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Saito I, Yamagishi K, Kokubo Y, Yatsuya H, Muraki I, Iso H, Inoue M, Tsugane S, Sawada N. Lifetime Risk of Incident Coronary Heart Disease, Stroke, and Cardiovascular Disease: The Japan Public Health Center-Based Prospective Study. J Atheroscler Thromb 2024:64934. [PMID: 38972723 DOI: 10.5551/jat.64934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
AIM The constellation of cardiovascular disease (CVD) risk factors greatly impacts the lifetime risk (LTR) of incident CVD, but the LTR has not been thoroughly evaluated in the Japanese population. METHODS We conducted a prospective study involving a total of 25,896 individuals 40-69 years old without a history of CVD in 1995 (Cohort I) and 1993-1994 (Cohort II) in Japan. CVD risk factors (blood pressure, non-high-density lipoprotein [HDL] cholesterol levels, smoking status, and glucose concentrations) were used to stratify them by risk. The sex-specific LTR of incident coronary heart disease, stroke, atherosclerotic CVD, and total CVD were estimated for participants 45 years old in the 4 risk categories with the cumulative incidence rate, adjusting for the competing risk of death. RESULTS We found apparent differences in the LTR of total CVD according to the risk stratification. Individuals with ≥ 2 of the risk factors of blood pressure ≥ 140/90 mmHg or treated, non-HDL cholesterol level ≥ 170 mg/dL or treated, current smoker, and diabetes had substantially higher adjusted LTRs of CVD than those in other groups, with a LTR of 26.5% (95% confidence interval, 24.0%-29.0%) for men and 15.3% (13.1%-17.5%) for women at 45 years. The LTR of incident stroke was the highest among CVDs, and the presence of hypertension and diabetes mellitus strongly influenced the LTR of total CVD. CONCLUSION The impact of risk accumulation on LTR of CVD was greater in men, and 1 in 4 men with ≥ 2 major risk factors at 45 years of age developed CVD in their lifetime.
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Affiliation(s)
- Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Isao Muraki
- Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | - Hiroyasu Iso
- Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
- The Institute for Global Health Policy, National Center for Global Health and Medicine
| | - Manami Inoue
- Division of Cohort Research, National Cancer Center Institute for Cancer Control
- Division of Prevention, National Cancer Center Institute for Cancer Control
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control
- International University of Health and Welfare Graduate School of Public Health
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control
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2
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Ho VS, Cenzer IS, Nguyen BT, Lee SJ. Time to benefit for stroke reduction after blood pressure treatment in older adults: A meta-analysis. J Am Geriatr Soc 2022; 70:1558-1568. [PMID: 35137952 PMCID: PMC9106841 DOI: 10.1111/jgs.17684] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/24/2021] [Accepted: 01/09/2022] [Indexed: 12/19/2022]
Abstract
Background Hypertension treatment in older adults can decrease mortality, cardiovascular events, including heart failure, cognitive impairment, and stroke risk, but may also lead to harms such as syncope and falls. Guidelines recommend targeting preventive interventions with immediate harms and delayed benefits to patients whose life expectancy exceeds the intervention's time to benefit (TTB). Our objective was to estimate a meta‐analyzed TTB for stroke prevention after initiation of more intensive hypertension treatment in adults aged ≥65 years. Methods Studies were identified from two Cochrane systematic reviews and a search of MEDLINE and Google Scholar for subsequent publications until August 31, 2021. We abstracted data from randomized controlled trials comparing standard (untreated, placebo, or less intensive treatment) to more intensive treatment groups in older adults (mean age ≥ 65 years). We fit Weibull survival curves and used a random‐effects model to estimate the pooled annual absolute risk reduction (ARR) between control and intervention groups. We applied Markov chain Monte Carlo methods to determine the time to ARR thresholds (0.002, 0.005, and 0.01) for a first stroke. Results Nine trials (n = 38,779) were identified. The mean age ranged from 66 to 84 years and study follow‐up times ranged from 2.0 to 5.8 years. We determined that 1.7 (95%CI: 1.0–2.9) years were required to prevent 1 stroke for 200 persons (ARR = 0.005) receiving more intensive hypertensive treatment. Heterogeneity was found across studies, with those focusing on tighter systolic blood pressure control (SBP < 150 mmHg) showing longer TTB. For example, in the SPRINT study (baseline SBP = 140 mmHg, achieved SBP = 121 mmHg), the TTB to avoid 1 stroke for 200 patients treated was 5.9 years (95%CI: 2.2–13.0). Conclusions More intensive hypertension treatment in 200 older adults prevents 1 stroke after 1.7 years. Given the heterogeneity across studies, the TTB estimates from individual studies may be more relevant for clinical decision‐making than our summary estimate. See related Editorial by Mark A. Supiano in this issue.
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Affiliation(s)
- Vanessa S Ho
- College of Medicine, California Northstate University, Elk Grove, California, USA.,Medical Student Training in Aging Research (MSTAR) Program, Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA
| | - Irena S Cenzer
- Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA
| | - Brian T Nguyen
- Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Northern California Institute for Research and Education, San Francisco, California, USA
| | - Sei J Lee
- Medical Student Training in Aging Research (MSTAR) Program, Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.,Division of Geriatrics, School of Medicine, University of California, San Francisco, California, USA.,Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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3
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Iso H, Cui R, Takamoto I, Kiyama M, Saito I, Okamura T, Miyamoto Y, Higashiyama A, Kiyohara Y, Ninomiya T, Yamada M, Nakagawa H, Sakurai M, Shimabukuro M, Higa M, Shimamoto K, Saito S, Daimon M, Kayama T, Noda M, Ito S, Yokote K, Ito C, Nakao K, Yamauchi T, Kadowaki T. Risk Classification for Metabolic Syndrome and the Incidence of Cardiovascular Disease in Japan With Low Prevalence of Obesity: A Pooled Analysis of 10 Prospective Cohort Studies. J Am Heart Assoc 2021; 10:e020760. [PMID: 34796738 PMCID: PMC9075363 DOI: 10.1161/jaha.121.020760] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background It is uncertain whether risk classification under the nationwide program on screening and lifestyle modification for metabolic syndrome captures well high‐risk individuals who could benefit from lifestyle interventions. We examined the validity of risk classification by linking the incidence of cardiovascular disease (CVD). Methods and Results Individual‐level data of 29 288 Japanese individuals aged 40 to 74 years without a history of CVD from 10 prospective cohort studies were used. Metabolic syndrome was defined as the presence of high abdominal obesity and/or overweight plus risk factors such as high blood pressure, high triglyceride or low high‐density lipoprotein cholesterol levels, and high blood glucose levels. The risk categories for lifestyle intervention were information supply only, motivation‐support intervention, and intensive support intervention. Sex‐ and age‐specific hazard ratios and population attributable fractions of CVD, which were also further adjusted to consider non–high density lipoprotein cholesterol levels, were estimated with reference to nonobese/overweight individuals, using Cox proportional hazard regression. Since the reference category included those with risk factors, we set a supernormal group (nonobese/overweight with no risk factor) as another reference. We documented 1023 incident CVD cases (565 men and 458 women). The adjusted CVD risk was 60% to 70% higher in men and women aged 40 to 64 years receiving an intensive support intervention, and 30% higher in women aged 65 to 74 years receiving a motivation‐support intervention, compared with nonobese/overweight individuals. The population attributable fractions in men and women aged 40 to 64 years receiving an intensive support intervention were 17.7% and 6.6%, respectively, while that in women aged 65 to 74 years receiving a motivation‐support intervention was 9.4%. Compared with the supernormal group, nonobese/overweight individuals with risk factors had similar hazard ratios and population attributable fractions as individuals with metabolic syndrome. Conclusions Similar CVD excess and attributable risks among individuals with metabolic syndrome components in the absence and presence of obesity/overweight imply the need for lifestyle modification in both high‐risk groups.
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Affiliation(s)
- Hiroyasu Iso
- Public Health Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Renzhe Cui
- Public Health Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Iseki Takamoto
- Department of Diabetes and Metabolic Diseases Graduate School of Medicine The University of Tokyo Hospital Tokyo Japan.,Department of Diabetes, Metabolism and Endocrinology Ichikawa Hospital International University of Health and Welfare Chiba Japan
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention Osaka Japan
| | - Isao Saito
- Department of Public Health and Epidemiology Faculty of Medicine Oita University Oita Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health Keio University School of Medicine Tokyo Japan
| | - Yoshihiro Miyamoto
- Preventive Cardiology National Cerebral and Cardiovascular Center Osaka Japan
| | - Aya Higashiyama
- Preventive Cardiology National Cerebral and Cardiovascular Center Osaka Japan
| | - Yutaka Kiyohara
- Hisayama Research Institute for Lifestyle Diseases Fukuoka Japan.,Department of Epidemiology and Public Health Graduate School of Medicine Kyushu University Fukuoka Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health Graduate School of Medicine Kyushu University Fukuoka Japan
| | - Michiko Yamada
- Department of Clinical Studies Radiation Effects Research Foundation Hiroshima Japan
| | - Hideaki Nakagawa
- Department of Social and Environmental Medicine Kanazawa Medical University Ishikawa Japan
| | - Masaru Sakurai
- Department of Social and Environmental Medicine Kanazawa Medical University Ishikawa Japan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology and Metabolism Fukushima Medical University Fukushima Japan
| | - Moritake Higa
- Diabetes and Life-Style Related Disease Center Tomishiro Central Hospital Okinawa Japan
| | | | | | - Makoto Daimon
- Global Center of Excellence Program Study Group Yamagata University School of Medicine Yamagata Japan.,Department of Endocrinology and Metabolism Hirosaki University Graduate School of Medicine Aomori Japan
| | - Takamasa Kayama
- Department of Advanced Medicine Yamagata University School of Medicine Yamagata Japan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism and Endocrinology Ichikawa Hospital International University of Health and Welfare Chiba Japan
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular Medicine Department of Medicine Tohoku University Hospital Miyagi Japan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology Graduate School of Medicine Chiba University Chiba Japan
| | - Chikako Ito
- Grand Tower Medical Court Life Care Clinic Hiroshima Japan
| | - Kazuwa Nakao
- Medical Innovation Center Kyoto University Graduate School of Medicine Kyoto Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases Graduate School of Medicine The University of Tokyo Hospital Tokyo Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases Graduate School of Medicine The University of Tokyo Hospital Tokyo Japan.,President Tranomon Hospital Tokyo Japan
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4
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Nakayama S, Satoh M, Metoki H, Murakami T, Asayama K, Hara A, Hirose T, Kanno A, Inoue R, Tsubota-Utsugi M, Kikuya M, Mori T, Hozawa A, Imai Y, Ohkubo T. Lifetime risk of stroke stratified by chronic kidney disease and hypertension in the general Asian population: the Ohasama study. Hypertens Res 2021; 44:866-873. [PMID: 33742168 DOI: 10.1038/s41440-021-00635-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/04/2020] [Accepted: 01/20/2021] [Indexed: 11/09/2022]
Abstract
Lifetime risk (LTR) evaluates the absolute risk of developing a disease during the remainder of one's life. It can be a useful tool, enabling the general public to easily understand their risk of stroke. No study has been performed to determine the LTR of cardiovascular disease in patients with chronic kidney disease (CKD) with or without hypertension; therefore, we performed this study in an Asian population. We followed 1525 participants (66.0% women; age 63.1 years) in the general population of Ohasama, Japan. We defined CKD as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and/or proteinuria. Hypertension was defined as a systolic/diastolic blood pressure ≥140/≥90 mmHg and/or the use of antihypertensive medication. We calculated the sex-specific LTR of stroke adjusted for the competing risk of death. During the mean follow-up period of 16.5 years, a first stroke occurred in 238 participants. The 10-year risk of stroke at the age of 45 years was 0.0% for men and women. The LTRs of stroke at the index age of 45 years (men/women) were 20.9%/14.5% for participants without CKD and hypertension, 34.1%/29.8% for those with CKD but not hypertension, 37.9%/27.3% for those with hypertension but not CKD, and 38.4%/36.4% for those with CKD and hypertension. The LTRs of stroke tended to be higher in younger participants than in older participants with CKD and/or hypertension. CKD contributed to the LTR of stroke, as did hypertension. The prevention of CKD and hypertension can reduce the LTR of stroke, especially in young populations.
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Affiliation(s)
- Shingo Nakayama
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan. .,Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan.,Department of Community Medical Support, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Takahisa Murakami
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Department of Community Medical Support, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kei Asayama
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan.,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Azusa Hara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Takuo Hirose
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Atsuhiro Kanno
- Division of Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ryusuke Inoue
- Medical Information Technology Center, Tohoku University Hospital, Sendai, Japan
| | - Megumi Tsubota-Utsugi
- Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine, Morioka, Japan
| | - Masahiro Kikuya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Takefumi Mori
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Takayoshi Ohkubo
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan.,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
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5
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Satoh M, Ohkubo T, Asayama K, Murakami Y, Sugiyama D, Waki T, Tanaka-Mizuno S, Yamada M, Saitoh S, Sakata K, Irie F, Sairenchi T, Ishikawa S, Kiyama M, Okayama A, Miura K, Imai Y, Ueshima H, Okamura T. A Combination of Blood Pressure and Total Cholesterol Increases the Lifetime Risk of Coronary Heart Disease Mortality: EPOCH-JAPAN. J Atheroscler Thromb 2021; 28:6-24. [PMID: 32269207 PMCID: PMC7875142 DOI: 10.5551/jat.52613] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/08/2020] [Indexed: 12/19/2022] Open
Abstract
AIM Lifetime risk (LTR) indicates the absolute risk of disease during the remainder of an individual's lifetime. We aimed to assess the LTRs for coronary heart disease (CHD) mortality associated with blood pressure (BP) and total cholesterol levels in an Asian population using a meta-analysis of individual participant data because no previous studies have assessed this risk. METHODS We analyzed data from 105,432 Japanese participants in 13 cohorts. Apart from grade 1 and 2-3 hypertension groups, we defined "normal BP" as systolic/diastolic BP <130/<80 mmHg and "high BP" as 130-139/80-89 mmHg. The sex-specific LTR was estimated while considering the competing risk of death. RESULTS During the mean follow-up period of 15 years (1,553,735 person-years), 889 CHD deaths were recorded. The 10-year risk of CHD mortality at index age 35 years was ≤ 0.11%, but the corresponding LTR was ≥ 1.84%. The LTR of CHD at index age 35 years steeply increased with an increase in BP of participants with high total cholesterol levels [≥ 5.7 mmol/L (220 mg/dL)]. This risk was 7.73%/5.77% (95% confidence interval: 3.53%-10.28%/3.83%-7.25%) in men/women with grade 2-3 hypertension and high total cholesterol levels. In normal and high BP groups, the absolute differences in LTRs between the low and high total cholesterol groups were ≤ 0.25% in men and ≤ 0.40% in women. CONCLUSIONS High total cholesterol levels contributed to an elevated LTR of CHD mortality in hypertensive individuals. These findings could help guide high-risk young individuals toward initiating lifestyle changes or treatments.
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Affiliation(s)
- Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Yoshitaka Murakami
- Department of Medical Statistics, Toho University School of Medicine, Tokyo, Japan
| | - Daisuke Sugiyama
- Faculty of Nursing and Medical Care, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Waki
- Department of Medical Statistics, Shiga University of Medical Science, Otsu, Japan
| | | | - Michiko Yamada
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Shigeyuki Saitoh
- Division of Medical and Behavioral Subjects, Sapporo Medical University School of Health Sciences, Sapporo, Japan
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Fujiko Irie
- Department of Health and Welfare, Ibaraki Prefectural Office, Mito, Japan
| | - Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan
| | - Shizukiyo Ishikawa
- Medical education center, Jichi medical university, Shimotsuke, Tochigi, Japan
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
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6
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Takahashi N, Misumi M, Murakami H, Niwa Y, Ohishi W, Inaba T, Nagamachi A, Suzuki G. Association between low doses of ionizing radiation, administered acutely or chronically, and time to onset of stroke in a rat model. JOURNAL OF RADIATION RESEARCH 2020; 61:666-673. [PMID: 32748938 PMCID: PMC7482173 DOI: 10.1093/jrr/rraa050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/10/2020] [Indexed: 06/10/2023]
Abstract
Exposure to high-doses of ionizing radiation has been reported to be associated with the risk of stroke. However, risks associated with lower dose exposures remain unclear, and there is little information available for the risk modification according to the dose-rate. There are few studies using animal models which might be able to provide complementary information on this association. In this study, the male stroke-prone spontaneously hypertensive rat (SHRSP) was used as a model animal. The rats were acutely irradiated with doses between 0 and 1.0 Gy or chronically irradiated with a cumulative dose of 0.5 or 1.0 Gy (at a dose rate of 0.05 or 0.1 Gy/day, respectively). The onset time of stroke related symptoms in SHRSP was used as an endpoint for evaluating the effects of low dose and the low dose-rate gamma-ray exposures. With respect to acute exposure, the time to the onset of stroke in the irradiated rats suggested the presence of a threshold around 0.1 Gy. For the low dose-rate chronically exposed, no significant increase in stroke symptom was observed. These findings are novel and demonstrate that the SHRSP system can be used to determine the association between the risk of stroke and radiation exposure with high sensitivity. Moreover, these studies provide important information regarding the association between the low dose and low dose-rate radiation exposure and circulatory diseases, especially stroke.
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Affiliation(s)
| | - Munechika Misumi
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Hideko Murakami
- Department of Molecular Biosciences, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Yasuharu Niwa
- Department of Molecular Biosciences, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Waka Ohishi
- Clinical Studies (Hiroshima), Radiation Effects Research Foundation (RERF), Hiroshima, Japan
| | - Toshiya Inaba
- Department of Molecular Oncology and Leukemia Program Project, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Akiko Nagamachi
- Department of Molecular Oncology and Leukemia Program Project, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Gen Suzuki
- International University of Health and Welfare Clinic, Otawara, Tochigi, Japan
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7
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Impact of hypertension stratified by diabetes on the lifetime risk of cardiovascular disease mortality in Japan: a pooled analysis of data from the Evidence for Cardiovascular Prevention from Observational Cohorts in Japan study. Hypertens Res 2020; 43:1437-1444. [PMID: 32620896 DOI: 10.1038/s41440-020-0502-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 12/30/2022]
Abstract
Lifetime risk is an informative estimate to motivate people to change lifestyle behaviors, especially from a younger age, in public health education. The impact of the combination of hypertension and diabetes on the lifetime risk of cardiovascular mortality has not been investigated in Asian populations. A pooled analysis of individual data from nine cohorts was performed. A total of 57,339 Japanese men and women were eligible for the analysis. We used the modified Kaplan-Meier approach and estimated the remaining lifetime risk of cardiovascular mortality starting from the index age of 35 years. Participants were classified into four categories defined by hypertension and diabetes. The lifetime risk was increased in the order of those without either risk, those without hypertension but with diabetes, those with hypertension but without diabetes, and those with both risks. The lifetime risk of cardiovascular mortality at the 35-year index age was as follows: 7.8% in men and 6.2% in women for those without either hypertension or diabetes, 13.2% in men and 9.5% in women for those without hypertension but with diabetes, 17.2% in men and 11.7% in women for those with hypertension but without diabetes, and 19.4% in men and 15% in women for those with both risks. These findings reinforce the need for a life-course perspective in the management of hypertension and diabetes from a younger age.
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8
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Washio T, Watanabe H, Ogoh S. Dynamic cerebral autoregulation in anterior and posterior cerebral circulation during cold pressor test. J Physiol Sci 2020; 70:1. [PMID: 32039699 PMCID: PMC6987085 DOI: 10.1186/s12576-020-00732-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/22/2020] [Indexed: 12/26/2022]
Abstract
We hypothesized that cerebral blood flow (CBF) regulation in the posterior circulation differs from that of the anterior circulation during a cold pressor test (CPT) and is accompanied by elevations in arterial blood pressure (ABP) and sympathetic nervous activity (SNA). To test this, dynamic cerebral autoregulation (dCA) in the middle and posterior cerebral arteries (MCA and PCA) were measured at three different conditions: control, early phase of the CPT, and the late phase of the CPT. The dCA was examined using a thigh cuff occlusion and release technique. The MCA and PCA blood velocities were unchanged at CPT compared with the control conditions despite an elevation in the ABP. The dCA in both the MCA and PCA remained unaltered at CPT. These findings suggest that CPT-induced elevations in the ABP and SNA did not cause changes in the CBF regulation in the posterior circulation compared with the anterior circulation.
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Affiliation(s)
- Takuro Washio
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Hironori Watanabe
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan.
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9
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Feigin VL. Anthology of stroke epidemiology in the 20th and 21st centuries: Assessing the past, the present, and envisioning the future. Int J Stroke 2019; 14:223-237. [DOI: 10.1177/1747493019832996] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This narrative overview of stroke epidemiology shows dramatic changes in stroke incidence, prevalence, mortality, disability, and the understanding of risk factors and primary stroke prevention strategies over the last few decades. Likely future directions of stroke epidemiology and prevention are outlined.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
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10
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Satoh M, Ohkubo T, Asayama K, Murakami Y, Sugiyama D, Yamada M, Saitoh S, Sakata K, Irie F, Sairenchi T, Ishikawa S, Kiyama M, Ohnishi H, Miura K, Imai Y, Ueshima H, Okamura T, Iso H, Kitamura A, Ninomiya T, Kiyohara Y, Nakagawa H, Nakayama T, Okayama A, Tamakoshi A, Tsuji I, Miyamoto Y, Yatsuya H. Lifetime Risk of Stroke and Coronary Heart Disease Deaths According to Blood Pressure Level. Hypertension 2019; 73:52-59. [DOI: 10.1161/hypertensionaha.118.11635] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lifetime risk (LTR) provides an absolute risk assessment during the remainder of one’s life. Few studies have focused on the LTRs of stroke and coronary heart disease (CHD), categorized by fine blood pressure in Asian populations. We aimed to assess it using a large database of a meta-analysis with the individual participant data. The present meta-analysis included 107 737 Japanese (42.4% men; mean age, 55.1 years) from 13 cohorts. During the mean follow-up of 15.2±5.3 years (1 559 136 person-years), 1922 died from stroke and 913 from CHD. We estimated risks after adjusting for competing risk of death other than the outcome of interest. The 10-year risk of stroke and CHD deaths at index age of 35 years was ≤1.9% and ≤0.3%, respectively. The LTRs of stroke death at the index age of 35 years (men/women) were 6.1%/4.8% for optimal, 5.7%/6.3% for normal, and 6.6%/6.0% for high-normal blood pressure groups, and 9.1%/7.9% for grade 1, 14.5%/10.3% for grade 2, and 14.6%/14.3% for grade 3 hypertension groups. The LTRs of CHD death similarly elevated with an increase in blood pressure but were lower (≤7.2%) than those of stroke death. In conclusion, blood pressure was clearly associated with an elevated LTR of stroke or CHD death, although the LTR of CHD death was one-half of that of stroke death in an Asian population. These results would help young people with hypertension to adopt a healthy lifestyle or start antihypertensive therapy early.
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Affiliation(s)
- Michihiro Satoh
- From the Division of Public Health, Hygiene, and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai (M.S.)
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo (T. Ohkubo, K.A.)
- Tohoku Institute for Management of Blood Pressure, Sendai (T. Ohkubo, K.A., Y.I.)
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo (T. Ohkubo, K.A.)
- Tohoku Institute for Management of Blood Pressure, Sendai (T. Ohkubo, K.A., Y.I.)
| | - Yoshitaka Murakami
- Department of Medical Statistics, Toho University School of Medicine, Tokyo, Japan (Y.M.)
| | - Daisuke Sugiyama
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo (D.S., T. Okamura)
| | - Michiko Yamada
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan (M.Y.)
| | - Shigeyuki Saitoh
- Division of Medical and Behavioral Subjects, Sapporo Medical University School of Health Sciences, Japan (S.S.)
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine, Japan (K.S.)
| | - Fujiko Irie
- Department of Health and Welfare, Ibaraki Prefectural Office, Mito, Japan (F.I.)
| | - Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsugagun-Mibu, Japan (T.S.)
| | - Shizukiyo Ishikawa
- Medical Education Center, Jichi Medical University, Shimotsuke, Tochigi, Japan (S.I.)
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Japan (M.K.)
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of Medicine, Japan (H.O.)
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan (K.M., H.U.)
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan (K.M., H.U.)
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai (T. Ohkubo, K.A., Y.I.)
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan (K.M., H.U.)
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan (K.M., H.U.)
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo (D.S., T. Okamura)
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Feigin VL, Nguyen G, Cercy K, Johnson CO, Alam T, Parmar PG, Abajobir AA, Abate KH, Abd-Allah F, Abejie AN, Abyu GY, Ademi Z, Agarwal G, Ahmed MB, Akinyemi RO, Al-Raddadi R, Aminde LN, Amlie-Lefond C, Ansari H, Asayesh H, Asgedom SW, Atey TM, Ayele HT, Banach M, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Barregard L, Basu S, Bedi N, Behzadifar M, Béjot Y, Bennett DA, Bensenor IM, Berhe DF, Boneya DJ, Brainin M, Campos-Nonato IR, Caso V, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Christensen H, Criqui MH, Damasceno A, Dandona L, Dandona R, Davletov K, de Courten B, deVeber G, Dokova K, Edessa D, Endres M, Faraon EJA, Farvid MS, Fischer F, Foreman K, Forouzanfar MH, Gall SL, Gebrehiwot TT, Geleijnse JM, Gillum RF, Giroud M, Goulart AC, Gupta R, Gupta R, Hachinski V, Hamadeh RR, Hankey GJ, Hareri HA, Havmoeller R, Hay SI, Hegazy MI, Hibstu DT, James SL, Jeemon P, John D, Jonas JB, Jóźwiak J, Kalani R, Kandel A, Kasaeian A, Kengne AP, Khader YS, Khan AR, Khang YH, Khubchandani J, Kim D, Kim YJ, Kivimaki M, Kokubo Y, Kolte D, Kopec JA, Kosen S, Kravchenko M, Krishnamurthi R, Kumar GA, Lafranconi A, Lavados PM, Legesse Y, Li Y, Liang X, Lo WD, Lorkowski S, Lotufo PA, Loy CT, Mackay MT, Abd El Razek HM, Mahdavi M, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Mantovani LG, Martins SCO, Mate KK, Mazidi M, Mehata S, Meier T, Melaku YA, Mendoza W, Mensah GA, Meretoja A, Mezgebe HB, Miazgowski T, Miller TR, Ibrahim NM, Mohammed S, Mokdad AH, Moosazadeh M, Moran AE, Musa KI, Negoi RI, Nguyen M, Nguyen QL, Nguyen TH, Tran TT, Nguyen TT, Anggraini Ningrum DN, Norrving B, Noubiap JJ, O’Donnell MJ, Olagunju AT, Onuma OK, Owolabi MO, Parsaeian M, Patton GC, Piradov M, Pletcher MA, Pourmalek F, Prakash V, Qorbani M, Rahman M, Rahman MA, Rai RK, Ranta A, Rawaf D, Rawaf S, Renzaho AMN, Robinson SR, Sahathevan R, Sahebkar A, Salomon JA, Santalucia P, Santos IS, Sartorius B, Schutte AE, Sepanlou SG, Shafieesabet A, Shaikh MA, Shamsizadeh M, Sheth KN, Sisay M, Shin MJ, Shiue I, Silva DAS, Sobngwi E, Soljak M, Sorensen RJD, Sposato LA, Stranges S, Suliankatchi RA, Tabarés-Seisdedos R, Tanne D, Nguyen CT, Thakur JS, Thrift AG, Tirschwell DL, Topor-Madry R, Tran BX, Nguyen LT, Truelsen T, Tsilimparis N, Tyrovolas S, Ukwaja KN, Uthman OA, Varakin Y, Vasankari T, Venketasubramanian N, Vlassov VV, Wang W, Werdecker A, Wolfe CDA, Xu G, Yano Y, Yonemoto N, Yu C, Zaidi Z, El Sayed Zaki M, Zhou M, Ziaeian B, Zipkin B, Vos T, Naghavi M, Murray CJL, Roth GA. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med 2018; 379:2429-2437. [PMID: 30575491 PMCID: PMC6247346 DOI: 10.1056/nejmoa1804492] [Citation(s) in RCA: 864] [Impact Index Per Article: 144.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases. METHODS We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate. RESULTS The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation. CONCLUSIONS In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).
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Wang L, Mu Z, Lin X, Geng J, Xiao TQ, Zhang Z, Wang Y, Guan Y, Yang GY. Simultaneous Imaging of Cerebrovascular Structure and Function in Hypertensive Rats Using Synchrotron Radiation Angiography. Front Aging Neurosci 2017; 9:359. [PMID: 29163140 PMCID: PMC5673661 DOI: 10.3389/fnagi.2017.00359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/19/2017] [Indexed: 12/12/2022] Open
Abstract
Hypertension has a profound influence on the structure and function of blood vessels. Cerebral vessels undergo both structural and functional changes in hypertensive animals. However, dynamic changes of cerebrovasculature and the factors involved in this process are largely unknown. In this study, we explored the dynamic changes of vascular structure in hypertensive rats using novel synchrotron radiation angiography. Twenty-four spontaneously hypertensive rats (SHR) and 24 Sprague–Dawley (SD) rats underwent synchrotron radiation (SR) angiography. Each group had 8 animals. We studied the cerebral vascular changes in SHR over a time period of 3–12-month and performed quantitative analysis. No vascular morphology differences between SHR and SD rats were observed in the early stage of hypertension. The number of twisted blood vessels in the front brain significantly increased at the 9- and 12-month observation time-points in the SHR compared to the SD rats (p < 0.01). The vessel density of the cortex and the striatum in SHR was consistently higher than that in SD rats at time points of 3-, 9-, and 12-month (p < 0.001). Vascular elasticity decreased both in SHR and SD rats with aging. There were statistically significant differences in the relative vascular elasticity of extracranial/intracranial internal carotid artery, middle cerebral artery, posterior cerebral artery and anterior cerebral artery between SHR and SD rats at 12-month (p < 0.01). We concluded that the dynamic vascular alterations detected by SR angiography provided novel imaging data for the study of hypertension in vivo. The longer the course of hypertension was, the more obvious the vascular differences between the SHR and the SD rats became.
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Affiliation(s)
- Liping Wang
- Department of Neurology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhihao Mu
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Department of Pathology and Pathophysiology, Faculty of Basic Medical Sciences, Kunming Medical University, Kunming, China
| | - Xiaojie Lin
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jieli Geng
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ti Qiao Xiao
- Shanghai Synchrotron Radiation Facility, Shanghai Institute of Applied Physics, CAS, Shanghai, China
| | - Zhijun Zhang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yongting Wang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yongjing Guan
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guo-Yuan Yang
- Department of Neurology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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13
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Turin TC, Okamura T, Rumana N, Afzal AR, Watanabe M, Higashiyama A, Nakao YM, Nakai M, Takegami M, Nishimura K, Kokubo Y, Okayama A, Miyamoto Y. Diabetes and lifetime risk of stroke and subtypes in an urban middle-aged population. J Diabetes Complications 2017; 31:831-835. [PMID: 28222941 DOI: 10.1016/j.jdiacomp.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
AIMS Lifetime risk (LTR) is defined as the cumulative probability of developing a disease in one's remaining lifetime from a given index age. The impact of diabetes on the LTR of stroke events in Asians, where stroke incidence is higher than for Westerners, has not been estimated yet. These estimates can be useful for diabetes knowledge translation activities. METHODS All participants who were stroke-free at baseline in the Suita Study, a cohort study of cardiovascular diseases in Japan, were included in the study sample. Age, in years, was used as the time-scale. Age-specific incidence rates were calculated using the person-years method within five-year bands. We estimated the sex- and index-age-specific LTR of first-ever stroke accounting for the competing risk of death. RESULTS In this cohort study, we followed 5515 participants from 1989 to 2007 for 71,374.23 person-years. At age 40, the LTRs, adjusted for competing risk of death, for all strokes were 15.98% for men without diabetes and 26.64% for men with diabetes. The LTR for stroke was 10.66% higher for men with diabetes than men without diabetes. For women of same index age, the LTR of stroke was 17.29% and 30.72% with diabetes and without diabetes, respectively. The difference in LTR between persons with diabetes and without diabetes was 13.43%. This increased LTR of strokes for persons with diabetes was observed among both men and women across all index ages. Similar results were observed for cerebral infarction stroke subtype. CONCLUSIONS In this urban community-based population we observed that diabetes has a significant effect on the residual LTR of stroke for both men and women of middle age. This knowledge can be used to inform public health education and planning.
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Affiliation(s)
- Tanvir Chowdhury Turin
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - Nahid Rumana
- Sleep Center, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Arfan Raheen Afzal
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Makoto Watanabe
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Aya Higashiyama
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoko M Nakao
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan; Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan; Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
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Abstract
BACKGROUND The lifetime risk (LTR) articulates the probability of disease in the residual lifetime for an index age. These estimates can be useful for general audience-targeted knowledge translation activities against hypertension. There are only a few reports on lifetime of impact of hypertension on stroke events in Asians in whom stroke incidence is higher than Westerners. METHODS The Suita Study, a cohort study of cardiovascular diseases in Japan, was established in 1989. We included all participants who were stroke free at baseline. Age (in years) was used as the time scale. Age-specific incidence rates were calculated with person-year method within 10-year bands. We estimated the sex and index-age specific LTR of first-ever stroke with taking the competing risk of death into account. RESULTS We followed 5783 men and women during 1989-2007 for 74 933 person-years. During the follow-up period, 276 (149 men and 127 women) participants had incident stroke. Of them, majority were cerebral infarction; 166 (102 men and 64 women). The LTR of stroke, accounted for competing risk of death, at 45 years of age for men without hypertension was 17.21% and it was 32.79% for hypertensive men. Among the hypertensive patients, participants with stage 2 or greater hypertension had higher LTR of stroke than the participants with stage 1 hypertension. This increased LTR of stroke for hypertensive patients were also observed among women and across all index ages for stroke. CONCLUSION In this urban community-based population, we observed that hypertension has significant effect on the residual LTR of stroke among both men and women of middle age, specifically for ischemic stroke.
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15
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Impact of hypertension on the lifetime risk of coronary heart disease. Hypertens Res 2016; 39:548-51. [DOI: 10.1038/hr.2016.23] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/26/2015] [Accepted: 12/30/2015] [Indexed: 01/11/2023]
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16
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Gorgui J, Gorshkov M, Khan N, Daskalopoulou SS. Hypertension as a Risk Factor for Ischemic Stroke in Women. Can J Cardiol 2014; 30:774-82. [DOI: 10.1016/j.cjca.2014.01.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/12/2014] [Accepted: 01/13/2014] [Indexed: 12/24/2022] Open
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Loo JH, Trejaut JA, Yen JC, Chen ZS, Ng WM, Huang CY, Hsu KN, Hung KH, Hsiao Y, Wei YH, Lin M. Mitochondrial DNA association study of type 2 diabetes with or without ischemic stroke in Taiwan. BMC Res Notes 2014; 7:223. [PMID: 24713204 PMCID: PMC4108081 DOI: 10.1186/1756-0500-7-223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/01/2014] [Indexed: 11/10/2022] Open
Abstract
Background The importance of mitochondrial DNA (mtDNA) polymorphism in the prediction of type 2 diabetes (T2D) in men and women is not well understood. We questioned whether mtDNA polymorphism, mitochondrial functions, age and gender influenced the occurrence of T2D with or without ischemic stroke (IS). Methods We first designed a matched case–control study of 373 T2D patients and 327 healthy unrelated individuals without history of IS. MtDNA haplogroups were determined on all participants using sequencing of the control region and relevant SNPs from the coding region. Mitochondria functional tests, systemic biochemical measurements and complete genomic mtDNA sequencing were further determined on 239 participants (73 healthy controls, 33 T2D with IS, 70 T2D only and 63 IS patients without T2D). Results MtDNA haplogroups B4a1a, and E2b1 showed significant association with T2D (P <0.05), and haplogroup D4 indicated resistance (P <0.05). Mitochondrial and systemic functional tests showed significantly less variance within groups bearing the same mtDNA haplotypes. There was a pronounced male excess among all T2D patients and prevalence of IS was seen only in the older population. Finally, nucleotide variant np 15746, a determinant of haplogroup G3 seen in Japanese and of B4a1a prevalent in Taiwanese was associated with T2D in both populations. Conclusions Men appeared more susceptible to T2D than women. Although the significant association of B4a1a and E2b1 with T2D ceased when corrected for multiple testings, these haplogroups are seen only among Taiwan Aborigines, Southeast Asian and the Pacific Ocean islanders where T2D is predominant. The data further suggested that physiological and biochemical measurements were influenced by the mtDNA genetic profile of the individual. More understanding of the function of the mitochondrion in the development of T2D might indicate ways of influencing the early course of the disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Marie Lin
- Mackay Memorial Hospital, No, 45, Mínshēng Rd, Danshui District, New Taipei City, Taiwan.
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Little MP, Azizova TV, Bazyka D, Bouffler SD, Cardis E, Chekin S, Chumak VV, Cucinotta FA, de Vathaire F, Hall P, Harrison JD, Hildebrandt G, Ivanov V, Kashcheev VV, Klymenko SV, Kreuzer M, Laurent O, Ozasa K, Schneider T, Tapio S, Taylor AM, Tzoulaki I, Vandoolaeghe WL, Wakeford R, Zablotska LB, Zhang W, Lipshultz SE. Systematic review and meta-analysis of circulatory disease from exposure to low-level ionizing radiation and estimates of potential population mortality risks. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:1503-11. [PMID: 22728254 PMCID: PMC3556625 DOI: 10.1289/ehp.1204982] [Citation(s) in RCA: 242] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 06/22/2012] [Indexed: 05/18/2023]
Abstract
BACKGROUND Although high doses of ionizing radiation have long been linked to circulatory disease, evidence for an association at lower exposures remains controversial. However, recent analyses suggest excess relative risks at occupational exposure levels. OBJECTIVES We performed a systematic review and meta-analysis to summarize information on circulatory disease risks associated with moderate- and low-level whole-body ionizing radiation exposures. METHODS We conducted PubMed/ISI Thomson searches of peer-reviewed papers published since 1990 using the terms "radiation" AND "heart" AND "disease," OR "radiation" AND "stroke," OR "radiation" AND "circulatory" AND "disease." Radiation exposures had to be whole-body, with a cumulative mean dose of < 0.5 Sv, or at a low dose rate (< 10 mSv/day). We estimated population risks of circulatory disease from low-level radiation exposure using excess relative risk estimates from this meta-analysis and current mortality rates for nine major developed countries. RESULTS Estimated excess population risks for all circulatory diseases combined ranged from 2.5%/Sv [95% confidence interval (CI): 0.8, 4.2] for France to 8.5%/Sv (95% CI: 4.0, 13.0) for Russia. CONCLUSIONS Our review supports an association between circulatory disease mortality and low and moderate doses of ionizing radiation. Our analysis was limited by heterogeneity among studies (particularly for noncardiac end points), the possibility of uncontrolled confounding in some occupational groups by lifestyle factors, and higher dose groups (> 0.5 Sv) generally driving the observed trends. If confirmed, our findings suggest that overall radiation-related mortality is about twice that currently estimated based on estimates for cancer end points alone (which range from 4.2% to 5.6%/Sv for these populations).
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Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland 20852-7238, USA.
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Takahashi I, Abbott RD, Ohshita T, Takahashi T, Ozasa K, Akahoshi M, Fujiwara S, Kodama K, Matsumoto M. A prospective follow-up study of the association of radiation exposure with fatal and non-fatal stroke among atomic bomb survivors in Hiroshima and Nagasaki (1980-2003). BMJ Open 2012; 2:e000654. [PMID: 22307102 PMCID: PMC3274709 DOI: 10.1136/bmjopen-2011-000654] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Use of medical radiotherapy has increased markedly in recent decades. Whether the consequence includes an increased risk of cardiovascular disease remains to be determined. The purpose of this study was to examine the association between radiation exposure and the incidence of stroke among Japanese atomic bomb survivors. DESIGN A prospective follow-up study. SETTING AND PARTICIPANTS Radiation exposure from the atomic bombing was assessed in 9515 subjects (34.8% men) with 24-year follow-up from 1980. Subjects were free of prevalent stroke when follow-up began. OUTCOME MEASURES Stroke events and the underlying cause of death were reviewed to confirm the first-ever stroke. Subtypes (ischaemic and haemorrhagic events) were categorised based on established criteria according to the definitions of typical/atypical stroke symptoms. RESULTS Overall mean radiation dose (±SD) in units of gray (Gy) was 0.38±0.58 (range: 0-3.5). During the study period, 235 haemorrhagic and 607 ischaemic events were identified. For men, after adjusting for age and concomitant risk factors, the risk of haemorrhagic stroke rose consistently from 11.6 to 29.1 per 10 000 person-years as doses increased from <0.05 to ≥2 Gy (p=0.009). Incidence also rose within the dose range <1 Gy (p=0.004) with no dose threshold. In women, the risk of haemorrhagic stroke rose with increasing radiation exposure but not until doses reached a threshold of 1.3 Gy (95% CI 0.5 to 2.3). Among women, for doses <1.3 Gy, differences in stroke risk were modest (13.5 per 10 000 person-years), while it increased to 20.3 per 10 000 person-years for doses that ranged from 1.3 to <2.2 Gy and to 48.6 per 10 000 person-years for doses that were higher (p=0.002). In both sexes, dose was unrelated to ischaemic stroke. CONCLUSION While the risk of haemorrhagic stroke increases with rising radiation exposure for both sexes, effects in women are less apparent until doses exceed a threshold at 1.3 Gy.
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Affiliation(s)
- Ikuno Takahashi
- Department of Clinical Studies, Radiation Effects Research Foundation (RERF), Hiroshima, Japan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
| | - Robert D Abbott
- Department of Statistics, Radiation Effects Research Foundation (RERF), Hiroshima, Japan
| | - Tomohiko Ohshita
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Tetsuya Takahashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
| | - Kotaro Ozasa
- Department of Epidemiology, Radiation Effects Research Foundation (RERF), Hiroshima, Japan
| | - Masazumi Akahoshi
- Department of Clinical Studies, Radiation Effects Research Foundation (RERF), Nagasaki, Japan
| | - Saeko Fujiwara
- Department of Clinical Studies, Radiation Effects Research Foundation (RERF), Hiroshima, Japan
| | - Kazunori Kodama
- Chief Scientist, Radiation Effects Research Foundation (RERF), Hiroshima, Japan
| | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
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Turin TC. Recognizing the risk of cardiovascular diseases: quantifying the short-term and lifetime risk projections. Hypertens Res 2011; 34:549-50. [DOI: 10.1038/hr.2011.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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