Non-Operative Treatment of Nonunion

No abstract available.

A Waterborne Outbreak and Detection of Cryptosporidium Oocysts in Drinking Water of an Older High-Rise Apartment Complex in Seoul

From May to June 2012, a waterborne outbreak of 124 cases of cryptosporidiosis occurred in the plumbing systems of an older high-rise apartment complex in Seoul, Republic of Korea. The residents of this apartment complex had symptoms of watery diarrhea and vomiting. Tap water samples in the apartment complex and its adjacent buildings were collected and tested for 57 parameters under the Korean Drinking Water Standards and for additional 11 microbiological parameters. The microbiological parameters included total colony counts, Clostridium perfringens, Enterococcus, fecal streptococcus, Salmonella, Shigella, Pseudomonas aeruginosa, Cryptosporidium oocysts, Giardia cysts, total culturable viruses, and Norovirus. While the tap water samples of the adjacent buildings complied with the Korean Drinking Water Standards for all parameters, fecal bacteria and Cryptosporidium oocysts were detected in the tap water samples of the outbreak apartment complex. It turned out that the agent of the disease was Cryptosporidium parvum. The drinking water was polluted with sewage from a septic tank in the apartment complex. To remove C. parvum oocysts, we conducted physical processes of cleaning the water storage tanks, flushing the indoor pipes, and replacing old pipes with new ones. Finally we restored the clean drinking water to the apartment complex after identification of no oocysts.

Post-traumatic Osteomyelitis

No abstract available.

The Relationship Between Heart Rate Recovery and Brain Natruretic Peptide in Patients With Chest Discomfort

BACKGROUND AND OBJECTIVES: The correlation between brain natruretic peptide (BNP) level and cardiac autonomic function has been studied in type 2 diabetic patients. However, there is limited data from patients with normal systolic function. We evaluated the association between heart rate recovery (HRR) representing autonomic dysfunction and three plasma BNP levels: pre-exercise, post-exercise, and change during exercise in patients with normal systolic function. SUBJECTS AND METHODS: Subjects included 105 patients with chest pain and normal systolic function. HRR was defined as the difference between the peak heart rate and the rate measured two minutes after completion of a treadmill exercise test. We measured plasma BNP levels before exercise, 5 minutes after completion of exercise, and during exercise (absolute value of difference between pre- and post-exercise BNP levels). RESULTS: Patients with abnormal HRR values (< or =24 beats for the first 2 minutes of HRR) had lower high-density lipoprotein, lower peak heart rates, and higher pre- and post-exercise BNP levels than patients with normal HRR values. The patients with coronary artery disease (CAD) had abnormal HRR. However, no significant differences were found between the two groups in terms of history of hypertension (HTN), diabetes, and peak systolic blood pressure (SBP) and diastolic blood pressure (DBP). HRR was significantly associated with pre-exercise BNP (r=-0.36, p=0.004) and post-exercise BNP (r=-0.27, p=0.006), but not BNP changes. Further, pre-exercise BNP levels showed a greater association with HRR than post-exercise BNP levels. CONCLUSION: HRR is independently associated with pre-exercise and post-exercise BNP levels, even in patients with normal systolic function.

Mid Term Results of Total Knee Arthroplasty (8 to 10 Years) / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the mid-term (8 to 10 years) clinical and radiologic results of total knee arthroplasty. MATERIALS AND METHODS: We evaluated 71 knees in 45 patients after they had undergone total knee arthroplasty between January 1996 and April 1998. All the procedures were performed by a single-surgeon using the PFC (Press Fit Condylar) system. The clinical and radiologic results were evaluated using the American Knee Society Scoring System and the American Knee Society Roentgenographic Evaluation and Scoring System. Survivorship analysis was performed using the Kaplan-Meier method with revision for any reason as the end point. RESULTS: The average range of motion of the knee joint was 102.7degrees (55-130degrees) preoperatively and 116.4degrees (90-140degrees) at the last follow-up. The average knee and functional scores were improved from 46.2 and 42 preoperatively to 88.7 and 82.9, respectively, at the last follow-up. The tibiofemoral angle changed from varus 6.5degrees preoperatively to valgus 4.6degrees at the last follow-up. The total radiolucecy rate was 34% and the total radiolucency score was 1.9. Reimplantations were performed in 5 cases and the survival rate was 94.7% at 8 years. No differences was found in the survival rate according to PCL preservation. CONCLUSION: The mid-term results of PFC total knee arthroplasty were reliable and satisfactory because there was an increased range of motion, decreased pain, restoration of function and a relatively low complication rate.

The Relationship between Serum Retinol-Binding Protein 4 Levels and Coronary Artery Disease in Korean Adults / 당뇨병

BACKGROUND: A recently discovered adipokine, retinol-binding protein-4 (RBP-4), is reportedly associated with insulin resistance and metabolic syndrome. This study was performed to analyze the relationship between serum RBP-4 levels and coronary artery disease (CAD) in Korean adults. METHODS: In 235 subjects (mean age 58 years) in whom coronary artery angiograms were performed due to complaints of chest pain, serum RBP-4 levels were measured by enzyme-linked immunosorbent assay. Coronary artery angiograms were performed in all subjects and the severity of CAD was assessed by the number of stenotic vessels. The presence of metabolic syndrome was defined by AHA/NHLBI criteria with body mass index substituted for waist circumference. RESULTS: Coronary angiogram showed that 101 subjects (43%) had normal coronary vessel, 82 subjects (34.9%) had 1-vessel disease, 31 subjects (13.2%) had 2-vessel disease and 21 subjects (8.9%) had 3-vessel disease. Subjects with coronary artery stenosis showed a higher mean age (60.5 +/- 10.0 years), fasting glucose (123.3 mg +/- 45.0 mg/dL) and lower mean value for high-density lipoprotein cholesterol (HDL-C) level (49.0 +/- 13.2 mg/dL), although serum RBP-4 levels were not significantly different between those with and without CAD. Mean age and fasting glucose level increased significantly as the number of stenotic vessels increased, although serum RBP4 level showed no significant differences among the different groups. Among the metabolic parameters, only serum triglyceride levels showed a significant correlation with serum RBP-4 levels. CONCLUSION: There was no difference in mean serum RBP-4 levels between subjects with or without coronary artery disease in Korean adults. Further studies are warranted to draw a clear conclusion on the effect of RBP-4 on atherosclerosis.

Prevalence and clinical characteristics of microalbuminuria in Koreans: a population-based cross-sectional study / 대한내과학회지

BACKGROUND: Microalbuminuria (MA) is independent predictor of cardiovascular disease and it cause mortality regardless of the presence of diabetes (DM) and hypertension (HTN). However, few published studies on this topic have been reported in Korea. Therefore, we investigated the MA prevalence and relationship between MA, insulin resistance and cardiovascular risk factor. METHODS: A total of 5,915 (3,053 men and 2,852 women) health screen examinees were enrolled in this study. We measured the anthropometric and biochemical parameters of the atherogenic indexes. RESULTS: The MA prevalence was 7.7% in all participants. The prevalence of MA in the men and women was 9.5% and 5.7%, respectively. Elevated levels of serum fasting glucose, serum fasting insulin, HOMA index, total cholesterols, LDL cholesterol, TG, Body Mass Index (BMI) and the systolic and diastolic blood pressure were significantly associated with MA. The results of multiple logistic regression analysis about MA showed that frequent drinking, low BMI, newly diagnosed DM and elevated levels of HOMA index and blood pressure were significantly associated with MA prevalence. Also, excluding newly diagnosed diabetic and hypertensive subjects, the MA prevalence was 5.7% (6.9% in men, 4.7% in women) and in multiple logistic regression analysis, the MA prevalence significantly increased in the individuals with pre-HTN rather than in the normotensives. CONCLUSIONS: The MA prevalence was 7.7% in all subjects. Except the newly diagnosed diabetic and hypertensive subjects, it was 5.7%. The MA prevalence was significantly increased in the individuals with pre-HTN rather than in the normotensives and MA was related with insulin resistance.

The association of KLOTHO gene polymorphism with coronary artery disease in Korean subjects / 대한내과학회지

BACKGROUND: Klotho knock-out mouse is being thought as a good animal model for human aging and these mice show typically severe atherosclerosis of large arteries. Recent studies report on the association of KLOTHO gene mutation with cardiovascular diseases in humans. We observed the frequencies of G395A in promoter and C1818T in exon 4 of KLOTHO gene and investigated their relationships with the presence of coronary artery disease (CAD) in those patients underwent coronary angiograms METHODS: Total 168 subjects (mean age 58 years, 26-87 years) who underwent coronary angiograms due to chest pain were enrolled and blood pressure, body mass index, fasting blood glucose and lipid profiles were measured in all subjects. Genotypings were performed with real-time polymerase chain reaction from sampled blood. RESULTS: The allele frequencies of G395A were 0.872 for G allele and 0.128 for A allele and those of C1818T were 0.830 for C allele and 0.170 for T allele. Both were in compliance with Hardy-Weinberg equilibrium (p=0.99, p=0.82). When the subjects were classified into four groups according to the number of stenotic vessels, there were no differences among the mean values of the cardiovascular risk factors, except high-density lipoprotein cholesterol, that showed a significant difference between that of normal and the diseased vessel groups. There were no differences in the prevalence of CAD according to the genotypes of G395A polymorphism, but for C1818T polymorphism, subjects with T allele showed lower prevalence of CAD than those with CC genotype. When the subjects were divided into two groups according to age, in the group under 60 years of age, T allele carriers of C1818T polymorphism showed lower prevalence of CAD than non-carriers. In the group older than 60 years, A allele carriers of G395A polymorphism showed lower prevalence of CAD than non-carriers. CONCLUSIONS: The frequencies of KLOTHO G395A and C1818T polymorphisms in Koreans were observed similarly to those reported in other Asian races and the phenotypic expression on CAD was different according to age groups. These results infer the possibility of KLOTHO gene as the candidate gene of atherosclerosis in humans, which needs further research.

Association between two SNPs (+45T>G and +276G>T) of the adiponectin gene and coronary artery diseases / 대한내과학회지

BACKGROUND: Adiponectin, an adipocyte-secreted protein, is known to have anti-atherogenic, anti-inflammatory and anti-diabetic properties. Adiponectin levels are decreased in obesity, type 2 diabetes, and coronary artery disease. Several studies have been performed aiming to investigate the association of genetic variations in the adiponectin with obesity, insulin resistance, and type 2 diabetes but few studies were performed in association with coronary artery disease. Therefore we examined the association between two single nucleotide polymorphisms (SNPs) (+45T>G and +276G>T) of the adiponectin gene and coronary artery diseases (CAD). METHODS: One hundred fifty six subjects were enrolled in which coronary angiograms were performed due to chest pain in Kangbuk Samsung Hospital from April to August, 2003 (97 males, 59 females, mean age 57.40+/-11.15 yrs). Body mass index, fasting blood glucose, lipid profiles were measured in every subject. Single nucleotide polymorphisms (SNPs) in the adiponectin gene were determined by Taqman polymerase chain reaction (PCR) method. The presence of CAD was defined as a >50% reduction of coronary artery diameter. RESULTS: Among 156 subjects, the allele frequencies were 0.683 for G allele and 0.317 for T allele in SNP +276G>T and 0.705 for T allele and 0.295 for G allele in SNP +45T>G. Both genotypes were in compliance with Hardy-Weinberg equlibrium. Mean serum fasting glucose level was significantly higher and mean high-density lipoprotein cholesterol (HDL-C) level was lower in CAD groups (p=0.015, p=0.004). No association with the presence of CAD was observed for adiponectin gene SNP276 and SNP45 (p=0.954, p=0.843). Also, no significant association was observed between the severity of CAD and either SNPs (p=0.571, p=0.955). CONCLUSIONS: Our study showed that SNP +276G>T and +45T>G in adiponectin gene were not associated with the presence of CAD. Further studies will be necessary to confirm the role of SNP 276G>T and 45T>G in the development of CAD.

Relationship between Heart Rate Turbulence and Heart Rate Variability in Korean Adults with Structurally Normal Heart

BACKGROUND AND OBJECTIVES: Heart rate variability (HRV) illustrates the autonomic integration of the heart. Depressed HRV has been proven to be associated with an increased risk of cardiac death, whereas heart rate turbulence (HRT) is believed to reflect baroreflex sensitivity and it was recently introduced as another noninvasive tool for risk stratification. The aim of this study was to determine the relationship between the HRT and HRV parameters in Korean adults with a structurally normal heart. SUBJECTS AND METHODS: We studied 61 adults (males: 31) who showed ventricular premature complexes on 24 hour Holter recording and who were found to have normal hearts on full noninvasive investigation. We calculated the mean heart rate (RR interval), the number of VPBs, the time- and frequency-domain HRV parameters and two HRT parameters: turbulence onset (To) and turbulence slope (Ts). RESULTS: Ts showed a strong correlation with the HRV parameters (LF/HF ratio: r=0.35, p=0.006; VLF: r=0.32, p=0.013; LF: r=0.27, p=0.035; SDNN: r=0.28, p=0.029; SDANN: r=0.32, p=0.012), but To showed no significant correlation with the HRV parameters. CONCLUSION: The HRT parameters, and especially Ts, correlate strongly with the HRV parameters; therefore, Ts should be considered as a parameter that reflects the overall cardiac autonomic tone.

Distribution of Serum Lipoprotein(a) Level and its Association with Other Risk Factors in Apparently Healthy Korean

BACKGROUND AND OBJECTIVES: Recent studies have demonstrated that lipoprotein (a) [Lp(a)] plays an important role in atherothrombogenesis and to be associated with an increased risk for cardiovascular disease. SUBJECTS AND METHODS: We evaluated the distribution of Lp (a) and its association with cardiovascular risk factors, by conducting a cross sectional survey of 14,516 apparently healthy Koreans. The study group consisted of 8,007 men and 6,509 women, aged 20 years and over. RESULTS: The mean, medium and 75th percentile Lp (a) levels were 20.1, 13.2 and 23.8 mg/dL, respectively. The distribution of Lp (a) was highly skewed toward a lower level. The Lp (a) level was positively associated with age (p<0.001) and low density lipoprotein (LDL)(p<0.001). The body mass index (BMI)(p=0.006), log (triglyceride)(p<0.001) and alcohol consumption more than 3 times per week (p<0.047) were inversely related to the Lp (a) level. However, no relationship was seen with smoking, gender, exercise, homeostatic model assessment-insulin resistance (HOMA-IR) and high sensitivity C reactive protein (hsCRP). CONCLUSION: The Lp (a) level was positively associated with age and low density lipoprotein (LDL). The body mass index (BMI) and log (triglyceride) were inversely related to the Lp (a) level. However, the association between Lp (a) and cardiovascular disease in the general Korean population should be confirmed via large scale prospective cohort studies.

Effect of Exercise on Serum C-Reactive Protein

BACKGROUND AND OBJECTIVES: Regular exercise protects us against numerous chronic diseases, and reduces the risk of cardiovascular disease. Also, C-reactive protein, a marker of inflammation, is known to be associated with the risk and prognosis of cardiovascular disease. The present study was designed to assess the effects of regular exercise on the level of high sensitive C-reactive protein (hsCRP). SUBJECTS AND METHODS: The serum level of hsCRP and the anthropometric indices of adiposity, metabolic variables, blood pressure (BP) and several cardiovascular risk factors were measured in 18445 subjects. A prospective study of 42 subjects with high baseline levels of hsCRP was conducted. After 3 months of regular aerobic exercise their hsCRP levels were rechecked and the association between regular exercise and hsCRP analyzed using a cross sectional and prospective study. RESULTS: Age, smoking, hypertension, diabetes and body mass index were found to be independent determinants of an elevated hsCRP level, but exercise was not found to be associated with a decreased hsCRP level in the cross-sectional study. In the prospective study, the mean serum hsCRP value was significantly reduced after 3 months in the exercise group (3.02+/-1.06 vs. 2.05+/-1.23 p=0.015), but not in the controls (3.03+/-1.09 vs. 2.57+/-1.11 p=0.104). However, the interval changes in hsCRP levels were not different in the exercise compared to the control group (p=0.660). CONCLUSION: These results suggest that exercise is not an independent determinant of the CRP level. Three months of regular aerobic exercise show a tendency to be associated with a reduction in the hsCRP level, but this putative effect of exercise on the hsCRP level was not significant in healthy subjects. Further larger sample, prospective cohort studies will be required to establish the effect of exercise on the hsCRP level.

Relationship between Heart Rate Reduction and Insulin Resistance in Normoglycemic Individuals

BACKGROUND AND OBJECTIVES: It is well known that, regardless of whether a person has cardiovascular diseases, the reduction of heart rate after exercise reflects the impairment of the autonomic nervous system. It is also a predictive factor of death rate and it correlates to insulin resistance. Therefore, we assessed these correlations in normoglycemic subjects. SUBJECTS AND METHODS: Exercise stress testing was performed according to the Bruce protocol. Anthropometric indices of adiposity, metabolic variables, blood pressure (BP) and several cardiovascular risk factors were measured. The HOMA index was used as the insulin resistance, and the impairment of the autonomic nervous system was assessed by measuring the reduction of heart rate for 2 minutes after the cessation of exercise. RESULTS: The reduction of heart rate during 2 minutes after the cessation of exercise statistically correlated with the HOMA index, gender, age, body mass index, the waist circumference, heart rate during rest, the maximum heart rate, serum total cholesterol concentration, serum high density lipoprotein cholesterol concentration and serum low density lipoprotein cholesterol concentration, (p<0.05). However, on multiple regression analysis, the HOMA index, gender, heart rate during rest, and the maximum heart rate significantly correlated to the reduction of heart rate during 2 minutes after the cessation of exercise. CONCLUSION: In individuals with normal serum glucose levels, even after adjustment was made for other factors, the reduction of heart rate after the cessation of exercise correlated to insulin resistance. Hence, in individuals with normal serum glucose levels, efforts to improve insulin resistance have to be made, and prospective study on this subject is required.

The Relationship between Cardiovascular Risk Factors and the Serum Ferritin Level in Relation to C-Reactive Protein in Korean

BACKGROUND AND OBJECTIVES: Iron is a key component in the production of oxidized low density lipoprotein (LDL), which increases cardiovascular disease through inflammation. However, there is little data to suggest that oxidative stress is positively correlated with C-reactive protein (CRP). The purpose of this study was to examine the influence of the serum ferritin level and cardiovascular risk factors on CRP in a Korean population. SUBJECTS AND METHODS: A total of 808 subjects (465 men, 343 women), who had undergone a medical check-up at the health promotion center at Kangbuk Samsung Hospital, between September 2002 and November 2002, were included in this study. Logistic regression models were computed using elevated or nonelevated hsCRP, as dependent variable, with cardiovascular risk factors, such as, serum ferritin, total, LDL and HDL cholesterols, controlling for potential confounders, including age, gender, body mass index (BMI), hypertension, diabetes and smoking. RESULTS: Significant positive correlations were found between hsCRP and age, BMI, triglyceride and the level of serum ferritin, with a negative correlation found between hsCRP and HDL cholesterol. In age, gender, BMI, hypertension, diabetes, a smoking-adjusted model, an elevated ferritin level were not significantly associated with elevated hsCRP in low LDL subjects (OR=1.68, 95% CI=0.81-3.48), but significant associations were observed in high LDL subjects (OR=11.21, 95% CI=1.14-110.27). And we observed the significant effect modification of the association of hsCRP with serum ferritin level by LDL-cholesterol (p=0.002). CONCLUSION: Our results suggest that increased LDL cholesterol and ferritin have an effect on the increment of hsCRP. Thus, iron-catalyzed oxidation of LDL cholesterol may be an important step of the development of the inflammatory process. Further prospective studies will need to be performed to establish the relationship between the decreasing of the serum ferritin level and CRP for the prevention of cardiovascular disease.

Concordance/Discordance between Apolipoprotein B Levels and the Cholesterol Indexes

BACKGROUND AND OBJECTIVES: Apolipoprotein B (Apo-B) has been reported to be a better predictor of the coronary artery disease (CAD) than the cholesterol indexes. The aim of this study was to examine the concordance/discordance between the apolipoprotein B levels and the cholesterol indexes, and to assess the factors affecting the discordance. SUBJECTS AND METHODS: A total of 11,816 participants (6,965 men and 4,851 women) were enrolled in this study from all the individuals who participated in medical screening examinations at the health promotion center in Kangbuk Samsung Hospital from January to December 2002. All the participants had no history of coronary artery disease. We assessed the concordance between the biochemical parameters of the atherogenic indexes, and we evaluated the factors affecting the discordance. RESULTS: Despite the fact that the Apo-B and the various cholesterol indexes were highly correlated, the concordance rate was merely 47-56%. Multinomial logistic regression analysis showed the possibility of an increased risk for the group of discordance in whom Apo-B level was disproportionately higher than LDL cholesterol in the elderly, the smokers, the men and the people having a larger waist circumference, a lower total cholesterol level, a higher triglyceride level and a higher HDL-C level. CONCLUSION: The measurement of apo B, along with the measurement of the standard lipid profile, could be a great help in evaluating the CAD risk and for aiding in the treatment of dyslipidemia in the elderly, the smokers, men and the people having a larger waist circumference, a lower total cholesterol level, a higher triglyceride level and a higher HDL-C level.

Assessment of Factors Influencing Plasma BNP Level in Patients with Chronic Atrial Fibrillation and Preserved Left Ventricular Systolic Function

BACKGROUND AND OBJECTIVES: Several studies have reported that Brain Natriuretic Peptide (BNP) were increased in patients with chronic atrial fibrillation (AF). The objective of this study was to assess the factors influencing plasma BNP levels in patients with chronic AF and preserved left ventricular (LV) systolic function. SUBJECTS AND METHODS: Transthoracic echocardiography was performed in 55 patients (25 men, 30 women; mean age 66.6+/-11.5 years) with chronic AF. At the same time, plasma BNP was measured with a Triage(r) kit (Biosite, San Diego, California). RESULTS: Women, long duration of AF and hypertension were more prevalent in the highest quartile group of BNP levels than in the lowest quartile group of BNP levels. Significant correlations were observed between plasma BNP levels and the following: mitral E velocity (r=0.339), mitral annular E'-velocity (r=-0.396), ratio of mitral E-velocity and mitral annular E' velocity (r=0.473), left atrium (LA) size (r=0.648), LA volume index (r=0.744), right atrium (RA) volume index (r=0.554), maximal velocity (Vmax) of mitral regurgitation (MR) (r=0.444), tricuspid regurgitation (TR) Vmax (r=0.544), MR grade (r=0.431), TR grade (r=0.427) and LV mass index (r=0.570). In stepwise multiple linear regression analysis, LA volume index (beta=0.299, p=0.014), LV mass index (beta=0.404, p<0.001) and duration of AF (beta=0.488, p<0.001) independently predicted plasma BNP levels in this study subjects. The patients with increased LA volume index exhibited longer duration of AF, larger RA volume index and LV mass index, higher MR Vmax, TR Vmax, MR and TR grade and plasma BNP level. CONCLUSION: LA volume index, LV mass index and duration of AF were independent predictors of plama BNP level in patients with chronic AF and preserved LV systolic function.

Seasonal Variation in Insulin Resistance in Koreans

BACKGROUND AND OBJECTIVES: There is a seasonal variation in the incidence of diabetes mellitus and cardiovascular disease. Insulin resistance is important in the development of both non-insulin dependent diabetes mellitus (Type II DM) and cardiovascular disease. Hyperinsulinemia, induced by an insulin resistant state, causes the development of a chronic inflammatory response in vascular structures, which is one of the main causes of cardiovascular disease. There have been several studies on seasonal variation in insulin resistance. Therefore, seasonal variation in insulin resistance were investigated to discover if any relationship existed. SUBJECTS AND METHODS: Korean people examined at a health care center were included. The subjects were divided into four groups, according to the season, and a homeostasis model assessment index (HOMA) calculated, as an indicator of insulin resistance, and compared between the groups. RESULTS: Using the homeostasis model assessment, the highest insulin resistance was observed during winter. Also, the body mass index and waist-hip ratio were highest during winter. CONCLUSION: Compensating for other metabolic factors (age, gender, body mass index, waist-hip ratio and season), insulin resistance was still found to be higher during winter. Seasonal variation in insulin resistance can be associated with the incidence of DM or cardiovascular disease. Therefore, a prospective study will be needed.

Serum C-Reactive Protein Level and its Association with Atrial Fibrillation in Korean Adults

BACKGROUND AND OBJECTIVES: Recent studies have implicated inflammation as playing an important role in the occurrence, persistence and recurrence of atrial fibrillation and that C-reactive protein is a useful marker of the inflammation. The purpose of this study is to evaluate the association between serum CRP levels and the risk of atrial fibrillation. SUBJECTS AND METHODS: This study was performed on 9,487 subjects (5,263 men and 4,224 women; mean age: 58.8+/-6.6 years) who underwent medical check-ups at the Health Promotion Center in Kanbuk Samsung Hospital. 9,438 normal control subjects and 49 atrial fibrillation patients were included in the study. The CRP was measured using a highly sensitive Behring Nephelometer II. RESULTS: When comparing the two groups, there were significant differences in age, gender and the presence of hypertension and cerebrovascular accident, and these are the previously known risk factors for atrial fibrillation. After adjustment was made for the clinical significant variables of atrial fibrillation, multiple regression analysis revealed that the hsCRP levels were not associated with the risk for atrial fibrillation (p=0.52). CONCLUSION: The inflammatory markers (CRP, WBC count) were not predictive of a higher risk for atrial fibrillation in the Korean population.

The Relationship of the Hypertension, Insulin Resistance, and Metabolic Syndrome in the Serum Uric Acid Level

BACKGROUND AND OBJECTIVE: The relationship between serum uric acid and metabolic syndrome variables has not been reported in Korea. Therefore, whether the circulating levels of serum uric acid are independently related to hypertension, insulin resistance and the variables of metabolic syndrome were assessed. SUCJECTS AND METHODS: A total of 53,477 health screen examinees were enrolled and divided into four groups (Quartile 1:6.29 mg/dL) according to their serum uric acid level. The blood pressure, lipid profiles, fasting plasma glucose, waist circumference, HOMA, high sensitivity CRP and apolipoprotein were compared between the four groups. RESULTS: There was a positive association between blood pressure and the serum uric acid level (p<0.001). After adjustment for covariates the prevalence of hypertension due to uric acid was 1.192 (95% CI, 1.038-1.368 p=0.013), and 1.408 (95% CI, 1.221-1.623 p<0.001) times higher in subjects in the third and fourth uric acid level quartiles, respectively, compared to the subjects in the first quartile. Insulin resistance and metabolic syndrome variables were positively correlated with the serum uric acid level. The number of metabolic syndrome variables was also increased with an elevated serum uric acid level. CONCLUSION: Our study suggests that serum uric acid levels were independently associated with hypertension, insulin resistance and the variables of metabolic syndrome in the Korean population. Although the serum uric acid level was normal value, the risk of metabolic syndrome was increased with an elevated serum uric acid level. However, because of the cross-sectional nature of our study, these findings should be confirmed in prospective cohort studies.

Association between serum osteoprotegerin levels and disease severity and cardiovascular risk factors in patients with coronary artery diseases / 대한내과학회지

BACKGROUND: Osteoprotegerin (OPG) is a glycoprotein that acts as a decoy receptor to receptor-activated RANKL (receptor-activated NF-kappa B ligand) and inhibits the differentiation of osteoclasts. OPG knock-out mice showed severe osteoporosis and aortic calcification and high serum OPG levels have been shown to predict future cardiovascular mortality in old Caucasian females. We measured serum OPG levels in coronary artery disease patients, compared serum OPG levels among different groups according to the number of stenotic vessels and observed the correlation with aortic calcification and cardiovascular risk factors. METHODS: One hundred subjects were enrolled in which coronary angiograms were performed due to chest pain in Kangbuk Samsung Hospital from April to August, 2003 (59 males, 41 females, mean age 56.9 +/- 11.9 yrs). Blood pressure, body mass index, fasting blood glucose, total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol levels were measured in every subject. Cardiac echocardiograms were checked in 82 subjects and left ventricular mass indices (LV mass index) were calculated. Serum OPG levels were measured with enzyme-linked immunosorbent assay (ELISA) method. The presence of calcifications in aortic knob was checked in simple chest X-ray. RESULTS: Subjects were divided in 4 groups according to the number of stenotic vessels (significant stenosis>or=50%); 45 subjects in normal group, 30 in 1-vessel disease group, 15 in 2-vessel disease group and 10 in 3-vessel disease group. Mean value for age was significantly different among groups (p<0.01). Mean serum HDL-cholesterol level of normal group was higher than that of 1-vessel disease or 2-vessel disease group (p<0.05). Serum OPG levels increased significantly as the number of stenotic vessels increased and in post-hoc analysis, mean serum OPG levels were higher in 3-vessel disease group than normal or 1-vessel disease groups (p<0.05). Age, LV mass index and number of stenotic vessels showed significantly positive correlation with serum OPG levels, although only number of stenotic vessels showed persistently significant correlation after adjustment for age. There were no differences of serum OPG levels according to the presence of fasting hyperglycemia or aortic calcifications. CONCLUSION: Serum OPG levels increased as the number of stenotic coronary arteries increased and showed positive relationships with age, LV mass index. OPG seems to be elevated as a compensatory mechanism to the progression of atherosclerosis in humans.