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 대한심장학회 2021 Korean Circulation Journal Vol.51 No.4

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, age-standardized 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.

Alopecia areata is not a risk factor for heart diseases: A 10-year retrospective cohort study

( Heera Lee ),( You Chan Kim ),( Jee Woong Choi ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: Alopecia areata (AA) is an autoimmune skin disease caused by chronic inflammation of the hair follicles. Chronic inflammatory skin diseases, such as psoriasis and lupus erythematosus can increase the risk of cardiovascular diseases. However, the relationship between AA and heart diseases is unclear. Objectives: To evaluate the risk for subsequent heart diseases in patients with AA Methods: We conducted a retrospective cohort study using data of 3,770 cases of AA, and age-, sex-, and income level-matched 18,850 controls from the National Health Insurance Service-National Sample Cohort. In subgroup analysis, those who suffered from alopecia totalis, alopecia universalis, and ophiasis designated as severe AA, and who having had over a year of the disease defined as long-standing AA. Results: AA was not related to a higher risk of heart failure, angina pectoris, and myocardial infarction. There was no significant increase in the risk of overall heart diseases associated with AA (adjusted hazard ratio, 1.17; 95 % confidence interval, 0.93-1.48; p= 0.177). Neither severity nor duration of AA was related to the increased risk of heart diseases. During the study period, AA patients didn’t show a significantly higher cumulative incidence of heart diseases than controls (log-rank p=0.157). Conclusion: AA does not increase the risk of heart diseases.

65세 이상의 노인 환자에서의 심판막 폐쇄부전증에 대한 임상적 고찰

류주성,왕준호,문언수,이홍순 대한노인병학회 2001 대한노인병학회지 Vol.5 No.4

공심병(空心病)과 철학상담

김여진 대한철학회 2019 哲學硏究 Vol.149 No.-

Empty heart disease(空心病) is a neologism coined by Xu Kai Wen(徐凱文) who is a professor of the department psychology at Beijing University in China and psychiatrist in one education forum held in November 2016. Although the symptoms are similar to the depression, the empty heart disease is different in that general psychotherapy or medication treatment is of no use in the latter case, which reveals the limitation of the existing psychological counseling or chemical treatment. In China, debates on the role and possibility of philosophical counseling have not been actively discussed so far. This paper criticized that the interpretation and prescription of the empty heart disease in China excessively depend on psychology as of now. By incorporating the concept of “empty heart” into the field of philosophical counseling and therapy, this paper put emphasis on the role and possibility of the philosophical counseling. The main body of this paper unfolds in the following context. First, the paper analyzed what the empty heart disease and its background is that Chinese college students are experiencing these days and introduced the discourse on its response and therapy method. Next, the paper argued that the empty heart disease should be a subject of the philosophical counseling. Arguing that the empty heart disease can be healed by the philosophical counseling, the paper criticized the existing interpretation of the empty heart, which is excessively psychological and passive regarding the term, symptoms, and alternatives. Finally, this paper considered a fundamental theory based on the Eastern philosophy, particularly the theory by Feng You Lan(馮友蘭) and Xun Zi(荀子) for the purpose of establishing a methodology of philosophical counseling that can respond to the symptoms of empty heart disease. This paper has timeliness as it dealt with the college students’ depression which recently emerged as a social issue. The paper satisfied the originality requirement of the research topic as it introduced the new terminology of empty heart for the first time in Korea from an aspect of philosophical counseling. Also, this study has significance from an aspect of research history as application of Xun Zi’s theory can be rarely seen in philosophical counseling research in Korea and China and that the paper established a model based on Eastern philosophy using specific cases among the philosophical counseling studies. However, this study has limitations that it could not elaborate on the logic of the methodology because the model was composed under the absence of clinical study, without provision of rich clinical cases. Further studies will address these limitations in the future. 공심병(空心病, Empty heart disease)이란, 중국 베이징(北京)대학의 심리학과 교수이자 정신과 주치의인 쉬카이원(徐凱文) 교수가 2016년 11월에 열린 한 교육포럼에서 처음 제기한 신조어이다. 증상만을 놓고 보면 우울증에 해당하지만 일반적인 심리치료의 기법이나 약물치료로는 아무런 효과가 없다는 것이 공심병의 특징이다. 기존의 심리 상담이나 화학적 치료의 한계가 드러나는 지점이긴 하지만 중국의 경우 철학상담(Philosophical Counseling)이라는 영역의 역할이나 가능성에 대해 아직 활발히 논의된 바가 없다. 이 글은 중국의 공심병이 지나치게 심리학적인 해석 및 처방에 의존하고 있음을 비판하며 ‘공심’을 철학상담치료의 영역으로 끌어들여 철학상담의 역할과 가능성을 주장하고자 한다. 본문의 내용은 다음과 같은 맥락에서 전개된다. 먼저, 최근 중국의 대학생이 겪고 있는 공심병이 무엇이며 어떠한 배경에서 출현하였고 그 대응책 및 치료방법에 대한 담론들은 어떠한지 소개한다. 다음은, 공심병이 왜 철학상담의 대상인지를 설득하고 철학상담을 통한 치료의 가능성을 주장하기 위해 중국의 공심에 대한 용어, 증상, 대안에 있어 지나치게 심리학적‧소극적인 해석을 비판한다. 마지막으로, 공심병 증세에 대응할만한 철학상담의 방법론을 세우기 위해 동양철학 특히 풍우란(馮友蘭)과 순자(荀子)의 이론에 기반한 토대 이론을 구상할 것이다. 이 글은 최근 이슈가 되고 있는 대학생의 우울을 다뤘다는 점에서 시의성을 지니며 공심병이란 신조어를 철학상담 영역에서 국내 처음 소개하고 있다는 점으로부터 연구 주제의 참신함을 갖는다. 또한 한국 및 중국의 철학상담 연구에 있어 순자의 이론을 적용한 시도는 찾아보기 힘들다는 점과 동양철학에 기반한 철학상담 연구 가운데 구체적인 사례를 들어 모형을 구상화했다는 점에서 연구사적 의의가 있다고 볼 수 있다. 하지만 풍부한 임상사례를 근거로 삼지 못했고 임상연구의 부재 하에 모형을 구상했기 때문에 방법론에 있어 보다 치밀한 논리로써 전개하지 못했다는 한계를 지닌다. 이에 대한 보완은 후속 연구에서 이어나가려고 한다.

心臟瓣膜疾患 手術治驗에 關한 臨床的 考察

曺洸鉉 인제대학교 1989 仁濟醫學 Vol.10 No.1

1985년 9월부터 1988년 3월까지 68例의 심장판막질환에 관한 수술 치료가 시행되었다. 이 중에는 單一瓣膜疾患이 41例, 二重瓣膜疾患이 14例, 三重瓣膜疾患이 9例, 선천성질환과 합병된 경우가 4例 등이었다. 이들 68例에 관한 治驗을 여러 각도에서 분석해 보고 문헉적 검토를 하여 향후의 치료에 도움이 되도록 노력하였다. Open heart surgeries for 68 cases of valvular heart diseases were performed in the department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University from Sep. 1985 to March 1988. And the results were summarized as follows with some literature reviews about specific problems of valvular surgeries 1) Among the 68 cases, there were 41 cases of single valve diseases(MS : 6, MSr : 14, MR : 4, MRs 13, AR : 2, ARs : 1, ASr : 1), 14 of double valve diseases(MRs+Ar : 1, MRs+AR : 1, MRs+ARs: 3, MSr+ASr :1, MSr+ARs : 1, MRs+TR : 4, MSr+TR : 3), 9 of triple valve diseases(MSr+Ar+TR : 3, MRs+ARs+TR : 1, MSr+AR+TR : 1, MSr+ASr+TR : 4) and 4 combined with congenital anomalies(MR+ASD : 1, MR+PDA : 1, AR+ASD+VSD : 1, MRs+TR+ASD : 1) 2) 2 cases were male, 48 cases were female and the age range of cases was 16 to 62 years with the mean age of 32 years. 3) The heart lung machine used for cardiopulmonary bypass was Sarns 7000,5 head roller pump. The modified GIK(glucose-insulin-potassium) solution was used as cardioplegic solution for the purpose of myocardi al protection during operation. 4) 41 of MVR were performed for single mitral valve diseases and 4 of AVR for single aortic valve diseases. 5) For 14 cases of double valve diseases, one of MVR, 5 of MVR+AVR, 7 of MVR+TVA were perfo rmed. 6) For 9 cases of triple valve diseases, 3 of MVR+TVA and 6 of MVR+AVR+TVA were performed. 7) For 4 cases combined with congenital anomalies, 2 of MVR, one of AVR and one of MVR+TVA were performed with radical corrections of the combined anomalies. 8) 80 of artificial valves were used for valve replacement. In MVR(62), 12 of mechanical valves(St. Jude Medical : 12), 50 of tissue valves(Carpentier-Edward : 46, Ionescu-Shiley : 4) were used. In AVR(18), 11 of St. Jude Medical valves and 7 of Carpentier-Edward valves were used. 9) Postoperative complications were occurred in 15 cases. Among them, low cardiac output syndrome was noticed in 10 cases as the highest incidence. Postoperative mortality was only one, which, one of MVR +AVR cases, occurred as sudden death with severe hemothorax and hypovolemic shock due to ventricular rupture.

임상 ; 모성 심질환과 임신에 관한 임상 연구

김아리 ( A Ri Kim ),박병준 ( Byung Joon Park ),서미원 ( Mee Won Seo ),김옥경 ( Ok Kyoung Kim ),김수평 ( Soo Pyung Kim ),신종철 ( Jong Chul Shin ) 대한주산의학회 2007 Perinatology Vol.18 No.4

목적: 본 연구는 모성 심질환이 동반된 임신의 결과를 알아보고자 하였다. 방법: 1995년 1월 1일부터 2006년 12월 31일까지 강남성모병원 산부인과와 부평자애병원 산부인과에서 분만한 심질환을 동반한 산모의 의무기록을 고찰하였다. 결과: 심질환을 갖는 39명의 산모에서 41건의 분만이 있었고, 1예는 쌍생아 임신이었다. 11예(26.7 %)은 류마티스성 심질환, 3예(7.3%)는 선천성 심질환, 22예(53.7%)는 부정맥이었으며, 나머지 기타에 해당하는 5예(12.3%)는 허혈성 심질환과 울혈성 심부전으로 구성되었다. 폐부종은 4예 모두에서 임신 지속 기간 중에는 발생하지 않았으나, 분만 전후 나타났다. 분만 전후의 New York Heart Association (NYHA) functional class는 32예에서 functional class I을 보였고, 나머지 8예 모두에서 functional class II를 보였다. 분만시 평균 임신 주수는 38.6주였고 평균 출생체중은 3,157g이었다. 2예의 부정맥이 있던 산모에서 태아 기형이 산전에 진단되었다. 결론: 모성 심질환이 있는 산모에서 NYHA functional class I이나 II일 경우 합병증 증가의 위험 없는 양호한 임신의 결과를 기대할 수 있다. Objective: To assess the pregnancy outcomes complicated by maternal heart diseases. Methods: From 1995 to 2006, medical records of pregnant women who had received full antenatal care at Kangnam St. Marys Hospital and Our Lady of Mercy Hospital with maternal heart diseases were reviewed. Results: Forty one deliveries from 39 women were enrolled for analysis. 11 (26.7%) cases of the heart diseases were of rheumatic origin, 22 (53.7%) cases had arrhythmic disease, 3 (7.3%) cases had congenital heart disease, and the remaining 5 (12.3%) cases were consisted of miscellaneous diseases such as ischemic heart disease and congestive heart failure. There were 4 (9.8%) cases of pulmonary edema which had occurred as maternal complication during pregnancy. One case was a twin pregnancy. All of them were in New York Heart Association (NYHA) functional classes I, II before, during, and after delivery. Mean gestational age at birth and birth weight were 38.6 weeks and 3,157 g respectively. Neonatal congenital heart disease was shown in only one case with tetralogy of Falot and the other fetal anomaly was multicystic dysplastic kidney. Conclusion: Our results indicate that successful pregnancy outcome in patients with maternal heart disease would be possible in NYHA functional classes of I and II without any increased risk of complications.

Implications of Managing Chronic Obstructive Pulmonary Disease in Cardiovascular Diseases

( Kartik Deshmukh ),( Arjun Khanna ) 대한결핵 및 호흡기학회 2021 Tuberculosis and Respiratory Diseases Vol.84 No.1

Globally, cardiovascular diseases and chronic obstructive pulmonary disease (COPD) are the leading causes of the non-communicable disease burden. Overlapping symptoms such as breathing difficulty and fatigue, with a lack of awareness about COPD among physicians, are key reasons for under-diagnosis and resulting sub-optimal care relative to COPD. Much has been published in the past on the pathogenesis and implications of cardiovascular comorbidities in COPD. However, a comprehensive review of the prevalence and impact of COPD management in commonly encountered cardiac diseases is lacking. The purpose of this study was to summarize the current knowledge regarding the prevalence of COPD in heart failure, ischemic heart disease, and atrial fibrillation. We also discuss the real-life clinical presentation and practical implications of managing COPD in cardiac diseases. We searched PubMed, Scopus, EMBASE, and Google Scholar for studies published 1981-May 2020 reporting the prevalence of COPD in the three specified cardiac diseases. COPD has high prevalence in heart failure, atrial fibrillation, and ischemic heart disease. Despite this, COPD remains under-diagnosed and under-managed in the majority of patients with cardiac diseases. The clinical implications of the diagnosis of COPD in cardiac disease includes the recognition of hyperinflation (a treatable trait), implementation of acute exacerbations of COPD (AECOPD) prevention strategies, and reducing the risk of overuse of diuretics. The pharmacological agents for the management of COPD have shown a beneficial effect on cardiac functions and mortality. The appropriate management of COPD improves the cardiovascular outcomes by reducing hyperinflation and preventing AECOPD, thus reducing the risk of mortality, improving exercise tolerance, and quality of life.

Sex difference in the effect of the fasting serum glucose level on the risk of coronary heart disease

Ahn, Song Vogue,Kim, Hyeon Chang,Nam, Chung Mo,Suh, Il Elsevier 2018 Journal of cardiology Vol.71 No.2

<P><B>Abstract</B></P> <P><B>Objective</B></P> <P>Diabetic women have a greater relative risk of coronary heart disease than diabetic men. However, the sex difference in the effect of fasting serum glucose levels below the diabetic range on the risk of coronary heart disease is unclear. We investigated whether the association between nondiabetic blood glucose levels and the incident risk of coronary heart disease is different between men and women.</P> <P><B>Methods</B></P> <P>The fasting serum glucose levels and other cardiovascular risk factors at baseline were measured in 159,702 subjects (100,144 men and 59,558 women). Primary outcomes were hospital admission and death due to coronary heart disease during the 11-year follow-up.</P> <P><B>Results</B></P> <P>The risk for coronary heart disease in women significantly increased with impaired fasting glucose levels (≥110mg/dL) compared to normal glucose levels (<100mg/dL), whereas the risk for coronary heart disease in men was significantly increased at a diabetic glucose range (≥126mg/dL). Women had a higher hazard ratio of coronary heart disease associated with the fasting serum glucose level than men (<I>p</I> for interaction with sex=0.021).</P> <P><B>Conclusions</B></P> <P>The stronger effect of the fasting serum glucose levels on the risk of coronary heart disease in women than in men was significant from a prediabetic range (≥110mg/dL).</P> <P><B>Highlights</B></P> <P> <UL> <LI> The risk of coronary heart disease increased from a prediabetic range (≥110mg/dL) in women. </LI> <LI> Women have a higher relative risk of coronary heart disease associated with the fasting serum glucose level than men do. </LI> <LI> More careful glycemic control in women with hyperglycemia is needed to prevent coronary heart disease. </LI> </UL> </P>

허혈성 심질환과 정상인의 운동부하 검사상 심박수 변화량 및 변화율의 차이

주동욱,강현재,김선웅,노태묵,손혁수,강병준,김새롬,이봉렬,정병천,이종주 대한내과학회 2004 대한내과학회지 Vol.66 No.6

목적 : 허혈성 심질환에서 운동부하 검사시 부교감신경계 재활성의 억제 정도가 반영되어 최고 운동 후 회복기 심박수의 변화량 및 변화율이 정상인보다 억제되는지를 알아보고 이에 따른 심실성 빈맥의 발생에 차이가 있는지를 고찰하였다. 부가적으로 허혈성 심질환에서 심근의 탈분극을 반영하는 R 파의 진폭의 변화가 정상인과 차이가 있는지 알아보았다. 방법 : 운동부하 검사는 연령 및 성별로 보정한 최대 심박수의 85% 이상을 적정 목표 심박수로 하여 Marquette사 case 8000 모델(미국)을 이용해 modified Bruce protocol로 시행하였다. 혈압, 심박수 및 심전도의 측정은 운동부하 전 기립위와 앙와위에서 측정하였으며 운동부하시는 매 3분 간격으로 답차운동의 단계가 증가할 때와 최대 운동시에 측정하였고, 회복기에는 각 1분, 3분, 5분 및 필요시 연장하여 측정하였다. 심박수의 변화량은 각 단계별 심박수로 그 전단계의 심바수를 뺀 절대값으로 하였으며, 심박수의 변화율은 각 단계별 변화량을 그 전단계의 심박수로 나눈 값을 백분율로 하였다. 또한 운동에 따른 부정맥의 발생 양상 및 빈도를 평가하기 위하여 안정시 심전도와 운동부하 검사를 시행하는 동안 및 회복기로 각각의 구간을 나누어 각 구간 중에 부정맥의 발생 유무와 종류, 빈도를 측정하였다. 안정시와 최대 운동시를 비교한 R 파 크기의 변화는 aVF 유도에서 대조군은 0.107±0.3403 mV였고, 양성군은 0.022±0.3771 mV로 두 군간에 유의한 차이를 보이지 않았으며(p=0.106), V5 유도에서도 대조군은 0.034±0.3439 mV였고, 양성군은 0.018±0.5061 mV로 두 군간에 유의한 차이를 보이지 않았다(p=0.782). 결과 : 전체 253명 중 남자 106명, 여자 147명이었으며, 남녀를 포함하여 대조군 196명(남자 78명, 여자 118명)이였고, 양성군 57명(남자 28명, 여자 29명)이었다. 평균 연령은 대조군 55±8.8세였고, 양성군 58±9.4세로 비슷하였다(p>0.05). 양군의 운동량은 양성군 8.1±2.5METs으로 대조군 10.5±2.3METs 보다 낮았다(p<0.001). 안정 심박수는 대조군 69±11회/분이였고, 양성군 70±13회/분으로 차이가 없었으나(p=0.630), 최대 운동부하시 심박수는 양성군 136±22회/분으로 대조군 155±18회/분보다 낮았다(p<0.001). 회복기 심박수는 양성군에서 회복기 1분에 105±23회/분, 3분에 86±15회/분, 5분에 85±15회/분으로 대조군의 회복기 1분에 116±16회/분, 3분에 93±13회/분, 5분에 89±12회/분에 비하여 모두 유의하게 낮았다(p=0.000, p=0.001, p=0.048). 심박수의 변화량은 양성군에서 최대 운동 후 1분일 Ep 31±14회/분, 3분일 때 19±12회/분, 5분일 때 2±4회/분으로 대조군의 최대 운동 후 1분일 때 39±10회/분, 3분일 때 23±9회/분, 5분일 때 6±7회/분에 비하여 낮았다(p<0.001, p=0.008, p=0.002). 심박수의 변화율은 양성군에서는 최대 운동 후 1분일 때 23±10%, 3분일 때 17±8%, 5분일 때 2±5%로 대조군의 최대 운동 후 1분일 때 25±6%, 3분일 때 20±7%, 5분일 때 5±6%에 비하여 낮았다(p=0.017, p=0.027, p=0.002). 심실성 부정맥 유무는 운동전후에 각각 비교시 양군간에 빈도의 차이가 없었고, 중증 심실조기수축의 빈도도 양군간에 유의한 차이가 없었다. 안정시와 최대 운동시를 비교한 R 파 크기의 변화는 aVF 유도에서 대조군과 양성군은 각각 0.107±0.3403 mV와 0.022±0.3771 mV였고, V5 유도에서는 각각 0.034±0.3439 mV와 0.018±0.561 mV로 차이를 보이지 않았다(p=0.106, p=0.782). 결론 : 운동 전후 심박수의 변화량과 변화율로 측정한 부교감신경의 활성정도는 허혈성 심질환이 있는 군과 정상인 간에서 차이를 보이며, 허혈성 심질환이 있는 군의 변화량과 변화률이 유의하게 적었다. 그러나 양군내 심실성 부정맥의 유무나 발생빈도에는 유의한 차이가 없었다. Background : The goal of this study is to evaluate the differences of the rate and the ratio of heart rate changes, which is well known to reflect the vagal reactivation, after peak exercise between ischemic heart disease and normal during treadmill exercise test. Additionally R-wave amplitude changes are evaluated to have the discriminal power between ischemic heart disease and normal. Methods : We have studied 253 human (196 control, 57 patients) who took the symptom-limited exercise test using Marquette case 8000 model. The 57 patients who showed the positive result by exercise test have confirmed by coronary angiography. The rate of heart rate changes was defined as the absolute difference of the heart rate subtracted by the just-previous stage heart rate. The ratio of heart rate changes was defined as the percentile of the rate of heart rate changes comparing to the just-previous stage heart rate. The changes of R-wave amplitude at lead V5 and aVF were obtained by the subtraction of R-wave amplitude at the peak exercise stage from that at the standing rest stage respectively. Additively heart rate recovery was deined as the rate of heart rate change which was obtained at 1 minute later after peak exercise. Results : In patients and control, the resting heart rate were 70±13 bpm and 69±11 bpm (p>0.05), and the peak heart rate were 136±22 bpm and 155±18 bpm respectively (p<0.001). The rate of heart rate changes in patients group were significantly lower than that in control at 1 minute, 3 minute, and 5 minute respectively (p<0.001, p=0.008, p=0.002). The ratio of heart rate changes in patients group were also significantly lower than that in control at 1 minute, 3 minute, and 5 minute respectively (p=0.017, p=0.027, p=0.002). With comparing both groups, the incidences of ventricular ectopy were not different during exercise and recovery stages, and the difference in the changes of R-wave amplitude at lead V5 and aVF were not observed respectively. Conclusion : The rate and ratio of heart rate changes are significantly lower in iscemic heart disease than in normal, and these are resulted from the depression of vagal reactivation. These findings are supplemental to make a diagnosis and a arrhythmic risk stratification of ischemic heart disease.

65세 이상의 노인 환자에서 대사증후군과 관상동맥질환과의 관계

김영진,김도균,류진수,엄우섭,조재현,조영중,남홍우,주신배,이홍순 대한노인병학회 2003 대한노인병학회지 Vol.7 No.4