Coronary Artery Risk Development In Young Adults Research Articles

Characterizing the Spectrum of Bladder Health and Lower Urinary Tract Symptoms (LUTS) Among Women: Results From the CARDIA Study

To operationalize a new definition for bladder health, we examined the distribution of lower urinary tract symptoms (LUTS) and impact, along with associated factors, among women in the Coronary Artery Risk Development in Young Adults (CARDIA) study. We performed cluster analyses using validated LUTS symptom burden and impact scales collected between 2005-2006 and 2010-2011. We performed multinomial logistic regression analyses to evaluate cardiovascular factors (metabolic syndrome, cardiovascular health behaviors, and inflammation) between clusters after adjusting for covariates (demographic, obstetric/gynecologic, co-morbidities). Among CARDIA women (median age 51, range 42-59) with complete LUTS data (n=1302), we identified and compared 4 cluster groups: women who reported no or very mild symptoms and no impact on well-being (bladder health, 44%, n=569), versus women with LUTS and negative impact on well-being ranging from mild (31%, n=407), moderate (20%, n=259), to severe (5%, n=67). With each 1-point lower BMI (kg/m2), odds of membership in mild (OR 0.97, CI 0.95-0.99), moderate (OR 0.95, CI 0.93-0.98), and severe (OR 0.90, CI 0.88-0.94) LUTS cluster groups versus the bladder health group were lower. Compared to women with metabolic syndrome, women without metabolic syndrome had lower odds of membership in mild (OR 0.67, CI 0.45-0.99), moderate (OR 0.51, CI 0.33-0.79), and severe (OR 0.48, CI 0.24-0.94) LUTS cluster groups versus the bladder health group. Two out of 5 midlife women met our definition of bladder health. Bladder health and cardiovascular health among women may share common factors, including lower BMI and the absence of metabolic syndrome.

Which Predicts Incident Cardiovascular Disease Better: A Plant-Centered Diet or a Low-Saturated Fat Diet? The Coronary Artery Risk Development in Young Adults (CARDIA) Study

ObjectivesA low-saturated fat diet has been suggested to reduce serum cholesterol and thereby presumably lower the risk of atherosclerotic cardiovascular disease (CVD). We compared associations of a low-saturated fat diet vs a plant-centered diet with lower serum low-density lipoprotein cholesterol (LDL-C) concentration and risk of incident CVD, coronary heart disease (CHD), and stroke. MethodsWe followed 4,887 Black and White men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, ages 18–30 years and free of CVD at baseline from 1985–86 (exam year 0) to 2018 (year 32). The A Priori Diet Quality Score (APDQS), a measure of plant-centered diet quality, was assessed in an interviewer-administered diet history at years 0, 7, and 20. Higher APDQS implies higher intake of nutritionally-rich plant foods with less high-fat meats and unhealthy plant foods. Low-saturated fat diet was judged by lower the Keys score, based on saturated fat, polyunsaturated fat, and dietary cholesterol intake. Linear and proportional hazards regression models were used, the latter with time-varying average APDQS and CVD outcomes, both adjusted for age, sex, race, education, energy intake, physical activity, smoking, and parental history of CVD (CVD outcome only). ResultsHigher APDQS had higher dietary fiber and lower total and saturated fat. Keys score and APDQS 7-year changes correlated similarly with lower concurrent LDL-C change. During the 32 year follow-up, we documented 280,135, and 92 incident cases of CVD, CHD, and stroke, respectively. LDL-C predicted CVD and CHD, but not stroke. APDQS, but not Keys score, was associated with a lower risk of each CVD outcome. Multivariable-adjusted HRs per 1-SD increment for the APDQS were 0.81 (95% CI: 0.68 – 0.96) for CVD, 0.78 (95% CI: 0.61 – 1.00) for CHD, and 0.71 (95% CI: 0.52 – 0.98) for stroke. The primary results for APDQS and for LDL-C were not substantially altered in mutually adjusted models. ConclusionsBoth a plant-centered and a low-saturated fat diet were associated with lower LDL-C. A plant-centered diet and LDL-C, but not a low-saturated fat diet, were associated with long-term CVD risk. Our findings imply that dietary strategies aimed solely to lower saturated fat may be less effective in reducing CVD burden than recommendations for a plant-centered diet. Funding SourcesHFHL, MnDRIVE, NHLBI.

Association of Magnesium Intake With Sleep Duration and Sleep Quality: Findings From the CARDIA Study

ObjectivesAs an antagonist of calcium (Ca), magnesium (Mg) has been hypothesized to improve individuals’ sleep disturbances, a common health problem, through regulating the glutamatergic and GABAergic systems. The objectives of this study were to examine the longitudinal associations of Mg intake and Ca-to-Mg intake ratio with sleep quality and duration. MethodsA total of 5115 American young adults, aged 18–30 years, were enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Dietary information, including intakes of Mg and other nutrients, was obtained using the CARDIA dietary history at baseline (1985–86), year 7 (1992–93), and year 20 (2005–06). Sleep measures, including self-reported sleep quality and sleep duration, were collected at year 15 (2000–01) and year 20. Sleep quality was assessed on a scale of 1 (very good) to 5 (very bad), whereas sleep duration was grouped into three categories: <7 hours, 7–9 hours, and >9 hours. Generalized estimating equation (GEE) was used to examine the associations of interest. ResultsAfter adjustment for potential demographical, behavioral, and nutritional confounders, Mg intake was associated with better sleep quality [highest intake quartile (Q4) vs. lowest intake quartile (Q1): odds ratio (OR) = 1.23; 95% CI = 1.00, 1.50, P for trend = 0.052]. Participants in Q4 were also less likely to have short sleep (<7 hours) compared to those in Q1 (OR = 0.64; 95% CI = 0.51, 0.81, P for trend = 0.012). The observed association with short sleep persisted among participants without depressive disorders (Q4 vs. Q1: OR = 0.64; 95% CI = 0.49, 0.82, P for trend <0.001), but not among individuals with depressive disorder. Ca-to-Mg intake ratio was not associated with either sleep quality or sleep duration regardless of depression status. ConclusionsMg intake was associated with sleep quality and duration in this longitudinal analysis. Randomized controlled trials with objective measures of sleep are warranted to establish the potential causal inference. Funding SourcesNational Institutes of Health (NIH).

Abstract P052: Less Appendicular Lean Mass Adjusted For Body Mass Index Is Associated With Higher Incident Diabetes In Middle-aged Adults In The CARDIA Study

Although less muscle mass is associated with greater diabetes prevalence in cross-sectional studies, prospective data in middle-aged Black and White adults are lacking. Middle age is a critical window as accelerated muscle loss is yet to occur, and preventing diabetes reduces lifelong morbidity and mortality. We hypothesized that lower appendicular lean mass adjusted for body mass index (ALM/BMI) is associated with higher incident diabetes in middle-aged Black and White adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study. ALM/BMI was measured by dual x-ray energy absorptiometry (DXA) in 2005-06 among middle-aged US men (n=855) and women (n=1045) in CARDIA. Incident diabetes occurred if any of the following were met in 2010-11 or 2015-16 among persons without diabetes in 2005-06: fasting glucose ≥7 mmol/L (126 mg/dL), 2-hour glucose ≥11.1 mmol/L (200 mg/dL) on a 75-gram glucose tolerance test, HbA 1C ≥48 mmol/mol (6.5%), or use of glucose-lowering medications. We used logistic regression models with sex stratification given sex differences in ALM. In men, mean age was 45.0 ± 3.5 y, BMI 28.0 ± 4.3 kg/m 2 , and ALM/BMI 1.07 ± 0.14 m 2 . In women, mean age was 45.2 ± 3.6 years, BMI 28.4 ± 6.4 kg/m 2 , and ALM/BMI 0.73 ± 0.12 m 2 . Diabetes developed in 70 men (8.2%) and 72 women (6.9%). For each standard deviation increase in ALM/BMI (m 2 ), the risk of diabetes decreased by 22% in men and 29% in women (Table 1). After adjusting for age, race, smoking, education, physical activity, and waist circumference, the association of ALM/BMI with diabetes incidence was no longer significant. Associations were similar between race-ethnic groups. In conclusion, less relative skeletal muscle mass is associated with a greater risk of developing diabetes in middle-aged men and women over 10 years, which is largely explained by the relationship of ALM/BMI to other metabolic risk factors. Low skeletal muscle mass in middle age is a marker for greater diabetes risk and may be a target for preventative interventions.

Abstract 071: Ten-year Change In Tv Viewing Is Associated With Concurrent Change In Pericardial Adipose Tissue In Middle-aged Adults: The Coronary Artery Risk Development In Young Adults (CARDIA) Study

Introduction: Pericardial adipose tissue (PAT), an ectopic adipose depot surrounding the coronary arteries, is a pathogenic risk factor for cardiometabolic disease; however, the association of sedentary behavior with PAT is poorly understood. We examined the longitudinal association of 10-year change in TV viewing with concurrent change in PAT. Hypothesis: Increased h/day of TV viewing over 10 years are associated with larger mean increases in PAT during the same 10-year period. Methods: Middle-aged adults (N=1659, mean age=40.4, 912 females, 733 blacks) from the Coronary Artery Risk Development in Young Adults (CARDIA) Study at the exam years 15 (2000-2001) and 25 (2010-2011) were included. Both TV viewing (h/day) and the volume of PAT (mL) were measured at Years 15 and 25 using the CARDIA physical activity questionnaire and computed tomography, respectively. Covariates measured at year 15 included PAT, sociodemographic factors, cardiovascular disease risk factors, diet quality, TV viewing, moderate-to-vigorous intensity physical activity (MVPA), inflammatory cytokines, and waist circumference. Multivariable linear regression was used to estimate 10-year change in PAT across increasing tertiles (≤ -1, &gt; -1 to &lt; 1, ≥ 1 h/day) of 10-year changes in TV viewing. Results: On average, TV viewing and PAT increased between the two exam years by 0.2 h/day (8.7% increase, mean: 2.3 → 2.5 h/day) and 11.8 mL (25.9% increase, mean: 45.6 → 57.4 mL), respectively (all p &lt; 0.01). In the fully adjusted model including MVPA and other major confounders, the highest tertile of 10-year change in TV viewing was associated with greater change in PAT (β = 2.97 mL, p &lt; 0.01) when compared with the lowest tertile (see Figure 1 ), while mean PAT change was intermediate in the middle tertile. Conclusions: A greater 10-year increase in TV viewing is associated with a greater concurrent increase in PAT, independent of MVPA and other important confounders. Reducing TV viewing time may be associated with less PAT accumulation with age.

Abstract P202: Early To Midlife Smoking Trajectories And Cognitive Function In Middle Aged Us Adults: The Coronary Artery Risk Development In Young Adults Study

Introduction: Smoking starts in early adulthood and persists throughout the lifecourse, but the association between these trajectories and midlife cognition remains unclear. We assessed the hypothesis that individuals with a heavy smoking trajectory from early adulthood to midlife would be more likely to demonstrate poor cognition at midlife. Methods: We studied 3364 participants (mean age: 50.1±3.6, 56% female, 46% black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Smoking trajectories were derived in latent class analysis among 1638 ever smokers based on smoking measures every 2-5 years from baseline (age 18-30, 1985-86) through Year 25 (2010-11). We estimated poor cognition using cognitive domain scores ≥1SD below the mean from tests of processing speed (Digit Symbol Substitution Test), executive function (Stroop) and memory (Rey Auditory Verbal Learning Test) at Year 25. Using adjusted logistic regression models, we examined the odds associated with poor midlife cognition and smoking trajectories (reference never smokers, n=1726) from early adulthood to midlife. Results: Five smoking trajectories emerged over 25-years: quitters (20%, 20/100), and minimal stable (40%, 40/100), moderate stable (20%, 20/100), heavy stable (15%, 15/100) and heavy declining smokers (5%, 5/100). As shown in the Figure, heavy stable smokers demonstrated poor cognition on all 3 domains compared to never smokers. Compared to never smokers, both heavy declining and moderate stable smokers exhibited slower processing speed, and heavy declining smokers additionally demonstrated poor executive function. For minimal stable smokers and quitters, no association was observed. Conclusions: In conclusion, we observed a dose-dependent association between early to midlife smoking and cognitive health risk at midlife. Our results underscore the cognitive health risk of moderate and heavy smoking trajectories in early and midlife periods and highlight the potential benefits of quitting, even in midlife.

Abstract MP27: Changes In Cardiac Structure And Function Over 25 Years Are Associated With Lower Midlife Cognition: The Cardia Study

Background: Cardiovascular risk factors are associated with worse cognition, yet much less is known about the association of cardiac structure and function and decline over time with cognitive function, even as early as midlife. Method: We included 2256 subjects from the CARDIA (Coronary Artery Risk Development in Young Adults) study (60% women, 44% black). Echocardiograms were repeated at Years 5, 25, 30 (mean age 30, 50, 55 years, respectively) to assess left ventricular (LV) mass (LVM); LV systolic function with LV ejection fraction (LVEF); LV diastolic function with left atrial volume (LAV) and early peak mitral velocity (E)/early peak mitral annular velocity (e’) ratio. Five cognitive domains were assessed at Year 30: verbal memory, verbal fluency, processing speed, executive function, and global cognition. We investigated the association of (1) 25-year change and (2) Year 25 cardiac structure and function on midlife cognition using linear regressions. Results: Over 25 years, LVM and LAV increased with mean change (SD) of 5.7 g/m 2 (21.7) and 9.6 mL/m 2 (7.4) while LVEF decreased by mean (SD) change of 1.5% (9.0). Greater 25-year increase in LVM was associated with lower global cognition, processing speed, executive function, verbal memory, and verbal fluency. Similarly, greater 25-year increase in LAV was associated with lower cognition on most cognitive domains. Adjustment for (1) demographics, education and (2) hypertension, diabetes, smoking did not notably change the results. 25-year decrease in LVEF was not associated with cognition. In addition, higher Year 25 LVM, LAV and E/e’ ratio were significantly associated with worse cognition on most cognitive domains. Conclusion: Midlife altered cardiac structure and adverse changes from early to middle adulthood are associated with lower midlife cognition. Moreover, LV diastolic but not systolic dysfunction is linked to lower cognition. Our results provide novel information linking early to midlife cardiac structure and function to cognition.

Inconsistent Reporting of Discrimination Over Time Using the Experiences of Discrimination Scale: Potential Underestimation of Lifetime Burden.

Studies documenting self-reported experiences of discrimination over the life course have been limited. Such information could be important for informing longitudinal epidemiologic studies of discrimination and health. We characterized trends in self-reports of racial, socioeconomic status, and gender discrimination over time measured using the Experiences of Discrimination Scale, with a focus on whether individuals' reports of lifetime discrimination were consistent over time. Overall experiences of discrimination and the number of settings in which discrimination was reported in 1992, 2000, and 2010 were examined among 2,774 African-American and White adults in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Reports of "ever" experiencing discrimination decreased for all forms of discrimination across the 3 study visits. Approximately one-third (30%-41%) of the sample inconsistently reported ever experiencing any discrimination over time, which contributed to the observed decreases. Depending on the form of discrimination, inconsistent reporting patterns over time were more common among African-American, younger, less educated, and lower-income individuals and women-groups who are often most exposed to and severely impacted by the health effects of discrimination. Our findings highlight the possible underestimation of the lifetime burden of discrimination when utilizing the Experiences of Discrimination Scale to capture self-reports of discrimination over time.

Cardiovascular risk and functional burden at midlife: Prospective associations of isotemporal reallocations of accelerometer-measured physical activity and sedentary time in the CARDIA study

Cardiovascular risk and functional burden, or the accumulation of cardiovascular risk factors coupled with functional decline, may be an important risk state analogy to multimorbidity. We investigated prospective associations of sedentary time (ST), light intensity physical activity (LPA), and moderate to vigorous intensity physical activity (MVPA) with cardiovascular risk and functional burden at midlife. Participants were 1648 adults (mean ± SD age = 45 ± 4 years, 61% female, 39% Black) from Coronary Artery Risk Development in Young Adults (CARDIA) who wore accelerometers in 2005–2006 and 2015–2016. Cardiovascular risk and functional burden was defined as ≥2 cardiovascular risk factors (untreated/uncontrolled hypertension and hypercholesterolemia, type 2 diabetes, reduced kidney function) and/or functional decline conditions (reduced physical functioning and depressive symptoms). Prospective logistic regression models tested single activity, partition, and isotemporal substitution associations of accelerometer-measured ST, LPA, and MVPA with cardiovascular risk and functional burden 10 years later. In isotemporal models of baseline activity, reallocating 24 min of ST to MVPA was associated with 15% lower odds of cardiovascular risk and functional burden (OR: 0.85; CI: 0.75, 0.96). Reallocating 24 min of LPA to MVPA was associated with a 14% lower odds of cardiovascular risk and functional burden (OR: 0.86; CI: 0.75, 0.99). In longitudinal isotemporal models, similar beneficial associations were observed when 10-year increases in MVPA replaced time in ST or LPA. Findings suggest that maintaining an MVPA dose reflecting daily physical activity recommendations in early midlife is associated with lower odds of cardiovascular risk and functional burden later in midlife.

Calcium Intake Is Inversely Related to Risk of Obesity among American Young Adults over a 30-Year Follow-Up.

Calcium (Ca) is an essential nutrient that may play an important role in weight maintenance through its involvement in energy or lipid metabolism. However, little is known about the long-term associations of Ca intake with obesity risk. We aimed to prospectively examine the association between cumulative Ca intake and the incidence of obesity among American young adults over 30 y of follow-up. Participants were from the CARDIA (Coronary Artery Risk Development in Young Adults) study. A total of 4097 of 5115 black and white individuals aged 18-30 y at baseline in 1985-1986 were included in the current analysis. Dietary and supplemental Ca intake was assessed by the validated interview-based CARDIA diet history at baseline and exam years 7 and 20. Incident cases of obesity were identified when BMI was ≥30kg/m2 for the first time since baseline. A survival analysis was performed using Cox proportional hazards regression models to estimate the HRs and corresponding 95% CIs for obesity incidence during follow-up. During a 30-y follow-up (mean±SD: 20± 10 y), 1675 participants developed obesity. Cumulative total Ca intake (dietary plus supplemental Ca) was inversely associated with incidence of obesity in multivariable-adjusted analysis [quintile (Q)5 (highest intake) compared with Q1 (lowest intake): HR: 0.68; 95% CI: 0.56, 0.82; P-trend <0.01]. This inverse association persisted among Ca supplement users (Q5 compared with Q1: HR: 0.53; 95% CI: 0.40, 0.70; P-trend <0.01), but was not seen among nonusers. Following a cohort of Americans from young adulthood to midlife, an inverse association between calcium intake and obesity incidence was observed. Further studies are needed to confirm our findings.

Cigarette Smoking and Longitudinal Associations With Blood Pressure: The CARDIA Study.

BackgroundThe associations of chronic cigarette smoking with blood pressure (BP) remain mixed. It is unclear whether a lack of examination of racial differences contributed to the mixed findings in previous studies. Black smokers metabolize nicotine at a slower rate than White smokers and racial discrimination contributes to nicotine dependence and higher BP among Black smokers.Methods and ResultsWe studied the association between cigarette smoking and longitudinal (30‐year) changes in systolic BP, diastolic BP, and pulse pressure (PP) in 4786 Black and White individuals from the CARDIA (Coronary Artery Risk Development in Young Adults) study using repeated‐measures regression models. Neither systolic BP, nor diastolic BP differed between Black consistent smokers compared with Black never smokers, although Black consistent smokers had higher PP than Black never smokers (β=1.01 mm Hg, P=0.028). White consistent smokers had similar systolic BP, but lower diastolic BP (β=−2.27 mm Hg, P<0.001) and higher PP (β=1.59 mm Hg, P<0.001) compared with White never smokers. There were no differences in systolic BP, diastolic BP, or PP between Black or White long‐term former smokers compared with never smokers (all P>0.05).ConclusionsAlthough the associations of cigarette smoking with alterations in BP are small, the greater PP observed in consistent smokers may contribute in part to the higher cardiovascular disease risk observed in this group because PP is a strong predictor of cardiovascular disease risk after middle age.

Clinical Correlates of Early-Onset Hypertension

BACKGROUNDEarly-onset hypertension has been established as a heritable trait and a risk factor for cardiovascular disease outcomes. However, the clinical correlates of early-onset hypertension remain unidentified.METHODSIn this study, we assessed the demographic characteristics and lifestyle factors related to hypertension onset age in a sample of 3,286 Coronary Artery Risk Development in Young Adults (CARDIA) study participants (mean baseline age 25 ± 4 years, 57% women). We examined the association between the participants’ baseline characteristics and age of hypertension onset subgroups (<35, 35‒44, or ≥45 years) using a multinomial logistic regression model with those who did not develop hypertension as the reference group. Hypertension onset was defined as blood pressure ≥140/90 mm Hg or antihypertensive medication use on 2 consecutively attended follow-up visits.RESULTSIn the multinomial logistic regression model, individuals who were black (odds ratio [OR], 5.08; 95% confidence interval [CI], 3.17–8.14), were more obese (OR, 1.57; 95% CI, 1.32–1.88), or had higher total cholesterol (OR, 1.34; 95% CI, 1.13–1.60 per SD) had increased odds of early-onset hypertension (onset at <35 years) vs. not developing hypertension. In contrast, 1-SD higher high-density lipoprotein (HDL)-cholesterol was related to decreased odds of early-onset hypertension (OR, 0.71; 95% CI, 0.57–0.89). The odds for having earlier hypertension onset increased linearly across age of onset categories in black individuals and individuals with lower HDL-cholesterol (P < 0.05 for trend for both).CONCLUSIONSOur findings suggest that individuals who are black, obese, have higher total cholesterol, or have lower HDL-cholesterol level, are potentially at an increased risk of having early-onset hypertension.

Magnesium intake was inversely associated with hostility among American young adults

Hostility is a complex personality trait associated with many cardiovascular risk factor phenotypes. Although magnesium intake has been related to mood and cardio-metabolic disease, its relation with hostility remains unclear. We hypothesize that high total magnesium intake is associated with lower levels of hostility because of its putative antidepressant mechanisms. To test the hypothesis, we prospectively analyzed data in 4,716 young adults aged 18-30 years at baseline (1985-1986) from four U.S. cities over five years of follow-up using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Magnesium intake was estimated from a dietary history questionnaire plus supplements at baseline. Levels of hostility were assessed using the Cook-Medley scale at baseline and year 5 (1990-1991). Generalized estimating equations were applied to estimate the association of magnesium intake with hostility as repeated measures at the two time-points (baseline and year 5). General linear model was used to determine the association between magnesium intake and change in hostility over 5 years. After adjustment for socio-demographic and major lifestyle factors, a significant inverse association was observed between magnesium intake and hostility level over 5 years of follow-up. Beta coefficients (95% CI) across higher quintiles of magnesium intake were 0 (reference), -1.28 (-1.92, -0.65), -1.45 (-2.09, -0.81), -1.41 (-2.08, -0.75) and -2.16 (-2.85, -1.47), respectively (Plinear-trend<.01). The inverse association was independent of socio-demographic and major lifestyle factors, supplement use, and depression status at year 5. This prospective study provides evidence that in young adults, high magnesium intake was inversely associated with hostility level independent of socio-demographic and major lifestyle factors.

Longitudinal Associations of Fitness and Obesity in Young Adulthood With Right Ventricular Function and Pulmonary Artery Systolic Pressure in Middle Age: The CARDIA Study.

BackgroundLow cardiorespiratory fitness (CRF) and obesity are risk factors for heart failure but their associations with right ventricular (RV) systolic function and pulmonary artery systolic pressure (PASP) are not well understood.Methods and ResultsParticipants in the CARDIA (Coronary Artery Risk Development in Young Adults) study who underwent maximal treadmill testing at baseline and had a follow‐up echocardiographic examination at year 25 were included. A subset of participants had repeat CRF and body mass index (BMI) assessment at year 20. The associations of baseline and changes in CRF and BMI on follow‐up (baseline to year 20) with RV systolic function parameters (tricuspid annular plane systolic excursion, RV Doppler systolic velocity of the lateral tricuspid annulus), and PASP were assessed using multivariable‐adjusted linear regression models. The study included 3433 participants. In adjusted analysis, higher baseline BMI but not CRF was significantly associated with higher PASP. Among RV systolic function parameters, higher baseline CRF and BMI were significantly associated with higher tricuspid annular plane systolic excursion and RV systolic velocity of the lateral tricuspid annulus. In the subgroup of participants with follow‐up assessment of CRF or BMI at year 20, less decline in CRF was associated with higher RV systolic velocity of the lateral tricuspid annulus and lower PASP, while greater increase in BMI was significantly associated with higher PASP in middle age.ConclusionsHigher CRF in young adulthood and less decline in CRF over time are each significantly associated with better RV systolic function. Higher baseline BMI and greater age‐related increases in BMI are each significantly associated with higher PASP in middle age. These findings provide insights into possible mechanisms through which low fitness and obesity may contribute toward risk of heart failure.

DNA Methylation GrimAge and Incident Diabetes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

DNA methylation (DNAm)-based biological age (epigenetic age) has been suggested as a useful biomarker of age-related conditions including type 2 diabetes (T2D), and its newest iterations (GrimAge measurements) have shown early promise. In this study, we explored the association between epigenetic age and incident T2D in the context of their relationships with obesity. A total of 1,057 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study were included in the current analyses. We stratified the participants into three groups: normal weight, overweight, and obese. A 1-year increase of GrimAge was associated with higher 10-year (study years 15-25) incidence of T2D (odds ratio [OR] 1.06, 95% CI 1.01-1.11). GrimAge acceleration, which represents the deviation of GrimAge from chronological age, was derived from the residuals of a model of GrimAge and chronological age, and any GrimAge acceleration (positive GrimAA: having GrimAge older than chronological age) was associated with significantly higher odds of 10-year incidence of T2D in obese participants (OR 2.57, 95% CI 1.61-4.11). Cumulative obesity was estimated by years since obesity onset, and GrimAge partially mediated the statistical association between cumulative obesity and incident diabetes or prediabetes (proportion mediated = 8.0%). In conclusion, both older and accelerated GrimAge were associated with higher risk of T2D, particularly among obese participants. GrimAge also statistically mediated the associations between cumulative obesity and T2D. Our findings suggest that epigenetic age measurements with DNAm can potentially be used as a risk factor or biomarker associated with T2D development.

Abstract P326: Vascular Risk Factors in Adulthood and Increased Diffusion Complexity of Neural Tissue Structure

Introduction: We performed a region of interest diffusion tensor imaging (DTI) and advanced diffusion complexity analysis of neural tissue to determine the impact of vascular health on novel diffusivity metrics in midlife adults. Methods: As shown in Table 1, 77 participants (26 black, 35 female) at year 30 visit in the Coronary Artery Risk Development in Young Adults (CARDIA) longitudinal study were scanned with an advanced diffusion-weighted imaging and FLAIR protocol. Fractional anisotropy (FA) and non-linear diffusion complexity, C, measures were estimated. Cumulative vascular measures were tracked from baseline up to year 30 examination. Partial correlation analyses assessed the association between cumulative vascular measures and diffusion metrics in these participants. Results: As shown in Figure 1, higher systolic blood pressure exposure was associated with increased complexity, C, (red) and decreased FA (blue). Additionally, in the white matter of black participants, who exhibited a higher cumulative vascular risk exposure, FA was lower and complexity was higher in comparison to white matter in white participants. Conclusion: Higher burden of vascular risk factor exposure from adulthood to midlife is associated with changes in the diffusion properties of neural tissue in midlife. These diffusion measures may reflect novel markers of axonal disruption, increased inflammation, and/or increased glial proliferation. These new results suggest that microstructural changes in neural tissue are sensitive to vascular health during young adulthood and are possibly therapeutic targets in interventions focused on preserving neural tissue health across life.

Urinary sodium and potassium excretions in young adulthood and blood pressure by middle age: the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

Data are sparse regarding the impact of sodium and potassium intakes on serial blood pressure (BP) levels during long-term follow-up. Among 1007 Coronary Artery Risk Development in Young Adults participants (mean age, 30.2 years; 53% blacks; 57% women) who had at least two 24-h urine samples collected at year 5 (Y5) examination, we assessed associations of urinary sodium and potassium excretions with BP trends and incident hypertension in the subsequent 25 years. Participants were classified by sex-specific medians for averaged 24-h urinary excretions: lower sodium and higher potassium (Na-Lo-K-Hi); higher sodium and lower potassium (Na-Hi-K-Lo); and others. In the adjusted generalized estimating equation model, SBP and DBP greatly increased in the Na-Hi-K-Lo group (n = 185) compared with the Na-Lo-K-Hi group (n = 185), with statistically significant BP differences at Y20, Y25, and Y30 (mean SBP, 3.93, 4.94, and 4.88 mmHg, respectively; and mean DBP, 4.70, 4.95, and 4.59 mmHg, respectively). During 25-year follow-up, among 926 participants without prevalent hypertension by Y5, 381 (41.1%) developed hypertension. In the adjusted Cox proportional hazards model, the Na-Hi-K-Lo group had hazard ratio (95% confidence interval), 1.45 (1.00-2.10) for incident hypertension compared with the Na-Lo-K-Hi group. The association with incident hypertension was predominant in blacks and white women (race--sex interaction, P = 0.03). Sodium-to-potassium ratio and sodium excretion were positively, whereas potassium excretion was inversely, associated with incident hypertension (all P trend <0.05). Our findings highlight the importance of dietary sodium reduction and higher potassium intake for hypertension prevention among young adults.

The Association of Lactation Duration with Visceral and Pericardial Fat Volumes in Parous Women: The CARDIA Study.

Lactation is associated with lower risks for cardiovascular disease in women. Organ-related adiposity, which plays significant roles in the development of cardiometabolic diseases, could help explain this observation. We evaluated the association of lactation duration with visceral (VAT) and pericardial (PAT) fat volumes in women. Data were obtained from 910 women enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study (1985-1986) without diabetes prior to pregnancy who had ≥1 birth during 25 years of follow-up and had VAT and PAT measured from computed tomographic scans in 2010-2011. Cumulative lactation duration across all births since baseline was calculated from self-reports collected at periodic exams. At baseline, the average age of women (48% black, 52% white) was 24 ± 3.7 years. After controlling for baseline age, race, smoking status, body mass index, fasting glucose, family history of diabetes, fat intake, total cholesterol, physical activity, and follow-up covariates (parity, gestational diabetes), the mean fat volumes across categories of lactation [none (n = 221), 1-5 months (n = 306), 6-11 months (n = 210), and ≥12 months (n = 173)] were 122.0, 113.7 105.0, and 110.1 cm3 for VAT and 52.2, 46.7, 44.5, and 43.4 cm3 for PAT, respectively. Changes in body weight from the first post-baseline birth to the end of follow-up mediated 21% and 18% of the associations of lactation with VAT and PAT, respectively. In this prospective study, longer cumulative lactation duration was associated with lower VAT and PAT volumes, with weight gain partially mediating these associations.

Joint Associations of Multiple Dietary Components With Cardiovascular Disease Risk: A Machine-Learning Approach.

The human diet consists of a complex mixture of components. To realistically assess dietary impacts on health, new statistical tools that can better address nonlinear, collinear, and interactive relationships are necessary. Using data from 1,928 healthy participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort (1985-2006), we explored the association between 12 dietary factors and 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD) using an innovative approach, Bayesian kernel machine regression (BKMR). Employing BKMR, we found that among women, unprocessed red meat was most strongly related to the outcome: An interquartile range increase in unprocessed red meat consumption was associated with a 0.07-unit (95% credible interval: 0.01, 0.13) increase in ASCVD risk when intakes of other dietary components were fixed at their median values (similar results were obtained when other components were fixed at their 25th and 75th percentile values). Among men, fruits had the strongest association: An interquartile range increase in fruit consumption was associated with -0.09-unit (95% credible interval (CrI): -0.16, -0.02), -0.10-unit (95% CrI: -0.16, -0.03), and -0.11-unit (95% CrI: -0.18, -0.04) lower ASCVD risk when other dietary components were fixed at their 25th, 50th (median), and 75th percentile values, respectively. Using BKMR to explore the complex structure of the total diet, we found distinct sex-specific diet-ASCVD relationships and synergistic interaction between whole grain and fruit consumption.

Early to Midlife Smoking Trajectories and Cognitive Function in Middle-Aged US Adults: the CARDIA Study.

Smoking starts in early adulthood and persists throughout the life course, but the association between these trajectories and midlife cognition remains unclear. Determine the association between early to midlife smoking trajectories and midlife cognition. Prospective cohort study. Participants were 3364 adults (mean age = 50.1 ± 3.6, 56% female, 46% Black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study: 1638 ever smokers and 1726 never smokers. Smoking trajectories were identified in latent class analysis among 1638 ever smokers using smoking measures every 2-5 years from baseline (age 18-30 in 1985-1986) through year 25 (2010-2011). Poor cognition was based on cognitive domain scores ≥ 1 SD below the mean on tests of processing speed (Digit Symbol Substitution Test), executive function (Stroop), and memory (Rey Auditory Verbal Learning Test) at year 25. Five smoking trajectories emerged over 25 years: quitters (19%), and minimal stable (40%), moderate stable (20%), heavy stable (15%), and heavy declining smokers (5%). Heavy stable smokers showed poor cognition on all 3 domains compared to never smoking (processing speed AOR = 2.22 95% CI 1.53-3.22; executive function AOR = 1.58 95% CI 1.05-2.36; memory AOR = 1.48 95% CI 1.05-2.10). Compared to never smoking, both heavy declining (AOR = 1.95 95% CI 1.06-3.68) and moderate stable smokers (AOR = 1.56 95% CI 1.11-2.19) exhibited slower processing speed, and heavy declining smokers additionally had poor executive function. For minimal stable smokers (processing speed AOR = 1.12 95% CI 0.85-1.51; executive function AOR = 0.97 95% CI 0.71-1.31; memory AOR = 1.21 95% CI 0.94-1.55) and quitters (processing speed AOR = 0.96 95% CI 0.63-1.48; executive function AOR = 0.98 95% CI 0.63-1.52; memory AOR = 0.97 95% CI 0.67-1.39), no association was observed. The association between early to midlife smoking trajectories and midlife cognition was dose-dependent. Results underscore the cognitive health risk of moderate and heavy smoking and the potential benefits of quitting on cognition, even in midlife.