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Cost-effectiveness of the Use of Statins in the Korean Population.

Ki Hoon HAN ; Hyo Jin KIM ; Jae Joong KIM

Journal of Lipid and Atherosclerosis.2012;1(2):87-94. doi:10.12997/jla.2012.1.2.87

OBJECTIVE: Statins reduce risk of cardiovascular disease through lowering of LDL-C (Low Density Lipoprotein cholesterol). We analyzed cost-effectiveness of statins in the reduction of serum LDL-C level among Korean population at high cardiovascular risk. METHODS: Rosuvastatin (5, 10, and 20 mg), atorvastatin (10, 20, 40, and 80 mg) and simvastatin (20, 40, and 80 mg) were included for the analysis, because those statins and doses were mostly prescribed in Korea. We determined effectiveness as % reduction of LDL cholesterol (LDL-C) levels per mg dose and % population reached to the ideal LDL-C level (<100 mg/dL), which is the target goal of LDL-C level for the high cardiovascular risk group as recommended by NCEP-ATP III guideline. The annual cost, which included overall cost for the drug price and management during follow up, was calculated. Average cost-effectiveness ratio (ACER) was calculated and used as the parameter representing cost-effectiveness of each statins. RESULTS: The lowest dose of each statins showed that achieving LDL-C target level was not high even in subjects showing relatively low basal LDL-C levels (<160 mg/dL). Also in case basal LDL-C level was over 160 mg/dL, the majority of statins were not sufficient to control LDL-C levels except atorvastatin 80 mg. In case of basal LDL-C level was lower than 160 mg/dl, atorvastatin 20 mg was the most cost-effective statin for LDL-C reduction regardless of considering basal LDL-C level. Simvastatin 40 mg was also cost-effective if basal LDL-C levels were between 100-129 mg/dL. CONCLUSIONS: For the reduction of LDL-C level in high risk subjects showing moderately elevated basal LDL-C level, atorvastatin 20 mg is the most cost-effective statin treatment strategy and then simvastatin 40 mg or rosuvastatin 10 mg was the second best option.
Cardiovascular Diseases ; Cholesterol, LDL ; Fluorobenzenes ; Follow-Up Studies ; Heptanoic Acids ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Korea ; Lipoproteins ; Pyrimidines ; Pyrroles ; Simvastatin ; Sulfonamides ; Atorvastatin Calcium ; Rosuvastatin Calcium

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The Association between Thigh Circumference and Lipids Profile in Korean Population: The Korea Medical Institute Study.

Keum Ji JUNG ; Gyu Jang LEE ; Sun Ha JEE

Journal of Lipid and Atherosclerosis.2012;1(2):79-86. doi:10.12997/jla.2012.1.2.79

OBJECTIVE: We performed a study of the relationship between thigh circumference and serum lipids. METHODS: A total of 314,842 Korean men and women aged 30 to 79 enrolled in the Korea Medical Institute for medical examination between February 2010 and December 2011 were included. Multiple logistic regression analysis was performed to examine the association of thigh circumference with various lipid profiles after adjustment for age, body mass index (BMI), waist circumference, smoking, and exercise. RESULTS: The average age of study participants was 42.3 years (42.6 years in men and 41.9 years in women). The mean thigh circumference was 53.2 cm (54.3 cm in men and 51.5 cm in women). Thigh circumference was positively correlated with BMI and waist circumference in both men and women. Before adjusting for BMI and waist circumference, thigh circumference was also positively correlated with total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, non-HDL cholesterol, and triglyceride / HDL cholesterol ratio. However, after adjusting for those two variables, the positive correlations became almost disappeared and showed opposite direction indicating that BMI and waist circumference were qualitative confounding variables. CONCLUSIONS: A small thigh circumference was associated with increasing levels of lipid profiles including triglyceride and decreasing level of HDL cholesterol. Through additional researches, establishment of causality is necessary.
Aged ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Female ; Humans ; Korea ; Lipoproteins ; Logistic Models ; Male ; Smoke ; Smoking ; Thigh ; Waist Circumference

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Effect of Adiponectin and Resistin on Coronary Plaque Composition and Coronary Artery Remodeling of Target Lesion in Patients with Stable Angina.

Jong Youn KIM ; Pil Ki MIN ; Young Won YOON ; Byoung Kwon LEE ; Bum Kee HONG ; Hyuck Moon KWON

Journal of Lipid and Atherosclerosis.2012;1(2):69-78. doi:10.12997/jla.2012.1.2.69

OBJECTIVE: The purpose of this study was to investigate the effect of adiponectin and resistin on coronary plaque composition determined by virtual histology (VH) intravascular ultrasound (IVUS) and coronary artery remodeling of target lesion in patients with stable angina. METHODS: We prospectively enrolled 48 patients who underwent coronary angiography and VH IVUS for stable angina (27 men, 61+/-9 years of age). Preintervention grayscale and VH IVUS analysis was done across the target lesion. Planar VH IVUS analysis at the minimum luminal site and volumetric analysis over a 10-mm-long segment centered at the minimum luminal site were performed. The subjects were divided into 2 groups based on remodeling index (RI): positive remodeling (PR) defined as RI>1.0 and non-PR as RI< or =1.0. Blood samples for analysis of adiponectin and resistin were obtained from the femoral artery before coronary angioplasty. RESULTS: Of the 48 patients enrolled, 23 (48%) had PR in their target lesion and 25 (52%) were non-PR group. Clinical and angiographic characteristics, VH IVUS parameters were not different between the PR and the non-PR groups. Adiponectin and resistin levels showed no significant correlations with coronary plaque composition evaluated with VH IVUS. Adiponectin showed no significant difference between the two groups. However, resistin showed trend toward higher level in non-PR group (4.17+/-2.18 ng/mL vs. 6.11+/-4.26 ng/mL, P=0.056) and a significant negative correlation with RI (r=-0.303, P=0.036). CONCLUSION: We found a negative correlation between the resistin level and RI of a de-novo target lesion in patients with stable angina.
Adiponectin ; Angina, Stable ; Coronary Angiography ; Coronary Vessels ; Femoral Artery ; Humans ; Male ; Phenobarbital ; Plaque, Atherosclerotic ; Prospective Studies ; Resistin

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The Associations between Alcohol Intake and HDL Cholesterol Subclasses in Korean Population.

Jung Eun LIM ; Jung Im KIM ; Sun Ju LEE ; Jae Woong SULL ; Myoungsook LEE ; Sun Ha JEE

Journal of Lipid and Atherosclerosis.2012;1(2):61-68. doi:10.12997/jla.2012.1.2.61

OBJECTIVE: Alcohol intake has been found to be associated with high-density lipoprotein (HDL) cholesterol. However, the association of alcohol intake with HDL cholesterol subclasses is unclear. Therefore, this study was conducted to determine the association between alcohol intake and HDL cholesterol subclasses among Koreans. METHODS: This study included in 1,101 healthy Koreans (men: 765, women: 336) who underwent health check-up at two hospitals in the Korean Cancer Prevention Study 2 (KCPS2). The amounts of alcohol intake were classified into 4 groups: non-, light, moderate, and heavy drinkers (0, <12.5, 12.5-49.9, and > or =50.0 g/day, respectively). The proportions of HDL cholesterol subclasses were measured after subclasses were identified by 4-30% gradient gel electrophoresis. Multiple regression models were used to estimate regression coefficients after multivariate adjustments. RESULTS: The concentration of HDL, HDL2 and HDL3 significantly increased with increasing amount of alcohol intake. After adjusted for age, body mass index (BMI), waist and smoking status, alcohol consumers of <12.5 g/day, 12.5-49.9 g/day and more than 50.0g/day showed significant positive associations with HDL, HDL2 and HDL3 concentration when compared to non-alcohol drinkers in men. In particular, The strongest positive associations were obtained with HDL2b and HDL3c. CONCLUSION: HDL2 and HDL3 were significantly associated with increasing amount of alcohol intake in Koreans. In particular, HDL2b among HDL2 and HDL3c among HDL3 showed the strongest positive association with increasing amount of alcohol intake.
Alcohol Drinking ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Electrophoresis ; Humans ; Light ; Lipoproteins ; Male ; Smoke ; Smoking

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Treatment Guidelines for Dyslipidemia: Summary of the Expanded Second Version.

Jong Il SON ; Sang Ouk CHIN ; Jeong Taek WOO

Journal of Lipid and Atherosclerosis.2012;1(2):45-59. doi:10.12997/jla.2012.1.2.45

KSLA published our first version of treatment guidelines for dyslipidemia in 1996, which was based on health examination data gathered by the National Health Insurance Corperation in 1994. A number of academic societies including the Korean Endocrine Society, the Korean Society of Cardiology, the Korean Society for Laboratory Medicine, the Korean Society for Biochemistry and the Korean Nutrition Society participated in the development of this guideline. In 2003, the second version of our guidelines was published based on the Korean National Health and Nutrition Survey (KNHANES) data which was collected in 1998. In 2006, the second version was modified and expanded with using KNHANES data collected in 2005. This article summarizes the recommendations included in the expanded second version of treatment guidelines. The full version of treatment guidelines in Korean is available at the KSLA Homepage (http://www.lipid.or.kr).
Biochemistry ; Cardiology ; Dyslipidemias ; National Health Programs ; Nutrition Surveys

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A Case of Periaortitis Diagnosed with Abdomen CT in a Patient with Malignant Fibrous Histiocytosis.

Se Kwun MOON ; Kyung Hwan KIM ; Hee Jong KIM ; Hong Ju AN ; Sang Sun LEE ; Ho Yeong SONG ; Won Yu KANG ; Sang Cheol CHO ; Sun Ho HWANG ; Wan KIM

Journal of Lipid and Atherosclerosis.2013;2(1):41-44. doi:10.12997/jla.2013.2.1.41

Periaortitis is a very rare disease, characterized by a fibro-inflammatory tissue which develops around abdominal aorta and iliac arteries, and spreads into the structures of retroperitoneum. Computed tomography (CT) or magnetic resonance imaging (MRI) is the modality of choice for the diagnosis. Here, we report a case of periaortitis diagnosed with abdomen CT in patient with malignant fibrous histiocytoma.
Abdomen ; Aorta, Abdominal ; Histiocytoma, Malignant Fibrous ; Histiocytosis ; Humans ; Iliac Artery ; Magnetic Resonance Imaging ; Rare Diseases ; Retroperitoneal Fibrosis

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Importance of Clinical Evaluations Related to Secondary Hypertension in Patients with Resistant Hypertension.

Jin Ho KIM ; Sung Ha PARK ; Ah Young JI ; Jung Hee LEE ; Moonyun JIN ; Changho SONG ; Insoo KIM ; Young Ju KIM ; Moon Hyoung LEE

Journal of Lipid and Atherosclerosis.2013;2(1):37-40. doi:10.12997/jla.2013.2.1.37

Resistant hypertension is defined as poorly controlled status of blood pressure despite of optimal use of three or more antihypertensive drugs of different classes, including diuretics. Although exact prevalence of resistant hypertension is not known, it has been reported to be 12.8% among patients treated with antihypertensive drugs. It is important to evaluate a possible secondary cause in patients with resistant hypertension. We report a case of resistant hypertension with renal artery segmental stenosis that was not revealed in renal Doppler study. Blood pressure of the patient was well controlled after renal balloon angioplasty.
Angioplasty, Balloon ; Antihypertensive Agents ; Blood Pressure ; Constriction, Pathologic ; Diuretics ; Humans ; Hypertension ; Prevalence ; Renal Artery

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Association of Plasma Homocysteine Level and Arterial Stiffness in Subjects with Type 2 Diabetes Mellitus.

Jenie Yoonoo HWANG ; Chang Hee JUNG ; Min Jung LEE ; Yu Mi KANG ; Woo Je LEE ; Joong Yeol PARK

Journal of Lipid and Atherosclerosis.2013;2(1):27-35. doi:10.12997/jla.2013.2.1.27

OBJECTIVE: Plasma homocysteine (Hcy) is considered to be a marker of endothelial dysfunction and a predictor of cardiovascular disease (CVD). Arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) is not only a marker of vascular damage but a significant predictor of CVD. Previous studies about the effect of high plasma Hcy levels on arterial stiffness have yielded inconsistent results. We therefore assessed the association between Hcy and baPWV in a relatively large number of subjects with type 2 diabetes mellitus (DM). METHODS: We retrospectively assessed plasma Hcy concentration and arterial stiffness in 1,477 Korean type 2 diabetic patients. Participants were also evaluated for plasma glucose, hemoglobin A1c (HbA1c), duration of DM, microvascular complications, lipid profile, and high sensitivity C-reactive protein (hsCRP). Arterial stiffness was measured noninvasively by baPWV. RESULTS: Correlation analysis indicated a significant positive association between serum Hcy levels and baPWV (r=0.245, p<0.001). In a multiple linear regression analysis, the association between serum Hcy levels and baPWV was independent of traditional cardiovascular risk factors (standardized beta=3.8, p=0.01). CONCLUSION: The results support the hypothesis that plasma Hcy levels are associated with arterial stiffness in patients with type 2 DM. Prospective studies are warranted to determine whether lowering serum Hcy level could reduce arterial stiffness and cardiovascular morbidity in type 2 DM.
C-Reactive Protein ; Cardiovascular Diseases ; Diabetes Mellitus, Type 2 ; Glucose ; Hemoglobins ; Homocysteine ; Humans ; Linear Models ; Plasma ; Pulse Wave Analysis ; Retrospective Studies ; Risk Factors ; Vascular Stiffness

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Effect of Fenofibrate Therapy on Blood Creatinine Levels in Patients with Hypertension and Hypertriglyceridemia.

Jun Hwan CHO ; Young Hwan CHOI ; Cheol Won HYEON ; Kyung Joon KIM ; Seonghyup HYUN ; Jee Eun KWON ; Eun Young KIM ; Wang Soo LEE ; Kwang Je LEE ; Sang Wook KIM ; Tae Ho KIM ; Chee Jeong KIM

Journal of Lipid and Atherosclerosis.2013;2(1):19-26. doi:10.12997/jla.2013.2.1.19

OBJECTIVE: Previous studies have reported that fenofibrate therapy increased blood creatinine levels. We investigated the effect of fenofibrate therapy on creatinine levels in patients with hypertension and hypertriglyceridemia. METHODS: This retrospective study included 36 hypertensive patients with hypertriglyceridemia taking fenofibrate for 1-3 years (Fenofibrate group) and 36 control patients with similar age, sex, follow-up duration, creatinine levels, and lipid levels to those of fenofibrate therapy (Control group). RESULTS: Baseline parameters except lipid profiles were similar between the fenofibrate and control groups. Creatinine levels increased in the fenofibrate group (from 0.90+/-0.18 mg/dL to 1.05+/-0.22 mg/dL, p<0.001) and did not change in the control group (from 0.91+/-0.12 mg/dL to 0.92+/-0.14 mg/dL, p=0.39). The elevation was more pronounced in the fenofibrate group than in the control group (0.15+/-0.12 vs. 0.02+/-0.11 mg/dL, p<0.001). Changes in creatinine levels were only associated with fenofibrate therapy (r=0.52, p<0.001) in the stepwise linear regression analysis. CONCLUSION: Fenofibrate therapy for 1-3 years significantly increased creatinine levels in hypertensive patients with hypertriglyceridemia. This finding suggests that follow-up measurement of creatinine level is necessary with fenofibrate therapy.
Creatinine ; Fenofibrate ; Follow-Up Studies ; Humans ; Hypertension ; Hypertriglyceridemia ; Linear Models ; Retrospective Studies

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Hypertension and Increased Left Ventricular End-diastolic Pressure Influence Arterial Stiffness.

Yae Min PARK ; Bong Roung KIM ; Wook Jin CHUNG ; Kyoung Hoon LEE ; Woong Chol KANG ; Seung Hwan HAN ; Tae Hoon AHN ; In Suk CHOI ; Mi Seung SHIN

Journal of Lipid and Atherosclerosis.2013;2(1):9-17. doi:10.12997/jla.2013.2.1.9

OBJECTIVE: There have been few studies regarding the relationship between arterial stiffness and left ventricular end-diastolic pressure (LVEDP). In the current study, we evaluated the relationship between the LVEDP and arterial stiffness in patients with hypertension (HTN). METHODS: Group I (n=34) included patients with a normal E/E' (< or =8) without HTN, group II (n=31) included patients with an elevated E/E' (>8) without HTN, group III (n=20) included patients with a normal E/E' (< or =8) with HTN, and group IV (n=49) included patients with an elevated E/E' (>8) with HTN. Aortic distensibility (AD) and the right brachial-ankle pulse wave velocity (baPWV) were measured. RESULTS: The mean age was 46.0+/-11.3 years. The mean value of AD was significantly lower in the group III compared to the group I. The group IV showed significantly lower AD compared to the group II. The group III demonstrated higher baPWV compared to the group I (1422+/-182 cm/sec vs. 1186+/-178 cm/sec, p<0.01), and the group IV showed higher baPWV compared to the group II (1456+/-228 vs. 1259+/-238 cm/sec, p<0.01). However, AD and baPWV were not significantly different between the group I and II, and between the group III and IV. The E/E' ratio showed a weak negative correlation with AD and a weak positive correlation with baPWV. CONCLUSION: Patients with hypertension showed a lower AD and a higher baPWV compared to those with normal blood pressure independent of the LVEDP. But the correlation between E/E' ratio and arterial stiffness suggests that a high LVEDP might not significantly influence arterial stiffness.
Blood Pressure ; Humans ; Hypertension ; Pulse Wave Analysis ; Vascular Stiffness

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