Details of a Researcher - Okamura, Tomonori

Papers - Okamura, Tomonori

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Associations between socioeconomic status and the prevalence and treatment of hypercholesterolemia in a general Japanese population: NIPPON DATA2010

Fujiyoshi N., Arima H., Satoh A., Ojima T., Nishi N., Okuda N., Kadota A., Ohkubo T., Hozawa A., Nakaya N., Fujiyoshi A., Okamura T., Ueshima H., Okayama A., Miura K., Saitoh S., Sakata K., Hayakawa T., Yanagawa H., Nakamura Y., Kasagi F., Murakami Y., Izumi T., Matsumura Y., Tokudome S., Toyoshima H., Nakagawa H., Kita Y., Miyamatsu N., Nakamura Y., Yoshita K., Miyamoto Y., Kodama K., Kiyohara Y., Ueda K.

Journal of Atherosclerosis and Thrombosis (Journal of Atherosclerosis and Thrombosis) 25 ( 7 ) 606 - 620 2018

Research paper (scientific journal), ISSN 13403478

© 2018 Japan Atherosclerosis Society. Aim: To investigate associations between socioeconomic status (SES) and the prevalence and treatment status of hypercholesterolemia in a general Japanese population. Methods: In 2010, we established a cohort study of 2417 adults (age 20-91 yr) from 300 randomly selected areas across Japan who participated in the National Health and Nutrition Survey of Japan. We cross-sectionally examined an association between SES and (1) prevalence of hypercholesterolemia in 2417 participants (999 men and 1418 women) and (2) not receiving medication for hypercholesterolemia in 654 participants (215 men and 439 women). SES included employment status, marital status, length of education, and household expenditures. Hypercholesterolemia was defined as a total serum cholesterol level of ≥ 6.21 mmol/L (240 mg/dL) or the use of lipid-lowering medications. Results: The overall prevalence of hypercholesterolemia was 21.5% in men and 31.0% in women. In men, the lowest quintile of household expenditures was associated with a higher prevalence of hypercholesterolemia (28.3%) compared with the upper 4 quintiles (19.9%) (multivariable-adjusted odds ratio 1.66; 95% confidence interval [CI] 1.16-2.38). Among participants with hypercholesterolemia, 55.4% of men and 55.1% of women were not receiving medication. Unmarried men were more likely to be untreated (75.0%) than married men (50.9%) (multivariable-adjusted odds ratio 2.53; 95%CI 1.05-6.08). SES had no significant effects in women. Conclusion: In a general population of Japanese men, low household expenditures were associated with a higher prevalence of hypercholesterolemia, and unmarried men with hypercholesterolemia were less likely to receive medication.

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Re-evaluation of the associations of egg intake with serum total cholesterol and cause-specific and total mortality in Japanese women

Nakamura Yasuyuki, Okamura Tomonori, Kita Yoshikuni, Okuda Nagako, Kadota Aya, Miura Katsuyuki, Okayama Akira, Ueshima Hirotsugu

European Journal of Clinical Nutrition (European Journal of Clinical Nutrition) 72 ( 6 ) 1 - 7 2017.12

Research paper (scientific journal), ISSN 0954-3007

Abstract: Background/objective: Egg intake was associated with serum total cholesterol adjusted for age (aTCH) and total mortality in women, but not in men, using data from NIPPON DATA (ND) 80 which followed up for 14 years. Re-evaluation of these associations in a different cohort is needed. Abstract: Subject/methods: We analyzed the associations of egg intake with aTCH and cause-specific and total mortality using the ND90 data set with a 15-year follow-up. A nutritional examination was done at the baseline in 1990 using the food-frequency method and by weighed food records. We followed 4686 female participants (ages ≥30 years), with no history of stroke or myocardial infarction (mean age 52.8 years) for 15 years. Abstract: Results: The participants were divided into 5 egg intake groups (<1/w, 1–2/w, 1/2d, 1/d, and ≥2/d). There were 203, 1462, 1594, 1387, and 40 women in each group, respectively. Egg intake was not associated with aTCH (P = 0.886). There were 183 cardiovascular disease (CVD), 210 cancer, and 599 total mortality cases during follow-up. Cox analysis, adjusted for background factors, found egg intake was directly associated with total and cancer mortality (HR in the ≥2/d vs. the 1 egg/d group: total, 2.05 (95% CI: 1.20–3.52); cancer, 3.20 (1.51–6.76)), and that cancer mortality in the 1–2/w group was significantly less than that in the 1 egg/d group (0.68 (0.47–0.97)). Egg intake was not associated with CVD mortality. Abstract: Conclusions: Egg intake was associated with cancer and total mortality. Reducing egg intake may have some definitive health benefits in women in Japan, at least.

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Effects of a school-based stroke education program on stroke-related knowledge and behaviour modification-school class based intervention study for elementary school students and parental guardians in a Japanese rural area

Kato Suzuka, Okamura Tomonori, Kuwabara Kazuyo, Takekawa Hidehiro, Nagao Masanori, Umesawa Mitsumasa, Sugiyama Daisuke, Miyamatsu Naomi, Hino Tenyu, Wada Shinichi, Arimizu Takuro, Takebayashi Toru, Kobashi Gen, Hirata Koichi, Yokota Chiaki, Minematsu Kazuo

BMJ Open 7 ( 12 ) e017632 2017.12

Research paper (scientific journal), ISSN 2044-6055

OBJECTIVES: This study aimed to determine the effect of a stroke education programme on elementary school students and their parental guardians in a rural area in Japan that has high stroke mortality.DESIGN: School class based intervention study.SETTING: Eleven public elementary schools in Tochigi Prefecture, Japan.PARTICIPANTS: 268 students aged 11-12 years and 267 parental guardians.INTERVENTIONS: Students received lessons about stroke featuring animated cartoons and were instructed to communicate their knowledge about stroke to their parental guardians using material (comic books) distributed in the lessons. Stroke knowledge (symptoms, risk factors and attitude towards stroke) and behavioural change for risk factors were assessed at baseline, immediately after the programme and at 3 months. We also evaluated behavioural change for risk factors among parental guardians.RESULTS: The percentage of students with all correct answers for stroke symptoms, risk factors and the recommended response to stroke was significantly increased at 3 months P<0.001). We observed a significant increase in the percentage of guardians who chose all correct symptoms (P<0.001: 61.0% vs 85.4%) and risk factors (P<0.001: 41.2% vs 59.9%) at 3 months compared with baseline. The percentage of parental guardians with a high behavioural response to improving risk factors was significantly increased at 3 months compared with baseline (P<0.001).CONCLUSIONS: In a rural population with high stroke mortality, stroke education can improve knowledge about stroke in elementary school students and their parental guardians.ETHICS AND DISSEMINATION: We conducted the intervention as a part of compulsory education; this study was not a clinical trial. This study was approved by the Ethics Committee of the National Cerebral and Cardiovascular Center (M27-026).

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Detection of Subclinical Peripheral Artery Ischemia in Healthy Male Smokers by an Ankle-Brachial Index after Exercise

Kubota Yoshimi, Higashiyama Aya, Marumo Mikio, Konishi Masami, Yamashita Yoshiko, Tashiro Chikara, Okamura Tomonori, Miyamoto Yoshihiro, Wakabayashi Ichiro

Angiology 68 ( 9 ) 769 - 775 2017.10

ISSN 0003-3197

We investigated the relationship between smoking and the risk of nonnormal (≤0.99) ankle-brachial index (ABI) at rest and after ankle plantar flexion exercise in healthy male community dwellers. A cross-sectional study was performed including 228 Japanese men aged 40 to 64 years without a history of cardiovascular diseases. Participants were classified as never, ex-, and current smokers. We estimated the multivariate-adjusted odds ratios (ORs) for nonnormal ABI of ex- and current smokers in relation to never smokers after adjusting for age and other confounding factors. At rest, the prevalence of nonnormal ABI was not significantly different by smoking status. After exercise, the prevalence of nonnormal ABI increased from 1.8% to 11.5% in ex-smokers and from 3.8% to 17.0% in current smokers, while the prevalence did not significantly change in never smokers. The multivariate-adjusted OR for nonnormal ABI after ankle plantar flexion exercise, in relation to never smokers, was 3.85 (95% confidence interval [CI]: 0.79-18.9) for ex-smokers and 6.97 (95% CI: 1.32-36.7) for current smokers. Our results suggest that ABI after ankle plantar flexion exercise is useful for early detection of subclinical peripheral artery ischemia in male smokers without typical symptoms.

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Detection of Subclinical Peripheral Artery Ischemia in Healthy Male Smokers by an Ankle-Brachial Index After Exercise: Sasayama Study.

Kubota Y, Higashiyama A, Marumo M, Konishi M, Yamashita Y, Tashiro C, Okamura T, Miyamoto Y, Wakabayashi I

Angiology 68 ( 9 ) 769 - 775 2017.10

Research paper (scientific journal), ISSN 0003-3197

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Detection of Subclinical Peripheral Artery Ischemia in Healthy Male Smokers by an Ankle-Brachial Index After Exercise: Sasayama Study.

Kubota Y, Higashiyama A, Marumo M, Konishi M, Yamashita Y, Tashiro C, Okamura T, Miyamoto Y, Wakabayashi I

Angiology 68 ( 9 ) 769 - 775 2017.10

Research paper (scientific journal), ISSN 0003-3197

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Risk of stroke and heart failure attributable to atrial fibrillation in middle-aged and elderly people: Results from a five-year prospective cohort study of Japanese community dwellers.

Ohsawa M, Okamura T, Tanno K, Ogasawara K, Itai K, Yonekura Y, Konishi K, Omama S, Miyamatsu N, Turin TC, Morino Y, Itoh T, Onoda T, Sakata K, Ishibashi Y, Makita S, Nakamura M, Tanaka F, Kuribayashi T, Ohta M, Okayama A

Journal of epidemiology 27 ( 8 ) 360 - 367 2017.08

Research paper (scientific journal), ISSN 0917-5040

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Risk of stroke and heart failure attributable to atrial fibrillation in middle-aged and elderly people: Results from a five-year prospective cohort study of Japanese community dwellers.

Journal of epidemiology 27 ( 8 ) 360 - 367 2017.08

Research paper (scientific journal), ISSN 0917-5040

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Causal effect of plasminogen activator inhibitor type 1 on coronary heart disease

Song Ci, Burgess Stephen, Eicher John D., O'Donnell Christopher J., Johnson Andrew D., Huang Jie, Sabater-Lleal Maria, Asselbergs Folkert W., Tregouet David, Shin So Youn, Ding Jingzhong, Baumert Jens, Oudot-Mellakh Tiphaine, Folkersen Lasse, Smith Nicholas L., Williams Scott M., Ikram Mohammad A., Kleber Marcus E., Becker Diane M., Truong Vinh, Mychaleckyj Josyf C., Tang Weihong, Yang Qiong, Sennblad Bengt, Moore Jason H., Williams Frances M.K., Dehghan Abbas, Silbernagel Günther, Schrijvers Elisabeth M.C., Smith Shelly, Karakas Mahir, Tofler Geoffrey H., Silveira Angela, Navis Gerjan J., Lohman Kurt, Chen Ming Huei, Peters Annette, Goel Anuj, Hopewell Jemma C., Chambers John C., Saleheen Danish, Lundmark Per, Psaty Bruce M., Strawbridge Rona J., Boehm Bernhard O., Carter Angela M., Meisinger Christa, Peden John F., Bis Joshua C., Okamura Tomonori

Journal of the American Heart Association 6 ( 6 ) 2017.06

ISSN 2047-9980

Background--Plasminogen activator inhibitor type 1 (PAI-1) plays an essential role in the fibrinolysis system and thrombosis. Population studies have reported that blood PAI-1 levels are associated with increased risk of coronary heart disease (CHD). However, it is unclear whether the association reflects a causal influence of PAI-1 on CHD risk. Methods and Results--To evaluate the association between PAI-1 and CHD, we applied a 3-step strategy. First, we investigated the observational association between PAI-1 and CHD incidence using a systematic review based on a literature search for PAI-1 and CHD studies. Second, we explored the causal association between PAI-1 and CHD using a Mendelian randomization approach using summary statistics from large genome-wide association studies. Finally, we explored the causal effect of PAI-1 on cardiovascular risk factors including metabolic and subclinical atherosclerosis measures. In the systematic meta-analysis, the highest quantile of blood PAI-1 level was associated with higher CHD risk comparing with the lowest quantile (odds ratio=2.17; 95% CI: 1.53, 3.07) in an age- and sex-adjusted model. The effect size was reduced in studies using a multivariable-adjusted model (odds ratio=1.46; 95% CI: 1.13, 1.88). The Mendelian randomization analyses suggested a causal effect of increased PAI-1 level on CHD risk (odds ratio=1.22 per unit increase of log-transformed PAI-1; 95% CI: 1.01, 1.47). In addition, we also detected a causal effect of PAI-1 on elevating blood glucose and high-density lipoprotein cholesterol. Conclusions--Our study indicates a causal effect of elevated PAI-1 level on CHD risk, which may be mediated by glucose dysfunction.

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Birthweight and cardiovascular risk factors in a Japanese general population

Katsuragi Shinji, Okamura Tomonori, Kokubo Yoshihiro, Ikeda Tomoaki, Miyamoto Yoshihiro

Journal of Obstetrics and Gynaecology Research 43 ( 6 ) 1001 - 1007 2017.06

Research paper (scientific journal), ISSN 1341-8076

Aim: This study was conducted to examine whether babies born small develop cardiovascular problems in later life. Methods: Data were examined retrospectively for 1241 city dwellers (men 521, women 720) aged 40–69 years who received a medical examination at a single institution. Blood tests, physical measurements, and a questionnaire survey regarding birth weight (small, medium, large), medication history and lifestyle (alcohol consumption, smoking, exercise) was administered. We selected 28 persons (12 men and 16 women) from and studied the rate of conformity between the participants’ memory (small, medium, large) and the actual birth weight recorded in their maternal and child health handbook (< 2500, 2500–3500, > 3500 g). Results: Participants’ recall of their birth weight correlated well with the weight recorded in the maternal notebook (r = 0.73; P < 0.025). Low-density lipoprotein (P < 0.05), and total cholesterol (P < 0.01) levels in men, and systolic (P < 0.05) and diastolic (P < 0.05) blood pressure in women were significantly inversely related to birth weight when controlling for age, body mass index, medication, and lifestyle. The percentage of women born small, medium, and large taking antidiabetic agents was 17.8%, 2.9% and 0% (P < 0.05), respectively. Conclusion: A low birth weight was associated with high low-density lipoprotein and total cholesterol levels in men, and hypertension and diabetes mellitus in women aged 40–69.

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Left ventricular hypertrophy by electrocardiogram as a predictor of success in home blood pressure control

Tanabe Ayumi, Asayama Kei, Hanazawa Tomohiro, Watabe Daisuke, Nomura Kyoko, Okamura Tomonori, Ohkubo Takayoshi, Imai Yutaka

Hypertension Research 40 ( 5 ) 504 - 510 2017.05

Research paper (scientific journal), ISSN 0916-9636

Few studies have focused on the effect of organ damage on achievement of long-term home blood pressure (BP) control. Based on the nationwide home BP-based trial data, we aimed to investigate the factors associated with home BP control, in particular, left ventricular hypertrophy (LVH) using the electrocardiogram in patients who started antihypertensive drug treatment. According to the trial protocol, we defined BP as controlled when systolic home BP reached specified targets (125-134 mm Hg in usual control (UC), n=1261; <125 mm Hg in tight control (TC), n=1288). At baseline, before drug treatment started, the mean Sokolow-Lyon voltage was 2.57±0.87 mV, and the mean Cornell product was 1573±705 mm·ms. The numbers of patients who achieved the target BP level in the UC and TC groups were 892 (70.7%) and 576 (44.7%), respectively. In both the UC and TC groups, systolic home BP at baseline was significantly lower in patients who achieved target levels than in those who did not achieve target levels (P<0.0001). Sokolow-Lyon voltage was significantly lower in patients who achieved target levels than in those who did not (P≤0.0055). The Cornell product levels in each group were similar (P≥0.12), although significantly different between patients who did or did not achieve the target level when the UC and TC groups were combined for analysis (P=0.031). Sokolow-Lyon voltage was significantly associated with achievement of home BP control in the multivariable-adjusted model (odds ratio, 1.13; 95% confidence intervals, 1.02-1.26; P=0.015), but Cornell product was not (P=0.13). These results indicate the difficulty of sufficient antihypertensive treatment when untreated patients had target organ damage, that is, LVH diagnosed by Sokolow-Lyon voltage.

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Fasting but not casual blood glucose is associated with pancreatic cancer mortality in Japanese

Nagai Masato, Murakami Yoshitaka, Tamakoshi Akiko, Kiyohara Yutaka, Yamada Michiko, Ukawa Shigekazu, Hirata Takumi, Tanaka Sachiko, Miura Katsuyuki, Ueshima Hirotsugu, Okamura Tomonori

Cancer Causes and Control 28 ( 6 ) 1 - 9 2017.03

Research paper (scientific journal), ISSN 0957-5243

Purpose: The dose–response relationship between fasting blood glucose levels and risk of pancreatic cancer has been investigated, but the association between casual blood glucose levels and pancreatic cancer death has not been examined. We examined the association between casual and fasting blood glucose levels and death due to pancreatic cancer in Japanese. Methods: We performed a pooled analysis of the individual Japanese including 46,387 participants aged 40–79 years from ten cohorts. Participants were classified into five groups: low normal, middle normal, high normal, prediabetes (casual blood glucose 140–199 mg/dl, or fasting blood glucose 110–125 mg/dl), and diabetes (casual blood glucose ≥200 mg/dl, fasting blood glucose ≥126 mg/dl, or anti-diabetic drug use). Low normal, middle normal, and high normal were defined according to tertiles of casual or fasting normal blood glucose levels. Hazard ratios (HRs) and 95% confidence intervals (CIs) for pancreatic cancer mortality were estimated stratifying casual and fasting blood glucose by cohort-stratified Cox proportional hazards regression analysis, with low normal (casual blood glucose <94 mg/dl, or fasting blood glucose <90 mg/dl) as a reference. Results: Fasting blood glucose showed a dose–response relationship with pancreatic cancer mortality (p for trend = 0.005). After adjusting for covariates, HRs (95% CIs) were 2.83 (1.18–6.76) for prediabetes and 3.96 (1.56–10.08) for diabetes. However, there were no significant associations with casual blood glucose. These tendencies were observed after the exclusion of participants who were censored for the first 5 years of follow-up. Conclusions: Fasting blood glucose is a better predictor of pancreatic cancer death than casual blood glucose.

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Impacts of chronic kidney disease and diabetes on cardiovascular mortality in a general Japanese population

Hirata Aya, Okamura Tomonori, Sugiyama Daisuke, Kuwabara Kazuyo, Kadota Aya, Fujiyoshi Akira, Miura Katsuyuki, Okuda Nagako, Ohkubo Takayoshi, Okayama Akira, Ueshima Hirotsugu

European Journal of Preventive Cardiology 24 ( 5 ) 505 - 513 2017.03

Research paper (scientific journal), ISSN 2047-4873

Background Studies have shown significant associations of chronic kidney disease (CKD) and diabetes mellitus (DM) with cardiovascular disease (CVD) mortality. The impact on the general population is an important public health issue. However, the population attributable fraction (PAF) of CVD because of CKD and/or DM in a general population is uncertain. Methods We followed 7229 participants (age: ≥30 years) with no history of CVD in a Japanese community. We divided participants into four categories according to CKD and/or DM and calculated hazard ratios (HRs) of CVD mortality for each category using a Cox proportional hazards model adjusted for age, dyslipidemia, smoking and alcohol consumption. In addition, PAFs of CVD were estimated among populations with CKD and/or DM. Results During 20-year follow-up, 488 participants died. HRs for CVD were 1.63 [95% confidence interval (CI): 1.16-2.30] with DM only, 1.42 (95% CI: 1.08-1.86) with CKD only and 2.37 (95% CI: 1.40-4.01) with CKD + DM. In men, the corresponding HRs for CVD were 1.88 (95% CI: 1.19-2.97), 1.71 (95% CI: 1.15-2.56) and 3.26 (95% CI: 1.69-6.30), respectively; the corresponding PAFs of CVD were 4.1%, 5.1% and 2.9%, respectively. PAFs for CVD among women were lower than those in men, 1.6% for DM only, 2.0% for CKD only and 0.7% for CKD + DM. Conclusions PAFs of CVD mortality due to CKD and/or DM were not so high in past 20 years; however, they might increase in the future because of recent increase in prevalence of these in Japanese population.

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Increased childhood BMI is associated with young adult serum uric acid levels

Kuwahara Erika, Murakami Yoshitaka, Okamura Tomonori, Komatsu Hirokazu, Nakazawa Akemi, Ushiku Hideo, Maejima Fumio, Nishigaki Yoshio, Nishiwaki Yuji

Pediatric Research 81 ( 2 ) 293 - 298 2017.02

Research paper (scientific journal), ISSN 0031-3998

Background:Growth pattern in early life is one of the most important factors affecting the pathogenesis of metabolic-associated diseases. The associations between serum uric acid (SUA) and hypertension, kidney disease, and coronary heart disease have been recognized. We investigated the association between increased BMI during childhood and adult SUA levels in Japan.Methods:We included 298 children with health examination data between 1981 and 2002 who had also undergone physical examinations after reaching early adulthood (approximately 27 y old). Subjects were divided into sex-specific tertiles based on the difference in their BMI (DBMI) over a 6-y period (6-12 y of age). The association between the three DBMI groups and SUA in adults was analyzed.Results:The predicted average SUA level in adults from the high DBMI group was 5.32 mg/dl after adjustment for related factors in a combined sex analysis. This was significantly higher than among the low DBMI group.Conclusion:Excessive BMI increases during childhood led to young adult SUA elevation even after adjusting for several factors. Lifestyle in early life may be a strong predictor of future uric acid metabolism and the resulting disease risk.

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Significant inverse association of equol-producer status with coronary artery calcification but not dietary isoflavones in healthy Japanese men

Ahuja Vasudha, Miura Katsuyuki, Vishnu Abhishek, Fujiyoshi Akira, Evans Rhobert, Zaid Maryam, Miyagawa Naoko, Hisamatsu Takashi, Kadota Aya, Okamura Tomonori, Ueshima Hirotsugu, Sekikawa Akira

British Journal of Nutrition 117 ( 2 ) 260 - 266 2017.01

Research paper (scientific journal), ISSN 0007-1145

Equol, a metabolite of the dietary isoflavone daidzein, is produced by the action of gut bacteria in some individuals who are termed as equol-producers. It is proposed to have stronger atheroprotective properties than dietary isoflavones. We examined a cross-sectional association of dietary isoflavones and equol-producer status with coronary artery calcification (CAC), a biomarker of coronary atherosclerosis, among men in Japan. A population-based sample of 272 Japanese men aged 40-49 years recruited from 2004 to 2007 was examined for serum isoflavones, serum equol, CAC and other factors. Equol-producers were classified as individuals having a serum level of equol >83 nm. The presence of CAC was defined as a coronary Ca score ≥10 Agatston units. The associations of dietary isoflavones and equol-producers with CAC were analysed using multiple logistic regression. The median of dietary isoflavones, equol and CAC were 512·7 (interquartile range (IQR) 194·1, 1170·0), 9·1 (IQR 0·10, 33·1) and 0·0 (IQR 0·0, 1·0) nm, respectively. Prevalence of CAC and equol-producers was 9·6 and 16·0 %, respectively. Dietary isoflavones were not significantly associated with CAC. After multivariable adjustment, the OR for the presence of CAC in equol-producers compared with equol non-producers was 0·10 (95 % CI 0·01, 0·90, P<0·04). Equol-producers had significantly lower CAC than equol non-producers, but there was no significant association between dietary isoflavones and CAC, suggesting that equol may be a key factor for atheroprotective properties of isoflavones in Japanese men. This finding must be confirmed in larger studies or clinical trials of equol that is now available as a dietary supplement.

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Is childhood exposure to parental smoking a risk factor for future cardiovascular disease?

Michikawa Takehiro, Okamura Tomonori

Journal of Atherosclerosis and Thrombosis 24 ( 12 ) 1204 - 1205 2017.01

Research paper (scientific journal), ISSN 1340-3478

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Risk for metabolic diseases in normal weight individuals with visceral fat accumulation

Tatsumi Yukako, Nakao Yoko M., Masuda Izuru, Higashiyama Aya, Takegami Misa, Nishimura Kunihiro, Watanabe Makoto, Ohkubo Takayoshi, Okamura Tomonori, Miyamoto Yoshihiro

BMJ Open 7 ( 1 ) e013831 2017.01

Research paper (scientific journal), ISSN 2044-6055

Objective To investigate the association between visceral fat area (VFA) and metabolic syndrome (Mets) among normal weight Japanese. Design A cross-sectional study. Setting The health check-up centre of the Takeda Hospital group in Kyoto, Japan. Methods This study involved 1674 men and 1448 women aged 30-74years who underwent medical check-ups in 2012 in the health check-up centre. They were stratified by Body Mass Index (BMI cut-off for obesity is set at 23.0kg/m² for Asians): normal weight 18.5-22.9kg/m² or higher weight ≥23.0kg/m². The age-adjusted ORs of the 2nd to 4th groups of sex-specific VFA quartiles compared with the 1st quartile for a Mets component clustering were estimated. The clustering was having two or more of the following factors: High blood pressure, high fasting blood glucose (FBG), low high-density lipoprotein cholesterol (HDL-C) and high triglycerides. Statistical analyses were conducted in 2016. Results Participants in the 2nd to 4th VFA quartiles had significantly higher clustering risks; ORs were 3.4 (1.5 to 8.0), 6.3 (2.8 to 14.2) and 9.3 (4.2 to 20.7) for normal weight participants, and 1.7 (1.2 to 2.6), 2.6 (1.8 to 3.9) and 6.0 (4.1 to 8.8) for higher weight participants, respectively. The ORs of the 4th VFA quartile for Mets components were significantly higher; ORs for normal weight participants were 2.1 (1.5 to 3.0) (high blood pressure), 2.4 (1.4 to 4.2) (high FBG), 5.2 (2.1 to 12.9) (low HDL-C) and 12.0 (5.7 to 25.3) (high triglycerides), and higher weight participants were 3.9 (2.8 to 5.5), 4.1 (2.8 to 6.2), 3.9 (2.2 to 6.9) and 5.0 (3.4 to 7.4), respectively. Conclusions Among participants with normal weight, as well as those of higher weight, dose-dependent responses were observed between VFA and risk for Mets components and the clustering among Japanese adults. VFA may be useful information for interventions to improve metabolic risk factors in people with normal weight.

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Associations of socioeconomic status with prevalence, awareness, treatment, and control of hypertension in a general Japanese population

Satoh Atsushi, Arima Hisatomi, Ohkubo Takayoshi, Nishi Nobuo, Okuda Nagako, Ae Ryusuke, Inoue Mariko, Kurita Shuji, Murakami Keiko, Kadota Aya, Fujiyoshi Akira, Sakata Kiyomi, Okamura Tomonori, Ueshima Hirotsugu, Okayama Akira, Miura Katsuyuki

Journal of Hypertension 35 ( 2 ) 401 - 408 2017

Research paper (scientific journal), ISSN 0263-6352

Objective: To investigate associations between socioeconomic status (SES) and prevalence, awareness, treatment, and control of hypertension in Japan's general population. Methods: In 2010, we established a cohort of participants in the National Health and Nutrition Survey of Japan. The cohort included 2623 adults from 300 randomly selected areas across Japan. Using baseline data, four crosssectional analyses were performed: association of SES with prevalent hypertension in 2623 participants; association of SES with unawareness of hypertension and with no treatment in 1282 hypertensive patients; and association of SES with uncontrolled hypertension in 720 treated hypertensive patients. SES was classified according to employment status, length of education, marital and living status, and household expenditure. Results: The overall prevalence of hypertension was 48.9%. Among hypertensive participants, the proportions of unawareness and no treatment were 33.1 and 43.8%, respectively. Target blood pressure levels were not achieved among 61.2% of treated hypertensive patients. Hypertension was more prevalent in the unmarried and living alone group than in the married group (odds ratio 1.76; 95% confidence interval 1.26-2.44), after adjustment for age, sex, BMI, smoking, alcohol consumption, habitual exercise, history of cardiovascular diseases, diabetes mellitus, hypercholesterolemia, dietary sodium, and potassium intake. SES was not clearly associated with unawareness, no treatment, nor poor control of hypertension. Conclusion: Being unmarried and living alone was associated with increased prevalence of hypertension. There was no clear association of SES with unaware, untreated, and uncontrolled hypertension.

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Age-specific impact of diabetes mellitus on the risk of cardiovascular mortality

Hirakawa Yoichiro, Ninomiya Toshiharu, Kiyohara Yutaka, Murakami Yoshitaka, Saitoh Shigeyuki, Nakagawa Hideaki, Okayama Akira, Tamakoshi Akiko, Sakata Kiyomi, Miura Katsuyuki, Ueshima Hirotsugu, Okamura Tomonori, Imai Yutaka, Ohkubo Takayoshi, Irie Fujiko, Iso Hiroyasu, Kitamura Akihiko, Nakayama Takeo, Sairenchi Toshimi, Tsuji Ichiro, Yamada Michiko, Kiyama Masahiko, Miyamoto Yoshihiro, Ishikawa Shizukiyo, Yatsuya Hiroshi

Journal of Epidemiology 27 ( 3 ) 123 - 129 2017

Research paper (scientific journal), ISSN 0917-5040

Background: Diabetes mellitus is a strong risk factor for cardiovascular disease. However, the age-specific association of diabetes with cardiovascular risk, especially in the elderly, remains unclear in non-Western populations. Methods: A pooled analysis was conducted using 8 cohort studies (mean follow-up period, 10.3 years) in Japan, combining the data from 38,854 individual participants without history of cardiovascular disease. In all, 1867 of the participants had diabetes, defined based on the 1998 World Health Organization criteria. The association between diabetes and the risk of death from cardiovascular disease, coronary heart disease (CHD), and stroke was estimated using a stratified Cox model, accounting for variability of baseline hazard functions among cohorts. Results: During the follow-up, 1376 subjects died of cardiovascular disease (including 268 of coronary heart disease and 621 of stroke). Diabetes was associated with an increased risk of cardiovascular death after multivariable adjustment (hazard ratio [HR] 1.62; 95% confidence interval [CI], 1.35-1.94). Similarly, diabetes was a risk factor for CHD (HR 2.13; 95% CI, 1.47-3.09) and stroke (HR 1.40; 95% CI, 1.05-1.85). In the age-stratified analysis of the risk of cardiovascular death, the relative effects of diabetes were consistent across age groups (p for heterogeneity = 0.18), whereas the excess absolute risks of diabetes were greater in participants in their 70s and 80s than in younger subjects. Conclusions: The management of diabetes is important to reduce the risk of death from cardiovascular disease, not only in midlife but also in late life, in the Japanese population.

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Risk of stroke and heart failure attributable to atrial fibrillation in middle-aged and elderly people

Ohsawa Masaki, Okamura Tomonori, Tanno Kozo, Ogasawara Kuniaki, Itai Kazuyoshi, Yonekura Yuki, Konishi Kazuki, Omama Shinichi, Miyamatsu Naomi, Turin Tanvir Chowdhury, Morino Yoshihiro, Itoh Tomonori, Onoda Toshiyuki, Sakata Kiyomi, Ishibashi Yasuhiro, Makita Shinji, Nakamura Motoyuki, Tanaka Fumitaka, Kuribayashi Toru, Ohta Mutsuko, Okayama Akira

Journal of Epidemiology 27 ( 8 ) 360 - 367 2017

ISSN 0917-5040

Background: The relative and absolute risks of stroke and heart failure attributable to atrial fibrillation (AF) have not been sufficiently examined. Methods: A prospective study of 23,731 community-dwelling Japanese individuals was conducted. Participantswere divided into two groups based on the presence or absence of prevalent AF (n = 338 and n = 23,393, respectively). Excess events (EE) due to AF and relative risks (RRs) determined using the non-AF group as the reference for incident stroke and heart failurewere estimated using Poisson regression stratified by age groups (middle-aged: 40-69 years old; elderly: 70 years of age or older) after adjustment for sex and age. Results: There were 611 cases of stroke and 98 cases of heart failure during the observation period (131,088 person-years). AF contributed to a higher risk of stroke both in middle-aged individuals (EE 10.4 per 1000 person-years;RR4.88;95%confidenceinterval [CI],2.88-8.29) andelderlyindividuals (EE18.3per1000 personyears; RR 3.05; 95% CI, 2.05-4.54). AFalso contributed to a higher risk of heart failure in middle-aged individuals (EE 3.7 per 1000 person-years; RR 8.18; 95% CI, 2.41-27.8) and elderly individuals (EE 15.4 per 1000 personyears; RR 7.82; 95% CI, 4.11-14.9). Results obtained from multivariate-adjusted analysis were similar (stroke: EE 8.9 per 1000 person-years; RR 4.40; 95% CI, 2.57-7.55 inmiddle-aged and EE 17.4 per 1000 person-years; RR 2.97; 95% CI, 1.99-4.43 in elderly individuals; heart failure: EE 3.1 per 1000 person-years; RR 7.22; 95% CI, 2.06-25.3 in middle-aged and EE 14.1 per 1000 person-years; RR 7.41; 95% CI, 3.86-14.2 in elderly individuals). Conclusions: AF increased the risk of stroke by the same magnitude as that reported previously in Western countries. AF increased the RR of heart failure more than that in Western populations.

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