Cardiovascular Prevention and Pharmacotherapy

Volume 5(2); April 2023

Review Articles

Research on obesity using the National Health Information Database: recent trends: Eun-Jung Rhee; Cardiovasc Prev Pharmacother. 2023;5(2):35-40. Published online April 28, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e8

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Abstract PDF: The prevalence of obesity has increased markedly in Korea during the past few decades. Korea is one of the most well-organized countries in terms of its National Health Insurance System (NHIS), which conducts screening examinations. Since the NHIS is unified and managed by the government, its data—contained in the National Health Insurance Database (NHID)—are centralized. The Korean government has recently encouraged researchers to access the NHID, conduct research, and write papers to convey their findings. Expanded research using the NHID could shed light on the future of big data research. In this review, I would like to present an overview of current trends in obesity research using the NHID.

Optimal target blood pressure in older patients with hypertension: Kwang-il Kim; Cardiovasc Prev Pharmacother. 2023;5(2):41-48. Published online April 24, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e4

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Abstract PDF: Hypertension is a common condition among older adults, and blood pressure (BP) control is effective for preventing cardiovascular morbidity and mortality even among the oldest-old adults. However, the optimal target BP for older patients with hypertension has been a subject of debate, with previous clinical trials providing conflicting evidence. Determining the optimal target BP for older adults is a complex issue that requires considering comorbidities, frailty, quality of life, and goals of care. As such, BP targets should be individualized based on each patient's unique health status and risk factors, and treatment should be closely monitored to ensure that it is effective and well-tolerated. The benefits and risks of intensive BP control should be carefully weighed in the context of the patient's overall health status and treatment goals. Ultimately, the decision to pursue intensive BP control should be made through shared decision-making between patients and their healthcare providers.

Liraglutide, a glucagon-like peptide-1 analog, in individuals with obesity in clinical practice: Juyoung Shin, Raeun Kim, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2023;5(2):49-53. Published online April 28, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e7

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Abstract PDF: Obesity is a disease requiring treatment. The prevalence of obesity is steadily increasing both in Korea and worldwide. Individuals with obesity are at elevated risks of diabetes, cerebrovascular disease, and solid cancer; therefore, obesity is now considered to be a disease requiring treatment, rather than merely a cosmetic problem. Nutrition and exercise are the basic forms of obesity management, but it is not easy to lose weight through only one’s own willpower. Accordingly, policies for establishing a cultural environment that encourages desirable behaviors are proposed through multifaceted efforts involving the media and local organizations. However, the pharmacological and surgical treatments selected as medical interventions should be individualized based on an understanding of each individual’s cause of obesity and characteristics. It is important to understand how to enhance and maintain the effectiveness of treatment not only for the prescribing medical staff, but also for the individual with obesity who is being treated.

Original Articles

Fabry disease screening in young patients with acute ischemic stroke in Korea: Yunjung Choi, Taedong Ok, Kyung-Yul Lee; Cardiovasc Prev Pharmacother. 2023;5(2):54-60. Published online April 24, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e5

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Abstract PDF: Background
Fabry disease is an X-linked lysosomal storage disorder that results from a mutation in the α-galactosidase A (GLA) gene. It shows multiple organ involvement, including cerebrovascular disease. Since Fabry disease has a prevalence of approximately 4% in young patients with cryptogenic stroke, screening for this condition is recommended for young stroke patients. This study aimed to investigate the prevalence of Fabry disease in young acute ischemic stroke patients in Korea, the distribution of GLA gene mutations, and the subtypes of ischemic stroke.
Methods
This study included 211 young patients with acute ischemic stroke or transient ischemic attack. To screen for Fabry disease, α-galactosidase A (α-Gal A) enzyme activity was measured and DNA sequencing analysis of the GLA gene was performed.
Results
None of the patients exhibited low α-Gal A enzyme activity or had a pathogenic GLA mutation, but 18 nonpathogenic GLA gene variants were detected, including c.-10C>T in 16 patients, c.-33C>T in one patient, and c.196G>C in one patient. The mean α-Gal A enzyme activity in 14 male patients with the c.-10C>T variant was 5.17±1.19, which was significantly lower than that of male patients with the normal genotype (7.47±3.48, P<0.05). The distribution of stroke subtypes in patients with GLA gene polymorphisms was not significantly different from that in patients with a normal genotype.
Conclusions
This study demonstrates that Fabry disease is rare in young patients with ischemic stroke or transient ischemic attack in Korea, and we suggest that routine screening for Fabry disease may not be necessary for ischemic stroke patients.

Correlation analysis of cancer incidence after pravastatin treatment: Jin Yu, Raeun Kim, Jiwon Shinn, Man Young Park, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2023;5(2):61-68. Published online April 28, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e6

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Abstract PDF: Background
Few studies have investigated the cancer-preventive effects of statins, which are known to protect against cardio-cerebrovascular diseases. In this study, we analyzed the degree to which pravastatin, a low-potency statin, could prevent cancer.
Methods
This retrospective cohort study used data from the Korean National Health Insurance Service database. Patients diagnosed with diabetes after the age of 50 years were divided into a pravastatin group and a control group that did not receive any statin prescriptions.
Results
This study included 557 patients in the pravastatin group and 2,221 patients in the control (no statin) group. During the 5-year follow-up, the incidence of cancer was 16.7% (93 of 557 patients) in the pravastatin group and 19.9% (442 of 2,221 patients) in the control group. The incidence of cancer was 22% higher in the control group than in the pravastatin group (hazard ratio, 1.22; 95% confidence interval, 0.97–1.52; P=0.09). Death from various causes occurred at a 45% higher frequency in the control group than in the pravastatin group (hazard ratio, 1.45; 95% confidence interval, 0.99–2.12; P=0.06). However, neither of those relationships reached statistical significance.
Conclusions
Although pravastatin use did not show a significant causal relationship with cancer incidence, fewer cases of cancer occurred in pravastatin users than in controls. However, further large-scale studies are required to confirm these findings.

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