Differential impact of unrecognised brain infarction on stroke outcome in non-valvular atrial fibrillation.

There has been little information regarding the impact of unrecognised brain infarctions (UBIs) on stroke outcome in patients with non-valvular atrial fibrillation (NVAF). By using volumetric analysis of ischaemic lesions, we evaluated the potential impact of UBIs on clinical outcome according to their presence and categorised type. This study enrolled 631 patients with NVAF having no clinical stroke history. UBIs were categorised into three types as territorial, lacunar, or subcortical. We collected stroke severity, functional outcome at three months, and the total volume of UBIs and acute infarction lesions. We investigated the association between clinical outcome and the type or volume of UBI, using a linear mixed model and logistic regression analysis. UBIs were detected in 285 (45.2 %) patients; territorial UBIs were observed in 24.4 % of patients (154/631), lacunar UBIs in 25 % (158/631), and subcortical UBIs in 15.7 % (99/631). Although initial stroke severity was not different between patients with UBIs and those without, those with UBIs had less improvement during hospitalisation, leading to poorer outcome at three months. Among the three types of UBIs, only territorial UBIs were associated with poor outcome, especially in patients with relatively smaller acute infarction volume. UBIs, in particular, territorial UBIs, may be considered as predictors for poor outcome after ischaemic stroke in patients with NVAF. Our results suggest that the impact of UBIs on clinical outcome differs according to the type of UBIs and the acute stroke severity.

The distribution of cerebral microbleeds determines their association with arterial stiffness in non-cardioembolic acute stroke patients.

BACKGROUND AND PURPOSE: Increased arterial stiffness causes vessel damage in the end-organs. Therefore small vessels in the brain may be susceptible to increased arterial stiffness. Cerebral microbleeds (CMBs) are topographically or pathophysiologically categorized as deep or infratentorial type and strictly lobar type. Whether the presence and location of CMBs are associated with brachial-ankle pulse wave velocity (baPWV) which represents a measure of arterial stiffness was investigated. METHODS: Between June 2006 and January 2012, 1137 consecutive patients diagnosed with non-cardioembolic acute ischaemic stroke and who underwent baPWV measurement and brain gradient-echo imaging were enrolled. CMBs were classified as deep or infratentorial or strictly lobar according to their location. Severity of leukoaraiosis was determined using the Fazekas scoring system. RESULTS: CMBs were found in 30.7% of the included patients. These patients were older than those without CMBs. Mean baPWV was higher in patients with CMBs than in those without (20 ± 5 m/s vs. 19 ± 5 m/s; P = 0.001). When comparing baPWV according to the location of the CMB, it was higher in the deep or infratentorial CMB group than in the strictly lobar CMB group (22 ± 5 m/s vs. 20 ± 5 m/s; P = 0.001). In univariate and multivariate multinomial logistic regression analyses, baPWV was found to be independently associated with deep or infratentorial CMBs. CONCLUSIONS: Arterial stiffness was independently associated with deep or infratentorial CMBs but not lobar CMBs. These findings suggest a pathophysiological association between arterial stiffness and CMBs in the deep or infratentorial region.

The frequency of cerebral microbleeds increases with CHADS(2) scores in stroke patients with non-valvular atrial fibrillation.

BACKGROUND AND PURPOSE: Cerebral microbleeds (CMBs) are extravasations of blood from lipohyalinized or amyloid angiopathic cerebral arterioles, and the presence and numbers of CMBs are significantly associated with the development of oral anticoagulation (OA)-related intracranial haemorrhage (ICH). The aim of this study was to investigate whether there is a difference in CMBs burden according to CHADS(2) scores or CHA(2) DS(2) -VASc scores in non-valvular atrial fibrillation (NVAF) patients. METHODS: We included 550 ischaemic stroke patients who had NVAF and who had undergone brain magnetic resonance imaging (MRI) with gradient-recalled echo (GRE) T2 sequences from our prospective stroke registry between January 2005 and November 2011. We calculated CHADS(2) scores and CHA(2) DS(2) -VASc scores for all patients based on their underlying cardiovascular diseases. The presence, location and number of CMBs were assessed in each patient. We also investigated whether the CMBs were actually associated with the development of ICH during follow-up. RESULTS: The mean patient age was 70.4 ± 10.5 years, and 324 (58.9%) patients were men. One-hundred and seventy-three patients (31.5%) had CMBs detected on GRE MRI. Higher CHADS(2) scores or CHA(2) DS(2) -VASc scores were strongly associated with the presence and number of CMBs. During follow-up of median 3.1 ± 1.6 years, the presence of CMBs was independently associated with the development of ICH, whilst the CHADS(2) scores or CHA(2) DS(2) -VASc scores were not. CONCLUSIONS: Considering the positive association between the presence of CMBs and OA-related ICH, our results suggest that the increase in ICH in high-risk groups during OA may be related to an increased burden of CMBs.

Low ankle-brachial index is a predictive factor for initial severity of acute ischaemic stroke.

BACKGROUND: A low ankle-brachial index (ABI) is predictive of peripheral arterial disease (PAD). For unknown reasons, patients with PAD demonstrate higher vascular mortality during follow-up than do those without. Initial stroke severity is a strong predictor of long-term outcome and may be different between patients with and without PAD. Thus, we investigated whether a low ABI was associated with severe stroke presentation. METHODS: We enrolled 1147 first-ever ischaemic stroke patients who underwent ABI measurements during hospitalization. Patients were categorized into the normal (≥ 0.90) or the abnormal (<0.90) ABI group. Baseline characteristics and initial National Institutes of Health Stroke Scale (NIHSS) scores were compared between the groups. We further analysed components of the NIHSS subscales in these groups. RESULTS: Ankle-brachial index was abnormal in 85 (7.4%) patients. Mean initial NIHSS score was higher in the abnormal ABI group (6.61 ± 6.56) than in the normal ABI group (4.36 ± 4.90) (P = 0.003). A low ABI was independently associated with higher NIHSS score in a multivariate analysis. In the abnormal ABI group, leg weakness was more severe than it was in the normal ABI group, and the contribution of leg weakness to the initial NIHSS score was higher. CONCLUSIONS: Patients with low ABI values presented with more severe ischaemic stroke. Contribution of pre-existing PAD to leg weakness may play a role in the initial severity of stroke in patients with PAD. Our findings suggest that poor clinical outcomes in patients with PAD may be partially explained by their increased likelihood for severe stroke.

Prediction of thrombus resolution after intravenous thrombolysis assessed by CT-based thrombus imaging.

The degree of thrombus resolution directly indicates the effectiveness of a thrombolytic drug. We investigated the degree of thrombus resolution and factors associated with thrombus resolution after intravenous (IV) recombinant tissue plasminogen activator (rt-PA) using thin-section noncontrast computed tomography (NCT). Thin-section NCTs were performed before and immediately after IV rt-PA infusion in acute stroke patients. The thrombus volume and Hounsfield unit were measured using three-dimensional imaging software. Immediate recanalisation was assessed immediately after IV rt-PA infusion using CT angiography. During a three-year study period, 130 patients were prospectively enrolled. On baseline thin-section NCT, no thrombi were found in 30 patients (23%). Among the 100 patients with confirmed thrombus, the median volume decreased by 20% on the follow-up NCT. The thrombus was completely resolved in 8%. Of note, an increase in thrombus volume was observed in 20 patients. Independent predictors of thrombus resolution were total rt-PA dose, thrombus location in the M2 segment of the middle cerebral artery, and time from baseline to follow-up NCT. Thrombus resolution increased by 9% per each 10-mg increase in rt-PA (p = 0.045). Immediate complete recanalisation was achieved in 12% of patients. Total dose of rt-PA was independently associated with complete recanalisation [odds ratio [OR] 4.52, 95% confidence interval [CI] 1.345-15.184) and good functional outcome at three months (modified Rankin scale score <3, OR 2.34, 95% CI 1.104-4.962). In conclusion, rt-PA dose was associated with the degree of thrombus resolution, immediate complete recanalisation, and good outcome at three months. CT-based thrombus imaging may be helpful in determining thrombolysis effectiveness.

External validation of nomogram for the prediction of recurrence after curative resection in early gastric cancer.

BACKGROUND: Nomograms are statistics-based tools that provide the overall probability of a specific outcome. In our previous study, we developed a nomogram that predicts recurrence of early gastric cancer (EGC) after curative resection. We carried out this study to externally validate our EGC nomogram. PATIENTS AND METHODS: The EGC nomogram was established from a retrospective EGC database that included 2923 consecutive patients. This nomogram was independently externally validated for a cohort of 1058 consecutive patients. For the EGC nomogram validation, we assessed both discrimination and calibration. RESULTS: Within the follow-up period (median 37 months), a total of 11 patients (1.1%) experienced recurrence. The concordance index (c-index) was 0.7 (P = 0.02) and the result of the overall C index was 0.82 [P = 0.006, 95% confidence interval (CI) 0.59-1.00]. The goodness of fit test showed that the EGC nomogram had significantly good fit for 1- and 2-year survival intervals (P = 0.998 and 0.879, respectively). The actual and predicted survival outcomes showed good agreement, suggesting that the survival predictions from the nomogram are well calibrated externally. CONCLUSIONS: A preexisting nomogram for predicting disease-free survival (DFS) of EGC after surgery was externally validated. The nomogram is useful for accurate and individual prediction of DFS, patient prognostication, counseling, and follow-up planning.

Use of a handheld, computerized device as a decision support tool for stroke classification.

BACKGROUND: The Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification has been widely used to determine etiology of ischemic stroke. However, interrater reliability is known to be modest. The complexity of abstraction and the interpretation of various clinical and laboratory data might limit the accuracy of the TOAST classification. In this study, we developed a computerized clinical decision support system for stroke classification that can be used in a handheld device and tested whether this system can improve diagnostic accuracy and reliability. METHODS: Based on the TOAST classification, a logical algorithm was developed and implemented on a handheld device, named iTOAST. After answering six questions using the touch interface, the stroke subtype result is displayed on the screen. Four neurology residents were randomly assigned to classify stroke subtypes using iTOAST or the conventional method (cTOAST). Using a crossover design, they classified the stroke subtypes of 70 patients. The standard subtypes were determined by three stroke experts. Correlated kappa coefficients using iTOAST compared with cTOAST were determined. RESULTS: The kappa (SE) value of iTOAST [0.790 (0.041), 95% CI: 0.707-0.870] was higher than that of cTOAST [0.692 (0.046), 95% CI: 0.600-0.782] (P<0.001). Neither sequence (P=0.857) nor period effect (P=0.999) was observed. CONCLUSIONS: The stroke classification tool using a handheld, computerized device was easy, accurate, and reliable over the conventional method. It may have additional benefit because a handheld, computerized device is accessible anytime and anywhere.

Early neurological outcomes according to CHADS2 score in stroke patients with non-valvular atrial fibrillation.

BACKGROUND AND PURPOSE: A higher CHADS(2) score or CHA(2)DS(2)-VASc score is associated with an increased risk of ischaemic stroke in patients with non-valvular atrial fibrillation (NVAF). However, there are no data regarding early neurological outcomes after stroke according to the risk levels. METHODS: In this study, a total of 649 stroke patients with NVAF were enrolled and categorized into three groups: low-risk (CHADS(2) score of 0-1), moderate-risk (CHADS(2) score 2-3), or high-risk group (CHADS(2) score ≥4). CHA(2)DS(2)-VASc score was divided into four groups including 0-1, 2-3, 4-5, and ≥6. We investigated whether there were differences in initial stroke severity, early neurological outcome, and infarct size according to CHADS(2) score or CHA(2)DS(2)-VASc score in stroke patients with NVAF. RESULTS: The initial National Institutes of Health Stroke Scale (NIHSS) score was highest in high-risk group [9.5, interquartile range (IQR) 4-18], followed by moderate-risk (8, IQR 2-17) and low-risk group (6, IQR 2-15) (P=0.012). Likewise, initial stroke severity increased in a positive fashion with increasing the CHA(2)DS(2)-VASc score. During hospitalization, those in the high-risk group or higher CHA(2)DS(2)-VASc score had less improvement in their NIHSS score. Furthermore, early neurological deterioration (END) developed more frequently as CHADS(2) score or CHA(2)DS(2)-VASc score increased. Multivariate analysis showed being in the high-risk group was independently associated with END (OR 2.129, 95% CI 1.013-4.477). CONCLUSIONS: Our data indicate that patients with NVAF and higher CHADS(2) score or CHA(2)DS(2)-VASc score are more likely to develop severe stroke and a worse clinical course is expected in these patients after stroke presentation.

Effect of warfarin withdrawal on thrombolytic treatment in patients with ischaemic stroke.

BACKGROUND AND PURPOSE: Abruptly discontinuing warfarin may induce a rebound prothrombotic state. Thrombolytic agents may also paradoxically induce prothrombotic conditions, which include platelet activation and thrombin generation. Therefore, prothrombotic states may be enhanced by withdrawing warfarin in patients under thrombolytic treatment. This study was aimed to determine whether patients with warfarin withdrawal have different clinical outcomes from those without warfarin use after thrombolytic treatment. METHODS: A total of 148 consecutive patients with atrial fibrillation who were not on anticoagulants at admission and who received thrombolysis were included in this study. We compared the outcomes between a warfarin withdrawal group and a no-warfarin group. RESULTS: Fourteen patients (9.5%) were included in the warfarin withdrawal group. Although baseline National Institute of Health Stroke Scale (NIHSS) scores, recanalization rates, and hemorrhage frequencies did not differ between the groups, the warfarin withdrawal group showed poorer outcomes. Increased NIHSS scores during the first 7days were more frequent in the warfarin withdrawal group (57.1% vs. 26.9%, P=0.029). The median percent improvement in NIHSS scores at 24h after thrombolysis was also lower in the warfarin withdrawal group. After adjusting for covariates, warfarin withdrawal was a strong predictor of poor functional outcome at 3months (modified Rankin score≥3) (odds ratio, 17.067, 95% CI 2.703-107.748). CONCLUSIONS: Discontinuing warfarin was associated with early neurologic deterioration and poor long-term outcomes after thrombolytic treatment.

Failure of complete recanalization is associated with poor outcome after cardioembolic stroke.

BACKGROUND: Recanalization is strongly associated with outcomes after thrombolytic treatment. Cardiac emboli are known as better response to fibrinolytic agents because they are fibrin-rich; however, cardioembolic stroke itself is associated with poor outcomes and high mortality. Completeness of recanalization may therefore affect the outcome of cardioembolic stroke. We investigated whether degree of recanalization influences outcomes following fibrinolytic therapy in cardioembolic stroke. METHODS: Consecutive stroke patients with relevant artery occlusions on baseline CT angiography who had received thrombolytic treatment were enrolled. Completeness of recanalization was assessed by the Thrombolysis in Myocardial Infarction (TIMI) grade, which was compared between patients with and without cardiac sources of embolism (CSE). We also investigated independent predictors of poor outcome (modified Rankin scale score 3-6) at 3 months. RESULTS: Of the 127 patients enrolled, 65 (51%) had one or more CSE. Although the overall recanalization rates (TIMI 2 or 3) in patients with CSE (65%) and patients without CSE (68%) were similar (P=0.710), patients with CSE were less likely to show complete recanalization (TIMI 3) compared with those without CSE (19% vs. 39%, P=0.011). Multivariate analysis revealed that CSE was associated with failure of complete recanalization (OR 2.809, 95% CI 1.097-7.192) and was an independent predictor of poor outcome at 3months (OR 3.629, 95% CI 1.205-8.869). CONCLUSIONS: In cardioembolic strokes, failure of complete recanalization following thrombolytic therapy was frequent and was associated with poor outcome after thrombolysis.

The effect of age on motor deficits and cerebral glucose metabolism of Parkinson's disease.

BACKGROUND: No systematic study has been made to separate age-related clinical deterioration and dysfunctional brain areas from those associated with Parkinson's disease (PD). METHODS: This study included 73 de novo patients with PD and 43 age-matched controls. All subjects underwent [(18)F]-fluorodeoxy glucose (FDG) positron emission tomography studies. The severity of parkinsonian motor deficit was measured using unified PD rating scale (UPDRS) motor scores. Multiple linear regression analysis was used to identify those parkinsonian motor deficits for which severity was correlated with the age of the patients and to locate brain areas in which normalized FDG uptake values were inversely correlated with the age of the subjects. RESULTS: Patient age was positively correlated with total UPDRS motor scores and with subscores for bradykinesia and axial motor deficits, but not with subscores for tremor and rigidity. In the control group, an age-related decline in glucose uptake was found only in the cingulate cortex. However, in the patient group, an inverse correlation between age and glucose uptake was observed in the prefrontal, cingulate, orbitofrontal, perisylvian areas, caudate, and thalamus. CONCLUSIONS: In PD, widespread age-related decline in cerebral function may exaggerate the deterioration associated with bradykinesia and the axial motor deficits associated with nigral neuronal loss.

Mirror pattern of cerebral artery atherosclerosis in patients with ischaemic stroke.

BACKGROUND AND PURPOSE: Although it has been suggested that bilateral symmetry of atherosclerosis can be found in paired arteries, including external carotid arteries and femoral arteries, it has remained unknown in intracranial arteries. We determined whether bilateral symmetry (a mirror pattern) of atherosclerosis presents in the entire cerebral arterial system. METHODS: Angiographic findings of 795 consecutive patients with ischaemic stroke, after excluding those with cardiac sources of embolism or other causes of stroke, were reviewed retrospectively. The presence (location) and severity (the degree of stenosis) of atherosclerosis were compared between left and right sides at 26 predetermined arteries/segments. RESULTS: We found 2230 lesions in predetermined segments/arteries from 669 patients. Amongst 509 patients with atherosclerotic lesions at two or more arteries/segments, mirror patterns were observed in 312 patients (61.3%). The mirror pattern increased steeply as the number of atherosclerotic arteries increased and was most frequently found in the carotid bulb (C1, 26.7%), followed by the middle cerebral artery (M1, 14.1%). The severity of stenosis was also correlated between left and right sides, and the correlation was highest in the C1 (r = 0.40, P < 0.001). Multiple logistic regression analyses revealed that the mirror patterns of atherosclerosis were more obvious in C1 and associated with a past history of ischaemic stroke and the number of stenotic lesions. CONCLUSION: Atherosclerosis in cerebral arteries may develop and progress in a mirror pattern. In patients with cerebral artery atherosclerosis, the occurrence and progression of atherosclerosis in the contralateral cerebral artery should be considered during follow-up examination.

A comparison of perinatal mortality in Korea on holidays and working days.

OBJECTIVE: To examine whether the perinatal mortality of infants born during holidays differs from that of infants born on workdays, and to elucidate its cause. DESIGN: Cross-sectional study. Setting Vital statistics linked to the National Infant Mortality Survey data for 1999 births in Korea. POPULATION: In all, 628 485 births in 1999 in Korea. METHODS: Number of births and perinatal mortality were classified according to the day of the week using the occurrence index. After adjusting for confounding factors, the odds ratios (ORs) for increased holiday mortality were estimated using logistic regression. MAIN OUTCOME MEASURE: Birthweight-adjusted perinatal mortality. RESULTS: Births on holidays were 33% fewer and perinatal deaths 24% higher than expected (PMR, Perinatal Mortality Rate, 16.4 versus 12.8; OR, 1.3; 95% CI, 1.2-1.4). After the adjustment of birthweight, gender, plurality and congenital anomalies, the odds ratio for death of infants born during holidays was 1.2 (95% CI, 1.1-1.3). CONCLUSIONS: The higher perinatal mortality during holidays in Korea appears to be due to different qualities of perinatal care, rather than difference in case-mix.

Economic burden of smoking in Korea.

OBJECTIVE: To support tobacco control policies in Korea by providing the estimated annual economic burden attributed to cigarette smoking. METHODS: The following two different approaches were used to estimate the cost: "disease specific" and "all causes". In the disease specific approach, we focused on estimating direct and indirect costs involved in treatments of cardiovascular, respiratory, and gastrointestinal diseases, and cancer as a result of smoking, by using an epidemiologic approach-the population attributable risk (PAR). To compute PAR, the relative risks of smoking in terms of physician visits, hospital admission, and death were estimated using the Cox proportional hazard model. In the all causes approach, we examined the differences in direct and indirect costs between smokers and non-smokers for all conditions and types of disease. The major data source was the Korea Medical Insurance Corporation cohort study, which had complete records of smoking status as of 1992 for 115 682 male and 67 932 female insured workers. RESULTS: By the disease specific approach, the estimated costs attributable to smoking in 1998 in Korea ranged from US 2269.42 million dollars (4.89 million dollars per 100,000 population; 0.59% of gross domestic product (GDP)) to 2956.75 million dollars (6.37 million dollars; 0.78% of GDP). The all causes approach yielded a minimum cost of 3154.75 million dollars (6.79 million dollars; 0.82% GDP) and a maximum of 4580.25 million dollars (9.86 million dollars; 1.19% GDP). CONCLUSION: The study confirms that smoking places a substantial economic burden on Korean society. In light of this, our study provides evidence for a strong need to develop a national policy to effectively control tobacco consumption in Korea.

Is body mass index the prognostic factor in breast cancer?: a meta-analysis.

This study was performed to integrate the results of previous studies that investigated the relationship between body mass index (BMI) and prognosis in breast cancer. We reviewed the English literatures using the MEDLINE database from 1966 to 1999. The materials included 12 published articles with a total of 8,029 cases of breast cancer. The effect size was obtained from hazard ratio in each study. Homogeneity test was conducted before the integration of each effect size and the result demonstrated that the studies were heterogeneous. A random effect model was used to integrate the overall effect size. The integrated effect size was 1.56 (95% confidence interval, 1.22-2.00). In addition, publication bias should be accounted for because each published study was asymmetric in shape revealed by funnel plot. These results suggest that BMI have a prognostic significance in breast cancer. We believe that well-designed longitudinal studies, involving a large number of samples are required to resolve these issues.

Low serum cholesterol and haemorrhagic stroke in men: Korea Medical Insurance Corporation Study.

BACKGROUND: In some prospective studies, haemorrhagic stroke occurs more frequently in individuals with low serum cholesterol than in those with higher concentrations. We aimed to determine whether low total serum cholesterol is an independent risk factor for haemorrhagic stroke (intracerebral haemorrhage and subarachnoid haemorrhage) in South Korea, a country that has a population with relatively low concentrations of total serum cholesterol. METHODS: We measured total serum cholesterol and other cardiovascular risk factors in 114,793 Korean men, aged between 35-59 years in 1990 and 1992, in a prospective observational study. We used data obtained in 1992 for smoking and alcohol consumption. We divided total serum cholesterol into quintiles (<4.31 mmol/L, 4.31-<4.74, 4.74-<5.16, 5.16-<5.69 and > or = 5.69). Our primary outcomes were hospital admissions and deaths from intracerebral and subarachnoid haemorrhage in a 6 year follow-up between 1993 and 1998. FINDINGS: 528 men had a haemorrhagic stroke--372 intracerebral and 98 subarachnoid haemorrhage--and 58 were unspecified strokes. The relative risks of intracerebral haemorrhage in each quintile of total serum cholesterol (lowest to highest were: 1.22 (95% CI 0.88-1.69); 0.86 (0.60-1.21); 1.08 (0.78-1.48); and 1.03 (0.75-1.41). The corresponding relative risks for subarachnoid haemorrhage were: 1.44 (0.76-2.73); 1.13 (0.59-2.20); 1.21 (0.64-2.29); and 1.12 (0.59-2.14). INTERPRETATION: Low total serum cholesterol is not an independent risk factor for either intracerebral or subarachnoid haemorrhagic stroke in Korean men.

Comparing the survival of two groups with an intermediate clinical event.

Consider a subject entered on a clinical trial in which the major endpoint is a time metric such as death or time to reach a well defined event. During the observational period the subject may experience an intermediate clinical event. The intermediate clinical event may induce a change in the survival distribution. We consider models for the one and two sample problem. The model for the one sample problem enables one to test if the occurrence of the intermediate event changed the survival distribution. This models provides a way of carrying out non-randomized clinical trial to determine if a therapy has benefit. The two sample problem considers testing if the probability distributions, with and without an intermediate event, are the same. Statistical tests are derived using a semi-Markov or a time dependent mixture model. Simulation studies are carried out to compare these new procedures with the log rank, stratified log rank and landmark tests. The new tests appear to have uniformly greater power than these competitor tests. The methods are applied to a randomized clinical trial carried out by the Aids Clinical Trial Group (ACTG) which compared low versus high doses of zidovudine (AZT).

Moderate dietary fat consumption as a risk factor for ischemic heart disease in a population with a low fat intake: a case-control study in Korean men.

BACKGROUND: Dietary fat intake is associated with the incidence of ischemic heart disease (IHD) in Western countries. In populations in which both the average dietary fat consumption and the incidence of IHD are lower than in Western countries, the association of dietary fat intake with IHD incidence remains unknown. OBJECTIVE: We conducted a case-control study to examine the association of dietary fat with IHD incidence in Korean men. DESIGN: The case group consisted of 108 patients with electrocardiogram-confirmed myocardial infarction or angiographically confirmed (> or =50% stenosis) IHD who were admitted to a university teaching hospital in Seoul, Republic of Korea. The controls were 142 age-matched patients admitted to the departments of ophthalmology and orthopedic surgery at the same hospital. Dietary fat intake was assessed by a nutritionist using a semiquantitative food-frequency questionnaire. Body mass index (BMI), cigarette use, alcohol intake, exercise, and history of disease were determined during an interview and examination. RESULTS: In a univariate analysis, the mean percentages of energy from total fat, saturated fatty acids, and monounsaturated fatty acids were significantly higher in the cases than in the controls. BMI, smoking, and a history of hypertension were associated with the occurrence of IHD. In multiple logistic analyses, total fat intake was a significant risk factor (odds ratio: 1.08 for 1% of energy intake; 95% CI: 1.02, 1.14) after adjustment for BMI and smoking. CONCLUSION: In a population with a relatively low fat intake (19% of energy intake), a moderate increase in total fat intake may be a risk factor for IHD.

Twelve-year tracking of blood pressure in Korean school children: the Kangwha Study.

Longitudinal data from different populations have shown different degrees of tracking of blood pressure (BP). To examine BP tracking in Korean school children, 219 of 430 children (100 males, 119 females) who were 6 years old in 1986 in Kangwha County, Korea have been examined annually up to 1997 in the Kangwha Study. BP was measured twice with standard mercury sphygmomanometers and the average of the two measurements was used for the level of BP. Diastolic BP were measured at the fourth Korotkoff sound. Tracking was examined using a time-lag correlation analysis and McMahan's tracking index tau, which indicates the proportion of variation attributable to tracking apart from the natural growth component. As well the jackknife method was used to obtain the confidence interval of tau. Correlation coefficients between systolic BP from age 6 to 17 ranged from 0.39-0.54 for males and 0.44-0.57 for females. Taus for systolic BP were 0.875 (95% CI: 0.803-0.947) and 0.900 (95% CI: 0.809-0.991) in males and females, respectively. Correlation coefficients between diastolic BP from age 6 to 17 ranged from 0.28-0.47 for males and 0.14-0.47 for females. Taus for diastolic BP were 0.983 (95% CI: 0.897-1.000) and 0.800 (95% CI: 0.717-0.883) in males and females, respectively. These findings showed strong evidence for BP tracking in Korean school children from childhood to late adolescence.