Details of a Researcher - Okamura, Tomonori

Papers - Okamura, Tomonori

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The determinants of plasma plasminogen activator inhibitor-1 levels differ for American and Japanese men aged 40-49

Takamiya Tomoko, Kadowaki Takashi, Zaky Wahid R., Ueshima Hirotsugu, Evans Rhobert W., Okamura Tomonori, Kashiwagi Atsunori, Nakamura Yasuyuki, Kita Yoshiyuki, Tracy Russell P., Kuller Lewis H., Sekikawa Akira

Diabetes Research and Clinical Practice 72 ( 2 ) 176 - 182 2006.05

ISSN 0168-8227

Background: Elevated plasma plasminogen activator inhibitor-1 (PAI-1) levels were associated with higher incidence of type II diabetes. Elucidating the determinants of PAI-1 in various ethnicities may help to understand the susceptibility to developing diabetes. The aim of our study was to compare PAI-1 levels between Americans and the Japanese in the post-war generation and to elucidate the determinants of the PAI-1 levels. Methods: We conducted a cross-sectional study on a total of 198 men aged 40-49 in the US (Body mass index (BMI): 27.0 ± 3.3 kg/m²) and Japan (BMI: 23.3 ± 3.1 kg/m²). Examination included physique measurement (BMI and waist girth), blood analysis (lipid profiles, glucose, insulin, C-reactive protein, and PAI-1), and life-style assessment by self-administered questionnaires. Results: PAI-1 levels were significantly lower in American than in Japanese men, even after adjustment for age, waist girth, cigarette smoking, habitual alcohol drinking, and other factors. In the Americans, waist girth, insulin, and cigarette smoking were significantly associated with PAI-1 levels, while waist girth and triglycerides were significantly associated with PAI-1 levels in the Japanese. Conclusions: PAI-1 levels were significantly lower in American than in Japanese men and the determinants of PAI-1 levels differ for American and Japanese men aged 40-49. © 2005 Elsevier Ireland Ltd. All rights reserved.

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Electrocardiogram screening for left high R-wave predicts cardiovascular death in a Japanese community-based population

Nakamura Koshi, Okamura Tomonori, Hayakawa Takehito, Kadowaki Takashi, Kita Yoshikuni, Okayama Akira, Ueshima Hirotsugu, Iimura Osamu, Omae Teruo, Ueda Kazuo, Yanagawa Hiroshi, Horibe Hiroshi, Kodama Kazunori, Kasagi Fumiyoshi, Tanihara Shinichi, Saito Shigeyuki, Sakata Kiyomi, Nakamura Yoshikazu, Kakuno Fumihiko, Takeuchi Toshihiro, Hasebe Mitsuru, Kusuno Fumitsugu, Kawamoto Takahisa, Minowa Masumi, Iida Minoru, Hashimoto Tsutomu, Tanaka Shigemichi, Terao Atsushi, Kawaminami Katsuhiko, Sawai Koryo, Shibata Shigeo

Hypertension Research 29 ( 5 ) 353 - 360 2006.05

ISSN 0916-9636

Little is known about the efficacy of left ventricular hypertrophy diagnosed by electrocardiography for predicting cardiovascular disease in a general Japanese population. In a large cohort of participants selected randomly from the overall Japanese population, we attempted to evaluate the usefulness of a high amplitude R-wave (left high R-wave) on the electrocardiogram for predicting cardiovascular death. A total of 6,688 Japanese (mean age, 50.7 years old; 57% women) free of previous cardiovascular disease and use of antihypertensive agents at baseline were followed for 10 years, from 1990 to 2000. Left high R-wave on the electrocardiogram (the Minnesota Code, 3-1 or 3-3) was found in 9.4% of the 6,688 participants, in 14.6% of the 2,413 hypertensives and in 4.1% of the 4,275 normotensives. During the follow-up period, 128 participants died due to cardiovascular disease. After adjustment for systolic blood pressure and other risk factors, left high R-wave conferred an increased risk of cardiovascular death; the hazard ratio among all the participants was 1.88 (95% confidence interval, 1.22-2.89; p<0.01), that among hypertensives was 1.97 (1.20-3.24; p=0.01), and that among normotensives was 1.66 (0.69-3.98; p=0.26). The population attributable risk percent of left high R-wave for cardiovascular death was 7.6% among all participants, 12.4% among hypertensives and 4.1% among normotensives. Left high R-wave on electrocardiogram, irrespective of the level of systolic blood pressure, was a predictive marker for cardiovascular death among community-dwelling Japanese.

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Age-specific effects of systolic and diastolic blood pressures on mortality due to cardiovascular diseases among Japanese men (NIPPON DATA80*)

Okayama Akira, Kadowaki Takashi, Okamura Tomonori, Hayakawa Takehito, Ueshima Hirotsugu

Journal of Hypertension 24 ( 3 ) 459 - 462 2006.03

ISSN 0263-6352

Objective: To clarify the relationship between mortality due to cardiovascular diseases (CVD) and systolic blood pressure (SBP) and diastolic blood pressure (DBP) in young and elderly Japanese men in the absence of antihypertensive treatments. Design: A 19-year cohort study using the 1980 National Survey of Cardiovascular Diseases and the identification of the underlying causes of death using national vital statistics data. Methods: In 1999, a 19-year follow-up study was conducted among participants randomly selected from the Japanese population for the 1980 National Survey of Cardiovascular Diseases. Among the male participants that were not receiving antihypertensive treatment, information was obtained for about 91.3% of the subjects (n = 3779). Age-adjusted mortality rates using the person-year method were calculated to compare the relationships of SBP and DBP levels with CVD mortality for different age groups (aged 30-64, 65-74, and 75 years or more). Results: The total number of observed person-years was 64 598 and the number of CVD-related deaths after 19 years was 253. Both SBP and DBP levels were significantly and linearly related to CVD mortality in the age groups 30-64 years (P < 0.001 and P = 0.01, respectively) and 65-74 years (P < 0.001 and P = 0.03, respectively). In the group of participants that were at least 75 years old, however, no significant increase in the relative risk of CVD was observed with increasing DBP levels (P = 0.156), whereas the relative risk of CVD increased significantly with increasing SBP levels (P = 0.038). Multivariate analysis adjusting for major risk factors confirmed these relationships. Standardized hazard ratios (95% confidence intervals) of SBP were 1.53 (1.19-1.96) for 30-64 year olds, 1.70 (1.31-2.20) for 64-74 year olds, and 1.23 (1.03-1.47) for participants 75 years old or more, whereas those of DBP were 1.52 (1.12-2.06), 1.60 (1.21-2.10), and 1.10 (0.94-1.28), respectively. Conclusions: These data show that elevated SBP is an independent risk factor for CVD mortality for Japanese men of all ages, whereas elevated DBP is not an independent risk factor for CVD mortality for elderly men. © 2006 Lippincott Williams & Wilkins.

Are comprehensive environmental changes as effective as health education for smoking cessation?

Kadowaki Takashi, Kanda H., Watanabe M., Okayama A., Miyamatsu N., Okamura T., Hayakawa T., Hishida K., Kita Y., Ueshima H.

Tobacco Control 15 ( 1 ) 26 - 29 2006.02

ISSN 0964-4563

Objectives: To compare the effectiveness of health education on smoking cessation for all smokers regardless of their willingness to quit smoking and cumulative environmental changes including designation of smoking places, legislation, and price rise. Design: Comparison of smoking cessation rates over two time periods: the period of health education on smoking cessation (1997-1999), and the period of cumulative environmental changes (2002-2004). Setting: An occupational setting in a radiator manufacturing factory in Japan. Subjects: All habitual male smokers who remained in the worksite through the pertinent time period (n = 202 in the period of health education and n = 170 in the period of environmental changes). Main outcome measurements: Smoking cessation rates at the end of each time period. Results: The smoking cessation rates over the periods of health education and environmental changes were 8.9% and 7.1%, respectively. There was no difference between these two proportions in χ² test (p = 0.513). The age adjustment did not significantly alter the cessation rate. Conclusions: Cumulative environmental changes are fairly effective in promoting smoking cessation, and may yield similar smoking cessation rates as a health education intervention reaching all smokers regardless of their willingness to quit smoking.

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The inverse relationship between serum high-density lipoprotein cholesterol level and all-cause mortality in a 9.6-year follow-up study in the Japanese general population

Okamura Tomonori, Hayakawa Takehito, Kadowaki Takashi, Kita Yoshikuni, Okayama Akira, Ueshima Hirotsugu

Atherosclerosis 184 ( 1 ) 143 - 150 2006.01

ISSN 0021-9150

In populations with higher high-density lipoprotein cholesterol (HDL-C) levels and lower coronary mortality than Western populations, such as in Japan, the beneficial effect of HDL-C on all-cause mortality may be different. Furthermore, prior studies have not focused on very high level of HDL-C. A total of 7175 community Japanese residents without a past history of cardiovascular disease in 300 randomly selected districts were followed for 9.6 years. During follow-up, there were 636 deaths. The multivariate adjusted hazard ratio (HR) of HDL-C for all-cause or cause-specific mortality was calculated using a Cox proportional hazard model adjusted for other cardiovascular risk factors. The all-cause mortality suggested an inverse, graded relation with HDL-C categories; HR for the very high HDL-C category (≥1.82 mmol/L), compared with the reference group (1.04-1.55 mmol/L), was 0.73 (95% confidence interval, C.I., 0.50-1.06) for men, 0.63 (95% C.I., 0.41-0.94) for women and 0.70 (95% C.I., 0.53-0.93) when men and women were combined. Serum HDL-C as a continuous variable showed a significant inverse association with all-cause mortality. The cardiovascular mortality indicated a non-significant but inverse graded relation with HDL-C categories. As in the many Western populations, serum HDL-C levels were inversely associated with all-cause mortality in the Japanese general population. © 2005 Elsevier Ireland Ltd. All rights reserved.

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Chronic kidney disease is a risk factor for cardiovascular death in a community-based population in Japan - NIPPON DATA90

Nakamura Koshi, Okamura Tomonori, Hayakawa Takehito, Kadowaki Takashi, Kita Yoshikuni, Ohnishi Hirofumi, Saitoh Shigeyuki, Sakata Kiyomi, Okayama Akira, Ueshima Hirotsugu

Circulation Journal 70 ( 8 ) 954 - 959 2006

ISSN 1346-9843

Background: Chronic kidney disease (CKD) has been identified as a risk factor for cardiovascular disease (CVD). Methods and Results: The risk of cardiovascular death was evaluated in a large cohort of participants selected randomly from the overall Japanese population. Participants (mean age, 52.4 years) free of previous CVD were followed up for 10 years. Glomerular filtration rate (GFR) was estimated using the abbreviated equation developed at the Cleveland Clinic laboratory for the Modification of Diet in Renal Disease study. Of the 7,316 participants, 6.7% had CKD with a GFR <60 at baseline. Even after adjustment for other risk factors, the presence of CKD conferred an increased risk of cardiovascular death with a hazard ratio of 1.20 (95% confidence interval, 0.82-1.76). Furthermore, a negative, graded correlation between GFR and risk of cardiovascular death was observed: 1.09 (0.72-1.64) for a 60≤ GFR <90, 1.15 (0.67-1.99) for a 45≤ GFR <60, 1.23 (0.49-3.09) for a 30≤ GFR <45, 5.52 (1.62-18.75) for a 15≤ GFR <30, 9.12 (2.12-39.29) for a GFR <15, as compared with normal kidney function (GFR ≥90). The proportion of excess cardiovascular death due to CKD was 1.3%. Conclusion: CKD was an independent risk factor for cardiovascular death in a community-dwelling Japanese population.

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Gender and age effects on ventricular repolarization abnormality in Japanese general carriers of a G643S common single nucleotide polymorphism for the KCNQ1 gene

Ozawa Tomoya, Ito Makoto, Tamaki Shinji, Yao Takenori, Ashihara Takashi, Kita Yoshikuni, Okamura Tomonori, Ueshima Hirotsugu, Horie Minoru

Circulation Journal 70 ( 6 ) 645 - 650 2006

ISSN 1346-9843

Background: The KCNQ1 single nucleotide polymorphism (SNP), G643S, is known to be associated with secondary long QT syndrome (LQTS) and to cause a mild reduction in KCNQ1 current. However, the precise incidence and its association with QT intervals remain unknown in the greater cohort of the population in Japan. Methods and Results: The genotype was screened at codon 643 of KCNQ1 in 992 residents of a farming community. Eighty-eight individuals (female/male=52/36, 8.9%) were found to have a heterozygous G643S SNP. Matching both gender and age, we randomly selected 243 control (G643G) cases and compared the electrocardiogram parameters in both groups; QT, QTf (QT corrected by Fridericia's formula) intervals, the peak and the end of the T wave (Tpe) interval, and the Tpe/QT ratio. The latter 2 reflect the transmural dispersion of ventricular repolarization (TDR). In G643S carriers, both Tpe and Tpe/QT were significantly longer than in noncarriers, without significant QT prolongation. Both genders showed a tendency for an increase in QTf with aging. In females, both Tpe and Tpe/QT showed a similar significant increase with age, which was not observed in males. Conclusions: In elderly females, G643S might be an independent risk factor for secondary LQTS by causing a greater TDR.

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Combined cardiovascular risk factors and outcome - NIPPON DATA80, 1980-1994

Nakamura Yasuyuki, Yamamoto Takako, Okamura Tomonori, Kadowaki Takashi, Hayakawa Takehito, Kita Yoshikuni, Saitoh Shigeyuki, Okayama Akira, Ueshima Hirotsugu

Circulation Journal 70 ( 8 ) 960 - 964 2006

ISSN 1346-9843

Background: To examine the prognostic significance of the high-risk group with combined cardiovascular risk factors in the Japanese, we analyzed the relationship between the high-risk group with combined risks and coronary heart disease (CHD) and stroke mortality using the NIPPON DATA80 database. Methods and Results: At baseline in 1980, those of age ≥30 years were randomly selected and 4,144 men and 5,318 women without CHD and/or stroke at baseline were followed for 14 years. The cutoff values for risk components obtained heuristically by Cox analysis were hypertension (systolic ≥130, or diastolic ≥85 mmHg, or on antihypertensive drugs), hypercholesterolemia (total cholesterol ≥200 mg/dl), hyperglycemia (≥130 mg/dl, or self-reported diabetes) and obesity (body mass index ≥27 kg/m²). Subjects were divided into 3 groups (0, 1-2 and 3-4 risks). Compared with those men in the risk 0 group, the hazard ratios in men in the risk 3-4 for CHD mortality was 8.04 (95% confidence interval: 1.03-62.6), and the stroke mortality was 5.06 (1.53-16.7). In women, no statistically significant difference was found due to a lesser number of events. Conclusion: The high-risk group with combined risk factors is important risk for Japanese men.

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The value of combining serum alanine aminotransferase levels and body mass index to predict mortality and medical costs

Nakamura Koshi, Okamura Tomonori, Kanda Hideyuki, Hayakawa Takehito, Okayama Akira, Ueshima Hirotsugu, Yamashita Shigeo, Tominaga Yoshinori, Katsuyama Kazuaki, Kakuno Fumihiko, Kitanishi Machiko, Tobita Yukio, Okamura Kanehiro, Hatta Kiminobu, Okada Takao, Hatanaka Michiko

Journal of Epidemiology 16 ( 1 ) 15 - 20 2005.12

ISSN 0917-5040

Background: Evidence suggests that the predictive value of serum alanine aminotransferase (ALT) levels for prognosis, measured by indices such as all-cause mortality and medical costs, may be modified by body mass index (BMI). However, the relationship between serum ALT and BMI has not been satisfactorily elucidated. Methods: Four thousand, five hundred and twenty-four community dwelling Japanese National Health Insurance beneficiaries, 40-69 years old, were classified into five categories according to their serum ALT levels (IU/L) (ALT<20, 20≤ALT<30, 30≤ALT<40, 40≤ALT<50 and 50≤ALT) and followed for 10 years. Hazard ratios for all-cause mortality, with reference to the lowest serum ALT category, and medical costs per person were evaluated for each serum ALT category after analyzing interactions between serum ALT levels and BMI for all-cause mortality and for medical costs. Results: A significant interaction between serum ALT levels and BMI was observed. In participants below the median BMI, positive, graded relationships were identified between serum ALT levels and all-cause mortality as well as between serum ALT levels and personal medical costs. The multivariate-adjusted hazard ratio in the "50≤ALT" category showed an approximately 8-fold increase. However, in the participants at or above the median BMI, no significant relationships between serum ALT levels and all-cause mortality or personal medical costs were identified. Conclusions: In these Japanese participants, the predictive value of serum ALT levels for prognosis was more evident if BMI was taken into account. A combination of high serum ALT levels and below median BMI was associated with excess mortality and medical cost. Copyright © 2006 by the Japan Epidemiological Association.

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Impact of hypertension on medical economics

Nakamura Koshi, Okamura Tomonori, Kanda Hideyuki, Hayakawa Takehito, Kadowaki Takashi, Okayama Akira, Ueshima Hirotsugu, Yamashita Shigeo, Tominaga Yoshinori, Katsuyama Kazuaki, Kakuno Fumihiko, Kitanishi Machiko, Tobita Yukio, Okamura Kanehiro, Hatta Kiminobu, Okada Takao, Hatanaka Michiko

Hypertension Research 28 ( 11 ) 859 - 864 2005.11

ISSN 0916-9636

Hypertension and related cardiovascular diseases may lead to an increase in medical costs for patients. We attempted to clarify the relationship between hypertension and long-term medical costs by a cohort study utilizing existing data as well as baseline blood pressures and medical costs over a 10-year period. The participants included 4,191 Japanese National Health Insurance beneficiaries aged 40-69 years, living in one area, who were not taking anti-hypertensive medication and did not have a history of major cardiovascular disease. They were classified into four categories according to their blood pressure. We evaluated the mean medical costs per month, cumulative hospitalization, and all-cause mortality for each blood pressure category. Hypertension-related medical costs attributable to hypertensive individuals, as compared to normotensive individuals, were estimated. There was a positively graded correlation between blood pressure and personal total medical costs, especially for men. The odds ratio for cumulative hospitalization and hazard ratio for all-cause mortality in severe hypertensive men were also higher than those in normotensive men. However, the hypertension-related medical costs for mild to moderate hypertensives were higher than those for severe hypertensives. The hypertension-related medical costs for all hypertensives accounted for 23.7% of the total, medical costs for the Japanese population. In conclusion, high blood pressure was a useful predictor for excess medical costs; moreover, concomitant hypertension, regardless of the grade, increased the medical costs of Japanese National Health Insurance beneficiaries.

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A cross-sectional study of alcohol drinking and health-related quality of life among male workers in Japan

Saito Isao, Okamura Tomonori, Fukuhara Shunichi, Tanaka Taichiro, Suzukamo Yoshimi, Okayama Akira, Ueshima Hirotsugu

Journal of Occupational Health 47 ( 6 ) 496 - 503 2005.11

ISSN 1341-9145

Background: Although light and moderate alcohol drinkers are likely to have better subjective health, the sub-scales for subjective health have not been well documented. Methods: We studied 4,521 male workers aged 25 yr and older with no history of cancer or cardiovascular disease, in 12 occupational groups in Japan. Data were from the High-risk and Population Strategy for Occupational Health Promotion Study (HIPOP-OHP). Drinking status was classified according to daily alcohol intake or frequency of drinking. We assessed the health-related quality of life (HRQOL) based on scores for five scales of the SF-36. Results: Decreased odds ratios of sub-optimal HRQOL conditions, defined as less than the median SF-36 scores, for Role-Physical and General Health were found among persons who consumed 1.0 to 22.9 g/d of alcohol. Odds ratios for sub-optimal Vitality conditions were lowered according to increased levels of alcohol intake. Role-Emotional scores were not associated with alcohol drinking. People who drank 5 to 6 d/wk had higher levels of Role-Physical and Vitality, and those who drank 1 to 2 d/wk had better Vitality and Mental Health scores than non-drinkers. When adjusted for age, marital status, working hours, physical activity at work, self-reported job stress, smoking, regular exercise, hypertension, hyperlipidemia, and diabetes, the associations were almost unchanged except for General Health. Conclusions: Associations of drinking patterns with subjective health varied in five sub-scales of the SF-36. Overall, alcohol drinkers rated their health as good in comparison with non-drinkers.

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Combined analysis of polymorphisms in angiotensinogen and adducin genes and their effects on hypertension in a Japanese sample

Tamaki Shinji, Nakamura Yasuyuki, Tabara Yasuharu, Okamura Tomonori, Kita Yoshikuni, Kodawaki Takashi, Tsujita Yasuyuki, Horie Minoru, Miki Tetsuro, Ueshima Hirotsugu

Hypertension Research 28 ( 8 ) 645 - 650 2005.08

ISSN 0916-9636

We examined the interactions between lifestyle and polymorphisms of salt-sensitive genes and their effects on hypertension in a general Japanese sample (The Shigaraki Study). The study group consisted of 2,902 subjects who underwent a medical examination in 1999 in Shigaraki, a suburban area in Shiga. Among 1,647 subjects not receiving antihypertensive medication, in a combined analysis of angiotensinogen (AGT) and adducin (ADD1) polymorphisms, double homozygosity of 235Trp or 460Trp was not found to be associated with hypertension. A multiple logistic regression analysis showed that age (odds ratio [OR]: 1.07, 95% confidence interval [95% CI]: 1.06-1.08), body mass index (BMI) (OR: 1.18, 95% CI: 1.13-1.23), alcohol consumption (OR: 1.39, 95% CI: 1.16-1.66), family history of hypertension (OR: 1.57, 95% CI: 1.18-2.07), and combined AGT M235T Thr/Thr and ADD1 Trp/Trp polymorphisms (OR: 1.37, 95% CI: 1.03-1.82) were associated with hypertension. However, there was no interaction between eating salty food and combined AGT and ADD1 polymorphisms. Furthermore, eating salty food was not associated with hypertension in a multivariate analysis. Therefore, a combination of the AGT and ADD1 polymorphisms appears to be associated with hypertension. However, a simple questionnaire regarding salt intake was not sufficient to confirm the relationship between salt intake and hypertension and/or salt-sensitive genes.

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The influence of alcohol drinking on medical care expenditures among National Health Insurance beneficiaries

Kanda Hideyuki, Nakamura Koshi, Hayakawa Takehito, Okamura Tomonori, Ueshima Hirotsugu

Nihon Arukoru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence 40 ( 3 ) 171 - 180 2005.06

ISSN 1341-8963

Heavy alcohol drinking is an important risk factor for some lifestyle-related diseases. However, the relationship between drinking habits and medical care expenditures has not been elucidated in a Japanese general population. We examined this relationship in a 9-year cohort study. Study participants were 2039 National Health Insurance beneficiaries aged 40-69 years living in a rural Japanese community. The baseline survey, with medical check-up, was performed in 1989 or 1990 and the subjects' drinking habits were estimated by questionnaire. Medical care use and costs were monitored by linkage with the National Health Insurance claim history files at baseline survey through the end of March 2000. Men who were daily heavy drinkers (ethanol intake > or =69 g per day) had significantly higher medical costs compared to participants who drank less, within 5 years after baseline. This difference was 2000 yen per month after adjusting for age, body mass index, smoking, systolic blood pressure, glycosuria, serum total cholesterol and alanine aminotransferase. Daily heavy male drinkers also had a higher hazard ratio for total mortality compared to occasional drinkers, by the Cox proportional hazard model (hazard ratio: 1.81), although it did not reach statistical significance (P = 0.153). In women, medical costs were almost the same for occasional and daily drinkers. Total medical costs among Japanese men aged 20 years and over may be decreased by about 8400 billon yen per year if we assume a 20% decrease in daily heavy drinkers. To reduce national medical costs, it is important to promote a program for heavy drinkers, as described in the "Health Japan 21" initiative, the Japanese national health promotion guidelines for the first 10 years of the 21st century.

Different effects of blood pressure on mortality from stroke subtypes depending on BMI levels

Miyamatsu N., Kadowaki T., Okamura Tomonori, Hayakawa T., Kita Yoshikuni, Okayama Akira, Nakamura Yosikazu, Oki I., Ueshima Hirotsugu, Iimura Osamu, Omae Teruo, Ueda Kazuo, Yanagawa Hiroshi, Kodama Kazunori, Kasagi Fumiyoshi, Saito Shigeyuki, Sakata Kiyomi, Hayakawa Takehito, Tanihara Shinichi, Horibe Hiroshi, Minowa Masumi, Takeuchi Toshihiro, Hasebe Mitsuru, Kusano Fumitsugu

Journal of Human Hypertension 19 ( 4 ) 285 - 291 2005.04

ISSN 0950-9240

To evaluate the relationship between blood pressure and cerebrovascular death depending on body mass index (BMI) levels, we analysed a database of 9338 subjects from the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged, which was originally conducted a baseline survey in 1980 and followed up in 1999. Relative risk (RR) and a 95% confidence interval (CI) of death from total stroke, cerebral infarction, and intracerebral haemorrhage after adjusting for age, sex, serum cholesterol, albumin, glucose, the use of anti-hypertensive agents, a past history of diabetes, BMI, smoking, and drinking were estimated with the Cox-proportional hazard model in the BMI tertile groups of a representative Japanese population. Cutoff points of BMI tertiles are 21.2 and 23.8 kg/m². The results indicated that a 10 mmHg systolic blood pressure (SBP) increase was associated with mortality from intracerebral haemorrhage at low and middle BMI groups (RR= 1.38 and 1.23; 95% CI=1.17-1.62 and 1.03-1.47, respectively). SBP was positively associated with mortality from cerebral infarction in middle and high BMI groups (RR=1.19 and 1.21; 95% CI=1.06-1.33 and 1.06-1.38, respectively). The effects of diastolic blood pressure on intracerebral haemorrhage and infarction had the same tendency as those of SBP. These results suggested that the causal effect of blood pressure on stroke subtypes might be modified by BMI. © 2005 Nature Publishing Group All rights reserved.

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Association between fish consumption and all-cause and cause-specific mortality in Japan

Nakamura Yasuyuki, Ueshima Hirotsugu, Okamura Tomonori, Kadowaki Takashi, Hayakawa Takehito, Kita Yoshikuni, Tamaki Shinji, Okayama Akira

American Journal of Medicine 118 ( 3 ) 239 - 245 2005.03

ISSN 0002-9343

PURPOSE: Although high consumption of fish may be one of the contributing factors for Japanese longevity, no epidemiological study using Japanese data has tested this hypothesis. SUBJECTS AND METHODS: The relationship between fish consumption and all-cause as well as cause-specific mortality was analyzed using the database of NIPPON DATA80. At baseline in 1980, history, physical, and blood biochemical measurement and a nutritional survey by the food-frequency method were performed in randomly selected community-based subjects aged 30 years and over in Japan. After exclusion of subjects with significant comorbidities at baseline, we followed 3 945 men and 4 934 women for 19 years. Men and women were analyzed comprehensively. Age- and sex-adjusted and multivariate adjusted relative risk for all-cause or cause-specific mortality was calculated using a Cox proportional hazards model with delayed entry. RESULTS: During 19 years of followup, there were 1 745 deaths. Subjects were divided into 5 groups according to fish consumption frequency. The multivariate Cox analyses showed that relative risks for subjects who ate fish more than twice daily compared with those of subjects who ate 1 to 2 times weekly were 0.99 (95% confidence intervals: 0.77-1.27) for all-cause, 1.26 (0.70-2.29) for stroke, 0.92 (0.20-4.23) for cerebral hemorrhage, 1.09 (0.48-2.43) for cerebral infarction, and 0.91 (0.35-2.35) for coronary heart disease mortality. CONCLUSION: Our results did not provide evidence in support of the fish hypothesis, perhaps because the majority of the Japanese subjects in the study ate fish more than the threshold level shown to be beneficial in the previous studies. © 2005 Elsevier Inc. All rights reserved.

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What factors are associated with high plasma B-type natriuretic peptide levels in a general Japanese population?

Kanda H., Kita Y., Okamura T., Kadowaki T., Yoshida Y., Nakamura Y., Ueshima H.

Journal of Human Hypertension 19 ( 2 ) 165 - 172 2005.02

ISSN 0950-9240

There are few community-based epidemiologic studies that have dealt with risk factors for heart failure in non-Western populations. It has been reported that the measurement of plasma B-type natriuretic peptide (BNP) is useful for detecting patients with asymptomatic heart failure. To clarify the determinants of high plasma BNP level, the association of BNP with cardiovascular risk factors in community dwelling residents was examined. The plasma BNP levels were measured in 686 residents aged 35-69 years who received annual health check-up. The relationship of BNP to blood pressure, blood haemoglobin, serum cholesterol (total and high-density lipoprotein cholesterol), plasma glucose, electrocardiographic (ECG) findings, urinary salt excretion, and lifestyle factors (smoking and alcohol consumption) were cross-sectionally analysed. The plasma BNP geometric mean was 13.7 pg/ml. Both linear and logistic regression analyses indicated that the plasma BNP levels were positively associated with age, urinary salt excretion, higher blood pressure, high R-wave voltage in the 12-lead ECG (Minnesota Code 3-1 or 3-3), and female gender. Plasma BNP levels were inversely associated with blood haemoglobin levels. Gender-specific analysis showed similar results. However, plasma BNP did not correlate with other cardiovascular risk factors such as serum lipids. © 2005 Nature Publishing Group All rights reserved.

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Much lower prevalence of coronary calcium detected by electron-beam computed tomography among men aged 40-49 in Japan than in the US, despite a less favorable profile of major risk factors

Sekikawa Akira, Ueshima Hirotsugu, Zaky Wahid Riad, Kadowaki Takashi, Edmundowicz Daniel, Okamura Tomonori, Sutton-Tyrrell Kim, Nakamura Yasuyuki, Egawa Katsuya, Kanda Hideyuki, Kashigawa Atsunori, Kita Yoshiyuki, Maegawa Hiroshi, Mitsunami Kenichi, Murata Kiyoshi, Nishio Yoshihiko, Tamaki Shinji, Ueno Yoshiki, Kuller Lewis H.

International Journal of Epidemiology 34 ( 1 ) 173 - 179 2005.02

ISSN 0300-5771

Background: Since World War II (WWII), exposures to westernized lifestyle have occurred in many non-Western countries, including Japan. National surveys showed that risk factor profiles for atherosclerosis around 1990 were similar in men in the post WWII birth cohorts in the US and Japan. We compared the degree of coronary calcium and other factors in men in the post WWII birth cohort: men aged 40-49 in the US and Japan. Methods: We conducted a cross-sectional study examining randomly selected 100 men from Kusatsu, Japan, and 100 men from Allegheny County, US. Coronary calcium was assessed using electron-beam computed tomography. Results: Systolic blood pressure, total cholesterol, low density lipoprotein (LDL)-cholesterol, and smoking rates were higher among the Japanese (122.6 ± 14.1 versus 113.7 ± 9.6 mmHg, P < 0.01; 5.72 ± 0.90 versus 4.99 ± 0.81 mmol/l (220.9 ± 34.6 versus 192.8 ± 31.3 mg/dl), P < 0.01; 3.52 ± 1.01 versus 3.10 ± 0.78 mmol/l (136.0 ± 39.0 versus 119.7 ± 30.0 mg/dl), P < 0.01; and 48 versus 15%, P < 0.01, respectively). Triglycerides and fibrinogen were similar. High density lipoprotein (HDL)-cholesterol was higher among the Japanese. Body mass index, fasting insulin, and C-reactive protein were higher among the Americans. Prevalence of coronary artery calcium score >0 was strikingly lower among the Japanese than the Americans (13% versus 47%, P < 0.01). Conclusions: Much lower prevalence of coronary calcium despite a less favourable profile of many major independent risk factors in the Japanese might imply that there are strong protective factors against atherosclerosis in the Japanese. Further investigation is of critical importance. © International Epidemiological Association 2004; all rights reserved.

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Proteinuria is a prognostic marker for cardiovascular mortality

Tanihara Shinichi, Hayakawa Takehito, Oki Izumi, Nakamura Yosikazu, Sakata Kiyomi, Okayama Akira, Fujita Yasuyuki, Ueshima Hirotsugu, Iimura Osamu, Omae Teruo, Ueda Kazuo, Yanagawa Hiroshi, Kodama Kazunori, Kasagi Fumiyoshi, Okamura Tomonori, Kita Yoshikuni, Saito Shigeyuki, Sakata Kiyomi, Tanihara Shinichi, Horibe Hiroshi, Minowa Masumi, Takeuchi Toshihiro, Hasebe Mitsuru, Kusano Fumitsugu, Kawaminami Katsuhiko, Choudhury Sohel R., Kiyohara Yutaka, Iida Minoru, Hashimoto Tsutomu, Terao Atsushi, Sawai Koryo, Shibata Shigeo

Journal of Epidemiology 15 ( 4 ) 146 - 153 2005

ISSN 0917-5040

Background: Proteinuria has been considered to be a prognostic marker for persons with diabetes mellitus, but only a limited number of studies about the relationship between proteinuria and mortality among general population has been available. Methods: The subjects were 10,897 individuals who participated in the National Cardiovascular Survey conducted in 1980 and who were aged 30 years or older living in 300 districts that had been randomly selected throughout Japan. The vital records were confirmed in 1999 and 7,203 subjects (3,180 males and 4,023 females) without a history of hypertension, stroke, heart disease, renal disease, or diabetes mellitus at the start of the study were investigated. Results: There were 126,825 person-years of follow-up. During the observed period of time, 371 died of cardiovascular causes, including 171 stroke deaths and 74 coronary deaths. The risk of proteinuria for cardiovascular mortality was greater than unity for those with a normal serum creatinine level, after adjusting for age and other cardiovascular disease risk factors. Conclusions: When contrasted with other cardiovascular disease risk factors, urinary protein is an independent risk factor for cardiovascular death among the Japanese population. Copyright © 2005 by the Japan Epidemiological Association.

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Applicability of the stages of change model for analyzing fruit and vegetable intake in relation to urinary potassium excretion

Tamaki Junko, Yoshita Katsushi, Kikuchi Yuriko, Takebayashi Toru, Chiba Nagako, Okamura Tomonori, Tanaka Taichiro, Kasagi Fumiyoshi, Minai Junko, Ueshima Hirotsugu

Hypertension Research 27 ( 11 ) 843 - 850 2004.11

ISSN 0916-9636

The Stages of Change model evaluates and conceptualizes attempts to alter particular behavior patterns. To investigate the validity of this model for assessing fruit and vegetable intake, we examined the association between the stage of change in fruit and vegetable intake and urinary potassium excretion. The data were from baseline surveys taken in 1999 and 2000 from the High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study in Japan. This was a non-randomized control trial at 12 worksites in Japan and aimed to decrease cardiovascular risk factors. Cross-sectional analysis was performed using data from 6,774 participants (5,364 men and 1,410 women). We used three categories of the model: precontemplation or contemplation (P/C), indicating no commitment to change; preparation (P), indicating readiness to change behavior but not actually doing so; and action or maintenance (A/M), indicating an actual change in behavior. Urinary potassium excretion was estimated from the potassium and creatinine concentrations in spot urine samples. Multivariate analysis indicated that urinary potassium excretion in the A/M stage was 1.65 mmol/day more than in the P stage, and 1.44 mmol/day more than in the P/C stage for men (p<0.05, respectively). For women, urinary potassium excretion in the A/M stage was 1.26 mmol/day more than in the P/C stage (p< 0.05) and 1.04 mmol/day more than in the P stage, although the latter result lacked statistical significance (p=0.08). This study supports the potential value of the Stages of Change model for increasing fruit and vegetable intake in the design of dietary intervention programs.

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A combination of serum low albumin and above-average cholesterol level was associated with excess mortality

Okamura Tomonori, Hayakawa Takehito, Kadowaki Takashi, Kita Yoshikuni, Okayama Akira, Elliott Paul, Ueshima Hirotsugu

Journal of Clinical Epidemiology 57 ( 11 ) 1188 - 1195 2004.11

ISSN 0895-4356

There is no population-based prospective study concerning the relation between serum albumin and mortality in a non-Western population, and few previous studies included the subgroup analysis stratified by serum cholesterol level. A 13.7-year cohort study was conducted on 6,957 males and females aged 30-59 years from 300 randomly selected areas throughout Japan, who participated in the National Survey on Circulatory Disorders in 1980. In the group with median and above of total cholesterol, one standard deviation (SD) increment of serum albumin (2.6 g/L for males and 2.4 g/L for females) was inversely associated with all-cause mortality for both males and females (relative risk RR = 0.68 and 0.81; 95% confidence interval CI = 0.53-0.87 and 0.68-0.98), and with cancer mortality for females (RR = 0.74; 95% CI = 0.57-0.96); and the lowest category of serum albumin (≤43 g/L) showed the highest cardiovascular mortality for males (RR = 5.04; 95% CI = 1.04-24.5) among the three albumin categories. These relationships were not evident in the group with total cholesterol level below median. A combination of a low albumin level and above average cholesterol level, even both within the clinical normal range, is associated with excess mortality in the Japanese general population. © 2004 Elsevier Inc. All rights reserved.

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