Association of Cardiovascular Mortality with Concurrent Coronary Artery Calcification and Physical Activity: A Cohort Study.

Background: Increased coronary artery calcification (CAC) has been reported in individuals with high levels of physical activity (PA). However, the association between increased CAC in a physically active population and cardiovascular mortality has not yet been well-established. This study aimed to investigate the association between PA levels and the presence or absence of CAC and cardiovascular mortality. Methods: A cohort study was conducted from 1 January 2011 to 30 December 2019. Mortality data were updated until 30 December 2020. The study population comprised 56,469 individuals who had completed the International Physical Activity Short Form Questionnaire and had undergone CAC score evaluation using a CT scan. We divided the participants into four groups: physically inactive individuals without CAC, physically inactive individuals with CAC, moderately active and health-enhancing physically active (HEPA) individuals without CAC, and moderately active and HEPA individuals with CAC. The primary outcome was cardiovascular mortality. The Cox proportional hazard model with confounding factor adjustment was conducted. Inverse probability of treatment weighting-based marginal-structural modelling was conducted. Results: The median follow-up duration was 6.60 years. The mean (SD) age of the study participants was 41.67 (±10.91) years, with 76.78% (n = 43,359) men. Compared with individuals without CAC, individuals with CAC demonstrated higher cardiovascular disease mortality regardless of PA level (Inactive and CAC > 0, HR 2.81, 95% CI: 1.76-19.19; moderately active and HEPA HR 3.27, 95% CI: 1.14-9.38). Conclusions: The presence of CAC might be associated with cardiovascular mortality regardless of PA level.

C-reactive protein and risk of atrial fibrillation in East Asians.

AIMS: Inflammation has been suggested to play a role in the pathogenesis of atrial fibrillation (AF). It is uncertain whether C-reactive protein, a robust inflammatory marker, is associated with AF incidence in Asians with lower levels of C-reactive protein compared with western population. This study aimed to determine the association between C-reactive protein and risk of AF in a large population of Koreans. METHODS AND RESULTS: A total of 402 946 Koreans were enrolled in a health screening programme from January 2002 to December 2013. Among them, 210 208 subjects were analysed during the mean follow-up of 4.59 years (1 062 513 person-years). Atrial fibrillation was identified by electrocardiography at every visits. Atrial fibrillation was identified in 561 subjects (0.1%) at baseline. The median (inter-quartile) baseline C-reactive protein levels were higher in subject with AF than in those without AF [0.9 mg/L (0.4-0.9) vs. 0.4 mg/L (0.2-1.0), P < 0.001]. Subjects in the highest quartile of C-reactive protein had more AF than those in the lowest quartile [adjusted odds ratio (OR) 2.02, 95% confidence interval (CI) 1.45-2.81; P< 0.001]. During a mean follow-up of 4.59 years, AF developed in 261 subjects (0.1%). The highest quartile of baseline C-reactive protein had a 1.68-fold (95% CI 1.06-2.67) increased risk of AF than the lowest quartile in multivariate Cox regression analysis. CONCLUSION: Baseline C-reactive protein levels are significantly associated with the prevalence of AF and the risk of AF in Korean populations even C-reactive protein concentrations are substantially lower than reported in white populations.

Absence of association between gallstone and coronary artery calcification.

BACKGROUND AND AIMS: Gallstone has been suggested to be associated with cardiovascular disease (CVD). Coronary artery calcification (CAC) is an excellent value to predict future CVD. The aim of this study was to evaluate the association between gallstone and CAC. METHODS: Data were analyzed from an occupational cohort of 46,893 subjects (37,557 men and 9336 women) between 2011 and 2014. Participants with cancer or CVD histories or missing data at baseline were excluded from the study. Gallstone was diagnosed by ultrasound-documentation. Multivariate logistic analysis was conducted to examine the relationship between gallstone and CAC. RESULTS: The total population who had gallstone was 1426 (3.1%). In multivariate analysis, odds ratios (OR) for gallstone were not different according to CAC score groups in men and women. In addition, gallstone was not associated with higher OR for CAC in men and women. CONCLUSIONS: Gallstone was not associated with CAC in both Korean men and women.

Association between serum uric acid and cardiovascular mortality and all-cause mortality: a cohort study.

OBJECTIVE: Previous studies have reported the association among serum uric acid (SUA) levels and cardiovascular and all-cause mortality; however, the results have been inconsistent. The aim of this study was to investigate whether SUA is independently associated with cardiovascular and all-cause mortality in relatively healthy Korean adults. METHODS: A total of 396 951 individuals were enrolled for the study between 2002 and 2012. About 39 991 participants were excluded for various reasons. All-cause and cardiovascular mortality data were collected. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals for all-cause and cardiovascular mortality according to baseline uric acid quintiles, and the third, middle SUA quintile was the reference group. RESULTS: A total of 356 960 participants were considered to be eligible for the analysis, and median follow-up duration was 5.88 years. The lowest and highest quintiles of SUA were less than 5.2 and more than 7.1 mg/dl in men, and less than 3.5 and more than 5.0 mg/dl in women, respectively. A total of 2082 deaths (312 from cardiovascular disease and 1770 from other causes) occurred during follow-up. In the highest SUA group, adjusted hazard ratios for all-cause mortality were 1.24 (1.01, 1.51) in men and 1.04 (0.76, 1.42) in women, and for cardiovascular mortality were 1.15 (0.72, 1.83) in men and 1.69 (0.70, 4.04) in women after adjustment for various possible confounding factors. CONCLUSION: In the current large relatively healthy population-based observational study, SUA showed no significant association with all-cause and cardiovascular mortality.

The association between dietary cholesterol intake and subclinical atherosclerosis in Korean adults: The Kangbuk Samsung Health Study.

BACKGROUND: The Scientific Report of the Dietary Guidelines Advisory Committee (2015) concluded that restriction of dietary cholesterol is unnecessary in most adults for the prevention of cardiovascular disease. OBJECTIVE: We aimed to assess the risk for subclinical atherosclerosis according to coronary artery calcium score (CACS), based on dietary cholesterol intake in apparently healthy Korean adults. METHODS: This was a cross-sectional study performed in 30,068 participants (mean age 40.8 years; 84.5% men) in a health screening program in Korea. The data were collected from 2001 to 2013 and analyzed in 2015. Total energy intake and dietary cholesterol intake were assessed with a food frequency questionnaire. The participants were stratified according to quartile of dietary cholesterol intake. CACS was measured by multi-detector computed tomography. Lipid profiles were measured, and the participants were divided into 6 groups according to low-density lipoprotein cholesterol (LDL-C) level: <70, 70 to 99, 100 to 129, 130 to 159, 160 to 189, and ≥190 mg/dL. RESULTS: The presence of coronary artery calcification was defined as CACS>0. Dietary cholesterol intake did not correlate with mean value of serum LDL-C level. For both genders, the odds ratio for coronary artery calcification was not significantly greater with greater amounts of dietary cholesterol (as assessed by quartile). The risk for coronary artery calcification was not higher in subjects with LDL-C 70-129 mg/dL compared with those with LDL-C < 70 mg/dL; however, the risk was significantly greater in subjects with LDL-C ≥ 130 mg/dL compared with those with LDL-C < 70 mg/dL. CONCLUSIONS: Dietary cholesterol intake did not have an association with LDL-C level or with risk for coronary artery calcification in apparently healthy Korean adults. The results have to be translated with consideration of limitation of population-based studies.

Association of Physical Activity and Inflammation With All-Cause, Cardiovascular-Related, and Cancer-Related Mortality.

OBJECTIVE: To investigate the association between physical activity (PA) and risk of mortality in a large middle-aged cohort stratified by inflammatory status. PATIENTS AND METHODS: A total of 336,560 individuals (mean age, 39.7 years; 58% male) who underwent comprehensive health screenings were enrolled in this prospective cohort study. They were grouped according to self-reported PA level using a questionnaire: no regular PA with a sedentary lifestyle, regular but insufficient PA (below the guidelines), sufficient PA (concordant with the guidelines), and health-enhancing PA. Inflammation was assessed via high-sensitivity C-reactive protein (hsCRP) level. Study end points were all-cause, cardiovascular-related, and cancer-related mortality. RESULTS: During the 1,976,882 person-years of follow-up (median follow-up duration, 6.17 years), 2062 deaths occurred. Compared with a sedentary lifestyle, the hazard ratios (95% CIs) on the multivariable Cox proportional hazards regression analyses for all-cause mortality by PA level were 0.95 (0.84-1.07), 0.85 (0.72-0.99), and 0.75 (0.60-0.93) (P for trend=.003), and those for cardiovascular- and cancer-related mortality were 0.95, 0.80, and 0.55 (P for trend=.05) and 0.82, 0.83, and 0.78 (P for trend=.01), respectively. Compared with participants with low hsCRP levels and any regular PA, those with high hsCRP levels and no regular PA had a significantly higher risk of mortality (1.59 [1.38-1.84]). CONCLUSION: Higher PA levels were associated with a dose-dependent reduced risk of cardiovascular-related, cancer-related, and all-cause mortality. Individuals with high hsCRP levels and no regular PA had the highest risk of mortality.

Urine Albumin/Creatinine Ratio Below 30 mg/g is a Predictor of Incident Hypertension and Cardiovascular Mortality.

BACKGROUND: Microalbuminuria is associated with cardiovascular disease (CVD) mortality, but whether lower levels of urine albumin excretion similarly predict CVD is uncertain. We investigated associations between urine albumin:creatinine ratio (UACR) <30 mg/g, and incident hypertension, incident diabetes mellitus, and all-cause and CVD mortality, during a maximum of 11 years of follow-up. METHODS AND RESULTS: Individuals (37 091) in a health screening program between 2002 and 2012 with baseline measurements of UACR were studied. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for incident hypertension, incident diabetes mellitus, and mortality outcomes (lowest UACR quartile as reference) at follow-up. For linear risk trends, the quartile rank was used as a continuous variable in regression models. Nine-hundred sixty-three cases of incident hypertension, 511 cases of incident diabetes mellitus, and 349 deaths occurred during follow-up. In the fully adjusted models, there was a significant HR for the association between UACR and incident hypertension (highest UACR quartile HR 1.95 [95% CI 1.51, 2.53], P-value for trend across UACR quartiles P<0.001). In contrast, the association between UACR and incident diabetes mellitus was not significant (highest UACR quartile, HR 1.15 [95% CI 0.79, 1.66], P-value for trend P=0.20). For CVD mortality, with increasing UACR quartiles, there was a significant increase in HR across quartiles, P=0.029, (for all-cause mortality, P=0.078). CONCLUSIONS: Low levels of albuminuria, UACR below 30 mg/g, are associated with increased risk of incident hypertension and CVD mortality at follow-up, but are not associated with increased risk of incident diabetes mellitus.

All cause mortality and body mass index in a young Asian occupational cohort without baseline metabolic syndrome components.

BACKGROUND: The aim was to investigate associations between underweight, overweight and obesity and all cause, cancer and cardiovascular disease (CVD) mortality, excluding subjects with known CVD, diabetes, hypertension and components of the metabolic syndrome (MetS) at baseline. METHODS: The study population consisted of examinees participating in a health screening in Korea from 2002 to 2013. Data were analyzed in 162,194 subjects (in a retrospective cohort study design-median (interquartile range (IQR) follow-up 4.9 (1.8-8.5years))). The outcomes were all cause mortality, cancer and CVD. RESULTS: The mean (age range) and median age (IQR) at baseline were 36.9(20.0-85.3) and 35.2 (30.8-40.6) years. There were 436 deaths during follow-up. For men and women together, the fully adjusted HR for underweight and all cause mortality, cancer and CVD was 1.53 (95% CIs 1.06-2.20), 1.21 (95% CIs 0.68-2.14) and 1.34 (95% CIs 0.40-4.49) respectively. In contrast, the fully adjusted HR for overweight/obesity combined and all cause mortality was 0.77 (95%CIs 0.63-0.95) and there were non significant trends towards decreased cancer and CVD mortality. The association between overweight/obesity and all cause mortality was similar for men and women considered separately and for overweight and obesity as separate BMI categories. Smoking did not seem to explain the increased HR in the underweight BMI category. CONCLUSIONS: In a young metabolically healthy adult cohort, underweight was associated with increased all cause mortality and overweight/obesity was associated with decreased all cause mortality if CVD, diabetes, hypertension and components of the metabolic syndrome (MetS) are excluded.

Lifestyle including dietary habits and changes in coronary artery calcium score: a retrospective cohort study.

BACKGROUND: General diet and lifestyle are considered to have an effect on levels of atherosclerosis but previous studies have shown inconsistent results. The aim of this study was to investigate whether macronutrient intake, physical activity and depressive symptoms are associated with progression of preclinical atherosclerosis in healthy Korean adults. METHODS: A total of 2623 individuals from Kangbuk Samsung Hospital Health Screening Center in South Korea were enrolled between 2010 and 2012 and had follow-up at 2013. Every participant received a non-enhanced coronary computed tomography (CT) and completed questionnaires for food intake frequency, depression and physical activity levels. The study population was divided into two groups according to CAC progression, namely CAC group (CAC score >0) or non-CAC group (CAC score ≤ 0), and were compared according to macronutrient intake, degree of depressive symptoms and physical activity. RESULTS: A total of 2175 subjects were eligible for the analysis and among them, 592 subjects had progression of CAC. Total energy, carbohydrate and fat intake showed significant differences between the two groups (p-values of 0.01, 0.021 and 0.016 respectively). However, levels of protein intake did not vary for the two groups (p = 0.286). Depressive symptoms and extent of physical activity were similar between the two groups. Multivariate analysis was conducted with adjustment for possible confounding factors. The hazard ratios for CAC progression were not different according to macronutrient intake, degree of depressive symptoms and physical activity. CONCLUSION: In this large relatively healthy population based observational study, CAC progression showed no significant association with total energy intake, proportion of macronutrient intake, depressive symptom and physical activity.