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Objectives@#This study aimed to evaluate the potential interaction between kidney function and the non-linear association between serum calcium levels and cardiovascular disease (CVD) mortality. @*Methods@#This study included 8927 participants enrolled in the Dong-gu Study. Albumin-corrected calcium levels were used and categorized into 6 percentile categories: 97.5th. Restricted cubic spline analysis was used to examine the non-linear association between calcium levels and CVD mortality. Cox proportional hazard regression was used to estimate hazard ratios (HRs) for CVD mortality according to serum calcium categories. All survival analyses were stratified by the estimated glomerular filtration rate. @*Results@#Over a follow-up period of 11.9±2.8 years, 1757 participants died, of whom 219 died from CVD. A U-shaped association between serum calcium and CVD mortality was found, and the association was more evident in the low kidney function group. Compared to the 25.0-50.0th percentile group for serum calcium levels, both low and high serum calcium tended to be associated with CVD mortality (97.5th: HR, 2.56; 95% CI, 0.76 to 8.66) in the low kidney function group. In the normal kidney function group, a similar association was found between serum calcium levels and CVD mortality (97.5th: HR, 1.65; 95% CI, 0.70 to 3.93). @*Conclusions@#We found a non-linear association between serum calcium levels and CVD mortality, suggesting that calcium dyshomeostasis may contribute to CVD mortality, and kidney function may modify the association.
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This study examined the gender-specific association between stroke status and depression in South Korea. A total of 5,746 men and 7,608 women aged ≥30 years who participated in the 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey were included in the analysis. The cross-sectional surveys targeted the general population consisting of nationally representative adults (≥19 years) residing in Korea. A 9-item Patient Health Questionnaire score of 10 or more was regarded as depression. A higher risk of depression in stroke survivors compared to the non-stroke population was not observed in men (odds ratio [OR], 1.51; 95% confidence intervals [CI], 0.82-2.81), while it was observed in women (OR, 2.49; 95% CI, 1.64-3.77). Compared to non-stroke women, women stroke survivors with a younger age at diagnosis (＜60 years) (OR, 4.05; 95% CI, 2.28-7.20) and stroke with duration of ≥10 years (OR, 3.12; 95% CI, 1.63-5.97) had a higher risk for depression. Gender aspects should be more intensively considered in the association between stroke status and depression in community settings.
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Background@#This study aimed to examine the difference of sleep quality between family members of dementia patients and general population in community. @*Methods@#Participants (n=215,676) aged 19 years and over in the 2018 Korea Community Health Survey were classified into three groups; family members living at home with a person with dementia (FHD; n=2,445), family members living separately from a person with dementia (FSD; n=9,132), and family members without a person with dementia in the family (FwoD; n=204,099). The Pittsburgh Sleep Quality Index greater than 6 points was regarded as poor sleep quality (PSQ). Multiple logistic regression analysis was used to explore the associations between living with dementia patients and PSQ. @*Results@#The prevalence of PSQ was 48.3% in FHD, 40.7% in FSD, and 38.8% in FwoD. After adjusting for potential confounders, compared to FwoD, the odds ratio for PSQ was 1.42 (95% confidence interval [CI], 1.31-1.54) in FHD and 1.22 (95% CI, 1.17-1.27) in FSD. Additionally, almost all age- and sex-stratified family of dementia patients, except for the youngest (<40 years) men of FHD and the youngest (<40 years) men of FSD, had a higher risk for PSQ than FwoD. @*Conclusions@#Both FHD and FSD have lower sleep quality than FwoD. Public psychological interventions and supports are needed to family members of dementia patients in the community.
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Background and Objectives@#In previous studies, high homocysteine levels were associated with high cardiovascular mortality. However, these results were inconsistent with those of randomized controlled trials. We aimed to evaluate the causal role of homocysteine on allcause and cardiovascular mortality using Mendelian randomization (MR) analysis. @*Methods@#This study included the 10,005 participants in the Namwon Study. In conventional observational analysis, age, sex, survey years, lifestyles, body mass index, comorbidities, and serum folate level were adjusted using multivariate Cox proportional regression. MR using 2-stage least squares regression was used to evaluate the association between genetically predicted plasma homocysteine levels and mortality. Age, sex, and survey years were adjusted for each stage. The methylenetetrahydrofolate reductase (MTHFR) polymorphism was used as an instrumental variable for predicting plasma homocysteine levels. @*Results@#Observed homocysteine levels were positively associated with all-cause (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.26–1.54) and cardiovascular (HR, 1.62; 95% CI, 1.28–2.06) mortality when plasma homocysteine levels doubled. However, these associations were not significant in MR analysis. The HRs of doubling genetically predicted plasma homocysteine levels for all-cause and cardiovascular mortality were 0.99 (95% CI, 0.62–1.57) and 1.76 (95% CI, 0.54–5.77), respectively. @*Conclusions@#This MR analysis did not support a causal role for elevated plasma homocysteine concentrations in premature deaths.
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Background and Objectives@#The association between bilirubin and atrial fibrillation (AF) has been evaluated previously in observational studies but with contradictory results. This study evaluated the causal association between serum bilirubin level and AF using Mendelian randomization (MR) analysis. @*Methods@#This cross-sectional study includes 8,977 participants from the Dong-gu Study.In the observational analysis, multivariate logistic regression was performed to evaluate the association between bilirubin and prevalent AF. To evaluate the causal association between bilirubin and AF, MR analysis was conducted by using the UGT1A1 rs11891311 and rs4148323 polymorphisms as instrumental variables. @*Results@#Elevated serum bilirubin levels were associated with an increased risk for AF in observational analysis (total bilirubin: odds ratio [OR], 1.31; 95% confidence interval [95% CI], 1.15–1.48 per 1 standard deviation [SD]; direct bilirubin: OR, 1.31; 95% CI, 1.18–1.46 per 1 SD), whereas the genetically predicted serum bilirubin levels in MR analysis did not show this association (total bilirubin: OR, 1.02; 95% CI, 0.67–1.53 per 1 SD; direct bilirubin: OR, 1.03; 95% CI, 0.61–1.73 per 1 SD). @*Conclusions@#Genetically predicted bilirubin levels were not associated with prevalent AF.Thus, the observational association between serum bilirubin levels and AF may be noncausal and affected by reverse causality or unmeasured confounding.
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Purpose@#To evaluate the difference in each retinal layer thickness in central retinal vein occlusion (CRVO) with resolved macular edema after intravitreal antivascular endothelial growth factor injection and normal contralateral eyes.. @*Methods@#Patients with ischemic and nonischemic CRVO whose macular edema resolved after intravitreal antivascular endothelial growth factor injections and did not recur for at least 6 months, and a normal contralateral eye were enrolled. Each retinal layer thickness between CRVO and normal contralateral eyes was compared according to Early Treatment Diabetic Retinopathy Study subfields using spectral domain optical coherence tomography. @*Results@#The thicknesses of outer nuclear layer, photoreceptor layer, and retinal pigment epithelium in central ring, ganglion cell layer, inner plexiform layer, outer nuclear layer, and photoreceptor layer in the inner ring, and ganglion cell layer in the outer ring of CRVO eyes were significantly thinner than those of normal contralateral eyes (all p < 0.05). Whereas, inner nuclear layer and outer plexiform layer thicknesses in central ring of CRVO eyes were 23.86 ± 8.8 and 25.76 ± 7.6 μm, respectively, which was significantly thicker than those of normal contralateral eyes (19.52 ± 7.7 and 22.76 ± 6.5 μm; p = 0.019 and p = 0.043, respectively). Additionally, the mean best-corrected visual acuity of CRVO eyes were significantly correlated with photoreceptor layer thickness in central ring (p = 0.005). @*Conclusions@#In CRVO eyes with resolved macular edema, the outer retinal layers were thinner as well as inner retinal layers, whereas inner plexiform layer and outer nuclear layer were thicker than normal fellow eyes. Additionally, photoreceptor layer thickness in foveal area had a significant impact on visual acuity in CRVO.
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Purpose@#We report a case of bilateral frosted branch angiitis caused by anti-phospholipid antibody syndrome.Case summary: A 60-year-old female complained of worsening vitreous floaters and decreased visual acuity in both eyes. The initial best-corrected visual acuity (BCVA) was 0.8 in the right eye and 0.05 in the left. On slit-lamp examination, inflammatory findings were observed in the anterior chamber and vitreous body of both eyes. On fundus examination, vascular sheathing in the shape of a frosted branch was observed in the posterior pole and peripheral retina in both eyes. Optical coherence tomography indicated macular edema in the left eye. Staining and leakage of dye along the vascular sheathing were observed in both eyes with fluorescein angiography. On suspicion of panuveitis, we conducted a blood test and started eye drops and oral steroid therapy. However, vitreous inflammation, macular edema, and vascular sheathing increased; thus, we proceeded with systemic steroid therapy. We conducted blood tests at 8-week intervals; lupus anticoagulant was negative but anticardiolipin antibody and anti- ß2 glycoprotein-I antibody were positive. We diagnosed the patient with bilateral frosted branch angiitis caused by anti-phospholipid antibody syndrome. During the follow-up period, the BCVA remained steady at 0.5 in the right eye and 0.3 in the left eye, without symptom recurrence. @*Conclusions@#Bilateral frosted branch angiitis, a rare disease, is known to respond well to systemic steroid treatment. However, if accompanied by primary anti-phospholipid antibody syndrome, as in the case presented, it may have an atypical prognosis.
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Background and Objectives@#Previous observational studies presented a positive association between alcohol and atrial fibrillation (AF). However, previous studies using genetic polymorphisms on the causal relationship between alcohol consumption and AF have reported conflicting results. This study aimed to evaluate the causality between alcohol consumption and AF using the aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism, which is the genetic variant with the most potent effect on drinking behavior. @*Methods@#A total of 8,964 participants from the Dong-gu Study were included in the present study. The causal association between alcohol consumption and AF was evaluated through a Mendelian randomization (MR) analysis using the ALDH2 rs671 polymorphism as an instrumental variable. @*Results@#No significant relationship between alcohol consumption and AF was found in the observational analysis. However, the genetic analysis using the ALDH2 polymorphism showed a significant association in men. In the MR analysis, genetically predicted daily alcohol consumption was positively related to AF. @*Conclusions@#MR analysis revealed a significant association between the amount of alcohol consumption and AF, which suggests that the association may be causal.
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Purpose@#In this prospective study, we evaluated the association between the serum levels of antioxidants uric acid (UA), albumin, and total bilirubin and the risk of cancer in a Korean population. @*Materials and Methods@#A total of 15882 subjects were followed up for cancer development and cancer-related death. During the follow-up period, 1619 cancer diagnoses and 617 cancer-related deaths were recorded. Cox proportional regression was performed to calculate the hazard ratio (HR) per standard deviation (SD) increment and 95% confidence interval (CI). The model was adjusted for covariates such as the age, sex, smoking, alcohol consumption, physical activity, education level, body mass index, and family history. Sensitivity analyses using the study subjects with physiological serum levels of each indicator were also performed. @*Results@#UA levels were positively correlated with cancer risk (HR per SD increment 1.04; 95% CI, 1.01–1.09), and albumin levels were inversely associated with the overall cancer risk (HR, 0.92; 95% CI, 0.88–0.96) and cancer-related death (HR, 0.86; 95% CI, 0.80–0.93). Total bilirubin levels were negatively correlated with the risk of cancer-related death (HR, 0.91; 95% CI, 0.83–0.99). By cancer type, UA was positively associated with prostate cancer, total bilirubin was positively associated with liver cancer, and albumin was inversely associated with lung cancer. @*Conclusion@#The findings of this study support the role of antioxidants in carcinogenesis. Future large-cohort studies are needed to confirm the predictive value of albumin, UA, and total bilirubin levels in each type of cancer.
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Purpose@#To analyze the repeatability of vessel density (VD) measurements and manual foveal avascular zone (FAZ) measurements using optical coherence tomography angiography (OCTA) in patients with retinal vein occlusion (RVO) without macular edema. @*Methods@#The study population consisted of patients with RVO and central macular thickness @*Results@#A total of 48 eyes were included in the study. The ICCs of the VDs in superficial capillary plexus (SCP) and the deep capillary plexus (DCP) were 0.748 and 0.665, respectively, and the CVs of the VDs in SCP and DCP were 9.1% and 12.6%, respectively. The ICCs associated with the FAZ of the superficial layer (SFAZ) and that of the deep layer (DFAZ) were 0.965 and 0.956, respectively, and the CV of the SFAZ and DFAZ were 8.8% and 9.7%, respectively. From Pearson correlation analyses, OCTA quality was significantly correlated with the CV of the VDs of SCP and DCP. However, there were no variables that were significantly correlated with the CV of SFAZ and DFAZ, including OCTA quality. @*Conclusions@#VD measurements in the SCP layer using OCTA exhibited good repeatability, and VD measurements in the DCP layer exhibited relatively low repeatability compared to that of SCP layer measurements in patients with RVO without macular edema after treatment with bevacizumab. Manual measurement of the FAZ area in both SCP and DCP layers resulted in good repeatability. In addition, the repeatability of VD measurements in SCP and DCP layers was correlated with OCTA image quality.
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Background and Objectives@#The aim of this study was to assess sex difference in the association between coronary artery disease (CAD) status and depression in a representative nationwide Korean population. @*Methods@#In total, 4,620 male and 6,151 female aged ≥40 years, who participated in the Korea National Health and Nutrition Examination Survey conducted in 2014, 2016, and 2018, were included in the analysis. Depression was defined as ≥10 points on the 9-item Patient Health Questionnaire. @*Results@#Among male participants, no significant association between CAD status and depression was observed. However, female with CAD had higher odds ratio (OR) for depression (OR, 2.68; 95% confidence interval [CI], 1.78–4.03) compared with those without CAD in a multiple logistic regression analysis after adjustment for covariates. Younger age at diagnosis of CAD was a significant relating factor for depression in female; OR (95% CI) was 1.73 (0.88–3.40), 3.01 (1.52–5.97), and 4.11 (2.04–8.28) for age ≥65 years, 55–64 years, and ≤54 years, respectively, compared with that in non-CAD controls. In addition, shorter duration of CAD was a significant relating factor for depression in female; OR (95% CI) was 2.42 (1.26–4.67), 2.61 (1.32–5.16), and 3.13 (1.54–6.34) for duration ≥10 years, 5-9 years, and ≤4 years, respectively, compared with that in non-CAD controls. @*Conclusions@#Consistent screening and psychosocial supports for depression after discharge are required to improve the mental health care of CAD survivors in the community, especially for female diagnosed at a younger age and recently diagnosed.
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Background@#Several studies have reported conflicting results regarding the relationship between alcohol consumption and cortisol levels. However, the causality between alcohol consumption and cortisol levels has not been evaluated. @*Methods@#This study examined 8,922 participants from the Dong-gu Study. The aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism was used as an instrumental variable for alcohol consumption. The association between the genetically predicted alcohol consumption and cortisol level was evaluated with Mendelian randomization (MR) using two-stage least squares regression. @*Results@#Alcohol consumption was positively associated with the serum cortisol level in both sexes in the observational analysis. In the MR analysis, the genetically predicted alcohol consumption was positively related to the cortisol level in men, with cortisol levels increasing by 0.18 µg/dL per drink per day. However, there was no relationship in women in the MR analysis. @*Conclusion@#The predicted alcohol consumption according to the ALDH2 rs671 polymorphism was positively related to the cortisol levels, suggesting a causal relationship between alcohol consumption and cortisol levels.
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This study aimed to identify and assess the differences in psychological health problems between families living with stroke survivors (FwSS) and the general population without stroke families (GwoSF). A total of 4,514 cases of FwSS were selected for analysis from the 2013 Korea Community Health Survey. In order to determine control groups in GwoSF, propensity scores were generated based on the sociodemographic characteristics of age, gender, residential region, marital status, educational level, monthly household income, and employment status. Each FwSS was matched to 3 controls of GwoSF (13,542 controls) using a greedy matching algorithm with 8 to 1 digit matching. After propensity score-matching, the proportion of usual stress (30.2% vs 24.6%), depressive mood (7.1% vs 6.1%), and suicidal ideation (13.0% vs 11.1%) in FwSS were all significantly higher than those in GwoSF (Ps<0.05). Compared to GwoSF, the adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for psychological health problems in FwSS were calculated using multiple logistic regression analysis. The aORs for usual stress (aOR 1.32, 95% CI 1.21-1.42), depressive mood (aOR 1.14, 95% CI 0.99-1.31; borderline significance), and suicidal ideation (aOR 1.17, 95% CI 1.05-1.30) were significantly higher among FwSS than GwoSF. Moreover, the psychological health problems of FwSS were more evident in females than in males. This study shows that FwSS have poorer psychological health outcomes than GwoSF with similar sociodemographic characteristics. Community-based strategies and family support programs, especially for female family members of stroke survivors, are essential to improve the psychological health of stroke families.
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Purpose@#In this prospective study, we evaluated the association between the serum levels of antioxidants uric acid (UA), albumin, and total bilirubin and the risk of cancer in a Korean population. @*Materials and Methods@#A total of 15882 subjects were followed up for cancer development and cancer-related death. During the follow-up period, 1619 cancer diagnoses and 617 cancer-related deaths were recorded. Cox proportional regression was performed to calculate the hazard ratio (HR) per standard deviation (SD) increment and 95% confidence interval (CI). The model was adjusted for covariates such as the age, sex, smoking, alcohol consumption, physical activity, education level, body mass index, and family history. Sensitivity analyses using the study subjects with physiological serum levels of each indicator were also performed. @*Results@#UA levels were positively correlated with cancer risk (HR per SD increment 1.04; 95% CI, 1.01–1.09), and albumin levels were inversely associated with the overall cancer risk (HR, 0.92; 95% CI, 0.88–0.96) and cancer-related death (HR, 0.86; 95% CI, 0.80–0.93). Total bilirubin levels were negatively correlated with the risk of cancer-related death (HR, 0.91; 95% CI, 0.83–0.99). By cancer type, UA was positively associated with prostate cancer, total bilirubin was positively associated with liver cancer, and albumin was inversely associated with lung cancer. @*Conclusion@#The findings of this study support the role of antioxidants in carcinogenesis. Future large-cohort studies are needed to confirm the predictive value of albumin, UA, and total bilirubin levels in each type of cancer.
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Purpose@#To analyze the repeatability of vessel density (VD) measurements and manual foveal avascular zone (FAZ) measurements using optical coherence tomography angiography (OCTA) in patients with retinal vein occlusion (RVO) without macular edema. @*Methods@#The study population consisted of patients with RVO and central macular thickness @*Results@#A total of 48 eyes were included in the study. The ICCs of the VDs in superficial capillary plexus (SCP) and the deep capillary plexus (DCP) were 0.748 and 0.665, respectively, and the CVs of the VDs in SCP and DCP were 9.1% and 12.6%, respectively. The ICCs associated with the FAZ of the superficial layer (SFAZ) and that of the deep layer (DFAZ) were 0.965 and 0.956, respectively, and the CV of the SFAZ and DFAZ were 8.8% and 9.7%, respectively. From Pearson correlation analyses, OCTA quality was significantly correlated with the CV of the VDs of SCP and DCP. However, there were no variables that were significantly correlated with the CV of SFAZ and DFAZ, including OCTA quality. @*Conclusions@#VD measurements in the SCP layer using OCTA exhibited good repeatability, and VD measurements in the DCP layer exhibited relatively low repeatability compared to that of SCP layer measurements in patients with RVO without macular edema after treatment with bevacizumab. Manual measurement of the FAZ area in both SCP and DCP layers resulted in good repeatability. In addition, the repeatability of VD measurements in SCP and DCP layers was correlated with OCTA image quality.
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Background and Objectives@#The aim of this study was to assess sex difference in the association between coronary artery disease (CAD) status and depression in a representative nationwide Korean population. @*Methods@#In total, 4,620 male and 6,151 female aged ≥40 years, who participated in the Korea National Health and Nutrition Examination Survey conducted in 2014, 2016, and 2018, were included in the analysis. Depression was defined as ≥10 points on the 9-item Patient Health Questionnaire. @*Results@#Among male participants, no significant association between CAD status and depression was observed. However, female with CAD had higher odds ratio (OR) for depression (OR, 2.68; 95% confidence interval [CI], 1.78–4.03) compared with those without CAD in a multiple logistic regression analysis after adjustment for covariates. Younger age at diagnosis of CAD was a significant relating factor for depression in female; OR (95% CI) was 1.73 (0.88–3.40), 3.01 (1.52–5.97), and 4.11 (2.04–8.28) for age ≥65 years, 55–64 years, and ≤54 years, respectively, compared with that in non-CAD controls. In addition, shorter duration of CAD was a significant relating factor for depression in female; OR (95% CI) was 2.42 (1.26–4.67), 2.61 (1.32–5.16), and 3.13 (1.54–6.34) for duration ≥10 years, 5-9 years, and ≤4 years, respectively, compared with that in non-CAD controls. @*Conclusions@#Consistent screening and psychosocial supports for depression after discharge are required to improve the mental health care of CAD survivors in the community, especially for female diagnosed at a younger age and recently diagnosed.
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Background@#Several studies have reported conflicting results regarding the relationship between alcohol consumption and cortisol levels. However, the causality between alcohol consumption and cortisol levels has not been evaluated. @*Methods@#This study examined 8,922 participants from the Dong-gu Study. The aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism was used as an instrumental variable for alcohol consumption. The association between the genetically predicted alcohol consumption and cortisol level was evaluated with Mendelian randomization (MR) using two-stage least squares regression. @*Results@#Alcohol consumption was positively associated with the serum cortisol level in both sexes in the observational analysis. In the MR analysis, the genetically predicted alcohol consumption was positively related to the cortisol level in men, with cortisol levels increasing by 0.18 µg/dL per drink per day. However, there was no relationship in women in the MR analysis. @*Conclusion@#The predicted alcohol consumption according to the ALDH2 rs671 polymorphism was positively related to the cortisol levels, suggesting a causal relationship between alcohol consumption and cortisol levels.
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This study aimed to identify and assess the differences in psychological health problems between families living with stroke survivors (FwSS) and the general population without stroke families (GwoSF). A total of 4,514 cases of FwSS were selected for analysis from the 2013 Korea Community Health Survey. In order to determine control groups in GwoSF, propensity scores were generated based on the sociodemographic characteristics of age, gender, residential region, marital status, educational level, monthly household income, and employment status. Each FwSS was matched to 3 controls of GwoSF (13,542 controls) using a greedy matching algorithm with 8 to 1 digit matching. After propensity score-matching, the proportion of usual stress (30.2% vs 24.6%), depressive mood (7.1% vs 6.1%), and suicidal ideation (13.0% vs 11.1%) in FwSS were all significantly higher than those in GwoSF (Ps<0.05). Compared to GwoSF, the adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for psychological health problems in FwSS were calculated using multiple logistic regression analysis. The aORs for usual stress (aOR 1.32, 95% CI 1.21-1.42), depressive mood (aOR 1.14, 95% CI 0.99-1.31; borderline significance), and suicidal ideation (aOR 1.17, 95% CI 1.05-1.30) were significantly higher among FwSS than GwoSF. Moreover, the psychological health problems of FwSS were more evident in females than in males. This study shows that FwSS have poorer psychological health outcomes than GwoSF with similar sociodemographic characteristics. Community-based strategies and family support programs, especially for female family members of stroke survivors, are essential to improve the psychological health of stroke families.
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Background@#This study aimed to determine whether the levels of healthcare indicators vary according to the duration of diabetes in diabetic people. @*Methods@#From the 2018 Korean Community Health Survey, a total of 20,113 diabetic people aged 40-79 years were analyzed. The distribution of people with diabetes and its corresponding diabetes duration were as follows: 34.9%, less than 4 years; 22.4%, 5-9 years; 18.9%, 10-14 years; 9.4%, 15-19 years; and 14.1%, more than 20 years. Outcome variables included eight health behavior indicators and seven diabetes management indicators. @*Results@#After adjusting for the sociodemographic characteristics, the longer the duration of diabetes, the less alcohol drinking and the more influenza vaccination was availed, whereas the regular tooth brushing, perceived usual stress, and perceived depressive symptoms tended to be unhealthy. Smoking, regular walking, and utilizing food nutrition label did not differ based on the duration of diabetes. Moreover, blood glucose control was evaluated to be poorly controlled as the duration of diabetes lengthened; however, diabetes management education and medical institution services (glycated hemoglobin measurement, diabetic retinopathy screening, and diabetic nephropathy screening) tended to increase significantly. There was also no difference in relation to diabetes duration in the recognition of early symptoms of myocardial infarction and stroke, which are the major complications of diabetes. @*Conclusions@#People with long-lasting diabetes are at a higher risk of developing diabetes-related complications; therefore, more active community strategies are needed to improve their health behavior.
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Purpose@#To analyze the repeatability of manual measurement of foveal avascular zone (FAZ) area in an optical coherence tomography angiography (OCTA) image in high myopia. @*Methods@#This study comprised patients with high myopia and controls. Two consecutive FAZ areas of the superficial and deep capillary plexus were obtained using OCTA. The intraclass correlation coefficient (ICC) and coefficient of variation (CV) were assessed, and univariate and multivariate generalized linear mixed models were conducted to identify factors related to repeatability. @*Results@#Thirty eyes with high myopia and 34 eyes of healthy subjects were included in the study. The mean age in high myopia and control subjects was 55.5 and 60.8 years, respectively, the mean spherical equivalent was −9.98 and −0.55 diopters, and the mean axial length was 28.0 and 23.9 mm. The ICCs of FAZ area of the superficial capillary plexus (SCP) were 0.891 and 0.919, while the CVs were 8.8% and 8.5%. In measurement of the deep capillary plexus, the ICCs were 0.788 and 0.907, while the CVs were 11.2% and 11.0%, which were acceptable but exhibited lower repeatability than those of SCP. Multivariate analyses showed that older age (p = 0.030) and greater axial length (p = 0.005) were significantly associated with lower repeatability of SCP FAZ area measurements. In addition, greater axial length (p = 0.044) was a significant factor for lower repeatability of deep capillary plexus FAZ area measurements. @*Conclusions@#Manual measurement of FAZ area using OCTA exhibited relatively good repeatability for high myopia. Age and axial length affected repeatability and should be considered when analyzing FAZ areas in high myopia patients.