Cardiometabolic Research Articles

Searching for a Novel HLA-Cw6-Linked Cardiometabolic Endotype in Psoriatic Disease.

In recent years, a possible connection between HLA-Cw6 and a distinctive cardiometabolic (CM) profile in patients with psoriatic disease (PsD) has been proposed, although there is still little support for this. Our aim was to further investigate this possible association by studying a large population of PsD patients. For this study, three different cohorts of patients with PsD were analyzed: two with a majority of cutaneous psoriasis, pooled n: 600, and a third with only psoriatic arthritis-PsA-cases, n: 340. Potential relationships between HLA-Cw6 and the different CM risk factors (hypertension, diabetes, obesity, dyslipidemia) were analyzed using univariate and multivariate regression models, while the final net effect was assessed using fixed- or random-effects meta-analyses, as appropriate. In the PsA cohort, no association was detected between HLA-Cw6 carriership and any of the CM comorbidity factors. In psoriasis cohorts, after correcting for age, sex, disease duration, and arthritis, HLA-Cw6 carriers had a reduced diabetes risk (OR 0.49, 95%CI: 0.26-0.91, p = 0.026). This latter effect was confirmed by a fixed-effects meta-analysis of the included cohorts (pooled OR: 0.50, 95%CI: 0.27-0.90). This work demonstrates a potential protective effect of the HLA-Cw6 allele on the risk of diabetes in PsD. Our findings together with those of others seem to confirm the existence of a novel HLA-Cw6-linked cardiometabolic endotype in this disease.

Protocol of the HARMONY study: A culturally relevant, randomized-controlled, stress management intervention to reduce cardiometabolic risk in African American women

BackgroundAfrican American Women (AAW) are at high risk for stress-related cardiometabolic (CM) conditions including obesity, heart disease, and diabetes. Prior interventions lack attention to culturally-nuanced stress phenomena (Superwoman Schema [SWS], contextualized stress, and network stress), which are positively and significantly associated with unhealthy eating and sedentary behavior. PurposeThe HARMONY Study is designed to test a culturally tailored mindfulness-based stress management intervention to address SWS, contextualized stress, and network stress as potential barriers to adherence to healthy exercise and eating goals. The study will help AAW build on their strengths to promote cardiometabolic health by enhancing positive reappraisal, self-regulation, and self-efficacy as protective factors against chronic stress-inducing biobehavioral morbidity and mortality risk. MethodsThis two-arm, randomized-controlled trial will test the effects of two group-based, online interventions. HARMONY 1 includes culturally-tailored exercise and nutrition education. HARMONY 2 includes mindfulness-based stress reduction, exercise, and nutrition education. We aim to recruit 200 AAW ≥ 18 years old with CM risk. ResultsPrimary outcomes (actigraphy and carotenoid levels) and secondary outcomes (body composition, inflammatory markers, glucose metabolism, and stress) are being collected at baseline and 4-, 8-, and 12-months post-intervention. Intent-to-treat, data analytic approaches will be used to test group differences for the primary outcomes. DiscussionThis study is the first to address culturally-nuanced stress phenomena in AAW (SWS, network stress, and contextualized stress) using culturally-tailored stress management, exercise, and nutrition educational approaches to reduce biobehavioral CM risk among AAW. Quantitative and qualitative results will inform the development of scalable and sustainable CM risk-reduction programming for AAW. Trial registrationThe Multiple PIs registered the clinical trial (Identifier: NCT04705779) and reporting of summary results in ClinicalTrials.gov in accordance with the NIH Policy on the Dissemination of NIH-Funded Clinical Trial Information, within the required timelines.

Course of coronary heart disease in patients with cardiovascular renal metabolic syndrome and separately metabolic

Introduction. Renal dysfunction is increasingly recognized as a key mediator of the association between metabolic risk factors and cardiovascular disease (CVD). Therefore, rather than simply viewing cardiorenal (CR) syndrome and cardiometabolic (CM) diseases as separate conditions, it is clear that we need to consider them as the broader concept of cardiovascular-renal-metabolic syndrome (CVMS). Purpose of the study: Studying the differences in the influence of SSMPS and separately metabolic (MS) on the course of coronary heart disease (CHD). Materials and methods. The study included 116 patients - 69 (59.5 %) men and 47 (40.5 %) women who were treated at the RCH Hospital No. 2 from 2022 to 2023. The patients were divided into two groups, the 1st group included n = 52 with cardiovascular-renal-metabolic syndrome, the 2nd group included n = 64 with metabolic syndrome. The duration of the study is 18 months. Results. Primary indicators of low-density lipoproteins (LDL) in the 1st group were 2.9 ± 3.6 in the 2nd group 2.6 ± 4.0 p < 0.05, and upon re-examination, the ratio of values was as follows - 3 .2 ± 2.8 to 3.0 ± 3.3 p > 0.05. Patients with type 2 diabetes mellitus (DM2) increased by the end of the examination in both groups, but not so significantly in relation to the total weight of 2.6 % to 3.4 % p < 0.05. During the repeated examination, the indicators of arterial hypertension (AH) of the 2nd degree prevailed (34.6 % to 32.8 %) p < 0.05, and there was also an increase in patients with hypertension of the 3rd degree (25.0 to 25.0) p < 0.05, mainly due to patients of the 1st group with kidney disease. Re-admission to the hospital occurred more often in patients with SSPMS than in the group with MS 9.5 ± 7.2 and 12.6 ± 6.8 months, p < 0.05. In-hospital mortality from acute myocardial infarction (AMI) slightly prevailed in group 1 upon re-admission to hospital, ratio n = 3 (5.8 %), in group 2 n = 1 (1.6 %), p > 0.05. Conclusions. In conclusion, our nonrandomized prospective study showed that patients with cardiovascular-renal-metabolic syndrome are at a higher risk of developing cardiovascular events than patients with metabolic syndrome alone. Analysis of lipid metabolism in the group of cardiovascular-renal-metabolic syndrome showed that in a short time after discharge from the hospital, from 6 months to 1.5 years, the indicators of total cholesterol, triglycerides and lowdensity lipoproteins progress negatively to the time of relapse of angina pectoris.

Abstract P490: The Oral Microbiome and Prospective Risks of All-Cause and Cardiometabolic Mortality: The National Health and Nutrition Examination Survey

Background: Dysbiosis of the oral microbiome and periodontitis (an inflammatory disease induced by dysbiosis) are plausible risk factors for cardiometabolic (CM) diseases. The relationship between the oral microbiome and CM mortality is less known. Hypothesis: Greater oral microbial diversity is associated with lower risks of all-cause and CM mortality, while poorer periodontal health is associated with greater mortality risk. Methods: We included n=5,255 adults aged 30+ from the National Health and Nutrition Examination Survey (NHANES) who had periodontal examinations and provided saliva samples at baseline. Baseline enrollment occurred in the 2009-2010 (n=2,681) and 2011-2012 (n=2,574) study cycles. Salivary microbiome data were generated in NHANES via 16s gene sequencing. Shannon and Inverse Simpson alpha diversity metrics were used to quantify oral microbial diversity for each participant. Clinical attachment loss (CAL) and probing depths from periodontal exams were included as historic and active measures of periodontitis, respectively. All-cause (non-accident deaths) and CM mortality (due to cardiovascular disease, cerebrovascular disease, diabetes, nephritis) through 2019 were ascertained via National Death Index linkages. We used multivariable Cox regression to compute hazard ratios and 95% confidence intervals (HR [95%CI]) of all-cause and CM mortality among 2 nd and 3 rd tertiles (vs 1 st tertile) of alpha diversity, CAL, and probing depth. We adjusted for study cycle, demographics, CM risk factors. Results: Mean age (SE) of participants was 48.1(0.2) years and 50% were men. Across 8.8 years of median follow-up, 193 all-cause deaths and 85 CM deaths occurred. Higher alpha diversity were associated with lower risks of all-cause and CM mortality, although non-significant. Relative risk of CM mortality in CAL Tertiles 3 vs. 1 is 1.81 (1.05, 3.09) (see Table ). Conclusion: Lower oral microbiome diversity and poorer indicators of periodontitis were not associated with all-cause and CM mortality.

Association of Endogenous Testosterone with Physical Fitness Measures during Firefighter Occupational Health Evaluations.

Firefighting is a physically demanding profession associated with unacceptably high on-duty cardiovascular mortality. Low endogenous total testosterone (TT) is an emerging cardiometabolic (CM) risk factor in men, but limited data exists on its interactions with physical fitness (PF). Data from occupational health and fitness assessments of 301 male career firefighters (FFs) were analyzed. TT was categorized as low (<264 ng/dL), borderline (264-399 ng/dL), and reference (400-916 ng/dL). PF tests included cardiorespiratory fitness (submaximal treadmill), body fat percentage (BF%), push-ups, plank, and handgrip strength assessments. In the crude analyses, FFs in the low TT group had worse muscular and cardiorespiratory fitness measures compared to the referent group. However, after adjusting for age and BF%, none of the PF differences remained statistically significant. Similarly, the odds of less-fit FFs (PF performance below median values) having low TT were higher compared to the fitter ones only before adjusting for age and BF%. Therefore, in the final adjusted model, there was no significant association between TT and PF. Our data suggest that age and body fat confound the association between PF and TT. Low TT and poor PF are important components of FFs' CM risk profile, and there is potential benefit to considering TT screening as part of a comprehensive occupational health program that manages performing medical evaluations and provides education and preventative programming.

Epidemiological characteristics of cardio-metabolic risk factors in women aged 15-49 years in 4 provinces of China in 2018

To analyze the prevalence of cardio-metabolic(CM) risk in women aged 15-49 years in 4 provinces of China and the influence of socioeconomic factors on them. A total of 2851 women aged 15-49 years from Community-based Cohort Study on Nervous System Disease in 2018 were selected. Obesity, central obesity, elevated triglyceride(TG), elevated total cholesterol(TC), decreased high-density lipoprotein cholesterol(HDL-C), elevated low-density lipoprotein cholesterol(LDL-C), elevated blood pressure, elevated blood glucose and risk factor aggregation were analyzed. χ~2 test was used for univariate analysis, multinomial Logit model was used to evaluate the relationship between socioeconomic factors and CM risk factors, and Cochran-Armitage trend test was used for trend analysis. The detection rate of CM risk factors in this study from high to low were central obesity(26.76%), overweight(22.41%), pre central obesity(17.47%), decreased HDL-C(15.36%), elevated TG(11.78%), borderline elevated TC(11.40%), borderline elevated TG(11.12%), elevated blood pressure(9.71%) and hypertension(9.12%). The prevalence rates of CM risk factors were different among different age groups, income groups and education levels(P&lt;0.05). In addition to decreased HDL-C, the prevalence of other metabolic risk factors increased with age(P_(trend)&lt;0.05). With the improvement of educational level, the prevalence rates of overweight, obesity, central obesity, central obesity, elevated TG, decreased HDL-C, elevated blood pressure, hypertension, elevated blood pressure and diabetes showed a downward trend(P_(trend)&lt;0.05). Multinomial Logit model showed that the rick of metabolic risk factors in the age group of 40 to 49 years old was higher than that in the younger age group aged 15-29 years, and was more significant in hypertension, elevated blood pressure and elevated blood glucose, which were 8.51 times(95% CI 5.45-13.27), 3.14 times(95%CI 2.20-4.48)and 2.66(95% CI 1.52-4.66)times of the younger age group, respectively. Women with high-income level have a higher risk of borderline elevated TC, elevated TC and borderline elevated LDL-C(OR=1.85, 95% CI 1.44-2.38;OR=2.01, 95% CI 1.25-3.22;OR=2.16, 95% CI 1.61-2.90), but the lower risk of overweight and elevated blood pressure(OR=0.79, 95% CI 0.64-0.98;OR=0.69, 95% CI 0.50-0.94). The risk of obesity, hypertension and diabetes of people with college degree or above was about 50% lower than those with junior high school education or below(OR=0.52, 95% CI 0.35-0.78;OR=0.43, 95% CI 0.27-0.67; OR=0.52, 95% CI 0.28-0.96). Central obesity, overweight, pre central obesity and HDL-C decrease were prominent CM risk factors in women aged 15-49 years in four provinces of China in 2018. The detection rate of CM risk factors is higher in women of high age group or low education level.

Prospective study of the association between chronotype and cardiometabolic risk among Chinese young adults

BackgroundThe association of evening chronotype with cardiometabolic disease has been well established. However, the extent to which circadian rhythm disturbances independently result in risk remains unclear. This study aimed to investigate the cross-sectional and prospective longitudinal associations between chronotype and cardiometabolic risk among Chinese young adults.MethodsFrom April to May 2019, a total of 1 135 young adults were selected to complete the self-administered questionnaire, and 744 fasting blood samples were collected to quantify cardiometabolic parameters. From April to May 2021, 340 fasting blood samples were collected to quantify cardiometabolic parameters. The Morning and Evening Questionnaire 5 (MEQ-5) was used to assess chronotype. The cardiometabolic (CM)-risk score was the sum of standardized Z scores based on gender for the 5 indicators: waist circumference (WC), mean arterial pressure (MAP), triglyceride (TG), homeostasis model assessment for insulin resistance (HOMA-IR), and high-density lipoprotein cholesterol (HDL-C), where the HDL-C is multiplied by-1. The generalized linear model was used to determine the cross-sectional and prospective longitudinal associations between chronotype and each cardiometabolic parameter.ResultsCross-sectional association analysis showed that lower MEQ-5 scores were correlated with higher fasting insulin (β=-1.420, 95%CI: -2.386~-0.453), higher HOMA-IR (β=-0.301, 95%CI: -0.507~-0.095), and higher CM risk score (β=-0.063, 95%CI: -0.122~-0.003), even after adjustment for covariates. Prospective longitudinal association analysis also showed that lower MEQ-5 scores were associated with 2 years later higher fasting glucose (β=-0.018, 95%CI: -0.034~-0.003), higher fasting insulin (β=-0.384, 95%CI: -0.766~-0.003), higher HOMA-IR (β=-0.089, 95%CI: -0.176~-0.002), and higher CM-risk score (β=-0.109, 95%CI: -0.214~-0.003) after adjustment for covariates.ConclusionsEvening chronotype was significantly correlated with higher CM risk among young adults. Our findings suggest that biologically and socially affected sleep timing misalignment is a contributing factor to cardiovascular disease risk.

Trajectories of quality of life and cognition in different multimorbidity patterns: Evidence from SHARE

ObjectivesThe study aimed to observe the trajectory of quality of life (QoL) and cognition, and to a analyze the bidirectional association between cognition and QoL for diverse multimorbidity patterns. MethodsIn total, 16,153 older participants age ≥50 years were included from the Survey of Health, Ageing and Retirement in Europe (SHARE). We used latent class analysis (LCA) to identify multimorbidity patterns in the baseline population. We used linear mixed models (LMM) to examine the trajectory of cognition and QoL in different multimorbidity patterns. A cross-lagged model was employed to analyze the bidirectional association between cognition and QoL in diverse multimorbidity patterns. ResultsLatent class analysis identified four multimorbidity patterns: high and low comorbidity burden (HC and LC), cardiometabolic (CA), and osteoarthrosis (OS). The HC group had the poorest cognitive function and QoL (p for trend < 0.001). Delayed and immediate episodic memory in the OS group declined at a highest rate (p for trend < 0.001). Additionally, a bidirectional association between cognition and QoL was observed. The effect of cognitive function on QoL was relatively stronger than the reverse in the CA and LC groups. ConclusionsThe rate of decline in cognition and QoL over the time differs in diverse multimorbidity patterns, and patients with four or more chronic diseases should be specially considered. Notably, early monitoring of cognitive function and can help break the vicious cycle between cognitive deterioration and poor QoL in patients with OS or CA diseases.

Association of Tree Nut Consumption with Cardiovascular Disease and Cardiometabolic Risk Factors and Health Outcomes in US Adults: NHANES 2011–2018

BackgroundTree nuts are nutrient dense, and their consumption has been associated with improvements in health outcomes. ObjectiveTo estimate the usual tree nut intake and examine the association between tree nut consumption and cardiometabolic (CM) health outcomes in a nationally representative sample of US adults. MethodsCross-sectional data were analyzed from a sample of 18,150 adults aged ≥ 20y who provided at least one reliable 24-h dietary recall and had complete data for the variables of interest in the NHANES 2011–2018. Tree nut consumers were defined as those consuming ≥ ¼ ounce/d (7.09 g). The National Cancer Institute Method was used to estimate the usual tree nut intake among consumers. Measurement error calibrated regression models were used to assess the association between tree nut consumption and each health outcome of interest. ResultsApproximately 8% of all participants (n = 1238) consumed tree nuts and had a mean ± SE usual intake of 39.5 ± 1.8 g/d. Tree nut consumers were less likely to have obesity (31% vs. 40%, P < 0.001) and low high-density lipoprotein cholesterol (22% vs. 30%, P < 0.001) compared with nonconsumers. Moreover, tree nut consumers had a lower mean waist circumference (WC) (97.1 ± 0.7 vs. 100.5 ± 0.3 cm, P < 0.001) and apolipoprotein B (87.5 ± 1.2 vs. 91.8 ± 0.5 mg/dL, P = 0.004) than nonconsumers. After adjusting models for demographics and lifestyle covariates, the difference in WC between average intake (33.7 g/d) and low threshold intake (7.09/g) of tree nuts was -1.42 ± 0.58 cm (P = 0.005). ConclusionsMost US adults do not consume tree nuts, yet modest consumption was associated with decreased prevalence of cardiovascular disease and CM risk factors and improvement for some health outcome measures.

Cardiometabolic risk factor clustering in persons with spinal cord injury: A principal component analysis approach

Context/Objective To identify cardiometabolic (CM) measurements that cluster to confer increased cardiovascular disease (CVD) risk using principal component analysis (PCA) in a cohort of chronic spinal cord injury (SCI) and healthy non-SCI individuals. Approach A cross-sectional study was performed in ninety-eight non-ambulatory men with chronic SCI and fifty-one healthy non-SCI individuals (ambulatory comparison group). Fasting blood samples were obtained for the following CM biomarkers: lipid, lipoprotein particle, fasting glucose and insulin concentrations, leptin, adiponectin, and markers of inflammation. Total and central adiposity [total body fat (TBF) percent and visceral adipose tissue (VAT) percent, respectively] were obtained by dual x-ray absorptiometry (DXA). A PCA was used to identify the CM outcome measurements that cluster to confer CVD risk in SCI and non-SCI cohorts. Results Using PCA, six factor-components (FC) were extracted, explaining 77% and 82% of the total variance in the SCI and non-SCI cohorts, respectively. In both groups, FC-1 was primarily composed of lipoprotein particle concentration variables. TBF and VAT were included in FC-2 in the SCI group, but not the non-SCI group. In the SCI cohort, logistic regression analysis results revealed that for every unit increase in the FC-1 standardized score generated from the statistical software during the PCA, there is a 216% increased risk of MetS (P = 0.001), a 209% increased risk of a 10-yr. FRS ≥ 10% (P = 0.001), and a 92% increase in the risk of HOMA2-IR ≥ 2.05 (P = 0.01). Conclusion Application of PCA identified 6-FC models for the SCI and non-SCI groups. The clustering of variables into the respective models varied considerably between the cohorts, indicating that CM outcomes may play a differential role on their conferring CVD-risk in individuals with chronic SCI.

Sphingolipid Levels and Signaling via Resveratrol and Antioxidant Actions in Cardiometabolic Risk and Disease.

Resveratrol (RSV) is a phenolic compound with strong antioxidant activity, which is generally associated with the beneficial effects of wine on human health. All resveratrol-mediated benefits exerted on different systems and pathophysiological conditions are possible through resveratrol's interactions with different biological targets, along with its involvement in several key cellular pathways affecting cardiometabolic (CM) health. With regard to its role in oxidative stress, RSV exerts its antioxidant activity not only as a free radical scavenger but also by increasing the activity of antioxidant enzymes and regulating redox genes, nitric oxide bioavailability and mitochondrial function. Moreover, several studies have demonstrated that some RSV effects are mediated by changes in sphingolipids, a class of biolipids involved in a number of cellular functions (e.g., apoptosis, cell proliferation, oxidative stress and inflammation) that have attracted interest as emerging critical determinants of CM risk and disease. Accordingly, this review aimed to discuss the available data regarding the effects of RSV on sphingolipid metabolism and signaling in CM risk and disease, focusing on oxidative stress/inflammatory-related aspects, and the clinical implications of this relationship.

Cardiometabolic Patient-Related Factors Influencing the Adherence to Lifestyle Changes and Overall Treatment: A Review of the Recent Literature.

It is well acknowledged that most of the modifiable risk factors for Cardiovascular Diseases (CVDs) can be averted through lifestyle modifications beyond medication adherence. This review aims to critically evaluate the cardiometabolic (CM) patient-related factors that influence the adherence to lifestyle changes studied alone and/or in combination with medication. A comprehensive literature search of PubMed articles from 2000 to 2023 retrieved 379 articles. After removing the articles which were not relevant, a total of 28 cross-sectional studies was chosen (12 qualitative, and 16 quantitative). The findings confirmed that five groups of factors influence patients' adherence to overall treatment: (1) health beliefs, knowledge, and perceptions regarding the risks and challenges of disease and medication intake along with adherence process perceptions; (2) self-concept; (3) emotions; (4) patient-healthcare providers relationship/communication and (5) social and cultural interactions. It is worth mentioning that cultural issues, such as culinary particularities, ethnic identity, social life as well as patients' skills and abilities, play a profound role in the effectiveness of the recommended lifestyle modifications beyond the aforementioned common factors. The need for clear-cut culturally adapted guidelines along with personalized advice from physicians is imperative as it could improve patients' self-efficacy. These socio-psychological factors should be seriously considered as a means to increase the effectiveness of future community prevention programs.

Test-retest Repeatability; Integrated assessment of adherence to treatment questionnaire for Cardiometabolic Diseases

Aim: Low adherence to health-related behaviors to treatment is still a major public health challenge in primary healthcare settings. Our aim was to assess the repeatability of a tool that can be used by health care professionals in the primary health care sector, as a means to evaluate the degree of adherence to medication and recommended lifestyle changes of patients with cardiometabolic diseases while simultaneously identifying potential treatment obstacles. Material: The Integrated Assessment of Adherence to Treatment Questionnaire for Cardio Metabolic Diseases (IAATQ-CMD) tool includes 126 questions concerning the following domains: (i) socio-demographic characteristics, (ii) medical history, (iii) dietary and lifestyle habits, (iv) healthcare system, (v) patients’ disease/treatment/health status awareness, (vi) adherence to medication (vii) self-efficacy to medication and lifestyle changes, and (viii) therapeutic treatment views/perceptions. In order to evaluate the repeatability of the IAATQ- CMD tool, Cohen’s kappa statistic was calculated for qualitative questions, while Kendall’s tau-b and the Bland &amp; Altman methods were applied for quantitative questions. Results: Fifty individuals (Mean (Standard Deviation (SD)): (66 (14) years old; 68% females) were recruited for the repeatability process. The repeatability of all parts of the IAATQ-CMD questionnaire was found to be adequate, as the relevant statistics (Cohen’s kappa, Kendall’s tau-b and the Bland &amp; Altman method) ranged in acceptable limits.

Association between device-measured stepping behaviors and cardiometabolic health markers in middle-aged women: The Australian Longitudinal Study on Women's Health.

The associations between different types and contexts of stepping behaviors and cardiometabolic (CM) health markers are unclear. This study aimed to examine the associations of daily total, walking, stair, incidental and purposeful steps with cardiometabolic risk. A total of 943 women (mean age ± SD = 44.1 ± 1.6 years) from the Australian Longitudinal Study on Women's Health (ALSWH) were included in this cross-sectional study. Daily total, walking, stair, incidental, and purposeful steps were measured using thigh-worn accelerometry. Outcomes comprised of CM markers of adiposity, blood pressure, resting heart rate, lipids, glycaemia, and the composite CM score. We used generalized linear modeling and multiple linear regression to assess the associations. We observed that all stepping behaviors were beneficial to CM health, for example, compared to the lowest quartile (Q1), the change of the composite CM score across low to high quartile of purposeful steps was -0.12 (Q2, 95% CI: -0.41, 0.17), -0.16 (Q3, -0.46, 0.14), and -0.36 (Q4, -0.66, -0.05). Stair steps showed linear associations with blood pressure and adiposity biomarkers, for example, the change of quartile of waist circumference was -1.45 cm (Q2, -4.35, 1.44), -3.56 cm (Q3, -6.52, -0.60), and -7.08 cm (Q4, -10.31, -3.86). Peak 30-min walking intensity showed independent association with adiposity biomarkers (p linear < 0.001 and p = 0.002 for waist circumference and BMI, respectively). Our study showed that all stepping forms were beneficial to CM health. Higher stair steps and peak 30-min walking cadence were associated with a steep decline of adiposity biomarkers. Purposeful steps showed more consistent associations with CM biomarkers than incidental steps.

Abstract P527: Epidemiology of Adverse Childhood Experiences and Cardiometabolic Risks

Purpose: Adverse Childhood Experiences (ACEs) have been linked to a wide range of adverse health outcomes. The purpose of this research is to better understand this association and elucidate the mechanisms by which ACEs influence cardiometabolic (CM) risk factors (blood pressure, BMI, pre-diabetes). Racial/ethnic distribution of ACEs and potential health outcomes were also examined. Methods: This study utilized data from the Florida Behavioral Risk Factor Surveillance System for the 2019-2021 survey years to examine the racial/ethnic distribution of ACEs and cardiometabolic risks. Results: A total of 13,198 participants were included in this study with non-Hispanic Whites representing 76% of the study population. The highest percentage of each racial/ethnic group reported two or fewer ACEs. The Multiracial non-Hispanic group tended to have higher percentages of reported ACEs. The association between ACEs and CM risk factors significantly differed across racial/ethnic groups.

Pre- and postnatal exposure to secondhand tobacco smoke and cardiometabolic risk at 12 years: Periods of susceptibility

BackgroundTo identify periods of heightened susceptibility to the association of secondhand tobacco smoke (SHS) exposure with cardiometabolic (CM) risk at age 12 years. MethodsWe used data from 212 adolescents from the HOME Study, a prospective pregnancy and birth cohort in Cincinnati, OH. Using multiple informant models, we estimated associations of maternal serum cotinine (mean of concentrations at 16 and 26 weeks of pregnancy) and children's serum cotinine concentrations (mean of concentrations at ages 1, 2, 3, and 4 years) with a CM risk summary score constructed of five risk components measured at age 12 years. We determined if these associations differed for pre- and postnatal exposure periods, and adolescent's sex. ResultsWe found some evidence that the cotinine-outcome associations differed by exposure period and sex. Postnatal, but not prenatal, cotinine was associated with higher CM risk scores and individual CM risk component values (interaction p-values = 0.04 to 0.35). Each 10-fold increase in postnatal cotinine was associated with 0.57 (95% CI: 0.32, 1.45), 0.09 (95% CI: 0.13, 0.31), 0.14 (−0.08, 0.35), 0.07 (95% CI: 0.34, 0.48), and 0.11 (95% CI: 0.04, 0.27) higher CM risk, HOMA-IR, TG to HDL-C ratio, leptin to adiponectin ratio, and visceral fat area. Postnatal cotinine was associated with higher visceral fat area among females but not males (sex × period × cotinine interaction p-value = 0.01). ConclusionsSerum cotinine concentrations during the postnatal period had greater influence on adolescent's CM risk compared to the prenatal period, and these associations may be sex-specific. This study reinforces the need for ongoing public health interventions to minimize children's exposure to SHS.

Individual Differences in the Association of Lifestyle with Cardiometabolic Risk in Middle-Aged Koreans Based on Traditional Korean Medicine.

Cardiometabolic (CM) risk differs in morbidity and disease progression depending on lifestyle and individual characteristics. This cross-sectional study aimed to analyze the association between CM risk and lifestyle and examine whether this association varies based on Sasang constitution (SC), a Korean medicine classification. Data were analyzed from 1996 individuals participating in the Korean Medicine Daejeon Citizen Cohort study. Individuals with CM risk had two to five CM risk factors. Lifestyle factors included physical activity, sleep duration, and eating index. SC types were Taeeum-in (TE) and non-TE. We estimated the odds ratio (OR) and 95% confidence interval for CM risk based on SC and lifestyle factors. Among the participants, 33.9% had a CM risk, and the TE and non-TE groups were 26.2% and 7.7%, respectively. In the TE group, CM risk was associated with low physical activity (OR, 1.63) and moderate eating index (OR, 1.41). In the non-TE group, CM risk was associated with ≥8 h of sleep (OR, 1.87) and marginally associated with ≤6 h of sleep. In the TE group alone, CM risk was significantly associated with lifestyle patterns that combined the three lifestyle factors and was approximately two-fold higher in patterns involving less physical activity. The effects of lifestyle on CM risk differed across SC types. To decrease the burden of cardiovascular diseases in middle-aged adults, we recommend an individualized management strategy of healthy lifestyle interventions for cardiovascular risks.

Racial disparities and prevalence of cardiovascular disease risk factors, cardiometabolic risk factors, and cardiovascular health metrics among US adults: NHANES 2011–2018

This study estimated the prevalence of cardiovascular disease (CVD) risk factors, cardiometabolic (CM) risk factors, and cardiovascular health metrics (CVHMs) among US adults and across race/ethnicity groups. The study comprised 8370 US adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) 2011–2018, free of coronary heart disease/heart failure, angina/angina pectoris, heart attack, and stroke, who provided complete data for the outcome variables of interest. Age-adjusted prevalence of CVD and CM risk factors, and CVHMs were computed for all adults and across race/ethnicity groups. All analyses accounted for the complex, multi-stage survey sampling design of the NHANES. Hypertension (45.0%), obesity (40.0%), fasting plasma glucose ≥ 100 mg/dL or hypoglycemic medication (51.0%), ideal physical activity (59.2%) and ideal smoking status (56.9%) were most prevalent for the whole sample. Mexican Americans and non-Hispanic Blacks had elevated risk for some, but not all, CVD and CM risk factors compared to non-Hispanic Whites and non-Hispanic Asians. Reducing further health disparities and persisting differences among racial and ethnic groups is vital to achieving the American Heart Association vision of all people having ideal cardiovascular health, living healthier and longer.

Abstract 14801: Protective Associations of Dairy Foods and Cardiometabolic Markers Differ by Food Type and Fat Content: The Boston Puerto Rican Health Study

Introduction: The relation of dairy intake with cardiometabolic (CM) markers remains unclear due to a complex nutrient profile across dairy types. This study aimed to evaluate associations between dairy intake and CM markers among Puerto Rican adults with excessive CM burden. Methods: Baseline and 2-y follow-up data on diet and CM markers were available for 1110 participants aged 46-78y. Diet was assessed with a validated food frequency questionnaire. Dairy groups (total, milk, yogurt, cheese, cream, total with any fat, total without fat) were created from disaggregated foods and presented as servings/d/2000 kcal (s/d). Mean dietary intakes across two visits were used. CM biomarkers were assessed from fasted blood at 2-y and included waist circumference (WC), HDL and LDL cholesterol, TG, insulin, HbA1c, HOMA-IR, homocysteine (Hcy), C-reactive protein (CRP), blood pressure (BP) and Framingham risk score (FRS). Generalized linear and logistic regression were used to determine associations between dairy variables and each CM marker, adjusted for age, sex, BMI, kcal, alcohol and fruit /vegetable intakes, CVD/diabetes medications, language acculturation score, smoking, perceived stress, and physical activity. Multiple comparisons were adjusted by FDR correction. Results: Mean age was 59.3±7.7y, 70% female, 80% with metabolic syndrome. Total dairy intake was 2.3±1.1 s/d; 2.1±1.0 from dairy with fat and 0.2±0.5 without fat. Total dairy, dairy with fat, and milk intakes were associated with lower Hcy (β -0.37, SE 0.12, P =0.0012; β -0.39, SE 0.13, P =0.003; β -0.42, SE 0.13, P =0.002; respectively); non-fat dairy with lower WC (β -1.41, SE 0.44, P =0.001); milk with lower odds of high BP (OR 0.84, P =0.04); cheese with lower TG (β -18.5, SE 9.2, P= 0.04); yogurt with lower HbA1c (β -0.46, SE 0.17, P =0.008); cream with lower HbA1c (β -0.20, SE 0.10, P =0.04) and HOMA-IR (β -1.33, SE 0.56, P =0.02). No associations were seen with cholesterol, CRP, insulin, or TG. After FDR correction, findings remained significant for total dairy, dairy with fat, and milk with Hcy. Conclusions: Protective associations of dairy with specific CM markers vary by type of dairy and fat content. Associations were independent of overall dietary pattern and other risk factors for CM disease.

Abstract 11488: Comparative Effectiveness of PET and SPECT Myocardial Perfusion Imaging for Identification of Low-Risk Patients With Cardiometabolic Disease

Introduction: The epidemiology of coronary artery disease (CAD) has shifted, with increasing cardiometabolic (CM) disease and decreasing obstructive CAD in patients referred for myocardial perfusion imaging (MPI). Coronary microvascular dysfunction, defined as impaired coronary flow reserve (CFR) by positron emission tomography (PET), has emerged as a key mediator of risk. Our objective was to assess whether CFR provides additive value to identify low-risk CM disease patients compared with single-photon emission computed tomography (SPECT) MPI. Methods: We retrospectively studied patients with CM disease (obesity, diabetes, or chronic kidney disease (CKD) stage ≥3) and without known CAD referred for PET or SPECT MPI at our center from 2006 to 2020. Annualized all-cause and cardiac mortality was determined from death certificates, and propensity-matched low-risk PET and SPECT patients were compared using Poisson and Cox regression. Results: CM disease was prevalent in consecutive MPI referrals without CAD including obesity (N=8869), diabetes (N=4896) and CKD (N=3555), and higher among PET MPI (p &lt;0.001). Prevalence of summed stress score (SSS) &gt;3 reflecting obstructive CAD was low (12%, 15% and 16%). Conversely, prevalence of CFR &lt;2 was high (52%, 61% and 69%), reflecting impaired myocardial perfusion. In adjusted hazard analysis, normal MPI was associated with lower risk of all-cause and cardiac death (p &lt;0.001). Normal PET (SSS ≤3 and CFR &gt;2) was associated with lower all-cause death compared to normal SPECT (Figure, A). Normal PET and SPECT identified low-risk (&lt;1%/year cardiac death) patients with obesity and diabetes, however those with CKD remained moderate-risk (1-3%/year) (Figure, B). Conclusion: CM disease is common among patients without CAD referred for MPI. Normal PET and SPECT MPI identify a low-risk group for obesity and diabetes, but not CKD. PET with CFR has additive prognostic utility to identify low-risk individuals compared to SPECT.