Ki-Dong Yoo

Catholic University of Korea, Sŏul, Seoul, South Korea

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Publications (56)133.42 Total impact

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    ABSTRACT: Chronic total occlusion (CTO) in a non-infarct-related artery (IRA) is an independent predictor of clinical outcomes in patients with acute myocardial infarction (AMI). This study evaluated the impact of successful percutaneous coronary intervention (PCI) for CTO of a non-IRA on the long-term clinical outcomes in AMI patients. A total of 4,748 AMI patients were consecutively enrolled in the COREA-AMI (COnvergent REgistry of cAtholic and chonnAm university for AMI) registry from January 2004 to December 2009. We enrolled 324 patients with CTO in a non-IRA. To adjust for baseline differences, propensity matching (96 matched pairs) was utilized to compare successful PCI and occluded CTO for the treatment of CTO in non-IRA. The primary clinical endpoints were all-cause mortality and a composite of the major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), stroke, and any revascularization during the 5-year follow-up. Patients who received successful PCI for CTO of non-IRA had lower rates of all-cause mortality (16.7% vs. 32.3%, hazard ratio [HR] 0.459, 95% confidence interval [CI] 0.251-0.841, p=0.012) and MACE (21.9% vs. 55.2%, HR 0.311, 95% CI 0.187-0.516, p<0.001) compared with occluded CTO group. Subgroup analyses revealed that successful PCI resulted in a better mortality rate in patients with normal renal function compared to patients with chronic kidney disease (p=0.010). In conclusion, successful PCI for CTO of non-IRA is associated with improved long-term clinical outcomes in patients with AMI.
    No preview · Article · Jan 2016
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    ABSTRACT: Arterial stiffness is associated with atherosclerosis and left ventricular (LV) diastolic function in general or hypertensive patients. However, the relationships between the arterial stiffness index measured at the radial artery and LV diastolic dysfunction in asymptomatic high-risk patients without atherosclerotic cardiovascular disease (ASCVD) have not been fully established.A total 532 statin-naïve patients (male:female ratio, 230:302, mean age, 56.0 ± 9.2 years) without ASCVD were enrolled from among subjects who simultaneously underwent transthoracic echocardiography and noninvasive semiautomated radial artery applanation tonometry from July 2011 to May 2014. Of these patients, 213 were categorized as the statin benefit group (Benefit) according to guidelines for blood cholesterol treatment, and the rest were placed in the nonbenefit control group (NoBenefit). Each group was subdivided into two groups (Y or N) according to antihypertensive medication administration. Thus, there were 4 groups: BenefitN (n = 80), BenefitY (n = 133), NoBenefitN (n = 251), and NoBenefitY (n = 68). There were significant differences in echocardiographic parameters of LV function and indices of arterial stiffness between the Benefit and NoBenefit groups. After adjusting for several risk factors, independent significant associations between echocardiographic parameters of LV diastolic function and arterial indices were identified with multivariate linear regression analysis in the Benefit patients.Parameters of arterial stiffness measured at the radial artery are associated with echocardiographic indices of LV diastolic function in asymptomatic high-risk patients without ASCVD. Therapies that prevent progression of arterial stiffness and reduce late-systolic pressure overload may help to reduce the prevalence of LV diastolic dysfunction in this population.
    Preview · Article · Jan 2016 · International Heart Journal
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    ABSTRACT: Blunt chest trauma can cause acute myocardial infarction, which may also be associated with pericarditis. However, such cases are rare. We herein report a case of a 57-year-old man suffering from acute myocardial infarction due to a blunt chest trauma and postcardiac injury syndrome after discharge with spontaneous resolution of a total coronary occlusion.
    Preview · Article · Jan 2016 · Internal Medicine
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    ABSTRACT: Background: Although randomized clinical trials are valuable tools to compare treatment effects, the results of randomized clinical trials cannot usually be extrapolated to the real-world setting because of selected patient subsets. To categorize the risk of future cardiovascular events in drug-eluting stent (DES)-treated patients, we analyzed demographic, clinical, and procedural data in all-comers who underwent a percutaneous coronary intervention (PCI). Methods: Patients who underwent PCI using DES from January 2004 were prospectively enrolled in the Catholic University of Korea-PCI registry and were followed up for a median of 2 years. We analyzed the risk of clinical outcomes in the all-patient cohort and in subsets of patients with angina and acute myocardial infarction (AMI). Results: The patients were categorized into two groups: those with angina (angina group, n=6183, 67.7%) and those with AMI (AMI group, n=2944, 32.3%). The AMI group had greater occurrence of major adverse cardiac events (MACE) during long-term follow-up than the angina group (23.8 vs. 20.1%, P<0.001). However, in the landmark analysis of data beyond 1 year, there was no significant difference in the occurrence of MACE between the two groups (P=0.44). In multivariable modeling, age, renal function, left ventricular ejection fraction, and multivessel disease were associated significantly with increasing MACE in the study population, angina or AMI groups. Conclusion: We found that higher MACE in patients with AMI during long-term follow-up after PCI was mainly because of higher mortality in the first year. Some demographic, clinical, and angiographic factors still significantly influence the long-term occurrence of MACE in the era of DES.
    No preview · Article · Dec 2015 · Coronary Artery Disease
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    ABSTRACT: Background-We aimed to compare the long-Term clinical outcomes between fractional flow reserve (FFR)-guided and routine drug-eluting stent (DES) implantation in patients with an intermediate coronary stenosis. Methods and Results-A total of 229 patients with an angiographically intermediate coronary stenosis were randomly assigned to FFR-guided or Routine-DES implantation group. For FFR-guided group (n=114), treatment strategy was determined according to the target vessel FFR (FFR<0.75: DES implantation [FFR-DES group]; FFR≥0.75: deferral of stenting [FFR-Defer group]). Routine-DES group underwent DES implantation without FFR measurement (n=115). The primary end point was the incidence of major adverse cardiac events, a composite of cardiac death, myocardial infarction, and target lesion revascularization. Of lesions assigned to FFR-guided strategy, only one quarter had functional significance (FFR<0.75). At 2-year follow-up, the cumulative incidence of major adverse cardiac events was 7.9±2.5% in the FFR-guided group and 8.8±2.7% in Routine-DES group (P=0.80). At 5-year follow-up, the cumulative incidence of major adverse cardiac events was 11.6±3.0% and 14.2±3.3% for the FFR-guided group and the Routine-DES group (P=0.55). There was no difference in major adverse cardiac events rates between the 2 groups ≤5-year follow-up (hazard ratio, 1.25; 95% confidence interval, 0.60-2.60). Conclusions-In lesions with angiographically intermediate stenosis, FFR guidance provides a tailored approach, which is at least as good as an angiography-guided routine-DES implantation strategy and avoids unnecessary DES-stenting in a considerable part of the patients. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00592228.
    No preview · Article · Dec 2015 · Circulation Cardiovascular Interventions
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    ABSTRACT: Home blood pressure (BP) monitoring offers clinically relevant information enriched with more abundant data. However, there are few studies addressing the reliability of home BP devices and the quality of its data. This study aimed to evaluate the current status of home BP devices in terms of validation and accuracy. Hypertensive patients with automated upper arm-type BP devices were consecutively enrolled. First, the validation status of each device was assessed through the website. Next, the accuracy of the individual device was evaluated by comparing the mean BP values between the automated device and a mercury sphygmomanometer. Accuracy of the device was defined as having less than a 5 mmHg difference in the mean BP values. A total of 212 individuals were analyzed; 38.7% (82 of 212) of the participants used validated devices and 85.4% (181 of 212) were accurate. Inaccuracy was more common with nonvalidated devices than validated devices [19.2% (n=25) vs. 7.3% (n=6), P=0.017]. The range of inaccuracy of the validated devices was 6-26 mmHg for the systolic BP and 6-11 mmHg for the diastolic BP. The present study showed that nonvalidated devices are used widely in clinical practice and a substantial portion is inaccurate. Therefore, recommendation of validated devices should be the first step. Furthermore, all devices need to be examined for accuracy before use irrespective of their validation status.
    No preview · Article · Apr 2015 · Blood pressure monitoring
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    ABSTRACT: Considering that contrast medium is excreted through the whole kidney in a similar manner to drug excretion, the use of raw estimated glomerular filtration rate (eGFR) rather than body surface area (BSA)-normalized eGFR is thought to be more appropriate for evaluating the risk of contrast-induced acute kidney injury (CI-AKI). This study included 2,189 myocardial infarction patients treated with percutaneous coronary intervention. Logistic regression analysis was performed to identify the independent risk factors. We used receiver-operating characteristic (ROC) curves to compare the ratios of contrast volume (CV) to eGFR with and without BSA normalization in predicting CI-AKI. The area under the curve (AUC) of the ROC curve for the model including all the significant variables such as diabetes mellitus, left ventricular ejection fraction, preprocedural glucose, and the CV/raw modification of diet in renal disease (MDRD) eGFR ratio was 0.768 [95% confidence interval (CI), 0.720-0.816; p < 0.001]. When the CV/raw MDRD eGFR ratio was used as a single risk value, the AUC of the ROC curve was 0.650 (95% CI, 0.590-0.711; p < 0.001). When the CV/MDRD eGFR ratio with BSA normalization ratio was used, the AUC of the ROC curve further decreased to 0.635 (95% CI, 0.574-0.696; p < 0.001). The difference between the two AUCs was significant (p = 0.002). Raw eGFR is a better predictor for CI-AKI than BSA-normalized eGFR.
    No preview · Article · Feb 2015 · CardioRenal Medicine
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    ABSTRACT: We investigated the association between cardiovascular autonomic neuropathy (CAN) and the future development of chronic kidney disease (CKD) in patients with type 2 diabetes. From Jan 2003 to Dec 2004, 1117 patients with type 2 diabetes without CKD (estimated glomerular filtration rate [eGFR]≥60ml/min/1.73m(2)), aged 25-75 years, were consecutively enrolled. A cardiovascular autonomic function test (AFT) was performed using heart rate variability parameters. The eGFR was measured at least more than once every year, and new onset CKD was defined as eGFR<60ml/min/1.73m(2) using a Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Among the 755 (67.6%) patients who completed the follow-up evaluation for 9.6 years, 272 patients (36.0%) showed a CKD stage ≥3. The patients who developed CKD were older, had a longer duration of diabetes, had hypertension, received more insulin and ACE inhibitor/angiotensin receptor blocker (ARB) treatment, and exhibited lower baseline eGFR, HbA1c, and albuminuria levels. Compared to patients without CKD, more patients with CKD at follow-up had CAN at baseline. In a multivariate analysis, after adjustment for age, sex, diabetes duration, presence of hypertension, mean HbA1c, diabetic complications, use of insulin, ACE inhibitor/ARB, statin, and baseline eGFR, the development of CKD was significantly associated with the presence of CAN (HR 2.62, 95% CI 1.87-3.67, P<0.001). In this prospective, longitudinal, observational cohort study, we demonstrated that diabetic CAN was an independent prognostic factor for the future development of CKD in type 2 diabetes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Jan 2015 · Diabetes Research and Clinical Practice
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    ABSTRACT: Cystatin-C, a marker of mild renal dysfunction, has been reported to be associated with cardiovascular diseases including vasospastic angina (VSA). We aimed to investigate the impact of cystatin-C level on the prevalence and angiographic characteristics of VSA in Korean patients.A total of 549 patients in the VA-KOREA (Vasospastic Angina in KOREA) registry who underwent ergonovine provocation tests were consecutively enrolled. Estimated glomerular filtration rate (eGFR) and levels of serum creatinine (Cr) and cystatin-C were assessed before angiography.The patients were classified into two groups: the VSA group (n = 149, 27.1%) and the non-VSA group (n = 400). Although eGFR and Cr levels were similar between the two groups, the VSA group had a significantly higher level of cystatin-C (P < 0.05). A high level of cystatin-C (second tertile, hazard ratio 1.432; 95% confidence interval [1.1491.805]; P = 0.026, third tertile, 1.947 [1.132-2.719]; P = 0.003) and current smoking (2.710 [1.415-4.098]; P < 0.001) were independently associated with the prevalence of VSA. Furthermore, the highest level of cystatin-C (> 0.96 ng/mL) had a significant impact on the incidence of multivessel spasm (2.608 [1.061-4.596]; P = 0.037).A high level of cystatin-C was independently associated with the prevalence of VSA and with a high-risk type of VSA in Korean patients, suggesting that proactive investigation of VSA should be considered for patients with mild renal dysfunction indicated by elevated cystatin-C.
    Preview · Article · Jan 2015 · International Heart Journal
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    ABSTRACT: Complete atrioventricular block (CAVB) in acute inferior ST-segment elevation myocardial infarction (STEMI) is associated with poor clinical outcomes after noninvasive treatment. This study was designed to determine the effect of primary percutaneous coronary intervention (PCI) in patients with CAVB complicating acute inferior STEMI, at a single center. We enrolled 138 consecutive patients diagnosed with STEMI involving the inferior wall; of these, 27 patients had CAVB. All patients received primary PCI. The clinical characteristics, procedural data, and clinical outcomes were compared in patients with versus without CAVB. Baseline clinical characteristics were similar between patients with and without CAVB. Patients with CAVB were more likely to present with cardiogenic shock, and CAVB was caused primarily by right coronary artery occlusion. Door-to-balloon time was similar between those two groups. After primary PCI, CAVB was reversed in all patients. The peak creatinine phosphokinase level, left ventricular ejection fraction and in-hospital mortality rate were similar between the two groups. After a median follow up of 318 days, major adverse cardiac events did not differ between the groups (8.1% in patients without CAVB; 11.1% in patients with CAVB) (P=0.702). We conclude that primary PCI can ameliorate CAVB-complicated acute inferior STEMI, with an acceptable rate of major adverse cardiac events, and suggest that primary PCI should be the preferred reperfusion therapy in patients with CAVB complicating acute inferior myocardial infarction.
    Full-text · Article · Nov 2014 · Clinical Interventions in Aging
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    ABSTRACT: Objective Arterial stiffness, as assessed by the brachial-ankle pulse wave velocity (baPWV), is associated with arterial aging and has been consistently linked to cardiovascular disease. The factors involved in reducing the progression of arterial stiffness in patients with type 2 diabetes mellitus (DM) have not yet been fully established. Methods Of 478 patients who underwent two baPWV measurements (at baseline and 1 year later) at the Department of Internal Medicine, St Vincent’s Hospital, from November 2009 to June 2011, 341 subjects were enrolled in this study (male to female ratio =150:191; mean age, 62.1±7.7 years). The 341 subjects were over the age of 50 with type 2 DM, were diagnosed without peripheral artery disease, and 170 if the subjects (50%) had hypertension. Results baPWV at baseline increased in a linear manner along with age (β=22.8, t=10.855; P<0.0001, R2=0.258). After 1 year follow-up, the change in baPWV (ΔbaPWV) was variable (median 32.7 cm/s [approximate range, −557 to ∼745]). In multiple linear regression, the change in systolic blood pressure (β=7.142, 95% confidence interval =4.557–9.727; P<0.0001, R2=0.305) was associated with ΔbaPWV during follow-up. The change in glycated hemoglobin (HbA1c) and a glycemic control of keeping HbA1c levels below 7.0% were not associated with ΔbaPWV. Conclusion We found that the variation of blood pressure was associated with the progression of vascular aging of the large- to middle-sized arteries in patients with type 2 DM. Therefore, control of blood pressure might be important in reducing arterial aging or PWV in patients with type 2 DM.
    Full-text · Article · Aug 2014 · Clinical Interventions in Aging
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    ABSTRACT: The amount of heart-type fatty acid-binding protein (FABP3) in cardiomyocytes may affect the prognosis of patients with coronary atherosclerosis. In this study, we examined whether single nucleotide polymorphisms (SNPs) of the FABP3 gene were prognostic factors in patients with coronary atherosclerosis. We enrolled 100 patients with myocardial infarction and coronary atherosclerosis and 100 healthy individuals to assess the genotypes of four SNPs of the FABP3 gene (RS2271072, RS16834408, RS2279885, and RS10914367). The MI patients with coronary atherosclerosis exhibited a higher frequency (16%) of the C/G-G/G haplotype of RS2271072 and RS10914367 than healthy individuals (7%). Koreans with the C/G-G/G haplotype for these SNPs had a higher risk of MI than did Koreans with the G/G-A/A haplotype. We calculated an odds ratio of 2.83 (95% confidence interval: 1.01-7.96). In conclusion, the C/G-G/G haplotype at RS2271072 and RS10914367 SNPs of FABP3 might be a prognostic factor in patients with coronary atherosclerosis.
    No preview · Article · Apr 2014 · Annals of clinical and laboratory science
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    Full-text · Article · Apr 2014 · Journal of the American College of Cardiology
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    ABSTRACT: Diastolic dysfunction is associated with increased arterial stiffness in patients with hypertension. However, the role of arterial stiffness in diastolic dysfunction in subjects without hypertension has not been fully established. A total of 287 subjects (male:female ratio 121:166, mean age 53.0±14.4 years) without hypertension or any heart disease who simultaneously received transthoracic echocardiography and noninvasively semiautomated radial artery applanation tonometry (with an Omron HEM-9000AI) in the Department of Internal Medicine, St Vincent's Hospital, from July 2011 to September 2012, were enrolled in this study. A total of 147 subjects (male:female ratio 59:88, mean age 61.7±9.9 years), representing 51.2% of the 287 subjects, had diastolic dysfunction (defined as abnormal relaxation pattern of mitral inflow). There were significant differences in systolic blood pressure (BP), pulse pressure, late systolic peak pressure (SBP2), and radial augmentation index (RaAIx) between normal diastolic function and diastolic dysfunction. ΔBP was defined as systolic BP minus SBP2, because of the difference in systolic BP between the two groups. ΔBP (odds ratio [OR] 1.059, 95% confidence interval [CI] 1.005-1.115; P=0.032) and RaAIx (odds ratio 1.027, 95% CI 1.009-1.044, P=0.003) were associated with diastolic dysfunction. A receiver operating-characteristic curve showed that ΔBP (area under the curve 0.875, 95% CI 0.832-0.911) and RaAIx (area under the curve 0.878, 95% CI 0.835-0.914) were associated with diastolic dysfunction. We found that ΔBP and increased RaAIx were associated with diastolic dysfunction in subjects without hypertension after adjustment for age and sex. Therefore, it is suggested that noninvasive estimation of central BP may be useful to reflect diastolic dysfunction in subjects with normal peripheral BP.
    Full-text · Article · Mar 2014 · Clinical Interventions in Aging
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    ABSTRACT: The no-reflow phenomenon is a potential complication of primary percutaneous coronary intervention (PCI). Predictors of the no-reflow phenomenon and the impact on long-term mortality remain unclear. Two thousand and seventeen patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary PCI were consecutively enrolled in the multicentre Acute Myocardial Infarction registry of Korea. The no-reflow phenomenon was diagnosed on the basis of angiographic criteria. The primary outcome was all-cause mortality. The no-reflow phenomenon was diagnosed in 262 patients (13.0%). Independent predictors of no-reflow were older age, high Killip class, reduced pre-PCI thrombolysis in myocardial infarction flow grade, and longer stent length in the culprit vessel. During a median follow-up period of 4.1 years (interquartile range: 3.0-5.2 years), patients with no-reflow showed a higher rate of mortality than that observed in patients with reflow (30.2 vs. 18.3%, P<0.001). The multivariate Cox proportional hazards model identified the no-reflow phenomenon as an independent correlate of long-term mortality [adjusted hazard ratio (HR): 1.45; 95% confidence interval (CI): 1.12-1.86; P=0.004]. Time period-specific analyses demonstrated that the association between no-reflow and mortality was significant and stronger for short-term (<30 days) mortality (adjusted HR: 3.11; 95% CI: 1.91-5.05; P<0.001) but was not significant for longer-term mortality (≥30 days; adjusted HR: 1.12; 95% CI: 0.82-1.52; P=0.47). In patients with STEMI who had undergone primary PCI, the no-reflow phenomenon was an independent predictor of short-term but not long-term mortality.
    No preview · Article · Mar 2014 · Coronary artery disease
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    ABSTRACT: β-blockers are the standard treatment for myocardial infarction (MI) based on evidence from the pre-thrombolytic era. The aim of this study was to examine the effect of β-blocker treatment in patients with acute MI and preserved systolic function in the era of percutaneous coronary intervention (PCI). We analysed a multicentre registry and identified 3019 patients who presented with acute MI between 2004 and 2009. Patients were treated with PCI, had left ventricular EFs ≥50% according to echocardiograms that were performed during the index PCI, and were alive at the time of discharge. The association between β-blocker use after discharge and mortality (all-cause death and cardiac death) within 3 years was examined. Patients who were not treated with β-blockers (n=595) showed higher rates of all-cause death and cardiac death compared to patients treated with β-blockers (10.8% vs 5.7%, p<0.001, 7.6% vs 2.6%, p<0001). The multivariate Cox proportional hazards model showed that β-blocker treatment was associated with a significant reduction in all-cause death (adjusted HR 0.633, 95% CI 0.464 to 0.863; p=0.004) and cardiac death (adjusted HR 0.47, 95% CI 0.32 to 0.70; p<0.001). Comparable results were obtained after propensity score matching. β-blocker treatment was associated with reduced long term mortality in patients with acute MI and preserved systolic function who received PCI.
    No preview · Article · Jan 2014 · Heart (British Cardiac Society)
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    ABSTRACT: Objective The aim of this study was to investigate the development of severe hypoglycemia (SH) in the presence of cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes.Research design and methodsFrom January 2001 to December 2002, a total of 894 patients with type 2 diabetes were enrolled. A cardiovascular autonomic function test (AFT) was performed using heart rate variability parameters: expiration-to-inspiration ratio, response to Valsalva maneuver and standing. From the results of the each three test (0 for normal, 1 for abnormal), a total AFT score of 1 was defined as early CAN, and a AFT score of ≥ 2 was defined as definite CAN.ResultsThe median follow-up time was 9.5 years. The mean age was 54.5 ± 10.1 years and the duration of diabetes was 8.9 ± 6.3 years. One hundred and ninety-six (31.4%) patients showed an abnormal cardiovascular AFT score at baseline. Sixty-two (9.9%) patients experienced 77 episodes of SH (1.33 per 100 patient-years). The events of SH increased as the CAN score increased (23 (5.4%) patients with normal, 17 (17.2%) patients with early, and 22 (22.7%) patients with definite CAN; P for trends < 0.001). Cox proportional hazard regression analysis revealed that SH was associated with definite CAN (normal vs. definite CAN, HR 2.43, 95% CI 1.21 - 4.84; P = 0.012).Conclusions Definite CAN was an independent prognostic factor for the development of SH in patients with type 2 diabetes.
    Full-text · Article · Aug 2013 · Diabetes care
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    ABSTRACT: The impact of the CYP2C19*17 polymorphism on the clinical outcome in Asians undergoing percutaneous coronary intervention (PCI) is unknown. We sought to assess the long-term impact of CYP2C19*17 on the risk for adverse clinical events in 2188 Korean patients taking clopidogrel after PCI. The prevalence of the CYP2C19*17 allele [*wt/*17: 2.4% (n=53), *17/*17: 0%] was very low. The 2-year cumulative event rates for bleeding [*wt/*17 vs. *wt/*wt: 2 vs. 2.3%; adjusted hazard ratio (HR), 1.23; 95% confidence interval (CI), 0.16-9.45], stent thrombosis (2 vs. 1.1%; HR, 3.98; 95% CI, 0.49-31.6) or composite of any death, and myocardial infarction or stroke (5.4 vs. 7.1%; HR, 1.37; 95% CI, 0.32-5.73) did not differ on the basis of the presence of CYP2C19*17. In conclusion, in our study population of Asian patients, the CYP2C19*17 polymorphism was not associated with adverse clinical outcomes after PCI because of its low prevalence, the rarity of homozygotes, and the relatively low rate of adverse clinical events.
    No preview · Article · Aug 2013 · Pharmacogenetics and Genomics
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    ABSTRACT: We investigated the relationship between endothelial dysfunction and diabetic retinopathy (DR) in patients with type 2 diabetes. We used a cross-sectional design to examine 167 patients with type 2 diabetes mellitus. All patients underwent biochemical and ophthalmological examination. We assessed endothelial dysfunction by a flow-mediated vasodilation method of the brachial artery. Changes in vasodilation (flow-mediated vasodilatation, %FMD) were expressed as percent change over baseline values. The mean±standard deviation of patient age was 54.1±8.6 years. The %FMD was significantly lower in patients with DR than without DR. The prevalence of retinopathy decreased across increasing tertiles of %FMD. After adjusting for patients' age, sex, diabetes duration, use of insulin, use of antihypertensive, antiplatelet, and lipid lowering medications, systolic blood pressure, fasting plasma glucose, 2-hour plasma glucose, glycated hemoglobin, and urinary albumin excretion, participants with a reduced %FMD were more likely to have DR (odds ratio, 11.819; 95% confidence interval, 2.201 to 63.461; P=0.004, comparing the lowest and highest tertiles of %FMD). Endothelial dysfunction was associated with DR, which was most apparent when the endothelial dysfunction was severe. Our study provides insights into the possible mechanism of the influence of endothelial dysfunction on the development of DR.
    Full-text · Article · Aug 2013 · Diabetes & metabolism journal
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    ABSTRACT: Objective: Dyslipidemia, a risk factor for cardiovascular diseases, is more prevalent in patients with rheumatoid arthritis (RA) than in the general population. We investigated whether single-nucleotide polymorphisms (SNP) modulating low-density lipoprotein (LDL) cholesterol affect susceptibility, severity, and progression of RA. Methods: We enrolled 302 patients with RA and 1636 healthy controls, and investigated the SNP modulating LDL cholesterol. Clinical characteristics of RA, serum adipocytokine concentrations, and radiographic severity were analyzed according to genotype score based on the number of unfavorable alleles. The influence of genotype score on radiographic progression was also investigated using multivariable logistic models. Results: We identified 3 SNP (rs688, rs693, and rs4420638) modulating LDL cholesterol in Koreans, which correlated well with LDL cholesterol levels in both patients with RA and controls. Among them, 2 SNP, rs688 and rs4420638, were more prevalent in patients with RA than in controls. In patients with RA carrying more unfavorable alleles (genotype score ≥ 3), disease activity measures, serum adipocytokine levels, and radiographic severity were all increased. The genotype score was an independent risk factor for radiographic progression of RA over 2 years, and its effect was greater than the influence of conventional risk factors. Conclusion: SNP modulating LDL cholesterol influence the risk, activity, and severity of RA. These results provide the first evidence that genetic mechanisms linked to dyslipidemia may directly contribute to the susceptibility and prognosis of RA, a representative of chronic inflammatory diseases, explaining the high incidence of dyslipidemia in RA.
    No preview · Article · Apr 2013 · The Journal of Rheumatology