additive effect of the combination of oral vitamins and chelation therapy was significant and of potential clinical relevance. Our findings in TACT offer several opportunities for novel research programs that may eventually lead to important therapeutic insights for treatment of CAD. Contact: Gervasio Lamas, gervasiolamas@gmail.com (1) (2) (3) (4) Beth Israel Deaconess Medical Center, Boston, MA, USA University of Leicester, Leicester, UK Brigham and Women’s Hospital, Boston, MA, USA Plymouth University, Plymouth, UK Purpose: Despite the lack of conclusive evidence of efficacy from well-designed clinical trials, the use of vitamins remains widespread. With recent reports of possible harm, the debate has shifted from benefits relative to placebo, to concerns about safety. Few studies have investigated the effect of genetic variation on treatment responses to vitamin E. Genetic variation is considered an important factor in heritability of CVD and treatment response. Catecholamines like epinephrine play a key role in cardiovascular function and are metabolized by catecholO-methyltransferase (COMT). The effect of genetic variation in COMT on CVD outcomes in women treated with vitamin E is not known. Methods: The Women’s Health Study (WHS) is a large prospective placebo-controlled trial of incident CVD prevention with random allocation to aspirin and vitamin E and 10 years follow-up. The Women’s Genome Health Study (WGHS), a large subset of the WHS for genetic analysis provided a unique dataset to examine the effects of the COMT rs4680 polymorphism. Results: The rs4680 high-activity val allele was protective for incident CVD among women in the placebo arm (HR[95%CI] = 0.66[0.51–0.84], P = 0.0007) such that val homozygotes had a 56% lower rate of major CVD relative to low-activity met homozygotes. The rs4680 protective association was abolished by randomized allocation to vitamin E such that val homozygotes experienced higher rates of major CVD with vitamin E compared to placebo (HR[95%CI] = 1.50[0.83–2.70], P = 0.180), while met homozygotes experienced lower rates (HR[95%CI] = 0.53[0.34–0.84], P = 0.023) thus revealing a significant interaction between COMT and vitamin E (P = 0.004). Conclusion: Common COMT polymorphism association with CVD risk and differential effects of vitamin E treatment suggests novel aspects of CVD pathophysiology. In an era where the use of vitamins is under debate, this study highlights the importance of considering genetic composition in evaluating clinical efficacy of vitamins and using pharmacogenomics to guide the development of smarter, individualized strategies for treatment and prevention. Contact: Kathryn Hall, kthall@bidmc.harvard.edu OA01.03 Chiropractic for Hypertension in Patients (CHiP): A Pilot Randomized Controlled Trial Christine Goertz (1), Cynthia Long (1), Robert Vining (1), Stacie Salsbury (1), Katherine Pohlman (2), Gervasio Lamas (3) (1) Palmer Center for Chiropractic Research, Davenport, IA, USA (2) University of Alberta, Edmonton, AB, Canada (3) Mount Sinai Medical Center, Miami Beach, FL, USA Purpose: Bakris et al. reported dramatic blood pressure (BP) lowering effects resulting from an upper cervical manipulation technique (NUCCA) in narrowly selected patients with Stage 1 hypertension. Our study compared BP changes between a similar but more commonly used upper cervical technique, Toggle Recoil (TR), and a sham intervention (SI) in a more generalizable sample. Methods: We conducted a 2-arm pilot RCT with participants age 21 to 75 with documented pre- to Stage 1 hypertension who saw the doctor of chiropractic (DC) twice weekly for 6 weeks. Participants and BP assessors were blinded to treatment, while DCs were masked to BP outcomes. Results: We screened 681 volunteers and randomly allocated 51 participants (24 TR and 27 SI; 59% males; mean age 58; mean BMI 31.3). At the first visit, pre/post adjusted mean systolic BP decreased 0.9 mmHg in the TR group and 5.5 mmHg in the SI group; diastolic BP increased 1.4 mmHg in the TR group and decreased 2.2 mmHg in the SI group. From baseline to week 6 (primary endpoint), adjusted mean systolic BP increased 0.6 mmHg in the TR group and decreased 4.2 mmHg in the SI group; diastolic BP increased 0.5 mmHg in the TR group and decreased 1.3 mmHg in the SI group; and the between group adjusted mean difference in systolic BP was 4.8 (95% CI: - 0.4, 10.0). No between group differences were statistically significant. Conclusion: We did not see the dramatic changes in BP reported in the Bakris et al. study; the differences we did observe were in favor of the sham. Our results provide more questions than answers about the value of spinal manipulation for the treatment of hypertension. We propose that basic science research is needed to understand the potential mechanisms of action before further clinical investigations are initiated. Contact: Christine Goertz, christine.goertz@palmer.edu Oral Abstract Session 02: Health Services Research OA02.01 A National Assessment of the Usage, Cost, and Reimbursement of Unconventional Medical Laboratory Tests Ather Ali (1), Nicholas Scoulios (2), Nicholas Ten (1), Anup Kanodia (3) (1) Yale School of Medicine, New Haven, CT, USA (2) Georgetown School of Medicine, Washington, DC, USA (3) Ohio State University, Columbus, OH, USA OA01.04 LB Catechol-O-methyltransferase Associated Risk of Cardiovascular Disease Is Modified by Treatment with Vitamin E Purpose: A growing number of unconventional medical laboratory tests have emerged and are anecdotally popular among CAM-oriented practitioners. In the United States, millions of unconventional medical laboratory tests are ordered annually, though no high quality data exist regarding practice patterns, cost, or reimbursement. To our knowledge, this is the first study Kathryn Hall (1), Christopher Nelson (2), Roger Davis (1), Julie Buring (3), Irving Kirsch (4), Murray Mittleman (1), Joseph Loscalzo (3), Nilesh Samani (2), Paul Ridker (3), Ted Kaptchuk (1), Daniel Chasman (3) A3 to formally assess and characterize the usage of unconventional medical tests in the United States. Methods: A cross-sectional survey among licensed healthcare professionals associated with 12 national CAM/integrative medicine organizations using an anonymous, online survey instrument. Participants were queried on the types and rationale regarding unconventional medical laboratory tests, reimbursement status, use in pediatric patients, and demographics. Results: Responses from 638 participants were recorded. The average age of survey participants was 46 years of age, with an average of 12.6 years of practice. The most frequently used medical laboratory tests included stool analyses, urine neurotransmitter assays, organic acid tests, salivary hormone assays, and urine heavy metal tests. 26–35% of adult patients receive unconventional laboratory tests, while 31–46% of tests are used in children. 61% of providers use unconventional tests with pediatric patients for a variety of indications. 40–53% of adult tests were reimbursed by third parties, with private insurance, and Medicare being the predominant payers. Conclusion: These data provide insights to the practice patterns and reimbursement status of this burgeoning clinical practice. Unconventional tests are often utilized in chronic conditions without reliable mainstream treatments. Further study on the validity of the most prevalent tests can provide greater insights to the clinical utility of unconventional medical laboratory testing. Contact: Nicholas Scoulios, njs51@georgetown.edu over the past 12 months. We estimated that adult cancer survivors in the United States spent $9.0 billion in total on out-ofpocket CAM use in 2012. Over two thirds of this total was spent on the purchase of vitamins and minerals ($6.2 billion), over 15% ($1.4 billion) was spent on herbs and non-vitamin supplements, and over 5% ($0.5 billion) was spent on massage. Breast cancer survivors were estimated to be the highest spending group, totaling $1.6 billion in out-of-pocket CAM costs over the past 12 months. Among all users, median annual cost of CAM use was estimated at $140. Compared to those who did not report CAM use due to their cancer diagnosis, survivors who reported using any CAM for cancer have 4.6 times the odds of being a high spender (p = 0.0028). Conclusion: The total 2012 out-of-pocket CAM costs for cancer survivors in the United States are estimated to be $9.0 billion— 7% of the estimated $125 billion for cancer survivors’ yearly health care costs. Contact: Gabriella John, gmj2113@columbia.edu OA02.03 Morbidity and Management Patterns of Traditional Chinese Medicine (TCM) Primary Care in Hong Kong Population Wendy Wong (1), Cindy Lam LK (1), Zhao Xiang Bian (2), Zhang Jin Zhang (3), Sze Tuen Ng (4), Shong Tung (5) (1) Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong (2) School of Chinese Medicine, The Hong Kong Baptist University, Hong Kong (3) School of Chinese Medicine, The University of Hong Kong, Hong Kong (4) Traditional Chinese Medicine Association, Hong Kong (5) Hong Kong Registered Chinese Medicine Practitioners Association, Hong Kong OA02.02 Costs of Complementary and Alternative Medicine for Cancer Survivors in the United States: Results from the 2012 National Health Interview Survey Gabriella John (1), Dawn Hershman (2), Laura Falci (1), WeiYann Tsai (3), Heather Greenlee (2) (1) Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA (2) Department of Epidemiology, Mailman School of Public Health, Columbia University; Department of Medicine, College of Physicians and Surgeons, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, USA (3) Department of Biostatistics, Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, USA Purpose: Primary health care plays an important role to the health of the population by managing more than 90% of the illnesses. There was a lack of information on the morbidity pattern and management process despite 8815 of Chinese Medicine Practitioners (CMP) providing primary care to Hong Kong population. This study aims to determine the morbidity pattern and the management process of CM in primary care in Hong Kong. Methods: A cross-sectional study of prospective recording of all clinical encounters that presented to the participating CMP were collected for four seasons in 2012. All health presenting problems were coded by ICPC-2 and the national classification of disease and Zheng of CM. The prevalence was expressed in percentage distribution. Results: 55,312 subjects’ health encounters were collected from 260 CMP in 2012. Females were more likely to consult CMP than males (67.0%). Most subjects (64.0%) consulted for a chronic problem whom were elderly. By ICPC-2 coding, the respiratory (24.9%, R) and musculoskeletal (22.7%, L) problems were the most common complaints, especially cough (11.7%, R05) and low back symptoms/complaints (6.6%, L03). By national classification of diseases, internal diseases (65.1%) were the most commonly diagnoses. The top 3 diseases were muscle/ tendon-related illnesses (9.4%), flu-related illnesses (8.8%) and cough (6.2%). By national classification of Zheng (i.e., syndrome differentiation), organs and channels-and-collaterals syndromes (40.5%) were the most common Zheng. Chinese herbs were Purpose: While it is known that a high percentage of cancer survivors use complementary and alternative medicine (CAM), little is known about the financial implications of such use. We sought to determine cancer survivors’ annual out-of-pocket spending on CAM. Methods: Data from the Adult Alternative Medicine questionnaire of the 2012 National Health Interview Survey (NHIS) were used to estimate out-of-pocket CAM costs among individuals with a history of a cancer diagnosis. The analysis was limited to adults with a history of cancer, excluding nonmelanoma skin cancers. Statistical methods were used to account for NHIS’s complex sampling methods. We performed a multivariate analysis to determine factors associated with the highest quartile of CAM spending. Results: We identified a cohort of 3,102 cancer survivors, of which 78.1% reported having used at least one CAM modality A4