2.Thirty-six Year Trends in Mortality from Diseases of Circulatory System in Korea
Jongmin BAEK ; Hokyou LEE ; Hyeok-Hee LEE ; Ji Eun HEO ; So Mi Jemma CHO ; Hyeon Chang KIM
Korean Circulation Journal 2021;51(4):320-332
Background and Objectives:
Understanding the trends in cardiovascular disease (CVD) mortality is important for developing burden reduction strategies. Based on the Cause of Death Statistics, we examined the changing patterns of CVD mortality in Korea between 1983 and 2018.
Methods:
Causes of death were coded according to the International Classification of Disease, 10th revision. Deaths from all diseases of circulatory system (I00-I99) and the following 6 subcategories were analyzed: total heart diseases (I00-I13 and I20-I51), hypertensive heart diseases (I10-I13), ischemic heart diseases (I20-I25), myocardial infarction (I21-I23), heart failure (I50), and cerebrovascular diseases (I60-I69). Crude, age-standardized, and age-stratified rates were calculated to assess temporal trends in CVD mortality.
Results:
The number of deaths and crude mortality rate for all diseases of circulatory system increased recently mainly due to the population ageing. Specifically, total heart diseases showed increasing trend, whereas cerebrovascular diseases showed decreasing trend. Between 1983 and 2018, age-standardized mortality rates significantly declined for all diseases of circulatory system, total heart diseases, hypertensive heart diseases, and cerebrovascular diseases. Age-standardized mortality rates for ischemic heart diseases and myocardial infarction peaked in the early 2000s then decreased thereafter. However, agestandardized mortality rate for heart failure rapidly increased, especially in recent years.
Conclusions
CVD mortality in Korea has remarkably decreased over the last 36 years.However, the recent rise in the absolute number of deaths from heart diseases, especially from heart failure, calls for attention in prevention and management of CVD and its sequelae.
3.Korea Heart Disease Fact Sheet 2020:Analysis of Nationwide Data
Hyeok-Hee LEE ; So Mi JEMMA CHO ; Hokyou LEE ; Jongmin BAEK ; Jang-Ho BAE ; Wook-Jin CHUNG ; Hyeon Chang KIM
Korean Circulation Journal 2021;51(6):495-503
Background and Objectives:
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. To provide an overview of the temporal trends in the burden of CVD, the Korean Society of Cardiology has published the Korea Heart Disease Fact Sheet in 2020.
Methods:
We analyzed anonymized data of the Causes of Death Statistics, National Health Insurance Claims Database, and Korea National Health and Nutrition Examination Survey to assess mortality, hospitalizations, and risk factors for CVD.
Results:
The CVD mortality decreased until 2010, then steadily increased up to 123 per 100,000 persons in 2018. Since 2002, the number and rate of CVD hospitalization have continued to grow. In 2018, approximately 12.1 million Korean adults had hypertension, 4.3 million had diabetes, 8.7 million had hypercholesterolemia, 14.9 million had obesity, and 8.8 million were currently smoking. The number of risk factors increased markedly with older age; 58.4% of adults age ≥70 years had ≥2 risk factors.
Conclusions
CVD mortality and hospitalization have gradually increased in the last decade, and a substantially high proportion of adults were carrying more than 1 cardiovascular risk factor in 2018. With the rapid population aging, a continued increase in CVD appears inevitable in Korea. Concerted and sustained approaches are essential to achieve early prevention and reduce the burden of CVD.
4.Thirty-six Year Trends in Mortality from Diseases of Circulatory System in Korea
Jongmin BAEK ; Hokyou LEE ; Hyeok-Hee LEE ; Ji Eun HEO ; So Mi Jemma CHO ; Hyeon Chang KIM
Korean Circulation Journal 2021;51(4):320-332
Background and Objectives:
Understanding the trends in cardiovascular disease (CVD) mortality is important for developing burden reduction strategies. Based on the Cause of Death Statistics, we examined the changing patterns of CVD mortality in Korea between 1983 and 2018.
Methods:
Causes of death were coded according to the International Classification of Disease, 10th revision. Deaths from all diseases of circulatory system (I00-I99) and the following 6 subcategories were analyzed: total heart diseases (I00-I13 and I20-I51), hypertensive heart diseases (I10-I13), ischemic heart diseases (I20-I25), myocardial infarction (I21-I23), heart failure (I50), and cerebrovascular diseases (I60-I69). Crude, age-standardized, and age-stratified rates were calculated to assess temporal trends in CVD mortality.
Results:
The number of deaths and crude mortality rate for all diseases of circulatory system increased recently mainly due to the population ageing. Specifically, total heart diseases showed increasing trend, whereas cerebrovascular diseases showed decreasing trend. Between 1983 and 2018, age-standardized mortality rates significantly declined for all diseases of circulatory system, total heart diseases, hypertensive heart diseases, and cerebrovascular diseases. Age-standardized mortality rates for ischemic heart diseases and myocardial infarction peaked in the early 2000s then decreased thereafter. However, agestandardized mortality rate for heart failure rapidly increased, especially in recent years.
Conclusions
CVD mortality in Korea has remarkably decreased over the last 36 years.However, the recent rise in the absolute number of deaths from heart diseases, especially from heart failure, calls for attention in prevention and management of CVD and its sequelae.
5.Korea Heart Disease Fact Sheet 2020:Analysis of Nationwide Data
Hyeok-Hee LEE ; So Mi JEMMA CHO ; Hokyou LEE ; Jongmin BAEK ; Jang-Ho BAE ; Wook-Jin CHUNG ; Hyeon Chang KIM
Korean Circulation Journal 2021;51(6):495-503
Background and Objectives:
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. To provide an overview of the temporal trends in the burden of CVD, the Korean Society of Cardiology has published the Korea Heart Disease Fact Sheet in 2020.
Methods:
We analyzed anonymized data of the Causes of Death Statistics, National Health Insurance Claims Database, and Korea National Health and Nutrition Examination Survey to assess mortality, hospitalizations, and risk factors for CVD.
Results:
The CVD mortality decreased until 2010, then steadily increased up to 123 per 100,000 persons in 2018. Since 2002, the number and rate of CVD hospitalization have continued to grow. In 2018, approximately 12.1 million Korean adults had hypertension, 4.3 million had diabetes, 8.7 million had hypercholesterolemia, 14.9 million had obesity, and 8.8 million were currently smoking. The number of risk factors increased markedly with older age; 58.4% of adults age ≥70 years had ≥2 risk factors.
Conclusions
CVD mortality and hospitalization have gradually increased in the last decade, and a substantially high proportion of adults were carrying more than 1 cardiovascular risk factor in 2018. With the rapid population aging, a continued increase in CVD appears inevitable in Korea. Concerted and sustained approaches are essential to achieve early prevention and reduce the burden of CVD.
6.Dyslipidemia Fact Sheets in Korea 2020: an Analysis of Nationwide Population-based Data
So Mi Jemma CHO ; Hokyou LEE ; Hyeok-Hee LEE ; Jongmin BAEK ; Ji Eun HEO ; Hyung Joon JOO ; Soon Jun HONG ; Hyeon Chang KIM ;
Journal of Lipid and Atherosclerosis 2021;10(2):202-209
Objective:
The Korean Society of Lipid and Atherosclerosis (KSoLA) has published the Dyslipidemia Fact Sheets in Korea 2020 to provide an overview of magnitude and management status of dyslipidemia and their recent trends therein.
Methods:
The Fact Sheets were based on the analyses of Korean adults aged 20 years or older of the 2007–2018 Korea National Health and Nutrition Examination Survey (KNHANES) and the 2002–2018 National Health Insurance Big Data (NHI-BD).
Results:
Between 2007 and 2018, the crude prevalence of hypercholesterolemia increased from 9.0% to 20.7%. During the same period, its management rate also improved yet remained unsatisfactory. In 2018, the prevalence of dyslipidemia was 45.6% in men and 31.3% in women, which increased with older age and presence of metabolic abnormalities.Indeed, the number of people diagnosed with dyslipidemia has increased nearly 8-fold from 1.5 million in 2002 to 11.6 million in 2018; alongside, the number of people receiving pharmacological treatment for dyslipidemia has also risen. Of the 7.7 million people treated for dyslipidemia in 2018, statin accounted for the majority (91.8%) of lipid-lowering drug prescriptions, followed by ezetimibe (14.6%), fibrate (8.5%), and omega-3 acid (5.9%). The most frequently used combination therapy was statin plus ezetimibe, accounting for 72% of dual therapy prescriptions.
Conclusion
Dyslipidemia continues to impose a substantial disease burden in Korea. Both healthcare practitioners and patients need to actively adopt guideline-recommended lifestyle modification and pharmacological treatment for comprehensive, timely, and sustained management.
7.Dyslipidemia Fact Sheets in Korea 2020: an Analysis of Nationwide Population-based Data
So Mi Jemma CHO ; Hokyou LEE ; Hyeok-Hee LEE ; Jongmin BAEK ; Ji Eun HEO ; Hyung Joon JOO ; Soon Jun HONG ; Hyeon Chang KIM ;
Journal of Lipid and Atherosclerosis 2021;10(2):202-209
Objective:
The Korean Society of Lipid and Atherosclerosis (KSoLA) has published the Dyslipidemia Fact Sheets in Korea 2020 to provide an overview of magnitude and management status of dyslipidemia and their recent trends therein.
Methods:
The Fact Sheets were based on the analyses of Korean adults aged 20 years or older of the 2007–2018 Korea National Health and Nutrition Examination Survey (KNHANES) and the 2002–2018 National Health Insurance Big Data (NHI-BD).
Results:
Between 2007 and 2018, the crude prevalence of hypercholesterolemia increased from 9.0% to 20.7%. During the same period, its management rate also improved yet remained unsatisfactory. In 2018, the prevalence of dyslipidemia was 45.6% in men and 31.3% in women, which increased with older age and presence of metabolic abnormalities.Indeed, the number of people diagnosed with dyslipidemia has increased nearly 8-fold from 1.5 million in 2002 to 11.6 million in 2018; alongside, the number of people receiving pharmacological treatment for dyslipidemia has also risen. Of the 7.7 million people treated for dyslipidemia in 2018, statin accounted for the majority (91.8%) of lipid-lowering drug prescriptions, followed by ezetimibe (14.6%), fibrate (8.5%), and omega-3 acid (5.9%). The most frequently used combination therapy was statin plus ezetimibe, accounting for 72% of dual therapy prescriptions.
Conclusion
Dyslipidemia continues to impose a substantial disease burden in Korea. Both healthcare practitioners and patients need to actively adopt guideline-recommended lifestyle modification and pharmacological treatment for comprehensive, timely, and sustained management.
8.Sex- and Age-Specific Trends in Cardiovascular Health in Korea, 2007–2018
So Mi Jemma CHO ; Hokyou LEE ; Hyeon Chang KIM
Korean Circulation Journal 2021;51(11):922-935
Background and Objectives:
We illustrated sex- and age-specific temporal trends in cardiovascular health among Korean adults.
Methods:
From the Korean National Health and Nutrition Examination Survey 2007–2018, we included 61,408 participants aged 20 years or older. The ideal levels of 6 components of cardiovascular health metrics were defined as never-smoking, ≥75 min/week of vigorous or ≥150 min/week of moderate-to-vigorous physical activity, body mass index (BMI) <23 kg/ m2 , total cholesterol <200 mg/dL, blood pressure (BP) <120/80 mmHg, and fasting glucose <100 mg/dL. Temporal trends in the number of ideal cardiovascular health components and distribution of each component were assessed by sex and age.
Results:
The average number of ideal cardiovascular health components decreased from 3.37 in 2007–2009 to 2.86 in 2016–2018. Never smoking increased from 56.0% to 59.2%, largely contributed by young men. Ideal physical activity halved (41.4–21.3%); such decline was more pronounced in women and with older age. Ideal BMI decreased from 44.3% to 42.2%, more apparently in young and elderly men. In contrast, ideal BMI increased in middle-aged and elderly women. Ideal cholesterol decreased from 65.5% to 50.3%, profoundly in young adults and relatively greater in men. Ideal BP declined from 55.1% to 46.9%, more evidently in men.However, ideal BP discernibly increased in middle-aged women. Ideal glucose decreased from 74.6% to 66.0%, comparatively greater and earlier in men.
Conclusions
The proportion of Korean adults with ideal cardiovascular health decreased between 2007 and 2018, but the course of responsible factors differed across sex and age groups.
9.Association of Snoring with Prediabetes and Type 2 Diabetes Mellitus: The Cardiovascular and Metabolic Diseases Etiology Research Center Cohort
So Mi Jemma CHO ; Hokyou LEE ; Jee-Seon SHIM ; Hyeon Chang KIM
Diabetes & Metabolism Journal 2020;44(5):687-698
Evidence suggests that habitual snoring is an independent risk factor for poor glycemic health. We examined the associations between snoring with prediabetes and diabetes in Korean population. Self-reported snoring characteristics were collected from 3,948 middle-aged adults without prior cardiovascular diseases. Multivariable linear regression assessed the association of snoring intensity, frequency, disruptiveness, and disrupted breathing with fasting glucose and glycosylated hemoglobin (HbA1c) level. Then, multinomial regression evaluated how increasing snoring symptoms are associated with the risk for prediabetes and diabetes, adjusting for socioeconomic and behavioral risk factors of diabetes, obesity, hypertension, and other sleep variables. Higher snoring intensity and frequency were positively associated with fasting glucose and HbA1c levels. Participants presenting the most severe snoring were at 1.84 times higher risk (95% confidence interval [CI], 1.09 to 2.29) for prediabetes and 2.24 times higher risk (95% CI, 1.84 to 2.95) for diabetes, compared to non-snorers. Such graded association was also observed amongst the most frequent snorers with higher risk for prediabetes (odds ratio [OR], 1.78; 95% CI, 1.29 to 2.22) and diabetes (OR, 2.03; 95% CI, 1.45 to 2.85). Disruptive snoring (OR, 1.60; 95% CI, 1.12 to 2.28) and near-daily disruptive breathing (OR, 2.18; 95% CI, 1.02 to 4.19) were associated with higher odds for diabetes. Such findings remained robust after additional adjustment for sleep duration, excessive daytime sleepiness, unwakefulness, and sleep-deprived driving. Snoring is associated with impaired glucose metabolism even in otherwise metabolically healthy adults. Habitual snorers may require lifestyle modifications and pharmacological treatment to improve glycemic profile.
10.Sex-, Age-, and Metabolic Disorder-Dependent Distributions of Selected Inflammatory Biomarkers among Community-Dwelling Adults
So Mi Jemma CHO ; Hokyou LEE ; Jee-Seon SHIM ; Hyeon Chang KIM
Diabetes & Metabolism Journal 2020;44(5):711-725
Inflammatory cytokines are increasingly utilized to detect high-risk individuals for cardiometabolic diseases. However, with large population and assay methodological heterogeneity, no clear reference currently exists. Among participants of the Cardiovascular and Metabolic Diseases Etiology Research Center cohort, of community-dwelling adults aged 30 to 64 without overt cardiovascular diseases, we presented distributions of tumor necrosis factor (TNF)-α and -β, interleukin (IL)-1α, -1β, and 6, monocyte chemoattractant protein (MCP)-1 and -3 and high sensitivity C-reactive protein (hsCRP) with and without non-detectable (ND) measurements using multiplex enzyme-linked immunosorbent assay. Then, we compared each markers by sex, age, and prevalence of type 2 diabetes mellitus, hypertension, and dyslipidemia, using the Wilcoxon Rank-Sum Test. In general, there were inconsistencies in direction and magnitude of differences in distributions by sex, age, and prevalence of cardiometabolic disorders. Overall, the median and the 99th percentiles were higher in men than in women. Older participants had higher TNF-α, high sensitivity IL-6 (hsIL-6), MCP-1, hsCRP, TNF-β, and MCP-3 median, after excluding the NDs. Participants with type 2 diabetes mellitus had higher median for all assayed biomarkers, except for TNF-β, IL-1α, and MCP-3, in which the medians for both groups were 0.00 due to predominant NDs. Compared to normotensive group, participants with hypertension had higher TNF-α, hsIL-6, MCP-1, and hsCRP median. When stratifying by dyslipidemia prevalence, the comparison varied significantly depending on the treatment of NDs. Our findings provide sex-, age-, and disease-specific reference values to improve risk prediction and diagnostic performance for inflammatory diseases in both population- and clinic-based settings.

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