Details of a Researcher - Okamura, Tomonori

Papers - Okamura, Tomonori

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The association of home and accurately measured office blood pressure with coronary artery calcification among general Japanese men

Satoh A., Arima H., Hozawa A., Ohkubo T., Hisamatsu T., Kadowaki S., Kadota A., Fujiyoshi A., Miyagawa N., Zaid M., Torii S., Okamura T., Sekikawa A., Miura K., Ueshima H.

Journal of Hypertension (Journal of Hypertension) 37 ( 8 ) 1676 - 1681 2019.08

Research paper (scientific journal), ISSN 02636352

© 2019 Wolters Kluwer Health, Inc. All rights reserved. Objective:We conducted a cross-sectional study to clarify whether home blood pressure (HBP) is more strongly associated with coronary artery calcification (CAC) than accurately measured office blood pressure (OBP) among the general population of Japanese men.Methods:We analyzed the data of 919 Japanese male participants who were randomly selected from general population (mean age 64.5 years). OBP was measured twice consecutively by a trained nurse using electrical device after 5 min of complete rest alone in a sitting position in a silent room. The participants were asked to measure HBP with an electrical device once in the morning during 7 consecutive days. CAC was assessed using computed tomography. Presence of CAC was defined as Agatston score at least 10. We calculated odds ratios for the presence of CAC per one SD higher OBP and HBP adjusted for age and other cardiovascular risk factors.Results:The mean systolic OBP (SD) and HBP (SD) were 136.8 (19.0) and 137.2 (18.5) mmHg, respectively, without statistical difference between the two (P = 0.595). OBP and HBP were highly correlated (r = 0.74 P < 0.001). CAC was found in 454 (49.4%) participants. Multivariable-adjusted odds ratios [95% confidence interval (CI)] for the presence of CAC were comparable between OBP (1.32, 95% CI: 1.12-1.56) and HBP (1.35, 95% CI: 1.14-1.60) (P heterogeneity = 0.813).Conclusion:The strength of association of accurately measured OBP with CAC was comparable with that of HBP among randomly selected male general population aged 40-79 years.

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Daily habit of water intake in patients with cerebral infarction before its onset; Comparison with a healthy population: A cross-sectional study

Nishikawa T., Miyamatsu N., Higashiyama A., Hojo M., Nishida Y., Fukuda S., Hirata T., Ichiura K., Kubota Y., Kubo S., Ueba T., Kadota A., Sugiyama D., Okamura T.

Cerebrovascular Diseases (Cerebrovascular Diseases) 47 ( 3-4 ) 143 - 150 2019.07

Research paper (scientific journal), ISSN 10159770

© 2019 S. Karger AG, Basel. Background: While water intake is frequently recommended to prevent cerebral infarction (CI), only few studies have been published on this topic. Objectives: This study retrospectively estimated the daily non-alcohol drink (NAD) intake in CI patients before CI onset and compared it with NAD in healthy subjects. Methods: We performed a cross-sectional study on CI patients in 3 hospitals and healthy subjects in the Kobe Orthopedic and Biomedical Epidemiologic (KOBE) study. Data from 1,287 subjects (274 CI patients and 1,013 healthy subjects) were used for the analyses. By dividing the CI patients into "increased", "unchanged", and "decreased" groups according to their current NAD intake, we compared the NAD intake between these 3 groups and healthy subjects by analyses of covariance and the post hoc test, adjusting for sex, age, surveyed month, body mass index, alcohol drinking history, and smoking history. Under the assumption that the NAD intake in the "unchanged" group was equal to the NAD intake before CI onset, the OR of less NAD intake for CI adjusting for the relevant variables in the "unchanged" group and the healthy subjects was calculated; the cut-off point was chosen using Youden's index. Results: The mean age (mean ± SD) of the participants was 62.8 ± 9.3 years. One hundred and fifty-one patients (36 women) were included in the "increased" group; 105 (30 women), in the "unchanged" group; 18 (2 women), in the "decreased" group; and 1,013 (706 women), in the "healthy" group. The mean NAD intake was 1,702.5 ± 670.2 mL in the "increased" group, 1,494.2 ± 611.2 mL in the "unchanged" group, 1,268.0 ± 596.1 mL in the "decreased" group, and 1,720.6 ± 686.0 mL in the "healthy" group. After adjusting for the relevant variables, a significant difference in NAD intake between the groups was observed (F = 6.1, p < 0.001), and a post hoc test demonstrated significant differences (p < 0.05) in NAD intake between the "healthy" and "unchanged" groups, and between the "increased" and "unchanged" groups. The OR of less NAD intake (<1,570 mL/day, chosen using Youden's index) for CI was 2.48 (95% CI 1.52-4.07). Conclusion: This study showed that daily NAD intake before CI onset in CI patients was less than that in healthy persons, indicating that sufficient intake of NAD may be protective for CI.

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Association of alcohol consumption with fat deposition in a community-based sample of Japanese men: The Shiga epidemiological study of subclinical atherosclerosis (SESSA)

Sumi M., Hisamatsu T., Fujiyoshi A., Kadota A., Miyagawa N., Kondo K., Kadowaki S., Suzuki S., Torii S., Zaid M., Sato A., Arima H., Terada T., Miura K., Ueshima H., Horie M., Nakano Y., Yamamoto T., Hayashi H., Ogawa E., Maegawa H., Miyazawa I., Murata K., Mitsunami K., Nozaki K., Tooyama I., Shiino A., Tsuru T., Ogita H., Shimizu A., Miyamatsu N., Kita T., Kimura T., Nishio Y., Nakamura Y., Okamura T., Sekikawa A., Barinas-Mitchell E.J., Edmundowicz D., Ohkubo T., Hozawa A., Miyagi S., Murakami Y., Okuda N., Kita Y., Higashiyama A., Nagasawa S., Azuma K., Yanagita M., Abbott R.D., Ohno S., Takashima N., Kadowaki T., Saito Y., Ito T., Satoh A., Yamazoe M.

Journal of Epidemiology (Journal of Epidemiology) 29 ( 6 ) 205 - 212 2019.06

Research paper (scientific journal), ISSN 09175040

© 2018 Masaki Sumi et al. Background: Excessive alcohol intake has been shown to be associated with cardiovascular disease via metabolic pathways. However, the relationship between alcohol intake and obesity has not been fully elucidated. We aimed to examine the association of alcohol consumption with fat deposition and anthropometric measures. Methods: From 2006–2008, we conducted a cross-sectional study in a population-based sample of Japanese men aged 40 through 79 years. Areas of abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were calculated using computed tomography imaging. Based on a questionnaire, we classified participants into five groups according to weekly alcohol consumption, excluding former drinkers: Non-drinkers (0 g=week), 0.1–160.9, 161–321.9, 322–482.9, and ≥483 g=week. Multivariable linear regression was used to estimate adjusted means of obesity indices for each group. Results: We analyzed 998 men (mean age and body mass index [BMI], 63.8 years and 23.6 kg=m2, respectively). Higher weekly alcohol consumption was strongly and significantly associated with higher abdominal VAT area, percentage of VAT, and VATto- SAT ratio (all P for trend <0.001), and also with waist circumferences and waist-to-hip ratio (P for trend = 0.042 and 0.007, respectively). These associations remained significant after further adjustment for BMI, whereas alcohol consumption had no significant association with abdominal SAT area. Conclusions: Higher alcohol consumption was associated with higher VAT area, VAT%, and VAT-to-SAT ratio, independent of confounders, including BMI, in general Japanese men. These results suggest that alcohol consumption may have a potential adverse effect on visceral fat deposition.

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The impact of sex on risk of cardiovascular disease and all-cause mortality in adults with or without diabetes mellitus: A comparison between the U.S. and Japan

Liu L., Miura K., Kadota A., Fujiyoshi A., Gracely E., Xue F., Liu Z., Takashima N., Miyagawa N., Ohkubo T., Arima H., Okayama A., Okamura T., Ueshima H.

Journal of Diabetes and its Complications (Journal of Diabetes and its Complications) 33 ( 6 ) 417 - 423 2019.06

Research paper (scientific journal), ISSN 10568727

© 2019 Elsevier Inc. Aims: To test a hypothesis that women with diabetes mellitus (DM)versus those without DM had a significantly higher risk of heart disease (HD), stroke and all-cause mortality than their male counterparts in the U.S. as well as in Japan. Methods: We analyzed two nationally representative datasets, one from the U.S. NHANES III cohort (n = 13,169), and the other from the Japan NIPPON DATA90 cohort (n = 7445). Hazard ratios (HRs)of DM for risk of mortality and sex-DM interaction effect on mortality were analyzed prospectively using Cox's proportional hazards regression models. Results: Patients with DM had significantly higher mortality from HD, stroke and all-cause mortality in the U.S. and in Japan. However, the HRs of DM versus non-DM for HD and all-cause mortality were significantly higher in women compared to men in the U.S. (sex-DM interaction: HR = 1.59, p = 0.01, and 1.24, p = 0.045 for HD and all-cause mortality), but the sex-DM interaction effect was not statistically significant in the Japanese cohort. Discussion: Patients with DM had a significantly higher risk of mortality than those without DM in the U.S. and Japan. However, women with DM versus those without DM had a higher relative risk of HD and all-cause mortality than their counterparts in men in the U.S, but this sex difference by DM status was not observed in the Japanese cohort. Whether the sex-difference effect of DM on HD and all-cause mortality is due to a difference in metabolic disorders between the two populations warrants consideration and further studies.

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Socioeconomic and lifestyle factors associated with depressive tendencies in general Japanese men and women: NIPPON DATA2010

Suzuki H., Kadota A., Okuda N., Hayakawa T., Nishi N., Nakamura Y., Arima H., Miyagawa N., Satoh A., Miyamatsu N., Yanagita M., Yatsuya H., Yamagata Z., Ohkubo T., Okamura T., Ueshima H., Okayama A., Miura K.

Environmental Health and Preventive Medicine (Environmental Health and Preventive Medicine) 24 ( 1 ) 37 2019.05

Research paper (scientific journal), ISSN 1342078X

© 2019 The Author(s). Background: The gender-specific characteristics of individuals at an increased risk of developing depression currently remain unclear despite a higher prevalence of depression in women than in men. This study clarified socioeconomic and lifestyle factors associated with an increased risk of subclinical depression in general Japanese men and women. Methods: Study participants were residents not receiving psychiatric treatments in 300 sites throughout Japan in 2010 (1152 men, 1529 women). Multivariable-adjusted odds ratios (OR) and 95% confidence intervals (95%CIs) for socioeconomic factors and lifestyle factors were calculated using a logistic regression analysis. Results: Risk of depressive tendencies was significantly higher in men who were single and living alone (OR, 3.27; 95% CI, 1.56-6.88) than those married. The risk was significantly lower in women who were not working and aged ≥ 60 years (OR, 0.39; 95% CI, 0.22-0.68) and higher in men who were not working and aged < 60 years (OR, 3.57; 95%CI, 1.31-9.72) compared with those who were working. Current smoking was also associated with a significantly increased risk of depressive tendencies in women (OR, 2.96; 95% CI, 1.68-5.22) but not in men. Conclusions: Socioeconomic and lifestyle factors were associated with an increased risk of depressive tendencies in general Japanese. Related factors were different by sex.

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Higher serum uric acid level is inversely associated with renal function assessed by cystatin C in a Japanese general population without chronic kidney disease: The KOBE study

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

BMC Nephrology (BMC Nephrology) 20 ( 1 ) 117 2019.04

Research paper (scientific journal), ISSN 1471-2369

© 2019 The Author(s). Background: Although several epidemiological studies have suggested that high serum uric acid (SUA) levels are related to a decline in kidney function, only a few studies have investigated using cystatin C to calculate estimated glomerular filtration rate (eGFR). We aimed to clarify the relationship between SUA levels and kidney function assessed by cystatin C in a Japanese general community population without chronic kidney disease (CKD). Methods: We conducted a community-based cross-sectional study that included 1086 healthy participants, aged 40-74 years, without CKD and not undergoing treatment of hyperuricemia, who had participated in the baseline survey of the Kobe Orthopedic and Biomedical Epidemiological (KOBE) study. The preconditions for participation in this study were no past histories of cardiovascular disease or cancer, and not undergoing treatment for diabetes, hypertension, or dyslipidemia. We classified the participants into quartiles stratified by sex according to their SUA level and then examined the relationship with eGFR. The odds ratios for having a low eGFR, defined as the lowest quartile of eGFR (i.e., ≤78.4 mL/min/1. 73m 2 ) was estimated according to SUA quartiles (men, Q1 ≤ 5.0, Q2 5.1-5.9, Q3 6.0-6.6, and Q4 ≥ 6.7; women, Q1 ≤ 3.8, Q2 3.9-4.3, Q3 4.4-4.9, and Q4 ≥ 5.0 mg/dL) after adjustment for age, body mass index, systolic blood pressure, HbA1c, high and low density lipoprotein cholesterol, and smoking and drinking habits. The adjusted mean of each quartile was also calculated. Results: Multivariable-adjusted means of eGFR showed a graded decrease in higher SUA quartiles (men, Q1 90.5, Q2 88.0, Q3 83.5, and Q4 82.0; women, Q1 95.7, Q2 91.3, Q3 89.2, and Q4 86.7). In addition, the multivariable-adjusted odds ratios for having a lower eGFR (95% confidence interval) for each SUA quartile compared with Q1 was Q2 2.29 (0.98, 5.35), Q3 4.94 (2.04, 11.97), and Q4 8.01 (3.20, 20.04) for men, and was Q2 2.20 (1.12, 4.32), Q3 2.68 (1.39, 5.20), and Q4 4.96 (2.62, 9.41) for women. Conclusions: There was a graded inverse relationship between mild elevations in SUA levels and eGFR assessed by cystatin C in an apparently healthy Japanese population without CKD. This association was similar in both men and women.

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Associations of Overweight, Obesity, and Underweight With High Serum Total Cholesterol Level Over 30 Years Among the Japanese Elderly: NIPPON DATA 80, 90, and 2010

Shibata Yosuke, Ojima Toshiyuki, Nakamura Mieko, Kuwabara Kazuyo, Miyagawa Naoko, Saito Yoshino, Nakamura Yasuyuki, Kiyohara Yutaka, Nakagawa Hideaki, Fujiyoshi Akira, Kadota Aya, Ohkubo Takayoshi, Okamura Tomonori, Ueshima Hirotsugu, Okayama Akira, Miura Katsuyuki, Ueshima Hirotsugu, Miura Katsuyuki, Okayama Akira, Okamura Tomonori, Okayama Akira, Okamura Tomonori, Ueshima Hirotsugu, Okayama Akira, Okamura Tomonori, Saitoh Shigeyuki, Sakata Kiyomi, Hozawa Atsushi, Hayakawa Takehito, Nakamura Yosikazu, Nishi Nobuo, Okuda Nagako, Okamura Tomonori, Murakami Yoshitaka, Ohkubo Takayoshi, Kasagi Fumiyoshi, Izumi Toru, Matsumura Yasuhiro, Ojima Toshiyuki, Tamakoshi Koji, Nakagawa Hideaki, Kita Yoshikuni, Miura Katsuyuki, Kadota Aya, Miyamatsu Naomi, Nakamura Yasuyuki, Yoshita Katsushi, Miyamoto Yoshihiro, Kodama Kazunori, Kiyohara Yutaka

JOURNAL OF EPIDEMIOLOGY (Journal of Epidemiology) 29 ( 4 ) 133 - 138 2019.04

Research paper (scientific journal), ISSN 0917-5040

© 2018 Yosuke Shibata et al. Background: The trend of association between overweight and high serum total cholesterol (TC) among the elderly is unclear. In addition, there is little evidence of risk of underweight for high TC. Therefore, we examined the trend of association of overweight or underweight with high TC among Japanese elderly people using nationwide population-based data. Methods: Data of the National Survey on Circulatory Disorders and National Health and Nutrition Survey for 1980, 1990, 2000, and 2010 were used in the analysis. High TC was defined as 220mg=dL and above. For participants aged =50 years, sex-specific odds ratios (ORs) of overweight or underweight compared with normal body mass index participants for high TC were calculated using a logistic regression model adjusted for age, smoking, drinking, exercise, food, and treatment of hyperlipidemia. Results: A total of 5,734, 4,673, 5,059, and 2,105 participants enrolled in these surveys in 1980, 1990, 2000, and 2010, respectively. Although overweight was positively and significantly associated with high TC in 1980, the association has gradually weakened since (ORs in 1980 and 2010 were 2.44; 95% confidence interval [CI], 1.83-3.24 and 0.92; 95% CI, 0.66-1.27 among men and 1.43; 95% CI, 1.18-1.72 and 1.08; 95% CI, 0.81-1.44 among women, respectively). While underweight was inversely and significantly associated with high TC in 1980, the association also gradually weakened among women (ORs in 1980 and 2010 were 0.28; 95% CI, 0.12-0.60 and 0.37; 95% CI, 0.10-1.28 among men and 0.39; 95% CI, 0.26-0.57 and 0.96; 95% CI, 0.58-1.57 among women, respectively). Conclusions: These findings provide evidence that high TC prevention efforts must expand the target to not only overweight but also to normal and underweight people.

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One-year weight loss maintenance outcomes following a worksite-based weight reduction program among Japanese men with cardiovascular risk factors

Tsukinoki R., Okamura T., Okuda N., Kadota A., Murakami Y., Yanagita M., Miyamatsu N., Miura K., Ueshima H.

Journal of Occupational Health (Journal of Occupational Health) 61 ( 2 ) 189 - 196 2019.03

Research paper (scientific journal), ISSN 13419145

© 2019 Japan Society for Occupational Health. Objectives: Worksite-based programs present a simple and effective approach to facilitate weight reduction in employees. Despite the importance of 1-year weight loss maintenance, studies have generally focused on the short-term effects of weight reduction programs. In addition, little is known about the long-term weight maintenance outcomes in Asian populations. We examined the long-term maintenance effects of a worksite-based weight reduction program among Japanese men with cardiovascular risk factors. Methods: The study sample comprised 58 overweight men with cardiovascular risk factors who had voluntarily participated in a randomized crossover trial involving a 3-month weight reduction program. Participants were followed up for 1 year after the trial concluded, and both groups were merged for the analysis. We compared the changes in body weight before the post-trial follow-up and after 12 months to examine the long-term maintenance effects of the program. Changes in other cardiovascular risk factors (eg, waist circumference, blood pressure, lipid measures, and diabetes-related measures) were also examined. Results: Both groups of study participants achieved weight loss during the weight reduction program. Total 53 participants (91.4%) completed the 12-month post-trial follow-up. There were no significant changes in mean body weight (mean: -0.11, 95% confidence interval: -0.7-0.49 kg) and other cardiovascular risk factors between the beginning and end of the follow-up period. Conclusions: This study showed that the worksite-based weight reduction program not only enabled short-term weight loss, but that the participants were able to successfully maintain their weight for 1 year after the program without any supplementary interventions.

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Impact of Hypertension on Hospitalizations for Cardiovascular Diseases in a Worksite Population: An Epidemiologic Study Using Claims Data for Workers

Fukushima Ayako, Khabtheni Wafa, Guelfucci Florent, Onishi Yoshie, Sugiyama Daisuke, Okamura Tomonori, Toumi Mondher

AMERICAN JOURNAL OF HYPERTENSION (American Journal of Hypertension) 32 ( 3 ) 298 - 307 2019.03

Research paper (scientific journal), ISSN 0895-7061

© 2018 American Journal of Hypertension, Ltd. All rights reserved. BACKGROUND Few of studies investigated the effect of antihypertensives among working population. We aimed to describe the impact of hypertension with and without antihypertensives on hospitalizations because of cardiovascular diseases (CVDs) in the Japanese working population. METHODS This retrospective study included adults aged 40-64 years whose systolic and diastolic blood pressure (BP) readings taken between 2008 and 2015 were available in the Japanese claims database. Individuals were categorized as treated (T) or untreated (UT) depending on their hypertension treatment history. Time to first CVD-related hospitalization was compared among individuals with different BP levels using Cox models that included baseline characteristics with either baseline BP level or a time-dependent variable reflecting BP changes over time. RESULTS Of 740,784 UT individuals (male: 61.9%, mean age: 47.9 years), 2,121 individuals were hospitalized due to a CVD over a 957.3-day average follow-up. Among 72,828 T individuals (male: 74.3%, mean age: 53.7 years), the corresponding figure was 470 individuals over an 813.4-day average follow-up. The risk of hospitalization increased with baseline hypertension severity among UT (hazard ratios [HRs] = 1.93, 2.82, and 6.32 for grade 1, grade 2, and grade 3, respectively; P < 0.0001, reference: Optimal) but not among T individuals. UT individuals with hypertension at any given time had a significantly higher probability of hospitalization compared to nonhypertensive individuals (HR = 1.74, P < 0.0001). CONCLUSIONS This study adds quantitative evidence on the impact of hypertension on the risk of CVD-related hospitalization in the Japanese working population. It suggests that antihypertensive treatment had beneficial effects in this relatively young, working population aged 40-64 years.

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Association of blood pressure with estimates of 24-h urinary sodium and potassium excretion from repeated single-spot urine samples

Trang Thi Minh Nguyen, Miura Katsuyuki, Tanaka-Mizuno Sachiko, Tanaka Taichiro, Nakamura Yasuyuki, Fujiyoshi Akira, Kadota Aya, Tamaki Junko, Takebayashi Toru, Okamura Tomonori, Ueshima Hirotsugu

HYPERTENSION RESEARCH (Hypertension Research) 42 ( 3 ) 411 - 418 2019.03

Research paper (scientific journal), ISSN 0916-9636

© 2018, The Japanese Society of Hypertension. While the association between 24-h urinary sodium and potassium excretion with blood pressure is well established, the relationships of these ions to spot urine measurements are unclear. Our purpose is to assess the association between blood pressure and the estimated 24-h sodium and potassium excretion from repeated single-spot urine samples. Spot urine and blood pressure were collected annually during a 5-year period from 4360 Japanese workers with ages ranging from 19 to 55 years. Estimates of 24-h sodium and potassium excretion were based on Tanaka’s formula. Overall, a single standard deviation increase in the estimated sodium excretion (36.5 mmol/day) was associated with a 1.3 mmHg higher systolic blood pressure and a 0.8 mmHg higher diastolic blood pressure (P < 0.001). A single standard deviation increase in estimated potassium excretion (8.9 mmol/day) was associated with a 1.1 mmHg lower systolic blood pressure and a 0.7 mmHg lower diastolic blood pressure (P < 0.001). As a combined measure of the excretion of both electrolytes, the estimated 24-h sodium-to-potassium ratio was positively associated with both blood pressures (P < 0.001). Associations of blood pressure with sodium and the sodium-to-potassium ratio increased with age and were stronger in men compared to women. Associations with potassium and the sodium-to-potassium ratio were stronger in individuals who were overweight. The findings provide evidence for an association between blood pressure and the estimated 24-h sodium and potassium excretion from repeated single-spot urine samples. As convenient measures of dietary intake for each electrolyte, repeated spot urine samples may be useful for assessing hypertension risk, especially in men, older individuals, and overweight individuals.

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Longitudinal Trajectories of Fasting Plasma Glucose and Risks of Cardiovascular Diseases in Middle Age to Elderly People Within the General Japanese Population: The Suita Study

Ogata Soshiro, Watanabe Makoto, Kokubo Yoshihiro, Higashiyama Aya, Nakao Yoko M., Takegami Misa, Nishimura Kunihiro, Nakai Michikazu, Kiyoshige Ed, Hosoda Kiminori, Okamura Tomonori, Miyamoto Yoshihiro

JOURNAL OF THE AMERICAN HEART ASSOCIATION (Journal of the American Heart Association) 8 ( 3 ) e010628 2019.02

Research paper (scientific journal), ISSN 2047-9980

Background Few previous studies used information on changes in fasting plasma glucose ( FPG ) assessed at multiple points in time in relationship to cardiovascular disease ( CVD ) incidence. The present study aimed to identify subgroups of FPG trajectories with assessing CVD incidence. Methods and Results The present study was based on the Suita study, a population-based cohort study in Japan. The primary outcome was incidence of the first CVD events consisting of stroke and coronary heart diseases between 1989 and 2013. The main exposure was FPG assessed every 2 years. We used joint latent class mixed models to derive FPG trajectories over time while evaluating cumulative incidence of CVD , and categorized participants into several subgroups based on those trajectories and cumulative incidence. We observed 356 and 243 CVD events during the median follow-up of 17.2 and 20.2 years among 3120 men and 3482 women, respectively. The joint latent mixed models found 3 subgroups in men and 2 subgroups in women. Of the 3 subgroups in men, 1 subgroup had FPG levels that increased sharply (96.5-205.0 mg/dL from aged 40 to 80 years) and higher CVD cumulative incidence. Of the 2 subgroups in women, 1 subgroup had FPG levels that increased sharply (97.7-190.5 mg/dL from aged 40 to 80 years) and tended to have slightly higher CVD incidence compared with the other subgroup. Conclusion It can be important to manage CVD risk factors especially for people whose FPG trajectories sharply increased to prevent CVD .

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Relationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities: An Individual Participant Data Meta-analysis in a Global Consortium

Inker L., Grams M., Levey A., Coresh J., Cirillo M., Collins J., Gansevoort R., Gutierrez O., Hamano T., Heine G., Ishikawa S., Jee S., Kronenberg F., Landray M., Miura K., Nadkarni G., Peralta C., Rothenbacher D., Schaeffner E., Sedaghat S., Shlipak M., Zhang L., van Zuilen A., Hallan S., Kovesdy C., Woodward M., Levin A., Astor B., Appel L., Greene T., Chen T., Chalmers J., Arima H., Perkovic V., Yatsuya H., Tamakoshi K., Li Y., Hirakawa Y., Matsushita K., Grams M., Sang Y., Polkinghorne K., Chadban S., Atkins R., Djurdjev O., Liu L., Zhao M., Wang F., Wang J., Ebert N., Martus P., Tang M., Heine G., Emrich I., Seiler S., Zawada A., Nally J., Navaneethan S., Schold J., Shlipak M., Sarnak M., Katz R., Hiramoto J., Iso H., Yamagishi K., Umesawa M., Muraki I., Fukagawa M., Maruyama S., Hasegawa T., Fujii N., Wheeler D., Emberson J.

American Journal of Kidney Diseases (American Journal of Kidney Diseases) 73 ( 2 ) 206 - 217 2019.02

Research paper (scientific journal), ISSN 02726386

© 2018 National Kidney Foundation, Inc. Rationale & Objective: Chronic kidney disease (CKD) is complicated by abnormalities that reflect disruption in filtration, tubular, and endocrine functions of the kidney. Our aim was to explore the relationship of specific laboratory result abnormalities and hypertension with the estimated glomerular filtration rate (eGFR) and albuminuria CKD staging framework. Study Design: Cross-sectional individual participant-level analyses in a global consortium. Setting & Study Populations: 17 CKD and 38 general population and high-risk cohorts. Selection Criteria for Studies: Cohorts in the CKD Prognosis Consortium with data for eGFR and albuminuria, as well as a measurement of hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, or calcium, or hypertension. Data Extraction: Data were obtained and analyzed between July 2015 and January 2018. Analytical Approach: We modeled the association of eGFR and albuminuria with hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, and calcium values using linear regression and with hypertension and categorical definitions of each abnormality using logistic regression. Results were pooled using random-effects meta-analyses. Results: The CKD cohorts (n = 254,666 participants) were 27% women and 10% black, with a mean age of 69 (SD, 12) years. The general population/high-risk cohorts (n = 1,758,334) were 50% women and 2% black, with a mean age of 50 (16) years. There was a strong graded association between lower eGFR and all laboratory result abnormalities (ORs ranging from 3.27 [95% CI, 2.68-3.97] to 8.91 [95% CI, 7.22-10.99] comparing eGFRs of 15 to 29 with eGFRs of 45 to 59 mL/min/1.73 m 2 ), whereas albuminuria had equivocal or weak associations with abnormalities (ORs ranging from 0.77 [95% CI, 0.60-0.99] to 1.92 [95% CI, 1.65-2.24] comparing urinary albumin-creatinine ratio > 300 vs < 30 mg/g). Limitations: Variations in study era, health care delivery system, typical diet, and laboratory assays. Conclusions: Lower eGFR was strongly associated with higher odds of multiple laboratory result abnormalities. Knowledge of risk associations might help guide management in the heterogeneous group of patients with CKD.

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Having few remaining teeth is associated with a low nutrient intake and low serum albumin levels in middle-aged and older Japanese individuals: findings from the NIPPON DATA2010

Nakamura Mieko, Ojima Toshiyuki, Nagahata Tomomi, Kondo Imako, Ninomiya Toshiharu, Yoshita Katsushi, Arai Yusuke, Ohkubo Takayoshi, Murakami Keiko, Nishi Nobuo, Murakami Yoshitaka, Takashima Naoyuki, Okuda Nagako, Kadota Aya, Miyagawa Naoko, Kondo Keiko, Okamura Tomonori, Ueshima Hirotsugu, Okayama Akira, Miura Katsuyuki

ENVIRONMENTAL HEALTH AND PREVENTIVE MEDICINE (Environmental Health and Preventive Medicine) 24 ( 1 ) 1 2019.01

Research paper (scientific journal), ISSN 1342-078X

© 2019 The Author(s). Background: Oral health is thought to be associated with diet quality, and socioeconomic status (SES) affects both oral health and diet. The aim of this study was to investigate the association between the number of teeth and dietary intake as well as nutritional biomarker, considering the subjects' SES. Methods: We conducted a cross-sectional analysis of data from 2049 individuals aged ≥ 50 years from the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010. The number of remaining teeth was categorized into age-specific quartiles (Q1 to Q4). We assessed the adjusted means and 95% confidence intervals for dietary variables by the number of teeth using analysis of covariance. Stratified analyses by SES were also conducted. Results: The intake of grain products was 31 g higher, and those of vegetables and meat were 30 g and 8 g lower, respectively, in Q1 (fewer teeth) than in Q4 (more teeth). Carbohydrate intake was higher whereas protein, minerals (potassium, magnesium, and zinc), vitamins (vitamins A, E, B 1 , B 6 , β-carotene, and folic acid), and dietary fiber intakes were lower among individuals with fewer teeth. Adjusted mean serum albumin levels were low in Q1. The associations between the number of teeth and dietary intake were more evident in individuals with a low SES. Conclusions: Having few remaining teeth was associated with a low nutrient intake and low serum albumin levels in middle-aged and older Japanese adults, and these associations were more evident in individuals with low SES.

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Lifetime Risk of Stroke and Coronary Heart Disease Deaths According to Blood Pressure Level: EPOCH-JAPAN (Evidence for Cardiovascular Prevention From Observational Cohorts in Japan)

Satoh Michihiro, Ohkubo Takayoshi, Asayama Kei, Murakami Yoshitaka, Sugiyama Daisuke, Yamada Michiko, Saitoh Shigeyuki, Sakata Kiyomi, Irie Fujiko, Sairenchi Toshimi, Ishikawa Shizukiyo, Kiyama Masahiko, Ohnishi Hirofumi, Miura Katsuyuki, Imai Yutaka, Ueshima Hirotsugu, Okamura Tomonori, Iso Hiroyasu, Kitamura Akihiko, Ninomiya Toshiharu, Kiyohara Yutaka, Nakagawa Hideaki, Nakayama Takeo, Okayama Akira, Sairenchi Toshimi, Tamakoshi Akiko, Tsuji Ichiro, Miyamoto Yoshihiro, Ishikawa Shizukiyo, Yatsuya Hiroshi, Okamura Tomonori

HYPERTENSION (Hypertension) 73 ( 1 ) 52 - 59 2019.01

Research paper (scientific journal), ISSN 0194-911X

© 2018 American Heart Association, Inc. Lifetime risk (LTR) provides an absolute risk assessment during the remainder of one's life. Few studies have focused on the LTRs of stroke and coronary heart disease (CHD), categorized by fine blood pressure in Asian populations. We aimed to assess it using a large database of a meta-analysis with the individual participant data. The present meta-analysis included 107 737 Japanese (42.4% men; mean age, 55.1 years) from 13 cohorts. During the mean follow-up of 15.2±5.3 years (1 559 136 person-years), 1922 died from stroke and 913 from CHD. We estimated risks after adjusting for competing risk of death other than the outcome of interest. The 10-year risk of stroke and CHD deaths at index age of 35 years was ≤1.9% and ≤0.3%, respectively. The LTRs of stroke death at the index age of 35 years (men/women) were 6.1%/4.8% for optimal, 5.7%/6.3% for normal, and 6.6%/6.0% for high-normal blood pressure groups, and 9.1%/7.9% for grade 1, 14.5%/10.3% for grade 2, and 14.6%/14.3% for grade 3 hypertension groups. The LTRs of CHD death similarly elevated with an increase in blood pressure but were lower (≤7.2%) than those of stroke death. In conclusion, blood pressure was clearly associated with an elevated LTR of stroke or CHD death, although the LTR of CHD death was one-half of that of stroke death in an Asian population. These results would help young people with hypertension to adopt a healthy lifestyle or start antihypertensive therapy early.

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Okami Yukiko, Ueshima Hirotsugu, Nakamura Yasuyuki, Kondo Keiko, Kadota Aya, Okuda Nagako, Okamura Tomonori, Miura Katsuyuki, Fujiyoshi Akira, Hozawa Atsushi, Kadota Aya, Kasagi Fumiyoshi, Nakagawa Hideaki, Toyoshima Hideaki, Yanagawa Hiroshi, Yoshita Katsushi, Kodama Kazunori, Ueda Kazuo, Sakata Kiyomi, Tamakoshi Koji, Okuda Nagako, Miyamatsu Naomi, Nishi Nobuo, Saitoh Shigeyuki, Tokudome Shinkan, Okubo Takayoshi, Hayakawa Takehito, Izumi Toru, Ojima Toshiyuki, Matsumura Yasuhiro, Miyamoto Yoshihiro, Kita Yoshikuni, Murakami Yoshitaka, Nakamura Yoshikazu, Kiyohara Yutaka

CIRCULATION JOURNAL (Circulation Journal) 83 ( 1 ) 147 - + 2019.01

Research paper (scientific journal), ISSN 1346-9843

© 2019, Japanese Circulation Society. All rights reserved. Background: In recent years, individuals with high serum total cholesterol (TC) have been more likely to modify their diet by reducing their intake of dietary lipids. The aim of this study was to investigate time-related changes in the relationships between the Keys score, dietary lipids, and TC between 1980 and 2010 in representative Japanese populations. Methods and Results: We used 3 cross-sectional cohort studies conducted among Japanese representative populations in 1980, 1990, and 2010 (NIPPON DATA80/90/2010) for the analyses. We analyzed data for 10,365, 7,714, and 2,657 participants, respectively, in each dataset. The relationships between TC and the Keys score (calculated by dietary lipids, cholesterol, and energy intake)/ dietary lipids were examined. In men, a 1-unit higher Keys score correlated with 0.92 mg/dL and 0.64 mg/dL TC in 1980 and 1990, respectively, but not in 2010. In women, a 1-unit higher Keys score correlated with 0.70 mg/dL and 0.74 mg/dL TC in 1980 and 1990, respectively, but with 0.33 mg/dL in 2010. In men and women, dietary cholesterol, saturated fatty acid (SFA), and trans fatty acid (TFA) levels were positively associated with TC concentrations in 1980 and 1990, but not in 2010. Conclusions: In these representative Japanese populations, a higher Keys score as well as dietary cholesterol, SFA, and TFA levels correlated with higher TC concentrations in 1980/1990, but the relationships were weaker or not observed in 2010.

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Vegetable protein intake was inversely associated with cardiovascular mortality in a 15-year follow-up study of the general Japanese population

Kurihara A., Okamura T., Sugiyama D., Higashiyama A., Watanabe M., Okuda N., Kadota A., Miyagawa N., Fujiyoshi A., Yoshita K., Ohkubo T., Okayama A., Miura K., Ueshima H.

Journal of Atherosclerosis and Thrombosis (Journal of Atherosclerosis and Thrombosis) 26 ( 2 ) 198 - 206 2019

Research paper (scientific journal), ISSN 13403478

© 2019 Japan Atherosclerosis Society. Aim: To examine the relationship between the intake of dietary vegetable protein and CVD mortality in a 15-year follow-up study of a representative sample of the Japanese population. Methods: A total of 7,744 participants aged 30 years or older (3,224 males and 4,520 females) who were free of CVD at baseline were included in this analysis. Vegetable protein intake (% energy) was assessed using a threeday semi-weighed dietary record at baseline. Multivariable-adjusted hazard ratios (HRs) were calculated using Cox’s proportional hazards model after adjusting for confounding factors. Results: The total person-years studied were 107,988 with a mean follow-up period of 13.9 years. There were 1,213 deaths during the follow-up period, among which 354 (29.2%) were due to CVD. Vegetable protein intake was associated inversely with CVD and cerebral hemorrhage mortality, with the HRs for a 1% energy increment in vegetable protein intake being 0.86 (95% CI, 0.75-0.99) and 0.58 (95% CI, 0.35-0.95), respectively. In the subgroup analysis of participants with or without hypertension, the inverse association between vegetable protein intake and CVD mortality was more evident in the nonhypertensive group, with the HRs for CVD and stroke being 0.68 (95% CI, 0.50- 0.94) and 0.50 (95% CI, 0.30-0.84), respectively. Conclusions: Vegetable protein intake may prevent future CVD, particularly in nonhypertensive subjects in the Japanese population. However, further studies are necessary to examine the biological mechanisms of this effect.

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A novel cell-free, non-fluorescent method to measure lox-1-binding activity corresponding to the functional activity of hdl

Kakino A., Usami Y., Horiuchi S., Fujita Y., Kotani K., Chen C., Okamura T., Sawamura T.

Journal of Atherosclerosis and Thrombosis (Journal of Atherosclerosis and Thrombosis) 26 ( 11 ) 947 - 958 2019

Research paper (scientific journal), ISSN 13403478

©2019 Japan Atherosclerosis Society. Aims: A functional abnormality in high-density lipoprotein (HDL) particles rather than a quantitative abnormality in HDL cholesterol levels has been suggested to promote atherosclerosis. The modification of HDL may underlie functional changes to HDL such as gaining the ability to bind and activate the lectin-like oxidized low-density lipoprotein (LDL) receptor-1 (LOX-1). We aimed to develop a novel method for measuring modified HDL on the basis of its binding to LOX-1. Methods: We designed a LOX-1 binding–based enzyme-linked immunosorbent assay (ELISA) with recombinant LOX-1 and anti-apoAI antibody. A lipid-free standard was devised by making a chimeric fusion protein containing anti-LOX-1 antibody and human apoAI fragment. We used this system to detect modified HDL, designated as LOX-1 ligand containing apoAI (LAA). Results: With our ELISA system, we detected HDL modified by copper oxidation, hypochlorous acid, 4-hydroxynonenal, and potassium cyanate, but not native HDL. Upon oxidation, HDL showed increased LOX-1 binding activity and decreased cholesterol efflux and paraoxonase-1 activities. In the ELISA, the chimeric fusion protein standard showed minimal variation in reference binding curves in contrast to copper-oxidized HDL preparations, suggesting better quality control of the chimeric fusion protein as the standard for measuring modified HDL activity. LAA was detectable in the plasma of healthy individuals and of mice fed a high-fat diet. Conclusion: We have developed a novel ELISA by using recombinant LOX-1 and anti-apoAI antibody to measure the activity of modified HDL in plasma.

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Association between body mass index and all-cause death in japanese population: Pooled individual participant data analysis of 13 cohort studies

Hozawa A., Hirata T., Yatsuya H., Murakami Y., Kuriyama S., Tsuji I., Sugiyama D., Satoh A., Tanaka-Mizuno S., Miura K., Ueshima H., Okamura T.

Journal of Epidemiology (Journal of Epidemiology) 29 ( 12 ) 457 - 463 2019

Research paper (scientific journal), ISSN 09175040

© 2018 Atsushi Hozawa et al. Background: We sought to investigate the optimal values of BMI for the lowest risk of all-cause death and whether the optimal BMI differs according to smoking status in large-scale pooled analysis of 13 Japanese cohorts. Methods: Data from 179,987 participants of 13 well-qualified cohort studies conducted throughout Japan were used for our analysis. A cohort-stratified Cox proportional hazard model was used. P values for interactions were calculated based on the cross product of BMI and age, sex, or smoking status. Results: In the entire study population, all-cause mortality risk was lowest when the BMI was 22.0–24.9 kg=m2. This was also the case for selected healthy participants (never smoked, baseline total cholesterol level ≥4.1 mmol=L; the first 5 years of follow-up data were excluded). No effect modification of age, sex, or smoking status was observed. Regardless of their BMI, never smokers always had a lower all-cause mortality risk than did current smokers even with an ideal BMI in terms of mortality risk. Conclusion: A BMI of 22–24.9 kg=m2 correlated with the lowest risk of mortality, regardless of whether all participants or selected healthy participants were analyzed. The fact that smoking was more strongly associated with mortality than obesity emphasizes the urgency for effective anti-smoking programs.

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Household Salt Intake Level is Associated With All-Cause, Cardiovascular and Stroke Mortality: A 24-Year Follow-Up of Nippon Data80

Shima Azusa, Miyamatsu Naomi, Miura Katsuyuki, Miyagawa Naoko, Okuda Nagako, Nishi Nobuo, Yoshita Katsushi, Kadota Aya, Suzuki Harumitsu, Kondo Keiko, Okamura Tomonori, Okayama Akira, Ueshima Hirotsugu

CIRCULATION 139 2019

Research paper (scientific journal), ISSN 0009-7322

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Differences Between Coronary Artery Calcification and Aortic Artery Calcification in Relation to Cardiovascular Disease Risk Factors in Japanese Men

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

JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS 26 ( 5 ) 452 - 464 2019

Research paper (scientific journal), ISSN 1340-3478

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