The severe acute respiratory syndrome coronavirus 2 is known to infect host cells by interacting with ACE2 (angiotensin-converting enzyme 2) expressed in the respiratory epithelium. There have been concerns on whether alterations of ACE2 expression by renin-angiotensin-aldosterone system (RAAS) inhibitors would contribute to the infectivity and severity of coronavirus disease 2019 (COVID-19). We performed a case-control study to investigate the association between RAAS inhibitors and risk and severity of COVID-19 infection in South Korea using the population-based data provided by the Korean National Health Insurance System. Of 16 281 subjects with hypertension, there were 950 (5.8%) confirmed COVID-19 cases. After case-control matching, multivariable-adjusted conditional logistic regression analysis was performed. The adjusted odds ratio and 95% CIs for COVID-19 infection and long-term hospitalization comparing exposure to RAAS inhibitors and nonexposure to RAAS inhibitors was 1.161 (0.958–1.407) and 0.863 (0.533–1.397), respectively. When comparing exposure to RAAS inhibitors and nonexposure to RAAS inhibitors for intensive care unit admission, high-flow oxygen therapy, and death, the adjusted odds ratios (95% CIs) were 1.515 (0.402–5.701), 0.663 (0.272–1.619), and 1.363 (0.513–3.662), respectively. In all analyses, P values were not significant ( P >0.05). The present study demonstrates the absence of an identifiable association between the exposure to RAAS inhibitors and risk and severity of COVID-19 infection, supporting the current medical guidelines and recommendations that patients should not discontinue RAAS inhibitors out of a concern that they are at increased risk for infection or severe illness of COVID-19.

SummaryIndividuals with intermediate to high cardiac risk for major noncardiac surgery suffer from perioperative myocardial ischemic injury. The purpose of this study was to evaluate the long-term impact of postoperative cardiac troponin elevation on clinical outcome after major noncardiac surgery.Patients (n = 750) aged ≥ 50 years who underwent major noncardiac surgery were eligible for the study. Postoperative cardiac troponin-I data were collected retrospectively and consecutively. The primary outcome measure was allcause mortality. The median follow-up period was 1727 days in all patients.Among 750 patients, 92 (12.2%) showed elevated postoperative troponin-I above 0.10 ng/mL. Operative mortality was 4.1% (31 subjects), and patients with troponin-I elevation showed a higher operative mortality rate (RR: 4.23, 95% CI: 2.67-11.31, P < 0.001). In multivariate Cox regression analysis, a troponin-I concentration above 0.10 ng/mL was associated with all-cause mortality (RR: 1.73, 95% CI: 1.27-2.36, P < 0.001). It should be noted that there was a significant difference between patients with elevated and non-elevated troponin-I in the rate of mortality until 6 months. However, these differences disappeared after 6 months. An elevated troponin-I level conferred an increase in mortality during the 7 year follow-up period after major noncardiac surgery. This difference in mortality was mainly derived from the result within the first 6 months. (Int Heart J 2016; 57: 278-284) Key words: Myocardial ischemia, Death, Surgical procedures A ll surgical procedures elicit a stress response, although the extent of the response depends on the extent of the surgery and the use of anesthetics and analgesics that are used to reduce the response. The stress response can lead to increases in heart rate and blood pressure, which can precipitate episodes of myocardial ischemia. 1)Individuals with intermediate to high cardiac risk for noncardiac surgery suffer from perioperative myocardial ischemic injury.2) Cardiac troponins are a useful tool that help clinicians in making the diagnosis of perioperative myocardial infarction.3-5) Many previous studies have investigated the role of cardiac troponins in the diagnosis of perioperative myocardial ischemic events and demonstrated the prognostic value of postoperative cardiac troponin elevation.6-9) A recent metaanalysis of studies in predominantly high-risk surgery patients also showed that cardiac troponin elevation was a strong independent predictor of mortality within the first year after surgery. 10) Editorial p.265The development of perioperative cardiovascular complications not only affects the short-term period prognosis but may also influence the long-term consequences. However, few studies have explored the long-term, defined as beyond the first year after major noncardiac surgery, prognostic value of cardiac troponin elevation in the prediction of postoperative outcome. We undertook this study to evaluate the clinical outcome of cardiac troponin elevation after major noncardiac sur...

Objectives Despite the growing pieces of evidence linking hyperuricemia with metabolic syndrome and cardiovascular disease, the relationship between dyslipidemia and serum uric acid has not yet been established. This study aimed to investigate the association between individual components of dyslipidemia and serum uric acid by using the nationally representative Korea National Health and Nutrition Examination Survey 2016-2017. Methods A total of 8,722 participants (age � 19 years) without missing values were analyzed for this study. Serum uric acid levels according to the presence of individual dyslipidemia components were calculated using multivariable-adjusted general linear models (GLM). Odds ratios of individual dyslipidemia components to hyperuricemia were calculated using unadjusted and multivariable-adjusted logistic regression analysis. Results A total of 1,061 participants were identified as having hyperuricemia, with a prevalence of 12.2%. Multivariable-adjusted GLM demonstrated a significant trend between individual dyslipidemia components and serum uric acid levels (P < 0.05). A positive association between the numbers of dyslipidemia components and the increments of serum uric acid levels was also observed (P < 0.001). In multivariable-adjusted logistic regression analysis, odds ratios (OR) and 95% confidence interval (CI) of all dyslipidemia components to hyperuricemia were shown to be statistically significant (P < 0.05). When further adjusted for the combined components themselves, each 10 mg/dL increments of total cholesterol (OR

pneumonia is related to oral health of the elderly and intensive care unit patients. However, studies on the relationship between overall oral health and pneumonia in the general population have been limited. the purpose of this study was to investigate the association between oral health and pneumonia using a nationwide population-based Korean cohort database. Data from 122,251 participants who underwent health screening and oral examinations in 2004 or 2005 were analyzed. Cox proportional hazard regression analysis was performed to evaluate the association between oral health and pneumonia. The risk of pneumonia increased significantly in groups with a higher number of dental caries and missing teeth, with respective adjusted hazard ratios (HRs) and 95% confidence interval (CI) of 1.265 (1.086-1.473; p = 0.0025) and 1.218 (1.113-1.332; p < 0.0001), and decreased significantly in frequent tooth brushing and regular professional dental cleaning groups, with respective adjusted HRs and 95% CI of 0.853 (0.786-0.926; p = 0.0001) and 0.920 (0.855-0.990; p = 0.0255). In addition, regardless of age and comorbidities, oral health status and oral hygiene behaviors were associated with pneumonia. the results indicate that improved oral health may reduce the risk of pneumonia in the general population. Pneumonia is a debilitating disease that can result in death in elderly individuals 1 and has been reported to be related to oral health 2. The oral cavity is a complex environment for multiple microorganisms and cytokines 3. In particular, aspiration of microorganisms and biological mediators such as cytokines and hydrolytic enzymes from the oral cavity can provoke inflammation and cause infections 4,5. The association between pneumonia and oral health has been examined in nursing homes, and the incidence of pneumonia has been reported to be lower in elderly populations receiving oral care 6. Besides, several studies have suggested that hospitalized intensive care unit (ICU) patients appear to benefit from daily oral cleansing 7,8. Oral hygiene can be improved through individual-based interventions 9. Daily personal oral hygiene behaviors such as tooth brushing are fundamental in the prevention of periodontal disease and bacterial plaque, which can respectively lead to tooth loss and dental caries 10,11. In addition, professional dental cleaning has been proven to reduce periodontal disease, dental caries, and tooth loss 12. Dentists recommend tooth brushing at least twice daily as well as regular dental visits for professional dental cleaning 13. While the link between pneumonia and oral health has been gaining increased attention, studies evaluating the relationship between overall oral health and pneumonia in the general population have been limited. The purpose of this study was to investigate the association between oral health and pneumonia using a nationwide population-based Korean cohort from the National Health Insurance Service-Health Screening (NHIS-HealS) database. Methods Data source. This study used the NHIS-H...

Background/Aims: The impact of liver cirrhosis on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) remains elusive. This study evaluated the association between liver cirrhosis and the development of severe complications from COVID-19. Methods: We used the National Health Insurance claims data of Korea. We included 234,427 patients older than 19 years who tested for severe acute respiratory syndrome coronavirus-2. Patients with liver cirrhosis who were infected with COVID-19 (n=67, LC+ COVID+) were matched with those with cirrhosis only (n=332, LC+ COVID-) and those with COVID-19 only (n=333, LC-COVID+) using a propensity score in a 1:5 ratio. The primary outcome was the development of severe complications. Results: Of the matched patients, the mean age was 60 years and 59.7% were male. Severe complications occurred in 18, 54, and 60 patients in the LC+ COVID+, LC+ COVID-, and LC-COVID+ groups, respectively. After adjusting for comorbidities, there was no significant difference in the risk of developing severe complications from COVID-19 between the LC+ COVID+ and LC-COVID+ groups but significant difference exists between the LC+ COVID+ and LC+ COVID-. Older age, hypertension, cancer, chronic obstructive pulmonary disease, and a higher Charlson comorbidity index were associated with a higher risk of severe complications in patients with cirrhosis and COVID-19. Conclusions: Our study suggests that liver cirrhosis was not independently associated with the development of severe complications, including mortality, in patients with COVID-19. Our results need to be evaluated through a large, prospective study.