[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; DOI:10.1038/ki.2015.183 · 8.52 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 · 4.87 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 · 2.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: 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 BMI (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 (i.e., hsCRP< 0.5 mg/L) and high (i.e., hsCRP ≥ 0.5 mg/L) systemic inflammation groups. Results: During a median follow-up of 36.5 months (range 4.8-81.7 months), 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% 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]). Conclusions: 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: Aims This study was performed to investigate whether ventilatory dysfunction is a predictor for the development of prediabetes and type 2 diabetes in Koreans. Methods 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) 1/FVC ≥ 0.70). Results Compared with subjects with normal ventilatory function, subjects with RVD had a higher incidence of type 2 diabetes (3.7 vs. 6.3 %; P P = 0.119). On multivariate logistic regression analysis, the odds ratio (OR) of RVD for type 2 diabetes was significantly increased after adjusting for age, sex, and lifestyle factors (1.40; 95 % CI 1.10-1.78). However, further adjustment for body mass index (BMI), waist circumference, and baseline glucose level attenuated the OR to become insignificant (1.12; 95 % CI 0.86-1.47). Among the 9,461 participants who had normal fasting glucose and HbA1c levels at baseline, the OR for progression to prediabetes or diabetes in the RVD group was significantly increased (1.30; 95 % CI 1.12-1.51). The increased OR remained significant after adjusting for BMI, waist circumference, and baseline glucose level (1.26; 95 % CI 1.07-1.47). Conclusions Our results indicate that restrictive, but not obstructive ventilatory dysfunction, is independently associated with development of prediabetes and precedes the development of type 2 diabetes.
[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: Background. The presence of common risk factors suggests that there is a relationship between osteoporosis and cardiovascular disease, possibly via dyslipidemia and inflammation. We investigated the relationships among the lipid profile, the inflammation marker high-sensitivity C-reactive protein (hsCRP), bone turnover markers, and bone mineral density (BMD) to assess the correlation between osteoporosis and cardiovascular disease and identify factors predicting osteoporosis. Methods. The study included 759 Korean women older than 20 years of age. The BMD, serum lipid profile, and levels of hsCRP, cross-linked C-terminal peptide (CTX), and osteocalcin were measured. We compared the serum biomarkers between groups with normal and low BMD and assessed the correlations between the levels of bone turnover markers and the lipid profile and hsCRP level. Results. The concentrations of CTX, osteocalcin, and total cholesterol were significantly higher in the low BMD group than in the normal BMD group in premenopausal women group. However, hsCRP was not correlated with these parameters. Multivariate logistic regression analysis revealed that TC (OR, 1.647; 95% CI, 1.190-2.279) and osteocalcin (OR, 1.044; 95% CI, 1.002-1.088) had an increased risk of low BMD in premenopausal women. Conclusions. These results indicate that total cholesterol concentration is correlated with the levels of bone turnover markers, suggesting that it might predict osteoporosis in premenopausal women.
BioMed Research International 05/2014; 2014:398397. DOI:10.1155/2014/398397 · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: To determine whether C-reactive protein is associated with the type of coronary plaque seen at computed tomographic (CT) angiography. Materials and Methods: The institutional review board approved this retrospective study, and the need for informed consent was waived. C-reactive protein levels were measured in 2653 asymptomatic subjects (mean age 6 standard deviation, 54.7 years +/- 9.2; 1811 men) who underwent self-referred coronary CT angiography as part of a general health checkup. The presence of coronary plaque, plaque type (calcified, mixed calcified, or noncalcified), stenosis degree, and number of involved segments were evaluated. Subjects with one type of plaque (calcified plaque, mixed plaque, and noncalcified plaque groups) and two or more types of plaque (multiple lesions group) were analyzed separately. Multivariate logistic regression analysis was used to evaluate the association between increasing C-reactive protein levels and plaque type. Results: Coronary plaque was found in 1150 of the 2653 subjects (43.3%): calcified plaque (n = 604, 22.8%), mixed plaque (n = 67, 2.5%), noncalcified plaque (n = 208, 7.8%), and multiple lesions (n = 271, 10.2%). The C-reactive protein cutoff value of the fourth quartile was 1.2 mg/L (11.4 nmol/L), and all types of coronary plaque were increased in the higher quartile of the C-reactive protein levels. Multivariate logistic regression analysis showed that a higher C-reactive protein level was an independent predictor for the presence of noncalcified plaque (fourth vs first quartile group, odds ratio = 1.70, P = .025) and significant (50% and higher) coronary stenosis (odds ratio = 1.76, P = .020) after adjustment for traditional risk factors for coronary artery disease. Conclusion: C-reactive protein is associated with noncalcified coronary arterial plaque, as seen at coronary CT angiography in asymptomatic patients after adjustment for traditional risk factors. (C)RSNA, 2014.
[Show abstract][Hide abstract] ABSTRACT: Context: Although the prevalence of both metabolic syndrome (MetS) and fractures increases with advancing age, studies on possible associations between these conditions in men are limited and the results are inconsistent. Objective: To clarify the impact of MetS on male risk of incident fractures. Design and Setting: A large, longitudinal study with an average 3-year follow-up period. Participants: Korean men (n=16,078) aged 50 years or older who had undergone comprehensive routine health examinations. Main Outcome Measures: Incident fractures found after baseline examinations were identified using selected ICD-10 codes in the nationwide claims database of the Health Insurance Review and Assessment Service of Korea. Results: In total, 158 (1.0%) men developed incident fractures. The fracture event rates for subjects with and without MetS were 26.2 and 35.7 per 10,000 person-years, respectively. After adjustment for potential confounders, subjects with MetS had a much lower risk of incident fractures than subjects without MetS (HR = 0.662, 95% CI = 0.445-0.986). Furthermore, subjects with 3 and 4 or more MetS components had a 49.4% and 50.4% lower risk, respectively, of incident fractures compared to subjects without any MetS components. Importantly, additional adjustment for body mass index eliminated the statistical significance of these associations. Conclusion: Our current results indicate that the beneficial effects of MetS in reducing fracture risk could be explained by the general obesity that accompanies MetS, although other related factors, such as greater padding effect, peripheral aromatization or adipokine changes, may also contribute.
The Journal of Clinical Endocrinology and Metabolism 02/2014; 99(5):jc20133608. DOI:10.1210/jc.2013-3608 · 6.31 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 01/2014; 4(5):e005025. DOI:10.1136/bmjopen-2014-005025 · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Oxidative stress has detrimental effects on bone metabolism, and gamma-glutamyl transferase (GGT) is known to play an important role in the generation of free radical species through the extra-cellular hydrolysis of glutathione, the main cellular antioxidant. We performed a large longitudinal study with an average follow-up period of 3 years to investigate the association between baseline serum GGT levels and the development of future osteoporotic fractures (OFs) in men. A total of 16,036 Korean men aged 50 years or older who had undergone comprehensive routine health examinations were enrolled. Incident fractures at osteoporosis-related sites (e.g., hip, spine, distal radius, and proximal humerus) that occurred after baseline examinations were identified from the nationwide claims database of the Health Insurance Review and Assessment Service of Korea using selected ICD-10 codes. Among the study subjects, 156 cases (1.0%) developed incident OFs during the study period. The event rate was 32.7 (95% CI = 28.0-38.3) per 10,000 person-years. Multivariable adjusted Cox proportional hazard analyses adjusted for age, body mass index, lifestyle factors, and medical and drug histories revealed that the hazard ratio per standard deviation increase of the baseline GGT levels for the development of incident fractures was 1.115 (95% CI = 1.011-1.230). These data provide the first epidemiological evidence, in support of previous in vitro and animal studies, of the harmful effects of GGT on bone metabolism, and indicate that the serum GGT level may be a useful biomarker of poor bone health outcomes in men.