Journal of Preventive Medicine and Public Health

Original Articles

Comorbid Conditions in Persons Exposed to Ionizing Radiation and Veterans of the Soviet–Afghan War: A Cohort Study in Kazakhstan: Saule Sarkulova, Roza Tatayeva, Dinara Urazalina, Ekaterina Ossadchaya, Venera Rakhmetova; J Prev Med Public Health. 2024;57(1):55-64. Published online November 1, 2023; DOI: https://doi.org/10.3961/jpmph.23.333

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Abstract Summary PDF: Objectives
This study investigated the prevalence and characteristics of comorbid conditions in patients exposed to ionizing radiation and those who were involved in the Soviet–Afghan war.
Methods
This study analyzed the frequency and spectrum of morbidity and comorbidity in patients over a long-term period (30-35 years) following exposure to ionizing radiation at the Semipalatinsk nuclear test site or the Chornobyl nuclear power plant, and among participants of the Soviet–Afghan war. A cohort study, both prospective and retrospective, was conducted on 675 patients who underwent comprehensive examinations.
Results
Numerical data were analyzed using the Statistica 6 program. The results are presented as the mean±standard deviation, median, and interquartile range (25-75th percentiles). The statistical significance of between-group differences was assessed using the Student t-test and Pearson chi-square test. A p-value of less than 0.05 was considered statistically significant. We found a high prevalence of cardiovascular diseases, including hypertension (55.0%) and cardiac ischemia (32.9%); these rates exceeded the average for this age group in the general population.
Conclusions
The cumulative impact of causal occupational, environmental, and ultra-high stress factors in the combat zone in participants of the Soviet–Afghan war, along with common conventional factors, contributed to the formation of a specific comorbidity structure. This necessitates a rational approach to identifying early predictors of cardiovascular events and central nervous system disorders, as well as pathognomonic clinical symptoms in this patient cohort. It also underscores the importance of selecting suitable methods and strategies for implementing treatment and prevention measures.; Summary

Key Message
This study investigated the long-term health effects on 675 individuals exposed to ionizing radiation at Semipalatinsk and Chornobyl, and those involved in the Soviet–Afghan war. Results showed a higher prevalence of cardiovascular diseases, notably hypertension (55%) and cardiac ischemia (32.9%), compared to the general population. The findings highlight the need for early detection of cardiovascular and central nervous system disorders in these groups, emphasizing tailored treatment and prevention strategies.

Associations of Workplace Violence With Cardiovascular Disease Among United States Workers: Findings From a National Survey: Zheyu Hu, Jian Li; J Prev Med Public Health. 2023;56(4):368-376. Published online July 10, 2023; DOI: https://doi.org/10.3961/jpmph.23.032

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Abstract PDF: Objectives
Recent research indicates a potential association between workplace violence and an increased risk of cardiovascular disease (CVD) in the working-age population. However, the relevant evidence in the United States is sparse. Thus, this study was conducted to explore the possible relationship between workplace violence and CVD among United States workers.
Methods
We utilized cross-sectional data from the 2015 National Health Interview Survey, which included a representative sample of 18 380 workers, to investigate the associations between workplace violence and the prevalence of CVD using logistic regression. Workplace violence was determined based on self-reported threats, bullying, or harassment at work over the past 12 months, supplemented with additional information regarding frequency. CVD included all forms of heart disease and stroke.
Results
A total of 1334 workers reported experiences of workplace violence, and 1336 workers were diagnosed with CVD. After adjustment for covariates, participants who reported any instance of workplace violence had significantly higher odds of having CVD (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.35 to 2.30) than those who reported no such violence. Furthermore, the highest odds of CVD (OR, 1.80; 95% CI, 1.23 to 2.63) were observed among those frequently exposed to workplace violence. Even occasional exposure to workplace violence was associated with 74% excess odds of CVD.
Conclusions
Our study indicates an association between workplace violence and CVD in United States workers, exhibiting a dose-response pattern.; Summary

Effect Modification of Kidney Function on the Non-linear Association Between Serum Calcium Levels and Cardiovascular Mortality in Korean Adults: Jung-Ho Yang, Sun-Seog Kweon, Young-Hoon Lee, Seong-Woo Choi, So-Yeon Ryu, Hae-Sung Nam, Hye-Yeon Kim, Min-Ho Shin; J Prev Med Public Health. 2023;56(3):282-290. Published online May 31, 2023; DOI: https://doi.org/10.3961/jpmph.23.068

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Abstract Summary PDF Supplementary Material: 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.; 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.

Decomposition of Socioeconomic Inequality in Cardiovascular Disease Prevalence in the Adult Population: A Cohort-based Cross-sectional Study in Northwest Iran: Farhad Pourfarzi, Telma Zahirian Moghadam, Hamed Zandian; J Prev Med Public Health. 2022;55(3):297-306. Published online May 3, 2022; DOI: https://doi.org/10.3961/jpmph.22.051

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Abstract PDF Supplementary Material: Objectives
The incidence of cardiovascular disease (CVD) mortality is increasing in developing countries. This study aimed to decompose the socioeconomic inequality of CVD in Iran.
Methods
This cross-sectional population-based study was conducted on 20 519 adults who enrolled in the Ardabil Non-Communicable Disease cohort study. Principal component analysis and multivariable logistic regression were used, respectively, to estimate socioeconomic status and to describe the relationships between CVD prevalence and the explanatory variables. The relative concentration index, concentration curve, and Blinder-Oaxaca decomposition model were used to measure and decompose the socioeconomic inequality.
Results
The overall age-adjusted prevalence of CVD was 8.4% in northwest Iran. Multivariable logistic regression showed that older adults, overweight or obese adults, and people with hypertension and diabetes were more likely to have CVD. Moreover, people with low economic status were 38% more likely to have CVD than people with high economic status. The prevalence of CVD was mainly concentrated among the poor (concentration index, -0.077: 95% confidence interval, -0.103 to -0.060), and 78.66% of the gap between the poorest and richest groups was attributed to differences in the distribution of the explanatory variables included in the model.
Conclusions
The most important factors affecting inequality in CVD were old age, chronic illness (hypertension and diabetes), marital status, and socioeconomic status. This study documented stark inequality in the prevalence of CVD, wherein the poor were more affected than the rich. Therefore, it is necessary to implement policies to monitor, screen, and control CVD in poor people living in northwest Iran.; Summary

Brief Report

Impact of Admission Diagnosis on the Smoking Cessation Rate: A Brief Report From a Multi-centre Inpatient Smoking Cessation Programme in Singapore: Jason Jia Hao See, Kay Choong See; J Prev Med Public Health. 2020;53(5):381-386. Published online July 17, 2020; DOI: https://doi.org/10.3961/jpmph.20.134

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Abstract PDF: Objectives
Few studies have been published regarding the relevance of the admission diagnosis to the smoking cessation rate. We studied smoking cessation rates in relation to admission diagnoses in our inpatient smoking cessation programmes.
Methods
This retrospective study included all patients recruited into our inpatient smoking cessation programmes at 2 institutions in Singapore between June 2008 and December 2016. Patients were given individualized intensive counselling and were followed up via phone interviews for up to 6-month to assess their smoking status. Multivariable logistic regression was used to analyse potential associations between admission diagnoses and 6-month abstinence.
Results
A total of 7194 patients were included in this study. The mean age was 54.1 years, and 93.2% were male. In total, 1778 patients (24.7%) were abstinent at the 6-month follow-up call. Patients who quit smoking tended to be of Chinese ethnicity, have initiated smoking at a later age, be better educated, and have lower Fagerström Test of Nicotine Dependence scores. After adjusting for these factors, patients with a cardiovascular admission diagnosis had a significantly higher probability of quitting tobacco use than patients with a respiratory or other diagnosis.
Conclusions
In patients acutely admitted to the hospital, a diagnosis of cardiovascular disease was associated with the highest quit rate. Smoking cessation interventions need to be incorporated into all cardiovascular disease treatment pathways to leverage the patient’s motivation and to improve the quit rate. In addition, patients in groups with lower quit rates may benefit from more intensive programmes to increase the rate of successful cessation.; Summary

Original Articles

Incidence, Risk Factors, and Prediction of Myocardial Infarction and Stroke in Farmers: A Korean Nationwide Population-based Study: Solam Lee, Hunju Lee, Hye Sim Kim, Sang Baek Koh; J Prev Med Public Health. 2020;53(5):313-322. Published online July 14, 2020; DOI: https://doi.org/10.3961/jpmph.20.156

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Abstract PDF

Objectives
This study was conducted to determine the incidence and risk factors of myocardial infarction (MI) and stroke in farmers compared to the general population and to establish 5-year prediction models.
Methods
The farmer cohort and the control cohort were generated using the customized database of the National Health Insurance Service of Korea database and the National Sample Cohort, respectively. The participants were followed from the day of the index general health examination until the events of MI, stroke, or death (up to 5 years).
Results
In total, 734 744 participants from the farmer cohort and 238 311 from the control cohort aged between 40 and 70 were included. The age-adjusted incidence of MI was 0.766 and 0.585 per 1000 person-years in the farmer and control cohorts, respectively. That of stroke was 0.559 and 0.321 per 1000 person-years in both cohorts, respectively. In farmers, the risk factors for MI included male sex, age, personal history of hypertension, diabetes, current smoking, creatinine, metabolic syndrome components (blood pressure, triglycerides, and high-density lipoprotein cholesterol). Those for stroke included male sex, age, personal history of hypertension, diabetes, current smoking, high γ-glutamyl transferase, and metabolic syndrome components (blood pressure, triglycerides, and high-density lipoprotein cholesterol). The prediction model showed an area under the receiver operating characteristic curve of 0.735 and 0.760 for MI and stroke, respectively, in the farmer cohort.
Conclusions
Farmers had a higher age-adjusted incidence of MI and stroke. They also showed distinct patterns in cardiovascular risk factors compared to the general population.

Summary

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Educational Intervention Based on the Health Belief Model to Modify Risk Factors of Cardiovascular Disease in Police Officers in Iran: A Quasi-experimental Study: Mohsen Saffari, Hormoz Sanaeinasab, Hassan Jafarzadeh, Mojtaba Sepandi, Keisha-Gaye N. O'Garo, Harold G. Koenig, Amir H. Pakpour; J Prev Med Public Health. 2020;53(4):275-284. Published online June 18, 2020; DOI: https://doi.org/10.3961/jpmph.20.095

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Abstract PDF Supplementary Material

Objectives
Police officers may be at a greater risk for cardiovascular disease (CVD) than the general population due to their highstress occupation. This study evaluated how an educational program based on the health belief model (HBM) may protect police officers from developing CVD.
Methods
In this single-group experimental study, 58 police officers in Iran participated in a 5-week intervention based on HBM principles. Outcomes included changes in scores on an HBM scale, time spent on moderate to vigorous physical activity (International Physical Activity Questionnaire), body mass index (BMI), blood lipid profile, blood glucose, and blood pressure. The intervention consisted of 5 HBM-based educational sessions. Follow-up was conducted at 3 months post-intervention. The paired t-test was used to examine differences between baseline and follow-up scores.
Results
All aspects of the HBM scale improved between baseline and follow-up (p<0.05), except the cues to action subscale. Self-efficacy and preventive behaviors improved the most. BMI decreased from 26.7±2.9 kg/m² at baseline to 25.8±2.4 kg/m² at follow-up. All components of the lipid profile, including triglycerides, cholesterol, high-density lipoprotein, and low-density lipoprotein, showed significant improvements post-intervention. Blood glucose and blood pressure also decreased, but not significantly. Nearly 25% of participants who were not physically active at baseline increased their physical activity above or beyond the healthy threshold.
Conclusions
A relatively brief educational intervention based on HBM principles led to a significant improvement in CVD risk factors among police officers. Further research is needed to corroborate the effectiveness of this intervention.

Summary

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An Intervention Program Using the Health Belief Model to Modify Lifestyle in Coronary Heart Disease: Randomized Controlled Trial
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Brief Report

Age-period-cohort Analysis of Cardiovascular Disease Mortality in Japan, 1995-2018: Tasuku Okui; J Prev Med Public Health. 2020;53(3):198-204. Published online April 14, 2020; DOI: https://doi.org/10.3961/jpmph.20.037

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Abstract PDF Supplementary Material

Objectives
This study aimed to analyze the mortality of heart disease (HD), ischemic heart disease (IHD), and cerebrovascular disease (CeVD) through an age-period-cohort (APC) analysis.
Methods
We used data on mortality due to cardiovascular disease from 1995 to 2018 in Japan, as determined by Vital Statistics. Age groups from 0 years to 99 years were defined by 5-year increments, and cohorts were defined for each age group of each year with a 1-year shift. We used Bayesian APC analysis to decompose the changes in the diseases’ mortality rates into age, period, and cohort effects.
Results
The period effects for all diseases decreased during the analyzed periods for both men and women. The cohort effects for men increased substantially in cohorts born from around 1940 to the 1970s for all types of cardiovascular diseases. The cohort effects of HD decreased in the cohorts born in the 1970s or later for both men and women. Regarding IHD and CeVD, either a non-increase or decrease of cohort effects was confirmed for cohorts born in the 1970s or later for men, but the effects for women showed a continuously increasing trend in the cohorts born in the 1960s or later.
Conclusions
The cohort effects for IHD and CeVD showed increasing trends in younger generations of women. This suggests that preventive approaches against cardiovascular diseases are needed, particularly for women.

Summary

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Original Article

Effects of Comorbid Sleep Disorders on Cardiovascular Complications of Hypertension Among Patients With Newly-diagnosed Hypertension: An Analysis of the Korean National Health Insurance Service-National Sample Cohort: Jeongmook Kang, Yoon-Hyung Park, Kwang Ik Yang, Jose Rene Bagani Cruz, Young Hwangbo; J Prev Med Public Health. 2020;53(1):37-44. Published online November 6, 2019; DOI: https://doi.org/10.3961/jpmph.19.248

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Abstract Summary PDF

Objectives
This study investigated the effects of comorbid sleep disorders (SD) on the incidence of cardiovascular complications among newly-diagnosed hypertension (HTN) patients.
Methods
As study population, 124 057 newly-diagnosed essential HTN patients aged 30 or older, without cardiovascular complications at diagnosis with HTN, were selected from the National Health Insurance Service-National Sample Cohort. The incidence of cardiovascular complications was calculated, Cox proportional-hazards regression model was used to analyze the risk of complications, and the population attributable fraction (PAF) for cardiovascular complications of having comorbid SD at HTN diagnosis was calculated.
Results
Over 10 years, 32 275 patients (26.0%) developed cardiovascular complications. In HTN patients with comorbid SD at diagnosis of HTN, the incidence of cardiovascular complications (78.3/1000 person-years; 95% confidence interval [CI], 75.8 to 80.9) was higher than in those without comorbid SD (58.6/1000 person-years; 95% CI, 57.9 to 59.3) and the risk of cardiovascular complications was 1.21 times higher (95% CI, 1.17 to 1.25), adjusting for age, gender, income, area of residence, and comorbid diabetes mellitus. The PAF of having comorbid SD at diagnosis of HTN for the incidence of cardiovascular complications was 2.07% (95% CI, 1.69 to 2.44).
Conclusions
Newly-diagnosed essential HTN patients aged 30 or older who had comorbid SD at the time of their HTN diagnosis had a higher incidence of cardiovascular complications than those without comorbid SD. Age, gender, income, area of residence, and comorbid diabetes mellitus had a significant effect on the incidence of cardiovascular complications. Approximately 2% of cardiovascular complications were found to occur due to the presence of SD.

Summary

Korean summary
본 연구 결과 심뇌혈관 합병증이 없었던 30세 이상 신규 일차성 고혈압 환자에서 고혈압 진단시 수면장애을 동반한 경우 심뇌혈관합병증 발생율은 78.3/1000인년(95% CI 75.8-80.9)으로 나타났으며, 수면장애을 동반하지 않은 경우 심뇌혈관합병증 발생율은 58.6/1000인년(95%CI 57.9-59.3)인 것으로 관찰되었다. 고혈압 진단시의 연령, 성별, 수입, 거주지역, 동반된 당뇨병력을 보정한 다중회귀분석에서 수면장애병력이 있는 고혈압 환자군의 심뇌혈관합병증 발생 위험도는 수면장애병력이 없는 환자에 비하여 1.21배(95% CI 1.17-1.25) 높은 것으로 나타났으며, 연구대상자에게 발생한 심뇌혈관합병증의 약 2%는 고혈압 진단시 동반된 수면장애가 기여한 것으로 분석되었다.

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Review

Measurement of Socioeconomic Position in Research on Cardiovascular Health Disparities in Korea: A Systematic Review: Chi-Young Lee, Yong-Hwan Lee; J Prev Med Public Health. 2019;52(5):281-291. Published online August 14, 2019; DOI: https://doi.org/10.3961/jpmph.19.094

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Abstract PDF

Objectives
The validity of instruments measuring socioeconomic position (SEP) has been a major area of concern in research on cardiovascular health disparities. The purpose of this systematic review is to identify the current status of the methods used to measure SEP in research on cardiovascular health disparities in Korea and to provide directions for future research.
Methods
Relevant articles were obtained through electronic database searches with manual searches of reference lists and no restriction on the date of publication. SEP indicators were categorized into compositional, contextual, composite, and life-course measures.
Results
Forty-eight studies published from 2003 to 2018 satisfied the review criteria. Studies utilizing compositional measures mainly relied on a limited number of SEP parameters. In addition, these measures hardly addressed the time-varying and subjective features of SEP. Finding valid contextual measures at the organizational, community, and societal levels that are appropriate to Korea’s context remains a challenge, and these are rarely modeled simultaneously. Studies have rarely focused on composite and life-course measures.
Conclusions
Future studies should develop and utilize valid compositional and contextual measures and appraise social patterns that vary across time, place, and culture using such measures. Studies should also consider multilevel influences, adding a focus on the interactions between different levels of intertwined SEP factors to advance the design of research. More attention should be given to composite and life-course measures.

Summary

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Original Articles

Cardiovascular Disease–related Health Beliefs and Lifestyle Issues Among Karen Refugees Resettled in the United States From the Thai-Myanmar (Burma) Border: Akiko Kamimura, Kai Sin, Mu Pye, Hsien-Wen Meng; J Prev Med Public Health. 2017;50(6):386-392. Published online November 2, 2017; DOI: https://doi.org/10.3961/jpmph.17.098

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Abstract PDF

Objectives
Refugees resettled in the US may be at risk for cardiovascular disease (CVD). However, little is known about CVD-related issues among Karen refugees who have migrated to the US from the Thai-Myanmar border. The purpose of this study was to examine CVD-related health beliefs and lifestyle issues among Karen refugees resettled in the US.
Methods
Karen refugees resettled in the US from the Thai-Myanmar border (n=195) participated in a survey study on health beliefs related to CVD, salt intake, physical activity (PA), and smoking in the fall of 2016.
Results
A high-salt diet, physical inactivity, and smoking were major lifestyle problems. Participants who adhered to a low-salt diet considered themselves to be susceptible to CVD. Most participants did not engage in regular PA. Regular PA was associated with less perceived susceptibility to CVD and greater perceived benefits of a healthy lifestyle for decreasing the likelihood of CVD.
Conclusions
Each refugee population may require individualized strategies to promote PA and a healthy diet. Future studies should develop health education programs that are specifically designed for Karen refugees and evaluate such programs. In addition to health education programs on healthy lifestyle choices, tobacco cessation programs seem to be necessary for Karen refugees. At the same time, it is important to foster strategies to increase the utilization of preventive care among this population by promoting free or reduced-fee resources in the community to further promote their health.

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So Hyeon Bang, Ya‐Ching Huang, Hsuan‐Ju Kuo, Emma S. Cho, Alexandra A. García
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Breaking the barriers: The impact of health information and cultural factors on immigrant health in the Nordic countries
Hamed Ahmadinia
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Long-Term Physical Health Outcomes of Resettled Refugee Populations in the United States: A Scoping Review
Gayathri S. Kumar, Jenna A. Beeler, Emma E. Seagle, Emily S. Jentes
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Linda A. Piwowarczyk, Fernando Ona
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Bibliometric analysis of global migration health research in peer-reviewed literature (2000–2016)
Waleed M. Sweileh, Kolitha Wickramage, Kevin Pottie, Charles Hui, Bayard Roberts, Ansam F. Sawalha, Saed H. Zyoud
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High Level Physical Activity and Prevalence of Cardiovascular Disease Using the Korea National Health and Nutrition Examination Survey Data, 2007-2013: Kyounghoon Park, Byung-Joo Park; J Prev Med Public Health. 2017;50(5):320-327. Published online September 5, 2017; DOI: https://doi.org/10.3961/jpmph.17.073

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Objectives
The purpose of our study was to evaluate the association between the intensity of physical activity (PA) and prevalence of cardiovascular disease (CVD) using Korean representative data. Methods: We analyzed 39 804 participant data from the Korea National Health and Nutrition Examination Survey, 2007-2013. Exposure variable was three levels of PA (low, medium, and high) in a week, and outcome variable was prevalence of CVD based on patient self-recognition and doctor’s diagnosis. Complex logistic regression analysis was performed to evaluate the relationship between level of PA and CVD adjusted by body mass index, hypertension, hypercholesterolemia, diabetes mellitus, stress recognition, household income, smoking, and current drinking. The indices of association w ere estimated as crude prevalence odds ratio (POR), adjusted POR, and their 95% confidence interval (CI). All statistical analyzes were performed using complex sample analysis procedure of the SPSS version 23.0. Results: When all variables were adjusted, only high level PA in women showed a significant association with stroke (adjusted POR by patient’s self-recognition, 0.57; 95% CI, 0.32 to 0.99, adjusted POR by doctor’s diagnosis, 0.55; 95% CI, 0.34 to 0.87) and CVD (adjusted POR by doctor’s diagnosis, 0.68; 95% CI, 0.48 to 0.96). Conclusions: High level PA in women has a significant reverse association with prevalence of stroke and CVD in Korea. Further study for elucidating the mechanism will be needed.

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Role of regular physical activity in modifying cardiovascular disease risk factors among elderly Korean women
Seunghui Baek, Youngmee Kim, Lorraine S. Evangelista
IJASS(International Journal of Applied Sports Scie.2018; 30(1): 20. CrossRef

C-reactive Protein Concentration Is Associated With a Higher Risk of Mortality in a Rural Korean Population: 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; J Prev Med Public Health. 2016;49(5):275-287. Published online August 23, 2016; DOI: https://doi.org/10.3961/jpmph.16.025

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Abstract PDF Supplementary Material

Objectives
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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The Impact of Educational Status on 10-Year (2004-2014) Cardiovascular Disease Prognosis and All-cause Mortality Among Acute Coronary Syndrome Patients in the Greek Acute Coronary Syndrome (GREECS) Longitudinal Study: Venetia Notara, Demosthenes B. Panagiotakos, Yannis Kogias, Petros Stravopodis, Antonis Antonoulas, Spyros Zombolos, Yannis Mantas, Christos Pitsavos; J Prev Med Public Health. 2016;49(4):220-229. Published online June 24, 2016; DOI: https://doi.org/10.3961/jpmph.16.005

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Abstract PDF

Objectives
The association between educational status and 10-year risk for acute coronary syndrome (ACS) and all-cause mortality was evaluated.
Methods
From October 2003 to September 2004, 2172 consecutive ACS patients from six Greek hospitals were enrolled. In 2013 to 2014, a 10-year follow-up (2004-2014) assessment was performed for 1918 participants (participation rate, 88%). Each patient’s educational status was classified as low (<9 years of school), intermediate (9 to 14 years), or high (>14 years).
Results
Overall all-cause mortality was almost twofold higher in the low-education group than in the intermediate-education and high-education groups (40% vs. 22% and 19%, respectively, p<0.001). Additionally, 10-year recurrent ACS events (fatal and non-fatal) were more common in the low-education group than in the intermediate-education and high-education groups (42% vs. 30% and 35%, p<0.001), and no interactions between sex and education on the investigated outcomes were observed. Moreover, patients in the high-education group were more physically active, had a better financial status, and were less likely to have hypertension, diabetes, or ACS than the participants with the least education (p<0.001); however, when those characteristics and lifestyle habits were accounted for, no moderating effects regarding the relationship of educational status with all-cause mortality and ACS events were observed.
Conclusions
A U-shaped association may be proposed for the relationship between ACS prognosis and educational status, with participants in the low-education and high-education groups being negatively affected by other factors (e.g., job stress, depression, or loneliness). Public health policies should be aimed at specific social groups to reduce the overall burden of cardiovascular disease morbidity.

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The Prevalence of Cardiovascular Disease Risk Factors and the Framingham Risk Score in Patients Undergoing Percutaneous Intervention Over the Last 17 Years by Gender: Time-trend Analysis From the Mayo Clinic PCI Registry: Moo-Sik Lee, Andreas J. Flammer, Hyun-Soo Kim, Jee-Young Hong, Jing Li, Ryan J. Lennon, Amir Lerman; J Prev Med Public Health. 2014;47(4):216-229. Published online July 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.4.216

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Abstract PDF

Objectives
This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at the Mayo Clinic. Methods: We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. Results: Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for β-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. Conclusions: Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends.

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