- Effect Modification of Kidney Function on the Non-linear Association Between Serum Calcium Levels and Cardiovascular Mortality in Korean Adults
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Jung-Ho Yang, Sun-Seog Kweon, Young-Hoon Lee, Seong-Woo Choi, So-Yeon Ryu, Hae-Sung Nam, Hye-Yeon Kim, Min-Ho Shin
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J Prev Med Public Health. 2023;56(3):282-290. Published online May 31, 2023
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DOI: https://doi.org/10.3961/jpmph.23.068
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Abstract
Summary
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- Objectives
This study aimed to evaluate the potential interaction between kidney function and the non-linear association between serum calcium levels and cardiovascular disease (CVD) mortality.
Methods This study included 8927 participants enrolled in the Dong-gu Study. Albumin-corrected calcium levels were used and categorized into 6 percentile categories: <2.5th, 2.5-25.0th, 25.0-50.0th, 50.0-75.0th, 75.0-97.5th, and >97.5th. Restricted cubic spline analysis was used to examine the non-linear association between calcium levels and CVD mortality. Cox proportional hazard regression was used to estimate hazard ratios (HRs) for CVD mortality according to serum calcium categories. All survival analyses were stratified by the estimated glomerular filtration rate.
Results Over a follow-up period of 11.9±2.8 years, 1757 participants died, of whom 219 died from CVD. A U-shaped association between serum calcium and CVD mortality was found, and the association was more evident in the low kidney function group. Compared to the 25.0-50.0th percentile group for serum calcium levels, both low and high serum calcium tended to be associated with CVD mortality (<2.5th: HR, 6.23; 95% confidence interval [CI], 1.16 to 33.56; >97.5th: HR, 2.56; 95% CI, 0.76 to 8.66) in the low kidney function group. In the normal kidney function group, a similar association was found between serum calcium levels and CVD mortality (<2.5th: HR, 1.37; 95% CI, 0.58 to 3.27; >97.5th: HR, 1.65; 95% CI, 0.70 to 3.93).
Conclusions We found a non-linear association between serum calcium levels and CVD mortality, suggesting that calcium dyshomeostasis may contribute to CVD mortality, and kidney function may modify the association.
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Summary
Korean summary
- 혈중 칼슘 농도와 심혈관 질환에 의한 사망은 U자형의 비선형 연관성을 보였다.
- 혈중 칼슘 농도와 심혈관 질환에 의한 사망의 비선형 연관성은 신기능이 정상인 그룹보다 신기능이 낮은 그룹에서 더 유의하게 나타났다.
- C-reactive Protein Concentration Is Associated With a Higher Risk of Mortality in a Rural Korean Population
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Jung Hyun Lee, Hyungseon Yeom, Hyeon Chang Kim, Il Suh, Mi Kyung Kim, Min-Ho Shin, Dong Hoon Shin, Sang-Baek Koh, Song Vogue Ahn, Tae-Yong Lee, So Yeon Ryu, Jae-Sok Song, Hong-Soon Choe, Young-Hoon Lee, Bo Youl Choi
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J Prev Med Public Health. 2016;49(5):275-287. Published online August 23, 2016
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DOI: https://doi.org/10.3961/jpmph.16.025
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9,731
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C-reactive protein (CRP), an inflammatory biomarker, has been widely used as a preclinical marker predictive of morbidity and mortality. Although many studies have reported a positive association between CRP and mortality, uncertainty still remains about this association in various populations, especially in rural Korea.
Methods A total of 23 233 middle-aged participants (8862 men and 14 371 women) who were free from cardiovascular disease, cancer, and acute inflammation (defined by a CRP level ≥10 mg/L) were drawn from 11 rural communities in Korea between 2005 and 2011. Blood CRP concentration was analyzed as a categorical variable (low: 0.0-0.9 mg/L; intermediate: 1.0-3.0 mg/L; high: 3.1-9.9 mg/L) as well as a continuous variable. Each participant’s vital status through December 2013 was confirmed by death statistics from the National Statistical Office. Cox proportional hazard models were used to assess the independent association between CRP and mortality after adjusting for other risk factors.
Results The total quantity of observed person-years was 57 975 for men and 95 146 for women, and the number of deaths was 649 among men and 367 among women. Compared to the low-CRP group, the adjusted hazard ratio for all-cause mortality of the intermediate group was 1.17 (95% confidence interval [CI], 0.98 to 1.40) for men and 1.27 (95% CI, 1.01 to 1.61) for women, and the corresponding values for the high-CRP group were 1.98 (95% CI, 1.61 to 2.42) for men and 1.41 (95% CI, 1.03 to 1.95) for women. Similar trends were found for CRP evaluated as a continuous variable and for cardiovascular mortality.
Conclusions Higher CRP concentrations were associated with higher mortality in a rural Korean population, and this association was more prominent in men than in women.
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- Binary cutpoint and the combined effect of systolic and diastolic blood pressure on cardiovascular disease mortality: A community-based cohort study
Ju-Yeun Lee, Ji Hoon Hong, Sangjun Lee, Seokyung An, Aesun Shin, Sue K. Park, Tariq Jamal Siddiqi PLOS ONE.2022; 17(6): e0270510. CrossRef - Association of serum high-sensitivity C reactive protein with risk of mortality in an Asian population: the Health Examinees cohort
Sang-Ah Lee, Sung Ok Kwon, Hyerim Park, Xiao-Ou Shu, Jong-Koo Lee, Daehee Kang BMJ Open.2022; 12(7): e052630. CrossRef - Associations of C-reactive protein and fibrinogen with mortality from all-causes, cardiovascular disease and cancer among U.S. adults
Junxiu Liu, Yanan Zhang, Carl J. Lavie, Fred K. Tabung, Jiting Xu, Qingwei Hu, Lixia He, Yunxiang Zhang Preventive Medicine.2020; 139: 106044. CrossRef - Sex differences in the association between self-rated health and high-sensitivity C-reactive protein levels in Koreans: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey
Se-Won Park, Seong-Sik Park, Eun-Jung Kim, Won-Suk Sung, In-Hyuk Ha, Boyoung Jung Health and Quality of Life Outcomes.2020;[Epub] CrossRef
- Ankle-brachial Index, Peripheral Arterial Disease, and Diabetic Retinopathy
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Hasan Kutsi Kabul, Aydogan Aydogdu, Ilker Tasci, Young-Hoon Lee, Min-Ho Shin
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J Prev Med Public Health. 2012;45(2):122-124. Published online March 31, 2012
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DOI: https://doi.org/10.3961/jpmph.2012.45.2.122
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6,666
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- Assessing the Utility of Toe Arm Index and Toe Pressure in Predicting Wound Healing in Patients Undergoing Vascular Intervention
Brian Luong, Christina M. Brown, Misty D. Humphries, Steven Maximus, Mimmie Kwong Annals of Vascular Surgery.2023; 97: 221. CrossRef - Blood pressure as a marker of subclinical atherosclerosis in prediabetes
B. Katipoglu, D.I. Yildirim, O.E. Cobankara, M.C. Kizilarslanoglu Kardiologiya i serdechno-sosudistaya khirurgiya.2021; 14(6): 483. CrossRef
- Arterial Stiffness is Associated With Diabetic Retinopathy in Korean Type 2 Diabetic Patients
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Yong-Woon Yun, Min-Ho Shin, Young-Hoon Lee, Jung-Ae Rhee, Jin-Su Choi
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J Prev Med Public Health. 2011;44(6):260-266. Published online November 14, 2011
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DOI: https://doi.org/10.3961/jpmph.2011.44.6.260
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10,537
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We evaluated the association between common carotid artery intima-media thickness (CCA-IMT), brachial-ankle pulse wave velocity (baPWV), carotid plaque, and peripheral arterial disease (PAD) as indicators of macroangiopathy and diabetic retinopathy as an indicator of microangiopathy in type 2 diabetic patients. MethodsWe analyzed 605 type 2 diabetic patients registered at a public health center in Korea. Following overnight fasting, venous blood and urine samples were collected and analyzed. The CCA-IMT, levels of carotid plaque, baPWV, and ankle-brachial index (ABI) of the subjects were assessed. We used non-mydriatic fundus photography to diagnose diabetic retinopathy. Multiple logistic regression analyses were used to evaluate the association between macroangiopathy and diabetic retinopathy. CCA-IMT and baPWV were divided into tertiles: CCA-IMT, 0.39 to 0.65 mm, 0.66 to 0.78 mm, and 0.79 to 1.30 mm; baPWV, 9.9 to 15.8 m/s, 15.9 to 18.9 m/s, and 19.0 to 38.0 m/s. ResultsThe association between baPWV and diabetic retinopathy remained significant after adjustment, with an increasing odds ratio (OR) in the second tertile (OR, 2.41; 95% confidence interval [CI], 1.27 to 4.55) and the third tertile (OR, 4.63; 95% CI, 2.33 to 9.21). No significant differences were observed in carotid plaque, PAD, and each tertile of CCA-IMT. ConclusionsBaPWV was associated with diabetic retinopathy, while CCA-IMT, carotid plaque, and PAD were not. This study suggests that the association between macroangiopathy and microangiopathy may be attributable to functional processes rather than structural processes within the vascular system.
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