Cardiovascular Prevention and Pharmacotherapy

Review Articles

Physical activity for prevention of cardiovascular disease: a consensus statement of the Korean Society of Cardio-cerebrovascular Disease Prevention: Ye Seul Yang, Eu Jeong Ku, Seung-Hyun Ko, Eun-Jung Rhee, Sang-Hyun Ihm, Sung Hee Choi, Won-Young Lee; Cardiovasc Prev Pharmacother. 2025;7(4):120-134. Published online September 15, 2025; DOI: https://doi.org/10.36011/cpp.2025.7.e15

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Abstract PDF: Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, highlighting the need for effective preventive strategies. This consensus statement emphasizes the critical role of regular physical activity, including aerobic and muscle- strengthening exercises, in reducing key CVD risk factors such as hypertension, dyslipidemia, obesity, and insulin resistance. Recommendations are provided for the general adult population as well as specific subgroups, including older adults, pregnant and postpartum women, individuals with CVD, and those with physical limitations. The importance of reducing sedentary behavior and integrating physical activity into daily life is also addressed. Recommendations should focus on tailored interventions, supportive environments, and evidence-based policies that encourage active lifestyles. Further research specific to the Korean population will enhance the development of evidence-based, population-tailored guidelines for more effective CVD prevention in Korea.

Stroke mechanisms and prevention in intracranial atherosclerosis: Sang Hee Ha, Bum Joon Kim; Cardiovasc Prev Pharmacother. 2025;7(3):94-101. Published online July 22, 2025; DOI: https://doi.org/10.36011/cpp.2025.7.e10

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Abstract PDF: Intracranial atherosclerosis (ICAS) is a leading cause of ischemic stroke worldwide, with a particularly high prevalence among Asian populations. While early research primarily attributed this to systemic risk factors such as metabolic syndrome, more recent studies highlighted the importance of local factors, including vascular geometry and hemodynamic stress. The pathophysiology of ICAS-related stroke is multifactorial and encompasses in situ thrombotic occlusion, artery-to-artery embolism, hemodynamic compromise, and perforator branch occlusion. A thorough understanding of these mechanisms is essential for precise risk stratification and the development of targeted preventive strategies. Despite advancements in imaging techniques and pharmacological therapies, ICAS continues to present significant clinical challenges. This review synthesizes current knowledge on stroke mechanisms associated with ICAS and discusses emerging evidence for both primary and secondary prevention, including antithrombotic strategies, risk factor modification, and novel imaging approaches such as high-resolution vessel wall magnetic resonance imaging.

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.

The emergence and clinical significance of artificial intelligence–enhanced electrocardiography: Yong-Soo Baek; Cardiovasc Prev Pharmacother. 2024;6(2):41-47. Published online April 26, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e7

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The integration of artificial intelligence (AI) with electrocardiography (ECG), a technology known as AI-ECG, represents a transformative leap in the field of cardiovascular medicine. This innovative approach has significantly advanced the capabilities of ECG, traditionally used for diagnosing heart diseases. AI-ECG excels in detecting subtle changes and interconnected patterns in cardiac waveforms, offering a level of precision and sensitivity that was previously unattainable with conventional methods. The scope of AI-ECG extends beyond the realm of heart diseases. It has shown remarkable potential in predicting and identifying the impacts of noncardiac conditions on heart health, thereby broadening the diagnostic capabilities of ECG. This is especially valuable given the complex nature of cardiovascular diseases and their interactions with other health conditions. Despite its groundbreaking potential, AI-ECG faces several challenges. One of the primary concerns is the "black box" nature of AI algorithms, which can make the decision-making process opaque and difficult to interpret. This poses a challenge in medical settings where understanding the rationale behind a diagnosis is crucial. Additionally, the effectiveness of AI-ECG is dependent on the quality and diversity of the datasets used to train the algorithms. Limited or biased datasets can lead to inaccuracies and diminish the reliability of the technology. However, the benefits of AI-ECG are significant. It enables faster, more accurate diagnoses and has the potential to greatly enhance the efficiency of cardiovascular care. As research and technology continue to evolve, AI-ECG is poised to become an indispensable tool in the diagnosis and management of heart diseases.

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AI-Enhanced ECG Applications in Cardiology: Comprehensive Insights from the Current Literature with a Focus on COVID-19 and Multiple Cardiovascular Conditions
Luiza Camelia Nechita, Aurel Nechita, Andreea Elena Voipan, Daniel Voipan, Mihaela Debita, Ana Fulga, Iuliu Fulga, Carmina Liana Musat
Diagnostics.2024; 14(17): 1839. CrossRef

Original Articles

Changes in cardiovascular-related health behaviors after the end of social distancing: the 2023 Cardiovascular Disease Prevention Awareness Survey: Jaeyong Lee, Eunji Kim, Won-Young Lee, Eun-Jung Rhee, Hyeon Chang Kim; Cardiovasc Prev Pharmacother. 2024;6(2):57-64. Published online April 5, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e6

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Abstract PDF Supplementary Material: Background
The COVID-19 pandemic and the implementation of social distancing have been reported to negatively impact cardiovascular-related health behaviors. However, the effects of lifting social distancing restrictions on these health behaviors remain unclear. This study investigated public awareness and behavioral changes related to cardiovascular disease prevention after the end of social distancing.
Methods
Between June 5 and June 12, 2023, 2,000 adults participated in the 2023 Cardiovascular Disease Prevention Awareness Survey in Korea. The survey comprehensively addressed sociodemographic factors, cardiometabolic disease history, cardiovascular disease concern, prevention awareness, and behavioral changes after the end of social distancing. Logistic regression analyses were performed to assess the associations between behavioral changes and sociodemographic factors.
Results
Cardiovascular disease ranked as the second most feared disease (most feared, 18.0%; second most feared, 26.3%) after cancer (most feared, 42.3%; second most feared, 21.7%). Among nine cardiovascular disease prevention recommendations, stress management, being physically active, and maintaining a healthy diet were perceived as the most challenging recommendations. After the end of social distancing, there were more positive changes than negative changes in smoking, alcohol consumption, dietary habits, physical activity, and healthcare service use, whereas stress management more frequently changed negatively (40.0%) than it changed positively (19.5%).
Conclusions
Positive changes in cardiovascular-related health behaviors, except for stress management, were observed after the end of social distancing. Further research is necessary to fully comprehend the impact of discontinuing social distancing practices.

Changes in cardiovascular-related health behaviors during the COVID-19 pandemic: Eunji Kim, Chan-Hee Jung, Dae Jung Kim, Seung-Hyun Ko, Hae-Young Lee, Kyung-Yul Lee, Dae Ryong Kang, Sung Kee Ryu, Won-Young Lee, Eun-Jung Rhee, Hyeon Chang Kim; Cardiovasc Prev Pharmacother. 2023;5(1):15-23. Published online January 27, 2023; DOI: https://doi.org/10.36011/cpp.2023.5.e2

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Abstract PDF Supplementary Material

Background
The COVID-19 pandemic has been the most pressing health challenge in recent years. Meanwhile, prevention for other diseases, such as cardiovascular disease (CVD) has been less prioritized during the pandemic. COVID-19, a novel infectious disease, both had a direct impact on public health and provoked changes in health-related behaviors, including those for CVD prevention. This study sought to examine changes in CVD-related health behaviors during the COVID-19 pandemic and related sociodemographic factors.
Methods
We used data from the Cardiovascular Disease Prevention Awareness Survey conducted in Korea in June 2022. A total of 2,000 adults across Korea’s 17 provinces completed a structured questionnaire online or on a mobile device. Self-reported changes in CVD-related health behaviors were investigated. We used unadjusted and adjusted logistic regression models to explore the associations between negative changes and sociodemographic factors.
Results
In smoking, drinking, and healthcare service use, the proportion of those with positive changes surpassed the proportion of respondents who reported negative changes. In contrast, negative changes predominated for diet, exercise, and stress. Most individuals (52.6%) reported a deterioration of psychological distress. These negative changes were significantly associated with age, sex, marital status, and the presence of cardiometabolic disease.
Conclusions
The COVID-19 pandemic has affected CVD-related health behaviors. Based on these changes, CVD prevention should be encouraged with appropriate and prioritized strategies.

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Changes in cardiovascular-related health behaviors after the end of social distancing: the 2023 Cardiovascular Disease Prevention Awareness Survey
Jaeyong Lee, Eunji Kim, Won-Young Lee, Eun-Jung Rhee, Hyeon Chang Kim
Cardiovascular Prevention and Pharmacotherapy.2024; 6(2): 57. CrossRef
Cardiovascular-related health behavior changes: lessons from the COVID-19 pandemic and post-pandemic challenges
Inha Jung, Won-Young Lee
Cardiovascular Prevention and Pharmacotherapy.2023; 5(4): 99. CrossRef

Public awareness of cardiovascular disease prevention in Korea: Eunji Kim, Chan-Hee Jung, Eun-Jung Rhee, Junghyun Noh, Jae Hyuk Lee, Hun-Jun Park, Sungha Park, Sang-Hyun Ihm, Won-Young Lee, Hyeon Chang Kim; Cardiovasc Prev Pharmacother. 2022;4(4):149-157. Published online October 26, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e20

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Abstract PDF Supplementary Material

Background
The burden of cardiovascular disease (CVD) is significant in Korea. Ultimately, public knowledge and awareness of CVD risk factors and prevention are essential to reduce its burden. Hence, this study aimed to examine the level of public awareness of CVD risk factors and prevention in Korea in 2022.
Methods
We used data from the Cardiovascular Disease Prevention Awareness Survey conducted by the Korean Society of Cardiovascular Disease Prevention in June 2022. Using a structured web-based questionnaire, 2,000 individuals aged 20 years or more were surveyed on computers or mobile devices. Information on sociodemographic characteristics, the presence of cardiometabolic disease, CVD concerns and self-assessed likelihood, and awareness of CVD prevention were analyzed.
Results
Cancer (44.3%) was the most feared disease, followed by CVD (19.5%). Nevertheless, most respondents stated that they were likely to develop CVD in their lifetime (67.4%). Only 9.2% of respondents were aware of the details of recommendations to prevent CVD, and this level of knowledge was also low among respondents with cardiometabolic diseases (10.7%). Not smoking, being physically active, eating a healthy diet, and reducing alcohol consumption were deemed easy to implement. On the contrary, reducing stress, being physically active, and eating a healthy diet were considered the most difficult recommendations to practice.
Conclusions
Public awareness of CVD risk factors and prevention appeared to be insufficient in Korea. Our research suggests that simple but practical recommendations should be conveyed and promoted to raise public awareness, which is currently inadequate.

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Guidelines for Holter and Wearable Electrocardiogram Monitoring in Arrhythmia Diagnosis and the Role of Medical Technologists
Do-Hee KIM, Ji-Yeon CHANG
Korean Journal of Clinical Laboratory Science.2025; 57(2): 215. CrossRef

Effects of physical activity on cardiovascular outcomes and mortality in Korean patients with diabetes: a nationwide population-based cohort study: Inha Jung, Sun Joon Moon, Hyemi Kwon, Se Eun Park, Kyung-Do Han, Eun-Jung Rhee, Won-Young Lee; Cardiovasc Prev Pharmacother. 2022;4(1):42-55. Published online January 20, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e3

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Abstract PDF Supplementary Material

Background
Since a sedentary lifestyle is considered a modifiable risk factor for cardiovascular disease (CVD), physical activity (PA) is recommended for type 2 diabetes mellitus (T2DM) patients to prevent CVD. We investigated the association between different levels of PA and the risk for CVD and all-cause mortality in patients with T2DM using nationwide data.
Methods
We examined health examination data and claims records of 2,745,637 participants with T2DM at baseline from the Korean National Health Insurance Service who underwent health examinations between 2009 and 2012. We excluded subjects with a history of myocardial infarction or stroke. Each participant was asked to report their weekly PA levels according to three categories: vigorous, moderate, and walking. The incidence of CVD and death was analyzed until 2017.
Results
The risk of CVD was lower in regular exercisers than in nonexercisers after adjusting for confounding variables. A dose-response trend was evident in the association between the degree of PA and CVD risk. All categories of PA were inversely associated with CVD risk and mortality. The reduction in CVD risk and all-cause mortality was more profound in patients aged ≥65 years.
Conclusions
Augmenting PA might have positive effects on the prevention of CVD and all-cause death, especially in the elderly. The benefits of PA were consistently observed in various subgroups regardless of the presence of chronic conditions. Therefore, clinicians should encourage elderly patients with T2DM to increase their daily PA.

Citations

Citations to this article as recorded by

The role of family health climate in physical activity and sedentary behaviour in primary care patients with diabetes – a cross-sectional study
Amelia Ahmad Hatib, Hui Li Koh, Sai Zhen Sim
BMC Primary Care.2025;[Epub] CrossRef
Adherence to physical activity guidelines and all-cause and cardiovascular disease mortality in individuals with and without type 2 diabetes
Soomin Lee, Younghwan Choi, Yeon Soo Kim
Journal of Diabetes & Metabolic Disorders.2025;[Epub] CrossRef
Physical activity for prevention of cardiovascular disease: consensus statement of Korean Society of Cardio-cerebrovascular Disease Prevention
Ye Seul Yang, Eu Jeong Ku, Seung-Hyun Ko, Eun-Jung Rhee, Sang-Hyun Ihm, Sung Hee Choi, Won-Young Lee
The Korean Journal of Internal Medicine.2025; 40(5): 696. CrossRef
Physical activity for prevention of cardiovascular disease: a consensus statement of the Korean Society of Cardio-cerebrovascular Disease Prevention
Ye Seul Yang, Eu Jeong Ku, Seung-Hyun Ko, Eun-Jung Rhee, Sang-Hyun Ihm, Sung Hee Choi, Won-Young Lee
Cardiovascular Prevention and Pharmacotherapy.2025; 7(4): 120. CrossRef
Incentivised physical activity intervention promoting daily steps among university employees in the workplace through a team-based competition
Ayazullah Safi, Sanjoy Deb, Adam Kelly, Matthew Cole, Natalie Walker, Mohammed Gulrez Zariwala
Frontiers in Public Health.2024;[Epub] CrossRef
Effect of physical activity on incident atrial fibrillation in individuals with varying duration of diabetes: a nationwide population study
JungMin Choi, So‑Ryoung Lee, Eue-Keun Choi, Kyung-Yeon Lee, Hyo-Jeong Ahn, Soonil Kwon, Kyung‑Do Han, Seil Oh, Gregory Y. H. Lip
Cardiovascular Diabetology.2024;[Epub] CrossRef

Review Article

Antiplatelet Therapy for Secondary Stroke Prevention in Patients with Ischemic Stroke or Transient Ischemic Attack: Kyung-Yul Lee; Cardiovasc Prev Pharmacother. 2021;3(4):86-94. Published online October 31, 2021; DOI: https://doi.org/10.36011/cpp.2021.3.e10

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Abstract PDF: The risk of stroke recurrence is highest in the acute phase after transient ischemic attack (TIA) or ischemic stroke. Therefore, patients with TIA or ischemic stroke should be treated with antiplatelet medication for stroke prevention. The short-term use of dual antiplatelet therapy between 21 and 90 days may be considered in those with acute minor stroke or TIA and highrisk of recurrence. However, the long-term use of dual antiplatelet therapy is not recommended due to the risk of bleeding. The current stroke guideline does not specify the administration of an antiplatelet for the secondary prevention of ischemic stroke. However, as clinical studies progress, antiplatelet therapy may become a personalized treatment in the future.

Special Article

Shifting from Pharmacotherapy to Prevention of Hypertension: Bernard Man Yung Cheung, Man-Fung Tsoi; Cardiovasc Prev Pharmacother. 2020;2(2):33-42. Published online April 30, 2021; DOI: https://doi.org/10.36011/cpp.2020.2.e8

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Hypertension is a common chronic disease affecting a large section of the general population. As hypertension is usually asymptomatic, awareness, treatment and control rates are low. Drug side-effects also affect compliance. Hypotension and electrolyte abnormalities in the elderly can be severe. Therefore, prevention is better than cure. As blood pressure rises with age, prevention should be started early. As there are many genes affecting blood pressure, genetic tests are not useful. Good antenatal care and care of preterm infants can help to prevent adult cardiovascular diseases including hypertension. Childhood obesity is an important determinant of blood pressure in childhood and adolescence. This is a window of opportunity for prevention. The current American College of Cardiology/American Heart Association guideline on hypertension defines stage 1 hypertension as a systolic blood pressure of 130–139 mmHg or a diastolic blood pressure of 80–89 mmHg. Although this makes many people in the general population hypertensive, stage 1 hypertension in young adults is already associated with increased cardiovascular and mortality risk. Fortunately, hypertension at this early stage is easy to control and weight loss is easier in young males, who can get exercise from work or exercise after work. Leisure-time physical activity seems more beneficial than occupational physical activity. Cardiovascular risk assessment and promoting a healthy lifestyle in the young are likely to forestall hypertension and future cardiovascular disease. Preventing or reversing hypertension is no longer an impossible dream.

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The Association Between Dietary Inflammatory Index (DII) and Risk of Hypertension: A Case–Control Study
Niloofar Shoaei, Nafiseh Shokri-Mashhadi, Awat feizi, Reza Ghiasvand
High Blood Pressure & Cardiovascular Prevention.2022; 29(6): 611. CrossRef

Review Article

Prevention of Type 2 Diabetes: Jong Dai Kim, Won-Young Lee; Cardiovasc Prev Pharmacother. 2020;2(3):63-76. Published online July 31, 2020; DOI: https://doi.org/10.36011/cpp.2020.2.e10

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The number of patients with type 2 diabetes (T2D) is increasing worldwide and that in Korea, particularly, has shown an exponential increase with a rise in the older population. The diabetic population is predicted to soar up to 6 million by 2050. The prevalence of diabetes among Korean adults is approximately 15%, while that of prediabetes is 25%, with a total prevalence of 40%. As 40% of the prediabetes cases subsequently progress to T2D, prevention through proactive interventions at the prediabetes stage is essential to reduce the socioeconomic burden due to T2D and the complications of diabetes. With regard to the prevention of T2D, new findings have been published related to the implementation of lifestyle interventions such as exercise and diet as well as drug treatments and surgeries, which have deepened our understanding of the prevention of T2D. Based on published evidence, this review aimed to examine the methods used in the prevention of diabetes.

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Diabetes-specific oral nutritional supplement for prediabetes improves postprandial glycemic responses: an open-label, crossover clinical trial
Yeongtaek Hwang, Minkyung Bok, Suk Chon, Hyunjung Lim
Nutrition Research and Practice.2025; 19(6): 904. CrossRef

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