• Journal of the Korean Society of Radiology
• /
• v.83 no.2
• /
• pp.360-371
• /
• 2022

Purpose This study aimed to assess the factors influencing aortic unfolding (AU) defined by aortic width on coronary artery calcium (CAC) scan and determine the normal limits for AU. Materials and Methods In this retrospective study, we measured AU in 924 asymptomatic subjects who underwent CAC scanning during routine health screening from June 2015 to June 2018. Multivariate regression analysis was used to evaluate the factors influencing AU. After the exclusion of subjects with risk factors associated with AU, 283 subjects were included in the analysis of normal values of AU. Mean AU, standard deviation, and upper normal limit were calculated. Results Sex, age, CAC score, body mass index, body surface area, hypertension, left ventricular hypertrophy, plasma creatinine, and smoking were significantly associated with AU. The mean AU was 102.2 ± 12.8 mm for men and 93.1 ± 10.7 mm for women. AU increased with advancing age (9.6 mm per decade). Conclusion AU determined from a single measurement on CAC scans was associated with cardiovascular risk factors. The normal limits of AU were defined by age, sex, and body surface area in low-risk subjects in this study.

• Journal of Chest Surgery
• /
• v.32 no.11
• /
• pp.1017-1022
• /
• 1999

Background: An increasing number of elderly are referred for open heart surgeries(OHS). These patients are assumed to have significantly increased morbidity and mortality because of compromised functional reserves in their vital organs. We reviewed the results of OHS patients who were 70 years old or older. Material and Method: Thirty six consecutive septuagenarians underwent OHS from 1995 to 1997. Operations were coronary artery bypass grafting(CABG) in 26 including 3 left main surgical angioplasty, valve replacement in 7, MVR+CABG in 2, and ASD closure+TAP in 1. Statistical tests were carried out to compare survivor group with nonsurvivor group in respect to risk factors including NYHA functional class, LVEF, emergent operation, IABP support, CPB/ACC time, ventilator time cardiac index, ICU stay and hospital stay for operative mortality. Result: Operative mortality rate and postoperative complication were 16%(6/36) and 50%(18/36). One-year and 3-year actuarial survival rates were 76%. Nine patients(25%) had major complications including third-degree A-V block(2), respiratory failure(1), stroke(3), renal failure requiring dialysis(3) and postoperative hemorrhage(2). The causes of death were pneumonia(1), bleeding(1), acute renal failure(1), low cardiac output(1), third-degree A-V block(1), and ventricular tachycardia(1). The univariate analysis of mortality shows that NYHA class IV, LVEF<40%, lesser values for C.I, and longer time for ventilatory support were associated with the risk factors(p value=0.03, 0.001, 0.007, and 0.014). The emergent operation, CPB/ACC time, IABP support, ICU stay and hospital stay were not significant. Conclusion: We conclude that cardiac operation can be performed in septuagenarians with acceptable outcomes when done in patients with normal to moderately depressed left ventricular function and adequate functional reserves in their vital organs.

• Journal of Chest Surgery
• /
• v.29 no.6
• /
• pp.599-605
• /
• 1996

A total of 249 patients undergoing isolated coronary revascularization were studied for the occurrence of postoperative atrial fibrillation(AF). Possible associations of this arrhythmia with various preoperative, intraoperative and postoperative factors were studied by univariate and multivariate analysis. The overall incidence of postoperative AF was 15%, with the median time occurence of 48 hours(mean time : 59.1 $\pm$ 56.9 hours) after arrival to the intensive care unit. Cardiac index decreased significantly after occurence of AF(p=0.001). There were no in-hospital complications in those patients with AF. Univariate studies indicated preoperative ejection fract on(EF), triglyceride level, postoperative peak CKMB isoenzpme and atrial pacing to be the dominant factor promoting postoperative AF, with an increasing prevalence in lower EF(p=0.025), triglyceride(p=0.006) and peak CKMB isoenzyme(p=0.002), and in patients with atrial pacing(p=0.001). Hospital stay(p=0.001) and late mortality(p=0.003) were significantly increased in patients with postoperative AF Multivariate analysis showed that body weight and postoperative atrial pacing to be the dominant factor promoting postoperative AF, with an increasing prevalence in over- weight patients(p=0.011) and patients with atrial pacing(p=0.001). Both univariate and multivariate analy- sis showed that the age was not a significant factor but tended to promote postoperative AF respectively (p=0.053, 0.064). After 30.1 $\pm$ 11.4 months gfollow-up, those patients with AF had sinus rhythm. We think that we must try to prevent postoperative AF after ccoronary artery bypass grafting because of its deleterio s hemodynamic effect, prolonged hospital stay, and increased late mortality.

• Diabetes and Metabolism Journal
• /
• v.42 no.6
• /
• pp.496-512
• /
• 2018

Background: This study aimed to investigate the association between the presence and severity of cardiovascular autonomic neuropathy (CAN) and development of long-term glucose fluctuation in subjects with type 2 diabetes mellitus. Methods: In this retrospective cohort study, subjects with type 2 diabetes mellitus who received cardiovascular autonomic reflex tests (CARTs) at baseline and at least 4-year of follow-up with ${\geq}6$ measures of glycosylated hemoglobin (HbA1c) were included. The severity of CAN was categorized as normal, early, or severe CAN according to the CARTs score. HbA1c variability was measured as the standard deviation (SD), coefficient of variation, and adjusted SD of serial HbA1c measurements. Results: A total of 681 subjects were analyzed (294 normal, 318 early, and 69 severe CAN). The HbA1c variability index values showed a positive relationship with the severity of CAN. Multivariable logistic regression analysis showed that CAN was significantly associated with the risk of developing higher HbA1c variability (SD) after adjusting for age, sex, body mass index, diabetes duration, mean HbA1c, heart rate, glomerular filtration rate, diabetic retinopathy, coronary artery disease, insulin use, and anti-hypertensive medication (early CAN: odds ratio [OR], 1.65; 95% confidence interval [CI], 1.12 to 2.43) (severe CAN: OR, 2.86; 95% CI, 1.47 to 5.56). This association was more prominent in subjects who had a longer duration of diabetes (>10 years) and lower mean HbA1c (<7%). Conclusion: CAN is an independent risk factor for future higher HbA1c variability in subjects with type 2 diabetes mellitus. Tailored therapy for stabilizing glucose fluctuation should be emphasized in subjects with CAN.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.7 no.2
• /
• pp.228-238
• /
• 2004

Purpose: Obesity is rapidly increasing in Korean children. Obesity is a risk factor for cardiovascular morbidity and is frequently associated with hypertension, diabetes mellitus and coronary artery disease. This study was designed to evaluate risk factors of the metabolic syndrome in obese children. Methods: From February 2000 to June 2004, eighty eight obese (body mass index ${\geq}95th$ percentile) children aged 4 to 15 years were included. We measured serum lipid levels (total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol), fasting sugar levels and insulin levels. Insulin resistance was determined by homeostasis model assessment, fasting insulin/glucose ratio and quantitative insulin sensitivity check index. Results: Clustering of risk factors for the metabolic syndrome in obese children demonstrated that 60.2% had more than one risk factors. Hypertension (14.8%), hypertriglyceridemia (14.8%), HDL-hypocholesterolemia (14.8%), LDL-hypercholesterolemia (12.5%) and hyperinsulinemia (12.5%) were observed. As BMI increased, there was statistically significant increase in systolic blood pressure, insulin and insulin resistance values. Insulin resistance was correlated to systolic blood pressure, serum lipid and insulin levels. The more risk factors for the metabolic syndrome obese children had, the higher was their insulin resistance. Conclusion: The increase in insulin resistance and clustering of risk factors for the metabolic syndrome are already apparent in obese children. Monitoring these risk factors for the metabolic syndrome should become a part of routine medical care for obese children.

• Journal of Nutrition and Health
• /
• v.36 no.6
• /
• pp.603-612
• /
• 2003

Postmenopausal women are at an increased risk of developing coronary artery disease. This is due to primarily dyslipidemia accompanying the loss of estrogen secretion. Soy isoflavones are known to have weak estrogenic effects. The purpose of this study is to investigate whether isoflavone supplement improves the risk of cardiovascular disease in hypercholesterolemic postmenopausal women. Subjects consisted of 39 Korean postmenopausal women with hypercholesterolemia (total cholesterol $\geq$ 200 mg/㎗ or LDL cholesterol $\geq$ 130 mg/㎗). Subjects were divided into 2 groups; placebo group (PG), isoflavone supplement group (IG). During 12 weeks, subjects were given placebo and 80mg isoflavone daily. Anthropometric measurement, blood sample analysis and dietary intake measurement were taken at baseline and after 12 weeks. After 12 weeks, systolic blood pressure was decreased significantly (p ＜ 0.01) and plasma HDL cholesterol level was increased significantly (p ＜ 0.05) in IG. But there were no significant changes in plasma total cholesterol, LDL cholesterol and triglyceride levels after isoflavone supplementation. There was a negative correlation between initial plasma HDL cholesterol level and the extent of plasma HDL cholesterol reduction in IG (r＝-0.572, p＝0.012). Atherogenic index (AI), total-/LDL- cholesterol ratio and LDL/HDL cholesterol ratio were improved significantly after isoflavone supplementation. In subjects whose initial plasma LDL cholesterol level were above 160 mg/㎗, plasma malondialdehyde (MDA) level were decreased and total antioxidant status (TAS) were increased significantly after isoflavone supplement (p ＜ 0.05). However there were no significant changes in flow-mediated dilator (FMD), the marker of endothelium-dependent vasodilation and nitroglycerine-mediated dilator (NMD), the marker of endothelium-independent vasodilation and the extent of DNA damage after isoflavone supplement. In conclusion, these results indicate that isoflavone supplement may decrease the risk of cardiovascular disease via improving blood pressure, HDL cholesterol level and AI in hypercholesterolemic postmenopausal women. Futhermore, in case of subjects with elevated LDL cholesterol level, isoflavone supplementation may have more antiatherogenic effects via improving antioxidant status.

• Journal of Nutrition and Health
• /
• v.40 no.2
• /
• pp.162-171
• /
• 2007

Obesity is an independent risk factor fur coronary artery disease in the postmenopausal women, which may be mediated by alteration of blood lipid metabolism. We are aimed to evaluate the effects of low energy diet, restriction of high fat foods and exercise education on weight, fat mass and blood lipid profile. Fifteen postmenopausal obese women were studied. Subjects received detailed advice about how to achieve a reduction of weight by a low-energy diet (1,200kcal), restriction of high fat food and increased exercise in every 4 wks during 8 wk. To evaluate the effectiveness for education programs, dietary fat habit and daily nutrient intakes, exercise were tested before and after intervention. Anthropometry, computerized tomography, and blood lipid profile were assessed before and after intervention. According to the nutrition education, energy intake (from 1776.1 ${\pm}$ 28.2 kcal to 1268.7 ${\pm}$ 115.2 kcal, p < 0.001) and percent of energy from fat (21.9%, p < 0.01) were significantly decreased. However, the index of nutritional quality was over 1.0. On the contrary, exercise (from 341.3 ${\pm}$ 222.1 kcal to 569.4 ${\pm}$ 309.8 kcal, p < 0.05) was increased and dietary fat habit scores (from 30.8 ${\pm}$ 5.2 to 36.1 ${\pm}$ 3.0, p < 0.01) were improved. Also, body weight (4.2%, p < 0.001), BMI (4.5%, p < 0.001), body fat mass (3.4%, p < 0.05) and waist to hip ratio (1.1%, p < 0.05) were decreased. Among abdominal fat, visceral fat (26.1%, p < 0.05) and subcutaneous fat (14.8%, p < 0.01) were decreased. But there was no difference in visceral fat to subcutaneous fat ratio. We observed HDL-cholesterol increase (11.7%, p < 0.05), triglyceride reduction(14.8%, p < 0.05) and atherogenic index improvement (from 2.7 ${\pm}$ 0.7 to 2.3 ${\pm}$ 0.7, p < 0.05) However, there was no change in LDL-cholesterol and total cholesterol. Theses results showed that low energy diet, restriction of high fat foods and exercise education could result in reduction of body weight, fat mass, visceral and subcutaneous fat, and in improvement of blood lipid profile in the postmenopausal obese women.

• Journal of the Korean Society of Radiology
• /
• v.7 no.6
• /
• pp.369-376
• /
• 2013

Prepared her for the early detection of the risk of cardiovascular disease prevention for the various attempts being made ill through a lot of research to the criteria of coronary artery calcification, but the figure is more than 100 the progress of the flow can be expected to be was. In this study, we quantify the correlation between body composition analysis, blood lipid levels of calcium and public asymptomatic even at low calcium levels in comparison with the existing studies by analyzing potential risk of cardiovascular disease will be represented on the were evaluated. Studies, the calcium scores in the body composition analysis "1-10", and when "11-100" when there was a significant correlation in BMI and WHR look more normal frequency range of the mean values in the normal range meomulreoteuna 21% relative HDL and TG in lipid profiles, no significant correlation look more normal frequency range of risk were derived from the mean values in the normal range, 21% to 40% of the relative risk were derived. meomulreoteuna. In addition, there is no correlation between BFM and BMR Also, average increases in the frequency of a higher standard was higher relative risk derived 31 to 93%, and geological correlation test TC above 20mg/dl atherosclerotic sclerosis seems to be the value of HDL to act to remove cholesterol from atheroma already looking at the same time to suppress the occurrence of atherosclerosis, increased LDL showed higher values occurs rapidly increasing. At this time, the relative risk of 43-50% have been identified. In other words, even when calcium levels are low, that is inherent in the incidence of cardiovascular disease was unknown.

• Clinical and Experimental Pediatrics
• /
• v.49 no.5
• /
• pp.475-481
• /
• 2006

Purpose : As the prevalence of childhood obesity is increasing, hypertension, hyperlipidemia, insulin resistance and diabetes mellitus have become problems. High homocysteine levels and low vitamin $B_{12}$ supplementation are acknowledged to have a role in coronary artery disease, but there are few studies on homocysteine, insulin and vitamin $B_{12}$ levels in obese children. We aimed to study whether homocysteine, insulin, vitamin $B_{12}$, folic acid levels could have any difference and relation in obese children. Methods : The disease group consisted of 27 children from 8 to 11 years old, whose obesity index was over 130. The control group consisted of 30 healthy children of the same age group. Obesity index and body mass index were calculated by height and body weight of the children, and their systolic and diastolic blood pressures at resting state were checked. Total cholesterol, triglyceride, homocysteine, insulin, vitamin $B_{12}$, folic acid levels were studied after 10 hours of fasting. Intracellular fluid, extracellular fluid, protein, mineral, muscle mass, lean body fat, fat mass and fat percentages were checked by bioelectrical impedance. Results : Homocysteine levels were higher in obese children($8.1{\pm}2.1{\mu}mol/mL$ vs. $4.9{\pm}1.0{\mu}mol/mL$). Insulin levels were also higher in obese children($26.8{\pm}11.2{\mu}IU/mL$ vs. $12.5{\pm}5.24{\mu}IUl/mL$). Vitamin $B_{12}$ was lower in obese children($798.6{\pm}174.3pg/mL$ vs. $967.8{\pm}405.0pg/mL$). But there was not a difference in the folic acid levels between the two groups. In obese children, systolic blood pressure (r=0.535), triglyceride(r=0.517), total cholesterol(r=0.408), folic acid(r=0.408), vitamin $B_{12}$(r=0.338) and abdomoanl fat %(r=0.306) had a positive correlation. Conclusion : We found definite differences of insulin, homocysteine, and vitamin $B_{12}$ plasma levels in obese children, but we need more study to use those parameters as risk factors of metabolic syndrome in pediatric obese patients.

• Journal of the Korean Society of Food Science and Nutrition
• /
• v.34 no.1
• /
• pp.42-56
• /
• 2005

Hyperlipidemia is one of the risk factors for coronary artery disease. Despite of epidemiological evidence that tea consumption is associated with the reduced risk of coronary heart disease, experimental studies designed to show that drinking tea affects blood lipid concentration or oxidative stress have been unsuccessful. The purpose of this study was to investigate whether functional tea (three servings/day) supplement with medical nutrition therapy (MNT) lead to a beneficial outcomes in mildly hyperlipidemic adults. From February to October, 2003, the 43 hyperlipidemic (23 men, 20 women) subjects (total cholesterol$\geq$200 mg/dL or triglyceride$\geq$150 mg/dL) admitted to K Medical Center were studied. Subjects were randomly divided into 3 groups; placebo tea (PT), half dose of functional tea (HFT), full dose of functional tea (FFT). During 12 weeks of study period, the subjects were given placebo or functional tea daily with MNT. Anthropometric measurements, blood chemical analysis including lipid levels, total superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels, and dietary assessment were carried out at the beginning and end of experiment. The effects of functional tea were compared with the placebo in randomized clinical trial study. The placebo was prepared to match with the functional tea in color and taste. After the 12 weeks of MNT, the subjects had regular and balanced meal pattern. Consumption of foods high in cholesterol and saturated fat, salty foods, fried foods, and instant foods decreased significantly in all three groups (p<0.05). Intake of energy and cholesterol also decreased (p<0.05). Drinking three servings per day (390 mL/day) of functional tea significantly reduced the levels of blood triglyceride (HFT, 42.5%; FFT, 29.4%), total cholesterol (HFT, 8.5%; FFT, 13.7%), and atherogenic index (HFT, 14.6%; FFT, 21.7%). Whereas no changes were found in the LDL-, HDL-cholesterollevels, and LDL/HDL ratio. Plasma homocysteine (Hcy) concentration decreased significantly (p<0.05) in functional tea groups (HFT, 14.9%; FFT, 14.1%). SOD increased significantly (p<0.05) in HFT (8.3%). GSH-Px increased significantly (p<0.05) in FFT (12.8%). In conclusion, the MNT improved the dietary habits, in addition, functional tea supplement decreased blood lipid levels and Hcy, and increased SOD and GSH-Px levels. These results indicate that functional tea consumption may decrease the risk of cardiovascular disease via improving blood lipid levels and antioxidant status.