Fasting Glucose Level and the Risk of Incident Atherosclerotic Cardiovascular Diseases

Park, Chanshin,Guallar, Eliseo,Linton, John A.,Lee, Duk-Chul,Jang, Yangsoo,Son, Dong Koog,Han, Eun-Jeong,Baek, Soo Jin,Yun, Young Duk,Jee, Sun Ha,Samet, Jonathan M. American Diabetes Association 2013 Diabetes care Vol.36 No.7

<P><B>OBJECTIVE</B></P><P>Although diabetes increases the risk of cardiovascular disease (CVD) and mortality, the dose-response relationship between fasting glucose levels below those diagnostic of diabetes with cardiovascular events has not been well characterized.</P><P><B>RESEARCH DESIGN AND METHODS</B></P><P>A prospective cohort study of more than one million Koreans was conducted with a mean follow-up of 16 years. A total of 1,197,384 Korean adults with no specific medical conditions diagnosed were classified by baseline fasting serum glucose level. Associations of fasting glucose level with CVD incidence and mortality, stroke incidence and mortality, and all-cause mortality were analyzed using multivariate proportional hazards regression.</P><P><B>RESULTS</B></P><P>The relationships between fasting glucose levels and CVD risks generally followed J-shape curves, with lowest risk in the glucose range of 85–99 mg/dL. As fasting glucose levels increased to >100 mg/dL, risks for CVD, ischemic heart disease, myocardial infarction, and thrombotic stroke progressively increased, but risk for hemorrhagic stroke did not. Fasting glucose levels <70 mg/dL were associated with increased risk of all stroke (hazard ratio 1.06, 95% CI 1.01–1.11) in men and (hazard ratio 1.11, 1.05–1.17) in women.</P><P><B>CONCLUSIONS</B></P><P>Both low glucose level and impaired fasting glucose should be considered as predictors of risk for stroke and coronary heart disease. The fasting glucose level associated with the lowest cardiovascular risk may be in a narrow range.</P>

Proton Pump Inhibitor Use Increases Pyogenic Liver Abscess Risk: A Nationwide Cohort Study

( Joo Hyun Oh ),( Danbee Kang ),( Wonseok Kang ),( Eliseo Guallar ),( Juhee Cho ),( Yang Won Min ) 대한소화기기능성질환·운동학회 2021 Journal of Neurogastroenterology and Motility (JNM Vol.27 No.4

Background/Aims Proton pump inhibitors (PPIs) increase gastric pH and alter the gut microbiome. An increased risk for infectious diseases has been reported in PPI users. However, little is known about the association of PPI use with pyogenic liver abscess (PLA) incidence risk. Methods We conducted a population-based cohort study using data from a nationwide representative sample of the Korean general population followed up for 10 years (January 1, 2003 to December 31, 2013). We identified PPI prescriptions and considered PPI as a time-varying variable. Proportional hazards regression model was used for incident PLA comparing PPI use versus non-use. Propensity score matching was also conducted. Results During the 4 209 229 person-years of follow-up, 58 595 participants had at least 1 PPI prescription and 541 patients developed liver abscess. The age-, sex-, residential area-, and income-adjusted hazard ratio for PLA incidence with PPI use was 4.19 (95% CI, 2.54-6.92). The association was observed in fully adjusted models (hazard ratio 3.88; 95% CI, 2.33-6.44). The positive association between PPI use and PLA was consistent in all subgroups analyzed and in propensity score matching group. Conclusion The present data indicate that PPI use is associated with an increased PLA risk. Therefore, it is necessary to prescribe PPIs with clear indication and to avoid improper use of PPIs. (J Neurogastroenterol Motil 2021;27:555-564)

Impact of nationwide hepatocellular carcinoma surveillance on the prognosis in patients with chronic liver disease

Won Sohn,Danbee Kang,Minwoong Kang,Eliseo Guallar,Juhee Cho,Yong-Han Paik 대한간학회 2022 Clinical and Molecular Hepatology(대한간학회지) Vol.28 No.4

Background/Aims: This study aimed to investigate the effect of hepatocellular carcinoma (HCC) surveillance using the Korea National Liver Cancer Screening Program on the receipt of curative treatment for HCC and mortality in patients with chronic liver disease. Methods: This population-based cohort study from the Korean National Health Insurance Service included 2003 to 2015 claims data collected from 1,209,825 patients aged ≥40 years with chronic hepatitis B, chronic hepatitis C, and liver cirrhosis. Patients were divided according to HCC surveillance using ultrasonography and serum alpha-fetoprotein every 6–12 months. The study outcomes were the receipt of curative treatment (surgical resection, radiofrequency ablation, or liver transplantation) and all-cause mortality. Results: The study population consisted of 1,209,825 patients with chronic hepatitis B, chronic hepatitis C, and liver cirrhosis (median age, 52.0 years; interquartile range, 46–55 years; 683,902 men [56.5%]). The proportion of participants who underwent HCC surveillance was 52.7% (n=657,889). During 10,522,940 person-years of follow-up, 74,433 HCC cases developed, including 36,006 patients who underwent curative treatment. The surveillance group had a significantly higher proportion of curative treatment for HCC than the non-surveillance group after adjusting for confounding factors (adjusted hazard ratio [HR], 5.64; 95% confidence interval [CI], 5.48–5.81). The surveillance group had a significantly lower mortality rate than the non-surveillance group (adjusted HR, 0.56; 95% CI, 0.55–0.56). Conclusions: HCC surveillance using the national screening program in patients with chronic viral hepatitis or liver cirrhosis provides better opportunity for curative treatment for HCC and improves overall survival.

Alcohol Intake and Mortality in Patients with Chronic Viral Hepatitis: A Nationwide Cohort Study

( Dong Hyun Sinn ),( Danbee Kang ),( Eliseo Guallar ),( Yoosoo Chang ),( Seungho Ryu ),( Di Zhao ),( Yun Soo Hong ),( Juhee Cho ),( Geum-youn Gwak ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: We evaluated the association between alcohol intake and all-cause and cause-specific mortality in subjects with chronic viral hepatitis, using nationwide population-based cohort study. Methods: A total of 364,361 men and women 40-84 years of age who underwent health screening exam between January 2002 and December 2013 that included assessment of frequency and amount of alcohol consumption were assessed for all-cause and cause-specific mortality. Results: In participants without chronic viral hepatitis, the fully-adjusted hazard ratios (HR) for all-cause mortality comparing light, moderate, and heavy drinkers to non-drinkers were 0.90 (95% CI 0.85-0.96), 1.06 (95% CI 0.99-1.13), and 1.48 (95% CI 1.30-1.68), respectively. In participants with chronic viral hepatitis, the corresponding HRs were 1.15 (95% CI 1.01-1.30), 1.18 (95% CI 1.01-1.37), and 1.66 (95% CI 1.26-2.20), respectively (P-value for alcohol intake by chronic viral hepatitis interaction <0.001). Compared to participants without chronic viral hepatitis, those with chronic viral hepatitis had substantially elevated liver cancer or liver disease (HR 11.76, 95% CI 10.58-13.07) and extrahepatic cancer mortality (HR 1.41, 95% CI 1.30-1.54). In patients with chronic viral hepatitis, the high mortality due to liver cancer or liver disease and the positive association of alcohol intake with liver cancer or liver disease mortality explained the positive association of alcohol intake with all-cause mortality. Conclusions: Even light to moderate alcohol intake was associated with increased all-cause mortality in individuals with chronic viral hepatitis. Clinicians and public health campaigns should advise against any amount of alcohol intake in individuals with chronic viral hepatitis.

Discordance in perceived needs between patients and physicians in oncology practice: a nationwide survey in Korea.

Shin, Dong Wook,Kim, So Young,Cho, Juhee,Sanson-Fisher, Robert W,Guallar, Eliseo,Chai, Gyu Young,Kim, Hak-Soon,Park, Bo Ram,Park, Eun-Cheol,Park, Jong-Hyock Grune Stratton ; American Society of Clinical Onco 2011 Journal of clinical oncology Vol.29 No.33

<P>Identification of supportive care needs in patients with cancer is essential for planning appropriate interventions. We aimed to determine patient-physician concordance in perceived supportive care needs in cancer care and to explore the predictors and potential consequences of patient-physician concordance.</P>

Delay to curative surgery greater than 12 weeks is associated with increased mortality in patients with colorectal and breast cancer but not lung or thyroid cancer.

Shin, Dong Wook,Cho, Juhee,Kim, So Young,Guallar, Eliseo,Hwang, Seung Sik,Cho, Belong,Oh, Jae Hwan,Jung, Ki Wook,Seo, Hong Gwan,Park, Jong Hyock Raven Press 2013 Annals of surgical oncology Vol.20 No.8

<P>Surgery for cancer is often delayed due to variety of patient-, provider-, and health system-related factors. However, impact of delayed surgery is not clear, and may vary among cancer types. We aimed to determine the impact of the delay from cancer diagnosis to potentially curative surgery on survival.</P>

Late Presentation of Hepatitis B among Patients with Newly Diagnosed Hepatocellular Carcinoma: A National Cohort Study

( Dong Hyun Sinn ),( Danbee Kang ),( Minwoong Kang ),( Seung Woon Paik ),( Eliseo Guallar ),( Juhee Cho ),( Geum-youn Gwak ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: As effective and well tolerated treatments for hepatitis B are available, early identification of patients with hepatitis B could effectively decrease burden from hepatitis B. Recently, a consensus definition of late presentation of chronic viral hepatitis for medical care has been suggested, to help quantify the proportion of patients missing timely diagnosis and treatment. Yet, clinical implications at the population level are largely unexplored. Methods: We used person-level longitudinal National Health Insurance Service-National Sample Cohort registration and claims: data collected between January 1, 2002 and December 31, 2013. From this cohort, we identified newly-diagnosed hepatitis B related hepatocellular carcinoma (HCC) patients, and classified patients into ‘late presentation of hepatitis B’, who were diagnosed with HCC without a prior clinic visit for hepatitis B, “regular” or “irregular” visit, who were diagnosed with HCC who had regular or irregular pattern of outpatient clinic visits for hepatitis B before HCC diagnosis. Results: Over the years, the proportion of patients with late presentation decreased from 50.8% in 2003 to 23.1% in 2013. In multivariable analysis compared with patients in the regular visits group, patients with late presentation were more likely to be younger and to be in lower income percentiles. After adjusting for age, sex, year of HCC diagnosis, income percentile, and initial treatment, the hazard ratios (95% confidence intervals) for all-cause mortality comparing the late presentation and irregular visits groups to the regular visits group were 1.76 (1.42-2.18) and 1.31 (1.06-1.61), respectively. Conclusions: In this nationally representative population-based study, timely diagnosis and treatment was suboptimal at the population level up to recent years. More precise and intensive strategies to minimize late presentation for hepatitis B is needed, with a special attention to younger people and lower income levels.

Life’s Simple 7 Cardiovascular Health Metrics and Progression of Coronary Artery Calcium in a Low-Risk Population : A Cohort Study

Kim, Seolhye,Chang, Yoosoo,Cho, Juhee,Hong, Yun Soo,Zhao, Di,Kang, Jeonggyu,Jung, Hyun-Suk,Yun, Kyung Eun,Guallar, Eliseo,Ryu, Seungho,Shin, Hocheol American Heart Association 2019 Arteriosclerosis, thrombosis, and vascular biology Vol.39 No.4

Nonalcoholic fatty liver disease is associated with cognitive function in adults

Seo, Sang Won,Gottesman, Rebecca F.,Clark, Jeanne M.,Hernaez, Ruben,Chang, Yoosoo,Kim, Changsoo,Ha, Kyoung Hwa,Guallar, Eliseo,Lazo, Mariana Ovid Technologies (Wolters Kluwer) - American Acad 2016 Clinical Neurophysiology Vol.86 No.12

<P>Objective: We hypothesized that nonalcoholic fatty liver disease (NAFLD) is independently associated with cognitive impairment in a representative sample of the general US population regardless of the presence of cardiovascular disease (CVD) or its risk factors. Methods: This was a cross-sectional study of 4,472 adults aged 20-59 years who participated in the Third National Health and Nutritional Examination Survey. The participants underwent assessment of liver enzyme activity and hepatic steatosis by ultrasound, and underwent cognitive evaluation using the following computer-administered tests: the Simple Reaction Time Test (SRTT), the Symbol-Digit Substitution Test (SDST), and the Serial Digit Learning Test (SDLT). We defined NAFLD as moderate/severe steatosis as determined by ultrasound in the absence of hepatitis B or C or excessive alcohol consumption. We used multiple linear regression models to examine the association between NAFLD and cognitive function while controlling for potential confounders. Results: Participants with NAFLD showed lower overall performance on the SDLT (beta = 0.726, 95% confidence interval [CI] 0.105-1.347), while associations with SRTT and SDST did not reach significance. Increased activity of the liver enzymes alanine aminotransferase (beta = 0.018, 95% CI 0.006-0.030) and aspartate aminotransferase (beta = 0.021, 95% CI 0.005-0.037) correlated with lower performance on the SDLT, while increased alanine aminotransferase was also correlated with lower performance in the SDST (beta = 0.002, 95% CI 0.0001-0.004). Conclusions: NAFLD was independently associated with lower cognitive performance independent of CVD and its risk factors. Given the scarcity of risk factors associated with age-related cognitive decline, these findings may have significant implications.</P>

Public attitudes toward cancer and cancer patients: a national survey in Korea

Cho, Juhee,Smith, Katherine,Choi, Eun‐,Kyung,Kim, Im‐,Ryung,Chang, Yoon‐,Jung,Park, Hyun‐,Young,Guallar, Eliseo,Shim, Young Mog John Wiley Sons, Ltd 2013 PSYCHOONCOLOGY Vol.22 No.3

<P><B>Abstract</B></P><P><B>Background</B></P><P>Regardless of improved survival rate, negative images and myths about cancer still abound. Cancer stigma may reduce patients' life opportunities resulting in social isolation, decreased level of emotional well‐being, and poor health outcomes. This study was aimed to evaluate public attitudes toward cancer and cancer patients and people's willingness to disclose cancer diagnosis in South Korea.</P><P><B>Methods</B></P><P>A cross‐sectional survey was conducted in August and September 2009. A nationally representative sample of 1011 men and women with no history of cancer was recruited. A set of 12 questions grouped into three domains (impossibility of recovery, cancer stereotypes, and discrimination) was used to assess public attitudes toward cancer.</P><P><B>Results</B></P><P>It was found 58.5% of study participants agreed that it is impossible to treat cancer regardless of highly developed medical science, 71.8% agreed that cancer patients would not be able to make contributions to society, and 23.5% agreed that they would avoid working with persons who have cancer. The proportions of people who said that that they would not disclose a cancer diagnosis to family, friends or neighbors, or coworkers were 30.2%, 47.0%, and 50.7%, respectively. Negative attitudes toward cancer were strongly associated with lower willingness to disclose a cancer diagnosis.</P><P><B>Conclusions</B></P><P>Negative attitudes, stereotypes, and discriminating attitudes toward cancer and people affected by the disease were very common in spite of clinical progress and improved survivorship.</P><P><B>Impact</B></P><P>Our findings emphasize the need for health policy and social changes to provide a more supportive environment for cancer survivors. Copyright © 2012 John Wiley & Sons, Ltd.</P>