Elevated On-Treatment Diastolic Blood Pressure and Cardiovascular Outcomes in the Presence of Achieved Systolic Blood Pressure Targets

Background and Objectives@#This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). @*Methods@#A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg). @*Results@#During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05–1.24) but not in those by the 2017 ACC/AHA definition. Elevated ontreatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18–1.70) and stroke (aHR, 1.19; 95% CI, 1.08–1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10;95% CI, 1.04–1.16). Similar results were seen in the propensity-score-matched cohort. @*Conclusion@#Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.

Prevalence and characteristics of isolated nocturnal hypertension in the general population

Background/Aims@#Ascertaining the prevalence of isolated nocturnal hypertension (INHT) in the general population and identifying the characteristics of patients with INHT may be important to determine patients who should receive 24- hour ambulatory blood pressure (BP) measurements. This study aimed to evaluate the prevalence and characteristics of INHT in the general population. @*Methods@#Of 1,128 participants (aged 20 to 70 years), we analyzed 823 who had valid 24-hour ambulatory BP measurements and were not on antihypertensive drug treatment. @*Results@#The prevalence of INHT in the study was 22.8%. Individuals with INHT had a higher office, 24-hour, and daytime and nighttime ambulatory systolic and diastolic BPs compared to individuals with sustained day-night normotension. INHT was more prevalent in individuals with masked hypertension (MH) than in those with sustained hypertension (59.8% vs. 15.6%, p < 0.001). Among individuals with INHT, 92.6% had MH. Among individuals with office BP-based prehypertension, 34.5% had both INHT and MH. The prevalence of INHT was highest in individuals with office BP-based prehypertension. INHT was an independent determinant of MH after adjustment for age, sex, body mass index, diabetes, low-density-lipoprotein cholesterol, 24-hour systolic and diastolic BP, systolic and diastolic BP dipping, and systolic and diastolic BP non-dipping. @*Conclusions@#The present study showed that INHT is not uncommon and is a major determinant of MH. Our findings strongly suggest the use of 24-hour ambulatory BP measurement for individuals within the prehypertension range of office BP owing to the high prevalence of INHT and MH in this population.

Prevalence and characteristics of isolated nocturnal hypertension in the general population

Background/Aims@#Ascertaining the prevalence of isolated nocturnal hypertension (INHT) in the general population and identifying the characteristics of patients with INHT may be important to determine patients who should receive 24- hour ambulatory blood pressure (BP) measurements. This study aimed to evaluate the prevalence and characteristics of INHT in the general population. @*Methods@#Of 1,128 participants (aged 20 to 70 years), we analyzed 823 who had valid 24-hour ambulatory BP measurements and were not on antihypertensive drug treatment. @*Results@#The prevalence of INHT in the study was 22.8%. Individuals with INHT had a higher office, 24-hour, and daytime and nighttime ambulatory systolic and diastolic BPs compared to individuals with sustained day-night normotension. INHT was more prevalent in individuals with masked hypertension (MH) than in those with sustained hypertension (59.8% vs. 15.6%, p < 0.001). Among individuals with INHT, 92.6% had MH. Among individuals with office BP-based prehypertension, 34.5% had both INHT and MH. The prevalence of INHT was highest in individuals with office BP-based prehypertension. INHT was an independent determinant of MH after adjustment for age, sex, body mass index, diabetes, low-density-lipoprotein cholesterol, 24-hour systolic and diastolic BP, systolic and diastolic BP dipping, and systolic and diastolic BP non-dipping. @*Conclusions@#The present study showed that INHT is not uncommon and is a major determinant of MH. Our findings strongly suggest the use of 24-hour ambulatory BP measurement for individuals within the prehypertension range of office BP owing to the high prevalence of INHT and MH in this population.

Impact of Longitudinal Changes in Metabolic Syndrome Status over 2 Years on 10-Year Incident Diabetes Mellitus

BACKGROUND: Metabolic syndrome (MetS) is a known predictor of diabetes mellitus (DM), but whether longitudinal changes in MetS status modify the risk for DM remains unclear. We investigated whether changes in MetS status over 2 years modify the 10-year risk of incident DM. METHODS: We analyzed data from 7,317 participants aged 40 to 70 years without DM at baseline, who took part in 2001 to 2011 Korean Genome Epidemiology Study. Subjects were categorized into four groups based on repeated longitudinal assessment of MetS status over 2 years: non-MetS, resolved MetS, incident MetS, and persistent MetS. The hazard ratio (HR) of new-onset DM during 10 years was calculated in each group using Cox models. RESULTS: During the 10-year follow-up, 1,099 participants (15.0%) developed DM. Compared to the non-MetS group, the fully adjusted HRs for new-onset DM were 1.28 (95% confidence interval [CI], 0.92 to 1.79) in the resolved MetS group, 1.75 (95% CI, 1.30 to 2.37) in the incident MetS group, and 1.98 (95% CI, 1.50 to 2.61) in the persistent MetS group (P for trend <0.001). The risk of DM in subjects with resolved MetS was significantly attenuated compared to those with persistent MetS over 2 years. In addition, the adjusted HR for 10-year developing DM gradually increased as the number of MetS components increased 2 years later. CONCLUSION: We found that discrete longitudinal changes pattern in MetS status over 2 years associated with 10-year risk of DM. These findings suggest that monitoring change of MetS status and controlling it in individuals may be important for risk prediction of DM.

Metabolic Syndrome Severity Score in Korean Adults: Analysis of the 2010–2015 Korea National Health and Nutrition Examination Survey

BACKGROUND: Continuous metabolic syndrome (MS) severity scores that can track metabolic risk in individuals over time have been developed for Western populations. The present study aimed to develop gender- and age-specific equations for MS severity scores in Korean adults. METHODS: Using data from the Korea National Health and Nutrition Examination Surveys (KNHANES) IV (2010–2012) and VI (2013–2015), we performed a confirmatory factor analysis of single MS factor that allowed for differential loadings across groups to generate gender- and age-specific, continuous MS severity scores. Then, we validated this equation in a different dataset of Korean adults. RESULTS: In confirmatory analysis, waist circumference had the highest factor loading, indicating that waist circumference had the strongest correlation with MS among Korean adults. Lower factor loadings (< 0.4) among Korean adults aged 40–59 years were noted for systolic blood pressure and fasting glucose. MS severity score values were significantly correlated with metabolic parameters, including high-sensitivity C-reactive-protein, glycated hemoglobin, and homeostasis model assessment of insulin resistance. Furthermore, MS severity scores well predicted traditional MS according to receiver operating characteristic analysis in a validation dataset (KNHANES VII). In a longitudinal cohort dataset, participants diagnosed with Adult Treatment Program III (ATP-III) MS after an initial assessment had progressively higher baseline MS severity scores in relationship to their time until ATP-III MS diagnosis. CONCLUSION: The new MS severity score equations for Korean adults proposed in this study provide a clinically-accessible continuous measure of MS for potential use in identifying adults at higher risk for MS-related diseases and following changes within individuals over time.

Stress-Induced Cardiomyopathy Presenting as Shock

Stress-induced cardiomyopathy has become a more recognized and reported entity. It can be caused by emotional or physical stress, which causes excessive catecholamine release. Typically, the clinical course is benign with conservative treatment being effective. However, stress-induced cardiomyopathy can be fatal. A 41-year-old female presented with cardiogenic shock followed by sudden back pain. Initial echocardiographic finding showed severely decreased ejection fraction with akinesia at all mid-to-apical walls with relatively preserved basal wall contractility. The coronary artery was intact on coronary angiography. Cardiac resuscitation and extra-corporeal membrane oxygenation was needed to manage the cardiogenic shock. Recovery was complete after 2 weeks.

Saccular Coronary Artery Aneurysm and Fistula with Organized Thrombi

Saccular coronary artery aneurysm, associated with coronary artery fistula, is a very rare condition. A 48-year-old woman was referred to our hospital for the evaluation of an abnormal shadow on the left cardiac border from a chest X-ray film during regular medical health examination. A huge saccular aneurysm with organized thrombi in the proximal left anterior descending artery (LAD) and coronary artery fistulae from LAD and conus branch of the right coronary artery to pulmonary artery was diagnosed by transthoracic echocardiography, multi-detector computer tomography (MDCT), and coronary angiography. The patient received surgical treatment, including thrombectomy of aneurysm, ligation of the inlet and outlet of aneurysmal sac, coronary artery bypass graft (left internal mammary artery-to-distal LAD), and ligation of fistulae. The postoperative course was uneventful, and postoperative echocardiography and MDCT revealed patent bypass graft; however, a small fistula from proximal LAD across aneurysmal sac to pulmonary artery was observed.

Saccular Coronary Artery Aneurysm and Fistula with Organized Thrombi

Saccular coronary artery aneurysm, associated with coronary artery fistula, is a very rare condition. A 48-year-old woman was referred to our hospital for the evaluation of an abnormal shadow on the left cardiac border from a chest X-ray film during regular medical health examination. A huge saccular aneurysm with organized thrombi in the proximal left anterior descending artery (LAD) and coronary artery fistulae from LAD and conus branch of the right coronary artery to pulmonary artery was diagnosed by transthoracic echocardiography, multi-detector computer tomography (MDCT), and coronary angiography. The patient received surgical treatment, including thrombectomy of aneurysm, ligation of the inlet and outlet of aneurysmal sac, coronary artery bypass graft (left internal mammary artery-to-distal LAD), and ligation of fistulae. The postoperative course was uneventful, and postoperative echocardiography and MDCT revealed patent bypass graft; however, a small fistula from proximal LAD across aneurysmal sac to pulmonary artery was observed.

Effect of Nonalcoholic Fatty Liver Disease on the Development of Type 2 Diabetes in Nonobese, Nondiabetic Korean Men

BACKGROUND/AIMS: We have a limited understanding of the effect of nonalcoholic fatty liver disease (NAFLD) on the development of type 2 diabetes. METHODS: The study subjects included male who had received biennial medical check-ups between 2005 and 2009 and who had been diagnosed with fatty liver disease. The subjects with sustained NAFLD (FL, n=107) and sustained non-NAFLD (NFL, n=1,054) were followed to determine the development of type 2 diabetes. RESULTS: In the FL group, there were more subjects with impaired fasting glucose (IFG), type 2 diabetes and high HOMA-IR than there were in the NFL group during the 5-year follow-up period (32.7 vs. 17.6%, 1.9 vs. 0.3%, 17.9 vs. 5.2% respectively, p<0.05). The FL group showed a higher risk than NFL group for abnormal glucose metabolism as determined using IFG (odds ratio [OR], 2.13; confidence interval [CI], 1.36 to 3.35), type 2 diabetes (OR, 7.63; 95% CI, 1.03 to 56.79) and high HOMA-IR (OR, 3.25; 95% CI, 1.79 to 5.91) and metabolic parameters such as body mass index (OR, 3.35; 95% CI, 1.87 to 6.02), triglyceride (OR, 3.05; 95% CI, 1.92 to 4.86) and fasting blood sugar (OR, 2.18; 95% CI, 1.39 to 3.41). CONCLUSIONS: Sustained NAFLD appears to be associated with an increased risk for the development of type 2 diabetes and deterioration of metabolic parameters in non-obese, non-diabetic Korean men.

Serum Uric Acid as a Predictor for the Development of Nonalcoholic Fatty Liver Disease in Apparently Healthy Subjects: A 5-Year Retrospective Cohort Study

BACKGROUND/AIMS: This study evaluated the relationship between hyperuricemia and nonalcoholic fatty liver disease (NAFLD) by comparing the incidence rates of NAFLD in relation to serum uric acid levels in apparently healthy subjects during a 5-year period. METHODS: Among 15,638 healthy Korean subjects who participated in a health-screening program in 2003 and 2008, respectively, 4954 subjects without other risk factors were enrolled in this study. We compared the incidence rates of NAFLD in 2008 with respect to baseline uric acid levels. RESULTS: In 2003, serum uric acid levels were categorized into the following quartiles: 0.6-3.9, 3.9-4.8, 4.8-5.9, and 5.9-12.6 mg/dL. The incidence of NAFLD in 2008 increased with the level of baseline uric acid (5.6%, 9.8%, 16.2%, and 20.9%, respectively; p<0.05). Multiple logistic regression analysis demonstrated that hyperuricemia was associated with the development of NAFLD. When compared to the subjects in quartile 1, the odds ratio (OR) for the incidence of NAFLD for quartiles 2, 3, and 4 were 1.53 (95% confidence interval [CI], 1.09-2.16; p=0.014], 1.69 (95% CI, 1.17-2.44; p=0.005), and 1.84 (95% CI, 1.25-2.71; p=0.002), respectively. CONCLUSIONS: High serum uric acid levels appear to be associated with an increased risk of the development of NAFLD.

Metabolic Syndrome, Insulin Resistance and Systemic Inflammation as Risk Factors for Reduced Lung Function in Korean Nonsmoking Males

The aim of this study was done to assess the association of lung function with insulin resistance (IR), systemic inflammation, and metabolic syndrome (MetS). In 9,581 apparently healthy non-smoking male adults, pulmonary function, fasting glucose, insulin, lipid profiles and serum high-sensitivity C-reactive protein (hs-CRP) levels were measured, and homeostatic model assessment (HOMA) was used to assess IR. The presence of MetS was defined according to the AHA/NHLBI criteria. The prevalence of MetS was 19.3%. The odds ratio of MetS for restrictive ventilatory pattern was 1.55 (95% confidence interval, 1.12-2.14), and that for obstructive ventilatory pattern was 1.39 (0.66-2.94) after adjustment for confounders. When subjects were divided in 4 groups according to quartiles of FVC or FEV1 (% predicted [pred]), HOMA-IR significantly increased as the FVC or FEV1 (% predicted [pred]) decreased. Individuals in the lowest FVC or FEV1 quartile had the highest hs-CRP level. Prevalence of MetS increased as FVC or FEV1 (% predicted [pred]) quartiles decreased. The abdominal obesity, hs-CRP and HOMA-IR were the independent predictors for the lowest FVC and FEV1 (% predicted [pred]) even after adjustment for confounders. These results indicate that MetS, IR, and systemic inflammation are important risk factors for reduced lung function in nonsmoking Korean males.

The Relationship Between Heart Rate Recovery and Brain Natruretic Peptide in Patients With Chest Discomfort

BACKGROUND AND OBJECTIVES: The correlation between brain natruretic peptide (BNP) level and cardiac autonomic function has been studied in type 2 diabetic patients. However, there is limited data from patients with normal systolic function. We evaluated the association between heart rate recovery (HRR) representing autonomic dysfunction and three plasma BNP levels: pre-exercise, post-exercise, and change during exercise in patients with normal systolic function. SUBJECTS AND METHODS: Subjects included 105 patients with chest pain and normal systolic function. HRR was defined as the difference between the peak heart rate and the rate measured two minutes after completion of a treadmill exercise test. We measured plasma BNP levels before exercise, 5 minutes after completion of exercise, and during exercise (absolute value of difference between pre- and post-exercise BNP levels). RESULTS: Patients with abnormal HRR values (< or =24 beats for the first 2 minutes of HRR) had lower high-density lipoprotein, lower peak heart rates, and higher pre- and post-exercise BNP levels than patients with normal HRR values. The patients with coronary artery disease (CAD) had abnormal HRR. However, no significant differences were found between the two groups in terms of history of hypertension (HTN), diabetes, and peak systolic blood pressure (SBP) and diastolic blood pressure (DBP). HRR was significantly associated with pre-exercise BNP (r=-0.36, p=0.004) and post-exercise BNP (r=-0.27, p=0.006), but not BNP changes. Further, pre-exercise BNP levels showed a greater association with HRR than post-exercise BNP levels. CONCLUSION: HRR is independently associated with pre-exercise and post-exercise BNP levels, even in patients with normal systolic function.

The Relationship between Serum Retinol-Binding Protein 4 Levels and Coronary Artery Disease in Korean Adults / 당뇨병

BACKGROUND: A recently discovered adipokine, retinol-binding protein-4 (RBP-4), is reportedly associated with insulin resistance and metabolic syndrome. This study was performed to analyze the relationship between serum RBP-4 levels and coronary artery disease (CAD) in Korean adults. METHODS: In 235 subjects (mean age 58 years) in whom coronary artery angiograms were performed due to complaints of chest pain, serum RBP-4 levels were measured by enzyme-linked immunosorbent assay. Coronary artery angiograms were performed in all subjects and the severity of CAD was assessed by the number of stenotic vessels. The presence of metabolic syndrome was defined by AHA/NHLBI criteria with body mass index substituted for waist circumference. RESULTS: Coronary angiogram showed that 101 subjects (43%) had normal coronary vessel, 82 subjects (34.9%) had 1-vessel disease, 31 subjects (13.2%) had 2-vessel disease and 21 subjects (8.9%) had 3-vessel disease. Subjects with coronary artery stenosis showed a higher mean age (60.5 +/- 10.0 years), fasting glucose (123.3 mg +/- 45.0 mg/dL) and lower mean value for high-density lipoprotein cholesterol (HDL-C) level (49.0 +/- 13.2 mg/dL), although serum RBP-4 levels were not significantly different between those with and without CAD. Mean age and fasting glucose level increased significantly as the number of stenotic vessels increased, although serum RBP4 level showed no significant differences among the different groups. Among the metabolic parameters, only serum triglyceride levels showed a significant correlation with serum RBP-4 levels. CONCLUSION: There was no difference in mean serum RBP-4 levels between subjects with or without coronary artery disease in Korean adults. Further studies are warranted to draw a clear conclusion on the effect of RBP-4 on atherosclerosis.

The Association of Osteoprotegerin with Cardiovascular Disease and the New York Heart Association Classification

BACKGROUND AND OBJECTIVES: Recent studies have suggested that there is a significant correlation between elevated serum Osteoprotegerin (OPG) levels and cardiovascular diseases. We investigated whether the serum OPG levels were associated with heart failure (HF), acute myocardial infarction (AMI) and unstable angina (UA), and whether the serum OPG levels were correlated with the NYHA classifications. SUBJECTS AND METHODS: The serum OPG levels were measured in 127 patients suffering with HF, AMI and UA and they were hospitalized in the cardiology department, and these values were compared to 63 healthy controls. The NYHA classification was used to define the clinical disease severity. The serum OPG level was measured by performing ELISA. RESULTS: The serum OPG levels were significantly higher in the patients with HF and AMI than those in the control subjects (p=0.003, p=0.002, respectively). The mean OPG levels were 555, 683, 774 and 856 pg/mL for the subjects and controls, according to the NYHA classifications II, III and IV, respectively. Multiple regression analysis revealed that the serum OPG levels were significantly associated with HF and AMI, and when all subjects were regrouped according to NYHA classification, the serum OPG levels were also significantly associated with the NYHA classification. CONCLUSION: The serum OPG levels were increased in Asian patients suffering with cardiovascular disease such as HF and AMI, and they were also increased with the NYHA classification. The serum OPG level could be a marker for different stages of cardiovascular disease.

The association of KLOTHO gene polymorphism with coronary artery disease in Korean subjects / 대한내과학회지

BACKGROUND: Klotho knock-out mouse is being thought as a good animal model for human aging and these mice show typically severe atherosclerosis of large arteries. Recent studies report on the association of KLOTHO gene mutation with cardiovascular diseases in humans. We observed the frequencies of G395A in promoter and C1818T in exon 4 of KLOTHO gene and investigated their relationships with the presence of coronary artery disease (CAD) in those patients underwent coronary angiograms METHODS: Total 168 subjects (mean age 58 years, 26-87 years) who underwent coronary angiograms due to chest pain were enrolled and blood pressure, body mass index, fasting blood glucose and lipid profiles were measured in all subjects. Genotypings were performed with real-time polymerase chain reaction from sampled blood. RESULTS: The allele frequencies of G395A were 0.872 for G allele and 0.128 for A allele and those of C1818T were 0.830 for C allele and 0.170 for T allele. Both were in compliance with Hardy-Weinberg equilibrium (p=0.99, p=0.82). When the subjects were classified into four groups according to the number of stenotic vessels, there were no differences among the mean values of the cardiovascular risk factors, except high-density lipoprotein cholesterol, that showed a significant difference between that of normal and the diseased vessel groups. There were no differences in the prevalence of CAD according to the genotypes of G395A polymorphism, but for C1818T polymorphism, subjects with T allele showed lower prevalence of CAD than those with CC genotype. When the subjects were divided into two groups according to age, in the group under 60 years of age, T allele carriers of C1818T polymorphism showed lower prevalence of CAD than non-carriers. In the group older than 60 years, A allele carriers of G395A polymorphism showed lower prevalence of CAD than non-carriers. CONCLUSIONS: The frequencies of KLOTHO G395A and C1818T polymorphisms in Koreans were observed similarly to those reported in other Asian races and the phenotypic expression on CAD was different according to age groups. These results infer the possibility of KLOTHO gene as the candidate gene of atherosclerosis in humans, which needs further research.

Prevalence and clinical characteristics of microalbuminuria in Koreans: a population-based cross-sectional study / 대한내과학회지

BACKGROUND: Microalbuminuria (MA) is independent predictor of cardiovascular disease and it cause mortality regardless of the presence of diabetes (DM) and hypertension (HTN). However, few published studies on this topic have been reported in Korea. Therefore, we investigated the MA prevalence and relationship between MA, insulin resistance and cardiovascular risk factor. METHODS: A total of 5,915 (3,053 men and 2,852 women) health screen examinees were enrolled in this study. We measured the anthropometric and biochemical parameters of the atherogenic indexes. RESULTS: The MA prevalence was 7.7% in all participants. The prevalence of MA in the men and women was 9.5% and 5.7%, respectively. Elevated levels of serum fasting glucose, serum fasting insulin, HOMA index, total cholesterols, LDL cholesterol, TG, Body Mass Index (BMI) and the systolic and diastolic blood pressure were significantly associated with MA. The results of multiple logistic regression analysis about MA showed that frequent drinking, low BMI, newly diagnosed DM and elevated levels of HOMA index and blood pressure were significantly associated with MA prevalence. Also, excluding newly diagnosed diabetic and hypertensive subjects, the MA prevalence was 5.7% (6.9% in men, 4.7% in women) and in multiple logistic regression analysis, the MA prevalence significantly increased in the individuals with pre-HTN rather than in the normotensives. CONCLUSIONS: The MA prevalence was 7.7% in all subjects. Except the newly diagnosed diabetic and hypertensive subjects, it was 5.7%. The MA prevalence was significantly increased in the individuals with pre-HTN rather than in the normotensives and MA was related with insulin resistance.

Association between two SNPs (+45T>G and +276G>T) of the adiponectin gene and coronary artery diseases / 대한내과학회지

BACKGROUND: Adiponectin, an adipocyte-secreted protein, is known to have anti-atherogenic, anti-inflammatory and anti-diabetic properties. Adiponectin levels are decreased in obesity, type 2 diabetes, and coronary artery disease. Several studies have been performed aiming to investigate the association of genetic variations in the adiponectin with obesity, insulin resistance, and type 2 diabetes but few studies were performed in association with coronary artery disease. Therefore we examined the association between two single nucleotide polymorphisms (SNPs) (+45T>G and +276G>T) of the adiponectin gene and coronary artery diseases (CAD). METHODS: One hundred fifty six subjects were enrolled in which coronary angiograms were performed due to chest pain in Kangbuk Samsung Hospital from April to August, 2003 (97 males, 59 females, mean age 57.40+/-11.15 yrs). Body mass index, fasting blood glucose, lipid profiles were measured in every subject. Single nucleotide polymorphisms (SNPs) in the adiponectin gene were determined by Taqman polymerase chain reaction (PCR) method. The presence of CAD was defined as a >50% reduction of coronary artery diameter. RESULTS: Among 156 subjects, the allele frequencies were 0.683 for G allele and 0.317 for T allele in SNP +276G>T and 0.705 for T allele and 0.295 for G allele in SNP +45T>G. Both genotypes were in compliance with Hardy-Weinberg equlibrium. Mean serum fasting glucose level was significantly higher and mean high-density lipoprotein cholesterol (HDL-C) level was lower in CAD groups (p=0.015, p=0.004). No association with the presence of CAD was observed for adiponectin gene SNP276 and SNP45 (p=0.954, p=0.843). Also, no significant association was observed between the severity of CAD and either SNPs (p=0.571, p=0.955). CONCLUSIONS: Our study showed that SNP +276G>T and +45T>G in adiponectin gene were not associated with the presence of CAD. Further studies will be necessary to confirm the role of SNP 276G>T and 45T>G in the development of CAD.

Relationship between Heart Rate Turbulence and Heart Rate Variability in Korean Adults with Structurally Normal Heart

BACKGROUND AND OBJECTIVES: Heart rate variability (HRV) illustrates the autonomic integration of the heart. Depressed HRV has been proven to be associated with an increased risk of cardiac death, whereas heart rate turbulence (HRT) is believed to reflect baroreflex sensitivity and it was recently introduced as another noninvasive tool for risk stratification. The aim of this study was to determine the relationship between the HRT and HRV parameters in Korean adults with a structurally normal heart. SUBJECTS AND METHODS: We studied 61 adults (males: 31) who showed ventricular premature complexes on 24 hour Holter recording and who were found to have normal hearts on full noninvasive investigation. We calculated the mean heart rate (RR interval), the number of VPBs, the time- and frequency-domain HRV parameters and two HRT parameters: turbulence onset (To) and turbulence slope (Ts). RESULTS: Ts showed a strong correlation with the HRV parameters (LF/HF ratio: r=0.35, p=0.006; VLF: r=0.32, p=0.013; LF: r=0.27, p=0.035; SDNN: r=0.28, p=0.029; SDANN: r=0.32, p=0.012), but To showed no significant correlation with the HRV parameters. CONCLUSION: The HRT parameters, and especially Ts, correlate strongly with the HRV parameters; therefore, Ts should be considered as a parameter that reflects the overall cardiac autonomic tone.

Distribution of Serum Lipoprotein(a) Level and its Association with Other Risk Factors in Apparently Healthy Korean

BACKGROUND AND OBJECTIVES: Recent studies have demonstrated that lipoprotein (a) [Lp(a)] plays an important role in atherothrombogenesis and to be associated with an increased risk for cardiovascular disease. SUBJECTS AND METHODS: We evaluated the distribution of Lp (a) and its association with cardiovascular risk factors, by conducting a cross sectional survey of 14,516 apparently healthy Koreans. The study group consisted of 8,007 men and 6,509 women, aged 20 years and over. RESULTS: The mean, medium and 75th percentile Lp (a) levels were 20.1, 13.2 and 23.8 mg/dL, respectively. The distribution of Lp (a) was highly skewed toward a lower level. The Lp (a) level was positively associated with age (p<0.001) and low density lipoprotein (LDL)(p<0.001). The body mass index (BMI)(p=0.006), log (triglyceride)(p<0.001) and alcohol consumption more than 3 times per week (p<0.047) were inversely related to the Lp (a) level. However, no relationship was seen with smoking, gender, exercise, homeostatic model assessment-insulin resistance (HOMA-IR) and high sensitivity C reactive protein (hsCRP). CONCLUSION: The Lp (a) level was positively associated with age and low density lipoprotein (LDL). The body mass index (BMI) and log (triglyceride) were inversely related to the Lp (a) level. However, the association between Lp (a) and cardiovascular disease in the general Korean population should be confirmed via large scale prospective cohort studies.

Effect of Exercise on Serum C-Reactive Protein

BACKGROUND AND OBJECTIVES: Regular exercise protects us against numerous chronic diseases, and reduces the risk of cardiovascular disease. Also, C-reactive protein, a marker of inflammation, is known to be associated with the risk and prognosis of cardiovascular disease. The present study was designed to assess the effects of regular exercise on the level of high sensitive C-reactive protein (hsCRP). SUBJECTS AND METHODS: The serum level of hsCRP and the anthropometric indices of adiposity, metabolic variables, blood pressure (BP) and several cardiovascular risk factors were measured in 18445 subjects. A prospective study of 42 subjects with high baseline levels of hsCRP was conducted. After 3 months of regular aerobic exercise their hsCRP levels were rechecked and the association between regular exercise and hsCRP analyzed using a cross sectional and prospective study. RESULTS: Age, smoking, hypertension, diabetes and body mass index were found to be independent determinants of an elevated hsCRP level, but exercise was not found to be associated with a decreased hsCRP level in the cross-sectional study. In the prospective study, the mean serum hsCRP value was significantly reduced after 3 months in the exercise group (3.02+/-1.06 vs. 2.05+/-1.23 p=0.015), but not in the controls (3.03+/-1.09 vs. 2.57+/-1.11 p=0.104). However, the interval changes in hsCRP levels were not different in the exercise compared to the control group (p=0.660). CONCLUSION: These results suggest that exercise is not an independent determinant of the CRP level. Three months of regular aerobic exercise show a tendency to be associated with a reduction in the hsCRP level, but this putative effect of exercise on the hsCRP level was not significant in healthy subjects. Further larger sample, prospective cohort studies will be required to establish the effect of exercise on the hsCRP level.