Go Red For Women Research Articles

The role of social support in the relation between chronotype and mental health in a cohort of women from the American Heart Association Go Red for Women Strategically Focused Research Network

ABSTRACT Women are disproportionally affected by psychological distress and lack of social support and are more vulnerable to the negative impact of chronotype on mental health. This study evaluates cross-sectional associations between chronotype and mental health, while assessing the mediating role of social support among women from diverse racial/ethnic backgrounds. Women from the American Heart Association Go Red for Women Research Network were included (N = 506, mean age = 37 ± 15.7, 61% racial/ethnic minority). Chronotype, depression, perceived stress, health-related quality of life, and social support were assessed at baseline using validated self-reported questionnaires. Linear regression and causal mediation analyses were performed. Depression and negative emotionality were higher among women with evening vs. morning/intermediate chronotypes (all p < 0.05). Multivariable analyses adjusted for sociodemographic and clinical confounders showed associations between evening chronotype and higher depression (p = 0.004) and negative emotionality (p = 0.010). However, these associations were no longer significant after adjusting for social support (depression: p = 0.12; negative emotionality: p = 0.18). Social support significantly mediated 44.6% and 45.8% of the total effect of chronotype on depression and negative emotionality, respectively. Social support represents a potential mechanism underlying the associations between eveningness and poor mental health. Chronotype and social support should be considered in interventions for the promotion of mental health in women.

Psychosocial factors are associated with sleep disturbances and evening chronotype among women: A brief report from the American Heart Association Go Red for Women Strategically Focused Research Network.

To evaluate associations between psychosocial factors and sleep characteristics commonly linked to cardiovascular disease risk among racially/ethnically diverse women. Women from the AHA Go Red for Women cohort (N=506, 61% racial/ethnic minority, 37±16years) were assessed using self-reported questionnaires. Logistic regression models were adjusted for age, race, ethnicity, education, and insurance. Women with depression had ∼3-fold higher odds of short sleep (95%CI=1.69-4.61), 2-fold higher odds of poor sleep quality and obstructive sleep apnea risk (95%CI=1.42-3.70 and 1.34-4.24), 4-fold higher odds of insomnia (95%CI=2.42-6.59), and greater likelihood of having an evening chronotype (OR:2.62, 95%CI=1.41-4.89). Low social support was associated with insomnia (OR:1.79, 95%CI=1.18-2.71) and evening chronotype (OR:2.38, 95%CI=1.35-4.19). Caregiving was associated with short sleep (OR:1.73, 95%CI=1.08-2.77) and obstructive sleep apnea risk (OR:2.46, 95%CI=1.43-4.22). Depression, caregiver strain, and low social support are significantly associated with poor sleep and evening chronotype, highlighting a potential mechanism linking these psychosocial factors to cardiovascular disease risk.

Abstract MP41: The Association Between Psychological Distress and Obesity is Mediated by Sleep and Attenuated by Resilience Among Racially and Ethnically Diverse Women: Evidence From the American Heart Association Go Red for Women Strategically Focused Research Network

Introduction: Psychological distress has been linked to obesity through its impact on health behaviors, including sleep, while resilience has shown a protective effect on health. However, limited evidence is available on the role of sleep and resilience on the association between psychological distress and obesity, especially among women. Hypothesis: We hypothesized that sleep would be a significant mediator of the positive association between psychological distress and obesity markers, while higher resilience would attenuate this association in a community-sample of racially/ethnically diverse women. Methods: This was a cross-sectional analysis of baseline data collected from 237 women from the AHA Go Red for Women cohort (69% [163 of 237] racial/ethnic minority, 34.1±13.5y). Psychological and sleep variables were assessed using validated self-reported questionnaires, including psychosocial questionnaires (Perceived Stress Scale, Global Perceived Stress Scale, Life Events Checklist, Patient Health Questionnaire, Brief Resilience Scale) and sleep questionnaires (Pittsburgh Sleep Quality Index, Insomnia Severity Index). Sleep outcomes included sleep duration, sleep quality, and insomnia severity. Anthropometric measures of obesity were collected by a trained study staff member and included BMI and waist circumference. Linear regression models, causal mediation, and moderation analyses were performed, adjusting for age and insurance status. Results: There was a trend for a positive association between perceived stress and waist circumference (β=0.22±0.12, p=0.069). All measures of psychological distress were associated with poorer sleep outcomes (all p&lt;0.05). Having shorter sleep, poor quality sleep, and higher insomnia severity was associated with higher BMI (β=-1.12±0.30, β=0.23±0.11, β=0.17±0.07, respectively; all p&lt;0.05) and waist circumference (β=-1.08±0.27, β=0.29±0.10, β=0.19±0.06, respectively; all p&lt;0.05). Sleep duration (Natural Indirect Effect [NIE]=0.11±0.04, p=0.012), sleep quality (NIE=0.10±0.05, p=0.037), and insomnia severity (NIE=0.13±0.05, p=0.020) mediated the association between perceived stress and waist circumference. Resilience attenuated the association between perceived stress and waist circumference (interaction effects: -0.78±0.34, p=0.021), such that those with higher resilience had a lesser influence of perceived stress on waist circumference. Conclusions: These findings suggest that promoting better sleep health and resilience among women reporting psychological distress may help reduce the risk of obesity and should be considered within interventions for the promotion of cardiometabolic health. However, the temporality and causality of the relationships between psychological factors, sleep, and obesity should be further investigated in longitudinal and clinical studies.

Sex Disparities in Prevention of Atherosclerotic Cardiovascular Disease Across the Life Course.

HomeCirculationVol. 147, No. 7Sex Disparities in Prevention of Atherosclerotic Cardiovascular Disease Across the Life Course No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextSex Disparities in Prevention of Atherosclerotic Cardiovascular Disease Across the Life Course Fatima Rodriguez, MD, MPH Fatima RodriguezFatima Rodriguez Correspondence to: Fatima Rodriguez, MD, MPH, Center for Academic Medicine, Department of Medicine/Division of Cardiovascular Medicine, Mail Code 5687, Stanford University School of Medicine, 453 Quarry Rd, Palo Alto, CA 94304. Email E-mail Address: [email protected] https://orcid.org/0000-0002-5226-0723 Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, CA. Search for more papers by this author Originally published13 Feb 2023https://doi.org/10.1161/CIRCULATIONAHA.122.063148Circulation. 2023;147:523–525FootnotesCirculation is available at www.ahajournals.org/journal/circThis article is part of the Science Goes Red™ collection. Science Goes Red™ is an initiative of Go Red for Women®, the American Heart Association’s global movement to end heart disease and stroke in women.For Sources of Funding and Disclosures, see page 525.The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Correspondence to: Fatima Rodriguez, MD, MPH, Center for Academic Medicine, Department of Medicine/Division of Cardiovascular Medicine, Mail Code 5687, Stanford University School of Medicine, 453 Quarry Rd, Palo Alto, CA 94304. Email [email protected]edu

Variable Eating Patterns: A Potential Novel Risk Factor for Systemic Inflammation in Women.

The timing and regularity of eating patterns could play a role in systemic inflammation, as circadian clocks responsible for daily rhythms of inflammatory signaling are entrained by food intake. To evaluate associations of intra-weekly and weekday-weekend differences in eating timing patterns with high-sensitivity C-reactive protein (hsCRP). A community-based sample of 103 U.S. women from the American Heart Association Go Red for Women Strategically Focused Research Network completed a meal-timing questionnaire and provided a blood sample for measurement of hsCRP. Differences in weekday versus weekend eating start time, eating end time, and nightly fasting duration were calculated as eating jetlag metrics. Intra-weekly variability in eating timing patterns was defined by the standard deviation (SD) of these variables. Multivariable linear regression models were used to evaluate cross-sectional associations of eating timing variability metrics with hsCRP. Each additional 30-min difference in weekday-weekend eating end time was related to 13% higher hsCRP (p = .023). Similarly, every 30-min increase in eating end time SD, reflecting greater variability in timing of last eating occasion, was associated with 29% higher hsCRP. Per 1-hr weekday-weekend difference in nightly fasting duration, there was a 45% elevation in hsCRP (p = .003). Every 30-min increase in nightly fasting duration SD, representing greater variability in span of the daily fasting/eating periods, was associated with 46% higher hsCRP. Variable eating timing patterns were associated with higher hsCRP. Intervention studies are needed to determine whether stabilizing the timing of eating occasions may represent a novel strategy to reduce chronic inflammation.

Diet as adjunctive therapy for sleep apnea risk: not only how much but also what to eat.

Diet as adjunctive therapy for sleep apnea risk: not only how much but also what to eat.

Abstract 14219: White Cell Inflammatory Biomarkers in Women With Myocardial Infarction With Non-Obstructive Coronary Artery Disease (MINOCA): Findings From the American Heart Association Go Red for Women Strategically Focused Research Network

Introduction: Myocardial infarction (MI) with non-obstructive coronary artery disease (MINOCA) occurs in 5-20% of women with MI. Underlying mechanisms of MINOCA are incompletely understood. Complete blood count (CBC) quantifies circulating cell types and can shed mechanistic insight into disease pathogenesis.. Methods: Peripheral blood was collected from women with MINOCA (n = 50; median 64 years [IQR 51-69]) and MI with coronary artery disease (MI-CAD; n = 71; 61 years [55-70]). Controls were women referred for elective cardiac catheterization found not to have obstructive CAD (n = 65; 62 years [57-69]). Blood was analyzed at the time of catheterization and in a subset of participants after 2 months. Associations between CBC parameters and MI subtype were estimated by multivariable logistic regression. Results: Overall, women with MI had higher WBC (p=0.008), monocyte counts (p&lt;0.001), neutrophil counts (p=0.001), monocyte:lymphocyte ratio (p&lt;0.001), and neutrophil:lymphocyte ratio (p&lt;0.001) than controls. No significant difference was noted for lymphocyte count, hemoglobin, platelet count and platelet size. When comparing MINOCA versus MI-CAD, there was no significant difference in age, race/ethnicity, diabetes, hypertension, and peak troponin. Women with MINOCA had lower WBC and neutrophil counts than MI-CAD at the time of MI. Compared to controls, women with MINOCA had higher monocyte counts, monocyte:lymphocyte ratio, and neutrophil:lymphocyte ratio. After adjustment for demographics, hypertension, hyperlipidemia, and diabetes, only monocyte count (β 0.22, p=0.04) and monocyte:lymphocyte ratio (β 0.32, p=0.005) were significantly associated with MINOCA (versus controls). Among 13 women with MI-CAD and 15 with MINOCA who had blood analyzed 2 months post their MI, monocyte count and monocyte:lymphocyte ratio decreased in the MI-CAD group, but did not decrease in the MINOCA group. Controls: In contrast leukocytosis across all white cell types in MI-CAD, women with MINOCA have a higher monocyte count and monocyte:lymphocyte ratio than controls. These parameters remained elevated over time in a pattern different from MI-CAD, suggesting a mechanistic role of monocytes in the pathogenesis of MINOCA.

Abstract 10596: Telephone-Based Stress Management in Women with Myocardial Infarction: Findings from the Go Red for Women Strategically Focused Research Network

Introduction: Elevated perceived stress is associated with adverse outcomes following myocardial infarction (MI) and accounts in part for poorer recovery in women compared with men. The goal of this multicenter randomized controlled trial was to assess efficacy of a telephone-based stress management program on perceived stress, depressive symptoms, anxiety and quality of life (QOL) among women with MI. Methods: Women with elevated stress levels (Perceived Stress Scale [PSS-4]≥6) at least 2 months after MI were enrolled from 12 hospitals in the U.S. and Canada participating in the NYU Women’s Heart Attack Research Program (HARP). Participants were randomized in 12 cohorts to stress management (mindfulness-based cognitive therapy adapted for telephone; MBCT-T) or enhanced usual care (EUC; heart disease education) and followed for 6 months. Both programs were delivered by phone in 8 weekly sessions (group and individual, respectively). Linear mixed effects models were used to test between-group differences in PSS-10 scores (primary outcome), depressive symptoms (PHQ-9), anxiety (Hospital Anxiety and Depression Scale) and QOL (Seattle Angina Questionnaire, PROMIS-Global) at 6 months. Results: The sample included 130 women with elevated stress at ≥2 months from MI (age 59.8±12.8 years, 33.8% racial/ethnic minorities, 26.2% with MI with non-obstructive coronary arteries [MINOCA]). Mean baseline PSS-10 scores were similar (18.2±5.2 MBCT-T vs. 18.3±5.6 EUC). The median number of sessions completed was 7 (IQR 3,8) for MBCT-T and 8 (IQR 6,8) for EUC. The 6-month retention rates were 82.1% (MBCT-T) and 82.5% (EUC). Perceived stress and anxiety declined in the EUC arm (p&lt;.05) and anxiety and depressive symptoms declined in the MBCT-T arm (p&lt;.01) but there were no significant group by time interactions. We will report results of sensitivity analyses that explore predictors of treatment response (e.g., age, race/ethnicity, clinical history, baseline psychosocial factors, intervention adherence, satisfaction). Conclusions: Stress management did not improve perceived stress or secondary outcomes more than enhanced usual care. Identifying predictors of treatment response will inform future studies of psychosocial interventions for women with MI.

Role of Awareness Activities in Mega-Events

Abstract Background Cardiovascular diseases remain to be one of the leading causes of death worldwide. There are some well-established risk factors such as a genetic disposition (hereditary), hypertension (high blood pressure), diabetes mellitus, obesity, high cholesterol level, poor dietary habits, inactive lifestyle, and smoking. The Egyptian direction is to invest in developing educational programs on cardiovascular diseases for the whole community and particularly for women. This initiative is echoed by experts who call for urgent action to improve care, prevent disease and increase awareness of cardiovascular diseases generally and within the women community. The Egyptian community is in great need to public awareness campaigns about cardiovascular diseases especially myocardial infarction and stroke. The CardioVascular Research, Education, Prevention foundation (CVREP) in collaboration with Stent Save a Life (SSL) initiative Egypt and the American Heart Association (AHA) and its initiative “Go Red For Women”, initiated a very successful awareness campaign for physicians and for public during the mega cardiovascular conference CardioAlex.21. ICOM Group (International Center for Organization and Marketing) in collaboration with Expand created a comprehensive public awareness program during CardioAlex.21 held in Alexandria, Egypt during the period 01 – 04 June, 2021. Aim Building awareness to the community to the signs and the “must take actions” in cardiovascular emergencies, as heart attacks. Methods A very creative campaign was held at the last day of CardioAlex.21 in Alexandria, Egypt, in which, ICOM and Expand teams organized a Marathon (Run) followed by an educational lecture for physicians and a session for public along with screening clinics stations for all attendees to have an onsite check up on their blood pressure and blood glucose level. “GO RED FOR WOMEN”, addressed the message for women to raise the awareness of cardiovascular risks and a very informative discussion was held. The audience questions were answered by SSL Board who moderated the session on a one-to-one story telling technique which made the sessions very interesting. Data was collected from persons who attended the session representing the Egyptian society. Results Eighty persons attended the awareness day, 54% of which were middle-aged participants with an age mean of 50 years old. 60% were women, 55% completed secondary education or more and 77% of them reported to have heard about heart attacks while, more than half stated they knew someone who had it. This campaign raised the public awareness regarding cardiovascular disease and how a minute is life changing, knowing how to react if someone experienced one or more of the heart attack symptoms as well as the proper management of MI patients. Also, the healthy lifestyle after undergoing a PPCI procedure was discussed.

Variability in Daily Eating Patterns and Eating Jetlag Are Associated With Worsened Cardiometabolic Risk Profiles in the American Heart Association Go Red for Women Strategically Focused Research Network.

BackgroundSleep variability and social jetlag are associated with adverse cardiometabolic outcomes via circadian disruption. Variable eating patterns also lead to circadian disruption, but associations with cardiometabolic health are unknown.Methods and ResultsWomen (n=115, mean age: 33±12 years) completed a 1‐week food record using the Automated Self‐Administered 24‐Hour Dietary Assessment Tool at baseline and 1 year. Timing of first and last eating occasions, nightly fasting duration, and %kcal consumed after 5 pm (%kcal 5 pm) and 8 pm (%kcal 8 pm) were estimated. Day‐to‐day eating variability was assessed from the SD of these variables. Eating jetlag was defined as weekday‐weekend differences in these metrics. Multivariable‐adjusted linear models examined cross‐sectional and longitudinal associations of day‐to‐day variability and eating jetlag metrics with cardiometabolic risk. Greater jetlag in eating start time, nightly fasting duration, and %kcal 8 pm related to higher body mass index and waist circumference at baseline (P<0.05). In longitudinal analyses, a 10% increase in %kcal 8 pm SD predicted increased body mass index (β, 0.52; 95% CI, 0.23–0.81) and waist circumference (β, 1.73; 95% CI, 0.58–2.87); greater %kcal 8 pm weekday‐weekend differences predicted higher body mass index (β, 0.25; 95% CI, 0.07–0.43). Every 30‐minute increase in nightly fasting duration SD predicted increased diastolic blood pressure (β, 0.95; 95% CI, 0.40–1.50); an equivalent increase in nightly fasting duration weekday‐weekend differences predicted higher systolic blood pressure (β, 0.58; 95% CI, 0.11–1.05) and diastolic blood pressure (β, 0.45; 95% CI, 0.10–0.80). Per 10% increase in %kcal 5 pm SD, there were 2.98 mm Hg (95% CI, 0.04–5.92) and 2.37mm Hg (95% CI, 0.19–4.55) increases in systolic blood pressure and diastolic blood pressure; greater %kcal 5 pm weekday‐weekend differences predicted increased systolic blood pressure (β, 1.83; 95% CI, 0.30–3.36). For hemoglobin A1c, every 30‐minute increase in eating start and end time SD and 10% increase in %kcal 5 pm SD predicted 0.09% (95% CI, 0.03–0.15), 0.06% (95% CI, 0.001–0.12), and 0.23% (95% CI, 0.07–0.39) increases, respectively.ConclusionsVariable eating patterns predicted increased blood pressure and adiposity and worse glycemic control. Findings warrant confirmation in population‐based cohorts and intervention studies.

Abstract 037: History Of Weight Cycling Is Prospectively Associated With Shorter And Poorer Quality Sleep, And Higher Sleep Apnea Risk In Diverse Us Women: Results From The AHA Go Red For Women Strategically Focused Research Network

Introduction: Poor sleep and history of weight cycling (HWC) are associated with worse cardiovascular health, yet limited research has evaluated the association between HWC and poor sleep patterns. Hypothesis: We hypothesized that HWC would be associated with poor sleep in US women. Methods: The AHA Go Red for Women Strategically Focused Research Network cohort at Columbia University (n=506, mean age 37 ± 15.7y, 61% racial/ethnic minority) was used to evaluate cross-sectional associations of HWC and sleep characteristics at baseline, and prospective associations of HWC from baseline with sleep measures at 1-yr. HWC, defined as losing and gaining ≥ 10 lbs at least once (excluding pregnancy), and number of WC episodes were self-reported. Sleep duration, measures of sleep quality, insomnia severity, and obstructive sleep apnea (OSA) risk were assessed using the validated Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Berlin questionnaire. Linear and logistic regression models, adjusted for age, race/ethnicity, education, health insurance status, pregnancy history, and menopausal status, were used to evaluate the relation of HWC with sleep. Results: Most women reported ≥1episode of weight cycling (72%). In linear models of cross-sectional and prospective data, each additional weight cycling episode was related to shorter sleep duration, poorer sleep quality, longer sleep onset latency, greater insomnia severity, more sleep disturbances and daytime dysfunction, lower sleep efficiency, and higher sleep medication use frequency. In logistic models, HWC (≥1 vs. 0 episodes) was associated with greater odds for short sleep, poor sleep quality, long sleep onset latency ≥26 min, high OSA risk, and sleep efficiency&lt;85% ( Table ). Conclusion: HWC predicted poor sleep among women, suggesting that weight maintenance may represent an important strategy to promote sleep health. Long-term studies are needed to disentangle the complex relations between weight fluctuations and sleep across the life course.

History of Weight Cycling Is Prospectively Associated With Shorter and Poorer-Quality Sleep and Higher Sleep Apnea Risk in Diverse US Women.

Poor sleep and history of weight cycling (HWC) are associated with worse cardiovascular health, yet limited research has evaluated the association between HWC and poor sleep patterns. The American Heart Association Go Red for Women Strategically Focused Research Network cohort at Columbia University (n = 506; mean age, 37 ± 15.7 years; 61% racial/ethnic minority) was used to evaluate the cross-sectional associations of HWC and sleep at baseline and the prospective associations of HWC from baseline with sleep at the 1-year visit. History of weight cycling, defined as losing and gaining 10 lb or more at least once (excluding pregnancy), was self-reported. Sleep duration, sleep quality, insomnia severity, and obstructive sleep apnea risk were assessed using the validated Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Berlin questionnaires. Linear and logistic regression models, adjusted for age, race/ethnicity, education, health insurance status, pregnancy history, and menopausal status, were used to evaluate the relation of HWC with sleep. Most women reported 1 or more episodes of weight cycling (72%). In linear models of cross-sectional and prospective data, each additional weight cycling episode was related to shorter sleep duration, poorer sleep quality, longer sleep onset latency, greater insomnia severity, more sleep disturbances, lower sleep efficiency, and higher sleep medication use frequency. In the logistic models, HWC (≥1 vs 0 episodes) was associated with greater odds for short sleep, poor sleep quality, long sleep onset latency (≥26 minutes), high obstructive sleep apnea risk, and sleep efficiency lower than 85%. History of weight cycling predicted poor sleep among women, suggesting that weight maintenance may represent an important strategy to promote sleep health. The potential bidirectional relationship between HWC and sleep requires further investigation.

Evening Chronotype Is Associated with Poorer Habitual Diet in US Women, with Dietary Energy Density Mediating a Relation of Chronotype with Cardiovascular Health

BackgroundAn innate preference for later timing of sleep and activity, termed evening chronotype, is linked to poorer cardiovascular health (CVH). However, associations of chronotype with specific health behaviors in US women are not well characterized. Of particular interest is habitual diet, because <1% of US adults meet recommendations for a healthful diet. ObjectivesWe aimed to evaluate cross-sectional and prospective associations of chronotype with diet quantity and quality in US women, and to assess whether dietary energy density (ED), a robust predictor of cardiometabolic outcomes, mediates an established chronotype-CVH relation. MethodsData were collected from participants in the AHA Go Red for Women Strategically Focused Research Network cohort (aged 20–76 y; 61% racial/ethnic minority) at baseline (n = 487) and 1-y follow-up (n = 432). Chronotype (evening compared with morning/intermediate) and habitual diet were ascertained from the Morningness-Eveningness Questionnaire and an FFQ, respectively. Multivariable-adjusted linear regression models evaluated cross-sectional and prospective associations of chronotype with diet. Causal mediation analyses assessed whether dietary ED mediated a relation between chronotype and CVH, quantified using AHA Life’s Simple 7 score, derived from clinical measurements and validated assessments of CVH components. ResultsEvening compared with morning/intermediate chronotype was associated with poorer diet quality, including lower intakes of plant protein (cross-sectional: β = −0.63 ± 0.24, P < 0.01; prospective: β = −0.62 ± 0.26, P = 0.01), fiber (cross-sectional: β = −2.19 ± 0.65, P < 0.001; prospective: β = −2.39 ± 0.66, P < 0.001), and fruits and vegetables (cross-sectional: β = −1.24 ± 0.33, P < 0.001; prospective: β = −1.15 ± 0.36, P = 0.001). Evening chronotype was also associated with higher dietary ED at baseline (β = 0.20 ± 0.05, P = 0.001) and 1 y (β = 0.19 ± 0.06, P = 0.001). Dietary ED was a partial mediator of the association between evening chronotype and poorer CVH (24.6 ± 9.1%, P < 0.01). ConclusionsEvening chronotype could contribute to unhealthful dietary patterns in US women, with higher dietary ED partially mediating the relation between eveningness and poorer CVH. Behavioral interventions to reduce dietary ED might mitigate cardiovascular disease risk in women with evening chronotype.

Go Red for Women Strategically Focused Research Network: Summary of Findings and Network Outcomes.

The Go Red for Women movement was initiated by the American Heart Association (AHA) in the early 2000s to raise awareness concerning cardiovascular disease (CVD) risk in women. In 2016, the AHA funded 5 research centers across the United States to advance our knowledge of the risks and presentation of CVD that are specific to women. This report highlights the findings of the centers, showing how insufficient sleep, sedentariness, and pregnancy‐related complications may increase CVD risk in women, as well as presentation and factors associated with myocardial infarction with nonobstructive coronary arteries and heart failure with preserved ejection fraction in women. These projects were augmented by collaborative ancillary studies assessing the relationships between various lifestyle behaviors, including nightly fasting duration, mindfulness, and behavioral and anthropometric risk factors and CVD risk, as well as metabolomic profiling of heart failure with preserved ejection fraction in women. The Go Red for Women Strategically Focused Research Network enhanced the evidence base related to heart disease in women, promoting awareness of the female‐specific factors that influence CVD.

Abstract 13175: Social Jet Lag in Eating Patterns as a Marker of Meal Timing Variability is Associated With Elevated Cardiometabolic Risk in the AHA Go Red for Women Strategically Focused Research Network

Introduction: Social jet lag, typically defined as the difference in sleep timing on work vs. free days, is related to elevated cardiovascular disease (CVD) risk, via circadian disruption. Irregular meal timing may also lead to circadian disruption, but the role of social jet lag in eating patterns in CVD risk has not been examined. Hypothesis: Social jet lag in eating patterns, a measure of meal timing variability, will be associated with elevated cardiometabolic risk in women. Methods: Women from the AHA Go Red for Women SFRN at Columbia (n=116, mean age: 33 y, 45% Hispanic) completed a 1-wk food record using the web-based NIH Automated Self-Administered 24-h Dietary Assessment Tool. Social jet lag in eating patterns was evaluated using the difference between weekday vs. weekend: 1) nightly fasting duration (NFD), 2) time of first meal, and 3) time of last meal. Standard deviation (SD) of % kcal consumed after 5PM and 8PM was used to capture variability in nighttime eating. Cardiovascular health (CVH) was assessed with the AHA Life Simple 7 (LS7) score. Linear regression models adjusted for age, socioeconomic status, and sleep were used to examine associations with CVH, BMI, waist circumference (WC), systolic blood pressure (SBP), diastolic BP (DBP), and fasting glucose. Results: The average time of first meal and NFD on weekdays vs. weekends was 8:54AM vs. 10:11AM and 12.5 h vs. 13.7 h, respectively; average time of last meal was similar (8:27PM). Each 1-h increase in the difference between first meal time on weekdays vs. weekends was associated with higher BMI (β=0.81, p=0.018), WC (β=0.67, p=0.029), DBP (β=1.34, p=0.049), and SBP (β=1.45, p=0.062). Each 1-h increase in the difference between weekday vs. weekend NFD was associated with higher BMI (β=0.55, p=0.045), fasting glucose (β=2.46, p=0.028), and SBP (β=1.17, p=0.058) and lower LS7 score (β=-0.24, p=0.014). Greater variability in nighttime eating (higher %kcal after 5PM and 8PM SD) was associated with higher WC (β=0.014, p=0.020 and β=0.030, p=0.040). Conclusions: Greater meal timing variability was related to poorer CVH and higher BMI, WC, BP, and fasting glucose. Results suggest that stabilizing meal timing patterns should be considered for lowering CVD risk and warrant confirmation in a larger sample.

Abstract 17179: Stress-Mediated Platelet Activation Contributes to Thrombosis: Findings From the American Heart Association Go Red for Women Strategically Focused Research Network

Background: Psychological stress is a risk factor for cardiovascular disease (CVD). Despite advancements in CV-prevention, CVD remains the global leading cause of disease burden, suggesting that additional factors contribute to sustained CV risk. The mechanisms by which stress contributes to increased CVD are largely unknown. However, in preclinical models increased sympathetic nervous system activity promotes systemic inflammation (e.g. monocyte activation, cytokine production), and may underlie increased CVD risk. We investigated perceived stress in women with MI and its association with platelet activity, and validated our findings in a murine model. Methods: Monocyte-platelet aggregates (MPA) and psychological stress, using the validated Perceived Stress Scale (PSS4), were measured in women post MI (n=96; median age 62.2 years) and in control women (n=31; 66.7 years). A mouse model of chronic variable stress was utilized to explore the impact of stress on platelet activity and risk of thrombosis-mediated death. Results: Perceived stress was higher in MI patients than matched women (p=0.009). Platelet activity, assessed by MPA, was significantly elevated in MI vs. controls (p=0.0025). MPA significantly correlated with PSS4 scores (R=0.412, p =0.009). In a female mouse model of chronic variable stress, circulating MPA was increased in stressed mice compared to controls (p&lt;0.05), and platelet activation markers P-selectin and JON/A were increased on platelets from stressed mice relative to stress free mice (p&lt;0.05). Using a platelet mediated thrombosis model, time to thrombosis and survival was reduced in stressed mice. Conclusion: Platelet activity was increased at the time of MI in women, and positively associated with stress. In a mouse model, we find that stress is a significant contributor to increased platelet reactivity, and promotes thrombosis-mediated death. Cross-talk between platelets and monocytes is a critical mechanism linking thrombosis and inflammation, thus stress-induced MPAs may represent an unexplored pathway linked to stress-mediated CVD-risk. Future studies will examine whether reducing stress reduces platelet hyperactivity and MI risk.

A Mediterranean Dietary Pattern Predicts Better Sleep Quality in US Women from the American Heart Association Go Red for Women Strategically Focused Research Network.

Consumption of a Mediterranean diet has been linked to better sleep health in older, European populations. However, whether this dietary pattern is predictive of sleep quality in US women, a group prone to poor sleep, is unknown. This prospective cohort study of 432 US women (20–76 y; 60% racial/ethnic minority) evaluated whether compliance with a Mediterranean diet at baseline predicted sleep quality at 1-y follow-up. Alternate Mediterranean (aMed) diet scores and habitual sleep quality were computed from the validated Block Brief Food Frequency Questionnaire and Pittsburgh Sleep Quality Index (PSQI), respectively. Linear regression models evaluated prospective associations of the aMed diet pattern and its components with measures of sleep quality, after adjustment for age, BMI, race/ethnicity, education, and health insurance status. Higher baseline aMed scores were associated with lower PSQI scores (β = −0.30 ± 0.10, p < 0.01), indicative of better sleep quality, higher sleep efficiency (β = 1.20 ± 0.35, p < 0.001), and fewer sleep disturbances (β = −0.30 ± 0.12, p = 0.01) at 1-y. Fruit and vegetable consumption also predicted lower PSQI scores, higher sleep efficiency and fewer sleep disturbances (all p < 0.05). Higher legume intake predicted better sleep efficiency (β = 1.36 ± 0.55, p = 0.01). These findings suggest that adherence to a Mediterranean diet pattern should be evaluated as a strategy to promote sleep quality in US women.

Associations of Inflammation, Physical Activity, and Sleep in a Diverse Population of Women.

Background: Cardiovascular disease (CVD) is the leading cause of mortality in United States with a recent rise seen in young adults, particularly women. Systemic inflammation, physical activity, and sleep are each individually linked to CVD risk. Whether there is an interaction of these variables, however, is unclear. We evaluated physical activity and sleep among racially ethnically diverse women, ages 20-79 years, to assess associations with systemic inflammation. Methods: We performed a cross-sectional study of 506 women (61% racial/ethnic minority; mean (standard deviation [SD]) age = 37 [15.7] years, body mass index 26.0 [5.7] kg/m2) enrolled in the American Heart Association (AHA) Go Red for Women Strategically Focused Research Network at Columbia University Irving Medical Center (CUIMC). Inflammation, assessed by C-reactive protein (CRP), was analyzed in the Biomarkers Core Laboratory at CUIMC. Physical activity and sleep were assessed using validated questionnaires. Multivariable models adjusted for demographic and clinical confounders were used to evaluate associations between CRP, physical activity, and sleep. Results: Mean (SD) physical activity was 282 (557.2) minutes/week, and mean (SD) sleep duration was 6.75 (1.24) hours/night. Mean CRP was 2.08 (3.56), and 17% of participants were categorized as high risk for obstructive sleep apnea (OSA). Participants who slept <6 hours/night were less likely to be physically active ≥150 minutes/week (odds ratios, ORs [95% confidence interval, CI]: 0.53 [0.33-0.84]). This association was nonsignificant after adjustment. High risk of OSA was associated with CRP ≥2 mg/L (OR [95% CI]: 1.91 [1.11-3.30]) following adjustment. Stratification by race/ethnicity showed that high risk of OSA was associated with CRP ≥2 mg/L among racial/ethnic minorities but not white women (OR [95% CI]: 2.75 [1.43-5.30] vs. 0.94 [0.31-2.88]). Conclusion: High risk of OSA and elevated CRP was significantly associated in women, particularly minority women. Both play a role in CVD, highlighting potential causes for the increased risk of CVD in younger women.

Impact of change in bedtime variability on body composition and inflammation: secondary findings from the Go Red for Women Strategically Focused Research Network.

Variability in daily sleep patterns is an emerging factor linked to metabolic syndrome. However, whether reducing bedtime variability improves markers of disease risk has not been tested. Here, we assessed whether body composition and inflammation were impacted by changes in bedtime variability over a 6-wk period, during which, women were instructed to maintain healthy, habitual sleep patterns (one arm of a randomized trial). Data were available for 37 women (age 34.9±12.4 y, BMI 24.7±2.9 kg/m2, sleep duration 7.58±0.49 h/night). Body composition and leukocyte platelet aggregates (LPA) were measured at baseline and endpoint using magnetic resonance imaging and flow cytometry, respectively. Sleep data were collected weekly using wrist actigraphy. Change in bedtime variability was calculated as the difference in the standard deviation of bedtimes measured during the 2-wk screening period and the 6-wk intervention period. Results showed that women who reduced their bedtime variability (n=29) during the intervention had reductions in total (P<0.001) and subcutaneous adipose tissue (P<0.001) relative to women who increased/maintained (n=8) bedtime variability. Similar effects were observed for LPA levels between women who reduced vs increased/maintained bedtime variability (P=0.011). Thus, reducing bedtime variability, without changing sleep duration, could improve cardiometabolic health by reducing adiposity and inflammation.

Abstract MP19: Impact of Change in Bedtime Variability on Body Composition: Secondary Findings From the Go Red for Women Strategically Focused Research Network

Variability in daily sleep duration and unstable bedtimes are emerging sleep-related factors that have been linked to metabolic syndrome. For example, in longitudinal studies, the odds of developing metabolic syndrome over 6.3 y median follow-up are 1.36 for every 1 h increase in sleep onset variability (standard deviation of bedtimes measured over 7 nights of actigraphy) in fully adjusted models. However, whether reducing bedtime variability improves markers of disease risk has not been tested. Here, we assessed whether body composition was impacted by changes in bedtime variability over a 6-wk period during which women were instructed to maintain healthy, habitual sleep patterns. This was a single arm of a randomized trial originally designed to test the impact of sleep restriction on cardiometabolic risk factors. Women, aged 20 y and older and with body mass index 20-33 kg/m 2 were recruited. All women were required to have adequate sleep duration of 7-9 h/night, determined over 2 wk using wrist-worn actigraphy. Upon randomization, women were given bed and wake time prescriptions aligned with their average screening bed and wake times in order to ensure maintenance of adequate sleep duration over the 6 wk study phase. The alternate phase required women to delay their bedtimes to achieve sleep restriction. Only data from the adequate sleep phase were used for the present analyses. Bedtime variability and body composition data were available for 37 women (age 34.9±12.4 y, BMI 24.7±2.9 kg/m 2 , screening sleep duration 7.58±0.49 h/night). Body composition was measured at baseline (0 wk) and endpoint (6 wk) using magnetic resonance imaging. Bedtime and sleep data were collected weekly using wrist actigraphy. Change in bedtime variability was calculated as the difference in the standard deviation of bedtimes measured during the 2-wk screening period and the 6-wk study phase. Sleep duration did not differ between screening and the average of 6 wk of the sleep phase (-4.8±24.7min, P=0.24). Average percent change in bedtime SD was 24.4±25.2% in those who increased their bedtime variability and -39.9±23.5% in those who reduced their bedtime variability. Results showed that, compared to women who increased or did not change (n=8) bedtime variability, women who reduced their bedtime variability (n=29) during the intervention had significant reductions in total (reduced: -0.52±0.98 vs increase/no change: 0.63±0.41 L, P&lt;0.001) and subcutaneous adipose tissue (reduced: -0.48±0.86 vs increase/no change: 0.56±0.31 L, P&lt;0.001). Thus, results provide novel preliminary information showing that reducing bedtime variability can improve body composition over time. Given that bedtimes are highly individualized, this may provide an easy public health message to maintain healthy sleep hygiene, particularly stable bedtime routine, to achieve better weight management and reduced CVD risk.