[Show abstract][Hide abstract] ABSTRACT: Background:
Elevated serum gamma-glutamyltransferase (GGT) has been demonstrated to be associated with coronary artery calcification (CAC). CAC progression is an important marker of atherosclerosis and correlates with future cardiovascular risk. However, there is a lack of research that directly examines the association between serum GGT and CAC progression. The aim of this study was to elucidate the association between serum GGT activity and CAC progression.
We enrolled 1246 asymptomatic participants who underwent repeated CAC score measurement during routine health examinations. To eliminate the dependence of the inter scan variability on the baseline CAC scores, square root-transformed CAC scores were used to analyze CAC progression. In addition, the annualized rate of change in CAC scores was computed.
Serum GGT activities were significantly higher in "progressors" than "nonprogressors". The prevalence of progression increased with the GGT tertile (11.9%, 20.1% and 27.9% in the 1st, 2nd, and 3rd GGT tertiles, respectively; p < 0.001). In the multivariate logistic regression analysis, the odds ratio (95% confidence interval) for CAC score progression was 1.85 (1.14-3.00) in the highest GGT tertile group. By multivariate linear regression analysis, baseline serum GGT activity demonstrated a positive association with the annualized change in CAC score (β = 0.002; p = 0.006) after adjusting for cardiovascular risk factors.
Elevated serum GGT levels are independently associated with CAC progression. Serum GGT levels may be a potential biomarker of future coronary atherosclerosis and prognosis.
[Show abstract][Hide abstract] ABSTRACT: Background:
The usefulness of the 2013 ACC/AHA guidelines for the management of blood cholesterol in the Asian population remains controversial. In this study, we investigated whether eligibility for statin therapy determined by the 2013 ACC/AHA guidelines is better aligned with the presence of subclinical coronary atherosclerosis detected by CCTA (coronary computed tomography angiography) compared to the previously recommended 2004 NCEP ATP III guidelines.
We collected the data from 5,837 asymptomatic subjects who underwent CCTA using MDCT during routine health examinations. Based on risk factor assessment and lipid data, we determined guideline-based eligibility for statin therapy according to the 2013 ACC/AHA and 2004 NCEP ATP III guidelines. We defined the presence and severity of subclinical coronary atherosclerosis detected in CCTA according to the presence of significant coronary artery stenosis (defined as >50% stenosis), plaques, and the degree of coronary calcification.
As compared to the 2004 ATP III guidelines, a significantly higher proportion of subjects with significant coronary stenosis (61.8% vs. 33.8%), plaques (52.3% vs. 24.7%), and higher CACS (CACS >100, 63.6% vs. 26.5%) was assigned to statin therapy using the 2013 ACC/AHA guidelines (P < .001 for all variables). The area under the curves of the pooled cohort equation of the new guidelines in detecting significant stenosis, plaques, and higher CACS were significantly higher than those of the Framingham risk calculator.
Compared to the previous ATP III guidelines, the 2013 ACC/AHA guidelines were more sensitive in identifying subjects with subclinical coronary atherosclerosis detected by CCTA in an Asian population.
PLoS ONE 09/2015; 10(9):e0137478. DOI:10.1371/journal.pone.0137478 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims:
To compare the association between cardiovascular diseases (CVD) and prediabetes defined by fasting plasma glucose (FPG)-only, HbA1c-only, or combined criteria in a Korean population.
In total, 76,434 South Korean individuals who voluntarily underwent a general health examination in the Health Screening and Promotion Center at Asan Medical Center were analyzed after excluding patients with previous history of CVD. CVD events and death during a median follow-up of 3.1 (interquartile range, 1.9-4.3) years were recognized from the nationwide health insurance claims database and death certificates by using ICD-10 codes.
Age- and sex-adjusted hazard ratios (HRs) for overall CVD events were significantly increased for participants with prediabetes by FPG-only criteria (1.19 [1.08-1.31]), HbA1c-only criteria (1.28 [1.16-1.42]), and combined criteria (1.20 [1.09-1.32]). After adjusting for multiple conventional risk factors such as hypertension, LDL and HDL cholesterol levels, smoking status, and family history of CVD and BMI, the HRs for overall CVD were significantly increased only for participants with prediabetes by HbA1c-only criteria. Age- and sex-adjusted HRs for major ischemic heart disease (IHD) events were significantly increased for participants with prediabetes by HbA1c-only and combined criteria. For percutaneous coronary intervention, age- and sex-adjusted HRs were significantly higher for participants with prediabetes only by HbA1c-only criteria. For diabetes, multivariate-adjusted HRs for all outcomes were significantly increased by all three criteria.
Adding the HbA1c criterion in defining prediabetes can be helpful in identifying individuals with an increased risk of CVD in Koreans. This article is protected by copyright. All rights reserved.
Journal of Diabetes 09/2015; DOI:10.1111/1753-0407.12343 · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Obesity has become an important risk factor for chronic kidney disease (CKD). The metabolically healthy obese (MHO) phenotype refers to obese individuals with a favorable metabolic profile. However, its prognostic value remains controversial and may depend on the health outcome being investigated. To assess this, we examined the risk of MHO phenotype with incident CKD in a Korean population of 41,194 people without CKD. Individuals were stratified by body mass index (cutoff value, 25.0 kg/m(2)) and metabolic health state (assessed using Adult Treatment Panel-III criteria). Incident CKD was defined as a glomerular filtration rate of <60 ml/min per 1.73 m(2) calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Over the median follow-up period of 38.7 months, 356 of the individuals developed incident CKD. Compared with the metabolically healthy nonobese (MHNO) group, the MHO group showed increased risk of incident CKD with a multivariate-adjusted hazard ratio of 1.38 (95% CI, 1.01-1.87). Nonobese but metabolically unhealthy individuals were at an increased risk of incident CKD (multivariate-adjusted hazard ratio, 1.37 (95% CI, 1.02-1.93)) than the MHNO group. Metabolically unhealthy obese individuals were at the highest risk of incident CKD. Thus, a healthy metabolic profile does not protect obese adults from incident CKD. Hence, it is important to consider metabolic health along with obesity when evaluating CKD risk.Kidney International advance online publication, 24 June 2015; doi:10.1038/ki.2015.183.
Kidney International 06/2015; 88(4). DOI:10.1038/ki.2015.183 · 8.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Little is known about subclinical atherosclerosis on coronary computed tomographic angiography (CCTA) in asymptomatic individuals with metabolic syndrome (MetS).Methods and Results:We analyzed 5,213 asymptomatic individuals who underwent CCTA. A cardiac event was defined as a composite of all-cause death, myocardial infarction, unstable angina, or coronary revascularization. Of the study participants, 2,042 (39.2%) had MetS. MetS was an independent predictor of significant coronary artery disease (CAD) in at least 1 coronary artery (odds ratio [OR]=1.992, 95% confidence interval [CI]=1.623-2.445, P<0.001) and significant CAD in the left main (LM) or proximal left anterior descending (LAD) artery (OR=2.151, 95% CI=1.523-3.037, P<0.001). During the follow-up period (median 28.1 [interquartile range, 19.2-36.5] months), 111 individuals had 114 cardiac events. Individuals with MetS were significantly associated with more cardiac events than those without (RR [rate ratio]=1.67, 95% CI=1.15-2.43, P=0.007). In the MetS group, individuals with significant CAD had the majority of cardiac events (RR=64.33, 95% CI=29.17-141.88, P<0.001). Furthermore, in the MetS with significant CAD group, those with significant CAD in the LM or proximal LAD had more cardiac events (RR=2.63, 95% CI=1.51-4.59, P=0.001).
MetS was associated with subclinical atherosclerosis on CCTA with subsequent high risk for cardiac events. These findings suggest the importance of reducing unfavorable metabolic conditions in asymptomatic individuals.
[Show abstract][Hide abstract] ABSTRACT: It is not clear whether screening by coronary computed tomographic angiography (CCTA) and/or exercise electrocardiogram (ECG) can improve clinical outcomes and reduce costs in individuals without known cardiovascular disease (CVD).In total, 71,811 consecutive individuals without known CVD who underwent general health examinations were enrolled. Using propensity-score matching according to screening tests, 1-year clinical outcomes and 6-month total and coronary artery disease-related medical costs were analyzed in separate groups: group 1 (CCTA [n = 2578] vs no screening [n = 5146]), group 2 (exercise ECG [n = 2898] vs no screening [n = 5796]), and group 3 (CCTA and exercise ECG [n = 2003] vs no screening [n = 4006]).There were no significant differences in the composite outcome of death, myocardial infarction, and stroke in each matched group: group 1 (0.35% vs 0.45%, P = 0.501), group 2 (0.14% vs 0.28%, P = 0.157), and group 3 (0.25% vs 0.27%, P = 0.858). However, revascularization was more frequent in the CCTA screening groups: group 1 (2.02% vs 0.45%, P < 0.001) and group 3 (1.40% vs 0.45%, P < 0.001). Matched screening groups had higher 6-month total and coronary artery disease-related medical costs: group 1 ($777 vs $603, P < 0.001 and $177 vs $39, P < 0.001), group 2 ($544 vs $492, P = 0.045 and $12 vs $15, P = 0.611), and group 3 ($705 vs $627, P = 0.090 and $135 vs $35, P < 0.001).In individuals without known CVD, CCTA screening with or without exercise ECG led to more frequent revascularization at the expense of higher medical costs, but did not decrease the 1-year risk of death, myocardial infarction, and stroke.
Medicine 05/2015; 94(21):e917. DOI:10.1097/MD.0000000000000917 · 5.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many lines of evidence indicate that dehydroepiandrosterone (DHEA) plays a distinct role in bone metabolism, and that its sulfated form (DHEA-S), which is easily measured in blood, may be a potential biomarker of osteoporosis-related phenotypes. However, most previous epidemiologic studies focused on postmenopausal women and reported conflicting results.
We aimed to investigate the association between the serum DHEA-S level and bone mass in men.
This large cross-sectional study included 1,089 healthy Korean men who participated in a routine health screening examination. Bone mineral density (BMD) at the lumbar spine, total femur, femur neck, and trochanter and serum DHEA-S level were obtained in all subjects.
After adjustment for age, body mass index, lifestyle factors, and serum levels of calcium, phosphorus, testosterone, 25-OH-vitamin D3, and cortisol, higher serum DHEA-S concentrations were associated with higher BMD values at all skeletal sites. Consistently, compared to the subjects in the highest DHEA-S quartile (Q4), those in the lowest DHEA-S quartile (Q1) showed significantly lower BMD values. Multiple logistic regression analyses revealed that the odds ratios for the risk of lower BMD (T-score <-1) increased in a dose-dependent manner across decreasing DHEA-S quartiles, and the odds for the risk of lower BMD was 2.59-fold higher in Q1 than in Q4.
These findings support previous evidences that DHEA-S has favorable effects on bone mass in men and suggest that a low serum DHEA-S level may be a potential risk factor for male osteoporosis. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: We sought to estimate the prevalence of coronary atherosclerosis by coronary computed tomographic angiography (CCTA) and to identify risk factors attributable to the development of coronary atherosclerosis in an asymptomatic Asian population. We analyzed 6,311 consecutive asymptomatic individuals aged 40 and older with no prior history of coronary artery disease (CAD) who voluntarily underwent CCTA evaluation as part of a general health examination. The mean age of study participants was 54.7 ± 7.4 years, and 4,594 (72.8 %) were male. After age and gender adjustment using the population census of the National Statistical Office, the prevalence of plaque was 40.5 % [95 % confidence interval (CI) 38.1-42.9], and significant CAD (diameter stenosis ≥50 %) was observed in 9.0 % (95 % CI 7.7-10.2). Individuals with significant CAD were significantly older than those without (59.2 ± 8.8 vs. 54.0 ± 7.1 years, p < 0.001). Compared with individuals with no cardiovascular risk factors, there was a higher prevalence of significant CAD in individuals with diabetes mellitus [standardized rate ratio (SRR) 2.66; 95 % CI 1.93-3.68; p < 0.001], hypertension (SRR 2.24; 95 % CI 1.69-2.97; p < 0.001), or hyperlipidemia (SRR 1.65; 95 % CI 1.25-2.17; p < 0.001). There was also a greater prevalence of significant CAD in individuals with an intermediate or high Framingham risk score (SRR 5.91; 95 % CI 2.34-14.95; p < 0.001) or a high atherosclerotic cardiovascular disease risk score (SRR 8.04; 95 % CI 3.04-21.23; p < 0.001). The prevalence of coronary atherosclerosis in this Asian population was not negligible and was associated with known cardiovascular risk factors and high-risk individuals.
The International Journal of Cardiovascular Imaging 01/2015; 31(3). DOI:10.1007/s10554-015-0587-0 · 1.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
This study sought to investigate whether the metabolically healthy obese (MHO) phenotype is associated with an increased risk of incident type 2 diabetes in a Korean population and, if so, whether systemic inflammation affects this risk in MHO individuals.
Design and methods:
The study population comprised 36 135 Koreans without type 2 diabetes. Participants were stratified by body mass index (cutoff value, 25.0 kg/m(2)) and metabolic health state (assessed using Adult Treatment Panel-III criteria). High-sensitive C-reactive protein (hsCRP) was used as a surrogate marker of systemic inflammation. Subjects were classified into low (ie, hsCRP < 0.5 mg/L) and high (ie, hsCRP ≥ 0.5 mg/L) systemic inflammation groups.
During a median followup of 36.5 months (range, 4.8-81.7 mo), 635 of the 36 135 individuals (1.8%) developed type 2 diabetes. The MHO group had a significantly higher risk of incident type 2 diabetes (multivariate-adjusted hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.16-2.11) than the metabolically healthy nonobese (MHNO) group. However, the risk of the MHO group varied according to the degree of systemic inflammation. Compared with the MHNO/low systemic inflammation group, the risk of type 2 diabetes in the MHO/low systemic inflammation group was not significantly elevated (multivariate-adjusted HR, 1.61; 95% CI, 0.77-3.34). However, the MHO/high systemic inflammation group had an elevated risk of incident type 2 diabetes (multivariate-adjusted HR, 3.73; 95% CI 2.36-5.88).
MHO subjects show a substantially higher risk of incident type 2 diabetes than MHNO subjects. The level of systemic inflammation partially explains this increased risk.
[Show abstract][Hide abstract] ABSTRACT: Background:
A model for predicting cardiovascular disease in Asian populations is limited.
Methods and results:
In total, 57 393 consecutive asymptomatic Korean individuals aged 30 to 80 years without a prior history of cardiovascular disease who underwent a general health examination were enrolled. Subjects were randomly classified into the train (n=45 914) and validation (n=11 479) cohorts. Thirty-one possible risk factors were assessed. The cardiovascular event was a composite of cardiovascular death, myocardial infarction, and stroke. In the train cohort, the C-index (95% confidence interval) and Akaike Information Criterion were used to develop the best-fitting prediction model. In the validation cohort, the predicted versus the observed cardiovascular event rates were compared by the C-index and Nam and D'Agostino χ(2) statistics. During a median follow-up period of 3.1 (interquartile range, 1.9-4.3) years, 458 subjects had 474 cardiovascular events. In the train cohort, the best-fitting model consisted of age, diabetes mellitus, hypertension, current smoking, family history of coronary heart disease, white blood cell, creatinine, glycohemoglobin, atrial fibrillation, blood pressure, and cholesterol (C-index =0.757 [0.726-0.788] and Akaike Information Criterion =7207). When this model was tested in the validation cohort, it performed well in terms of discrimination and calibration abilities (C-index=0.760 [0.693-0.828] and Nam and D'Agostino χ(2) statistic =0.001 for 3 years; C-index=0.782 [0.719-0.846] and Nam and D'Agostino χ(2) statistic=1.037 for 5 years).
A risk model based on traditional clinical and biomarkers has a feasible model performance in predicting cardiovascular events in an asymptomatic Korean population.
[Show abstract][Hide abstract] ABSTRACT: Aims
This study was performed to investigate whether ventilatory dysfunction is a predictor for the development of prediabetes and type 2 diabetes in Koreans.
We analyzed the clinical and laboratory data of 16,195 Korean adults (age 20–79 years) who underwent routine medical checkups with a mean 4.7-years (range 3.0–5.9 years) interval. Spirometry results were categorized into three patterns: normal, obstructive ventilatory dysfunction [OVD; forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)
[Show abstract][Hide abstract] ABSTRACT: We investigated the association between microalbuminuria and prediabetes in Korean population using data from the KNHANES 2011-2012. Prevalence of microalbuminuria was significantly increased in prediabetes group. However, the odds ratio became insignificant after adjustment for blood pressure, and the prevalence of microalbuminuria was not increased in prediabetic subjects without hypertension.
Diabetes Research and Clinical Practice 09/2014; 106(2). DOI:10.1016/j.diabres.2014.09.004 · 2.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective The objectives of this study were to develop a coronary heart disease (CHD) risk model among the Korean Heart Study (KHS) population and compare it with the Framingham CHD risk score.
Design A prospective cohort study within a national insurance system.
Setting 18 health promotion centres nationwide between 1996 and 2001 in Korea.
Participants 268 315 Koreans between the ages of 30 and 74 years without CHD at baseline.
Outcome measure Non-fatal or fatal CHD events between 1997 and 2011. During an 11.6-year median follow-up, 2596 CHD events (1903 non-fatal and 693 fatal) occurred in the cohort. The optimal CHD model was created by adding high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides to the basic CHD model, evaluating using the area under the receiver operating characteristic curve (ROC) and continuous net reclassification index (NRI).
Results The optimal CHD models for men and women included HDL-cholesterol (NRI=0.284) and triglycerides (NRI=0.207) from the basic CHD model, respectively. The discrimination using the CHD model in the Korean cohort was high: the areas under ROC were 0.764 (95% CI 0.752 to 0.774) for men and 0.815 (95% CI 0.795 to 0.835) for women. The Framingham risk function predicted 3–6 times as many CHD events than observed. Recalibration of the Framingham function using the mean values of risk factors and mean CHD incidence rates of the KHS cohort substantially improved the performance of the Framingham functions in the KHS cohort.
Conclusions The present study provides the first evidence that the Framingham risk function overestimates the risk of CHD in the Korean population where CHD incidence is low. The Korean CHD risk model is well-calculated alternations which can be used to predict an individual's risk of CHD and provides a useful guide to identify the groups at high risk for CHD among Koreans.
BMJ Open 05/2014; 4(5):e005025. DOI:10.1136/bmjopen-2014-005025 · 2.27 Impact Factor