Inclisiran and bempedoic acid (BA) are non-statin lipid-lowering agents that have been approved for use in the US and Europe. Inclisiran, a subcutaneously administered small interfering RNA targeting proprotein convertase subtilisin/kexin type 9 messenger RNA, is effectively delivered to the liver via lipid nanoparticles and conjugation. In several phase 3 trials, it has successfully reduced low-density lipoprotein cholesterol (LDL-C) by 50% and has an acceptable safety profile. Currently, the results of clinical outcome studies are awaited. While it is indicated for both primary and secondary cardiovascular prevention, it is selectively recommended after statin-based regimens. BA, an oral inhibitor of adenosine triphosphate-citrate lyase, decreases cholesterol production and enhances LDL uptake by hepatocytes. This enzyme is absent in muscle cells, and BA has fewer muscle-related adverse events. In clinical trials, it lowered LDL-C by 17%–21% compared to placebo and showed a clinical outcome benefit in patients with statin intolerance. This agent modestly increases the incidence of gout and cholelithiasis. For primary and secondary prevention, it may be recommended as a non-first-line agent, either alone or in combination therapy.

Inclisiran and bempedoic acid (BA) are non-statin lipid-lowering agents that have been approved for use in the US and Europe. Inclisiran, a subcutaneously administered small interfering RNA targeting proprotein convertase subtilisin/kexin type 9 messenger RNA, is effectively delivered to the liver via lipid nanoparticles and conjugation. In several phase 3 trials, it has successfully reduced low-density lipoprotein cholesterol (LDL-C) by 50% and has an acceptable safety profile. Currently, the results of clinical outcome studies are awaited. While it is indicated for both primary and secondary cardiovascular prevention, it is selectively recommended after statin-based regimens. BA, an oral inhibitor of adenosine triphosphate-citrate lyase, decreases cholesterol production and enhances LDL uptake by hepatocytes. This enzyme is absent in muscle cells, and BA has fewer muscle-related adverse events. In clinical trials, it lowered LDL-C by 17%–21% compared to placebo and showed a clinical outcome benefit in patients with statin intolerance. This agent modestly increases the incidence of gout and cholelithiasis. For primary and secondary prevention, it may be recommended as a non-first-line agent, either alone or in combination therapy.

Inclisiran and bempedoic acid (BA) are non-statin lipid-lowering agents that have been approved for use in the US and Europe. Inclisiran, a subcutaneously administered small interfering RNA targeting proprotein convertase subtilisin/kexin type 9 messenger RNA, is effectively delivered to the liver via lipid nanoparticles and conjugation. In several phase 3 trials, it has successfully reduced low-density lipoprotein cholesterol (LDL-C) by 50% and has an acceptable safety profile. Currently, the results of clinical outcome studies are awaited. While it is indicated for both primary and secondary cardiovascular prevention, it is selectively recommended after statin-based regimens. BA, an oral inhibitor of adenosine triphosphate-citrate lyase, decreases cholesterol production and enhances LDL uptake by hepatocytes. This enzyme is absent in muscle cells, and BA has fewer muscle-related adverse events. In clinical trials, it lowered LDL-C by 17%–21% compared to placebo and showed a clinical outcome benefit in patients with statin intolerance. This agent modestly increases the incidence of gout and cholelithiasis. For primary and secondary prevention, it may be recommended as a non-first-line agent, either alone or in combination therapy.

Inclisiran and bempedoic acid (BA) are non-statin lipid-lowering agents that have been approved for use in the US and Europe. Inclisiran, a subcutaneously administered small interfering RNA targeting proprotein convertase subtilisin/kexin type 9 messenger RNA, is effectively delivered to the liver via lipid nanoparticles and conjugation. In several phase 3 trials, it has successfully reduced low-density lipoprotein cholesterol (LDL-C) by 50% and has an acceptable safety profile. Currently, the results of clinical outcome studies are awaited. While it is indicated for both primary and secondary cardiovascular prevention, it is selectively recommended after statin-based regimens. BA, an oral inhibitor of adenosine triphosphate-citrate lyase, decreases cholesterol production and enhances LDL uptake by hepatocytes. This enzyme is absent in muscle cells, and BA has fewer muscle-related adverse events. In clinical trials, it lowered LDL-C by 17%–21% compared to placebo and showed a clinical outcome benefit in patients with statin intolerance. This agent modestly increases the incidence of gout and cholelithiasis. For primary and secondary prevention, it may be recommended as a non-first-line agent, either alone or in combination therapy.

Background: As the prevalence of hypertension increases with age and the proportion of the older population is also on the rise, research on the characteristics of older hypertensive patients and the importance of frailty is necessary. This study aimed to identify clinical characteristics of older hypertension in Korea and to investigate these characteristics based on frailty status. Methods: The HOW to Optimize eLDerly systolic BP (HOWOLD-BP) is a prospective, multicenter, open-label, randomized clinical trial that aims to compare intensive (target systolic blood pressure [SBP] ≤ 130 mmHg) with standard (target SBP ≤ 140 mmHg) treatment to reduce cardiovascular events in older hypertensive Korean patients aged ≥ 65 years. Data were analyzed through a screening assessment of 2,085 patients recruited from 11 university hospitals. Demographic, functional (physical and cognitive), medical history, laboratory data, quality of life, and medication history of antihypertensive drugs were assessed. Results: The mean age was 73.2 years (standard deviation ± 5.60), and 48.0% (n = 1,001) were male. Prevalent conditions included dyslipidemia (66.5%), obesity (body mass index ≥ 25 kg/m 2 , 53.6%), and diabetes (28.9%). Dizziness and orthostatic hypotension were self-reported by 1.6% (n = 33) and 1.2% (n = 24), respectively. The majority of patients were on two antihypertensive drugs (48.4%), while 27.5% (n = 574) and 20.8% (n = 433) were on 1 and 3 antihypertensive medications, respectively. Frail to pre-frail patients were older and also tended to have dependent instrumental activities of daily living, slower gait speed, weaker grip strength, lower quality of life, and lower cognitive function. The frail to pre-frail group reported more dizziness (2.6% vs. 1.2%, P < 0.001) and had concerning clinical factors, including lower glomerular filtration rate, more comorbidities such as diabetes, stroke, and a history of admission. Frail to pre-frail older hypertensive patients used slightly more antihypertensive medications than robust older hypertensive patients (1.95 vs. 2.06, P = 0.003). Pre-frail to frail patients often chose beta-blockers as a third medication over diuretics. Conclusion This study described the general clinical characteristics of older hypertensive patients in Korea. Frail hypertensive patients face challenges in achieving positive clinical outcomes because of multifactorial causes: they are older, have more morbidities, decreased function, lower quality of life and cognitive function, and take more antihypertensive medications. Therefore, it is essential to comprehensively evaluate and monitor diseaserelated or drug-related adverse events more frequently during regular check-ups, which is necessary for pre-frail to frail older patients with hypertension.

Background: Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during 30-day postoperative period, is associated with long-term mortality, but with limited clinical evidence. We compared long-term mortality with PACE using data from nationwide multicenter electronic health records. Methods: Data from 7 hospitals, converted to Observational Medical Outcomes Partnership Common Data Model, were used. We extracted records of 277,787 adult patients over 18 years old undergoing non-cardiac surgery for the first time at the hospital and had medical records for more than 180 days before surgery. We performed propensity score matching and then an aggregated meta‑analysis. Results: After 1:4 propensity score matching, 7,970 patients with PACE and 28,807 patients without PACE were matched. The meta‑analysis showed that PACE was associated with higher one-year mortality risk (hazard ratio [HR]: 1.33, 95% CI [1.10, 1.60], P = 0.005) and higher three-year mortality (HR: 1.18, 95% CI [1.01, 1.38], P = 0.038). In subgroup analysis, the risk of one-year mortality by PACE became greater with higher-risk surgical procedures (HR: 1.20, 95% CI [1.04, 1.39], P = 0.020 for low-risk surgery; HR: 1.69, 95% CI [1.45, 1.96], P < 0.001 for intermediate-risk; and HR: 2.38, 95% CI [1.47, 3.86], P = 0.034 for high-risk). Conclusions A nationwide multicenter study showed that PACE was significantly associated with increased one-year mortality. This association was stronger in high-risk surgery, older, male, and chronic kidney disease subgroups. Further studies to improve mortality associated with PACE are needed.

Background: To make good use of the prognostic value of arterial stiffness, it is important to identify the population with the greatest benefit. In this study, we compared the prognostic value of brachial-ankle pulse wave velocity (baPWV) according to various clinical characteristics. Methods: A total of 10,597 subjects who underwent baPWV measurement (mean age, 61.4 ± 9.5 years; female proportion, 42.5%) were retrospectively analyzed. Major adverse cardiovascular events (MACEs), defined as a composite of cardiac death, non-fatal myocardial infarction, coronary revascularization, and ischemic stroke were assessed during the clinical follow-up period. Results: In the multivariate analysis, clinical variables with more than 4,000 subjects were selected as grouping variables, which were sex (men and women), age (≥ 65 and < 65 years), body mass index (BMI) (≥ 25 and < 25 kg/m 2), hypertension (presence and absence), estimated glomerular filtration rate (≥ 90 and < 90 mL/min/1.73 m 2 ), and statin use (user and non-user). During the median clinical follow-up duration of 3.58 years (interquartile range, 1.43–5.38 years), there were 422 MACEs (4.0%). In total study subjects, baseline higher baPWV was associated with increased risk of MACE occurrence (hazard ratio for baPWV ≥ 1,800 cm/s compared to baPWV < 1,400 cm/s, 4.04; 95% confidence interval, 2.62–6.21; P < 0.001). The prognostic value of baPWV was statistically significant regardless of sex, age, BMI, hypertension, renal function, and statin use. Conclusion Our results suggest that baPWV is not only effective in specific clinical situations, but can be effectively applied to predict cardiovascular prognosis in various clinical situations.

Background/Aims: The optimal systolic blood pressure (SBP) goal for elderly patients with hypertension, especially to reduce cardiovascular disease (CVD) incidence and improve outcome, is unclear. This study aimed to evaluate the beneficial effects of intensive treatment for hypertension on the incidence of CVD in elderly Korean patients. Methods: The HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial is a multicenter, parallel-design, open-label, randomized controlled trial designed to evaluate whether intensive treatment (SBP ≤ 130 mmHg) will provide more benefits in lowering the incidence and mortality associated with CVD than standard treatment (SBP ≤ 140 mmHg) in elderly patients with hypertension aged ≥ 65 years. For this study, eleven university hospitals in Korea will enroll approximately 3,176 elderly patients with hypertension between 2019 and 2022. Patients will be requested to visit the clinic every 4 months for the first year and every 6 months thereafter for 36 months. Parameters, including clinic and home blood pressure, anthropometric and laboratory findings, and frailty assessments, will be collected according to the standardized protocol. The primary outcome is a composite of CVD (acute coronary syndrome, stroke, and heart failure) incidence and cardiovascular deaths. Results: As of December 2021, 1,655 participants had been enrolled in the study, including 831 patients in the standard group and 824 patients in the intensive group. Conclusions The HOWOLD-BP trial is the first study performed in Korea to evaluate the beneficial effects of intensive blood pressure treatment on CVD in elderly patients with hypertension. The results of this study will help clarify the appropriate target SBP for this population.

Background and Objectives: This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). Methods: A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg). Results: During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05–1.24) but not in those by the 2017 ACC/AHA definition. Elevated ontreatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18–1.70) and stroke (aHR, 1.19; 95% CI, 1.08–1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10;95% CI, 1.04–1.16). Similar results were seen in the propensity-score-matched cohort. Conclusion Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.

With the recent rapid increase in obesity worldwide, metabolic syndrome (MetS) has gained significant importance. MetS is a cluster of obesity-related cardiovascular risk factors including abdominal obesity, atherogenic dyslipidemia, high blood pressure and impaired glucose tolerance. MetS is highly prevalent and strongly associated with an increased risk of developing diabetes and cardiovascular disease, putting a great burden on human society. Therefore, it is very important to reduce MetS risk, which can improve patients’cardiovascular prognosis. The primary and most effective strategy to control each component of MetS is lifestyle change such as losing body weight, keeping regular exercise, adopting a healthy diet, quitting smoking and alcohol drinking in moderation. Many studies have shown that lifestyle modification has improved all components of MetS, and reduces the incidence of diabetes and cardiovascular disease. Here, the Korean Society of CardioMetabolic Syndrome has summarized specific and practical methods of lifestyle modification in the management of MetS in the healthcare field.