with CMS-identified MI had an SHS-identified MI. Among the 69 participants with only an SHS-identified MI, 40.3% had an outpatient MI code or an inpatient MI code in the third position or lower in CMS data. SHS M&M detected possible MI, probable MI, or any type of CHD event, excluding definite MI, in 39.1% of the 77 participants with only a CMS-identified MI. Conclusions: Moderate agreement was observed between SHS definite MI and CMS MI events. CMS data may complement the identification of MI events in M&M surveillance of prospective cohort studies such as the SHS.

Development of new bilingual oral health behavior social support (OHBSS) scales in English and Spanish

This paper describes the simultaneous co-development of Oral Health Behavior Social Support (OHBSS) scales in English and Spanish. OHBSS scales assess social support for toothbrushing, flossing, and dental care utilization, which are targets for interpersonal-level interventions to promote oral health among Hispanic/Latino adults. The focus was on Mexican-origin adults, who comprise the largest United States Hispanic/Latino subgroup and experience a high oral disease burden. All participants self-identified as Mexican-origin adults (ages 21–40 years old), living along the California-Arizona-Mexico border. Independent samples were recruited for each study partnering with Federally Qualified Health Centers. First, we conducted semi-structured interviews about social support for oral health behaviors in August to November 2018 (Study 1, N = 72). Interviews were audio recorded, transcribed (in original language, Spanish or English), and qualitative data were coded and analyzed in Dedoose following three topical codebooks; excerpts were used to co-create the large bilingual item data bank (OHBSSv1). The item bank was pre-tested via 39 cognitive interviews between December 2019 to March 2020, reviewed by an expert panel with several bilingual members, reduced to 107 Spanish/109 English items (OHBSSv2), then pilot tested in January to December 2021 (Study 2, N = 309). Pilot survey data were analyzed through Exploratory Factor Analysis and Horn’s parallel analysis, overall and by language, to examine response patterns and inform item selection (OHBSSv3). The scales queried social support for toothbrushing, flossing, and dental care utilization across 39 items from three sources (family, health providers, others/friends), plus up to nine optional dental care-related items (Study 3, conducted April 2022 to February 2023, N = 502). Confirmatory Factor Analysis (CFA) assessed model fit, overall and by language (multiple group CFA). Final OHBSS scales include 37 items, plus seven optional items. Acceptable model fit for three-factor structures for each oral health behavior was found, providing evidence of the scales’ construct validity. Cronbach’s alphas and McDonald’s omegas were tabulated; all were above 0.95, overall and by language, supporting scales’ internal consistency.

Abstract P3046: Association of Epigenetic Age Acceleration with Diabetes and Glucose Metabolism Markers Among Hispanic/Latino Adults in The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Background: Epigenetic age acceleration (AA) has been associated with diabetes, but associations differ across DNA methylation (DNAm) based epigenetic clocks and populations. We examined whether epigenetic age acceleration (EAA) estimated from several epigenetic clocks was associated with the prevalence of diabetes and glucose metabolism markers among Hispanic/Latino adults in the United States. Methods: Genome-wide DNAm was profiled in a random sample of 1,000 participants from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and was used to estimate EAA derived from four well-known epigenetic clocks (Horvath, Hannum, PhenoAge, GrimAge). Using a cross-sectional study design, we investigated the associations between each EAA measure and diabetes status at baseline, as well as their associations with glucose metabolism markers [fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), 2-h post-prandial blood glucose (2hBG), and homeostatic model assessment of insulin resistance (HOMA-IR)]. Survey-weighted Poisson regression models with robust variance were used to estimate prevalence ratios (PRs) for the associations between each EAA measure and diabetes status, adjusting for sex, education, age, smoking status, alcohol use, physical activity, diet, sleep duration, and cell type proportions. Survey-weighted multivariate linear regression models were used to estimate associations between each EAA measure and log-transformed glucose metabolism marker. Results: Five-year increases in EAA were associated with higher prevalence of diabetes for PhenoAA [PR: 1.37 (1.19, 1.57)] and GrimAA [PR: 1.43 (1.06, 1.91)]. Estimates also indicated a higher prevalence of diabetes for HannumAA [PR: 1.22 (0.99, 1.50)] and HovarthAA [PR: 1.13 (0.94, 1.35)]; however, these associations were not statistically significant. In linear regression models, increases in EAA were associated with higher glucose metabolism markers. For example, 5- year increases in PhenoAA were associated with higher levels of FBG [β: 0.02 (0.01, 0.03)] and HbA1c [β: 0.02 (0.01, 0.03)]. Increases in HannumAA, PhenoAA, and GrimAA were associated with higher HOMA-IR (p <0.05). Conclusion: Among a population-based sample of Hispanic/Latino adults, EAA was associated with a higher prevalence of diabetes and higher glucose metabolism markers. Further research on the longitudinal association EAA and diabetes is needed to identify individuals at greater risk for developing diabetes.

Abstract P1033: The Association of Adverse Pregnancy Outcomes with Left Ventricular Structure and Function in Early Midlife: Results from the Bogalusa Heart Study

Background: Studies about the association between the adverse pregnancy outcomes (APO) and cardiac structure and function in midlife are scarce despite evidence that APO increases the risk of cardiovascular disease in later life. Objectives: The current study aims to investigate the association of APO with left ventricular (LV) structure and function after follow-up of approximately 15 years post-pregnancy. Methods: The Bogalusa Heart Study (BHS) is an ongoing rural community-based cohort in Louisiana. We examined 454 women who experienced singleton pregnancies and had follow-up echocardiography performed post-pregnancy. APO included pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), preterm birth, and miscarriage at any pregnancy. Echocardiographic parameters at follow-up included LV ejection fraction (LVEF), LV mass index (LVMi), and LV geometry. LV geometry was classified as normal, concentric remodeling, concentric and eccentric hypertrophy. Multivariable linear and logistic regression analyses were applied and adjusted for age, race, education, smoking, alcohol intake, systolic blood pressure, fasting blood glucose, and total cholesterol. Interactions by age and race were tested. Results: The mean age across any pregnancy was 23.0 ± 5.6 years, and 33.7% were Black. After a median follow-up period of 15.1 years, in adjusted analyses, preterm birth and miscarriage were not statistically associated with LVEF, LVMi, and LV geometry. However, PIH (β coefficient = 0.12; p = 0.014) was associated with greater LVMi in midlife, but not with LVEF or LV geometry. GDM was associated with LV geometry, specifically with an increased risk of concentric hypertrophy (Odds Ratio, 3.42; 95% Confidence Interval, 1.04-11.30; p = 0.044). Interactions by race and age were not statistically significant. Conclusion: We identified the association of APO, specifically PIH and GDM, with greater subsequent LVMi and concentric remodeling 15 years later. Further studies are warranted to replicate these findings; however, women with PIH and GDM might be at higher risk of heart disease later in life. Keywords: Adverse pregnancy outcome, pregnancy induced hypertension, echocardiography, left ventricular mass index

Abstract P2084: Independent prognostic factors of mortality in young patients after STEMI

Young patients (pts) with acute myocardial infarction and ST-segment elevation (STEMI) are a specific subset of a population with different risk factor profiles, clinical presentations, and prognosis as compared to older patients. Despite the more favorable hospital course of STEMI in young pts, major CV events after discharge from hospital remains at a high level. The Aim: To identify independent markers of high death risk in young STEMI pts during long-term follow-up. Materials and Methods: The data of long-term observation of 130 pts aged<45 years (mean 39.4±5.7 years) hospitalized with a diagnosis of STEMI were analyzed. The follow-up period of patients was 4.89±2.66 years. The development of death from any cause assessed. Identification of independent risk factors performed using multivariate analysis (Cox regression). Results: During the 5 years of follow-up, 11 deaths from any cause were recorded (8% or 14.5 cases per 10,000/months). The median time to death is 34 months. The main risk factors for death were smoking (aHR14.17: 95%CI, 2.14-93.69) and arterial hypertension (aHR6.42: 95%CI, 1.45-28.39). More than half of the deaths (6/11) occurred among patients who had both factors – smoking and hypertension. Conclusions: The combination of independent risk factors for death in young pts after STEMI (smoking and arterial hypertension) is important marker of long-term prognosis.

A cross-sectional survey analysis of patient and family knowledge, confidence, and perceived barriers to reporting patient deterioration

Background The knowledge, confidence, and skills of healthcare consumers to identify acute clinical deterioration and appropriately escalate concerns remain largely undetermined. This gap is despite the widespread international introduction of consumer escalation systems intended to provide patients and family an avenue to escalate their concerns if worried about deterioration in their own or relative’s condition during a hospital stay. Aim To explore patient and family knowledge of acute clinical deterioration, and their confidence and perceived barriers to escalating their concerns. Design Cross-sectional, in-person, consumer surveys across an Australian acute adult hospital. The study specific survey tool was developed through a multistage process with healthcare consumer input during creation and testing. Methods Questions explored healthcare consumer knowledge, confidence, and perceived barriers in association with acute clinical deterioration, recognising deterioration, and escalating concerns. Descriptive and inferential analysis was completed, and knowledge, confidence, and barrier scores established. Association between scores and consumer type, gender, age, education level, prior experience with clinical deterioration or rapid response team review, and hospitalisation history in the last 12 months were assessed using multivariable linear regression. Results 133 surveys were completed. Knowledge scores varied across respondents. Awareness of the local consumer escalation system was low. A positive association was identified between knowledge and confidence that diminished with increasing barrier scores. A strong negative correlation was present between barriers and confidence. No significant difference existed in knowledge, confidence, or barrier scores based on consumer type, gender, education level, previous experience with deterioration or rapid response team review, or hospitalisation history. Conclusions Limitations in patient and family knowledge may impede consumer escalation system success. Increasing knowledge may enhance patient and family confidence to identify deterioration and escalate concerns. However, barriers to consumer escalation decrease this potential. Interventions to increase consumer knowledge should therefore be accompanied by strategies to minimise barriers.

Abstract P3080: Factor IX and Incident Hypertension in Black and White Adults: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort

Background: A significant fraction of Americans are diagnosed with hypertension. Prior studies have shown Black adults experience a disproportionate amount of this burden. Certain biomarkers of thrombosis are associated with a greater risk of hypertension. Factor IX is a marker of thrombosis. Whether higher factor IX correlates with an increased risk of incident hypertension or explains some of the disproportionate burden faced by Black adults is not fully known. Methods: We included Black and White participants from the REasons for Geographic and Racial Difference in Stroke (REGARDS) study, excluding those with prevalent hypertension, missing factor IX level, or covariates of interest. Modified Poisson regression estimated risk ratios (RR) for incident hypertension by higher factor IX tertiles. A mediation analysis was performed using inverse odds ratio weighting to assess whether racial differences in hypertension risk could be attributed to factor IX levels. Results: A total of 1,824 participants were included, (55% female and 24% Black race), with 36% of participants developed incident hypertension. Higher factor IX levels were seen in Black participants with a mean of 110% vs 105% for White participants (p=0.0018). As shown in the Table, there was a greater risk of incident hypertension by higher factor IX tertile in all models. Mediation analysis did not demonstrate factor IX level mediated hypertension risk in any model. Conclusions: In this prospective study of Black and White adults without prevalent hypertension, higher factor IX was associated with a greater risk of developing hypertension, after adjusting for known confounders. A mediation analysis did not indicate that the excess burden of hypertension experienced by Black adults could be explained by factor IX level.

Correction to: Prevalence of Coronary Atherosclerosis in Female Masters Endurance Athletes

Abstract P2114: Metabolites Associated with Long Term Risk of Peripheral Artery Disease and Critical Limb Ischemia: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Peripheral artery disease (PAD) is a prevalent yet underrecognized vascular condition associated with significant morbidity and mortality. Traditional atherosclerotic risk factors such as smoking and diabetes increase the risk of PAD but do not fully explain its pathogenesis. Metabolomics offers a novel approach to identifying biochemical pathways, but studies focusing on PAD are sparse. Aim: To identify metabolites independently associated with incident PAD and its severe form critical limb ischemia (CLI). Methods: We included 4,032 participants (mean age 54 [SD 6] years, 62% Black, and 60% female) from the Atherosclerosis Risk in Communities (ARIC) study with serum metabolomic data at visit 1 (1987-89). We investigated 636 endogenous metabolites quantified by an untargeted gas and liquid chromatography–mass spectrometry approach. PAD and CLI were ascertained using discharge codes. We ran Cox proportional hazards models adjusting for sociodemographic, clinical, and lifestyle factors. Multiple testing was corrected using the Benjamin-Hochberg method. Results: Over a mean follow-up of 24 years, there were 453 cases of PAD, including 132 CLI cases. We identified 12 metabolites independently associated with PAD and 10 with CLI, representing peptides, lipids, and carbohydrates. Of these, gamma-glutamylthreonine (HR of PAD per 1SD metabolite increment 0.84 [95% CI 0.76-0.92]), gamma-glutamyltyrosine (0.85 [0.78-0.93]), 1,5-anhydroglucitol (0.79 [0.72-0.87]) and glucose (1.25 [1.10-1.42]) were associated with both PAD and CLI (Table). Asparagylvaline, lysylleucine, 1-docosahexaenoylglycerol, 1-linoleoylglycerol and 1-linoleoylglycerophosphocholine (18:2n6) were uniquely associated with CLI. Conclusion: We identified several metabolites independently associated with PAD and its severe form, CLI. Of these, gamma-glutamylthreonine, gamma-CEHC, asparagylvaline, lysylleucin and arginylproline have not been reported previously for any atherosclerotic diseases.

A study on the mechanism of school support to improve school adjustment of rural left-behind children——Analysis based on CEPS (2013–2014) data

School adjustment is related to the educational achievements and future career development of rural left-behind children. School support is an important institutional measure to promote the school adjustment of rural left-behind children in China. Using Structural Equation Modeling (SEM) based on CEPS data, this paper analyzed the effects of school support on rural left-behind children’s school adjustment, and found that: (1) school support effectively improves rural left-behind children’s school adjustment ability; (2) school support enhances students’ school adjustment ability by improving their educational expectation and mental health, especially the effects of teachers’ relationship support and school soft environment support are significant; (3) teacher support has a greater effect on students’ school adjustment ability than environment support, and soft environment support enhances students’ school adjustment ability by improving their mental health, while the impact of hard environment support is weaker. This study provides theoretical support for the formulation of intervention policies for rural left-behind children and offers practical evidence for understanding the relationship between school education and family education.

Abstract P3061: Uncovering Neighborhood-Level Inequities in Access to Transthoracic Echocardiograms

Methods: From a sample cohort of 274,539 consecutive adults who sought care at Mayo Clinic between 2018-2022, we ascertained demographic and clinical information, including clinically indicated TTE within 15 days and up to a year after the index clinical visit. The Area Deprivation Index (ADI), a tool that captures neighborhood-level disadvantages that are linked to cardiovascular morbidity and outcomes, was extracted from the Neighborhood Atlas and ranked accordingly as state percentiles stratified in quintiles, with the highest values representing “most disadvantaged” areas. We performed non-parametric multivariate regression models that adjusted for cardiovascular risk factors expressed in odds ratio (OR) and 95% confidence interval (CI). Results: A total of 45,823 (16.9%) subjects had a TTE performed, with a mean age of 63±16 years, 48% were women, and 86% were non-Hispanic white. According to the TTE, 4% of subjects had LVSD, while 11% had a high probability of LVSD by AI-ECG. Median state ADI was 4 IQR (2-7). In the whole cohort, subjects residing in the most disadvantaged areas were less likely to have a TTE [OR 0.94 CI (0.91- 0.97)] see Fig. 1-A ; conversely, they were more likely to have LVSD by TTE [OR 1.80 CI (1.52-2.13)] see Fig. 1-B , and higher probability of LVSD by AI-ECG [OR 1.43 CI (1.36-1.51)] when compared to those with the least disadvantage see Fig. 1-C , independent of age, sex, and cardiovascular risk factors, p for trend<0.001. Conclusion: Individuals living in socially disadvantaged areas were slightly less likely to have an echocardiogram despite a significantly higher likelihood of having an LVSD (suspected by AI-ECG and confirmed by TTE), independent of cardiovascular risk factors. Highlighting an important disparity in the diagnosis of LVSD.

Abstract P3082: Pregnancy heavy metal, essential element, and micronutrient mixtures and mid-life blood pressure and hypertension: findings from a prospective U.S. pregnancy cohort study with two decades of follow-up

Background: Heavy metals are cardiovascular disease risk factors, while essential elements possess antioxidant and anti-inflammatory properties and are crucial for health at trace levels. Metals may also interact with elements, leading to synergistic or antagonistic health effects. The associations of a mixture of metals and elements during pregnancy with women’s mid-life blood pressure (BP) and hypertension are unclear. Objective: To examine the prospective associations of a mixture of 6 metals, 5 elements, and 2 micronutrients in early pregnancy with women’s BP and risk of hypertension in mid-life. Methods: Project Viva is a prospective pregnancy cohort that enrolled women between 1999-2002 from Eastern MA. We measured metals (As, Ba, Cd, Cs, Hg, Pb) and elements (Cu, Mg, Mn, Se, Zn) in red blood cells, along with folate and vitamin B12 in plasma, all collected during pregnancy (median: 9.9w gestation). We measured mid-life BP in 2017-2020 (median maternal age: 51.2y). We examined associations of individual metals and elements with BP using linear regression and with hypertension (BP ≥130/80 mmHg or use of anti-hypertensive medication) using modified Poisson regression. We used Bayesian kernel machine regression (BKMR) to examine the mixture effects of all exposures. Models were adjusted for confounders listed in the Figure footnote . Results: Of the 493 women, 72% were White, 78% were college graduates, and 65% had a household income >$70K/y. The median (IQR) follow-up time was 18.1 (17.8-18.6)y. A doubling of Cu and Mn concentrations was associated with 0.75 (95% CI: 0.57, 0.99) and 0.80 (95% CI: 0.71, 0.91) times the risk of hypertension, respectively. A doubling of Cs and Se was respectively associated with 1.22 (95% CI: 0.94, 1.57) and 1.19 (95% CI: 0.77, 1.83) times the risk of hypertension, though the 95% CIs were wide. A doubling of vitamin B12 was associated with a 3.64 (95% CI: 1.23, 6.04) mmHg lower systolic BP and a 2.52 (95% CI: 0.72, 4.32) mmHg lower diastolic BP ( Figure 1 ). BKMR showed similar, linear associations for BP (results not shown) and hypertension ( Figure 2 ) and did not identify metal-element or metal-micronutrient interactions. The essential element mixture was monotonically associated with lower BP and risk of hypertension ( Figure 3 ). Conclusion: Optimizing essential element levels during pregnancy, particularly Cu and Mn, along with vitamin B12, may offer protective benefits against higher BP and hypertension in mid-life women.

Abstract P2128: Can We Swim Our Way to Better Health? A Cross-sectional National Survey

Background: This study examined obesity and comorbidity rates, physical activity levels, and cardiovascular health, using Life’s Essential 8 (LE8), among the United States Masters Swimming (USMS) adult swimmers. Methods: A cross-sectional Qualtrics survey was distributed by USMS via an online newsletter and by 52 local masters swimming organizations via email. Results: We received responses from 1,097 USMS members. The participants’ mean age was 42.8 (range 18-84), body mass index was 25.1 (range 17-47), and 59.0% identified as women and 89.5% as White. The obesity rates among USMS participants were four times lower than the national rate (10.9% vs 41.9%). The obesity prevalence did vary significantly by race, education, and household income but not by age or occupational physical activity. USMS and national rate comparisons were 23.0% vs. 44.5% for hypertension, 5.6% vs. 14.3% for type 2 diabetes, 8.6% vs. 11.4% for high total cholesterol, and 6.3% vs. 17.2% for low high-density lipoprotein cholesterol, respectively. The rate of USMS swimmers who met the recommended ≥150 minutes of aerobic activity a week, ≥two muscle-strengthening activities a week, and both was 96.6%, 65.6%, and 64.5%, respectively. When it comes to LE8 total score, USMS participants had 20% higher score than U.S. young adults free from cardiovascular disease (83.5 and 69.6, respectively, p=0.0001). In our sample, three in four adults had an ideal LE8 total score (≥80), compared to one in four from the NHANES sample that represents an estimated 90 million of the U.S. population. Overall, older USMS participants (mean age of 43; range 18-85) had significantly better LE8 score and estimated cardiovascular health than younger U.S. adults (mean age of 31; range 18-44). Conclusion: We observed low obesity and comorbidity rates and ideal estimated cardiovascular health among adult swimmers who are part of supervised and educational exercise environment overseen by the USMS.

Comparison of generic drug prices in Korea and eight high-income countries across four therapeutic classes

Background The prices of generic drugs in general are known to be higher in Korea than in other countries. However, it remains unknown whether the price levels of generic drugs in Korea relative to other countries can differ by therapeutic class. Therefore, this study compared the prices of generic drugs in four commonly used drug classes in Korea with those in other high-income countries. Methods Using IQVIA’s Pricing Insight data from 2018 to 2022, we calculated the Laspeyres price index for generic drugs in four therapeutic classes (antidiabetic drugs, lipid-modifying agents, antihypertensive drugs, and antibiotics). We selected eight high-income countries, such as Canada, France, Germany, Italy, Japan, Switzerland, the United Kingdom, and the United States, for comparison and Korea as the base country. Price to chemist was used and the currency conversion was based on the exchange rate and the purchasing power parity. Results Prices of generic drugs are lower in all of comparison countries combined than in Korea for lipid-modifying drugs and antihypertensive drugs. For these two drug classes, all countries but the U.S. have the index lower than one. The index for antidiabetic drugs was less than one in all countries except for Canada and the U.S. For antibiotics, all countries but France, Italy, and Japan have the index that is greater than one. Furthermore, the price index for generic antibiotics increased from 2018 to 2022 in all countries but Canada and Japan. Conclusion The prices of generic drugs are higher in Korea than in other high-income countries for lipid-modifying agents and antihypertensive drugs. The prices of generic antibiotics are higher in many comparison countries and have further increased from 2018 to 2021.