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  • Choi, Eue-Keun  (35)
  • English  (35)
  • 1
    Online Resource
    Online Resource
    Risk of Atrial Fibrillation in Young Adults With Isolated Diastolic, Isolated Systolic, and Systolic-Diastolic Hypertension
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Hypertension Vol. 78, No. 5 ( 2021-11), p. 1248-1258
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 78, No. 5 ( 2021-11), p. 1248-1258
    Abstract: There is limited evidence regarding the risks of incident atrial fibrillation (AF) associated with stage 1 isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH), especially among young adults. We aimed to evaluate the association between early stage of hypertension and AF in young adults. From the Korean nationwide health screening database, 2 958 544 subjects aged 20 to 39 years who were not prescribed antihypertensive medication at the index examination in 2009 were included. Subjects were categorized into 8 groups according to the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines: normal BP, elevated BP, stage 1 IDH, stage 1 ISH, stage 1 SDH, stage 2 IDH, stage 2 ISH, and stage 2 SDH. The primary outcome was new-onset AF. During a median follow-up of 8.3 years, 7347 subjects had incident AF (0.3 per 1000 person-years). Compared with normal BP, stage 1 IDH (adjusted hazard ratio, 1.160 [95% CI, 1.086–1.240]) and stage 1 SDH (1.250 [1.165–1.341] ) were associated with higher risks of incident AF, but not stage 1 ISH. Stage 2 IDH, ISH, and SDH were associated with higher risks of incident AF by 24%, 37%, and 61%, respectively. Stage 1 IDH and SDH were associated with higher risks of incident AF compared with normal BP. The risk of incident AF with stage 2 IDH was similar to that of stage 1 SDH. Optimal BP control, including diastolic BP, is associated with the lowest risk of new-onset AF, even among young adults.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.121.17399
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2094210-2
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  • 2
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    Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Prior Gastrointestinal Bleeding
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 2 ( 2021-02), p. 511-520
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 2 ( 2021-02), p. 511-520
    Abstract: Limited data support the benefits of non–vitamin K oral anticoagulants (NOACs) among atrial fibrillation patients with prior gastrointestinal bleeding (GIB). We aimed to evaluate the effectiveness and safety of NOACs compared with those of warfarin among atrial fibrillation patients with prior GIB. Methods: Oral anticoagulant–naive individuals with atrial fibrillation and prior GIB between January 2010 and April 2018 were identified from the Korean claims database. NOAC users were compared with warfarin users by balancing covariates using the inverse probability of treatment weighting method. The primary outcomes were ischemic stroke, major bleeding, and the composite outcome (combined ischemic stroke and major bleeding). Fatal events from each outcome were evaluated as secondary outcomes. Results: A total of 42 048 patients were included (24 781 in the NOAC group and 17 267 in the warfarin group). The mean time from prior GIB to the initiation of oral anticoagulant was 3.1±2.6 years. After inverse probability of treatment weighting, baseline characteristics were balanced between the two groups (mean age, 72 years; men, 56.8%; and mean CHA 2 DS 2 -VASc score, 3.7). Lower risks of ischemic stroke, major bleeding, and the composite outcome were associated with NOAC use than with warfarin use (weighted hazard ratio, 0.608 [95% CI, 0.543–0.680]; hazard ratio, 0.731 [95% CI, 0.642–0.832] ; and hazard ratio, 0.661 [95% CI, 0.606–0.721], respectively). For all secondary outcomes, NOACs showed greater risk reductions compared with warfarin. Conclusions: NOACs were associated with lower risks of ischemic stroke and major bleeding than warfarin among atrial fibrillation patients with prior GIB.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.030761
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Body Mass Index and Clinical Outcomes in Asian Patients With Atrial Fibrillation Receiving Oral Anticoagulation
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 2 ( 2021-02), p. 521-530
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 2 ( 2021-02), p. 521-530
    Abstract: The influence of body mass index (BMI) on clinical outcomes in patients with atrial fibrillation remains controversial, especially among Asians. We aimed to evaluate the association between BMI and clinical outcomes in Asian patients with atrial fibrillation receiving oral anticoagulants. Methods: Using the Korean National Health Insurance database between January 2015 and December 2017, we identified oral anticoagulant new users among patients with nonvalvular atrial fibrillation who had BMI information. We analyzed ischemic stroke, intracranial hemorrhage, hospitalization for gastrointestinal bleeding, major bleeding, all-cause death, and the composite clinical outcome according to BMI categories. Results: A total of 43 173 patients were included across BMI categories (kg/m 2 ): underweight ( 〈 18.5) in 3%, normal (18.5 to 〈 23) in 28%, overweight (23 to 〈 25) in 24%, obese I (25 to 〈 30) in 39%, and obese II (≥30) in 6%. Higher BMI (per 5 kg/m 2 increase) was significantly associated with lower risks of ischemic stroke (hazard ratio [HR], 0.891 [95% CI, 0.801–0.992] ), hospitalization for gastrointestinal bleeding (HR, 0.785 [95% CI, 0.658–0.937]), major bleeding (HR, 0.794 [95% CI, 0.686–0.919] ), all-cause death (HR, 0.658 [95% CI, 0.605–0.716]), and the composite clinical outcome (HR, 0.751 [95% CI, 0.706–0.799] ), except for intracranial hemorrhage (HR, 0.815 [95% CI, 0.627–1.061]). The underweight group was associated with an increased risk of composite clinical outcome (HR, 1.398 [95% CI, 1.170–1.671] ), mainly driven by an increased risk of all-cause death. The effects of non–vitamin K antagonist oral anticoagulant versus warfarin on clinical outcomes were similar across BMI groups. Conclusions: Higher BMI was independently associated with a lower risk of ischemic stroke, major bleeding, and better survival. Underweight patients had a higher risk of all-cause death and composite clinical outcome. The optimal BMI for patients with atrial fibrillation should be defined and managed according to an integrated care pathway.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.030356
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 4
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    Non–Vitamin K Antagonist Oral Anticoagulants in Asian Patients With Supranormal Renal Function
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. 6 ( 2019-06), p. 1480-1489
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 6 ( 2019-06), p. 1480-1489
    Abstract: In clinical trials, the reduced efficacy of non–vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention was reported for patients with nonvalvular atrial fibrillation with a creatinine clearance (CrCl) 〉 95 mL/min compared with that of warfarin. We examined the effectiveness, safety, and net clinical benefit of NOACs compared with warfarin in Asian patients with atrial fibrillation and supranormal renal function. Methods— Using data from the Korean National Health Insurance Service database from January 2014 to December 2016, we included patients with nonvalvular atrial fibrillation with CrCl 〉 80 mL/min. Among these incident oral anticoagulant users with rivaroxaban (n=6297), dabigatran (n=4241), apixaban (n=3395), edoxaban (n=1187), and warfarin (n=9884) were analyzed. Propensity score weighting was used to balance covariates across study groups. Hazard ratios for ischemic stroke, intracranial hemorrhage, gastrointestinal bleeding, major bleeding, all-cause death, and the composite outcome defined as ischemic stroke+intracranial hemorrhage+gastrointestinal bleeding+all-cause death were analyzed using Cox regression analysis with warfarin as the reference. Results— Baseline characteristics were well balanced among all groups (mean age, 66±11 years; 63% were men; mean CHA 2 DS 2 -VASc score, 3.0±1.8). Forty-five percent of the patients had CrCl 〉 95 mL/min. Pooled NOACs yielded lower risks of ischemic stroke (hazard ratio, 0.51; 95% CI, 0.43–0.60) and the composite outcome (hazard ratio, 0.64; 95% CI, 0.58–0.70) than warfarin in patients with CrCl 〉 80 mL/min. These benefits were consistent in those with CrCl 〉 95 mL/min. All 4 NOACs reduced the risks of ischemic stroke and the composite outcome in both patients with CrCl 〉 80 mL/min and 〉 95 mL/min. Conclusions— The NOACs showed better effectiveness and safety than warfarin in the patients with atrial fibrillation and supranormal renal function; this was consistently observed for all 4 NOACs and in patients with CrCl 〉 95 mL/min.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.118.024264
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
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    Predictors of ischemic stroke for low-risk patients with atrial fibrillation: A matched case-control study
    Elsevier BV ; 2021
    In:  Heart Rhythm Vol. 18, No. 5 ( 2021-05), p. 702-708
    Details
    In: Heart Rhythm, Elsevier BV, Vol. 18, No. 5 ( 2021-05), p. 702-708
    Type of Medium: Online Resource
    ISSN: 1547-5271
    URL: Article
    DOI: 10.1016/j.hrthm.2021.01.016
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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  • 6
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    Alcohol Abstinence and the Risk of Atrial Fibrillation in Patients With Newly Diagnosed Type 2 Diabetes Mellitus: A Nationwide Population-Based Study
    American Diabetes Association ; 2021
    In:  Diabetes Care Vol. 44, No. 6 ( 2021-06-01), p. 1393-1401
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 44, No. 6 ( 2021-06-01), p. 1393-1401
    Abstract: To investigate the effects of alcohol abstinence on prevention of new-onset atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS A total of 1,112,682 patients newly diagnosed with T2DM between 2011 and 2014 were identified from the Korean National Health Insurance Service database. After excluding those with a history of AF, 175,100 patients were included. The primary outcome was new-onset AF. RESULTS During a mean follow-up of 4.0 years, AF occurred in 4,174 patients. Those with heavy alcohol consumption (alcohol intake ≥40 g/day) before T2DM diagnosis had a higher risk of AF (adjusted hazard ratio [aHR] 1.22; 95% CI 1.06–1.41) compared with patients with no alcohol consumption. After T2DM diagnosis, those with moderate to heavy alcohol consumption (alcohol intake ≥20 g/day) who abstained from alcohol had a lower risk of AF (aHR 0.81; 95% CI 0.68–0.97) compared with constant drinkers. Alcohol abstinence showed consistent trends toward lower incident AF in all subgroups and was statistically significant in men (aHR 0.80; 95% CI 0.67–0.96), those aged & gt;65 years (aHR 0.69; 95% CI 0.52–0.91), those with CHA2DS2-VASc score & lt;3 points (aHR 0.71; 95% CI 0.59–0.86), noninsulin users (aHR 0.77; 95% CI 0.63–0.94), and those with BMI & lt;25 kg/m2 (aHR 0.68; 95% CI 0.53–0.88). CONCLUSIONS In patients with newly diagnosed T2DM, alcohol abstinence was associated with a low risk of AF development. Lifestyle modifications, such as alcohol abstinence, in patients newly diagnosed with T2DM should be recommended to reduce the risk of AF.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc20-2607
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2021
    detail.hit.zdb_id: 1490520-6
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  • 7
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    Response to Comment on Choi et al. Alcohol Abstinence and the Risk of Atrial Fibrillation in Patients With Newly Diagnosed Type 2 Diabetes Mellitus: a Nationwide Population-Based Study. Diabetes Care 2021;44:1393–1401
    American Diabetes Association ; 2021
    In:  Diabetes Care Vol. 44, No. 11 ( 2021-11-01), p. e199-e199
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 44, No. 11 ( 2021-11-01), p. e199-e199
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dci21-0039
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2021
    detail.hit.zdb_id: 1490520-6
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  • 8
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    Effectiveness and Safety of Direct Oral Anticoagulants in Relation to Temporal Changes in Their Use
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 13, No. 3 ( 2020-03)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 13, No. 3 ( 2020-03)
    Abstract: Since the direct oral anticoagulants (DOAC) were introduced, oral anticoagulant (OAC) prescription patterns have rapidly changed in patients with atrial fibrillation (AF). We aimed to evaluate the evolving trends of OAC use in a large nationwide cohort and specifically examine the changes in patient profiles treated with warfarin or DOAC and whether the time trends in OAC use affected clinical outcomes. Methods and Results: Using the Korean Health Insurance Review and Assessment database, we divided OAC naive patients with AF into 3 groups according to the enrollment period between January 2015 and December 2017 (n=35 353 in cohort 1, n=36 631 in cohort 2, and n=44 819 in cohort 3). DOAC use increased from 59% to 89%, whereas warfarin use has decreased from 41% to 11% during the study period. Patients treated with warfarin were increasingly younger from cohort 1 to cohort 3 (mean age 68–65 years, P 〈 0.001) with lower mean CHA 2 DS 2 -VASc scores (3.3–2.9, P 〈 0.001), whereas those with DOAC did not show a significant difference in clinical characteristics over the study period. Warfarin group had improved clinical outcomes over time, reflecting dynamic changes in patient characteristics. Compared with warfarin group, unadjusted hazard ratios of composite outcome for DOAC group have changed over time (hazard ratio 0.77 [95% CI, 0.69–0.85] in cohort 1, hazard ratio 0.84 [95% CI, 0.73–0.97] in cohort 2, and hazard ratio 1.00 [95% CI, 0.78–1.25] in cohort 3). After propensity score weighting between warfarin and DOAC groups in each cohort, DOAC showed consistently lower risks of the composite outcome by approximately 23% to 25% compared with warfarin across 3 different periods. Conclusions: In contemporary clinical practice, OAC prescription patterns and characteristics of patients treated warfarin or DOAC have dynamically changed. Despite these changes, DOAC showed a consistent better net clinical benefit compared with warfarin across different periods.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/CIRCOUTCOMES.119.005894
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 9
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    Reduction of Upper Gastrointestinal Bleeding Risk With Proton Pump Inhibitor Therapy in Asian Patients With Atrial Fibrillation Receiving Direct Oral Anticoagulant: A Nationwide Population-based Cohort Study
    Elsevier BV ; 2024
    In:  Clinical Gastroenterology and Hepatology ( 2024-1)
    Details
    In: Clinical Gastroenterology and Hepatology, Elsevier BV, ( 2024-1)
    Type of Medium: Online Resource
    ISSN: 1542-3565
    URL: Article
    DOI: 10.1016/j.cgh.2023.12.022
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
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  • 10
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    Bodyweight fluctuation is associated with increased risk of incident atrial fibrillation
    Elsevier BV ; 2020
    In:  Heart Rhythm Vol. 17, No. 3 ( 2020-03), p. 365-371
    Details
    In: Heart Rhythm, Elsevier BV, Vol. 17, No. 3 ( 2020-03), p. 365-371
    Type of Medium: Online Resource
    ISSN: 1547-5271
    URL: Article
    DOI: 10.1016/j.hrthm.2019.09.029
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
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