Details of a Researcher - Okamura, Tomonori

Papers - Okamura, Tomonori

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Relative and absolute risks of all-cause and cause-specific deaths attributable to atrial fibrillation in middle-aged and elderly community dwellers

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

International Journal of Cardiology 184 ( 1 ) 692 - 698 2015

Research paper (scientific journal), Joint Work, Accepted, ISSN 0167-5273

Background: The relative and absolute risks of outcomes other than all-cause death (ACD) attributable to atrial fibrillation (AF) stratified age have not been sufficiently investigated. Methods: A prospective study of 23,634 community dwellers aged 40 years or older without organic cardiovascular disease (AF = 335, non-AF = 23,299) was conducted. Multivariate-adjusted rates, rate ratios (RRs) and excess deaths (EDs) for ACD, cardiovascular death (CVD) and non-cardiovascular death (non-CVD), and sexand age-adjusted RR and ED in middle-aged (40 to 69) and elderly (70 years or older) for ACD, CVD, non-CVD, sudden cardiac death (SCD), stroke-related death (Str-D), neoplasm-related death (NPD), and infectionrelated death (IFD) attributable to AF were estimated using Poisson regression. Results: Multivariate-adjusted analysis revealed that AF significantly increased the risk of ACD (RR [95% confidence interval]:1.70 [1.23-2.95]) and CVD (3.86 [2.38-6.27]), but not non-CVD. Age-stratified analysis revealed that AF increased the risk of Str-D in middle-aged (14.5 [4.77-44.3]) and elderly individuals (4.92 [1.91-12.7]), SCD in elderly individuals (3.21 [1.37-7.51]), and might increase the risk of IFD in elderly individuals (2.02 [0.80-4.65], p = 0.098). The RR of CVD was higher in middle-aged versus elderly individuals (RRs, 6.19 vs. 3.57) but the absolute risk difference was larger in elderly individuals (EDs: 7.6 vs. 3.0 per 1000 person-years). Conclusions: Larger absolute risk differences for ACD and CVD attributable to AF among elderly people indicate that the absolute burden of AF is higher in elderly versus middle-aged people despite the relatively small RR.

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Long-term outcomes associated with prolonged PR interval in the general Japanese population

Hisamatsu Takashi, Miura Katsuyuki, Fujiyoshi Akira, Okamura Tomonori, Ohkubo Takayoshi, Nagasawa Shin Ya, Horie Minoru, Okayama Akira, Ueshima Hirotsugu, Saitoh Shigeyuki, Sakata Kiyomi, Hozawa Atsushi, Hayakawa Takehito, Nakamura Yosikazu, Matsumura Yasuhiro, Nishi Nobuo, Okuda Nagako, Kasagi Fumiyoshi, Izumi Toru, Ojima Toshiyuki, Tamakoshi Koji, Nakagawa Hideaki, Murakami Yoshitaka, Kita Yoshikuni, Miyamatsu Naomi, Nakamura Yasuyuki, Yoshita Katsushi, Kadota Aya, Miyamoto Yoshihiro, Kodama Kazunori, Kiyohara Yutaka

International Journal of Cardiology 184 ( 1 ) 291 - 293 2015

Research paper (scientific journal), ISSN 0167-5273

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Associations between Inflammatory Markers and Subclinical Atherosclerosis in Middle-aged White, Japanese-American and Japanese Men: The ERA-JUMP Study.

Nagasawa SY, Ohkubo T, Masaki K, Barinas-Mitchell E, Miura K, Seto T, El-Saed A, Kadowaki T, Willcox BJ, Edmundowicz D, Kadota A, Evans RW, Kadowaki S, Fujiyoshi A, Hisamatsu T, Bertolet MH, Okamura T, Nakamura Y, Kuller LH, Ueshima H, Sekikawa A, ERA-JUNP Study Group.

Journal of atherosclerosis and thrombosis 22 ( 6 ) 590 - 8 2015

Research paper (scientific journal), ISSN 1340-3478

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Associations between Inflammatory Markers and Subclinical Atherosclerosis in Middle-aged White, Japanese-American and Japanese Men: The ERA-JUMP Study.

Journal of atherosclerosis and thrombosis 22 ( 6 ) 590 - 8 2015

Research paper (scientific journal), ISSN 1340-3478

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The Relationship between Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 Ligands Containing Apolipoprotein B and the Cardio-Ankle Vascular Index in Healthy Community Inhabitants: The KOBE Study.

Sugiyama D, Higashiyama A, Wakabayashi I, Kubota Y, Adachi Y, Hayashibe A, Kawamura K, Kuwabara K, Nishimura K, Kadota A, Nishida Y, Hirata T, Imano H, Miyamatsu N, Miyamoto Y, Sawamura T, Okamura T

Journal of atherosclerosis and thrombosis 22 ( 5 ) 499 - 508 2015

Research paper (scientific journal), ISSN 1340-3478

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Sugiyama D, Higashiyama A, Wakabayashi I, Kubota Y, Adachi Y, Hayashibe A, Kawamura K, Kuwabara K, Nishimura K, Kadota A, Nishida Y, Hirata T, Imano H, Miyamatsu N, Miyamoto Y, Sawamura T, Okamura T

Journal of atherosclerosis and thrombosis 22 ( 5 ) 499 - 508 2015

Research paper (scientific journal), ISSN 1340-3478

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Cumulative impact of axial, structural, and repolarization ECG findings on long-term cardiovascular mortality among healthy individuals in Japan

Inohara Taku, Kohsaka Shun, Okamura Tomonori, Watanabe Makoto, Nakamura Yasuyuki, Higashiyama Aya, Kadota Aya, Okuda Nagako, Murakami Yoshitaka, Ohkubo Takayoshi, Miura Katsuyuki, Okayama Akira, Ueshima Hirotsugu

European Journal of Preventive Cardiology 21 ( 12 ) 1501 - 1508 2014.12

Research paper (scientific journal), Joint Work, Accepted, ISSN 2047-4873

Methods and Results: Community-dwelling Japanese residents from the National Integrated Project for Perspective Observation of Non-Communicable Disease and its Trends in the Aged, 1980-2004 and 1990-2005 (NIPPON DATA80 and 90), were included in this study. Baseline ECG findings were classified using the Minnesota Code and categorized into axial (left axis deviation, clockwise rotation), structural (left ventricular hypertrophy, atrial enlargement), and repolarization (minor and major ST-T changes) abnormalities. The hazard ratios of the cumulative impacts of ECG findings on long-term CVD death were estimated by stratified Cox proportional hazard models, including adjustments for cohort strata. In all, 16,816 participants were evaluated. The average age was 51.2 ±13.5 years; 42.7% participants were male. The duration of follow up was 300,924 person-years (mean 17.9±5.8 years); there were 1218 CVD deaths during that time. Overall, 4203 participants (25.0%) had one or more categorical ECG abnormalities: 3648 (21.7%) had a single abnormality, and 555 (3.3%) had two or more. The risk of CVD mortality increased as the number of abnormalities accumulated (single abnormality HR 1.29, 95% CI 1.13-1.48; ≥2 abnormalities HR 2.10, 95% CI 1.73-2.53).Conclusions: Individual ECG abnormalities had an additive effect in predicting CVD outcome risk in our large-scale cohort study.Aims: Various cohort studies have shown a close association between long-term cardiovascular disease (CVD) outcomes and individual electrocardiographic (ECG) abnormalities such as axial, structural, and repolarization changes. The combined effect of these ECG abnormalities, each assumed to be benign, has not been thoroughly investigated.

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Low-carbohydrate diets and cardiovascular and total mortality in Japanese

Nakamura Yasuyuki, Okuda Nagako, Okamura Tomonori, Kadota Aya, Miyagawa Naoko, Hayakawa Takehito, Kita Yoshikuni, Fujiyoshi Akira, Nagai Masato, Takashima Naoyuki, Ohkubo Takayoshi, Miura Katsuyuki, Okayama Akira, Ueshima Hirotsugu

British Journal of Nutrition 112 ( 6 ) 916 - 924 2014.09

Research paper (scientific journal), Joint Work, Accepted, ISSN 0007-1145

Long-term safety of consuming low-carbohydrate diets (LCD) in Asian populations, whose carbohydrate intake is relatively high, is not known. In the present study, the association of LCD with CVD and total mortality was assessed using data obtained in the NIPPON DATA80 (National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged 1980) during 29 years of follow-up. At baseline in 1980, data were collected from study participants aged ≥30 years from randomly selected areas in Japan. LCD scores were calculated based on the percentage of energy as carbohydrate, fat and protein, estimated by 3d weighed food records. A total of 9200 participants (56% women, mean age 51 years) were followed up. During the follow-up, 1171 CVD deaths (52% in women) and 3443 total deaths (48% in women) occurred. The multivariable-adjusted hazard ratio (HR) for CVD mortality using the Cox model comparing the highest v. lowest deciles of LCD score was 0·60 (95% CI 0·38, 0·94; P_trend=0·021) for women and 0·78 (95% CI 0·58, 1·05; P_trend=0·079) for women and men combined; the HR for total mortality was 0·74 (95% CI 0·57, 0·95; P_trend=0·029) for women and 0·87 (95% CI 0·74, 1·02; P_trend=0·090) for women and men combined. None of the associations was statistically significant in men. No differential effects of animal-based and plant-fish-based LCD were observed. In conclusions, moderate diets lower in carbohydrate and higher in protein and fat are significantly inversely associated with CVD and total mortality in women.

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Blood pressure, low-density lipoprotein cholesterol, and incidences of coronary artery disease and ischemic stroke in Japanese

Tsukinoki Rumi, Okamura Tomonori, Watanabe Makoto, Kokubo Yoshihiro, Nishimura Kunihiro, Takegami Misa, Murakami Yoshitaka, Okayama Akira, Miyamoto Yoshihiro

American Journal of Hypertension 27 ( 11 ) 1362 - 1369 2014.07

Research paper (scientific journal), Joint Work, Accepted, ISSN 0895-7061

BACKGROUND Blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) are risk factors for coronary artery disease (CAD) and ischemic stroke. However, the hazards of their coexistence are not fully understood in Asian populations. We investigated whether the relationship between BP and cardiovascular disease (CVD) outcomes are modified by LDL-C level in a Japanese population.METHODS Individuals aged 30-79 years (n = 5,151) were classified into 6 groups according to LDL-C levels (<140 and ≥140mg/dL or lipid medication) and BP levels (optimal BP, prehypertension, and hypertension; reference: low LDL-C and optimal BP). Hazard ratios (HRs) were calculated after adjusting for age, high-density lipoprotein cholesterol, diabetes, smoking status, and alcohol consumption. The effect modification of LDL-C on BP-CVD association was assessed using likelihood ratio tests.RESULTS There were 264 CAD and 215 ischemic stroke events during 13 years of follow-up. With low LDL-C, the HRs of prehypertension and hypertension for CAD were 2.01 and 4.71, respectively. Similar trends of HRs were observed with high LDL-C (optimal BP = 2.09, prehypertension = 3.45, hypertension = 5.94). However, the HRs for ischemic stroke did not differ between normal and high LDL-C levels at the same BP level. The apparent effect modification of LDL-C was not observed in the BP-CVD association in either CAD (P = 0.48) or ischemic stroke (P = 0.39).CONCLUSIONS The HRs for CAD in prehypertensive and hypertensive groups were higher than those in the optimal BP group at the same LDL-C levels in a Japanese population; however, there was no statistical effect modification of LDL-C on the BP-CAD association.

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Hypertension and medical expenditure in the Japanese population: Review of prospective studies.

Nakamura K, Okamura T, Miura K, Okayama A

World journal of cardiology 6 ( 7 ) 531 - 8 2014.07

Research paper (scientific journal)

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Hypertension and medical expenditure in the Japanese population: Review of prospective studies.

Nakamura K, Okamura T, Miura K, Okayama A

World journal of cardiology 6 ( 7 ) 531 - 8 2014.07

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Lipoprotein particle profiles compared with standard lipids in association with coronary artery calcification in the general Japanese population

Hisamatsu Takashi, Fujiyoshi Akira, Miura Katsuyuki, Ohkubo Takayoshi, Kadota Aya, Kadowaki Sayaka, Kadowaki Takashi, Yamamoto Takashi, Miyagawa Naoko, Zaid Maryam, Torii Sayuki, Takashima Naoyuki, Murakami Yoshitaka, Okamura Tomonori, Horie Minoru, Ueshima Hirotsugu

Atherosclerosis 236 ( 2 ) 237 - 243 2014.07

Research paper (scientific journal), Joint Work, Accepted, ISSN 0021-9150

Objective: The utility of lipoprotein particle profiles measured by nuclear magnetic resonance (NMR) spectroscopy beyond standard serum lipids remains inconclusive. Furthermore, few studies have compared NMR measurements with standard lipids in association with coronary artery calcification (CAC) in Japanese, where the coronary atherosclerotic burden is low. We examined whether NMR-based lipoprotein particle profiles are associated with CAC, and compared them with standard lipid and lipid ratios in the Japanese general population. Methods and Results: We conducted a cross-sectional study in 851 men aged 40-79 years without cardiovascular diseases and lipid-lowering therapies. Adjusted odds ratios (ORs) (95% confidence intervals) for the top versus the bottom quartile of NMR-measured particle concentrations were 2.01 (1.24-3.23) for low-density lipoprotein (LDL-P), 1.04 (0.62-1.75) for high-density lipoprotein (HDL-P), 1.82 (1.13-2.95) for very-low-density lipoprotein (VLDL-P), and 1.92 (1.18-3.17) for LDL-P/HDL-P ratio. Similarly adjusted ORs of NMR-measured particle sizes were 0.59 (0.36-0.97) for LDL-P, 0.66 (0.40-1.10) for HDL-P, and 0.67 (0.40-1.12) for VLDL-P. The corresponding ORs were 1.82 (1.14-2.90) for total cholesterol (TC), 2.06 (1.28-3.30) for low-density lipoprotein cholesterol (LDL-C), 0.56 (0.34-0.91) for high-density lipoprotein cholesterol (HDL-C), 2.02 (1.24-3.29) for triglycerides, 2.08 (1.29-3.36) for non-high-density lipoprotein cholesterol (non-HDL-C), 2.27 (1.37-3.78) for TC/HDL-C ratio, and 1.73 (1.06-2.85) for LDL-C/HDL-C ratio. After mutual adjustment for total LDL-P concentration and TC/HDL-C ratio or non-HDL-C, LDL-P was no longer associated, whereas TC/HDL-C ratio remained significantly associated with CAC. Conclusions: In community-based Japanese men, the overall association of CAC with NMR-measured lipoprotein indices is comparable, but not superior, to that with standard lipids.

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Validation of homogeneous assays for HDL-cholesterol using fresh samples from healthy and diseased subjects

Miida Takashi, Nishimura Kunihiro, Okamura Tomonori, Hirayama Satoshi, Ohmura Hirotoshi, Yoshida Hiroshi, Miyashita Yoh, Ai Masumi, Tanaka Akira, Sumino Hiroyuki, Murakami Masami, Inoue Ikuo, Kayamori Yuzo, Nakamura Masakazu, Nobori Tsutomu, Miyazawa Yukihisa, Teramoto Tamio, Yokoyama Shinji

Atherosclerosis 233 ( 1 ) 253 - 259 2014.03

Research paper (scientific journal), Joint Work, Accepted, ISSN 0021-9150

Background: High-density lipoprotein-cholesterol (HDL-C) is a negative risk factor for cardiovascular events. Although several homogeneous HDL-C assays are available, their accuracy has not been validated, particularly in subjects with disease. We aimed to clarify whether HDL-C concentrations measured by homogeneous assays [HDL-C (H)] agree with those determined by the reference measurement procedures [HDL-C (RMP)] using ultracentrifugation and precipitation with heparin-manganese reagent in fresh clinical samples. Methods: HDL-C concentrations in samples from 48 healthy subjects and 119 subjects with disease were determined using 12 homogeneous assays and RMPs. Results: All reagents showed excellent intra- and inter-assay CVs (<2.23%) for two pooled sera. Furthermore, the mean bias was within ±1.0% in nine reagents using samples from healthy subjects and in eight reagents using samples from subjects with disease. In a single HDL-C (H) determination, the total error requirement of the National Cholesterol Education Program (95% of results<13%) was fulfilled in nine reagents using samples from healthy subjects and six reagents in those from subjects with disease. Error component analysis revealed that only one reagent exceeded ±10% total error in samples from healthy subjects, whereas four reagents exceeded this error in samples from subjects with disease. Correlations between HDL-C (H) and HDL-C (RMP) revealed that the slopes were within 1.00±0.06 in six reagents in healthy subjects, and eight reagents in subjects with disease. Conclusions: Except for three reagents, HDL-C (H) agrees well with HDL-C (RMP) in subjects with common disease, but not in those with extremely low HDL-C or abnormal HDL composition. © 2014 The Authors.

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Long-chain n-3 polyunsaturated fatty acids intake and cardiovascular disease mortality risk in Japanese

Miyagawa Naoko, Miura Katsuyuki, Okuda Nagako, Kadowaki Takashi, Takashima Naoyuki, Nagasawa Shin ya, Nakamura Yasuyuki, Matsumura Yasuhiro, Hozawa Atsushi, Fujiyoshi Akira, Hisamatsu Takashi, Yoshita Katsushi, Sekikawa Akira, Ohkubo Takayoshi, Abbott Robert D., Okamura Tomonori, Okayama Akira, Ueshima Hirotsugu

Atherosclerosis 232 ( 2 ) 384 - 389 2014.02

Research paper (scientific journal), Joint Work, Accepted, ISSN 0021-9150

Background: Dietary intake of long-chain n-3 PUFA (LCn3FA) among Japanese is generally higher than that in Western populations. However, little is known whether an inverse association of LCn3FA with cardiovascular disease (CVD) risk exists in a population with higher LCn3FA intake. Objective: To investigate the association between LCn3FA intake and the long-term risk of CVDs in a Japanese general population. Methods: We followed-up a total of 9190 individuals (56.2% women, mean age 50.0 years) randomly selected from 300 areas across Japan and free from CVDs at baseline. Dietary LCn3FA intake was estimated using household weighed food records. Cox models were used to calculate multivariate-adjusted hazard ratios (HR) and confidence intervals (CI) according to sex specific quartiles of LCn3FA intake. Results: During 24-year follow-up (192,897 person-years), 879 cardiovascular deaths were observed. The median daily intake of LCn3FA was 0.37%kcal (0.86g/day). Adjusted HR for CVD mortality was lower in the highest quartile of LCn3FA intake (HR 0.80; 95% CI 0.66-0.96) compared with the lowest quartile, and the trend was statistically significant (P=0.038). The similar but statistically non-significant trends were observed for coronary heart disease death and stroke death. In analyses by age groups, the inverse associations of LCn3FA intake with the risk of total CVD death and stroke death were significant in younger individuals (30-59 years at baseline). Conclusion: LCn3FA intake was inversely and independently associated the long-term risk of total CVD mortality in a representative sample of Japanese with high LCn3FA intake. © 2013 Elsevier Ireland Ltd.

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Steeper increases in body mass index during childhood correlate with blood pressure elevation in adolescence

Kuwahara Erika, Asakura Keiko, Nishiwaki Yuji, Komatsu Hirokazu, Nakazawa Akemi, Ushiku Hideo, Maejima Fumio, Nishigaki Yoshio, Hasegawa Tomonobu, Okamura Tomonori, Takebayashi Toru

Hypertension Research 37 ( 2 ) 179 - 184 2014.02

Research paper (scientific journal), Joint Work, Accepted, ISSN 0916-9636

The aim of this study was to clarify the relationship between long-term changes in body mass index (BMI) during childhood and adolescent blood-pressure levels in a general Japanese population. We used health report data from 900 Japanese children between 1983 and 2007. After adjusting for baseline BMI and other confounding factors multivariate linear regression analyses were performed to examine the relationship between changes in BMI (ΔBMI) over a 6-year period (6-12 years) and blood pressure once children reached ages 14 or 15. Sub-group analyses were also performed to ascertain the relationship between ΔBMI and blood pressure at 9th grade for children who had been in the bottom BMI tertile at 1st grade. Endpoint blood-pressure levels in boys (systolic and diastolic) and girls (systolic) from the group whose BMIs increased the most were significantly higher than those from the group whose BMIs increased the least (P<0.05, analysis of variance). After adjustment for baseline BMI and school-entrance year, the former group showed higher blood pressure at the endpoint than the latter (P<0.05, multiple regression analysis). Further adjustment for baseline blood pressure also showed similar results in a combined-sex analysis (n=592). Higher ΔBMI was associated with higher SBP 9 even in children whose BMI was in the lowest tertile at baseline after adjustment for sex and school-entrance year (P=0.02, multiple regression analysis). Steeper BMI increases during primary school lead to adolescent increases in blood pressure even if baseline BMI is low. Growth during childhood should be carefully managed. © 2014 The Japanese Society of Hypertension All rights reserved.

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Effect size and cost-effectiveness estimates of breast and cervical cancer screening reminders by population size through complete enumeration of Japanese local municipalities

Komoto Shigekazu, Nishiwaki Yuji, Okamura Tomonori, Tanaka Hideo, Takebayashi Toru

BMC Public Health 14 ( 1 ) 43 2014.01

Research paper (scientific journal), Joint Work, Accepted

Background: Client reminders are known to increase cancer screening attendance rates. However, there are significant costs associated with them, and their effect by population size is unknown. Methods. In 2007 and 2008, the Japanese Government surveyed breast and cervical cancer screening in every municipality in Japan. From the results, we selected all 1,464 municipalities that carried out both screening types. We examined whether changes in screening attendance rates between 2007 and 2008 were associated with client reminders, number of public health nurses per 100,000 population, financial strength index, and 2007 attendance rates for different population sizes. We then calculated cost-effectiveness estimates of client reminders by population size and screening type. Results: Client reminders were associated with increased attendance rates in populations <100,000. For populations of 50,000-100,000, there was a 2.76% increase in breast cancer screening (95% CI: 0.41, 5.11), and a 2.25% increase in cervical cancer screening (95% CI: 0.89, 3.61). The incremental cost per additional attendance was higher in populations <50,000 than in populations of 50,000-100,000 (breast, $100 versus $54; cervical, $149 versus $67 respectively). Conclusions: Client reminders for breast and cervical cancer screening increased attendance rates in smaller municipalities in Japan. © 2014 Komoto et al.; licensee BioMed Central Ltd.

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[Series: Clinical study from Japan and its reflections; LOX-1 ligands containing apolipoprotein B and carotid intima-media thickness in middle-aged community-dwelling US Caucasian and Japanese men].

Okamura T, Sekikawa A, Sawamura T, Ueshima H

Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 103 ( 1 ) 173 - 80 2014.01

Research paper (scientific journal), ISSN 0021-5384

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[Series: Clinical study from Japan and its reflections; LOX-1 ligands containing apolipoprotein B and carotid intima-media thickness in middle-aged community-dwelling US Caucasian and Japanese men].

Okamura T, Sekikawa A, Sawamura T, Ueshima H

Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 103 ( 1 ) 173 - 80 2014.01

Research paper (scientific journal), ISSN 0021-5384

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Impact of metabolic syndrome on the risk of cardiovascular disease mortality in the united states and in Japan

Liu Longjian, Miura Katsuyuki, Fujiyoshi Akira, Kadota Aya, Miyagawa Naoko, Nakamura Yasuyuki, Ohkubo Takayoshi, Okayama Akira, Okamura Tomonori, Ueshima Hirotsugu

American Journal of Cardiology 113 ( 1 ) 84 - 89 2014.01

Research paper (scientific journal), Accepted, ISSN 0002-9149

The United States has a higher prevalence of metabolic syndrome (MS) and cardiovascular disease (CVD) mortality than Japan, but it is unknown how much of the difference in MS accounts for the mortality difference. The aim of this study was to examine the impact of MS on the excess CVD mortality in the United States compared with that in Japan. Data from the United States Third National Health and Nutrition Examination Survey (NHANES III; n = 12,561) and the Japanese National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in Aged (NIPPON DATA; n = 7,453) were analyzed. MS was defined as ≥3 of 5 risk factors (obesity, high blood pressure, decreased high-density lipoprotein cholesterol, elevated glycosylated hemoglobin, and elevated triglycerides). The results show that after a median of 13.8 years of follow-up in the United States, 1,683 patients died from CVD (11.75 per 1,000 person-years), and after a median of 15 years of follow-up in Japan, 369 patients died from CVD (3.56 per 1,000 person-years). The age-adjusted prevalence of MS was 26.7% in the United States and 19.3% in Japan. Of 5 MS factors, obesity, high blood pressure, elevated triglycerides, and glycosylated hemoglobin in the United States, and high blood pressure and elevated glycosylated hemoglobin in Japan were significant risk factors for CVD mortality. Estimates of 13.3% and 44% of the excess CVD mortality for the United States could be explained by the higher prevalence of MS and MS plus baseline CVD history than in Japan. In conclusion, the present study is the first to quantitatively demonstrate that MS and MS plus baseline CVD history may significantly contribute to the explanation of excess CVD mortality in the United States compared with Japan. © 2014 Elsevier Inc. All rights reserved.

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Vegetarian diets and blood pressure ameta-analysis

Yokoyama Yoko, Nishimura Kunihiro, Barnard Neal D., Takegami Misa, Watanabe Makoto, Sekikawa Akira, Okamura Tomonori, Miyamoto Yoshihiro

JAMA Internal Medicine 174 ( 4 ) 577 - 587 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 2168-6106

IMPORTANCE Previous studies have suggested an association between vegetarian diets and lower blood pressure (BP), but the relationship is not well established. OBJECTIVE To conduct a systematic review and meta-analysis of controlled clinical trials and observational studies that have examined the association between vegetarian diets and BP. DATA SOURCES MEDLINE andWeb of Science were searched for articles published in English from 1946 to October 2013 and from 1900 to November 2013, respectively. STUDY SELECTION All studiesmet the inclusion criteria of the use of (1) participants older than 20 years, (2) vegetarian diets as an exposure or intervention, (3) mean difference in BP as an outcome, and (4) a controlled trial or observational study design. In addition, none met the exclusion criteria of (1) use of twin participants, (2) use of multiple interventions, (3) reporting only categorical BP data, or (4) reliance on case series or case reports. DATA EXTRACTION AND SYNTHESIS Data collected included study design, baseline characteristics of the study population, dietary data, and outcomes. The data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Net differences in systolic and diastolic BP associated with the consumption of vegetarian diets were assessed. RESULTS Of the 258 studies identified, 7 clinical trials and 32 observational studiesmet the inclusion criteria. In the 7 controlled trials (a total of 311 participants; mean age, 44.5 years), consumption of vegetarian diets was associated with a reduction in mean systolic BP (?4.8 mmHg; 95%CI, ?6.6 to ?3.1; P < .001; I2 = 0; P = .45 for heterogeneity) and diastolic BP (?2.2 mmHg; 95%CI, ?3.5 to ?1.0; P < .001; I2 = 0; P = .43 for heterogeneity) compared with the consumption of omnivorous diets. In the 32 observational studies (a total of 21 604 participants; mean age, 46.6 years), consumption of vegetarian diets was associated with lower mean systolic BP (?6.9mmHg; 95%CI, ?9.1 to ?4.7; P < .001; I2 = 91.4; P < .001 for heterogeneity) and diastolic BP (?4.7mmHg; 95%CI, ?6.3 to ?3.1; P < .001; I2 = 92.6; P < .001 for heterogeneity) compared with the consumption of omnivorous diets. CONCLUSIONS AND RELEVANCE Consumption of vegetarian diets is associated with lower BP. Such diets could be a useful nonpharmacologic means for reducing BP. Copyright © 2014 American Medical Association. All rights reserved.

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