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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.

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.

Comparative Predictive Value of Three Visceral Adiposity Indices for Cardiovascular Disease: A 17.5-Year Korean Cohort Study

2026-04-01T00:00:00Z

Title: Comparative Predictive Value of Three Visceral Adiposity Indices for Cardiovascular Disease: A 17.5-Year Korean Cohort Study Authors: Cho, A-Ra; Heo, Seok-Jae; Han, Taehwa; Kwon, Yu-Jin Abstract: Aims Cardiovascular diseases (CVD) are the leading cause of death worldwide, with excess visceral adipose tissue (VAT) being identified as an independent indicator of poor cardiovascular outcomes. We examined the association between three indices of VAT, namely, metabolic score for visceral fat (METS-VF), visceral adiposity index (VAI), and lipid accumulation product (LAP), and the development of CVD in a large cohort of middle-aged Korean adults.Materials and Methods The study recruited 8192 participants without CVD at baseline from the Korean Genome and Epidemiology Study. METS-VF, VAI, and LAP were calculated using established formulas based on anthropometric and metabolic parameters. Incident CVD was defined based on self-reported physician diagnoses confirmed by trained interviewers. Multivariable Cox proportional hazard regression analyses were performed to estimate the hazard ratio (HR) with a 95% confidence interval (CI) for incident CVD. Heagerty's integrated areas under the receiver operating characteristic curves (iAUC) were used to compare the discriminatory performance of three indices.Results The adjusted HRs (95% CIs) for incident CVD in the highest tertile compared with the lowest tertile were 1.62 (1.29-2.03), 1.38 (1.08-1.77), and 1.66 (1.32-2.09) for METS-VF, VAI, and LAP, respectively. METS-VF showed statistically higher discriminatory performance than VAI and LAP for incident CVD (p < 0.001), although the overall discriminative ability of indices was modest.Conclusions METS-VF, VAI, and LAP were independently associated with an increased risk of CVD events. Among these indices, METS-VF demonstrated relatively better discriminatory performance, suggesting its potential role as a complementary tool for cardiovascular risk stratification.

Overall survival with relacorilant and nab-paclitaxel in patients with platinum-resistant ovarian cancer (ROSELLA): a phase 3 randomised controlled trial

2026-04-01T00:00:00Z

Title: Overall survival with relacorilant and nab-paclitaxel in patients with platinum-resistant ovarian cancer (ROSELLA): a phase 3 randomised controlled trial Authors: Lorusso, Domenica; Gladieff, Laurence; O'Malley, David M.; Kim, Jae-Weon; Garbaos, Gabriel; Fagotti, Anna; Gilbert, Lucy; Mileshkin, Linda; Quesada, Stanislas; Hopp, Elizabeth; Lee, Yong Jae; Oaknin, Ana; Scaranti, Mariana; Kim, Byoung-Gie; Clamp, Andrew; Prillaman, Christina; Diakos, Connie; Bagameri, Andrea; Leiser, Aliza L.; Salutari, Vanda; Monk, Bradley J.; Follana, Philippe; McClung, Emily; Carbone, Vittoria; Slomovitz, Brian; Giudice, Elena; Cannizzaro, Maria Chiara; Gavoille, Laurene; Devaux, Alix; Scollo, Paolo; Scandurra, Giuseppa; Cassani, Chiara; Artioli, Grazia; Van Gorp, Toon; Santaballa, Ana; Dreiling, Lyndah K.; Kesner-Hays, Amanda; Tudor, Julia Cristina; Jubb, Adrian M.; Colombo, Nicoletta; Olawaiye, Alexander B. Abstract: Background Relacorilant is a selective glucocorticoid receptor antagonist that increases the sensitivity of many cancer cell types to chemotherapy. The efficacy and safety of relacorilant plus nab-paclitaxel were assessed in the phase 3 ROSELLA (GOG-3073, ENGOT-ov72, APGOT-Ov10, and LACOG-0223) trial; the combination showed significant improvement in progression-free survival among patients with platinum-resistant ovarian cancer compared with nab-paclitaxel monotherapy. Results of the final overall survival analysis are reported here. Methods In this open-label phase 3 trial, patients were randomly assigned 1:1 to receive relacorilant (150 mg orally the day before, day of, and day after nab-paclitaxel infusion) plus nab-paclitaxel (80 mg/m(2) intravenously on days 1, 8, and 15 of each 28-day cycle) or nab-paclitaxel monotherapy (100 mg/m(2) intravenously on the aforementioned schedule). Patients, aged 18 years or older, with one to three lines of previous anticancer therapy and platinum-resistant disease (progression <6 months from their last dose of platinum) were eligible. The trial was conducted at 117 hospitals and community oncology centres in 14 countries across Australia, Europe, Latin America, North America, and South Korea. Progression-free survival, assessed by blinded independent central review, and overall survival (time from randomisation to death from any cause) were dual primary endpoints. Additional prespecified endpoints included safety, second progression-free survival (time from randomisation to disease progression on subsequent anticancer therapy or death due to any cause, whichever occurred first), and patient-reported outcomes. This trial is registered at ClinicalTrials.gov, NCT05257408, and is ongoing. Findings Between Jan 5, 2023, and April 8, 2024, 381 patients were randomly assigned to the relacorilant combination group (n=188) or the nab-paclitaxel monotherapy group (n=193). All patients had received bevacizumab; 167 (44%) had received three previous lines of therapy, and 234 (61%) had received a poly(ADP-ribose) polymerase inhibitor. At a median follow-up of 24 & centerdot;8 months (95% CI 23 & centerdot;6-25 & centerdot;7), the addition of relacorilant to nab-paclitaxel resulted in a statistically and clinically significant improvement in overall survival compared with nab-paclitaxel monotherapy (hazard ratio for death 0 & centerdot;65 [95% CI 0 & centerdot;51-0 & centerdot;83]; p=0 & centerdot;0004); 18-month overall survival was 46% and 27%, respectively. The median overall survival in the relacorilant combination group was extended by 4 & centerdot;1 months compared with the nab-paclitaxel monotherapy group (16 & centerdot;0 [95% CI 13 & centerdot;0-18 & centerdot;3] vs 11 & centerdot;9 months [10 & centerdot;0-13 & centerdot;8]). Subsequent anticancer treatments were similar across study groups. Adverse events were similar in both groups when adjusted for duration of study treatment. Neutropenia (121 [64%]), anaemia (115 [61%]), fatigue (101 [54%]), and nausea (82 [44%]) were the most common adverse events in the relacorilant combination group. No new safety signals were observed with additional follow-up since the primary analysis. Interpretation The addition of relacorilant to nab-paclitaxel led to significantly longer overall survival in patients with platinum-resistant ovarian cancer, without the need for biomarker selection. The findings support relacorilant plus nab-paclitaxel as a potential new standard treatment option for patients with platinum-resistant ovarian cancer.