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CPP : Cardiovascular Prevention and Pharmacotherapy

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Volume 4(1); January 2022
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Review Articles
Adverse effects of statin therapy and their treatment
Dae Young Cheon, Sang-Ho Jo
Cardiovasc Prev Pharmacother. 2022;4(1):1-6.   Published online January 20, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e4
  • 1,171 View
  • 83 Download
Abstract PDF
Statins are one of the most widely used drugs worldwide as first-line drugs for the treatment of hyperlipidemia and the prevention and treatment of cardiovascular diseases. Most of the side effects of statins are known to be mild, and mainly hepatotoxicity and various muscle symptoms are known. Recently, there have been studies on concerns about an increase in the incidence of diabetes after using statins, but it was found that the benefits sufficiently outweigh the risk of side effects. Therefore, the use of statins in the appropriate group should be actively performed, and it seems that the side effects can be prevented through close physical observation and appropriate examination.
Anti-inflammatory effects of colchicine on coronary artery disease
Hun-Jun Park
Cardiovasc Prev Pharmacother. 2022;4(1):7-12.   Published online January 20, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e5
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  • 37 Download
Abstract PDF
Inflammation plays a crucial role in the pathophysiology of coronary artery disease (CAD). Several types of sterile inflammation are mediated through the nucleotide-binding oligomerization domain-like receptor pyrin domain containing 3 (NLRP3) inflammasome. Colchicine has recently been shown to effectively block NLRP3 inflammasome assembly in addition to several other actions on inflammatory cells. Recent evidence also points to favorable effects of colchicine in patients with CAD, including lower levels of inflammatory markers, coronary plaque stabilization, and more favorable cardiac recovery after injury. This review focuses on the role of colchicine in the process of atherosclerosis and discusses its potential as a therapeutic option for the prevention and treatment of CAD.
Polygenic risk score: a useful clinical instrument for disease prediction and risk categorization
Jae-Seung Yun
Cardiovasc Prev Pharmacother. 2022;4(1):13-17.   Published online January 21, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e7
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Abstract PDF
Genetic information is one of the essential components of precision medicine. Over the past decade, substantial progress has been made, such as low-cost, high-throughput genotyping arrays, advances in statistical techniques, and progressively larger discovery datasets, enabling the discovery of alleles contributing to common diseases, such as coronary artery disease and type 2 diabetes. The polygenic risk score (PRS) represents the aggregate contribution of numerous common genetic variants, individually conferring small to moderate effects, and can be used as a marker of genetic risk for major chronic diseases. PRSs can be obtained from early childhood, and only one measurement is needed to determine the score. PRSs can potentially be used for triage of further investigations to confirm disease susceptibility and to optimize individualized preventive strategies for high-risk disease groups. We provide an overview and commentary on important advances in deriving and validating PRSs, as well as the implementation of PRSs for clinically useful purposes.
Original Articles
Indirect comparison of nonvitamin K oral anticoagulants and left atrial appendage occlusion
Sung-Hwan Kim, So-Yoon Park, Seung-Sik Hwang
Cardiovasc Prev Pharmacother. 2022;4(1):18-25.   Published online January 18, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e1
  • 644 View
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Abstract PDFSupplementary Material
Background
Anticoagulation is important in atrial fibrillation (AF) patients to reduce the occurrence of thrombotic events. We evaluated the efficacy and safety of percutaneous left atrial appendage occlusion (LAAO) as an alternative to systemic anticoagulation through an indirect comparative analysis.
Methods
An indirect comparative analysis of nonvitamin K oral anticoagulants (NOACs) and LAAO was conducted. Comparisons were made using data from four landmark randomized clinical trials (RE-LY, ROCKET-AF, ARISTOTLE, and PROTECT AF). Using warfarin as the common comparator, an indirect comparison was performed using data from each trial, and the relative risk was calculated between NOACs and LAAO.
Results
NOACs and LAAO showed similar results for the reduction of stroke and systemic embolism, with a non-statistically significant trend favoring NOACs (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.37–1.46 for dabigatran; HR, 0.99; 95% CI, 0.50–1.92 for rivaroxaban; HR, 0.89; 95% CI, 0.45–1.74 for apixaban). Significantly fewer major bleeding and procedure-related complications were found in patients treated with apixaban compared with LAAO (HR, 0.45; 95% CI, 0.26–0.75). Cardiovascular death occurred more frequently in patients administered NOACs than in patients with LAAO (HR, 2.28; 95% CI, 1.03–5.10 for dabigatran; HR, 2.41; 95% CI, 1.09–5.42 for rivaroxaban; HR, 2.40; 95% CI, 1.10–5.36 for apixaban).
Conclusions
The rate of all-cause death was similar between NOACs and LAAO. Compared with LAAO, NOACs led to a nonsignificant numerical decrease in stroke and embolism in AF patients. Significantly fewer safety events occurred in patients treated with apixaban. LAAO significantly reduced cardiovascular death.
Safety and efficacy of low-dose aspirin in patients with coronary artery spasm: long-term clinical follow-up
Byoung Geol Choi, Kyung-Hee Kim, Seung-Woon Rha
Cardiovasc Prev Pharmacother. 2022;4(1):26-33.   Published online January 21, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e6
  • 673 View
  • 24 Download
Abstract PDF
Background
Aspirin is known to aggravate coronary artery spasm (CAS) regardless of the dose (100–325 mg/day). However, it is unclear whether low-dose aspirin (LDA; 100 mg) has deleterious impacts on the clinical course of CAS patients in the long-term. Thus, we investigated the impact of LDA on the long-term clinical outcomes of CAS patients.
Methods
A total of 5,697 consecutive patients without significant coronary artery disease who underwent an acetylcholine provocation test from November 2004 to May 2015 were enrolled. Of these patients, 3,072 CAS patients were enrolled in the study and divided into two groups based on whether they took LDA: the LDA group (n=338) and the non-LDA group (n=2,734). All CAS patients were prescribed anti-anginal medication as appropriate. To adjust for any potential confounders that could cause bias, a propensity score matching analysis was performed using a logistic regression model.
Results
After propensity score matching, two propensity-matched groups (524 pairs, 1,048 patients, C-statistic=0.827) were generated, and the baseline characteristics of the two groups were balanced. The two groups were showed no significant differences in any follow-up events, such as major adverse cardiac events and recurrent angina.
Conclusions
The main finding of the present study is that the use of LDA did not affect cardiovascular events up to 5 years in CAS patients. Therefore, the prescription of LDA in these patients should be individualized considering their clinical status.
Association between reproductive aging and hypertension among Korean women
Eunji Kim, Youngrong Lee, Hyeon Chang Kim
Cardiovasc Prev Pharmacother. 2022;4(1):34-41.   Published online January 19, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e2
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Abstract PDFSupplementary Material
Background
Although postmenopausal women are well known to have a high prevalence of hypertension, it is unclear whether menopause itself increases blood pressure independently from the known risk factors of hypertension. This study sought to determine whether an association exists between reproductive aging, analyzed as a gradual transition, and an increased risk of hypertension among Korean women.
Methods
This cross-sectional study used baseline data from 5,456 women aged 30 to 64 years who participated in the Cardiovascular and Metabolic Diseases Etiology Research Center study in Korea from 2013 to 2018. The participants’ stage of reproductive aging was assessed by a questionnaire and categorized as premenopause, perimenopause, and postmenopause. Multiple logistic regression models were used to analyze the association between menopausal status and hypertension after adjusting for age, education level, marital status, employment, household income, smoking, drinking, physical activity, body mass index, and hormone replacement therapy use.
Results
The prevalence of hypertension increased with reproductive aging: 9.8% in premenopause, 25.2% in perimenopause, and 27.7% in postmenopause. The adjusted odds ratio (95% confidence interval) for having hypertension was 1.70 (1.07–2.72) for perimenopausal women and 1.14 (0.88–1.48) for postmenopausal women, compared to premenopausal women.
Conclusions
Our study shows that perimenopausal women are at high risk of developing hypertension. Since the menopausal transition may last months or years, blood pressure monitoring and early interventions are crucial for not only postmenopausal women, but also those in the transition.
Effects of physical activity on cardiovascular outcomes and mortality in Korean patients with diabetes: a nationwide population-based cohort study
Inha Jung, Sun Joon Moon, Hyemi Kwon, Se Eun Park, Kyung-Do Han, Eun-Jung Rhee, Won-Young Lee
Cardiovasc Prev Pharmacother. 2022;4(1):42-55.   Published online January 20, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e3
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  • 20 Download
Abstract PDFSupplementary Material
Background
Since a sedentary lifestyle is considered a modifiable risk factor for cardiovascular disease (CVD), physical activity (PA) is recommended for type 2 diabetes mellitus (T2DM) patients to prevent CVD. We investigated the association between different levels of PA and the risk for CVD and all-cause mortality in patients with T2DM using nationwide data.
Methods
We examined health examination data and claims records of 2,745,637 participants with T2DM at baseline from the Korean National Health Insurance Service who underwent health examinations between 2009 and 2012. We excluded subjects with a history of myocardial infarction or stroke. Each participant was asked to report their weekly PA levels according to three categories: vigorous, moderate, and walking. The incidence of CVD and death was analyzed until 2017.
Results
The risk of CVD was lower in regular exercisers than in nonexercisers after adjusting for confounding variables. A dose-response trend was evident in the association between the degree of PA and CVD risk. All categories of PA were inversely associated with CVD risk and mortality. The reduction in CVD risk and all-cause mortality was more profound in patients aged ≥65 years.
Conclusions
Augmenting PA might have positive effects on the prevention of CVD and all-cause death, especially in the elderly. The benefits of PA were consistently observed in various subgroups regardless of the presence of chronic conditions. Therefore, clinicians should encourage elderly patients with T2DM to increase their daily PA.

CPP : Cardiovascular Prevention and Pharmacotherapy