Effective Timing of Introducing an Inpatient Smoking Cessation Program to Cancer Patients.

PURPOSE: We aimed to identify factors influencing smoking cessation success among cancer patients registered in an inpatient smoking cessation program at a single cancer center. MATERIALS AND METHODS: The electronic medical records of enrolled patients with solid cancer were retrospectively reviewed. We evaluated factors associated with 6-month smoking cessation. RESULTS: A total of 458 patients with cancer were included in this study. Their mean age was 62.9±10.3 years, and 56.3% of the participants had lung cancer. 193 (42.1%) had not yet begun their main treatment. The mean number of counseling sessions for the participants was 8.4±3.5, and 46 (10.0%) patients were prescribed smoking cessation medications. The 6-month smoking cessation success rate was 48.0%. Multivariate analysis showed that younger age (<65 years), cohabited status, early stage, and the number of counseling sessions were statistically significant factors affecting 6-month smoking cessation success (p<0.05). Initiation of a cessation program before cancer treatment was significantly associated with cessation success (odds ratio, 1.66; 95% confidence interval, 1.02-2.70; p=0.040). CONCLUSION: Smoking cessation intervention must be considered when establishing a treatment plan immediately after a cancer diagnosis among smokers.

Efficacy of an inpatient smoking cessation program at a single regional cancer center: A prospective observational study.

ABSTRACT: Smoking is the leading cause of preventable death and a risk factor for cancer, but smoking cessation is difficult even in patients who need hospitalization. This study aimed to investigate the usefulness of an inpatient smoking cessation consultation program and to analyze the clinical factors associated with abstinence. In this observational study, patients received regular counseling for 6 months, and abstinence was objectively assessed via urine and exhaled carbon monoxide testing. Cessation rates were assessed at 4 weeks and 6 months, and clinical characteristics associated with cessation success were investigated. Of the 571 patients referred to participate in the program, 170 (29.8%) were enrolled, and only 2 (1.2%) used smoking cessation drugs in addition to counseling. The smoking cessation rate was 77.6% after 4 weeks and 59.1% after 6 months. The cessation rates were significantly higher in patients with cancer than in those without cancer at both timepoints (63.8% vs 21.9%, P < .001, 53.6% vs 12.5%, P < .001), and they were also higher in the first admission group than in the re-admission group (87.4% vs 74.7%, P = .033, 88.5% vs 76.1%, P = .037). In patients with lung cancer, progression-free survival and overall survival tended to be better in those enrolled in the program (P = .158, P = .183). In conclusion, the inpatient smoking cessation program was associated with a high abstinence rate. Most patients maintained cessation without medication, suggesting that initial admission, along with a cancer diagnosis, can provide enough motivation to abstain from smoking. In addition, the smoking cessation effort showed potential to improve survival during lung cancer treatment.

Association of Plasma Pentraxin-3 Level with Lipid Levels and Cardiovascular Risk Factors in People with No History of Lipid-Lowering Medication: the Dong-gu Study.

AIM: To elucidate the role of pentraxin-3 (PTX3) in atherosclerosis, we evaluated lipid and cardiovascular risk profiles according to the plasma PTX3 levels in subjects from the general population. METHODS: A sub-cohort of 2,000 subjects was randomly sampled from a Korean community-based cohort study. After excluding those with a medication history for dyslipidemia, 1,747 subjects (902 men and 845 women) were included in the final analyses. Linear and logistic regressions with adjustment for appropriate variables were performed. RESULTS: The PTX3 level was positively associated with the high-density lipoprotein cholesterol (HDL-C) level and negatively associated with the log-transformed triglyceride (TG) level, total cholesterol/HDL-C ratio, and low-density lipoprotein cholesterol (LDL-C)/HDL-C ratio (p＜0.05). Subjects with the highest PTX3 levels (≥ 1.17 ng/dl) exhibited a lower risk of metabolic syndrome (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.57-0.94), overweight/obesity (OR 0.65, 95% CI 0.50-0.83), increased TG level (OR 0.66, 95% CI 0.51-0.86), and increased HDL-C level (OR 0.67, 95% CI 0.51-0.88) compared to those with the lowest PTX3 level (＜0.7 ng/dl). CONCLUSION: The circulating PTX3 level was inversely associated with metabolic syndrome, overweight/obesity, and parameters of dyslipidemia, suggesting a cardioprotective role of PTX3 in atherosclerosis.

Association between Plasma Pentraxin 3 Levels and Bone Mineral Density in Elderly Koreans: the Dong-gu Study.

BACKGROUND: We investigated the association between pentraxin 3 (PTX3), a novel inflammatory marker, and bone mineral density (BMD) in the general Korean population. METHODS: We selected a sub-cohort of 1,440 subjects (757 men and 683 women) from participants in the community-based Dong-gu Study. The mean age was 66.0 ± 8.1 years for men and 63.7 ± 7.9 years for women. The plasma PTX3 levels were measured using an enzyme-linked immunosorbent assay, and BMD was measured in the femoral neck and lumbar spine using dual-energy X-ray absorptiometry. Linear regression analyses were used to evaluate the association between the plasma PTX3 levels and BMD. RESULTS: PTX3 was inversely associated with the BMD of the lumbar spine (P = 0.010) and femoral neck (P < 0.001) in men but not in women. For men, the association with the BMD of the femoral neck remained after adjustment for multiple comparison (P = 0.020). CONCLUSION: This study suggests that PTX3 levels might be inversely associated with BMD in elderly men.

Socioeconomic differences in self- and family awareness of viral hepatitis status among carriers of hepatitis B or C in rural Korea.

BACKGROUND: Hepatitis is the most important cause of hepatocellular carcinoma in Korea. This study evaluated the socioeconomic differences in self- and family awareness of hepatitis status among hepatitis B and C carriers and their cohabitants in rural Korea. METHODS: In total, 5,017 randomly selected rural residents participated in a seroepidemiologic and questionnaire survey. We found 326 hepatitis B surface antigen carriers or hepatitis C antibody carriers and 310 family members cohabiting with members of this group. RESULTS: Among the hepatitis B carriers and their family members, 48.1% were aware of their own status and 36.7% were aware of their cohabitant's hepatitis status, respectively. Only 28.1% of the hepatitis C carriers were aware of their own status, and only 23.3% of their cohabiting family members knew about their family member's hepatitis C status. A multivariate analysis including health-related factors, such as alcohol consumption, family history of liver disease, and recent acupuncture history, found that self-awareness was significantly lower in the older group and significantly higher in the more educated and higher-income groups. Family awareness was also increased in those working in salaried jobs. CONCLUSIONS: Socioeconomic disparities in awareness of hepatitis status were found among hepatitis carriers and their families.

Relationship between plasma pentraxin 3 level and risk of chronic kidney disease in the Korean elderly: the Dong-gu study.

Purpose This study investigated the cross-sectional association between chronic kidney disease (CKD) and plasma pentraxin 3 (PTX3) levels in a Korean population, in a community-based cohort study. METHODS: A total of 1816 (891 men, 925 women) subjects were randomly selected from the cohort of participants for the final analyses. Plasma PTX3 concentration was determined using enzyme-linked immunosorbent assays. The participants were divided into four quartiles according to the PTX3 levels. Multivariate logistic regression was performed to evaluate the association between plasma PTX3 level and CKD. Covariates inserted into the multivariate model included smoking status, systolic blood pressure, body mass index, waist circumference, high-density lipoprotein, low-density lipoprotein uric acid, white blood cell count, and carotid intima-media thickness. RESULTS: Compared to the lowest PTX3 group (Q1), a significantly higher risk of CKD was found in the highest group (Q4), with an odds ratio of 1.58 and 95% confidence interval of 1.18-2.11 (P for trend <0.001). CONCLUSIONS: This study showed that higher plasma PTX3 levels are significantly associated with CKD risk. The biological mechanism remains unclear; therefore, further molecular investigation of association between CKD and PTX3 is needed.

Association between ABO genotype and risk of hepatocellular carcinoma in Koreans.

BACKGROUND: Associations between ABO blood groups and risk of several malignancies have been reported, although there are limited data regarding hepatocellular carcinoma (HCC). The aim of this study was to investigate any possible association between the ABO genotype, especially blood group A, and HCC risk in Koreans. MATERIALS AND METHODS: We conducted a case-control study of 1,538 patients with newly diagnosed HCC at Chonnam National University Hwasun Hospital and 1,305 randomly selected members of the general population. The ABO genotype was determined by multicolor real-time polymerase chain reaction (PCR) using displacing probes. Adjusted odds ratios (aORs) and their 95% confidence intervals (CIs) were calculated using logistic regression models with adjustment for gender, age, smoking, alcohol drinking, and hepatitis B and C status. RESULTS: The risk of HCC in genotype AA was significantly higher than in OO (aOR=1.773, 95% CI=1.161-2.705). The risk in blood group A was also higher than in blood group O (aOR=1.448, 95% CI=1.005 1.897). No significant difference was found for the AA, BO, BB, and AB genotypes, or blood group B and AB. CONCLUSIONS: Blood group A and genotype AA showed the highest risks of HCC in a Korean population. No significant difference was found for the AO, BO, BB, and AB genotypes, or blood group B and AB.

Lack of association between serum gamma-glutamyltransferase and carotid atherosclerosis: the Namwon Study.

OBJECTIVES: There is little evidence for an association between gamma-glutamyltransferase (GGT) and carotid atherosclerosis, an independent predictor of cardiovascular disease. We examined the association between serum GGT and carotid atherosclerotic parameters, including carotid intima-media thickness (IMT) and plaques, in a large general population. METHODS: The study population consisted of community-dwelling adults who participated in the baseline survey of the Namwon Study. A total of 9120 subjects aged 45-74 years were included in the analyses. High-resolution B-mode ultrasound was used to measure carotid IMT and to evaluate the presence of carotid plaques. A mean carotid IMT of ≥1.0 mm was classified as 'high carotid IMT'. RESULTS: Serum GGT levels were classified into quartiles. In a fully adjusted model, we found no linear trend between GGT quartile and mean carotid IMT (P for trend = 0.167). Compared with the first quartile (the reference category), the odds ratios (ORs) and 95% confidence intervals (CIs) for high carotid IMT were 0.89 (0.68-1.16), 1.10 (0.84-1.43), and 0.97 (0.71-1.33) for the second, third, and fourth quartiles (P for trend = 0.754), respectively. The ORs (95% CIs) for carotid plaques were 0.89 (0.77-1.02), 0.95 (0.82-1.10), and 0.94 (0.79-1.11) for the second, third, and fourth quartiles, respectively, in the fully adjusted model (P for trend = 0.644). CONCLUSIONS: No significant association of GGT concentration with carotid IMT or plaques was found in this large cross-sectional study. Further longitudinal studies are needed to confirm our findings.

Normative and mean carotid intima-media thickness values according to metabolic syndrome in Koreans: the Namwon study.

OBJECTIVES: We determined the gender- and age-specific normative values of carotid intima-media thickness (IMT) in a healthy Korean population. We also present the mean age-specific carotid IMT values according to the presence of metabolic syndrome (MetS) and the number of MetS components. METHODS: A total of 9374 subjects from the Namwon Study aged 45-74 years were included in the analysis. Subjects without hypertension, diabetes, dyslipidemia, obesity, and current smoking were classified as the healthy reference population (n = 2595). MetS was identified by the presence of three or more of the following five components: abdominal obesity, high triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and high fasting blood glucose. Common carotid artery IMT (CCA-IMT) and carotid bulb IMT values were determined in a region free of plaque by B-mode carotid ultrasonography. RESULTS: The mean normative CCA-IMT values of 45-49, 50-54, 55-59, 60-64, 65-69, and 70-74 year old males were 0.614, 0.671, 0.711, 0.759, 0.783, and 0.787 mm and 0.613, 0.653, 0.689, 0.718, 0.753, and 0.778 mm for females, respectively. An increase in CCA-IMT of 0.007 mm/year was estimated in both genders. The mean CCA-IMT values of subjects with 0, 1, 2, 3, 4, and 5 MetS components were 0.744, 0.753, 0.765, 0.766, 0.771, and 0.798 mm for males and 0.688, 0.705, 0.724, 0.734, 0.757, and 0.762 mm for females, respectively. CONCLUSION: The gender-specific normative carotid IMT values were determined in a large healthy Korean population. An increasing trend in the CCA-IMT values was observed with an increasing number of MetS components in both genders.

The association between liver enzymes and risk of type 2 diabetes: the Namwon study.

BACKGROUND: We examined the association between liver enzymes and development of type 2 diabetes in a general Korean population. METHODS: A total of 10,667 subjects (4,201 males and 6,466 females) aged 45 to 74 years participated in a baseline examination between 2004 and 2007. Among the subjects, 8,157 (3,231 males and 4,926 females) underwent follow-up examination from 2007 to 2011, for a median follow-up period of 4.2 years. Type 2 diabetes was defined as intake of anti-diabetic agents, insulin treatment, fasting glucose concentration of more than 126 mg/dl, or hemoglobin A1c of more than 6.5% at re-examination. Associations of liver enzymes with incidence of type 2 diabetes were analyzed using logistic regression models. RESULTS: During the follow-up period, 548 subjects (235 males, 313 females) developed type 2 diabetes. After adjusting for comprehensive diabetes risk factor, the risk of type 2 diabetes was significantly higher in the highest alanine aminotransferase (ALT) quartile than in the lowest quartile (odds ratio (OR): 1.95, 95% confidence interval (CI): 1.18-3.21 in males; OR: 1.49, 95% CI: 1.03-2.16 in females). Similar results were observed for gamma-glutamyltransferase (GGT) quartiles, but in the fully adjusted analysis, the OR for the highest versus lowest quartiles was significant only for females (OR: 1.58, 95% CI: 0.95-2.63 in males; OR: 1.85, 95% CI: 1.23-2.79 in females). CONCLUSIONS: Our results suggest that serum ALT concentrations were independently associated with type 2 diabetes in both sexes, and that GGT was also independently associated but only in females.

The association of ankle brachial index with left ventricular hypertrophy and left ventricular mass index: the Dong-gu study.

BACKGROUND: To investigate the association between ankle-brachial index (ABI), left ventricular hypertrophy (LVH) and left ventricular mass index (LVMI) in a general population. PATIENTS AND METHODS: The study population consisted of 8,246 people aged 50 years and older who participated in the baseline survey of the Dong-gu Study conducted in Korea between 2007 and 2010. Trained research technicians measured LV mass using mode M ultrasound echocardiography and ABI using an oscillometric method. RESULTS: After adjustment for risk factors and common carotid artery intima-media thickness (CCA-IMT) and the number of plaques, higher ABIs (1.10 1.19, 1.20 - 1.29, and ≥ 1.30) were significantly and linearly associated with high LVMI (1.10 - 1.19 ABI: ß, 3.33; 95 % CI, 1.72 - 4.93; 1.20 - 1.29 ABI: ß, 6.51; 95 % CI, 4.02 - 9.00; ≥ 1.30 ABI: ß, 14.83; 95 % CI, 6.18 - 23.48). An ABI of 1.10 - 1.19 and 1.20 - 1.29 ABI was significantly associated with LVH (1.10 - 1.19 ABI: OR, 1.35; 95 % CI, 1.19 - 1.53; 1.20 - 1.29 ABI: OR, 1.59; 95 % CI, 1.31 - 1.92) and ABI ≥ 1.30 was marginally associated with LVH (OR, 1.73; 95 % CI, 0.93 - 3.22, p = 0.078). CONCLUSIONS: After adjustment for other cardiovascular variables and CCA-IMT and the number of plaques, higher ABIs are associated with LVH and LVMI in Koreans aged 50 years and older.

Association of bone mineral density with albuminuria and estimated glomerular filtration rate: the Dong-gu Study.

BACKGROUND: Kidney dysfunction and albuminuria may be associated with BMD. However, little evidence has been reported on relationships between BMD and eGFR and albuminuria. METHODS: A total of 8,992 subjects aged 50 years or older participated in a survey conducted. Participants had their lumbar spine and femoral neck BMD measured by a Lunar Prodigy bone densitometer (GE, Madison, WI). Kidney function was assessed using MDRD eGFR and diagnosis of albuminuria was based on albumin-creatinine ratio. RESULTS: ACR was negatively associated with lumbar spine and femur neck BMD in females (lumbar spine: 1.001, 0.988, 0.974 and 0.979 g/cm(2), p < 0.001; femur neck: 0.796, 0.790, 0.783 and 0.782 g/cm(2), p = 0.002), but not in males, after adjusting for covariates. Additionally, eGFR was shown to be negatively associated with lumbar spine BMD after adjusting for covariates (male: 1.181, 1.166, 1.152 and 1.149 g/cm(2), p = 0.001; female: 0.997, 0.980, 0.979 and 0.982 g/cm(2), p = 0.005), but demonstrated no association with femur BMD. CONCLUSIONS: ACR in females was negatively associated with lumbar spine and femur neck BMD, but not in males. eGFR was negatively associated with lumbar spine BMD in both males and females.

Association between total bilirubin and hemoglobin A1c in Korean type 2 diabetic patients.

Recent studies have shown that bilirubin is negatively associated with hemoglobin A1c (HbA1c) in the general population. The association between bilirubin and HbA1c in serum of diabetes patients has not yet been studied. The aim of the present study was to evaluate the association between total bilirubin and HbA1c in Korean patients with type 2 diabetes. A total of 690 of the 1,275 type 2 diabetes patients registered with the public health centers in Seo-gu, Gwangju and Gokseong-gun, Jeollanam-do participated in this study. Following an overnight fast, venous blood and urine samples were collected and analyzed. The mean HbA1c values differed significantly according to total bilirubin (≤ 0.4 mg/dL, 7.6%; 0.5 mg/dL, 7.3%; 0.6-0.7 mg/dL, 7.2%; and ≥ 0.8 mg/dL, 7.1%; P for trend = 0.016) after we adjusted for other confounding factors. When the odds ratio (OR) was adjusted for other confounding factors, there was a significant association between total bilirubin and HbA1c (OR, 0.4 [95% confidence interval, 0.2-0.8] for total bilirubin ≥ 0.8 mg/dL versus ≤ 0.4 mg/dL. In conclusion, total bilirubin concentrations in serum are negatively associated with HbA1c levels after adjustment for sex, age, and other confounding factors in type 2 diabetes patients.

Cumulative smoking exposure, duration of smoking cessation, and peripheral arterial disease in middle-aged and older Korean men.

BACKGROUND: We investigated the association of cumulative smoking exposure and duration of smoking cessation with peripheral arterial disease (PAD). METHODS: The study population consisted of 2517 community-dwelling Korean men aged 50 years and older. Information on smoking characteristics such as smoking status, pack-years of smoking, and years since quitting smoking was collected using a standardized questionnaire. PAD was defined as an ankle-brachial index (ABI) less than 0.90 in either leg. RESULTS: The odds ratio (OR, 95% confidence interval) of PAD was 2.31 (1.20-4.42) for former smokers and 4.30 (2.13-8.66) for current smokers, after adjusting for other cardiovascular risk factors. There was a significant dose-response relationship between pack-years of smoking and PAD. Compared with those who had never smoked, the multivariate-adjusted ORs of PAD for smokers of 0.1-20.0, 20.1-40.0, and >40.0 pack-years were 2.15 (1.06-4.38), 2.24 (1.08-4.65), and 2.93 (1.41-6.09), respectively. There was a significant decrease in PAD risk as the years since quitting smoking increased. The multivariate-adjusted ORs of PAD for 11-20 and ≥ 21 years smoking cessation were 0.41 (0.19-0.86) and 0.49 (0.24-0.98), compared with current smokers. CONCLUSIONS: Cumulative smoking exposure and duration of smoking cessation were significantly associated with PAD in middle aged and older Korean men.

Comparison of the Framingham Risk Score, UKPDS Risk Engine, and SCORE for Predicting Carotid Atherosclerosis and Peripheral Arterial Disease in Korean Type 2 Diabetic Patients.

BACKGROUND: To compare the predictability of the Framingham Risk Score (FRS), United Kingdom Prospective Diabetes Study (UKPDS) risk engine, and the Systematic Coronary Risk Evaluation (SCORE) for carotid atherosclerosis and peripheral arterial disease in Korean type 2 diabetic patients. METHODS: Among 1,275 registered type 2 diabetes patients in the health center, 621 subjects with type 2 diabetes participated in the study. Well-trained examiners measured the carotid intima-media thickness (IMT), carotid plaque, and ankle brachial index (ABI). The subject's 10-year risk of coronary heart disease was calculated according to the FRS, UKPDS, and SCORE risk scores. These three risk scores were compared to the areas under the curve (AUC). RESULTS: The odds ratios (ORs) of all risk scores increased as the quartiles increased for plaque, IMT, and ABI. For plaque and IMT, the UKPDS risk score provided the highest OR (95% confidence interval) at 3.82 (2.36, 6.17) and at 6.21 (3.37, 11.45). For ABI, the SCORE risk estimation provided the highest OR at 7.41 (3.20, 17.18). However, no significant difference was detected for plaque, IMT, or ABI (P = 0.839, 0.313, and 0.113, respectively) when the AUCs of the three risk scores were compared. When we graphed the Kernel density distribution of these three risk scores, UKPDS had a higher distribution than FRS and SCORE. CONCLUSION: No significant difference was observed when comparing the predictability of the FRS, UKPDS risk engine, and SCORE risk estimation for carotid atherosclerosis and peripheral arterial disease in Korean type 2 diabetic patients.

Metabolic syndrome and carotid artery parameter in Koreans aged 50 years and older.

BACKGROUND: Few studies have reported on the relationship between metabolic syndrome (MetS) and carotid artery structure. The objective of this study was to examine the relationship between MetS and carotid artery parameters such as the common carotid artery intima-media thickness (CCA-IMT), plaques, and the diameter of the common carotid artery (CCAd). METHODS AND RESULTS: The study population consisted of 1.730 community-dwelling Koreans aged 50 years and older without hypertension, diabetes mellitus or dyslipidemia. MetS was defined according to the modified National Cholesterol Education Program's Adult Treatment Panel III criteria. The risk for abnormal CCA-IMT (>or=1.00 mm) was significant in women with MetS (odds ratio (OR) 2.22; 95% confidence interval (CI) 1.14-4.31), but not in men with MetS (OR 1.06; 95%CI 0.39-2.91). No significant relationship between MetS and carotid plaques was observed in either sex. The relationship between MetS and high CCAd (highest quintile) was significant in both men (OR 2.19; 95%CI 1.38-3.49) and women (OR 2.02; 95%CI 1.39-2.94). CONCLUSIONS: MetS independently correlates with carotid atherosclerosis and carotid enlargement. The effect of MetS on carotid atherosclerosis is more pronounced in women than in men.

[Management of diabetic mellitus in low-income rural patients].

OBJECTIVES: Knowledge about the management status of diabetic mellitus (DM) is essential to improve diabetic management. Moreover, low income is associated with poor adherence to treatment and increased mortality. This study was performed to evaluate the management status of DM in low-income patients in a rural area. METHODS: We enrolled 370 patients with type 2 DM living in Gokseong county, JeollaNamdo. A well-trained examiner measured the height, weight, waist circumference, blood pressure, total cholesterol, triglyceride, high density lipoprotein cholesterol, fasting blood sugar and glycosylated hemoglobin (HbA1c) levels. Carotid ultrasonography was used to measure carotid artery carotid artery intima media thickness (IMT) and plaque. ankle-brachial index (ABI) was used to evaluate peripheral artery disease. A fundoscopic examination was performed to evaluate diabetic retinopathy. A history of diabetes complications and health-related questionnaires were also completed. RESULTS: The age of diabetic subjects was 68.7+/-8.7 years and the duration of diabetes was 8.9+/-8.2 years. Most (63.5%) had hypertension, and 45.7% had triglycerides below 150 mg/dl, 38.1% had low density lipoprotein cholesterol (LDL) cholesterol below 100 mg/dl, 48.7% had urine albumin to creatinine ratio (UACR) below 30 mg/g. Less than half (45.9%) achieved the goal of HbA1c less than 7% suggested by the American Diabetes Association (ADA). 10.6% had peripheral vascular disease, 11.9% had retinopathy, and 60.8% had chronic kidney disease. CONCLUSIONS: DM management in low income patients is very poor and requires further work to improve.