Among young adults, the association of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) High Blood Pressure Clinical Practice Guidelines with risk of cardiovascular disease (CVD) later in life is uncertain.OBJECTIVE To determine the association of blood pressure categories before age 40 years with risk of CVD later in life.

Antibacterial and biofilm removal activity of a new podoviridae Staphylococcus aureus bacteriophage (SAP-2), which belongs to the phi29-like phage genus of the Podoviridae family, and a cell-wall-degrading enzyme (SAL-2), which is derived from bacteriophage SAP-2, have been characterized. The cell-wall-degrading enzyme SAL-2 was expressed in Escherichia coli in a soluble form using a low-temperature culture. The cell-wall-degrading enzyme SAL-2 had specific lytic activity against S. aureus, including methicillin-resistant strains, and showed a minimum inhibitory concentration of about 1 microg/ml. In addition, this enzyme showed a broader spectrum of activity within the Staphylococcus genus compared with bacteriophage SAP-2 in its ability to remove the S. aureus biofilms. Thus, the cell-wall-degrading enzyme SAL-2 can be used to prevent and treat biofilm-associated S. aureus infections either on its own or in combination with other cell-wall-degrading enzymes with anti-S. aureus activity.

IMPORTANCE Previous studies have shown a U-or J-shaped association of body mass index (BMI) or change in BMI with coronary heart disease (CHD) among middle-aged and elderly adults. However, whether a similar association exists among young adults is unclear. OBJECTIVE To determine whether an association exists between BMI or BMI change with CHD among young adults. DESIGN, SETTING, AND PARTICIPANTS This population-based longitudinal study used data obtained by the Korean National Health Insurance Service from 2002 to 2015. The study population comprised 2 611 450 men and women aged between 20 and 39 years who underwent 2 health examinations, the first between 2002 and 2003 and the second between 2004 and 2005. EXPOSURES World Health Organization Western Pacific Region guideline BMI categories of underweight, normal weight, overweight, obese grade 1, and obese grade 2 derived during the first health examination and change in BMI calculated during the second health examination. MAIN OUTCOMES AND MEASURES Body mass index (calculated as weight in kilograms divided by height in meters squared). Absolute risks (ARs), adjusted hazard ratios (aHRs), and 95% CIs for acute myocardial infarction or CHD during follow-up from 2006 to 2015. RESULTS Data from 1 802 408 men with a mean (SD) age of 35.1 (4.8) years and 809 042 women with a mean (SD) age of 32.5 (6.3) years were included. The mean (SD) BMI was 23.2 (3.2) for the total population, 24.0 (3.0) for men, and 21.4 (2.9) for women. Compared with normal weight men, overweight (AR, 1.38%; aHR, 1.18 [95% CI, 1.14-1.22]), obese grade 1 (AR, 1.86%; aHR, 1.45 [95% CI, 1.41-1.50]), and obese grade 2 (AR, 2.69%; aHR, 1.97 [95% CI, 1.86-2.08]) men had an increased risk of CHD (P < .001 for trend). Similarly, compared with normal weight women, overweight (AR, 0.77%; aHR, 1.34 [95% CI, 1.24-1.46]), obese grade 1 (AR, 0.95%; aHR, 1.52 [95% CI, 1.39-1.66]), and obese grade 2 (AR, 1.01%; aHR, 1.64 [95% CI, 1.34-2.01]) women had an increased risk of CHD (P < .001 for trend). Compared with participants who maintained their weight at normal levels, those who became obese had elevated CHD risk among men (0.35% increase in AR; aHR, 1.35 [95% CI, 1.17-1.55]) and women (0.13% increase in AR; aHR, 1.31 [95% CI, 0.95-1.82]). Weight loss to normal levels among obese participants was associated with reduced CHD risk for men (0.58% decrease in AR; aHR, 0.77 [95% CI, 0.64-0.94]) and women (0.57% decrease in AR; aHR, 0.66 [95% CI, 0.45-0.98]). CONCLUSIONS AND RELEVANCE Obesity and weight gain were associated with elevated risk of CHD among young adults in this study. Studies that prospectively determine the association between weight change and CHD risk are needed to validate these findings.

BackgroundAlthough high serum cholesterol in young adults is known to be a predictor for cardiovascular events, there is not enough evidence for the association of cholesterol level change with cardiovascular disease (CVD). This study aimed to evaluate whether the change in cholesterol is associated with incidence of CVD among young adults.Methods and ResultsWe examined 2 682 045 young adults (aged 20–39 years) who had undergone 2 consecutive national health check‐ups provided by Korean National Health Insurance Service between 2002 and 2005. Cholesterol levels were classified into low (<180 mg/dL), middle (180–240 mg/dL) and high (≥240 mg/dL). CVD events were defined as ≥2 days hospitalization attributable to CVD for 10 years follow‐up. Increased cholesterol levels were significantly associated with elevated ischemic heart disease risk (adjusted hazard ration [aHR]=1.21; 95% confidence interval [CI]=1.03–1.42 in low‐high group and aHR=1.21; 95% CI=1.15–1.27 in middle‐high group) and cerebrovascular disease (CEVD) risk (aHR=1.24; 95% CI=1.05–1.47 in low‐high group and aHR=1.09; 95% CI=1.02–1.16 in middle‐high group). Decreased cholesterol levels were associated with reduced ischemic heart disease risk (aHR=0.91; 95% CI=0.88–0.95 in middle‐low group, aHR=0.65; 95% CI=0.56–0.75 in high‐low group and aHR=0.68; 95% CI=0.65–0.73 in high‐middle group). Furthermore, lower cerebrovascular disease risk (aHR=0.76; 95% CI=0.62–0.92) was observed in the high‐low group compared with patients with sustained high cholesterol.ConclusionsThe findings of our study indicate that increased cholesterol levels were associated with high CVD risk in young adults. Furthermore, young adults with decreased cholesterol levels had reduced risk for CVD.

BackgroundAnemia is thought to increase mortality risks, but the effects of high hemoglobin concentration on survival are unclear. The effect of change in hemoglobin concentrations on survival in the general population is also unknown. This study aimed to examine the effect of hemoglobin concentrations and their changes on cardiovascular and all‐cause mortality risks.Methods and ResultsWe retrospectively analyzed a cohort from the NHIS‐HEALS (National Health Insurance Service–National Health Screening Cohort) database, including 170 078 men and 122 116 women without cardiovascular diseases, aged >40 years at baseline, with hemoglobin concentrations available for both first and second health examinations. We assessed 2 independent variables: “One‐time” hemoglobin concentrations and changes in hemoglobin from first to second examination. Participants were followed up for a median of 8 years to determine mortality related to myocardial infarction, stroke, all cardiovascular diseases, and all causes. Hemoglobin concentrations showed a U‐ or J‐shaped association with cardiovascular and all‐cause mortality after adjusting for cardiovascular risk factors. When anemic men achieved normal hemoglobin concentrations, the all‐cause mortality risk decreased, with an adjusted hazard ratio of 0.67 (95% confidence interval, 0.59–0.77), in comparison with those whose anemia persisted. Both increases and decreases of hemoglobin concentration outside the normal range elevated all‐cause mortality risk (adjusted hazard ratio: 1.39 [95% confidence interval, 1.28–1.49] and 1.10 [95% confidence interval, 1.01–1.20], respectively), compared with persistent normal hemoglobin concentrations. The trend was similar in women but was less significant.ConclusionsLow or high hemoglobin concentrations were associated with elevated cardiovascular and all‐cause mortality. Reaching and maintaining hemoglobin concentrations within the normal range correlated with decreased all‐cause mortality.

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BackgroundThe effect of change in blood glucose levels on the risk of cardiovascular disease among individuals without diabetes is currently unclear. We aimed to examine the association of change in fasting serum glucose with incident cardiovascular disease and all-cause mortality among representative large population.MethodsWe analyzed the data from retrospective cohort of Korean National Health Insurance Service. In total, 260,487 Korean adults aged over 40 years, without diabetes mellitus and cardiovascular disease at baseline measured change in fasting serum glucose according to the criteria of impaired and diabetic fasting glucose status: normal fasting glucose (NFG, fasting glucose: < 100 mg/dL), impaired fasting glucose (IFG, fasting glucose: 100.0–125.9 mg/dL), and diabetic fasting glucose (DFG, fasting glucose: ≥ 126.0 mg/dL). Compared to the persistently unchanged group (i.e. NFG to NFG or IFG to IFG), Cox proportional hazards regression analyses were performed in the changed group to obtain the hazards ratio (HR) with 95% confidence interval (CI) for the subsequent median 8-year myocardial infarction, stroke, and all-cause mortality.ResultsCompared to individuals with persistent NFG (i.e., NFG to NFG), individuals who shifted from NFG to DFG had an increased risk of stroke (HR [95% CI]: 1.19 [1.02–1.38]) and individuals who shifted from NFG to IFG or DFG had increased risks of all-cause mortality (HR [95% CI]: 1.08 [1.02–1.14] for NFG to IFG and 1.56 [1.39–1.75] for NFG to DFG). Compared to individuals with persistent IFG, individuals who shifted from IFG to DFG had an increased risk of MI and all-cause mortality (HR [95% CI]: 1.65 [1.20–2.27] and 1.16 [1.02–1.33], respectively).ConclusionsIncreasing fasting glucose in non-diabetic population is associated with risks of the MI, stroke, and all-cause mortality, which is more rapid, more severe.Electronic supplementary materialThe online version of this article (10.1186/s12933-018-0694-z) contains supplementary material, which is available to authorized users.

In spite of the high degree of amino acid sequence similarity between the newly discovered phage endolysin SAL-1 and the phage endolysin LysK, SAL-1 has an approximately 2-fold-lower MIC against several Staphylococcus aureus strains and higher bacterial cell-wall-hydrolyzing activity than LysK. The amino acid residue change contributing the most to this enhanced enzymatic activity is a change from glutamic acid to glutamine at the 114th residue.Staphylococcus aureus is a highly virulent human pathogen, and S. aureus infections are a significant cause of morbidity and mortality, particularly in settings such as hospitals, nursing homes, and infirmaries (24). In addition to the more severe consequences of contact with S. aureus, this pathogen is also responsible for many cases of food poisoning (14). Many recent isolates of S. aureus show innate resistance to currently available antibiotics (18), leading to challenges in managing S. aureus infections.Since the discovery of bacteriophages, their destructive effect on their host organisms has been exploited as a way of treating infectious bacteria (10). In addition, phage endolysins, also termed lysins, have been proposed as potent antibacterial agents (15,17). Phage endolysins derived from bacteriophages are bacteriophage-encoded peptidoglycan hydrolases that have evolved to rapidly break down the bacterial cell wall, thereby allowing the release of phage progeny (30). Many phage endolysins have shown promise in preclinical trials involving animal models of human diseases (3,5,7,16,20,27), and they thus constitute a promising route for the discovery and development of novel antibacterial therapeutic agents.The phage endolysin LysK from staphylococcal phage K (22) is a valuable endolysin due to its broad-spectrum activity against the staphylococcal genus (23). A large number of articles have been published about this phage endolysin (2, 6, 11) due to its potency and promise as an antibacterial agent.The present study was prompted by the serendipitous observation that phage endolysin SAL-1, derived from the bacteriophage SAP-1 recently isolated in our laboratory, had a significantly lower MIC than phage endolysin LysK in spite of the high level of amino acid sequence similarity between the two proteins. Based on sequencing studies, we determined that phage endolysin SAL-1 only differs from LysK at three residues: isoleucine instead of valine at the 26th residue, glutamine instead of glutamic acid at the 114th residue, and histidine instead of glutamine at the 486th residue.This article describes a comparative study of the newly discovered phage endolysin SAL-1 and the well-studied phage endolysin LysK.An S. aureus bacteriophage was isolated from an environmental sample by a conventional method (29) and designated bacteriophage SAP-1. The gene encoding the endolysin of bacteriophage SAP-1 was identified by comparison with reported sequences and subcloned into the pBAD-TOPO vector (Invitrogen, Carlsbad, CA) by conventional PCR cloning methods. Escherichia coli TOP10 (I...