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Clinical and preclinical obesity: cardiovascular implications of a new diagnostic paradigm

Cardiovascular Prevention and Pharmacotherapy.2025;7(2):21-27. doi:10.36011/cpp.2025.7.e6

The traditional definition of obesity, relying solely on body mass index, inadequately captures individual health status and is insufficient for guiding therapeutic interventions. In January 2025, The Lancet Diabetes & Endocrinology Commission proposed a paradigm-shifting redefinition that introduces the concepts of “clinical obesity” and “preclinical obesity.” Clinical obesity is defined as a chronic, systemic illness characterized by excess adiposity resulting in functional impairments in tissues, organs, or overall individual health. In contrast, preclinical obesity involves excess adiposity without current functional impairment. This review examines the significance of this new diagnostic paradigm for cardiovascular disease prevention and risk assessment. From a cardiovascular perspective, the new framework offers several advantages: it facilitates personalized intervention strategies based on individual risk profiles, refines cardiovascular risk assessments by incorporating body fat distribution and functional parameters, promotes more efficient resource allocation, and shifts treatment goals toward functional improvements beyond mere weight loss. Although further research is required to evaluate practical implementation and long-term outcomes, this novel approach represents a substantial advancement in obesity management and cardiovascular disease prevention.

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The connection between diabetes mellitus and stroke: a brief review

Junghyun NOH

Cardiovascular Prevention and Pharmacotherapy.2025;7(2):55-60. doi:10.36011/cpp.2025.7.e7

Stroke is one of the major macrovascular complications of diabetes and increases morbidity and mortality. Hyperglycemia contributes to a heightened risk of stroke incidence. Moreover, people with diabetes may have poorer post-stroke outcomes and higher risk of stroke recurrence than those without diabetes. Recent cardiovascular outcome trials of some antidiabetic medications have shown beneficial effects on stroke prevention. Prevention and improving outcomes of stroke in patients with diabetes requires proper management of hyperglycemia and additional risk factors. This review is an evidence-based approach to epidemiology of stroke in diabetes, the role of glycemic control, and antidiabetic medications in stroke prevention in patients with diabetes mellitus.

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Sex-specific challenges in cardiovascular disease among women: gaps in recognition, diagnosis, and management

Mi-Seung SHIN

Cardiovascular Prevention and Pharmacotherapy.2025;7(2):50-54. doi:10.36011/cpp.2025.7.e8

Despite being the leading cause of mortality among women, cardiovascular disease remains underrecognized and undertreated due to sex-related differences in clinical presentation, risk factors, and healthcare delivery. Women are often excluded from clinical trials, undergo fewer diagnostic evaluations, and are less likely to receive guideline-directed therapies. Additionally, female-specific risk factors, such as pregnancy-related disorders, early menopause, and autoimmune diseases, are frequently overlooked. Addressing these disparities through sex-specific risk assessment, increased clinician awareness, and inclusion of women in research is imperative to optimize prevention and treatment strategies and reduce cardiovascular disease-related morbidity and mortality in women.

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Clinical impact and practical use of sodium-glucose cotransporter 2 inhibitors for patients with chronic kidney disease

Jang-Whan BAE

Cardiovascular Prevention and Pharmacotherapy.2025;7(2):44-49. doi:10.36011/cpp.2025.7.e4

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have transformed the treatment of both cardiovascular and renal diseases. Although originally developed for glycemic control in type 2 diabetes mellitus, these agents have demonstrated significant benefits by reducing cardiovascular events and slowing the progression of kidney disease, even in patients without diabetes. Landmark trials, including EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58, and DAPA-HF, consistently demonstrated reductions in heart failure hospitalizations and renal deterioration among patients at high cardiovascular risk. However, many of these studies excluded patients with advanced chronic kidney disease (CKD), limiting the generalizability of their findings for this population. More recent investigations, such as CREDENCE, DAPA-CKD, and EMPA-KIDNEY, have focused on patients with CKD and confirmed that SGLT2 inhibitors offer significant renal and cardiovascular protection regardless of diabetic status. This review summarizes key clinical trials, outlining their design and outcomes with a particular emphasis on inclusion and exclusion criteria and the implications for CKD populations. Further, it discusses the practical application and safety considerations of SGLT2 inhibitors in nephrology, underscoring their emerging role as a fundamental therapeutic strategy in CKD management.

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Ultra-low-dose direct oral anticoagulants in vulnerable patients with atrial fibrillation or coronary artery disease

Dae young CHEON ; Jae Hyuk CHOI

Cardiovascular Prevention and Pharmacotherapy.2025;7(2):38-43. doi:10.36011/cpp.2025.7.e5

Direct oral anticoagulants (DOACs) have largely supplanted warfarin for stroke prevention in atrial fibrillation due to their superior safety and efficacy profiles. Although standard dosing regimens are well-established, lower doses—often referred to as ultra‐low-dose (ULD) DOACs—have been investigated in selected populations to balance thrombotic and bleeding risks. The concept of ULD DOACs was first introduced in the 2013 European Heart Rhythm Association Practical Guide specifically for post‐acute coronary syndrome patients with residual thrombotic risk. Clinical trials, including ATLAS ACS-TIMI 51 and COMPASS, demonstrated that rivaroxaban 2.5 mg twice a day reduced ischemic events when combined with aspirin, although this benefit was accompanied by an increased risk of major bleeding. Similarly, the ELDERCARE-AF trial revealed that edoxaban 15 mg once a day effectively prevented stroke in frail older patients. Conversely, evidence supporting ULDs of dabigatran and apixaban remains limited. Despite their potential benefits, inappropriate dose reductions based on subjective physician judgment rather than rigorous clinical guidelines may result in suboptimal anticoagulation and a heightened risk of thromboembolic events. This review explores the indications, supporting evidence, and potential risks associated with ULD DOACs, underscoring the need for well-designed studies to establish clear guidelines.

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Weight fluctuation and incidence of end-stage renal disease in Korea: a nationwide cohort study

Koh-Eun SHIN ; Byoungduck HAN ; Gyu Bae LEE ; Jihyun YOON ; Kyungdo HAN ; Yang-Hyun KIM

Cardiovascular Prevention and Pharmacotherapy.2025;7(2):28-37. doi:10.36011/cpp.2025.7.e9

Background: The impact of weight or weight changes on kidney function remains a matter of debate. This study aimed to investigate the association between weight fluctuation and the incidence of end-stage renal disease (ESRD) using data from the Korean National Health Insurance Corporation health checkups (2009–2015). Methods: The study included 2,310,667 participants (1,546,749 men and 763,918 women), aged ≥40 years. Weight fluctuation was assessed using the average real variability (ARV) of weight and categorized into quartiles (Q1–Q4). Hazard ratios (HRs) and 95% confidence intervals for ESRD incidence were calculated using multivariable Cox proportional hazards models. Results: After adjustment for comorbidities, increased body mass index was associated with a decreased HR for ESRD. The highest quartile of weight variability (ARV Q4) demonstrated a higher probability and HR for ESRD compared to the lower variability quartiles (Q1–Q3). Among men, individuals with sustained weight, and those with weight gain, the ARV Q4 group showed significantly increased HRs for ESRD (HR of 1.372, 1.222, and 1.49, respectively). Furthermore, irrespective of changes in creatinine levels, all ARV Q4 groups exhibited increased HRs for ESRD (HR of 1.342, 1.472, and 1.299, respectively). Conclusions High weight fluctuation (ARV Q4) was associated with an increased incidence of ESRD in the general Korean population, with notable significance in men and in groups with sustained or increased weight. Clinically, individuals in the ARV Q4 category should be considered at risk for ESRD, and early interventions should be pursued for this population.

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The prognostic role of lipoprotein(a) in cardiovascular disease

Eun-Jung RHEE

Cardiovascular Prevention and Pharmacotherapy.2025;7(1):9-12. doi:10.36011/cpp.2025.7.e3

Lipoprotein(a) (Lp(a)), is not a new entity; however, it has become an increasingly discussed and studied risk factor for atherosclerotic cardiovascular disease (CVD) and aortic valve stenosis. Recent guidelines recommend measuring Lp(a) levels throughout the lifetime in patients at high risk for CVD, as Lp(a) can serve as a signature marker for identifying individuals at elevated risk for CVD. Numerous genetic and epidemiological studies have underscored the significant causal role of Lp(a) in the incidence of CVD. Individuals with high Lp(a) levels face an increased risk for CVD, even with optimal low-density lipoprotein cholesterol lowering. Furthermore, Lp(a) levels are primarily determined by genetics and are not significantly reduced by lifestyle changes or certain medications. This review will discuss the characteristics, genetic factors, and epidemiological properties of Lp(a) in relation to CVD.

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Pharmacological management of diabetes in older adults

Junghyun NOH

Cardiovascular Prevention and Pharmacotherapy.2025;7(1):13-20. doi:10.36011/cpp.2025.7.e1

As the global population continues to age, the rising prevalence of diabetes among older adults has become a significant public health concern. Consequently, effective and safe management of diabetes mellitus in this population is an increasingly critical focus in clinical practice. Older patients present considerable variability in functional status, with many experiencing physical disabilities, visual impairments, cognitive decline, or psychological conditions such as depression. Therefore, individualized treatment strategies that consider the presence and progression of geriatric syndromes, comorbidities, and the risk of hypoglycemia are essential for optimizing the pharmacological management of diabetes in older adults.

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Nonalcoholic fatty liver disease and heart failure with preserved ejection fraction: a focus on risk factors and management

Joonpyo LEE ; Mi-Seung SHIN

Cardiovascular Prevention and Pharmacotherapy.2025;7(1):1-8. doi:10.36011/cpp.2025.7.e2

Nonalcoholic fatty liver disease (NAFLD) and heart failure with preserved ejection fraction (HFpEF) are two increasingly prevalent conditions that share common risk factors, including obesity, diabetes, and aging. NAFLD, marked by hepatic steatosis, is a leading cause of liver disease globally, with cardiovascular disease accounting for most deaths among those affected. HFpEF, characterized by diastolic dysfunction and systemic inflammation, accounts for a growing share of heart failure cases, especially among older adults. The bidirectional relationship between NAFLD and HFpEF involves shared mechanisms such as systemic inflammation, insulin resistance, and metabolic dysfunction. These overlapping processes create a vicious cycle that exacerbates each condition. This review emphasizes the shared pathophysiology, risk factors, and management strategies for these interconnected diseases. Promising interventions, including exercise, weight loss, and emerging pharmacological treatments like sodium-glucose cotransporter 2 inhibitors, are effective in addressing both NAFLD and HFpEF. By targeting these common pathways, there is a unique opportunity to develop integrated treatment approaches that could improve outcomes for affected patients.

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Changes in cardiovascular-related health behaviors after the end of social distancing: the 2023 Cardiovascular Disease Prevention Awareness Survey

Jaeyong LEE ; Eunji KIM ; Won-Young LEE ; Eun-Jung RHEE ; Hyeon Chang KIM

Cardiovascular Prevention and Pharmacotherapy.2024;6(2):57-64. doi:10.36011/cpp.2024.6.e6

Background: The COVID-19 pandemic and the implementation of social distancing have been reported to negatively impact cardiovascular-related health behaviors. However, the effects of lifting social distancing restrictions on these health behaviors remain unclear. This study investigated public awareness and behavioral changes related to cardiovascular disease prevention after the end of social distancing. Methods: Between June 5 and June 12, 2023, 2,000 adults participated in the 2023 Cardiovascular Disease Prevention Awareness Survey in Korea. The survey comprehensively addressed sociodemographic factors, cardiometabolic disease history, cardiovascular disease concern, prevention awareness, and behavioral changes after the end of social distancing. Logistic regression analyses were performed to assess the associations between behavioral changes and sociodemographic factors. Results: Cardiovascular disease ranked as the second most feared disease (most feared, 18.0%; second most feared, 26.3%) after cancer (most feared, 42.3%; second most feared, 21.7%). Among nine cardiovascular disease prevention recommendations, stress management, being physically active, and maintaining a healthy diet were perceived as the most challenging recommendations. After the end of social distancing, there were more positive changes than negative changes in smoking, alcohol consumption, dietary habits, physical activity, and healthcare service use, whereas stress management more frequently changed negatively (40.0%) than it changed positively (19.5%). Conclusions Positive changes in cardiovascular-related health behaviors, except for stress management, were observed after the end of social distancing. Further research is necessary to fully comprehend the impact of discontinuing social distancing practices.

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