Prevalence and Current Management of Cardiovascular Risk Factors in Korean Adults Based on Fact Sheets

The association between TSH and thyroid hormones in the normal or subclinical dysfunction range with left ventricular diastolic dysfunction

Thyroid hormones modulate the cardiovascular system. However, the effects of subclinical thyroid dysfunction and euthyroidism on cardiac function remain unclear. We investigated the association between left ventricular (LV) diastolic dysfunction and subclinical thyroid dysfunction or thyroid hormones within the reference range. This cross-sectional study included 26,289 participants (22,197 euthyroid, 3,671 with subclinical hypothyroidism, and 421 with subclinical thyrotoxicosis) who underwent regular health check-ups in the Republic of Korea. Individuals with thyroid stimulating hormone (TSH) levels > 4.2 µIU/mL and normal free thyroxine (FT4, 0.78-1.85 ng/dL) and triiodothyronine (T3, 76-190 ng/dL) levels were defined as having subclinical hypothyroidism. Individuals with serum TSH levels < 0.4 µIU/mL and normal FT4 and T3 levels were defined as having subclinical thyrotoxicosis. The cardiac structure and function were evaluated using echocardiography. LV diastolic dysfunction with normal ejection fraction (EF) was defined as follows: EF of > 50% and (a) E/e' ratio > 15, or (b) E/e' ratio of 8-15 and left atrial volume index ≥ 34 mL/m2. Subclinical hypothyroidism was significantly associated with cardiac indices regarding LV diastolic dysfunction. The odds of having LV diastolic dysfunction was also increased in participants with subclinical hypothyroidism (adjusted odds ratio [AOR] 1.36, 95% confidence interval [CI], 1.01-1.89) compared to euthyroid participants. Subclinical thyrotoxicosis was not associated with LV diastolic dysfunction. Among the thyroid hormones, only serum T3 was significantly and inversely associated with LV diastolic dysfunction even within the normal range. Subclinical hypothyroidism was significantly associated with LV diastolic dysfunction, whereas subclinical thyrotoxicosis was not. Serum T3 is a relatively important contributor to LV diastolic dysfunction compared to TSH or FT4.

Integrative Bioinformatics Approaches to Uncover Hub Genes and Pathways Involved in Cardiovascular Diseases

Cardiovascular diseases (CVD) represent a significant global health challenge resulting from a complex interplay of genetic, environmental, and lifestyle factors. However, the molecular pathways and genetic factors involved in the onset and progression of CVDs remain incompletely understood. Here, we performed an integrative bioinformatic analysis to highlight specific genes and signaling pathways implicated in the pathogenesis of 80 CVDs. Differentially expressed genes (DEGs) were identified through the integrated analysis of microarray and GWAS datasets. Then, hub genes were identified after gene ontology functional annotation analysis and protein-protein internet (PPI) analysis. In addition, pathways were identified through KEGG and gene ontology enrichment analyses. A total of 821 hub genes related to 80 CVDs were identified, including 135 common and frequent CVD-associated genes. TNF, IL6, VEGFA, and TGFB.1 genes were the central core genes expressed in 50% or more of CVDs, confirming that the inflammation is a key pathological feature of CVDs. Analysis of hub genes by KEGG enrichment revealed predominant enrichment in 201 KEGG pathways, of which the AGE-RAGE signaling pathway in diabetic complications was identified as the common key KEGG implicated in 62 CVDs. In addition, the outcomes showed an overrepresentation in pathways categorized under human diseases, particularly in the subcategories of infectious diseases and cancers, which may be common risk factors for CVDs. In conclusion, this powerful approach for in silico fine-mapping of genes and pathways allowed the identification of determinant hubs genes and pathways implicated in the pathogenesis of CVDs which could be employed in developing more targeted and effective interventions for preventing, diagnosing, and treating CVDs. The function of these hub genes in CVDs needs further exploration to elucidate their biological characteristics.

Sex Differences in Coronary Artery Disease: Insights From the KoRean wOmen'S chest pain rEgistry (KoROSE)

Interest in sex differences in coronary artery disease (CAD) has been steadily increasing. Concurrently, most of the data on these differences have primarily been Western-oriented. The KoRean wOmen'S chest pain rEgistry (KoROSE), started in 2011, has since published numerous research findings. This review aims to summarize the reported differences between men and women in CAD, integrating data from KoROSE. Cardiovascular risk in postmenopausal women escalates dramatically due to the decrease in estrogen levels, which normally offer cardiovascular protective effects. Lower estrogen levels can lead to abdominal obesity, insulin resistance, increased blood pressure, and endothelial dysfunction in older women. Upon analyzing patients with CAD, women are typically older and exhibit more cardiovascular risk factors than men. Diagnosing CAD in women tends to be delayed due to their symptoms being more atypical than men's. While in-hospital outcome was similar between sexes, bleeding complications after percutaneous coronary intervention occur more frequently in women. The differences in long-term prognosis for CAD patients between men and women are still a subject of ongoing debate. Pregnancy and reproductive factors also play a significant role as risk factors for cardiovascular disease in women. A notable sex disparity exists, with women found to use fewer cardiovascular protective drugs and undergo fewer interventional or surgical procedures than men. Additionally, women participate less frequently than men in clinical research. Through concerted efforts to increase awareness of sex differences and mitigate sex disparity, personalized treatment can be provided. This approach can ultimately improve patient prognosis.

The Longitudinal Effect of Ultra-Processed Food on the Development of Dyslipidemia/Obesity as Assessed by the NOVA System and Food Compass Score

SCOPE

Ultra-processing food (UPF) has been a nutrition and health interest. This study is aimed to investigate the association between UPF consumption and the risk of obesity or dyslipidemia.

METHODS AND RESULTS

This study is performed using an ongoing cohort study including 17 310 individuals aged ≥40 years in South Korea. UPF is categorized by the NOVA system and FCS, respectively. After an average 5-year follow-up, there is a positive association between NOVA-defined UPF and dyslipidemia. The risk of the Q4 group is almost 20% higher than that of the Q1 group (men, adjusted HR = 1.209 [95% CI 1.039-1.407], women, adjusted HR = 1.195 [95% CI 1.096-1.303]). Consuming high-FCS foods (less processed and healthier foods) show a lower risk for dyslipidemia in both sexes and lower obesity risk in women compared to low-FCS consumption (men, dyslipidemia, adjusted HR = 0.857 [95% CI 0.744-0.988]; women, dyslipidemia, adjusted HR = 0.919 [95% CI 0.850-0.993], obesity, adjusted HR = 0.759 [95% CI 0.628-0.916]).

CONCLUSION

Higher UPF intakes assessed by the NOVA system and FCS are associated with increased incidences of dyslipidemia and obesity. Furthermore, NOVA-defined UPF shows a statistically significant negative association with AMED score, indicating poor diet quality.

The association between hyperuricemia and cardiovascular disease history: A cross-sectional study using KoGES HEXA data

This cross-sectional study examines the association between hyperuricemia and cardiovascular diseases (CVDs). Data from the Korean Genome and Epidemiology Study from 2004 to 2016 were analyzed. Among the 173,209 participants, we selected 11,453 patients with hyperuricemia and 152,255 controls (non-hyperuricemia). We obtained the history of CVDs (stroke and ischemic heart disease [IHD]) from all participants. Crude and adjusted odds ratios (aORs) (age, income group, body mass index, smoking, alcohol consumption, anthropometry data, and nutritional intake) for CVDs were analyzed using a logistic regression model. Participants with hyperuricemia reported a significantly higher prevalence of stroke (2.4% vs 1.3%) and IHD (5.6% vs 2.8%) than controls did (P < .001). Participants with hyperuricemia had a significantly higher aOR for CVD than the controls. The aOR of hyperuricemia for stroke was 1.22 (95% confidence interval = 1.07-1.39, P = .004). When analyzed by subgroup according to age and sex, this result was only persistent in women. The aOR of hyperuricemia for IHD was 1.45 (95% confidence interval = 1.33-1.59, P < .001). In the subgroup analyses, the results were similar, except in young men. Hyperuricemia was significantly associated with CVD in the Korean population.

Association between endocrine-disrupting chemical mixture and metabolic indices among children, adolescents, and adults: A population-based study in Korea

Exposure to endocrine-disrupting chemicals (EDCs) play a role in the etiology of obesity and dyslipidemia. However, few studies have analyzed the combined effects of EDC mixtures. This study explored the association between concurrent exposure to EDCs and obesity or dyslipidemia in children, adolescents, and adults. A total of 1454 children, 891 adolescents, and 3758 (for BMI) and 3424 (for TG/HDL) adults from the Korean National Environmental Health Survey 2015 to 2017 were included in this cross-sectional study. Urinary concentrations of eight phthalate metabolites, three phenols, three parabens, and one pyrethroid pesticides metabolite were quantified. Body mass index (BMI) was measured for all participants, and triglyceride (TG) and high-density lipoprotein cholesterol (HDL-c) levels were measured for adolescents and adults. Associations between combined EDC mixtures with the BMI and TG to HDL-c ratio were evaluated using Bayesian Kernel Machine Regression (BKMR). In all age groups, most of the chemical exposures, with the exception of BPF and BPS, were detected in more than 90% of participants. There were significant moderate to high correlations within phthalate metabolites and a high correlation within parabens. The BKMR showed that EDC mixtures were associated with higher BMI in both adolescents and adults, with greater significance in adults compared with adolescents, and a higher TG/HDL in male adolescents. In adolescents, MEP and MCPP drove the main effects on BMI and TG/HDL, respectively. In adults, 3PBA and BPA drove the main effects on BMI. The findings of this study suggest that exposure to EDC mixtures is associated with higher BMI and TG/HDL, and adolescence may be a critical period for EDC mixture in terms of both outcomes. Further studies are needed, but strategies to reduce EDC exposure from early life stages may be necessary to lower the risk of metabolic disease.

Sex and Gender Determinants of Vascular Disease in the Global Context

Globally, vascular diseases are a leading cause of morbidity and mortality. Many of the most significant risk factors for vascular disease have a gendered dimension, and sex differences in vascular diseases incidence are apparent, worldwide. In this narrative review, we provide a contemporary picture of sex- and gender-related determinants of vascular disease. We illustrate key factors underlying sex-specific risk stratification, consider similarities and sex differences in vascular disease risk and outcomes with comparisons of data from the global North (ie, developed high-income countries in the Northern hemisphere and Australia) and the global South (ie, regions outside Europe and North America), and explore the relationship between country-level gendered inequities in vascular disease risk and the United Nation's gender inequality index. Review findings suggest that the rising incidence of vascular disease in women is partly explained by an increase in the prevalence of traditional risk factors linked to gender-related determinants such as shifting roles and relations related to the double burden of employment and caregiving responsibilities, lower educational attainment, lower socioeconomic status, and higher psychosocial stress. Social isolation partly explained the higher incidence of vascular disease in men. These patterns were apparent across the global North and South. Study findings emphasize the necessity of taking into account sex differences and gender-related factors in the determination of the vascular disease risk profiles and management strategies. As we move toward the era of precision medicine, future research is needed that identifies, validates, and measures gender-related determinants and risk factors in the global South.

Genetic variation rs1121980 in the fat mass and obesity-associated gene (FTO) is associated with dietary intake in Koreans

Background

Fat mass and obesity-associated gene (FTO) is a well-known gene associated with body weight and obesity risk. Recent studies have suggested that genetic variations in FTO may play a role in the regulation of food preference and consumption. However, little is known with respect to Asian populations.

Objective

This study examined whether rs1121980 C > T in FTO is associated with food intake in Koreans.

Design

This study was performed using data from the Korean Genome and Epidemiology Study (Ansan/Ansung cohort). Dietary intake was determined using the semi-food frequency questionnaire, and the FTO rs1121980 genotypes of 6,262 individuals (3,049 males and 3,213 females) were analyzed along with sex and body mass index (BMI).

Result

Genetic variation did not show a significant association with the population's energy-nutrient intake. However, female T allele carriers with BMI ≥ 25 consumed more blue fish and coffee, and their coffee creamer consumption was decisively higher than that of T allele non-carriers (P _adjusted = 0.004). In males, the presence of the T allele showed a putative association with the consumption of sweets, snacks, and coffee creamer by the BMI level.

Conclusion

The FTO rs1121980 variation was associated with a preference for foods particularly high in fat (e.g. coffee creamer, blue fish, sweets, and snacks) in Koreans; these preferences varied by sex and BMI.

Current status of obesity treatment in Korea: based on the 2020 Korean Society for the Study of Obesity guidelines for obesity management

Background: Obesity is a complex disease, and its prevalence is gradually increasing globally. The increasing prevalence of obesity is shown to significantly affect the development of obesity-related comorbidities. This paper describes the recent updates on obesity treatment in Korea based on the 2020 Korean Society for the Study of Obesity guidelines for obesity management.Current Concepts: Accurate evaluation of obesity is important before treatment initiation. Obesity in Korean adults is defined as body mass index ≥25 kg/m2, and abdominal obesity is defined as waist circumference ≥90 cm for men and ≥85 cm for women. It is recommended that energy intake be reduced and that the degree of energy restriction be individualized based on patient characteristics and medical conditions. Guidelines recommend assessment of the exercise participation and health status before prescribing exercise therapy; aerobic exercise for at least 150 min/week or 3–5 times/week is advised to facilitate weight loss. Although nutrition and behavior therapy and increased physical activity constitute the mainstay of obesity treatment, pharmacotherapy is recommended concomitant with comprehensive lifestyle modification. Bariatric surgery should be actively considered in patients with severe obesity and in those with obesity-related comorbidities.Discussion and Conclusion: Obesity and the associated comorbidities result in an increased socioeconomic and medical burden. Multifactorial intervention using a team approach is warranted for optimal management of obesity. This guideline will benefit primary care physicians for safe and effective decision-making regarding obesity management and treatment.

Dyslipidaemia-Genotype Interactions with Nutrient Intake and Cerebro-Cardiovascular Disease

A comprehensive understanding of gene-diet interactions is necessary to establish proper dietary guidelines to prevent and manage cardio-cerebrovascular disease (CCD). We investigated the role of genetic variants associated with dyslipidaemia (DL) and their interactions with macro-nutrients for cardiovascular disease using a large-scale genome-wide association study of Korean adults. A total of 58,701 participants from a Korean genome and epidemiology study were included. Their dietary intake was assessed using a food frequency questionnaire. Dyslipidaemia was defined as total cholesterol (TCHL) ≥ 240 mg/dL, high-density lipoprotein (HDL) < 40 mg/dL, low-density lipoprotein (LDL) ≥ 160 mg/dL, triglycerides (TG) ≥ 200 mg/dL, or dyslipidaemia history. Their nutrient intake was classified as follows: protein intake: high ≥ 30%, 30% > moderate ≥ 20%, and 20% > low in daily total energy intake (TEI); carbohydrate intake: high ≥ 60%, 60% > moderate ≥ 50%, and 50% > low; fat intake: high ≥ 40%, 40% > moderate ≥ 30%, and 30% > low. Odds ratios and 95% confidence intervals were calculated after adjusting for age; sex; body mass index (BMI); exercise status; smoking status; alcohol intake; principal component 1 (PC1); principal component 2 (PC2); and intake of carbohydrates, fats, and proteins. This analysis included 20,596 patients with dyslipidaemia and 1027 CCD patients. We found that rs2070895 related to LIPC was associated with HDL-cholesterol. Patients with the minor allele (A) in rs2070895 had a lower risk of CCD than those carrying the reference allele (G) (odds ratio [OR] = 0.8956, p-value = 1.78 × 10−2). Furthermore, individuals consuming protein below 20% TEI with the LIPC reference allele had a higher risk of CCD than those with the minor allele (interaction p-value 6.12 × 10−3). Our findings suggest that the interactions of specific polymorphisms associated with dyslipidaemia and nutrients intake can influence CCD.

Effects of exercise initiation and smoking cessation after new-onset type 2 diabetes mellitus on risk of mortality and cardiovascular outcomes

Lifestyle changes after a diagnosis of type 2 diabetes mellitus (DM) can affect vascular health outcomes. The objective of this study was to investigate the effects of changes in smoking and exercise on the risk of cardiovascular disease (CVD) and mortality in patients with newly diagnosed DM. Data were analyzed for 181,591 people with newly diagnosed type 2 DM who underwent 2 serial health examinations within 2 years before and after DM diagnosis. The study population was followed from the baseline to the date of death or cardiovascular events, or until December 31, 2018 and median follow-up was 6.07 years. Based on the change in status from before to after the diagnosis, participants were grouped into smoking groups (continuous smokers, quitters, new smokers, and nonsmokers) and exercise groups (constant exercisers, new exercisers, exercise dropouts, and nonexercisers). Compared with the nonexercisers, those who initiated exercise after their DM diagnosis had a lower risk of myocardial infarction (MI), stroke, and all-cause mortality: the hazard ratio (HR; 95% confidence interval [CI]) was 0.85 (0.76–0.94) for MI, 0.86 (0.78–0.94) for stroke, and 0.84 (0.89–0.90) for all-cause mortality. Quitters had a higher risk of MI, stroke, and all-cause mortality than nonsmokers, but their risk level was much lower than that in continuous smokers. When the group of continuous smokers and nonexercisers was considered as the reference group, participants who quit smoking and remained nonexercisers had a 21% lower risk of CVD (HR 0.79; 95% CI 0.70–0.90). Those who quit smoking and started exercising had a 46% reduced risk of CVD (HR 0.54; 95% CI 0.41–0.71) and a 22% reduced risk in all-cause mortality (HR 0.78; 95% CI 0.63–0.96). Smoking cessation and exercise initiation after a diagnosis of new-onset type 2 DM was associated with a reduced risk of CVD and all-cause mortality.

Correlates of Objectively Measured Sitting Time in South Korean Adults: 2014-2015 Korea National Health and Nutrition Examination Survey

The purpose of this study was to investigate daily amounts of time spent sitting and frequency of breaks from sitting and to identify their sociodemographic, environmental, and health behavioral correlates for Korean adults (age = 19–65). This study analyzed accelerometer subdata from the 2014–2015 Korea National Health and Nutrition Examination Survey (n = 1,768). Ordinary least squares regression models stratified by weekday and weekend were tested to identify correlates of time spent sitting and number of sitting breaks. The average daily amounts of sitting time during weekdays and weekends were 500.63 min (95% confidence interval [CI] = 495.20–506.06) and 488.10 min (95% CI = 481.72–494.49), respectively. On weekdays and weekends, the average numbers of breaks from sitting per hour were 6.62 (95% CI = 6.57–6.68) and 6.60 (95% CI = 6.54–6.66), respectively. The participants with the greatest daily sitting time tended to be male, middle-aged, never married, office workers, and residents of a metropolis; tended to have a high school educational level or higher; and had never smoked, were underweight, were physically inactive, and slept <6 h a day. Fewer breaks from sitting was associated with being male, never married, middle-aged, an office worker, an apartment resident, never having smoked, and underweight. Higher education level and physical inactivity were associated with more frequent breaks from sitting. To reduce sedentary behavior, this study helps identify at-risk populations and their characteristics. Future studies should incorporate longitudinal data and measure domain-specific sedentary behavior.

Association between metabolic syndrome and left ventricular geometric change including diastolic dysfunction

BACKGROUND

We investigated the association between individual components of metabolic syndrome (MetS) and left ventricular (LV) geometric changes, including diastolic dysfunction, in a large cohort of healthy individuals.

METHODS

Overall, 148 461 adults who underwent echocardiography during a health-screening program were enrolled. Geographic characteristics on echocardiography and several markers of LV relaxation function were identified according to individual MetS components. Univariate linear regression analysis and a multivariate regression model adjusted for factors known to influence LV relaxation function were conducted.

RESULTS

The prevalence of LV diastolic dysfunction (LVDD) was higher in the MetS group than in the non-MetS group (0.56% vs. 0.27%, p < .001). In univariate and multivariate analyses, E/A ratio, e' velocity, and left atrial volume index were significantly associated with each component of MetS and covariates (all p ≤ .001). In the age- and sex-adjusted model, MetS was significantly associated with LVDD (odds ratio [95% confidence interval], 1.350 [1.103, 1.652]). However, subjects with more MetS components did not have a significantly higher risk of LVDD. As the analysis was stratified by sex, the multivariate regression model showed that MetS was significantly associated with LVDD only in men (1.3 [1.00, 1.68]) with higher risk in more MetS component (p for trend < .001). In particular, triglyceride (TG) and waist circumference (WC) among MetS components were significantly associated with LVDD in men.

CONCLUSIONS

MetS was associated with the risk of LVDD, especially in men, with a dose-dependent association between an increasing number of components of MetS and LVDD. TG and WC were independent risk factors for LVDD in men.

The Influence of Obesity and Metabolic Health on Vascular Health

The prevalence of obesity is rapidly increasing worldwide. Obesity should not be understood only as the accumulation of fat in the body, but instead as a phenomenon that exerts different effects on our health according to the place of fat deposition and its stability. Obesity is the starting point of most metabolic diseases, such as diabetes, hypertension, metabolic syndrome, sleep apnea, and eventually cardiovascular disease. There are different kinds of obesity, ranging from simple obesity to sarcopenic obesity. The main purpose of intervening to address obesity is to decrease the ultimate consequence of obesity-namely, cardiovascular disease. The main mechanism through which obesity, especially abdominal obesity, increases cardiovascular risk is the obesity-induced derangement of metabolic health, leading to the development of metabolic diseases such as diabetes, non-alcoholic fatty liver disease, and metabolic syndrome, which are the main initiators of vascular damage. In this review, I discuss the influence of various types of obesity on the risk of metabolic diseases, and how these diseases increase cardiovascular disease risk.

Genetic Determinants of Visit-to-Visit Lipid Variability: Genome-Wide Association Study in Statin-Naïve Korean Population

Background and Aim

There is a growing evidence that fluctuation in lipid profiles is important in cardiovascular outcomes. We aimed to identify single nucleotide polymorphism (SNP) variants associated with low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C) variability in statin-naïve Korean subjects and evaluate their associations with coronary atherosclerosis.

Methods

In statin-naïve subjects from Gene-Environment of Interaction and phenotype cohort, we performed genome-wide association studies of lipid variability; the discovery (first) and replication (second) sets included 4,287 and 1,086 subjects, respectively. Coronary artery calcium (CAC) score and degree of coronary artery stenosis were used as outcome measures. Cholesterol variability was determined by standard deviation and average successive variability, and significant coronary atherosclerosis was defined as CAC score ≥400 or coronary stenosis ≥70%.

Results

Mean HDL-C and LDL-C level were 54 ± 12 and 123 ± 30 mg/dL in the first set and 53 ± 12 and 126 ± 29 mg/dL in the second set. APOA5 rs662799 and APOA5 rs2266788 were associated with LDL-C variability and PXDNL rs80056520, ALDH2 rs671, HECTD4 rs2074356, and CETP rs2303790 were SNPs associated for HDL-C variability. APOA5 rs662799 passed Bonferroni correction with p-value of 1.789 × 10⁻⁹. Among the SNPs associated with cholesterol variability, rs80056520 and rs2266788 variants were associated with CACS ≥400 and coronary stenosis ≥70% and rs662799 variant was associated with coronary stenosis ≥70%.

Conclusion

Two SNPs associated with LDL-C variability (APOA5 rs662799 and rs2266788) and one SNP associated with HDL-C variability (PXDNL rs80056520) were significantly associated with advanced coronary artery stenosis. Combining GWAS results with imaging parameters, our study may provide a deeper understanding of underlying pathogenic basis of the link between lipid variability and coronary atherosclerosis.

Awareness and Related Factors of Dyslipidemia in Menopausal Women in Korea

This study aims to identify the awareness of dyslipidemia and the factors affecting it in menopausal women to prevent cardiovascular disease, a major cause of female mortality. This study used data from 2019, the first year of the eighth (2019-2021) Korea National Health and Nutrition Examination Survey conducted by the Korea Disease Control and Prevention Agency. A total of 975 women fulfilled the selection criteria. Dyslipidemia awareness and the related factors were analyzed with SPSS 26.0 complex sample software. Only 27.3% of menopausal women over age 40 with dyslipidemia were aware of the condition. Factors affecting their awareness level were age, subjective health awareness, body mass index, and underlying disease. The prevalence of dyslipidemia in menopausal women was high, but their awareness was significantly low. This finding confirms the need for measures to improve dyslipidemia awareness to prevent cardiovascular diseases in menopausal women.

Metabolic risks in living kidney donors in South Korea

Background

Considering the growing prevalence of Western lifestyles and related chronic diseases occurring in South Korea, this study aimed to explore the progression of metabolic risk factors in living kidney donors.

Methods

This study enrolled living kidney donors from seven hospitals from 1982 to 2016. The controls were individuals that voluntarily received health check-ups from 1995 to 2016 that were matched with donors according to age, sex, diabetes status, baseline estimated glomerular filtration rate, and date of the medical record. Data on hyperuricemia, hypertension, hypercholesterolemia, and overweight/obesity were collected to determine metabolic risks. Logistic regressions with interaction terms between the medical record date and donor status were used to compare the trends in metabolic risks over time in the two groups.

Results

A total of 2,018 living kidney donors and matched non-donors were included. The median age was 44.0 years and 54.0% were women. The living kidney donors showed a lower absolute prevalence for all metabolic risk factors, except for those that were overweight/obese, than the non-donors. The proportion of subjects that were overweight/obese was consistently higher over time in the donor group. The changes over time in the prevalence of each metabolic risk were not significantly different between groups, except for a lower prevalence of metabolic risk factors ≥ 3 in donors.

Conclusion

Over time, metabolic risks in living kidney donors are generally the same as in non-donors, except for a lower prevalence of metabolic risk factors ≥3 in donors.

Frequency of Exposure to Impaired Fasting Glucose and Risk of Mortality and Cardiovascular Outcomes

BACKGROUND

Metabolic abnormalities, such as impaired fasting glucose (IFG), are dynamic phenomena; however, it is unclear whether the timing of IFG exposure and cumulative exposure to IFG are related to cardiovascular disease (CVD) and mortality risk.

METHODS

Data were extracted from a nationwide population-based cohort in South Korea for adults (n=2,206,679) who were free of diabetes and had 4 years of consecutive health examination data. Fasting blood glucose levels of 100 to 125 mg/dL were defined as IFG, and the number of IFG diagnoses for each adult in the 4-year period was tabulated as the IFG exposure score (range, 0 to 4). Adults with persistent IFG for the 4-year period received a score of 4.

RESULTS

The median follow-up was 8.2 years. There were 24,820 deaths, 13,502 cases of stroke, and 13,057 cases of myocardial infarction (MI). IFG exposure scores of 1, 2, 3, and 4 were associated with all-cause mortality (multivariable-adjusted hazard ratio [aHR], 1.11; 95% confidence interval [CI], 1.08 to 1.15; aHR, 1.16; 95% CI, 1.12 to 1.20; aHR, 1.20; 95% CI, 1.15 to 1.25; aHR, 1.18; 95% CI, 1.11 to 1.25, respectively) compared with an IFG exposure score of 0. Adjusting for hypertension and dyslipidemia attenuated the slightly increased risk of MI or stroke associated with high IFG exposure scores, but significant associations for allcause mortality remained.

CONCLUSION

The intensity of IFG exposure was associated with an elevated risk of all-cause mortality, independent of cardiovascular risk factors. The association between IFG exposure and CVD risk was largely mediated by the coexistence of dyslipidemia and hypertension.

A Century of Progress in Diabetes Care with Insulin: A History of Innovations and Foundation for the Future

The year 2021 marks the 100th anniversary of the discovery of insulin, which has greatly changed the lives of people with diabetes and become a cornerstone of advances in medical science. A rapid bench-to-bedside application of the lifesaving pancreatic extract and its immediate commercialization was the result of a promising idea, positive drive, perseverance, and collaboration of Banting and colleagues. As one of the very few proteins isolated in a pure form at that time, insulin also played a key role in the development of important methodologies and in the beginning of various fields of modern science. Since its discovery, insulin has evolved continuously to optimize the care of people with diabetes. Since the 1980s, recombinant DNA technology has been employed to engineer insulin analogs by modifying their amino acid sequence, which has resulted in the production of insulins with various profiles that are currently used. However, unmet needs in insulin treatment still exist, and several forms of future insulins are under development. In this review, we discuss the past, present, and future of insulin, including a history of ceaseless innovations and collective intelligence. We believe that this story will be a solid foundation and an unerring guide for the future.

Differing Nutrient Intake and Dietary Patterns According to the Presence of Hyper-Low-Density Lipoprotein Cholesterolemia or Hypertriglyceridemia

Dietary choices may have differing effects on low-density lipoprotein cholesterol or triglyceride levels. The aim of this study was to investigate daily nutrient intake and dietary patterns of individuals with hyper-low-density lipoprotein cholesterolemia (hLDL) and hypertriglyceridemia (hTG) in a large Korean population-based study using propensity score (PS) matching. This study used data from the Korea National Health and Nutrition Examination Survey. Propensity score values for the predicted probability of patients with hLDL or hTG were estimated using logistic regression analysis, with age, sex, body mass index, alcohol consumption, smoking status, physical activity status, hypertension, and diabetes. After PS matching, intake of carbohydrates (%) was significantly lower (p = 0.021), and intake of fats (%) and saturated fatty acids (%) was significantly higher in the hLDL group than in the non-hLDL group (p = 0.025 and p = 0.013, respectively). The percentage of individuals with a high score for the Korean Healthy Eating Index (KHEI) "whole grains" or "saturated fatty acids" components was higher in the non-hLDL group than in the hLDL group (p < 0.05 for both). Dietary sodium/potassium ratio was significantly higher in the hTG than in the non-hTG (p = 0.049). Our results suggest that individualized dietary information and counseling require consideration of a person's specific lipid levels.

Comparison of the Efficacy and Safety of Atorvastatin 40 mg/ω-3 fatty acids 4 g Fixed-Dose Combination and Atorvastatin 40 mg Monotherapy in Hypertriglyceridemic Patients Who Poorly Respond to Atorvastatin 40 mg Monotherapy: An 8-Week, Multicenter, Randomized, Double-Blind Phase III Study

PURPOSE

Residual cardiovascular risk in patients with hypertriglyceridemia, despite optimal low-density lipoprotein cholesterol levels being achieved with intensive statin treatment, is a global health issue. The purpose of this study was to investigate the efficacy and tolerability of treatment with a combination of high-dose atorvastatin/Ω-3 fatty acid compared to atorvastatin + placebo in patients with hypertriglyceridemia who did not respond to statin treatment.

METHODS

In this multicenter, randomized, double-blind, placebo-controlled study, patients who had residual hypertriglyceridemia after a 4-week run-in period of atorvastatin treatment were randomly assigned to receive UI-018 (fixed-dose combination atorvastatin/Ω-3 fatty acid 40 mg/4 g) or atorvastatin 40 mg + placebo (control). The primary efficacy end points were the percentage change from baseline in non-high density lipoprotein cholesterol (non-HDL-C) level at the end of treatment and the adverse events recorded during treatment. A secondary end point was the percentage change from baseline in triglyceride level.

FINDINGS

After 8 weeks of treatment, the percentage changes from baseline in non-HDL-C (-4.4% vs +0.6%; p = 0.02) and triglycerides (-18.5% vs +0.9%; p < 0.01) were significantly greater in the UI-018 group (n = 101) than in the control group (n = 99). These changes were present in subgroups of advanced age (≥65 years), status (body mass index ≥25 kg/m²), or without diabetes. The prevalences of adverse events did not differ between the 2 treatment groups.

IMPLICATIONS

In patients with residual hypertriglyceridemia despite receiving statin treatment, a combination of high-dose atorvastatin/Ω-3 fatty acid was associated with a greater reduction of triglyceride and non-HDL-C compared with atorvastatin + placebo, without significant adverse events.

Epidemiology of cardiovascular disease and its risk factors in Korea

Cardiovascular disease (CVD) is the leading cause of death and a major contributor to disability worldwide. Currently, Korea is among countries with the lowest CVD mortality rates, and the age-adjusted CVD mortality rate is still decreasing. However, depending on the CVD type, the mortality and incidence trends vary. Without age-standardization, cerebrovascular disease mortality peaked in 1994 (82.1 per 100K) and continued to decline until 2018 (44.7 per 100K), while heart disease mortality recorded the lowest level in 2001 (44.9 per 100K) then increased again until 2018 (74.5 per 100K). Age-standardized mortality rates showed different trends: both cerebrovascular disease and heart disease mortality rates have declined over the past few decades, although the rate of decline varies. Based on the National Health Insurance claim database, the numbers of hospitalization for cerebrovascular disease and ischemic heart disease are increasing, but the age-standardized hospitalization rates are decreasing. Unlike other types of CVDs, heart failure is rapidly increasing in both mortality and hospitalization rates regardless of age-standardization. Seventy percent of Korean adults have at least one risk factor, 41% have ≥ 2 risk factors, and 19% have ≥ 3 risk factors including hypertension, diabetes, hypercholesterolemia, obesity, and smoking. Exposure to multiple risk factors increases with age, with 65% of senior citizens over 70 having ≥ 2 risk factors and 34% having ≥ 3 risk factors. As the elderly population, especially those with multiple risk factors and chronic disorders, is increasing, the management of this high-risk group will be an important challenge to prevent CVD in Korea.

The Clinical Characteristics of Gestational Diabetes Mellitus in Korea: A National Health Information Database Study

BACKGROUND

To investigate the clinical characteristics of gestational diabetes mellitus (GDM) in Korea, using a nationwide database.

METHODS

We analyzed 417,139 women who gave birth between 2011 and 2015 using the Korean National Health Information Database. They underwent the Korean National Health Screening Program within one year before pregnancy and were not prescribed drugs for diabetes nor diagnosed with diabetes mellitus before 280 days antepartum. Patients with GDM were defined as those who visited the outpatient clinic more than twice with GDM codes.

RESULTS

The prevalence of GDM was 12.70% and increased with increasing maternal age, prepregnancy body mass index (BMI), waist circumference (WC), and fasting plasma glucose (FPG) (P for trend <0.05). As compared with those aged <25 years, the odds ratio for women with GDM aged ≥40 years were 4.804 (95% confidence interval [CI], 4.436 to 5.203) after adjustment for covariates. Women with prepregnancy BMI ≥30 kg/m2 were at 1.898 times (95% CI, 1.736 to 2.075) greater risk for GDM than those with prepregnancy BMI <18.5 kg/m2. Women with WC of ≥95 cm were at 1.158 times (95% CI, 1.029 to 1.191) greater risk for GDM than women with WC of less than 65 cm. High FPG, high income, smoking, and drinking were associated with an elevated risk of GDM.

CONCLUSION

The prevalence of GDM in Korean women increased up to 12.70% during 2011 to 2015. These data suggest the importance of GDM screening and prevention in high-risk groups in Korea.

Comorbidities and Factors Determining Medical Expenses and Length of Stay for Admitted COVID-19 Patients in Korea

Purpose

No previous investigations of coronavirus disease 2019 (COVID-19) have estimated medical expenses, length of stay, or factors influencing them using administrative datasets. This study aims to fill this research gap for the Republic of Korea, which has over 10,000 confirmed COVID-19 cases.

Patients and Methods

Using the nationwide health insurance claims data of 7590 confirmed COVID-19 patients, we estimated average medical expenses and inpatient days per patient, and performed multivariate negative binomial, and gamma regressions to determine influencing factors for higher outcomes.

Results

According to the results, COVID-19 patients with history of ICU admission, chest CT imaging, lopinavir/ritonavir and hydroxychloroquine use stayed longer in the hospital and spent more on medical expenses, and anti-hypertensive drugs were insignificantly associated with the outcomes. Female patients stayed longer in the hospital in the over 65 age group but spent less in medical expenses that the 20-39 group. In the 40-69 age group, patients with health insurance stayed longer in the hospital and spent more on medical expenses than those aged over 65 years. Comorbidities did not affect outcomes in most age groups.

Conclusion

In summary, contrary to popular beliefs, medical expenses and length of hospitalization were mostly influenced by age, and not by comorbidities, anti-viral, or anti-hypertensive drugs. Thus, responses should focus on infection prevention and control rather than clinical countermeasures.

Association between Diabetes Mellitus and Oral Health Status in Patients with Cardiovascular Diseases: A Nationwide Population-Based Study

Diabetes mellitus (DM) can lead to poor oral health. However, oral health among diabetic patients with cardiovascular diseases (CVDs) is scarcely studied. This study aimed to elucidate the prevalence of oral health complications and the relationship between DM and oral health status in diabetic patients with CVDs. This retrospective nationwide cross-sectional study evaluated 3495 patients aged ≥40 years with CVD, with DM (n = 847) and without DM (n = 2648). The participant's characteristics between the two groups were compared using the Chi-square test and t-test. Logistic regression analyses were performed to identify associations between DM and oral health status. The prevalence of periodontitis (54.3% vs. 43.2%) and <20 number of remaining teeth (30.9% vs. 22.8%) was significantly higher in the DM than in the non-DM group. In the multivariate regression analysis, the incidence of periodontitis was 1.4 times higher in the DM group than in the non-DM after adjusting for confounders; however, the number of remaining teeth and active caries were not associated with DM. In conclusion, the oral health status of patients with coexisting CVD and DM should be assessed closely and actively. Healthcare professionals should provide accessible dental care services and develop strategies to improve patients' oral health.

Cumulative exposure to impaired fasting glucose and future risk of type 2 diabetes mellitus

AIMS

The status of metabolic abnormalities including impaired fasting glucose (IFG) can change over time, yet little is known about how exposure duration to IFG is related to diabetes risk.

METHODS

Using nationally representative data from the Korean National Health Insurance system, 2,513,127 people who were free of diabetes and who received four consecutive annual health examinations commencing in 2006 or 2007 were followed up at the end of 2016. IFG was defined as fasting blood glucose levels of 100-125 mg/dL. Participants were classified numerically according to the cumulative number of IFG diagnoses.

RESULTS

Over 4 years, 53% of the population participants remained normoglycemic, while 3% had persistent IFG and 44% had intermittent IFG. The risk of type 2 diabetes mellitus (DM) increased gradually with increasing IFG exposure score. Subjects with an IFG exposure score of 2, 3, or 4 had a 3.75- to 9.77-fold increased hazard ratio (HR) for incident diabetes (IFG exposure score 0 reference; score 2, HR 3.75, 95% confidence interval [CI] 3.67-3.83; score 3, HR 6.21, 95% CI 6.08-6.36; score 4, HR 9.77, 95% CI 9.53-10.02).

CONCLUSIONS

Cumulative IFG exposure was associated with a higher risk of type 2 DM in a dose-response fashion.

Thirty-six Year Trends in Mortality from Diseases of Circulatory System in Korea

BACKGROUND AND OBJECTIVES

Understanding the trends in cardiovascular disease (CVD) mortality is important for developing burden reduction strategies. Based on the Cause of Death Statistics, we examined the changing patterns of CVD mortality in Korea between 1983 and 2018.

METHODS

Causes of death were coded according to the International Classification of Disease, 10th revision. Deaths from all diseases of circulatory system (I00-I99) and the following 6 subcategories were analyzed: total heart diseases (I00-I13 and I20-I51), hypertensive heart diseases (I10-I13), ischemic heart diseases (I20-I25), myocardial infarction (I21-I23), heart failure (I50), and cerebrovascular diseases (I60-I69). Crude, age-standardized, and age-stratified rates were calculated to assess temporal trends in CVD mortality.

RESULTS

The number of deaths and crude mortality rate for all diseases of circulatory system increased recently mainly due to the population ageing. Specifically, total heart diseases showed increasing trend, whereas cerebrovascular diseases showed decreasing trend. Between 1983 and 2018, age-standardized mortality rates significantly declined for all diseases of circulatory system, total heart diseases, hypertensive heart diseases, and cerebrovascular diseases. Age-standardized mortality rates for ischemic heart diseases and myocardial infarction peaked in the early 2000s then decreased thereafter. However, age-standardized mortality rate for heart failure rapidly increased, especially in recent years.

CONCLUSIONS

CVD mortality in Korea has remarkably decreased over the last 36 years. However, the recent rise in the absolute number of deaths from heart diseases, especially from heart failure, calls for attention in prevention and management of CVD and its sequelae.

Identification of susceptibility loci for cardiovascular disease in adults with hypertension, diabetes, and dyslipidemia

BACKGROUND

Hypertension (HTN), diabetes mellitus (DM), and dyslipidemia (DL) are well-known risk factors of cardiovascular disease (CVD), but not all patients develop CVDs. Studies have been limited investigating genetic risk of CVDs specific to individuals with metabolic diseases. This study aimed to identify disease-specific and/or common genetic loci associated with CVD susceptibility in chronic metabolic disease patients.

METHODS

We conducted a genome-wide association study (GWAS) of a multiple case-control design with data from the City Cohort within Health EXAminees subcohort of the Korean Genome and Epidemiology Study (KoGES_HEXA). KoGES_HEXA is a population-based prospective cohort of 173,357 urban Korean adults that had health examinations at medical centers. 42,393 participants (16,309 HTN; 5,314 DM; 20,770 DL) were analyzed, and each metabolic disease group was divided into three CVD case-controls: coronary artery disease (CAD), ischemic stroke (IS), and cardio-cerebrovascular disease (CCD). GWASs were conducted for each case-control group with 7,975,321 imputed single nucleotide polymorphisms using the Phase 3 Asian panel from 1000 Genomes Project, by logistic regression and controlled for confounding variables. Genome-wide significant levels were implemented to identify important susceptibility loci.

RESULTS

Totaling 42,393 individuals, this study included 16,309 HTN (mean age [SD], 57.28 [7.45]; 816 CAD, 398 IS, and 1,185 CCD cases), 5,314 DM (57.79 [7.39]; 361 CAD, 153 IS, and 497 CCD cases), and 20,770 DL patients (55.34 [7.63]; 768 CAD, 295 IS, and 1,039 CCD cases). Six genome-wide significant CVD risk loci were identified, with relatively large effect sizes: 1 locus in HTN (HTN-CAD: 17q25.3/CBX8-CBX4 [OR, 2.607; P = 6.37 × 10^-9]), 2 in DM (DM-IS: 4q32.3/MARCH1-LINC01207 [OR, 5.587; P = 1.34 × 10^-8], and DM-CCD: 17q25.3/RPTOR [OR, 3.511; P = 1.99 × 10^-8]), and 3 in DL (DL-CAD: 9q22.2/UNQ6494-LOC101927847 [OR, 2.282; P = 7.78 × 10^-9], DL-IS: 3p22.1/ULK4 [OR, 2.162; P = 2.97 × 10^-8], and DL-CCD: 2p22.2/CYP1B1-CYP1B1-AS1 [OR, 2.027; P = 4.24 × 10^-8]).

CONCLUSIONS

This study identified 6 susceptibility loci and positional candidate genes for CVDs in HTN, DM, and DL patients using an unprecedented study design. 1 locus (17q25.3) was commonly associated with CAD. These associations warrant validation in additional studies for potential therapeutic applications.

Anti-Obesity and Antidiabetic Effects of Nelumbinis Semen Powder in High-Fat Diet-Induced Obese C57BL/6 Mice

Nelumbinis Semen (NS, the seeds of Nelumbo nucifera) extract is a traditional Korean medicine with anti-oxidant activity. The present study examined the anti-obesity and antidiabetic effects of NS powder in high-fat diet (HFD)-induced obese C57BL/6 mice. Mice (n = 8/group) were fed a normal diet (CON), HFD, HFD containing 5% NS powder (HFD-NS5%), or HFD containing 10% NS powder (HFD-NS10%) for 12 weeks. Food intake was relatively higher in groups HFD-NS5% and HFD-NS10%, while the food efficiency ratio was highest in group HFD (p < 0.05). HFD-NS5% reduced the body weight (-39.1%) and fat weight (-26.6%), including epididymal fat and perirenal fat, and lowered the serum triglyceride levels (-20.6%) compared with HFD. Groups HFD-NS5% and HFD-NS10% showed hepatoprotective properties, reducing the serum ALT levels (p < 0.05) and fat globules (size and number) in the liver compared with group HFD. HFD-NS5% and HFD-NS10% regulated the blood glucose, improved the glucose intolerance, and showed a 12.5% and 15.0% reduction in the area under the curve (AUC) of intraperitoneal glucose tolerance test (IPGTT), and a 26.8% and 47.3% improvement in homeostatic model assessment insulin resistance (HOMA-IR), respectively, compared with HFD (p < 0.05). Regarding the expressions of genes related to anti-obesity and antidiabetes, there was a 1.7- and 1.3-fold increase in PPAR-α protein expression, 1.4- and 1.6-fold increase in PPAR-γ protein expression, and 0.7- and 0.6-fold decrease in TNF-α protein expression, respectively, following HFD-NS5% and HFD-NS10% treatments, compared with HFD, and GLUT4 protein expression increased relative to CON (p < 0.05). These results comprehensively provide the fundamental data for NS powder's functional and health-promoting benefits associated with anti-obesity and antidiabetes.

Association of the Healthy Eating Index with Estimated Cardiovascular Age in Adults from the KNHANES 2013-2017

In this paper, we hypothesized that the gap between estimated cardiovascular age (eCV-age) and chronological age had a gender-wise correlation with the Korean Healthy Eating Index (KHEI). We tested the hypothesis in adults aged 20-64 years old using the KNHANES 2013-2017 data. eCV-age was estimated based on the designated risk factors of cardiovascular disease (CVD) and age-gap was calculated by subtracting the eCV-age from the chronological age in 12,317 adults. Adjusted odds ratios for the age-gap were measured according to KHEI, while controlling for covariates to influence risk factors of CVD, using logistic regression analysis with the complex sample survey design. Age-gaps were divided into four groups: >4 (High), 0-4 (Moderate), -4-0 (Mild), and <-4 years (Low). The higher the age-gap, the lower the cardiovascular risk. Persons included in the following categories belonged to the high and moderate age-gap groups: young (<40 years), women, urban living, better than high school education, higher income, lean, mild drinking, and exercising regularly. KHEI scores were overall higher in women than men (p < 0.01). Having breakfast and saturated fat intake were primary factors that influenced the age-gap for men, whereas fresh fruit intake and carbohydrate intake influenced the age-gap in women. The KHEI scores positively correlated with nutrient intake, especially fiber and vitamin C intake in women (p < 0.05). Participants with high KHEI scores increased their chances of belonging to the high age-gap group by 2.16 times for men and 2.10 for women after adjusting for covariates of sex, age, and residence. However, after adding the covariates of education, income, marriage, and obesity, in conjunction with smoking, alcohol, and regular exercise, this reduced to 1.34 times in women. In conclusion, both genders had a positive correlation between age-gap and overall KHEI scores.