Differences in coronary angiographic findings and outcomes between men and postmenopausal women with stable chest pain

BACKGROUND

Despite the significant increase in cardiovascular events in women after menopause, studies comparing postmenopausal women and men are scarce.

METHODS

We analyzed data from a nationwide, multicenter, prospective registry and enrolled 2412 patients with stable chest pain who underwent elective coronary angiography. Binary coronary artery disease (b-CAD) was defined as the ≥50% stenosis of epicardial coronary arteries, including the left main coronary artery.

RESULTS

Compared with the men, postmenopausal women were older (66.6 ± 8.5 vs. 59.5 ± 11.4 years) and had higher high-density lipoprotein cholesterol levels (49.0 ± 12.8 vs. 43.6 ± 11.6 mg/dl, P  < 0.01). The prevalence of diabetes did not differ significantly ( P  = 0.40), and smoking was more common in men than in postmenopausal women ( P  ≤ 0.01). At enrollment, b-CAD and revascularization were more common in men than in postmenopausal women (50.3% vs. 41.0% and 14.4% vs. 9.7%, respectively; both P  < 0.01). However, multivariate analyses revealed that revascularization [odds ratio (OR): 0.72; 95% confidence interval (CI): 0.49-1.08] was not significantly related to sex and a similar result was found in age propensity-matched population (OR: 0.80; 95% CI: 0.52-1.24). During the follow-up period, the secondary composite cardiovascular outcomes were lower in postmenopausal women than in men (OR: 0.55; 95% CI: 0.31-0.98), also consistent with the result using the age propensity-mated population (OR: 0.33; 95% CI: 0.13-0.85).

CONCLUSION

Postmenopausal women experienced coronary revascularization comparable to those in men at enrollment, despite the average age of postmenopausal women was 7 years older than that of men.Postmenopausal women exhibit better clinical outcomes than those of men if optimal treatment is provided.

Early menopause is associated with abnormal diastolic function and poor clinical outcomes in women with suspected angina

Early identification of women at high risk for cardiovascular diseases (CVD), with subsequent monitoring, will allow for improved clinical outcomes and generally better quality of life. This study aimed to identify the associations between early menopause, abnormal diastolic function, and clinical outcomes. This retrospective study included 795 menopausal women from is a nationwide, multicenter, registry of patients with suspected angina visiting outpatient clinic. The patients into two groups: early and normal menopause (menopausal age ≤ 45 and > 45 years, respectively). If participants met > 50% of the diastolic function criteria, they were classified as having normal diastolic function. Multivariable-adjusted Cox models were used to test associations between menopausal age and clinical outcomes including the incidence of major adverse cardiovascular events (MACE), over a median follow-up period of 771 days. Early menopause was associated with increased waist circumference (p = 0.001), diabetes prevalence (p = 0.003), obstructive coronary artery disease (p = 0.005), abnormal diastolic function (p = 0.003) and greater incidences of MACE, acute coronary syndrome, and hospitalization for heart failure. In patients with abnormal diastolic function, early menopause increased MACE risk significantly, with no significant difference in normal diastolic function. These findings highlight early menopause and abnormal diastolic function as being potential risk markers in women for midlife CVD events.

Sex differences of sequential changes in coronary blood flow and microvascular function in patients with suspected angina

AIMS

This study evaluated the sex differences of sequential changes in coronary blood flows and microvascular function in patients with suspected angina but with no obstructed coronary arteries.

METHODS

A total of 202 consecutive patients who experienced chest pain but had no significant coronary artery stenosis and who underwent adenosine stress echocardiography were included in the study. Coronary blood flow (CBF) velocities were measured at 1, 2, and 3 min after adenosine infusion.

RESULTS

The mean age was 61 years, and 138 (68%) were women. Approximately 40% of patients had coronary microvascular dysfunction (CMD, coronary flow velocity reserve < 2.3), with women exhibiting higher CMD prevalence. The left ventricular (LV) mass index was similar between men and women, while women exhibited higher baseline rate pressure products (RPP). At baseline, coronary blood flow velocities were similar between the sexes. However, CBF velocities in women gradually increased during the examination; and in men, the increase was abrupt and steep during the early stages of examination (p = 0.015 for interaction between time and sex), even with similar RPP in stress. Coronary flow velocity reserve was steadily lower in women compared to men (1 min, 2.09 ± 0.86 vs 2.44 ± 0.87; 2 min, 2.39 ± 0.72 vs 2.63 ± 0.85; 3 min, 2.45 ± 0.70 vs 2.68 ± 0.73).

CONCLUSIONS

In patients with suspected angina but with no obstructed coronary arteries, CMD was especially prevalent among women. Women exhibited higher oxygen consumption, while exhibiting slower and gradual increases in CBF velocities. Conversely, men exhibited faster and steeper increases in CBF velocities even with similar RPP in stress.

Association between the number of pregnancies and cardiac target organ damages: a cross-sectional analysis of data from the Korean women's chest pain registry (KoROSE)

BACKGROUND

Pregnancy increases long-term cardiovascular risk after childbirth, but the mechanisms are unclear. This study was performed to investigate the association between the number of pregnancies and several cardiac target organ damage (TOD) in middle-aged and elderly women.

METHODS

Using the database of the nation-wide registry, a total of 1,137 women (mean age 63.0 ± 10.9 years) with stable chest pain undergoing invasive coronary angiography (CAG) were analyzed. Information on the number of pregnancies was obtained through a questionnaire. Obstructive coronary artery disease (CAD), left ventricular (LV) mass index (LVMI) and LV septal annular (e') velocity were assessed as indicators of cardiac TOD.

RESULTS

Women with higher number of pregnancies (≥ 3) were older (66.3 ± 9.6 vs. 57.4 ± 10.7 years; P < 0.001), had more cardiovascular risk factors, and took more cardiovascular medications than those with lower number of pregnancies (< 3). In multivariable analyses, higher number of pregnancies (≥ 3) was associated with obstructive CAD (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.21-2.17; P = 0.001), a higher LVMI (> 95 g/m²) (OR, 1.46; 95% CI, 1.08-1.98; P = 0.013) and a lower septal e' velocity (< 7 cm/s) (OR, 1.55; 95% CI, 1.12-2.14; P = 0.007) even after controlling for potential confounders. As the number of pregnancies increased, the prevalence of CAD and LVMI increased, and the septal e' velocity gradually decreased (P < 0.001 for each).

CONCLUSIONS

In women with chest pain undergoing invasive CAG, higher number of pregnancies was associated with multiple cardiac TOD. Parity information should be checked when assessing a woman's cardiovascular risk.

Awareness of cardiovascular disease among Korean women: Results from a nationwide survey

Women underestimate the risk of cardiovascular disease (CVD). It is essential to assess and raise awareness regarding CVD among women to reduce disease burden and mortality. Therefore, we investigated the awareness regarding CVD among Korean women. We conducted a nationwide survey between December 2020 and January 2021 among a representative sample of Korean women using random-digit-dialing telephonic interviews. We sought information regarding the awareness of CVD risk; recognition of symptoms and signs; and knowledge of the cause and prevention of and appropriate response to CVD. A total of 1,050 women (mean age, 60.2 ± 11.9 years) participated in the study. Approximately 52.0% of participants were unaware of CVD, and only 26% of participants had heard of CVD. Participants considered that compared to other diseases, CVD was not an important health issue for women, and few of them thought that cerebrovascular diseases and CVD were the leading causes of death (10.9% and 7.6%, respectively). After adjustment for possible confounding factors, age >70 years, rural residence, and educational attainment below college were independently associated with a lack of awareness regarding CVD. The awareness regarding CVD being the leading cause of death in women is low, and most women do not consider it an important health issue. Therefore, special attention must be paid to educate the public regarding CVD in women.

Prevalence and characteristics of isolated nocturnal hypertension in the general population

BACKGROUND/AIMS

Ascertaining the prevalence of isolated nocturnal hypertension (INHT) in the general population and identifying the characteristics of patients with INHT may be important to determine patients who should receive 24- hour ambulatory blood pressure (BP) measurements. This study aimed to evaluate the prevalence and characteristics of INHT in the general population.

METHODS

Of 1,128 participants (aged 20 to 70 years), we analyzed 823 who had valid 24-hour ambulatory BP measurements and were not on antihypertensive drug treatment.

RESULTS

The prevalence of INHT in the study was 22.8%. Individuals with INHT had a higher office, 24-hour, and daytime and nighttime ambulatory systolic and diastolic BPs compared to individuals with sustained day-night normotension. INHT was more prevalent in individuals with masked hypertension (MH) than in those with sustained hypertension (59.8% vs. 15.6%, p < 0.001). Among individuals with INHT, 92.6% had MH. Among individuals with office BP-based prehypertension, 34.5% had both INHT and MH. The prevalence of INHT was highest in individuals with office BP-based prehypertension. INHT was an independent determinant of MH after adjustment for age, sex, body mass index, diabetes, low-density-lipoprotein cholesterol, 24-hour systolic and diastolic BP, systolic and diastolic BP dipping, and systolic and diastolic BP non-dipping.

CONCLUSION

The present study showed that INHT is not uncommon and is a major determinant of MH. Our findings strongly suggest the use of 24-hour ambulatory BP measurement for individuals within the prehypertension range of office BP owing to the high prevalence of INHT and MH in this population.

Incremental value of QT interval for the prediction of obstructive coronary artery disease in patients with chest pain

Identification of obstructive coronary artery disease (OCAD) in patients with chest pain is a clinical challenge. The value of corrected QT interval (QTc) for the prediction of OCAD has yet to be established. We consecutively enrolled 1741 patients with suspected angina. The presence of obstructive OCAD was defined as ≥ 50% diameter stenosis by coronary angiography. The pre-test probability was evaluated by combining QTc prolongation with the CAD Consortium clinical score (CAD2) and the updated Diamond-Forrester (UDF) score. OCAD was detected in 661 patients (38.0%). QTc was longer in patients with OCAD compared with those without OCAD (444 ± 34 vs. 429 ± 28 ms, p < 0.001). QTc was increased by the severity of OCAD (P < 0.001). QTc prolongation was associated with OCAD (odds ratio (OR), 2.27; 95% confidence interval (CI), 1.81–2.85). With QTc, the C-statistics increased significantly from 0.68 (95% CI 0.66–0.71) to 0.76 (95% CI 0.74–0.78) in the CAD2 and from 0.64 (95% CI 0.62–0.67) to 0.74 (95% CI 0.72–0.77) in the UDF score, respectively. QT prolongation predicted the presence of OCAD and the QTc improved model performance to predict OCAD compared with CAD2 or UDF scores in patients with suspected angina.

Sex Difference in the Association Between Metabolic Syndrome and Obstructive Coronary Artery Disease: Analysis of Data from the KoRean wOmen'S chest pain rEgistry (KoROSE)

Background: The sex-related impact of metabolic syndrome (MetS) on obstructive coronary artery disease (OCAD) has not been well evaluated. Methods: A total of 1156 patients (62 years and 58% women) with chest pain undergoing invasive coronary angiography (CAG) were recruited from the database of the nation-wide chest pain registry. MetS was defined according to the criteria of the International Diabetes Federation. OCAD was defined as ≥50% stenosis of the left main coronary artery and/or ≥70% stenosis of any other coronary arteries. Results: Women were older than men (65 vs. 59 years, p < 0.001). OCAD (32.0% vs. 30.9%) and MetS (27.8% vs. 27.9%) prevalence rates were similar in both sexes (p > 0.05). The presence of MetS was associated with higher prevalence of OCAD in women (24.5% vs. 47.3%, p < 0.001), but not in men (31.0% vs. 34.3%, p = 0.487). The linear association between the number of components meeting MetS criteria and OCAD prevalence was significant in both sexes (p < 0.001 for each), but it was stronger in women than in men (Chi-square value: 81.9 vs. 14.8, p < 0.001). In a multivariable model, the presence of MetS was independently associated with OCAD in women even after controlling for potential confounders (odds ratio, 1.92; 95% confidence interval, 1.31-2.81; p = 0.001). Conclusions: In patients with chest pain undergoing invasive CAG, the association between the number of components meeting MetS criteria and OCAD prevalence was stronger in women than in men.

Comparison of Blood Pressure Variability Between Losartan and Amlodipine in Essential Hypertension (COMPAS-BPV)

BACKGROUND

Antihypertensive therapy using renin-angiotensin system blockers and calcium channel blockers to target blood pressure variability (BPV) has not yet been established. We aimed to compare the ability of losartan and amlodipine to lower BPV and systolic blood pressure (SBP) in essential hypertensive patients.

METHODS

Patients were randomly assigned either losartan 50 mg or amlodipine 5 mg. Medications were uptitrated and hydrochlorothiazide was added according to protocol for 6 months. The primary endpoint was the office visit-to-visit SD of SBP. The secondary endpoints included average real variability (ARV), office SBP, and home SBP.

RESULTS

The losartan group (n = 71) and amlodipine group (n = 73) finished the scheduled visits between April 2013 and May 2017. The office visit-to-visit SD of SBP was comparable between the losartan and amlodipine groups (11.0 ± 4.2 vs. 10.5 ± 3.8, P = 0.468). The office visit-to-visit ARV of SBP was significantly elevated in the losartan group (10.6 ± 4.3 vs. 9.1 ± 3.4, P = 0.02). The absolute SBP decrement from baseline to 6 months was similar between groups, although the office mean SBP at 6 months was higher in the losartan group (132.3 ± 12.9 vs. 127.5 ± 9.0 mm Hg, P = 0.011). In home blood pressure analysis, evening day-to-day BPV indexes (SD and ARV) were significantly higher in the losartan group at 6 months.

CONCLUSIONS

The lowering effect of the office visit-to-visit SD of SBP was similar between losartan and amlodipine. However, the losartan group showed a higher office visit-to-visit ARV of SBP and evening day-to-day home BPV indexes. Therefore, amlodipine may be better to lower BPV in essential hypertensive patients.

Gender differences in the presentation of chest pain in obstructive coronary artery disease: results from the Korean Women's Chest Pain Registry

BACKGROUND/AIMS

Chest pain in patients with obstructive coronary artery disease (OCAD) is affected by several social factors. The gender-based differences in chest pain among Koreans have yet to be investigated.

METHODS

The study consecutively enrolled 1,549 patients (male/female, 514/1,035; 61 ± 11 years old) with suspected angina. The predictive factors for OCAD based on gender were evaluated.

RESULTS

Men experienced more squeezing type pain on the left side of chest, while women demonstrated more dull quality pain in the retrosternal and epigastric area. After adjustment for risk factors, pain in the retrosternal area (odds ratio [OR], 1.491; 95% confidence interval [CI], 1.178 to 1.887) and aggravation by exercise (OR, 2.235; 95% CI, 1.745 to 2.861) were positively associated with OCAD. In men, shorter duration (OR, 1.581; 95% CI, 1.086 to 2.303) and dyspnea (OR, 1.610; 95% CI, 1.040 to 2.490) increased the probability for OCAD, while left-sided chest pain suggested a low probability for OCAD (OR, 0.590; 95% CI, 0.388 to 0.897). In women, aggravation by emotional stress (OR, 0.348; 95% CI, 0.162 to 0.746) and dizziness (OR, 0.457; 95% CI, 0.246 to 0.849) decreased the probability for OCAD.

CONCLUSION

This is the first study to focus on gender differences in chest pain among Koreans with angina. Symptoms with high probability for OCAD were different between sexes. Our findings suggest that patient's medical history in pretest assessment for OCAD should be individualized considering gender.

Effect of inter-arm blood pressure differences on outcomes after percutaneous coronary intervention

BACKGROUND

We investigated the effect of inter-arm blood pressure differences (IABPD) on the percutaneous coronary intervention (PCI) outcomes of patients with coronary artery diseases.

METHODS

We retrospectively reviewed the data of blood pressures measured simultaneously in the bilateral arms of 855 patients (560 males) who underwent PCI with drug-eluting stents for coronary artery diseases. IABPD was defined as the difference of blood pressure in both arms. The primary outcome was the presence of major adverse cardiac events (MACE) consisting of cardiovascular death, myocardial infarction, stroke, and ischemia-driven target vessel revascularization.

RESULTS

The mean age of the included patients was 66.2 ± 11.6 years, with a mean follow-up period of 44.5 ± 26.4 months. MACE occurred in 15.2% of patients, showing a higher rate in the higher IABPD group (≥10 mmHg) than in the lower IABPD group (<10 mmHg) (22.5% vs 14.5%, p = 0.081). The difference was induced by a higher rate of ischemia-driven target vessel revascularization (17.5% vs 8.3%, p = 0.011). The Kaplan-Meier survival analysis revealed a greater incidence of MACE in patients with a higher IABPD (log rank p = 0.054). The Cox proportional hazard analysis showed that IABPD was an independent predictor of long-term MACE (hazard ratio, 1.028; 95% confidence interval, 1.002-1.055; p = 0.037), along with age, diabetes mellitus, and number of implanted stents.

CONCLUSION

Among patients treated with PCI, the incidence of MACE was significantly higher in those with a higher IABPD (≥10 mmHg) than in those with a lower IABPD (<10 mmHg), which was mainly driven by ischemia-driven target vessel revascularization.

Association between obesity type and obstructive coronary artery disease in stable symptomatic postmenopausal women: data from the KoRean wOmen'S chest pain rEgistry (KoROSE)

OBJECTIVES

This study investigated the association between obesity type and obstructive coronary artery disease (CAD) in postmenopausal women.

METHODS

Study data were obtained from a nation-wide registry, composed of 659 women older than 55 years with chest pain undergoing elective invasive coronary angiography in the suspicion of CAD. Obstructive CAD was defined as angiographic findings of ≥50% diameter stenosis with any major epicardial coronary artery. Overall obesity was defined as a body mass index of ≥25 kg/m, and central obesity was defined as a waist circumference of ≥85 cm.

RESULTS

A total of 311 women (47.2%) had obstructive CAD. The incidence of overall obesity was not different between participants with and without obstructive CAD (P = 0.340), but the prevalence of obstructive CAD was significantly higher in participants with central obesity than those without (55.5% vs 41.0%, P < 0.001). There was no significant difference in body mass index between participants with and without obstructive CAD (P = 0.373). Multivariable analysis showed that central obesity was associated with obstructive CAD even after controlling for potential confounders (odds ratio, 1.61; 95% confidence interval, 1.10-2.34; P = 0.013). However, overall obesity was not associated with obstructive CAD in the same multivariable analysis (P = 0.228).

CONCLUSIONS

Central obesity but not overall obesity is associated with obstructive CAD in postmenopausal women with stable chest pain undergoing invasive coronary angiography. : Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A440.

Effects of sarcopenia, body mass indices, and sarcopenic obesity on diastolic function and exercise capacity in Koreans

AIMS

Obesity induces left ventricular diastolic dysfunction and ultimately causes heart failure. Sarcopenic obesity is common in heart failure with preserved ejection fraction (HFpEF). However, the precise mechanism by which sarcopenic obesity is related to HFpEF is poorly understood. We aimed to evaluate the combined effect of sarcopenia (SP) and obesity on left ventricular diastolic function and exercise capacity.

METHODS

This study included 733 healthy subjects who underwent health check-ups in a tertiary hospital in Korea. All participants were categorized into four groups: non-SP/non-obese, SP/non-obese, non-SP/obese, and SP/obese. Comprehensive echocardiography with cardiopulmonary exercise testing was performed. Diastolic dysfunction was defined as an E/e' ratio ≥ 10.

RESULTS

Across SP and obesity groups, a gradual decrease in e' velocity and an increase in the E/e' ratio was noted after adjustment for age and sex. Furthermore, a gradual decrease in percent-predicted peak VO₂ was observed across the groups. In the multivariate logistic regression analysis, the SP/obese group had the highest risk for diastolic dysfunction (OR 4.27, 95% CI 2.41-7.57), followed by the non-SP/obese group (OR 2.88, 95% CI 1.57-5.29) and the SP/non-obese group (OR 1.90, 95% CI 1.01-3.56) compared with the reference (non-SP/non-obese) group even after controlling for various confounders.

CONCLUSION

Sarcopenic obesity was associated with impaired diastolic function and decreased exercise capacity, suggesting a possible mechanism by which sarcopenic obesity contributes to the development of HFpEF.

Dose–response association of 24-hour urine sodium and sodium to potassium ratio with nighttime blood pressure at older ages

Aims

We investigated the dose–response association of 24-hour urine sodium and potassium with 24-hour ambulatory blood pressure.

Design

Cross-sectional community-based study.

Methods

Among the 1128 participants in the community-based cross-sectional survey, 740 participants (aged 20–70 years) with complete 24-hour urine collection and valid 24-hour ambulatory blood pressure monitoring were included in the study. Participants were grouped into younger (<55 years, n = 523) and older (≥55 years, n = 217).

Results

In the older population, nighttime blood pressure linearly increased with 24-hour urine sodium and the sodium to potassium ratio. For 24-hour urine sodium, adjusted β was 0.171 (95% confidence interval (CI) 0.036–0.305) for nighttime systolic blood pressure and 0.144 (95% CI 0.012–0.276) for nighttime diastolic blood pressure. For the 24-hour urine sodium to potassium ratio, adjusted β was 0.142 (95% CI 0.013–0.270) for nighttime systolic blood pressure and 0.144 (95% CI 0.018–0.270) for nighttime diastolic blood pressure. The 24-hour blood pressure linearly increased with the 24-hour urine sodium to potassium ratio and adjusted β was 0.133 (95% CI 0.003–0.262) for 24-hour systolic blood pressure and 0.123 (95% CI 0.003–0.244) for 24-hour diastolic blood pressure. Daytime blood pressure and 24-hour systolic blood pressure showed a significant but non-linear association with 24-hour urine sodium among the older population. In the younger population, 24-hour urine sodium, potassium and the sodium to potassium ratio were not associated with ambulatory blood pressure.

Conclusion

In the older population, 24-hour urine sodium and the sodium to potassium ratio showed a linear and positive association with nighttime blood pressure, and 24-hour urine sodium was associated with 24-hour systolic blood pressure and daytime blood pressure in a non-linear fashion.

Effects of multiparity on left ventricular diastolic dysfunction in women: cross-sectional study of the KoRean wOmen'S chest pain rEgistry (KoROSE)

OBJECTIVES

To investigate the association between left ventricular (LV) diastolic dysfunction and multiparity in patients with suspected coronary artery disease (CAD).

DESIGN

Cross-sectional study.

SETTING

Linked secondary and tertiary care records from 29 cardiac centres which participated in KoRean wOmen'S chest pain rEgistry.

PARTICIPANTS

960 women with suspected CAD who underwent invasive coronary angiography from February 2011 to May 2017. The patients were classified by parity number, as follows: low-parity, 0 to <3; multiparity, ≥3 pregnancies.

MAIN OUTCOME MEASURE

Prevalence of LV diastolic dysfunction.

RESULTS

There were 302 and 658 low-parity and multiparity patients, respectively. The prevalence of LV diastolic dysfunction was significantly higher in the multiparity than in the low-parity group. The multiparity group had significantly lower E and e´ septal velocities and E/A ratio, and had a significantly higher E/e´ ratio and right ventricular systolic pressure, which are parameters of LV diastolic dysfunction, than the low-parity group. The prevalence of CAD was significantly higher in the multiparity than in the low-parity group. Receiver operating characteristic curve analysis identified a parity of 2.5 as the cut-off for predicting LV diastolic dysfunction (area under the curve, 0.66; sensitivity, 74.1%; specificity, 52.0%; 95% CI 0.607 to 0.706; p<0.001). After adjustment for confounding factors, multivariate regression analysis showed that multiparity had a 1.80-fold increased risk for LV diastolic dysfunction (OR 1.80, 95% CI 1.053 to 3.081, p=0.032).

CONCLUSIONS

The prevalence of LV diastolic dysfunction was higher in multiparity than in low-parity women with suspected CAD. Multiparity was an independent risk factor for LV diastolic dysfunction. LV diastolic dysfunction should be evaluated in multiparous women for the risk of subsequent cardiovascular disease and facilitate the initiation of appropriate treatment.

Relationships between blood pressure measurements and target organ damage: Data from the Korea women's chest pain registry

This study was performed to investigate the association between four BP measurements (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], and pulse pressure [PP]) and four TOD parameters (left ventricular mass index [LVMI], E/e', estimated glomerular filtration rate [eGFR], and obstructive coronary artery disease [CAD]). Data were obtained from a nation-wide registry, composed of 652 patients (471 women, 58.4 ± 10.5 years) with suspected CAD who underwent elective invasive coronary angiography (CAG). A total of 217 patients (33.2%) had obstructive CAD (≥50%). In multivariable analyses, E/e' was associated with SBP, MAP and PP, and CAD was associated with SBP and PP (P < 0.05 for each). All four BP measurements were not associated with LVMI and eGFR (P > 0.05 for each). In patients undergoing elective invasive CAG, SBP, and PP had stronger relationships with E/e' and CAD than DBP and MAP.

Sex Differences in Traditional and Nontraditional Risk Factors for Obstructive Coronary Artery Disease in Stable Symptomatic Patients

BACKGROUND

There have been limited data on sex-specific risk factors for coronary artery disease (CAD) in patients with stable chest pain. This study was performed to investigate whether risk factors for CAD differ by sex in stable symptomatic patients.

METHODS

Data were obtained from a nation-wide registry, enrolling 1025 patients (age, 62.0 ± 11.0 years, 587 women) with chest pain who underwent elective invasive coronary angiography under the suspicion of CAD.

RESULTS

A total of 373 patients (36.4%) had obstructive CAD (≥50% stenosis) (men vs. women: 33.8% vs. 38.3%, p = 0.135). In men, univariate analyses showed that age, renal function, total cholesterol, low-density lipoprotein cholesterol, triglyceride, C-reactive protein (CRP), left ventricular (LV) systolic function, and septal annular velocity of LV (e') were significantly associated with the presence of obstructive CAD. Among these factors, a high CRP level (≥0.50 mg/dL) was an independent predictor of CAD in multivariable analysis (odds ratio [OR], 2.93; 95% confidence interval [CI], 1.26-6.82; p = 0.012). In women, univariate analyses showed that age, waist circumference, heart rate, hypertension, diabetes mellitus, low high-density lipoprotein cholesterol, LV systolic function, LV mass index, e' velocity, E/e', and left atrial size were significantly associated with the presence of obstructive CAD. Among these factors, lower e' velocity (<6.35 cm/s) was an independent predictor of CAD in multivariable analysis (OR, 2.38; 95% CI, 1.21-4.70; p = 0.012).

CONCLUSIONS

Among patients with stable chest pain, inflammation and LV diastolic dysfunction are independently associated with obstructive CAD in men and women, respectively.

Heart Rate and Bone Mineral Density in Older Women with Hypertension: Results from the Korea National Health and Nutritional Examination Survey

OBJECTIVES

To determine whether high heart rate is associated with low bone mineral density (BMD) in older women with hypertension.

DESIGN

Retrospective cohort study.

SETTING

Population-based study conducted in Korea (Korea National Health and Nutritional Examination Survey 2009-10).

PARTICIPANTS

Postmenopausal women aged 60 and older with hypertension (N=981) divided into 2 groups according to resting heart rate, with a cut-off value of 80 bpm, which has been found to be associated with osteoporosis.

MEASUREMENTS

BMD profiles and clinical and laboratory data were collected. Osteoporosis was defined as a T-score of -2.5 or less, according to World Health Organization criteria.

RESULTS

BMD was significantly lower in participants with a high heart rate, even after adjustment for age, diabetes mellitus, white blood cell count, and fasting glucose and triglyceride levels. The prevalence of osteoporosis was also significantly higher in those participants. In multivariate logistic regression analysis, the group with high heart rate was 1.7 times as likely (95% confidence interval=1.2-2.3) to have osteoporosis as those with a lower heart rate, independent of age, body mass index, comorbidities, and laboratory findings.

CONCLUSION

High heart rate is independently associated with lower BMD in older women with hypertension; proactive surveillance of BMD could be helpful when managing older women with hypertension and a high heart rate.

Relationships between cognitive function and body composition among community-dwelling older adults: a cross-sectional study

Background

Previous studies reported mixed results regarding the association between cognition and body weight in late life. We evaluated the relationships between cognitive function and body composition among community-dwelling older adults.

Methods

Three hundred twenty subjects (≥65 years, women 53%) with available data of cognitive function and body composition from 2010 Hallym Aging Study. Cognitive function was assessed using Korean Mini-Mental State Examination (K-MMSE). Dual-energy X-ray absorptiometry (DEXA) was used for measuring body composition including body fat and lean body mass. Anthropometric measurements and laboratory data were collected in clinical examination. Body composition variables were divided into sex-specific tertiles, and examined by multivariable logistic regression.

Results

Among female, the highest tertile group of fat mass and second tertile group of total lean body mass were associated with lower risk for cognitive impairment compared to the respective first tertile groups (odds ratios, 0.23 and 0.09, respectively; 95% confidence intervals, 0.04–0.88 and 0.01–0.44, respectively) after adjusting for confounding factors. In male, higher arm bone mineral content was associated with lower risk for cognitive impairment, but significance was lost after adjusting for adiponectin, age, and education.

Conclusions

Higher fat mass and lean body mass were associated with lower risk of cognitive impairment in older women. These observations suggest that body fat and lean mass later in life might be beneficial for cognition.

Electronic supplementary material

The online version of this article (10.1186/s12877-017-0651-9) contains supplementary material, which is available to authorized users.

A huge saccular aortic aneurysm compressing right coronary artery 7 years after aortic valve replacement due to bicuspid aortic valve insufficiency: A rare case report

BACKGROUND

In a patient underwent aortic valve replacement (AVR) due to bicuspid aortic valve (BAV) insufficiency without marked dilation of ascending aorta, the development of delayed-typed aneurysmal complication of ascending aorta has been often reported because the dilated aorta tends to grow insidiously with age.

CASE SUMMARY

A 58-year-old man who underwent AVR with mechanical valve due to severe aortic regurgitation secondary to BAV 7 years previously presented with exertional chest discomfort for 1 year. An echocardiography showed a well-functioning mechanical aortic valve without any significant abnormal findings. Cardiac multidetector computed tomography (MDCT) revealed a huge saccular aortic root aneurysm (79.7 mm × 72.8 mm in size) compressing the proximal right coronary artery resulting in ∼90% eccentric diffuse luminal narrowing. The patient subsequently underwent open-heart surgery with resection of the ascending aortic aneurysmal sac and consecutive ascending aorta and hemi-arch replacement using a graft.

CONCLUSION

After successful AVR in the patient with BAV insufficiency and mildly dilated ascending aorta, a regular aortic imaging such as cardiac MDCT with aortography would be helpful to monitor the morphology and size of ascending aorta and related complications to guide future management.

The changes of individual carotid artery wall layer by aging and carotid intima-media thickness value for high risk

AIM

It is still unclear which layer (intima or media) is mainly involved in increased carotid intima-media thickness (CIMT) by aging and also unclear regarding CIMT value suggesting high cardiovascular risk, although 75th percentile value of CIMT is known as a high risk in asymptomatic adults. We sought to find the changes of carotid intima thickness (CIT) and carotid media thickness (CMT) by aging and the 75th percentile value of CIMT in asymptomatic Korean adults.

METHOD

This is an observational cohort study. Carotid ultrasound findings (n=2204 from 12 hospitals) were prospectively collected. The carotid images were sent to Korea Research Institute of Standards and Science for analysis using specialized software which can measure intima and media wall also.

RESULTS

Mean age was 58.1±13.5 years old (52% of men). Pearson's correlation coefficient between age and right CIMT (r=.489, P<.001) and right CMT (r=.482, P<.001) was higher than that between age and right CIT (r=.284, P<.001). Mean right CIMT in male and female was 0.696±0.163 and 0.686±0.167 mm (P=.180), and the 75 percentile value was 0.778 and 0.771 mm, respectively. Mean right CIT was 0.311±0.069 and 0.303±0.064 mm (P=.009), and mean right CMT was 0.391±0.124 and 0.388±0.131 mm (P=.694) in male and female, respectively. Left carotid ultrasound findings showed similar to the right one.

CONCLUSION

An increased CIMT by aging was mainly due to increased CMT rather than CIT in asymptomatic adults. The 75th percentile values of right CIMT were 0.778 and 0.771 mm in asymptomatic Korean male and female adults, respectively.

Sex Difference in the Association Between Brachial Pulse Pressure and Coronary Artery Disease: The Korean Women's Chest Pain Registry (KoROSE)

This study was performed to investigate the association between brachial pulse pressure (PP) and the presence/extent of obstructive coronary artery disease (CAD) in men and women. Study data were obtained from a nation-wide registry composed of 632 patients (173 men and 459 women, 58.1±10.5 years) with suspected CAD who underwent invasive coronary angiography. PP was higher in patients with obstructive CAD (≥50% stenosis) than those without CAD in both sexes (P=.032 in men; P<.001 in women). However, PP increased proportionally with the increasing number of obstructed coronary arteries in women (P<.001) but not in men (P=.070). Multiple logistic-regression analyses demonstrated that higher PP (≥50.5 mm Hg) was an independent factor for determining obstructive CAD even after controlling for potential confounders in women (odds ratio, 2.83; 95% confidence interval, 1.40-5.73; P=.004). These results were consistent in 173 selected women matched with 173 men based on age and CAD severity. In conclusion, the association between brachial PP and obstructive CAD was more pronounced in women than in men. Brachial PP can be a simple and useful indicator of CAD especially in women.

Relationship between serum vitamin D concentrations and clinical outcome of community-acquired pneumonia

SETTING

Hospitalised patients with community-acquired pneumonia (CAP) in a tertiary referral hospital in South Korea.

OBJECTIVE

To determine the burden of vitamin D deficiency in patients hospitalised with CAP and to investigate whether vitamin D deficiency affected clinical outcomes.

DESIGN

Serum 25-hydroxyvitamin D (25[OH]D) levels were measured at admission; vitamin D deficiency was defined as 25(OH)D <20 ng/ml. Data were retrospectively analysed for incidence of vitamin D deficiency. The primary outcome was the relationship between serum vitamin D concentration and 28-day all-cause mortality in CAP.

RESULTS

The mean age was 68.1 years (standard deviation [SD] ± 14.6), and the mean pneumonia severity index was 98.0 (± SD 28.6). Of the 797 patients (males 66.0%), 641 (80.4%) had vitamin D deficiency. Overall mean serum 25(OH)D level was 14.0 ± 7.4 ng/ml. The 28-day all-cause mortality rate in vitamin D-deficient patients was significantly higher than in non-deficient patients (8.3% vs. 2.6%, P = 0.01), and serum vitamin D level was negatively associated with risk of 28-day mortality in CAP after adjustment for pneumonia severity index and serum lactate levels (OR 0.94, 95%CI 0.90-0.99, P < 0.01).

CONCLUSION

The prevalence of vitamin D deficiency was ~80% in patients hospitalised with CAP. Vitamin D deficiency was also a significant predictor of increased 28-day all-cause mortality.

Temporal variability of glucocorticoid receptor activity is functionally important for the therapeutic action of fluoxetine in the hippocampus

Previous studies have shown inconsistent results regarding the actions of antidepressants on glucocorticoid receptor (GR) signalling. To resolve these inconsistencies, we used a lentiviral-based reporter system to directly monitor rat hippocampal GR activity during stress adaptation. Temporal GR activation was induced significantly by acute stress, as demonstrated by an increase in the intra-individual variability of the acute stress group compared with the variability of the non-stress group. However, the increased intra-individual variability was dampened by exposure to chronic stress, which was partly restored by fluoxetine treatment without affecting glucocorticoid secretion. Immobility in the forced-swim test was negatively correlated with the intra-individual variability, but was not correlated with the quantitative GR activity during fluoxetine therapy; this highlights the temporal variability in the neurobiological links between GR signalling and the therapeutic action of fluoxetine. Furthermore, we demonstrated sequential phosphorylation between GR (S224) and (S232) following fluoxetine treatment, showing a molecular basis for hormone-independent nuclear translocation and transcriptional enhancement. Collectively, these results suggest a neurobiological mechanism by which fluoxetine treatment confers resilience to the chronic stress-mediated attenuation of hypothalamic-pituitary-adrenal axis activity.

Cardiac Effects of Thyrotropin Oversuppression with Levothyroxine in Young Women with Differentiated Thyroid Cancer

Background. We investigated the cardiac effects of TSH (thyroid-stimulating hormone) oversuppression in women with thyroidectomized differentiated thyroid cancer (DTC) during levothyroxine suppression therapy. Methods. Fourteen young female patients with DTC were enrolled. The duration of TSH-suppressive therapy was 5 to 9 years. They satisfied the following criteria: (1) a serum level of TSH < 0.1 mU/L in the intermediate-risk or TSH < 0.3 mU/L in the low-recurrence-risk group and (2) having been receiving a fixed dose of LT4 before the study. Controls matched for age, sex, and body mass index (BMI) were compared in terms of the levels of serum free T4, free T3, TSH, plasma N-terminal pro-brain natriuretic peptide (NT-pro-BNP), and cardiac functions and structures. Results. DTC patients and control subjects were well matched in heart rate and blood pressure. There were marked differences in serum TSH (P = 0.001) and free T4 (P = 0.002). However, there were no differences between the groups in serum free T3 and plasma NT-pro-BNP. Furthermore, there were nonsignificant differences in cardiac functions and structures between the groups. Conclusions. This study shows that TSH suppression therapy in women with DTC may be safe with respect to cardiac functions and structures despite intermittent oversuppression of TSH during long-term suppressive therapy. Trial Registration. This trial is registered with clinicaltrials.gov identifier NCT02645786.

The effect of high-dose vitamin D supplementation on insulin resistance and arterial stiffness in patients with type 2 diabetes

BACKGROUND/AIMS

Recent epidemiological studies revealed a striking inverse relationship between vitamin D levels, glucose intolerance/insulin resistance (IR), and cardiovascular disease. However, few interventional studies have evaluated the effect of vitamin D supplementation on cardiovascular risk, such as IR and arterial stiffness, in diabetes. We investigated the role of vitamin D supplementation on cardiovascular risk in type 2 diabetes patients, including metabolic parameters, IR, and arterial stiffness.

METHODS

We enrolled patients who were taking antidiabetic medications or managed their diabetes using lifestyle changes. We excluded patients who were taking vitamin D or calcium supplements. We randomized participants into the vitamin D group (cholecalciferol 2,000 IU/day + calcium 200 mg/day, n = 40) or the placebo group (calcium 200 mg/day, n = 41). We compared their IR (homeostasis model of assessment [HOMA]-IR) and arterial stiffness (brachial-ankle pulse wave velocity and radial augmentation index) before and after 24 weeks of intervention.

RESULTS

The baseline characteristics of the two groups were similar. A total of 62 participants (placebo, 30; vitamin D, 32) completed the study protocol. At the end of the study period, the 25-hydroxyvitamin D [25(OH)D] levels were significantly higher in the vitamin D group than in the placebo group (35.4 ± 8.5 ng/mL vs. 18.4 ± 7.3 ng/mL, p < 0.001). There was no difference in HOMA-IR or changes in arterial stiffness (placebo, 21, vitamin D, 24) between the groups.

CONCLUSIONS

Our data suggest that high-dose vitamin D supplementation might be effective in terms of elevating 25(OH)D levels. However, we identified no beneficial effects on cardiovascular risk in type 2 diabetes, including IR and arterial stiffness.

Estimation of 24-hour urinary sodium excretion using spot urine samples

The present study evaluated the reliability of equations using spot urine (SU) samples in the estimation of 24-hour urine sodium excretion (24-HUNa). Equations estimating 24-HUNa from SU samples were derived from first-morning SU of 101 participants (52.4 ± 11.1 years, range 24–70 years). Equations developed by us and other investigators were validated with SU samples from a separate group of participants (n = 224, 51.0 ± 10.9 years, range 24–70 years). Linear, quadratic, and cubic equations were derived from first-morning SU samples because these samples had a sodium/creatinine ratio having the highest correlation coefficient for 24-HUNa/creatinine ratio (r = 0.728, p < 0.001). In the validation group, the estimated 24-HUNa showed significant correlations with measured 24-HUNa values. The estimated 24-HUNa by the linear, quadratic, and cubic equations developed from our study were not significantly different from measured 24-HUNa, while estimated 24-HUNa by previously developed equations were significantly different from measured 24-HUNa values. The limits of agreement between measured and estimated 24-HUNa by six equations exceeded 100 mmol/24-hour in the Bland-Altman analysis. All equations showed a tendency of under- or over-estimation of 24-HUNa, depending on the level of measured 24-HUNa. Estimation of 24-HUNa from single SU by equations as tested in the present study was found to be inadequate for the estimation of an individual’s 24-HUNa.

Aspirin decreases systemic exposure to clopidogrel through modulation of P-glycoprotein but does not alter its antithrombotic activity

Decreased oral clopidogrel absorption caused by induction of intestinal permeability glycoprotein (P-gp) expression after aspirin administration was observed in rats. This study evaluated the effect of aspirin coadministration on the pharmacokinetics/pharmacodynamics of clopidogrel in humans. A single 75-mg dose of clopidogrel was orally administered before and after 2 and 4 weeks of once-daily 100-mg aspirin administration in 18 healthy volunteers who were recruited based on CYP2C19 and PON1 genotypes. Plasma concentrations of clopidogrel and its active metabolite, H4, and relative platelet inhibition (RPI) were determined. The P-gp microRNA miR-27a increased by up to 7.67-fold (P = 0.004) and the clopidogrel area under the concentration-time curve (AUC) decreased by 14% (P > 0.05), but the AUC of H4 remained unchanged and RPI increased by up to 15% (P = 0.002) after aspirin administration. These findings indicate low-dose aspirin coadministration may decrease clopidogrel bioavailability but does not decrease its efficacy.

Gender differences in adiponectin levels and body composition in older adults: Hallym aging study

Background

Body composition changes with ageing can influence the adiponectin concentration. However, the component of body composition that is associated with adiponectin concentrations in older adults remains unclear.

Methods

There were 152 males and 168 females aged 65 years or older that participated in the 2010 Hallym Aging Study (HAS). Body composition (assessed by dual energy X-ray absorptiometry; DXA), anthropometric parameters and adiponectin were obtained from all participants. Multivariate linear regression models assessed the association of body fat percentage, regional muscle and bone mineral contents of body composition and waist/height ratio with adiponectin concentration. Age, albumin, testosterone concentration and metabolic parameters were considered as confounding factors.

Results

In correlation analysis, age was positively associated with adiponectin in males (P < 0.01), but not in females. Fasting glucose, albumin, arm skeletal muscle mass and bone mineral content were negatively associated with adiponectin in males (P < 0.05). Testosterone and leg bone mineral content were negatively associated with adiponectin in females (P < 0.05). In multivariate linear regression models, body fat percentage and albumin (P < 0.05) were negatively associated with adiponectin, and high-density lipoprotein cholesterol (HDL-C) (P < 0.001) and age (P < 0.01) were positively associated with adiponectin in older males. In older females, the only factors that correlated significantly with adiponectin concentration were the homeostasis model assessment of insulin resistance (P < 0.001) and HDL-C (P < 0.05). The waist/height ratio and bone mineral content were not associated with adiponectin in either gender.

Conclusion

Plasma adiponectin levels correlated negatively with body fat percentage in older males but not in older females. The differential results between older males and females suggest that certain gender-specific mechanisms may affect the association between adiponectin and age-related body composition changes.

A case of paraplegia following endovascular stent repair of descending thoracic aortic aneurysm

Paraplegia secondary to spinal cord infarction is a recognized complication of open thoracic and thoracoabdominal aortic aneurysm (TAA) repair. TAA is serious and unpredictable condition. Therefore, aortic repair requires thorough information on managing the potential complications will facilitate improve control the problem. We report the symptoms and management of paraplegia in a patient who underwent stent insertion as TAA.

Efficacy of fractional flow reserve measurements at side branch vessels treated with the crush stenting technique in true coronary bifurcation lesions

BACKGROUND

Measurement of fractional flow reserve (FFR) has been frequently used to optimize the results of coronary stenting in patients with significant narrowing of coronary arteries.

HYPOTHESIS

There has been a consensus that an FFR value > 0.90 after stenting is a useful surrogate for favorable long-term clinical outcome. We evaluated the efficacy of FFR measurement at side branch vessels of true coronary bifurcation lesions that were treated with the crush stenting technique.

METHODS

This study included 12 patients with significant narrowing in both a main coronary vessel and side branch vessel who underwent the crush stenting procedure.

RESULTS

After crush stenting, FFR measurement was performed at the side branch vessel prior to and after kissing balloon angioplasty (KBA). FFR values increased significantly, from 0.94 +/- 0.04 pre-KBA to 0.97 +/- 0.03 post-KBA (P = 0.011). FFR values after crush stenting but prior to KBA already measured > 0.90 in 9 of the 12 patients (75%). FFR values for the remaining 3 patients were 0.88, 0.88, and 0.90, respectively.

CONCLUSIONS

FFR measurement at side branch vessels of coronary bifurcation lesions treated with crush stenting may not contribute to adequate decision-making for improvement of long-term clinical outcomes. KBA should be strongly considered for patients with bifurcation lesions treated with crush stenting.

Synthesis and electrochemical studies of nano-scale carbon-coated LiFePO4 electrodes for Li-ion batteries

Regardless of high capacity and stability during lithium extraction, LiFePO4 materials have difficulty in the applications for high electrical density because of low electrical conductivities. In order to optimize this problem, we synthesized carbon coated LiFePO4 by adding humic acid using solid state reaction method. We characterized the synthesized compounds via the crystallinity, the valence states of Fe ions, and their shapes. We found the carbon coating using X-ray photoelectron spectroscopy (XPS) and transmission electron microscope (TEM). We also found that the iron ion is substituted from 3+ to 2+ through XPS measurement. We showed that the carbon coating increased the electrochemical behavior by measuring the charge-discharge characteristics.

Phenylpropanolamine contained in cold remedies and risk of hemorrhagic stroke

In this study, we sought to elucidate whether phenylpropanolamine (PPA) in cold remedies (small and divided doses) increases the risk of hemorrhagic stroke (HS). PPA exposure significantly increased the risk, and the risk was much higher in women. In women, linear trends were also found in recency, duration, and dosage of PPA exposure. PPA contained in cold remedies increases the risk of HS, particularly in women.