Achievement of LDL-C Targets Defined by ESC/EAS (2011) Guidelines in Risk-Stratified Korean Patients with Dyslipidemia Receiving Lipid-Modifying Treatments

양예슬,이서영,김정선,최경묵,이강욱,이상철,조정래,오승진,김지현,최성희 대한내분비학회 2020 Endocrinology and metabolism Vol.35 No.2

Background: This study assessed the proportion of risk-stratified Korean patients with dyslipidemia achieving their low-density lipoprotein cholesterol (LDL-C) targets as defined by the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) (2011) guidelines while receiving lipid-modifying treatments (LMTs). Methods: In this multicenter, cross-sectional, observational study, we evaluated data from Korean patients aged ≥19 years whowere receiving LMTs for ≥3 months and had an LDL-C value within the previous 12 months on the same LMT. Data were collectedfor demographics, cardiovascular (CV) risk factors, medical history, and healthcare consumption. Patients were risk-stratified according to the ESC Systematic COronary Risk Evaluation (SCORE) chart and LDL-C target achievement rate was assessed. Results: Guideline-based risk-stratification of the 1,034 patients showed the majority (72.2%) to be in the very high-risk category. Investigators’ assessment of risk was underestimated in 71.6% compared to ESC/EAS guidelines. Overall LDL-C target achievement rate was 44.3%; target achievement was the highest (66.0%) in moderate-risk patients and the lowest (39.0%) in very high-riskpatients. Overall 97.1% patients were receiving statin therapy, mostly as a single-agent (89.2%). High-intensity statins and the highest permissible dose of high-intensity statins had been prescribed to only 9.1% and 7.3% patients in the very high-risk group, respectively. Physician satisfaction with patients’ LDL-C levels was the primary reason for non-intensification of statin therapy. Conclusion: Achievement of target LDL-C level is suboptimal in Korean patients with dyslipidemia, especially in those at veryhigh-risk of CV events. Current practices in LMTs need to be improved based on precise CV risk evaluation posed by dyslipidemia.

Age at Diagnosis and the Risk of Diabetic Nephropathy in Young Patients with Type 1 Diabetes Mellitus (Diabetes Metab J 2021;45:46-54)

양예슬,손태서 대한당뇨병학회 2021 Diabetes and Metabolism Journal Vol.45 No.2

Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism

양예슬,이승훈,김정희,유지희,이정현,이서영,홍아람,이동화,고정민,김재현,김상완 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.4

Background: Adrenal venous sampling (AVS) is performed to distinguish the subtype of primary aldosteronism (PA). The clinicalimplication of contralateral suppression (CS; aldosterone/cortisolnondominant<aldosterone/cortisolperipheral) at AVS remains unclear. Weaimed to investigate the clinical significance of CS and its impact on postoperative outcomes after unilateral adrenalectomy. Methods: In this retrospective observational multi-center study, we analyzed PA patients who underwent both successful adrenocorticotropin hormone-stimulated AVS and unilateral adrenalectomy. Successful cannulation was defined as the selectivity index (cortisoladrenal/cortisolperipheral) ≥3. Clinical and biochemical outcomes after unilateral adrenalectomy were evaluated based on the international Primary Aldosteronism Surgical Outcome consensus. Results: Among 263 patients analyzed, 247 had CS (93.9%). Patients with CS had lower serum potassium levels, higher plasma aldosterone concentration, higher aldosterone-to-renin ratio (ARR), and larger adenoma size than those without CS. Those with CSshowed significantly higher lateralization index than those without CS (P<0.001). Although postoperative blood pressure and ARRsignificantly decreased in those with CS, clinical and biochemical outcomes were comparable in both groups. When the cut-off valueof age was determined using receiver operating characteristic (ROC) analysis, patients aged ≥50 years old with contralateral suppression index (CSI; the ratio between aldosterone/cortisolnondominant and aldosterone/cortisolperipheral) ≤0.26 had greater odds ratio(6.43; 95% confidence interval, 1.30 to 31.69) of incident chronic kidney disease than those aged <50 years with CSI >0.26 afteradjusting for other factors. Conclusion: CS may not predict postoperative clinical and biochemical outcomes in subjects with unilateral aldosterone excess, butit is associated with postsurgical deterioration of renal function in subjects over 50 years with CSI ≤0.26.

Smoking as a Target for Prevention of Diabetes

양예슬,손태서 대한당뇨병학회 2020 Diabetes and Metabolism Journal Vol.44 No.3

Editorial

Lipid Management in Korean People With Type 2 Diabetes Mellitus: Korean Diabetes Association and Korean Society of Lipid and Atherosclerosis Consensus Statement

양예슬,김학령,김상현,문민경 한국지질동맥경화학회 2023 지질·동맥경화학회지 Vol.12 No.1

Dyslipidemia in patients with diabetes is an important treatment target as a modifiable risk factor for cardiovascular disease (CVD). Although the primary treatment goal for dyslipidemia is to control low-density lipoprotein cholesterol (LDL-C), achieving this goal remains suboptimal according to recent studies. It is important to set the target goal for LDL-C control based on an accurate risk assessment for CVD. Here, we summarize the latest evidence on lipid management in patients with diabetes and present a consensus of the Korean Diabetes Association and Korean Society of Lipid and Atherosclerosis on the treatment goals of LDL-C according to the duration of diabetes, presence of CVD, target organ damage, or major cardiovascular risk factors. In patients with type 2 diabetes mellitus (T2DM) and CVD, an LDL-C goal of <55 mg/dL and a reduction in LDL-C level by 50% or more from the baseline is recommended. For the primary prevention of CVD in patients with T2DM with a duration of diabetes ≥10 years, major cardiovascular risk factors, or target organ damage, an LDL-C goal of <70 mg/dL is recommended. In patients with T2DM with a duration of diabetes <10 years and no major cardiovascular risk factors, an LDL-C goal of <100 mg/dL is recommended.

Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism (Endocrinol Metab 2021;36:875-84, Ye Seul Yang et al.)

양예슬,김상완 대한내분비학회 2022 Endocrinology and metabolism Vol.37 No.6

Canine Multicentric Large B Cell Lymphoma with Increased Mott Cells Diagnosed by Flow Cytometry

양예슬,정재하,황성현,김용백 한국임상수의학회 2021 한국임상수의학회지 Vol.38 No.1

A 12-year-old dog was referred due to multiple superficial lymphadenopathy. On cytology, each lymph node showed different cell populations where some of them consisted of intermediate to large lymphocytes with frequent Mott cells. Presence of Mott cells along with immature lymphocytes made the cytological diagnosis challenging, and therefore, supplementary diagnostic tests including PCR for Antigen Receptor Rearrangement (PARR) assay and flow cytometry were performed. This case report illustrates the value of flow cytometry in the diagnosis of lymphadenopathy with ambiguous cytologic findings.

가정의를 위한 요실금과 배뇨장애의 이해

양예슬,김영상 대한가정의학회 2020 Korean Journal of Family Practice Vol.10 No.4

Urinary disorders are important factors that affect the quality of life. Urinary incontinence refers to urine leakage against will and is categorized into stress incontinence, urge incontinence, and other types. The prevalence of incontinence increases with aging. Since most patients hesitate talking about urinary problems, it is important to proactively ask questions to ensure proper care. The diagnostic approach includes history taking, physical examination, and urinalysis. The use of specific questionnaires and voiding diaries is also beneficial. The first management option for patients with incontinence is conservative treatment, especially training for strengthening the pelvic floor muscles. Anti-cholinergic medications and mirabegron are used for treating urge incontinence. To minimize adverse events, starting medications at low doses, with follow-up at short intervals, is recommended. For treating stress incontinence, surgical approaches like sling surgery are preferred to medications. Primary physicians need to pay attention to urinary problems to help older patients address their difficulties and to promote their quality of life. 배뇨장애는 삶의 질을 좌우하는 중요한 요소이다. 배뇨장애의 대표적 질환인 요실금은 의지에 반하여 소변이 새는 증상을 일컬으며, 복압성 요실금, 절박성 요실금, 그 외 다양한 종류의 요실금 등으로 나뉜다. 나이가 많아질수록 요실금의 유병율은 상승하게 되지만, 막상 환자들은 본인들의 소변 관련 증상을 언급하는데 주저하기 때문에 일차진료 의사는 적절한 치료를 위해 직접적으로 요로 증상에 대해 질문할 필요가 있다. 진단적 접근 방향은 우선 병력 청취, 신체 진찰, 그리고 소변 검사가 일차적으로 이루어져야 한다. 질병 상태에 대한 특화된 설문지를 사용하거나 배뇨일지를 사용하면 진료에 도움이 될 수 있다. 요실금이 있는 환자에 대한 첫 번째 치료 방향은 골반 근육을 강화하기 위한 특별한 운동법이나 보존적인 치료이다. 절박성 요실금의 경우 항콜린제와 mirabegron 사용이 도움이 된다. 부작용의 가능성을 줄이기 위해 약물 치료는 저용량에서 시작하고 짧은 간격으로 추적하는 것이 바람직하다. 복압성 요실금의 치료는 주로 수술적 치료가 우선시 되며, sling surgery가 대표적이다. 일차진료 의사는 배뇨 증상에 대해 충분히 관심을 기울여야 하며, 이는 환자의 어려움을 개선시키고 삶의 질을 향상시키는데 큰 도움이 될 것이다.

Obesity Fact Sheet in Korea, 2021: Trends in Obesity Prevalence and Obesity-Related Comorbidity Incidence Stratified by Age from 2009 to 2019

양예슬,한병덕,한경도,정진형,손장원,On Behalf of the Taskforce Team of the Obesity Fact Sheet 대한비만학회 2022 Journal of obesity & metabolic syndrome Vol.31 No.2

Background: The global public health burden of obesity has increased with socio-economic development. The Korean Society for the Study of Obesity released the 2021 Obesity Fact Sheet to address trends in obesity prevalence and comorbid conditions by different age groups. Methods: Individuals ≥20 years old who underwent a health checkup provided by the Korean National Health Insurance Service between 2009 and 2019 were included. The prevalence of obesity and abdominal obesity was standardized by age and sex based on the 2010 population and housing census. The incidence of obesity-related comorbidities was tracked from 2009 to 2019, and the incidence per 1,000 person-years was calculated using Poisson regression adjusted for age and sex. Results: Obesity and abdominal obesity prevalence has increased for the entire population over the past 11 years. Obesity prevalence has risen rapidly in individuals in their 20s and 80s compared with other age groups. Additionally, class III obesity prevalence in both men and women has significantly increased by nearly threefold. The relative risk of developing type 2 diabetes, myocardial infarction, ischemic stroke, and cancers in people with obesity or abdominal obesity is greater than in people without obesity or abdominal obesity. The relative risk was higher in young and middle-aged individuals than in the older population. Conclusion: The findings based on the 2021 Obesity Fact Sheet suggest the need to better understand obesity characteristics according to age and sex and to establish individualized treatment strategies.

작업치료사의 직업의식이 직무만족도와 직무스트레스에 미치는 영향

양예슬,용미현 고령자･치매작업치료학회 2023 고령자.치매작업치료학회지 Vol.17 No.1

Objective : The purpose of this study was to investigate the effects of professional consciousness on job satisfaction and job stress. Methods : For this purpose, 230 questionnaires were collected from August 16, 2020 to October 16, 2020, targeting occupational therapists working. Among them, a total of 211 questionnaires were analyzed except for the questionnaires incorrect or missing answers. The data analysis was conducted using SPSS 25.0 version statistical program. Results : There was a significant correlation between professional consciousness, work ability, job satisfaction, and job stress. the professional consciousness had an effect on job satisf action. The job commitment of the sub-category of professional consciousness had the most influence on the promotion opportunity and interpersonal relationship among job satisfaction, and the professional consciousness sub-category of professional pride had the most influence on the job itself among job satisfaction, and the professional consciousness sub-category of will of service had the most influence on the pay level among job satisfaction. The professional consciousness had an effect on job stress. The professional consciousness sub-item expertise recognition had the most influence on organizational system among job stress, and professional consciousness sub-item job commitment had the most influence on inadequacy of compensation and workplace culture among job stress. The professional consciousness sub-item professional pride had the most influence on organizational system among job stress, and professional consciousness sub-item will of service had the most influence on relationship conflict among job stress. Conclusion : This study is significant in providing basic data to prepare improvement plans for occupational therapists' job stress in their work environment. Research on ways to efficiently manage occupational therapists' job stress and improve job satisfaction is continuously needed.