Junhee Park

Background/Objectives: Stroke-induced cardiac damage may lead to lifelong cardiac problems, such as heart failure (HF). We aimed to compare the incidence of HF between stroke survivors and the general non-stroke population. Methods: We performed a population-based study of individuals in the Korean National Health Insurance Service database. We included 220,231 stroke survivors between 2010 and 2018 and 1:1 age- and sex-matched non-stroke controls. The study outcome was HF and the cohort was followed up until 2019. Cox hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for HF risk. Results: At baseline, stroke survivors had a substantially higher comorbidity burden than matched controls (Charlson Comorbidity Index 4.1 vs. 1.6), with higher rates of hypertension, type 2 diabetes, and dyslipidemia, and were more likely to be current smokers and heavy drinkers. Stroke survivors showed a higher risk for HF (aHR 1.69, 95% CI 1.65–1.73) compared to controls. The risks were further increased with disability, as demonstrated in comparison of those with mild disability (aHR 1.78, 95% CI 1.70–1.87) and those with severe disability (aHR 2.22, 95% CI 2.10–2.36). Before applying the 1-year lag period, the association appeared more prominent among hemorrhagic stroke survivors than ischemic stroke survivors. However, following the 1-year lag period, the HF risk was similar between stroke subtypes (hemorrhagic stroke with disability: aHR 1.77, 95% CI 1.62–1.93; ischemic stroke with disability: aHR 1.71, 95% CI 1.63–1.80). Propensity score matching incorporating all baseline characteristics confirmed the robustness of the primary findings. Conclusions: Stroke survivors, who had a greater burden of cardiovascular risk factors, were at significantly greater risk for incident HF compared with age- and sex-matched non-stroke controls, particularly those with disability. Clinicians need to be aware of the importance of HF in stroke survivors who have multiple comorbidities and disability.

Boyoung Han, Junhee Park, Yun-Mi Song, Dong Wook Shin, Jinyoung Shin, Belong Cho. Korean J Fam Pract 2025;15:154-66. https://doi.org/10.21215/kjfp.2025.15.3.154

Background: Circadian misalignment is associated with metabolic syndrome. This study aimed to examine the association between circadian rhythm-disturbing factors and metabolic syndrome.Methods: We used data from the 7th and 8th Korea National Health and Nutrition Examination Survey conducted between 2016 and 2020, which surveyed 16,253 individuals. Circadian rhythm-disturbing factors were defined as follows: sleep duration outside the reference group (6–8 hours), irregular breakfast, shift work, and physical inactivity. The adjusted odds ratio (aOR) for metabolic syndrome was calculated based on the number of circadian rhythm-disturbing factors present in adults over the age of 19 years.Results: Among a total of 16,253 participants (mean age 48.2±15 years), metabolic syndrome was found in 5,237 participants (29.3%). The participants were classified into three categories based on the number of circadian rhythm-disturbing factors as follows: 2,627 (15.6%) did not have any factors, 6,406 (38.13%) had one factor, and 7,220 (46.3%) had two or more factors. Participants with a single circadian rhythm-disturbing factor were 21% more likely to have metabolic syndrome (aOR, 1.21; 95% confidence interval [CI], 1.08–1.36), and participants with two or more factors were 27% more likely to have metabolic syndrome (aOR, 1.27; 95% CI, 1.12–1.43).Conclusion: Circadian rhythm-disturbing factors were significantly associated with the prevalence of metabolic syndrome in Korean adults. This finding has potential clinical implications for maintaining circadian rhythms by avoiding certain factors to prevent metabolic syndrome. Further studies are required to confirm these findings.

Background/Objectives: Cardiovascular disease (CVD) risk may be based on the sequence of hypertension (HTN) and diabetes mellitus (DM) occurrence since the pathophysiological mechanisms might not be the same. The present study examined the risk of CVD according to the precedent relationship between HTN and DM. Methods: Participants with both HTN and DM in a national health screening program in 2015–2016 were divided into two groups based on the order of HTN and DM occurrence: ‘HTN → DM’ and ‘DM → HTN’. The primary outcomes were newly diagnosed myocardial infarction (MI) and ischemic stroke based on the International Classification of Diseases, 10th revision code. Results: Among 914,338 participants, there were 28,368 MI events and 35,632 ischemic stroke events during the follow-up period. The DM → HTN group showed a higher risk of MI (adjusted hazard ratio [aHR]: 1.13 [95% CI: 1.10–1.15]) and ischemic stroke (aHR: 1.06 [95% CI: 1.04–1.09]) than the HTN → DM group. The increased risk of MI in the DM → HTN group was more prominent in females than in males and in those without dyslipidemia than in those with dyslipidemia. A higher risk of MI and ischemic stroke in the DM-HTN group was found in patients with chronic kidney disease (CKD) than in patients without CKD. Conclusions: MI and ischemic stroke were more frequent in patients in the DM → HTN group than in those of the HTN → DM group. When approaching HTN and DM clinically and epidemiologically, two phenotypes based on the order of occurrence should be considered. Given the generalization limitations of Asian patients, who develop DM at an early age compared to other groups, future studies are needed to reveal the underlying mechanism in the precedence relationship between HTN and DM.

Background: Adolescent dependency on smartphones is the highest among all age groups. Adolescents can be influenced to evaluate their body image by popular ideals about beautiful bodies via smartphone content, which can cause body image distortion. This study aimed to examine the association between body image distortion and smartphone dependency and the duration of smartphone usage among Korean adolescents.Methods: This study used data from the 16th Korean Youth Risk Behavior Web-Based Survey (2020), and included 42,981 participants, who were grouped according to self-reported duration of smartphone usage and smartphone dependency, as measured by a questionnaire. Body image distortion is defined as an exaggerated subjective body image compared to the actual body image. Multivariable-adjusted logistic regression was used to determine the odds ratios (ORs) with 95% confidence intervals (CIs) of body image distortion on smartphone dependency and usage time after adjusting for various factors related to body image distortion.Results: Among the 42,981 participants, both moderate and high levels of smartphone dependency were associated with body image distortion in boys (moderate: adjusted OR [aOR], 1.11; 95% CI, 1.01–1.22; high: aOR, 1.18; 95% CI, 1.05–1.32) and girls (moderate: aOR, 1.14; 95% CI, 1.05–1.23; high: aOR, 1.30; 95% CI, 1.18–1.42) compared to the low-level dependency group. However, no significant association was found between smartphone usage duration and body image distortion.Conclusion: Our study demonstrated that moderate to high levels of smartphone dependency are associated with body image distortion in adolescents. Therefore, it is necessary to establish strategies for checking and managing adolescents’ smartphone dependence.

Background: Since the World Health Organization’s pandemic declaration in March 2020, Korea has witnessed shifts in lifestyle behaviors, impacting habits tied to socioeconomic status and contributing to metabolic syndrome (MetS). To investigate this issue, the current study aimed to investigate changes in MetS prevalence, particularly based on income levels before and after the coronavirus disease 2019 (COVID-19) pandemic.Methods: This study used data from the 8th Korea National Health and Nutrition Examination Survey (2019–2020). A total of 6,840 individuals aged 30–65 years were included in this study. Household income was divided into high (≥75th percentile), middle (25–75th percentile), and low (≤25th percentile). A multivariable logistic regression analysis was performed to explore the interaction between this association before and after the COVID-19 pandemic.Results: A statistically significant difference was found in the prevalence of MetS before and after the COVID-19 pandemic (26.7% to 30.2%, P=0.001). These changes differed based on income levels. The increase in the prevalence of MetS was statistically significant in the low- and high-income groups but not in the middle-income group (low: 8.0%p increase [P=0.039], middle: 1.0%p increase [P=0.522], high: 6.4%p increase [P<0.001]). The interaction between household income and the COVID-19 pandemic on MetS was statistically significant (P for interaction=0.032).Conclusion: This study revealed that P for interaction between household income, MetS, and the period before and after the COVID-19 pandemic was significant. Changes in physical activity and eating habits during the COVID-19 pandemic may have contributed to these differences.

Background: This study aimed to examine the effects of different types of skipped meals on cardiometabolic risk factors (CMRF) in Korean adults.Methods: We analyzed 14,062 adults from the Korea National Health and Nutrition Examination Survey conducted between 2016 and 2018. The irregularity of breakfast, lunch, and dinner consumption was assessed using 24-hour recall data, and we categorized the habit of skipping regular meals into eight types. Multiple linear regression was used to estimate the association between each type of meal skipping and the CMRF. We also presented the estimated effects of individual types of meal skipping on the CMRF based on their predicted values and mean differences.Results: Korean adults tended to have irregular meal consumption habits when they had one or more of the following characteristics: female sex, under the age of 50 years, middle-high to high household income, high school or college or higher education levels, alcohol consumption, and current smoking. Compared to regular eaters, we have observed significantly higher total cholesterol in the following types of meal skipping: irregular breakfast (IB) (P<0.001), irregular lunch (P=0.005), irregular breakfast and lunch (IBL) (P=0.001), irregular breakfast and dinner (P=0.001); higher low-density lipoprotein-cholesterol in IB (P=0.009); higher triglyceride in IB (P=0.005) and IBL (P=0.034); and higher fasting glucose in IB (P=0.046).Conclusion: Different types of meal skipping were associated with CMRF. Regular breakfast and lunch consumption should be emphasized to prevent and manage cardiometabolic disorders. However, skipping dinner showed no significant association with CMRF.

The physiological changes and alterations in gait following amputation may increase the risk of fractures. However, there is insufficient research on fracture risk in amputees. Therefore, this study intended to analyze whether the risk of new fractures increases after traumatic amputations. This population-based, retrospective cohort study used data from the Korean National Health Insurance System database. The study included 19,586 participants who had undergone an amputation and 76,645 matched controls. The incidence of any fracture and site-specific fractures (vertebral, hip, and others) according to amputation site(s) and severity of disability due to amputation were evaluated using Cox proportional hazard regression analysis. During the mean follow-up of 4.2 years, amputees had a higher incidence rate (IR) of any fracture (adjusted HR [aHR] 1.47, 95% CI 1.36–1.60), vertebral fracture (aHR 1.63, 95% CI 1.44–1.85), hip fracture (aHR 1.85, 95% CI 1.39–2.46), and other fracture (aHR 1.34, 95% CI 1.20–1.49) compared to that of controls. In the presence of disability, the risks were further increased and were highest among amputees with severe disabilities. All fracture risks were higher in amputees than they were in controls, regardless of lower limb or upper limb amputation. This cohort study demonstrated that traumatic amputees experienced higher incidence of all fractures than did individuals without amputations, and this risk increases with severity of disability. This finding underscores the importance of early screening and lifestyle interventions to address fracture risk in traumatic amputees.

BACKGROUND: Stroke survivors face physical and cognitive challenges, leading to an increased dependency and a higher fall risk. We aimed to investigate the impact of poststroke disability and stroke type on fracture risk at various sites compared with matched controls. METHODS: This retrospective cohort study used data from the Korean National Health Insurance System database (2010–2018), including patients with stroke and 1:1 matched controls. Stroke survivors were grouped based on the presence and severity of their poststroke disability and stroke type. The primary outcome was a newly diagnosed fracture, analyzed by Cox proportional hazard regression analyses adjusting for potential confounders. RESULTS: Among 223 358 stroke survivors (mean age, 64.8±10.9 years; 61.2% men), 16 344 fractures occurred during a mean follow-up of 3.7±2.5 years. In matched controls (n=322 161; mean age, 65.4±11.2 years; 61.3% men), 20 398 fractures were identified. Stroke survivors had increased overall fracture risk compared with matched controls (adjusted hazard ratio [aHR], 1.40 [95% CI, 1.37–1.43]). Specifically, hip fracture risk was even greater in stroke survivors (incidence rate per 1000 person-years, 4.7 [95% CI, 4.5–4.8]; aHR, 2.42 [95% CI, 2.30–2.55]) than controls (incidence rate, 2.2 [95% CI, 2.1–2.3]). The risk of vertebral fractures (aHR, 1.29 [95% CI, 1.25–1.34]) and other fractures (aHR, 1.19 [95% CI, 1.15–1.23]) was also higher than that of the control group. Hip fracture risk was the highest among stroke survivors with severe poststroke disability (aHR, 4.82 [95% CI, 4.28–5.42]), although vertebral or other fracture risk was the highest among those with mild poststroke disability. No significant difference in fracture risk was found between hemorrhagic and ischemic stroke survivors when stratified by disability status. CONCLUSIONS: Our findings showed increased subsequent fracture risk among stroke survivors, particularly those with poststroke disability and for hip fracture. Bone health assessment and treatment should be emphasized as an essential part of stroke management.