Dong-Hyuk Jung

Relationship of neutrophil-lymphocyte ratio with arterial stiffness and coronary calcium score

BACKGROUND Emerging evidence suggests that the neutrophil/lymphocyte ratio (NLR) may be a useful marker of cardiovascular disease and a more powerful predictor than any other leukocyte subtypes. We determined whether NLR is related to atherosclerosis measured by brachial-ankle pulse wave velocity (baPWV) and coronary calcium score (CCS). METHODS We examined the relationship of NLR with baPWV and CCS in 849 Korean adults in a health examination program. The odds ratios for a high baPWV or a high CCS were calculated using multivariate logistic regression analysis across NLR quartiles. A high baPWV was defined as >1500 cm/s (>75th percentile) and a high CCS was defined as over 100 (at least moderate atherosclerotic plaque burden). RESULTS The ORs (95% CIs) for a high baPWV by NLR quartiles were 1.00, 0.76 (0.41-1.39), 1.08 (0.61-1.90), and 2.12 (1.18-3.83) after adjusting for confounding variables. Similarly, positive associations between NLR and a high CCS were also observed after adjusting for the same co-variables. CONCLUSION A higher NLR was independently associated with arterial stiffness and CCS. Accordingly, a higher NLR may be a useful additional measure in assessing cardiovascular risks in clinical practice.

The Relationship Between Arterial Stiffness and Nonalcoholic Fatty Liver Disease

AimNonalcoholic fatty liver disease (NAFLD) is currently the most common form of chronic liver disease and some studies have documented its link with cardiovascular risk factors. This study aimed to investigate the association between arterial stiffness and NAFLD.MethodsAmong 1,442 health check-up subjects (955 men, 487 women), we examined the association between brachial-ankle pulse wave velocity (baPWV) as a measurement of arterial stiffness and the presence of NAFLD based on abdominal sonographic findings. Multivariate linear and logistic regression analyses were conducted to examine the independent association between baPWV and the presence of NAFLD in gender-specific manners.ResultsIn multivariate regression analysis, NAFLD was found to be independently associated with baPWV in both men and women. Moreover, in multivariate logistic regression analysis, a graded independent relation was found between higher levels of baPWV and the prevalence risk of NAFLD. Odds ratios (95% CI) for the highest vs. the lowest quartile of baPWV were 1.85 (range, 1.13–2.62) in men and 3.32 (1.45–7.62) in women after adjusting for age, smoking status, regular exercise, body mass index, blood pressure, fasting plasma glucose, triglyceride, HDL-cholesterol, hypertension and diabetes.ConclusionArterial stiffness was independently associated with the prevalence risk for NAFLD regardless of classical CVD risk factors.

Association between resting heart rate and arterial stiffness in Korean adults

BACKGROUND Higher resting heart rate, a simple and useful indicator of autonomic balance and metabolic rate, has emerged as an independent predictor for atherosclerotic cardiovascular disease. AIM To determine the association between resting heart rate and arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV). METHODS We examined the association between resting heart rate and baPWV in 641 Korean adults (366 men, 275 women) in a health examination program. A high baPWV was defined as greater than 1450 cm/s (>75th percentile). The odds ratios for high baPWVs were calculated using multivariable logistic regression analysis after adjusting for confounding variables across heart rate quartiles (Q1<or=56, Q2=57-62, Q3=63-68, Q4>or=69 beats/min). RESULTS Age-adjusted baPWV mean values increased gradually with heart rate quartile (Q1=1281, Q2=1285, Q3=1354, Q4=1416 cm/s). The odds ratios (95% confidence intervals) for high baPWVs in each heart rate quartile were 1.00, 1.28 (0.57-2.86), 2.63 (1.20-5.79) and 3.66 (1.66-8.05), respectively, after adjusting for age, sex, smoking status, alcohol intake, exercise, body mass index, hypertension medication, diabetes medication, hyperlipidaemia medication, mean arterial blood pressure, fasting plasma glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, white blood cell count, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and uric acid. CONCLUSION These findings indicate that a higher resting heart rate is independently associated with arterial stiffness. Accordingly, early detection of increased resting heart rate is important for preservation of arterial function and assessment of cardiovascular risk.

The relationship of platelet count, mean platelet volume with metabolic syndrome according to the criteria of the American Association of Clinical Endocrinologists: A focus on gender differences

Metabolic syndrome (MS) is becoming globally prevalent and it is clinically important because of its association with type 2 diabetes and cardiovascular disease, and some cancers. Recently, platelet count has been linked to insulin resistance and MS in addition to being a marker of hemostasis. Also, mean platelet volume (MPV) has been known to represent platelet activity. Platelet counts and MPV are modified by various biosocial and lifestyle factors such as race, age, gender, smoking habit, alcohol consumption, and physical activity. Thus, the direction and magnitude of this association may differ by gender. In this regard, proper interpretion of platelet counts and MPV by gender could be important in the people with MS. We examined the relationship between platelet counts, MPV, and MS through gender-specific analyses for 3827 Korean adults (2169 men and 1658 women) in a health examination program. In women, platelet counts were significantly higher in subjects with MS compared to in those without MS (p < 0.001), whereas MPV was significantly lower (p = 0.001). However, no such trend was observed in men. Multiple regression analyses also showed that MS is positively associated with platelet counts and inversely associated with MPV, independently of confounding variables only in women. The results suggest that platelet counts and MPV might be a surrogate marker associated with clustered MS in women.

The association between non-alcoholic hepatic steatosis and mean platelet volume in an obese Korean population.

Non-alcoholic fatty liver disease (NAFLD) is now the most common liver disease. Since the prevalence of NAFLD in overweight/obese people is rather high, there is a general concern about the possibility that NAFLD may have an association with cardiovascular risk factors and atherosclerosis. Mean platelet volume (MPV) is becoming of increasing interest as a new independent cardiovascular risk factor. Accordingly, the aim of our study was to evaluate the relationship between NAFLD and MPV in obese patients. The study was performed at the health promotion center in Gangnam Severance Hospital between July 2007 and June 2008. A total of 6499 healthy subjects (age range, 20–65 years) were recruited in Seoul. We performed a cross-sectional study to evaluate the association with non-alcoholic hepatic steatosis (NAHS) and MPV in 628 obese subjects. The population was divided into three groups according to MPV values. (T1 : MPV ≤ 7.7 fL, T2 : 7.7 < ≤ 8.4, T3 : > 8.4) The odds ratios (ORs) for NAHS were calculated across all three groups. The prevalence of NAHS was significantly higher according to increased MPV values after adjustment for confounding variables. The adjusted OR for NAHS according to the three groups were 1.00, 2.01(1.14 ∼ 3.56), and 2.12(1.11 ∼ 4.06) in obese subjects. In summary, there was a significant association between NAHS and MPV in obese study population.

Relationship of hepatic steatosis and alanine aminotransferase with coronary calcification.

Abstract Background: It has been observed that hepatic steatosis is related to an increased risk of cardiovascular disease (CVD). Alanine aminotransferase (ALT), an indicator of the severity of hepatic steatosis is also associated with CVD. This study focused on the relationship between hepatic steatosis and ALT with coronary calcification. Methods: We performed a cross-sectional study to examine the association between hepatic steatosis and serum ALT with coronary calcification in 1218 subjects (772 men, 446 women; ages 30–75 years). We evaluated hepatic steatosis and ALT as categorical variables, and constructed four groups (reference group; only with hepatic steatosis; only with ALT >30 U/L; with both hepatic steatosis and ALT >30 U/L), which did not overlap. Multi-detected row computed tomography (MDCT) was used to measure coronary calcium score. Results: The adjusted ORs (95% CIs) for coronary calcification in the four groups were 1.00 (reference), 1.24 (0.68–2.26), 1.82 (0.78–4.23), and 2.12 (1.08–4.20) after adjusting for confounding variables. In addition, an increase in serum ALT activity of 10 U/L was associated with an increased risk of coronary atherosclerosis. Conclusions: In summary, patients with both hepatic steatosis and increases in ALT are associated with coronary calcification as a marker of coronary atherosclerosis determined by MDCT. This finding suggested that subjects with both hepatic steatosis and increased ALT should be considered for further evaluation of coronary atherosclerosis. Clin Chem Lab Med 2010;48:1829–34.

Relationship between non‐alcoholic fatty liver disease and pulmonary function

Background:  It has been observed that non‐alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular disease and insulin resistance. Pulmonary function is also known to be related with cardiovascular disease and metabolic syndrome.

Relationship of body composition and C-reactive protein with pulmonary function

OBJECTIVES It has been observed that restrictive pulmonary function is associated with obesity and C-reactive protein (CRP), an indicator for systemic inflammation. However, the interrelationship among body composition, CRP, and restrictive pulmonary function has been poorly understood. This study focused on the combined effects of body composition and CRP on restrictive pulmonary function. METHODS We performed a cross-sectional study to examine the association of body composition and CRP with restrictive pulmonary function in 12,787 subjects (7083 men, 5704 women; ages 20-75 yr). We evaluated body composition and CRP as a categorical variable (non-obesity, percentage body fat <or=75 percentile; obesity, percentage body fat >75 percentile; low-inflammation, CRP <or=75 percentile; high-inflammation, CRP >75 percentile) and constructed 4 groups, which were non-overlapping (reference, inflammatory, obese, obese and inflammatory). The odds ratios (ORs) and 95% confidence intervals (CIs) for restrictive pulmonary function were calculated across all 4 groups. RESULTS The adjusted ORs (95% CIs) for restrictive pulmonary function according to the 4 groups were 1.00(reference), 1.19(0.93-1.52), 2.01(1.53-2.64) and 3.51(2.60-4.74) in men and 1.00 (reference), 1.26 (0.96-1.69), 1.02 (0.58-1.81), and 3.32 (2.09-5.27) in women after adjusting for confounding variables. Interaction was found between the body fat percentage and CRP in women only (P < 0.05). CONCLUSIONS In summary, the coexistence of high fat accumulation and systemic subclinical inflammation is associated with restrictive pulmonary function.

Sex Differences in the Relationship Between Leukocyte Count and Chronic Kidney Disease: The 2007 Korean National Health and Nutrition Examination Survey

BACKGROUND Chronic kidney disease (CKD) has emerged as an independent predictor for cardiovascular disease (CVD), which is now regarded as an inflammatory disease. This study aimed to determine the association of CKD with white blood cell (WBC) count as a marker of systemic inflammation. METHODS We examined the association of WBC count with CKD in 2825 Korean adults (1155 men, 1670 women) in the 2007 Korean National Health and Nutrition Examination Survey (KNHANES). CKD was defined as either proteinuria or a glomerular filtration rate (GFR) <60 mL/min/1.73 m(2). The odds ratios (ORs) for CKD were calculated using multivariate logistic regression analysis after adjusting for confounding variables across gender-specific WBC count quartiles. RESULTS The proportion of CKD increased with increasing WBC quartiles, from 9.7% in the lowest quartile to 20.7% in the highest quartile for women. In multivariate logistic regression analysis, the corresponding odds ratios (95% confidence intervals [CIs]) for a CKD across WBC count quartiles among women were 1.00, 1.45 (0.91-2.31), 1.65 (1.03-2.63), and 2.11 (1.33-3.35), after adjusting for age, body mass index (BMI), systolic blood pressure, fasting plasma glucose, smoking status, current drinking high-density lipoprotein cholesterol (HDL-C), and triglyceride. In contrast, compared with women, men appeared to have no significant results of a relationship between WBC quartiles and CKD. CONCLUSIONS Our study shows a significant association between WBC count and the risk for CKD in women. Accordingly, potential health benefits of early detection of a higher level of WBC count may be useful for CKD risk assessment in women.

Association of Renal Manifestations with Serum Uric Acid in Korean Adults with Normal Uric Acid Levels

Several studies have reported that hyperuricemia is associated with the development of hypertension and cardiovascular disease. Increasing evidences also suggest that hyperuricemia may have a pathogenic role in the progression of renal disease. Paradoxically, uric acid is also widely accepted to have antioxidant activity in experimental studies. We aimed to investigate the association between glomerular filtration rate (GFR) and uric acid in healthy individuals with a normal serum level of uric acid. We examined renal function determined by GFR and uric acid in 3,376 subjects (1,896 men; 1,480 women; aged 20-80 yr) who underwent medical examinations at Gangnam Severance Hospital from November 2006 to June 2007. Determinants for renal function and uric acid levels were also investigated. In both men and women, GFR was negatively correlated with systolic and diastolic blood pressures, fasting plasma glucose, total cholesterol, uric acid, log transformed C reactive protein, and log transformed triglycerides. In multivariate regression analysis, total uric acid was found to be an independent factor associated with estimated GFR in both men and women. This result suggests that uric acid appears to contribute to renal impairment in subjects with normal serum level of uric acid.