AIMS:Hypertension is a significant risk factor for myocardial infarction (MI), stroke, and death. While anti-hypertensive medication is known to reduce these risks, the optimal timing for initiation remains controversial. This study aims to evaluate and compare the outcome risks associated with early vs. delayed anti-hypertensive treatment in a general health screening setting. METHODS AND RESULTS:This study utilized data from 505 212 general health screening examinees without a history of hypertension treatment, MI, and stroke. The population was categorized into normotensive, early treatment (newly diagnosed with hypertension and treated in the same year), and delayed treatment (newly diagnosed but started medication after a year) for hypertension. The risks of MI, stroke, and death were assessed across these groups using Cox proportional hazards models, adjusting for demographic, behavioural, and clinical variables. During the follow-up period (11.34 ± 0.67 years), the incidences of death, MI, and stroke were 6810 (1.3%), 4666 (0.9%), and 7274 (1.4%) subjects, respectively. The hazard ratios (HRs) for MI in the early and delayed treatment groups were 1.52 (1.36-1.69) and 1.56 (1.38-1.76), respectively (P for trend <0.0001). For stroke, the HRs were 1.46 (1.35-1.59) in the early treatment group and 1.58 (1.43-1.74) in the delayed treatment group (P for trend <0.0001). The risk of death was higher in the delayed treatment group with an HR of 1.79 (1.64-1.97) compared with 1.47 (1.35-1.60) in the early treatment group (P for trend <0.0001). CONCLUSION:This study provides population-scale evidence from general health screening participants, encouraging the prompt initiation of anti-hypertensive medication to reduce the risk of adverse outcomes. Delayed consideration of medication in primary health screenings may be associated with higher risks of MI, stroke, and death.
BACKGROUND:The role of long-term beta-blocker therapy after a myocardial infarction in patients without left ventricular systolic dysfunction or heart failure is unclear in the era of contemporary coronary-artery reperfusion and secondary prevention interventions. METHODS:We conducted an open-label, randomized, noninferiority trial at 25 centers in South Korea. Patients whose condition remained stable after a myocardial infarction, who had a left ventricular ejection fraction of at least 40% and no heart failure, and who had received beta-blocker therapy for at least 1 year after the myocardial infarction were randomly assigned in a 1:1 ratio to discontinue or to continue beta-blocker therapy. The primary end point was a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure. The prespecified noninferiority margin was an upper limit of the 95% confidence interval for the hazard ratio of 1.4. RESULTS:A total of 2540 patients underwent randomization; 1246 were assigned to beta-blocker discontinuation and 1294 to beta-blocker continuation. The mean age of the patients was 63.2 years, and 12.8% were women. At a median follow-up of 3.1 years (interquartile range, 2.5 to 3.5), a primary end-point event had occurred in 58 patients (4-year Kaplan-Meier estimate, 7.2%) in the discontinuation group and in 74 patients (4-year Kaplan-Meier estimate, 9.0%) in the continuation group (hazard ratio, 0.80; 95% confidence interval, 0.57 to 1.13; P = 0.001 for noninferiority). The incidence of serious adverse events was similar in the two groups. CONCLUSIONS:Among patients who received beta-blocker therapy beyond the first year after a myocardial infarction, discontinuation of beta-blocker therapy was noninferior to continuation with respect to a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure. (Funded by Patient-Centered Clinical Research Coordinating Center in the Ministry of Health and Welfare, South Korea; SMART-DECISION ClinicalTrials.gov number, NCT04769362.).
OBJECTIVES:To provide the clinically validated, nationwide estimates of multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in Korea, and to describe their relative proportions. METHODS:From January to March 2025, 47 referral hospitals participating in a nationwide hospital-based registry identified actively followed patients with MS, NMOSD, or MOGAD. Diagnoses followed international criteria, and antibody status was confirmed using validated CBAs. Actively followed patients had ≥1 outpatient visit in the prior 6 months. Centers provided demographics, treatments, and Expanded Disability Status Scale. Prevalence used national population data. RESULTS:A total of 4,196 patients were identified, 1,799 MS, 1,616 NMOSD, and 781 MOGAD (ratio 2.3:2.1:1). Mean age at onset was 33.4 ± 12.0 years for MS, 42.7 ± 14.7 for NMOSD, and 41.7 ± 17.8 for MOGAD, and the female-to-male ratios were 2.2:1 for MS, 5.1:1 for NMOSD (6.5:1 in aquaporin-4-IgG positive cases), and 1.5:1 for MOGAD. Crude prevalence estimates were 3.48, 3.13, and 1.51 per 100,000, respectively. DISCUSSION:This nationwide registry demonstrates a distinctive Korean CNS inflammatory demyelinating disease profile, with a relatively higher proportion of NMOSD and MOGAD reflecting the low prevalence of MS in East Asia.
Purpose: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial lung disease of unknown etiology that primarily affects older adults. It is characterized by worsening dyspnea, declining lung function, and poor prognosis. This review summarizes current approaches to IPF diagnosis and treatment.Current concepts: Diagnosis requires a multidisciplinary approach integrating clinical, radiological, and, when necessary, histopathological findings. A key feature is the usual interstitial pneumonia pattern on high-resolution computed tomography and/or lung biopsy. Pirfenidone and nintedanib appear to slow the decline in lung function, including forced vital capacity (FVC), and are recommended as first-line therapies. Clinical trials of novel agents are ongoing, with several recent trials yielding promising findings. Non-pharmacological management, including pulmonary rehabilitation, oxygen therapy, and symptom control, is essential for comprehensive care. Lung transplantation remains the only curative option and should be considered in eligible patients.Discussion and conclusion: Early, accurate IPF diagnosis is essential and requires a multidisciplinary approach that integrates clinical, radiological, and histopathological findings, as outlined in the 2018 and 2022 American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Latin American Thoracic Association guidelines. Pirfenidone and nintedanib remain the cornerstone antifibrotic agents for pharmacological treatment, slowing FVC decline and reducing the risk of acute exacerbation. Emerging agents, including nerandomilast and inhaled treprostinil, have shown promise in recent phase 3 clinical trials. Non-pharmacological strategies, including pulmonary rehabilitation, oxygen therapy, and palliative care, are integral to comprehensive management. Despite these advances, IPF remains a progressive and fatal disease, underscoring the need for continued research into novel therapeutic strategies.
Background High bleeding risk (HBR) is associated with an increased risk of both ischemic and bleeding events and is known to have a worse prognosis than non‐HBR in patients with acute myocardial infarction. However, data regarding the prognostic impact of complete revascularization (CR) in acute myocardial infarction and multivessel disease patients complicated by HBR remain limited. Methods A total of 13 460 patients with acute myocardial infarction and multivessel disease who underwent successful percutaneous coronary intervention for infarct‐related artery were selected from the nationwide Korean registry from 2011 to 2020. Primary outcome was major adverse cardiac and cerebrovascular events during 3 years of follow‐up. Results Of the 13 460 patients, 4401 (32.7%) were classified as the group with HBR according to modified Academic Research Consortium‐HBR criteria and 1577 patients (35.8%) underwent CR. Among the group without HBR, 3911 patients (43.2%) underwent CR for noninfarct‐related artery. The group with HBR had significantly higher risk of major adverse cardiac and cerebrovascular events (non‐HBR versus HBR; 16.4% versus 35.7%; adjusted hazard ratio [HR], 1.70 [95% CI, 1.56–1.85]; P<0.001) and Bleeding Academic Research Consortium type 2 or greater bleeding (4.5% versus 10.4%; adjusted HR, 1.63 [95% CI, 1.38–1.94]; P<0.001) than the group without HBR. Patients who underwent CR were associated with lower risk of major adverse cardiac and cerebrovascular events at 3 years than those with incomplete revascularization in both groups with HBR (40.0% versus 28.1%, adjusted HR, 0.65 [95% CI, 0.55–0.75], P<0.001) and without HBR (19.0% versus 13.1%, adjusted HR, 0.71 [95% CI, 0.63–0.80], P<0.001). The incidence of bleeding events was similar between the CR and incomplete revascularization groups in both groups with HBR (10.7% versus 10.0%, adjusted HR, 1.07 [95% CI, 0.84–1.37], P=0.572) and without HBR (4.2% versus 5.0%, adjusted HR, 0.98 [95% CI, 0.78–1.23], P=0.867). Conclusions In patients with acute myocardial infarction and multivessel disease, CR was associated with a lower risk of major adverse cardiac and cerebrovascular events compared with incomplete revascularization in both HBR and non‐HBR. Registration KAMIR‐NIH; KCT‐0000863, KAMIR‐V; KCT‐0008355.
