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Background TNF-related apoptosis-inducing ligand (TRAIL) is a member of the tumor necrosis factor receptor superfamily and its serum level is known to be closely associated with future cardiovascular events and prognosis of various cardiovascular diseases. We investigated whether serum TRAIL levels are associated with the severity of acute ischemic stroke and specific stroke subtype. Methods We used an enzyme-linked immunosorbent assay to measure the serum TRAIL levels of 293 patients with acute ischemic stroke within 7 days of onset. Stroke subtype was classified as large artery atherosclerosis, cardioembolism, small vessel occlusion and other determined etiology. We used National Institute of Health Stroke Scale (NIHSS) score of first hospital day and stroke volume on diffusion-weighted imaging within 7 days of stroke onset for measuring the severity of acute ischemic stroke. Results The level of serum TRAIL showed significant negative correlations with NIHSS score and stroke volume. Serum TRAIL levels significantly decreased as the tertile of NIHSS score and stroke volume increased. The relative risk of patients with serum TRAIL < 64.0 pg/mL for the presence of highest tertile of NIHSS score was significantly increased (adjusted OR [95%CI]; 7.07 [3.64–13.74]). Regarding stroke volume, the relative risk of patients with serum TRAIL < 71.5 pg/mL for the presence of highest tertile of stroke volume was also significantly increased (adjusted OR [95%CI]; 2.81 [1.61–4.92]). There are no significant differences of serum TRAIL level among stroke subtypes. Conclusions Low serum TRAIL levels were significantly associated with the acute ischemic stroke severity. This finding suggests that serum TRAIL might also have a role in acute ischemic stroke as well as other cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Abstract: The metabolic syndrome (MS) is a cluster of risk factors for cardiovascular disease related to insulin resistance. Recently, serum gamma glutamyltransferase (GGT) has been proposed as a marker of oxidative stress and is associated with a marked increase in the risk of cardiovascular disease. So, we investigated the association between serum GGT and components of the metabolic syndrome in the Korean adults. A total 3246 adults (aged 20–70 years, 1622 men and 1624 women) who visited Center for Health Promotion in Pusan National University Hospital for a medical checkup were included. We measured serum GGT and lipid profiles, fasting glucose, fasting insulin and blood pressure. As the quartile of serum GGT increased, the number of components of MS and prevalence of MS were increased. Serum GGT was also increased according as the number of components of MS was increased. A significant correlation (r =0.200, p <0.001 in men and r =0.133, p <0.001 in women) was noted between the numbers of the components of the MS and serum GGT. In addition, serum GGT was correlated significantly (r =0.266, p <0.001 in men and r =0.264, p <0.001 in women) with homeostasis model assessment of insulin resistance (HOMA-IR). In linear regression model, serum GGT was mainly influenced by the concentration of triglycerides and fasting glucose. In conclusion, serum GGT is closely related with insulin resistance and the increased number of components of MS. Among components of MS, serum GGT may be more associated with dyslipidemia and abnormal glucose tolerance, suggesting that serum GGT has more relationship with hepatic insulin resistance regardless of non-alcoholic fatty liver disease. [Copyright &y& Elsevier]

Objective: This study investigated the association between relative hand grip strength (HGS) and glycemic status, such as impaired fasting glucose (IFG) and diabetes, using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Methods: We performed a cross-sectional study using the data from the KNHANES of 27,894 individuals from 2014 to 2019. Relative HGS was defined as the absolute HGS divided by body mass index and divided into quartiles in men and women. Odds ratios (OR) for diabetes and IFG were calculated using multivariate logistic regression analysis. All analyses were stratified by sex, and subgroup analysis was age-stratified. Results: The lowest relative HGS quartile had a significant increase in the risk for diabetes (men: OR 2.72, 95% confidence interval [CI] 2.12–3.50; women: OR 3.38, 95% CI 2.70–4.24) and IFG (men: OR 1.35, 95% CI 1.15–1.59; women: OR 1.60, 95% CI 1.40–1.84). The ORs for diabetes and IFG according to the decreasing quartiles of relative HGS gradually increased in both sexes (P for trend <0.001). ORs and 95% CI of the lowest relative HGS quartile for diabetes were higher in the younger age group than that of the older age group (men: 4.47 and 2.80–7.14 for young adults; 2.41 and 1.37–4.25 for older adults; women: 5.91 and 3.06–9.38 for young adults; 1.47 and 0.92–2.33 for older adults). ORs and 95% CI for IFG was similar with the trend of ORs for diabetes (men: 1.80 and 1.43–2.26 for young adults; 1.17 and 0.75–1.84 for older adults; women: 2.20 and 1.77–2.72 for young adults; 1.33 and 0.86–2.07 for older adults). Conclusion: Lower relative HGS was associated with a higher risk of not only diabetes but also IFG in both sexes. These trends were stronger in younger adults than in older adults. [ABSTRACT FROM AUTHOR]

[Display omitted] • TyG index in normal glucose tolerance (NGT) correlated with composite ISI. • High TyG index in NGT increased the risk of T2DM over an 18-year follow-up. • The predictability of TyG index for T2DM surpassed that of OGTT-derived markers. We explored the role of the triglyceride-glucose (TyG) index as an early and superior predictor of type 2 diabetes mellitus (T2DM) in individuals with normal glucose tolerance (NGT) using a community-based Korean cohort over 18 years. We retrospectively examined 6,072 adults with NGT from the Korean Genome and Epidemiology Study. Cox proportional hazard regression models were employed to evaluate the risk of incidence of T2DM and receiver operating characteristic analysis was used to calculate the area under the curve (AUC). At baseline, the TyG index correlated with the homeostasis model assessment of insulin resistance (HOMA-IR) and the composite insulin sensitivity index (ISI) (β: 0.045, p < 0.001; β: −0.105, p < 0.001, respectively). Over the 18-year follow-up period, 999 individuals developed T2DM. An increase in the TyG quartile independently predicted the incidence of T2DM [hazard ratio, 2.36 (1.9–2.93) for Q4]. The AUC value of the TyG index was 0.642, the highest value among HOMA-IR and OGTT-derived insulin sensitivity and secretion markers. The TyG index is associated with HOMA-IR and composite ISI even with NGT. The TyG index demonstrated independent predictability for T2DM incidence in individuals with NGT, better than OGTT-derived insulin sensitivity and secretion markers. [ABSTRACT FROM AUTHOR]

Body mass index is considered to be insufficient to diagnose obesity in population with metabolic abnormalities. In this study, we aimed to determine the optimal criteria for metabolically obese, normal weight (MONW) with insulin resistance or with metabolic syndrome to provide reliable diagnostic tool for obesity, especially targeting Korean population. This is a cross-sectional study based on the data extracted from the Korean National Health and Nutrition Examination Survey in 2010-2012. A total of 6274 adults with the normal weight were enrolled, and each subject was classified into either MONW with insulin resistance (MONW-IR) or MONW with metabolic syndrome (MONW-Mets) in order to analyze the risk of cardiovascular events. The Framingham risk score (FRS) and atherosclerotic cardiovascular disease risk equation (ASCVD) were used in the process. The odds ratio for the cardiovascular disease risk based on the FRS in the MONW-IR group (1.132; 95% confidence interval (CI), 0.854-1.502) was not significantly elevated whereas the odds ratio for the cardiovascular disease risk using the ASCVD in the MONW-IR group (1.809; 95% CI, 1.410-2.322) was significantly increased. The odds ratio for the cardiovascular disease risk in the MONW-Mets group was both significantly increased (2.93; 95% CI, 2.19-3.91 by FRS, 8.44; 95% CI, 6.19-11.49 by ASCVD) as well. However, the risk of cardiovascular disease was not significantly increased after excluding the subjects with diabetes mellitus that were the majority of MONW-IR group. Metabolic syndrome criteria can be considered more useful tool in diagnosing MONW in the Korean population. However, further prospective studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Background: Serum cystatin C has been known as a novel marker of preclinical renal dysfunction, and higher cystatin C levels are associated with increased risks of hip and nonvertebral fractures. However, there are few reports on the association between serum cystatin C and bone mineral density (BMD), especially in the Asian population. We evaluated the association between cystatin C levels and BMD of the spine and hip in Korean adults.Methods: A cross-sectional study was performed in 865 Korean adults (325 men and 540 women) who participated in a comprehensive medical examination program and underwent bone densitometry. Renal function was assessed by the estimated glomerular filtration rate (eGFR), which was calculated using an equation based on creatinine (eGFRcre) and cystatin C (eGFRcys).Results: The serum cystatin C level was negatively correlated with different types of BMD, including the lowest lumbar, total lumbar, femoral neck, and total femur BMD, in women, but not in men. Higher cystatin C levels were associated with a higher prevalence of osteoporosis in women (odds ratio [OR], 3.68; 95% confidence interval [CI], 1.69-8.03; P=0.001), but not in men (OR, 0.85; 95% CI, 0.30-2.38; P=0.761). However, this association was attenuated in the multivariable model adjusted for age, body mass index, serum 25-hydroxyvitamin D3, and creatinine (OR, 1.01; 95% CI, 0.38-2.71) in women. In addition, the eGFRcys showed a stronger positive correlation with BMD than the eGFRcre.Conclusion: Our findings suggest that serum cystatin C levels might help identify women with osteoporosis who are susceptible to fractures. [ABSTRACT FROM AUTHOR]

Background: Multiple hypointense vessels (MHV) on susceptibility-weighted imaging (SWI) are frequently observed in patients with acute cerebral ischemia, but their implication has not been clearly established. To elucidate the clinical significance of MHV on SWI, we investigated the association of MHV on SWI with clinical data and other MR markers in patients with acute ischemic stroke. Methods: We enrolled acute stroke patients with internal carotid or proximal middle cerebral artery occlusion who underwent MRI including SWI within 3 days from stroke onset. Baseline clinical data were reviewed. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS). We graded the degree of MHV on SWI as four groups of none, subtle, relative, or extensive by the modified Alberta Stroke Program Early CT Scan (ASPECTS) system. To evaluate the degree of collateral flow, distal hyperintense vessels (DHV) on FLAIR and vessels on post-contrast time-of-flight MR angiography (TOF MRA) source images were graded respectively as 3 groups: none/subtle/prominent and poor/moderate/good. Diffusion and perfusion lesion volume and diffusion-perfusion mismatch (DPM) ratio were measured in all patients. We analyzed the association of the degree of MHV on SWI with clinical data and MR markers. Results: Eighty patients were included in the study. The mean MR time from stroke onset was 12.4 h (range 0.5-63.0). There is no difference in MR time from stroke onset between groups of MHV on SWI. MHV were observed in 68 (85%) of 80 patients: none in 12, subtle in 11, relative in 13, and extensive in 44. There were no statistically significant associations between MHV on SWI and vascular risk factors. Patients with more extensive MHV on SWI had a smaller diffusion volume (p < 0.001), larger DPM (p < 0.001), and lower initial NIHSS scores (p = 0.022). Prominent DHV was presented in 29 of 44 patients with extensive MHV (p < 0.001). Good collateral flow on TOF MRA source images was presented in 37 of 44 patients with extensive MHV (p < 0.001). Conclusions: More extensive MHV on SWI in acute ischemic stroke is associated with lower initial NIHSS scores, smaller diffusion lesion volume, better collateral flow, and larger DPM. Our results show the possibility that MHV on SWI may be a useful surrogate marker for predicting increased oxygen extraction fraction and diffusion-perfusion mismatch in acute ischemic hemisphere. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]