Tags

Type your tag names separated by a space and hit enter

Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study.
JAMA 1999; 282(22):2149-55JAMA

Abstract

CONTEXT

Few studies have examined the interactive effects of smoking and serum cholesterol level on morbidity and mortality from cardiovascular dieseases. In East Asia, where the prevalence of smoking is among the highest in the world, morbidity and mortality from ischemic heart disease (IHD) is rapidly escalating.

OBJECTIVES

To determine whether cigarette smoking is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) in the Republic of Korea (South Korea), a population that has relatively low levels of serum cholesterol, and to determine whether serum cholesterol levels modify the risk relationship between smoking and ASCVD.

DESIGN

Prospective cohort study with a follow-up period of 6 years (1993-1998).

SETTING AND SUBJECTS

A total of 106745 Korean men aged 35 to 59 years who received health insurance from the Korea Medical Insurance Corporation and who had biennial medical evaluations in 1990 and 1992.

MAIN OUTCOME MEASURES

Hospital admissions and deaths from IHD, cerebrovascular disease (CVD), and total ASCVD.

RESULTS

At baseline, 61389 (58%) were current cigarette smokers and 64482 (60%) had a total cholesterol level of less than 5.17 mmol/L (200 mg/dL). Between 1993 and 1998, 1006 IHD events (176 per 100000 person-years), 1364 CVD events (238 per 100000 person-years), and 716 other ASCVD events (125 per 100000 person-years) occurred. In multivariate Cox proportional hazard models controlling for age, hypertension, hypercholesterolemia, and diabetes, current smoking increased the risk of IHD (risk ratio [RR], 2.2; 95% confidence interval [CI], 1.8-2.8), CVD (RR, 1.6; 95% CI, 1.4-1.8), and total ASCVD (RR, 1.6; 95% CI, 1.5-1.8). For each outcome, there were significant dose-response relationships with amount and duration of smoking. Throughout the range of serum cholesterol levels, current smoking significantly increased the risk of IHD and CVD. In the lowest quartile of serum cholesterol levels (<4.42 mmol/L [171 mg/dL]), the RR from current smoking was 3.3 (95% CI, 1.7-6.2) for IHD and 1.6 (95% CI, 1.2-2.3) for CVD. There was no evidence of an interaction between smoking and serum cholesterol (P for interaction = .75, .87, and .92 for IHD, CVD, and total ASCVD, respectively).

CONCLUSIONS

This study demonstrates that in Korea smoking is a major independent risk factor for IHD, CVD, and ASCVD and that a low cholesterol level confers no protective benefit against smoking-related ASCVD.

Authors+Show Affiliations

Department of Epidemiology and Disease Control, Graduate School of Health Science and Management, Yonsei University, Seoul, Republic of Korea.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10591337

Citation

Jee, S H., et al. "Smoking and Atherosclerotic Cardiovascular Disease in Men With Low Levels of Serum Cholesterol: the Korea Medical Insurance Corporation Study." JAMA, vol. 282, no. 22, 1999, pp. 2149-55.
Jee SH, Suh I, Kim IS, et al. Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study. JAMA. 1999;282(22):2149-55.
Jee, S. H., Suh, I., Kim, I. S., & Appel, L. J. (1999). Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study. JAMA, 282(22), pp. 2149-55.
Jee SH, et al. Smoking and Atherosclerotic Cardiovascular Disease in Men With Low Levels of Serum Cholesterol: the Korea Medical Insurance Corporation Study. JAMA. 1999 Dec 8;282(22):2149-55. PubMed PMID: 10591337.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study. AU - Jee,S H, AU - Suh,I, AU - Kim,I S, AU - Appel,L J, PY - 1999/12/11/pubmed PY - 2001/8/14/medline PY - 1999/12/11/entrez SP - 2149 EP - 55 JF - JAMA JO - JAMA VL - 282 IS - 22 N2 - CONTEXT: Few studies have examined the interactive effects of smoking and serum cholesterol level on morbidity and mortality from cardiovascular dieseases. In East Asia, where the prevalence of smoking is among the highest in the world, morbidity and mortality from ischemic heart disease (IHD) is rapidly escalating. OBJECTIVES: To determine whether cigarette smoking is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) in the Republic of Korea (South Korea), a population that has relatively low levels of serum cholesterol, and to determine whether serum cholesterol levels modify the risk relationship between smoking and ASCVD. DESIGN: Prospective cohort study with a follow-up period of 6 years (1993-1998). SETTING AND SUBJECTS: A total of 106745 Korean men aged 35 to 59 years who received health insurance from the Korea Medical Insurance Corporation and who had biennial medical evaluations in 1990 and 1992. MAIN OUTCOME MEASURES: Hospital admissions and deaths from IHD, cerebrovascular disease (CVD), and total ASCVD. RESULTS: At baseline, 61389 (58%) were current cigarette smokers and 64482 (60%) had a total cholesterol level of less than 5.17 mmol/L (200 mg/dL). Between 1993 and 1998, 1006 IHD events (176 per 100000 person-years), 1364 CVD events (238 per 100000 person-years), and 716 other ASCVD events (125 per 100000 person-years) occurred. In multivariate Cox proportional hazard models controlling for age, hypertension, hypercholesterolemia, and diabetes, current smoking increased the risk of IHD (risk ratio [RR], 2.2; 95% confidence interval [CI], 1.8-2.8), CVD (RR, 1.6; 95% CI, 1.4-1.8), and total ASCVD (RR, 1.6; 95% CI, 1.5-1.8). For each outcome, there were significant dose-response relationships with amount and duration of smoking. Throughout the range of serum cholesterol levels, current smoking significantly increased the risk of IHD and CVD. In the lowest quartile of serum cholesterol levels (<4.42 mmol/L [171 mg/dL]), the RR from current smoking was 3.3 (95% CI, 1.7-6.2) for IHD and 1.6 (95% CI, 1.2-2.3) for CVD. There was no evidence of an interaction between smoking and serum cholesterol (P for interaction = .75, .87, and .92 for IHD, CVD, and total ASCVD, respectively). CONCLUSIONS: This study demonstrates that in Korea smoking is a major independent risk factor for IHD, CVD, and ASCVD and that a low cholesterol level confers no protective benefit against smoking-related ASCVD. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/10591337/Smoking_and_atherosclerotic_cardiovascular_disease_in_men_with_low_levels_of_serum_cholesterol:_the_Korea_Medical_Insurance_Corporation_Study_ L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/282/pg/2149 DB - PRIME DP - Unbound Medicine ER -