Association between Serum 25-hydroxyvitamin D Levels and Type 2 Diabetes in Korean Adults / 전남의대학술지

Previous studies have suggested that a vitamin D deficiency increases the risk of type 2 diabetes. This study evaluated the association between serum vitamin D levels and type 2 diabetes in Korean adults. This study included 9,014 subjects (3,600 males and 5,414 females) aged ≥50 years who participated in the Dong-gu Study. The subjects were divided into groups in whom the serum vitamin D level was severely deficient (<10 ng/mL), deficient (10 to <20 ng/mL), insufficient (20 to <30 ng/mL) and sufficient (≥30 ng/mL). Type 2 diabetes was defined by a fasting blood glucose level of ≥126 mg/dL and/or an HbA1c proportion of ≥6.5% and/or self-reported current use of diabetes medication. Multiple logistic regression was performed to evaluate the association between vitamin D status and type 2 diabetes. The age- and sex-adjusted prevalence of type 2 diabetes was 22.6%, 22.5% and 18.4% and 12.7% for severely deficient, deficient, insufficient, and sufficient, respectively. Multivariate modeling revealed that subjects with insufficient or sufficient vitamin D levels were at a lower risk of type 2 diabetes than were subjects with deficient vitamin D levels [odds ratio (OR), 0.82; 95% confidence interval (CI), 0.71–0.94 and OR, 0.51; 95% CI, 0.35–0.74, respectively]. Higher serum vitamin D levels were associated with a reduced risk of diabetes in Korean adults, suggesting that vitamin D may play a role in the pathogenesis of diabetes.

A Gender-Specific Association between Self-Reported Snoring and Hemoglobin A1c Levels in a General Population without Type 2 Diabetes Mellitus

PURPOSE: We explored whether a gender difference was evident in terms of the associations of snoring with hemoglobin A1c (HbA1c) and homeostatic model assessment-insulin resistance (HOMA-IR) levels in a healthy population without type 2 diabetes mellitus (DM). MATERIALS AND METHODS: We analyzed 2706 males and 4080 females who participated in the baseline survey of the Namwon Study. In terms of self-reported snoring frequency, participants were classified as non-snorers or occasional (1–3 days/week), frequent (4–6 days/week), or constant (7 days/week) snorers. Participants with DM, defined as a fasting blood glucose level ≥126 mg/dL and/or use of insulin or hypoglycemic medication, were excluded from the analysis. RESULTS: In females, the fully adjusted mean (95% confidence interval) HbA1c levels in non-snorers and in occasional, frequent, and constant snorers were 5.53% (5.47–5.59%), 5.53% (5.47–5.59%), 5.57% (5.49–5.64%), and 5.57% (5.51–5.64%), respectively, reflecting a dose-response relationship (p trend=0.004). Compared with female non-snorers, the risk of an elevated HbA1c level (top quintile, ≥5.9%) in constant snorers remained significant (odds ratio 1.30, 95% confidence interval 1.02–1.66) after full adjustment. In addition, in females, a significant linear trend in HbA1c level odds ratio by increased snoring frequency was apparent (p trend=0.019 in model 3). In contrast, no significant association between snoring frequency and HbA1c level was identified in males. No significant association between snoring frequency and HOMA-IR was detected in either gender. CONCLUSION: We discovered a gender-specific association between snoring and HbA1c level in a healthy, community-dwelling population free of DM.

Association between Serum 25-hydroxyvitamin D Levels and Type 2 Diabetes in Korean Adults / 전남의대학술지

Previous studies have suggested that a vitamin D deficiency increases the risk of type 2 diabetes. This study evaluated the association between serum vitamin D levels and type 2 diabetes in Korean adults. This study included 9,014 subjects (3,600 males and 5,414 females) aged ≥50 years who participated in the Dong-gu Study. The subjects were divided into groups in whom the serum vitamin D level was severely deficient (<10 ng/mL), deficient (10 to <20 ng/mL), insufficient (20 to <30 ng/mL) and sufficient (≥30 ng/mL). Type 2 diabetes was defined by a fasting blood glucose level of ≥126 mg/dL and/or an HbA1c proportion of ≥6.5% and/or self-reported current use of diabetes medication. Multiple logistic regression was performed to evaluate the association between vitamin D status and type 2 diabetes. The age- and sex-adjusted prevalence of type 2 diabetes was 22.6%, 22.5% and 18.4% and 12.7% for severely deficient, deficient, insufficient, and sufficient, respectively. Multivariate modeling revealed that subjects with insufficient or sufficient vitamin D levels were at a lower risk of type 2 diabetes than were subjects with deficient vitamin D levels [odds ratio (OR), 0.82; 95% confidence interval (CI), 0.71–0.94 and OR, 0.51; 95% CI, 0.35–0.74, respectively]. Higher serum vitamin D levels were associated with a reduced risk of diabetes in Korean adults, suggesting that vitamin D may play a role in the pathogenesis of diabetes.

Impact of Age on Clinical Outcomes in Middle-aged Korean Female Patients with Acute Myocardial Infarction - Based on a Cut-off Age of 55 Years / 대한내과학회지

BACKGROUND/AIMS: It is well known that the menopause is related to interference in lipid metabolism, obesity, and a hypercoagulable state. The aim of the present study was to examine the impact of the menopause in middle-aged Korean females with acute myocardial infarction (AMI). METHODS: A total of 1,781 middle-aged females (aged < 65 years) in the Korean Acute Myocardial Infarction registry were enrolled into this study between November 2005 and December 2013. The patients were divided into two groups; the pre-menopause group (≤ 55 years old) and the menopause group (56-64 years old). Major adverse cardiac events (MACE) were analyzed over a one-year follow-up period. RESULTS: The pre-menopause and menopause groups comprised 669 patients (mean age, 49.1 ± 5.6 years) and 1,112 patients (mean age, 60.6 ± 2.6 years), respectively. The incidence of hypertension (42.2% vs. 59.4%, p < 0.001), diabetes mellitus (DM) (27.4% vs. 35.7%, p < 0.001), and dyslipidemia (12.9% vs. 17.7%, p = 0.008) were more frequent in menopausal patients. Additionally, the rates of smoking (20% vs. 12.7%, p < 0.001) and familial history (12% vs. 6.8%, p < 0.001) were higher in the pre-menopause group. The cumulative rates of MACE did not show any differences between the two groups. A history of atrial fibrillation, previous AMI and DM, higher Killip class, and multi-vessel disease were independent risk factors for predicting one-year MACE. CONCLUSIONS: The survival analysis demonstrated that there was no significant difference in MACE rates between the pre-menopause and menopause groups during the one-year follow-up. Therefore, middle-aged pre-menopausal women should be treated more intensively, regardless of whether they are menopausal.

Association between Vitamin D Status and Risk of Peripheral Arterial Disease: The Dong-gu Study / 전남의대학술지

Low levels of vitamin D have been associated with increased cardiovascular disease risk. However, few studies have evaluated the association between vitamin D status and peripheral arterial disease (PAD). We therefore aimed to investigate whether low 25-hydroxyvitamin D (25(OH)D) levels were associated with increased risk of PAD in the Korean population. This cross-sectional study was conducted among 8,960 subjects aged 50 years or older without known myocardial infarction or stroke. PAD was defined by an ankle brachial blood pressure index <0.9. Multivariate logistic regression was used to evaluate the association between serum 25(OH)D levels and risk of PAD. Of the 8,960 subjects, 3.0% had PAD and the age and sex adjusted prevalence of PAD decreased with the increasing 25(OH)D quartile. After adjusting for potential confounders and parathyroid hormones, serum 25(OH)D levels were associated with a significantly decreased risk of PAD (OR for one SD increase, 0.98; 95% CI, 0.95-1.0, P for trend=0.040). Compared with the first 25(OH)D quartile, the odds of PAD were 0.86 (95% CI, 0.62-1.21), 0.67 (95% CI, 0.46-0.97), and 0.71 (95% CI, 0.49-1.04) for the second, third, and fourth quartiles, respectively. In this cross-sectional study, we found that low serum 25(OH)D levels were associated with an increased risk of PAD, independent of traditional cardiovascular risk factors and parathyroid hormone. Our findings suggest that low vitamin D levels may contribute to PAD in the Korean population.

Association of APOE Genotype with Bone Mineral Density in Men and Women: The Dong-gu and Namwon Studies / 전남의대학술지

Many studies have investigated relationships between APOE genotype and bone mineral density (BMD). However, the results of these studies have been inconsistent. Few studies have been carried out in Asian populations. We studied the relationship of the APOE gene polymorphism and BMD in two large population-based studies. The datasets included the Dong-gu Study (3575 men and 5335 women) and the Namwon Study (2310 men, 3512 women). Lumbar spine and femoral neck BMD were measured by dual-energy X-ray absorptiometry. APOE genotypes were analyzed by polymerase chain reaction-restriction fragment length polymorphism. The APOE genotypes were classified into APOE E2 (E2/E2 and E2/E3), APOE E3 (E3/E3), and APOE E4 (E3/E4 and E4/E4). The genotype distribution of the study population was in Hardy-Weinberg equilibrium. There were no significant differences among APOE genotype groups in lumbar and femoral neck BMD in either cohort. Our data do not support the hypothesis that the APOE genotype is associated with BMD.

Association of APOE Genotype with Bone Mineral Density in Men and Women: The Dong-gu and Namwon Studies / 전남의대학술지

Many studies have investigated relationships between APOE genotype and bone mineral density (BMD). However, the results of these studies have been inconsistent. Few studies have been carried out in Asian populations. We studied the relationship of the APOE gene polymorphism and BMD in two large population-based studies. The datasets included the Dong-gu Study (3575 men and 5335 women) and the Namwon Study (2310 men, 3512 women). Lumbar spine and femoral neck BMD were measured by dual-energy X-ray absorptiometry. APOE genotypes were analyzed by polymerase chain reaction-restriction fragment length polymorphism. The APOE genotypes were classified into APOE E2 (E2/E2 and E2/E3), APOE E3 (E3/E3), and APOE E4 (E3/E4 and E4/E4). The genotype distribution of the study population was in Hardy-Weinberg equilibrium. There were no significant differences among APOE genotype groups in lumbar and femoral neck BMD in either cohort. Our data do not support the hypothesis that the APOE genotype is associated with BMD.

Association between Vitamin D Status and Risk of Peripheral Arterial Disease: The Dong-gu Study / 전남의대학술지

Low levels of vitamin D have been associated with increased cardiovascular disease risk. However, few studies have evaluated the association between vitamin D status and peripheral arterial disease (PAD). We therefore aimed to investigate whether low 25-hydroxyvitamin D (25(OH)D) levels were associated with increased risk of PAD in the Korean population. This cross-sectional study was conducted among 8,960 subjects aged 50 years or older without known myocardial infarction or stroke. PAD was defined by an ankle brachial blood pressure index <0.9. Multivariate logistic regression was used to evaluate the association between serum 25(OH)D levels and risk of PAD. Of the 8,960 subjects, 3.0% had PAD and the age and sex adjusted prevalence of PAD decreased with the increasing 25(OH)D quartile. After adjusting for potential confounders and parathyroid hormones, serum 25(OH)D levels were associated with a significantly decreased risk of PAD (OR for one SD increase, 0.98; 95% CI, 0.95-1.0, P for trend=0.040). Compared with the first 25(OH)D quartile, the odds of PAD were 0.86 (95% CI, 0.62-1.21), 0.67 (95% CI, 0.46-0.97), and 0.71 (95% CI, 0.49-1.04) for the second, third, and fourth quartiles, respectively. In this cross-sectional study, we found that low serum 25(OH)D levels were associated with an increased risk of PAD, independent of traditional cardiovascular risk factors and parathyroid hormone. Our findings suggest that low vitamin D levels may contribute to PAD in the Korean population.

Comparison of Clinical Outcomes after Implantation of First- and Second-Generation Overlapping Drug-Eluting Stents to Treat Diffuse Long Coronary Lesions / 대한내과학회지

BACKGROUND/AIMS: Despite improved revascularization techniques, the clinical outcomes of patients with diffuse coronary artery lesions after percutaneous coronary intervention are unsatisfactory. However, few studies have compared the efficacy of first- and second-generation drug-eluting stents (DES) in patients with diffuse long coronary artery lesions. METHODS: Between January 2006 and July 2012, 364 patients who were treated with DES for long coronary artery stenosis (> 30 mm) were enrolled in this study and assigned to either Group I (first-generation DES, 62.3 +/- 10.4 years, 136 males, n = 183) or Group II (second-generation DES, 64.3 +/- 10.7 years, 134 males, n = 181). The incidence of major adverse cardiac events (MACE) was compared between the two groups over 2 years of follow-up, and predictive factors associated with MACE were evaluated through a multivariate analysis. RESULTS: Although several coronary angiographic characteristics were different between the two groups, most demographic and baseline clinical variables were the same. The cumulative incidence of MACE was significantly higher in Group I than in Group II (25.7 vs. 6.6%; p < 0.001), mainly due to reduced target lesion revascularization (21.9 vs. 2.2%; p < 0.001). According to the results of the multivariate analysis, the use of a paclitaxel-eluting stent (PES) (hazard ratio [HR], 5.168; 95% confidence interval [CI], 2.515-10.617; p < 0.001), decreased left ventricular function (< or = 45%; HR, 3.586; 95% CI, 1.839-6.990; p < 0.001), and diabetes mellitus (HR, 2.984; 95% CI, 1.605-5.548; p < 0.001) were independent contributors to MACE. CONCLUSIONS: For patients with diffuse long coronary artery stenosis, the use of second-generation DES improved the clinical outcome compared with first-generation DES. In addition, the use of a PES, left ventricular dysfunction, and diabetes were predictors of MACE after overlapping stenting.

APOE Polymorphism Is Associated with C-reactive Protein Levels but Not with White Blood Cell Count: Dong-gu Study and Namwon Study

We evaluated the association of the APOE polymorphism with serum C-reactive protein levels and white blood cell count in two large population-based studies in Korean. The datasets included the Dong-gu study (n = 8,893) and the Namwon Study (n = 10,032). APOE genotypes were identified by polymerase chain reaction-restriction fragment length polymorphism. Multivariable linear regression analysis was performed to evaluate the relationship of APOE genotypes with C-reactive protein levels and white blood cell count with adjustments for age, sex, body mass index, smoking, diabetes, hypertension, and serum lipids. In the multivariate model, carriers of E3E4 or E4E4 genotype had significantly lower C-reactive protein levels compared with carriers of E3E3 genotype group (0.50 mg/L vs. 0.67 mg/L; 0.37 mg/L vs. 0.67 mg/L, respectively, for the Dong-gu Study and 0.47 mg/L vs. 0.66 mg/L; 0.45 mg/L vs. 0.66 mg/L, respectively, for the Namwon Study). However, there was no difference in white blood cell count among APOE genotypes. We found that the APOE E4 allele is associated with lower C-reactive protein levels, but not white blood cell count. Our results suggest that APOE genotype may influence C-reactive protein levels through non-inflammatory pathway.

Clinical Outcome Comparison of Everolimus- and Biolimus-eluting Stents in Patients with Acute Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: We compared the efficacy and safety of the second-generation everolimus-eluting stent (EES) and the third generation biolimus-eluting stent (BES) in patients with acute myocardial infarction (AMI). METHODS: We analyzed 629 consecutive patients (mean age 65.1 +/- 11.2 years, 426 males) with AMI undergoing percutaneous coronary intervention from February 2008 to April 2012. They were divided into two groups according to stent type (EES group, n = 426; BES group, n = 203). The primary end-point was 2-year major adverse cardiac events (MACEs), defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, non-target vessel revascularization and target lesion revascularization. The secondary end-point was 2-year target lesion failure (TLF). RESULTS: There were no significant differences in baseline characteristics, except that the patients with EES had a significantly higher prevalence of diabetes mellitus (34.7 vs. 22.7%, p = 0.002) and were older (67.1 +/- 11.3 vs. 64 +/- 12.9 years, p = 0.039) compared with the patients with BES. After propensity score matching, 2-year clinical outcomes showed no differences in composite MACEs or TLF between the two groups. Multivariate Cox regression analysis showed that stent type was not a predictor of 2-year mortality or MACEs. However, older age (hazard ratio [HR] 1.037, 95% confidence interval [CI] 1.014-1.060, p = 0.001), diabetes mellitus (HR 2.247, 95% CI 1.426-3.539, p = 0.001) and a left ventricular ejection fraction < or = 45% (HR 3.007, 95% CI 1.978-4.573, p = 0.001) were independent predictors for 2-year MACEs in patients undergoing EES or BES. CONCLUSIONS: Patients with BES had similar clinical 2-year outcomes compared with EES patients with AMI.

Methylenetetrahydrofolate Reductase 677 Genotype-Specific Reference Values for Plasma Homocysteine and Serum Folate Concentrations in Korean Population Aged 45 to 74 Years: The Namwon Study

The reference interval for plasma total homocysteine (tHcy) and serum folate concentrations were estimated. Total of 3,154 reference individuals (1,029 men and 2,125 women) were selected based on stringent exclusion criteria. For plasma tHcy concentration (microM/L), reference values (median [5-95 percentile]) were 7.72 (5.03 to 13.80) and 6.09 (3.95-10.19) in men and women, respectively. For serum folate concentration (nM/L), reference values were 23.71 (11.73-38.44) and 28.95 (15.23-40.44) in men and women, respectively. The tHcy levels of both genders in the present study were lower than those in previous reports from other countries and Korea.

Clinical Impact of High Triglycerides and Central Obesity in Patients with Acute Myocardial Infarction who Underwent Percutaneous Coronary Intervention / 대한내과학회지

BACKGROUND/AIMS: Dyslipidemia and obesity are risk factors for the development of acute myocardial infarction (AMI) that affect the clinical outcomes in patients. METHODS: We analyzed 2,751 consecutive AMI patients who underwent percutaneous coronary intervention (PCI) (mean age, 63.7 +/- 12.1 years). The patients were divided into four groups based on serum triglyceride levels and central obesity [Group Ia: triglycerides or = 200 mg/dL and (-) central obesity; Group IIb: triglyceride > or = 200 mg/dL and (+) central obesity]. In-hospital outcome was defined as in-hospital mortality and complications. One-year clinical outcome was compared and defined as the composite of 1-year major adverse cardiac events (MACE), including death, recurrent MI, and target vessel revascularization. RESULTS: Total MACE developed in 502 patients (18.2%), while 303 patients (11.0%) died prior to the 1-year follow-up visit. In-hospital complications and in-hospital mortality were not different among the four groups. One-year clinical outcomes based on triglyceride levels (Group I vs. Group II) were not different. In addition, there were no differences in clinical outcomes in patients with a triglyceride level < 200 mg/dL, regardless of central obesity. One-year MACE rates were not significantly different among the four groups. CONCLUSIONS: There was no significant difference in the 1-year MACE rate based on the triglyceride level and presence of central obesity in patients with AMI who underwent PCI.

Clinical Impact of High Triglycerides and Central Obesity in Patients with Acute Myocardial Infarction who Underwent Percutaneous Coronary Intervention / 대한내과학회지

BACKGROUND/AIMS: Dyslipidemia and obesity are risk factors for the development of acute myocardial infarction (AMI) that affect the clinical outcomes in patients. METHODS: We analyzed 2,751 consecutive AMI patients who underwent percutaneous coronary intervention (PCI) (mean age, 63.7 +/- 12.1 years). The patients were divided into four groups based on serum triglyceride levels and central obesity [Group Ia: triglycerides or = 200 mg/dL and (-) central obesity; Group IIb: triglyceride > or = 200 mg/dL and (+) central obesity]. In-hospital outcome was defined as in-hospital mortality and complications. One-year clinical outcome was compared and defined as the composite of 1-year major adverse cardiac events (MACE), including death, recurrent MI, and target vessel revascularization. RESULTS: Total MACE developed in 502 patients (18.2%), while 303 patients (11.0%) died prior to the 1-year follow-up visit. In-hospital complications and in-hospital mortality were not different among the four groups. One-year clinical outcomes based on triglyceride levels (Group I vs. Group II) were not different. In addition, there were no differences in clinical outcomes in patients with a triglyceride level < 200 mg/dL, regardless of central obesity. One-year MACE rates were not significantly different among the four groups. CONCLUSIONS: There was no significant difference in the 1-year MACE rate based on the triglyceride level and presence of central obesity in patients with AMI who underwent PCI.

Association between Apolipoprotein E Polymorphism and Chronic Kidney Disease in the Korean General Population: Dong-gu Study / 가정의학회지

BACKGROUND: Few studies have investigated the association between Apolipoprotein E (APOE) polymorphisms and chronic kidney disease (CKD) in the general population, and their results are inconsistent. METHODS: The current study population was composed of 9,033 subjects aged > or = 50 years who participated in the baseline survey of the Dong-gu Study, which was conducted in Korea between 2007 and 2010. APOE polymorphisms were identified by polymerase chain reaction, and the estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease equation. RESULTS: Individuals with the APOE E2 allele had significantly lower total and low density lipoprotein cholesterol levels, those with the APOE E4 allele had lower high density lipoprotein (HDL) cholesterol levels, and those with the APOE E3 allele had lower log-triglyceride levels. Adjusting for covariates (sex, age, body mass index, smoking, systolic blood pressure, hypertension, diabetes, total cholesterol, HDL cholesterol, log-transformed triglycerides, and log-transformed albumin to creatinine ratio), mean eGFR was not significantly different among APOE alleles (E2, 69.4 mL/min/1.73 m2; E3, 69.5 mL/min/1.73 m2; E4, 69.4 ml/min/1.73 m2; P = 0.873). Additionally, the odds ratios (ORs) indicated that APOE polymorphisms were not independent risk factors for CKD (OR, 1.07; 95% confidence interval [CI], 0.91 to 1.26 for the E2 vs. E3 allele; OR, 1.01; 95% CI, 0.88 to 1.16 for the E4 vs. E3 allele). CONCLUSION: APOE polymorphisms were not associated with either eGFR or CKD in the general Korean population.

High Prevalence of Vitamin D Deficiency in Adults Aged 50 Years and Older in Gwangju, Korea: the Dong-gu Study

Vitamin D plays an important role in bone metabolism and maintaining bone health. Recently, new evidence has revealed that vitamin D affects chronic diseases such as autoimmune diseases, cardiovascular diseases and certain cancers. The aim of this study was to evaluate the vitamin D status and the prevalence of vitamin D deficiency in an urban Korean population. This study included 8,976 participants (3,587 men and 5,389 women) aged 50 yr and older. Serum 25(OH)D level was measured by chemiluminescent microparticle immunoassay. The prevalence of vitamin D deficiency [25(OH)D < 20 ng/mL] was 59.7% and 86.5% in men and women, respectively. The prevalence of vitamin D deficiency increased significantly with age in men, but not in women and it decreased from April to July, more prominently in men than in women. These results suggest that sun exposure, intake of vitamin D supplement, and regular physical activities is recommended in an urban Koreans, especially in women.

Gender Differences in the Association between Depressive Symptoms and Carotid Atherosclerosis among Middle-Aged and Older Koreans: The Namwon Study

We investigated the association of depressive symptoms with carotid intima-media thickness (IMT) and plaques in the general Korean population. A total of 7,554 Korean males and females aged 45-74 yr who were free from cardiovascular diseases were included in the analyses. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Subjects with a score of > or =16 were classified as having clinically significant depressive symptoms. Carotid ultrasonography was used to measure mean carotid IMT (C-IMT) and to determine the presence of plaques. A significant association between depressive symptoms and C-IMT was observed only in females. After adjustment for established cardiovascular risk factors, females with depressive symptoms had significantly greater C-IMT than females without depressive symptoms (mean difference 0.011+/-0.004 mm; 95% confidence interval, 0.003-0.019 mm). Compared with controls, the fully adjusted risk of females with depressive symptoms for abnormal C-IMT (> or =1.0 mm) was significant (odds ratio, 1.63; 95% confidence interval, 1.16-2.30). No significant association between depressive symptoms and carotid plaques was observed in either gender. This study shows a significant association between depressive symptoms and C-IMT in middle-aged and older females.

Factors Influencing Delay in Symptom-to-Door Time in Patients with Acute ST-Segment Elevation Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: Delay in symptom-to-door time (SDT) in patients with acute ST-segment elevation myocardial infarction (STEMI) is the most important factor in the prediction of short and long-term mortality. The purpose of this study was to investigate the social and clinical factors affecting SDT in patients with STEMI. METHODS: We analyzed 784 patients (61.0 +/- 13.2 years, 603 male) diagnosed with STEMI from November 2005 to February 2012. The patients were divided into four groups according to SDT: Group I (n = 163, 3 h). RESULTS: Delay in SDT increased with age (Group I, 58.4 +/- 12.0; Group II, 59.4 +/- 13.3; Group III, 62.0 +/- 12.8; Group IV, 63.0 +/- 13.8 years, p = 0.001). In 119 patients, transportation was less frequently used as the delay in SDT (41.7% vs. 29.0% vs. 26.1% vs. 9.8%, p < 0.001). By multiple logistic regression analysis, family history [OR, 0.488; CI, 0.248-0.959; p = 0.037], previous ischemic heart disease [OR, 0.572; CI, 0.331-0.989; p = 0.045], no occupation [OR, 1.600; CI, 1.076-2.380; p = 0.020] and method of transportation [OR, 0.353; CI, 0.239-0.520; p < 0.001] were independent predictors of delay in SDT. CONCLUSIONS: Our study shows that general education about cardiovascular symptoms and a prompt emergency call could be important to reduce SDT in STEMI.

Left Atrial Volume is a Predictor of Major Adverse Cardiac Events in Patients with Acute Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: Diastolic dysfunction may develop in conjunction with or without systolic dysfunction in patients with acute myocardial infarction (AMI). The present study investigated the association between left arterial (LA) volume and major adverse cardiac events (MACE) in 772 patients with AMI. METHODS: The patients were divided into groups according to LA volume index (LAVI) measured using echocardiography according to the American Society of Echocardiography guidelines: LAVI > or = 40 mL/m2 (Group I: n = 260, 191 males; age, 71.1 +/- 10.8 years) and LAVI < 40 mL/m2 (Group II: n = 512, 432 males; age, 62.8 +/- 12.7 years). The mean observational period was 314.2 +/- 134.6 days. RESULTS: Group I patients were older than those in Group II. Hypertension (56.8% vs. 46.0%, respectively; p = 0.007) and advanced Killip class (42.6% vs. 21.0%, respectively; p < 0.001) were more frequent in Group I than in Group II. MACE was more prevalent in Group I than in Group II (20.3% vs. 13.7%, respectively; p = 0.037). MACE-free survival rates were higher in Group II than in Group I during clinical follow-up. The multivariate analysis revealed that high LAVI was an independent predictor of mortality (hazard ratio, 3.002; confidedce interval, 1.051-8.569; p = 0.040). CONCLUSIONS: LA volume is an independent predictor of adverse cardiac events in patients with AMI, and the LAVI is useful for AMI risk stratification.

Predictive Factors for Long-term Clinical Outcomes in Patients with Variant Angina / 대한내과학회지

BACKGROUND/AIMS: The incidence of variant angina (VA) is relatively high in Korea compared with western countries, but its long-term clinical outcomes are not well defined. METHODS: Patients who underwent ergonovine provocation tests at the cardiac catheterization laboratory of Chonnam National University Hospital between 1996 and 2011 were enrolled in this study (n = 1162). Of them, 686 patients with positive ergonovine provocation tests were divided into two groups: patients with cardiac events (Group I: 153 patients, 52.4 +/- 11.0 years, M: F = 103: 50) and those without (Group II: 533 patients, 51.6 +/- 10.7 years, M: F = 350: 183). The mean follow-up duration was 40.2 +/- 38.0 months. Cardiac events were defined as cardiac death, recurrent ischemia, rehospitalization, myocardial infarction, and follow-up angiography. Clinical findings, laboratory and coronary angiographic characteristics were compared between the groups. RESULTS: A history of smoking was more common in Group I than in Group II (45.8% vs. 36.3%, p = 0.037). The levels of low-density lipoprotein cholesterol (119.4 +/- 35.3 vs. 111.1 +/- 32.2 mg/dL, p = 0.010) were higher in Group I than in Group II. According to Cox proportional hazard regression analysis, the major predictive factor for cardiac events during clinical follow-up was smoking (HR 1.80, 95% CI 1.036-3.126, p = 0.037). CONCLUSIONS: A history of smoking was the only independent risk factor for cardiac events during a long-term clinical follow-up in Korean patients with variant angina.