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Park KW, Kang J, Koo BK, Rhee TM, Yang HM, Won KB, Rha SW, Bae JW, Lee NH, Hur SH, Han JK, Shin ES, Kim HS. Aspirin vs. Clopidogrel as a Chronic maintenance monotherapy after PCI in patients with high ischemic risk and high bleeding risk: Subgroup analysis of the HOST-EXAM trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
on behalf of the HOST-EXAM investigators
Background
The HOST-EXAM randomized clinical trial recently performed a comparison of clopidogrel monotherapy vs. aspirin monotherapy in patients requiring indefinite antiplatelet monotherapy after percutaneous coronary intervention (PCI). This study randomized 5,438 patients who maintained dual antiplatelet therapy without clinical events for 6–18 months after PCI with drug-eluting stents (DES) to receive a monotherapy agent of clopidogrel 75 mg once daily or aspirin 100 mg once daily for 24 months. During the 24-month follow-up, the primary outcome (a composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium (BARC) bleeding type 3 or greater) rate was significantly lower in the clopidogrel group (hazard ratio [HR] 0.73 [95% CI 0.59–0.90]; p = 0.0035). However, it is uncertain whether the beneficial effect of clopidogrel will be consistent in patients with high ischemic risk or those with high bleeding risk.
Methods
This is a post-hoc analysis of the HOST-EXAM trial. A high ischemic risk was defined as those who had at least 1 of the following procedural features: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI, total stent length >60 mm, or left main PCI. Patients with high bleeding risk were defined according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria. The co-primary outcome were thrombotic endpoints (a composite of cardiac death, non-fatal myocardial infarction, ischemic stroke, readmission due to acute coronary syndrome, and definite or probable stent thrombosis) and bleeding endpoints (BARC type ≥2 bleeding events) at 24-month follow-up.
Results
Among the total population, 22.1% had high ischemic risk and 21.4% had high bleeding risk. Complex PCI was not associated with a higher risk of thrombotic endpoints, nor bleeding endpoints. For patients with a high bleeding risk, these patients had a higher risk of both thrombotic endpoints (HR 1.545, 95% CI 0.141-2.092, p = 0.005) and bleeding endpoints (HR 3.418, 95% CI 2.413-4.840, p < 0.001). The primary results focusing on the interaction between high ischemic risk, high bleeding and the antiplatelet regimen will be presented.
Conclusion
The current post-hoc analysis of the HOST-EXAM trial will evaluate the efficacy of clopidogrel monotherapy vs. aspirin monotherapy during the chronic maintenance period after PCI, in patients with high ischemic risk or those with high bleeding risk.
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Affiliation(s)
- K W Park
- Chungbuk National University Hospital, Cheongju, Korea (Republic of)
| | - J Kang
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - B K Koo
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - T M Rhee
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - H M Yang
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - K B Won
- Ulsan University Hospital, Ulsan, Korea (Republic of)
| | - S W Rha
- Korea University Guro Hospital, Seoul, Korea (Democratic People"s Republic of)
| | - J W Bae
- Chungbuk National University Hospital, Cheongju, Korea (Republic of)
| | - N H Lee
- Hangang Sacred Hospital, Seoul, Korea (Republic of)
| | - S H Hur
- Keimyung University Hospital, Daegu, Korea (Republic of)
| | - J K Han
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - E S Shin
- Ulsan University Hospital, Ulsan, Korea (Republic of)
| | - H S Kim
- Seoul National University Hospital, Seoul, Korea (Republic of)
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Kim BJ, Park JI, Nam JH, Lee JH, Lee CH, Son JW, Park JS, Shin DG, Kim U, Her SH, Chang KY, Ahn TH, Jeong MH, Rha SW, Kim HS. Clinical impact of intravascular ultrasound guidance in patients of ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention with drug eluting stent. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is little data about clinical role of intravascular ultrasound (IVUS)-guided Percutaneous (PCI) in the setting of ST-segment elevation myocardial infarction (STEMI).
Methods
From 2005 to 2018, a total of 8,129 patients who underwent PCI with STEMI were investigated from the Korea Acute Myocardial Infarction Registry-National Institute of Health database. Patients with Non-ST segment elevation myocardial infarction, cardiogenic shock, bare metal stent implantation, thrombolytic treatment, and coronary artery bypass graft surgery were excluded. We categorized patients into two groups based on the treatment strategy: IVUS-guided PCI group (n=1,544), and coronary angiography guidance (CAG)-guided PCI group (n=6,585). The primary endpoint was composite of major adverse cardiovascular (MACE), including, cardiac death, myocardial infarction (MI), repeat target vessel revascularization (TVR) and stent thrombosis (ST).
Results
IVUS-guided PCI was performed in 19% patients (1544/8129). After propensity score matching, there were no statistically difference in the rate of cardiac death (0% in IVUS vs. 0.26% in CAG, p=0.947), MI (2.01% vs. 2.01%, p=0.408), TVR (1.23% vs. 0.91%, p=0.131), ST (0.32% vs. 0.45%, p=0.828) and composite of MACE at 1 year between two groups (2.01% vs. 2.40%, p=0.843). Independent risk factors for MACE were diabetes mellitus and multi-vessel disease, but not IVUS-guided PCI (HR 1.167, 95% CI, 0.896–1.520, p=0.251).
Conclusion
This study suggests that routine usage of IVUS in the setting of STEMI may not be necessary. Large-scaled random study will be needed for further evaluation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B J Kim
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J I Park
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J H Nam
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J H Lee
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - C H Lee
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J W Son
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J S Park
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - D G Shin
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - U Kim
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - S H Her
- St. Vincent's Hospital, College of Medicine, Suwon, Korea (Republic of)
| | - K Y Chang
- The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea (Republic of)
| | - T H Ahn
- Gachon University Gil Medical Center, Incheon, Korea (Republic of)
| | - M H Jeong
- Chonnam National University Hospital, Gwangju, Korea (Republic of)
| | - S W Rha
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - H S Kim
- Seoul National University Hospital, Seoul, Korea (Republic of)
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Jang WY, Kim W, Kang DO, Park Y, Park EJ, Na JO, Choi CU, Rha SW, Park CG, Seo HS, Park S, Kim EJ. P4339Reference values for cardiorespiratory fitness in healthy Koreans: compared to western nations and nomogram. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cardiorespiratory Fitness (CRF), defined as the integrated ability to properly oxygenate skeletal muscles during physical activity, is associated with a high risk of cardiovascular disease and all-cause mortality. The reference range for CRF may differ among nations, with Asians under-represented in previous data.
Purpose
In this study, we sought to establish reference values of CRF for Asians using a recent Korean cohort.
Methods
We analyzed 2646 healthy Korean adults recently enrolled in the Korea Institute of Sports Science Fitness Standards (KISS FitS) project with estimated maximal oxygen uptake (VO2max) values during treadmill test. Patients with cardiovascular or renal disease, systemic infection, pregnant women and those with orthopedic injuries unable to measure physical fitness were excluded. Age-specific mean VO2max values were compared with those from recent American, Norwegian, Danish cohorts and old Korean data.
Results
Age-specific reference values for healthy Korean adults in this cohort were as shown (Table). We were able to draw a nomogram to predict exercise capacity for a given age and MET value (Figure). When compared to other countries, less CRF reduction by aging was seen in Asians than in other Westerners. When compared to old Korean data from the 1980s, values were similar after adjustment for difference in methods, except for those under 30 years old which were decreased.
Exercise capacity of healthy Korean Men Women Age VO2max (ml/kg/min) N P-value for trend Age VO2max (ml/kg/min) N P-value for trend 19–29 42.3±6.3± 209 <0.01 19–29 34.3±4.3± 110 <0.01 30–39 42.0±5.0± 170 39–39 32.2±4.5± 211 40–49 41.4±5.6± 238 40–49 30.8±4.6± 284 50–59 38.0±5.7± 274 50–59 28.3±4.6± 367 60–69 32.4±6.2± 134 60–69 26.0±5.7± 336 70–79 27.2±5.6± 83 70–79 23.9±4.4± 195 >80 24.1±4.0± 11 >80 21.0±3.7± 24 Total 38.6±7.4± 1119 Total 28.5±5.8 1527 Data are presented as mean ± standard deviation. VO2max, maximal oxygen uptake; N, number.
Nomogram of exercise capacity in Koreans
Conclusions
While there was no significant change in CRF over time in the same ethnic group, there was a clear inter-ethnic difference. CRF should be assessed according to ethnic or national standards, and it is necessary to establish a reference for each nation or ethnicity with periodic updates.
Acknowledgement/Funding
National Sports Promotion Fund of the Korea Sports Promotion Foundation in 2015
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Affiliation(s)
- W Y Jang
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - W Kim
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - D O Kang
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - Y Park
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - E J Park
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - J O Na
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - C U Choi
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - S W Rha
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - C G Park
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - H S Seo
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - S Park
- Korea Institute of Sport Science, seoul, Korea (Republic of)
| | - E J Kim
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
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Rha SW, Choi BG, Choi SY, Byun JK, Cha JA, Park TS. P6435A diagnostic prediction model of coronary artery disease in patient with chest pain using machine learning. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chest pain is a major symptom of coronary artery disease (CAD), which can lead to acute coronary syndrome and sudden cardiac death. Accurate diagnosis of CAD in patients who experience chest pain is crucial to provide appropriate treatment and optimize clinical outcomes.
Objective
This study was to develop a machine learning model which can predict and diagnose CAD in patients complaining of chest pain based on a large real-world prospective registry database and computing power.
Method
A total of 10,177 subjects with typical or atypical chest pain who underwent a coronary angiography at the cardiovascular center of our University Hospital, South Korea between November 2004 and May 2014 were evaluated in this study. The generation of the diagnostic prediction model for CAD used the classification application by technical support of MATLAB R2017a. The performance evaluation of the learning model generated by machine learning was evaluated by the area under the curve (AUC) of the receiver-operating characteristic (ROC) analysis.
Results
The diagnostic prediction model of CAD had been generated according to the user's accessibility such as the general public or clinician (Model 1–4). The performance of the models has ranged from 0.78 to 0.96 by the AUC of ROC analysis. The prediction accuracy of the models ranged from 70.4% to 88.9%. The performance of the diagnostic prediction model of CAD by machine learning improved as the input information increased.
Figure 1. Study Flow Chart
Conclusion
A diagnostic prediction model of CAD using the machine learning method and the registry database was developed. Further studies are needed to verify our results.
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Affiliation(s)
- S W Rha
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - B G Choi
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - S Y Choi
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - J K Byun
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - J A Cha
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - T S Park
- Virginia Commonwealth University, Division of Cardiology, Richmond, United States of America
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Jang WY, Kang DO, Park Y, Kim W, Park EJ, Na JO, Choi CU, Rha SW, Park CG, Seo HS, Kim EJ. P2501Validation of FRIEND and ACSM equations for cardiorespiratory fitness: comparison to direct measurement in male CAD patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Cardiorespiratory fitness (CRF) is associated with a high risk of cardiovascular disease and all-cause mortality. The regression equation of American College of Sports Medicine (ACSM) was a preferred method for estimating maximal oxygen consumption (VO2max). It is well-known that CRF is overestimated in ACSM equation. Recently, Kokkinos reported more precise equation from the Fitness Registry and the Importance of Exercise National Database (FRIEND). Both equations were made from western healthy people.
Purpose
In this study, we compared VO2max estimated by ACSM and FRIEND equations to VO2max directly measured in male coronary artery disease (CAD) patients.
Methods
We analyzed 103 male CAD patients who underwent percutaneous coronary intervention and who participated in cardiac rehabilitation between June 2015 and December 2018. VO2max was directly measured by the gas exchange analysis during treadmill test with modified Bruce protocol. Exclusive criteria were pulmonary disease, chronic kidney disease on hemodialysis, malignancy, peripheral artery disease, insufficient cardiopulmonary exercise test and orthopedic injuries. Directly measured VO2max were compared to ACSM and FRIEND equations.
Results
Age-specific VO2max values, which were directly measured from male CAD patients, were shown in Table. Smaller CRF difference was shown in FRIEND equation than ACSM equation. Compared to the measured value, CRF estimated by ACSM equation was overestimated by 22%, but the one estimated by FRIEND equation had only 2% gap. Figure presents Bland-Altman plots. ACSM equation had the higher bias (5.52ml/kg/min) compared with FRIEND equation (0.200ml/kg/min).
Comparison table of VO2max estimated by ACSM and FRIEND equations with directly measured VO2max in male CAD patients Age Number VO2max (ml/kg/min) Measured ACSM % predicted FRIEND % predicted 30–39 4 29.5 ± (6.6) 35.7 ± (6.1) 122.3 ± (8.5) 29.1 ± (4.3) 100.1 ± (8.7) 40–49 20 29.1 ± (5.1) 35.7 ± (5.4) 123.6 ± (11.1) 29.1 ± (3.8) 101.2 ± (9.5) 50–59 32 25.6 ± (4.3) 31.5 ± (5.1) 123.8 ± (10.1) 26.2 ± (3.6) 103.2 ± (8.5) 60–69 27 26.0 ± (5.1) 31.1 ± (2.6) 120.5 ± (12.6) 25.9 ± (4.0) 100.8 ± (10.5) 70–79 18 21.2 ± (6.0) 26.8 ± (5.4) 123.2 ± (14.8) 22.8 ± (3.9) 105.2 ± (12.0) >80 2 25.0 ± (10.1) 22.8 ± (2.6) 97 ± (28.9) 19.9 ± (1.9) 85.1 ± (27.0) Total 103 25.7 ± (5.6) 31.4 ± (6.0) 122.2 ± (12.4) 26.1 ± (4.3) 102.1 ± (10.4) Data are presented as mean ± (standard deviation).
Bland-Altman plots
Conclusions
FRIEND equation can estimate CRF more accurately than ACSM equation, even in Asian patients with CAD.
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Affiliation(s)
- W Y Jang
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - D O Kang
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - Y Park
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - W Kim
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - E J Park
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - J O Na
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - C U Choi
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - S W Rha
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - C G Park
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - H S Seo
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - E J Kim
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
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Choi CU, Choi JI, Kim W, Jang WY, Kang DO, Park Y, Na JO, Kim EJ, Rha SW, Park CG, Seo HS, Kim JW. P2523Hand grip strength as a predictor of exercise capacity in coronary heart disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
A recent study has shown that quadriceps strength can be used to predict the level of exercise capacity in patients with coronary heart disease (CHD). We investigated whether the relationship between muscular strength and exercise capacity is also observed with hand grip strength (HGS). We studied 443 participants (age, 61.8±11.2 y; 77.7% male) who underwent coronary intervention and participated in cardiac rehabilitation between 2015 and 2018. Participants were assessed for grip strength, measured using a Jamar dynamometer. Logistic regression was used to assess the relationship between various clinical measures (HGS, age, sex, etc) with the distance walked on a 6-minute walk test (6MWT) and maximal oxygen uptake (VO2max). HGS was significantly related to distance walked on the 6MWT (r=0.435, p<0.001). It was the only predictor of all exercise capacity categories, and one of the strongest predictors of each exercise capacity category. A HGS of 25.5% of body weight predicted an achievement of a 200 m walk on the 6MWT (positive predictive value = 0.95). However, HGS less than 35.5% of body weight predicted that 500m could not be done in 6 minutes (negative predictive value = 0.97). This trend was also observed in the subgroups in which VO2max was measured. This study demonstrates that HGS is associated with exercise capacity in CHD and can be used to predict the level of exercise capacity. These findings may contribute to setting the recommended level of daily activity as well as the level of cardiac rehabilitation in CHD.
Logistic regression models for different levels of exercise capacity Level of exercise capacity B±S.E p-value Odd ratio 95% CI Distance of 6MWT 200 m Grip strength 0.054±0.014 <0.001 1.056 1.027–1.086 300 m Grip strength 0.042±0.009 <0.001 1.042 1.024–1.062 400 m Grip strength 0.047±0.011 <0.001 1.048 1.026–1.070 500 m Grip strength 0.051±0.016 0.001 1.053 1.021–1.086 VO2max level 4 METs Grip strength 0.054±0.010 <0.001 1.056 1.036–1.076 6 METs Grip strength 0.059±0.011 <0.001 1.061 1.039–1.083 8 METs Grip strength 0.081±0.015 <0.001 1.085 1.053–1.117 10 METs Grip strength 0.113±0.049 0.019 1.12 1.019–3.232 Data are presented as mean ± standard deviation (SD). 6MWT, 6-minute walk test; STEMI, ST-Elevation Myocardial Infarction; SE, standard error; CI, confidence interval; VO2max, Maximal Oxygen uptake; METs, Metabolic equivalents.
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Affiliation(s)
- C U Choi
- Korea University Guro Hospital, Cardiology, Seoul, Korea (Republic of)
| | - J I Choi
- Korea University Anam Hospital, Seoul, Korea (Republic of)
| | - W Kim
- Korea University Guro Hospital, Cardiology, Seoul, Korea (Republic of)
| | - W Y Jang
- Korea University Guro Hospital, Cardiology, Seoul, Korea (Republic of)
| | - D O Kang
- Korea University Guro Hospital, Cardiology, Seoul, Korea (Republic of)
| | - Y Park
- Korea University Guro Hospital, Cardiology, Seoul, Korea (Republic of)
| | - J O Na
- Korea University Guro Hospital, Cardiology, Seoul, Korea (Republic of)
| | - E J Kim
- Korea University Guro Hospital, Cardiology, Seoul, Korea (Republic of)
| | - S W Rha
- Korea University Guro Hospital, Cardiology, Seoul, Korea (Republic of)
| | - C G Park
- Korea University Guro Hospital, Cardiology, Seoul, Korea (Republic of)
| | - H S Seo
- Korea University Guro Hospital, Cardiology, Seoul, Korea (Republic of)
| | - J W Kim
- Korea University Guro Hospital, Cardiology, Seoul, Korea (Republic of)
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Rha SW, Choi BG, Choi SY, Byun JK, Cha JA. P1944Relationship between the duration of hypertension and cerebral and cardiovascular disease in the adult Korean population. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although advances in medical technology and health care have led to increased life expectancy, the prevalence of chronic diseases such as hypertension, diabetes, stroke and cardiovascular events has increased.
Purpose
This study evaluated the prevalence of hypertension, treatment, and the impact of hypertension on cardiovascular disease (CVD) and stroke risk in Koreans.
Methods
The Korean National Health and Nutritional Examination Survey (KNHANES) database, which is a stratified random sampling to assess the health and nutritional status of Koreans (https://knhanes.cdc.go.kr), was analyzed for this study. The subjects of the survey were sampled to represent the entire population of the Republic of Korea. The endpoints of the study are the risk of CVD and stroke due to the prevalence of hypertension. We also examined the relationship between the control of hypertension and the risk of CVD and stroke.
Results
The prevalence of hypertension has increased rapidly as with longer life expectancy of the population. As the duration of hypertension increases, CVD and stroke risks are increased. Achieving a target goal blood pressure below 140/90 mmHg can reduce the risk of all CVD and stroke by nearly half.
Korea-HTN
Conclusion
The risk of CVD and stroke in hypertensive patients can be significantly reduced by achieving optimal blood pressure control.
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Affiliation(s)
- S W Rha
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - B G Choi
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - S Y Choi
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - J K Byun
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - J A Cha
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
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Rha SW, Choi BG, Choi SY, Byun JK, Hong JY, Park JY, Park SH, Choi CU, Park CG, Seo HS. P281Impact of anemia on development of new-onset diabetes mellitus and 5-year major clinical outcomes in the korean population. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S W Rha
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - B G Choi
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - S Y Choi
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - J K Byun
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - J Y Hong
- Hanil general hospital, Seoul, Korea Republic of
| | - J Y Park
- Eulji General Hospital, Seoul, Korea Republic of
| | - S H Park
- Soonchunhyang University Cheonan Hospital, Cheonan, Korea Republic of
| | - C U Choi
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - C G Park
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - H S Seo
- Korea University Guro Hospital, Seoul, Korea Republic of
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Rha SW, Choi BG, Choi SY, Byun JK, Hong JY, Park JY, Park SH, Choi CU, Park CG, Seo HS. P282Application of machine learning for predicting new-onset diabetes mellitus during 5-year follow-up in non-diabetic patients with cardiovascular risk. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S W Rha
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - B G Choi
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - S Y Choi
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - J K Byun
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - J Y Hong
- Hanil general hospital, Seoul, Korea Republic of
| | - J Y Park
- Eulji General Hospital, Seoul, Korea Republic of
| | - S H Park
- Soonchunhyang University Cheonan Hospital, Cheonan, Korea Republic of
| | - C U Choi
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - C G Park
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - H S Seo
- Korea University Guro Hospital, Seoul, Korea Republic of
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10
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Park EJ, Eo JS, Jang WY, Na JO, Choi CU, Kim EJ, Rha SW, Park CG, Seo HS, Kim JW. P1689Association of brain amygdalar activity with plaque burden and vulnerability in coronary artery. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E J Park
- Korea University Guro Hospital, Caradiovascular Center, Seoul, Korea Republic of
| | - J S Eo
- Korea University Guro Hospital, Department of Nuclear Medicine, Seoul, Korea Republic of
| | - W Y Jang
- Korea University Guro Hospital, Caradiovascular Center, Seoul, Korea Republic of
| | - J O Na
- Korea University Guro Hospital, Caradiovascular Center, Seoul, Korea Republic of
| | - C U Choi
- Korea University Guro Hospital, Caradiovascular Center, Seoul, Korea Republic of
| | - E J Kim
- Korea University Guro Hospital, Caradiovascular Center, Seoul, Korea Republic of
| | - S W Rha
- Korea University Guro Hospital, Caradiovascular Center, Seoul, Korea Republic of
| | - C G Park
- Korea University Guro Hospital, Caradiovascular Center, Seoul, Korea Republic of
| | - H S Seo
- Korea University Guro Hospital, Caradiovascular Center, Seoul, Korea Republic of
| | - J W Kim
- Korea University Guro Hospital, Caradiovascular Center, Seoul, Korea Republic of
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11
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Won J, Jeong HK, Hong YJ, Jeong MH, Kim YJ, Chae SC, Hong TJ, Seong IW, Chae JK, Kim CJ, Cho MC, Rha SW, Bae JH, Seung KB, Park SJ. P6438Comparative efficacy of angiotensin converting enzyme inhibitor and angiotensin receptor blocker for patients with acute myocardial infarction and renal dysfunction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Won
- Chonnam National University Hospital, Division of Cardiology, Gwangju, Korea Republic of
| | - H K Jeong
- Chonnam National University Hospital, Division of Cardiology, Gwangju, Korea Republic of
| | - Y J Hong
- Chonnam National University Hospital, Division of Cardiology, Gwangju, Korea Republic of
| | - M H Jeong
- Chonnam National University Hospital, Division of Cardiology, Gwangju, Korea Republic of
| | - Y J Kim
- Yeungnam University Hospital, Division of Cardiology, Daegu, Korea Republic of
| | - S C Chae
- Kyungpook National University Hospital, Division of Cardiology, Daegu, Korea Republic of
| | - T J Hong
- Pusan National University Hospital, Division of Cardiology, Pusan, Korea Republic of
| | - I W Seong
- Chungnam National University Hospital, Division of Cardiology, Daejeon, Korea Republic of
| | - J K Chae
- Chonbuk National University Hospital, Division of Cardiology, Jeonju, Korea Republic of
| | - C J Kim
- Kyung Hee University Hospital at Gangdong, Division of Cardiology, Seoul, Korea Republic of
| | - M C Cho
- Chungbuk National University Hospital, Division of Cardiology, Cheongju, Korea Republic of
| | - S W Rha
- Korea University Guro Hospital, Division of Cardiology, Seoul, Korea Republic of
| | - J H Bae
- Konyang University hospital, Division of Cardiology, Daejeon, Korea Republic of
| | - K B Seung
- Seoul St. Mary's Hospital, Division of Cardiology, Seoul, Korea Republic of
| | - S J Park
- Asan Medical Center, Division of Cardiology, Seoul, Korea Republic of
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12
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Park EJ, Kim WH, Choi JY, Jang WY, Na JO, Choi JI, Kim JW, Kim EJ, Rha SW, Park CG, Seo HS, Choi CU. P2690The bleeding and cardiovascular risk according to NSAIDs selectivity in patients receiving antithrombotics and concomitant NSAIDs after myocardial infarction: a nationwide cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E J Park
- Korea University Guro Hospital, Cardiology, Seoul, Korea Republic of
| | - W H Kim
- Korea University Guro Hospital, Cardiology, Seoul, Korea Republic of
| | - J Y Choi
- Korea University Guro Hospital, Cardiology, Seoul, Korea Republic of
| | - W Y Jang
- Korea University Guro Hospital, Cardiology, Seoul, Korea Republic of
| | - J O Na
- Korea University Guro Hospital, Cardiology, Seoul, Korea Republic of
| | - J I Choi
- Korea University Anam Hospital, Seoul, Korea Republic of
| | - J W Kim
- Korea University Guro Hospital, Cardiology, Seoul, Korea Republic of
| | - E J Kim
- Korea University Guro Hospital, Cardiology, Seoul, Korea Republic of
| | - S W Rha
- Korea University Guro Hospital, Cardiology, Seoul, Korea Republic of
| | - C G Park
- Korea University Guro Hospital, Cardiology, Seoul, Korea Republic of
| | - H S Seo
- Korea University Guro Hospital, Cardiology, Seoul, Korea Republic of
| | - C U Choi
- Korea University Guro Hospital, Cardiology, Seoul, Korea Republic of
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13
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Rha SW, Byun JK, Choi BG, Choi SY, Hong JY, Park JY, Park SH, Choi CU, Park CG, Seo HS. P3623Impact of blood urea nitrogen/creatinine ratio in coronary artery disease patients underwent successful percutaneous coronary intervention with drug eluting stents: 5-year follow-up results. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S W Rha
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - J K Byun
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - B G Choi
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - S Y Choi
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - J Y Hong
- Hanil general hospital, Seoul, Korea Republic of
| | - J Y Park
- Eulji General Hospital, Seoul, Korea Republic of
| | - S H Park
- Soonchunhyang University Cheonan Hospital, Cheonan, Korea Republic of
| | - C U Choi
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - C G Park
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - H S Seo
- Korea University Guro Hospital, Seoul, Korea Republic of
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14
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Rha SW, Mashaly A, Choi BG, Choi SY, Byun JK, Hong JY, Park JY, Park SH, Choi CU, Park CG, Seo HS. P1636Impact of uric acid on 5-year clinical outcomes after below-the-knee endovascular intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S W Rha
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - A Mashaly
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - B G Choi
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - S Y Choi
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - J K Byun
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - J Y Hong
- Hanil general hospital, Seoul, Korea Republic of
| | - J Y Park
- Eulji General Hospital, Seoul, Korea Republic of
| | - S H Park
- Soonchunhyang University Cheonan Hospital, Cheonan, Korea Republic of
| | - C U Choi
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - C G Park
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - H S Seo
- Korea University Guro Hospital, Seoul, Korea Republic of
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15
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Cho KI, Cho BR, Jeon DW, Rha SW, Lee JY, Lim HS, Jin DK, Ahn HS, Park SW. P3801Effect of nebivolol on gender-different efficacy and safety in Korean patients with hypertension: result from BENEFIT-KOREA study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K I Cho
- Kosin University School of Medicine, Department of Internal Medicine, Division of Cardiology, Busan, Korea Republic of
| | - B R Cho
- Kangwon National University Hospital, Chuncheon, Korea Republic of
| | - D W Jeon
- Ilsan Hospital, Goyang, Korea Republic of
| | - S W Rha
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - J Y Lee
- Kangbuk Samsung Hospital, Seoul, Korea Republic of
| | - H S Lim
- Ajou University Hospital, Suwon, Korea Republic of
| | - D K Jin
- SoonChunHyang University Hospital, Chonan, Korea Republic of
| | - H S Ahn
- Sahmyook Medical Center, seoul, Korea Republic of
| | - S W Park
- A. Menarini Korea Ltd, seoul, Korea Republic of
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16
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Sim DS, Jeong MH, Kim HS, Gwon HC, Seung KB, Rha SW, Chae SC, Kim CJ, Cha KS, Park JS, Yoon JH, Chae JK, Joo SJ, Choi DJ, Hur SH. P4610Utility of GRACE and ACUITY-HORIZONS risk scores to guide dual antiplatelet therapy in patients with acute myocardial infarction undergoing drug-eluting stenting. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D S Sim
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - M H Jeong
- Chonnam National University Hospital, Gwangju, Korea Republic of
| | - H S Kim
- Seoul National University Hospital, Seoul, Korea Republic of
| | - H C Gwon
- Samsung Medical Center, Seoul, Korea Republic of
| | - K B Seung
- The Catholic University of Korea, Seoul, Korea Republic of
| | - S W Rha
- Korea University Guro Hospital, Seoul, Korea Republic of
| | - S C Chae
- Kyungpook National University Hospital, Daegu, Korea Republic of
| | - C J Kim
- Kyunghee University, Seoul, Korea Republic of
| | - K S Cha
- Pusan National University Hospital, Pusan, Korea Republic of
| | - J S Park
- Yeungnam University Hospital, Daegu, Korea Republic of
| | - J H Yoon
- Wonju Medical College, Wonju, Korea Republic of
| | - J K Chae
- Chonbuk National University Hospital, Jeonju, Korea Republic of
| | - S J Joo
- Jeju National University Hospital, Jeju, Korea Republic of
| | - D J Choi
- Seoul National University Bundang Hospital, Seongnam, Korea Republic of
| | - S H Hur
- Keimyung University Hospital Dongsan Medical Center, Daegu, Korea Republic of
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17
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Park JY, Rha SW, Choi BG, Choi SY, Byun JK, Hong JY, Park SH, Choi CU. P1682Impact of gender difference on five-year clinical outcomes in coronary artery spasm patients using propensity matching analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Y Park
- Eulji University, Seoul Eulji Hospital, Seoul, Korea Republic of
| | - S W Rha
- Korea University Guro Hospital, Cardiovascular Center, Seoul, Korea Republic of
| | - B G Choi
- Korea University Guro Hospital, Cardiovascular Center, Seoul, Korea Republic of
| | - S Y Choi
- Korea University Guro Hospital, Cardiovascular Center, Seoul, Korea Republic of
| | - J K Byun
- Korea University Guro Hospital, Cardiovascular Center, Seoul, Korea Republic of
| | - J Y Hong
- Hanil General Hospital, Department of cardiology, Seoul, Korea Republic of
| | - S H Park
- Soonchunhyang University Hospital, cardiology, Cheonan, Korea Republic of
| | - C U Choi
- Korea University Guro Hospital, Cardiovascular Center, Seoul, Korea Republic of
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18
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Kim YK, Seo HS, Lee EM, Na JO, Choi CU, Lim HE, Kim EJ, Rha SW, Park CG, Oh DJ. Association of hypertension with small, dense low-density lipoprotein in patients without metabolic syndrome. J Hum Hypertens 2011; 26:670-6. [PMID: 21975689 DOI: 10.1038/jhh.2011.86] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A higher proportion of small, dense low-density lipoprotein (sdLDL) is known to be associated with a high prevalence of cardiovascular disease in association with metabolic syndrome (MS). Hypertension (HTN) is one of the known risk factors for MS. However, whether HTN is associated with sdLDL in patients without MS is not yet clear. The lipid profiles, including low-density-lipoprotein (LDL) subfractions, of 383 consecutive subjects were evaluated. The patients without MS consisted of 198 hypertensive patients (non-MS/HTN group) and 108 normotensive subjects (non-MS/non-HTN group). The peak and mean particle diameter of LDL were measured by gradient gel electrophoresis. Plasma total cholesterol, LDL cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride (TG), HDL cholesterol/Apo A1, LDL-C/ApoB and Apo(A1, B, CII and E) levels did not differ between the non-MS/non-HTN and non-MS/HTN groups. When analyzing LDL subfraction, the absolute amount of patterns A and B was not different between the non-MS/non-HTN and non-MS/HTN groups. Compared with the non-MS/non-HTN groups, the proportion of sdLDL was higher in the non-MS/HTN group (37.7% versus 39.9%, P=0.046), but not significant after adjustment of waist circumference, serum TG, age and statin usage. The proportion of sdLDL to total LDL was higher in hypertensive subjects, even those without MS, than in normotensive subjects. However, this difference of LDL subfraction in hypertensive patients is associated with higher waist circumference, higher serum TG, older age and more statin usage. This result suggests that HTN may contribute to atherosclerosis and endothelial dysfunction with associated risk factors that influence LDL size.
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Affiliation(s)
- Y K Kim
- Department of Internal Medicine, Division of Cardiology, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
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19
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Kim EJ, Yong HS, Seo HS, Na JO, Choi CU, Kim JW, Lim HE, Rha SW, Park JH, Park CG, Oh DJ. Abstract: 1038 VASCULAR CALCIFICATION, BONE DENSITY, AND CORONARY ARTERY DISEASE: SIMULTANEOUS ASSESSMENT BY CARDIAC CT ANGIOGRAPHY. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70392-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Chen KY, Rha SW, Li YJ, Poddar KL, Jin Z, Minami Y, Saito S, Park JH, Na JO, Choi CU, Lim HE, Kim JW, Kim EJ, Park CG, Seo HS, Oh DJ. Impact of hypertension on coronary artery spasm as assessed with intracoronary acetylcholine provocation test. J Hum Hypertens 2009; 24:77-85. [PMID: 19458625 PMCID: PMC3011093 DOI: 10.1038/jhh.2009.40] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Both hypertension and coronary artery spasm (CAS) are associated with endothelial dysfunction. Thus, a higher incidence of CAS is expected in hypertensive patients. We evaluated the impact of hypertension on CAS with intracoronary acetylcholine (ACh) provocation test. A total of 986 patients (685 hypertensive patients vs 301 normotensive patients) who underwent coronary angiography with ACh provocation test were enrolled. ACh was injected into the left coronary artery in incremental doses of 20, 50 and 100 microg min(-1). Significant CAS was defined as a transient >70% luminal narrowing with concurrent chest pain and/or ST-segment changes. Although the incidences of significant ACh-induced CAS were similar between hypertensive and normotensive patients (35.8 vs 39.2%, P=0.303), multivariate logistic analysis showed that hypertension was negatively associated with ACh-induced CAS (odds ratio: 0.70, 95% confidence interval: 0.51-0.94, P=0.020). The angiographic characteristics of ACh-induced CAS were similar between these two groups. Subgroup analysis regarding the impact of the status of blood pressure control on CAS showed that hypertensive patients with controlled blood pressure had a significantly higher incidence of CAS than those with uncontrolled blood pressure (45.2 vs 27.9%, P<0.001), and that uncontrolled blood pressure was negatively associated with ACh-induced CAS (odds ratio: 0.56, 95% confidence interval: 0.40-0.79, P=0.001). In conclusion, despite the expected endothelial dysfunction, hypertension and uncontrolled blood pressure are negatively associated with CAS, suggesting that the mechanisms and risk factors of CAS may be significantly different from those of coronary artery disease.
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Affiliation(s)
- K-Y Chen
- Department of Internal Medicine, Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
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Kim JW, Seo HS, Na JO, Suh SY, Choi CU, Kim EJ, Rha SW, Park CG, Oh DJ. Myocardial bridging is related to endothelial dysfunction but not to plaque as assessed by intracoronary ultrasound. Heart 2007; 94:765-9. [PMID: 17881476 DOI: 10.1136/hrt.2007.115980] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Myocardial bridge (MB) is characterised by focal compression of a coronary artery in systole by an overlying band of myocardium. Chronic compression and relaxation of the MB may produce endothelial dysfunction by direct stress. OBJECTIVE To determine whether MB alters endothelial function, thus influencing the plaque formation. METHODS 128 patients (mean (SD) age 54.7 (10.9) years, 56 men) with typical angiographic systolic milking effects and >30% reduction in diameter of the coronary artery during systole after intracoronary nitrate (glyceryl trinitrate, 200 mug) infusion were studied. 231 control patients (mean (SD) age 52.9 (12.1) years, 111 men) without overt coronary artery disease including MB were also studied. Endothelial function was estimated by incremental acetylcholine (Ach) infusion into the left coronary ostium. Intracoronary ultrasound assessments were obtained in 74/128 patients with MB and 81/231 controls. RESULTS The mean (SD) vasoconstrictive response to maximal Ach was more pronounced at the bridging segments than at matched segments in controls (-71.9 (14.9) vs -30.3 (22.6), p = 0.009). Coronary vasoconstriction (>50%) to Ach was seen more often in the MB group than in controls (114/128 (89.1%) vs 81/231 (35.1%), p = 0.007). No significant correlation was found between the severity of MB and vasoconstriction in response to Ach. A typical half-moon phenomenon was seen in 71/74 (95.9%) cases of the MB group, but not in controls (p<0.001). Plaques at the bridging segments were absent in 67/74 (90.5%) and mild in 7/74 (9.5%) cases, as compared with those of matched segments of the left anterior descending coronary artery in controls (plaque burden 5.91 (1.37)% vs 24.71 (24.21)%, p = 0.002). CONCLUSION Despite the prominent relationship between MB and endothelial dysfunction, bridging segments are spared from atherosclerotic plaque formation.
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Affiliation(s)
- J W Kim
- Guro Hospital, Cardiovascular Centre, Korea University, 97 Gurodong-Gil, Guro-gu, Seoul, Republic of Korea 152-703
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Kim EJ, Park CG, Park JS, Suh SY, Choi CU, Kim JW, Kim SH, Lim HE, Rha SW, Seo HS, Oh DJ. Relationship between blood pressure parameters and pulse wave velocity in normotensive and hypertensive subjects: invasive study. J Hum Hypertens 2006; 21:141-8. [PMID: 17136108 DOI: 10.1038/sj.jhh.1002120] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Blood pressure (BP) is one of the most important contributing factors to pulse wave velocity (PWV), a classic measure of arterial stiffness. Although there have been many non-invasive studies to show the relation between arterial stiffness and BP, the results are controversial. The aim of this study is to evaluate the role of BP as an influencing factor on PWV using invasive method. We observed 174 normotensive and untreated hypertensive subjects using coronary angiography. Arterial stiffness was assessed through aorto-femoral PWV by foot-to-foot velocity method using fluid-filled system. And BP was measured by pressure wave at the right common femoral artery. From univariate analysis, age, diabetes mellitus (DM), hypertension, waist, waist-to-hip ratio, total cholesterol-to-high-density lipoprotein cholesterol ratio, systolic BP (SBP), pulse pressure (PP) and mean arterial pressure (MAP) showed significant association with PWV. To avoid multiple colinearity among SBP, PP and MAP, we performed multiple regression analysis predicting PWV thrice. Age, DM and each BP were significantly and consistently correlated to PWV. In the first and third modules, compared to age, SBP and MAP were less strong predictors, respectively. However, PP was the stronger predictor than age and DM in the second module. Lastly, we simultaneously forced MAP and PP with other variables in the fourth multivariate analysis. Age, DM and PP remained significantly correlated with PWV, but the significance of MAP was lost. This is the first invasive study to suggest that PP has the strongest correlation with PWV among a variety of BP parameters.
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Affiliation(s)
- E J Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Guro-gu, Seoul, Republic of Korea
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Rha SW, Yong HS, Park CG. Anomalous origin of the left coronary artery from the pulmonary artery in an elderly patient visualised by three dimensional multidetector CT coronary angiography. Heart 2005; 91:947. [PMID: 15958368 PMCID: PMC1768987 DOI: 10.1136/hrt.2004.051292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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