This review examines strategies for the prevention and management of obesity, hypertension, type 2 diabetes mellitus and dyslipidaemia, conditions that are increasing in Singapore, as components of individualised health plans in 'Healthier SG' and beyond. We describe cardiometabolic disease prevention and management initiatives in Changi General Hospital (CGH), including collaborations with SingHealth Polyclinics, Active SG, Exercise is Medicine Singapore and community partners in the Eastern Community Health Outreach programme, and highlight advances in curable hypertension (e.g., primary hyperaldosteronism) and novel cardiovascular risk markers such as lipoprotein(a). We also outline technology-based interventions, notably the CGH Health Management Unit, which demonstrate the utility and convenience of telemedicine, and digital therapeutics in the form of apps that have been shown to improve treatment adherence and clinical outcomes. Individual empowerment, in partnership with community and healthcare providers and supported by research and innovation of care delivery, is key to building a healthier and stronger nation.
Humans ; Singapore ; Diabetes Mellitus, Type 2/therapy* ; Hypertension/therapy* ; Obesity/therapy* ; Dyslipidemias/therapy* ; Telemedicine ; Cardiovascular Diseases/prevention & control* ; Exercise ; Metabolic Diseases/prevention & control*

OBJECTIVE: To investigate the spatial patterns of the prevalence, awareness, treatment, and control rates of dyslipidemia at the provincial level in China. METHODS: A national and provincial representative cross-sectional survey was conducted among 178,558 Chinese adults in 31 provinces in mainland China in 2018-2019, using a multi-stage, stratified, cluster-randomized sampling design. Subjects, as households, were selected, followed by a home visit to collect information. Both descriptive and linear regression procedures were applied in the analyses. RESULTS: The overall prevalence of dyslipidemia was 35.6%, and wide geographic variations of prevalence, treatment, and control rates of dyslipidemia were identified among 178,558 eligible participants with a mean age of 55.1 ± 13.8 years. The highest-lowest difference regarding the provincial level prevalence rates were 19.7% vs. 2.1% for high low-density lipoprotein cholesterol, 16.7% vs. 2.5% for high total cholesterol, 35.9% vs. 5.4% for high triglycerides, and 31.4% vs. 10.5% for low high-density lipoprotein cholesterol. The treatment rate of dyslipidemia was correlated with the socio-demographic index ( P < 0.001), urbanization rate ( P = 0.01), and affordable basic technologies and essential medicines ( P < 0.001). CONCLUSION Prevailing dyslipidemia among the Chinese population and its wide geographic variations in prevalence, treatment, and control suggest that China needs both integrated and localized public health strategies across provinces to improve lipid management.
Humans ; Adult ; Middle Aged ; Aged ; Cross-Sectional Studies ; Prevalence ; East Asian People ; Dyslipidemias/prevention & control* ; China/epidemiology* ; Cholesterol, HDL ; Risk Factors ; Triglycerides

Objectives: This cross-sectional study evaluates the degree of agreement between the 2018 American College of Cardiology/American Heart Association (ACC/AHA2018) and 2020 Philippine Guideline (PG2020) treatment algorithms for the primary prevention of dyslipidemia among Filipinos. Methodology: This review included 159 charts of statin-naive Filipinos who are 45-79 years old. Using risk profile and lipid measurements, statin treatment recommendation was determined through the PG2020 algorithm and ACC/AHA-ASCVD Risk Estimator Plus web application. The degree of agreement was measured by Cohen’s kappa statistic with the two algorithms as independent raters. Results: A total of 159 patients were included in the final analysis. There was a slight agreement with a kappa coefficient of 0.209 or 4.4% (95% CI 0.078-0.340, p=0.003). Statin treatment was recommended in 69 out of 159 patients (43.4%) by the PG2020 overlapping with ACC/AHA2018 in 56 cases (81.2%). On the other hand, 109 cases (68.6%) were recommended for statin treatment by ACC/AHA2018 overlapping with PG2020 in only 51.4%. Conclusions The low degree of agreement between the two treatment algorithms highlights the key demographic and ethnic variations in dyslipidemia management necessitating outcome-based studies to translate these differences. Overestimation of ASCVD risk calculation in the ACC/AHA2018 and consideration of important, unique risk factors among Filipinos favors the applicability of the Philippine guideline.
Dyslipidemias ; Hypercholesterolemia ; Algorithms ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Primary Prevention

BACKGROUND: This study evaluated the cost-effectiveness of 21 different national dyslipidemia screening strategies according to total cholesterol (TC) cutoff and screening interval among 40 years or more for the primary prevention of coronary heart disease over a lifetime in Korea, from a societal perspective. METHODS: A decision tree was used to estimate disease detection with the 21 different screening strategies, while a Markov model was used to model disease progression until death, quality-adjusted life years (QALYs) and costs from a Korea societal perspective. RESULTS: The results showed that the strategy with TC 200 mg/dL and 4-year interval cost ￦4,625,446 for 16.65105 QALYs per person and strategy with TC 200 mg/dL and 3-year interval cost ￦4,691,771 for 16.65164 QALYs compared with ￦3,061,371 for 16.59877 QALYs for strategy with no screening. The incremental cost-effectiveness ratio of strategy with TC 200 mg/dL and 4-year interval versus strategy with no screening was ￦29,916,271/QALY. At a Korea willingness-to-pay threshold of ￦30,500,000/QALY, strategy with TC 200 mg/dL and 4-year interval is cost-effective compared with strategy with no screening. Sensitivity analyses showed that results were robust to reasonable variations in model parameters. CONCLUSION: In this study, revised national dyslipidemia screening strategy with TC 200 mg/dL and 4-year interval could be a cost-effective option. A better understanding of the Korean dyslipidemia population may be necessary to aid in future efforts to improve dyslipidemia diagnosis and management.
Cholesterol ; Coronary Disease ; Cost-Benefit Analysis ; Decision Trees ; Diagnosis ; Disease Progression ; Dyslipidemias ; Humans ; Korea ; Mass Screening ; Primary Prevention ; Quality-Adjusted Life Years

Dyslipidemia, highly elevated, low-density lipoprotein (LDL) cholesterol, is a major cardiovascular risk factor. Statins have been proven to effectively reduce the risk of atherosclerotic cardiovascular disease (ASCVD) and are recommended as a first-line therapy for the primary and secondary prevention of ASCVD. However, statins may not be sufficient in decreasing LDL cholesterol levels and pose a significant on-treatment residual risk of major cardiovascular events (i.e., residual cholesterol risk) according to meta-analyses of statin trials. Current guidelines for cholesterol management to achieve additional LDL cholesterol reduction and reduce ASCVD risk recommend two hyperlipidemic agents besides statins. Use of ezetimibe, a cholesterol absorption inhibitor, leads to additional LCL cholesterol reduction and decreased ASCVD risk, when added to statin therapy, without raising significant safety concerns. Furthermore, in combination with a mild-to-moderate statin intensity, ezetimibe is used in situations of statin-associated adverse effects such as myalgia and the combination therapy is relatively safer. Monoclonal antibody of proprotein convertase subtilisin/kexin type 9 (PCSK9), alirocumab, and evolocumab, have been approved to lower LDL cholesterol level. While there are drawbacks to the use of PCSK9 inhibitors, including high cost and adverse events such as injection site reaction, they significantly decreased serum LDL cholesterol levels and thereby ASCVD risks when added to maximally tolerated statin therapy.
Absorption ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Dyslipidemias ; Ezetimibe ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Lipoproteins ; Myalgia ; Proprotein Convertases ; Risk Factors ; Secondary Prevention

Serum cholesterol is major risk factor and contributor to atherosclerotic cardiovascular disease (ASCVD). Therapeutic cholesterol-lowering drugs, especially statin, revealed that reduction in low-density lipoprotein cholesterol (LDL-C) produces marked reduction of ASCVD events. In the preventive scope, lower LDL-C is generally accepted as better in proven ASCVD patients and high-risk patient groups. However, in patients with low to intermediate risk without ASCVD, risk assessment is clinically guided by traditional major risk factors. In this group, the complement approach to detailed risk assessment about traditional major risk factors is needed. These non-traditional risk factors include ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, lipoprotein(a) (Lp[a]), apolipoprotein B (apoB), or coronary artery calcium (CAC) score. CAC measurements have an additive role in the decision to use statin therapy in non-diabetic patients 40–75 years old with intermediate risk in primary prevention. This review comprises ASCVD lipid/biomarkers other than CAC. The 2013 and 2018 American College of Cardiology/American Heart Association (ACC/AHA) guidelines suggest these factors as risk-enhancing factors to help health care providers better determine individualized risk and treatment options especially regarding abnormal biomarkers. The recent 2018 Korean guidelines for management of dyslipidemia did not include these biomarkers in clinical decision making. The current review describes the current roles of hsCRP, ABI, LP(a), and apoB in personal modulation and management of health based on the 2018 ACC/AHA guideline on the management of blood cholesterol.
Ankle Brachial Index ; Apolipoproteins ; Apolipoproteins B ; Biomarkers ; C-Reactive Protein ; Calcium ; Cardiovascular Diseases ; Cholesterol ; Clinical Decision-Making ; Complement System Proteins ; Coronary Vessels ; Dyslipidemias ; Health Personnel ; Heart ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Lipoprotein(a) ; Lipoproteins ; Primary Prevention ; Risk Assessment ; Risk Factors

Tight control of dyslipidemia and hypertension in elderly diabetic patients aged 65 years or older are considered to be very important for the secondary prevention of cardiovascular disease and control of severe diseases associated with macrovascular complications. In addition, in elderly diabetes with risk factors for cardiovascular disease, it is important to control all of the accompanying risk factors together to accomplish the primary prevention of cardiovascular disease. In elderly diabetic patients, thorough control of blood glucose level by itself prevents macrovascular complications. However, it is recommended to perform tight blood glucose control along with other risk factors in consideration of the function and life of the patient. In particular, insulin resistance progresses before the onset of diabetes mellitus and other risk factors for cardiovascular disease. It is important to suppress and prevent the progression of macrovascular complications.
Aged ; Blood Glucose ; Cardiovascular Diseases ; Diabetes Mellitus ; Dyslipidemias ; Humans ; Hypertension ; Insulin Resistance ; Primary Prevention ; Risk Factors ; Secondary Prevention

Atherosclerosis is a major cause of ischemic stroke that can be effectively prevented with appropriate lifestyle modifications and control of cardiovascular risk factors. Medical advances in recent years along with aggressive cardiovascular risk factor modifications have resulted in decreased recurrence rates of atherosclerotic stroke. Non-statin lipid-lowering molecules have recently shown clinical benefit and are recommended for very high-risk patients to reduce their risk of stroke. Aggressive hypertension treatment is crucial to reduce atherosclerotic stroke risk. Advances in antithrombotic treatments include combinations of antiplatelets and new antiplatelet agents in the acute phase post-stroke, which carries a high risk of recurrence. Intensive medical treatment has also limited the indications for carotid interventions, especially for asymptomatic disease. Intracranial atherosclerotic disease may provoke stroke through various mechanisms; it is increasingly recognized as a cause of ischemic stroke with advanced imaging and is best managed with lifestyle modifications and medical therapy. The diagnostic search for the vulnerable culprit atherosclerotic plaque is an area of intense research, from the level of the intracranial arteries to that of the aortic arch. Ultrasonography and novel magnetic resonance imaging techniques (high-resolution vessel-wall imaging) may assist in the identification of vulnerable atherosclerotic plaques as the underlying cause in cryptogenic or misdiagnosed non-atherosclerotic ischemic stroke. Vertebrobasilar atherosclerotic disease is less common than carotid artery disease; thus, high-quality data on effective prevention strategies are scarcer. However, aggressive medical treatment is also the gold standard to reduce cerebrovascular disease located in posterior circulation.
Aorta, Thoracic ; Arteries ; Asymptomatic Diseases ; Atherosclerosis ; Carotid Artery Diseases ; Cerebrovascular Disorders ; Dyslipidemias ; Humans ; Hypertension ; Life Style ; Magnetic Resonance Imaging ; Plaque, Atherosclerotic ; Platelet Aggregation Inhibitors ; Recurrence ; Risk Factors ; Secondary Prevention* ; Stroke* ; Ultrasonography

BACKGROUND/AIMS: The association between metabolic syndrome and colorectal cancer (CRC) has been suggested as one of causes for the increasing incidence of CRC, particularly in younger age groups. The present study examined whether the current age threshold (50 years) for CRC screening in Korea requires modification when considering increased metabolic syndrome. METHODS: We analyzed data from the National Health Insurance Corporation database, which covers ~97% of the population in Korea. CRC risk was evaluated with stratification based on age and the presence/absence of relevant metabolic syndrome components (diabetes, dyslipidemia, and hypertension). RESULTS: A total of 51,612,316 subjects enrolled during 2014 to 2015 were analyzed. Among them, 19.3% had diabetes, hypertension, dyslipidemia, or some combination thereof. This population had a higher incidence of CRC than did those without these conditions, and this was more prominent in subjects < 40 years of age. The optimal cutoff age for detecting CRC, based on the highest Youden index, was 45 years among individuals without diabetes, dyslipidemia, and hypertension. Individuals with at least one of these components of metabolic syndrome had the highest Youden index at 62 years old, but the value was only 0.2. Resetting the cutoff age from 50 years to 45 years achieved a 6% increase in sensitivity for CRC detection among the total population. CONCLUSIONS: Starting CRC screening earlier, namely, at 45 rather than at 50 years of age, may improve secondary prevention of CRC in Korea.
Colonic Neoplasms ; Colorectal Neoplasms* ; Cross-Sectional Studies* ; Diabetes Mellitus ; Dyslipidemias ; Humans ; Hypertension ; Incidence ; Korea ; Mass Screening* ; National Health Programs ; Secondary Prevention

The Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide registry that reflects current therapeutic approaches and acute myocardial infarction (AMI) management in Korea. The results of the KAMIR demonstrated different risk factors and responses to medical and interventional treatments. The results indicated that the incidence of ST-elevation myocardial infarction (STEMI) was relatively high, and that the prevalence of dyslipidemia was relatively low with higher triglyceride and lower high-density lipoprotein cholesterol levels. Percutaneous coronary intervention (PCI) rates were high for both STEMI and non-ST-elevation myocardial infarction (NSTEMI) with higher use of drug-eluting stents (DESs). DES were effective and safe without increased risk of stent thrombosis in Korean AMI patients. Triple antiplatelet therapy, consisting of aspirin, clopidogrel, and cilostazol, was effective in preventing adverse clinical outcomes after PCI. Statin therapy was effective in Korean AMI patients, including those with very low levels of low-density lipoprotein cholesterol and those with cardiogenic shock. The KAMIR score had a greater predictive value than Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores for long-term mortality in AMI patients. Based on these results, the KAMIR will be instrumental for establishing new therapeutic strategies and effective methods for secondary prevention of AMI and guidelines for Asian patients.
Asian Continental Ancestry Group ; Aspirin ; Cholesterol ; Drug-Eluting Stents ; Dyslipidemias ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Korea* ; Lipoproteins ; Mortality ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Prevalence ; Registries* ; Risk Factors ; Secondary Prevention ; Shock, Cardiogenic ; Stents ; Thrombosis ; Triglycerides