Lymphocyte DNA damage and plasma antioxidant status in Korean subclinical hypertensive patients by glutathione S-transferase polymorphism

BACKGROUND/OBJECTIVES: Glutathione S-transferase (GST) forms a multigene family of phase II detoxification enzymes which are involved in the detoxification of xenobiotics by conjugating substances with glutathione. The aim of this study is to assess the antioxidative status and the degree of DNA damage in the subclinical hypertensive patients in Korea using glutathione S-transferase polymorphisms. SUBJECTS/METHODS: We examined whether DNA damage and antioxidative status show a difference between GSTM1 or GSTT1 genotype in 227 newly diagnosed, untreated (systolic blood pressure (BP) ≥ 130 mmHg or diastolic BP ≥ 85 mmHg) subclinical hypertensive patients and 130 normotensive subjects (systolic BP < 120 mmHg and diastolic BP < 80 mmHg). From the blood of the subjects, the degree of the DNA damage in lymphocyte, the activities of erythrocyte superoxide dismutase, the catalase, and the glutathione peroxidase, the level of glutathione, plasma total radical-trapping antioxidant potential (TRAP), anti-oxidative vitamins, as well as plasma lipid profiles and conjugated diene (CD) were analyzed. RESULTS: Of the 227 subjects studied, 68.3% were GSTM1 null genotype and 66.5% were GSTT1 null genotype. GSTM1 null genotype had an increased risk of hypertension (OR: 2.104, CI: 1.38-3.35), but no significant association in GSTT1 null genotype (OR 0.982, CI: 0.62-1.55). No difference in erythrocyte activities of superoxide dismutase, catalase, or glutathione peroxidase, and plasma TRAP, CD, lipid profiles, and GSH levels were observed between GSTM1 or GSTT1 genotype. Plasma levels of α-tocopherol increased significantly in GSTT1 wild genotype (P < 0.05); however, plasma level of β-carotene increased significantly in GSTT1 null genotype (P < 0.01). DNA damage assessed by the Comet assay was significantly higher in GSTM1 null genotype than wild genotype (P < 0.05). CONCLUSIONS: These results confirm the association between GSTM1 null genotype and risk of hypertension as they suggest that GSTM1 null genotype leads to an increased oxidative stress compared with wild genotype.

Association between oxidative stress and blood pressure in Korean subclinical hypertensive patients

This study was conducted in order to investigate the association between hypertension and oxidative stress-related parameters and to evaluate these parameters in subclinical hypertensive patients and normotensive subjects living in Korea. We attempted to determine whether oxidative stress-related parameters would differ between two groups of 227 newly-diagnosed, untreated (systolic blood pressure (BP) > or = 130 mmHg and diastolic BP > or = 85 mmHg) and 130 normotensive subjects (systolic BP < 120 mmHg and diastolic BP < 80 mmHg). General characteristics of the subjects were collected using a simple questionnaire. From subjects' blood, degree of DNA damage in lymphocytes, the activities of erythrocyte superoxide dismutase, catalase, and glutathione peroxidase, level of plasma total radical-trapping antioxidant potential (TRAP), glutathione, and anti-oxidative vitamins, as well as plasma lipid profiles and conjugated diene (CD) were analyzed. Evaluation of the associations of oxidative stress-related parameters with blood pressure of the subjects was performed using Pearson partial correlation and multivariate logistic regression analysis after adjusting for confounding factors. Several oxidative stress-related parameters were higher in subclinical hypertensive patients than in normotensive subjects. Plasma levels of alpha-tocopherol, beta-carotene, TRAP, and activity of GSH-px were significantly lower in subclinical hypertensive patients than in normotensive subjects. Increased levels of DNA damage, lipid peroxidation, triglyceride, total cholesterol, and LDL-cholesterol were observed in subclinical hypertensive patients. These results confirm an association between blood pressure and oxidative stress-related parameters and suggest that the pathogenic role of oxidative stress in hypertension might be significant.

Predictors of Insulin Resistance in Postmenopausal Women / 대한폐경학회지

OBJECTIVES: Insulin resistance plays an important role in cardiovascular diseases, type 2 diabetes, and non-alcoholic fatty liver disease. The objective of this study was to determine the association between obesity and elevated alanine aminotransferase (ALT) with insulin resistance and compare these factors with metabolic syndrome in postmenopausal women. METHODS: We analyzed 606 postmenopausal women who had visited the Health Promotion Center. The medical history and lifestyle data were collected by questionnaire and history taking. Anthropometric parameters and blood pressure were measured. Laboratory tests included fasting glucose and insulin levels, and liver and lipid profiles. Metabolic syndrome was defined based on NCEP-ATP III criteria. As a maker of insulin resistance, the homeostatic model assessment-insulin resistance (HOMA-IR) was calculated. We grouped all subjects into four groups, based on the quartiles of HOMA-IR. The top fourth quartile group was defined as the group with insulin resistance. We performed multivariate logistic regression analysis for the odds ratio of the risk for insulin resistance. RESULTS: The prevalence rates of obesity (body mass index > or = 25 kg/m2) and elevated ALT (> or = 34 U/L) increased with increased HOMA-IR. Obesity and elevated ALT were associated with insulin resistance, after adjusting for age, smoking status, and exercise. Women with co-existing obesity and elevated ALT were at increased risk for insulin resistance (OR = 5.87; 95% CI, 2.93~11.74) compared to women with metabolic syndrome (OR = 3.43; 95% CI, 2.18~5.41). CONCLUSION: Obesity and elevated ALT are associated with insulin resistance in postmenopausal women. A combination of these factors is superior to metabolic syndrome in predicting insulin resistance.

Predictors of Insulin Resistance in Postmenopausal Women / 대한폐경학회지

OBJECTIVES: Insulin resistance plays an important role in cardiovascular diseases, type 2 diabetes, and non-alcoholic fatty liver disease. The objective of this study was to determine the association between obesity and elevated alanine aminotransferase (ALT) with insulin resistance and compare these factors with metabolic syndrome in postmenopausal women. METHODS: We analyzed 606 postmenopausal women who had visited the Health Promotion Center. The medical history and lifestyle data were collected by questionnaire and history taking. Anthropometric parameters and blood pressure were measured. Laboratory tests included fasting glucose and insulin levels, and liver and lipid profiles. Metabolic syndrome was defined based on NCEP-ATP III criteria. As a maker of insulin resistance, the homeostatic model assessment-insulin resistance (HOMA-IR) was calculated. We grouped all subjects into four groups, based on the quartiles of HOMA-IR. The top fourth quartile group was defined as the group with insulin resistance. We performed multivariate logistic regression analysis for the odds ratio of the risk for insulin resistance. RESULTS: The prevalence rates of obesity (body mass index > or = 25 kg/m2) and elevated ALT (> or = 34 U/L) increased with increased HOMA-IR. Obesity and elevated ALT were associated with insulin resistance, after adjusting for age, smoking status, and exercise. Women with co-existing obesity and elevated ALT were at increased risk for insulin resistance (OR = 5.87; 95% CI, 2.93~11.74) compared to women with metabolic syndrome (OR = 3.43; 95% CI, 2.18~5.41). CONCLUSION: Obesity and elevated ALT are associated with insulin resistance in postmenopausal women. A combination of these factors is superior to metabolic syndrome in predicting insulin resistance.

Socioeconomic Factors Associated with Initiating and Quitting Cigarette Smoking Among Korean Men / 가정의학회지

BACKGROUND: The prevalence of current cigarette smoking is the net result of different processes over the entire life course, namely initiation, continuation and cessation of smoking. This study examined the association of socioeconomic indicators with initiating and quitting smoking among South Korean men. METHODS: We analyzed a total of 2,798 men aged 25-64 who participated in the Korean National Health and Nutrition Examination Survey in 2005. Odds ratios (ORs) with 95% confidence intervals (CIs) for smoking initiation and cessation according to socioeconomic position indicators were calculated with logistic regression. Socioeconomic position was measured by education, occupation, income and marital status. RESULTS: Greater rates of ever initiation of smoking were observed among lower educated men (OR = 1.51; 95% CI = 1.09-2.09) after controlling for other socioeconomic factors. Independent associations were found among men who performed manual labor (OR = 1.55; 95% CI = 1.12-2.14). After simultaneous adjustment for socioeconomic factors, lower likelihood of quitting smoking was detected among men who were in the middle third and the lower third income group (OR = 0.72; 95% CI = 0.55-0.92, OR = 0.60; 95% CI = 0.46-0.79, respectively), who performed manual labor (OR = 0.66; 95% CI = 0.50-0.86) or who were not married (OR for never-married = 0.65; 95% CI = 0.42-0.99 and OR for divorced or widowed = 0.56; 95% CI = 0.36-0.87, respectively). CONCLUSION: For Korean men, educational attainment was a strong predictor of ever initiating smoking, however, smoking cessation was independently related to income and marital status. To be effective, tobacco control interventions should consider these different social determinants in initiating and quitting smoking.

Determinants of Responsiveness of LDL-cholesterol Lowering to Lifestyle Modification in Hypercholesterolemic Patients / 가정의학회지

BACKGROUND: Current guidelines for the treatment of hyperlipidemia propose lifestyle modification as a first-line intervention. The aim of this study was to identify the factors which determine responsiveness of LDL-cholesterol lowering to lifestyle modification in hypercholesterolemic patients. METHODS: A total of 109 patients aged between 30 and 70 years (52 men and 109 women) who were diagnosed with hypercholesterolemia between July 2007 and February 2008 at Asan Medical Center were enrolled in this study. The patients were educated on lifestyle modifications by trained family physicians. We measured clinical, anthropometric, lifestyle parameters and lipid profiles initially and at eight weeks after education. Stepwise multiple linear regression models were used to assess covariates and variance components. RESULTS: The serum level of LDL-cholesterol decreased in both women (8.0 +/- 15.37%, P < 0 .001) and men (4.95 +/- 9.81%, P < 0.001). In women, dietary adherence (beta = 0.267, P = 0.004), change in physical activity duration (beta = 0.196, P = 0.034) and menopausal state (beta = -0.207, P = 0.026) were significant predictors in response of percent change in LDL-cholesterol. In men, dietary adherence (beta = 0.372, P = 0.007) was a predictor in response of percent change in LDL-cholesterol. CONCLUSION: Adherence to lifestyle modification was a main factor which had influenced on response of percent change in LDL-C levels. In women, however, menopausal state was also an important factor.

A Case of Lateral Medullary Infraction Presenting with Thoracic Sensory Level

Loss of pain and temperature sensation due to lateral medullary infarction are well known and classically involve the ipsilateral side of the face and the lower part of the body on the controlateral side. This pattern of sensory loss below a certain level on the trunk, usually a sign of spinal cord disease, may also appear following a lesion in the lateral medullar, due to damage to the spinothalamic tract. A 72-year-old hypertensive man developed sudden dizziness, headache, and gait ataxia. On neurologic examination, he had left limb and gait ataxia. Five days later he noted loss of pain and temperature sensation on the right leg and trunk with a sensory level at T4 with preservation of touch, vibration, and joint position sense in all limbs. Brain MRI showed a small infarct in the left lower lateral medulla. Brain MR angiography showed stenosis of the right proximal carotid artery, left distal vertebral artery, and mid-basilar artery. We report a case of sensory defects with a sensory level on the trunk that occured as the result of lesion of the lower lateral medulla.