Risk of Heart Disease in Patients With Amputation: A Nationwide Cohort Study in South Korea

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Abstract

Background

Amputation confers disabilities upon patients and is linked to substantial morbidity and death attributed to heart disease. While some studies have focused on traumatic amputees in veterans, few studies have focused on traumatic amputees within the general population. Therefore, the present study aimed to assess the risk of heart disease in patients with traumatic amputation with disability within the general population using a large‐scale nationwide population‐based cohort.

Methods and Results

We used data from the Korean National Health Insurance System. A total of 22 950 participants with amputation were selected with 1:3 age, sex‐matched controls between 2010 and 2018. We used Cox proportional hazard models to calculate the risk of myocardial infarction, heart failure, and atrial fibrillation among amputees. Participants with amputation had a higher risk of myocardial infarction (adjusted hazard ratio [aHR], 1.30 [95% CI, 1.14–1.47]), heart failure (aHR, 1.27 [95% CI, 1.17–1.38]), and atrial fibrillation (aHR, 1.17 [95% CI, 1.03–1.33]). The risks of myocardial infarction and heart failure were further increased by the presence of disability (aHR, 1.43 [95% CI, 1.04–1.95]; and aHR, 1.38 [95% CI, 1.13–1.67], respectively).

Conclusions

We demonstrate an increased risk of myocardial infarction, heart failure, and atrial fibrillation among individuals with amputation, and the risk further increased in those with disabilities. Clinicians should pay attention to the increased risk for heart disease in patients with amputation.

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Most cited references 54

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Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS).

Andreas Festa, Ralph D’Agostino, George Howard … (2000)

Inflammation has been suggested as a risk factor for the development of atherosclerosis. Recently, some components of the insulin resistance syndrome (IRS) have been related to inflammatory markers. We hypothesized that insulin insensitivity, as directly measured, may be associated with inflammation in nondiabetic subjects. We studied the relation of C-reactive protein (CRP), fibrinogen, and white cell count to components of IRS in the nondiabetic population of the Insulin Resistance Atherosclerosis Study (IRAS) (n=1008; age, 40 to 69 years; 33% with impaired glucose tolerance), a multicenter, population-based study. None of the subjects had clinical coronary artery disease. Insulin sensitivity (S(I)) was measured by a frequently sampled intravenous glucose tolerance test, and CRP was measured by a highly sensitive competitive immunoassay. All 3 inflammatory markers were correlated with several components of the IRS. Strong associations were found between CRP and measures of body fat (body mass index, waist circumference), S(I), and fasting insulin and proinsulin (all correlation coefficients >0.3, P<0.0001). The associations were consistent among the 3 ethnic groups of the IRAS. There was a linear increase in CRP levels with an increase in the number of metabolic disorders. Body mass index, systolic blood pressure, and S(I) were related to CRP levels in a multivariate linear regression model. We suggest that chronic subclinical inflammation is part of IRS. CRP, a predictor of cardiovascular events in previous reports, was independently related to S(I). These findings suggest potential benefits of anti-inflammatory or insulin-sensitizing treatment strategies in healthy individuals with features of IRS.

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Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study

Annika Rosengren, Steven Hawken, Stephanie Ounpuu … (2004)

Psychosocial factors have been reported to be independently associated with coronary heart disease. However, previous studies have been in mainly North American or European populations. The aim of the present analysis was to investigate the relation of psychosocial factors to risk of myocardial infarction in 24767 people from 52 countries. We used a case-control design with 11119 patients with a first myocardial infarction and 13648 age-matched (up to 5 years older or younger) and sex-matched controls from 262 centres in Asia, Europe, the Middle East, Africa, Australia, and North and South America. Data for demographic factors, education, income, and cardiovascular risk factors were obtained by standardised approaches. Psychosocial stress was assessed by four simple questions about stress at work and at home, financial stress, and major life events in the past year. Additional questions assessed locus of control and presence of depression. People with myocardial infarction (cases) reported higher prevalence of all four stress factors (p<0.0001). Of those cases still working, 23.0% (n=1249) experienced several periods of work stress compared with 17.9% (1324) of controls, and 10.0% (540) experienced permanent work stress during the previous year versus 5.0% (372) of controls. Odds ratios were 1.38 (99% CI 1.19-1.61) for several periods of work stress and 2.14 (1.73-2.64) for permanent stress at work, adjusted for age, sex, geographic region, and smoking. 11.6% (1288) of cases had several periods of stress at home compared with 8.6% (1179) of controls (odds ratio 1.52 [99% CI 1.34-1.72]), and 3.5% (384) of cases reported permanent stress at home versus 1.9% (253) of controls (2.12 [1.68-2.65]). General stress (work, home, or both) was associated with an odds ratio of 1.45 (99% CI 1.30-1.61) for several periods and 2.17 (1.84-2.55) for permanent stress. Severe financial stress was more typical in cases than controls (14.6% [1622] vs 12.2% [1659]; odds ratio 1.33 [99% CI 1.19-1.48]). Stressful life events in the past year were also more frequent in cases than controls (16.1% [1790] vs 13.0% [1771]; 1.48 [1.33-1.64]), as was depression (24.0% [2673] vs 17.6% [2404]; odds ratio 1.55 [1.42-1.69]). These differences were consistent across regions, in different ethnic groups, and in men and women. Presence of psychosocial stressors is associated with increased risk of acute myocardial infarction, suggesting that approaches aimed at modifying these factors should be developed.

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Psychosocial factors and cardiovascular diseases.

Susan Everson-Rose, Tené Lewis (2005)

Rapidly accruing evidence from a diversity of disciplines supports the hypothesis that psychosocial factors are related to morbidity and mortality due to cardiovascular diseases. We review relevant literature on (a) negative emotional states, including depression, anger and hostility, and anxiety; (b) chronic and acute psychosocial stressors; and (c) social ties, social support, and social conflict. All three of these psychosocial domains have been significantly associated with increased risk of cardiovascular morbidity and mortality. We also discuss critical pathophysiological mechanisms and pathways that likely operate in a synergistic and integrative way to promote atherogenesis and related clinical manifestations. We conclude by discussing some of the important challenges and opportunities for future investigations.

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Author and article information

Contributors

Kyungdo Han:

ORCID: https://orcid.org/0000-0002-6096-1263

hkd917@naver.com

Dong Wook Shin:

ORCID: https://orcid.org/0000-0001-8128-8920

dwshin.md@gmail.com

Journal

Journal ID (nlm-ta): J Am Heart Assoc

Journal ID (iso-abbrev): J Am Heart Assoc

Journal ID (doi): 10.1002/(ISSN)2047-9980

Journal ID (publisher-id): JAH3

Journal ID (hwp): ahaoa

Title: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2047-9980

Publication date (Electronic): 10 May 2024

Publication date Collection: 21 May 2024

Volume: 13

Issue: 10 ( doiID: 10.1002/jah3.v13.10 )

Electronic Location Identifier: e033304

Affiliations

[ ¹ ] Department of Family Medicine/Executive Healthcare Clinic Severance Hospital, Yonsei University College of Medicine Seoul South Korea

[ ² ] Department of Clinical Research Design & Evaluation Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University Seoul Republic of Korea

[ ³ ] Department of Family Medicine Healthcare System Gangnam Center, Seoul National University Hospital Seoul Republic of Korea

[ ⁴ ] Department of Family Medicine Seoul National University College of Medicine Seoul Republic of Korea

[ ⁵ ] Department of Family Medicine/Supportive Care Center, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea

[ ⁶ ] Department of Medical Statistics The Catholic University of Korea Seoul Republic of Korea

[ ⁷ ] Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea

[ ⁸ ] Division of Cardiology Seoul National University Hospital Healthcare System Gangnam Center Seoul Republic of Korea

[ ⁹ ] Department of Statistics and Actuarial Science Soongsil University Seoul Republic of Korea

Author notes

[*] [* ] Correspondence to: Kyungdo Han, PhD, Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo‐ro, Dongjak‐gu, Seoul 06978, Republic of Korea. Email: hkd917@ 123456naver.com

Dong Wook Shin, MD, DrPH, MBA, Department of Family Medicine/Supportive Care Center, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Republic of Korea and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 81 Irwon‐Ro, Gangnam‐gu, Seoul 06351, Republic of Korea. Email: dwshin.md@ 123456gmail.com

[*]

H. L. Choi and J. E. Yoo contributed equally.

Author information

Hea Lim Choi https://orcid.org/0000-0001-9021-5870

Jung Eun Yoo https://orcid.org/0000-0001-8344-6291

Miso Kim https://orcid.org/0000-0001-7824-1056

Bongsung Kim https://orcid.org/0000-0002-1022-3553

Junhee Park https://orcid.org/0000-0003-3780-6844

Won Hyuk Chang https://orcid.org/0000-0002-4969-7895

Heesun Lee https://orcid.org/0000-0003-4037-3955

Kyungdo Han https://orcid.org/0000-0002-6096-1263

Dong Wook Shin https://orcid.org/0000-0001-8128-8920

Article

Publisher ID: JAH39640 Other ID: JAHA/2023/033304

DOI: 10.1161/JAHA.123.033304

PMC ID: 11179827

PubMed ID: 38726914

SO-VID: 1745a39a-12ae-49a6-a916-067b710f0451

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date received : 26 October 2023

Date accepted : 08 April 2024

Page count

Figures: 2, Tables: 3, Pages: 10, Words: 6500

Custom metadata

source-schema-version-number 2.0

cover-date 21 May 2024

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.4.3 mode:remove_FC converted:23.05.2024

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: amputation,cohort studies,heart diseases,cardiovascular disease,risk factors

Data availability:

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: amputation, cohort studies, heart diseases, cardiovascular disease, risk factors

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Risk of Heart Disease in Patients With Amputation: A Nationwide Cohort Study in South Korea

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Abstract

Background

Methods and Results

Conclusions

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Cardiovascular Innovations and Applications

Most cited references 54

Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS).

Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study

Psychosocial factors and cardiovascular diseases.

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