National Health And Nutrition Examination Survey Survey Research Articles

Association between sleep apnea and ultrasound-defined liver fibrosis: Results from NHANES 2017 to 2020.

Liver fibrosis is a critical factor in the advancement of nonalcoholic fatty liver disease towards cirrhosis. There is limited research exploring the association between obstructive sleep apnea (OSA) and liver fibrosis among community populations. The present study aimed to assess the association between sleep apnea (SA) and liver fibrosis based on the National Health and Nutrition Examination Survey (NHANES). Data were acquired from NHANES survey cycle 2017 to 2020. We assessed liver fibrosis by the median values of liver stiffness measurement (LSM). The diagnosis of SA was based on participants' response to sleep questionnaire. Univariate and multivariate logistic regression were used to validate the association of SA and liver fibrosis. A total of 7615 participants were included in this study. The LSM level of SA group was significantly higher than non-SA group. The proportion of liver fibrosis in SA group was markedly higher than that in non-SA group (14.0% vs 7.3%, P < .001). Univariate logistic analysis showed that SA was positively associated with liver fibrosis (OR = 2.068, 95%CI = 1.715-2.494, P < .001). Further multivariate logistic analysis revealed that SA was independently associated with increased risk of liver fibrosis after adjusting for confounding factors (OR = 1.277, 95%CI = 1.003-1.625, P = .048). The current study demonstrated an independent association between self-reported SA and increased risk of ultrasound-defined liver fibrosis in community-based sample.

P113 Rheumatoid arthritis modifies the relationship between depression and overall mortality among African Americans

Abstract Background/Aims Rheumatoid arthritis (RA) has been known to be connected with many comorbidities and vascular diseases. Depression is two times more common in the RA population versus the general population. In this research, we will demonstrate the effect of depression on overall mortality and how the connection is influenced by rheumatoid arthritis among African Americans. Methods The National Health and Nutrition Examination Survey (NHANES) is a survey completed by non-institutionalized population of the United States. All respondents from the NHANES survey, who were 20 years or older and African American between the years 2005-2010 were included in the analysis with follow-up through December 31, 2019. Healthcare diagnosed self-reported information was used for the determination of RA. We determined depression by Patient Health Questionnaire (PHQ-9) with score ≥ 10. Analysis was performed using complex samples Cox regression to determine the relationship of depression on all-cause mortality and how rheumatoid arthritis influences this. Results Percent mortality among African American individuals with rheumatoid arthritis was 23.34% (CI 17.18%-29.34%) among males and 20.83% (CI 15.8-25.8) among females with mean follow-up of 10.1 years. For overall mortality, the age and sex-adjusted hazard ratio (HR) for depression was 2.52 (95% confidence interval [CI], 1.34-4.74 p = 0.01). The adjusted HR was elevated, 3.82 (CI 1.07-13.58, p = 0.04), among people with depression who also had rheumatoid arthritis but close to 1.0 (1.79 CI 0.47-6.88, p = 0.37) among individuals with depression who had no rheumatoid arthritis, after adjusting for medical (tobacco use, hypertension, and obesity) and demographic risk factors (poverty-income-ratio, age, and gender). Conclusion Among African Americans, we found that not only does depression lead to 2.5 times higher overall mortality but also rheumatoid arthritis occurrence affects this relationship even after controlling for potential confounders. As for treatment, African Americans are treated less with Disease-Modifying Anti-Rheumatic Drugs (DMARDS) than Caucasians according to previous research. Prevention and treatment programs for rheumatoid arthritis and screening for depression are especially important to treat comorbidities and to implement social change. Disclosure S. Banerjee: None. J. Khubchandani: None. M. Mesidor: None. P. Lane: None. R. Gonzales-Lagos: None.

Higher serum chromium level may be associated with the presentation of depression in patients with metabolic dysfunction-associated fatty liver disease: evidence from NHANES survey.

Depressive symptoms are frequently observed in patients with Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD), a prevalent metabolic disorder that affects many individuals. It is not yet clear whether there is an association between serum chromium levels and depression. The purpose of this research was to explore the association between serum chromium level and the manifestation of depression among patients with MAFLD. The selection of 1837 patients diagnosed with MAFLD was based on data obtained from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) database in this research. The Patient Health Questionnaire-9 (PHQ-9) was employed to evaluate the severity of depression. The researchers utilized logistic regression models that were weighted for multiple variables to investigate the association between depression and serum chromium levels. In our study, we found that 8.98% of US adults with MAFLD were suffering from depression at the time of evaluation. In the logistic regression model, serum chromium levels showed an inverse association with depression (OR=0.82, 95%CI: 0.69-0.96; p=0.016), this relationship remained after adjusting for fully confounding factors (OR=0.83, 95%CI: 0.71-0.97; p=0.021), subgroup analyses showed that the association between serum chromium levels and depression existed in relatively high-prevalence of depression groups. Patients diagnosed with MAFLD have a greater likelihood of experiencing depression, whereas individuals with higher levels of serum chromium are less likely to suffer from depression, and this association persists even after adjusting for other factors. These findings indicate supplementing chromium may be a viable treatment for their depressive symptoms.

Association between high-density lipoprotein cholesterol and type 2 diabetes mellitus: dual evidence from NHANES database and Mendelian randomization analysis.

Low levels of high-density lipoprotein cholesterol (HDL-C) are commonly seen in patients with type 2 diabetes mellitus (T2DM). However, it is unclear whether there is an independent or causal link between HDL-C levels and T2DM. This study aims to address this gap by using the The National Health and Nutrition Examination Survey (NHANES) database and Mendelian randomization (MR) analysis. Data from the NHANES survey (2007-2018) with 9,420 participants were analyzed using specialized software. Logistic regression models and restricted cubic splines (RCS) were used to assess the relationship between HDL-C and T2DM incidence, while considering covariates. Genetic variants associated with HDL-C and T2DM were obtained from genome-wide association studies (GWAS), and Mendelian randomization (MR) was used to evaluate the causal relationship between HDL-C and T2DM. Various tests were conducted to assess pleiotropy and outliers. In the NHANES study, all groups, except the lowest quartile (Q1: 0.28-1.09 mmol/L], showed a significant association between HDL-C levels and reduced T2DM risk (all P < 0.001). After adjusting for covariates, the Q2 [odds ratio (OR) = 0.67, 95% confidence interval (CI): (0.57, 0.79)], Q3 [OR = 0.51, 95% CI: (0.40, 0.65)], and Q4 [OR = 0.29, 95% CI: (0.23, 0.36)] groups exhibited average reductions in T2DM risk of 23%, 49%, and 71%, respectively. In the sensitivity analysis incorporating other lipid levels, the Q4 group still demonstrates a 57% reduction in the risk of T2DM. The impact of HDL-C levels on T2DM varied with age (P for interaction = 0.006). RCS analysis showed a nonlinear decreasing trend in T2DM risk with increasing HDL-C levels (P = 0.003). In the MR analysis, HDL-C levels were also associated with reduced T2DM risk (OR = 0.69, 95% CI = 0.52-0.82; P = 1.41 × 10-13), and there was no evidence of pleiotropy or outliers. This study provides evidence supporting a causal relationship between higher HDL-C levels and reduced T2DM risk. Further research is needed to explore interventions targeting HDL-C levels for reducing T2DM risk.

Abstract 17568: Myocardial Infarction Modifies the Effect of Food Insecurity on Diabetes-Related Mortality

Introduction: Food Insecurity continues to be a public health problem that requires attention. A quarter of households have experienced food insecurity in their lifetime. Hypothesis: In this study, we will determine how myocardial infarction increases the effect of food insecurity among diabetes-related mortality. Methods: The National Health and Nutrition Examination Survey (NHANES) is a survey completed by non-institutionalized population of the U.S. All respondents from the NHANES survey, who were 20 years or older between the years 1999-2010 were included in the analysis with follow-up through 2019. Self-reported information was used for USDA Food Security Survey. Analysis was performed using complex samples Cox regression to determine the relationship of food insecurity on diabetes-related mortality and how myocardial infarction influences this. Results: Percent mortality among individuals with diabetes was 6.11% among males and 5.67% among females with mean follow-up of 13.7 years. For diabetes-related mortality, the crude hazard ratio (HR) for food insecurity was 1.42 (95% confidence interval [CI], 1.03-1.95 p = 0.03). The adjusted HR was elevated, 2.66 (CI 1.05-6.78, p = 0.04), among food insecure individuals who had myocardial infarction (MI) but close to 1.0 (1.33 CI 0.99-1.79, p = 0.06) among food insecure individuals who had no MI infarction, after adjusting for medical (tobacco use) and demographic risk factors (poverty-income-ratio, age, gender, ethnicity). Conclusions: We found that not only food insecurity leads to higher diabetes-related mortality, but also MI occurrence affects this relationship. Prevention programs for food insecurity are especially important with comorbidities to implement social change.

Association of different obesity patterns with hypertension in US male adults: a cross-sectional study

Obesity is an important risk factor for hypertension. We aimed to investigate the association between different obesity patterns and hypertension risk in a large male population in the US. Male participants from the National Health and Nutrition Examination Survey (NHANES) (2007–2018) were enrolled in this cross-sectional study. Social demographic information, lifestyle factors, anthropometric measurements and biochemical measurements were collected. Three obesity patterns were classified according to the body mass index (BMI) and waist circumference (WC), including overweight and general obesity, abdominal obesity, and compound obesity. We adopted multivariate logistic regression to investigate the associations between hypertension and different obesity patterns after adjusting for cofounding factors. Subgroup analysis, stratified by age, smoking, drinking and estimated glomerular filtration rate (eGFR), was also conducted to explore the associations between obesity patterns and hypertension risk among different populations. Moreover, the association between WC and hypertension among male individuals was also explored using restricted cubic spline (RCS) analysis. Receiver operating characteristic (ROC) was used to evaluate the discriminatory power of WC for screening hypertension risk. 13,859 male participants from NHANES survey (2007–2018) were enrolled. Comparing with the normal-weight group, the odds ratios (ORs) [95% confidence interval (CI)] for hypertension in individuals with overweight and general obesity, abdominal obesity and compound obesity were 1.41 [1.17–1.70], 1.97 [1.53–2.54] and 3.28 [2.70–3.99], respectively. Subgroup analysis showed that the effect of different obesity patterns on hypertension risk was highly stable among individuals with different clinical conditions. In addition, WC had a positive correlation with the risk of hypertension (OR: 1.43; 95% CI 1.37–1.52; P < 0.001) in fully adjusted multivariate logistic regression model. RCS analysis showed that the association between WC and hypertension risk was in a nonlinear pattern, and WC had a good discriminatory power for hypertension in ROC analysis. Different patterns of obesity have a great impact on the risk of hypertension among male individuals. Increment of WC significantly increased the hypertension risk. More attention should be paid to the prevention of obesity, especially abdominal obesity and compound obesity in male individuals.

Estimation of Serum PFOA Concentrations from Drinking and Non-Drinking Water Exposures.

Estimation of Serum PFOA Concentrations from Drinking and Non-Drinking Water Exposures.

E-cigarette use and prevalence of lung diseases among the U.S. population: a NHANES survey.

The primary aim of this study was to evaluate epidemiological characteristics and prevalence of lung disease among e-cigarettes users in the United States. A population-based, cross-sectional survey was performed using the National Health and Nutrition Examination Survey (NHANES) of 2015-2018. Adults using e-cigarettes (SMQ900), traditional smoking (SMQ020: > 100 cigarettes in lifetime or SMQ040: current cigarettes use), and dual smoking (e-cigarettes and traditional smoking) were identified and compared in their sociodemographic characteristics and prevalence of lung diseases (Asthma: MCQ010 and COPD: MCQ160O). We used the chi square test (categorical variables) and Mann-Whitney test and unpaired-student t test (continuous variables). p-value <0.05 was used as a reference. We excluded respondents <18 years and missing data on demographics and outcomes. Out of 178,157 respondents, 7745 (4.35%), 48,570 (27.26%), and 23,444 (13.16%) were e-cigarette smokers, traditional smokers, and dual smokers, respectively. Overall prevalence of asthma was 15.16% and COPD was 4.26%. E-cigarette smokers were younger in comparison to traditional smokers (median: 25 years vs 62 years; p < 0.0001). In females (49.34% vs 37.97%), Mexican (19.82% vs 13.35%), annual household income above $100,000 (23.97% vs 15.56%), prevalence of e-cigarette smoking was higher in comparison to traditional smoking (p < 0.0001). The prevalence of COPD was higher among dual smokers in comparison to e-cigarette and traditional smoking (10.14% vs 0.25% vs 8.11%; p < 0.0001). Prevalence of asthma was higher among dual and e-cigarette smokers in comparison with traditional smokers and non-smokers (22.44% vs 21.10% vs 14.46% vs 13.30%; p < 0.0001). Median age (Q1-Q3) was lower at which asthma (7 years (4-12) vs 25 years (8-50)) was diagnosed first among e-cigarettes smokers in comparison with traditional smokers. In a mixed effect multivariable logistic regression analysis, we found higher odds of asthma among e-cigarette users in comparison with non-smokers (Odds ratio (OR): 1.47; 95% Confidence Interval (CI): 1.21-1.78; p = 0.0001). Chronic Obstructive Pulmonary Disease (COPD) respondents were also associated with 11.28 higher odds of e-cigarette utilization (Oddsratio (OR): 11.28; 95% Confidence Interval (CI): 5.59-22.72; p < 0.0001). We conclude the higher prevalence of e-cigarette users is seen among the younger population, female, Mexican race, and annual income above $100,000 in comparison to traditional smokers. Chronic Obstructive Pulmonary Disease (COPD) and asthma were both more prevalent in dual smokers. As asthma was more prevalent and diagnosed at an early age in e-cigarette smokers, more prospective studies are needed to understand the effects of e-cigarette among the population at risk to mitigate the sudden rise in utilization and to create awareness.

The Circadian Syndrome Is a Significant and Stronger Predictor for Cardiovascular Disease than the Metabolic Syndrome-The NHANES Survey during 2005-2016.

The study aimed to compare the predictive value of the Circadian Syndrome (CircS) and Metabolic Syndrome (MetS) for cardiovascular disease (CVD). We used data of 12,156 adults aged ≥20 years who attended National Health and Nutrition Examination Survey (NHANES) 2005-2016. Mortality was obtained from the registry updated to 2019. The CircS was defined based on components of the MetS, in addition to short sleep and depression. Both the MetS and CircS were directly associated with self-reported history of CVD. The odds ratios for prevalent CVD associated with the CircS and MetS, respectively, were 2.92 (95% confidence interval (CI) 2.21-3.86) and 3.20 (2.38-4.30) in men, and 3.27 (2.34-4.59) and 3.04 (2.15-4.30) in women. The CircS had a better predictive power for prevalent CVD than that of MetS, as indicated by the higher positive predictive value (PPV); in men, the PPV for prevalent CVD with CircS was 23.1% and with MetS 20.9%, and in women these were 17.9% vs. 16.4%, respectively. However, the PPV of the CircS and MetS did not differ for the CVD mortality prediction. Women with CircS alone had a higher risk for both prevalent CVD and CVD mortality than those with MetS alone. In conclusion, the CircS is a significant and stronger predictor for CVD than the MetS in US adults.

HPV vaccination in women living with HIV in the United States (133)

HPV vaccination in women living with HIV in the United States (133)

Abstract P063: Socioeconomic Status And Component Of Iatrogenic Obesity In The United States

Introduction: Overweight and obesity are more prevalent in people with lower socioeconomic status (SES). Use of obesogenic prescription medications such as certain anticonvulsants, antidepressants, beta-blockers, and antidiabetic medications may contribute to the disparities in obesity by SES in US adults. Methods Using data from the 2009-2018 National Health and Nutrition Examination Survey (NHANES), we assessed the use of obesogenic medication by SES among overweight and obese adults aged ≥20 years taking ≥1 prescription medication. Based on low SES indicator – &lt;high school education, household income &lt;federal poverty level, and having public health insurance only, we categorized participants into 3 SES groups (0, 1, and ≥2 low SES indicators as high, intermediate, and low SES). We used logistic regression to examine the association between SES and obesogenic medication use. All analyses accounted for the complex NHANES survey design. Results Among 11,796 participants (mean age 54.6, 54.1% female), the mean body mass index (SE) was 32.5 (0.1) kg/m 2 . Use of obesogenic medication was more common among people with lower SES in all survey years, with a trend toward increased prevalence over time among people with low SES ( Figure ). Lower SES was associated with obesogenic medication use in demographic-adjusted models (OR 1.4 [95%CI 1.2-1.5] for intermediate SES and 1.9 [1.7-2.1] for low SES, compared to high SES). The associations remained significant after further accounting for number of medications (OR [95% CI] =1.1 [1.0-1.3] for intermediate SES and 1.2 [1.0-1.4] for low SES). Results were consistent when assessed by individual SES indicators. Conclusions: Use of obesogenic medication is common in the US. Lower SES was associated with more frequent use of obesogenic medication even after controlling for medication burden. These results suggest that disparities in obesogenic medication use may contribute to the higher obesity prevalence among people with lower SES.

Insufficient Vitamin C Levels among Adults in the United States: Results from the NHANES Surveys, 2003-2006.

Vitamin C, well-established in immune function and a key factor in epigenetic inflammatory modifications, is only obtained through consistent dietary intake. Identifying individuals at risk for Vitamin C insufficiency may guide prevention and treatment, however, national surveillance has not been evaluated in the United States since 2006. A descriptive, cross-sectional secondary analysis was performed utilizing data from the 2003–2006 National Health and Nutrition Examination Surveys (NHANES) assessing non-institutionalized adults. Five categories of plasma Vitamin C were delineated: deficiency (<11 μmol/L), hypovitaminosis (11–23 μmol/L), inadequate (23–49 μmol/L), adequate (50–69 μmol/L), and saturating (≥70 μmol/L). Results indicated 41.8% of the population possessed insufficient levels (deficiency, hypovitaminosis, and inadequate) of Vitamin C. Males, adults aged 20–59, Black and Mexican Americans, smokers, individuals with increased BMI, middle and high poverty to income ratio and food insecurity were significantly associated with insufficient Vitamin C plasma levels. Plasma Vitamin C levels reveal a large proportion of the population still at risk for inflammatory driven disease with little to no symptoms of Vitamin C hypovitaminosis. Recognition and regulation of the health impact of Vitamin C support the goal of Nutrition and Healthy Eating as part of the Healthy People 2030.

397 Health Insurance Status in Subjects at High Risk for Obstructive Sleep Apnea

Abstract Introduction Undiagnosed obstructive sleep apnea (OSA) is a major public health problem. Undiagnosed OSA can result in decreased productivity due to absenteeism, increased risk of comorbidities (cardiovascular disease, diabetes, and depression), and increased motor vehicle as well as workplace accidents. Lack of health insurance coverage can lead to undiagnosed and therefore untreated OSA. The objective of this study is to evaluate health insurance status in subjects at high-risk for OSA. Methods This is a cross-sectional, population-based study of adults 18 years and older who participated in the 2017–2018 National Health and Nutrition Examination Survey (NHANES). A modified STOP-Bang score was used to calculate OSA risk. This score included all the variables from the standard STOP-Bang questionnaire, except neck circumference, since it was not reported in the NHANES survey. Subjects were divided into two groups: those at low-risk for OSA with a modified STOP-Bang score of ≤ 3 and those at high-risk for OSA with a modified STOP-Bang score of &amp;gt;4. Results A total of 4,847 adult subjects were included, which represented 223,385,241 of the U.S. non-institutionalized population. Using the modified STOP-Bang score cutoff of &amp;gt;4, 20.9% of the sample were classified as high-risk for OSA, while 79.1% were classified as low-risk for OSA. 90% of the high-risk OSA group and 85.1% of the low-risk OSA group reported having health insurance. Sociodemographic data will also be analyzed and included. Conclusion Approximately 10% of subjects who are at high-risk for OSA reported not having health insurance. This represents over 4.6 million Americans in the non-institutionalized population. Health insurance can improve access to health care. Timely diagnosis and treatment of OSA not only can reduce morbidity and mortality, but can also reduce health care costs. Support (if any) CDC for NHANES Data.

Abstract 14788: African Americans and Hispanics Are Disproportionately Impacted by Obesity: National Health and Nutrition Examination Surveys (NHANES) 2003-2018

Introduction: There are numerous health disparities impacting African Americans and Hispanics compared to other racial and ethnic groups in the US leading to poorer clinical outcomes. Obesity is an important risk factor predisposing to cardiac and renal diseases and it is important to quantify differences in obesity in greater detail. Hypothesis: African Americans and Hispanics may be disproportionately and adversely impacted by obesity. Methods: From 77007 participants in 8 NHANES surveys (between 2003-2004 and 2017-2018), we included 39952 aged 20-79 years. Participants with BMI data (n = 39440, 98.7%) were categorized as being underweight (BMI &lt; 18.5), normal (BMI 18.5 - &lt;25), overweight (BMI 25 - &lt;30), obese (BMI 30 - &lt;40) or morbidly obese (BMI 40+). Results were extrapolated to the entire US population (50 states plus the District of Columbia) using the direct method to the US Census 2000 population. The R language was used to perform statistical analyses. Results: Morbid obesity is as more common in black women (16%) compared with white or Hispanic women (both 8%). Black women are more overweight, obese, or morbidly obese compared with black men (80% vs 71%). Black men (7%) have a higher prevalence of morbid obesity compared to white (5%), Hispanic (5%), or “other” (race other than Hispanic, black, Asian, or white) racial/ethnic groups (4%). Hispanic men (80%) and African American women (80%) have the highest prevalence of overweight/obesity/morbid obesity. Normal weight is more common among race/ethnicity ‘other’ in both men and women. White women have a higher prevalence of normal weight compared to white men (34% vs 25%). Conclusion: There are important differences in the prevalence of obesity and morbid obesity between racial and ethnic groups in US adults. More emphasis needs to be placed on preventing/treating morbid obesity, particularly in Hispanic men and African American women, to reduce CV risk and correct disparities in health outcomes.

Abstract 14675: Rising Prevalence of Obesity in the Us: National Health and Nutrition Examination Survey (NHANES) 2003-2018

Introduction: Obesity is increasing globally. Obesity exacerbates risk for diabetes, dyslipidemia, hypertension, and ASCVD. We evaluated the prevalence of overweight and obese adults in the US during 2003-2018. HYPOTHESIS: The percentage of men and women overweight/obese is increasing continuously and may exceed the percentage with ‘normal’ weight. Methods: From 77007 participants in 8 NHANES surveys (between 2003-2004 and 2017-2018), we selected 39952 aged 20-79 years for this analysis. Participants with BMI data (n = 39440, 98.7%) were categorized as being underweight (BMI &lt; 18.5), normal (BMI 18.5 - &lt;25), overweight (BMI 25 - &lt;30), obese (BMI 30 - &lt;40) or morbidly obese (BMI 40+). Results were extrapolated to the entire US population (50 states plus the District of Columbia) using the direct method to the US Census 2000 population. Statistical analyses were performed in the R language. Results: There are statistically significant mean increases in BMI (95% confidence interval and p-value) between successive surveys of 0.18 (0.11, 0.25, p&lt;0.0001) for men and 0.24 (0.14, 0.33, p&lt;0.0001) for women. There are clear trends in morbid obesity (BMI 40+) from 3% in the first survey to 7% among men in the last survey, and from 7% to 12% in women. Obesity/morbid obesity (BMI 30+) increased from 31% to 44% in men and from 34% to 43% in women. About 78% of adult men are either overweight, obese, or morbidly obese (BMI 25+) in the most recent survey, an increase from 71% in the first survey. Among women 70% are either overweight, obese, or morbidly obese, an increase from 63% in the first survey. Very few US adults (1-2%) are underweight (BMI&lt;18.5). About one quarter of US adults have normal weight (BMI 18.5- 25). Conclusion: During the period 2003-2018, there has been a substantial rise among both US adult men and women in BMI who are overweight/obese. This necessitates invigorated public education about the clinical hazards posed and the need for lifestyle/dietary modification to stem this crisis.

High risk US adults with untreated hyperlipidaemia in NHANES: estimated reduction in cardiovascular events with statin treatment

Abstract Introduction Dyslipidemia is widely prevalent. Despite guidelines that recommend statin therapy for high-risk patients, many of these patents are untreated. This gap in care must be urgently closed. Purpose We analyzed data from the National Health and Nutrition Examination Survey (NHANES) in order to: (1) ascertain the number of high-risk individuals with dyslipidaemia not receiving lipid lowering therapy in the United States; and (2) estimate the reduction in acute cardiovascular (CV) events if those individuals were treated with either moderate or high potency statins in order to achieve at minimum a 30% or 50% reduction in LDL-C levels. Methods Data from NHANES participants who had fasting blood serum data available, including lipids, were included in our analysis (n=14,888). Statistical analyses were performed in the R language. Coronary heart disease (CHD) risk was assessed using NCEP ATP III criteria, and participants were categorized as being at high, intermediate, or low CHD risk. Data from seven surveys from 2003–4 to 2015–6 was used and extrapolations to the US adult population (50 states plus the District of Columbia) were performed using the direct method to the US Census 2000 population. Results We identified 1162 adults (age 20–79) who were high-risk and untreated despite being hyperlipidaemic (LDLC ≥100mg/dL). We estimated they represent 12.8 million individuals in the US 2015–16 population. Without lipid modification and hypothecating 10-year risks of CV events in this group of 20, 25, 30, 35 and 40%, respectively, predicted numbers of CV events are 2.6M, 3.2M, 3.9M, 4.5M, and 5.1M. Moderate-intensity statins reduce LDLC by 30–40% and high-intensity statins by 50–60%. Using untreated LDL-C values from all NHANES surveys we calculated predicted absolute reductions in LDL-C would be at least 42 mg/dL if a moderate-intensity statin was used and at least 70 mg/dL if a high-intensity statin was used, with reductions in CV risk of at least 27% and 46%, respectively. In this group of untreated high-risk individuals, predicted numbers of CV events that could be prevented by moderate-intensity statin for 10 years range from at least 0.7M to at least 1.4M, and with high-intensity statin use for 10 years from at least 1.2M to at least 2.3M, depending on the level of untreated risk. With Numbers Needed to Treat (NTT) between 5 and 18, use of statin treatment in this group would be highly beneficial and cost-effective. Conclusions There are a large number of untreated high-risk individuals with dyslipidaemia in the US. Use of moderate and high dose statin therapy in these patients for 10 years would reduce CV risk by at least 27% and 47%, respectively. Among untreated high-risk patients, the NNTs for moderate and high dose statin therapy are 9–18 and 5–11, respectively, depending on 10-year level of CV risk. The quality of life and socioeconomic implications of these estimates are substantial. Funding Acknowledgement Type of funding source: None

Dietary quality differs among cannabis use groups: data from the National Health and Nutrition Examination Survey 2005-16.

To describe diet quality (Healthy Eating Index 2010 (HEI-2010) and Healthy Eating Index 2015 (HEI-2015)) according to self-reported cannabis use among the National Health and Nutrition Examination Survey (NHANES) adult participants. Utilizing cross-sectional data, we assessed diet quality with up to two 24-h diet recalls from NHANES participants. Usual intakes were estimated via the multivariate Markov Chain-Monte Carlo method. Diet quality scores were compared among never users, previous users and current users of cannabis. NHANES surveys from 2005 to 2016. Adult NHANES participants (17855) aged 20-59 years with valid data for dietary recalls and drug use questionnaires. Current adult cannabis users (ages 20-59 years) had significantly lower total diet quality (HEI-2010) scores (51·8 ± 0·7) compared with previous (56·2 ± 0·4) and never users (57·7 ± 0·4). Similar differences in total and individual HEI-2015 scores were observed. For the HEI-2015 scores, cannabis users had a significantly higher (better) sodium scores (4·1 ± 0·2) compared with never users (3·3 ± 0·1) and previous users (3·2 ± 0·1). Cannabis users scored lower compared with never users on total vegetables (3·1 ± 0·1 v. 3·7 ± 0·0), total fruit (2·1 ± 0·1 v. 3·0 ± 0·1) and whole fruit (2·2 ± 0·1 v. 3·3 ± 0·1) for the HEI-2015 index. Current cannabis users' usual intakes reflect lower diet quality compared with never or previous users, particularly lower subcomponent scores of total vegetables, greens and beans, total fruit and whole fruit. Cannabis users should increase their intake of fruit and vegetables to improve overall diet quality.

Polypharmacy in patients with epilepsy: A nationally representative cross-sectional study

ObjectiveThe objective of the study was to characterize the prevalence of polypharmacy and central nervous system (CNS)-acting medications in patients with epilepsy, and particular types of medications. MethodsThis was a retrospective cross-sectional study using data from the nationally representative National Health and Nutrition Examination Survey (NHANES). We included patients who reported taking at least one prescription medication in order to treat seizures or epilepsy during NHANES survey years 2013–2016. We assessed the number and types of drugs and predictors of total number of medications using a negative binomial regression. We then assessed prevalence of polypharmacy (≥5 medications), CNS polypharmacy (≥3 CNS-acting medications) and additional CNS-acting medications, and drugs that lower the seizure threshold (i.e., bupropion and tramadol), and extrapolated prevalence to estimated affected US population. ResultsThe NHANES contained 20,146 participants, of whom 135 reported taking ≥1 antiseizure medication (ASM) for seizures or epilepsy representing 2,399,520 US citizens using NHANES's sampling frame. Patients reported taking a mean 5.3 (95% confidence interval (CI): 4.3–6.3) prescription medications. Adjusting for race, sex, and uninsurance, both age and number of chronic conditions predicted increased number of medications (incident rate ratio (IRR) per decade: 1.16, 95% CI: 1.04–1.28; IRR per chronic condition: 1.19, 95% CI: 1.11–1.27). Polypharmacy was reported by 47% (95% CI: 38%–57%) of patients, CNS polypharmacy by 34% (23%–47%), benzodiazepine use by 21% (14%–30%), opioid use by 16% (11%–24%), benzodiazepine plus opioid use by 6% (3%–14%), and 6% (2%–15%) reported a drug that lowers the seizure threshold. Twelve percent (7%–20%) took an opioid with either a benzodiazepine or gabapentinoid. ConclusionsPolypharmacy is common in patients with epilepsy. Patients taking ASMs frequently reported also taking other CNS-acting medications (i.e., opioids, benzodiazepines, seizure threshold-lowering medications), and medication combinations with black box warnings. Central nervous system polypharmacy poses health risks. Future research is needed to explore drivers of polypharmacy and strategies to help mitigate potentially harmful prescription use in this high-risk population.

Abstract P318: Prevalence and Trends of Type 2 Diabetes Mellitus and Prediabetes Among Community-Dwelling Heart Failure Patients in the U.S. 2005-2016: A National Health and Nutrition Examination Survey (NHANES) Analysis

Introduction: Recent scientific statements highlight the importance of understanding the effects of the coexistence of heart failure (HF) and type 2 diabetes mellitus (T2DM) on disease management decisions and patient outcomes. Various prevalence estimates of the T2DM burden among HF patients have been reported; however, national estimates are not available. The objective of the study was to assess the prevalence and trends of T2DM (total, diagnosed, and undiagnosed) and prediabetes among community-dwelling HF patients using nationally representative data. Methods: We included 473 participants (20+ years) with a diagnosis of HF using data from the 2005-2016 NHANES survey cycles. Diagnosed T2DM was defined by self-report of a previous physician diagnosis. Undiagnosed T2DM was defined by the absence of a physician diagnosis and the presence of ≥ 1 of 3 criteria: 1) Two-hour plasma glucose (2hPG) after oral glucose tolerance test (OGTT) ≥ 200 mg/dL, 2) Hemoglobin A1c (HbA1c) ≥ 6.5%, 3) Fasting plasma glucose (FPG) ≥ 126 mg/dL. Total T2DM was defined as having diagnosed or undiagnosed T2DM. Prediabetes was defined by the absence of T2DM and the presence of ≥ 1 of 3 criteria: 1) 2hPG after OGTT of 140 mg/dL to 199 mg/dL, 2) HbA1c of 5.7% to 6.4%, 3) FPG of 100 mg/dL to 125mg/dL. We stratified estimates by age-standardized socio-demographic characteristics. Trends of the prevalence of T2DM and prediabetes were examined using logistic regressions. Results: The prevalence rates of total, diagnosed, and undiagnosed T2DM and prediabetes among HF patients were 51.4% (95% CI, 46.0%-56.7%), 37.5% (31.7%-43.6%), 13.8% (10.0%-18.2%), and 36.0% (30.2%-42.1%), respectively. The prevalence of T2DM and prediabetes did not significantly change across individual survey cycles. Conclusion: Rates of T2DM and prediabetes among community-dwelling HF patients in the U.S have been persistently high over the past decade. These findings support the need for the prevention and targeted intervention of T2DM in HF patients.

Association between Sleep Disturbances and Cardiovascular Diseases: Results from NHANES

Objectives: The relationship between sleep disturbances and cardiovascular disease (CVD) is not well established. This study assesses the association between sleep disturbances and CVD, and the effect of sleep duration on the relationship between sleep disturbances and CVD among adults in the United States (US). Design: Cross-sectional analysis. Setting: NHANES (National Health and Nutrition Examination Survey). Participants: A total of 5660 adults were included from the 2015-2016 cycle of the NHANES survey. Measurements: The main outcome was the presence of any CVD and included self-reported angina, congestive heart failure, coronary heart disease, hypertension and myocardial infarction. Associations between sleep disturbances and sleep duration with CVD were analyzed using logistic regression. Stratified models by sleep duration were used to assess effect modification. Results: We included 5660 participants (52.2% males), 32.7% of the participants reported having a disturbed sleep and 38% reported a CVD. Compared to those who did not report any sleep disturbances, those with sleep disturbance had 85% higher odds of CVD (OR 1.85, 95% CI 1.43 - 2.39). Similarly, there were 40% higher odds of CVD (OR 1.40, 95% CI 1.01 - 1.95) among those with shorter sleep duration compared with those that slept for 6 to 9hours. However, there was no evidence of effect modification by sleep duration. Conclusions: Our findings show that sleep disturbance is associated with higher odds of CVD. Clinicians and other healthcare providers need to consider the consequence of sleep disturbances and implement strategies in the treatment of patients with or at high risk of CVD.