Cardiovascular health metrics and all-cause and cardiovascular disease mortality among middle-aged men in Korea: the Seoul male cohort study.

OBJECTIVES: This study estimated the association of cardiovascular health behaviors with the risk of all-cause and cardiovascular disease (CVD) mortality in middle-aged men in Korea. METHODS: In total, 12 538 men aged 40 to 59 years were enrolled in 1993 and followed up through 2011. Cardiovascular health metrics defined the following lifestyle behaviors proposed by the American Heart Association: smoking, physical activity, body mass index, diet habit score, total cholesterol, blood pressure, and fasting blood glucose. The cardiovascular health metrics score was calculated as a single categorical variable, by assigning 1 point to each ideal healthy behavior. A Cox proportional hazards regression model was used to estimate the hazard ratio of cardiovascular health behavior. Population attributable risks (PARs) were calculated from the significant cardiovascular health metrics. RESULTS: There were 1054 total and 171 CVD deaths over 230 690 person-years of follow-up. The prevalence of meeting all 7 cardiovascular health metrics was 0.67%. Current smoking, elevated blood pressure, and high fasting blood glucose were significantly associated with all-cause and CVD mortality. The adjusted PARs for the 3 significant metrics combined were 35.2% (95% confidence interval [CI], 21.7 to 47.4) and 52.8% (95% CI, 22.0 to 74.0) for all-cause and CVD mortality, respectively. The adjusted hazard ratios of the groups with a 6-7 vs. 0-2 cardiovascular health metrics score were 0.42 (95% CI, 0.31 to 0.59) for all-cause mortality and 0.10 (95% CI, 0.03 to 0.29) for CVD mortality. CONCLUSIONS: Among cardiovascular health behaviors, not smoking, normal blood pressure, and recommended fasting blood glucose levels were associated with reduced risks of all-cause and CVD mortality. Meeting a greater number of cardiovascular health metrics was associated with a lower risk of all-cause and CVD mortality.

Zolpidem use and risk of fracture in elderly insomnia patients.

OBJECTIVES: To evaluate the risk of fractures related with zolpidem in elderly insomnia patients. METHODS: Health claims data on the entire South Korean elderly population from January 2005 to June 2006 were extracted from the Health Insurance Review and Assessment Service database. We applied a case-crossover design. Cases were defined as insomnia patients who had a fracture diagnosis. We set the hazard period of 1 day length prior to the fracture date and four control periods of the same length at 5, 10, 15, and 20 weeks prior to the fracture date. Time independent confounding factors such as age, gender, lifestyle, cognitive function level, mobility, socioeconomic status, residential environment, and comorbidity could be controlled using the case-crossover design. Time dependent confounding factors, especially co-medication of patients during the study period, were adjusted by conditional logistic regression analysis. The odds ratios and their 95% confidence intervals (CIs) were estimated for the risk of fracture related to zolpidem. RESULTS: One thousand five hundred and eight cases of fracture were detected in insomnia patients during the study period. In our data, the use of zolpidem increased the risk of fracture significantly (adjusted odds ratio [aOR], 1.72; 95% CI, 1.37 to 2.16). However, the association between benzodiazepine hypnotics and the risk of fracture was not statistically significant (aOR, 1.00; 95% CI, 0.83 to 1.21). Likewise, the results were not statistically significant in stratified analysis with each benzodiazepine generic subgroup. CONCLUSIONS: Zolpidem could increase the risk of fracture in elderly insomnia patients. Therefore zolpidem should be prescribed carefully and the elderly should be provided with sufficient patient education.

Impact of individual and combined health behaviors on all causes of premature mortality among middle aged men in Korea: the Seoul Male Cohort Study.

OBJECTIVES: The aim of this study was to evaluate and quantify the risk of both individual and combined health behaviors on premature mortality in middle aged men in Korea. METHODS: In total, 14 533 male subjects 40 to 59 years of age were recruited. At enrollment, subjects completed a baseline questionnaire, which included information about socio-demographic factors, past medical history, and life style. During the follow-up period from 1993 to 2008, we identified 990 all-cause premature deaths using national death certificates. A Cox proportional hazard regression model was used to estimate the hazard ratio (HR) of each health risk behavior, which included smoking, drinking, physical inactivity, and lack of sleep hours. Using the Cox model, each health behavior was assigned a risk score proportional to its regression coefficient value. Health risk scores were calculated for each patient and the HR of all-cause premature mortality was calculated according to risk score. RESULTS: Current smoking and drinking, high body mass index, less sleep hours, and less education were significantly associated with all-cause premature mortality, while regular exercise was associated with a reduced risk. When combined by health risk score, there was a strong trend for increased mortality risk with increased score (p-trend < 0.01). When compared with the 1-9 score group, HRs of the 10-19 and 20-28 score groups were 2.58 (95% confidence intervals [CIs], 2.19 to 3.03) and 7.09 (95% CIs, 5.21 to 9.66), respectively. CONCLUSIONS: Modifiable risk factors, such as smoking, drinking, and regular exercise, have considerable impact on premature mortality and should be assessed in combination.

Indoor physical activity reduces all-cause and cardiovascular disease mortality among elderly women.

OBJECTIVES: The aim of this study was to investigate whether a medium to high degree of total physical activity and indoor physical activity were associated with reduced all-cause and cardiovascular mortality among elderly Korean women. METHODS: A prospective cohort study was done to evaluate the association between physical activity and mortality. The cohort was made up of elderly (≥ 65 years of age) subjects. Baseline information was collected with a self-administered questionnaire and linked to death certificates retrieved from a database. Cox proportional hazard models were used to estimate the hazard ratios (HRs) with 95% confidence interval (CI) levels. RESULTS: Women who did not suffer from stroke, cancer, or ischemic heart disease were followed for a median of 8 years (n=5079). A total of 1798 all-cause deaths were recorded, of which 607 (33.8%) were due to cardiovascular disease. The group with the highest level of total physical activity and indoor physical activity was significantly associated to a reduced all-cause mortality (HR, 0.60; 95% CI, 0.51 to 0.71 and HR, 0.58; 95% CI, 0.50 to 0.67, respectively) compared to the group with the lowest level of total physical activity and indoor physical activity. Additionally, the group with the highest level of total physical activity and indoor physical activity was significantly associated to a lower cardiovascular disease mortality (HR, 0.53; 95% CI, 0.40 to 0.71 and HR, 0.51; 95% CI, 0.39 to 0.67, respectively) compared to the group with the lowest level of total physical activity and indoor physical activity. CONCLUSIONS: Our study showed that regular indoor physical activity among elderly Korean women has healthy benefits.

Digestion-resistant fraction from soybean [Glycine max (L.) Merrill] induces hepatic LDL receptor and CYP7A1 expression in apolipoprotein E-deficient mice.

Soybean [Glycine max (L.) Merrill] is known to have hypocholesterolemic effects; however, the function and mechanism of its digestion-resistant fraction (RF) in cholesterol reduction is not clearly understood. In the present study, we investigated the hypocholesterolemic effects of the RF from soybean in C57BL/6J and apolipoprotein E (apoE)-deficient mice. RFs were prepared either from raw or preheated crops to measure compositional changes in RF during cooking. Preheating reduced the RF yields and the resistant starch (RS) fraction in RF. After 1 week of feeding, the raw soybean RF (5%, w/w) was the most effective in lowering plasma cholesterol concentrations by 27% (P<.05) in apoE-deficient (apoE-/-) mice. A smaller but significant reduction was found in C57BL/6J mice. The RF from preheated soybean tended to have lower hypocholesterolemic effects than did the RF from raw soybean in apoE-/- mice. This suggests the RS may be a key hypocholesterolemic component from soybean RF. RF consumption (5%, w/w) dramatically increased hepatic low-density lipoprotein receptor and cholesterol 7alpha-hydroxylase expression in both apoE-/- and C57BL/6J mice followed by increased bile acid excretion. 3-Hydroxy-3-methylglutaryl-coenzyme A reductase was only marginally altered. Our results show that the RF, especially from raw soybean containing high level of RS, significantly reduces plasma cholesterol concentrations under hyperlipidemic condition. The cholesterol was reduced by multiple mechanisms such as increased hepatic cholesterol uptake, cholesterol degradation into bile acids and bile acid excretion.

Selective increase in pinolenic acid (all-cis-5,9,12-18:3) in Korean pine nut oil by crystallization and its effect on LDL-receptor activity.

The aims of this study were to obtain concentrated pinolenic acid (5,9,12-18:3) from dietary Korean pine (Pinus koraiensis) nut oil by urea complexation and to investigate its cholesterol-lowering effect on the LDL-receptor activity of human hepatoma HepG2 cells. Pine nut oil was hydrolyzed to provide a low-pinolenic acid-containing FA extract (LPAFAE), followed by crystallization with different ratios of urea in ethanol (EtOH) or methanol (MeOH) as a solvent to produce a high-pinolenic acid-containing FA extract (HPAFAE). The profiles of HPAFAE obtained by urea complexation showed different FA compositions compared with LPAFAE. The long-chain saturated FA palmitic acid (16:0) and stearic acid (18:0) were decreased with urea/FA ratios (UFR) of 1:1 (UFR1), 2:1 (UFR2), and 3:1 (UFR3). Linoleic acid (9,12-18:2) was increased 1.3 times with UFR2 in EtOH, and linolenic acid (9,12,15-18:3) was increased 1.5 times with UFR3 in MeOH after crystallization. The crystallization with UFR3 in EtOH provided the highest concentration of pinolenic acid, which was elevated by 3.2-fold from 14.1 to 45.1%, whereas that of linoleic acid (9,12-18:2) was not changed, and that of oleic acid (9-18:1) was decreased 7.2-fold. Treatment of HepG2 cells with HPAFE resulted in significantly higher internalization of 3,3'-dioctadecylindocarbocyanine-LDL (47.0 +/- 0.15) as compared with treatment with LPAFAE (25.6 +/- 0.36) (P< 0.05). Thus, we demonstrate a method for the concentration of pinolenic acid and suggest that this concentrate may have LDL-lowering properties by enhancing hepatic LDL uptake.

Hydrogeochemistry of alluvial groundwaters in an agricultural area: an implication for groundwater contamination susceptibility.

Alluvial groundwaters in the area where intensive agricultural activity takes place were geochemically investigated to evaluate factors regulating groundwater quality of alluvial aquifers. For this study, 55 groundwater samples were taken from the uniformly distributed irrigation wells and were classified into three distinct groups according to their geochemical characteristics. This study reveals that the groundwater quality and the geochemical characteristics of the clustered groups are consistent with the geology of the area. The samples collected from the area where a thick silt bed overlies the sand aquifer are clustered into Group II and show water quality that is only slightly affected by the contaminants originating from the land surface. However, groundwaters of this group are very high in Fe and Mn levels due to strong anoxic condition caused by the thick silt bed. In contrast, Group I shows water quality largely influenced by agricultural activities (i.e., fertilization, liming) and occurs in the area adjacent to the river where the silt bed is not observed and the sand aquifer is covered with sandy soils. Group III mostly occurs in the upgradient of Group I where a thin, silty soil covers the sand aquifer. In overall, the results show that the clustered groups closely reflect the groundwater susceptibility to the contaminants originated from the land surface. This suggests that groundwater clustering based on water chemistry could be applied to the contamination susceptibility assessment for groundwaters in the agricultural area.