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Continuity of care for patients with hypertension or diabetes mellitus reduced medical utilization, total medical costs, and cardiovascular events based on the Korean NHIS-HEALS cohort

2026-06-01T00:00:00Z

Title: Continuity of care for patients with hypertension or diabetes mellitus reduced medical utilization, total medical costs, and cardiovascular events based on the Korean NHIS-HEALS cohort Authors: Yun, Eun-Kyeong; Shim, Jae Yong; Shin, Sang-Jun; Kang, Hee-Taik Abstract: Background and aim: Continuous care of chronic diseases can improve the efficiency of medical system. This study aims to investigate whether continuity of care (CoC) for hypertension or diabetes mellitus (DM) improves medical utilization, costs, and health outcomes, including cardiovascular diseases (CVDs). Methods and results: For this study, 14,246 hypertensive and 9382 diabetic patients aged 60 years or older from the Korean NHIS-HEALS cohort were included. CoC was categorized into three tertiles by disease and sex. Medical utilization and costs were compared using negative binomial regression models and Gamma regression models after adjusting for potential confounders. Cox proportional hazards regression models were constructed to examine the association between the CoC index and the health outcomes (all-cause mortality, CVDs, ischemic heart diseases [IHDs], and cerebrovascular diseases [CbVDs]). In hypertensive patients, hospitalizations decreased across both sexes and emergency room (ER) visits decreased for females with increasing CoC index. Likewise, hospitalizations and medical costs related to DM decreased with increasing CoC index for both sexes. Clinic visits for DM were lowest in T3 group for both sexes. Higher CoC was associated with a lower risk of CVDs, including IHDs and CbVDs, in patients with hypertension or diabetes, as well as with all-cause mortality in patients with diabetes in the fully adjusted model. Conclusions: Continuous care for hypertension or diabetes was inversely associated with medical utilization in patients with hypertension or DM, as well as with medical costs in patients with DM. In addition, CoC decreased CVDs in patients with hypertension or diabetes and reduced all-cause mortality in patients with diabetes.

Diabetes-dependent association between metabolic score for visceral fat and chronic kidney disease: findings from a longitudinal cohort study

2026-06-01T00:00:00Z

Title: Diabetes-dependent association between metabolic score for visceral fat and chronic kidney disease: findings from a longitudinal cohort study Authors: Kwon, Yu-Jin; Song, Youhyun; Lee, Ji-Won; Heo, Seok-Jae; Lee, Jung Eun Abstract: Aims: Metabolic dysfunction drives chronic kidney disease (CKD). Although the metabolic score for visceral fat (METS-VF) emerged as a novel marker of cardiometabolic health, its association with CKD remains unclear. We investigated the association between METS-VF and incident CKD and determined whether this relationship varies according to diabetes status. Methods: This longitudinal study analyzed data from 8,092 participants in the Korean Genome and Epidemiology Study. METS-VF was categorized into quartiles. Hazard ratios (HRs) for CKD development were estimated using Cox proportional hazards model and underwent multivariate adjustment. Results: During a mean follow-up of 12.8 years, 2,202 incident CKD cases were identified. Compared to Q1, Q4 was associated with an increased CKD risk in the unadjusted model (HR: 2.941; 95% CI: 2.591-3.339; P < 0.001) which persisted after multivariate adjustment (adjusted HR: 1.373; 95% CI: 1.201-1.571; P < 0.001). Subgroup analyses revealed the association between METS-VF and incident CKD was significant only in individuals with normoglycemia. Conclusions: Higher METS-VF was associated with increased risk of CKD development; however, it was confined to individuals with normal glucose tolerance. This suggests METS-VF may serve as an exploratory marker for stratified risk assessment for early CKD risk before the onset of glucose dysregulation, emphasizing the critical window for early metabolic intervention.

Association between dietary patterns and CAIDE-predicted dementia risk: A 20-year cohort of the Korean Genome and Epidemiology study

2026-05-01T00:00:00Z

Title: Association between dietary patterns and CAIDE-predicted dementia risk: A 20-year cohort of the Korean Genome and Epidemiology study Authors: Youn, Ji-Eun; Heo, Seok-Jae; Lee, Yae-Ji; Han, Tae-hwa; Kwon, Yu-Jin; Lee, Ji-Won Abstract: This study examined associations between dietary habits and the risk of developing Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE)-predicted late-life dementia risk in Korean adults. A total of 5,042 participants aged 40-69 years were included. We assessed associations between dietary patterns-the Mediterranean diet, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, Korean Healthy Eating Index (KHEI), and Empirical Dietary Inflammatory Index (EDII)-and CAIDE-predicted high risk of dementia. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, and cumulative incidence was assessed using Kaplan-Meier analysis. Longitudinal trajectories of CAIDE scores over a 10-year period were analyzed using linear mixed-effects models. During follow-up of 15.83 years, 30.9% progressed to CAIDE-predicted high risk of dementia. The highest tertile of the Mediterranean diet, MIND diet, and KHEI were associated with lower cumulative incidence (P = .008, P < .001, and P < .001) and reduced risk of progression to CAIDE-predicted high risk of dementia (HR 0.78, 95% CI 0.67-0.90, HR 0.80, 95% CI 0.69-0.93, and HR 0.80, 95% CI 0.70-0.91, respectively) along with lower CAIDE score (P < .001, P < .001, P = .002). Conversely, the highest EDII tertile showed the highest cumulative incidence (P < .001), an increased risk of progression to CAIDE-predicted high risk of dementia (HR 1.15, 95% CI 1.01-1.32), and elevated CAIDE scores (P < .001). Greater adherence to the Mediterranean diet, MIND diet, and KHEI, and lower consumption of pro-inflammatory diets were associated with a lower risk of high CAIDE-predicted late-life dementia and slower accumulation of risk factors.

Metabolic dysfunction-associated steatotic liver disease and incident coronary events with revascularization: A nationwide cohort study

2026-04-01T00:00:00Z

Title: Metabolic dysfunction-associated steatotic liver disease and incident coronary events with revascularization: A nationwide cohort study Authors: Kim, Minhong; Lee, Hyun-Ah; Kim, Joungyoun; Kang, Hee-Taik Abstract: Background and aims: Metabolic dysfunction-associated steatotic liver disease (MASLD), a new diagnostic category replacing non-alcoholic fatty liver disease (NAFLD), is strongly linked to cardiovascular diseases. Most previous studies defined cardiovascular outcomes broadly and relied only on diagnostic codes, limiting clinical specificity. We aimed to investigate whether MASLD, defined using the fatty liver index (FLI), is associated with an increased risk of acute coronary syndrome (ACS) and myocardial infarction (MI) with revascularization in the Korean general population. Methods: We analyzed 211,881 adults from the Korean NHIS-HEALS cohort who underwent health screening in 2009-2010. MASLD was defined using the fatty liver index (FLI >= 30) in combination with at least one metabolic risk factor, while excluding heavy alcohol intake and viral hepatitis. The primary outcomes were ACS and MI with revascularization, identified using both diagnostic and procedure codes. Cox proportional hazards models were applied, adjusting for cardiovascular, lifestyle, and socioeconomic factors. Results: Individuals with MASLD had a higher cumulative incidence of ACS and MI compared with non-MASLD. Compared to those without MASLD, fully adjusted HRs (95% CIs) for ACS with revascularization were 1.34 (1.16-1.55) and 1.35 (1.08-1.68) in men with intermediate-risk and high-risk MASLD, and 1.44 (1.16-1.79) and 1.16 (0.76-1.77) in women. A comparable association was found for MI with revascularization. Conclusions: MASLD was significantly associated with an increased risk of ACS and MI with revascularization. These findings support MASLD as an early marker and potential preventive target for atherosclerotic cardiovascular disease.