American Heart Association EPI|Lifestyle Scientific Sessions: 2021 Meeting Highlights.

The annual American Heart Association (AHA) EPI|Lifestyle Scientific Sessions for 2021 was held in a virtual format from May 20 to 21, 2021. The AHA EPI|Lifestyle Scientific Sessions were combined meetings of the Council on Epidemiology and Prevention (EPI) and the Council on Lifestyle and Cardiometabolic Health. The 2021 conference's theme was Health Equity and Social Justice and highlighted keynote sessions on health equity, structural racism, and COVID‐19 and cardiovascular disease (CVD) research. Results from observational studies and randomized controlled trials were presented at the meeting, including research on topics such as social determinants of health, maternal and child health, omics, nutrition, physical activity, and sleep. Participants of the virtual conference included clinicians, public health professionals, and trainees. Over 600 people took part in this year's event, which hosted 212 poster presentations, 66 moderated posters, and 80 oral presentations. The meeting chair representing the Council on Lifestyle and Cardiometabolic Health was Dr Kristie Lancaster from New York University, and Dr Pamela Lutsey from the University of Minnesota represented the EPI council. The vice chairs were Dr Marie‐France Hivert from Harvard University representing the Council on Lifestyle and Cardiometabolic Health, and Dr Alvaro Alonso representing the EPI council.

Conference Theme: Health Equity and Social Justice

In welcoming remarks, Dr Mitchell Elkind, AHA president, recognized that 2020 was a year characterized by a pandemic and an increased focus on structural racism, social justice, and the impacts of social determinants of health. To address the COVID‐19 crisis, the AHA created a rapid special response grant mechanism, and studies are ongoing. Additionally, as a result of the Presidential Advisory on Structural Racism published in November 2020, the AHA is committing $100 million over the next 5 years toward health equity and structural racism research.

Keynote Sessions

Health Equity and Social Justice

The opening keynote session, Health Equity and Social Justice, featured Drs Olajide Williams and LaPrincess Brewer, and was moderated by Dr Kristie Lancaster. Dr Olajide Williams from Columbia University presented an overview of the relationship between racism and poor health. Intense amygdala activation and greater startle response occur when unfamiliar Black male faces are shown, and this is associated with higher unconscious bias, starting in early adolescence. The effects of racism have seeped into every sector of US society. In working to prevent the detrimental effects of racism on cardiovascular health, Dr Williams used Dr Camara Jones’ cliff analogy. If a group of people are at the edge of a cliff of good health, secondary and tertiary prevention strategies would focus on treating those who fall off, for instance by providing medical care to those who have fallen off the cliff (tertiary prevention) or positioning a trampoline halfway down the cliff to soften the fall (secondary prevention, safety‐net program). Primary prevention strategies would aim to prevent people from falling in the first place. Even more effective, however, would be to implement primordial prevention strategies that move people back from the edge of the cliff face. Furthermore, interventions to address the determinants of equity would address the unequal distribution of populations at the edge of the cliff and resources for prevention. In the context of cardiovascular health, Dr Williams discussed the importance of addressing structural racism and racism in all its forms.

Dr LaPrincess Brewer from the Mayo Clinic spoke about community‐based participatory research to address cardiovascular disparities. Dr Brewer is the principal investigator of fostering African‐American improvement in total health (FAITH!), a culturally tailored mobile health intervention that integrated community‐based participatory research approaches to address cardiovascular health disparities within Black communities. Dr Brewer highlighted the importance of engaging community members in the research process when conducting studies addressing cardiovascular disparities. According to Dr Brewer, successful community‐based participatory research (1) is a partnership between community members, organizations and academics (of the people), (2) obtains community input and support from the beginning of the research (by the people), and (3) supports sustainability and dissemination for long‐term population health (for the people).

COVID‐19

The second day of the conference featured keynote lectures on COVID‐19 and cardiovascular health, and was moderated by Dr Pamela Lutsey. The first speaker was Dr Scott D. Solomon from Brigham and Women’s Hospital who presented on COVID‐19 and the cardiovascular system. Cardiovascular risk factors and comorbidities are associated with severe COVID‐19. Endothelial damage may be the link between cardiovascular complications/risk factors and severe COVID‐19. Additionally, symptoms of postacute sequalae of COVID‐19 are linked to various organ systems including the cardiovascular system. Unfortunately, the extent of cardiovascular consequences of postacute sequalae of COVID‐19 are not yet fully known, and further rigorous epidemiologic research is needed.

The second speaker was Dr Mercedes Carnethon from Northwestern University. Dr Carnethon presented on how disparities in cardiometabolic and cardiovascular morbidities contributed to the disproportionate burden of severe COVID‐19. Structural racism and its effects on social determinants of health increase the risk of both COVID‐19 infection and cardiometabolic and cardiovascular conditions, which are associated with severe COVID‐19 outcomes. As a result, across the spectrum of COVID‐19, from infection to postacute sequalae of COVID‐19, marginalized groups, including communities of color, have disproportionately suffered. To address COVID‐19 disparities, it would be important to expand access to health care, establish equitable care models, and address social determinants of health.

David Kritchevsky Memorial Lectureship

The David Kritchevsky Memorial Lectureship was created in 2007 in honor of Dr David Kritchevsky for his important influence on our understanding of the role of diet in the pathophysiology of atherosclerosis. This year’s honoree was Dr Serge Hercberg from the University of Sorbonne, Paris, France. Dr Hercberg began his lecture by acknowledging previous honorees, all of whom have made significant contributions to the field of nutritional science. His talk focused on the Nutri‐Score, a summary, graded, color‐coded, front‐of‐pack nutrition label first adopted in France in 2017 and subsequently in several other European countries. The Nutri‐Score rating system is designed to help consumers make healthier food choices at the point of purchase and incentivize manufacturers to reformulate their products. Dr Hercberg presented a summary of evidence used to support the implementation of the Nutri‐Score system, including understanding of Nutri‐Score among European consumers, comparisons with other front‐of‐pack labels on consumer purchase intentions, validation of the nutrient profile system underlying the Nutri‐Score, and associations of Nutri‐Score scores with prospective health outcomes. For example, consumption of foods in the poorest quartile of the Nutri‐Score rating conferred a 61% higher risk of CVD.

Oral Abstract Presentations

Following the keynote and named lecture sessions, oral abstracts were presented on a broad range of topics, described below. Moderated poster presentations are detailed in Data S1.

Abstracts presented in this session, moderated by Dr Bertha Hidalgo from the University of Alabama at Birmingham aligned with the conference theme of health equity and social justice and highlighted research among Hispanic and Latinx, South Asian, and Black adults, incarcerated persons, and individuals living in rural communities.

Jonathan Oxman from the Albert Einstein College of Medicine examined the relationship of perceived discrimination with cardiac structure and function in the HCHS/SOL (Hispanic Community Health Study/Study of Latinos): ECHO/SOL (Echocardiographic Study of Latinos) ancillary study. Stigmatization/devaluation and experiencing discrimination at work or school predicted left arterial volume index, and total discrimination score predicted left ventricular ejection fraction. Dr Alex Montiel Ishino from the National Institute on Minority Health and Health Disparities presented data from the MASALA (Mediators of Atherosclerosis in South Asians Living in America) study. Using a syndemic framework, findings showed that the latent profile at the highest risk of cardiometabolic disease was more likely to use an assimilation acculturation strategy.

Research by Dr Shabatun Islam from Emory University examined the relationship of neighborhood characteristics with arterial stiffness among participants from Jackson, Mississippi, and Atlanta, Georgia. Social cohesion and activity with neighbors were associated with better arterial health in both settings, whereas lower violence was associated with improved arterial health in Jackson, and improved food access was associated with better arterial health in Atlanta. Dr Chelsea Singleton from the University of Illinois presented research showing physical inactivity and obesity were associated with higher violent crime rates in majority Black or Hispanic census tracts, but not majority White census tracts in Chicago, Illinois.

Among women with a history of breast and gynecologic cancers, Dr Duke Appiah from the Texas Tech University Health Sciences Center found that the prevalence of cardiovascular mortality was higher among women living in rural compared with urban areas, which could be explained by individual‐ and neighborhood‐level factors. Dr Stephen Clarkson from the University of Alabama at Birmingham discussed predictors of establishing care in an interprofessional heart failure clinic following heart failure hospitalization at a hospital in Birmingham, Alabama. Black individuals residing in rural areas were least likely to establish care and more likely to have other comorbidities such as hypertension and alcohol use disorder than urban dwellers. Ary Spilkin from Northern Arizona University examined dietary content in a rural Southwest jail in comparison to guidelines for a heart‐healthy pregnancy. Sodium and saturated fat exceeded recommended amounts, whereas whole grains were inadequate.

Cardiovascular Outcomes and Risk Prediction

In the session on risk prediction, moderated by Dr Alvaro Alonso from Emory University, multiple presentations leveraged machine‐learning approaches. Dr Zhi Yu from the Broad Institute used data from the ARIC (Atherosclerosis Risk in Communities) study to address the impact of time‐varying risk factors on predicting the risk of sudden cardiac death using a novel machine‐learning approach. Dr Matthew Matheson from Johns Hopkins University tested the ability of random survival forest algorithms to identify the most important markers for incident CVD among 155 108 Japanese adults >40 years of age.

The value of longitudinal, cardiovascular cohorts was also displayed. Dr Rebecca Song from Boston University explored the prognostic usefulness of subclinical disease measures, such as coronary artery calcium score, left ventricular hypertrophy, and microalbuminuria, in the Framingham Offspring and Third Generation cohorts. Dr Mercedes Sotos‐Prieto of Universidad Autónoma de Madrid hypothesized that the Healthy Heart Score, a lifestyle‐based score, would improve the prediction of cardiovascular risk in the Jackson Heart Study, but it did not improve prediction of midlife CVD events beyond age alone. Using data from 6 US population‐based cohorts, Dr Priya Freaney from Northwestern University found Black women are 3 times more likely to experience premature natural menopause (<40 years) than White women, which was associated with a 40% higher risk of coronary heart disease in both Black and White women, emphasizing premature menopause should be assessed as a risk‐enhancing variable in clinical prevention decisions. Using data from the ARIC study, Dr Scott Mu from Johns Hopkins University found that the lowest mean value of self‐rated health occurred 1 year after hospitalization, and that poor self‐rated health was strongly associated with adverse outcomes, including a 4‐fold greater risk of mortality compared with excellent self‐rated health. Dr Zakaria Almuwaqqat from Emory University showed there was a synergistic association of posttraumatic stress disorder and mental stress‐induced myocardial ischemia on the risk of adverse cardiovascular outcomes in a cohort of individuals with stable coronary artery disease.

Diabetes and Obesity

Dr Justin Echouffo‐Tcheugui from Johns Hopkins University moderated the session on diabetes and obesity. Based on maternal birth record data for live births from 2016 to 2018, Dr Natalie Cameron from Northwestern University observed that the proportion of women with favorable prepregnancy cardiometabolic health (normal body mass index, no smoking, no diabetes, and no hypertension), has declined, with the lowest rates in the Southern and Midwestern states. Dr Ambarish Pandey from University of Texas Southwestern presented on the risk of heart failure for different measures of body composition and observed that higher fat mass and waist circumference were associated with a higher risk of heart failure among people with diabetes or prediabetes. Dr Di Zhao from Johns Hopkins University used a mobile application to evaluate the effect of time‐restricted eating on weight, and found that a higher number of medium or large meals was associated with weight gain, whereas a higher number of snacks was associated with decreased weight trajectory. Based on data from the action for health in diabetes (Look AHEAD) trial, Dr Mike Bancks from Wake Forest University found that the effect of the intensive lifestyle intervention on cardiovascular disease prevention may differ according to diabetes subgroup. Dr Rikuta Hamaya from Brigham and Women’s Hospital used data from the Women’s Health Study to identify modifiable lifestyle factors for serum levels of branched‐chain amino acids, which are associated with insulin resistance and type 2 diabetes. Body mass index was the only risk factor that explained a substantial portion of the variation in serum branched‐chain amino acid levels. Dr Xiang Gao from Colorado State University examined moderators and mediators of the relationship between the vasoconstrictor endothelin 1 and risk for diabetes in Black adults in the Jackson Heart Study. Dr Carolina Ochoa‐Rosales from Erasmus University found the beneficial effect of coffee on type 2 diabetes risk was partially mediated by improvements in systemic inflammation, as reflected in C‐reactive protein and adiponectin levels.

Nutrition

Dr David Jacobs from the University of Minnesota moderated the nutrition session, which featured several presentations on dietary patterns. Fenglei Wang from Harvard University reported that among 10 684 participants of the Nurses’ Health Study, Nurses’ Health Study II, and the Health Professionals Follow‐Up Study, metabolomic signatures of plant‐based diets were associated with a significant 18% lower risk of incident type 2 diabetes. Dr Stephen Juraschek from Beth Israel Deaconess Medical Center presented a secondary analysis of the dietary approaches to stop hypertension (DASH)‐Sodium trial, which showed that compared with the control diet, participants randomized to a combined low‐sodium and DASH diet had lower levels of high‐sensitivity cardiac troponin I, N terminal pro‐B‐type natriuretic peptide, and high‐sensitivity C‐reactive protein. Dr Sun Young Jeong, an internal medicine resident at Beth Israel Deaconess Medical Center, demonstrated that individuals randomized to a DASH diet or a diet more broadly emphasizing fruits and vegetables had an average 10% and 11% reduction, respectively, in their 10‐year arteriosclerotic cardiovascular disease risk compared with those randomized to a control diet over an 8‐week period. Dr Marialaura Bonaccio from IRCCS Neuromed showed that individuals with greater adherence to a Mediterranean diet over 12.7 years experienced a reduction in inflammatory markers, including the granulocyte‐to‐lymphocyte ratio, compared with those with lower adherence. Dr Kathy Trieu from the George Institute for Global Health presented systematic review data suggesting that higher levels of dairy fat biomarkers (15:0 and 17:0) were associated with a lower risk of incident arteriosclerotic cardiovascular disease.

Novel CVD Risk Factors

In this oral abstract session, moderated by Dr Deepak Gupta from Vanderbilt University, a variety of novel environmental, endogenous, and behavioral CVD risk factors were presented.

Fan He of Pennsylvania State University used 24‐hour individual‐level acute particulate matter PM2.5 monitors and concurrently measured 24‐hour ECG recordings in the Penn State Child Cohort, and found that within 2 hours of exposure, every 10‐µg/m3 increase in PM2.5 was associated with a 5% increase in counts of premature ventricular contractions. Dr Erin Richard from the University of California San Diego used a Mendelian randomization approach to investigate the associations of various kidney function biomarkers and cognitive function in adults from the UK Biobank study, and found no evidence of causal effects for genetically determined levels of serum uric acid, creatinine‐based estimated glomerular filtration rate, or cystatin C‐based estimated glomerular filtration rate with cognitive performance. Dr Brandilyn Peters‐Samuelson from the Albert Einstein College of Medicine examined the impact of menopause on the microbiome and related associations with metabolic syndrome in the HCHS/SOL. There were similarities in the microbiomes of men and postmenopausal women, with a reduced abundance of potentially pathogenic bacteria Escherichia coli and Shigella dysenteriae.

Adam Haines from the Albert Einstein College of Medicine found that use of nonbenzodiazepine gamma‐aminobutyric acid receptor agonists, but not other prescription hypnotic use, was associated with increased risks of incident CVD and all‐cause mortality in older women with known sleep disturbances in the WHI (Women’s Health Initiative). Yifei Lu from the University of North Carolina presented research from the ARIC study showing both higher midlife metabolic dysregulation and greater changes in metabolic dysregulation over time were associated with reduced later‐life physical function.

Dr Megan Nelson from the University of Idaho showed that over a 3‐hour bout of uninterrupted sitting, both physically active and inactive adults experienced negative physiological effects, including a worsening hemodynamic profile and increased levels of biomarkers interleukin‐6 and endothelin‐1. Dr Steven Nguyen from the University of California San Diego used ARIC data to examine the association of GrimAge, a DNA methylation‐based measure of aging that predicts all‐cause mortality, with incident heart failure and its potential usefulness for risk prediction.

Sleep

Dr Chandra Jackson from the National Institute of Environmental Health Sciences moderated the session on sleep. Using data from the Nurses’ Health Study and the Health Professionals Follow‐Up Study, Dr Marta Guasch‐Ferré from Harvard University found that a healthy lifestyle score including sleep duration was associated with lower incidence of total CVD, coronary heart disease, and stroke. Adding sleep duration to the traditional lifestyle score improved the model’s prediction. Dr Faris Zuraikat from Columbia University presented a randomized crossover outpatient trial of adequate sleep versus sleep restriction characterized by a 1.5‐hour delay in bedtime. Chronic short sleep patterns were associated with greater sedentary time and lower physical activity, particularly among women.

Vivian Cao from Columbia University presented results of a cross‐sectional analysis of a diverse cohort of women, which showed a history of weight cycling (weight loss and regain) was associated with shorter sleep duration, poorer sleep quality, greater insomnia severity index, more sleep disturbances, and daytime dysfunction. Dr Julio Fernandez‐Mendoza from Pennsylvania State University presented findings showing that cumulative exposure to sleep‐disordered breathing over 15 years was associated with increased risk of endothelial dysfunction in young adults in the Penn State Child Cohort. Dr Adam Knowlden from the University of Alabama used National Health and Nutrition Examination Survey data to determine whether short sleep and insomnia represented independent constructs and if these constructs predicted obesity, hypertension, and diabetes. Claire Zhang from the University of California, San Diego discussed a novel, low‐cost tool that passively captures respiration during sleep via mechanical sensors placed under the legs of a bed to enable long‐term home investigation of periodic breathing.

COVID‐19 and CVD

This session included timely individual‐ and community‐level investigations related to COVID‐19 and CVD, and was moderated by Dr Elizabeth Oelsner from Columbia University.

Dr Joshua Elliott from Imperial College presented data from the UK Biobank cohort of 473 574 participants at risk for COVID‐19 from January 2020. Age, male sex, Black race, low income, CVDs, hypertension, diabetes, autoimmune disease, history of steroid use, and cystatin C jointly predicted COVID‐19 mortality. In a population‐based sample of COVID‐19 cases and controls from the OneFlorida research consortium, Dr Osama Dasa from the University of Florida found there was a significantly higher prevalence of cardiovascular comorbidities in Black compared with White individuals with COVID‐19 infection.

Ashwin Sunderaj from Northwestern University examined the associations of community‐level factors, including social vulnerability (eg, crowded living conditions and limited food access) and socially protective factors (eg, having a primary care provider) with COVID‐19 mortality across 77 community areas in Chicago. Dr Alexander Ivanov from Wake Forest Baptist Medical Center presented findings from a serological substudy of 5000 randomly selected participants included in the COVID‐19 Community Research Partnership cohort and highlighted the independent association of heart failure with SARS‐CoV‐2 seroconversion. Eugenia Wong from the University of North Carolina used data from North Carolina disease event tracking and epidemiologic collection tool (NC DETECT), the state’s syndromic surveillance system, to document an abrupt decrease in overall emergency department volume and acute myocardial infarction and stroke/transient ischemic attack emergency department visits following announcements of the state‐wide stay‐at‐home order. Dr Hanna Moon from Yonsei University Severance Hospital presented a systematic review on the characteristics and outcomes of in‐hospital cardiac arrest among patients with COVID‐19. Finally, Dr Gregory Heath from the University of Tennessee, Chattanooga discussed the use of geospatial data and subsequent intersectoral collaboration to eliminate disparities in COVID‐19 testing.

Maternal and Child Health

This session, moderated by Dr Marie‐France Hivert from Harvard University featured several presentations aimed at addressing disparities in maternal and child health.

Dr Michelle Ogunwole from Johns Hopkins University examined disparities in gestational diabetes among US‐ versus foreign‐born women by analyzing data from the 2016 to 2017 National Health Interview Survey. Dr Samantha E. Parker from Boston University found 1 in 10 women in a diverse safety‐net hospital population with normotensive pregnancies developed de novo hypertension within 12 months postpartum; risk factors included identifying as non‐Hispanic Black, delivery via cesarean section, preterm delivery, or multiparous gestation. Dr Angela Malek from the Medical University of South Carolina investigated the associations of hypertensive disorders of pregnancy and prepregnancy hypertension with incident maternal embolism within 5 years of delivery overall and by race and ethnicity using data from a retrospective cohort study in South Carolina.

Using data from the Boston Birth Cohort, Dr Anum Minhas from Johns Hopkins University found greater adherence to a Mediterranean style diet was associated with lower odds of preeclampsia. Dr Adebamike A. Oshunbade from the University of Mississippi Medical Center evaluated the relationship between hypertensive diseases in pregnancy and biomarkers of hemodynamic stress later in life in the Genetic Epidemiology Network of Arteriopathy study.

Michael Wang from Northwestern University used the 2014 to 2018 US National Center for Health Statistics Natality Files to examine the associations of maternal prepregnancy cardiovascular health factors (normal body mass index, nonsmoking, no diabetes, and no hypertension) with adverse maternal and fetal outcomes (maternal intensive care unit admission, preterm birth, low birthweight, and fetal death). Suboptimal prepregnancy cardiovascular health was more common among non‐Hispanic Black and Hispanic women, and had strong, graded associations with adverse maternal and fetal outcomes. Dr Kara Whitaker from the University of Iowa investigated variations in health behaviors among pregnant women during the COVID‐19 pandemic using data from the COVID‐19: Health in Pregnancy and Postpartum Study. Most participants reported no changes or improvement in diet, physical activity, or sleep, but women more likely to report adverse lifestyle behavioral changes were those who reported experiencing pregnancy complications, loss of income, and changes in social connections because of the pandemic.

Clinical Epidemiology

Dr Anna Kucharska‐Newton from the University of Kentucky served as the moderator for the session on clinical epidemiology. Dr Rahul Aggarwal from Beth Israel Deaconess Medical Center examined racial disparities in hypertension and diabetes mortality in urban and rural communities in the United States among Black and White adults from 1999 to 2018. Black adults had higher rates of mortality attributable to diabetes and hypertension than White adults in both urban and rural areas, but the gap narrowed only in urban areas. Dr Kiran Biddinger from the Broad Institute conducted a Mendelian randomization study in the UK Biobank to evaluate the causal relationship between alcohol and cardiovascular disease and found exponential increases in risk for both clinical and subclinical cardiovascular disease across all levels of alcohol consumption.

Dr Neil Kalwani from Stanford University presented research on the operational impact of telehealth in a preventive cardiovascular clinic. The study, conducted before the COVID‐19 pandemic, found video visits for preventive care were more likely to start and end on time, and were more operationally efficient than in‐person visits. Using data from the ARIC study, Dr Mauro Felippe Felix Mediano from the Oswaldo Cruz Foundation found higher levels of prestroke physical activity, during both work and leisure, were associated with decreased mortality after stroke. Radha Dhingra from the Pennsylvania State College of Medicine examined the burden of CVD in a psychiatric outpatient population by comparing electronic health record data from a psychiatric outpatient clinic with nationally representative data from the National Health and Nutrition Examination Survey. Yuta Ishikawa from the University of Georgia College of Public Health evaluated diagnostic tests for diabetes among people with heart failure in the National Health and Nutrition Examination Survey.

Hypertension

Dr Jared Magnani from the University of Pittsburgh moderated the session on hypertension. Dr Saate Shakil from the University of Washington presented results on the global patterns of mean systolic blood pressure between 1990 and 2019. Overall, the highest mean systolic blood pressures in 1990 were observed in high‐income locations, but in 2019, the highest systolic blood pressures were observed in Sub‐Saharan Africa. To assess whether there were racial and ethnic differences in blood pressure during the 2016 US general election, Dr Andrew Hwang from High Point University analyzed National Health and Nutrition Examination Survey data from periods before the election (May 2016–October 2016) and after the election (November 2017–April 2018). At the population level, racial and ethnic minorities had increased blood pressure following the US general election. Dr Gabriel Tajeu from Temple University presented findings from the Jackson Heart Study, which showed less than half of participants in the study on antihypertensive medication had persistent blood pressure control.

Presenting findings from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort, Dr Carol Oladele from Yale University examined the association between ultraprocessed food and hypertension incidence. Consumption of ultraprocessed food was higher among Black adults and associated with increased risk of hypertension among Black adults, but not among White adults. So Mi Jemma Cho from Yonsei University presented research on nocturnal blood pressure dipping and chronic kidney disease among patients with controlled blood pressure and showed patients with reverse or nondipping blood pressure patterns had higher odds for albuminuria and reduced kidney function. Using data from the International Childhood Cardiovascular Cohorts Consortium, Dr Elaine Urbina from Cincinnati Children’s Hospital discussed findings that showed blood pressure trajectories across childhood might identify youth at risk for developing hypertension in adulthood. Dr Jennifer McLeod from the Albert Einstein College of Medicine discussed results from the ECHO/SOL ancillary study on cardiac structure and function in relation to hypertension and the impact of blood pressure control.

Physical Activity

In the session on physical activity moderated by Dr Sarah Camhi from the University of San Francisco, observational and intervention studies were presented.

Christopher Moore from the University of North Carolina examined the association of daily steps accumulated outside of bouts of physical activity (sporadic steps) and all‐cause mortality, before and after accounting for bouted steps, using data from the Women’s Health Study. Dr Katie Crist from University of California, San Diego presented findings from a cluster‐randomized trial that compared the effects of a multilevel PEP4PA (Peer Empowerment Program 4 Physical Activity) versus usual senior center programming on moderate‐to‐vigorous physical activity, blood pressure, perceived quality of life, and depressive symptoms among a diverse population of predominantly low‐income older adults over 24 months. Using data from the CARDIA (Coronary Artery Risk Development in Young Adults) study, Minsuk Oh from the University of Iowa found a greater 10‐year increase in television viewing was associated with a greater increase in pericardial adipose tissue, controlling for moderate‐to‐vigorous physical activity and other confounders. Dr Maira Tristao Parra from the University of California, San Diego examined the cross‐sectional association between mindfulness and physical activity among patients with stage B heart failure in the University of California, San Diego and Veteran Affairs San Diego Health Care Systems. Xiao Hu from Johns Hopkins University examined physical function and subsequent risk of cardiovascular events in older adults in ARIC, and found participants with low and intermediate physical function had significantly higher risk of the composite CVD outcome than those with high physical function.

Dr Angelique Brellenthin from Iowa State University examined the independent and joint associations of familial dementia (dementia in a first‐degree relative) and healthy lifestyle behaviors with dementia risk in adults ≥60 years of age in the UK Biobank Study. A greater number of healthy behaviors was associated with a lower risk of dementia, whereas familial dementia was associated with a higher risk of dementia; among those with familial dementia, adopting 3 or more healthy behaviors was associated with lower dementia risk. Alexis Jones from the University of South Carolina examined differences in body composition at baseline and in response to a 20‐week endurance training program in the HERITAGE (Health, Risk Factors, Exercise Training, and Genetics) study by metabolic health and weight status.

Jeremiah and Rose Stamler Research Award for New Investigators Finalist Presentations

Dr Donald Lloyd‐Jones from Northwestern University moderated the Stamler Award finalist presentations and presented this year’s award to Mingyu Zhang from Johns Hopkins University. Zhang applied Bayesian kernel machine regression to data from the Boston Birth Cohort to examine the association of in utero coexposure to metals lead, cadmium, mercury, manganese, and selenium with offspring systolic blood pressure in children 3 to 15 years of age.

Dr Shreya Rao from the University of Texas Southwestern examined longitudinal trajectories and predictors of county‐level cardiovascular mortality in the United States from 1980 to 2014. Daniela Charry from the University of North Florida presented research on total brachial artery reactivity and incident heart failure in the MESA (Multi‐Ethnic Study of Atherosclerosis). Dr Daniel Huck from the University of Colorado presented a retrospective cohort study in the University of Colorado Health System comparing cardiovascular outcomes of patients with hypertension taking the vasodilatory β‐blocker nebivolol with patients taking the nonvasodilatory β‐blockers atenolol and metoprolol. Finally, Dr Andrew Agbaje from the University of Eastern Finland examined whether lean mass and systolic blood pressure, independent of fat mass and cardiometabolic and lifestyle factors, are associated with changes in carotid‐femoral pulse wave velocity and carotid intima‐media thickness from 17 to 24.5 years of age in the Avon Longitudinal Study of Parents and Children birth cohort.

National Heart, Lung, and Blood Institute Cardiovascular Epidemiology, Biostatistics, and Prevention Trainee Session

As in previous years, the National Heart, Lung, and Blood Institute (NHLBI) sponsored a concurrent session at AHA EPI|Lifestyle that highlighted the work of NHLBI‐supported trainees. Fifteen trainees from 10 institutions presented their work across 2 sessions. The first, moderated by Drs James Lash (University of Illinois) and Vanessa Xanthakis (Boston University), featured presentations on physical activity, diabetes, blood pressure, stress, and SARS‐CoV‐2. Several presentations closely aligned with the meeting theme of health equity and social justice. Dr Telisa Spikes from Emory University presented work focused on the associations between net worth, debt stress, and ambulatory blood pressure in Black women. Two studies focused on factors related to the build environment; Genevieve Davison from Washington University in St. Louis presented work on neighborhood concentrated disadvantage and its null association with behavioral obesity treatment response, and Mary Schiff from the University of Pittsburgh demonstrated the differential associations of residential segregation on gestational hypertension among minority women.

The second session was moderated by Drs Jan Hughes‐Austin (University of California, San Diego) and Shakia Hardy (University of Alabama at Birmingham) and featured presentations on pulmonary health, dental health, COVID‐19, diet, and social isolation. Three studies leveraged data from the ARIC study. Dr Brian Steffen of the University of Missouri used large‐scale proteomic data to show that those at greater genetic risk of COVID‐19–related respiratory failure are susceptible to interleukin‐15 suppression. Rebecca Molinsky of the University of Minnesota discussed the association between periodontal disease and incident heart failure, highlighting an understudied potential risk factor for cardiovascular disease in older adults. Dr Albert Liu discussed the associations between social isolation, social support, and cognitive decline in older adults. All 3 presentations highlighted risk factors that may be significantly affected by the ongoing global pandemic and COVID‐19 precautionary practices such as social distancing. Although ongoing NHLBI‐supported cohorts are well positioned to study these changes, new studies may also be necessary to assess these risk factors in populations not under study such as children, younger adults, and racial minorities.

As in previous years, the NHLBI trainee session highlighted timely and methodologically strong work presented by early career investigators in cardiovascular epidemiology. Longitudinal cohorts continue to play an important role in providing structured training opportunities for these investigators. New approaches, methods, and studies were also highlighted including geographic/spatial analyses, data from randomized controlled trials, and financial data. The NHLBI trainee session continues to be an important venue for the trainees to present their work.

Early Career Committee Events

Epidemiology and Prevention Council: At the Heart of It All: Non–Cardiovascular‐Based Cohorts to Address Cardiovascular Research Questions for Early‐Stage Investigators

The session was moderated by Drs Sadiya Khan (Northwestern University) and Chris Longnecker (Case Western University), with Drs Ravi Kalhan (Northwestern University), Becky McNeil (RTI International), Philip Greenland (Northwestern University), and Heidi Crane (University of Washington) serving on the panel.

Dr Ravi Kalhan highlighted the need for a lung‐health cohort to help with lung disease prediction, prevention, and management and discussed the establishment of a community‐based cohort to help fill this gap in research. Dr Heidi Crane discussed opportunities that the Center for AIDS Research Network of Integrated Clinical Systems cohort offers for researchers to examine longitudinal data on people with HIV being treated with highly active antiretroviral therapy (HAART). She encouraged researchers to examine available data on resistance, patient‐reported and validated outcomes, and biological specimens. Drs Greenland and McNeil talked about the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers‐to‐Be) study among racially, ethnically, and geographically diverse pregnant women. The nuMoM2b is a prospective cohort study to evaluate the underlying, interrelated mechanisms of common adverse pregnancy outcomes, which can be unpredictable in women with little or no pregnancy history, to help guide their treatment. This initiative addresses a critical group of at‐risk women who are understudied and represent 40% of US births each year. Study results will help inform health care providers and their patients who are pregnant or considering pregnancy and support future research to improve care and outcomes.

Lifestyle and Cardiometabolic Health Council: Designing and Implementing Research Studies to Promote Health Equity and Inclusion

Drs Anika Hines and Danielle Crookes moderated this early career committee event with Drs LaPrincess Brewer, Sharon Taverno Ross, Yvonne Commodore‐Mensah, and Clyde Yancy serving as panelists. To succeed in health equity research among persons in minoritized communities, the panelists stressed the importance of researchers (1) offering their authentic selves, skills, and resources before others request them, (2) providing resources before requiring information or collecting data from the community, and (3) not stopping at engaging the community but also investing in the community. The panelists also discussed the importance of not only having mentors but also sponsors to support and help early career investigators succeed.

Networking Roundtables

On each day of the conference, attendees had the opportunity to network with colleagues with shared interests via virtual roundtable discussions (Table S1).

Council Awards

Council awards presented at this year’s conference are highlighted in Tables 1, , , , , , , , , , , , , , and 2, , , , , , according to the scientific council.

Table 1

Council on Epidemiology and Prevention Conference Awards

Council on Epidemiology and Prevention Awards
Awards	Presenter and Title
Roger R. Williams Award for Genetic Epidemiology and the Prevention and Treatment of Atherosclerosis	Kiran J. Biddinger Alcohol Increases Risk of Cardiovascular Disease at All Levels of Intake 57
Trudy Bush Fellowships for Cardiovascular Disease Research in Women’s Health	Dr Samantha E. Parker De Novo Postpartum Hypertension in a Safety‐Net Hospital: Incidence and Risk Factors 52 Dr S. Michelle Ogunwole Disparities in Gestational Diabetes Mellitus Among US‐ vs Foreign‐Born Women: An Analysis of 2016–2017 National Health Interview Survey 51 Dr Natalie M. Golaszewski Social Isolation, Loneliness, and Cardiovascular Disease Among Older Women in the Women’s Health Initiative 81
Epidemiology and Prevention Mentoring Award	Dr Donald M. Lloyd‐Jones
Sandra A. Daugherty Award for Excellence in Cardiovascular Disease or Hypertension Epidemiology and Prevention	Dr Stephen P. Juraschek Effects of Sodium Reduction and the DASH Diet on Subclinical Cardiac Damage: Results From the DASH‐Sodium Trial 27 Dr Marta Guasch‐Ferré A Healthy Lifestyle Score Including Sleep Duration and Risk of Cardiovascular Disease 38 Dr Ben King Odds of Heart Disease and Arrythmia Associated With Exposure Dose to Homelessness 82 Dr Zakria Almuwaqqat Post‐Traumatic Stress Disorder, Mental Stress‐Induced Myocardial Ischemia, and Cardiovascular Outcomes in Patients With CAD 19 Dr Bernhard Haring Blood Pressure Variability and Risk of Heart Failure in Postmenopausal Women. Results From the Women’s Health Initiative 83
Jeremiah and Rose Stamler Research Award for New Investigators	Mingyu Zhang (Winner) In Utero Exposure to Metal Mixtures and Offspring Blood Pressure: An Analysis of the Boston Birth Cohort Using Bayesian Kernel Machine Regression 76 Dr Shreya Rao Longitudinal Trajectories and Predictors of County‐Level Cardiovascular Mortality in the United States (1980–2014) 77 Daniella Charry Total Brachial Artery Reactivity and Incident Heart Failure and Heart Failure Subtypes: Multi‐Ethnic Study of Atherosclerosis 78 Dr Daniel Huck Nebivolol Associated With Reduced Incident Cardiovascular Events in Hypertensive Patients Compared With Nonvasodilatory Beta Blockers 79 Dr Andrew O. Agbaje A 15‐year Cumulative High Exposure to Lean Mass and Blood Pressure but Not Fat Mass Predicts the 7‐Year Change in Carotid‐Femoral Pulse Wave Velocity and Carotid Intima‐Media Thickness: The ALSPAC Study 80

Table 2

Council on Lifestyle and Cardiometabolic Health Conference Awards

Council on Lifestyle and Cardiometabolic Health Awards
Awards	Presenter and Title
Award for Excellence in Research Addressing Cardiovascular Health Equity	Dr Carol R. Oladele Ultra‐Processed Food and Hypertension Incidence in the REGARDS Cohort 65
Scott Grundy Award for Excellence in Metabolism Research	Dr Simon Higgins Social Jetlag, Independent of Other Sleep Characteristics, Is Associated With Obesity‐Related Outcomes in 9–11‐Year‐Old Girls 84 Dr Natalie A. Cameron Geographic Variation in Prepregnancy Cardiometabolic Health in the United States, 2016–2018 20 Dr Liliane Aguayo Adolescent Predictors of Changes in Weight Status From Adolescence to Adulthood: Evidence From the Addhealth Study 85
Steven N. Blair Award for Excellence in Physical Activity Research	Dr Kelley Pettee Gabriel Sedentary Behavior in Mid‐Life and Structural Brain Magnetic Resonance Imaging Markers of Cerebrovascular Disease and Neurodegeneration in Late‐Life: The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC‐NCS) 86
Mark Bieber Award	Dr Faris M. Zuraikat Night‐to‐Night Variability in Sleep Duration Is Associated With Higher Energy Intake and Poorer Diet Quality in the Multi‐Ethnic Study of Atherosclerosis 87

Alcohol Increases Risk of Cardiovascular Disease at All Levels of Intake

De Novo Postpartum Hypertension in a Safety‐Net Hospital: Incidence and Risk Factors

Disparities in Gestational Diabetes Mellitus Among US‐ vs Foreign‐Born Women: An Analysis of 2016–2017 National Health Interview Survey

Social Isolation, Loneliness, and Cardiovascular Disease Among Older Women in the Women’s Health Initiative

Effects of Sodium Reduction and the DASH Diet on Subclinical Cardiac Damage: Results From the DASH‐Sodium Trial

A Healthy Lifestyle Score Including Sleep Duration and Risk of Cardiovascular Disease

Odds of Heart Disease and Arrythmia Associated With Exposure Dose to Homelessness

Post‐Traumatic Stress Disorder, Mental Stress‐Induced Myocardial Ischemia, and Cardiovascular Outcomes in Patients With CAD

Blood Pressure Variability and Risk of Heart Failure in Postmenopausal Women. Results From the Women’s Health Initiative

In Utero Exposure to Metal Mixtures and Offspring Blood Pressure: An Analysis of the Boston Birth Cohort Using Bayesian Kernel Machine Regression

Longitudinal Trajectories and Predictors of County‐Level Cardiovascular Mortality in the United States (1980–2014)

Total Brachial Artery Reactivity and Incident Heart Failure and Heart Failure Subtypes: Multi‐Ethnic Study of Atherosclerosis

Nebivolol Associated With Reduced Incident Cardiovascular Events in Hypertensive Patients Compared With Nonvasodilatory Beta Blockers

A 15‐year Cumulative High Exposure to Lean Mass and Blood Pressure but Not Fat Mass Predicts the 7‐Year Change in Carotid‐Femoral Pulse Wave Velocity and Carotid Intima‐Media Thickness: The ALSPAC Study

Ultra‐Processed Food and Hypertension Incidence in the REGARDS Cohort

Social Jetlag, Independent of Other Sleep Characteristics, Is Associated With Obesity‐Related Outcomes in 9–11‐Year‐Old Girls

Geographic Variation in Prepregnancy Cardiometabolic Health in the United States, 2016–2018

Adolescent Predictors of Changes in Weight Status From Adolescence to Adulthood: Evidence From the Addhealth Study

Sedentary Behavior in Mid‐Life and Structural Brain Magnetic Resonance Imaging Markers of Cerebrovascular Disease and Neurodegeneration in Late‐Life: The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC‐NCS)

Night‐to‐Night Variability in Sleep Duration Is Associated With Higher Energy Intake and Poorer Diet Quality in the Multi‐Ethnic Study of Atherosclerosis

Conclusions

The 2021 AHA EPI|Lifestyle Scientific Sessions brought investigators together virtually to share cutting‐edge science and advance understanding of the prevention and treatment of cardiovascular disease through a health equity lens. A continued focus on social justice and health equity is needed to equitably increase healthy life expectancy. We look forward to this year’s AHA EPI|Lifestyle Scientific Sessions to be held in March 2022 in Chicago, Illinois.

Sources of Funding

Dr Turkson‐Ocran was supported by the Strategically Focused Research Network Award from the American Heart Association grant number 17SFRN33590069. Drs Foti, Minhas, Rooney, and Tilves, F. M. Wang, and A.S. Wallace were supported by grant number T32 HL007024 from the National Heart, Lung, and Blood Institute, National Institutes of Health. Dr Hines is supported by grant number 1K01HL152011‐01A1 from the National Heart, Lung, and Blood Institute, National Institutes of Health. Dr Kamin Mukaz is supported by grant number U01 NS41588 cofunded by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging; grant number R01 AG061186 from the National Institute on Aging, National Institutes of Health; American Heart Association Postdoctoral Fellowship (award number 897188); and the Cardiovascular Research Institute of Vermont. Dr Martin was supported by grant number T32 HL007457 from the National Heart, Lung, and Blood Institute, National Institutes of Health. Dr Scott is supported by training grant number 5T32HL007560 from the National Heart, Lung, and Blood Institute, National Institutes of Health. Mr. Thomas is supported by the National Institutes of Health grant numbers T32HL007055 and F99AG073565. Mr. Zhang is supported by the American Heart Association Predoctoral Fellowship (award number 827990). Dr Lutsey was supported by grant number K24 HL159246 from the National Heart, Lung, and Blood Institute, National Institutes of Health.

Disclosures

None.

Data S1

Table S1

References 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142

Click here for additional data file.