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Tamaki N, Kimura T, Wakabayashi SI, Umemura T, Kurosaki M, Loomba R, Izumi N. Long-term clinical outcomes in steatotic liver disease and incidence of liver-related events, cardiovascular events and all-cause mortality. Aliment Pharmacol Ther 2024; 60:61-69. [PMID: 38664876 DOI: 10.1111/apt.18015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/01/2024] [Accepted: 04/12/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND A multi-society consensus group proposed a new nomenclature for steatotic liver disease (SLD) including metabolic-dysfunction associated steatotic liver disease (MASLD), MASLD and increased alcohol intake (MetALD) and alcohol-associated liver disease (ALD). However, the risk of liver-related events, major adverse cardiovascular events (MACE) and all-cause mortality among various sub-groups is unknown. AIMS To evaluate the risk of liver-related events, MACE and death among patients with SLD. METHODS We conducted a nationwide, population-based study and enrolled 761,400 patients diagnosed with MASLD, MetALD or ALD. The primary endpoint was the occurrence of liver-related events, MACE and death in patients with MASLD, MetALD and ALD. RESULTS The cumulative incidence of liver-related events and death were highest in ALD, followed by MetALD and MASLD (p < 0.001 for both liver-related events and death), while the incidence of MACE was highest in MASLD, followed by MetALD and ALD (p < 0.001). Using MASLD as the reference and adjusting for age, sex, smoking, diabetes mellitus, dyslipidaemia and hypertension, the adjusted hazard ratios (95% confidence intervals) for liver-related events, MACE and death in MetALD were 1.42 (1.1-1.8), 0.68 (0.63-0.73) and 1.13 (0.98-1.3), respectively. In ALD, they were 3.42 (2.6-4.6), 0.58 (0.49-0.67) and 1.60 (1.3-2.0), respectively, for liver-related events, MACE and death. CONCLUSIONS The new consensus nomenclature can be used to stratify the risk of complications and prognosis. The nomenclature is beneficial for risk stratification and identifying new mechanisms for disease-specific therapeutic implications.
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Affiliation(s)
- Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
- MASLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Deigo, La Jolla, California, USA
| | - Takefumi Kimura
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Shun-Ichi Wakabayashi
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takeji Umemura
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Rohit Loomba
- MASLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Deigo, La Jolla, California, USA
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
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Suzuki Y, Kaneko H, Okada A, Komuro J, Fujiu K, Takeda N, Morita H, Ako J, Nishiyama A, Yano Y, Ieda M, Node K, Yasunaga H, Komuro I. Comparison of incident hypertension between SGLT2 inhibitors vs. DPP4 inhibitors. Hypertens Res 2024; 47:1789-1796. [PMID: 38600275 PMCID: PMC11224012 DOI: 10.1038/s41440-024-01649-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 04/12/2024]
Abstract
Although several randomized clinical trials have reported the potential benefit of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in reducing blood pressure (BP), whether SGLT2i can reduce incident hypertension is unknown. We analyzed individuals with diabetes who were newly prescribed SGLT2i or dipeptidyl peptidase 4 inhibitors (DPP4i) in a large-scale epidemiological database. The primary outcome was the incidence of hypertension. A propensity score matching algorithm was employed to compare the subsequent development of hypertension between the SGLT2i and DPP4i groups. After propensity score matching, 5708 well-balanced pairs of SGLT2i and DPP4i users were identified. SGLT2i administration was associated with a reduced risk of hypertension (HR 0.91, 95% CI: 0.84-0.97). The advantage of SGLT2i use over DPP4i use for incident hypertension was generally consistent in several sensitivity analyses, and subgroup analyses showed that SGLT2i use was significantly associated with a lower risk of hypertension in men, patients with baseline HbA1c of <7.5%, and baseline systolic blood pressure ≥127 mmHg. Our investigation using nationwide real-world data demonstrated the potential advantage of SGLT2i over DPP4i in reducing the development of hypertension in individuals with diabetes.
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Affiliation(s)
- Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jin Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yuichiro Yano
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Family Medicine and Community Health Duke University Durham NC, Durham, NC, USA
| | - Masaki Ieda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Tokyo, Japan
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Ueno K, Kaneko H, Suzuki Y, Okada A, Fujiu K, Jo T, Takeda N, Kamiya K, Ako J, Morita H, Node K, Yasunaga H, Komuro I. Change in Body Mass Index and Cardiovascular Outcomes in Patients With Cancer. Mayo Clin Proc 2024; 99:891-901. [PMID: 38703179 DOI: 10.1016/j.mayocp.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To investigate the association between body mass index (BMI) changes and the risk of cardiovascular disease (CVD) in patients with cancer. PATIENTS AND METHODS This retrospective observational study used data from the JMDC Claims Database obtained between January 2005, and April 2021. We included 52,344 individuals (median [IQR] age, 53 years [46 to 60 years]; 23,584 [45.1%] men) with cancer and no prior CVD. Patients were classified into 3 groups based on the percentage change in BMI from the initial health checkup to the checkup 1 year later: -5.0% or less (BMI loss), -5.0% to 5.0% (stable BMI), and 5.0% or more (BMI gain). The primary end point was composite CVD events including heart failure, atrial fibrillation, ischemic heart disease, and stroke. RESULTS During a median follow-up period of 763 days (IQR, 369 to 1274 days), 3124 composite CVD events were observed. Compared with stable BMI, the hazard ratios (HRs) of BMI loss and gain for CVD events were 1.16 (95% CI, 1.00 to 1.34) and 1.10 (95% CI, 0.96 to 1.25), respectively. A U-shaped association was observed between the BMI changes and CVD events, particularly for nonatherosclerotic CVD outcomes including heart failure and atrial fibrillation. Compared with stable BMI, both BMI loss and gain increased the risk of heart failure (HR, 1.30; 95% CI, 1.08 to 1.57 and HR, 1.22; 95% CI, 1.02 to 1.47, respectively) and atrial fibrillation (HR, 1.70; 95% CI, 1.18 to 2.45 and HR, 1.55; 95% CI, 1.07 to 2.24, respectively). CONCLUSION Cancer survivors with BMI loss and gain were at greater risk of CVD. Body mass index loss is associated with a higher risk of CVD.
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Affiliation(s)
- Kensuke Ueno
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan; Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan; Department of Advanced Cardiology, University of Tokyo, Tokyo, Japan.
| | - Yuta Suzuki
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan; Department of Advanced Cardiology, University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
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Ueno K, Kaneko H, Suzuki Y, Okada A, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Kamiya K, Ako J, Node K, Yasunaga H, Komuro I. Metabolic syndrome and cardiovascular disease in cancer survivors. J Cachexia Sarcopenia Muscle 2024; 15:1062-1071. [PMID: 38515400 PMCID: PMC11154793 DOI: 10.1002/jcsm.13443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 08/01/2023] [Accepted: 01/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The risk of subsequent cardiovascular disease (CVD) is high in cancer survivors. Although metabolic syndrome is an established risk factor for CVD, its association with cancer survivors has not yet been established. This study aimed to clarify whether metabolic syndrome is associated with subsequent CVD risk in patients with cancer using a nationwide epidemiological dataset. METHODS We retrospectively analysed 53 510 patients with a history of breast, colorectal, or stomach cancer, which is reportedly a major site for developing cancer in Japan. Study participants were categorized into two groups based on the presence of metabolic syndrome, defined using the Japanese criteria (high waist circumference and ≥2 metabolic parameters including elevated blood pressure, elevated triglycerides, reduced high-density lipoprotein cholesterol, or elevated fasting plasma glucose). The clinical outcomes were collected between 2005 and 2021. The primary endpoint was defined as the composite CVD outcome, including myocardial infarction, angina pectoris, stroke, and heart failure. RESULTS The median patient age was 54 years, and 37.5% of the patients were men. Metabolic syndrome was observed in 5558 (10.4%) patients. Over a mean follow-up period of 973 ± 791 days, 3085 composite CVD outcomes were recorded. Multivariable Cox regression analyses showed that metabolic syndrome was associated with a greater risk of developing CVD events (HR = 1.29, 95% CI = 1.15-1.45). Metabolic syndrome was also associated with an increased risk of CVD in patients with a follow-up period ≥1 year (HR = 1.33, 95% CI = 1.15-1.53). This relationship was also observed when metabolic syndrome was defined according to the International Diabetes Federation criteria (HR = 1.34, 95% CI = 1.21-1.49) and the National Cholesterol Education Program Adult Treatment Panel III criteria (HR = 1.32, 95% CI = 1.19-1.46). Subgroup analyses showed that the relationship between metabolic syndrome and incident CVD was more pronounced in the non-obese participants than in the obese participants. CONCLUSIONS Metabolic syndrome is associated with a greater risk of developing CVD, even among cancer survivors.
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Grants
- 21AA2007 Ministry of Health, Labour and Welfare, Japan
- 21K08123 Ministry of Education, Culture, Sports, Science and Technology, Japan
- 21H03159 Ministry of Education, Culture, Sports, Science and Technology, Japan
- 20H03907 Ministry of Education, Culture, Sports, Science and Technology, Japan
- Ministry of Health, Labour and Welfare, Japan
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Affiliation(s)
- Kensuke Ueno
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
- Department of Rehabilitation Sciences, Graduate School of Medical SciencesKitasato UniversityKanagawaJapan
| | - Hidehiro Kaneko
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
- Department of Advanced CardiologyUniversity of TokyoTokyoJapan
| | - Yuta Suzuki
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Satoshi Matsuoka
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
| | - Katsuhito Fujiu
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
- Department of Advanced CardiologyUniversity of TokyoTokyoJapan
| | | | - Taisuke Jo
- Department of Health Services ResearchUniversity of TokyoTokyoJapan
| | - Norifumi Takeda
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
| | - Hiroyuki Morita
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health SciencesKitasato UniversityKanagawaJapan
| | - Junya Ako
- Department of Cardiovascular Medicine, School of MedicineKitasato UniversityKanagawaJapan
| | - Koichi Node
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public HealthUniversity of TokyoTokyoJapan
| | - Issei Komuro
- Department of Cardiovascular MedicineUniversity of TokyoTokyoJapan
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Wakabayashi SI, Tamaki N, Kimura T, Umemura T, Kurosaki M, Izumi N. Natural history of lean and non-lean metabolic dysfunction-associated steatotic liver disease. J Gastroenterol 2024; 59:494-503. [PMID: 38570344 DOI: 10.1007/s00535-024-02093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Conflicting evidence regarding the prognosis of lean metabolic dysfunction-associated steatotic liver disease (MASLD) has raised substantial questions. AIM This study aimed to elucidate the prognosis of lean MASLD by conducting a comprehensive analysis of a vast Asian cohort. METHODS This study used a nationwide, population-based database and analyzed 2.9 million patients. The primary endpoints were liver-related events (LREs) and cardiovascular events (CVEs) in patients with lean MASLD, non-lean MASLD, and normal liver control groups. RESULTS The median observation period was 4.2 years. The 5-year incidence values of LREs in the lean MASLD, non-lean MASLD, and normal liver control groups were 0.065%, 0.039%, and 0.006%, respectively. The LRE risk of lean MASLD was significantly higher than that of normal liver control (adjusted hazard ratio [aHR]: 5.94, 95% confidence interval [CI]: 3.95-8.92) but comparable to that of non-lean MASLD (aHR: 1.35, 95% CI: 0.87-2.08). By contrast, for CVEs, the non-lean MASLD group exhibited a higher 5-year cumulative incidence rate (0.779%) than the lean MASLD (0.600%) and normal liver control (0.254%) groups. The lean MASLD group had a reduced risk of CVEs compared with the non-lean MASLD group (aHR, 0.73; 95% CI: 0.64-0.84), and comparable risk of CVEs to the normal liver control group (aHR, 0.99; 95% CI: 0.88-1.12). CONCLUSION Lean MASLD exhibits a similar LRE risk and a lower CVE risk to non-lean MASLD. Therefore, follow-up and treatment strategies should be tailored to the specific MASLD condition.
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Affiliation(s)
- Shun-Ichi Wakabayashi
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, 1-26-1 Kyonan-Cho, Musashino-Shi, Tokyo, 180-8610, Japan
| | - Takefumi Kimura
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takeji Umemura
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, 1-26-1 Kyonan-Cho, Musashino-Shi, Tokyo, 180-8610, Japan.
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, 1-26-1 Kyonan-Cho, Musashino-Shi, Tokyo, 180-8610, Japan
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Nagasawa H, Kaneko H, Suzuki Y, Okada A, Fujiu K, Takeda N, Morita H, Nishiyama A, Yano Y, Node K, Viera AJ, Carey RM, Oparil S, Yasunaga H, Touyz RM, Komuro I. Association of cancer with the risk of developing hypertension. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:228-234. [PMID: 37321962 PMCID: PMC11112520 DOI: 10.1093/ehjqcco/qcad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIMS Although the importance of hypertension in patients with cancer is widely recognized, little is known about the risk of developing hypertension in patients with a history of cancer. METHODS AND RESULTS This retrospective observational cohort study analysed data from the JMDC Claims Database between 2005 and 2022, including 78 162 patients with a history of cancer and 3692 654 individuals without cancer. The primary endpoint was the incidence of hypertension.During a mean follow-up period of 1208 ± 966 days, 311 197 participants developed hypertension. The incidence of hypertension was 364.6 [95% confidence interval (CI) 357.0-372.2] per 10 000 person-years among those with a history of cancer, and 247.2 (95% CI 246.3-248.1) per 10 000 person-years in those without cancer. Individuals with a history of cancer had an elevated risk of developing hypertension, according to multivariable Cox regression analyses [hazard ratio (HR) 1.17, 95% CI 1.15-1.20]. Both cancer patients requiring active antineoplastic therapy (HR 2.01, 95% CI 1.85-2.20), and those who did not require active antineoplastic therapy (HR 1.14, 95% CI 1.12-1.17) had an increased risk of hypertension. A multitude of sensitivity analyses confirmed the robustness of the relationship between cancer and incident hypertension. Patients with certain types of cancer were found to have a higher risk of developing hypertension than those without cancer, with varying risks dependent on the type of cancer. CONCLUSION Our analysis of a nationwide epidemiological database revealed that individuals with a history of cancer have a higher risk of developing hypertension, and this finding applies to both cancer patients who require active antineoplastic therapy and those who do not.
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Affiliation(s)
- Hajime Nagasawa
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yuichiro Yano
- Noncommunicable Disease (NCD) Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - Robert M Carey
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Rhian M Touyz
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Tokyo, Japan
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Iwata R, Mochizuki S, Hasegawa T, Ishii K, Matsumaru N, Tsukamoto K. Preventive Effects of Bioabsorbable Anti-Adhesion Barriers on Bowel Obstruction After Colectomy in Colon Cancer Patients: A Retrospective Cohort Study Using an Insurance Claims Database. Ther Innov Regul Sci 2024:10.1007/s43441-024-00660-3. [PMID: 38710990 DOI: 10.1007/s43441-024-00660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 05/01/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Postoperative adhesions can be prevented by the use of bioabsorbable anti-adhesion barriers. Although the occurrence of postoperative bowel obstruction is an important concern for patients, at the time of approval of anti-adhesion barriers, its effectiveness in preventing postoperative bowel obstruction had not been evaluated. We aimed to retrospectively evaluate the incidence of bowel obstruction after colectomy in patients with colon cancer using an insurance claims database. METHODS This retrospective cohort study analyzed the data of colon cancer patients (between 2005 and 2017 from a national insurance claims database) who underwent colectomies to compare the proportion of individuals with postoperative bowel obstruction between the barrier and no barrier groups. RESULTS Of the 587 patients who met the inclusion criteria, 308 and 279 patients were identified as the barrier and no barrier groups, respectively. The incidence of postoperative bowel obstruction was significantly lower in the barrier group (log-rank test, P = 0.0483). The cumulative incidence of postoperative bowel obstruction 37 months after the initial colectomy was 6.1% and 10.9% in the barrier and no barrier groups, respectively. Moreover, consistent results were obtained in the matched cohort. CONCLUSION In colectomies for patients with colon cancer, the use of anti-adhesion barriers could significantly reduce the incidence of postoperative bowel obstruction. Evaluations using insurance claims databases could provide important information on outcomes following implementation of medical devices.
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Affiliation(s)
- Risa Iwata
- Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan.
- Medical Device Unit, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, 100-0013, Tokyo, Japan.
| | - Shuichi Mochizuki
- Medical Device Unit, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, 100-0013, Tokyo, Japan
| | - Tomoaki Hasegawa
- Division of Pharmacoepidemiology, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Kensuke Ishii
- Medical Device Unit, Pharmaceuticals and Medical Devices Agency, Kasumigaseki 3-3-2, Chiyoda-ku, 100-0013, Tokyo, Japan
| | - Naoki Matsumaru
- Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
| | - Katsura Tsukamoto
- Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
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Ishibashi R, Inaba Y, Koshizaka M, Takatsuna Y, Tatsumi T, Shiko Y, Kashiwagi Y, Maezawa Y, Kawasaki Y, Kawakami E, Yamamoto S, Yokote K. Sodium-glucose co-transporter 2 inhibitor therapy reduces the administration frequency of anti-vascular endothelial growth factor agents in patients with diabetic macular oedema with a history of anti-vascular endothelial growth factor agent use: A cohort study using the Japanese health insurance claims database. Diabetes Obes Metab 2024; 26:1510-1518. [PMID: 38240052 DOI: 10.1111/dom.15454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 03/05/2024]
Abstract
AIM We assessed the effectiveness of sodium-glucose co-transporter 2 inhibitors (SGLT2is) in reducing the administration frequency of anti-vascular endothelial growth factor (VEGF) agents in patients with diabetic macular oedema (DMO) using a health insurance claims database. MATERIALS AND METHODS This retrospective cohort study analysed health insurance claims data covering 11 million Japanese patients between 2005 and 2019. We analysed the frequency and duration of intravitreal injection of anti-VEGF agents after initiating SGLT2is or other antidiabetic drugs. RESULTS Among 2412 matched patients with DMO, the incidence rates of anti-VEGF agent injections were 230.1 per 1000 person-year in SGLT2i users and 228.4 times per 1000 person-year in non-users, respectively, and the risk ratio for events was unchanged in both groups. Sub-analysis of each baseline characteristic of the patients showed that SGLT2is were particularly effective in patients with a history of anti-VEGF agent use [p = .027, hazard ratio (HR): 0.44, 95% confidence interval (CI): 0.22-0.91]. SGLT2is reduced the risk for the first (p = .023, HR: 0.45, 95% CI: 0.22-0.91) and second (p = .021, HR: 0.39, 95% CI: 0.17-0.89) anti-VEGF agent injections. CONCLUSIONS There was no difference in the risk ratio for the addition of anti-VEGF therapy between the two treatment groups. However, the use of SGLT2is reduced the frequency of anti-VEGF agent administration in patients with DMO requiring anti-VEGF therapy. Therefore, SGLT2i therapy may be a novel, non-invasive, low-cost adjunctive therapy for DMO requiring anti-VEGF therapy.
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Affiliation(s)
- Ryoichi Ishibashi
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Kimitsu Chuo Hospital, Kisarazu, Japan
- Department of Endocrinology, Hematology, and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yosuke Inaba
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Masaya Koshizaka
- Department of Endocrinology, Hematology, and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Yoko Takatsuna
- Department of Ophthalmology, Chiba Rosai Hospital, Ichihara, Japan
- Department of Ophthalmology and Vision Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoaki Tatsumi
- Department of Ophthalmology and Vision Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuki Shiko
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yusuke Kashiwagi
- Department of Artificial Intelligence Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology, and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Eiryo Kawakami
- Department of Artificial Intelligence Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Vision Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology, and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
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9
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Yamazaki Y, Fujihara K, Sato T, Harada Yamada M, Yaguchi Y, Matsubayashi Y, Yamada T, Kodama S, Kato K, Shimano H, Sone H. Usefulness of New Criteria for Metabolic Syndrome Optimized for Prediction of Cardiovascular Diseases in Japanese. J Atheroscler Thromb 2024; 31:382-395. [PMID: 37981330 PMCID: PMC10999718 DOI: 10.5551/jat.64380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/11/2023] [Indexed: 11/21/2023] Open
Abstract
AIMS We attempted to clarify whether the multiple criteria for metabolic syndrome (MetS) can sufficiently predict cardiovascular disease, whether waist circumference (WC) should be required, and whether sex-specific thresholds for each component are necessary. Only a few large-scale studies among East Asians have addressed the ability of MetS to predict cardiovascular disease. METHODS We analyzed the data of 330,051 men and 235,028 women aged 18-74 years with no history of coronary artery disease (CAD) or cerebrovascular disease (CVD) from a nationwide Japanese claims database accumulated during 2008-2016. The association of each MetS component with CAD or CVD (CAD/CVD), MetS associated with CAD/CVD according to various criteria, and utility of modified criteria with more specific optimal values for each component were examined using multivariate Cox regression and receiver operating characteristic (ROC) analysis. RESULTS During the study, 3,934 men (1.19%) and 893 women (0.38%) developed CAD/CVD. For each current MetS criteria, there was a 1.3- to 2.9-fold increased risk of CAD/CVD. Optimal thresholds for predicting CAD/CVD were WCs of 83 and 77 cm, triglycerides levels of 130 and 90 mg/dl, high-density lipoprotein cholesterol levels of 50 and 65 mg/dl, blood pressures of 130/80 and 120/80 mmHg, and fasting plasma glucose levels of 100 and 90 mg/dl for men and women, respectively. The existing MetS criteria and modified criteria were not significantly different in predicting CAD/CVD, but using the modified criteria markedly increased the prevalence of MetS and percentage of people with MetS developing CAD/CVD. CONCLUSIONS Although various criteria for MetS similarly predicted CAD/CVD, the new criteria greatly reduced the number of high-risk individuals, especially women, overlooked by the current criteria.
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Affiliation(s)
- Yurie Yamazaki
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Takaaki Sato
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Mayuko Harada Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Yuta Yaguchi
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Yasuhiro Matsubayashi
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Takaho Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Satoru Kodama
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Kiminori Kato
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Hitoshi Shimano
- Department of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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10
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Okada A, Kaneko H, Konishi M, Kamiya K, Sugimoto T, Matsuoka S, Yokota I, Suzuki Y, Yamaguchi S, Itoh H, Fujiu K, Michihata N, Jo T, Matsui H, Fushimi K, Takeda N, Morita H, Yasunaga H, Komuro I. A machine-learning-based prediction of non-home discharge among acute heart failure patients. Clin Res Cardiol 2024; 113:522-532. [PMID: 37131097 PMCID: PMC10955024 DOI: 10.1007/s00392-023-02209-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Scarce data on factors related to discharge disposition in patients hospitalized for acute heart failure (AHF) were available, and we sought to develop a parsimonious and simple predictive model for non-home discharge via machine learning. METHODS This observational cohort study using a Japanese national database included 128,068 patients admitted from home for AHF between April 2014 and March 2018. The candidate predictors for non-home discharge were patient demographics, comorbidities, and treatment performed within 2 days after hospital admission. We used 80% of the population to develop a model using all 26 candidate variables and using the variable selected by 1 standard-error rule of Lasso regression, which enhances interpretability, and 20% to validate the predictive ability. RESULTS We analyzed 128,068 patients, and 22,330 patients were not discharged to home; 7,879 underwent in-hospital death and 14,451 were transferred to other facilities. The machine-learning-based model consisted of 11 predictors, showing a discrimination ability comparable to that using all the 26 variables (c-statistic: 0.760 [95% confidence interval, 0.752-0.767] vs. 0.761 [95% confidence interval, 0.753-0.769]). The common 1SE-selected variables identified throughout all analyses were low scores in activities of daily living, advanced age, absence of hypertension, impaired consciousness, failure to initiate enteral alimentation within 2 days and low body weight. CONCLUSIONS The developed machine learning model using 11 predictors had a good predictive ability to identify patients at high risk for non-home discharge. Our findings would contribute to the effective care coordination in this era when HF is rapidly increasing in prevalence.
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Affiliation(s)
- Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Masaaki Konishi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Tadafumi Sugimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Isao Yokota
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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11
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Komuro J, Kaneko H, Suzuki Y, Okada A, Fujiu K, Takeda N, Jo T, Morita H, Senoo K, Node K, Yasunaga H, Ieda M, Komuro I. Sex Differences in the Relationship Between Schizophrenia and the Development of Cardiovascular Disease. J Am Heart Assoc 2024; 13:e032625. [PMID: 38411545 PMCID: PMC10944025 DOI: 10.1161/jaha.123.032625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/11/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND There are few data on sex differences in the association between schizophrenia and the development of cardiovascular disease (CVD). We sought to clarify the relationship of schizophrenia with the risk of developing CVDs and to explore the potential modification effect of sex differences. METHODS AND RESULTS We conducted a retrospective analysis using the JMDC Claims Database between 2005 and 2022. The study population included 4 124 508 individuals aged 18 to 75 years without a history of CVD or renal replacement therapy. The primary end point is defined as a composite end point that includes myocardial infarction, angina pectoris, stroke, heart failure, atrial fibrillation, and pulmonary thromboembolism. During a mean follow-up of 1288±1001 days, we observed 182 158 composite end points. We found a significant relationship of schizophrenia with a greater risk of developing composite CVD events in both men and women, with a stronger association observed in women. The hazard ratio for the composite end point was 1.63 (95% CI, 1.52-1.74) in women and 1.42 (95% CI, 1.33-1.52) in men after multivariable adjustment (P for interaction=0.0049). This sex-specific difference in the association between schizophrenia and incident CVD was consistent for angina pectoris, heart failure, and atrial fibrillation. CONCLUSIONS Our analysis using a large-scale epidemiologic cohort demonstrated that the association between schizophrenia and subsequent CVD events was more pronounced in women than in men, suggesting the clinical importance of addressing schizophrenia and tailoring the CVD prevention strategy based on sex-specific factors.
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Affiliation(s)
- Jin Komuro
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Hidehiro Kaneko
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
- The Department of Advanced CardiologyThe University of TokyoTokyoJapan
| | - Yuta Suzuki
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
- Center for Outcomes Research and Economic Evaluation for HealthNational Institute of Public HealthSaitamaJapan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Katsuhito Fujiu
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
- The Department of Advanced CardiologyThe University of TokyoTokyoJapan
| | - Norifumi Takeda
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Taisuke Jo
- The Department of Health Services ResearchThe University of TokyoTokyoJapan
| | - Hiroyuki Morita
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Keitaro Senoo
- Department of Cardiac Arrhythmia Research and Innovation, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
- Department of Cardiovascular Medicine, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Koichi Node
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
| | - Masaki Ieda
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Issei Komuro
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
- International University of Health and WelfareTokyoJapan
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12
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Tamaki N, Wakabayashi SI, Kimura T, Yasui Y, Tsuchiya K, Nakanishi H, Huang DQ, Umemura T, Kurosaki M, Izumi N. Glycemic control target for liver and cardiovascular events risk in metabolic dysfunction-associated steatotic liver disease. Hepatol Res 2024. [PMID: 38400797 DOI: 10.1111/hepr.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/26/2024]
Abstract
AIMS Optimizing glycemic control may prevent liver-related events and major adverse cardiovascular events (MACE) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). However, the optimal hemoglobin A1c (HbA1c) threshold associated with a lower risk of complications, particularly liver-related events as well as MACE is unknown. METHODS We investigated a nationwide population-based cohort and identified 633 279 patients with MASLD, with a mean follow-up of 4.2 years. Hemoglobin A1c levels were measured annually. The primary endpoint was the risk of liver-related events and MACE and to determine the optimal HbA1c level associated with the risk of complications. RESULTS Mean HbA1c (per 1%) was associated with liver-related events (subdistribution hazard ratio [sHR] 1.26; 95% confidence interval [CI], 1.12-1.42) as well as MACE (sHR 1.36; 95% CI, 1.32-1.41) after adjustment for confounders. Multivariable sHR (95% CI) for HbA1c of <5.0%, 6.0%-6.9%, 7.0%-7.9%, 8.0%-8.9%, and ≥9.0% (reference, 5.0%-5.9%) were 14 (9.1-22), 1.70 (1.2-2.3), 3.32 (2.3-4.8), 3.81 (2.1-6.8), and 4.83 (2.4-9.6) for liver-related events, and 1.24 (0.8-1.8), 1.27 (1.2-1.4), 1.70 (1.5-2.0), 2.36 (1.9-2.9), and 4.17 (3.5-5.0) for MACE. An HbA1c level of 7% was selected as the optimal threshold for predicting complications (sHR 2.40 [1.8-3.2] for liver-related events and 1.98 [1.8-2.2] for MACE). CONCLUSION The risk of liver-related events as well as MACE increased in a dose-dependent fashion with an increase in HbA1c levels, except for patients with HbA1c <5.0% for liver-related events. An HbA1c level of 7% was the optimal threshold associated with a lower risk of complications and may be utilized as a target for glycemic control in patients with MASLD.
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Affiliation(s)
- Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Shun-Ichi Wakabayashi
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takefumi Kimura
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Yutaka Yasui
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Kaoru Tsuchiya
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hiroyuki Nakanishi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Daniel Q Huang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Takeji Umemura
- Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
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13
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Yamashita Y, Fukasawa T, Takeda C, Takeuchi M, Ono K, Kawakami K. Clinical Characteristics and Outcomes of Patients With Venous Thromboembolism Receiving Edoxaban in the Real World. Circ J 2024; 88:371-379. [PMID: 38143083 DOI: 10.1253/circj.cj-23-0818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND The effectiveness and safety of edoxaban for venous thromboembolism (VTE) in unselected real-world patients have not been fully evaluated.Methods and Results: In the Japanese nationwide administrative database, we identified 6,262 VTE patients in whom edoxaban was initiated; these patients were divided into 3 groups based on their index doses: 15 mg/day (n=235), 30 mg/day (n=4,532), and 60 mg/day (n=1,495). We evaluated patient characteristics, recurrent VTEs, and a composite endpoint of intracranial hemorrhage (ICH) and gastrointestinal (GI) bleeding. Patient characteristics among the 15-, 30-, and 60-mg edoxaban groups varied widely regarding several aspects, including age (mean 81.0, 76.2, and 65.0 years, respectively) and body weight (mean 49.5, 51.8, and 70.3 kg, respectively). At 180 days, the cumulative incidence of recurrent VTEs in the 15-, 30-, and 60-mg edoxaban groups was 4.4%, 2.6%, and 1.8%, respectively, whereas that of ICH or GI bleeding was 7.3%, 5.4%, and 3.3%, respectively. Subgroup analyses showed that the cumulative incidence of ICH or GI bleeding in patients in the 15-mg edoxaban group was 3.6% for patients aged ≥80 years, 8.4% for those with a body weight <60 kg, and 31.3% for those with renal dysfunction. CONCLUSIONS Only a minority of patients with VTEs received a super low dose (15 mg) of edoxaban, and these patients may be at higher risk of bleeding as well as VTE recurrence.
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Affiliation(s)
- Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Toshiki Fukasawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
- Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | - Chikashi Takeda
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
- Department of Anesthesia, Kyoto University Hospital
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
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14
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Suzuki Y, Kaneko H, Okada A, Fujiu K, Jo T, Takeda N, Tanaka A, Node K, Morita H, Yasunaga H, Komuro I. Benign Prostatic Hyperplasia and Incident Cardiovascular Disease. Circ J 2024; 88:408-416. [PMID: 38246651 DOI: 10.1253/circj.cj-23-0607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Data regarding the relationship between benign prostatic hyperplasia (BPH) and incident cardiovascular disease (CVD) are scarce. We aimed to clarify the association of BPH with the risk of developing CVD using a nationwide epidemiological database.Methods and Results: This retrospective observational cohort study analyzed data from the JMDC Claims Database between 2005 and 2022, including 2,370,986 men (median age 44 years). The primary endpoints were myocardial infarction (MI), angina pectoris (AP), stroke, heart failure (HF), and atrial fibrillation (AF), which were assessed separately. BPH was observed in 48,651 (2.1%) men. During a mean (±SD) follow-up of 1,359±1,020 days, 7,638 MI, 52,167 AP, 25,355 stroke, 58,183 HF, and 16,693 AF events were detected. Hazard ratios of BPH for MI, AP, stroke, HF, and AF were 1.04 (95% confidence interval [CI] 0.92-1.18), 1.31 (95% CI 1.25-1.37), 1.26 (95% CI 1.18-1.33), 1.21 (95% CI 1.16-1.27), and 1.15 (95% CI 1.07-1.24), respectively. We confirmed the robustness of our primary findings through a multitude of sensitivity analyses. In particular, a history of BPH was associated with a higher risk of developing CVD, even in participants without obesity, hypertension, diabetes, or dyslipidemia. CONCLUSIONS Our analysis of a nationwide epidemiological dataset demonstrated that BPH was associated with a greater risk of developing CVD in middle-aged men.
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Affiliation(s)
- Yuta Suzuki
- Department of Cardiovascular Medicine, The University of Tokyo
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo
- Department of Advanced Cardiology, The University of Tokyo
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo
- Department of Advanced Cardiology, The University of Tokyo
| | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo
- International University of Health and Welfare
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15
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Zheng Y, Fukasawa T, Yamaguchi F, Takeuchi M, Kawakami K. Cardiovascular Safety of Atomoxetine and Methylphenidate in Patients With Attention-Deficit/Hyperactivity Disorder in Japan: A Self-Controlled Case Series Study. J Atten Disord 2024; 28:439-450. [PMID: 38084080 DOI: 10.1177/10870547231214993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To investigate the association between atomoxetine or methylphenidate use and arrhythmia, heart failure (HF), stroke, and myocardial infarction (MI) in attention-deficit/hyperactivity disorder (ADHD) patients mainly focused on the people of working age. METHODS In a self-controlled case series study using a Japanese claims database, we identified events of arrhythmia, HF, stroke, and MI among 15,472 atomoxetine new users and 12,059 methylphenidate new users. Adjusted incidence rate ratios (aIRRs) of outcome events were estimated using multivariable conditional Poisson regression. RESULTS An increased risk of arrhythmia was observed during the first 7 days after the initial atomoxetine exposure (aIRR 6.22, 95% CI [1.90, 20.35]) and in the subsequent exposure (3.23, [1.58, 6.64]). No association was found between methylphenidate exposure and arrhythmia, nor between atomoxetine or methylphenidate exposure and HF. The limited number of stroke and MI cases prevented thorough analysis. CONCLUSIONS Clinicians should consider monitoring for arrhythmia after patients initiating or re-initiating atomoxetine.
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Affiliation(s)
- Yunlong Zheng
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Japan
| | - Toshiki Fukasawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Japan
- Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Japan
| | - Fumitaka Yamaguchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Japan
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16
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Ohno R, Kaneko H, Suzuki Y, Okada A, Matsuoka S, Ueno K, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Node K, Yasunaga H, Komuro I. Association of Metabolic Dysfunction-Associated Fatty Liver Disease With Risk of HF and AF. JACC. ASIA 2023; 3:908-921. [PMID: 38155795 PMCID: PMC10751648 DOI: 10.1016/j.jacasi.2023.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 12/30/2023]
Abstract
Background Metabolic dysfunction-associated fatty liver disease (MAFLD) is a novel concept of hepatic disease. Although the prevalences of heart failure (HF) and atrial fibrillation (AF) are increasing worldwide, limited data have assessed the extent to which MAFLD is associated with incident HF and AF. Objectives The authors sought to examine the association of MAFLD with incident HF and AF. Methods Analyses were conducted using a nationwide epidemiologic database including 3,279,918 individuals (median age 45 years; 57.6% men). Metabolic dysfunction was defined as 1 or more of the following: overweight (body mass index ≥23 kg/m2), metabolic syndrome, or diabetes mellitus. FLD was defined as fatty liver index of >30. MAFLD was defined as the coexistence of metabolic dysfunction and FLD. We categorized study participants into 4 groups: non-FLD/nonmetabolic dysfunction (n = 1,709,116), metabolic dysfunction (n = 584,483), FLD (n = 89,497), and MAFLD (n = 896,822). The primary outcomes were HF and AF. Results Over a mean follow-up period of 1,160 ± 905 days, 62,746 incident HF events and 15,408 incident AF events were recorded. Compared with the non-FLD/non-metabolic dysfunction group, HRs for HF and AF, respectively, were 1.20 (95% CI: 1.18-1.23) and 1.13 (95% CI: 1.08-1.19) for metabolic dysfunction, 1.24 (95% CI: 1.19-1.30) and 1.13 (95% CI: 1.04-1.23) for FLD, and 1.73 (95% CI: 1.69-1.76) and 1.51 (95% CI: 1.46-1.57) for MAFLD. MAFLD was also associated with a higher risk of developing myocardial infarction, angina pectoris, and stroke. A risk of developing cardiovascular events differed between MAFLD subtypes (Wald test P < 0.001). Conclusions MAFLD was associated with a greater risk of developing HF and AF, suggesting the clinical importance of this novel hepatic disease concept.
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Affiliation(s)
- Ryusei Ohno
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Yuta Suzuki
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Matsuoka
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kensuke Ueno
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Tokyo, Japan
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17
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Kodera R, Fujihara K, Koyama T, Shiozaki H, Mutsuma Y, Yagyuda N, Hatta M, Tsuruoka K, Takeda Y, Araki A, Sone H. Impact of a history of cardiovascular disease and physical activity habits on the incidence of functional disability. Sci Rep 2023; 13:20793. [PMID: 38012261 PMCID: PMC10682401 DOI: 10.1038/s41598-023-47913-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
We examined the impact of a history of coronary artery disease (CAD) or cerebrovascular disease (CVD) and physical activity habits on functional disability among community-dwelling Japanese adults. This population-based retrospective cohort study included 10,661 people aged 39-98 years in Japan (5054, men). Median follow-up was 3.7 years. During the study period, 209 functional disabilities occurred in the overall study population. In multivariable analysis, a history of CVD (hazard ratio [HR] 1.57 [95% CI: 1.00-2.45]) and no physical activity habit (HR 1.74 [1.27-2.39]) presented increased risks for functional disability. HRs for functional disability among patients with a CVD history with and without a physical activity habit were 1.68 (0.75-3.74) and 2.65 (1.49-4.71), respectively, compared with individuals without a history of CVD with a physical activity habit. Similar results were observed for CAD. We found no significant difference in the incidence of functional disability between the group with a history of CAD or CVD and physical activity habits and the group with no history of CAD or CVD and without physical activity habits. Physical activity habits had a favorable influence on avoiding functional disability regardless of a history of CAD or CVD. Future prospective studies are needed to clarify these associations.
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Affiliation(s)
- Remi Kodera
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan.
| | - Tetsuya Koyama
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Haruka Shiozaki
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Yurie Mutsuma
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Noriko Yagyuda
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Mariko Hatta
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Kahori Tsuruoka
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Yasunada Takeda
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
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18
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Nakahata M, Tanaka-Mizuno S, Yamaguchi F, Takeuchi M, Kawakami K. Does nutritional guidance reduce cardiovascular events in patients with type 2 diabetes mellitus? A retrospective cohort study using a nationwide claims database. Acta Diabetol 2023; 60:1541-1549. [PMID: 37421440 DOI: 10.1007/s00592-023-02147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
AIM To examine the effect of nutritional guidance (NG) provided by a registered dietitian under the direction of a physician on the development of subsequent cardiovascular events in patients with early-stage type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS This retrospective cohort study used the JMDC claims database to explore patients aged 18 years or older who first met the diagnostic criteria for T2DM at a health checkup between January 2011 and January 2019. The last day of the observation period was set for 28 February, 2021. Exposure was defined as receiving NG within 180 days of diagnosis of T2DM. The primary outcome was a composite endpoint of coronary artery disease (CAD) and cerebrovascular disease, and the secondary outcomes were each event, and time to event was compared. The propensity score weighting method was used for adjusting the distribution of confounding variables. Cox regression was conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Overall, 31,378 patients met the eligibility criteria at an annual health checkup. 9.6% received NG (n = 3013). Patients who attended ≥ 1 NG after diagnosis had significantly reduced risk of cardiovascular composite (adjusted HR 0.75, 95% CI 0.58-0.97) and cerebrovascular disease (adjusted HR 0.65, 95% CI 0.47-0.90) during approximately 3.3 years of follow-up. In contrast, no difference was observed for CAD. CONCLUSIONS Receiving NG in early-stage diabetes may reduce the incidence of cardiovascular events, especially cerebrovascular events.
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Affiliation(s)
- Misaki Nakahata
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Sachiko Tanaka-Mizuno
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
- Department of Digital Health and Epidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
| | - Fumitaka Yamaguchi
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
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19
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Shigemi D, Yasunaga H. Association of white blood cell count after operative vaginal delivery with maternal adverse outcome: A retrospective cohort study. ANNALS OF CLINICAL EPIDEMIOLOGY 2023; 5:113-120. [PMID: 38504951 PMCID: PMC10944988 DOI: 10.37737/ace.23015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/20/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND The white blood cell count is often used to assess the maternal condition after an operative vaginal delivery. However, it remains unknown whether the maternal white blood cell count on the day after delivery is associated with sequential maternal adverse outcomes, especially infectious complications. The aim of this study was to investigate the association between maternal white blood cell count on the day after operative vaginal delivery and sequential maternal adverse events. METHODS The study was a retrospective cohort study using the Medical Data Vision claims database containing administrative claims data, discharge abstracts, and laboratory values in Japan. We identified all patients who underwent operative vaginal delivery with data on maternal white blood cell count from December 2011 to November 2020. The main composite outcome was maternal adverse outcomes, comprising additional treatment for maternal injuries, postpartum intravenous antibiotic use, and intensive care unit use during hospitalization. We conducted a restricted cubic spline analysis to investigate the nonlinear association between white blood cell count and the primary outcome. RESULTS There were 485 eligible patients including 73 patients with occurrence of the primary outcome. The median (interquartile range) white blood cell count on the day after delivery in all eligible women was 15,170 (12,610-18,300)/mL. In the restricted cubic spline analysis, there was no significant association of white blood cell count with the primary outcome. CONCLUSION White blood cell count on the day after operative vaginal delivery was not significantly associated with maternal adverse outcomes during hospitalization.
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Affiliation(s)
- Daisuke Shigemi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
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20
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Masuda S, Fukasawa T, Takeuchi M, Fujibayashi S, Otsuki B, Murata K, Shimizu T, Matsuda S, Kawakami K. Predictors of the Need for Surgery in Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Cohort Longitudinal Study Using a Claims-based Database. Clin Spine Surg 2023; 36:E271-E276. [PMID: 36850023 DOI: 10.1097/bsd.0000000000001448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/25/2023] [Indexed: 03/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to determine predictors associated with the needfor cervical ossification of the posterior longitudinal ligament (cOPLL) surgery amongindividuals with cOPLL. SUMMARY OF BACKGROUND DATA cOPLL is a spinal disorder caused by ectopic ossification of the posterior longitudinal ligament. However, factors associated with a higher rate of surgery to treat the neurological symptoms of cOPLL are poorly understood. MATERIALS AND METHODS This retrospective population-based cohort study using a commercial administrative claims database from JMDC Inc. (Tokyo, Japan) enrolled patients newly diagnosed with cOPLL from April 2005 to October 2020 and followed to April 2021. A total of 1506 cOPLL patients aged 18 years or older with no history of cervical spine surgery and with a record of metabolic profiles obtained at general health checkups were included. Cox proportional hazards regression models identified patient characteristics and comorbidities associated with cOPLL surgery. RESULTS Of 1506 patients with cOPLL with a median of 1.8 years of follow-up after initial cOPLL diagnosis, 439 (29.2%) received cOPLL surgery. The 1-year cumulative incidence (95% CI) was 26.0% (23.7-28.2). In multivariable Cox proportional regression analysis, male (hazard ratio: 1.68; 95% CI: 1.26-2.24; P < 0.001) and obesity (body mass index: ≥25) (hazard ratio: 1.45; 95% CI: 1.10-1.89; P = 0.007) were associated with an increased risk of cOPLL surgery. CONCLUSIONS In this large claims-based study of adults newly diagnosed with cOPLL, males and obesity were associated with a higher risk of cOPLL surgery. These findings may help clinicians to predict the future course of cOPLL in patients, although further research is needed to elucidate the biological role of these progression-associated factors.
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Affiliation(s)
- Soichiro Masuda
- Department of Orthopedic Surgery, Graduate School of Medicine
- Department of Pharmacoepidemiology
| | - Toshiki Fukasawa
- Department of Pharmacoepidemiology
- Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | | | | | - Bungo Otsuki
- Department of Orthopedic Surgery, Graduate School of Medicine
| | - Koichi Murata
- Department of Orthopedic Surgery, Graduate School of Medicine
| | | | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine
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21
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Yamana H, Konishi T, Yasunaga H. Validation studies of Japanese administrative health care data: A scoping review. Pharmacoepidemiol Drug Saf 2023; 32:705-717. [PMID: 37146098 DOI: 10.1002/pds.5636] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 04/04/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Large-scale administrative health care databases are increasingly being utilized for research. However, there has not been much literature that validated administrative data in Japan; a previous review identified six validation studies published between 2011 and 2017. We conducted a literature review of studies that assessed the validity of Japanese administrative health care data. METHODS We searched for studies published by March 2022 that compared individual-level administrative data with a reference standard from another data source, as well as studies that validated administrative data using other data within the same database. The eligible studies were also summarized based on characteristics which included data types, settings, reference standard used, numbers of patients, and conditions validated. RESULTS There were 36 eligible studies, including 29 that used external reference standard and seven that validated administrative data using other data within the same database. Chart review was the reference standard in 21 studies (range of the numbers of patients, 72-1674; 11 studies conducted in single institutions and nine studies in 2-5 institutions). Five studies used a disease registry as the reference standard. Diagnoses of cardiovascular diseases, cancer, and diabetes were frequently evaluated. CONCLUSIONS Validation studies are being conducted at an increasing rate in Japan, although most of them are small scale. Further large-scale comprehensive validation studies are necessary to effectively utilize the databases for research.
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Affiliation(s)
- Hayato Yamana
- Data Science Center, Jichi Medical University, Shimotsuke, Japan
- Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Meguro, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Japan
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Japan
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22
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Setogawa N, Ohbe H, Isogai T, Matsui H, Yasunaga H. Characteristics and short-term outcomes of outpatient and inpatient cardiac catheterizations: A descriptive study using a nationwide claim database in Japan. J Cardiol 2023:S0914-5087(23)00125-9. [PMID: 37247658 DOI: 10.1016/j.jjcc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Most previous studies on outpatient cardiac catheterization have been conducted in Western countries, but Japanese studies are rare. We aimed to describe patient characteristics and short-term clinical outcomes of outpatient cardiac catheterization compared to those of inpatient cardiac catheterization in Japan. METHODS We conducted a retrospective cohort study using data from the JMDC Claims Database. We identified all adult patients aged ≥18 years who underwent cardiac catheterization between April 2012 and October 2021. We investigated patient characteristics and clinical outcomes (i.e. all-cause mortality, stroke, acute kidney injury, bleeding, vascular complications, percutaneous coronary intervention, and total healthcare costs) within 2, 7, and 30 days between patients who underwent outpatient cardiac catheterization (outpatient group) and those who underwent inpatient cardiac catheterization (inpatient group). RESULTS Of the 37,002 eligible patients (57.6 % <60 years old, and 80.2 % male), 1853 (5.01 %) underwent outpatient cardiac catheterization. The outpatient group was more likely to be male, have more comorbidities, and be performed at non-university hospitals than the inpatient group. The proportion of patients who underwent right heart catheterization and imaging was lower in the outpatient group. There were no significant differences in 7-day major complications between the two groups (all-cause mortality, 0.0 % versus 0.0 %, p = 0.57; acute kidney injury, 0.0 % versus 0.1 %, p = 0.10, bleeding, 0.5 % versus 0.9 %, p = 0.052; vascular complication, 0.0 % versus 0.1 %, p = 0.23, respectively). The 30-day total healthcare costs were lower in the outpatient group than in the inpatient group (mean 3212 US dollars versus 3955 US dollars, p = 0.003). CONCLUSIONS Approximately 5 % of cardiac catheterizations were performed in an outpatient setting. Given the low adverse event risk observed in this study, it may be a reasonable option to widen outpatient cardiac catheterization to include potential populations in Japan, warranting further studies.
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Affiliation(s)
- Nao Setogawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Isogai
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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23
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Suzuki Y, Kaneko H, Tamura Y, Okada A, Fujiu K, Michihata N, Takeda N, Jo T, Morita H, Node K, Yasunaga H, Komuro I. Cardiovascular events after the initiation of immune checkpoint inhibitors. Heliyon 2023; 9:e16373. [PMID: 37251893 PMCID: PMC10220239 DOI: 10.1016/j.heliyon.2023.e16373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023] Open
Abstract
We sought to clarify the incidence of major adverse cardiac events (MACE) after the initiation of immune checkpoint inhibitors (ICIs). We analyzed the JMDC Claims Database between 2005 and 2021. The study included 2972 patients with no history of cardiovascular disease and a prescription for an ICI. The primary outcome was the incidence of MACE, including myocarditis, pericarditis, Takotsubo cardiomyopathy, atrio-ventricular block, heart failure, myocardial infarction, and stroke. The median age of study participants was 59 (Q1-Q3 53-65) years, and 2163 participants (72.8%) were male. Lung cancer was the most common cancer site (n = 1603). Among ICIs, programmed cell death-1 (PD-1) was most frequently used, and a combination ICI treatment was conducted in 110 patients (3.7%). During a mean follow-up of 358 ± 327 days, 419 MACE events were recorded. The incidence rate of myocarditis, pericarditis, Takotsubo cardiomyopathy, atrio-ventricular block, heart failure, myocardial infarction, and stroke was 3.4, 142.3, 10.3, 17.2, 1191.2, 55.2, and 278.5 per 10,000 person-years, respectively. The incidence of cardiovascular events was higher within 180 days after the initial prescription of ICI. The continuation rate of ICI after MACE was 38.4%. In conclusion, our analysis of a nationwide epidemiological dataset demonstrated the incidence of MACE after the initiation of ICI treatment. The incidence of heart failure was higher than expected, and the continuation rate of ICI treatment after MACE was low. Our results indicated the importance of monitoring and prevention of cardiovascular events in cancer patients requiring ICI treatment.
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Affiliation(s)
- Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Yuichi Tamura
- Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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Setogawa N, Ohbe H, Matsui H, Yasunaga H. Amputation After Endovascular Therapy With and Without Intravascular Ultrasound Guidance: A Nationwide Propensity Score-Matched Study. Circ Cardiovasc Interv 2023; 16:e012451. [PMID: 37071721 DOI: 10.1161/circinterventions.122.012451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) provides precise intravascular information during endovascular therapy (EVT). However, the clinical efficacy of IVUS in patients who undergo EVT remains unknown. The present study aimed to determine whether the use of IVUS-guided EVT is associated with better clinical outcomes in a real-world setting. METHODS Using the Japanese Diagnosis Procedure Combination administrative inpatient database from April 2014 to March 2019, we identified patients diagnosed with atherosclerosis of arteries of extremities and underwent EVT (percutaneous endovascular transluminal angioplasty and thrombectomy for extremities or percutaneous endovascular removal). Propensity score matching analysis was performed to compare outcomes between the patients who underwent IVUS on the same day as the first EVT intervention (IVUS group) and the others (non-IVUS group). The primary outcome was major and minor amputation for extremities within 12 months of the first EVT procedure. Secondary outcomes were bypass surgery, stent grafting, reintervention, all-cause death, readmission, and total hospitalization costs within 12 months of the first EVT procedure. RESULTS Among 85 649 eligible patients, 50 925 (59.5%) were IVUS group. After propensity score matching, the IVUS group had significantly lower incidence of 12-month amputation compared with the non-IVUS group (6.9% in the IVUS group versus 9.3% in the non-IVUS group; hazard ratio, 0.80 [95% CI, 0.72-0.89]). Compared with the non-IVUS group, the IVUS group showed a lower risk of bypass surgery and stent grafting and decreased total hospitalization costs, while a higher risk of reintervention and readmission. No significant differences in all-cause death were found between the 2 groups. CONCLUSIONS In this retrospective study, IVUS-guided EVT was associated with a lower amputation risk than non-IVUS-guided EVT. Our findings should be interpreted carefully because of the limitations of an observational study using administrative data. Further studies are warranted to confirm whether IVUS-guided EVT leads to decreased amputations.
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Affiliation(s)
- Nao Setogawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
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25
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Suzuki Y, Kaneko H, Tamura Y, Okada A, Michihata N, Jo T, Takeda N, Morita H, Fujiu K, Node K, Yasunaga H, Komuro I. Sex-Specific Differences in the Risk of Heart Failure following Anti-HER2 Monoclonal Antibody Therapy. Oncology 2023; 101:358-361. [PMID: 36940681 DOI: 10.1159/000530215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Anti-HER2 monoclonal antibody is associated with a greater risk of heart failure (HF) in female breast cancer patients. In recent years, the indication of anti-HER2 monoclonal antibodies was further expanded to stomach, colorectal, and salivary gland cancers regardless of sex in Japan. However, there have been no data on sex difference in the risk of HF after the anti-HER2 monoclonal antibody treatment. OBJECTIVES We compared the risk of HF between male and female cancer patients treated with anti-HER2 monoclonal antibody using a nationwide population-based database. METHOD We analyzed 4,608 cancer patients (230 men, median age; 52 years, breast cancer; 4,333) treated with HER2 monoclonal antibody enrolled in the JMDC Claims Database. The primary outcome was the incidence of HF. RESULTS Over a mean follow-up of 917 ± 835 days, 559 HF events were documented. Kaplan-Meier curves showed no significant difference in the incidence of HF between men and women. Multivariable Cox regression analysis showed that male sex was not associated with a risk of HF compared with women (HR, 0.76; 95% CI: 0.39-1.49). CONCLUSIONS Our analysis of a nationwide population-based database firstly revealed that no significant sex difference existed in the risk of HF among cancer patients treated with anti-HER2 monoclonal antibody. Our findings suggest that the use of anti-HER2 monoclonal antibodies in male patients may be associated with similar risks observed in female patients.
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Affiliation(s)
- Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Yuicui Tamura
- Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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26
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Kanazawa S, Kaneko H, Yano Y, Suzuki Y, Okada A, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Node K, Yasunaga H, Komuro I. Sex Differences in the Association Between Hypertension and Incident Atrial Fibrillation. J Am Heart Assoc 2023; 12:e026240. [PMID: 36802850 PMCID: PMC10111461 DOI: 10.1161/jaha.122.026240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background Limited evidence is available on sex differences about the association between hypertension and incident atrial fibrillation (AF). Methods and Results We used a nationwide health checkup and claims database to analyze 3 383 738 adults (median age, 43 (36-51) years, 57.4% men). We investigated the relationship between hypertension and incident AF in men and women using a Cox regression model. We used restricted cubic spline functions to identify the association of blood pressure (BP) as a continuous parameter with incident AF. We categorized the men and women into 4 groups according to the 2017 American College of Cardiology/American Heart Association BP guidelines. During a mean follow-up of 1199±950 days, 13 263 AF diagnoses were recorded. The incidence (95% CI) of AF was 15.8 (15.5-16.1) per 10 000 person-years in men and 6.1 (5.9-6.3) per 10 000 person-years in women. Compared with normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension were associated with an increased risk AF in both men and women. However, the hazard ratios were greater in women than in men, and the P value for interactions in the multivariable model was 0.0076. The models using restricted cubic spline showed that the risk of AF associated with elevated systolic BP increased steeply above an approximate threshold of systolic BP of 130 mm Hg in men and 100 mm Hg in women. Although our primary findings were consistent across subgroup analyses, this association was most significant in younger individuals. Conclusions Although the incidence of AF was higher in men, the association between hypertension and incident AF was more pronounced in women than in men, suggesting a potential sex difference in the relationship between hypertension and incident AF.
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Affiliation(s)
- Satoshi Kanazawa
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan.,The Department of Advanced Cardiology The University of Tokyo Tokyo Japan
| | - Yuichiro Yano
- Department of Advanced Epidemiology, NCD Epidemiology Research Center Shiga University of Medical Science Shiga Japan.,The Department of Family Medicine and Community Health Duke University Durham NC
| | - Yuta Suzuki
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan.,Center for Outcomes Research and Economic Evaluation for Health National Institute of Public Health Saitama Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Satoshi Matsuoka
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan.,The Department of Advanced Cardiology The University of Tokyo Tokyo Japan
| | - Nobuaki Michihata
- The Department of Health Services Research The University of Tokyo Tokyo Japan
| | - Taisuke Jo
- The Department of Health Services Research The University of Tokyo Tokyo Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan
| | - Koichi Node
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo Tokyo Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan
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27
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Kobayashi A, Fujihara K, Yamada MH, Sato T, Yaguchi Y, Kitazawa M, Matsubayashi Y, Iwanaga M, Yamada T, Kodama S, Sone H. Combined effects of blood pressure and glycemic status on risk of heart failure: a population-based study. J Hypertens 2023; 41:470-475. [PMID: 36728245 DOI: 10.1097/hjh.0000000000003362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS To investigate the combined effects of blood pressure (BP) and glycemic status on the risk of heart failure. METHODS Examined was a Japanese claims database from 2008 to 2019 on 589 621 individuals. Cox proportional hazards model identified the incidence of heart failure among five levels of SBP/DBP according to glucose status. RESULTS Mean follow-up period was 5.6 years. The incidence of heart failure per 1000 person-years in the normoglycemia, borderline glycemia, and diabetes groups were 0.10, 0.18, and 0.80, respectively. In normoglycemia, a linear trend was observed between both SBP and DBP categories and hazard ratios for heart failure ( P for linearity <0.001). In borderline glycemia, J-shaped association was observed between DBP categories and hazard ratios, although the liner trend was significant ( P < 0.001). In diabetes, the linear trend for the relationship between DBP categories and hazard ratios was not significant ( P = 0.09) and the J-shaped association in relation to the hazard ratios was observed between SBP categories and heart failure risk. In the lowest SBP category (i.e. SBP < 120 mmHg), patients with diabetes had more than five-fold heart failure risk [hazard ratio (95% confidence interval), 5.10 (3.19-8.15)], compared with those with normoglycemia and SBP less than 120 mmHg. CONCLUSION The association between SBP/DBP and heart failure risk weakened with worsening of glucose metabolism, suggesting strict BP control accompanied by excessively lowered DBP should be cautious in prevent heart failure in abnormal glycemic status. Particularly in diabetes, comprehensive management of risk factors other than BP may be essential to prevent heart failure. Further trials are needed to support these suggestions and apply them to clinical practice.
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Affiliation(s)
- Ayako Kobayashi
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
- Niigata College of Nursing, Joetsu, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Mayuko Harada Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Takaaki Sato
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Yuta Yaguchi
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Masaru Kitazawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | | | - Midori Iwanaga
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Takaho Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Satoru Kodama
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
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28
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Kanaoka K, Iwanaga Y, Okada K, Terasaki S, Nishioka Y, Nakai M, Kamon D, Myojin T, Soeda T, Noda T, Horii M, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Validity of Diagnostic Algorithms for Cardiovascular Diseases in Japanese Health Insurance Claims. Circ J 2023; 87:536-542. [PMID: 36709984 DOI: 10.1253/circj.cj-22-0566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND We aimed to validate a claims-based diagnostic algorithm to identify hospitalized patients with acute major cardiovascular diseases (CVDs) from health insurance claims in Japan.Methods and Results: This retrospective multicenter validation study was conducted at 4 institutes, including Japanese Circulation Society-certified and uncertified hospitals in Japan. Data on patients with CVDs in departmental lists or with International Classification of Diseases, 10th Revision (ICD-10) codes for CVDs hospitalized between April 2018 and March 2019 were extracted. We examined the sensitivity and positive predictive value of a diagnostic algorithm using ICD-10 codes, medical examinations, and treatments for acute coronary syndrome (ACS), acute heart failure (HF), and acute aortic disease (AAD). We identified 409 patients with ACS (mean age 70.6 years; 24.7% female), 615 patients with acute HF (mean age 77.3 years; 46.2% female), and 122 patients with AAD (mean age 73.4 years; 36.1% female). The respective sensitivity and positive predictive value for the algorithm were 0.86 (95% confidence interval [CI] 0.82-0.89) and 0.95 (95% CI 0.92-0.97) for ACS; 0.74 (95% CI 0.70-0.77) and 0.79 (95% CI 0.76-0.83) for acute HF; and 0.86 (95% CI 0.79-0.92) and 0.83 (95% CI 0.76-0.89) for AAD. CONCLUSIONS The validity of the diagnostic algorithm for Japanese claims data was acceptable. Our results serve as a foundation for future studies on CVDs using nationwide administrative data.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center.,Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine.,Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine
| | | | - Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Daisuke Kamon
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University
| | - Manabu Horii
- Department of Cardiovascular Medicine, Nara City Hospital
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University
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29
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Suzuki Y, Kaneko H, Yano Y, Okada A, Fujiu K, Matsuoka S, Michihata N, Jo T, Takeda N, Morita H, Node K, Yasunaga H, Oparil S, Komuro I. The association of BP with cardiovascular outcomes in patients with dipstick proteinuria and preserved kidney function. Hypertens Res 2023; 46:856-867. [PMID: 36658302 DOI: 10.1038/s41440-022-01146-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 01/20/2023]
Abstract
Little is known about the relationship between blood pressure (BP) and incident cardiovascular disease (CVD) in people with proteinuria and a preserved estimated glomerular filtration rate (eGFR). This study sought to investigate the association of BP with CVD risk in adults with proteinuria and preserved eGFR. We studied 188,837 individuals with proteinuria and preserved eGFR ≥60 mL/min/1.73 m2. We categorized individuals who were not taking BP-lowering medications into four groups based on the 2017 American College of Cardiology/American Heart Association BP guideline and categorized those who were taking BP-lowering medications using the same BP ranges. The primary outcome was a composite CVD endpoint that included myocardial infarction, angina pectoris, stroke, and heart failure. Over a mean follow-up of 1,050 days, 7,039 CVD events were identified. Compared with normal BP, stage 1 hypertension (hazard ratio [HR]: 1.30, 95% confidence interval [95% CI]: 1.21-1.40) and stage 2 hypertension (HR: 2.17, 95% CI: 2.01-2.34) were associated with an increased risk for CVD events among medication-naïve individuals. Only stage 2 hypertension range (HR: 1.19, 95% CI: 1.02-1.38) was associated with an increased CVD event risk among people taking BP-lowering medications. Restricted cubic spline analysis showed that the risk of CVD events increased monotonically with BP at an SBP/DBP > 120/80 mmHg among medication-naïve individuals, but risk increased only at an SBP/DBP > 140/90 mmHg among individuals taking BP-lowering medications. In conclusion, among people with proteinuria and preserved eGFR, stage 1 and stage 2 hypertension were associated with a greater risk of CVD among medication-naïve individuals, whereas only stage 2 hypertension was associated with an increased CVD risk among those taking BP-lowering medications.
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Affiliation(s)
- Yuta Suzuki
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan. .,Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Yuichiro Yano
- Department of Advanced Epidemiology, NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan.,Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Satoshi Matsuoka
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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30
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Osawa T, Fujihara K, Yamada MH, Yaguchi Y, Sato T, Kitazawa M, Matsubayashi Y, Yamada T, Kodama S, Sone H. Association of the estimated glomerular filtration rate (eGFR) and/or proteinuria to predict the risk of initiation of dialysis in people with and without diabetes. Diabetol Int 2023; 14:86-93. [PMID: 36636159 PMCID: PMC9829938 DOI: 10.1007/s13340-022-00603-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 09/01/2022] [Indexed: 01/16/2023]
Abstract
Aims To determine the associations between combined urinary protein (UP) and a reduced estimated glomerular filtration rate (eGFR) and the risk of starting dialysis with or without diabetes mellitus (DM). Methods A nationwide database with claims data on 335,778 people with and without DM aged 19-72 years in Japan was used to elucidate the impact of the severities of UP and eGFR on starting dialysis. Initiation of dialysis was determined from claims using ICD-10 codes and medical procedures. Using multivariate Cox modeling, we investigated the severities of UP and eGFR to predict the initiation of dialysis with and without DM. Results Both eGFR < 60 and UP(+) were independent predictors for starting dialysis with and without DM, and their values exhibited a synergistic risk of dialysis. eGFR < 60 presented a nearly twofold risk for starting dialysis compared to UP(+) regardless of DM. Risk of starting dialysis was increased with UP(+) and eGFR ≥ 60 accompanied by DM although this association was not observed without DM. Those who had UP(-) and eGFR < 60 had a high risk of starting dialysis regardless of DM. Compared with DM(-)UP(-)eGFR ≥ 60, HRs for starting dialysis for DM(+)UP(+)eGFR ≥ 60, DM(+)UP(-)eGFR < 60 and DM(+)UP(+)eGFR < 60 significantly increased 17.7 (10.6-29.7), 25.5 (13.8-47.1) and 358.1 (239.1-536.5) times, respectively. Conclusions eGFR < 60 and UP(+) together presented an extremely high risk of dialysis especially with DM. UP( +) increased the risk of starting dialysis regardless of the eGFR with DM. Both patient education and a treatment strategy by physicians might be helpful to avoid the progression of renal failure.
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Affiliation(s)
- Taeko Osawa
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, Niigata 951-8510 Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, Niigata 951-8510 Japan
| | - Mayuko Harada Yamada
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, Niigata 951-8510 Japan
| | - Yuta Yaguchi
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, Niigata 951-8510 Japan
| | - Takaaki Sato
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, Niigata 951-8510 Japan
| | - Masaru Kitazawa
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, Niigata 951-8510 Japan
| | - Yasuhiro Matsubayashi
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, Niigata 951-8510 Japan
| | - Takaho Yamada
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, Niigata 951-8510 Japan
| | - Satoru Kodama
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, Niigata 951-8510 Japan
| | - Hirohito Sone
- Department of Internal Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi, Niigata, Niigata 951-8510 Japan
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31
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Suzuki Y, Kaneko H, Yano Y, Okada A, Itoh H, Matsuoka S, Yokota I, Imaizumi T, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Node K, Yasunaga H, Komuro I. Interaction of Blood Pressure and Glycemic Status in Developing Cardiovascular Disease: Analysis of a Nationwide Real-World Database. J Am Heart Assoc 2022; 12:e026192. [PMID: 36565182 PMCID: PMC9973580 DOI: 10.1161/jaha.122.026192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Hypertension and diabetes frequently coexist. However, little is known about the interaction between high blood pressure (BP) and hyperglycemia in the development of cardiovascular disease (CVD). Methods and Results We conducted an observational cohort study that included 3 336 363 patients (median age, 43 years old; men, 57.2%). People taking BP- or glucose-lowering medications or those with prior history of CVD were excluded. We defined stage 1 hypertension as having systolic BP of 130 to 139 mm Hg or diastolic BP of 80 to 89 mm Hg and stage 2 hypertension as having systolic BP of ≥140 mm Hg or diastolic BP of ≥90 mm Hg. We defined prediabetes as having fasting plasma glucose of 100 to 125 mg/dL and diabetes as having fasting plasma glucose of ≥126 mg/dL. Over a mean follow-up period of 1185 ± 942 days, 5665 myocardial infarction, 52 475 angina pectoris, 25 436 stroke, 54 508 heart failure, and 12 932 atrial fibrillation events occurred. The BP and fasting plasma glucose categories additively increased the risk of myocardial infarction, angina pectoris, stroke, heart failure, and atrial fibrillation. However, the relative risk of stage 1 and stage 2 hypertension developing into CVD was attenuated with deteriorating glycemic status. Similarly, the relative risk of prediabetes and diabetes developing into CVD was attenuated with increasing BP. For example, the relative risk reduction of stage 2 hypertension for heart failure was 53.5% in individuals with normal fasting plasma glucose, 46.4% in those with prediabetes, and 37.2% in those with diabetes. The robustness of our findings was confirmed using a multitude of sensitivity analyses. Conclusions Although hypertension and hyperglycemia additively increase the risk of developing CVD, the relative contribution of hypertension to the development of CVD decreased with deteriorating glycemic status and that of hyperglycemia was attenuated with increasing BP. Our results indicate a potential interaction between hypertension and hyperglycemia in the development of CVD.
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Affiliation(s)
- Yuta Suzuki
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan,Center for Outcomes Research and Economic Evaluation for HealthNational Institute of Public HealthSaitamaJapan
| | - Hidehiro Kaneko
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan,The Department of Advanced CardiologyThe University of TokyoTokyoJapan
| | - Yuichiro Yano
- Department of Advanced Epidemiology, NCD Epidemiology Research CenterShiga University of Medical ScienceShigaJapan,The Department of Family Medicine and Community HealthDuke UniversityDurhamNorth Carolina
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hidetaka Itoh
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Satoshi Matsuoka
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Isao Yokota
- Department of Biostatistics, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Takahiro Imaizumi
- Department of Advanced MedicineNagoya University HospitalNagoyaJapan
| | - Katsuhito Fujiu
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan,The Department of Advanced CardiologyThe University of TokyoTokyoJapan
| | - Nobuaki Michihata
- The Department of Health Services ResearchThe University of TokyoTokyoJapan
| | - Taisuke Jo
- The Department of Health Services ResearchThe University of TokyoTokyoJapan
| | - Norifumi Takeda
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Hiroyuki Morita
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Koichi Node
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
| | - Issei Komuro
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
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32
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Kaneko H, Suzuki Y, Ueno K, Okada A, Fujiu K, Matsuoka S, Michihata N, Jo T, Takeda N, Morita H, Kamiya K, Node K, Yasunaga H, Komuro I. Association of Life's Simple 7 with incident cardiovascular disease in 53 974 patients with cancer. Eur J Prev Cardiol 2022; 29:2324-2332. [PMID: 36056806 DOI: 10.1093/eurjpc/zwac195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023]
Abstract
AIMS Cancer survivors have a greater risk of cardiovascular disease (CVD). Although Life's Simple 7 is used for CVD risk stratification in a general population, its utility in cancer survivors remains unknown. We aimed to clarify the association of Life's Simple 7 with incident CVD among cancer survivors. Furthermore, we analyzed the relationship between the change in Life's Simple 7 and the subsequent CVD risk. METHODS AND RESULTS This retrospective observational study was conducted using the JMDC Claims Database, and we analyzed 53 974 patients with a prior history of breast, colorectal, or stomach cancer, which is a common cancer site in the Japanese population. The median age was 54 years, and 37.8% were men. We modified the original definition of Life's Simple 7 and identified the following ideal Life's Simple 7 cardiovascular health metrics: non-smoking, body mass index < 25 kg/m2, physical activity at goal, optimal dietary habits, untreated fasting plasma glucose < 100 mg/dL, untreated blood pressure < 120/80 mmHg, and untreated total cholesterol < 200 mg/dL. The primary endpoint was composite CVD outcome, including myocardial infarction, angina pectoris, stroke, and heart failure. Over a mean follow-up period of 975 ± 794 days, 3150 composite CVD outcomes were recorded. The risk of CVD events increased with a greater number of non-ideal Life's Simple 7. The hazard ratio per 1-point increase in non-ideal Life's Simple 7 was 1.15 [95% confidence interval (CI): 1.12-1.18). Furthermore, a 1-point increase in non-ideal Life's Simple 7 over 1 year was associated with subsequent CVD risk (hazard ratio: 1.12, 95% CI: 1.06-1.19). CONCLUSION Life's Simple 7 could be applicable for CVD risk stratification even among cancer survivors. Optimizing Life's Simple 7 may prevent the development of CVD in cancer survivors.
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Affiliation(s)
- Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,The Department of Advanced Cardiology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-8655 Tokyo, Japan
| | - Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kensuke Ueno
- Department of Rehabilitation Science, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.,The Department of Advanced Cardiology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-8655 Tokyo, Japan
| | - Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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33
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Fukasawa T, Seki T, Nakashima M, Kawakami K. Comparative effectiveness and safety of edoxaban, rivaroxaban, and apixaban in patients with venous thromboembolism: A cohort study. J Thromb Haemost 2022; 20:2083-2097. [PMID: 35748327 DOI: 10.1111/jth.15799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/30/2022] [Accepted: 06/19/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although several studies have compared the effectiveness and safety of rivaroxaban and apixaban in patients with venous thromboembolism (VTE), direct comparison of these drugs with edoxaban is lacking. OBJECTIVE We compared the effectiveness and safety of edoxaban, rivaroxaban, and apixaban in patients with VTE. PATIENTS/METHODS In this retrospective cohort study using a Japanese hospital administrative database, we identified three mutually exclusive groups of patients with VTE beginning treatment with edoxaban, rivaroxaban, or apixaban. Primary effectiveness outcome was recurrent VTE, and principal safety outcome was a composite of intracranial hemorrhage and gastrointestinal bleeding. Subjects were followed for up to 180 days. Baseline characteristics among groups were balanced using propensity score matching weights. RESULTS Three thousand three hundred sixty-nine edoxaban, 1592 rivaroxaban, and 1998 apixaban initiators were identified. There were no significant differences among the three drugs in the prevention of recurrent VTE (adjusted incidence rate ratio [aIRR], 0.77; 95% confidence interval [CI], 0.45-1.30 for edoxaban vs. rivaroxaban; aIRR, 0.92; 95% CI, 0.54-1.56 for edoxaban vs. apixaban; and aIRR, 1.20; 95% CI, 0.69-2.10 for rivaroxaban vs. apixaban), or in the risk of intracranial hemorrhage or gastrointestinal bleeding (aIRR, 1.57, 95% CI, 0.85-2.90 for edoxaban vs. rivaroxaban; aIRR, 1.30, 95% CI, 0.76-2.23 for edoxaban vs. apixaban; and aIRR, 0.83, 95% CI, 0.42-1.64 for rivaroxaban vs. apixaban). CONCLUSIONS In routine care, edoxaban, rivaroxaban, and apixaban appear to have similar effectiveness and safety in the treatment of VTE.
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Affiliation(s)
- Toshiki Fukasawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Tomotsugu Seki
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masayuki Nakashima
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Ohtsu H, Shimomura A, Miyazaki S, Yonemoto N, Ueda S, Shimizu C, Sase K. Cardiotoxicity of adjuvant chemotherapy with trastuzumab: a Japanese claim-based data analysis. Open Heart 2022; 9:openhrt-2022-002053. [PMID: 35995458 PMCID: PMC9403121 DOI: 10.1136/openhrt-2022-002053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/05/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Adjuvant chemotherapy with trastuzumab improves the postoperative life expectancy of women with early-stage breast cancer. Although trastuzumab is reportedly cardiotoxic, quantification based on real-world evidence is lacking. Therefore, in this study, we aimed to analyse trastuzumab cardiotoxicity using a nationwide claim-based database. METHODS In this retrospective study, we used data from a nationwide claims database (Japan Medical Data Center, Tokyo, Japan) under the universal healthcare system. Women with breast cancer who underwent initial surgery were included. Patients with recurrent or advanced-stage breast cancer, with a history of heart failure, receiving neoadjuvant chemotherapy or a preoperative history of less than 6 months were excluded. Propensity score (PS) was calculated using logistic regression based on age, cardiovascular risk factors, radiotherapy and concomitant anthracyclines (AC). RESULTS We identified 12 060 eligible patients (mean age 50.8±8.56 years) between January 2010 and December 2019. After 1:2 PS matching (trastuzumab users, TZ, n=1005; non-users, NT, n=2010), Cox proportional hazards model analysis showed that the rate of heart failure development within 18 months postoperative was significantly higher in the TZ group than in the NT group (adjusted HR 2.28, 95% CI 1.38 to 3.77). Baseline cardiac evaluation in the combined AC/TZ cases was 27.2% preoperative, 66.0% pre-AC and 86.6% pre-TZ, respectively. CONCLUSION Trastuzumab cardiotoxicity remained relevant in the claim-based analysis adjusted for AC effects. Further collaborative studies in cardio-oncology with real-world data are warranted to improve the rate of baseline cardiovascular risk assessment in patients with cancer scheduled for cardiotoxic cancer treatment.
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Affiliation(s)
- Hiroshi Ohtsu
- Leading Center for the Development and Research of Cancer Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.,Institute for Medical Regulatory Science, Waseda University, Shinjuku-ku, Tokyo, Japan.,Clinical Pharmacology and Regulatory Sciences, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Akihiko Shimomura
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Tokyo, Japan
| | - Sakiko Miyazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.,Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Shinichiro Ueda
- Department of Clinical Pharmacology, University of the Ryukyus Faculty of Medicine Graduate School of Medicine, Nakagami-gun, Okinawa, Japan
| | - Chikako Shimizu
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Sase
- Institute for Medical Regulatory Science, Waseda University, Shinjuku-ku, Tokyo, Japan .,Clinical Pharmacology and Regulatory Sciences, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Fujioka I, Ohtsu H, Yonemoto N, Sase K, Murashima A. Association between prenatal exposure to antidepressants and neonatal morbidity: An analysis of real-world data from a nationwide claims database in Japan. J Affect Disord 2022; 310:60-67. [PMID: 35490881 DOI: 10.1016/j.jad.2022.04.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression during pregnancy is relatively undertreated; however, the relationship between prenatal exposure to antidepressants and neonatal outcomes remains controversial. METHODS This retrospective cohort study used a Japanese nationwide claims database. Data of 114,359 singletons born between January 2005 and November 2019 were used to evaluate the relationship between prenatal exposure to antidepressants and neonatal morbidity. RESULTS Of 2892 mothers with a history of depression before delivery, 352 (12.1%) received prescriptions within three months before delivery (MP3), and 2540 did not (non-MP3). The participants were propensity score matched (PSM) in a ratio of 1:3 using logistic regression (MP3_PSM [n = 351] vs non-MP3_PSM [n = 1052]), and maternal prescriptions of antidepressants within three months before delivery were associated with neonatal morbidity indicators, including admission to the neonatal intensive care unit (NICU) (15.7 vs. 9.1%, odds ratio (OR) 1.9 [95% confidence interval (CI): 1.3-2.6]), poor neonatal adaptation syndrome (6.0 vs 1.0%, OR 6.6 [95% CI: 3.1-14.2]), transient tachycardia (15.7 vs. 6.7%, OR 2.6 [95% CI: 1.8-3.8]), and meconium aspiration syndrome (3.1 vs 0.7%, OR 4.8 [95% CI, 1.9-12.5]). There were no significant differences in the long-term duration of stay at the NICU (>15 days). LIMITATIONS Confounding factors may remain even after the propensity matching. CONCLUSION Maternal prescription of antidepressants within three months before delivery was associated with increased admission to the NICU. However, the absolute risk of severe neonatal morbidity was low. Therefore, collaborative care for prenatal depression and the neonatal intensive care is warranted.
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Affiliation(s)
- Izumi Fujioka
- The Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Japan; Department of Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University, Japan.
| | - Hiroshi Ohtsu
- Department of Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University, Japan; Institute for Medical Regulatory Science, Organization for University Research Initiatives, Waseda University, Japan; Department of Leading Center for the Development and Research of Cancer Medicine, Juntendo University, Japan
| | - Naohiro Yonemoto
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan; Department of Public Health, Graduate School of Medicine, Juntendo University, Japan
| | - Kazuhiro Sase
- Department of Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University, Japan; Institute for Medical Regulatory Science, Organization for University Research Initiatives, Waseda University, Japan
| | - Atsuko Murashima
- The Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Japan; Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Japan
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Kimura Y, Ohtsu H, Yonemoto N, Azuma N, Sase K. Endovascular versus open repair in patients with abdominal aortic aneurysm: a claims-based data analysis in Japan. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000131. [PMID: 35989874 PMCID: PMC9345055 DOI: 10.1136/bmjsit-2022-000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022] Open
Abstract
ObjectivesEndovascular aortic repair (EVAR) evolved through competition with open aortic repair (OAR) as a safe and effective treatment option for appropriately selected patients with abdominal aortic aneurysm (AAA). Although endoleaks are the most common reason for post-EVAR reintervention, compliance with lifelong regular follow-up imaging remains a challenge.DesignRetrospective data analysis.SettingThe Japan Medical Data Center (JMDC), a claims database with anonymous data linkage across hospitals, consists of corporate employees and their families of ≤75 years of age.ParticipantsThe analysis included participants in the JMDC who underwent EVAR or OAR for intact (iAAA) or ruptured (rAAA) AAA. Patients with less than 6 months of records before the aortic repair were excluded.Main outcome measuresOverall survival and reintervention rates.ResultsWe identified 986 cases (837 iAAA and 149 rAAA) from JMDC with first aortic repairs between January 2015 and December 2020. The number of patients, median age (years (IQR)), follow-up (months) and post-procedure CT scan (times per year) were as follows: iAAA (OAR: n=593, 62.0 (57.0–67.0), 26.0, 1.6, EVAR: n=244, 65.0 (31.0–69.0), 17.0, 2.2), rAAA (OAR: n=110, 59.0 (53.0–59.0), 16.0, 2.1, EVAR: n=39, 62.0 (31.0–67.0), 18.0, 2.4). Reintervention rate was significantly higher among EVAR than OAR in rAAA (15.4% vs 8.2%, p=0.04). In iAAA, there were no group difference after 5 years (7.8% vs 11.0%, p=0.28), even though EVAR had initial advantage. There were no differences in mortality rate between EVAR and OAR for either rAAA or iAAA.ConclusionsClaims-based analysis in Japan showed no statistically significant difference in 5-year survival rates of the OAR and EVAR groups. However, the reintervention rate of EVAR in rAAA was significantly higher, suggesting the need for regular post-EVAR follow-up with imaging. Therefore, international collaborations for long-term outcome studies with real-world data are warranted.
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Affiliation(s)
- Yuki Kimura
- Clinical Pharmacology and Regulatory Science, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan
| | - Hiroshi Ohtsu
- Clinical Pharmacology and Regulatory Science, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan
- Leading Center for the Development and Research of Cancer Medicine, Juntendo University, Bunkyo-ku, Japan
- Institute for Medical Regulatory Science, Organization for University Research Initatives, Waseda University, Wakamatsu-cho, Shinjuku-ku, Japan
| | - Naohiro Yonemoto
- Department of Public Health, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Midorigaoka higashi Asahikawa, Japan
| | - Kazuhiro Sase
- Clinical Pharmacology and Regulatory Science, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan
- Institute for Medical Regulatory Science, Organization for University Research Initatives, Waseda University, Wakamatsu-cho, Shinjuku-ku, Japan
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Matsubayashi Y, Fujihara K, Yamada-Harada M, Mitsuma Y, Sato T, Yaguchi Y, Osawa T, Yamamoto M, Kitazawa M, Yamada T, Kodama S, Sone H. Impact of metabolic syndrome and metabolic dysfunction-associated fatty liver disease on cardiovascular risk by the presence or absence of type 2 diabetes and according to sex. Cardiovasc Diabetol 2022; 21:90. [PMID: 35655263 PMCID: PMC9161475 DOI: 10.1186/s12933-022-01518-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/28/2022] [Indexed: 12/17/2022] Open
Abstract
Background To determine the impact of metabolic syndrome (MetS) and/or metabolic dysfunction-associated fatty liver disease (MAFLD), which are pathophysiologically similar and include insulin resistance, on the development of new-onset cardiovascular disease with and without type 2 diabetes and according to sex. Methods This study included 570,426 individuals without a history of cardiovascular disease who were enrolled in a nationwide claims database from 2008 to 2016 and were classified by the presence or absence of MetS and/or MAFLD stratified by the presence or absence of type 2 diabetes and sex. The fatty liver index was used to determine the presence or absence of fatty liver that required a diagnosis of MAFLD. Risks of developing coronary artery disease (CAD) and cerebrovascular disease (CVD) in each category were analyzed using a multivariate Cox proportional hazard model. Results During a median follow-up of 5.2 years, 2252 CAD and 3128 CVD events occurred. Without type 2 diabetes the hazard ratio (HR) (95% CI) for CAD/CVD compared with neither MAFLD nor MetS was 1.32 (1.17–1.50)/1.41(1.28–1.57) for MAFLD only (without MetS), 1.78 (1.22–2.58)/1.66 (1.34–2.06) for MetS only (without MAFLD), and 2.10 (1.84–2.39)/1.73 (1.54–1.95) for MAFLD + MetS. For those with type 2 diabetes, the HR for CAD for MAFLD only (compared with neither MAFLD nor MetS) was 1.29 (1.06–1.58), for MetS only 1.34 (0.84–2.13), and for MAFLD + MetS 1.22 (1.02–1.47). For CVD, there was a significant increase in HR only in MAFLD + MetS [1.44 (1.18–1.76)]. The results of the analysis stratified by sex showed that MAFLD had a greater impact in men, and MetS had a greater impact in women regarding the development of CAD. Conclusions Distinguishing between MetS and/or MAFLD in the presence or absence of type 2 diabetes and according to sex may aid in accurately identifying patients at high risk of cardiovascular disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01518-4.
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Suzuki Y, Kaneko H, Okada A, Itoh H, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Kamiya K, Matsunaga A, Ako J, Node K, Yasunaga H, Komuro I. Comparison of cardiovascular outcomes between SGLT2 inhibitors in diabetes mellitus. Cardiovasc Diabetol 2022; 21:67. [PMID: 35585590 PMCID: PMC9115977 DOI: 10.1186/s12933-022-01508-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background There have been scarce data comparing cardiovascular outcomes between individual sodium-glucose cotransporter-2 (SGLT2) inhibitors. We aimed to compare the subsequent cardiovascular risk between individual SGLT2 inhibitors. Methods We analyzed 25,315 patients with diabetes mellitus (DM) newly taking SGLT2 inhibitors (empagliflozin: 5302, dapagliflozin: 4681, canagliflozin: 4411, other SGLT2 inhibitors: 10,921). We compared the risks of developing heart failure (HF), myocardial infarction (MI), angina pectoris (AP), stroke, and atrial fibrillation (AF) between individual SGLT2 inhibitors. Results Median age was 52 years, and 82.5% were men. The median fasting plasma glucose and HbA1c levels were 149 (Q1-Q3:127–182) mg/dL and 7.5 (Q1-Q3:6.9–8.6) %. During a mean follow-up of 814 ± 591 days, 855 HF, 143 MI, 815 AP, 340 stroke, and 139 AF events were recorded. Compared with empagliflozin, the risk of developing HF, MI, AP, stroke, and AF was not significantly different in dapagliflozin, canagliflozin, and other SGLT inhibitors. For developing HF, compared with empagliflozin, hazard ratios of dapagliflozin, canagliflozin, and other SGLT2 inhibitors were 1.02 (95% confidence interval [CI] 0.81–1.27), 1.08 (95% CI 0.87–1.35), and 0.88 (95% CI 0.73–1.07), respectively. Wald tests showed that there was no significant difference in the risk of developing HF, MI, AP, stroke, and AF among individual SGLT2 inhibitors. We confirmed the robustness of these results through a multitude of sensitivity analyses. Conclusion The risks for subsequent development of HF, MI, AP, stroke, and AF were comparable between individual SGLT2 inhibitors. This is the first study comparing the wide-range cardiovascular outcomes of patients with DM treated with individual SGLT2 inhibitors using large-scale real-world data. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01508-6.
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Affiliation(s)
- Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Associations of kidney tests at medical facilities and health checkups with incidence of end-stage kidney disease: a retrospective cohort study. Sci Rep 2021; 11:20717. [PMID: 34702949 PMCID: PMC8548563 DOI: 10.1038/s41598-021-99971-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022] Open
Abstract
No study has assessed the association between no health checkup and end-stage kidney disease (ESKD). This retrospective cohort study, including 69,147 adults aged ≥ 40 years in Japan who were insured by the National Health Insurance and the Late-Stage Medical Care System for the Elderly, assessed the associations of kidney tests at medical facilities and health checkups with incident ESKD. The main exposure was the histories of kidney tests using dipstick urinalysis and/or serum creatinine measurement at medical facilities and checkups in the past year: “checkups,” “no kidney test (without checkup),” and “kidney tests (without checkup)” groups. During the median observational period of 5.0 years, ESKD was observed in 246 (0.8%) men and 124 (0.3%) women. The “no kidney test” group was associated with ESKD in men (adjusted subhazard ratio of “no kidney test” vs. “checkups”: 1.66 [95% confidence interval, 1.04–2.65], but not in women. Age-specific subgroup analyses identified the “no kidney test” group as a high-risk population of ESKD in elderly men (1.30 [0.70–2.41] and 2.72 [1.39–5.33] in men aged 40–74 and ≥ 75 years, respectively). Elderly men with no kidney test at medical facilities and no health checkup were at higher risk of ESKD.
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Oe M, Fujihara K, Harada-Yamada M, Osawa T, Kitazawa M, Matsubayashi Y, Sato T, Yaguchi Y, Iwanaga M, Seida H, Yamada T, Sone H. Impact of prior cerebrovascular disease and glucose status on incident cerebrovascular disease in Japanese. Cardiovasc Diabetol 2021; 20:174. [PMID: 34479567 PMCID: PMC8417951 DOI: 10.1186/s12933-021-01367-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although both a history of cerebrovascular disease (CVD) and glucose abnormality are risk factors for CVD, few large studies have examined their association with subsequent CVD in the same cohort. Thus, we compared the impact of prior CVD, glucose status, and their combinations on subsequent CVD using real-world data. METHODS This is a retrospective cohort study including 363,627 men aged 18-72 years followed for ≥ 3 years between 2008 and 2016. Participants were classified as normoglycemia, borderline glycemia, or diabetes defined by fasting plasma glucose, HbA1c, and antidiabetic drug prescription. Prior and subsequent CVD (i.e. ischemic stroke, transient ischemic attack, and non-traumatic intracerebral hemorrhage) were identified according to claims using ICD-10 codes, medical procedures, and questionnaires. RESULTS Participants' mean age was 46.1 ± 9.3, and median follow up was 5.2 (4.2, 6.7) years. Cox regression analysis showed that prior CVD + conferred excess risk for CVD regardless of glucose status (normoglycemia: hazard ratio (HR), 8.77; 95% CI 6.96-11.05; borderline glycemia: HR, 7.40, 95% CI 5.97-9.17; diabetes: HR, 5.73, 95% CI 4.52-7.25). Compared with normoglycemia, borderline glycemia did not influence risk of CVD, whereas diabetes affected subsequent CVD in those with CVD- (HR, 1.50, 95% CI 1.34-1.68). In CVD-/diabetes, age, current smoking, systolic blood pressure, high-density lipoprotein cholesterol, and HbA1c were associated with risk of CVD, but only systolic blood pressure was related to CVD risk in CVD + /diabetes. CONCLUSIONS Prior CVD had a greater impact on the risk of CVD than glucose tolerance and glycemic control. In participants with diabetes and prior CVD, systolic blood pressure was a stronger risk factor than HbA1c. Individualized treatment strategies should consider glucose tolerance status and prior CVD.
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Affiliation(s)
- Momoko Oe
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
- Kowa Company. Ltd, 10-4 Nihonbashi-honcho 3-chome, Chuo-ku, Tokyo, 103-0023, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan.
| | - Mayuko Harada-Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Taeko Osawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Masaru Kitazawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Yasuhiro Matsubayashi
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Takaaki Sato
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Yuta Yaguchi
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Midori Iwanaga
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Hiroyasu Seida
- JMDC Inc, 2-5-5 Shiba Daimon, Minato-ku, Tokyo, 105-0012, Japan
| | - Takaho Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
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