Self-reported Medication Use Research Articles

Detailed descriptions of physical activity patterns among individuals with diabetes and prediabetes: the Lolland-Falster Health Study

IntroductionThis study aimed to describe objectively measured physical activity patterns, including daily activity according to day type (weekdays and weekend days) and the four seasons, frequency, distribution, and timing of...

Initiation of Antihypertensive Medication from Midlife on Incident Dementia: The Health and Retirement Study.

Hypertension has been identified as a risk factor of dementia, but most randomized trials did not show efficacy in reducing the risk of dementia. Midlife hypertension may be a target for intervention, but it is infeasible to conduct a trial initiating antihypertensive medication from midlife till dementia occurs late life. We aimed to emulate a target trial to estimate the effectiveness of initiating antihypertensive medication from midlife on reducing incident dementia using observational data. The Health and Retirement Study from 1996 to 2018 was used to emulate a target trial among non-institutional dementia-free subjects aged 45 to 65 years. Dementia status was determined using algorithm based on cognitive tests. Individuals were assigned to initiating antihypertensive medication or not, based on the self-reported use of antihypertensive medication at baseline in 1996. Observational analog of intention-to-treat and per-protocol effects were conducted. Pooled logistic regression models with inverse-probability of treatment and censoring weighting using logistic regression models were applied, and risk ratios (RRs) were calculated, with 200 bootstrapping conducted for the 95% confidence intervals (CIs). A total of 2,375 subjects were included in the analysis. After 22 years of follow-up, initiating antihypertensive medication reduced incident dementia by 22% (RR = 0.78, 95% CI: 0.63, 0.99). No significant reduction of incident dementia was observed with sustained use of antihypertensive medication. Initiating antihypertensive medication from midlife may be beneficial for reducing incident dementia in late life. Future studies are warranted to estimate the effectiveness using large samples with improved clinical measurements.

National Estimates of the Adult Diabetes Care Continuum in India, 2019-2021

Diabetes is widespread and treatable, but little is known about the diabetes care continuum (diagnosis, treatment, and control) in India and how it varies at the national, state, and district levels. To estimate the adult population levels of diabetes diagnosis, treatment, and control in India at national, state, and district levels and by sociodemographic characteristics. In this cross-sectional, nationally representative survey study from 2019 to 2021, adults in India from 28 states, 8 union territories, and 707 districts were surveyed for India's Fifth National Family Health Survey (NFHS-5). The survey team collected data on blood glucose among all adults (18-98 years) who were living in the same household as eligible participants (pregnant or nonpregnant female individuals aged 15-49 years and male individuals aged 15-54 years). The overall sample consisted of 1 895 287 adults. The analytic sample was restricted to those who either self-reported having diabetes or who had a valid measurement of blood glucose. The exposures in this survey study were district and state residence; urban vs rural residence; age (18-39 years, 40-64 years, or ≥65 years); sex; and household wealth quintile. Diabetes was defined by self-report or high capillary blood glucose (fasting: ≥126 mg/dL [to convert to mmol/L, multiply by 0.0555]; nonfasting: ≥220 mg/dL). Among respondents who had previously been diagnosed with diabetes, the main outcome was the proportion treated based on self-reported medication use and the proportion controlled (fasting: blood glucose <126 mg/dL; nonfasting: ≤180 mg/dL). The findings were benchmarked against the World Health Organization (WHO) Global Diabetes Compact targets (80% diagnosis; 80% control among those diagnosed). The variance in indicators between and within states was partitioned using variance partition coefficients (VPCs). Among 1 651 176 adult respondents (mean [SD] age, 41.6 [16.4] years; 867 896 [52.6%] female) with blood glucose measures, the proportion of individuals with diabetes was 6.5% (95% CI, 6.4%-6.6%). Among adults with diabetes, 74.2% (95% CI, 73.3%-75.0%) were diagnosed. Among those diagnosed, 59.4% (95% CI, 58.1%-60.6%) reported taking medication, and 65.5% (95% CI, 64.5%-66.4%) achieved control. Diagnosis and treatment were higher in urban areas, older age groups, and wealthier households. Among those diagnosed in the 707 districts surveyed, 246 (34.8%) districts met the WHO diagnosis target, while 76 (10.7%) districts met the WHO control target. Most of the variability in diabetes diagnosis (VPC, 89.1%), treatment (VPC, 85.9%), and control (VPC, 95.6%) were within states, not between states. In this survey study, the diabetes care continuum in India is represented by considerable district-level variation, age-related disparities, and rural-urban differences. Surveillance at the district level can guide state health administrators to prioritize interventions and monitor achievement of global targets.

Effectiveness of digital cognitive-behavioral therapy for insomnia alone or combined with sleep medication: A real-world evidence study

Insomnia is a highly prevalent sleep disorder, but its first line of treatment (Cognitive Behavioral Therapy for Insomnia - CBTi) is not widely available and affordable. Digital therapy has been an alternative to these limitations and its combination with pharmacological treatment may improve patients' clinical outcomes and therapy adherence. This was a real-world evidence study aimed to evaluate the efficacy of a CBTi smartphone app combined or not with sleep medication, based on a sample of users of a CBTi smartphone app (SleepUp®) registered between June 2020 and June 2022. Individuals were categorized into two groups (“dCBTi alone” and “dCBTi combined”) according to their self-reported use of sleep medication on the first day of treatment. Assessments were made based on the self-report of sleep logs (sleep quality and efficiency) and on insomnia severity (Insomnia Severity Index). Comparisons were made considering the first entry (baseline) and the mean of the last three days in which sleep logs were filled out (final). The final samples comprised 143 individuals: 73 (51%) reported using sleep medication at baseline, while 70 (49%) did not. In both groups, there was an improvement in sleep quality, (p<0.001), sleep efficiency (p<0.001), and insomnia severity (p<0.001). The magnitude of effects on sleep efficiency and insomnia severity was greater in the dCTBi combined group. This result indicates that dCBTi can be useful as an adjuvant treatment for insomnia.

#6749 PREVALENCE, AWARENESS, TREATMENT, AND CONTROL OF HYPERTENSION IN OLDER ADULTS WITH CHRONIC KIDNEY DISEASE: THE IRISH LONGITUDINAL STUDY ON AGEING

Abstract Background and Aims Hypertension is a well-known modifiable risk factor for chronic kidney disease (CKD) yet effective management remains a challenge. Data on hypertension awareness, treatment and control among CKD patients in Ireland is limited. Therefore, the objective of this study was to determine the prevalence, extent of awareness, treatment and control of hypertension among older adults with CKD in the Irish population. Method We utilised cross sectional data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) conducted between 2009 and 2011. Participants aged 50 years or more with complete measurements on serum creatinine and blood pressure (BP) were included (n = 5, 356). CKD was defined as eGFR &amp;lt;60ml/min/1.72m2. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or self-reported use of antihypertensive medication. Participants’ awareness and treatment of hypertension were defined using self-report and hypertension control was evaluated as systolic/diastolic blood pressure &amp;lt;140/90 mmHg. We determined the weighted prevalence of hypertension, awareness, treatment, and control using sample weights, and multivariable logistic regression explored associations of demographic, clinical and behavioural characteristics with control of hypertension. Associations were expressed using adjusted odds ratios (OR) with 95% confidence intervals (CIs). Analyses were conducted in Stata and R. Results There were 639/5,356 participants [13.3% (95%CI: 12.3-14.4)] with CKD. The weighted prevalence of hypertension was significantly higher in participants with CKD than without CKD (81.8% versus 59.8% respectively, P&amp;lt;0.001). Among those with CKD and hypertension, 70.8% (95% CI: 66.5-74.7) were aware of hypertension, and 83.4% (95% CI 79.9-86.5) were treated with antihypertensive medication. Despite higher levels of awareness and treatment of hypertension in those with CKD, only 50.4% (95% CI 45.4-55.5) of treated subjects had BP &amp;lt;140/90 mmHg. BP control was similarly poor for non-CKD participants at 49.4% (95%CI: 46.9-51.8). The most commonly used medications among treated CKD participants were β-blockers 41.8% (95% CI 36.7-47.1), angiotensin-converting enzyme inhibitors 34.0% (95% CI 29.2-39.2), and angiotensin receptor blockers 33.7% (95% CI: 28.9-38.8). Over half [54.8% (95% CI: 49.5-60.0)] of CKD participants were treated with ≥ 2 antihypertensive medications. In multivariable analysis, the likelihood of BP control (&amp;lt;140/90 mmHg) was lower for older CKD patients [OR: 0.94 (95% CI: 0.90-0.98) per 1 year increase in age], greater for those on combination therapy [OR: 1.87 (95%CI: 1.13-3.1)] and for those with history of cardiovascular disease [OR: 2.33 (95%CI: 1.43-3.82)]. Conclusion Despite established evidence that control of hypertension can slow the progression of CKD and reduce cardiovascular complications, our results indicate that the prevalence of hypertension in older adults with CKD is high and the control of hypertension is poor and worsens with advancing age. Approximately, one third of participants with CKD were unaware of their hypertensive status and approximately one fifth of participants were untreated.

Impacts of Anxiety and Depression on Clinical Hypertension in Low-Income US Adults.

Depression and anxiety are common leading causes of disability and are associated with systemic effects including cardiovascular comorbidities. Low-income populations may experience higher frequencies of depressive or anxiety-related symptoms, and be at greater risk for developing hypertension. We performed a cross-sectional study of low-income participants who completed hypertension and disability questionnaires as part of the 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES) to identify associations between depressive/anxiety-related symptoms and hypertension status. Multivariable logistic regressions were performed to identify whether (1) frequency of depressive symptoms, (2) frequency of anxiety-related symptoms, (3) self-reported depression medication use, or (4) self-reported anxiety medication use predicted previous hypertension diagnosis. A total of 74,285,160 individuals were represented in our cohort. Participants that reported taking depression (OR 2.72; 95% CI 1.41-5.24; P = 0.009) and anxiety (OR 2.50; 95% CI 1.42-4.41; P = 0.006) medications had greater odds of hypertension. Individuals with depressive feelings daily, monthly, and few times per year were more likely to have hypertension. Respondents with daily (OR 2.28; 95% CI 1.22-4.24; P = 0.021) and weekly (OR 1.88; 95% CI 1.05-3.38; P = 0.040) anxiety symptoms were more likely to have hypertension. Low-income adults in the United States with symptoms of anxiety or depression have higher likelihood of hypertension than those with no symptoms. Respondents who indicated taking medication for anxiety disorders or depression were more likely to have been diagnosed with hypertension.

PCR150 Effects of Smoking on the Prevalence of Self-Reported Antihypertensive Medication Use Among Community-Dwelling Stroke Survivors

To evaluate the effects of cigarette smoking on the prevalence of antihypertensive medication use among community-dwelling stroke survivors.

Diagnosis, pelvic pain, and medication mediate cognitive empathic abilities among women with endometriosis or polycystic ovary syndrome

Objective: Investigate how women with self-reported endometriosis, polycystic ovary syndrome (PCOS), or no known reproductive disease perform on the Reading the Mind in the Eyes task, a metric of social cognitive empathic abilities, and how these scores are mediated by self-reported pelvic pain, depression levels, and medication use. Design: Cross-sectional. Setting: Online survey. Population: Saskatchewan; mixed ethnicities. Methods: Participants ( n = 342) completed surveys on diagnoses of endometriosis and PCOS, levels of pelvic pain, medications, depression, and cognitive empathy (the Reading the Mind in the Eyes task, RMET). Results: Women with endometriosis showed lower scores on the RMET, compared to unaffected women and women with PCOS. However, among women with endometriosis, higher levels of pelvic pain and higher scores on an index of depression were associated with enhanced RMET performance. Among women with PCOS, medication with spironolactone, an androgen receptor antagonist, was associated with higher RMET scores, compared to women with PCOS who were not medicated or who were taking different medications. Conclusions: Symptoms (including pelvic pain), hormonal correlates, and some treatments of PCOS and endometriosis mediated variation in cognitive empathy.

Prediabetes, intervening diabetes and subsequent risk of dementia: the Atherosclerosis Risk in Communities (ARIC) study.

The aim of this work was to evaluate whether the association of prediabetes with dementia is explained by the intervening onset of diabetes. Among participants of the Atherosclerosis Risk in Communities (ARIC) study we defined baseline prediabetes as HbA1c 39-46 mmol/mol (5.7-6.4%) and subsequent incident diabetes as a self-reported physician diagnosis or use of diabetes medication. Incident dementia was ascertained via active surveillance and adjudicated. We quantified the association of prediabetes with dementia risk before and after accounting for the subsequent development of diabetes among ARIC participants without diabetes at baseline (1990-1992; participants aged 46-70 years). We also evaluated whether age at diabetes diagnosis modified the risk of dementia. Among 11,656 participants without diabetes at baseline, 2330 (20.0%) had prediabetes. Before accounting for incident diabetes, prediabetes was significantly associated with the risk of dementia (HR 1.12 [95% CI 1.01, 1.24]). After accounting for incident diabetes, the association was attenuated and non-significant (HR 1.05 [95% CI 0.94, 1.16]). Earlier age of onset of diabetes had the strongest association with dementia: HR 2.92 (95% CI 2.06, 4.14) for onset before 60 years; HR 1.73 (95% CI 1.47, 2.04) for onset at 60-69 years; and HR 1.23 (95% CI 1.08, 1.40) for onset at 70-79 years. Prediabetes is associated with dementia risk but this risk is explained by the subsequent development of diabetes. Earlier age of onset of diabetes substantially increases dementia risk. Preventing or delaying progression of prediabetes to diabetes will reduce dementia burden.

Changing socioeconomic and geographic gradients in cardiovascular disease risk factors among Indians aged 15-49 years - evidence from nationally representative household surveys.

Cardiovascular diseases (CVDs) are the leading cause of death in most low- and middle-income countries (LMICs). CVDs and their metabolic risk factors have historically been concentrated among urban residents with higher socioeconomic status (SES) in LMICs such as India. However, as India develops, it is unclear whether these socioeconomic and geographic gradients will persist or change. Understanding these social dynamics in CVD risk is essential for mitigating the rising burden of CVDs and to reach those with the greatest needs. Using nationally representative data with biomarker measurements from the fourth (2015-16) and fifth (2019-21) Indian National Family and Health Surveys, we investigated trends in the prevalence of four CVD risk factors: smoking (self-reported), unhealthy weight (BMI ≥25 ), diabetes (random plasma glucose concentration ≥200mg/dL or self-reported diabetes), and hypertension (one of: average systolic blood pressure ≥140mmHg, average diastolic blood pressure ≥90mmHg, self-reported past diagnosis, or self-reported current antihypertensive medication use) among adults aged 15-49 years. We first described changes at the national level and then trends stratified by place of residence (urban versus rural), geographic region (northern, northeastern, central, eastern, western, southern), regional level of development (Empowered Action Group member state or not), and two measures of socioeconomic status: level of education (no education, primary incomplete, primary complete, secondary incomplete, secondary complete, higher) and wealth (quintiles). Unhealthy weight increased among all social and geographic groups but both the absolute and the relative changes were substantially higher among people with low SES (as measured by education or wealth) and in rural areas. For diabetes and hypertension, the prevalence increased for those from disadvantaged groups while staying constant or even decreasing among the wealthier and more educated. In contrast, smoking consumption declined for all social and geographic groups. In 2015-16, CVD risk factors were higher among more advantaged subpopulations in India. However, between 2015-16 and 2019-21, the prevalence of these risk factors grew more rapidly for less wealthy and less educated subpopulations and those living in rural areas. These trends have resulted in CVD risk becoming far more widespread throughout the population; CVD can no longer be characterized as a wealthy urban phenomenon. This work was supported by the Alexander von Humboldt Foundation (grant received by NS); the Stanford Diabetes Research Center [grant received by PG] and the Chan Zuckerberg Biohub [grant received by PG].

Associations between cooking fuels and hypertension prevalence in Chinese adults: A prospective cohort analysis focusing on fuel transitioning

BackgroundUsing polluting cooking fuels is a suggested risk factor for hypertension. Transitioning to clean cooking fuels has occurred widely in China in the past 30 years. This provides an opportunity to examine whether the transition could reduce hypertension risk and to ascertain the inconsistent literature on the relationship between cooking fuels and hypertension prevalence. MethodsInitiated in 1989, the China Health and Nutrition Survey (CHNS) enrolled participants from 12 provinces in China. By 2015, nine waves of follow-up have been conducted. Based on self-reported cooking fuels, participants were classified into persistent clean fuel users, persistent polluting fuel users and those who transitioned from polluting fuels to clean fuels. Hypertension was defined as having systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or self-reported current use of antihypertension medication. FindingsAmong 12,668 participants, 3963 (31.28%) were persistent polluting fuel users; 4299 (33.94%) transitioned to clean fuels; and 4406 (34.78%) were persistent clean fuel users. During the period of follow-up (7.8 ± 6.1 years), hypertension was diagnosed in 4428 participants. Compared to persistent clean fuel users, persistent polluting fuel users had a higher risk for hypertension (hazard ratio [HR] 1.69, 95%CI 1.55–1.85), while those transitioned to clean fuels did not. The effects were consistent by gender and urbanicity, respectively. The HRs for hypertension were 1.99 (95%CI 1.75–2.25), 1.55 (95%CI 1.32–1.81) and 1.36 (95%CI 1.13–1.65) among those persistent polluting fuel users aged 18–44, 45–59 and ≥60 years old, respectively. InterpretationTransitioning from using polluting fuels to clean fuels prevented an increase in hypertension risk. The finding highlights the importance of promoting the fuel transition as a risk-reduction strategy for reducing the disease burden from hypertension.

Long-term residential exposure to air pollution and risk of chronic respiratory diseases in Italy: The BIGEPI study

Long-term exposure to air pollution has adverse respiratory health effects. We investigated the cross-sectional relationship between residential exposure to air pollutants and the risk of suffering from chronic respiratory diseases in some Italian cities.In the BIGEPI project, we harmonised questionnaire data from two population-based studies conducted in 2007–2014. By combining self-reported diagnoses, symptoms and medication use, we identified cases of rhinitis (n = 965), asthma (n = 328), chronic bronchitis/chronic obstructive pulmonary disease (CB/COPD, n = 469), and controls (n = 2380) belonging to 13 cohorts from 8 Italian cities (Pavia, Turin, Verona, Terni, Pisa, Ancona, Palermo, Sassari). We derived mean residential concentrations of fine particulate matter (PM10, PM2.5), nitrogen dioxide (NO2), and summer ozone (O3) for the period 2013–2015 using spatiotemporal models at a 1 km resolution. We fitted logistic regression models with controls as reference category, a random-intercept for cohort, and adjusting for sex, age, education, BMI, smoking, and climate.Mean ± SD exposures were 28.7 ± 6.0 μg/m3 (PM10), 20.1 ± 5.6 μg/m3 (PM2.5), 27.2 ± 9.7 μg/m3 (NO2), and 70.8 ± 4.2 μg/m3 (summer O3). The concentrations of PM10, PM2.5, and NO2 were higher in Northern Italian cities. We found associations between PM exposure and rhinitis (PM10: OR 1.62, 95%CI: 1.19–2.20 and PM2.5: OR 1.80, 95%CI: 1.16–2.81, per 10 μg/m3) and between NO2 exposure and CB/COPD (OR 1.22, 95%CI: 1.07–1.38 per 10 μg/m3), whereas asthma was not related to environmental exposures. Results remained consistent using different adjustment sets, including bi-pollutant models, and after excluding subjects who had changed residential address in the last 5 years.We found novel evidence of association between long-term PM exposure and increased risk of rhinitis, the chronic respiratory disease with the highest prevalence in the general population. Exposure to NO2, a pollutant characterised by strong oxidative properties, seems to affect mainly CB/COPD.

Nut and seed consumption is inversely associated with metabolic syndrome in females but not males: findings from the 2005–2018 NHANES data

PurposeTo assess the association between nut and seed consumption, both combined and separately, and metabolic syndrome and its components, including fasting glucose, triglycerides, high-density lipoprotein (HDL) cholesterol, central obesity, and blood pressure.MethodsThis cross-sectional analysis used data from 22,687 adults (aged ≥ 18 years) involved in seven cycles (2005–2018) of the National Health and Nutrition Examination Survey (NHANES). Habitual nut and seed intakes were estimated by the Multiple Source Method using data from two 24-h dietary recalls. Metabolic syndrome was ascertained using biochemical data and self-reported medication use. Sex-specific effect estimates were obtained using logistic and linear regressions adjusting for lifestyle and socioeconomic confounders.ResultsCompared to non-consumers, female, but not male, habitual consumers of either nuts or seeds had lower odds of having metabolic syndrome (OR: 0.83, 95% CI 0.71, 0.97). Both nut intake alone and seed intake alone were inversely associated with high fasting glucose and low HDL-cholesterol in females compared to non-consumers. When restricted to habitual consumers only, the combined intake of nuts and seeds at 6 g/day was associated with the lowest triglycerides and highest HDL-cholesterol in females. Combined consumption of nuts and seeds up to one ounce-equivalent (15 g) per day, but not in higher intake levels, was inversely associated with metabolic syndrome, high fasting glucose, central obesity, and low HDL-cholesterol in females.ConclusionsNut and seed consumption, both separately or combined, below 15 g/day was inversely associated with metabolic syndrome and its component conditions in females but not males.

Hypertension Statistics for US Adults: An Open-Source Web Application for Analysis and Visualization of National Health and Nutrition Examination Survey Data.

Data from the US National Health and Nutrition Examination Survey are freely available and can be analyzed to produce hypertension statistics for the noninstitutionalized US population. The analysis of these data requires statistical programming expertise and knowledge of National Health and Nutrition Examination Survey methodology. We developed a web-based application that provides hypertension statistics for US adults using 10 cycles of National Health and Nutrition Examination Survey data, 1999 to 2000 through 2017 to 2020. We validated the application by reproducing results from prior publications. The application's interface allows users to estimate crude and age-adjusted means, quantiles, and proportions. Population counts can also be estimated. To demonstrate the application's capabilities, we estimated hypertension statistics for noninstitutionalized US adults. The estimated mean systolic blood pressure (BP) declined from 123 mm Hg in 1999 to 2000 to 120 mm Hg in 2009 to 2010 and increased to 123 mm Hg in 2017 to 2020. The age-adjusted prevalence of hypertension (ie, systolic BP≥130 mm Hg, diastolic BP≥80 mm Hg or self-reported antihypertensive medication use) was 47.9% in 1999 to 2000, 43.0% in 2009 to 2010, and 44.7% in 2017 to 2020. In 2017 to 2020, an estimated 115.3 million US adults had hypertension. The age-adjusted prevalence of controlled BP, defined by the 2017 American College of Cardiology/American Heart Association BP guideline, among nonpregnant US adults with hypertension was 9.7% in 1999 to 2000, 25.0% in 2013 to 2014, and 21.9% in 2017 to 2020. After age adjustment and among nonpregnant US adults who self-reported taking antihypertensive medication, 27.5%, 48.5%, and 43.0% had controlled BP in 1999 to 2000, 2013 to 2014, and 2017 to 2020, respectively. The application developed in the current study is publicly available at https://bcjaeger.shinyapps.io/nhanesShinyBP/ and produced valid, transparent and reproducible results.

Hypertension severity, apparent treatment resistant hypertension and hyperuricemia in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Prior studies have identified an association between hypertension and hyperuricemia; however, there has been limited research on the association between hypertension severity and hyperuricemia. We studied 997 Black and white adults with serum urate data from the reasons for geographic and racial differences in stroke (REGARDS) study. Hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or self-reported use of antihypertensive medication. Apparent treatment-resistant hypertension (aTRH) was defined as a SBP ≥ 140 mmHg or DBP ≥ 90 mmHg with concurrent use of three classes of antihypertensive medications, or taking four or more classes of antihypertensive medication regardless of BP level. Controlled BP was defined as SBP <140 mmHg and DBP <90 mmHg. Overall 5.9% of participants had aTRH and 36.6% had hyperuricemia, defined as serum urate >7.0 mg/dl for men and >6.0 mg/dl for women. After full multivariable adjustment, the odds ratio (OR) for hyperuricemia associated with hypertension was 1.60 [95% confidence interval (95% CI): 1.06-2.40]. Compared to participants not taking antihypertensive medication, the ORs for hyperuricemia for participants taking one, two and three classes of antihypertensive medication without aTRH were 1.98 (95% CI: 1.23-3.20), 2.08 (95% CI: 1.25-3.43), 4.31 (95% CI: 2.07-8.97), respectively, and 3.96 (95% CI: 1.75-8.96) for aTRH. Compared to participants without hypertension, the odds ratios for hyperuricemia were 1.67 (95% CI: 1.08-2.58) and 1.46 (95% CI: 0.88-2.44) among those with hypertension with and without controlled BP, respectively. Diuretic use was associated with a higher odds of hyperuricemia. This study suggests that individuals taking more classes of antihypertensive medication may benefit from monitoring for hyperuricemia.

Development and validation of an electronic daily control score for asthma (e-DASTHMA): a real-world direct patient data study

Validated questionnaires are used to assess asthma control over the past 1-4 weeks from reporting. However, they do not adequately capture asthma control in patients with fluctuating symptoms. Using the Mobile Airways Sentinel Network for airway diseases (MASK-air) app, we developed and validated an electronic daily asthma control score (e-DASTHMA). We used MASK-air data (freely available to users in 27 countries) to develop and assess different daily control scores for asthma. Data-driven control scores were developed based on asthma symptoms reported by a visual analogue scale (VAS) and self-reported asthma medication use. We included the daily monitoring data from all MASK-air users aged 16-90 years (or older than 13 years to 90 years in countries with a lower age of digital consent) who had used the app in at least 3 different calendar months and had reported at least 1 day of asthma medication use. For each score, we assessed construct validity, test-retest reliability, responsiveness, and accuracy. We used VASs on dyspnoea and work disturbance, EQ-5D-VAS, Control of Allergic Rhinitis and Asthma Test (CARAT), CARAT asthma, and Work Productivity and Activity Impairment: Allergy Specific (WPAI:AS) questionnaires as comparators. We performed an internal validation using MASK-air data from Jan 1 to Oct 12, 2022, and an external validation using a cohort of patients with physician-diagnosed asthma (the INSPIRERS cohort) who had had their diagnosis and control (Global Initiative for Asthma [GINA] classification) of asthma ascertained by a physician. We studied 135 635 days of MASK-air data from 1662 users from May 21, 2015, to Dec 31, 2021. The scores were strongly correlated with VAS dyspnoea (Spearman correlation coefficient range 0·68-0·82) and moderately correlated with work comparators and quality-of-life-related comparators (for WPAI:AS work, we observed Spearman correlation coefficients of 0·59-0·68). They also displayed high test-retest reliability (intraclass correlation coefficients range 0·79-0·95) and moderate-to-high responsiveness (correlation coefficient range 0·69-0·79; effect size measures range 0·57-0·99 in the comparison with VAS dyspnoea). The best-performing score displayed a strong correlation with the effect of asthma on work and school activities in the INSPIRERS cohort (Spearman correlation coefficients 0·70; 95% CI 0·61-0·78) and good accuracy for the identification of patients with uncontrolled or partly controlled asthma according to GINA (area under the receiver operating curve 0·73; 95% CI 0·68-0·78). e-DASTHMA is a good tool for the daily assessment of asthma control. This tool can be used as an endpoint in clinical trials as well as in clinical practice to assess fluctuations in asthma control and guide treatment optimisation. None.

Abstract P432: Statin Initiation for Primary Prevention and Dose Intensity According to Age in the Women’s Health Initiative

Introduction: Over 50% of US adults older than 75 live free of atherosclerotic cardiovascular disease (ASCVD) and diabetes (DM), yet data on incident statin use among this population are lacking. Our objective was to assess statin initiation by age among the Women’s Health Initiative cohort free of ASCVD and DM at baseline (1993). Hypothesis: Statin initiation is higher at older ages and differs by race/ethnicity. Methods: Exclusions were statin use at baseline, known ASCVD, DM, and no follow-up after baseline. Self-reported medication use was assessed in 1996 and 2008. Specific statin and dose prescribed at the time of initiation were identified using National Drug Codes and determined statin intensity, defined by the ACC/AHA guidelines. We estimated the adjusted association between age group (&lt;65, 65-74, and ≥75) and statin initiation and assessed for heterogeneity by race/ethnicity. We also assessed statin dose at the time of initiation. Results: Over 12 years of follow-up, 27% of 99,631 women free of ASCVD and DM at baseline initiated a statin; initiation was lower with older age (Table). This association remained after adjustment for ASCVD risk factors and did not differ by race/ethnicity (p for interaction &gt;0.5). Moderate intensity dose was most common at statin initiation overall, and moderate and high intensity dose were both lower with older age. Conclusion: Of women free of ASCVD and DM, women older than 75 were least likely to start a statin and most likely to start low intensity statin therapy at initiation than younger women. We identified a potential clinical gap for investigation: whether lower overall use of statins and lower intensity statin therapy among older women are associated with preventable ASCVD.

Abstract P393: AHA Life’s Essential 8 and Incident Hypertension Among US Hispanics/Latinos: Results From the Hispanic Community Health Study/Study of Latinos

Background: The American Heart Association’s Life Essential 8 (LE8) are a set of eight simple health metrics used to define cardiovascular (CV) health and promote healthy behaviors. Our objectives are to: 1) describe for the first time, LE8 among Hispanics/Latinos of diverse backgrounds and 2) determine the association between LE8 and incident hypertension, a leading risk factor for CV disease. Methods: The Hispanic Community Health Study/Study of Latinos is a population-based study of diverse Hispanics/Latinos aged 18-74 years from four US communities. Participants were examined in 2008-2011 (visit 1) and 2014-2017 (visit 2). At visit 1, information on behavioral factors (diet, smoking status, physical activity, sleep duration) and clinical factors (BMI, blood pressure, cholesterol, fasting glucose, and medication use) were measured and used to estimate a LE8 score (range: 0 to 100%) for 14,772 participants with complete information. Ideal cardiovascular health (ICH) was defined by LE8 ≥ 80%. Hypertension was defined as systolic BP ≥130 mmHg or diastolic BP ≥80 mmHg, or self-reported use of antihypertensive medications. We estimated ICH and described LE8 score according to Hispanic/Latino background group. Among the 5,667 participants free from hypertension at visit 1, we used Poisson regression models to determine the association between LE8 and incident hypertension at visit 2 including time between visits as an offset. Models were adjusted for age, sex, Hispanic/Latino background, income, education, nativity, health insurance, and marital status. All analyses accounted for the complex survey design of the study. Results: Among diverse US Hispanics/Latinos with a mean age of 41, 21.6% (SE: 0.7) had ICH. Mean LE8 score (68.2, SE: 0.3) varied by Hispanic/Latino background (p&lt;0.05). Compared with Mexican background, (mean: 72.6, SE: 0.3), LE8 was significantly lower (less favorable) in all other Hispanic/Latino background groups: mean score of 62.2 (SE: 0.4) among Puerto Ricans; 62.3 (SE: 0.5) among Cubans; 69.3 (SE: 0.4) among Central Americans, 70.2 (SE: 0.5) among Dominicans; and 70.2 (SE: 0.7) among South Americans. Among Hispanics/Latinos without hypertension at Visit 1, each 10% decrement in LE8 score was associated with 23% increased risk of hypertension over approximately six years (incident density ratio: 1.23, 95% CI: 1.16, 1.30). Conclusion: Only one in five Hispanics/Latinos had ICH and LE8 varied substantially across Hispanic/Latino background group. Improvements in other components of CV health may result in lower risk of developing hypertension.

Abstract 08: Prevalence and Patterns of Cardiovascular Multimorbidity in Black and White Adults at Midlife: The Bogalusa Heart Study

Background: Multiple chronic conditions, primarily of cardiovascular origins, are a major cause of disability, death, and health care spending. Cardiovascular multimorbidity is also associated with multiplicative risk of morality and substantially lower life expectancy, which may exacerbate health disparities. However, its impact in a rural and low socioeconomic community with a high proportion of minorities is understudied. We aimed to describe multimorbidity prevalence and patterns by race, sex, and socioeconomic status in a middle-aged, community-based cohort. Methods: We examined 1,298 Black (35%) and White (65%) individuals (mean age 48.17 ± SD 5.27 years; 59% female) from the Bogalusa Heart Study, a rural, community-based, longitudinal cohort in Bogalusa, Louisiana, between 2013 and 2016. Eight chronic conditions (CCs) selected based on CMS (Centers for Medicare &amp; Medicaid Services) guidance were defined using data from self-reported medical history, medication use, and physiological or laboratory measures. We defined multimorbidity as the coexistence of two or more of these conditions. The prevalence of cardiovascular multimorbidity and the most commonly occurring dyads and triads were assessed by race, sex, and socioeconomic factors using chi-square tests. Results: We found that 70% of the 1,298 participants had ≥2 CCs, while 31% had ≥3 CCs. The most prevalent conditions were dyslipidemia (87.9%, n=1,141), hypertension (66.6%, n=864), and diabetes (19.7%, n=255). The prevalence of multimorbidity was higher in Black than in White (76.8%, n=344 vs. 66.5%, n=565; p&lt;0.01) participants and higher in men than in women (73.6%, n=393 vs. 67.5%, n=516; p&lt;0.02). Hypertension and dyslipidemia made up the most prevalent dyad (33.0%, n=413), while hypertension, dyslipidemia, and diabetes made up the most prevalent triad (9.4%, n=116). Multimorbidity prevalence was significantly higher among participants with government issued insurance compared to private insurance (80.7%, n=267 vs. 64%, n=427; p&lt;0.001), and more common among lower income compared to higher income (74.6%, n=390 vs 65.4%, n=397; p&lt;0.01), respectively. Conclusion: Cardiovascular multimorbidity is highly prevalent in midlife among participants of the Bogalusa cohort compared to national and even state-wide levels. These findings have critical public health ramifications and support the need to better study multiple CCs in rural, underserved populations to create tailored interventions that are effective among adults in their most productive years of life despite geographic and income barriers.

PREVALENCE OF ELEVATED AST, ALT, ALP IN TYPE 2 DIABETES MELLITUS

Background:Type 2 diabetes mellitus (T2DM) is a major public health concern affecting millions of people worldwide. The relationship between liver enzymes and T2DM has been reported in limited studies. The aim of this study is to evaluate the prevalence of elevated liver enzymes in T2DM. Methods: A total of 200 individuals (100 diabetic and 100 nondiabetic) were enrolled in the study. Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP) activities were measured in serum collected from them. T2DM was dened as fasting blood glucose (FBG) ≥126 mg/dLor self-reported recent use of insulin or antidiabetic medications. Results:Among the participants, 63% in T2DM and 30% in the non-diabetic group had at least one or more elevated liver enzymes in serum. The mean concentrations of serum AST, ALT and ALP were signicantly higher in the T2DM group compared to the non-diabetes group, suggesting high prevalence of elevated liver enzymes in the T2DM. Conclusions: A high prevalence of elevated liver enzymes was observed in subjects having T2DM than in non-diabetics. More studies of this nature should be carried out in developing countries to get proper insights into the importance of assessing liver enzymes in T2DM.