Chinese visceral adiposity index and its relation to abnormal left ventricular remodeling assessed by relative wall thickness and left ventricular mass index.

BACKGROUND AND AIMS: The Chinese visceral adipose index (CVAI) is more significantly associated with cardiometabolic risk factors than other obesity indices. This study investigated the relationship between CVAI and left ventricular (LV) remodeling. METHODS AND RESULTS: This study included 75,132 Koreans who underwent echocardiography during a health checkup. They were grouped according to quartile levels of the CVAI, body mass index (BMI), waist circumference (WC), and visceral adiposity index (VAI). LV remodeling was defined as the presence of abnormal relative wall thickness (ARWT) and left ventricular hypertrophy (LVH). Multivariate adjusted logistic regression analysis (adjusted OR [95% confidence interval]) was used to analyze the association between ARWT and LVH according to the quartile levels of each index. Receiver operating characteristic (ROC) graphs and areas under the curve (AUC) were calculated to identify the predictive ability of the indices for ARWT and LVH. ARWT was associated proportionally with CVAI quartiles in both men (second quartile: 1.42 [1.29-1.56], third quartile: 1.61 [1.46-1.77], fourth quartile: 2.01 [1.84-2.21]), and women (second quartile: 1.06 [0.78-1.45], third quartile: 1.15 [0.86-1.55], and fourth quartile: 2.09 [1.56-2.80]). LVH was significantly associated with third (1.74 [1.07-2.83]) and fourth quartile (1.94 [1.18-3.20]) groups of CVAI in women. ROC and AUC analyses indicated that CVAI was superior to other indices in predicting ARWT in men and LVH and ARWT in women. CONCLUSION: The CVAI is an effective surrogate marker of LV remodeling, particularly in women.

Association of environmental tobacco smoke exposure with metabolic syndrome: A longitudinal Cohort Study of 71,055 never smokers.

BACKGROUND AND AIMS: Effects of environmental tobacco smoke (ETS) exposure and a change in ETS exposure status on metabolic syndrome (MetS) remain unknown. Thus, the aim of this study was to evaluate the effect of ETS exposure on MetS in self-reported and cotinine-validated never smokers. METHODS AND RESULTS: From a large longitudinal cohort study, 71,055 cotinine-validated never smokers without MetS at baseline were included. These participants were divided into four groups (no, new, former, and continuous ETS exposure groups) based on their ETS exposure status at baseline and follow-up. The association between ETS exposure and MetS was assessed using multivariable Cox hazard regression analyses. During a median follow-up of 33 months, 15.0 cases/10,000 person-years (PY) developed MetS. Incidence rates per 10,000 PY of MetS in no, new, former, and continuous ETS exposure groups were 14.0, 18.5, 16.5, and 19.0, respectively. In multivariable Cox hazard regression analyses, the new and continuous ETS exposure groups showed increased risk of MetS compared to the no ETS exposure group (hazard ratio [95% confidence interval]: 1.35 [1.16, 1.56], p-value < 0.001 for the new ETS exposure group and 1.19 [1.06, 1.34], p-value = 0.004 for the continuous ETS exposure group). However, the former ETS exposure group did not show an increased risk of MetS (0.96 [0.88, 1.05], p-value = 0.36). CONCLUSION: This study showed that ETS exposure and changes in ETS exposure status over approximately three years could modify the risk of MetS, suggesting that avoidance of ETS may not increase the risk of incidence of MetS.

Effect of physical activity on the development and the resolution of nonalcoholic fatty liver in relation to body mass index.

BACKGROUND: Data on whether physical activity (PA) levels are related to nonalcoholic fatty liver disease (NAFLD) when considering body mass index (BMI) are scarce. We assessed whether PA affects the development or resolution of NAFLD in conjunction with BMI changes. METHODS: Overall, 130,144 participants who underwent health screening during 2011-2016 were enrolled. According to the PA level in the Korean version of the validated International PA Questionnaire Short Form, participants were classified into the inactive, active, and health-enhancing PA (HEPA) groups. RESULTS: In participants with increased BMI, the hazard ratio (HR) and 95% confidence interval after multivariable Cox hazard model for incident NAFLD was 0.97 (0.94-1.01) in the active group and 0.94 (0.89-0.99) in the HEPA group, whereas that for NAFLD resolution was 1.03 (0.92-1.16) and 1.04 (0.88-1.23) (reference: inactive group). With increased BMI, high PA affected only new incident NAFLD. PA enhancement or maintenance of sufficient PA prevented new incident NAFLD. In participants with decreased BMI, the HRs were 0.98 (0.90-1.07) and 0.88 (0.78-0.99) for incident NAFLD and 1.07 (0.98-1.17) and 1.33 (1.18-1.49) for NAFLD resolution in the active and HEPA groups, respectively. With decreased BMI, high PA reduced incident NAFLD and increased NAFLD resolution. Maintenance of sufficient PA led to a considerable resolution of NAFLD. CONCLUSION: In this large longitudinal study, PA prevented incident NAFLD regardless of BMI changes. For NAFLD resolution, sufficient PA was essential along with BMI decrease. Maintaining sufficient PA or increasing the PA level is crucial for NAFLD prevention or resolution.

Association of Sugar-Sweetened Carbonated Beverage with the Alteration in Left Ventricular Structure and Diastolic Function.

BACKGROUND: High consumption of sugar-sweetened carbonated beverage (SSCB) has been associated with multiple metabolic risk factors for cardiovascular disease. However, published data is scarce regarding the influence of SSCB consumption on left ventricular (LV) structure and diastolic function. The present study is to investigate the association of SSCB consumption with alteration in LV structure and diastolic function. METHOD: Study subjects were 46,417 Koreans who received echocardiography as an item of health checkup. They were categorized into 4 groups by SSCB consumption based on one serving dose (200 ml) with never/almost never, <1 serving/week, 1 ≤ serving/week <3 and ≥3 serving/week. Multivariate logistic regression analysis was used in calculating adjusted odd ratio (OR) and 95% confidence interval (CI) (adjusted OR [95% CI]) for left ventricular hypertrophy, increased relative wall thickness (IRWT) and impaired LV relaxation with each group (reference: never/almost never consumption). Subgroup analysis was conducted by age of ≥40 and <40. RESULT: Compared with never/almost never consumption, SSCB consumption ≥3 serving/week had the higher mean levels in body mass index, blood pressure and triglyceride despite of younger age. In fully adjusted analysis, SSCB consumption ≥3 serving/week was associated with IRWT (1.14 [1.02-1.27]) and impaired LV relaxation (1.23 [1.08-1.41]). This association was reinforced in age subgroup ≥40 years, but not statistically significant in age subgroup <40 years. CONCLUSION: SSCB consumption ≥3 serving/week was associated with the increased probability of IRWT and impaired LV relaxation.

Effects of Age, Sex, and Obesity on N-Terminal Pro B-Type Natriuretic Peptide Concentrations in the General Population.

BACKGROUND: Data regarding complex relationships between age, sex, obesity and N-terminal pro B-type natriuretic peptide (NT-proBNP) remain scarce. Thus, we investigated sex-specific associations of obesity and NT-proBNP levels among adults in the general healthy population in Korea.Methods and Results:The associations of age, sex and obesity-associated parameters (waist circumference [WC], body mass index [BMI] and body weight) with NT-proBNP were analyzed in 39,937 healthy adult participants. Multivariable regression models adjusted for factors known to affect NT-proBNP were used to identify associations between NT-proBNP and obesity-related parameters. NT-proBNP levels were higher in females than males. Older age was also associated with higher NT-proBNP levels in the overall population (P<0.001). When accounting for age in multivariable linear regression models, there was a strong inverse association between WC, BMI, and NT-proBNP in females and a weaker inverse association in males, with a significant difference between the sexes (P interaction <0.001). After adjusting for the effects of WC and BMI on each other, abdominal obesity was associated with lower NT-proBNP levels in females but not males (P interaction <0.001). CONCLUSIONS: In this large sample of young and healthy Asians, younger age, male sex, and increases in obesity-related parameters were related to lower levels of NT-proBNP. Further comprehensive studies are needed to understand the factors affecting NT-proBNP levels in different populations.

Smoking Status, Intensity of Smoking, and Their Relation to Left Ventricular Hypertrophy in Working Aged Korean Men.

INTRODUCTION: Smoking is an established risk factor for atherosclerotic cardiovascular disease. However, the effect of smoking on left ventricular (LV) structure has been less studied. This study was designed to assess the association of smoking status and smoking intensity with left ventricular hypertrophy (LVH). METHODS: Study subjects were 53,666 working aged Korean men who received echocardiography as an item of health check up. They were grouped by smoking status (never, former, and current smokers), pack-year of smoking (never, <10, 10-19.9, and ≥20 pack-year), and urine cotinine excretion (<100, 100-999, ≥1000 ng/mL). Multivariate logistic regression analysis was used in calculating adjusted odds ratios (ORs) and 95% confidence interval for LVH (adjusted odds ratios [95% confidence interval]). The proportions of abnormal LV geometry patterns were compared among groups. RESULTS: Former and current smokers had the higher levels in LV mass index, relative wall thickness, and the prevalence of LVH than never smoker. The association with LVH increased in order of never (reference), former (1.44 [1.01-2.04]), and current smokers (2.10 [1.44-3.05]). LVH showed the proportional relationship with pack-year of smoking (never smoker: reference, <10: 1.45 [1.01-2.08], 10-19.9: 1.73 [1.17-2.57], ≥20: 2.43 [1.58-3.74]) and urine cotinine excretion (never smoker: reference, 100-999: 1.70 [1.21-2.37], >1000: 1.97 [1.43-2.72]). The proportions of abnormal LV geometry patterns were higher in smoking groups than never smoking group. CONCLUSION: Exposure to tobacco use and intensity of smoking was associated with LVH in working aged population. IMPLICATIONS: In working aged Koreans with mean age of 39.9 ± 7.0 years, former and current smokers are more likely to have LVH than never smoker. Dose-dependent relationship was found between the smoking status (never, former, and current smokers), pack-year of smoking, urine cotinine excretion, and LVH. These findings indicate that smoking has an adverse influence on LV structure even in relatively young age group.

The association between left ventricular hypertrophy and consumption of nuts, including peanuts, pine nuts, and almonds.

BACKGROUND AND AIMS: Studies have reported that nut consumption is potentially beneficial in preventing cardiovascular disease. However, data are insufficient regarding the association between nut consumption and left ventricular hypertrophy (LVH). METHODS AND RESULTS: In the Kangbuk Samsung Health Study, the participants were 34,617 men and 12,257 women who completed a food-frequency questionnaire for nut consumption and received echocardiography. Nut consumption was evaluated only for peanuts, pine nuts, and almonds defining 15 g as one serving/servings dose. Multivariable adjusted odds ratio (OR) and 95% confidence interval (CI) for LVH were evaluated according to the consumption frequency of one serving dose of nut. The frequency of nut consumption was categorized into five groups (<1/month, 1/month-1/week, 1-2/week, 2-4/week, and ≥4/week). The subgroup analysis was conducted by dividing the participants into the following two groups: the nonhypertensive/nondiabetic group and hypertensive or diabetic group. In women, nut consumption ≥2/week had the lower multivariable adjusted OR and 95% CI for LVH (2-4/week: 0.46 [0.26-0.81] and ≥4/week: 0.48 [0.25-0.92]) when compared with nut consumption <1/month. This association was identically observed in the subgroup analysis for women without hypertension and diabetes mellitus (DM) and women with hypertension or DM. However, men did not show the significant association. CONCLUSION: In women, nut consumption ≥2/week was associated with the decreased probability of LVH. Further research studies should investigate whether the beneficial effect of nut consumption on LV structure results in better cardiovascular prognosis.

Association of Left Ventricular Hypertrophy with Hemoglobin Levels in Nonanemic and Anemic Populations.

INTRODUCTION: It is established that anemia leads to adaptive changes in cardiac geometry including left ventricular hypertrophy (LVH). However, published data are still scarce regarding the association of LVH with normal-range hemoglobin levels. OBJECTIVE: To evaluate the association between hemoglobin level and LVH in subjects with or without anemia. METHODS: The study included 48,034 Korean men and women who received echocardiography during their medical health checkup. They were divided into 4 groups according to their hemoglobin concentration (g/dL) in men (<14, 14-14.9, 15-15.9, and ≥16) and women (<12, 12-12.9, 13-13.9, and ≥15). Multivariate logistic regression analysis was used to calculate adjusted ORs and 95% CI for LVH in each group compared with the group with the lowest hemoglobin. Subgroup analysis was conducted for subjects within normal hemoglobin levels. RESULTS: There was an inverse relationship between hemoglobin levels and LVH, where unadjusted and adjusted ORs and 95% CI for LVH decreased with increasing hemoglobin levels in both men and women. In subgroup analysis, this inverse relationship was also observed in subjects with hemoglobin in the nonanemic range. CONCLUSION: The decrease in hemoglobin was significantly associated with the increased probability of LVH, and this association was found even in nonanemic subjects.

Mildly Decreased Renal Function and Its Relation to Left Ventricular Geometry Change.

BACKGROUND: It is believed that left ventricular (LV) geometry change contributes to the elevated cardiovascular risk in patients with chronic kidney disease. However, data are less available on the association between LV geometry change and mildly decreased renal function within estimated glomerular filtration rate (eGFR) from 60 to 89 (mL/min/1.73 m2).Methods and Results:In a cohort of 47,730 Koreans undergoing echocardiography as part of a health check-up, we evaluated the association of LV hypertrophy (LVH) and abnormal relative wall thickness (RWT) with 4 levels and 3 levels of eGFR in men (≥90, 89.99-80, 79.99-70, 69.99-60) and women (≥90, 89.99-80, 79.99-60), respectively. Multivariate logistic regression analysis was used to calculate the odds ratios (OR) and 95% confidence intervals (CI) for LVH and abnormal RWT, adjusting for conventional cardiovascular risk factors (adjusted OR [95% CI]). In the fully adjustment model, men did not show a significant association between LVH and levels of eGFR between 60 and 89. However, abnormal RWT was significantly associated with the levels of eGFR between 60 and 89. Women did not show a significant association of LVH and abnormal RWT with levels of eGFR between 60 and 89. CONCLUSIONS: Men with mildly decreased renal function (eGFR between 60 and 89 mL/min/1.73 m2) had increased probability of LV geometry change represented by abnormal RWT.

Association Between Sonographically Diagnosed Nephrolithiasis and Subclinical Coronary Artery Calcification in Adults.

BACKGROUND: Although recent studies suggest an association between nephrolithiasis and clinical cardiovascular events, this association has been underexplored. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: 62,091 asymptomatic adults without known coronary heart disease who underwent a screening health examination that included cardiac tomography. PREDICTOR: Nephrolithiasis. OUTCOME: Coronary artery calcification (CAC). MEASUREMENTS: Nephrolithiasis assessed using ultrasonography of the abdomen. CAC scoring assessed using cardiac computed tomography. RESULTS: The prevalence of CAC scores > 0 was 13.1% overall. Participants with nephrolithiasis had a higher prevalence of coronary calcification than those without (19.1% vs 12.8%). In Tobit models adjusted for age and sex, the CAC score ratio comparing participants with nephrolithiasis with those without nephrolithiasis was 1.56 (95% CI, 1.19-2.05). After further adjustment for screening center, year of screening examination, physical activity, alcohol intake, smoking status, education level, body mass index, family history of cardiovascular disease, total energy intake, glucose concentration, systolic blood pressure, triglyceride concentration, high-density lipoprotein cholesterol concentration, uric acid concentration, and estimated glomerular filtration rate, the CAC score ratio was attenuated, but remained significant (CAC score ratio, 1.31; 95% CI, 1.00-1.71). LIMITATIONS: Computed tomographic diagnosis of nephrolithiasis was unavailable. CONCLUSIONS: Nephrolithiasis was associated with the presence of CAC in adults without known coronary heart disease, supporting the hypothesis that these 2 health conditions share a common pathophysiology.

Sleep Duration and Quality as Related to Left Ventricular Structure and Function.

OBJECTIVE: Inadequate sleep is associated with increased risk of cardiovascular events; however, the associations between sleep duration or quality and cardiac function or structure are not well understood. This cross-sectional study was conducted to investigate to what extent sleep duration and quality are associated with left ventricular (LV) diastolic dysfunction or structural deterioration. METHODS: A total of 31,598 healthy Korean adults who received echocardiography and completed the Pittsburg Sleep Quality Index were enrolled in this study. Participants were stratified into three groups by self-reported sleep duration (i.e., <7, 7-9, >9 hours) and into two groups by subjective sleep quality. Sleep duration was also assessed as a continuous variable. The odds ratios for impaired LV diastolic function, increased relative wall thickness, and LV hypertrophy (LVH) were compared between groups using multivariable logistic regression analyses. RESULTS: After adjustment for confounding variables (e.g., age, smoking, body mass index), there was a statistically significant association between short sleep duration (<7 hours) and greater LVH (fully adjusted odds ratio = 1.32 [95% confidence interval {CI} = 1.02-1.73]). Short sleep duration was also significantly associated with greater LVH (0.87 per hour [95% CI = 0.78-0.98]) and increased relative wall thickness (0.92 [95% CI = 0.86-0.99]), but there was no significant association between sleep and LV diastolic function. Among individuals with normal sleep duration, poor quality of sleep was not associated with adverse cardiac measures. CONCLUSIONS: These results indicate that short sleep duration (<7 hours) is associated with unfavorable LV structural characteristics. The association of insufficient sleep with adverse cardiovascular health outcomes may be mediated in part by adverse changes in cardiac structure and function.

Association of Age at Menarche With Left Ventricular Diastolic Dysfunction in Middle-Aged Women.

BACKGROUND: There is sparse research on whether if early menarche is related to left ventricular (LV) diastolic dysfunction. The present study examined this relationship in Korean women.Methods and Results:In a cross-sectional study we analyzed the records of 18,910 Korean women (≥30 years) who underwent echocardiography as part of a comprehensive health examination. Age at menarche was assessed using standardized, self-administered questionnaires. Presence of LV diastolic dysfunction was determined from the echocardiographic findings. Of the 18,910 women, 3,449 had LV diastolic dysfunction. Age at menarche was inversely associated with prevalence of LV diastolic dysfunction. In a multivariable-adjusted model, odds ratios (95% confidence interval) for LV diastolic dysfunction comparing menarche age to menarche at 15-18 years were 1.77 (1.38-2.27) for <12 years, 1.31 (1.11-1.54) for 12 years, 1.26 (1.11-1.43) for 13 years, and 1.03 (0.91-1.15) for 14 years (P for trend <0.001). Adjusting for body mass index or percent fat mass partially reduced these associations. CONCLUSIONS: This large study found an inverse relationship between menarche age and LV diastolic dysfunction. Future prospective studies are needed to investigate potential causal relationships.

Effect of non-alcoholic fatty liver disease on left ventricular diastolic function and geometry in the Korean general population.

AIM: Previous studies showed that non-alcoholic fatty liver disease (NALFD) could be related to subclinical left ventricular (LV) diastolic dysfunction and remodeling. However, this association is still equivocal in the general population. Thus, this study was carried out to examine whether NAFLD is associated with the risk for LV diastolic dysfunction and remodeling. METHODS: A cross-sectional study was carried out for 20 821 Korean men and women who received a health checkup including echocardiography from 2011 to 2012. The study population was divided into three groups of normal, mild and moderate-to-severe NAFLD detected by ultrasonography. Using multivariable logistic regression analysis, the odd ratios of abnormal LV relaxation and remodeling were analyzed according to the degree of NAFLD. Additionally, adjusted mean values of LV diastolic functional and structural parameters were evaluated in the three groups. RESULTS: Compared with the normal group, the mild and moderate-to-severe NAFLD groups had higher odd ratios for abnormal LV relaxation (mild group 1.29, 95% confidence interval 1.15-1.46; moderate-to-severe group 1.95, 95% confidence interval 1.61-2.35) and increased relative wall thickness (>0.42; mild group 1.26, 95% confidence interval 1.05-1.52; moderate-to-severe group 1.46, 95% confidence interval 1.08-1.95). Analyzing adjusted mean values of LV parameters also showed the significant association between the degree of NAFLD and impaired LV diastolic function and concentric LV remodeling. CONCLUSIONS: The risk for LV diastolic dysfunction and remodeling proportionally increased according to the degree of NAFLD. NAFLD is significantly associated with LV functional and structural alteration.

Effect of Overweight and Obesity (Defined by Asian-Specific Cutoff Criteria) on Left Ventricular Diastolic Function and Structure in a General Korean Population.

BACKGROUND: Although obesity is a well-known risk factor for cardiovascular disease, the cutoff of body mass index (BMI) for elevated cardiovascular risk is still controversial in Asian. Thus, this study was conducted to investigate the functional and structural changes of the left ventricle (LV) according to the degree of obesity in a general Korean population.Methods and Results:A total of 31,334 apparently healthy Korean adults who underwent echocardiography were enrolled. The study population was stratified into 5 groups according to the degree of obesity classified by the Asian-Pacific obesity guideline. The odd ratios (ORs) with 95% confidence interval (CI) of impaired LV diastolic function, LV remodeling, and hypertrophy were compared among the 5 groups using multivariable logistic regression analysis. When the normal group was set as the reference, the adjusted ORs (95% CI) for impaired LV diastolic function showed a proportional relationship with BMI [OR; 0.86 (95% CI 0.59-1.22) in underweight, 1.81 (95% CI 1.63-2.00) in overweight, 2.75 (95% CI 2.49-3.03) in obese, and 4.34 (95% CI 3.65-5.16) in severe obese]. Adjusted ORs for LV remodeling and hypertrophy significantly increased proportional to BMI. CONCLUSIONS: Even with strict classification of obesity by the Asian-Pacific guideline, BMI of more than overweight (≥23 kg/m2) was significantly associated with impaired LV diastolic function, remodeling, and hypertrophy. (Circ J 2016; 80: 2489-2495).

Lipoprotein(a)-related cardiovascular and all-cause mortalities in Korean adults.

AIMS: There are inconsistent results on the association between lipoprotein(a) and mortality-related outcomes due to a lack of evidence from large-scale observational studies of Asians. This study aims to evaluate the effects of lipoprotein(a) on mortality-related outcomes in the Korean population. METHODS AND RESULTS: This cohort study included 275 430 individuals (mean age: 38 years; 50.1% men) enrolled in the Kangbuk Samsung Health Study between 2003 and 2016. The median follow-up period was 6.6 years. Cox proportional hazards analysis was used to estimate the adjusted hazard ratios (HRs) for evaluating mortality risk based on lipoprotein(a) levels and specific lipoprotein(a) categories. The median lipoprotein(a) value was 18.5 mg/dL, and the proportion of lipoprotein(a) ≥50 mg/dL was 12.8%. Multivariable Cox regression analysis showed that the group with lipoprotein(a) ≥50 mg/dL had a significantly increased risk of cardiovascular mortality (HR[95% CI]: 1.83[1.26, 2.64]) and all-cause mortality (1.20[1.03, 1.41]) than the group with lipoprotein(a) < 50 mg/dL without increased risk of cancer mortality (1.05[0.81, 1.34]). The relationship between lipoprotein(a) and cardiovascular mortality was significant regardless of low-density lipoprotein cholesterol. Specifically, lipoprotein(a) ≥100 mg/dL was associated with more than twice as increased a risk of cardiovascular mortality (2.45[1.12, 5.34]) than lipoprotein(a) < 10 mg/dL. In subgroup analyses, there was an interaction in the relationships between the two lipoprotein(a) categories and cardiovascular mortality for only high-density lipoprotein cholesterol. CONCLUSIONS: High lipoprotein(a) concentration is an independent predictor of cardiovascular mortality in the Korean population, regardless of low-density lipoprotein cholesterol levels.

Association between secondhand smoke exposure and new-onset hypertension in self-reported never smokers verified by cotinine.

BACKGROUND/AIMS: There is no study assessing the effect of changes of secondhand smoke (SHS) exposure and new-onset hypertension. We investigated the effect of a change of SHS exposure status on new-onset hypertension in self-reported and cotinine-verified never smokers. METHODS: Out of individuals enrolled in the Kangbuk Samsung Health Study between 2011 and 2016, 87,486 self-reported and cotinine-verified never smokers without hypertension at baseline visit were included with a median follow-up of 36 months. Individuals were divided into four groups on the basis of their SHS exposure status at baseline and at follow-up: no, new, former, and sustained SHS exposure groups. RESULTS: The incidence rates per 10,000 person-year of new-onset hypertension in no, new, former, and sustained SHS exposure groups were 84.7, 113.3, 102.0, and 123.7, respectively (p < 0.001). A multivariable Cox-hazard analyses showed that new and sustained SHS exposure groups increased their hazard ratio (HR) for new-onset hypertension compared to no SHS exposure group (HR, 1.31; 95% confidence interval [CI], 1.08 to 1.60 for new SHS exposure group; and HR, 1.24; 95% CI, 1.06 to 1.45 for sustained SHS exposure group). However, being part of the former SHS exposure group did not increase the risk of new-onset hypertension (HR, 0.91; 95% CI, 0.81 to 1.03). CONCLUSION: This study showed that either new, or sustained SHS exposure, but not former SHS exposure, increased the risk for new-onset hypertension in self-reported never smokers verified as nonsmokers by urinary cotinine. These findings show the possibility that changing exposure to SHS even for a relatively short period can modify the risk of new-onset hypertension in self-reported and cotinine-verified never smokers.

Echocardiographic parameters of left ventricular structure and diastolic function and their relation to coronary artery calcification.

Alteration in left ventricular (LV) structure and diastolic function is associated with poor cardiovascular (CV) prognosis. Coronary artery calcium score (CACS) is a reliable marker for coronary artery calcification, predicting adverse CV events. However, evidence is still insufficient to establish the association between alteration in LV structure and diastolic function and CACS. 9053 Korean adults (male: 84.2%, mean age: 42.5 years) were grouped by quartile levels of echocardiographic parameters for LV structure and diastolic function. CACS was detected by multidirectional computed tomography and categorized into CACS > 0 or CACS = 0. Multivariate regression analysis was used to calculate adjusted odd ratios (OR) and 95% confidence interval (CI) for CACS > 0 (adjusted OR [95% CI]) in each quartile group of echocardiographic parameters (reference: quartile 1 group). CACS > 0 was significantly associated with structural parameters above third quartile in LVMI (1.19 [1.00-1.41]), RWT (1.23 [1.03-1.46]) and IVST (1.42 [1.20-1.70]) and fourth quartile in PWT (1.36 [1.14-1.63]). In parameters of diastolic function, septal e' velocity ≥ 10.7 cm/s (fourth quartile) was less associated with CACS > 0 than septal e' velocity ≤ 7.7 cm/s (first quartile). Additionally, the fourth quartile of E/e' was more significantly associated with CACS > 0 than that of first quartile. Echocardiographic parameters close to LV hypertrophy and LV diastolic dysfunction are associated with CACS > 0.

Association between secondhand smoke exposure and diabetes mellitus in 131 724 Korean never smokers using self-reported questionnaires and cotinine levels: Gender differences.

OBJECTIVE: The aim of this study is to compare the gender-different associations between secondhand smoke (SHS) exposure and diabetes in self-reported never smokers verified by cotinine. METHODS: Self-reported never smokers verified by cotinine levels (<50 ng/mL) enrolled in the Kangbuk Samsung Health Study between April 2011 and December 2016 were included for this study. SHS exposure was defined as current exposure to passive smoke indoors at home or workplace. The gender-specific association between SHS exposure and diabetes was assessed using multivariable regression analyses. RESULTS: Of the total 131 724 individuals (mean age 35 years, SD 7.1 years), 66.8% were female, and the prevalence of SHS exposure in the entire population was 22.9%. The prevalence of diabetes in the group exposed to SHS was higher than that in the group unexposed to SHS only in females (1.8% vs 1.2%, P < .001 for females; 2.2% vs 2.2%, P = .956 for males). A significant gender interaction existed for the relationships between SHS exposure and diabetes (P for interaction <.001). The multivariate regression model showed that SHS exposure was significantly associated with diabetes only in females (odds ratio [95% CI], 1.40 [1.20, 1.65] for females; 1.00 [0.85, 1.19] for males). In particular, females with SHS exposure ≥1 hour/day, ≥3 times/week, and ≥10 years showed an increased risk of diabetes by more than 50% compared to those without SHS exposure. CONCLUSIONS: SHS exposure was significantly associated with diabetes in female never smokers with dose-dependent relationship. However, further longitudinal studies are needed to elucidate the gender difference in the incidence of diabetes associated with SHS exposure.

Fatty Liver Is Associated with Low N-Terminal Pro-B-Type Natriuretic Peptide in a Healthy Population.

Fatty liver (FL), insulin resistance (IR) and obesity often coexist, but data on the independent impacts of these factors on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels are scarce. We examined the impact of FL, IR and obesity on NT-proBNP levels using a large set of cross-sectional data. The associations of FL, IR and obesity with NT-proBNP were analyzed in 39,923 healthy adult participants. IR was estimated using a homeostasis model assessment-estimated insulin resistance (HOMA-IR) index. A multivariable regression model was conducted to identify associations between NT-proBNP and FL on abdominal ultrasound. FL, IR and obesity showed independent inverse associations with NT-proBNP after multiple adjustments for baseline characteristics. In a multivariable regression model adjusting for IR and obesity, FL was independently associated with lower levels of NT-proBNP (estimates, Exp(ß) 0.864, 0.849-0.880). The combination of FL and IR was a powerful dual indicator, lowering NT-proBNP levels approximately 25% in the generally healthy study population. In conclusion, FL was independently associated with lower NT-proBNP levels. FL and a high HOMA-IR index are a powerful indicator combination for lower NT-proBNP levels. Further research is needed to elucidate the mechanism underlying the association between FL and NT-proBNP.

Association between Cigarette Smoking and New-Onset Diabetes Mellitus in 78,212 Koreans Using Self-Reported Questionnaire and Urine Cotinine.

BACKGROUND: No study has assessed association between cigarette smoking and new-onset diabetes mellitus (NODM) incidence using two different smoking classification systems: self-reported questionnaire and urine cotinine. The objective of this longitudinal study was to evaluate NODM risk using the above two systems in Korean adults. METHODS: Among individuals enrolled in Kangbuk Samsung Health Study and Cohort Study who visited between 2011 and 2012 at baseline and 2014 at follow-up, 78,212 participants without baseline diabetes mellitus were followed up for a median of 27 months. Assessment of NODM incidence was made at the end of follow-up period. Cotinine-verified current smoking was having urinary cotinine ≥50 ng/mL. RESULTS: Percentages of self-reported and cotinine-verified current smokers were 25.9% and 23.5%, respectively. Overall incidence of NODM was 1.5%. According to multivariate regression analyses, baseline self-reported current smoking (relative risk [RR], 1.33; 95% confidence interval [CI], 1.07 to 1.65) and cotinine-verified current smoking (RR, 1.27; 95% CI, 1.08 to 1.49) increased NODM risk compared to baseline self-reported never smoking and cotinine-verified current non-smoking. Higher daily amount and longer duration of smoking were also associated with increased NODM risk (P for trends <0.05). In particular, self-reported current smokers who smoked ≥20 cigarettes/day (RR, 1.62; 95% CI, 1.25 to 2.15) and ≥10 years (RR, 1.34; 95% CI, 1.08 to 1.67) had the highest RRs for NODM. These results remained significant in males, although there was no gender interaction. CONCLUSION: This longitudinal study showed that baseline self-reported and cotinine-verified current smoking were associated with increased risks of NODM, especially in males.