Cardiovascular Prevention and Pharmacotherapy

Original Article

Weight fluctuation and incidence of end-stage renal disease in Korea: a nationwide cohort study: Koh-Eun Shin, Byoungduck Han, Gyu Bae Lee, Jihyun Yoon, Kyungdo Han, Yang-Hyun Kim; Cardiovasc Prev Pharmacother. 2025;7(2):28-37. Published online April 25, 2025; DOI: https://doi.org/10.36011/cpp.2025.7.e9

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Abstract PDF Supplementary Material: Background
The impact of weight or weight changes on kidney function remains a matter of debate. This study aimed to investigate the association between weight fluctuation and the incidence of end-stage renal disease (ESRD) using data from the Korean National Health Insurance Corporation health checkups (2009–2015).
Methods
The study included 2,310,667 participants (1,546,749 men and 763,918 women), aged ≥40 years. Weight fluctuation was assessed using the average real variability (ARV) of weight and categorized into quartiles (Q1–Q4). Hazard ratios (HRs) and 95% confidence intervals for ESRD incidence were calculated using multivariable Cox proportional hazards models.
Results
After adjustment for comorbidities, increased body mass index was associated with a decreased HR for ESRD. The highest quartile of weight variability (ARV Q4) demonstrated a higher probability and HR for ESRD compared to the lower variability quartiles (Q1–Q3). Among men, individuals with sustained weight, and those with weight gain, the ARV Q4 group showed significantly increased HRs for ESRD (HR of 1.372, 1.222, and 1.49, respectively). Furthermore, irrespective of changes in creatinine levels, all ARV Q4 groups exhibited increased HRs for ESRD (HR of 1.342, 1.472, and 1.299, respectively).
Conclusions
High weight fluctuation (ARV Q4) was associated with an increased incidence of ESRD in the general Korean population, with notable significance in men and in groups with sustained or increased weight. Clinically, individuals in the ARV Q4 category should be considered at risk for ESRD, and early interventions should be pursued for this population.

Review Articles

Sex-specific challenges in cardiovascular disease among women: gaps in recognition, diagnosis, and management: Mi-Seung Shin; Cardiovasc Prev Pharmacother. 2025;7(2):50-54. Published online April 25, 2025; DOI: https://doi.org/10.36011/cpp.2025.7.e8

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Abstract PDF: Despite being the leading cause of mortality among women, cardiovascular disease remains underrecognized and undertreated due to sex-related differences in clinical presentation, risk factors, and healthcare delivery. Women are often excluded from clinical trials, undergo fewer diagnostic evaluations, and are less likely to receive guideline-directed therapies. Additionally, female-specific risk factors, such as pregnancy-related disorders, early menopause, and autoimmune diseases, are frequently overlooked. Addressing these disparities through sex-specific risk assessment, increased clinician awareness, and inclusion of women in research is imperative to optimize prevention and treatment strategies and reduce cardiovascular disease-related morbidity and mortality in women.

The connection between diabetes mellitus and stroke: a brief review: Junghyun Noh; Cardiovasc Prev Pharmacother. 2025;7(2):55-60. Published online April 25, 2025; DOI: https://doi.org/10.36011/cpp.2025.7.e7

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Abstract PDF: Stroke is one of the major macrovascular complications of diabetes and increases morbidity and mortality. Hyperglycemia contributes to a heightened risk of stroke incidence. Moreover, people with diabetes may have poorer post-stroke outcomes and higher risk of stroke recurrence than those without diabetes. Recent cardiovascular outcome trials of some antidiabetic medications have shown beneficial effects on stroke prevention. Prevention and improving outcomes of stroke in patients with diabetes requires proper management of hyperglycemia and additional risk factors. This review is an evidence-based approach to epidemiology of stroke in diabetes, the role of glycemic control, and antidiabetic medications in stroke prevention in patients with diabetes mellitus.

Clinical and preclinical obesity: cardiovascular implications of a new diagnostic paradigm: Ga Eun Nam; Cardiovasc Prev Pharmacother. 2025;7(2):21-27. Published online April 25, 2025; DOI: https://doi.org/10.36011/cpp.2025.7.e6

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Abstract PDF: The traditional definition of obesity, relying solely on body mass index, inadequately captures individual health status and is insufficient for guiding therapeutic interventions. In January 2025, The Lancet Diabetes & Endocrinology Commission proposed a paradigm-shifting redefinition that introduces the concepts of “clinical obesity” and “preclinical obesity.” Clinical obesity is defined as a chronic, systemic illness characterized by excess adiposity resulting in functional impairments in tissues, organs, or overall individual health. In contrast, preclinical obesity involves excess adiposity without current functional impairment. This review examines the significance of this new diagnostic paradigm for cardiovascular disease prevention and risk assessment. From a cardiovascular perspective, the new framework offers several advantages: it facilitates personalized intervention strategies based on individual risk profiles, refines cardiovascular risk assessments by incorporating body fat distribution and functional parameters, promotes more efficient resource allocation, and shifts treatment goals toward functional improvements beyond mere weight loss. Although further research is required to evaluate practical implementation and long-term outcomes, this novel approach represents a substantial advancement in obesity management and cardiovascular disease prevention.

Ultra-low-dose direct oral anticoagulants in vulnerable patients with atrial fibrillation or coronary artery disease: Dae young Cheon, Jae Hyuk Choi; Cardiovasc Prev Pharmacother. 2025;7(2):38-43. Published online April 25, 2025; DOI: https://doi.org/10.36011/cpp.2025.7.e5

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Abstract PDF: Direct oral anticoagulants (DOACs) have largely supplanted warfarin for stroke prevention in atrial fibrillation due to their superior safety and efficacy profiles. Although standard dosing regimens are well-established, lower doses—often referred to as ultra-low-dose (ULD) DOACs—have been investigated in selected populations to balance thrombotic and bleeding risks. The concept of ULD DOACs was first introduced in the 2013 European Heart Rhythm Association Practical Guide specifically for post‐acute coronary syndrome patients with residual thrombotic risk. Clinical trials, including ATLAS ACS-TIMI 51 and COMPASS, demonstrated that rivaroxaban 2.5 mg twice a day reduced ischemic events when combined with aspirin, although this benefit was accompanied by an increased risk of major bleeding. Similarly, the ELDERCARE-AF trial revealed that edoxaban 15 mg once a day effectively prevented stroke in frail older patients. Conversely, evidence supporting ULDs of dabigatran and apixaban remains limited. Despite their potential benefits, inappropriate dose reductions based on subjective physician judgment rather than rigorous clinical guidelines may result in suboptimal anticoagulation and a heightened risk of thromboembolic events. This review explores the indications, supporting evidence, and potential risks associated with ULD DOACs, underscoring the need for well-designed studies to establish clear guidelines.

Clinical impact and practical use of sodium-glucose cotransporter 2 inhibitors for patients with chronic kidney disease: Jang-Whan Bae; Cardiovasc Prev Pharmacother. 2025;7(2):44-49. Published online April 25, 2025; DOI: https://doi.org/10.36011/cpp.2025.7.e4

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Abstract PDF: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have transformed the treatment of both cardiovascular and renal diseases. Although originally developed for glycemic control in type 2 diabetes mellitus, these agents have demonstrated significant benefits by reducing cardiovascular events and slowing the progression of kidney disease, even in patients without diabetes. Landmark trials, including EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58, and DAPA-HF, consistently demonstrated reductions in heart failure hospitalizations and renal deterioration among patients at high cardiovascular risk. However, many of these studies excluded patients with advanced chronic kidney disease (CKD), limiting the generalizability of their findings for this population. More recent investigations, such as CREDENCE, DAPA-CKD, and EMPA-KIDNEY, have focused on patients with CKD and confirmed that SGLT2 inhibitors offer significant renal and cardiovascular protection regardless of diabetic status. This review summarizes key clinical trials, outlining their design and outcomes with a particular emphasis on inclusion and exclusion criteria and the implications for CKD populations. Further, it discusses the practical application and safety considerations of SGLT2 inhibitors in nephrology, underscoring their emerging role as a fundamental therapeutic strategy in CKD management.

The prognostic role of lipoprotein(a) in cardiovascular disease: Eun-Jung Rhee; Cardiovasc Prev Pharmacother. 2025;7(1):9-12. Published online January 22, 2025; DOI: https://doi.org/10.36011/cpp.2025.7.e3

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Abstract PDF: Lipoprotein(a) (Lp(a)), is not a new entity; however, it has become an increasingly discussed and studied risk factor for atherosclerotic cardiovascular disease (CVD) and aortic valve stenosis. Recent guidelines recommend measuring Lp(a) levels throughout the lifetime in patients at high risk for CVD, as Lp(a) can serve as a signature marker for identifying individuals at elevated risk for CVD. Numerous genetic and epidemiological studies have underscored the significant causal role of Lp(a) in the incidence of CVD. Individuals with high Lp(a) levels face an increased risk for CVD, even with optimal low-density lipoprotein cholesterol lowering. Furthermore, Lp(a) levels are primarily determined by genetics and are not significantly reduced by lifestyle changes or certain medications. This review will discuss the characteristics, genetic factors, and epidemiological properties of Lp(a) in relation to CVD.

Nonalcoholic fatty liver disease and heart failure with preserved ejection fraction: a focus on risk factors and management: Joonpyo Lee, Mi-Seung Shin; Cardiovasc Prev Pharmacother. 2025;7(1):1-8. Published online January 21, 2025; DOI: https://doi.org/10.36011/cpp.2025.7.e2

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Abstract PDF: Nonalcoholic fatty liver disease (NAFLD) and heart failure with preserved ejection fraction (HFpEF) are two increasingly prevalent conditions that share common risk factors, including obesity, diabetes, and aging. NAFLD, marked by hepatic steatosis, is a leading cause of liver disease globally, with cardiovascular disease accounting for most deaths among those affected. HFpEF, characterized by diastolic dysfunction and systemic inflammation, accounts for a growing share of heart failure cases, especially among older adults. The bidirectional relationship between NAFLD and HFpEF involves shared mechanisms such as systemic inflammation, insulin resistance, and metabolic dysfunction. These overlapping processes create a vicious cycle that exacerbates each condition. This review emphasizes the shared pathophysiology, risk factors, and management strategies for these interconnected diseases. Promising interventions, including exercise, weight loss, and emerging pharmacological treatments like sodium-glucose cotransporter 2 inhibitors, are effective in addressing both NAFLD and HFpEF. By targeting these common pathways, there is a unique opportunity to develop integrated treatment approaches that could improve outcomes for affected patients.

Pharmacological management of diabetes in older adults: Junghyun Noh; Cardiovasc Prev Pharmacother. 2025;7(1):13-20. Published online January 20, 2025; DOI: https://doi.org/10.36011/cpp.2025.7.e1

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Abstract PDF: As the global population continues to age, the rising prevalence of diabetes among older adults has become a significant public health concern. Consequently, effective and safe management of diabetes mellitus in this population is an increasingly critical focus in clinical practice. Older patients present considerable variability in functional status, with many experiencing physical disabilities, visual impairments, cognitive decline, or psychological conditions such as depression. Therefore, individualized treatment strategies that consider the presence and progression of geriatric syndromes, comorbidities, and the risk of hypoglycemia are essential for optimizing the pharmacological management of diabetes in older adults.

Relationship between autonomic and peripheral neuropathies and cardiovascular outcomes in diabetes: Jae-Seung Yun; Cardiovasc Prev Pharmacother. 2024;6(4):123-127. Published online October 31, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e17

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Abstract PDF: This review explores the complex relationship between diabetic neuropathy and cardiovascular disease (CVD). Neuropathy, a common complication of type 1 and type 2 diabetes, is divided into autonomic and peripheral types, each impacting cardiovascular health. Cardiovascular autonomic neuropathy, a form of autonomic neuropathy, is associated with various CVD complications, including arrhythmias, impaired nocturnal blood pressure regulation, and increased mortality. The prevalence of cardiovascular autonomic neuropathy varies depending on the type and duration of diabetes and is influenced by factors like glycemic control and metabolic stress. Peripheral polyneuropathy, which is often linked to diabetic foot disease, is also correlated with elevated CVD risk; research suggests shared pathophysiological mechanisms between peripheral neuropathy and cardiovascular conditions. Screening for neuropathies using tools like the Michigan Neuropathy Screening Instrument and heart rate variability analyses can facilitate early detection of CVD risk. Additionally, emerging technologies, like deep learning models, have demonstrated promise in detecting early cardiovascular patterns associated with autonomic neuropathy through electrocardiogram analysis. These findings underscore the value of integrating novel diagnostic approaches for early intervention. As CVD represents a leading cause of death among patients with diabetes, this article emphasizes the need for thorough assessment and proactive management of neuropathy to mitigate cardiovascular risk. The review recommends a multidisciplinary approach to diabetes care, including early screening, accurate risk stratification, and targeted therapeutic strategies to prevent or slow the progression of CVD in patients with autonomic and peripheral neuropathies. Further research is warranted to clarify the optimal intervention strategies for reducing CVD risk in these populations.

Sodium-glucose cotransporter 2 inhibitors in cardiocerebrovascular disease: Jin Joo Park; Cardiovasc Prev Pharmacother. 2024;6(4):103-108. Published online October 31, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e16

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Abstract PDF: Cardiovascular disease is a leading cause of global mortality, necessitating effective strategies for prevention and treatment. The cardiovascular disease continuum concept highlights the progression from risk factors such as hypertension and diabetes mellitus to advanced stages, including heart failure (HF) and death. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed to manage diabetes, have emerged as effective therapies across all stages of the cardiovascular disease continuum. Numerous cardiovascular outcome trials demonstrate that SGLT2 inhibitors significantly reduce major adverse cardiovascular events and hospitalizations for HF in patients with and without established atherosclerotic cardiovascular disease. Notably, SGLT2 inhibitors have shown remarkable benefits in reducing HF risk, even in patients without diabetes, including those with HF and preserved ejection fraction. Furthermore, recent studies in post–myocardial infarction patients suggest potential benefits in reducing hospitalizations for HF. Despite their widespread use, the precise mechanisms by which SGLT2 inhibitors confer cardiovascular protection remain unclear, suggesting the need for further investigation. In conclusion, SGLT2 inhibitors have revolutionized cardiovascular disease management, offering significant therapeutic potential across a broad spectrum of patients, and are expected to play an increasingly prominent role in both the prevention and treatment of cardiovascular disease.

Paradigm shift from glucocentric to organ protection for the management of hyperglycemia in patients with type 2 diabetes: Jie-Eun Lee, Jong Chul Won; Cardiovasc Prev Pharmacother. 2024;6(4):116-122. Published online October 31, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e15

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Abstract PDF: The UK Prospective Diabetes Study was the first study to investigate the effectiveness of glycemic control in patients with type 2 diabetes. Since then, many studies have evaluated the impact of intensive glycemic control on diabetes-related morbidities and mortality. The results of these studies were intended to change the paradigm for controlling glycated hemoglobin and preventing diabetes-related complications, but the beneficial outcomes were limited to microvascular diseases rather than diabetes-related cardiorenal diseases and deaths. This has emphasized the need for comprehensive management of other risk factors (hypertension, dyslipidemia, renal failure, etc.) in addition to hyperglycemia to prevent atherosclerotic cardiovascular diseases and end-stage renal disease in type 2 diabetes. Since 2008, clinical trials to demonstrate cardiovascular safety have shown a beneficial effect of sodium-glucose transporter 2 inhibitors or glucagon-like peptide-1 receptor agonists on macrovascular or renal complications in patients with type 2 diabetes. Recently, major societies around the world including the Korean Diabetes Association, have shifted the goals of diabetes management from the typical glucocentric view to cardiorenal outcome-oriented (organ protection) care, which has been widely accepted and is gradually applied to primary care.

Moyamoya disease: insights into the clinical implications of the RNF213 gene: Taedong Ok; Cardiovasc Prev Pharmacother. 2024;6(4):109-115. Published online October 31, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e14

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Abstract PDF: Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of the terminal internal carotid arteries and the formation of compensatory collateral vessels, which appear as a “puff of smoke” on cerebral angiography. It is a significant cause of stroke in East Asia, with an incidence of 0.5 to 1.5 cases per 100,000 people annually. The etiology of MMD remains unclear; however, the identification of the RNF213 gene, particularly the R4810K variant, as a major susceptibility factor among the East Asian population, has provided crucial insights into the disease's pathophysiology and clinical manifestations. MMD typically presents with transient ischemic attacks, ischemic and hemorrhagic strokes, seizures, headaches, and cognitive deficits. Diagnostic criteria have evolved to emphasize advanced imaging techniques. Pathological features include fibrocellular intimal thickening, irregular undulation of the elastic lamina, and the formation of moyamoya vessels. The mutation in the RNF213 gene impairs the degradation of proteins involved in vessel development, leading to abnormal angiogenesis. Genotype-phenotype studies indicate that the RNF213 variant is associated with an earlier onset, transient ischemic attacks, infarctions, and involvement of the posterior cerebral artery, although its effects vary between regions. Additionally, the homozygous RNF213 variant consistently correlates with an earlier age of onset and a higher risk of cerebral infarction. However, further research is necessary to fully understand its long-term impacts and its relationship with revascularization outcomes. Ongoing research is crucial to fully comprehend the pathophysiology and genetics of MMD, improve prognostic predictions, and develop novel therapies.

Use of dual-energy x-ray absorptiometry for body composition in chronic disease management: Tae Nyun Kim; Cardiovasc Prev Pharmacother. 2024;6(4):128-134. Published online October 31, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e13

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1 Citations

Abstract PDF

As individuals age or contend with chronic diseases, shifts in body composition often emerge, characterized by a loss of muscle mass and an increase in fat mass, even among those with stable body weight. Both obesity and sarcopenia are key drivers of frailty, disability, and heightened morbidity and mortality. The simultaneous decline in skeletal muscle and accumulation of visceral fat can work synergistically, magnifying their detrimental effects on physical function and metabolic health. Today, dual-energy x-ray absorptiometry (DEXA) is widely recognized as one of the most versatile imaging techniques for assessing not only osteoporosis but also sarcopenia and obesity. Whole-body DEXA facilitates comprehensive analysis, offering detailed insights into fat mass, non-bone lean mass, and bone mineral content at both total and regional levels. DEXA is highly valued for its accuracy, reproducibility, speed, affordability, and low radiation exposure. Furthermore, advancements in DEXA technology and software now allow for precise estimation of visceral adipose tissue. This review underscores the clinical applications of whole-body DEXA, focusing on the use of muscle and fat mass indices in diagnosing low muscle mass, sarcopenia, and sarcopenic obesity, aligned with the latest research and guidelines.

Citations

Citations to this article as recorded by

Developing a reliable and convenient methodology for ultrasound muscle assessment in critically ill patients: A reliability study
Yong Jae Na, Shin Who Park, Woo Jung Seo, Kyung Cheon Seo, Jong Yoon Chang, Hyo Jin Lim, Hyeon Jeong Moon, Roo Ma Lee, Eun Jae Ko, Sang-Bum Hong, Won Kim
Medicine.2025; 104(17): e42263. CrossRef

Original Article

Health behaviors, knowledge, and attitudes toward cardiovascular disease risk factors in young Iraqi adults: a sample from Erbil, Iraq: Halmat Ahmed Sulaiman, Isil Isik Andsoy; Cardiovasc Prev Pharmacother. 2024;6(3):92-101. Published online July 30, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e12

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Abstract PDF: Background
Cardiovascular disease continues to be a leading cause of death among young people globally. This cross-sectional study was designed to assess the health behaviors, knowledge, and attitudes regarding cardiovascular disease risk factors among young adults in Erbil, Iraq.
Methods
Data were collected using the WHO STEPS Instrument for Chronic Disease Risk Factor Surveillance and the Heart Disease Fact Questions.
Results
Ninety percent of participants demonstrated moderate to high knowledge and exhibited a positive attitude. Multiple linear regression analysis revealed that while a history of smoking, a lack of knowledge, and the absence of formal education negatively impacted knowledge levels, being aged 38 to 45 years, recognizing the importance of consuming less salt, walking for at least 10 minutes on 5 or more days per week, and regularly checking blood sugar levels positively contributed to knowledge. Unwillingness to change lifestyle had the most significant negative influence on knowledge.
Conclusions
Establishing effective educational interventions may increase knowledge and promote more positive attitudes.

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