Association of Self-Reported and Cotinine-Verified Smoking Status with Atrial Arrhythmia.

BACKGROUND: The relationship between self-reported and urinary cotinine-verified smoking status and atrial arrhythmia (AA) is unclear. The aim of this study was to evaluate the association of self-reported and urine cotinine-verified smoking status with AA. METHOD: A total of 201,788 participants (106,375 men, mean age 37 years) who had both a urinary cotinine measurement and electrocardiogram were included. Cotinine-verified current smoking was defined as a urinary cotinine level above 50 ng/mL. Individuals were divided into three groups based on self-reported smoking and two groups based on cotinine-verified smoking status. RESULTS: Among overall subjects, 505 had documented AA (0.3%) and 135 had atrial fibrillation (AF) (0.1%). Self-reported current smoking was associated with an increased risk of AA (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.06-1.91; P = 0.019) and AF (OR, 2.20; 95% CI, 1.24-3.90; P = 0.007), whereas self-reported former smoking had no significant association with AA (OR, 1.30; 95% CI, 0.97-1.73; P = 0.078) and AF (OR, 1.74; 95% CI, 1.00-3.04; P = 0.051). Cotinine-verified current smoking showed no significant association with AA (OR, 1.24; 95% CI, 0.98-1.58; P = 0.080) and AF (OR, 1.20; 95% CI, 0.79-1.83; P = 0.391). CONCLUSION: Self-reported current smoking was associated with AA and AF, while self-reported former smoking and cotinine-verified current smoking showed no significant association with AA and AF.

Association between Cigarette Smoking and New-Onset Diabetes Mellitus in 78,212 Koreans Using Self-Reported Questionnaire and Urine Cotinine.

BACKGROUND: No study has assessed association between cigarette smoking and new-onset diabetes mellitus (NODM) incidence using two different smoking classification systems: self-reported questionnaire and urine cotinine. The objective of this longitudinal study was to evaluate NODM risk using the above two systems in Korean adults. METHODS: Among individuals enrolled in Kangbuk Samsung Health Study and Cohort Study who visited between 2011 and 2012 at baseline and 2014 at follow-up, 78,212 participants without baseline diabetes mellitus were followed up for a median of 27 months. Assessment of NODM incidence was made at the end of follow-up period. Cotinine-verified current smoking was having urinary cotinine ≥50 ng/mL. RESULTS: Percentages of self-reported and cotinine-verified current smokers were 25.9% and 23.5%, respectively. Overall incidence of NODM was 1.5%. According to multivariate regression analyses, baseline self-reported current smoking (relative risk [RR], 1.33; 95% confidence interval [CI], 1.07 to 1.65) and cotinine-verified current smoking (RR, 1.27; 95% CI, 1.08 to 1.49) increased NODM risk compared to baseline self-reported never smoking and cotinine-verified current non-smoking. Higher daily amount and longer duration of smoking were also associated with increased NODM risk (P for trends <0.05). In particular, self-reported current smokers who smoked ≥20 cigarettes/day (RR, 1.62; 95% CI, 1.25 to 2.15) and ≥10 years (RR, 1.34; 95% CI, 1.08 to 1.67) had the highest RRs for NODM. These results remained significant in males, although there was no gender interaction. CONCLUSION: This longitudinal study showed that baseline self-reported and cotinine-verified current smoking were associated with increased risks of NODM, especially in males.

Association between Secondhand Smoke Exposure and Hypertension in 106,268 Korean Self-Reported Never-Smokers Verified by Cotinine.

: No study has reported the relationship between secondhand smoke (SHS) exposure and hypertension in self-reported never-smokers verified by nicotine metabolite. The aim of this study is to determine the relationship between SHS exposure and hypertension in self-reported and cotinine-verified never-smokers. A total of 106,268 self-reported never-smokers, verified as nonsmokers by urinary cotinine, who participated in Kangbuk Samsung Cohort study (KSCS) between 2012 and 2016 were included. Cotinine-verified nonsmokers were defined as individuals having urinary cotinine <50 ng/mL. SHS exposure was defined as current exposure to passive smoke indoors at home or the workplace. The multivariate regression model revealed that SHS exposure was associated with hypertension (odds ratio (OR) (95% confidence interval (CI)), 1.16 (1.08, 1.24)). Current SHS exposure that has been exposed to home SHS (1.22 (1.11, 1.33)) as well as current SHS exposure only at the workplace (1.15 (1.02, 1.29)) significantly increased the ORs for hypertension compared to no SHS exposure. There was no significant gender interaction for the relationships between SHS exposure and hypertension. This study showed that SHS exposure was significantly associated with hypertension in self-reported never-smokers verified as nonsmokers by urinary cotinine, suggesting necessity of health program and stricter smoking regulation to reduce the risk of hypertension.

Relationship Between Brachial-Ankle Pulse Wave Velocity and Incident Hypertension According to 2017 ACC/AHA High Blood Pressure Guidelines.

Background Arterial stiffness predicts both cardiovascular events and incident hypertension. However, whether brachial-ankle pulse wave velocity (baPWV) is predictive of incident hypertension based on the 2017 American College of Cardiology/American Heart Association (ACC/AHA) High Blood Pressure Guidelines has not been established. We performed a large cohort study to investigate whether incident hypertension could be predicted from baPWV measurements as a measure of arterial stiffness, even when applying updated hypertension criteria. Methods and Results A total of 10 360 Korean adults who underwent baPWV examination during a health-screening program between 2010 and 2016 were enrolled. Hypertension was defined according to the 2017 ACC/AHA Guidelines as 130/80 mm Hg. Cox proportional hazard analysis was used to assess the risk of incident hypertension according to baPWV quartiles. The mean age of the study subjects was 40.2 years and 75.6% were men. During the follow-up period (median 2.17 years), 2000 subjects (19.3%) developed hypertension. The subjects in the highest baPWV quartile group showed an increased risk of hypertension compared with the lowest baPWV quartile group as confirmed by multivariate adjusted hazard ratios of 1.64 (95% CI 1.41-1.89; P<0.001) in men and 12.36 (95% CI 4.41-34.62; P=0.005) in women. The increased risk of developing hypertension was consistent after adjusting for several confounding factors. Conclusions Arterial stiffness measured by baPWV is associated with incident hypertension according to the updated 2017 ACC/AHA Guidelines and is a useful independent predictor of incident hypertension among relatively healthy people.

Publisher Correction: Association between self-reported physical activity and incident atrial fibrillation in a young Korean population.

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Association between self-reported physical activity and incident atrial fibrillation in a young Korean population.

The association between physical activity (PA) and atrial fibrillation (AF) remains unclear. We thus investigated association of PA with the development of AF. Type and duration data for PA were acquired from 211,992 AF-free individuals using the validated Korean version of the International Physical Activity Questionnaire Short From between March 2002 and December 2014. Individuals were divided into four groups according to self-reported PA level and previous international PA guidelines: no PA with a sedentary lifestyle, insufficient PA, sufficient PA, and health-enhancing PA. AF was diagnosed by annual 12-lead electrocardiogram. During a median follow-up of 5.6 years, AF occurred in 304 participants (annual AF incidence rate 2.5/10,000 person-years). After adjusting for age and sex, PA level was not associated with AF incidence (P for trend = 0.26). The multivariable-adjusted hazard ratios (95% confidence interval) for incidental AF was 1.00 (0.74-1.37) for the insufficient PA group, 1.34 (0.91-1.97) for the sufficient PA group, and 1.27 (0.72-2.23) for the health-enhancing PA group compared with the no PA group (P for trend = 0.18). Thus, our study does not support an association between the risk of AF and PA level in a young Korean population.

Association of self-reported and cotinine-verified smoking status with incidence of metabolic syndrome in 47 379 Korean adults.

BACKGROUND: The relationship of cotinine-verified vs self-reported smoking status with the incidence of metabolic syndrome (MetS) is not known. This study investigated the effect of urinary cotinine-verified vs self-reported smoking status on incident MetS. METHODS: In all, 47 379 participants without MetS enrolled in the Kangbuk Samsung Health Study and Kangbuk Samsung Cohort Study between 2011 and 2012 (baseline) were included in this study and followed-up in 2014; median follow-up duration was 25 months. Cotinine-verified current smoking was defined as urinary cotinine concentrations >50 ng/mL. According to cotinine-verified smoking status at baseline and follow-up, individuals were divided into four groups: never, new, former, and sustained smokers. RESULTS: The incidence of MetS in the never, former, new, and sustained smoking groups was 9.9%, 19.4%, 21.4%, and 18.7%, respectively. Multivariate Cox hazard regression analyses revealed that the relative risk (RR) for incident MetS in cotinine-verified former smokers was significantly increased compared with that in cotinine-verified never smokers (RR 1.27; 95% confidence interval [CI] 1.16-1.37), especially in individuals exhibiting weight gain (≥2 kg). These results were consistent with those of self-reported smoking status. Baseline cotinine-verified current smoking (RR 1.09; 95% CI 1.03-1.15) and self-reported former (RR 1.10; 95% CI 1.02-1.18) and current (RR 1.15; 95% CI 1.07-1.23) smoking were also significantly associated with incident MetS. CONCLUSIONS: This large observational study showed that cotinine-verified and self-reported former smoking during follow-up increased the risk for incident MetS, especially in individuals exhibiting weight gain (≥2 kg). This suggests that weight control in former smokers would be very important to reduce the development of MetS.

Relationship Between Cotinine-Verified Smoking Status and Incidence of Hypertension in 74,743 Korean Adults.

BACKGROUND: The relationship between chronic smoking and hypertension (HTN) is inconclusive in previous studies, which were mainly based on self-reported smoking status. The aim of this study was to evaluate the association of cotinine-verified smoking status with incident HTN.Methods and Results:A total of 74,743 participants (43,104 men; age 38±5.4 years) were included in the study, with a mean follow-up period of 29 months. Individuals were divided into 4 groups on the basis of their cotinine-verified smoking status at baseline and at follow-up (never-smoking, new-smoking, former-smoking, and sustained-smoking). The incidence rate of HTN in the never-smoking, new-smoking, former-smoking, and sustained-smoking groups was 8.2%, 7.6%, 10.1%, and 8.7% for men and 1.8%, 2.5%, 1.5%, and 2.2% for women, respectively. In a multivariate Cox-hazard regression analysis adjusted for the variables with a univariate relationship, new-smoking and sustained-smoking had decreased relative risks (RRs) for incident HTN compared with never-smoking (RR [95% CI], 0.75 [0.58, 0.96] for new-smoking and 0.82 [0.74, 0.90] for sustained-smoking). Cotinine-verified current smoking at baseline was also inversely associated with incident HTN compared with cotinine-verified never-smoking at baseline (0.91 [0.84, 0.98]). These results remained significant only in men, although there was no sex interaction. CONCLUSIONS: This longitudinal study showed that cotinine-verified new-smoking and sustained-smoking decreased the risk for incident HTN, especially in men, compared with never-smoking.

Endoscopic ultrasound-guided sampling of a metastatic mucinous adenocarcinoma mimicking a gastric subepithelial tumor.

Metastatic mucinous adenocarcinoma of appendix origin and mimicking a gastric subepithelial tumor (SET) is very rare. Endoscopic ultrasound (EUS)-guided sampling is a useful diagnostic method for SETs. However, the cytologic findings of metastatic mucinous adenocarcinoma are unfamiliar to many pathologists and gastroenterologists. These findings present a diagnostic challenge because the introduction of gastric epithelium and mucin into the specimen during the procedure can be misleading. This is the first reported experience of an EUS-guided sampling of a gastric SET in a patient with suspected appendiceal tumor, to make the diagnosis of a mucinous adenocarcinoma.

Pulse pressure as a prognostic marker in patients receiving extracorporeal life support.

BACKGROUND: It is not easy to predict the prognosis of patients receiving extracorporeal life support (ECLS) because of the highly variable situation around its implementation. We evaluated the role of pulse pressure (PP), which is available on real-time basis, as a hemodynamic prognostic marker during ECLS. METHODS: From January 2009 to August 2011, data from 69 patients who were treated with ECLS for at least 6h in a single center for any cause was collected. We calculated the mean PP over the first 6h after ECLS implantation and examined if there was any correlation between mean PP and the study endpoints, in-hospital death and ECLS weaning failure. RESULTS: The causes of ECLS were of cardiac origin in 36 patients (52%). 27 patients (39.1%) weaned off ELCS and 13 patients (18.8%) survived to discharge. In Cox regression analysis (with age, Killip class ≥3, ECLS implementation during cardiopulmonary resuscitation (CPR), CPR duration, out-of-hospital arrest, initial laboratory results including blood gas analysis, initial systolic blood pressure (SBP), mean SBP over the first 6h after ECLS implantation, mean PP over the first 6h after ECLS implantation as independent variables), mean PP over the first 6h after ECLS implantation (hazard ratio [95% confidence interval]=0.96[0.94-0.98], P<0.001) and out-of-hospital arrest (HR[95%CI]=2.04[1.14-3.62], P=0.02) were independent predictors of in-hospital mortality and mean PP over the first 6h after ECLS implantation (HR[95% CI]=0.95[0.93-0.98], P<0.001) was the sole independent predictor of weaning failure. CONCLUSION: Higher mean PP over the initial 6h after ECLS implementation independently predicted successful weaning and survival. Our findings may help better predict and analyze prognosis in patients receiving ECLS.