Hansol Choi

Effects of Age, Sex, and Menopausal Status on Blood Cholesterol Profile in the Korean Population

Background and Objectives To investigate age-specific and sex-specific distributions of blood cholesterol in the general Korean population. Subjects and Methods We analyzed data for 8284 men and 9246 women aged ≥10 years who participated in the fifth (2010-2012) Korea National Health and Nutrition Examination Survey. Age-specific means, medians, and selected percentiles were calculated for men, premenopausal women, and postmenopausal women. Results Median total cholesterol (TC) level increased with age across all age groups, from 147 to 196 mg/dL in males and from 159 to 210 mg/dL in females. Triglyceride (TG) levels increased with age in females; however, in males, TG levels rapidly increased during young adulthood, peaked at 50-54 years, and then decreased. High density lipoprotein-cholesterol (HDL-C) levels were higher in females than in males and decreased with increasing age in both males and females. Low density lipoprotein-cholesterol (LDL-C) levels increased with age across all age groups, from 89 to 127 mg/dL in males and from 82 to 113 mg/dL in females. Lipoprotein-cholesterol fraction (TC/HDL-C, LDL-C/HDL-C, TG/HDL-C, non-HDL-C) levels increased with age in females, but increased more rapidly in males during young adulthood and decreased after middle age. Conclusion Blood cholesterol levels and lipoprotein-cholesterol fractions present different distributions by age, sex, and menopausal status.

Sleep duration and chronic kidney disease: The Korean Genome and Epidemiology Study (KoGES)-Kangwha study

Background/Aims Sleep duration affects health in various ways. The objective of this study was to investigate the associations of sleep duration with chronic kidney disease (CKD) in a Korean adult population. Methods This cross-sectional analysis was conducted for total of 1,360 participants who completed baseline health examinations for the Korean Genome and Epidemiology Study-Kangwha study in 2010 to 2011. Sleep habits were measured by an interviewer-assisted questionnaire. Sleep duration was calculated based on the number of hours per day participants had slept over the past 1 year. CKD was defined as either proteinuria or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Multiple logistic regression models were applied to examine associations between sleep duration and CKD. Results Women with very long sleep duration (≥ 9 hours/day) were at significantly increased odds for having high serum creatinine (odds ratio [OR], 2.936; 95% confidence interval [CI], 1.176 to 7.326), low eGFR (OR, 3.320; 95% CI, 1.372 to 8.034), and CKD (OR, 3.112; 95% CI, 1.315 to 7.363), compared those with a typical sleep duration (7 to < 8 hours/day), after adjusting for sociodemographic status, socioeconomic status, health behaviors, comorbidities, and sleep quality. Among women, for every 1 hour increase in sleep duration per day, there was a 24.6% increase in the presence of CKD (OR, 1.246; 95% CI, 1.019 to 1.523). However, among men, sleep duration was not significantly associated with CKD. Conclusions Very long sleep duration was independently associated with a higher prevalence of CKD among Korean women. Gender may influence this association.

Serum uric acid concentration and metabolic syndrome among elderly Koreans: The Korean Urban Rural Elderly (KURE) study

BACKGROUND Epidemiologic studies have demonstrated that elevated serum uric acid concentration is an independent risk factor for metabolic syndrome. However, few studies have focused on elderly populations. Thus, we investigated the association of serum uric acid concentration with metabolic syndrome in community-dwelling elderly Koreans. METHODS This cross-sectional analysis included 2940 participants (986 men and 1954 women) aged 65 years or older who participated in a baseline health assessment for the Korean Urban Rural Elderly cohort study from 2012 to 2014. Serum uric acid concentration was analyzed using both continuous and dichotomous variables. Hyperuricemia was defined as a uric acid concentration ≥7.0 mg/dL in men and ≥6.0 mg/dL in women. Metabolic syndrome was defined according to the 2009 harmonizing definition. Multiple logistic regression models were used to investigate independent association between serum uric acid and metabolic syndrome, after adjusting for age, body mass index, LDL cholesterol, glycated hemoglobin, blood urea nitrogen, estimated glomerular filtration rate health behaviors, and medications. RESULTS Prevalence of metabolic syndrome and its components increased significantly according to uric acid concentration in both sexes. The adjusted odds ratios for having metabolic syndrome per 1.0mg/dL higher uric acid concentration were 1.16 (95% CI: 1.03-1.31) in men and 1.27 (95% CI: 1.13-1.42) in women. Hyperuricemia was also associated with metabolic syndrome, with adjusted odds ratios of 1.71 (95% CI: 1.11-2.63) in men and 1.55 (95% CI: 1.05-2.29) in women. CONCLUSIONS Elevated serum uric acid concentration was independently associated with an increased prevalence of metabolic syndrome in community-dwelling elderly Koreans.

Association between HbA1c and carotid atherosclerosis among elderly Koreans with normal fasting glucose

Aim We examined whether glycated haemoglobin (HbA1c) is associated to carotid atherosclerosis in an elderly Korean population with normal fasting glucose. Methods Using data from the Korean Urban Rural Elderly study, we conducted a cross-sectional analysis of 1,133 participants (335 men and 798 women) with a mean age of 71.8 years. All participants had fasting blood glucose less than 100mg/dL (5.6 mmol/L) and HbA1c level below 6.5% (48 mmol/mol). They were also free from a history of cardiovascular disease, known type 2 diabetes mellitus or use of anti-diabetes medications. Carotid atherosclerosis was assessed by intima-media thickness (IMT) using ultrasonography. The association between HbA1c and carotid IMT was investigated using multivariable linear regression analysis. Results HbA1c levels were independently and positively associated with carotid IMT (β = 0.020, p = 0.045) after adjusting for sex, age, body mass index, systolic blood pressure, diastolic blood pressure, triglyceride, LDL cholesterol, smoking and alcohol intake. However, fasting insulin and glucose levels were not associated with carotid IMT. Conclusion HbA1c levels were positively associated with carotid atherosclerosis, as assessed by carotid IMT, in an elderly population with normoglycemia. Our study suggested that higher HbA1c level is an effective and informative marker of carotid atherosclerosis in an elderly population.

Secondhand smoke exposure and mental health problems in Korean adults

OBJECTIVES: To evaluate the association between secondhand smoke exposure (SHSE) and mental health problems among Korean adults. METHODS: We analyzed data from the 2011 Korean Community Health Survey. From the total of 229,226 participants aged 19 years or above, we excluded 48,679 current smokers, 36,612 former smokers, 3,036 participants with a history of stroke, 2,264 participants with a history of myocardial infarction, 14,115 participants who experienced at least one day in bed per month due to disability, and 855 participants for whom information regarding SHSE or mental health problems was not available. The final analysis was performed with 22,818 men and 100,847 women. Participants were classified into four groups according to the duration of SHSE: none, <1 hr/d, 1-<3 hr/d, and ≥3 hr/d. The presence of depressive symptoms, diagnosed depression, and high stress were measured by questionnaire. RESULTS: After adjusting for demographic factors, lifestyle, and chronic disease, the odds ratio (OR) and 95% confidence interval (CI) of depressive symptoms with 1-<3 hr/d and ≥3 hr/d SHSE were 1.44 (95% CI, 1.14 to 1.82) and 1.59 (95% CI, 1.46 to 1.74), respectively. However, SHSE ≥3 hr/d had a higher OR of 1.37 (95% CI, 1.20 to 1.58) for diagnosed depression. SHSE was also associated with high stress (1-<3 hr/d: OR, 1.56; 95% CI, 1.38 to 1.76; ≥3 hr/d: OR, 1.33 95% CI, 1.28 to 1.40). However, the association between SHSE and symptoms of depression and stress did not differ significantly by region. CONCLUSIONS: SHSE may be associated with mental health problems such as depression and stress in Korean adults.

Comparative Cardiovascular Risks of Dipeptidyl Peptidase-4 Inhibitors: Analyses of Real-world Data in Korea

Background and Objectives To compare cardiovascular disease (CVD) risk associated with 5 different dipeptidyl peptidase-4 inhibitors (DPP-4is) in people with type 2 diabetes. Methods We identified 534,327 people who were newly prescribed sitagliptin (n=167,157), vildagliptin (n=67,412), saxagliptin (n=29,479), linagliptin (n=220,672), or gemigliptin (n=49,607) between January 2013 and June 2015 using the claims database of the Korean National Health Insurance System. A Cox proportional hazards model was used to estimate hazard ratios (HRs) for major CVD events (myocardial infarction, stroke, or death) among users of different DPP-4is. The model was adjusted for sex, age, duration of DPP-4i use, use of other glucose-lowering drugs, use of antiplatelet agents, hypertension, dyslipidemia, atrial fibrillation, chronic kidney disease, microvascular complications of diabetes, Charlson comorbidity index, and the calendar index year as potential confounders. Results Compared to sitagliptin users, the fully adjusted HRs for CVD events were 0.97 (95% confidence interval [CI], 0.94–1.01; p=0.163) for vildagliptin, 0.76 (95% CI, 0.71–0.81; p<0.001) for saxagliptin, 0.95 (95% CI, 0.92–0.98; p<0.001) for linagliptin, and 0.84 (95% CI, 0.80–0.88; p<0.001) for gemigliptin. Conclusions Compared to sitagliptin therapy, saxagliptin, linagliptin, and gemigliptin therapies were all associated with a lower risk of cardiovascular events.

Serum high-density lipoprotein cholesterol concentration and functional state: The Korean Urban Rural Elderly (KURE) Study

BACKGROUND Functional state and cholesterol metabolism are important for older adults; however, this association has not been fully investigated among community-dwelling older adults. Thus, we investigated the association of HDL cholesterol with multiple functional state measures in an elderly Korean population. METHODS This cross-sectional analysis included 3514 participants, aged 65 years or older, who participated in baseline health assessment for the Korean Urban Rural Elderly cohort study from 2012 to 2015. HDL cholesterol concentration was analyzed using both continuous and categorical variables. Functional state was assessed by the mini-mental state examination (MMSE), activities of daily living (ADL) scale, instrumental activities of daily living (IADL) scale, timed up-and go (TUG) test, and chair-rise test (CRT). Multiple logistic regression models were used to investigate independent association between HDL cholesterol and functional state, after adjusting for sex, age, body mass index, systolic blood pressure, fasting glucose, lipid-lowering drug, history of cancer and cardiovascular disease, and health behaviors. RESULTS HDL cholesterol concentration was significantly associated with MMSE, ADL, IADL, TUG, and CRT in the unadjusted model. After adjustment for covariates, the association remained significant for MMSE (standardized β=0.059, p=0.001), ADL (standardized β=-0.053, p=0.004), and CRT (standardized β=-0.037, p=0.037). In fully-adjusted model, Participants who had a lower HDL concentration (<40mg/dL) showed significantly increased odds for having MMSE decline (OR 1.451, 95% CI 1.119-1.883) and ADL dependency (OR 2.251, 95% CI 1.119-4.526), compared reference group (≥60mg/dL). CONCLUSIONS Higher HDL cholesterol concentration was associated with better functional state among Korean older adults.

OS 22-07 Association between hemoglobin A1c and carotid atherosclerosis among elderly Koreans with normal fasting glucose.

Objective: We examined whether HbA1c is associated with carotid atherosclerosis in a community-dwelling elderly Korean population with normal fasting glucose. Design and Method: Using data from the Korean Urban Rural Elderly study, we conducted a cross-sectional analysis in 1,133 participants (335 men and 798 women) with mean age 71.8 years. All participants had fasting blood glucose less than 100   mg/dL (5.6mmol/L) and a level of HbA1c below 6.5% (48 mmol/mol). They were also free from history of cardiovascular disease, known diabetes or use of anti-diabetes medication. Carotid atherosclerosis was assessed by intima-media thickness (IMT) and the number of plaques using ultrasonography. The relationships of HbA1c with carotid IMT and plaque were investigated by multiple linear regression analysis. Results: HbA1c levels are independently and positively associated with carotid IMT (standardized &bgr;=0.06, p = 0.042) and number of plaques (standardized &bgr;=0.06, p = 0.021) after adjustment for sex, age, body mass index, systolic blood pressure, diastolic blood pressure, triglyceride, LDL cholesterol, smoking and alcohol intake, particularly in men. However, fasting insulin and glucose levels were not associated with carotid IMT or plaques. Conclusions: HbA1c levels are positively associated with carotid atherosclerosis measured by carotid IMT and plaques in an elderly population with normoglycemia. Our study suggested that higher HbA1c level may contribute to carotid atherosclerosis among older adults with normal fasting glucose.

PS 12-01 ASSOCIATION OF SOCIOECONOMIC STATUS AND CHRONIC KIDNEY DISEASE

Objective: Socioeconomic status (SES) can have diverse health effects and contribute as a strong risk factor in premature morbidity and mortality of diseases. However, only a few studies have suggested that SES could influence on kidney function. Thus, we investigated the association of SES with chronic kidney disease (CKD) in middle-aged Korean population. Design and Method: This cross-sectional analysis included 4847 participants (1869 men and 2978 women) who completed baseline health examination for the Korean Genome and Epidemiologic Study-Kangwha study in 2010–2011. SES was determined using the household income and education level by interviewer-assisted questionnaire. CKD was defined as either proteinuria or the estimated glomerular filtration rate (eGFR)<60mL/min/1.73m2. Multiple logistic regression models were used to examine independent association between SES and CKD. Results: Women with the lowest household income group (<1,000,000 Korean Won/month) had significantly increased odds for having CKD (odds ratio 3.45, 95% confidence interval 1.18–10.08) compared those with the highest household income group (≥1,000,000 Korean Won/month) after adjusting for socio-demographic status, socio-economic status, health behaviors, comorbidities, and other SES elements, but not in men. However, both in men and women, education level was not significantly associated with CKD before and after adjustment for covariates. Conclusions: Poor household income was independently associated with higher prevalence of CKD among middle-aged Korean women. In addition, gender may influence this association.