Papers - Okamura, Tomonori

Current Status of Cardiovascular Disease in Japan: Prevention Strategies, Future Challenges, and Fundamental Lessons

Okamura T., Hirata A.

Journal of the American College of Cardiology 86 ( 22 ) 2106 - 2108 2025.12

ISSN  07351097

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Association of repeated high serum osmolarity with cognitive function in older Japanese adults in a KOBE study subanalysis

Nishikawa T., Miyamatsu N., Higashiyama A., Kubota Y., Nishida Y., Hirata T., Hirata A., Miyazaki J., Tatsumi Y., Sugiyama D., Kuwabara K., Kubo S., Miyamoto Y., Okamura T.

Scientific Reports 15 ( 1 ) 36784 2025.12

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The relationship between serum osmolarity and cognitive function has not been fully characterized. This study aimed to examine the cross-sectional association between repeated high serum osmolarity and cognitive performance among elderly community residents. We performed a subanalysis of the Kobe Orthopedic and Biomedical Epidemiological Study, including residents aged ≥ 75 years who completed the Japanese Montreal Cognitive Assessment (MoCA-J) in 2016–2017 (n = 127), 2018–2019 (n = 71), and 2020 (n = 16). Serum osmolarity was obtained from the data in the 2012–2013 survey and in the 2016–2017 survey. MoCA-J scores were dichotomized at ≤ 22 versus > 22. Multivariate logistic regression adjusted for demographic, lifestyle including daily non-alcohol drink intake, seasonal, and clinical covariates to assess associations between osmolarity status and cognitive group. Among 214 participants (mean age 76.2 ± 1.3 years; 56% female), high osmolarity (≥ 300 mOsm/L) in 2012–2013 was associated with MoCA-J ≤ 22 (OR 2.67, 95% CI 1.29–5.53, p = 0.008). A similar association emerged for 2016–2017 measurements (OR 6.12, 95% CI 1.46–25.61, p = 0.013). Participants with high serum osmolarity at both time points showed a stronger cross-sectional association with lower MoCA-J scores (OR 17.64, 95% CI = 1.8–184.83, p = 0.017). No significant association was observed between daily non-alcoholic drink (NAD) intake and either MoCA-J scores or serum osmotic pressure. Repeated high serum osmolarity was cross-sectionally associated with lower cognitive performance in Japanese community-dwelling older adults. While NAD intake showed no significant association, further research is needed to explore the potential role of serum osmolarity in cognitive health. These findings warrant confirmation in larger prospective studies.

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[Comparison of estimated salt and potassium intake and urinary sodium-to-potassium ratio based on casual urine: A 10-year follow-up of NIPPON DATA2010].

Kitaoka K, Kadota A, Yoshita K, Okami Y, Kondo K, Harada A, Okuda N, Ohkubo T, Okamura T, Miura K

[Nihon koshu eisei zasshi] Japanese journal of public health  2025.10

ISSN  0546-1766

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Low-Density-Lipoprotein Cholesterol Control and Treatment Status 1 Year after the Initial Health Checkup in Individuals with Referral-Level LDL Cholesterol.

Aoki H, Kitaoka K, Suzuki Y, Kaneko H, Okada A, Takeda N, Morita H, Hiroi Y, Node K, Furui Y, Okamura T, Miura K, Yasunaga H, Takeda N

Journal of atherosclerosis and thrombosis  2025.09

ISSN  1340-3478

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Effectiveness of recommendations in promoting the use of Mobile health applications in health guidance: a randomized controlled trial.

Onoue T, Nishida K, Nakata Y, Hayashi F, Marutani M, Sakane N, Moriguchi J, Muto S, Kato K, Masuda I, Okamura T, Matsuzaki K, Kawamura T, Tsushita K

Journal of occupational health 67 ( 1 )  2025.07

ISSN  1341-9145

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Objectives: Use of commercially available mobile health (mHealth) applications in supporting lifestyle improvements has become popular in recent years. However, the effectiveness of advice promoting the use of such applications based on individual behavioral goals in a health guidance setting remains unclear. This study explored how guiding participants of the Specific Health Guidance (SHG) program, a Japanese public health initiative to prevent cardiovascular disease, to use commercially available mHealth applications impacted their application usage, lifestyle habits, and cardiovascular risk factors. Methods: In this multicenter, randomized, open-label, parallel-group comparison study, 156 individuals with a history of SHG participation and who were engaged in the Motivational Health Guidance program (a type of SHG) in 2021 were assigned to intervention (n = 76) or control (n = 80) groups. Whereas both groups received standard guidance, the intervention group also received recommendations for mHealth applications based on their individual behavioral goals. The participants' application usage, behavioral changes, and body weight were assessed after 3 months, with health checkup data evaluated after 1 year. Results: The proportion of mHealth application users after 3 months was significantly higher in the intervention group (68.4%) than in the control group (40.0%). The intervention group also reported a significantly greater weekly frequency of mHealth application usage. Moreover, the intervention group reported a significantly decreased change in triglyceride levels after 1 year compared with the control group. Conclusions: Recommending commercially available mHealth applications in a health guidance setting significantly increased the number of mHealth application users and their frequency of use.

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Association of Social Participation with Cardiovascular Risk Factors: A Systematic Review.

Miura M, Ikeda A, Sato S, Muraki I, Okamura T, Ohira T, Miyazaki J, Ishihara M, Okamoto K, Kamijima J, Li Q, Ikeda S, Yamagishi K, Tanigawa T

Journal of atherosclerosis and thrombosis 32 ( 8 ) 897 - 910 2025.05

ISSN  1340-3478

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Aim: Although social participation, defined as involvement in social activities, may be beneficial for cardiovascular health, evidence about the association remains limited. This systematic review summarized the relationship between social participation and cardiovascular risk factors. Methods: Original articles of longitudinal observational studies published in English before January 1, 2024, were searched via PubMed, Scopus, and Cochrane Library. Two investigators selected eligible literature for four health outcomes: hypertension, diabetes, dyslipidemia, and obesity. Results: Eight articles (including duplicates) covering cohort studies were included. The results indicated that social participation is associated with lower hypertension risk, but gender differences may exist in the association between social participation and hypertension. Two articles from a Japanese cohort study were found on diabetes, both of which reported significant preventive association with social participation. The only study on dyslipidemia showed a higher hyperlipidemia risk among women, but not men, with social participation. Two studies on the risk of obesity showed inconsistent results, with one reporting the association between social participation and maintenance of smaller waist circumference only among men, while the other found no association with body mass index. Conclusions: There is some evidence of the association between social participation and better cardiovascular health outcomes. However, evidence on gender differences and validation of the methodology for measuring social participation was still lacking.

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Serum Total Cholesterol and Fatal Subarachnoid Hemorrhage in 120,000 Japanese: A Pooled Analysis of Data from 12 Cohorts.

Satoh A, Arima H, Tanaka-Mizuno S, Fujiyoshi A, Kadota A, Miura K, Ueshima H, Okamura T, Murakami Y, EPOCH JAPAN Research Group

Journal of atherosclerosis and thrombosis 32 ( 11 ) 1425 - 1433 2025.05

ISSN  1340-3478

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Aim: The aim of this study was to clarify the association between serum total cholesterol and fatal subarachnoid hemorrhage in Japanese men and women. Methods: The study involved a pooled analysis of individual data from 12 well-qualified cohort studies conducted in Japan. The participants were classified according to their serum total cholesterol levels: ＜4.14 mmol/L (＜160 mg/dL), 4.14–4.64 mmol/L (160–180 mg/dL), 4.65–5.16 mmol/L (180–199 mg/dL), 5.17–5.68 mmol/L (200–219 mg/dL), 5.69–6.20 mmol/L (220–239 mg/dL), and ≥ 6.21 mmol/L (≥ 240 mg/dL). The outcome of the analysis was death from subarachnoid hemorrhage. Results: A total of 120,973 participants (70,947 women and 50,026 men) aged 18–96 years at baseline underwent follow-up for a median of 12.7 years, and 261 participants died from subarachnoid hemorrhage during this period. In women, both low (＜5.69 mmol/L [＜220 mg/dL]) and high (≥ 6.21 mmol/L [≥ 240 mg/ dL]) serum total cholesterol levels were significantly associated with a higher risk of fatal subarachnoid hemorrhage compared with the reference group (5.69–6.20 mmol/L [220–239 mg/dL]). These associations remained significant after adjustment for confounding factors. In contrast, no associations were observed in men. Conclusion: Both low and high serum total cholesterol levels were associated with a higher risk of fatal subarachnoid hemorrhage in 70,947 female participants from 12 cohort studies throughout Japan.

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Cross-Sectional Association between Sedentary Behavior and Physical Inactivity with Cardiometabolic Risk Factors among Japanese: The NIPPON DATA2010.

Ohashi M, Miyagawa N, Yanagita M, Okuda N, Fujiyoshi A, Ohkubo T, Kadota A, Okami Y, Kondo K, Harada A, Okamura T, Ueshima H, Okayama A, Miura K, NIPPON DATA2010 Research Group

Journal of atherosclerosis and thrombosis 32 ( 10 ) 1328 - 1346 2025.05

ISSN  1340-3478

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Aim: Sedentary behavior and physical inactivity increase the risk of cardiometabolic diseases. It is important to evaluate physical activity in daily life and understand the influence of these factors on cardiometabolic diseases in the Japanese population, which tends to have a prolonged sitting time. We examined the association between sedentary behavior and physical inactivity, characterized by extended television (TV) viewing and low step counts, which are easily monitored and modifiable, and cardiometabolic risk factors in the Japanese population. Methods: This cross-sectional study included 2,531 Japanese adults (1,087 men and 1,444 women) 20–91 years old, randomly selected throughout Japan. TV viewing was assessed using a self-reported questionnaire, and step counts were measured using pedometers. Cardiometabolic risk factors were determined using physical examinations or blood samples. The association between sedentary behavior and physical inactivity with each risk factor was examined using a cross-sectional analysis with multivariate-adjusted logistic regression models. Results: In both sexes, longer TV viewing positively correlated with low high-density lipoprotein (HDL) cholesterol and high triglycerides (TG). In women, TV viewing time is associated with obesity and increased abdominal circumference (AC). Conversely, in men, lower step counts were positively associated with obesity and increased AC, low HDL cholesterol, and high TG levels. Conclusions: The association between prolonged TV viewing and cardiometabolic risk factors was more pronounced in women than in men, whereas the influence of lower step counts was stronger in men than in women. These findings contribute to the improvement of cardiovascular health by monitoring and managing individual screen times and step counts in daily life.

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Genome-wide association study of plasma amino acids and Mendelian randomization for cardiometabolic traits.

Toki R, Fushiki S, Kojima S, Sutoh Y, Otsuka-Yamasaki Y, Harada S, Iida M, Hirata A, Miyagawa N, Matsumoto M, Edagawa S, Miyake A, Kuwabara K, Hirayama A, Sugimoto M, Sato A, Amano K, Soga T, Tomita M, Arakawa K, Kinoshita K, Sakurai-Yageta M, Tamiya G, Ohmomo H, Shimizu A, Okamura T, Takebayashi T

Scientific reports 15 ( 1 ) 14569 2025.04

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Plasma amino acids (AAs) have emerged as promising biomarkers for metabolic disorders, yet their causality remains unclear. We aimed to investigate the genetic determinants of AA levels in a cohort of 10,333 individuals and their causal effects on cardiometabolic traits using Mendelian randomization (MR). Plasma levels of 20 AAs were quantified using capillary electrophoresis mass spectrometry. Genome-wide association studies were conducted using BOLT-LMM and heritability estimation via LDSC analysis. Causal effects of AAs on 11 cardiometabolic traits were examined using two-sample MR analyses. We identified 85 locus-metabolite associations across 43 genes for 18 AAs, including 44 novel loci linked to metabolic genes. Heritability for AAs was estimated at 16%. MR analysis demonstrated cystine to positively associate with systolic blood pressure (SBP) (β = 0.056, SE = 0.010), while serine indicated protective effects on SBP (β = − 0.040, SE = 0.011), diastolic BP (β = − 0.044, SE = 0.010), and coronary artery disease (odds ratio 0.888, SE = 0.028). We identified potentially novel genetic loci associated with AA levels and demonstrated robust causal associations between several AAs and cardiometabolic traits. These findings reinforce the importance of AAs as potential biomarkers and therapeutic targets in cardiometabolic health.

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A Randomized Clinical Trial of ICT-based Interventions for Sodium and Potassium Regulation in Healthy Adults.

Yano Y, Kitaoka K, Ohkubo T, Okamura T, Kanegae H, Yoshita K, Tsukinoki R, Okami Y, Node K, Rakugi H, Itoh H, Miura K

American journal of hypertension 38 ( 8 ) 588 - 594 2025.04

ISSN  0895-7061

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BACKGROUND: There is limited knowledge regarding effective strategies, including information and communication technology (ICT)-based interventions, to reduce sodium intake and increase potassium intake in healthy individuals. METHODS: We conducted a 3-month randomized controlled trial involving healthy adult employees with spot urine sodium-to-potassium ratios (spot UNa/UK) ≥4.0 or estimated 24-hour salt intake ≥10g. Estimated 24-hour UNa and UK were calculated using the Tanaka formula. Participants were assigned to one of four groups: (i) online education, where participants monitored their spot UNa/UK and received feedback from dieticians (n = 84); (ii) messaging, with similar self-monitoring and dietician messages (n = 84); (iii) self-learning, provided with an educational leaflet (n = 87); and (iv) a control group (n = 87). The primary outcome was the change in spot UNa/UK ratios, and secondary outcomes included changes in estimated 24-hour UNa and UK. The trial protocol specified a hierarchical order for testing the interventions, anticipating the highest efficacy in the online education group. RESULTS: After the intervention, the online education group showed a decrease in spot UNa/UK ratios (mean -0.9 (95% CI: -1.8 to 0.0), P = 0.052) compared to the control group. The increase in estimated 24-hour UK excretion was larger in online education compared to the control group (mean + 2.5 mmol/day (95% CI: -0.3 to 5.3), P = 0.085). The difference in estimated 24-hour UNa excretion between the online education and control groups was -4.3 mmol/day (95% CI: -15.5 to 6.9, P = 0.45). CONCLUSIONS: Combining self-monitoring of sodium and potassium intake with ICT-based interventions, including online nutritional education, was associated with a modest reduction in the estimated ratios of sodium and potassium intake in healthy individuals.

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Atherosclerotic Cardiovascular Disease Risk Prediction Models in China, Japan, and Korea: Implications for East Asians?

Nguyen P.K., Zhao D., Okamura T., Chang Kim H., Wong N.D., Yang E.

JACC: Asia 5 ( 3 ) 333 - 349 2025.03

ISSN  2772-3747

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The management of atherosclerotic cardiovascular disease (ASCVD) in the United States is currently based upon large epidemiological studies in primarily non-Hispanic White subjects. Although this strategy provides a uniform approach that is simpler to implement, it may result in inappropriately targeting certain Asian populations for treatment based on inaccurate ASCVD risk estimation. In this state-of-the-art review, we detail the similarities and differences in the prevalence of ASCVD and its risk factors among Chinese, Japanese, and Korean people living in the United States and in their native countries. We highlight the limitations of current risk calculators when applied to East Asian immigrants and summarize risk stratification approaches in China, Japan, and Korea. Our review underscores the need to disaggregate registry, cohort, and clinical trial data by East Asian subgroups, to actively engage these populations in research, and to initiate studies to better define ASCVD risk in East Asian people living in the United States.

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All-Cause and Cause-Specific Mortality Associated with Long-Term Exposure to Fine Particulate Matter in Japan: The Ibaraki Prefectural Health Study

Michikawa, T; Nishiwaki, Y; Asakura, K; Okamura, T; Takebayashi, T; Hasegawa, S; Milojevic, A; Minami, M; Taguri, M; Takeuchi, A; Ueda, K; Sairenchi, T; Yamagishi, K; Iso, H; Irie, F; Nitta, H

JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS 32 ( 8 ) 982 - 993 2025.01

ISSN  1340-3478

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Aims: Long-term exposure to fine particulate matter (PM2.5) is causally associated with mortality and cardiovascular disease. However, in terms of cardiovascular cause-specific outcomes, there are fewer studies about stroke than about coronary heart disease, particularly in Asia. Furthermore, there remains uncertainty regarding the PM2.5-respiratory disease association. We examined whether long-term exposure to PM2.5 is associated with all-cause, cardiovascular and respiratory disease mortality in Japan. Methods: We used data of 46,974 participants (19,707 men; 27,267 women), who were enrolled in 2009 and followed up until 2019, in a community-based prospective cohort study (the second cohort of the Ibaraki Prefectural Health Study). We estimated PM2.5 concentrations using the inverse distance weighing methods based on ambient air monitoring data, and assigned each participant to administrative area level concentrations. A Cox proportional hazard model was applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality. Results: During the average follow-up of 10 years, we confirmed 2,789 all-cause deaths. All outcomes including stroke mortality did not significantly increase as the PM2.5 concentration increased. For non-malignant respiratory disease mortality, the multivariable adjusted HR per 1 µg/m³ increase in the PM2.5 concentration was 1.09 (95% CI = 0.97–1.23). Conclusions: In this population exposed to PM2.5 at concentrations of 8.3–13.1 µg/m³, there was no evidence that long-term exposure to PM2.5 had adverse effects on mortality. Weak evidence of positive association observed for non-malignant respiratory disease mortality needs further studies in other populations.

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Comprehensive assessment of the impact of blood pressure, body mass index, smoking, and diabetes on healthy life expectancy in Japan: NIPPON DATA90.

Tsukinoki R, Murakami Y, Hayakawa T, Kadota A, Harada A, Kita Y, Okayama A, Miura K, Okamura T, Ueshima H

Journal of epidemiology 35 ( 8 ) 349 - 54 2025.01

ISSN  0917-5040

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Background: Healthy life expectancy (HLE) is a population health indicator that is widely used in developed countries, but little is known about its relationships with combinations of non-communicable disease risk factors. This study was conducted to examine HLE at age 65 years according to combinations of blood pressure levels, body mass index, smoking status, and diabetes mellitus (DM) in a Japanese population. Methods: In a nationwide cohort study (NIPPON DATA90), data on these risk factors were obtained from participants in 1990 through physical examinations, blood tests, interviews, and questionnaires. Subsequently, participants aged ≥65 years underwent surveys on activities of daily living in 1995 and 2000, and multistate life tables were used to calculate combination-specific HLEs and their 95% confidence intervals (CIs). Results: The study population comprised 6,569 participants (men: 2,797; women: 3,772) who were followed until 2010. HLE at age 65 years in men with grade II/III hypertension, obesity, current smoker status, and DM (HLE 12.9; 95% CI, 12.9–13.0 years) was 9.7 years shorter than men without these risk factors (HLE 22.6; 95% CI, 22.4–22.8 years). Similarly, HLE at age 65 years in women with grade II/III hypertension, obesity, current smoker status, and DM (HLE 16.2; 95% CI, 15.9–16.5 years) was 10.1 years shorter than women without these risk factors (HLE 26.3; 95% CI, 26.3–26.3 years). Conclusion: The large discrepancies in HLEs underscore the impact of non-communicable disease risk factors, which should be considered when formulating health interventions to improve HLE in Japanese older adults.

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Association between employment status and long-term changes in psychological stress across the COVID-19 pandemic period in Japan: NIPPON DATA2010.

Abe M, Arima H, Okuda N, Taniguchi H, Satoh A, Nishi N, Aono N, Higashiyama A, Suzuki H, Okami Y, Kondo K, Kitaoka K, Kadota A, Okamura T, Ohkubo T, Okayama A, Miura K, NIPPON DATA Research Group

Journal of occupational health 67 ( 1 )  2025.01

ISSN  1341-9145

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Objectives: There is a growing interest in understanding the long-term impact of employment status on psychological stress. We aimed to explore the association between socioeconomic status and psychological stress over a long-term follow-up period across the COVID-19 pandemic, employing the Kessler 6-Item Psychological Distress Scale (K6). Methods: We evaluated K6 scores from the 2021 follow-up survey of NIPPON DATA2010 using a self-administered questionnaire. The association between employment status and changes in K6 scores over 11 years was examined. Multiple regression analyses were used to estimate both crude and adjusted differences in K6 score changes across various socioeconomic factors including employment category, annual household income, marital status, and household size. Analyses were stratified by age, gender, and prefectural population size. Results: This study included 1532 participants with an average age of 54.9 years. Over 11 years (2010–2021), participants in both gender and age groups showed increases in mean K6 scores (men: 2.79 to 3.06; women: 3.15 to 3.56; <65 years: 3.27 to 3.47; ≥65 years: 2.37 to 3.08). Nonemployed participants, particularly homemakers, showed significantly greater increases in K6 scores, compared with full-time employees, especially among women, younger individuals, and those in densely populated areas, with a significant interaction with age. Conclusions: Nonemployed individuals, especially homemakers, experienced greater psychological stress over the past 11 years than did their fully employed counterparts. Public interventions, including strengthened social connections and telemental health services, may help mitigate these disparities, enhance mental well-being, and foster a sense of belonging.

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Long-term risk of cardiovascular mortality according to age group and blood pressure categories of the latest guideline

Satoh M., Ohkubo T., Miura K., Harada A., Tsutsui A., Hozawa A., Shimizu Y., Ishikawa S., Kokubo Y., Okamura T., Murakami Y.

Hypertension Research 48 ( 4 ) 1428 - 1433 2025

ISSN  09169636

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This study examined the association between the latest blood pressure (BP) classification and cardiovascular disease (CVD) mortality risk, using data from 70,570 individuals across 10 Japanese cohorts. Participants were stratified by age (40–64 and 65–89 years) and antihypertensive treatment use. BP was classified according to the 2019 Japanese Society of Hypertension Guidelines. During a follow-up period of approximately 10 years, 2304 CVD deaths occurred. Cox models demonstrated that CVD mortality risk increased stepwise with the BP category, with this association being especially pronounced in patients aged 40–64 years, where the Grade I hypertension group showed the highest population-attributable fraction (PAF). When the treated participants were included in the hypertension group, the overall PAF for CVD mortality was 41.1%. Similar patterns were observed for CVD subtype mortality risk, with hypertension showing particularly high PAFs for intracerebral hemorrhage. These findings highlight the importance of early-stage prevention and management of hypertension. (Figure presented.)

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Associations between mental health and lifestyle changes during the COVID-19 pandemic in a general Japanese population: NIPPON DATA2010.

Aono N, Higashiyama A, Suzuki H, Fujiyoshi A, Abe M, Satoh A, Arima H, Nishi N, Kadota A, Ohkubo T, Okamura T, Okuda N, Okayama A, Miura K

Environmental health and preventive medicine 30   28 2025

ISSN  1342-078X

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BACKGROUND: Deterioration in lifestyle associated with poor mental health could be an important concern during the coronavirus disease 2019 (COVID-19) pandemic. However, few studies have investigated the association between mental health status and lifestyle changes during the pandemic in nationwide Japanese general population. METHODS: This cross-sectional study was conducted using the data among 1,546 participants of the follow-up study of NIPPON DATA2010 in 2021. Recent mental status, as assessed using the Kessler 6 (K6) scale, and lifestyle changes compared to before the pandemic were determined using self-reported questionnaires. Some lifestyle changes such as decreased physical activity were defined as undesirable, whereas others such as decreased alcohol drinking were defined as desirable. The participants were divided into three groups based on the K6 scores: the K6<5, 5≤K6<9, and K6≥9 groups. The odds ratios (ORs) and 95% confidence intervals (CIs) of the K6 groups for each lifestyle change compared with that in the K6<5 group were estimated after adjusting for possible confounders. RESULTS: The ORs of the K6≥9 group for all undesirable lifestyle changes were significantly high, especially increased alcohol drinking (OR 4.64; 95% CI, 2.71-7.93), and decreased physical activity (OR 4.63; 95% CI, 3.29-6.52). Among the desirable changes, the OR of the 5≤K6<9 group was significantly high for increased eating home cooking. CONCLUSIONS: Poor mental health showed a significant association with undesirable lifestyle changes, especially increased alcohol drinking and decreased physical activity, in a nationwide general Japanese population during the COVID-19 pandemic.

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[Effect of the combination of "weight gain of more than 10 kg since age 20" and obesity on the new onset of diabetes mellitus].

Naruse H, Kuwabara K, Hirata A, Imai Y, Sugiyama D, Funamoto M, Okamura T

[Nihon koshu eisei zasshi] Japanese journal of public health 72 ( 3 ) 199 - 207 2024.12

ISSN  0546-1766

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Progression of aortic calcification among Japanese in Japan and white and Japanese Americans: a prospective cohort study

Li, MY; Fujiyoshi, A; Willcox, BJ; Li, JT; Kadota, A; Kadowaki, S; Seto, T; Kadowaki, T; Chang, YF; Evans, R; Miura, K; Edmundowicz, D; Okamura, T; Masaki, KH; Ueshima, H; Sekikawa, A

EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING 26 ( 2 ) 273 - 279 2024.11

ISSN  2047-2404

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Aims Continued low mortality from coronary heart disease in Japan, despite deleterious changes in traditional risk factors, remains unexplained. Since aortic calcification (AC) was an early predictor of cardiovascular mortality, we compared the progression and incidence of AC between Japanese in Japan, white Americans, and third-generation Japanese Americans in the ERA JUMP cohort. We examined whether higher blood levels of marine-derived n-3 fatty acids (FAs) in Japanese than in Americans accounted for the difference. Methods Men (n = 700) aged 40–49 years (252 Japanese in Japan, 238 white, and 210 Japanese Americans) were examined at baseline and results and 4–7 years later. AC was evaluated from the aortic arch to the iliac bifurcation with computed tomography and quantified by the Agatston method. Robust linear regression and linear mixed models were used to compare the progression of AC. Multivariable logistic regression models were fitted to compare the incidence of AC (AC ≥ 50 at follow-up) among those with baseline AC < 50. Japanese in Japan had a significantly slower progression of AC than white and Japanese Americans after adjusting for age, baseline AC, follow-up time, and traditional risk factors. White Americans had a significantly higher incidence of AC than Japanese in Japan [OR = 4.61 (95% CI, 1.27–16.82)]. Additional adjustment for blood levels of n-3 FAs accounted for the difference in AC incidence but not progression. Conclusion Japanese in Japan had a significantly slower progression and lower incidence of AC than white Americans. High levels of marine-derived n-3 FAs in Japanese in Japan partly accounted for the difference in incidence.

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Evaluation of Medication Adherence Among Prevalent Users in Hypertension, Dyslipidemia, and Diabetes Using Health Insurance Claims: A Population-Based Cohort Study in Japan

Matsumoto, M; Harada, S; Ikuta, H; Iida, M; Kato, S; Sata, M; Shibuki, T; Ishibashi, Y; Miyagawa, N; Hisamatsu, M; Hirata, A; Kuwabara, K; Takeuchi, A; Sugiyama, D; Suzuki, S; Nakamura, T; Okamura, T; Takebayashi, T

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY 33 ( 8 ) e5855 2024.08

ISSN  1053-8569

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Purpose: Hypertension (HT), dyslipidemia (DL), and diabetes mellitus (DM) are major risk factors for cardiovascular diseases. Despite the wide availability of medications to reduce this risk, poor adherence to medications remains an issue. The aim of this study is to evaluate medication adherence of prevalent users in these disease medications (HT, DL, DM) using claims data. Factors associated with non-adherence were also examined. Methods: Of 7538 participants of the Tsuruoka Metabolomics Cohort Study, 3693 (HT: 2702, DL: 2112, DM: 661) were identified as prevalent users of these disease medications. Information on lifestyle was collected through a questionnaire. Adherence was assessed by a proportion of days covered (PDC) and participants with PDC ≥0.8 were defined as adherent. Predictors of non-adherence were determined by performing multivariable logistic regression. Results: Medication adherence differed by treatment status. Among those without comorbidities, those with HT-only showed the highest adherence (90.2%), followed by those with DM-only (81.2%) and those with DL-only (80.8%). Factors associated with non-adherence in each medication group were skipping breakfast and poor understanding of medications among those with HT medications, females, having comorbidities, having a history of heart disease, and drinking habit among those with DL medications, and good sleep quality and skipping breakfast among those with DM medications. Conclusion: While participants showed high medication adherence, differences were observed across medication groups. The identified predictors of non-adherence could help target those in need of adherence support.

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Risk Factors for Heart Failure and Coronary Artery Disease Mortality Based on the National Vital Statistics During a 25-Year Follow-up in Japan　- NIPPON DATA90.

Kubo K, Hirata A, Kadota A, Harada A, Nakamura Y, Hayakawa T, Takashima N, Fujiyoshi A, Okami Y, Kita Y, Okayama A, Miura K, Ueshima H, Okamura T, NIPPON DATA90 Research Group

Circulation journal : official journal of the Japanese Circulation Society 88 ( 9 ) 1478 - 1487 2024.07

ISSN  1346-9843

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Background: Prevention of heart failure (HF) is a public health issue. Using the National Vital Statistics, we explored risk factors for HF and coronary artery disease (CAD) mortality. Methods and Results: Altogether, 7,556 Japanese individuals aged ≥30 years in 1990 were followed over 25 years; of these, 139 and 154 died from HF and CAD, respectively. In multivariable Cox proportional hazard analysis, common risk factors for CAD and HF mortality were hypertension (hazard ratio [HR] 1.48 [95% confidence interval {CI} 1.00–2.20] and 2.31 [95% CI 1.48–3.61], respectively), diabetes (HR 2.52 [95% CI 1.63–3.90] and 2.07 [95% CI 1.23–3.50], respectively), and current smoking (HR 2.05 [95% CI 1.27–3.31) and 1.86 [95% CI 1.10–3.15], respectively). Specific risk factors for CAD were male sex, chronic kidney disease, history of cardiovascular disease, and both abnormal T and Q waves, with HRs (95% CIs) of 1.75 (1.05–2.92), 1.78 (1.19–2.66), 2.50 (1.62–3.88), and 11.4 (3.64–36.0), respectively. Specific factors for HF were current drinking (HR 0.43; 95% CI 0.24–0.78) and non-high-density lipoprotein cholesterol (non-HDL-C; HR 0.81; 95% CI 0.67–0.98). There was an inverse association between non-HDL-C and HF in those aged ≥65 years (HR 0.71; 95% CI 0.56–0.90), but not in those aged <65 years. Conclusions: We identified common risk factors for HF and CAD deaths; a history of cardiovascular disease was a specific risk for CAD.

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