Details of a Researcher - Okamura, Tomonori

Papers - Okamura, Tomonori

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A "natural experiment" in cardiovascular epidemiology in the early 21st century

Sekikawa Akira, Horiuchi B. Y., Edmundowicz D., Ueshima H., Curb J. D., Sutton-Tyrrell K., Okamura T., Kadowaki T., Kashiwagi A., Mitsunami K., Murata K., Nakamura Y., Rodriguez B. L., Kuller L. H.

Heart 89 ( 3 ) 255 - 257 2003.03

ISSN 1355-6037

What cause of mortality can we predict by cholesterol screening in the Japanese general population?

Okamura Tomonori, Kadowaki T., Hayakawa T., Kita Y., Okayama A., Ueshima H.

Journal of Internal Medicine 253 ( 2 ) 169 - 180 2003.02

ISSN 0954-6820

Objective. In a population with a markedly lower coronary mortality such as in Japan, the benefit of cholesterol screening may be different from Western populations. We attempted to assess the importance of cholesterol screening in Japan. Design. A 13.2-year cohort study for cause-specific mortality. Setting. Three hundred randomly selected districts throughout Japan in which the National Survey on Circulatory Disorders 1980 was performed. Subjects. A total of 9216 community dwelling persons aged 30 years and over, with standardized serum cholesterol measurement and without a past history of cardiovascular disease. Results. There were 1206 deaths, which included 462 deaths due to cardiovascular disease with 79 coronary heart diseases. Hypercholesterolemia (>6.21 mmol L^-1) showed a significant positive relation to coronary mortality (relative risk; 2.93, 95% confidence interval: 1.52-5.63) but not to stroke. Although hypocholesterolemia (<4.14 mmol L^-1) was significantly associated with an increased risk of liver cancer, noncardiovascular, noncancer disease and all-cause mortality, these associations, except for liver cancer, disappeared after excluding deaths in the first 5 years of the follow-up. The multivariate adjusted attributable risk of hypercholesterolaemia for coronary disease was 0.98 per 1000 person-years, which was three-fold higher than that of hypocholesterolemia for liver cancer: 0.32 per 1000 person-years. The attributable risk percentage of hypercholesterolaemia was 66% for coronary heart disease. Conclusion. Similar to Western populations, it is recommended to provide screening for hypercholesterolaemia in Japan, especially for males, although its attributable risk for coronary disease might be small.

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Electron-beam computed tomography for identification of high-risk persons in primary prevention of coronary heart disease in the United States and its implication for Japan

Sekikawa Akira, Okamura Tomonori, Kadowaki Takashi, Mitsunami Kenichi, Murata Kiyoshi, Kashiwagi Atsunori, Nakamura Yasuyuki, Kanda Hideyuki, Edmundowicz Daniel, Sutton-Tyrrell Kim, Curb J. David, Kuller Lewis H., Ueshima Hirotsugu

[Nippon kōshū eisei zasshi] Japanese journal of public health 50 ( 3 ) 183 - 193 2003

ISSN 0546-1766

Coronary heart disease (CHD) is the leading cause of death in the United States (US). Approximately half of deaths from (CHD) occur out of hospital, most being sudden. The majority of sudden cardiac deaths occur in asymptomatic subjects. Recent lipid-lowering trials in asymptomatic subjects have demonstrated the potential for risk reduction for CHD events by primary prevention. It is, however, generally acknowledged that risk will be underestimated in asymptomatic subjects who fall into the category of intermediate risk by the traditional risk factors. Non-invasive measurements of subclinical atherosclerosis, which is the end result of risk-factor exposure, have the possibility of improving the risk stratification of asymptomatic subjects in intermediate-risk. Electron-beam computed tomography (EBCT) is a non-invasive and highly sensitive means to detect calcification within coronary arterial wall. Coronary artery calcification (CAC) is a recognized marker of atherosclerosis. Atherosclerotic burden of coronary arteries correlates strongly with the amount of CAC measured by EBCT. Studies examining the predictive value of CAC among asymptomatic subjects consistently reported that CAC is a risk for CHD. Two studies reported that unadjusted odds ratios of CAC for CHD were over 20. Incremental value of EBCT over the traditional risk assessment models, however, has not been established. Although CHD mortality in Japan remains uniquely low in industrialized countries, among men aged 30-49, risk factor profiles for CHD are similar between men in the US and Japan, except higher prevalence of cigarette smoking in Japan and higher prevalence of obesity in the US. It is reported that the declining trend in CHD mortality in Japan has recently slowed down in metropolitan areas, especially in men aged 30-49, and that the incidence has increased in middle-aged workers in a metropolitan area. A mortality validation study reported that the differences in CHD mortality between the US and Japan were not as large as suggested by vital statistics. It is, therefore, important to evaluate subclinical atherosclerosis measured by EBCT in men in recent birth cohorts in Japan and compare it to that in men in the US in order to predict future trend in CHD in Japan.

Smoking scenes in Japanese television dramas

Kanda Hideyuki, Okamura Tomonori, Kadowaki Takashi, Hayakawa Takehito, Kita Yoshikuni, Ueshima Hirotsugu

[Nippon kōshū eisei zasshi] Japanese journal of public health 50 ( 1 ) 62 - 70 2003

ISSN 0546-1766

BACKGROUND: Exposure to smoking scenes in movies and TV dramas has been known to be a trigger for young people starting habitual smoking, but it has not been clarified to what extent youth is routinely exposed to smoking scenes in television programs in Japan. OBJECTIVE: To clarify the status quo of smoking scenes and smoking-related items in serial TV dramas targeting young audience in Japan. METHOD: Seven TV dramas targeting a young audience broadcast between July and September, 2001 were analyzed. A total of 63 hours of TV programs were divided into units of three minutes (a total of 1,264 units). All the units were reviewed for smoking scenes, description of social contexts related to smoking behavior, existence of smoking and smoking-related items. FINDINGS: Among the 1,264 three-minute units, 129 (10.2%) contained smoking behavior, and 258 (20.4%) depicted smoking environment with presence of smoking-related items. Smokers were male actors (126 units, 97.7%), aged 20-40 years (118 units, 91.5%), leading actors (72 units, 55.8%), and were smoking alone (80 units, 62.0%). Smoking places mainly took place in indoor settings (56 units, 43.4%). Ashtrays were the most frequently observed smoking-related items (8.1% of the total units). The smoking scenes with actions other than smoking itself accounted for 70 units (54.3% of the smoking scenes). As for the actions other than smoking, working (28 units, 21.7%) and eating (17 units, 13.2%) were commonly observed. Regarding smoking scenes without any other actions, 32 units (24.8%) were observed in the beginning or ending telops, and 27 units (20.9%) showed a person smoking without doing anything else. There were only 3 units (0.2%) which were against smoking behavior. Approximately 30% of the Japanese serial television drama scenes featured tobacco use in story plots. As the general features of the smoking scenes, most of them do not necessarily require smoking in the story. Furthermore, there was little consideration about separation of designated smoking areas.

Determinants of platelet aggregation in 50-70-year-old men from three Japanese communities

Imano Hironori, Iso Hiroyasu, Sato Shinichi, Kitamura Akihiko, Okamura Tomonori, Tanigawa Takeshi, Ohira Tetsuya, Kudo Minako, Naito Yoshihiko, Iida Minoru, Shimamoto Takashi

Atherosclerosis 165 ( 2 ) 327 - 334 2002.12

ISSN 0021-9150

To investigate the association of lifestyle and constitutional variables with platelet aggregation, we examined the platelet aggregation, serum fatty acid composition, alcohol intake, smoking, and dietary intake of seafood and soybean estimated by a 1-week dietary record in 448 males aged 50-70 in three rural Japanese communities: Ikawa, Akita prefecture (northeast coast), Noichi, Kochi prefecture (southwest coast), and Kyowa, Ibaraki prefecture (central inland). Platelet aggregatory threshold index (PATI) was used to determine the minimum concentration of adenosine 5′-diphosphate (ADP) that caused a non-reversible aggregation of platelets. Intake of seafood and n3-polyunsaturated fatty acid and ingestion of ethanol were higher in the northeast coastal community than in the other two communities. Mean platelet and white blood cell counts were lower in northeast coastal community than in the other two communities. The geometric mean PATI was higher (i.e. platelet aggregation was lower) in the northeast coastal community than the other two communities. Within the entire sample, platelet aggregation correlated inversely with serum level of n3-polyunsaturated fatty acids and γ-glutamyl transpeptidase, an index of alcohol consumption, and positively with platelet and white blood cell counts. Platelet aggregation tended to correlate positively with serum arachidonic acid. There was no correlation between smoking and platelet aggregation. Our results suggest that seafood intake and moderate alcohol consumption reduce platelet aggregation. © 2002 Elsevier Science Ireland Ltd. All rights reserved.

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Epidemiologic study of the association of low-Km mitochondrial acetaldehyde dehydrogenase genotypes with blood pressure level and the prevalence of hypertension in a general population

Amamoto Kenji, Okamura Tomonori, Tamaki Shinji, Kita Yoshikuni, Tsujita Yasuyuki, Kadowaki Takashi, Nakamura Yasuyuki, Ueshima Hirotsugu

Hypertension Research 25 ( 6 ) 857 - 864 2002.11

ISSN 0916-9636

In Japanese and other Asians, the prevalence of genetically decreased mitochondrial aldehyde dehydrogenase (ALDH2) activity is higher than in Caucasians. The aim of this study was to elucidate the relation between ALDH2 genotypes and blood pressure levels or hypertension in Japanese. After obtaining informed consent for genetic analysis from 917 men and 1,478 women who lived in a mountainous farming region near Kyoto and who were free from cardiovascular disease and liver dysfunction, the authors identified the ALDH2 genotype in all subjects. Differences in blood pressure level among genotypes were then compared by analysis of covariance, and the relation between genotypes and hypertension was also analyzed by logistic regression analysis. The frequencies of genotypes *1/*1, *1/*2, and *2/*2 were 44.7%, 46.9% and 8.4% in men, and 50.1%, 43.2% and 6.8% in women, respectively. In men, systolic and diastolic blood pressures tended to decrease in the order of *1/*1>*1/*2>*2/*2. However, adjustment for confounding factors including alcohol consumption resulted in the disappearance of significance. Logistic regression analysis adjusted for the same confounding factors for men showed that the odds ratios (OR) of being hypertensive in the *2 allele to not having *2 allele were 0.67 (95% confidence interval (CI): 0.47-0.96). However, in the subgroup analyses, this relation was not observed in the group having a below-median level of alcohol consumption (OR=0.92; 95% CI: 0.53-1.62) or in the group not taking antihypertensive agents (OR=0.77; 95% CI: 0.52-1.15). Furthermore, we did not observe any relation between the ALDH2/*2 allele and hypertension in women (OR=1.07; 95% CI: 0.80-1.42). The results suggest that there may be no causal relation between hypertension and the ALDH2 genotype per se, after excluding for some confounding factors, especially for alcohol drinking.

Polymorphism of the angiotensin converting enzyme gene and blood pressure in a Japanee general population (the Shigaraki study)

Tamaki Shinji, Nakamura Yasuyuki, Tsujita Yasuyuki, Nozaki Akihiko, Amamoto Kenji, Kadowaki Takashi, Kita Yoshikuni, Okamura Tomonori, Iwai Naoharu, Kinoshita Masahiko, Ueshima Hirotsugu

Hypertension Research 25 ( 6 ) 843 - 848 2002.11

ISSN 0916-9636

Recent studies have described a linkage between angiotensin converting enzyme (ACE) gene polymorphism and hypertension in a large number of hypertensive sibs. Moreover, among Japanese, the DD genotype of the ACE gene has been reported to be a genetically predisposing factor for hypertension in a large general population. However, there is some controversy regarding the association between the ACE insertion/deletion (I/D) polymorphism and systemic hypertension. Therefore, we examined the influence of the ACE I/D polymorphism in a random Japanese population. The participants were 2,892 subjects (1,110 males: mean age, 58.4±15.5; 1,782 females: mean age, 56.2±15.7) who underwent medical examinations in 1999 in Shigaraki, a suburban town located in an urban area in Shiga prefecture. Among them, 2,395 subjects (917 males: mean age, 58.0±15.7; 1478 females: mean age, 56.3±15.6) who gave their informed consent for genetic analysis were enrolled in the present study. Every year since 1991, we have repeatedly performed medical examinations in Shigaraki. ACE genotypes were determined by polymerase chain reaction (PCR) methods. Logistic analysis revealed that age (p<0.001; odds ratio=1.091), body mass index (BMI) (p<0.001; odds ratio=1.211), and family history of hypertension (p<0.001; odds ratio=0.371) were associated with hypertension (systolic blood pressure greater than 140 mmHg and diastolic greater than 90 mmHg). There was no association between ACE polymorphism and blood pressure. There were also no significant differences in blood pressure among males or females across the three genotypes. Moreover, in an analysis of 1,484 subjects (549 males: mean age, 62.8±12.1; 935 females: mean age, 61.2±12.6) who were followed-up since 1991, there was no association between ACE polymorphism and changes in blood pressure (p=0.3905). We conclude that ACE polymorphism does not appear to have any significant association with blood pressure, changes in blood pressure or sex in Japanese subjects, who have a more homogeneous genetic background than any other group reported to date.

Effects of serum B vitamins on elevated plasma homocysteine levels associated with the mutation of methylenetetrahydrofolate reductase gene in Japanese

Moriyama Yuri, Okamura Tomonori, Kajinami Kouji, Iso Hiroyasu, Inazu Akihiro, Kawashiri Masaaki, Mizuno Mihoko, Takeda Yoshiko, Sakamoto Yasuki, Kimura Humio, Suzuki Hideyoshi, Mabuchi Hiroshi

Atherosclerosis 164 ( 2 ) 321 - 328 2002.10

ISSN 0021-9150

High plasma homocysteine, a risk factor for atherosclerosis, is frequently caused by a common mutation in the gene for the enzyme, 5,10-methylenetetrahydrofolate reductase (MTHFR), C677T (alanine to valine substitution) or low intake of B vitamins that affect the remethylation or transsulfuration pathways in homocysteine metabolism. However, the interaction of the C677T mutation and B vitamins other than folate has not been well elucidated. We conducted a cross-sectional survey of 324 men and 641 women who participated in a 1996 health examination under a hypothesis that high nutritional status of folate, vitamin B12 and vitamin B6 expressed as high serum levels, may compensate for the hyperhomocysteinemia associated with homozygosity for the C677T mutation, but not for having the mutation per se. Age-adjusted plasma homocysteine levels were higher for both men and women with the homozygous genotype for the mutation than those who were heterozygous or had no mutation. Elevated homocysteine levels in homozygous genotype was attenuated among persons with higher serum levels of vitamin B12 and folate, but not vitamin B6, and among persons with the combination of lower folate and higher vitamin B12 and of higher folate and higher vitamin B12, split by the median. These findings suggest that elevated homocysteine levels among Japanese with the homozygous genotype for the MTHFR gene mutation can be modified efficiently by dietary supplement of vitamin B12 as well as folate. © 2002 Elsevier Science Ireland Ltd. All rights reserved.

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What unfavorable factors are associated with low serum total cholesterol in a Japanese population?

Mao Xu, Okamura Tomonori, Choudhury Sohel R., Kita Yoshikuni, Kadowaki Takashi, Okayama Akira, Niki Isao, Ueshima Hirotsugu

Journal of Epidemiology 12 ( 3 ) 271 - 279 2002.05

ISSN 0917-5040

An inverse association between blood cholesterol level and excess mortality in low cholesterol level subjects has been reported, but there has been no reasonable explanation widely accepted. To evaluate the associations between unfavorable factors and low blood cholesterol in non-Western populations, we performed a cross-sectional study in a rural Japanese population. A self-administered questionnaire concerning health characteristics and a nutritional survey, using a continuous 48-hour dietary record, was conducted on 461 males and 571 females aged 20-79 years old. The serum total cholesterol (TC) of less than 160 mg/dl was defined as low cholesterol, which accounted for 18% of the subjects. The multivariate odds ratio of having low cholesterol adjusted for age and selected variables were 0.70 (95% Cl: 0.52-0.94) for 1SD increment of Key's lipid factor, 0.71 (0.51-0.97) for 1SD increment of vitamin A intake, 2.23 (1.01-4.91) for heavy drinking, 2.80 (1.21-6.46) for being underweight and 2.59 (1.01-6.61) for blood transfusion in males, and 1.04 (1.00-1.08) for 10 cigarette-year increase in smoking in females. Even when further adjusted for body mass index, these associations were still significant except for those who were underweight and had undergone blood transfusion in males. These findings may partly explain the excess mortality of the Japanese males with low serum TC.

A simple method to estimate populational 24-h urinary sodium and potassium excretion using a casual urine specimen

Tanaka Taichiro, Okamura T., Miura K., Kadowaki T., Ueshima H., Nakagawa H., Hashimoto T.

Journal of Human Hypertension 16 ( 2 ) 97 - 103 2002

ISSN 0950-9240

In order to estimate the salt and potassium intake in a population and to compare their annual trends, we developed a simple method to estimate population mean levels of 24-h urinary sodium (24HUNaV) and potassium (24HUKV) excretion from spot urine specimens collected at any time. Using 591 Japanese data items from the INTERSALT study as a gold standard, we developed formulas to estimate 24-h urinary creatinine (24HUCrV), 24HUNaV and 24HUKV using both spot and 24-h urine collection samples. To examine the accuracy of the formulas, we applied these equations to 513 external manual workers. The obtained formulas were as follows: (1) PRCr (mg/day) = -2.04 × age + 14.89 × weight (kg) + 16.14 × height (cm) - 2244.45; (2) estimated 24HUNaV (mEq/day) = 21.98 × XNa^0.392; (3) estimated 24HUKV (mEq/day) = 7.59 × XK^0.431; where PRCr = predicted value of 24HUCr, SUNa = Na concentration in the spot voiding urine, SUK = K concentration in the spot voiding urine, SUCr = creatinine concentration in the spot voiding urine, XNa (or XK) = SUNa (or SUK)/SUCr × PRCr. In the external group, there was a significant but small difference between the estimated and measured values in sodium (24.0 mmol/day) and potassium (3.8 mmol/day) excretion. In every quintile divided by the estimated 24HUNaV or 24HUKV, the measured values were parallel to the estimated values. In conclusion, although this method is not suitable for estimating individual Na and K excretion, these formulas are considered useful for estimating population mean levels of 24-h Na and K excretion, and are available for comparing different populations, as well as indicating annual trends of a particular population.

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Linoleic acid, other fatty acids, and the risk of stroke

Iso Hiroyasu, Sato Shinichi, Umemura Utako, Kudo Minako, Koike Kazuko, Kitamura Akihiko, Imano Hironori, Okamura Tomonori, Naito Yoshihiko, Shimamoto Takashi

Stroke 33 ( 8 ) 2086 - 2093 2002

ISSN 0039-2499

Background and Purpose - The role of serum fatty acids as a risk factor for stroke and stroke subtypes is largely unknown. Methods -A prospective nested case-control study of Japanese 40 to 85 years of age was conducted through the use of frozen serum samples from 7450 participants in cardiovascular risk surveys collected from 1984 to 1989 for 1 community and 1989 to 1992 for the other 2 communities. By the end of 1998, we identified 197 incident strokes whose subtypes were confirmed by imaging studies. Three controls per case were selected by matching for sex, age, community, year of serum storage, and fasting status. Results - Compared with controls, total (n=197), hemorrhagic (n=75), and ischemic (n=122) strokes had similar proportions of n3 polyunsaturated fatty acids, lower proportions of linoleic and arachidonic acids, and higher proportions of saturated and monosaturated acids, determined by gas chromatography. The multivariate odds ratios associated with a 1-SD increase in linoleic acid (5%) after adjustment for hypertension, diabetes, serum total cholesterol, and other cardiovascular risk factors were 0.72 [95% confidence interval (CI), 0.59 to 0.89] for total stroke, 0.66 (95% CI, 0.49 to 0.88) for ischemic stroke, 0.63 (95% CI, 0.46 to 0.88) for lacunar infarction, and 0.81 (95% CI, 0.59 to 1.12) for hemorrhagic stroke. The respective odds ratios for saturated fatty acids (4%) were 1.13 (95% CI, 1.05 to 1.65), 1.35 (95% CI, 1.01 to 1.79), 1.44 (95% CI, 1.03 to 2.01), and 1.21 (95% CI, 0.82 to 1.80). Further adjustment for other fatty acids attenuated these relations, but the relation between linoleic acid and risk of ischemic stroke remained statistically significant. Conclusions - A higher intake of linoleic acid may protect against ischemic stroke, possibly through potential mechanisms of decreased blood pressure, reduced platelet aggregation, and enhanced deformability of erythrocyte cells.

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Genetic variation in aldehyde dehydrogenase 2 and the effect of alcohol consumption on cholesterol levels

Nakamura Yasuyuki, Amamoto Kenji, Tamaki Shinji, Okamura Tomonori, Tsujita Yasuyuki, Ueno Yoshiki, Kita Yoshikuni, Kinoshita Masahiko, Ueshima Hirotsugu

Atherosclerosis 164 ( 1 ) 171 - 177 2002

ISSN 0021-9150

Moderate drinkers with a defective alcohol dehydrogenase type 3 (ADH3) genotype have higher high-density lipoprotein (HDL) levels and a decreased risk of coronary artery disease (CAD). We examined the interaction between the aldehyde dehydrogenase type 2 (ALDH2), alcohol intake, and HDL levels in 826 men and 1295 women in a rural town in Japan. The ALDH2 genotype of each subject was determined by polymerase chain reaction (PCR) analysis. HDL was adjusted for the alcohol intake, age, body mass index, smoking status, total cholesterol, triglycerides and HbA1c levels. None of the subjects had a history or ECG suggestive of CAD. The proportions of ALDH2, *1/*1, *1/*2, and *2/*2 (defective homozygote) were 45.8, 46.0, and 8.2%, respectively, for men. Drinking more than two drinks daily was associated with lower HDL levels in men with the defective genotypes compared with men with a normal genotype (55.6±0.9 vs. 51.2±0.9 mg/dl, mean±S.E., P<0.0001). Also, drinking more than 0.5 drinks daily was not associated with beneficial effects on HDL levels in women with defective ALDH2 genotypes. Conclusions: Alcohol intake did not have beneficial effects on HDL levels in the defective ALDH2 genotype and may not protect against CAD in subjects with defective ALDH2 genotypes. © 2002 Elsevier Science Ireland Ltd. All rights reserved.

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Estimated relative and absolute risk for cardiovascular disease according to alcohol consumption increase in Japanese general population

Okamura T., Hayakawa T., Kadowaki T., Amamoto K., Kita Y., Okayama A., Ueshima H.

Nihon Arukoru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence 36 ( 6 ) 586 - 595 2001.12

ISSN 1341-8963

To calculate the estimated relative and absolute risks for cardiovascular diseases according to alcohol consumption increase, we performed a cross-sectional study of men aged 40-79 years using the data from the National Survey of Circulatory Disorders 1990 in Japan. First, we investigated the association between alcohol intake and two types of biochemical variables: serum lipids and blood pressure, by using analysis of variance. Then, concerning the subjects aged 40-59 years, linear regression analyses between alcohol intake and these biochemical markers were done to calculate regression coefficients adjusted for confounding factors. Finally, we substituted these regression coefficients for previously reported regression coefficients in Cox proportional hazard models to calculate relative and absolute risks for coronary heart disease and stroke. Alcohol intake positively correlated to systolic and diastolic blood pressure (SBP and DBP) and high-density lipoprotein cholesterol (HDLC). However, there was no relation between alcohol intake and serum total cholesterol. Linear regression coefficients of SBP, DBP and HDLC were 2.25, 1.43, 2.70, respectively. We used two proportional hazard regression formulas of Japanese population: one for coronary disease (Circulation 89, 2533-39) and the other for stroke (NIPPON DATA80, a 14-year cohort study of randomly selected Japanese). The estimated relative risks of coronary heart disease and stroke were 0.89 and 1.06 for 1 "go" (23 g of ethanol) increment of alcohol intake. The results indicate that the mortality rates shift from 0.44 to 0.39 per 1,000 person-years for coronary heart disease and from 0.76 to 0.81 per 1,000 person-years for stroke in the representative Japanese population aged 40-59 years. The absolute risk of cardiovascular disease may be unchanged if we assume 23 g increment of ethanol intake in Japan because the risk reduction in coronary heart disease was nearly equal to the risk increment in stroke.

Serum triglycerides and risk of coronary heart disease among Japanese men and women

Iso Hiroyasu, Naito Yoshihiko, Sato Shinichi, Kitamura Akihiko, Okamura Tomonori, Sankai Tomoko, Shimamoto Takashi, Iida Minoru, Komachi Yoshio

American Journal of Epidemiology 153 ( 5 ) 490 - 499 2001.03

ISSN 0002-9262

To examine the relation of triglycerides with coronary heart disease among populations with low mean total cholesterol, the authors conducted a 15.5-year prospective study ending in 1997 of 11,068 Japanese aged 40-69 years (4,452 men and 6,616 women with mean total cholesterol = 4.73 mmol/liter and 5.03 mmol/liter, respectively), initially free of coronary heart disease or stroke. There were 236 coronary heart disease events comprising 133 myocardial infarctions, 68 angina pectoris events, and 44 sudden cardiac deaths. The coronary heart disease incidence was greater in a dose-response manner across increasing quartiles of nonfasting triglycerides for both sexes. The multivariate relative risk of coronary heart disease adjusting for coronary risk factors and time since last meal associated with a 1-mmol/liter increase in triglycerides was 1.29 (95% confidence interval (Cl): 1.09, 1.53; p = 0.004) for men and 1.42 (95% Cl: 1.15, 1.75; p = 0.001) for women. The trend was similar for myocardial infarction, angina pectoris, and sudden cardiac death. The relation of triglycerides with coronary heart disease was not influenced materially by total cholesterol levels or, in a subsample analysis (51% of total sample), by high density lipoprotein cholesterol levels. Nonfasting serum triglycerides predict the incidence of coronary heart disease among Japanese men and women who possess low mean values of total cholesterol. Further adjustment for high density lipoprotein cholesterol suggests an independent role of triglycerides on the coronary heart disease risk.

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A changing pattern of food frequency according to aging. A study in a rural cohort with 14-year follow-up

Iino M., Moriwake S., Okamura T., Sato S., Murayama M., Suzuki R., Terao A., Ishikawa Y., Kitamura A., Naito Y., Imano H., Nagano E., Nakagawa Y., Iida M.

[Nippon kōshū eisei zasshi] Japanese journal of public health 48 ( 1 ) 38 - 46 2001

ISSN 0546-1766

Lipid disorder and atherosclerosis caused by smoking

Kadowaki T., Okamura T., Ueshima H.

Nippon rinsho. Japanese journal of clinical medicine 59 Suppl 3 214 - 219 2001

ISSN 0047-1852

Plasma fibrinogen and coronary heart disease in urban japanese

Sato Shinichi, Nakamura Masakazu, Iida Minoru, Naito Yoshihiko, Kitamura Akihiko, Okamura Tomonori, Nakagawa Yuko, Imano Hironori, Kiyama Masahiko, Iso Hiroyasu, Shimamoto Takashi, Komachi Yoshio

American Journal of Epidemiology 152 ( 5 ) 420 - 423 2000.09

ISSN 0002-9262

There is little information on the relation of plasma fibrinogen concentration to the risk of coronary heart disease in Asians, including Japanese, whose plasma fibrinogen concentration has been reported to be low by Western standards. The authors conducted a prospective study with 4.8 years of follow-up of 11,977 men and women aged 21-89 years (mean value of fibrinogen = 267 mg/dl) living or working in Osaka, Japan, in 1990-1996 to examine the relation of plasma fibrinogen with the incidence of coronary heart disease (myocardial infarction and angina pectoris). Mean fibrinogen concentration was 293.6 mg/dl for men who developed coronary heart disease (n = 35) compared with 261.6 mg/dl for men free of coronary heart disease (n = 8,094; difference, p < 0.01), and 355.2 mg/dl for women who developed coronary heart disease (n = 6) compared with 276.8 mg/dl for women free of coronary heart disease (n = 3,842; difference, p < 0.01). With a Cox proportional hazards model to adjust for cardiovascular risk factors, the relative risk for the highest fibrinogen quartile (≥295 mg/dl) compared with the lowest (<228 mg/dl) was 4.8 (95% confidence interval: 1.4, 16.8, p = 0.01) for coronary heart disease, and 3.8 (95% confidence interval: 1.1, 13.4, p = 0.04) for myocardial infarction. Plasma fibrinogen is useful to predict the risk of coronary heart disease among urban Japanese, whose mean plasma fibrinogen is relatively low.

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Prospective study on alcohol intake and risk of subarachnoid hemorrhage among Japanese men and women

Sankai Tomoko, Iso Hiroyasu, Shimamoto Takashi, Kitamura Akihiko, Naito Yoshihiko, Sato Shinichi, Okamura Tomonori, Imano Hironori, Iida Minoru, Komachi Yoshio

Alcoholism: Clinical and Experimental Research 24 ( 3 ) 386 - 389 2000.03

Research paper (scientific journal), Joint Work, Accepted, ISSN 0145-6008

Background: Few prospective data are available to evaluate potential risk factors of subarachnoid hemorrhage among the Japanese, although several prospective studies conducted in the United States and in Europe have shown a positive relationship between alcohol intake and the risk of subarachnoid hemorrhage. Methods: A 9.4 year follow-up study was conducted on 12,372 men and women age 40 to 69 years who had no history of stroke, in six communities in Japan. The incident cases of subarachnoid hemorrhage were confirmed with computed tomography findings and/or clinical findings. Alcohol intake and other cerebrovascular risk factors were measured at the baseline examination. A Cox proportional hazard analysis was used to estimate the relative risks and 95% confidence intervals of the incidence of subarachnoid hemorrhage. Results: During the follow-up assessment, 71 cases of subarachnoid hemorrhages occurred. For men, heavy drinking appeared to be an independent risk factor for subarachnoid hemorrhage; multivariate-adjusted relative risk was 4.3 (95% confidence interval [CI]: 1.1-16.8;p = 0.04). Among women, no excess risk was found for heavy drinking, probably due to the small number of heavy drinkers (n = 15). The combination of heavy drinking with smoking or hypertension increased the risk of subarachnoid hemorrhage substantially for men; the multivariate-adjusted relative risk was 6.0 (95% CI: 1.8-20.1;p = 0.004) for heavy drinking smokers and 13.0 (95% CI: 3.9-43.9; p < 0.001) for heavy drinking hypertensives. Conclusions: A reduction in alcohol intake, smoking cessation, and control of hypertension are important in preventing subarachnoid hemorrhage among Japanese men.

Validity and reliability of the japanese version of the selected anger expression scale and age, sex, occupation and regional differences in anger expression among Japanese

Ohira Tetsuya, Iso Hiroyasu, Tanigawa Takeshi, Sankai Tomoko, Imano Hironori, Okamura Tomonori, Kiyama Masahiko, Kitamura Akihiko, Nakagawa Yuko, Sato Shinichi, Naito Yoshihiko, Lida Minoru, Shimamoto Takashi

Journal of Epidemiology 10 ( 2 ) 118 - 123 2000

ISSN 0917-5040

To examine the reliability and construct validity of the Japanese version of the Anger Expression Scale among four Japanese communities, and to examine distributions of anger expression scores according to sex, age, occupation, and community, we performed a crosssectional study among 1,802 men and 3,229 women aged 20-70 in four geographic populations in 1995-97. We handed a self-administered questionnaire, which was selected from the Spielberger Anger Expression Scale, to the participants in the risk factor surveys and measured anger-in and anger-out as the anger expression scale. These scales had high internal consistency (Cronbach's alpha coefficient was 0.97-0.98 for anger-out and 0.77-0.86 for angerin) and were of almost the same structure as the original. The Pearson correlation coefficients for the anger expression scale examined in 1995 and 1996 were 0.69 for anger-out and 0.57 for anger-in (both p<0.001). The mean scores of both anger-out and anger-in were inversely associated with age. The mean anger-out score was higher for men than for women (p<0.001), whereas the mean anger-in score did not vary significantly between the sexes. Furthermore, the mean scores of anger-out and anger-in varied among populations and occupational groups. The present study suggests that the Japanese version of the selected Anger Expression Scale is an acceptable scale for evaluatinq anger expression among Japanese.

Plasma level of homocysteine is correlated to extracranial carotid- artery atherosclerosis in non-hypertensive Japanese

Okamura Tomonori, Kitamura Akihiko, Moriyama Yuri, Imano Hironori, Sato Shinichi, Terao Atushi, Naito Yoshihiko, Nakagawa Yuko, Kiyama Masahiko, Tamura Yoshitaka, Iida Minoru, Suzuki Hideyoshi, Komachi Yoshio

Journal of Cardiovascular Risk 6 ( 6 ) 371 - 377 1999

Research paper (scientific journal), Joint Work, ISSN 1350-6277

Background: Results of some epidemiologic studies in Western countries have clarified that hyperhomocysteinemia is a plausible risk factor for atherosclerotic vascular disease, but its role in Japanese communities is not known. Design: A community-based cross-sectional design. Methods: We performed a cross-sectional study of 474 elderly men aged 60-74 years in two Japanese rural communities (Noichi in southwestern Japan and Ikawa in northeastern Japan). We examined the association between plasma concentrations of homocysteine and the maximum intima-media thickness (assessed by ultrasonography). Results: The prevalence of thickening was 10.7% for the lowest fertile of homocysteine level and 21.1% for the highest fertile. For the subjects without hypertension, the odds ratio for having carotid intima-media thickening was 5.8; it was significantly higher for the highest fertile of homocysteine level than it was for the lowest after adjusting for age, hypercholesterolemia, hypoalphalipoproteinemia, diabetes, and smoking by using a multiple logistic regression model. However, its correlation was not evident for those with hypertension. Conclusions: High levels of plasma homocysteine are correlated to extracranial carotid artery atherosclerosis in elderly men without hypertension in Japanese rural communities.

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