Lee GN, et al. Allergy Asthma Immunol Res. 2022 Mar;14(2):273-283. https://doi.org/10.4168/aair.2022.14.2.273

Choi SS, et al. Korean Circ J. 2025 Apr;55:e74. https://doi.org/10.4070/kcj.2024.0411

Background: Heart failure (HF) is one of the most common initial manifestations of cardiovascular disease in patients with type 2 diabetes. Although smoking is an independent risk factor for HF, there is a lack of data for the incidence of HF according to changes in smoking behaviors in patients with type 2 diabetes. Objective: We aimed to examine the association between interval changes in smoking behavior and the risk of HF among patients with type 2 diabetes. Methods: We conducted a retrospective cohort study using the National Health Insurance Service database. We identified 365,352 current smokers with type 2 diabetes who had 2 consecutive health screenings (2009-2012) and followed them until December 31, 2018, for the incident HF. Based on smoking behavior changes between 2 consecutive health screenings, participants were categorized into quitter, reducer I (≥50% reduction) and II (<50% reduction), sustainer (reference group), and increaser groups. Results: During a median follow-up of 5.1 (IQR 4.0-6.1) years, there were 13,879 HF cases (7.8 per 1000 person-years). Compared to sustainers, smoking cessation was associated with lower risks of HF (adjusted hazard ratio [aHR] 0.90, 95% CI0.86-0.95), whereas increasers showed higher risks of HF than sustainers; heavy smokers who increased their level of smoking had a higher risk of HF (aHR 1.13, 95% CI 1.04-1.24). In the case of reducers, the risk of HF was not reduced but rather increased slightly (reducer I: aHR 1.14, 95% CI 1.08-1.21; reducer II: aHR 1.03, 95% CI 0.98-1.09). Consistent results were noted for subgroup analyses including type 2 diabetes severity, age, and sex. Conclusions: Smoking cessation was associated with a lower risk of HF among patients with type 2 diabetes, while increasing smoking amount was associated with a higher risk for HF than in those sustaining their smoking amount. There was no benefit from reduction in smoking amount.

Purpose: Although insulin resistance (IR) varies with age and puberty in children and adolescents, most previous attempts to determine cutoff values for IR indices overlook factor. This study assesses age-related differences in IR index values and evaluates how diagnostic performance varies by age when using a uniform cutoff for diagnosing metabolic syndrome (MetS) without considering age.Methods: We analyzed age-related differences in IR indices (the homeostatic model assessment of insulin resistance [HOMA-IR], triglyceride-glucose [TyG] index, and triglyceride/high-density lipoprotein cholesterol [TG/HDL-C] ratio) among 1,641 participants in the 2019–2021 Korea National Health and Nutrition Examination Survey. We also examined IR index values for diagnosing MetS in 1,574 participants.Results: IR indices showed significant age-related variations in group-comparison tests, with a peak at ages 12–13 years in males and 11–13 years in females (P<0.001 for the HOMA-IR, P<0.005 for the TG/HDL-C ratio in both males and females, and P=0.003 for the TyG index in females). Applying a uniform cutoff derived from receiver operating characteristic curve analysis for diagnosing MetS showed substantial age-related variation in diagnostic accuracy, with standard deviation-to-mean ratios of age-specific accuracy of >10% for the HOMA-IR and >5% for the TyG index, while showing minor variation (<5%) for the TG/HDL-C ratio. Using age-specific percentiles for the HOMA-IR (80th of the general population) and TyG index (80th of those without MetS) reduced these variations to <5% while maintaining similar diagnostic performance.Conclusion: This study highlights the importance of age-related variation in IR in children and adolescents.

Background: Obstructive sleep apnea (OSA) is a sleep disorder associated with an increased risk of cardiovascular and metabolic complications. Albuminuria, an early marker of kidney damage, is a proposed risk factor for OSA and its adverse outcomes. The study explored the association between OSA and albuminuria in Korean adults. Methods: We screened participants from the cross-sectional Korean National Health and Nutrition Examination Survey (2019– 2021). The study included participants aged 40 years and older who completed the STOP-BANG questionnaire, a tool used to assess the OSA risk. Albuminuria was defined as a urine albumin-to-creatinine ratio ≥30 mg/g Cr. The participants were categorized based on albuminuria presence and severity. A multivariate logistic regression analysis examined the association between albuminuria and OSA. Results: This study included 10,923 participants. Participants with albuminuria had significantly higher STOP-BANG scores than those without. Moreover, albuminuria remained strongly associated with an increased risk of OSA (odds ratio, 2.01; 95% confidence interval, 1.66–2.43), after multivariate adjustment. This association was more pronounced as albuminuria severity increased. Participants with high STOP-BANG scores were more likely to have albuminuria (odds ratio, 2.51; 95% confidence interval, 1.89–3.31), highlighting the bidirectional relationship between albuminuria and OSA. Conclusion: The present study demonstrated a significant association between albuminuria and an elevated risk of OSA. These findings underscore the importance of early screening for OSA in patients with albuminuria, particularly in those with additional metabolic risk factors, to improve their long-term outcomes.

Kim JH, et al. J Lipid Atheroscler. 2025 May;14(2):190-199. https://doi.org/10.12997/jla.2025.14.2.190