Difference in SBP between arms is a predictor of chronic kidney disease development in the general Korean population.

OBJECTIVE: An increased inter-arm SBP difference (IASBPD) is associated with mortality and cardiovascular events, as well as peripheral vascular disease, which is attributed to subclavian stenosis. The aim of the present study was to investigate the association between the IASBPD and incident chronic kidney disease (CKD) in the Korean population. METHODS: A retrospective cohort study was performed on 8780 Korean adults without baseline CKD. The bilateral blood pressure was measured sequentially and repeatedly at the first visit. IASBPD was defined as a BP at least 15 mmHg according to the National Institutes for Health and Clinical Excellence guidelines, and CKD was defined as an estimated glomerular filtration rate less than 60 ml/min per 1.73 m. We assessed the value of IASBPD to predict the incidence of CKD and investigated cardiovascular disease, including coronary heart disease and stroke. RESULTS: Over a mean follow-up period of 8.5 years, 96 of 581 (16.5%) patients in the IASBPD group and 1037 of 8199 (12.6%) patients in the non-IASBPD group developed incident CKD. Compared with the non-IASBPD, an IASBPD was associated with incident CKD [hazard ratio (HR): 1.336, 95% confidence interval (CI): 1.08-1.65, P = 0.007]. After adjusting for potential confounders, including age, sex, hypertension, diabetes, and obesity, we found that the hazard ratio was also robust (hazard ratio 1.275, 95% CI 1.03-1.58, P = 0.024). CONCLUSION: Increased IASBPD is an independent predictor of incident CKD in the general population.

Microalbuminuria as a simple predictor of incident diabetes over 8 years in the Korean Genome and Epidemiology Study (KoGES).

Microalbuminuria (MAU) is a common subclinical disease and related with cardiovascular outcome both in diabetic and non-diabetic patients. However, there is rare data about the effect of MAU on the development of diabetes. Thus, we aimed to investigate whether MAU is associated with the development of incident diabetes. A total of 3385 subjects without diabetes (1503 men and 1882 women; mean age, 53 years) who participated in the Ansung-Ansan cohort study from 2001-2002 (baseline) to 2011-2012 (fifth follow-up visit) were followed for a mean of 8 years. The prevalence of MAU at baseline was 10.8% (365 patients), and the incidence of newly developed diabetes during the follow-up period was 15.3% (56 patients) in subjects with MAU. The hazard ratio (HR) for development of diabetes was 1.43 (95% confidence interval (CI) 1.07-1.91, p-value 0.016), independent of traditional risk factors for diabetes including pre-diabetes, age, obesity, and family history. The impact of MAU on diabetes was also significant in the non-pre-diabetic population (HR 2.08, 95% CI 1.07-4.03, p-value 0.031). In conclusion, our results show that incident MAU is associated with future development of diabetes and could be an early marker for diabetes, even in the non-prediabetic population.

Relationship between sleep duration and Framingham cardiovascular risk score and prevalence of cardiovascular disease in Koreans.

Studies have shown sleep duration to be related to the prevalence of metabolic syndrome and hypertension. However, whether sleep duration is associated with cardiovascular disease (CVD) risk and the prevalence of CVD irrespective of conventional CV-risk factor, such as diabetes mellitus, obesity, and metabolic syndrome, has not been well established for the Korean population.A total of 23,878 individuals aged 18 years or older from the 2007-2010 Korean National Health and Nutrition Examination Survey were analyzed. We evaluated the relationship between sleep duration and CV-event risk using the Framingham Cardiovascular Risk Score (FRS; ≥10% or ≥20%) and the prevalence of CVD.After adjusting for traditional risk factors of CVD, a short sleep duration (≤5 hours) yielded odds ratios (OR) of 1.344 (95% confidence interval [CI] 1.200-1.505) for intermediate to high risk and 1.357 (95% CI, 1.140-1.614) for high risk. A long sleep duration (≥9 hours) was also associated with both intermediate to high (OR 1.142, 95% CI 1.011-1.322) and high cardiovascular FRS (OR 1.276, 95% CI 1.118-1.457).Both short and long sleep durations were related with high CVD risk, irrespective of established CVD risk, and a short sleep duration was associated with a higher prevalence of CVD than an optimal or long sleep duration.

Predictors of poor clinical outcomes after successful chronic total occlusion intervention with drug-eluting stents.

BACKGROUND: The aim of this study was to identify the prognostic predictors for the worse clinical outcomes after a successful chronic total occlusion (CTO) intervention with drug-eluting stents. PATIENTS AND RESULTS: A total of 2334 patients in the multicenter Korean CTO registry who underwent a successful CTO intervention with drug-eluting stents (first generation, 1367, new generation, 967) were enrolled. The primary endpoint was the composite of cardiac death, myocardial infarction, and stent thrombosis.The cumulative incidence of the primary endpoint was 2.5% (median follow-up duration: 22 months). In multivariate analysis, age above 65 years [hazard ratio (HR)=1.769, 95% confidence interval (CI)=1.025-3.052, P=0.041], heart failure (HR=4.242, 95% CI=2.335-7.705, P<0.001), and diabetes (HR=1.773, 95% CI=1.043-3.012, P=0.034) were the significant predictors. The cumulative incidence of the primary endpoint was significantly higher in patients with three risk factors (19.1%) than in those with one (2.2%) or two (3.0%) risk factors (P=0.001). The cumulative target-vessel revascularization rate was 8.4%, with the significant predictors being a diffuse long lesion (HR=1.626, 95% CI=1.129-2.340, P=0.009) and at least three implanted stents (HR=1.964, 95% CI=1.301-2.965, P=0.001). CONCLUSION: Clinical parameters such as age, diabetes, and heart failure were independent predictors of the composite of cardiac death, myocardial infarction, and stent thrombosis, whereas angiographic or procedural parameters such as lesion length and number of implanted stents were predictors of target-vessel revascularization. Clinical outcomes after CTO intervention were worse in patients with multiple risk factors.

Association of physical activity on body composition, cardiometabolic risk factors, and prevalence of cardiovascular disease in the Korean population (from the fifth Korea national health and nutrition examination survey, 2008-2011).

BACKGROUND: Data regarding associations among physical activity (PA) level, body composition, and prevalence of cardiovascular diseases in Asian populations are rare. METHODS: The International Physical Activity Questionnaire (IPAQ) was utilized to estimate PA levels and analyze the association of PA level with various body composition parameters and the prevalence of cardiovascular diseases by using data from the Korean National Health and Nutrition Examination Survey from 2008 to 2011. RESULTS: Moderate and high PA levels were associated with lower prevalence of hypertension and diabetes mellitus, and lower concentrations of serum ferritin, parathyroid hormone, and alkaline phosphatase. Sarcopenia (low vs. moderate vs. high PA group: 14.3% vs. 10.5% vs. 7.3%, p = 0.001), underweight (5.7% vs. 4.9% vs. 3.5%, p = 0.001), and central obesity (7.8% vs. 6.9% vs. 6.3%, p = 0.002) were more often observed in the low PA group. The prevalence rates of cardiovascular diseases were lower in the moderate (odds ratio [OR], 0.822; 95% confidence interval [CI], 0.737-0.916; p = 0.001) and high activity groups (OR, 0.663; 95% CI, 0.589-0.748; p = 0.001) than in the low activity group, even after adjusting for age, sex, smoking, underlying disease, and general or abdominal obesity and muscle mass. CONCLUSION: Regular physical activity was associated with a low prevalence of cardiovascular diseases (stroke, myocardial infarction, stable angina, and chronic renal disease), which was independent of body composition and conventional risk factors in the Korean population, with a positive dose-response relationship.

Long-Term Clinical Outcomes of a Biodegradable Polymer-Based Biolimus-Eluting Stent.

OBJECTIVES: To investigate the long-term clinical outcomes of biolimus-eluting stents with biodegradable polymers in real-world clinical practice. BACKGROUND: Long-term clinical outcomes of biolimus-eluting stents have not been clearly established. METHODS: A total of 824 all-comer patients (971 lesions) treated with unrestricted implantation of a biolimus-eluting stent with a biodegradable polymer were prospectively enrolled. Patients were divided into complex (413 patients) versus noncomplex (411 patients) groups according to the complexity of coronary lesions. Long-term clinical outcomes for stent efficacy (target lesion revascularization) and safety (composite of cardiac death, target lesion-related myocardial infarction, and definite or probable stent thrombosis) were compared between the two groups during 5 years of follow-up. RESULTS: The complex group showed higher rates of decreased left ventricular ejection fraction, impaired renal function, previous history of myocardial infarction, and diabetes mellitus compared to the noncomplex group. In the overall population, the 5-year cumulative rate of target lesion revascularization was 4.8% (8.3% in the complex group vs 1.6% in the noncomplex group, P < 0.001). For stent safety, the 5-year cumulative rate for a composite of cardiac death, target lesion-related myocardial infarction, and stent thrombosis was 2.5% overall (3.9% in the complex group vs 1.1% in the noncomplex group, P = 0.010). Overall 5-year cumulative rate of stent thrombosis was 0.4% (0.5% in the complex vs 0.2% in the noncomplex group, P = 0.561) with no very late stent thrombosis (VLST). CONCLUSIONS: Biodegradable polymer-based biolimus-eluting stents showed favorable efficacy and safety in all-comer patients during 5 years of follow-up.

Elevated serum cystatin C level is an independent predictor of contrast-induced nephropathy and adverse outcomes in patients with peripheral artery disease undergoing endovascular therapy.

OBJECTIVE: The aim of this study was to investigate the association of serum cystatin C levels with contrast-induced nephropathy (CIN) and adverse clinical events in patients with peripheral artery disease (PAD). METHODS: A total of 240 PAD patients who received endovascular therapy were included in this retrospective analysis. Serial serum levels of creatinine and cystatin C before and within 48 hours of endovascular therapy were evaluated for the incidence of CIN. The relationship between serum cystatin C levels and the incidence of major adverse events, defined as a composite of all-cause death, myocardial infarction, stroke, amputation, and target vessel revascularization, was investigated. RESULTS: The incidence of CIN increased from 1.7% to 27.9%, depending on the quartile of baseline cystatin C level. Baseline serum cystatin C level (area under the curve of the receiver operating characteristic curve, 0.757; 95% confidence interval [CI], 0.696-0.735) predicted the incidence of CIN better than baseline serum creatinine level (area under the curve, 0.629; 95% CI, 0.563-0.691; P < .001). An elevated baseline cystatin C level was an independent predictor of CIN (hazard ratio, 14.37; 95% CI, 4.11-50.19; P < .001) and major adverse events in patients with PAD (hazard ratio, 2.57; 95% CI, 1.28-5.17; P = .008). CONCLUSIONS: We found elevated baseline cystatin C level to be an independent risk factor for CIN and a predictor of all-cause mortality and major adverse events in patients with PAD undergoing endovascular therapy.

Associations between Genetic Variants and Angiographic Characteristics in Patients with Coronary Artery Disease.

AIM: In this study, we investigated the genetic determinants of lesion characteristics and the severity of coronary artery disease (CAD) using a genome-wide association study (GWAS) and replication genotyping. METHODS: The discovery set for GWAS consisted of 667 patients exhibiting angiographically diagnosed CAD with symptoms. For replication genotyping, 837 age- and sex-matched CAD patients were selected. Genetic determinants of lesion characteristics (diffuse vs. non-diffuse lesions), the number of diseased vessels (multi-vessel vs. single vessel disease) and the modified Duke score (high vs. low), which indicates the severity of CAD, were analyzed after adjusting for confounding factors. RESULTS: Single nucleotide polymorphisms (SNPs) rs12917449, rs10152898 and rs231150 were associated with diffuse lesions, while rs1225006 and rs6745588 were associated with multi-vessel disease. However, on replication genotyping, no significant associations were found between any of these five SNPs and the lesion characteristics or CAD severity. In contrast, in the combined population of both the discovery and replication sets, genotypes rs125006 of CPNE4 and rs231150 of TRPS1 were found to be significantly associated with the modified Duke score. The addition of rs1225006 to conventional risk factors had significant incremental value in the model of the score. CONCLUSIONS: The associations between five SNPs identified using GWAS and angiographic characteristics were not significant in the current replication study. However, two variants, particularly rs1225006, were found to be associated with the severity of CAD in the combined set. These results indicate the potential clinical implication of these variants with respect to the risk of CAD.