Publications by authors named "Hyeon Chang Kim"

282 Publications

Gender role stereotypes, patriarchal mindset, and cognitive function in the elderly rural population: A cross-sectional study.

Epidemiol Health 2021 Apr 7:e2021023. Epub 2021 Apr 7.

Yonsei University Graduated School, Department of Public Health, Seoul, Republic of Korea.

Objectives: We analyzed whether gender role stereotypes (GRS) and patriarchal mindset are associated with cognitive function in an elderly community population.

Methods: We utilized data from 580 people enrolled in the Korean Social Life, Health and Aging Project. GRS and patriarchal mindset were measured using a questionnaire. We divided GRS and patriarchal mindset into two groups following their median levels: a conservative mindset and an open mindset. Cognitive function was assessed using the Mini-Mental State Examination, Korean version (MMSE-K). Cognitive impairment was defined as MMSE-K ≤21 points. A multivariable logistic regression was performed, adjusting for sex, age, socio-demographic and lifestyle factors, and social network size. Age and lifestyle factors were stratified.

Results: Compared with open-minded people, those with a more conservative mind regarding gender roles and higher adherence to a patriarchal mindset had adjusted odds ratios of 1.88 (95% confidence interval, CI: 1. 11-3.19) and 1.67 (95% CI: 1.00-2.79) for cognitive impairment, respectively. In the stratified analysis, subgroups with a younger age and good lifestyle maintained a protective association with cognitive impairment.

Conclusion: GRS and patriarchal mindset were marginally significantly associated with cognitive impairment among women in later life.
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http://dx.doi.org/10.4178/epih.e2021023DOI Listing
April 2021

Impact of Smoking in Survivors from Acute Myocardial Infarction.

Authors:
Hyeon Chang Kim

Korean Circ J 2021 Apr;51(4):349-350

Department of Preventive Medicine, Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.4070/kcj.2021.0035DOI Listing
April 2021

Thirty-six Year Trends in Mortality from Diseases of Circulatory System in Korea.

Korean Circ J 2021 Apr;51(4):320-332

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background And Objectives: Understanding the trends in cardiovascular disease (CVD) mortality is important for developing burden reduction strategies. Based on the Cause of Death Statistics, we examined the changing patterns of CVD mortality in Korea between 1983 and 2018.

Methods: Causes of death were coded according to the International Classification of Disease, 10th revision. Deaths from all diseases of circulatory system (I00-I99) and the following 6 subcategories were analyzed: total heart diseases (I00-I13 and I20-I51), hypertensive heart diseases (I10-I13), ischemic heart diseases (I20-I25), myocardial infarction (I21-I23), heart failure (I50), and cerebrovascular diseases (I60-I69). Crude, age-standardized, and age-stratified rates were calculated to assess temporal trends in CVD mortality.

Results: The number of deaths and crude mortality rate for all diseases of circulatory system increased recently mainly due to the population ageing. Specifically, total heart diseases showed increasing trend, whereas cerebrovascular diseases showed decreasing trend. Between 1983 and 2018, age-standardized mortality rates significantly declined for all diseases of circulatory system, total heart diseases, hypertensive heart diseases, and cerebrovascular diseases. Age-standardized mortality rates for ischemic heart diseases and myocardial infarction peaked in the early 2000s then decreased thereafter. However, age-standardized mortality rate for heart failure rapidly increased, especially in recent years.

Conclusions: CVD mortality in Korea has remarkably decreased over the last 36 years. However, the recent rise in the absolute number of deaths from heart diseases, especially from heart failure, calls for attention in prevention and management of CVD and its sequelae.
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http://dx.doi.org/10.4070/kcj.2020.0424DOI Listing
April 2021

Socioeconomic Characteristics and Trends in the Consumption of Ultra-Processed Foods in Korea from 2010 to 2018.

Nutrients 2021 Mar 29;13(4). Epub 2021 Mar 29.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Korea.

There is growing evidence for a global transition to a more highly processed diet. While the dietary share of ultra-processed foods depends on a country's economic status, food choice and consumption are also influenced by the socioeconomic situation of individuals. This study investigated whether ultra-processed food consumption differed across socioeconomic subgroups and over time (2010-2018) in Korea. Cross-sectional data from the Korea National Health and Nutrition Examination Survey 2010-2018 were analyzed. Food and beverages reported in a one-day 24 h recall were classified according to the NOVA food classification criteria. The dietary energy contribution of ultra-processed foods was high among men and urban residents, and increased with education and income level; additionally, it reached its peak in adolescents and thereafter decreased with increasing age. After adjusting the socioeconomic variables, such associations remained significant, except for income level. The overall contribution of ultra-processed foods increased from 23.1% (2010-2012) to 26.1% (2016-2018), and the same trend over time was observed in all age groups and socioeconomic strata. In the Korean population, ultra-processed food consumption differed by individual socioeconomic characteristics, but gradually increased over time, and this trend was consistently found in all socioeconomic subgroups. Future strategies to promote healthy food choices are needed for the Korean population.
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http://dx.doi.org/10.3390/nu13041120DOI Listing
March 2021

Correction to: Korea hypertension fact sheet 2020: analysis of nationwide population-based data.

Clin Hypertens 2021 Mar 29;27(1):10. Epub 2021 Mar 29.

Department of Public Health, Yonsei University Graduate School, Seoul, 03722, South Korea.

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http://dx.doi.org/10.1186/s40885-021-00167-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008570PMC
March 2021

Office Blood Pressure Range and Cardiovascular Events in Patients With Hypertension: A Nationwide Cohort Study in South Korea.

J Am Heart Assoc 2021 Apr 19;10(7):e017890. Epub 2021 Mar 19.

Division of Cardiology Department of Internal Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea.

Background It is unclear what office blood pressure (BP) is the optimal treatment target range in patients with hypertension. Methods and Results Using the Korean National Health Insurance Service database, we extracted the data on 479 359 patients with hypertension with available BP measurements and no history of cardiovascular events from 2002 to 2011. The study end point was major cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, or stroke. This cohort study evaluated the association of BP levels (<120/<70, 120-129/70-79, 130-139/80-89, 140-149/90-99, and ≥150/≥100 mm Hg) with MACE. During a median follow-up of 9 years, 55 401 MACE were documented in our cohort. The risk of MACE was the lowest (adjusted hazard ratio [HR], 0.79; 95% CI, 0.76-0.84) at BP level of <120/<70 mm Hg, and was the highest (HR, 1.32; 95% CI, 1.29-1.36) at ≥150/≥100 mm Hg in comparison with 130 to 139/80 to 89 mm Hg. These results were consistent in all age groups and both sexes. Among patients treated with antihypertensive medication (n=237 592, 49.5%), in comparison with a BP level of 130 to 139/80 to 89 mm Hg, the risk of MACE was significantly higher in patients with elevated BP (≥140/≥90 mm Hg), but not significantly lower in patients with BP of <130/<80 mm Hg. Low BP <120/70 mm Hg was associated with increased risk of all-cause or cardiovascular death in all age groups. Conclusions BP level is significantly correlated with the risk of MACE in all Korean patients with hypertension. However, there were no additional benefits for MACE amongst those treated for hypertension with BP <120/70 mm Hg.
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http://dx.doi.org/10.1161/JAHA.120.017890DOI Listing
April 2021

Comorbidity index for predicting mortality at 6 months after reperfusion therapy.

Sci Rep 2021 Mar 16;11(1):5963. Epub 2021 Mar 16.

Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, Korea.

The eligibility of reperfusion therapy has been expanded to increase the number of patients. However, it remains unclear the reperfusion therapy will be beneficial in stroke patients with various comorbidities. We developed a reperfusion comorbidity index for predicting 6-month mortality in patients with acute stroke receiving reperfusion therapy. The 19 comorbidities included in the Charlson comorbidity index were adopted and modified. We developed a statistical model and it was validated using data from a prospective cohort. Among 1026 patients in the retrospective nationwide reperfusion therapy registry, 845 (82.3%) had at least one comorbidity. As the number of comorbidities increased, the likelihood of mortality within 6 months also increased (p < 0.001). Six out of the 19 comorbidities were included for developing the reperfusion comorbidity index on the basis of the odds ratios in the multivariate logistic regression analysis. This index showed good prediction of 6-month mortality in the retrospective cohort (area under the curve [AUC], 0.747; 95% CI, 0.704-0.790) and in 333 patients in the prospective cohort (AUC, 0.784; 95% CI, 0.709-0.859). Consideration of comorbidities might be helpful for the prediction of the 6-month mortality in patients with acute ischemic stroke who receive reperfusion therapy.
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http://dx.doi.org/10.1038/s41598-021-85390-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966783PMC
March 2021

Disparities in Mortality and Cardiovascular Events by Income and Blood Pressure Levels Among Patients With Hypertension in South Korea.

J Am Heart Assoc 2021 Apr 15;10(7):e018446. Epub 2021 Mar 15.

Division of Cardiology Department of Internal Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea.

Background Socioeconomic status is associated with differences in risk factors of cardiovascular disease and increased risks of cardiovascular disease and mortality. However, it is unclear whether an association exists between cardiovascular disease and income, a common measure of socioeconomic status, among patients with hypertension. Methods and Results This population-based longitudinal study comprised 479 359 patients aged ≥19 years diagnosed with essential hypertension. Participants were categorized by income and blood pressure levels. Primary end point was all-cause and cardiovascular mortality and secondary end points were cardiovascular events, a composite of cardiovascular death, myocardial infarction, and stroke. Low income was significantly associated with high all-cause (hazard ratio [HR], 1.26; 95% CI, 1.23-1.29, lowest versus highest income) and cardiovascular mortality (HR, 1.31; 95% CI, 1.25-1.38) as well as cardiovascular events (HR, 1.07; 95% CI, 1.05-1.10) in patients with hypertension after adjusting for age, sex, systolic blood pressure, body mass index, smoking status, alcohol consumption, physical activity, fasting glucose, total cholesterol, and the use of aspirin or statins. In each blood pressure category, low-income levels were associated with high all-cause and cardiovascular mortality and cardiovascular events. The excess risks of all-cause and cardiovascular mortality and cardiovascular events associated with uncontrolled blood pressure were more prominent in the lowest income group. Conclusions Low income and uncontrolled blood pressure are associated with increased all-cause and cardiovascular mortality and cardiovascular events in patients with hypertension. These findings suggest that income is an important aspect of social determinants of health that has an impact on cardiovascular outcomes in the care of hypertension.
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http://dx.doi.org/10.1161/JAHA.120.018446DOI Listing
April 2021

Korea hypertension fact sheet 2020: analysis of nationwide population-based data.

Clin Hypertens 2021 Mar 15;27(1). Epub 2021 Mar 15.

Department of Public Health, Yonsei University Graduate School, Seoul, 03722, South Korea.

Background: The Korean Society of Hypertension has published the Korea Hypertension Fact Sheet 2020 to provide an overview of the magnitude and management status of hypertension and their recent trends.

Methods: The Fact Sheets were based on the analyses of Korean adults aged 20 years or older of the 2007-2018 Korea National Health and Nutrition Examination Survey (KNHANES) and the 2002-2018 National Health Insurance Big Data (NHI-BD).

Results: Currently, the population average of systolic/diastolic blood pressure was 118/76 mmHg in Korean adults aged 20 years or older showing little change in the recent decade. However, the number of people with hypertension increased steadily, exceeding 12.0 million. Indeed, the number of people diagnosed with hypertension increased from 3.0 million in 2002 to 9.7 million in 2018. During the same period, the number of people using antihypertensive medication increased from 2.5 million to 9.0 million, and the number of people adherent to treatment increased from 0.6 million to 6.5 million. Hypertension awareness, treatment, and control rates increased rapidly until 2007, but showed plateaued thereafter. In 2018, the awareness, treatment, and control rates of hypertension among all adults were 67, 63, and 47%, respectively. However, the awareness and treatment rates were only 17 and 14% among adults aged 20 to 39 years old with hypertension. Among patients treated for hypertension, 61% of them were also using glucose-lowering or lipid-lowering drugs. Among antihypertensive prescriptions, 41% of the patients received monotherapy, 43% received dual therapy, and 16% received triple or more therapy. The most commonly prescribed antihypertensive medication was angiotensin receptor blockers, followed by calcium channel blockers and diuretics.

Conclusion: To achieve further improvement in management of hypertension, we need to encourage awareness and treatment in young adults. It is required to develop tailored prevention and management strategies that are appropriate for and inclusive of various demographics.
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http://dx.doi.org/10.1186/s40885-021-00166-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958489PMC
March 2021

Protective effect of controlled blood pressure on risk of dementia in low-risk, grade 1 hypertension.

J Hypertens 2021 Mar 11. Epub 2021 Mar 11.

Division of Cardiology, Severance Cardiovascular Hospital and Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul Department of Statistics and Computer Science, Daegu University, Gyeongsan Department of Preventive Medicine, Yonsei University College of Medicine Division of Nephrology, Department of Internal Medicine, School of Medicine, Ewha Womans University Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea Division of Cardiology, Seoul National University College of Medicine Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Department of Internal Medicine, Cardiovascular Center, School of Medicine, Ewha Womans University Institute of Human Complexity and Systems Science, Yonsei University, Seoul, Republic of Korea.

Objective: High blood pressure (BP) increases the risk of dementia; however, few studies have reported on the risk of dementia in patients with low-risk, early-grade hypertension. We investigated the protective effect of controlled BP on risk of dementia in treated, low-risk, grade 1 hypertensive patients from the entire National Health Insurance Service National Health Examinee cohort.

Methods: We selected grade 1 hypertension (140-159/90-99 mmHg) patients with low risk, diagnosed in 2005-2006. All patients (N = 128 665) were classified into controlled (average BP < 140/90 mmHg during the follow-up) and uncontrolled (average BP ≥ 140/90 mmHg) BP groups and followed up until 2015. The risk of dementia was estimated using Cox proportional hazard model after adjustments for propensity score.

Results: Average BP was 131/81 mmHg in the controlled group (N = 49 408) and 144/87 mmHg in the uncontrolled group (N = 99 257). Overall dementia incidence rates in controlled and uncontrolled groups were 4.9 and 8.1 per 1000 person-year, respectively. The controlled group showed lower risk of overall dementia, Alzheimer's disease, and vascular dementia than the uncontrolled group. The controlled group had a low risk of vascular dementia at all ages, especially in the younger group (age <60). The optimal BP level associated with the lowest risk of dementia was 130 to less than 140 mmHg for SBP and 70 to less than 80 mmHg for DBP.

Conclusion: We concluded that among even low-risk and grade 1 hypertension patients, controlled BP significantly reduced the risk of dementia, including Alzheimer's disease and vascular dementia.
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http://dx.doi.org/10.1097/HJH.0000000000002820DOI Listing
March 2021

Adherence to Antihypertensive Medication and Incident Cardiovascular Events in Young Adults With Hypertension.

Hypertension 2021 Apr 1;77(4):1341-1349. Epub 2021 Mar 1.

From the Department of Preventive Medicine (H.L., H.C.K.), Yonsei University College of Medicine, Seoul, Korea.

[Figure: see text].
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.16784DOI Listing
April 2021

Correlates of psychological resilience and risk: Prospective associations of self-reported and relative resilience with Connor-Davidson resilience scale, heart rate variability, and mental health indices.

Brain Behav 2021 Feb 27:e02091. Epub 2021 Feb 27.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.

Background: There are several ways to determine psychological resilience. However, the correlation between each measurement is not clear. We explored associations of baseline relative "resilience" and risk with later self-reported trait resilience and other biological/mental health indices.

Methods: We utilized baseline and follow-up survey data from 500 participants aged 30-64 in the community cohort. Baseline "relative" resilience was defined by: (a) negative life events (NLEs) in the six months before baseline and (b) depressive symptoms at baseline, yielding four groups of individuals: i) "Unexposed and well," "Vulnerable (depression)," "Reactive (depression)," and "Resilient." "Trait" resilience at follow-up was self-reported using the Connor-Davidson Resilience Scale (CD-RISC). Associations between relative resilience at baseline, CD-RISC, and heart rate variability (HRV) indices at follow-up were assessed with generalized linear regression models after adjustments. Associations between baseline resilience and subsequent loneliness/depression indices were also evaluated.

Results: Overall trait resilience and its subfactors at follow-up showed strong negative associations with "Reactive" at baseline (adj-β for total CD-RISC score: -11.204 (men), -9.472 (women)). However, resilience at baseline was not associated with later HRV, which was compared with the significant positive association observed between CD-RISC and HRV at the same follow-up time point. The "Reactive" exhibited significantly increased depressive symptoms at follow-up. The overall distribution pattern of CD-RISC subfactors differed by baseline resilience status by sex.

Conclusions: The "relative" resilience based on the absence of depression despite prior adversity seems to be highly related with trait resilience at follow-up but not with HRV. The sub-factor pattern of CD-RISC was different by sex.
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http://dx.doi.org/10.1002/brb3.2091DOI Listing
February 2021

Association between Socioeconomic Status and Longitudinal Sleep Quality Patterns Mediated by Depressive Symptoms.

Sleep 2021 Feb 25. Epub 2021 Feb 25.

Department of Public Health, Yonsei University Graduate School, Seoul, South Korea.

Study Objectives: We aimed to examine whether associations between socioeconomic status (SES) and longitudinal sleep quality patterns are mediated by depressive symptoms.

Methods: We utilized data on 3,347 participants in the Korean Genome and Epidemiology Study aged 40-69 years at baseline from 2001-2002 who were followed up for 16 years. A group-based modeling approach was used to identify sleep quality trajectories using the Pittsburgh Sleep Quality Index (year 2, 6, 8, 10, and 12). Educational attainment (college graduated or less), monthly household income (≥$2,500 or less), and occupation (unemployed, manual labor, and professional labor) at baseline (year 0) were used for analyses. Depressive symptoms were assessed using Beck's Depression Inventory at year 4. Associations between SES and sleep quality patterns were examined using a multinomial logistic regression model. The mediation effect of depressive symptoms was further examined using PROC CAUSALMED.

Results: We identified five distinct sleep quality trajectories: "normal-stable" (n=1,697), "moderate-stable" (n=1,157), "poor-stable" (n=320), "developing to poor" (n=84), and "severely poor-stable" (n=89). Overall, associations between SES levels and longitudinal sleep patterns were not apparent after full adjustment for socio-demographic and lifestyle factors measured at baseline. Depressive symptoms, however, tended to fully mediate associations between SES levels and sleep quality patterns (odds ratio range for indirect effects of depressive symptoms: for education, 1.05-1.17; for income, 1.05-1.15).

Conclusion: A significant mediating role for depressive symptoms between SES levels and longitudinal sleep quality warrants consideration among mental health care professionals.
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http://dx.doi.org/10.1093/sleep/zsab044DOI Listing
February 2021

Association between Physical Activity and Inflammatory Markers in Community-Dwelling, Middle-Aged Adults.

Appl Physiol Nutr Metab 2021 Feb 10. Epub 2021 Feb 10.

Yonsei University College of Medicine, 37991, Department of Preventive Medicine, Seodaemun-gu, Korea (the Republic of).

Physical activity has been known to deter inflammatory process; yet, the evidence is scarce in healthy, middle-aged population. We assessed the association between physical activity and inflammatory biomarkers, including high sensitivity (hs) C-reactive protein (CRP), interleukin (IL)-1α, -1β, -6, tumor necrosis factor (TNF) -α, -β, and monocyte chemotactic protein (MCP) -1, -3. Functional and leisure-time physical activity was assessed by the International Physical Activity Questionnaire. Inflammatory biomarkers were measured by multiplex enzyme-linked immunosorbent assay. Compared to highly physically active participants based on total metabolic equivalent of task, the most sedentary group had significantly higher odds ratio (OR) and [95% confidence interval (CI)] for ≥75th percentile of TNF-α (1.64 [1.10-2.44]), TNF-β (1.50 [1.09-2.07]), IL-1β (2.14 [1.49-3.09]), hsIL-1β (1.72 [1.15-2.58]), IL-6 (1.84 [1.24-1.73]), hsIL-6 (2.05 [1.35-3.12]), and MCP-1 (1.91 [1.28-2.87]) levels. Results for IL-1α and MCP-3 were inconsistent, as the least active group had lower odds for above the median IL-1α (0.65 [0.49-0.95]) and MCP-3 (0.71 [0.54-0.93]) yet higher odds for ≥75th percentile IL-1α (2.36 [1.63-3.42]) and MCP-3 (2.44 [1.63-3.64]) levels. Based on duration of moderate-to-vigorous physical activity, sedentary participants had significantly higher odds for above median (1.40 [1.13-1.73]) and ≥75th percentile (1.33 [1.00-1.77]) IL-1β compared to those fulfilling the guideline recommendation. Subgroup analyses showed minimal sex differences. Routine inflammatory assessment may help to achieve primordial prevention of cardiovascular and metabolic diseases. NOVELTY ●Healthy, middle-aged adults with physically active lifestyle were generally at lower odds for elevated inflammatory status. ●The associations persisted regardless of sex, age, comorbidities, adiposity, and diet.
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http://dx.doi.org/10.1139/apnm-2020-1069DOI Listing
February 2021

Computed Tomography-Derived Skeletal Muscle Radiodensity Predicts Peak Weight-Corrected Jump Power in Older Adults: The Korean Urban Rural Elderly (KURE) Study.

Calcif Tissue Int 2021 Feb 10. Epub 2021 Feb 10.

Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.

Computed tomography (CT)-derived skeletal muscle area (SMA) and skeletal muscle radiodensity (SMD) reflect distinctive quantitative and qualitative characteristics of skeletal muscles. However, data on whether CT-based muscle parameters, especially SMD, can predict muscle function is limited. In a prospective cohort, 1523 community-dwelling older adults who underwent abdominal CT scans and the countermovement two-legged jumping test on a ground reaction force platform were analyzed (mean age 74.7 years, 65.1% women). SMA and SMD were measured at third lumbar vertebra level (L3). Individuals with low jump power (peak weight-corrected jump power < 23.8 W/kg in men and < 19.0 W/kg in women using clinically validated threshold) were older; had lower SMA, SMD, and maximal grip strength values; and had lower chair rise test and timed up and go test performance than those without low jump power. SMD was positively associated with peak weight-corrected jump power (adjusted β = 0.33 and 0.23 per 1 HU increase in men and women, respectively, p < 0.001). One HU decrement in SMD was associated with 10% elevated odds of low jump power (adjusted OR [aOR] 1.10, p < 0.001) after adjusting for age, sex, height, inflammation, and insulin resistance markers, whereas the association of SMA with low jump power was attenuated (aOR 1.00, p = 0.721). SMD showed better discrimination for low jump power than SMA (AUC 0.699 vs. 0.617, p < 0.001), with additional improvement when added to SMA and conventional risk factors (AUC 0.745 to 0.773, p < 0.001). Therefore, CT-measured L3 SMD can be a sensitive surrogate marker for muscle function along with SMA in older adults, which merits further investigation.
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http://dx.doi.org/10.1007/s00223-021-00812-9DOI Listing
February 2021

Association between nocturnal blood pressure dipping and chronic kidney disease among patients with controlled office blood pressure.

Am J Hypertens 2021 Feb 9. Epub 2021 Feb 9.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background: Although abnormal blood pressure patterns are associated with adverse cardiorenal outcomes, their associations are yet unquantified by nocturnal dipping status. We examined the association of nocturnal blood pressure dipping pattern with albuminuria and kidney function among participants with controlled hypertension without prior advanced kidney disease.

Methods: Ambulatory blood pressure measurements were collected from 995 middle-aged, cardiology clinic patients with controlled office blood pressure (<140/90 mmHg). The magnitude of dipping was calculated as the difference between daytime and nighttime systolic blood pressure divided by daytime systolic blood pressure. Accordingly, the participants were categorized as extreme-dipper (≥20%), dipper (10-<20%), non-dipper (0-<10%), or reverse-dipper (<0%). We analyzed the cross-sectional associations of dipping with albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and decreased estimated glomerular filtration rate (<60 ml/min/1.73m 2), adjusting for office/ambulatory blood pressure, antihypertensive class, body mass index, total cholesterol, fasting glucose, socioeconomic status, and health behavior.

Results: The participants (mean age 60.2 years; 52.9% male) consisted of 13.5% extreme-dippers, 43.1% dippers, 34.7% non-dippers, and 8.7% reverse-dippers. In reference to dippers, odds ratios [95% confidence interval] for albuminuria were 1.73 [1.04-2.60] in reverse-dippers, 1.67 [1.20-2.32] in non-dippers, and 0.62 [0.38-1.04] in extreme-dippers. Likewise, abnormal dipping profile was associated with decreased kidney function: reverse-dipping, 2.02 [1.06-3.84]; non-dipping, 1.98 [1.07-3.08]; extreme-dipping, 0.69 [0.20-1.17]. The associations persisted participants with more conservatively controlled office blood pressure (<130/80 mmHg).

Conclusions: Monitoring diurnal and nocturnal blood pressure may identify chronic kidney disease otherwise overlooked based on office blood pressure.
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http://dx.doi.org/10.1093/ajh/hpab031DOI Listing
February 2021

Risk Factors Influencing the Occurrence and Severity of Symptomatic Dry Eye Syndrome: A Cross-sectional Study.

Ophthalmic Epidemiol 2021 Jan 31:1-7. Epub 2021 Jan 31.

Department of Preventive Medicine, Yonsei University College of Medicine , Seoul, Republic of Korea.

: We aimed to investigate the prevalence and risk factors of dry eye syndrome (DES) among a population-based cohort study.: This cross-sectional study was conducted on 475 subjects (184 men and 291 women) enrolled in the Study Group for Environmental Eye Disease at July 2013. Using the ocular surface disease index (OSDI), we measured the DES severity and defined DES as OSDI score ≥13. Current symptoms of DES and possible risk factors such as body mass index, occupations, comorbidities, exercise, smoking and drinking status were assessed by multivariate logistic regression.: Prevalence of DES was significantly higher in women (52.6%) than in men (41.9%) ( < .001). Compared to white-collar workers, blue-collar workers and unemployed persons showed significantly higher DES prevalence and severity. Compared to those with low BMI (<23.0 kg/m), people with extremely high BMI (≥30.0 kg/m) had significantly higher odds ratio (OR) of having DES after fully adjusted for sex, age, hypertension, diabetes, menopausal status, hormone replacement therapy, occupation, and lifestyle factors (OR: 2.83, 95% confidence interval: 1.04-7.71).: We found some novel factors which have been unknown to the relationship with DES through the five years observation of the cohort. The positive associations of unemployment status, blue-collar work, alcohol habit, and obesity with DES suggests a person's comprehensive condition, not individual factors, contribute significantly in developing DES. Further studies will be helpful to understand the underlying mechanisms.
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http://dx.doi.org/10.1080/09286586.2021.1879172DOI Listing
January 2021

Smartphone / smartwatch-based cuffless blood pressure measurement : a position paper from the Korean Society of Hypertension.

Clin Hypertens 2021 Jan 25;27(1). Epub 2021 Jan 25.

Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea.

Smartphone technology has spread rapidly around the globe. According to a report released by the Korea Information Society Development Institute, about 95% of Koreans aged more than 30 years old owned smartphones. Recently, blood pressure (BP) measurement using a photoplethysmography-based smartphone algorithm paired with the smartwatch is continuously evolving. In this document, the Korean Society of Hypertension intends to remark the current results of smartphone / smartwatch-based BP measurement and recommend optimal BP measurement methods using a smartphone device. We aim to increase the likelihood of success in implementing these new technologies into improved hypertension awareness, diagnosis, and control.
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http://dx.doi.org/10.1186/s40885-020-00158-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831256PMC
January 2021

Response by Lee et al to Letter Regarding Article, "Cardiovascular Risk of Isolated Systolic or Diastolic Hypertension in Young Adults".

Circulation 2021 Jan 19;143(3):e22-e23. Epub 2021 Jan 19.

Department of Preventive Medicine (H.L., H.C.K.), Yonsei University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.051719DOI Listing
January 2021

Metabolic Dysfunction-Associated Fatty Liver Disease and Incident Cardiovascular Disease Risk: A Nationwide Cohort Study.

Clin Gastroenterol Hepatol 2020 Dec 22. Epub 2020 Dec 22.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea. Electronic address:

Background & Aims: An international expert panel proposed a new definition for metabolic dysfunction-associated fatty liver disease (MAFLD) as a name change from nonalcoholic fatty liver disease (NAFLD). The clinical impact of this change on the assessment of cardiovascular disease (CVD) risk is yet unknown. We evaluated the prevalence of fatty liver disease (FLD) and the associated CVD risk using each of these definitions.

Methods: From a nationwide health screening database, we included 9,584,399 participants (48.5% male) aged 40-64 years between 2009 and 2010. Participants were categorized by presence of NAFLD and MAFLD, separately, and by the combination of the 2 definitions-Neither-FLD, NAFLD-only, MAFLD-only, or Both-FLD. The primary outcome was a composite CVD event, including myocardial infarction, ischemic stroke, heart failure, or CVD-related death.

Results: The prevalence of NAFLD and MAFLD was 28.0% and 37.3%, respectively. After excluding those with prior CVD, 8,962,813 participants were followed for a median of 10.1 years. NAFLD and MAFLD were each associated with significantly higher risk for CVD events. When the Neither-FLD group was the reference, multivariable-adjusted hazard ratios (95% confidence interval) for CVD events were 1.09 (1.03-1.15) in the NAFLD-only group, 1.43 (1.41-1.45) in the MAFLD-only group, and 1.56 (1.54-1.58) in the Both-FLD group.

Conclusions: A considerable proportion of middle-aged Korean adults have MAFLD without satisfying the former definition of NAFLD. The change from NAFLD to MAFLD criteria may identify a greater number of individuals with metabolically complicated fatty liver and increased risk for CVD.
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http://dx.doi.org/10.1016/j.cgh.2020.12.022DOI Listing
December 2020

Prediction of systemic biomarkers from retinal photographs: development and validation of deep-learning algorithms.

Lancet Digit Health 2020 10;2(10):e526-e536

Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore. Electronic address:

Background: The application of deep learning to retinal photographs has yielded promising results in predicting age, sex, blood pressure, and haematological parameters. However, the broader applicability of retinal photograph-based deep learning for predicting other systemic biomarkers and the generalisability of this approach to various populations remains unexplored.

Methods: With use of 236 257 retinal photographs from seven diverse Asian and European cohorts (two health screening centres in South Korea, the Beijing Eye Study, three cohorts in the Singapore Epidemiology of Eye Diseases study, and the UK Biobank), we evaluated the capacities of 47 deep-learning algorithms to predict 47 systemic biomarkers as outcome variables, including demographic factors (age and sex); body composition measurements; blood pressure; haematological parameters; lipid profiles; biochemical measures; biomarkers related to liver function, thyroid function, kidney function, and inflammation; and diabetes. The standard neural network architecture of VGG16 was adopted for model development.

Findings: In addition to previously reported systemic biomarkers, we showed quantification of body composition indices (muscle mass, height, and bodyweight) and creatinine from retinal photographs. Body muscle mass could be predicted with an R of 0·52 (95% CI 0·51-0·53) in the internal test set, and of 0·33 (0·30-0·35) in one external test set with muscle mass measurement available. The R value for the prediction of height was 0·42 (0·40-0·43), of bodyweight was 0·36 (0·34-0·37), and of creatinine was 0·38 (0·37-0·40) in the internal test set. However, the performances were poorer in external test sets (with the lowest performance in the European cohort), with R values ranging between 0·08 and 0·28 for height, 0·04 and 0·19 for bodyweight, and 0·01 and 0·26 for creatinine. Of the 47 systemic biomarkers, 37 could not be predicted well from retinal photographs via deep learning (R≤0·14 across all external test sets).

Interpretation: Our work provides new insights into the potential use of retinal photographs to predict systemic biomarkers, including body composition indices and serum creatinine, using deep learning in populations with a similar ethnic background. Further evaluations are warranted to validate these findings and evaluate the clinical utility of these algorithms.

Funding: Agency for Science, Technology, and Research and National Medical Research Council, Singapore; Korea Institute for Advancement of Technology.
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http://dx.doi.org/10.1016/S2589-7500(20)30216-8DOI Listing
October 2020

Effects of Income Level on the Association Between Hypertension and Depression: 2010-2017 Korea National Health and Nutrition Examination Survey.

J Prev Med Public Health 2020 Nov 8;53(6):439-446. Epub 2020 Oct 8.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Objectives: This study analyzed the associations of hypertension (HTN) with symptoms and diagnosis of depression by income level among Korean adults.

Methods: This study was based on the 2010-2017 Korea National Health and Nutrition Examination Survey data; a total of 29 425 adults (aged 20 years or older) were analyzed. HTN was defined as a systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or use of hypertensive medications. Depression symptoms were evaluated based on a questionnaire about depression-related symptoms. A depression diagnosis was defined based on questionnaire responses indicating that a participant had been diagnosed with depression. Household income was divided into higher or lower income ranges based on the median income of the participants. Multiple logistic regression analyses were performed to assess the associations between HTN and depression symptoms/diagnosis in the higher-income and lower-income groups.

Results: In the higher-income group, the odds ratio (OR) for the association between HTN and depression symptoms was 1.15 (95% confidence interval [CI], 0.97 to 1.37), and the OR for the association between HTN and depression diagnosis was 1.41 (95% CI, 1.13 to 1.76). In the lower-income group, the OR for the association between HTN and depression symptoms was 1.18 (95% CI, 1.04 to 1.34), whereas the OR for the association between HTN and depression diagnosis was 0.82 (95% CI, 0.70 to 0.97).

Conclusions: The associations of HTN with symptoms and diagnosis of depression differed by income level.
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http://dx.doi.org/10.3961/jpmph.20.337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733750PMC
November 2020

Association of social network size and composition with physical activity in Korean middle-aged adults.

Epidemiol Health 2020 25;42:e2020070. Epub 2020 Nov 25.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Objectives: Physical activity (PA) is an established protective factor for many chronic diseases. Numerous studies have established positive relationships between social networks and PA. Accordingly, this study examined the relationship between social network structures (specifically the network size and the number and proportion of same-sex alters) and self-reported PA in Korean middle-age adults, where the term "alter" refers to a respondent's social network members.

Methods: We analyzed 8,092 participants of the Cardiovascular and Metabolic Diseases Etiology Research Center cohort. We assessed the association between each network structure variable and PA level using a linear regression model. Then, we employed logistic regression to evaluate associations between social network structure and adherence to guideline-recommended exercise levels. Socio-demographic factors and health status measures were used as covariates.

Results: In both sexes, the social network size and proportion of same-sex network members showed positive relationships with total and moderate-to-vigorous PA. Notably, female participants with a greater number of kin were more likely to satisfy the recommended amount of total PA.

Conclusions: These findings suggest that large scale, same-sex intervention programs can help to achieve recommended PA regimens.
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http://dx.doi.org/10.4178/epih.e2020070DOI Listing
February 2021

Psychosocial factors affecting sleep misperception in middle-aged community-dwelling adults.

PLoS One 2020 23;15(10):e0241237. Epub 2020 Oct 23.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Sleep misperception has long been a major issue in the field of insomnia research. Most studies of sleep misperception examine sleep underestimation by comparing the results of polysomnography conducted in a laboratory environment with patients' sleep diary entries. We aimed to investigate psychosocial characteristics of adults who underestimated or overestimated sleep time in a nonclinical, middle-aged community-dwelling population. We collected one week of sleep data with wrist-worn accelerometers. We used egocentric social network analysis to analyze the effects of psychosocial factors. Among 4,060 study participants, 922 completed the accelerometer substudy. Underestimation was defined as an accelerometer-measured sleep time ≥ 6 h and a subjective sleep time < 6 h. Overestimation was defined as an objective sleep time < 6 h and a subjective sleep time ≥ 6 h. Psychosocial characteristics of the sleep misperception group were evaluated using multivariate regression analysis. A total of 47 participants underestimated sleep time, and 420 overestimated sleep time. Regression analysis revealed that women, living with spouse, economic satisfaction, and bridging potential had protective effects against sleep underestimation. Blame from a spouse involved a 3.8-times higher risk of underestimation than the control group (p = 0.002). In men, discussing concerns with a spouse had a protective effect against underestimation (p < 0.001). Economic satisfaction, feeling social network-based intimacy, and support from a spouse were associated with overestimation in women. In men, feeling social network-based intimacy was also associated with overestimation (p < 0.001). We found that social relationship quality was related to sleep overestimation and underestimation. This association was marked in women. Good social relationships may have positive effects on sleep misperception via attenuation of negative emotional reactions and effects on emotional regulation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241237PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584196PMC
December 2020

Blood pressure levels and cardiovascular risk according to age in patients with diabetes mellitus: a nationwide population-based cohort study.

Cardiovasc Diabetol 2020 10 19;19(1):181. Epub 2020 Oct 19.

Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.

Background: Little is known about age-specific target blood pressure (BP) in hypertensive patients with diabetes mellitus (DM). The aim of this study was to determine the BP level at the lowest cardiovascular risk of hypertensive patients with DM according to age.

Methods: Using the Korean National Health Insurance Service database, we analyzed patients without cardiovascular disease diagnosed with both hypertension and DM from January 2002 to December 2011. Primary end-point was composite cardiovascular events including cardiovascular death, myocardial infarction and stroke.

Results: Of 241,148 study patients, 35,396 had cardiovascular events during a median follow-up period of 10 years. At the age of < 70 years, the risk of cardiovascular events was lower in patients with BP < 120/70 mmHg than in those with BP 130-139/80-89 mmHg. At the age of ≥ 70, however, there were no significant differences in the risk of cardiovascular events between patients with BP 130-139/80-89 mmHg and BP < 120/70 mmHg. The risk of cardiovascular events was similar between patients with BP 130-139/80-89 mmHg and BP 120-129/70-79 mmHg, and it was significantly higher in those with BP ≥ 140/90 mmHg than in those with BP 130-139/80-89 mmHg at all ages.

Conclusions: In a cohort of hypertensive patients who had DM but no history of cardiovascular disease, lower BP was associated with lower risk of cardiovascular events especially at the age of < 70. However, low BP < 130-139/80-89 mmHg was not associated with decreased cardiovascular risk, it may be better to keep the BP of 130-139/80-89 mmHg at the age of ≥ 70.
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http://dx.doi.org/10.1186/s12933-020-01156-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574489PMC
October 2020

Effect of Smartphone-Based Lifestyle Coaching App on Community-Dwelling Population With Moderate Metabolic Abnormalities: Randomized Controlled Trial.

J Med Internet Res 2020 10 9;22(10):e17435. Epub 2020 Oct 9.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

Background: Metabolic disorders are established precursors to cardiovascular diseases, yet they can be readily prevented with sustained lifestyle modifications.

Objective: We assessed the effectiveness of a smartphone-based weight management app on metabolic parameters in adults at high-risk, yet without physician diagnosis nor pharmacological treatment for metabolic syndrome, in a community setting.

Methods: In this 3-arm parallel-group, single-blind, randomized controlled trial, we recruited participants aged 30 to 59 years with at least 2 conditions defined by the Third Report of the National Cholesterol Education Program expert panel (abdominal obesity, high blood pressure, high triglycerides, low high-density lipoprotein cholesterol, and high fasting glucose level). Participants were randomly assigned (1:1:1) by block randomization to either the nonuser group (control), the app-based diet and exercise self-logging group (app only), or the app-based self-logging and personalized coaching from professional dieticians and exercise coordinators group (app with personalized coaching). Assessments were performed at baseline, week 6, week 12, and week 24. The primary outcome was change in systolic blood pressure (between baseline and follow-up assessments). Secondary outcomes were changes in diastolic blood pressure, body weight, body fat mass, waist circumference, homeostatic model of assessment of insulin resistance, triglyceride level, and high-density lipoprotein cholesterol level between baseline and follow-up assessments. Analysis was performed using intention-to-treat.

Results: Between October 28, 2017 and May 28, 2018, 160 participants participated in the baseline screening examination. Participants (129/160, 80.6%) who satisfied the eligibility criteria were assigned to control (n=41), app only (n=45), or app with personalized coaching (n=43) group. In each group, systolic blood pressure showed decreasing trends from baseline (control: mean -10.95, SD 2.09 mmHg; app only: mean -7.29, SD 1.83 mmHg; app with personalized coaching: mean -7.19, SD 1.66 mmHg), yet without significant difference among the groups (app only: P=.19; app with personalized coaching: P=.16). Instead, those in the app with personalized coaching group had greater body weight reductions (control: mean -0.12, SD 0.30 kg; app only: mean -0.35, SD 0.36 kg, P=.67; app with personalized coaching: mean -0.96, SD 0.37 kg; P=.08), specifically by body fat mass reduction (control: mean -0.13, SD 0.34 kg; app only: mean -0.64, SD 0.38 kg, P=.22; app with personalized coaching: mean -0.79, SD 0.38 kg; P=.08).

Conclusions: Simultaneous diet and exercise self-logging and persistent lifestyle modification coaching were ineffective in lowering systolic blood pressure but effective in losing weight and reducing body fat mass. These results warrant future implementation studies of similar models of care on a broader scale in the context of primary prevention.

Trial Registration: ClinicalTrials.gov NCT03300271; http://clinicaltrials.gov/ct2/show/NCT03300271.
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http://dx.doi.org/10.2196/17435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584978PMC
October 2020

Indoxyl Sulfate-Mediated Metabolic Alteration of Transcriptome Signatures in Monocytes of Patients with End-Stage Renal Disease (ESRD).

Toxins (Basel) 2020 09 28;12(10). Epub 2020 Sep 28.

Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul 03080, Korea.

End-stage renal disease (ESRD) is the final stage of chronic kidney disease, which is increasingly prevalent worldwide and is associated with the progression of cardiovascular disease (CVD). Indoxyl sulfate (IS), a major uremic toxin, plays a key role in the pathology of CVD via adverse effects in endothelial and immune cells. Thus, there is a need for a transcriptomic overview of IS responsive genes in immune cells of ESRD patients. Here, we investigated IS-mediated alterations in gene expression in monocytes from ESRD patients. Transcriptomic analysis of ESRD patient-derived monocytes and IS-stimulated monocytes from healthy controls was performed, followed by analysis of differentially expressed genes (DEGs) and gene ontology (GO). We found that 148 upregulated and 139 downregulated genes were shared between ESRD patient-derived and IS-stimulated monocytes. Interaction network analysis using STRING and ClueGo suggests that mainly metabolic pathways, such as the pentose phosphate pathway, are modified by IS in ESRD patient-derived monocytes. These findings were confirmed in IS-stimulated monocytes by the increased mRNA expression of genes including G6PD, PGD, and TALDO1. Our data suggest that IS causes alteration of metabolic pathways in monocytes of ESRD patients and, thus, these altered genes may be therapeutic targets.
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http://dx.doi.org/10.3390/toxins12100621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601745PMC
September 2020

Factors Associated with Awareness, Treatment, and Control Rate of Hypertension among Korean Young Adults Aged 30-49 Years.

Korean Circ J 2020 Dec 7;50(12):1077-1091. Epub 2020 Sep 7.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background And Objectives: Hypertension awareness, treatment, and control have been substantially improved in the last decades worldwide, but hypertension management in younger adults is still challenged. We analyzed a nationally representative sample of Korea to investigate factors affecting hypertension management among the young Korean population.

Methods: Among 8,024 young adults aged 30-49 years from the 2014-2018 Korea National Health and Nutrition Examination Survey, 1,103 participants with hypertension were analyzed to identify factors associated with hypertension management status. Multiple logistic regression models were conducted separately by sex.

Results: Young adults with hypertension showed a low rate of awareness (35.8%), treatment (30.9%), and control (23.0%). The older age (40-49 years), obese (body mass index ≥25.0 kg/m²), having diabetes mellitus (DM), and having past-history of cardiovascular disease were positively associated with awareness, and taking health examination in the past 2 years were positively associated with both treatment and control of hypertension among male. Young females who were older (40-49 years), rural residents, unemployed, not taking sodium over the recommended amount, having dyslipidemia, and having DM showed a higher likelihood of awareness. Young females who have not experienced unmet medical needs in the past year were more likely to be treated or controlled with hypertension.

Conclusions: The factors associated with hypertension awareness, treatment, and control were different by sex and age group. Enhancing attention on hypertension among young hypertension and encouraging them to visit clinics would be key strategies to improve hypertension management among the young hypertensive population.
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http://dx.doi.org/10.4070/kcj.2020.0208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7707985PMC
December 2020

2018 Guidelines for the Management of Dyslipidemia in Korea.

J Lipid Atheroscler 2019 Sep 7;8(2):78-131. Epub 2019 Aug 7.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.

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http://dx.doi.org/10.12997/jla.2019.8.2.78DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379116PMC
September 2019