Predictors of Serum Low-Density Lipoprotein Cholesterol Level in Postmenopausal Women

Background@#In general, women tend to increase serum low-density lipoprotein cholesterol levels after menopause. Hypercholesterolemia is a risk factor that causes atherosclerosis and increases the risk of cardiovascular disease. Additionally, low-density lipoprotein cholesterol increases even when attempting to modify lifestyles in menopausal women. Therefore, we wanted to find out what risk factors are associated with low-density lipoprotein cholesterol in menopausal women. @*Methods@#Data were gathered from 4,943 subjects who had visited a Health Promotion Center. Variables are measured in body metering and blood tests. Partial correlation analysis was performed to identify the variables that are related to low-density lipoprotein cholesterol, and multiple regression analysis was performed to find the variables that can predict low-density lipoprotein cholesterol. @*Results@#The mean age of the subjects was 57.3±6.6 years old, the average low density lipoprotein cholesterol concentration was 124.6±33.3 mg/dL, the average body mass index was 23.6±3.2 kg/m 2 , and the average waist circumference was 78.4±8.3 cm, and 21.5 percent of subjects was abdominal obesity. Serum low-density lipoprotein cholesterol level showed a positive correlation with obesity, oxidative stress-related indices, and inflammatory markers such as ESR, CRP. ESR, body fat mass, total bilirubin, uric acid, fasting plasma glucose, and WBC count showed positive correlation with serum low-density lipoprotein cholesterol levels, and age showed negative correlation. @*Conclusion@#This study identified several factors, such as inflammatory markers, obesity and oxidative stress related indices were associated with elevated serum low-density lipoprotein cholesterol levels in postmenopausal women.

Menopause

Menopause can lead to poor quality of life and health problems and is associated with an increased risk of cardiovascular disease and osteoporosis. The health goals of postmenopausal women are to maintain optimal physical, psychological, and social well-being by treating short-term and long-term health problems related to menopause and correcting risk factors for chronic diseases related to aging. The menopausal transition is an excellent opportunity for a general health assessment including assessment of chronic diseases and cancer screening. Recommendations from scientific societies clarify that initiation of menopausal hormone therapy (MHT) is appropriate for symptomatic women without contraindications when they are in the early postmenopausal period (i.e., age <60 years or within 10 years of menopause onset). The decreasing rate of MHT use and/or its premature discontinuation may lead to an increased prevalence of chronic conditions, such as cardiovascular disease and osteoporosis. Primary care physicians should be able to provide symptomatic women with the right information about the benefits and risks of MHT and recommend MHT without any underlying fear.

The Association between Non-Alcoholic Fatty Liver Disease Fibrosis Score and Serum Low Density Lipoprotein-Cholesterol Levels in Adults with Non-Alcoholic Fatty Liver Disease

Background@#Non-alcoholic fatty liver disease fibrosis score (NFS) is a scoring system applied in clinical practice to predict advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). Evidence shows that progression of steatohepatitis and liver fibrosis reduces the production of verylow- density lipoprotein. The aim of this study was to identify the association of NFS and serum low-density lipoprotein cholesterol (LDL-C) levels and in adults with NAFLD. @*Methods@#Data were gathered from 24,889 subjects who had visited a health promotion center. NFS was calculated to assess the severity of fibrosis in all the subjects. Serum LDL-C levels were measured using a direct method. @*Results@#Serum LDL-C levels tended to decrease with increasing NFS quartiles (P for trend<0.01). NFS was one of the major determinants of serum LDL-C level after adjusting for age, sex, lifestyle-related factors, and other covariates. The estimated mean serum LDL-C level was significantly lower in the highest quartile of NFS than in the lowest quartile of NFS. @*Conclusion@#NFS had a negative association with serum LDL-C levels in adults with NAFLD. Elevated LDL-C level is not only a risk factor of cardiovascular disease but also a predictive indicator of NAFLD severity.

Ventricular Septal Defect Closure in a Neonate with Osteogenesis Imperfecta / 대한흉부외과학회지

A male patient weighing 2.5 kg was admitted for respiratory difficulty, and a large ventricular septal defect (VSD) was diagnosed. During care, sudden right leg swelling with a femur shaft fracture occurred. The patient's father had a history of recurrent lower extremity fractures; thus, osteogenesis imperfecta was considered. The patient's respiratory difficulty became aggravated, and VSD repair in the neonatal period was therefore performed with gentle sternal traction and great vessel manipulation under total intravenous anesthesia to prevent malignant hyperthermia. The patient was discharged without notable problems, except minor wound dehiscence. Outpatient genetic testing revealed that the patient had a COL1A1/COL1A2 mutation.

Ventricular Septal Defect Closure in a Neonate with Osteogenesis Imperfecta

A male patient weighing 2.5 kg was admitted for respiratory difficulty, and a large ventricular septal defect (VSD) was diagnosed. During care, sudden right leg swelling with a femur shaft fracture occurred. The patient's father had a history of recurrent lower extremity fractures; thus, osteogenesis imperfecta was considered. The patient's respiratory difficulty became aggravated, and VSD repair in the neonatal period was therefore performed with gentle sternal traction and great vessel manipulation under total intravenous anesthesia to prevent malignant hyperthermia. The patient was discharged without notable problems, except minor wound dehiscence. Outpatient genetic testing revealed that the patient had a COL1A1/COL1A2 mutation.

Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients

BACKGROUND: Many patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) experience depression. Depression influences patient quality of life (QOL), dialysis compliance, and medical comorbidity. We developed and applied a group cognitive behavioral therapy (CBT) program including mindfulness meditation for ESRD patients undergoing HD, and measured changes in QOL, mood, anxiety, perceived stress, and biochemical markers. METHODS: We conducted group CBT over a 12-week period with seven ESRD patients undergoing HD and suffering from depression. QOL, mood, anxiety, and perceived stress were measured at baseline and at weeks 8 and 12 using the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BREF), the Beck Depression Inventory II (BDI-II), the Hamilton Rating Scale for Depression (HAM-D), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS). Biochemical markers were measured at baseline and after 12 weeks. The Temperament and Character Inventory was performed to assess patient characteristics before starting group CBT. RESULTS: The seven patients showed significant improvement in QOL, mood, anxiety, and perceived stress after 12 weeks of group CBT. WHOQOL-BREF and the self-rating scales, BDI-II and BAI, showed continuous improvement across the 12-week period. HAM-D scores showed significant improvement by week 8; PSS showed significant improvement after week 8. Serum creatinine levels also improved significantly following the 12 week period. CONCLUSION: In this pilot study, a CBT program which included mindfulness meditation enhanced overall mental health and biochemical marker levels in ESRD patients undergoing HD.

Airway Improvement with Medium-Term Compression Duration after Right Pulmonary Artery Anterior Translocation

Left main bronchus compression occasionally occurs in patients with cardiac disease. A 19-month-old female patient weighing 6.7 kg was admitted for recurrent pneumonia and desaturation. She had an a trial septal defect (AS D) with a right aortic arch. Her left main bronchus had been compressed between the enlarged right pulmonary artery (RPA) and the descending thoracic aorta for 14 months. We conducted ASD closure and RPA anterior translocation via sternotomy. The left main bronchus compression was relieved despite the medium-term duration of compression.

Airway Improvement with Medium-Term Compression Duration after Right Pulmonary Artery Anterior Translocation / 대한흉부외과학회지

Left main bronchus compression occasionally occurs in patients with cardiac disease. A 19-month-old female patient weighing 6.7 kg was admitted for recurrent pneumonia and desaturation. She had an a trial septal defect (AS D) with a right aortic arch. Her left main bronchus had been compressed between the enlarged right pulmonary artery (RPA) and the descending thoracic aorta for 14 months. We conducted ASD closure and RPA anterior translocation via sternotomy. The left main bronchus compression was relieved despite the medium-term duration of compression.

Lymphocyte DNA damage and plasma antioxidant status in Korean subclinical hypertensive patients by glutathione S-transferase polymorphism

BACKGROUND/OBJECTIVES: Glutathione S-transferase (GST) forms a multigene family of phase II detoxification enzymes which are involved in the detoxification of xenobiotics by conjugating substances with glutathione. The aim of this study is to assess the antioxidative status and the degree of DNA damage in the subclinical hypertensive patients in Korea using glutathione S-transferase polymorphisms. SUBJECTS/METHODS: We examined whether DNA damage and antioxidative status show a difference between GSTM1 or GSTT1 genotype in 227 newly diagnosed, untreated (systolic blood pressure (BP) ≥ 130 mmHg or diastolic BP ≥ 85 mmHg) subclinical hypertensive patients and 130 normotensive subjects (systolic BP < 120 mmHg and diastolic BP < 80 mmHg). From the blood of the subjects, the degree of the DNA damage in lymphocyte, the activities of erythrocyte superoxide dismutase, the catalase, and the glutathione peroxidase, the level of glutathione, plasma total radical-trapping antioxidant potential (TRAP), anti-oxidative vitamins, as well as plasma lipid profiles and conjugated diene (CD) were analyzed. RESULTS: Of the 227 subjects studied, 68.3% were GSTM1 null genotype and 66.5% were GSTT1 null genotype. GSTM1 null genotype had an increased risk of hypertension (OR: 2.104, CI: 1.38-3.35), but no significant association in GSTT1 null genotype (OR 0.982, CI: 0.62-1.55). No difference in erythrocyte activities of superoxide dismutase, catalase, or glutathione peroxidase, and plasma TRAP, CD, lipid profiles, and GSH levels were observed between GSTM1 or GSTT1 genotype. Plasma levels of α-tocopherol increased significantly in GSTT1 wild genotype (P < 0.05); however, plasma level of β-carotene increased significantly in GSTT1 null genotype (P < 0.01). DNA damage assessed by the Comet assay was significantly higher in GSTM1 null genotype than wild genotype (P < 0.05). CONCLUSIONS: These results confirm the association between GSTM1 null genotype and risk of hypertension as they suggest that GSTM1 null genotype leads to an increased oxidative stress compared with wild genotype.

The Association between Muscle Mass Deficits Estimated from Bioelectrical Impedance Analysis and Lumbar Spine Bone Mineral Density in Korean Adults

BACKGROUND: Bone mineral density (BMD) is influenced by many factors. Despite the reported association between body components and BMD, most of these studies investigated the relationship between absolute muscle mass or fat mass and BMD in postmenopausal women or elderly subjects. The aim of this study is to investigate the association between muscle mass deficits (MMD) estimated from bioelectrical impedance analysis (BIA) and lumbar spinal BMD in Korean adults 20 to 49 years of age. METHODS: This cross-sectional study included 1,765 men and women who visited a health promotion center for a routine checkup. The lumbar spinal BMD was measured by dual energy X-ray absorptiometry. Body composition analysis was performed using BIA. RESULTS: The mean age of the subjects was 40.2±6.3 years. Ten thousand subjects (56.7%) were males and 126 subjects (7.1%) belonged to the low BMD (Z-score ≤-2.0). MMD had the strongest influence on BMD after adjusting for all covariates. The adjusted odds ratio of Group 3 (MDD >2.6 kg) for low BMD was 2.74 (95% CI, 1.46-5.15) after adjusting for age, gender, body mass index, height, and smoking. CONCLUSIONS: MMD estimated by BIA showed a significant association with BMD and could be regarded as an independent risk factor for low BMD in adults 20 to 49 years of age. These findings support that interventions such as physical activity or lifestyle changes may simultaneously modify both muscle and bone health in this age group.

The Impact of a Spouse's Depression on Family Functioning and Communication

BACKGROUND: Depression is known to affect family function and communication. However, the distress experienced by those who have spouse with depression has not been properly assessed to date. This study attempted to examine the effect of depression on family function and communication as reported by the spouses of the depressed patients. METHODS: The participants of this study were 445 couples who visited 28 family doctors from April 2009 to June 2011. The Family Adaptability and Cohesion Evaluation Scale III (FACES-III) was used to evaluate the family function, and the family communication scale in FACES-IV was used to evaluate communication among family members. A score of more than 21 points on the CES-D scale was used to indicate depression. The relationships between family type, family communication, and the depression of one's spouse were analyzed using the chi-square test and logistic regression. RESULTS: The odds ratios, indicating how the family is heading towards an extreme level, were statistically significant in all male and female respondents (male: odds ratio [OR] 3.08, 95% confidence interval [CI] 1.73-5.48; female: OR 2.09, 95% CI 1.02-4.27). On the other hand, only female respondents with depressed spouses reported their family communication not to be good (male: OR 1.65, 95% CI 0.88-3.07; female: OR 2.48, 95% CI, 1.25-4.93). CONCLUSIONS: This study revealed people perceive their family function and communication not good when they have spouses with depression. There was no gender difference in the evaluation of their family function, but the perception on their family communication were different by gender.

New Antiresorptive Therapies for Postmenopausal Osteoporosis

Osteoporosis is a systemic skeletal disease whose risk increases with age and it is common among postmenopausal women. Currently, almost all pharmacological agents for osteoporosis target the bone resorption component of bone remodeling activity. Current antiresorptive agents are effective, but the effectiveness of some agents is limited by real or perceived intolerance, longterm adverse events (AEs), coexisting comorbidities, and inadequate long-term adherence. New antiresorptive therapies that may expand options for the prevention and treatment of osteoporosis include denosumab, combination of conjugated estrogen/bazedoxifene and cathepsin K inhibitors. However, the long-term efficacy and AEs of these antiresorptive therapies need to be confirmed in studies with a longer follow-up period.

Emerging Anabolic Therapies for Osteoporosis / 대한골다공증학회지

Osteoporosis is defined as low bone mineral density (BMD) associated with fragility fractures. It is characterized by unbalanced bone remodeling activity leading to bone loss and eventually fractures. Osteoporosis-related fractures are one of the leading causes of significant morbidity and disability in elderly and increase burden to patients, society, and healthcare systems. The goal of osteoporosis treatment is to prevent fractures. Present antiresorptive agents are effective, but they have relative lack of efficacy on nonvertebral fractures because their effects are restricted to remodeling-based activities. Also, there is a great need for additional and reasonable anabolic agents in situations of severe osteoporosis and extensive bone loss. The two main bone anabolic pathways are parathyroid hormone (PTH) signaling and canonical wingless-int (Wnt)/beta-catenin signaling. These pathways stimulate bone formation through increasing the activation frequency or direct activation of bone modeling or a combination of both. Especially, the discovery of the Wnt signaling pathway and its activity in bone tissue has led to the development of novel anabolic agents that can enhance Wnt signaling in skeletal cells. This review aims at providing an overview of the currently available anabolic agents and an insight into promising investigational anabolic agents for the treatment of osteoporosis.

Association between oxidative stress and blood pressure in Korean subclinical hypertensive patients

This study was conducted in order to investigate the association between hypertension and oxidative stress-related parameters and to evaluate these parameters in subclinical hypertensive patients and normotensive subjects living in Korea. We attempted to determine whether oxidative stress-related parameters would differ between two groups of 227 newly-diagnosed, untreated (systolic blood pressure (BP) > or = 130 mmHg and diastolic BP > or = 85 mmHg) and 130 normotensive subjects (systolic BP < 120 mmHg and diastolic BP < 80 mmHg). General characteristics of the subjects were collected using a simple questionnaire. From subjects' blood, degree of DNA damage in lymphocytes, the activities of erythrocyte superoxide dismutase, catalase, and glutathione peroxidase, level of plasma total radical-trapping antioxidant potential (TRAP), glutathione, and anti-oxidative vitamins, as well as plasma lipid profiles and conjugated diene (CD) were analyzed. Evaluation of the associations of oxidative stress-related parameters with blood pressure of the subjects was performed using Pearson partial correlation and multivariate logistic regression analysis after adjusting for confounding factors. Several oxidative stress-related parameters were higher in subclinical hypertensive patients than in normotensive subjects. Plasma levels of alpha-tocopherol, beta-carotene, TRAP, and activity of GSH-px were significantly lower in subclinical hypertensive patients than in normotensive subjects. Increased levels of DNA damage, lipid peroxidation, triglyceride, total cholesterol, and LDL-cholesterol were observed in subclinical hypertensive patients. These results confirm an association between blood pressure and oxidative stress-related parameters and suggest that the pathogenic role of oxidative stress in hypertension might be significant.

Factors Associated with Serum Levels of Carcinoembryonic Antigen in Healthy Non-smokers / 가정의학회지

BACKGROUND: Carcinoembryonic antigen (CEA), a serological marker of malignant tumors, demonstrates a modest increase under nonmalignant conditions such as aging and smoking. Also, recent study results suggested that serum CEA levels may be related to insulin resistance or low-grade inflammation. The aim of this study was to investigate the factors associated with serum CEA levels in healthy non-smokers. METHODS: Data was gathered from 21,501 adults aged 20 and over. We excluded 19,081 subjects who had omissions in anthropometric measurements or laboratory tests, or who had previous or current smoking history. RESULTS: The mean CEA level was 1.18 +/- 0.85 ng/dL in males and 0.93 +/- 0.73 ng/dL in females. After adjustment for age, CEA level was positively correlated with fasting glucose, glycosylated hemoglobin (HbA1C), high density lipoprotein (HDL) cholesterol, estimated glomerular filtration rate in males. In females, CEA level was positively correlated with fasting glucose, HbA1C, HDL cholesterol, aspartate aminotransferase, and high-sensitivity C-reactive protein. In both gender groups, HbA1C had a strong influence on CEA levels when all other variables were included in the regression model (P < 0.05). CONCLUSION: Within normal range, serum CEA levels were significantly associated with HbA1C levels but not with homeostasis model assessment of insulin resistance in the non-smoking population. These findings suggest that serum CEA levels are influenced by the glucose level itself instead of insulin resistance.

Blood Pressure Variability and Its Management in Hypertensive Patients / 가정의학회지

Optimizing treatment for hypertension has focused on reducing cardiovascular risk through reduction of mean blood pressure (BP) under the basic assumption that lower is better, as long as diastolic BP is sufficient to maintain coronary perfusion. However, antihypertensive therapy as currently practiced does not eliminate all hazards associated with BP elevation. Blood pressure variability (BPV) correlates closely with target-organ damage independent of mean BP and transient increases in BP are also triggers of vascular events. So far, there is no definitive outcome data relating specific reduction in BPV to decline cardiovascular events or death. Thus, the decision whether BPV should be considered a new therapeutic target is left to the clinical judgment of physicians and individualized for each patient. However, new evidence suggests that taking an antihypertensive medication at bedtime significantly affects BPV and lowers the risk of cardiovascular events and death. This strategy may provide a means of individualizing treatment of hypertension according to the circadian BPV of each patient and may be a new option to optimize BP control and reduce risk.

New Insight into the Action of Vitamin D / 가정의학회지

Vitamin D deficiency is now recognized as a pandemic with more than half of the world's population currently at risk. Traditionally, vitamin D has been associated primarily with bone and calcium metabolism. However, it is now known that adequate vitamin D status is important for optimal function of many organs and tissues throughout the body. This discovery has provided new insights into the action of vitamin D. Many epidemiologic studies have demonstrated an association between vitamin D deficiency and the risk of various chronic diseases, including cardiovascular disease, diabetes, cancers, autoimmune diseases, and infectious diseases. However, it is not enough to limit definitive conclusions. Large randomized controlled trials are needed to establish the relevance of vitamin D status to such as chronic diseases. Vitamin D deficiency and insufficiency can be both treated and prevented safely through supplementation. Recommendation of adequate vitamin D intake should be considered in appropriate patients to optimize general health. In this article, I review its role in skeletal and extraskeletal health and the adverse impact of vitamin D deficiency on musculoskeletal system, cardiometabolic health, immune system, and oncogenesis, and suggest strategies for prevention and treatment of vitamin D deficiency.

Predictors of Insulin Resistance in Postmenopausal Women / 대한폐경학회지

OBJECTIVES: Insulin resistance plays an important role in cardiovascular diseases, type 2 diabetes, and non-alcoholic fatty liver disease. The objective of this study was to determine the association between obesity and elevated alanine aminotransferase (ALT) with insulin resistance and compare these factors with metabolic syndrome in postmenopausal women. METHODS: We analyzed 606 postmenopausal women who had visited the Health Promotion Center. The medical history and lifestyle data were collected by questionnaire and history taking. Anthropometric parameters and blood pressure were measured. Laboratory tests included fasting glucose and insulin levels, and liver and lipid profiles. Metabolic syndrome was defined based on NCEP-ATP III criteria. As a maker of insulin resistance, the homeostatic model assessment-insulin resistance (HOMA-IR) was calculated. We grouped all subjects into four groups, based on the quartiles of HOMA-IR. The top fourth quartile group was defined as the group with insulin resistance. We performed multivariate logistic regression analysis for the odds ratio of the risk for insulin resistance. RESULTS: The prevalence rates of obesity (body mass index > or = 25 kg/m2) and elevated ALT (> or = 34 U/L) increased with increased HOMA-IR. Obesity and elevated ALT were associated with insulin resistance, after adjusting for age, smoking status, and exercise. Women with co-existing obesity and elevated ALT were at increased risk for insulin resistance (OR = 5.87; 95% CI, 2.93~11.74) compared to women with metabolic syndrome (OR = 3.43; 95% CI, 2.18~5.41). CONCLUSION: Obesity and elevated ALT are associated with insulin resistance in postmenopausal women. A combination of these factors is superior to metabolic syndrome in predicting insulin resistance.

Predictors of Insulin Resistance in Postmenopausal Women / 대한폐경학회지

OBJECTIVES: Insulin resistance plays an important role in cardiovascular diseases, type 2 diabetes, and non-alcoholic fatty liver disease. The objective of this study was to determine the association between obesity and elevated alanine aminotransferase (ALT) with insulin resistance and compare these factors with metabolic syndrome in postmenopausal women. METHODS: We analyzed 606 postmenopausal women who had visited the Health Promotion Center. The medical history and lifestyle data were collected by questionnaire and history taking. Anthropometric parameters and blood pressure were measured. Laboratory tests included fasting glucose and insulin levels, and liver and lipid profiles. Metabolic syndrome was defined based on NCEP-ATP III criteria. As a maker of insulin resistance, the homeostatic model assessment-insulin resistance (HOMA-IR) was calculated. We grouped all subjects into four groups, based on the quartiles of HOMA-IR. The top fourth quartile group was defined as the group with insulin resistance. We performed multivariate logistic regression analysis for the odds ratio of the risk for insulin resistance. RESULTS: The prevalence rates of obesity (body mass index > or = 25 kg/m2) and elevated ALT (> or = 34 U/L) increased with increased HOMA-IR. Obesity and elevated ALT were associated with insulin resistance, after adjusting for age, smoking status, and exercise. Women with co-existing obesity and elevated ALT were at increased risk for insulin resistance (OR = 5.87; 95% CI, 2.93~11.74) compared to women with metabolic syndrome (OR = 3.43; 95% CI, 2.18~5.41). CONCLUSION: Obesity and elevated ALT are associated with insulin resistance in postmenopausal women. A combination of these factors is superior to metabolic syndrome in predicting insulin resistance.

A case of port site implantation of borderline mucinous tumor of ovary after the laparoscopic operation / 대한산부인과학회지

Borderline tumor of ovary is epithelial proliferation without stromal invasion, first reported by Taylor in 1929. Borderline ovarian tumor occurs in younger women and is detects in early stage. Laparosocopy is alternative treatment of younger women for postoperative quality of life because it reduces postoperative adhesion. But it is limited to incomplete staging, tumor cell dissemination and recurrence. We report a case of port site implantation of mucinous borderline tumor after the laparoscopic operation; usually recurrence of borderline tumors were occurred after ten or fifteen years later, this case a direct evidence of cause of metastasis after the laparoscopic operation.