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Aims Emerging evidence suggests that remnant cholesterol (RC) promotes atherosclerotic cardiovascular disease (ASCVD). We aimed to estimate RC-related risk beyond low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apoB) in patients without known ASCVD. Methods and results We pooled data from 17 532 ASCVD-free individuals from the Atherosclerosis Risk in Communities study (n = 9748), the Multi-Ethnic Study of Atherosclerosis (n = 3049), and the Coronary Artery Risk Development in Young Adults (n = 4735). RC was calculated as non-high-density lipoprotein cholesterol (non-HDL-C) minus calculated LDL-C. Adjusted Cox models were used to estimate the risk for incident ASCVD associated with log RC levels. We also performed discordance analyses examining relative ASCVD risk in RC vs. LDL-C discordant/concordant groups using difference in percentile units (>10 units) and clinically relevant LDL-C targets. The mean age of participants was 52.3 ± 17.9 years, 56.7% were women and 34% black. There were 2143 ASCVD events over the median follow-up of 18.7 years. After multivariable adjustment including LDL-C and apoB, log RC was associated with higher ASCVD risk [hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.45–1.89]. Moreover, the discordant high RC/low LDL-C group, but not the low RC/high LDL-C group, was associated with increased ASCVD risk compared to the concordant group (HR 1.21, 95% CI 1.08–1.34). Similar results were shown when examining discordance across clinical cutpoints. Conclusions In ASCVD-free individuals, elevated RC levels were associated with ASCVD independent of traditional risk factors, LDL-C, and apoB levels. The mechanisms of RC association with ASCVD, surprisingly beyond apoB, and the potential value of targeted RC-lowering in primary prevention need to be further investigated.

Background Current literature examining the prospective relation of circulating omega-3 (n-3) and omega-6 (n-6) PUFAs and atrial fibrillation (AF) is limited to predominantly white populations. Objectives We investigated the association of circulating n-3 and n-6 PUFAs with incident AF in participants from the Multi-Ethnic Study of Atherosclerosis. Methods A total of 6229 participants (mean age = 62 y; 53% female; 39% white, 27% black, 22% Hispanic, and 12% Chinese) who were free of baseline AF and with plasma phospholipid PUFAs measured at baseline using GC were prospectively followed for the development of AF. Incident AF was ascertained using International Classification of Diseases-9 codes from hospital discharge records and Medicare claims data with follow-up through 2014. Multivariable Cox proportional hazards regression analysis was performed to determine the risk of incident AF. Results During a median follow-up of 12.9 y, 813 (13%) participants developed AF. Each higher SD increment in arachidonic acid (AA; 20:4n-6) concentrations was associated with an 11% decreased risk of incident AF (HR: 0.89; 95% CI: 0.82, 0.96). Similarly, higher overall n-6 PUFA concentrations were also associated with a reduced AF risk (HR per SD increment: 0.93; 95% CI: 0.87, 1.00). Although no significant overall associations were observed for any individual n-3 PUFAs, higher circulating concentrations of DHA (22:6n-3) and EPA (20:5n-3) were associated with a decreased AF risk in blacks and Hispanics (DHA only) but not whites or Chinese Americans. Conclusions In a multiethnic cohort of individuals free of baseline cardiovascular disease, higher plasma concentrations of n-6 PUFAs, particularly AA, were associated with a reduced risk of incident AF. Important differences in AF risk were also noted across race/ethnicity for the n-3 PUFAs DHA and EPA.

PURPOSE: Evidence for the association of anthropometrics with colorectal neoplasms is limited for African Americans. METHODS: We examined anthropometric measures with both colorectal adenoma and colorectal cancer (CRC) risk in the ongoing Black Women’s Health Study. In a nested case-control analysis, 954 cases of colorectal adenoma were compared with 3,816 polyp-free controls, matched on age and follow-up time. For the CRC analyses, 413 incident CRC cases were identified over a 16-year follow up (802,783 person-years). Adenoma cases and CRC were verified by medical record review. We used multivariable conditional logistic regression analyses (for adenoma) and Cox proportional hazards analyses (for CRC) that included anthropometric exposures and selected confounders. RESULTS: Overall body mass index (BMI) and other anthropometric factors were not associated with colorectal adenoma or cancer risk in Black women. However, increased risk of adenoma (but not CRC) was observed among especially related to adenomas in the proximal colon. Among women ≥50 years of age, risk of proximal adenoma increased 14% (95% CI: 1.00, 1.31), 35% (95% CI: 1.12, 1.63), and 25% (0.93, 1.68) with each standard deviation increase in BMI, waist circumference, and waist to hip ratio, respectively. None of the anthropometric factors were associated with young onset CRC or adenoma risk. CONCLUSION: Our results suggest that obesity might be an initiator for colon adenomas but not a promoter for colorectal cancer among Black women.

Background: Evidence for the role of omega-3 fatty acids in the prevention of atrial fibrillation (AF) remain inconsistent, with some recent RCTs even suggesting possible harm. Whether long-term dietary intake of these fatty acids, as assessed using objective biomarkers, is related to AF is not known. Aims: To prospectively evaluate circulating and tissue levels of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), and the sum of EPA and DHA (also known as the omega-3 index), with respect to incident AF. Methods: We used data from a global consortium of 13 prospective cohort studies with measurements of EPA, DPA, or DHA in adults (age≥18) identified through March 2021. Participating studies conducted de novo participant-level analyses using a prespecified analytical plan with harmonized definitions for exposures, outcomes, covariates, and subgroups. Associations were pooled using inverse-variance weighted meta-analysis. Results: Among 45,910 participants, a total of 6,229 incident cases of AF were ascertained, with median follow-up ranging from 0.9 to 29.1 years. In the multivariable analysis, per interquintile range (difference between the 90 th and 10 th percentiles for each fatty acid), DPA, DHA, and EPA+DHA ( Figure 1 ) were associated with 11%, 13%, and 9% lower incidence of AF, respectively ( P I 2 ranged from 0% for DPA to 56.7% for EPA+DHA. Associations were broadly consistent irrespective of baseline cardiovascular risk, global region, age, sex, or lipid fraction. Conclusion: Biomarkers of omega-3 fatty acids including DPA, DHA, and EPA+DHA demonstrated an inverse association with incident AF. In the absence of RCTs examining long-term dietary omega-3 intake and AF risk, our results do not suggest that higher levels of these fatty acids are associated with harm.

Literature examining the relationship of circulating omega-3 and omega-6 polyunsaturated fatty acids [n-3(ω-3) and n-6 (ω-6) PUFAs] and arterial elasticity in large cohort-based populations are lacking. We investigated the association of circulating ω-3and ω-6 PUFAs with large artery elasticity (LAE) and small artery elasticity (SAE) in participants from the Multi-Ethnic Study of Atherosclerosis (MESA).A total of 6124 participants (mean age 61.9; 52% female; 38% White, 27% Black, 22% Hispanic, and 13% Chinese-American) with plasma phospholipid PUFAs and arterial elasticity measured at baseline were included. LAE and SAE were derived from pulse contour analysis of the radial artery in all subjects in a supine position using tonometry. Linear regression models were used to determine associations for levels of (1) each circulating fatty acid, (2) total ω-3PUFAs, and (3) total ω-6 PUFAs with log-transformed LAE and SAE.Each standard deviation (SD) increment in circulating levels of total ω-3 PUFAs, eicosapentaenoic acid, and docosahexaenoic acid were associated with a 0.017 ml/mmHg, 0.017 ml/mmHg, and 0.015 ml/mmHg higher LAE respectively (p values all0.01). No significant trends were observed for ω-3 PUFAs levels with SAE.22 Similarly, no significant trends were observed for ω-6 PUFA levels with either LAE or SAE.In a multi-ethnic cohort of individuals free of baseline cardiovascular disease, higher plasma levels of total and individual ω-3 PUFAs were associated with an increased LAE. Further understanding into differential associations of ω-6 PUFAs with LAE and SAE is needed.

Introduction: Emerging evidence suggests that remnant cholesterol (RC) promotes future atherosclerotic cardiovascular disease (ASCVD) events. Our aim was to estimate the risk associated with RC beyond low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apoB). Hypothesis: RC provides incremental prognostic information regarding incident ASCVD, independent of LDL-C and apoB. Methods: We pooled data from 17,532 individuals from Atherosclerosis Risk in Communities study (n=9,748), Multi-Ethnic Study of Atherosclerosis (n=3,049) and Coronary Artery Risk Development in Young Adults (n=4,735), who were ASCVD-free at baseline and had measurements of lipids, apoB and apolipoprotein A1. RC was calculated as non-high-density cholesterol (non-HDL-C) minus LDL-C estimated by the Martin/Hopkins equation. Adjusted Cox models were used to estimate the risk for incident ASCVD associated with log RC levels. We also performed discordance analyses examining relative ASCVD risk in discordant/concordant groups of RC and LDL-C across median cutpoints and cutpoints of percentile equivalence to LDL-C targets (70 and 100 mg/dL). Results: Mean age of participants was 52.3±17.9 years, 56.7% women and 34% black. There were 2,143 ASCVD events over median follow-up of 18.7 years. After multivariable adjustment including apoB and HDL-C, logRC was associated with higher ASCVD risk [HR 1.42, 95% CI (1.23-1.63)]. In discordance analyses, the high RC and low LDL-C group (≥/ Conclusion: In ASCVD-free individuals, elevated RC levels were associated with ASCVD independent of traditional risk factors and LDL-C and apoB levels. RC assessment and management in primary prevention, beyond LDL-C and apoB, is useful and requires further scrutiny.

Background Physical activity (PA) is recommended for women with breast cancer (BC); however, data are sparse on the association of PA with quality of life (QOL) and patient-reported symptoms for women on adjuvant endocrine therapy (AET). Methods Women with hormone receptor-positive BC who were taking AET completed standardized surveys about their health-related QOL, AET-related symptoms, and levels of PA using validated measures. A Wald chi-square test and an analysis of variance were used to assess associations with PA and independent variables. Generalized linear regression analyses assessed associations between PA, QOL, and AET-related symptoms. Results The analytic cohort included 485 Black and White women. Black race, a high body mass index (BMI), and being on aromatase inhibitors (vs tamoxifen) were associated with lower PA in a bivariate analysis. In a multivariate analysis, lower self-reported PA was associated with a high BMI (P = .02) and chemotherapy uptake (P = .006). Better health-related QOL (P = .01), less severe overall AET-related symptoms (P = .02), and less severe gynecological symptoms (P = .03) were associated with increasing levels of moderate PA. Conclusions Among women taking AET, moderate levels of PA may be associated with fewer medication-related symptoms and overall better ratings of health-related QOL. Because of the low levels of PA observed in the sample overall and particularly for Black women, identifying successful strategies to promote PA are needed.

Background: Lung cancer is the second most common site of cancer among Black women. Black women have higher incidence rates of lung cancer despite having a lower smoking prevalence than their White counterparts. These differences are not well understood but may be due to differences in smoking behavior and other potential lung cancer risk factors (e.g., physical activity). Lower reported physical activity levels among Black women compared to White women could contribute to observed lung cancer disparities. Previous studies have shown a 20-50% lower risk of lung cancer among those who are physically active but overall, findings are equivocal. To our knowledge, no previous studies have examined the relationship between physical activity and lung cancer risk in Black women and few studies have examined the associations of physical activity with lung cancer risk stratified by smoking status. Objective: The objective of this study is to evaluate the association between physical activity over time and lung cancer incidence in the Black Women's Health Study, and determine if tobacco use modifies this association. Methods: In this ongoing prospective cohort of Black women (analytic cohort n=46217), 291 cases of lung cancer were diagnosed between 1995 (baseline) and 2013. Questionnaire data, collected at baseline and updated every other year thereafter, were used to calculate recreational physical activity (walking for exercise, vigorous physical activity) and smoking history. The Anderson-Gill method was used as a time-varying analysis tool to continuously update exposures and covariates over time. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals (CIs). Results: At baseline, 65.5% of women were never smokers and 44% reported Citation Format: Marsha Samson, Sarah Nomura, Chiranjeev Dash, Traci Bethea, Lynn Rosenberg, Lucile Adams-Campbell. Prospective cohort study of physical activity and lung cancer risk in the Black Women's Health Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5252.

Evidence for the association of anthropometric factors with colorectal neoplasms is limited for African Americans. Association of 6 anthropometric measures with the risk of both colorectal adenomas and colorectal cancer (CRC) in the ongoing Black Women's Health Study cohort was examined. Using a nested case-control design for the adenoma analyses, 954 cases of colorectal adenoma were compared with 3,816 controls without a colorectal polyp, matched on age and follow-up time. For the CRC analyses, 413 incident CRC cases were identified over a 16-year follow up (802,783 person-years). Cases of adenoma and CRC were verified by medical record review. We used multivariable logistic regression analyses (for adenoma) and Cox proportional hazards analyses (for CRC) that included anthropometric exposures and selected confounders. Among postmenopausal women, risk of adenoma increased by 10% (95% CI: 1.00, 1.22), 11% (95% CI: 1.01, 1.29), and 9% (1.00, 1.19) with 1 standard deviation increase in body mass index, waist circumference, and weight change since age 18 , respectively. Anthropometric factors were not associated with adenoma risk among premenopausal women. None of the anthropometric factors were associated with CRC risk among either pre- or postmenopausal women. Future research should attempt to replicate the modest association of obesity with colon adenoma risk but not CRC risk among postmenopausal African American women. Citation Format: Chiranjeev Dash, Lynn Rosenberg, Jeffrey Yu, Sarah Nomura, Julie Palmer, Lucile L. Adams-Campbell. Association of anthropometric factors with risk of colorectal neoplasia in the Black Women's Health Study [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr A18.

Background: Rates of breast cancer incidence among African American women are increasingly similar to rates among Caucasian American women. Lifestyle behaviors, such as sedentary time, may contribute to differences in breast cancer incidence, but have not been well studied among African American women. Sedentary activities (physically inactive tasks that require little to no additional energy expenditure beyond basal metabolic rate) account for a large proportion of time per day in the United States and are more prevalent among African American women. Sedentary behavior may contribute to cancer risk independently of physical activity, but has not been well studied among African American women. Objective: The objective of this study was to evaluate the association between sedentary behaviors over time on breast cancer incidence in the Black Women's Heath Study. Methods: In this ongoing prospective cohort of African American women (analytic cohort N = 55,629), 2,482 incident breast cancer cases were diagnoses between baseline (1995) and 2013. Questionnaire data (collected every two years since 1995) was used to calculate time spent sitting. Time spent sitting at work and sitting doing recreational activities (watching TV, using internet) was summed to total sedentary time. A time-varying analytic approach was utilized (Anderson-Gill method) to reduce within-person variation and better represent long-term habits. Results: Among women in this cohort, 23.8% reported spending Conclusions: Our findings suggest that high sedentary time may increase risk for breast cancer among African American women. Additionally, leisure time physical activity levels and body size did not change associations, suggesting sedentary time may confer additional risk. Previously reported frequent sedentary behavior among African Americans could contribute to breast cancer disparities and should be explored further in future studies. Citation Format: Sarah Nomura, Chiranjeev Dash, Jeffrey Yu, Julie Palmer, Lynn Rosenberg, Lucile L. Adams-Campbell. Sedentary behavior and breast cancer in the Black Women's Health Study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1743.