Lifestyle Modification in the Management of Metabolic Syndrome:Statement From Korean Society of CardioMetabolic Syndrome (KSCMS)

With the recent rapid increase in obesity worldwide, metabolic syndrome (MetS) has gained significant importance. MetS is a cluster of obesity-related cardiovascular risk factors including abdominal obesity, atherogenic dyslipidemia, high blood pressure and impaired glucose tolerance. MetS is highly prevalent and strongly associated with an increased risk of developing diabetes and cardiovascular disease, putting a great burden on human society. Therefore, it is very important to reduce MetS risk, which can improve patients’cardiovascular prognosis. The primary and most effective strategy to control each component of MetS is lifestyle change such as losing body weight, keeping regular exercise, adopting a healthy diet, quitting smoking and alcohol drinking in moderation. Many studies have shown that lifestyle modification has improved all components of MetS, and reduces the incidence of diabetes and cardiovascular disease. Here, the Korean Society of CardioMetabolic Syndrome has summarized specific and practical methods of lifestyle modification in the management of MetS in the healthcare field.

Long-term efficacy of vasodilating β-blocker in patients with acute myocardial infarction: nationwide multicenter prospective registry

Background/Aims@#Long-term benefit of vasodilating β-blockers is unknown. This study aimed to investigate the long-term benefit of vasodilating β-blockers over conventional β-blockers in patients with acute myocardial infarction (AMI). @*Methods@#Using nationwide prospective multicenter Korean Acute Myocardial Infarction Registry data, we analyzed 3-year clinical outcomes of 7,269 patients with AMI who received percutaneous coronary intervention (PCI) and β-blocker therapy. Patients were classified according to treatment strategy (vasodilating β-blockers vs. conventional β-blockers). The primary endpoint was a composite of cardiac death, myocardial infarction (MI), and hospitalization for heart failure (HF) at 3 years. Secondary outcomes were each component of the primary outcome. Propensity score matching was performed to adjust for differences of baseline characteristics. @*Results@#In 3,079 pairs (6,158 patients) of propensity score-matched patients, the primary outcome occurred significantly less in the vasodilating β-blockers group compared with the conventional β-blockers group (7.6% vs. 9.8%, p = 0.003). Among the secondary outcomes, cardiac death occurred significantly less in the vasodilating β-blockers group than in the conventional group (3.5% vs. 4.8%, p = 0.015). The incidence rates of MI (2.4% vs. 3.0%, p = 0.160) or hospitalization for HF (2.6% vs. 3.2%, p = 0.192) were not significantly different between the two groups. @*Conclusions@#Vasodilating β-blocker therapy was associated with better clinical outcomes compared with conventional β-blocker therapy in AMI patients undergoing PCI during 3 years follow-up. Vasodilating β-blockers could be recommended preferentially for these patients.

Double Right Coronary Arteries Originated from Separate Ostia with Total Occlusive Lesion in One of the Two Right Coronary Arteries

Double right coronary arteries (RCA) are very rare congenital anomalies of coronary artery. We report a case of double RCA with total occlusion, incidentally found by collateral flows. A 71-year-old patient underwent percutaneous coronary intervention of left coronary arteries for angina, and the presence of double RCA was missed at initial coronary angiography (CAG). About 20 months later, second CAG was performed due to recurrent angina, and the CAG showed newly developed collateral flow suggesting the presence of the other missed RCA. There was a total occlusion at missed RCA and the lesion was successfully revascularized with drug eluting stent. If there was no collateral flow, the other RCA could not be found and its critical lesion could not be managed properly. Our case suggests that collateral flow can be a useful clue in detecting coronary anomaly. Besides, it is important to fully understand coronary anatomy, not to miss uncommon coronary lesion.

Aesthetic Breast Surgery in Korean

Breast surgery is fully justified only in aesthetic perspectives. Although there are largely two areas in breast surgery, reconstruction and aesthetic, they frequently overlap each other. A reconstructed breast, therefore, should be aesthetically as natural as possible and similar to the contralateral one, even if this means reproducing some little defects. The authors present our experience of recent 6 years in breast reconstruction with an aesthetic eye and an artistic touch, and illustrate personal tips and technical adjustments: use of anatomical prostheses, autologous tissue transfer, axillary fold and nipple-areola complex reconstruction, including augmentation mammaplasty(implant, fat injection) and reduction mammaplasty. In 6 years, 178 cases of breast surgery were performed. Breast reconstruction(post-mastectomy, post burn deformity, congenital deformity etc) was 106 cases. There were 83 TRAM free flap cases, 10 Latissimus dorsi free flap cases. 7 cases using tissue expander and breast implant and 6 were fat graft cases. Number of breast augmentation was 35(25 submuscular, 10 subglandular). Breast reduction procedure was performed in 37 cases(13 periareolar, 8 vertical, 14 inferior pyramidal and 2 free nipple graft technique). The factors characterizing aesthetic results are profiles of breast(projection, inframammary fold location, superficial evenness, and ptosis), symmetry, axillary fold, areola, and nipple. In every procedure, we take account above factors, and results were satisfactory both surgically and aesthetically.

Eyebrow Lift and Malar Fat Lift by Absorbable Suture Fixation with Subperiosteal Dissection

In some blepharochalasis patients, upper blepharoplasty alone is not satisfactory because of narrow distance between eyebrow and eyelash. On that occasion, eyebrow lift is advisable. There are many methods of classical eyebrow lift, such as direct excision, transblepharoplasty approach, anterior hairline technique, and so on. But they are not so effective, have a tendency to recur and also give rise to side effects; unacceptable scar, facial nerve palsy, sensory loss and hematoma, etc. Some patients who have prominent nasolabial folds, are reluctant to perform face lift procedure due to psychologic or economic burden. The authors performed the eyebrow lift procedure separately or simultaneously with face lift or forehead lift. After making 2 or 3 slit incisions, we passed absorbable suture material, 3-0 vicryl, through suborbicularis oculi fat layer. Then it was passed through subperiosteal plane and fixated to the temporalis fascia. When patients complain prominent nasolabial folds, malar fat pad was elevated also in the same manner. This methods is effective and has minimal complication such as facial nerve palsy, scar, sensory loss. Recurrent tendency was rarely observed during follow- up. Dimples were observed at slit incision sites but they disappeared within 2 or 3 weeks. Eyebrow lift and malar fat lift by absorbable suture elevation with subperiosteal dissection is a simple and less morbid. Because of its effectiveness and little side effect or complication, this procedure can be a useful method.

Prognostic Value of C-reactive Protein in Patients with Non-ischemic Dilated Cardiomyopathy: Prospective Study

BACKGROUND AND OBJECTIVES: Previous studies advocated the C-reactive protein (CRP) as an objective marker of the inflammatory reaction in cardiovascular disease, and an independent risk factor for predicting the progression of heart failure (HF) of an ischemic origin. However, it is unclear if this can also be applied to non-ischemic HF. We report the measurement of the CRP in non-ischemic dilated cardiomyopathy (DCM), and its relationship to the prognosis. SUBJECTS AND METHODS: Sixty-nine consecutive patients, with non-ischemic DCM, were enrolled based on their history, echocardiography and coronary angiography findings. The variables, including NYHA functional class, were examined. The CRP levels were measured with high sensitive turbidometry; and each patient followed up for 18 months. The endpoints of the study were considered as readmission and death. RESULTS: Out of the 69 patients, there were 47 (68%) were males and 22 (32%) females, with an average age of 60+/-12. The CRP level (mg/d) in the patients with DCM (1.66+/-2.91) was higher than in the controls (0.07+/-0.25;p<0.001), and increased in relation to the NYHA functional class on discharge (I:0.98+/-2.15, II:0.78+/-1.48, III:3.55+/-4.66, IV:2.94+/-2.39;p<0.01). During the follow-up, 19(28%) experienced the aggravation of HF and had higher CRP and NYHA functional classes, and lower Na+, K+ and hemoglobin levels. From a multiple regression analysis, only the K+ and NYHA functional class on discharge revealed significant relationships with the aggravation of HF (p<0.05). Moreover, an increased in the CRP level had a significant negative relation to the Na+ only (p<0.05). CONCLUSION: The patients with non-ischemic DCM exhibited an increase in CRP levels in relation to the severity of the HF. However, the levels of CRP in non-ischemic DCM could not elucidate the prognosis as with ischemic HF.

Alteration of Nitric Oxide/cyclic-GMP pathway in patients with exaggerated systolic blood pressure response during exercise test / 대한내과학회지

BACKGROUND: The diagnostic and prognostic implication of exaggerated blood pressure response to exercise has not been well characterized. Endothelial dysfunction has been demonstrated in patients with atherosclerosis or with risk factors for coronary artery disease. However, whether the cause of exercise induced hypertension might be due to endothelial dysfunction has not been well elucidated. Therefore, we designed this study to evaluate the endothelial function in patients with exaggerated blood pressure response during exercise. METHODS: Exercise hypertension is defined as a systolic blood pressure >or= 210 mmHg in men and >or= 190 mmHg in female, during treadmill exercise test. The endothelial function of the brachial artery, in 35 patients with exercise hypertension and 35 control subjects (mean age of 45.5+/-8.1) were measured by a high resolution ultrasound technique. The concentrations of nitrite and cyclic-GMP were measured from exercise hypertension group and control subjects during, before and after treadmill exercise. RESULTS: There were no significant differences in the clinical variables between the control and exercise hypertension group. The LVH on ECG was detected more frequently in exercise hypertension group (14 % vs. 40 %, p0.05), a significant difference of cyclic GMP level during the maximal exercise was noted between the groups (10+/-1.8 vs. 8.3+/-2.5 pmol/mL, p<0.05). CONCLSUION: Patients with exercise induced hypertension have impaired endothelium-dependent vasodilation. This study supports the concept that endothelial dysfunction may play a significant role in exercise induced hypertension.

The Origin of Proinflammatory Cytokines in Patients with Idiopathic Dilated Cardiomyopathy

Proinflammatory cytokines and their receptors are increased in the peripheral blood of patients with heart failure. We measured cytokines and their receptors in systemic artery (SA), coronary sinus (CS) and infra-renal inferior vena cava (IVC), in order to investigate their origin and influential factors. Thirty patients with idiopathic dilated cardiomyopathy were performed echocardiography at admission, and right heart catheterization after stabilization. Blood was drawn from 3 sites for measurement of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and soluble tumor necrosis factor- receptor (sTNFR) I, II. TNF-alpha at CS (3.25+/-0.34 pg/mL) was higher than those of SA (1.81+/-0.39 pg/mL) and IVC (1.88+/-0.38 pg/mL, p<0.05). IL-6 at CS (18.3+/-3.8 pg/mL) was higher than that of SA (5.8+/-1.2 pg/mL, p<0.01). The levels of sTNFR I, II showed increasing tendency in sequence of SA, IVC and CS. TNF-alpha and sTNFR I, II from all sites were proportional to worsening of functional classes at admission (p<0.05). E/Ea by Doppler study at admission, which reflects left ventricular end-diastolic pressure (LVEDP) was positively correlated with TNF-alpha from SA (R=0.71, p<0.01), CS (R=0.52, p<0.05) and IVC (R=0.46, p<0.05). Thus, elevated LVEDP during decompensation might cause cytokine release from myocardium in patients with idiopathic dilated cardiomyopathy.