일개 사업장 남성 노동자들에서 심혈관질환 발병위험도평가(KOSHA 모형)와 한국인 허혈성심질환 발생예측모형(Jee's 모형)의 비교

이경진,허현택,김동원,김인아,김수영,노준래,문제혁 大韓産業醫學會 2009 대한직업환경의학회지 Vol.21 No.2

Objectives: This study was conducted to evaluate the relationship between KOSHA's cardiovascular disease risk assessment and the predicted lO-year risk of cardiovascular disease developed by Jee. Subjects and Methods: Data were obtained from a structured questionnaire survey and medical examination of 509 male workers aged 30-59 years employed at a wallpaper and floor covering workplace in May 2008. We calculated KOSHA's cardiovascular disease risk assessment and Jee's predicted l0-year risk of cardiovascular disease. A high risk of cardiovascular disease was defined as the upper 10th percentile of Jee's predicted 10-year risk of cardiovascular disease, Statistical analysis was conducted using the Wilcoxon rank sum test, Kruskal Wallis test and a logistic regression model. Results: Jee's predicted 10-year risk of cardiovascular disease significantly increased as KOSHA's cardiovascular disease risk increased. Logistic regression analysis indicated that the group with 3 or more cardiovascular disease risk factors according to KOSHA's model was more likely to experience Cardiovascular disease within 10 years(0R=34.4, 95% C.I.=4.4-267.2). Conclusions: KOSHA's cardiovascular disease risk assessment was fairly well associated with Jee's predicted lO-year risk of cardiovascular disease and was believed to be a practical and convenient method of preventing cardiovascular disease at the workplace. 목적: 이 연구는 한국산업안전보건공단의 KOSHA 모형과 Jee's 모형 사이의 관련성을 확인한 후 이를 통해 KOSHA 모형의 활용도를 평가하고자 하였다. 방법: 2008년 5월 일개 제조업 사업장에 종사하는 30-59세 남성 노동자를 대상으로 설문과 건강검진을 실시하여 총 509명을 분석하였다. KOSHA 모형과 Jee's 모형에 따라 대상자의 허혈성심질환 발생위험도를 평가하였으며, 허혈성심질환 발생위험도 점수의 상위 10%를 고위험군으로 정의하였다. 또한 K08HA 모형에 따라 정상군, 저·증등도위험군, 고위험군으로 나누었으며, 두 모형을 비교하기 위해 Wilcoxon rank sum test, Kruskal-Wallis test 및 multiple logistic regression 분석을 시행하였다. 결과: 연구 대상자들의 Jee s 모형에 따른 허혈성심질환 발생위험도는 30대는 0.67%, 40대는 2.23%, 50대는 3.78%이었다. Jee's 모형과 KOSHA 모형에 따른 위험인자의 logistic regression 분석 결과, 3개 이상의 위험인자를 갖고 있는 경우 Jee s 모형에서 10년 이내 허혈성심질환이 발생할 위험도가 크게 증가하였다 (OR=34.4, 95% C.I. =4.4-267.2). 또한 KOSHA 모형의 저·중등도위험군, 고위험군에서 Jee's 모형의 허혈정심질환 발생위험도가 정상군에 비해 통계적으로 유의하게 높게 나타났다. 결론: KOSHA 모형은 Jee's 모형과 상당한 관련성을 갖고 있었으며, 사업장에서 KOSHA 모형을 이용하여 신속하고 간편하게 심혈관질환 발병위험도를 평가하여 위험인자에 대한 적극적인 관리를 할 수 있을 것으로 판단된다.

Risk of Cardiovascular Disease Using Framingham Risk Score in Korean Cancer Survivors

Ji-Hyun So,Jung-Kwon Lee,Jin-Young Shin,Wan Park 대한가정의학회 2016 Korean Journal of Family Medicine Vol.37 No.4

Background: Cardiovascular disease is an important cause of morbidity and mortality in cancer survivors. The aim of this study was to investigate the modifiable cardiovascular disease risk factors and 10-year probability of the disease based on the Framingham risk score in cancer survivors, compared with the general population. Methods: A total of 1,225 cancer survivors and 5,196 non-cancer controls who participated in the 2007–2013 Korea National Health and Nutrition Examination Surveys were enrolled. We assessed modifiable cardiovascular disease risk factors including smoking, body mass index, physical inactivity, high blood pressure, high cholesterol, and elevated blood glucose level. The 10-year probability of cardiovascular disease was determined by applying the Framingham cardiovascular disease risk equation among cancer survivors and non-cancer controls, ranging from 30 to 74 years old who had no overt cardiovascular diseases. Results: The proportion of subjects who had higher fasting glucose levels, hemoglobin A1c levels, systolic blood pressure, and low density lipoprotein cholesterol levels, and those who had lower high density lipoprotein cholesterol levels was significantly higher in the cancer survivors than in the non-cancer controls. The average 10-year probability of cardiovascular disease among the cancer survivors was higher than that in the non-cancer controls in both men and women. The average 10-year probability of cardiovascular disease in relation to the cancer type was significantly higher in patients with hepatic, colon, lung, breast, and gastric cancer. Conclusion: Cancer survivors have a higher cardiovascular disease risk and 10-year probability of cardiovascular disease than non-cancer controls. Control of cardiovascular disease risk factors and implementation of a well-defined cardiovascular disease prevention program are needed for treating cancer survivors.

제2형 당뇨병환자에서 심혈관질환 예측인자로서 혈중 Cystatin C의 유용성

이승환,이강우,김은숙,박예리,김헌성,박신애,강미자,안유배,윤건호,차봉연,손호영,권혁상 대한당뇨병학회 2008 Diabetes and Metabolism Journal Vol.32 No.6

Background: Recent studies suggest that serum Cystatin C is both a sensitive marker for renal dysfunction and a predictive marker for cardiovascular diseases. We aimed to evaluate the association between Cystatin C and various biomarkers and to find out its utility in estimating risk for cardiovascular diseases in type 2 diabetic patients. Methods: From June 2006 to March 2008, anthropometric measurements and biochemical studies including biomarkers for risk factors of cardiovascular diseases were done in 520 type 2 diabetic patients. A 10-year risk for coronary heart diseases and stroke was estimated using Framingham risk score and UKPDS risk engine. Results: The independent variables showing statistically significant associations with Cystatin C were age (β = 0.009, P < 0.0001), hemoglobin (β = -0.038, P = 0.0006), serum creatinine (β = 0.719, β < 0.0001), uric acid (β = 0.048, P = 0.0004), log hsCRP (β = 0.035, P = 0.0021) and homocysteine (β = 0.005, P = 0.0228). The levels of microalbuminuria, carotid intima-media thickness, fibrinogen and lipoprotein (a) also correlated with Cystatin C, although the significance was lost after multivariate adjustment. Calculated risk for coronary heart diseases increased in proportion to Cystatin C quartiles: 3.3 ± 0.4, 6.2 ± 0.6, 7.6 ± 0.7, 8.4 ± 0.7% from Framingham risk score (P < 0.0001); 13.1 ± 0.9, 21.2 ± 1.6, 26.1 ± 1.7, 35.4 ± 2.0% from UKPDS risk engine (P < 0.0001) (means ± SE). Conclusions: Cystatin C is significantly correlated with various emerging biomarkers for cardiovascular diseases. It was also in accordance with the calculated risk for cardiovascular diseases. These findings verify Cystatin C as a valuable and useful marker for predicting future cardiovascular diseases in type 2 diabetic patients. (KOREAN DIABETES J 32:488-497, 2008) Background: Recent studies suggest that serum Cystatin C is both a sensitive marker for renal dysfunction and a predictive marker for cardiovascular diseases. We aimed to evaluate the association between Cystatin C and various biomarkers and to find out its utility in estimating risk for cardiovascular diseases in type 2 diabetic patients. Methods: From June 2006 to March 2008, anthropometric measurements and biochemical studies including biomarkers for risk factors of cardiovascular diseases were done in 520 type 2 diabetic patients. A 10-year risk for coronary heart diseases and stroke was estimated using Framingham risk score and UKPDS risk engine. Results: The independent variables showing statistically significant associations with Cystatin C were age (β = 0.009, P < 0.0001), hemoglobin (β = -0.038, P = 0.0006), serum creatinine (β = 0.719, β < 0.0001), uric acid (β = 0.048, P = 0.0004), log hsCRP (β = 0.035, P = 0.0021) and homocysteine (β = 0.005, P = 0.0228). The levels of microalbuminuria, carotid intima-media thickness, fibrinogen and lipoprotein (a) also correlated with Cystatin C, although the significance was lost after multivariate adjustment. Calculated risk for coronary heart diseases increased in proportion to Cystatin C quartiles: 3.3 ± 0.4, 6.2 ± 0.6, 7.6 ± 0.7, 8.4 ± 0.7% from Framingham risk score (P < 0.0001); 13.1 ± 0.9, 21.2 ± 1.6, 26.1 ± 1.7, 35.4 ± 2.0% from UKPDS risk engine (P < 0.0001) (means ± SE). Conclusions: Cystatin C is significantly correlated with various emerging biomarkers for cardiovascular diseases. It was also in accordance with the calculated risk for cardiovascular diseases. These findings verify Cystatin C as a valuable and useful marker for predicting future cardiovascular diseases in type 2 diabetic patients. (KOREAN DIABETES J 32:488-497, 2008)

양대 구강병과 심혈관계 질환의 연관성

남용옥 ( Yong-ok Nam ),김인자 ( In-ja Kim ) 한국치위생학회(구 한국치위생교육학회) 2018 한국치위생학회지 Vol.18 No.5

Objectives: The purpose of this study was to examine the association between two major oral diseases and cardiovascular diseases. Methods: Data from the 6th Korean National Health and Nutrition Examination Survey (2013-2015) were used. The study included 12,754 adults, aged ≥19 years, who participated in the questionnaire survey of health related to hypertension, stroke, myocardial infarction, and angina pectoris as well as completed blood tests, anthropometry, and oral examination. Statistical analyses included complex sample frequency, complex sample general linear, complex sample cross-tabulation, and complex sample logistic regression analyses. Results: With respect to the number of Decayed-Missing-Filled-Teeth(DMFT), patients with hypertension (DMFT 8.05), stroke (DMFT 8.66), and angina pectoris (DMFT 8.24) showed a DMFT score of >2, compared with those who did not have these diseases (p<0.05). Patients with hypertension, stroke, myocardial infarction, and angina pectoris presented an approximately 2.7, 3.5, 4, and 3 times higher incidence of periodontal diseases, respectively, than those who did not (p<0.05). Based on the analysis of the relationship between the number of DMFT and cardiovascular diseases, patients with cardiovascular diseases had a risk of 1.033 higher DMFT than those who did not (p<0.05). As per the analysis of the relationship between periodontal diseases and cardiovascular diseases, patients with cardiovascular diseases had a 2.969 higher risk of periodontaldiseasesthanthosewithout them (p<0.05). Conclusions: Two major oral diseases were found to be associated with cardiovascular diseases. Therefore, to prevent these major oral diseases in patients with cardiovascular diseases, oral hygiene management must be actively performed.

Development and Evaluation of Health Literacy Scale for Patients with Cardiovascular Disease in Korea

JeongEun Sim,SeonYoung Hwang 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim: In Korea, cardiovascular diseases such as coronary artery disease and heart failure are rapidly increasing due to aging and westernization of lifestyle habits. Health literacy is a concept that has been identified as an influencing factor in determining the health behavior of cardiovascular patients and is drawing attention, but there is currently no health literacy scale for cardiovascular patients. The purpose of this study is to develop a scale to measure the health literacy of cardiovascular patients, and to verify its reliability and validity of the developed tool. Methods: This study was conducted with 391 cardiovascular patients at two medical institutions located in Seoul and Gyeonggi-do according to the tool development procedure was based on DeVellis. Results: 29 initial questions were derived based on the results of a conceptual analysis of the health literacy of patients with cardiovascular disease. To the next step, content validity was conducted twice with 10 experts, and then 24 questions were selected by revising and supplementing the initial question. As a last step, an exploratory factor analysis was performed after the item analysis to confirm the construct validity. Of a total of 391 subjects, 190 subjects were analyzed using the case random sampling method. Four factors were determined and 22 items were derived through the screen test and the cumulative variance ratio. The cumulative variance ratio of the four sub-factors was 62.86%. As a result of verifying convergence validity and discriminatory validity in the confirmation factor analysis, the convergence validity was confirmed with a factor load of .50 or higher, a significance (C.R) of 1.965 or more, and a concept reliability of 70 or more. In the stability reliability and homogeneity reliability test, the test-retest correlation coefficient was .86 and the intra-class correlation coefficient (ICC) was .84, ensuring reliability of stability. An internal consistency reliability Cronbach"s alpha was .89 was found, confirming the high reliability of the scale. Conclusion: If the tool with reliability and validity developed in this study is used, it will contribute to quickly and easily assessing the level of health literacy of patients with cardiovascular disease in the medical field, and early assessment and identification of patients with cardiovascular disease with low health literacy. In addition, it will be possible to organize intervention plans necessary for cardiovascular disease patients, such as the production of health information materials for cardiovascular disease patients with low health literacy. The research results using this tool will provide the basis for the development of programs for improving communication quality and self-management ability of health care providers and health promotion.

심뇌혈관질환과 건강기능식품

조경희,박영민 대한가정의학회 2010 Korean Journal of Family Medicine Vol.31 No.8

Functional foods are becoming increasingly available to consumers worldwide. The health effects of use of functional foods on cardiovascular diseases must be advised. Omega-3 fatty acid can play a role in primary prevention of deaths from coronary heart disease. It has also been reported to be promising treatment for prevention of deaths from cardiovascular diseases particularly in high-risk group. Vitamin E has no primary prevention of cardiovascular disease, but has high possibility of increasing the risk of heart failure and deaths from cardiovascular disease in high-risk group. Vitamin B complex reduces homocysteine, but don't reduce the risk of cardiovascular disease. Apart from them, gamma linolenic acid, chitosan, soy protein, and red yeast rice may reduce cholesterol levels and the risk of cardiovascular disease, still,further studies are needed. To prevent cardiovascular diseases, it is the most important to main healthy lifestyle habits. Functional foods should only be supplementary. 건강에 대한 관심이 증가하면서 건강기능식품에 대한 수요도 증가하고 있다. 이에 각각의 건강기능식품들이 심뇌혈관질환에 끼치는 영향들을 적절하게 권고해줄 필요가 있다. 오메가-3 지방산은 관상동맥질환에 의한 사망을 감소시키는일차예방 효과가 있으며, 심뇌혈관질환의 고위험군에서도 심뇌혈관질환 사망률 및 총사망률을 감소시키는 것으로 나타났다. 비타민 E는 심뇌혈관질환의 일차예방효과가 없었으며, 고위험군에서 심부전 등의 위험 증가 및 사망률 증가를 초래할가능성이 있다. 비타민 B복합체는 혈중 호모시스테인을 감소시키나 심뇌혈관질환을 감소시키지는 못했다. 그 외, 감마리놀렌산, 키토산, 대두단백질, 홍국과 같은 물질들은 콜레스테롤을 낮추고 심뇌혈관질환을 감소시킬 가능성이 있으나 장기적인 연구가 필요한 상태이다. 심뇌혈관질환의 예방을 위해서는 건강한 생활습관을 유지하는 것이 가장 중요하며, 건강기능식품은 단지 보조적으로 사용해야 한다.

Work-related Cerebro-Cardiovascular Diseases in Korea

Dae-Seong Kim,Seong-Kyu Kang Korean Academy of Medical Science 2010 Journal of Korean medical science Vol.25 No.S

Cerebro-cardiovascular disease (CVD) is one of compensable occupational diseases in Korea as in Japan or Taiwan. However, most countries accept only cardiovascular diseases (ischemic heart diseases) as compensable occupational diseases if any, but not cerebrovascular diseases. Korea has a prescribed list of compensable occupational diseases. CVD was not included in the list until 1993. In the early 1990s, a case of cerebral infarction was accepted as occupational disease by the Supreme Court. The decision was based on the concept that workers' compensation system is one of the social security systems. In 1994, the government has established a diagnostic criterion of CVD. The crude rate of compensated cerebrovascular disease decreased by 60.0% from 18.5 in 2003 to 7.4 in 2008 per 100,000 workers, and that of compensated coronary heart disease decreased by 60.5% from 3.8 in 2003 to 1.5 in 2008 per 100,000 workers. The compensated cases of CVD dramatically increased and reached its peak in 2003. Since many preventive activities were performed by the government and employers, the compensated cases have slowly decreased since 2003 and sharply decreased after 2008 when the diagnostic criterion was amended. The strategic approach is needed essentially because CVDs are common, serious and preventable diseases which lead to economic burden.

Cardiovascular Diseases and Panax ginseng: A Review on Molecular Mechanisms and Medical Applications

김종훈 고려인삼학회 2012 Journal of Ginseng Research Vol.36 No.1

Ginseng is one of the most widely used herbal medicines and is reported to have a wide range of therapeutic and pharmacological applications. Ginseng may also be potentially valuable in treating cardiovascular diseases. Research concerning cardiovascular disease is focusing on purifi ed individual ginsenoside constituents of ginseng to reveal specifi c mechanisms instead of using whole ginseng extracts. The most commonly studied ginsenosides are Rb1, Rg1, Rg3, Rh1, Re, and Rd. The molecular mechanisms and medical applications of ginsenosides in the treatment of cardiovascular disease have attracted much attention and been the subject of numerous publications. Here, we review the current literature on the myriad pharmacological functions and the potential benefi ts of ginseng in this area. In vitro investigations using cell cultures and in vivo animal models have indicated ginseng’s potential cardiovascular benefi ts through diverse mechanisms that include antioxidation, modifying vasomotor function,reducing platelet adhesion, infl uencing ion channels, altering autonomic neurotransmitters release, and improving lipid profi les. Some 40 ginsenosides have been identifi ed. Each may have different effects in pharmacology and mechanisms due to their different chemical structures. This review also summarizes results of relevant clinical trials regarding the cardiovascular effects of ginseng,particularly in the management of hypertension and improving cardiovascular function. Ginseng is one of the most widely used herbal medicines and is reported to have a wide range of therapeutic and pharmacological applications. Ginseng may also be potentially valuable in treating cardiovascular diseases. Research concerning cardiovascular disease is focusing on purifi ed individual ginsenoside constituents of ginseng to reveal specifi c mechanisms instead of using whole ginseng extracts. The most commonly studied ginsenosides are Rb1, Rg1, Rg3, Rh1, Re, and Rd. The molecular mechanisms and medical applications of ginsenosides in the treatment of cardiovascular disease have attracted much attention and been the subject of numerous publications. Here, we review the current literature on the myriad pharmacological functions and the potential benefi ts of ginseng in this area. In vitro investigations using cell cultures and in vivo animal models have indicated ginseng’s potential cardiovascular benefi ts through diverse mechanisms that include antioxidation, modifying vasomotor function,reducing platelet adhesion, infl uencing ion channels, altering autonomic neurotransmitters release, and improving lipid profi les. Some 40 ginsenosides have been identifi ed. Each may have different effects in pharmacology and mechanisms due to their different chemical structures. This review also summarizes results of relevant clinical trials regarding the cardiovascular effects of ginseng,particularly in the management of hypertension and improving cardiovascular function.

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.

심초음파검사에 의한 최근 15년간의 심혈관질환의 변화

김윤년,허승호,김권배,신경목,김기식,김경환 啓明大學校 醫科大學 1996 계명의대학술지 Vol.15 No.3

The improvement of nutritional status, the change of life style, and medical progress have changed the pattern of cardiovascular disease. There were many epidemiologic studies on cardiovascular disease in 1970s and 1980s, but rare in recent years in Korea. The purpose of this study was to investigate the recent change of the cardiovascular disease by examining of the echocardiographic diagnosis of these 15 years. Echocardiography data of 23,339 successive cases that were done at Keimyung University Dongsan Hospital, from January 1981 to December 1995 were reviewed and classified into twelve disease group and a normal group. Major findings of this study were as follows: The mean age of patients who received echocardiogram tended to increase by more than 10 years through this period. The frequency of ischemic heart disease, hypertensive heart disease, and arrhythmia had increased throughout the period, and adult congenital heart diseased, valular heart disease, infective endocarditis, pericardial disease were of decreasing tendency in relative frequency of cardiovascular area. Frequency of cardiovascular disease, such as hypertension, ischemic heart disease, was higher in female than in male. The mean ages of each cardiovascular disease group were increasing except ischemic heart disease and cor pulmonale. On consideration of above findings, the detailed epidemiologic study for cardiovascular diseases might be recommented, and now, we should plan for the effective management of ischemic heart disease and hypertensive heart disease that are increasing in these years.