1
|
Noh J, Moon MK, Rhee EJ, Park SH, Kim HC, Kim BJ, Kim HJ, Choi S, Na JO, Hyun YY, Kim BJ, Han KD, Jeong IK. Association between Low-Density Lipoprotein Cholesterol Level and Cardiovascular Outcomes in Korean Adults: A Nationwide Cohort Study. Diabetes Metab J 2023; 47:59-71. [PMID: 36727164 PMCID: PMC9925149 DOI: 10.4093/dmj.2021.0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 10/06/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To validate the treatment target of low-density lipoprotein cholesterol (LDL-C) level according to the cardiovascular disease (CVD) risk which was recommended by Korean dyslipidemia guideline. METHODS We used the Korean National Health Insurance Service database which included 3,958,048 people aged 20 to 89 years who underwent regular health screening. The primary outcome was incident CVD, defined as a composite of myocardial infarction and stroke during the follow-up period from 2009 to 2018. RESULTS The risk of CVD increased from LDL-C level of 70 mg/dL in very high-risk and high-risk groups and from 130 mg/dL in moderate-risk and low-risk groups. Adjusted hazard ratios (HRs) of LDL-C ranges 70-99, 100-129, 130-159, 160-189, and ≥190 mg/dL were 1.20 (95% confidence interval [CI], 1.08-1.33), 1.27 (1.15-1.42), 1.39 (1.23-1.56), 1.69 (1.45-1.96), and 1.84 (1.49- 2.27) in very high-risk group, and 1.07 (1.02-1.13), 1.16 (1.10-1.21), 1.29 (1.22-1.36), 1.45 (1.36-1.55), and 1.73 (1.58-1.90) in high-risk group. Adjusted HRs (95% CI) of LDL-C ranges 130-159, 160-189, and ≥190 mg/dL were 1.15 (1.11-1.20), 1.28 (1.22- 1.34), and 1.45 (1.36-1.54) in moderate-risk group and 1.07 (1.02-1.13), 1.20 (1.13-1.26), and 1.47 (1.37-1.57) in low-risk group. CONCLUSION We confirmed the incidence of CVD was increased in higher LDL-C range. The risk of CVD increased from ≥70 mg/dL of LDL-C in very high-risk and high-risk groups, and from ≥130 mg/dL of LDL-C in moderate-risk and low-risk groups in Korean adults.
Collapse
Affiliation(s)
- Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Hyun Park
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Jin Kim
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Seonghoon Choi
- Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jin Oh Na
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Young Youl Hyun
- Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Stroke Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - In-Kyung Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Corresponding author: In-Kyung Jeong https://orcid.org/0000-0001-7857-546X Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea E-mail:
| | | |
Collapse
|
2
|
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. Clin Ther 2021; 43:1419-1430. [PMID: 34332788 DOI: 10.1016/j.clinthera.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/03/2021] [Accepted: 07/02/2021] [Indexed: 11/20/2022]
Abstract
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.
Collapse
|
3
|
Wang JM, Kim BO, Bae JW, Oh DJ. Implementation of National Health Policy for the Prevention and Control of Cardiovascular Disease in South Korea: Regional-Local Cardio-Cerebrovascular Center and Nationwide Registry. Korean Circ J 2021; 51:383-398. [PMID: 33975386 PMCID: PMC8112182 DOI: 10.4070/kcj.2021.0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 11/15/2022] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity, mortality, and health care costs in South Korea. The prevalence of preventable and treatable risk factors for CVD such as obesity, hypercholesterolemia, and smoking has continued to increase, despite improvements management of hypertension. Active leadership, participation, and support of professional organizations and medical institutions in national cardiovascular registries and regional treatment network have proven to be effective models to reduce the global burden of CVD in the Europe and North America. Regional treatment network systems for ST-segment elevation myocardial infarction have established to coordinate percutaneous coronary intervention (PCI) treatment centers, non-PCI treatment centers, and emergency centers especially across the Europe. The Act on the Prevention and Management of Cardio-cerebrovascular Disease was enacted in South Korea in 2017 to establish the legal frameworks and a comprehensive plan for the prevention and management CVD and risk factors. To fully achieve the goal of a National Health Plan for Cardiovascular Disease, it is necessary to embark on a nationwide registry project and to promote the regional acute treatment accessibility which can therefore play a key role in achieving the objectives of the 2017 Act. In this regard, the Korean Society of Cardiology advocates a national project for health promotion and cardiovascular prevention to improve cardiovascular outcomes, which includes the expansion and establishment of regional cardio-cerebrovascular centers (CCVCs) and new local CCVCs.
Collapse
Affiliation(s)
- Ju Mee Wang
- The Korean Cardiac Research Foundation, Seoul, Korea
| | - Byung Ok Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea.
| | - Jang Whan Bae
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Chungbuk National University Hospital, Cheongju, Korea
| | - Dong Jin Oh
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| |
Collapse
|
4
|
Prasad M, Sara J, Widmer RJ, Lennon R, Lerman LO, Lerman A. Triglyceride and Triglyceride/ HDL (High Density Lipoprotein) Ratio Predict Major Adverse Cardiovascular Outcomes in Women With Non-Obstructive Coronary Artery Disease. J Am Heart Assoc 2020; 8:e009442. [PMID: 31014162 PMCID: PMC6512120 DOI: 10.1161/jaha.118.009442] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Women with non‐obstructive coronary artery disease have increased cardiovascular morbidity. The role of risk factors in this population has yet to be established. We aimed to study the predictive effect of triglycerides and the triglyceride/high‐density lipoprotein ratio on major adverse cardiovascular events (MACE) in patients with non‐obstructive coronary artery disease, and to explore the role of lipid lowering therapy in modifying this risk. Methods and Results This is a prospective cohort study enrolling patients with anginal symptoms referred to the cardiac catheterization laboratory for suspected ischemia, who were subsequently diagnosed with non‐obstructive coronary artery disease, defined as no stenosis >20% on angiography. All patients had baseline laboratory testing and were followed for 7.8±4.3 years for the development of major adverse cardiovascular events. We performed Cox proportional hazard testing to determine the effect of triglycerides on risk of major adverse cardiovascular events among men and women by baseline statin use. A total of 462 patients were included. Median age was 53 (Q1, Q3: 45, 62) years. In a Cox proportional hazard model stratified by statin use adjusting for confounders, among those not on baseline statins, triglycerides were independently predictive of major adverse cardiovascular events in women (per 50 mg/dL risk ratio: hazard ratio 1.25 [95% CI: 1.06, 1.47]; P=0.01). This was not true among men. The interaction between triglycerides and sex, and triglycerides and statin was statistically significant. Conclusions Triglyceride levels may play a key role in predicting cardiovascular‐specific risk in women, and statin use may be protective. Further investigation is necessary to better delineate the role of statin use in preventing cardiovascular risk.
Collapse
Affiliation(s)
- Megha Prasad
- 1 Division of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Jaskanwal Sara
- 1 Division of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Robert J Widmer
- 1 Division of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Ryan Lennon
- 1 Division of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Lilach O Lerman
- 1 Division of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Amir Lerman
- 1 Division of Cardiovascular Diseases Mayo Clinic Rochester MN
| |
Collapse
|
5
|
Sung J. The Long and Winding Road: To the Proper Understanding of High-density Lipoprotein. Korean Circ J 2020; 50:248-249. [PMID: 32100481 PMCID: PMC7043956 DOI: 10.4070/kcj.2020.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/15/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Jidong Sung
- Division of Cardiology, Department of Medicine, Prevention & Rehabilitation Center, Heart Vascular & Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
6
|
Kim Y, Ahn Y, Cho MC, Kim CJ, Kim YJ, Jeong MH. Current status of acute myocardial infarction in Korea. Korean J Intern Med 2019; 34:1-10. [PMID: 30612415 PMCID: PMC6325441 DOI: 10.3904/kjim.2018.381] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/27/2018] [Indexed: 01/16/2023] Open
Abstract
Coronary artery disease, especially acute myocardial infarction (AMI), is a leading cause of death in the Asia-Pacific region. The Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide, prospective, multicenter registry of Korean patients with AMI. Since the KAMIR first began in November 2005, more than 70,000 patients have been enrolled, and 230 papers have been published (as of October 2018). Moreover, published data from the KAMIR have revealed different characteristics from those of Western AMI registries regarding risk factors, interventional strategies, and clinical outcomes. As a result, the KAMIR study has improved the outcomes of percutaneous coronary intervention and reduced mortality. We propose the use of the KAMIR score in the prediction of 1-year mortality. Using data from the KAMIR, we provide an overview of the current status of AMI in Korea, including trends in demographic characteristics, risk factors, medications, treatment strategies, and clinical outcomes.
Collapse
Affiliation(s)
- Yongcheol Kim
- Departemt of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Departemt of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Myeong Chan Cho
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Chong Jin Kim
- Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea
| | - Young Jo Kim
- Department of Cardiology, Yeungnam University Medical Center, Daegu, Korea
| | - Myung Ho Jeong
- Departemt of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| |
Collapse
|
7
|
Sim DS, Jeong MH. Differences in the Korea Acute Myocardial Infarction Registry Compared with Western Registries. Korean Circ J 2017; 47:811-822. [PMID: 29035427 PMCID: PMC5711672 DOI: 10.4070/kcj.2017.0027] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/14/2017] [Accepted: 05/31/2017] [Indexed: 01/26/2023] Open
Abstract
The Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide registry that reflects current therapeutic approaches and acute myocardial infarction (AMI) management in Korea. The results of the KAMIR demonstrated different risk factors and responses to medical and interventional treatments. The results indicated that the incidence of ST-elevation myocardial infarction (STEMI) was relatively high, and that the prevalence of dyslipidemia was relatively low with higher triglyceride and lower high-density lipoprotein cholesterol levels. Percutaneous coronary intervention (PCI) rates were high for both STEMI and non-ST-elevation myocardial infarction (NSTEMI) with higher use of drug-eluting stents (DESs). DES were effective and safe without increased risk of stent thrombosis in Korean AMI patients. Triple antiplatelet therapy, consisting of aspirin, clopidogrel, and cilostazol, was effective in preventing adverse clinical outcomes after PCI. Statin therapy was effective in Korean AMI patients, including those with very low levels of low-density lipoprotein cholesterol and those with cardiogenic shock. The KAMIR score had a greater predictive value than Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores for long-term mortality in AMI patients. Based on these results, the KAMIR will be instrumental for establishing new therapeutic strategies and effective methods for secondary prevention of AMI and guidelines for Asian patients.
Collapse
Affiliation(s)
- Doo Sun Sim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea.
| |
Collapse
|
8
|
Jang JS, Han KR, Moon KW, Jeon DW, Shin DH, Kim JS, Park DW, Kang HJ, Kim J, Bae JW, Hur SH, Kim BO, Choi D, Gwon HC, Kim HS. The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2017; 47:328-340. [PMID: 28567083 PMCID: PMC5449527 DOI: 10.4070/kcj.2017.0071] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although several multicenter registries have evaluated percutaneous coronary intervention (PCI) procedures in Korea, those databases have been limited by non-standardized data collection and lack of uniform reporting methods. We aimed to collect and report data from a standardized database to analyze PCI procedures throughout the country. MATERIALS AND METHODS Both clinical and procedural data, as well as clinical outcomes data during hospital stay, were collected based on case report forms that used a standard set of 54 data elements. This report is based on 2014 Korean PCI registry cohort data. RESULTS A total of 92 hospitals offered data on 44967 PCI procedures. The median age was 66.0 interquartile range 57.0-74.0 years, and 70.3% were men. Thirty-eight percent of patients presented with acute myocardial infarction and one-third of all PCI procedures were performed in an urgent or emergency setting. Non-invasive stress tests were performed in 13.9% of cases, while coronary computed tomography angiography was used in 13.7% of cases prior to PCI. Radial artery access was used in 56.1% of all PCI procedures. Devices that used PCI included drug-eluting stent, plain old balloon angioplasty, drug-eluting balloon, and bare-metal stent (around 91%, 19%, 6%, and 1% of all procedures, respectively). The incidences of in-hospital death, non-fatal myocardial infarction, and stroke were 2.3%, 1.6%, and 0.2%, respectively. CONCLUSION These data may provide an overview of the current PCI practices and in-hospital outcomes in Korea and could be used as a foundation for developing treatment guidelines and nationwide clinical research.
Collapse
Affiliation(s)
- Jae-Sik Jang
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Kyoo-Rok Han
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Keon-Woong Moon
- Division of Cardiology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Dong Woon Jeon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Juhan Kim
- Division of Cardiology, Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Byung Ok Kim
- Division of Cardiology, Sanggye-Paik Hospital, University of Inje College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
9
|
Koh KK, Han SH, Sakuma I, Zhao D. Calming down chaos regarding redefining blood pressure targets-the importance of statin-based therapy. Int J Cardiol 2016; 221:572-4. [PMID: 27420580 DOI: 10.1016/j.ijcard.2016.06.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/22/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Kwang Kon Koh
- Department of Cardiovascular Medicine, Heart Center, Gachon University Gil Medical Center, Incheon, Republic of Korea; Gachon Cardiovascular Research Institute, Incheon, Republic of Korea.
| | - Seung Hwan Han
- Department of Cardiovascular Medicine, Heart Center, Gachon University Gil Medical Center, Incheon, Republic of Korea; Gachon Cardiovascular Research Institute, Incheon, Republic of Korea
| | - Ichiro Sakuma
- Cardiovascular Medicine, Hokko Memorial Clinic, Sapporo, Japan
| | - Dong Zhao
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|