Details of a Researcher - Okamura, Tomonori

Papers - Okamura, Tomonori

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Cerebrovascular diseases

Journal of Atherosclerosis and Thrombosis 21 ( 3 ) 175 - 179 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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The elderly

Journal of Atherosclerosis and Thrombosis 21 ( 3 ) 180 - 185 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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Cardiovascular risk with and without antihypertensive drug treatment in the japanese general population

Asayama Kei, Satoh Michihiro, Murakami Yoshitaka, Ohkubo Takayoshi, Nagasawa Sin Ya, Tsuji Ichiro, Nakayama Takeo, Okayama Akira, Miura Katsuyuki, Imai Yutaka, Ueshima Hirotsugu, Okamura Tomonori

Hypertension 63 ( 6 ) 1189 - 1197 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 0194-911X

To evaluate the cardiovascular mortality risk in association with blood pressure level among people with and without antihypertensive treatment, we performed the participant-level meta-analysis that included 39 705 Japanese from 6 cohorts (58.4% women; mean age, 60.1 years; 20.4% treated). Multivariable-adjusted Cox models were used to analyze the risk of cardiovascular mortality and its subtypes among 6 blood pressure levels according to recent guidelines, optimal to Grade 3 hypertension, and the usage of antihypertensive medication at baseline. During median 10.0 years of follow-up, there were 2032 cardiovascular deaths (5.1 per 1000 person-years), of which 410 deaths were coronary heart disease, 371 were heart failure, and 903 deaths were stroke. Treated participants had significantly higher risk for cardiovascular mortality (hazard ratios, 1.50; 95% confidence intervals, 1.36-1.66), coronary heart disease (hazard ratios, 1.53; confidence intervals, 1.23-1.90), heart failure (hazard ratios, 1.39; confidence intervals, 1.09-1.76), and stroke (hazard ratios, 1.48; confidence intervals, 1.28-1.72) compared with untreated people. Among untreated participants, the risks increased linearly with an increment of blood pressure category (P≤0.011). The risk increments per blood pressure category were higher in young participants (<60 years; 22% to 79%) than those in old people (≥60 years; 7% to 15%) with significant interaction for total cardiovascular, heart failure, and stroke mortality (P≤0.026). Among treated participants, the significant linear association was also observed for cardiovascular mortality (P=0.0003), whereas no stepwise increase in stroke death was observed (P=0.19). The risks of cardiovascular mortality were ≈1.5-fold high in participants under antihypertensive medication. More attention should be paid to the residual cardiovascular risks in treated patients. © 2014 American Heart Association, Inc.

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Predicting coronary heart disease using risk factor categories for a Japanese urban population, and comparison with the Framingham risk score

Nishimura Kunihiro, Okamura Tomonori, Watanabe Makoto, Nakai Michikazu, Takegami Misa, Higashiyama Aya, Kokubo Yoshihiro, Okayama Akira, Miyamoto Yoshihiro

Journal of Atherosclerosis and Thrombosis 21 ( 8 ) 784 - 798 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

Aim: The Framingham risk score (FRS) is one of the standard tools used to predict the incidence of coronary heart disease (CHD). No previous study has investigated its efficacy for a Japanese population cohort. The purpose of this study was to develop new coronary prediction algorithms for the Japanese population in the manner of the FRS, and to compare them with the original FRS.Methods: Our coronary prediction algorithms for Japanese were based on a large population-based cohort study (Suita study). The study population comprised 5,521 healthy Japanese. They were followed-up for 11.8 years on average, and 213 cases of CHD were observed. Multiple Cox proportional hazard model by stepwise selection was used to construct the prediction model.Results: Our coronary prediction algorithms for Japanese patients were based on a large population-based cohort study (the Suita study). A multiple Cox proportional hazard model by stepwise selection was used to construct the prediction model. The C-statistics showed that the new model had better accuracy than the original and recalibrated Framingham scores. The net reclassification improvement (NRI) by the Suita score with the inclusion of CKD was 41.2% (P＜0.001) compared with the original FRS. The recalibration of the FRS slightly improved the efficiency of the prediction, but it was still worse than the Suita score with the CKD model. The calibration analysis suggested that the original FRS and the recalibrated FRS overestimated the risk of CHD in the Japanese population. The Suita score with CKD more accurately predicted the risk of CHD.Conclusion: The FRS and recalibrated FRS overestimated the 10-year risk of CHD for the Japanese population. A predictive score including CKD as a coronary risk factor for the Japanese population was more accurate for predicting CHD than the original Framingham risk scores in terms of the C-statics and NRI.

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Diagnosis of atherosclerosis

Journal of Atherosclerosis and Thrombosis 21 ( 4 ) 296 - 298 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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Comparison of HOMA-IR, HOMA-β% and disposition index between US white men and Japanese men in Japan

Ahuja Vasudha, Kadowaki Takashi, Evans Rhobert W., Kadota Aya, Okamura Tomonori, El Khoudary Samar R., Fujiyoshi Akira, Barinas-Mitchell Emma J M, Hisamatsu Takashi, Vishnu Abhishek, Miura Katsuyuki, Maegawa Hiroshi, El-Saed Aiman, Kashiwagi Atsunori, Kuller Lewis H., Ueshima Hirotsugu, Sekikawa Akira

Diabetologia 58 ( 2 ) 265 - 271 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 0012-186X

Aims/hypothesis: At the same level of BMI, white people have less visceral adipose tissue (VAT) and are less susceptible to developing type 2 diabetes than Japanese people. No previous population-based studies have compared insulin resistance and insulin secretion between these two races in a standardised manner that accounts for VAT. We compared HOMA-IR, HOMA of beta cell function (HOMA-β%) and disposition index (DI) in US white men and Japanese men in Japan.Methods: We conducted a population-based, cross-sectional study, comprising 298 white men and 294 Japanese men aged 40–49 years without diabetes. Insulin, glucose, VAT and other measurements were performed at the University of Pittsburgh. We used ANCOVA to compare geometric means of HOMA-IR, HOMA-β% and DI, adjusting for VAT and other covariates.Results: White men had higher HOMA-IR, HOMA-β% and DI than Japanese men, and the difference remained significant (p < 0.01) after adjusting for VAT (geometric mean [95% CI]): 3.1 (2.9, 3.2) vs 2.5 (2.4, 2.6), 130.8 (124.6, 137.3) vs 86.7 (82.5, 91.0), and 42.4 (41.0, 44.0) vs 34.8 (33.6, 36.0), respectively. Moreover, HOMA-IR, HOMA-β% and DI were significantly higher in white men even after further adjustment for BMI, impaired fasting glucose and other risk factors.Conclusions/interpretation: The higher VAT-adjusted DI in white men than Japanese men may partly explain lower susceptibility of white people than Japanese people to developing type 2 diabetes. The results, however, should be interpreted with caution because the assessment of insulin indices was made using fasting samples and adjustment was not made for baseline glucose tolerance. Further studies using formal methods to evaluate insulin indices are warranted.

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Statements

Journal of Atherosclerosis and Thrombosis 21 ( 4 ) 299 - 303 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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Long chain n-3 polyunsaturated fatty acids and incidence rate of coronary artery calcification in Japanese men in Japan and white men in the USA

Sekikawa Akira, Miura Katsuyuki, Lee Sunghee, Fujiyoshi Akira, Edmundowicz Daniel, Kadowaki Takashi, Evans Rhobert W., Kadowaki Sayaka, Sutton-Tyrrell Kim, Okamura Tomonori, Bertolet Marnie, Masaki Kamal H., Nakamura Yasuyuki, Barinas-Mitchell Emma J M, Willcox Bradley J., Kadota Aya, Seto Todd B., Maegawa Hiroshi, Kuller Lewis H., Ueshima Hirotsugu

Heart 100 ( 7 ) 569 - 573 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1355-6037

Objective: To determine whether serum concentrations of long chain n-3 polyunsaturated fatty acids (LCn3PUFAs) contribute to the difference in the incidence rate of coronary artery calcification (CAC) between Japanese men in Japan and white men in the USA. Methods: In a population based, prospective cohort study, 214 Japanese men and 152 white men aged 40.49 years at baseline (2002.2006) with coronary calcium score (CCS)=0 were re-examined for CAC in 2007.2010. Among these, 175 Japanese men and 113 white men participated in the follow-up exam. Incident cases were defined as participants with CCS≥10 at follow-up. A relative risk regression analysis was used to model the incidence rate ratio between the Japanese and white men. The incidence rate ratio was first adjusted for potential confounders at baseline and then further adjusted for serum LCn3PUFAs at baseline. Results: Mean (SD) serum percentage of LCn3PUFA was >100% higher in Japanese men than in white men (9.08 (2.49) vs 3.84 (1.79), respectively, p<0.01). Japanese men had a significantly lower incidence rate of CAC compared to white men (0.9 vs 2.9/100 personyears, respectively, p<0.01). The incidence rate ratio of CAC taking follow-up time into account between Japanese and white men was 0.321 (95% CI 0.150 to 0.690; p<0.01). After adjusting for age, systolic blood pressure, low density lipoprotein cholesterol, diabetes, and other potential confounders, the ratio remained significant (0.262, 95% CI 0.094 to 0.731; p=0.01). After further adjusting for LCn3PUFAs, however, the ratio was attenuated and became non-significant (0.376, 95% CI 0.090 to 1.572; p=0.18). Conclusions: LCn3PUFAs significantly contributed to the difference in the incidence of CAC between Japanese and white men.

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Metabolic syndrome.

Journal of Atherosclerosis and Thrombosis 21 ( 1 ) 1 - 5 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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Diabetes mellitus

Journal of Atherosclerosis and Thrombosis 21 ( 2 ) 93 - 98 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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Familial hypercholesterolemia

Teramoto Tamio, Sasaki Jun, Ishibashi Shun, Birou Sadatoshi, Daida Hiroyuki, Dohi Seitaro, Egusa Genshi, Hiro Takafumi, Hirobe Kazuhiko, Iida Mami, Kihara Shinji, Kinoshita Makoto, Maruyama Chizuko, Ohta Takao, Okamura Tomonori, Yamashita Shizuya, Yokode Masayuki, Yokote Koutaro, Harada-Shiba Mariko, Arai Hidenori, Bujo Hideaki, Nohara Atsushi, Ohta Takao, Oikawa Shinichi, Okada Tomoo, Wakatsuki Akihiko

Journal of Atherosclerosis and Thrombosis 21 ( 1 ) 6 - 10 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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Other types of primary Hyperlipoproteinemia (Hyperlipidemia)

Journal of Atherosclerosis and Thrombosis 21 ( 2 ) 82 - 85 2014

Research paper (scientific journal), Joint Work, Accepted, ISSN 1340-3478

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High risks of all-cause and cardiovascular deaths in apparently healthy middle-aged people with preserved glomerular filtration rate and albuminuria

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

International Journal of Cardiology 170 ( 2 ) 167 - 172 2013.12

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

Background The reason why coexistence of preserved estimated glomerular filtration rate (eGFR) and albuminuria contributes to a high risk of death and which cause of death increases all-cause mortality have not been elucidated. Methods A total of 16,759 participants aged 40 to 69 years with normal or mildly reduced eGFR (45-119 ml/min/1.73 m²) were enrolled and divided into six groups (group 1, eGFR: 90-119 without albuminuria; group 2, eGFR: 90-119 with albuminuria; group 3, eGFR: 60-89 without albuminuria (reference); group 4, eGFR: 60-89 with albuminuria; group 5, eGFR: 45-59 without albuminuria; group 6, eGFR: 45-59 with albuminuria) based on GFR estimated by using the CKD-EPI study equation modified by a Japanese coefficient and albuminuria (urine albumin-creatinine ratio ≥ 30 mg/g). Outcomes included all-cause death (ACD), cardiovascular death (CVD) and neoplasm-related death (NPD). Multivariable-adjusted mortality rate ratios (RR) and their 95% confidence intervals (CIs) in the groups were estimated by Poisson's regression analysis. Results The highest risk of ACD (RR (95% CIs): 3.95 (2.08-7.52)), CVD (7.15 (2.25-22.7)) and NPB (3.25 (1.26-8.38)) was observed in group 2. Subjects in group 2 were relatively young and had the highest levels of body mass index, blood pressure and HbA_1c and the highest prevalence of diabetes and metabolic syndrome. Conclusion Coexistence of preserved eGFR and albuminuria increases risks for ACD, CVD and NPD. Relatively young metabolic persons having both preserved eGFR and albuminuria should be considered as a very high-risk population. © 2013 Elsevier Ireland Ltd.

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The economic and medical costs of alcohol consumption in Japan.

Kanda H, Okamura T

The West Indian medical journal 62 ( 9 ) 785 - 6 2013.12

ISSN 0043-3144

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Long-term outcome of healthy participants with atrial premature complex

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

PLoS ONE 8 ( 11 ) e80853 2013.11

Research paper (scientific journal), Joint Work, Accepted

Background: Atrial premature complexes (APC) are among the most frequently encountered electrocardiographic abnormalities. However, their prognostic value among healthy individuals is unclear. This study aimed to clarify the role of APC in predicting cardiovascular events in a large Japanese community cohort using long-term follow-up data. Methods: National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged, 1990-2005, (NIPPON DATA 90) was a large cohort study of cardiovascular disease (CVD) in Japan. A total of 7692 otherwise healthy participants with no history of myocardial infarction, stroke, atrial fibrillation, or atrial flutter were enrolled (men, 41.5%; mean age, 52.5 ± 13.7 years). Results: A total of 64 (0.8%) participants had at least one beat of APC on screening 12-lead electrocardiogram. During the follow-up of 14.0 ± 2.9 years (total, 107,474 patient-years), 338 deaths occurred due to CVD. The association between APC and CVD outcome was assessed using Cox proportional hazard models. Cox regression analysis revealed that the presence of APC was an independent predictor for CVD deaths (HR: 2.03, 95% CI: 1.12-3.66, P = 0.019). The association of APC on CVD death was more evident in participants with hypertension (P-value for interaction, 0.03). Conclusions: APC recorded during the screening electrocardiogram are significantly associated with an increased risk of CVD deaths in a Japanese community-dwelling population and are a strong prognostic factor for hypertensive participants. © 2013 Inohara et al.

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HbA_1c and the risks for all-cause and cardiovascular mortality in the general Japanese population

Sakurai Masaru, Saitoh Shigeyuki, Miura Katsuyuki, Nakagawa Hideaki, Ohnishi Hirofumi, Akasaka Hiroshi, Kadota Aya, Kita Yoshikuni, Hayakawa Takehito, Ohkubo Takayoshi, Okayama Akira, Okamura Tomonori, Ueshima Hirotsugu

Diabetes Care 36 ( 11 ) 3759 - 3765 2013.11

Research paper (scientific journal), Joint Work, Accepted, ISSN 0149-5992

Objective - Associations between HbA_1c and cardiovascular diseases (CVD) have been reported mainly in Western countries. It is not clear whether HbA_1c measurements are useful for assessing CVD mortality risk in East Asian populations. Research Design and Methods - The risk for cardiovascular death was evaluated in a large cohort of participants selected randomly from the overall Japanese population. A total of 7,120 participants (2,962men and 4,158 women; mean age 52.3 years) free of previous CVD were followed for 15 years. Adjusted hazard ratios (HRs) and 95% CIs among categories of HbA_1c (<5.0%, 5.0-5.4%, 5.5-5.9%, 6.0-6.4%, and ≥6.5%) for participants without treatment for diabetes and HRs for participants with diabetes were calculated using a Cox proportional hazards model. Results - During the study, there were 1,104 deaths, including 304 from CVD, 61 from coronary heart disease, and 127 from stroke (78 from cerebral infarction, 25 from cerebral hemorrhage, and 24 from unclassified stroke). Relations to HbA_1c with all-cause mortality and CVD death were graded and continuous, and multivariate-adjusted HRs for CVD death in participants with HbA_1c 6.0-6.4% and ≥6.5%were 2.18 (95% CI 1.22-3.87) and 2.75 (1.43-5.28), respectively, compared with participants with HbA_1c <5.0%. Similar associations were observed between HbA_1c and death from coronary heart disease and death from cerebral infarction. Conclusions - High HbA_1c levels were associated with increased risk for all-cause mortality and death from CVD, coronary heart disease, and cerebral infarction in general East Asian populations, as in Western populations. © 2013 by the American Diabetes Association.

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Association of total marine fatty acids, eicosapentaenoic and docosahexaenoic acids, with aortic stiffness in Koreans, whites, and Japanese Americans.

Sekikawa A, Shin C, Masaki KH, Barinas-Mitchell EJ, Hirooka N, Willcox BJ, Choo J, White J, Evans RW, Fujiyoshi A, Okamura T, Miura K, Muldoon MF, Ueshima H, Kuller LH, Sutton-Tyrrell K, ERA JUMP Study Group.

American journal of hypertension 26 ( 11 ) 1321 - 7 2013.11

Research paper (scientific journal), ISSN 0895-7061

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Association of total marine fatty acids, eicosapentaenoic and docosahexaenoic acids, with aortic stiffness in Koreans, whites, and Japanese Americans.

American journal of hypertension 26 ( 11 ) 1321 - 7 2013.11

Research paper (scientific journal), ISSN 0895-7061

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Effects of intensive and moderate public education on knowledge of early stroke symptoms among a Japanese population

Morimoto Akiko, Miyamatsu Naomi, Okamura Tomonori, Nakayama Hirofumi, Toyoda Kazunori, Suzuki Kazuo, Toyota Akihiro, Hata Takashi, Yamaguchi Takenori

Stroke 44 ( 10 ) 2829 - 2834 2013.10

Research paper (scientific journal), Joint Work, Accepted, ISSN 0039-2499

Background and Purpose-To assess the effects of intensive and moderate public education on knowledge of early stroke symptoms among a general Japanese population. Methods-Information on early stroke symptoms was distributed by leaflet 12× and by booklet twice in an intensive intervention area >22 months, and by leaflet and booklet once each in a moderate intervention area. No distribution occurred in the control area. Before and after the intervention, a mailed survey was conducted in the 3 areas. A total of 2734 individuals, aged 40 to 74 years, who did not select all 5 correct symptoms of stroke in the preintervention survey were eligible for our analysis. Results-The numbers of correct answers selected about stroke symptoms did not differ significantly among the 3 areas in the preintervention survey (P=0.156). In the postintervention survey, the proportions of participants who selected sudden 1-sided numbness or weakness (94.2% in the intensive intervention area, 88.3% in the moderate intervention area, and 89.2% in the control area P<0.001) and sudden severe headache (76.8%, 70.1%, and 70.4%, respectively P<0.001) differed significantly among the 3 areas. After adjustment for confounding factors, the multivariable-adjusted odds ratios (95% confidence intervals) for correctly choosing all 5 symptoms were 1.35 (1.07-1.71) in the intensive intervention area and 0.96 (0.74-1.24) in the moderate intervention area compared with the control area. Conclusions-Our findings suggest that frequent distribution of leaflets and booklets significantly improved the short-term knowledge of community residents about early symptoms of stroke. © 2013 American Heart Association, Inc.

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A cross-sectional association of obesity with coronary calcium among Japanese, Koreans, Japanese Americans, and US Whites

Fujiyoshi Akira, Sekikawa Akira, Shin Chol, Masaki Kamal, David Curb J., Ohkubo Takayoshi, Miura Katsuyuki, Kadowaki Takashi, Kadowaki Sayaka, Kadota Aya, Edmundowicz Daniel, Shah Amber, Evans Rhobert W., Bertolet Marianne, Choo Jina, Willcox Bradley J., Okamura Tomonori, Maegawa Hiroshi, Murata Kiyoshi, Kuller Lewis H., Ueshima Hirotsugu

European Heart Journal Cardiovascular Imaging 14 ( 9 ) 921 - 927 2013.09

Research paper (scientific journal), Joint Work, Accepted, ISSN 2047-2404

AimsConflicting evidence exists regarding whether obesity is independently associated with coronary artery calcium (CAC), a measure of coronary atherosclerosis. We examined an independent association of obesity with prevalent CAC among samples of multi-ethnic groups whose background populations have varying levels of obesity and coronary heart disease (CHD).Methods and resultsWe analysed a population-based sample of 1212 men, aged 40-49 years free of clinical cardiovascular disease recruited in 2002-06; 310 Japanese in Japan (JJ), 294 Koreans in South Korea (KN), 300 Japanese Americans (JA), and 308 Whites in the USA (UW). We defined prevalent CAC as an Agatston score of ≥10. Prevalent CAC was calculated by tertile of the body mass index (BMI) in each ethnic group and was plotted against the corresponding median of tertile BMI. Additionally, logistic regression was conducted to examine whether an association of the BMI was independent of conventional risk factors. The median BMI and crude prevalence of CAC for JJ, KN, JA, and UW were 23.4, 24.4, 27.4, and 27.1 (kg/m²); 12, 11, 32, and 26 (%), respectively. Despite the absolute difference in levels of BMI and CAC across groups, higher BMI was generally associated with higher prevalent CAC in each group. After adjusting for age, smoking, alcohol, hypertension, lipids, and diabetes mellitus, the BMI was positively and independently associated with prevalent CAC in JJ, KN, UW, but not in JA.ConclusionIn this multi-ethnic study, obesity was independently associated with subclinical stage of coronary atherosclerosis among men aged 40-49 years regardless of the BMI level. © 2013 Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013.

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