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Abstract P3169: Significant Social Determinants of Health Disparities Exist Between Rural and Non-rural Residents with Elevated Blood Pressure: Findings from the LINKED-BP Study
Background: Rural populations face multiple challenges related to social determinants of health (SDOH). However, the extent of these disparities between rural and non-rural residing people with elevated blood pressure or untreated stage 1 hypertension is not well described. Further understanding of these disparities in the context of a hypertension prevention program focused on addressing SDOH that may contribute to the development of hypertension may inform targeted interventions. Objective: To examine differences in SDOH between rural and non-rural residents with elevated blood pressure or untreated stage 1 hypertension and identify areas for targeted interventions within the context of a blood pressure management program. Methods: This cross-sectional study analyzed baseline data from the LINKED-BP (Home Blood Pressure Telemonitoring Linked with Community Health Workers to Improve Blood Pressure) Program. SDOH were assessed using standardized questionnaires covering education, income, housing, food security, transportation, utilities, and social support. Rurality was determined based on zip code. Chi-square tests for categorical variables and Kruskal-Wallis tests for continuous variables were used for comparisons between rural and non-rural groups. Results: The study included 308 adults (127 rural, 181 non-rural) with known ZIP codes. People residing in rural areas had lower educational attainment (25.2% vs 1.1% with less than high school education, P<0.001) and lower income (40.2% vs 6.1% earning ≤$39,999 annually, P<0.001) compared to non-rural residents. Food insecurity (24.4% vs 5.0%, P<0.001) and transportation needs (19.7% vs 3.9%, P<0.001) were more prevalent in rural areas. Housing insecurity was higher in rural areas but was not statistically significant (5.5% vs 1.7%, P=0.060). No differences were found in housing conditions, utility needs, or social/emotional support. Conclusions: Significant SDOH disparities exist between rural and non-rural populations particularly in education, income, food security, and transportation access. These findings highlight potential challenges in implementing home blood pressure telemonitoring programs in rural areas. Targeted interventions addressing these SDOH factors could enhance the effectiveness of blood pressure management programs in rural communities. Future research should explore whether proactively addressing SDOH disparities in rural communities prevents hypertension and cardiovascular disease.
Abstract P2110: Differences by Race, but not Sex, in Metabolomic Profiles Associated with Red and Processed Meat Consumption in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Introduction: Higher red and processed meat (RPM) consumption is associated with higher cardiometabolic risk. While consumption patterns vary by sex and race in the US population, it is not known whether RPM-associated metabolic signatures differ by sex or race. Methods: We used data from 2,841 women and men of self-reported Black and White race (mean age: 45 years; 45% Black race; 57% women) at the year 20 follow-up (2005-06) of the prospective, U.S.-based CARDIA study, which boasts high-quality, interviewer-administered diet history and well-characterized lifestyle data. Using ultra-high performance liquid chromatography and mass spectrometry, we generated untargeted fasting plasma metabolomics data. We iteratively regressed each of the 7,522 metabolite peaks onto RPM consumption (servings/day, continuous variable), with race- and sex-interactions, and adjustment for multiple comparisons using false discovery rate<0.1 with three covariate-adjusted linear regression models: Minimally-adjusted=age+race+sex+center+education+metabolite batch+energy intake; Lifestyle behavior-adjusted=Minimally-adjusted+smoking status+physical activity+alcohol intake+diet quality, and Maximally-adjusted=Lifestyle behavior-adjusted+anti-hypertensive and lipid-lowering medication use+BMI. We used Mummichog software to identify enriched metabolic pathways with higher activity than expected (Fisher’s Exact Test (FET) p<0.05). We also fit orthogonal partial least squares regression (OPLS-R) models to identify metabolic signatures that distinguished participants by race and sex, with evaluation of principal components via variance explained in RPM consumption. Results: We identified metabolic pathways that were differentially enriched according to race (FET p<0.05; Figure), but not sex. Based on race- and sex-specific OPLS-R models, the full set of metabolite peaks was more strongly associated with RPM consumption among participants of White race (Q 2 :0.25) compared to participants of Black race (Q 2 :0.14). Moreover, metabolite peaks among men (Q 2 :0.098) and women (Q 2 :0.065) were similarly associated with RPM consumption. Conclusions: Metabolic pathway activity differed by race, but not sex, with slightly different strength of association between metabolite peak data and RPM consumption across groups. While we expected differences by metabolic profile reflecting biological sex-related differences, the observed race differences suggest potential environment-related metabolic activity.
Abstract P1078: Association of Poverty with Pharmacy Access in Minnesota
Background: Pharmacy access is important for medication adherence and may be a modifiable factor which could improve health equity in the management of cardiovascular disease risk factors. Methods: We geocoded all MN pharmacies in 2022 and determined the population weighted, mean drive times from each census tract to the nearest pharmacies. Census tracts were stratified by urban and rural status and divided into quartiles by poverty defined as the proportion of families living below the 75% poverty line. Poverty quartiles were characterized by demographic and income data from the 2016-2019 American Community Survey. We evaluated differences in pharmacy access by poverty quartile using one-way ANOVA. Results: In both rural and urban quartiles, the lowest poverty quartile (Q1) was majority white (96% and 83% respectively) with more college graduates (30% and 50% respectively) compared to the highest poverty quartile (Q4, 20% and 31% respectively). Q4 was more racially diverse – rural 88% white, 1% Black, 5% Hispanic; urban 61% white, 18% Black, 10% Asian, 10% Hispanic. Among urban census tracts Q1-Q3 had similar pharmacy drive times (3.3-3.5 min, Table) while Q4 (highest poverty) had a shorter mean drive time (2.8 min) and more pharmacies available within 10 and 15 min drive times compared to Q1 (Table, p<0.01 for all pharmacy access measures). Among rural census tracts, drive time to the nearest pharmacy was shortest in Q1 and Q4. Compared to Q1, rural residents in Q4 had a longer drive to the 2 nd nearest pharmacy (15.5 min vs 13.1 min) and fewer pharmacies within 15 min drive time (2.6 vs 5.9; Table, p<0.01 for all measures). Conclusion: Pharmacy access may be an important factor in low income rural communities. However, restricted pharmacy access did not correlate strongly with under-resourced neighborhoods in urban communities. Barriers to medication access are likely multifactorial and may differ between urban and rural areas
Using natural vegetation succession to evaluate how natural restoration proceeds under different climate in Yunnan, Southwest China
Currently, natural restoration has been widely proposed as the primary method of ecological restoration and has been studied for a long time. However, research on how to quantify the progress of natural restoration in different climate conditions, especially using long-term succession monitoring data combined with habitat quality data across various succession stages, has been scarce. Our study aims to address this issue in Yunnan, southwest China. To quantify the progress of natural restoration under different climates in Yunnan, we introduced an index, the Natural Succession Index. Utilizing topography and meteorological data, we divided the study area into different climate sub-areas using the Two-stage clustering algorithm. We then combined 1703 sets of 30-year succession monitoring data, each with six observations taken at five-year intervals from 1987 to 2017, with habitat quality data from different succession stages (grassland, shrub, and forest) to quantify the Natural Succession Index. Yunnan province was divided into 14 sub-areas, namely C(I to II), M(I to III), W(I to IV), and H(I to IV), each possessing a unique environment. The indices in each sub-area were calculated, with the results showing a specific order: H-I (0.7812) > H-IV (0.7739) > W-I (0.6498) > M-III (0.6356) > H-III (0.6316) > M-II (0.5735) > W-III (0.5644) > W-IV (0.5571) > C-II (0.4778) > W-II (0.3980) > M-I (0.3624) > H-II (0.3375) > C-I (0.2943). The times for natural succession to reach the forest stage vary from 5 to 19 years, which aligns with the order of indices. The stand volumes of vegetation in the forest stage range from 5 m³ to 110 m³, with a higher Natural Succession Index value corresponding to a higher stand volume of vegetation. In the future, the index could be utilized to reallocate investments in natural restoration projects for better returns. Constant vigilance is required in the first five years following the implementation of restoration actions to avoid failure due to calculation errors.
Abstract 056: Exposure to artificial light at night in relation to weight gain and cardiovascular risk among women cancer survivors
Background: Cancer survivors are at high risk for weight gain and cardiovascular disease (CVD) after treatment. Artificial light at night (ALAN) may contribute to elevate risks by disrupting circadian rhythm, affecting hormonal regulation and metabolism. This relationship has not been evaluated in women cancer survivors. Methods: After excluding women with daytime sleep schedules and those with prevalent CVD, 2,401 women (aged 35-74 years) who reported a history of cancer other than non-melanoma skin cancer when they enrolled in the Sister Study (2003-2009) were followed through September 2021 (mean follow-up: 11.8 years). Self-reported indoor ALAN exposure during sleep was categorized as: no light (reference group), small nightlight in the room, light outside the room, and television/light on in the room. Generalized Poisson regression models with a log link and robust standard errors were used to estimate multivariable relative risks (RRs) for weight gain ≥5 kg and a BMI increase ≥10% over follow-up. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident CVD, including myocardial infarction, angina, heart failure, heart bypass surgery, angioplasty, transient ischemic attack, or stroke. Results: At cohort entry, the median time since cancer diagnosis was 9.8 years and 28.6% of participants were obese (BMI ≥30). Any ALAN was associated with weight gain (RR 1.51, 95% CI 1.12-2.03) and BMI increase (RR 1.46, 95% CI 1.02-2.09). Sleeping with a television or light on was positively associated with weight gain (RR 1.83, 95% CI 1.27-2.65, P trend =0.0002), particularly in long-term survivors (>10 years, RR 2.99, 95% CI 1.71-5.23, P trend <0.0001), and with BMI increase (RR 1.89, 95% CI 1.21-2.94, P trend =0.003) over follow-up. These associations persisted after adjusting for sleep duration and quality, dietary patterns, and physical activity. Sleeping with a television or light on was also associated with increased CVD risk (HR 1.61, 95% CI 1.05-2.46, P trend =0.03), with a stronger association among survivors with pre-existing CVD risk factors (diabetes, hypertension, or dyslipidemia) at enrollment (HR 1.90, 95% CI 1.13-3.17, P trend =0.0008). Conclusions: ALAN may contribute to weight gain, higher BMI, and elevated CVD incidence in cancer survivors who are women. ALAN may be a modifiable risk factor for obesity and CVD in this high-risk population. Future studies should include an assessment of daytime light exposure.
Abstract P2153: Correlates of Sleep Health in Women of the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Introduction: The American Heart Association recently added sleep to Life’s Essential 8 key measures for cardiovascular health. As middle age is a period when women’s risk for cardiovascular disease increases, we investigated the contributions of sociodemographic, biological, mental and lifestyle characteristics on sleep health among middle-aged women. Hypothesis: Adverse levels of these characteristics are associated with poorer sleep health and associations will vary by domain of sleep. Methods: We analyzed correlates of sleep health of 567 women using cross-sectional data from the Coronary Artery Risk Development in Young Adults sleep ancillary study at year 35, a prospective cohort study which enrolled Black and White individuals aged 18 to 30 years at baseline (1985-86). Outcomes were sleep regularity index, fragmentation, duration, and sleep percentage determined using the wrist-worn Actiwatch TM accelerometer. Values for each participant were averaged across the number of days they wore the device (min 4, max 7). The following categories of correlates were measured using questionnaires and examinations: sociodemographic (marital status, education, number of people in household, having a bed partner, retirement status); biological (BMI, waist circumference, menopausal symptoms); mental (social support, quality of life, depression, loneliness, social network); lifestyle (physical activity, alcohol use, smoking status). We used linear regression models to generate effect estimates for each of the characteristics and the 4 sleep health outcomes adjusted for age, cardiovascular disease and study center. Given known differences in sleep health by race, we chose a priori to carry out stratified analyses by race. Results: The mean age of participants was 61.3 years (SD= 3.6) and 44.8% were Black. The mean value for sleep percentage was 90.4% (SD=4.5), sleep regularity was 79.7% (SD=11.0), sleep fragmentation was 19.8% (SD =7.4), and sleep duration was 415.8 minutes (SD =59.9). Lifestyle was the only category that was associated with sleep health. Black women who were current or former smokers had less favorable sleep health (Table 1). More physical activity was associated with more favorable sleep health in White women. The characteristics we investigated were not associated with sleep duration. Conclusions: We observed a contribution of lifestyle behaviors with measures of sleep health that reflect sleep regularity and quality.
Abstract 030: The Association of Obesity Measures on the Development and Progression of Coronary Artery Calcium: Insights from the CARDIA Study
Background: Coronary artery calcium (CAC) is a well-established marker of subclinical atherosclerosis and of cardiovascular risk. Identifying modifiable risk factors early in life such as body mass index (BMI) and waist-to-hip ratio (WHR) that predict development and progression of CAC in midlife can guide early intervention to decrease cardiovascular risk. Hypothesis: We hypothesize that higher BMI and WHR in young adulthood is associated with both the presence and progression of CAC 10 years later. Methods: We analyzed participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Study with BMI and WHR measured at Y5 (Ages 23 to 35), and CAC measured between Y15-25 (ages 33 to 55). We used logistic regression models to assess the association between BMI/WHR and the presence of CAC (Agatston score >0) at Y15, and a repeated-measures GEE linear model to assess the association between BMI/WHR and progression of CAC (log Agatston score) from Y15 to Y25. We conducted nested models adjusting for demographic variables (age, sex, race) and cardiovascular risk factors (diabetes, hypertension, smoking status, total cholesterol, lipid-lowering pharmacotherapy use). Results: A total of 2,838 participants had full data on obesity measures and CAC. Patients in higher quartiles of both BMI and WHR at Y5 had higher systolic blood pressures and total cholesterol. For each 5 kg/m 2 higher BMI at Y5, there was an associated increase in the prevalence of CAC>0 at Y15 (i.e., 10 years later) by 28% (OR: 1.28, 95% CI: 1.13 to 1.44, P= 0.001), adjusting for age, sex, and race; however, this association was attenuated after full adjustment (OR: 1.12, 95% CI: 0.98 to 1.29). For each 0.1 increase in WHR at Y5, there was an associated increase in the prevalence of CAC>0 at Y15 by 31% (after full adjustment (OR: 1.31, 95% Ci: 1.01, 1.69). There was an association of change in slope of yearly CAC progression between Y15-25 which increased by 18% for every 5 kg/m 2 higher BMI and by 58% for every 0.1 higher WHR assessed in young adulthood ( Figure ). Conclusion: BMI and WHR measured in young adulthood are both associated with the presence and progression of CAC 10-20 years later; however, WHR may be a stronger predictor of CAC and progression of CAC than BMI.
Perspectives of stakeholders on barriers to COVID-19 protective behaviors adherence and vaccination among Myanmar migrant workers in southern Thailand: A qualitative study
Studies have been conducted on migrant health during the COVID-19 pandemic. However, in-depth information is scarce regarding the barriers to preventing COVID-19 in this vulnerable population. The objective of the study is to explore the barriers to COVID-19 protective behaviors adherence and vaccination among Myanmar migrant workers in Thailand. We conducted an interview-based qualitative study among 7 migrants from Myanmar, 6 Thai employers, and 9 Thai healthcare providers in the cities of Hat Yai and Pattani in Southern Thailand. We recruited participants by purposive sampling. We conducted in-depth interviews in-person or via telephone in Thai or Burmese language, transcribed the interview, and conducted thematic analysis. Regarding adherence to COVID-19 protective behaviors, two themes emerged: lifestyle and habit-related barriers, and non-vaccine supply chain management barriers. Regarding COVID-19 vaccination, three common themes emerged: fear, barriers related to health education and health promotion, and vaccine supply chain management. Supply chain management was a common theme in both domains. However, each domain also had additional themes. Our study contributed empirical findings that could be of interest to stakeholders in migrant health. However, limitations regarding the generalizability of the findings and social desirability should be considered in the interpretation of the findings.
Abstract P2003: Trends in the Prevalence of Overweight and Diabetes Mellitus Before and After the Great East Japan Earthquake: Analysis of NDB Data
Background: In Japan, the Great East Japan Earthquake occurred in 2011, and people in Fukushima were affected by the earthquake, Tsunami, and radiation from the nuclear power plant accident. As a result, an increase in lifestyle-related diseases has been reported, but long-term trends in overweight and diabetes mellitus (DM) in whole Fukushima Prefecture have not been reported. Hypothesis: The prevalence of overweight and DM are higher in evacuation areas after the disaster. Methods: A total of 3,861,563 residents of Fukushima aged 40-74 years who participated in specific health check-ups during 2008-17, with the sufficient data were included. Fukushima was divided into evacuation area and other 3 areas, and age-adjusted prevalence rates were calculated for each area in each year and compared using Poisson regression models. Annual percent change (APC) was also calculated for each year using the Joinpoint regression program. Overweight was defined as BMI ≥ 25 kg/m 2 , and DM as HbA1c ≥ 6.5%, fasting blood glucose 126 mg/dl, or medication use. Results: The prevalence of overweight increased in all regions after the disaster and did not decrease thereafter. The increase was more evident in evacuation areas regardless of sex and age. The change in prevalence from 2010-12 was from 33.5 to 38.4% for men and 26.5 to 30.1% for women in the evacuation areas, and the APCs were 7.0(2.7-11.5) for men and 6.2(3.2-9.3) for women for the entire period (2008-17) with no inflection point. The prevalence of DM increased slowly after the disaster in the non-evacuation areas, but increased rapidly in the evacuation areas until 2013, and then slowly thereafter. In the evacuation areas, the percentage change from 2010-13 was from 11.8 to 14.9% in men and from 5.7 to 8.5% in women, and the APCs were 3.3(1.7-4.9) for the entire period in men, and -0.9(-0.2-2.1) for 2010-17 in women with the inflection point in 2010 (p=0.02). The increase in the prevalence of DM in the evacuation area was more evident with those aged ≥60, increasing from 11.4 to 15.9% in 2010-13. Conclusions: The prevalence of overweight and DM in Fukushima increased after the disaster, and did not decrease with particularly large increases in the evacuation areas. Longitudinal analysis examining the association between lifestyle and overweight and DM is needed.
Abstract P3119: Increased Trunk Fat and Decreased Limb Fat Correlate with Adverse Blood Lipid Profiles: Evidence From the MECH-HK Cohort
Introduction: The associations between different regional body fat composition and blood lipids remain unclear, especially in Chinese population. The aim of this study was to investigate the associations of trunk, arm and leg body fat composition with blood lipids. Hypothesis: We hypothesized that trunk, arm and leg body fat percentages (BFP) would be differentially associated with blood lipid levels. Method: The baseline data of the MECH-HK (Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women) cohort were used for this study. The participants were recruited between October 2019 and October 2021. InBody 270 bioelectrical impedance analysis device was used for body fat composition measurement. Fingerstick capillary blood samples were collected for blood lipid measurements using point-of-care testing devices. Multivariable linear regression models were used to investigate the associations between regional body fat composition and blood lipids. Results: We included 3616 women participants (age: 56.12±8.51) in this analysis. The mean regional arm, trunk and leg BFP were 4.59%, 15.38% and 10.76%, respectively. The mean levels of total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride were 198.42 mg/dL, 65.39 mg/dL, 102.39 mg/dL, and 158.42 mg/dL, respectively. After adjusting for age, education level, monthly family income, smoking and drinking status, physical activity levels, family history of hyperlipidemia and BMI, higher trunk BFP was associated with increased total cholesterol (β: 1.15, 95% CI: 0.25 to 2.04, P = 0.01), LDL cholesterol (β:1.62, 95% CI: 0.83 to 2.41, P < 0.001), and triglyceride (β: 7.85, 95% CI: 5.80 to 9.90, P < 0.001) and decreased HDL cholesterol (β: -1.74, 95% CI: -2.12 to -1.37, P < 0.001). In contrast, higher arm and leg BFP were associated with decreased triglyceride (β for arm BFP: -25.62, 95% CI: -32.49 to -18.74, P < 0.001; β for leg BFP: -8.10, 95% CI: -11.16 to -5.04, P < 0.001) and increased HDL cholesterol (β for arm BFP: 5.34, 95% CI: 4.09 to 9.59, P < 0.001; β for leg BFP: 1.95, 95% CI: 1.39 to 2.50, P < 0.001). Conclusions: Higher trunk BFP was associated with an adverse blood lipid profile, while higher arm and leg BFP was associated with a favorable blood lipid profile. Regional body fat composition may differentially impact blood lipid metabolism.
Abstract P3149: Association of Bone Mineral Density with Progression and Incidence of Aortic Calcification: the ERA JUMP Study
Decreased bone mineral density (BMD) is associated with atherosclerosis in postmenopausal women and older men. Limited research has explored this relationship in middle-aged men. Aortic calcification (AC) is a novel biomarker for aortic atherosclerosis. This study aimed to examine whether baseline BMD is associated with the progression of AC in an international multi-ethnic cohort of middle-aged men participating in the ERA-JUMP Study (The Electron-Beam Tomography Risk Factor Assessment Among Japanese and U.S. Men in the Post-World War II Birth Cohort). We hypothesized that higher BMD at baseline would be associated with less progression of AC. This analysis included participants who completed two visits an average of 5.69 years apart. Participants (mean age: 45.3 + 2.9) were recruited from population-based samples in the United States (Pennsylvania and Hawaii) and Japan (Shiga). All participants were free of clinical cardiovascular disease at baseline. BMD was measured via electron-beam tomography images of the T12 to L4 vertebrae. AC was evaluated from the aortic arch to the iliac bifurcation with computed tomography and scored via the Agatston Scoring Method. Incidence of AC was defined as an AC score <100 at baseline and ≥ 100 at follow-up. Linear regression was employed to assess the association between baseline BMD and changes in AC (Visit 2 – Visit 1). Model 1 adjusted for follow-up time, age, and race/ethnicity. Model 2 was further adjusted for cardiovascular risk factors: hypertension, diabetes, LDL-C, HDL-C, and lipid medication. Model 3 additionally adjusted for BMI and smoking status. Logistic regression, with the same models, was used to assess the association between baseline BMD and incident AC at Visit 2. At baseline, the average BMD was 173.1 HU (+ 37.1), and the median AC score was 3.0. The median change in AC score was 39.76 (IQR: 0- 220.3). There were 159 incident cases of AC in the cohort. Baseline BMD was inversely associated with the change in AC in Models 1, 2 (p<0.05) and Model 3 (p<0.1). Similarly, baseline BMD was inversely associated with incident AC in Models 1, 2 (p<0.05), and Model 3 (p=0.10). Our findings suggest that skeletal and cardiovascular health may be linked in middle-aged healthy men. Higher baseline BMD appears to be associated with reduced progression and lower incidence of AC. These results underscore the need for further longitudinal studies to confirm this relationship and explore its clinical implications.
Nurses’ perceptions of job security and performance: A comparative study between governmental and private hospitals
Aim Job security and performance are crucial needs for nurses, greatly influencing their motivation and commitment to work. This study seeks to examine Jordanian nurses’ perceptions of job security and employee performance and to compare these factors between government and private hospitals. Design A descriptive, comparative cross-sectional design was used for the study. Methods The study was conducted in two government and two private hospitals. A total of 156 nurses were conveniently sampled to participate. Data were collected using the Job Security Questionnaire and the Six-Dimension Scale of Nursing Performance. Results The mean job security score was 3.26, indicating a moderate level of job security. The mean employee performance score was 2.68, reflecting a high level of job performance. Nurses in private hospitals had significantly higher scores in both job security (t = -5.53, p < 0.001) and employee performance (M = 2.53, SD ± 0.53) compared to nurses in government hospitals. Conclusion Nurses with moderate job security levels achieved high job performance scores. Private hospitals demonstrated higher job security and employee performance levels than government hospitals. Future research could investigate specific aspects of the Jordanian nursing work environment that may contribute to the differences observed in job security and employee performance.
Abstract P1109: Yogurt consumption is associated with poorer sleep outcomes cross-sectionally, but not long-term
Introduction: Emerging evidence suggests that diet also influences sleep health. Dairy intake may impact sleep but few studies have evaluated the association between dairy consumption and sleep health. We evaluated the association between dairy consumption (total and subtypes) and sleep outcomes cross-sectionally and longitudinally in a French population. Hypothesis: Participants with higher dairy intakes will have better sleep outcomes compared to those with lower intakes. Methods: We studied 37,396 adults from the NutriNet-Santé e-cohort (mean age 49.9±14.8 y). Dairy product intake was estimated at baseline (2014) from at least two 24-h dietary recalls and stratified as low, moderate, or high based on average intake. Trouble sleeping, chronic insomnia, and acute insomnia were assessed at baseline and follow-up (2023). Total sleep time (TST) was estimated from sleep logs at baseline. We fit multivariate logistic regression models adjusted for sociodemographics, anthropometrics, lifestyle behaviors, sugar and saturated fat intakes, and diet quality to estimate the odds ratio (OR) of sleep health associated with dairy consumption. Results: In cross-sectional analyses, participants with high total dairy intake had 6% higher odds of acute insomnia, compared to those with low intake (OR high vs low =1.06; 95% CI 1.00-1.12; P-trend=0.042). High intake of yogurt-like products (e.g. yogurts, curd cheese and petit-suisses) was associated with higher odds of trouble sleeping (OR high vs low =1.07; 95% CI 1.02-1.13; P-trend=0.013), chronic insomnia (OR high vs low =1.08; 95% CI 1.01-1.15; P-trend=0.027), and acute insomnia (OR high vs low =1.13; 95% CI 1.08-1.19; P-trend<0.0001), but lower odds of long TST (OR high vs low =0.79; 95%CI 0.70-0.88; P-trend<0.0001). Similar associations for TST were observed for high fermented dairy (e.g., cheese and yogurt) (P-trend=0.0006) and high-fat dairy (P-trend=0.0072) intakes. In longitudinal analyses, trends in the opposite direction were noted for chronic insomnia (P-trend range: 0.064–0.994). Conclusions: Our findings suggest that certain dairy products may be associated with poorer sleep outcomes in cross-sectional analyses; however, these associations did not predict sleep quality long-term. It is possible that individuals with sleep difficulties increased their dairy intake to improve sleep. Clinical interventions are warranted to confirm findings, address causality, and accurately inform dietary guidelines for sleep health.
Abstract P3063: Community Partner Engagement Preferences and Needs Across the RESTORE Health Equity Research Network
Introduction: Effective and regular engagement of community partners (CPs) is critical to the success of community-based research projects. Informed by the National Academy of Medicine’s Assessing Community Engagement model, we describe the multi-tiered community engagement activities conducted by the RESTORE (AddREssing Social Determinants TO pRevent hypErtension) Network and the adoption of a novel data collection tool: the Community Engagement Tracking Form. Methods: RESTORE is a multi-site collaboration funded by the American Heart Association. It includes 5 independent, community-engaged research projects focusing on nutrition and groceries, physical activity, empowerment, access, linkage, and home blood pressure telemonitoring. In this study, we describe the frequency and type of CP engagement, topics discussed, and categories of CPs engaged. Results: Between September 21, 2021, and September 30, 2024, the Network carried out 758 engagement activities. Formats of engagement employed most were informal field meetings with CPs (n=238, 31.40%), electronic communication through email, phone, and text (n=211, 27.84%), and scheduled meetings partner(s) or partner group(s) (n=149, 19.66%). Of all primary topics discussed (n=915), study implementation was the most common (n=558, 60.98%). Across 28 community advisory board meetings, primary topics (n=68) discussed most frequently were describing, interpreting, and disseminating results (n=26, 38.24%) and study implementation (n=20, 29.41%). Community- and faith-based organizations, local businesses and healthcare organizations were the most frequently engaged CPs. Health insurance organizations, technology companies, private industry, and patients/caregivers were engaged least often. Conclusions: In conclusion, this adoption report highlights key learnings about CP engagement across a multi-site research network. Informal field meetings were used more commonly than both structured or scheduled meetings (possibly due to higher flexibility) and electronic contact (which is interesting given the rise of remote communication since the pandemic). Study implementation required the most attention from study teams and CPs. More holistic and multilateral CP engagement may be needed, with intentionality in inclusion and presence of payers, industry, frontline workers, patients, and caregivers. Future work will explore barriers and facilitators to engaging CPs, data completeness, and responsiveness of study teams to CP input.
Abstract P3118: Temporal Trends and Differential Increase in High Body Mass Index and Obesity Prevalence among Asian American, Native Hawaiian and Other Pacific Islander Adults: Insights from the PANACHE Study
Introduction: Obesity is linked to cardiovascular disease (CVD) and excess mortality. However, contemporary data about obesity trends in disaggregated Asian American, Native Hawaiian and other Pacific Islander (AANHPI) adults are lacking, especially among younger adults. We examined temporal trends in high body mass index (BMI) and obesity among AANHPI compared to non-Hispanic White (NHW) adults aged 30-49y receiving care in a large California healthcare system. Methods: Among adults aged ≥30y with no prior CVD who were Kaiser Permanente Northern California members in 2012-2022, we ascertained the first BMI per person per calendar year (2010-2023) at ages 30-49y. BMI ≥27.5 (lower intervention threshold for Asian adults) and BMI ≥30 kg/m2 (obesity) were classified for all groups. Sex-specific prevalence estimates were age-standardized to the overall population aged 30-49y with measured BMI. To estimate trends in prevalence of high BMI over time, we conducted sex-stratified modified Poisson regression models for both BMI outcomes with calendar year, race/ethnicity, age at BMI, and an interaction term between race/ethnicity and calendar year as covariates with a robust variance estimator to account for within-person clustering. Results: Among 1,284,415 adults aged 30-49y (mean age 40±6, 61% women), 89,067 (6.9%) were Chinese, 86,683 (6.7%) Filipino, 21,591 (1.7%) Native Hawaiian/Pacific Islander, 68,633 (5.3%) South Asian, 29,512 (2.3%) Vietnamese, 18,240 (1.4%) other Southeast Asian, 8148 (0.6%) Japanese, 9306 (0.7%) Korean, and 953,235 (74.2%) NHW. Age-adjusted prevalences of BMI ≥27.5 and BMI ≥30 were generally higher for men than women, highest for Native Hawaiian/Pacific Islander adults, and lower for East Asian, Vietnamese, and South Asian compared to NHW adults across all years (Figures 1-2). From 2010 to 2023, prevalence of high BMI accelerated fastest among Filipino and other Southeast Asian vs NHW adults (p<0.001). By 2023, the prevalence of high BMI among Filipino and other Southeast Asian adults approached that of NHW adults. Conclusions: High BMI/obesity prevalence and trends vary significantly across AANHPI subgroups compared to NHW adults aged 30-49y receiving care, with Native Hawaiian/Pacific Islander adults having the highest burden and Filipino and Southeast Asian adults experiencing rapid increases. These findings underscore the need for effective interventions targeting obesity among younger AANHPI adults to prevent CVD and adverse outcomes.
Is it all in your head? Reducing virtual reality induced cybersickness by pleasant odor imagery
Although immersive technologies such as virtual reality are constantly growing for personal and professional purposes, their use can often induce a transient state of discomfort known as cybersickness, resulting in numerous symptoms and perceptive-motor vulnerability. In an attempt to develop leads to mitigate cybersickness, encouraging findings have reported decreased symptoms during the presentation of pleasant smells. However, the diffusion of smells in ecological settings is very challenging. An interesting alternative could reside in odor imagery (OI), known for its neurophysiological, behavioral and psychological similarities with odor perception. The aim of this study was therefore to determine the effects of pleasant OI on virtual reality induced cybersickness. Thirty participants performed two 14-minute virtual reality sessions simulating a first-person view from a boat. During the second session we added a picture at the center of the visual field, allowing for pleasant and intense OI based on individualized psychometrical measures. Participants were instructed to focus on the smell evoked by this picture. For both immersions, cybersickness was characterized by the evolution of scores on the Simulator Sickness Questionnaire, and duration of immersion. Our results show that both measures were positively affected by pleasant OI, indicating a decreased intensity of cybersickness symptoms associated with a longer tolerance of the virtual environment. We suggest the observed effects could be mediated by emotional regulation mechanisms driven by pleasant OI, alleviating cybersickness in a similar way to pleasant odor perception. These findings could open the door to new applications of pleasant sensory imagery as strategies to alleviate transient states of discomfort in immersive technologies or perhaps motion-induced sickness.
Abstract P1155: Different Heart Failure Risk Factors Have Distinct Patterns of Preclinical Cardiac Dysfunction: The Atherosclerosis Risk in Communities (ARIC) Study
Introduction: In individuals at risk for heart failure (HF), pre-clinical cardiac dysfunction is a target for preventive interventions. We hypothesized that different HF risk factors are associated with distinct patterns of cardiac dysfunction, with implications for underlying pathophysiology and approaches to screening and prevention. Methods: We conducted a cross-sectional analysis of 4,470 participants without prevalent HF from Visit 5 (2011-13) of the ARIC study with echocardiographic data, cardiac biomarker measurements (the N terminal pro-B-type natriuretic peptide [NT-proBNP] and high-sensitivity cardiac troponin T [hs-cTnT]) and data on HF risk factors (atherosclerotic cardiovascular disease [ASCVD], obesity, diabetes [DM], hypertension and chronic kidney disease [CKD]). Multivariable logistic regression was used to assess the associations of HF risk factors with different echocardiographic abnormalities and elevated cardiac biomarker levels, adjusted for age, sex, race, and other HF risk factors ( Table ). Results: The mean age was 76 years, with 58% women and 20% Black individuals. A total of 2,424 (54.2%) participants had abnormal echocardiographic measures, and 2,169 (48.5%) participants had elevated NT-proBNP or hs-TnT. Among HF risk factors, only ASCVD was independently associated with left ventricular (LV) systolic dysfunction (Table). In contrast, hypertension was associated with 4/4 indices of LV diastolic dysfunction, obesity 3/4 diastolic indices and CKD, ASCVD and DM with 2/4 diastolic indices. All risk factors were associated with increased LV filling pressures (average E/e'). Obesity was most strongly associated with LV hypertrophy among risk factors. All risk factors were associated with elevated hs-cTnT, but nominally inverse associations with NT-proBNP were seen for both diabetes and obesity. Conclusion: Different HF risk factors are associated with distinct patterns of preclinical cardiac dysfunction. Tailored approaches to screening and prevention may be needed to most effectively avert the onset of clinical HF for individuals with different risk factor profiles.
Abstract MP10: Using Target Trials and Machine Learning to Estimate Heterogeneous Treatment Effects of First-Line Antihypertensive Medications
Introduction: Guidelines for hypertension (HTN) treatment make universal recommendations, ignoring prior research demonstrating differences in BP reduction between HTN medication classes in individuals with different clinical presentations. Here, we leveraged causal inference methods to emulate randomized trials to assess heterogeneity in the effectiveness of first-line HTN treatments. Methods: A hypothetical target trial was designed to assess comparative effectiveness of first-line HTN medications in subgroups defined by clinical presentation. For its emulation, patients with new HTN diagnosis (2014-2022) at Northwestern Medicine (NM) who initiated medication treatment (ACEi, ARB, CCB, Diuretics, CCB or Diuretic combination treatment [with ACEi/ARB]) were selected from the NM electronic health records. Eligibility criteria were: no prior prescription of HTN medication, 1+ outpatient visit in the year before diagnosis, and no pregnancy within a year of HTN diagnosis. The primary outcome was achieving a blood pressure of under 140/90 mm Hg after six months. The analysis involved three steps: using g-computation to estimate individual treatment effects (ITE) of antihypertensive medications, employing Causal Forest to identify key clinical variables affecting ITE, and using targeted maximum likelihood estimation with SuperLearner to estimate treatment effects within patient subgroups. Results: Our study included 22,433 eligible patients from NM. We created 16 patient subgroups by using commonly used clinical thresholds of systolic BP, low-density lipid cholesterol, age, and BMI to partition the overall patient population. Statistically significant differences in treatment effects were found in several subgroups – e.g. in subgroup 1, diuretics were found to perform significantly better than all other HTN medications ( Figure ). Conclusions: Personalized HTN treatment strategies have the potential to improve BP control rates in many patient populations.
Abstract P2061: Depressive Symptoms and Food Security in the Addressing Blood Pressure Control through Dietary Approaches (ABCD) Study in Jamaica: A cross-sectional study
Introduction: Globally approximately 280 million people have depression which accounts for 7.5% YLD and is the single largest contributor to non-fatal health loss. Persons with limited or uncertain access to adequate food (food insecurity-FI) are at increased risk of CVD including hypertension making it a critical public health issue. In some populations it has been suggested that FI might be a stronger predictor of depressive symptoms than some of the traditional CVD risk factors. However, the nature of this association is unclear. The aim was to evaluate the prevalence of depressive symptoms and the association between depressive symptoms and food insecurity among persons with hypertension in Jamaica. Hypothesis: Depressive symptoms are directly related to food insecurity. Methods: Cross-sectional study of patients with hypertension attending 2 clinics (1 primary care, 1 specialist hypertension) recruited by sequential sampling. An interviewer administered questionnaire collected socio-demographic (age, sex, marital status, education, employment and comorbidities), depression and food security information. Depressive symptoms were scored using the Patient Health Questionnaire-2 (PHQ-2) based on 2 questions and scored on a scale of 0-6. Questions asked whether, in the last two weeks, participants had a) little pleasure in doing things or b) feeling down or depressed. A score of ≥3 suggested major depressive disorder is likely. A modified 9 item questionnaire based on The Latin America and Caribbean Food Security Scale (ELSCA) classified FI into mild, moderate and severe. Logistic regression was used to assess the association between depressive symptoms and food security. Results: Data of 247 hypertensive participants 29% male with a mean [SD] age of 65.3 ± 12.2 years were analysed. The prevalence of depressive symptoms was 10.2% (n=26) increased with age (p =0.002) and among those with mild 5.8%, moderate 15.7%, and severe 19.4% of food insecurity, but was not statistically significant. In final model adjusted for age and sex the odds of depressive symptoms were not significantly associated with food insecurity. Conclusion: One in ten patients with hypertension in these clinics screen positive for depression using the PHQ2 questionnaire. While depressive symptoms were higher among persons with higher levels of food insecurity the association was not statistically significant. These associations should be further explored in larger studies.
Postoperative pneumonia in isolated coronary artery bypass grafting: A comprehensive study of epidemiology, etiology, and disease burden from China (2020–2023)
Objective To investigate the epidemiological trends,etiological profiles and disease burden metrics related to postoperative pneumonia following isolated coronary artery bypass grafting (CABG). Methods A retrospective analysis was conducted on data from 518 patients who developed postoperative pneumonia following isolated CABG between January 1, 2020, and November 30, 2023. Results Postoperative pneumonia occurred at a rate of 11.34% among the cohort (518/4569),which fluctuated by year (P < 0.001). Patients aged 60–80 and over 80 years exhibited significantly higher incidence rates compared to those under 60 years (all P < 0.05) A total of 416 strains were identified, with Gram-negative bacteria accounting for 86.5%, primarily represented by Klebsiella pneumoniae (31.0%), while pseudomonas aeruginosa (21.4%) and stenotrophomonas maltophilia (5.3%) demonstrated an increasing trend in the period of 2022–2023 (both P < 0.05). The proportion of Staphylococcus aureus in the fourth quarter was significant lower than that in the first quarter (4.8% vs 14.4%, P < 0.05). The overall detection rate of multi-drug resistant organisms (MDRO) was 57.7%,with 53.9% for Gram-negative bacteria and 82.1% for Gram-positive bacteria.Late-onset postoperative pneumonia was significantly associated with a higher detection rate of MDRO (63.8% vs 50.3%, P < 0.01). Postoperative pneumonia prolonged median length of postoperative hospital[20.00 (13.00,31.25) days vs 15.50(10.25,19.75) days, P < 0.001] and ICU [9.00(5.00,14.00)days vs 4.00(3.00,11.75) days, P = 0.002] stay, thereby increasing hospitalization costs[￥255592.15 (193384.29, 336337.53) vs ￥180501.02 (154493.58, 220501.03),P < 0.001]. The incidence of severe pneumonia significantly increased in patients infected with MDRO (19.30% vs. 5.51%, P < 0.001) or co-infected (40.00% vs. 9.52%, P < 0.001), leading to marked differences in postoperative hospital stay and hospitalization costs (all P < 0.05). Conclusion The etiological patterns of postoperative pneumonia following isolated CABG showed temporal variations by year and quarter. MDRO infection and co-infections could significantly exacerbate the disease burden on patients.