Search

Background The combined associations of physical activity and particulate matter (PM) with subsequent cardiovascular disease (CVD) risk is yet unclear. Methods and Results The study population consisted of 18 846 cancer survivors who survived for at least 5 years after initial cancer diagnosis from the Korean National Health Insurance Service database. Average PM levels for 4 years were determined in administrative district areas, and moderate‐to‐vigorous physical activity (MVPA) information was acquired from health examination questionnaires. A multivariable Cox proportional hazards model was used to evaluate the risk for CVD. Among patients with low PM with particles ≤2.5 µm (PM2.5; (19.8–25.6 μg/m3) exposure, ≥5 times per week of MVPA was associated with lower CVD risk (adjusted hazard ratio [aHR], 0.77; 95% CI, 0.60–0.99) compared with 0 times per week of MVPA. Also, a higher level of MVPA frequency was associated with lower CVD risk (P for trend=0.028) among cancer survivors who were exposed to low PM2.5 levels. In contrast, ≥5 times per week of MVPA among patients with high PM2.5 (25.8–33.8 μg/m3) exposure was not associated with lower CVD risk (aHR, 0.98; 95% CI, 0.79–1.21). Compared with patients with low PM2.5 and MVPA ≥3 times per week, low PM2.5 and MVPA ≤2 times per week (aHR, 1.26; 95% CI, 1.03–1.55), high PM2.5 and MVPA ≥3 times per week (aHR, 1.34; 95% CI, 1.07–1.67), and high PM2.5 and MVPA ≤2 times per week (aHR, 1.38; 95% CI, 1.12–1.70) was associated with higher CVD risk. Conclusions Cancer survivors who engaged in MVPA ≥5 times per week benefited from lower CVD risk upon low PM2.5 exposure. High levels of PM2.5 exposure may attenuate the risk‐reducing effects of MVPA on the risk of CVD.

BackgroundConcerns about a growing number of colorectal cancer survivors have emerged regarding cardiovascular disease (CVD) risks. However, there is not yet a predictive tool that can estimate CVD risk and support the management of healthcare as well as disease prevention in terms of CVD risk among long-term colorectal cancer survivors.AimTo develop predictive tools to estimate individualized overall and each subtype of CVD risk using a nationwide cohort in South Korea.Methods and ResultsA total of 4,709 newly diagnosed patients with colorectal cancer who survived at least 5 years in the National Health Insurance System were analyzed. Cox proportional hazard regression was used for the identification of independent risk factors for the derivation of predictive nomograms, which were validated in an independent cohort (n = 3,957). Age, fasting serum glucose, γ-glutamyl transpeptidase, Charlson comorbidity index, household income, body mass index, history of chemotherapy, cigarette smoking, and alcohol consumption were identified as independent risk factors for either overall CVD or each subtype of CVD subtype. Based on the identified independent risk factors, six independent nomograms for each CVD category were developed. Validation by an independent cohort demonstrated a good calibration with a median C-index of 0.687. According to the nomogram-derived median score, relative risks of 2.643, 1.821, 4.656, 2.629, 4.248, and 5.994 were found for overall CVD, ischemic heart disease, myocardial infarction, total stroke, ischemic stroke, and hemorrhage stroke in the validation cohort.ConclusionsThe predictive tools were developed with satisfactory accuracy. The derived nomograms may support the estimation of overall and individual CVD risk for long-term colorectal cancer survivors.

Abstract Background The effect of change in blood glucose levels on the risk of cardiovascular disease among individuals without diabetes is currently unclear. We aimed to examine the association of change in fasting serum glucose with incident cardiovascular disease and all-cause mortality among representative large population. Methods We analyzed the data from retrospective cohort of Korean National Health Insurance Service. In total, 260,487 Korean adults aged over 40 years, without diabetes mellitus and cardiovascular disease at baseline measured change in fasting serum glucose according to the criteria of impaired and diabetic fasting glucose status: normal fasting glucose (NFG, fasting glucose:

Background Body mass index and waist circumference (WC) are commonly used metrics that reflect general obesity and abdominal obesity. However, the impact of general and abdominal obesity discrepancies on the risk for major adverse cardiac events (MACE) is less explored. Methods and Results The study population was derived from the Korean National Health Insurance Service‐Health Screening Cohort. Among 315 982 participants aged 40 years or older who underwent health examinations between 2008 and 2009, body mass index and WC were used to determine the obesity status. The participants were followed from January 1, 2010 for MACE until December 31, 2015. Cox proportional hazards models were used to evaluate the association of obesity and the risk of MACE. Compared with men who were not obese, those with abdominal obesity without general obesity (adjusted hazard ratio (aHR) 1.29, 95% CI 1.16–1.43), and general and abdominal obesity (aHR 1.20, 95% CI 1.12–1.29) had elevated risk of MACE, while those with general obesity without abdominal obesity (aHR 1.06, 95% CI 0.98–1.16) did not. Similarly, women with abdominal obesity without general obesity (aHR 1.13, 95% CI 1.03–1.24) and those with general and abdominal obesity (aHR 1.15, 95% CI 1.06–1.25) had increased risk of MACE, while those with general obesity without abdominal obesity (aHR 1.07, 95% CI 0.88–1.30) did not. Conclusions Abdominal obesity without general obesity was associated with an elevated risk of major cardiovascular outcomes while general obesity without abdominal obesity did not. Concurrent determination of body mass index and WC may be beneficial for the accurate determination of future cardiovascular risk.

Background The combined effect of transitions of metabolic health and weight on cardiovascular disease (CVD) remains unclear. We aimed to examine the association of concurrent changes of metabolic health and weight on CVD over time. Methods and Results The study population consisted of 205 394 from the Korean National Health Insurance Service. Metabolic health was determined by fasting serum glucose, total cholesterol, and blood pressure levels, while obesity was determined by body mass index. All participants were divided into either metabolically healthy nonobese (MHNO), metabolically healthy obese, metabolically unhealthy nonobese, or metabolically unhealthy obese for each of the first (2002–2003) and second (2004–2005) health screening periods, after which participants were followed‐up for CVD from 2006 to 2015. Cox proportional hazards regression was used to determine adjusted hazard ratios (aHRs) and 95% CIs. Among initial MHNO participants, those who became metabolically healthy obese (aHR, 1.25; 95% CI, 1.10–1.41), metabolically unhealthy nonobese (aHR, 1.23; 95% CI, 1.15–1.31), and metabolically unhealthy obese (aHR, 1.34; 95% CI, 1.12–1.61) had elevated risk for CVD compared with those who remained MHNO. Conversely, improving metabolic health and obesity were associated with reduced CVD risk among initially metabolically unhealthy nonobese to secondary MHNO (aHR, 0.79; 95% CI, 0.73–0.84), metabolically unhealthy obese to MHNO (aHR, 0.68; 95% CI, 0.58–0.81), and metabolically unhealthy obese to metabolically healthy obese (aHR, 0.73; 95% CI, 0.66–0.80) participants. Conclusions Changes toward metabolically unhealthy or obese states resulted in increased CVD risk. Improving metabolic health along with reducing weight may lead to decreased risk of CVD.

Background Anemia is considered to increase the risk of mortality in high‐risk populations, but its effect has not been examined among young populations. This study aimed to determine the effect of hemoglobin (Hb) concentration and its changes on the risk of acute myocardial infarction (AMI), stroke, cerebrovascular disease and all‐cause mortality among young women. Methods and Results We analyzed data from the Korean National Health Information Database on 808 143 women aged 20 to 39 years without any cardiocerebrovascular disease. A 1‐time Hb concentration and changes in Hb over a 2‐year period were calculated as exposures. Participants were followed for a median of 10 years to determine the risk of AMI, stroke, cerebrovascular disease, and all‐cause mortality. There were U‐ or J‐shaped associations between Hb concentration or change in Hb and AMI, stroke, cerebrovascular disease, and all‐cause mortality. Increasing the Hb concentration from normal to high increased the risk for AMI (hazard ratio [95% confidence interval]: 1.49 [1.08‐2.04]). With regard to the risk for stroke, increasing the Hb concentration from a normal to a high range increased the risk (hazard ratio [95% confidence interval]: 1.10 [1.02‐1.35]), and decreasing the Hb concentration from a high to a normal range decreased this risk (hazard ratio [95% confidence interval]: 0.80 [0.60‐0.97]). Improving anemia to the normal Hb range decreased all‐cause mortality (hazard ratio [95% confidence interval]: 0.81 [0.69‐0.94]); however, overcorrection of Hb concentration (Hb≥14.0 g/dL) was not significant. Conclusions These findings suggest that regular Hb analysis may assist in identifying young women who are at risk of AMI, stroke, cerebrovascular disease, and all‐cause mortality.

Background Although high serum cholesterol in young adults is known to be a predictor for cardiovascular events, there is not enough evidence for the association of cholesterol level change with cardiovascular disease (CVD). This study aimed to evaluate whether the change in cholesterol is associated with incidence of CVD among young adults. Methods and Results We examined 2 682 045 young adults (aged 20–39 years) who had undergone 2 consecutive national health check‐ups provided by Korean National Health Insurance Service between 2002 and 2005. Cholesterol levels were classified into low (

BackgroundAnemia is thought to increase mortality risks, but the effects of high hemoglobin concentration on survival are unclear. The effect of change in hemoglobin concentrations on survival in the general population is also unknown. This study aimed to examine the effect of hemoglobin concentrations and their changes on cardiovascular and all‐cause mortality risks. Methods and ResultsWe retrospectively analyzed a cohort from the NHIS‐HEALS (National Health Insurance Service–National Health Screening Cohort) database, including 170 078 men and 122 116 women without cardiovascular diseases, aged >40 years at baseline, with hemoglobin concentrations available for both first and second health examinations. We assessed 2 independent variables: “One‐time” hemoglobin concentrations and changes in hemoglobin from first to second examination. Participants were followed up for a median of 8 years to determine mortality related to myocardial infarction, stroke, all cardiovascular diseases, and all causes. Hemoglobin concentrations showed a U‐ or J‐shaped association with cardiovascular and all‐cause mortality after adjusting for cardiovascular risk factors. When anemic men achieved normal hemoglobin concentrations, the all‐cause mortality risk decreased, with an adjusted hazard ratio of 0.67 (95% confidence interval, 0.59–0.77), in comparison with those whose anemia persisted. Both increases and decreases of hemoglobin concentration outside the normal range elevated all‐cause mortality risk (adjusted hazard ratio: 1.39 [95% confidence interval, 1.28–1.49] and 1.10 [95% confidence interval, 1.01–1.20], respectively), compared with persistent normal hemoglobin concentrations. The trend was similar in women but was less significant. ConclusionsLow or high hemoglobin concentrations were associated with elevated cardiovascular and all‐cause mortality. Reaching and maintaining hemoglobin concentrations within the normal range correlated with decreased all‐cause mortality.