Adiponectin is Associated with Impaired Fasting Glucose in the Non-Diabetic Population

OBJECTIVES: Adiponectin is strongly associated with diabetes in the Western population. However, whether adiponectin is independently associated with impaired fasting glucose (IFG) in the non-obese population is unknown. METHODS: The serum adiponectin, insulin resistance (IR), and waist circumference (WC) of 27,549 healthy Koreans were measured. Individuals were then classified into tertile groups by gender. IFG was defined as a fasting serum glucose of 100-125 mg/dL without diabetes. IR was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR). The association of adiponectin and IFG was determined using logistic regression analysis. RESULTS: WC and adiponectin were associated with IFG in both men and women. However, the association of WC with IFG was attenuated in both men and women after adjustment for the HOMA-IR. Adiponectin was still associated with IFG after adjustment for and stratification by HOMA-IR in men and women. Strong combined associations of IR and adiponectin with IFG were observed in men and women. Multivariate adjusted odds ratios (ORs) (95% confidence interval [CI]) among those in the highest tertile of IR and the lowest tertile of adiponectin were 9.8 (7.96 to 12.07) for men and 24.1 (13.86 to 41.94) for women. CONCLUSION: These results suggest that adiponectin is strongly associated with IFG, and point to adiponectin as an additional diagnostic biomarker of IFG in the non-diabetic population.ope

Plasma transforming growth factor β1 as a biochemical marker to predict the persistence of atrial fibrillation after the surgical maze procedure

ObjectivesThe Cox maze procedure was developed as a surgical treatment for atrial fibrillation. However, atrial fibrillation recurs in some patients, and atrial remodeling in the form of fibrosis can lead to perpetuation of atrial fibrillation. To identify the predictor of the persistence of atrial fibrillation after the maze procedure using cryoablation, we evaluated the preoperative plasma transforming growth factor β1. We also examined the correlations between plasma transforming growth factor β1 levels and the degree of atrial fibrosis.MethodsPreoperative plasma transforming growth factor β1 levels were measured in 86 consecutive patients (age, 54 ± 12 years) who underwent both the open heart operation for valvular heart disease and the surgical maze procedure with cryoablation for persistent atrial fibrillation. We measured the degree of fibrosis from the tissue of the left atrium.ResultsAt 1 year's follow-up, 10 of 86 patients had persistent atrial fibrillation. Patients with persistent atrial fibrillation had higher preoperative plasma transforming growth factor β1 levels than the patients with sinus rhythm (0.44 ± 0.29 vs 0.32 ± 0.15 ng/mL, P = .03). Patients with persistent atrial fibrillation had higher mRNA expressions of collagen III and lower mRNA expressions of atrial natriuretic peptide than those with sinus rhythm, and the plasma transforming growth factor β1 levels correlated with the degree of fibrosis in the left atrium (r = 0.497, P = .022). Multiple logistic regression analysis revealed that plasma transforming growth factor β1 levels were independently associated with the postoperative persistence of atrial fibrillation at 1 year's follow-up.ConclusionsPreoperative plasma transforming growth factor β1 levels could be used to predict the persistence of atrial fibrillation at 1 year's follow-up after the surgical maze procedure by using cryoablation. Preoperative plasma transforming growth factor β1 levels were correlated with the degree of fibrosis in the left atria of patients with mitral valvular heart disease

Lung function, coronary artery calcification, and metabolic syndrome in 4905 Korean males

SummaryBackgroundImpaired lung function is an independent predictor of cardiovascular mortality. We assessed the relationships of lung function with insulin resistance (IR), metabolic syndrome (MetS), systemic inflammation and coronary artery calcification score (CACS) measured by computed tomography (CT) scan an indicator of coronary atherosclerosis.MethodsWe identified 4905 adult male patients of the Health Promotion Center in Samsung Medical Center between March 2005 and February 2008 and retrospectively reviewed the following data for these patients: pulmonary function, CT-measured CACS, anthropometric measurement, fasting glucose, insulin, lipid profiles, serum C-reactive protein (CRP) and homeostatic model assessment (HOMA-IR). MetS was defined according to the AHA/NHLBI criteria.ResultsWhen the subjects were divided into four groups according to quartiles of FVC or FEV1 (% pred), serum CRP level, HOMA-IR, prevalence of MetS and CACS significantly increased as the FVC or FEV1 (% pred) decreased. The odds ratios (ORs) for MetS in the lowest quartiles of FVC and FEV1 (% pred) were 1.85 (95% CI, 1.49–2.30; p<0.001) and 1.47 (95% CI, 1.20–1.81; p<0.001) respectively. The ORs for the presence of coronary artery calcification in the lowest quartiles of FVC and FEV1 (% pred) were 1.31 (95% CI, 1.09–1.58; p=0.004) and 1.22 (95% CI, 1.02–1.46; p=0.029) respectively. Obesity, CRP, HOMA-IR, and the presence of coronary artery calcium were independent risk predictors for impaired lung function.ConclusionMetabolic syndrome, insulin resistance, coronary atherosclerosis, and systemic inflammation are closely related to the impaired lung function

Concurrent smoking and alcohol consumers had higher triglyceride glucose indices than either only smokers or alcohol consumers: a cross-sectional study in Korea

Background The triglyceride glucose (TyG) index is a noninsulin-based marker for insulin resistance (IR) in general practice. Although smoking and heavy drinking have been regarded as major risk factors for various chronic diseases, there is limited evidence regarding the combined effects of smoking and alcohol consumption on IR. This study aimed to investigate the relationship between the TyG index and smoking and alcohol consumption using two Korean population-based datasets. Methods This study included 10,568 adults in the Korean National Health and Nutrition Examination Survey (KNHANES) and 9586 adults in the Korean Initiatives on Coronary Artery Calcification (KOICA) registry datasets. Multivariate logistic analysis was conducted to explore the relationship between smoking and alcohol consumption and the TyG index. To assess the predictive value of smoking and alcohol consumption on high TyG index, the area under the curve (AUC) were compared and net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses were derived. Results The combined effect of smoking and alcohol consumption was an independent risk factor of a higher TyG index in the KNHANES (adjusted odds ratio: 4.33, P < .001) and KOICA (adjusted odds ratio: 1.94, P < .001) datasets. Adding smoking and alcohol consumption to the multivariate logistic models improved the model performance for the TyG index in the KNHANES (AUC: from 0.817 to 0.829, P < .001; NRI: 0.040, P < .001; IDI: 0.017, P < .001) and KOICA (AUC: from 0.822 to 0.826, P < .001; NRI: 0.025, P = .006; IDI: 0.005, P < .001) datasets. Conclusions Smoking and alcohol consumption were independently associated with the TyG index. Concurrent smokers and alcohol consumers were more likely to have a TyG index that was ≥8.8 and higher than the TyG indices of non-users and those who exclusively consumed alcohol or smoking tobacco.This work was supported by the Technology Innovation Program (20002781, A Platform for Prediction and Management of Health Risk Based on Personal Big Data and Lifelogging) funded by the Ministry of Trade, Industry and Energy (MOTIE, South Korea) to JW Lee, and the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) Baek et al. Lipids in Health and Disease (2021) 20:49 Page 9 of 11 (NRF-2019R1A2C1010043) to H Lee. Additionally, this work was supported by Institute for Information and Communications Technology Promotion (IITP) grant funded by the Korean government (MSIT) (2019-31-1293), for autonomous digital companion framework and application to HJ Chan

The Effects of Short-duration Exercise on Arterial Stiffness in Patients with Stable Coronary Artery Disease

Arterial stiffness is an important contributor to the development of cardiovascular disease. We investigated the effect of short duration exercise using the treadmill test on arterial stiffness in the presence of coronary artery disease. We enrolled patients with and without coronary artery diseases (CAD and control group, 50 patients each) referred for treadmill testing. Brachial-ankle pulse wave velocity (baPWV) were measured before and after treadmill testing. Values of baPWV were significantly reduced at 10 min after exercise in both groups, more in the CAD group than in the control group (baseline baPWV and post-exercise change [cm/sec]: 1,527±245 and -132±155 in the CAD group, 1,439±202 and -77±93 in the control group, respectively, P for change in each group <0.001, P for difference in changes between the two groups <0.001). These findings persisted after adjusting for age, body mass index, systolic blood pressure, mean arterial pressure (MAP), MAP decreases, and baseline baPWV. Significant post-exercise baPWV reductions were observed in both groups, and more prominently in the CAD group. This finding suggests that short-duration exercise may effectively improve arterial stiffness even in patients with stable coronary artery disease

Metabolic Syndrome Is Associated with Delayed Heart Rate Recovery after Exercise

Heart rate (HR) recovery after exercise is a function of vagal reactivation, and its impairment is a predictor of overall mortality and adverse cardiovascular events. While metabolic syndrome is associated with sympathetic overactivity, little is known about the relationship between metabolic syndrome and HR recovery. A symptom-limited exercise stress test in healthy subjects (n=1,434) was used to evaluate HR recovery. Metabolic syndrome was defined according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP-III) criteria. Seventeen percent of subjects had ≥3 criteria for metabolic syndrome. HR recovery was lower in men than women and in smokers than nonsmokers. The subject with metabolic syndrome (vs. without) showed lower HR recovery (10.3±11.6 vs. 13.6±9.7 per minute) and higher resting HR (64.3±10.3 vs. 61.6±9.1 per minute). HR recovery correlated inversely to age (r=-0.25, p<0.0001), but not to resting HR or maximal oxygen uptake. Delayed HR recovery was associated with metabolic syndrome after an adjustment for age, sex, resting HR and smoking (p<0.01). Metabolic syndrome is associated with impaired vagal reactivation. Adverse cardiovascular outcomes associated with metabolic syndrome may be mediated by the failure of vagal reactivation in addition to sympathetic overactivity

The effect of non-optimal lipids on the progression of coronary artery calcification in statin-naïve young adults: results from KOICA registry

BackgroundDespite the importance of attaining optimal lipid levels from a young age to secure long-term cardiovascular health, the detailed impact of non-optimal lipid levels in young adults on coronary artery calcification (CAC) is not fully explored. We sought to investigate the risk of CAC progression as per lipid profiles and to demonstrate lipid optimality in young adults.MethodsFrom the KOrea Initiative on Coronary Artery calcification (KOICA) registry that was established in six large volume healthcare centers in Korea, 2,940 statin-naïve participants aged 20–45 years who underwent serial coronary calcium scans for routine health check-ups between 2002 and 2017 were included. The study outcome was CAC progression, which was assessed by the square root method. The risk of CAC progression was analyzed according to the lipid optimality and each lipid parameter.ResultsIn this retrospective cohort (mean age, 41.3 years; men 82.4%), 477 participants (16.2%) had an optimal lipid profile, defined as triglycerides &lt;150 mg/dl, LDL cholesterol &lt;100 mg/dl, and HDL cholesterol &gt;60 mg/dl. During follow-up (median, 39.7 months), CAC progression was observed in 434 participants (14.8%), and more frequent in the non-optimal lipid group (16.5% vs. 5.7%; p &lt; 0.001). Non-optimal lipids independently increased the risk of CAC progression [adjusted hazard ratio (aHR), 1.97; p = 0.025], in a dose-dependent manner. Even in relatively low-risk participants with an initial calcium score of zero (aHR, 2.13; p = 0.014), in their 20 s or 30 s (aHR 2.15; p = 0.041), and without other risk factors (aHR 1.45; p = 0.038), similar results were demonstrable. High triglycerides had the greatest impact on CAC progression in this young adult population.ConclusionNon-optimal lipid levels were significantly associated with the risk of CAC progression in young adults, even at low-risk. Screening and intervention for non-optimal lipid levels, particularly triglycerides, from an early age might be of clinical value

Investigating the Performance of As-Built and Overlaid Pavements: A Competing Risks Approach

Overlay has been a commonly used rehabilitation measure for flexible pavements. Properly designed and constructed overlays restore pavement service conditions and economically extended pavement service lives. In the light of different failure modes that could be experienced by a flexible pavement, such as cracking, rutting and roughness, and complex interactions among them, this paper considers these failure modes as competing risks and evaluates performance differences between overlaid pavements and as-built pavements in terms of hazard function, cause-specific cumulative incidence function and cause-specific conditional cumulative incidence function. A case study was undertaken using the pavement condition survey data in Florida. It was found that the overlaid pavements generally have a higher failure risk compared with the originally built pavements across all failure modes and exhibit three distinct phases of failure hazard change: increasing, stabilising and decreasing. For as-built pavements, the failure hazard increases dramatically after exceeding the design lives of pavements

Experience of suffering in patients with hypertension: a qualitative analysis of in-depth interview of patients in a university hospital in Seoul, Republic of Korea

Objective To describe the suffering experienced by patients with hypertension, not only regarding symptoms, but also suffering in a social context.Design A qualitative analysis of semi-structured interview data. Interviews were audio-recorded and transcribed verbatim. A descriptive approach was taken by exploring patient accounts and presenting their experiences and perspectives.Setting Cardiology clinic in a university hospital (Samsung Medical Center, Seoul, Republic of Korea).Participants Patients with hypertension and without serious comorbidities who had been followed-up at a cardiology clinic of a training university hospital.Results Nineteen men and women (male:female=12:7) were interviewed. The mean age was 44 years, and the average hypertension duration was 4 years. All 19 patients reported symptoms allegedly to be associated with hypertension. Anxiety about blood pressure fluctuation and hypertension complications, dislike of antihypertensive medication and associated labelling effect, family stress and refusal to be enrolled in life insurance were commonly found among patients’ interviews. Relatively younger (≤50 years of age), actively working patients experienced stigmatisation and discrimination in the workplace.Conclusion The illness experience of patients with hypertension consists of suffering associated with threatened or damaged self-identity at the individual and social level. Medical professionals should have more awareness of the suffering of these patients to improve the quality of care. An education programme with proper focus on the elements of patients’ suffering may help to alleviate it

Factorial Effects of Mix Design Variable on the Coefficient of Thermal Expansion of Concrete Mixtures

The coefficient of thermal expansion (CTE) is one of the most critical parameters for concrete pavement design. Concrete paving mixtures with high CTEs are generally subjected to temperature-related stresses and deterioration. In this study, a 2k design of experiment was applied to evaluate the effects of concrete mix design variables on the CTE of resultant concrete mixtures. Laboratory experiments were conducted by controlling six mix design variables, each at two levels, including aggregate type (granite or dolomite), fine sand type (manufactured or natural), fly ash type (Class C or Class F), cement content (314 or 273 kg/m 3), coarse aggregate content (1246 or 682 kg/m 3), and air content (3% or 6%). The respective and collective effects of these factors on the CTE were analysed. It showed that the type of coarse aggregate, fine sand, fly ash, and their respective contents are significant in explaining the variance of the lab-measured CTEs. The minimum CTE is a result of the concrete mixture consisting of low content of granite and cement in combination with high content of manufactured sand and Class F fly ash. To generalise the results, a parsimonious model was formulated and is capable of explaining over 92% of the total variance of the CTE and predicting it in a reasonably accurate manner