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Abstract P2082: Discordance of Small Dense Low-Density Lipoprotein Cholesterol beyond Low-Density Lipoprotein Cholesterol or Non-High-Density Lipoprotein Cholesterol and Carotid Plaque Risk
Introduction: We aimed to evaluate the associations of small dense low-density lipoprotein cholesterol (sdLDL-C), large buoyant LDL-C (lbLDL-C), and sdLDL-C/LDL-C ratio with carotid plaque (CP) risk in the general Chinese population, and to conduct discordance analyses to determine which of these lipid biomarkers can more effectively reflect CP risk beyond traditional lipid markers, such as total LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C). Hypothesis: We inferred that sdLDL-C and sdLDL-C/LDL-C ratio would provide additional CP risk information beyond LDL-C and non-HDL-C. Methods: This study enrolled 20,369 participants from the Beijing Healthy Management Cohort. Discordances between sdLDL-C, lbLDL-C, or sdLDL-C/LDL-C with LDL-C or non-HDL-C, as well as discordance between sdLDL-C/LDL-C and sdLDL-C, were defined based on residual differences and medians. CP was diagnosed using Color Doppler ultrasound of the carotid artery. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: In our study, 10,445 (51.28%) participants were men, and the median age was 43.00 [34.00, 54.00] years. Higher sdLDL-C and sdLDL-C/LDL-C ratio, but not lbLDL-C, were associated with increased CP risk. Additionally, discordantly high sdLDL-C (OR, 1.403; 95% CI, 1.283–1.534 for LDL-C; OR, 1.356; 95% CI, 1.240–1.483 for non-HDL-C) and discordantly low lbLDL-C (OR, 1.406; 95% CI, 1.286–1.537 for LDL-C; OR, 1.178; 95% CI, 1.077–1.288 for non-HDL-C), relative to LDL-C or non-HDL-C, were significantly associated with an elevated risk of CP compared to the concordance groups. Conversely, discordantly low sdLDL-C (OR, 0.823; 95% CI, 0.743–0.911 for LDL-C; OR, 0.863; 95% CI, 0.781–0.953 for non-HDL-C) and discordantly high lbLDL-C (OR, 0.825; 95% CI, 0.745–0.913 for LDL-C; OR, 0.930; 95% CI, 0.845–1.023 for non-HDL-C) were associated with a reduced risk. Finally, the discordantly high sdLDL-C/LDL-C ratio versus LDL-C (OR, 1.310; 95% CI, 1.199–1.431), non-HDL-C (OR, 1.228; 95% CI, 1.124–1.343) and sdLDL-C (OR, 1.464; 95% CI, 1.323–1.620) was linked with increased CP risks. Conclusions: The sdLDL-C and sdLDL-C/LDL-C ratio, not lbLDL-C, are superior to LDL-C and non-HDL-C in identifying CP risk, and sdLDL-C/LDL-C further captures additional risk information beyond sdLDL-C alone. These findings underscore the importance of monitoring sdLDL-C and sdLDL-C/LDL-C to enhance residual risk assessment for atherosclerosis in clinical practice.
Abstract P3121: Temporal Changes in Blood and Fecal Metabolites and Fecal Microbiome After Bariatric Surgery
Background: Temporal changes in blood and fecal metabolites and fecal microbiome following bariatric surgery remain unclear. This study thus aimed to explore those intra-individual changes after bariatric surgery. Methods: Plasma and stool samples were collected from 62 patients who underwent first-time Roux-en-Y gastric bypass or sleeve gastrectomy at pre- and 3- and 12-month post-surgery. Global metabolite profiling and targeted short-chain fatty acid profiling were performed using LC-MS/MS. The microbiome was profiled by shotgun metagenomic sequencing. Paired Wilcoxon signed-rank tests and fold change (FC) were applied. Significant changes (FDR<0.05 and FC>1.5 or <0.67) were categorized into three patterns: early changed, late sustained (i.e., significant when comparing 3-month post- to pre-surgery, which sustained comparing 12- to 3-month post-surgery); early changed, late reversed (significant opposite changes in both periods); early unchanged, late changed (only significant when comparing 12- to 3-month post-surgery). Results: Significant changes were observed in 274 plasma metabolites,143 fecal metabolites, and 102 microbial species. Major plasma metabolite changes involved sustained increases in primary bile acids and hemoglobin-related metabolites, and a decrease in tryptophan; reverses in ketone bodies, secondary bile acids, and fatty acids; late increases in lysophospholipids, benzoate, and energy-related metabolites, and a late decrease in long-chain fatty acids. Major fecal metabolite changes included sustained increases in medium- and long-chain fatty acids, and decreases in secondary bile acids and dipeptides; late increases in energy-related metabolites, and decreases in primary bile acids and sterols. Major microbial species changes were sustained increases in Streptococcus parasanguinis , S. salivarius , S. thermophilus , E. coli , and Klebsiella pneumoniae, and decreases in Agathobacter rectalis , Anaerobutyricum hallii , Dorea_A longicatena, Fusicatenibacter saccharivorans, and Roseburia inulinivorans ; reversed changes in Copromonas sp900066785 and Ruminococcus_D bicirculans ; and late increases in Agathobaculum butyriciproducens and Dysosmobacter butyriciproducens . Most changes did not differ significantly by surgical type or patient gender. Conclusions: Our findings indicate temporal changes in metabolites and microbiome following bariatric surgery, warranting further research on these changes and their link to long-term health outcomes.
Abstract 049: Ultra-processed food consumption and MRI-based carotid plaque characteristics: results from the ARIC study
Introduction: Ultra-processed food and beverage (UPF) consumption has been linked with several adverse cardiovascular outcomes, yet its association with detailed characterization of carotid atherosclerosis remains less explored. Objectives: To examine cross-sectional associations between UPF consumption and carotid artery plaque measurements assessed by magnetic resonance imaging (MRI). Methods: A total of 895 white participants (mean age 71 years, 54% female) from the Carotid MRI visit (2004-2005) were stratified sampled from the Atherosclerosis Risk in Communities (ARIC) study and were included in the analysis. Dietary intake was assessed using a food frequency questionnaire, with food processing levels categorized according to the NOVA classification. Carotid artery imaging was performed using MRI and analyzed with semiautomated software. Weighted multivariable linear and logistic regression models were used to assess the associations between quartiles of UPF consumption and standardized plaque measurements or lipid core presence, adjusting for sociodemographic and lifestyle factors. Results: Higher UPF consumption was positively associated with total wall volume [beta-coefficient (β) = 0.28, 95% CI: 0.08-0.48], total lipid core volume (β = 0.53, 95% CI: 0.16-0.90), maximum segmental wall thickness (β = 0.23, 95% CI: 0.02, 0.44), and maximum lipid core area (β = 0.48, 95% CI: 0.11-0.85). UPF consumption was not significantly associated with the presence of lipid core ( Figure ). Conclusion: Higher intake of UPFs was associated with a greater burden of atherosclerotic plaque in the carotid artery. Dietary modifications to minimize UPFs should be considered to prevent vascular changes and future systemic vascular diseases.
Enhancing patient-centered care: Evaluating quality of life in type 2 diabetes management
Aims To evaluate quality of life (QoL) in patients with type 2 diabetes mellitus (T2DM). Methods A cross-sectional study included 151 T2DM patients at the Clinical Centre of Montenegro. The Ferrans and Powers Quality of Life Index (QLI), validated for the Montenegrin population, assessed QoL across five domains. Participants rated items on a Likert scale from 1 (very dissatisfied) to 5 (very satisfied). Data were analysed using SPSS version 22. Results The cohort included 51% women, with a mean age of 60.05 ± 11.63 years. Of the patients, 42% had diabetes for over a decade, and 64% had no additional health conditions. Overall, patients reported satisfactory QoL, especially in self-care and glucose management, though dissatisfaction was high regarding sexual life. Emotional support from family, housing, and friendships significantly contributed to life satisfaction, while financial concerns and job dissatisfaction were common. QoL showed no significant gender differences but declined with age and was notably lower in patients with comorbidities. Conclusion Patients with T2DM report generally satisfactory QoL, with notable concerns in socio-economic and health-related areas. Routine QoL assessments in clinical practice can improve communication, aid in early complication detection, and enable timely interventions to enhance patient outcomes.
Abstract P2125: Association of Gender with Self-reported Physical Activity Among Younger Persons After a Myocardial Infarction
Introduction: Recreational physical activity (PA) is cardio-protective but often underutilized, and women in the general population engage less in leisure PA compared to men. Whether this disparity extends to individuals after a myocardial infarction (MI) in midlife, a high-risk group that may especially benefit from PA promotion, is unknown. Methods: We recruited women and men ≤ 61 years of age who were hospitalized for MI in the previous 8 months in metropolitan Atlanta, balancing the number by sex. We evaluated leisure PA behavior with the validated, self-reported Baecke Habitual Physical Activity Questionnaire. We constructed a linear mixed-effect model to estimate the association between gender and the PA leisure score, then adjusted sequentially for demographics (age, race, income, education), obesity status, and heart failure ( Table ). Results: Our sample included 619 participants (46% women, 59% black) with mean age 51 years (SD: 7). On a Likert scale of 1 (least) to 5 (most), the mean (SD) PA leisure score was lower among women (2.4 (0.5)) compared to men (2.5 (0.5); p=<0.05). Walking was the most common leisure PA activity reported by both groups. In all models, we found that there was a statistically significantly lower PA leisure score for women compared to men ( Table ). More men than women reported they walked (31% vs. 22%), biked (8% vs. 2%), or played sports (10% vs. 2%) often or always during leisure time. Results remained similar when patients with poor functional capacity (defined using the Duke Activity Score Index) were excluded. Discussion: Women reported significantly lower leisure PA as compared to men. Interventions and education about promoting PA, especially walking, should be considered in this patient population.
Abstract P2157: Social Determinants of Health and Health Behaviors Among Adults with Multiple Chronic Diseases: The LINKED-HEARTS Program
Introduction: Social determinants of health (SDoH) contribute to cardiovascular outcomes and health disparities. Despite a recent focus on structural drivers of health disparities, the associations between SDoH and health behaviors among adults with multiple chronic diseases remains understudied. Objectives: To examine the association between SDoH and health behaviors in the “LINKED-HEARTS” (a Cardiometabolic Health Program LINKED with Community Health WorkErs and Mobile HeAlth TelemonitoRing To reduce Health DisparitieS) Program. Method: We conducted a cross-sectional analysis using baseline data from the “LINKED-HEARTS” Program, an ongoing cluster-randomized controlled trial of adults with uncontrolled hypertension in addition to diabetes or chronic kidney disease (CKD). The outcome was adherence to three or more cardiometabolic health promoting behaviors: healthy diet (Mediterranean Eating Pattern for Americans scale), moderate or vigorous physical activity (≥ 150 minutes/week), non-smoking, and recommended sleep duration (7–9 hours/night). The exposures were SDoH ( Table ). To examine the association between SDoH and health behaviors (> 3 vs. ≥ 3), we conducted a multivariable logistic regression analysis, adjusting for demographics (age, sex, race/ethnicity), marital status, and general health status. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated. Results: The study included 214 adults with hypertension in addition to diabetes or CKD, with a mean age of 64 years (±SD 12.3), of whom 61.1% were female, 52.8% were non-Hispanic Black adults. Of the adults included, only 28% (n=60) reported engaging in three or more health behaviors. Participants who reported experiencing any financial strain were 64% less likely to adhere to three or more health behaviors (aOR 0.36, 95% CI: 0.14-0.96) compared to those who never experienced financial strain ( Table ). Additionally, those who reported frequent social isolation were 56% less likely to adhere to ≥ 3 health behaviors (aOR 0.44, 95% CI: 0.21-0.93) compared to those who reported no feelings of social isolation. Conclusion: Financial strain and social isolation were associated with fewer health behaviors among adults with multiple chronic diseases. These findings indicate the need to continually assess and address SDoH in interventions aimed at improving lifestyle behaviors and cardiovascular health outcomes in high-risk populations.
Abstract P2112: Longitudinal Associations Between the Microbiome and Glucose Homeostasis Over Time in The Microbiome and Insulin Longitudinal Evaluation Study (MILES)
Type 2 diabetes (T2D) is associated with both relative, and absolute, changes in the microbes colonizing the digestive tract (the gut microbiome). However, T2D-related pathogenesis predates diagnosis by up to decade, and few studies have examined whether gut microbiome differences also relate to the various components of insulin and glucose homeostasis that contribute to onset. The goal of this study was to conduct such an investigation using repeated stool samples from 114 non-Hispanic White and 44 African American individuals without T2D participating in MILES (mean age 60, 67% female), leveraging MILES’ longitudinal design to minimize the influence of temporary microbiome fluctuations. Participants underwent three oral glucose tolerance test, spaced ~ one year apart, from which fasting glucose (FG) and insulin, and C-peptide were derived, and insulin sensitivity, insulin secretion, and disposition index (DI) calculated. Microbes with a prevalence >= 30% were included in multi-level linear models which examined associations of overall composition (diversity, evenness and richness), as well as the relative abundance of individual species, with each of the six glucose measures. Models used centered log-ratio transformed data, included a correction for bias due to compositional effects, and controled for sequencing depth, batch, demographics, and medication useage. P-values equivalent to a<.05 after an FDR correction for the number of microbes (N=130) were considered significant. FG was associated with lower (Shannon index; b=-0.19(0.08),P=.03) and evenness (Inverse Simpson; b=-0.02(0.01),P=.02), with a similar trend inverse association seen for DI (diversity: b=-0.19(0.08),P=.03; evenness: b=0.02(0.01),P=.02). These two indices were also associated with the relative abundance of seven microbes; both FG (logFC=0.46,P=9.9*10-4) and DI (logFC=-0.54,P=1.1*10-4) were associated with Ruthenibacterium lactatiformans, FG only with Anaerotruncus colihominis (logFC=1.31,P=1.22*10-4) and Flavonifractor plautii (logFC=0.68,P=8.3*10-4), and DI only with Adlercreutzia equolifaciens (logFC =-0.55, P=4.6*10-5 ), Asaccharobacter celatus (logFC=-0.38,P=6.6*10-4), Enterorhabdus caecimuris (lofFG=-0.82,P=8.1*10-4), Gordonibacter pamelaeae (logFC=-0.49,P=5.9*10-4), and Limnochorda Pilosa (logFC=-0.40,P=1.2*10-3). The roles of these microbes in lactate, equol, butyrate, and tryptophan production point to the gut microbiome as a mediator of diet-T2D associations.
Metabolic versatility and nitrate reduction pathways of a new thermophilic bacterium of the Deferrivibrionaceae: Deferrivibrio metallireducens sp. nov isolated from hot sediments of Vulcano Island, Italy
A novel thermophilic (optimum growth temperature ~ 60 °C) anaerobic Gram-negative bacterium, designated strain V6Fe1T, was isolated from sediments heated by the hydrothermal circulation of the Aeolian Islands (Vulcano, Italy) on the seafloor. Strain V6Fe1T belongs to the recently described family Deferrivibrionaceae in the phylum Deferribacterota. It grows chemoorganotrophically by fermentation of proteinaceous substrates and organic acids or by respiration of organic compounds using fumarate, nitrate, Fe(III), S°, and Mn(IV) as electron acceptors. The strain V6Fe1T can also grow chemolithoautotrophically using H2 as an electron donor and nitrate, nitrous oxide, Fe(III), Mn(IV), or sulfur as an electron acceptor. Stable isotope probing showed that V6Fe1T performs denitrification with nitrate reduction to dinitrogen and Dissimilatory Nitrate Reduction to Ammonium (DNRA). Culture experiments with RT-qPCR analysis of target genes revealed that strain V6Fe1T performs DNRA with the nitrite reductase formate-dependent NrfA and denitrification with an Hcp protein and other redox partners yet to be identified. Genomic analysis and experimental data suggest that strain V6Fe1T performs autotrophic carbon fixation via the recently discovered reversed oxidative TCA cycle (roTCA cycle). Based on genomic (ANI) and phenotypic properties, strain V6Fe1T ( = DSM 27501T = JCM 39088T) is proposed to be the type strain of a novel species named Deferrivibrio metallireducens.
Abstract P2140: Changes in Cardiovascular Health in Midlife Following a Pregnancy Complicated by Preeclampsia and/or Placental Maternal Vascular Malperfusion Lesions
Introduction: Preeclampsia (PE) with or without evidence of maternal vascular malperfusion (MVM) lesions in the placenta is a key risk factor for future maternal cerebrovascular and cardiovascular disease, and midlife is a crucial time during which subclinical disease may be developing. However, the trajectory of traditional risk factors in midlife following PE and/or MVM is not clear. We aimed to identify whether differential midlife changes in cardiovascular health were evident in those with or without PE and/or MVM to inform future intervention strategies. Methods: Participants (38.3±6.1 years, 33% racial/ethnic minority) with and without PE and/or MVM (-PE/-MVM, n=67; -PE/+MVM, n=37; +PE/-MVM, n=9; +PE/+MVM, n=11) were assessed 9.2±0.9 and 14.5±0.8 years following the index pregnancy. Cardiovascular health scores (0-100, higher is healthier) were generated using seven of the Life’s Essential 8 components: diet, smoking, sleep duration, body mass index (BMI), blood pressure, lipids, and glucose. Linear mixed effects regression assessed changes across time between PE/MVM exposure groups. Results: No significant differences in change across time were found between PE/MVM exposure groups for the overall cardiovascular health score (p=0.09), but the +PE/+MVM group demonstrated significantly more deterioration in component scores for diet, smoking, and lipids compared to the -PE/-MVM group ( Table ). The +PE/-MVM group also demonstrated significantly worsening diet scores, while the -PE/+MVM group showed a significant improvement in blood glucose scores compared to the -PE/-MVM group. Conclusions: Those with PE, both with and without MVM lesions, appear to demonstrate a worsening cardiovascular health profile in middle age driven by modifiable components including diet, smoking, and cholesterol. Interventions to encourage healthy behaviors and lipid control should be considered in this time frame, as they may be impactful to prevent disease progression.
Abstract 024: Should Women Have Lower Blood pressure Goals Than Men? Sex Differences in Blood Pressure and Cardiovascular Disease in the UK Biobank
Background: Recent studies show that the risk of cardiovascular disease (CVD) increases from a lower level of systolic blood pressure (SBP) in women than men, and increases at a steeper rate. This has led to a suggestion for sex-based SBP thresholds for hypertension diagnosis. Aims: To investigate sex differences in the association of SBP and incident CVD. Methods: The UK Biobank recruited over 500,000 participants aged 40-70 years between 2006 and 2010, with follow up until May-October 2022. The present study included 420,649 participants with no prior history of CVD. The primary outcome was incident CVD, defined as a first diagnosis of fatal or non-fatal coronary heart disease (CHD) or stroke. Age-adjusted sex-specific risks, relative risks and risk differences relating SBP to CVD were estimated using Poisson and Cox regression. Results: The mean (SD) age among 235,556 (56.0%) women was 56.1 (8.0) years and among 185,093 men was 56.1 (8.2) years. Over a mean follow-up of 13.2 years, there were 28,628 CVD events. CVD risks across SBP levels showed a “J-shape”, and were higher in men than women at all BP levels. The lowest risk for CVD among women was at SBP 100-<105 mmHg (15.6 [95% CI 11.8-23.1] events per 10,000 person-years) and SBP 110-<115 among men (47.2 [95% CI 41.8-53.0]). Compared with SBP 100-<110 mmHg, sex-specific relative risks at SBP above 120 mmHg were higher in women than men, but risk differences were higher in men than women at all levels of SBP. Furthermore, compared to men at SBP100-<110 mmHg (i.e. the men with least risk), risks in women were lower at all levels of SBP below 170 mmHg, and the relative risk at the highest SBP (≥180 mmHg) in women (1.3 [95% CI 1.1-1.5]) remained lower than men (2.4 [95% CI 2.0-2.7]) at the same SBP level. Conclusions: Consideration of the risks and sex-combined analyses do not support that women should have lower BP thresholds than men.
Abstract MP38: The Implications of COVID-19 Pandemic for The Black-White Diabetes Mortality Gap: Has The Disparity’s Dynamic Changed?
Background: Previous studies have investigated racial disparities in diabetes mellitus, including the existence of diabetes mortality gap between African Americans and whites. However, it remains unknown whether the coronavirus SARS-CoV-2 (COVID-19) pandemic changed the magnitude of earlier documented Black-White gap in diabetes mortality. Study Objective: To investigate the dynamic change in the magnitude of the Black-White diabetes mortality gap in relation to COVID-19 pandemic. Methods: Diabetes mortality rates in relation to race, adjusting for major covariates, were analyzed using the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database on underlying causes of death in the United States. Diabetes mortality was analyzed for the three years preceding the pandemic (2017-2019; defined as pre-COVID era diabetes mortality) and the first three years of the pandemic (March 2020 to February 2023; defined as COVID-era diabetes mortality). Diabetes deaths were identified in the CDC WONDER database using the ICD-10 codes E10-E11. To adjust for multiple covariates, general linear modeling (GLM) analysis was conducted (SAS, ver. 9.4). Results: Both African Americans and whites experienced an increase in diabetes mortality rates from the pre-COVID-era to COVID-era period: from 11.0/100,000 to 15.1/100,000 (crude mortality rates) and from 12.4/100,000 to 15.9/100,000 age-adjusted mortality rates) in African Americans; from 10.9/100,000 to 14.1/100,000 (crude mortality rates) and from 8.3/100,000 to 10.3/100,000 age-adjusted mortality rates) in whites. However, when comparing the magnitude of the change in diabetes mortality rates between the pre-COVID and COVID-era periods, the multivariate-adjusted diabetes mortality rate increase in African Americans was 4.26/100,000 greater than in whites (p=0.028). Conclusions: COVID-19 pandemic had a statistically significant impact on the magnitude of racial gap in diabetes mortality. Further research investigating the underlying mechanisms of these findings is warranted.
Association of expenditure on ultra-processed foods and beverages and anthropometric indicators in Mexican children: A longitudinal study
The prevalence of obesity in Mexico has been rising dramatically from school age onward. The high consumption of ultra-processed food has been identified as a contributing factor. We explored the longitudinal association between household expenditure on ultra-processed foods and beverages (UPF) and changes in anthropometric indicators of obesity among Mexican children aged 5 to 10 years in 2002. We used data from the Mexican Family Life Survey (MxFLS), a longitudinal, probabilistic, multipurpose, and representative survey of the Mexican population conducted in 2002, which reports household expenditure on the main food and beverage groups, as well as anthropometric indicators and sociodemographic characteristics of household members, across three rounds surveyed between 2002 and 2012 (n = 2,677). The exposure variable was UPF expenditure, categorized into tertiles, and the outcomes studied were BMI z-score for age, waist circumference, and waist-to-height ratio. We estimated random effects models and generalized estimating equation models for longitudinal data. Using an interaction term between tertiles of UPF expenditure and survey rounds, we found that household membership in the middle and upper tertiles of UPF expenditure in 2002 was associated with an increase in waist circumference and waist-to-height ratio, particularly after three years of follow-up. For instance, the middle tertile of UPF expenditure was associated with an increase of 4.43 centimeters in waist circumference compared to the low tertile of UPF expenditure after three years of follow-up (p < 0.01). Our findings suggest that higher UPF expenditure in households with children aged 5–10 years drives abdominal obesity in the short and medium term, underscoring the need for comprehensive policies to limit the purchase and consumption of UPF from an early age.
Abstract P3016: Blood Pressure Measures are Not Associated with Early Metabolic Imbalance: The U.S. National Health and Nutrition Examination Survey
Introduction: Early metabolic imbalance (EMI) is a hidden condition prevalent in teens and young adults. It is characterized by compensated insulin resistance, where fasting glucose, triglycerides, HDL cholesterol, and hemoglobin A1c are all within normal limits (Fig. 1). Thus, EMI does not meet the criteria for prediabetes or metabolic syndrome and eludes risk screening for type 2 diabetes and CVD. In addition to hyperinsulinemia, EMI is associated with chronic inflammation, oxidative stress, and hypoxia. The overproduction of nitric oxide from high circulating insulin may keep blood pressure low. Therefore, we investigated the association of blood pressure with EMI. Hypothesis: In EMI, blood pressure measures are lower or unchanged compared to healthy balanced metabolism. Methods: The fasting subsample from the 2015-2018 U.S. National Health&Nutrition Examination Survey was analyzed: 6,227 observations representing 270.2 million people in the U.S. ages 12 and up. Population-weighted multinomial logistic regression was performed using Stata v18.5. The outcome variable was cardiometabolic health, categorized into 1 of 4 groups: healthy balanced metabolism, EMI, prediabetes/dyslipidemia (PD), or type 2 diabetes/ASCVD (Fig. 1). EMI was defined as elevated fasting insulin with normal glucose, A1c, TG and HDL, using prognostic insulin cutpoints from timeROC analysis of the CARDIA cohort. The 1° exposure was systolic BP. Diastolic BP, mean arterial pressure, and pulse pressure were 2° exposures. The adjusted covariates were age, male gender, race/ethnicity, waist circumference, sedentary behavior, low-salt diet, and BP medications. For measuring association, the effect size was relative risk ratio with 95% confidence interval and p-value. Results: After adjusting for confounders, no significant change in systolic blood pressure was observed between the EMI and balanced metabolism groups (Table 1). By contrast, the PD and diabetes/ASCVD groups were associated with increases in systolic BP. Nearly identical results were obtained when diastolic BP, mean arterial pressure, or pulse pressure was substituted for systolic BP. Age emerged as the most influential confounder for the association between blood pressure and EMI. Conclusion: In EMI, blood pressure measures were unchanged compared with healthy balanced metabolism. Higher blood pressure values or taking BP medications may serve as a marker to help differentiate other cardiometabolic health categories from EMI.
Abstract P2044: Racial discrimination, preeclampsia and hypertension status 12-15 years after pregnancy
Introduction: Experiences of discrimination are associated with increased risk of preeclampsia during pregnancy and cardiovascular disease later in life. We examined the association of discrimination with hypertension in the years after pregnancy. Methods: Participants (n=580) were recruited at Magee-Womens Hospital (Pittsburgh PA) with births in 2008-2012 and questionnaires (Everyday Discrimination Scale [EDS], health history, demographics) completed in 2024 (mean age 43 years). Prior preeclampsia was abstracted from medical records. Self-identified race was Black (n=150) compared to a composite of non-Black (White [n=415], Latina [n=6] or Asian [n=9]) due to small numbers of some groups. Outcome was self-reported hypertension, validated in a subset (n=171) with measured blood pressure following a standardized protocol (positive and negative predictive values were 91% and 59%, respectively). Logistic models estimated the association between discrimination and hypertension after pregnancy adjusted for age, education, preeclampsia, and body mass index; results were stratified by race. Results: Black women were younger (39.2 ±6 vs. 43.6 ±6), more likely to have a high school education or less (36.9% vs. 12.9%), more likely to report current hypertension (31.1% vs. 16.7%, p=0.0002) and had higher discrimination scores (22.5 ±10.9 vs. 17.7 ±7.2, p<0.001) than non-Black women. Black women indicated the main reason for discrimination was race or ancestry (69.4% vs. 6.8%; p <0.001); non-Black women reported the main reason was gender (32.6% vs. 18.0%; p= 0.007). Each unit increase in discrimination was associated with 2.4% increased odds of hypertension, adjusted for age, education, and preeclampsia (aOR 1.024, 95% CI 1.0, 1.049, p=0.05), and BMI (aOR 1.029, 95% CI 0.99, 1.06). The magnitude of this association was similar to that of age (aOR 1.06, 95% CI 1.02, 1.11 per year). The association between discrimination and hypertension was restricted to Black women (aOR 1.027, 95% CI 0.99, 1.06; p=0.130) and was not detected in non-Black women (aOR 0.995, 95% CI 0.96, 1.04; p=0.816). Discussion: Black women reported higher discrimination in the years after pregnancy that was related to higher rates of hypertension, independent of prior preeclampsia and other risk factors. It is imperative to understand the biological implications of discrimination, particularly during pregnancy, which may provide a unique view of the impacts of racism on cardiovascular health.
Neutrophil CRACR2A Promotes Neutrophil Recruitment in Sterile Inflammation and Ischemic Stroke
BACKGROUND: Ca 2+ release-activated Ca 2+ channel regulator 2A (CRACR2A) has been linked to immunodeficiency attributable to T-cell dysfunction in humans. We discovered that neutrophil CRACR2A promotes neutrophil adhesive and migratory functions by facilitating Ca 2+ mobilization and β2 integrin activation. METHODS: Myeloid-specific Cracr2a conditional knockout mice and intravital microscopy were used to investigate the physiologic role of neutrophil Cracr2a in neutrophil recruitment in vascular inflammation. Cracr2a-deficient neutrophils or dHL-60 (differentiated human promyelocytic leukemia) cells and Cracr2a-derived peptides were used in flow cytometry, immunoprecipitation, cytosolic Ca 2+ mobilization, and flow chamber assays to elucidate the molecular mechanism. Four-dimensional confocal intravital microscopy of mice after focal brain ischemia and single neutrophil behavioral analysis demonstrated the pathologic role of neutrophil Cracr2a in brain damage. RESULTS: Compared with wild-type control mice, Cracr2a conditional knockout mice exhibited significantly reduced adhesion, crawling, and transmigration of neutrophils on ear and cremaster venules in tumor necrosis factor–α–induced sterile inflammation. Neutrophil Cracr2a rapidly interacts with Stim1 (stromal interaction molecule 1) after agonist stimulation and facilitates Ca 2+ mobilization, increasing the ligand-binding function of β2 integrin. Our findings in Cracr2a-deficient mouse neutrophils are recapitulated in dHL-60 cells, in which CRACR2A is deleted by CRISPR/Cas9. Furthermore, overexpression of CRACR2A in CRACR2A KO dHL-60 cells restores normal function. Using a series of peptides covering the coiled-coil region of Cracr2a, we identified a palmitoylated 20-mer that blocks Stim1-Cracr2a interaction. Treating neutrophils with this 20-mer inhibits Ca 2+ mobilization and β2 integrin activation after agonist stimulation, reducing neutrophil recruitment to an activated endothelial cell monolayer under venous shear stress and to ear venules in tumor necrosis factor–α–challenged mice. Cerebral 4-dimensional intravital microscopy of mice after focal brain ischemia revealed that neutrophil Cracr2a enhances the emergence of highly migratory neutrophils by increasing the surface level of αMβ2 integrin, thereby facilitating neutrophil infiltration into brain tissue and exacerbating brain injury. CONCLUSIONS: Our results demonstrate that neutrophil CRACR2A promotes neutrophil recruitment to sites of sterile inflammation, such as ischemic stroke. Blocking the STIM1–CRACR2A interaction may be a novel therapeutic strategy to mitigate inflammation and consequent tissue injury.
Psychological stress associated with prognostic uncertainties in recently diagnosed Parkinson’s disease patients: A qualitative study
Background Parkinson’s disease (PD) is a common neurodegenerative disorder that negatively impacts thousands of patients in Canada. The unexpected nature of PD is associated with a decline in mental health. The highest level of psychological stress occurs during the early years following the diagnosis. Objectives To understand the psychological stress associated with prognostic uncertainties in recently diagnosed PD patients, uncover the gaps in the current support systems, and recommend areas for improvement in the support services that aim to decrease the psychological stress associated with receiving the PD diagnosis. Methods An exploratory qualitative study was conducted using semi-structured interviews with 13 PD patients diagnosed for more than 6 months and less than 5 years. Participants were recruited from the Toronto Western Hospital Movement Disorders Clinic, Toronto, Ontario, Canada until saturation of key themes was reached. Results Five major themes were identified capturing the lived experiences of PD patients following diagnosis: 1) the circumstances of receiving the diagnosis and its psychological impact on PD patients, 2) the impact of intrapersonal factors on the PD journey, 3) the role of social relationships in PD patient’s life, 4) the interaction of PD patients with different elements of the healthcare system, and 5) support services available for recently diagnosed PD patients. Conclusions This study uncovers the psychological burden faced by PD patients due to prognostic uncertainties and insufficient support systems. It emphasizes the importance of a patient-centered approach for improving their quality of life and healthcare experiences through personalized support services.
Abstract P3010: Association of sedentary behavior with cardiovascular risk biomarkers in a population with overweight or obesity: the PREDIMED-Plus trial
Background: Sedentary behavior is linked to a higher risk of cardiovascular disease (CVD). Examining its association with CVD-related biomarkers can help understand the underlying mechanisms. Methods: We studied 98 participants (55-75 years, BMI 27-40 kg/m2, with metabolic syndrome) in PREDIMED-Plus, a multicenter randomized trial in Spain for the primary prevention of CVD. Accelerometer was used to measure physical activity (PA) at baseline and at least once during follow-up at years 3 and 5. Blood samples were collected at each time point to measure CVD-related biomarkers: propeptide of procollagen type I (PICP, cardiac fibrosis), high-sensitivity (hs) troponin T (hsTnT, myocardial damage), hs C-reactive protein (hsCRP, inflammation), 3-nitrotyrosine (3-NT, oxidative stress), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP, cardiac overload). Sedentary time was assessed as inactive time (< 1.5 METs in waking time). Using isotemporal substitution, we analyzed the impact of replacing 30-min sedentary time per day with low-intensity PA (LPA, 1.5–3 METs), moderate to vigorous PA (MVPA, > 3 METs) and time in bed (time difference between going to bed and leaving) on log-transformed biomarkers cross-sectionally and longitudinally. Results: At baseline, year 3 and 5, 98, 72 and 65 participants had valid data. Participants averaged 65 years old (SD 4.9), BMI 32.2 kg/m2 (SD 3.3), and 40% were female. Cross-sectionally, replacing 30-min sedentary time with LPA, MVPA, or time in bed had no significant effect on biomarkers. After 5 years, reallocating baseline 30-min of sedentary time per day with LPA or MVPA was associated with a lower hs-TnT level compared to baseline (-0.05, 95% CI -0.08, -0.02; -0.01, 95% CI -0.06, 0.04, respectively). Substituting 30-min sedentary time with LPA or MVPA showed nonsignificant reductions in NT-proBNP (-0.04, 95% CI -0.12, 0.04; -0.04, 95% CI -0.16, 0.09, respectively), but not a consistent impact on other biomarkers (Table). Conclusion: In overweight/obese individuals, prolonged sedentary time, when compared to engaging in PA, was associated with unfavorable levels of hs-TnT over 5 years, but not with other CVD risk biomarkers. Further research is warranted to confirm these results in other populations.
Abstract P1154: Childhood Parental Incarceration, Cardiovascular Health, and Subclinical CVD in Young Adults: the Future of Families and Cardiovascular Health Among Young Adults (FF-CHAYA) Study
Background: Few studies have prospectively examined associations of parental incarceration during childhood with offspring cardiovascular health (CVH). We assessed: (1) associations between parental incarceration and subclinical cardiovascular disease (subCVD) in young adulthood, and (2) whether associations were mediated by CVH. Methods: Data are from the FF-CHAYA Study, an ancillary study of the Future of Families and Child Wellbeing Study. Incarceration of mothers and fathers as well as the number of times the father was incarcerated (never, once, ≥2 times) was collected via interviews at birth and ages 1, 5, and 9y. Carotid intima-media thickness (IMT) was measured at age 22 using B-mode ultrasound and analyzed as a continuous or dichotomous (high IMT ≥75 th percentile) outcome. In linear and logistic regression models, covariates included age, sex, race, mother’s poverty level, young adult’s arrest history, and CVH (Life’s Essential 8 score at age 22). Attenuation by adjustment and formal mediation analyses were performed to understand how much of the association between parental incarceration and subCVD was explained by CVH. Results: Among 1,372 participants, 54% identified as female, 51% as Black, 27% as Hispanic, 17% as non-Hispanic White, and 4% as Other or Mixed; 278 (20.3%) experienced incarceration of a parent prior to age 9y. Most parental incarceration was paternal (n=222; 79.9%); 106 (47.7%) reported their father was incarcerated once and 116 (52.3%) reported their father was incarcerated ≥2 times. Parental incarceration was associated with higher mean-mean (Model 2: b= 0.86; 95% CI: 0.05, 1.67) and mean-max cIMT (b=0.94; 95% CI: 0.06, 1.82) but was attenuated and nonsignificant after adjustment for CVH (Model 3). There was significant mediation by CVH (22.3% and 25.7% for mean-mean and mean-max cIMT, respectively, P < 0.05). Paternal incarceration ≥2 or more times (versus never) was associated with high mean-mean (OR=1.66; 95% CI: 1.01, 2.73) and mean-max (OR=2.05; 95% CI: 1.25, 3.36) IMT. Conclusions: In these young adults, the association between parental incarceration and subCVD was partially mediated by CVH, suggesting that promotion of CVH earlier in life may lessen future CVD risk, although other pathways may also be important. Further, a greater number of paternal incarcerations was associated with developing high IMT suggesting that targeted interventions may help mitigate future CVD risk among this vulnerable population.
Abstract P2046: Gestational Hypertension in the Latine Population by Race, Ancestry, and Nativity: An Intersectional-MAIHDA Approach
Objectives: Gestational hypertension (GH), hypertension during pregnancy, is associated with greater risk of cardiovascular disease later in life. Aggregating Latine populations may mask important heterogeneity in the burden of this adverse pregnancy outcome. Differences have been examined by nativity, but few have accounted for potential heterogeneity by race or ancestry, and none have accounted for all three simultaneously. Thus, the purpose of this research is to use a novel intersectional modeling approach to estimate the prevalence of GH among Latine birthing people by race, nativity, and ancestry. Methods: 2020 Natality Public Use Data of 863,907 Latine birthing people’s live births were analyzed. Data on GH (yes/no), birthing person’s nativity (U.S. Born/Not U.S. Born), race (White, Black, Native American/Native Alaskan [Native A/A], Asian, Native Hawaiian/Pacific Islander [NOPI], and more than 1 race) and ancestry (Mexican American, Puerto Rican, Dominican, Cuban, Central South American [C/S American] and Other) were extracted from birth certificates. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA) was used to examine variation in GH across strata of nativity, race, and ancestry. This modeling approach allows for assessment of intersectionality in a way that maximizes statistical efficiency. Results: Mean GH prevalence among Latine birthing people was 7.1%. Black birthing people were more likely to develop GH than White birthing people, and non-U.S. born individuals were less likely to develop GH than U.S. born (Table 1). Puerto Rican, Dominican, and Cuban birthing people were more likely to develop GH than Mexican birthing people (Table 1). I-MAIHDA produced 72 nativity-race-ancestry strata, ranging in size from 10 to 278,584 birthing people (mean: 11,998.7). Birthing people with the lowest predicted probability of GH were predominately non-U.S. C/S Americans, while those with the highest predicted probability were predominately Black and Indigenous U.S. Born Puerto Rican and Dominican (Table 2). Approximately 14% of the between-stratum variance in GH was explained by nativity-race-ancestry intersectional effects (versus the main additive effects of each). Conclusion: We found evidence of variation in GH prevalence within the Latine birthing population. Future research should consider which factors drive heterogeneity in GH prevalence among Latine birthing people.
Improvement of RT-DETR model for ground glass pulmonary nodule detection
Currently, pulmonary nodules detection work mostly focus on recognition and diagnosis of solid nodules. However, ground glass nodules have higher probability of malignancy, posing greater identification challenges and thus greater value for detection. To achieve rapid and accurate detection of ground glass nodules. This article proposed an algorithm based on RT-DETR model with the following enhancement: 1) optimize the backbone network with FCGE blocks to increase the detection accuracy of small-sized and blurred edge nodules; 2) replace the AIFI module with HiLo-AIFI module to reduce redundant computation and improve the detection accuracy of pure ground glass pulmonary nodules and mixed ground glass pulmonary nodules; 3) replace the DGAK module with CCFF module to address the issue of capturing complex features and recognition of irregularly shaped ground glass nodules. To obtain a more lightweight model, modules are designed for smaller number of parameters and higher computational efficiency. Model are tested on mixed dataset composed of LIDC-IDRI data and clinical data from cooperating hospitals. Compared to the baseline model, it shows an average precision improvement (mAP50/mAP50:95) of 2.1% and 1.7%, with a reduction parameters by 5.2 million. On a specialized dataset containing both pure and mixed ground glass nodules, our model outperformed the baseline model in all evaluation metrics. In general, the model proposed in this paper achieves improvement on lightweightness and detection accuracy. However, the model exhibits poor noise resistance and robustness, suggesting optimization in future work.