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Original Article
Association Between Atrial Fibrillation and the Risk of Dementia in the Korean Elderly: A 10-Year Nationwide Cohort Study
Min-Ah Nah, Kyeong Soo Lee, Tae-Yoon Hwang
J Prev Med Public Health. 2020;53(1):56-63.   Published online January 3, 2020
DOI: https://doi.org/10.3961/jpmph.19.117
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  • 173 Download
  • 7 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
The objective of this study was to determine the effect of atrial fibrillation (AF) on the risk of dementia in the Korean elderly.
Methods
A 10-year retrospective cohort study was conducted using the National Health Insurance Service-Senior Cohort database. We excluded those who were under 65 years of age as of January 2006 (n=46 113), those who were diagnosed with dementia between 2002 and 2005 (n=9086), and those with a history of stroke prior to AF diagnosis (n=8392). We used a Cox proportional hazards model with a time-varying covariate to determine whether AF is associated with the risk of dementia after adjusting for potential confounders.
Results
In univariable Cox regression, the hazard ratio (HR) of dementia according to AF status was 1.28 (95% confidence interval [CI], 1.23 to 1.33). After adjusting for potential confounders, AF was found to increase the risk of dementia (HR, 1.12; 95% CI, 1.07 to 1.17), Alzheimer dementia (HR, 1.12; 95% CI, 1.07 to 1.17), and vascular dementia (HR, 1.10; 95% CI, 1.03 to 1.18). In patients diagnosed with AF, the incidence of dementia was lower (HR, 0.50; 95% CI, 0.47 to 0.52) in patients who were treated with oral anticoagulants.
Conclusions
Investigating the potential risk factors of dementia in an aged society is important. We found a slightly higher risk of dementia in those with AF than in those without AF, and we therefore concluded that AF is a potential risk factor for dementia.
Summary
Korean summary
본 연구에서는 국민건강보험공단 노인표본코호트 자료를 사용하여 심방세동의 유무가 치매의 발생위험과 연관되어 있는지 분석하였다. 잠재적인 교란변수들을 통제하여 분석한 결과 심방세동은 치매(HR 1.12, 95% CI 1.07 to 1.17), 알츠하이머 치매(HR 1.12, 95% CI 1.07 to 1.17), 혈관성 치매(HR 1.10, 95% CI 1.03 to 1.18) 발생과 연관되어 있는 것으로 나타났다. 한 편, 심방세동 환자에서의 항응고제 복용은 치매 발생위험(HR 0.50, 95% CI 0.47 to 0.52)을 감소시키는 것으로 나타났다.

Citations

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Review
Lifestyle and Cancer Risk.
Elisabete Weiderpass
J Prev Med Public Health. 2010;43(6):459-471.
DOI: https://doi.org/10.3961/jpmph.2010.43.6.459
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  • 680 Download
  • 62 Crossref
AbstractAbstract PDF
The main behavioural and environmental risk factors for cancer mortality in the world are related to diet and physical inactivity, use of addictive substances, sexual and reproductive health, exposure to air pollution and use of contaminated needles. The population attributable fraction for all cancer sites worldwide considering the joint effect of these factors is about 35% (34 % for low-and middle-income countries and 37% for high-income countries). Seventy-one percent(71%) of lung cancer deaths are caused by tobacco use (lung cancer is the leading cause of cancer death globally). The combined effects of tobacco use, low fruit and vegetable intake, urban air pollution, and indoor smoke from household use of solid fuels cause 76% of lung cancer deaths. Exposure to these behavioural and environmental factors is preventable; modifications in lifestyle could have a large impact in reducing the cancer burden worldwide (WHO, 2009). The evidence of association between lifestyle factors and cancer, as well as the main international recommendations for prevention are briefly reviewed and commented upon here.
Summary

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Original Article
A Nested Case-Control Study on the High Normal Blood Pressure as a Risk Factor of Hypertension in Korean Middle-aged Men.
Jong Myon Bae, Yoon Ok Ahn
Korean J Prev Med. 1999;32(4):513-525.
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  • 31 Download
AbstractAbstract PDF
OBJECTIVES
'High-normal blood pressure' is a factor influencing decision to initiate targeted intensive intervention strategy in westernized populations. JNC-VI offered the vigorous lifestyle modification for persons with 'high-normal blood pressure', who could be early detected. As a hypertension seems to be the result of multiple genetic factors operating in concert with associated environmental factors, it will be necessary to identify the high-normal blood pressure as a risk factor of hypertension for applying primary prevention strategy in Korean people. METHODS: Although cohort study design might be adequate to recruit incidence cases, to keep time sequence of events, and to prevent information bias, nested case-control study was chosen for avoiding measurement errors because hypertension is a benign disease. Source population was the 'Seoul Cohort' participants and follow-up was done by using Korea Medical Insurance Corporation's database on the utilization of health services from 1Jan93 to 30Jun97. Incidence cases were ascertained through the chart review, telephone contacts, and direct blood pressure measurements. Controls included the pairing of 4 individuals to each case on the basis of age. RESULTS: As 75 % of 247 incident cases had high-normal blood pressure, the crude odds ratio for hypertension was 2.04 (95% CI 1.47-2.83). Another statistically significant risk factors of hypertension were body mass index, dietary fiber, alcohol consumption, weekly activity and history of quitting smoking. The multivariate odds ratio of high-normal blood pressure adjusted for all risk factors was 1.84 (95 % CI 1.31-2.56). Among high-normal blood pressure group, body mass index, weekly ethanol amounts, weekly physical activity, and dietary fiber except history of quitting smoking were still risk factors of hypertension. CONCLUSION: 'High-normal blood pressure' is a risk factor for hypertension in Korean middle-aged men, which represents that the vigorous lifestyle modification for persons with 'high-normal blood pressure' is need.
Summary

JPMPH : Journal of Preventive Medicine and Public Health