Yu Sam Won

High-sensitivity C-reactive protein is associated with the presence of coronary artery calcium in subjects with normal blood pressure but not in subjects with hypertension.

BACKGROUND AND AIMSnAn association has been described between high sensitivity C-reactive protein (hs-CRP) and cardiovascular disease (CVD) in some studies but not in others. This finding may be explained by a differential impact of inflammation according to the absence or presence of certain co-existing risk factors. Because hypertension may be an effect modifier of inflammation on CVD, our aim was to investigate the relationship between hs-CRP and pre-clinical atherosclerosis in subjects with normal blood pressure and hypertension.nnnMETHODSnData were analyzed from 14,584 Korean subjects. Subjects were stratified according to: a) 6030 (41.3%) patients with normal blood pressure (<120/80 mmHg), b) 5630 (38.6%) patients with pre-hypertension (120-139 mmHg and 80-89 mmHg) and c) 2924 (20.0%) patients with hypertension (≥140/90 mmHg). Prevalence and odds ratio for the association between increased hs-CRP (>2 mg/L) and presence of CAC (coronary artery calcium) were calculated.nnnRESULTSnIn both normal and pre-hypertensive groups, the prevalence of CAC >0 was higher in subjects with increased hs-CRP concentrations (>2 mg/L). Adjusting for age, sex, cerebrovascular accident, coronary heart disease and diabetes mellitus, lifestyle, obesity, fasting glucose, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol concentrations, there was a significant association between higher hs-CRP levels (>2 mg/L) and CAC score in the normal group (OR 1.55, 95% CI 1.11-2.16; pxa0= 0.010); a borderline significant association in the pre-hypertensive group (OR 1.33, 95% CI 0.99-1.76; pxa0= 0.054); and no association in the hypertensive group (OR 1.01, 95% CI 0.76-1.33; pxa0= 0.94).nnnCONCLUSIONSnHigher hs-CRP levels (>2 mg/L) are associated with pre-clinical atherosclerosis in subjects with normal blood pressure but not hypertension.

The association between dietary cholesterol intake and subclinical atherosclerosis in Korean adults: The Kangbuk Samsung Health Study

BACKGROUNDnThe Scientific Report of the Dietary Guidelines Advisory Committee (2015) concluded that restriction of dietary cholesterol is unnecessary in most adults for the prevention of cardiovascular disease.nnnOBJECTIVEnWe aimed to assess the risk for subclinical atherosclerosis according to coronary artery calcium score (CACS), based on dietary cholesterol intake in apparently healthy Korean adults.nnnMETHODSnThis was a cross-sectional study performed in 30,068 participants (mean age 40.8xa0years; 84.5% men) in a health screening program in Korea. The data were collected from 2001 to 2013 and analyzed in 2015. Total energy intake and dietary cholesterol intake were assessed with a food frequency questionnaire. The participants were stratified according to quartile of dietary cholesterol intake. CACS was measured by multi-detector computed tomography. Lipid profiles were measured, and the participants were divided into 6 groups according to low-density lipoprotein cholesterol (LDL-C) level: <70, 70 to 99, 100 to 129, 130 to 159, 160 to 189, and ≥190xa0mg/dL.nnnRESULTSnThe presence of coronary artery calcification was defined as CACS>0. Dietary cholesterol intake did not correlate with mean value of serum LDL-C level. For both genders, the odds ratio for coronary artery calcification was not significantly greater with greater amounts of dietary cholesterol (as assessed by quartile). The risk for coronary artery calcification was not higher in subjects with LDL-C 70-129xa0mg/dL compared with those with LDL-Cxa0<xa070xa0mg/dL; however, the risk was significantly greater in subjects with LDL-Cxa0≥xa0130xa0mg/dL compared with those with LDL-Cxa0<xa070xa0mg/dL.nnnCONCLUSIONSnDietary cholesterol intake did not have an association with LDL-C level or with risk for coronary artery calcification in apparently healthy Korean adults. The results have to be translated with consideration of limitation of population-based studies.

The Relationship between Vitamin D and Glaucoma: A Kangbuk Samsung Health Study

Purpose To investigate the relationship between vitamin D and glaucoma. Methods This retrospective, cross-sectional study included subjects who underwent a health screening at the Health Screening Center of Kangbuk Samsung Hospital from August 2012 to July 2013. All fundus photographs were reviewed by ophthalmologists. The ophthalmologists determined if an eye was glaucomatous based on the criteria set forth by the International Society of Geographical and Epidemiological Ophthalmology and by the appearance of the retinal nerve fiber layer and optic disc. If the subjects previously underwent an ophthalmologic examination, they were enrolled based on the documented history. In addition to fundus photographs, each participant underwent a systemic examination including blood sampling and sociodemographic and behavioral questionnaires. The subjects were divided into five groups according to serum 25-hydroxyvitamin D (25(OH)D) level. Multivariate logistic regression models were constructed to assess possible associations between elevated glaucoma risk and systemic factors with a p < 0.2 on univariate analysis. Results Of the 169,208 subjects older than 20 years, 123,331 were eligible for the study. There was no difference in the prevalence of glaucoma according to quintile of serum 25(OH)D level based on sex (p = 0.412 for males, p = 0.169 for females). According to the multivariable-adjusted logistic analysis, the odds ratio of glaucoma for the fourth quintile was significantly lower than that of the first quintile in females (odds ratio, 0.713; 95% confidence interval, 0.520 to 0.979). Conclusions Lower 25(OH)D level was significantly associated with an elevated risk of glaucoma in females compared with higher 25(OH)D level. Further evaluation is needed to investigate the relationship between glaucoma and vitamin D.

Relationships Between Anthropometric Measurements and Intraocular Pressure: The Korea National Health and Nutrition Examination Survey

PURPOSEnTo evaluate the relationship between intraocular pressure (IOP) and various anthropometric measures.nnnDESIGNnA population-based cross-sectional study.nnnMETHODSnA total of 5008 participants, 2080 men and 2928 women ≥19 years of age were included from the Korea National Health and Nutrition Examination Survey V database, focusing on the years 2010 and 2011. We selected IOP in the right eye of a normal healthy population as the outcome variable of our study. We analyzed the relationship between IOP and anthropometric parameters using dual-energy X-ray absorptiometry by sex. Lean body mass was calculated as total body mass minus fat mass. We used general linear models and logistic regression analysis to evaluate risk factors of high IOP. Our main outcome measure was correlation between anthropometric data and IOP.nnnRESULTSnIn multivariate general linear models, greater body mass index (BMI) and waist circumference were correlated with higher IOP for both men (BMI, βxa0= 0.053, Pxa0= .026; waist circumference, βxa0= 0.016, Pxa0= .067) and women (BMI, βxa0= 0.074, P < .001; waist circumference, βxa0= 0.028, P < .001). Greater fat mass (βxa0= 0.027, Pxa0= .037) and fat mass/lean body mass (βxa0= 1.170, Pxa0= .06) were correlated with higher IOP, while greater lean body mass/weight (βxa0=xa0-3.188, Pxa0= .025), lean body mass/BMI (βxa0=xa0-1.379, Pxa0= .002), appendicular skeletal muscle mass/BMI (βxa0=xa0-2.270, Pxa0= .022), and bone mineral content/BMI (βxa0=xa0-11.653, Pxa0= .031) were correlated with lower IOP in women, but not in men (P > .10).nnnCONCLUSIONSnIn healthy women, greater fat mass was associated with higher IOP, and greater muscle mass was associated with lower IOP after adjusting for weight and BMI. Fat and muscle influenced IOP in women independently.

Association of Initial Infarct Extent and Progressive Motor Deficits in Striatocapsular Infarction

Background and purpose Progression of motor deficits in the acute period is frequently observed in patients with subcortical striatocapsular infarctions. Therefore, we sought to determine the factors associated with early motor progression in patients with infarcts confined to the striatocapsular region. Methods We studied 80 consecutive patients with striatocapsular-region infarction, as defined by clinical and MRI criteria, within 24 hours after stroke onset. Motor progression was defined as an increase of >2 points in the motor items of the National Institutes of Health Stroke Scale (NIHSS) within 7 days of stroke onset. The study population was divided into patients with and without motor progression, and risk factors, clinical features, and brain MRI/magnetic resonance angiograpy (MRA) findings were compared between these groups. Results Motor progression was observed in 40% of the 80 patients. The independent variables associated with motor progression were a history of hypertension (OR=7.8, 95% CI=1.5-39.8, p=0.013) and an initial infarct extent of ≥15 mm (OR=9.2, 95% CI=1.8-45.7, p=0.006). However, there were no differences in the initial NIHSS score, other stroke risk factors, vascular stenosis pattern, or cardioembolic source. Conclusions Early motor progression in patients with striatocapsular-region infarction is associated with the initial extent of the lesion. However, the stroke mechanism and vascular stenosis did not differ between the motor progression and stable groups.

Association between Renal Function and Open-Angle Glaucoma: The Korea National Health and Nutrition Examination Survey 2010–2011

PURPOSEnTo investigate the relationship between renal function and primary open-angle glaucoma (POAG) in a South Korean population.nnnDESIGNnA population-based, cross-sectional survey using a multistage, stratified, probability-clustered sampling method from the Korean National Health and Nutrition Examination Survey (KNHANES).nnnPARTICIPANTSnA total of 5971 participants at least 40 years of age were selected from the KNHANES between 2010 andxa02011.nnnMETHODSnA standardized protocol was used to interview every participant and perform comprehensive ophthalmic examinations. Glaucoma was diagnosed according to criteria from the International Society of Geographical and Epidemiological Ophthalmology. The estimated glomerular filtration rate (eGFR) was calculated from serum creatinine concentrations using the Cockcroft-Gault formula, as follows: eGFRxa0= (140xa0- age)xa0× massxa0(kg)xa0× (0.85 for female subjects)/(72 × serum creatinine (mg/dl). The presence of proteinuria also was assessed. Subjects were stratified by eGFR into the following groups: ≥90, 60-90, 45-59, and <45 ml/min/1.73 m(2).nnnMAIN OUTCOME MEASURESnRenal function and POAG.nnnRESULTSnThe overall prevalence of POAG was 5.5%. The prevalence of low eGFR (<60 ml/min/1.73 m(2)) was 9.5%, and the prevalence of eGFR <45 ml/min/1.73 m(2) was 2.0%. Multiple linear regression models were adjusted for age, sex, and other confounding factors (high-density lipoprotein level, blood glucose concentration, blood pressure, and intraocular pressure). These models revealed a positive correlation between the presence of POAG and low eGFR (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.44-5.76). No association was found between proteinuria and POAG (adjusted for age, sex, and other confounding factors; OR, 0.96; 95% CI, 0.29-3.17).nnnCONCLUSIONSnThis population-based study of South Korean adults showed that low eGFR levels are independently associated with POAG.

Relationship between high serum ferritin level and glaucoma in a South Korean population: the Kangbuk Samsung health study

Background/aims To investigate the association between serum ferritin levels and glaucoma in a South Korean population. Methods This retrospective cross-sectional study included 164u2005029 subjects who underwent screening at Kangbuk Samsung Hospital Health Screening Center between August 2012 and July 2013. All subjects underwent a physical examination, answered sociodemographic and behavioural questions, and provided samples for laboratory analyses. A digital fundus photograph of both eyes was taken, and all photographs were reviewed by ophthalmologists. The ophthalmologists determined if an eye had glaucoma based on criteria set forth by the International Society of Geographical and Epidemiological Ophthalmology and the appearance of the retinal nerve fibre layer and optic disc. Results The mean serum ferritin level was 56.98u2005ng/mL in women and 223.82u2005ng/mL in men. After adjusting for age, serum iron, total iron-binding capacity (TIBC), transferrin saturation, white blood cell (WBC) count, high-sensitivity C-reactive protein (HsCRP) and total vitamin D level, males in the highest quartile for serum ferritin level had a higher OR for glaucoma than males in the lowest quartile (OR=1.176, 95% CI 1.030 to 1.342, p=0.016); we did not observe this relationship among women. Other markers of iron metabolism, such as iron level, transferrin saturation and TIBC, and inflammation measures, including WBC, HsCRP and total vitamin D, were not associated with glaucoma. Conclusions High serum ferritin level was associated with a high risk of glaucoma in men, but not in women. Because serum ferritin is related to oxidative stress and inflammation, it might play a role in glaucoma development.

Relationship between anthropometric parameters and open angle glaucoma: The Korea National Health and Nutrition Examination Survey.

Aims To evaluate the relationships between open-angle glaucoma (OAG) and various anthropometric measurements. Design Korea National Health and Nutrition Examination Survey (KNHANES), a population-based cross-sectional study using a complex, stratified, multistage, probability-cluster survey. Methods A total of 5,255 participants including 247 glaucoma patients, aged ≥ 19 years were included from the KNHANES V database. Glaucoma diagnosis was based on International Society of Geographical and Epidemiological Ophthalmology criteria. Various anthropometric data regarding obesity were analyzed including body mass index (BMI), total body fat mass, total body muscle mass (lean body mass, non-bone lean body mass, and appendicular skeletal muscle (ASM) mass), and waist circumference (WC). The differences in OAG prevalence with respect to anthropometric parameter quartiles were examined. Results In males, the multivariate general linear model adjusted for age, alcohol, smoking, exercise, systemic hypertension, diabetes, and intraocular pressure (IOP) showed the quartiles for the anthropometric parameters BMI, fat mass/weight ratio and fat mass/muscle mass ratio were negatively associated with OAG. However, muscle mass parameter/BMI ratio was significantly positively associated with OAG (P for trend<0.05). In females, height and fat mass/BMI showed a significant relationship with the risk of OAG. (P value<0.05) Conclusions In the present study, high fat mass was associated with low OAG risk. Body composition seemed to affect the prevalence of OAG, but further evaluation is needed.

Relationship between Plasma Homocysteine Level and Glaucomatous Retinal Nerve Fiber Layer Defect

ABSTRACT Aims: To investigate the association between plasma homocysteine levels and glaucomatous retinal nerve fiber layer (RNFL) defect in South Korean population. Materials and methods: This retrospective cross-sectional study included subjects who underwent screening at Kangbuk Samsung Hospital Health Screening Center between August 2012 and July 2013. Subjects underwent physical examination and provided samples for laboratory analysis of homocysteine. Subjects were divided equally into four quartiles (Qs) based on plasma homocysteine level. Digital fundus photographs of both eyes were obtained. Determination of glaucomatous disc appearance was based on criteria set forth by the International Society of Geographical and Epidemiological Ophthalmology and based on the appearance of the RNFL and optic disc. Multivariate logistic regression models were used to define elevated glaucoma risk with P < 0.2 on univariate analysis. Results: A total of 78,049 subjects were included; 76,093 subjects were male, and 1956 subjects were female. When analyzed by gender, the mean homocysteine level in the male group with glaucomatous RNFL defects (11.05 ± 3.80 µmol/L) was higher than those without RNFL defects (10.81 ± 4.12 µmol/L (P = 0.000, χ2 test). Upon multifactorial logistic regression analysis adjusted for age, gender, creatinine, diabetes mellitus, hypertension, and hyperlipidemia, glaucomatous RNFL defects had a significant correlation with plasma homocysteine level. Based on the Q2 level, the odds ratio (OR) of Q3 was 1.267, while the OR of Q4 was 1.285 (95% CI = 1.067−1.505, 1.081−1.529, respectively, P for trend = 0.001). Conclusion: Our results suggest that homocysteine level is associated with the presence of glaucomatous RNFL defects.

Association Between Optic Disc Hemorrhage and Renal Function in South Korea

Purpose: The purpose of this article is to investigate the relationship between renal function and disc hemorrhage (DH). Materials and Methods: This retrospective cross-sectional survey was conducted at Kangbuk Samsung Hospital Health Screening Center between August 2012 and July 2013, and a total of 168,044 participants at least 20 years of age who voluntarily visited the health screening center for systemic and ophthalmologic examinations, including fundus photography, were enrolled. All subjects underwent a physical examination and provided samples for laboratory analysis. Digital fundus photographs of both eyes were taken and reviewed. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine concentration using the Modification of Diet in Renal Disease (MDRD) formula and Cockcroft-Gault (CG) formula. Subjects were stratified by eGFR into quartiles. Results: Among participants, 220 (0.1%) showed DH, and 2376 (1.6%) showed glaucomatous retinal nerve fiber layer defects. The DH group showed higher creatinine and lower eGFR than the non-DH group. A significant trend was observed among higher creatinine, decreased eGFR as obtained by the MDRD and CG formulas, and the prevalence of DH (P for trend ⩽0.003, logistic regression analysis). A multiple logistic regression model adjusted for age, sex, hypertension, diabetes, and hyperlipidemia showed that the lowest eGFR quartiles estimated by MDRD and CG were significantly associated with DH compared with the highest eGFR quartile (adjusted odds ratio, 1.96; 95% confidence interval, 1.22-3.14 by CG, 1.86; 95% confidence interval, 1.17-2.96 by MDRD). Conclusion: Renal function impairment was independently associated with a higher prevalence of DH in a South Korean population.