Cardiovascular Prevention and Pharmacotherapy

Volume 1(2); October 2019

Review Articles

Recent Technology-Driven Advancements in Cardiovascular Disease Prevention: Jisan Lee, Hun-Sung Kim, Dai-Jin Kim; Cardiovasc Prev Pharmacother. 2019;1(2):43-49. Published online October 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e7

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Abstract PDF Supplementary Material: Recent dramatic developments in information and communication technologies have been widely applied to medicine and healthcare. In particular, biometric sensors in wearable devices linked to smartphones are collecting vast amounts of personal health data. To best use these accumulated data, personalized healthcare services are emerging, and digital platforms are being developed and studied to enable data integration and analysis. The implementation of biometric sensors and smartphones for cardiovascular and cerebrovascular healthcare emerged from the research on the feasibility and efficacy of the devices in the clinical environment. It is important to understand the recent research trends in data generation, integration, and application to prevent and treat cardiovascular and cerebrovascular diseases. This paper describes these recent developments in treating cardiovascular diseases.

Pregnancy at Late Maternal Age and Future Cardiovascular Health: Mi-Jeong Kim; Cardiovasc Prev Pharmacother. 2019;1(2):50-56. Published online October 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e9

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Abstract PDF: Increasing numbers of women are delivering their first child at a later age. First pregnancy at a later age is, per se, a high-risk pregnancy. Pregnancy after 35 years is traditionally considered a late maternal age. The risks of obstetric complications including fetal and maternal complications are increased. Defective placenta syndrome, including hypertensive disorders, preterm birth, and intrauterine growth retardation, shares similar pathophysiologic mechanisms with endothelial dysfunction, although their clinical presentations differ. Recent medical advances have improved the medical performance of pregnancy-related cardiovascular disease (CVD). Recent evidence has shown that women with underlying defective placental syndrome or other pregnancy-related complications have an increased risk of unfavorable cardiovascular outcomes in later life. An increasing number of women delivering their first child at a later age have epidemiological characteristics that differ from those reported previously and for which data are limited data regarding the cardiovascular prognosis. Therefore, increased attention to public health and CVD prevention is required for women with complicated pregnancies.

Special Article

Improving Causal Inference in Observational Studies: Propensity Score Matching: Min Heui Yu, Dae Ryong Kang; Cardiovasc Prev Pharmacother. 2019;1(2):57-62. Published online October 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e6

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Abstract PDF: Propensity score matching (PSM) is a useful statistical methods to improve causal inference in observational studies. It guarantees comparability between 2 comparison groups are required. PSM is based on a “counterfactual” framework, where a causal effect on study participants (factual) and assumed participants (counterfactual) are compared. All participants are divided into 2 groups with the same covariates matched as much as possible. Propensity score is used for matching, and it reflects the conditional probabilities that individuals will be included in the experimental group when covariates are controlled for all subjects. The counterfactuals for the experimental group are matched between groups with characteristics as similar as possible. In this article, we introduce the concept of PSM, PSM methods, limitations, and statistical tools.

Original Articles

CYP2C19 Polymorphisms and Smoking Status Affects Responsiveness to the Platelet P2Y12 Receptor Antagonist Clopidogrel: Sang Won Han, Yong-Jae Kim, Woo-Keun Seo, Sungwook Yu, Hyo Suk Nam, Sung Sang Yoon, Seo Hyun Kim, Jong Yun Lee, Jun Hong Lee, Yang-Ha Hwang, Jun Lee, Kyung-A Lee, Kyung-Yul Lee; Cardiovasc Prev Pharmacother. 2019;1(2):63-70. Published online October 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e8

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Abstract PDF: Background
The “comparison of triflusal and clopidogrel effects in secondary prevention of stroke based on cytochrome P450 2C19 (CYP2C19) genotyping (MAESTRO)” study was a prospective, multicenter, randomized, open-label, and blind genotype trial. We performed a subgroup analysis of the MAESTRO study to explore the relationship between VerifyNow P2Y12 assay with regard to CYP2C19 polymorphisms and smoking status in patients with non-cardiogenic ischemic stroke who underwent clopidogrel treatment.
Methods
For the study, patients treated with clopidogrel and who underwent VerifyNow P2Y12 assay was selected from the MAESTRO study.
Results
Of the 393 patients in 18 hospitals, 256 (65%) patients in 12 hospitals were entered for this subgroup analysis. P2Y12 reaction unit (PRU) was significantly lower and percent inhibition (% INH) was higher in the current smoking group than in the nonsmoking group (p<0.001). The same results were also observed in the good genotype group when compared with the poor genotype group (p<0.001). Among the groups, significant lower PRU and higher % INH was demonstrated in current smoking with good genotype group. However, there was no difference in PRU and % INH between current smoking with poor genotype group and nonsmoking with good genotype group, suggesting that clopidogrel activity was concurrently related to CYP2C19 polymorphisms and smoking status.
Conclusions
Regarding secondary stroke prevention, patients who were current smokers and had a poor genotype for clopidogrel metabolism may benefit from clopidogrel treatment similar to that in patients who were nonsmokers and had a good genotype.

Preterm Labor and Later Maternal Cardiovascular Disease in General Population: Doubtful Relationship with Atherosclerosis: Mi-Jeong Kim, Hae Ok Jung, Sung Ha Chun, Hyeon Woo Yim, Doo Soo Jeon; Cardiovasc Prev Pharmacother. 2019;1(2):71-78. Published online October 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e10

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Abstract PDF: Background
The maternal cardiovascular system experiences an enormous challenge during pregnancy. A history of preterm labor suggestive of dysfunctional pregnancy might be associated with the maternal later life chronic cardiovascular disease (CVD). We evaluated the association between preterm labor and the late development of maternal atherosclerotic CVD using the national database of general population.
Methods
Data for 5,226 postmenopausal women aged ≥50 years were analyzed from the Korean National Health and Nutrition Examination Survey V, which had conducted from 2010 to 2012.
Results
The numbers of preterm labor and CVD (stroke, myocardial infarction, or angina pectoris) were 151 (3.0±0.3%) and 367 (6.6±0.4%), respectively. In a multivariate analysis, CVD was independently associated with age (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.8–2.0), the presence of hypertension (OR, 1.9; 95% CI,1.5–2.3), diabetes (OR, 2.3; 95% CI, 1.8–2.9), chronic kidney disease (OR, 1.8; 95% CI, 1.4–2.2) and low high-density lipoprotein cholesterol concentration (OR, 0.8; 95% CI, 0.7–0.9) were independently associated with CVD. A history of preterm labor was not associated with CVD (OR, 1.5; 95% CI, 0.6–3.8).
Conclusions
There was no significant association between preterm labor and atherosclerotic CVD in general population. A history of preterm labor is not likely to be a risk factor for later CVD in women.

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