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Sedentary behavior has been shown to have deleterious effects on cardiovascular outcomes. This study aimed to examine the association between sedentary time and cardiovascular risk factors in Korean adults.
A cross-sectional study was performed using data from adults aged 19 years and above in the 2013 Korean National Health and Nutrition Examination Survey. Sedentary time was self-reported and categorized into quintiles. Cardiovascular risk factors, including blood pressure (BP), total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein cholesterol, and fasting glucose levels, were categorized into dichotomous variables according to the Adult Treatment Panel III criteria. Multivariate logistic regression was performed with adjustment for various demographic and lifestyle variables, body mass index (BMI), waist circumference (WC), and moderate-to-vigorous physical activity. Complex sampling design was used, and survey weights and sample design variables were applied in analyses.
A total of 3,301 individuals were included in the analyses, and mean sedentary time was 6.1 h/d. Prolonged sedentary time was significantly associated with high diastolic BP (top vs. bottom quintile: adjusted odds ratio [OR], 1.71; 95% confidence interval [CI], 1.09–2.68; Ptrend=0.03) and low HDL cholesterol level (top vs. bottom quintile: adjusted OR, 1.42; 95% CI, 1.02–1.98; Ptrend=0.02) after adjustment for BMI, WC, moderate-to-vigorous physical activity, and other variables. No significant associations were found between sedentary time and other cardiovascular risk factors.
Prolonged sedentary time was significantly associated with high diastolic BP and low HDL cholesterol level in Korean adults. The associations were independent of general and abdominal obesity and moderate-to-vigorous physical activities.
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Cigarette smoking is a risk factor for cardiovascular disease (CVD) and has both beneficial and harmful effects in CVD. We hypothesized that weight gain following smoking cessation does not attenuate the CVD mortality of smoking cessation in the general Korean population.
Study subjects comprised 2.2% randomly selected patients from the Korean National Health Insurance Corporation, between 2002 and 2013. We identified 61,055 subjects who were classified as current smokers in 2003–2004. After excluding 21,956 subjects for missing data, we studied 30,004 subjects. We divided the 9,095 ex-smokers into two groups: those who gained over 2 kg (2,714), and those who did not gain over 2 kg (6,381, including weight loss), after smoking cessation. Cox proportional hazards regression models were used to estimate the association between weight gain following smoking cessation and CVD mortality.
In the primary analysis, the hazard ratios of all-cause deaths and CVD deaths were assessed in the three groups. The CVD risk factors and Charlson comorbidity index adjusted hazard ratios (aHRs) for CVD deaths were 0.80 (95% confidence interval [CI], 0.37 to 1.75) for ex-smokers with weight gain and 0.80 (95% CI, 0.50 to 1.27) for ex-smokers with no weight gain, compared to one for sustained smokers. The associations were stronger for events other than mortality. The aHRs for CVD events were 0.69 (95% CI, 0.54 to 0.88) and 0.81 (95% CI, 0.70 to 0.94) for the ex-smokers with and without weight gain, respectively.
Although smoking cessation leads to weight gain, it does not increase the risk of CVD death.
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Female sexual dysfunction, which can occur during any stage of a normal sexual activity, is a serious condition for individuals and couples. The present study aimed to determine the prevalence and predictive factors of female sexual dysfunction in women referred to health centers in Ilam, the Western Iran, in 2014.
In the present cross-sectional study, 444 women who attended health centers in Ilam were enrolled from May to September 2014. Participants were selected according to the simple random sampling method. Univariate and multivariate logistic regression analyses were used to predict the risk factors of female sexual dysfunction. Diffe rences with an alpha error of 0.05 were regarded as statistically significant.
Overall, 75.9% of the study population exhibited sexual dysfunction. Univariate logistic regression analysis demonstrated that there was a significant association between female sexual dysfunction and age, menarche age, gravidity, parity, and education (P<0.05). Multivariate logistic regression analysis indicated that, menarche age (odds ratio, 1.26), education level (odds ratio, 1.71), and gravida (odds ratio, 1.59) were independent predictive variables for female sexual dysfunction.
The majority of Iranian women suffer from sexual dysfunction. A lack of awareness of Iranian women's sexual pleasure and formal training on sexual function and its influencing factors, such as menarche age, gravida, and level of education, may lead to a high prevalence of female sexual dysfunction.
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Violence against women in families is the most common form of violence against them. The purpose of this study was to determine the prevalence of domestic violence and its effects on married women of Ilam.
In this descriptive-sectional research, 334 married women referred to medical health centers in Ilam were selected to participate using a random sampling method. After obtaining their consent to participate in the study, participants responded to a 46 items questionnaire and responses were analyzed using IBM SPSS for Windows ver. 20.0 (IBM Co., Armonk, NY, USA).
The majority of the participants reported experiencing domestic violence and emotional violence was more prevalent than other kinds of violence. Logistic regression analysis showed that lower education level, marriage at a younger age, shorter duration of marriage, fewer children, being a housewife, and husband's unemployment had a significant relationship with domestic violence against women.
The high prevalence of wife abuse in Ilam especially emotional violence due to lower education levels and marriage at younger age could be a serious threat for women's health as well as for other members of the family. This could be a grounding factor for other social harms such as suicide and this issue must be studied from legal, religious, and cultural standpoints.
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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.
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.
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.
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.
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Gallstone formation is the result of a complex interaction between genetic and nongenetic factors. We searched and reviewed the available literature to define how the primary prevention of gallstones (cholesterol gallstones in particular) could be applied in general practice. Electronic bibliographical databases were searched. Prospective and retrospective cohort studies and case–controlled studies were analyzed and graded for evidence quality. The epidemiological data confirmed that genetic factors are estimated to account for only approximately 25% of the overall risk of gallstones, while metabolic/environmental factors are at least partially modifiable in stone-free risk groups, and are thus modifiable by primary prevention measures related to diet, lifestyle, and environmental factors (i.e., rapid weight loss, bariatric surgery, somatostatin or analogues therapy, transient gallbladder stasis, and hormone therapy). There is no specific recommendation for the secondary prevention of recurrent gallstones. Family physicians can contribute to preventing gallstones due to their capability to identify and effectively manage several risk factors discussed in this study. Although further studies are needed to better elucidate the involvement of epigenetic factors that may regulate the effect of environment and lifestyle on gene expression in the primary prevention of gallstone formation, preventive interventions are feasible and advisable in the general practice setting.
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Neck circumference, as a predicator of obesity, is a well-known risk factor for obstructive sleep apnea and cardiovascular diseases. However, little research exists on neck length associated with these factors. This study explored the association of neck length with sleep and cardiovascular risk factors by measuring midline neck length (MNL) and lateral neck length (LNL).
We examined 240 patients aged 30 to 75 years who visited a health check-up center between January 2012 and July 2012. Patients with depressive disorder or sleep disturbance were excluded from this study. MNL from the upper margin of the hyoid bone to the jugular notch and LNL from the mandibular angle to the mid-portion of the ipsilateral clavicle were measured twice and were adjusted by height to determine their relationship with sleep and cardiovascular disease risk factors.
Habitual snorers had shorter LNL height ratios (P = 0.011), MNL height ratios in men (P = 0.062), and MNL height ratios in women (P = 0.052). Those snoring bad enough to annoy others had shorter MNL height ratios in men (P = 0.083) and women (P = 0.035). Men with objective sleep apnea had longer distances from the mandible to the hyoid bone to the mandible (P = 0.057). Men with metabolic syndrome had significantly shorter LNL height ratios (P = 0.021), and women with diabetes, hyperlipidemia, and metabolic syndrome had shorter MNL height ratios (P < 0.05).
This study shows that a short neck by measuring the MNL is probably associated with snoring. In addition, MNL is related to cardiovascular disease risk factors in women.
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This study aimed to evaluate some of the major risk factors of myocardial infarction including dehydroepiandrosterone sulfate in patients with premature myocardial infarction (age <50 years old) and myocardial infarction (age ≥50 years).
This is a parallel case-control study on 50 premature myocardial infarction patients and 50 myocardial infarction patients. We also recruited 50 matched participants for each of the two groups. Patients and their control groups were assessed for dehydroepiandrosterone sulfate serum level, diabetes mellitus, hyperlipidemia, hypertriglyceridemia, and hypertension. In addition, family history of cardiovascular disease and current smoking was recorded. Univariate and multivariate logistic regression analyses were performed to evaluate predictors of premature myocardial infarction and myocardial infarction.
No significant differences were observed between the demographic data of patients and their controls. The dehydroepiandrosterone sulfate serum level was significantly higher in patients with premature myocardial infarction compared with controls. Multivariate logistic regression analysis revealed only serum dehydroepiandrosterone sulfate dehydroepiandrosterone sulfate level to be significantly associated with premature myocardial infarction (odds ratio, 2.65; 95% confidence interval, 1.44 to 4.877; P = 0.002). Additionally, hypertension was found to be associated with myocardial infarction.
Higher levels of serum dehydroepiandrosterone sulfate level are associated with premature myocardial infarction but not with myocardial infarction, and this association is independent of the effects of other risk factors.
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Although hemorrhoids are one of the most common anal diseases among Koreans, risk factors for hemorrhoids have not been well identified.
We analyzed the data from the 4th Korean National Health and Nutrition Examination Survey (KNHANES) between 2007 and 2009. Study subjects were 17,228 participants of KNHANES who were aged 19 years or older. Logistic regression analysis was conducted to evaluate associations between hemorrhoids and probable risk factors.
Overall prevalence of hemorrhoids among study subjects was 14.4%, being more prevalent among women (15.7%) than among men (13.0%). Obesity and abdominal obesity were associated with a higher risk of hemorrhoids with odds ratio (OR) (95% confidence intervals, 95% CI) of 1.13 (1.01 to 1.26) and 1.16 (1.04 to 1.30), respectively. Both self-reported depression (OR, 1.83; 95% CI, 1.62 to 2.08) and physician diagnosed depression (OR, 1.71; 95% CI, 1.35 to 2.17) were associated with significantly higher risk of hemorrhoids. No regular walking (OR, 1.11; 95% CI, 1.00 to 1.23) and experience of pregnancy (OR, 1.62; 95% CI, 1.17 to 2.25) for women were also associated with higher risk of hemorrhoids. However, educational level, alcohol consumption, physical activities, diabetes mellitus, hypertension, fiber, fat intake, and energy intake were not associated with a risk of hemorrhoids. Low quality of life assessed with EuroQol-5 Dimension and EuroQol-Visual Analogue Scale was significantly associated with hemorrhoids.
This nationwide cross-sectional study of Korean adults suggests that obesity, abdominal obesity, depression, and past pregnancy may be risk factors for hemorrhoids and hemorrhoids affect quality of life negatively.
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Although cigarette smoking is a major modifiable risk factor for the occurrence of primary and secondary cardiovascular disease (CVD), not all survivors from CVD attacks can successfully stop smoking. However, little is known about the factors associated with the change in smoking behavior after CVD attack.
Study subjects included 16,807 participants (≥19 years) in the fourth Korean National Health and Nutrition Examination Surveys. From them, we selected 180 persons who had previous CVD diagnosis (angina pectoris, myocardial infarction, or stroke) and were smoking at the time of CVD diagnosis. Then, we categorized the 180 persons into two groups according to change in smoking status after the CVD: quitter and non-quitter. Logistic regression analysis was done to evaluate multivariable-adjusted association.
Even after CVD diagnosis, 63.60% continued to smoke. Fully-adjusted analysis revealed that regular drinking (odds ratio [OR], 4.44) and presence of smokers among family members (OR, 5.86) were significantly (P < 0.05) associated with greater risk of persistent smoking, whereas lower education level (OR, 0.20), larger amount of smoking (OR, 0.95), longer time since diagnosis (OR, 0.88), and diabetes (OR, 0.36) were significantly (P < 0.05) associated with decreased risk of persistent smoking after CVD.
A great proportion of CVD patients tended to continue smoking in the Korean population. In order to reduce smoking rates among CVD patients further, more aggressive efforts towards smoking cessation should be continuously made with consideration of individual socioeconomic, behavioral, and clinical characteristics of CVD patients.
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It has traditionally been known that there is normally a difference in blood pressure (BP) between the two arms; there is at least 20 mm Hg difference in the systolic blood pressure (SBP) and 10 mm Hg difference in the diastolic blood pressure (DBP). However, recent epidemiologic studies have shown that there are between-arm differences of < 5 mm Hg in simultaneous BP measurements. The purposes of this study is to examine whether there are between-arm differences in simultaneous BP measurements obtained from ambulatory patients without cardiovascular diseases and to identify the factors associated these differences.
We examined 464 patients who visited the outpatient clinic of Gangneung Asan Hospital clinical department. For the current analysis, we excluded patients with ischemic heart disease, stroke, arrhythmia, congestive heart failure, or hyperthyroidism. Simultaneous BP measurements were obtained using the Omron MX3 BP monitor in both arms. The inter-arm difference (IAD) in BP was expressed as the relative difference (right-arm BP [R] minus left-arm BP [L]: R - L) and the absolute difference (|R - L|).
The mean absolute IAD in SBP and DBP were 3.19 ± 2.38 and 2.41 ± 1.59 mm Hg, respectively, in men and 2.61 ± 2.18 and 2.25 ± 2.01 mm Hg, respectively, in women. In men, there were 83.8% of patients with the IAD in SBP of ≤ 6 mm Hg, 98.1% with the IAD in SBP of ≤ 10 mm Hg, 96.5% with the IAD in DBP of ≤ 6 mm Hg and 0% with the IAD in DBP of > 10 mm Hg. In women, 89.6% of patients had IAD in SBP of ≤ 6 mm Hg, 92.1% with IAD in DBP of ≤ 6 mm Hg, and 0% with IAD in SBP of > 10 mm Hg or IAD in DBP of > 10 mm Hg. Gangneung Asan Hospital clinical series of patients showed that the absolute IAD in SBP had a significant correlation with cardiovascular risk factors such as the 10-year Framingham cardiac risk scores and higher BP in men and higher BP in women. However, the absolute IAD in SBP and DBP had no significant correlation with the age, obesity, smoking, drinking, hyperlipidemia, diabetes, metabolic syndrome, and renal function.
Our results showed that there were no significant between-arm differences in simultaneous BP measurements. It was also shown that most of the ambulatory patients without cardiovascular diseases had an IAD in SBP of < 10 mm Hg and an IAD in DBP of < 6 mm Hg.
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The purpose of this study was to investigate how educational status influences cardiovascular risk factors and care of diabetes mellitus and hypertension.
From Korean National Health and Nutrition Survey IV, we obtained survey results of 6,835 men and 9,067 women more than 30 years old. We performed multivariate logistic regression to compare cardiovascular risk factors and care of hypertension and diabetes respective to educational status.
There were disparities in cardiovascular risk factors by educational status. In men, impaired fasting glucose, high triglyceride, and smoking were less frequently found in the highest educated group than in the middle educated group. In women, the prevalence of abdominal obesity, impaired fasting glucose, high blood pressure, high triglyceride, and metabolic syndrome among the highest educated group were significantly lower. The proportion of those with proper physical activity in the highest educated group was found to be less than that of the middle educated group, regardless of gender. For care of diabetes mellitus and hypertension, disease recognition and treatment were lower among the lowest educated group in men, while these disparities were not shown in women. Instead, the lowest educated group in diabetic women received screening exams for eye and kidney complications less than the middle education group. In both genders, the high education group had a higher chance of receiving education about diabetes mellitus.
There were educational disparities in cardiovascular risk factors and care of hypertension and diabetes mellitus. The disparities were found to be different by gender.
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