Metabolic Diseases Etiology Research Center Research Articles

The association between psychological resilience and cognitive function in longitudinal data: Results from the community follow-up survey

Background: The present study aimed to investigate the association between resilience and cognitive function of middle-aged Koreans in a longitudinal setting. Methods: We utilized the baseline and 5-year follow-up data from the Cardiovascular and Metabolic Diseases Etiology Research Center study. The final number of participants included in the analysis was 397 (108 men, 289 women, mean age 55.4 years) who had valid measurements of both baseline resilience and Mini-Mental State Estimation at follow-up. The resilient people at baseline were operationally defined as the people who had at least one negative experience in the Life Experience Survey without depression, which was defined as a Beck Depressive Inventory-Ⅱ score of 20 or above. Cognitive function was evaluated by the Korean version of the Mini-Mental State Examination in both surveys. A generalized linear model was applied after adjusting for confounders. The association between resilience and cognitive function was further analyzed using stratification by median age and education level. Results: At follow-up, only in men, the resilience group showed a higher MMSE level compared to the reference group (β = 1.3, p = 0.002). Stratified by median age, both the younger group (β = 1.2, SE = 0.5, p = 0.031) and the older group among men (β = 2.1, SE = 0.7, p = 0.0069) showed a positive association between resilience and cognitive functions. However, when stratified by education level, only the low-education group presented the association (β = 1.7, SE = 0.5, p = 0.002). In women, no significant results were found. Limitation: This study had limited number of participants. Conclusion: Resilience at baseline was associated with more well-preserved cognitive function at follow-up in men.

OPTIMAL THRESHOLDS FOR AMBULATORY BLOOD PRESSURE IN PATIENTS WITH HIGH CARDIOVASCULAR RISK

Objective: Recent 2017 American College of Cardiology/American Heart Association hypertension guideline suggested new ambulatory blood pressure (ABP) thresholds, however there are arguments whether it is optimal for defining hypertension. The objective of this study was to find optimal ABP thresholds for outcomes especially in patients with high cardiovascular risk. Design and method: From the Cardiovascular and Metabolic Disease Etiology Research Center – High Risk Cohort (CMERC-HI), 2026 patients who had 24-hour ABP monitoring data were selected. Baseline 24-hour ABP, daytime ABP, nighttime ABP, morning ABP threshold were determined separately using Cox proportional hazard model with propensity scores adjustment. The composite of cardiovascular disease (CVD) outcomes (hospitalization with MI, stroke, or heart failure) and all-cause mortality were primary end-points of this study. Results: A total of 2026(median age, 60 years, 52.6% male) subjects were analyzed in this study. Median follow-up was 3.4 years. There were 54 CVD outcomes and all-cause mortality (8.1 per 1000 person-years). Compared to 24-hour ABP <135/85 mmHg, 24-hour ABP more than 135/85 mmHg was associated with significantly poor outcomes (HR 1.49, 95% CI, 1.02–2.17). However, 24-hour ABP more than 130/80 mmHg and 24-hour ABP more than 125/75 were not associated with significantly higher risk. For daytime ABP, the threshold of 140/90 mmHg was significantly related to higher risk of CVD outcomes or death, (HR 1.78, 95% CI, 1.04–3.05) rather than ABP 135/85 mmHg or 130/80 mmHg. For nighttime ABP, no cut-off level other than 125/75 mmHg (HR 1.58, 95% CI, 1.08–2.32) was statistically meaningful. There was no adequate threshold for morning ABP in this analysis. Conclusions: In patients with high risk for CVD, 135/85mmHg for 24hr-ABP, 140/90 mmHg for daytime ABP, 125/75 mmHg for nighttime ABP seemed to be the threshold associated with increased outcomes. The BP threshold suggested by the ACC/AHA guideline was not significantly associated with increased outcomes.

Soluble Urokinase-Type Plasminogen Activator Receptor, Changes of 24-Hour Blood Pressure, and Progression of Chronic Kidney Disease.

BackgroundSoluble urokinase‐type plasminogen activator receptor (suPAR) is associated with cardiovascular risks and poor renal outcomes. However, whether elevated suPAR levels are associated with 24‐hour blood pressure patterns or kidney disease progression in patients with chronic kidney disease (CKD) is unclear.Methods and ResultsA total of 751 patients with CKD stage 1 to 5 were recruited from CMERC‐HI (Cardiovascular and Metabolic Disease Etiology Research Center–High Risk) cohort study (2013–2018). The relationship of serum suPAR levels to 24‐hour blood pressure parameters and CKD progression was analyzed. The median serum suPAR level was 1439.0 (interquartile range, 1026.2–2150.1) pg/mL, and the mean estimated glomerular filtration rate was 52.8±28.5 mL/min per 1.73 m2 at baseline. Patients with higher suPAR levels had significantly higher levels of office, 24‐hour, daytime, and nighttime systolic blood pressure and nighttime diastolic blood pressure than those with lower suPAR levels. The highest suPAR tertile was associated with an increased risk of a reverse dipping pattern (odds ratio, 2.93; 95% CI, 1.27–6.76; P=0.01). During a follow‐up of 43.2 (interquartile range, 27.0–55.6) months, the CKD progression occurred in 271 (36.1%) patients. The highest suPAR tertile was significantly associated with higher risk of CKD progression than the lowest tertile (hazard ratio [HR], 2.09; 95% CI, 1.37–3.21; P=0.001). When the relationship was reevaluated with respect to each dipping pattern (dipper, extreme dipper, nondipper, and reverse dipper), this association was consistent only in reverse dippers in whom the risk of CKD progression increased (HR, 1.43; 95% CI, 1.02–2.01; P=0.03) with every 1‐unit increase in serum suPAR levels.ConclusionsElevated suPAR levels are independently associated with CKD progression, and this association is prominent in reverse dippers.

Association of social network size and composition with physical activity in Korean middle-aged adults.

OBJECTIVESPhysical activity (PA) is an established protective factor for many chronic diseases. Numerous studies have established positive relationships between social networks and PA. Accordingly, this study examined the relationship between social network structures (specifically the network size and the number and proportion of same-sex alters) and self-reported PA in Korean middle-age adults, where the term “alter” refers to a respondent’s social network members.METHODSWe analyzed 8,092 participants of the Cardiovascular and Metabolic Diseases Etiology Research Center cohort. We assessed the association between each network structure variable and PA level using a linear regression model. Then, we employed logistic regression to evaluate associations between social network structure and adherence to guideline-recommended exercise levels. Socio-demographic factors and health status measures were used as covariates.RESULTSIn both sexes, the social network size and proportion of same-sex network members showed positive relationships with total and moderate-to-vigorous PA. Notably, female participants with a greater number of kin were more likely to satisfy the recommended amount of total PA.CONCLUSIONSThese findings suggest that large scale, same-sex intervention programs can help to achieve recommended PA regimens.

Sex differences in the association between social relationships and insomnia symptoms.

Social relationships are an understudied factor affecting insomnia. In particular, these effects have not been evaluated in the context of sex differences. In this study, we investigated differences between sexes with regard to the association between insomnia symptoms and social relationships. We used data from 2681 middle-aged adults (aged 40-64 years; females, 68.8%) from the Cardiovascular and Metabolic Diseases Etiology Research Center project. Insomnia symptoms were defined as difficulty with sleep induction or maintenance ≥3 nights per week. We assessed social network size and bridging potentials as indicators of social relationships. Social network size is a quantitative measure of the size of social relationships, and bridging potential is a qualitative indicator of the diversity and independence of these relationships. Multivariate regression analysis controlling for confounding factors was performed to evaluate associations between social relationships and insomnia symptoms. Smaller social network size was significantly associated with sleep induction (adjusted odds ratio = 0.866, P = .015) and sleep maintenance (adjusted odds ratio = 0.862, P = .015) difficulties, but only in men. Poor bridging potential was also associated with sleep induction (adjusted odds ratio = 0.321, P = .024) and maintenance (adjusted odds ratio = 0.305, P = .031) difficulties only in men. For women, social relationship variables were not significantly associated with insomnia symptoms. The association between insomnia symptoms and social relationships varied by sex, as noted by statistical analyses accounting for covariates affecting insomnia symptoms. These results suggest that qualitative assessments of social relationship variables should be considered in clinical practice, since these variables can be interpreted differently for men and women.

Does serum vitamin D level affect the association between cardiovascular health and cognition? Results of the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) study.

Few studies have assessed the role of vitamin D in the association between cardiovascular risk factors and cognitive function. Here, the aim was to investigate the association between cardiovascular health (CVH) and cognitive function according to vitamin D level in a middle-aged Korean population. This cross-sectional study included 840 men and 1811 women (mean age 57.2years) from the Cardiovascular and Metabolic Diseases Etiology Research Center study baseline enrolment (2013-2018). Life's Simple 7 tools from the American Heart Association were used to assess CVH. Cognitive function was evaluated using the Mini-Mental State Estimation for Dementia Screening (MMSE-DS), and the serum 25-hydroxyvitamin D level was measured. In the adjusted generalized linear regression models, no significant association between a high Life's Simple 7 score (4-7 metric at optimal level) and MMSE-DS score (β=0.01, P=0.93) was found. Amongst men with a high vitamin D level, the high Life's Simple 7 score group showed a significantly higher MMSE-DS score (β=0.48, P=0.03). However, amongst men in the low vitamin D group, the association was opposite with no statistical significance (β =-0.23, P=0.08). In women, the results were similar, but both strata according to vitamin D level showed no statistical significance. Our findings suggest that vitamin D is an effect modifier in the association between CVH and cognition, especially in men.

Associations between social network properties and metabolic syndrome and the mediating effect of physical activity: findings from the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) Cohort

IntroductionSocial isolation and loneliness are positively associated with metabolic syndrome. However, the mechanisms by which social isolation affects metabolic syndrome are not well understood.Research design and methodsThis study was designed...

Sex-, Age-, and Metabolic Disorder-Dependent Distributions of Selected Inflammatory Biomarkers among Community-Dwelling Adults.

BackgroundInflammatory cytokines are increasingly utilized to detect high-risk individuals for cardiometabolic diseases. However, with large population and assay methodological heterogeneity, no clear reference currently exists.MethodsAmong participants of the Cardiovascular and Metabolic Diseases Etiology Research Center cohort, of community-dwelling adults aged 30 to 64 without overt cardiovascular diseases, we presented distributions of tumor necrosis factor (TNF)-α and -β, interleukin (IL)-1α, -1β, and 6, monocyte chemoattractant protein (MCP)-1 and -3 and high sensitivity C-reactive protein (hsCRP) with and without non-detectable (ND) measurements using multiplex enzyme-linked immunosorbent assay. Then, we compared each markers by sex, age, and prevalence of type 2 diabetes mellitus, hypertension, and dyslipidemia, using the Wilcoxon Rank-Sum Test.ResultsIn general, there were inconsistencies in direction and magnitude of differences in distributions by sex, age, and prevalence of cardiometabolic disorders. Overall, the median and the 99th percentiles were higher in men than in women. Older participants had higher TNF-α, high sensitivity IL-6 (hsIL-6), MCP-1, hsCRP, TNF-β, and MCP-3 median, after excluding the NDs. Participants with type 2 diabetes mellitus had higher median for all assayed biomarkers, except for TNF-β, IL-1α, and MCP-3, in which the medians for both groups were 0.00 due to predominant NDs. Compared to normotensive group, participants with hypertension had higher TNF-α, hsIL-6, MCP-1, and hsCRP median. When stratifying by dyslipidemia prevalence, the comparison varied significantly depending on the treatment of NDs.ConclusionOur findings provide sex-, age-, and disease-specific reference values to improve risk prediction and diagnostic performance for inflammatory diseases in both population- and clinic-based settings.

Associations between age and dyslipidemia are differed by education level: The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) cohort

BackgroundDyslipidemia is a multifactorial disorder, which arises from complex interactions among genetic and environmental risk factors. Previous studies have established the deteriorating effect of aging on lipid profiles. However, little is known about the role of education level, a stable marker of socioeconomic status, which reflect modifiability of lifestyle risk factors. Therefore, we examined the association between age and individual dyslipidemia parameter across education level among healthy, middle-aged Korean women.MethodsFrom 2049 middle-aged women, education attainment was classified into completion of elementary school or below, middle school, high school, college or above. Dyslipidemia was assessed in adherence to the 2018 Korean Dyslipidemia Treatment Guideline. Multivariable logistic regression and generalized linear model tested for associations between age and dyslipidemia parameter across education level and other known risk factors, including menopause, obesity, and current drinking and smoking.ResultsIn this cross-sectional analysis, the prevalence of each dyslipidemia parameter was significantly different by age and education level. The odds ratio (OR) for dyslipidemia was higher among participants who were older and had received higher education (OR = 2.31, p for interaction = 0.008) than younger and low education counterpart. The interaction between age and education level remained significant for hypercholesterolemia (p for interaction = 0.003) and hyper-LDL-cholesterolemia (p for interaction = 0.002).ConclusionsSeparate examination of individual dyslipidemia parameter indicated varying degree of interaction with age and education level. Such results imply that each type of lipid abnormality may arise from and be exacerbated by heterogeneous composition of biological and lifestyle risk factors, which may be reflected by education level.

Association Between Psychological Resilience and Cognitive Function in Later Life: Effect Modification by Inflammatory Status

Background: We aimed to examine the association between psychological resilience and cognitive function and investigate the role of acute inflammation as an effect modifier. Methods: Total 7,535 people from the Cardiovascular and Metabolic Disease Etiology Research Center (CMERC), aged ≥50, were included in the analysis. Stressful life events in the past 6 months were gauged by the Life Experience Survey, and current depression symptoms were analysed with the Beck Depression Inventory-II. Participants were categorised into four groups according to their past experience and depression status: ‘reference,’ ‘resilient,’ ‘reactive depression,’ and ‘vulnerable depression.’ Cognitive function was evaluated using the Mini-Mental State Examination (MMSE). The level of high-sensitivity C-reactive protein (hsCRP) and Interleukin-6 were measured from blood samples. A generalised linear regression was performed. Upon adjusting for socio-demographic factors, comorbidity, and lifestyle factors, the final model was stratified with the highest quartile of the hsCRP level by sex. Findings: Compared with the reference group, ‘resilient group’ showed higher MMSE, which was also significant in women (adj-β=0·280, p-value<0·001). ‘Vulnerable depression’ showed a significant lower MMSE (adj-β=-0·997, p-value 0·002) in especially men. This pattern seemed to be limited to the low hsCRP subgroup. Interpretation: Psychological resilience was associated with a lower likelihood of cognitive deficit in women. This pattern seemed to be modulated by inflammatory status. Funding Statement: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Science and ICT (2018R1C1B5083722), and the CMERC cohort study was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number HI13C0715). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The Institutional Review Board of Yonsei University (YUIRB-4-2013-0661) approved the protocol of this study, and all participants provided written informed consents.

Dose-Response Association between Smoking Cessation and Arterial Stiffness: The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) Cohort.

Background and ObjectivesCigarette smoking has been reported to be associated with arterial stiffness. However, the clinical relevance of smoking cessation on arterial stiffness is debatable. Thus, we evaluated whether smoking cessation is associated with arterial stiffness.MethodsA total of 1,169 male participants aged 30–64 years with absence of cardiovascular diseases in 2013–2017 were selected from the Cardiovascular and Metabolic Disease Etiology Research Center cohort study. The subjects were classified into the following 5 groups based on self-reporting: non-smokers, former smokers (<1, 1 to <10, and ≥10, years after cessation), and current smokers. Arterial stiffness was assessed using the augmentation index (AIx). The radial artery AIx was obtained from the peripheral artery waveform. The association was explored cross-sectionally.ResultsThe AIx of former smokers did not differ from that of non-smokers (p=0.089). However, after former smokers were stratified by duration of smoking cessation, we noted a linear trend according to the smoking status (p<0.001). Men who quit smoking <1 year ago showed an elevated AIx (β=3.94, standard error=1.54, p=0.011) as much as ones of current smokers (β=4.39, standard error=0.74, p<0.001), while those who quit more than a decade ago showed an AIx similar to that of non-smokers (β=0.35, standard error=0.82, p=0.670) after controlling covariates.ConclusionsA dose-response association between smoking cessation and AIx was revealed, which implies the possibility of a reversible effect of smoking cessation on arterial stiffness. Therefore, our findings may motivate current smokers to modify their smoking habits to delay or reverse disease progression.

Effects of cigarette smoking on blood lipids in Korean men: Cardiovascular and Metabolic Diseases Etiology Research Center cohort.

Background/AimsCigarette smoking and abnormal blood lipids are major risk factors for cardiovascular disease. The results of previous studies on the relationship between cigarette smoking and dyslipidemia are controversial. In the present study, we investigated the independent association between cigarette smoking and blood lipid levels in a male Korean population.MethodsA total of 1,932 men aged from 30 to 64 years old participated in the Cardiovascular and Metabolic Diseases Etiology Research Center cohort study. Smoking history was obtained by in-person interviews. In all regression models, measurements of triglyceride levels were log-transformed.ResultsTriglyceride levels were higher in current smokers than in never-smokers (median: 149 mg/dL vs. 115 mg/dL, p < 0.001) even after adjusting age, body mass index, alcohol intake, systolic blood pressure, fasting glucose, physical activity, and nutrition intake (β = 0.14, p < 0.001). We further divided people into heavy and light smokers using 20 pack-years as the cut-off. Higher triglyceride were found in current heavy smokers (β = 0.18, p < 0.001), current light smokers (β = 0.13, p < 0.001), as well as in past heavy smokers (β = 0.08, p = 0.037), as compared to never-smokers. Moreover, significantly lower high-density lipoprotein cholesterol (HDL-C) were observed in current heavy smokers (β = –2.27 mg/dL, p = 0.009).ConclusionsCigarette smoking is associated with higher triglyceride in Korean men, with the most dramatic effect seen in current smokers with a smoking history of more than 20 pack-years. HDL-C were also lower in current smokers with more than 20 pack-years.

Stressful life events and augmentation index: results from the Cardiovascular and Metabolic Diseases Etiology Research Center

Several studies have reported a positive association between psychological stress and cardiovascular diseases; however, there is scarce evidence about various aspects of life stress, including traumatic, positive, and negative events. We aimed to evaluate the association between various stressful life events and indicators of cardiovascular risk, including the augmentation index. A total of 3276 participants from the Cardiovascular and Metabolic Diseases Etiology Research Center cohort (Mean age: 50.9) were analyzed cross-sectionally. By using the Life Experience Questionnaire, exposures were grouped as a "positive event," "negative event," or "traumatic event." The augmentation index and subclinical atherosclerosis were measured. Multivariate polytomous logistic regression was used. Overall, stressful life events did not show any significant association with any cardiovascular index; however, increased odds ratios were observed between augmentation index quartiles and those who had experienced traumatic events (quartile 4: odds ratio = 1.41, 95% confidence interval = 1.09-1.82). The association remained valid among women when stratified by sex. There was no significant result in men. Traumatic events in women were positively associated with the augmentation index. These findings suggest that more attention should be paid to trauma in the context of increased cardiovascular risk in women.

Cohort Profile: The Cardiovascular and Metabolic Diseases Etiology Research Center Cohort in Korea.

Mortalities from cardiovascular disease in Korea have decreased markedly over the past three decades. The major cardiovascular and metabolic risk factors, however, remain prevalent, and their burden on health is large. The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) planned a cohort study in order to identify novel risk factors and to develop evidence-based prevention strategies of cardiovascular and metabolic diseases. The CMERC deliberately designed two prospective cohorts, a community-based general population cohort (the CMERC cohort) and its sister cohort (a hospital-based high-risk patient cohort), covering a broad spectrum of cardiovascular and metabolic diseases. This paper describes the CMERC cohort study of community-dwelling adults aged 30 to 64 years. A total of 8097 adults completed baseline measurement between 2013 and 2018. Baseline measurements assessed socio-demographic factors, medical history, health-related behaviors, psychological health, social network and support, anthropometry, body composition, and resting blood pressure and comprised electrocardiography, carotid artery ultrasonography, fasting blood analysis, and urinalysis. Both active follow-up through an annual telephone survey and a 5-year on-site health examination survey and passive follow-up through secondary data linkage with national databases, such as national death records, have been applied. Researchers interested in collaborative research may contact the corresponding author.

The Association of Adiponectin and Visceral Fat with Insulin Resistance and β-Cell Dysfunction.

BackgroundObesity is a risk factor for metabolic abnormalities. We investigated the relationship of adiponectin levels and visceral adiposity with insulin resistance and β-cell dysfunction.MethodsThis cross-sectional study enrolled 1,347 participants (501 men and 846 women aged 30–64 years) at the Cardiovascular and Metabolic Diseases Etiology Research Center. Serum adiponectin levels and visceral fat were measured using enzyme-linked immunosorbent assay kits and dual-energy X-ray absorptiometry, respectively. Insulin resistance was evaluated using the homeostatic model assessment of insulin resistance (HOMA-IR) and Matsuda insulin sensitivity index. β-cell dysfunction was evaluated using the homeostatic model assessment of β-cell function (HOMA-β), insulinogenic index, and disposition index.ResultsRegarding insulin resistance, compared with individuals with the highest adiponectin levels and visceral fat mass < 75th percentile, the fully adjusted odds ratios (ORs) for HOMA-IR ≥ 2.5 and Matsuda index < 25th percentile were 13.79 (95% confidence interval, 7.65–24.83) and 8.34 (4.66–14.93), respectively, for individuals with the lowest adiponectin levels and visceral fat ≥ 75th percentile. Regarding β-cell dysfunction, the corresponding ORs for HOMA-β < 25th percentile, insulinogenic index < 25th percentile, and disposition index < 25th percentile were 1.20 (0.71–2.02), 1.01 (0.61–1.66), and 1.87 (1.15–3.04), respectively.ConclusionLow adiponectin levels and high visceral adiposity might affect insulin resistance and β-cell dysfunction.

Comparison between Right and Left Upper Arms in Detection of Hypertension.

Background and ObjectivesThis study aimed to investigate the right-left arm difference in detection of hypertension in the general Korean population.MethodsThis study analyzed data from the Cardiovascular and Metabolic Disease Etiology Research Center cohort. Study population was 2,103 people who were aged 30 to 64 years old, without history of major cardiovascular diseases, and did not use antihypertensive medication. Brachial blood pressures (BPs) were measured for both arms using an automated oscillometric device equipped with 2 cuffs for simultaneous double-arm measurements. Systolic and diastolic blood pressures (SBP and DBP) were measured 3 times, and the average value was used in the analysis. Overall hypertension was defined as elevated blood pressure (SBP/DBP ≥140/90 mmHg) at the arm with higher value, while right-arm or left-arm hypertension was defined as elevated BP at each arm. Sensitivity was calculated as the number of each-arm hypertension divided by the number of overall hypertension.ResultsOverall 8.6% of the population had hypertension at either arm, while 7.8% had right-arm hypertension, 7.2% had left-arm hypertension, and 6.4% had both arms hypertension. The sensitivity for the detection of hypertension was 90.6% when BP was measured only at right arm, and 83.4% when measured only at left arm. Corresponding sensitivity were 87.9% and 87.1% in men, and 95.4% and 76.9% in women.ConclusionsSingle-arm measurements, compared to double-arm measurements, may underestimate the prevalence of hypertension. However, if double-arm measurements are unavailable, right arm is preferred for measurement of BP, especially in women.

Global Impact of the 2017 American College of Cardiology/American Heart Association Hypertension Guidelines.

Global Impact of the 2017 American College of Cardiology/American Heart Association Hypertension Guidelines.

Association of appendicular skeletal muscle mass with carotid intima-media thickness according to body mass index in Korean adults

OBJECTIVESThe combined effects of obesity and appendicular skeletal muscle (ASM) on atherosclerosis, especially in middleaged populations, remain poorly understood. This cross-sectional study investigated the effects of ASM on carotid intima-media thickness (IMT) according to body mass index (BMI) in middle-aged Korean adults.METHODSHerein, 595 men and 1,274 women aged 30-64 years completed questionnaires and underwent health examinations as part of the Cardiovascular and Metabolic Disease Etiology Research Center cohort. ASM was measured via bioelectrical impedance analysis and adjusted for weight (ASM/Wt). IMT was assessed using B-mode ultrasonography; highest quartile of IMT was defined as gender-specific top quartile of the IMT values. Higher BMIs was defined as a BMI over 25.0 kg/m2 .RESULTSCompared to the highest ASM/Wt quartile, the lowest ASM/Wt quartile was significantly associated with highest quartile of IMT in men with lower BMIs (adjusted odds ratio [aOR], 2.78; 95% confidence interval [CI], 1.09 to 7.13), but not in those with higher BMIs (aOR, 0.59; 95% CI, 0.24 to 1.91). In women, there was no significant association of low skeletal muscle mass with highest quartile of IMT, regardless of BMI.CONCLUSIONSLow appendicular skeletal muscle mass is associated with carotid arterial wall thickening in men with lower BMIs, but not in men with higher BMIs. Our findings suggest that the risk of atherosclerosis may be low in middle-aged Korean men with appropriate body weight and skeletal muscle mass maintenance.

A16036 Large Discrepancy between Unobserved Automated Office Blood Pressure and Ambulatory Blood Pressure in a High Cardiovascular Risk Cohort

Objectives: Recently, automated office blood pressure (AOBP) has been shown to eliminate the white-coat effect and to be more concordant with ambulatory blood pressure monitor (ABPM) and home blood pressure (BP) measurements. The purpose of this study was to compare BP measured by AOBP with that by ABPM in high cardiovascular risk patients. Methods: The study participants were recruited from a prospective cohort study (Cardiovascular and Metabolic Disease Etiology Research Center–High Risk Cohort [CMERC-HI]; clinicaltrials.gov: NCT02003781). 1,208 participants who had undergone both AOBP and ABPM within 7days of each measurement were analyzed for this study. Results: The 95% limits of agreement between systolic AOBP and daytime ABPM systolic blood pressure (SBP) were − 34.78 to 20.19 mmHg (mean difference = − 7.30 ± 14.0). The mean differences in quintiles of AOBP distributions increased with decreasing AOBP measurements [ − 17.8 ± 11.2 (Q1, systolic AOBP < 113), − 10.9 ± 11.1 (Q2, systolic AOBP 113–121), − 8.5 ± 10.7 (Q3, systolic AOBP 121–128), − 4.2 ± 11.8 (Q4, systolic AOBP 128–137), 4.9 ± 14.2 (Q5, systolic AOBP > 137), p < 0.001]. The prevalence of masked uncontrolled hypertension was 310 (25.7%), and the prevalence of white-coat effects was 102 (8.4%). Large discrepancy was significantly associated with lower systolic AOBP, higher ASCVD risk score, and history of cardiovascular disease. Conclusion: Lower range of systolic AOBP showed a large discrepancy with daytime ABPM SBP and a high prevalence of masked hypertension in high-risk patients. The status of BP control should be confirmed by out-of-office BP measurements, even when using AOBP as a clinical BP of reference in high-risk patients.

Association between appendicular skeletal muscle mass and depressive symptoms: Review of the cardiovascular and metabolic diseases etiology research center cohort

BackgroundThe effects of skeletal muscle mass on depressive symptoms remain poorly understood, especially in the middle-aged population. We examined the relationship between skeletal muscle mass and depressive symptoms according to sex and menopausal status in the middle-aged Korean population. MethodsHerein, 1,151 men and 2,176 women aged 30–64 years completed questionnaires and underwent health examinations in the Cardiovascular and Metabolic Disease Etiology Research Center study. Appendicular skeletal muscle mass (ASM) was measured via bioelectrical impedance analysis and adjusted for height squared (ASM/Ht2). Both continuous values and tertile groups of ASM/Ht2 were used for analysis. Depressive symptoms were assessed using the Beck Depressive Inventory-II (BDI), and the prevalence of depressive symptoms was determined as a BDI score ≥ 20. ResultsMultiple logistic regression analysis using a fully adjusted model showed that depressive symptoms were more frequently observed among men in the lower ASM/Ht2 tertile and middle ASM/Ht2 tertile than among those in the higher ASM/Ht2 tertile. Each 1-kg/m2 decrease in ASM/Ht2 was significantly associated with the presence of depressive symptoms in men. Such significant association was not observed among premenopausal and postmenopausal women. LimitationsThe cross-sectional nature of the study design, measurement of skeletal muscle mass and depressive symptoms only once, estimation of skeletal muscle mass using bioelectrical impedance analysis, assessing depressive symptoms by self-reported questionnaire, and potential unknown confounding variables constitute the limitations of our study. ConclusionsThe independent association between low skeletal muscle mass and depressive symptoms was observed in men but not in women.