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The Journey of Resistant Hypertension: From the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure to American Heart Association/American College of Cardiology Guidelines

Abstract MP63: Associations of Salt intake With Risk of Hypertensive disorders of pregnancy in Women with and Without Calcium Supplementation

Background: To examine the associations between salt intake and hypertensive disorders of pregnancy among women with and without calcium supplementation. Methods: Researchers used questionnaires to collect dietary information including calcium and multivitamin supplement use, and condiments such as salt and soy sauce consumption were obtained through weighing. Salt consumption was estimated based on salt and soy sauce during cooking. Hypertensive disorders of pregnancy were ascertained through the clinical records. Logistic regression models were used to estimate odds ratios (ORs) and 95% CIs. Interactions were assessed by adding interaction terms between calcium supplement use and salt intake levels in the models. Results: The analysis included 4192 pregnant women with complete follow-up data until delivery, and there were 109 cases of hypertensive disorders of pregnancy. Among women without calcium supplements at baseline, higher daily salt intake (≥5.0 g) was significantly associated with an 86% increased risk of hypertensive disorders compared to those with intake <5.0 g (95% CI 1.07-3.24, P=0.029). This association was not found in those taking calcium supplements (OR 0.66, 95% CI 0.34-1.28, P=0.218). Interaction analysis showed significant heterogeneity in the association between salt intake and hypertensive disorders of pregnancy based on calcium supplement use (P for interaction=0.019). Similar results were observed when the low-calcium group was redefined based on multivitamin supplements and dietary calcium intake. Joint analysis showed that compared to those taking calcium supplements with salt intake <5.0 g/day, the ORs for hypertensive disorders of pregnancy among those taking calcium supplements with salt intake ≥5.0 g/day were 0.64 (95% CI 0.34-1.22, P=0.177) and 0.49 (95% CI 0.26-0.93, P=0.030) for non-users with salt intake <5.0 g/day. For non-users of calcium supplements with salt intake ≥5.0 g/day, the OR was 0.90 (95% CI 0.50-1.61, P=0.719). These results were consistent across subgroup and sensitivity analyses. Conclusions: Our study revealed that in the participants without calcium supplements, higher salt intake was associated with a higher risk of hypertensive disorders of pregnancy, while this association was not observed in the people taking calcium supplements. These findings suggest that the balance between sodium and calcium intake may be an important factor influencing the development of hypertensive disorders of pregnancy.

Abstract P2129: A scoping review comparing individual and multi-level physical activity interventions in rural women in the United States

Purpose: The aim of this review is to summarize physical activity interventions in rural women in the United States using the socio-ecological model of health framework. Methods: We conducted a scoping review of peer-reviewed literature in Medline, CINAHL Complete, Web of Science, and PsychINFO in August 2023. We narratively synthesized the evidence and, in studies with a comparison group, calculated pooled estimates to compare intervention effects by levels of the socio-ecological model. We used an adapted GRADE approach to assess study quality. Findings: Our search yielded 41 reports of 38 different interventions that met our eligibility criteria (24 individual and 17 multi-level). Nineteen individual (83%) and eight multi-level (73%) interventions increased physical activity. Pooled estimates indicated that multi-level interventions increased physical activity to a greater extent (1.09 [-0.44, 2.16]) than individual-level interventions (0.18 [-0.26, 0.62]). Limited studies included measurements of feasibility, acceptability, strengths, and barriers or clearly defined rurality. Special considerations for intervention design included ensuring that participants feel supported, training and supporting strong interventionists using new technology, and assessing cost-effectiveness. Conclusion: Our findings suggest individual-level interventions often increased physical activity in rural women, but multi-level interventions yielded larger effects. More high-quality, multi-level interventions that track key implementation factors (feasibility, acceptability, strengths, barriers) and define rurality are needed Figure 2. Individual vs. Multi-level Intervention Effects.

Failure mechanism of soft– hard- interbedded rock slopes in cold regions: Numerical simulation and theoretical analysis

The soft– hard- interbedded rock slope in cold regions generally undergo the differential weathering due to the freeze-thaw effects, for which the irregular rock fractures increase the risk of geological disasters occurrence. To investigate the failure mechanism of the rock slope, both the numerical simulation and theoretical analysis were adopted in the present research. The structural integrity of the soft– hard- interbedded rock slope subjected to three different conditions (e.g., freeze-thaw cycles, natural, and anchored surroundings) was evaluated. The results indicated that the stability of the rock slope is significantly affected by the freeze-thaw cycles, the performance of which is much different from that under the natural- and anchored conditions. The failure process of the soft– hard- interbedded rock slope in cold regions exhibited the unloading-tensile cracking-sliding characteristics. The damage of the irregular structural surfaces subjected to the long-term weathering and freeze-thaw cycles is the one of the main factor controlling the failure mode. As revealed by numerical simulation, the application of the anchor rods can effectively prevent and control the collapse of the soft– hard- interbedded rock slope. The findings obtained from this research provide an important guidance for the stability assessment and mitigation design of the soft– hard- interbedded rock slopes in cold regions.

Abstract 073: Gestational Diabetes, Mid-life Cardiovascular Health, and 10-year Predicted CVD Risk in South Asian Women in the United States

Background: Gestational diabetes mellitus (GDM) increases the risk of suboptimal cardiovascular health (CVH). The association of GDM with overall CVH and predicted cardiovascular disease (CVD) risk in mid-life remains to be defined among South Asian women in the US, a subgroup at excess risk for CVD. Methods: In female participants of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study with a history of ≥1 live birth, we examined the association between self-reported GDM history with Life’s Essential 8 (LE8) CVH score (scale 0-100) and 10-year predicted CVD risk calculated by the base and HbA1c-enhanced PREVENT total CVD risk models. Multivariable linear regression models adjusted for age, site, parity, and post-menopausal status. Additional models adjusted for social determinants of health inclusive of income, education, years lived in the United States, and acculturation per the validated traditional cultural beliefs scale. Results: Among 511 participants, 48 (9.4%) reported a history of GDM, mean (SD) age was 55.9 (8.7) years, and participants lived in the U.S. for a mean 26.9 (11.5) years. There were 70 participants (13.7%) with a parity of 1, 320 (62.6%) with a parity of 2, and 121 (23.7%) with a parity of ≥3. Mean (SD) LE8 CVH score was 68 (12). Median (25th, 75th percentile) PREVENT 10-year total CVD risk was 4.0% (1.8%, 7.5%) in the base model and 4.1% (2.0%, 7.7%) in the HbA1c-enhanced model. GDM history was significantly associated with lower (i.e., worse) LE8 CVH score and higher PREVENT 10-year predicted CVD risk (Table) . After adjustment, GDM was associated with a 3.9-point lower LE8 CVH score (95% CI [-7.5, -0.4]), a 1.5% (0.4, 2.5) higher absolute 10-year predicted total CVD risk in the PREVENT base model, and a 1.9% (0.8, 2.9) higher absolute 10-year predicted total CVD risk in the PREVENT HbA1c-enhanced model. Conclusions: Among U.S. South Asian women in mid-life, a history of GDM was associated with worse CVH and clinically significant higher predicted risk for CVD.

Abstract P1081: Urine Metabolomic Profiles Associated with Incident Heart Failure in Older Adults

Introduction: Metabolomic biomarkers have enhanced heart failure (HF) prediction in addition to clinical risk factors. However, urine metabolites related to incident HF have not been studied. Hypothesis: Novel urine metabolites, as well as uremic toxins, are associated with an increased risk of HF. Methods: Metabolomic profiling was performed in the Atherosclerosis Risk in Communities (ARIC) study at visit 5 using urine samples. Urine metabolite levels were probabilistic quotient normalized prior to the analyses, and 914 known urine metabolites were evaluated with incident HF using Cox proportional hazard regression. Replication analyses were performed on 3,431 participants, including 172 HF cases (mean age=58) from the German Chronic Kidney Disease (GCKD) study (100% Whites). Results: During an average of 7 years of follow-up, 226 incident HF events occurred among 1,242 ARIC participants (54.3% Whites, mean age= 76). After adjusting for clinical risk factors and eGFR, ten urine metabolites were associated with incident HF (FDR p-value <0.05). Guanosine-3',5'-cyclic monophosphate (cGMP), a biologic marker reflecting renal activities of natriuretic peptides, was associated with an increased risk of HF (HR=1.40, 95% CI= 1.21-1.63). Sucrose, a disaccharide composed of glucose and fructose, was also associated with an increased effect on HF (HR=1.30, 95% CI= 1.12-1.50), and the effect persisted with further adjustment of fasting glucose levels. The associations of urine cGMP and sucrose with HF were replicated in GCKD (HR cGMP =1.40, 95% CI= 1.24-1.56; HR sucrose = 1.19, 95% CI= 1.03-1.35, Figure). Additional analyses revealed that cGMP was more strongly associated with HF with reduced (HFrEF) than with preserved ejection fraction (HFpEF), while sucrose was more strongly associated with HFpEF than HFrEF. Conclusions: Urinary metabolites associated with incident HF and its subtypes were identified, providing complementary insights into the molecular mechanism of the development of HF.

Abstract P1044: External validation of a novel cancer-associated venous thromboembolism risk assessment score in a safety-net hospital

Background: Cancer-associated VTE (CAT) is the second leading cause of death in patients diagnosed with cancer. However, pharmacologic thromboprophylaxis use in cancer patients must be tightly regulated due to a two-fold increased risk of experiencing a major bleeding event within this population. A cancer-associated venous thromboembolism (CAT) risk assessment model (RAM) has recently been developed utilizing patient electronic health records (EHR) that reports improved performance over the prior state-of-the-art Khorana score. Objective: To externally validate a recently published RAM using EHR data from 2,103 cancer patients at Boston Medical Center, New England’s largest safety-net hospital, and to compare this RAM to the Khorana score. Methods: We conducted a retrospective study of Boston Medical Center (BMC) cancer patients diagnosed between January 2014 and December 2022 using data from the BMC tumor registry and electronic health record system. We validated the risk assessment model using measures of discrimination and calibration. Results: The recently published score exhibited a strong ability to discriminate risk of CAT (C statistic, 0.67) substantially higher than the classic Khorana score (C statistic, 0.58). This increased discrimination power reflects the 20% of patients correctly reclassified into high or low risk by the expanded score. Model calibration was also strong in this dataset. Conclusion: In our external validation, the recently published CAT score clearly and improvedly separated patients at high and low risk for CAT. This expanded CAT score could facilitate improved selection of prophylactic therapy among cancer patients.

The impact of postoperative glucocorticoids on complications after head and neck cancer surgery with free flap reconstruction: A retrospective study

Background After head and neck cancer surgery with free flap reconstruction, the use of glucocorticoids is often required to alleviate inflammation and edema. However, the impact of glucocorticoid on postoperative complications and cancer progression remains unclear. Methods This retrospective cohort study included 711 elderly patients who underwent head and neck cancer surgery with free flap reconstruction at Shanghai Ninth People’s Hospital from January 1, 2014, to December 31, 2022. Patients were categorized based on postoperative glucocorticoid usage into a high-dose steroid group (n = 307) and a control group (n = 404). The study focused on the impact of postoperative GC use on postoperative complications and long-term oncological outcomes. Results Multivariate analysis indicated that compared to the control group, the high-dose steroid group had a significant increase in postoperative complications, including atelectasis (OR: 3.83, 95% CI: 1.27–14.11, P = 0.025), postoperative hyperglycemia (OR: 1.54, 95% CI: 1.14–2.08, P = 0.006), and flap complications (OR: 4.61, 95% CI: 3.31–6.47, P < 0.001). These complications often required extended hospital stays (β: 1.656, 95% CI: 1.075-2.236, P <  0.001). Additionally, the high-dose steroid group had a higher rate of unplanned readmissions within one year (OR: 5.61, 95% CI: 3.87–8.25, P < 0.001). The increased readmission rates were notably due to difficulties swallowing requiring percutaneous gastrostomy (OR: 3.62, 95% CI: 1.97–6.98, P < 0.001), recurrence (OR: 9.34, 95% CI: 5.02–19.05, P < 0.001), and metastasis (OR: 4.78, 95% CI: 2.58-9.44, P < 0.001). Conclusion The use of high-dose postoperative glucocorticoids is associated with increased postoperative complications, higher readmission rates, and poorer oncological outcomes in patients. The results advocate for cautious use and dosage management of perioperative glucocorticoids in head and neck surgeries to optimize patient outcomes.

Abstract MP73: Long-Term Effects of Physical Activity, Sleep, and Screen-Time on Hypertension Incidence in Adolescents – ABCD Study

Background: Hypertension is a critical risk factor for cardiovascular diseases with a high prevalence in pediatric populations. However, the long-term effects of physical activity, sleep, and screen time on hypertension incidence in adolescents remain unclear. Research Questions: How do long-term physical activity, sleep, and screen time influence the incidence of hypertension in adolescents within the Adolescent Brain Cognitive Development (ABCD) Study? Aims: i) Investigate the long-term effects of physical activity, sleep patterns, and screen time on hypertension incidence in adolescents using Fitbit and self-reports. Methods: Our analysis involved 1,702 adolescents (51.5% boys) from the ABCD study across 21 US cities, followed prospectively from 2018-2020 (T0) to 2020-2022 (T1), focusing on those with complete data on physical activity, sleep, screen time, and covariates (sex, age, waist circumference and social determinants). Hypertension was defined according to AAP guidelines. Movement behaviors were categorized as ≥ 60 minutes of moderate to vigorous physical activity daily, ≤ 2 hours of recreational screen time, and 9-11 hours of sleep. We estimated hypertension incidence and relative risks, examining the individual and joint additive effects of movement behaviors. Results: At the T0, the mean age was 11.9 years, increasing to 14.1 years at T1. Adolescents who did not meet the screen time recommendations had higher hypertension prevalence (1.9%) and incidence (4.0%) compared to those who met the guideline (1.0% prevalence; 1.7% incidence). No significant differences were observed for sleep guideline adherence. Physical activity guideline adherence was associated with higher hypertension incidence (4.7% vs. 3.1%), but not prevalence (1.2% vs. 2.7%). Meeting two or more components of the 24-hour movement behavior guidelines was associated with significantly reduced hypertension risk (RR 0.31, 95% CI 0.09-0.98). Conclusions: High screen time and not meet physical activity guideline are linked to increased hypertension risk in adolescents. Adhering two or more 24-hour movement behavior recommendations reduces this risk of hypertension, emphasizing the need for comprehensive and combined lifestyle interventions to promote cardiovascular health.

Abstract P3005: Blood Biomarkers and the Risk of Coronary Disease in Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is the most common arrhythmia worldwide. Although it was recently identified as a risk factor for coronary heart disease (CHD), the underlying pathophysiology is not well understood. Initial studies suggested an embolic mechanism when compared to those without AF. We studied several biomarkers to understand possible mechanisms and identify potential predictors of CHD in this population. Methods: The REGARDS cohort study enrolled 30,239 White and Black adults aged 45 and older in 2003-7. We included those with baseline AF and no history of stroke, myocardial infarction (MI), or coronary revascularization. We calculated hazard ratios (HR) for incident CHD, defined as definite or probable MI, per 1 SD increment of each biomarker using Cox models adjusted for CHD risk factors and medications. Results: The 1,807 participants had mean age 66 years; 33% were Black, 57% female, 76% had hypertension, and 21% diabetes. Incident CHD was seen in 201 participants (39.8% fatal) over a mean follow-up of 9 years. Among the 14 biomarkers (figure), significant associations were seen with cholesterol (HR 2.9; 1.4-6.2), cystatin C (HR 2.6; 1.6-4.2), GDF15 (HR 2.0; 1.5-2.9), serum creatinine (HR 1.8; 1.1-2.9) NTproBNP (HR 1.4; 1.3-1.6), D-dimer (HR 1.4; 1.2-1.7), IL6 (HR 1.3; 1.2-1.5), CRP (HR 1.3; 1.1-1.5), GGT (HR 1.25; 1.02-1.54), and LP(a) (HR 1.22; 1.05-1.41). Conclusions: Total cholesterol, LP(a), D-dimer, GGT, and biomarkers of kidney function (cystatin C, creatinine), myocardial strain (NTproBNP), and inflammation (IL6, CRP, GDF15) were associated with incident CHD in AF. These findings lay the groundwork for further research to determine potential therapeutic targets to prevent CHD in people with AF.

Abstract P1175: Endometriosis diagnosis, staging, and typology in relation to dyslipidemia

Background: Individuals with endometriosis, a gynecologic condition affecting approximately 11% of people with a uterus, may have an elevated risk for developing cardiovascular disease (CVD) later in life. However, the mechanisms underlying this association are not well understood. Methods: We investigated the association between incident endometriosis diagnosis, staging, and typology and lipid biomarkers measured at time of diagnostic surgery among women participating in the NICHD ENDO study (n=395). Endometriosis was categorized using the American Society for Reproductive Medicine staging (I−IV). Endometriosis typology was defined by lesion depth and location and categorized as superficial endometriosis (SE), ovarian endometrioma (OE), and deep infiltrating endometriosis (DE). With no endometriosis as our reference, we evaluated the associations between endometriosis diagnosis, stage (I/II vs III/IV), and typology (SE, OE, DE, OE+DE) and dyslipidemia using standard clinical thresholds (total cholesterol ≥200 mg/dL, high-density lipoprotein (HDL) <50 mg/dL, low-density lipoprotein (LDL) ≥100 mg/dL, triglycerides ≥175 mg/dL, non-HDL ≥130 mg/dL, VLDL ≥30 mg/dL, Apolipoprotein A-1 (APO-A1) <125 mg/dL, Apolipoprotein B (APOB) ≥120 mg/dL; APOB/APO-A1 ratio >0.78). We calculated adjusted prevalence ratios (aPR) and 95% CIs via generalized linear models, controlling for age, race/ethnicity, marital status, BMI, income (poverty level), and serum cotinine as a marker of smoking. Results: At the time of gynecologic surgery, individuals were mean 32 years (SD: 7 years), non-Hispanic white (79%), married (71%), and mean BMI 28 (SD=8). While we found no differences in endometriosis diagnosis or endometriosis staging and dyslipidemia ( Figure 1; Table 1 ), a pattern emerged regarding endometriosis typology ( Table 2 ). Women with OE+DE, compared to no endometriosis, had increased prevalence of dyslipidemia: total cholesterol >200 mg/dL: 1.87 (0.99, 3.57); triglycerides > 175 mg/dL: 2.48 (1.34, 4.57); VLDL ≥30 mg/dL: 2.08 (1.28, 3.38); and APOB mg/dL ≥120: 2.86 (1.22, 6.66). OE appeared to be driving this association. SE was not associated with dyslipidemia. Conclusions: The association between endometriosis, especially of more severe typology, and subsequent CVD may be through dyslipidemia, which may be detectable at the time of endometriosis diagnosis. Further research in larger, more representative samples is needed before definitive conclusions can be made.

A fuzzy robust optimization model for dual objective forward and reverse logistics networks considering carbon emissions

The inherent unpredictability within the low-carbon integrated supply chain logistics network complicates its management. This paper endeavours to address the challenge of designing a low-carbon logistics network within a context of uncertainty and with consideration of low-carbon policies. It also endeavours to identify locations of facilities and appropriate transportation routes between nodes. Robust optimisation and fuzzy programming techniques are employed to examine the various attributes of the network. In addition, the strategic planning model of a multi-level forward/reverse integration logistics network is examined, with the aims of cost minimisation and emission reduction. Extensive computational simulations substantiate the efficacy of the proposed robust fuzzy programming model. Moreover, analytical results indicate the rationality and applicability of the decisions suggested by the proposed optimisation model and the solution approach. Furthermore, the results indicate that a decision maker can ascertain that the decisions derived from three cases considered have a 50% probability of being the most favourable outcomes.

Abstract 071: Association Between Proximity to Hazardous Waste Sites and Cardiometabolic Diseases: Coronary Heart Disease, Stroke, Hypertension, and Diabetes

Introduction: Proximity to hazardous waste sites may increase cardiometabolic risk. However, differences in these associations by socioeconomic status and urban-rural residency is underexplored. We estimated the associations of proximity to hazardous waste sites with prevalence of coronary heart disease (CHD), stroke, hypertension, and diabetes, while exploring the moderating roles of the Social Vulnerability Index (SVI) and Rural-Urban status. Hypothesis: We hypothesized that neighborhoods closer in proximity to hazardous waste sites have an incrementally higher prevalence of the selected disease outcomes compared to neighborhoods furthest away. Methods: We used data from 57,845 (~70%) U.S. census tracts, creating a percentile-ranked score based on proximity to hazardous waste sites from the Environmental Justice Index, classified into quartiles (Q4 = closest). Prevalence of health outcomes were obtained from the Centers for Disease Control and Prevention (CDC) PLACES dataset, and SVI and Rural-Urban Commuting Area (RUCA) codes were obtained from the CDC and U.S. Department of Agriculture, respectively. A linear mixed-effects model assessed prevalence differences between quartiles, adjusting for percentages of uninsured, race/ethnicity minority, aged ≥65, and <17, with county-level random effects. We also evaluated the moderating role of SVI and urbanicity. Results: After adjustment, neighborhoods closest to hazardous waste sites (Q4) had a significantly higher prevalence of each of the cardiometabolic diseases when compared to Q1: CHD (0.35%; 95% CI, 0.33-0.38), Stroke (0.19%; 95% CI, 0.17-0.21), Hypertension (0.44%; 95% CI, 0.35-0.54) and Diabetes (0.48%; 95% CI, 0.43-0.53). The interaction term between SVI, RUCA, and our exposure was significant for all health outcomes (p<0.05), based on the Wald chi-square test. The magnitude of the associations were stronger in higher socially vulnerable neighborhoods (compared with low) (Figure 1). Although the prevalence of cardiometabolic diseases was higher in non-metro tracts, there was a weaker association with proximity to hazardous waste sites, compared to metropolitan tracts. Conclusion: These findings highlight the potential role of environmental factors in shaping community-level cardiometabolic health disparities. While individual inferences are limited by the study's ecological nature, the results emphasize addressing environmental and social vulnerabilities to promote health equity at a population level.

Abstract P3051: Longitudinal trends in glucose and hearing loss in midlife: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Hearing loss (HL) is a common condition that often goes undetected until the deficits are pronounced. Diabetes may affect the vasculature and neural system of the inner ear, damaging both the auditory nerve and the vestibular systems, leading to HL. Less is known about how hyperglycemia over prolonged periods of time from young adulthood is associated with HL in midlife. Hypothesis: Young adults who experience early increases in fasting glucose levels will experience greater odds of future HL compared to those whose glucose levels either stay stable or increase later in life. Methods: CARDIA participants had hearing assessed at the Year 35 exam (Y35, 2020-2022, ages 53-70 years) using an automated method for testing auditory sensitivity to obtain pure-tone air-conduction thresholds. HL was defined as a sound detection threshold >25 dB in the better ear at high frequencies (4000-8000 Hz). Fasting serum glucose was measured by standardized methods starting at baseline (1985-1986). Fasting glucose trajectories were created using PROC TRAJ (SAS) for 1921 participants with complete hearing and covariate data. Results: Mean glucose at Y0 was 81.9 mg/dL and 107.7 mg/dL at Y35. The sample was 57.4% women and 44.1% Black; 61.3% had normal hearing, 21.6% had mild HL and more severe HL was rare. Three distinct trajectories were identified: glucose remained low; glucose increased early; and glucose increased later (Figure). Compared to the remained low group, those whose glucose increased in early adulthood had 93% higher odds of high frequency HL. Those whose glucose increased later in adulthood had 14% higher odds of HL that did not reach statistical significance. Odds ratios were unchanged after adjustment for age, race, sex, education, smoking, drinking, physical activity and obesity. Conclusions: Prolonged exposure to elevated glucose was associated with mild high-frequency HL in midlife in a population-based cohort without severe HL, providing additional motivation to manage hyperglycemia.

Abstract P1146: A Multifaceted Blood Pressure Intervention Improves Medication Adherence in Low Income Adults with Hypertension

Methods: A secondary analysis from the I mplementation of M ultifaceted Pa tient- C entered T reatment S trategies for Intensive BP Control (IMPACTS) cluster randomized trial in federally qualified health centers in the Gulf South was done. Participants were randomized to intervention (standardized BP measurement education, stepped-care treatment algorithm, team-based care, health coaching, home BP monitoring) versus EUC. Adherence was measured with the Krousel-Wood Medication Adherence Scale-4 item (K-Wood-MAS-4; range 0-4); score<1=high adherence. SBP&diastolic BP (DBP) were assessed with a standard protocol using automated BP devices. A multivariable mixed effects logistic regression model with group-by-time interaction estimated predicted probabilities of high adherence for each group at each time point; between-group differences were assessed. A multivariable mixed effects linear regression model estimated difference in SBP for high versus low adherence across all time points. Models were adjusted for baseline socio-demographics, SBP, hypertension duration, number antihypertensive drugs, and comorbidities. Results: Data from 1,272 hypertensive adults from 36 clusters (mean cluster size 35.3, SD 10.6, range 21-60) were analyzed: mean age was 58.3 years (SD 8.9), 56.7% female, 66.5% Black; 62.9% household income <$20K. At baseline, mean SBP&DBP were 147.6 mm Hg (SD 12.5) and 84.6 mm Hg (SD 10.9), respectively; mean K-Wood MAS-4 score was 0.82 (SD 0.89); only 44.3% reported high adherence. Adjusted percent of high adherence at baseline, 6-, 12-&18 months: Intervention group: 43% (95% CI 39%, 47%), 53% (95% CI 48%, 57%), 53% (95% CI 49%, 58%)&54% (95% CI 50%, 59%), respectively; EUC group : 46% (95% CI 42%, 50%), 44% (95% CI 40%, 48%), 48% (95% CI 44%, 53%)&55% (95% CI 50%, 59%), respectively. Between-group differences in probability of high adherence were higher in intervention versus EUC groups at 6 (p=0.001)&12 months (p=0.018) but not 18 months (p=0.463). Across all visits, high versus low adherence was associated with mean 4.35 mm Hg lower SBP (p<0.001). Conclusion: The multifaceted intervention versus EUC increased adherence at 6M and 12M post randomization; higher adherence was associated with lower SBP.

Field size as a predictor of “excellence.” The selection of subject fields in Germany’s Excellence Initiative

We investigate the selection of subject fields in Germany’s “excellence initiative,” a two-phase funding scheme administered by the German Research Foundation (DFG) from 2005 to 2017 to increase international competitiveness of scientific research at German universities. While most empirical studies have examined the “excellence initiative’s” effects at the university level (“elite universities”), we focus on subject fields within universities. Based on both descriptive and logistic regression analyses, we find that the “excellence initiative” reveals a stable social order of public universities based on organizational size, that field selection is biased toward those fields with many professors and considerable grant funding, and that funding success in the second phase largely follows decisions from the first phase. We discuss these results and suggest avenues for future research.

Abstract P1083: Religiosity and Risk of Heart Failure in the Southeastern United States

Introduction: Greater religiosity, or degree of involvement in religious activities, associates with better CV health profiles. Yet, studies of the association between religiosity and incident CV events have yielded mixed results. The southeastern US is characterized by strong religious practice but has among the highest rates of incident heart failure (HF). The relationship between religiosity and incident HF is not well characterized, particularly among low-income populations. Methods: We studied 23,893 Black or White Southern Community Cohort Study participants (median age 53 years, 70% Black, 64% women, 70% annual household income <$15k) without prevalent HF or CAD at enrollment (2002-2009). Religiosity, defined by religious service attendance, was ascertained at enrollment via a single item adapted from the Duke University Religion Index. Incident HF was determined using Centers for Medicare and Medicaid Services Research Identifiable Files (ICD-9/-10 codes 428.x or I50, I110) through December 31, 2016. We quantified the association of religious attendance with incident HF via Cox models adjusted for demographics, HF risk factors (HTN, HLD, DM, BMI, CVA), health behaviors (smoking, alcohol, physical activity, DASH diet), socioeconomic (income, education, employment, neighborhood deprivation, rurality) and psychosocial factors (marital status, social support, depressive symptoms, anti-depressant use). Results: Religious service attendance was common: >1/week (24%), 1/week (27%), <1/week (33%), and never (15%). Participants attending >1/week were more likely to be older and female, had relatively higher SES and more comorbidities, but better health behaviors and psychosocial support. HF developed in 6081 participants (25%; median 10-yr follow-up). Adjusting for demographics and HF risk factors, attendance >1/week associated with lower HF risk (HR 0.88 [0.82,0.94] and HR 0.92 [0.84,1.00] compared to <1/week or never, respectively). Attendance 1/week compared to <1/week showed similar association (HR 0.91 [0.85, 0.97]). Further adjustment for health behaviors, socioeconomic and psychosocial factors attenuated the association to non-significance. There was no interaction between religiosity and race. Conclusion: Greater frequency of religious service attendance associated with lower incident HF risk adjusting for demographics and HF risk factors; however, this association attenuated with adjustment for health behaviors, socioeconomic and psychosocial factors.

Abstract P3065: Unveiling Sex-Specific Disparities in Cardiovascular Risk Factors Among Asian American Ethnic Subgroups

Background: Despite being one of the fastest-growing minority groups in the US, Asian Americans are often studied as a single entity. While some research has explored subgroup differences in CVD risk, sex-specific disparities remain unclear. Since lifestyle, shaped by ethnic background, influences CVD risk, identifying sex-specific differences across subgroups is crucial for tailored interventions. Hypothesis: We assessed the hypothesis that CVD risk factors vary significantly by sex among Asian American subgroups compared to White males. Methods: We analyzed data from the National Health Interview Survey (NHIS) years 2010 to 2018 of 135,809 adults, categorized as non-Hispanic White and Asian subgroups (Chinese, Asian Indian, Filipino, Other Asian). Six CVD risk factors were assessed: hypertension, diabetes, high cholesterol, smoking, overweight, and physical inactivity. Poisson regression models estimated prevalence ratios (PRs), adjusted for demographic and healthcare characteristics. We assessed sex-specific disparities within subgroups, using non-Hispanic White males as the reference group. NHIS survey weights were employed to derive national estimates. Results: The mean age was 51 ± 0.12 years overall, with Asian Indians being the youngest (40.30 ± 0.54 years). Hypertension prevalence was highest in Filipino males (PR 1.10, 95% CI 1.01–1.20), while Chinese females had the lowest prevalence (PR 0.58, 95% CI 0.51–0.66). Diabetes prevalence was reported highest in Asian Indian males (PR 1.42, 95% CI 1.16–1.74) compared to the reference group; however, across subgroups, other Chinese females reported the lowest prevalence of diabetes (PR 0.46, 95% CI 0.34–0.63). Filipino males had the highest prevalence of high cholesterol (PR 1.23, 95% CI 1.11–1.37). Smoking prevalence was highest among other Asian males (PR 0.84, 95% CI 0.74–0.94). Intriguingly, the prevalence of physical inactivity was significantly high across all female subgroups, with Asian Indian women (PR 1.27, 95% CI 1.18–1.36), followed by other Asian women (PR 1.22, 95% CI 1.15–1.28), Filipino women (PR 1.17, 95% CI 1.10–1.25), and Chinese women (PR 1.17, 95% CI 1.09–1.26) (see figure) Conclusion: In conclusion, this study unveils significant sex-specific disparities in CVD risk factors among Asian American subgroups. Culturally tailored, targeted interventions are needed. Addressing these disparities can help mitigate CVD burden in high-risk, sex-specific population and improve health equity.

Abstract P1003: Enhancing Medication Safety and Outcomes for Elderly Patients in Rural Outpatient Cardiology: Year Long Evaluation of a Pharmacist-Led Remote Medication Reconciliation Program

Background: Challenges of ensuring medication safety and compliance are compounded by limited access to healthcare services. Elderly individuals are disproportionately affected, often having to navigate complex medication regimens prescribed by multiple providers. Moreover, rural patients face a similar challenge, constrained by the number of nearby healthcare facilities and providers. Our study investigates the efficacy of a pharmacist-led (PharmD) remote medication reconciliation program, as part of Medicare’s Chronic Care Management (CCM) program, at a rural cardiology clinic serving a predominantly elderly population in Georgia, USA. Methodology: Methodology was centered around evaluation of medication reconciliation encounters (N=2123) performed by the PharmD team at a rural cardiology clinic from February 2023 to February 2024. The team conducted these encounters with 1065 patients (Avg. of 1.99 calls/patient) facilitated by a structured questionnaire. Initial priority for scheduled medication reconciliations was given to patients: with two or more chronic conditions, older than 65 years old, and six or more active medications. Key topics of focus from the questionnaire are shown in Table 1. Data from the questionnaires was retrospectively analyzed to evaluate program outcomes and efficacy. Conclusion: Retrospective analysis strongly illustrated the program’s effectiveness and clinical impact in a rural cardiology setting. The program's success demonstrates the substantial benefits of comprehensive medication reconciliation as part of Medicare’s CCM program in enhancing medication safety and promoting preventive care, especially among older populations with complex health needs. The program’s identification of notable drug-drug interactions allows for better month to month monitoring of patients’ symptoms, particularly those anticipated by the interaction report. The program allows elderly patients, who frequently have extensive medication regimens from multiple providers, to have a thorough up to date review of their medications in their own home. Through careful analysis of the state’s vaccine registry and current guidelines, the PharmD team discovered an alarming shortfall in preventive vaccinations and boosters among this rural patient population. The PharmD team's interventions during the medication reconciliation encounters, aimed at educating and advocating for vaccination, help protect this at-risk population from severe illnesses and complications.

Genetic subtyping by Whole Exome Sequencing across Diffuse Large B Cell Lymphoma and Plasmablastic Lymphoma

Diffuse Large B-Cell Lymphoma (DLBCL) is a heterogeneous disease characterized by a limited number of molecularly defined subtypes. Recently, genomic-based algorithms have been proposed for the classification of this disease. The whole exome sequencing was conducted on 108 diagnostic samples of diffuse large B-cell lymphoma (DLBCL). Somatic variants, predicted copy number alterations (CNAs), and available fusion data were utilized to classify the cases. Additionally, the enrichment of mutations in the TP53, MYC, and MAPK/ERK pathways was analyzed. Genetic subtypes were identified in approximately 55% of the cases. Cases with a specific genetic subtype exhibited a significantly higher Tumor Mutation Burden compared to molecularly unclassified cases (Mann-Whitney U test, p =  0.024). The prevalence of subtypes varied according to the cell of origin phenotypes. GC-B type DLBCL NOS were classified as EZB (5 cases, 16%), ST2 (5 cases, 16%), and BN2 (1 case, 3%). Four cases (13%) were genetically composite. Three cases of HGBCL/DLBCL double-hit (MYC & BCL2) were classified as EZB-MYC. Forty-three non-GC-B type DLBCL cases were classified as ST2 (5 cases, 11%), BN2 (6 cases, 14%), and MCD (3 cases, 7%). Nine cases were genetically composite (20%). MYC pathway mutations were enriched in cases with EZB and ST2 genetic features, while they were absent in the MCD subtype. TP53 mutations were identified in 11% of the cases. Plasmablastic lymphomas exhibit genetic diversity, with 27% of tumors classified as ST2. Recurrent somatic mutations indicate dysregulation of the JAK/STAT, MAPK/ERK, and tyrosine kinase signaling pathways.