Lifestyle risk behavior and atherosclerotic cardiovascular risk: An analysis using the Korea National Health and Nutrition Examination Survey

Minwoo Lee; Hyo-Jeong Ahn; Su Jung Lee; Pum-Jun Kim; Chulho Kim; Sang-Hwa Lee; Jong-Hee Sohn; Jae-Jun Lee

doi:10.1371/journal.pone.0307677

Peer Review History

Original SubmissionApril 25, 2024
25 Jun 2024 Decision Letter - Hidetaka Hamasaki, Editor PONE-D-24-16325Lifestyle Risk Behavior and Atherosclerotic Cardiovascular Risk: An Analysis Using the Korea National Health and Nutrition Examination SurveyPLOS ONE Dear Dr. Kim, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 09 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear editor, Thank you for allowing me to review this manuscript. The authors present a manuscript with valuable insights into the relationship between lifestyle risk behaviors and ASCVD risk in the Korean population, employing robust statistical methods and utilizing nationally representative data from KNHANES. Here are my minor comments: - In the discussion section; the second paragraph lacks references. “Lifestyle modifications, including smoking cessation and maintaining a high level of physical activity, are effective preventive measures that can reduce the CVD risk and maintain overall health. As described, many studies have reported that the CVD risk can be reduced by correcting multiple LRBs. However, it is clinically relevant to evaluate which of the LRBs precedes the effect modifier to reduce the CVD risk using limited preventive resources. To our best knowledge, only a few studies have 9 reported the causal relationship between several LRBs and CVD risk in a prospective cohort. Although this study used cross-sectional and retrospective data, the Bayesian network model was used to present which LRB component can probabilistically precede the other components.” - I encourage the authors to provide a paragraph on the discussion section addressing how can healthcare professionals utilize this information to improve CVD risk assessment and prevention strategies. Reviewer #2: 1. The manuscript is technically sound, and the data supported the conclusions. 2. The statistical analysis has been performed appropriately and rigorously. 3. The authors have made all data underlying the findings in their manuscript fully available. 4. The manuscript is presented in an intelligible fashion and written in standard English. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Kassa Demissie Abdi (PhD) ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: comments plos one ASCVD.docx Attachment Submitted filename: Final Manuscript.docx https://doi.org/10.1371/journal.pone.0307677.r001
Revision 1
2 Jul 2024 Author Response MS ID#: PONE-D-24-16325 MS TITLE: Lifestyle Risk Behavior and Atherosclerotic Cardiovascular Risk: An Analysis Using the Korea National Health and Nutrition Examination Survey Dear Dr. Hidetaka Hamasaki Thank you for providing us with the opportunity to revise and resubmit our manuscript entitled ‘Lifestyle Risk Behavior and Atherosclerotic Cardiovascular Risk: An Analysis Using the Korea National Health and Nutrition Examination Survey’ (MS ID: PONE-D-24-16325) for possible publication in PLOS ONE. We are sincerely grateful to the reviewers for their insightful comments, which have significantly contributed to the enhancement of our manuscript. Enclosed, please find our revised manuscript. We have provided point-by-point responses to the reviewers’ comments below. The reviewers’ feedback is highlighted in blue text and set in an 11-point font, while our response can be found directly beneath each reviewer’s comment. For your convenience, all changes made to the manuscript are highlighted with a yellow background. It is our hope that, with these revisions, our manuscript will be deemed suitable for publication in PLOS ONE. Should you require any further information or clarification, please do not hesitate to contact me. Sincerely yours, Chulho Kim, MD, PhD Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, 24253 Chuncheon, Korea Telephone: +82-33-240-5255 Fax: +82-33-255-1338 E-mail: gumdol52@naver.com Reviewer #1 The authors present a manuscript with valuable insights into the relationship between lifestyle risk behaviors and ASCVD risk in the Korean population, employing robust statistical methods and utilizing nationally representative data from KNHANES. Here are my minor comments: Comment #1 In the discussion section; the second paragraph lacks references. “Lifestyle modifications, including smoking cessation and maintaining a high level of physical activity, are effective preventive measures that can reduce the CVD risk and maintain overall health. As described, many studies have reported that the CVD risk can be reduced by correcting multiple LRBs. However, it is clinically relevant to evaluate which of the LRBs precedes the effect modifier to reduce the CVD risk using limited preventive resources. To our best knowledge, only a few studies have 9 reported the causal relationship between several LRBs and CVD risk in a prospective cohort. Although this study used cross-sectional and retrospective data, the Bayesian network model was used to present which LRB component can probabilistically precede the other components.” Response #1 We thank the reviewer for this insightful comment. To address this, we have cited appropriate articles we have reviewed while writing the manuscript in the paragraph. Lifestyle modifications, including smoking cessation and maintaining a high level of physical activity, are effective preventive measures that can reduce the CVD risk and maintain overall health7,10,11. As described, many studies have reported that the CVD risk can be reduced by correcting multiple LRBs10,11. However, it is clinically relevant to evaluate which of the LRBs precedes the effect modifier to reduce the CVD risk using limited preventive resources. To the best of our knowledge, only a few studies have reported the causal relationship between several LRBs and CVD risk in a prospective cohort28.29. Although this study used cross-sectional and retrospective data, the Bayesian network model was used to present which LRB component can probabilistically precede the other components. References 28.Liu G, Li Y, Hu Y, Zong G, Li S, Rimm EB, et al. Influence of lifestyle on incident cardiovascular disease and mortality in patients with diabetes mellitus. Journal of the American College of Cardiology. 2018;71:2867-2876 29.Nambo R, Karashima S, Mizoguchi R, Konishi S, Hashimoto A, Aono D, et al. Prediction and causal inference of cardiovascular and cerebrovascular diseases based on lifestyle questionnaires. Sci Rep. 2024;14:10492 Comment #2 I encourage the authors to provide a paragraph on the discussion section addressing how can healthcare professionals utilize this information to improve CVD risk assessment and prevention strategies. Response #2 We thank the reviewer for this valuable suggestion. In response, we have added a paragraph in the discussion section that addresses how healthcare professionals can utilize the findings of our study to improve CVD risk assessment and prevention strategies. The new paragraph has been included below: [Discussion, Last paragraph] Our study results can be utilized by healthcare professionals to promote healthy lifestyles for patients, with a particular focus on encouraging regular physical activity to mitigate sequential LRBs, especially among older males, given the significant role of LRBs in mediating ASCVD risk. Additionally, understanding the interplay between different LRBs allows for more personalized and effective preventive measures, ultimately optimizing resource allocation and enhancing patient outcomes. Reviewer #2 Comment #1 1. The manuscript is technically sound, and the data supported the conclusions. 2. The statistical analysis has been performed appropriately and rigorously. 3. The authors have made all data underlying the findings in their manuscript fully available. 4. The manuscript is presented in an intelligible fashion and written in standard English. Response #1 We thank the reviewer for their positive comments and appreciation of our work. Attachments Attachment Submitted filename: Response to the Reviewers.docx https://doi.org/10.1371/journal.pone.0307677.r002
10 Jul 2024 Decision Letter - Hidetaka Hamasaki, Editor Lifestyle Risk Behavior and Atherosclerotic Cardiovascular Risk: An Analysis Using the Korea National Health and Nutrition Examination Survey PONE-D-24-16325R1 Dear Dr. Kim, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. 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If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: 1. The authors have adequately addressed my comments raised in a previous round of review and I feel that this manuscript is now acceptable for publication. 2. The manuscript is technically sound and the data support the conclusions. 3. The statistical analysis has been performed appropriately and rigorously. 4. The authors have made all data underlying the findings in their manuscript fully available. 5. The manuscript is presented in an intelligible fashion and written in standard English. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: Yes: Kassa Demissie Abdi (PhD) ******** https://doi.org/10.1371/journal.pone.0307677.r003
Formally Accepted
18 Jul 2024 Acceptance Letter - Hidetaka Hamasaki, Editor PONE-D-24-16325R1 PLOS ONE Dear Dr. Kim, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Hidetaka Hamasaki Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0307677.r004

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