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Original Articles
Hematological inflammatory indices and their relationship to the risk of hypertension
Ju Young Jung, Chang-Mo Oh, Jae-Hong Ryoo, Sung Keun Park
Epidemiol Health. 2026;48:e2026008.   Published online February 4, 2026
DOI: https://doi.org/10.4178/epih.e2026008
  • 1,260 View
  • 46 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Chronic inflammation has been implicated in the development of hypertension in numerous previous studies. However, evidence regarding the association between hematological inflammatory indices derived from complete blood count tests and the long-term risk of hypertension remains limited. Therefore, this study aimed to investigate the association between various hematological inflammatory indices and the risk of incident hypertension in a large cohort study.
METHODS
We analyzed data from a large Korean cohort (n=128,241). The incident risk of hypertension was evaluated according to quartiles of the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI) using Cox proportional hazards models. Additional analyses were conducted for high-sensitivity C-reactive protein (hsCRP) levels and stratified by gender.
RESULTS
During a median follow-up of 6.8 years, 18,503 participants (14.4%) developed hypertension. Higher quartiles of SII, SIRI, and NLR were significantly associated with an increased risk of incident hypertension in both genders. PLR showed a clearer positive association in women, whereas MLR demonstrated only marginal associations. These patterns were consistent with the associations observed for hsCRP.
CONCLUSIONS
These findings suggest that elevated hematological inflammatory indices above certain thresholds are associated with an increased risk of hypertension, even among young and generally healthy individuals.
Summary
Korean summary
특정 수치 이상의 혈액학적 염증 지표들은 증가한 고혈압의 위험과 관련되었다. SII, SIRI, NLR은 남성과 여성 모두에서 고혈압의 발생 위험과 용량-반응 관계(dose–response relationship)를 나타내었다. 혈액학적 염증 지표들은 아마도 고혈압의 위험 예측에 유용한 지표로 사용될 수 있을 것이다.
Key Message
Hematological inflammatory indices (SII, SIRI, NLR, MLR, and PLR) above specific values were associated with the increased risk of incident hypertension. SII, SIRI, and NLR showed dose–response relationships with the risk of hypertension in both men and women. Hematological inflammatory indices may serve as accessible markers for the risk stratification of hypertension.
Predictive ability of the Chinese visceral adiposity index for incident hypertension in working-aged Koreans
Ju Young Jung, Chang-Mo Oh, Hyun chul Jo, Sung Keun Park
Epidemiol Health. 2024;46:e2024034.   Published online February 27, 2024
DOI: https://doi.org/10.4178/epih.e2024034
  • 18,059 View
  • 167 Download
  • 10 Web of Science
  • 9 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The Chinese visceral adiposity index (CVAI) was developed to assess visceral adipose tissue in the Asian population. This study evaluated the predictive ability of the CVAI for incident hypertension in Korean adults.
METHODS
The study participants included 128,577 Koreans without hypertension. They were grouped in quartiles according to body mass index (BMI), waist circumference (WC), visceral adipose index (VAI), and CVAI values. The Cox proportional hazard assumption was used to evaluate the hazard ratio (HR) and 95% confidence interval (CI) for incident hypertension (adjusted HR [95% CI]) according to quartile level across a follow-up period of 6.9 years. Subgroup analyses were conducted by gender and obesity. The area under the curve was calculated to compare the predictive abilities of all indices (BMI, WC, VAI, and CVAI) for incident hypertension.
RESULTS
The CVAI was proportionally associated with the risk of hypertension in all participants (quartile 1: reference; quartile 2: 1.71 [95% CI, 1.59 to 1.82]; quartile 3: 2.41 [95% CI, 2.25 to 2.58]; and quartile 4: 3.46 [95% CI, 3.23 to 3.71]). Time dependent receiver operating characteristic curve analysis indicated that the CVAI was superior to BMI, WC, and VAI in predicting hypertension at the 2-year, 4-year, 6-year, and 8-year follow-ups. This finding was also observed in the gender and obesity subgroups. The predictive ability of the CVAI was greater in the women and non-obese subgroups than in the men and obese subgroups.
CONCLUSIONS
The CVAI was a stronger predictor of hypertension than BMI, WC, and VAI.
Summary
Korean summary
고혈압은 심혈관 질환의 주요 원인이다. 내장 지방은 비만에서 고혈압의 병태 생리에 중요한 역할을 한다. 최근의 연구는 Chinese visceral adiposity index (CVAI)가 다른 비만 지표 보다 아시아 인에서 심혈관 질환의 고 위험군을 더욱 잘 구분해 낸다는 것을 보고하였다. 우리는 체질량 지수, 허리 둘레, visceral adiposity index, CVAI의 고혈압에 대한 예측력을 비교 하였다. 우리의 연구는 CVAI가 고혈압을 예측하는데 있어 다른 지표 보다 우월하다는 것을 보여주었다.
Key Message
Hypertension is a leading risk factor for cardiovascular disease. It is known that visceral adiposity has an important role in the pathogenesis of hypertension in obesity. Recent studies have demonstrated that Chinese visceral adiposity index (CVAI) is more discriminative the high risk group for cardiovascular disease in Asians than other obesity indices. We compared the predictive ability for the development hypertension among body mass index, waist circumference, visceral adiposity index, and CVAI. Our study showed that CVAI is superior to predict hypertension than other indices.

Citations

Citations to this article as recorded by  
  • Hematological inflammatory indices and Long-Term risk of depressive symptoms: a korean cohort study
    Ju Young Jung, Chang-Mo Oh, Jae-Hong Ryoo, Yeongu Chung, Sung Keun Park
    The World Journal of Biological Psychiatry.2026; 27(2): 135.     CrossRef
  • Chinese visceral adiposity index as stronger predictor of hypertension and prehypertension in middle-aged and elderly Chinese adults: A comparative analysis with conventional adiposity indices
    Zhenzhen Qin, Jie Wu, Qing Ye, Shengxiang Qi, Yijia Chen, Chenchen Wang, Xin Hong
    Nutrition, Metabolism and Cardiovascular Diseases.2026; 36(4): 104471.     CrossRef
  • Assessment of six surrogate insulin resistance indexes for predicting hypertension risk in rural Chinese adults
    Ge Liu, Lu Cao, Hongwei Wen, Mengna Liu, Xinxin He, Mengdi Wang, Yijia Su, Fan Xu, Jingli Kong, Canjie Piao, Aijun Xu, Ming Zhang, Fulan Hu, Dongsheng Hu, Yang Zhao
    Hypertension Research.2025; 48(4): 1285.     CrossRef
  • Association of long working hours with visceral adiposity index, anthropometric indices, and weight management behaviors: a study of Korean workers
    Seong-Uk Baek, Jin-Ha Yoon
    Family Practice.2025;[Epub]     CrossRef
  • Association of physical fitness with visceral fat status and metabolic dysfunction-associated fatty liver disease in individuals with spinal cord injury using manual wheelchair in Korea
    Minjun Kim, Inhwan Lee
    Preventive Medicine Reports.2025; 57: 103182.     CrossRef
  • Chinese visceral adiposity index predicts all-cause mortality in patients with type 2 diabetes, heart failure, and chronic kidney disease: a retrospective cohort study
    Xiang Zhao, Dan Zhang, Bing Zhu, Yuanhao Yao, Lingxiao Geng, Xiang Ma, Zhenyan Fu, Yitong Ma
    BMC Research Notes.2025;[Epub]     CrossRef
  • Association of traditional and novel obesity indicators with stroke risk: Findings from the Rural Chinese cohort study
    Dongdong Zhang, Weifeng Huo, Weiling Chen, Xi Li, Pei Qin, Ming Zhang, Jing Li, Xizhuo Sun, Yu Liu, Dongsheng Hu
    Nutrition, Metabolism and Cardiovascular Diseases.2024; 34(9): 2065.     CrossRef
  • Comparison of obesity indicators for predicting cardiovascular risk factors and multimorbidity among the Chinese population based on ROC analysis
    Xiang Feng, Jinhua Zhu, Zhaolai Hua, Shenghua Yao, Haiyuan Tong
    Scientific Reports.2024;[Epub]     CrossRef
  • Impact of Chinese visceral adiposity index on all-cause mortality risk in community-dwelling older adults: a prospective cohort study
    Yuyu Zhang, Mingyue Shi, Zhao Dong, Tingting Li, Yangfan Gong, Wei Ge
    Aging Clinical and Experimental Research.2024;[Epub]     CrossRef
Changes in proteinuria and the associated risks of ischemic heart disease, acute myocardial infarction, and angina pectoris in Korean population
Sung Keun Park, Ju Young Jung, Min-Ho Kim, Chang-Mo Oh, Eunhee Ha, Eun Hye Yang, Hyo Choon Lee, Soonsu Shin, Woo Yeon Hwang, Sangho Lee, So Youn Shin, Jae-Hong Ryoo
Epidemiol Health. 2023;45:e2023088.   Published online September 30, 2023
DOI: https://doi.org/10.4178/epih.e2023088
  • 14,199 View
  • 194 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Proteinuria is widely used to predict cardiovascular risk. However, there is insufficient evidence to predict how changes in proteinuria may affect the incidence of cardiovascular disease.
METHODS
The study included 265,236 Korean adults who underwent health checkups in 2003-2004 and 2007-2008. They were categorized into 4 groups based on changes in proteinuria (negative: negative → negative; resolved: proteinuria ≥1+ → negative; incident: negative → proteinuria ≥1+; persistent: proteinuria ≥1+ → proteinuria ≥1+). We conducted 6 years of follow-up to identify the risks of developing ischemic heart disease (IHD), acute myocardial infarction (AMI), and angina pectoris according to changes in proteinuria. A multivariate Cox proportional-hazards model was used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident IHD, AMI, and angina pectoris.
RESULTS
The IHD risk (expressed as HR [95% CI]) was the highest for persistent proteinuria, followed in descending order by incident and resolved proteinuria, compared with negative proteinuria (negative: reference, resolved: 1.211 [95% CI, 1.104 to 1.329], incident: 1.288 [95% CI, 1.184 to 1.400], and persistent: 1.578 [95% CI, 1.324 to 1.881]). The same pattern was associated with AMI (negative: reference, resolved: 1.401 [95% CI, 1.048 to 1.872], incident: 1.606 [95% CI, 1.268 to 2.035], and persistent: 2.069 [95% CI, 1.281 to 3.342]) and angina pectoris (negative: reference, resolved: 1.184 [95% CI, 1.065 to 1.316], incident: 1.275 [95% CI, 1.160 to 1.401], and persistent: 1.554 [95% CI, 1.272 to 1.899]).
CONCLUSIONS
Experiencing proteinuria increased the risks of IHD, AMI, and angina pectoris even after proteinuria resolved.
Summary
Korean summary
- 본 연구의 목적은 요 시험지 검사를 통해 확인된 단백뇨의 3-5년간의 변화 수준에 따른 허혈성 심질환, 급성 심근 경색, 협심증의 발생 위험을 평가하는 것이다. - 지속적으로 단백뇨가 음성인 집단에 (negative proteinuria) 비해서, 단백뇨가 있었다 사라진 집단 (resolved proteinuria), 새로이 단백뇨가 생긴 집단 (incident proteinuria), 지속적으로 단백뇨가 존재하는 집단 (persistent proteinuria)은 유의하게 증가한 허혈성 심질환, 급성 심근 경색, 협심증의 발생 위험을 나타내었다. - 이러한 결과는 단백뇨가 일단 발생한 사람은, 나중에 사라지더라도, 관상 동맥 질환에 대한 위험이 높으며, 이에 대한 관리와 주의가 필요하다는 것을 시사한다.
Key Message
- The present study was to evaluate the risk of incident ischemic heart disease, acute myocardial infarction, and angina pectoris according to changes in urine dipstick proteinuria over 3-5 years. - Compared with persistently negative proteinuria (negative → negative), resolved proteinuria (positive → negative), incident proteinuria (negative → positive), and persistent proteinuria (positive → positive) had the increased risk of ischemic heart disease, acute myocardial infarction, and angina pectoris. - These results suggest that once manifested proteinuria lead to the increased risk of coronary artery disease, regardless of changes in proteinuria.

Citations

Citations to this article as recorded by  
  • Frequency and sequence of proteinuria positivity and clinical outcomes in patients with diabetes: A nationwide cohort study
    Junseok Jeon, Kyungho Lee, Jung Eun Lee, Wooseong Huh, Kyungdo Han, Hye Ryoun Jang
    Diabetes, Obesity and Metabolism.2025; 27(6): 3274.     CrossRef
  • Changes in proteinuria and the risk of urogenital cancer in Korean men
    Dong-Young Lee, Min-Ho Kim, Eunhee Ha, Soonsu Shin, Sungjin Kim, Dosang Cho, Ah Rah Lee, Jae-Hong Ryoo
    Maturitas.2025; 203: 108754.     CrossRef
The influence of the dietary intake of vitamin C and vitamin E on the risk of gastric intestinal metaplasia in a cohort of Koreans
Sung Keun Park, Yeongu Chung, Chang-Mo Oh, Jae-Hong Ryoo, Ju Young Jung
Epidemiol Health. 2022;44:e2022062.   Published online July 29, 2022
DOI: https://doi.org/10.4178/epih.e2022062
  • 23,572 View
  • 218 Download
  • 6 Web of Science
  • 5 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Studies have suggested that the dietary intake of antioxidant vitamins, such as vitamin C and vitamin E, has a potential role in inhibiting gastric carcinogenesis. The present study investigated the effect of antioxidant vitamins on the incidence of gastric intestinal metaplasia (GIM).
METHODS
This study included 67,657 Koreans free of GIM who periodically underwent health check-ups. Dietary intake was assessed by a semiquantitative food frequency questionnaire based on the Korean National Health and Nutrition Examination Survey. Participants were categorized into 4 groups by quartiles of dietary vitamin C and vitamin E intake. The Cox proportional hazard assumption was used to determine the multivariable hazard ratio (HR) and 95% confidence interval (95% CI) for GIM.
RESULTS
The third and fourth quartiles of vitamin C intake had a lower risk of GIM than the first quartile (multivariable-adjusted HR, 0.95; 95% CI, 0.88 to 1.03 in the second quartile, HR, 0.88; 95% CI, 0.81 to 0.97 in the third quartile, and HR, 0.85; 95% CI, 0.76 to 0.95 in the fourth quartile). Vitamin E intake greater than the second quartile level was significantly associated with a lower risk of GIM than the first quartile (multivariable-adjusted HR, 0.90; 95% CI, 0.82 to 0.97 in the second quartile, HR, 0.90; 95% CI, 0.82 to 0.99 in the third quartile, and HR, 0.83; 95% CI, 0.74 to 0.94 in the fourth quartile). This association was observed only in the subgroup analysis for men.
CONCLUSIONS
Higher dietary intake of vitamin C and vitamin E was associated with a lower risk of GIM.
Summary
Korean summary
본 연구에서는 6만명 이상의 한국인을 대상으로 비타민 C와 비타민 E의 섭취량과 장기적인 위 장상피화생 (GIM) 발생 위험도의 상관 관계를 연구했다. 우리는 비타민 C와 E 섭취량이 많은 근로 연령대의 한국인에서 낮은 위 장상피화생 발생 위험을 확인했다. 이 연관성은 여성보다 남성에서 더 분명하게 나타났다.
Key Message
1. This study investigated the long-term effect of vitamin C and vitamin E intake on the longitudinal risk of GIM in more than 60,000 Koreans 2. We found increased intake of Vitamin C/E is associated with lower incidental risk of GIM in working aged Korean. 3. This association was more prominent in men than women.

Citations

Citations to this article as recorded by  
  • A review of potential mechanisms and treatments of gastric intestinal metaplasia
    Yueyao Wu, Kehan Zhang, Yichao Zheng, Haifeng Jin
    European Journal of Gastroenterology & Hepatology.2025; 37(4): 383.     CrossRef
  • Intake of sodium and potassium, sodium-potassium intake ratio, and their relation to the risk of diabetes mellitus
    Sung Keun Park, Chang-Mo Oh, Jae-Hong Ryoo, Ju Young Jung
    Scientific Reports.2025;[Epub]     CrossRef
  • Dietary Intake of Antioxidant Vitamins and Its Relation to the Progression of Chronic Kidney Disease in Adults With Preserved Renal Function
    Sung Keun Park, Chang-Mo Oh, Eugene Kim, Ju Young Jung
    Journal of Renal Nutrition.2024; 34(5): 438.     CrossRef
  • The Clinical Implication of Nocturia in Predicting Hypertension Among Working-Aged Koreans
    Sung Keun Park, Chang-Mo Oh, Jae-Hong Ryoo, Hyun chul Jo, Eugene Kim, Ju Young Jung
    American Journal of Hypertension.2024; 37(12): 962.     CrossRef
  • Longitudinal analysis for the risk of depression according to the consumption of sugar-sweetened carbonated beverage in non-diabetic and diabetic population
    Sung Keun Park, Yeongu Chung, Yoosoo Chang, Chang-Mo Oh, Jae-Hong Ryoo, Ju Young Jung
    Scientific Reports.2023;[Epub]     CrossRef
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