OBJECTIVE: Limited information is available on the effectiveness of lipid-modifying therapy (LMT) for low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) in the Korean population. The objective of this study was to describe the prevalence of different types of lipid disorders in Korean patients using LMT. METHODS: Eight hundred seventy-one dyslipidemia patients, who were LMT-naive for >1 year prior to retrospective enrollment, were included for analysis. Serum levels of LDL-C, HDL-C, TG and total cholesterol (TC) were assessed after >1 year of LMT. We also analyzed the therapeutic effects of LMT in the subjects with high cardiovascular risk factors (n=629), atherosclerotic cardiovascular disease (ASCVD) (n=296) or diabetes without ASCVD (n=316). RESULTS: The rates of elevated LDL-C without other abnormal lipids levels, elevated TG or decreased HDL-C (with normal LDL-C levels) and high LDL-C combined with elevated TG and/or decreased HDL-C were 33.4%, 13.0% and 53.6%, respectively. After at least one year on LMT (statin alone: 81%, statin and cholesterol absorption inhibitor: 10%, fibrates alone: 3%, others: 3%), 61% of patients had at least one lipid abnormality, with 3.4% failing to reach the therapeutic LDL-C target level or a normal level of HDL-C and TG. After LMT, 64.9% of patients with high cardiovascular risk factors, 64.5% of those with ASCVD or and 64.2% of those with diabetes without ASCVD also had at least one lipid abnormality. CONCLUSION: Approximately two-thirds of patients did not reach the target or normal lipid profile after taking LMT, irrespective of combining disease and high cardiovascular risk factors. Tight lipid control is required, especially in patients with dyslipidemia and high cardiovascular risk factors or comorbid diseases.
Absorption ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Dyslipidemias* ; Fibric Acids ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Korea* ; Lipoproteins ; Observational Study* ; Prevalence* ; Primary Health Care ; Retrospective Studies ; Risk Factors ; Therapeutic Uses ; Triglycerides

Moyamoya disease (MMD) is a steno-occlusive disease of the cerebral artery around the circle of Willis. It was first described in 1957 in Japan and named because the characteristic appearance of the basal collaterals in cerebral angiography looks like “a puff of smoke” (moyamoya in Japanese). MMD is one of the major causes of stroke in children worldwide, however most common in Korea, Japan and China. In 2011 the ring finger protein 213 gene (RNF213) was identified as a susceptibility gene for MMD. The RNF213 R4810K variant is an Asian founder mutation common to above nations with carrier rates of 0.5-2% of the general population but a 1/150 penetrance of clinical MMD. MMD patients in Korea and Japan harbors RNF213 R4810K variant in 70-90%. In MMD arterial stenosis was found to occur systematically, not only in the intracranial cerebral arteries but also in renal, coronary, pulmonary arteries, suggesting that MMD is a systemic vasculopathy. These extracranial vasculopathy (ECV) is rare but important as a cause of renovascular hypertension, ischemic heart disease, and pulmonary hypertension especially in children with MMD or family members of MMD. Clinical features of ECV will be reviewed in this article.
Asian Continental Ancestry Group ; Cerebral Angiography ; Cerebral Arteries ; Child ; China ; Circle of Willis ; Constriction, Pathologic ; Coronary Vessels ; Fingers ; Humans ; Hypertension, Pulmonary ; Hypertension, Renovascular ; Japan ; Korea ; Moyamoya Disease* ; Myocardial Ischemia ; Penetrance ; Pulmonary Artery ; Renal Artery ; Stroke

The endothelium covers the entire luminal surface of blood vessels, organizes the interface between the blood and underlying tissues, and controls vascular tone, blood clotting, transport of various substances across the vascular wall, adhesion and transmigration of leukocytes, and so forth. The structural and functional integrity of endothelium is essential for the maintenance of vascular health. In light of its important role, the endothelium should have a self-defense system such as vasohibin-1 (VASH1), a protein preferentially expressed in endothelial cells (ECs). Unique features of VASH1 are its anti-angiogenic activity and ability to promote stress tolerance of ECs. This mini review summarizes the current understanding of VASH1, especially the posttranscriptional regulation of its synthesis in response to cellular stresses and aging.
Aging ; Blood Coagulation ; Blood Vessels ; Endothelial Cells ; Endothelium ; Leukocytes ; Phenobarbital

We investigated the importance of comprehensive physiologic assessment about culprit vessel in STEMI in estimating long-term clinical outcomes after complete revascularization. Comprehensive physiologic assessment provides additional information about microvascular function in coronary artery disease. This assessment includes three indices, fractional flow reserve (FFR), index of microcirculatory resistance (IMR) and coronary flow reserve (CFR). We have performed the comprehensive physiologic assessment in culprit vessels after successful primary PCI in STEMI patients. Both cases were thrombotic total occlusion in mid right coronary artery with inferior wall STEMI, successfully revascularized with stent implantation after thrombus suction. However, in post PCI physiologic assessment, one case showed overt microvascular damage. CFR was 1.1, and IMR was 75U, which was defined as a combined criterion of low CFR (<2.0) and high IMR (≥25U) in culprit vessel, but the other case showed 2.2 in CFR and 24U in IMR, which suggested no overt microvascular damage. Moreover, we can validate these findings by cardiac MR after primary PCI. Previous studies presented that the presence of overt microvascular damage was significantly associated with worse clinical outcome in patients with coronary artery disease. We suggest that comprehensive physiologic evaluation provides important information about the degree of microvascular damage and long-term clinical outcomes after complete revascularization in culprit vessel in STEMI.
Coronary Artery Disease ; Coronary Vessels ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Stents ; Suction ; Thrombosis

Left-sided portal hypertension and consequent gastric varices can occur in patients with isolated splenic vein thrombosis. It is a rare but clinically significant and curable cause of gastrointestinal hemorrhage. Our patient, a 20-year-old woman, with left flank pain was diagnosed with having idiopathic splenic vein thrombosis with resultant splenic infarction. Thorough workups for the possible etiologies of splenic vein thrombosis were all negative. After six months of anticoagulation, follow-up computed tomography revealed formation of gastric varices; one month following the discovery, she developed gastrointestinal bleeding. Splenectomy was performed, resulting in the resolution of gastric varices.
Esophageal and Gastric Varices* ; Female ; Flank Pain ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Hypertension, Portal ; Splenectomy ; Splenic Infarction* ; Splenic Vein* ; Thrombosis* ; Young Adult

A 44-year-old man, who had a history of myocardial infarction (MI) due to thrombotic occlusion of right coronary artery (RCA) aneurysm, visited emergency department presenting with ST-segment elevation myocardial infarction (STEMI). The patient had been on oral anticoagulant therapy (warfarin) from the first thrombotic event, but the medication had been recently changed to aspirin 4 months before the second event. Emergent coronary angiography revealed thrombotic total occlusion of RCA with heavy thrombotic burden from middle RCA to the ostium of the posterior descending branch. Combination pharmacotherapy was performed with anticoagulants (heparin), fibrinolytics (urokinase), and Glycoprotein IIb/IIIa antagonists (abciximab), in addition to mechanical thrombosuction. However, on hospital day 2, the patient complained recurrent chest pain and again underwent coronary angiography, which revealed distal embolization of large thrombus to the posterior lateral branch. Coronary flow was recovered after repeated mechanical thrombosuction was performed. This case has shown the importance of aggressive combination drug therapy, accompanied by mechanical thrombosuction in patient with myocardial infarction due to thrombotic occlusion of coronary artery aneurysm and the importance of unceasing life-long anticoagulant therapy in those particular patients.
Adult ; Aneurysm* ; Anticoagulants ; Aspirin ; Chest Pain ; Coronary Aneurysm ; Coronary Angiography ; Coronary Occlusion* ; Coronary Vessels* ; Drug Therapy ; Drug Therapy, Combination ; Emergency Service, Hospital ; Glycoproteins ; Humans ; Myocardial Infarction* ; Thrombectomy ; Thrombosis ; Warfarin*

OBJECTIVE: The aim of this study is to compare the clinical benefits between high-intensity and low-to moderate-intensity statin therapy in patients with acute myocardial infarction (AMI). METHODS: A total of 1,230 patients in the Korea AMI Registry (KAMIR) were enrolled. Patients were divided into two groups according to the dosage of statin for the secondary prevention after AMI. The primary endpoint was composite of major adverse cardiac events (MACEs) including cardiac death, non-fatal MI, repeat revascularization during the 12 months of clinical follow-up. RESULT: The primary endpoint occurred in 101 patients (11.3%) from the low-to moderate-intensity statin group and 45 patients (13.4%) from the high-intensity statin group. The cumulative incidence of MACEs during 12-month follow-up was not significantly different between the two groups (p=0.323). After multi-variate analysis, MACEs-free survival rate was not significantly different between the two groups. CONCLUSION: High-intensity statin therapy did not show additional clinical benefit over low-to moderate-intensity statin therapy after AMI.
Death ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Incidence ; Korea ; Myocardial Infarction* ; Secondary Prevention ; Survival Rate

OBJECTIVE: There are still a limited number of studies assessing the prevalence of metabolic syndrome in the community. The aim of this study is to investigate the prevalence and gender-related characteristics of metabolic syndrome in Korean community. METHODS: A total of 417 community subjects (mean age was 60.7+/-13.6 years, 35.3% were men) who attended the routine check-up were analyzed. National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) III clinical guideline was used to define metabolic syndrome. RESULTS: Metabolic syndrome was diagnosed in 38.1% of study subjects. The prevalence of metabolic syndrome was not different between men and women (men 39.0% vs. women 37.5%, p=0.766). The positive association between age and the prevalence of metabolic syndrome was more pronounced in women (chi2=17.52, p for trend<0.001) than men (chi2=2.38, p for trend=0.123). In young age group (<50 years), the prevalence of metabolic syndrome was higher in men than in women (34.7% vs. 11.7%, p=0.042). This gender difference was not observed in older group (> or =50 years). The most prevalent factor of metabolic syndrome was hypertriglyceridemia (49.9%) and hypertension (47.6%) in both genders. Among metabolic syndrome components, central obesity (40.5% vs. 25.2%, p=0.002) and hypertriglyceridemia (54.5% vs. 41.8%, p=0.015) were more prevalent in women than in men, and the prevalence of other components were similar between genders. CONCLUSIONS: In the community, metabolic syndrome was highly prevalent in middle-aged and elderly Korean adult. Age related change in the prevalence of metabolic syndrome was gender specific. Age and gender effects should be considered for the effective control of metabolic syndrome in the community.
Adult ; Aged ; Cholesterol ; Education ; Female ; Humans ; Hypertension ; Hypertriglyceridemia ; Male ; Obesity, Abdominal ; Prevalence*

OBJECTIVES: The purpose of the study was to compare plaque characteristics by coronary computed tomography angiography (CCTA) with those by virtual histology-intravascular ultrasound (VH-IVUS). METHODS: We enrolled 50 asymptomatic patients with diabetes mellitus or more than two risk factors for coronary artery disease such as hypertension, smoking, and hyperlipidemia. If the patient had a coronary lesion (plaque with more than 50% stenosis or calcium score more than 100), we recommended coronary angiography and VH-IVUS and compared CCTA findings with VH-IVUS findings. RESULTS: 35 patients (70%) had coronary lesions, and we performed both CCTA and VH-IVUS in 23 patients. All 23 patients had multiple risk factors, and the majority of target lesions were located at left anterior descending artery (73.9%), and calcium score of lesion site was 106+/-162 with plaque volume of 232+/-153 mm3 by CCTA. Calcium score of lesion site was significantly greater in diabetic patients (n=14) than non-diabetic patients (n=9) (118+/-159 vs. 88+/-175, p=0.038). By VH-IVUS, plaque volume was 174+/-127 mm3, absolute necrotic core (NC) volume was 22+/-21 mm3, and relative NC volume was 20.8+/-8.7%. Absolute dense calcium (DC) volume and absolute NC volumes were significantly greater in diabetic patients than non-diabetic patients (11.5+/-13.8 mm3 vs. 9.1+/-11.0 mm3, p=0.028, and 23.9+/-24.7 mm3 vs. 18.1+/-14.3 mm3, p=0.035, respectively). Plaque volume by CCTA correlated with that of VH-IVUS (r=0.742, p<0.001), and plaque volume by CCTA correlated with absolute NC volume by VH-IVUS (r=0.621, p<0.001), and calcium score of lesion site by CCTA correlated with absolute dense calcium volume by VH-IVUS (r=0.478, p=0.028). CONCLUSION: Coronary lesion was detected by CCTA in 70% of asymptomatic patients with multiple coronary risk factors, and parameters detected by CCTA correlated well with those detected by VH-IVUS.
Angiography* ; Arteries ; Calcium ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease* ; Diabetes Mellitus ; Humans ; Hyperlipidemias ; Hypertension ; Risk Factors* ; Smoke ; Smoking ; Ultrasonography*

The kinesin superfamily is a class of motor proteins moving along microtubule filaments and playing essential roles in mitosis of eukaryotic cells. In the cancer biology, mitotic activity is an essential factor for development and metastasis of various cancers. Therefore, the inhibition of kinesin activity is suggested as an alternative cancer therapy. Accumulated clinical evidences have proved the potency of kinesin inhibitors in cancer treatments. In this review, we provided an overview of kinesins that play a critical role in the pathophysiology of various cancers and described the beneficial vs. side effects of their inhibitors that have been tested in both basic science and clinical studies.
Biology ; Eukaryotic Cells ; Kinesin* ; Microtubules ; Mitosis ; Neoplasm Metastasis ; Translational Medical Research*