Details of a Researcher - Okamura, Tomonori

Papers - Okamura, Tomonori

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Dietary habits in middle age and future changes in activities of daily living - NIPPON DATA80-NIPPON DATA80 research group

Nakamura Yasuyuki, Hozawa Atsushi, Turin Tanvir Chowdhury, Takashima Naoyuki, Okamura Tomonori, Hayakawa Takehito, Kita Yoshikuni, Okayama Akira, Miura Katsuyuki, Ueshima Hirotsugu

Gerontology 55 ( 6 ) 707 - 713 2009.11

ISSN 0304-324X

Background: Almost no studies have investigated the relationship between food intake measured at middle age and future disability. Objective: To examine the association of meat, fish and egg intake with risk of subsequent mortality and/or future decline in activities of daily living (ADL) among the elderly. Methods: The cohort consisted of 2,316 Japanese individuals aged 47-60 at the baseline who were randomly selected throughout Japan and followed up for 19 years from 1980. Results: Those who ate meat at least once every 2 days were younger, there were more men, daily drinkers, professional workers and urban residents compared to those who ate meat less than once every 2 days. Over 19 years of follow-up, 75 participants became dependent due to impaired ADL. A higher intake of meat was associated with a statistically significant decrease in impaired ADL occurrence (odds ratio = 0.61, 95% confidence intervals 0.38-0.99, p = 0.04). Fish and egg intake were not associated with any difference in impaired ADL occurrence. None of the 3 foods were associated with any changes in mortality. Conclusion: A higher intake of meat may prevent impaired ADL occurrence, although this was not associated with a lower mortality. Copyright © 2009 S. Karger AG, Basel.

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Cholesteryl Ester Transfer Protein, Coronary Calcium, and Intima-Media Thickness of the Carotid Artery in Middle-Age Japanese Men

Okamura Tomonori, Sekikawa Akira, Kadowaki Takashi, El-Saed Aiman, Abbott Robert D., Curb J. David, Edmundowicz Daniel, Nakamura Yasuyuki, Murata Kiyoshi, Kashiwagi Atsunori, Sutton-Tyrrell Kim, Evans Rhobert W., Zmuda Joseph M., Maegawa Hiroshi, Hozawa Atsushi, Mitsunami Ken Ichi, Nishio Yoshihiko, Miljkovic-Gacic Iva, Horie Minoru, Miyamatsu Naomi, Murakami Yoshitaka, Kuller Lewis H., Ueshima Hirotsugu

American Journal of Cardiology 104 ( 6 ) 818 - 822 2009.09

ISSN 0002-9149

The relation between cholesteryl ester transfer protein (CETP) levels and atherosclerosis is controversial. We examined whether the serum CETP levels were associated with subclinical atherosclerosis, independent of its most common gene variant, in a sample of Japanese men. A population-based cross-sectional study of 250 Japanese men aged 40 to 49 years was conducted to assess the intima-media thickness of the carotid artery, coronary artery calcium, serum CETP levels, and the CETP D442G gene variant. Compared with the lowest CETP quartile, the multivariate adjusted odds ratio for coronary artery calcium was 0.77 (95% confidence interval 0.18 to 3.36), 0.96 (95% confidence interval 0.27 to 3.40), and 3.49 (95% confidence interval 1.05 to 11.6) with increasing CETP quartiles. The serum CETP quartiles were also positively associated with the intima-media thickness of the carotid artery (adjusted mean 602, 616, 615, and 646 μm for the lowest to top quartile, respectively). The findings remained unchanged after additional adjustment for the CETP D442G gene variant. No significant difference was found in the prevalence of coronary artery calcium or in the mean intima-media thickness of the carotid artery between participants with and without the CETP D442G gene variant. © 2009 Elsevier Inc. All rights reserved.

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Association between polymorphism of the AGTR1 and cardiovascular events in a Japanese general sample (The Shigaraki Study)

Tamaki Shinji, Nakamura Yasuyuki, Tabara Yasuharu, Okamura Tomonori, Kanda Hideyuki, Kita Yoshikuni, Kadowaki Takashi, Tsujita Yasuyuki, Chowdhury Turin Tanvir, Horie Minoru, Miki Tetsuro, Ueshima Hirotsugu

International Journal of Cardiology 136 ( 3 ) 354 - 355 2009.08

ISSN 0167-5273

We examined whether the A1166C polymorphism of the angiotensin II type I receptor gene (AGTR1) affects cardiovascular event occurrence in a Japanese prospective cohort study. The 2212 participants who gave informed consent for genetic analysis were enrolled in this study (the Shigaraki Study). The average observation period was 1954 days. Cardiovascular events occurred in 37 individuals (1.7%). The independent factors which specified cardiovascular events were age (hazard ratio (HR) = 1.13; 95% confidence interval (CI): 1.10-1.16; p < 0.0001) and sex (HR = 2.18; 95%CI: 1.23-3.85; p = 0.007). However, the A1166C polymorphism of AGTR1 was not a predictive factor for cardiovascular events (HR = 1.11; 95%CI: 0.61-2.02; p = 0.731). © 2008 Elsevier Ireland Ltd. All rights reserved.

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Association study of 11β-hydroxysteroid dehydrogenase type 1 gene polymorphisms and metabolic syndrome in urban Japanese cohort

Miyamoto Yoshihiro, Morisaki Hiroko, Yamanaka Itaru, Kokubo Yoshihiro, Masuzaki Hiroaki, Okayama Akira, Tomoike Hitonobu, Nakao Kazuwa, Okamura Tomonori, Yoshimasa Yasunao, Morisaki Takayuki

Diabetes Research and Clinical Practice 85 ( 2 ) 132 - 138 2009.08

ISSN 0168-8227

11β-Hydroxysteroid dehydrogenase type 1 (11β-HSD1), one of the isoforms of the 11β-hydroxysteroid dehydrogenase enzymes, acts as an oxo-reductase to reactivate cortisone to cortisol, plays a critical role in tissue-specific corticosteroid reactions, and is therefore a key molecule associated with the development of metabolic syndrome. We investigated whether variations in the 11β-HSD1 gene correlated with metabolic syndrome. We performed case-control study using a population-based urban Japanese cohort. Among 3005 urban residents, we examined 431 subjects diagnosed with metabolic syndrome according to the Japanese definition and 777 subjects with none of metabolic syndrome criteria as control. We genotyped three single nucleotide polymorphisms (SNPs) (+9410T>A, +17925C>T, +27447G>C) across the 11β-HSD1 gene in them and analyzed the associations of SNPs and haplotypes with metabolic syndrome. The +9410A allele showed a tendency to metabolic syndrome (OR = 1.5, 95%C.I., 1.0-2.2; P = 0.041 and Bonferroni corrected P = 0.123) without statistical significance. However, we could not find any significant association between metabolic syndrome and SNPs in the 11β-HSD1 gene. Our findings indicate that polymorphisms and haplotypes in the 11β-HSD1 gene are not significantly associated with metabolic syndrome in the Japanese population. © 2009 Elsevier Ireland Ltd. All rights reserved.

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Higher liver fat content among Japanese in Japan compared with non-Hispanic whites in the United States

Azuma Koichiro, Kadowaki Takashi, Cetinel Cemal, Kadota Aya, El-Saed Aiman, Kadowaki Sayaka, Edmundowicz Daniel, Nishio Yoshihiko, Sutton-Tyrrell Kim, Okamura Tomonori, Evans Rhobert W., Takamiya Tomoko, Ueshima Hirotsugu, Curb J. David, Abbott Robert D., Kuller Lewis H., Kelley David E., Sekikawa Akira

Metabolism: Clinical and Experimental 58 ( 8 ) 1200 - 1207 2009.08

ISSN 0026-0495

Among Asians, including Japanese, obesity is related to dyslipidemia and insulin resistance at a lower level of body mass index (BMI) compared with non-Hispanic whites (NHW). We hypothesize that this ethnic difference in the relationship between BMI and metabolic risks is partly associated with the ethnic difference in fat distribution, namely, liver fat as well as visceral adipose tissue. To compare liver fat content among Japanese vs NHW men, regional computed tomographic images were taken to measure liver computed tomographic density in population-based samples of 313 Japanese and 288 NHW men aged 40 to 49 years, along with the assessment of metabolic parameters. Liver fat content was higher in Japanese than NHW men (liver to spleen attenuation ratio [lower value means higher liver fat content]: 1.01 ± 0.16 vs 1.07 ± 0.15, respectively; P < .01), despite a lower mean BMI in Japanese men (BMI: 23.6 ± 2.9 vs 27.8 ± 4.2 kg/m², P < .01). Moreover, Japanese men had a greater disposition for fatty liver with a small increase in BMI than NHW (P < .01), whereas both groups had a similar relationship between visceral adipose tissue and BMI. In both groups, liver fat content correlated with triglycerides, homeostasis model assessment of insulin resistance, and C-reactive protein. Liver fat content is higher among Japanese than NHW; and this ethnic difference becomes more robust with a small increase in BMI, suggesting that fatty liver is a sensitive marker for the failure of the adipose tissue to expand to accommodate an increased energy influx, and is associated with similar metabolic risk in Japanese despite lower BMI compared with NHW men. © 2009 Elsevier Inc. All rights reserved.

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Relationship between blood pressure category and incidence of stroke and myocardial infarction in an Urban Japanese population with and without chronic kidney disease

Kokubo Yoshihiro, Nakamura Satoko, Okamura Tomonori, Yoshimasa Yasunao, Makino Hisashi, Watanabe Makoto, Higashiyama Aya, Kamide Kei, Kawanishi Katsuyuki, Okayama Akira, Kawano Yuhei

Stroke 40 ( 8 ) 2674 - 2679 2009.08

ISSN 0039-2499

BACKGROUND AND PURPOSE-: Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for stroke and myocardial infarction (MI). Few studies, however, have examined the relationship between blood pressure (BP) category and these diseases in subjects with and without CKD. METHODS-: We studied 5494 Japanese individuals (ages 30 to 79, without stroke or MI at baseline) who completed a baseline survey and received follow-up through December 2005. The glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease study equation modified by the Japanese coefficient. CKD was defined as an estimated GFR <60 mL/min/1.73m. BP categories were defined by the European Society of Hypertension and European Society of Cardiology 2007 criteria. RESULTS-: In 64 395 person-years of follow-up, we documented 346 incidences of cardiovascular diseases (CVD; 213 strokes and 133 MI events). Compared with the GFR (≥90 mL/min/1.73m) group, the hazard ratios (95% confidential intervals) for stroke were 1.9 (1.3 to 3.0) in the GFR 50 to 59 mL/min/1.73m group and 2.2 (1.2 to 4.1) in the GFR <50 mL/min/1.73m group. Results for cerebral infarction were similar. Compared with the optimal BP subjects without CKD, the normal BP, high-normal BP, and hypertensive subjects without CKD showed increased risks of CVD and stroke; however the impact of each BP category on CVD (P for interaction: 0.04 in men, 0.49 in women) and stroke (0.03 in men, 0.90 in women) was more evident in men with CKD. CONCLUSIONS-: CKD may increase the association of BP and CVD in a Japanese urban population. © 2009 American Heart Association, Inc.

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Association of serum n-6 and n-3 polyunsaturated fatty acids with lipids in 3 populations of middle-aged men

Motoyama Kenneth R., Curb J. David, Kadowaki Takashi, El-Saed Aiman, Abbott Robert D., Okamura Tomonori, Evans Rhobert W., Nakamura Yasuyuki, Sutton-Tyrrell Kim, Rodriquez Beatriz L., Kadota Aya, Edmundowicz Daniel, Willcox Bradley J., Choo Jina, Katsumi Nakata, Otake Teruo, Kadowaki Sayaka, Kuller Lewis H., Ueshima Hirotusgu, Sekikawa Akira

American Journal of Clinical Nutrition 90 ( 1 ) 49 - 55 2009.07

ISSN 0002-9165

Background: The association of serum polyunsaturated fatty acids (PUFAs) with lipids in different populations is not known. Objective: Our aim was to examine the association of serum n-6 (omega-6) or n-3 (omega-3) PUFAs with triglycerides or HDL-cholesterol concentrations in 261 white, 285 Japanese, and 212 Japanese American men aged 40-49 y. Design: We used a population-based cross-sectional study. Of the original sample (n = 926), those taking lipid-lowering medications or who had diabetes (n = 168) were excluded. Serum fatty acids were analyzed by capillary gas-liquid chromatography. Multiple regression models as a function of tertile groups of each PUFA were used. Results: Serum n = 6 PUFAs were significantly inversely associated with triglycerides across populations after adjustment for age, body mass index, pack-years of smoking, and ethanol consumption [β = -0.39 (P < 0.001), -0.38 (P < 0.001), and -0.33 (P < 0.001) in whites, Japanese, and Japanese Americans, respectively]. Marine n-3 PUFAs were significantly inversely associated with triglycerides across populations [β = -0.15 (P < 0.001), -0.22 (P < 0.001), and -0.13 (P < 0.001) in whites, Japanese, and Japanese Americans, respectively]. n-6 PUFAs were significantly positively associated with HDL cholesterol in whites (β = 4.49, P < 0.001) and Japanese (β = 3.73, P < 0.01). Marine n-3 PUFAs were significantly positively associated with HDL cholesterol in Japanese (β = 2.15, P < 0.05), and eicosapentaenoic acid was significantly positively associated with HDL cholesterol in whites (β = 2.68, P < 0.01). Conclusion: Serum n-6 and n-3 PUFAs are inversely associated with triglycerides across populations. © 2009 American Society for Nutrition.

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Elevated serum creatine kinase predicts first-ever myocardial infarction

Watanabe Makoto, Okamura Tomonori, Kokubo Yoshihiro, Higashiyama Aya, Okayama Akira

International Journal of Epidemiology 38 ( 6 ) 1571 - 1579 2009.06

ISSN 0300-5771

Background: In myocardial infarction (MI), it is well known that serum creatine kinase (s-CK) increases after onset, but it is unclear whether s-CK elevates before MI onset. The present analysis examined whether elevated s-CK levels predicted first-ever MI or stroke. Methods: This study was a population-based cohort study in a Japanese urban area. Study subjects were comprised of 5026 initially healthy Japanese (2370 men and 2656 women, mean age: 54.5 years) without a history of MI or stroke. They were followed-up for 11.8 years on average, and 103 MIs (definite: 45; probable: 58) and 168 strokes (definite: 126; probable: 42) were observed. There was no subject who developed MI just at baseline (the follow-up period among those with definite MI was, at earliest, 0.20 years). Results: The adjusted hazard ratio for definite MI was 4.18 (95% confidence interval 1.66-10.53) with s-CK levels of ≥200 IU/l, compared with the reference category (s-CK levels of ≤99 IU/l), whereas no relationship was observed between s-CK levels and the risk for stroke. With regard to definite MI, an interaction between s-CK levels and dyslipidaemia was observed. Among subjects with hypercholesterolaemia, the hazard ratio linearly elevated with increased s-CK levels. On the other hand, no linear elevation was observed among subjects without hypercholesterolaemia (P for interaction = 0.011). Conclusions: The present study suggested that screening for elevated s-CK levels in initially healthy Japanese subjects was useful to predict first-ever MI in the future, especially in subjects with dyslipidaemia. Published by Oxford University Press on behalf of the International Epidemiological Association. © The Author 2009.

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Identification of genetic markers associated with high-density lipoprotein-cholesterol by genome-wide screening in a Japanese population - The Suita study

Hiura Yumiko, Shen Chun Shen, Kokubo Yoshihiro, Okamura Tomonori, Morisaki Takayuki, Tomoike Hitonobu, Yoshida Teruhiko, Sakamoto Hiromi, Goto Yoichi, Nonogi Hiroshi, Iwai Naoharu

Circulation Journal 73 ( 6 ) 1119 - 1126 2009.06

ISSN 1346-9843

Background: Recent genome-wide association studies (GWAS) have identified genes or loci affecting lipid levels. Given the difference in allele frequencies and linkage disequilibrium patterns across the populations, a GWAS was conducted using the Illumina 550K in a Japanese population (n=900) in search of population-specific genetic variations associated with high-density lipoprotein (HDL)-cholesterol. Methods and Results: Among the 368,274 single nucleotide polymorphisms (SNPs) with a minor allele frequency of at least 0.1, 43 SNPs exceeded the arbitrary threshold of -log₁₀P >4.0. The most significant SNP was rs3764261, located 5′upstream of CETP, exhibiting a -log₁₀P value of 6.17. Increasing the sample size by genotyping in the additional Suita sample (n=1,810) further improved the level of significance, with each additional copy of the minor allele being associated with an increase in HDL-cholesterol by 6.2 mg/dl (P=3.4×10^-12). Interestingly, the minor allele was more prevalent in cases with myocardial infarction than in controls (0.221 vs 0.196, nominal P=0.02). Conclusions: The association between genetic variants at CETP and HDL-cholesterol was replicated in our sample. None of the genetic variants exerted a greater influence on HDL levels than those at CETP. Associations for the top-ranked SNPs need to be tested for further replication in an independent sample.

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Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol and the incidence of cardiovascular disease in an urban Japanese cohort study

Okamura Tomonori, Kokubo Yoshihiro, Watanabe Makoto, Higashiyama Aya, Miyamoto Yoshihiro, Yoshimasa Yasunao, Okayama Akira

Atherosclerosis 203 ( 2 ) 587 - 592 2009.04

ISSN 0021-9150

Objective: Only a small number of population-based cohort studies have directly compared the predictive value of low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDLC) for coronary artery disease in Asian populations, such as Japan. Methods: We performed an 11.9-year cohort study of 4694 men and women, aged 30-74 years, selected randomly from an urban general population in Japan. Baseline LDL-C levels were estimated using the Friedewald formula. The predictive values of LDL-C and non-HDLC for myocardial infarction (MI) and stroke were compared. Results and conclusion: During the follow-up period, there were 80 incident cases of MI and 139 of stoke, comprised of 23 intracerebral hemorrhages, 85 cerebral infarctions and 31 other types of stroke. The Hazard ratio (HR) for MI was highest in the top quintile of LDL-C (HR: 3.03, 95% CI, 1.32-6.96) when male and female data were combined. The HR for MI was also highest in the top quintile of non-HDLC (HR: 2.97, 95% CI, 1.26-6.97). Analysis of trends showed a significant positive relationship between MI incidence and serum LDL-C and non-HDLC levels (both P = 0.02). However, there was no relationship between the incidence of any subtype of stroke and either LDL-C or non-HDLC. The predictive value of LDL-C and non-HDLC for MI, assessed by calculating the differences in the -2 logarithm likelihood (-2 ln [L]) and area under the curve (AUC), were almost similar. © 2008 Elsevier Ireland Ltd. All rights reserved.

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Effects of habitual alcohol intake on ambulatory blood pressure, heart rate, and its variability among japanese men

Ohira Tetsuya, Tanigawa Takeshi, Tabata Minako, Imano Hironori, Kitamura Akihiko, Kiyama Masahiko, Sato Shinichi, Okamura Tomonori, Cui Renzhe, Koike Kazuko A., Shimamoto Takashi, Iso Hiroyasu

Hypertension 53 ( 1 ) 13 - 19 2009.01

ISSN 0194-911X

We sought to examine effects of habitual alcohol intake on ambulatory blood pressure (BP), heart rate (HR), and HR variability among Japanese men. Subjects were 539 men aged 35 to 65 years from rural and urban communities. Ambulatory BP and HR were monitored with an automated, portable, noninvasive multibiomedical recorder. Power spectral analysis of the RR intervals on the ECG was performed every 5 minutes. Compared with nondrinkers, moderate drinkers (alcohol intake 23 to 45 g/d) and heavy drinkers (alcohol intake ≥46 g/d) showed higher age- and field-adjusted mean values of systolic and diastolic BPs during the morning and while awake, but there were no differences in BPs over 24-hour periods and while asleep among the alcohol intake categories. Alcohol intake was positively associated with mean values of sleep-morning differences and daytime variability in BPs, HRs while awake and asleep, and low frequency: high frequency ratio while asleep. The results were virtually unchanged after adjustment for body mass index, smoking, and diabetes mellitus. Compared with the nondrinkers, age- and field-adjusted odds ratios of the morning BP surge (excess elevation of BP in the morning: morning systolic BP minus sleep systolic BP ≥37 mm Hg) for light (alcohol intake 0 to 22 g/d), moderate, and heavy drinkers were 0.96 (95% CI: 0.34 to 2.78), 1.68 (95% CI: 0.64 to 4.38), and 2.73 (95% CI: 1.12 to 6.67), respectively. Habitual alcohol intake was associated with increased BP in the morning, HR while awake and asleep, and sympathetic activity while asleep, which may explain some of the mechanisms of the relationship between heavy alcohol intake and risk of cardiovascular diseases. © American Heart Association, Inc.

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Association of Asn221Ser mutation in tissue factor pathway inhibitor-β with plasma total tissue factor pathway inhibitor level

Ishikawa Junko, Okada Hiromi, Kato Hisao, Takeshita Satoshi, Honda Shigenori, Kawasaki Tomio, Suehisa Etsuji, Tsuji Hajime, Madoiwa Seiji, Sakata Yoichi, Kojima Tetsuhito, Murata Mitsuru, Ikeda Yasuo, Kokubo Yoshihiro, Okamura Tomonori, Tomoike Hitonobu, Miyata Toshiyuki

Blood Coagulation and Fibrinolysis 20 ( 1 ) 22 - 26 2009.01

ISSN 0957-5235

Tissue factor pathway inhibitor (TFPI) is an anticoagulant protease inhibitor that inhibits the tissue factor-initiated blood coagulation cascade reactions. Based on these anticoagulant functions of TFPI, we hypothesized that genetic variations in TFPI may alter the TFPI expression or impair the anticoagulant function and could predispose persons to deep vein thrombosis (DVT). This study was undertaken to examine whether the genetic polymorphisms in TFPI are associated with the plasma TFPI levels and risk for DVT. We sequenced the entire coding regions of TFPI in 175 Japanese DVT patients and identified 12 genetic variants, including one missense mutation, Asn221Ser. The missense mutation occurred at the site presumably attached to the glycosylphosphatidylinositol anchor in the TFPI-p form. The allele frequency of the mutant Ser-coding allele of the Asn221Ser mutation was 8% in the Japanese general population consisting of 1684 individuals. The Asn221Ser mutation was significantly associated with the total TFPI levels (Asn/Asn, n = 108, total TFPI = 56.57 ± 0.88 ng/ml (mean ± SD) vs. Asn/Ser + Ser/Ser, n = 16, total TFPI = 63.44 ±.28 ng/ml, P= 0.0058). The genotype was not associated with the free TFPI level. This Asn221Ser mutation was not associated with DVT. Thus, the Asn221Ser mutation occurring in the TFPI-p form was associated with the total TFPI level, but not a risk for DVT. The absence of the putative glycosylphosphatidylinositol anchor in TFPI-β under pathological conditions remains to be studied. Blood Coagul Fibrinolysis 20:22-26 © 2009 Wolters Kluwer Health Lippincott Williams & Wilkins.

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Risk of smoking and metabolic syndrome for incidence of cardiovascular disease - Comparison of relative contribution in urban Japanese population

Higashiyama Aya, Okamura Tomonori, Ono Yuu, Watanabe Makoto, Kokubo Yoshihiro, Okayama Akira

Circulation Journal 73 ( 12 ) 2258 - 2263 2009

ISSN 1346-9843

Background: Risk factor clustering, the so-called metabolic syndrome (MetS), is an important risk factor for cardiovascular disease (CVD). Smoking is also an important CVD risk factor with still a high prevalence. However, few previous studies have compared the risk for CVD or the population-attributable fraction (PAF) of smoking, MetS, and both. Methods and Results: The present study was an 11.9-year cohort study of 1,822 men and 2,089 women, aged 40-74 years, selected randomly from an urban general population in Japan. MetS was defined according to the National Cholesterol Education Program on Adult Treatment Panel III (NCEP-ATPIII) guideline modified by the Asian criteria for waist circumference. The prevalence of smoking was 49.5% in men and 11.1% in women, and that of MetS was 19.8% and 23.5%, respectively. In men, the multivariate-adjusted hazard ratio for CVD incidence, compared with non-smoking participants without MetS, was 2.07 (1.26-3.40) in those who smoked, 2.09 (1.08-4.04) in those with MetS, and 3.56 (1.89-6.72) in those with both. In men the PAF for CVD incidence was 21.8% because of smoking, 7.5% because of MetS, and 11.9% because of both. Conclusions: Although countermeasures for MetS are important, smoking should continue to be considered an important public health problem and antismoking campaigns should be promoted, especially for men, to prevent CVD.

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High blood pressure in middle age is associated with a future decline in activities of daily living. NIPPON DATA80

Hozawa A., Okamura T., Murakami Y., Kadowaki T., Okuda N., Takashima N., Hayakawa T., Kita Y., Miura K., Nakamura Y., Okayama A., Ueshima H.

Journal of Human Hypertension 23 ( 8 ) 546 - 552 2009

ISSN 0950-9240

Although several studies have reported on the relation between high blood pressure (BP) and impaired activities of daily living (ADL), only a few studies have reported on the relation of high BP in middle-aged subjects with future impaired ADL. Furthermore, no studies reported an excess impaired ADL due to non-normal BP. Using ADL 1999 data, we compared data from NIPPON DATA80 survivors without impaired ADL (N = 1816) with those with impaired ADL (N = 75) using baseline BP information collected in 1980. We analysed participants who were aged 47-59 years at baseline. Multiple adjusted logistic regression analyses were used to estimate the risk of impaired ADL, according to baseline BP categories using Joint National Committee 7 guidelines (normal BP, prehypertension, stage 1 hypertension (HT) and stage 2 HT). Subjects who used antihypertensive medications were classified as having stage 2 HT. We calculated excess impaired ADL due to non-normal BP. Compared with normal BP categories, the adjusted odds ratio (OR) and 95% confidence interval (CI) of having impaired ADL was higher in subjects with prehypertension (OR = 1.50, 95% CI: 0.55-4.09), stage 1 HT (OR = 1.56, 95% CI: 0.56-4.32) and stage 2 HT (OR = 2.96, 95% CI: 1.09-8.05). Non-normal BP explained 45% (33.7/75) of impaired ADL. A positive relation of BP categories with the composite end point of mortality and impaired ADL was also observed. In conclusion, controlling BP in middle age may prevent deaths and future ADL decline.

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Prognostic value of Q wave for cardiovascular death in a 19-year prospective study of the Japanese general population

Higashiyama Aya, Hozawa Atsushi, Murakami Yoshitaka, Okamura Tomonori, Watanabe Makoto, Nakamura Yasuyuki, Hayakawa Takehito, Kadowaki Takashi, Kita Yoshikuni, Okayama Akira, Ueshima Hirotsugu, Iimura Osamu, Omae Teruo, Ueda Kazuo, Horibe Hiroshi, Kodama Kazunori, Kasagi Fumiyoshi, Tanihara Shinichi, Saitoh Shigeyuki, Sakata Kiyomi, Nakamura Yosikazu, Kakuno Fumihiko, Takeuchi Toshihiro, Hasebe Mitsuru, Kusano Fumitsugu, Kawamoto Takahisa, Minowa Masumi, Kawaminami Katsuhiko, Choudhury Sohel R., Kiyohara Yutaka, Iida Minoru, Hashimoto Tsutomu, Terao Atsushi, Sawai Koryo, Shibata Shigeo

Journal of Atherosclerosis and Thrombosis 16 ( 1 ) 40 - 50 2009

ISSN 1340-3478

Aim: Little is known about the prognostic value of q wave abnormality for cardiovascular disease (CVD) on a resting electrocardiogram (ECG) of the Japanese general population with an extremely low incidence of myocardial infarction. Methods: We followed 8,339 participants without a past and present history of CVD for 19 years. The multivariate-adjusted hazard ratio (HR) of q wave abnormality for CVD mortality was estimated by the Cox proportional hazards model. Results: The multivariate-adjusted HR of composite findings of moderate or severe q wave abnormality was 1.75 (95% confidence interval (CI): 0.97-3.17) for mortality due to CVD and 2.97 (95%CI: 1.43-6.16) due to heart diseases. The multivariate-adjusted HR of mild abnormality for mortality from heart diseases was 1.95 (95%CI: 1.00-3.81). The relationship between moderate or severe abnormalities and mortality from CVD was unchanged when participants with ST-T changes and high amplitude R waves were excluded and when participants were divided by the presence of major CVD risk factors such as hypertension. Q wave abnormality was not associated with the risk of stroke. Conclusion: Moderate or severe q wave abnormalities are prominent and important predictors of mortality due to CVD and heart disease in the Japanese general population without CVD history.

A Japanese diet and 19-year mortality

Nakamura Yasuyuki, Ueshima Hirotsugu, Okamura Tomonori, Kadowaki Takashi, Hayakawa Takehito, Kita Yoshikuni, Abbott Robert D., Okayama Akira

British Journal of Nutrition 101 ( 11 ) 1696 - 1705 2009

ISSN 0007-1145

Few studies have examined the association between Japanese diet and mortality outcomes. We analysed the relationship between a healthy Japanese diet and all-cause and cause-specific mortality using the database from the National Integrated Project for Prospective Observation of Non-Communicable Diseases and its Trends in the Aged, 1980. At baseline in 1980, data were collected on study participants aged ≧30 years from randomly selected areas in Japan. We defined a measure of a healthy reduced-salt Japanese diet based on seven components from FFQ. The total score ranged from 0 to 7, with 0 being least healthy and 7 being most healthy. Participants were divided into approximate tertiles of dietary scores (0-2, 3 and 4-7 scores). After excluding participants with co-morbidities, we followed 9086 participants (44% men) for 19 years. There were 1823 all-cause and 654 cardiovascular deaths during the follow-up. With the dietary score group 0-2 serving as a reference, the Cox multivariate-adjusted hazard ratios for groups with scores 3 and 4-7 were 0.92 (95% CI 0.83, 1.04) and 0.78 (95% CI 0.70, 0.88) for all-cause mortality (trend P<0.0001), and 0.91 (95% CI 0.75, 1.10) and 0.80 (95% CI 0.66, 0.97) for cardiovascular mortality (trend P = 0.022). Adherence to a healthy reduced-salt Japanese diet was associated with an approximate 20% lower rate of all-cause and cardiovascular mortality.

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Effect of chronic kidney disease on individual and population medical expenditures in the Japanese population

Higashiyama Aya, Okamura Tomonori, Watanabe Makoto, Murakami Yoshitaka, Otsuki Hidemi, Adachi Noriko, Kaneko Chiaki, Uehara Emi, Okayama Akira, Ueshima Hirotsugu

Hypertension Research 32 ( 6 ) 450 - 454 2009

ISSN 0916-9636

Chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease (CVD), and may also lead to an increase in medical expenditures. The effect of CKD on individual and population medical expenditures was examined in a Japanese cohort study. The participants included 4026 Japanese National Health Insurance beneficiaries aged 40-74 years living in one city, who had no history of major CVD. They were classified into three categories according to their glomerular filtration rate (GFR) at the baseline survey, and their total medical expenditures were followed-up for 3 years. The arithmetic and geometric means of the cumulative medical expenditures were calculated for each category. The geometric mean was also expressed after adjusting for several confounding factors using analysis of covariance. The CKD-related medical expenditures attributable to the participants with mild (60 ≤ GFR<90) or moderate (30 ≤ GFR<60) kidney dysfunction were compared with those of participants with normal (GFR < 90) kidney function. There was a negative correlation between the GFR category and the arithmetic and geometric means of personal medical expenditures (adjusted geometric mean: GFR < 90, 167879 yen; 60 ≤GFR <90, 210660 yen; and 30 ≤ GFR<60, 330050 yen). The CKD-related medical expenditures accounted for 11.5 and 6.5% of the total medical expenditures for the participants with mild and moderate kidney dysfunction, respectively. The prevention of mild CKD is very important for containing medical expenditures. Appropriate strategies, such as regular creatinine measurement, are needed for early detection of CKD.

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The taste of salt measured by a simple test and blood pressure in Japanese women and men

Michikawa Takehiro, Nishiwaki Yuji, Okamura Tomonor, Asakura Keiko, Nakano Makiko, Takebayashi Toru

Hypertension Research 32 ( 5 ) 399 - 403 2009

ISSN 0916-9636

Salt intake is an important risk factor for hypertension. Because it has been reported that increased salt intake dulls the taste of salt, measuring the sense of taste might be a good way of identifying individuals who consume excessive salt. Using a recently developed simple salt taste test, we investigated the relationship between the taste of salt and blood pressure. The subjects in this cross-sectional study were 823 Japanese adults (479 women and 344 men) 40 years old or older. Following a taste test with salt-impregnated taste strips, the subjects were divided into two groups: normal (recognition threshold of salt at <1.0% concentration) and taste impaired (≥1.0%). We determined hypertension from the measured blood pressure. In women, the multi-adjusted odds ratio (95% CI) of hypertension in the impaired group was 2.47 (1.53-3.99) compared with the normal group, whereas no significant difference was observed between the two male groups. When we excluded subjects with moderate and severe hypertension, similar findings were observed. A sub-analysis of couples living alone showed a higher prevalence of hypertension among men whose wives were in the impairment group (58.8%) than in the normal group (36.7%, P=0.10). In conclusion, the taste of salt is associated with blood pressure in Japanese women, but not in men. Because most family meals in Japan are prepared by women, educating women about salt reduction may contribute to the prevention of hypertension, not only among women but also among their husbands and family members.

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Gender-specific associations of vision and hearing impairments with adverse health outcomes in older Japanese

Michikawa Takehiro, Nishiwaki Yuji, Kikuchi Yuriko, Nakano Makiko, Iwasawa Satoko, Asakura Keiko, Milojevic Ai, Mizutari Kunio, Saito Hideyuki, Ishida Susumu, Okamura Tomonori, Takebayashi Toru

BMC Geriatrics 9 ( 1 ) 2009

ISSN 1471-2318

Background. Several epidemiological studies have shown that self-reported vision and hearing impairments are associated with adverse health outcomes (AHOs) in older populations; however, few studies have used objective sensory measurements or investigated the role of gender in this association. Therefore, we examined the association of vision and hearing impairments (as measured by objective methods) with AHOs (dependence in activities of daily living or death), and whether this association differed by gender. Methods. From 2005 to 2006, a total of 801 residents (337 men and 464 women) aged 65 years or older of Kurabuchi Town, Gunma, Japan, participated in a baseline examination that included vision and hearing assessments; they were followed up through September 2008. Vision impairment was defined as a corrected visual acuity of worse than 0.5 (logMAR = 0.3) in the better eye, and hearing impairment was defined as a failure to hear a 30 dB hearing level signal at 1 kHz in the better ear. Information on outcomes was obtained from the town hall and through face-to-face home visit interviews. We calculated the risk ratios (RRs) of AHOs for vision and hearing impairments according to gender. Results. During a mean follow-up period of 3 years, 34 men (10.1%) and 52 women (11.3%) had AHOs. In both genders, vision impairment was related to an elevated risk of AHOs (multi-adjusted RR for men and women together = 1.60, 95% CI = 1.05-2.44), with no statistically significant interaction between the genders. In contrast, a significant association between hearing impairment and AHOs (multi-adjusted RR = 3.10, 95% CI = 1.43-6.72) was found only in the men. Conclusion. In this older Japanese population, sensory impairments were clearly associated with AHOs, and the association appeared to vary according to gender. Gender-specific associations between sensory impairments and AHOs warrant further investigation. © 2009 Michikawa et al; licensee BioMed Central Ltd.

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Cardiovascular disease and risk factors in Asia

Ueshima Hirotsugu, Sekikawa Akira, Miura Katsuyuki, Turin Tanvir Chowdhury, Takashima Naoyuki, Kita Yoshikuni, Watanabe Makoto, Kadota Aya, Okuda Nagako, Kadowaki Takashi, Nakamura Yasuyuki, Okamura Tomonori

Circulation 118 ( 25 ) 2702 - 2709 2008.12

ISSN 0009-7322

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