Annals of Occupational and Environmental Medicine

Original Articles

The relationship between skeletal muscle mass and the KOSHA cardiovascular risk in obese male workers: Hyo Won Chong, JunSeok Son, Changho Chae, Changho Jae; Ann Occup Environ Med 2023;35:e40. Published online October 4, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e40

Abstract Abstract in Korean PDF PubReader ePub: Background
Efforts for the prevention and management of cardiovascular diseases (CVDs) in workers have been actively pursued. Obesity is one of the important risk factors related to CVDs. Obesity has various metabolic characteristics, and some individuals can be metabolically healthy. Body composition including skeletal muscle mass is known to have protective effect in obesity. The study aims to investigate the association between skeletal muscle mass and Korea Occupational Safety and Health Agency (KOSHA) CVD risk among obese male manufacturing workers in Korea and to identify appropriate indicators of skeletal muscle mass for predicting risk of CVDs.
Methods
The study was conducted on 2,007 obese male workers at a manufacturing industry aged more than 19 years. Skeletal muscle mass, skeletal muscle index (SMI), skeletal muscle mass percent (SMM%) and skeletal muscle to body fat ratio (MFR) were used to evaluate body composition and these indicators were divided into quartiles. The odds ratios (ORs) and 95% confidence intervals (CIs) for the KOSHA CVD risk groups according to quartiles of skeletal muscle mass indicators were estimated using ordinal logistic regression analysis.
Results
The OR for the KOSHA CVD risk groups in the highest quartile of SMI was 1.67 (95% CI: 1.42–1.92), while the ORs for the KOSHA CVD risk groups in the highest quartiles of SMM%, SMM/body mass index (BMI), and MFR were 0.47 (95% CI: 0.22–0.72), 0.51 (95% CI: 0.05–0.76), and 0.48 (95% CI: 0.23–0.74), respectively.
Conclusions
We found that high SMI increase the likelihood of high risk of CVDs, while high SMM%, SMM/BMI, and MFR lower the likelihood of high risk of CVDs. Accurate evaluation of skeletal muscle mass can help assess the cardiovascular risk in obese male workers.; 비만 남성 근로자에서 골격근량과 KOSHA 심혈관질환 위험도와의 연관성
목적
근로자의 심혈관질환의 예방과 사후관리를 위한 노력이 활발이 이루어지고 있다. 비만은 심혈관질환과 관련한 중요한 위험인자로 알려져 있다. 비만은 다양한 대사 특성을 나타내며 일부는 대사적으로 건강하다. 기전 중 하나로 골격근량을 포함한 체성분 구성의 대사적 보호 효과가 알려져 있다. 본 연구를 통해 국내 제조업 비만 남성 근로자를 대상으로 골격근량과 KOSHA 심혈관질환 위험도 간의 연관성을 확인하고, 심혈관질환 위험도를 예측할 수 있는 적절한 골격근량 지표를 확인하고자 하였다.
방법
제조업에 근무하는 19세 이상의 비만 남성 근로자 2,007명을 대상으로 연구를 진행하였다. 체성분을 평가하기 위해 골격근량, skeletal muscle index (SMI), skeletal muscle mass percent (SMM%) 및 skeletal muscle to body fat ratio (MFR) 지표를 사용하였으며 4분위수로 나누었다. 순서형 로지스틱 회귀분석을 시행하여 골격근량 지표의 사분위수에 대한 KOSHA 심혈관질환 위험도의 교차비와 95% 신뢰구간을 산출하였다.
결과
순서형 로지스틱 회귀분석을 시행한 결과, SMI 의 높은 사분위수에서 심혈관질환 위험군의 교차비는 1.67 (95% CI, 1.42-1.92) 으로 나타났다. SMM%, SMM/BMI 및 MFR 의 높은 사분위수에서 MHO 군의 심혈관질환 위험군의 교차비는 각각 0.47 (95% CI, 0.22-0.72), 0.51 (95% CI, 0.05-0.76), 및 0.48 (95% CI, 0.23-0.74) 으로 나타났다.
결론
본 연구에서 높은 SMI 에서 KOSHA 심혈관질환 위험도가 높게 나타날 가능성이 높으며, 높은 SMM%, SMM/BMI 및 MFR 에서 KOSHA 심혈관질환 위험도가 높게 나타날 가능성이 낮았다. 정확한 골격근량의 평가는 비만 남성 근로자의 심혈관질환 위험도를 가늠하는데 도움이 될 것으로 보인다.

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Comparing Korea Occupational Safety & Health Agency and National Health Insurance Service’s cardio-cerebrovascular diseases risk-assessment tools using data from one hospital’s health checkups: Yunrae Cho, Dong Geon Kim, Byung-Chan Park, Seonhee Yang, Sang Kyu Kim; Ann Occup Environ Med 2023;35:e35. Published online August 21, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e35

Abstract Abstract in Korean PDF PubReader ePub: Background
Cardio-cerebrovascular diseases (CVDs) are the most common cause of death worldwide. Various CVD risk assessment tools have been developed. In South Korea, the Korea Occupational Safety & Health Agency (KOSHA) and the National Health Insurance Service (NHIS) have provided CVD risk assessments with health checkups. Since 2018, the KOSHA guide has stated that NHIS CVD risk assessment tool could be used as an alternative of KOSHA assessment tool for evaluating CVD risk of workers. The objective of this study was to determine the correlation and agreement between the KOSHA and the NHIS CVD risk assessment tools.
Methods
Subjects of this study were 17,485 examinees aged 20 to 64 years who had undergone medical examinations from January 2021 to December 2021 at a general hospital. We classified subjects into low-risk, moderate-risk, high-risk, and highest-risk groups according to KOSHA and NHIS’s CVD risk assessment tools. We then compared them with cross-analysis, Spearman correlation analysis, and linearly weighted kappa coefficient.
Results
The correlation between KOSHA and NHIS tools was statistically significant (p-value < 0.001), with a correlation coefficient of 0.403 and a kappa coefficient of 0.203. When we compared risk group distribution using KOSHA and NHIS tools, CVD risk of 6,498 (37.1%) participants showed a concordance. Compared to the NHIS tool, the KOSHA tool classified 9,908 (56.7%) participants into a lower risk category and 1,079 (6.2%) participants into a higher risk category.
Conclusions
In this study, KOSHA and NHIS tools showed a moderate correlation with a fair agreement. The NHIS tool showed a tendency to classify participants to higher CVD risk group than the KOSHA tool. To prevent CVD more effectively, a higher estimation tool among verified CVD risk assessment methods should be selected and managements such as early intervention and treatment of risk factors should be performed targeting the high-risk group.; 일개 병원 건강검진 자료를 이용한 한국산업안전보건공단과 건강보험공단의 심뇌혈관질환 위험도 평가의 비교
목적
심뇌혈관질환은 전 세계적으로 가장 많은 사망원인으로, 국내외에서 다양한 위험도 예측모형이 개발되었다. 국내에서는 한국산업안전보건공단의 뇌심혈관계질환 발병위험도 평가와 건강보험공단의 심뇌혈관질환 위험 평가가 있으며, 국가건강검진과 함께 제공되고 있다. 한국산업안전보건공단은 2018년부터 건강보험공단의 심뇌혈관질환 위험 평가의 결과를 평가에 이용할 수 있도록 하고 있어, 두가지 위험도 평가도구를 비교하고 그 상관관계와 일치도를 확인하고자 하였다.
방법
이 연구는 경주의 일개 종합병원에서 2021년 1월부터 12월까지 건강검진을 시행한 17,485명의 수검자를 대상으로 하였다. 건강검진 결과를 이용하여 한국산업안전보건공단와 건강보험공단의 지침에 따라 위험도 평가를 실시하였으며, 저위험군, 중등도위험군, 고위험군, 최고위험군으로 분류하였다. 이후 각각의 위험도 평가에 따른 위험군에 대하여 교차분석 및 스피어만 상관분석, 그리고 선형가중카파를 이용한 일치도 분석을 실시하였다.
결과
한국산업안전보건공단과 건강보험공단의 위험도 평가도구의 상관관계와 일치도는 통계적으로 유의하게 나타났고(p-value < 0.001), 상관계수는 0.403, 카파계수는 0.203으로 나타났다. 두가지 도구의 위험군 분포를 비교하였을 때, 6,498명(37.2%)는 동일한 위험군으로 평가되었다. 건강보험공단의 도구에서 더 높은 위험군으로 평가한 경우는 9,908명(56.7%), 한국산업안전보건공단의 도구에서 더 높은 위험군으로 평가한 경우는 1,079명(6.2%)로 나타났다.
결론
이 연구에서 한국산업안전보건공단과 건강보험공단의 위험도 평가도구는 중간정도의 상관관계와 어느정도의 일치도를 보였다. 두가지 도구 중 한가지만 사용할 경우에는 도구와 수검자의 특성에 따른 신중한 선택이 필요하다. 두가지 도구 중 건강보험공단의 도구가 더 높은 위험군으로 평가하는 경향을 보였다. 검증된 두가지 도구 중 더 높은 위험군으로 평가하는 쪽을 선택함으로써 위험요인을 조기에 발견하고 관리한다면 심뇌혈관질환의 효과적인 예방에 도움이 될 것이다.

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Special Issue

Statement by the Korean Society of Occupational and Environmental Medicine on the proposed reform of working hours in South Korea: Hee-Tae Kang, Chul-Ju Kim, Dong-Wook Lee, Seung-Gwon Park, Jinwoo Lee, Kanwoo Youn, Hwan-Cheol Kim, Kyoung Sook Jeong, Hansoo Song, Sung-Kyung Kim, Sang-Baek Koh; Ann Occup Environ Med 2023;35:e17. Published online July 5, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e17

Abstract PDF Supplementary Material PubReader ePub

The current 52-hour workweek in South Korea consists of 40 hours of regular work and 12 hours of overtime. Although the average working hours in South Korea is declining, it is still 199 hours longer than the Organisation for Economic Co-operation and Development average of 1,716 hours per year. In view to this, the South Korean government has now proposed to reform the workweek, mainly intending to increase the workweek to 69 hours when the workload is heavy. This reform, by increasing the labor intensity due to long working hours, goes against the global trend of reducing work hours for a safe and healthy working environment. Long working hours can lead to increased cerebrovascular and cardiovascular diseases, industrial accidents, mental health problems, and safety accidents due to lack of concentration. In conclusion, the Korean government’s working hour reform plan can have a negative impact on workers’ health, and therefore it should be thoroughly reviewed and modified.

Citations

Citations to this article as recorded by

Association between long working hours and metabolic dysfunction–associated steatotic liver disease: a nationwide population-based study in Korea
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Association between long working hours and engagement in preventive healthcare services in Korean workers: Findings from the Korean National Health and Nutrition Examination Survey
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Preventive Medicine.2024; 180: 107849. CrossRef
Long working hours, work-life imbalance, and poor mental health: a cross-sectional mediation analysis based on the sixth Korean Working Conditions Survey, 2020–2021
Seong-Uk Baek, Yu-Min Lee, Jin-Ha Yoon, Jong-Uk Won
Journal of Epidemiology.2024;[Epub] CrossRef
Association between long working hours and the onset of problematic alcohol use in young workers: A population-based longitudinal analysis in South Korea
Seong-Uk Baek, Jong-Uk Won, Jin-Ha Yoon
Journal of Affective Disorders.2024; 344: 141. CrossRef
Changes in Korea’s working time policy: the need for research on flexible working hours considering socioeconomic inequality
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Effect of long working hours on psychological distress among young workers in different types of occupation
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Association between long working hours and the development of suicidal ideation among female workers: An 8-year population-based study using the Korean Longitudinal Survey of Women & Family (2012–2020)
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Special Series I: Working hours as a social determinant of workers’ health
Kyunghee Jung-Choi, Tae-Won Jang, Mo-Yeol Kang, Jungwon Kim, Eun-A Kim
Annals of Occupational and Environmental Medicine.2023;[Epub] CrossRef
Association between long working hours and cigarette smoking, leisure-time physical activity, and risky alcohol use: Findings from the Korea National Health and Nutrition Examination Survey (2014–2021)
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Preventive Medicine.2023; 175: 107691. CrossRef

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Special Article

Standards for recognition and approval rate of occupational cerebro-cardiovascular diseases in Korea: Ui-Jin Kim, Won-Jun Choi, Seong-Kyu Kang, Wanhyung Lee, Seunghon Ham, Junhyeong Lee, Yongho Lee, Eunseun Han, Sanghyuk Lee, Yongkyu Kim, Inah Kim; Ann Occup Environ Med 2022;34:e30. Published online October 25, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e30

Abstract Abstract in Korean PDF Supplementary Material PubReader ePub

Background

Although working hours have decreased in Korea, they are still high compared to that of other countries. In Korea, cardiovascular and cerebrovascular diseases (CCVDs) related to overwork in Korea continually occur, and the social burden from overwork is estimated to be high. This study investigated the amendment of regulations affecting the approval rate of occupational CCVDs.

Methods

The change in approval rate of occupational CCVDs and related regulations were investigated using the Act and public notice on the standards for recognition of occupational CCVDs and the yearbooks of the Ministry of Employment and Labor. The CCVD mortality was estimated using data on the number of deaths according to the cause of death, the number of employed people, and resident registration population aged 15–64 years. The cumulative mortality of CCVDs was estimated using the Kaplan-Meier method.

Results

Since the establishment of the standards for recognition in Korea in 1982, the scope of occupational diseases has been expanded to include intracerebral hemorrhage, subarachnoid hemorrhage, cerebral infarction, myocardial infarction, and aortic dissection. In 2013, the concept of working hours was introduced in chronic overwork. The approval rate of occupational CCVDs was 44.7% in 2006, which decreased to 12.9% in 2011. After the improvement of related regulations, the approval rate increased to 41.3% in 2018. From 2000 to 2017, the CCVD mortality of both the unemployed and employed tended to decrease, and their cumulative CCVD mortalities were 549.3 and 319.7 per 100,000 people, respectively.

Conclusions

CCVDs are recognized as occupational diseases in Korea. The amendments to the standards for recognition, the introduction of the Occupational Disease Adjudication Committee, the principle of presumption, and the reduction of working hours have changed the approval rate of occupational CCVDs. A strategic approach is needed to further reduce the incidence of CCVDs.

한국의 직업성 뇌심혈관계 질환에 대한 연구
목적
근로기준법 개정 적용 사업장 확대로 우리나라의 근무시간은 지속적으로 감소 추세에 있으나 타 국가에 비하면 여전히 높은 수준이다. 우리나라의 과로 관련 뇌심혈관계 질환은 지속적으로 나타나고 있으며 과로로 인한 사회적 부담이 클 것으로 추정된다. 이번 연구에서는 우리나라 뇌심혈관계 질환의 업무상 질병 승인율 변화 및 관련된 제도의 변화를 요약하고자 하였다.
방법
뇌심혈관계 질환 업무상 질병 인정기준에 관한 법령 및 고시와 고용노동부 사업연보를 통해 뇌심혈관계 질환 산재 승인율 변화 및 관련 규정을 조사하였다. 국가통계포털의 사망 원인, 취업자 수 및 주민등록인구 자료를 사용하여 우리나라의 뇌심혈관계 질환 사망자수, 사망률을 조사하고 Kaplan-Meier 방법을 통해 누적사망률을 산출하였다.
결과
1982년 우리나라에서 뇌졸중과 급성심장사에 대한 업무상 질병 인정기준이 제정된 이후 수차례 개정을 거쳐 인정 대상 질병 범위가 뇌실질내출혈, 지주막하출혈, 뇌경색, 심근경색증, 해리성대동맥류로 확대되었다. 2013년 만성과로 인정기준에 근무시간 개념이 도입되었다. 뇌심혈관계 질환 업무상 질병 승인율은 2006년 44.7%였다가 2011년 12.9%건까지 감소하였다. 제도적인 개선 후 승인율은 2018년 41.3%까지 증가하였다. 2000년부터 2017년까지 뇌심혈관계 질환 사망률은 미취업자 및 취업자 모두에서 감소하는 경향을 보였으며 이 기간 동안 미취업자 및 취업자의 뇌심혈관계 질환 누적사망률은 각각 10만 명당 549.3명 및 319.7명이었다.
결론
우리나라는 뇌심혈관계 질환을 업무상 질병으로 받아들이고 있다. 뇌심혈관계 질환 업무상 질병 승인율은 업무상 질병 인정기준 개정, 업무상질병판정위원회 제도 도입, 추정의 원칙 도입 및 평균 근무시간 감소 등에 의해서 변동되었다. 뇌심혈관계 질환은 그 경제적 부담이 크고 예방 가능한 질환으로 지속적인 예방 사업 등 발병 예방을 위한 전략적 접근이 필요하다.

Citations

Citations to this article as recorded by

Association between long working hours and the development of suicidal ideation among female workers: An 8-year population-based study using the Korean Longitudinal Survey of Women & Family (2012–2020)
Seong-Uk Baek, Yu-Min Lee, Jin-Ha Yoon
Psychiatry Research.2024; 333: 115731. CrossRef
Association between long working hours and diet quality and patterns: A latent profile analysis of a nationally representative sample of Korean workers
Seong-Uk Baek, Jong-Uk Won, Yu-Min Lee, Jin-Ha Yoon
Preventive Medicine.2024; 180: 107890. CrossRef
Self-Esteem Trajectories After Occupational Injuries and Diseases and Their Relation to Changes in Subjective Health: Result From the Panel Study of Workers’ Compensation Insurance (PSWCI)
Seong-Uk Baek, Won-Tae Lee, Min-Seok Kim, Myeong-Hun Lim, Jin-Ha Yoon, Jong-Uk Won
Journal of Korean Medical Science.2023;[Epub] CrossRef

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Research Articles

Association between depression and cardiovascular disease risk in general population of Korea: results from the Korea National Health and Nutrition Examination Survey, 2016: Jinho Song, Tae Hwan Koh, One Park, Daeil Kwon, Seonghoon Kang, Kyeongmin Kwak, Jong-Tae Park; Ann Occup Environ Med 2019;31:e10. Published online June 20, 2019; DOI: https://doi.org/10.35371/aoem.2019.31.e10

Abstract PDF Supplementary Material PubReader ePub

Background

Depression is considered as a risk factor for cardiovascular disease (CVD) and associated with changes in individuals' health status that might influence CVD risk. However, most studies have scrutinized this relationship on a rather narrower and specific study population. By focusing on general population of Korea, we sought to inspect the association of depression with CVD risk and cardiovascular risk factors.

Methods

The data from the first year (2016) of the 7th Korea National Health and Nutrition Examination Survey was used. Participants were classified by the Patient Health Questionnaire-9 (PHQ-9) score as such: normal group (PHQ-9 score 0–4), mild depression (MD) group (PHQ-9 score 5–9) and moderate and severe depression (MSD) group (PHQ-9 score 10–27). General linear model was used to analyze differences and the trend of mean CVD risk according to depression level. Adjusted odds ratios (AORs) were calculated by logistic regression to identify the association between depression and cardiovascular risk factors after adjusting for age.

Results

Mean CVD risk of MSD group was higher than that of normal group (p < 0.05). There was a tendency of CVD risk to increase as depression worsened (p < 0.01). Among men, MSD group was associated with current smoking (AOR, 2.97; 95% confidence interval [CI], 1.78–4.97), taking antihypertensive medications (AOR, 2.42; 95% CI, 1.26–4.66), increased fasting blood sugar (> 125 mg/dL; AOR, 2.37; 95% CI, 1.25–4.50) and taking diabetes medications (AOR, 3.08; 95% CI, 1.65–5.72). MD group was associated with current smoking (AOR, 1.60; 95% CI, 1.18–2.17). Among women, MSD group was associated with high body mass index (≥ 25 kg/m²; AOR, 1.61; 95% CI, 1.11–2.32), large waist circumference (≥ 85 cm; AOR, 1.63; 95% CI, 1.12–2.37), current smoking (AOR, 5.11; 95% CI, 3.07–8.52) and taking diabetes medications (AOR, 2.62; 95% CI, 1.68–4.08). MD group was associated with current smoking (AOR, 1.86; 95% CI, 1.18–2.93).

Conclusions

We suggest that depression is associated with increased risk for CVD occurrence in general population of Korea.

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Association between night work and cardiovascular diseases: analysis of the 3rd Korean working conditions survey: Sungjin Park, Juhyun Nam, Jong-Ku Lee, Sung-Soo Oh, Hee-Tae Kang, Sang-Baek Koh; Ann Occup Environ Med 2015;27:15. Published online May 11, 2015; DOI: https://doi.org/10.1186/s40557-015-0064-1

Abstract PDF PubReader ePub

Objectives

This study was conducted to investigate the relationship between night work and cardiovascular diseases among wage workers in Korea.

Methods

The study was based on the 3rd Korean Working Conditions Survey (KWCS; 2011). This study included 29,711 wage workers. We used the chi-squared test and logistic regression to examine the association between cardiovascular diseases and night work and cumulative night work.

Results

Among all of the paid workers, 12.5% reported doing night work ≥ 1 day per month. Night work was significantly associated with an increased risk of cardiovascular diseases (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.11-2.25). Also, compared to the group that did not do night works, the group with higher cumulative night work demonstrated an increased risk for cardiovascular diseases (OR 1.81, 95% CI 1.19-2.74).

Conclusions

This study suggests that night work is significantly associated with cardiovascular diseases.

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Original Articles

Risk Assessment for Cardiovascular Diseases in Male Workers: Comparing KOSHA Guidelines and the Framingham Risk Score System: In Yong Um, Won Jun Choi, Deul Lee, Jae Seok Oh, Min Kee Yi, Jong Wan Yoon, Sang Hwan Han; Korean Journal of Occupational and Environmental Medicine 2012;24(4):365-374. Published online December 31, 2012; DOI: https://doi.org/10.35371/kjoem.2012.24.4.365

Abstract PDF

OBJECTIVES
This study aimed to investigate the 10-year risk of cardiovascular disease (CVD) by Framingham risk score (FRS) who classified as "healthy group" by Korean Occupational Safety and Health Agent (KOSHA)' s cardiovascular risk assessment.
METHODS
The subjects of this study were 1,781 male workers in a large steel company. Health status was obtained periodically through medical examinations and questionnaires. We assessed cardiovascular risk using KOSHA guidelines and calculated the 10-year risk of cardiovascular disease using the Framingham risk score for those categorized to the "healthy group" by KOSHA guideline. A closer examination of cardiovascular risk factors was performed in 62 subjects paradoxically placed in the "healthy group" by KOSHA guidelines and the "high-risk group" by FRS.
RESULTS
Among the "healthy group" by KOSHA's cardiovascular risk assessment, 230(15.8%) subjects had more than 3 CVD risk factors and 62(4.2%) subjects were high risk group (more than 20%) in 10-years risk of CVD by Framingham risk score. Modifiable risk factors included cigarette smoking (96.8%), high serum total cholesterol (82.3%), high serum triglyceride (66.1%), insufficient physical activity (66.1%), and obesity (58.1%).
CONCLUSIONS
Among subjects with normal blood pressure, it seems that KOSHA guidelines underestimate CVD risk, identified by the Framingham risk score. For the effective prevention and management of CVD, modifiable risk factors, such as cigarette smoking, dyslipidemia, and obesity, need to be constructively controlled.

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Are Cerebrovascular and Cardiovascular Diseases among Employees Work-related?: Jungsun Park; Korean Journal of Occupational and Environmental Medicine 2005;17(4):288-296. Published online December 31, 2005; DOI: https://doi.org/10.35371/kjoem.2005.17.4.288

Abstract PDF

Cerebrovascular and cardiovascular diseases (CVDs) are a major cause of deaths among workers as well as in general population in Korea. The term "Karoshi" in Japan represents work-related cerebrovascular and cardiovascular diseases (WR-CVD) due to excessive overwork. According to the Karasek's Demand-Control Model many prospective studies reported a significant association between working in jobs with high strain and increased likelihood of subsequent development of cardiovascular diseases. However, further understanding of the etiopathology of each different work-relatedness is needed to prevent WR-CVDs effectively. This review was planned to help the readers with knowledge on the etiopathology of the WR-CVDs. Based on the causal or triggering factors, work-relatedness in the literature can be classified into four types: 'accidental type (e.g. sudden cardiac deaths)', 'typical Karoshi type due to extreme overwork', 'maladaptation type due to dramatic change in job characteristics', and 'job stress type due to inherent characteristics'. Even though the outcome of each type is apparently similar, their causes and pathophysiologic mechanisms are quite different. In conclusion, the work-relatedness of CVDs among employees is very limited and usually works as a trigger rather than as the causal factors. A thorough understanding of the etiopathology of WR-CVDs can be very helpful in developing a prevention strategy.

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