Papers - Okamura, Tomonori

Long-Term Exposure to Particulate Matter and Mortality from Cardiovascular Diseases in Japan: The Ibaraki Prefectural Health Study (IPHS).

Takeuchi A, Nishiwaki Y, Okamura T, Milojevic A, Ueda K, Asakura K, Takebayashi T, Hasegawa S, Sairenchi T, Irie F, Ota H, Nitta H

Journal of atherosclerosis and thrombosis (Journal of Atherosclerosis and Thrombosis)  28 ( 3 ) 230 - 240 2020.07

Research paper (scientific journal),  ISSN  1340-3478

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© 2021, Japan Atherosclerosis Society. All rights reserved. Aim: To examine the association between long-term exposure to suspended particulate matter (SPM) and cardiovascular mortality in Japan after controlling for known major confounding factors among a large middle and elderly cohort study in Ibaraki Prefecture, Japan. Methods: We followed 91,808 residents (men 34%) who undertook a national health check-up at age 40–79 years for 17 years (1993–2010). Two different exposure indices were adopted: baseline SPM concentration (in the year 1990) and average SPM concentration for the first (average of 1990 and 1995) and the second half (average of 2005 to 2009) of the study period. Sex-specific adjusted risk ratios (RRs) for cardiovascular mortality were calculated using general mixed Poisson regression models after adjusting the age, BMI, history of diabetes mellitus and hypertension, creatinine, glutamic pyruvic transaminase, total cholesterol, high-density lipoprotein cholesterol, smoking, alcohol, and temperature. The variation between seven medical administration areas was also taken into account as a random effect. Results: Baseline SPM concentration was associated with an increased risk of mortality from all cardiovascular diseases, coronary artery disease, and stroke. The adjusted RRs (95% confidence interval [CI]) per 10 µg/m3 increase in SPM concentration for all cardiovascular mortality were 1.147 (1.014–1.300) for men and 1.097 (0.985–1.222) for women. The point estimate of RR was highest for non-hemorrhagic stroke in men (1.248 [0.991–1.571]), although CI overlapped the unity. The RRs seemed slightly lower in the second half than in the first half, though the CIs widened in the second half. Conclusion: Our results suggest that long-term exposure to SPM is associated with an increased risk of all cardiovascular mortality for men in Ibaraki, Japan.

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Isolated systolic hypertension and 29-year cardiovascular mortality risk in Japanese adults aged 30--49 years.

Hisamatsu T, Miura K, Ohkubo T, Kadota A, Kondo K, Kita Y, Hayakawa T, Kanda H, Okamura T, Okayama A, Ueshima H, NIPPON DATA80 Research Group.

Journal of hypertension (Journal of hypertension)  38 ( 11 ) 2230 - 2236 2020.07

Research paper (scientific journal),  ISSN  0263-6352

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OBJECTIVE: The prognostic implication of isolated systolic hypertension (ISH), defined as SBP at least 140 mmHg and DBP less than 90 mmHg, among young-to-middle-aged adults remains controversial. We examined the association of ISH with cardiovascular disease (CVD) risk in adults aged 30-49 years. METHODS: In a prospective cohort of representative Japanese general populations from the NIPPON DATA80 (1980-2009), we studied 4776 participants (mean age, 39.4 years; 55.4% women) without clinical CVD or antihypertensive medication. Participants were classified as follows: normal blood pressure (BP) (SBP/DBP, <120/<80 mmHg), high-normal BP (120-129/<80 mmHg), elevated BP (130-139/80-89 mmHg), ISH, isolated diastolic hypertension (IDH) (<140/≥90 mmHg), and systolic--diastolic hypertension (SDH) (≥140/≥90 mmHg). RESULTS: ISH was observed in 389 (8.1%) participants. During the 29-year follow-up, 115 participants died of CVD, 28 of coronary heart disease, and 49 of stroke. Cox proportional hazards models adjusted for demographics and CVD risk factors showed that participants with ISH had higher risk of CVD mortality than those with normal BP [hazard ratio (confidence interval), 4.10 (1.87-9.03)]. The magnitude of CVD mortality risk related to ISH was comparable with that related to IDH [3.38 (1.31-8.72)] and not as great as that related to SDH [5.41 (2.63-11.14)]. We found significant associations of ISH with coronary and stroke mortality. The association of ISH with CVD mortality was consistent across men and women and those aged 30-39 and 40-49 years. CONCLUSION: ISH among young-to-middle-aged Japanese adults was independently associated with higher risk of CVD mortality later in life.

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Neurologically favourable outcomes of cardiogenic out-of-hospital cardiac arrest with relation to the type of witness in Japan

Shirakawa K., Kanao K., Saito Y., Doi K., Takuma K., Okamura T., Takebayashi T.

Resuscitation (Resuscitation)  152   97 - 104 2020.07

Research paper (scientific journal),  ISSN  03009572

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© 2020 Elsevier B.V. Aim: To assess the current situation and neurologically favourable outcomes after out-of-hospital cardiac arrest (OHCA) with respect to the type of witness. Methods: This retrospective observational study used data from the All-Japan Utstein Registry of the Fire and Disaster Management Agency collected between January 1, 2016, and December 31, 2016. Patients with cardiogenic OHCA aged ≥18 years who were witnessed by bystanders were included. The primary outcome measure was a neurologically favourable outcome 1 month after the OHCA. Results: Among the 123,554 patients with OHCA registered between January 1, 2016, and December 31, 2016, 24,856 patients were included. Of them, 15,139 were witnessed by family, and 9717 were witnessed by non-family (friends, 1306; colleagues, 951; passers-by, 997; others, 6463). When witnessed by family, the rate of neurologically favourable outcomes was significantly lower than that when witnessed by non-family (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.41–0.49, P < 0.001). After adjusting for potential confounders, the rate of neurologically favourable outcomes remained lower when OHCA was witnessed by family (OR = 0.88, 95% CI = 0.79–0.99, P = 0.03). However, in subgroup analysis, adjusted ORs for neurologically favourable outcomes were slightly greater for 65–84-year-old women and ≥85-year-old women with family witnesses than for those with non-family witnesses. For all other groups, non-family witnesses outperformed family witnesses. Conclusion: Family-witnessed OHCA events had fewer neurologically favourable outcomes before and after adjusting for confounders. BLS education for family members may lead to improved prognosis of witnessed cardiogenic OHCAs.

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Association between Plasma Metabolites in the Urea Cycle and Diabetic Kidney Disease (DKD) in a Japanese Population

Yamamoto Masahiko, Harada Sei, Okamura Tomonori, Fujihara Kazuya, Yaguchi Yuta, Komatsu Takeshi, Sato Takaaki, Kitazawa Masaru, Yamada Mayuko H., Kaneko Masanori, Osawa Taeko, Matsubayashi Yasuhiro, Yamada Takaho, Kodama Satoru, Sone Hirohito, Takebayashi Toru

DIABETES 69 2020.06

Research paper (scientific journal),  ISSN  0012-1797

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A Combination of Blood Pressure and Total Cholesterol Increases the Lifetime Risk of Coronary Heart Disease Mortality: EPOCH-JAPAN.

Satoh M, Ohkubo T, Asayama K, Murakami Y, Sugiyama D, Waki T, Tanaka-Mizuno S, Yamada M, Saitoh S, Sakata K, Irie F, Sairenchi T, Ishikawa S, Kiyama M, Okayama A, Miura K, Imai Y, Ueshima H, Okamura T, Evidence for Cardiovascular Prevention from Observational Cohorts in Japan (EPOCH–JAPAN) Research Group.

Journal of atherosclerosis and thrombosis (Journal of Atherosclerosis and Thrombosis)  28 ( 1 ) 6 - 24 2020.04

Research paper (scientific journal),  ISSN  1340-3478

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© 2021 Japan Atherosclerosis Society. Aim: Lifetime risk (LTR) indicates the absolute risk of disease during the remainder of an individual’s lifetime. We aimed to assess the LTRs for coronary heart disease (CHD) mortality associated with blood pressure (BP) and total cholesterol levels in an Asian population using a meta-analysis of individual participant data because no previous studies have assessed this risk. Methods: We analyzed data from 105,432 Japanese participants in 13 cohorts. Apart from grade 1 and 2–3 hypertension groups, we defined “normal BP” as systolic/diastolic BP ＜130/＜80 mmHg and “high BP” as 130–139/80–89 mmHg. The sex-specific LTR was estimated while considering the competing risk of death. Results: During the mean follow-up period of 15 years (1,553,735 person-years), 889 CHD deaths were recorded. The 10-year risk of CHD mortality at index age 35 years was ≤ 0.11%, but the corresponding LTR was ≥ 1.84%. The LTR of CHD at index age 35 years steeply increased with an increase in BP of participants with high total cholesterol levels [≥ 5.7 mmol/L (220 mg/dL)]. This risk was 7.73%/5.77% (95% confidence interval: 3.53%–10.28%/3.83%–7.25%) in men/women with grade 2–3 hypertension and high total cholesterol levels. In normal and high BP groups, the absolute differences in LTRs between the low and high total cholesterol groups were ≤ 0.25% in men and ≤ 0.40% in women. Conclusions: High total cholesterol levels contributed to an elevated LTR of CHD mortality in hypertensive individuals. These findings could help guide high-risk young individuals toward initiating lifestyle changes or treatments.

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Risk Factors Associated With Ischemic Stroke in Japanese Patients With Nonvalvular Atrial Fibrillation

Okumura K., Tomita H., Nakai M., Kodani E., Akao M., Suzuki S., Hayashi K., Sawano M., Goya M., Yamashita T., Fukuda K., Ogawa H., Tsuda T., Isobe M., Toyoda K., Miyamoto Y., Miyata H., Okamura T., Sasahara Y.

JAMA network open (JAMA network open)  3 ( 4 ) e202881 2020.04

Research paper (scientific journal),  ISSN  2574-3805

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Importance: Despite the development of risk stratification schemes that have been widely used to determine the risk for thromboembolism in patients with nonvalvular atrial fibrillation (NVAF), risk stratification schemes in Asian patients with NVAF remain undetermined. Objective: To determine risk factors for ischemic stroke in Japanese patients with NVAF. Design, Setting, and Participants: This cohort study analyzed individual patient data from 5 AF registries in Japan: J-RHYTHM (Japanese Rhythm Management Trial for Atrial Fibrillation) Registry, Fushimi AF Registry, Shinken Database, Keio Interhospital Cardiovascular Studies (Keio Study), and Hokuriku-Plus AF Registry. Patients with atrial fibrillation were registered from 158 institutions in the J-RHYTHM Registry, 80 in the Fushimi AF Registry, a single hospital in Shinken Database, 11 in the Keio Study, and 19 in the Hokuriku-Plus AF Registry. Patients with valvular AF or lacking data were excluded. Data were collected and integrated in March 2016, and those from the Keio Study were updated in April 2018. Data were analyzed from April 2018 to February 2020. Main Outcomes and Measures: Significant risk factors for ischemic stroke were determined by adjusted Cox proportional hazards analysis. Results: In total, 12 289 patients with NVAF (3758 [31%] female; mean [SD] age 70.2 [11] years) were analyzed with a mean (SD) follow-up period of 649 (181) days (1.8 [0.5] years). During 21 820 person-years of follow-up, 241 cases of ischemic stroke were reported. Risk factors associated with ischemic stroke after adjustment for oral anticoagulant use at enrollment were age (75-84 years: hazard ratio [HR], 1.74; 95% CI, 1.32-2.30; P < .001; and ≥85 years: HR, 2.41; 1.63-3.56; P < .001), hypertension (HR, 1.60; 95% CI, 1.15-2.23; P = .006), previous stroke (HR, 2.75; 95% CI, 2.09-3.62; P < .001), persistent or permanent AF (HR, 1.59; 95% CI, 1.21-2.10; P = .001), and body mass index less than 18.5 (HR, 1.55; 95% CI, 1.05-2.29; P = .03). Neither diabetes nor heart failure were identified as risk factors for ischemic stroke. Conclusions and Relevance: Previous stroke, advanced age, hypertension, persistent or permanent AF, and low body mass index were independent risk factors associated with ischemic stroke in Japanese patients with NVAF.

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Statin Intolerance Clinical Guide 2018.

Kajinami K, Tsukamoto K, Koba S, Inoue I, Yamakawa M, Suzuki S, Hamano T, Saito H, Saito Y, Masuda S, Nakayama T, Okamura T, Yamashita S, Kagawa T, Kaneyama J, Kuriyama A, Tanaka R, Hirata A, Statin Intolerance Clinical Guide Working Group; The Japan Society of Hepatology, Japanese Society of Neurology, Japan Atherosclerosis Society, The Japanese Society for the Study of Xenobiotics

Journal of atherosclerosis and thrombosis 27 ( 4 ) 375 - 396 2020.04

ISSN  1340-3478

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Echocardiographic Parameters and the Risk of Incident Atrial Fibrillation: The Suita Study

Higashiyama Aya, Kokubo Yoshihiro, Watanabe Makoto, Nakao Yoko Masukata, Okamura Tomonori, Okayama Akira, Miyamoto Yoshihiro

JOURNAL OF EPIDEMIOLOGY (Journal of Epidemiology)  30 ( 4 ) 183 - 187 2020.04

Research paper (scientific journal),  ISSN  0917-5040

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© 2019 Aya Higashiyama et al. Background: Left atrial dimension (LAD) and other parameters of echocardiography have been reported to be associated with the risk of atrial fibrillation (AF). However, few studies have investigated the associations between echocardiographic parameters and the risk of AF in the Asian general population, which has a low AF incidence. Methods: A prospective cohort study was performed in 1,424 individuals in the Suita study with echocardiographic parameters, including LAD, and no history of AF. After echocardiography, the participants were followed using 12-lead electrocardiography and questionnaires to detect AF incidence. The multivariable-adjusted hazard ratios (HRs) of echocardiographic parameters for AF incidence were estimated after adjustment for the risk factors of the AF risk score. Results: During the median 6.0 years of follow-up, 31 AF cases occurred. The multivariable-adjusted HR of a 1-mm increase in LAD for AF was 1.18 (95% confidence interval [CI], 1.08-1.28). The multivariable-adjusted HR for AF of a 1-standard-deviation increase in LAD was higher than that of left ventricular internal dimensions in diastole, left ventricular mass, ejection fraction, and percent fractional shortening, and it was the only significant factor. In 667 participants with both LAD and LA volume (LAV) measurements, LAD and LAV were independently associated with the risk of AF incidence. Conclusions: LAD on echocardiography was an independent risk factor of incident AF in the Japanese population. LAD might be useful for identifying individuals with a high risk of AF in health check-ups of the general population.

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Electrocardiographic Left Atrial Abnormality and B-Type Natriuretic Peptide in a General Japanese Population: NIPPON DATA2010.

Shoji S, Kohsaka S, Sawano M, Okamura T, Hirata A, Sugiyama D, Ohkubo T, Nakamura Y, Watanabe M, Kadota A, Ueshima H, Okayama A, Miura K, NIPPON DATA2010 Research Group.

Journal of atherosclerosis and thrombosis (Journal of Atherosclerosis and Thrombosis)  28 ( 1 ) 34 - 43 2020.03

Research paper (scientific journal),  ISSN  1340-3478

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© 2021 Japan Atherosclerosis Society. Aims: P-wave terminal force in lead V1 (PTFV1) is an electrocardiogram marker of increased left atrial pressure and may be a noninvasive and early detectable marker for future cardiovascular events in the general population compared to serum B-type natriuretic peptide (BNP) concentration. The clinical significance of PTFV1 in the contemporary general population is an area of unmet need. We aimed to demonstrate the correlation between PTFV1 and BNP concentrations in a contemporary representative Japanese population. Methods: Among 2,898 adult men and women from 300 randomly selected districts throughout Japan (NIPPON DATA2010), we analyzed 2,556 participants without cardiovascular disease (stroke, myocardial infarction, and atrial fibrillation). Elevated BNP was defined as a value of ≥ 20 pg/mL based on the definition from the Japanese Circulation Society guidelines. Results: In total, 125 (4.9%) participants had PTFV1. Participants with PTFV1 were older with a higher prevalence of hypertension, major electrocardiographic findings, and elevated BNP concentrations (13.5 [6.9, 22.8] versus 7.8 [4.4, 14.5] pg/mL; P＜0.001). After adjustment for confounders, PTFV1 was correlated with elevated BNP (odds ratio, 1.66; 95% confidence interval, 1.05–2.62; P= 0.030). This correlation was consistent among various subgroups and was particularly evident in those aged ＜65 years or those without a history of hypertension. Conclusions: In the contemporary general population cohort, PTFV1 was independently related to high BNP concentration. PTFV1 may be an alternative marker to BNP in identifying individuals at a higher risk of future cardiovascular events in the East Asian population.

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Relationship between thin physique at 6 years and metabolic disease risks in middle-aged Japanese women: The Suita study

Katsuragi S., Okamura T., Kokubo Y., Watanabe M., Higashiyama A., Ikeda T., Miyamoto Y.

Journal of Obstetrics and Gynaecology Research (Journal of Obstetrics and Gynaecology Research)  46 ( 3 ) 517 - 526 2020.03

Research paper (scientific journal),  ISSN  13418076

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© 2020 Japan Society of Obstetrics and Gynecology Aim: We previously reported that female babies born small developed cardiovascular risks in middle age. The present study was conducted using the same cohort to examine the relationship between physique at 6 years and the metabolic disease risk in middle age. Methods: Data collected from 721 women aged 41–69 years who underwent a medical examination at a single institution between 2007 and 2008 were retrospectively examined. We collected data from medical examinations and a questionnaire on physique (thin, normal, and fat) at 6 years. The relationship between birthweight and physique at 6 years was investigated. Results: Among females who were born small (< 2500 g), 80%, 16%, and 4% became thin, normal, or fat, respectively, by 6 years. Physique at 6 years had a negative relationship with future triglyceride, fasting glucose, HbA1C, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) levels and a positive relationship with high-density lipoprotein cholesterol levels. Conclusion: Although our findings may be specific to the study population, physique at 6 years had a negative relationship with the metabolic disease risk in middle-aged Japanese women. Insulin and MOMA-IR levels negatively correlated with physique at 6 years, and development from low birthweight infants to childhood obesity was rare in this cohort.

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Elevated Fasting Blood Glucose Levels Are Associated With Lower Cognitive Function, With a Threshold in Non-Diabetic Individuals: A Population-Based Study

Liu Ziyi, Zaid Maryam, Hisamatsu Takashi, Tanaka Sachiko, Fujiyoshi Akira, Miyagawa Naoko, Ito Takahiro, Kadota Aya, Tooyama Ikuo, Miura Katsuyuki, Ueshima Hirotsugu, Hirotsugu Ueshima, Miura Katsuyaki, Horie Minoru, Yamamoto Takashi, Hayashi Hideki, Nakano Yasutaka, Ogawa Emiko, Maegawa Hiroshi, Miyazawa Itsuko, Murata Kiyoshi, Mitsunami Kenichi, Nozaki Kazuhiko, Shiino Akihiko, Tsuru Teruhiko, Ogita Hisakazu, Shimizu Akio, Miyamatsu Naomi, Kita Toru, Kimura Takeshi, Nishio Yoshihiko, Nakamura Yasuyuki, Okamura Tomonori, Sekikawa Akira, Barinas-Mitchell Emma J. M., Edmundowicz Daniel, Ohkubo Takayoshi, Hozawa Atsushi, Murakami Yoshitaka, Okuda Nagako, Arima Hisatomi, Kita Yoshikuni, Higashiyama Aya, Nagasawa Shinya, Azuma Koichiro, Yanagita Masahiko, Abbott Robert D., Takashima Naoyuki, Ohno Seiko, Kadowaki Takashi, Kadowaki Sayaka, Kondo Keiko, Torii Sayuki, Saito Yoshino, Suzuki Sentaro, Satoh Atsushi, Yamazoe Masahiro

JOURNAL OF EPIDEMIOLOGY 30 ( 3 ) 121 - 127 2020.03

Research paper (scientific journal),  ISSN  0917-5040

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Relationship between calcium intake and impaired activities of daily living in a Japanese population: NIPPON DATA90.

Kogure M, Tsuchiya N, Narita A, Hirata T, Nakaya N, Nakamura T, Hozawa A, Hayakawa T, Okuda N, Miyagawa N, Kadota A, Ohkubo T, Murakami Y, Sakata K, Miura K, Okayama A, Okamura T, Ueshima H

Journal of epidemiology (Journal of Epidemiology)  31 ( 1 ) 119 - 124 2020.02

Research paper (scientific journal),  ISSN  0917-5040

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© 2020 Mana Kogure et al. Background: Major reasons for long-term care insurance certification in Japan are stroke, dementia, and fracture. These diseases are reported to be associated with calcium intake. This study examined the association between calcium intake and impaired activities of daily living (ADL) using the data from NIPPON DATA90, consisting of representative sample of the Japanese population. Methods: A population-based nested case-control study was performed. A baseline survey was conducted in 1990, followed by ADL surveys of individuals ≥65 years old in 2000. Individuals with impaired ADL and selected age-and sex-matched controls were then identified. We obtained 132 pairs. Calcium intake was energy-adjusted using the residual method. The association between calcium intake and impaired ADL was examined using conditional logistic regression models. To assess the accuracy of the estimates, we conducted bootstrap analyses. Results: The adjusted odds ratios (ORs) for impaired ADL compared with the group with a calcium intake of <476 mg/day were 0.72 (95% confidence interval [CI], 0.37–1.40) for the 476–606 mg/day group and 0.44 (95% CI, 0.21–0.94) for the ≥607 mg/ day group in 2000 (P for linear trend = 0.03). After the bootstrap analyses, the inverse relationship unchanged (median OR per 100-mg rise in calcium intake, 0.87 [1,000 resamplings]; 95% CI, 0.76–0.97). Conclusions: After bootstrap analyses, calcium intake was inversely associated with impaired ADL 10 years after the baseline survey.

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Development of a Cardiovascular Disease Risk Prediction Model Using the Suita Study, a Population-Based Prospective Cohort Study in Japan.

Nakai M, Watanabe M, Kokubo Y, Nishimura K, Higashiyama A, Takegami M, Nakao YM, Okamura T, Miyamoto Y

Journal of atherosclerosis and thrombosis (Journal of Atherosclerosis and Thrombosis)  27 ( 11 ) 1160 - 1175 2020.02

Research paper (scientific journal),  ISSN  1340-3478

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© 2020 Japan Atherosclerosis Society. Aim: To construct a risk prediction model for cardiovascular disease (CVD) based on the Suita study, an urban Japanese cohort study, and compare its accuracy against the Framingham CVD risk score (FRS) model. Methods: After excluding participants with missing data or those who lost to follow-up, this study consisted of 3,080 men and 3,470 women participants aged 30–79 years without CVD at baseline in 1989–1999. The main outcome of this study was incidence of CVD, defined as the incidence of stroke or coronary heart disease. Multi-variable Cox proportional hazards models with stepwise selection were used to develop the prediction model. To assess model performance, concordance statistics (C-statistics) and their 95% confidence intervals (CIs) were cal-culated using a bootstrap procedure. A calibration test was also conducted. Results: During a median follow-up period of 16.9 years, 351 men and 241 women developed CVD. We for-mulated risk models with and without electrocardiogram (ECG) data that included age, sex, systolic blood pres-sure, diastolic blood pressure, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, diabetes mellitus, smoking, and urinary protein as risk factors. The C-statistics of the Suita CVD risk models with ECG data (0.782; 95% CI, 0.766–0.799) and without ECG data (0.781; 95% CI, 0.765–0.797) were significantly higher than that of the FRS model (0.768; 95% CI, 0.750–0.785). Conclusions: The Suita CVD risk model is feasible to use and improves predictability of the incidence of CVD relative to the FRS model in Japan.

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Relationship of household salt intake level with long-term all-cause and cardiovascular disease mortality in Japan: NIPPON DATA80

Shima A., Miyamatsu N., Miura K., Miyagawa N., Okuda N., Yoshita K., Kadota A., Suzuki H., Kondo K., Okamura T., Okayama A., Ueshima H., Saitoh S., Sakata K., Hozawa A., Hayakawa T., Nakamura Y., Nishi N., Ohkubo T., Kasagi F., Murakami Y., Izumi T., Matsumura Y., Ojima T., Tamakoshi K., Nakagawa H., Kita Y., Fujiyoshi A., Nakamura Y., Miyamoto Y., Kodama K., Kiyohara Y.

Hypertension Research (Hypertension Research)  43 ( 2 ) 132 - 139 2020.02

Research paper (scientific journal),  ISSN  09169636

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© 2019, The Japanese Society of Hypertension. In Asian countries, a major source of salt intake is from seasoning or table salt added at home. However, little is known about the adverse effects of salt intake evaluated according to household unit. We investigated the relationship between household salt intake level and mortality from all-cause and cardiovascular diseases (CVDs). Participants included 8702 individuals (56% women) who were living with someone else and who were aged 30–79 years and enrolled in the National Nutritional Survey of Japan in 1980 with a 24-year follow-up. Household nutrient intake was evaluated using a 3-day weighing record method in which all foods and beverages consumed by any of the household members were recorded. The household salt intake level was defined as the amount of salt consumed (g) per 1000 kcal of total energy intake in each household, and its average was 6.25 (2.02) g/1000 kcal. During the follow-up, there were 2360 deaths (787 CVD, 168 coronary heart disease [CHD], and 361 stroke). Cox proportional hazard ratios (HRs) for an increment of 2 g/1000 kcal in household salt intake were calculated and adjusting for sex, age, body mass index, smoking status, alcohol consumption status, self-reported work exertion level, household potassium intake, household saturated fatty acid intake, and household long-chain n-3 polyunsaturated fatty acid intake. The HRs (95% confidence intervals) were 1.07 (1.02, 1.12) for all-cause mortality, 1.11 (1.03, 1.19) for CVD, 1.25 (1.08, 1.44) for CHD, and 1.12 (1.00, 1.25) for stroke. The household salt intake level was significantly associated with long-term risk of all-cause, CVD, CHD, and stroke mortality in a representative Japanese population.

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Relationship between carbohydrate and dietary fibre intake and the risk of cardiovascular disease mortality in Japanese: 24-year follow-up of NIPPON DATA80

Miyazawa I., Miura K., Miyagawa N., Kondo K., Kadota A., Okuda N., Fujiyoshi A., Chihara I., Nakamura Y., Hozawa A., Nakamura Y., Kita Y., Yoshita K., Okamura T., Okayama A., Ueshima H.

European Journal of Clinical Nutrition (European Journal of Clinical Nutrition)  74 ( 1 ) 67 - 76 2020.01

Research paper (scientific journal),  ISSN  09543007

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© 2019, Springer Nature Limited. Background/Objectives: The association between carbohydrate intake and cardiovascular disease (CVD) risk has been investigated, but whether the quality of carbohydrate is more important than its amount is not known. We examined the associations between intake of dietary fibre (DF), carbohydrate, available carbohydrate, and starch with long-term CVD mortality in a Japanese population. Subjects/Methods: We prospectively followed 8925 participants (3916 men and 5009 women) aged 30–79 years without CVD at baseline who participated in the National Nutrition Survey in Japan. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs) for CVD mortality by quartiles of exposure variables. Results: During 24 years of follow-up, 823 CVD deaths were observed. In men, the multivariable-adjusted HR for CVD mortality was lower in the highest quartile of DF intake (HR: 0.64; 95% CI: 0.47–0.87; Ptrend = 0.007) compared with the lowest quartile. This association was not significant in women. Multivariable-adjusted HR for total stroke mortality was lower in the highest quartile of DF intake (HR: 0.61; 95% CI: 0.38–0.98; Ptrend = 0.046) compared with the lowest quartile in women. Carbohydrate, available carbohydrate, and starch intake were not associated with CVD mortality. Conclusions: Higher intake of DF was associated significantly with a lower risk of CVD mortality in men and lower risk of stroke mortality in women. Intake of carbohydrate, available carbohydrate, and starch were not associated with the risk of CVD mortality in men or women.

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Dietary inflammatory index positively associated with high-sensitivity C-reactive protein level in Japanese from NIPPON data2010

Yang Y., Hozawa A., Kogure M., Narita A., Hirata T., Nakamura T., Tsuchiya N., Nakaya N., Ninomiya T., Okuda N., Kadota A., Ohkubo T., Okamura T., Ueshima H., Okayama A., Miura K.

Journal of Epidemiology (Journal of Epidemiology)  30 ( 2 ) 98 - 107 2020

Research paper (scientific journal),  ISSN  09175040

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© 2019 Yunqing Yang et al. Background: It has been reported that chronic inflammation may play an important role in the pathogenesis of several serious diseases and could be modulated by diet. Recently, the Dietary Inflammatory Index (DII®) was developed to assess the inflammatory potential of the overall diet. The DII has been reported as relevant to various diseases but has not been validated in Japanese. Thus, in the present study, we analyzed the relationship between DII scores and high-sensitivity C-reactive protein (hs-CRP) levels in a Japanese population. Methods: Data of the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010 (NIPPON DATA2010), which contained 2,898 participants aged 20 years or older from the National Health and Nutrition Survey of Japan (NHNS2010), were analyzed. Nutrient intakes derived from 1-day semi-weighing dietary records were used to calculate DII scores. Energy was adjusted using the residual method. Levels of hs-CRP were evaluated using nephelometric immunoassay. Multiple linear regression analyses were performed. Results: After adjusting for age, sex, smoking status, BMI, and physical activity, a significant association was observed between DII scores and log(CRP+1) (standard regression coefficient = 0.05, P < 0.01). Although it was not statistically significant, the positive association was consistently observed in almost all age-sex subgroups and the non-smoker subgroup. Conclusions: The current study confirmed that DII score was positively associated with hs-CRP in Japanese.

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The perinatal condition around birth and cardiovascular risk factors in the Japanese general population: The suita study

Katsuragi S., Okamura T., Kokubo Y., Watanabe M., Higashiyama A., Ikeda T., Miyamoto Y.

Journal of Atherosclerosis and Thrombosis (Journal of Atherosclerosis and Thrombosis)  27 ( 3 ) 204 - 214 2020

Research paper (scientific journal),  ISSN  13403478

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© 2019 Japan Atherosclerosis Society. Aim: To investigate the relationship between perinatal condition around birth and cardiovascular risk in later life. Methods: Retrospective data were examined from 1241 city dwellers (521 men, 720 women; age 41–69 years) who had undergone medical examination at a single institution including blood tests and physical measurements from 2007 to 2008. The questionnaire was conducted to determine how perinatal factors affect their lives later. We also selected and studied a total of 28 individuals (12 men and 16 women) specifically about the conformity rate of the breastfeeding method between participants’ memories and what was written in the maternal and child health handbooks. Results: The conformity rate of the breastfeeding method between a self-questionnaire and his/her maternal and child health handbook was well correlated (r =0.73; p＜0.025). Among the data in women who were born at home, HbA1C levels (5.36±0.03 vs. 5.25±0.05 mg/dL, p=0.03) and low-density lipoprotein cholesterol (136.0±1.4 vs. 129.3±2.5 mg/dL, p=0.04) were higher than women who were born at the hospital. Women raised by formula showed higher low-density lipoprotein cholesterol levels than women fed breast milk or a mixture of breast milk and formula (150.2±4.8 vs. 138.7±3.7, 142.5±2.6 mg/dL, p =0.04). Fasting blood glucose levels at an adult time in men and women born through breech presentation were higher than those by the cephalic presentation (123.2±7.8 vs. 106.8±1.2 mg/dL, p=0.03). Conclusion: The study proposed that some perinatal conditions around birth such as delivery place, presenting part, and lactation affected especially Japanese women’s cardiovascular risks between ages 41 and 69 years.

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Hypercholesterolemia and lifetime risk of coronary heart disease in the general japanese population: Results from the suita cohort study

Sugiyama D., Turin T.C., Yeasmin F., Rumana N., Watanabe M., Higashiyama A., Takegami M., Kokubo Y., Okamura T., Miyamoto Y.

Journal of Atherosclerosis and Thrombosis (Journal of Atherosclerosis and Thrombosis)  27 ( 1 ) 60 - 70 2020

Research paper (scientific journal),  ISSN  13403478

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© 2020 Japan Atherosclerosis Society This article is distributed under the terms of the latest ver. Lifetime risk (LTR) is a measure of disease burden, which presents the probability of occurrence of a specific disease in the remaining lifetime of a group of people for a given index age. This measure is useful for presenting the risk dynamics of a disease at the population level, which constitutes important public health information toward prevention. To date, there have been no studies investigating the LTR for coronary heart diseases (CHDs) in relation to hypercholesterolemia in Asian populations. Therefore, we estimated the LTR of CHDs according to serum low-density lipoprotein cholesterol (LDL-C). Methods: The participants included in this study were 2,559 men and 2,848 women, enrolled in the Suita Cohort Study of urban residents followed up from 1989 to 2007 for a total of 69,823 person-years. We estimated the sex-and index-age-specific LTR for the first CHD event among participants with or without hypercholesterolemia (LDL-C ≥ 160 mg/dL), accounting for the competing risk for mortality. Results: For men with hypercholesterolemia, the LTR was 47.2% (95% confidence interval [CI]: 29.3–65.1%) and 44.5% (95% CI: 21.4–68.5%) for those aged 45 and 75, respectively. The LTRs of women with hypercholesterolemia were also higher than of those without hypercholesterolemia. However, their LTRs were lower for all index ages compared to men. These results did not differ for hypercholesterolemia defined by non-high-density lipoprotein cholesterol. Conclusions: The presence of hypercholesterolemia increases the LTR for CHDs in the Japanese population, especially in men. This estimate can be used in preventive knowledge translation efforts at the population level.

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Reference intervals of serum non-cholesterol sterols by gender in healthy Japanese individuals

Yoshida H., Tada H., Ito K., Kishimoto Y., Yanai H., Okamura T., Ikewaki K., Inagaki K., Shoji T., Bujo H., Miida T., Yoshida M., Kuzuya M., Yamashita S.

Journal of Atherosclerosis and Thrombosis (Journal of Atherosclerosis and Thrombosis)  27 ( 5 ) 409 - 417 2020

Research paper (scientific journal),  ISSN  13403478

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© 2020, Japan Atherosclerosis Society. All rights reserved. Aims: The present study was conducted to establish a practical method for measuring non-cholesterol sterols and reference intervals of serum levels. Methods: Healthy subjects (109 men and 151 women), four patients with sitosterolemia, and 10 heterozygous mutation carriers of ABCG5/ABCG8 genes were investigated. Then, three non-cholesterol sterols (sitosterol, campesterol, and lathosterol) of fasting serum samples were measured via a practical and highly sensitive gas chromatography (GC) method with 0.2 µg/mL as the lower limit of quantification. The coefficient of variation (CV) values for within-run reproducibility were 3.06%, 1.89%, and 1.77% for lathosterol, campesterol, and sitosterol, respectively. The CV values for between-run reproducibility were 2.81%, 2.06%, and 2.10% for lathosterol, campesterol, and sitosterol, respectively. Results: The serum levels of sitosterol and campesterol were significantly higher in women than in men, whereas the serum levels of lathosterol were significantly higher in men than in women. Because of these gender difference, the determination of reference intervals of the three sterol values was performed by considering gen-der. The reference intervals of sitosterol, campesterol, and lathosterol were 0.99–3.88, 2.14–7.43, and 0.77–3.60 µg/mL in men and 1.03–4.45, 2.19–8.34, and 0.64–2.78 µg/mL in women, respectively. The serum levels of sitosterol and campesterol were higher in patients with sitosterolemia (94.3±47.3 and 66.3±36.6 µg/mL, respectively) than in healthy subjects. Conclusion: These results demonstrate a practical and highly sensitive GC method to measure non-cholesterol sterol levels and gender-segregated reference intervals of sitosterol, campesterol, and lathosterol in Japanese healthy subjects.

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Impact of hypertension stratified by diabetes on the lifetime risk of cardiovascular disease mortality in Japan: a pooled analysis of data from the Evidence for Cardiovascular Prevention from Observational Cohorts in Japan study

Imai Y., Hirata T., Saitoh S., Ninomiya T., Miyamoto Y., Ohnishi H., Murakami Y., Iso H., Tanaka S., Miura K., Tamakoshi A., Yamada M., Kiyama M., Ueshima H., Ishikawa S., Okamura T.

Hypertension Research (Hypertension Research)   2020

Research paper (scientific journal),  ISSN  09169636

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© 2020, The Japanese Society of Hypertension. Lifetime risk is an informative estimate to motivate people to change lifestyle behaviors, especially from a younger age, in public health education. The impact of the combination of hypertension and diabetes on the lifetime risk of cardiovascular mortality has not been investigated in Asian populations. A pooled analysis of individual data from nine cohorts was performed. A total of 57,339 Japanese men and women were eligible for the analysis. We used the modified Kaplan–Meier approach and estimated the remaining lifetime risk of cardiovascular mortality starting from the index age of 35 years. Participants were classified into four categories defined by hypertension and diabetes. The lifetime risk was increased in the order of those without either risk, those without hypertension but with diabetes, those with hypertension but without diabetes, and those with both risks. The lifetime risk of cardiovascular mortality at the 35-year index age was as follows: 7.8% in men and 6.2% in women for those without either hypertension or diabetes, 13.2% in men and 9.5% in women for those without hypertension but with diabetes, 17.2% in men and 11.7% in women for those with hypertension but without diabetes, and 19.4% in men and 15% in women for those with both risks. These findings reinforce the need for a life-course perspective in the management of hypertension and diabetes from a younger age.

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