Yu-Mi Kim

Genetic Variation in CDH13 Is Associated With Lower Plasma Adiponectin Levels but Greater Adiponectin Sensitivity in East Asian Populations

Variants in the CDH13 gene have been identified as determinants of blood levels of adiponectin, an insulin-sensitizing adipokine. However, their association with other metabolic risk factors remains unclear. We examined variants at CDH13 in relation to total and high-molecular-weight (HMW) adiponectin using data from a genome-wide association study performed in 2,434 Singaporean Chinese with replication in up to 3,290 Japanese and 1,610 Koreans. The top signal rs4783244 in CDH13 showed strong associations with total adiponectin (standardized β [β] = −0.34, 95% CI −0.38 to −0.30, P = 2.0 × 10−70), HMW adiponectin (β = −0.40, 95% CI −0.43 to −0.36, P = 1.1 × 10−117), and the HMW-to-total adiponectin ratio (β = −0.44, 95% CI −0.49 to −0.40, P = 3.2 × 10−83). In the replication study, this single nucleotide polymorphism explained 4.1% of total and 6.5% of HMW adiponectin levels. No association was observed between rs4783244 and metabolic traits associated with insulin resistance before adjustment for HMW adiponectin levels. After adjustment for HMW adiponectin levels, the minor allele was associated with lower BMI (β = −0.15, 95% CI −0.19 to −0.11, P = 3.5 × 10−14), homeostasis model assessment-insulin resistance index (β = −0.16, 95% CI −0.20 to −0.12, P = 9.2 × 10−16), and triglycerides (β = −0.16, 95% CI −0.19 to −0.12, P = 1.3 × 10−16) and with higher HDL (β = 0.16, 95% CI 0.12 to 0.19, P = 2.1 × 10−17). CDH13 variants strongly influence plasma total and HMW adiponectin levels in East Asian populations but appear to alter adiponectin sensitivity, resulting in better metabolic health than expected based on circulating adiponectin levels.

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.

Not nondipping but nocturnal blood pressure predicts left ventricular hypertrophy in the essential hypertensive patients: the Korean Ambulatory Blood Pressure multicenter observational study.

Objective: The aim of this study was to investigate whether nocturnal blood pressure (BP), established on the basis of a single 24-h BP monitoring, is a stronger predictor of left ventricular hypertrophy (LVH) compared with nondipping status in the essential hypertensive patients. Methods: A total of 682 hypertensive patients (mean age 56.1u200a±u200a14.5 years, 50.7% women) who underwent echocardiography were enrolled. ‘Nondipping status’ was defined as a nocturnal SBP fall less than 10% of daytime mean SBP. LVH was defined as a left ventricular mass index exceeding 54.0u200ag/m2.7 in men and 53.0u200ag/m2.7 in women. Each patient was categorized in three groups according to the total cardiovascular risk using 2007 European Society of Hypertension/ European Society of Cardiology guidelines as average or low, moderate, and high or very high added risk. Results: Among 682 participants, 184 (26.9%) showed LVH on echocardiography. The proportion of individuals with high or very high added cardiovascular risk profile was 356 (52.1%). In multiple logistic regression analysis, age 56 years at least [odds ratio (OR) 1.047, 95% confidence interval (CI) 1.031–1.063, Pu200a<u200a0.0001], female participants (OR 1.751, 95% CI 1.172–2.616, Pu200a=u200a0.0062), BMI higher than 24.6u200akg/m2 (OR 1.178, 95% CI 1.110–1.250, Pu200a<u200a0.0001), smoking (OR 1.793, 95% CI 1.028–3.127, Pu200a=u200a0.0397), and nocturnal SBP at least 127u200ammHg (OR 1.032, 95% CI 1.009–1.055, Pu200a=u200a0.0059) were significant independent predictors for LVH whereas nondipping was not (OR 0.857, 95% CI 0.481–1.528, Pu200a=u200a0.6013). Conclusion: These findings suggest that nocturnal BP rather than nondipping may be a better predictor of LVH, especially in secondary or tertiary referral hospital setting targeting relatively high cardiovascular risk patients.

A reverse dipping pattern predicts cardiovascular mortality in a clinical cohort.

An abnormal dipping pattern in ambulatory blood pressure monitoring (ABPM) is a cardiovascular (CV) risk factor. However, its impact on CV mortality has not been investigated sufficiently in clinical practice to be considered a standard parameter. We assessed the association between abnormal dipping patterns and increased CV mortality in a tertiary hospital in Korea. Our retrospective cohort study included 401 patients who underwent ABPM between 1994 and 1996 in Hanyang University Hospital, Seoul, Korea. The patients were classified as risers (<0% drop in systolic BP; n=107), and others included dippers and non-dippers (≥0% drop, n=294). The follow-up period was 120 months. The frequency of CV mortality was 14.0% in risers and 5.8% in others. A Cox regression analysis found a significant association between dipping pattern and CV mortality, after adjusting for age, gender, body mass index, hypertension, diabetes mellitus, smoking and hypercholesterolemia. Risers were at greater risk of CV death than others (RR, 3.02, P=0.022), but there was no difference in event rates between dippers and non-dippers. The reverse dipping pattern may be more frequent in clinical settings than in the population at large, and it is strongly associated with increased risk of CV mortality in Korea.

Bone Mineral Density is an Independent Determinant of Left Ventricular Mass Index in the General Female Population

Background and Objectives Left ventricular hypertrophy (LVH) is a well known cardiovascular prognostic predictor. Osteoporosis has been suggested to be associated with cardiovascular disease. According to studies of primary hyperparathyroidism, a pathophysiological association between calcium metabolism and LVH has been suggested but is not yet fully understood. This study was performed to investigate the association between bone mineral density (BMD) and left ventricular mass index (LVMI) in a general population. Subjects and Methods Data from 460 subjects among 543 subjects sampled from a general population in a rural area in Korea were analyzed. BMD, echocardiography, brachial-ankle pulse wave velocity (baPWV), carotid intima-media thickness (IMT) measurement as well as the measurements of blood pressure, blood chemistry and metabolic parameters were analyzed. BMD was measured using the Sahara Clinical Bone Sonometer (Hologic Inc., Mass., USA). Results Age of the subjects was 59.4±12.4 years. Males were 42.2% (n=194). In a simple correlation analysis on female subjects, age and waist circumference showed negative correlation, and body mass index (BMI) showed positive correlation with BMD. However, only age showed negative correlation with BMD in male subjects. After adjusting baPWV and carotid IMT, we found that BMD was an independent determinant of LVMI in female subjects (β=-13.703, p=0.016), but not in male subjects (β=-1.235, p=0.841). Conclusion BMD is a consistent and independent determining factor of LVMI, BMI and carotid IMT in postmenopausal women.

Discordance between ambulatory versus clinic blood pressure according to global cardiovascular risk group.

Background/Aims: The detection of white coat hypertension (WCH), treated normalized hypertension, and masked hypertension (MH) is important to improve the effectiveness of hypertension management. However, whether global cardiovascular risk (GCR) profile has any effect on the discordance between ambulatory blood pressure (ABP) and clinic blood pressure (CBP) is unknown. Methods: Data from 1,916 subjects, taken from the Korean Multicenter Registry for ABP monitoring, were grouped according to diagnostic and therapeutic thresholds for CBP and ABP (140/90 and 135/85 mmHg, respectively). GCR was assessed using European Society of Hypertension 2007 guidelines. Results: The mean subject age was 54.1 ± 14.9 years, and 48.9% of patients were female. The discordancy rate between ABP and CBP in the untreated and treated patients was 32.5% and 26.5%, respectively (p = 0.02). The prevalence of WCH or treated normalized hypertension and MH was 14.4% and 16.0%, respectively. Discordance between ABP and CBP was lower in the very high added-risk group compared to the moderate added-risk group (odds ratio [OR], 0.649; 95% confidence interval [CI], 0.487 to 0.863; p = 0.003). The prevalence of WCH or treated normalized hypertension was also lower in the very high added-risk group (OR, 0.451; 95% CI, 0.311 to 0.655). Conclusions: Discordance between ABP and CBP was observed more frequently in untreated subjects than in treated subjects, and less frequently in the very high added-risk group, which was due mainly to the lower prevalence of WCH or treated normalized hypertension.

Comparison Between an Automated Device and a Manual Mercury Sphygmomanometer in an Epidemiological Survey of Hypertension Prevalence

BACKGROUNDnAutomated devices (AD) for measuring blood pressure (BP) are gradually replacing mercury sphygmomanometers (MM) in clinical settings. However, the use of ADs in epidemiological surveys has not been established. We investigated the factors associated with measurement differences when using an MM and an AD.nnnMETHODSnTwo trained observers took three BP measurements in 454 subjects as part of an epidemiological survey, alternately using an MM and an AD. BP measurement difference was defined as BPMM - BPAD. Alarm reactions (ARs) were calculated by subtracting the third systolic BP (SBP) measurement from the first SBP.nnnRESULTSnThe mean age of subjects was 50.7±15.4 years (n = 454). The mean BPs using the MM and the AD were 119.8±13.9 vs. 119.5±13.6mm Hg in males and 115.0±16.8 vs. 111.6±15.7mm Hg in females for SBP and 77.7±10.4 vs. 74.7±10.4mm Hg in males and 73.2±9.3 vs. 69.9±10.3mm Hg in females for diastolic BP (DBP). Age, gender, arm circumference, and AR were the factors related to the difference. The concordance correlation coefficients for SBP and DBP were 0.8914 (95% confidence interval [CI], 0.8727-0.9102) and 0.8207 (95% CI, 0.7920-0.8494). The kappa values for the diagnosis of hypertension and Joint National Committee 7 BP classification were 0.6538 (0.5436-0.7641) and 0.5703 (0.5055-0.6351), respectively. The diagnostic sensitivity for hypertension was 59.0%.nnnCONCLUSIONSnAge, gender, arm circumference, and AR were the factors related to the differences. Despite small differences in the mean values, the agreement and reliability were not good enough to recommend the A&D UA-767PC for adoption in epidemiological surveys of hypertension prevalence.

Association of heart rate and left ventricular structure in a rural population in Korea

Abstract We investigated the association of heart rate (HR) and estimated glomerular filtration rate (eGFR) with left ventricular (LV) structure in a multi-rural cohort project in Korea. A total of 3215 subjects were analyzed for factors related to Echo-LV mass index (LVMI). eGFR was positively associated with both types of LVMI whereas HR was negatively associated with both. Odd ratios (ORs) (highest versus lowest quartiles) for LVMI by height2.7 were significant for HR (OR: 0.441, pu2009=u20090.0035 in males; OR: 0.638, pu2009=u20090.0226 in females), and for eGFR (OR:1.643, pu2009=u20090.0145) in females. In conclusion, in addition to age, systolic blood pressure and body mass index, eGFR is positively associated with echocardiographic LVMI and HR is negatively associated with echocardiographic LVMI.

Impact of Visit-to-Visit Variability in Systolic Blood Pressure on Cardiovascular Outcomes in Korean National Health Insurance Service—National Sample Cohort

BACKGROUNDnDespite an association between visit-to-visit blood pressure (BP) variability (VV-BPV) and cardiovascular (CV) outcomes, many studies performed during the past 4 years have shown conflicting results. This study investigated the impact of VV-BPV on CV outcomes in the Korean National Health Insurance Service (NHIS) database-National Sample Cohort.nnnMETHODSnFrom the 2002 Korean NHIS database (n = 47,851,928), sample subjects with 3 or more BP measurements (n = 51,811) were divided into 2 groups according to a 10 mm Hg cutoff in the SD of systolic BP (SD-SBP). The CV outcomes of these groups were compared by sensitivity analyses using various sampling methods.nnnRESULTSnIrrespective of sampling method, subjects with SD-SBPs ≥10 mm Hg had higher rates of CV events or death, nonfatal myocardial infarction (MI) or stroke, and total mortality, but were not associated with CV mortality. The hazard ratios for CV events or death, nonfatal MI or stroke, CV mortality, and total mortality were 1.43 (95% confidence interval [CI], 1.25-1.63, P < 0.01), 1.45 (95% CI, 1.27-1.65, P < 0.01), 1.32 (95% CI, 0.89-1.94, P = 0.17), and 1.18 (95% CI, 1.01-1.38, P = 0.04), respectively.nnnCONCLUSIONSnIncreased VV-BPV was an independent risk factor for future CV outcomes, independent of mean BP status, even in normotensive subjects and in all subgroups, except females. Similar VV-BPV values in the sensitivity analyses suggest VV-BPV is a reproducible phenomenon, reflecting the various types of intrinsic physiologic properties.

PS 14-30 PREVALENCE OF RESISTANT HYPERTENSION AND ASSOCIATED FACTORS FOR BLOOD PRESSURE CONTROL STATUS USING KOREAN AMBULATORY BLOOD PRESSURE MONITORING REGISTRY DATA

Objective: Resistant hypertension (RH) may be one of the cause of the plateau in improving the control rate in hypertension (HT) management. The misdiagnosis of RH by clinic blood pressure (BP) is important clinical problem. Aim of the study were to investigate the prevalence of RH by ambulatory blood pressure monitoring (ABPM) and the factor associated with control status of ambulatory BPs. Design and Method: For 1230 subjects taking one or more antihypertensive medication (AHM) enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) registry, the prevalence of RH was calculated which was defined as uncontrolled BP by three AHM classes including diuretic or BP in need of four or more AHM classes. The prevalence determined by clinic versus ambulatory BP was compared. Results: The age was 59.3u200a±u200a12.5 years, and 44.3% were female (nu200a=u200a1230). Among them 72 subjects were taking three AHM drugs including diuretics and 105 subjects were taking four or more AHM classes. With uncontrolled daytime ambulatory BP in 41 among 72 subjects, prevalence of RH was 11.9% (146/1230). By using nighttime BP criteria, there was significant difference in the prevalence of RH for clinic versus nighttime BP (146/177 vs. 159/177, pu200a=u200a0.0124). For control status of daytime BP, masked uncontrolled BP was 16.9% and controlled BP with white-coat effect was 14.1%. For nighttime BP control status, odd ratios for smoking (0.624), drinking (1.512), coronary artery disease (0.604), calcium antagonist (1.705), and loop diuretics (0.454) were all significant. Conclusions: The prevalence of RH was 11.9% by daytime BP and it was significantly higher when using nighttime BP criteria. Control status of daytime BP was misclassified in 31.0%. Smoking, drinking, coronary artery disease, calcium antagonist, and loop diuretics were associated with nighttime BP control status.