Several randomized placebo controlled clinical trials, which were based on the solid data from cell biologic, animal, and phase 1 clinical trials, have been published to demonstrate the efficacy of cell therapy to improve the contractility of myocardium in patients with myocardial infarction. Intracoronary infusion of the bone marrow mononuclear cells into infarct territory proved to be effective in improving coronary flow and contractility of the damaged myocardium in patients with AMI or OMI. Intracoronary infusion of the mobilized peripheral blood mononuclear cells with G-SF also proved to be effective in induction of angiomyogenesis in infarct territory of patients with AMI. Intramyocardial injection surgically or through catheter of autologous skeletal myoblast expanded ex vivo provided gain of LV contractility with possible side effect of arrhythmogenecity. From these trials we got the insight regarding the limitation and the solution to overcome it. In order to introduce cell therapy in the daily clinical practice, we have to find out the best protocol to ensure the reproducible and remarkable efficacy from active communication between basic and clinical researches. The limitation of efficacy in cell therapy may be overcome in two ways. One is to enhance the number and vitality/function of the cells for therapy. The other is to improve the homing/integration rate of transplanted cells to infarct territory after intracoronary infusion or intramyocardial injection.Stem cell therapy for angiomyogenesis in infarcted myocardium of patients proved to be effective. Future studies should be focused on to improve the limited efficacy and then to test the new protocols in large clinical trials.
Animals ; Bone Marrow ; Catheters ; Cell- and Tissue-Based Therapy ; Granulocyte Colony-Stimulating Factor ; Humans ; Myoblasts, Skeletal ; Myocardial Infarction* ; Myocardium ; Stem Cells*

Stem cell therapy using mobilized peripheral blood stem cells with G-CSF is considered a promising alternative of bone marrow stem cell therapy. G-CSF based therapy has many advantages compared to stem cell therapy using bone marrow stem cells, including noninvasiveness and direct protective effects on cardiomyocytes. Results from clinical trials using G-CSF mobilization alone showed mixed outcomes. However, additional intra-coronary infusion of mobilized stem cell by G-CSF showed better and consistent improvement in outcomes than G-CSF mobilization alone. Safety concerns about G-CSF raised by earlier clinical trials, such as aggravation of restenosis, were mostly resolved by recent clinical trials. However, long term safety and efficacy of stem cell therapy should be carefully evaluated by further studies. Current efficacy of stem cell therapy should be improved by tailored therapy for individual patients and optimized by modification of current stem cell therapy.
Bone Marrow ; Granulocyte Colony-Stimulating Factor* ; Humans ; Myocardial Infarction* ; Myocytes, Cardiac ; Stem Cells*

Stem cell therapy using mobilized peripheral blood stem cells with G-CSF is considered a promising alternative of bone marrow stem cell therapy. G-CSF based therapy has many advantages compared to stem cell therapy using bone marrow stem cells, including noninvasiveness and direct protective effects on cardiomyocytes. Results from clinical trials using G-CSF mobilization alone showed mixed outcomes. However, additional intra-coronary infusion of mobilized stem cell by G-CSF showed better and consistent improvement in outcomes than G-CSF mobilization alone. Safety concerns about G-CSF raised by earlier clinical trials, such as aggravation of restenosis, were mostly resolved by recent clinical trials. However, long term safety and efficacy of stem cell therapy should be carefully evaluated by further studies. Current efficacy of stem cell therapy should be improved by tailored therapy for individual patients and optimized by modification of current stem cell therapy.
Bone Marrow ; Granulocyte Colony-Stimulating Factor* ; Humans ; Myocardial Infarction* ; Myocytes, Cardiac ; Stem Cells*

BACKGROUND: The accumulation of lipoprotein and monocyte in the intima of the arterial wall is the most important step of the development of coronary artery disease (CAD). Lipoprotein lipase (LPL) plays an anti-atherogenic role by lipolysis of triglyceride-rich lipoproteins, but, it may also act as a receptor of some lipoproteins and monocyte at the arterial wall and act as a atherogenic molecule. Previous studies showed somewhat contradictory results about the association of CAD and LPL polymorphisms and mutations. Racial and dietary difference may contribute to these contradictory results. In this study, we tried to find out the association of CAD and the genetic variation of the LPL (PvuII RFLP in intron 6, HindIII RFLP in intron 8 and Ser 447 Ter mutation in exon 9) in Korean population. METHOD AND RESULT: CAD patients (n=146), confirmed by coronary angiography and healthy Korean adult volunteers (n=110) were genotyped for PvuII/HindIII RFLP and Ser447Ter mutation of the LPL gene by PCR-digestion method. Between two groups, the genotype frequency of these genetic variations was not different. But, the genetic variations showed different effect on lipid profile and body mass index (BMI) in the CAD group and in the control group. In the CAD group, P1 allele carriers showed higher total cholesterol (P1P1+P1P2:P2P2=216+-51 mg/dl:198+/-38 mg/dl, p=0.039) and higher LDL cholesterol level (P1P1+P1P2:P2P2=143+/-46 mg/dl:126+/-36 mg/dl, p=0.047), and H1 allele carriers had lower Body mass index than non-carriers (23.8+/-2.3 kg/m2 :24.8+/-2.9 kg/m2 , p=0.047). In the control group, the Ser447Ter mutation carriers had higher HDL cholesterol level than non-carriers (59+/-10mg/dl versus 53+/-11mg/dl, p=0.049) and patients with P1 allele showed lower body mass index (P1P1+P1P2: P2P2=23.1+/-2.6 kg/m 2 :24.5+/-2.6 kg/m2 , p=0.006). CONCLUSION: In Korean, PvuII/HindIII RFLP and Ser447Ter mutation was not associated with CAD, and they showed different effect on the lipid profile and on the body mass index according to the study group. These results suggests that the phenotypic characteristics of the LPL gene of the Korean people are different from those of occidental people.
Adult ; Alleles ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Exons ; Genetic Variation ; Genotype ; Humans ; Introns ; Lipolysis ; Lipoprotein Lipase* ; Lipoproteins* ; Monocytes ; Polymorphism, Restriction Fragment Length ; Volunteers

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is essential after percutaneous coronary intervention (PCI), while many studies have focused on determining the optimal degree of platelet inhibition and optimal DAPT duration to minimize complications after PCI. Current guidelines developed by the American College of Cardiology/American Heart Association and the European Society of Cardiology summarize previous studies and provide recommendations. However, these guidelines are mainly based on Western patients, and their characteristics might differ from those of East Asian patients. Previous data suggested that East Asian patients have unique features with regard to the response to antiplatelet agents. On comparing Western and East Asian patients, it was found that East Asian patients have a lower rate of ischemic events and higher rate of bleeding events after PCI, despite a higher on-treatment platelet reactivity, which is referred to as the “East Asian paradox.” As the main purpose of DAPT is to minimize ischemic and bleeding complications after PCI, these differences should be clarified before adopting the guidelines for East Asian patients. Therefore, in this article, we will review various issues regarding DAPT in East Asian patients, with a focus on the unique characteristics of East Asian patients, previous studies regarding antiplatelet agents in East Asian patients, and a guideline from an East Asian perspective.
Asian Continental Ancestry Group ; Aspirin ; Blood Platelets ; Cardiology ; Heart ; Hemorrhage ; Humans ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is essential after percutaneous coronary intervention (PCI), while many studies have focused on determining the optimal degree of platelet inhibition and optimal DAPT duration to minimize complications after PCI. Current guidelines developed by the American College of Cardiology/American Heart Association and the European Society of Cardiology summarize previous studies and provide recommendations. However, these guidelines are mainly based on Western patients, and their characteristics might differ from those of East Asian patients. Previous data suggested that East Asian patients have unique features with regard to the response to antiplatelet agents. On comparing Western and East Asian patients, it was found that East Asian patients have a lower rate of ischemic events and higher rate of bleeding events after PCI, despite a higher on-treatment platelet reactivity, which is referred to as the “East Asian paradox.” As the main purpose of DAPT is to minimize ischemic and bleeding complications after PCI, these differences should be clarified before adopting the guidelines for East Asian patients. Therefore, in this article, we will review various issues regarding DAPT in East Asian patients, with a focus on the unique characteristics of East Asian patients, previous studies regarding antiplatelet agents in East Asian patients, and a guideline from an East Asian perspective.

BACKGROUND AND OBJECTIVES: Several studies have showed a large 'treatment gap' between clinical practice and the guidelines for treating hypercholesterolemia. There is little information on the real practice of managing patients with hypercholesterolemia in Korea. This study was done to investigate the "treatment gap" in the management of Korean hypercholesterolemic patients. SUBJECTS AND METHODS: 500 Hypercholesterolemic patients, who did not receive any lipid-lowering mediation during the prior six months to the index date and who were treated for more than one year thereafter, were included in the study. 100 investigators of general hospitals retrospectively reviewed the medical records of 500 hypercholesterolemic patients. The proportion of patients who reached their cholesterol goal was determined. Logistic regression was used to assess the patient characteristics associated with goal attainment. RESULTS: Of the total 500 patients, 369 patients (73.8%) had coronary heart disease (CHD) or CHD risk-equivalent disease. 86 patients (17.2%) were in the moderate risk group and 45 (9.0%) were in the low risk group. 45% of the CHD/CHD risk equivalent patients showed a baseline LDL cholesterol level of more than 160 mg/dL. The overall trend for the initial choice of the drug level for statin treatment showed a similar pattern among all patients, and this was not influenced by the presence of CHD or the serum lipid level. 77% of patients stayed on the same drug level and 41% of all patients (37% of CHD patients, 52% of non-CHD patients) attained their LDL cholesterol goal during the study period. CONCLUSION: The majority of hypercholesterolemic patients were treated without achieving their goal. More effective treatment of hypercholesterolemia is needed for the prevention of cardiovascular disease.
Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Coronary Disease ; Health Expenditures* ; Hospitals, General ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia* ; Korea* ; Logistic Models ; Medical Records ; Negotiating ; Research Personnel ; Retrospective Studies

Background The benefit of statin use after acute ST-segment elevation myocardial infarction (STEMI) has been well established, however, the influence of the timing of statin administration has not been elucidated. The objective of this study focused on early clinical outcomes after percutaneous coronary intervention (PCI). Methods This analysis of the Korea Working Group on Myocardial Infarction registry (KorMI) study included 3,584 STEMI patients (mean age, 63 ±13 years;male, 2,684, 74.9%) undergoing PCI from January 2008 to June 2009. Rates of major adverse cardiac events (MACE:all-cause death, recurrent MI, and target lesion revascularization) were compared among patients grouped according to statin therapy timing:I, both during and after hospitalization (n=2,653, 74%);II, only during hospita-lization (n=309, 8.6%);III, only after discharge (n=157, 4.4%);and IV, no statin therapy (n=465, 13%). Mean follow-up duration was 234 ± 113 days. Results Multivariate factors of statin use during hospitalization included prior statin use, multiple diseased vessels, final thrombolysis in myocardial infarction flow grade III, and low-density lipoprotein cholesterol level. At 6-month follow-up, groups III and IV had the highest MACE rates (2.3%, 3.9%, 5.1%, and 4.9%for groups I-IV, respectively, P=0.004). After adjusting for confounders, groups II-IV had a higher MACE risk than group I [hazard ratio (HR):3.20, 95%confidence interval (95%CI):1.31-7.86, P=0.011;HR:3.84, 95%CI:1.47-10.02, P=0.006;and HR:3.17, 95%CI:1.59-6.40, P=0.001;respectively]. Conclusions This study, based on the national registry database, shows early and continuous statin therapy improvs early outcomes of STEMI patients after PCI in real-world clinical prac-tice.

BACKGROUND: The prevalence of hypercholesterolemia in Korea is growing. In spite of the wide use of HMG-CoA reductase inhibitors (statins), some patients don't reach optimal cholesterol reduction and suffer hepatotoxicity or myopathy. Combination therapy of lipid lowering agents, which inhibits hepatic synthesis of cholesterol (i.e. simvastatin) and intestinal cholesterol absorption (i.e. ezetimibe), may achieve further reduction of serum cholesterol levels and less drug side effects. This study assessed the safety and efficacy of the combination therapy with ezetimibe and simvastatin in Korean patients with primary hypercholesterolemia. METHODS: This study was a randomized, double-blind, simvastatin controlled, multi-center trial. After 4 weeks of life style modification for cholesterol reduction, patients with a baseline low-density lipoprotein cholesterol (LDL-C) 145~250 mg/dL and triglyceride (TG) Absorption ; Apolipoprotein A-I ; Apolipoproteins ; Cholesterol ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia* ; Korea ; Life Style ; Lipoprotein(a) ; Lipoproteins ; Muscular Diseases ; Prevalence ; Simvastatin* ; Triglycerides ; Ezetimibe

Cardiovascular disease has been one of leading causes of death and has an increasing importance in Korea. However the current treatment modalities for cardiovascular disease have limited efficacy. To overcome the limitations of current therapies, stem cell therapy has been evaluated as a new therapeutic option. Most experience and achievements of stem cell therapy for clinical applications have come from bone marrow-derived stem cells. Recent meta-analyses showed that stem cell therapy is safe and effective for improving cardiac systolic functions in patients with acute myocardial infarction. However, the long term efficacy and effects on clinical outcomes need to be determined. Stem cell therapy for acute cardiovascular disease, especially for acute myocardial infarction, has a proven efficacy and safety in short term follow up. Newer stem cell sources and therapeutic approaches such as adjunctive therapy or pretransplantation cultivation will be applied in this field to improve the efficacy of stem cell therapy. Stem cell therapy is a promising new therapeutic option for cardiovascular disease.
Achievement ; Cardiovascular Diseases ; Cause of Death ; Humans ; Korea ; Myocardial Infarction ; Stem Cells