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Sedentary behavior has been shown to have deleterious effects on cardiovascular outcomes. This study aimed to examine the association between sedentary time and cardiovascular risk factors in Korean adults.
A cross-sectional study was performed using data from adults aged 19 years and above in the 2013 Korean National Health and Nutrition Examination Survey. Sedentary time was self-reported and categorized into quintiles. Cardiovascular risk factors, including blood pressure (BP), total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein cholesterol, and fasting glucose levels, were categorized into dichotomous variables according to the Adult Treatment Panel III criteria. Multivariate logistic regression was performed with adjustment for various demographic and lifestyle variables, body mass index (BMI), waist circumference (WC), and moderate-to-vigorous physical activity. Complex sampling design was used, and survey weights and sample design variables were applied in analyses.
A total of 3,301 individuals were included in the analyses, and mean sedentary time was 6.1 h/d. Prolonged sedentary time was significantly associated with high diastolic BP (top vs. bottom quintile: adjusted odds ratio [OR], 1.71; 95% confidence interval [CI], 1.09–2.68; Ptrend=0.03) and low HDL cholesterol level (top vs. bottom quintile: adjusted OR, 1.42; 95% CI, 1.02–1.98; Ptrend=0.02) after adjustment for BMI, WC, moderate-to-vigorous physical activity, and other variables. No significant associations were found between sedentary time and other cardiovascular risk factors.
Prolonged sedentary time was significantly associated with high diastolic BP and low HDL cholesterol level in Korean adults. The associations were independent of general and abdominal obesity and moderate-to-vigorous physical activities.
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Body mass index (BMI) and waist circumference (WC) are associated with cardiovascular (CV) risk factors. The aim of this study was to investigate the correlation of CV risk factors by cross-tabulating central obesity with multiple BMI categories in Korea.
A total of 328,789 adults aged 30–84 years who completed health assessments for National Health Insurance in 2012–2013 in Korea were examined. The participants were divided into two WC and five BMI groups to investigate CV risk factors, including metabolic syndrome (MetS), hypertension, diabetes, and dyslipidemia.
The proportions of central obesity and obesity were 24.2% and 39.5% in men and 19.4% and 28.1% in women, respectively, according to the Korean Society for the Study of Obesity and World Health Organization Asia-Pacific Guideline criteria. The odds ratios (ORs) of CV risk factors in all sexes increased with increases in BMI and WC. Compared to the group with a normal WC and BMI, the adjusted ORs (95% confidence intervals) for having MetS and diabetes in the centrally obese and highest BMI group (BMI ≥30.0 kg/m2) were 35.95 (33.75–38.30) and 3.51 (3.26–3.77) in men and 29.22 (27.36–31.20) and 4.35 (4.02–4.70) in women, respectively. Participants who were centrally obese and obese (BMI ≥25.0 kg/m2) had the strongest correlation with all CV risk factors compared with those who were not centrally obese or obese.
The presence of central obesity in multiple BMI categories may significantly identify individuals at increased risk of CV risk factors.
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Uric acid has been reported to function both as an oxidant or antioxidant depending on the context. A previous study in the Korean population reported a positive linear association between serum uric acid level and arterial stiffness in men, but little is known about how serum uric acid level is related to the risk of increased arterial stiffness in Korean postmenopausal women.
We performed a cross-sectional study of 293 subjects who participated in a health examination program run by the health promotion center of Gangnam Severance Hospital between October 2007 and July 2010. High brachial-ankle pulse wave velocity was defined as a brachial-ankle pulse wave velocity of more than 1,450 cm/s. The odds ratios (ORs) for high brachial-ankle pulse wave velocity were calculated using multivariate logistic regression analysis across uric acid quartiles after adjusting for other indicators of cardiovascular risk.
The 293 postmenopausal women were divided into quartiles according to uric acid level. The mean brachial-ankle pulse wave velocity values of each quartile were as follows: Q1, 1,474 cm/s; Q2, 1,375 cm/s; Q3, 1,422 cm/s; Q4, 1,528 cm/s. The second quartile was designated as the control group based on mean brachial-ankle pulse wave velocity value. Multivariate adjusted ORs (95% confidence intervals) for brachial-ankle pulse wave velocity across the uric acid quartiles were 2.642 (Q1, 1.095–6.3373), 1.00, 4.305 (Q3, 1.798–10.307), and 4.375 (Q4, 1.923–9.949), after adjusting for confounding variables.
Serum uric acid level has a J-shaped association with arterial stiffness in Korean postmenopausal women.
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Cardiovascular disease (CVD) has become the most common cause of mortality and morbidity worldwide. Health screening is associated with higher outpatient visits for detection and treatment of CVD-related diseases (diabetes mellitus, hypertension, and dyslipidemia). We examined the association between health screening, health utilization, and economic status.
A sampled cohort database from the National Health Insurance Corporation was used. We included 306,206 participants, aged over 40 years, without CVD (myocardial infarction, stroke, and cerebral hemorrhage), CVD-related disease, cancer, and chronic renal disease. The follow-up period was from January 1, 2003 through December 31, 2005.
Totally, 104,584 participants received at least one health screening in 2003–2004. The odds ratio of the health screening attendance rate for the five economic status categories was 1.27 (95% confidence interval [CI], 1.24 to 1.31), 1.05 (95% CI, 1.02 to 1.08), 1, 1.16 (95% CI, 1.13 to 1.19) and 1.50 (95% CI, 1.46 to 1.53), respectively. For economic status 1, 3, and 5, respectively, the diagnostic rate after health screening was as follows: diabetes mellitus: 5.94%, 5.36%, and 3.77%; hypertension: 32.75%, 30.16%, and 25.23%; and dyslipidemia: 13.43%, 12.69%, and 12.20%. The outpatient visit rate for attendees diagnosed with CVD-related disease was as follows for economic status 1, 3, and 5, respectively: diabetes mellitus: 37.69%, 37.30%, and 43.70%; hypertension: 34.44%, 30.09%, and 32.31%; and dyslipidemia: 18.83%, 20.35%, and 23.48%.
Thus, higher or lower economic status groups had a higher health screening attendance rate than the middle economic status group. The lower economic status group showed lower outpatient visits after screening, although it had a higher rate of CVD diagnosis.
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Cigarette smoking is a risk factor for cardiovascular disease (CVD) and has both beneficial and harmful effects in CVD. We hypothesized that weight gain following smoking cessation does not attenuate the CVD mortality of smoking cessation in the general Korean population.
Study subjects comprised 2.2% randomly selected patients from the Korean National Health Insurance Corporation, between 2002 and 2013. We identified 61,055 subjects who were classified as current smokers in 2003–2004. After excluding 21,956 subjects for missing data, we studied 30,004 subjects. We divided the 9,095 ex-smokers into two groups: those who gained over 2 kg (2,714), and those who did not gain over 2 kg (6,381, including weight loss), after smoking cessation. Cox proportional hazards regression models were used to estimate the association between weight gain following smoking cessation and CVD mortality.
In the primary analysis, the hazard ratios of all-cause deaths and CVD deaths were assessed in the three groups. The CVD risk factors and Charlson comorbidity index adjusted hazard ratios (aHRs) for CVD deaths were 0.80 (95% confidence interval [CI], 0.37 to 1.75) for ex-smokers with weight gain and 0.80 (95% CI, 0.50 to 1.27) for ex-smokers with no weight gain, compared to one for sustained smokers. The associations were stronger for events other than mortality. The aHRs for CVD events were 0.69 (95% CI, 0.54 to 0.88) and 0.81 (95% CI, 0.70 to 0.94) for the ex-smokers with and without weight gain, respectively.
Although smoking cessation leads to weight gain, it does not increase the risk of CVD death.
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Cardiovascular disease is an important cause of morbidity and mortality in cancer survivors. The aim of this study was to investigate the modifiable cardiovascular disease risk factors and 10-year probability of the disease based on the Framingham risk score in cancer survivors, compared with the general population.
A total of 1,225 cancer survivors and 5,196 non-cancer controls who participated in the 2007–2013 Korea National Health and Nutrition Examination Surveys were enrolled. We assessed modifiable cardiovascular disease risk factors including smoking, body mass index, physical inactivity, high blood pressure, high cholesterol, and elevated blood glucose level. The 10-year probability of cardiovascular disease was determined by applying the Framingham cardiovascular disease risk equation among cancer survivors and non-cancer controls, ranging from 30 to 74 years old who had no overt cardiovascular diseases.
The proportion of subjects who had higher fasting glucose levels, hemoglobin A1c levels, systolic blood pressure, and low density lipoprotein cholesterol levels, and those who had lower high density lipoprotein cholesterol levels was significantly higher in the cancer survivors than in the non-cancer controls. The average 10-year probability of cardiovascular disease among the cancer survivors was higher than that in the non-cancer controls in both men and women. The average 10-year probability of cardiovascular disease in relation to the cancer type was significantly higher in patients with hepatic, colon, lung, breast, and gastric cancer.
Cancer survivors have a higher cardiovascular disease risk and 10-year probability of cardiovascular disease than non-cancer controls. Control of cardiovascular disease risk factors and implementation of a well-defined cardiovascular disease prevention program are needed for treating cancer survivors.
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Rheumatoid arthritis (RA) and metabolic syndrome (Mets) are considered to be diseases with common traits that can increase the risk of cardiovascular disease incidence; studies in other countries examined the relationship between these diseases. However, existing studies did not show consistent results. In the present study, the relationship between RA and Mets in Koreans was examined using the data of the 4th and 5th Korea National Health and Nutrition Examination Survey (KNHANES).
The present study used the data of the 4th and 5th KNHANES, conducted between 2007 and 2012. Among 25,812 adults aged over 40, 19,893 were selected as study subjects, excluding 5,919 who did not have variable information needed for the analysis. T-test and chi-square test were used for the analysis of related variables. To determine the relationship between diagnostic status of RA and Mets, multivariate logistic regression analysis was performed by controlling confounding variables, which were selected through literature review and statistical analysis.
Multivariate logistic regression analysis was conducted to examine the relationship between diagnostic status of RA and Mets. When age, education level, average monthly household income, smoking, alcohol consumption, and level of physical activity were adjusted, the prevalence of Mets was lower in RA patients (adjusted odds ratio [aOR], 0.79; 95% confidence interval [CI], 0.65 to 0.96). Multivariate logistic regression analysis was performed to examine the relationship between treatment status of RA and Mets. When age, education level, average monthly household income, smoking, alcohol consumption, and level of physical activity were adjusted, there was a significant negative correlation in women (aOR, 0.65; 95% CI, 0.44 to 0.96).
The relationship between RA and Mets showed a significantly negative correlation in Korean women. The group that received RA treatment showed significantly lower prevalence of the Mets as compared to the untreated group in Korean RA women.
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Health-related quality of life (HRQoL) is considered an important outcome measure in chronic diseases, in particular cardiovascular disease (CVD), which is known to be associated with impaired HRQoL. However, few studies have examined HRQoL in individuals at high risk of CVD.
Using the Fifth Korea National Health and Nutrition Examination Survey 2010-2012, we analyzed data from 10,307 adults aged ≥30 years. The study subjects were stratified into 3 groups on the basis of their Framingham risk score-a 10-year estimate of CVD risk: <10.0% (low risk), 10.0%-19.9% (moderate risk), and ≥20.0% (high risk). The EuroQol-5D (EQ-5D) was used to evaluate HRQoL.
A significantly higher proportion of high-risk subjects than low-risk participants had impaired HRQoL (defined as the lowest quartile of the EQ-5D index); this held true even after adjustment for confounding factors in multivariable logistic regression analysis (men: odds ratio [OR], 1.62; 95% confidence interval [CI], 1.24-2.11; women: OR, 1.46; 95% CI, 1.02-2.08). In terms of the 5 EQ-5D dimensions, a 10-year CVD risk ≥20.0% was significantly associated with self-reported problems of mobility in men (OR, 3.15; 95% CI, 2.02-4.90), and of mobility (OR, 1.56; 95% CI, 1.09-2.24), self-care (OR, 2.14; 95% CI, 1.09-4.22), and usual activity problems (OR, 1.80; 95% CI, 1.17-2.78) in women.
A high CVD risk is associated with impaired HRQoL. After adjustment for demographic and clinical factors, a 10-year CVD risk ≥20.0% is an independent predictor of impaired HRQoL in the general population; in particular, of mobility problems in men, and of mobility, self-care, and usual activity problems in women.
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The aim of this study was to determine the association between carotid intima-media thickness (IMT) and newly developed 10-year atherosclerotic cardiovascular disease (ASCVD) risk score.
Participants were 201 Korean adults who underwent carotid ultrasonography at the Health Promotion Center of the Eulji General Hospital. We obtained information about medical history and lifestyle, and conducted laboratory tests. Carotid IMT by B-mode ultrasonography was measured. Carotid injury was considered present when the maximum carotid IMT was ≥0.9 mm or when arteriosclerotic plaques were detected. The 10-year ASCVD risk score was calculated using the 2013 American College of Cardiology/American Heart Association guidelines.
Men had higher 10-year ASCVD risk score than did women (mean±standard deviation: 7.15±6.04 vs. 2.53±3.67, respectively; P<0.001). Ten-year ASCVD risk was significantly correlated with right maximum carotid IMT (r=0.307), left maximum carotid IMT (r=0.230), right mean carotid IMT (r=0.322), and left mean carotid IMT (r=0.264). The group with high 10-year ASCVD risk were at even higher risk of carotid injury than were the group with low 10-year ASCVD risk (odds ratio, 2.201; 95% confidence interval, 1.162-4.1706; P=0.019). Only 10-year ASCVD risk score was significantly associated with carotid injury (odds ratio, 4.104; 95% confidence interval, 1.570-10.729). Variables that were not included in the 10-year ASCVD risk score were not significantly associated with carotid injury.
The findings of this study suggest that 10-year ASCVD risk score is associated with carotid injury.
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The effect of dietary fat intake on the risk of cardiovascular disease remains unclear. We investigated the association between dietary fat and specific types of fat intake and the risk of metabolic syndrome.
The study population included 1,662 healthy adults who were 50.2 years of age and had no known hypertension, diabetes, hyperlipidemia, or metabolic syndrome at the initial visit. Dietary intake was obtained from a 1-day food record. During 20.7 months of follow-up, we documented 147 cases of metabolic syndrome confirmed by self-report, anthropometric data, and blood test results. The intakes of total fat, vegetable fat, animal fat, saturated fatty acid (SFA), polyunsaturated fatty acid (PUFA), monounsaturated fatty acid (MUFA), and cholesterol level divided by quintile. Multivariate analyses included age, sex, body mass index, smoking status, alcohol intake, physical activity, total calorie, and protein intake.
Vegetable fat intake was inversely associated with metabolic syndrome risk (odds ratio for the highest vs. the lowest quintile, 0.33; 95% confidence interval, 0.14 to 0.76). Total fat, animal fat, SFA, PUFA, MUFA, and cholesterol intakes showed no association with metabolic syndrome. Vegetable fat intake was inversely associated with the risk of hypertriglyceridemia among the components of metabolic syndrome.
These data support an inverse association between vegetable fat and the risk of metabolic syndrome.
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Neck circumference, as a predicator of obesity, is a well-known risk factor for obstructive sleep apnea and cardiovascular diseases. However, little research exists on neck length associated with these factors. This study explored the association of neck length with sleep and cardiovascular risk factors by measuring midline neck length (MNL) and lateral neck length (LNL).
We examined 240 patients aged 30 to 75 years who visited a health check-up center between January 2012 and July 2012. Patients with depressive disorder or sleep disturbance were excluded from this study. MNL from the upper margin of the hyoid bone to the jugular notch and LNL from the mandibular angle to the mid-portion of the ipsilateral clavicle were measured twice and were adjusted by height to determine their relationship with sleep and cardiovascular disease risk factors.
Habitual snorers had shorter LNL height ratios (P = 0.011), MNL height ratios in men (P = 0.062), and MNL height ratios in women (P = 0.052). Those snoring bad enough to annoy others had shorter MNL height ratios in men (P = 0.083) and women (P = 0.035). Men with objective sleep apnea had longer distances from the mandible to the hyoid bone to the mandible (P = 0.057). Men with metabolic syndrome had significantly shorter LNL height ratios (P = 0.021), and women with diabetes, hyperlipidemia, and metabolic syndrome had shorter MNL height ratios (P < 0.05).
This study shows that a short neck by measuring the MNL is probably associated with snoring. In addition, MNL is related to cardiovascular disease risk factors in women.
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The purpose of this study was to examine the relationship between cardiovascular disease risk and alcohol consumption according to facial flushing after drinking among Korean men.
The subjects were 1,817 Korean men (non-drinker group, 283 men; drinking-related facial flushing group, 662 men; non-flushing group, 872 men) >30 years who had undergone comprehensive health examinations at the health promotion center of a Chungnam National University Hospital between 2007 and 2009. Alcohol consumption and alcohol-related facial flushing were assessed through a questionnaire. Cardiovascular disease risk was investigated based on the 2008 Framingham Heart Study. With the non-drinker group as reference, logistic regression was used to analyze the relationship between weekly alcohol intake and cardiovascular disease risk within 10 years for the flushing and non-flushing groups, with adjustment for confounding factors such as body mass index, diastolic blood pressure, low density lipoprotein cholesterol, triglycerides, and exercise patterns.
Individuals in the non-flushing group with alcohol consumption of ≤4 standard drinks (1 standard drink = 14 g of alcohol) per week had significantly lower moderate or high cardiovascular disease risk than individuals in the nondrinker group (adjusted odds ratio, 0.51; 95% confidence interval, 0.37 to 0.71). However, no significant relationship between the drinking amount and cardiovascular disease risk was observed in the flushing group.
Cardiovascular disease risk is likely lowered by alcohol consumption among non-flushers, and the relationship between the drinking amount and cardiovascular disease risk may differ according to facial flushing after drinking, representing an individual's vulnerability.
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Carcinoembryonic antigen (CEA), a serological marker of malignant tumors, demonstrates a modest increase under nonmalignant conditions such as aging and smoking. Also, recent study results suggested that serum CEA levels may be related to insulin resistance or low-grade inflammation. The aim of this study was to investigate the factors associated with serum CEA levels in healthy non-smokers.
Data was gathered from 21,501 adults aged 20 and over. We excluded 19,081 subjects who had omissions in anthropometric measurements or laboratory tests, or who had previous or current smoking history.
The mean CEA level was 1.18 ± 0.85 ng/dL in males and 0.93 ± 0.73 ng/dL in females. After adjustment for age, CEA level was positively correlated with fasting glucose, glycosylated hemoglobin (HbA1C), high density lipoprotein (HDL) cholesterol, estimated glomerular filtration rate in males. In females, CEA level was positively correlated with fasting glucose, HbA1C, HDL cholesterol, aspartate aminotransferase, and high-sensitivity C-reactive protein. In both gender groups, HbA1C had a strong influence on CEA levels when all other variables were included in the regression model (P < 0.05).
Within normal range, serum CEA levels were significantly associated with HbA1C levels but not with homeostasis model assessment of insulin resistance in the non-smoking population. These findings suggest that serum CEA levels are influenced by the glucose level itself instead of insulin resistance.
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Although cigarette smoking is a major modifiable risk factor for the occurrence of primary and secondary cardiovascular disease (CVD), not all survivors from CVD attacks can successfully stop smoking. However, little is known about the factors associated with the change in smoking behavior after CVD attack.
Study subjects included 16,807 participants (≥19 years) in the fourth Korean National Health and Nutrition Examination Surveys. From them, we selected 180 persons who had previous CVD diagnosis (angina pectoris, myocardial infarction, or stroke) and were smoking at the time of CVD diagnosis. Then, we categorized the 180 persons into two groups according to change in smoking status after the CVD: quitter and non-quitter. Logistic regression analysis was done to evaluate multivariable-adjusted association.
Even after CVD diagnosis, 63.60% continued to smoke. Fully-adjusted analysis revealed that regular drinking (odds ratio [OR], 4.44) and presence of smokers among family members (OR, 5.86) were significantly (P < 0.05) associated with greater risk of persistent smoking, whereas lower education level (OR, 0.20), larger amount of smoking (OR, 0.95), longer time since diagnosis (OR, 0.88), and diabetes (OR, 0.36) were significantly (P < 0.05) associated with decreased risk of persistent smoking after CVD.
A great proportion of CVD patients tended to continue smoking in the Korean population. In order to reduce smoking rates among CVD patients further, more aggressive efforts towards smoking cessation should be continuously made with consideration of individual socioeconomic, behavioral, and clinical characteristics of CVD patients.
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The purpose of this study was to investigate how educational status influences cardiovascular risk factors and care of diabetes mellitus and hypertension.
From Korean National Health and Nutrition Survey IV, we obtained survey results of 6,835 men and 9,067 women more than 30 years old. We performed multivariate logistic regression to compare cardiovascular risk factors and care of hypertension and diabetes respective to educational status.
There were disparities in cardiovascular risk factors by educational status. In men, impaired fasting glucose, high triglyceride, and smoking were less frequently found in the highest educated group than in the middle educated group. In women, the prevalence of abdominal obesity, impaired fasting glucose, high blood pressure, high triglyceride, and metabolic syndrome among the highest educated group were significantly lower. The proportion of those with proper physical activity in the highest educated group was found to be less than that of the middle educated group, regardless of gender. For care of diabetes mellitus and hypertension, disease recognition and treatment were lower among the lowest educated group in men, while these disparities were not shown in women. Instead, the lowest educated group in diabetic women received screening exams for eye and kidney complications less than the middle education group. In both genders, the high education group had a higher chance of receiving education about diabetes mellitus.
There were educational disparities in cardiovascular risk factors and care of hypertension and diabetes mellitus. The disparities were found to be different by gender.
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Optimizing treatment for hypertension has focused on reducing cardiovascular risk through reduction of mean blood pressure (BP) under the basic assumption that lower is better, as long as diastolic BP is sufficient to maintain coronary perfusion. However, antihypertensive therapy as currently practiced does not eliminate all hazards associated with BP elevation. Blood pressure variability (BPV) correlates closely with target-organ damage independent of mean BP and transient increases in BP are also triggers of vascular events. So far, there is no definitive outcome data relating specific reduction in BPV to decline cardiovascular events or death. Thus, the decision whether BPV should be considered a new therapeutic target is left to the clinical judgment of physicians and individualized for each patient. However, new evidence suggests that taking an antihypertensive medication at bedtime significantly affects BPV and lowers the risk of cardiovascular events and death. This strategy may provide a means of individualizing treatment of hypertension according to the circadian BPV of each patient and may be a new option to optimize BP control and reduce risk.
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