Soon Gil Kim

Body Fat Distribution After Menopause and Cardiovascular Disease Risk Factors: Korean National Health and Nutrition Examination Survey 2010

BACKGROUND The prevalence of cardiovascular disease in women increases sharply after menopause. The purpose of this study was to clarify the relationship between menopause and body fat distribution and to investigate their association with cardiovascular disease risk factors. METHODS We analyzed 2035 women 20-79 years of age using the National Health and Nutrition Examination Survey (KNHANES) 2010 database. Body fat was measured using dual-energy X-ray absorptiometry. RESULTS The percentage of total body fat and the body fat distribution (BFD) index (the ratio of the trunk fat mass to leg fat mass) are significantly higher in postmenopausal women than in premenopausal women (all p<0.001). When adjusted for age, menopause was associated with higher total body fat percentage (adjusted β=1.082, 95% confidence interval [CI] 0.074-2.090, p=0.035). In women with a body mass index<25 kg/m(2), the higher BFD index was also independently associated with menopause (adjusted β=14.408, 95% CI 1.672-27.145, p=0.027). After adjusting for age and body fat percentage, the BFD index showed significant and independent associations with systolic and diastolic blood pressure (adjusted β=0.060 and 0.042, all p<0.001, respectively), fasting glucose (adjusted β=0.007, p<0.001), total and high density lipoprotein cholesterol (adjusted β=0.001 and -0.002, p<0.05 and p<0.001, respectively), and triglyceride levels (adjusted β=0.007, p<0.001- except for low density lipoprotein cholesterol. CONCLUSIONS After menopause, women have not only higher total body fat percentage but also its different distribution, which independently correlates with cardiovascular disease risk factors. Therefore, this change in body fat may cause the sharp increase in cardiovascular disease incidence in middle-aged women, especially after menopause.

Relationship between sodium intake and blood pressure according to metabolic syndrome status in the Korean National Health and Nutrition Examination Survey.

ObjectivesThe relationship between sodium intake and blood pressure (BP) in population studies varies depending on the dietary habit and the characteristics of the population studied. Asian dietary patterns and salt sensitivity have been suggested to explain this association. Aging and metabolic syndrome (MS) are the most common reasons for salt sensitivity in populations. Participants and methodsWe therefore examined the dietary patterns in the Korean National Health and Nutrition Examination Survey. ResultsIn a multiple regression model for 3757 patients, age, antihypertensive medication, BMI, family history of hypertension, and MS were positively associated with systolic BP, whereas female sex, income, educational status, and fruit intake were negatively associated with systolic BP. Fruit intake was the only dietary factor that was negatively associated with systolic BP (P=0.017). In MS (n=712), sodium and fruit intake was independently positively and negatively associated with systolic BP, respectively, discounting age and medication. In contrast, in normal individuals (n=3045), diet was not related to systolic BP. The relationship between diet and systolic BP is more clear-cut in MS. ConclusionDietary pattern and salt sensitivity at the population level could be a cause of the relationship between sodium intake and BP.

A Comparison of Cornell and Sokolow-Lyon Electrocardiographic Criteria for Left Ventricular Hypertrophy in Korean Patients

Background and Objectives Electrocardiography (ECG) is a cost-effective and useful method for diagnosing left ventricular hypertrophy (LVH) in a large-scale study or in clinical practice. Among ECG criteria, the Cornell product (Cor P) and Sokolow-Lyon criteria were adopted by the European Society of Hypertension-European Society of Cardiology Guidelines but have different performances among races. The aim of this study was to compare the diagnostic performance of two voltage criteria in Korean patients. Subjects and Methods Electrocardiography and echocardiographic LV mass of 332 (159 male, 173 female) consecutive patients were analyzed. Cornell voltage criteria and the Cor P were compared with Sokolow-Lyon voltage (Sok V) and the Sokolow-Lyon product (Sok P). The sensitivities and specificities were estimated using a receiver-operating characteristics (ROC) curve in relation to the LVH diagnosis. The sensitivities and revised cut-off values were derived at specificity levels of 90, 95, and 100%. Results The Cornell-based criteria generally showed better performance than that of the Sok V criteria and Sok P in the area under the ROC curve analysis. The revised cut-off values for the Cornell voltage criteria (20 and 16 mm for males and females, respectively) showed an improved sensitivity (19.7 and 30.3% for males and females, respectively), with a high specificity of 95%. Conclusion The Cornell-based criteria had better performance than that of the Sokolow-Lyon criteria in both Korean men and women. However, revised cut-off values are needed to improve accuracy.

Non-Dipper Pattern is a Determinant of the Inappropriateness of Left Ventricular Mass in Essential Hypertensive Patients.

Background and Objectives Inappropriately high left ventricular mass (iLVM) is known to be related to cardiovascular prognosis. A non-dipper pattern has a greater mean left ventricular (LV) mass than the dipper pattern in hypertensive patients. However, the appropriateness of LV mass in dipper or non-dipper patterns has not been adequately investigated. The aim of this study was to define the relationship between nocturnal dipping and the appropriateness of LV mass. Subjects and Methods Using the ambulatory blood pressure monitoring (ABPM) database, the data of 361 patients who underwent ABPM and echocardiography was analyzed retrospectively. Appropriateness of LV mass was calculated as observed/predicted ratio of LV mass (OPR) using a Korean-specified equation. Nocturnal dipping was expressed as percent fall in systolic blood pressure (BP) during the night compared to the day. Results Daytime, nighttime and 24 hours BP in hypertensive patients was 140.4±14.8 mmHg, 143.7±15.2 mmHg and 129.4±20.0 mmHg, respectively. OPR was 106.3±19.9% and nocturnal dipping was 10.2±10.9 mmHg. In a multiple linear regression model, 24 hours systolic BP (β=0.097, p=0.043) and nocturnal dipping (β=-0.098, p=0.046) were independent determinants of OPR as well as age (β=0.130, p=0.025) and body mass index (BMI) (β=0.363, p<0.001). Odds ratio of the non-dipper pattern was 2.134 for iLVM (p=0.021) and 3.694 for obesity (p<0.001; BMI >25 kg/m2). Conclusion The non-dipper pattern is independently associated with iLVM in hypertensive patients as well as obesity.

The Relationship Between Ambulatory Arterial Stiffness Index and Blood Pressure Variability in Hypertensive Patients

Background and Objectives Ambulatory arterial stiffness index (AASI) is well known as a predictor of cardiovascular mortality in hypertensive patients. Mathematically, AASI reflect the standard deviation (SD) of blood pressure (BP) variation. AASI is measured higher levels in non-dipper than dipper. Thus, AASI has a possibility of not only reflecting arterial stiffness but also BP variability and/or autonomic nervous dysfunction. Subjects and Methods Consecutive data from 418 untreated hypertensive patients were analyzed retrospectively. We examined the association between the 24-hour ambulatory BP monitoring (ABPM) parameters and AASI. Results AASI had a simple correlation with age (R=0.189, p<0.001), relative wall thickness (RWT) (R=0.115, p=0.019), left ventricular mass index (LVMI) (R=0.192, p<0.001), average systolic BP (SBP) (R=0.232, p<0.001), average pulse pressure (PP) (R=0.363, p<0.001), SD of diastolic BP (DBP) (R=-0.352, p<0.001), SD of PP (R=0.330, p<0.001), SD of heart rate (HR) (R=-0.268, p<0.001), and nocturnal dipping (R=-0.137, p=0.005). In multiple linear regression analysis model including clinical parameters and 24 hour-ABPM parameters, independent predictors of AASI were SD of PP (β=1.246, p<0.001), SD of DBP (β=-1.067, p<0.001), SD of SBP (β=-0.197, p<0.001), and non-dipper (β=0.054, p=0.033). Conclusion AASI is closely correlated with BP variability. The result of this study shows that AASI is not only a parameter for arterial stiffness, but also a parameter for BP variability.

Health-related quality of life in coronary heart disease in Korea: the Korea National Health and Nutrition Examination Survey 2007 to 2011.

Using data from 2007 to 2011 of the Korea National Health and Nutrition Examination Survey, we evaluated the influence of coronary heart disease (CHD) on health-related quality of life (HRQoL) as measured by the EQ-5D in comparison with the general population and the predictors of HRQoL in CHD. Compared with the general population, HRQoL was impaired in the EQ-5D dimensions of mobility, usual activities, pain/discomfort, and anxiety/depression. The impairment of HRQoL was much greater in the older age group and in females. In subjects with CHD, the predictors for a low EQ-5D index were old age, female sex, low education, stroke, and noncardiovascular comorbidities, and the predictors for a low EQ Visual Analogue Scale were low income and noncardiovascular comorbidities. For the improvement in HRQoL, preventing stroke and noncardiovascular comorbidities is important, especially among female and older Asian patients with CHD.

Changes in body fat distribution through menopause increase blood pressure independently of total body fat in middle-aged women: the Korean National Health and Nutrition Examination Survey 2007-2010.

Blood pressure in women increases sharply in middle age, especially after menopause. As the menopausal transition is known to induce changes in body fat distribution, the aim of this study was to investigate the effect of body fat distribution as compared with the effect of total body fat on blood pressure through the menopausal transition. We analyzed 1422 subjects aged 45–55 years using the database from the Korean National Health and Nutrition Examination Survey 2007–2010. The waist circumference (WC) of post-menopausal women was larger than that of pre-menopausal women (80.44 cm, 95% confidence interval (CI) 79.36–81.52 vs. 78.94 cm, 95% CI 78.27–79.61, P=0.013), but there was no statistically significant difference in body mass index (BMI). Systolic and diastolic blood pressure (SBP and DBP) were significantly higher in post-menopausal women than in pre-menopausal women: SBP was 118.33 mm Hg, 95% CI 116.52–120.15 vs. 115.22 mm Hg, 95% CI 114.17–116.28 (P=0.003) and DBP was 76.94 mm Hg, 95% CI 75.88–77.99 vs. 75.25 mm Hg, 95% CI 74.57–75.93 (P=0.009). BMI and WC were positively correlated with BP. After adjustment for BMI, the correlation of WC with SBP remained significant (β=0.250, 95% CI 0.024–0.476, P=0.030). In a stratified analysis, WC correlated with SBP in women with BMI<25 kg m−2 (β=0.358, 95% CI 0.138–0.579, P=0.001), but not in women with BMI⩾25 kg m−2. We conclude that the changes in body fat distribution through the menopausal transition are associated with SBP, independent of total body fat. This finding indicates that alterations in the localization of body fat are another cause of menopause-related changes in BP.

The relationship between bone mineral density and blood pressure in the Korean elderly population: the Korea National Health and Nutrition Examination Survey, 2008–2011

Abstract It is not clear whether the inverse relationship between bone mineral density (BMD) and blood pressure (BP) could be generalizable to the general elderly population. We used data from the fourth and fifth Korea National Health and Nutrition Examination Survey. The study sample consisted of 8439 men and postmenopausal women aged 50 years and older. We evaluated the relationship between BMD and BP. When adjusted for covariates, femur neck T-score [coefficient = −0.391, 95% confidence interval (CI) −0.766 to −0.016, p = 0.041] had an inverse relationship with diastolic BP (DBP), whereas lumbar spine BMD (coefficient = 0.395, 95% CI 0.058–7.752, p = 0.047) and T-score (coefficient = 0.458, 95% CI 0.005–0.911, p = 0.047) had a positive relationship with systolic BP (SBP). When adjusted for confounding factors, SBP (128.67 ± 0.979 mmHg versus 126.36 ± 0.545 mmHg, p = 0.026) and DBP (78.8 ± 0.622 mmHg versus 77.27 ± 0.283 mmHg, p = 0.016) were significantly higher in femur neck osteoporosis subjects than non-osteoporosis subjects. However, there were no differences in BP in relation to lumbar spine osteoporosis. Femur neck osteoporosis (odds ratio = 1.422, 95% CI 1.107–1.827, p = 0.006) had a significant and positive relationship with hypertension, whereas the other parameters of BMD were not significantly related to hypertension. In conclusion, higher BP and hypertension were significantly and positively correlated with femur neck osteoporosis in men and postmenopausal women aged 50 years and older.

Relationship between bone mineral density and a 10-year risk for coronary artery disease in a healthy Korean population: the Korea National Health and Nutrition Examination Survey 2008-2010.

IntroductionBone mineral density (BMD) is associated with atherosclerosis and vascular calcification. If BMD is related independently to the risk of coronary heart disease (CHD), BMD could play an important role in CHD risk prediction. We assessed the hypothesis that BMD is related independently to the risk of CHD. Materials and methodsWe used data from the fourth and fifth Korea National Health and Nutrition Examination Surveys. The study sample included men and women aged 20–79 years, who did not have myocardial infarction, angina pectoris, stroke, or diabetes mellitus. We evaluated the relationship between BMD and the Framingham risk score for each sex. ResultsIn the male population, femur neck BMD [coefficient=−2.167, 95% confidence interval (CI) −3.385 to −0.950, P=0.001] and lumbar spine BMD (coefficient=−1.539, 95% CI −2.546 to −0.532, P=0.003) showed an inverse correlation with the Framingham risk score after adjusting for covariates. In the female population, the relationship between BMD parameters and the Framingham risk score was not significant after adjusting for covariates. In the male population, those with femur neck BMD values in the first quartile had greater odds of a 10-year risk greater than or equal to 10% for CHD compared with those in the fourth quartile (odds ratio=1.942, 95% CI 1.315–2.869, P<0.001). ConclusionBMD was correlated inversely with the 10-year risk for CHD in the healthy male population. This result suggests that in the male population, measurement of BMD could be useful for prediction of the risk of CHD.

Association between central obesity and circadian parameters of blood pressure from the korean ambulatory blood pressure monitoring registry: Kor-ABP registry.

Central obesity has been reported as a risk for atherosclerosis and metabolic syndrome. The influence of central obesity on diurnal blood pressure (BP) has not been established. In this study, we investigated the influence of central obesity on the circadian parameters of BP by 24 hr ambulatory BP monitoring. Total 1,290 subjects were enrolled from the Korean Ambulatory BP registry. Central obesity was defined as having a waist circumference≥90 cm in males and ≥85 cm in females. The central-obese group had higher daytime systolic BP (SBP), nighttime SBP and diastolic BP (DBP) than the non-obese group (all, P<0.001). There were no differences in nocturnal dipping (ND) patterns between the groups. Female participants showed a higher BP mean difference (MD) than male participants with concerns of central obesity (daytime SBP MD 5.28 vs 4.27, nighttime SBP MD 6.48 vs 2.72) and wider pulse pressure (PP). Central obesity within the elderly (≥65 yr) also showed a higher BP MD than within the younger group (daytime SBP MD 8.23 vs 3.87, daytime DBP 4.10 vs 1.59). In conclusion, central obesity has no influence on nocturnal dipping patterns. However, higher SBP and wider PP are associated with central obesity, which is accentuated in women.